Southern Medical and Surgical Journal, 1846

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SOUTHERN

MEDICAL AID SURGICAL JOUMAL

KDlTlD B T

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

Medical College of Georgia.

" Je prends Ic Men ou je le trouvc."

VOL. II.-- 184 6. -NEW SERIES.

AUGUSTA, GA.

JAMES McCAFFERTY,

PRINTER AND PUBLISHER.

1846.

V

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL,

Vol. 2.] NEW SERIES. JANUARY, 1816. [No. 1.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

On the Modus Operandi of the Poison of Venomous Reptiles, fyc.
By Alexander Means, A. M., Professor of Chemistry and Phar-
macy in the Medical College of Georgia, and Professor of the
Physical Sciences in Emory College, Oxford, Ga.

The brief disquisition which follows, was called forth in reply to
some interesting inquiries received by letter from an intelligent
young friend ardently engaged in the study of Medicine, and who
had for some time been prosecuting a series of experiments upon the
virus of serpents.

The article, therefore, was not written for the Journal, but at the
special request of some medical friends, it has been hesitatingly sub-
mitted for publication, with the humble hope that the views which it
presents, may aid, at least some of the younger members of the pro-
fession, in forming correct opinions upon the mode of action and
pathological effects of animal poisons an important pre-requisite to
the administration of judicious and appropriate remedies.

First, then : How do poisons act upon the human system, (espe-
cially the poison of serpents,) is it through the medium of the
blood, or from impressions made upon the sentient extremeties of the
nerves, and communicated along their tissue to the several nervous
centres? So late as twenty years ago, in contravention to the doc-
trines of " the humoral pathology," Professors in the first medical
schools in the United States, taught that morbific, as fellas sanative

Poison of Venomous Reptiles, c* [January,

impressions were propagated exclusively by sympathy, from one point
to another of the human system ; nor would they even allow the
necessary intervention of the nervous tissue, as the Odos along
which these impressions were communicated. More sound physio-
logical views now generally obtain, but there are yet many medical
philosophers, who reject the doctrine of venous absorption, and regard
ail impressions as communicated by nervous impulse. The most
modern of those who have presented a plausible defence of these
views, accompanied by appropriate (?) experiments, are Addison and
Morgan, in an "essay" published in London in 1829, "on the
operation of poisonous agents." These gentlemen, however, only
deny that absorption is in any case necessary to the operation of
poison, and yet contend vehemently against the action of medicinal
agents at all through the meciium of the circulation. A distinguish-
ed Professor in the medical department of the Pennsylvania Univer-
sity, has long been an uncompromising unbeliever and an exclusive
solidist of the old school, and so far as is known to the writer, has
never, to the present hour, publicly announced any change in his
views. Dr. Charles Caldwell, of the West, has also, for more than:
twenty years, as well in the lecture room, as from the press, warraly
and inflexibly vindicated similar opinions. Now, we hold the doc-
trine of Imbibition to be so well settled at the present day by the
experiments of Magendie, Muller, Blake, Mitchell and others, as to
challenge scepticism itself. But to the question more directly. Do
pois.ons act by this process? 1st. It is known that whatever pro-
motes absorption, hastens the action of medicines. 2nd. Almost
every medicinal and poisonous substance, whose sensible or chemical
properties subject it to ready detection, has been discovered in the
blood or some of the secretions formed from it and this too after the
ordinary modes of administration. But the rapidity with which
some deleterious agents act, has given rise to the opinion that these
morbific impressions could not have been made through the circula-
tory system.

Now from Mr. Blake's experiments, half a drachm of concentrated
hydrocyanic acid (one of the most virulent and diffusible poisons in
the world) when poured upon the tongue, produced no morbid symp-
tom until after the lapse of eleven seconds death ensuing in thirty-
three seconds after its administration, and this too whenthe fatal result
was no doubt hastened by the inhalation of the vapor and its diffusive
contact with the mucous lining of the air cells, which, according to

184G.] Poison of Venomous Reptiles, 4*c.

Leibig's recent experiments, constitutes the most speedy and effective
mode of action for this poison. Whereas by the result of satisfactory
experiments by the same gentleman, (Dr. B.,) Prof. Herring, of
Stutgard, &c, it is ascertained that a substance will pass from any
part of the vascular system in dogs, back again to the same point, in
from twelve to twenty seconds. Now poison, it is believed, does not
act in less than "nine seconds"' (and this limit we think too small)
after its introduction into the capillaries or veins, and therefore
there is sufficient time for the poisonous molecules to pass to the
various organs and tissues by the blood. Again : the manifesta-
tion of poison from the bites of venomous reptiles, in all the cases
which I have known, or of which I have read, do not occur in
less time than this, and may therefore be supposed to act through
the venous channels. One of the worst cases which occurs to my
recollection, and which originated from the bite of a viper, is that
described by Dr. Braun, and reported by Dr. Christison in his work
on poisons, where a professed snake-charmer attempted to show that
he could thrust the head of the animal into his mouth with impuni-
ty, he introduced it, but suddenly dashed it from him with violence,
when it was ascertained " that he was bitten near the root of the
tongue." Here, where the part was so vascular, so moist, and so
liberally supplied with nerves, it was not until " a few minutes after-
wards," says the Doctor, that " he became so faint that he could not
stand, and died within fifty minutes. This case, therefore, allowed
sufficient time for venous transmission.

Before we abandon our enquiries upon this point, it is proper to
remark that the distinguished author from whose valuable and popu-
lar treatise the above case has been extracted, and who at one time
was inclined to favor the doctrine of the sympathists in accounting
for the diffusion of poisonous impressions, has evidently felt himself
somewhat embarrassed in the maintainance of these views, since the
experiments of Mr. Blake upon hydrocyanic acid, and although, at
the time in which his last edition was ready for the press (Nov. 1844)
he was confessedly not convinced that this virulent poison always
acts by absorption, yet, with the ingenuousness characteristic of a
great mind, he remarks, "on a dispassionate view of the whole in-
vestigation, it must be granted to be doubtful, whether this argument"
(i. c., in favor of a sympathetic action.) "can be now appealed to in
its present shape with the confidence which is desirable. And on
the whole, the velocity of the circulation on the one hand, and the

Poison of Venomous Reptiles, tfye. [January,

celerity of the action of certain poisons on the other, are both of
them so very great, and the comparative observation of the time
occupied by the two phenomena respectively, becomes in conse-
quence, so difficult and precarious, that it seems unsafe to found
upon such an inquiry, a confident deduction on either side of so im-
portant a physiological question, as the existence or non-existence
of an action of poisons by sympathy." The discovery of Dr. Her-
ring of Stutgard, made a few years before, and reported by Dr.
Christison himself, had shaken " the validity of many, though not
all, of the facts which had been previously referred to the agency of
nervous impression, on the ground of the celerity with which the
effects of poisons are manifested." In this case it was shown that
" the ferrocyanide of potassium, injected into the jugular vein of a
horse, was discovered throughout the venous system at large in the
short space of twenty or thirty seconds, and consequently must have
passed in that period throughout the whole double circle of the pul-
monary and systemic circulation." The vast improvements in
chemical analysis within the last few years, (some of them, since the
first publication of Dr. C's excellent work,) and employed by toxic-
ologists in the detection of poisonous agents, circulating in the
blood, have contributed much to throw light upon this hitherto ob-
scure region of physiological research. These discoveries, together
with very recent toxicological experiments, some of them even since
the publication of the last edition of the treatise referred to, incline
us but the more confidently to maintain the views above advanced,
viz. that to venous transmission, and not to sympathetic action, we
are to refer the morbid phenomena which result from the introduc-
tion of poisons into the human system. Among the most recent
experiments furnished from any quarter are those of Dr. H. Meyer,
upon the effects of prussic acid, and reported in the October number
of the British and Foreign Medical Review. He confirms the cor-
rectness of Prof. JSmmert's experiments, to which we may hereafter
refer, and stales that "he found it to act only when received into
the vascular system. On mechanically arresting the circulation,
the poison did not act, although the integrity of the nervous system
was preserved. On restoring the circulation, the operation of the
poison was immediately observed." And again, as it regards the
lapse of time which intervenes between the introduction of the poi-
son and its deleterious effects, he adds : " Hydrocyanic acid does not
act so rapidly as it wai formerly believed. Its operation was never

1846.] Poison of Venomous Reptiles, fyc.

*

instantaneous." The fallacy of the prevalent opinion that the deadly-
effects of this formidable volatile compound are experienced imme-
diately, or at most within nfew seconds, after its administration, so
as to allow no time for acts of volition or locomotion, has been re-
peatedly proved. A case, first reported in The Lancet of June 7th,
of the present year, and again furnished in the last number of the
Medical Review, is strikingly illustrativo of the fact that ther3 is
time for freedom of thought and deliberate action, even after the
largest draught of the poison, before its paralyzing effects are ex-
perienced. "A girl swallowed an ounce of prussic acid, recorked the
phial, thrust the bottle to a full arm's length between the feather bed
and the mattrass, got into bed, and then drew the clothes over her
body," Again, this "protraction of symptoms" is still more satis-
factorily evinced in a case reported by Mr. Godfrey, in the Provin-
cial Medical and Surgical Journal, and copied into the Review : "A
gentleman swallowed half an ounce of prussic acid, placed the bottle
in the grate, walked to the top of a flight of stairs, (ten paces) de-
scended the stairs, seventeen in number, and proceeded to a druggist's
shop, (forty-five paces ) making a total of fifty-five paces and seven-
teen stairs. He entered the shop in his usual manner, which was
slow and easy, and said in his usual tone of voice, * I want some
more of that prussic acid' his eyes then became fixed with a stare,
he fell and died (probably) within ten or twelve minutes from the
time of taking the poison." In fact, the violence of the action of
this fatal drug has generally created such alarm and confusion in
cases where it has been taken, that the celerit}' of its effects,
although fearfully rapid in any event, has probably been exagger-
ated. From the very infrequency of its former administration, per-
haps, these overwrought estimates of its speedy fatality required
some time before they could be corrected. And nothing but careful
observation, and a comparative familiarity with the alarming results
of its action, could have enabled the medical philosopher deliberately
to mark the progress of the pathological phenomena which it exhib-
its, and which are so readily traceable to its absorption and diffusion
through the venous circulation. This being the most prompt and
formidable article under the whole survey of toxicology, we have
dwelt the longer upon its action, because if its rapidly occurring
symptoms allow sufficient time for the vascular transmission of the
absorbed poison, then we need entertain no scruples upon that head
in regard to the modus operandi of the most intensely active virus
found within the limits of the animal kingdom.

Poison of Venomous Reptiles, %c. [January,

But, secondly: If poisons act through the blood, how is the action
propagated ? I answer, it may be 1st, by maintaining its identity
in the circulation, and thus being brought in contact with the struc-
ture of the organ or organs which it effects. Or, 2ndly, by acting
chemically upon the constituents of the blood, and thereby so altering
its vital condition as to unfit it for the pupposes of life. To consider
the first mode then. It is found by experiment, that tartar-emetic,
castor oil, strychnia, opium, and many other articles whose specific
effects upon the stomach, alimentary canal, nerves, &c, when ad-
ministered per orem, are well known, manifest precisely the same
properties, and are directed in their action to the same organs or
tissues, when injected into the ei*,-prbvrng, that the* introduc-
tion into the circulation did not deprive them of their identity, and
of their capability to excite their accustomed functional changes upon
the various organs, most susceptible of their several specific impress-
ions. Why, the medicinal molecules of tartar-emetic, when diffused
throughout the mass of the circulation, should prefer to manifest
their effects upon the slomach, rather than the lungs, the kidneys,
or the salivary glands, is a question which has provoked the sarcasm
of a popular American writer,* and yet the astuteness of intellect
which characterizes the Philadelphia Professor, would surely find
no more difficulty in allowing such preference than in allowing the
well established philosophical fact, that while Light is pouring upon
the ear, the palate, and the nostril, with an intensity equal to that with
which it falls upon the eye, yet the latter organ alone is sensitive to Ms
act;0F1 ^because neither the auditory, nor gustatory, but the visual
nerve exclusively, was constituted to depend for the performance of Us
important function upon the peculiar stimulus of that one agent, and
the whole mechanical organism of the eye was designed for its admis-
sion and made subject to its laws. In fact, every organ and every
tissue has its own susceptibilities to impression, and the appropriate
qualities must exist in the agents employed to act upon it before the
characteristic developments of its nature can be expected.

By this sort of physical election, it would seem, the poisonous
alkali, *onia, acts upon the nervous system violently, by destroying
its irritability and inducing paralysis. Probably the poison of some
venomous serpents, sent rapidly by the torrent of the circulation to
the heart, paralyzes that muscle, and occasions almost instant death,
in accordance with the conclusions drawn' by Dr. Meyer from . his
See'Chapman's Therapeutics, 4th Edition-, vol. J, p. 73.

1846.] Poison of Venomous Reptiles, c.

experiments with hydrocyanic acid. Toxicological researches au-
thorize the belief that poisons, by thus coming in contact with
organic structures may derange functions or effect injurious and
even fatal lesions. And if Magendie's observations are to be cred-
ited, even so bland, innocuous an agent as atmospheric air, when
introduced into a vein, may, by its mechanical admixture with the
blood-globules, so interrupt the pulmonary circulation as to produce
asphyxia and death.

But to pass to the consideration of the second mode, i. e. by
chemical combination. And here let me premise what follows by
remarking, in the language of Leibig,* that " no other part of the
organism can be compared to the blood, in respect to the feeble re-
sistance which it offers to exterior influences. The blood is not an
organ which is formed, but an organ in the act of formation ; indeed
it is the sum of all the organs which are being formed. The chemi-
cal force and the vital principle hold each other in such perfect equi-
librium, that every disturbance, however trifling, or from whatever
cause it may proceed, effects a change in the blood." A great
variety of substances are known bv chemical action to cause signal
changes in this fluid as well acids and alkalis, as metalic salts and
alcohol, ecc. These substances perhaps mainly act upon the fibrin
and albumen, and upon the constituents of the blood disks. Hydro-
cyanic acid unquestionably changes the consistence aad color of the
blood, and exhales its characteristic peach blossom odor from almost
all parts of the body, ear' fealb, and even before through the

breath especially from the serous membranes, and has been detect-
ed by Meyer in the form of cyanide of potassium, not only in the
blood, but also in the serous secretions and sundry soft solids. Oxalic
acid, acetates, citrates and tartrates, are satisfactorily known to
undergo decomposition in the course of the circulation. But I find
myself involuntarily overrunning my intended limits, and must with-
hold. From what has been said, however, we feel warranted in
believing that some poisons act by compounds with the con-

stituents of the blood which incapacitates it for vital purposes.

While, therefore, we could hardly feel justified in unequivocally
denying the sympathetic action of all poisonous agents, through the
nervous tissiM alone, yet we must regard the burthen of fncts and
experiments as opji such action, while their

venous distribution has ' many instances, I

Poison of Venomous Reptiles, $c. [January,

question. Emmert and Christison (and their experiments extended
still further by Biake) have both found that some of the most virulent
poisons "have no effect whatever when the circulation of the part to
which they are applied has been arrested." Again, they will not
act upon a dissevered nerve, (though it may still retain its irritabili-
ty,) when that nerve is isolated from the circulation. Nor will poison
introduced into the largest blood-vessels, around which a ligature
has been thrown in advance, act at all, (though the nerves of the
part are all left entire,) until the ligature is removed it then acts
rapidly. Lastly, (upon this point,) Magendie, Brodie, Emmert and
others, have tested the quick, full, and characteristic effects of poi-
sons by injection into the blood-vessels, when all the nerves supplying
the part had been previously divided. Once more : If nervous influ-
ence propagated poisonous impressions, then surely, as the cutaneous
surface is covered by a perfect, unbroken next-work of nervous tissue,
so continuous and extended that a pin's point cannot be laid down
without striking a nerve, then a superficial snake-bite, where the
fangs of the animal have but freely scratched the part and lacerated
a great many nervous fibiilloe, ought to prove the most dangerous,
as furnishing so many more points of radiation for the virus,
whereas it is the fact that such bites are comparatively harmless,
while those in which the fangs have penetrated deeply, as in the
finger or foot, where the part could be included within the jaws of
the reptile, and the poison was injected in the neighborhood of deep-
seated blood-vessels, have been uniformly most fatal.

And now, to your next enquiry : Is Orfila right when he recom-
mends sleep ? If the views which I entertain of the pathology of
such cases be correct, his counsel in this particular is certainly inju-
dicious. My own conviction is that, like opium, conia, foxglove
and tobacco, the virus of serpents deserves to be classed with the
cerekro-spinants of Pereira, or those agents which excite the cerebral
and true spinal 'system of nerves, acting as powerful sedatives in
reducing the force of the circulation, and either paralysing some
portion of the nervous tissue by which the vital functions of the part
are immediately suspended, (as, for example, the action of the heart,
or the respiratory muscles,) or subtracting from its general healthy
tone, and exciting irregular, spasmodic movements.

Mark the symptoms caused by the bite of the viper, (the only poison-
ous serpent known in Great Britain.) as detailed by Dr. Christison,*

* See Chriitison on Poison, vol.2, p. 185.

1846.] Poison of Venomous Reptiles, Sfc.

and compare them with some produced by the class of agents
above referred to viz. " lancinating pain, which begins in from
three to forty minutes after the bite, and rapidly stretches up the
limb swelling, at first firm and pale afterwards, red, livid and
hard, tendency to fainting bilious vomiting sometimes convul-
sions, (more rarely, jaundice,) quick, small, iwegular pulse
difficult breathing cold perspiration dimness of vision and injury
of the mental faculties." Now the cardiaco-vascular sedatives, fox-
glove and tobacco, " produce nausea, sometimes vomiting and
purging weakness and irregularity of pulse, syncope, impaired vis-
ion giddiness and confusion of ideas : while paralysis, convulsions,
delirium and stupor, are occasional symptoms." The strong coin-
cidence of symptoms will at once be recognized by comparing the
words in italics. It is also a singular and interesting fact, in accord-
ance with our view, that loss of intellect and sensation, with convul-
sions, generally result alike from the use of hydrocyanic acid, from
epilepsy, and from excessive haemorrhage, and that in all these cases,
ammonia is a valuable remedy. Does not this argue a oneness of
pathological condition to which the same remedial agent is applica-
ble 1 Now that condition in haemorrhage we know to depend upon
an atony of the nervous system induced by the sudden abstraction of
too great a quantity of blood the natural stimulus of that tissue:
and it may be legitimately inferred, therefore, in the other two cases.
Why not also in cases of poisoning by serpents where the same re-
storative (ammonia) is so successfully resorted to ? The rationale cf
its operation we design to consider presently. But can sleep be ad-
visable with these facts before us? We are again constrained to
answer, No. Indeed, from our views of the character of the poison,
and the superinduced condition of the system, we can but believe it
would contribute to hasten a fatal termination. An atony of the
nervous system has already been produced : it is below par in its
functional capabilities, and, as the effects of cold and opium which
overcome nervous sensibility, must be arrested by rousing stimulants,
even amounting, in some cases, to the use of violent mechanical
force; so, we apprehend, the influence of this class of sedative poi-
sons, should be counteracted by forced wakefulness and stimulants.
Every reader of history is familiar with the fact, that in crossing the
frozen Alps, on their return from Egypt, the soldiers of Bonaparte
were sinking by hundreds under the contra-stimulant chects of cold,
and were only preserved by flogging, from falling into the sleep of

10 Poison of Venomous Reptiles, c. [January,

death. How, then, may a combination of alcohol and ammonia (say
in the form of brandy and hartshorn) operate favorably as an anti-
dote to these poisons? I suppose that without resorting to a solu-
tion, dependent upon the chemical change in the substances, (which
we are satisfied, in some other instances does go on.) we may ration-
ally account for their antidotal effects, by remembering that accord-
ing to the best authorities in Pharmacodynamics, the specific region
of action for alcohol is the cerebrum and cerebellum, while ammonia
manifests its power mainly upon the true spinal or eoccilo-motory sys-
tem of nerves. Here, then, by the combination, we reach the nerves
of the enccphalon and spinal marrow both. May it not be, therefore,
by this extensive rally upon the partially exhausted irritability of the
nerves through the great thoroughfare of the sanguiferous channels,
that these dreadful sedatives are counteracted. En passant, let me
not forget to urge, in such cases, the propriety of inhaling as freely
as possible the vapor from diluted aqua ammonia (the concentrated
water of the shops is too irritating and may produce troublesome or
even dangerous inflammation of the mucous lining of the air passa-
ges.) The restorative salt, carbonate of ammonia, furnishes also a
good form for inhalation. In both cases the minutely divided parti-
cles of aeriform ammonia comes in extensive contact with the whole
mass of blood circulating through the lungs, (the membranous cov-
erings of the air-cells being readily permeable by gaseous bodies,)
and consequently its characteristic effects are more promptly and
decidedly manifested. But to conclude. The poisonous injections
from the stings of insects, such as the wasp, the bee, the hornet, &c,
may be regarded, we apprehend, as acting under some of the laws
already considered. Our opinions in regard to the pathology and
modus medendi of such cases, may be briefly enunciated, however,
as follows, viz: The injected virus, by its powerful contra-stimulant
effect, is supposed to produce a temporary spasm or paralysis of the
capillary tubes, incapacitating them from conveying red globules,
within the reach of its action, which is generally defined by a circum-
scribed, colorless areola, surrounding the point of puncture, but as
the poisonous deposit is small is introduced superficially, and is
consequently limited to a small circle, the vitality and vigor of the
neighboring circulation at length overcomes the morbid inaction, and
an over-excitement takes place in the form of cellular inflammation,
which, when uninterrupted, always ends in resolution. But, as in a
case of superficial pinch or b, hy whiteness of the part

1846.] Hog's Lard in Obstruction of the Bowels. 11

and injury of the subcutaneous vessels, it is known that immediate
mechanical irritation, in the way of friction, will sustain and recruit
the crippled and languid capillaries, from which the blood has been
violently expelled, and enable them forthwith to transmit their usual
contents, thus at once restoring the circulation of the part and pre-
venting ecchymosis : so, by a process not greatly dissimilar, we
suppose that the prompt and peculiar action of ammonia instantly
overcomes the hyposthenic effect of the poison restores tone to the
nervous and vascular systems, and prevents subsequent inflamma-
tion. I have seen strong tincture of camphor almost instantly re-
lieve the sting of a wasp ; and although I have never tried it, see no
good reason why sulphuric ether, liberally applied and retained on
the part, might not prove a quick and valuable auxiliary to our list
of antidotes.

ARTICLE II.

Hog's Lard, again successfully used in Obstruction of the Bowels,
By E. B. Rook, M. D., of Jefferson County, Ga.

My attention was particularly called to a communication of Dr. J.
A. Mays, of South Carolina, published in the June number of this
Journal, on obstinate obstructions of the bowels a disease that
startles us by its frequency and shocks us by its fatality. It has been
my unenviable lot to have had several such cases under my care, and to
have seen others in connection with other physicians : with one or
two exceptions, they all proved fatal.

After much reflection upon this painful subject, founded upon
recorded cases, and those which had come under my own observa-
tion, I had fully determined to treat the next case I should have, at
least after a moderate trial of the usual means, with injections, the
mildest aperients, warm bath, &c. I was convinced that drastic
purgatives, used to a great extent, would produce intense inflamma-
tion of the stomach and bowels, and therefore should be used with
great caution. Having formed this resolution, but not being very
confident of the success of this palliative treatment, it gave me
much pleasure to meet with and read the communication above re-
ferred to. My previous reflections fended to commend Dr. Mays'

12 Hog's Lard in Obstruction of the Bowels. [January,

plan to my adoption. To fill the bowels in these cases with a mild,
unirrilating oil, could do no injury; and might operate advantage-
ously from the aperient oAuality of the oil, and from its mechanical
force in lubricating and distending the intestine. These very proba-
ble effects of the proposed plan in connection with the peristaltic
action of the bowels, promised a3 fairly, as any thing known to me,
to overcome the obstruction, and I resolved to try it on the first suita-
ble occasion. It was not long before one occurred.

On the 11th of September, as I was passing Mr. J. A. Parker's
place, his man Sam, hailed me, to say that he had had a chill in the
morning which lasted two hours, and that ever since (now half-past 5
o'clock, p. m ) he had high fever. He had had no operation from
the bowels for four days. I prescribed 20 grs. sub. m. hycig. and a
dose of castor oil for the next morning.

On the 12th, I found him with considerable fever, tongue coated
with thick white fur and disposed to become dry. I learned that he had
vomited very freely two hours after taking the submuriate ; and again
this morning after taking the oil ; but neither had produced any
operation from the bowels. Having ordered the oil to be repeated as
soon as the stomach should be composed, I left him to visit other
patients. When I returned at dark he had very high fever, and
complained of great pain in the right iliac region, much aggravated
on pressure. I bled him, and left him ten grains more of the sub.
mur. hydg. to be taken as before. The stomach had not been suffi-
ciently composed for the oil, and it had not been given. A bag of
scalded bran was also ordered to be kept to the iliac region.

13th. No operation from the bowels; considerable fever; pulse
small and rather tense ; no perceptible diminution of the pain in the
iliac region. I did not think it advisable to bleed him again, as the
former bleeding nearly prostrated him, without the least apparent
benefit. In the course of six hours he had now taken three large doses
of oil and one of salts, administered by his owner during my absence.
When I saw him again in the evening there was no alteration, except
for the worse. I advised injections to be used freely through the
night, and left him.

14th. Thursday, the symptoms were, as far as a change was per-
ceptible, dry tongue, retching, but vomiting up nothing, pulse con-
siderably weaker than at any previous period. I now gave 1 drops
croton oil, to be assisted by injections tin's was repeated after wait-
ing three hours, injection? given frequently. These having also

1846.] Case of Intermittent Fever: complicated, <fyc. 13

failed, the stomach-tube was introduced into the colon, and some five
or six injections given in this way; and although the tube was several
times introduced its entire length, the fluid used would pass back af-
ter the lapse often, fifteen and twenty minutes, without color or smell.

He had now taken 30 grs. of the submuriate, about a half-pint of
castor oil, one large dose of salts, 3 drops of croton oil, assisted by
20 or 30 injections, including those by the stomach tube, had been
kept in the warm bath until the approach of syncope, and had been
bled nearly to the same effect, without the least appearance of relief.
I determined to try the hogs lard, as a last resort. I had wished to
give it a fair trial, and therefore it was necessary to try the usual
remedies first. I now had one quart melted, and succeeded in getting
him to swallow one half of it the balance was injected into the
bowels. After the lapse of three hours, 1^ drops more of croton oil
were given. After taking it he laid very still for an hour and a half,
a complete picture of despair, in constant anticipation of death. At
this time, his whole countenance lighting up as if by magic, he sud-
denly exclaimed, "It has broken loose." On being asked what had
broken loose, he put his hand on the right iliac region. In less than
ten minutes afterwards, he was lifted up, and had a small but very
foetid operation. The bowels now soon began to act freely, the lard
passing off in variable quantities with each of the first six or eight
stools. He was under treatment a few days longer, without inter-
ruption of his convalescence, and was discharged fully cured.

I ascribe this cure to the lard, although the responsibility we feel
on these occasions did not allow me to trust wholly to it. 1 am anx-
ious to hear from others on this subject, and therefore unite with
Dr. Mays in requesting them to make trial of the lard in similar
cases, and to report the result.

ARTICLE III.

Case of Intermittent Fever complicated with Purpura Hemorrhagica:
cured by Quinine and Nitric Acid. By W. W. Leak, M. D., of
Cass county, Ga.

Mr. , aged 75 years, a wagon-maker by trade, of plethoric

habit and somewhat intemperate says he has been unwell for two
weeks, and on the 29th of September had a chill followed by fovcr.

14 Case of Intermittent Fever, complicated, $$c. [January,

Soon after this there was an appearance of blotches over various
parts of the body, especially on the lower extremities ; he had also
some spitting of blood ; and on the 30th another chill and fever, with
vomiting of blood.

At 3 o'clock, P. M., of the 30th, he presented the following symp-
toms : Countenance pale ; headache ; pulse a little more feeble
than natural, and soft ; has a cough ; some oppression in the chest,
and expectorates a little blood ; oozing of blood from the mouth and
nose ; has no appetite ; some tenderness over epigastric region ; ex-
travasation of blood under the cuticle on various parts of the body,
especially on the lower extremities and neck ; some bloody vesicles
on the tongue as large as peas. Prescription*. V. S. 4 to 6 ounces,
which relieved the pain in head and chest.

ft. Calomel, ... 6 grs.
Dover's Powder, . 6 "
Acetate of Lead, . 3 " Mix.
Divide into three powders, and give one every third hour. An ounce
of castor oil to be taken at night ; warm pediluvium with salt. 8 grs.
sulph. quinine, 2 grs. to be given every hour, commencing at seven
o'clock in the morning.

Oct. 1st, 8, A. M. Patient better in all respects, except there is
no disappearance of the blotches ; has had no cough since the first
powder was taken. Prescription. 10 grs. of calomel, to be follow-
ed by oil; a tea-spoonful of elixir vitriol to one pint of sage tea, to
be taken during the day; acetate of lead and Dover's powder to be
given if the hoemorrhage returned; 20 grs. sulph. quinine, one-fourth
to be given each hour, commencing in the morning at 7 o'clock.

Oct. 2d, 8, A. M. Had a chill yesterday at 1 o'clock, followed
by haemorrhage from the mucous surfaces. Pulse 110, and quite
feeble. In consultation with my friend, Dr. Milner, we determined
on giving the nitric acid according to the formula in the August No.
of the Southern Medical and Surgical Journal, of Dr. J. J. Bradford,
ft. Nitric acid, .... 3;

Pulv. gum arabic,

White sugar, aa. . . 3ii.

Water, sv.'^Mix.

Of this, we gave one table-spoonful every six hours, instead of a half
table-spoonful, as is recommended by Dr. B.

3, P. M. Patient is easy ; pulse 100 ; haemorrhage less. To con-
tinue the acid, with 25 grs. sulph. quinine, one-fourth to be given
each hour, commencing in the morning at 7 o'clock.

1840. j Case of Gun-shot Wound. 15

Oct. 3d, 8, A. M. Patient has rested well last night; had no
haemorrhage except per rectum and urethram, which was not so copi-
ous as previously. Pulse 80. Continue the acid. -

5, P. M. Had no chill to-day. Pulse 72 ; complains of his head
and ears ringing; the blotches are disappearing; his bowels have
been moved once or twice. , 12 grains quinine to be given in the
morning in 3 gr. doses, commencing at 7 o'clock.

Oct. 4th. Improvement in all respects; blotches disappearing
very fast. The acid to be continued for a few days. Dismissed the
case to-day.

Although this patient has had two or three chills since, we learn
there has been no recurrence of the purpura.

The indication in this case was to check the chill, and though the
disease complicating it, purpura hsemorrhagica, was abated by the
prescriptions first employed, still we think its cure may be clearly
attributed to the nitric acid.

ARTICLE IV

Case of Gun-shot Wou?id the patient receiving nineteen buck-shot
from a gun ten paces distant, and surviving more than eleven days.
By Paul F. Eve, M. D., Professor of Surgery in the Medical
College of Georgia.

Gun-shot wounds are occasionally met with in civil practice not
devoid of interest, and the particulars of the one about to be trans-
cribed from my note book, will at least exhibit the extent of suffering
which may be endured by the human system in desperate injuries.
With a view to placing the case fully and at once before the reader,
the report is here given of the post mortem examination made to the
jury at the Coroner's inrpuest, held the 7th of July, 1845, and signed
by F. Jeter Martin, Robert Campbell, jun., Edward H. Holliday,
George M. Newton, Paul F. Eve, and H. F. Campbell." Having
been requested to examine the body of J. W. T., we report that we
find nineteen wounds on his person ten of these are on the left side
and back of his chest, four on the right and six on the left side of
the spinal column seven are on the left arm, making a shattered
(comminuted) fracture of the bone extending up to within two and a

16 Case of Gun-shot Wound. [January,

half inches of the shoulder-joint and two are in the right arm,
dividing the main (brachial) artery. Within the thorax, we find on
the left side about seven pints of bloody fluid, (serum,) and two buck-
shot which had passed through the lung of that side. We therefore
give it as our opinion, that the deceased came to his death in conse-
quence of the wounds above described."

Mr. T. was 24 years old, of good constitution, well made, and
quite vigorous. On the morning of the 26th, he had taken a light
breakfast, and at 10| o'clock was shot by a double-barrel gun,
charged with about thirty buck-shot. The person firing upon him
approached from behind, but Mr. T. hearing a noise, was in the act
of turning round when stricken by the first discharge. He had
thrust his right hand into his pocket, and had seized a pistol, but
found he had not the power to use it in self defence. His hat having
fallen off, he tried to pick it up with the left hand ; he felt he could
touch it with his fingers, but could not grasp it. He now walked a
few steps to get round a house, when he received a part of the con-
tents of the second barrel. After this, he ran the distance of about
one hundred yards, and fell to the ground exhausted.

I reached the patient in some twenty minutes after he was shot, and
found Dr. Campbell, and Messrs. Martin and Campbell, students of
medicine, already in attendance. Some of the wounds had been pro-
bed, and two or three buck-shot of a large size extracted. Pulsation at
the wrist of the left side had been distinctly felt by Dr. C, but now the
patient had fainted. The fracture of the left arm was compound and
comminuted, made so by several shot entering together ; but the prin-
cipal hemorrhage had been from the right arm, at the wrist of which
side no pulsation had been felt after the accident. We gave some
brandy and water, applied temporary dressings to the arms, and had
our patient conveyed home upon a mattrass laid on a door.

At 12, M., there was some reaction ; stopped the brandy and wa-
ter, and applied roller bandages and splints to each fore-arm. Patient
now complains of most distressing pain on the left side of the spinal
column, and passing down to the left kidney; desires to be placed on
the right side, but can lie on it only for a few seconds.

Dr. J. A. Eve was now added to the consultation. At 1 o'clock
gave gr. sulphate of morphine to relieve his suffering, and allowed
cold water to allay his thirst. The thermometer this day at 4, P. M.,
was 96, and our patient was much oppressed by heat and the
crowd which continually surrounded him.

1846.] Case of Gun-shot Wound. 17

June 27th, 4, A. M. Our patient has slept some, and has urina-
ted. Pulse in the temporal arteries 130. Can detect feeble pulsa-
tions at the right wrist for the first time since the injury. He con-
tinues the morphine, taking about | gr. every twelve hours. At
12, M.,he has severe spasms of the left side of the trunk, particularly
observed in the left rectus abdominis muscle. Also, hiccough from
9, A. M. to 9, P. M ., and for which the musk mixture was prescribed.
Dr. Newton saw the patient at 4, P. M., and noticed the spasmodic
action of the left rectus abdominis. The pulse in the evening is
120, and pretty distinct at the left wrist ; it is still feeble in the right
side. A poultice was applied to the wounds on the back, and upon
which the patient lies exclusively. Took during the day three raw
eggs beaten up with sugar, at his own request.

28th, 4, A. M. Has slept under use of the morphine. Has taken
another egg during the night. At 9, A. M., dressed all the wounds.
Those on the trunk are doing well. The right arm is quite dark in
the course of the principal blood-vessels ; no pulsation detected in
the brachial artery, but a feeble pulse is felt at the wrist. Applied
compress and bandage to this extremity. To the left arm adapted
Roe's apparatus. 12, M., our patient has been retching and vomit-
ing. Ordered injection of salt and water ice internally, and lem-
onade gum water. 9, P. M., vomiting has ceased, but enema brought
away only -some flatus.

29th. Has passed a good night, which he attributes to the opiate
preparation, and which itches the skin. Says he is better ; and has
had a quiet day.

30th. Gave a dose of Henry's magnesia patient complains of it
making him sick all day. At 7, P. M., gave a seidlitz powder, which
operated freely. Pulse 120.

July 1st. Is doing well medicine has operated ten times. Diet,
rice custard. Dressed the wounds the arms are tolerably well, but
the back is throwing ofTsloughs in some of the places where the shots
have entered.

2d. "Pulse 108. Had a good evacuation last night. Has passed
a tolerable night. Right arm is doing well. Sloughs are improving
on the back. Patient complains of heat, though the temperature
this morning is 58 deg. Recommended change of position ; light
diet. Dull sound is found over the left side of thorax by percussion,
and no respiratory murmur is dedected by auscultation. We could

18 Case of Gun-shot Wound. [January,

not make a thorough examination of the contents of the chest be-
fore this, owing to the critical condition of our patient.

3d. Has had a good night. Took several soda powders. Has
had three or four evacuations from the bowels of dark colored faeces.
Pulse 108.

4th. Passed a bad night pulse 120 ; respiration 28 per minute.
Is troubled in mind. Ordered bowels to be moved and diet to be
moderate, 6, P. M. Respiration 40 ; pulse 120. Applied diluted
chloride of soda to the left arm and back. Soda powders to be ta-
ken internally.

5th. Has passed another bad night. Took 20 drops of laudanum
at 3, A. M. Has slept some since then, and feels better. Pulse
110 ; respiration 22.

6th. Took 20 grs. blue mass with 5 grs. calomel ; they operated
twice. Pulse 120 ; respiration 40, and tubal on the right side
none detected in the left. Gave camphor water and morphine.
Slept scarcely any last night. Dressed all his wounds. Found
right arm nearly well ; but still without any pulsation in the brachial
artery. Left arm is suppurating at the fractured point. 6, P. M.
Patient cannot lie down, on account of oppression. Respiration 50,
or panting, and the pulse 140. He is told, at 8 o'clock, P. M., that
he cannot live long. Our patient had hoped that he only was laboring
under pneumonia, produced by exposure of his body to the changes
in the atmosphere, for he would not suffer even a shirt or sheet over
his chest. He now became convinced that he must die, and recon-
ciled to his fate.

7th. He had no pulse for some time last night, but revived a little
at 3, A. M. He still has to be supported in the sitting position, and
his respiration is becoming every moment more difficult. He died
at 1, P. M. making eleven days and three and a half hours after
he was wounded.

To remove the impression, that as six shot entered on the left of
the spine, and four openings or wounds existed on the right side, and
two of the buck-shot were found in the left plural cavity, therefore,
four of these six shot had traversed or passed through the chest we
remark, that three or four shot were taken out immediately after the
injury, by Dr. Campbell, two were gotten out by myself, and two
others by Dr. Newton, who made the post-mortem examination, and
these last four were superficially situated upon the left side of the
chest and near the spinal column. In the account given above, I

1846.] On the Seat of Volition in the Alligator. 19

have adopted the generally received opinion that Mr. T. was shot
with both barrels of the gun, and this was his own declaration. But
my own impression has always been, that only the discharge of the
first barrel struck him seven shot entered the left arm, six struck
the chest to the left of the spine, and two others passing through a
portion of the skin and muscles to the right side (making the four
openings,) cut the brachial artery of the right arm. Seven, six and
two, will make the fifteen shot with which the gun was charged.
The condition of the patient immediately after being wounded, and
his living long enough for the tracts made by the shot to become
obliterated, have prevented this opinion being corrected or verified.
Of course I would not impeach the words of a dying man, but think
he may have been deceived by the agitation and excitement of the
moment.

The two buck-shot were found lying in the cavity of the left pleu-
ra, and had passed through the inferior lobe of the left lung, being
that portion not much distended in ordinary respiration, and which
was hepatised they were probably arrested by the vertebrae.

PART II. REVIEWS AND EXTRACTS.

Experiments illustrating the Seat of Volition in the Alligator, or
Crocodilus Lucius of Cuvier.* By John Le Conte, M. D., of
Savannah Georgia. (From the New York Journal of Medicine,
for Nov. 1845.)

Having frequently had occasion, during my boyhood, to witness
the extraordinary tenacity of life manifested by this reptile when
seriously mutilated, and my attention having been powerfully fixed
on the suitable and determinate movements which it exhibits after
decapitation, the following experiments were instituted, with the
view of obtaining clearer ideas on the subject :

On the 10th of March, 1845, with the assistance of my friends
Drs. J. F. Posey, J. S. Morel, J. B. Tufts, and two unprofessional
gentlemen, I performed the following experiments on a young Alliga-
tor, (Crocodilus Lucius, Cuv.) 2 feet 8 inches long. The animal
being well secured, decollation was effected at the articulation of the
atlas with the occiput. Not more than two ounces of blood flow-

* The substance of this paper was read before the Georgia Medical Societv,
at Savannah, on the 7th of August, 1813.

20 On the Seat of Volition in the Alligator, [January,

ed from the wound. Experiments were made upon the head
the jaws snapped at anything which touched the teeth, tongue, or
lining memhrane of the mouth. After the violent convulsive mo-
tions produced by decapitation had subsided, the trunk of the animal
remained in a state of torpor resembling profound sleep. But, when
pricked or pinched on the sides, he would scratch the spot, sometimes
with the anterior and sometimes with the posterior extremity, ac-
cording to the situation of the injury inflicted. These movements
of the limbs were promptly and determinately performed, and were
always confined to the members on the side of the irritating cause.
If touched below the posterior extremity, on the thick portion of the
tail, he would slowly and deliberately draw up the hind foot and
scratch the part, and would use considerable force in pushing aside
the offending object. These experiments were repeatedly perform-
ed, and always with the same results the animal invariably mani-
festing slow and determinate movements, accurately directed to some
particular spot for a definite purpose.

Conjecturing that a portion of the Medulla oblongata remaining
in the upper part of the vertebral canal, might give rise to these ex-
hibitions of apparent sensation and volition, I introduced an iron
wire 010 of an inch in diameter, with the point reduced to a cutting
edge, for the purpose of avoiding compression of the medullary mat-
ter in forcing it downwards, into the cervical extremity of the spinal
marrow. As soon as the instrument penetrated the canal, violent
spasmodic motions supervened the anterior extremities were forci-
bly pressed against the table, while the posterior were extended
backwards, downwards and outwards, as in ordinary locomotion.
These subsided in a few moments, and the animal relapsed into its
former state of dreamy torpor. The experiments in pricking and
scratching were now repeated, with precisely the same results ; ex.
cepting that the torpor appeared to be more profound, requiring a
longer application of the exciting cause to produce the movements.
These motions were never spasmodic or convulsive ; they were
slowly and deliberately performed. The wire was cautiously forced
down t he spine at intervals, giving time to repeat the experiments in
sensation and volition, at every stage of its progress downwards.
Any movement of the instrument produced convulsive motions of the
extremities, lasting, however, only a few seconds after its progress
was arrested the limbs which before were flexed, were, at this stage
of the experiments, suddenly and forcibly extended they remained
for some time fixed parallel to one another, and to the axis of the
trunk, and then gradually relaxed. The same phenomena in motion
were manifested upon the application of an irritant, until the point of
the wire passed the roots of the nerves supplying the anterior ex-
tremities, when they were instantly paralyzed, and, of course, ceased
to indicate any power of moving. However, the posterior members
continued to exhibit the same phenomena, more or less conspicuous-
ly, while the instrument traversed the whole length of the spinal

1846.] On the Seat of Volition in the Alligator. 21

canal, even to the origin of the nerves supplying the hind-feet. At
this point, all determinate motion ceased ; or, at least, we had no
means of ascertaining its character, for all ofthelimhs were now
paralvzed, although the tail still continued to move slightly when
irritated. Towards the close of these experiments the lethargic state
became more and more profound, the animal was plunged in a sleep
resemhling coma, and it was very difficult to arouse him sufficiently
to indicate the character of the motions. Smart taps of a riding-
whip over the fleshy part of the tail, quickly repeated, or the con-
stant scratching of the same part with the finger nails, were found to
be the most effectual methods of eliciting these determinate motions.
These movements were not convulsive or sudden, and were only
manifested by the foot on the side of the irritant. The experiments
occupied about one hour.

Remarks D'Alembert has well designated the space which lies
between geometry and metaphysics, " L'abime des incertitudes et
le theatre des decouoertes." In the present state of our knowledge
the science of the nervous functions occupies a remarkable part of
this*wide intellectual domain, forming a sort of neutral ground be-
tween the strictly physical sciences those which deal with matter
in its various form, and those which have relation to the phenomena
of menial existence. Physiological researches irresistably lead us
almost beyond the frontiers of the material world into the region of
sensation and perception, thought and will. We pass from physics
to metaphysics, from the body to the soul, from physical phenomena
to those that are hyperphysical, from those that are mechanical and
chemical to those which are hyper-mechanical and hyper-chemical,
from biology to psychology, from things to persons, from nouns to
pronouns. It is this proximity to the borders of metaphysics which
has thrown around the subject so much ambiguity and obscurity.
The chasm which intervenes between matter and motion on the one
side, and thought and feeling on the other, is brought into view by
such investigations ; but none of the numerous hypothesis which have
been broached can effectually bridge it over. We labor in vain to
follow physical analogies in illustrating the operations of will and
thought, when they have nothing in common, excepting a conven-
tional and metaphorical phraseology borrowed from the world of
matter.

That external impressions upon the nerves are all conveyed to one
internal organ, the encephalon; and that from this organ all impres-
sions of the will appear to proceed ; and that thus t he brain is the
centre of animal life, towards which sensations converge, and from
which volitions diverge, is a doctrine distinctly maintained by
Herophilus. and Erasistratus, as well as by Galen, and his successors.
Later researches have confirmed this grand physiological law, so far
as it is applicable to man and the higher vertebrata ; hat in many of
the inferior orders of animals, we find thai isolated portions of the

22 On the Seat of Volition in the Alligator, [January,

spinal cord perform functions analogous to those of the encephalon ;
receiving impressions which are followed by contractions of those
very same muscles, which, while the brain maintained its integrity,
obeyed the determinations of the will, and produced regular and me-
thodical movements directed to the removal of the cause of injury.
The question now arises, whether these indications of sensorial
powers are accompanied by actual feeling and volition ; or whether
they exist only in appearance, and without any real consciousness
on the part of the individual percipient being. The solution of this
problem involves that of another, equally obscure; namely, as to
the locality and extent of the sensorium in all the classes of the ani-
mal kingdom.

Great confusion has been introduced into this subject by the in-
accurate language employed by physiologists in theorizing on these
phenomena ; and particularly in generalizing the idea of sensibility
to such a degree, as to give that appellation to every nervous cooper-
ation accompanied with motion, even when the animal had no per-
ception of it, when not characterized by attendant consciousness.
Many eminent writers have deceived themselves to such an extent
by the employment of these figurative and ambiguous expressions,
that they thought they had explained phenomena, when in fact they
had only translated the phraseology of them into metaphorical lan-
guage ; and have thus fallen into that kind of sophism designated
by logicians under the name of the syllogism of four terms. Some
physiologists have likewise spoken of a sensation without conscious-
ness ; but later writers have considered it desirable to restrict the
term sensation to the consciousness of an impression.

With regard to the seat of the sensorium commune, or nervous cen-
tre of volition and sensation, much discrepancy of opinion has arisen
among the most distinguished modern physiologists. A majority of
them agree in assigning this function, at least in the higher verte-
brata, to some portion of the encephalon. Similar contrariety exists
in the experiments, regarding the particular parts of the encephalon,
that are concerned in voluntary movements. Dr. W, B. Carpenter
appears to confine the power oforiginating voluntary actions exclu-
sively to the cerebrum (vide Principles of Human Physiology, 1st
Am. edit., Philad., 1843, pp. 200 et 208, paragraphs 279 et 288).
This opinion is directly at variance with the experiments of several
eminent continental physiologists. Thus the vivisections of MM.
Flourens and Bouillaud seem to show, that the cerebral lobes are not
the exclusive receptacle of intelligence, of instincts and volition; for
to admit this proposition would be to grant that an animal which re-
tains the power of locomotion which makes every effort to escape
from irritation which preserves its appropriate attitude, and exe-
cutes the same movements after as before mutilated, may perform all
those actions without the agency of the will. The power ofeffecting
regular and combined movements, on external stimulation, evidently
survives the destruction of the cerebral hemispheres (vide Report on

1846.] On the Seat of Volition in the Alligator. 23

the Physiology of the Nervous System, by William Charles Henry,
M. D., in Dunglison's American Med. Library, in volume of Med.
and Surg. Monographs, Philad , 1840, p. 269). Prof. Adelon main-
tains most unequivocally that volition is exclusively restricted to the
encephalon, without designating, however, in what portion of the
brain it originates (vide Article Encephale (Physiol.) in Diet, de
Med., Xom.'l Paris, 1823). MM. Foville and Pinel Grandchamp
thought that the cerebellum is the seat of sensibility ; but the experi-
ments of MM. Rolando, Flourens, Magendie, Schoeps, and Hertwig,
demonstrate that sensation continues even after the entire removal of
this portion of the encephalon. From the researches of MM. Ma-
gendie, Flourens, and Desmoulins, it results that even the total abla-
tion of the cerebral hemispheres and the cerebellum does not deprive
an animal of sensation, and that when thus mutilated, it is still capa-
ble of executing regular movements: For example, M. Magendie
has repeatedly seen hedgehogs and guinea-pigs, in which he had
extirpated both cerebrum and cerebellum, rub their nose with their
paws, when a bottle of strong acetic acid was held to it (vide "Precis
Elementaire" 2d edit., torn. 1, p.. 340 Paris, 1823). Anencepha-
lous monsters have also been known to perform voluntary move-
ments.

Prof. I. Muller places the seat of sensation and volition in the
brain. He compares the primitive fibres of all the voluntary nerves
spread out at their central extremity in the encephalon to receive
the influence of the will, to the keys of a pianoforte, on which our
thoughts play or strike, and thus give rise to vibrations of the nervous
principle in a certain number of elementary fibres, and consequently
to motions. The mind is the performer or excitor ; the primitive
fibres of all the nerves which expand out in the brain, are the strings ;
and their cerebral extremities, the keys. In another place, he more
explicitly designates the medulla oblongata, as the source of all vol-
untary movements: where, the fibres of all the motor, cerebral, and
spinal nerves may be imagined as spread out, and exposed to the in-
fluence of the will, like the keys of a pianoforte. (Vide Elements of
Physiology, Am. Ed., by John Bell, M. D., Philad. 1843, pp. 535,
007, 621, 674.) From these conflicting opinions, it is obviously
impossible to eliminate any thing categorical, respecting the special
seat ofvolition. [t seems to be tolerably well established, however,
that the seat of the sensorium is not restricted exclusively to one
spot in the encephalon ; and that, in the higher animals, the cerebrum,
cerebellum, and medulla oblongata appear to possess the faculty of
acting primordially and spontaneously. (Vide Henry's Report, cit.
supra, pp. 274 et 290.) Whether this function appertains to the
spinal cord in reptiles and the lower classes of animals, is a problem
which can only be resolved by cautiously conducted experiments: a
priori reasoning only serves to involve the subject in impenetrable
mystery. Deductions drawn from the analogies of the phenomena
exhibited by man. and the higher animals, can avail us but little,

2-1 On the Seat of Volition in the Alligator. [January,

when we observe, that reptiles after decapitation, manifest endow-
ments which the former do not display under the same circum-
stances. Some physiologists, while they maintain that volition is
seated in the encephalon, nevertheless admit, that an analogous func-
tion may extend over the whole cerebro-spinal axis. In deciding a
question absolutely, no half results, no approximatives are sufficient :
if sensation and volition are functions of the spinal cord in the lower
vertebrata, experiment should give us unequivocal indications of it.

The larger Sauria are peculiarly adapted for such experiments.
These animals possess an obvious development of the cerebellic
lobes as well as the cerebral hemispheres : they are remarkably te-
nacious of life, and long survive the destruction of the brain. The
free and unrestrained condition of their limbs render them prefera-
ble to the Chelonia, for the purpose of testing the volitional character
of their movements. It is manifest that no inference on a question
of this kind could be drawn from experiments performed on the
Ophidia and other apodal reptiles: for it would be impossible to de-
termine whether the motions exhibited, are prompted by design and
regulated by determinate motives.

It would be difficult to imagine that the decapitated Alligator, in
the experiments which 1 have recorded above, could have performed
all of those movements, had it been totally devoid of sensation and
consciousness. His motions appear to have been performed with a
perfect knowledge of the end in view ; they were directed peculiar-
ly to that end ; they varied according as the conditions in which
they were elicited altered, and the alteration made was always so
contrived as to suit the variation in the circumstances. It is true
we cannot communicate with animals, and ascertain from them, as
we do from our fellow men, whether their motions are, under any
circumstances, prompied by a distinct and conscious effort of volition.
Nevertheless, by varying our observations on them in new and arbi-
trary combinations of circumstances, we can reduce the chances of
error to a very small amount, and render our inferences as highly
probable as are most of the propositions of contingent truth. Now
the question arises, can all such definite and co-ordinate motions be
referred to any other cause than a volition resulting from the con-
sciousness ofan impression ?

Pathology as well as therapeutics has, doubtless, been vastly en-
riched by the researches of Dr. Marshall Hall, Prof. J. Muller, and
others, respecting the excito-motory phenomena of the spinal system,
which have, likewise, resulted in some of the most brilliant discove-
ries in physiology. But it may be questioned whether they have
thrown much light upon the locality of the sensorium commune, or
have contributed, in any appreciable degree, to fix with clearness
and precision in the minds of physiologists, an obvious distinction
between the voluntary and reflex motions. It is assume!! that the
former are always attended with perception and consciousness, while
the latter take place without the intervention of sensation. Admit-

1846.] On the Seat of Volition in the Alligator. 25

ting this distinction, the Question recurs, how a>-e we to determine
whether any given motion is the product of a conscious act of voli-
tion, or merely the result of an involuntary reflex action 1 Manifest-
ly, in the case of animals, only by varied experiments by placing
them in circumstances which will test the existence of a volent
power.

Dr. Marshall Hall distinguishes the motions which belong to the
sentient and voluntary system, from those appertaining to the exciio-
motory by the circumstances that the former are frequently sponta-
neous, while the latter are always excited. (Vide Lectures on the
Nervous System and its Diseases!! Am. Ed., Philad., 1836, pp. 24,
29 et 30. Paragraphs, 16, 29. 30 and 35.) This distinction is ex-
tremely vague and unsatisfactory. For it must be recollected that
voluntary motions are not necessarily spontaneous ; they are fre-
quently called into action by external irritation : and hence it would
be a miserable non-sequitur to infer that movements which are exci-
ted, which supervene upon the application of stimuli, are always
unattended by sensation and consciousness. Even if it be granted,
as Dr. Hall asserts, that decapitated animals originate no self-depend-
ent motions, his conclusion would still be unsatisfactory, viz., that
reflex motions are always accomplished without the co-operation oi
mind. If it be denied that reflected movements proceed from sensa-
tions, assuredly the discontinuance of the one cannot prove the
absence of the other. It therefore follows, that the want of sponta-
neity of motion is not a good criterion of the non-existence of the
sensori-volitional power.

Dr. William B. Carpenter contends that adaptiveness in muscular
movements excited by external stimuli, is no proof that they are
performed in obedience to sensation and volition ; since many of
the purely instinctive actions, which are manifestly performed with-
out any effort of the will; as, for example, the act of deglutition,
the contractions of the alimentary canal, heart, <x;c; are neverthe-
less, perfectly adapted to a given purpose. (Principles of Human
Phys. Ed. cit. ante, pp. 91 and 136. Paragraphs 106 and 180.)
Every physiologist must admit that, on all vital actions, the charac-
ter of adaptiveness is impressed ; indeed, it is involved in our funda-
mental conception of organization : yet all the vital functions do
not proceed from the mind. It will be remarked, however, that the
involuntary or instinctive motions are peculiar in this ; that they in-
variably act in the same way they appear to depend upon mechan-
ical relations they are intended to subserve some definite purpose
in the animal economy, and no other they do not vary with the va-
riation of external conditions they are not capable of being modi-
fied to any extent by the will of the animal. Adaptiveness of move-
ments to some definite end, is, therefore only an index of the persis-
tence of volition, when the alteration of conditions elicits a respon-
dent variation in the action, perfectly adapted to the new circum-
stances. When motions arc thus regulated and directed, it is hardly

26 On the Seat of Volition in the Alligator. [January,

possible to imagine that the phenomena are purely physical it can
scarcely be denied that they are governed by a conscious mind and
a presiding will. The movements manifested by the decapitated
Alligator, in the experiments which I have detailed, appeared to
partake of this volitional character ; the animal seemed to know, to
intend, and to accomplish its definite object.

It is true that an animal thus mutilated, assumes a torpid air ; that
he neither himself originates an act of volition, nor performs any
spontaneous movement ; but when he is stricken or wounded, he ex-
hibits all the appearance of an animal exercising its usual functions.
In the language of M. Cuvier, "Indeed he moves and acts precisely
like a sleeping man ; but we are far from believing that a man, while
asleep, who moves himself into the most convenient positions and
attitudes, is absolutely without sensations ; nor does it by any means
follow, because his perception of them was indistinct, and because he
has retained no recollection of them, that therefore he has not expe-
rienced them." (Vide Cuvier's Report to the Academy of Scien-
ces on the Researches of IYI. Flourens on the Nervous System, in
Phil. Mag. and Journal, Old series, vol 61, p. 122. London, 1823.)
I am aware that some physiologists maintain, that the harmonious
and co-ordinate movements exhibited by man during profound sleep,
are purely reflex; that they are independent of sensation and con-
sciousness. But a slight attention to the subject will convince us
that, although all recollection of the cause of the change of attitude
may have been lost in such cases, yet, that the mind is always par-
tially aroused to a sense of consciousness at the time the position is
altered. This is manifest from the fact, that an individual is invari-
ably more or less awake under such circumstances, and he will
usually respond if addressed at the proper period. Indeed, in some
instances, if a sleeping man is disturbed by another person, he will
not only answer interrogatories promptly and often rationally, but
will sometimes make use of threats and violence; and yet he will not
retain any remembrance of what has transpired. The cerebral lobes
must be active in such cases.

Comparative anatomy may afford us some assistance in elucidating
the locality and extent of the sensorium in the animated creation.
Physiologists and naturalists have been unable to discover any ner-
vous system in the lowest tribes of the radiated division of the animal
kingdom. Many of the polygastrica appear to have an acute sense
of taste, they distinguish, pursue, and seize their prey, they avoid
impinging on each other while swimming, crowded in myriads, in a
drop of water ; they contract and bend their body in every direction ;
and they increase or retard, or cease at pleasure, their progressive
motion and the vibration of their cilia, like the muscular and gangli-
ated rotiferous animalcules ; yet, nervous filaments have not been
distinctly detected in their minute transparent bodies. The numer-
ous straight parallel jaws, seen in many of the genera, are opened and
closed, advanced and retracted, with great quickness and precision,

1 S4G.] On the Seat of Volition in the Alligator. 27

and all the movements of these minute animals appear to be as regu-
lar, methodical, spontaneous, and well-directed as those of many high-
er animals with obvious nerves. In the pariphera, the component
particles of the nervous and muscular systems have been*thought to
be diffused through every portion of the soft cellular tissue of the
body, which possesses the same living properties in every part, and is
almost indefinitely divisible without destroying its vitality. Even
the reproductive gemmules of these animals vibrate their cilia with
great regularity and force ; they appear to be conscious of each
other's approach, and can accelerate, retard, or cease their motions
at pleasure; they are sensitive to light, and seem to be guided by its
influence in selecting the place of attachment most suited for the
growth of each species ; yet they exhibit no muscular or nervous
filament in the gelatinous texture of their body. (Vide Outlines of
Comparative Anatomy, by Robert E. Grant, M. D., F. R. S., etc.,
London, 1S41, pp. 1S1 and 1S2.) It is reasonable to suppose, how-
ever, from the consentaneousness of action manifested by them, that
these faculties are associated with nervous filaments of such trans-
parency and delicacy as to elude our means of research, and to pre-
vent our detecting in these animals the rudiment of that form of the
nervous system, which is seen in the wheel-animalcules, and in the
higher articulated classes. But even in the obviously gangliated an-
imals, as the asterias, every segment of the body appears equal in its
character and endowments to the remainder; each has a ganglion
appropriated to it ; and as the ganglia, like the segments, are all
alike, neither of them can be regarded as having any presiding influ-
ence. Nevertheless, Dr. Carpenter concludes from an elaborate
review of the structure of the nervous system of invertebrate animals,
that in them, the cephalic ganglia, which are the analogies of the
cerebral hemispheres in the vertebrata, alone are the instruments of
sensation and of voluntary power ; and that when these are extirpa-
ted, all the movements which are performed are strictly reflex, and
totally independent of consciousness and volition. (Vide Prize
Thesis on the Physiological Inferences from the Structure of the \er-
-\vstem in the Invertebrated Animals, in Dun^iison's American
Med. Library Med. and Surg. Monographs, Philad., 1840. p. 13T
etscq.) Yet this ingenious physiologist admits, in a more recent
production, that from the experiments of MM. Flourens, Hertwig.
Magendie, and others, it appears that not only reptiles, but birds and
mammalia, may survive for many months after the ablation of the
whole cerebrum. He remarks that, ' It is difficult to substantiate
the existence in them of actual sensation ; but their movements ap-
pear to be of a higher kind than those resulting from mere reflex
action. One of the most remarkable phenomena in such a being, is
the power of maintaining its equilibrium, which could scarcely exist
without consciousness. (Vide Carpenter's Principles of Human
Physiology, lA Am. edit., Philad., 1S43, p. 191, paragraph 264.)
Prof. A. \V. Volkmaon of Dorpat, remarked, that decapitated

28 On the Seat of Volition in the Alligator. [January,

frogs executed movements which evinced a certain degree of harmo-
ny and adaptation, amounting to an apparent exercise of volition.
He found that when a frog thus mutilated, is grasped roughly in the
pectoral region, he stretches the thigh forwards, presses his ieet firmly
against the hand which holds him, and seeks to free himself. If a
person pinches the skin on the abdomen or spine with a pair of pinch-
ers, nothing is more common than the mutilated animal should
scratch the irritated part with the hind leg of the corresponding side.
It appears on the whole, as if the decapitated animal felt the opera-
tion of the stimulus, and from among various means selected the most
suitable to remove the offending cause. According to M. Volkmann,
the present state of our knowledge is not sufficient to prove that all
the so-called reflex motions of decapitated animals, and especially
amphibia, goon without the co-operation of mind, as a principle of
sensation and will. (Vide Analysis of ?,I. Volkmann's Paper on Re-
flex Motions, in the Medico-Chirmgical Review, for July, 1838, pp.
145, 148 : taken from the Archiv. Filr Anatomie, Physiologie, by
Dr. I. Mailer, 1838.) Prof. I. Muller affirms that he never observ-
ed such spontaneous movements of decapitated frogs, except when
the head was separated close to the occiput, so as to leave a portion
of the medulla oblongata in the spinal canal. When the section was
made lower down on the spinal cord, the motions of the frog did not
indicate the slightest degree of volition. He distinctly avows that,
" We are in possession of no facts which prove that the spinal cord,
when separated from the brain and medulla oblongata, can be the
seat of sensation. The reflected motions excited by irritation ofthe
surface in decapitated frogs are no proof of this; whenever these
reflected movements present any degree of adaptation to a purpose,
it is certain that the spinal cord has been divided at its very com-
mencement." (Elements of Physiology, by I. Muller, M. D., Am.
edit., by John Bell, M. D., Philad., 1833, p. 602.) My experiments
on the alligator appear to confirm the opinion of M. Volkmann, that
the motions consequent on impressions, even after the complete des-
truction ofthe medulla oblongata, are the result of an appropriate
voluntary reaction ofthe sensorium excited by sensation. Our diffi-
culty lies in ascertaining what are to be regarded, in animals thus
mutilated, as unequivocal indications of consciousness and volition ;
but the movements of this reptile seemed to participate in the peculi-
arities which characterize the manifestations of mind and will.

In this case of uncertainty, with regard to the deductions drawn
from experiments on the inferior animals, some physiologists have
appealed to certain pathological phenomena exhibited in the human
subject, to prove that reflex actions are independent of sensation.
Thus the interesting cases of paralysis and paraplegia, recorded by
Dr. Wm. Budd in the 22d volume of the Medico-Chirurgical Trans-
actions, clearly demonstrate, that violent retractions of the paralytic
limb followed the application of stimuli, without the slightest con-
sciousness on the part of the individual. Such movements are, with-

1S46.] On the Seat of Volition in the Alligator. 29

out doubt, strictly reflex. They possess no resemblance to voluntary
motions they do not evince any character of determinateness and
harmonious accordance. Thev are analogous to convulsive motions,
and do not exhibit the guidance of a directing will they are never
varied to suit an alteration of circumstances. Such, I believe, is the
character of all strictly reflex motions of those which take place
without the smallest influence of sensation or volition. The general
spa-ms which are excited bv touching the skin of a decapitated sala-
mander, or by stimuiusof a sensitive nerve in animals in a state of
narcotization, are of this kind, and do not, in the slightest degree, re-
semble the phenomena of spontaneous reaction manifested in the
decollated Alligator. I conceive that this distinction between volun-
tary and reflex actions, based upon the deliberate character of the
one, and the spasmodic nature of the other, is very clear, and is highly
important in determining this delicate question in physiology. In
this case, some may doubt whether the true reflex motions always
partake of the nature of spasms. But on this subject, we may, I con-
ceive, with safety, adopt the decision of Prof. Wm. Whewell, deliber-
ately given after a careful examination of the reflex phenomena.
"Here," says he, " sensations (impressions) produce motions, but
with no trace of intervening perception or will. The sensation (im-
pression) appears to be reflected back from the central element of
animal life, in the form of a muscular contraction but in this case
the sensation (impression) is not modified or regulated by any idea.
These reflected motions have no reference to relations of space or
force among surrounding objects. They are blind, and involuntary,
like the movements of convulsion, depending for direction and amount
only on the position and circumstances of the limb itself, with its mus-
cles. Here the centre from which the reflection takes place is mere-
ly animal, not intellectual." (Vide WhewelPs Philosophy of the
Inductive Sciences, vol. ii. p. 73. London, 1840.)

This is an essential distinction, and one upon which I wish to be
clearly understood. It is not denied that in entire animals the reflex
phenomema are frequently, nay, generally, accompanied by more or
less sensation. Indeed, they are frequently modified by voluntary
efforts. Such are the movements concerned in sneezing, ejaculatio
soninis. etc. : the latter of which M. Brachet ascertained could be
produced in the human subject, as well as in the do. after sensibility
and consciousness were abolished. (Carpenter's Human Phys.,Ed.
cit. ante p. 138. par. 182.) But this fact does not, by any means,
render the reflex function in any way dependent for its manifesta-
tion upon sensitive reaction ; neither does it destroy the strict analogy
which it bears to convulsive movements. The volent faculty may
modify, and, perhaps, to some extent, control the mode in which it is
manifested ; but when removed from such influences it must act
spasmodically. In fact, if we admit that reflex action is a physical
phenomena, in contradistinction to a psychical one, if such motions
result from a centripetal influence transmitted from the point of irri.

30 On the Seat of Volition in the Alligator. [January,

tation to the spinal axis, which is reflected back from thence in the
form of a centrifugal impulse propagated along the motor nerves ; if
this is done without the intervention of sensation or volition, but
operating on the spinal cord, to use the expression of Prochaska, ac-
cording to certain "peculiar laws written, as it were, by nature on
its medullary pulp" it is difficult to imagine, without violating all
analogy in nervous action, how the movements could be otherwise
than convulsive. When all control of the will is removed, the cen-
tripetal excitement resulting from the application of stimuli to the
cutaneous surface, is propagated to the spinal marrow, from whence
the centrifugal action irradiates to the periphery, with the rapidity
of a galvanic shock along conducting wires. Here every thing is
mechanical, every thing is purely physical, every thing is strictly
involuntary nothing is intellectual, nothing indicates the guidance
of an internal volent faculty. Hence the motions are convulsive -
they are spasmodic. Such are the movements which are observed
to follow the application of irritants to the limbs of paralytic indi-
viduals, after sensation has been destroyed or suspended by injury of
the spinal cord and such are likewise the tetanic spasms superven-
ing from touching animals while in a state of narcotisation.

Again, if purely reflex motions are produced by the transfer of a
centripetal action arising from, and originating in a local irritation
of the sensitive fibres of the afferent nerves, to the spinal marrow,
whence it is reflected back along the motor nerves; it is clearly
presumable that the energy of the excito-motory phenomena resulting
therefrom, must be proportionate to the degree of susceptibility to
irritation, and to the intensity of the impression made upon the
cutaneous nerves. Yet, in my experiments on the alligator, the
posterior extremity was slowly and deliberately drawn up and applied
to the point of irritation, after which, considerable exertion was fre-
quently made to remove the offending object. How is it, that the
energy of the latter movements was so much greater than the former
under the same stimulus, if both were nothing more than the physi-
cal manifestations of an external impression? A self-dependent
internal principle must have been active in the animal.

Whatever may be the cause of the suitable and determinate mo-
tions performed by the amphibia after decapitation, it is very mani-
fest that the spinal marrow is the centre, or rather the axis, whence
these movements proceed. Their character of suitableness to the
attainment of a definite object, appears to indicate internal connec-
tion and harmony. The end generally shows itself in the motions,
such purpose being to remove the external irritant which gives rise to
them, and frequently considerable exertion is made for the accom-
plishment of this object. Now, the question is, are we to ascribe
these phenomena to the existence of an obscure, but distinct volun-
tary power residing in the spinal cord ? Or, are we to attribute them
to a peculiar faculty or endowment of the spinal marrow, giving rise
to manifestations resembling those of volition, and yet unattended

1846.] On the Seat of Volition in the Alligator. 31

with consciousness and will ? In other words, are these movements
guided in any way, by the mind; or do they necessarily result from
certain physical conditions of the nervous system? If their adap-
tiveness is the result of mental guidance, then not only sensation,
but judgment and volition must necessarily be involved; since it is
impossible that sensation can guide to the choice of one out of many
modes of action, without the exercise of these faculties. These
questions cannot, perhaps, be definitely answered in the present state
of physiological science.

Dr. John W. Arnold of Heidelberg, does not hesitate to give the
spinal marrow a power to feel external irritants, independently of
the brain and medulla oblongata, which he designates as its percep-
tive faculty. This power, he affirms, regards not merely the irritant
in general, but also the kind, the degree, and the locality of it. But
the property of perceptions connected with consciousness is wanting.
M. Arnold also maintains, that the spinal marrow possesses the fac-
ulty of reacting correspondingly to excitements occasioned by im-
pressions, and in consequence of this to perform suitable, combined,
and harmonious motions ; this he calls its reactive faculty. These
movements are no doubt suitable, and harmonious; still they want
the character of freedom ; they are not external manifestations of a
will. To use his own language, "That which takes place in the
spinal marrow during the perception of external influences, and the
determination of motions following thereon, is analogous to that
which takes place in the brain during conscious sensations and vol-
untary motions, only that clear consciousness and freedom of will
are wanting to it, whilst the character of suitableness and of harmo-
monious accordance appertains to it in the highest degree." (Vide
Review of M. Arnold's work on the Theory of Reflex Function, in
Medico. Chir. Rev., for Jan., 1843, p. 55.) M. Arnold does not inform
us why he has invoked the assistance of a new power in the nervous
system, to account for phenomena every way analogous to those re-
sulting from the ordinary manifestations of volition. Certainly it
required no greater elongation of hypothesis to suppose that the
spinal cord possessed an obscure faculty of volition, than to endow it
with perceptive and reactive faculties, distinct from consciousness
and will. Indeed, the accordance of the former supposition with
analogy, would have rendered it infinitely more rational. The the-
orist was obviously led astray by the employment of a new and conven-
tional phraseology. For, according to the acknowledged acceptation
of the term, perception implies a consciousness of the sensation.*
By distorting the sense of words in common use, the speculator takes
refuge in an abstraction so wide, that if, by it, he simplifies the phe-
nomena, he annihilates all precise language in physiology.

It is not a warrantable distinction to say that the motions are not

The will intervenes between knowledge and action; and the cycle of oper-
au )ns which take plaee when animals act with reference to external! objects is
this; Impression, Sensation, Perception, Volition, Muscular Contraction.

32 On the Seat of Volition in the Alligator, [January,

accompanied with sensation and volition, merely because they are not
spontaneous, but are always excited by external stimuli ; for I have
already shown that true voluntary movements frequently originate
as during sleep from some cause of irritation. In some cases our
sensations are distinctly and directly the objects of our attention, in
others they are obscurely the subjects of our consciousness. In
extreme cases the mental part of the process is obvious enough. But
we may gradually pass from these two cases in which the mental
operation is more and more obscure, until it vanishes altogether.
Many of the actions which we daily perform, such as walking, speak-
ing, writing, or playing upon a musical instrument, afford examples
of apparent automatic motions, being linked together by associations
which do not require any conscious acts of volition. All these
movements, however, are still voluntary, inasmuch as they remain
under the control of the will which commands their commencement,
can regulate their course, and can arrest them at pleasure. Recent
physiological researches render it more than probable that the
changes immediately connected with sensation and volition, are not
confined to a single point in the nervous apparatus which might
emphatically be termed the " seat of the soul" as Descartes express-
ed it, when he boldly pronounced the pineal gland to be that spot.
And, in the present state of science, it is unquestionably more rea-
sonable to suppose, that an obscure volent power extends along the
spinal marrow in the lower animals, than to imagine that it is in-
vested with new faculties manifesting themselves in the similitude of
true voluntary motions.

We have already remarked, that there is no evidence for the local-
ization of consciousness which 1 take to be the essence of mind
in the cerebral hemispheres. The study of comparative anatomy,
physiological experiment and pathological investigation, seem to lead
irresistibly to the conclusion that these organs are the instruments
of both one class of mental phenomena, and that they are not the
peculiar seat of consciousness ; in other words, that the sensorium
does not reside exclusively in them. In the amphibia, the whole
encephalo-rachidian mass seems to be invested with some degree of
consciousness. It is hardly possible to conceive the co-existence of
two separate and independent centres of volition and sensation in any
animal, because we find it impossible to understand how conscious-
ness can be subdivided. But if the essential seat of mind as we
have seen be not in the cerebral hemispheres, and if those organs
be only employed as its instruments in a certain class of mental
operations, it seems quite legitimate to admit that the several parts
of the encephalo-rachidian mass in reptiles may usually work together
as a whole, whilst either of them is capable of operating alone under
favorable circumstances, without involving ourselves in the modern
paradox concerning the "Duality of the Mind."* Two illustrations

* This view of the subject was suggested by the perusal of the able review of
Dr. A. L. Wigan's work on the " Duality of the Mind," contained in the British
and Foreign Medical Review, for July 1845, p. 1 et seq.

184G.] On Constipation. 33

the one drawn from the inorganic, the other from the organic
world may render my meaning more apparent. If a magnetized
barofstee] be cut or broken across the middle, each half becomes a
perfect magnet ; a new north and another south pole manifesting
themselves at the points of separation. Yet the original magnet
was not made up of the two which were formed by the division ; it
was one, capable, however, of being separated not only into two,
but into any number of minor magnets, each complete in itself.
Again, it is well known, that the circulation of fluid which takes
place in the chara, within the long cells that form its stem and branch-
es, has been carefully studied by eminent phytologists. The fluid
passes along one side of each cell, from end to end; then returns
along the opposite side ; and then again follows its first track.
Now, if a ligature be put around the middle of the cell, so as to divide
it into two, this will not check the circulatory action ; on the contrary,
it will establish two currents, one in each new cell ; and these will
goon as regularly as if the interruption had not been made. Here,
then, are two instances in which we can divide a whole into parts,
of which each shall perform its functions ; and yet the functions of
the whole were neither the mere aggregate of those of the parts, nor
had the functions of the parts an independent existence, until the di-
vision was made. Thus, when the amphibia are decapitated, sen-
sation and volition are not entirely annihilated ; the spinal cord still
retains the power of performing these functions in an imperfect
manner. Such an animal seems to be reduced by this mutilation,
still lower in the scale ; and for this reason becomes capable even of
further mutilation, without the immediate extinction of life.

Prof. C. J. B. Williams on Constipation. (Boston Med. and Surg.
Journ., from London Med. Times.)

We now pass on to the consideration of that form of constipation
which corresponds with indigestion. This affection is principally
seated in the colon, and may be regarded as opposed to diarrhoea ; it
may consist in defective secretion of the canal, or defective muscular
action, or both combined ; and each of these, defective secretion
and defective muscular action, may depend on different patholo-
gical causes. Generally speaking, defective secretion and. defec-
tive muscular action go together, just as excessive secretion and
excessive muscular action of the canal constitute diarrhoea. They
produce torpor of the bowels, and extreme irregularity in their
action.

Now, among the causes to which we may trace this imperfect ac-
tion, we find, in the first place, the character of the food to be the
main source of costiveness. For example, food of a certain nature
will produce ficculent matter, but docs not, by its presence, excite

3

34 On Constipation* [January,

the biliary secretion, or the peristaltic action of the bowel?. This is
the character of all farinaceous food generally ; more particularly of
those kinds which abound in starch, as arrow-root, gluten, and rice.
Rice and arrow-root we find are constipating, not from any astrin-
gent property they possess, but merely negatively so, from the want
of any stimulating property. Feculent matter, formed in large
quantity, tends to lessen, rather than increase the peristaltic action ;
and the bowels are liable to become costive from the mechanical
obstruction offered to the passage of the food. Further, the food
may be astringent, by having the effect of arresting the secretions
of the canal, or else by its acrid and irritating quality, causing spas-
modic contractions, as is sometimes the case in colic. Some liquids,
such as vinegar in any considerable quantity, very often produce
costiveness of the bowels, at the same time that they greatly irritate
the passages.

Secondly, we may trace constipation to torpor or imperfect action
of the intestinal muscles; and, perhaps, not only of the muscles, but
also of the secretory power of the intestines ; for the intestinal canal
is not only a moving organ, but also a secretory organ. This is
illustrated after the operation of a strong purgative; the bowels gen-
erally become torpid, and inasmuch as the intestines become exhaust-
ed, and the secretions otherwise have been excited too freely, they
seem to secrete less freely afterwards. But, sometimes, it is a sign
of general weakness of the intestinal muscles, a part of the general
weakness of the system ; and, accordingly, in anaemia, you find tor-
por of the bowels taking place. The same thing is observed in any
state of great weakness, after fevers and illnesses, and after extreme
fatigue of the body. Paralysis, and particularly paraplegia, are cau-
ses of this. Some other causes act in a similar way. Enervating
heat, exhausting the body, greatly reduces the powers of the intes-
tines. Continued cold has a similar effect. Moderate cold, however,
increases the tonic action of the intestines to a high degree. In
other conditions the state of atonic plethora, for example a costive
state of the bowels is frequently present. The excretions are often
defective from irritability of the muscles of the intestines.

Thirdly, this morbid condition may arise more directly from de-
ficient secretion, rather than defective peristalic action, which latter
may go on, even if the secretion be imperfect ; a scanty evacuation
is the result. This is to be met with in connection with defective
secretion of the liver, more particularly ; arising from different dis-
eases of that organ interrupting its secretion, or from obstruction of
the ducts passing out of it. Diseased states, likewise, of the intes-
tine, such as congestion of its coats, connected with derangement of
the liver, are often attended with this sort of defective secretion.
Inflammation may be considered as, in some degree, interfering with
the powers of secretion of the liver and the intestines. Enteritis is
one of the instances in which the secretion appears to be greatly in-
terrupted. There is, here, not merely spasmodic contraction, but the

1646.] On Constipation. 35

secretion is interfered with. So, with regard to gastritis, where there
is much irritation, it frequently happens that the lower part of the
canal is defective in excitability and in secretion. Defective secre-
tion and imperfect contractility are frequently combined together.

Now, from this you may understand that constipation may be ei-
ther symptomatic of various diseases, or it may be idiopathic itself
the chief cause of disease. The frequency of the occurrence of
symptomatic constipation is one great reason why purgatives are so
often useful in the treatment of diseases of almost every kind ; for, in
a majority of cases, there is symptomatic costiveness, and a tendency
to great constipation of the bowels. It thus becomes an indication
to use purgatives ; not merely to remove this state, but, likewise,
because the accumulation of the faeces becomes a source of still further
mischief, aggravating greatly the organic disease, and adding to the
local and general symptoms. In febrile diseases, there is apt to be
a reaction, and it often happens that the evacuation of the loaded
bowels very much mitigates this effect. Idiopathic constipation,
where it exists without any other permanent disorder, is not uncom-
mon, and, in a great number of cases, it, perhaps, consists in an in-
sufficient action of the lower intestines, or of the colon. Sometimes,
in costiveness, there is distention of the bowels, especially of the
colon, by flatus, causing a feeling of fulness and tightness in the ab-
domen. There is often, too, considerable tympanitic distention,
where wind is secreted in large quantities. Accordingly, the sounds
arising from the motion of wind in the intestines are commonly
heard in persons of a constipated habit. There are shifting or aching
pains felt in various parts of the abdomen, usually, perhaps, in the
right iliac, or hypochondriac region, about the right and sometimes
the left hip, and in the loins ; also, uneasy feelings, such as restless-
ness, and inability to be quiet, without being able to explain exactly
why. In children, symptoms of chorea sometimes arise from a costive
state of the bowels; and, ID adults, there are cramps of the legs,
which are very common signs connected with imperfect action of the
bowels. Other symptoms arise in the general system: headache is
a very common sign, and there is, is general, languor and depri
of spirits. These different symptoms arise partly from the direct
irritation of the accumulated fasces on the nerves, and partly from
the noxious influence of the retained and absorbed exerement, for
matters long retained in the alimentary canal, are partly al
again into the system. The B in a compact and dry State,

if the bowels are not regular!) d, which shows that the

moister parts arc absorbed away : and those persona who have habit-
ual costiveness of the bowels, generally have unpleasanj smells about

them, and the countenanee is more sallow than iimi.1I : the tongue
is usually more or less loaded, and the breath is very foetid : the
faeces, too. are darker than usual, and they I moulded form

from the cells of the colon, or the different portions of the inl
in which ih > have been retained. The accumulation of!

36 On Constipation. [January,

the abdomen may cause a considerable amount of swelling, and vari-
ous other symptoms; for example, by their pressure, as not un fre-
quently happens, on the gall-ducts, they may produce jaundice; or,
on the stomach, nausea, and a disturbance of the function of diges-
tion or dyspepsia ; and, frequently, haemorrhoidal swellings, or piles,
are caused by their presence. In extreme cases, numbness and
swelling of the legs, and even paralysis, have been produced by their
pressure on the nerves of the pelvis. Sometimes the abdomen is
enormously distended ; and I have seen such patients, who have had
the appearance of advanced degrees of dropsy, and who have been
pronounced to be laboring under organic disease, and tumors of vari-
ous kinds. I remember the case of a patient who, when brought into
the hospital, was supposed to be affected with organic disease of the
abdomen, and had been treated for such for some time, in whom the
abdomen had been distended for six or eight weeks, to a very great
degree, insomuch that the cartilages of the lower ribs were turned
out, and yet all this tumor vanished, after a purgation of some days,
and was produced solely by a vast accumulation of feculent matter.
Neglected constipation will lead to local irritation, and, as a result,
you may have diarrhoea set up, from the irritation of the parts, and
increased secretion results. Dysentery even may ensue, and inflam-
mation of the colon, attended with pains of various kinds ; neuralgia
and severe griping pains of the bowels, accompanied with colic, and
a spasmodic contraction, ending in deep-seated enteritis, and cholera.
These are the local effects. Organic changes, too, may arise ; and,
in addition, a cachectic state of the whole system, a low febrile state,
from the bad influence of the accumulated fasces on the nervous
system.

The predisposing causes you may deduce from what I have
already said, as to the pathological characters of constipation. Se-
dentary habits, especially when combined with various enervating
influences, greatly promote constipation. This occurs very often
among females who are much confined within doors, and who are in
the habit of using but little exercise. It is sometimes excited by
attacks of hysteria, and, as I said before, by bad or defective diet.
Particular kinds of waters, those abounding in iron and calcareous
matters greatly aid in producing constipation. All the different
causes that produce general weakness may cause costiveness. Ex-
cessive action of purgatives, and neglect of the bowels, will often
produce it. But, perhaps, one of the most frequent causes, which it
is important to remember, is inattention to the calls of nature, or
want of regularity in the evacuation of the bowels. It is a process
that ought always to be considered as conducive to health, and
should be set\ipart to be done at a regular time in the day, quite as
much so as the eating of any given meal.

Now, with regard to the treatment. The first indication of the
common form of constipation, where there is an accumulation of
faeces, is to unload the bowels; and to fulfil this, purgatives and in-

1846.] On Constipation. 37

jections are the chief means. The best purgatives for this purpose, are
the mixed purgatives, those which exercise an action on the whole ca-
nal; for, although costivenee3s often proceeds from the defect of one
part of the canal, the torpor ultimately extends to the whole ; and it
is not a safe practice to administer too strong a purgative of one kind,
to act on one part of the canal only. The effect of giving a large
dose of aloes, or a large dose of colocynth alone, is to irritate one part
of the canal, and leave the liver unaffected, and thus, perhaps, con-
vert constipation into inflammation. For this reason it is highly
advantageous to combine the different purgatives together ; and if
there is already much pain and irritation produced by the constipa-
tion, we should combine with purgatives those medicines which
deaden the sensibility, and prevent spasm. For this reason, the
combination of calomel, colocynth, rhubarb, and henbane, answers
well. If these are not sufficient, great advantage will result from
the addition of occasional doses of castor oil, or else of salts and
senna, in the form of a black draught. I cannot dwell too strongly
on the virtues of castor oil in cases of prolonged constipation. If
given in large doses, it does not irritate as other medicines; yet it
acts more thoroughly ; it penetrates, and, in some degree, has the
mechanical power of insinuating itself into the crevices and curva-
tures of the intestines, and thus dislodging the accumulated masses,
wljere calomel and other medicines had failed to act. Mercury,
though it acts more especially on the liver, and stimulates the secre-
tion of bile, is accompanied with a great deal of griping pain, and is
not, by itself, so effective in unloading the bowels. Where the
accumulation is very considerable, it is desirable to facilitate the ac-
tion of the bowels by copious injections of oil or soap and water.
Remember that these accumulations of faeculent matter sometimes
consist of a hard and compact mass so hard that purgatives, which
merely stimulate the canal to contraction, procuce very little effect
upon it. Injections of castor oil, with a little turpentine, or of olive
and linseed oil, mixed up with gruel, are useful; of this, one, two,
three, or four pints may be thrown up. The use of turpentine is
indicated where there is a tympanitic distention of the abdomen.
Rue and asafcetida injections are also useful in such cases. After
the faeces have been dissolved, the bowels pass into an irritable state,
and there is often a considerable amount of pain. It frequently
happens that, after the great accumulation has been removed, the
tongue is more furred, the pulse more excited and the system more
deranged. In this state of things, mercurial purgatives, combined
with opium, or mercury and Dover's powder, followed by small doses
of castor oil, or else rhubarb, or some other mild aperient, may be
given, for several days afterwards, with great advantage. If tho
opium irritates, instead of giving Dover's powder, conium may be
employed as a substitute; moderate doses of conium and mild aper-
ients may be given until the bowels are brought into regular action.
Wher ;> tendency to low inflammatory aflbctionsj such as

38 Statistical Summary of Aural Diseases. [January,

gastritic dyspepsia, which often occurs in costive habits, the aperient
that suits best will be found to be small doses of castor oil ; a tea-
spoonful, the first thing in the morning, or the last thing at night, acts
admirably, and ensures the regular evacuation of the bowels. In
some persons olive oil acts in the same way. Castor oil is extremely
valuable in cases of dyspepsia, where stronger purgatives do mis-
chief. Sulphate of potash and sulphur sometimes answer very well.
The diet of persons disposed to constipation should be of a plain
character, not too much abounding in faricinaceous food. Too
much bread should be avoided. There is a common error with re-
spect to bread, and many persons will eat it all day long; hence it
becomes a great cause of constipation. It is better to eat it two or
three times a day, in small quantities. A thing you will find of great
use and which is very popular in the sister-kingdom is oatmeal
porridge. It has none of the constipating effects of farinaceous food
in general. Fruit is very often taken with a view to counteract
costiveness, but I believe its effects have been overrated. The most
important part ofthe treatment of constipation consists in preventing
the accumulation of faeculent matter; and, therefore, the promoting
of the proper and natural action of the bowels is far better than any
description of diet or medicine that can be given. I must say a few
words upon the practice fallen into of late, by a good many individu-
als, namely : that of confining themselves to* the use of injections to
promote the action ofthe bowels. I think this practice is a very in-
jurious one ; for, when injections are frequently administered, instead
of producing a healthy action in the bowels, they generally tend to
bring it into a state of torpor. They mechanically distend the
bowels, and thus do mischief. General tonic measures, to improve
the health, are sometimes necessary. The application of electricity,
or galvanism, has been recommended by some to promote the action
of the bowels ; it may be useful so far as excitement of the peristaltic
action is concerned.

A Statistical Summary of Aural Diseases Read before the South-
ern Branch of the Provincial Medical and Surgical Association,
held at Reading, June 26th, 1845. By Isaac Harrison, Esq.
(From Prov. Med. and Surg. Jour., for July, 1845.)

It is somewhat curious to observe the way in which surgeons and
physicians of the highest eminence, in their recent works, have
treated, or rather passed over, the subject of aural diseases. For
example, Professor Liston, in speaking of ascertaining the condition
of the meatus and mcmbrana tyrrpani by the speculum, says : "But
it is perhaps unnecessary to enlarge further here on this subject, for
such is the division of labor in these days, that a distinct profession
is founded on the operation of squirting water into the external ear.

Statistical Summary of Aural Diseases. 39

It is true that other operations are talked of by these aurists, as they
style themselves, but the advantage to be derived from any of them
is often very doubtful," and yet this same surgeon describes three
different modes of everting the upper eyelid. Diseases of the eye,
in his surgery, occupy sixty-four pages, while those of the ear barely
engage six.

Professor Ferguson remarks in his Surgery: "The ordinary prin-
ciples of surgery will serve to point out the routine of practice in
most of these cases."

Dr. Marshall Hall, also, in his last book, has a chapter headed,
"Case of inflammatory Cold, Otitis, &c." The paper is taken up
with an account of the "genial atmosphere produced by Arnott's
stove," "inverted teapots," "the sad effects which might have fol-
lowed putting boiling water into a flat pint bottle had it cracked err
broken," but not a word is said about the ear itself; though pain in
the ear was the burden of the " little patient's" complaint, its re-
lief the burden of the physician's solicitude. Nothing is narrated to
lead you to infer that the ear was ever looked into, much less accu-
rately examined, in order to ascertain whether the case was one of
external otitis, relievable by simple means, or of internal otitis, intract-
able, and jeopardizing the patient's very existence. The conclusion
of the case and chapter is remarkable : " The little patient," he says,
"was slightly deaf before, but I have now to deplore deafness aug-
mented to a serious degree." Such a result is not surprising.

No age appears to be exempt ; the cases range from two months
to eighty years. Three-fourths, however, occur between five and
fifty ; more than one-fifth from ten to twenty, when the constitution
is being developed, and the causes of disease are most in operation.

The greatest number of cases were from ten to twenty years' dura-
tion ; the next from five to ten ; nearly one-third between five and
twenty years' duration. This is a lamentable fact, and shews one
of two things, either that they have been unsuccessfully treated, or
had not been treated at all. There is a prevailing popular prejudice
that nothing can be done for diseases of the ear, and therefore no at-
tention is paid to them ; they are let alone, and left to pursue their
destructive course unheeded.

Ear affected. The right and left were affected singly in sixty-
nine cases; the right in thirty-six, the left in thirty-three. Both
were affected in one hundred and twenty-one cases ; the right most
in twenty-nine, the left most in thirty-seven cases. Both equally in
fifty -five cases.

The left is usually considered to be most frequently affected than
the right: various reasons have been assigned, but not, I think, satis-
factorily. The fact that both are affected nearly twice as frequently
!i singly, would serve to show the operation of a general, not a
local can

! 1) saXness. The de^ren varied from the slightest im-
pair m ;ol to t! e most complete surdity. The phases were infinite:

40 Statistical Summary of Aural Diseases. [January,

the circumstances ever varied. Some (the majority), could hear
better in dry weather, a few in wet; some in hot, others in cold;
some when aloud noise prevailed, others when all was still. Two
might hear a watch at equal distances, but of these, one would catch
every word of a sermon, the other none. The hearing point of a lady
was natural, but she had lost her musical ear ; she could not play
duets could not keep together as she had been wont.

CAUSES.

None assignable 83

Cold 53

Scarlatina 11

Measles 5

Small-pox 3

* Impetigo 3

Eczema 3

Fever 6

Foreign bodies in, accidents to, the ear . . 4

Dyspepsia 2

Mumps ., . . . . 1

Syphilis .' 2

Congenital 1

Amenorrhcea 1

Dentition 3

Salivation 1

In more than two-fifths of the cases, no probable cause could be
assigned. This might depend on want of observation ; or forgetful-
ness in the older cases; or its attack might be so insidious as faintly
to mark its origin ; its operation so obscure as dimly to trace its
progress. Cold was stated to be the cause in nearly one-third of
the cases, and the number probably is not overstated. It is indubita-
bly the great cause, applied in one shape or other, of the great ma-
jority of deafnesses. The eruptive diseases next follow a fruitful
source of the most severe and intractable cases. It is rather remark-
able, that in our standard works on medicine, mention is scarcely,
or not at all, made of the liability of the ear to become affected in
these diseases, and that preventative and curative measures and di-
rections should not be given and insisted on. Whole treatises have
been written on various ophthalmia, and yet the existence of such a
disease is very problematical. Deafness after fever is not an unusual
symptom, dependent generally on ceruminous accumulation some-
times on anaemia. The ear appears to be peculiarly exempt from
accidents and external injury. The remaining causes are thinly
scattered in various directions.

DISEASES.

Accumulation of cerumen 40

Hypertrophy of auricle 1

Abscess behind the ear 2

Foreign bodies in the ear, &c 4

1846.] Statistical Summary of Aural Diseases. 41

Acute externa] otitis 5

Chronic external otitis 21

Inflammation of the membrana tympani . . 2

Acute internal otitis .5

Chronic internal otitis 49

Throat deafness 25

General organic change 30

Deafness from ancemia 1

Periodic deafness 1

Tinnitus 2

Deaf dumbness (congenital) 1

Deafness from diseased brain 1

The most numerous class is not one of trivial importance, as ob-
tains in the common affections of most other organs but one compro-
mising most materially the function of audition, and endangering,
from trivial causes, the life of the individual, viz., internal chronic
otitis. This class comprehends more than one-fourth of the cases
that have come under my observation. In thirty-five out of forty-
nine rases, one or both membranas tympanorum were destroyed or
perforated. The constitution of this class is essentially strumous.
There are many interesting particulars and points of practice con-
nected with this and the other classes, which must be reserved for the
special consideration of each. In this the supervention of paralysis
of the portio dura, the treatment of otorrhcea, fungi, in young subjects
the induction of dumbness, &c, would particularly claim attention.
The next in point of numbers, more than one-fifth of the whole, is
from accumulated cerumen, interesting chiefly from the degree of
deafness to which it gives rise, from the unsuspected nature of the
cause in many cases, and from its physiological or sympathetic de-
pendencies.

General organic change includes those numerous and distressing
cases which do not admit as far as we know, of curative treatment.
There may be nothing externally to see, at most the membrane of
the tympanum, more or less thickened and opaque. They are, I be-
lieve, the product of inflammation, having generally been, in their
origin, cases of throat-deafness, admitting of cure, but now irreme-
diable from the tympanitic apparatus having become spoiled by a
deposit of lymph, &c. For this demonstration we are indebted to
Mr. Toynbee, who is working with great zeal in the right direction,
and by the only means by which we can arrive at a precise apprecia-
tion of their nature.

Throat deafness is one of great interest and frequency, more than
one-eighth of the cases, interesting from the mode in which deafness
is produced, and also from the means by which it is removed. The
throat is, I believe, the grand source of the great majority of cases
of deafness. We arc much indebted to Mr. Yearsley for directing
to it more particularly the attention of the Profession.

Acute internal otitis, acute and chronic external otitis, foreign

42 Statistical Summary of Aural Diseases. [January,

bodies in the ear, inflammation of the membrana tympani, abscess
behind the ear, deaf dumbness, &c, must be left for more detailed
consideration.

Tinnitus, that frequent and distressing symptom, sometimes the
only one, requires an essay for its elucidation.

The only case of nervous deafness (properly so called) arose from
anaemia, after severe fever. The deafness was extreme, the tinnitus
annoying. Recovery was progressive with that of the general
health.

The case of hypertrophy of the auricle was singular. It occurred
in the ri^ht ear of a boy six years of age, was of four years' duration,
arose from eczema, and the affected part was about three times its
natural size. It was cured by the repeated application of leeches,
the continued use of lead lotion, and the exhibition of mercurial
alteratives and iodine mixture.

The cases of periodic deafness occurred in a girl aged 10, who had
never menstruated. She was seized every night, at seven o'clock,
with giddiness, loud tinnitus, and almost complete deafness, and
awoke in the same condition. It disappeared after breakfast to return
again in theevening. This was continued for some weeks. Noihing
abnormal could be seen about the ears. She was immediately re-
lieved of all her symptoms by the appearance of the catamenia.

A remarkable case of periodic aural disease was related to me by
our esteemed and experienced President. He was called to a young
lady with an intermittent otalgia. Tne paroxysms were regular, daily,
and the pain was most intense ; with the pain there came a puriform
discharge, so profuse as to run down the check : during the paroxysm
there were heat, redness, &c, and all the symptoms of inflammation.
With the paroxysm every symptom disappeared to be renewed the
next day, and again to disappear. He advised a full dose of opium
at the time of the paroxysm, and in the interval full doses of quinine,
and with the most complete success. She was quickly cured.

Treatment. The successful treatment of aural diseases requires
all the skill of the anatomist, the learning of the pathologist, the inge-
nuityand dexterity of the surgeon, and the ample resources of the
accomplished physician. It includes operations requiring as much
tact and delicacy as in most other organs, and affections as painful
and dangerous as any to which the human body is liable. It com-
prehends general treatment of varied application, and special treat-
ment of great variety and interest.

Some modes which, a few years ago, were to do every thing, as
catheterism of the Eustachian tubes, and the air press, have taken that
level to which further experience has reduced them, as occasionally
useful auxiliaries, or have fallen into almost undisturbed desuetude.
This must necessarily be the fate of all remedies unduly used, and
indiscriminately applied. There is yet room, however, for further
additions, i<ir it must be confessed that our means are not equal to our
wants. A majority, it is true, of the sum of the cases may submit to

1846.] Statistical Summary of Aural Diseases. 43

our remedial measures, others may be much relieved, yet it must not
be withheld that there are entire classes which wholly refuse to obey
our best directed efforts. It may be replied, the mischief is already
clone ; it cannot be removed. But what does this imply ? either that
the disease advanced unsuspected or undiscovered, or if observed,
unchecked by treatment too feeble or inadequate.

The duration, of course, will vary in the different classes; and in
some it will be short, conclusive, and exceedingly gratifying ; in
others, prolonged, irregular, and making large demands on our pa-
tience and resources.

Thy summary of the result of 190 cases is :

Cured 102

Improved (much, 23 ; little, 12) .... 35
Incurable (treated, 6 ; not treated, 35) . . 41

Irregular 6

Death 1

Under treatment 5

This shews that little more than one-half were cured, a result
which, I venture to assert, does not obtain in the treatment of disease
of any other organ, and presents not a very flattering view of our
success.

The cured comprehended cases, chiefly of accumulated cerumen
and throat deafness those most amenable to treatment.

A majority of those marked improved oniy admitted of improve-
ment, having one or both mombranst tympani perforated or destroy-
ed. This may be considered a trifling accident, not influencing
ordinary audition to any very inconvenient extent ; yet by it the
patient is constantly exposed to mischief, severe in kind and perilous
in result. For example, a female aged 30 had perforation of the
right membrana tympani : the deafness was slight, otorrhcea occa-
sional, and thought unworthy of attention. Accidentally, on a hot
summer's evening, she sat for a short time with the ear next a bro-
ken window. Severe pain almost immediately followed; otitis of a
grave character was quickly established; it proved intractable, and
ended in death. On examination the temporal and occipital bones
were found riddled with caries, and, together with the neighboring
sinuses and structures, bathed in pus. It will not serve our purpose
to say that this is a rare extreme case, it is enough to know that it is
liable to occur.

The incurable cases mean those incurable in the present state of
our knowledge. They include those cases where extensive disorgan-
ization is evident, or principally where there is no visible organic
alteration. These latter are those generally styled nervous deafness,
a species I have not admitted in my classification ; they depend
more probably (from the researches ofToynbee) on deposit of lymph
in some part of the tympanum. Other deposits are also said to occur
in this situation, as cholesterine, carbonate of lime, v^c. The cath-
eter, rfhorial vnnour, injections-, galvanism &c. were vaunted not

44 Sub- Carbonate of Iron in Uterine Hemorrhage. [January,

long ago as specifics here, but they have shared the fate of all rem-
edies, the agency of which has been rather guessed at than inferred
and rigidly deduced. If this species of deafness, I may say with
Heberden, be not incurable, a discovery of the proper remedies is
one of the many desiderata in the art of healing.

Sub -Carbonate of Iron in the treatment of Uterine Hemorrhage.
By S. Malherbe, M. D., of Bonvillard, Switzerland. (Transla-
ted for this Journal, from the Journal des ponnaisances Medico-
Chirurg., October, 1845.)

Why have authors classed the preparations of Iron amongst emmena-
gogucs ? Doubtless because they have regarded them as exerting a
powerful stimulation on the uterine system, the effect of which would
be to provoke menstruation. The result of observations on this
point would lead us to expect from their use considerable hemor-
rhage. Hence, ir was not until we had read the learned treatise of
Therapeutics and Materia Medica by Professors Trousseau and
Pidoux, (article Iron, class Tonics.) in which these authors cite the
case of a chlorotic female affected with abundant uterine hemorrhage,
and which was successfully treated with lozenges of ferruginous
chocolate, that we ventured to use the therapeutic agent in question.
We confess that we apprehended effects opposite to those we desired ;
but our fears were dispelled, and the result has surpassed our hopes,
as may be seen by the subjoined cases.

Case 1. P , a mechanic, consulted me in January, 1842, in

relation to his wife, who was 42 years of age ; strong, robust, of a
rather tympanic temperament, who had menstruated regularly and
enjoyed good health, with the exception of a slight uterine hemor-
rhage which occurred in November, 1841. He stated to me that his
wife was suffering great loss of blood and was very feeble that the
hemorrhage was preceded by pain in the lower abdomen and loins,
&c. She was, however, still able to attend to her household affairs.
We prescribed as follows :

R. Pulv. sub-carbonate of Iron, . . 155 grs.

Pulv. cinnamon, 10 grs.

Mix, and divide into twenty doses one to be taken thrice daily in a
little sweetened water.

In two days the hemorrhage ceased. She was directed to take
the remainder of the doses in order to ensure success, and has had no
further return of the disease. Regimen was tonic and analeptic.

Case 2. B , aged 48 years, had menstruated regularly, the

mother of three children, of a good constitution, and in the enjoy-
ment of fine health, was taken without known cause, with great
uterine hemorrhage. I saw her on the 13th May, 184'?, and found
her in bed, pale and feeble, with considerable flow of blood. She

184G.] Sub-Carbonaie of Iron in Uterine Hemorrhage. 45

had been suffering several days with pain in the loins and hypogas-
tric region was agitated, could not sleep quietly ; pulse irregular
and frequent; occasional chills. I ordered her:

Pulv. sub-carb. Iron, . . 180 grs.
Pulv. cinnamon, ... 7 "

Mix, a^l divide into fifteen doses one to be taken thrice daily in a
little tea. Perfect repose. Cooling drinks.

On the fourth day the hemorrhage had entirely ceased. The pa-
tient took the remaining doses and continued well. In July follow-
ing, she consulted me for the same affection. I ordered the same
prescription, and with the same success.

Case 3. On the 23d September, 1843, I was called to see Miss

P , aged 25 years, of a sanguineous temperament and habitual

good health, although irregularly menstruated. On the 26th she
suffered hemorrhage, and on the 23th was compelled to take her bed.
I found her feeble, pale, with difficult respiration, palpitations, small
and frequent pulse, thirst, and pains in the loins and abdomen. The
flow was considerable, and increased by motion ; no sleep ; agita-
tion ; apprehension. I prescribed :

R. Pulv. sub-carb. Iron, . . 210 ,grs.
Pulv. cinnamon, ... 7 "
Mix, and divide into twenty doses one to be taken every three hours,
in sweetened water. Perfect rest. Crowfoot tea and broth.

30th Sept. Same state treatment continued. Oct. 1st. Dry
cups to the chest; flow suspended an hour after, but returned during
the night. 2nd. Flow diminished nothing but a few coagula dis-
charged ; able to sleep. 3rd. Flow arrested ; general condition
good ; the patient can move about same treatment continued.
Convalescence was slow because the hemorrhage had been great ;
several weeks were required to restore her to perfect health, during
which she used animal broths, vegetables, and a little red \^ne ; she
also took a tea made with garmander (chamedryos amarum) and
orange peel. I see her frequently, and her health is perfectly good.

Case 4. On the 23d October, 1844, a female, 62 years of age,
robust, who had borne several children, and ceased menstruating,
consulted me for uterine hemorrhage of several weeks continuance,
brought on by mental distress. She travelled a league to see me;
was feeble, pale, had pains in the loins and abdomen, a small and
feeble pulse, free respiration, chills, headache, &c. I recommended
nourishing diet, rest, and the powders of sub-carbonate of Iron and
cinnamon.

I was a longtime without seeing her, but met her accidentally

in the village, when she told me she had been very much relieved.

As she had not taken enough of the powders, I prescribed others; for

-liould in such cases be continued until the disease be arrested.

I have not since seen her.

:: 5. B , aged 26 years, the mother of three children,

ot a lymphatico-sanguine temperament, generally healthy, was de-

46 Sub-Carbonate of Iron in Uterine Hemorrhage. [January,

livered of her last child about a fortnight ago. I was called to see
her on the 10th November, 1344, and learned that she had been taken
with uterine hemorrhage three clays before, without evident cause.
Found her pale, with headache at night, sleepless, very feeble, suffer-
ing occasional pains in the loins and hypogastrium, thirst, anorexia,
with healthy stools, cough, palpitations, small and frequent pulse,
hot skin, and occasional chills the flow was coagulated. 1 pre-
scribed the same powders, rest, broth, crowfoot tea sweetened,
&c. The hemorrhage was arrested on the 12th, and returned no
more.

Case 6. R , 46 years of age, unmarried ; sanguineous tern-

perament, strong, robust, was healthy until her menstruation became
irregular and followed by copious hemorrhage, which left but a short
interval before the return of 'the menses. I was first consulted by
her on the 9th November, 1844: she was feeble, had good appetite,
a little distress in the loins and epigastrium ; pulse small and frequent,
skin natural. This state had existed three weeks. I prescribed,
after her menstruation, a combination of 180 grs. of sub-carb. Iron
and 8 grs. of pulv. cinnamon, to be divided into sixteen doses one
of which to be take,n every three hours.

December 2d. General condition better flow diminished. Pre-
scribed 25 more doses of 15 grs. each, to be taken every two hours.
Dec. 10. Hemorrhage arrested ; strength returning; powders to be
continued every third hour. The cure was complete. I will add
that, in this case a physician insisted that there was an organic affec-
tion of the uterus, &c.

Case 7. V , aged 35 years, nervoso-sanguineous tempera-
ment, medium stature, had had several children, an attack of nervous
fever in 1838, but generally healthy until the end of October, 1844,
when she experienced pains in the abdomen and lower extremities,
occasional chills, palpitations, and headaches. She was suddenly
taken with severe uterine hemorrhage, which returned every two or
three days. Her state on the 11th November, 1844, is as follows :
Pale, restless during the night, pulse small, frequent and irregular,
pains in abdomen, lungs and encephalon normal. Prescribed sub-
carb. ferri and cinnamon, and quiet. A few days after, she ex-
pelled a large coagulum, containing a macerated and bloodless icetus
about three months old, which appeared to have been dead for some
time. 1 ordered the powders to be continued in order to arrest the
hemorrhage.

In this case the remedy moderated the hemorrhage, but could not
arrest it so long as its cause remained. It will be remarked that the
abortion was not occasioned by the Iron, for the hemorrhage existed
prior to its administration.

Case 8. On the 25th October, 1844, I was called to see Mrs.

D , aged 25 years, strong, robust, sanguineous temperament,

usually healthy, and four months pregnant. She was taken, without
known cause, eight days since, with great uterine hemorrhage, pre-

184G.] Sub-Carbonate of Iron in Uterine Hemorrhage. 47

ceded by the expulsion of the foetus ; when I saw her, the flow was
continuing, face pale and haggard, feeble, warm skin, thirst, little
appetite, palpitations, pulse small, frequent and irregular, restless
sleep. I prescribed the powders. 29th, flow diminished; 80th,
flow ceased in the morning. Powders continued every three hours
to confirm the cure.

Case 9. Called on the 14lh February, 1845, to Mrs. V ,

aged 27 years, lymphatic temperament, had, in 1843, ptyriasis capi-
tis; otherwise healthy gave birth to her first child ten days ago,
and was taken, without known couse, five days afterwards with con-
siderable uterine hemorrhage. The midwife had used some remedies
without success. I found the patient feeble, pale, with lumbar pains,
small and rather frequent pulse, general depression, unquiet sleep,
and syncope whenever moved in bed. I ordered the powders of
iron (210 grs ) and cinnamon (8 grs.), divided into twenty doses.

The hemorrhage ceased at 11, P. M. She had commenced taking
the powders at noon ; one every half hour, and then every hour.
Broths, herb tea, analeptics, &c, completed the cure.

Case 10. C , aged 31 years, lymphatico-sanguine tempera-
ment, good health until the end of October, 1844, but menstruated
too freely. Was left quite feeble after each period. She consulted
me in April, 1845. Notwithstanding her weakness, she still had
some appetite. Digestion laborious; alvine discharges natural;
pulse small and frequent ; sleep good ; pain in loins and hypogastri-
um ; other functions normal. I prescribed the powders in doses
similar to the preceding case ; one dose to be taken the two days
preceding menstruation and during the three first days of its exist-
ence. The desired effect, was secured; the flow was less copious,
general health better, digestion improved. The remaining doses
were taken before the next return of menstruation in order to regu-
late it. The result was satisfactory, as I had anticipated.

Case 11. On the 23d May, 1845, I was summoned to see Miss

L. B , aged 24 years, of a sanguine temperament, robust, and of

good health. She was taken in the night, without known cause,
with very great uterine hemorrhage. I found her feeble, paie, agita-
ted, rigors followed by heat, small, contracted, but resisting pulse,
thirst, pain in loins and hypogastrium, &c. The hemorrhage still
continuing, I gave her the powders. On the morning of the 26th
the flow was arrested, and health gradually restored.

Case 12. Mrs. M , 27 years of age, had two children, en-
joying good health, save that the menstrual flux is excessive, and
continues five days, being followed by debility and prostration. In-
deed her state was rather one of hemorrhage than of menstruation.
I ordered her 60 grs. carb. fer. with 8 grs- pulv. cinnamon, to be
divided into four doses one to be taken at night in a little sweeten-
ed water. The first doss diminished the flux; the second lessened
it one half. My object being simply to diminish the discharge, my
design was attained.

43 Sub. Carbonate of Iron in Uterine Hemorrhage. [January,

Case 13. A female, asthmatic, was taken a fortnight after par-
turition, with violent uterine hemorrhage. I found it very difficult to
control, by refrigerants, cold lotions to the abdomen and hands ; it
would always return in a few days. I was obliged to resort to the
sub-carb. of iron in large doses. Since then the hemorrhage has not
returned, although convalescence was very slow.

In 1839, I saw a lad 13 years of age, feeble, and who suffered with
epistaxis every day for about an hour, which left him weak and deject-
ed, and finally caused his death. Had I then known the use of the
sub-carbonate, he might have been saved.

In 1S44, I attended Mrs. D , 32 years of age, of a sanguine

temperament, who had been bleeding at the nose several days. A
physician thought her case fatal, such was her state of anaemia. Her
blood was pale, for she had lost at least four or five pints of it. I
ordered her ISO grs. sub-carb. fer. and 15 grs. pulv. cinnam., to be
divided into twenty doses; one of which to be taken every two hours.
The first doses arrested the epistaxis. All known remedies had been
previously used in vain.

The details of my cases may appear too scanty : but I have fur-
nished only the prominent facts, in order not to lengthen this commu-
nication. These cases demonstrate that the sub-carbonate of Iron
is a good haemostatic remedy in uterine hemorrhages, even in those
which proceed from the presence of the ovum or its appendages.
(See case 7.) In all the other cases, the flow ceased in two or three
days, and in one of them in ten hours-

The 10th and 12th cases will show that the remedy maybe useful
in excessive menstruation ; that it may moderate and even regulate
it. They all teach us that it can be used without hazard. I know
that we should not be too exclusive ; but, for my part, I prefer this
preparation because it is not disagreeable when taken with a little
cinnamon. It is necessary to have a good article. M. Bertholet,
apothecary at Grandson, has prepared it for me very skilfully, and it
always acts satisfactorily.* It will be remarked, that the doses do
not vary much, and that they were given at greater or less intervals,
according to effect. We need no longer be afraid to give it in acute
uterine hemorrhage, since it is not an emmenagogue as stated in
works on Materia Medica. Nothing but observation could have
convinced me of its opposite effects. I am therefore authorized to
state that the sub-carbonate of Iron is not an emmenagogue ; but,
on the contrary, arrests and moderates the menstrual flux will ar-
rest internal hemorrhages, and, in short, is a powerful haemostatic
agent. Let this active agent no longer be dreaded. I furnish these
cases in the hope that they may prove useful to that extensive class
of practitioners whose first object is the relief of their patients.

* The Precipitated Carbonate of Iron of our shops, when well prepared, is a
very fine preparation of the remedy here recommended.

1S4C] Bibliographical. 49

BIBLIOGRAPHICAL NOTICES.

Elementary Chemistry, Theoretical and Practical. By George
Fownes, Ph. D., Clinical Lecturer in the Middlesex Hospital Med-
ical School, and to the Pharmaceutical Society of Great Britain :
edited with additions, by Robert Bridges, M. D., of Philadelphia,

Is the title of a new work, published by Messrs. Lea & Blanchard,
and designed as a manual of Chemistry for the American student.
It is no easy task, in the present rapidly advancing state of this de-
partment of science, to pass over the whole field of discovery and
improvement, and select from the constantly accumulating mass of
materials, the most important facts and principles, giving a subordi-
nate place to those of confessedly less value or of more equivocal
pretensions, and embodying, classifying and condensing the whole,
into an octavo volume of 450 pages.

This desideratum, however, has been happily attained in the
excellent compendium of Professor Fownes, and while, as a book of
reference for the experienced chemist, or for the advanced student
who has leisure to read extensively, the more elaborate works of Gra-
ham or Kane, might be recommended, yet we know of none within
the same limits which has higher claims to our confidence as a college
class book, both for accuracy of detail and scientific arrangement.

The author has availed himself of the latest researches in inorganic,
as well as organic chemistry, and has enriched the latter division
of his work especially, by many contributions from the invaluable
labors of the celebrated Liebig. In short, the whole work, having
passed approvingly under the supervision of its able American edi-
tor, Dr. R. Bridges, is a sufficient guarantee of its scientific value.

A. M.

Manual of Diseases of the Skin, from the French of M. M. Cazen-
ave and Schedel; with notes and additions by Thomas H.
Burgess, M. D.. &c. Revised and corrected, with additional
notes, by H. D. Bulkley, M. D., <&c.

The above work has just been issued from the press of J. & II.
G. Langley, of New-York, who have kindly furnished us a copy of
it. We are happy to see a work calculated to be so useful, issued
in such good taste and convenient form. Diseases of the skin have
attracted but littie attention with the great mass of our practitioners,
and we know of no book better adapted to facilitate their study and

4

EO Case of Hermaphrodism* [January,

treatment than the one before us. The authors are practical men,
and had in the preparation of their Manual the invaluable aid of
Biett's experience and sound judgment. Indeed, the work may be
considered as incorporating the views and practice of this most emi-
nent teacher, with all that was valuable in the works of Bateman and
Willan. We cordially recommend it to the profession. D.

PART III. MONTHLY PERISCOPE.

Case of Hermaplirodism. Mr. Grigor, of Nairn, states that when
called on some years ago to reduce a large inguinal hernia in a poor
woman, he was surprised at feeling "a penis-like organ (clitoris)
becoming erect." "The woman died on the 4th April, 1845, aged
50. After some difficulty, I obtained leave to make a limited exam-
ination of the dead body ; which I did on the 6th. Time and oppor-
tunity were not afforded me of making so careful an inspection as I
could have wished.

" An immense inguinal hernia, enclosed in a scrotal-like bag, near-
ly covered the upper third of the left thigh; and on the contents
being returned into the abdomen, it remained large, and like what a
scrotum would have been in similar circumstances. I believe it,
however, to have been the left labium major, though I certainly
could distinguish little or no trace of a right one. There was a right
inguinal hernia ; but it had not descended below the external ring.
The pubes was well covered with hair. The penis-like organ,
though tightly bound down by the framum, measured an inch and a
half; its gland was imperforate, and the prepuce could not be drawn
over the gland ; the corona, gland, frcenum, and prepuce, were all
very distinct. A little below the penis-like organ, there was a quill-
sized foramen. No trace of a vagina was seen ; and in addition to
what has been described, along-looking perineum, with some relax-
ed integuments, formed the external genitals. A probe introduced
into the foramen passed downwards for about an inch and a half;
this passage was laid open by cutting through the skin and a few
muscular fibres. The urethra proper and vagina were in this way
made visible ; they were situated nearer the anus than was normal,
and thus obliterated the perineum. The vagina was capable of great
dilatation; was about three inches in length; and terminated in a
cul de sac. The uteruu was a mere rudimentary organ, barely ca-
pable of admitting a crow-quill ; it contained a small quantity of
mucous. I could distinguish neither ovaries nor Fallopian tubes;
but observed very large, round ligaments. The other contents f
the abdomen, so far as I saw, presented nothing worthy of remark.

1346.] Therapeutical application of Electricity. 51

The mammary glands were not to be seen ; and the nipples were
diminutive. The thyroid cartilage was prominent. The pelvis was
small. The outline of the bones was prominent. The muscles were
well developed.

"This pauper was not seen by any medical man in her last ill-
ness ; but I am inclined to think that she suffered, before death, from
symptoms of strangulated hernia. I have ascertained that she was
never known to have had vicarious menstruation, or amorous desires.
When I first saw the external genitals and bodily configuration, I
believed this person to have been as much male as female ; and al-
though the preponderance of female organs may entitle her, in popu-
lar language, to be called a woman, yet, in strict scientific phrase,
this lusus natures must be termed neuter, because the essential organs
of both sexes the testicles and ovaries- were wanting.

"In jurisprudence this person would be regarded as a female; for
Coke thus lays down the common law : 'Every heir is either a male
or a female, or an hermaphrodite ; that is, both male and female.
And an hermaphrodite shall be heir, either as a male or female, ac-
cording to that kind of sex which does prevail.' (Coke, Littleton 8,
a.) I apprehend that at birth, and indeed during the whole of her
life, it would have been difficult to have determined which sex truly
preponderated ; and this case is certainly one of those which would
during the life of the subject be apt to puzzle the investigations
of the medical jurist." [The London and Edinburgh Monthly
Journal of Medical Science. Dublin Journal.

On the Therapeutic application of Electricity. By Dr. Ch. de
Puisaye. (Translated.) The work of M. Puisaye deserves attention,
because it furnishes us the remarkable results obtained by M. Magen-
die from Electro-acupuncturation. We can however, at present only
give the conclusions to which the author arrives, viz :

1st. In idiopathic neuralgia, especially of the face, galvanism
should be regarded the most valuable remedy.

2d. In paralysis of the organs of the senses, the diagnosis being
well established, galvanism is highly beneficial.

3d. In idiopathic paralysis, especially of the face, electro-punctu-
ration never fails.

4th. In anesthesia of the face or limbs, when dependant upon a
modification of nervous influence without appreciable lesion of the
nerves, we must resort to galvanism.

">th. In affections of the voluntary motor system, before resorting
to means, the inadequacy of which is but too well known, electricity
shouid be employed.

Gth. Lastly, even admitting that these diseases might be relieved
by other means, electricity possesses the advantage of being more
convenient to the physician and agreeable to the patient. [Arch.
Generates de Med., Sept., 1845,

52 Scarification of the Gums. [January,

Scarification of the Gums Reasons for it. Dr. Marshall Hall
says that there is no practical fact, of the truth and value of which
he is more satisfied than that of the effect and efficacy of scarifica-
tion of the gums in infants, and not in infants only, but in children,
"The process of teething," he observes, "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 ac-
tivity. 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
general vascular system, and there are, too frequently, convulsions
of various degrees and kinds, manifested in the muscles which move
the eyeball, the thumb and finger, the toes, the larynx, the parictcs
of the respiratory 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 of 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 actions? I think not. The real source of these phenomena
is in the entire dental system, in which actions of unusual energy
and extent are going on sub-inflammatory 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 emanate
is, I believe, not as is generally imagined, the nerves of the mere
gums seated over the prominent parts of the teeth, but the nerves
which may be emphatically termed the nerves of the teeth themselves,
the nerves which enter into the very fangs and substance of the teeth.

" It is to the base of the gums, not to their apex merely, that the scar-
ification should be applied. The most marked case in which I have
observed the instant good effect of scarification was one in which all
the teeth had pierced the gums !

"This view of the subject may assist in removing the futile ob-
jections of some who have, without due consideration I am convinced,
opposed my plan of frequent, often daily, scarification of the gums,
to whom I would say, as my sole reply : Better scarify the gums un-
necessarily one hundred times than allow the accession of one fit or
convulsion from the neglect of this operation, which is equally im-
portant in its results and triflingjn its character.

" And it is not merely the prominent and tense gum over the edges
of the teeth which should be divided ; the gums, or rather the blood-

1846.] Salicine icith Quinine in Intermittent Fever. 53

vessels, immediately over the very nerves of the teeth, should be scari-
fied and divided, as you would divide the vessels of the conjunctiya
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
in urgent cases even twice a day. I would here repeat my maxim :
Better do this one hundred times unnecessarily than have one single
fit from 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 so trifling, the
other so momentous." [London Lancet.

Comparison of Salicine with Quinine in the treatment of Inter-
mittent Fever. Our readers have already been informed that the
Surgeon-General of the United States Army has issued an order to
the medical corps, to give a fair trial to salacine, (the ext. of willow
bark,) in the treatment of fevers. Dr. E D. Fenner, one of the
editors of the Xew-Orleans Medical ^id Surgical Journal, and one of
the physicians to the Charity Hospital of that city, has just concluded
his experiments with this article. From the last number of this
Journal, we make the following extract :

Thus have I given careful observations, of the effects of salicine
in twenty cases of intermittent fever, taken promiscuously, and all
occurring within a short period. I had commenced its use in two
other cases, and would willingly have reported a much larger num-
ber, but desisted on account of the expense of the remedy. Perhaps
no place in the world presents greater advantages for observations
upon this disease than the N. O. Charity Hospital. It is very tedi-
ous either to prepare or to examine reports of this kind ; but if faith-
fully executed, they offer the best medium of information, both in
regard to the effects of remedies, and the nature and progress of
disease. It is hoped that these twenty cases will prove in some de-
gree instructive. Let us sum up their results, and see what conclu-
sions they will authorize. Although these statistics may not be
mathematically exact, they are sufficiently so for our purpose.

Total amount of medicine given in the '20 cases ; salicine gvii, 5vi,
3ii; piperine, 5i 3ii; quinine 3 iv.

Largest amount given in any case ; salicine 5vii; pipeline, 3iss;
quinine, 5iii, 3i.

Smallest amount given in any case; salicine, 3i,grs. x; pipeline,
grs. xii ; quinine, 3ii.

Averag of salicine to each patient, 5iii, grs. viii.

It was first tried alone, in all the 20 cases.

54 Salicine with Quinine in Intermittent Fever. [January,

It succeeded when given alone, in 11 cases.

It failed when given alone, in 9 cases.

Of these, it succeeded when combined with piperine, in 4 cases.

Quinine had to be resorted to in 6 cases.

Average time of sickness previous to treatment, 1\ days.
Do " " under treatment 6^ days.

Greatest number of paroxysms, after salicine was commenc'd, 6 days.

Smallest " " " 0 "

Average " " " " " 9 "

There were one or more paroxysms after salicine was commenced,
in 14 cases.

There were none, in 6 cases.

I am informed by the Apothecary of the Hospital that the cost of
salicine was $2 00 per oz. Consequently, the value of the amount
used in these 20 cases (say 7^ oz ) was about $15 50; and of the
average amount given to each patient, (say 3iii.) 75 cents. The ar-
ticle appeared to be fresh and genuine.

I prescribed it in the forms of solution, powder and pill ; in doses
varying from five grains, to one drachm ; and at intervals of from
one hour to twelve.

The general efFects of the comedy appeared to be tonic and dia-
phoretic. The appetite and strength were generally improved, and
the sweating was profuse. I observed no unpleasant effect that I could
attribute to the remedy. Where it failed to do good, it did no harm.

Comparative statement of 20 cases of Intermittent Fever treated
with the sulphate of quinine. After the foregoing observations on
the use of salicine were completed, I resolved to note 20 cases of
intermittent fever treated mainly with quinine ; with the view of as-
certaining the relative efficacy and cost of the two remedies. Twenty
recent admissions were taken throughout the wards of the Hospital,
and of course under the care of different physicians. Upon inquiry
I found that no two of them administer the remedy alike; some of
them prescribe it in large doses, and at long intervals ; others, the
reverse ; some give it alone ; others, in combination with blue mass,
opium, or morphia. As minute notes were taken of these 20 cases,
as of the preceding ; but for wearying the reader, I will only give the
results, and the conclusion to which they brought me.

Whole amount of quinine used in the 20 cases, about giss.

Largest amount given in any case, 3i.

Smallest amount given in any one case, grs. xviii.

Average amount of quinine given to each patient, xxxvi. grs.
It was given combined with sulph. morphia, grs. xii, to gr. , in 2 cases.
" " with ext. opii, grs. xviii, to gr. i, in 4 cases.

" " with blue mass: grs. vi, to grs. x, in 1 case.

" " alone in 13 cases.

All the cases were promptly cured.
Average time of sickness before admission ; 10 days.

" " after 4

1846.] Arsenic in Intermittent. Fever. 53

Greatest number of paroxysms in any case afi quinine, ~ days.

Smallest " " " ' " " " 0 "

Average number of paroxysms, 35 "

There were one or more paroxysms after taking quinine, in 19 cr.sis.
There was none in 10 cases.

The cost of quinine was 83 25 pr. oz., consequently the value of
the whole amount used in these 20 cases [say l-h oz.] was 84 87i,
and of the average amount, (say 36 grains.) about 25 cents.

Candor compels me to state that the cases treated by saiicine were
generally more severe, than those treated by quinine; it will be re-
collected that one of them was so malignant as to be with difficulty
saved by upwards of 3iii of quinine, after having previously taken
5 iiiss of saiicine. The saiicine cases occurred chiefly in the months
of June and July, when intermittcnts usually assume their worst
form ; the quinine cases all occurred about the first of October,
when the disease is generally mildest. These circumstances arc
worthy of grave consideration, lest we be enduced to underrate the
actual virtues of saiicine. However, taking the two sets Gf cases as
they are presented to us in the foregoing comparative statement, and
reviewing the effects of the two remedies in their various combina-

fns before mentioned, we are brought to the conclusion that the
erage amount of quinine required to cure 20 cases of 'intermittent
fever, and costing 25 cents, is fully three times as efficacious as the
average amount of saiicine required in alike number of cases, and
costing 75 cents.

The comparison made in this instance cannot however be consid-
ered a perfectly fair one ; but when the foregoing reports are taken
in conjunction with others that will doubtless be made from the med-
ical department of the Army, they may aid in leading us to a proper
estimate of the virtues of saiicine. How many of the forego: ng
cases would have had their paroxysms broken up merely by the change
of residence, and attention to regimen, without any medicine whatever,
must remain a matter of conjecture. My own opinion is, there
would have been a goodly number. Hence the importance of exer-
cising a sound judgment and careful observation in regard to the ac-
tion and comparative value of medicines.

On the use of Arsenic in Intermittent Fevers. By M. Boudix.
We find in the Archives Generales de .Medicine, (.September, 1845,)
the notice of a paper sent to the Royal Academy of Medicine of Paris,
on the use of Arsenic in the treatment of Intermittent Fevers, from
which we condense the following facts:

. In the course of five years 2917 patients, of all ages, were subject-
ed to the arsenical treatment, without the occurrence of a solitary
accident attributable to the remedy. Upwards of 2000 of them had
been prcvicusly treated from one to ten times by quinine. Nearly
500 of them had been taking quinine, in vain, for several days previ-
ously. The cases treat wore taken promiscuously or
without selection, and at all seasons.

56 Dropsical Affections. Umbilical Hernia. [January,

The duration of the treatment was usually short, the cases rarely
resisting beyond the first or second dose of arsenic. Relapses have
been remarkably rare, which may be attributed to the continuance
of the remedy eight or ten days after the cessation of the fever. The
solutions of Fowler and of Pearson being rather inconvenient to pfe-
pare, Mr Boudin made use of a solution of arsenious acid (white
arsenic of the shops) in distilled water. The medium dose of arsenic
used was a fifteenth of a grain, given three hours before the expected
paroxysm ; but if the case seemed obstinate, this dose was preceded
by two other similar ones, at intervals of two hours. [Translated.

Dropsical Affections successfully treated with Sugar. We find in
the Gazette Medicale (11th Oct., 1845,) the notice of a collection of
cases recently published by M. Bagot, illustrating the beneficial effects
of sugar in dropsical affections. It seems to have been first used by
Dr. Gamier, who, towards the close of the last century, became
affected in the French West Indies, with ascites, for which he was
tapped three times, when, looking upon his case as hopeless, he in-
dulged an inordinate propensity to eat sugar. Finding that it agreed
with him, he soon made it his sole food, and, to his great astonish-
ment, found his disease rapidly giving way. He was restored to
perfect health, and the case published in Paris.

M. Bagot now reports about twenty cases, including almost every
variety of dropsy, even one of ovarian encysted dropsy, in which
sugar has been used advantageously. The brown sugar is thought
preferable to the refined, and should be used almost to the exclusion
of all other nourishment the quantity being increased from a few
ounces to a pound per day. The remedy is simple, and certainly
worthy of trial. [Translated.

Umbilical Hernia treated with adhesive bands. A recent No. of
the "Journal de Medicine de Bruxelles" contains the following de-
tails of Dr. Seutin's method of treating umbilical hernia in children :
"The hernia having been reduced, the surgeon places a small pad
over the orifice and retains it with his index finger, whilst with his
thumb and middle finger he draws up a fold of skin on each side of
it longitudinally. The band of adhesive plaster is then applied, one
end being applied by an assistant to the lumbar region, and held
there until the surgeon can carry the other end over the cutaneous
folds and pad, and finally to the opposite lumbar region. A roller
bandage is then passed several times around the abdomen in order to
secure the adhesion of the plaster, and may be removed in a few
hours. Mr. S. renews this bandage every two or three weeks, and
if an eruption is produced, one end of the piaster may be raised so
as to allow the application of a little cerate, without removing the
whole." [Translated.

Professor Dugas informs us that he has been in the habit of treating

1846.] Cauterization. Enlargements of the Tonsils. 57

umbilical hernia with adhesive plaster for the last six years, with
uniform success. Prof. D. does not, however, proceed as recom-
mended by Dr. Seutin, but simply carries a band of adhesive plaster,
three inches wide and from eight to twelve inches long, across the
abdomen, by first placing the centre of the plaster over the reduced
hernia, and maintaining it there with one hand, whilst with the other
he extends the ends to each side of the body, carefully avoiding the
formation of any cutaneous folds. In some cases another plaster of
similar dimensions is laid over the first, in order to increase the stiff-
ness of the application. In but one or two cases has Prof. D. re-
sorted to a small compress of old linen over the umbilicus. Accord-
ing to Prof. D., the plasters are to be renewed whenever they cease
to adhere firmly, or occasion an eruption in which latter case, the
plaster may be applied obliquely so as not to cover the same surface,
save that about the umbilicus, which may then be covered with a bit
of linen and simple cerate for a few days.

By thus applying to the skin a firm and unyielding covering, its
own elasticity is overcome, and the protrusion consequently pre-
vented.

Cauterization of the Pharynx. We are informed by the Journal
des Cohnaissances Meclico-Chirurgicales (October, 1845) that the
application of aqua ammonia, more or less diluted, to the pharynx,
by means of a small mop, was introduced into Paris, a few years
since, by a physician of Marseilles, who is said to have used it very
extensively. It is specially recommended in cases of asthma, and of
dyspnoea connected with emphysema, and not only affords prompt
temporary relief in most cases, but is said occasionally to prove per-
manently beneficial. Whilst the original employer of this agent
recommends the mop to be carried as far back as the posterior walls
of the pharynx, M. Rayer, who has resorted to it, alleges that serious
accidents may arise from this plan, and would limit its projection to
the confines of the soft palate. [Translated.

Might not this application be useful in croup and oedema glottidis ?

Efficacy of the Extract of " Brou de Noix"* in chronic enlarge-
ments of the tonsils. By Dr. Bkcker. A boy was effected with
an enlargement of the tonsils of some years standing, which had in-
creased so much as to affect the voice materially, and occasionally to
render, respiration almost impossible at night. The following solu-
tion was directed to be applied with a pencil :

ft. Ext. de Brou de Noix, . . 3i. ) lr a .
Aqua. Dist 5 'J* 5

The effect of this topical application was so rapid that the tume-
faction had entirely subsided before the whole of the solution had

* This is a remedy prepared by the French, by puttiDg one pari of the envelope
of the walnut into six parts ofwater,and boiling down I
dinary extracts.

Axillary Aneurism cured by Compression. [January,

been used. [Mediciniscks Zeitung and Jour, des Conxaisscnces

Medico-Ch'r., October, 1345. [Translated.

Axillary Aneurism cured by Compression. 3y Prof. M. Gold-
smith, of Castleton College, Vt, Ilr. Bellows, the subject of

this case, is a native of Vermont, healthy, but not robust, and 20
years of age. In the month of February last, while engaged in the
marble quarry at West Rutland, he received some fragments of mar-
ble, which were propelled by an accidental blast, into the anterior
and lateral portions of his right breast, and into the axilla of this
side. These wounds were not attended by haemorrhage, and inflam-
mation was developed about the small fragments of marble which
his attendant physician, on account of their minuteness, had been
unable to remove. For the first week or two, the case apparently
progressed favorably, but after ihe lapse cf three weeks, the patient
observed a small tumor in the axilla, which gradually increased till
he applied to Dr. Goldsmith, about the middle of April.

"At this time, 1 found," said Dr. G., "an aneurism of the axillary
artery, and apparently embracing it very nearly the whole length
of the vessel from the termination of the subclavian to the beginning
of the brachial. The tumor was somewhat irregular in shape, and
was observable by its lower extremity just below the tendon of the
pectoralis major. The tumor pulsated plainly when grasped in any
of its diameters, and ceased its pulsations when the subclavian was
compressed as it passed over the first rib. And it gave the aneurysm-
al thrill. The circulation was free but not strong in the brachial
artery, and the pulse could be felt at the wrist."

In the opinion of Dr. G., the aneurism was of the false variety, like
those which sometimes occur at the bend of the elbow from venesection.

" As the situation of the tumor was such," Dr G. remarked, " that I
could apply a compress upon the artery, at a point between which
and the tumor there was no branch given off, I determined to try the
effect of permanent compression. For this purpose, I used the com-
mon screw tourniquet, with three pads, to make the pressure on cer-
tain points, leaving the rest of the arm uncompressed. I put him upon
the use of antimony and digitalis, and with these drugs I was able
most of the time to keep his pulse reduced from the natural standard
74, to between 45 and 55. I kept up the compression during the
term of seven weeks; and for four, kept him under the influence of
antimony and digitalis."

The pulsation in the tumor grew more feeble from the first appli-
cation, till it disappeared on the 15th day. The tumor diminished
in size until it was about as large as a pigeon's ^g^i, when he was dis-
charged. This was about the size of the tumor when the patient
was presented to the Society. The tumor felt dense and membran-
ous, and the circulation is restored, though feeble, in the brachial
artery. This probably is through the medium of the recurrent
branches at the elbow.

1846.] Axillary Aneurism cured by Compression. 59

Preceding, during, and after the medical and surgical treatment,
the patient, besides the attendance of Dr. Goldsmith, was seen and
examined repeatedly by Dr. Sheldon, of West Rutland ; Drs. Porters,
of Rutland ; Dr. Northrop, of Castleton ; and Professors Perkins,
Parkman and Carr, of the Medical College.

Remarks. The successful event in this instance ought to be re-
garded as one of the most brilliant achievements of modern surgery.
A proper estimate of its importance can be made by a consideration
of the amount of pain and anxiety which was saved to the patient,
and the degree of risk to which his life would have been exposed by
the ordinary method of tying the subclavian artery. The former
can be realized only by those who have suffered or are about to suffer
from similar and hazardous operations. The sum of danger avoided
can be ascertained with a tolerable degree of certainty by reference
to Dr. Norris's table, showing the mortality following the operation
of tying the subclavian artery, contained in the July No. of the
American Journal of Medical Sciences. The table contains a report
of sixty. nine cases in which the subclavian artery was the seat of
the operation by the Hunterian method; and "of these sixty -nine
cases, thirty-six recovered and thirty-three died,'''' nearly one half
thus proving fatal. If Dr. Goldsmith had immediately proceeded to
the operation of tying the subclavian, and thereby subjected the
young man to the unavoidable torture incident to such an occasion,
and, at the same time, subjected him to an equal risk of losing with
saving his life, the profession and the public would have been satis-
tied ; and, if the event had proved favorable, the act would have been
lauded as a splendid affair. As it is, the case has hardly excited any
notice or attention. It has been very justly remarked by a distin-
guished European surgeon, that a surgeon, on commencing an oper-
ation, ought to feel chagrined because he was compelled to do like a
savage what he had not knowledge sufficient to accomplish like a
skilful man.

In the case under consideration the cure was very judiciously at-
tempted by the combination of medication and pressure. By making
the pressure on the distal side of the tumor, it is believed, Dr. G. is
unprecedented, especially in case of axillary aneurism.

M. Vernet attempted this method in a case of inguinal aneurism ;
but the pulsations were so increased, and the inconvenience so great,
that it had to be abandoned. " This method," remarks Velpeau, 'mas
been generally blamed, even by those who have adopted the idea of
Crasdor on the subject of ligature ; but yet it does not seem worthy
of entire rejection. If, tor example, it wore necessary to treat an
aneurism, above which it would be impossible, or at least highly dan-
gerous, to apply compression or ligature; ii^ on the other hand, no
important branch were furnished between the cardiac extremity and
the free part of the tumor, it is by no means certain that, by com-
pressing the artorv on this latter point, you will not succeed in sus-
pending the circulation in the aneurism, in occasionmg the formation

60

Hydrocele. Ukers.-Iod. Pot.-Laryngismus. [January,

of solid coagulum in its cavity, and, in short, of produciBganob.it-
cration of the arterial canal, and a perfect cure of the disease

That which this eminent and learned French surgeon conceived I o
be barely possible, has been shown in the present case to be no only
possibU, but safe, easy, and practicable And in fact, th Nn>
taken in connection with four or five other cases ,n -^J
recently been accomplished by compression made on the artery be-
Iween he tumor and the heart, intimate in the strongest manner that
he ancient method of cure by pressure has too soon been proscr .bed.
And when it is considered that these cures by compression hate oc-
airred in succession in different hospital* and.under the care of
oZent surgeons, we have reason to believe that the ear y plan of
cure by pressure will be revived, improved, and probably, by an
adoption to some extent, of the method of Valsalva, -
many cases, the modes of Anol, Hunter or Brasdor.-rSo**0" Med.
and Surg. Journal.

Radical cure for Hydrocele^ A. A. ^"y^^.
employed the following plan of curing hydrocele : First discharge
the fluid with a trochar, or pocket lancet, and then apply a warm
vine poultice all over the'scro.um, in order to bring on inflamma
tien which generally takes place in a few hours, and becomes painful.
X: sufficient inflammation has been excited, -move the vinegar
noultice and applv a bread and milk poultice. In a short time, the
2B gen-ally subside, and the cure is complete.
Give a few smart doses of purgative medicine. [Lancet.

Treatment of Scrofulous Ulcers.-*. Brefeld praises very highly
the following ointment, which he uses spread on lint, in the treatment
of scrofulous ulcers :

Cod-liver oil, . 15

Euphorbii, . . . 8 u{x__Jour,dePhar.etdeChi,n.

Lard,

Adulteration of Iodide of Potassium. M. Destouches found in
some dide of potassium derived from Paris 22 per cent, carbonate of
potash. The preparation was milk-white, turned red himus-paper
strongly blue, and effervesced with weak ac.ds.-[* rom Journ. de
Pharm. Am. Journ. ofPharm.

Cure of Laryngismus Stridulus, by Cod-liver 00. M. E. Roesch
in HufelLd's Journal*, xc. gives several rases of th.sdisease cured by
cod fiver nil, in doses of a delert-spoonful four times a day. In some
other means were previously tried without the least benefit . rha Mite
concludes, from the rapidity of the curc.that enlargement ol the thymus
"land could not have been the organic cause ol the disease and he |.e-
fieTe , Thatt he curative effect of. he cod-liver oil is duo to Us joe, a-
t^igestion,*** improving the tone of the constitution, and thus

1846.] Bronchocele. Urinary Calculus. Quinine. 61

causing the nervous system to exercise only its normal influence.
Dublin J urnal.

Bronchocele. Dr. B. R. Morris calls attention to rheumatism a3
an occasional cause of goitre, and relates three cases of the disease
which he attributes to that cause. In one of these cases a cure was
effected by the use of half a drachm of hydriodate of potass in an
ounce of soap liniment, rubbed into the tumor every night. [L. and
E. Month. Jour. Med. Science.

Mercury found in the centre of an Urinary Calculus. Professor
Malago having removed by lithotomy a calculus weighing about four
ounces from the bladder of a man 18 years of age, presented the
stone to the Academy of Ferrara, with the request that it be analysed.
Three persons were appointed by the learned body to effect this.
M. Agostino Galli, one of the chemists, found in the calculus an
unctuous substance, animal matter, urate of ammonia, ammoniaco-
magnesian phosphate, uric acid, lime, and, lastly, a substance of a
dull, yellow color, which resisted the tests used. This substance
having been treated with distilled water, and placed on a filter, four
distinct globules of mercury could be seen with the naked eye, and
other much smaller ones with the aid of a magnifying glass. As the
other analists had not made the same observation, and as it was sup-
posed that the mercury might have been derived from some of the
tests used, another committee repeated the researches, and obtained
the same results, save that the quantity of mercury was much less.
After having indulged in a thousand conjectures on the origin of the
mercury, M. Malago ascertained that the young man had, when
about seven years of age, used mercurial frictions for a long time
for a lymphatic tumor. [II Filatre Sebezio, and Jour, des Connais-
sances Medico -Chir., October, 1845. Translated.

Fcrrocyonate of Quinine. If by the term Quininism, here used,
the author means to designate the disagreeable deafness, ringing in
the ears, and roaring in the head, with which some persons are nearly
always affected by the sulphate of quinine, we would respectfully add
to the valuable suggestion of Prof. Mitchell, of giving it by the skin
or rectum, with the view to avoiding them, the superior advantage
of the fcrrocyonate of quinine. This form of the medicine seems to
exercise all the febrifuge and antiperiodic virtues, without producing
the disagreeable effects above mentioned. It is much prescribed in
this city, in cases where the head or stomach cannot bear the sul-
phate. We very recently had an opportunity of witnessing its good
effects in a case of malignant intermittent, associated with painful
dysenteric symptoms. The gentleman formerly resided in the mala-
rious Western District of Tennessee, where he had occasion to learn
that whilst the sulphate of quinine displayed, upon his system, its
usual beneficial influence, in breaking up the paroxysms of fever, it

62 Poisoning by Cherry Kernels. [January,

at the same time, produced temporarily the most distressing effect
upon his brain. He apprised us of this, but we deemed the remedy
indispensable, and prescribed a scruple of it, in five grain doses, on
the well day ; to be repeated the following morning. When we call-
ed on this day, we found that he was omitting the quinine on account
of its distressing effects upon his brain the previous evening ; he had
been made almost perfectly deaf. As we could not persuade him to
continue it, we warned him of the consequences, and advised him to
keep himself warm. But the paroxysm came, and he got through it
with such difficulty as to leave but little doubt that another would be
attended with the most imminent danger. With the concurrence of
Dr. Stone, who was now called in consultation, we determined to give
the ferrocyanate, in five grain doses, every two or three hours during
the intermission. The patient was now sufficiently alarmed to be
perfectly submissive ; he asked no questions, nor made any remon-
strances. We gave him about half a drachm of the ferrocyanate in
this manner, with the most satisfactory result. He had no return of
paroxysm, and could scarcely be made to believe that he had been
taking any form of quinine, so free had his head been from its usual
effects. [Dr. Fcnner, in N. O. Med. and Surg. Jour.

Poisoning by Cherry Kernels. A daughter of a widow, ast. five
years, ate a considerable quantity of the kernels of sweet cherries
(prunus avium.) Her brother, a few years older than herself, also
ate some. After the lapse of a few hours, symptoms of poisoning
appeared. When the author was called the next clay, he found the
girl so comatose, that she could not be roused by any means. The
eyes were closed, pupils considerably dilated, the skin moist and hot,
respiration exceedingly hurried, pulse small and quick, urine and
faeces discharged involuntarily; the child very restless. A satura-
ted solution (probably citric acid, with a carbonate of potash) was
ordered internally, and cold fomentations to the head externally ;
after a few hours, vomiting of a greenish mass ensued, and was fol-
lowed by retching, which lasted till death ; the body was spasmodic-
ally contracted backwards. The illness lasted forty hours. On the
postmortem examination, the stomach externally was normal, and
internally rather swollen and reddened ; the intestines were strictured
and invaginated, but there was not any inflammation. The liver,
spleen, and large vessels, contained black tar-like blood. The boy,
who had eaten fWver cherry kernels, became likewise ill, but recov-
ered in the course of a month. An eruption analogous to urticaria,
came out on the fore-arms of both children ; they were both perfect-
ly well (according to the statement of the mother) before eating the
cherry kernels, and no other cause for the attack could be assigned.
The kernel of the prunus avium (cerasus nigra MM.) containing
amygdaline, and developing prussic acid, with ethereal oil in the
stomach, is a very remarkable occurrence, and one which ought to
serve as a warning. [London Med. Times, from Mertens of Wan-
groweit in der Med. Zeit.f. Heilkunde, Prussic Med. Ex.

1346.] Squill, Milan Flies, Mercurial Ointment, 63

Squill. Squill obviates some of the ill effects of opium. If an
aperient be added besides, the good effects of opium may often be
obtained when it would otherwise be inadmissible.

ftPulv. opii: pulv. scillae, aa gr. iii.; aloes; conserve rosae, aa

gr. ix. Fiat mass, divid. in pill. vi. eequales. Sign, opiate pills,

two at bed time.

We have remarked very beneficial results in cases of chronic ill

health with tendency to dryness of the skin, from the continued use

of such combinations as the following. Besides its diaphoretic effect

it should be regarded as alterative.

ft Resinae guaiaci ; extract, gentianae, aa 5i.; pulv. ipecacuanhas,
gr. xv. Ft. mass, divid. in pill. xxx. aequales. Sign, tonic al-
terative pills, two twice a dav.
Or, if an aperient be required, aloes may be substituted for the
gentian, and then the combination will somewhat resemble the pulv.
aloes comp. of the London Pharmacopoeia.

A simple and very effectual treatment of the less severe bowel
complaints, so apt to prevail at this season, is the following :

ft Sulph. magnesias, gss ; aquas menthae, gvi. Solve. Sign, a

wine-glassful to be used at intervals of an hour, till the bowels

have been distinctly acted on by the medicine, and then a pill

containing one grain of opium is to be taken.

Even where the pain is considerable, and the case threatens to be

severe, this simple plan often succeeds. [Northern Jour, of Med,

Milan Flies (ceretto vesicatoris) Formula of Terrari. Several
formulae for this preparation have been recently published, and are
much employed. The following I owe to M. Pessina, of Milan, cor-
respondent of the Societe de Pharmacie of Paris, and I think it good :
Take choice Colophon, clear Turpentine, aa 135 gram.
Melt and add :

Finely powdered Cantharides, 90 gram.
Euphorbium powdered, 15 gram.
Mix carefully with the melted mass, and then add,

Liquid styrax, 15 gram.
The plastic mass is spread hot on black taffetas, to about the
thickness of a shilling.

N. B. In summer the quantity of colophon should be increased,
and the turpentine diminished. Journal de Pharmacie et de Chim,

Preparation of Mecurial Ointment. M. Heusler recommends the
following method : 6 oz. of Mercury, 2 oz. of Suet, and 6 oz. of
Lard, are rubbed together in a shallow iron mortar with the addition of
about a drachm of sulphuric ether at intervals, until all the globules
have disappeared.

The process occupies about three quarters of an hour, and the
quantity of ether required is about 7 drachms. Jahrb, fur Prakt,
Pharm. and Chan, Gaz.- Am. Jour, Pharm.

C4

Medical Intelligence. Meteorological Table,

MEDICAL INTELLIGENCE.

Gazette Medicate. "We observe in one of the last Gazettes Medicale de Paris,
that it was about to be sold at auction. Its chief Editor, M. Jules Guerin, states
that he had a difficulty with one of the sub-editors, and that the court had de-
cided against him. He could not tell who would be the future conductor of the
Journal, but intimates that there woutd probably be no change, and that it
would still be managed by him.

Impure Medicines. We notice that the College of Pharmacy of New York,
has recently detected the importation of impure Opium and Blue Mass; the
latter from the house of Mr.Wm. Baily, of Wolverhampton, England.

Obituary Notice. It is with sincere regret that we have to announce the death
of Dr. James Johnson, of London one of the most distinguished men of the
age, and long and extensively known as the Editor of the Medico-Chirurgical
Review. He died at Brighton, on the 9th of Oct., in the G9th year of his age.

METEOROLOGICAL OBSERVATIONS, for November, 1845, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

c

<

Thermo
Sunrise.
53

METER.
3, P.M.

Baro>

Sunrise.

IETER.
3, P.M.

Wind.

Remarks.

1

73

29 84-100

29 70-100

Cloudy sprinkle last night.

2

61

70

" 40-100

30-100

w.

Fair at 12, M. heavy blow.

3

46

58

" 36-1001 " 37-lOOi

w.

Fair.

4

4L

58

" 49-100

" 50-100

N. W.

Fair.

5

34

60

" 60-100

" 01-100

s. W.

Cloudy sprinkle.

6

54

71

i " 71-100

" 71-100

s. w.

Fair blow.

7

44

62

1 " 75-100

73-100

s. w.

Fair.

8

48

(il

" 52-100

" 41-100

w.

Rain 4^-10 inch.

9

38

52

, t( 63-100

< 72-100

N. W.

Fair.

10

30

62

" 82-100

44 81-100

N. W.

Fair.

11

32

57

" 80-100

" 78-100

S.

Cloudy.

12

34

63

14 82-100

44 84-100

N. W.

Fair.

13

33

66

44 94-100

" 97-100

N. W.

Fair.

11

34

67

" 91-100

" 86-100

W.

Fair.

15

42

67

" 80-100

44 84-100

N. W.

Fair.

16

36

70

" 80-100

44 80-100

s. w.

Fair.

17

39

70

44 80-100

80-100
44 80-100

s. w.

Fair.

18

46

76

44 80-100

s.

Fair.

19

55

68

44 90-100 " 90-100

w.

Fair.

20

42

65

44 87-100

44 78-100

s. w.

Cloudy.

Jl

38

70

44 07-100

" 63-100

w.

Fair.

22

38

65

" 70-100

44 70-100

w.

'Fair.

23

52

56

! 70-100

<: 66-100

i X. W.

Rain 3|-10 inch blow.

21

32

56

! " 95-100

30 3-100

i N. E.

Fair.

25

29

60

30 15-100'30 15-100

N. E.

JFair.

Cloudy.

26

34

56

30 5-100

29 87-100

N. E.

27

41

54

129 55-100

29 59-100

N. W.

Fair heavy blow.

28

28

48

29 82-100

29 90-100

N. W.

Fair.

29

26

49

30 10-100

30 9-100

N.

Cloudy.
Cloudy.

30

32

<0

30 7-100 29 90-100

N. E.

21 Fair days. Quantity of Rain, 8-10 of an inch.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I] NEW SERIES. FEBRUARY, 1846. [No. 2.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE V.

Arc account of the operations of Lithotrity and Lithotripsy in the
United States, with a successful Case. By Paul F. Eve, M. D.,
Professor of Surgery in the Medical College of Georgia.

A brief historical notice of the operations for crushing stone in
the bladder, that have been performed in our country, it is thought
would not be uninteresting or unacceptable to the profession ; and be
also a suitable introduction to the first case of the kind in which it
is believed, this method has been successfully resorted to, in the
South-west.

The word Lithotrity is derived from Xi0o$, a stone, and Tirpau, or
Tepcco, I pierce that of Lithontripsy, or Lithotripsy, from \id6s, a stone
and TpiSa, I pulverize, or Tpinrrw, 1 crush, or T>t7nS, pulverization.
The first designates the operation which Civiale established twenty
years ago, and consisted in repeatedly drilling holes through a calculus
in the bladder ; and the latter term we apply to the more recent one of
crushing the stone directly and at once, without previously piercing it.

About the year 1820, a regular series of experiments were com-
menced in the city of Paris, having for their object the destruction of
stone in the bladder without resorting to cutting instruments. To
obviate the necessity of so dreadful an operation as that of lithotomy,
and to remove urinary calculi by some other method, was, it is well
known, no new idea ; but these attemps were the first which led to
useful practical results. Those who became famous and honorable
by these investigations were Civiale, Le Roy, Heurteloup, and
Jacobson.

There have been practiced three modifications for destroying urin-
ary calculi by a bloodless operation. The first by drilling, and the

66 Liiholrity and Lithotripsy. [February,

two others by crushing. The instrument originally invented, con-
sisted of a straight catheter, having within it a steel canula, whose
free extremity was split into three branches that closed when drawn
into the catheter, but expanded by the elasticity of the metal when
pushed beyond it. Introduced into the bladder, the branches were
gradually opened and the stone seized. Being thus secured, a rod
or stilet was passed through the steel canula down to the calculus,
and then as a drill it was set in motion by a bow attached to its han-
dle. This was called the lithontriptor of M. Civiale ; and with but
slight improvement was sucessfully employed for ten or twelve years.
It was with it, that the two first operations of the kind were comple-
ted in this country ; but it has now been superseded by two new
instruments, one the invention of M. Jacobson of Copenhagen, and
the other of Baron Heurteloup, formerly of France, but now of
London.

Dr. Jacobson's instrument is simply two metallic plates secured
together, but sliding one upon the other, and made round and curved
so as to resemble a catheter. One of the plates or branches where
it joins the other at its free extremity, has three or four short articu-
lations that are united like a chain saw. By pushing upon one blade
a loop is made in which the stone is caught and crushed it is called
the brise-pierre-articule. When Dr. Physick first witnessed its suc-
cessful application, he declared that, in his opinion, "a statue should
be erected in honor of its inventor." The first operations of litho-
tripsy in the United States were performed with this instrument.
Since 1840, however, I believe the preference has generally been
given to Baron Heurteloup's invention as now modified and im-
proved.

This consists of a male and female branch of steel sliding easily
in a groove; both are curved near their free extremity, and are
compared to the bill of a duck. By withdrawing one branch at the
handle, the bills are separated, between which the calculus may be
seized and broken by closing them. This is the instrument general-
ly selected at the present day, both in Europe and this country. It
is the Percuteur courbe, or brise-coque of Dr. Heurteloup.

Soon after the very favorable report made in 1824, by a commis-
sion to the Royal Academy of France, upon the application of M.
Civiale, claiming to have invented instruments by which he could
remove a calculus from the bladder without making incisions, at-
tempts were made in this country to imitate the French. I well

1846.] Lithotrity and Lithotripsy. 67

recollect, while a student in Philadelphia in 1827, the many regrets
expressed at the failure of the lithontriptic instruments in the hands
of the late distinguished Dr Physick. The operation of lithotrity,
that of piercing or drilling the stone alone, has never been success-
fully performed in that city. In no case reported there, was the cure
completed by the original instrument.

The first successful case on record in the United States, was
operated upon by Dr. Depeyre, then of New-York, and may be
found in ihe February No. of the New- York Medical Journal, for
1831. His operation was essentially that of M. Civiale. In the
American Journal of the Medical Sciences, for September, 1834, Dr.
Randolph claimed to have performed the first operation of this kind
in America. But in a subsequent No. of the same Journal, Novem-
ber, 1836, he gives to Dr. Depeyre full credit for being the surgeon
who first successfully operated by lithotrity in this country. Dr.
Randolph was not even the second ; nor indeed did he succeed in
any one instance that he reports with Civiale's lithontriptor alone,
as did the two physicians who were in reality the first and only sur-
geons of our country to employ it.

The second successful case was by Dr. P. S. Spencer, of Peters-
burgh, Virginia, and the operation was performed on the 20th of
May, 1832. The instrument used was that of M. Civiale ; the stone
was perforated three times, then crushed by closing its three branch-
es forcibly, and the whole proceeding occupied but twenty minutes.
No second sitting, or operation, was required. In three days the
patient, an adult, passed off fragments and particles weighing sixty-
five grains, and he soon completely recovered being reported well
ten months afterwards. This case is reported in the August No.
(1833) of the American Journal of the Medical Sciences ; but being
placed under the head of medical intelligence, seems to have escaped
attention Dr. Randolph does not even allude to it, though he pub-
lishes his own cases the very next year, and in the very same Jour-
nal. These are the only instances, two successful cases, I find re-
corded, wherein lithotrity alone was resorted to in our country.

The first series of cases successfully treated by lithotripsy or
crushing of urinary calculi, are reported in the November No. (1834)
of the Journal just named, and were operated upon by Dr. Randolph,
of Philadelphia, the son-in-law of the late Dr. Physick. Dr. R.'s
first case, the third of the kind in America, was commenced on the
22d of September, 1832, and was considered well on the 26th of No-

68 Lithoirity and Lithotripsy. [February,

vember following ; but subsequently to this period, a fragment had
to be crushed. Civiale's instrument was employed in four settings^
and then Jacobson's to complete the disintegration of the calculus.
The second and third cases of this series were females, and the same
course of treatment were pursued with them as was adopted in the
first one viz : the lithontriptor and then the brise-pierre or stone
crusher. The same operations were performed on the fourth and
fifth cases ; and in the last one, the sixth, Jacobson's instrument
was alone used because the enlargement of the prostate gland pre-
vented the introduction of a straight one. Dr. Randolph now aban-
doned his attempts at lithotrity, and with good reason performs
lithotripsy alone and at once. He was the first to execute this latter
operation in America, and has now operated a greater number of
times than probably any one on this side of the Atlantic. He selected
Jacobson's instrument at first, but we are informed he now prefers
that of Huerteloup.

The next series of cases are by Professors Gibson, of Philadelphia,
and N. R. Smith, of Baltimore, and are close upon the heels of each
other. Dr. G. commenced his first operation in June, 1835, and
reports five cases. He gives the decided preference to Huerteloup's
preceuteur. Dr. S. performed his first operation in August of this
same year, (1835,) and up to 1842, had succeeded in ten out of eleven
cases. He operated successfully on a child only one year and ten
months old the youngest patient on record cured by lithotripsy or
lithotrity. Contrary to usual practice, Dr. S. prefers the bladder
empty when he operates. He too, first gave his unqualified prefer-
ence to Jacobson's instrument, but like Dr. Randolph, it is said, he
now uses Heurteloup's.

In the supplementary appendix to Cooper's Surgical Dictionary,
edited by Dr. Reese, of New- York, in 1842, we learn that Dr. Gold-
smith, of that city, known formerly as Dr. Alban G. Smith, of Dan-
ville, Kentucky, and late Professor of Surgery in more than one
College, has performed lithotrity three times, and lithotripsy six
times, with success. A review of a pamphlet by himself, in which he
gives the particulars of one of his cases, may be seen in the New-
York Journal of Medicine and the American Journal of the Medical
Sciences, for 1843 or '44. From the same source, (Dr. Reese,) we
are informed that Dr. George McClellan, late Professor of Surgery
in the Jefferson Medical College, Philadelphia, has operated thirteen
times by lithotripsy, and had only one failure. Also, that Dr. John

1846.] Lithotrity and Lithotripsy. 69

Rea Barton, of the same city, has several times tried lithotripsy, but
thinks few cases of stone adapted to it.

Professor Warren, of Boston, reports one case in which he fully
succeded, with Heurteloup's preceuteur, in relieving his patient, a
lady aged about 50 years. He operated in 1840, and in publishing
the account in 1844, says he has had occasion to resort to this me-
thod two or three times.

In 1842, Dr. Josiah C. Nott, of Mobile, Alabama, reported four
cases of large sized stone, which he easily extracted, after having
made the common incisions for lithotomy, by crushing them with
Heurtetoup's instrument introduced through the wound into the blad-
der. He recommends this instrument to be added to every lithotomy
case, so that the bladder may not be injured by improper efforts made
to withdraw a large calculus through the incisions.

This completes the account of all the cases I have been able to
collect. It is a faithful history so far as it goes, but does not lay
claim to be considered a perfect one. Other instances of lithotripsy
have undoubtedly occurred in our wide extended country, but these
are all I find recorded upon a hasty examination of works on Surgery,
and of the medical periodicals of the day. In the second edition of
Druitt's Surgery, by Dr. J. B. Flint, late Professor of Surgery in the
Louisville Institute, Kentucky, and dated March, 1844, he says,
"notwithstanding the frequency of calculous affections in the valley
of the Mississippi, this operation (lithotrity or lithotripsy) has never
been successfully performed, so far as I can learn, on this side of the
mountains." The case about to be detailed, ma}r, therefore, be re-
garded as the first in this section of the country, and with the single
exception of Dr. Spencer's, the first south of Baltimore. And we
are now prepared to appreciate the skill and remarkable success
(complete cure in twenty minutes) of this promising and enterprising
surgeon, of Petersburgh, in Virginia; when we reflect he operated
with the original instrument, and which has subsequently been so
much improved.

Case. Calculus measuring one inch anal an eighth in diameter,
and composed of phosphate of lime destroyed in eighteen sittings by
Heurteloup's instrument, and causing neither pain nor the loss of one
drop of blood.

In my previous communications on the subject of stone in the
bladder, published in the American Journal of the Medical Sciences.

70 Lithotrity and Lithotripsy. [February.

and in this Journal, the operation recommended was the bilateral.
All the patients upon whom I have thus operated were under eight
years of age. It gives me great pleasure to state that the first adult
laboring under calculous affection, who has applied for relief, has been
cured by the bloodless and painless operation of lithotripsy.

Mr. James M. Layton, aged 34, of Early county, in this State, was
kindly directed to me by Dr. Wm. J. Johnson, of Fort Gaines. He
has been laboring under symptoms of stone for three years, and ten
months ago was sounded by Dr. J., and its existence clearly ascer-
tained. Mr. L. arrived here on the 14th of last November, and the
next day, after introducing a large sound and finding an ample urethra
and good condition of the bladder, lithotripsy was proposed Instead
of lithotomy, for which he had come to consult me. On the 15th,
the calculus was seized with Heurteloup's crusher, and found to meas-
ure thirteen and a half lines, or one inch and an eighth in diameter :
this was verified by Prof. Means. Having made the necessary pre-
parations, the operation was performed on the 17th, before the Class
of the Medical College. The patient was seated on the edge of a
table, the instrument introduced, and the stone secured. By gradual
forcible pressure with the hand, it suddenly yielded with a crushing
report audible to many in the room. It gave the sensation of a
pretty resisting shell containing more friable materials. To the
gratification of all present, the patient immediately voided some of
the debris, one or two fragments being the size of buck-shot. The
bladder contained about eight ounces of urine. The operation itself
did not occupy five minutes. After it, Mr. Layton amused himself
with the students in the College museum ; he then walked home to
the Surgical Infirmary, took a warm hip-bath, and passed a com-
fortable night.

On the 18th, at 6, A. M., found his pulse 66 in the recumbent
position. He had experienced no pain, and had passed other por-
tions of the stone. Prescribed diluent drinks, moderate diet, and
the warm hip-bath twice a day. 6, P. M. Had eaten some chicken
from misunderstanding the directions ; pulse at 84.

19th. Not so well this morning; feels some soreness along the
urethra ; has some fullness about the head, and pulse still 84. To
take a dose of calcined magnesia at once, and to use the bath.
3, P. M. Medicine has operated well and to the entire relief of the
patient. Came before the Class again ; injected 7 of mucilage into
the bladder ; introduced the instrument and crushed two fragments.

1846.] Lithotrity and Lithotripsy. 71

From this time to December the 5th, the instrument was em-
ployed for a few minutes nearly every day. On the 27th of Novem-
ber, the fragments which had been preserved, (for many had been
lost as the bowels had been evacuated at different places, and the
smaller particles never were collected,) weighed 47 grains. On the
28th, those passed after one sitting weighed 15 grains. December 2d.
What had been collected for the three past days amounted to 65
grains; and for the two last sittings we weighed 55 grains. Total
weight of large fragments, exclusive of some known to have been
lost, and of the finer particles, 182 grains, or over 3iii.

On the 4th, I could detect no stone. On the 5th, I made a care-
ful and minute exploration of the bladder, by all the ordinary pro-
cesses, without finding a particle remaining the patient insisting he
was entirely free of all symptoms. The next day he was examined
by three physicians before the class, and pronounced free of calcu-
lous affection. He left the same day for his residence, distant about
three hundred miles.

Besides the occasional presence of my colleagues of the College,
Drs. Carter, Hitchcock, of the U. S. Army, A. HammonJ, Jones, of
Columbia county, and Strong, of Tennessee, witnessed some of the
sittings. On analysis by Prof. Means, the calculus proved to be
bone earth or phosphate of lime, and which is rarely met with ac-
cording to Leibig. Although it was first broken by the power of
the hand alone, it was found necessary to use the pinion or screw
to crush some of the fragments. It was ascertained too, that the
instrument could be held far steadier, when the latter force was
applied.

It would be wrong to produce the impression that lithotripsy is a
very simple or easy operation, or that it can be adapted to all cases
of stone. It certainly requires great care and prudence, a good con-
dition of the urethra and bladder, some tact in manipulation, and well
regulated perseverance. But during the whole treatment of this
case, the patient was up and about, even in the streets; he never
complained once of the operation ; the only uneasiness he experi-
enced, was from fragments lodging in the urethra or neck of the
bladder; he was never confined one moment to bed, and never
passed a single drop of blood.

Mr. Layton writes from Blakely, Early county, and dated 17th
of December "I got home the ninth day after I left Augusta,
and had to travel through very cold and rainy weather. I feel

72 Extirpation of Schirrous Tumors. [February,

no symptoms of stone since I left you, and arn in hopes I never
shall."*

Having thus been exposed under trying circumstances, and with-
out any return of the old affection, I think the case may with safety
be pronounced cured.

ARTICLE VI.

Extirpation of Schirrous Tumors from the mammary region and of an
enlarged axillary gland the patient having been rendered insen-
sible by Mesmerism. By L. A. Dugas, M. D., Professor of
Physiology and Pathological Anatomy in the Medical College of
Georgia.

The subject of these remarks is one whose name has already been
twice before the readers of this journal. (See the Nos. for March
and September, 1845.) On the 11th of November last, Mrs. Clarke
came to the city, and I found that she was suffering considerable
annoyance from pain in the right mammary region, which sometimes
darted towards the arm-pit of the same side ; that there were two
indurated lumps to be felt beneath the skin in the neighborhood of the
cicatrix, resulting from the last operation ; and that one of the axillary
glands under the right arm was considerably enlarged. Her general
health was not as good as usual, irregular febrile paroxysms occur-
ring frequently, especially at night, and her pulse being at all times
too frequent. She was very low-spirited and apprehensive that
another operation would certainly prove fatal, particularly if the
arm-pit had to be attacked with the knife. Perceiving, however,
that the removal of the tumors was all that could be done with any
possibility of averting their rapid development, she consented to have
those removed from the mammary region first, and, after the wound
had healed, she would submit to the more formidable operation in the
axilla, provided she bore the first without pain.

With this understanding, Mrs. C. was mesmerized occasionally
by Mr. B. F. Kenrick, with as much facility as heretofore.- I tested

* This report is confirmed by another letter dated 26th of December, and
written by Dr. T. M. Standifer, a practitioner of medicine, ol" Blakely, who vis-
ited Mr. L. at my request.

1846.] Extirpation of Schirrous Tumors. 73

her sensibility when under the mesmeric influence, and became satis-
fied that she would not feel the operation. I then determined to
operate on the 19th of November, to remove the mammary tumors
first, and, if she proved to be insensible, to proceed immediately to
the extirpation of the axillary gland. This determination was care-
fully concealed from the patient and her friends.

On the appointed day Mrs. C. was mesmerized at about fifteen
minutes before 9 o'clock, A. M. aroused in about an hour to see
some friends, and again put to sleep at about half past 10 o'clock.
The operation was commenced at about 11 o'clock. Mr. Kenrick,
still preferring to be blind-folded, lest he might be affected by the
operation, a handkerchief was placed over his eyes, and he held the
hands of the patient in his own during the operation. The two tu-
mors on the chest were included between two elliptic incisions, each
about three inches long, and dissected out. It was then perceived
that some of the adjacent tissue had a bad appearance, and this was
removed along with another small portion of skin.

No evidence of sensibility having been evinced, I now announced
my intention to proceed to the axilla, and did so, after some delay
in arresting the bleeding of the wound just made. An incision about
four inches long was made through the skin and sub-cutaneous cellu-
lar tissue of the axilla, and the tumor gradually detached by lacerating
the surrounding tissues with an ordinary grooved director. The
nervous filaments, so numerous in this region, were broken either
with the director, or with forceps, in such a manner as purposely to
produce the greatest possible pain, if she were not insensible. The
tumor was globular, about an inch and a half in diameter, and much
softer than the normal tissue of these glands. It was very easily
torn by the hooks used in elevating it, which, together with the great
depth of its position, the use of blunt instead of cutting instruments,
the difficulty of seizing the bleeding vessels, and the conviction on
the part of the surgeon that, as he gave his patient no pain, haste
was unnecessary, all combined to consume much more time than is
usually required in such operations. About an hour elapsed, from
the commencement of the first extirpation to the termination of the
last. The wounds were left open about two hours, and then dressed
with adhesive strips. The patient's dress being adjusted, she was
allowed to sleep on until half past 2 o'clock, P. M., when her mes-
merizer aroused her by an effort of volition, without word or contact.
During the whole time of the operations the patient remained

74 Hog's Lard in Obstruction of the Bowels, [February,

perfectly quiet, and gave no indication whatever of sensibility nor
of muscular contraction. Lying in the horizontal position, her right
arm was raised and placed over her head, and remained so without
being touched by any one. Her respiration, pulse and countenance,
were closely watched, without revealing any modification whatever.
During the interval of the two operations she was asked if she felt
any pain ; to which she replied in the negative. The same question
was propounded after the last, and answered in the same way. On
being aroused, she was evidently unconscious that the operation had
been performed, until apprised of the fact by her surgeon. On find-
ing that the operation had been extended to the arm-pit, she gradually
relapsed into the state of apprehension she had evinced before, and
would often exclaim that she knew it would kill her. During the
afternoon, and for several days subsequently, she suffered very much
from the soreness of the wounds, and would cry out whenever moved
in the slightest degree. Indeed, it is a singular fact in her case,
that when in the natural state, she bears pain with as little fortitude
as any person I have ever known. It was this circumstance which
led her to be mesmerized the first time. The wounds healed as
usual, and she left the city on the 28th of the month.

There were present at the operation, Professors Ford and Means,
of the Medical College of Georgia, Doctors J. Carter, J. A. Ham-
mond, J. C. Wilson, Hitchcock, H. F. Campbell, W. H, Tutt, E.
Barry, and Messrs. L. C. Dugas, J. Harriss, jr., and A. Wright,
Judge of the Superior Court.

This is not the place to discuss the propriety of the operation.
The insensibility of the patient certainly removed the greatest objec-
tion that could be adduced under such circumstances.

Augusta, January 1st, 1846.

ARTICLE VII.

Successful treatment of a Case of Obstruction of the Bowels, by Hog's
Lard. By Edward L. Baker, M. D., of Darien, Ga.

It is a pleasing fact, to know that medical men possess the means
by which they may communicate one to another (let them be ever so
distant) the success which attends the administration of particular
remedies in disease, and each member of the faculty should feel it to

1846.] Hog's Lard in Obstruction of the Bowels, 75

be a duty which he owes, not only to medical science, but to man-
kind in general, to make known as early as possible his success in the
treatment of any disease which has hitherto proved obstinate or dif-
ficult to cure at the same time, we should never allow ourselves to
be led away, or biased, in favor of a remedy, by the encomiastic
publication of another, until we have given such remedy a fair and
unprejudiced trial. Medical men are, in general, too apt to content
themselves with the "ipse dixit" of others, because they have ob-
tained the reputation of being eminent. Many valuable lives have
no doubt been sacrificed in this way. I need only point you to the
very pernicious practice of Rasori and his followers for an instance.
I am happy, however, to see that the profession are beginning to
examine and think more for themselves, and except they are guided
by a sound pathology and reason, are disposed to be at least dubious
in taking hold of any thing hypothetical and it is only among those
who are indisposed to mental exertion where we find such characters
as described above. It will be observed at once, by all who have read
Dr. J. A. Mays' article, published some time since in the Southern
Medical and Surgical Journal, that I was led to administer hog's
lard in this case, from the success which he obtained from it in a case
of the same kind.

Case. September 25th, 1845. Mr. B. Baker (my father) hear-
ing of my being in his neighborhood, called me to see a servant
woman. When I arrived, found that Dr. B. B. King had been sent
for the day before, but could not attend in consequence of business;
ascertained upon enquiry, that thepatienthad not passed faeces or urine
for ten days.* They had given salts, oil, and injections. From the
irritable state of the rectum, injections were passed off as soon as
given. Upon making an examination at 8 o'clock, A. M., found a
coated tongue ; pulse full, but soft ; no fever, and very little pain ;
haggard expression of countenance, which, so far as my experience
goes, is always observed in cases of this kind; great distension of
bladder, &c. Ordered, ft. Sub. mur. hydrarg. 40 grs., ipecac 20 grs.,
opii. pulv. 4 grs. Mix, and divide into three powders one to be
given every two hours. As soon as nausea supervened, patient to
be placed in a warm bath, and kept there until completely prostrated,
then to take oil and turpentine injections. Not having my catheter
with me, could not draw off the urine. Business at this time

* Dr. B. must certainly intend to say, no free emission of urine. Edts.

76 Treatment of Yellow Fever. [February,

(3 o'clock, P. M.) called me away left directions, if not relieved by
8 o'clock, P. M., to give half pint lard by the mouth, and one pint in in-
jection, and if not relieved, to be repeated early next morning. This
was accordingly done, and next day (26th) at 12 o'clock, A. M., she
had a discharge ofboth fseces and urine, and continued to have them at
intervals. Dr. J. P. Stevens arrived on the 26th, having been sent by
Dr. King he found her, however, relieved in some degree, and all
that was necessary to do was to empty the bladder by means of
a catheter, and renew the injections. She speedily recovered, without
any symptoms of inflammation. I should have mentioned before,
that soon after I left, she vomited several times stercoraceous matter,
and what is somewhat remarkable, she never vomited after taking
the lard, nor did she pass off the injections of lard; and before this
she invariably discharged the enemata, though even the mildest
were given.

There may be some disposed to attribute the success in this case,
to the remedies which preceded the lard ; but to convince my readers
that such cannot be the fact, it will only be necessary for them to
look at the length of time that elapsed from the time she took the
calomel, &c, to the time she was relieved, being about twenty-four
hours. The medicine certainly must have lost all power before this
time at any rate, so thoroughly convinced am I that it was the lard
which saved the life of my patient, that were I to meet with a similar
case, I would not delay one moment in administering it with unlimit-
ed confidence.

PART II. REVIEWS AND EXTRACTS.

Dr. Harrison, Professor in the Medical College of Louisiana, has
published an excellent article in the New-Orleans Medical and Sur-
gical Journal, on the subject of Yellow Fever. In the last No. of
this periodical it is completed, and on account of the character of the
production itself, the connection of all febrile affections, and the
interests involved in their treatment, we make the following extract:

Treatment of Yellow Fever. Of all the diseases which afflict the
human race, there is none that requires more unremitting care and
attention on the part ofboth physician and nurse, than yellow fever.
Accidents, or acts of imprudence, which, in other diseases, are mere

1846.] Treatment of Yellow Fever. 77

trifles, are of tremendous importance in this. The mere getting out
of bed, has cost many a man his life. Exposure to cold currents of
air, or negligence to take the requisite precautions against a change
in the weather, has been equally fatal. A man in this disease, how-
ever safe the physician may think him, is hovering between life and
death a trifle may decide his fate. Hence the great necessity, the
all-important need of good and experienced nurses.

There is, from the very commencement of the attack, a great and
rapidly increasing prostration of strength, inconceivable to those who
have never experienced the disease. The mind cannot act; the
senses, at first exceedingly acute, become during the progress of the
disease, indifferent to impressions; the muscular power is almost
annihilated ; the patient is indifferent to his fate, or morbidly anxious
about trifles. The extraordinary disturbance in the nervous system,
its extreme liability to undergo change from the slightest impressions,
enforce upon the attendants and physician, the greatest prudence
and solicitude. Experence has taught them this, but, unfortunately,
all injunctions are frequently lost upon the sufferers. They cannot
be made to understand how the mere getting out of bed, or even the
sitting up in it, can be of so much importance as they are asserted to
be. Their feelings deceive them ; they make in some unguarded
moment the trial, and conviction comes too late.

When a person is taken sick with this disease, no time is to be
lost not a minute. The physician and nurse should be with him as
early as possible. His room should be in some quiet place, and, if
possible in the second story, on account of the dampness of the
ground-floors. The windows should be closed, for many suffer much
from intolerance of light. The room should be well aired, care
being taken to protect the patient from currents. All persons, except
those attending on the sick, should be rigidly excluded ; conversation
on the part of the patient, or others, prohibited. These last injunc-
tions are all-important, for it is not an uncommon thing for the sick
to be annoyed with unseasonable visitors; who, to gratify an idle
curiosity, rush in where they can do no possible good, and may inflict
measureless harm. The patient should not, from the very hour of
his attack, be permitted to rise from his bed, for any purpose whatever.
No matter how supported, or with what precautions and care he be
taken out, it is always dangerous, and often leads to a fatal result.
His evacuations should be received in abed-pan, and removed imme-
diately from the room. There ought, if practicable, to be two or
more nurses, so that the patient should never be left alone for a sin-
gle instant. His bed-clothes and person should be kept as clean as
possible; but all changes of linen, e%., without absolute necessity,
deferred until the patient is out of danger.

As to the medical treatment, the like precautions are necessary.
The physician should never forget, for an instant, the peculiar char-
acter of the disease its treacherous nature the rapidity with which
alarming symptoms come on. He must bear in mind that the pa-

77 Treatment of Yellow Fever. [February*

tient is hourly losing strength ; that his nervous system is becoming
more and more deranged. He must remember that there is no safety
for his patient until the disease has run its course, and convalescence
established beyond all doubt. Those who see the disease for the
first time, are exceedingly apt to make a serious mistake: the fever
subsides on the third or fourth day the pulse and skin are good
the patient complains of no pain, and the physician supposes him out
of danger. The truth is, the danger is then most imminent the
most critical period of the disease has arrived, and the patient is re-
quired to be watched more assiduously than ever. It is at this stage
that a purgative, or any other medicine improperly administered, may
decide his fate.

As to the details of the treatment, they must be left to the judg-
ment of the physician. Any specific treatment is just as absurd in
yellow fever, as in any other disease. The physician is not called
in to treat an abstraction, but a sick man. The treatment must be
varied according to the peculiarities of the cases. Remedies, benefi-
cial in one case, may be most injurious in another; and success in
practice will depend, in a great degree, upon the sagacity and ac-
quirements of the physician.

Certain modes of practice, however, have prevailed here, as else-
where. All have had their advocates, who point to results as evi-
dences of their value. If we were to rely upon the statements of
partizans, it would be difficult, indeed, to form an opinion of their
respective merits ; but it must be remembered, that patients in yellow
fever die, and that others get well, under all sorts of treatment. I
was once called to an Irishman, who had been sick five days, and
who had done nothing but drink whiskey the whole time. He was
suffering with great irritability of the stomach, but recovered. It is
not then, from such statements that we can form any correct opinion
concerning the methodus medendi in this disease. We must fall back
upon the broad principles of pathology and therapeutics.

Of the methods in vogue, we may point out three that have had
the largest number of advocates. They may be denominated the
Calomel, the Depleting, and the Quinine practice. I shall proceed
to make some comments upon each of them.

Calomel. I should, perhaps, speak of this practice in the past
tense; at least I know of no physician in New-Orleans who pursues
it, or mentions it with respect. Absurd as it is, however, it has had
as strenuous supporters as any other delusion in medicine. It has
not been more than twelve years, when he was a bold man who un-
dertook to affirm, that a case of yellow fever might get well without
the aid of calomel. The pratltire seems originally to have been
adopted in sheer desperation, and continued from the same cause.

The treatment consists in bringing the patient, as soon as possible,
under the influence of the drug. For this purpose, ten, or twelve
grains are administered every two, or three hours. Should time pass
on, however, and the patient show no symptoms of salivation, the

1846.] Treatment of Yellow Fever. 79

dose is either increased, or the intervals between its administration
lessened. Should we ask for some pathological reason for such
practice, we are told, that the calomel acts by emulging the liver ;
that experience has pointed out the necessity of the treatment; and
that, every case is saved in which ptyalism occurs. Let us examine
these arguments.

As for the liver, the symptoms of the disease throughout its whole
course, as well as post mortem examinations, show that it is by no
means particularly affected. The passage of bilious stools, during
the first days of yellow fever, is as common an occurrence as we
meet with, though not a grain of any mercurial has been taken. We
find also bile in the gall-bladder after death ; so that the whole argu-
ment about the liver is just upset by these facts.

It may be contended, however, that the yellow hue of the skin, &c,
is caused by the accumulation of the principles of bile in the blood;
and that, therefore, the liver should be excited to increased action in
order to eliminate these principles from the system. I do not be-
lieve that the yellow hue of the skin is owing to bile ; we frequently
see the skin, at first of a bright pink, gradually assume the yellow
tinge, as if it depended upon some change in the coloring matter of
the blood. But, for the sake of argument, let us grant that the bile
is the cause of it ; does the administration of calomel prevent, or even
retard its appearance in the slightest degree? Not at all. The yel-
low skin the passive haemorrhages, &c, are just as bad, to say
nothing more, in cases treated with mercurials, as in those in which
not a grain has been given.

But, whatever effect calomel may have upon the liver, it is very
plain that administered as it usually is, it must first act upon an organ
just as important to the welfare of the system, and which, postmortem
examinations show, is by far the most frequently affected. I mean
the stomach. The connections of this organ with the rest of the
system are so numerous, that some have even called it the centre of
the sympathies; its extreme irritability is one of the most marked traits
of the disease; its serious derangement is what the physician most
particularly dreads; and can anyone believe, that we shall shun this
danger by administering a mineral drug, such as calomel, every hour
or two ?

As for experience proving the necessity of administering calomel,
I shall dismiss the subject with the remark, that experience has prov-
ed just the contrary.

But all cases recover, in which mercury produces pytalism ? Ad-
mitting this to be true, which is by no means the case, it is but
reasoning post hoc ergo propter hoc. The disease runs its course
the fever subsides the patient recovers in spite of the remedy, and
the poison introduced into the system then takes effect. Instead of
a rapid convalescence and a speedy restoration to health, as is usually
the case in yellow fever, he is the martyr of a most noisome and in-
sufferable disease, for weeks or even months; and is fortunate,
indeed, if he gets off so well.

80 Treatment of Yellow Fever, [February,

In 1833, there occurred a phenomenon which was as common as
any other in the disease. It was suppuration and ulceration of the
parotid glands. It is now rarely met with, and the reason is, less
calomel is given.

The parotids were not the only glands that suffered. In the autopsies
of that year, it was as common a thing to find the mesenteric glands
swollen and enlarged, as to meet with any other lesion.

By the foregoing remarks, I do not wish to be understood, as in-
culcating the total abandonment of calomel in yellow fever. Given
as a cathartic, in the commencement of an attack, I have seen it act
admirably. It causes but little nausea, and will bring away feculent
matter, when castor oil, or saline purgatives, fail to do so.

Depletion. All the characters of this disease would seem to incul-
cate, in the strongest possible manner, the greatest reserve and dis-
cretion in the use of the lancet. Of this instrument, all powerful
for good or for evil, according to the mind that directs it, it has been
long ago remarked, that, perhaps, its victims numbered more than
those of the sword. Sure, I am, it has fully done its work in yellow
fever.

On the first days of the fever, before the patient is much prostrated ;
when the pulse is full and strong ; when the pains are severe ; when
the patient is of robust constitution, venesection unquestionably does
good. Whenever, during the febrile period, it is to be feared that
congestion is forming in any organ the brain, lungs, or stomach,
the lancet should be employed, but employed with prudence. The
physician should never forget that this is a disease arising from
poison that prostration is rapidly approaching, and that by impro-
perly using the lancet, he is hastening its advent and adding to its
intensity. When the patient is of a nervous temperament, or feeble
constitution when any ataxic symptoms supervene, such as nervous
delirium, &c, the lancet should not be thonght of. Some have used
this instrument, as if they thought it possible to bleed the disease
out of the body. A greater error was never committed. Large
quantities of blood are taken from the patient, who has been made to
sit up, and syncope supervenes. In the course of an hour or so,
observe his pulse. Has his fever abated ? are his sufferings less
severe ? Not a whit. His skin is as hot, his pulse is as bounding as
ever, but has lost its force. Standing some distance from the pa-
tient, we can see the carotids violently throbbing. We feel the pulse,
and it has a peculiar thrill. Again and again is the lancet employ-
ed ; and more and more grave, all the symptoms become. The
patient begins to wander in his thoughts, and speaks incoherently.
"The brain is becoming inflamed," says the physician, "and he
must lose more blood ; again the lancet fulfils its office, and a change
sudden and appalling, takes place. The patient becomes cold and
pale a clammy sweat breaks out over the body the pulse sinks
black vomit is thrown up in large quantities, and death soon follows.
This is no fancy sketch it is what may be witnessed every epidemic
year.

1846.] Treatment of Yellow Fever. 81

The nervous system is particularly liable to derangement in yel-
low fever ; the most fatal of all the symptoms are those which indi-
cate affections of the brain. Now, there is nothing that has a more
powerful control over the nervous system than the lancet, and hence
extreme caution is necessary in its use.

But for what purpose is so much blood taken from the system ?
What indication is to be fulfilled ? Is it to relieve organs suffering
from inflammation ? Post mortem examinations ought to settle the
question. In the worst cases, those of a congestive character, there
are scarcely any lesions to be found after death ; and as for the con-
gestions usually found in the stomach and intestinal canal, it is far
more probable that they are of the same nature with the petechia?,
and other congestions, which we see form on the surface of the
body, than that they are the results of inflammatory action.

We are told by Andral, that in idiopathic fevers there is a diminu-
tion of fibrine in the blood. In yellow fever the blood is remarkably
slow in coagulating, and when passive haemorrhages occur it will
hardly coagulate at ail. Assuredly we cannot expect to increase
the proportions of fibrine in such a disease, by blood-letting.

With regard to the use of other means of depletion, such as leeches
and cups, the same prudence and caution are required. As they take
blood, however, in a slower and more gradual manner than the lan-
cet, there is not the same risk of affecting the nervous system. They
are, therefore, much safer. Cups are frequently very serviceable in
relieving the intense pains in the loins and head, which the patients
suffer during the febrile period.

Sulph. Quinine. This remedy had often been employed as a tonic
during the latter days of an attack, but in 1839 a new mode of ad-
ministering it was adopted at the Charity Hospital, and in the private
practice of many physicians. This mode, so far as I know, was first
put in practice by Dr. J. M. Mackie, of this city, who adopted it at
the suggestion of Dr. Thomas Hunt, also of this city. Dr. Hunt was
led to believe in its efficacy from a review of the writings of Maillot,
published in the July number, 18*39, of the British and Foreign Medi-
cal Review. From that work I make a fti\v extracts :

'The first of these publications consists of a memoir read to the
Royal Academy of Medicine, founded upon observations made or
collected by the author, in the garrison of Bona, relative to the des-
tructive epidemics of the years from 1S32 to 1S35. In those years,
the garrison, consisting of between three and four thousand men,
22,530 were admitted into the hospital, and 2,513 died, or 1 in 8 ;
or, according to the more particular statement, there were

"Admitted in 1832, 4033, of whom 449 died; or 1 in 7.
1S33, 6704, " 152G " or 1 in 3^.

" 1S35'(11593, " 538 " orlin2-

M. Maillot's attention was first and principally directed to dctcrmin-

0

82 Treatment of Yellow Fever. [February,

ing the analogies existing between the fevers of Bona and those which
he had previously had an opportunity of observing at Algiers and in
Corsica, with a view to deciding on the propriety of applying to them
the treatment which he had found adapted to the latter. The estab-
lishment of the characteristic of intermittence, as common to both,
seems to have been the result ; the fevers of Bona, like those of Cor-
sica and of Algiers, arising in the neighborhood of marshes, the
greater proximity of which to the troops at Bona, gave a severer
character to the fever ; demanding, as it proved, a prompt and more
energetic treatment. M. Maillot maintains the relation of the con-
tinued forms to the intermittent ; and the tendency of the intermit-
tent, if unchecked, to pass into the continued ; and of the continued,
if bleeding was employed, to pass into the intermittent or remittent.
These circumstances, he says, convinced him that he had not to deal
with true continued fevers, the gastro-enteritis or gastro-cephalitisof
France. He concluded that the probability was that the affections
before him were those spoken of by Torti, part of the character of
which is 'dc intermittente sensim, acutam et malignam migrat;'
and resolved on giving the quinine boldly in all the continued cases,
without waiting either for remissions or intermissions, which were
'only instantaneous when they were obtained.' The results, which
are very striking, arc seen in the diminished mortality exhibited in

the above statement."

********

"In the Bona fever, M. Maillot says it was possible, as late as the
first days of June, to cause a kind of remission of the symptoms.
This remission, however, appears to have been no more than the
morning remission of symptoms, so common in the continued fevers
of our own climate ; and even this was only induced after bloodlet-
ting ; by which sometimes the fever was entirely subdued, and some-
times converted into a distinct intermittent ; it often seems, on the
other hand, to have run on to malignant and typhoid form. And, at
the end of June, the continued fevers were quite distinctly separated
from the intermittent. Yet the continued fevers, it would seem,
begin occasionally with a few intermittent paroxysms; after which
they pursue their course even without remissions, however slight.
The point of practice which M. Maillot is most anxious to enforce is,
that, notwithstanding this appearance of continuity, the treatment
demanded was the administration of bark in full doses. The same
circumstances, and the necessity for this practice, were pointed out
by M. Coutanceau in the epidemic pernicious fevers of Bordeaux, in
1805 ; and his opinions are quoted by M. Maillot, who declares them
to be equally applicable to the fevers of Bona of 1832 and 1833.
With these convictions, M. Maillot gave large doses of sulphate of
quinine in all cases of continued fever, with the exception of some in
which there was ileo-colitis ; in which, although he thinks he was
wrong in making them an exception, he deferred its administration.
In all the cases thus treated, in which he enumerates cases of gastro-

1840.] Treatment of Yellow Fever. 83

cephalitis, of acute gastro-enteritis, of follicular ileo-colitis (diarrhoea),
of hemorrhagic ileo-colitis (dysentery), &c, the disease, except in a
few instances, was relieved in a few (jays. In almost all these cases,
the patients began to take some light food on the third or fourth day.
Of ninety-eight cases of gastro-cephalitis included among them,
occurring in the month of July, not one became typhoid ; and only
five died, of whom two sunk the day after admission into the hospital.
In the other cases, the solution of the disease was speedy, and the
convalescence rapid.

"There is something surprising in this account, and we have al-
lowed the reader to share in our astonishment, although, at page 26
of his memoir, when M. Maillot comes to relate particular cases, we
find another article of treatment generally preceding the use of the
sulphate of quinine, and which, although it is no other than pretty
free bleeding, general and local, had not been before alluded to as of
the smallest importance.

" 'A. soldier of the 59th, aged twenty-five years, was admitted into the hospi-
tal on the 8th of August, on the second day of an acute and excessively intense
gastro-cephalitis. I immediately prescribed bleeding from the arm to fifteen
ounces, the application of forty leeches to the epigastrium, and twenty leeches
in the course of the jugulars; low diet ; lemonade.

" ' On the 8th, at the morning visit, the reaction was not entirely subdued;
but the condition of the pulse, that of the skin, and all the other symptoms, deno-
ted a remission indicative of approaching remittence or intermittence ; and I
consider it a continued gastro-cephalitis, passing into intermittent or remittent
fever. Low diet ; lemonade ; twenty-four grains of sulphate to be taken in a
potion at one dose, and immediately.

" ' Complete apyrexia established itself during the day. The apyrexia con-
tinued on the morning of the 10th: nevertheless, I prescribed another potion of
twenty-four grains of sulphate of quinine, fearing that the fever might be tertian,
and return the next morning. But the fever did not return; and convalescence
went on rapidly. On the 18th, the patient was nearly on full diet. (p. 27.)'

" Such was very nearly the treatment of 295 cases of gastro-
cephalitis ; except that the sulphate of quinine, in subsequent cases,
was given immediately after the venesection ; and, in certain circum-
stances, before any sanguine evacuation, as many of the men had
been carried off by paroxysms of pernicious fever, some hours
after the opening of a vein. Of the 295 cases thus treated, only
twelve died, or 1 in 24. These results were certainly satisfactory ;
but M. Maillot observes, that such treatment would not be suitable to
cases occurring in the north of France, in which dangerous typhoid
affections, and (in case of recovery) tedious convalescence, would be
the consequences. There can be little doubt that such would be the
serious results of similar practice in the continued fevers of England ;
yet we believe there is much evidence of the most respectable kind
among previous writers on the fevers of the Mediterranean, and of
Italy, and of Africa, in support of the practice observed by M. Maillot.

" Among the cases of true inter mi tent fever, 1582 were quotidian,
730 tertian, and 2G quartan. Of these 2339 cases of intermittent
fever, the accession took place between midnight and noon in 1G52,
and between noon and midnight in G86. The greatest number of

84 Treatment of Yellow Fever, [February,

accessions took place between nine in the morning and noon. 658
of the cases were simple, and 1680 complicated. In 1078 instances
the intestinal canal was affected ; alone in 343 cases : with the brain
in 686 cases; with the lungs in 31 cases; with the brain and lungs
in 13 cases. In 25 cases the spleen alone was diseased ; and in one
case the peritoneum alone. The brain was affected alone in 466
cases ; the spinal cord in one ; the lungs alone in 103 cases, and the
pleura alone in five. In one case, a tertian, there was angina with
the formation of a false membrane, and no other lesion. The inten-
sity of all the complications was in direct ratio to the elevation of
the temperature ; and they were always unfavorably affected by the

wind of the desert."

********

"In this country, pathologists have not been very ready to admit
this theory of intermittent inflammatory conditions of the intestinal
canal and brain. M. Maillot presents the doctrine in the least objec-
tionable form. The secondary congestions, he says, are ordinarily
very feeble in the first accessions, and disperse in the interval between
one accession and the next. Complete apyrexia therefore ensues,
without functional disorder of the digestive or respiratory passages.
But when the accessions are many times repeated, and, above all,
when they assume a quotidian type, each leaves some anatomical
traces of congestion in the viscera affected. The capillaries soon
become unable to disembarrass themselves of the blood which each
accession determines to them ; the tissues soon become unable to re-
sist a state of congestion so frequently renewed, and the irritation
"fixes itself anatomically," and betrays itself by symptoms more or
less continued. Hence arises a prolongation of the reaction ; that
is to say, of the febrile symptoms, thirst, redness of the tongue,
head-ache, heat of the skin, and all the symptoms of a gastroenter-
itis, a gastro-cephalitis, a pneumonia, &c, according to the organs
which are over-irritated (suirrites).

"To these remarks, M. Maillot adds the very important practical
observation, that simple irritations, and those not of great intensity,
and which yield in the intervals of an intermittent, give rise to
symptoms in this class of fevers as marked and violent as those of
acute gastro-cephalitis. This circumstance, he observes, if unknown
or unattended to, might lead the practitioner to see inflammations
where none exist, and to be afraid of administering the quinine, on
which alone the hope of preventing the returning accession of con-
gestion must rest. In illustration of his practice, M. Maillot inserts
a case in which, after bleeding during the paroxysms to fifteen ounces,
the patient presenting the symptoms of acute gastro-cephalitis, twenty
four grains of sulphate of quinine were given at once, thirty leeches
were applied to the epigastrium, and there was not another parox-
ysm. Of 250 cases thus treated, he lost only eleven, or 1 in 22 ;
the fatal cases were all quotidian. In the pernicious forms of fever,
with coma, he gave forty grains of the sulphate of quinine at a dose;

1846.} Treatment of Yellow Fever. 85

and in cme such case, 148 grains were given in less than twenty
hours, and the patient, from being in a state of coma, almost resem-
bling death, became speedily and completely convalescent. In cases
of the algide form, or with extreme coldness, ether was administer-
ed with the sulphate of quinine.

" The most convincing proofs of the correctness of the above prac-
tice, and perhaps of the theory also, is that M. Maillot appears to
have reduced the mortality in the fearful epidemic he had to contend
with from 1 in 3^ to 1 in 20 ; for these results cannot be ascribed to
any alteration in the character of the disorder ; but became sensible
when he began to use the sulphate of quinine more freely than he
had ventured to do at first, and to bleed less copiously. Subsequent
engorgements of the abdominal viscera, dropsy, diarrhoea, so often
considered to arise from the use of bark, were scarcely seen in any
case; and M. Maillot considers them as the results, not of the medi-
cine, but of repeated paroxysms of the disease."

" Of the different kinds of bark, M. Maillot prefers the red
(oblongifolia), not only to the gray (lancifolia), which contains only
cinchona and not quina, but also to the yellow (cordifolia), from
which, on account of tho quantity of quina it contains, the disulph-
ate of the London pharmacopoeia is prepared. But he prefers the
sulphate of quinine (disulphate of quina) to all preparations of bark ;
the doses being more easily regulated, the stomach tolerating it better,
and its action being surer and speedier ; qualities which practitioners
are not all equally inclined, we think, to accord it the possession of.
When the stomach rejected it, the sulphate was given in a lavement ;
if purging or colic ensued, the endermic method was had recourse
to; ana1 sometimes the patients were put into a bath saturated with
cinchona. In salicine and ilicine, M. Maillot places, as might be
expected, little confidence. He seems not to have given any trials
to opium ; but he quotes the opinions of Lind and of M. Bailly, to
show that its power is only sedative, and not febrifuge ; and that, if
it seems to shorten the duration of the attacks, it does not prevent
their recurrence. We have little doubt that there are cases in which
opium mitigates the sufferings incidental to intermittents; and in
some cases, at least in our own climate, a large dose, given in the
cold stage, will put an end to it, and even to the disease altogether.
M. Maillot agrees with M. Baiily in condemning the combination of
antimony with opium, as useless. With less reason he utterly con-
demns arsenical preparations. He also reprobates the notion of giv-
ing an emetic or even a purgative before commencing the adminis-
tration of the sulphate of quinine ; being of opinion that the attention
of the practitioner, being directed to the subduing of abdominal or
other irritations by leeches, would be uselessly given to removing any
internal sources of irritation, which he looks upon as imaginary, and
but the relics of exploded doctrines. In this respect, theory certainly
interferes unfavorably with M. Maillot's practice ; and that there are

86 Treatment of Yellow Fever, [February,

even cases of intermittent in which, after the application ofbleeches
to the epigastrium, and the administration of a purgative, the disor-
der will disappear before a grain of bark is given, every one who has
seen much of ague must have found. The general propriety of M.
Maillot's rule, however, not to delay giving the sulphate of quinine
as soon as a complete apyrexia is established, cannot be controvert-
ed ; and the old doctrine of coction and crisis led, without doubt, to
hurtful delay, during which the constitution suffered greatly from
repeated paroxysms. He is, as we have seen, decidedly an advocate
for giving the sulphate in doses of twenty or more grains, which he
administers in four ounces of water; and the time he prefers is three
or four hours before the expected attack. His experience in Africa
determined him at length not to repeat the medicine more than once
or twice after the suppression of a paroxysm ; and he has pursued the
same plan with success since his return to France. The prolonged
use of the medicine is objectionable; and he agrees with M. Hepple
in believing that it does not even prevent the return of the fever, after
a given time, so certainly as having recourse to it anew, at the ex-
pected periods of return ; supposing such periods to be ascertained,
as stated by M. Hepple, namely, the eleventh and twenty-first day in
quotidians and tertians, and between the twentieth, and thirtieth in
quartans.

"The unfortunate tendency to a relapse makes it desirable, M.
Maillot observes, that the patients should consider themselves as con-
valescent, for two or three months, however well they may appear
to be. When relapses take place, bleeding, except by leeches, is
generally less required than at first: but the sulphate of quinine
should be given in increased doses. In some cases a cjompleto
change of residence is indispensable to recovery; soldiers who were
sent home to France after obstinate and renewed attacks, often re-
covered health during the voyage."

The new mode of administering the sulph. quinine may easily be
inferred from the foregoing extracts. It consisted in waiting for no
abatement of the fever, but in promptly giving the sulph. quinine as
soon as possible after the attack. The dose varied from 20 to 80
grains, given in a little cold water. If the stomach was very irrita-
ble, it was given by injection. When the practice was first intro-
duced a cathartic was generally first given, and the administration of
the quinine deferred until the bowels were moved. This practice
was afterwards abandoned, on account of the loss of valuable time.
In strong and robust constitutions, the lancet was employed for the
purpose of producing a temporary remission, during which the qui-
nine was given. This practice was decidedly beneficial. If the
first dose failed in eight or ten hours to" produce an apyrexia, a se-
cond was given, The earlier it was given the better, but it should
not be given after the second day. This is a most important point in
the treatment ; I have given it on the third and fourth day, but always

1846.] Treatment of Yellow Fever^ 87

with injury to the patient. It increases the irritability of the stom-
ach, and causes the tongue to become dry. In addition to the sulph.
quinine, other remedies were used according to the circumstances of
the case : such as would suggest themselves to any physician.

Before venturing to give the sulphate of quinine in such large doses
and upon such a raging fever, I)rs. Hunt and Mackie performed a
number of experiments to test its physiological action. The experi-
ments were performed in 1839, at the Charity Hospital, upon conva-
lescents from different diseases. From notes furnished me by Dr.
Hunt, I transcribe the following cases ;

Case 1st. At 20 minutes of 10, A. M., pulse 72, took 15 grains
of sulph. quinine. At 11, A. M., pulse GO; has slept; complains of
heat at epigastrium ; feels a little dizzy ; pupils slightly dilated. At
half past 12, P. M., no other change.

Case 2d. At 10, A. M., pulse 56, took 11 grains. At 11, A. M.,
pulse 48 ; has slept ; has slight ringing in the ears ; sweating freely
a short time after taking the quinine. No restlessness.

Case 3d. At 15 minutes of 10, A. M., pulse 64; took 9 grains;
at 11, A. M., pulse 52; has slept; pupils slightly dilated; no other
change.

Case 4th. At 15 minutes of 10, A. M., pulse 100, took 20 grains.
At 11, A. M., pulse 96; has slept; pupils slightly dilated; no other
change. At 15 minutes past 11, A. M., took 15 grains. At half
past 12, P. M., pulse 92.

All these cases were watched. The effects, as narrated, gradually
wore off, without any other change.

It may be mentioned here, that when the sulph. quinine was given
in large doses, a part of it was found, in the experiments made for
that purpose unaltered in the urine.

So much for the method of administering the sulphate of quinine;
it now remains to speak of its effects. The fever in most cases was
cut short as if by enchantment. I shall never forget the surprise I
felt, the first time I witnessed its effects. Three patients in the
wards of Dr. Mackie were put under its influence. The conditions
of the three were pretty much the same as also were the results ;
the description of one case will therefore suffice for the whole. The
patient, a robust young man of about twenty-eight years, had been
taken with yellow fever at 1, P. M. He was prescribed for the same
day, at 6, P. M. Ten cups were ordered to the epigastrium, 30 grs.
of sulph. quinine to be taken by the mouth, immediately after the
cupping, and 40 grains by injection. He had been cupped before I
saw him, but had not yet taken the quinine. His condition was as
follows: Pulse 120, full and strong: great heat of skin; great pains
in the head, back, and lower extremities; tongue a little furred;
eyes heavy and a little injected ; great restlessness on account of tho
pains. I saw him next morning, between 0 and 7 o'clock. He was
perfectly free from pain ; the pulse was at 84 ; skin cool ; in short,
every vestige of disease had disappeared. From prudential motives,

88

Treatment of Yellow Fever. [February,

he was kept in the hospital four or five days, and then discharged.
There was never any return of the disease.

The other cases terminated in a similar manner, and the practice
was soon adopted by a number of physicians, myself among the num.
ber. The results were, in general, highly satisfactory.

T shall say but few words, with regard to the manner in which qui-
nine acts, to produce such effects. No doctrine of stimulants, counter-
stimulants, or sedatives, can reach the explanation. Nothing, that
we know of, can be substituted for quinine: its effects are, therefore,
specific, and are owing to its chemical character. I believe that it
acts, like the poison of which it seems to be the antidote, directly upon
the nervous substance breaking up the whole condition upon which
the morbid actions depend, but in a manner, perfectly inexplicable
in the present state of science. If there be any way of cutting short
an idiopathic fever, it is assuredly to be effected by quinine. .But,
there are certain facts which lead me to believe, that the disease un-
der consideration runs its course, even after all febrile symptoms
have succumbed to the power of quinine, and indeed, after all mor-
bid symptoms, whatever, have disappeared. In 1841,1 lost a patient,
and in 1812, another; one on the 6th, the other on the /th day, in
whom the fever had been cut short, as usual, by the administration
of quinine. .Thev lay in bed for two or three days, without a single
symptom qf disease, and, indeed, were kept in bed more from mo-
tives of prudence, on account of a change in the weather, than for
any other reason. Yet they both died with black vomit.

I have remarked in another place, that the pathology of yellow
fever was, in part, to be inferred from some points in its treatment.
I alluded to the effects of quinine in the first stages of the disease.
Surely, these effects give no support to the supposition that the dis-
ease arises from local inflammation. . .

From the above observations, concerning the effects of quinine, it
will not, I hope, be understood, that I advocate its administration m
all cases whatever. As I have before remarked there can be no
specific treatment for yellow fever, or any other disease. When in
the commencement there is great congestion of blood in the brain, or
anv other important organ ; or, where the fever supervenes upon
chronic inflammatory diseases, I would most certainly resort to other
means. Nor would I be understood as speaking of quinine as an
infallible remedy. The practitioner to whom the disease is. a new
one, will soon discover that in certain cases, particularly those of the
congestive and ataxic types, that quinine- is as inefficacious as any
oher remedy. In cases, hi which the fever is well and fully devel-
oped, it will, unquestionably, cut that fever short, and thus prevent
the formation of those local congestions which are produced by the
febrile action. In this consists its value, and assuredly, it is a great

one

It remains to say a few words concerning f '?,rf f es. ^(T

employed in the course of treatment. We shall first speak of baths.

1846.] Treatment of Yellow Fever. 89

Cold Bath. I have but little experience in the use of cold bath^
as I have been averse to employing them from pathological principles.
There is a great tendency to sudden changes in this disease, and the
congestive state is one of the most fatal forms in which it can present
itself. When the fever is high and fully developed, the danger is far
less. Even so unfavorable, in my opinion, are any symptoms of
congestion, that 1 always look upon it as a very bad sign, when the
patient, after the second hour, complains of being chilly and hot at
the same time. Now, cold baths in many cases, tend to prolong this
congestion ; or to produce a chill when the fever was about being
developed ; and in other cases, in which its administration is follow-
ed by quick reaction, the fever would have been sufficiently high
without it. At any rate, it should only be used in the first days of
the disease, for the obvious reasons, that it fatigues the patient to be
often taken out of the bed; and in the latter stage, it is inadmissible,
on account of the prostration of the patient.

Warm Bath. Warm baths in congestive cases may be servicea-
ble in promoting reaction ; but when the fever runs high, and parti-
cularly if it be accompanied by ataxic symptoms, it does no good,
but harm the skin soon becomes hot and dry the eyes and face
flushed and the pulse more bounding than before. In the latter
days of the attack, its employment is improper for obvious reasons.

Cold Affusions. I have used cold affusions in some violent con-
gestive cases, with the hopes of producing, by the sudden shock, a
reaction, and full development of the feven ; but, uniformly, without
success. The patient when put to bed and enveloped in blankets,
had but slight reaction, and that of an ataxic character.

Sponging and Foot Baths By far the best mode of applying wa-
ter, is by sponging the surface of the body, and by the frequent
administration of hot mustard foot baths. The first should be applied
to the head, throat, chest, and upper extremities the temperature to
be regulated by the condition of the patient. If his fever be burning
hot, and he complains of heat, he will bear even ice-water. Should
he complain that the sponging produces chilliness, the water should
be tepid or quite warm a little vinegar mixed with the water, pro-
motes its evaporation. Ice applied to the head also gives great
relief to the patient, but should it produce chilliness, it is subject to
the same objection as sponging with water.

The sponging keeps the skin moist relieves to a great degree the
sufferings of the patient, and moderates the burning heat of the sur-
face. The footbaths lend to equalize the circulation, and to relieve
the insufferable pains in the legs. The skin should never be permit-
ted to become dry, during the febrile action and the foot baths
should be frequently repeated.

Emetics. In persons attacked immediately after meals, I have
employed an emetic of pulv. ipecac, in order to relieve the stomach
promptly of its contents ; but have used them in no other way. In
this way, I have seen it do no harm. Dr. Cartwright, of Hatches,

GO Treatment of Yellow Fever. [February,

has employed tart, antim., in closes from three to ten grains, given
every one, two, or three hours, dissolved in a little water, or, what he
considers better, in the form of pills. It is only to be given in the
first stage of the disease, and in cases of congestive or ataxic charac-
ter. " Tartar emetic,'' says Dr. C, " used in this state, restored
sensibility to the torpid organs, produced secretion, and destroyed the
ataxic character of the disease, by establishing a general and equable
excitement ; or, in other words, converted an irregular and intracta-
ble condition of the system, into an open, plain, and manageable case
of fever." I have no experience in regard to this treatment, but
think it well worthy the attention of the profession. The great ob-
jection to using tart, antim. is, it tends to increase the irritability of
the stomach, so prominent a feature in this disease. But the suppo-
sition that inflammation exists in the stomach from the commence-
ment, is a mere bugbear ; and if, by the administration of any remedy,
we can break up those fatal forms of congestion and ataxia we some-
times meet with, and produce an open, well developed fever, we
should do so, even at the expense of increasing the irritability of the
stomach. When the fever is fully formed, we can manage it other-
wise, not.

Purgatives. The bowels should be evacuated as early as possible,
and thoroughly. They, moreover, should never be permitted to remain
unmoved over 24 hours; in other words, their own proper secretions
should be removed. The best purgatives are of the milder kind ;
blue pill, or a little calomel, followed in a few hours by a dose of castor
oil, and some mild saline laxative. Drastic cathartics do injury by
irritating the intestinal mucous membrane. Costiveness is not a very
common symptom in this disease, and, after the first evacuations,
clysters are generally sufficient to keep the bowels open. The repe-
tition of purgatives, after the bowels are well emptied, do no good,
but often a great deal of harm. They seem to dispose the intestinal
canal to sanguine engorgements, and consequently, to passive
haemorrhages.

Narcotics. Opium and the salts of morphia are sometimes admin-
istered to check the incessant vomiting which supervenes in the
beginning of the last stage; sometimes, also, they have been given
to relieve the hiccough, and sometimes to quiet the patient in nervous
delirium. In neither case have I ever seen good effects from their
use. Without effecting the object aimed at, they appear to check at
once the already too greatly diminished secretions.

Blisters, <fyc. Applied to the epigastrium, blisters are sometimes
of great service in relieving the gastric irritability in the commence-
ment of the last stage. Their administration, however, requires
caution, for if they are too large, or administered in improper cases,
they do mischief by affecting the already exhausted nervous system.

Stimulants. Such as brandy, ale, port wine, carb. amnion., cam-
phor, &c, are often resorted to, towards the close of the attack, but
generally in cases altogether hopeless. In many instances, however,

1846.] Remittent, Typhoid, and Typhus Fevers. 91

I have thought that they did a great deal of good the patients recov-
ering under their use. The extreme prostration, to which the patients
are generally reduced after the febrile stage is gone by, demands
some artificial support to be given to the system. The early admin-
istration of a little English ale, or sangaree of port wine, I have often
thought has turned the scale of life in favor of the patient. But it
must be remembered that yellow fever is not typhus fever, ami that
the like benefit from stimulants cannot be expected.

The remaining classes of the Materia Medica, such as tonics,,
diaphoretics, diuretics, &c, require no particular notice.

I have now concluded the task I undertook. In a future number I
may offer some speculations, concerning the etiology of this disease.

Distinctive characters of Remittent, Typhoid, and Typhus Fevers.
By Austin Flint, M. D., Editor of the Buffalo Medical Journal,,
and from the January No., 15-ib", of said periodical.

Nosological classifications of fevers, and the nomenclature of this-
class of diseases, have been as mutable as the numerous theories re-
specting the intimate pathological perversions constituting the febrile
state. Inflammatory, putrid, adynamic, bilious, yellow, jail, nervous,
malignant, petechial, congestive, ataxic, gastro-enierite, and a host of
other names have been at different times, and by different writers,
employed to distinguish forms of this disease, their application being
based upon circumstances ascertained or imagined, appertaining to
their origin, location, peculiar complications, or visible appearances.
It is easy to raise objections to each of these appellations, and, indeed
so long as the essential pathology of the febrile state remains un-
known, so long will any arrangement and nomenclature be liable to
be overturned and rendered obsolete by the ever-changing results of
progressive, pathological investigations. The distinction between
periodic and continued fevers, being founded on obvious facts, has
been retained for a long time, and will probably be permanent ; but
the different varieties of the latter are still subjects of discussion,
and the occasion for much difference of doctrine. The term typhus
has been in use ever since the time of Hippocrates, to denote a va-
riety of fever characterised by peculiar conditions of the mind and
general powers, which are expressed in its etymology. From its
appropriateness and long use, it is not probable that this term will be
soon abandoned : moreover, modern investigations have shown that
the variety of the disease which it is intended to express is very dis-
tinctively marked, not only by the cerebral symptoms and general
prostration, but by other and peculiar phenomena. Heretofore its
application was not so well defined as it is now. By Armstrong,
whose writings until lately were deemed of the highest authority, its
latitude was extended so as to embraee, by means of qualifying ad-

03 Remittent^ Typhoid, and Typhus Fevers. [February,

jectives, a great proportion of the cases cf continued fever. It has
now become more limited, embracing only a variety distinguished by
pcculiarsymptoms, attended by a constant exanthema, and especially
involving, as its remote cause, (in addition to contagion or infection)
concentrated animal effluvia. It is exceedingly rare that an oppor-
tunity presents itself for witnessing specimens of true Typhus in
this locality. It has fallen under the writer's observation in two
well-marked instances, only, during the last ten years. In one of
these it occurred in the family of an irish emigrant who had recently
arrived in this country. One of the three children had been affect-
ed and died with it on their passage. The other two were attacked
on their arrival in this place. The other instance occurred at the
alms-ho.use near this city in the winter of 1840-41. Four cases
transpired there in quick succession, under circumstances which ren-
dered it almost certain that the origin of the disease was due to the
malaria engendered by close congregation of the inmates of the
house in unventilated apartments. These cases were reported for
the Boston Medical and Surgical Journal, June, 1841.

The term typhoid, as applied to distinguish a certain class of fevers,
is of recent date, and is not recognised in this sense by all patholo-
gists. It originated with Louis, of Paris, whose researches into the
history and comparative phenomena of the fevers of the Parisian
hospitals, may be said to have created a new era for this department
of pathological science, and will remain an imperishable monument
of unsparing industry, and professional zeal. The investigations of
this truth-loving, talented pathologist, in themselves of great value,
are still more valuable as furnishing a new point of departure, and
giving impulse to a movement, which has enlisted the efforts of a
multitude of co-laborers in different countries. Louis ascertained
that the fevers of Paris were allied to each other by a certain unifor-
mity of lesions, the most constant of which were disorganization of
the glands of Peyer, and a softened condition of the spleen. The
same disease, by those who believe it to be in fact a local affection,
of which the febrile symptoms are symptomatic, has been entitled
Dothinenterite or follicular enteritis. After these minute and com-
prehensive investigations in France, it became an interesting and
important point of inquiry, in how far the same form of fever pre-
vails in other countries. The attention of Pathologists was soon
directed to this point. In the British Islands it was found that in
some of the cases of the, there so called, typhus fever, the descrip-
tions of Louis were applicable, and in others they were not. Thence
it appears to be the prevailing opinion of British writers that the
Typhus and Typhoid forms of fever are identical, but presented
under different modifications. They do not generally acknowledge
typhoid fever as a distinct form of the disease. In our country it
has been ascertained by Jackson, Hale, Shattuck, and others of Bos-
ton, that the fever indigenous in New England, and known there as
the common-continued, or autumnal fever, presents, in the phenom-

1846.] Remittent, Typhoid, and Typhus Fevers. 03

ena before and after death, an entire similarity to the typhoid fever
as portrayed by Louis. Gerhard, of Philadelphia, has also described
a fever indigenous in that locality, identical with the typhoid; and,
also, an epidemic typhus, which he traced to importation from Eng-
land by means of the English immigrants arriving there, in which
the characteristic symptoms and lesions of typhoid fever were ab-
sent. He regards the two forms of fever as distinctly separable ;
and having had abundant opportunities to study the disease as it pre-
sents itself abroad and at home, his opinions are entitled to great
consideration. Nevertheless, it is by no means regarded as settled
by pathologists of this country, that the two forms of disease are in-,
trinsically distinct. It is still a question sub-judice whether they
are not one and the same disease, presented at different times and
places under different modifications. While there is much weight of
authority for the negative of this question, the numerical vote, we
imagine, would be in favor cf the affirmative.

We have extended these remarks farther than we intended when
we commenced writing. Without entering into the controversial
question just referred to, it had occurred to us that it would be ac-
ceptable to our readers to present a brief synopsis of the distinctive
characters appertaining to the forms of fever distinguished as Typhus
and Typhoid, and also, those which belong to the common Remit-
tent fever, as distinguished from both of the preceding. Whether
we accept the doctrine which makes a specific distinction between
the two forms, or that which regards them as varieties of the same
species, there can be no doubt that the distinctions exist, and it is, to
say the least, convenient to indicate this fact by different terms.
The fever which generally prevails in this locality, is the common
remittent, or, as is miscalled, bilious fever. But there is reason to
suppose that sporadic cases of Typhoid fever occasionally occur, and
we are liable, at any time, to meet with this, or undoubted typhus in
an epidemic form. Under these circumstances, it appears to us that
there will be an advantage in having a synoptical view of these se-
veral forms of the disease which will admit of easy reference.

CHARACTERS DISTINGUISHING REMITTENT AND TYPHOID FEVER.

Typhoid. Access is gradual : a week or more with podromic
symptoms.

Remittent. Access is generally sudden.

Typhoid Characterized by prostration and stupor ("typhoid
symptoms") early in the disease.

Remittent. The symptoms commonly called 'typhoid,' do not
occur until quite late in the disease.

Typhoid. Seldom a distinct chill, but only chilly sensations,
which do not recur with periodicity.

Remittent. Chills generally pronounced, and apt to recur several
times with observance of periodicity*

Typhoid. Diarrhoea one of the most constant symptoms; occurs
early, and is apt to continue. Mctcorism is generally present.

94 Remittent, Typhoid, and Typhus Fevers. [February,

Remittent. Diarrhoea only an occasional symptom. Meteorism
of less frequent occurrence.

Typhoid. Sordes of mouth, with low muttering delirium early in
the disease.

Remittent. These symptoms are not found until the latter part of
the disease, and very often absent.

Typhoid. Attacks subjects, almost invariably under 30 years of
age.

Remittent. Shows no such discrimination.

Typhoid. Cough and Expectoration (Bronchitis) are generally
.prominent symptoms.

Remittent. Of much less frequency.

Typhoid. Rose, or red spots (taches rouges') occur over abdomen
and breast, from the 8th to the 15th day.

Remittent. Absent.

Typhoid.^-Tongue is brown and dark.

Remittent. Generally yellowish white. Nausea and vomiting
are characteristic of its early stage ; while they are less prominent,
and often absent in Typhoid. The conjunctiva is frequently yellow,
and the urine impregnated with bile. The skin is apt to be yellow or
sallow. These symptoms do not occur in Typhoid. The mind, also,
in Remittents, is frequently unaffected ; very rarely so in Typhoid.

Typhoid. Subsultus frequently present.

Remittent. Rarely.

Typhoid. Occurs rarely before November, sometimes in the
latter part of October.

Remittent. Occurs especially in August and September ; unfre-
quent in October, and rarely afterward.

Typhoid. Contagious and infectious.

Remittent. No evidence that it is either.

Typhoid. Presents after death disease of the Elliptical Plates, ot
Peyers glands, the mesenteric ganglions, and softening of spleen.

Remittent. Spleen may be softened. The other lesions mention-
ed, rare. Stomach and Liver almost invariably evince disease.
(Stewardson.) A fact which often enables us to confirm our diagno-
sis of remittent fever at its close, or after the case has terminated, is
this : It is very apt to resolve itself into an intermittent form ; and,
in a very large proportion of cases, individuals who have had remit-
tent fever, experience an attack of intermittent within a twelve
month after their recovery. This fact may, also, serve to correct a
diagnosis of Typhoid fever if it has been incorrectly made.

CHARACTERS DISTINGUISHING TYPHUS AND T1PHOID FEVERS.

The following is an abstract of the diagnostic symptoms distin-
guishing the two forms of a fever above mentioned, presented by Dr.
Gerhard, in his lecture on the subject, published in connection with
the lectures of Dr. Graves, of Dublin. The descriptions are abbre-
viated a,s much as practicable. He classes the symptoms under 4
heads.

1840.] Remittent, Typhoid, and Typhus Fevers. 95

CEREBRAL AND NERVOUS SYMPTOMS.

Typhoid. Loss of strength and prostration very early in the dis-
ease. Singing in ears, Vertigo, Epistaxis. Pains in head and limbs
not so violent as in intermittent and remittent fevers. Chilliness,
but not defined chill. Brain symptoms increase slowly. Delirium
rarely entirely wanting ; sometimes only at night.

Typhus. Stupor prominent from the first. Patient becomes
comatose at an early period. Delirium always of the still, mutter-
ing kind.

OF THE SKIN.

Typhoid. Rose spots fewer in number, often only six or eight ;
rarely more than 30 ; rather larger, elliptical, and more elevated.

Typhus. Exanthema extends over the whole body. Papulae are
rounded, varying in size from an imperceptible point to breadth of a
line. Occurs on the 3d day. May continue 12 or 14 days gener-
ally only 5.

ABDOMINAL ORGANS.

Typhoid. Diarrhoea after a few days, a frequent, but not invaria-
ble symptom. Meteorism, or abdominal pains generally present.

Typhus. These symptoms not present excepting as rare anu*
accidental complications. Thirst more marked.

THORACIC SYMPTOMS.

Typhoid. Some congestion of smaller bronchial tubes, which
may pass into bronchitis, or pneumonitis.

Typhus. Congestion different : apparently more dependent on
the state of the blood, which obeys the law of gravitation the de-
pendent part always full of blood. Pulse more frequent. Eye more
dull, heavy, and blood-shot.

He states the following general circumstances :

Typhus spares no age ; prevails as an epidemic, extending by
contagion, or direct propagation from an infected individual.

Typhoid, rarely assumes this character ; rarely epidemic, and
scarcely infectious, excepting ichen prevailing epidemically.

The medical physiognomy is very diagnostic, but difficult to bo
described.

To these it is to be added that the characteristic intestinal lesion of
Typhoid fever, or, to use the language of Louis, its anatomical char-
acter, while it is essential to constitute this disease, is an infrequent
complication only, in Typhus.

In view of the acknowledged ability of Dr. Gerhard as a patholo-
gist, his extensive and peculiar opportunities for clinical observation,
and the fact that he has advocated the doctrine of an essential dis-
tinction between these two forms of fever, it seems fair to conclude
that he would submit as strong a contrast of diagnostic symptoms as
will comport with a rigid adherence to an exact description of phe-
nomena. The practical reader will perhaps be enabled from the pre-
ceding comparison to form an opinion whether the antithetic charac-
ters are sufficient to constitute a radical distinction, or whether they

90 On the Cause of Disorder in Pregnancy, [February,

are not of so kindred a nature as to denote the same disease under
somewhat different aspects. For our own part, we incline to the
latter view, although we admit that the circumstances indicated,
enable the practitioner to determine in most cases, without much
trouble, whether the disease be more appropriately agreeably to
this classification called typhus, or typhoid ; and that it is con-
venient and useful to make the distinction. In short, while all must
acknowledge that they are in nearness of kin, cousin-germans we
are disposed to regard them as even more closely allied to each other,
being, if not one and the same individual, at least pathological twin-
brothers.

On the Cause of Disorder in Pregnancy. By John H. Shearman,
M. D., of New York. (From New York Journal of Medicine.)

The notoriety of disorder, in some shape or other, in almost every
<rase of pregnancy, and the long catalogue of disorders of pregnant
women which has been accumulated by the observation and industry
of obstetric practitioners, render any proof of the assumed fact un-
necessary.

The history of ages has been collected the most refined distinc-
tion, analysis, and classification of symptoms have been achieved
remedies and preventives have been copiously suggested, until every
symptom as well as malady is provided for ; but the cause of disor-
der is still left unexplored. The, action of the gravid uterus on the
rest of the body, or the sympathy of <he body with the uterus, being
the only explanation attempted or expected.

But why should the process of gestation occasion disorder? Is not
the process a natural one ? Why should not a man suffer from the
process of generating, as well as a woman from gestating? The
woman is formed for the purpose of breeding and bearing children,
and the whole of her life tends towards that, as the aim and end of
her existence. Gestation is not to be considered as disease. The
reproduction of our species is not a foreign process. Why then
should the body be disordered, and be said to sympathize with the
uterus in this condition? The common cant of evading the assign-
ment of the true cause, by assigning some meaningless words in-
stead, to cover our ignorance, can be of no service to us; and an
honest "I don't know," is much to be preferred, to "words without
knowledge, which darken counsel."

Among the other facts which have been observed, that the blood
is not in its usual, or as it is called, normal condition, during preg-
nancy, is a fact universally admitted. The similarity of the appear-
ance of the blood in pregnancy to that in inflammation, has long
been known, and although this single but singular (act might have
led some acute mind to the very heart of the mystery, yet to this day

1346.] On the Cause of Disorder in Pregnancy,

it remains unexplored a secret and a marvel. Indeed, the uterus
has for ages been regarded with a degree of superstition, as capable
of doing many marvellous things, and in the opinion of the million,
medical as well as non medical, performs wonders much greater
than bringing forth men. It is supposed to be capable of altering
the whole condition of the body, as in cases of chlorosis and hyste-
ria; and so potent is the uterus considered to be in the matter of
health or disease, that hardly any medical man attends a female
patient, without conscientiously enquiring into the condition of the
uterus and its functions ; nor would any patient consider herself pro-
perlv attended, without such inquiry.

The condition of the uterus in pregnancy, from the moment of
conception to that of birth, has been very ably examined, and all
that relates to anatomical and physiological states has been most
minutely investigated, by men whose names are immortalized in the
annals of anatomy. Ruysch, Harvey. Haller, the Hunters, Home,
and a hundred others, have ably explored these fields of science : but
the cause of all the morbid phenomena of pregnancy seems to have
escaped investigation, as if the process of gestation were a secret
out of the reach of man.

I have already observed, that it is a well-known fact, that the blood
is not in its normal state, in pregnancy. But why is this ? What is
there in the process of gestation to alter the condition of the blood 1
The answer to this is the key to the whole question. What is done
with the blood in the uterus during gestation causes the whole of the
phenomena. It has been usual to consider the state of gestation, as
one which is like to that of inflammation, because of the exhibition
of the burly coat of the blood ; and since inflammation precedes, and
sometimes appears to accompany the process of reparation in cases
of injury, the reformation of a part, and the reproduction of a being,
have both been set down as results of the process denominated in-
flammation.

However, inflammation is invariably the result of interrupted
nutrition : or. if some will have it so, the cause of it : but whichever
way the theorists might decide with regard to inflammation, it can
never be the cause of reproduction. Let any mnn venture to carry
out the theory, even on paper, "Gestation, an inflammatory process
of the Uterus," and see what he will do. In the meantime, let us
endeavor to trace out as well and as far as we enn, what takes place
in the process of gestation, and ascertain what effects would be likely
to follow such proc

No sooner is the semen deposited in the uterus, than there is a
process of formation set up. The membranes in which the ovum is
enveloped, and the placenta by which it is nourished, have to be
formed, and this process necessarily diminishes the quantity, as
as deteriorates the quality of the blood in general circulation. How-
ever, as the membranes and placenta are composed of the usual
elements of the body, there is little, if any, change in the condition

7

98 On the Cause of Disorder in Pregnancy. [February,

of the blood, and but trifling disturbance while this process is com-
mencing; but as the fcetus begins to be developed, there is more or
less disturbance, so that in some cases death itself is occasioned.

It is allowed, that the first stage of the process consists in the de-
position or formation of serous and albuminous matter, in which the
foetus is to be developed. These fluids contain considerable quanti-
ties of the alkaline and acid constituents of animal substances, and
when subtracted from the general mass of the blood, must to a cer-
tain extent alter its chemical condition. The animal alkalies and
acids, which are the result of animal chemistry, may be formed out
of the elements of the blood, without inconvenience to the rest of the
body : but the mineral acids, alkalies, and other substances which are
secreted to form these depositions, can be procured only by fresh sub-
stances taken into the body. Phosphorus, chlorine, sulphur, lime,
soda, potash, magnesia, silica, iron, manganese, &c, can be procur-
ed only from outward sources; and when withdrawn from the general
mass of blood, and not replaced, must of necessity cause considera-
ble change in its condition.

The next stage in the process of gestation consists in the further
development of the foetus, now the nidus for it has been prepared;
and the fcetus is at first, principally, serous, albuminous, and
gelatinous; in all of which, the saline and mineral compositions of
the body most abound ; and of course this process occasions a con-
siderable draught upon the whole quantity of the blood. As the
foetus becomes developed, the bones require large quantities of lime
and phosphoric acid, which will be fetched from the composition of
the substance of the mother, if not found in sufficient quantity in the
blood; so that the draught upon the peculiar elements which are
required for the growth and perfection of the fcetus, if not supplied
exactly in the same proportions as those in which they are abstracted,
causes a defection in the constituent elements of the mother.

Not only is the quality of the blood of the mother liable to be al-
tered by the development of the fcetus, but the quantity to be seri-
ously and even formidably diminished. The growth of the fcetus in
the course of nine months, being from a grain to eight or ten pounds,
the principal quantity of which is produced during the last three
months, must necessarily abstract largely from the whole quantity of
the blood; and quantity as well as quality of blood is one of the
elements of health. If the daily abstraction of quantity as well as
quality from the blood, could be daily repaired, there would little dis-
order happen ; but as the condition of the fcetus is absolute, requiring
to be perfected in a certain time admitting of no delay, and permit-
ting no lack of supply of requisite materials ; and as the condition of
the mother, from external circumstances, or from improper manage-
ment or conduct, may be unfitted for the process which is going on,
much disorder and misery may occur.

If the disorders of pregnancy be owing to the causes which I have
pointed out, then they would be likely to occur when these causes

1840.] On the Cause of Disorder in Pregnancy. 99

have been operating for the longest periods of time, most uninter-
ruptedly ; and this appears to be most undoubtedly the case. The
night, especially during sleep, is the time when most nutrition is per-
formed. The foetus must therefore grow more by night than by day,
and consequently draw most copiously on the blood at that time.
The morning necessarily will be the time, contrary to the usual course
of other ailments, when the pregnant woman will experience most
inconvenience. Then it is usually, that her languor, head-ache,
nausea, and vomiting come on, and the thousand and one ailments
of her condition press most heavily upon her.

The appetites and longings of women in pregnancy are indubita-
ble proofs of disordered biood; for, if we knew rightly how to trace
effects to their causes, we should find, that the substances for which
they long, contain the elements in which their blood is defective.
Thus if a woman have a longing for cabbage, greens, radishes, or
any species of the Brassica, we may know that sulphur and phos-
phorus, and most probably hydrogen and nitrogen, are deficient. If
she have longing for fish, we may conclude that gelatine and phos-
phorus are deficient. If she long for carbon in any shape, it is need-
ed to neutralize the nitrogen and hydrogen in excess and if she
long for lime and magnesia, they are defective. In these matters,
physiological observers have done little more than recount the fancies
of gestating women, and leave them to the pity or ridicule of medi-
cal men. "As fanciful as a pregnant woman," is an old standing
proverb.

But perhaps the altered state of the blood may be admitted, with-
out conceding that the different condition of the blood causes the
disorders in question. Yet, will any one point to a disease or disor-
der of any kind, which does not depend on an altered condition of
the blood ? Wliat fever does not depend on the state of the blood 1
What inflammation, spasm, or nervous affection, tooth-ache or ear-
ear-ache, but is attended with some disordered condition of the blood,
either in the whole quantity or some part? How does the bite of
insects and venomous animals affect us? Is not the condition of the
blood in the part changed immediately, and in some instances the
whole mass of the blood altered ? Moses asserted that the life was in
the blood, and Hippocrates, Harvey and Hunter, have proved it.
When the mode of life is altered, the condition of the blood is changed.
In ease and health the condition of the blood is natural. In pain
and disorder the blood is unnatural. It is on this principle that the
whole of the phenomena of poisoning are accounted for and on
this principle is the whole theory of medicine founded : for all medi-
cine, and all food, and all treatment of every description, act on, and
through the blood.

VVe have then a fine field of observation thrown open to us in the
investigation of the condition of the blood of Restating women, and
the chemical nature of the food which they desire. Indeed, the food
which we take, as well as the food which we desire, admits and re-

109 On the Cause of Disorder in Pregnancy. [February,

quires the nicest and most thorough investigation. Such as our food
is, such is our blood ; and although it follows that what we desire for
food we ought to have, to keep us as we are ; yet it does not follow
that we ought to be what we are, nor therefore that we ought to take
the food which we take.

Too much care cannot be exercised with regard to the substances
taken into the body by pregnant women. The smallest quantity of
a substance which is not wanted in the body, may produce most dis-
tressing consequences. How appalling to think of the quantities of
substances in the shape of medicine, which pregnant women take.
Salts, senna, sulphur, castor-oil, aloes, rhubarb, colocynth, magnesia,
soda, ammonia, iron, zinc, mercury, silver; with a multitude of others
after the art of the apothecary. If one thirfg will not do, try ano-
ther ; as if the human body were to be kept -together, as well as
kept going, by the apothecary's art. The stomach must be kept
right, and the bowels kept right by the ''medicine man." Nor does
the spell-man nor incantation-man hold in more complete unnatural
and superstitious thraldom, the unenlightened Indians and Barbarians
than the ignorant drugger holds the civilized races of man.

But there is another cause of the disorders of pregnancy to which
we must advert, which operates in the same way. As a woman has
to support another being beside herself, she must necessarily take in
a larger supply of food, and make a greater quantity of blood than
she did before pregnancy. For this purpose, the whole of the circu-
lation must be augmented, or quickened, or both, and not only the
ingesta, but the egesta, be increased. A pregnant woman is a larger
woman in every sense of the word, than she was before pregnancy,
and her secretions and excretions must necessarily be increased. If
these be improperly retained, there is the same result produced as if
too much be taken away : for the blood, the solids and the fluids,
must be of the normal condition, to prcduce health.

There need be no doubt of the requisite arrangements for these con-
ditions in every woman who is completely formed for every thing
and being in nature is adapted to its use and end. The doubt is,
whether the arrangements of society are adapted to the condition of
women in such circumstances. Close, tight, hot, and cumbersome
clothing the greater portion of the skin excluded from light, air,
and water soft, close, heating beds close, unventilated rooms, un-
naturally heated little or no exercise food of an unsuitable nature,
improperly administered in quality and time long sitting at one time
and in one place, particularly when crowded and heated remaining
up at the most suitable time for repose and remaining abed at the
most suitable time for rising and all the other unnatural modes and
habits of towns and cities, interfere most terribly with the natural,
healthy condition of women particularly. They modify the condi-
tion of the blood, the appetite, digestion, nutrition, secretion, excre-
tion, and all the functions of life. Tight lacing prevents the due
performance of respiration, because it diminishes the space for the

1846.] On the Cause of Disorder in Pregnancy. 101

lungs it hinders digestion, because of the compressed state of the
stomach and neighboring vessels and it obstructs the assimilating
and separating process of the intestines, because they have not room
for sufficient peristaltic motion the functions of the kidney and
bladder are hindered, because of the obstructed circulation in their
tissues, and the uterus is kept down, and the neighboring parts
obliged to offer great resistance to its enlargement and elevation.
Yet who will go without corsets to save her health ? They are, from
custom, as requisite to support and existence, as ale. wine, and spir-
its are, to those who take them habitually but no more.

Women in a state of nature, or, if it be thought more proper, in a
wild state, suffer remarkably less in pregnancy and labor, than wo-
men in civilized life. Their functions are less interrupted, and they
have better health. They breed and bear with an ease which fash-
ionably educated women know nothing of. Their food is more sim-
ple they have little or no medicine, and their dress, if not so elegant,
may be as serviceable. They have more to do with light, air, and
water, are better fitted to the elements in which they live, and are a
large and important proof to us, that pregnancy, when it has fair
play, occasions little disorder.

The principal reason to be assigned, why some women in civilized
life, differ so much from others, in their condition in pregnancy, is,
that they have better general health, or manage themselves better
than others ; and those who live in the most simple style, and tne
nearest to the requirements of nature, are invariably in the best
health.

It is not my purpose, in this paper, to allude to the mechanical
causes of disorder in pregnancy as that is amply performed by
others more competent than myself; nor can I enter into the details
of treatment and management of the disorders of pregnancy. It is
enough at one time, to point out the cause, or even the direction in
which the cause lies, and turn the attention to the investigation of the
subject. But there are a few remarks requisite on the menses and
the milk, which will serve to illustrate and confirm what I have ad-
vanced.

The menses are a periodical accumulation of discharge from the
uterus, evidently keeping up the aptitude forthe function of pregnan-
cy; and when they are defective, interrupted or irregular, there is
either local or general disorder preceding such disturbance. The
retention of the menses, or rather non-cecernment of them, is mostly
the effect of a peculiar condition of the blood, not the cause of it.
Delicate women, of a spare habit of body, have usually a large quan-
tity of this peculiar secretion. This is in consequence of the little
vigor of the organs of the body, and therefore only a small supply of
blood is required, and there is much to be thrown off. Robust and
rigorous women have less secretion, as there is less superfluous
blood almost all being required for use. But little or much, the
secretion is for the purpose of habituating women to nourish another

102 On the Treatment of Wounded Arteries. [February,

being beside themselves. Accordingly, when women are no longer
fitted for the purpose of supporting and producing offspring, this se-
cretion ceases.

During each period that pregnancy occurs, the breasts are en-
larged, and there is a tendency to the secretion of milk but there is
rarely any milk actually secreted, until the birth of the child. Then,
the milk begins to flow freely enough for its sustenance. The body
having been accustomed for some time to nourish a parasitic being,
has acquired a capacity for this function: and the child no longer
receiving its supply from the uterus, is now furnished with it at the
breast. The blood which was previously employed to sustain the
child in the uterus, is now employed to secrete the milk in the breasts.
This function of sustaining another being, increases after the birth
of the child for the infant requires more nourishment progressively
after the birth than before, and yet the mother is usually capable of
supplying all the wants of her infant, for nearly the first year.

Now in the case of the menses, and the milk, as they are both sup-
plied from the blood, and therefore are secretions, and must necessa-
rily draw largely on the blood, especially the milk if that portion
of the blood which they abstract, is not constantly supplied, how soon
the woman fulls info disorder. After the principal flow of menses,
women are often much exhausted and after a night's suckling, how
many women vomit and faint, and suffer as much as during pregnan-
cy. In both these cases, the blood of the woman has been materially
altered, both in quality and quantity; and hence the symptoms of
disorder which occur.

The more simple the causes of phenomena, the more easy of man-
agement are they. If the principal disorders of pregnancy are pro-
duced by the condition of the blood and that condition depends
simply upon what is put into and taken out of the blood and if the
nature of the food modifies the nature of the blood, it maybe reason-
ably hoped, that a more thorough acquaintance with the nature of
food will enable us to avoid or palliate much of the sufferings of preg-
nancy. In cases of poverty, where the supply of food is unsuitable
and insufficient, no art or science can supply the want of it nor
will any medicinal treatment be of use, except such as may tend to
restore the blood to its proper condition.

On the Treatment of wounded Arteries, with Cases. By Warren
Stone, M. D., Professor of Surgery in the Medical College of
Louisiana. (From the New Orleans Medical and Surgical Jour.)

The operative surgery of the arteries maybe considered complete,
and yet but little is said of the minute treatment and management
of wounded arteries. There is no more merit in casting a ligature
around an artery than belongs to the skilful mechanic ; but there is

1846.] On the Treatment of Wounded Arteries. 103

merit in knowing when, and when not, to use the knife. There are
cases, when by avoiding a painful operation, life may be saved ; on
the contrary, by temporizing, and allowing repeated haemorrhages,
even from minor arteries, life may be sacrificed. It is not necessary
to enter into the pathology of wounded arteries, for it is sufficiently
understood. I shall speak of it in connection with the treatment of
particular cases.

When an artery of considerable size is divided, it is our duty to tie
it at once, provided the wound is open, and the vessel accessible with-
out an operation ; but if this is not the case, and the bleeding can be
easily controlled by compression, we are justified in attempting a
cure by this means. The usual mode of making compression, in
such cases, is to apply a large compress over the wound, and confine
it with a bandage, enveloping the whole limb, which serves to pre-
vent the escape of blood externally, but does not prevent its escape
into the tissues around the divided vessel, and which, while it may
favor the formation of a clot in the artery, tends at the same time to
prevent that adhesive inflammation upon which we depend for a cure.
Compression should be made immediately over the mouth of the di-
vided vessel (by whatever means may be convenient), and kept
steadily applied, until a coaguium forms in the artery, which will
take place in a short time, precisely as if a ligature was applied, pro-
vided the compression be complete; but if an occasional escape of
blood is allowed, it will break up the forming clot. The length of
time required for the formation of the clot, varies according to the
size of the vessel. In small vessels, a slight coaguium around the
mouth is sufficient to arrest the bleeding, and this may form in a few
minutes; but in large vessels it is necessary for the clot to form in
the artery (which we know will take place, if the bleeding mouth be
kept closed), as far back as the first collateral branch. In a large
artery, I think it requires from two to three hours for the perfect
formation of the clot. When this is accomplished, the compression
should be removed or lessened, the wound, if possible, cleared of
blood, the parts brought accurately together, and no more pressure
made than can be allowed without interrupting the process of union,
or the deposition and organization of lymph around the mouth of the
vessel. Too strong compression prevents the natural adhesive pro-
cess, and rather favors secondary bleeding. If the wound presents
an unhealthy, sloughy appearance, and secondary haemorrhage oc-
curs, it is useless to attempt a cure by compression, even in minor
arteries; for repeated hemorrhages will follow, until the patient is
exhausted. If, however, the wound is healthy and granulating,
slight compression may be made, just sufficient to prevent any inju-
rious loss of blood ; the granulations will close the vessel. If com-
pression is strong, absorption of the granulations is effected, render-
ing the cas worse, without affording any additional security against
ing, which will occur as often >t dissolves, and continue

until another forms. A light graduated compress of soft, dry lint,

104 On the Treatment of Wounded Arteries. [February,

with light pressure, will, so long as the compress remains dry, pre-
vent bleeding in the large sized arteries; therefore, the compress
should be removed as often as it becomes saturated with the dis-
charge.

Case I. Showing that large arteries will unite without ligature.
Mr. H , a robust man, in the prime of life, received a gun-shot wound
in November, 1843, which divided the left femoral artery, at or above
the profunda. The ball entered the anterjor part of the right thigh,
just below tl;e spine of the ilium, passed through, entered the scrotum
anterior to the right spermatic cord, and passing behind the left, came
through ; entered the left groin, and came out just below, and ante-
rior to, the trochanter, dividing in its course the femoral artery and
vein, and producing serious injury to the crural nerve. I was but a
iew paces from him at the time, and immediately made pressure with
one hand, and assisted him in lying down with the other; but, in the
act of lying down, he was seized with faintness. followed by convul-
sions, which were produced more by the shock the nervous system had
received, through the injury of the crural nerve, than by the loss of
blood. He gradually resuscitated, and when sensibility returned, he
experienced an almost intolerable pain in the course of the nerve,
more particularly at the lower extremity. This pain he described
as similar to what he felt in the hand, upon contusion of the ulnar
nerve, though much more severe. The bleeding was easily and
completely controlled by pressure in the track of the wound, imme-
diately over the mouth of the divided vessel; and as he was suffering
as much as humanity could bear, the application of the ligature
which was of course deemed necessary was deferred. Laudanum
and brandy were administered, half an ounce of the former and half
a pint of the latter, in the course of two or three hours, which barely
sufficed to render his pains tolerable. At this time, it was found that
the artery was perfectly closed by a coagulum, and as the vehicle
had arrived to convey him to his lodgings (the distance of three or
four miles), I concluded, with the concurrence of Dr. Harrison, to
allow him to be moved before tying the artery. Dr. Harrison ac-
companied him, to make pressure, should it be necessary. No
bleeding, however, was produced by the removal. He was still suf-
fering as much as he could well bear, and feeling confident that if
adhesive inflammation took place healthily, the artery would close, I
concluded to leave it to nature for the time. A few friends were
selected to stay by his side, by turns, with instructions in case of
bleeding. Simple water dressings were applied to the wounds. No
bleeding occurred, and the wounds healed with little annoyance.
The main difficulty was in preserving the limb. Dry heat, frictions,
and finally the gentle application of electro-magnetism, were em-
ployed, and with evident benefit. Apparently no circulation existed
in the limb; the blood seemed to penetrate the tissues, and on the
third dav made its way as far as the inltep, where it ceased its course.
Great difficulty was experienced, also, in effecting the return of the

18-13.] On the Treatment of "Wounded Arteries. 105

blood, in consequence of the wound of the femor.il vein. The injury
of the nerve, no doubt, operated upon the nutritive action in the
limb. The pain gradually subsided, and sensation and nutrition are
now restored. The foot, of course, sloughed from the point where
nutrition ceased, which was at the junction of the tarsal and meta-
tarsal bones. It may be said that this being a gun-shot wound of
the artery, it united, which would not have been the case had the
wound been an incised one. I admit, that haemorrhage is more easily
arrested in gun-shot wounds, but secondary haemorrhage is more like-
ly to occur; for the reason, that lymph is not s*Jikely to be thrown
out and organized around the mouth of a vessel when divided by a
ball, as when divided by incision.

Case II. Mr. H., the subject of the former case, received a gun-
shot wound in the head several years since. The ball entered just
below the left eye, passed through the antrum, fractured the palate
bone and pterygoid process of the sphenoid, and probably struck
against the spine, just below the cuneiform process of the occiput,
and fell into the fauces. Mr. H. fell senseless from the concussion ;
profuse haemorrhage followed, but ceased with the syncope. In this-
state he was conveyed to his room as dead ; he, however, gradually
resuscitated, and no further bleeding occurred for the time. Simple
applications, I believe, were made to the wound, and very light nour-
ishment allowed. The wound did well, and he gradually rallied until
the seventh day, when his friends carried him on board of a boat at
Natchez (where the accident occurred), for the purpose of bringing
him to New Orleans. From the excitement of moving, or some
other cause, an alarming haemorrhage took place shortly after leav-
ing Natchez, which continued, in spite of every effort made by the
physician that accompanied him, until syncope ensued, and another
coagulum formed. This secondary clot sufficed to prevent bleeding
for 18 or 20 hours, when it either dissolved, or arterial re-action
came on and forced it away. Another bleeding ensued, and termin-
ated in the same manner. The boat was detained, and a third haem-
orrhage took place before he arrived in New-Orleans. I saw him
soon after his arrival, and found hirn with a pale cadaverous counte-
nance, pulse 140 in a minute, and barely perceptible. It was certain
that, in due time, another haemorrhage would occur, and I therefore
proposed to tie the carotid artery at once. This was objected to, on
the ground that it was too late, and would only add to his sufferings.
He, however, rallied under the use ofa little ale and broth, when the
point was yielded, and I threw a ligature around the common carotid,
by candle light. Some difficulty was experienced ; first, from the
difficulty of throwing light down into a deep wound (the patient had
a short, thick, muscular neck) ; and, secondly, from the irregular
(though not unfrequent) distribution of the superficial veins. The
external jugular and superior thyroid veins united in one trunk, and
dipping down, emptied into the internal jugular, crossing the artery
exactly at the point where I wished to pass the ligature. I succeed-

On the Treair.ent of ^ci'rided Arteries. [February,

ed, however, in opening the common sheath by means of two pairs of
forceps. The sheath was seized with one pair, and raised; while
with the other, it was seized as near the first as possible, and an open-
in# made in it. By careful management, he gradually recovered
without any unpleasant symptom. It is impossible to say what arte-
ry was wounded in this case. From the violence of the bleeding, the
physician that accompanied him thought it was the internal carotid,
but it may have been only the internal maxillary.

This case shows the folly of attempting to arrest secondary bleed-
ing by pressure or plugs. A secondary coagulum in an artery, I
believe, never does become organized, but merely obeys physical
laws. This case occurred in the same individual, in which the
femoral artery united so kindly ; and at a time, too, when his system
was in a more favorable condition. It is probable, that if from the
beginning perfect rest had been maintained, haemorrhage would not
have occurred. The position of the wound, too, was unfavorable, for
from the scantiness of soft parts, and from their being held asunder
by the surrounding bony structure, it is probable that no lymph was
thrown out around the mouth of the vessel ; and the whole resistance
to the heart's action, was in the clot in the artery.

Case III. Mr. G , aged about 27 years, of good constitu-
tion, was admitted into the Maison de Sante, or Stone & Kennedy's
Infirmary, in December, 1844, for femoral aneurism. Ke repre-
sented that about a year previous, when in the act of lifting a barrel
of molasses, his right foot slipped, and the leg was forcibly abducted.
He instantly felt a sudden pain in the upper and inner part of the
thigh, and from that time had odserved the tumor, which had gradu-
ally increased until he was disabled. The ligature was advised, and
as the tumor was high up, I thought proper to tie the artery above
the profunda, and with this view, tied it about three-fourths of an inch
below Poupart's ligament, where the size of the artery was such as
to satisfy me that I was above the profunda. Pulsation ceased in
the tumor ; the wound united as kindly as usual in such cases. The
angles united by the first intention, and the rest of the wound filled
with healthy granulations, leaving merely a sinus around the ligature.

Some days after the artery was tied, I observed upon examination
that pulsation existed in the artery to within the eighth of an inch of
the ligature. Subsequently the pulsation could be traced past the
ligature, although the tumor was quiet and subsiding rapidly. I was,
of course, convinced that I had tied the artery just below the bifurca-
tion, and warned the patient of the additional danger of bleeding,
and of the importance of absolute rest. He, however, grew impatient
of confinement, and on the twelfth day, made unnecessary exertions,
and profuse haemorrhage took place. Mr. McManus, the very able
house surgeon, made pressure over the artery, which controlled the
bleeding for the time, and sent for Dr. Carpenter (who was near)
and me. On my arrival I found every thing ready for tying the
arterv. I decided that the case could be treated safely without ano-

1846.] On the Treatment of VTotmded Arteries. 137

ther operation. The case was simply this : the artery had giveft
away in consequence of the position of the ligature which left /id
space for a coagulurn. But every thing was in a healthy condition ;
and when the ligature was removed there was merely an orifice,
which had only been kept open by the necessary presence of the
ligature, and prevented from being filled by granulations.

Here then was a sinus leading from the divided extremity of the
artery to the surface, eking it out as it were, and rendering one con-
tinuous tube to the surface. The ligature being removed, nature was
ready to fill speedily that portion of the tube from the surface to the
point where the ligature was applied, with granulations, and experi-
ence has taught me that it was only necessary to avoid any injurious
loss of blood, and that nature would in a few days close the sinus.
The force of the current of blood in an artery is overrated, for very
slight pressure, upon the bleeding mouth of an artery is sufficient to
control bleeding. The ligature was removed, and a light compress
of dry lint applied, and confined by adhesive plaster; being careful,
however, not to make too great pressure, lest the granulating process
might be interrupted. It was my intention to dress every twelve
hours, or as often as the lint became moist by the discharge, but being
called away, and my directions not being understood, the dressings
were allowed to remain and bleeding occurred. Strong compress-
ion was made, but notwithstanding, bleeding occurred again. On
removing the dressings, I found that absorption of the granulations
was going on in consequence of undue pressure. I then explained
the principle upon which I relied for a cure ; which is, that very light
pressure with dry lint in cases like this, is sufficient to control bleed-
ing, if renewed often, at least as often as it becomes saturated by the
discharges, and that the bleeding vessel will be closed by granula-
tions. This course was carefully followed, and no more bleeding
took place. It was the unhesitating opinion of several physicians
who saw this case, that the patient was saved by avoiding a second
operation ; for the patient was seized with erysipelas, which was
very prevalent, and of a bad character at the time ; just at the period
when the adhesive process should have been going on, had the artery
been tied a second time ; and from the severity of his symptoms
there is little doubt that bleeding would have occurred again.

I could mention many other cases of smaller arteries ; but this case
is sufficient to illustrate the principle, which is all I have aimed at.

Case IV. Mr. P., while defending himself from an attack, re-
ceived a wound in the hand from a dirk, which evidently divided the
deep palmar arch. I saw him five days after the accident, and was
told by him that profuse haemorrhage followed the wound. A physi-
cian was called, a compress was applied, which arrested the bleeding
for the time ; but almost thirty-six hours afterwards, it occurred
again. The compress was renewed ; but twenty-four hours after-
wards the ha3inorrnage returned, and continued to return regularly
every twenty-four hours, up to the time I saw him. I advised him

103 On the Treatment of 7Younded Arteries, [February,

to enter the hospital, as he was evidently suffering from the loss of
blood, and would be in danger, if not relieved. Believing that com-
u could certainly secure an artery of this magnitude, I made a
ated compress, and filled the palm, so that the bandage could
have full effect, at least as much as the parts could bear without en-
dangering sloughing. The watchman in the hospital was directed
tc see him often ; and at the usual hour bleeding occurred, in spite
of the compress. I was called, but haemorrhage ceased before I
could remove the dressing. The compress was renewed, with more
force ; in fact so great as to induce a slight degree of sloughing, but
hoemo/rhage followed after the usual interval, notwithstanding. The
hand was then left without dressing, and appeared to be the better,
for it was relieved from a source of irritation, and no bleeding occur-
red until the usual hour, when it was arrested by the spontaneous
formation of a clot, with as little loss of blood as when the compress
was applied. The case had now become dangerous, and the radial
and ulnar arteries were tied at the wrists, and the patient recovered.

This case illustrates two principles : first, that when an artery is
wounded, and the hleeding is arrested externally, but allowed to go on
internally, filling the tissues, and forming a clot around the mouth of
the artery, larger than can become organized, haemorrhage is likely
to occur when the clot dissolves, as it is bound by the laws of nature
to do ; secondly, that when the first effort of nature fails, and the clot
gives way, there is very little probability of a second clot becoming
organized. Strong compression will never effect it; in fact, I be-
lieve it never occurs, but granulations may shoot out from the sur-
rounding cellular tissue, and enclose or cap the mouth of the vessel,
and thus effect a cure. Strong compression would of course inter-
rupt this process, but where secondary haemorrhage occurs, and the
wound is tolerably healthy, a little lint may be pressed down upon
the mouth of the vessel, and gentle pressure made, such as will not
interfere with the granulating process, and in almost every case where
minor arteries are concerned, a cure will be effected.

Case V. Mr. M , a mechanic, had an altercation with a fellow
workman, who assaulted him with a narrow chisel, and struck him
in the fore arm, about two inches below the bend of the arm, and
cut the ulnar artery, where it lies under the bellies of the flexor mus-
cles of the wrist and hand. An old and experienced physician was
called, who found no difficulty in controlling the bleeding externally,
but a large quantity of blood was extravasated, in the inter-muscular
spaces, and when this began to dissolve, bleeding occurred again,
and continued until fresh clots were formed. This recurred several
times ; when he was admitted into the hospital, exhausted from loss
of blood, and the arm tense from the extravasation of blood beneath
the facia. The brachial artery was tied, and a free incision made in
the arm to discharge the blood and relieve the tension ; but the patient
being exhausted, gangrene took place. Amputation was resorted to,
and the patient narrowly escaped death with the loss of an arm. I

1846.] On the Treatment of Wounded Arteries, 109

do not mention this case because it is extraordinary or rare, but be-
cause it is common, and because the best physicians and surgeons too
(closet surgeons) are too apt to temporize and hope for a favorable re-
sult, when there is no hope without prompt action. In this case it
was proper to disgorge the parts as much as possible of the extrava-
sated blood, and then make decided pressure over the mouth of the
divided artery, such as to secure it from throwing out any blood, and
continue it until a coagulum had formed in the artery ; after which
moderate compression should have been continued, sufficient to sup-
port the coagulum, and prevent the adhesive process from being dis-
turbed by undue motion of the muscles. But if this course had
failed, and haemorrhage had occurred the next day, or the second
day, the artery should have been tied, and no reliance placed upon a
second clot. The principle may be applied, so far as dressing is con-
cerned, in penetrating wounds in fleshy or muscular parts. It is
commonly the case that a wound of this character, which is a mere
trifle in its superficial aspect, is drawn together in the most scientific
manner, so as to arrest the bleeding, while the small deep vessels are
throwing out blood, which being deprived of an external escape,
makes its way between the muscles and fascia, and perhaps eventu-
ally causes extensive suppuration. Such cases should rather be left
to nature than treated in this manner. Compression should be made
in the course of the wound to prevent, if possible the extravasation
of blood in the tissues, and to secure a perfect co-aptation of the deep
parts; this being effected, there can be no objection to closing the
orifice, although it will be found that if the deep parts unite favora-
bly, no great skill will be required to ciose the small orifice in the
integuments.

In penetrating wounds of the chest, there is too great a fondness
for hiding the mischief by applying adhesive plaster to the external
wound. The immediate danger of penetrating wounds of the chest
is haemorrhage, and the remote is inflammation. If air is admitted
into the chest, and the lung thereby allowed to collapse, haemorrhage
will be^trrested (unless the large vessels are wounded) with as much
certainty as the placental vessels from the contraction of the uterus,
and no one will pretend that air in the cavity of the chest is a very
powerful cause of inflammation, while all must admit that blood to
any considerable amount is almost certainly fatal if left to nature.
In penetrating wounds of the chest when the lung is wounded, even
when the haemorrhage is not immediately dangerous, it is proper to
admit air and allow the lung to collapse.

Case VI. A Spaniard was admitted into the hospital, having re-
ceived a wound in the left chest, between the fifth and sixth ribs,
which penetrated deep into the long. The external wound had been
very nicely drawn together, but bleeding continued, both in the cavity
of the chest, and into the bronchia. Various remedies were used,
such as are usually resorted to in internal hemorrhage, but with no
effect. The dressings were renewed a free ingress of air allowed,

HO The Blood-corpuscle. [February,

(the wound being large) when the lung collapsed and bleeding ceas-
ed. A large quantity of blood had escaped into the cavity of the
chest, and the external wound being open, it was discharged by
means of a large cupping glass which answered the purpose admira-
bly. Pleuritic inflammation followed, but did not run high, and was
evidently caused more by coagulated blood, than by the air. The
patient gradually recovered, and the lung resumed its functions per-
fectly.

It is evident that had the external wound been kept closed, this
patient would have died, probably from haemorrhage, or if he had
escaped immediate death, he would have died from inflammation,
which the blood in the chest must have necessarily produced.

These few cases I have selected from hundreds I witnessed, not
because there is any thing remarkable in the cases, but merely to
illustrate certain principles.

We are indebted to our esteemed and talented co-laborer, Dr.
John Le Conte, of Savannah, for the following valuable and inter-
esting Reviews. We shall be happy to hear often from the same
source, and solicit similar notices, &c, from our friends. Edts.

" The Blood-corpuscle considered in its different phases of develop-
ment in the Animal Series." By Thomas Wharton Jones, Esq.,
F. R. S., etc. Read before the Royal Society, June 9th, 1845.

This paper is divided into three parts: the first relating to the
blood-corpuscles of the vcrtebrata; the second to those of the inver-
tebrata ; and the last to a comparison between the two. He first
describes the microscopic appearances of these corpuscles in differ-
ent classes of vertebrate animals, beginning with the skate and the
frog, and proceeding to birds and mammifera ; first in theif early
embryonic state, and next in the subsequent periods of their growth.
He finds in oviparous vertebrata generally four principal forms of
corpuscles. These he distinguishes as the phases, first of the granule
blood-cell, which he describes as a cell filled with granules, disclosing
by the solvent action of dilute acetic acid on these granules a vesi-
cular, or as the author terms it, a " cellaform" nucleus. These
granule cells appear under two stages of development, namely, the
coarsely gravulous stage and the finely gravulous stage. The second
phase is that of the nucleolated blood-cell, oval in shape, containing
a vesicular (or " cellceform") nucleus, and red-colored matter. These
cells likewise appear under two stages of development; colorless in

1846.] The Blood-corpuscle. Ill

the first and colored in the second, in which last stage it constitutes
the red-corpuscle. In the early mammiferous embryo, he finds, in
addition to the former, a third phase, that of free vesicular nucleus,
exhibiting, like the nucleolated cell, the colorless and the colored
stages.

On examining the corpuscles of the lymph of vertebrated animals,
the author finds them in all the classes to be identical in structure
with their blood corpuscles, and differing only in the inferior degree
of coloration attending their last stage. In the oviparous classes, he
observes that the nucleolated are more numerous than the granule
cells, while in the mammifera the latter are predominant, which is
the reverse of the proportion in which they exist in the blood of these
animals. He finds that some of the nucleolated cells of the contents
of the thoracic duct exhibited a marked degree of coloration, and
have an oval shape ; thus offering a resemblance to the blood of the
early embryonic state.

The blood-corpuscles of all the invertebrate animals in which the
author examined them, present the same phases of granule and nu-
cleolated cells as in the higher classes, except that in the last stage
of the latter phase the coloration is very slight, but the vesicular
nucleus is frequently distinctly colored. As in the higher classes,
corpuscles exist in different states of transition from the granular to
the nucleolated form of cell. In some of the invertebrata, corpus-
cles are found which appear to be the nuclei of some of the nucleo-
lated cells becorife free ; and these the author considers to be abor-
tions, rather than examples, of cells having attained their third phase
of free cells. Corpuscles are also met with in these animals, in
greater or less abundance, belonging to the lowest forms of organic
elements, namely, elementary granules.

The comparison which the author institutes between the blood-
corpuscles of the vertebrate and invertebrate divisions of the animal
kingdom, tends to show that they in all cases pass through similar
phases of development, except with respect to the last, or colored
stage of the nucleolated cell, which they do not attain in the lower
classes of animals. He finds that the blood-corpuscles of the crab?
according to an analysis made by Prof. Graham, contain a sensible
quantity of iron, perhaps as much as red-corpuscles. He considers
the corpuscles of the blood of the invertebrata, in as far as relates to
the absence of nucleated cells, as resembling those of the lymph of
vertebrate animals. (From the Abstract of the Proceedings of the

112 Electro-Physiological Researches. [February,

Royal Society, in the London, Edinburgh and Dublin Philosophical
Magazine, for Nov., 1845, pp. 393 et. 394.) J. Le C.

" Electro-Physiological Researches:' Memoir First. By Professor
Carlo Matteucci. Communicated by Michael Faraday, Esq.,
D. C. L., F. R. S. Read before the Royal Society, on the 5th
of June, 1845.

The author describes several arrangements by which he was ena-
bled to make new experiments in confirmation of the laws of muscular
currents, of which he has given an account in his recent work, entitled
Traite des Phenomenes ElectroPhysiologiques des Animaux." He
finds that, in these experiments, the employment of a galvanometer
is unnecessary, as the sensibility of the electroscopic frog of Galvani
gives sufficient indication of the electric current without the use of
that instrument.

The general results obtained from these experiments are the
following :

In the first place, the intensity and duration of the muscular current
is independent of the nature of the gas in which the muscular pile is
immersed. Secondly, it is altogether independent of the cerebro-
spinal portion of the nervous system. Thirdly, the circumstances
which exercise a marked influence on its intensity are the conditions
of the respiratory and circulatory systems. Fourthly, those poisons
which seem to act directly on the nervous system, such as hydrocy-
anic acid, morphia and strychnine, have no influenct on the nervous
current. Fifthly, sulphurretted hydrogen has a decided influence in
diminishing the intensity of the muscular current. Sixthly, the
intensity of this current in frogs varies according to the temperature
in which the frogs have been kept for a certain time during life ; a
result which, of course, is not obtainable with animals which do not
take the temperature of the surrounding medium- Lastly, the in-
tensity of the muscular current in animals increases in proportion to
the rank they occupy in the scale of beings: and on the other hand,
its duration after death is exactly in an inverse ratio to its original
intensity. The author concludes by stating his belief, that the pro-
perty of the muscles immediately connected with their electric cur-
rents, is identical with that which was long ago denominated by
Haller irritability, but which is at present more usually designated
by the term contractility. He ascribes the development of this
muscular electricity to the chemical actions which are attendant on

134G.] On the Temperature of Man. 113

the process of nutrition of the muscles, and result from the contact
of arterial blood with the muscular fibre. He conceives that in the
natural state of the muscle, the two electricities thus evolved neu-
tralize each other at the points at which they are generated; while
in the muscular pile contrived by the author, a portion of this electri-
city is put into circulation in the same manner as happens in a pile
composed of acid and alkali separated from one another by a simply
conducting body. (From the Abstract of the Proceedings of the
Royal Society, in the London, Edinburgh, a?ul Dublin Philosophical
Magazine, for Nov., 1845, p. 391.) J. Le C.

" On the Temperature of Man." By Johx Davy, M. D.. F. R. S.,
L. et. E. Read before the Royal Society on the 19th June, 1845.

Having in a former paper shown that, contrary to a commonly re-
ceived opinion, the temperature cf the human body, as measured by
a thermometer placed under the tongue, is not a constant one, the
author has resumed the inquiry, and gives, in the present paper, the
results of his numerous observations made with a particular instru-
ment constructed for the purpose, admitting of minute accuracy,
(each degree of the scale being divided into ten parts.) and when
used with the precautions pointed out, affording satisfactory indica-
tions in many problems which may be proposed relative to the tem-
perature of man, etc., and confines himself to a small number, offer-
ing the information he brings forward only as a preliminary contri-
bution in aid of their solution.

The paper is divided into seven sections.

The fust, treats of variations of temperature during the 24 hours.
The author finds from his observations, that the temperature is high-
est in the morning, on rising after sleep ; that it continues high, but
fluctuating, til! the evening ; and that it is lowest about midnight,
ranging on an average from 93.7 to 97.9.

The second, of variations during the different seasons. These, he
finds, bear some relation to the temperature of the air, but less than
might be expected ; which he attributes to the majority of the obser-
vations having been made within doors, under circumstances pecu-
liarly favorable to uniformity.

The third, of the influence of active exercise on the temperature.
The etfect of this, when not carried to the length of exhausting
fatigue, he finds to be elevating ; and that the augmentation is,
within a certain limit, proportional to the degree of muscular exertion,

8

1 14 Growth and Development of the Epidermis, [February,

The fourth, of passive, such as carriage exercise. The effect of
this in a cool air, contrary to that of quick walking or riding, would
appear to be lowering.

The fifth, of abstinence from all exercise in a cold atmosphere.
This he finds to be depressing in a still greater degree ; sitting in a
cold church has occasioned a reduction of temperature from 1 to 2,
the air of the church being from 42 to 32.

The sixth, of sustained attention or exertion of mind. This would
appear to have the effect of raising the temperature, but in a much
less degree than bodily exercise.

The seventh, of taking food. It would appear that a light meal,
such as breakfast, alters very little the temperature, whilst a heavy
meal, such as dinner with wine, tends to lower it.

The conclusion drawn by the author from his observations, consid-
ered in their greatest generality, is, that the temperature of man is
constantly fluctuating within a certain limit; regularly during the
24 hours; and irregularly according to the operation of certain dis-
turbing circumstances.

Should multiplied observations give similar results, he infers that
they will admit of many applications, both as regards the regulation
of clothing, the warming of apartments, and possibly the prevention
and cure of diseases, conducive alike to increase of comforts and
health.

Tables are appended, containing a series of observations extend-
ing through eight months, in which not only the temperature of the
body is noticed, but also the frequency of the pulse and of respiration
and the temperature of the air. (From the Abstract of the Proceed-
ings of the Royal Society, in the London, Edinburg, and Dublin
Philosophical Magazine, for Nov., 1845, pp. 399 et. 400.)

J. Le C.

" Observations on the Growth and Development of the Epidermis."
By Ekasmus Wilsox, Esq., F. R. S. Read before the Royal
Society on the 19th of June, 1845.

The author adduces evidence derived from his microscopic obser-
vations, in confirmation of the commonly received doctrine respecting
the origin of the cells of the epidermis and epithelium generally,
from the materials furnished by the liquor sanguinis or plasma of the
blood ; which fluid, passing by endosmosis through the waMs of the
capillary vessels and peripheral boundary of the suriace, developes

1846.] Growth and Development of the Epidermis. 115

granules by a vital process, analogous to coagulation. On a careful
examination of the inner surface of the epidermis with the aid of the
microscope, he finds it to be composed of four kinds of elements,
arranged in such a manner as to constitute an irregular plane,
similar to a tassolated or mosaic pavement. These elements are,
1. Granules, which the author terms primitive, of a globular form,
solid and apparently homogeneous, and measuring about 1-20, 000th
part of an inch in diameter. 2. Aggregated granules, having about
double the diameter of the former, and apparently composed of as
many of these as can be aggregated together without leaving an un-
occupied space in the centre of the mass. 3. Nucleated granules,
measuring in diameter from the 6000th to the 4000th part of an inch,
each being composed of an aggregated granule as a nucleus, envelop-
ed by a single layer of aggregated granules, giving the whole mass
an oval or circular, and at the same time flattened shape. Their
constituent granules have acquired, during this aggregation, greater
density, and are separated from each other by distinct interstitial
spaces filled with a transparent homogeneous substance. 4. Nu-
cleolo -nucleolated cells pervading the deep stratum of the epidermis,
and of which the longer diameter measures from the 3000th to the
2500th part of an inch. These cells, which constitute the principal
portion, and may be regarded as the chief constituent of the epider-
mis, are formed from the nucleolated granules, on the exterior of
which there is superposed a transparent layer, bounded by a well-
defined outline, by the dark interstitial substance of the wall of the
cell ; the nucleolated granule being the nucleus, and the aggregated
granule the nucleolus of these primitive cells of the epidermis. The
author is of opinion that the nuclei, up to a certain point, grow with
the cells, by the separation of the original granules from the deposi-
tion between them of interstitial matter, and also by the cleavage of
the latter and the consequent multiplication of the granules. This
peripheral growth of the cells is totally different from the mode of
growth described by Schwann, and explains the disappearance of the
nucleus in the scales of the epidermis. The observations of the au-
thor lead him to believe that the same process of development and of
growth is followed in the epithelium as in the epidermis ; and he offers
evidence, showing that similar arrangements take place in the cells
of melanosis, in the pigment cells of the choroid membrane of the
eye, and in those of the skin of the negro. (From the Abstract of the
proceedings of the Royal Society in the London, Edinburgh, and
Dublin Philosophical Mag. for Nov., 1845, p. 308.) J. Ll C.

116 Contributions to the Chemistry of the Urine, $c. [February,

Contributions to the Chemistry of the Urine ; on the variations in
the Alkaline and Earthy Phosphates in the healthy jtate, and on
the Alkalescence of the Urine from fixed Alkali. by Hkmh.
Bence Jones, M. A., Cantab, etc. Read before the Royal Soci-
ety, June 19th, 1845.

The author, having observed that in some states of disease there
occurs in the urine a great excess of the earthy phosphates, was in-
duced to investigate the subject; and as a preliminary inquiry, to
ascertain the variations in the amount of these phosphates at differ-
ent times in the same person in a state of health, and to trace the
causes which determine an excess or a deficiency of these salts in the
urine ; noting, at the same time, the variations in the quantity of the
alkaline phosphates contained in it, with a view of discovering whether
these variations are influenced by the same, or by different causes.
The principal results to which his experiments have conducted him
are the following. The quantity of the earthy phosphates in the
urine, voided soon after taking food, is considerably greater than in
that voided at other times ; and this happens whether the meal con-
sists of animal food or ofbread only. After long fasting, the propor-
tion of earthy phosphates is considerably diminished. On the other
hand, the alkaline phosphates are present in greatest quantity when
the food consists of bread alone : when meat alone is taken, the defi-
ciency in those salts is still more marked than the excess in the
former case. Exercise occasions no change in the quantity of the
earthy phosphates, but causes an increase of nearly one-third in the
amount of alkaline phosphates; but its influence is, on the whole,
less than that of diet. The earthy phosphates are increased in quan-
tity by chloride of calcium, sulphate of magnesia, and calcined mag-
nesia taken into the stomach.

The author next examines the conditions in which the urine is
alkalescent, and which he considers to be of two kinds ; the one, long
known as ammoniacal, and arising from the presence of carbonate of
ammonia; and the other, which has not hitherto been distinctly re-
co-nized, arising from fixed alkali, and appearing most frequently in
urine secreted during a period of from two to four hours after break-
fast, in persons suffering only from defective digestion. Under these
circumstances, it may be, when voided, either turbid from amorphous
sediment, or clear and alkaline when tested, or free from deposit and
slightly acid. If in eithei\of these last cases it be heated, an amor-
phous precipitate falls down, which is soluble in dilute hydrochloric

1846.] New Metals. Effects of Food on the Blood. 117

acid, or in a solution of Diphosphate of soda. Healthy urine may at
any time be made to yield a precipitate of earthy phosphate, by heat,
even though it be acid, by having a portion of this acid neutralized by
any alkali, or by phosphate of soda, tbe fluid becoming more acid
when boiled. A solution of earthy phosphates in biphosphate of soda
also gives a precipitate on boiling, if some of its acid reaction is re-
moved by any alkali. The fluid when boiled becomes more acid to
test-paper, indicating the formation of a more basic earthy phos-
phate. A result precisely similar is obtained when common phos-
phate of soda, phosphate of lime, and a little biphosphate of soda
exist together in solution; and by varying the quantities of each of
these substances, the various phenomena which the urine occasionlly
presents may be imitated. The time at which the alkalescence of
the urine from fixed alkali generally occurs, indicates the existence
of some alkaline phosphate, or of some carbonated alkali in the
food. (Idem., p. 396.) J. Le C.

NEW METALS.

During the year 1845, the European Chemists have discovered
three new metals. The justly celebrated Prof. H. Rose has found
two new metals in the Bavarian Tantalites. One of them he calls
Pelopimn, and the other Niobium, from Xiobe, daughter of Tantalus,
a name which suggests to the mind the resemblance between the two

Co

metals and their oxides ; the salts of tantalic and niobic acids being
very similar in their properties. More recently another new metal
called Ruthenium, has been discovered in the platinum residues, by
Prof. Claus, of Kasan. J. Le C.

PART III. MONTHLY PERISCOPE.

On the Effects of Food on the Blood. Dr. Buchanan has drawn
the following conclusions on the state of the blood afier taking fond :

1. The serum of the blood of a healthy man fasting, is perfectly
transparent, and of a yellowish or slightly greenish tint. 2. A het-
erogeneous meal, such as that usually set on the tables of the rich,
renders the serum white. 3. The \\ hiteness may commence as early
as half an hour after eating, and may continue ten or twelve, and
sometimes as long as eighteen hours, according to the kind and qual-
ity of the food, and the stale of the functions of the primary and

118 Both Kidneys on the same side. [February,

secondary digestion. 4. Starch, and Sugar, probably all vegetable
substances destitute of oil, give no whiteness to the serum of the
blood. 5. Fibrin, Albumen, and Casein, and probably Protein -
compounds in all their forms, if destitute of oil, give no whiteness.
6. Oils, combined, whether naturally or artificially, with protein
compounds or with starch, render the serum of the blood white ; pro-
bably, therefore, oils produce that effect in whatever way taken. 7.
Gelatin seems to render the serum of the blood white ; this, however,
cannot be considered as certainly established, as there may have
been some fat in the beef tea which was taken along with the calf-foot
jelly in both experiments on which the above conclusion rests. 8.
The coagulum of the blood very frequently exhibits, after taking
food, a crust of pellucid fibrin, or of pellucid fibrin dotted with more
opaque particles, and with little of the contraction technically named
"cupping." 9. The appearances of the coagulum just mentioned
are much more common after azotized than after non-azotized food.

These conclusions relating to the visible characters of the blood
may be considered, with the single exception above mentioned, as
well established. The conclusions which follow relate chiefly to
the chemical properties of the blnod, and are not worthy of the same
reliance ; but the evidence on which they rest has been laid before
the reader, and he must judge of them for himself.

1. The substance defined above under the name of Pabulin, is most
abundant in the blood a few hours after taking food, sooner or later
according to the rapidity of digestion. 2. It is less abundant as the
time when the food has been taken is more remote, and is small in
quantity after a fast of twenty four hours. 3. It is much more
abundant after azotized, than after non-azotized food. 4. It varies
in quality, floating or subsiding, according to the kind of food taken.
5. It is probably analogous in nature to the white substance which
gives color to the serum of the blood. 6. The difference between
these two forms of this substance probably is, that it is sometimes
combined with an alkaline, or earthy salt (chloride of sodium, sulphate
of soda, &c), and sometimes with an oily body (stereate of glycerine,
&c). In the former case it seems to dissolve completely in the blood,
while in the latter it is only partially dissolved, and renders the serum
opaque. 7. The azotized principles of the food are probably made
to combine, in the digestive tube, with the alkaline, earthy, and oily
salts mentioned above ; and thus become capable of being absorbed
into the blood. 8. The alkaline and earthy compounds are probably
absorbed directly by the blood-vessels, while it seems to be well as-
certained that the oily compounds are absorbed through the lacteals.

[London Medical Gazette.

Both Kidneys on the same side of the Spinal Column. Dr. J. Reid
narrates the following rare anatomical anomaly :

" When in charge of the dissecting-rooms in Old Surgeon's Hall,
Edinburgh, I found that in one of the bodies which was being dis-

1846.] Treatment of Albuminuria. 119

sected, by the students, the kidney was wanting on the left, and that
there were two kidneys on the other side. The one was placed below
the other, and the lower end of the upper one, and the upper end of
the under one, were fused together. The renal artery supplying the
upper kidney was given off by the aorta, near its usual origin ; the
one supplying the lower kidney arose from the aorta, near its divis-
ion into the two primitive iliacs. The ureter from the lower kidney
passed across the mesial line, after entering the pelvis, so that these
two tubes entered the bladder in the usual manner. The preparation
is now in my collection. A case where the kidneys presented ex-
actly the same appearance is described and figured by Dr. John
Hunter, in the third volume of the ' Medical Transactions of the
College of Physicians in London,' vol. iii., p. 250, 1765." [Cor-
mack's Monthly Journal.

On the Treatment of Albuminuria. Professor Williams, in a val-
uable course of clinical lectures, thus expresses himself in reference
to the treatment of morbus Brightii :

The first indication is, to remove the congestion ; the second, to
restore the secreting function of the kidney ; the third, to counteract
the effects of the diseased state of the blood ; and the fourth, and
last, to treat the various symptoms of disease that may arise out of
this disordered condition of the blood. New the first indication will
be affected by the remedies already pointed out for congestion, and
more especially bloodletting. Cupping at the loins may also be ap-
plied. Bloodletting should be employed freely, in proportion to the
strength of the patient and the fulness of the blood-vessels. This is
to be aided by derivatives. Hydragogue purgatives tend to diminish
the amount of blood in the system, and to drive out its watery parts.
One of the best is cream of tartar, in large doses, or combined with
jalap, but in its general effect it is better alone. One-ounce doses of
cream of tartar, with half a grain of elaterium. The chief objection
to this latter is, that it is very nauseating. The indication of deriva-
tion may also be assisted by sudorifics, by warm or vapour-baths, or a
hot-air bed. Tartar emetic may also be given, where the circulation
is excited, and Dover's powder, so as to increase the cutaneous se-
cretion. It is also useful, after the excessive congestion has been
removed, to venture on some diuretics, on precisely the same princi-
ples that you apply stimulating lotions externally. The diuretics that
answer best, are the tincture of cantharides, the tincture of digitalis,
and cream of tartar, in small doses, combined with opium or tincture
of henbane, to soothe any irritating effect these remedies may have.
It has been supposed by some that diuretics are pernicious. I believe
that they may do great harm in the early stage of congestion, as
they are liable to convert it into inflammation ; but after this has
been removed, they come into useful operation. Cupping at the
loins, and counter irritation, may be combined, to allay any remains
of inflammatory or congestive action. These may be continued

120 Croup. * [February,

until the urine loses its albuminous deposition, when they should be
withdrawn. As to the third indication, that of counteracting the
effects of the diseased blood, we do not know much about the means
of doing this. There is a retention of urea in the blood, and we
, are very little acquainted with the means by which to counteract its
injurious and poisonous effect; but I think it is a subject worthy of
inquiry, whether matters which contain oxygen in excess will have
any influence in this respect. The chief object is to evacuate it,
and this is done by the measures already adverted to, hydragogue
purgatives tend to remove urea, and to purify the blood. The fourth
indication is one of great importance, and that is to alleviate the
the troublesome symptoms. The vomiting, and other very distress-
ing symptoms, in the early stage, may often be counteracted by med-
icines ; diarrhcea may be restrained by sulphate of copper ; bronchi-
tis by large blisters (as we treat the asthenic form of bronchial flux,)
together with the use of opium. The dropsical effusions are to be
overcome by the different methods already adverted to, hydra-
gogue purgatives and diuretics. Chronic albuminuria is also con-
nected with other structural diseases, and in a few instances, with
cancer of the kidney, and the form of yellow tubercle; but m
ninety-nine cases out of a hundred it is combined with granular

degeneration. ." n

In reference to the same subject, Mr. Kidd (Dublin Med. Press,
Jan. 15, 1S43-) observes that in the chronic form of the disease our
chief reliance should be placed in local depletion, as cupping in the
loins, and the establishment of an issue in the same situation. He
however cautions us against the promiscuous employment of the
former means in debilitated subjects. Raver (Maladies des Raines)
has derived great benefit from the internal use of canthandes, ten
or twelve minims for a dose in almond emulsion. Dr. Wells was in
the habit of giving much larger doses (30 to 40 minims.) Purgatives
associated with diuretics are recommended by Dr. Prout. Blisters
are also occasionally useful, but in general whatever treatment we
may employ will be found but of temporary benefit. \Kanking s Ab.

Croup. Dr. J. A. Swelt reported having seen two cases of croup,

where a false membrane existed, covering the mouth and gums, but
was thicker in the throat. In one case, the child had neither cough-
ed nor cried, twenty-four hours before the appearance of the false
membrane. 1Q.n

During a late residence at Geneva, N. Y., (Oct. and INov., 184o,)
says Prof. Lee, we found the membranous form of croup of very fre-
quent occurrence, so much so, as to merit the appellation of epidemic.
In three families, two children died in each, of the disease, in the
course of two weeks, besides several others in different parts of the
village. The disease came on for the most part very insidiously,
with the usual symptoms of a cold, attended with a dry barking, ring-
inn- couTh, a total suppression of the natural mucous secretion, and a

1846.] Pulmonary Phthisis and Intermittent Fever. 121

deposit of albumen at a very early period of the disense. The larynx
was evidently the part first affected, the inflammation gradually ex-
tending down the bronchi, until the whole mucous surface of the
pulmonary structure was involved. The fatality of the disease was
perhaps owing, in a great measure, to the late period at which the
physician was called in. In three instances, however, which came
within our knowledge, a homoeopathic physician was called at a very
early period, but the disease went on unchecked unto a fatal termina-
tion. In one instance a false membrane of tubular form, some two
inches or more in length, was thrown offin the act of vomiting, after
calomel had been given in two grain doses, every two hours, for
twenty-four hours, with ipecacuanha, in sufficient doses to keep up
constant nausea. In this case, the patient, two and a half years old,
died the day after the detachment of the membrane with every symp-
tom of bronchitis, involving the minute structure of the lungs. In
another instance, the operation of tracheotomy was performed by Dr.
T. R. Spencer, on a fine boy of four years, and before there were
any prominent signs that the disease had extended far below the chief
rami of the bronchi; and although the operation was attended with
striking and immediate relief, (the general distress and dyspnoea be-
ing the greatest we have ever witnessed in this disease,) the inflam-
mation rapidly extended to the pulmonary cells, and death took place
about twenty- four hours after the opening was made into the trachea.
Both these cases occurred in the same family, and at the same time.
A third child, the eldest, was attacked about the same time with the
other two, but less severely. The disease was kept in check by
antimony, ipecac, and hive syrup, followed by small doses of calomel
and mercurial inunction over the trachea ; by the two last remedies,
the patient was supposed to have been saved. Is it owing to sensi-
ble changes in the atmosphere, in relation to heat and cold, moisture
or dryness, &c, that croup is more rife at some periods than at others ;
or, is there some specific and unknown cause, to which the complaint
may more properly be attributed ? In relation to treatment, we may
observe, that in the only instances in which we have succeeded in
saving the patient after the formation of an albuminous deposit in the
trachea, we attributed our success to the constitutional effects of
mercury, rapidly produced by inunction and internal exhibition. Its
modus operandi in these cases seems to be not only by checking the
albuminous secretion, and promoting the absorption of that already
effused, but in bringing on the natural secretion of mucus, beneath
the false membrane, by which the latter is loosened, and by the
operation of emetics thrown off by expectoration. [New- York Jour.
of Medicine.

Antagonism of Pulmonary Phthisis and Intermittent Fever. At
the scientific congress of Lucca this subject was warmly discussed,
without any satisfactory result having been arrived at. Dr. Si
noli presented a series of cases, accompanied by a statistical table,

122 Headache Diet Treatment of Fissuraani. [February,

tending to show that in the Maremma district , / T"80^'^
intermittent fevers are numerous, pulmonary phthisis and scrofu a
are but rarely met with. This pathological fact he endeavors to
explain in the following manner :_If weadm.t, says he, a phyMolo-
gical antagonism between the liver and the lungs, which most physi-
ovists do, it is easy to understand why phth.s.s should be rare
where intermittent fever is common. Malaria acts principally on
the abdominal viscera, increasing their action and volume This
increase of abdominal vitality diminishes the vital actions of the lungs,
and thus prevents the development of tubercles ,n their tissue Dr.
Henri criticised Dr. Salvagnoli's statistical table, and remarked that
in marshy districts the number of individuals who arrive at a favora-
ble agtfor the development of pulmonary phthisis is re atively smaller
than in more favored localities, and that consequently a calculation
established only on the number of deaths from phthisis in such lo-
cahue a could not be exact. If the generations disappear during
en ldhood-if the medium age, which is thirty years, is infinitely dess
in marshy districts, it becomes evident that more persons will die
from thciflammatory diseases of early life, and few.rtaf
affections. Dr. Grifia confirmed the observations of Dr. Salvagnoh
rapecSno the rarity of phthisis in the Marcmma. Dr. R.no, on the
conWyrmaintained, from observations made at the chn.que of Pisa
that phth sis was common in marshy countries. These views were
also suppled by Dr. Turche.ti, who asserted that in the marshy
d itrictsPof Fucccchio and Bientina he had remarked the antagonism
wheh was described by Dr. Salvagnoli as existing u. L*Marema.
Dr. Trompeo stated that he had great opportunities of observation n
Piedmont, where malaria was kept np by the r.ce-grounds, and m
slrdbda where intermittent, are extremely frequent and severe, and
that in both these countries he had found phthisis very rare wherever
intermittent fever was common {Bulletin of Med. Science.

HeadacheTit. McCready relates cases of Yio'en^heff ^J^;
lievedbythe use of the saturated Tinctnx of A** riem dose, of
from four to five drops taken internally [New York Journ.

M Piorry strongly recommends a nourishing diet in typhoid
fevers as preferable to the severe diet which many French physicians
enforce fora fortnight, or even a moth-[Gz. des Hopitaux-from
New-Orleans Med. and Surg. Journal.

Treatment of Fissura AniM. Blandin, in reference to the
treatment of fissuraani, concludes, that when, there is fissure of
ne anus, with spasmodic contraction of the sphincter whether
tnU be p imary or consecutive, it is necessary to operate. This
may beP performed in two ways: by Buyer's method which
consists in making a free cut through the muscle; and by the sub-
method. He recommends the sub-cutaneous method,

1840.] Spermorrhcea cured by pressure. 123

as it has among other advantages, that of healing more promptly,
and is not so apt to give rise to serious accidents, such as phlebitis,
for example. In a word, it promises all the advantages of Boyer's
method, without many of its inconveniences.

He prefers making the incision laterally, as by cutting anteriorly,
there is risk of wounding the bladder, and posteriorly, in order to
divide the muscle, it makes too deep a wound.

The muscle once divided, it is necessary to keep the anus dilated,
for some time; to excise any little excresences, and to treat the
fissure by topical applications. [Ibid.

Spermorrhcea cured by pressure applied to the Perineum. In an
article contained in the June No. of the Annales de Chirurgie, J. L.
Brachet of Lyons, says that a respectable citizen of that town had
used pressure applied to the perineum, as a means of curing spermor-
rhcea, and learning from him what had been the result of the treat-
ment, he had employed it in a number of cases with complete suc-
cess. He does not propose it as a substitute, in all cases, for Lalle-
mand's treatment, but thinks it applicable to many, even in which the
other treatment had failed. The cases treated by him had originated
from the usual varieties of causes, such as gonorrhoea, masturbation,
and other venereal excesses ; in some, the emissions were nocturnal,
in others, both nocturnal and diurnal, and others continued and un-
perceived. The debility, emaciation, and other deplorable conse-
quences of this affection existed in the different cases, and some were
brought to the brink of the grave, when the pressure was applied,
and in all the reported cases, a cure was effected.

In some of the cases, all the ordinary remedies had been employ-
ed, such as ferruginous tonics, baths ; and even cauterization, with-
out any apparent advantage.

M. Brachet does not describe the particular apparatus used ; but
states that, in some of the cases, the pressure produced a considerable
degree of irritation in the parts over which it was applied, which
caused its use to be suspended, until the inflammation induced could
be combatted by appropriate treatment. This symptom, which some-
times existed to an extent which led to the apprehension of prostatic,
urethral, or vesical inflammation, was regarded as a favorable indi-
cation, as the artificial irritation replaced, or modified, the existing
pathological condition. In some cases, the pressure was continued
until a cure was effected, and in others, its use was suspended when-
ever the irritation became considerable, and reapplied when this
was subdued. The time required for relief was from one to three
months.

M. Brachet says, that the few cases treated by him, are insufficient
to enable him to establish general rules, or any positive precepts:
but merely desires to call the attention of the profession to the
experiment, that they may by repetition prove cither useful or value-
less. [Ibid.

124 Copaiba in Gonorrhoea. Leech Bites, [February,

The mode of action of Copaiba in the cure of Gonorrhoea. Mr.
Gates related, in a late number of the Medical Gazette^ case which
seems to illustrate this vexata questio.

*' When a lad, this patient had tied a piece of string round the mid-
dle of the penis, and so tightly, that from the sudden and great
swelling produced, the urethra and corpus spongiosium were both
nearly divided, and an opening into the canal was left at this point,
through which the whole of the urine was voided in micturition from
this time. The appearance of the penis, wben not erect, was as if
broken : the anterior portion hanging down almost at rtght angles
with the posterior. The gonorrhoea was violent, with a profuse dis-
charge from the meatus urinarius, as well as from the- false opening
or fistula, ifone may so term it, showing that a great extent of the
urethra was the seat of the inflammation. After a few days of pallia-
tive treatment, by diuretics and diluents, during which the discharge
remained in statu quo, M. Ricord ordered for him the balsam of co-
paiba, under the use of which, the portion of the urethra posterior to
the fistula, viz : so much of the canal as was traversed by the urine,
got completely well, while from the anterior portion the discharge
was as profuse as ever. The indication was here clear; the copaiba
was continued, and a syringe given to the man, with which he was
directed to inject his urine into the meatus urinarius after each mic-
turition, and in a few days the cure was complete. This case shows
very clearly the modus operandi of the balsam of copaiba in gonor-
rhoea to be, by impregnating the urine with its principles, and being
so applied to the inflamed membrane, and not by being in any other
way determined to the part. This is further shown in similar affec-
tions in the female, where the urethra is more implicated than the
vagina: it also points out the use of injections of copaiba in gonor-
rhoea ; and although they have been tried with partial success, it is
by no means a general way of using the remedy. If, however, a
formula could be found in which it could be so combined and modi-
fied, as when eliminated with the urine, all the advantages of the
medicine might probably be secured. There is no doubt copaiba is
the most powerful resource we possess in gonorrhoea, and where it
does not succeed, it is generally from its nauseating the stomach to
such an extent as to be inadmissible, or otherwise deranging the
system ; and, could it be used in an appropriate form as an injection,
the patient might be spared the disgust and unpleasantness conse-
quent on a course of this nauseous drug." [London Lancet.

On a simple means of arresting Bleeding from Leech Bites. The
troublesome and occasionally fatal effects of hemorrhage from leech
bites, especially in children, has led to a great number of devices
for the purpose of arresting the bleeding. Mr. Gosset recommends
the following plan, which from its extreme simplicity, is worthy of
universal publicity. "After wiping away the blood he applies quick-
ly a piece of visiting card, cut into a circular form about the size of

1846.] Air into the veins, Hydrocele. Hemorrhage- 125

a silver penny, the glazed side being applied to the wound. This
must be pressed firmly into the wound, and held there about a min-
ute; it will then become glued to the part and effectually restrain
further hemorrhage." In this way Mr. Gosset has continually ar-
rested hemorrhages which has resisted caustic, acetic acid, &c.

[Lancet. Ranking's Abstract.

On the Treatment to be pursued in the Admission of Air into the
Veins. The plan here mentioned is one given in a monograph by
Dr. Wattman, upon the subject of the admission of air into the
veins, and is said by the author to be a certain means of preventing
the fatal consequences. The plan consists in the instant closure of
the orifice in the vein by the finger, and dashing cold water into the
face, if the patient has already experienced symptoms of delirium.
The permanent closure of the vein is to be effected, either by gently
closing and uniting the lips of the wound, or by ligature or torsion.

[Am. Jour. Med. Sci. Ibid.

Hydrocele cured by Electricity. Dr. F. Campbell Stewart men-
tioned having recently cured a large hydrocele, seventeen inches in
circumference, and thirteen and a half from pubis to its base, by
electricity; one needle was inserted into the cavity of the tunica
vaginalis testis, also one through the cellular tissue over the scrotum.
The application of electricity was continued half an hour, and was
attended with intense pain. In forty-eight hours the fluid had en-
tirely disappeared. A second case treated in a similar manner was
not successful. \_N. Y. Journal of Medicine.

On Compression of the Abdominal Aorta in Uterine Hemorrhage.
By M. Se^tix. (Bulletin de l'Academie Med. Beige.) After some
general remarks upon the nature of the hemorrhages which occur
after childbirth, and respecting the history of the above operation,
the author thus describes the process adopted by himself: "The
woman is to be placed on a horizontal plane, with the head and shoul-
ders raised, and the thighs flexed upon the pelvis, in order to relax
the abdominal muscles as much as possible, and to avoid the me-
chanical engorgement of the uterjne vessels. The surgeon, placed
on the right side of the patient, uses the left hand to compress the
vessel, keeping the right disengaged for any other purpose which the
case may demand.

"The intestines being pushed on one side by gentle manipulation,
the three fingers of the left hand are pressed firmly and deeply be-
hind, and to the left of the uterus, nearly on a level with the umbil-
icus. By this plan the aortic pulsations will be evident, and further
pressure is then to be made in a direction downwards and backwards.

"In order that the operator may not be too much fatigued by con-
tinued exertion, his hand may be compressed by those of an assist-
ant. [Banking's Abstract.

126 Cod-liver Oil. Acid Rain. New Journals. [February,

On the Topical Application of Cod-Liver Oil in Strumous Affec-
tions. The medicinal qualities of this substance, if we are to believe
the reports of the German physicians, who appear to have given it
an extensive trial, are of a high order. Dr. Brefeld has lately pub-
lished a Memoir recommending the local application of the oil in
certain scrofulous affections, as in glandular engorgement, ulcera-
tions, &c. The preparation used by him is as follows:
R Cod-liver oil 15 grammes

Saturnine extract 8 "

Yolk of eggs 12;
mix intimately. This ointment is applied to the ulcers thinly spread
upon lint. In strumous ophthalmia, M. Brefeld anoints the edges of
the eye-lids several times a day with the undiluted oil. In mesenter-
ic disease the oil may be rubbed into the abdomen either warm or
cold, as is most suitable to the feelings of the patient. [Journal de
Medecine. Ibid.

Observations on Acid Rain by M. Ducres, (Journ. de Pharm.,
April, 1845.) During the early part of June, 1842, a storm occurred
in the town of Nismes, accompanied with much thunder and a large
amount of hail. From some peculiarity in the taste of the hail, the
author was led to examine it more closely. Having collected a quan-
tity of it, and allowed it to melt, it was found to have an acid reac-
tion, which, upon examination, was found to be due to nitric acid,
formed no doubt by the action of electric fluid on the elements of the
atmosphere. The occurrence of nitric acid in hail is not new, but
the statement of this fact goes to confirm observations previously
made. [A?nerican Journal of Science and Arts.

MEDICAL INTELLIGENCE.

New Medical Journals. The first in date added to our exchange list, is the
New-York Medical and Surgical Reporter, edited by Clarkson T. Collins, M. D.
Its chiet design is to report the medical and surgical clinics of the great city in
which it is published. It is issued every two weeks, contains sixteen pages each
No., and the subscription is two dollars per annum. The four numbers we have
received extend to December 1st, and evidence ability and industry on the part
of the Editor.

The Medical Intelligencer, commenced also last fall in New- York, has been
discontinued. Its Editor, Dr. Meikleman, has nobly offered to refund all mo-
neys paid for it, thus subjecting himself to pecuniary loss.

We have received since our last issue, The Southern Journal of Medi-
cine and Pharmacy, published in Charleston, and edited by J. Lawrence
Smith, M. D., and S. D. Sinkler. M. D. "The original plan of publishing
this Journal in monthly numbers of 5G pages, is abandoned, and it will hence-

1846.] Medical Intelligence. 127

forth appear every second month, in pamphlets of 120 pages each. Subscription
Four Dollars per annum, payable in advance." The first number of this
Bi-monthly, besides the Introductory from the Editors, contains seven original
communications, three articles under the head of Reviews and Bibliographical
Notices, then Abstracts from Foreign and American Journals, and lastly, twenty
pages devoted to Pharmacy. The work is printed upon new type, and makes a
very favorable impression. One of its Editors is already well known through
contributions to Silliman's Journal, and we have no doubt The Southern Journal
of Medicine and Pharmacy, will deserve the patronage of the profession in the
South. We welcome it as a co-laborer in the same field, and for which we
would ever cultivate the kindest feelings.

Dr. John Redman Cox, of Philadelphia, is engaged in preparing for the press
an epitome of the works of Hippocrates and Galen. We doubt not that many
subscribers to the work will be found among his former pupils of the University
of Pennsylvania, in which he ^as for years a Professor.

The following letters we have received from our well known correspondents,
Drs. Harden and Le Conte. The second one is also published in the New York
Journal of Medicine, in which the article it alludes to was originally issued.

t: Liberty County, Nov. 14th, 1845.

" Gentlemen For the exclusive benefit of those readers of the Southern Med-
ical and Surgical Journal, who feel an interest in the study of Botany, I beg
that you will insert this note in your next number: In a Note published with
my catalogue of Plants, in October last, I stated that I was very doubtful whe-
ther the plant referred to under the name of Manisuris granulaxis, was the plant
described by Mr. Elliott I have since found that my suspicion, that it had not
been described by Mr. Elliott, is correct; but it has been very accurately de-
scribed by Mr. Nuttall, in his : Genera of North American" Plants,' as the
1 Rotbollio, rugosa' and was collected in Florida by Dr. Baldwin. Mr. Elliott,
therefore, even if he knew the plant, did not consider it to be within the limits
of his ' Sketch.1

" In relation to my supposed new Panicum, I would also state that having
since my publication determined the ' Gibbum' of Elliott, I know that it cannot
be that species; but I have been led to suspect that although it does not agree in
every particular with his description, it is most probably the P. Waited, or
Walter's Panicum. I have also found lately the following: Panicum debile,
P. paroiflorum, P. scoparium, Agrostes trichopodes, A. juncea, Proserpinaca
palustres (oat of season), Ludwegia palustris, Collinsonia punctata, four
more species of Smilax, viz., caduca, hastata, lanceolata and pumila, and Ac-
ncda Cannebina a plant so nearly allied to the Cannabis Sativa or Hemp,
that I have been led to suspect it might possess similar medical properties I
have a desire to make trial of it if I do, I will let you know the result.

" Very respectfully, &c. JOHN M. B. HARDEN."

11 Savannah, Dec. 25th, 1845.
" Gentlemen On the 1st of November, 1845, with the assistance of my bro-
ther, Dr. Joseph LeConte, I repeated the experiments detailed in ray paper", on a
very young Alligator about 12 inches long. We were somewhat surprised to
find that, although the decapitated trunk writhed under the application of irri-
tants. Y I exhibit th ml movements which were
manifested in my former experiments, and which both of us had repeatedly

first view, this facl may seem to militate
againsl I of the deductions contained in my paper, with respect to

ry character of the motions; but a little reflection will con-
vince u invalidating the justness of my conclusions, it

128

Meteorological Table,

affords the strongest confirmation possible that, the movements elicited in the older
animals are reuUy voluntary. The very young Alligator, just out of the eggt
is, so far as the "manifestations of sensations are concerned, in a condition
analogous to the new-born infant, which exhibits symptoms of suffering, but is
unable to direct its hand to the injured part, because experience has not yet
taught it the proper use of its limbs. If the movements elicited in the decapita-
ted Alligator necessarily resulted from certain physical conditions of the nervous
system, in other words, if they were strictly and purely reflex, they should
be manifested in the very young animal as well as in the more experienced. In-
deed, I think that the want of determinate motions on irritation, in the very young
animal, may be regarded as an V. m crucisy in favor of the strictly vol-

untary character of the movements manifested in the older specimens. That
which can be taught by experience, can scarcely be imagined to beany thing else
than a conscious and presiding ink rnal volent faculty, than mind.

'[ have detailed the foregoing fact, with similar reflections, to Dr. C.A.Lee,
in a long letter. I do not know what use he will make of it the letter was pri-
vate. I thought that the statement of these additional experiments might be
interesting to you. JOHN LE CONTE."

METEOROLOGICAL OBSERVATIONS, for December, 1845, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

a

R

c

Thermo

Sunrise.

METER.
2, P. M.

Baroa

Sunrise.

IETER.
2, P.M.

Wind.

Remarks.

~7

37

53 ,

20 55-100

29 oo-i oo;

N. W.

Fair rain last night 7

-10 in.

2

27

" 80-100

80-100

N. W.

Fair.

3

30

35

" 93-100

" 85-100,

N. E.

Rain. > 1 . *
Rain. 1 linch'

4

33

37

" 78-100

:[ 51-100

N. E.

5

31

56

:: 75-100

" 86-100

W.

Fair.

6

31

60

30 9-100

30 28-100

N.

Fair.

7

20

60

:< 30-100

" 30-100.

N. E.

Fair.

8

43

54

!< 5-100

29 87-100

S. E.

&] "-"ho

9

5i

60

29 71-100

" 70-100

s. w.

10

44

56

" 77-100

75-100

w.

Cloudy.

H

36

41

" 80-100

" 95-100

N. E.

Cloudy misty.

12

38

38

:< 97-100

30 9-100

N. E.

Do. do.

13

33

35

30 14-100

" 9-100

N.

Do. do.

14

35

38

29 89-100

29 80-100;

N. E.

Rain, 9-10 inch.

15

39

48

" 31-100

" 23-100

W.

Blow, heavy.

16

34

51

" 67-100

" 82-100'

N. W.

Fair.

17

28

55

" 93-100

" 90-100

s. w.

Fair.

18

40

47

" 75-100

" 70-100.

s.

Rain, 2-10 inch.

10

3G

35

" 70-100

:: 72-100

N. W.

Cloudy.

20

20

30

" 77-100

79-100'

N. W.

Fair blow.

21

13

35

30 7-100

30 7-100
29 98-100.

S. W.

Fair.

22

18

48

" 1-100

S. W.

Fair.

23

24

41

it

30

s.

Cloudy.

21

38

38

29 94-100

29 77-100:

N. E.

Rain, 1\ inch.

2:.

37

50

" 85-100

" 83-100

X. w.

Cloudy.

26

32

50

" 02-100

30

N. W.

Fair breeze.

27

24

45

30 13-100

;< 10-100

N. W.

Fair.

38

22

53

;; 3-100

u

s. w.

Fair.

2!)

26

61

29 92-100

29 85-100

s.w.

Fair.

36

38

58

82-100

<! 83-100

:;. w.

Fair.

3]

30

60

" 07-100

30

S. E.

iFair.

16 Fair days. Gluantity of Rain, 5 inches and 2-10.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 2,] NEW SERIES MARCH, 1846. [No. 3.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE VIII.

Outlines of the Pathological Anatomy of the Liver. By L. A. Dugas,
M. D., Professor of Physiology and Pathological Anatomy, in the
Medical College of Georgia.

Affections of the liver, like those of most other organs, are mark-
ed by phenomena of two classes; the one more or less readily
detected prior to death, and the other revealed only by post-mortem
examination. Pathological anatomy takes cognizance of the latter
class, and establishes a singular contrast between the diseases of the
biliary apparatus and those of other portions of the body for
whilst morbid action in certain localities, the nervous system in par-
ticular, is most clearly indicated by symptoms during life, and leaves
few or no traces discernible after death, the converse obtains most
frequently with regard to the liver, whose vitiated condition though
very often unattended with diagnostic indications prior to death, is
most generally found in strong relief on occular inspection. The
nervous system, although that which is perhaps most frequently
affected by disease, yields but few specimens of morbid anatomy,
whereas collections of such specimens are replete with strongly
marked alterations of the hepatic texture. This contrast may be
attributed to the imperfection of our means of observation, with re-
gard to the alteration of the other textures alluded to; yet, until we
be enabled fully to appreciate all the symptoms and organic changes,
we must look upon pathological anatomy, not as the study of disease
itself, but as the examination of one class of the phenomena which
mark morbid action. The disregard of other manifestations of dis-
ease, in the present enthusiastic devotion of the profession to anatom-

9

130 Pathological Anatomy of the Liver, [March,

ical research, would be fraught with as much error as was the neglect
of pathological anatomy which so long prevailed. It is only by the
combined study of symptomatology and organic lesions that they
can both be made useful indices for therapeutic application. It is
to the striking deficiency of this connected study in relation to the
liver, that must be attributed the numerous instances of diseased liver
found in subjects who had lived without suspecting such disorder.

The liver is an organ whose functions are of considerable impor-
tance, and, consequently, one whose integrity cannot be impaired
without inconvenience, more or less serious, to the whole system.
Yet there is perhaps no organ in the body that can be so exten-
sively modified by disease without proving immediately or necessarily
fatal, nay, without being even suspected during the life of the patient.
That its lesions should not always affect the biliary secretion, is
manifest from its physiology,* as well as from the facts developed
by morbid anatomy; hence the errors fallen into by those who have
looked to its secretory action alone for evidence of its disease. The
connexion of this great viscus with the circulation of the general
system, and especially with that of certain portions of the system, is
so intimate that its affections must very frequently implicate other
organs, whose more exalted vitality may cause the secondary to
mask the primary lesion during life. We repeat then, that it should
never be forgotten by the practitioner that the liver has other func-
tions than that of secretion to perform, and that its influence over the
circulation, whether general or local, should ever be most rigidly
scrutinized. A due regard to these considerations would doubtless
have a strong tendency to do away much of the empiricism which
prevails in the treatment of affections of this organ, and which is
based on the twofold assumption, that disease of the liver is always
attended with increased, diminished or vitiated secretion of bile, and
that mercury is the common antidote, possessing the extraordinary
faculty of adapting itselfto the nature of the case, of altering diseased
action, and above all, of always making a beneficial alteration. If
the secretion be too great, calomel will diminish it; if too small,
calomel will increase it; and if it be vitiated, the same great regula-
tor will, by its alterative virtue, restore the secretion to its wonted
purity !

Let us now examine the changes produced in the hepatic organ by
disease. These may be referred, as has been done by the illustrious

* See Southern Medical and Surgical Journal, vol. 3, p. 513.

1846.] Pathological Anatomy of the Liver. 131

Andral with regard to all living structures, to four great series of phe-
nomena : the 1st to those of circulation, the 2nd to those of nutrition,
the 3rd to those ofsecretion, and the 4th to those of innervation.
These will therefore be studied separately.

1st. Lesions of Circulation. The texture of the liver may be
modified by the condition of its circulation, whether of the larger
vessels or of the capillaries; and these modifications being relative
to quantity, constitute two opposite states, designated by the terms
Hyperemia* and Anemia,-)" both of which may be partial or
general. The state of hyperemia or of repletion of the capillaries
may be active, passive, mechanical, or post mortem. It is active
when attended with increased action of the capillaries, as in irritation,
which may be apparently spontaneous (idiopathic), or consequent on
foreign agency. Hyperemia is said to be passive when resulting
from deficient action or energy of the capillary circulation, as is the
case in the gums when affected with scurvy, in diseases of low type,
&c. It is mechanical when occasioned by obstruction of the vessels
whose office it is to convey the blood from the organ affected. Such
obstructions may be produced by the pressure of tumors, by hypertro-
phy of the surrounding tissues, by concretions within the cavity of
these vessels, by congenital or morbid diminution of their caliber, &c.
Affections of the heart tending to impede the circulation, must also
cause blood to accumulate in the liver ; and the same may be said of
the impediments arising from affections of the lungs ; for, if the capa-
city of these organs for blood be diminished, there must necessarily be
an accumulation at the sources from whence the heart derives the
fluid usually sent to the lungs. Now these sources are the general
venous system and the hepatic veins. That the state of the lungs
does influence the circulation of the liver, is well established by all
who have studied the condition of this organ in subjects affected with
phthisis pulmonalis, and also appears to be strongly exemplified in the
cases stated by Andral % as having been observed by Billard, in
which the liver was frequently found highly congested, and even the
scat of sanguineous effusions more or less extensive, in infants who
died during parturition in a state of asphyxia.

The hyperemic or congested state of the liver, during the cold stage

* Hyperemia, from iirlp, over, and a7/<a. blood.
i Aiioiii;:, from a, priv., and alpa, blood.
: Anatomic Pathologique, Tom 11. p.

132 Pathological Anatomy of the Liver* [March,

of intermittent fevers, may perhaps be with more propriety referred
to mechanical agency than to an active or a passive condition of its
capillaries. Under a modification of innervation, the blood recedes
from the vessels of the general surface and extremities of the body,
and accumulates in the large trunks leading to the heart, whose ener-
gy is at the same time considerably impaired. The heart being then
supplied with more than the usual quantity of fluid from the general
capillaries, draws less from the liver, and consequently less from the
spleen and alimentary canal which supply the liver. The ultimate
effect of the recession of blood from the surface and extremities must
then necessarily be congestion of the liver, spleen and digestive appa-
ratus, independently of any increased or diminished action on the
part of the capillaries thus overloaded.

Hyperemia of the liver may be either partial or general. When
general, the entire volume of the liver is increased, its elasticity per-
mitting it to be readily distended to a considerable degree. When
the hyperemia is partial, the seat of the accumulation is more or less
tumefied. The accumulation of blood also imparts to the liver a
degree of redness proportioned to the degree of hyperemia. It will
be recollected that the texture of the liver in the normal state, pre-
sents an admixture of red and yellow substances.* When, how-
ever the hyperemia is excessive, the yellow color disappears and the
whole tissue becomes red. If, on the other hand, the liver be affected
with anemia, the yellow color preponderates, and the tissue becomes
pale, or even yellowish throughout.

The consistence or resistance of the tissue not unfrequently varies
in modifications of the circulation, but seems to recognize another
cause, that will subsequently engage our attention, viz. inflammation.
In simple congestion it is but little affected ; the tissue bleeds freely
when incised and when compressed. The liver is occasionally found
to be the seat of sanguineous effusions more or less considerable,

* This is denied by Dr. Kiernan, Cruveilhier, Gross, &c, but believed by
Andral, Meckel, Hope, &c. The question maybe considered still undetermin-
ed. Dr, Kiernan insists thatr " when the congestion results from the portal
veins, the granules are the parts which are most vascular; whilst, when it is
caused by the hepatic veins, it is most distinct in the intervening cellular tissue.
When both systems are filled with blood, the redness will be equally conspicuous
in both textures." (Gross Path. Anat. vol. 2, p. 308.) It is difficult to under-
stand how either of these systems of veins can be congested without occasioning
a similar state in the other, seeing that they communicate freely with each other
and are indeed continuous.

1846. J Pathological Anatomy of the Liver. 133

which may be occasioned either by an inordinate accumulation of
blood in the whole or a portion of the organ, or by a morbid condition
of its vessels.

We have observed that hyperemia of the liver may be traced to
post-mortem causes. This is especially the case if much time have
elapsed between death and the examination. After death the blood
will gravitate to the most depending portions of the organs and thus
simulate true congestion. The corpse being usually kept in the
horizontal position and on the back, the posterior portions of the
liver will, under such circumstances, be found to be the seat of accu-
mulation; and it is only by bearing this in mind and comparing the
condition of other organs similarly situated, as well as by referring
to the previous history of the case, that we can determine the real
cause of the hyperemia.

Anemia of the liver is by no means uncommon. It may accom-
pany an anemic state of the general system, or be confined to the
liver, in which case it is often the consequence of hypertrophy of the
tissues surrounding and therefore compressing the portal veins. It
is frequently met in those who die of ascites, in victims of intem-
perance, in asiatic cholera, and in yellow fever. It may be recog-
nized, as already stated, by the pale or yellow hue of the tissue, and
by the paucity or absence of blood on incising the organ. The con-
sistence of the tissue is usually indurated when it is connected with
hypertrophy.

2nd. Lesions of Nutrition. It is by the process of nutrition that
the molecules of organic matter are formed and continually renova-
ted ; and, as long as this process is accomplished in a healthy manner,
the organs are formed and remain in accordance with the normal
standard. The modifications to which the nutritive process is liable
are of four kinds, and affect the arrangement of the molecules, their
number, their consistence, and their nature.* To a vitiated
arrangement of the molecules are referred the great variety of mal-
formations or monstrosities, whether from excessive, deficient, or
perverted evolution. The alterations in the number of the molecules
are attended with hypertrophyf or an increased number of normal
molecules; with atrophy J or a diminished number of molecules;

* Andral, op. cit.

t Hypertrophy, i'rom v-nip, over and rpoQrj, nutrition.

J Atrophy, I'rom a, priv., and rpnO$, nutrition.

134 Pathological Anatomy of the Liver, [March,

and with ulceration or a cessation of molecular deposit to supply the
place of those removed by absorption. Alterations of consistence
result in induration, or softening of the tissues, consequent on a cor-
responding change in the molecules themselves. Lastly, modifica-
tions in the nature of the molecules are very numerous, and give rise
to the various transformations of the tissues, as for example, the
conversion of the cellular into the cartilaginous, the fibrous, the mu-
cous tissues, &c.

The lesions of nutrition by which the liver is affected, are various
and complicated. The arrangement of its molecules may be per-
verted during the evolution of the organ, or subsequently. Congeni-
tal malformations of the liver are by no means rare, presenting
modifications of form and of the relative proportions of its lobes, &c.

Increased nutrition produces local or general hypertrophy of one
or more of the tissues entering into the structure of the liver. We
have already remarked that the predominence of the red or yellow
substance was effected by modifications of the capillary circulation ;
but this may also depend on a lesion of nutrition, for, if the yellow
substance be hypertrophied without a corresponding condition of the
red, the liver will present a much more yellowish color than that
which belongs to it in the normal state ; and, vice versa, if the yel-
low tissue be alone atrophied, the liver will be more red, without
necessarily containing an excess of capillary circulation. The
granulations or acini of the liver are also, not unfrequently, found
considerably hypertrophied, and, consequently, more apparent than
usual; and the enlargement of the acini may depend either on the
simultaneous hypertrophy of both of these tissues or of one alone.
This state of things may be local or general ; when local, small por-
tions of the liver may be more granular than the surrounding struc-
ture, and, according to the peculiar substance affected, will be the
appearance presented. The diseased locality will be either red or
yellow, and sometimes greenish. A very striking form of this granular
hypertrophy was noticed and called by Laennec cirrhosis,* speci-
mens of which are beautifully represented in Cruveilhier's great work
on Pathological Anatomy. Whilst Andral regards it as hypertrophy
of the yellow substance alone, Cruveilheir, who denies the existence
of this substance, considers it as resulting from hypertrophy of a por-
tion of the granulations consequent on the destruction of the remain-
der by pressure of the cellular tissue, which is at the same time also

* Cirrhosis, from ki^ws, yellowish.

1846.] Pathological Anatomy of the Liver, 135

hypertrophied. The yellow color he refers to an exudation of the
biliary fluid. The number of enlarged granulations in such cases is
unquestionably much smaller than that presented in a sound liver,
and the quantity and density of the cellular tissue are much increas-
ed. Yet we cannot admit that the mere effusion of yellow bile would
so mask the redness of blood as to give rise to the striking yellowness
of the liver under such circumstances. Incases of cirrhosis, the liver
is often attended with great diminution of volume, appears shrivelled,
and is usually indurated. It is frequently found accompanying ascites.

The cellular tissue may alone be the seat of hypertrophy, in which
case the granulations, and even blood-vessels, may be more or less
compressed, and the general texture indurated. Finally, all the tis-
sues of a portion or of the whole organ may be hypertrophied, so as
to increase the dimensions of certain portions or of the entire liver.

Hypertrophy then may modify the volume and color of the liver,
or of portions of it, and may be attended with an increased, dimin-
ished, or normal consistence. The increase of volume is sometimes
confined to a lobe or to numerous smaller portions, giving the organ
an irregular form or a knotty appearance ; but all these effects must
be distinguished from the results of mere hyperemia, which may be
done by reference to the color and by close inspection.

When the consistence of the liver is normal, the parenchyma can
be penetrated by the end of the finger without much difficulty, which
cannot be done when the induration is excessive. The degree of
mollescence or softening of which the liver is susceptible, varies from
the normal consistence to that of a soft, pulpy, and even semi-fluid
mass. It can then, not only be penetrated with ease by the finger,
but also torn or reduced to shreds.* These modifications of con-
sistence may obtain with or without hypertrophy, atrophy, hypere-
mia or anemia, and should therefore be studied in connection with
these various conditions of the organ.

Atrophy of the liver is the result of defective nutrition, and may,
like the converse state, be local or general, and affect one or more of
its tissues. Although usually attended with diminution of volume,
it is not invariably so, for it sometimes happens that the atrophied
tissue is replaced by one of new formation, especially by cellular
tissue.f It may, like hypertrophy, be attended with modifica-
tions of consistence and color.

* Andral op. cit., Tom. 11, p. 503.
t Andral up. cit., Tom. J I.

136 Pathological Anatomy of the Liver. [March,

The liver may be said to undergo a gradual process of atrophy from
the earliest fcetal age to advanced life, inasmuch as its relative volume
is continually diminishing in the physiological state of the system.
Shortly after its evolution, its volume is equal to that of the remain-
der of the product of conception. At birth it is still very large, often
reaching down to the pelvic bones, whereas, in the adult it projects
but little, if any, below the ribs, and is still smaller in old age.*

The effects of perverted or vitiated nutrition manifest themselves
by transformations of the tissues, and by new products. The trans-
formation of one tissue into another is one of the most common physi-
ological phenomena of evolution, the cellular tissue being changed
into the fibrous, the cartilaginous into the osseous, &c. Such trans-
formations also continually result from morbid causes. In the liver
we not unfrequently find the cellular tissue giving place to fibrous, to
cartilaginous, and even to osseous deposits, either about its investing
membrane or along the course of its vessels. The liver is often the
seat of cysts, more or less extensive and numerous, in which a lining
membrane has been formed at the expense of the cellular tissue.
The formation of these cysts is supposed by Andral to depend on a
previous hemorrhage, which, being gradually absorbed, leaves a cavi-
ty, the walls of which become organized and secrete the peculiar
fluid they are found to contain ; and the same distinguished author
would seem to refer even the acephalocysts or hydatids contained in
these cysts to a similar cause. His arguments are, however, by no
means satisfactory, and are utterly at variance with the observations
of Cruveilhier, who simply refers them to a morbid action, without
indicating the nature of this. Fibrous tumors are met in the liver,
which may be attributed either to a transformation, or to hypertrophy
of the cellular tissue. Although these modifications of nutrition may
account satisfactorily for the production of tumors purely fibrous,
they appear insufficient in reference to those tumors which originally
appear to be simply fibrous, but which subsequently undergo the
changes peculiar to schirrus. Schirrous tumors, properly speaking,
contain an element (carcinomatous matter) resulting, manifestly,
from a morbid secretory action, and should therefore be treated of
under the head of lesions of secretion.

3rd. Lesions of Secretion. Under this head we shall treat in the
first place of the intersticial secretion, and in the second of that

* See Southern Med. and Surg. Jour., vol. 3, p. 519.

1846.] Pathological Anatomy of the Liver. 13'

peculiar to the glandular structure of the organ. The act of secretion,
whether intersticial or glandular, may be modified by the condition
of the tissues or by that of the blood.

The secretion peculiar to the cellular tissue may be increased or
diminished, giving rise either to an'cedematous condition of the liver,
or to an opposite state of things. Increased cellular secretion here,
as in other parts of the body, is most frequently produced by an
obstruction offered to the return of blood from the locality thus
affected. This is the cause of many dropsical effusions, whether of
the cellular tissue or of serous sacs. Yet it may depend on a pecu-
liar state of the tissue itself or of the blood sent to it.

The secretion of the cellular tissue is frequently perverted, so as
to occasion an inordinate accumulation of adipose matter in the liver,
constituting what has been denominated by the French "foie.gras"
fat liver. This is one of the most common attendants on phthisis
pulmonalis, and is recognized by the unctuous feel of the liver and a
peculiar yellowish hue assimilated by some, to that of dead leaves.
It is also by a perversion of this act that we explain the deposit of
tubercular matter, of the various forms of carcinomatous matter,
and frequently of pus; these morbid products being secreted in lieu
of the normal fluid destined to lubricate the cells of this tissue.
There is no portion of the body in which these abnormal secretions
are so frequently met as in the liver Indeed the manifestation of
carcinomatous tumors in any other locality is by some deemed prima
facia evidence of their existence also to a greater or less extent in the
liver. Purulent collections in the liver are well known to accompany
in many cases the suppurative process set up in remote portions of
the body. These do however occasionally seem to result from inju-
ries of the head without any other evident cause, and are then re-
ferred to sympathy. Yet, from the size and great friability of the
liver, it may have, in many such accidents, sustained direct injury
without the knowledge of the patient or his attendants.

The opinion of Cruveilhier is that carcinomatous as well as puru-
lent deposits owe their existence to a disease of the venous radicles
of the liver. These, however, being imbedded in the tissues con-
taining morbid matter, may derive what he has detected in them by
simple imbibition, as they would any other fluid in contact with their
coats. Yet there can be no doubt that pus is sometimes conveyed
along with the blood, and accumulated in the liver as well as lungs
and spleen, these being the organs in which the blood is sent in

133 Pathological Anatomy of the Lker* [March,

greatest quantities and in which it remains most at rest, if we may
use the expression.

In relation to carcinomatous formations, although their origin is
certainly to be traced to a perverted act of secretion, they present to
us when fully developed, not only the presence of a new matter, but
also the effects of this new matter on the adjacent tissues. The
carcinomatous matter undoubtedly acts the part not only of a foreign
body in the tissues, but of one possessed of peculiarly irritating pro-
perties ; hence the modifications of circulation, nutrition, innervation,
&c, and even the contamination of the whole system* which attend
tumors thus formed.

The glandular secretion of the liver, may like all other secretions,
be increased, diminished, or perverted ; moreover this organ being
furnished with conduits for the egress of its special secretion, the
bile may be abnormally accumulated in the whole or a portion of the
liver, by obstructions of the ducts. Mere modifications in the quan-
tity of the biliary secretion will not affect the appearance of the liver
if its ducts be in a normal state, but would show themselves by in-
spection of the receptacles of bile, viz., the duodenum and the gall-
bladder. If, however, there be any impediment offered to the egress
of the bile, its accumulation will manifest itself in the liver, and
sometimes in all the white tissues of the body, as in icterus.

Biliary concretions are of very common occurrence in the gall-
bladder, and are occasionally found in the course of the hepatic
ducts, and even in the granulations or acini themselves. These
concretions would seem most frequently to depend on a morbid in-
crease of cholesterine in the bile, and sometimes perhaps on the
viscidity of the bile itself. They may be formed by the yellow col-
oring matter, the resinous matter, and sometimes by calcareous mat-
ter. They are more frequently found in the gall-bladder, because
bile is here accumulated in larger quantity than elsewhere, and is in
the most favorable condition for depositing its solid particles and
thick mucus. Obstructions along the course of the hepatic ducts or
at their termination, will be found most generally to exist where
such concretions are detected in the body of the liver, and their for-
mation will, by furnishing new obstructions, lead to a farther increase
of concretions, as well as of accumulated bile in the organ. Their
presence in the liver may give rise to inflammation and to abscesses.
This is also frequently the case in the gall-bladder, not because they
obstruct the egress of bile from the bladder (for by the same median-

1846.] Pathological Anatomy of the Liver. 139

ism they would prevent also its ingress, and what it already contained
would be readily absorbed,) but because they act as foreign bodies.
Biliary cystitis is frequently produced in this way, and maybe attended
with adhesion of the cyst to the stomach or, as more frequently occurs,
to the intestines, and subsequently the formation of an opening of
communication by which the calculi are permitted to pass off. Cru-
veilhier thinks that calculi scarcely ever get from the gall-bladder
into the intestines in any other way, their passage through the cystic
duct being rendered extremely difficult by its peculiar structure.

Obstructions of the cystic duct alone are thought by high author-
ity scarcely ever to occasion jaundice, whereas this is a frequent
attendant on obstructions of the hepatic ducts.

The presence of entozoaria in the liver is much more rare in man
than in quadrupeds, some of which are exceedingly subject to them,
especially the hog, ox, and sheep. Whilst in the present state of our
knowledge it is difficult to account satisfactorily for the formation of
hydatids and liver flukes, it is generally admitted that the lumbri-
coid worms occasionally met in the biliary ducts have probably
passed into them from the duodenum.

4th. Lesions of Innervation. These lesions can only be appre-
ciated in their effect on the other acts of the organism. The normal
supply of nervous influence to an organ may be modified by affec-
tions of the special nerves of the organ or of the centres from which
they emanate; but the scalpel fails in the great majority of cases to
detect such affections. We are therefore left, as just observed, to
infer such disease from the effects of perverted innervation on the
circulation, nutrition, and secretion of the organ supplied by nerves
in a morbid state. The capillary circulation being largely influenced
by innervation or nervous influence, must necessarily be modified by
perturbations of this influence; and the act of nutrition being effect-
ed by means of the capillary circulation, cannot fail to be influenced
by its modifications ; so likewise of the act of secretion. The degree
to which each or all of these acts may be perverted, will vary in
accordance with circumstances difficult to appreciate.

We have seen, however, that these acts may be perverted by causes
entirely independent of innervation, as a primary cause. Physical
violence, mechanical obstructions, the state of the blood, &C., are
fruitful sources of disease in the liver.

Wo have now reviewed, very briefly it is true, the morbid effects

140 Pathological Anatomy of the Liver. [March,

consequent on modifications of circulation, nutrition, secretion and
innervation. And yet, it has doubtless been remarked by the reader,
that we have scarcely used the term inflammation, although one daily
applied in the description of almost every form of disease. We trust,
however that the course we have pursued will tend to show that there
can be no greater error than that of considering all lesions as ne-
cessarily connected with inflammation. What is inflammation?
Certainly not a simple, but a very complex phenomenon. Modifica-
tions of the capillary circulation alone will, we presume, not now be
regarded as constituting inflammation. Nor will modifications of
nutrition alone, or of secretion alone, or of innervation alone, be
regarded as such. Inflammation is, on the contrary, characterized
by a simultaneous affection of all these functions, and may either
occur spontaneously, or rather without appreciable cause, or be in-
duced by known influences. In no case of true inflammation can
we fail to detect perversion of circulation, nutrition, secretion and
innervation to a greater or less extent. It is true that some of these
functions may be modified to a greater relative degree than others,
and in this fact do we find the special differences observed in various
inflammations. Whilst in one inflammation, we find the circulation
most perverted, we may find that in another the most striking fea-
ture will be a perversion of the act of nutrition or of secretion.

Let us observe what takes place under the influence of irritating
agents applied to the tissues under our eye. The first effect of the
irritant is unquestionably on the nervous ramifications, for pain is
immediately experienced ; the second on the capillaries, (in conse-
quence of the modified innervation,) for we perceive these minute
vessels diminishing in size, or contracting, to use a common though
probably an erroneous expression, inasmuch as muscular fibres have
never been proven to exist in them. The lessened caliber of the
vessels is attended with an increase of rapidity in the movements*

* The increased activity of the circulation is, probably, rather the cause
than the effect of the diminished capacity of the capillaries ; as also the slug-
gishness and final arrest of motion in the globules is rather the cause than the
effect of the increased capacity of these vessels. In the former case the rapidity
of the circulation would permit an elastic retraction of the vessels, whereas in the
latter the accumulation of blood would mechanically distend them. With this
explanation we are not forced to admit the existence of muscular fibres where
they have never been demonstrated, but merely to concede to the capillaries a
texture similar to that of the arteries with which they are continuous. But it
may be asked, what hastens the movements of the blood globules'? We do not

1846.] Pathological Anatomy of the Liver. 141

of the globules of the blood, and with their concentration towards
the point of irritation. But all this does not constitute inflamma-
tion; and, if the agent be not too powerful, a return to the normal
state will soon ensue. If, on the other hand, the agent have been
very destructive, instead of a return to the normal state, it will be
observed that the globules, after concentrating towards the point of
irritation, will distend the capillaries to the utmost, will cease to
move, and will soon pass under the influence of chemical affinities,
presenting us the phenomena of mortification, the nervous influence
which controlled their motion having been completely annihilated.
There is nothing here like inflammation ; but simply a cessation of
life, such as would result from cutting off entirely all nervous influ-
ence from any given locality. Did the irritant possess an interme-
diate degree of intensity, the lesion of innervation would merely
modify the capillary circulation, (producing congestion, redness and
heat,) and this modification would affect the secretion of the part,
(producing effusion or tumefaction,) as well as its nutrition, (pro-
ducing induration or softening of the tissues.) Here then would be
a case of true inflammation, presenting all the characteristics of this
condition, viz: pain, congestion, redness, heat, tumefaction, and al-
teration of consistence.

The liver may then be extensively diseased without inflammation.
It may be hyperemic or anemic ; hypertrophied or atrophied ; indu-
rated or softened; the seat of various abnormal deposits of serum,
flit, tubercles, carcinomatous matter, melanosis, &c, &c, without
any inflammatory action whatever as a primary cause. Yet it
may, like all other organs, be the seat of genuine inflammation,
which can always be recognized by the description above given.
We hesitate not to say that true hepatitis will be found of compara-
tively rare occurrence, if judged by the above standard, and that the
views here presented will reveal the cause of the inefficacy of anti-

know certainly, but think it not improbable that they are impelled or attracted
by the nervous influence in a manner somewhat similar to the influence of elec-
tricity or galvanism on matters suspended in liquids. The mere contraction of
the capillaries might occasion the increased activity of the circulation, but
could not accountfor the concentration of the globules towards the point of irri-
tation. In the perturbations of the capillary circulation, -whether purely physi-
ological, as in the blush of the cheek under certain mental conditions, or patho-
logical under the influence of local stimulation or irritation, we must look
therefore for some other cause than a mere increase or diminution of the capa-
city of the vessels. That we have suggested appears the most rational.

142 Remarks on Fungus Hcematodes. [March,

phlogistics alone in the treatment of affections of the liver, and,
above all, the error of looking too exclusively to modifications of its
glandular secretion for evidence of its morbid condition, and conse-
quently of directing our remedial agents to the modification of this
process alone, as the means by which the organ is to be restored to
health.

Augusta, 1st January, 1846.

ARTICLE IX.

Some remarks on Fungus H(Bmaiodes> with a Case. By William
Williamson, M. D., of White Plains, Benton County, Alabama.

Having seen the notice of a case of fungus hsematodes, in the De-
cember No. of the Southern Medical and Surgical Journal, by Gilbert
H. Wooten, M. D., of Florence, Ga. in which he adverts to the very
rare occurrence of this disease, its great danger, and questions the
propriety of certain points of practice in it; and believing that there
is an obligation on physicians to give what information they can on
any difficult or obscure points in the science of medicine or surgery,
I am therefore induced to offer a short history of a case of disease
that occurred partly under my notice. There appears to be a diversi-
ty of opinion as regards the pathology and consequently the appropri-
ate treatment of the above mentioned affection. Mr. Burns, of
Glasgow, gives the first description of it under the term spungoid
inflammation. His description of the disease corresponds pretty
much with the case that fell under my observation. Mr. Hay, of
Leeds, denominated it fungus hsematodes. Other writers have given
it other names, either expressive of its appearances or malignancy,
such as medullary sarcoma, carcinoma hcematodes, soft cancer, &c.
It is "an extremely alarming carcinomatous affection; it consists
in the development of cancerous tumors, in which the inflammation
is accompanied with violent heat and pain, and with fungous and
bleeding excrescences. Even when the diseased part is extirpated
at a very early period and this is the only wise plan that can be
adopted recovery rarely follows : other organs being generally im-
plicated at the same time." (Dunglison.) "In the majority of
examples of fungus hsematodes, this distemper is found affecting in
the same subject a variety of parts. In addition to the outward tu-

1846.] Remarks on Fungus Ilcematodes 143

mor, we find swellings of a similar nature perhaps in the liver, the
lungs, the mesenteric glands, or even in the brain." (Cooper.)

Thus we observe that some whom we look upon as high au-
thority in medicine, inculcate the view that this disease is a con-
stitutional one, and that if we extirpate or amputate even at a very
early stage, we have no security that the disease will be eradicated.
But on the contrary, we should add that the shock and prostration
consequent on the operation to the already debilitated state of
the system, may hasten on the disease to a fatal termination.
Hence, when a case of this rare disease presents itself, the phy-
sician, examining authority, finds there is little or no chance for
his patient's recovery, he is discouraged, and probably fails to put in
requisition the only means that might snatch his patient's life from an
untimely grave. But does actual experience shew such fatality in this
disease 1 I fear it doesin a majority of cases. But if it does not in
all, we have some encouragement to hope, when there is a favorable
case presented to our care, that by proper surgical aid we may pos-
sibly prolong the existence of a fellow being.

In the communication first referred to, the question is asked : If
before the inguinal glands became inflamed we had amputated,
would it have been good surgery ? I do not undertake to answer
the question, or place my surgical knowledge in opposition with that
of Dr. Wooten, but simply to detail a case as it occurred, and leave
others to form their own opinions. During the spring of 1838, Maj.
Adrian, of Randolph county, Ala., shewed me a tumor which he had
on- his right fore-arm, about one and a half or two inches above the
wrist, and when the hand was proned, on the superior and external
part. The tumor was about the size of a musket ball, it was proba-
bly bound down by the fascia, as it was firm and tense, and felt as
though it was attached to the bone ; it was slightly elastic, and with-
out pain, discoloration or increased sensibility. Maj. A. was proba-
bly about 50 or 55 years of age, of good constitution and of sanguine
temperament. I advised him. to have it extirpated immediately ;
but owing to pecuniary arrangements this was neglected. I lost
sight of the case until the 10th of the following October, when I
was sent for to remove the tumor. I found a large fungous excres-
cencc, probably as large as a goose's cg,g, very painful, anddischarging
a great quantity of thin sanious or bloody fluid. The tumor had
very much the appearance of a large mushroom, with a moderately
small pedicle and a widely expanded surface. The surrounding parts

144 Remarks on Fungus Hcemalodes. [March,

did not appear to be contaminated to much extent. In conformity
to his wishes, and also following the advice of surgical writers, I pro-
ceeded to remove all the diseased structure, and in order to be certain
of this, I cut into what appeared to be sound skin and muscle.
There was but little haemorrhage, consequently I was enabled to ex-
amine the parts carefully. The muscles appeared sound, and its
attachment to the bone or periosteum appeared to be by rather loose
cellular tissue, without any apparent diseased structure remaining.
The wound was dressed and appeared to be healing kindly, with the
exception of a little fungous growth. I discontinued my attendance
about the 20th of November, and did not see the case for about two
months. He was then laboring under intermitent fever, and had been
for some time ; the sore was also assuming a bad appearance, and the
disease seemed to be returning. I prescribed quinine for the fever
and as a tonic, the general health being greatly affected. I did not
see the case again until the 6th of March. He was then truly an.
object of pity the fungus had again appeared, and grown to about
the size of a child's head ; the pedicle was much larger than in the
first instance, and the outer surface very large and expanded to a
soft, spongy texture. It was truly a vast and unwieldly tumor at-
tached to so small a member as the arm. It was attended with pro-
fuse discharges of thin saneous fluid, and of late frequent and profuse
haemorrhages. The patient was also worn down by daily exacerba-
tions of fever, colliquative sweats, &c. He was greatly emaciated,
with pale, haggard countenance, and prostration of strength. His
case was so extremely dangerous that I did not believe it possible
that he could live two weeks longer, without aid of some kind. He
was apprized of his danger, and stated that if he continued to sink
as he had done for a few days past, he would not survive a week.
The axillary glands were slightly enlarged and somewhat painful.
He insisted on having the arm amputated. I explained to hiui the
great uncertainty of success from the operation, that he might sink
under it, or if he should outlive the removal of the arm, many wri-
ters of eminence gave it as their opinion that it was a constitutional
disease, and that other parts would quickly become affected with the
same complaint. He replied, that he knew he should die if it was
not done, and he would have it off.

Accordingly, on the 7th, assisted by Drs. Burnham and Ware, I
removed the arm by the circular-flap operation, about two inches
above the elbow joint. The case did well, and under the use of

1846.] Cases in Obstetric Practice. 145

gentle tonics and nutritious diet, the patient's general health improv-
ed, and the stump healed in about the usual time. I will mention
one circumstance that occurred during the cure, in order to show
that if there had been a tendency to a return of the disease, the irri-
tation might have had considerable bearing on it, and probably would
have aroused the disease into action again. When my patient was
convalescing, and the stump partly healed in walking, he stumbled
and fell, striking the stump on the ground ; yet no evil consequences
resulted from the accident, with the exception of severe pain and
smart inflammation. More than six years have elapsed since the
operation, and the patient has remained in good health, with the ex-
ception of occasional attacks of sickness unconnected with the ori-
ginal disease. In consequence of indisposition at the time, I did not
examine the arm removed, but Dr. Ware dissected it, and informed
me that the bone was diseased, extending into the joint, but appeared
to be sound above the elbow.

ARTICLE X.

Cases in Obstetric Practice. By W. Frankun Bask, M. D.,
of Greenville, Tennessee.

I. Dysmenorrhea. A case cured with Extract Stramonium and
Prussiate of Iron. I was called to see Mrs. G., a middle aged wo-
man, the mother of seven children, spare make, and of laborious habit.
I found her laboring under the following symptoms : Violent pain in
the head ; dry skin ; pulse of natural size, but frequent ; tongue cov-
ered with white fur, with clean edges; bowels constipated ; pains in
the back, hips, loins, thighs, and hypogastrium, resembling those of
parturition which were followed by profuse discharge, that would
debilitate her very much, but which relieved her of pain until ano-
ther paroxysm. Each discharge would be preceded by the pains
mentioned above of a violent character, and which, in her own lan-
guage, were " as severe as those attending the birth of any child she
ever had."

She had been laboring under this affection for eight or nine months ;
the catamenia returning at irregular periods of three or four weeks.
During the first two or three menstrual periods, the discharg
accompanied with coagula, at the fourth with a pseudo-membranous

10

146 Cases in Obstetric Practice, [March,

substance, (according to her account,) "about the size of a placenta."
Since then, no coagula or membranous substance has accompanied
the discharges. Her general health was much impaired, so much
so that she had been unable to attend to her work for some time.
The lumbar vertebrae were tender on pressure ; pubic region tender
during menstrual period.

She had been under the attention of another physician I being
requested by him to visit her when I did, as he was unable to go him-
self. I found, from the medicine left by him, that he was treating
her for menorrhagia. He had given opium and acetate of lead, to
be taken each menstrual stage ; and nothing in the interval. As
this remedy relieved the pain and checked the discharges, I request-
ed her to continue it only leaving some purgative medicine, as her
bowels were constipated, and recommended a blister to the lumbar
'vertebrae.

As the attending physician intended leaving the country, the case
was placed in my care. To effect a cure, I prescribed Dewees'
laxative pills to keep the bowels in a soluble condition, five grains of
prussiate of iron three times a day, and four days previous to the
return of the attack, one-fourlh of a grain of the extract of stram-
onium, three times a day, until it produced vertigo, when it was to
be discontinued until this subsided, when it was to be resumed. If
the pains were severe on the return of the catamenia, eight grains
camphor and four grains pulv. Doveri, every two hours until relief
was given. Flannel was directed to be worn next the skin. As
there were symptoms of prolapsus uteri, directed recumbent position,
injection decoction red oak bark, and the T bandage.

The Jirst return of the catamenia after using the above remedies
was attended with no more pain than she had experienced before
marriage, and no more than generally falls to the lot of females at
this time. The symptoms of procidentia were also removed.

The remedies were continued for about four months, when I
ceased my attention. Her general health is now good, and she has
become somewhat fleshy.

II. Ergot in Uterine Hcemorrhage. May 1st. I was sent to
see Mrs. C. she had been laboring under uterine haemorrhage
for a day. Her husband, being a physician, had prescribed for her
himself. He had given ipecacuhana by itself, made applications
to the vulva, &c. Her bowels had been operated upon by a cathar-

1846.] An Inquiry into the Causes of Disease. 147

tic. I prescribed opium, acetate of lead and ipecac in combination.
This was continued for two days, but seemed to do but little good.
I then prescribed ergot in doses of 10 grs. every four honrs. There
was no return of haemorrhage after the first dose had been given.
She recovered without taking another dose.

PART II. REVIEWS AND EXTRACTS.

An Inquiry into the Causes of Disease. By Wi. P. Hort, M. D.,
of New-Orleans. (From N. O. Medical and Surgical Journal.)

It is reasonable to suppose that an inquiry into the origin and
causes of disease was cotemporary with the Science of Medicine
itself. If we go back to a period anterior to that of authentic his-
tory, we find that ./Esculapius was reputed to be the founder of
medicine. According to Homer, his sons Machaon and Podalirius
were the physicians of the Grecian army at the siege of Troy. The
description of the plague in the Grecian camp, produced by the
exhalations from the marshy ground near which the army was en-
camped, establishes the fact that an inquiry had been made into the
causes of disease, long before the time of Homer. jEscuIapius is
supposed to have lived 1280 years before Christ. The siege of Troy
took place about the year 1184 B. C. ; and Homer, according to the
best critics, lived 900 years B. C. Now Homer describes a fact which
must have been known at the time of thesiege of Troy ; we can there-
fore trace an inquiry into the causes of disease back to the time of
the sons of^Esculapius, and it is probable that this inquiry was begun
by the father. As ^Esculapius is called the founder, so is Hippo-
crates, who was born about 406 years B. C. styled the Father of
Medicine. He diligently investigated the causes of disease, but
does not appear to have discovered any thing more than what was
previously known. It seems proper to make a distinction between
the origin and cause of a disease. The former signifies the first ap-
pearance of a disease, or the time when it was first noticed, and the
latter refers to the circumstances which produced it. Most of the
ancient writers observed new diseases. The time of the introduction
of hydrophobia and elephantiasis into Europe is marked by Celsus
and Pliny. Dio Cassius mentions a new disease contracted by the
Roman army in Arabia Felix. Another disorder, the lichenae or
mentagra, lost to us, was imported from Asia to Rome, according to
Pliny, and raged among the Roman nobility. Thucydides and
Plutarch ascribe the great plague in Athens during the Peloponesian
war, to the multitudes of rustics who were introduced into the city
by Pericles, and crowded together in huts within the walls ; and

148 An Inquiry into the Causes of Disease. [March,

Livy imputed the first plague in Rome to the number of inhabitants
panned up in its narrow limits. (Ferriar ; Med. Hist.)

During the middle ages, several strange diseases suddenly appear-
ed, and as suddenly disappeared, which almost depopulated the
countries through which they passed. These have been accurately
described by medical writers; but what they have written is simply
a history of the disease, and not an explanation of its cause.

Glisson, Hunter, Diemerbrock, Sydenham, Willis, Sennertus,
Ferriar, Lind, Pringle, Cullen, and a host beside, have endeavoured
to investigate the causes of disease. Some have presented us with
ingenious theories, and others with wild speculations and obscure
notions, better calculated to bewilder than to enlighten the mind. In
short almost every eminent physician, and distinguished professor of
medicine has had his own peculiar theory as to the cause and nature
of disease. Thus we find solidists at one time, and humoral pathol-
ogists at another. Then every thing is referred to the nerves, and
we are treated with an essay on sympathies, and morbid sympathetic
movements. Nor must we forget the septon and the septic acid of
the Dutch School of Medicine, to which at one time, almost all dis-
eases were referred. It would appear, then, that the question of the
cause of disease is as unsettled as it was three thousand years ago.
But the researches of medical men, like those of the alchymists, have
not been altogether useless. They have discovered some important
facts, which serve as a foundation for future discoveries. Thus,
where there is rich alluvial soil, or low swampy lands in tropical cli-
mates, we find disease prevailing, and it is referred to the exhalations
emanating from the surface of the earth, and in some instances, from
certain plants. Again, in more Northern climates, putrid and ma-
lignant fevers of the typhoid type, are clearly traced to an atmosphere
vitiated by human beings crowded together in rooms that are badly
ventilated, where there is a deficient supply of food, or perhaps vitia-
ted food, with a total disregard of cleanliness. But what those ex-
halations, and that animal effluvia consists of, is altogether another
thing. Chemistry as the science of inorganic matter, has thrown no
light upon the subject, and probably never will. It remains, then, to
be seen what assistance we can derive from organic chemistry in dis-
cussing this interesting subject; but before doing this, it may be
proper to make some preliminary remarks.

Of chemistry as a science, the ancients knew literally nothing.
Taking a departure from the time of Aristotle, we find that the
Arabians were the first to devote themselves seriously to the study
of chemistry. Rhazes, Avicenna, Avenzoor, and others, may be said
to have laid the rough foundation. They were followed by Paracel-
sus and the alchymists. Stahl next appeared, and although errone-
ous in theory, he nevertheless laid the foundation of a regular
science, or rather, improved the foundation that had been begun by
the Arabian chemists. The next great advance? was made in the
discovery of hydrogen by Cavendish, of nitrogen by Rutherford, of

1846.] An Inquiry into the Causes of Disease. 149

oxygen by Priestly, and of carbonic acid gas by Black. As tbey
discovered the four most important elements in the science of animal
chemistry, we must date the development of that branch of science
from the time of these discoveries, which were made during the last
quarter of the 18th century. They were followed by Lavoisier,
Guytonde Morveau, and Berthollet, who introduced a new technical
nomenclature, which was adopted in 1787. But the most brilliant
discoveries have been made in the present century. The galvanic
apparatus ofVolta enabled Sir Humphrey Davy to demonstrate that
the fixed alkalies were compounds of oxygen with metallic bases.
Chlorine was discovered by Scheele, but Davy established its elemen-
tary nature, as well as that of iodine. It was, however, the discov-
ery of the atomic theory, or doctrine of chemical equivalents, by
Dalton, aided by Vauquelin, Gay Lussac, Thenard, Berzelius, and
Thompson, which at once elevated chemistry into the rank of a fixed
and certain science. Dr. Wollaston constructed the logametric
scale of chemical equivalents, which, when proper care is taken, may
be considered as accurate as tables of interest, or as the principles
of mathematics. Gay Lussac discovered cyanogen ; which, as it
was the first radical compound discovered, and is more fertile in
results than any other discovery yet made in organic chemistry,
entitles him to the honorable post of pioneer in this rich and impor-
tant science.

Up to this period, although organic chemistry had hardly been
considered or spoken of as a science, and much less as the true basis
of physiology, yet the foundation was laid, first by the use of the
microscope, which revealed to Lewenhoeck and Spallanzani the
wonders of a new creation ; secondly by the discoveries of oxygen,
nitrogen, hydrogen, and carbonic acid ; and lastly, by the discovery of
cyanogen. Since these results were obtained, Redtenbacher, Lau-
rent, Valentin, Gerhardt, Dumas, Boussingault, Raspail, Johnston,
Mulder, Roget, Liebig, and many others, have made most diligent
researches in this department of science, attended with brilliant and
astonishing results. Organic chemistry treats of those substances
which result from the ordinary laws of matter, influenced by the
mysterious laws of vitality ; it brings to light an infinitude of new
compounds, and those compound radicals which, in their chemical
relations, act precisely as elements. From it we learn that a certain
class of substances called nitrogenized, furnish the elements of nu-
trition ; while another class called non-nitrogenized, support respira-
tion. Both are necessary to carry on the operations of nature, and
to preserve life, but neither can perform the functions of the other ;
we also derive correct views of the source of animal heat. In the
union of oxygen and carbon which is going on in all parts of the
system, a continued slow combustion is kept up in the formation of
carbonic acid. Despretz has found that the combustion of 1 oz. of
carbon will raise the temperature of 78.15 oz. of from 32 to 212 ,
and if, as he says, 13.9 oz. of carbon are daily converted into carbonic

150 An Inquiry into the Causes of Disease. [March,

acid in the body of a healthy adult, evolving 195531 degrees of heat,
there is no longer any difficulty in accounting for the production of
a regular and necessary supply of animal heat. In organic chemis-
try, we see most beautifully illustrated the simplicity and the resour-
ces of nature. What an immense variety of compound substances
resulting from a few elements, has already been discovered, and as
yet there appears to be no limit to our researches ; an unbounded "
field is open for scientific investigation, particularly when we reflect
on the mysterious connection existing under certain circumstances,
between inorganic and organic matter.

But, it is time to turn our attention to the bearing which this
branch of chemical science has in relation to the causes of disease.

I shall begin by enumerating as far as may be known to me, or
that I can sustain by authority, the animalcules, and organized mat-
ter, whether animal or vegetable, which are found in the human body
and in animals, and which are not a cause of disease. Animalcules,
called spermatozoa, are found in the vas deferens and in the vesiculae
seminales. They were discovered by a student at Leyden, and first
described by Lewenhoeck. There are several varieties of these
animalcules, the most remarkable of which exist in the vertebrata, in-
vestigated and described by Wagner, and in the invertebrata, by
Von Siebold. The motions of these spermatozoa, in many instances,
continue for several hours after the death of the subject from which
they were taken. By some physiologists they are considered as
simple organized matter. (Todd and Boicman, Physical Anatomy.)
Mandell has described the animalcules of the brain ; also, those in
the blood, which are in some cases very abundant. (Mandell and
Goodfellow. )

Animalcules have been discovered in the saliva, supposed to form
when dead, the tartar around the teeth. (London Medico-Chi-
rurgical Review.) Animalcules called cilia are found on many
epithelium membranes; certain surfaces, which are in their natural
and healthy state lubricated by fluid, are covered with a multitude of
hair-like processes of extreme delicacy of structure and minuteness
of size. They are called cilia from cilium,an eye-lash. They are
generally conical in shape, attached by their bases to the epithelium
that covers the surface, on which they play, tapering gradually to a
point; they are disposed in rows. During life, and for a certain
period after death, these filaments exhibit a remarkable movement
of a fanning or lashing kind, so that each cilium bends rapidly in one
direction, and returns again to the quiescent state. (Todd and Bow-
man.)

Animalcules of different kinds are formed in the sebaceous glands
in different parts of the body. They are found in all persons, espe-
cially when the skin is torpid. They multiply in sickness. In
healthy persons, one to three may be found in each follicle. (Todd
and Bowman.)

Animalcules (monads) have been found in all the mucous secre-

1846.] An Inquiry into the Causes of Disease, 151

tions. (Raspail.) I shall now consider those which may, or may
not, he a cause of disease.

Animalcules have been discovered in the sputa of consumptive per-
sons, not known to be either the cause, or result of diseases. (Bennett.)

Raspail speaks confidently of the existence of organized matter in
the expectoration of grippe, catarrhal affections, laryngitis, and
bronchitis, (p. 620.)

The last time the yellow fever prevailed in Philadelphia, myriads
of animalcules were discovered in the fluid of the stomach. (Dr.
Harlan.)

Worms of different species have been found in various parts of the
body :

1. Acephalocystis endogena, in the liver and abdominal cavity.

2. Acephalocystis multifida, in the brain.

3. Echinococcus hominis, in the liver, spleen, and omentum.
(Bory St. Vincent.)

4. Cystercus cellulasae, in muscle, brain, and the eye.

5. Animalcula echinococci, in the liver.

6. Diplosoma erenata, in the urinary bladder.

7. Tenia solium, in the small intestines.

8. Bothriocepalus, in the small intestines.

9. Distoma hepaticum, in the gall bladder.

10. Polystoma pinguicola, in the ovary.

11. Trichina spiralis, in muscle.

12. Filaria medinensis, in cellular tissue.

13. Filaria oculi, in the eye,

14. Filaria bronchialis, in the bronchial gland.

15. Tricocephalus dispar, in the ccecum.

16. Spiroptera hominis, in the urinary bladder.

17. Dactylius aculeatus, in the urinary bladder.

18. Strongylus gigas, in the kidney.

19. Ascaris lumbricoides, in the small intestines.

20. Ascaris vermicularis, in the rectum. (Owen.)

Dr. Bird states that minute animalcules of the genus Vibrio, are
sometimes developed in urine, so soon after passing it, as to lead to
the idea that their germs must have existed in the urine before it
passed the bladder. They have been found in abundance in cases
of syphilitic cachexia, and in mesentery disease.

Capillary fungiform productions have been observed by Fuchsand
others, in several exanthematous eruptions.

Erenburg has observed the chactophora meteorica growing on the
scales of the salmo eperlans.

Owen observed in dissecting a flamingo, a green vegetable mould
growing on the lining membrane of tubercular cavities in the lungs,
and in the smallest ramifications of the bronchial tubes.

Serrurieur and Rousseau mention having noticed a vegetable
mould in a hind. (Cercis Axis.)

Lagenbeck observed a high degree of fungous growth, in the body

152 An Inquiry into the Causes of Disease. [March,

of a man who died with typhus ; it extended from the amygdalae
through the oesophagus to the cardia.

Gruby and Delafond state that one, in fifty dogs, is affected with
minute filaria in the blood ; such dogs, however, enjoy good health;
the blood in such animals is usually redder and more serous: regi-
men, exercise, loss of blood, &c, neither influence the number, form,
nor movements of the filaria. When the serum of a dog thus affect-
ed, was injected with the blood of an animal not verminous, no filaria
were produced ; but when the blood was injected, they were produced,
but without affecting the health of the subject. These filaria are
only found in the blood.

Wilson and Goodsir have observed in the discharges from the stom-
achs of dyspeptic persons, and in the stomach after death, a micro-
scopic cryptogamous plant, to which Goodsir has given the name of
carcina ventriculi.

The pollen of flowers contains animalcules. (Raspail.)
It is probable that the phosphoric light emitted by fish, and observ-
ed in the wake of a vessel at night, is occasioned by animalcules.
In dark nights, the fishermen on the coast of Scotland are aware of
the approach of large quantities of fish, by a light thrown on the
clouds from the sea. When this fact was announced to me, I scraped
a few scales from a herring, which were agitated for a minute or
two, in a small phial, with water. On examining a single drop of
the water with the microscope, numbers of animalcules were seen of
an oval shape, rather sharpened at the ends ; they were incessantly
revolving, presenting alternately a luminous and a dark side. In
short, as a general rule, every animal and every plant, is more or
less affected with parasites, some peculiar to it, and some not so, and
with organized matter, which may or may not be a cause of disease.

But there are diseases of the human body, of animals, and of plants,
which are known, and acknowledged to be produced by animalcules,
or by vegetable or animal organized matter. Psora or scabies is now
universally acknowledged to be occasioned by animalcules which
have been distinctly seen and accurately described. Avenzoor ap-
pears to have been aware of this fact ; he speaks of an animalcule
which exists in the skin. In 1657, Scaliger speaks distinctly of the
Acarus Scabiei : its form is globular ; it can scarcely be seen with
the naked eye ; it burrows under the skin, producing a burning and
itching sensation. Linnaeus treats of the same animalcule as the
cause of scabies. (Journal des Progres des Sciences. T. 4.) And
it is fair to conclude that the following diseases described by Willan,
originate from a similar cause. 1. Psoriasis guttata ; 2. psoriasis
diffusa; 3. psoriasis gyrati ; 4. psoriasis palmaris ; 5. psoriasis labia-
lis ; 6. psoriasis scrotalis ; 7. psoriasis infantilis ; 8. psoriasis in-
veterata.

Porrigo is a disease occasioned by a growth of disorganized matter ;
by some supposed to be vegetable ; but in this, as in many other in-
stances, there maybe some doubt as to the correct classification.

1846.] An Inquiry into the Causes of Disease, 153

Wilson gives it the name of acarus folliculorum. Dr. Wallace, of
New-York, says it has been ascertained to be a vegetable which even
sheds its seed.

The chigger or chigre (pulex penetrans) is a very troublesome in-
sect in tropical climates. Its attack may be warded off, if promptly
attended to ; but if neglected, it will produce a very serious and dis-
tressing disease. It generally attacks the feet, producing an intoler-
able burning and itching sensation: it generates rapidly and spreads
in every direction under the skin ; its course can be traced by a hard
red line. I have seen in Florida, the bones of the foot and particu-
larly of the toes, laid bare by this disease. Cuvier says, the ulcer
caused by them is cured with difficulty, and sometimes proves mortal.
The vermis medinensis vena medinensis or vermiculus capilla-
rs or Guinea worm, produces also a very troublesome disease.
This animal is common in both Indies, in most parts of Africa, occa-
sionally at Genoa, and in other hot countries. It resembles the
common worm, but is much larger; is commonly found in the legs,
but sometimes in the muscular part of the arms. While it moves
under the skin, it creates no trouble; but, at length, suppuration
takes place, and the animal protrudes its head. Considerable skill
is required to extract it, for if it is drawn so forcibly as to break it,
the part left within creates intolerable pain. In the Edinburg Medi-
cal Essays, mention is made of one that was three yards and a half
in length. {Hooper's Dictionary.)

The tape worm, toenia osculis marginalibus tcenia osculis super-
ficialibus cucurbitinae is a cause of disease producing very dis-
tressing symptoms. They have been seen from ten to one hundred
and sixty feet long. {Chapman.) The ascarides and the lumbri-
coides, the round worms, have already been alluded to as not neces-
sarily producing disease. It is probable that they feed on the
secretions of the intestines, and that when these secretions are sud-
denly carried off, they produce disease by acting on the inner mem-
brane of the bowels or stomach. Chapman attributes the following
diseases to their irritation : Opthalmia, paralysis, aphonia, croup,
hydrocephalus, phthisis, dysentery, pleuritic pains, stupor, lethargy,
mania, febris verminosa, epilepsy, &c. There is a round worm from
four to six inches long, almost transparent, terminating at both ends
in a horny sharp point. I have seen it ejected from the stomach by
the operation of an emetic, but do not recollect ever to have seen it
passed by the bowels. Cases have occurred where this worm has
caused death, by perforating the coats of the stomach.

Both the ascarides and lumbrici have been found in a well near
Cork, and it was remarked, by Dr. Barry, if I mistake not, that the
inhabitants, in the vicinity, who drank the water, were very much
troubled with worms. Worms covered with coagulum were found
in the pulmonary artery of a dog, from one inch to ten or eleven
inches long: the dog sickened and died in ten weeks from the be-
ginning of the attack. No other cause could be assigned for his
death. {Wright London Lancet, American Edition, p. 351.)

154 An Inquiry into the Causes of Disease. [March,

Myriads of animalcules in lively motion have been seen in the
matter vomited from the stomach during life; also, in sanguineous
exudations of the gums and nostrils, and in the blood from the capil-
laries of the skin : they were considered a cause of disease. (Good-
fellow.) , ,

Raspail has no doubt that an insect is the cause of cholera, whose
location is in the lower part of the intestines. He also believes that
plague, yellow fever, cholera and malignant fevers ot every kind are
caused by parasites ; and also all cutaneous diseases. Linnseus con-
sidered the exhalations from the Pontine marshes to be organized
matter. Professor Harrison regards the cause of yellow fever to be
of an organic nature. (New-Orleans Med. and Surg. Journal.)
Donne has discovered in the pus of chancre, by the aid of the micro-
scope, animalcules which are constantly present, and which he re-
cards as the cause of the transmission of Jhe disease. (Annates de
Sciences Naturelles, series 2, vol. 6, p. 167.) The same author has
observed in the secretions around the glans penis, in cases of gonor-
rhoea, a species of vibrio; another subject inoculated with this pus,
produced a pustule from which a fluid escaped, abounding in the
same ammalculse. The same fact has been observed by Dujardin.
Hydatids may be classed amongst the organized causes that produce
disease ; the'y are always connected with serous membranes. They
are found in the abdomen and ventricles of the brain, and more fre-
quently in the liver, kidnev, and lungs, where they produce diseased
action of those viscera. The common color of hydatids, **"}*
yet they are occasionally seen of a light amber color. (Bailie.)
" On the inside of a hydatid smaller ones are sometimes found, which
are commonly not larger than (he heads of pins, but sometimes as
larcre as even a gooseberry. Hydatids of the liver are often found
connected with each other, but sometimes they have been seen to
enclose each other in a series, like pill boxes. The origin and real
nature of these hydatids are not fully understood ; it is extremely
probable, however, that they are a sort of imperfect animalcules.
There is no doubt at all that the hydatids in the livers of sheep are
animalcules; they have been seen to move when taken out of the
liver and put into warm water ; and they retain the power of mo-
tion for a good many hours after the sheep has been killed. 1 he
analogy is great between hydatids in the sheep and those of the hu-
man subject." (Bailie.) Thev have been found in the brain of a
sheep, and sometimes on the end of the cartilages of the eyelids, or
on the conjunctiva. (M. De St. Ives.) >

Klencke, of Brunswick, has shown that many contagious d.seases
owe their transmissibility to morbific cells which seem to possess a
semi-individual life. He has demonstrated the contagion of me lano-
sis in an experiment performed on a horse. Some of the cellules
found floating in a black pulpy mass of a melanol.c tumor were in-
serted beneath the skin, and the result was the production of a
growth similar to the original one. He also says that various con-

1846.] An Inquiry into the Causes of Disease. 155

dylomatous tumors, as well as ozenia, choriza, &c, are transmissi-
ble in the same way, and that cellules of a recent choriza are very
different from the confervae of ozenia, and that as the disease de-
clines, the cellules gradually disappear, and are replaced by sporules
or confervae. He further mentions that he has detected the morbific
cells of the malignant carbuncle in all the yellow colored discharge
that flows from the gangrenous sore; and he has detected those of
hydrophobia not only in the salivary glands of dogs affected with
rabies, but also in a wound caused by their bite. According to his
researches the proximate cause of vaccina and variola is the exist-
ence of morbid cells in the circulating fluid, and the severity of these
diseases is in general proportional to the number of cells developed.
"Ergot, secale cornutum, a fungiform growth, a disease of the secale
cereale, is occasioned by an insect which penetrates the grain and
feeds on its amylaceous parts, and leaves its poison in the parenchy-
ma. This poison is probably the larvae of the insect. Ergot has a
singular effect on the animal economy. The meal or flour sprinkled
on a wound, coagulates the blood, excites a heat, and then a numb-
ness in the part, and soon after in the extremities. Bread made from it,
produces intoxication, lassitude, a sense of something creeping in the
skin, weakness of the parts, with convulsions occurring periodically.
It produces a species of dry mortification, which commences in the
toes or fingers, and which gradually extends itself. It is called necrosis
cerealis, and has proved fatal in some parts of France." (Hooper.}
Dr. Wallace, of New-York, observes, speaking of ergot, it is probably
that the species of fungus* will vary with the plant, and that the va-
riety of the fungi will produce different effects; thus, the dust frora-
one kind of fungus or other parasite may produce yellow fever, from
another cholera, and soon. The same writer says parasites, then,
are the chief sources of disease.

Epidemics are frequent among silk worms ; they are attacked by
an epizootic fungus called muscardine. When a worm dies there
arises from its surface a multitude of minute fungi, whose roots bad
been previously spreading under the skin ; it then spreads sporules m
every direction, infecting all the other worms and other insects about
the establishment. (Audoin.) A form of the same disease, (spheria
entomorhiza,) is very destructive to the wasps in the West Indies,
and to those in our own country. (Carpenter.)

Fungi have been found in the air cells of the eider duck. (Des-
longchamps.)

In man all the vegetation yet discovered have been found connect-
ed with the matter effused into the textures in scrofulous constitu-
tions. (Bennet.) He remarks on the association of parasitic vege-
tation with tubercles; "the fungi found growing on the tuberculous
cavities of the lungs, and others discovered by Schonlin,and describ-
ed by Gruby, constituting scrofulous eruptions of the >kin, grew on
a finely granular amorphous mass, which presented no evidence of

* Acinula clavus, and by some considered the cause of the disease in rye.

156 An Inquiry into the Causes of Disease. [March,

organization." The fungi found by Rousseau and Serruneur in the
paroquet, grew on a species of false membrane. Pigeons are also
frequently destroyed by the same kind of parasitic vegetation.

According to the observations of Valentine the parasitic confervas
found growing upon fish are connected with the diseased state of the

inp^orosperms have been described by Muller, also the corpuscules,
noticed by the same naturalist, as constituting a peculiar disease ot
the swimming bladder of the gadus callurias.

Laurent has observed crvptogamic vegetations in the eggs ot the
Limax agrestis, which more or less impede the development of the
embryo ; and they may therefore be considered a cause of disease.
" Bennet gives an excellent account of the mucedo of favus, and has
illustrateuhis observations by some beautiful delineations, lhe
same disease has been found in the mouse.

Sycosis has recently been made the subject of research by Uruby
of Vienna. This gentleman has announced the discovery of a cryp-
too-amic plant developed in the root of the hair, in the form of sycosis,
towhich he assigns the designation mentagra contagiosum. In
harmony with the view entertained by Mr. Gruby, he suggests that
favus should form a new order with two other diseases of vegetable
origin: aptha and sycosis contagiosum. The itch of which I have
already spoken, affects horses and dogs as well as man ; but in each
case, the disease is produced by a different animalcule, although the
disease presents the same appearances. (Raspail.)

Epidemics amongst the lower animals, and amongst plants, are
governed by the same laws as those which affect man ; and as iar as
the subject has been investigated, the cause has been found to be
either animal or vegetable. .

The smut in wheat and other grains is known to be a species ot
fungus called puccinia. (Carpenter.) , r _ .

The rot in cotton is occasion^, by a minute fungus of the genus
spheria; which attacks the bowls. The rust in the same plant is also
a spheria, which attacks the root, permeating all the tissues of the
root, and lower part of the stem, cutting off nutrition from the upper
part, causing the death of the leaves, and finally of the plant. (Car-

rf)P7lt(5V I

The peach is sometimes attacked by a minute fungus of the same
kind, which is epidemic and often very destructive. (Carpenter.)

The disease of the potato which has created such havoc for some
years past in Europe, has been discovered in France to be a species
of the fungi. It is probable that the murrain, as it is called, that has
destroyed the potato crop in Ireland lately, is owing to the same cause.
(Carpenter.) There have been several remarkable epidemics this
vear affecting animal as well as vegetable life. In the spring we
were informed that the sea from Long Island to the A ineyard Sound
was filled with dead fish. Recently it has been stated that the ter-
rapins and fisb in the Dismal Swamp, North Carolina, were dying

1846.] An Inquiry into the Causes of Disease. 157

by thousands. In fact every kind of animal matter is subject to the
depredations of other animals ; some reside on the surface alone,
and do not produce disease ; some attack the skin, others penetrate
the tissues, producing various degrees of irritation. Some are con-
fined to certain districts, as the Guinea worm, chigger, &c, and others
abound everywhere. The varieties of organized matter or of ani-
malcules may be as great as the ever varying circumstances favor-
able to their production.

From the time of Hippocrates it has been observed that the at-
mosphere which produces malignant fevers, causes the production of
myriads of insects. And the myriads seen by the unassisted eye are
but as an unit when compared with the myriads on myriads which
are revealed by the use of the microscope, and of whose existence
man would never have dreamt without the aid of that instrument.
Errhenberg has determined that the smaller monads are near one
twenty-four thousandth part of an inch in diameter ; and he has es-
timated that there are Jive hundred millions of them in the space of a
cubic line, or drop of liquid which he examined. These monads are
the smallest of visible animalcules, and they have been spoken of as
constituting "the ultimate term of vitality." (Roget.) Without
the aid of the microscope some insects, millions of times larger than
a monad, would have been considered the ultimate term of vitality;
and there may be, and no doubt are, organized beings as many mil-
lions of times smaller than a monad as it is, compared with an insect
visible to the eye. The human mind can form no just conception
of the ultimate term of vitality any more than it can of the ultimate
molecule of matter. In either case there is a limit which we cannot
transcend ; but though man may find, from the finite nature of his
faculties a point beyond which he cannot extend his enquiries and
prosecute his researches, yet there is no limit to creative power, and
to the wonders of creation. The infusory animalcules, or infusoria
were so named by Muller, a Danish naturalist, from the circumstance
of their swarming in all infusions of vegetable or animal substances
that have been kept for a sufficient time ; it is to the microscope
alone that we owe our knowledge of their existence, and of the cu-
rious phenomena they present. (Roget.) Of these animalcules
there are innumerable varieties: monas, rotifera, cyclidium, volvox,
cercaria, kerona, vibrio, gonium, kolpoda, urceolara, vorticella, pro-
teus, volvoa globator, volvoa contlector, &c. The mode in which infu-
sory animalcules are produced and multiplied is involved in much
obscurity. Many distinguished naturalists adopting the views of
BufTon, have regarded them as the product of an inherent power be-
longing to a certain class of material particles, which in circumstances
favorable to its operation tends to form those minute organizations,
and in this manner they explain how the same organic matter which
had composed former living aggregates, 'on the dissolution of their
union reappear under new firms of life, and gives rise to the pheno-
mena of innumerable animalcules starling into being and common-

158 An Inquiry into the Causes of Disease. [March,

einga new, but fleeting career of existence. Yet the analogy of
every other department of the animal and vegetable kingdom is di-
rectly opposed to the supposition that any living being can arise
without its having been originally derived from an individual of the
same species as itself, and of which it once formed a part. The dif-
ficulty which the hypothesis of the spontaneous production of infuso-
ry animalcules professses to remove, consists in our inability to trace
the pre-existence of the germs in. the fluid where these animalcules
<ire found to arise, and to follow the operations of nature in these re-
gions of infinite minuteness.

The discoveries of Errhenberg relative to the organization of the
rotifera, go far towards placing these diminutive beings on a level,
both in structure and in function, with the larger animals, of whose
history and economy we have a more certain knowledge, and in su-
perseding the hypothesis above referred to for the explanation of the
observed phenomena. In many of these animalcules he has seen
the ova excluded in the form of extremely minute globules, the twelve
thousandth part of an inch in diameter. When these had grown to
the size of the seventeen hundredth part of an inch, or seven times
their original diameter, they were distinctly seen to excite currents,
and to swallow food. The same diligent observer detected the young
of the rotifera vulgaris, perfectly formed, moving in the interior of
the parent animalcule, and excluded in a living state, thus constitu-
ting them viviparous animals, as the former were oviparous. Other
species, again, imitate the hydra, in being what is termed gemmipa-
rous, that is producing gemmules, (like the budding of a plant,)
which shoot forth from the side of the parent, and are soon provided
with cilia, enabling them when separated, to provide for their own
subsistence, although they are of a very diminutive size when thus
oast off. (Rogetfs Ani. and Veg. Physiology, vol 2.)

However strongly, then, some mysterious facts may appear to sup-
port Buffon's fanciful theory, it is certainly untenable when we
consider the facts and striking analogies that can be arrayed against
the doctrine of an inherent power in material particles capable of
producing organic matter.

Aristotle speaks of an acarus which is engendered in old cheese,
{Journal des Progres des Sciences.) Of these acari or mites, Cuvier
observes they are oviparous, and excessively prolific. (Animal King-
dom, 3.) How then do the animals from which these ova spring, get
into the cheese, found as they often are, imbedded in the heart of a.
solid cheese, which would seem to be impervious to external agents ?
The organic matter from which they originated, must have been de-
posited in the milk from which the cheese was made. The same
remark will apply to those active little skippers, which are of the
color of the cheese, and have the same taste as cheese, and are
often found imheded, when they can have no connection with the
atmosphere or external agents. " The most mysterious circumstance
in the natural history of the Infusoria, is the susceptibility which

1846.] An Inquinj into the Causes of Disease. 159

some of them possess, of remaining an indefinitely long time, in a
perfectly dry and seemingly lifeless condition. The rotifer redevi-
rus, or wheel animalcule, which was first observed by Lewenhoeck,
can only live in water, and is commonly found in that which has
remained stagnant for some time in the gutters of houses. But it
may be deprived of this fluid, and reduced to perfect dryness, so that
all the functions of life may be completely suspended, yet without
the destruction of the vital principle; for this atom of dust, after re-
maining for years in a dry state, may be revived in a few minutes,
by being supplied with water- This alternate suspension and restor-
ation of life may be repeated, without apparent injury to the animal-
cule, for a great number of times. Similar phenomena are present-
ed by the vibrio tritici, and eel-like animalcule, which infests diseased
wheat, and which, when dried, appears in the form of a fine powder.
On being moistened, it soon resumes its living and active state.
(Riddell.) The gordius aquaticus, or hair-worm, which inhabits
stagnant pools, and which remains in a dry and apparently lifeless
state when the pond is evaporated, will, in a like manner, revive in
a very short time, on being again immersed in water. The same
phenomenon is exhibited by the filaria, a thread-like parasitic worm,
which infests the cornea of a horse. (RogeVs Physiology.) In the
Edinburg Encyclopedia, it is stated that the wheel animalcules have
been thus resuscitated from a state of dormant vitality, as many as
seventeen times in succession, and that the presence of sand is ne-
cessary in the fluid, or they will not revive. {Riddell.) Such facts
as the foregoing, are amply sufficient to explain those vital phenom-
ena, which would otherwise be to us both inexplicable and mysterious.
In no other department of animated Nature, are we presented with
such strange and anomalous modes of reproduction. Many of the
globular monads and vorticellae increase by spontaneous and equal
division. The living globule will, at first, appear as if encircled by
an equatorial band, which will continue to be drawn more and more
tight, until a complete separation occurs, each portion being an inde-
pendent monad, which in turn is bisected like its parent. In this
manner, a mysterious multiplication goes on indefinitely. The monas
uva consists offour or five corpuscles in a cluster, by the spontaneous
separation of which, the species is propagated. (Riddell.) "The
volvox globator consists of a spherical membranous sac, filled with
liquid, in which float many more diminutive globules like itself.
These have precisely the same structure as the enveloping membrane
even to containing within them a series of still minuter spherules.
Observers have thus seen the fifth generation in the same individual
animalcule. The gonium pectorale has an angular flattened body,
containing sixteen corpuscles, which subsequently become distinct
animalcules, like those in the volvox." (Riddell)

Bennett observed a curious being, provided with a beak, in an infu-
sion of hemp, which, fixing itself to some solid substance, assumes a
spherical form, and rotates irregularly until it bursts into four ani-

160 An Inquiry into the Causes of Disease. [March,

malcules. It is, indeed astonishing to observe, how short a time is
sufficient to bring these beings to full maturity. An infusion of beet
yields a species that increases by detaching obliquely, a small piece
of its own substance, which, after a lapse of a single day is also capa-
ble of propagating ; and the vorticella ramosa exercises the power of
reproduction, within a few hours only, after having been itself usher-
ed into existence. So far as investigation has been carried, this
proposition has been fairly established, that animal or vegetable food
is essential to every subject of the animal kingdom. It must, there-
fore, follow, if the proposition be universally true, that the infusoria
feed on organic substances; and it is probable that many of them
subsist on corpuscles more minute than themselves. Goeze has seen
the trichodim cimex, a bristly microscope creature, of an oval form,
seize upon and devour the lesser animalcules with great voracious-
ness. . -.

I have been spared much trouble and research by quoting freely, in
the two last pages, from an admirable treatise on miasm and conta-
gion, written in 1836, by Professor Riddell, and read before the Cin-
cinnati Medical Society.

It has been seen that the science of chemistry, relating to mere
matter, has never been able to develope the true causes of disease.

An inquiry has, therefore, been instituted to ascertain what light
animal chemistry, or physiology and chemistry combined, aided by
the microscope, can throw upon this interesting subject.

A great variety of cases has been brought forward, of diseases pro-
duced in a man, in animals, and in plants, by organized matter, either
animal or vegetable, and the facts are sustained by the highest au-
thority. This, at least, furnishes strong presumptive evidence, that
all malignant fevers attributed to miasm, or to animal effluvium ;
all the exanthematous, and in fact, all diseases whatever, except such
disturbances in the svstein as may arise from external injury, or the
internal administration of poison, and, perhaps, in a few cases, from
sudden and great changes of temperature, or any excessive indul-
gence of the appetite or passions, are produced by organized matter,
in some form or another.

It is a well established fact that in all parts of the world where
local circumstances exist to produce malignant diseases, there myriads
of insects abound ; and no doubt, for each one of those insects visi-
ble to the eye, there are countless series of myriads of animalcules,
which neither the eye nor the microscope can discover. As differ-
ent plants and animals are found in different climates and in differ-
ent countries, so, no doubt, different kinds of animalcules are gener-
ated according to local circumstances. Thus plague is probably
produced by animalcules peculiar to the valley of the Nile, and from
thence propagated to Smyrna, Constantinople, &c. As the cause of
cholera, we would expect to find another kind of animalcules in the
Valley of the Ganges, and the variety producing yellow fever, in the
yellow fever region ; and so on, with regard to every kind of maiig-

1846.] An Inquiry into the Causes of Disease. 161

nant disease of atmospheric origin, caused by what is usually called
malaria. No such disease is contagions, but all diseases caused by
human effluvium are more or less contagious. The animalcules,
then, that produce yellow fever, do not extend their influence beyond
the individual, who can never communicate it to another person;
but the animalcules that produce the contagious malignant epidemics
of the northern latitudes certainly extend their influence from one
person to another, either directly or indirectly; and the following
case goes far to prove that organized matter is the contagion itself.
I recollect to have read many years ago, an account of what is called
the Black Assize of the city of London. The prisons were very
much crowded with state prisoners; the malignant hospital or jail
fever broke out, attended with great mortality, (hi a certain occa-
sion several prisoners were brought out of the pestilential atmosphere,
and arrayed before the recorder and several assisting judges ; the
court room was crowded, and a window was opened to admit air.
All to leeward of the current of air that passed over the prisoners,
including the recorder, some of the judges, lawyers, jurymen and
spectators, contracted the jail fever, of which nearly all died.

Now the prisoners had not at the time, nor had they previously
had, the disease in question. They therefore could not communicate
to others a disease which they had not themselves, by radiating that
human effluvium which is the result of the disease. The disease,
then, must necessarily have been produced by the germs of the
animalcules that are the cause of the jail fever, which were on the
clothing of the prisoners, and carried from them by the current of air
to those persons who contracted the disease. And there is nothing
absurd or unreasonable in this supposition, when we reflect how in-
definitely small the atoms of this organized matter may be, and in
what an extraordinary manner its vitality may be maintained.

But the question may be asked, how does organized matter act on
the system? Inasmuch as parasites have been found in almost all
parts of the body, and which they could only reach by means of the
blood vessels, then it is evident that organized matter can make its
way into the blood vessels, and become developed in organs; and
let this be the answer to the question proposed.

We have now positive and varied proof that very many diseases,
attacking not only the human family, but animals and plants, are
occasioned by parasites, or organized animal or vegetable matter in
some or another form. Reasoning by analogy, it would be a fair
inference to suppose that all diseases, with very few exceptions, are
occasioned by a similar cause ; and especially, when there is no
shadow of proof or argument to establish any other doctrine.

Professor Riddell remarks: "Miasmatic poisons, when applied to
the animal system, generally require several days before the obvious
developement of any effect. This time, called the latent period, af-
fords a strong argument in favor of the organized nature ofthe poison ;
for ordinary poisons never delay their action so long ; whereas, if

11

162 An Inquiry into the Causes of Disease. [March,

contagion consists of living corpuscles like the ova of insects, or the
germs of plants, they would naturally require time for their develop-
ment and multiplication. "

It has been established by the experiments of Moscati and Bous-
singault, that organic matter exists in extremely small quantities in
the noxious air that hovers over marshes. Moscati, many years ago,
suspended in the air, over the rice grounds of Tuscany, a globular
glass filled with ice. An abundant deposition of dew took place
upon its surface, which, when collected, appeared at first to be pure
limpid water. There was soon, however, an appearance of little
flakes, possessed of properties peculiar to animalized matters, and
finally, at the end of some days, the liquid putrefied completely.
(Riddell.)

These facts arFtestimony directly to the point, and they are not
yet exhausted. In a memoir read before the French Academy of
Sciences, in 1834, M. Boussingault reports some striking experiments
tried by him at Cartago, in South America. In the middle of a
swampy meadow, in every instance, carbonaceous matter was detect-
ed in the dew, by the addition of sulphuric acid. He remarks :
11 The results obtained prove very clearly that in marshy places,
during the precipitation of dew, there is an organic matter deposited
with it." (Riddell.)

The following experiments made by Professor Riddell, " with a
view ofdetecting the aerial miasm of small pox," are so much in
point, and so interesting, that I should do injustice to the subject were
I to omit to quote them. The apparatus is thus described : A per-
fectly clean ounce phial was half rilled with distilled water; a small
glass tube, with a capillary orifice, was made to terminate near the
bottom, the upper and much larger portion of the tube bending hori-
zontally to receive the silver nozzle of a delicate pair of bellows;
several turns of gauze were passed around the mouth of the phial,
embracing the tube, and the whole was securely fixed in an appro-
priate frame-work. This apparatus was carried to the city* pest
house, and under the superintendence of Dr. Herron, it was placed
on a table two or three feet from a small pox patient, just in that stage
of the disease when the circumambient air was supposed to be most
contagious. The bellows were blown by the nurses pretty constant-
ly for twelve hours, thus presenting a great amount of noxious air to
the distilled water. The apparatus was left undisturbed until it came
into my possession, three days after, when I made the following ex-
periments.

1. One-fourth of a drachm of the water contained in the phial,
evaporated very slowly in a watch glass, over an alcohol lamp, left
concentric circles of a whitish substance. Upon bringing this residue
under the object glass of a good microscope, I discovered that it con-
sisted mostly of long crystals, which shot from each other at right
angles. The outer margin ofeach concentric band was less distinct-
ly crystalline, and evidently contained some other substance.

* Cincinnati.

1846.] An Inquiry into the Causes of Disease. 1G3

2. A minute drop of sulphuric acid, carefully distilled and collected
on a glass rod, so as not to leave the slightest trace when evaporated
from clean glass, was placed upon some of the residue. [Experi-
ment No. 1.] The application of heat rendered the acid black, and
upon complete evaporation a dark stain was left, thus showing the
presence of organic matter.

3. Upon adding a drop of pure sulphuric acid, to near an eighth
of a drachm of the water, and expelling the water by a careful heat,
the acid became black. This experiment, as well as the one which
follows, was performed upon a piece of Florence flask, rinsed in clear
water, and then heated to redness over an alcohol lamp, in order to
remove every trace of organic matter.

A drop of the water hastily evaporated, left a whitish residue, not
crystalline to appearance, but consisting of extremely minute grains.
Upon the application of a high heat short of redness, it became dark
colored, indicating the presence of organic matter by the charcoal
liberated. A still higher heat, in contact with air, removed the dark
color, and left a mere trace of white adherent powder.

These results compel us to believe, that organic matter was com-
municated to the distilled water by the air which was transmitted
through it. This matter did not exist in the air by virtue of its
volatility, else in the first experiment, it would have been dissipated
by evaporation. It was most likely in the form of organized corpus-
cles, sustained in the air by their exceeding small size. I have
quoted these experiments in detail, that others may know precisely
how to repeat them, and that doubters may have an opportunity of
fully satisfying themselves.

There is one more curious experiment, on snow water, by the same
author, which I think is worth while to transcribe: "In the winter
of 1833, I prepared several bottles of water, from clean, recently
fallen snow. They were tightly corked, and kept for three or four
months in the shaded corner of a room, where the water was not
liable to be frozen. At the expiration of this time, having occasion
to use some of the water, I observed that the lower portion of each
bottle was traversed by myriads of delicate dark colored fdaments,
bearing a close resemblance to some of the fresh water alga?. Upon
removing the cork, a most unpleasant odor was exhaled, similar to
that of animal putrefaction. No one, I presume, will doubt, that
the living germs of this curious organization came down from the
high regions of the atmosphere, in conjunction with the snow."

This experiment is interesting, because it shows how epidemics,
such as the cholera, for instance, can travel over the world, and it
accounts for the disease appearing in some countries, and leaving
others untouched ; as the living germs descended to the surface of the
earth, or were borne up to the higher regions of the atmosphere ; and
there is no other possible way of accounting for the erratic and ex-
traordinary course of that pestilence, when it last left the valley of
the Gun^e^ and passed over the civilized world.

164 An Inquiry into the Causes of Disease. [March,

It has been already observed that the celebrated naturalist Linnae-
us, considered the miasm of the Pontine marshes to be of an organi-
zed nature, and doubtless he was right, for how could the miasm of
the Pontine marshes be carried to Rome, eighteen miles, unless we
admit the existence of organized matter, in minute germs or corpus-
cles? Mere material atoms would be dissipated and scattered in
every directiou by the wind, before a sufficient quantity could arrive
at a point eighteen miles off, to produce disease; while a very small
number of minute corpuscles, having in them the germ of vitality,
and the power of rapid generation, would suffice to engender a pesti-
lence. With such facts and such authorities arrayed in proof of the
organized nature of the causes of disease, ami not justified in calling
upon the enlightened members of the medical profession, in all coun-
tries, to turn their attention to this subject, and to investigate it calm-
ly and impartially ? No one can deny that its claims are strong.
It is the true field of science, which invites our patient and persever-
ing researches, and where we shall not labor in vain. It is, at least,
the only one left, where with the present lights of science, we can
have any reason to expect success. In the discussion of this subject,
and in its elucidation, physiology and chemistry must go hand in hand.

Much confusion arises from the improper use of terms. We read of
remote, and predisposing, and exciting, and ultimate causes of disease,
and some authors call the first departure from the normal condition, the
proximate cause; thus confounding cause and effect. Liebig, in his
chapter on the theory of disease, says, " disease occurs when the sum of
vital force which tends to neutralize all causes of disturbance (in other
words, when the resistance offered by the vital force,) is weaker than
the acting cause of disturbance.7' This may be more clearly expressed
in fewer words, to. wit : whatever tends to disturb the equilibrium on
which the normal state depends, is a cause of disease. This is, no
doubt, true, and this disturbance of the equilibrium of forces, is the
first link in the chain of abnormal motions and symptoms. We want
but two causes to operate iu the production of any disease, under any
circumstances; and in many instances, one is sufficient. Any thing
that has a tendency to weaken the vital power the force of resist-
ance whether it be cold, or want of food, or vitiated food, or exces-
sive fatigue, or sensual indulgence of any kind, is a predisposing
cause of disease ; and that malaria which is in the atmosphere, be it
mere matter or organized matter, for it amounts to the same thing, is
the exciting cause of disease. Tims one man by prudence may re-
sist the cause of yellow fever, or cholera, while another by dissipation
so weakens the power of resistance in the system, that he falls an
easy prey to the devouring pestilence.

Liebig is right when he combats the opinion that putrefaction is
produced by the microscopic animals, and when he observes " the
presence of microscopic animalcules often perceived in such enor-
mous numbers in putrefying matter is not particularly to be wondered
at, since they find there the conditions of their nutrition and devel-

1646.] Spina-bijida, successfully treated, 165

opment. [London Lancet, p. 367.) It is to be regretted that this
distinguished physiologist and chemist has not written a chapter on
the causes, as he has on the theory of diseases. Whether the cause
of pestilence is of an inorganic nature, or whether it is organized
matter, is certainly interesting in a scientific point of view, but in
a practical point of view it is of comparatively little importance,
since the same condition of things that would produce malaria, js
equally favorable to the production of animalcules ; therefore what-
ever means may be employed to suppress exhalations from the earth
and from putrefying substances on the surface of the earth, would
equally prevent the generation of animalcules; they cannot be gen-
erated in pure air or in pure water.

In concluding this article, it is due to Prof. W. M. Carpenter to ac-
knowledge that the mass of information herein adduced respecting
parasitic animals, animalcules and organized growths, was kindly
furnished by him, he having for many years past, observed and col-
lected such facts, with reference to their bearing upon the origin and
causes of disease ; and it is much to be hoped that ere long he will,
over his own signature, give the results of his inquiries to the world.

My attention was first called to this subject in 1839 by Professor J.
L. Riddell, the first writer I have met with who has consistently advo-
cated the organized nature of miasm and contagion. [Western
Journal of Medical and Physical Sciences, March, 1834.) At that
time I entertained very different views; but after a fair examination
of the question, I feel pleasure in sacrificing early prejudices and long
cherished theories for what I believe to be the cause of science and
of truth.

Spina-b/fida, successfully treated by a new method. By Dr. Latil
de Thimecour.

The Gazette Medicale de Paris (29th Nov., 1845,) contains an in-
teresting article on Spina-bifida, by the above named physician,
accompanied by the details of the case we have translated and here
subjoin. It will be perceived that a formidable disease, almost inva-
riably fatal heretofore, has been successfully treated by a very simple
and ingenious method. Should the plan prove equally successful on
farther trial, it will add another to the many signally beneficial
achievements of modern surgery.

"Case. John TJ. Chaillou, born at Belleville (Rhone,) on the 1st
Nov., 1844, was presented to us in January following by his parents,
who had been told by various physicians that the ease was incurable
and would necessarily terminate fatally if any operation were attempt-

166 Spina-biftda, successfully treated. [March,

ed, and who sought less unfavorable advice beyond their vicinity.
Moreover, seeing that their child had lived two months, they deter-
mined to leave nothing undone to relieve their anxiety.

According to the mother, the child, otherwise perfect, was born with
a tumor, about the size of a small apple, on the rump, which the
midwife regarded as a mark, and therefore as unimportant. This
tiynor, at first soft and not tense, very soon filled with a transparent
fluid, and the mother on examining the child two days after his birth,
observed that he could not move his left leg, and that the foot of the
same side was so distorted that the heel touched the tibia, that the
toes were strongly flexed against the sole of the foot (varus equinus),
and that the leg was flexed against the thigh.

The tumor increased rapidly : it was moveable at its circumfer-
ence, was carried to the right or left according to the position of the
child, who cried out whenever it was moved or compressed. Although
his functions were performed regularly, he had lost much flesh, and
his countenance, otherwise interesting, indicated manifest suffering.
, At our first examination, the tumor was of the size of the head of
anew-born infant, was situated over the lumbo-sacral region, at the
junction of the sacrum and vertebra. It was attached to the verte-
bral column by a thick pedicle, longitudinally flattened, 52 millime-
tres (about 2 inches) in height, and covered with skin and cellular
tissue. By projecting the finger against the pedicle, it penetrated a
hiatus bounded by a bony crest; but during this examination the
child cried violently, and would be taken with convulsive movements
and paroxysms of suffocation, to such a degree that it was deemed im-
prudent to prolong it. The skin insensibly terminated on (he side
and towards the base of the tumor, the remainder of which was co-
vered with a thin transparent membrane, similar to that of a bladder,
with strice of apparently fibrous tissue, and bloodvessels recognized
by their color. The pouch itself was filled with a transparent and
slightly yellowish fluid, and so distended as to seem to be on the
point of being ruptured. On the left side of the tumor the remains
of a circular or umbilical shaped cicatrix could be observed. Was
this a real cicatrix resulting from a rupture of the sac at the time of
birth or during uterine existence, as in the remarkable case reported
by M. Berard, Sr., or in those represented by M. Cruveilhier in his
Anatomie Pathologique (16 liv.) 1

Under these circumstances, convinced of the great danger of open-
ing the tumor, and having seen two children succumb after it in the
Parisian hospitals, we determined to attempt an operation, after having
fully apprised the mother of the great improbability of its success.
We begged also a professional brother of Trevoux to aid us in the
attempt, which was to be made on the 20th of January.

Owing to the difficulty of procuring other instruments, we obtained
two rods of hard wood about a line thick and three inches'long, per-
forated at each extremity for the admission of ligatures. The tu-
mor was seized between these bits of wood, which were drawn to-

1S4G.] Spina-bijida, successfully treated, 167

gether by the ligatures until brought in contact at their extremities.
The tumor was then punctured with a trocar so as to give issue to its
contents, whilst by gentle pressure we endeavored to push back any
nervous filaments that might be floating in the liquid ; we now drew
together more firmly the bits of wood in order that the serous surf-i-
ces of the sac included between them might be completely brought
in contact; and finally, laid open the tumor freely with a bistouri.
Although the mortification and removal of the portions of the sac
situated externally to the compression, was what we desired, we think
this end more effectually attained by this species of ligature than by
a thread; for by this long and round instrument of compression, we
secured the important advantage of avoiding the crimping and
bruising attending the ordinary means. By this method the surfaces
are brought in contact in a straight line and under an uniform com-
pression, and will consequently unite more regularly and efficaciously.
This method is moreover similar to those devised by Dupuytren for
enterotomy,* and by Breschet for the radical cure of varicocele. It
is also an almost exact imitation of a plan still in use in many coun-
tries for the castration of domestic animals. Although it has been
denied that nerves have been injured by ligatures and by the knife in
certain operations for spina-bifida, such a denial cannot be made in
relation to the use of M. Breschet's forceps, as I myself witnessed an
instance of the kind at the Xeckar hospital in 1841, and as this
always occurs when the scrotum and testicles are made to slough off
under the compression of bits of wood.

In the case before us, the rods were applied immediately against
the vertebral column, closing the hiatus and supplying as it were the
deficiency at the same time that they maintained in apposition the
sides of the base of the tumor. This soon became livid, and the
child, who had not seemed to suffer much during the operation, for
lie only cried occasionally, passed the remainder of the day without
accident, without convulsions nor vomiting; lie took the breast as
u>ual and did not appear materially fatigued.

On the following day, I found that my patient had not slept well,
but had no fever; the tumor was purplish ; the opening made into it
was cicatrized ; the pouch contained a certain quantity of fluid and
its walls were considerably thickened. Tire rods were again tight-
ened.

22d January. The child has slept pretty well ; the tumor has
become black and has acquired its original dimensions from accumu-
lated fluid. I laid it open in its entire length, turned its lips over the
rods on each side, and tightened tiie ligatures anew.

23d. The mother thinks the child had a little fever and was
restless during the night. The patient's head perspires freely, and
secretion emits a very fetid odour.

21th. The parictes of the tumor are completely mortified.

T . , -. prior claim to this invention.

- N&LATOR,

168 Spina-bifida, successfully treated. [March,

25th. A slight diarrhoea has supervened, and the perspiration of
the head has diminished. I removed the gangrenous sac even with
the rods, and drew these still tighter. The surface to be bathed with
an emollient infusion.

27th. The child is very well; sucks well, looks better, and is
more cheerful than before the operation. The skin is deeply ulcer-
ated around the rods, and the pedicle included between these seems
to be perfectly dry and black. We now determined to remove them
cautiously ; but the ligatures at one end were no sooner cut and this
extremity of the rods slightly separated, than a jet of liquid suddenly
escaped from the centre of the pedicle and flew in our face. The
rods were immediately approximated and secured firmly. Thus at
the end of eight days, the opening of communication between the
pouch and the spinal canal was not yet completely closed, nor had
the serous walls adhered perfectly, for there was still an orifice in the
very centre of the pedicle. In order to facilitate this occlusion, we
thought at first of using a few stitches, of passing needles or pins
beneath the rods, according to the method used by M. Bonnet (of Ly-
ons) for the radical cure of hernia and varices; but, on reflection,
we concluded to leave the matter to nature, simply making the com-
pression of the rods more perfect.

28th. The child slept badly; his head again'perspires abundantly,
and he has slight diarrhoea.

30th. Is pretty well ; the rods are moveable ; the skin deeply
ulcerated around them ; a large membranous and flabby pedicle is
seen at the bottom of the ulceration; the constriction is continued
and the rods made fixed with a bandage.

1st February. Child continues to do well ; the rods now hold only
Ijy a membranous pedicle, the remains of the internal parietes of the
sac which were doubtless formed by the protrusion of the vertebral
membranes through the apperture of the spinal canal. This pedicle
was carefully included in a ligature, beyond which it was clipped off*
with scissors, and the gangrenous portions removed along with the
rods. An oblong and pretty extensive wound, of good aspect, was
thus exposed, which we dressed with lint and cerate.

5th. The wound has diminished in size considerably, and the
ligature has come away. The child no longer cries when handled, is
cheerful, sucks heartily, and may be placed on either side and
even on the back without evincing pain.

12th. The child is in fine health, and the mother may return
home. The wound is reduced to the size of a franc piece,* is cover-
ed with healthy granulations, and presents no trace of the membrane
or tumor. The skin in the neighborhood is smooth. The left side
which had been evidently depressed by the tumor is rapidly filling
up; but, what is especially important, the alvine and urinary evacu-
ations have been for some days effected with perfect regularity and
without pain, whereas these functions were always attended with

* A coin about three-fourths of an inch in diameter. Thans.

1846.] Cases of Fever, with Remarks. 169

pain prior to ihe operation. The paralyzed limb executes move-
ments yet imperfect, but the child has been seen to carry it across
the other leg, which he had never done before.

In five days more the wound was entirely healed, and six months
after the cure, the child was presented to the Society of Medical
Emulation of Lyons, at its session in the last week of July, 1845;
and carefully examined by all the members present. It was then
ascertained that the child, now more than nine months old, was as
well grown as children of that age are usually ; that there remained
no appearance of tumor along the spine; that a very slight cicatrix
was discernible over the junction of the last lumbar vertebra and sa-
crum, beneath which a slight depression was felt that allowed the end
of the finger to rest on a resisting medium probably the cartilaginous
deposit preceding the final ossification of the vertebral aperture.

The lower extremities were of eo^al strength and volume, the flesh
of the left more flabby than that of the right, and the left foot was still
turned as heretofore stated. The position of the foot could, however,
be rectified with much less efibrt than before the operation. When
we bent the leg. the child would extend it himself, but he could not
flex it. The thigh could be moved in all directions, but had a mani-
fest tendency to lie across the opposite one.

This case is interesting, inasmuch as the success was as complete
as could have been desired, and that it was attended with no accident,
save that of the 8th day, which experience has taught us to avoid
hereafter ; that the patient suffered neither convulsions, fever, syn-
cope, nor any of those accidents that have occurred in nearly all the
cases operated on by other methods, and without any impairment of
his usual functions. These results we think may be attributed to
our mode of operation, and we appeal to experience to substantiate its
merits." D.

Cases of Fever i with remarks. By J. R. Buck, M. D., Lecturer on
the Theory and Practice of Medicine in the Louisville Summer
School of Medicine. (From the Western Journal of Medicine
and Surgery.)

D. K., set. 27 years, very robust, strictly temperate, ship carpen-
ter; health perfect till the fall of 1941, when he first came to Louis-
ville, since which time fte has had several attacks of mild intermittent
fever. In May, 1844, I attended him several days during a slight
attack of bilious fever. In July following I again prescribed for
him for chills and fever.

On the 14th of August, 1844, was called to see him ; attack com-
menced two days previous with alternate flashes of heat and chilliness
continuing all day. 13th. Had slight but distinct chill, followed by
considerable fever. The morning of the 1 lth I found him with

170 Cases of Fever, with Remarks. [March,

slight fever ; dull headache ; anorexia ; no nausea or vomiting ; not
the slightest pain or tenderness on pressure over any part of the ah-
domen ; pulse rather frequent, and compressible. Bowels loose from
Lee's pills taken on the 12th. Tongue coated with a dense brownish
fur. R Calomel and Dover's powder.

15th. 8 o'clock, A. M. More fever, with much more tenseness
and fulness of pulse. Bled to 16 ounces. Calomel and Dover's
powder repeated.

16th. No fever; in all respects better; some little tympanitis;
bowels still too loose. R Quinine grs. x, opii gr. i, to be taken at
one dose ; after which was very comfortable until 12 o'clock at night,
when fever with delirium came on ; frequent copious watery dejec-
tions during the night ; no tenderness over the abdomen.
. 17th. Dr. Gross called in consultation. Blisters covering the
abdomen ; calomel and quinine iia grs. v ,morphiae acetat. grs. ii, to
be repeated every four hours, until the watery dejections ceased.
The only effect of this prescription, which Mas repeated several
times, was to produce free bilious evacuations, still, however, very
watery. No sudamina. No peteehiae, or rose colored spots upon
any part of the body. No sordes. Tongue became red and clean ;
sense of hearing impaired.

Died on the 20th; constant noisy delirium for IS hours previous.

Examination seven, hours after death. Rigidity of limbs ; no
unnatural appearance of the body. Brain not examined. Chest,
perfectly healthy throughout. Abdomen, very slight inflammatory
redness in cardiac extremity of stomach ; also same in duodenum.
Jejunum healthy. In lower part of ilium seven patches of of Peyer's
glands ulcerated, with slight inflammation of the mucous membrane
between them. Ccrxum larger than natural ; whole internal lining
membrane in a high state of inflammation, with numerous patches
of a greenish yellow lymph upon it. Colon healthy. Rectum, in-
tense inflammation, with some greenish yellow lymph. Spleen two-
thirds larger than natural, and much softened. Liver and Kidneys
healthy.

Case II. J. H., set. 20, ship carpenter, stout, robust, habits good,
generally healthy. In July, 1844, had erysipelas of face and neck,
mild, yielding in a few days to laxatives, with argon, nitrat. as an
external application.

August 31st, 1844. Called to see him; had been slightly indis-
posed for two days; some fever; very slight pain in the lower part
of the abdomen upon firm pressure ; tongue Covered with a brownish
coat; pulse 88, moderately full : three dejections in fifteen hours,
thin and light colored; some little nausea, with occasional vomiting.
R. Leeches to lower part of abdomen ; calomel and opium.

September 1st. Pulse more frequent, more volume; pain over the
eyes; skin dry and hot; bowels still loose. Bled to 16 ounces.
Calomel and opium repeated.

2nd. Some better; pulse reduced in force and frequency; skin

134G.] Cases of Fever, with Remarks \ 171

moist ; no pains ; discharges from bowels more frequent, but of dark
bilious color ; no abdominal tenderness. R blister to lower part of
abdomen, calomel and quinine ciu grs. x , morph. grs. ii., to be given
every three hours. Under this prescription the patient for two days
seemed to improve: the discharges from the bowels being less fre-
quent. On the third day, the discharges became much more
frequent and tinged with blood. The morphia was now increased to
four grains every two hours without at all altering the condition of
the bowels or procuring a moment's sleep. Mercurial inunction had
been resorted to, but without producing any sensible effect. Mus-
tard poultices to the extremities. Carb. ammonia, wine whey, and
brandy toddy were all given.

Died on the 8th ; intellect clear to the last. No post-mortem ex-
amination.

Case III. J. P., aet. 30, tall, not very muscular, ship carpenter,
habits good, lived in same room with case 2nd; taken sick at the
same time, and with symptoms so analogous, that one prescription
answered for both. This almost identity of symptoms, and conse-
quently of treatment, continued until the fourth day, when in case
3rd a profuse hemorrhage from the bowels (two quarts, according to
the nurse's estimate) occurred ; the patient was much prostrated by
this discharge of blood. A little brandy toddy was given Occasion-
ally for six or eight hours, when quinine and morphia in very small
doses were prescribed, and continued several days. On the eighth
day discharged half a pint of blood from the nose. Discontinued
attendance on the tenth day ; convalescence dating from the first
haemorrhage.

Remarks. In the three cases here reported we hare a type of fe-
ver prevailing, more or less in the latter part of every summer and
fall, ia Louisville anrl its vicinity. The particular locality in which
these cases occurred (near the ship yard) is especially subject to this
form of disease. Two causes may be assigned for this. 1st. The
situation is low and flat, subject very rarely to overflow, but after
every rain remaining very damp, with several large ponds of
water upon it for weeks; this low land extends half a mile back of
the ship yard to Beargrass creek, which empties into the Ohio river
at the city steamboat landing. Unless the season be unusually wet,
this creek is little less than a chain of stagnant ponds, into which
much filth is thrown from tan-yards and slaughter-houses. 2ndly.
The very great increase in the boat building of this city, and the
consequent demand for ship carpenters, attracts every spring a large
number of men from the most healthy portions of Ohio, Pennsylvania,
New-York, &c, and who of course are entirely unused to our cli-
mate. Cases 1st and 2nd, were from Elizabethtown, Pennsylvania ;
and case 3rd, from Maine. This disease, however, is by no means
confined to this locality ; it occurs occasionally in the densely popu-
lated part of the city in Jeffersonville, Indiana, on the opposite bank
of the river, and is very com non indeed in the surrounding counties.

172 Pneumonia in Chidren. [March,

Does it differ at all from the ordinary autumnal remittent fever,
as it has prevailed throughout the West and South for the last few
years, or the last half century, at particular seasons? Let the read-
ers of the Western Journal answer.

I have thought that a detailed account of a few cases might be
instructive as throwing some light, not upon the cause of fever per-
haps, but upon those structural lesions which are the immediate cause
of death, and thereby leading to a more rational and more successful
treatment. The most interesting points in their histories, are the
entire absence of pain upon pressure over the abdomen in one, and
the very slight pain in the other two, notwithstanding the intense and
extensive inflammation in the organs of this cavity ; and the little
influence that opium and its preparations had in controlling the dis-
charges from the bowels. That the same lesions were present in
the two last cases, which dissection revealed in the first, there can be
no doubt ; the close analogy between the symptoms in all these cases,
and the identical effects of the same remedies, would alone be suffi-
cient to prove it; but again, in case second there was slight hemor-
rhage from the bowels, and in case third it was most profuse, pros-
trating the patient very much, and caused in all probability by the
sudden rupture of a blood-vessel from ulceration. What practical
deductions are to be drawn from these cases ? 1st. That absence of
pain or tenderness upon pressure over the abdomen, is not inconsist-
ent with the most extensive inflammation and ulceration of the bow-
els. 2nd. That as in case third a decidedly favorable change dated
from a veiy copious hemorrhage, when the pulse did not seem at all
to indicate the loss of blood ; therefore free depletion, either general
or local, would promise benefit in such cases, and the pulse cannot
be relied upon as an infallible guide. 3rd. That the liver is healthy,
secretinc bile with its usual energy, and as sensible to the action of
its appropriate stimulus, mercury, as in perfect health ; that therefore
large doses of calomel for the purpose of acting upon this organ are
not indicated, and productive of no benefit. 4th. That we cannot
hope by the largest doses of opium and its preparations to arrest the
discharges from the bowels until, by depletion, the inflammation is
relieved.

Pneumonia in Children. By R. J. Graves, M. D. (From the
Medical News.)

The next case to which I shall call your attention is that of J.
Duffy, a little boy, who, on the first of this month, was attacked
with symptoms of fever followed by thirst, nausea, and vomiting.
On his admission, six days afterwards, we found him complaining of
headache and sleeplessness, but the fever, thirst, and abdominal
symptoms had disappeared. The weight of the disease seemed to

1846.] Pneumonia in Children. 173

have fallen chiefly on the respiratory system, for he had loud, hard,
incessant cough, increased by motion, a suspicion of the existence
of pneumonia struck me, and on applying the stethoscope under the
right scapula, I found extensive dulness, absence of the respiratory
murmur, and crepitus. Overall the rest of the thorax respiration
appeared to be clear and natural, but here, instead of the clear
sound, we had nearly complete absence of respiration, with slight
crepitus. The disease was therefore fever complicated with exten-
sive inflammation of the posterior-inferior part of the lung.

Now inflammation of the parenchyma of the lung, when it attacks
children, presents some remarkable points of difference from the
same disease in the adult.

I am not at present prepared to enter upon an explanation of the
pathological differences which exist between the pneumonia of in-
fants and children below the age of three, and children above that
age; certain it is that important differences do exist, and that also
inflammation of the lungs in adults is essentially different from both.
Again, in persons advanced in years a fourth variety of pneumonia
occurs, whose features are very characteristicand peculiar. Observe
gentlemen, when I assert that inflammation of the lungs assumes
different characters, according to the age of the individual attacked,

T

I am touching on a practical point of the greatest importance, for I
have no hesitation in adding that the same mode of treatment is not
applicable to any two or three varieties of pulmonary inflammation.
Thus mercurial salivation rapidly produced is our sheet-anchor in the
pneumonia of adults and persons in the vigor of life, but such a me-
thod of treatment cannot be applied either in infants, children, or in
old persons. Again, in the pneumonia of children above three years
old, nauseating doses of tartar emetic, perevered in with judgment,
and combined with bloodletting, leeching, blistering, &c, are chiefly
to be relied upon, whereas in infants a perseverance in the exhibi-
tion of tartar emetic for more than one or two doses is inadmissible,
while minute doses of calomel, ipecacuanha, and chalk, exert a most
beneficial influence on the complaint. In infants, too, there must
be much more caution exercised with respect to the detraction of
blood ; but, gentlemen, I find that, this subject has not yet been ex-
amined with that attention it deserves, and that consequently we
cannot lay down generol rules for your guidance. Certain I am that
much remains still to be done concerning the best means of treating
inflammation of the lungs according to the age of the patient. A
very good foundation for the pathology of this disease in infants and
children has been laid down in an essay by Gerhard, which you will
find detailed in a former number of the Dublin Medical Journal.

In the case before us there were some circumstances worthy of
remark, as being calculated to make a false impression, and to pre-
vent us from following the only mode of treatment likely to produce
relief. There was no febrile action present, and the pulse was only
72, soft and regular. There was scarcely any heat of skin, the bow-

174 Pneumonia in Children. [March,

els were natural, and he had some appetite ; the only circumstances
indicative of general disturbance of the system were some foulness of
tongue and want of sleep. Here the state of the pulse and skin,
with the absence of fever, would be likely to mislead the practitioner,
and cause him to overlook the real nature of the disease. I need not
tell you, that this would he a very important error ; the spontaneous
efforts of nature would be totally inadequate to its removal, and it
would in all probability terminate fatally.

You may perhaps ask, whether the state of pulse, observed in this
boy, be a good or bad sign. If we look to nosological arrange-
ments, we shall find that pneumonia is generally accompanied by a
strong quick pulse, in fact that this is its natural condition under such
circumstances, and therefore we should say that the slow and tran-
quil state of the pulse in this case, was not a good sign. But my
impression is that, c ceteris paribus, the quieter the pulse in pneumo-
nia, the better. It indicates a disease of less violence, and much
more amenable to treatment. The worst cases I have seen, all those
cases of young and healthy individuals which terminated fatally in
spite of active treatment, were cases characterized by high excite-
ment of the circulation, and where bleeding, leeching, and tartar
emetic failed in overcoming the hardness, or abating the velocity of
the pulse. Thus in a case which I saw with Mr. M. Colles, and
where the patient was a powerful strong man, bleeding after bleeding
failed to diminish either the frequency or the hardness of the pulse,
neither did the most energetic measures in the slightest degree seem
to check_pr even retard the progress of the inflammation, which, pro-
ducing a rapid hepatization of one portion of the lung after another,
soon proved fatal; so great was the arterial action in this case, that
all the superficial veins of the hand had a distinct pulsation commu-
nicated to them. On the contrary, when the pulse is soft and slow,
the disease, though likely to be latent, and thus give rise to error, is
generally under the influence of ordinary treatment. Wherever
the pulse remains quick and hard after the employment of free anti-
phlogistic treatment, your prognosis should always be doubtful if not
unfavorable.

In treating this boy's case I diaViot order general bleeding, for no
matter where the inflammation maybe situated, if it has no effect on
the general circulation, if it be unaccompanied by increase of pulse
and heat of skin, you may dispense with venesection, for it will not do
any good. Here your means of treatment should be cupping, leeches,
blisters, and the internal use of antiphlogistic remedies. I have or-
dered this boy to be leeched and blistered ; and to take small doses
of mercury. I beg leave to observe here, that in exhibiting mercury
for pneumonia in children, or boys under the age of puberty, I do
not, as in the case of adults, prescribe it in large doses^pr with the
view of producing a decided action upon the system. In the pneu-
monia of adults, calomel is given in very large doses (I sometimes
give it in scruple doses twice a day), with the view of inducing sud-

1846.] Pneumonia in Children. 175

den salivation, because we know from experience, that there is
nothing which checks so rapidly the progress of inflammatory action.
It is true that mercury will occasionally stop the further progress of
pleuritisor pneumonia without having affected the mouth, just as we
now and then observe the removal of syphilis without actual saliva-
tion. But, generally speaking, when you give mercury to cure syphi-
litic iritis, common pneumonia, or pleuritis, its action is more favora-
ble and more decidedly curative, when it operates fully on the system,
as denoted by the affection of the breath, gums, and salivary glands.
This, however, is not the case with respect to children or boys under
the age of puberty. Mercurialization has not the same beneficial
influence on the pneumonia of early life, as at the adult period, and I
believe the same remark will be found to hold good with respect to the
aged. Certain it is, that in very young children and infants it is scarce-
ly possible to affect the gums, mouth and salivary glands, in fact to
establish a true sore mouth and fetid breath by means of mercury ;
with respect to the aged I cannot affirm positively, that the same
observation applies, but this I know, that large doses of mereury,
calomel for instance, do not cure inflammations in old people with
anything like the certainty they display in the inflammations of
young adults, or of the middle aged. In the present case I have
given calomel in small doses, combined with ipecacuanha. It is my
intention to carry it so far as to affect the system, and I have com-
bined it with ipecacuanha because its administration in this way has
been found exceedingly useful in the bronchitis and pneumonia of
children. We attempted here the resolution of the pneumonia by
leeching, blistering, aud antiphlogistic regimen, and the use of calo-
mel and ipecacuanha, half a grain of the former and a quarter of a
grain of the latter, every fourth hour. This acted twice on the
bowels, and it is very probable that this soluble state will continue.
Yesterday I ordered eight leeches to the chest, and when the bleeding
ceased, eight more wore to be applied. To-day, I have ordered
twelve more. When you apply leeches to the chest in children,
you should not rest content with merely ordering them, you should
know how they arc applied. There is a vast difference between
merely prescribing remedies and seeing them properly employed. It
too often happens that this powerful means of checking inflammation
is rendered inefficient or even injurious by want of attention on the
part of tiie physician. The leeches are ordered and sent from the
apothecary's, but they are applied by an inexperienced mother or a
bungling nurse. They are put on one after another anywhere they
may chance to take, very seldom over the proper place, and during
the whole time they remain on, the child's chest is left quite naked.
This needless exposure of the chest is further increased by the habit
of applying fomentations after the leeches have dropped off; the
child gets fresh cold, and when the physician comes next day, he
finds matters worse than before. The best way of applying them is
to put them into a small box made of fresh deal shavings, such as is

176 Remarks on Indian Diseases and Remedies. [March,

sometimes used for pill-boxes, and place this exactly over the inflamed
part. Having thus applied them over a circumscribed space, you
may draw the bed clothes gently over the child's chest, and he may
remain covered until they are about to drop ofT; instead of fomenta-
tions, order a warm dry sheet or large piece of flannel to be placed
over the chest, and in this way you will be able to get a large quan-
tity of blood without exposing the child to the risk of cold. You
may perhaps think these observations unimportant and even superflu-
ous, but I am convinced that I have seen lives lost for want of proper
care and expertness in the performance of an operation apparently
so easy.

Remarks on Indian Diseases and Remedies. By Wm. Winder,
M. D., of Montreal. (From the British American Journal.)

Although the Indians, being without the advantages of science to
guide them in their choice of remedies, and treatment of diseases,
derive their principles from mere experience, it is certam that we are
indebted to their Materia Medica for many valuable articles of a
vegetable kind ; it is as certain that they are frequently successful in
their adaptation of these to complaints of a formidable character.
One of the remedies in great use amongst them is the Geranium
Maculatum, which many eminent physicians of the United States
rank as one of the most powerful vegetable astringents, being princi-
pally composed of tanin and gallic acid. In the second stage of
dysentery and diarrhoea, after evacuants; in hemorrhages of the
alimentary canal ; and as a styptic in external bleedings, it rarely
fails of giving relief. Its dose is from gr. x. to 3ss. of the powder,
or 3ss. to 5j. of a decoction made with Rad. Geranii., 5j, Aquoae
ferventis lb. ss. With the Indians it is a favorite external styptic,
the dried root being powdered and placed on the mouth of the bleed-
ing vessel. It is also much used by them as a wash in Leucorrhea.
Internally, in doses of half a teaspoon ful in cold water, they consider
it very efficacious in hcemoptysis, and in this opinion, they are fully
sustained by Thacher, Mease, Bigelow, and others.

The Xanthoxylum Fraxineum, or Prickly Ash, is one of the most
valuable remedies of the Indians for the cure of rheumatism. It is
said to resemble guaiacum in its properties, and is much used by the
Americans as a remedy in chronic rheumatic complaints, and partic-
ularly in cases of a syphilitic taint. Bigelow says he gave the bark
of this shrub in closes of ten and twenty grains with great advantage.

An excellent tonic is the Xanthoriza Apifolia, its composition
being principally resin and gum, and the taste intensely bitter. The
dose is 3ij. of the powdered root. The Indians administer it as a
diuretic in dropsy, and also use a cold watery infusion for sore eyes.

A favouri.te and well known remedy with the Aborigines is the

1846.] Remarks on Indian Diseases and Remedies. 177

Eupatorium Perfoliatum, having the familiar names in the United
States, of Boneset, Crowswort, Tboroughwort, &e. [is taste is in-
tensely bitter, with a slight astringencv, but no acrimony, and its
operation is tonic, sudorific, cathartic : according to the mode ot its
exhibition. It is given in cold infusion in intermiitents, continued
fevers, and inflammatory diseases, to produce vomiting and catharsis
in hot, infusion, and as a tonic in substance. In the United Slates
Pharmacopoeia, there is an officinal formula Infusum EtipatorU. The
natives administer it with good effect in fever, and as a common
drink in acute rheumatism, pouring a quart of boiling water on two
drachms of the leaves, and drinking about three ounces three times
in the day.

The Cornns Florida, Dog wood, is snid to differ little in its chem-
ical composition from the Peruvian Bark, and Dr. John Walker
states, that of all the indigenous tonics, this is the most beneficial in
intermittents. Thirty-five grains of Dog wood Bark are said to be
equal to thirty grains of cinchona. The Indians use a decoction of
small branches and buds, in want of appetite, and debility of the
stomach. It is valued also as a poultice to correct ill-conditioned
sores.

The PoJygala Senega is too well known to need description. It is
much used by the Indians, who give it in cold infusion during the
remission of fevers, attended with great prostration of strength, and
in diseases of the pulmonary organs. Thev also esteem it highly in
female complaints, and in this agree with Dr. Chapman, who consid-
ers it the most efficacious emmenagogue, and useful in all forms of
amenorrhoea.

It is not a little remarkable, that among all the Indian tribes known
to Europeans, the production of increased perspiration constitutes one
of their principal remedies. A favorite and universal mode of pro-
curing this is, the use of the vapour hath, and the construction of this
is similar throughout the different nations of the North West. Mr.
Cormack, in his account of his expedition tp discover the aborigines
of Newfoundland, or Red Indians, says, that he discovered, in a de-
serted village, the remains of a vapour bath. The method used to
raise the steam was by pouring water on large stones made very hot.
Over these are a hemispherical-frame work, closely covered with
skins, was placed to exclude the external air. The patient then crept
in under the skins, with a birch rind bucket of water, and a small
bark dish to pour the water on the stones, and thus enable him to
produce the steam at pleasure. He remains as long as the heated
rocks retain heat sufficient to raise the vapor, when he retires, wrap-
ped in a robe or blanket, and goes to bed. The bath is principally
Used in rheumatism, dropsy, and the cold stnge of fever. Warm
sudorific infusions are taken in the bath, and the debility induced is
sometimes so great that the patient faints, which, however, followed
by proper treatment, generally has a beneficial effect.

Ihave said that the Indian is guided by experience in his treatment

12

178 Remarks on Indian Diseases and Remedies. [March,

of disease. For example, when suffering from acidity of the stom-
ache, he takes some of the absorbent earths that are found on the
banks of the rivers. Bleeding in their inflammatory diseases is also
much used. But the simple native of the forest does not employ the
former from any knowledge he possesses of the principles oi chemis-
try, nor the latter from any acquaintance with the laws of physiology.
We, on the contrary, when a few grains of soda are taken to effect
the same object, shew our learning, and sometimes our pedantry, by
explaining that, as the soda contains an alkaline principle, the acidity
of the stomach is neutralized by its administration, and a purgative
salt being formed, in some measure, by the combination, the double
purpose is thus effected of a corrective and an aperient; whilst the
bleeding lessens the momentum of the circulation, and checks inflam-
matory action. Still the results are the same. The uncivilized
man gropes his way in the dark, and though we are led by the light
of the lamp of science, each attains his object by the same means.
Their remedies must necessarily be simple inordinary cases, consist-
ing chiefly of warm infusions, powdered barks, roots, and leaves. A
modern writer states, that in their febrile diseases, they make the
state of the skin and bowels the guide by which to regulate their
practice. When the skin is moist for a considerable time, and the
thirst ceases, they say there is no danger. When the evacuations
from the bowels become less offensive, and change their colour, the
tongue becoming clean, they stop purging and diaphoresis. If there
is great debility, they commence giving tonics, which are commonly
bitters. Should these induce costiveness or a return of the fever,
evacuants are again had recourse to. There is something so ration-
al, and yet so simple, in all this, that I hardly think we should find
any thing to improve upon it in Sydenham, or Cullen ; and, as the
great Boerhaave tells us, that "simplicity is the seal of truth," pro-
bably here is as much practical, unsophisticated truth, as will be
found in the elaborate treatises of ancient and modern professors.

That they are acquainted with the mode of relieving inward pains
by treatment similar to the moxa, is seen by their burning a piece of
touch-wood over the pained part, and suffering it to produce a blister.
They are also aware of the advantage of relaxing the muscles in dis-
locations, for in cases where they do not succeed readily, they nau-
seate the patient to a most distressing degree, and then find very
little difficulty in reducing the luxation. Tumors and abscesses are
allowed to suppurate, generally, without any application to them.
When much inflamed and painful, plasters of bruised herbs, or warm
fomenting poultices are used. If matter forms, they make an incision
for its escape, and continue the poultices to promote the discharge.

The subject of Indian diseases, and remedies, affords much matter
interesting to the philosophical inquirer, particularly as to their
mode of treating the more formidable complaints of Dropsy, Rheu-
matism, Syphilis, Pulmonary Consumption, and Asthma, in which
they are sometimes very successful.

1846.] On the Medical Treatment of Dyspepsia, 179

The space I have now occupied warns me to conclude for (he
present, but having received, through the kind attention of Mr. Var-
don, chief clerk in the Indian Department, a copy of the Sick
Report of the Indians, for the year 1844, I hope to make it the sub-
ject of a future" communication, with some observations on the dis-
eases above mentioned.

On the Medical Treatment of Dyspepsia. By Tiio3ias Barbour,
M. D., Professor of Obstetrics, &c, in the Medical Department
of Kemper College, St. Louis, Mo. (From the Missouri Medical
and Surgical Journal.)

As dyspepsia is a most painful and afflicting malady, the unfortu-
nate subjects of which, are but too often doomed, under the ordinary
modes of management, to endure a bodily and mental distress,
which renders life hateful and undesirable, any suggestion which
might conduce to its relief, should be acceptable to the profession.
Dr. John Mcintosh remarks, that, " the physician, to be able effectu-
ally to treat this affection, should have suffered from it himself; as
one who has had the good fortune never to feel as if he had a stom-
ach, can scarcely believe or listen to the complaints of those who
have experienced that sensation." Having had sad personal experi-
ence, and having had the gratification of affording relief to many
sufferers by the means which proved so beneficial in my own case, I
desire to make known the plan of treatment which I pursue, and
which I feel justified in recommending as eminently successful.

It is not my design to enter into the regular consideration of the
symptoms and pathology of dyspepsia, which has been so ably and
elaborately discussed in late treatises on the subject, but I will as-
sume that the affection usually presents itself under two forms:

1st. Functional, of which there are two principal modifications :
first variety I would designate nervous, and is characterized by great
morbid sensibility of the nerves of the stomach, evidenced by very-
acute pain, which is frequently paroxysmal in its character, associ-
ated with most of the ordinary symptoms of dyspepsia. Second
variety of functional form, I would call atonic, and is characterized
by atony of the mucous membrane and muscular fibres of the stom-
ach, and a moderate degree of nervous irritation.

2d. Organic, characterized by the ordinary signs and symptoms of
chronic muco-gastritis; the most prominent of which are epigastric
tenderness, and tongue furred, and slightly red on the tip and edges.

In the first variety of the functional form, I administer the follow-
ing combination : 1st. R. hydrarg. prot. iod., 15 grs., ext. rhei, J
dr.; ext. byoseiam., 1 dr., made into 30 pills, of which I give one or
tw# every night, or every other night, to regulate the bowels, and
improve the biliary secretion. If the bowels be torpid, I substitute

180 On the Medical Treatment of Dyspepsia. [March,

the compound ext. of colocynth for the ext. rhei, in the same pro-
portion. 2d R Bismuth sub. nit., 2 drs. ; morph. aeet., 3 grs., made
into 30 pills, of which I give two or three, morning, noon and night.
If t!ie pill form is disagreeable, I order the above to be made into 12
powders, of which one may be taken thrice daily.

The sub-nitrate of bismuth is highly recommended by the best
writers on the Materia Medica, in many of the chronic derange-
ments of the stomach, especially in dyspepsia, attended with gastro-
dvnia, or pyrosis. Prof. Chapman, who is pre-eminently high
authority, speaks of it in the most favorable terms; the distinguish-
ed authors of the United States Dispensatory especially commend it
to the attention of the profession; and Pereira, the highest European
authority, considers it of great value in gastric disorders; yet,
strange to say, but few physicians have confidence in it, or ever
think of using it. I regard this agent as the most valuable which we
possess in the different forms of chronic gastric derangements. It
is antacid in its properties, and tends to relieve the uneasy sensations
arising from free acid in the stomach; but I attribute its chief effica-
cy to its tonic and nervine agency. Whatever may be its modus
operandi, it is certain that, in my own case, and in others of a most
serious character which have come under my care, it acted like a
charm. In regard to the dose, we should be governed by the severity
of pain. Ordinarily ten grains three times a-day will suffice; if,
however, the pain is very intense, amounting to what is termed gas-
trodynia, I would not hesitate to give 20 or even 30 grains at a dose.
I use it, also, in large doses for the relief of pyrosis. In the second
variety oi" the functional form, namely, the atonic, I prescribe the
following : 1st. R. Hydrarg. prot. iod., 15 grs.; ext. colocynth
comp., -| dr.; ext. hyoscyam., 1 dr., made into 30 pills, of which I
give one or two every night, or every other night, according to the
torpor of the liver and bowels. 2d. R. bismuth sub. nit., 2 dr.; sulph.
quince, | dr.; ol. month, pip., gtts. xx., made into 36 pills, of which
I give two or three, morning, noon and night; or divide the above
into 12 powders, and give one thrice daily.

In the second, or organic form, characterized by the marks of
chronic muco. gastritis, I would advise full doses of opium say 4
grains with 10 of pil. hydrarg., occasionally repeated, after which,
mild aperients, or purgative enemata, and the free application of
tartar emetic ointment on the epigastrium. When the inflammatory
condition of the stomach has been, in a good degree, relieved, I would
then use the two prescriptions for the prot. iodide of mercury, and
sub. nitrate of bismuth, as already given for the first variety of the
functional form of the disease.

In the conclusion of this very brief sketch of the treatment of
dyspepsia, I will remark that the experience of fifteen years has
confirmed me in the belief that the above plan, if sufficiently perse-
vered in, together with proper dietic measures, will prove successful
in every case in which serious structural disease of the stomach does
not exist.

1946.] Remarks on the Treatment of Bilious Colic. 181

Remarks on the Treatment of Bilious Colic by copious Enemafa.
By J. S. Paige, 31. D., of Owego, N. Y. (From the New-York
Journal of Medicine.)

Dr. Lee: Dear Sir When I made known to you my method of
treating bilious, spasmodic or constrictive colic, you were kind
enough to express to me your favorable opinion of it, and to offer to
extend its publicity by inserting it in your valuable Medical Journal ;
and believing-, as I do, that it may arm the physician with very effi-
cient means of combating this, and perhaps other kindred diseases,
and also subserve the interests of humanity, I hope no apology may
be deemed necessary from me in offering it for publication.

The case which led to my first essay in this mode of treatment oc-
curred in the summer of 1818, when I was called to attend a man
aged about 35 years, who was laboring under a very severe attack of
bilious colic. 1 pursued the routine of treatment usually followed in
such cases, and called to my aid several reputable practitioners of
medicine as counsel, and after using various cathartic and emetic
medicines, blood-letting, opium, a blister on the abdomen, fomenta-
tions, general warm bathing, and oft-repeated enemas, for forty-eight
hours or more, I found that I had made no progress towards affording
my patient even any hope of relief from his almost intolerable condi-
tion, when a lucky thought, as it proved to be, came into my mind
that of making a direct application of some degree of pressure upon
the constricted portion of the intestine from below, by introducing a
large quantity of fluid with a syringe.

I accordingly directed six pints of water, milk, and molasses, which
I commenced using with a half-pint springe. the largest at my com-
mand at the time and after u-ing almost the whole of the liquid on
hand, the patient began to complain of increased pain and pressure at
the point of obstruction, and desired me to desist; hut when I made
known to him my plan of operations, and that this afforded him
the only hope of relief, as I believed, he patientjy submitted to my
wishes to retain the fluid and allow me to make a little firm pressure
therewith on the constriction for a few minutes, which I did, and on
withdrawing the syringe, I, as well as the patient, had the great satis-
faction to find that the ohject of our most earnest desires was accom-
plished; for copious discharges of faecal matter took place in a very
short time, and an almost immediate relief was the result, only a con-
siderable degree of tenderness and some fever remaining, which
however soon subsided by the use of mild laxatives, diaphoretics, &c.

Two or three weeks afterwards the same individual had another
attack of the same disease from his own imprudence. I commenced
the treatment by overcoming the obstruction in the same way as at
first, whieh succeeded in a very lew minutes in giving relief; three
quarts of fluid also were used on this occasion.

The success of this plan in these two cases induced me to commence
the treatment of similar cases in the same way, and it has been the

182 Remarks on the Treatment of Bilious Colic. [March,

uniform mode of rny treatment ever since, (except in one case of a
female where delicacy required a short trial of the ordinary means and
which were soon successful in that case,) and I have never failed in
affording speedy relief in any case.

In two cases occurring in another individual, I found it necessary
to use six quarts each time before relief was obtained; but I have ne-
ver found it necessary to introduce more than about three quarts in
any case except in the ones last mentioned.

Since the compound syringe has been introduced into use, we are
enabled to force liquids into the intestines with more facility than
with the common syringe, and therefore whenever it becomes neces-
sary to use large quantities in this way, for any purpose, we have
more efficient means of doing it at our command.

The quantity of fluid to be used in these cases must be measured
by the demand of each individual case, and the directions I would
give for securing the object in view, are, to introduce on our first ar-
rival at a case of this kind, a quantity of mild liquid, such as warm wa-
ter, or warm water mixed with molasses, or some mucilaginous fluid,
slowly and steadily till the obstruction he reached, and then to keep the
instrument, in situ, a few minutes, and make a gentle but firm pres-
sure with the liquid upon the constriction, for if this precaution be not
observed, we may fail of affording the relief we so much desire.

After the bowels are evacuated, and the obstruction overcome, some
mild laxative should be given to gently move the bowels, and this
will generally finish the work ; and for this purpose a dose of olive or
castor oil, 1 suppose, will be as good as anything, unless the disease
depended on a derangement of the liver, as is often the case, and
then more active medicines should be used at the discretion of the
physician.

Some of the considerations which urge me to recommend this mode
of treatment, are, that relief may be more promptly and surely ob-
tained than by any other method, for although other means may act
in time, there must necessarily be some delay, if they be not rejected
by vomiting, which usually attends this disease.

Great certainty and promptness, these are strong recommendations
in favor of the mechanical treatment, and from what I have seen, I
feel very confident that it will succeed in almost all curable cases, if
seasonably applied, and there is perfect safety also to recommend it,
if used with reasonable caution. The use of large injections may
serve other valuable purposes they may be resorted to in removing
intestinal concretions, hardened faeces in obstinate constipation, in
reducing intussusception of the bowels, perhaps in removing worms
in some cases, also in irritated conditions of the mucous membrane,
in dysentery or other inflammations, and in some cases of poisons in
the bowels.

From the great extent of the digestive and absorbent tube and its
many diseases, I think it not improbable that much may be done by
large injections as media of conveying medicinal agents where they
may be directly applied in the treatment of diseases in that canal.

1846.] Test for Bile. Morphine in Odontalgia, $c. 183

PART III. MONTHLY PERISCOPE.

New test for Bile and Sugar. By Dr. M. Pettexkoffer. (Ann.
der Chem. and Pharm., Oct., 1844.) This test is based upon the
deep violet tint afforded by the addition of sulphuric acid and sugar
to the bile, even when perfectly colorless. It is upon the choleic
acid, (which forms the essential part of the bile,) that this reaction
takes place. A little of the liquid suspected to contain the bile is
poured into a test tube, and two thirds of its volume of sulphuric
acid added by drops, so as not to allow the temperature of the mix-
ture to exceed 144 Fahr., as a higher temperature would decom-
pose the choleic acid ; then add from 2 to 5 drops of a solution of
one part of sugar to four-fifths of water and shake the mixture ; if
bile be present, the violet red color will appear in a shorter or longer
space of time, according to the quantity present. The precautions
necessary to succeed are, not to allow the temperature to exceed
144 Fahr.; not to add too much sugar; the sulphuric acid must be
free from sulphurous acid. If albumen be present in the suspected
liquor, it is best to coagulate it previous to testing, with a little alco-
hol or heat. If the bile be in small quantity, it should be concen-
trated in a wafer bath, extracted with alcohol, and this last evaporated
to a small bulk, and the test applied to the solution when cold ; this
is particularly to be attended to, when the urine and other secretions
are the subjects of experiments. Bv means of this test, bile was
detected in the urine of a patient suffering under pneumonia. The
faeces of a healthy man when extracted with spirits and tested, did
not show any indication of the presence of bile, whereas in adding
a little bile previously to the fasces, the test did not fail to indicate it.
In all cases of diarrhoea bile is found in the stools, so after the ad-
ministration of calomel and other purgatives. This test reversed,
may be used for the detection of sugar, that is to say, a mixture of bile
and sulphuric acid is first made, and tiie suspected liquid added; if
sugar be present, the violet red color will appear. This is a ready
way of testing diabetic urine.

To test the blood for bile, albumen is first separated bv boiling
with alcohol, and the concentrated solution tested as already men-
tioned. [Am. Joum. of Science and Art.

Hydrochlorate of Morphine in Odontalgia, frontal and facial
Neuralgias. M. Ebrard, Phvsioian to the Hospital of Bourg, re-
commends in these divers affections, the hydrochlorate, or as it is
most generally called the muriate of morphine, in frictions upon the
gums of the painful side. He says the relief is prompt and effica-
cious, because the nerve irritated is only covered by a thin membrane,
whereas by the endermic method, the absorption is not so favorable,
and the painful nerve often quite distant from the point of application.
Nothing is more simple or easy than the administration of the hy-

*84 Diagnosis of Fracture. [March,

drochlorat.e by these frictions upon the gums, or by snuffing it into
the nose, and the results are truly surprising. He gives thirteen
cases in his memoir. The 1 to f of a grain of this salt of morphine
has a local action in energy and promptitude which can only be com-
pared to that of the extract of belladonna upon the pupils, when
applied to the e^e-lids. Odontalgia, or the tooth-ache, may thus be
removed in two hours, one hour, or half an hour; and often in two
days the irritability of the dental nerve disappears. [Translated from
Jour, des Connaissances Medico-Chir.

On the Diagnosis of Fracture. By Mr. Grantham.* Although
the following method is by no means new to the English surgeon, it
is at present but seldom adopted. 4i The stethoscope applied over the
place of fracture, in the slightest motion of the part, conveys a much
more decided crepitus than is perceived by the naked ear during the
most extended movements of the part. In many cases, even the
slight pressure of the ear on the stethoscope, suffices to produce the
crepitation, a circumstance of no small importance, as freeing the
patient from the pain unnecessarily excited by the motion requisite
in the manual examinations. The crepitus yielded by the more solid
bones is sonorous, and resembles the sound produced by breaking a
piece of wood across the knee; it is accompanied with a sensation of
roughness unpleasant to the ear. The sound yielded by the more
spongy bones is duller, and resembles the effect of a rasp on wood ;
except that now and then this noise is broken by a sound of a clearer
kind, like those afforded by the compacter bones, only not so loud.
The sound from oblique fractures is stronger than from those which
are transverse ; but when one end of the fractured bone rides over
the other, the sound is then obscured, and, in some cases, may not be
perceived without slight extension or counter-extension of the limb.
If the fracture is comminuted, the sensation, as of distinct portions of
the bone, is conveyed by the stethoscope. When fluids are effused
around the fracture, a gurgling is combined with the crepitation, and
which is compared to the sound produced by a shoe full of water.
(Lisfranc). A dry crepitus rattle is produced by inflammation of the
cellular structure, wherein the serum becomes suppressed, and the
cells distended with air, which may be mistaken for the crepitus
arising from fracture. It is much louder, and may be distinctly
heard by the patient or bystander; it is heard by making gentle pres-
sure with the fingers, or end of the stethoscope, over the injured part;
it is most distinct on the third day, and decreases on the fifth ; it is a
sound apt to be mistaken for fracture of the fibula. We have a
sound like this in the common subcutaneous emphysema, on pressing
uninterruptedly with the hand on the affected part. [Revue JMedi.
cale de Dijon, 1844, in RanJcing's Half Yearly Abstract.

* Facts and Observations on Medicine and Surgery. London, 1845. p. Gl.

1846.] Aneurism treated by Electro-Galvanic Action. 1S5

Aneurism treated by Electro-Galvanic Action. Dr. Petrequin,
chief surgeon to the Hotel Dieu at Lyons, in a communication read
to the Academy of Sciences, November 3, stated that he had applied
electricity to the cure of aneurism in three cases. Two of these he
had unfortunately lost sight of before the influence of the treatment
could be duly appreciated. The third case occurred in a man nine-
teen years of age, who was brought to the hospital senseless on the
4th of August, 1845, immediately after a violent fall on the head.
The lower maxilla was fractured at the symphysis, and the left orbit
was the seat ofconsiderable ecchymosis. The symptoms of cerebral
commotion had given way in a great measure when variola declared
itself. The eruptive fever accomplished its periods in the usual man-
ner, and it was only on September the 9th, five weeks after the
accident, that M. Petrequin could direct his attention towards a
tumor occupying the left temporal region, and which he had noticed
long before. The swelling was of the size of an almond, soft, and
almost indolent on pressure; it was seated on the course of the
temporal artery, and presented pulsations isochronous with those of
the arteries. These pulsations ceased when pressure was exerted
on the temporal artery below the tumor, and reappeared on the pres-
sure being removed. These signs left no doubt of the nature of the
case, and aneurism of the temporal artery, probably due to the injury
experienced by the vessel during the accident, was diagnosed. On
the 10th of September, galvano-puncture was performed by the in-
troduction of two sharp steel pins crossing each other at right angles
in the tumor; the heads of the pins were then placed in communica-
tion with the wires of a voltaic pile, and a shock and a sharp pain
were experienced by the patient, the pain increasing with the inten-
sity of the electrical action. The operation lasted ten minutes, and
fifteen plates were employed. The pulsations gradually diminished
in the tumor during the operation, and at its close had entirely dis-
appeared. So accident followed the experiment, but a solid indura-
ted swelling took the place of the tumor, the temporal artery ceasing
to beat above the aneurism, whilst its pulsations remained distinct
below. On the 20th of September, absorption had achieved the cure,
and neither tumefaction nor pulsations could be detected in the spot
where the malady had existed. M. Petrequin gives the following
precepts, which he deems will ensure a complete coagulation of the
blood contained in aneurismal tumors: 1. Compression of the arte-
ry between the aneurism and the heart during the application of the
galvanic agency. 2. The pins introduced into the tumor should be
numerous, cross each other at right angles, and their surface should
he protected by a coat of varnish in order to prevent unprofitable loss
of the electric fluid. 3. After the operation ice should be applied to
the tumor. This is the first case on record of aneurism cured, or even
treated, by this method, which has been of late employed in the treat-
ment of a large number of diseases. [Medical Times, Sow 15, 1813.

186 Creosote in Dysentery. Remedy for Strangury. [March,

Creosote in Dysentery. In a severe form of dysentery which oc-
curred near Tunbridge Wells, and in which all methods of treatment
appeared unsuccessful, the mortality being as high as 25 per cent.,
]3r. Wilmot thought of trying creosote enemata in the strength of
5i. to ^xij. of starch. This remedy produced a speedy amelioration
of the disease. [Ra?iJcing,s Abstract from Pr. Yereinszeitung .Med.
News.

New Remedy for Strangury. Dr. F. H. Gordon, of Wilson Co.,
Tenn., in an article on Epidemic Metritis, (West. Jour. Med. and
Surg., Nov., 1845,) gives the following account of a new remedy,
which, he says, was successful in the treatment ofstranguary which
was a common attendant on the disease. This remedy was an infu-
sion of the apis meliflca, or honey bee. "Sweep 40 to 60 bees into
a pan of water, so as to make them manageable ; put the whole into
a teacup, pour one gill of boiling water on them, and cover the cup
securely. When it has remained twenty minutes, pour off the infu-
sion and let the patient take the whole at a draught. This remedy
relieved the strangury in from two to fifteen minutes with great
certainty.

"It was introduced into the practice of medicine some years ago
by Mrs. Perry, an old woman in ihe habitual practice of midwifery
in the county of Smith ; and experience proves that its efficacy is not
less considerable because of its unscientific origin. Some six or seven
practitioners in that section of country, (some of whom do honor to
the profession,) have given the remedy numerous fair trials, and, so
far as I have learned, all estimate it highly. The writer has tried it
repeatedly in the retention of urine from inflammation of the bladder,
and from the effects of cantharides, and found it to be more prompt
and certain than any other remedy. There can be no question but
that the 'bee tea' will prove a valuable accession to our materia
medica. How far it may be found to be useful in ischuria and dysu-
ria from every variety of cause, remains to be tested ; and its known
value affords abundant encouragement for further investigation.

"As to the class to which this agent naturally belongs, I have but
little hesitation in placing it among the narcotics. That it acts as an
antispasmodic there can be no doubt, but whether it is a specific for
the sphincter muscle of the urinary bladder, as the ergot is supposed
to be a specific for certain fibres of the uterus, has not been clearly
determined.

"It is probable that the virus ejected by the bee in poisoning the
wound it inflicts upon its enemy, is the material which gives virtue to
the bee tea. This virus is secreted and collected in a sac in the ab-
domen of the bee, near the base of its lance or sting. When war is
made upon its enemy, the virus is injected into the puncture made by
the lance, and the wound is poisoned. It is also emitted during the
anger of the insect, as is known by its peculiar pungent odour; and
that the virus which gives out this odour is the same which imparts
the antisposmodic virtue to the infusion, is evinced by two facts.

1846.] Tape-icorm expelled. Fistula. Iodine. 187

" 1st. The lea, when recently made, has a taste and smell identical
with the odour of the incensed bee, and now the infusion is efficacious.

"2nd. But if the infusion be allowed to stand and cool, and espe-
cially if allowed to remain uncovered, its charistic odour and taste
disappear, and the tea is correspondingly inefficient. These facts
justify another conclusion that the virus is quite volatile, and re-
quires care to prevent its escape.

" Whether this valuable virus may not be collected and concentra-
ted, or combined with some chemioal element, so as to render it
portable and convenient, is a matter of interest and well worth the
attention of the chemist." [Am. Jour, of the Med. Sciences.

Tape-Worm Expelled. Dr. Parker exhibited about twenty-four
feet of tape-worm, which had come away from a patient, under
the use of an infusion of the punica granatum. The following is a
brief history of the case. On Tuesday morning, an infusion of two
ounces of powdered pomegranate in one quart of water boiled clown
to a pint, was administered to the patient; this was followed by a
dose of castor oil at noon. At one o'clock, he commenced passing
the worm, he remained upon the stool five hours, and during that
time passed six feet; it then broke off. The following evening, a
dose of senna and salts was administered ; this was followed on
Wednesday morning, by another pint of the infusion, and a dose of
castor oil ; during Wednesday night, he passed a portion of taenia
eighteen feet in length. The pomegranate occasioned no febrile ex-
citement, only slight nausea at first. This is a favorite remedy
against tcenia in the East, it is very little used here. [New York
Medical and Surgical Reporter.

Yesico -Vaginal Fistula. Dr. Berthet read three cases in which
he had succeeded in curing vesico-vaginal fistula by cauterisation
assisted by insufflation. After preparing the patient as usual, he
blows air into the bladder continuously during the operation, so as to
render the fistula prominent in the vagina, and to separate its lips.
He then cauterises with a red-hot cautery the entire extent of the
edges of the wound. Subsequently, these edges are, at short inter-
vals, cauterised with the nitrate of silver, and the vagina is kept
plugged with cotton, introduced by means of the speculum. The
patient is placed, whilst the treatment lasts, in such a position as to
prevent the urine from bathing the edges of the wound. The regi-
men must also be severe ; the more so the better. The only food
which he allows is a small quantity of dry bread or toast, along with
a little boiled or roast meat. The effect of this diet is to diminish
the quantity of urine secreted, the excretion of which is the principal
obstacle to the cure of the disease. [R. of Acad, de Med Lancet,

Employment of Iodine to remove a fragment of Iron from the
cornea. A cutler having received into the eye while working, a par-

188 Iodide of Potassium. Dothinc?iteritis. Cancer. [March,

tide of Iron which became fixed in the thickness of the cornea, and
which for eight days had resisted the attempts to remove it by forceps
and other mechanical means, M. Reiniger prescribed the following
collyrium: R. Iodine, .... 0,05

Iodide of Potash, . 0,50
Rose Water, . . 100,00 Mix.
By the first application the Iron was oxidized and its brillancy dis-
appeared. Soon the symptoms of ophthalmia ameliorated, and by
continuing the remedy he recovered his perfect sight. The conver-
sion of the metal into a soluble iodide is certainly very ingenious,
and the remedy preferable to diluted acetic acid, now in general use
under these circumstances. (Translated.) Journal des Connais-
sances Medico-Chir.

Iodide of Potassiinn. M. Jaenger relates the case of a man
afflicted with chronic coryza, subject to frequent aggravation of in-
tensity, which had been treated ineffectually some fifty times. M.
Jaenger, being led to suspect old syphilitic taint, ordered him iodide
of potassium, which effected a cure in three or four days.

Some cases of neuralgia, of longstanding, and giving rise to par-
tial derangement, as well as a case of enormous enlargement of the
thigh, with fistulous orifices, reaching to the bone, the sequel of a
Menorrhagia, were also related in proof of the therapeutic efficacy
of iodide of potassium in doses of from 10 to 15 gr. per day.

[Dublin Journal of Medical Science.

Laudanum in the. delirium occurring in the last stage of Dothinen-
teritis. Dr. Morand, of Tours, is of opinion that great advantage
may be derived from certain preparations of opium in the treatment
of the delirium which supervenes in the last stage of the dothinen-
teritis. He relates a case of a girl 11 years of age, who, on the 32d
day of an attack of dothinenteritis, seemed in the most-hopeless con-
dition. She had continued delirium, and screamed without cessa-
tion. A portion containing fifteen drops of laudanum was ordered
to be given every hour, which quieted her cries, procured sleep, and
in 18 hours the delirium ceased. The portion was afterwards con-
tinued for a few days to prevent a return of the delirium, and with a
nourishing regimen the patient entirely recovered. [Jour, de Med.

Note on the use of Nitrate of Lead in Ulcerated Cancer. By M.
Lemaitre. (Comptes Rendus, 11th Aug., 1845.) In a memoir
presented to the French Academy of Sciences in 1841, by M. L., in
which he gave the results of his investigations relative to the mode
of action of chemical agents employed in the treatment of wounds,
ulcers, and other external affections, he stated that the decomposition
of diseased parts can be arrested, and the formation of plastic matter,
which causes their restoration to the healthy state, be promoted, solely
by precipitating the albumen of the blood. Later researches have

184G.] Taxis in Strangulated Hernia. Eau Brocchieri. 189

confirmed him in this opinion, and he thinks he may assert that all
agents which precipitate albumen without irritating the nervous sys-
tem, are endowed with curative or cicatrizing powers.

Guided by theso principles, and also calling to mind the fortunate
application made by M. Leddoyen of the nitrate of lead for disinfect-
ing faecal matters, it occurred to M. Lemaitre, on a recent occasion,
to employ the same salt for correcting the fetid odour of a cancerous
ulcer, which odour was very distressing to the patient and attend-
ants, and which the different preparations of chlorine had failed to
remove. A solution of the nitrate was accordingly injected into the
cavities of the ulcer, and its surface was covered with charpie moist-
ened with the same. The fetid odour was not only entirely destroy-
ed by this application, but the fungous growths have diminished, and
this treatment having been now continued for a month, the disease is
manifestly better.

[Dr. Rognetta reports (Annales de Therapeutique, Sept., 1845),
two cases, in which M. Robert experimented with this article at the
Hopital Beaujon. The solution was used of the strength of 20 de-
grees of the aerometer. In both cases the fetor was entirely destroy-
ed and the condition of the sores much ameliorated.] American
Jour, of the Med. Sciences.

Taxis combined with continued irrigation and the cold water douche,
for the reduction of Strangulated Hernia. (Journal de Chirurgie,
June, 1845.) In this memoir, which was addressed to the Royal
Academy of Medicine, the author, M. Moreau-Boutard, extols the
efficacy of the taxis, combined with continued irrigation with cold
water under the form of douche, as more successful in the reduction
of strangulated hernia, than the taxis alone, and relates three cases
in which the last named measure failed, and in which the former was
then resorted to with entire success. [Ibid.

Eau Brocchieri. Prof. Mott took this occasion to make some
remarks respecting the celebrated "eau Brocchieri" which is making
so much nnis<> at this time 10 the public prints, as being capable of
arresting hemorrhage remarkably ; he exhibited some which he
brought from Paris, and which was given him by -M- Brocchieri him-
self; but he had never thought it of sufficient value, to uncork the
bottl

I knew M. Brocchieri when I was in Paris; he is an uneducated
man. and a perfect charlatan. When his discovery was made known
in Paris, it created some stir; and I made several experiments with
it, in connection with several other gentlemen, one of whom was
< d in the preparation of the water. The subjects of the ex-
perini ng and healthy sheep, upon whose carotid arter-

operated, and we found that its power to stop hemorrhage was
to nothing, and where the bleeding was arrested, it was princi-
pally from the pressure made by the large quantities of but, with

190 Tetanus. Scalds. Lupus or Noli-me-tangere. [March,

which the wound was filled. Therefore, I say, as the result of my
experience, that the styptic powers pf this preparation are not to be
relied upon, for a moment : that it is infinitely less useful than an in-
fusion of rhalany, or tannin, and that it can never take the place of
needles and ligatures.

The other qualities that have been ascribed to it, of curing disease,
and arresting haemoptysis, are equally non-existant.

Doctor M. having occasion to remove a tumor from the cheek of a
female, during his lecture, applied some of the nostrum, but without
the least effect. [New- York Med. and Surg. Reporter.

Strichnine in Tetanus. Dear Doctor : I send you another case of
traumatic tetanus, treated by strychnine. Mrs. J., of Thompson st.,
stuck a needle into her hand, a part of which remained ; the piece
was removed in a \e\v days, but not until the arm, however, had be-
come much swollen, and the glands in the axilla much enlarged. I
found her with the characteristic spasms, locked jaws, &c. on Nov.
15th. I at once gave the strychnine in doses of TT of a grain, every
two hours ; and as soon as it produced its peculiar effect, the tetanic
spasms ceased. The jaws gradually relaxed until the fifth day, when
the strichnine was discontinued and the patient quite well.

Yours, &c, J. Weldon Fell.

[N. Y. Med. $ Surg. Reporter.

Treatment of Scalds. Dr. Grosskopf speaks strongly in favor of
the Ung. Plumbi Acetat. as a local application in cases of scalds,
stating that if applied at once, it invariably prevents the formation
of vesicles, speedily allays pain, and diminishes redness and swelling.
In cases where vesicles have already formed and burst, its application
quickly promotes the healing of the exposed surfaces. No evil effects
on the system have followed its employment. [New York Medical
Intelligencer.

Two Cases of Lupus or Noli-me-tangere, cured by M. Payaw, of
Aix, in France. We condense from the Bulletin General de Thera-
peutique, the following details :

One of these cases had been unsuccessfully treated by the various
alteratives resorted to in syphilitic and scrofulous diseases and for
purifying the blood. The local application repeatedly of the acid
nitrate of mercury effected a radical cure.

In the second case, in addition to other internal remedies, M. Payan
used for a long time the arsenite of iron, the oxide of gold, &c,
without benefit. As in the former case, nothing seemed to do any
good, until he resorted to local cauterization. Here the acid nitrate
of mercury failed, as also did the muriate of gold, their effect being
too superficial and too transient. The arsenical paste of Rousselot
and corrosive sublimate in powder, applied to the diseased surface,
perfected the cure.

1946.] Glanders and Farcy. Ergot of Rye, Ointment. 191

M. Payan does not entirely reject general modification, and re-
commends general restoration, especially good diet, iodide of iron, or
what is preferable, iodide of potassium. His object is to insist on
the paramount importance of local application of caustics.

Glanders and Farcy in the Human Subject. The Revue Medi-
cate of July last, contains the details of a case in which an officer
took these diseases from a horse, and in which experiments were
made by M. Audouard, to test the contagiousness of the human fluids
introduced into other animals. The captain of a military train, 43
years of age, of a delicate constitution, had charge of the horses at
Algiers affected with these diseases. He first took the farcy, and
two months afterwards was severely attacked with glanders, which
terminated fatally in about 12 days. Post mortem inspection revealed
all the characteristics of these diseases. The following experiments
were made 13 hours after his death:

1. A mare was inoculated with the nasal mucus, without any del-
eterious consequences.

2. A stout mule was inoculated with pus taken from one of the
glanders. The mule was first seized with glanders, and shortly after
with farcy, both of which diseases progressed to a fatal termination
in about one month.

3. A stout mare was inoculated with pus taken from the inter-
muscular tissue. She experienced decided symptoms of glanders,
such as discharge from the nostrils, incipient ulceration, enlarged
gland, dec, which, after reaching a certain point, gradually subsided,
and the animal recovered.

4 A horse was inoculated with blood taken from the heart, and
died in 17 days with all the symptoms of acute glanders.

Supposed fatal effects on the child of the Ergot of Rye. Prof.
Beatty, in an article in a recent No. of the Dublin Medical Press,
stated "that when delivery was not accomplished within two hours
from the exhibition of the ergot of rye, the child's life was generally
lost," and this statement has been since reiterated by Dr. Hardy, in
a paper read before the Dublin Obstetrical Society, and published in
the 5th No. of the Dublin Hospital Gazette. In the 17th No. of the
last-mentioned Journal, Mr. J. Pratt relates several cases which dis-
prove the above statement. In one case three hours elapsed between
the taking of the medicine and delivery; in another five hours, in
another three hours and a half, and in a fourth case six hours, and all
fine healthy children were born. [Am. Jour, of the Med. Sciences.

Ointment for the Common Itch. Ii. Tar 8,00

Camphor 2.00

Lard 30,00. Mix. Apply

morning and evening in frictions. (Translated.) Journal des Con.

Med. Chir.

T92

Prescriptions. Meteorological Observations,

Aihelmintic Formula. Prof Piling, of Bale, recommends highly
the employment of aloetic injections against the ascarides of the
rectum. His prescription is : R. Aloes 3i, mucilage of gum Ara-
bic to make into 20 pills. Dissolve one of these in water and inject
into the rectum.

Dr. Calloud employs with great success the following prescription
for children troubled with lumbrocoides :

#. Powdered Santonin, (wormseed would be better,) 3i.
White Sugar, ..... v.

Gum Tragacant, .... 3iss.

Mix. Make 144 pills or boluses. Give from 2 to 20 of these each
<lay, according to the age of the child. (Translated.) Journ. des
Con. Med. Chir.

METEOROLOGICAL OBSERVATIONS, for January, 184G, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

*.

*

Sue

Ther.

l Rise.
Bar.

2,]
Ther.

P. M.
Bar.

Wind.

Remarks.

1

39

30

54

29 85-100

s.

Cloudy rain last night 21-10

2

50

29 60-100

61

" 63-100

w.

Fair.

3

36

" 70-100

56

" 62-100

s.

Fair.

4

33

" 66-100

56

" 62-100

s.

Fair.

5

36

" 80-100

61

" 84-100
" 55-100

s.

Fair hazy.

6

48

" 70-100

53

N. E.

Rain 5|-10 in.

7

4G

" G5-100

59

<; 72-100

w.

Fair.

8

33

" 89-100

58

" 90-100

w.

Fair.

9

33

" S3-100J

55

" 83-100

N. W.

Fair breeze.

10

29

" 92-100

46

85-100

N.W.

Fair.

11

25

65-100

54

" 58-1 001

w.

Fair breeze.

12

34

60-100

55

" 68-100

w.

Fair.

13

28

89-100

55

" 95-100

w.

Fair.

11

28

" 98-100

58

" 98-100

w.

Fair.

15

42

" 80-100

45

" 45-100

N. E.

Rain all day, 1 inch.

L6

42

" 50-100

54

" 52-100

w.

Cloudy blow.

17

44

57-100.

52

62-100

"SV.

Fair.

18

32

" 95-100'

54

" 99-100

N. E.

Fair.

19

33

30 10-100

42

30 5-100

N. E.

Cloudy.

30

34*

29 90-100

32

29 67-10!)

N. E.

Rain and sleet, 1 inch and 9-10

31

35

" 50-100

46

" 57-100

S. W.

Cloudy breeze.

22

34

" 87-100

53

30 4-100

N. W.

Fair.

23

32

30 27-100

53

30 24-100

N.W.

Fair.

21

28

" 20-100

54

" 22-100

N. W.

Fair.

25

28

" 10-100

62

" 1-100

s. w.

Fair.

26

40

29 92-100

64

29 80-100

s. w.

Fair some flying clouds.

27

51

" 71-100

66

<; 72-100

w.

Fair heavy blow.

2H

35

" 90-100

65

" 93-100

E.

Fair hazy.

29

36

" 90-100

58

" 87-100

S. E.

Cloudy.

30

47

"'78-100

65

" 68-100

S. E.

Cloudy blow.

31

GO

" 68-100

72

" 65-100

S. W.

Flying clouds rain 2^-10 in.

21 Fair days. Ctuantity of Rain, 4 inches and 2-10.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 2.] NEW SERIES APRIL, 1846. [No. 4.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XI.

Remarks on Pneumonia and its Treatment. By Wm. J. Johnson,
M. D., of Fort Gaines, Ga.

' Pneumonia is a disease of unfreqtient occurrence in this section of
the State. Owing to the mildness of the climate, the salubrity of the
atmosphere and its uniform temperature, many winters pass by,
without presenting to the notice of the medical practitioner a solitary
case of this dangerous complaint. I have practiced in this neighbor-
hood nearly fourteen consecutive years, and have, enjoyed too, for a
portion of the time, a very extensive patronage, and during a consid-
erable part of the time, when it should prevail, (during the winter
months,) I have not seen or heard of a single case of pneumonia.

In the fall of the year 1843, the Grippe, or influenza made its
appearance here, as it did almost universally in this State. Every
case of a violent character, which occurred in this section was compli-
cated either with pleurisy, bronchitis, or pneumonia most generally
with the latter. Several cases occurred in my own family, and they
were usually very indomitable, running a tedious and protracted
course, and stubbornly resisting for several days, any and cverv plan
of treatment which could be suggested. One of inv fa mil v, a negress,
was attacked first with the "grippe" and a few days thereafter, with
pneumonia typhoides, attended with complete prostration of strength,
amounting almost to perfect helplessness. Her situation, for flays,
was so critical that all despaired of her recovery, and it was with the
utmost difficulty, supporting her strength all the time with cordials,
stimulants, tonics and nourishment, that we finally succeeded in
arresting the disease.

13

194 Remarks on Pneumonia and its Treatment. [April?

During the winters of 1843-'44, a great many persons were attack-
ed. Some suffered immensely, particularly when the influenza was
complicated with pneumonic symptoms, and required prompt and
energetic treatment for their relief; but among temperate white per-
sons, who had previously been hearty, the disease was very amenable
to proper treatment ; consequently among that class the mortality
was comparatively trifling. The fatal cases were almost exclusive-
ly confined to aged persons, intemperate habits and negroes, a great
number of whom, from exposure, the complicated nature of their
attacks, &c, died. With the exception of that winter, I have never
known pneumonia to prevail here epidemically. When we have met
with the complaint at all, except during the season already mentioned,
the cases have been but sporadic cases and uncomplicated for the most
part, with pleurisy or other affections of the respiratory organs. During
the winters of 1844-'45, pneumonia scourged the central and eastern
portions of this (Early) county most severely a great many deaths
occurred in the neighborhood of Blakely, the county site. Onegentle-
man, Mr. Sheffield, residing some sixteen miles from that place, lost
about twelve or fifteen members of his family from this complaint, and
that too in quick succession. It may have been, and perhaps was, raging
there epidemically. No case of the disease occurred here, nor in the
neighborhood, according to my recollection, during the whole of that
winter ; nor did I see a single one of the cases which destroyed so
many persons in the remote parts of the country. From its fatality,
I am induced to believe it could not have been Gerhard's "Frank
Pneumonia," but a dangerous form of it, complicated, with typhoid
or cerebral symptoms ; and my belief is confirmed, from the fact
that nearly all the cases, from the information I could derive respect-
ing them, were of short duration, producing death in a very few days.
I understand the disease has again made its appearance in the country
surrounding Blakely, and I have been pained frequently to hear of
the death of several of my friends, whose lives have been unfortunate-
ly terminated by this destructive disease. The present has been by
far the coldest winter we have ever experienced in this section :
hence, in part, I suppose, is to be ascribed the recent frequent occur-
rence of pneumonia about Fort Gaines. The cold weather commenced
early in November last, and has continued, uniformly and uninter-
ruptedly to the present time, January 23d. I have repeatedly,
during the winter, observed the mercury, in Fahrenheit's scale, as
low as 18, and once down at 14, a circumstance so unusual here,

1846.] Remarks on Pneumonia and its Treatment. 195

as scarcely to admit of belief by our own citizens, had they not expe-
rienced the cold on their own persons, and witnessed the temperature
by the thermometer. Shortly after Christmas, I was called to treat
several cases of pneumonia, and from that time to the present, 1 have
met with a number of cases (some ten or twelve) of the same disease;
and on account of its prevalence, and the frightful fatality of its at-
tacks, in the central and eastern parts of the county, I have been
induced to offer, for the benefit of my brother practitioners, a few
remarks on the appropriate plan of treatment to be pursued, in its
management, in order to conduct it to a favorable issue. Before I
proceed farther, I would take leave to remark that, most of the cases
which have fallen under my notice, have been those of "frank pneu-
monia." I have seen but one well marked case of pleuro-pneumonia,
and one or two oniy, of pneumonia with bronchitis. A large majority
of the subjects have been negroes, a number of whom were attacked
soon after the expiration of the Christmas holidays, and as I have
as yet seen nothing which would lead me to believe in its epidemic
character, I am compelled to think they were brought on by exposure
to the cold, especially at night, in going to and returning from their
frolics, when they no doubt indulged in large potations of poor whis-
key," set up and danced until near day-light, committing all kinds of
excesses, and then returning to their homes, half drunk, and half
frozen. It is not my present purpose to write an elaborate
treatise on pneumonia neither shall I enter into a full and minute
description of all the symptoms, physical and general, which charac
terize this complaint. This task has already been repeatedly per*
formed, by a number of medical gentlemen of distinguished ability
and superior attainments, a considerable part of whose lives has been
untiringly and undefatigably devoted to a careful and thorough stu-
dy, practically and theoretically, of all the morbid phenomena, func-
tional derangements, and structural lesions, of the parenchyma and
investing membranes of the lungs. Hence, from the pathological
knowledge acquired by their investigating researches, we are happily
enabled to ascertain the extent and precise seat of pneumonia, and to
trace it, as it were, step by step, through all its progressive stages,
from the first stage of engorgement to gangrene, and to accommodate
the treatment accordingly. The discoveries made by the investiga-
tions in pathological anatomy, or that branch of it, at least, which
rs tothe morbid conditions of the thoracic viscera, have contributed
to throw much light on the treatment of pneumonia, and other kin-

196 Remarks on Pneumonia and its Treatment. [April,

dred affections : hence, the therapeutic management of such cases
has become a task of easy accomplishment. Among the illustrious
worthies who have contributed so much by their laborious researches,
interesting writings, and untiring industry, to shed light on this sub-
ject, and whose explorations of the external parts of the chest, and
post mortem examinations of the diseased organs contained in the
thoracic cavity, have been prosecuted with so much zeal, I may
mention the names of Andral, Louis and Laennec, of France, Stokes,
of Ireland, Williams, of England; and last, though not least, Ge-
rhard, of our own country, whose invaluable little work on Diseases
of the Chest, should constitute a portion of the library of every physi-
cian, and be read with care and studied thoroughly. The object of
this paper being simply to offer some suggestions in reference to the
treatment of pneumonia alone, I shall take it for granted, the profes-
sion are well acquainted with the pathology, physical signs, and
anatomical characters, and several stages of the disease as described
by modern authors, and proceed at once, to portray some of tho
prominent general symptoms, as they are called, omitting altogether
the physical signs, which are based upon explorations by ausculta-
tion and percussion.

This disease consists of inflammation of the parenchymatous struc-
ture of the lungs, and is usually ushered in by a well marked chill,
or in the absence of that, by rigors or chilly sensations, which may
continue from a few minutes to several hours. At the same time
there is pain, more or less acute, in some part of the thorax, cough,
dyspnoea, and accelerated pulse, which is most frequently quick and
hard, or, as Dr. Watson defines it, "Apart from the physical signs,
the symptoms of pneumonia are pain, more or less severe, on one
side of the chest, dyspnoea, cough, a peculiar expectoration, and
fever." The fever is generally intense, occasioning tumultuous ex-
citement of the heart and arterial system, and is often accompanied
by flushing of the face, and headache, particularly over the orbits in
the frontal region. The flush is sometimes perfectly circumscribed,
and occupies but a limited portion of each cheek at other times it
is widely diffused, and spreads over the greater portion of the face.
The seat ofthe pain varies according to the nature of the attack, and
the part of the pulmonary texture implicated in the inflammation :
sometimes it appears to be deep at others more superficial ; some-
times it is located under the sternum, within the breast, under the
scapula or clavicle. I have at this time a patient under treatment

1846.] Remarks on Pneumonia and its Treatment. 197

for pneumonia, whose situation is dangerous in the extreme, and who
has invariably referred the seat of his pain to the upper and anterior
part of the chest, just below and under the clavicles. Sometimes the
pain, especially in latent pneumonia, is entirely absent; hence, Dr.
Gerhard attaches but little importance to it as a symptom. He says,
in many cases pain is wanting, and when present it does not indicate
the extent of the pulmonary inflammation, and is therefore a sign of
but little importance. {Gerhard on the Chest, p. 81.)

All modern authors agree in the fact, that the pain, when excru-
ciatingly severe, is symptomatic of inflammation of the pleura, and
more especially when attended with laborious and difficult respiration.
In the first stage of pneumonia, or the stage of engorgement, the
cough is a very distressing and troublesome symptom, being dry, hard,
and suppressed; or, " short," as it is vulgarly called. Sometimes it
comes on in paroxysms, each one aggravating the pain, rendering the
respiration difficult and laborious, and adding much to the sufferings
of the patient. At this stage of the disease, the cough is unaccompa-
nied with any expectoration, except a scanty, glairy, or frothy
mucus. Another very tormenting symptom in this stage is the short-
ness or quickness of breathing, and when very urgent, more espe-
cially if the efforts to respire are rapid and laborious, is a sure indica-
tion that the disease is extensive ; and the danger attending it may, to
a limited degree, be measured by this symptom. In addition to the
symptoms above enumerated, patients commonly complain of great
thirst, anorexia, pain in the head and limbs, anchother constitutional
symptoms, while the tongue is loaded with a thick fur, generally
white; when drawn from a vein, the blood exhibits the bnffy coat,
and presents a cupped appearance with a hard firm crassamentum,
and when allowed to stand until a separation of its constituent parti-
cles takes place, the serum presents sometimes a yellowish at others a
;rayish, ash-colored, or milky appearance. The disease having pro-
cessed for a day or two, a change in the color and consistence of the
sputa expectorated occurs. From being white, semi-transparent and
rrothy, it begins to assume its characteristic or pathognomonic lint
viz., tawny or reddish colored, and is so thick, viscid, tenacious and
coherent, and adheres so firmly to the bottom and walls of the vessel
which contains it, as not to admit of flowing, even though the vessel
should be inverted, and, as Dr. Watson says, shaken with much force
and violence. This symptom is uniformly present in pneumonia.
Another one of the general symptoms of this disease, is difficulty and

198 Remarks on Pneumonia and its Treatment. [April,

inability to lie on the affected side, and hence much reliance is placed
by some authors, on the dorsal decubitus, as a characteristic symp-
tom of pneumonia.

I promised to give some of the " prominent general symptoms,
omitting the physical signs," of pneumonia, and as I have redeemed
that pledge, (though a great many others might have been enumera-
ted,) I shall, for fear of extending this article beyond the limits I
intended it to occupy, now proceed to the treatment.

The treatment of pneumonia varies very much in reference to its
different stages. What is applicable to the first stage, is not suitable
for the second, and so on of the remaining stages.

The remedies used in this complaint, may be arranged as follows,
to wit: 1. J3lood-letting ; g. tart, ant.; 3. calomel, or calomel In
combination with opium; 4- expectorants; 5. blisters, and other
counter-irritants; 6. quinine; 7. mucilaginous and diluent drinks
and in the last stage of complicated pneumonia, cordials and stimu-
lants, among which we may class wine, carb, ammon., camphor, &c.
The treatment o^ the first stage consists in relieving the engorgement
of the pulmonary vessels, and giving such remedies as have a ten-
dency to favor the termination of the disease by resolution in other
words, to prevent it, if possible, from passing jnto the second, or stage
pf hepatization. For this purpose we resort to blood-letting, and the
exhibition of tar^arizcd antimony ; and in this climate, quinine. If
these remedies are judiciously applied, the complaint rarely ever
passes beyond the first stage. Most of the cases I have seen the
present winter--rindeed I might venture to assert that all of them
have been arrested in the stage of engorgement, provided I have been
palled to the patient within the first twenty-four hours of his attack.
When called to see a patient in the first stage, I usually prescribe
bleeding to a considerable extent, if there be nothing to contra-
indicate its employment, and repeat the abstraction of it in smaller
quantities, until a decided impression is made on the system. As
soon as most of the circulating fluid is sensibly diminished, the
pulse will become softer and fuller, and the sense of respiratory
constraint abated, and the dyspnoea relieved. As an auxiliary to
general bleeding, I often use cups and rubefacient applications to the
surface, fixing them as near as I can over the seat of pain, and shifting
their place from time to time, according to the effects produced, and
the erratic or settled nature of the pain.

1846.] Remarks on Pneumonia and its Treatment. 199

Next in point of importance to venesection as a remedial agent,
is the tartarized antimony, as an antiphlogistic or contra-stimulant.
It is an essential adjuvant to the lancet, and when venesection can
no longer be safely resorted to, on account of its prostrating effects,
this agent supplies its place and can be employed alone or in combi-
nation with calomel, or calomel combined with opium, and its use
persisted in until every vestige of inflammation is totally extinguish-
ed. This drug is not used with a view to its emetic effects. It is
only in small, nauseating doses, that its power of subduing or con-
trolling pectoral inflammation is so conspicuously manifest. Its
utility in this respect is now so fully recognized by the members of
the profession, that by some, especially Laennec, its value is con-
sidered superior to venesection, and to the efficacy of this remedy
alone he chiefly ascribes the success of his treatment, and the un-
commonly small mortality of his practice being two only in fifty-
seven cases. Rasori and his followers, among whom I suppose we
may rank Laennec, administered this article in " heroic" doses.
Dr. Williams informs us that he has seen in the wards of Laennec,
patients daily taking 20 grains without experiencing sickness, pain,
or diarrhoea, or even loosing theirjappetite for food, or the power of
digesting it.

No American physician, so far as" I am advised, ever uses it in such
extravagant doses from the d of to 1 grain, repeated every two
or three hours, until the stomach can tolerate it, (as the European phy-
sicians term it,) is the amount usually prescribed. If it occasion
vomiting, the dose is diminished. If it produce diarrhoea, or is dis-
posed to pass off too rapidly by the bowels, a few drops of laudanum
added to each dose will generally succeed in arresting it, particularly
if a large sinapism be applied over the epigastrium. I sometimes
direct pills composed of Tart. Ant. ^ or - of a grain, Gum Opium ^,
and continue them until the power of tolerance is established, when
I discontinue them, and substitute the following mixture, viz: Ant.
Tart. grs. vi., pure water, or Gum-water, jiv Dose, a tablespoon,
ful repeated every two hours. Under this plan of treatment, (large
venesection and smaller abstractions of blood, local and general,
with the Ant. Tart.) the complaint will frequently yield in a few
hours. I have had the happiness to witness this result in more than
one instance. The following described case, (and I could detail the
particulars of several others,) will confirm my statement and exem-
plify conclusively my assertions.

200 Remarks on Pneumonia and its Treatment. [April,

Case. Mr. R s, aged about 25 years, after prolonged expo-
sure to wet and cold, was attacked on the 7th January, about 10
o'clock, A. M.,-\vith a severe chill, which continued at least two
hours, f saw him about 2, P. M , same day. He had a full, hard
pulse, numbering 120 strokes per minute; respiration 42, difficult
and laborious; dyspnoea distressing; cough, dry, suppressed, and in-
cessant ; pain acute over sternal region and on right side of chest
V. S., %<x. Prescription Sal. Ant. Tart, of the strength of 6 grs.
to four ounces ..Gum- water A tablespoon-full of the mixture to bo
exhibited every two hours. 8 'clock, P. M. Called to see patient
again, found an amelioration of all the symptoms; he had vomited
once or twice after taking the mixture before the power of tolerance
was established. The improvement in his condition was so manifest
as to be perceptible to all in the house at which he was staying. Or-
dered him to have his interior extremities immersed in a warm mus-
tard pediluvium, and continue the mixture through the night. Jan.
8'h Called at 8, A. M., to see my patient: symptoms all relieved;
pulse 70, full and soft ; respiration nearly natural ; coughs but little;
expectorates freely; has no pain or dyspnoea ; says he feels quite
well, and asks permission to sit up and walk about his room. Direct-
ed the mixture to be continued, enjoined the horizontal posture, and
at noon prescribed a dose of oil and turpentine. The patient rapidly
recovered under this treatment discontinued my visits, and in a day
or two thereafter saw him in the village attending his ordinary vo-
cation. The effects of the ant. tart, are however, not generally
manifested with so much promptness as in the case above described ;
the relief sometimes not being conspicuous for 24, 36, or 48 hours,
and often not until the third or fifth day.

The modus operandi of this article is not well understood. It is
an universally received opinion in the profession, that its antiphlo-
gistic power does not depend either on its nauseating, emetic, purga-
tive, or diaphoretic effect. Dr. Williams says, "it appears to be
antiphlogistic by a specific action on the inflamed vessels." I think
a considerable amount of its power depends upon the facility with
which it provokes expectoration ; but whether it does this by any
specific expectorant influence, apart from its power of subduing in-
flammation, and thus producing a favorable tendency to terminate
the complaint by resolution, I am unprepared to say ; whether it is
a "direct expectorant" or not, certain it is the ant. tart, has for a
great while, held an exalted rank among the class of expectorants.

1846.] Remarks on Pneumonia and its Treatment. 201

Next to venesection and the tartarized antimony, in importance as
a therapeutic agent in this climate, is the sulphate of quinine, given
in large sedative or contra-stimulant doses. Now, whether this^arti-
cle can be safely used in the Northern and Western States in the-
treatment of acute pneumonia, I have not the means of informing-
myself, but that it is a sine qua non in the treatment of that affec-
tion here, admits of no doubt. I have not neglected to prescribe it
in one protracted case of pneumonia which I have treated the pre-
sent winter, and always with the most pleasing success. In a very
excellent paper, published by Dr. W. W. polling, of Alabama, ir*
the July No. of the American Journal of the Medical Sciences,
the virtues of this medicine in the treatment of "Inflammatory affec-
tions of malarious districts" has been brought to the notice of the
profession. Dr. B. regards this article in large doses as a sedative
and contra-stimulant, and extols it highly. He details at length the
particulars of a number of cases of an inflammatory character, such
as meningitis, bronchitis, pneumonia, dysentery, inflammatory en-
gorgement of cervex uteri, (metrorrhagia,) inflammation of the neck
of the bladder, &c, &c, all of which were successfully treated with
quinine. I had intended to give the treatment pursued with this ar-
ticle in several cases, but for fear of making this paper too lengthy, I
am compelled to omit them. I have the notes of six cases, made
out and prepared for this purpose. I can only say that with Dr.
Boiling I agree in every particular, the result of every case of pneu-
monia which I have treated with quinine conforming to his state-
ments : given in large doses, say 5 grains, repeated every two hours,
until a scruple has been administered, it certainly possesses and ex-
erts a controlling effect on "inflammatory affections of malarious
districts." I speak advisedly on this subject. Though it is said as
a general rule, that its administration is improper and prejudicial in
inflammatory diseases, yet to this statement I feel justified most fully
in saying many exceptions exist. That our inflammatory affections,
many of them at least, assume the intermittent or remittent type, I
have repeatedly witnessed : There are usually marked exacerbations
and remissions which sometimes amount to distinct intermissions
and in those kind of cases, after free abstractions of blood, moderate
purging, &c, I commence with the ant. tart., and as soon as the
remission is perceptible, I alternate its exhibition with quinine, and
on account of its anti-periodic character, the exacerbations will be
prevented, and a full stop will sometimes be put to the complaint at

202 Remarks on Pneumonia and its Treatment. [April,

once. All the cases which I have treated with bloodletting, tartar
emetic and quinine, the present winter, with one or two exceptions,
have yielded within the fifth day. Should the disease resist these
remedies, I generally resort to calomel or calomel, opium and anti-
mony, in small doses repeated at intervals; with expectorant drinks,
and blisters to the chest or side. In those cases which have been
persistent complicated with gastro-enteritic irritation, marked by
pain and heat in the region of the stomach and bowels, nausea, gri-
ping and purging I have found nothing answer better than small
and frequently repeated doses of calomel and opium, mucilaginous
drinks, such as barley-water, slippery elm bark, or gum-water and
opiate enemata. This constitutes the plan of treatment which I
generally pursue in the first stage of pneumonia. In the treatment
of the second stage, or stage of hepatization, more reliance is placed
on mercury and its preparations than any other one remedy. Here
too, in order to subdue irritation, it is necessary to combine opium
with it, and repeat the dose frequently. It is said that this remedy
will modify the action of the diseased vessels and promote the ab-
sorption of the effused matter, and in order to insure this effect, the
medicine has to be continued until the system has been brought un-
der its specific influence manifested by soreness of the gums, mercu-
Tial fetor of the breath, &c. In this stage too will peculiar benefit
result from blistering or from pustulating the surface with tartar
emetic ointment. This is the stage too in which expectorants are
imperiously demanded. Infusions of fol. senega, cupatorium, butter-
fly-root, with carb. of potass, nitre, squills, ext. liquorice, carb. of
ammonia, are the remedies of this class I use most frequently. Ha-
ving already extended this article to a much greater length than I
intended, I shall omit the treatment of the remaining stages of
pneumonia.

I have concluded it would add something to the interest of this pa-
per, to detail the particulars of a few cases of pneumonia which I
have recently treated. I therefore add an appendix, which the edi-
tors can publish or not, at their option :

APPENDIX.

Case 1. On 3d January, was called to see Frank, a little negro
about 6 years of age. Had been unwell for several days, with per-
tussis. Three days previous to the one on which I visited him, was
attacked with pneumonia. Found him with high fever, complaining

1846.] Remarks on Pneumonia and its Treatment, 203

of pain in the chest more intense on the right than left side ; pulse
130; respiration 42; cough frequent, dry and hard; expectoration
bloody. Ordered, calomel 4 grs., rhubarb grs. xviii, to be given imme-
diately ; quinine grs. xviii., divided in six powders, one to be given
every two hours, commencing at daylight next morning at which
time there had been since his attack a remission. Jan. 5 The di-
rections had been followed, but with no perceptible amendment.
Directed, calomel grs. v., opium gr. i., divided into five powders, one
to be given every third hour, sol. tart. ant. in the intervals ; applied
a blister to chest and side, and directed quinine to be given as before.
Jan. 6 Patient improved in every respect; pulse about 90; respi-
ration 24 ; cough freer and looser, and expectorating finely. All
physical signs of pneumonia absent. Continued the quinine, and in
a short time the patient was rapidly convalescing, as I had the satis-
faction to be informed by his master.

Case 2. Elick, a negro 18 years of age, had been indisposed for
several days, with symptoms of catarrhal fever. On the night of
12th January, was attacked with chill, and on the following morning
I was called to see him. His situation was as follows: Pulse 120,
respiration frequent and laborious, acute pain over sternal region ex-
tending to right side, cough dry and hard. Ordered, sol. of ant. tart,
grs. vi., water iv. dose, a tablespoon-full repeated every two hours;
quinine 3i., divided into five powders^one to be given every second
hour alternating with preceding mixture. Jan. 14 Much improved
in every respect : pulse 90, respiration 24, easy and unattended with
pain; sfcin soft and moist, and not pretcrnaturally warm; expector-
ating freely, a thick, white, frothy mucus. Continue the prescription
of preceding day. 15th Still improving: pulse 85, respiration 22,
coughs but little. Patient says he feels belter in every respect, and
desires something to eat. Continue quinine, and discontinue sol. tart,
ant., and give a syrup composed of pol. senega, scilla, and ext. glycyr-
rhiza, repeated pro re nata. 16th Patient not so well : pulse 120;
passed a restless night; symptoms of gastro-enteritic irritation mani-
fested by pain and tenderness over the epigastric region ; nausea,
vomiting, &c; edges of tongue red, and this organ somewhat pointed?
Prescribed calomel 3>s., opium 1J grs., to be administered immedi-
ately, and followed in four or five hours with oil and turpentine.
17th Found him much better. Continue quinine. The patient
recovered rapidly. In this case, we succeeded in relieving the
patient without resorting to bloodletting, either generally or locally,

204 Sulphate and Ferro-cyanate of Quinia. [April,

or blisters, the disease having yielded to the ant. tart, quinine and
calomel and opium.

Case 3. W. S., a gentleman aged 33, was attacked on the night
of January 1st, with a hard ague, which lasted several hours. As
soon as the stage of reaction supervened, he was bled freely from the
arm, by his brother. A large blister was then applied all over the
chest and side, and a dose of oil and Bateman's drops exhibited.
This constituted nearly the whole of the treatment, until the Wed-
nesday following (7th) I was then sent for, found him complaining
of severe pain troublesome cough, high fever, surface bathed in a
hot perspiration, a little delirious at times thirst urgent tongue
coated from root to tip with white fur. Prescribed pills of tart. ant.
and opium, one grain of former to one-fourth grain of the latter,
repeated once in three hours, and as soon as the remission occurred,
quinine pills, consisting of 5 grs. quinine and 1 gr. ext. of liquorice.
On repeating my visit next day, patient was better : pain relieved in
a great measure, thirst abated, breathing easier, inclined to sleep.
Pills of opium and tart, had made him very sick through the night,
and he had vomited once or twice. Complained of deafness, tinni-
tus aurium, &c, which effects I ascribed to the quinine. Kept him
on the preceding treatment for a day or two longer, when the disease
yielded, and the patient is now well, Jan. 26th.

I could detail several othercases, but I presume it is unnecessary.
To those who have never tried the quinine plan of treatment, I would
recommend its adoption in the first favorable case which presents
itself, and I think they will have occasion to be pleased with the re-
suit of their practice. I do not recommend it as superior either to
venesection or the tart, ant., but as a valuable auxilliffry to those
remedies in the treatment of pneumonia, in this climate.

ARTICLE XII.

Practical Remarks on the Sulphate and Ferro-cyanate of Quinia.
By H. V. Wooten, M. D., of Lowndesboro, Ala.

Perhaps no article of medicine has ever grown so rapidly and ex--
tensively into use, within the same period of time, as has the Sulphate
of Quinia, within the last few years. It is now justly regarded as
the Sampson of the Materia Medica in our Southern climate, and

1-1"). J Sulphate and Ferro-cyanate of Quinia. 205

more especially in all malarial regions. Ten years ago, when I com-
menced the practice of medicine in Alabama, I found physicians
almost unanimously relying upon calomel, as the chief, and often the
sole means of combating all the various forms of disease, and disor-
dered action, which were comprehended in the general term, " Fever. "
Ail forms of enteritis, of intermittent and remittent, as well as every
other disorder, exhibiting prominently amongst its symptoms febrile
excitation, were charged to the inaction of the liver, and calomel, as
the most potent of its castigators, was sent down in quantities propor-
tionate to the amount ofsluggishness presumed to exist in the physio-
logical action of that organ.

Passing by the pathological error upon which this practice was
predicated, and saying nothing of the absurdity of uniformly stimu-
lating an organ to action, without stopping to ascertain whether its
state of excitation was above, or below the secreting point, it maybe
sufficient to refer to the fact, that while this practice prevailed, our
summer and autumnal fevers remittent and congestive were justly
viewed with a horror equalled only by the devastation and death which
marked their history. But the practice in these diseases is new
greatly changed, and their destructive character proportionately les-
sened. Still, however, we have some practitioners, who adhere, in a
great degree, to their old notions, of pathology and therapeutics; but
they are fast yielding to the force of a more enlightened view of the
fevers of our climate, and as they yield, the fevers lessen in their
horrible fatality.

This change in practice, is attributable to the more valuable, and
I may say. specific powers of the quinia in the febrile diseases of
our warm and miasmatic regions. It was the fashion in past years,
not to jjse the sulphate of quinia during the existence of the least
febrile action, or while there was reason to apprehend the presence of
any inflammatory action in any part of the system, and I used it in
accordance with the prevailing fashion of the time, only during com-
plete intermission of fever, or during convalescence, as a tonic. Under
these views, I found myself continually encountering the most em-
barrassing difficulties. A patient would be seized with chill in the
morning; at night a partial abatement of fever would ensue, but
much general irritation, with restlessness, frequency of pulse, &c,
would continue, with dry tongue, headache, thirst, &c, until next
morning, when, in the midst of this febrile action, another chill would
occur, less distinct than the former, but followed by much higher

206 Sulphate and Ferro-cyanate of Quinia. [April,

general irritation. During these paroxysms, purgative doses of calo-
mel, and other medicines would act very well, but the fever would
progress to the third paroxysm, which would either destroy the pa-
tient, or produce such extensive visceral engorgement or inflamma-
tion, as to place his life in extreme hazard, and subject him, at best,
to a tedious, and exhausting continued fever.

Having met with little to encourage me in the treatment of these
fevers, under the customary method, I determined in the summer of
1839, to try the anti-periodic powers of the sulphate of quinia, upon
the paroxysmal exacerbations, regardless of fever. So I commenced
by prescribing two grains every two hours in some mild infusion,
beginning at such an hour as would enable the patient to take four
doses by the time for the anticipated paroxysm 5 and from the first, I
was gratified by meeting better success than I had dared to anticipate.
I found some cases, in which the feverish excitement was apparently
increased by the remedy, but it never failed to break up the periodical
exacerbations, and the fever, which the quinia seemed to increase,
subsided in a very few hours, to rise no more. On observing that
those patients who took the remedy most freely, suffered least general
irritation during the fever, I increased the dose, and when I had no
doubt about the hour at which to expect the paroxysm, (the object
being merely to impress the nervous system,) I would give but two
doses of five grains each, the last to be given one hour before the
paroxysm, or one dose of from ten to fifteen grains, two hours be-
fore the paroxysm, and with the effects of the increased doses I was
greatly pleased. The patient remained more quiet and comfortable
than when under any other medicinal influence. The quinia seamed
to act in the double capacity of a sedative and diaphoretic. Since
adopting this plan of using the quinia, I always feel confident of my
ability to control all cases of fever, at all marked by periodical exacer-
bations and remissions, in which organic inflammation is not already
too extensive, and far advanced to admit of relief. And here I may
remark 1st, that I have been surprised at the very large proportion
of cases, which had usually been called "continued fever," that, on
close investigation, are found to exhibit this periodicity in their
course; and 2nd, that however great the organic inflammation may
be, and in whatever way induced, it is nevertheless necessary, to
check and control the periodical returns, or I may, perhaps, better
say the nervous disorder, before our remedies for the existing in-
flammation can have fair play. I mention the quinia, not as the sole

1846.] Sulphate and Ferro-cyanate of Quinia. 207

remedy in these diseases, but as an absolutely necessary part of any
system of treatment from which we may confidently expect success,
in cases of any violence. I have met with many cases in which the
organic inflammation had so entirely effaced the paroxysmal charac-
ter of the fever, that I could never suspect its existence from the
symptoms presented. In such cases, when from a reliable history of
their progress I can ascertain the existence of the periodical changes
in the beginning, I do not hesitate to administer the quinia, just as
though the paroxysms continued to recur, at the same hour as in the
beginning of the case, allowing for the anticipations which usually
mark the first three returns. In adopting this course, I have very
rarely been disappointed in its good effects, and not unfrequently I
have seen such cases, in which the patient was nearly exhausted,
when the introduction of the quinia, properly timed, seemed to arrest
the course of the disease, and at least put the patient in a curable
condition. I am thus general, and brief, in repeating my views on
the use of quinia in our summer and autumnal epidemics, because
the practice mentioned has now become so general amongst enlight-
ened physicians as to render detail unnecessary, and doubtless irk-
some, to many readers.

There is, however, another class of fevers in which I esteem the
use of the quinia of great importance, but in which I apprehend few
practitioners use it, at least to a profitable extent I allude to our
winter epidemics. But a short time has elapsed, since the bare idea
of administering quinia in high inflammations of the respiratory appa-
ratus, would have been branded as absurd, if not actually criminal.
Indeed I have heard the criminal brand put upon the suggestion, by
an old practitioner, during the past twelve months. I am not pre-
pared to assert, that the quinia exerts any curative effect over pure
inflammation : I feel, confident, however, that in proper forms, it
does not exercise any such injurious influence in that disease, as has
been ascribed to it. But in all fevers, there is a prominent disorder
of the nervous system, which, it seems to me, requires a remed}'.
This disorder may be primary or secondary. The languor, apparent
exhaustion, and the irregularity with which the vital powers are ex-
erted, and their actions distributed, all betray its existence, and it is
too often the case that these important matters are overlooked in the
treatment. We exhaust our resources upon the structural disease,
real or supposed, whilst we neglect to attend to the regulation of
that system by whose regular actions alone, these structures can per-

208 Sulphate and Ferro-cyanate of Quinia. [April,

form healthy functions, even after we have cured them. All fevers
are not inflammations, nor are all inflammations fevers. Under
this view of fever and inflammation, I frequently administer the
quinia toact upon the nervous system, whilst at the same time, I
deplete the vascular system, generally or locally, to lessen inflamma-
tion, or relieve visceral engorgements, all with the happiest harmony
of effect.

It is not my purpose to attempt an explanation of the modus oper-
andi of the quinia. Perhaps there is no article so extensively used,
whose action is so little, or so variously understood. Many attempts
have been made to explain, or specify it, but none have perhaps gone
farther than to establish the general facts, 1st, That it exerts its ac-
tion chiefly upon the nervous system, and 2d, That its curative
powers are specifically adapted to that species of disorder to which
miasmata is assigned as a first cause. Of the truth of both these
propositions, observation has long since convinced me. The old
opinion that it is a stimulant, is fast receding before enlightened ex-
perience, and that its primary action upon nervous irritation is seda-
tive, there remains no doubt. I have thought that the effect of qui-
nia upon the nervous system, resembles that which, when exercised
upon the secretory and nutritive organs, we call " alterative,1* more
than any other, and I should prefer calling the medicine a nervous
alterative to any other therapeutic appellation. It imparts tone,
regularity and permanency of action. But, to return :

When, in any locality there is a particular epidemic prevailing, it is
well known, that whatever other disease may arise within the infect-
ed district, will be modified, if not controlled by the prevailing epi-
demic poison. This is witnessed during the prevalence of measles,
scarlatina, &c. But this law of epidemics, is no where better ex-
emplified than in our Southern malarial regions. Whatever may be
the prominent character or prime cause of diseases occurring in
these regions, if the nervous system is so far involved as to produce
fever, we will generally find, upon close examination, that they par-
take more or less of the remittent character. The inflammatory
affection may preserve its uniformity, but there will be some of the
symptoms as the febrile excitement, irregularity of temperature,
pains in some particular part of the system, &c, which will be found
to undergo a regular remission and exacerbation at particular periods.
This modification, I have thought attributable to the same malarial
influence, which controls the character of our summer and autumnal

1846.] Sulphate and Ferro-cyanatc of Quinia. 209

epidemics, and I have found my views answered by the most satis-
factory results from the treatment which they suggested.

It is not at all uncommon to meet with very grave cases of pneu-
monia, which, resisting all the powers of an active anti-phlogistic
treatment, and such adjuvant remedies as are usually resorted to in
the treatment of diseases purely inflammatory, will go on from day
to day, undergoing no apparent change, except a gradual exhaustion
of the patient, until death is the result. On scrutinizing the pro-
gress of these cases, however, it will be found very generally, that,
at some particular period, either once in twenty-four, or forty-eight
hours, there is a reguiar exacerbation of excitement, or some other
periodical action, in the system, and which on every return aggra-
vates the disease, or at least neutralizes the amelioration which may
have been attained.

I have met with cases of almost every disease, which were modified
by this periodic disturbance, either primarily, or after the general
system had become deranged, and the important visceral functions
disordered. For instance, I am at this time attending a case of cys-
titis, produced by contusion, in which for several days, the patient
underwent a daily exacerbation of fever, followed by diaphoresis, and
all of which, I may add, was relieved by the use of the ferro-cyanate
of quinia. I will now give two cases, which will perhaps serve to
illustrate the complication of disease of which I am speaking, and
also the effects of the remedy alluded to.

1st. I was called to a child aged six years, previous health good.
Had been confined to bed ten days with constant fever, surface dry
and warm, pulse 140, small and corded, much general restlessness,
and considerable dyspnoea, tongue dry and brown, thirst considera-
ble, countenance anxious, complexion pale, but rather livid over the
cheeks. On examination, found the two lower lobes of the right
lung heavily engorged, and the upper exhibiting throughout the mu-
cous rattle, which was also discovered to some extent in the left.
Had been bled twice in the early part of the case ; had taken purga-
tives, diaphoretics, expectorants, and been blistered, all under the
care of a physician, who was still in attendance. The child's mo-
ther expressed great fear that it would not live through the next day,
as it was its worst day. This expression gave rise to enquiries, from
which I ascertained, that every morning about four o'clock, the fever
would somewhat abate, and about six commence rising again ; and
that on every second day, the fever and all the other symptoms were

14

210 Sulphate and Ferro-cyanate of Qui nia. [April,

much worse. This being its better day, it really seemed that the
mother was right in her apprehensions, as it appeared to me impos-
sible that the child could get much worse and live. I advised the
administration of ten grains of the sulphate of quinia in four doses,
to be taken one every second hour, commencing at 10 o'clock, P. M.
in infusion of flax-seed. The attending physician, after some hesi-
tation, agreed to it as a sort of desperate resort. Next morning, at
8 o'clock, found the patient under the peculiar influence of the quinia,
general warm perspiration, pulse 104, tongue moist, but still coated,
complaining of uneasiness in the frontal region, which he was con-
tinually inclined to press, respiration slower, but still embarrassed,
cough easier, but still frequent. This instead of being his worst
day, was really, (excepting the annoying effects of the quinia) the
best that he had had since the attack. The quinia was administered
the next night with similar results. From this time the patient con-
tinued to improve very rapidly, considering the amount of pulmonic
inflammation under which he labored, and very soon got entirely
well, under the usual treatment, having no more "bad days."

2nd. A lady, aged 35, previous health good, (excepting a few par-
oxysms of intermittent fever three months previous,) was taken two
days before, with a very acute pain in the right side of the chest,
increased by deep respirations ; cough, and general fever, headache,
some nausea and vomiting, but, altogether, did not think herself very
sick until three hours before I saw her, when she was seized with a
sudden increase of pain, which was very severe. I found her suffer-
ing intensely, very restless, high fever, pulse 130, and breathing
difficult, on account of the pain in the right lung. On attempting
percussion, she complained of such acute pain from it, that I wa3
compelled to desist. Bled to xx. Hot mustard pediluvia. Gave
viii. grs. Dover's powder, with ii. grs. calomel, every two hours, un-
til three doses were given. Flax-seed tea to be given freely ; coun-
ter irritation over right lung. Called next day : patient much better ;
fever continues; cough easier and less frequent; soreness of chest
much less, but suffers considerable pain on coughing; expectorates
pretty well ; calomel purged twice ; skin moist. Called on the fol-
lowing morning, and found patient still improving, though with some
fever. Left a diaphoretic and expectorant prescription. On the
afternoon of this day, was sent for in haste, patient represented as
getting rapidly worse ; found her very much in the same condition
that I saw her in on first visit, with all the bad symptoms increased

134G J Sulphate and Ferro-cyanale of Quinia. 211

in violence. I remained with the patient four hours, during which
time the usual means of relieving pain and allaying general irrita-
tion, were resorted to, and all the violent and urgent symptoms sub-
sided. It now occurred to me that these grave symptoms, or parox-
ysms of irritation, were periodical in their occurrence, doubtless, a
malarial complication of the pulmonary inflammation under which
the patient labored, and from an observation of similar cases I was
convinced that every paroxysm would aggravate the inflammation,
and eventually endanger the life of the patient. On suggesting the
Use of quinia the patient strenuously objected, contending that her
system was peculiarly opposed to its introduction ; that it always gave
her great pain in the head, deafness, &c, which would last several
days, and, to use her own words, that it "run her crazy." She
finally yielded, however, and consented to try it. I directed the next
paroxysm to be anticipated by four doses of the sulphate, of five
grains each, to be administered two hours apart, so as to take the
last about the hour for the paroxysm. I visited the patient about two
hours before the time of the paroxysm, wishing to witness the effects
of the medicine upon a system peculiarly opposed to it, and taking it
whilst laboring under inflammation and fever. When I arrived she
was already under its influence. Pulse 112, full and soft; tongue
dry, nausea, deafness, great uneasiness and "roaring" in the head,
much general restlessness and anxiety. Notwithstanding these
symptoms, I administered the remaining dose, at the appointed hour,
and these disagreeable disturbances continued about eight hours, when
they began gradually to subside, but there was no return of the par-
oxysm ; the case continued to improve in every respect, and at the
end of four days the fever, and effects of the quinia, all subsided
together.

I have cited these two cases : the first, to illustrate the effects of
the sulphate of quinia when it acts most happily in inflammation
and fever, and the second, to exhibit its effects under similar circum-
stances, but on a system peculiarly opposed to its use. Between
these two extremes, I could cite a great number of cases of inflam-
matory disease of almost every organ, in which the quinia was used
with good effect. It must be remembered, that I do not claim to
have cured inflammation with this medicine, but to have relieved it
of a distressing, and often controlling and dangerous complication,
with which we very frequently, I i generally, find it connect-

ed, in all malarial regions. Yet 1 would nui be understood as assert-

212 Sulphate and Ferro-cyanate of Quinia. [April,

ing that the quinia is necessary in all cases of disease, even under a
malarial atmosphere. I meet with cases occasionally, in which I can
find no indication for its use. On the other hand, we sometimes
encounter winter epidemics, of pneumonia particularly, which re-
quire its free exhibition from the beginning. The patient will be
seized with chill, great prostration, frequent and feeble pulse; the
skin will be either dry, or bathed in perspiration, continuously ; the
extremities will remain cool, and the patient will die in a very few
days, if not relieved promptly. Bleeding will not be borne, and
quinia, in large doses, I have found the most reliable remedy. In
fact, in many cases of this class, it will restore the patient, when
nothing else within my knowledge will. When it is rejected by the
stomach, I find great advantage from combining with each dose, one
or two grains of pulverized capsicum ; but when, as sometimes hap-
pens, I cannot introduce it effectually by the stomach, I combine it
with morphine, mixing it in as small a bulk of mucilage as possible,
and introduce it by the rectum. When driven to it, I have found this
a very excellent expedient; the object being, as before remarked, to
impress the nervous system. I think there are a great many cases
of inflammatory disease, in which this malarial influence upon the
nervous system, is the chief point to be attended to, and it will fre-
quently be found, that cases which exhibit such high evidences of
disease as to be pronounced hopeless, will turn out quite manageable,
after this point is attended to. I have hacfc several cases, which I
considered hopeless, but after I had restored the balance of nervous
action, I have been surprised to find how nearly clear of disease
they were.

But it is objected, that the sulphate of quinia produces in the sys-
tem, very often, very annoying disturbances, which are highly objec-
tionable in inflammatory diseases. This I may admit, but must be
permitted to remark, that although I have administered it in all cases
where it is desired to impress the nervous system with its powers,
regardless of fever or inflammation, and that, allthough I have seen
its worst effects in a variety of cases, yet I can freely say, that I have
never witnessed a single case, in which its disagreeable effects were
more than transient in duration, and that I have neirer seen a case,
in which I believed that inflammation was increased, or fever perma-
nently aggravated by it. This brings me to the main object of this
paper viz : the consideration of the Ferro-cyanate of Quinia.

It was long a source of much anxiety to me, that in exerting what

1845.] Sulphate and Ferro-cyanate of Quinia, 213

I considered an indispensable action upon the system of my patients,
I was at the same time producing at least temporary uneasiness and
distress, when about two years ago, I read in a French journal, an
account of the preparation of the Ferro-cyanate of Quinine, by a
French chemist. It occurred to me, from a little reflection upon the
subject, that it would in all probability answer the purpose of a sub-
stitute for the sulphate, in all those peculiar cases, in which I had so
long felt the need of one a remedy which would exercise all of what
I may call the sedative and alterative powers of the sulphate, without
so great a liability to create distress as that article. I accordingly
procured an ounce of the ferro-cyanate from New- York, and after
considerable hesitation, commenced the cautious use of it. I had
mislaid, even the slight notice above alluded to, and was consequent-
ly entirely without a guide. Being afraid that I might either work
injury with it, or so administer it as to fail in obtaining its good
effects, I first used it in the treatment of typhoid fever.

Whatever may be the essential physical lesion in this fever, I have
long been convinced, that the nervous system has no inconsiderable
portion of the burthen to bear. I have read several attempts to de-
scribe the differences betwixt typhoid and remittent fevers, but am
yet satisfied, that a great many cases occur, of dothinenterite, in
which the nervous system is disturbed precisely as in remittent fever,
only that the remissions and exacerbations are not usually so distinct,
particularly after the first few days. How these things may be else-
where, I cannot say ; but here, in our warm climate, and malarial
atmosphere, scarcely a case occurs, whatever may be the evidences
of follicular enteritis, which is not marked by great disorder of the
nervous system, as well as decided periodicity of febrile excitement.
So general is this disorder of the nervous system in these fevers, that
they have acquired the name very generally amongst the people, of
"nervous fevers." I believe, that there are many cases of ilietis,
with remitting fever, which are cured by timely remedies, that would,
if left alone, or badly treated, result in that peculiar disease of the
intestinal glands, which is said to exist alone in typhoid fever. To
control, and regulate the action of the nervous system in these cases,
there is nothing equal to the ferro-cyanate of quinia it does not
only break up the pcriodial accessions of febrile excitement, as does
the sulphate, but it seems to exert, much more powerfully, that ac-
tion which I have called alterative, upon that system, giving strength,
restoring tranquillity, and steadiness of action.

214 Sulphate and Ferro-cyanate of Quinia. [April,

A gentleman, aged 26, of spare habit, and sanguine temperament,
had been confined to his bed with fever ten days ; lies upon his back,
apparently asleep ; countenance stupid ; answers questions with
hesitation, and as few words as possible ; complains of no particular
pain, but is unable to get up, or remain even a few minutes in a sit-
ting posture ; tongue pointed, dry, covered over centre with dark
brown coat, cracked, red edges, and so tremulous as to be protruded
with difficulty ; surface very dry ; temperature irregular, but slight-
ly elevated; no thirst; pulse 12G, small acid soft; tremor of hands
so great as to be unable to direct a glass to his mouth ; evacuations
from bowels, about once in four hours, dark, watery and offensive,
Taking a terebinthinate and mucilaginous preparation for disease of
bowels. Added to prescription three grains of ferro-cyanate of quinia,
every four hours, changing the time of the other medicine to four
hours, and alternating, a dose every two hours.

Twenty-four hours after the prescription was commenced, the
tremor of the tongue and extremities had entirely ceased ; much
more steadiness of action, and expressed himself as feeling stronger
and more alive to things around him than for several days ; surface
of pretty uniform temperature, and covered with a general healthful
moisture; pulse 100, more full and firm. Prescription continued
without alteration for three days patient continued improving gradu-
ally- at the end of three days the quinia was ordered to be given
only three times a day. Improvement continued, and patient recov-
ered in good time. No unpleasant effect was produced by the quinia
in this case, although the patient was peculiarly susceptible to the
sulphate, and usually suffered much from its use. It was my opin-
ion, founded on experience in other similar cases, that this patient
would have died, had no restorative been addressed especially to the
nervous system*

I have merely given the above case to exhibit my manner of using
the ferro-cyanate of quinia in typhoid fever. 1 could give several
others equally striking, but deeming it unnecessary to do so, I will
merely remark, that I frequently meet with cases very similar to the
one given above, marked more particularly by periodical exacerba-
tions of fever, and in which the article under consideration acted with
more decided and happy promptitude. Indeed, from my observation,
thus far, I think that it answers an important purpose in the man-
agement of this fever, to which nothing else is well adapted.

During the present winter, the character of the cases ofpneumo-

184G.] Sulphate and Ferro-cyanatc of Quinia. 215

nia, acute bronchitis, catarrhal fever," &c, with which I have met,
have often been marked by a complication altogether unusual, and
very embarrassing, viz., a diseased condition of the spinal marrow
either high irritation, or actual inflammation* which affected the
nerves both of sensation and motion. In the midst of a violent
pneumonia, or other pulmonary inflammation, the patient would be
seized with intense pain in some part of the spine, more or less exten-
sive, which would extend to all the parts to which the nerves of the
affected part of the spine were distributed, producing a mixed neural-
gia and paralysis the patient suffering irregularly recurring neu-
ralgic pains of the most severe kind, and in the same parts either
irregular spasmodic jerking of the muscles, or palsy more or less
complete. I have seen several cases resulting in complete paratysis
of voluntary motion, after a few days suffering from neuralgia, &c.
In the treatment of this new and embarrassing affection, I found
more decided benefit from the ferro-cyanate of quinia than any other
medicine: its peculiar influence seemed to be precisely that which
the disordered nervous action called for, whilst the sulphate produced
very little good, and frequently seemed only to add to the distress by
its annoying effects upon the head. I will give a single case, which
pretty fairly represents a good number that might be given, did my
limits permit.

A young unmarried lady fine stature, full form and good action,
nervo-sanguine temperament, and previous good health was attack-
ed with acute bronchitis, which was subdued in a week, leaving some
bronchial irritation, with considerable cough, and occasional slight
febrile disturbance, until, at the end of two weeks, on slight exposure
to cool air, she was seized with severe pain in the lumbar spine and
running down the right hip and thigh, to the knee, where it stopped;
much* pain also in the right side of the chest, great aggravation of
cough, constant fever, and general restlessness ; pulse 130, small but
firm. On examination the lungs gave no evidence of disease, except
a slight bronchial irritation on the left side. Bled ^xii. ; laxatives,
counter irritation to spine, and anodyne liniment to seat of pain in
other parts. Next day, every thing had had its legitimate effect, but
the distress of the patient was still very great. She now had violent
and constant tremor of both right extremities, and entire loss of vol-
untary power over them. About once in four or six hours, at irregu-
lar intervals, she would be seized with violent rigors, presenting the
appearance of one in li grave ague ; with countenance shrunken and

216 Sulphate and Ferro-cyanate of Quinia. [April,

anxious, and the pulse extremely frequent, and so feeble as not to be
counted. I was called to her during the first of these rigors : the
friends around her, supposing her to be in articulo mortis. These
rigors would last about thirty minutes, and would pass off, leaving
the patient in the former condition, with the exception of a sense of
great fatigue. After resorting to various expedients, to relieve the
distressing condition of the patient, for forty-eight hours, with nothing
but the most transient benefit, I proposed the use of quinia. At this
she became very uneasy, and made decided objection, saying that it
invariably distressed her very much, and made her deaf for several
days. She finally consented, however, to its use, as I assured her
that it was altogether important. I told her nothing of the particu-
lar preparation which I designed giving her, as I was not then suffi-
ciently acquainted with its effects, to promise any thing particularly
concerning it. I gave her four grains of the ferro-cyanate every
four hours, in pills, and continued the external remedies. She had
no rigor after taking the second dose, a warm perspiration soon en-
sued, (her skin had before remained quite dry,) and twenty-four hours
after the remedy was commenced, the tremors had entirely ceased,
and the patient was comparatively comfortable. She protested that
she was not taking any preparation of quinia, as she had not felt the
least of its bad effects. The pains in the chest and extremities had
subsided, except when excited by motion, and then were much lighter
than formerly ; her pulse had fallen to 104, and became full and soft ;
every symptom much better. She continued the ferro-cyanate, with
such adjuvants as were indicated, and continued improving, recover-
ing fully, much earlier than I anticipated.

In this case, the good effects of the ferro-cyanate, and its advanta-
ges over the sulphate of quinia, were very striking, and I have not
the slightest doubt, that they were legitimate, as they correspond so
well with at least a dozen other cases of similar character, which I
could give were it necessary to do so. I have selected the above case
as an illustration, because my opportunities of understanding it well,
were good, and because I could rely fully upon every particular
which I received, of its history during my absence.

I will give another case, of an irregular character, in which the
ferro-cyanate acted very happily, as illustrating its general use in
cases of a miscellaneous nature, if I may use the term.

A gentleman, aged forty-five, a slender frame and delicate consti-
tution, has labored under chronic bronchitis for several years, and

1846.] Sulphate and Ferro-cyanate of Quinia. 217

has suffered frequently from attacks of facial neuralgia, consulted
me during the present winter concerning his case. He was laboring,
at the time, under frequent irregular pains about his shoulders, and
through his chest, a harsh and frequent cough, with frequent but
irregular "dumb chills;" complained of constant coldness of feet,
and great general debility. He has during most of his life resided in
a malarial atmosphere, and often suffered from intermittent fever.
When I advised the use of quinia to restore the action of the nervous
system, he objected to it on account of the great distress which he
said it always gave him, but consented to try the ferro-cyanate. I
directed three grains every four hours to be continued, except during
the hours of sleeping, until twenty doses were taken, unless its im-
pression was previously decidedly manifest. After the first three
doses his "dumb chill" ceased. His neuralgic pains gradually sub-
sided under its use, and gave way entirely before the quantity was all
taken. His circulation became well distributed, his feet warm, his
pulse less frequent. His strength greatly improved, with steadiness
and tranquility of nervous action. And, at the end of a week, he
expressed himself as feeling much better in every respect, than he
had since the commencement of his cough, which he thought was
also greatly benefited by the medicine. It produced none of the
much dreaded effects which he had always suffered from the sulphate.
He has since continued the occasional use of it, which he thinks
benefits him very much. In this case, there was pretty extensive
bronchial inflammation, which, instead of being aggravated, really
appeared to be benefited.

I have, altogether, used the ferro-cyanate of quinia in about fifty
cases, presenting a great variety of symptoms and diseased action,
but in every case it was addressed particularly to some disease, or
disorder, of the nervous system, upon principles which I have at-
tempted to set forth above, and in no case have I been wholly disap-
pointed in its effects. It should not be understood that I have cured
all these various cases by this medicine alone. It was only applied
to one general class of morbid actions, which frequently gave it a
merely subordinate position, whilst again, in other cases, it acted the
part of an indispensahle remedy. When pure, I have found it to act
uniformly without those unpleasant effects which generally arise
from the use of the sulphate, whilst it is just as certain, and more pow-
erful, as an anti-periodic remedy. It lessens the frequency of the
pulse, and gives tone and regularity to its action. It is more of a

218 Sulphate and Ferro-cyanate of Quinia. [April,

sedative to nervous irritation than the sulphate, and I believe that it
will be found to act more uniformly as a diaphoretic than any other
medicine. Being at first unacquainted with its effects, I gave it in
very small doses, but experience soon led me to use it in doses of
from two to five grains, according to the promptness of effect desired.

In ordinary cases of intermittent fever, I cannot see that its effects
are superior to those of the sulphate, (except that it gives no uneasu
ness,) and as it costs about double the price I continue to use the
sulphate in most cases of that disease. But in cases in which there
is febrile excitement or inflammation, where the use of quinia is indi-
cated, I use the ferro-cyanate altogether, as I find it more certain and
decided in its good effects than the sulphate, and not liable to produce
any of the disagreeable disturbances of that salt. And I may add,
that I use it with full confidence in all cases where I wish to exert a
sedative and alterative, or regulating power upon the nervous system.

For near two years, I have been on the look out, amongst the
Medical Journals, to find something on the use of this article, and
have seen nothing at all, until very recently. I met with a single
case, reported by Dr. Fenner, of New Orleans, of intermittent fever,
treated with it in five grain doses, and in which its effects correspond
with those which I have always obtained from it. This case is all that
I have seen of its use elsewhere, except that Dr. F. merely observes
in his note, that it is pretty extensively used in that city, but gives no
particulars. I think it a most valuable accession to our medical re-
sources, and one that ought to be known, and used by the profession
generally, and entertaining this opinion, I have offered these few
facts and thoughts of mine, to the profession, hoping that they may
induce someone to give a more thorough investigation to the subject
for common benefit. I have put them together during leisure mo-
ments, when my mind was frequently engaged, and my body greatly
fatigued with different matters, and of course, I claim for them no-
thing like perfection, but simply an attentive reading, and a candid
experimental examination.

I will remark, in conclusion, that the ferro-cyanate of quinia, from
its high price, is particularly liable to adulteration, and those who use
it should be very sure that it is pure, or they may condemn it unjustly,
as I was about doing while using my second ounce, which was found
to contain a large portion of the sulphate.

184G.J Abortive Treatment of Phlegmonous Inflammation. 219

PART II. REVIEWS AND EXTRACTS.

ARTICLE XIII.

Abortive "Treatment of Phlegmonous Inflammation by Sub-cutaneous

Incisions.

Dr. Jules Guerin, of Paris, publishes in the Gazette Medicale
(Dec. 20th and 27th, 1843) a very interesting memoir on the subject
of the Abortive Treatment of Phlegmonous Tumors by means of sub-
cutaneous incisions, and adduces in support of his views a series of
cases in which this method proved successful. In order to convey,
in the briefest manner, some idea of the circumstances in which this
plan has been adopted, we give the following abstract of M. Guerin's
cases :

Case I. Sanguineous tumor occurring five davs after the section
of the sacro-lumbalis and longissimus dorsi, in consequence of the
introduction of air into the wound and of the rupture of the cicatrix
symptoms of commencing inflammation. Sub-cutaneous puncture
occasions the discharge of black semi-coagulated blood, and is follow-
cd by resolution, without accident.

Case II. Sanguineous tumor in the right lumbar region, after the
sub-cutaneous section of the sacro-lumbalis, and occasioned by the
introduction of air into the wound. Inflammation was beginning,
when a sub-cutaneous puncture was made, which gave issue to black
and grumous blood, and was immediately followed by relief, and
subsequently by adhesion by first intention.

Case III. Commencing phlegmonous tumor in the dorsal lumbar
region, consequent on a sub-cutaneous section of the common mus-
cular mass of the right side and the ingress of air into the wound
acute local pain, extending to the entire limb ; great tension of the
skin; conical tumefaction; impending suppuration; intense cepha-
lalgia; fever; movements attended with great pain in the region of
the tumor. A sub-cutaneous puncture being made gave issue to
blood mingled with gas, and was immediately followed by a cessation
of the local and general symptoms.

(' lse IV. Phlegmonous inflammation of the axillary region, pre-
ceded by general indisposition and gastric derangement pain, tume-
faction and redness increasing for three days. The sub. cutaneous

220 Abortive Treatment of Phlegmonous Inflammation. [April,

puncture and discharge of blood relieved the pain immediately, but
some induration continued ten days, and terminated by resolution.

Case V. Spontaneous inflammation and tumefaction of the palm-
ar surface of the distal phalanx of the index finger, of two days
standing, considerable tension, lancinating pains at the end of the
finger, tenderness of the whole hand, movements impossible, irregu-
lar fever, loss of sleep. A whitlow was forming. Sub-cutaneous
puncture and incision attended with immediate relief of the acute
symptoms, and cure by resolution.

Case VI. Intense phlegmon of the dorsal surface of the left
wrist, of six days standing; considerable swelling; redness; acute
and lancinating pains ; commencing suppuration : movements of
wrist and fingers impossible; continued fever ; cephalalgia; loss of
sleep. Sub-cutaneous punctures ; discharge of blood and pus im-
mediate relief; cure.

The abortive treatment of phlegmonous inflammations consists of
a sub-cutaneous puncture, which should extend through the whole
disease so as to liberate the strangulated tissues, but should not
wound the internal surface of the skin. The first object of the oper-
ation is to deplete the tumor and reduce its phlogosis ; the second to
give issue to the morbific principle or principles which may have oc-
casioned it. It is therefore important that the instrument be made
to reach and divide the entire thickness of the cellular tissue in which
it is principally seated. If a horizontal incision does not prove suffi-
cient for this, if a certain quantity of blood flowing from the circum-
ference and centre of the nucleus does not suffice, it will be neces-
sary to make vertical and transverse incisions in addition to the
horizontal, such will most probably be needed in extensive tumors,
in which a mere horizontal incision might not succeed. It is scarcely
necessary to add that the operation should be performed with the
precautions recommended in all applications of the sub-cutaneous
method, viz: that the orifice should be small, remote from the scat
of disease, and made, whenever possible, in a cutaneous fold. The
puncture should for the same reason be covered with adhesive plaster.

It is important to use a proper instrument. The ordinary bistoury
and all instruments having a wide blade and extensive cutting edge,
are objectionable. It should be a grooved director with a lance
point (sojide cannelee a dard) or rather a*bistoury made like a double
edged lance (bistouri enfer de lance a double tranchant). The in-
strument should be held in the wound as long as an v discharge issues,

1S4G.] Ulceration of the Gums in Children. 221

and if one puncture does not suffice, it should be repeated once, twice,
thrice, always in a new place, and at such intervals as may be deem-
ed necessary.

Dr. Guerin advises this practice in all cases of sub-cutaneous in-
flammation, attended with tumefaction and pain, and thinks that the
sooner it is instituted the better although it may be useful at all
stages of the disease. He insists that this does not prevent the anti-
phlogistic means.

Ulceration of the Gums in Children occurring in an epidemic form*
By James F. Duncan, A. M. M. B., Fellow of the King and
Queen's College of Physicians in Ireland, &c, <kc* (From the
Dublin Journal.)

The disease to which I allude is a very severe and fatal ulceration
of the gums and mouth of young children, attended with high fever,
and apparently of an epidemic origin. At least I have never observ-
ed any case of the complaint in the workhouse, during the five years
it has been opened, till the last winter, and since then I have met
with eight or nine instances. The age of the patients varied from
about a year and a half to five years. I have no reason to believe
it infectious, but in more than one instance it attacked a second
member of the same family. Generally speaking, the attack was
preceded for some days by diarrhoea ; but from the period of life
corresponding often with the occurrence of dentition, this feature
was not always sufficient to attract the attention of the mother, and
little was done to arrest its progress till the condition of the mouth
was observed. The children at first did not seem to suffer pain in the
bowels, and could bear the usual pressure of manual examination
without inconvenience. The alvine evacuations were usually un-
healthy, but they differed in appearance in different cases. Some-
times they were thin and watery, but not deficient in bile; more
generally they were whitish, and exceedingly offensive ; and in al-
most all of them blood was discharged, either in a fluid state or
mixed with jelly-like mucus. When this diarrhoea had continued a
week or ten days, the mother would mention that the child had a sore
mouth, and on examination it would be found that the gums were
ulcerated, and the fangs of the teeth exposed, and covered with a

We regrei that our limits will not permit us to publish this article entire.
The frequent accusations of unskilful treatment made against physicians when
cases of gangrenous ulcerations of the mouth occur in their practice, and the
unjust prejudice which such cases often produce against a valuable remedy as
the sole cause, render the views of an intelligent practitioner like the author of
this article, of much inti [Eurs.

222 Ulceration of the Gums in Children. [April,

yellowish white sordes. According as the disqase advanced, the
gums lost their pale flesh colour, and became red, swelled, and
spongy, and the margins exhibited a tendency to bleed, both spon-
taneously and on being touched. In one case, where the diseased
condition of the mouth had not previously been noticed, haemoptoe
occurred in so marked a form as to be regarded by the anxious mother
as confirmatory of her suspicions that the child was far gone in con-
sumption, an opinion she had already formed, and not without reason,
from the peculiar and long-continued delicacy of appearance of the
child. On examining the mouth the true source of the sanguineous
discharge was detected. The breath gradually became offensive,
and the secretion of the salivary glands increased, so that the saliva
used at times to flow from the mouth and even to wet the pillow on
which the patient lay. Partly from the attending fever, but princi-
pally from the tender and inflamed state of the gums, the children
were unable to take food, but their thirst was often excessive. In no
instance did I observe the teeth to fall out ; probably because, in fatal
cases, death took place, from the constitutional irritation running so
high, before the local affection had time to produce its legitimate ef-
fects. I did not examine the teeth, to ascertain whether they were
loosened in their sockets or not. At first the disease did not appear
urgent, but as soon as the ulceration of the gums took place, and
especially if appropriate means to arrest its progress were not adopt-
ed, it advanced with considerable rapidity to a fatal termination.
When this event occurred it seemed due rather to the violence of the
attending fever, or the intractable persistence of the diarrhoea, than
to any peculiar changes effected in the condition of the mouth. In
some of the cases the disease seemed to be arrested for a time, the
diarrhoea being completely checked, the alvine evacuations improved,
the appetite restored, and every symptom of a permanent convales-
cence being visible, when, after a time, the former symptoms would
return in a severer form, and resisting all measures of a remedial
nature, hurry the victim to the grave. The condition of the gums,
presenting a certain superficial resemblance to the usual effect of the
administration of mercury on these organs, might easily lead to
serious mistakes as to the real cause of this affection ; and involve
the attending practitioner in undeserved reproach. In the present
instances I have no hesitation in saying that the disease originated
in a constitutional condition, and not at all in the use of that mineral :
an opinion in which I am sure the members of the section will agree
when I mention that some of these children had been for months in
the house previous to the attack, and had taken no medicine of any
kind for a long period before ; and that while I have always been in
the habit of using mercurial preparations with the freedom that
seemed necessary for the proper management of those important
inflammations to which children arc liable, I have never had an op-
portunity of witnessing the disease till the commencement of the last
winter. It is true that in both cases we observe ulceration of the

18-lG.j Ulceration of the Gums in Children. 223

gums, factor of the breath, and increased secretion of saliva, but these
symptoms differ in a remarkable manner in the idiopathic and mer-
curial gingivitis, as will be fully explained hereafter. Mercury, so
far from having a tendency to produce the disease, I have found can
be safely exhibited while it exists, and exerts rather a beneficial in-
fluence in checking its advance.

That an impaired state of the constitution is the true cause of this
affection, may, I think, be inferred from a variety of circumstances
connected with its history. I have already alluded to the fact of its
having been found, in two instances, to attack two members of the
same family, and this not depending so much on proximity of place,
as on similarity of habit, either natural or acquired. The red and
swollen and spongy condition of the gums, with their tendency to
bleed, naturally points out some analogy between it and purpura
hemorrhagica, an opinion still further confirmed by the sanguineous
discharges by stool that have been noticed in every easel have met
with.

The importance of establishing a clear and satisfactory diagnosis
between this disease and the Common form of mercurial ulceration of
the mouth is so self-evident, that I am sure it needs no apology on
my part for dwelling on it more at large than would otherwise come
withinthe purpose of the present paper. And as all the reasoning
about to be produced in support of the opinion, that in no respect is
mercury to be regarded as an exciting cause of the disease, applies
With equal force to cancrum oris, I shall take the liberty of referring
to it at some length, as being more generally known, and as being
still a subject of dispute as to its real origin* Indeed I think it may
be fairly inferred that the two affections differ only in intensity.
The infant constitution in the one yielding to the violence of the
fever, before the local gangrene has developed itself. This is confirm-
ed by the circumstance that since this paper was read at Cambridge,
another case has occurred in a child, and ran on to actual gangrene
of the cheek. Many persons believe that although some cases of
cancrum oris occur independently of mercury, the majority of those
Usually met with arise from the incautious use of this medicine, and
that blame is of course attached to those persons who have been the
agents of its administration. Were this opinion to be sanctioned by
authority, we should be obliged to abandon the use of this most valu-
able class of medicines under all circumstances, for as no one can
discover beforehand the existence of that peculiar idiosyncrasy which,
according to this hypothesis, determines the danger of using them,
the only alternative that would be left to us would be the total disuse
of mercurial preparations on the one hand, or the risk of occasionally
producing this dangerous result. But if it can be shewn, as I think
it can, that mercury has nothing whatever to say to the disease, that
even when it has been administered conjointly with the occurrence
of the affection, it is entirely beside the line of causation, all this un-
pleasant apprehension will necessarily vanish, and we shall be enabled,

224 Ulceration of the Gums in Children. [April,

on fitting occasions, to avail ourselves of the assistance that these
medicines are calculated to afford.

The importance of this point will be better understood when it is
recollected how very frequently, even of late years, accusations have
been brought against medical men of unskilful treatment, or even of
causing the death of their patients by the exhibition of mercury,
when the occurrence of cancrum oris was the real cause of the ca-
lamity. In many cases, it may be presumed, the unkind suspicion
has been permitted to rankle silently in the breast of the surviving
relatives, and to operate to the prejudice of the professional man in
their subsequent intercourse with him. And in other instances,
where less delicacy has been felt, the charge has beqp publicly pre-
ferred, and the unoffending physician has been dragged, on a coro-
ner's warrant, into open court, to answer the accusation at the bar of
public opinion. In these cases it is almost needless to add, that
whatever may be the verdict of the jury, an unfavorable impression
is apt to remain on the minds of the public ; to be accused is tanta-
mout to be convicted. Few persons take the trouble to inform them-
selves correctly of the true state of affairs, and of those who do few
are candid enough to be convinced by the arguments they hear, in
opposition to the weight of previous prejudices and long-cherished
opinions. The following case, copied from Dr. Taylor's Manual of
Medical Jurisprudence, illustrates this statement in a remarkable
manner :

A boy, ret. 3 years, while suffering under an attack of measles,
took small doses of mercury by the prescription of a physician* Soon
after the administration of the medicine the child became worse, the
mouth became inflamed, dark, and discolored, and the teeth dropped
out. He died in a few days. A practitioner who had been called in
subsequently, pronounced that tho child had been excessively saliva-
ted. Mercury had been undoubtedly taken, and it was proved that
the person who dispensed the medicine did not weigh it. An inquest
was held, and a verdict returned that the child had died from an over-
dose of mercury.

But a still stronger instance occurred to Dr. Marshall Hall, who
was himself one of the first to bring the disease under the notice of
the Profession, in the Edinburgh Medical Journal. It is put upon
record in the Lancet for 1839-40. He there states that he was
summoned as consulting physician to the Western Dispensary, Lon-
don, to visit a little boy, in Nov., 1839, aged 4 years and 4 months,
at No. 28, Charles-street, Lisson-grove. Two gentlemen met him
in consultation there. On examination he found the boy affected
with gangrena oris. He explained the nature of the case fully to
both the parents at the time. What was his surprise to find, after
the death of the boy, that the father had demanded an inquest, under
the suspicion that the affection of the mouth and cheek was the effect
of the calomel that had been prescribed for his son ! He does not
mention what was the verdict returned in the case* but it is easy to

1846.] Ulceration of the Gums in Children. 225

see, (hat had the gentleman in attendance been ignorant of its real
nature, or had they not taken the obvious precaution of explaining
beforehand its probable result, they would have left themselves open
to very unpleasant consequences. It is to be feared, that in many
instances where a second practitioner is called in to cases of this
kind, and the suspicion of improper management is raised in the
mind of the distressed relatives, the unjust accusation is to be traced
to the unworthy motive unhappily to be found in dishonorable minds,
of endeavoring to advance their own interests by the sacrifice of ano-
ther's reputation. But however true this may be in certain cases, I
think it is probable, that generally where such a charge is advanced,
the real circumstance that has led to its adoption has been ignorance
of the true nature of the disease, and confounding it with an affec-
tion to which it bears some resemblance, but from which it differs
essentially.

It is quite plain, that in order to sustain such an opinion as that
mercury is the real cause of cancrurn oris, it would be necessary, on
the part of the advocates of that opinion, to prove that it never occurs
except in persons to whom that mineral has been administered, a
proposition that is known to be decidedly erroneous. Many cases
are upon record where not a single particle of mercury had been ad-
ministered, in any form or shape, internally or externally Dr.
Taylor, in the work already quoted, gives an instance of a case
which occurred in August, 1840. where a charge was brought against
a medical practitioner of having caused the death of a child aged 4
years, by administering an over-dose of some mercurial preparation.
The child had been laboring under hooping-cough, for which some
medicine was prescribed. On the fourth day he complained of sore-
ness of the mouth, the teeth became loose and fell out, the tongue and
cheek were very much swollen, and the child died in the course of a
i'ew days from gangrene in tne left cheek. The answer to the charge
was, that not a particle of mercury had been exhibited, a fact clearly
proved by the production of a prescription book of the medical at-
tendant.

But while it must be admitted that there are few members of the
Profession who maintain that the use of mercury alone is the cause
of the disease, (although such an opinion is the only one that could
justify the charge of mala praxis brought forward in these cases,) I
think it will not he denied by any one conversant with the sentiments
at present prevailing in the medical world, that a modification of this
view is generally entertained, namely, that the use of mercury is suf-
ficient to produce it in certain states of the constitution, either ori-
ginal or acquired.

The advocates of this opinion maintain that the development of
the disease is due to a combination of causes, of which the untimely
administration of mercury is one. They consider that the peculiar
predisposition observed in these cases is one which tends to the pro-
duction of gangrene from slight causes, and that the administration

15

22G Ulceration of the Gums in Children. [April,

of mercury, from its natural tendency to excite the salivary organs,
gives the requisite direction to the development of that gangrene in
the gums and cheek.

Now while it is evident that such an hypothesis, however ingenious
for the explanation of those cases in which the previous use of mer-
cury can be clearly proved, will not enable us to understand how it
happens that in others, where no mercury has been taken, the disease
occupies the same situation, and presents the same symptoms. It
must be admitted to be a matter of some consequence to determine
the point, whether in those cases in which mercury has been used,
the mercury has had any thing to say to the production of the dis-
ease ; for if so, it follows as a matter of course that all the prepara-
tions of that mineral must be excluded from the subsequent treatment
of the case; and if otherwise, there will be nothing to prevent our
resorting to their assistance, should there arise any thing in the course
of the case to warrant our doing so.

The principal arguments in favor of this hypothesis appear to me
to be deduced from the situation of the affection and the symptoms
it produces. Let us examine them a little more closely. In can-
crumoris, as well as in mercurial action, we have ptyalism, foetor of
the breath, ulceration of the gums, and loss of teeth; but these symp-
toms, when carefully examined, do not present the same appearance
in the two cases.

In the first place, the salivation that attends cancrum oris, though
distinct, is moderate in quantity, and altogether unlike that which
attends the excessive use of mercury. Then the fcetor of the breath
does not present the peculiar and characteristic odour by which we
are enabled, even in doubtful cases, to recognize the incipient effects
of this medicine. But the ulceration of (he gums is, perhaps, the
most satisfactory proof of all, because, unlike the ordinary appearan-
ces of mercurial ulceration, it is generally confined to a part only of
the alveolar process. Usually it is found engaging both the upper
and lower jaw upon one side of the mouth, while the other side is
perfectly healthy ; and occasionally it is not even so extensive as
this, a few teeth only in one jaw being thus affected.

In support of this assertion, which, indeed, is too well known to re-
quire proof, I cannot adduce a more interesting instance than the one
already quoted on the authority of Dr. Marshall Hall, which was
made the subject of inquisitorial examination. The child had been
laboring under pneumonia of the lower lobe of the right lung, for the
cure of which the gentleman in attendance had been induced to or-
der calomel. It took fifteen grains in about a fortnight, and the
existence of the pneumonia was established in the post mortem exam-
ination. The condition of the mouth and gums was examined with
the greatest care by Dr. M. Hall himself, and with a special refer-
ence to the question immediatelv before the coroner ; and he reports
that the tongue was perfectly free from tumefaction, ulceration, or
other morbid condition ; the gums and internal parts of the cheek,

1846.] Ulceration of the Gums in Children. 227

excepting those affected with gangrene, were also free from any mor-
bid appearance, and the teeth were perfectly firm in their sockets:
and he concludes his account with the following observations : "The
facts last-mentioned are, in my opinion, definitive as to the question
of this affection having arisen from calomel- Not to mention the
extreme rarity of ptyalism in children, in cases in which many times
more calomel has been given, it is well-known to every observer that
the effect of calomel, when it does take place, is universally diffused
over the gums, tongue, and internal parts of the cheek."

The arguments, therefore, in support of the opinion, that the de-
velopment of the disease is due to the action of mercury upon an un-
healthy constitution, are, I think, capable of being explained away
easily, and without force. It remains for me to state those of an
opposite tendency, and which, joined to the observations already
made, will be sufficient to convince every candid mind of the truth
of the view advocated in this paper. In the first place, the disease
is almost exclusively confined to children, who, it is well known, are
scarcely at all susceptible of the ordinary effects of mercurial action :
very few instances, indeed, have occurred in persons beyond the age
of seven years ; and even within this limit the frequency of the
affection is by no means proportioned to the commonness of the use
of mercury. Cancrum oris is to be looked upon as rather a rare
disease, while the use of mercurial medicines in infantile affections
is exceedingly common.

Again, it is well known that the existence of fever is quite suffi-
cient to prevent the usual physiological effects of mercury developing
themselves so long as the vascular excitement continues, and that
the manifestation of ptyalism indicates, if nothing else does, a remis-
sion in the violence of the constitutional disturbance. Now it has
been observed by the best writers on this disease, that it is always
connected with this very state of the system, in which, under other
circumstances, it is so difficult to salivate the patient ; besides, it is n
curious phenomenon connected with the disease, and altogether dif-
ferent from what we should otherwise expect, were mercury its
cause, that the violence of the symptoms is not by any means pro-
portioned to the quantity of the mineral taken. The severest cases
often occur where the smallest quantities have been administered,
and vice versa.

But perhaps the strongest and most important argument in sup-
port of this view is that which is derived from the effects of remedies.
I have already stated, that if mercury be the exciting cause of the
disease, it would be worse than useless to think of administering any
of its preparations in the subsequent treatment. Now it is a remark-
able fact, that many cases have been treated by a judicious use of
those medicines, not only without injury, but, combined with other
measures, with perfect success. Dr. Cuming, of Armagh, who has
written an excellent paper on the disease, at ;< time when it wai less
generally known (ban at present, in the fourth volume of the Dublin

228 Ulceration of the Gums in Children. [April,

Hospital Reports, did not hesitate to use calomel, in combination
with jalap, in a case which required the use of purgatives, and which
ultimately succeeded. I have myself resorted to this practice in some
of the few cases that have fallen under my notice, and, so far from
observing any bad effects to follow, 1 have uniformly found them
preferable to the other forms of purgative medicine in general use
with children. Indeed, when proper attention is paid to the condi-
tion of the digestive organs in this affection, and to the character of
the alvine evacuations, it will generally be found that they are either
so deficient in bile, being usually of a whitish, clayey appearance, or
so morbid otherwise as naturally to demand the use of those remedies
which especially excite the action of the liver.*

In the views we are led to form of different diseases, the scientific
physician will often avail himself of the assistance that analogy is
capable of forming: he investigates thern very much in the same
way that a botanist or a natural historian examines the subjects of
his peculiar study. He endeavours, by a careful investigation of
their external characteristics, to group them into classes, not for the
purpose of artificial distribution, but to enable him to form a more
exact perception of their real nature, and to guide him to sound
principles of successful treatment. When similarity of nature has
been established, similarity of treatment follows as a matter of course.
Now it is universally admitted that cancrum oris exhibits a very
evident analogy to the gangrenous ulceration of the pudendum that
occurs in young females. In their general appearance, and in the
history and progress of the two a flection, this analogy is sustained.
Now Mr. Kinder Wood, whose paper in the seventh volume of the
Medico Chirurgical Transactions was the first to call attention to the
subject, expressly points out the unhealthy condition of the digestive
organs in the cases he had met with, and the necessity of correcting
their secretions by mild alterative aperients. Now this, I conceive,
on the principles already referred to, must be regarded as confirmatory
of the opinion I have just advanced, namely, the safety of using
mercurial preparations in the treatment of cancrum oris.
****** ***

I might enlarge upon this subject by shewing that it is from the
bold and persevering administration of tonics, in their simplest and
most efficient forms, that we are principally to expect the cure of so
formidable a disease as cancrum oris, when it does admit of being

The writer's views in relation to the efficacy of mercury in this affection,
are fully sustained by many American practitioners. Dr. Jackson gave one
hundred and fifty grains of calomel to a child after gangrene had began, and
though she suffered severely, she was nevertheless cured. In an article on this
subject in the 1st volume of the first series of this Journal, Dr. E. A. Eve states
that the late Prof. Antony considered mercurials as the very best means for
arresting the disease. Many other eminent practitioners, also entertain the
5ame opinions. [Edts.

1846.] Ulceration of the Gums in Children. 229

arrested. I fully agree with the statement made by Dr. Elliotson in
one of his published Clinical Lectures on this subject, where lie says
the proper treatment is to administer tonics, and to push them to the
greatest extent possible. In all cases he is in the habit of giving
quinine in the largest quantity he can exhibit it: good nourishing
diet, such as strong beef ten, wine, porter, &c; and I can, from my
own observation, repeat that I have resorted to this practice with the
happiest results; while I have been surprised at the quantity of sti-
mulants that young children in such circumstances have been able
to bear.

I must, however, hasten to the conclusion of the proper subject of
this paper, merely repeating what I have already remarked, that the
foregoing observations apply with equal force to the disease under
consideration as to the more common form of cancrum oris ; and
in speaking of the pathology of the disease which I have so has-
tily described, I would say that I believe it consists essentially in
inflammation of the intestinal mucous membrane. The affection of
the mouth is a part, and but a part, of a more general moibid state,
without the due appreciation of which it will be impossible to have a
correct idea of the local complication. It is this which gives it its
real importance, enables us at once to estimate its pressing clanger,
and points out the proper mode in which its treatment is to be con-
ducted. Whether it is to be regarded as a kind of sympathy between
different members of the same system of structures, or merely as a
wise provision of Nature, to enable us to recognize the morbid con-
dition of what is beyond the range of our inspection, it is a curious
general law prevailing in the economy, that a similar action is devel-
oped in those parts of the mucous membrane that are exposed to
view, to what is found to exist in those which are more remote and
hidden. In ordinary aphthae, and in the condition of the tongue in
gastric affections, we have examples of this general principle.

This view of the disease is, I think, established by a variety of
proofs. The diarrhoea which usually preceded its development, and
persisted with greater or less obstinacy throughout, pointed to this
condition as its origin ; and in all those cases which terminated fa-
tally I have found either decided ulceration of the intestinal mucous
membrane, or enlargement and increased development of the follicu-
lar glands. In one case the whole colon was an immense sheet of
minute, circular, and deep ulcers; while the portion of the mucous
membrane which intervened was of a bright crimson hue. It is also
confirmed by the peculiar type of the diseases which prevailed at the
same time, and which partook, to an unusual extent, of the gastric
character.

Having satisfied ourselves as to the true nature of the nfTection, it
follows as a matter of course, that our principal attention is to be
directed to the cure of this intestinal inflammation. So far as my
observation went, I remarked that little benefit resulted from local
treatment; I tried various astringent and other gargles and applies-

230 Ulceration of the Gums in Children. [April,

tions, borax and honey, muriatic acid and sulphate of copper, but
found them to exert no appreciable influence upon the disease, while
constitutional remedies certainly did. The ordinary astringents,
such as chalk mixture, catechu, and acetate of lead, often faiied to
check the diarrhoea; and even opium, given in as large doses as I
thought safe, to patients so young, did not appear more effectual.
The best internal medicine for this purpose was an acidulated decoc-
tion of bark, or an infusion of columbo and nitric acid. This con-
trolled, in a remarkable degree, the diarrhoea which had resisted
other remedies, was readily taken by the children, and did not appear
to produce any unpleasant effects. I have already mentioned the
feet of my having used mercurial preparations, in the form of Hyd. c.
Creta combined with Dover's powder, with considerable encourage-
ment. I was induced to resort to this class of medicines from ob-
serving the unhealthy condition of the alvine discharges. Of course
I did not think of using this combination at the same time that the
patient was taking any acidulated medicine. And the great benefit
the patient uniformly experienced from this form of administering the
bark, coupled with that hesitation which always must attend the use
of a medicine in unusual circumstances, prevented me from perse-
vering very long in its administration, unless when I saw there was
no immediate danger, or that it was decidedly agreeing.

But the most valuable agent I met with in the management of
these cases was a speedy and decided counter-irritation of the abdomi-
nal surface. The excitement of the capillaries here relieved, in a
remarkable manner, the congestion that existed within. For many
reasons I did not resort to what may appear a more appropriate plan
of operation, namely, leeching. The peculiar constitution of the
patients, the character of the prevailing diseases, and the observed
effects of this mode of drawing blood in kindred affections, deterred
me from their use. The best mode of producing a light, and at the
same time a sufficiently enduring irritation of the surface, I found to
be the laying on of a mustard poultice on the abdomen, till the skin
was reddened, and the immediate application of a blister on the part
for a single hour. Its action was speedy, safe, and effectual. It
never failed to vesicate, and its subsequent management was alto-
gether free from those unpleasant effects that are so often met with
in blistering children. It was astonishing to find how instantaneous-
ly it acted in checking the progress of the disease. It controlled
almost immediately the distressing and wasting diarrhoea, lowered
the fever, and improved the condition of the mouth.

1846.] Menstruation, fyc, with Illustrative Cases, 231

Menstruation, its True Nature and Office, with a Review of the Evi-
dence of its Vesicular Origin, with Illustrative Cases. By Saxuel
S. Purple, M. D., of New-York.

Interesting and many are the facts and observations which, within
the last few years, have been presented to the profession, upon the
history and phenomena of menstruation. The theory of Power
the researches of Girdvvood, Jones, Patterson, and Lee, (London) ;
Gendrin, Raciborski, and Boismont, (Paris) ; BischofF, (Leipsic) ;
Negrier, (Angers) ; and of many others who are devoted to the cause
of science, and improvement of sound physiology, are well worth the
perusal of every member of the profession. Dr. Paget, in a " Report
on the progress of Human Anatomy and Physiology, in the years
1842-3,"* has given an excellent summary of the then existing facts
relating to this subject, corroborative of Dr. Power's theory. It is
not our intention to go into the minute detail of all that has been
written in reference to the elucidation of the nature of this function
of the female economy. It will, however, be our aim to give, in as
concise a manner as possible, a summary account of the facts
relating to this subject, with such conclusions as we may be able
legitimately to draw from them; and in order to do this successfully,
it becomes necessary to inquire first, What is the true nature of
the menstrual fluid?

All the more modern elementary treatises on Physiology and Mid-
wifery, agree in describing the menstrual fluid "to consist of blood
deprived of its fibrin, the fluid being composed of serum in which red
corpuscles are suspended. "f This opinion has gained universal
currency upon the authority of Brande and Lavagna ; at least it
would seem to be so, as it does not appear that any such opinions
were held previous to the publishing of their views. Mauriceau^:
says that the menstrual fluid "commonly differs in no way from that
which continues in a woman's body." J. Hunter terms menstrua-
tion, " a natural evacuation of blood * * * thrown oft* from the
common mass by an action of the vessels of the uterus, similar to
that of secretion ; by which action the blood loses the principle of co-
agulation, and I suppose life."

The presence of the unaltered globules of the bleed, in the men-
strual fluid, is expressly stated by Hunter, who says "The red
globules, however, are not dissolved, they retain their figure. 7:j| The
truth of this remark is fully confirmed by the more recent observa-
tions of Dr. Donne, ^ made in the true spirit of inquiry. Donne
submitted to careful microscopic examination, healthy menstrual

*Rrit. and For. Med. Rev., vol. xvii., IS! 1.

t Carpenter's Principles of Human Physiology, 710. Muller's Elements of
Physiology, Bostick's Elementary Sysiein, Mujendie, Elliotson, Mayo, v.v<-. doe.

. Meckel's Archives, 1318.

Hunter on the Blood, 2d Amcr. edit. 18-23, p. (57. II Ibid, p. 15.

U M. Brierre de Boismont, "De la menstruation." Paris, 1842, vvh
analysis of a number of observers are given in full with rem;

232 Menstruation, <$*c, with Illustrative Cases, [April,

blood obtained from two healthy females, and found it to contain, 1st.
Common blood globules of the proper character and form ; 2d. Mu-
cus from the vagina united with epithelial scales; and 3d. Globules
of mucus from the cervix uteri. Professor Shultz (Berlin) examined
a teaspoonful of menstrual blood, taken from a healthy female, with
the like result as to the globules. He describes the globules as sepa-
rating and falling to the bottom of the fluid, where they appeared
"to the naked eye a cheese-like coagulum ; observed through the
microscope, this apparent coagulum was found to be composed of
perfect vesicles, heaped together, yet isolated, and not adherent to
each other, as easily happens to the vesicles of living arterial and
venous blood."*

From the foregoing remarks, it will be seen that the menstrual
fluid consists of serum and the natural corpuscles of the blood. But
is the fibrin absent? Let us see. From the result of the numerous
experiments made to ascertain the composition of this fluid, we are
compelled to believe that there is also present a full quantity of fibrin.
M. Bouchardiit.f by means of a speculum fitted around the cervix
uteri, collected in a pure state a quantity of menstrual blood, and,
upon analysing it, found that it was composed of the ordinary ingre-
dients of the blood, combined in arterial proportions; thus confirm-
ing the previous observations of .Mr. Denis. The interesting research-
es of J. Miilier also show "a full quantity of fibrin." Dr. Dewees,
in speaking of the opinion that this fluid contains no fibrin, and
hence does not coagulate, says, M It is more probable that this sub-
stance (fibrin) has been deprived of the power of coagulating, by
being subjected to the influence of the vessels of the secreting por-
tion of the uterus. This opinion is strengthened by recurring to the
fact, that the coagulating lymph always accompanies the red globules,
wherever the latter may be found." Indeed, we should expect a,
priori the presence of fibrin, for we know of no process or secretion
by which the fibrin may be retained, and yet the unchanged globules
of the blood be allowed freely to pass. How then are we to account
for the want of power to coagulate, which this fluid possesses? (For
the occasional instances of coagula, found during deranged menstru-
ation, must be considered exceptions to the general rule; and as J.
Hunter says, "if that discharge (the menstrual) is natural and
healthy, the blood does not coagulate; but, on the other hand, if the
extravasation is nf<t a healthy one, the blood coagulates, as it is ex-
tra vasated, and comes away in clots.' ) Before answering this ques-
tion, we shall give some of the views which have been put forth to
account for this occurrence. Hunter supposed it to depend upon
"a natural action of the living bodv. which destroys the life of the
blood in the act of extravasation. '*|| And again, " the blood dies (in
this species ef ecchymosis) in the act of extravasation, in the same

Boismont, edit. cit. t Ibid.
: Treat, on Diseases of Females, Philadelphia, 1810, p. 97.

* Principles of Surgery, Amer. edit.. 1S30, p. 35. II Ibid.

1846.] Menstruation, <fyc., with Illustrative Cases, 233

manner as the blood of the menstrual discharge, whenever it is
effused."*

It is possible that the opinion of Dr. Dewees (before cited) may
have been made up from a review of Mr. Hunter's, as it appears to
be but a slight extension of the same views.

Mr. Retzius believes it to be owing to the presence of phosphoric
and lactic acids developed in the uterine vessels. Now it appears to
us, and we think we shall be able to show, that Mr. Hunter and M.
Retzius have both labored under a mistake in the location of the
change. Each places the change in the uterine capillaries : the for-
mer supposes an action or property inherent in the vessels to exist,
by which the death of the blood is produced in the act of extravasa-
tion; and the latter, advancing a step farther, supposes the develop-
ment or production of an acid, by which a change is effected in the
vessels as the process of extravasation goes on. Now as to the
production of phosphoric or lactic acid, it may be said that in the
present state of our knowledge no such acids are known to be evolv-
ed from the mucous membrane of the uterus or vaginia in a healthy
state.

When an acid is evolved, excoriation of the parts over which it
passes, is the result, constituting that form of leucorrhcea mentioned
by Thompson, Jones, and Ashwell, requiring alkaline injections.
Again, healthy menstrual fluid is alkaline; and again, "healthy mu-
cus from the uterus or vagina," says Prof. Draper, "does not con-
tain an acid." Now, were it fully proved that one or both of these
or any other free acid is present or disengaged from this surface, then
any furlher explanation would be useless, for it is well known that
acids produce this effect upon healthy blood, but as we have shown
that the contrary is the case, we are compelled to look further for an
explanation or answer to our question.

From repeated experiments and observations it has been found that
ordinary blood mixed with mucus does not coagulate, and also that a
slow secretion of effusion of blood from a mucous surface does not
coagulate. May we not infer that it is the presence of mucus that
prevents the coagulation ; Indeed, with these facts before us, can we
hesitate for a moment to declare that the secretion and blending of
mucus with the extravasated menstrual fluid, is the sole and only cause
of the non-coagulation of the menstrual blood (for we believe it to dif-
fer in no way in the act of extravasation from ordinary blood which
remains in the body)?

But it may be asked, in what manner is this extravasation of blood
brought about, or in other words, what is the cause of the menstrual
discharge? In all spontaneous hemorrhages the proximate cause is
local hyperemia, or congestion of the capillaries of the part from
which the flow takes place. Now, if what we have said be true, if
the menstrual fluid be simply a sanguineous exhalation, and if local
hvperaemia he the proximate cause, should we not expect to find this

* Hunter on the Blood, edit, cit., p. 161.

234 Menstruation, <fyc, with Illustrative Cases. [April,

congestion after death? Let us see what the facts in reference to
this state are. In all cases where death has taken place during the
catamenial flow, the uterus and its appendages have been found con-
gested. Increased vascularity is a characteristic attendant. If du-
ring the menstrual flow an examination be made with the speculum,
the vagina will be found unusually vascular, the cervix uteri swollen
and red, the os tincce nearly closed. M. Boismont* " found the cervix
uteri hot, soft, and tumid to the touch, and on examination with the
speculum, the vagina unusually vascular, the cervix uteri enlarged
and of a bright red color, differing from its usual pink violet hue
and hence considers it in a state of engorgement."

Dr. Blundellf had an opportunity of observing this in a severe case
of procidentia. He says, "the increase took place regularly, and
the whole womb might distinctly be felt to throb, and hence we may
reasonably infer that whatever, month by month, may be the cause
of the topical increase of the vascular action in the menstruating ves-
sels, it is the determination of blood on the uterus, produced by this
topical excitement of the vessels that gives rise to the discharge." In
a recent case where death took place during the catamenial flow,
(which will be referred to more minutely hereafter) the uterus, one
ovary, and its corresponding fallopian tube were found in a high state
of engorgement. It may be safely stated, then, that local hyperemia
of the uterus and its appendages is the proximate cause of men-
struation.

If, then, this be the proximate, it will be asked what is the remote
or exciting cause ? Here it will be necessary to treat more minutely
of what we hastily referred to at the commencement of this paper,
viz., the observation of Cruikshank,:): Power, Lee,|| Jones, H Gird-
wood,** and many other English writers Gendrin,ff BischofT, Ra-
ciborski.Jt Negrier, Boismont, |||| and a number of other French
and German writers, who have done and said much upon this subject,
and whose labors prove beyond a reasonable doubt that it \sihe peri-
odical maturation and rupture of a graafian vesicle, with the escape
of an ovum from the ovary into the fallopian tube, which is " washed
away by the menstrual blood."

It would augment too much the size of this paper were we to give
in full the cases of the writers just referred to ; we cannot, however,
refrain from giving some of them, with the conclusions drawn there-
from.

* Edit. cit. t Diseases of the uterus Philadelphia, 1841.

I Phil. Trans., for 1797.

Essays on the Female Economy. London, 1821.

II Cyc. Prac. Med., Art. Ovary. London, 1834. Also Lectures on Mid., Am.
Edit. ' Philadelphia, 1844.

IT Practical Observations on Diseases of Women. London, 1830,

** London Lancet, 1843.

tt Gendrin, Traite Phil, de Med. Prac. Paris. 1839.

;; Gaz. des Hopitaux, tome 4. 1842.

Res. Ana. et Phys. sur les Ovaires, &c. Paris. 1840

llll De la Menstruation. Paris, 1842.

1846.] Menstruation, <$*c, with Illustrative Cases. 233

It is impossible to say with whom the idea originated that the cata-
menia were in some way connected with the ovaries for we find it
spoken of by Kirkringius as early as 167*2, who believed that ova
were discharged with the menstrual fluid, at the first appearance of
this function at least. He says, " Aliquando fceminae dejiciunt haec
ova imprimis temporae menstruorum." Friend, in his Emmenalogia,
alludes to it as a then existing belief. The first case tending to
prove or establish this opinion, so far as we have been able to ascer-
tain, is that recorded by Pott,* in which he extirpated the ovaries in
an operation for inguinal hernia : the woman, who before had been
regular, ceased to menstruate. Since that time a number of instan-
ces have been observed in which the ovaries being absent, this func-
tion was not performed. In all the cases on record where these
organs were removed, or found absent, the catamema were also ab-
sent, although all the other organs of generation were perfect. The
next important case bearing upon this subject was that of Mr.
Cruikshank, published in the Transactions of the Royal Society for
1797. " I have (says he) in my possession the uterus and ovaries of
a young woman who died with the menses upon her. The external
membrane of the ovaries was burst at one place, from whence I sus-
pect an ovum escaped, descended through the tube into the uterus,
and was washed away by the menstrual fluid." This case of Mr.
Cruikshank's, with the observations of Kirkringius, seems to have
been entirely disregarded by writers and observers, as we find nothing
farther on this subject until the year 1821 (except the case of Mr,
Pears),f when Mr. Power put forth his theory of menstruation, which
supposes it to depend upon the maturation and rupture of a graafian
vesicle with the escape of an ovum. Whether Mr. Power had his
eye upon Mr. Cruikshank's case or not. we are unable to say ; if he
did not, it is a beautiful illustration of the accidental approach of
theory to the truth when preceding fact.

Having given the cases of Pott and Cruikshank, with the theory
of Power, we come now to the remaining and more recent observa-
tions of the French and English writers. And here we find existing
i

the spirit of contention, that which has done more than any one thing

else to hinder the progress of science, and the respective writers of
each nation engaged in a warm controversy as to the priority of dis-
covery. On this subject we shall have nothing to say, leaving it
entirely to themselves to settle this dipute.

In 1333, Mr. R. Lee, in the Cyclopaedia of Practical Medicine,
vol. iii., art. "Disease of the Ovaries," reported four cases in which
he had examined the uterus and ovaries of females dying whilst men-
struating. His first case is dated March 11th, 183i ; his words are,
"atone point a small circular opening with thin irregular edges was
observed in the peritoneal coat, which led to a cavity of no great
depth in the ovarium * * * * to an extent of three or four lines ;

Works, case 24, p.
t Trans of ihc Royal Society, for 1805.

230 Menstruation, <$., with Illustrative Cases. [April,

the surface of the ovary was of a bright red color * * * * both fallo-
pian tubes were uniformly red and swollen, and their cavities were-
filled vvith menstrual fluid."

In the autumn of the same year he examined a second case, a
young female zet. 20 years, who died suddenly of acute inflammation,
of the lungs. The right ovary "atone part the peritoneal coat
to a small extent had been removed. The edges of the opening were
extremely thin and irregular."

His third case was sent him by Sir Astley Cooper, in July, 1832 ;
it was the ovary of a young female who died of cholera. On exam-
ination, " at one point there was an irregular opening in the peritoneal
coat, through which a slender coagulum of blood was suspended..
This led to a cavity in the ovary filled with a firm coagulum." In
the autumn of this year (1832) Mr. Gird wood sent him the uterus
and ovaries of a female who died of scarlet fever. The menstrual
flux made its appearance (according to Mr. G.) "six hours before
dissolution." "On the left ovary there was an oval cavity large
enough to admit a tare, and no doubt left by the recent escape of an?
ovule ; its margin was unequal and floccular, and as well as the walls
throughout of a deep red color."

In his lectures on midwifery, Mr. Lee relates a fifth case, which
was seen by Mr. Shaw in the Middlesex Hospital, May 31, 1841.
The following was the appearance of the right ovarium: "In the
right ovarium the appearance was presented of one of the graaffian
vesicles having been ruptured. A part of the surface of the size of
a four penny piece was distinguished by a dark stain upon it ; and
here the peritoneal coat was slightly elevated, and the rugged edges
towards the centre of the stained spot were of a particularly black
color." From the foregoing it will be seen that there came under
the immediate inspection of Mr. Lee four cases ; his fifth was related
to him by Mr. Shaw.

Mr. Girdwood's first and only case, so far as we have been able to
ascertain, is the one already related by Mr. Lee. All his other cases
go to prove or establish the views first expressed by him, viz., that
the number of cicatrices correspond to the number of times the fe-
male has menstruated.

M. Gendrin, in 1839, published five cases which had been observ-
ed by him of females who died during the catamenial flows.

In the first, the left ovary was found congested ; on the surface,
near the middle, was seen an aperture about a line in diameter, with
an irregular margin leading to a cavity as large as a hemp seed ; its
walls were vascular.

In his second case was seen a small circular opening, leading to a
cavity two lines in diameter; the walls were of a bright red color.
In the remaining three cases the same appearances were observed
from all of which he concludes a graafian vesicle had been ruptured,
and an ovum escaped.

M. Negrier has made nearly the same statement in the account
given of the cases he examined.

1846.] Menstruation, <$* with Illustrative Cases. 237

M. Raciborski hns also given an account of his examination in
four cases, in each of which he found a rupture in the peritoneal coat,
with thin, irregular edges, and the opening leading to a cavity, from
which he concludes that an ovum had been recently discharged from
the ovary.

Prof. BischofThas also examined four, and in each he found a rup-
ture of the peritoneal coat, leading to a cavity tilled with coagulated
blood ; his conclusions are the same as those of M. Raciborski.

M, Boismont has come to the same conclusions from the observa-
tions he has made. There is a case reported by Dr. Post, in the
New York Med. Gaz. for 1842, with remarks by Prof. Gillman, and
an imperfect account of the cases on record, up to that time where
the female is said to have "menstruated within a week of her death;"
but Dr. Post gives only a general statement of the case. It is not
mentioned whether an opening was found (if there was one) in the
peritoneal coat of the ovary.

Mr. Ritchie, in the London Med. Gaz. for 1844, gives an account
of three cases. One menstruated six days previous to death, and the
other two, ten previous to death. In each of the three cases the irre-
gular opening was present, leading to a cavity filled with coagula.
And yet he adds at the close, "no trace of a vesicle which had been
affected by menstruation was perceptible." It is from such cases as
these that Mr. Ritchie "has set forth a copious proof, in his opinion
entirely subversive of the recent hypothesis of the vesicular origin
of menstruation."*

It is impossible for me to say what evidence Mr. Ritchie could wish
if that related by him, and in the foregoing cases, is not sufficient to
prove the truth of what he assumes to be a hypothesis.

In a case examined October 24th 1845, by Dr. W. C. Parker and
myself, in the presence of Prof. Gillman and Dr. Rawson,the woman
died from apoplexy, and was menstruating at the time. The follow-
ing were the appearances, and I find them recorded in my notes,
taken at the time.

The left ovary with its corresponding fallopian tube, much con-
gested; the peritoneal coat on its anterior and superior surface was
of a bluish purple color; near the centre of t his portion were seen
two points which appeared as if a rupture in the peritoneal coat had
taken place; these points were filled with coagula ; on removing this
it was found that it filled two cicatrices, of which there were a num-
ber on various parts of the ovaries; between these two points a third
was seen, where a rupture in the peritoneal coat had taken place;
it was of a V shape, and irregular; the loose end of which turned
up; the opening was filled with coagula. On laying open the ovary,
a small cavity was found, about the size of a wheat seed, filled with
coagula, nearly deprived of its red globules; the walls of the cavity
were vascular; the fallopian tube was filled with menstrual blood;

238 Menstruation, <fyc, with Illustrative Cases. [April,

(he cervix uteri injected, and appeared swollen, and the villi of the
inner surface elongated and covered with the menstrual fluid ; atone
extremity of the ovary was observed an enlargement, which, when
laid open, proved to be a well-marked cojyus luteum, about four lines
in breath, and five in length, containing a cavity. Upon tracing out
the history of this case, it was found that she had miscarried nine
weeks previous.

A very interesting case was published by Mr. Jones, in his work
on the Diseases of Females. (London, 1839.) In prefacing it he
says, "It has occasionally happened that at the post-mortem exami-
nation of a woman who has died during the existence of the catn-
menial effusion, an ovum has been found partly within the expanded
extremity of the fallopian tube, and partly detached from the ovary ;
whilst the ovary has exhibited signs of congestion, and that portion
of its membrane which surrounds the ovum has borne recent traces
of a rupture. Some fourteen months since this condition was wit-
nessed by myself and Mr. Lovegrove of Upper Baker st., in the left
ovary of a woman who died of congestion of the brain, on the first
day of the catamenial effusion, in whom the hymen was perfect, and
whose ovaries exhibited six or seven cicatrices. The same appear-
ance has been reported by my late colleague, Dr. Richmond."

It is now very generally admitted that the graafian vesicles proceed
from the interior to the circumference of the ovaria in their develop-
ment, and that they are not fully developed until they reach the
surface of the ovaria (which takes place at the age of puberty, or at
the first appearance of the catamenia.) This opinion may be con-
sidered to have been almost proved to a demonstration by the observ-
ations of Girdwood and Ritchie, who have both examined the ova-
ries of the human female from infancy or birth up to puberty.

The cicatrices of which we have spoken, as being present in some
of the cases, arc found in no instance before the appearance of men-
struation at least such appears to be the result of the observations
of the writers just referred to. And such also is the result of our
own observations. In cases of aged females who have ceased men-
struating, the ovaries present a shrivelled appearance, and upon
minute inspection are found covered with these scars or cicatrices.

In a case examined by Dr. W. C. Parker and myself, of a woman,
ret. 60 yenrs, the ovaries were found very much shrivelled and wasted,
and the cicatrices could be seen crossing each of her at various points.

If then, these be the appearances presented during and after men-
struation, it may be asked, what is the final nature of the menstrual
flow ? or what important service does it perform in the human econ-
omy 1 or in other words what important object is intended by nature
to be accomplished by it? From a review of the cases related in
.this paper, we are disposed to regard the answer to the question as
not difficult, but, on the contrary, as easy, and coming from well
established facts.

In order to understand more fullv the answer we shaH cive to the

1846.] Be Vernice Caseosa. 239

inquiry, it will be necessary to give a summary view of what takes
place in the formation of the membrana decidua after impregnation
takes place ; after which we can return to the consideration of the
true nature of menstruation.

In the more modern elementary treatises on physiology and mid-
wifery it is generally conceded that the highly congested state of the
uterus and its appendages, which exist at the time of impregnation,
gives rise to the effusion of coagulable lymph from its inner surface,
that this becomes organized, and constitutes the decidua. A recent
opinion has been advanced that it is formed by a thickening of the
mucous membrane. And although this comes to us from high au-
thority, we are led to doubt the correctness of it not only from our
own observations, but from equally as high authority, as that of Dr.
Sharpey, and Prof. Weber. That the mucous membrane is thick-
ened and its villi are elongated there can be no doubt hut that the
decidua is composed entirely of this membrane in a thickened state,
we still want tacts to prove. But to return, whilst the formation of
the decidua is going on, the ovum, which escaped from the ovary by
the rupture of the graafian vesicle, is passing through the fallopian
tube to the uterus, there to go through successive stages of devel-
opment.

Now let us turn to the nature and office of menstruation. The
uterus and its appendages during this flow are found in the same
state of engorgement the rupture of a graaffian vesicle takes place
with the escape of an ovum into the fallopian tube the villi of the
inner surface of the uterus are elongated the ovum escapes into the
uterus in the same manner and an effusion of blood and conse-
quently lymph takes place, but no decidua is formed here the analo-
gy ceases but why cease here ? surely from no other cause than the
want of impregnation. The object of this function then is the for-
mation of the decidua, and menstruation maybe defined to be, as
Mr. Power said, "an imperfect or disappointed action of the uterus
in the formation of the decidual membrane."

It will be seen that these are not hypothetical views presented to
our minds unaccompanied by facts to confirm them; but legitimate
conclusions drawn from facts, made without reference to any particu-
lar theory or preconceived opinion.

As to the formation of a corpus hit cum, as some have supposed, at
each menstrual period, when a rupture of the graafian vesicle takes
place, we shall have nothing to say at present, leaving this inquiry
replete with important consequences in a medico-legal sense, lor a
future occasion.

Be Vernice Caseosa; diss, inavg. quam scripsit. Gust. Bttxk.

Hal is, 18 14. This work contains a complete history of the researches

made in relation to the unctuous deposit on the skin of new-born in-

240 De Vernice Caseosa. [April,

fants. After {jiving a general account of the authors who have treated
this subject, M. Buek takes up the chemical examination, relates and
comments upon the analyses made by his predecessors, and then fur-
nishes the following results obtained by his own investigations. 100
parts of the matter yielded him :

Fat, 10,15

Epithelium, .... 5,40
Water, 84,45

The fat contains two acids, the oleic and the margaric or stearic ;
the author could not determine which of the two last. The cinders
(cendres) contained sulphates, phosphates and carbonates of potass
and lime and traces of oxide of iron.

By microscopic examination, M. Buek perceived that the unctuous
deposit consisted of epidermic cells and of fatty particles. The
epidermic cells were less dry and less crimped than in the adult, and
presented a distinct nucleus. When these cells are disposed in sev-
eral strata, the most deep seated differ very little from the more
superficial. After being treated by ether and filtered, the residuum
consists exclusively of epidermic cells.

Microscopic observation concurs then with chemical analysis in
demonstrating that the unctuous matter on the skin of new-born in-
fants consists simply of epidermic debris and fat. The author could
not see the crystals announced by Simon; but he not unfrequently
found hairs mixed up with the other matters. In the physiological
portion of his book, Mr. B. has turned his attention to the origin of
this deposit, the period of its appearance, its quantity and its uses.

We know that two opinions prevail in relation to the origin of this
unctuous coating: some believing it to be derived from the fcetus,
whilst others think it deposited by the liquor amnii. He discusses
lengthily the reasons advanced in support of both hypotheses, and
finally admits, with Bischoffand Ncegele, the opinion (doubtless the
most probable) that this unctuous coating is composed of the secre-
tion of the sebaceous follicles of the skin and of the debris or remains
of the epidermis. In fact. M. Valentin has demonstrated the exist-
ence of these sebaceous glands as early as the fourth month of foetal
life; and the origin of the epidermic cells is evident. On the other
hand, (his coating cannot be regarded as a deposit from the amniotic
fluid, since no trace of such deposit is to be found on the inner sur-
face of the membranes, nor on the umbilical cord, and that the mate-
rials of which it consists are not found in the liquor amnii.

M. Buek admits, with most writers, that it is only about the sixth
month that this matter begins to be formed, and this is not surprising,
inasmuch as it is only in the latter months of gestation that the cutane-
ous glands and the epidermis itself are sufficiently developed to perform
their proper functions. The quantity of this coating varies consid-
erably, is sometimes very small, and often so much so that the author
could not collect enough for microscopic examination. The largest
quantity he obtained was about three and a half drachms ; the medi-

1846.] Bibliographical Notices, . 241

urn quantity was from one to two drachms. The author does not
think that it decreases towards the termination of gestation, as has
been alleged ; this is however an assertion very difficult to verify,
because of the various quantities found, and which must depend on
the degree of activity of the sehaceous glands, as well as of the ra-
pidity of epidermic desquamation. This matter is not found in
equal quantities on all parts of the surface; the author found it in
greatest quantity on the back, especially the sacral region, the
groins, the axilla and the head.

It is never equally spread, because all the glands do not, doubtless,
reach the same degree ofdevelopment at the same time, and also be-
cause of the child's movements. In relation to its uses, the author
justly objects to the tendency of certain minds to explain all things,
and rejects the opinion of those who attrihute to this coating the pro-
perty of protecting the skin of the foetus against maceration, of against
some supposed injurious effect of the liquor amnii. This unctuous
coating is a physiological product peculiar to the conditions of fcetal
existence, and it is not rational to attribute to it any special use. It
is an error also to imagine that the removal of this matter after birth
may be injurious to the child an error which also flows from an ex-
aggerated disposition to explain all things. [Translated from the
Gazette Medicale, 29th Nov., 1845.

BIBLIOGRAPHICAL NOTICES.

1. On the Diseases of the Liver, by George Budd, M. D., F. R. S.,

Professor of Medicine in King's College, London, and Fellow of
Caius College, Cambridge. With coloured plates and numerous
woodcuts. Philadelphia: Lea & Blanchard. 1846. p. p. 392.

We are indebted to the publishers for the above work, gotten up in
their usual handsome style, and without the appendage of "Notes,"
the main object of which is too often merely to secure a copy right
to English productions, and thereby to extort from the profession an
exorbitant price.

A good monograph on the Diseases of the Liver has long been a
desideratum in our language, and the one before us will doubtless
meet with general approbation. Not being able at present to furnish
an analysis of Dr. Budd's work, the reader may form some idea of
its extent by the caption of the chapters into which it is divided.
These are preceded by an introduction, treating briefly of the anato-
my and physiology of the liver. Viewing, as we do, the liver as
presiding over several very important functions, other than that of
Mie secretion of bile, we think this portion of the work essentially

10

242 Bibliographical Notices. [April,

defective. To regard this large viscus as exclusively destined to
effect this secretion, is however one of the most common errors of
the day, among those who have not specially cultivated the study of
Physiology. There can now be no doubt that, independently of the
secretion of bile, one great object of the liver is to secure the gradual
introduction, through the portal system, of foreign or new materials,
into the general circulation. We know that many of the substances
taken into the digestive apparatus, especially liquids and remedial
agents, do not undergo chylification, and consequently cannot get
into the circulation through the lacteals. They are therefore taken
up by imbibition, carried into the veins of the stomach and bowels,
and thence to the liver, from which they are gradually poured into
the vena cava. By this process, materials which, if introduced
directly into the circulation, would prove highly injurious or eVen
fatal, may gain admission without risk, for they are eliminated by
their proper emunctories, the skin, kidneys, or lungs, almost as rap-
idly as introduced. An illustration of this fact is presented daily in
the free use of alcoholic beverages. Were these to be thrown into
the crural, or brachial vein death would speedily ensue, yet, by being
gradually introduced through the portal system, they are eliminated
by the lungs, their proper emunctories, sufficiently fast to prevent
under ordinary circumstances any undue accumulation. Arsenic,
Iodine, the Terebinthinates, &c, are in like manner prevented from
accumulating by the action of the kidneys, the special eliminators of
these substances.

Again, the Liver, by its elastic, spongy and vascular texture, is,
like the spleen, eminently fitted for the reception of the large quanti-
ties of blood which recede from the general surface and extremities
under various perturbating causes, especially the cold stage of fevers.
Were not these organs provided, in which such an afflux of blood may
take place without much inconvenience, an ordinary paroxysm of
intermittent fever would almost necessarily be attended with fatal
congestion of the brain, lungs, or alimentary canal.

The Liver also performs the important office of regulating the sup-
ply of blood sent to the heart. But it is not our purpose to enter
formally on the study of the functions of this great organ. We have
said enough to show that he who looks upon this as an organ of mere
secretion, takes but a very narrow view of the subject.

The 1st chapter treats of Congestion of the Liver; the 2nd of the
Inflammatory diseases of the Liver; the 3rd of the diseases which

184C] Bibliographical Notices. 243

result from the faulty nutrition of the liver, or faulty secretion; the
4th, of the diseases which result from some growth foreign to the
natural structure; the 5th, of Jaundice; the 6th, or appendix, of the
liver-fluke, &c.

Dr. Budd's style is both chaste and succinct ; his views practical.
We cheerfully recommend his work to the profession as the best with
which we are acquainted. D.

2. A new Edition of Dr. Churchill's System of Midwifery ; edited
by Professor Huston, of the Jefferson Medical College. Published
by Messrs. Lea & Blanchard, Philadelphia.

It is with great pleasure that we announce to the profession the
appearance of a second edition of this most excellent work, rendered
even more valuable than the first, by additional facts and observations
from the American editor.

Dr. Churchill's System of Midwifery is too extensively known and
highly appreciated by the profession in our country, to require us at
the present time to institute an examination into its merits, or to set
forth its claim to attention.

Whilst some of the more voluminous treatises recently published
are necessarily more full on some departments of obstetric knowledge,
this is certainly the most perfect system extant, that which comprises
in a condensed form and at a reasonable expense, more valuable in-
formation on every subject connected with the theory and practice
of Midwifery, than any other. It is the best adapted for the purposes
of a text book, and is that which he whose necessities confine him to
one book, should select in preference to all others. J. A. E.

& Lectures on the Operations of Surgery, and on Diseases and
Accidenis requiring Operations. By Robert Liston, Esq., F.
R. S., Senior Surgeon and Prof, of Clinical Surgery in the Uni-
versity College Hospital, London. Witth numerous Additions
by Thomas H. Mutter, M. D., Prof, of Surgery in Jefferson Medi-
*cal College, &c.,&c.,&c, &c. Philadelphia: Lea & Blanchard.
1346. 1 Vol., 505 pages.

We are indebted to the publishers, the most extensive in the med-
ical line in our country, and certainly the most deserving, for this
excellent volume on Surgery. The Lectures of xMr. Liston appeared
last year in the London Lancet, and Prof. Mutter has done well to
collect and issue them in a more permanent and convenient form ;
and has greatly added to their value by contributing many pages of
interesting matter to the subjects on which they treat. We design

244 New Gland. New mode of Analysing Blood. [April,

simply by this notice to bring the work before the profession, and
may hereafter review it. Nothing can be added to the neatness and
correctness with which this volume is published.

PART III. MONTHLY PERISCOPE.]

New Gland in the interior of the tip of the Tongue. A German
physician, Dr. Nuhn, has lately discovered and described a gland in
the interior of the tongue. It may easily be seen by removing the
mucous membrane from a slightly elevated elongated oval space,
which is always seen about two lines from the median line, on the
under surface of the apex of the tongue ; this exposes a layer of Ion-
gitudinal muscular fibres; we then reflect, or remove some of the
fibres, which form part of the inferior lingualis, and the anterior
fibres of the stylo-glossus, when the gland is seen just under the canine
artery, outside the expanding branches of the lingual (5th) nerve,
just anterior to the edge of the hypo-glossus. The gland measures
from seven to ten lines in length, from three to four and a half in
breadth, and from one and a half to two and a half in thickness,
agreeing in the structure and general aspect with the labial, lingual,
and other similar glands. It has many ducts, which open through
the mucous membrane over it, by irregularly placed orifices, each of
which is surrounded by a slightly elevated ring. It is believed to
be a mucous gland, and has been found in no other animals than
man, and the orang. New- York Journal of Medicine.

New mode of analysing blood. We find in the Gazette M^dicale
de Paris (3rd Jan., 1846) a notice of M. Polli's researches on the
blood, published in the Annali Universal! di Medicina of Milan,
Sept., 1845. We translate the following very simple method of de-
termining the proportions of the principal constituents of blood. The
subject is one of great importance, and is now attracting very strong-
ly the attention of the profession.

"The blood being drawn, a small portion of it is put into a test ves-
sel, and its density and temperature immediately ascertained by means
of the areometer and thermometer before coagulation.

"This blood is now mixed with the remainder, and the whole whipped
with sticks until all the fibrin is isolated; this fibrin is collected with
the fingers, and squeezed in the hand so as to press out all the serum
from it; the test vessel is filled with the fluid thus deprived of fibrin,
and examined again with the areometer. If now this fluid be eleva-
ted by a water bath to the temperature of the blood when drawn, the
density of the blood deprived of its fibrin may be ascertained.

1946.] Activity of Digitalis. Uses of Arnica Montana. 245

" The blood deprived of fibrin is then allowed to rest in a vessel suffi-
ciently narrow and deep to permit its globules to settle and the clear
serum to remain above. The serum is then decanted into a test ves-
sel and examined with the areometer and thermometer, in order to
determine its density when deprived of both fibrin and blood globules.

"A certain quantity of water being added to the serum, this is co-
agulated by heat and strained through a cloth so as to separate the
albuminous flakes. The liquid is again tested, by which the density
of the serum deprived of its albumen, or. in other words, the water
of the blood holding in solution certain salts and organic matters, is
determined. This result will not only give the quantity of albumen
the serum contained, but also, by comparing it with the density of
distilled water, that of the saline and organic matters that were con-
tained in the blood.

' It is evident that by successively subtracting the densities severally
obtained, the relative proportions of fibrin, of globules, of albumen, of
salts, &c, mav be determined.'"'

Method of ascertaining the activity of Digitalis. According to
M. Falken, apothecary at Aebo, the following process will enable us
to determine the degree of activity of any parcel of digitalis:

Make an infusion of 50 centigrammes of the powdered leaves of
digitalis in boiling water, and filter an hour afterwards. Add then to
this infusion (when cold; 20 or 30 drops of a solution of ferro-cyanide
of potassium, prepared by dissolving 75 centigrammes of this salt in
15 grammes of distilled water. It* the digitalis be active, the infu-
sion will become gradually turbid, but if this does not occur in 10 or
15 minutes, the digitalis may be considered too inactive for use. M.
Falken considers the digitalis cultivated in Switzerland as the best.
[Translated/torn Gaz. Med., 20 Dec, 1845.

New uses of Arnica Montana. The " Journal de Chimie Midi-
cale.' announces three new applications of Arnica Montana; the
first for painful hemorrhoidal tumors; the second for varicose veins
of pregnant women ; and the third iu cases of tremors occurring in
gilders, and amaurotic amblyopia.

According to M. Szerlecki. who has tried it. the alcoholic tincture
of Arnica (prepared with the fresh juice of the plant) diluted with
four parts of water, or sometimes more, and applied to the painful
hemorrhoidal tumors, has always given relief.

M. Liedbeck, of Upsal, uses advantageously the Arnica adminis-
tered internally to pregnant females affected with varicose veins. He
infuses one gramme of tiie flowers or' A.rnica in 250 grammes of wa-
ter, and adds to it a few grammes of alcohol. Of this infusion he
a table-spoonful (bur times a day. The ehvct of this medica-
tion is to diminish the pains of the varices and to make the enlarge-
ment gradually disappear.

Lastly, M. Thielmann, of S:. Petersburg, prescribes in the afiec-

246 Croup. Purpura Hemorrhagica. Headache. [April.

tions common to gilders an infusion of 12 grammes of the flowers of
Arnica in 200 grammes of water, of which a table-spoonful is given
every 2 hours. [Trans, from Gaz. Med., 20 Dec, 1845.

Croup, treated by Sulphate of Copper. The Journal desConnais-
sances Medico-Chirurgicales contains an article from the pen of M.
Godefroy, in which he adds his testimony to that of Hoffman, Zim-
merman, &c, in support of the efficacy of the Sulphate of Copper
in the secondary stages of croup. The remedy is administered in
doses of from one-fourth to half-a-grain every half hour, until free
emesis be induced ; and its effect is alleged to be infinitely more
beneficial than that of any other emetic substance.

Turpentine in Purpura Hemorrhagica. The Edinburgh Monthly
Journal of Medical Science, for December, 1845, gives the history
of two very interesting cases of purpura treated by large doses of tur-
pentine. Dr. Neligan states that "it acts as a powerful cathartic,
also possesses the property of checking hemorrhage, depending on an
atonic state of the smaller blood-vessels, owing, probably, to its pow-
ers as a diffusable stimulant. In consequence of those views, I em-
ployed this remedy in the four cases that afterwards came under my
care while in charge of the district, and they all recovered. I pre-
scribed the oil both in the form of draught and of enema ; the usual
dose for adults being from one ounce to an ounce and a half, and for
children from two drachms to half an ounce, generally in combina-
tion with castor oil, to render its cathartic action more certain.

"Since that time I have employed oil of turpentine in every case
of purpura which has been under my care, and its use has been inva-
riably attended with beneficial results." [New-York Jour, of Med.

On Headache, accompanied by Alkaline Urine. [Dr. Sherman
describes this species of headache in the following words:]

Another malady of not unfrequent occurrence, may be allowed to
be mentioned here: a peculiar form of headache, accompanied with
alkaline urine, of the specific gravity of from 1,015 to 1,030, deposit-
ing triple phosphates and phosphate of lime ; with a deficiency of urea.
The headache is described as a dull, weary pain, affecting the memo-
ry and imagination ; there is uneasy sleep, often conjuring up unusual
sensations and ideas. The appetite continues good; bowels regular;
tongue clean : pulse quick and often feebie; but a great feeling of
debility attends this form of headache.

I imagine, in this disease, that there is just sufficient urea circulating
inthe blood to derange the brain, and that this is the sole cawseofthe
headache; for as soon as the kidneys return to health, and separate
the whole of the urea from the blood, the pain ceases.

Instead of giving purgatives, using local bleeding, blistering the
back of the neck, &cM I think the be?t mode of treating this affection
is to give animal food, good sound porter, light tonics, with nitric and

1846.] Asiatic Cholera, Aconitum Napellus. 247

muriatic acids ; merely attending to the secretions and excretions,
without using any decided alterative course of medicine. I have met
with several such cases, which have soon yielded to this simple mode
of treatment: and I think this is the class of headaches, cases of
which are sometimes quickly cured by tonics and stimulants, pre-
scribed at random, after the failure of an antiphlogistic mode of treat-
ment. [Provincial Med. and Surg. Journal.

Treatment of Asiatic Cholera. Dr. McGregor, in the Quarterly
Medical and Surgical Journalofthe North-western Provinces, speaks
highly of croton oil in this fatal disease, assuring us that it has sel-
dom failed in curing the disease, when given sufficiently early, and
combined with opium. He says, " if no blood can be obtained, I
give the following draught immediately:

ft 01. Crotonis .... gts. v.
Tinct. Hyoscyami . . 5j.
Opii grs. v. M. ft. haust.

If the spasms remain, and free vomiting does not succeed, the fol-
lowing pills are administered until it arises, when the skin becomes
warm, and other symptoms improve :

R Opii grs. iij.

01. Crotonis . . . gtts. v. M. ft. pil.

Nine grains of opium and fifteen drops of oil in repeated doses, will
produce these effects, but in one case Dr. McGregor gave eighteen
grains of opium and twenty-seven drops of oil before the disease
yielded. To prevent a relapse, he recommends quinine.

[Dr. Jephson, who writes in the same journal, treats cholera differ-
ently: he tells us, that after trying without benefit, stimulants, calo-
mel, opium, &c, "he determined to pursue the same treatment as is
usually followed in ague," being convinced that the two diseases were
strictly analogous in their symptoms and origin. Acting upon this
impression, he exhibited emetics and neutral salts, "modified and
combined with opium and stimulants in some of the stages." His
usual formula was a mixture consisting of an ounce of Epsom salts,
two grains of tartar emetic, and eight ounces of water : the dose one
ounce every half hour. After the third or fourth dose, the vomiting
and purging often ceased. Dr. Anderson relates two cases in which
decided benefit was obtained from the use of saline enemata.]

[Med. and Chir. Review.

On the Therapeutical Action of the Aconitum Napellus. By A.
Fleming, M. D., President of Royal Medical Society of Edinburgh.
The physiological and therapeutical action of the aconitum napellus
or monkshood forms the subject of a most admirable inaugural thesis,
written for the degree of M. D. in the University of Edinburgh.*

Dr. Fleming's work is full of interest in every point of view, but

* An inquiry into the physiological and medicinal properties of the Aconitum
Napellus. London, 1813, 'p. 160.

248 Ammonia in Scarlatina. Sleeplessness during Fever. [April,

as it will be noticed at length in our Report on Materia Medica, we
shall confine ourselves in the present place to a condensed account
of the therapeutical action of the medicine. It may be stated briefly,
that its medicinal action, as stated by the author, is in the first place
anodyne, secondly, it is anti-neuralgic, differing in this case from
opium, in that it not only decreases the sensibility of the affected
nerve for the time being, but removes the morbid condition of the
nerves. It is also calmative in inordinate excitability, and anti-
spasmodic. As an agent capable of depressing vascular action it
possesses considerable power, and is said by the author to be superior
to venesection, mercury, and purging in this respect, that it may be
continued for weeks without producing any unpleasant effects. The
diuretic properties of the drug are not decided, but it possesses un-
doubted powers as a deobstruent, causing the absorption of fluid
effused into (he joints, in synovial rheumatism, and promoting, ac-
cording to Storck and others, the discussion of glandular swellings.

The diseases in which aconite is said by Dr. Fleming to be useful
are in various forms of neuralgia ; in the general pains of fever ; in
diseases of the heart and great vessels, and in rheumatism.

[Ranking's Abstract.

Carbonate of Ammonia in Scarlatina. The value of carbonate of
ammonia in scarlet fever has been attested by several observers, and
during the past year by Dr. Pic-ken, of Dublin, and Dr. Rieken, of
Belgium ; while at St. Petersburg!! it is said to have been employed
by the German physicians without any evident advantage. Mr. H.
Freke suggests that it may act by taking the place of urea, and thus
supply the natural stimulus to the renal functions; and Messrs. Her-
denreich and Heim have observed, that in cases of scarlatina an
ammoniacal alkali is deposited on the skin, and hence offer another
explanation of its efficacy. Whatever the theory, the amount of
practical evidence preponderates in favor of the administration of
ammonia in scarlet fever. [Dr. Cowans lleirosp. Address in Prov.
Trans. No. 1, N. S. 1845. Braithwaite.

Sleeplessness during Fever. The most important medical pro-
perty of tobacco is the application of the moistened leaves to the
bare scalp in severe cases of fever attended by pervigilium and de-
lirium. If it succeed in inducing sleep under these circumstances,
it will be an invaluable remedy, for we know of no more deplorable
condition, or one more fraught with danger, being the forerunner of
collapse and death. We have been told of a curious and efficacious
use of tobacco in America : the fact was not stated by a professional
person, though by one of undoubted veracity. A leaf of tobacco is
often applied over the radial artery, or the pulse at the wrist. It seldom
fails to produce free vomiting. Its powerful effects when applied to
the whole surface of the scalp may be easily conceived. [Quarterly
Med. Journal, Delhi, India. Lancet. Braithwaite.

1846.] Bronchitis. Hooping-Cough. Yen. Vegetations, S?c. 249

Alum in Bronchitis. Dr. Andrews, of Teddington, strongly re-
commends the use of alum in acute as well as in chronic bronchitis.
His usual formula is forty-eight grains in five ounces of half-boiling
water, with half an ounce of syrup. The dose varies from half a
drachm to half an ounce three or four times a day. according to the
age of the patient. Dr. Cowan s Address. Braithwaite.

Tar-vapour in Hooping-Cough. Mr. Waddington recommends
in the treatment of hooping-cough, which has lately been so preva-
lent, a remedy which is, to say the least, cheap, and easily applied.
He says,

There are three stages of hooping-cough. In the first stage, the
patient should be taken into the open air, as usual, if the weather will
permit, live sparingly, and take every now and then a gentle emetic.
In the second stage, confine the patient to a bed-room and sitting-
room upon the same floor, communicating with each other. In these
rooms Swedish tar should be kept boiling, night and day, over a
small lamp; thus the vapour of tar will pervade both rooms. When
the symptoms run high, the remedy is almost miraculous. [Lancet.

On the Treatment of Venereal Vegetations. M. Vidal de Cassis
observes, " that there are few surgeons who have not experienced
disappointment in the treatment of these vegetations. Dissatisfied
with the usual means of curing them, as excision, cauterization, and
ligature, he was led to the adoption of a powder composed of equal
parts of burnt alum and powdered savine ; the efficacy of this appli-
cation is stated to be very great, the vegetations drying and shrivel-
ling up speedily. Two applications in the day are sufficient.

[Annates de la Chirurgie.

Treatment of excessive Tpmpanitic Distension. The accumula-
tion of gas within the bowels has occasionally been known to be so
great as to lead to laceration : the remedy which Schonlein has
found to be most effectual for the relief of this symptom, is a clyster of
cold water; the cold contracts the bowels, and diminishes the expan-
sion of the gas, while the water at the same time absorbs a portion
of it. This injection may be frequently repeated. [Rev. of Schon-
lein's Lectures, Medico- Chirurg. Rev.

Obstinate Diarrhcea. Canstatt relies greatly upon the nitrate of
silver in obstinate forms of diarrhoea; having succeeded with it in
several cases after the failure of other remedies. He prefers the
subjoined formulary:

ft. Argent, nitr. chrystall. gr. -\ ad h. solve in aqurs distill, gij :
adde gum. minos. 3ij, sacchari altei 3ij. Misoe. Dose: A teaspoojj-
ful or two every second hour. [Die Spccicllc Pathologie, tyc, in
Dublin Journal.

250 Menorrhagia, Neuralgia, Haemoptysis, Puncture. [April,

Nitrate of Silver in Cases of Menorrhagia. In cases of menor-
rhagia, ordinarily followed or preceded by a copious acrid discharge
from the vagina, M. Ditterich found nitrate of silver very useful.
Ten or fifteen drops of a mixture composed of three grains of the
nitrate of silver to a drachm of water, given in a little sugar and
water, diminished the disease in ten days. But it is necessary to
continue the remedy for two or three months, in consequence of the
affection being so likely to return. This medicine employed by
Kopp, in the same affection, seems to have been equally successful.
This practitioner gave one-tenth, or one-twelfth of a grain every two
hours. [Gaz. Med. de Paris. Southern Jour n. Med. and Phar.

"Extract of Tobacco in Neuralgia. Extractum nicotiance will
cure neuralgia so that it will not return again, and this with once
using. I, but a few weeks ago, gave some of an aqueous solution of

this extract to Mr. H , (aged between 30 and 40), who was on

business at Hampstead, and who was then, and had long been suffer-
ing from tic douloureux. His wife, whom I have since seen, informed
me that he had only occasion to rub it on his face once, which re-
lieved him, and from that time he had no return of it: and likewise
that three or four persons, who were laboring under the same com-
plaint, had also used it, and experienced similar relief. I have known
it to cure toothache speedily with once rubbing on the face.*' [Lancet,

On the Employment of the Fumes of Belladonna in Haemoptysis.
M. Schroeder speaks highly of this herb in haemoptysis, used in the
following manner: The dried leaves are cut into small pieces, and
about two drachms are then thrown upon burning coals, so that the
patient may be enabled to inspire the fumes as they arise. In all the
cases of haemoptysis in which this simple expedient was tried, the
author found it effectual in arresting the hemorrhage, generally at
the same time allaying the cough, and producing a feeling of relief in
the chest. It is singular that inhalation of the steam from a decoc-
tion of these leaves, or their internal administration, does not appear
to have an equally beneficial effect. [Annali Universali di Mede-
cina. Ranking's Abstract.

Puncture of the Heart by a large Needle, without any ill conse-
quences. This case occurred in the service of M. Trelat, at the

Salpetriere. On the twenty-third of August, Miss Q , in a fit

of despondency plunged a needle in the region of the heart between
the sixth and seventh ribs. She immediately declared that she was
about to die. An examination did not detect the presence of any
foreign body her pulse was calm, and there were no unpleasant
symptoms. She passed a good night, and on the next day ate as
usual. A slight impression as of a foreign body could now be per-
ceived in the region of the heart, and pressure at this point produced
slight pain. The absence however of any symptoms of disorder,

1846.] Injurious effect of Catheters. Lupus Exedens. 251

prevented any attempts at extraction. On the twenty-sixth of Au-
gust she complained that a large needle was permitted to remain in
her heart. Having now learned the size of the foreign body, its ex-
traction was immediately attempted It was seized with a pair of
dissecting forceps, and it was not without great surprise that we saw
come forth from the wound a needle of large size, which had heen
plunged perpendicularly into the heart, between the sixth and seventh
ribs. The needle was about two inches in length. It had become
oxydized by remaining in the wound so long. This needle had remain-
ed in the heart for three clays, yet it had produced no disorder in that
organ it had neither irritated it, nor modified its sensibility, for its
pulsations were at all times uniform. [Bui. Gen. de Ther. Trans.

Injurious effect of the eyes of Catheters. M. Cazenave, of Bor-
deaux, calls the attention of the profession, very judiciously, to the
injurious effects of the eyes of catheters. It will be readily under-
stood that during the introduction of these instruments, the mucous
membrane of the urethra, being firmly applied to the catheter, must
penetrate its lateral openings or eyes. This being the case, any far-
ther propulsion of the catheter must drag the portion of mucous
membrane thus insinuated into the eyes until it is liberated and
another portion introduced. In this manner the whole length of the
canal is irritated or abraided, to the serious discomfort of the patient.
Every one must have had occasion to remark how much more pain-
ful is the introduction of a catheter than a bougie, a circumstance
readily explained as above. M. Cazenave proposes, when the cath-
eter is to be used, that its eyes be filled with wax, or that a stylet be
introduced into it, of sufficient size at the portions that occupy the
regions of the eyes to close these effectually. This stylet may be
withdrawn after the catheter is introduced, if necessary, and replaced
before drawing out the catheter. [Translated from Gazette Med.
de Paris.

Lupus Exedens. Dr. Liston says that local treatment can alone be
depended on in this disease. He thinks chloride of zinc the best appli-
cation ; it is to be mixed dry with an equal quantity of flour, and then
moistened with a little water. When of the consistence of bird-lime,
it may be spread on some 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 the paste becomes
elevated at the edges. You will then find 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 cicatrization all
around. The surface is then poulticed to remove the scabs; and if,
subsequently, any portion should continue to present an unhealthy
aspect, the cauterization ought to be repeated. [Dublin Hosp. Gaz.

252 Divided Tendons. Hare-lip. Iodine. [April,

The suture used in the treatment of divided tendons. M. E. Ber-
therand reports in the Gazette Medicale de Paris, two cases in which
extensor tendons of the fingers having been divided, were treated
successfully by bringing the ends together by means of a thread
passed through them. The approximation was favored by the posi-
tion of the hand, as was the union by maintaining the muscles quiet
with the roller bandage and splint. The cure was completed in eight
days, and the function of the tendons completely restored.

Operation for Hare-Lip. M. Boudon, of Clermont, announces
to the Academie de Medicine (16 Dec, 1845,) that he has just suc-
cessfully performed the operation for hare-lip on an infant, according
to the plan recommended by Professor P. Dubois. The case was one
of congenital double hare-lip, with a deep cleft in the palatine arch,
which prevented sucking. It was even very difficult to feed the in-
fant with a spoon, as the liquid would in a great measure return
through the fissure of the lips. The child was but a few days old
when presented to M. Boudon. I hesitated sometime, says he, be-
fore operating on so young a subject, and 1 would not have determin-
ed to do so, had I not seen Prof. Dubois's communication recently
made to the Academy on this subject. The operation was performed
four days after the infant's birth.

The method adopted was precisely that prescribed by M. Dubois.
The edges of the fissure in the lip, after having been denuded by
incision, were approximated by the twisted suture. These first threads
were removed in twenty four hours, and others applied less tightly.
This plan was repeated daily, and the threads made less tight at each
dressing, until the pins were withdrawn. The pins were removed
only when the union was perfect, and the case terminated most suc-
cessfully and without the least accident. [Translated from the Ga-
zette Medicale de Paris, 20 Dec, 1845.

Iodine used for distinguishing Arsenical from Antimonial stains
in medico-legal inquiries. M. Lassaigne, after repeated attempts,
was led to the discovery of a process by which the most minute
quantities of arsenic and its compounds may be detected. His pro-
cess consists in exposing arsenical or antimonial stains to the action
of the small quantity of vapour emitted by iodine subjected to a
temperature of from 12 to 15 degrees of the centigrade scale. The
former stains or spots will assume a pale, brownish, yellow hue, which
becomes of a lemon yellow color after exposure a few minutes to the
air. The latter or antimonial spols, subjected to the same influences,
become of a deep yellow (jaune carmelite fonce) color which passes
to the orange on exposure to ihe air, and remains so. In order to
obtain these results, which are developed at the ordinary temperature
in 10 or 15 minutes, it is necessary to turn the porcelain capsule, on
which the stains have been obtained by Marsh's apparatus, over a
saucer in the centre of which a small quantity of dry lamellated

18-1G.] Pruritus Vulva*. Lotions in Porrigo. Odontalgia. 253

crystals of iodine has beon placed. [Reports of Acad, des Sciences,
15 Dec, 1845, in Gaz. Med. de Paris, 20 Dec, 1845. Trans.

Treatment of Pruritus Vulva. Dr. Meigs observes that having
been many times consulted for the relief of pruritus vulvae, and most
frequently in pregnant women, he has rarely had occasion to order
any thing more than the following formula :
R Sodce bibor. gss ;

Morphias sulph. grs. vj ;
Aq. rosaB distil, sviij. M. F. lotio.
He directs this to be applied three times a day to the affected parts,
by means of a piece of sponge or a piece of linen, taking the precau-
tion first to wash the surfaces with tepid soap and water, and to dry
them before applying the lotion. He confidently recommends this
prescription as suitable in mo3t cases of this distressing malady.

[Colombat on Diseases of Females.

Lotions in Porrigo decalvans and other diseases causing falling
off of the hair. Mr. Wilson advises that persons with short hair
should immerse the head in cold water morning and night, and after
drying and well brushing it to moisten the roots with one of the fol-
lowing lotions. In females with long hair the cold washing may be
dispensed with. The lotions are three in number:

No. 1. Vinegar of canlharides, half an ounce.
Eau de Cologne, one ounce,
Rose water, one ounce. Mix.

2. Eau de Cologne, two ounces.
Tincture of cantharides, half an ounce.
Oil of nutmegs, half a drachm.

Oil of lavender, ten drops. Mix.

3. Mozereon bark, one ounce.
Horseradish root, one ounce.
Boiling distilled vinegar, half a pint.

The infusion to stand for a week and then to be strained. If the
hair becomes dry and harsh after using these lotions, a small quanti-
of pomatum may be rubbed in. [Practical Treatise on Healthy
Skin, <$fc. Ranking'' s Abstract.

MEDICAL INTELLIGENCE.

R 0 <..Dr. Thomas W. Carter, one of our recent graduate*,

has furnished us \\ ith the following recipe for tooth-ache, which he

failed in his hands in a [ph., Tinct, Cam*

phorce, Tinct. Opii., equal parts. Mix. A piece of lint or cotton thoroughly
wet with the lotion is I and suffered to re-

main until the pain subsides, which will usually take place in one or two minutes.

254 National Medical Convention. [April,

^National Medical Convention. It is known to most of our readers that the
New York State Medical Society took measures early last year, to assemble a
convention of medical men in the city of New York, for the purpose of " eleva-
ting the standard of medical education in the United Slates," &c. &c. It will be
seen below, that the first Tuesday in May next is the time appointed for the pro-
posed meeting. We have only time at this late period to express our hope that
the profession at the South will be fully represented. Our College will send her
Delegates, we know that the Georgia Medical Society in Savannah has the sub-
ject now before them, and the Central Board of Physicians for the State should
be convened and representatives appointed. Delegates too might with propriety
be nominated from the Medical Societies of Columbus, Macon, Athens, &c, &c.
More than ten years ago, the Faculty of the Medical College of Georgia, pro-
posed a similar movement on the part of the Profession in our country, and the
proposition was favorably received; but in compliment to the University of
Pennsylvania, the oldest medical school of the United States, the time 'and
place for holding the convention and the number of Delegates to be appointed,
were left to her suggestion, and her faculty then, as now, declined to have any
thing to do with a Convention.

"The Committee appointed at the last Annual Meeting of the New York
State Medical Society, to carry into effect a resolution passed at the same meet-
ing inviting a National Medical Convention, in May next, would respectfully
report as follows :

"In the early part of last season the Committee, through their chairman,
addressed a circular containing the preamble and resolutions of this society,
with such comments as were deemed advisable, to all the State medical societies
and medical colleges in the United States, as far as the existence of such societies
and colleges could be ascertained. And in those States where neither State
societies nor colleges existed, a circular was addressed to some leading member
of the profession, inviting him to take measures lor having his State represented
in the proposed convention. Replies to these circulars and letters have been
received from the following officers of medical societies, and colleges and private
members of the profession, viz: Drs. W. W. Morris, of Dover, Delaware State;
A. H. Buchanan, of Tennessee; W. P. Johnston, of Washington city; T. T.
Hewson, R. M. Huston, and W. E. Horner, of Philadelphia; Luther Ticknor,
Connecticut; W. H. McKee, of North Carolina; E. H. Pearlec, of Hanover;
Paul F. Eve. of Georgia; J. H. Thompson, of New Jersey; J. W. Davis, of
Indiana; A. Twitchell, of New Hampshire; John W. Draper, A. H. Stevens,
Willard Parker, and C. A. Lee, of New York; J. Drake, of Ohio; Lawson, of
Kentucky, and Carpenter, of Louisiana. And delegates have been freely pledged
from societies and colleges in Maine, New Hampshire, Connecticut, New Jersey,
Delaware, District of Columbia, South Carolina, Georgia, Mississippi, Louis-
iana, Tennessee, Kentucky, Ohio, Indiana, and New York. Tiie medical
schools of Philadelphia are the only ones from whom replies have been received,
that decline sending delegates, and giving a hearty support to the proposed
measure. Nearly every medical journal throughout the whole Union has not
only favorably noticed, but warmly commended the holding of such a convention.

" There are some institutions from ^vhom no replies have been received 'f but
from information obtained from other sources, there is good reason for believing
that most if not all these will appoint delegates as soon as they are fully assured
that the convention will be held. It will thus be seen that in far the larger part
of our Union, the invitation of this society has met with a prompt and hearty
response from the profession ; and it is with much regret that we find even a few
institutions declining to take any part in so important a movement. But when
we consider the wide extent of our territory, and the great number of our insti-
tutions, all engaged, we should hope, in a generous rivalry with each other, the
expression in favor of a convention is certainly more unanimous and more pro-
mising of good than could have been anticipated. Indeed the leading and
influential members of the medical profession have long felt the necessity of
some national action ; some central point of influence around which the active
and choice spirits of the whole profession can rally, and from which may be

1846.] National Medical Convention Comp. Ch. Pectoral, 255

made to radiate an elevating, healthful, and nationalizing influence over the
whole country.

" Hence, it only remains for this society to carry out the work it has so nobly
commenced. The faculty in the New-York University have very generously
tendered to this society, the use of any room or rooms in their college edifice, that
may be desired, for the convention to meet in. Some State societies and col-
leges have already appointed their delegates, while others have expressed a de-
sire that the society would fix the number of delegates to be appointed by each
society and college. For the purpose of *furthering the objects in view, your
committee would respectfully submit the following resolutions, viz:

" 1st. Resolved, That the preamble and resolutions passed by this society, at
its annual session, Feb. 6th, 1845, did not contemplate the appointment of dele-
gates to the National Convention, by county or merely local societies, in those
States where delegates, are appointed by a regularly organized State society.

" 2d. Resolved, That as some societies and colleges have already appointed
their delegates, therefore the number to be appointed by any one of these institu-
tions should be left entirely to the discretion of the appointing body.

"3d. Resolved, That sixteen delegates be appointed to represent this, society in
the proposed National Convention, viz: two from each senatorial district in the
State. *

"4th. Resolved, That this society accept the offer of the faculty in the New York
University, respecting their room's; and consequently that the members of said
National Convention are invited to assemble in the college edifice of New York
University, at 10 o'clock, A. M., on the first Tuesday in May next.

" 5th. Resolved, That a committee of three be appointed to continue the efforts
to further the objects of the proposed convention ; and to exert all their influence
to make it truly National in composition and action.

"6th. Resolved, That the above committee be authorized to invite the superin-
tendents of lunatic asylums in the several States to attend the Convention.

"7th. Resolved, That the committee be further authorized and enjoined to send
a copy of this report, together with the action of this society thereon, to all the
medical journals in the United States, with a request that they publish the same,
on or before the first of April next.

"N.S.Davis, 1

James McNaughton, > Committee.
Peter Van Buren, S

" Albany, Feb. 3, 1846.

" The above report and resolutions were unanimously adopted by the society.
The same committee of three was re-appointed in answer to the 5th resolution.
Two delegates were also appointed from each senatorial district in obedience to
resolution 3d.

" .N S. DAVIS,

" To Paul F. Eve, M. D., &c." Chairman of Committee.

"VVe are indebted to our friends, Messrs. Haviland, Risley & Co., Druggists,
of this city, for the following note :

"I send you herewith an article of my preparation, which aspires to the gen-
eral favor of medical men. You will'sec I have successfully combined, in a
rich, permanent, and agreeable form, some of the choicest remedies in use.
TheSyrupof Wild Cherry, particularly, is nowmuch relied on, by many leading
members of the profession, as an invaluable adjuvant, in subduing pulmonary
disease. I beg you will give it a trial, and if you find it worthy, your influence,
Comp. Ch. Pectoral. ft. Acet. Morph. gr. iv.
Tr. Sang. Can. 5ij.
Vin. Antim. Tart.
Vin. Ipecac, aa 5iij.
Syr. Pruni Virg. siii.
"The equivalent ultimate principles nre here combined in their puritv, viz:
Morphine, Sanguinerine, Tart. Ox. Antim., Emetine, Hvdrocyan. Acid, Sacha-
rine, Spts.& Aqur.

Respectfully, JAS. C. AYER."

256

Medical College of Georgia. Meteorology.

Medical College of Georgia. The Course of Lectures in this Institution was
terminated on the 28th of February. The Class consisted of one hundred and
twelve gentlemen, of whom 77 were from Georgia, 18 from South Carolina, 12
from Alabama, 1 from Vermont, 1 from Virginia, 1 from Mississippi, 1 from
Canada, and 1 from Ireland.

The Exercises of the Commencement took place on the 4th of March, when
the honorary degree of Doctor of Medicine was conferred upon Dr. Alexander
Means and Dr. Tomlinson Fort. The following gentlemen were graduated
Doctors of Medicine ;

Robert Austin,

of Georgia.

N. B. Johnson,

of Alabama.

C. W. Ardis,

" So. Ca.

J. A. Mann,

" Georgia.

G. T. Burton,

" Georg-ia.

F. J. Martin,

u H *

H. H. Carey,

" Vermont.

Sherrod McCartv,

M (

T. W. Carter,

" So.Ca.

J. A. S. Milligan,

U U

J. W. Clark,

" Georgia.

W. W. Mims,

" So.Ca.

J. M. Colquitt,

" Alabama.

E. W. Murray,

" Georgia.

A. J. Creisrhton,

" Georgia.

J. T. Palmer,

N If

Wm. Clardv,

" So. Ca.

S. A. Pugeslv,

(i U

Win. E. Dearing,

" Georgia.

A. B. Spruill,

<< . II

Joseph Forbes,
R. H. Fryer.

(i

W. M. Trammel,

" Alabama.

" Alabama.

V. H. Walker,

" Georgia.

G. P. Gilder,

(t i<

J. S. Wilson,

(< t<

A. A Giltenan,

" Ireland.

D. A. Weaver.

<( (i

James Gillespie,

" Georgia.

J. M. Nash, M, D.

, of Alabama,

E. S. Hibbler,

" So. Ca.

ad eundem gradum.

METEOROLOGICAL OBSERVATIONS, for February, 1846, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

Sun Rise

Tiikr

Bar.

29 75-1001

30 3-100
30 5-100

29 98-100
98-100

" 90-100
" 40-100
" 50-10
" 55-100

30 1-100
29 80-100

82-100
30

29 45-100
" 50-100'
" 82-100
" 97-100
" 85-100
" 65-1001
" 41-100
" G3-100
" 60-1001;
" 78-100
" 90-lOOj
;< 8*2-100

30 2-100
30 12-100
29 80-100

2,

P. M.

Wind.

TflEH.

Bar.
29 75-100

04

n. w.

60

30 3-1001

N\ E.

58

30

N. W.

64

29 96-100

S.

67

' 93-100

S.

47

75-100

X. E.

52 .

i; 42-100

W,

04

" 52-100

W.

40

" 80-100

X. w.

48

30 2-100

S. E.

57

29 71-100

8. w.

62

" 85-100

w.

55

" 90-100

N. E.

50

" 95-100

N.

42

" 50-100

N. W.

58

81-100

W.

62

i: 97-100

E.

57

" 75-100

E.

38

" 45-100

N. E.

43

" 48-100

W.

51

" 56-100

S.

53

<: 70-100:

w.

60

" 85-100,

w.

70

" 85-100

s.

65

" 80-100

g.

53

30 6-100

N. E.

40

30 7-100

N. E.

47

29 64-100.

E.

Remarks.

Fair.

Fair.

Fair.

Fair.

Fair.

Rain all day, 2 inch, and 1-10

Flying clouds.

Fair.

Cloudy.

Cloudy.

Cloudy.

Fair.

Cloudy rain last night 4-10

Rain 8-10 in.

Cloudy blow.

Fair.

Fair.

Cloudy.

Rain 8 -10 inch,

Cloudy blow.

Hnzv blow.

Fair.

Fair.

Fair.

Cloudy.

Cloudy.

Cloudy.

Cloudy.

12 Fair days. Quantity of Rain 4 inches and 1^-10.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 1] NEW SERIES. MAY, 1816. [No. 5.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XIV.

Statistical Researches on Cancmr. By Johx Le Conte, M. D.,
of Savannah, Georgia.

accidental and individual peculiarities, possess certain common
qualities or properties, which vary according to determinable laws.
For example, the ratio of the sexes at birth, their relative weight at
the same epoch, their gradual growth until the period of maturity,
their attainment of a certain mean age, and their liability to death
from various causes, are found to observe fixed laws ; they are
always the same under the same circumstances. It is the enumera-
tion, systemization, and generalization of these facts that constitute
what has been happily designated by the illustrious Laplace, "Vital
Statistics." Until very recently, physicians do not appear to have
sufficiently appreciated and employed the valuable instrument of
statistical calculation. It is probably only by the assistance of such
an exact test, that we shall eventually arrive at fixed conclusions
respecting the efficacy of different modes of treating a disease, and
the prognosis to be formed regarding the probable issue of various
maladies. In the history of the more demonstrative sciences, it will
be found that it is the introduction and use of accurate numerical
measures, that forms the prelude to the epoch of rapid advancement.
The theory of gravitation in astronomy, that of definite proportions
in chomistry, and that of luminiferous undulations in optics, are all
numerical theories, susceptible of mathematical expression. There
is, of course, no absolute certainty beyond the pale of the pure
mathematics, as probabilities pertain even to the most perfect of the
mixed mathematical sciences; nevertheless, the extent to which any
science admits of the application of numbers, may be regarded as a
fair measure of its exactness. In respect of a single individual, or a

17

258 Statistical Researches on Cancer, [May,

small number of persons, the uncertainty of the duration. of life is
proverbial ; but the case is entirely changed when multitudes are
concerned ; and there are few classes of contingent events of which
the results can be predicted with so little risk of departure from
truth, as the average age to which the lives of a considerable number
of persons will be prolonged. Various as are the causes operating in
the production of disease, it is now demonstrated, that mortality is
subject to a law, the operation of which is scarcely less regular and
certain than that of gravitation. Deaths and their causes are scien-
tific facts, admitting of mathematical analysis, and medicine, like
the other natural sciences, is beginning to substitute numerical ex-
pressions for crude hypotheses and vague conjectures. Our existing
means of observation and the present state of mathematical analysis,
are still too imperfect to enable us to trace the elements of the human
body through the cycle of organization ; but these same obstacles
are encountered even when dealing with the inorganic atoms of
chemistry, and the multifarious phenomena of meteorology. And
since in this, as in all genuine sciences, our knowledge becomes real
and scientific, only in so far as it is verified in particular facts, and
thus established in general propositions, a separation of the subjects
of research is requisite to a correct appreciation of many points in
vital statistics.

Several peculiarities in the laws of development and mortality in
Cancerous affections, have long arrested my attention. On a
former occasion, statistical researches on this subject, led me to the
remarkable conclusion, that cancer is increasing in frequency : (1)
my table, deduced from a comparison of the general mortality with
that from the disease in question, showing that in London, the pro-
portional deaths from this cause had "nearly quadruplicated in a
period of 113 years" !! Since that time, my deductions relative to
this point, have received abundant confirmation from the elaborate
statistical researches of M. Tanehou, presented to the French Acade-
my of Sciences during the year 1843. (2) The method ofcalculation

(1) This Monograph on Cancer, was read before the " Society of Alumni of
the College of Physicians and Surgeons of the University of the State of New
York," on the 18th of October, 1842; and Avas published in the first number of
their '-Transactions," and likewise in the New York Lancet for Oct. 29th and
Nov. 5th, 1842, pp. 281 et 299.

(2) For abstracts of M. Tanchou's Researches, see London Lancet for August
5th, 1843, Am. Ed. p. 593, from Gazette des Hbpitaux for July Gth, 1813; Phila-
delphia Medical Examiner for Sept. 2d, 1813, p. 200; and Medico-Chir. Rev.
for Jan. 1841, p. 213, from Gazette des Hopiiaux.

184G.]

Stalistical Researches on Cancer.

259

employed in these cases, is not strictly correct, inasmuch as the va-
riation in the proportional mortality from carcinoma may be caused
by a variation in the general mortality at different times, which
forms the basis of the numerical compaiison. For example, in Lon-
don, during the last century, the mortality has decreased from 1 in 20
to 1 in 40 of the entire population at the two extreme periods; hence,
assuming the ratio of deaths from cancer to the number living to have
been constant during this time, the proportional results deduced from
a comparison of the total mortality at the end of the century with
the amount who died from this particular disease at the same
epoch, would apparently indicate a duplication in the mortality from
cancer in 100 years, when, in fact, there had been no real alteration.
It appears, therefore, that the facts developed by my former research-
es, as well as those contained in the Memoir of M. Tanchou, only
furnish a high degree of probability that cancer is increasing in fre-
quency. Such being the case, perhaps it may be instructive for us
to submit all of the available statistical data relating to this disease,
to a more rigid analysis.

First, with respect to Age : The following table furnished by
Prof. W. H. Walshe, embracing 1200 cases occurring in England
in 1837, will illustrate this point. (Vide. Cyclopedia of Practical
Surgery, Article Cancer; and Dr. J. M. Warren's Am. Ed. of the
same, in 1 vol. 12mo., Boston, 1844, p. 104.) I have added a co-
lumn showing the ratio of deaths in the two sexes at different acres.

Table I.

Age.

Males.

Females.

Both S

Ratio or Males to Females.

Under 5 years

3

9

12

1 to

300

5 and under 10

3

2

5

1 to

0-G6

10 " " 15

1

4

5

1 to

400

15 " " 20

3

5

8

1 to

166

20 " 25

4

2

6

1 to

0-50

25 " " 30

1

13

14

1 to

13-00

30 " " 35

6

2

29

1 to

383

:;:> "40

15

43

58

1 to

287

40 15

1!)

77

%

i to

10.-.

45 " 50

23

98

121

1 to

4-26

50 " 55

:;i

130

itil

1 to

382

:':> " " 60

35

120

1 55

1 to

3-43

GO " " 66

11

110

154

l to

2 50

05 ' " 70

45

88

133

i to

t-96

70 - " 75

35

69

nil

1 to

197

:: ' so

30

10

70

1 to

t-fiS

" 85

10

11

l to

1 75

" 90

I

8

9

l to

800

" 95

-i

l

3

1 to

0 50

upwards

0
871)

1

1 to

Totals"

1 to

260

Statistical Researches on Cancer,

[May,

This table clearly illustrates the important influence of Age on the
development of cancer. We will farther elucidate this point, by
presenting a table embracing upwards of 9000 cases, which occurred
in the department of the Seine in France, during the eleven years
from 1830 to 1840 inclusive. The data are obtained from the Me-
moir of Tanchou, to which reference has been previously made.

Table 2.

Age.

Males.

Females.

Both Sexes.

Ratio of Males to Females.

From 1 to 10 years

9

14

23

1 to 1-55

10 to 20 "

13

13

26

1 to 100

20 to 30 "

62

169

231

1 to 2-73

30 to 40 "

190

822

1012

1 to 4-33

40 to 50 "

339

1636

1975

1 to 4-82

50 to 60 "

488

1620

2108

1 to 3-32

60 to 70 "

598

1469

2067

1 to 2-46

70 to 80 "

398

917

1315

1 to 3-30

80 to 90 "

62

273

335

1 to 4-40

90 to 100 "

4

22
6955

26

1 to 5-50

Totals.

2163

9118

1 to 3-215

A comparison of these two tables shows a very remarkable agree-
ment, which must develop an abiding assurance that, the law of
mortality from carcinomatous affections, is fixed and uniform in its
operation. This uniformity will be more clearly illustrated, by
combining the data in both tables, in such a form as to render the
results more conspicuous. From these materials, 1 have computed
the following table, exhibiting the proportional mortality from cancer
in 1000 deaths from that disease, in each sex, at each decennial peri-
od from 20 to 90 years.

Table 3.
deaths from cancer in 1000 deaths from cancer.

Englaiu

Both Sexes.

France.

Ages.

Males.

Females.

Males.

Females.

Both Sexes.

20 to 30

4167

12-500

16-667

6-799

18-535

25-334

30 to 40

17-500

55-000

72-500

20-838

90151

110-989

40 to 50

35000

145-830

180-830

37179

179-430

216-609

50 to 60

57-500

208-330

365-830

53-521

177-670

231191

60 to 70

74-166

165000

239- 166

65-585

161110

226-695

70 to 80

54-167

98-333

152-500

43-650

100-570

144220

80 to 90

14167

30-000

44167

6 799

29941

36-740

From these tables we learn the proportional numbers of individuals
dying from cancer at each specified period of life; but we are by no
nrujans warranted in the conclusion which might seem to follow, viz:
that these numbers represent the relative tendency to the disease at

1846.]

Statistical Researches on Cancer,

261

different ages. This is a serious error into which writers frequently
fall, when treating of the influence of age on the development of dis-
eases. It must be borne in mind, that the number of persons living
at the different ages is very far from beincr equal. For instance, it
appears from table 2, that 1620 females die from carcinoma between
the ages of 50 and 60, while only 917 perish between those of 70 and
80; but if the total number of females living of the former age were
somewhat more than double that of those alive of the latter, the true
proportional mortality at both decennial periods of life would be
nearly equal, instead of being in one of them nearly double that of the
other. In order, therefore, to ascertain with accuracy whether par-
ticular ages exercise any influence on the development of the disease,
we must compare the absolute mortality with the total number living
at each age. This Prof. Walshe has been enabled to do in the fol-
lowing table, with the assistance of the population estimates of Mr.
Rickman, and the data contained in table 1. (Walshe op, cit., Bos-
ton Ed., p. 105.) As on a previous occasion, I have added a column
exhibiting the proportional mortality of the sexes at the different ages.

Table 4.

Deaths from Cancer in 1000 living.

Ratio of Male?
1 to

Ages.

[Males.

Females.

Mean.

to Females.

Under 5 vears

006

017

283

5 and under 10

007

004

006

1

to

0-57

10 " " 15

002

010

006

1

to

500

15 " " 20

009

017

013

1

to

1-83

20 " " 30

Oil)

024

017

1

to

2-40

30 " " 40

058

192

105

1

to

2-6-2

40 " " 50

140

-983

561

1

to

: j

50 " " 60

290

i-i t;;

678

1

to

3 68

60 " " 70

686

1 102

919

1

to

1-89

70 " 80

035

1-421

1-178

1

to

1-.V2

80 " " 100

L207

973

1089

1

to

081

All ages

103

215

174

1

to

238

Several peculiarities in the law of mortality in the sexes, as exhib-
ited in the foregoing table, seem to render it exceeding desirable, that
their accuracy should be tested by a more extended statistical inves-
tigation. The elaborate materials collected by M. Tanchou, appear
to be peculiarly adapted for such a test. Extending, as they do, over
the mortuary registers of 11 years, we feel assured, that the mean
results will be presented in a form almost totally disengaged from the
accidental perturbations, which necessarily attach to the records of a
single year There art}, however, many difficulties in the way of
applying these data. In the first place, we have no means of aseer-

263

Statistical Researches on Cancer.

[May,

taining the proportionate number of persons of each age living in
France, or even in the department of the Seine ; and secondly, grant-
ing that this preliminary information could be furnished, yet, it would
be an unwarrantable assumption to suppose, that the population was
stationary curing the period of time included in the mortuary records.
In order to remove these obstacles, I have resorted to a method of
approximation, which, I trust, will be found sufficiently accurate for
the purposes intended. As it is very probable that the population
increases in a uniform geometrical progression, and as M. Tanchou's
researches extend from 1830 to 1840 inclusive, it is fair to assume,
that the population of the department, according to the enumeration
of 1836, is a good estimate of the average number living during the
whole 11 years. Now the population of the Department of the
Seine, (embracing Paris and the arrondissements of Sceaux and St.
Denis.) was, in 1336, 1,106,891. Assuming the proportional
numbers of the sexes to be the same as they are in England, and we
have 540,738 males, and 566,153 females. Again: assuming the
number of persons of each sex living at each age in France, to be in
the same proportion as in England, with the assistance of the Eng-
lish population estimates at our command, it becomes a mere matter
of calculation to furnish the required materials for instituting our nu-
merical comparisons. The English estimates are furnished by the
census of 1841, and may be found in the American Almanac for 1846,
page 163. Of course, this mode of determining the number living at
the different ages, is not absolutely correct; but the approximation is
so near the truth, as scarcely to influence the proportional mortality
deduced therefrom, when the divisors are from 30,000 to 140,000.
Without going into the intermediate steps in the calculation, which
are sufficiently obvious, we present the reader with the results of
our algebraic labors in the subjoined table. The numerical elements
of table 2, were, of course, used.

Table 5.

Estimated averase number

living in

Annual Deaths from Cancer in

Dtp. oj Stine, per annum.

1830-40.

1000 living pe

r annum.

Ages.

Males.

Females.

Total.
~279.O0h

Males.

0058S

Females.

Both Sexes.

Ratioof Malesto Females

Under 10

139,IS6

139.640

00910

00740

1 to

1-55

10 to 20

1 1 5,556

115.069

230.S25

01023

010-20

0 1 0-24

1 to

1003

GO to 30

0-2,736

104.342

197.078

06078

147-.')

100 =.5

1 to

2 42

30 to 40

69.485

73.0(13

1 4 2.68-

.-248^8

1-02081

64476

1 to

411

40 to 50

52.073

54,1-24

106.197

59l>2

2-74786

1-6906S

1 to

4 '4

50 to 60

34,607

36.SO0

71407

1-28192

400198

2-68372

1 to

312

60 to 70

2-2,9-28

-25.703

48,631

2-37111 5 19564

3-86399

1 to

2 19

70 to SO

1 1 .055

1-2.852

23,937

3-26399 6 4S6-9

4-99417

1 tc

199

80 to 00

2,S66

3.6^0

6,546

190669 6 74408

4-65239

1 to

3 4:2

90 to 100

216

340

556

1-66110 5S8769

4 25114

1 to

350

All ages.

540,738

566,153

U06.S91

36364

1 LI679

l to

3 071

1846.] Statistical Researches on Cancer. 263

It will be observed that tables 4 and 5 concur in demonstrating
the inaccuracy ofthe prevailing opinion, that the tendency to cancer
is at its maximum between the 35th and 50th years. On the con-
trary, in both sexes, the mortality goes on steadily augmenting with
each succeeding decade until the 60th year, and among females,
according to table 5, until the 90th; after that period, the number
of cases is probably too small to furnish any reliable comparison.
While there is a remarkable general agreement in the results con-
tained in the last two tables, yet there are several differences in the
details, which deserve special notice. In the first place, it clearly
appears, that the mortality from cancerous affections in the Depart-
ment of the Seine is about quadruple what it is in England, while the
ratio of deaths in the sexes is nearly the same in both ! ! This sub-
ject will come under consideration hereafter. And secondly, the
numbers representing the proportional mortality, which I have de-
duced from the French records, present tar greater uniformity in the
increments at each decennial period, than those contained in the
table of Prof. Walshe. This is what might have been a priori ex-
pected, from the fact, that table 5 shows the mean results of the
mortuary registers of 11 years, from which, we might reasonably
anticipate, all accidental irregularities would be eliminated. Deduc-
tions drawn from very limited statistical records, often present such
irregularities in a form so striking, as to give apparent confirmation
to erroneous pre-conceived opinions. For example, according to
table 4, it appears that there exists a remarkable difference in the law
of mortality in the sexes. The most general character of this differ,
ence seems to consist in the greater regularity of increase with
advancing age among the males. By inspecting that table, (Xo. 4,)
it will be discovered, ihat the number of deaths from 30 to 40, is in
both sexes about 6 times greater than from 20 to 30 ; but here the
similitude of increase vanishes; in the next decennial period the
mortality among females augments more than sextuply, while the
deaths among males only increase 2 times. Hence, Prof. Walshe
concludes, (op. cit., Boston Ed., pp. 107 et 103,) that the enormous
and abrupt augmentation of female mortality between the ages of 40
and 50, when taken in connection with the equally sudden diminu-
tion ofthe intensity of fecundity among women at the same epoch
of life, (as exhibited in the Swedish tables,) lends strong support to
the validity of the current opinion respecting the proclivity to uterine
and mammary cancer during the declining activity and cessation of

264

Statistical Researches on Cancer,

[May,

the reproductive functions. Now, this inference is partially at vari-
ance with the results contained in table 5 ; which, from the number
of cases as well as the period of time which they embrace, are
assuredly more worthy of confidence than those drawn from the
records of one half year. It is true, that this table shows, that the
excess of female over male mortality is at its maximum between the
ages of 30 and 50, and, in so far, affords a fair confirmation of the
opinion above-mentioned; but no sudden and abrupt alteration of
the law of mortality in the sexes, is here exhibited at that period
oflife. In fact, the most enormous increase of deaths among females
takes place between 20 and 30, when the intensity of fecundity is
probably at its maximum. The following proportional numbers,
readily obtained from table 5, will illustrate this point more clearly
than words.

Ages.

Males.

Females.

10 to 20

1

1

20 to 30

6

14-5

30 to 40

25

102

40 to 50

59

275

50 to 60

128

400

It appears, therefore, that, while the changes which take place in
the system of the female, during the period of declining activity of the
reproductive functions, tend to accelerate to a considerable extent
the development of cancerous affections, as exhibited in the excess
of female deaths at this epoch over the general mean of the sexes at
all ages ; yet, that the law of increasing frequency with advancing
age, sutlers but a comparatively slight perturbation from this cause.
Indeed, after the age of 30, the rate of increase with advancing life
is remarkably uniform among females up to the 80th year ; the mean
increment of these 5 decennial periods being about 1*30 per 1000
living, for each decade. These facts are rendered easily compre-
hensible by the following diagram constructed from the elements
contained in table 5, in which number is represented by space.

1846.]

Statistical Researches on Cmncer.

265

Diagram, deduced from Table 5, showing the relative mortal-
ity from Cancer at different ages in both sexes.

Mali

Females, Both Sexes,

Scale -lOOnr-1- of an inch.

""*

o

o

o

o

G

o

o

o

o

o

fcD

a

o

CI

o

CO

o

o

CO

o

o

QO

o
o

<

The fact likely to be most strongly impressed on the reader by this
diagram, is, the remarkable regularity of increase in mortality with
advancing life after the age of 30, especially among females. After
the 80th year, the law appears to be disturbed by irregularities; but
this probably arises from the fact, that the number of cases after this
epoch is too small to admit of useful comparison. Between the ages
of 30 and 80, the law of mortality may, with considerable approxi-

260

Statistical Researches on Cancer.

[May,

mation to truth, be geometrically represented by a series of right-
angled triangles including each other, whose bases are the number of
decennial periods above 30 years, and whose perpendicular sides are
the proportional deaths during each decade. For example, assuming
that the mortality among females increases as life advances, in an
arithmetical progression, whose common increment is 1*30 per 1000
living for each decennial period, and we are furnished with the data
requisite for constructing the series of triangles given below; the
scale being the same as that used in our diagram.

The accordance of the geometrical representation with observation,
is exhibited in the following comparison of numerical results.

Ages.

Accord

ing to Table 5.

According to Calculation.

30 to 40

i-03

1-30

40 to 50

2-74

2-60

50 to 60

4-00

3-90

60 to 70

5-20

5-20

70 to 80

6-49

6-50

1840.]

Statistical Researches on Cancer.

2G7

Among males the increase is not so regular, and its law seems to
approach nearer a geometrical progression whose least term is '30,
and whose common ratio is 2. The following comparison will
illustrate this point.

Ages.
30 to

40

Accord

ng to Table 5.

According to Caleaiy

25

30

40 to

50

59

60

50 to

60

1-28

1-30

GO to

70

237

240

70 to

80

326

-4-bO

But it is more than likely that the rate of increase with advancing
life, would be found to observe the same law in both sexes, if our ob-
servations were sufficiently numerous to disengage our results from
accidental circumstances. In the absence of such data, perhaps, it
is reasonable to give the preference to the law deduced from the
female mortality, since it is drawn from 3 times the number of
cases as that for the males, as affording the nearest approximation
to the truth.

2. Sex. The relative frequency of cancer in the two sexes may
be learned from Mr. Wm. Farr's valuable Reports of the causes of
death throughout England and Wales, as likewise from the statistical
data furnished by the researches of M. Tanchou at Paris. For con-
venience of comparison, I have placed both of them in the same
table.

Table 6.

Country.

Year.

Males.

Females.

873"

1,828
2,031
6,955

Ratio of Males to Females.

England and Wales,

ii k i.

Dep't. of Seine,

| of 1837
1836

1839

1830-40

355

680

G60

2,163

1 to 2-459
1 to S448

1 to 3077
1 to 3-215

Totals,

:;:::s

11,687

1 to 3-077

It is well-known that, throughout Europe, a certain degree of nu-
merical superiority exists on the side of the female population, yet
it is quite inadequate to account for the vastly higher quota of can-
cerous deaths in that sex. as exhibited in the foregoing table. By
calculating the rate of mortality in proportion to the numbers living
of each sex, any error arising from the numerical inequality of
the sexes is avoided, and the insufficiency of this difference in
numbers to explain the disparity in the liability to carcinoma, is
brought prominently into view. This I have endeavored to do

268

Statistical Researches on Cancer.

[May,

approximatively, and present the reader with the results in the
annexed table :

Table

7.

Estimated Number Living.

Deaths from Cancer in 1000 Living.

Country.
England and Wales,

Dep't. of Seine,

Year.

1S3S~

1839

1830-40

Males. | Females.

7,469.450 7 8-29 451

7,57 -2:873; 7,932,874

540.73SJ 5 6.153

Males.

"OSSO
0871
3636

"0948"

Females.j Ratio of Males to Females
2335 1 to 2813
2560 1 to 2938
11168 | 1 to 8-071

Total,

15,5S3,06l|l6,32S,47S

2751 1 1 to 2903

This shows that the annual mortality from cancer among females,
exceeds that among males, nearly in the proportion of 3 to 1. This
striking difference in the liability to carcinomatous affections in the
two sexes, is the more remarkable from the fact, that the average
annual mortality of the English population in the 5 years 1838 42,
from all diseases, is 22*94 per 1000 living among males, while it is
only 21*24 per 1000 among females. As the expectation of life
among women exceeds that of men by about 2 years, it follows that
a greater proportional number of the former live to an advanced
age. This circumstance would obviously tend to augment the fre-
quency of cancer among females as compared with males, in so far
as a greater proportion of women reach the age which is most ob-
noxious to the disease. But this is wholly insufficient to account
for the vast disparity in the mortality from this disease in the two
sexes. For, by inspecting the last column of table 5, where the
ratio is deduced from a comparison of the proportional mortality of
each sex at different ages, it will be seen, that the excess is main-
tained by the females throughout life, and especially after the age of
30. Indeed, it is impossible to assign any physiological cause or
combination of causes, which will account for this remarkable differ-
ence in the rate of mortality in the two sexes. As the various organs
which sympathize with the periodical modifications of the genital
system in the female, exhibit a striking proclivity to cancerous
affections, it has been conjectured that the development of the
disease is in some manner connected with these changes. These
changes have doubtless, as has been previously remarked, some
influence in the production of cancer; but they are far from being
adequate to explain the disparity in question : for not only does the
excess of female mortality obtain prior to the age at which the sexual
functions are manifested, but it continues still more conspicuously
long after the reproductive functions have become dormant. This is

1846.] Statistical Researches on Cancer. 269

clearly apparent from tables 4 and 5. Perhaps, the excess in the
deaths from carcinoma in females, may be, with greater plausiblility,
ascribed to certain original physiological peculiarities in the sexes,
favoring the development of some class of diseases. That such con-
nate differences do exist, seems to be rendered probable from the fact,
noticed by Dr. Emerson of Philadelphia, that the diseases most fatal
to male children seem to be of the sthenic class, such as attend upon
constitutions in which the energies of organic life are highly exalted ;
whereas, those which arc most destructive with female children, are
of the asthenic class, characterized by less energy of the forces of
organic life, and feebleness of the system. (Vide. Amer. Journal
of the Med. Sciences, for Jan., 1846, p. 91 et seq.) Cancer appro-
priately belongs to the latter class.

3. Frequency. Whether the frequency of cancerous disease is
on the increase is a question of considerable interest, but one to
which a satisfactory reply cannot be furnished, until we have the
means of ascertaining the proportion of the population annually cut
offbythe disease during a series of years. As already remarked,
my former statistical researches on this subject, (which were pub-
lished 8 months prior to those of M. Tanchou.) led me to the con-
clusion, that the ratio of deaths from cancer to the total mortality of
London had increased in 113 years (1728 to 1841) from 200 to 7 95
per 1000. M. Tanchou has, by a totally independent course of in-
vestigation, arrived at an analogous result, with respect to the preva-
lence of this disease in France. It appears that in 11 years, from
1830 to 1840 inclusive, there died at Paris, and the arrondissements
of Sceaux and St. Denis, 382.851 persons, 194,735 men, and
188,116 women. Of this number 9118 died of cancerous affections;
of whom 2163 were males, and 6955 females. The deaths from this
disease, at the extremes of this period, were 668 in 1830, and 889 in
1840. Hence M. Tanchou concludes, that the mortality from
cancer was irregularly progressive throughout this time, to an extent
beyond what could be ascribed to the increase of population. He
estimates the deaths from this cause to be about 1*96 per cent, on
the deaths of 1830, and 2 40 on those of 1840. A little reflection
will show, however, that the establishment of a numerical compari-
son between the number of deaths from any given cause and the
total mortality from all causes, is not an accurate test of the relative
frequency of the specified disease at several successive epochs. For
not only is the population a variable element, but the general mor-

270 Statistical Researches on Cancer, [May,

tality as compared with the living varies with the increase or decrease
of epidemic diseases. For example, a decrease in the mortality
from epidemics, would, by diminishing the whole number of
deaths, apparently tend to augment the proportion of deaths from
cancer, although the latter remained absolutely constant. I, there-
fore, deem it advisable to submit the question to a more rigid
statistical examination. This can only be done by calculating
the ratio of the whole number of deaths from cancer for each year,
to the total population living at the same time. To accomplish
this, it becomes necessary for us to devise some means of computing
the rate of increase of the population, so that we may be able to
estimate the number of persons living for each year. Wishing to
apply this numerical test both to the French and English records,
I found it necessary to make separate computations for each, inas-
much as the proportional annual increment of population is not the
same in the two countries. According to the census of 1826, the
population of the Department of the Seine was 1,013,373, while
in 1836, it was 1,106,891. Assuming that the population increased
during this period, in a geometrical progression, it follows that the
common ratio must have been 1*008866, or the increase was at
the rate of 0*8866 per cent, annually. This enables us to estimate
the number living during each of the years embraced in the mor-
tuary records examined by M. Tanchou, upon the assumption that
the rate of increase continued the same from 1836 to 1840, as it
did from 1826 to 1836. Again, on the 1st of July, 1841, the popu-
lation of England and Wales was estimated to be 15,927,867- As
the mean annual rate of increase in the 10 years (1831-1841) was
1*334 per cent., we have the data for estimating the population
living in each year, by assuming that the numbers increase at a
uniform rate in geometrical progression. These estimates are,
of course, not exactly correct ; but the approximations to the true
numbers are so close, that the quotients of mortality will not be
appreciably affected, where the divisors vary from 1 to 16 millions.
With the aid of the foregoing explanations, the mode of calculating
the following table will be apparent to the reader. The numbers
expressing the absolute deaths from cancer in each year, were
obtained from the Memoir of M. Tanchou, and from the Reports
of the Registrar-General.

1816.]

Statistical Researches on Cancer.

271

Table 8,

London.

Year.

172S-57
1771-80
1831-35
1840-41

Estimated
Population.

Specifi-
ed
Deaths.

Deaths

from

Caucer.

80,321

G38

Deaths from] Deaths from
Cancer in Cancer in 1000
1000 Deaths Livinjr.

200*
3-40*
4-40*
795

Dep;t. of Seine,

1830

1.049,793

668

0-630316

u (t (

1831

1,059,100

865

0-816731

<( (< t(

1832

1,068,491

814

0-761822

II li (C

1833

1,077.964

814

0-755127

II Ct II

1834

1,087.521

857

0-788030

(1 (( (1

1835

1,097,164

906

0825766

(1 (1 ((

1836

1,106.891

837

0-756172

(C (( S|

1837

1,116.705

778

0-696692

(I II (I

1838

1,126,606

803

0 712760

II U (t

1839

1,136.594

887

0-780401

tt It ((

1810

1,146.672

889

0 775287

Mean,

829

0 755009

England <& Wales.

1838 115.307,005

330.559

1 2448

1 7-4056

0159926

it i< ii

1839 |15,511,264

330.497

1 2691

1 81423

0173487

ii (i ii

1840 115,718,183

351.757

1 2786

1 79202

0-177247

<( (( n

1841 1 15,927,867

336.66-1

1 2746

8-1565

01 72402

(C (( II

1842 16,140,344

312.774

1 2941

1 8-5800

0182214

Mean,

1 2722

1 80409

0173055

A comparison of the last two columns of that portion of this table
relating to England and Wales, clearly illustrates the fallacy of
estimating the relative frequency of cancer by the ratio which the
annual deaths from it bears to the total yearly mortality. For in-
stance, the proportion of deaths from cancer in 1000 deaths, is, in
1840, considerably below that of 1839; whereas the ratio per 1000
living is above it. Again, in 1841, the ratio of deaths from cancer
as compared with the general mortality for that year, shows a con-
siderable increase in frequency over 1840; whereas the proportion
deduced from the number living at that time, indicates a relative
decrease of deaths from that cause. In fact, the numbers represent-
ing the total mortality, are principally from the influence of epi-
demic diseases more liable to annual fluctuations than those indica-
ting the frequency of cancer; and hence, the ratio deduced from a
comparison of the two, would show a corresponding and proportion-
ate oscillation, wholly independent of any variation in the real mor-
tality from carcinoma. Doubtless, the fluctuations in the general
mortality are governed by fixed laws ; but we are not as yet in pos-

* These 3 proportional numbers are taken from McCulloch's Stati:>iical Ac-
count of the British Empire, vol. 2, p. 577, 2d ed., London, 1839.

272 Statistical Researches on Cancer. [May,

session of sufficient data for estimating the value of the coefficients
representing these perturbations, so as to apply them in our average
reductions. The method of comparing the number of deaths from
any given cause with the number living at that period, is certainly
unobjectionabie. In the preceding table, the question of the increas-
ing frequency of cancerous affections has been submitted to this se-
vere numerical test; and it will be seen, that there has been a pro-
gressive augmentation in the number of deaths per 1000 living, both
in Fiance and England. In the Department of the Seine, the mor-
tality from this cause has increased in 11 years, from 0*636 to 0*775
per 1000 living at the two extremes of the period embraced in the
records. In England, the proportion has augmented in 5 years,
from 0*160 to 0-182 per 1000 living. The absolute increase in the
Department of the Seine during the 11 years, has, therefore, been
about 0-139 per 1000 living; making a mean annual increase of
0-0126. In England, it has been less : being 0-0223 per 1000
living for the 5 years, or 0-00446 per annum. Although the rate of
increase is higher in France than in England, yet, owing to the vastly
lower mortality from cancer in the latter, it would require only about
37 years to double the ratio of deaths for 1838 in England; while it
would take about 51-5 years to duplicate the proportion for 1830 in
the Department of the Seine. Of course, it will be observed, that
the increase is not very uniform from year to year, it is irregularly
progressive. Above we have compared the proportional numbers of
the extreme years contained in the mortuary records of both coun-
tries, on the assumption that the law of increase follows an arithmet-
ical progression ; but where such irregularity prevails, too much
confidence shouid not be placed in the deductions. It appears to be
clearly demonstrated, however that carcinomatous diseases are in-
creasing in frequency both in France and England ; although the
data are insufficient to determine the law of the increment. The
conclusion drawn from my former statistical researches, as well as
those of M. Tanchou, has, therefore been corroborated.

As the French records contain the number of deaths from cancer
during each year in Paris alone, and in the other two arrondissements
composing the Department of the Seine united, I was anxious to
ascertain whether the increase in frequency was the same in the me-
tropolis and its environs. The whole number of deaths from cancer
during the 11 years in Paris proper, was 7999; while in the arron-
dissements of Sceaux and St. Denis united, it was 1119. The popu-

1846.]

Statistical Researches on Cancer.

273

Jation of the whole Department having been in 1826 and 1836
respectively 1,013,373 and 1,106,891, and that of the city of Paris
890,431 and 909,126, at the same epochs, it follows that of the
arrondissements must have been 122,9 12 and 197,765 at those periods.
The mean rate of increase in Paris was, therefore, only 0*2080 per
cent, annually, while in the environs it was 4-8685 per cent. As-
suming the same rate of increase in population to have continued
up to 1840, and we are furnished with the data requisite for com-
puting the following table. Of course, the population estimates are
only approximations, but perhaps, sufficiently correct for our purposes.

Table 9.

C.

l.y of Paris.

Arrondissements.

Year.

Estimated

Deaths

from
Cancer.

Deaths from Cancer

Estimated

Deaths

from
Cancer.

Deaths from Cancer

Population.

in 1000 Living.

Population.

in 1000 Living.

1830

897,862

595

0 662685

148,689

73

0490956

1831

899,730

756

0840252

155.928

109

0-699039

1832

901,601

712

0789706

163.519

102

0-623779

1833

903.477

7-21

0798028

171.480

93

0-542336

1834

905.336

752

0-830613

179,829

105

0-583888

1835

907.239

800

0-881796

188,584

106

0-562084

1836

909,126

728

0800769

197,765

109

0 551159

1837

9 J 1.017

674

0-739832

207.393

104

0 501463

1838

912.912

703

0-770063

217,490

100

0459791

1839

914.811

779

0851542

228.079

108

0473521

1840

916.713

779

0-849775

239,182

J 10

0 459900

Mean,

0-801369

Mean,

0-540720

A glance at this table shows, 1st, that the mortality from cancer
in the French metropolis exceeds that in the environs by about 0-261
per 1000 living, or by more than one-third; and 2d, that the increase
in the frequency of the disease, if such augmentation really does
obtain, appears to be confined to the city of Paris. The irregulari-
ty in the proportional numbers representing the mortality from
cancer for the different years, only warrants us in concluding, that
there has been a general tendency in the disease to become more
frequent in the metropolis, while no such proclivity seems to exist in
the arronctyssements. But where the statistical data are so meagre,
it is hazardous to rely upon any deductions which may be drawn
from them. We must wait for a satisfactory solution of this problem,
until a vast number of facts extending over a series of years, can be
subjected to numerical analysis.

Admitting the correctness of the conclusion, that carcinoma is
augmenting in frequency, the question naturally arises, what are the
probable causes of the increase? M. Tanchou is of opinion, that

18

274

Statistical Researches on Cancer.

[May,

cancer, like insanity, increases in a direct ratio to the civilization of
the country and of the people. And it is certainly a remarkable
circumstance, doubtless in no small degree flattering to the national
vanity of the French savant, that the average mortality from cancer
at Paris during 11 years is about 0-80 per 1000 living annually,
while it is only 0*20 per 1000 at London !!! Estimating the intensity
of civilization by these data, it clearly follows, that Paris is 4 times
more civilized than London !! Seriously, however, the greater fre-
quency of carcinoma in France as compared with England, is a very
curious fact. Perhaps, some may be disposed to ascribe this dispari-
ty to a greater latitude in the application of the term cancer on the
Continent. But the English bills of mortality, at least since the
Registration Act has been in operation, do not exhibit any such
difference in the nomenclature of disease. Both in France and
England, nearly all local malignant affections are included under the
name of cancer or carcinoma. In a comparative view of the num-
ber of deaths in 1838 and 1839 in England and Wales, from the
diseases classified according to their pathological characters, Mr.
Wm. Farr includes what are registered under the head of tumors of
uncertain seat, among the carcinomatous affections. (Vide London
Lancet for Jan. 22d, 1842, p. 575.) This is the only discoverable
difference in the registration of deaths from cancerous diseases in
France and England; and it is totally inadequate to account for the
remarkable disparity in the mortality from this cause in the two
countries. The following comparison will illustrate this point :

Table 10.

Deaths from Cancer and Tmnor.

Country.

Year.

Estimated
Population.

Cancer and Tumor
Deaths from

Proportion in
1000 Living.

England and Wales,

1838ll5,307,065
1839[15,511,264

2821
3065

0-18429
0-19760

a " "

Mean of 2 years,

0-19094

Dep't of Seine,

Mean of 11 years, 1830-40,

075501

It appears, therefore, that, after making due allowance for the dif-
ference in the systems of registration, the mortality from cancer in
the Department of the Seine, is nearly quadruple what it is in Eng-
land and Wales. Hence it is clear, that the great preponderance of
the disease on the Continent, cannot be reasonably ascribed to any
diversity in the classification of kindred diseases. Moreover the ex-

1846.] Statistical Researches on Cancer. 275

act agreement in the proportional number of males and females who
die from cancer in the two countries, as exhibited in tables 6 and
7, proves that the remarkable peculiarity in the relative mortality
of the sexes from this disease obtains in both, and goes far towards
demonstrating, that the arrangement of such affections in the respec-
tive systems of registration, must be nearly identical. Perhaps, the
habit of making necroscopic examination may be more common in
the French metropolis than it is in England, and thus a greater num-
ber of cases of internal cancers may be detected and registered. But
it is hardly reasonable to suppose, that the disparity growing out of
this circumstance, would amount to the enormous proportion of 4 to 1.
Wc have no means of ascertaining what may be the influence of
diet, habits of life, physical geography, etc., on the production of
carcinomatous affections. Neither is it possible for us to estimate
what share governmental influences may have in the induction of
the peculiar predisposition to such diseases. In assigning a relative
value to the various causes which concur in the production of chronic
maladies, physicians have almost overlooked the evils, moral and
physical, which have their origin in the endemic agency of bad gov-
ernment. Doubtless, in many instances, physical influences are, in
a measure, subordinate to this silent and potent agent. Its operation
is slow, and, perhaps, inappreciable amid the multiplicity of disturb-
ing causes which are around ; but it is constant and unrelenting, and
the effect is certain and inevitable : the canker of discontent and
restlessness, which corrodes the vitals of a degraded and oppressed
people during a series of generations, must react on the physical sys-
tem in a most powerful manner. With regard to the question under
consideration, however, the proverbial gayety and elasticity of mind
which characterize the French, precludes the idea of this cause hav-
ing any great agency in producing the great frequency of cancer in
the Department of the Seine. Indeed in the present state of medical
statistics, it is imposible to assign any adequate cause fur the great
prevalence of this disease in France, and it is worse than useless to
indulge in vague conjecture. The great proportion of uterine can-
cers in the Department of the Seine, (299G out of 9113 cases,) as
exhibited in M. Tanchou's tables, points to the abuses of the sexual
organs, as one of the causes of the extraordinary frequency of such
affections in France.

But to resume. How will we account for the supposed fact that
carcinomatous affections are on the increase ! To some extent, the

~76 Statistical Researches on Cancer. [May,

augmentation may be only apparent ; arising from more careful
registration, and from improvements in pathology and greater accu-
racy in diagnosis. It is impossible to estimate the extent of the
influence of these circumstances. It is a well-established fact that,
even within a comparatively few years, the mean duration of human
life has been sensibly increased, by the rapid advancement of medical
science, and by a more philosophical application of hygienic and
sanatory regulations. Admitting the influence of age on the produc-
tion and development of cancer, and the increase in the mean duration
of life stands to us in the nature of vera causa tending to augment
the frequency of the disease ; inasmuch as a greater proportion of
the population would reach that period of existence which is peculiar-
ly obnoxious to such affections. If this is the true cause of the
increase in frequency, it must indeed be co-extensive with the pro-
gressive advancement of civilization ; unless some counteracting
influences are brought to bear on the operation of ulterior causes.
Future statistical inquirers will be able to determine whether the
alteration in the duration of life, is adequate, through the influence
of age alone, to explain the presumed augmentation. According
to Mr. Chadwick, the mean duration of human life increased in
London in the 103 years, from 1728 to 1830, 4 years and 9 months.
At Geneva, M. Edouard Mallet estimates, that the probability of life
has increased in 274 years, (from 1560 to 1833,) in the proportion of
the numbers 100 to 521 ; while the mean duration of life has aug-
mented, during the same period, in the ratio of 100 to 191. It is
very evident, that the prolongation of life which arises from the pro-
gress of civilization, must tend to increase the frequency of such
diseases as are dependent on advanced age for their production and
development ; but the available data are insufficient to determine the
extent to which the mortality from cancer is influenced by this cause.
As the mean duration of life is somewhat greater in England than
it is in France, the excessive mortality from carcinomatous affections
in the latter country, cannot be ascribed to this cause.

Assuming, with Prof. Walshe, the mean duration of cases of can-
cer to be 2% years, and that of phthisis to be 2 years, and we have
the data for calculating the comparative frequency of the two dis-
eases, as exhibited in the subjoined table, which has reference to the
mortality of England and Wales.

1846.]

Statistical Researches on Cancer.

277

Table 11.

Cancer.

1838

2.448
t 01599
[ 6,120

1839
2,691
01735
6,727

1840
2,786
01772
6,965

184J

1842

Mean.

Total Deaths,
Deaths in 1000 living,
Constantly Sick,

2,746
01724

6,865

2.941
01822

7,352

2,722
01731
6,806

Phthisis.

Total Deaths,
Deaths in 10U0 living,
Constantly Sick,

59,025

3-996

118.050

59.559

3-939

119,116

59.923

3-ft97

119,846

59.592

3-822

119,184

59,291

3;073
118,582

59,478

3-865

118.956

It appears from this comparison that about 1 person dies from
cancer to every 22 deaths from phthisis; and that, for every case of
the former there are nearly 17 cases of the latter, supposing the dis-
eases to be mortal and of the relative mean duration above stated.

4. Habitation. M. Breschet announces among the few firmly
established positions respecting the etiology of cancer, that, " this
disease is as rare among persons employed in agriculture, and the
country population generally, as it is common among the lower
orders of the population of large towns." The soundness of this
doctrine can be only tested by an appeal to extended statistical data.
Unfortunately the materials at our command, having a direct bearing
on this question, are comparatively meagre. The following table is
constructed from data furnished by Prof. Walshe. (Op. cit., Boston
Ed., p. 110 etseq.)

Table 12.

Population

Speciticd

Deaths

Proportion in

Proportion in

in Oct. 1837.

Deaths.

from Cancer.

1000 Deaths.

1000 Living.

London,

185

0206

Counties,

126

0143

Metropolis and

Towns,

3,553,161

46,849

337

7193

0189

Rural Districts

nrl Counties.

3,500,750

28,036

289

10308

0-165

This table indicates an average preponderance in the frequency of
cancer in the metropolis and large towns in England, as compared
with the rural districts; but the difference is by no means commen-
surate with the density of population. An inspection of the two last
columns, shows a result precisely of the kind we might have antici-
pated in the law of a mortality in a disease, which is but slightly
influenced by city habitation. As the proportional number of deaths
from diseases, propagated or increased in severity by the insalubrious-
fiegfl of densely populated communities, i* necessarily less in rural
districts than in cities, the proportion of deaths from affections but

278

Statistical Researches on Cancer.

[May,

slightly thus influenced must be higher in the country than in the
towns, even when the relative frequency of such maladies, as indi-
cated by the ratio to the number living, is absolutely greater in the
latter. For instance, the mean annual mortality from all causes in
4 years, from 1838-41, being 27-073 per 1000 living in the Eng-
lish towns, while it is only 19*300 in the country; it is very obvious
that the number of deaths in an equal population of each, is far greater
in the former than the latter ; and assuming the absolute mortality from
cancer to be the same in both, a comparison of the number of deaths
from this cause with the total mortality, would inevitably underrate
the proportion for the cities, while it would pro tanto exaggerate that
for the rural districts. This affords another very striking illustration
of the fallacy of estimating the relative mortality from different dis-
eases, by establishing a numerical comparison with the total deaths,
instead of the number living. In our last table, the ratios indicated
in the two last columns are completely reversed !!

A curious fact connected with the question of metropolitan and
provincial frequency of cancer, is noticed by Dr. Walshe viz: that
females furnish the excess in towns, when such excess occurs. This
is seen in the following comparison :

Metropolis
and Towns.

Counties and
Rural District?.

Metropolis

and Towns.

Counties and
Rural Districts.

Males,
Males,

45
29

42
53

Females,
Females.

140
123

82

no

Total,

74

95

| Total,

203

192

This peculiarity is very remarkable, and may be, with considerable
probability, ascribed, in part at least to causes which indirectly
operate upon the sexual Grgans in cities. But perhaps, it is prudent
to suppress any speculations of this character, as they must of neces-
sity be more or less hypothetical. One thing is certain, as Prof.
Walshe observes, that the law in respect of cancerous diseases dif-
fers from that regulating the sexual ratio of general mortality in
towns and country. The following numbers, representing the total
deaths in the cities and counties above referred to, show that the
mortality of the former exceeds that of the latter by very nearly the
same amount in each sex.

Males,
Females,

Cities.

24,402
23,551

Counties.

14,841
14.582

184G.] Statistical Researches on Cancer. 279

M. Tanchou estimates the deaths from cancer in the arrondisse-
ments of Sceaux and St. Dennis united, at 1*63 per cent, of the total
mortality for the suburbs, whilst intra muros, or in Paris proper, it
was 2-54 per cent. ; showing that this disease is much more frequent
in the capital than its environs. It has already been shown, that
this method of estimating the relative frequency of cancer, is falla-
cious. By deducing the ratio to the number living, as I have done
in table 9, this source of error is avoided. And it will be seen by a
glance at it, that the mean annual mortality from cancer in the
French metropolis is about 0*801 per 1000 living, while in the arron-
dissements it is only 0*541 per 1000: thus exhibiting an excess of
frequency in Paris above its environs, of about 0*260 per 1000 living,
or nearly one third. Hence, the mortality from cancerous affections
in the environs, is to that in the city, as 1 to 1*4820. In England,
according to table 12, the frequency of cancer in the counties as
compared with London, is in the proportion of 0*143 to 0*206, or as
1 to 1*4406. The remarkable agreement in these proportional
numbers, reduced from two totally independent registers, would seem
to justify the conclusion, that city habitation is favorable to the pro-
duction of carcinoma. But we should be cautious how we draw
hasty deductions even from the most elaborate statistical datar when
there are so many causes of perturbation in action, whose amount it
is impossible to estimate with accuracy. In the present case, it is
only necessary to call attention to a few of these disturbing elements.
The practice of making autopsies is more common in cities than in
the country, which would, of course, reveal many internal cancers,
that would otherwise be registered under some other name. Again,
the fact that many cancerous subjects who have acquired the disease
in the country, remove, as an ultima spes, to the large towns for the
sake of obtaining professional aid, die and are registered there, and
consequently swell the sum of deaths from the disease in cities, while
they, pro tanto, diminish it in the country, must inevitably tend to
augment the difference of the real frequency of it in town and rural
life, and appear to exaggerate the unfavorable influence of city hab-
itation. On the other hand, the greater mean duration of life in the
rural districts, must have a tendency c<r!eris paribus, to increase the
proportion of carcinomatous affections, as a larger number of persons
attain to that period of existence which renders them peculiarly
liable to the disease. The influence of age being such an important
clement in the development of cancer, this circumstance would have

230 Statistical Researches on Cancer. [May,

a decided effect in swelling the proportion for the country. For
example, Mr. Farr estimates the mean duration of life in the extra-
metropolitan parts of Surrey to be 45 years, 37 years in London, and
only 26 years in Liverpool. Here we observe a difference of 8 years
in the duration of life between Surrey and the metropolis, and when
compared with Liverpool, the disparity amounts to 19 years. In an
equal population in Surrey, therefore, there are a greater number of
persons between 40 and 80 years of age than in London, and, of
course, a larger proportion of the population exposed to the slow
destruction of cancer. Thus, from this cause, there might occur an
excess in the ratio of mortality in the country over the towns, when
in reality the liability to carcinoma among an equal number of indi-
viduals at any given age, might be absolutely greater in the cities.
It is impossible, in the existing state of statistical science, to assign a
determinate value to each of these conflicting elements of perturba-
tion, so as to ascertain whether the resultant is favorable to country
or city habitation. In the absence of more satisfactory data, how-
ever, it appears to be a very rational conclusion, that the denizens of
cities are, cceteris paribus, more liable to cancerous diseases than the
inhabitants of rural districts. In the extremely artificial state of
society which exists in densely-peopled communities, all the condi-
tions, moral and physical, are present, which we should reasonably
anticipate, would tend to increase the production and mortality from
all classes of authentic diseases. With regard to cancer,' the effect
is, perhaps, not so marked as we should a priori expect ; yet, it is
probable that these causes are not without their influence on the de-
velopment of this disease.

Respecting the frequency of carcimonatous affections in different
parts of the British metropolis of unequal concentration of population,
Prof. Walshe has made some very curious statistical researches.
(Vide. op. cit., Boston Ed., pp. 113 et 114.) The two following
tables have been computed from the data furnished by him. They
are deduced from the analysis of 470 deaths from cancer occurring
in London, from July 1st, 1837, to Dec. 31st, 1838, arranged accord-
ing to the Unions in which they took place. By collecting the
Unions into 3 groups, ascertained by Mr. Farr to present different
degrees of general salubrity, it will at once appear whether cancer
follows the same law, in this respect, as others of the most destructive
maladies. The absolute number of cases is given in the subjoined
table, compared with the ratio per 1000 living per annum.

1846.]

Statistical Researches on Cancer.

281

T

ABLE 12

31 Unions.

Deaths from Cancer.

Population
in 1838.

Males.

14

36
46

Females.

Proportion in
Total. 1000 Living.

A. 10 most unhealthy,

B. 11 medium salubrity,

C. 10 healthiest,

517,288
505,746

7*>7,785

82
103
189

90 0 124
139 0183

235 0-199

From this it would seem that the mortality from this cause increases
with the salubrity of the locality; a result which is rendered more
startling by comparing it with the calculations of Mr. Farr, of the
annual mortality from all diseases, from typhoid fever and from
phthisis in the same districts, as exhibited in the following table:

Table 14.

Districts,

No. of square
yards to one
person.

57

78

219

Annual general
rate of mortal it)
per 1000 living

33-21
28-39
21-63

Annual rate of Mortality -per 1000 from

Typhoid Fever.

3-24

2-05
1-07

Phthisis. |

4-73
4-51
3-54

Cancer.

"(Fl-iT

0-183

0-199

It would hardly be warrantable to conclude from these tables, that
general salubrity is favorable to the production of cancer, since our
previous researches with respect to the influence of city and country
habitation, drawn from a more extended series of facts, show to the
contrary. But it clearly follows, that the influences increasing the
mortality from disease in general, and from typhoid fever and phthisis
in particular in London, exercise no such influence on carcinoma.
The number and extent of hospitals in each district are sufficiently
equal to require scarcely any correction on this score. The greater
mean duration of life in the healthy districts of the metropolis, must
tend to raise the ratio of cancerous deaths, inasmuch as they contain
a larger proportional number of middle aged and old persons, those
most liable to the disease. In the unhealthy districts where tho
population is very dense, so many are carried off in early life by dis-
eases which attack the young, that comparatively few arc left for the
slow inroads of cancer. The extent to which this cause operates,
can only bo tested by comparing the mortality from cancer at each
age with the total number living at the same epochs of life, in both
classes of districts. This we have no means of accomplishing. In
making such researches, it is very desirable that the statistical data
should be drawn from the records of a scries of years. For, with

282

Statistical Researches on Cancer.

[May,

regard to a disease whose mean duration is about 30 months, it is
hardly to be expected that any thing very conclusive could be de-
duced from the mortuary registers of a single year.

5. Trade or Occupation. In the broadest division of occupa-
tion in a hygienic point of view, into those connected with agriculture
on the one hand, and with trade, manufactures, and handicraft on
the other, we have already brought the question of the relative mor-
tality from cancer partially under consideration, when treating of the
influence of habitation. But the comparison of the relative liability
of individuals residing in town and rural districts to carcinoma, is not
a rigid test of the proclivity of persons belonging to these great divis-
ions of society to suffer from the disease; as numbers engaged in
agricultural pursuits may be inhabitants of towns, and vice versa.
For the purpose of making a more accurate comparison, Prof. Walshe
has selected Birmingham, as furnishingthe greatest excess of trading
over agricultural families, and a division of England, comprising
Cambridge, Huntington, and the Southern parts of Lincoln, as ex-
emplifying the converse condition. (Vide. op. cit., Boston Ed.,
p. 115.) From his data we have been able to construct the follow-
in": table :

Table 15.

No. of Families employed in

Agriculture.

Trade, etc.

Other
Families.

Deaths from
Cancer.

Proportion in
1000 Living.

Birmingham,
Counties named.

301
35,105

20,763

18,816

2,870
13.433

14

30

0-224
0-178

The advantage appears somewhat in favor of agricultural pursuits ;
but the lower rate of mortality is hardly proportionate with the vast
relative minority of manufacturing families in the country districts.
For according to the foregoing table, in Birmingham the families
engaged in trade and artisanship are 69 times more numerous than
those employed in agriculture; while in the rural districts enumera-
ted, the latter class of families is about double as numerous as the
former. As has been previously suggested, the greater mean dura-
tion of life in the country, must render individuals following agricul-
tural pursuits, coeteris paribus, more liable to cancer, than those
employed in manufacturing. Taking this fact into consideration,
the advantage in favor of rural life will be somewhat augmented.

In a certain number of mining districts in England, with a popu-

1846.] Statistical Researches on Cancer. 28S

lation in 1831, of 542,398, the deaths from cancer were, according,
to Dr. Walshe, 42 in six months. This would indicate an annual
mortality from that disease of 0*155 per 1000 living, which is consid-
erably &e/o* the average for the whole of England. But the num-
ber of cases is too small to serve as the basis of any reliable deduction-
Moreover, it should be recollected that, the mean duration of life is
materially lower among miners than other laborers ; this must have
the effect of lessening the frequency of cancer among them, inasmuch
as very few of them attain an old age.

M. Benoiston de Chateauneuf has shown, in a paper on the mor-
tality of the French infantry, that, out of a total number of 4915
deaths occurring in six years in a military body 723,741 strong, 33
were from "cancers and ulcers." (Annates d' Hygiene, torn. 10,
p. 239, 1833; as cited by Walshe, op. cit., p. 116.) Hence the an-
nual mortality was only 0*045 per 1000 from those affections; and
6*71 per 1000 of the total number of deaths are thus produced.
The cause of this apparently low proportion in the army is easily
explained. The age at which youths are eligible for service is 21;
when enlisted they are obliged to serve 6 years ; the mean age of the
great majority of foot soldiers is, therefore, 25 years. Now on re-
ferring to table 5, we find that the rate of mortality per 1000 among
French civilians from 20 to 30 is 0-061; hence the chances would
appear slightly in favor of a military life in respect of this disease.

Unfortunately we are in possession of no available documents,
which throw any light on the influence, if any, of particular kinds of
occupations in the production of carcinomatous diseases. It is true,
Prof. Walshe (op. cit., p. 117) has given us a table of 650 individu-
als who died from cancer, in which he noted the trade or profession
as stated in the registers ; but no deduction of a satisfactory charac-
ter can be drawn from such data, until the relative proportions of
individuals living in each position or trade referred to, at the period
these cases occurred, has been ascertained. As far as my know-
ledge extends, no materials exist for the establishment of this pre-
liminary point. A variety of other conditions, the effect of which
it is almost impossible to express numerically, render the estab-
lishment of the influence of profession on disease in general, one of
the most difficult and least certain points in medical statistics.

0. M akhied and Singlb State. The influence of the matrimo-
nial condition on the production of cancer, can scarcely be estimated
with any chance of accuracy. Nevertheless, Prof, Walshe has at-

284 Statistical Researches on Cancer. [May,

tempted to make an approximation. (Vide. op. cit., Boston Ed.,
pp. 119 et 120. Among 172 females whose matrimonial condition
he extracted from the registers, he found 17 spinsters, 84 married
women, and 71 widows. On the supposition that the proportional
number of females belonging to each of these classes in England, is
equal to that of the Parisian population, he calculates the ratio of
mortality from cancer to be, of the unmarried 0-07 ; of the married
0*49 ; of widows 1-32 per 1000 living. But these proportions do not
in reality represent the influence of the matrimonial condition upon
the development of carcinoma; but mainly the effect of the mean age
of the different classes of women furnishing them. The low mor-
tality from this cause among the unmarried, as contrasted with
widows, in the foregoing comparison, is unquestionably due to vast
difference of age in the respective classes. It is difficult to estimate
the extent of this influence, from the want of the requisite data.
Perhaps, this point may be, in some degree, elucidated, by compar-
ing the mean ages of women in the respective conditions. From a
table, constructed by Mr. Wm. Farr, showing the ages at which the
marriages of 40,874 persons in England were contracted in 2 years,
(June, 1839-41,) it appears that mean age of

Bachelors was nearly 25-45 years.

Spinsters " "

24-30

ii

Widowers " "

40-80

M

Widows " "

38-95

II

Mean age of men

27-45

II

u n u Women

25-46

CI

This shows that the mean age of widows at the time of their re-
marriage, exceeds that of single women who marry for the first time,
by 14*65 years. But the difference here exhibited is greatly beloic
the mark; for the above numbers indicate the mean age of the
classes at the time marriage was contracted, and not the average age
of all individuals belonging to the respective conditions. As widows
usually remarry comparatively early in life, the influence of this
circumstance must be very important.

Again, observations made in France, Switzerland, and Holland,
by MM. Deparcieux, Odier, and Caspar, clearly demonstrate that
the mean duration of life among married persons is considerably
greater than among the unmarried. In females, the difference, on
an average, is about 5 years ; and "a young woman of 20 years of
age, by marrying, adds 9} years to the probable duration of her life."

1846.]

Statistical Researches on Cancer.

285-

(Vide. Philadelphia Med. Examiner, for March 28th, 1833, pp. lia
et 114.) It is true, Mr. Rickman has attempted to refute this,
what has been styled, ''libel upon bachelors and maids," but we
think the statistical documents prove conclusively that the balance
is decidedly against the advocate for "single blessedness." The-

following tables will illustrate this point :

Mean Duration of Life.

,

20 years of age,
25 " " "
30 " " "
35 " " "
40 m i< <

In Married
Females.

40-33
3604
32-38
28-86
25-54

In Unmarried
Females.

30-62
30-51
28-86
26-28
23-38

Difference.

9-71 years.
5-53 * "
3-52 "
2-58 "
2-16 "

Of every 100 persons there die :

Period of Life.

Married Men.

Bachelors.

Married Women.

Unmarried Women.

20 to 30
30 to 45

2-8
18-9

31-3
27-4

7-7
20-3

28-0
19-3

Again, of 100 persons there are alive :

Up to

30 years,
45 "
60 "
70 "

Married M<

97-2

78-3
481

27-2

Bachelors.! Married Women

68-7
41-3
22-6
11-1

92-3
720
49-4
29-2

Unmarried Women,

72-0
52-7
37-2
23-7

According to Biches' calculation, of 100 individuals there die :

From

Married Men.

Single Men.

Married Women.

Single Women.

20 to 30
30 to 45
45 to 60

3-6
17-9
29-2

33-1
271
15-6

4-7
16-5
22-6

26-5
24-5
19-2

The foregoing tables present a remarkable difference in the relative
mortality and longevity of married and single persons. This fact
is, undoubtedly owing, in a great measure, to the circumstance that
marriages arc, particularly among Europeans, as a general rule,
contracted between parties who have acquired a comfortable position
in the world ; which, it is well known, contributes very much to the
diminution of mortality. But, no matter what may he the cause of
the difference, it cannot affect my position ; which is to show that,

286 Statistical Researches on Cancer, [May,

the apparent excess of deaths from cancer among married women
and widows as compared with the unmarried, is due to the greater
mean age of the two former. The greater duration of life among
married women, would tend to augment the number of deaths from
carcinoma among them, irrespective of any influence which their
condition in society may be supposed to originate. The vast influ-
ence of age on the development of cancerous affections, has been
sufficiently dwelt upon in a former part of this paper, to render this
fact self-evident. In determining the relative liability of persons in
different conditions, to a disease in which age forms such an import-
ant element, it is absolutely necessary that the comparison should
be instituted between a number of individuals dying within the same
periods of life. When this is not done, me may be attributing to an
occupation or mode of life, a result which is really due to an excess of
old persons in the classes assumed to be unhealthy.

7. Climate. It seems to be a prevalent opinion, that cancerous
affections are more frequent and virulent in high northern latitudes
than in the southern regions of Europe. Fabricius Hildanus and
Mason Good mention it as a matter of general agreement : but the
grounds of this uniformity of opinion are not stated. It has already
been shown that, the disease is more frequent in the Department of
the Seine in France than it is in England and Wales, nearly in the
ratio of 4 to 1 : but this striking disparity cannot be ascribed to the
influence of climate, inasmuch as the difference of latitude in this
case is comparatively trifling. Mr. Henry Marshall observes that*
during a period of 10 years, 16,283 patients were treated by the
medical officer attached to the Civil Hospital at Gibraltar ; and of
this number only eight were returned under the head of cancer. He
also informs us that, the disease is rare in Jamaica, and that he only
saw one case in Ceylon, although having extensive opportunities of
observing the natives under disease. (Vide. Edinburgh Med. Surg.
Journal, No. 113, for Oct., 1832, p. 332.) Of a total number of
30, 102 cases admitted into the Hobart-town Hospital during 12
years, there were only 4 cases of "scirrhus." (Scott, in Prov. Med.
et Surg. Trans., vol. 3, 1835, as cited by Walshe, op. cit., Boston
Ed., p. 121.) M. Tanchou states that, M. Hamon, an eminent
veterinary surgeon who has been attached to Mehemet All's service
for 14 years, never observed cancerous affections among the native
Egyptian women, and only occasionally among the Turkish females.
M. Clot-Bey has made a similar remark ; and M. Bac, surgeon to

1846.] Statistical Researches on Cancer. 287

the 2d regiment of African Chasseurs, never met with a single case
during the 0 years he resided at Senegal. According to M. Rouzet,
cancer is very rare in Africa. Again, M. Baudens, the surgeon-in-
chief at the Val de Grace, who enjoyed a considerable practice at
Algiers for 8 years, saw in that time only 2 or 3 cases. Finally, Mr
Tanchou asserts, that M. Puzin, who in 1835, established a civil
hospital 10 leagues beyond the French outposts, in the midst of the
Arabs, did not see a case of genuine cancer out of 10,000 patients.
These facts, in the opinion of M. Tanchou, leave no doubt concern-
ing the influence of climate on the production of carcinomatous af-
fections.

On the contrary, Prof. Otto in his elaborate essay on the medical
topography of Copenhagen, (Lat. 55 41'), makes no mention of
carcinoma. (Prov. Med. et Surg. Trans., vol. 7, 1839, as cited by
Walshe, op. cit., p. 121.) Perhaps, the truth of the matter is,[that
the foregoing statistics have no reliable bearing on the question of the
influence of climate on the production of this disease. But little
dependence can be placed in those drawn from the Army registers,
as the soldiers are constantly changing, and seldom continue in ser-
vice when they become affected with chronic diseases of a grave
character. Moreover, as a general rule, the mean duration of life is
considerably lower in the southern parts of Europe than in the north :
this would give rise to an apparent immunity to carcinomatous affec-
tions in low latitudes, growing out of the fact that a smaller number
of the population reach the period of life peculiarly obnoxious to the
disease. On the whole, I think we are warranted in the opinion, that
the question of the influence of climate on the production of cancer,
must still be considered subjudice: the statistical data on this point
being of such a character, as to preclude the deduction of any satis-
factory conclusion. The problem is one of extreme complexity : a
variety of disturbing elements, duration of life, occupation, condi-
tion of society, diet, form of government, physical geography, etc.,
must be eliminated, before the effect of climate can be correctly ap-
preciated. It is quite obvious, therefore, that the influence of climate
on the development of the disease, could only emerge as a residual
phenomenon, after clearing away all the effects of these perturbations.
On this account, the solution of this problem is infinitely more diffi-
cult than when our researches arc confined to the comparison of the
mortality of different individuals residing in the same country, since,
under these circumstances, many of these variables become elimi-
nated.

288

Statistical Researches on Cancer.

[May,

8. Season. The inclemency of the weather accelerates the death
of individuals laboring under cancer, as it does in the case of most
chronic diseases. Thus, of 1032 deaths from cancer, which occurred
in England and Wales during the year ending the 30th of June,
1840, the distribution according to the seasons was as follows :

Winter.

Spring jSummer.

Autumn.

276

230 264

262.

This gives a preponderance of 46 deaths to the winter as compa-
red with the spring. The same fact is displayed in the two following
tables furnished by Prof. Walshe (op. cit., Boston ed., pp. 129-130.)
They are drawn from an analysis of 285 deaths from cancer occur-
ring in London in 1838.

Quarters ending.

Aiales.

Females.

Totals.

March 31,

18

73

Sri

June 30,

8

40

48

Sept. 30,

11

G4

75

Dec. 31,

14

57

71

This point is more clearly illustrated, when the deaths occurring in
the two more genial quarters of the year, are compared with those
which took place in the more inclement.

Temperate half-year.
Cold half-year.

Males.

19

32

Females

104
130

Totals.

123
162

Although these statistics sufficiently demonstrate the influence of
season on the mortality from cancer, yet it would be an unfair infer-
ence to conclude that they indicate the effects of temperature on the
production of the disease. For, as we might a priori expect, inclem-"
ent weather tends to accelerate the fatal termination of most chronic
maladies, by virtue of the depressing influence of cold on systems
already debilitated.

9. Okgans Affected. We are in possession of very little statis-
tical data relating to the comparative frequency of carcinoma in the
different organs of the body. Indeed, the only materials available
for such a comparison, which have fallen under our notice, are con-
tained in the Memoir of M. Tanchou, to which reference has been
frequently made in this paper. The following table, which I have

1846.]

Statistical Researches on Cancer.

289

computed from his data, will illustrate this point. Tho whole num-
ber of cases was 9118.

Table 16.

Ratio to total Deaths

Proportion in 1000 Deaths

Organ.

Xo. of Deaths.

from Cancer.

from Cancer.

Uterus,

2996

1 in 3 0434

328-58

Stomach,

2303

1 in 39592

252-58

Mamma,

198L

1 in 46027

217 26

Liver,

578

1 in 15775

63-391

Rectum,

221

1 in 41-253

24238

Abdomen 1

188

1 in 48500

20-619

Intestine,

14(5

1 in 62-452

16-012

Bladder,

72

1 in 126-64

7-8965

Face,

71

1 in 128-42

77868

Mesentery,

66

1 in 138- 15

7-2384

Ovary,

64

1 in 142-47

70191

Tongue,

36

1 in 253 28

3-9482

Eve,

24

1 in 379 92

2-6322

Jaw,

24

1 in 379 92

2-6322

Brain,

23

1 in 32564

30708

Testicle,

21

1 in 43419

2 3031

Lips,

16

1 in 56987

1-7548

All other Organs,

233

1 in 32-219

31037

From this it appears, that the deaths from cancer of the uterus con-
stitute about 32-8 per cent., those of the stomach 25-2 percent., of
the mamma 21-7 per cent., of the liver 6-3 per cent., etc., of the
total mortality from this disease. These numbers accord remarkably
with those obtained by M. Leroy d'EtiolIes, from a careful analysis
of 2781 cases of carcinoma occurring in the practice of 174 surgeons
in France. He found the cases of cancer of the uterus to be about
30 per cent. : of the breast 24 per cent. (London Lancet, June 3d,
1843. Am. ed., vol. 2, 1842-43, p. 308.)

We have already seen that, of the 9118 cases noted by M. Tan-
chou, there were 6955 females, and 2163 males. The two subjoined
tables indicate the proportional frequency of cancer in particular
organs peculiar to each sex, as compared with the total deaths from
the disease in the respective sexes.

Table 17.

Female Organs

No. of Deaths.

Ratio to Total Deathsl Proportion in 1 000 Deaths
among Females. | anions Females.

Uterus,
Mamma,
Ovary,
Vagina,

2996

1976
64

14

1 in 2-3214 430-77
1 in 3-5198 284'11
1 in 108-67 9-2020
1 in 496-78 2-0 129

19

290

Statistical Researches on Cancer.

[May,

Table 18.

Male Organs.

Testicle,
Penis,
Scrotum,
Mamma,

No. of Deaths.

21
10

7
5

Ratio to Total Deaths
amonjr Males.

1 in 103-00

1 in 216-30

1 in 309-00

1 in 432-60

Proportion in 1000 Deaths
among Males.

9-7087
4-6232
3-2363
2-3116

The first table shows that, the mortality from cancer of the uterus,
is, in France, about 43 per cent, of the total number of females per-
ishing from this disease : of the mamma, it is, in females, 28*4 per
cent., while in males, it is only 0-23 per cent, of the total deaths in
the respective sexes. The ratio of the mortality from cancer of the
ovary nearly accords with that of the corresponding organ in the
male, the testicle : the one being 0.92 per cent., and the other
0-97 per cent.

Resume.
A careful review of the statistical data contained in the foregoing
pages, seems to justify the following conclusions :

1. Age is one of the most important elements in the development
of cancerous affections. The absolute mortality from this cause is
greatest between the age of 50 and 60 ; but the relative tendency or
liability to the disease, as deduced from the ratio of deaths to the
number living at each age, goes on steadily augmenting, in both
sexes, to the 80th year.

2. Women are more liable to cancer than men, nearly in the pro-
portion of 3 to 1. This ratio is not materially altered by the slight
numerical inequality in the sexes in favor of females.

3. The frequency of cancerous affections appears to be progressive-
ly increasing in both France and England. This apparent augmen-
tation is, without doubt, partly owing, to a progressive increase in
the mean duration of human life, causing a greater number of persons
to attain the age which renders them peculiarly obnoxious to the dis-
ease. In the Department of the Seine, the increase seems to be
confined to the city of Paris. The disease is more frequent in the
Department of the Seine than it is in England and Wales nearly the
ratio of 4 to 1. No adequate explanation can be given of this
striking disparity. About I person dies from cancer to every 22
deaths from phthisis in England ; and for every case of the former
there are 17 cases of the latter.

1846.] Statistical Researches on Cancer. 291

4. Rural Habitation seems to be unfavorable to the production
of carcinoma. Both in London and Paris the proportional mortality-
is higher than it is in the adjacent country districts. But this may
be owing to other circumstances than the influence of habitation.

5. Individuals following agricultural pursuits appear to be less lia.
ble to cancer than those employed in manufacturing. However, the
data are insufficient to test, in a satisfactory manner, the influence
of particular occupations.

6. The influence of the matrimonial condition on the production
of carcinomatous affections, cannot be correctly estimated for want
of the data requisite for establishing a just comparison.

7. The effect of climate is very doubtful.

8. The mortality from cancerous diseases is at its maximum during
the cold season of the year: the inclemency of the weather acceler-
ating the deaths from this cause, as it does in the case of most chronic
diseases. The statistics show the influence of season on the mortal-
ity from cancer, but not on the production of the malady.

9. In relation to organs affected, the uterus is most liable to cancer :
being attacked in about 32*8 per cent, of the total deaths from the
disease in France ; the stomach comes next, 25.2 per cent.; then the
mamma, 21*7 per cent.; and then the liver, 6-3 per cent., etc.
Among females, the mortality from cancer uteri is about 43 per cent,
of the total deaths from the disease in that sex, and the mamma 28*4
per cent. These proportions relate to the mortality from cancerous
affections in the Department of the Seine in France.

Before concluding this very imperfect attempt at elucidating tho
laws of production and development in respect of cancerous diseases
in general, it is proper to remark, that the science of vital statistics
is in its infancy. This is the period for collecting facts, for multiply,
ing observations, for establishing the basis for wider and higher gen-
eralizations. The condition of man in almost every region of tho
globe is changed, and we have only to look around us in the narrow-
est circle of the community, to behold elements and principles in
action, of whose existence, a few years ago, we had no conception.
There are impulses on an immense scale impelling population for-
ward ; artificial wants of a new kind continually creating ; and the
basis of the social system is widening and spreading into innumera-
ble forms on all sides. The "great constants," to adopt an idea of
Mr. Babbage, which mark these important changes, it is the busi.

292 Statistical Researches on Cancer. [May,

ness of statistical science to collect. The philosopher who loves to
dwell on causes and effects, to trace the deep processes of thought
by which the great purposes of nature have been revealed, both in
the heavens above, and in the physical structure of the earth on
which he treads ; or who endeavors to deduce from incongruous
masses of figures, results closely interwoven with the social destiny
of man, and the mysterious laws which regulate his progress here,
cannot undervalue the importance of the vast labors of the cultiva-
tors of this department of mathematics. He will soon perceive, that
there is a relation of some kind, of a fixed and immutable nature,
among the various grades of society, as likewise among the causes of
disease and death, and there must be laws which govern their amount.
The problems which are presented to the statistical inquirer are of
the most complicated character. The circumstances which affect
the mean duration of human life depend upon a great number of
different causes; as climate, the facility of obtaining subsistence, the
state of civilization, the manner of living, progress of medical science,
diet, form of government, physical geography, etc., all of which vary
in different countries and at different times. The law of mortality,
therefore, must vary with these circumstances ; and consequently,
if expressible by any mathematical function, it must be one affected
by numerical coefficients depending on the circumstances, and of
which the values can only be determined by observation. On this
account, it is very evident, that any algebraic formula deduced from
a priori considerations can only be trusted so far as it is found to ac-
cord with experience. The sum of all the phenomena which con-
stitute life, is to be regarded as a collection of facts; and the great
difficulty consists in isolating each of them, so that they may be stated,
with clearness and distinctness, in a separate, concise and available
form. And in endeavoring to trace out the causes of the numerous
modifications which result in disease and death, such is the complexi-
ty of the combinations of phenomena which are presented for analysis,
that some time must elapse before philosophers will be able to obtain
such general expressions for these laws, as will lead them to the
higher points of generalization. Where the difference in the mor-
tality is considerable, and there is only one cause in operation, its
influence may be easily determined; but such simple problems are
seldom presented by nature; and upon reflection, we can scarcely
expect the science of living matter to be less difficult, less complica-
ted, less in need of the resources of observation, experiment, and

I

1840.] Constipation and its Treatment. 293

calculation, than the science of dead matter, than astronomy, natu-
ral philosophy, or chemistry. Recently, much has been done, in
some countries, towards furnishing the requisite data for discovering
some of the most obvious of these laws of vitality. But there is still
much to be accomplished in the way of collecting facts; and in en-
tering upon the exact estimation of causes, the door of a vast laby-
rinth has only just been thrown open, which it may employ many
generations to traverse, but which must needs be explored, before we
can penetrate to the oracular chamber of truth, or be enabled to lay
an effectual grasp on these complex and refractory problems.

PART II. REVIEWS AND EXTRACTS.

On Constipation from Indolence of the Bowels, and its Treatment.
(From the Lancet.)

Dr. Teissier, assistant-physician to the Hotel Dieu at Lyons, has
published in the last number of the Journal de Medecine of that town,
an interesting article on the treatment of constipation from indolence
of the bowels. This form is undoubtedly the one most frequently
met with in practice. It is a frequent cause of ailments, which, when
misunderstood, in the end seriously affect the health. The disease is
very frequently met with among persons advanced in age, and among
the hypochondriacal, in females, particularly those affected with chlo-
rosis, or disease of the uterus ; in individuals who do not take sufficient
exercise and in those who devote themselves especially to literature. It
accompanies almost invariably all serious affections of the nervous
system, and, above all, paralysis. Its consequences are, headaches,
indigestion, painful hemorrhoidal tumours, displacement of the uterus,
sanguineous discharges from that organ, and leucorrhcea, in females,
and in extreme cases may lead to marasmus. It is most important,
then, to be able to recognize the sort of constipation of which we
speak, and, above all, to know the most effectual means to remove it.

The directions given by most authors for this last purpose, are, in
general, of little use; sometimes they are even hurtful and danger-
ous. In fact, the means most frequently recommended are oily
enemata, or simple lavements of decoction of mallow, of bran, &c,
at the temperature of, at least, from 80 to 8G F. ; and later, when
these lavements fail to unload the bowels, manna, senna, tamarinds,
rhubarb, castor oil, Seidlitz water, scammony, in short, all sorts of
laxatives, or even the most drastic purgatives are recommended.

Now it is at present recognized as a fact among all practitioners
of experience, that in the sort of constipation here treated of, the use
of warm injections is hurtful, because as it depends on a sort of
atony, or indolence of the muscular fibres of the bowels, the moro

294 Constipation and its Treatment. [May,

you inject warm water into them, the more the muscular fibres are
lengthened, distended, softened, and deprived of their contractile
power. It is known, also, that the use of purgatives, far from being
beneficial in this sort of constipation, is, on the contrary, very
prejudicial, inasmuch as they blunt the sensibility of the coats of the
bowels, which at length become insensible to the stimulus of the foecal
bolus ; besides this, their continued use may violently irritate the
bowels. But this is not all, for, as Teissier remarks, the authors
who most strongly advocate the use of purgatives in this disease,
acknowledge also the inconvenience arising from the use of such
substances in a great many cases.

Beyond these means, it might truly be said that no resource re-
mains. But Science is not so powerless as might at first be supposed ;
nay, numerous useful means exist, of which the three principal are,
nux vomica, cold lavements, and astringents, which Dr. Teissier, on
the recommendation of some authors, has employed in several cases,
and with apparently happy effects.

Schmidtmann was the first to recommend the use of nux vomica
in cases of sluggish digestion, with flatulence, distention of the bow-
els, and constipation. Teissier cites four cases which show that this
substance has been equally successful in his hands under like cir-
cumstances. In the first case, a female, the sluggishness of the
bowel was caused by the existence of syphilitic excrescences at the
anus, with thickening of the rectum in its whole circumference, which
for more than a year caused great difficulty in defecation. After
the venereal affection was cured, the constipation continued, and
resisted all the means used to overcome it. Dr. Teissier having re-
marked, that the introduction into the anus of tents (meches) for
several successive days, and cold lavements, had in some degree
relieved the constipation, was led to think that these means had only
acted by rousing the contractile power of the large intestine, and
that that end would be more fully attained by administering the nux
vomica. He accordingly gave his patient, every morning, in a pill,
nearly the fifth of a grain (one centigramme) of the extract of this
substance. Under the use of the nux vomica, in this dose, for a fort-
night, the constipation entirely disappeared, and a year has now
passed without any relapse. From time to time, merely, when the
bowels are inclined to become sluggish, the patient takes one of the
pills as above, and the next day the usual evacuation takes place.
In the second case, the constipation which was of long standing, was
complicated with disorder of the stomach, referred to supposed gas-
tritis. The patient was at first put on low diet, gum-water emolient
injections, and the white meats, which only increased the sluggishness
of the bowels. Recourse was then had to various other means,
which relieved the gastric symptoms, without entirely curing them,
but had no effect on the constipation. Dr. Teissier, seeing the little
success attending this mode of treatment, had recourse to full diet,
and the use of the extract of nux vomica, in the dose of the fifth of a

1846.] Constipation and its Treatment. 295

grain, daily. In less than fifteen days the constipation and the other
symptoms had almost entirely disappeared, and in less than a month,
convalescence was complete. In the two other cases the result was
the same. It must not, however, be supposed that the remedy is in-
fallible ; the doctor admits that he has seen it fail in the case of ner-
vous individuals suffering from obstinate constipation. He thinks it
is particularly indicated in those cases where there is reason to sus-
pect a general want of tone in the bowels, as in the paralytic, or in
old persons, or where we may suspect a want of tone of the muscu-
lar coat of the intestine, in consequence of great and long-continued
distension, or, in short, when the constipation can be referred to an
undue secretion of gas, which, of itself, by causing distension of the
bowels, diminishes their contractile power.

Injections of cold water, better known than nux vomica, constitute
likewise a valuable resource against constipation from want of tone.
Of late years they have been much vaunted ; but, nevertheless, they
are as yet but rarely used in practice. They act somewhat in tho
same way as the nux vomica in rousing the sensibility and the con-
tractile power of the intestine. Our author does not, however, con-
sider that the two remedies ought to be used indiscriminately under
the same circumstances ; he thinks the cold injections particularly
suitable to individuals of a nervous, highly irritable temperament;
to the hypocondriacal, and to females suffering from irritation or
engorgement of the. womb.

Females who have contracted the pernicions habit of taking a
warm enema daily, and who have thus lost the power of evacuating
the bowels by the sole efforts of nature, ought to substitute cold for
warm water ; they would thus more easily attain the end they have
in view, and avoid the inconvenience of diminishing more and more
every day the contractile force of the muscular fibres of the bowels,
and thereby increasing the degree of constipation. In general, cold
injections are very harmless and very well borne; they produce,
however, in some individuals, an uncomfortable sensation of cold in
the bowels and loins, which may continue for an hour or two. Some-
times they may produce pain in the bowels, and slight diarrhcea; in
this case, all that is required is to discontinue them for a time, and to
use them only every third or fourth day, instead of daily. In the case
of patients in whom there is little reaction against cold, it is better
not to prescribe water at the ordinary temperature at once, but to
begin with it at the degree of 6S3 Fabr., gradually coming down to
64, 59, and 53, till, at length, water of the natural temperature
may be used.

Astringent injections are also highly useful, under certain circum-
stances, in relieving constipation. Brotonneau was tho fust to
establish this new and important fact, which haa boon again brought
forward by Trousseau and Pidoux, in their "Treatise oh Therapeu.
tics," hul without its having been as yet generally adopted in prac*
One can readily imagine the reluctance some medical men

296 Constipation and its Treatment. [May,

have to recommend, in constipation, injections containing the sub-
stances they are in the habit of prescribing in diarrhoea such as
catechu, krameria, alum, &c. But if we reflected, that in persons
who have long suffered from constipation, particularly females, the
rectum forms above the sphincter a pouch, sometimes of considera-
ble size, in consequence of distension from accumulated faeces, to
which the coats of the bowels have been subjected, we should be less
surprised that the idea has occurred to have recourse to the injection
into the rectum of tonic and astringent substances, with the view of
causing corrugation of the muscular fibres of the bowels, which, by
corrugating, becomes shorter, and thus diminish the enlargement of
the cul-de-sac now spoken of.

Astringent injections are particularly suitable in cases where there
is reason to suspect an abnormal dilatation of the lower portion of
the rectum; for instance, in constipation from the presence of a me-
chanical obstacle at the anus, caused by hemorrhoidal tumours,
swellings of a venereal or cancerous character, or contraction of the
sphincter with or without fissure. These injections are moreover,
suitable, for the same reason, to females in whom constipation exist,
along with engorgement or retroversion of the uterus, and to all those
persons who, having their bowels relieved only once in eight or ten
days, void, after painful efforts, which can be compared to nothing but
a sort of parturition, an enormous mass of hardened and dry fasces.
In all these cases, it is of consequence to rouse the tonic action of the
muscular bands of the large intestine, and this indication is well ful-
filled by astringent injections.

The ingredients of these injections may be infinitely varied ; they
may be composed of red roses, krameria, oak bark, bistorta, catechu,
alum, &c. The following is Teisseir's mode of proceeding: He
begins with the simple infusion of roses, cold, and at the end of a
few days, he adds to each injection from fifteen to thirty grains of
the extract of rhatany. He thinks that in obstinate cases a minute
portion of the extract of nux vomica one-seventh or two-sevenths
of a grain, for instance might be added, with advantage, to each
enema. He considers, also, that they should measure ten or twelve
ounces, so that they may not be retained many minutes; that their
action may be of short duration, and that the muscular fibres of the
bowels may be allowed readily to contract themselves. The nux
vomica, the cold, and the astringent injections, are not certainly the
only means at the disposal of the practitioner in the constipation we
are now treating of; but they are those of which our author has had
most experience, and from which he has derived most success. We
must not forget here the means proposed lately by Fleury viz., the
introduction of tents into the rectum, which, acting as a foreign body,
stimulate the bowel by their contact, and rouse its contractile power ;
nor the champooing of the rectum, proposed by Recamier; nor,
lastly, inspissated ox-gall.

To all these means must be added, as auxiliaries, drinks composed

184G.] Insanity : Us Symptoms and Diagnosis. 297

of vegetable bitters, a tonic diet, the use of black meats, Bordeaux
wine, active exercise in the open air, &c. These are useful auxilia-
ries, much more beneficial certainly than the use of white meats,
(veal and chicken,) relaxing vegetables, such as sorrel, spinach,
chiccory, cooling lemonades, juice of prunes, bouillon aux herbs, &c.

INSANITY:

Its Symptoms and Diagnosis. By J. B. Steward, M. D.*

(From Ranking's Abstract.)

"The premonitory symptoms of insanity may be divided into two
classes, viz., those which evince a predisposition to mania, and those
which characterize its approach.

" In the former class, we have hereditary tendency great natural
timidity a disposition to view all the occurrences of life through an
exaggerated medium, leading to unwarrantable depression or eleva-
tion a highly sensitive and delicate feeling.

* In the second class, or those symptoms which portend the ap-
proach of insanity, stands first, insomnia, or indisposition to sleep;
restlessness unusual irritability or excitability abandonment of
former habits inability to follow any fixed pursuit suspicion and
unfounded dread of evil, avoidance of society self-colloquy a
watchful yet averted eye.

" This combination of symptoms is not, however, immediate. At
first a change is noticed in the manners and habits of the individual
which scarcely attracts attention ; it is felt rather than observed, and
seldom elicits more than a passing remark. Gradually this alteration
becomes more evident; some or all of the symptoms above enumer-
ated are added ; the sufferer is impatient of contradiction or control ;
he suspects all around him. and resists all attempts to pacify him.
Daily he more and more developes his true feelings; the caution
which has for a time restrained him gradually diminishes; he takes
less and less care to conceal his opinions and impulses ; till at length
the change becoming too evident to admit of a doubr, the individual
feels himself as it were detected, and confident in the truth and jus-
tice of his opinions, no longer hides but defends them.

"It is also to be observed, that whatever form insanity may after-
wards assume, in its first approach it is almost always accompanied by
derangement of the general health ; the secretions and excretions are
alike unhealthy, the tongue is loaded, and the circulation irregular."

[The proximate symptoms which in fact constitute the disease
itself are divided by the author into the latent and the evident, the
former requiring a certain train of thought to be hit upon in order to
insure their manifestation, the latter sufficiently appreciable on all

Practical Notes on Insanity. London, 18-15.

298 Insanity: its Prognosis. [May,

occasions. The diagnosis of insanity from the diseases with which
it may be confounded is thus stated :]

"The disease most likely to be confounded with insanity is deliri-
um tremens; but the bustling agitated manner, the expression of
anxiety generally about matters of business, the tremulous tongue,
supported by the fact of the attack having been preceded by a fit of
hard drinking, are ample for the purpose of right judgment."

[Hypochondriasis is thought by the author to be the effect of dys-
pepsia upon a mind predisposed to insanity, and the distinction is in
many cases not easily drawn. Hysteria also resembles insanity in
some of its forms, but may be known by the incongruity of the symp-
toms, the peculiar coating of the tongue, muttering delirium, and
above all by the sound sleep, which generally occurs as in health.
To the experienced eye the general appearance of the patient is a
sure guide.

From the delirium of phrenitis insanity is distinguished by the ab-
sence of fever in the latter, and the state of the pulse, tongue, and
surface.] " At the same time we must not forget, that that form of
symptomatic mania accompanied by increased circulation through, or
congestion in the brain, or its membranes, not only resembles phre-
nitis but sometimes ends in it. In such cases we can only become
acquainted with the true state of the case when the maniacal symp-
toms subside simultaneously with the removal of the functional de-

Its Prognosis. By Prof. Williams.
[In a lecture upon mental diseases, Dr. Williams observes that :]
"With regard to the prognosis of insanity, it may continue only a
few days, and then cease, and not return again, or it may last for a
long period, or for life; and its termination maybe either recovery,
permanent aberration of the mental powers, or fatuity. The pro-
portion of recoveries varies very much in different establishments,
and Esquirol calculates that it varies from one in four to one in two.
In England the average is below 50 per cent, in public establish-
ments. In the asylum at York, conducted by the Society of Friends,
the average of forty-four years has been 50 per cent. ; in the Exeter
and the Limerick Asylums, the result for thirty-nine years gives the
average of recoveries at 52 per cent. On the the other hand, at
Hanwell, about which we hear so much, the recoveries are only 22
per cent, for a nine years' average ; but this being an asylum for the
lower classes, many of these cases have been treated in workhouses
and infirmaries previously, and they may be considered to be cases of
the worst nature. Recovery sometimes takes place suddenly, and
in recent cases it is usually after a sound sleep, or after a spontane-
ous discharge from diarrhoea; more generally the recovery is gradual
with lucid intervals: the age of the patient influences the recovery;
the young have a better chance, and in old people few above GO re-
cover at all. Pinel states that the recoveries take r-lace within five

1846.] Insanity: its Treatment. 299

or six months, on the average ; and Esquirol remarks, that the
greatest number of recoveries take place in the first year. The ac-
count given by Dr. Thompson with regard to the York Asylum is,
that the recoveries take place within three months of the first attack,
in above 50 per cent. Esquirol gives a table of cases not complica-
ted with paralysis, in which, out of 2005, 604 recovered in the first
year, 497 in the second year, 86 in the third year, and only 41 in
the seven following years. In a few rare cases, recovery takes place
after a much longer period. Pinel gives a case of a girl who was
mad ten years, an 1 suddenly came to her senses, on the reappearance
of the catamenia which had been suppressed. After the first month
the disease is apt to become chronic. Sometimes the recovery is
complete, the patient being in mind and body as sound as he ever
was; but in the greatest number of cases there is a great liability to
relapse, and where the disease is not properly removed, the patients,
though quite rational, never have the same strength of mind they
had previously." [Medical Times.

Its Treatment. By Dr. Woodward.

[The following concise observations upon the important subject of
the medical treatment of insanity occur in Dr. Woodward's report
of the State Lunatic Asylum at Worcester, United States. We
shall give the extract nearly in the author's words :]

Bleeding. All agree that depletion by general bleeding and ac-
tive cathartics is not favorable in insanity. If bloodletting procure
relief, it is but temporary, and the excitement generally returns with
greater violence than before. The indications for active depletion
are the effect and not the cause of excitement.

Cupping and leeching. Local bleeding, though less injurious than
general, cannot be relied onto cure insanity. It is only useful tem-
porarily, in order to reduce excitement, until other remedies can be
brought to exert their influence. If there be much determination to
the head, cupping may be resorted to, while other means are used to
restore the equilibrium of the circulation. In some cases of maniacal
excitement, a state of dementia immediately follows excessive vene-
section.

Cathartics. Drastic purging is often even more hurtful than
bleeding. The digestive organs of the insane are peculiarly suscep-
tible of disturbance, dyspepsia, vomiting, and costiveness, or diar-
rhoea, being often troublesome symptoms with them. Drastic pur-
gatives generally aggravate these symptoms when they exist, nnd
produce them when they do not. Constipation is generally to bo
obviated by mild cathartics; and is far less troublesome than diar-
rhoea, which is often an obstinate, and too frequently a dangerous
symptom when attendant upon insanity. If the secretions of the
liver are unhealthy or deficient, blue pill or small doses of calomel
may be indicated. These romedies often produce very favorable im-
pressions, and prepare the system for others which may be necessary

300 Insanity: its Treatment, [May,

to remove the insanity itself. In short, cathartics, as such, rarely do
good in insanity, but alteratives are often necessary, and in many
cases cannot be dispensed with. Tincture of rhubarb, and senna,
with aromatics, are valuable remedies of this class.

In torpid states of the intestinal canal, my favorite remedy is the
tincture or powder of guaiacum ; no remedy has been in my hands
more successful than this, in melancholy attended by dyspepsia, and
distress after taking food. It invigorates the stomach, acts upon the
skin and bowels, and in females is emmenagogue. It ma}r be given
in doses from 1 dr. to ^ oz., three or four times a day in milk and
sugar. If the object be chiefly to act upon the bowels, the powder
is the better form.

Croton oil in small doses often proves serviceable in the removal
of costiveness.

Narcotics. This is by far the most influential class of medicines
in acute mania, after the system has been duly prepared. It is gen-
erally conceded in the present day that the condition of the brain
in mania is not inflammation, but rather a high state of nervous irri-
tation. For this state of the brain, narcotics would seem to be the
most natural remedies, and experience shows that such is the fact.

Morphine. The remedies of this class most extensively useful are
the muriate and other similar preparations. The exact time, circum-
stances, and cases when these remedies can be applied with the
greatest benefit, must depend upon the judgment of the practitioner ;
on this, doubtless, depends their greater success in the hands of some
men than in others. The morphine should be administered in a so-
lution, the dose proportioned to the urgency of the case. Moderate
doses should be tried in the first instance. When the medicine acts
favorably it exercises controhng influence over the symptoms, and the
patient becomes more tranquil and rational. The time in which it
is necessary to persist in the use of this medicine, varies from a
few weeks to many months. In the few cases in which it is neces-
sary to administer narcotics in large doses, to produce decided im-
pressions, the tincture of opium is the best preparation. Dover's
powder has been used by us when the skin is dry, with the most
marked benefit.

It is rare that any benefit arises from single doses of opiates at
nisht, to produce sleep, unless the system be kept under the influence
of them the whole time; in violent cases, the doses should be repeat-
ed once in four or six hours. It is important to know the symptoms
which contraindicate the use of narcotics. When the skin is hot
and dry, the tongue furred, or dry and red, the bowels costive, the
pupil contracted, and the conjunctival vessels injected, they cannot
be used without injury.

Datura stramonium. This acts favorably in some cases, disap-
points in others, and in some cases aggravates the symptoms. In
cases connected with epilepsy, Dr. Woodward has seen excellent
effects from this remedy. It is seldom, in a case thus complicated,

1846.] Insanity: its Treatment. 301

that the patient entirely recovers, but under the use of stramonium,
the symptoms are often greatly diminished in force and frequency.
In some cases the epileptic attacks have been entirely suspended ;
but the medicine must be given in doses sufficient to dilate the pupils
and produce some difficulty of vision ; the preparation preferred by
Dr. Woodward is the tincture of the seed.

Conium maciilalum. The extract of hemlock either alone or in
combination with mineral tonics, has proved useful in some forms of
insanity. It is worthy of but little confidence as a means of re-
moving maniacal excitement, but for some forms of melancholy,
especially if combined with dyspepsia or neuralgia, it often proves
very useful. In cases of melancholy also, complicated with disease
of the stomach and torpor of the liver, attended with uneasiness,
restlessness, and nervous pains, it is often auxiliary of cure. It may
be used in large doses without danger. The minimum dose should
be ten grains three times a day, the maximum two or three drachms,
as frequently repeated. Dr. Woodward has rarely seen any advan-
tage from less than from fifteen to twenty grains for a dose three times
a day, but commonly gives from thirty to forty grains. The efficacy
of the extract appears to be increased by its combination with the
carbonate or red oxide of iron.

Hyoscyamus is a useful medicine in some cases of moderate ex-
citement, and in sleeplessness. In high maniacal excitement, and in
the extreme suffering of some cases of melancholy, it is only an aux-
iliary to the more powerful remedies before considered. Its virtues
have probably been overrated, but it is worth a trial in many cases
which do not require more potent medicines. I hardly know of a
remedy more likely to produce sleep in simple watchfulness, than a
combination of hyoscyamus, camphor, and lupuline, from two to five
grains of each.

Nux vomica. Dr. Woodward uses this medicine in cases of mel-
ancholy with flatulence and general muscular relaxation, and com-
bined with the nitrate of silver in neuralgia, epilepsy, and chorea.
The first unpleasant symptom arising from its use is a sense of
constriction of the stomach.

Ammonia, ether, aromalics, <$fc. These have been found service-
able by Dr. Woodward in low cases of melancholy, and even in
cases ofexcitcment, when the skin is cold and moist, with weak pulse
and other indications of a languid circulation. "In some cases of
recent dementia in which the patient will stand like a statute, with
the face fixed to the floor, moving neither hands nor feet, neither
taking food nor attending to the calls of nature, strong stimulants,
aromatics, and cordials are indicated, and often produce decidedly
good effects."

Tonics. " In acute mania, after the first excitement is over, tonics
are often indicated, and not unfrequently may boused with propriety
early in the disease.'" When the patient is exhausted and feeble,
although still excited, quinine, bark, and often wine are beneficial,

302 On the Different Diagnosis of Pneumonia. [May,

used at the same time with narcotics. In melancholy, our principal
reliance must often be placed in tonic medicines. Bark, and sulphate
of zinc, are often of great service in this form of insanity.

Baths. In acute mania the warm bath used frequently, and for a
lengthened period, is found by the author to be decidedly beneficial.
It is also serviceable in melancholy and chronic insanity, when the
skin is in an unhealthy condition. Cold douches to the head, and
warm pediluvia, are important adjuvants in the treatment of insanity.
The nitro-muriatic-acid bath, the mustard and the salt-water baths
are also commended, and where baths are objectionable, frequent
ablution with warm water. [Am. Journ. of the Medical Sciences.

On the Different Diagnosis of Pneumonia. By M. Rostan.
(Gazette des Hopitaux. From Idem.)

"Inflammation of the parenchymatous structure of the lungs may
attack indifferently any portion of those organs. In the onset of
the disease, their density is not materially altered, but their tissue is
seen to be red and injected. If the thorax be percussed in this
stage of the malady, no difference will be perceived in the sound as
it occurs in a perfectly healthy person. As the disease progresses,
however, very important alterations take place in this respect ; the
sound becomes dull, but not to the extent to which it arrives in pleu-
ritic effusion. If the lung should subsequently pass into the condi-
tion known as 'grey hepatization,' the dullness of the sound is still
further increased.

"The natural sound produced by the entrance of air into the lungs,
need not be here insisted upon, as it is perfectly well known; we
shall therefore pass on to consider the changes which it undergoes in
pneumonia, and to contrast it with those of other affections for which
the latter disease may be mistaken.

"In pleurodynia, the respiratory murmur is not different from that
of health. Neither does it undergo any change in the early stage of
pleurisy. If, however, effusion have taken place, this sound is no
longer normal. It becomes rough, and at length degenerates into
the veritable bronchial 'whiff,' louder in proportion as the effusion
is more considerable. We particularly call attention to this point ;
as this sound has been in general considered as confined to pulmon-
ary hepatization. It is not so, however, but as we have stated is
also heard in pleuritic effusion. How then are we to distinguish the
one case from the other?

"In pneumonia the respiratory murmur is always more or less
mixed up with the crepitous rale, a sound which is characteristic of
the first period of the disease, and is heard in no other, if we except
perhaps the case of simple pulmonary congestion. As the disease
advances this rale and the vesicular murmur decrease and finally dis-

1846.] On' Ancemic Murmurs. 303

appear, and their place is supplied by the tubar or bronchial respira-
tion. The circumstance which distinguishes this form of bronchial
respiration from that which depends upon pleuritic effusion is this,
that the fine crepitation of the earlier stage of pneumonia may al-
ways be heard at a greater or less distance from the spot in which
the ' whiff" is produced.

"If the bronchial tubes alone be the seat of the inflammation, the
rales produced are subcrepitant, that is, are distinguished by large
bubbles instead of the fine crackling of pneumonia; they are at
other times hissing or snoring, and are heard both with the inspira-
tion and expiration.

" The auscultation of the voice gives likewise certain results by
which the presence of pneumonia may be detected. It is loud and
resounding, as if the patient spoke directly into the ear; this, howe-
ver, is confined to the spot at which the respiration is bronchial. In
pleuritic effusion the voice is also louder than natural, but it has a
peculiar tremulous intonation whence it has been termed cegophony,
from its resemblance to the bleat of a goat. We must allow, however,
that this latter sound is not to be depended upon as diagnostic be-
tween pleuritic effusion and hepatization of the lung, for the voice
has occasionally the trembling character in the latter.

"Independently of auscultation, some importance in diagnosis is
to be received from a consideration of the general symptoms, as the
state of the pulse, heat of the skin. The latter sign is one of consid-
erable import, for although it accompanies all forms of inflammation,
it is remarkably pronounced in inflammation of the substance of the
lung. The tongue is generally white and furred, with a red point,
and the urine high colored.

"In pleurodynia, although the pain is very acute, the system does
not sympathize, the pulse remains quiet, and there is no febritedis-
turbance.

"In pleurisy with effusion, the general symptoms appear to be in
inverse ratio with the local mischief, a circumstance which is almost
peculiar to that disease. From this fact alone, we have frequently
been able, without the aid of auscultation, to determine between dull-
ness on percussion arising from effusion, and that depending upon
pulmonary hepatization."

On Ancemic Murmurs. By H. M. Hughes, M. D., Assistant Phy-
sician to Guy's Hospital.* (From Idem.)

In certain states of the system, or it may be, with certain conditions
of the circulating fluid, as in chlorosis, or in anaemia from hemor-
rhage, or from other causes, murmurs frequently arise from the pas-
sage of the blood, independently of absolute disease of the heart or

Clinical Introduction to the Practice of Auscultation, &c., p. -J^t.

304 On Anamic Murmurs. [May,

great vessels. These are termed anaemic murmurs, or "chloroiic
bruits."

They are ordinarily of the softer kind, and resemble the blowing
of a pair of bellows ("bruit de soitjflet"). but they are sometimes
quite harsh, and resemble the rougher morbid sounds, as that of filing
or sawing ("bruit de rape and bruit de scie").

They are very generally supposed to be confined to the aortic
openings. This is certainly a mistake. They are most assuredly
very frequently connected with the pulmonary artery, in which mur-
murs, quite independent of any disease of the vessel, or of its valves,
are far from uncommon.

Murmurs often arise from some body pressing upon this vessel ;
as a solid mass, the result of pleurisy, of pneumonia, or of phthisis,
or enlarged bronchial glands, abscesses of the anterior mediastinum,
&c, &c. The murmurs frequently also coexist with chlorosis, or
with other forms of anaemia. Are these latter murmurs, then, whe-
ther in the pulmonary artery or in any other part of the circulating
system, to be distinguished with tolerable certainty from morbid
sounds, the result of organic obstruction within or without the heart
or large vessels?

Generally speaking, they may, I believe, be distinguished from
each other ; but they certainly cannot always be so; and never with
absolute certainty by the mere character of the murmur alone.
There are, I feel assured, some examples of these anaemic murmurs,
which can be proved to be simply functional, and not to arise from
organic disease of the heart or its vessels, or from pressure upon
them, only by the results of treatment.

Let, then, the student be careful not to assert too confidently that
a patient on the one hand, has organic disease of the heart, or great
vessels, merely because he has a harsh murmur over the aorta, an
occasionally irregular rhythm, and a vibrating pulse, which usually
coexist with an ancemic condition of the body, or he may cause un-
necessary alarm and anxiety; nor let him, upon the other hand, too
hastily determine, that, because a murmur is soft, and his patient is
an hysterical girl, with a pale face, and is subject to leucorrhoca and
to amenorrhoea, that she has no organic disease ; or some day, to his
great surprise, grief, and mortification, and possibly also to his dis-
grace, he may find she has died suddenly with diseased heart.

Anaemic murmurs, however, it may be stated, are very local and
are generally pretty much confined to the situation of the sigmoid
valves, either aortic or pulmonary, or both; they do not follow the
course of the large vessels so fully, or so frequently, as do the mur-
murs arising from disease of the valves, or of the arteries : they occur
only during the systole of the ventricles ; and as they cannot arise
from regurgitation through the mitral valve, they are not heard very
distinctly below the left nipple ; they are always, so far as I know,
accompanied with a smart smacking impulse ; they generally disap-
pear for a time while the individual is quiet, mentally as well as

1846.] On Anazmic Murmurs, 805

bodily, if by that quiet the heart assumes a natural impulse; and
they are always diminished, and generally disappear entirely, under
suitable treatment.

The origin of the anaemic murmurs has latterly been very gener-
ally attributed to a watery condition, or a diminution of ordinary
viscidity, of the blood ; in consequence of which it is believed that
the particles of the fluid move more easily over each other, are there-
fore more freely agitated, and thus give rise to the vibrations which
produce the murmur. This may have some, and perhaps an impor-
tant, influence in producing them.

But there are other circumstances which also appear to play an
important part in their causation. The principal of these is the re-
markably quick and sudden contraction of the ventricles; in conse-
quence of which thefluid contents of the cavities are propelled through
the comparatively small area of the mouths of the large arteries in a
shorter time than during the leisurely contractions of health, or the
frequent, but not sudden, contractions existing in some other forms
of disease. Though, therefore, no actual contraction exists, an ob-
struction is practically produced by the increased velocity with which
the blood is propelled through the aortic and pulmonary openings.
The increased agitation in the fluid thence arising, it is at least pro-
bable, has a principal part in the production of anaemic murmurs.

If the heart beat quietly, and the impulse be natural, however de-
cided the pallor of the face, and whatever the watery condition of
the blood, no murmur, I believe, exists, when no mechanical obstruc-
tion is present.

It is also possible that the quantity of the circulating fluid is de-
creased in such cases, in addition to its quality being altered, and that
while, by the elasticity of their coats, the arteries are capable of ac-
commodating themselves to the diminished quantity of the fluid, the
cavities of the ventricles retain their normal capacity, and that on
this account an absolute, as well as a comparative obstruction, may
exist to the transit of the blood.

Concurrently with these anaemic murmurs at the origin of the large
arteries, there is often heard, upon the application of the stethoscope
to the side of the neck, a curious sort of humming noise, which ceases
when firm pressure is exerted upon the jugular vein at a point above
that on which the end of the stethoscope is placed. It is continuous,
not intermittent like the arterial murmur, and is, therefore, some-
times called the "continuous humming," as well as the "venous
murmur," "bruit de diable,'' &c.

It most probably depends upon partial obstruction to the quickened
flow of blood through the veins. Strong pressure causes it to cease ;
but without pressure, directly or indirectly applied, it is, I believe,
never heard. Like the anaemic murmur of the arteries, it is suppos-
ed to be associated with a watery condition of the blood, and it is, wo
are told, a frequent, if not a constant, attendant upon that state of
the system with which such a watery condition of the blood is a con-
comitant.

20

306 On Ancemic Murmurs. [May,

This statement is not made from my own observation, but if true,
the venous hum may perhaps be considered a useful assistant indica-
tion of the anaemic state.

But great obstruction to the blood may, as has been previously
hinted, exist ; extensive disease may be present in the valves of the
heart, or in the large arteries, and yet no murmur may be heard.
This arises from circumstances which may be, as they have already
been partially, illustrated by the stream, in which a certain rapidity
of the current is necessary to produce such an agitation of the water
as will give rise to sound. Though the bottom of a rivulet be very
uneven, and its banks exceedingly irregular, yet if the current be
not tolerably strong, little or no ripple will be produced, and no sound
will be generated. It is just so with the blood; rapidity of the
current of the blood, as well as obstruction thereto, is necessary to
produce such an agitation among the particles of the fluid as will
give rise to sound.

Hence it often happens that a heart with extensive disease of the
valves may be without murmur while the patient is quiet, and the
circulation is slow ; though immediately the circulation is accelera-
ted, either by physical exertion or by mental emotion, a murmur be-
comes distinct. Hence, also, it happens, that when the cavities of
the heart become greatly distended, in consequence either of the
magnitude of the obstruction, or of defective nervous power, the ven-
tricles are frequently incapable of acting upon and propelling their
contents with sufficient force to produce a murmur. The channel
is irregular enough, but the rapidity ofthe current, and of the result-
ing vibrations, is not equal to the generation of sound. Hence, like-
wise, it arises, that when fluid is present to a large amount in the
pericardium, the heart may be so oppressed with the accumulation
upon the exterior, that, though great obstruction exist within, no
murmur is produced. Thus it will be often observed that when the
obstruction is greatest, the murmur, if even it be heard at all, is very
feeble; and that when the obstruction is small, the murmur is very
loud; thus also, in persons who, for weeks and months, and even
years, have presented notably morbid cardiac sounds, these sounds,
if the individuals are not carried off suddenly, very frequently, or
perhaps even generally, cease altogether some days before death.

The cause of this, as before stated, is either that the heart does not
contract with sufficient power, or if it act forcibly, that it cannot act
upon, and propel through the contracted orifices, the large quantity
of blood which distends its cavities with a rapidity sufficient to give
rise to sound.

Let, then, the student ever bear in mind the truth, that mere ob-
struction is not in itself sufficient, but that a certain force or rapidity
ofthe circulation must be necessarily combined with that obstruc-
tion, to give rise to morbid endocardial sounds. Murmurs may ex-
ist without any obstruction of an organic kind ; but without a certain
degree of force in the circulating current they cannot exist.

1846.] Treatment of Scrofulous Diseases. 307

On the Treatment of Scrofulous Diseases. By M. Saxdkat.
(Bulletin de Therapeutique, Encyclographie Medicale, Aout.
From Idem.)

The expensiveness of the preparations of iodine asgeneral remedies
in the treatment of a class of diseases which for the most part affect
poorer portions of the community, and fall to the care of charitable in-
stitutions, led the author of the present communication to devise a plan
of treatment which should as far as possible be independent of iodine,
and yet be not less efficacious. The medicines which he employs with
this intention are not new; the extract of walnut shells in particular
(vide ' Abstract,' vol. )., p. 98), has been extensively used in Germa-
ny, but the order in which he exhibits them, invests his communica-
tions with a certain degree of utility and interest. As may be sup-
posed, M. Sandrat attacks at the same time the general health, and
the local disease : his plan is as follows :

1. He takes care in the first place to keep his patients upon a
generous diet, consisting of roast or fried meats, bread and vegetables,
with wine, or wine and water, according to circumstances. A mixed
diet is found by him to agree with the majority of patients better than
one exclusively animal or vegetable.

2. He is very particular to enforce exercise in the open air, until
a slight sense of fatigue is induced.

3. Three sorts of baths are employed by him; the gelatinous, the
alkaline, and the sulphurous; others are also occasionally used, as
the alcoholic and the iodine, but their expense precludes their general
use in hospitals. The gelatinous baths are intended to soften the
skin and subdue irritation either general or local.

The alkaline baths, which are made either with soda or ordinary
soap, are indicated when slight stimulation is not injurious ; when a
greater degree of stimulus is wanted, in cases of flabby ulcerations,
he is in the habit of prescribing sulphurous baths, as they do not
produce the relaxing effect upon the tissues which always follows the
use of plain baths in scrofulous habits.

4. In addition to baths, the author makes use of three principal inter-
nal medicines ; these are iodine, the extract of walnuts, and steel.

Iodine is given under different forms; as a tincture, under the
form of hydriodate of potash, in simple solution, in pills of the
iodide of iron, or lastly as the proto-iodide of mercury, or as it is
found in the cod-liver oil. Whatever be the preparation exhibited,
the author agrees with Lugol in recommending the dose to be small.
He complains, however, that the tincture of iodine, the ioduretted
hydriodate, and the iodide of iron too readily decompose; the cod-
liver oil he finds too nauseous; the iodide of potassium, therefore, in
solution either simple, or with the addition of iodine, is the formula
which he generally prefers. He adds that these medicines have been
serviceable when combined with others, which he is about to mention,
but that as he has latterly tried these without the iodine with equal

308 Bibliographical Notice, [May,

success, he does not consider that the latter is deserving of the ex-
treme laudation which it has received at the hands of some physicians.
Indeed he thinks that he is now able to replace iodine with a medi-
cine equally efficacious, and more easy of administration. This
medicine is the extract of green walnuts.

The ordinary form in which the extract is exhibited, is that of syr-
up, of which the patient takes a teaspoonful several times a day. By
this treatment, he states, that the appetite is increased, digestion is
improved, and the scrofulous aspect is gradually dissipated.

As regards steel, M. Sandrat exhibits it chiefly as an auxiliary, and
considers it one of incontestable power. He gives it therefore in all
anaemic cases, and especially in young scrofulous females.

It is not an opinion confined to M. Sandrat, that the power of
iodine in scrofulous disease has been much overrated, more particu-
larly by its great advocate M. Lugol. Baudelocque (Traite des
Maladies Scrofuleuses) does not hesitate to avow that he has fre-
quently been disappointed in it, and that it fails to cause the absorp-
tion of tuberculous matter. We are disposed from a very considera-
ble experience of iodine in all forms of scrofulous disease, to range
ourselves on the side of Lugol, and are inclined to think that much of
the discredit which is attached to the medicine, may in France bo
traced to a spirit of jealousy, from which unfortunately the greatest
names are not entirely exempt. In this country it is different. As
we have taken occasion to remark in another place (Researches and
Observations on the Causes of Scrofulous Diseases), much of the
want of success with iodine is to be attributed to the little discrimina-
tion with which it is given, the doses being in general too large, and
too long continued. For our own parts we can conscientiously say
that e\ery day adds to our confidence in its virtues.

BIBLIOGRArAICAL NOTICE.

The Half. Yearly Abstract of the Medical Sciences, &c, &c. Edit-
ed by*W. H. Rankin, M. D., Cantab. July to December, 1845.
Part II., Vol. I. Republished by J. & H. G. Langley, 8 Astor
House, New York.

This re-publication has been sent us by the printing house of the
Messrs. Langley of New York, to whom we are indebted for
many similar favors. This number (part second) contains 373 pages,
and with the first part makes a volume of over 700 pages, and is
very neatly printed.

Dr. Ranking, assisted by others, has in imitation of Braithwaite,
commenced a review of the Medical Sciences every half year, and
issues two Nos. during this period, viz., the 1st of July and 1st of

1846.] Descendens Noni Nerve. Electrical Girl. 309

January, making one volume, and which is reprinted in this country
at the very low price of one dollar.

Our estimate of this work can be readily arrived at, by reference
to the pages of the last and this No. of our own Journal. We can
add nothing to this expression and recommendation of its value.

PART III. MONTHLY PERISCOPE.

Anomaly of the Descendens Noni Nerve. By Samuel Park max,
M. D., Demonstrator of Anatomy in the Medical School of Harvard
University, Boston. As anomalies of the nerves are somewhat
rare, a description of one which I have at present under my
notice, in the descendens noni nerve, and which I believe is not
mentioned, seems worthy of being placed on record.

As is well known to anatomists, this nerve when traced upwards is
seen to be formed from the first and second cervical, which send a
branch to a small filament coming from the hypoglossal just before it
makes its rectangular curve : in fact, the nerve is principally com-
posed of the cervical filaments, in some cases even the third and
fourth concurring to its formation. This cervical origin of the nerve
is constant, although, in some cases, more readily distinguished than
in others, from the filaments being enclosed in separate sheaths. In
the case in question the descendens had no connection with the
hypoglossal on either side, but the filament that should have come
from this latter nerve was supplied by the pnewno -gastric. This was
the same on both sides, except that on the right junction was a little
lower down, and the pneumo-gastric filament, at the point where it
touched the descendens, passed upwards in a retrograde direction, so
as not to enter into the distribution of the nerve.

The distribution of the descendens was normal, but from its deep-
er origin in the neck, it did not appear so immediately in the anterior
aspect of the sheath of the vessels as is usual. [American Journal
of Medical Sciences.

Electrical Girl. M. Arago stated to the French Academy of
Sciences, at their meeting on the 16th Feb. last, that he had been
called upon to witness some of the most singular phenomena which
he had ever beheld, in the shape of electric discharges of the most
violent character, proceeding from the person of a young girl, aged
thirteen, lately submitted t< his inspection. This truly remarkable
child overturns tables ami chairs by merely touching them with her
apron. When she sits down, the moment her feet touch the ground
the chair is upset, and she is suddenly propelled with considerable
force. M. Arago said he had seen all these experiments, and had
not been able to detect any trick. He begged the Academy would
appoint a committee to investigate the matter. [Med. Times.

310 Fevers. Scrofula. Influence of Imagination, 6$c. [May,

Forms of Disease in which Opiates are indicated. Dr. Sobern-
heim furnishes us with the summary of the diseases in which opium
is beneficial, and the form of its exhibition :

Fever, Intermittent, when offering a nervous character, (strong
shivering, great anguish, unusual excitement, followed by exhaustion,
giddiness, heaviness of the head, hallucinations and alienation of the
senses, spasmodic and convulsive symptoms; pulse small, frequent,
and irregular, skin cool, cold extremities, violent vomiting and purg-
ing.) In such cases, it is either administered in large doses (from
1 to 3 grains) shortly before the paroxysm, or a little after the shiv-
ering has commenced (4 to 6 drops of tincture every hour, with
chamomile tea,) or in the intermission (a quarter of a grain ofopium
with two grains of quinine every three hours;) if the disease be com-
bined with apoplectic phenomena, venesection is to precede it ; if
with gastric symptoms, an emetic. Graefe and Luders recommend
opium (a quarter of a grain) with quinine (2 grains)against the dan-
gerous shivering, subsequent to deep traumatic lesions, undoubtedly
caused by the reflex action of the spinal marrow. Malgaigne also
uses opium with the greatest success, after serious operations, to pre-
vent fatal traumatic inflammations. He administers from 6 to 10
grains ofopium during the day, and continues it as long as inflam-
mation is to be feared. By this method he asserts to have prevented
fever, local inflammation, and even pain. Typhus fever, with great
excitability (exhausting discharges, great excitement and sensi-
tiveness, loquacious delirium, continual sleeplessness, pulse small,
spasmodically contracted, skin dry, extremities cold,) in small, re-
peated doses, in the form of Dover's powder, with ammon. carbon,
pyro-oleos., to encourage the crisis of the skin, but with great caution.
In those forms of typhus abdominalis which are combined with in-
flammation and ulceration of the intestinal mucous membrane, it is
to be employed, according to Lesser (most advantageously in the
form of clyster,) when the alvine evacuations cause great exhaustion,
and appear peculiarly discoloured. [Ranking's Abstract.

Treatment of Scrofula. The basis of a very rational plan of
treating scrofula consists in the administration of alkalies, and the
continued use of highly animalized diet. Chemistry has lately
shown in an interesting manner the reason of this fact, which is,
that phosphates are passed in the urine of scrofulous patients to an
extent many times greater than natural. The reason for the avoid-
ance therefore of vegetable diet, which by forming lactic acid, tends
to dissolve the earthy phosphates, and the persistence in the use of
alkalies, which neutralize the acid in the system, is clearly shown.

[Dr. Cowan's Address, Prov. Trans.

Influence of the Imagination in the Cure of Disease. In open-
in^ a course of lectures on Physiology lately at the College of France,
M. Magendie spoke at length on the power of the mind in relieving
disease. A few detached quotations are here given.

1^46. J Effects of Hydropathy on the Blood. 311

"These reflections explain at once the cures of which homcepathy
is so proud. Homcepathy, instead of bleeding a patient, will place
gravely on his tongue a globule of aconite, which he will swallow
with confidence and faith. You then see the disease improve. But
it would have improved just as well without globules, provided some
singular operation had struck the imagination of the patient. It is
really too great a stretch of credulity to believe that a globule pre-
pared by the formulae of Hahnemann can contain any active princi-
ple. But, on the other hand, any one who has seen disease, must
at once admit that this same globule may exercise, through the im-
agination, a powerful moral effect. You must not, indeed, accuse
me of partiality towards homcepathy, when I state that I firmly be-
lieve that a physician would cure a patient sooner with globules, if the
patient has faith in them, than with the most appropriate medicinal
substances, if he distrusted their action.

M What I state respecting medicinal substances is equally appli-
cable to bleeding. A patient is seized with the symptoms to which
the term inflammatorv has been applied, and asks to be bled, believ-
ing that the loss of blood will cure him. You open a vein, and the
abstraction of a certain quantity of the vital fluid is followed by an
amelioration of the symptoms. But take care how you interpret
the fact ; the improvement may be owing to the moral effect produced,
more than to the venesection. For more than ten years I have not
found it necessary to have recourse to copious bleeding; in other
words, I have rather endeavored to act on the mind of the patient
than on the circulation, and I have no hesitation in asserting that
my practice has not been the less successful.

"Yes, gentlemen, we love error, and often refuse to yield to evi-
dence, even when it is proved to us that our good faith and credulity
have been imposed upon. Of this tact I will give you the following
proof. A lady, a fervent believer in mesmerism, asked tier niece,
who was poorly, for a lock of her hair, in order to consult a somnam-
bulist. The niece, wishing to try the credulity of her aunt, gave her
the hair of her maid instead of her own. A renowned somnambulist
was consulted, and at once recognized, by the hair of t lie maid, all
the symptoms presented by the niece, whose sufferings she minutely
described, to the great edification of the lady. The latter was then
informed of the trick that had been played. You would naturally
tare thought that she would have recognized the imposture of the
somnambulist. Not at all ; she preferred concluding that the maid
servant had the same disease as her niece, and obliged her to submit
to a regular treatment, as if she had bpen poorly, although at that
time in the best possible health." [Boston Med. and Sarg. Journal.

Effects of Hydropathy, on the Blood. A German physician, M.
Albert,* who has had ample opportunities of witnessing the operation
of the water-cure, has remarked that persons who have pursued (he

M i i i Blatl

312

Gout and Rheumatism.

[May,

system uninterruptedly for two or three months, are apt to acquire
a habit of body not dissimilar to that of scurvy. The pulse becomes
accelerated, soft and feeble. The patient is subject to palpitations
and a continual feeling of lassitude, and eventually suffers from
spongy gums and aphthous ulceration of the interior of the lips and
cheeks. From these symptoms M. Albert concludes that the immoder-
ate use of water has a tendency to impoverish the blood. [Bulletin.

On the differential Diagnosis of Govt, and Rheumatism. By Ciias.
Mackin, M. D. (Lancet March 22, 1845.) On an accurate compari-
son of the phenomena of rheumatism brought into juxta-position
with those of gout, we shall find sundry material differences, and a
numerous train of minor points of distinction interesting both to the
pathologist and the practitioner. The following table will serve in a
general manner to illustrate this assumption.

Gout. Rheumatism.

1. Is rare in females, who in- 1. Is frequent among females,
deed are seldom attacked by the especially those who are necessa-

disease in a strict and uncompli-
cated form.

2. Is scarcely ever seen prior
to the age of manhood.

3. Is generally, though not al-
ways, induced by high living, free
indulgence at the table, &c.

4. Is hereditary, descending
from father to son, sometimes
missing one generation.

ft* 5. Affects the smaller joints,
although the larger are often at-
tacked. The parts abounding in
fibrous tissues, as the sole of the
foot, are seldom attacked by true
gout.

6. Less frequently becomes
chronic.

rily exposed to its causes.

2. Is common to all stages of
life, except perhaps infancy.

3. Is more frequent among the
lower orders, and those to whom
poverty and privation are familiar.

4. Is not hereditary, at least
not obviously so.

5. Affects the larger joints and
fibrous tissues.

6. Has great tendency to be-
come chronic.

7. Subsequent amelioration not

7. Subsequent to the paroxysm
the patient is improved in general so evident
health, that is comparatively.

8. Metastasis to other joints
(common,) to the stomach (fre-
quent,) to the membranes of the
brain (rare,) to the pericardium
(scarcely ever.)

9. Cornea, the most frequent
seat of gouty inflammation of the the sclerotic coat
eye.

10. Localization of gout not 10. Rheumatic arthritis gencr
preceded by rigors. ally preceded by rigor."

8. Metastasis to othe^ joints
(always,) to the stomach (rare,)
to membranes of the brain (fre-
quent,) to the pericardium (very
common.)

9. Rheumatism chiefly attacks

1846.] Poisoning by Poppy-heads. Croup. Scabies. 313

The author might have added, gout frequently induces tophaceous
deposits in the joints ; rheumatism never.

Poisoning by Poppy -heads. The "Gazette des Ifopitaux," April
15, 1845, quotes from the " Echo de la Frontiere," published at Va-
lenciennes, the following cases. Three children of one of the fau-
bourgs of Cambri sucked some unripe poppy-heads, and soon after,
on going home, fell asleep. In the middle of the night the mother
was roused from sleep by the unusual sound of their respiration,
which consisted of a short, laborious rale. At the same time, the
eyes were found wide open, the countenance pale and haggard, and
the body convulsed. A medical man was immediately sent for,
who succeeded in savins: two of the children. Fruitless efforts were
made to introduce an emetic into the stomach of the youngest ;
deglutition was arrested, the infant foamed at the mouth, and expired
four hours after. [St. Louis Med. and Surg. Journal.

Tracheotomy in Croup. Professor Trousseau has written a valu-
able paper on this subject. He regards the operation as not danger-
ous, and the ill-success which has attended its performance in laryn-
gitis and croup, as arising from its delay until the phenomena of
asphyxia set in. In 121 cases, M. Trousseau had but one fatal acci-
dent during the operation. An adult died the instant an incision
was made in the skin. In 150 operations, 39 children have been
saved. M. Trousseau always operates very slowly, and never makes
a stroke with the knife, without being directed by the finger and
the eye. He is thus certain of avoiding the left carotid, if given off
from the innominata and crossing the trachea. He has several times
had the innominata under the edge of the bistoury, but on bending
the incision a little to the left, and separating the tissues with the
fingers, the operation has been completed without fear or accident.
"Surgeons," M. Trousseau remarks, "who pride themselves upon
performing the operation with marvellous rapidity, and plunge the
bistoury boldly into the trachea to divide it from below upwards, as
soon as they have finished the incision of the skin, will deplore this
imprudent and useless celerity." Ill effects have never resulted from
blood accidentally introduced into the trachea, when the lips of the
wound have been held open, or the canula at once introduced. To-
pical applications may be introduced in the after treatment, through
the canula, as the injection of warm water in small quantities, to
relieve irritation and assist the expulsion of false membranes ; or a
weak solution ofnitrate of silver; or a stronger solution (1 part to 5 of
water) may be applied by means of a mop, at first three or lour times,
andafterwards once daily. [Half- Yearly Abstract of Med. Sciences.

On the Treatment of Scabies. Every practitioner has had occa-
sion to lament that the best remedy for this disease is one of so
disgusting a nature as is the sulphur ointment. The profession

314 Injections in Navus. Burns. [May,

therefore, will be glad to learn from the following communication
from Mr. Stiff, that the sulphur may be dispensed with, and that the
essential portion of the compound is the adipose matter. Mr. Stiff
states, that during the last six months he has frequently tested the
action of sulphur in scabies, and considers that it may be cured with-
out it. The truth of this assertion is rendered more evident, he
thinks, by looking into the nature of the disease, and by examining
the anatomy of the animal. The acarus scabiei belongs to a class
of insects which breathe by the tracheae, and its respiration is there-
fore suspended by smearing its body with any oleaginous substance.
It is in this manner, then, the sulphur ointment acts, according to
the author, and not in virtue of any specific action of the sulphur.
In proof of this, he affirms that he has cured more than forty cases by
inunction with simple lard, unaided by any other treatment. The
average duration of treatment was only a week. [Medical Times.

Injections in Ncevus. R. S. Davis Esq., (London,) has cured sev-
eral cases of naevi by injection, and considers it in most cases prefer-
able to any other mode. He says:

UI first puncture the naevus with a needle, in four or five directions,
making but one puncture through the skin. I then charge Anel's eye
syringe with a saturated solution of alum, insert its pipe into the
puncture made by the needle, and inject the naevus until it becomes
somewhat hard and swollen. No other treatment will be required ;
and after the subcutaneous inflammation has subsided (occupying a
period of ten days or a fortnight,) the naevus will be observed gradu-
ally to diminish, and will in a few months entirely disappear, leaving
no scar, or the slightest disfigurement."

He has operated twice on one naevus, but thinks it would have been
unnecessary, if he had waited. The merit of originating this mode
of proceeding is due to the late Mr. Tyrrell. The operation, Mr. D.
says, is, so far as his experience goes, entirely free from any danger-
ous or unpleasant consequences, and if excessive inflammation sets
up, an aperient, reduced diet, and cold lotion applied for a day or two,
are invariably sufficient to restrain it. [Lancet.

Burns. The great fatality of these accidents treated by any of the
accepted methods, both in hospital and private practice, gives an in-
terest to every new proposal, and to every modification of the various
plans which have been adopted. In the Hospital St. Louis, they have
been recently treated by M. Jobert with great success by means of
iced water. In extensive burns the cold bath is used repcatedlv. and
in the intervals, the injured parts are kept covered with large pledgets
of cloths steeped in cold water, and covered with bladders of ice.
Patients are said to have recovered under this treatment, who, in all
probability, would have perished had it not been adopted. The cold
water treatment is accompanied in had cases with bleeding, low diet,
and refreshing drinks, by which general reaction is completely check-

1840.] Exanthemic Linement. YelpeaiCs Neic Caustic. .'315

ed. When the eschars are about to separate, the ice is replaced with
simple applications of cold water. Under the treatment the patients-
feel refreshed, the pains -abate, the fever diminishes, and they enjoy
sleep, the restorative powers are invigorated, and a speedy cure occurs.

The theory employed to account for the efficacy of this treatment
is. that mortification from a burn occurs the moment the color ic is
applied, and even at places where nothing is appreciable, but where
eschars appear at a later period. That fact must not, however be over-
looked that mortification may come on spontaneously from the phleg-
monous reaction, which is of a gangrenous nature, independently of
the primary action of the caloric. The burned parts for a time xemair*
very warm, and the whole adjacent tissues may be felt of a burning
heat for a short period, and the primary and fundamental indication is
the withdrawal by every possible means of the caloric accumulated ir?
the injured part, whether it be that communicated by the original bun*
or that caused by reaction. M. Jobert is very severe on the use of
cotton and other specifics from the East with "occult qualities."

Prof. Miller is in favor of instant immersion in cold water, and re-
taining the parts there, not for minutes, but for hours ; but when a
burn or scald involves a large part of the surface, he la}rs it down as ai
principle that nothing must be done to favor the depression, on which
account the continuous use of cold cannot with propriety be employ-
ed. Chelius also favors the use of cold in the slightest degree of
burns. But the use of cold water and ice in cloths or in bladders
were strongly advocated by Mr. James Earle. Mr. South's notes to
Chelius comprise a resume of the various remedies which have been
in vogue. [Half -Yearly Abstract.

Exanthemic Liniment. The following liniment is particularly re-
commended by Dr. Morris, when desirous of keeping up a mild rash
upon the skin: )l. 01. crot. M. xx. ; antim. tart., 3j.; liq. potassa?,
5j.; aq. purae, 3vij. M., while Dr. Hennay, of Glasgow, considers
ipecacuanha one of the most manageable and efficient applications.
His formula is pulv. ipecac, ol. olivse, aa 3ij.; adipis. suill. fss. M.
It requires to be rubbed in for fifteen to twenty minutes, and is, ho
thinks, peculiarly adapted to cases of cerebral irritation in children,
dependent on receded eruption. [Dr. Cowan's Address.

M. Yelpeau's New Caustic. M. Velpeau has found that sulphuric
acid with saffron forms an admirable caustic. The powerful cauter-
izing effects of the acid are not destroyed, but by the combination a
black paste is formed, which hardens into a crust shortly after ex-
posure to the air. The peculiar properties of this caustic are iis
combining great power, with facility of circumscribing its action,
and it is stated also that the eschar thus formed, though deep, is
quickly thrown off. In cancerous affections, the peculiar and dis-
gusting fetid odour was quickly destroyed, nor did any had effects,
indicating its absorption, arise during its use. Northern Journal of
Medicine.

316 Casarian Operation. Ergot of Rye in Labor. [May,

A Child saved by the Ccesarian Operation, performed on a woman
after death. On the 23d August, 1843, M. Loweg was sent for to
attend a pregnant woman who had been ill for some time. She died
before his arrival, but, thinking the child might possibly still survive,
he practised the operation in the ordinary manner. A child at full
term, which had evidently lived up to the period of the death of the
mother, was removed apparently dead. Without cutting the cord,
the placenta and child were put into a warm bath ; after keeping up
artificial respiration for eight or ten minutes, animation was com-
pletely restored. [Dublin Jour, of Med. Science. Southern Journal
of Medicine and Pharmacy.

On the Exhibition of Ergot of Rye in Lingering Labor, and the
conditions for its safe employment. By S. Hall Davis, M. D., Lec-
turer on Midwifery, and Physician to the Maternity Charity. Dr.
Davis considers that the following conditions should be present in
order to render the exhibition of the medicine a safe proceeding.

1. The soft parts should be lax, and free from heat.

2. With rare exceptions, the orifice of the uterus should be nearly
fully dilated, and always dilatable.

3. The pelvic space should present the average dimensions.

4. In head presentations only ; in breech and footling cases it is
objectionable, on account of the very gradual descent of the present-
ing parts required for the subsequent passage of the head without
risk to the cord. In transverse presentations it is obviously improper.

5. The head should be in an average good position, and not im-
pacted.

6. The inertia of the womb should not have its source in plethora.

7. The absence of any source of irritation in any other organ capa-
ble of disturbing the parturient function by reflex action should first
be ascertained, as of faecal accumulation, urine in the bladder, or
crude ingesta, which are to be met by their obvious indications of
treatment.

8. The uterine inertia should be ascertained not to depend upon
disturbance of the nervous functions, from loss of rest, or from de-
pressing emotions.

9. There should not be present any cause of distension of the
womb, beyond its power of acting to advantage, as by excessive
quantity of liquor amnii or twins.

10. It would not be indicated when the inertia arises from con-
stitutional weakness.

11. It is rarely advisable in primiparoe; much time and slower
parturient action being required in these cases.

In short, this remedy being indicated on account of inertia of the
womb, arising from the effect of previous distensions, there should be
for its safe exhibition, a natural presentation, a wide pelvis, soft parts
relaxed, nothing wanting, in a word, but efficient action of the uterus
to finish the labor. [Lancet. From Ranking's Abstract.

1846.] Tooih.Powders. 317

Tooth-Powders. By Dr. Heilder. Among the constituents of
a good tooth-powder, the first in importance is charcoal, and espe-
cially lime tree charcoal. It forms a very soft and cheap powder, and
moreover possesses the valuable property of absorbing cohering sub-
stances, and destroying the disagreeable odor produced by carious
teeth. Small quantities left in the spaces between the teeth have a
disinfecting action on the particles of food which collect there. It
does not, it is true possess a pleasing color, and is on that account
rejected by many ; moreover, particles sometimes accidentally get in
between the teeth and gums, and shine through with a bluish color.

Next to it in importance is carb. of magnesia, both on account of its
absorbent power and its extreme softness. Its property of neutralizing
acids deserves particular attention, and, from its white color, any pleas-
ing tint may be imparted to it by some harmless coloring substance.

The lapides cancrorum and creta alba pr&parata resemble the car-
bonate of magnesia in their chemical behavior, and in their action.
Ossa sepicB concha prcrparata corallia alba et rubra, are, as carbon-
ate of lime, insoluble, like the two preceding, in the secretions of the
mouth; but they are less soft, and should therefore only be employed by
grown up persons, and even then should be mixed with other powders.

Ashes are less to be recommended ; they are sometimes even in-
jurious, for in them i the alkali is not neutralized by carbonic acid.
Soap, in which the alkali is combined with fatty acid, deserves the
preference, and, were it not for its disagreeable taste, would form an
excellent ingredient in tooth-powders.

Orris root is a harmless substance, and is generally added to tooth-
powders on account of its agreeable odor. 3Iany of the ingredients
most frequently mixed with tooth powders, such as alum, cream of
tartar, tartaric and citric acids, borax, chloride of lime, &c, are ab-
solutely injurious, and should always be rejected.

The most usual coloring substances employed are carmine, Flor-
entine lake, sanguis draconis, bolus armeniaca, corallia rubra, cocci-
nella, lignum Santali rubrum ; but only the first two give a beautiful
color, in small quantities.

To please the organs of smell and taste, a few grains of vanilla, or
a couple of drops of an essential oil, such as bergamot, neroli, rose oilf
oil of cloves, or oil of peppermint, may be added.

With respect to the mode of application, it is recommended to clean
the teeth with a soft brush and some powder, in the evening before
going to rest; otherwise the particles of food have time during the
night to undergo putrefaction, and, when removed in the morning,
may have already produced considerable injury.

Professor Carebelli used to prescribe a grey tooth-powder, in the
following form: R Pulv. oes. sepiae;

Lapid. cancrorum iss. aa.
Corticis cinnamoni;
Iridis Florentine ;
Carb. lign. tiliae 5iij. aa.
Vanillic gr. x. Misce.

318 Aperient Biscuits. Adulteration of Iodine. [May ,

For a less expensive powder, calcined oyster shells might be em-
ployed instead oi'os sepia, and a few drops of bergamot oil instead f
vanilla. He ohjected to red tooth-powders, from their rendering it
impossihle to tell when the gums bleed.

For children and young people carbonate of magnesia, without any
other addition, is most to be recommended, because on account of its
softness, it is not liable to injure the still weak enamel, and, at trm
same time, it neutralizes the acid which frequently occurs in the se-
cretions of the mouth in children. [CEstr. Medicin. Wochenschrift,
and Chemical Gaz. Ranking's Abstract.

Aperient Biscuits. The late Dr. Jos. Baader, who was towards
the end of the last century, one of the most successful medical men
in large practice at Munich, ordered, when he wanted a drastic purga-
tive, scammony resin in various combinations, in preference to other
remedies. It is adopted for use in many cases, more especially as it
has not the nauseous taste of jalap resin. Scammony resin is pre-
pared by digesting repeatedly powdered Aleppo scammony in alcohol,
and precipitating the resin by means of water, as jalap resin is ob-
tained from tincture of jalap. When dry, the resin is friable, trans-
parent, and verv soluble in spirit. If we drop a saturated solution
on biscuit, the fluid is immediately absorbed, and thus forms a very
flood preparation for children. Dr. Warrenner observes, in the
Medico-Chirurgical Journal, that Dr. Baader ordered a biscuit for
adults, to which he had added sapo medicatus, and prepared accord-
ing to this recipe: R. Scammoniae 3j.; Saponis Venet., gr. v.;
Sacchari albi, gr. ix. M. These ingredients were to be rubbed down
to a fine powder, and mixed with one ounce of powdered biscuit.
The mass was then to be kneaded, with the aid of a few drops of wa-
ter, to a stiff paste, which was dried in the air, and weighed out into
portions of 3x. Of this mass 3j. contains gr. vj. of scammony resin.
Scammony resin is not unpleasant to take, rubbed down with sugar.
Eight grains of the resin are sufficient to produce several evacua-
tions in an adult ; six grains are sufficient for an individual of about
fifteen years; four grains for a child of seven or eight years; two
grains for a child of two years. Scammony is one of the best an-
thelmintics. [Respetorium filr die Pharmacie. Band xxxvii. Heft 1.
Lancet.

Adulteration of Iodine. M. Herberger draws attention to the fact
that with the present high price of iodine sophistications are un-
commonly frequent. Thus he found in one sample native sulphuret
of antimony. But the adulteration with artificial graphite is far
more deceptive ; it may, however, be readily detected by driving off
the iodine at a gentle heat, and subsequently raising the temperature
with access of air. In one instance the author found no less than
51 per cent, of graphite. [Pharm. Jour., from Jahrb.fiir Prakt.
Pharm. American Journ. of Pharm.

1846.] Turpentine. Castor Oil. Tartar Emetic, $c. 310

Administration of Turpentine. It is stated that turpentine when
made into an electuary with mucilage, honey, and a little magnesia,
may be given without exciting the disgust and nausea, so frequently
caused as ordinarily prescribed. [Dr. Cowan's Address.

Prescription of Castor Oil. It is worth knowing, that the nauseous
greasy taste of castor oil is pretty effectually disguised by mixing it with
milk, and adding a little nitric aether and oil of cinnamon. Druitt.

The disadvantage of giving Tartar Emetic in solution in large
doses. M. Ernest Boudet communicated to the Royal Academy of
Medicine, some remarks on the unpleasant results of employ ingiartar
emetic in solution according to the Rasorian mode. The inconveni-
ences consist in an inflammation of the mucous membrane of the
alimentary canal, particularly of the buccal membrane, and often
there is a notable difficulty in respiration. Mr. B. recommends to
give this medicine in the form of pills. [Translated from Archives
Generates.

MEDICAL INTELLIGENCE.

The elaborate character of the original article in this No. of our Journal, has
precluded the introduction of others which were on hand. Its interest will we
think be found commensurate with its length.

The tardiness in the arrival of the Boston steamer, must be our apology for
the deficiency in our translations.

~ Death of Doctor Baber Ellis's Medical Formulary. "When the death of Dr.
Baber, of Macon, Ga., from an over-dose of the " Medicated Hydrocyanate of
Potassium," occurred a month or two since, our attention was called to the error
in the prescription taken by him from Ellis's Formulary. A notice of it for the
last No. of our Journal was promised, but it failed to come to hand. Below we
insert what we have just received from the publishers of this work. We cannot
refrain from expressing our surprise and deep regret, that such a fatal error in
the prescription of so deadly a poison as prussic acid is known to be, should
have remained thus long undetected and uncorrected, in so popular a recipe-book
as Ellis's Medical Formulary.

"ELLIS'S MEDICAL FORMULARY.
Corrfxtion. The Publishers of this Work respectfully request those persons
who have the seventh edition, to correct a typographical error for the "Medico-
Hydrocyanate of Potassium'' at page 83; wherein the symbol for an ounce is
used in place of that for a drachm. The following is the correct prescription,
and corresponds with the proportions directed in all the previous editions of the
Work :

fy. Potassii hydrocyanici medicati, 5j.
Aqua destillatae, Oj.
Sacchari purificati, Jisa.
Fiat volutin. Dose, a table-spoonful, night and morning

320 Med. Intelligence. Meteorological Observations.

Dear Sirs, May we ask the favour of you to insert the above in the next No.
of your Journal, that this correction may be widely diffused, and oblige

Yours, very respectfully,

I LEA&BLANCHARD.
Philadelphia, April 4th, 1846.

To Editors of Southern Med. and Surg. Journal"

Prof. Paine'' s Defence of the Medical Profession of the United States.' In depart-
ing from our custom of simply acknowledging on the cover, the reception of
annual Lectures, which may have been published and sent us, we do so to express
the mortification produced by perusing the one now under consideration. We
consider this Lecture inappropriate as a valedictory, in bad taste, and the attack
upon the projector of the National Medical Convention totally uncalled for. The
charges brought by Dr. Paine against Dr. Davis in this publication, are un-
founded and unjust, as the letter addressed by the latter to us proves.

METEOROLOGICAL OBSERVATIONS, for March, 1846, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

Sun
Ther.

Rise.
Bar.

2,1

Ther. 1

\ M. |
Bar.

29 14-1001

Wind.

Remarks.

1

50

29 61-100,

48

N. .

Gale Rain 2 inches and 1-10

2

38

" 46-1001

4T

" 58-100J

N.W.

Cloudy misty.

3

40

" 93-100.

60

30 3-100

N.

Fair.

4

35

30 10-100;

60

30 6-100

N. E.

Fair.

5

42

29 90-100!

72

29 85-100;

N. W.

Fair.

6

46

" 77-100

70

" 71-100

s. w.

Cloudy.

7

50

" 76-100!

76

" 78-100!

W.

Fair.

8

45

" 79-100!

77

80-100

w.

Fair.

9

55

" 75-100

68

" 76-100

N. E.

Rain 1 inch.

10

52

" 74-100i

57

77-100

N. E.

Cloudy.

Ji

46

" 86-100!

58

" 86-100

S. E.

Cloudy rain.

12

56

" 84-100;

69

70-100

S.

Cloudy rain in morn'g 2-10 in.

13

60

" 6l-100!

67

44-100

S.

[Cloudy rain, th. & light., 5-10.

U

46

" 59-100

60

" 67-100

N.W.

Fair blow.

ir>

46

" 73-100!

70

" 65-100

s. w.

iHazy blow.

16

45

" 77-100

58

80-100

N. W.

JFair blow.

17

35

" 90-100

66

91-100

N. W.

Fair ice this morning.

18

43

" 92-100

70

" 91-100

S. E.

Fair hazy.

1!)

44

" 89-100

79

" 86-100

W.

(Fair.
Cloudy.

20

56

" 81-100

70

" 78-100

w.

21

52

:' 87-100

71

" 91-100

N.J8J

Fair.

2-2

47

30 2-100

68

30 3-100

N. E.

Fair.

23

52

29 91-100

58

29 83-100

S. E.

Rain 2|-10 in.

21

56

" 53-100

60

" 23-100

S. E.

Rain 1 inch 1J-10.

25

55

" 29-100

64

" 25-100

S. W.

Fair.

26

45

" 39-100

62

" 37-100

s. w.

Fair.

27

44

" 49-100

70

" 62-100

w.

Fair heavy blow.

28

42

" 67-100

76

67-100

s. w.

Fair.

20

53

" 74-100

72

" 74-100

s.

Fair.

30

50

" 87-100

63

" 91-100

N. E.

Cloudy.

31

54

" 90-100

48

" 93-100

N. E.

iRain all day, -10 in.

17 Fair days. Quantity of Rain 6 inches and 9-10.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 2.] NEW SERIES. JUNE, 1846. [Re. 6.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XV.

Spinal Irritation, with Cases. By Robert E. Little, M. D.,
of Quincy, Florida.

The advancement of medical science has been retarded to an ex-
tent unknown to the world at large, by the failure of members of the
profession to make known to each other facts, which whole centuries
may not again present facts, which if properly estimated, might
lead in the end to the real theory and treatment of disease. To this
charge many of Us are peculiarly obnoxious. The secrets of the
Spanish Inquisition were not more closely veiled from observation,
than have been many of the interesting facts witnessed by practi-
tioners in the Southern country, never again destined to be observed
perhaps even in the most luxuriant field of experience. This failure
cannot be attributed to our being too learned, and thus fancying our-
selves beyond the necessity of taking another draught from the
inspired fountain, but to an indolence, to say the least of it, cen-
surable.

From what has been said, let it not be supposed that we are about to
disclose any discovery of new facts or new hypotheses : to nothing
of the kind do we pretend, our aim being to attempt something in
confirmation of the observations of others, by presenting a digest of
several cases of a disease, in relation to which we are already wise,
if wisdom is to be found in the number of essays upon a subject.
We refer to spinal irritation : a term which has heretofore been used
in a most unsatisfactory manner, bearing with it nothing which
would indicate the nature of the disease to which it is applied.
Scarcely any two pathologists have been able to agree on the precise
meaning of the term : by one, it is used to express an excitement

21

322 Spinal Irritation. [June.

of function; a second, to mean a grade of disease beyond simple
excitement; and by a third, all the stages and varieties of inflam-
mation neither being able to fix the exact amount or extent of
disease to which he would apply the term irritation. The expression
should be legitimately applied to a disturbance in function, separate
and apart from any disorganization in the structure of, or inflamma-
tory, action in the spinal column. Although irritation has no
legitimate dependence on change of structure, still it is frequently
accompanied by congestion ; and we are inclined to adopt the opin-
ion, that to this cause is to be attributed the symptoms which mark
the existence of the disease in question, notwithstanding morbid
anatomy has failed to furnish scarcely any light on diseases of the
nervous system. Formerly the nervous system was regarded as a
homogeneous mass; consequently the healthy functions were not
well understood, while the pathology of the diseases incident to it
was veiled in obscurity. Since the discoveries of Bichat, Magendie,
Hall, and others, different views have been entertained both in re-
gard to the normal and abnormal conditions of the nervous system ;
while a classification of cases regarded (vaguely) as nervous, has been
properly made and their treatment based on rational principles, so
that we are now enabled to give a satisfactory solution of many of
those singular phenomena in former times looked upon with a super-
stitious awe as the result of some mysterious agency beyond the
comprehension of the human mind.

Spinal irritation may be either idiopathic or symptomatic; and
though the latter is of much practical importance, our observations
will be confined to its existence as an original disease. Young prac-
titioners are frequently perplexed in making a diagnosis of cases of
disease presented to their consideration, on account of the variety of
forms assumed by them at different times, at one moment attacking
organs, and the next their functions, their onset being not more sud-
den than their disappearance. The time, however, is near at hand
when this difficulty will be overcome, as it now is in a great measure,
their capriciousness being referable to irritation of one of the three
great nervous centres the brain, spinal marrow or ganglionic sys-
tem, the second being the most usual seat of irritation. There is no
effect without a cause no function performed without an agent ; so
those organs and functions which are influenced by spinal or gangli-
onic nerves, feel that influence when the latter are in a state of
disease as well as health, which influence seems to effect parts in

1846.] Spinal Irritation. 323

proportion to the distance from the seat of irritation. Thus, parts
near the spinal column appear to feel the morbid influence arising
from irritation of the spinal extremity, to a less extent than those at
a greater distance a circumstance which, if overlooked, may lead
the practitioner into the error of supposing the disease to be local, or
rather the cause producing it to be situated in the complaining organ,
instead of referring it to its true seat the brain or spinal marroir.
Man j have been lead to doubt the influence which is said to be exert-
ed (perniciously) by irritation of the spinal marrow: they refer the
irritation to the ganglionic system, because of the special functions
attributed to that system, instead of the nerves arising immediately
from the spinal marrow. This we do not believe, but can readily
suppose how this error has been adopted. The implication of gan-
glionic with spinal disease, undoubtedly may, and usually does pro-
duce a modification in the symptoms present : this modification being
observed only in cases where the healthy influence of the ganglionic
system is manifest. The spinal and ganglionic nerves from their
proximity having but for a very short distance a distinct existence
are extremely liable to sympathize with each other, or rather, disease
is very apt to travel from the former to the latter, and thus cause the
error into which many have fallen.

All parts of the spinal column are liable to be affected : and from
the situation of the sympathizing part are we enabled to judge of the
seat of irritation. Irritation of the cervical division is indicated by
pains in the face, temples and scalp, accompanied frequently by
rigidity of the muscles of the jaw, when confined to the superior part.
When the irritation is lower clown, there is pain in the region of the
clavicle, scapula andchest, extending alongthearm.givingriseto great
lassitude, sighing, spasmodic twitching of the muscles, <kc. When the
dorsal division is affected we have, in addition to a few of the foregoing,
stricture across the chest, difficult breathing, palpitation ofthe heart,
angina pectoris, darting pains in the intercostal muscles, edges ofthe
ribs and the epigastrium : lower down still in the dorsal division,
pains in the stomach and abdomen are felt. In addition to these, a
burning sensation in the sternum and ensiform cartilage is said to
be always present in decided cases of irritation of the dorsal nerves.
This accords with our own observation, all the cases witnessed by ns,
since we were aware of this circumstance, having been marked by a
burning sensation in the parts referred to.

When the lumbar and sacral divisions are in a state ofirrital

324 Spinal Irritation. [June,

we have pains of an acute lancinating character, soreness in the skin
and muscles over the genital organs, spasmodic twitching along the
course of the crural nerves, together with an unsteady carriage in
walking; the patient having no confidence in his ability to retain an
erect posture, and exhibiting the reeling appearance of a drunken
man.

As before remarked, spinal irritation is liable to be complicated
with irritation of the various ganglia so from the special influence
exerted by the latter over the heart, lungs, stomach, intestines, geni-
tal organs, and the sympathies we have when they are deranged,
a perversion in the functions of the organs named. The symptoms
observed, in addition to the foregoing, when the superior spinal
nerves extend their irritation to the cervical ganglia, are acute paina
in the head, throbbing of the temporal and carotid arteries, and an
uneasy sensation in and under the angle of the jaws and front part
of the neck. The irritation, when extensive, is communicated to the
cardiac plexus, indicated by violent palpitation of the heart, painful
sensation in the organ, and a feeling of inability to expel the air from
the lungs, symptoms which are aggravated by any sudden or violent
emotion of the mind. Should the irritation extend to the stomachic
plexus, a sense ofdepression is felt in the pericardial region immedi-
ately after a meal, the patient complains of indigestion, tenderness
on pressing the stomach, with the thousand other symptoms accom-
panying disordered digestion. A fear of death from apoplexy con-
stantly tormented a patient affected with irritation of the stomachic
plexus, with whom we were intimate a few years ago, to such an
extent that he would never stoop to pick up any thing from the
ground, or permit himself to be alone for any length of time Jest he
should suddenly fall a victim to the dreaded disease. He was finally
relieved of his disease, and his restoration to health dissipated
the fear of death from apoplexy. The secretions of the stomach are
also deranged to a great extent; the gastric juice becoming acid and
incapable of performing its duty as a solvent of food. The liver is"
occasionally affected through the medium of the secondary ganglia
of the central plexus, indicated by a dull pain, and perverted function,
thus leading the superficial observer into the error of "bleeding,
blistering, and giving mercurials," and otherwise tormenting the un-
lucky patient, with a view of correcting a diseased liver; and all to
no purpose the fans el origo of the disease not being understood.
In short, all the abdominal and pelvic viscera, as their special ganglia

1346.] Spinal Irritation. 325

rj ^

become implicated in the irritation, are in turn affected : none, how-
ever, so commonly or so severely as the uterine organs.

The difference in the intensity violence of the symptoms in va-
rious cases, is not less remarkable than the appearances assumed by
the disease, ranging as it does from the slightest perceptible pain to
the most excruciating. In mild cases the pain is scarcely ever
noticed, save when the patient's attention is directed to it, considera-
ble pressure on the spine being necessary to cause much uneasiness;
while in others, pressure, even gently applied, causes a degree of
pain almost insupportable, and not unfrequently spasms of the most
frightful kind. Cases of such severity as the latter are not frequently
met with in a limited country practice : still, cases approaching them
are sometimes observed. The pain is intermittent or continued, as
the disease is mild or the reverse.

The diagnosis of spinal irritation is usually not difficult, percussion
or pressure betraying sensibility at some point on the spinal column
where irritation exists, not by acting immediately on the spinal
marrow, enclosed as it is in a bony case, but on the nervous filaments
supplying the processes and arches of the column and neighboring
muscles and ligaments. To this there are exceptions, as we have
seen more than one instance of unequivocal spinal irritation, with-
out being able to detect the least sensibility on pressure. Still, how-
ever, pain on pressure should be received as the most certain usual
diagnostic symptom.

In regard to prognosis, little more can be said of this than other
diseases, depending as it does on the violence, extent, and duration of
the affection. In mild cases of recent standing, we may generally
promise a cure; and even in pretty severe cases much may be dono
towards relief, by a judicious course of treatment.

The following cases, which have come under our notice, either
during our pupilage or since the commencement of our professional
career, are given with the design of illustrating the nature, symptoms,
and treatment of spinal and ganglionic irritation :

Case I. Irritation of the second, third, and fourth dorsal vertebra,
simulating disease of the heart. The patient, a gentleman twenty-
seven years of age, a member of the legal profession, about four years
ago, after spending a winter in laborious mental occupation, began to
complain of an uneasy sensation in the region of tho heart, attended
occasionally with palpitation nnd difficult respiration, increased by

326 Spinal Irritation. [June,

mental excitement and bodily fatigue. During the paroxysms,
which usually lasted from five to ten minutes, the face would be-
come red, and the eyes suffused: the whole countenance exhibiting
the most intense mental suffering. His medical adviser supposed
that he was laboring under an affection of the heart, the exact nature
of which he was unable to determine, (supposed, however, to be
nervous) ; as a consequence the treatment was empirical. Becom-
ing worse, a consultation was called, which ended in a discovery of
tenderness on pressure of the second, third, and fourth dorsal vertebrae.
Pressure on them caused a paroxysm to come on, which terminated
with its removal.

Rest, mild aperients,cupping and pustulating the spine with tartrate
of antimony, continued for about three months, effected a restora-
tion to health.

Here was a case of spinal, complicated with ganglionic irritation,
which, as might be supposed, resisted a plan of treatment based on
erroneous views of the pathology of nervous diseases. The case was
looked on as having its origin in the nervous tissue of the part affect-
ed its sympathetic character not being at first suspected; as a
consequence the treatment was directed, without effect, to the sym-
pathizing point of disease, instead of the true sources a fact which
was evidenced by the subsequent and more successful treatment.

Case II. Irritation of the lower cervical vertebral simulating
or rather mistaken for rheumatism. A black man, thirty-five years
of age, applied to us on account of a supposed rheumatic affection of
the right arm and shoulder. For several years past he has complain-
ed of transient pains in the arm and shoulder, for which he used a
variety of remedies, all, however to no purpose. Being a strong,
athletic man, and accustomed to laboring in the open air, spinal
irritation was not suspected, although the symptoms differed materi-
ally from rheumatism. The usual remedies were resorted to, how-
ever, and continued for a week. The patient not improving, a more
thorough examination of his case was made. A sponge, dipped in
warm water was applied to the spine, and the moment it touched the
lower division of the cervical vertebrae, the painful affection of the
shoulder and arm was increased, thus revealing the true character of
the disease. Treatment similar to that used in the first case was re-
sorted to, with success. The patient remained well for a year, when
he was lost sight of.

The patient in this case need not have been suhjectcd to any active

1846.] Spinal Irritation. 33?

treatment, had we been sufficiently attentive in our first examination,
rheumatism and pain from spinal irritation differing so materially as
to require but little judgment to distinguish one from the other their
causes, mode of access, progress and termination being radically
different. Their cure we need not say is also effected by opposite
remedies.

Case III. Spinal Irritation mistaken for hepatitis. A young
man, twenty years of age, of nervo-sanguine temperament, called at
the office of a medical friend, and requested his advice in regard to a
disease of the liver, with which he had been afflicted for two years,
during which time he had been treated by a respectable neighboring
practitioner for chronic hepatitis having taken, to use his own
expression, " a cart load of doctor's stuff.7' He complained of pain
in the right shoulder, back part of the neck and head, and correspond-
ing hypochondriac region. The digestive organs were deranged to
a considerable extent, which, together with the foregoing symptoms,
had induced a belief that the young man was laboring under chronic
hepatitis. The pain in the hypochondriac region and shoulder was
of an acute lancinating character, more so than is usually felt in
chronic affections of the liver. The treatment pursued by the physi-
cian then in attendance was well calculated to subdue disease of the
liver; yet under its influence the patient, instead of getting better,
was daily becoming worse, a circumstance which induced a suspicion
as to the probability of a mistake as to the true nature of the disease.
The young man, in giving an account of his various ailments, re-
marked that he frequently had cramps in his arm, followed by a
sensation of numbness which would continue for a day or two, and
of late they had become much worse. An affection of the spine was
now for the first suspected, and an examination of the vertebrae with
a moistened sponge was made. Pressure revealed spinal irritation,
which at once accounted for the symptoms and the want of success
in the treatment. The points of irritation supplied the complaining
organs with nerves, the symptoms all answering to the nervous
branches derived from the irritated portions of the spinal column.

The success of the treatment advised and pursued, fully corrobo-
rated the opinion as to the nervous character oi" the disease. The
patient in a few weeks was entirely restored to health.

Case IV. A lady, forty years of age, the wife of a respectable
fanner, Uw several months had suffered from frequent and violent
attacks of palpitation of the heart, accompanied by pain in the neck,

-328 Spinal Irritation. [June,

right shoulder and arm, and right hypochondriac region extending
to the umbilicus and left lumbar region, which was increased by
pressure. The attacks usually came on at night, just before or im-
mediately afrer lying down, and were aggravated by a full meal.
The hypochondriac region was evidently enlarged. She had suffer-
ed much from domestic misfortunes, and to the depression of spirits
produced by these, her friends were inclined to attribute her impaired
health. There being no excitement of the general system, or change
in the appearance of the patient compatible with the disease under
which she was supposed to be laboring, the nervous system was- na-
turally looked to as the seat of disease. The spinal column was
examined. Tenderness on pressure, confirmed us in the opinion that
such a train of symptoms could be referred only to spinal irritation.
The pain in the neck and shoulders was much increased by pressing
on the tenth pair of nerves, where they issue from between the occiput
and first vertebra; the second cervical from between the first and
second vertebras; and so on to the third, fourth and fifth (branches
of the fourth, uniting with the third and fifth, constitute the phrenic
nerve, sending branches also to the neck and shoulders) while pres-
sure on points lower down, in the dorsal section of the column,
augmented in the same manner the other distressing symptoms to
which the patient had been subjected. A key to the mystery was
now in possession counter-irritation, induced by the following oint-
ment, preceded, however, by the application of cups to the points
irritated, and continued for seven or eight weeks, caused a suspension
of the violent symptoms for a considerable length of time,
ft. Hydriodate Potass. . . 3j.

Iodine, ..... grs. xv.

Ung. Hyd. Fort. . . ss. M.

The application of the ointment produced a considerable amount
of soreness, on account of a greater amount being applied than was
directed. Emollient poultices soon abated the inflammation set up,
and, as before remarked, symptoms of disease disappeared only,
however, to return with an increase in their violence. In addition
to counter-irritation, the patient was now enjoined to observe greater
regularity in her diet, to avoid all causes of mental excitement, and
court the society of cheerful friends. After her relapse, she regular-
ly made use of some one of the preparations of iron, which we believe
she even now continues, although a restoration to comparative good
health has been effected. The palpitation of the heart, pain in the

1846.] Spinal Irritation. 32S

shoulder, arm, and region of the liver and umbilicus, have all disap-
peared; she still labors, however, under the symptoms incident to
females at the critical time of life.

The above case, as well as the preceding, had been pronounced one
of liver disease ; yet, notwithstanding the derangement in the diges-
tive functions, and pain and soreness in the region of the liver
symptoms supposed to be almost pathognomonic of hepatic affection
still the treatment and relief obtained clearly evinces the mistake in
the first diagnosis. They also shew that spinal irritation causes not
only derangement in function, but also an appearance of change in
structure of an organ. We arc well convinced that patients are
daily bled, blistered, purged and mercurialized, without being bene-
fited, under the supposition that they are laboring under hepatic
affection, when in reality their disease has "another name and hab-
itation:" all to be attributed to the propensity in the profession to
the adoption of an exclusive system of pathology and treatment of
disease.

Case V. Hysteria: complicated with and augmented in violence
by Spinal Irritation. A girl, seventeen years of age, whose cata-
menial discharge appeared two years ago, but for the last twelve
months in deranged condition, being small in quantity, and attended
with considerable pain ; complained a few days before its anticipated
return of head-ache, and intolerance of light. At the request of her
owner we visited her. Her bowels were constipated, pulse 98,
tongue slightly furred, and skin covered with moisture: a purgative
was prescribed, which had the effect of causing the expulsion of a
large quantity of hardened fasces, without, however, in the least miti-
gating the pain in the head. At the next visit, eight hours after the
first, we found her breathing laborious, and complaining of a severe
pain in the side, just below the left mamma, with her back arched,
her fingers spasmodically closed, and arms flexed, as were her lower
extremities. We suspected this to be a case of hysteria, and on ex-
amining the spinal column, the moment the sponge touched the lower
cervical and upper dorsal divisions, the violence of the symptoms
was increased. The ointment of hydriodate of potass, and iodine
was applied, and in the course of twenty-four hours scarcely a vestige
of the spasmodic affection was evident. A combination of iron and
aloes restored the menstrual function. The counter-irritation was
kept up for a month.

The defective menstruation we believe was the prime cause of the

330 Experiments on the relative areas of Arteries. [June,

above case of hysteria ; still we are equally confident that spinal
irritation was the source of the spasmodic affection of the extremities,
as it is nine times in ten, of the fantasies of an hysterical paroxysm.
In all cases of hysteria, especially if there be inflammatory symptoms
of any of the organs, prior to prescribing, a careful examination of
the spine should be made, and we venture to assert that in a majority
of such cases these symptoms will be found to be the result of spinal
irritation, and not of inflammation. Though an active antiphlogistic
treatment may appear to mitigate the symptoms, still it will rarely
relieve them. Counter-irritation applied to the seat of the disease,
will alone cause the symptoms to yield ; they are liable to return
unless the uterine derangement be corrected, which is in fact the
exciting cause of the irritation the irritation in its turn reacting on
the system, gives rise to the protean symptoms.

Other and perhaps more convincing cases might have been given;
but having already extended this paper to a length, greater than was
at first anticipated, we must omit them, trusting, however, that
enough has been said to induce the reader to seek for the cause of
many of those anomalous cases of disease so often encountered and
not amenable to the usual plan of treatment in other parts of the
system than the one immediately complaining.

Aim CLE XVI.

Some Experiments to determine the relative areas of the Trunks and
Branches of Arteries. By J. M. B. Harden, M. D., of Liberty
County, Georgia.

It has been a very general opinion among Anatomists, which seems
to have been confirmed by the experiments of John Hunter, (1) that
"when an artery ramifies, the area of the different branches exceeds
considerably that of the main trunk. Upon this principle the aorta
and its branches have been compared to a cone, the basis of which is
formed by the branches, and the apex by the trunk." (2)

To this opinion, objections might be urged upon the common prin-
ciples of hydraulics. It is well known, that if a fluid run through a
canal or pipe of various widths, the velocity of the fluid in different
parts of it will be reciprocally as the transverse sections of those

(1) On the Blood. Section 8th. (2) Wistar's Anatomy, \ ol. 2d, p. :2-23.

L8 Iti. j Experiments on the relative areas of Arteries. 331

parts. If it were true then, that the area of the branches of an artery
is greater than the area of the main trunk, the velocity of the current
of blood would be so far diminished as to produce a partial stagna-
tion in those vessels; and if the converse of the proposition were
tnre, that this area was less than that of the main trunk, then it would
follow that there would be a partial stagnation of blood in the trunk,
and a greater propulsive power in the heart would be necessary in
order to circulate tiie same amount of blood through the system, in
the same time that would be required by a different arrangement.

The best condition, that we can imagine, for a free and uniform
circulation of blood through the vessels, is that they compose a per-
fect cylinder; or, in other words, that the areas of the trunks should
be equal to the sum of the areas of the different branches, and this,
we have no doubt, will be found to be true, if we apply to the investi-
gation of the subject the rule which should guide us in such cases.
This rule is the simple geometrical law that the areas of circles arc
to one another as the squares of their diameters.

Experiments -upon this principle have been performed by Ferne-
ry (3) and Paget.

The result of the experiments of the former gentleman shows a
remarkable correspondence between these areas. The observations
of M. Paget have led him to the conclusion that there is seldom an
exact equality between them, but that "the area sometimes increases
and sometimes diminishes ; the former being the general rule for
the subdivision of the aorta and its principal branches in the upper
extremities, the latter in the lower."

My object at present is to detail a few experiments which I per-
formed upon this subject on the arteries of a negro man, on the 15th
day of August, 1934; and on the arteries of three hogs, on the 21st
and 2Sth of January, 1839. On account of the difficulty of ascer-
taining the exact diameter of an artery, it is not to be expected that
they can be very accurate. The diameters were found by measuring
the circumferences, and to be as exact as possible, I measured each
portion of artery in three places, and took the average. The cir-
cumference was obtained by laving open the arteries, pasting them
on a flat surface without stretching, and then measuring their inter-
nal surface by a compass. The numbers are expressed in decimals
of a half inch.

(3) Medical Gazette, as quoted by Carpenter. Principles of Human
p. 359.

332

Ex-periments on the relative areas of Arteries. [June,

In Man.

Trunk,

Branches,

Trunk,
Branches,

Trunk,
Branches.

Trunk,
Branches,

Trunk,
Branches.

Names of Jliteries.

Aorta before branching,
f Arteria innominata,
J Left Subclavian,
| Left common Carotid,
^ Aorta just below left Subclavian,

Arteria innominata,
Right common Carotid,
Right Subclavian,

Aorta just above comlnon Iliac.
Right common Iliac,
Left common Iliac,

Right common Iliac,
Right internal Iliac,
Right externa.. Iliac,

Left common Iliac,
Left interna] Iliac,
Left external Iliac,

Circumftr.

Diameters.

Squares

2-58

82

6724

1-27

40

1600

72

23

529

77

24

576

1-80

57

3249

1-27

40

1600

80

25

625

94

30

900

1-30

41

1681

77

25

625

91

29

841
625

77

25

72

23

529

GO

19

361

91

29

841

73

23

529

73

23

529

Sums

6724

5954
1600

1525
1681

1466
625

890
841

1058

In Hogs.

Trunk,
Branches,

Trunk,
Branches,

Trunk,
Branches.

Trunk,
Branches,

Trunk,
Branches,

Namts of Arter ie 8-

Aorta before branching,

Arteria innominata,

Left Subclavian,

Aorta below left Subclavian,

Common Carotid,
Right Carotid,
Left Carotid,

Aorta before branching
( Arteria innominata,
1 Left Subclavian,
f Aorta below left Subclavian,

Arteria innominata,
Left Carotid,
Left Subclavian,

Aorta before branching,
( Arteria innominata,
* ? Left Subclavian,
(Aorta below left Subclavian,

Circumftr

98

81

1-48

:72~

56

49

1-59

87

77

1-29

Diarneters.\ Squares.

63
31
25
47
23
17
15

1-73

54

98

31

84

26

1-42

45

98

31

62

19

68

21

3969
961
625

2209

529

289
225

2916
961
676

2025

961
361
441_

2500"

27 729

24 576

41 1681

Sums.

3969

3795
529

514
2916

3662
961

_802
2500

2986

The discrepancy in the above results, although in some instances
considerable, is nevertheless within the limits of error in experiments
of this kind. Besides the difficulties incident to manipulation, there
is one which is connected with the mode of origin of the arterial
branches which must be borne in mind. The figure, of any branch
which comes off at an angle less than a right angle with the main
trunk, is, at its point of origin, an ellipse and not a circle, and hence,
to preserve the same area, the circumference at this point must be

"~* In these hogs the left carotid did not take its rise from the aorta, but the
arteria innominata divided into two branches the right subclavian, and a
branch which after continuing about an inch, divided into the right and left
carotids. Is it uniformly so in these animals %

184G.] A Case of Acute Glossitis. 333

greater, and of course its calculated diameter. This ellipsoidal char-
acter continues for a short distance, and then gradually the artery
assumes the form of a circle. To obtain, therefore, the ratio of the
area of the branch at this point, with the main trunk, it is necessary
to determine, not the circumference or diameter, but the transverse
and conjugate axes ; insomuch as, circles and ellipses are to one ano-
ther as the square of the diameter to the rectangle of the axes ; and
this would be of course a matter of great difficulty if it be not indeed
impracticable. When the branches are very near together this diffi-
culty is greatly increased.

Notwithstanding the discrepancy above mentioned, I am under the
impression that these experiments tend strongly to strengthen the
conviction that the areas of the branches do not increase, but that
the sum of the areas is equal to the area of the main trunk, proving
that the main trunk of an artery may be regarded as the hypothenuse
of a right-angled triangle, while the two branches are the sides that
make up the right angle.

articid xvn.

A Case of Acute Glossitis. By Thomas Hamilton, M. D., of This-
tledale, Cass County, Ga.

A month ago, a young gentleman whose residence is a little more
than thirty miles from this, in the direction of Tennessee, and in a
neighborhood in which several deaths, it is said, have occurred from
a disease prevalent there under the popular name of " black-tongue,'3"
was unfortunate enough while on a visit in my neighborhood to re-
ceive a fracture of the thigh bone. The obvious inexpediency of
any attempt to carry him home, together with my sympathy for him,
moved me to offer him a room at my house, to which he was carried,
under the eye of his intelligent physician. Within a few days after-
wards, his black man, John, came down from home to wait on him,
and this he continued to do without attention to any other business
for the last three weeks. John's age is about twenty-five years, he
is by nature cheerful and active, has a sound constitution, and was in
good health till Tuesday the 17th of this month. At 11 o'clock in
the forenoon of that day, he was heard to speak of a slight smarting
sensation in his tongue, affecting mostly its right side, and which he

334 A Case of Acute Glossitis. [June,

had just then for the first time perceived. Within four hours after-
wards, or by three o'clock in the afternoon, this sensation had assu-
med the character of a constant pain, attended by a sense of heat ;
and notwithstanding neither his pulse nor skin as yet indicated fever,
it was thought proper to prescribe a dose of sulphate of magnesia,
which he took without delay. In the course of the afternoon, and
before the operation of the salts, head-ache came on with increased
secretion of saliva and a sense of burning in the skin on the right
side of his neck, his description of which agreed with that of erysip-
elas. Neither swelling nor hardness any where appeared except in
his tongue, which was now perceptibly thickened and somewhat
rigid; it was too a little more florid than is usual in the healthy
state, yet it was moist and but slightly furred. At 7 o'clock of the
next morning, his medicine having produced three or four alvine
evacuations, his head-ache was abated and he thought his case in
other respects no worse. His pulse, however, had begun to indicate
a febrile movement, his articulation was impaired by increased rigid-
ity and tenderness of his tongue, and a long cylinder of viscid saliva
hung from his mouth. This body of saliva, which he was unable to
discharge by the action of his tongue and lips, he occasionally remo-
ved with his hand, but by an active secretion it was immediately re-
produced. By one o'clock in the afternoon the case had made fearful
progress; the patient's skin was hot and dry, his pulse had acquired
a firmness and frequency much above the healthy standard, and the
hardness and tenderness having extended from his tongue to all the
parts embraced by the rami of the inferior maxillary and the hyoid
bones, he was without the power of articulating a word, and at every
breath he groaned.

Decisive treatment was now determined on : accordingly, a vein
was opened from which the blood was permitted to flow in a large
stream until relaxation was denoted by a weakened state of the pulse,
anxiety, nausea and sweating. Half an hour afterwards the anxiety
and nausea were carried off by the^act of vomiting, after which the
patient rested quietly. At 5 o'clock, which was the fourth hour
after the time of the bloodletting, the case was again examined,
when the pulse was found to be recovering its firmness and the skin
to be losing its softness. With a view to restrain the circulation
steadily and to maintain the softness of the skin, it was deemed ex-
pedient to employ a nauseant in aid of the lancet: accordingly the
patient was turned upon his back, his head a little elevated, and half

1R4G. J Cases of Ona n ism . 3 3 5

a grain of tartar emetic dissolved in a spoonful of water, was, with
some difficulty, conveyed into his stomach. Within twentv-flve
minutes after the administration of this remedy its effects appeared
in a general perspiration, a reduction of the pulse, nausea and rest-
lessness : and the lapse of an hour brought about an effort to vomit
by which these were entirely removed. After this, the state of the
pulse and skin continuing good, medication was omitted and the pa-
tient free from pain, rested comfortably through the night. At 7
o'clock of the next morning, he was so far advanced in convalescence
as to need no other prescription than that of rest and a gruel diet.

Having read but little, and seen less of diseases for the last tea
years. I must leave it to others to decide what affinity, if any, this
case bears to the Western epidemic commonly called "the black-
tongue.'' Yet judging from the rapid progress of the symptoms and
the intensity of the inflammation, I may hazard the opinion, that the
tendency was to a termination in gangrene, and that nothing was
wanting to have made this a case exhibiting a livid appearance of
the tongue and contiguous parts, than delay in the use of proper rem-
edies till it should have been too late for them to avert such a termi-
nation. Most probably it would have been a case of black-tongue
indeed, and one well calculated to discredit the lancet, if the patient
in the dread of treatment or hope of amendment, had deferred the
use of that remedy until symptoms should have supervened, suggest-
ing the name for his disease.

It is well remembered to have been said by the "greatest and
best" in the profession of medicine, that the lancet is the " magnum
bonum Dei": and although this truth will survive the wreck of many
an innovation in theory and practice, yet its full benefits can never
be realized until it comes to be generally known, that the efficacy of
bleeding depends upon its early employment, as cases like this tend
to show.

ARTICLE XVIII.

A few cases illustrative of the ill ejects of Onanism. By Edward
J.. BaKjbb, M. D., of Fort King, Florida.

Onanism, or the sin of Onan, is from a perverted passage In the

Pentateuch. The discharge of semen from a preternatural stimulus
is the vice, it is said, of the solitary monk, and perhaps, of other

336 Cases of Onanism. [June,

recluses, to whom more natural enjoyments are denied. It is a habit
of the most destructive tendency, enervating, in the highest degree,
both the body and mind, as the following cases will illustrate. Na-
ture seems to have fixed a strong mark on those disposed to every
unnatural enjoyment, however secret their practices may be, and so
indelible is this mark, that they cannot escape detection from that
tact -'which has been peculiarly distinguished by the term o-sensus
medlcus. In general, the countenance is sallow, with a peculiar
dejection in the look. The voice is hurried and unsteady ; the face
sometimes covered with dark colored blotches or flushed, particularly
when looked upon full in the face, and the whole frame displays a
peculiar debility. The dejection, at times, almost amounts to insan-
ity, and every effort appears to threaten instant death. The tremor
and apprehension prevent the natural enjoyments, by which they
might be otherwise weaned from this destructive habit; and the whole
life is alternated with doubts, apprehensions, and despair. Unfortu-
nately, the practice is seldom forsaken at least, we have reason
to think so.

The apprehensions of discovery and the despair, render these un-
fortunate persons the dupes of quacks. Regular practice exhausts
the whole class of tonics and stimulants with little effect. The warm
balsams, of which the quack medicines consist, are either rejected
from the hands of the physician, or not continued a sufficient time;
and even our best remedies, do not fix the imagination so strongly as
the Solar tincture or the balm of Gilead. It is probable, if not too
long continued, a prudent marriage might recover the patient; but
it would be unjust, cruel, and impolitic, to condemn a healthy young
woman to the shadow of a man. I will now give the report of a
few cases.

Case 1st. A man aged about 30, was brought from a distance
and placed under my care. I found him in the following situation :
A very large and ample frame, his muscles soft and flabby, and very
much emaciated ; he had no appetite, almost loathed food of all kinds,
had no energy either of mind or body, but would sit in one position
nearly all day ; he appeared even reluctant to answer in monosylla-
bles, felt convinced that he could not live, was troubled at times with
great thirst for cold drinks ; his cheeks were very much flushed,
could not look in the face even his most intimate friends, but always
inclined his eyes downwards, complained at times, particularly after

1846. J Cases of Onanism. 337

eating, (and that too of the most simple articles of food,) of pyrosis.
Pulse frequent but weak; almost constant cephalalgia, with tender,
ness of epigastrium under pressure.

I was led to believe his a case of genuine dyspepsia, or chronic
inflammation of the stomach, and treated it accordingly. Sometime,
however, after this, I accidentally discovered from a friend of his,
that he had been addicted to the most disgusting practice of secret
pollution from his boyhood. I then adopted a moral course of treat-
ment, endeavored to reason the case with him, informed him that
this was the cause of his disease, that it was this that was killing
liim, and that the only chance for his life, was for him to leave off
this most diabolical habit. I even went so* far as to pustulate the
penis with the ung. tart, antim., but this did not prevent him, and he
died in about ten days after.

Case 2nd. A physician of considerable celebrity had a negro
man placed under his care : he kept him in his yard, that he might
watch more closely the effects of his medicines. The patient was
very much emaciated, constant cephalalgia, palpitation of the hear!,
pain and some swelling, with extreme weakness in the joints of the
inferior extremities he was compelled to use crutches and as in the
former case, was very much dejected, and was firmly of opinion that
he would die ; he was treated by his physician for disease of the
heart, and also for spinal irritation. After sometime, finding he
made no progress in relieving his disease, he requested me to see
him. I at once, and without hesitation, (after examination and ob-
serving his countenance) stated to my friend that I suspected him of
being addicted to onanism. He accordingly took care to watch him
and detected him in the act. He at once told him he would be com-
pelled to castrate him unless he would quit this practice. He also
applied the ointment as used in the preceding case, and gave tonics,
stimulants, cold bath, cVrc. This patient ultimately recovered, and is
now a health}' and valuable servant. He has since acknowledged to
his physician that he had been addicted to the practice for seven or
eight years, and that he not unfrequently operated in this manner
eight or nine times in the course of the twenty. four hours. Both of
the above patients complained of pain in the occiput and were very
nervous.

Case 3d. The following case was related to me by a physician
who had been intimate with the young man. This friend, he Bays,
hid received a good education from a father who was very wealth v

33S Strangulated Inguinal Hernia. [June,

and stood high in society. The young man, however, became ad-
dicted to this vice, was gloomy and taciturn, shunned his friends,
and indeed all society, sought solitude, and his eyes were always cast
down in fact he was to all appearance miserable. His father one
day mentioned to him that, at such a time he would give him a cer-
tain amount of money, for the purpose of commencing business for
himself, and that he would render him all the assistance in his power.
The idea of being compelled to mingle in society (as he would have
been forced to do if he went into business,) preyed so much upon his
mind, that before the day arrived for him to receive his gift, he
committed suicide.

I am acquainted with three idiots, and in each of the cases, it is a
fact known to all who are acquainted with their histories, that they
are daily addicted to this vice.

I should be happy to hear from others on this important subject
I feel convinced that the great majority of the cases of chronic dis-
eases which we meet with in practice, can be traced to this cause.
There has been so little written on this subject in this country, that
physicians rarely suspect a case of this kind unless they are made
acquainted with it by some accidental occurrence.

ARTICLE XIX.

Strangulated Inguinal Herniajifa large portion of Omentum, cured
by an Operation. By Paul W. Eve, M. Dm Professor of Surgery in
the Medical College of Georgia.

On the 17th of last August, I was requested by Drs. Hanson and
Jones, of an adjoining county, to see with them, a patient laboring

under strangulated hernia. Mr. G. S is about 44 years, weighs

185 lbs., and is only five feet six inches high: his habits are very
good. In 1841, four years ago, while lifting a cotton bale, "he felt
something give way in the region of the right groin." On Thursda)',
the 14th of August, when sowing turnips, he suddenly experienced
pain low down in the right side of his abdomen. He took soon after
this a dose of salts, which acted freely upon his bowels; but as no
relief was thus obtained, Dr. Hanson was sent for, and reached him
early on Saturday morning the 16th. Mr. S. "Was now freely bled,
and means employed to reduce a hernia found existing in the right

18 1G.] Strangulated Inguinal Hernia. 339

inguinal region. Reduction not being effected, Dr. Jones was sent
for, and arrived the evening of the same day. All ordinary means
failing to restore the protruding viscus, including tobacco injection,
which evacuated the bowels freely, I was sent for at 2, A. M., of the
17th, and saw the patient a few hours afterwards. At half past 3
o'clock, having exhausted taxis, &c, as my two professional friends
had already done, the operation was decided upon.

The tumor extended from the external abdominal ring to the bot-
tom of the scrotum on the right side. It was much distended, and
the patient complained of great pain at this region. In making the
incisions, the artcria ad euicm abdominis, was found to require the
ligature, and when the sac was opened, a saucer was employed to
catch the bloody serum which flowed out. Of this there was more
than a half pint, which, together with a portion of omentum, about
the size of a man's fist, formed the hernial tumor. There were no
adhesions to the sac. The internal abdominal ring was now divided
by carrying the edge of Sir Astley Cooper's knife directly upwards,
and efforts made to return the protruding portion of omentum. From
the induration of the part presented at the internal ring, success
did not attend this attempt at reduction. The knife had again to
he resorted to, and the ring greatly enlarged by free incisions,
and then the omentum only returned by prolonged and forcible
manipulations.

After the operation, we concurred in the opinion that our patient,
in all probability, would not long survive it* Forty drops of lauda-
num were prescribed, also absolute diet and quietude. Upon opiates,
however, was placed the greatest reliance; and Dr. H., the fami-
ly physician, kindly consented to remain twenty-four hours with
Mr. S.

On the 19th, two days after the operation, I was much gratified
to receive a very favorable report from our patient. His sufferings
had gradually diminished, his pulse was at 88, and his wound which
was now dressed, found to be doing weli. We even placed him on
another mattrass, while his bed was made up. and his linen changed.
He had yet had no evacuation from the bowels, but had passed some
Hutu*. An emollient enema was prescribed, should he be troubled in
the bowels during the day, which if not moved on the morrow, were
then to be stimulated to action by an injection.

Tho l>t September I heard Mr. S. was improving, and on tho
6th of October, iie went eleven miles to vote at our State election.

540 Physical Education and the Preservation of Health, [June,

The ligature to the small artery was not removed until the 16th of
this month, and during November last I met him in our streets at-
tending to his business.

The soft pad of a truss, with rather a weak spring, was recommend-
ed to be worn, in this case, for a few months.

PART II. REVIEWS AND EXTRACTS.

ARTICLE XX.

Physical Education and the Preservation of Health, By Johx C.
Warren, M. D., Professor of Anatomy and Surgery, in Harvard
University pp. 90. Boston: Wm. D. Ticknor & Co. 1846.

This short manual, we are informed by the author, was " originally
a Lecture on Physical Education, delivered before the American
Institute in 1830." Frequent applications having been made for
copies of this lecture, Dr. Warren was induced to re-publish it
in its present form, in which additions have been made to the
original text "for the purpose of more fully illustrating some of
the most important means of attaining and preserving a good con-
stitution."

It is a homely adage, and yet it embodies a great deal of valuable
truth, that " an ounce of prevention is worth a pound of cure ;" and
we know not a more important subject to which the mind of the
medical philosopher can be directed than the means by which health
may be preserved. We have many standard works upon Hygiene,
but the most of them are either too voluminous or too technical for
the mass of readers, and hence they fail in the end of accomplishing
the chief object of their publications, namely, the instruction of the
public. The work before us is free from this objection : it is short,
concise, written in a plain and popular style, and accessible to all.
The greater portion of the work is devoted to the subject of Physical
Education a point which becomes every day more important, from
the fact, that as civilization advances, there is a constant tendency
among the higher classes at least, to cultivate the mind and the intel-
lectual faculties without paying proper attention to the development
of the physical powers. The systems of school education among us

1846.] Physical Education and the Preservation of Health. 311

are, for the most part, at least in reference to females, sadly defective
in this regard. Strenuous efforts, we know, have been made at re-
form, and manual labor has been attempted to be introduced as a
part of school exercise, but we believe this plan has generally
failed. The reason for this failure we know not, unless it be
found in that very erroneous but very popular notion that manual
labor is degrading.

However this may be, the fact is no less true, that from the sys-
tems of education as at present pursued, "numerous instances of
decay in the most vigorous constitutions, and of distortion in the best
proportioned forms," are daily to be met with. Dr. Warren asserts,
that of the well educated females within his sphere of observation,
"about one half are affected with some degree of distortion of the
spine." This statement is confirmed by the observation of Lachaise,
who says that " it is so common, that out of twenty young girls who
have attained the age of fifteen years, there are not two who do not
present very manifest traces of it." Now this, be it remembered, is
all the result of a want of attention to the training and development
of the physical power. In the boy, except at the intervals of confine-
ment at school, a "large part of his time is passed in sedentary pur-
suits and in crowded rooms;" and "the female at an early age is
discouraged from activity, as unbecoming her sex, and js taught to
pass her leisure hours in a state of quietude at home." Dr. Warren
enters into an examination of the structure and mechanism of the
human frame, in order to show how distortions may be produced by
improper attitudes and enervating habits.

Although among the causes of debility and premature decay, Dr.
W. very properly places in the first rank, want of exercise and un-
wholesome diet, yet belays great, stress likewise upon "//<e influence
of too great occupation of the mind in study, and that of feelings and
passions of a depressing nature" and here we beg leave to call at-
tention to an important point alluded to by our author: I mean the
practice in schools of exciting the minds of children by competition
ofcrivalry. " These efforts," says Dr. W., "are attended with but
too much success in susceptible minds. An anxiety to excel be-
comes the predominant passion. The health, the sports, and too
often the friendships of youth, are sacrificed to the desire of surpass-
ing those around. When this becomes an all-absorbing passion the
result is most unfriendly to physical organization, and a multitude of
fine constitutions are ruined by it in both sexes. u. Tins system of

342 Physical Education and the Preservation of Health. [June.

rivalry, he goes onto say, " inflames the imagination, festers the
passions, and poisons the happiness of the brightest days of life,
and since the very highest grade of literary acquirement is not
essential to the duties of the sex, it seems as unnecessary as it is per-
nicious."

With these views we fully accord ; nor do we believe that the
evils are exaggerated. We have, however, another argument to
urge against the practice, and it is this, that no one ever was profound
in knowledge where this constituted the chief motive, to study, no
matter how brilliant naturally the mind may be. When this compe-
tition stops, all effort ceases, and hence we find many examples of
activity and energy, and even brilliancy of mind, exhibited in schools
and colleges, in which after the diploma of the alma mater has been
obtained, there has followed a nerveless apathy in regard to everyV
scientific pursuit, and the literary trash of novel writers has been
made to feed the morbid cravings of a mind that had been festered by
an unnatural stimulus.

Dr. Warren does not know of any substitute for this principle of
action. For our own part we think the only substitute should be a
love of knowledge, a curiosity to know. This is the only proper
motive for study, either in the school-boy or the adult man. Where
this is wanting, you had better add no other, for you do but give that
knowledge which is a "Jlangerous thing." Where this is present,
you need add no other, for the chief difficulty will be found in re-
straining the desire.

Having pointed out some of the causes, Dr. W. proceeds to throw
out some hints as to the modes in which physical education may be
improved, so as to obviate the effects arising from those causes.
The great secret by which these defects are to be remedied is a right
combination of physical and intellectual cultivation. "When tho
mind is closely occupied, the body should be carefully guarded. If
the pursuits of the former arc severe and absorbing, those of the
latter should be cheerful and relaxing. Instead then of abandoning
the physical to the intellectual culture, it should be increased in t^e
same ratio, and followed with the same earnestness. Our author
then passes in review the physical training best adapted to the differ-
ent sexes, and the different stages of life, from infancy to adult age,
in regard to exercise, dress, food and drink. He particularly in-
veighs against the practice among females of wearing tight stays,
for the purpose of adding beauty to their form. "In what notions

1846.] Physical Education and the Preservation of Health. '> LI

of beauty this practice took its origin, I am unable to discover. The
angular projections formed by a tightly drawn cord are in direct
opposition to the models of Grecian or Roman beauty. In the
flowing robes of the Juno, the Vesta and Diana, every part is light
and graceful. Nor have I been able to discover in the representations
of the Muses or the Graces, any habiliment which would lead us to
believe they wore stays or corsets. The taste of the other sex is
uniformly opposed to the wasp-like waist and the boarded chest, yet,
strange as it seems, there is scarcely a young lady of fifteen who has
not imbibed a disposition for this species of application, and scarcely
a well dressed lady of any age whose chest is not confined in such a
manner, as to impede the motions of respiration and the free use of
the muscles of the upper extremities."

As a mode of invigorating the body, Dr. W. speaks very highly of
cold bathing, particularly the shower-bath, also of regular frictions over
the whole body, and especially the chest and neck, and the judicious
use of the voice by reading aloud. He rather objects to the practice
of singing, believing that it should only be pursued by those, "whose
chests are ample and pulmonary organs vigorous."

It has been long known what great importance Dr. W. attaches
to dietetics Who does not know of the tumor that he once eradi-
cated by a two years regimen, nearly amounting at one time to
starvation ? and yet who will doubt that most people are too
thoughtless upon this subject. Most persons treat the stomach as if
it were nothing more than the Satura of the Romans. Dr. \W devotes
twelve pages to the subject of digestion in which he inculcates
strongly the practice of habitual temperance in the use of food,
as being indispensable to the healthy action of the physical
powers. He specially objects to the taking of quantities of liquid
nt the same time with solid food. He thinks this habit contrary to
Nature, and savs that the disadvantage of doinjx so "must be obvious
to all those who consider that the digesting liquid is diluted and
weakened in proportion to the quantity of drink." He also objects
most strongly to the use of all kinds of stimulating drinks more
particularly those that are alcoholic. He thinks that these last have
the property of preventing the decomposition, and of course tho di-
gestion, of food and lastly, he is a most strenuous opponent of the
use of tobacco in any form. Smoking, be. supposes, may favor tho
deposit of tuberculous matter in the lungs of those who are predis-
posed to this disease. Snuff impairs the voice sometimes to a re-

344 Benedict's Compendium of Chapman's Lectures. [June,

markable degree. But the worst form in which tobacco is employed
is chewing "If we wished," says he, "to reduce our physical powers
in a slow, yet certain way, we could not adopt a more convenient
process than that of chewing tobacco." Among the effects of this
habit, he enumerates " indigestion, fixed pains about the region of
the stomach, in some cases looseness of the bowels, torpor of these
parts, debility of the back and of the organs in the lower part of the
trunk of the body, affections of the brain producing vertigo, and
also affections of the mouth generating cancer."

From what has preceded, some idea may be bad of the scope and
value of this little volume, which, so far as it goes, we consider to
be the most useful work upon the subject of which it treats, which
has fallen into our hands, and we think it should be read by all who
may have any thing to do with the education of youth.

J. M. B. H.

ARTICLE XXI.

A Compendium of Lectures on the Theory and Practice of Medicine f
delivered by Professor Chapman, of the University of Pennsylva-
nia, prepared, with permission, from Dr. Chapman's manuscripts,
and published with his approbation. By N. D. Benedict, M. D.,
&c.j &c. 1846.

This ira syllabus of Prof. Chapman's Lectures, gotten up in the
very best typographical style, by the celebrated Publishers, Lea &
Blanchard. In passing hastily over its pages for it would be a
heavy condemnation to be obliged to read it the question naturally
arises, of what value to the Profession, or to the Student, is such a
Work? consisting of heads of discourse, and of successive, unsus-
tained theses of principles and of practice. There is a large body of
Physicians in our country, however, to whom it will be acceptable
viz., those who have listened to the spirited and eloquent lecturer ;
for it will aid them to recall the development of these principles and
the reasons of his modes of treatment. The publishers doubtless have
paid largely for the copy-right of these scraps from the deservedly
celebrated author, under the expectation of a rapid sale of the Work;
while we will venture to say, that if a full translation of Bailly's
magnificent Work on Intermittent Fever, or of any other on fever,
containing a vast number of facts, from which were deduced general

1846.] Benedict's Compendium of Chapman's Lectures. 345

principles illustrative of its nature, and a rational practice, were
gratuitously offered to them, they would decline to publish it. This
surely would be no reproach to them they do but minister to the
well-known demand of the profession, in this country, for these com-
pendiums and compilations to their desire to possess the whole
Science ofMedicine within the covers of some " Practice of Physic. "
It is highly probable that this other specimen of the multum in parvo,
will rapidly run through many editions.

From the nature of the Work it is impossible to criticise it; but
feeling curious to know the teaching which Southern students receive
in the University of Pennsylvania, upon the diseases of our climate,
we turned to the article on Remittent Fever. The paragraph on
pathology commences with this very satisfactory announcement:
"This fever is synochus with a tendency to typhoid degeneration,
commencing in gastro-enteric irritation, soon converted into inflam-
mation, the liver, then commonly the brain, and finally the circulatory
apparatus become affected." It closes with the conclusion, that
whatever varieties it may assume in its course, the disease M was
primarily gastro-enteric fever."

The treatment is given under the two heads "Forming stage of
the fever," and " Fever fully formed." The main remedies are vena3-
section, local bleeding, cold applications to the head, stimulating pedi-
luvia, purgatives, emetics and laxatives. Of emetics it is written,
41 very salutary" a commendation scarcely to be expected from one
who holds that the disease is primarily a gastro-eateritis ; and accord-
ingly, the paragraph closes with the recommendation to "the inexpe-
rienced physician, to forbear emetics, unless clearly demanded," &c,
manifesting a doubt as to their propriety, which must ever agitate
him, who has no better pathology than this. "The subsidiary
measures," are cold sponging, enemata of cold water, antimonials,
blisters, and bark. Here is the paragraph on bark, the last of the
subsidiaries in Remittent fever:

"This may be given when the case is lingering, feeble, and
endued with decided paroxysmal manifestations. The tongue, too,
must be moist, the surface cool, relaxed, and perspirable, and there
must be no marked local affection. Given otherwise, it is apt to
cause a typhoid degeneration. Sulphate of quinine, however, is by
high authority said to answer when the bark will not as, where the
skin is dry.

346 MotCs YelpeaxCs Surgery. [June,

"But when the disease has taken a decidedly intermittent type,
then the quinine is, undoubtedly, of prime value"

Fortunately for the interests of humanity, a better pathology and
practice is now almost universally prevailing with Southern physi-
cians, so that a short intercourse with the profession here, would save
a pupil of the oldest Medical College in the United States, from the
hazard of that practice, which regards quinine as a subsidiary in
Remittent fever.

A quarter of a century ago, this article on Remittent fever, with
its formal divisions and subdivisions, would have been esteemed ad-
mirable even ten years ago, passable; but at the present day, such
an emanation from the head quarters of Medical Science will surprise
the profession everywhere. F.

ARTICLE XXII.

New Elements of Operative Surgery. By Alf. A. L. M. Velpeau,
Prof, of Surgical Clinique of the Faculty of Medicine of Paris,
Surgeon of the Hospital of La Charite, Member of the Institute of
France, <fec, &c, carefully revised, entirely remodelled, and aug-
mented with a Treatise on minor Surgery illustrated by over
300 Engravings, &c. ; accompanied with an Atlas in quarto of
twenty-two plates, &c, &c. Translated by P. S. Townsend,
M. D. augmented by the addition of several hundred pages of
entirely new matter, &c, &c., under the supervision of, and with
notes and observations by Valentine Mott, M. D., Prof, in the
University of New-York, Foreign Associate of the Academie Roy-
ale of Medicine of Paris, &c, <$cc. In three volumes. Vol. It.,
p. 1091. New-York : J. & H. G. Langley, 8 Astor House. 1846.

We are indebted to the Publishers for the 2d volume of this Work,
the condensed title of which we have given above. Mott's Velpeau's
Operative Surgery is, however, the common name of it, and is suffi-
ciently comprehensive.

Some years ago, the intelligent and most industrious Surgeon of
La Pitie Hospital of Paris, but now of La Charitie, published a Work
on Practical Surgery. In 1839, during the residence of our coun-
tryman, Dr. Mott, in the French metropolis, a second edition of the
new Elements of Operative Medicine, as M. Velpeau entitled his
publication, was issued from the press, in four volumes of about 700
pages each, and accompanied with an atlas. It is this edition

1840.] MotCs VelpeaiCs Surgery. 34J

that Dr. Towasend is translating, and Prof. Mott is enlarging by
additions with notes and observations; and ihe whole work, it will
be perceived, is to be completed in three volumes, with, also, an
atlas of Plates.

Vol. II., the one before us, is an immense octavo of nearly
1100 pages, and its typographical execution is creditable to its
Publishers.

It is not our purpose to review this Work, since it has been for
some years before the profession in the French language. We may,
however, briefly notice the translation, and the numerous additions
made to the original.

The translator, Dr. Townsend, has certainly displayed commenda-
ble industry and perseverance in his undertaking, and he has also
exhibited extraordinary zeal in behalf of his "long-cherished, per-
sonal and honored friend, preceptor and kinsman," Dr. Molt. "This
great work of over 3000 pages, is designed to be," says Dr. T., "a
precious treasure for the student of all future time. * * * It
will, we feel assured, prove to be a great organum in Practical Sur-
gery, which the practitioner, as well as student, may never cease to
peruse and re-peruse."

Dr. T. has taken the course the most successful to make this a big
book. Not only has he been careful to translate every French word,
(essentially a very verbose language,) but he has often given in addi-
tion the original itself; and this too, where there was neither proprie-
ty nor necessity. A single sentence will suffice to illustrate this.
"M. Desmarres, (Archiv. Gen. dc Med., 4e. sir., Paris, Nov., 1843,
/. III., p. 363,) at the sitting of the Paris Academy of Sciences,
Oct. 2, 1843, states that he has ascertained that the cornea of a rab-
bit may with much facility (assez facile) be engrafted on that of
another animal of the same species; but that the transparency of
the new graft (lamheau) is generally deficient, (ordinaircment nuUc,)
at least in the greater part of its extent." Seven lines, and about
eighty words, are here used to express, and even then not correctly,
that ML Desmarres in the Academy of Sciences of Paris in 1843,
stated that the cornea of a rabbit might easily be engrafted upon
the cut surface of another cornea in an animal of the same species,
but that its transparency would generally be deficient.

While we cannot but wish the translation of Prof. Yelpeau's Work
on Practical Surgery, had been condensed and made more perspicu-
ous and methodical, it gives us pleasure to bear testimony to the

348 Moll's Velpeau's Surgery. [June,

patient labor and great care of the translator to render*it into English
verbatim et literatim. It may truly be considered an omnium gath-
erum of every kind of Surgery, good, bad and indifferent; and pre-
sented without much order, method or system.

Dr. Tovvnsend has another excellent quality : he is a christian,
and that will cover a multitude of errors and bad taste, in an author
who has attempted so much.

We make the following quotation in reference to a patient upon
whom Dr. Mott had performed the exsection and disarticulation of
the entire half of the lower jaw :

"But he exhibited constantly the same imperturbable calm and re-
solution which he had during the operation ; because he believed, as
he said before the operator began, and when he took leave of some
of his young friends the day before, upon a higher power than man.
It was this serene christian faith and resignation which was the true
secret of his incomparable and heroic courage. I have seen such
demonstrations, but none of so high an order, on the dying couch,
from the same blessed consolation, which none but those who have
imparted to them this priceless boon, and through divine grace, can
realize or enjoy. And I have often said, that if any thing were want-
ing to convince me of the power of religion on the heart, and of the
constant supervision of the divine Creator over human actions, and
the link between Him and the immortality of the soul, it would be
these sublime moral spectacles in the hour of overwhelming tribula-
tion and unutterable anguish, and when reliance, and hope alone in
our Almighty Father, can disarm death and every mortal sorrow of
their sting, and make us triumph over every worldly desire and the
grave itself."

The several hundred pages added to this translation of Velpeau's
Surgery, under the supervision of, and with notes and observations
by Valentine Mott, M. D., &c, have certainly not only augmented
but greatly increased its value.

We consider the Professor of Surgery in the University of
New-York, the first Surgeon of the present day. Astley Cooper,
and particularly Dupuytren, were greater, Marjolin's judgment
may be more correct, Roux might operate even more skilfully,
Velpeau is more learned, Liston may be holder, Miller is more
classical, several of his contemporaries are no doubt better writers
and lecturers, but Mott is the best, the safest, the most successful

1846.] Practical Medicine, Pathology and Therapeutics. 349

operator of the age in which we live. To him we would apply for
a capital operation upon our own person.

This being then our opinion of Dr. Mott, we cannot but regret
that he did not issue a Work on Surgery in his own name, rather
than play second to any man, especially to one who is his junior.
This course was due to the position he occupies, to his profession, to
his country. The materials are abundant for two or more volumes
on Surgery, independent of the translation ; and we believe we re-
present the wishes of his professional brethren, by declaring this to
have been their general expectation.

It is designed to complete this work in a few months ; the remaining
volume and the atlas are to be ready by October next, and the
price is ten dollars for the whole. Considering the immense amount
of matter, and embracing every thing on practical Surgery, it cer-
tainly will not only be a most valuable but cheap work.

Report on the Progress of Practical Medicine, Pathology and
Therapeutics. (From Ranking's Abstract.)

GENERAL PATHOLOGY.

I. DISEASES OP THE BLOOD.

1. Spontaneous coagulation of the blood in the veins in (he cach-
exia, and in various chronic diseases. The attention of pathologists
having once been directed to the existence of fibrinous clots in the
veins, as it occurs in phlogmasia doiens, it was not long before it was
perceived that an affection of an analogous nature occasionally ap-
pears, not only in non-puerperal women, but under certain circum-
stances in the other sex also. This non-puerperal coagulation of the
venous blood forms the subject of a very comprehensive essay by M.
Bouchut,* the main points of which we shall endeavor to lay before
our readers.

In detailing the history of the affection, the author does ample jus-
tice to the writings of those of his own countrymen who have pre-
ceded him, but among British writers, alludes only to Hunter, Aber-
nethy, and Travers. To those he might have added the names of
Dr. Robert Lee, who distinctly acknowledges the existence of a dis-
ease analogous to phlegmasia doiens, unconnected with the puerperal

* Gazette Medicale, Nos. 16, 17. 1815.

350 Practical Medicine, Pathology and Therapeutics, [June,

state, and of Dr. Bright (Reports of Medical Cases, vol. ii, p. 63),
who, in addition to this, traces the connection' between the disease
and a cachectic state of the system, which is indeed the direct object
of the author's present communication. The matter contained in
the memoir of M. Bouchut is thus distributed. The first chapter
contains a record of the cases upon which his opinions are based ;
the second a description of the anatomical characters of the disease ;
in the third, are described the symptoms which announce the coagu-
lation of the blood ; the fourth, fifth, sixth, seventh, and eighth, are
occupied with the progress and termination, the diagnosis, prognosis,
causes, and treatment, of the disease respectively.

The cases alluded to were as follows : Three phthisical women in
the last stage of marasmus; a woman laboring under calculous nephri-
tis, with destruction of the tubular structure of the kidney ; a man
affected with encephaloid disease of the liver; a female greatly re-
duced by typhoid fever; a boy ill with a severe burn; and some
others, each of whom, from various causes, was suffering under great
prostration of the vital powers.

The most common seat of the coagulation is in the veins of the
lower extremities ; but it sometimes, though more rarely, occurs in
those of the arms and neck. It is found also occasionally in the sin-
uses of the brain, as observed by Abercrombie; and in the pulmo-
nary arteries, and in the veins of the liver, as described by MM.
Bouillaud and Baron. The inferior extremities, however, are so
much the most frequent seat of the disease, that it occurred in that
situation in 44 cases out of 51 observed by M. Bouchut. The au-
thor mentions, as a remarkable fact, that the veins implicated are
usually those the most distant from the organ chiefly affected by the
disease, which gives rise to the cachectic state of the system; he
does not deny, however, that in tubercular phthisis and in cancer,
the smaller veins in the immediate neighborhood of the diseased
structure may become obstructed by coagula. The extent of the
coagulum varies in different cases, but is, as a general rule, regulated
by the locality at which the collateral veins originate. The coagu-
lum first appears in the form of a dark clot, which takes the shape of
the vessel, but does not adhere to its inner coat. When adhesion
does take place, it is supposed by the author to be due to a secondary
phlebitis, set up by the irritation of this clot, but in no case does he
believe that the coagulation originates in inflammation in the first
instance. After an interval of fifteen or twenty days, the coagula
lose their color, and become tough and consistent, and in some cases
even of cartilaginous or calcareous hardness.

The symptoms which announce the coagulation are strictly local,
and unconnected with the cachexia or chronic disease, in the course
of which the phenomenon arises. The patient experiences pain in
the thigh or ankle of the affected limb, which pain is in the course
of a few days followed by cedema. The skin is of a dull white color,
as in puerperal phlegmasia dolens.

1846.] Practical Medicine, Pathology and Therapeutics. 351

The diagnosis is founded upon the occurrence of sudden pain in
the limb, in the latter stages of a chronic malady, and the rapid su-
pervention of oedema ; in such a case M. Bouchut considers that
obliteration of the vein may he confidently pronounced to exist.

The prognosis is not unfavorable, as far as the local affection is
concerned; the danger is entirely dependent upon the anterior
condition of the patient. It must inevitably be considered a serious
complication when it supervenes in the latter stages of phthisis or
cancerous disease, and, under such circumstances, indicates the near
approach of a fatal termination. In more favorable cases, either the
vein itself becomes pervious by the absorption of the coagula, or, as is
more frequently the case, the circulation is maintained by the en-
largement of the collateral veins.

In the treatment of this affection, M. Bouchut discountenances
depletory measures of all kinds, but trusts entirely to narcotic foment-
ations, and the internal exhibition of opium.

It has been mentioned in the course of the above imperfect sketch
of 31. Bouchut's memoir, that Bouillaud and Baron had observed the
spontaneous coagulation of the blood in the pulmonary arteries; we
may further state that Mr. Paget* has paid considerable attention to
the same lesion, but without laying any stress upon its alliance to
cachectic states of the constitution. The conditions under which
the latter gentleman has noticed it, are principally four: first, in
pulmonary apoplexy ; secondly, in the advanced stage of pneumonia ;
thirdly, when the matter of medullary cancer passes into the blood,
and becomes arrested in the lungs; and, fourthly, in cases of exten-
sive pulmonary cedema.

2. Suppuration of the blood. Purulent infection: The presence
of pus in the blood, gives rise to a train of symptoms of so fatal a
nature, and at the same time so surrounded bv obscurity, that any
communication tending to advance our knowledge upon the subject
cannot fail to be of considerable interest. Of this character is an
essay by Dr. H. Ben net, ofEdinburg, which appears in the "Edin.
fed. and Surg. Journal," of October, 1845. The purulent contami-
nation of the blood here referred to, is noticed in connexion with
chronic disease of the spleen, two cases of which are related. The
first case is that of a man, act. 30. who was admitted into the Royal
Infirmary with enlarged spleen. There was little disturbance of the
system in the first instance, but, about the fifth day, febrile action
ensued, with headache and diarrhoea, and the man died suddenly.
After death, in addition to the enlarged spleen, the blood was found
to be much*alteretl in cl^ractcr, being coagulated in the principal
venous trunks; and exhibiting a mixture of a whitish substance, ap-
parently either lymph or pus. The lining membrane of the veins
did not exhibit any perceptible alteration, as would have been the
case, had the coagulation depended upon phlebitis; neither were

lico-Chirurgical Transaction-, vol. xxvii., andMeeting of the v.
Chirnrgi.jal Society, June 21, 1515.

352 Practical Medicine, Pathology and Therapeutics. [June,

there any purulent depots in various parts of the body, as is usually
seen when the pus has gained admission into the circulation by ab-
sorption ; for these reasons Dr. Bennet, who has reviewed the case
in connextion with another occurring under similar circumstances,
regards it as an instance of true suppuration of the blood. The
apriori view of the case, as is indeed allowed by Dr. Bennet, tends
rather to the belief that the whitish substance described, is the soft-
ened fibrine described by Gulliver, or the same material existing in
connexion with coagulation, of the nature above described by Bou-
chut; a view which would be strengthened by the fact that, although
the precise office of the spleen in sanguification is not decided, dis-
ease of that organ is known to be almost invariably followed by a
peculiar cachectic state of the system. The evidence, however, ad-
duced by Dr. Bennet in proof that the globules were in reality those
of pus, is sufficiently strong, to induce us to coincide with him in the
present instance. The point mainly depends upon the question,
whether pus can be formed in the blood independently either of in-
flammation, or of absorption from purulent depots. Dr. Bennet says
that it can, for as pus. globules arise in a blastema formed in the
liquor sanguinis, he sees no reason why they should not arise in the
vessel as well as out of it, if any circumstance should arise, which
determines the separation of the serum from the more solid constitu-
ents of the blood.

3. In connexion with the formation of the disseminated abscesses
seen in the lungs, liver, and other organs, as a sequel to purulent in-
fection, we find some valuable remarks in a recent and most talented
work on the Diseases of the Liver, by Dr. George Budd.* It is a
commonly received opinion that the pus found in these organs is not
the product of local inflammation, but that it is all brought with the
blood from the spot at which the primary suppuration took place (as
in the veins of the diploe for instance), and is merely deposited in the
spots in which it is found. Dr. Budd objects to this opinion, for the
reason which appears sufficiently forcible, that pus-globules being
twice as large as the blood globules, they could not escape bodily
from the blood-vessels without the blood escaping as well. He
alleges also in support of his opinion, the researches of Dance and
Cruveilhier, which show that although fully formed abscesses are
generally found in the lungs, in the cases in question, yet, that in
some instances in which death occurred earlier, smaller hepatized
spots, or in other words an earlier stage of inflammation, are seen to
occupy the site of the small collection of pus. From these and simi-
lar observations, Dr. Budd considers it "estffclished, that t&e abscesses
which form in the liver and other organs' after surgical operations
and injuries, are owing to suppurative inflammation of a vein, and
consequent contamination of the blood by pus. The globules of pus
mingled with blood, are conveyed to the capillary vessels of the lungs,

* On Diseases of the Liver. London, 8vo., p. 53.

1846.] Practical Medicine, Pathology and Therapeutics. 3o3

and by becoming arrested there, excite circumscribed inflammation
and abscess.

4. Purpura. The profession appears to be much divided in opin-
ion, if we may judge by a late discussion upon the subject, at the
London Medical Society,* as to the pathology of purpura. The ma-
jority having regard to the analysis of the blood in this disease by
Becquerel and Rodier, (vide Half-yearly Abstract, vol. 1, p. 320.)
will doubtless consider that it mainly depends upon a deficiency of
fibrin. f Some are, however, disposed to view it as occasionally a
local disease^ Dr. Rees believes that, like Blight's disease, purpu-
ra consists of two stages, the one exhibiting a superabundance of
fibrin, the other a deficiency. In the treatment of the profuse
hemorrhages which sometimes occur during the progress of the dis-
ease, turpentine is highly spoken of by Mr. Headland! and Dr.
Neligan.|| and erirot of rye by Dr. Ross, of Boulogne.

5. Effect df Hydropathy upon the blood. [This we noticed in our
last Xo. Edts. S. M. 4 S. Journal.]

6. Anemia M. Beau endeavors to point out a distinction between
anemia, more properly so called, arising from an absolute deficiency
in the quantity of blood, and that condition of the circulating fluid
which consists not so much in a diminution in absolute quantity, as
in a relative increase in its watery constituents. In the first, which
follows immediately upon direct loss of blood, there is pallor and
feebleness, but the pulse is small, and no arterial bruit is heard. The
latter to which he gives the same of polyhcemie sereus, is generally
consequent upon the other, and depends upon an abundant ingestion
of liquids, called for by the urgent thirst. This form of anemiadoes
not in general declare itself until the fourth day after the loss of
blood; and may continue for an unlimited time. In this, as in the
former case, there is pallor and debility, but the pulse is even more
developed than before the hemorrhage ; and an arterial bruit be-
comes very distinct. H

A case in which death was produced by anemia, is related by Mr.
fearce ;** the fatal event being attributed to coagulation of the blood
in the sinuses of the brain. The patient was suddenly seized with
acute pain in the head, followed by convulsions and coma. It is to
be regretted, that this case loses much of its value in a pathological
point of view, from the want of a post-mortem examination; it is,
however, worthy of attention, inasmuch as it may put us upon our
guard with respect to the prognosis of these usually simple rases.
That the supposition of Mr. Pearce, as to the immediate cause of
death, is supported by experience, is shown by Dr. C.J. B. Williams,
Who records three eases in which coagulation in the cerebral sinuses
was found after death, under similar circumstances. It is also coun-

i Paper bv Mr. I ster, Med. Times, ( >ci. 25, 1845.

: Lanc< t. ( let. 35, 1845. n Lancet, ( ><i. 25, I -

Dublin Journal, Nov., 1845.
TT Archives G6n6ralesde Medicine, Aout, 1845. *y Lancet, June 7, 1845

354 Practical Medicine, Pathology and Therapeutics, [June,

tenanced by the researches of M. Bouchut, to which we have above
alluded.

7. Effect of disease vpon animal temperature. Although the re-
cords of medical science include many isolated groups of experiments
upon this interesting subject, a well-digested and at the same time
extensive series of investigations is still a desideratum.* In as far
as the reunion of partial observations may ultimately tend to the
acquisition of definite ideas on the point in question, we are indebted
to M. Roger, who has carefully studied the effects of disease upon
the development of animal heat in children. This pathologist has
found, as one result of his observations, that although in adults the
temperature of the body in disease fluctuates through a range of only
7 cent., in children it varies as much as 19. The highest tempera-
ture observed by him was 42 cent., and occurred in typhus, pneu-
monia, and meningitis. Among the practical deductions which he
has proposed is the'one that typhus may be diagnosticated to a cer-
tainty if the temperature of the body reaches 40, the pulse at the
same time not surpassing 100. In all other diseases in which the
same degree of heat exists, he declares that the pulse is considerably
quicker. It is more common for the temperature to exceed the
physiological level, according to the author's remarks, than to sink
below it. The latter is, however, seen to occur in paralysis, gan-
grene, cholera, and in the cold stage of intermittent fever. We may
remark that the latter observation is directly opposed to the opinion
of Andral; who found the temperature to rise from 2 to 4 in the
cold stage. The disease which exhibits the greatest fall of tempera-
ture in children, is the oedema of the cellular tissue. The disease is,
according to the author, to be apprehended when the thermometer
points to 36 cent., it may be considered as established if it marks a9
low as 30. We give these results of M. Roger as we find them, they
are obviously too meagre to allow of implicit confidence. j"

II Zymotic Diseases.
8. Fever : Typhus and Typhoid. The French Academy has for
a considerable period since the date of our last Report been occupied
by discussions respecting one or two points of great importance in
the pathological history of fever. The questions of essentiality or
non-essentialitv, of its dependence or non-dependence upon inflam-
mation of the peyerian glands, have at length ceased to be agitated,
and in their place we have that of the identity or non-identity of
typhoid with typhus fever, and of its contagious nature. The discus-
sion on these points originated in the presentation of a memoir by
M. Gaultier de Claubry,^ in which both propositions were distinctly
affirmed. M. Rochoux, who opened the debate which ensued, de-

* Since the above was written, Dr. Hake has published two papers upon the
subject in the Medical Gazette, [Xov. 14,] but has not yet attempted any analysis
of his tacts. t Archives Generates He Med., and Lan^ctj Aug. 9, 1845.

; Revue Medicate, and Archives Gen., Juillet, 1845.

184G.] Practical Medicine, Pathology and Therapeutics. 355

nied the identity of the two diseases on these several grounds:
1. That iyphus was contagious, typhoid fever not so. 2. That the
former attacks at all ages, the latter rarely occurs before 15, or after
40. 3. That the peculiar delirium and eruptions of typhus are not
observed in typhoid fever ; and lastly, that the duration of the two
affections is different, being in the one case from ten to fifteen days,
in the other, from twenty to thirty.

This confessedly intricate question is extremely well reviewed, by
a writer in the Dublin Journal, (Sept., 1845.) who discusses the ob-
jections of M. Rochoux seriatim, after the following manner :

The first point of difference which .M. Rochoux seeks to establish,
is the circumstance of contagion. This argument the author of the
article alluded to shows to be of little value, as the typhus of Ireland
is not always contagious, any more than the typhoid fever of Paris.
As a proof of this, he states that out of 9588 cases of fever admitted
into the Belfast Hospital, no trace of contagion could be discovered
in 2.342.

A second ground of distinction much insisted upon, is the differ-
ent ages at which the two diseases occur. This is opposed by the
author for two reasons : 1st. That much error is committed in esti-
mating age, from the omission to notice the fact, that as it is the
custom for the youth of both sexes to congregate in Paris from all
parts of the French dominions, the majority of patients of all classes
must necessarily be near the age of puberty. 2d. That the reason
why typhoid fever is said never to occur in children, is, that the
French pathologist is apt to deny the existence of the disease, unless
he has an opportunity of seeing the diseased bowels, which, as chil-
dren comparatively speaking seldom die of fever, he has but little
opportunity of doing. But, as the author observes, the objection is
completely reversed by the fact, that cases are on record in which
the rose-colored spots of fever were visible even at birth. On the
other hand he remarks, that the true typhus of Ireland is equally rare
among children with the typhoid fever of France, and equally un-
common among aged persons, since of 11209 cases admitted into
the Belfast Hospital, 301 only were under 6 years of age, and 171
only were over 60. The other objections of M. Rochoux meet with
the same opposition at the hands of the author, who therefore con-
cludes that there are no just grounds for regarding the two diseases
as distinct affections, but that the most which can be said is that they
arc varieties of the same type of fever.

The contagiousness of typhoid fever asserted by M. Gaultier do
Clauhry is likewise maintained by M. Jacques,* and by M. Patry,f
the former of whom affirms that the disease never quits a house until
every person has been attacked who is predisposed ; and that is ex-
tremely rare to see the inhabitants of the same lodging, clown with
the fever, at separate times, with an interval of more than a fort-
night, the usual limit of the period of incubation.

- Reported in Archives G^n. de Med., Aout, 1845
I GazetU M dical No. 21, 1845.

356 Practical Medicine, Pathology and Therapeutics. [June,

In the treatment of fever we might gain but little information from
the writings of the last few months. The plan pursued by M. Jac-
ques, is the combination of emetics and purgatives, with the constant
application of cold to the head and abdomen. The same treatment
is likewise recommended by Professor Huss,* with the addition of
frequent ablution with chlorine water, and the exhibition of opium,
musk, and phosphoric acid. The latter medicine was found parti,
cularly serviceable in the adynamic forms of the disease, and it is
somewhat remarkable that the professor takes the same symptom as
an indication for the employment of this medicine, which is mention-
ed by Dr. Graves as indicating the necessity for wine, namely, a
feebleness of the first sound of the heart, and its approach in charac-
ter to the introduction of the second sound.

9. Typhus Material. It is a favorite theory with the German
physicians, that during the progress of typhus fever, a certain morbid
material, said by Rokitansky to resemble medullary sarcoma, is
poured out from the blood into the texture of various organs. Vogel,-f
among others, has paid much attention to the point, and has publish-
ed observations which have recently been translated by our talented
reporter on anatomy and physiology, Mr. Kirkes. It would seem
that the parts most liable to become the seat of the above-mentioned
material are the mucous membranes, but it may also appear in the
substance ofthe denser organs. The action which precedes the de-
position of the typhus material, is said to be inflammatory, and to-
affect especially the solitary and aggregate glands of the small intes-
tines. The most important transformation undergone by the typhus
material after its deposition is its conversion into a hrownish slough,
which upon separation leaves the typhus ulcer. The material ex-
amined by the microscope is seen, according to Vogel, to consist of
an amorphous granular product of a brownish-white color, and con-
taining cells of l-300th of a line diameter; some nucleated.

The subject ofthe typhus material has also been taken up by En-
gel. : This author has observed it under two forms, a fluid and a
solid, usually combined; the fluid matter is viscid and opaque, and
when allowed to rest, throws down an abundant sediment of epithelial
cells and phosphate crystals; the solid matter, as observed by Vogel
and Rokitansky, is chiefly found in the*intestinal follicles. The pro*
cesses of ulceration and reparation are faithfully described by Engel,
as well as certam anomalies to which the diseased product is occasion-
ally subjected ; for a detailed description of these, we must refer the
reader to the original.

10. Yellow Fever. The pathology of this severe malady, which
has lately been invested with unusual interest from its appearance
on our own shores, is ably treated of in a communication from the
pen of Dr. Xott|| of Mobile, giving the particulars of several epidem-

* Gazette Medicate, No. 21.

t Erlauterungstafel zur Pathologischen Histologic, and Med. Gaz., Oct. 31.
: Schmidt's Jahrbucher, No. 7, 1845, and Med. Cazette, Oct. 31.
li American Journal of Medical Sciences, April. 1615.

1846.] Practical Medicine, Pathology and Therapeutics. 357

ics witnessed by him in that locality. In seeking to determine the
nosological status of this fatal disease, he comes to a conclusion, of
the truth of which little douht can be entertained, namely, that it is
a special fever, and like other fevers, subject to considerable varia-
tions in sts leading characters, occording to the local or individual
circumstances under which it arises. The author eulogizes, as every
candid reader must do, the philosophical researches of Louis upon
the disease as it occurred in Gibraltar, but finds it necessary to differ
from him in some particulars. Louis, as may be remembered, con-
siders the leading characteristic of yellow fever to be a "peculiarly
anemic and friable condition of the liver, giving to it the color of
butter." This appearance was not found by Dr. Xott as a general
rule, being present in only one-third of his cases. It may be observ-
ed, however, that Dr. Imray,* to whom we are also indebted for an
essay on the fever in question, sides with Louis.

Dr. Nott has examined with great minutenesss the condition of the
blood and secretions in yellow fever. As in other fevers, the blood
was found to be dark and grumous, and exhibited but little disposition
to coagulate. The peculiar and fatal symptom, the black vomit, is
decided by actual experiment to be blood, modified by admixture
with the acids of the stomach.

The causes of yellow fever are discussed both by Dr. Nott and
Dr. Imray ; the former, however, goes no further than to admit, what
cannot in the present day be doubtful, that it is a poison which by
some means or other gains admission into the blood, and then propa-
gates itself by zymotic action. He does not pretend to decide whe-
ther the poison is of animal or vegetable origin. Dr. Imray examinee
the question upon a more extended basis, and discusses the opinion
held by some, that the exciting cause is of malarial origin, differing
only from that which originates the intermittents and remittents of
tropical climates, in the degree and concentration of its effects. He
considers this opinion to be a fallacy, since there are many localities,
as the islands of Dominica and St. Lucia for instance, in which cir-
cumstances necessary to the development of malaria exist in a high
degree, without the production of yellow fever, while, on the other
hand, in the neighboring island of Barbadoes, to which intermittent
fever is comparatively a stranger, yellow fever forms a fearfully large
item in the bills of mortality. Another reason which he considers to
militate against the identity in origin of yellow with intermittent
fever, is the fact that the former does not appear to be intluenced
either by season or temperature, being equally rife in wet seasons
and dry; when the temperature was high, and when it was low. In
this he is quite borne out by the observations of Rufz.f

11. Intermittent Fever. M. Piorrv has lately adopted the strange
opinion that ague is not, as is generally held to be, the cause of the
enlarged condition of the spleen with which it is associated, hut, on

Edinburgh Medical and Surgical Journal, Oct., 18-15.
t Gazette M< iii< . I", No. 37, el seq.

358 Practical Medicine, Pathology and Therapeutics. [June,

the contrary, that the hypertrophy of this organ is the exciting cause
of the febrile paroxysm. True to his belief, he has lately recorded a
case which proved rebellious to quinine, and which was at length
cured by the application of a bandage preventing the descent of the
enlarged spleen. The paroxysms are supposed by him to depend
upon traction exercised upon the splenic plexus of nerves.* At a
late meeting of Academie de Medecinef M. Saviel denied the influ-
ence of miasmata in the production of intermittent fever, and attri-
butes the disease to the agency of cold and damp; the opinion, as
might be expected, met with decided opposition from the majority of
the members present. In the treatment of ague, M. Trousseaui advises
the exhibition of quinine in a single large dose, rather than in repeated
small doses ; he states that he has known an obstinate case which had
resisted an ounce of quinine given in the ordinary way, to yield at
once to a single dose of fifteen grains. The same opinion as to the
efficacy of large doses, it may be remarked, is held by Dr. Elliotson
(vide Watson's Lectures, vol. 1, p. 747), and has recently been ac-
knowledged by Dr. Chambers. || of Colchester. The Achillea mille-
folium has also recently been employed with success as a substitute
for quinine, by an Italian physician.

12. Measles. The only communication of interest upon this sub-
ject, is one by Dr. Battersby,> containing the description of an
unusually severe epidemic which occurred in the South Dublin Union
Workhouse, at the close of the last year. This epidemic was remarka-
ble for the frequent supervention of various untoward complications,
principal of which was a diptheritic inflammation of the fauces, the
mouth, and larynx, accompanied by pneumonia, which latter affec-
tion was, in the majority of fatal cases, the immediate cause of death.
The diptheritic affection, according to the author's experience, was
not in itself a formidable symptom. In another class of cases, a se-
vere diarrhoea, with bloody stools, frequently appeared about the
decline of the eruption. It was readily controlled if unconnected
with pulmonary complication.

In the treatment of the majority of the cases which occurred during
this epidemic, general bloodletting is described as being inadmissible,
whatever might be the local complication, but in some instances
leeches were employed with advantage, as were also warm baths,
and counter-irritation with the local application of nitrate of silver
in solution to the fauces.

13. Syphilis. M. CullerierU has lately performed a series of
experiments in order to determine the inoculability of the lower ani-
mals, with the syphilitic poison. The result of repeated trials upon
monkeys, guinea-pigs, &c, appears to be that the disease in question
is confined to the human race, as in no instance was the experiment-
er enabled to communicate the disease.

* Gazette Medieale.

tFrance.Sept lti, reported in Med. Times, Sept. 27. 1K.1.Y

: Journ. de Mid., Mars, 1845. II Provincial Med. Journ., Get. 29.

Dublin Journ., Sept. 1845. IT Archives Gen. de Mt-dicinc, Mai. 1845.

1846.] Practical Medicine, Pathology and Therapeutics. 359

14. Vaccination Several communications on various points con-
nected with vaccination have recently been put forth. One of these
is a work by Sir Matthew Tierney, entitled ''Observations on Variola
Vaccina or Cowpock ;" another to which we may refer, is an excel-
lent Report on " Smallpox in Calcutta," and "Vaccination in Ben-
gal," by Dr. Stewart.* M. Blouquierf" also has investigated the
subject with respect to the age at which it is most safe to vaccinate
an infant. It seems that in France the operation is considered dan-
gerous in very tender infancy. M. Blouquier therefore writes for
the purpose of convincing his countrymen, that the younger the sub-
ject, the less the disturbance of the system. This is most interesting
information, however, coming within the period of our Report of M.
Serres upon the memoirs which were presented to the French Acade-
mie des Sciences, in competition for the vaccination prize offered by
that learned body. We regret that our space will not allow of an
analysis of the entire article ; we shall therefore be content with
presenting an abstract of the principal conclusions to which the vari-
ous memoirs tended. These are as follows:

1. The preservative power of vaccination is absolute in the ma-
jority of cases ; it is temporary in comparatively few, and in these
it is almost absolute until puberty.

2. Smallpox rarely attacks vaccinated persons before the age of
ten or twelve years.

3. Independently of its preservative virtue, vaccination introduces
into the organization a principle which has the property of diminish-
ing the virulence of the symptoms, and shortening the duration of the
disease.

4. Inoculation direct from the cow gives rise to symptoms of great
intensity, but it is more certain than vaccination with the ordinary
virus.

5. The preservative virtue of vaccine does not appear to be pro-
portionate to the violence of the local symptoms, but is nevertheless
advisable to renew the virus after a certain period.

6. Among the means proposed for this renewal, the only one wor-
thy of confidence consists in taking the virus from its original source,
the cow.

7. Revaccination is the only method by which the properly vac-
cinated can be distinguished from those who are not safe. ^

8. The success of revaccination does not necessarily prove that
the party would have contracted smallpox ; only that such an event
was prohable.

9. In ordinary times persons should be revaccinated at the end of
fourteen years, but the operation should not be so long deferred during
the existence of an epidemic. ||

* Reviewed in Medico-Chirtirgical Review, Oct., 1845.

t Encyclographie Medieale, April, 1845.

; It may here be remarked thai the value of revaccination, except as i tesi of
a former operation, isdenied by Mr. Newnham, o! Farnham, in a paper lately
published in ihe Medical Gazette, Oct. 17.
Bulletin des Acad.. Nos. 7, 8, and P. 1845

360 Practical Medicine, Pathology and Therapeutics. [June,

III. Accidental Productions.

15. Accidental 'productions in general.- -M. Baron,* in continuing
his researches upon the nature and mode of development of the vari-
ous accidental formations to which the human hody is liable, has
arrived at a conclusion, which the growing confidence in the truth
of the "cell theory" renders less remarkable, namely, that they are
all identical in origin. The reasons upon which he founds this pro-
position are, the frequent similarity of anormal tissues; the mutual
transformations which they undergo; their analogy of seat ; the
similarity of symptoms, progress and termination of the diseases to
which they severally give rise, and lastly, their identity in chemical
composition. In seeking to establish the proximate cause of the
various forms of accidental tissue, M. Baron differs both with Trous-
seau and others, who attribute them to a low form of inflammation,
and also with Cruveilhier, who considers them to arise in a phlebitis
of the part in which they are seen. The opinion to which he leans,
is that which has long been maintained by Andral in respect of tuber-
cle, that they originate in a perverted action of ordinary nutrition;
by which, instead of the development of a normal cell, one is formed
which is disposed to go through the various phases of diseased devel-
opment seen to exist in the different varieties of accidental tissue.
The diseased cell is considered by the author to be in the initiatory
stage identical in every species of morbid development, whether it
be cancer, melanosis, tubercle, false membranes, hydatids, &c.
What the principle is which impresses upon this cell the peculiar
characteristics of the individual structure to which it is destined to
give rise, he does not pretend to decide. The remote cause of all
accidental formation is attributed to some inappreciable modification
of one or more of the constituents of the blood.

16. Cancer. Some observations on the microscopic anatomy of
cancer, are to be found in the "Medical Gazette," of September,
1845, which are extracted from a recent work by Vogel. These are
not, however, of importance, as they add little or nothing to our pre-
vious knowledge of the subject. The frequency with which cancer
displays itself at different ages, and in the two sexes, is investigated
in a short communication by Mr. Wilkinson King,| being the result
of post-mortem examinations made at Guy's Hospital. If any facts
were wanting to show the danger of a too implicit reliance upon the
"numerical method," the following conclusions might, we think, be
adduced. Mr. King finds that half of the number of females dying
at or about the age of 44 years, are the subjects of cancerous forma-
tions ; of males dying at the same age, one-eighth are similarly
affected. He also states that in both sexes cancer increases in fre-
quency from youth to the age of 44, and then decreases.

A few interesting cases of cancer of various organs have been re-
corded within the period of our Report, which will be noticed under
the section on special pathology.

* Gazette Medicale, xMai, 181.3. t Medical Gazette, An?. 1, JS15.

1846.] Practical Medicine, Pathology and Therapeutics. 361

17. Tubercle, presence of, in different organs. The following is
a condensed summary of a valuable essay, for the details of which we
refer the reader to Art. 26.

"In 152 autopsies of adults affected with tubercles, M. Cless*
found the lungs free from tubercles six times. In 2 of these 6
cases, the peritoneum was sprinkled with tubercular granulations ; in
1, the pulmonary and costal pleura of the right side were affected ;
in 1, the bronchial glands, mesentery, and lower part of the ileum,
were the seat of the tubercular disease. In the 5th case, both the
pleura? and the peritoneum were sprinkled over with tubercles of va-
rious sizes, from that of millet-seeds to that of peas, densely packed
together; there was also tuberculous matter in the glands of the neck
and chest, liver and spleen; the lungs, compressed by effusion into
the pleural cavities, were perfectly free from tubercles. In the 6th
case, there was tuberculous matter in the bronchial glands. In 21
autopsies of children, he only found the lungs free from tubercles
once; this was in a boy 11 years of age, who, besides a considerable
6erous effusion into the ventricles of the brain, had two large masses
of tubercle in the cerebellum, many small ones on the surface of the
liver, and caries of the vertebrae.

"In 146 adults affected with tubercles in the lungs, there were
only 35 in whom the disease was confined exclusively to these organs ;
in the remaining 111, or nearly three-fourths of the whole, the disease
had extended to other organs. In children, the proportion in which
the deposit of tubercles is limited to the lungs is smaller than in
adults, M. Cless finding only 3 cases out of 20, in which all other
organs were free. Barthez and Rillet state the proportion to*be^3
to 269. In 166 cases (adults and children) of tubercular deposit in
the lungs, there were only 13 in which the disease was confined to
one lung; of these, in ten cases it was the right lung, in 3 the left;
It is true, that in the greater number of cases the disease had not ad-
vanced very far. When both lungs were affected, the right was
usually most diseased, the proportion being 45 to 30; this result is
not in accordance with the observations of Louis and others. In 110
adults, in whom the lungs were diseased, vomica3 were found 105
times, there being none in the other 41 cases; in children, the pro-
portion in which vomica3 existed was smaller, there being only 0
cases out of 20 in which they were found ; usually, the younger the
child is, the less frequent is the occurrence of vomica; the very
young ones most commonly sink under an acute tuberculization,
which causes death before passing on to suppuration ; moreover,
young children are frequently carried oft' by other diseases superad-
ded to the tubercular deposit, such as acute hydrocephalus, ^c. Out
of 166 cases, pneumothorax, from rupture of a vomica, was noted
as occurring four times, twice in the right lung, twice in the left.
M. Cless relates two exceptions to the established rule, that the
usual seat of tubercles is at the summit of the lungs; in these two

Schmidt's Jahrbudh

362 Practical Medicine, Pathology and Therapeutics. [June,

cases the disease affected the lower lobe especially, and in one there
even existed a vomica."

M. Rochoux* very justly blames the majority of microscopists,
that in their examination of tubercular deposit, they have not ob-
served it at a sufficiently early period, but have selected instances in
which the characteristics of the formations are obscured by the pro-
ducts of destruction of the surrounding pulmonary tissue. If a mass
of commencing tubercular matter be placed under the microscope,
it presents, according to Rochoux, a rounded form of 0,15 to 0,20 of
a millimetre in diameter; and imbedded in the substance of healthy
lung structure. In this state it cannot be removed without the des-
truction of numerous filaments of healthy tissue with which it ap-
pears to be necessarily connected. In color, tubercle is semi-trans-
parent, according to this observer, with a slightly roseate tinge. In
internal texture it resembles the crystalline lens, being composed of
a filamentous tissue disposed in a regular order; a section viewed
under a power of 600 diameters exhibits a metallic lustre. The
inflammatory origin of tubercle is maintained by Zehetmayer.j" in a
paper in which he describes minutely the process by which he con-
ceives that the plastic deposit of pneumonia is converted into tuber-
cular matter. His views, however, are, like many of those of his
countrymen, too hypothetical for these pages; suffice it to say that
he considers that the conversion of effused fibrin into tubercle de-
pends upon the deficiency of the former in serum, causing an impedi-
ment to its resolution ; for, says he, as crystals cannot form in a too
concentrated solution, so the fibrin cannot be converted into pus,
which according to him is the natural process of resolution, unless
there be a sufficient quantity of serum. When, therefore, the serum
is by any means abstracted in pneumonia, either by over-depletion,
or by the occurrence of an exhausting diarrhoea, he regards the tuber-
cular metamorphosis as inevitable.

The influence of anterior disease on the production of tubercle is
closely investigated by Bouchut in his late work on the diseases of
children. There are many diseases, according to his belief, which
have a natural tendency to originate the tubercular diathesis, but in
none is their tendency so palpable as in measles. To this opinion,
which it must be allowed is very general in this country, and is held
by many trustworthy observers, we may cite the opposite conclusions
ofM. Lugol ("On the Causes of Scrofulous Diseases"). This latter
author positively denies that any of the maladies which are common-
ly supposed to have the power of producing tubercular diathesis, are
capable of so doing. That phthisis and other forms of tubercular
disease frequently show themselves for the first time after an attack
of measles, scarlatina, the puerperal state, &c, he fully admits, but
be regards the subsequent disease not as produced de novo, but merely

as a manifestation of a previously existing scrofulous or tubercular

, i

* Archives Generates, Mai, 1845.

+ Zcitschrin derk. k. Gescllschaft der Aertze zu Wien.

I - 16. j Practical Medicine, Pathology and Therapeutics. 369

diathesis, which had remained dormant until called into activity
through the depressing agency of the prior disease.

18. Entozoa. Some very interesting remarks upon the natural
history and pathological relations of this class of parasitic animals
occur in a lately published work by Klencke,* a concise analysis of
which is to be found in the 'British and Foreign Medical Review'
of the present month. f The main object of the communication ap-
pear* to be, to declare the result of experiments by inoculation of
the germs of different forms of hydatids by which lie appears to
have fully succeeeed in ingrafting the parasitic animal. With re-
spect to the order of intestinal worms, the author conceives that the
ova are deposited with the faeces, and are hatched externally to the
body, as he has frequently discovered the embryos of the species
which are known to invest the human race, in the water of ditches.
He entertains certain fanciful notions concerning the manner in
which these embryos gain admission into the human body, but ex-
cludes from his consideration the very obvious way of ingestion with
the food or drink.

IV. Cachexia.

19. Antagonism of Cachexia. The antagonism of cachexia? is
one of the favorite doctrines of the day, with the Continental physi-
cians. M. Trousseau + has lately added to the list of mutually ex-
clusive disorders, by affirming that there exists an antagonism
between the chlorotic and the tubercular diathesis. He carries this
hypothesis so far as to discountenance the exhibition of iron in the
former class of affections, under the idea that in proportion as you
cure the one state of the constitution, you render it amenable to the
other. We need scarcely point out the absurdity of such notions ;
it' no other grounds of objection were to be adduced, the experiments
of Coster are totally subversive of M. Trousseau's fancies.

The mutual exclusion of tubercle and cancer, which is held by
gome, is satisfactorily denied by Lebert from direct post-mortem
investigation. He adduces three cases in which both products^
co-existed. A similar case is also recorded by Dr. Martin of
Munich. ||

Sconlein admits the antagonism of phthisis and intermittent fever;
on the other hand, MM. SigaudU and Lefevre** distinctly deny it.
The opinion of the former is particularly worthy of credence, inas-
much as he was at one time a zealous advocate of the doctrine.
The experience of the latter is derived from the neighborhood of Ro-
chefort, where both diseases arc unusually common. Dr. Chamberstt

Impvereuche and Natur-historisch P I Qtersuchm

forscbungdei I [elminthiaa< :\<a\.

tOctober 1845. oal de M. Beau, Juillet. 18

2,1841 \ & Lancet, Aug. 1845

/. Medical
rl-Pi rin< ial Me li< ; I J< i I Oct. 29 1845

364 Thovghts on Serous Polyazmia. [June,

of Colchester, in a recent communication upon intermittent fever,
alludes to a case within his own knowledge, in which a patient was
attacked with well-marked quartan ague, when in the last stage of
phthisis.

Thoughts on Serous Polycemia. By Robt. E. Little, M. D., of
Quincy, Florida. (From Am. Journ. of Med. Sciences.)

In the extreme portions of the Southern states is to be found a
class of diseases which we apprehend is to be rarely met with in any
other part of the Union save now and then in the densely popula-
ted cities of the seahoard. We refer to those diseases arising not
from a paucity of blood, but from an opposite condition of the sys-
tem, in which there is an increase of the serous, without, however, a
corresponding addition to the quantity ofcrassamentum, constituting
what may properly be denominated serous polyaemia. The state of
the system to which reference is made, is usually regarded as essen-
tially dependent on a deficiency in the amount of the circulating
fluid, there being at the same time an unnatural proportion in the
relative quantity ofeach of its constituents, but which we are con-
vinced is to be attributed to the cause assigned above, an unhealthy
increase in the quantity of blood, with a modification in the usual
proportions of serum and crassamentum. A comparison of the
symptoms of anaemia, limiting the term to that condition of the cir-
culatory system to which it is intended to apply, and that opposite
state to which it is also applied, without, however, a proper regard
being paid to a dissimilarity in several prominent pathognomic
symptoms, and the absurdity of applying it so indiscriminately will
be manifest. A distinction should be made, otherwise two diseases
essentially different are liable to be confounded, and thus produce
an unsettled methodus medendi. Strangers visiting the southern
states, are astonished at the number of pah; and bloated faces to be
seen, especially among children, faces which attract but little notice
from the inhabitants of the country, so long have they been regarded
as the result of an unhealthy location (malarial), or a. deranged liver,
the latter being the commonly assigned cause. To neither of the
above causes, we venture to assert, are they to be attributed save
in a very few cases an assertion which we are assured will be se-
conded by a majority of the well-informed and observant members
of the profession. During our residence in Florida, we have been
called on to treat many cases of what we have denominated serous
polysemia ; the results of observations made during their progress
we design presenting in the present paper.

Symptoms of disease are manifested not only in the appearance
of the countenance pale and bloated but also in the contour of
body, the abdomen large, limbs emaciated, and muscles inelastic.

/

1846.] Thoughts on Serous Polycemia. 365

The physical appearance of the patient to an experienced eye, indi-
cates the true character of the disease. The slightest exertion pro-
duces difficulty of breathing, increased action of the heart, and in a
very short time pulsations in many of the larger veins are perceptible,
particularly in those of the neck. The face has a cadaverous ap-
pearance, the eyes lose their accustomed brilliancy, suffusion of the
cheeks rarely appears, and when it does it is circumscribed: in short
the intellectual manifestations (physically) are in a great measure
wanting. In the early stages of the disease the pulse is usually
small and feeble, occasionally intermittent, but as the disease ad-
vances, it is apt to become full, and convey, when felt at the wrist, an
idea that the finger is placed on the femoral instead of the radial
artery, a phenomenon which disappears, however, a short time be-
fore dissolution. The appetite is capricious, at one time ravenous
and desiring articles not usually esteemed luxuries, such as paper,
leaves and buds of trees, pieces of slate, red clay, &c, while again
the stomach revolts at any thing presented. The breath is fetid, the
bowels loose and constipated by turns, and the discharges of an ash
color. Not unfrequently before death, a dropsical accumulation oc-
curs in one or more of the great cavities of the body, and occasional-
ly it is universal.

But the most remarkable features of the disease are the peculiar
sounds given out by the larger blood-vessels, both veins and arteries.
Bouillaud says that if the ear be applied over an artery, a dull rubbing
sound may be heard; though feeble, it may be distinctly detected.
Aware of this fact, the sounds attendant on the disease in question,
when recognized in one of the first patients which came under oof
care, were not deemed altogether unnatural, but subsequent exam-
inations convinced us, that they were louder and longer than those
given out during a state of health, and consequently the result of dis-
ease. In every case since treated, stethoscopic examinations have
been made, and we regard such sounds as being almost certainly in-
dicative of the existence of serous polycemia, as they are to be heard
very rarely under any other condition either of the blood-vessels or
the blood itself. V. S., a boy fifteen years of age, a native of South
Carolina, but for the last six years a resident of Florida, presented
himself to us as the subject of "liver complaint." His physical ap-
pearance, indicated the nature of his disease. A walk of a mile had
almost completely exhausted him. His breathing was hurried, pt;lsc
130 and full, the carotids beating so violently as to be visible at the
distance of twenty or thirty feet ; abdomen large, limbs emaciated,
and his face of a cadaverous appearance. He lamented his indispo-
sition to apply himself to any steady employment. A stethoscope
was applied to the precordial region ; the bruit de soujfiet was dis-
tinctly heard, inexperience leading us to imagine the existence of a
contracted state of some of the cardiac orifices. The same sound
was heard over the course of the carotid and femoral arteries. At a
subsequent examination the bruit de soufjlet failed to be heard in the

366 Thoughts on Serous Polyamia. [June,

precordial region, although it was still clearly to be distinguished in
the arteries. In the first instance, the patient had been taking exer-
cise on foot : in the latter he had abstained from exercise for a day or
two. A majority of the cases seen have exhibited the same symptoms
in a greater or less degree, the rubbing sound disappearing gradually
as the health was restored.

The cause of this grating sound has been attributed to induration
of the valves of the heart, a parlicular vital condition, a spasm or ten-
sion of the artery, &c. It may depend on either of these causes in
some cases, but our own opinion is, that it is caused in all cases simi-
Jar to the above, by a superabundance of blood, as it is never heard
until the disease is considerably advanced. An increase in the
quantity of blood demands an increased action of the heart to carry
on its circulation ; the blood-vessels are consequently unnaturally
distended ; (he distension beins greater at some points than at others,
and the heart giving a "coup cle foucV at each diastole: hence the
sounds. The loudest sounds are heard in those vessels nearest the
centre of circulation, for instance in the subclavian and carotid arte-
ries. There is frequently a difference between the right and left
carotids, the left giving out the loudest sound, which is capable of
being increased by pressure moderately applied, or entirely stopped
by compressing the vessels between the point where the ear is appli-
ed and the heart. Position also influences the intensity of the bruit,
an erect posture increasing, a recumbent diminishing it. It is always
heard most distinctly when the larynx is in its natural position ;
drawing it to the opposite side diminishes it, frequently entirely des-
troys id

The blood drawn from patients laboring under serous polyaemia,
after being allowed to stand for a short time, shows a very large
amount of serum, with a corresponding diminution in the quantity
of crassamentum, a state of things which we all know must exist when
regard is paid to the elements which are used in its formation. To*
organic chemistry are we indebted for a knowledge of the influence
possessed by physical laws over vital phenomena. No one at all ac-
quainted with the late discoveries in chemistry, will for a moment
deny the necessity of the inorganic elements of food, ftnd to a partial
absence of these, is in a great measure to be attributed the existence
of serous polvasmia among children in some parts of the southern
country* In the northern part of Middle Florida, (in which we re-
side,) the soil is deficient to a great extent in calcareous matter, and
here lies the foundation of the evil, The principal bread-stuff of
the inhabitants is Indian corn, (which under any circumstancs con-
tains less lime than wheat,) and as vegetable matter is influenced m
its constituents by the character of the soil on which it is grown, it is
obvious that maize cannot be well adapted to the nutrition of the
system, wanting as it is in calcareous matter. The same may be
said of all other vegetable matter growing in the country. Inferior
animals feeding on such material, in a very short time feel the effects

L 846.1 Thoughts on Serous Polycemia. 367

of a diet destitute of inorganic elements; they consequently seldom
attain their natural growth, and are wanting in that soundness which
characterizes those of their species which luxuriate in the pastures of
a region rich in calcareous matter, matter essential to the nourish-
ment of the system. The diet of persons inhabiting a section of
country partially destitute of some of the inorganic constituents of
the human body, must after a time produce a derangement in the ani-
mal economy, the derangement being sooner manifest in the young
than in the adult subject, and to a much greater extent. This is
manifest in our own immediate neighborhood; very few of the na-
tives of the country are over twenty years of age, their parents ha-
ving emigrated principally from the Carolinas. Many of the former
sutler greatly from the use of food destitute of inorganic elements,
indicated by their pale and bloated faces, while the latter having
emigrated after a full development of the system, muscular and
osseous, and consequently not demanding so imperatively as their
offspring a supply of mineral matter for a healthy action of their
system, suffer comparatively very little. Experiments instituted by
Chossat, demonstrate the necessity of graminivorous animals being
supplied with lime. Pigeons which he supplied with wheat, an arti-
cle containing but about 2.80 per cent, of lime, became after a time
emaciated and finally died, but when lime was added to their food,
they increased in plumpness. The bones of those that died exhib-
ited a brittlenes not at all consistent with a healthy state of the osse-
ous system, a state of things frequently met with in the human subject
during that period, when the process of ossification is going on most
rapidly. Dr. Le Conte, in an article recently published on Geophagy,
mentions in confirmation of the necessity of inorganic elements in
the food of all animals, that the cattle in one of the counties of Geor-
gia subsist on a species ofgrass destitute of phosphatic or calcareous
matter, and that as a substitute for these principles in their food, are
in the hahit of chewing bones, which they do with the head elevated,
to prevent the saliva from flowing from the mouth, until the bulk of
bony matter is reduced to a very small size, when it is rejected as
being of no further service. These cattle are lean and of diminu-
tive stature. Removal to a section of country with a different geolo-
gical formation, does away with the habit, a habit the result of
instinct. Upon the same principle may be explained the tendency
in some children and pregnant women to dirt-eating, nature urging
them thus to supply the deficiency of, or increased demand for calca-
reous and saline ingredients in their ordinary food, a habit which
experience has proved may be indulged in to a certain extent with-
out invariably causing disease, especially if the subject of it be not
confined to a limited number of articles of diet. We are more and
more convinced from daily observation of the truth of the experiments
of Magendie and others in regard to the necessity of a variety in
diet. In the families of those who are in the habit of varying the diet
fiu. ii time to time, cases of serous polysomia are rare, while in others

368 Extra Uterine Pregnancy. [June,

where the same articles of diet are used for months in succession, the
disease is common. So also is its prevalence influenced by the use
of the flesh of wild and domestic animals: the former being much
more likely to cause an unhealthy state of the system than the latter.
But enough has been said to give an idea of the probable cause of the
disease.

The treatment pursued by us is simple, and usually attended with
success. It consists in the exhibitions of the different preparations
of iron, in combination with mild aperients, together with a generous
diet, the articles being oftejjparied. When complicated with drop-
sical accumulations, an addition of diuretics to the ferruginous pre-
parations, are of service. A steady perseverance in their use has
seldom failed in our hands, if timely resorted to, in procuring an
amelioration, if not an entire abatement of the symptoms,

Extra Uterine Pregnaney-^-Retention of the Pectus fifteen years in"
the cavity of the abdomen, during which time the patient was de-
livered of a full-grown child, at term removal of the extra-uterine
fcetus-^-complete recovery. By Thomas H. Yardley, M. D., Con-
sulting Physician to the Lying-in Department of the Northern
Dispensary. (From Amer. Journ. of the Medical Sciences.)

M. G., aged 41 years, of leucophlegmatic temperament, accus-
tomed to much exposure and hard work, applied to me for advice ifi
the early part of August, 1844. She had considerable ferer, and
complained of pain in the lower part of the abdomen, where a large
tumour could be distinctly felt. She said this lump had been
there for many years: that it gave her very little inconvenience,
except when she lifted heavy burdens or took cold, and then a few
days' rest and a mild aperient would remove the unpleasant symp-
toms. She refused to submit to the necessary examination to
ascertain the extent and locality of the tumour, and the usual anti-
phlogistic treatment was adopted.

1 continued to visit her occasionally till the end of the year, by
which time she had become very much reduced by pain, irritation
and hectic fever.

Early in January, 1845, a large quantity of purulent matter wa*
passed from the bowels: this discharge continued at intervals till
July, when she informed me that small bones had come away with
the matter from her bowels. On examination they proved to be the'
bones of a foetus; and with considerable, difficulty I learned from
her the following history of her case ; of which she acknowledged
she had intentionally kept me in ignorance for fear of having to
submit to some unpleasant operation.

In 1830, soon after her marriage to her present husband, (she had
previously been married, but had not a child,) she became pregnant.

1S4G.] Extra Uterine Pregnancy. iit9

tatamenia was suspended] her breasts enlarged ; and she had nausea
and morning sickness as in ordinary pregnancy, but no unusual or
anomalous symptoms.

When near the term of utero-gestation she had a fall which was
followed by violent crampy pains in the abdomen, but not like the
labour-pains which she suffered in her subsequent confinement, and
there was no discharge per vaginam, A physician visiting in the
neighborhood was called to see her : he, however, made no examina-
tion, and after directing an anodyne left her with the understanding
that he was to be sent for if his services were required. He was
not sent for; and though she suffered severely for several days, and
was unable to leave the houie for six months, yet she never had any
regular medical attendant.

She had no vaginal discharge* for at least a year after this attack
of pain, and at that time her catamenia returned ; her health gradu-
ally improved, and early in 1S31 she again became pregnant, and
passed through the usual period of utero-g^station without the occur-
rence of any thing unusual. My friend Dr. Noble attended her
during her accouchement, and has kindly furnished me with the
following account. "In looking over my note-book I find that on
the 5th of 10th month, October, 1834, I attended M. G. in her con-
finement with a still-born male child, at which time there was (appa-
rently) a full-sized infant of a former pregnancy, in the abdominal
cavity, extra-uterine.

* I well remember that it caused much difficulty by the head of the
extra-uterine foetus slipping into the cavity of the pelvis, thus ob-
structing the passage of the last-formed child ; but by constantly
pressing up the head of the extra-uterine foetus, the other child was
delivered, though not living.

"During the convalescence there was nothing very remarkable."

After she was delivered of this child, she says she became pregnant
two or three times and miscarried in the second or third month, but
was not attended by a physician. Her general health, however, was
very good, and she worked hard till August, 1644, a period of nearly
ten years.

As the case was one of unusual interest, and the patient appeared
in a critical situation, I called on Professor Hodge, of the University
of Pennsylvania, who kindly gave his assistance.

On making an examination per rectum, the os femoris ef a foetus
was found projecting into that cavity from an opening on its anterior
surface, about four inches from the anus; and on examining per
Vagi nam, the uterus was found pressed against the pubis by a large
mass, (evidently a sack containing part of a foetus,) which filled up
the posterior part of the pelvis and pressed the vagina forwards.

Dr. Hodge removed the os lemons and one or two small bones,
but it was apparent that the soft parts of the foptus were still firm, ex-

k The parienr is very positive on this point.

370 Extra Uterine Pregnancy. [June,

cept where it was exposed to the air from the opening into the rectum.
It was, therefore, deemed most prudent to wait till decomposition had
produced such a solution of continuity as would enable us to operate
with safety. The difficulty of the undertaking being greatly in-
creased by the fact that the opening into the rectum was on the upper
part of the sac, the main body of the foetus lying below it.

Dr. Hodge visited the patient with me at intervals of two or three
days, and at each visit removed such portions of the foetus as could
be separated from the main body without using imprudent force.
During these operations, the patient became much exhausted, and
appeared to suffer severely, particularly from the passage of sharp
points of bone through the rectum.

After each operation, and on the intermediate days, the sac was
washed out by passing a flexible tube through the rectum into the
opening, and injecting a large quantity of tepid water. Tonics and
a nourishing diet were also given to support her system.

About the middle of August, inflammation and suppuration took
place in the perineum, and some small pieces of bone passed through
the opening, and Dr. Hodge, by enlarging the aperture, extracted
an os-ilium.

The space between the anterior part of the sac and the vagina
had now become very thin, and as the head and a considerable portion
of the fcetus still remained in the sack, which continued to recede
still further below the opening, thereby rendering it still more diffi-
cult to remove the contents, it became a question whether it would
not be proper to make an opening into the lower part of the sac from
the vagina, and through that passage at once remove the remains of
the fcetus: particularly as the strength of the patient seemed failing,
and it appeared probable that nature would make the opening if we
did not.

In this state of the case, Professor Horner was called in consulta-
tion. It was decided to continue to operate from the rectum as here-
tofore ; the dread of a troublesome recto-vaginal fistula being the
principal objection to an incision from the vagina.

Dr. Hodge being called to visit an obstetric patient, Dr. Horner,
at his request, proceeded to remove such portions as could be detach-
ed. The bones of the head were found separated from each other,
and were removed with much less difficulty than had been anticipated,
though their sharp edges caused much pain as they passed through
the rectum. One of the thighs with the flesh on it was removed :
and also the principal part of the spine united by the ligaments and
muscles. During the passage of these large masses through the
rectum, the abdominal muscles were called into action, and bearing-
down efforts similar to those ofordinary labor were produced.

The process of removing from time to time such remains of the
fcetus as could be extracted without injury to the mother, was continu-
ed for some weeks. Dr. Hodge punctured, from the rectum, a flue- '
hinting tumor below the main sac, from which a quantity of bloody
fluid escaped, but it contained no bones.

1840.] The Modification of Variola by Vaccination. i571

The patient began to improve early in October, acd the sac, in
which no bones could be felt, seemed to contract, although there was
a good deal of thickening on the left side of the rectum. Mildly as-
tringent injections were now thrown into the sac, and the patient
encouraged to use exercise in the open air. From this time she
rapidly regained her health and strength, and by Christmas she was
perfectly well. The fistulous opening in the perineum was healed,
and she was not conscious of any unnatural sensation in the pelvic
region.

Many of the small bones were lost, but those which were preserv-
ed are in the possession of Professor Hodge of the University of
Pennsylvania.

The Modification of Variola by Vaccination. Communication by
M. Ambboisb Tardieu, Adjunct Professor to the Faculty of
Medicine of Paris. (Translated tor this Journal.)

M. Tardieu says, I do not think that according to the works of
Willan, Odier of Geneva, of ftl. M. Rayer, Herpin, Couture, Legen-
dre and Clerault, it is possible to question the mutually modifying
influence which variola and vaccinia developing themselves simulta-
neously, exercise upon each other, no more than the utility of vacci-
nation during the period of incubation or during the first fever of
variola. But here a doubt in some way arises, still more increased
by a fact entirely new, (at least I believe so,) which was observed at
the Hospital la Charite, in the department of Professor Bouillaud,
and which I have the honour to adduce at present* In publishing
this curious observation, I have reason to think it could apply itself
usefully to important facts which the science already possesses on a
subject otherwise difficult and complicated.

Case. Vaccination on the commencement of the variolic erup-
tion ; variola modified ; vaccine eruption appearing only after the
desquamation of the variola, and modified like it.

A young man, an ice-cream maker, a^ed 18 years, was sent to
Ward No. s. Saint Jean rJe Dieu, on the ltth September, 1845; he
w.ts seized with the fust symptoms of a febrile affection, apparently
(pule serious, for which was prescribed the next day a bleeding from
the arm. On the morning of the fourth day (the 20th.) there ap-
peared the first pustules of the small-pox. It was then only, that
Dr. Flandin, learning that the patient had never been vaccinated,
tried a very late inoculation, but which he endeavored to render
more energetic by making, according to the practice of Eichorn,
twelve or fifteen punctures in each arm. The matter which he used
wis dry and preserved between two plates of glass. The next day,
the- 2 1st, second day after the eruption, this young man entered La
Charite. At our first visit he already presented a great number of

372 The Modification of Variola by Vaccination. [June,

variolic pustules, spread over the whole surface of the body, and
particularly over the face, nevertheless not confluent. The disease
was otherwise very moderate as to the vaccinia, there was no other
trace than three or four small superficial points without redness or
swelling on the right arm.

The variolic eruption pursued its course regularly and ran through
its different phases with great rapidity. He had no secondary fever
or swelling of the face or extremities, and on the seventh or eighth
day after their appearance, the pustules had already arrived at the
stage of desquamation. From that time till the 29th of Sept. (the
tenth day of the eruption,) what still further assured us, the traces
of vaccinal inoculation had had no change of aspect and the points
had actually made no progress.

We had since that time omitted the daily examination of the arm ;
the desquamation has gone on regularly, and the papular form to-
gether with the prominent state of the cicatrices, strike us as the last
characteristics of modified variola. On the 5th of October, at our
morning visit, the patient told us that he had forgotton to tell us that
for the last five days the vaccination seemed to have taken effect.
And indeed what was our surprise in discovering on the right arm,
on the level of the points which had remained visible, there could be
no mistake, four vaccinal pustules already almost completely dry ; in
the centre of the little cicatrices left white and elevated by the vari-
ola, were seen these four pustules of size from five to ten millimetres
covered some with a thick brown crust and others with a liquid partly
dried and surrounded by very narrow circular areola of a bright red,
and devoid of the vaccine turgescence. It is impossible not to
recognize by these characteristics a moderate vaccinia.

Here then is a case where the insertion of the vaccine took place
after the appearance of the variolic eruption, and where nevertheless,
it is so much modified, that in less than fifteen days desquamation
is complete. And moreover, this happy influence of the vaccination
was exercised before the vaccinal pustule is itself developed. And
it was not indeed but after the disappearance of the variola, that the
vaccine pustules showed themselves running through, in their turn,
these periods so rapidly, that it seemed as if they must have pro-
gressed latently until the time when they made their appearance
externally. Indeed, although only dating six days back, they ap-
peared when we saw them to have acquired a development almost
equal to the period at which the inoculation took place, from the
15th to the 16th day.

Struck from the beginning with the evident modification which
the variola had experienced, I asked myself, and have since put the
same question to my learned preceptor, 31. Rayer, if vaccinal inocu-
lation not followed by eruption could ever have a preventive influ-
ence. The question seems settled by the fact that, however much
the vaccine virus may be suspended for a while in its course, it never-
theless arrives always by an evolution more or less regular to this

184G.J Supra-renal, Thymus and Typhoid Bodies. 375

very condition. One cannot but appreciate bow much I have to
regret not having been present myself at the first development of
these late vaccine pustules, and not having been able to follow them
in their various modifications, and I reproach myself for not having
kept awake my attention sufficiently long on this point. But it will
be seen without doubt that this omission fortunately does not dimin-
ish in any degree the value of a fact which remains clear and
positive. The testimony of M. Raver, who had been anxious to
prove this himself, confirms all that I have said.

We can boldly then come to this practical conclusion, that, in
those individuals who have not been vaccinated, inoculation by
vaccine is indicated, and may be useful, and even not only du-
ring the first fever, but at the beginning of the variolic eruption,
and as in this last case, rather than fear the uncertainty which may
exist during the prodromic period, it will be easier to try the experi-
ment and to generalize this practice. If, for example, vaccine matter
was at the disposition of the physicians of the Government office,
would it be to the disadvantage of the patients who present themselves
at the hospital, most frequently after the appearance of the first pus-
tule, if even at that late period they were submitted to vaccination ?

" On the Supra-renal, Thymus and Thyroid Bodies." By Jon*
Goodsik, Esq., communicated by RiCHARO Owen, Esq., F. R. S.,
etc. Read before the Royal Society, Jan. 22d, 1846.

In this paper, the author enters on the development of the theory
he advanced two years ago, with regard to the origin and nature of
the supra-renal, thymus and thyroid bodies, and the correctness of
which, with certain modifications, he has been enabled to confirm by
subsequent observation and reflection. His hypothesis was, that the
three organs in question, arc the remains of the hlasto-dcrma ; the
thyroid heing the development of a portion of the original cellular
substance of the germinal membrane grouped around the two branch-
es of the omphalo-mesenteric vein; the supra-renal capsules, the
developments of other portions grouped around the omphalomesente-
ric arteries; and the thymus-, the development of the intermediate
portion of the membrane arranged along the sides of the embryonic
visceral cavity, lie has since ascertained, however, that the thyroid
body derives its origin in a portion of the included metnbrana infer-
media remaining in connection witli anastomosing vessejs between
the first and second aortic arches, or carotid and subclavian vessels.
He considers these organs as essentiallv similar in their structure,
as well as in their origin, in continuous portions of the blaslo-d.-rma
situated along (ac|, sj(jc 0f the spine, and extending from the VVolfian
hod i os to tin.' base ot'il ic cranium : the development of the supra- rnal
capsules having relation to the omphalo-mesenteric vessels the

374 The Liver* Clinical Lectures on Surgery. [June,

thymus, to the jugular and cardinal veins and ductus Cuvieri ; and
the thyroid gland, to the anastomosing branches of the first and
second aortic arches. The functions of these organs he regards as
being analogous to those, of the blasto-derma ; with this difference,
however, 'that as the blasto-derma not only elaborates nourishment
for the embryo, but absorbs it also from without, that is, from I he
yolk, the developed organs only elaborate the matter which has
already been absorbed from other parts, and is now circulating in the
vessels of the more perfect individual.* (Fr*om the Abstract of the
Proceedings of the Royal Society, in the London, Edin., and Dublin
Philosophical Magazine, for March, 1846, p. 220.) J. Le C.

"On the Secretory Apparatus and Function of the Liver," By
C. Handfield Jones, M. D., communicated by Sir Benjamin
C. Brodie, Bart., F. R. S. Read before the Roval Society,
Feb. 5th, 1846.

The author is led by his researches into the minute structure of
the liver, to results which confirm the view of Mr. Bowman, in oppo-
sition to those of Mr. Kiernan on this subject : and particularly with
regard to the absence of real tubercular ducts from the interior of the
lobules. He concludes that the accreting process commences in the
rows of epithelial cells surrounding the central axis of the lobule,
and that the fluid there secreted is transmitted to the cells forming
the margin of the lobule, where it is further elaborated, and by the
bursting of these cells, is conveyed into the cavity of the surrounding
d\}cLr-(Idctn, p. ?23.) J. Le C.

KIBLIOGRAFAICAL NOTICE.

Clinical Lectures on Surgery. Delivered at St. George's Hospital,
by Sir B. C. Brodie, Bart., &c, &c. Philadelphia: Lea &
Blanchard. 1846. pp. 352.

It is perhaps unnecessary to enter into a full review of this truly
practical work, inasmuch as its merits have so lately been submitted
to the criticism of the profession, while passing through the columns
of the Medical News and Library. The embodied work is valuable,
both for the amount of highly available matter it contains, and also
for the care and attention with which many topics of minor Surgery
are discussed by the distinguished author. The short treatise on
Affections of the Tongue, should alone ensure it a place in the library
of every student and physician. H. F. C.

1846.] Metallic Substances. -Abstinence from Drinks. -Quinine. 37;

PART III. MONTHLY PERISCOPE.

Epoch of the elimination of certain Metallic Substances introduced
into the Animal Economy. MM. Milon and Laveran, in a note ad-
dressed to the Institute, have given the results of their numerous
observations on cases in which their patients have taken tartar emetic,
once, or at most twice, in the common dose of 1^ grains, but in some
cases as high as 4 grains. They observed 1st, that the antimony
was always found in the urine ; 2d, that the elimination of the metal
was slow in many cases : they were thus led to watch its passage in
the urine, not only many days after its ingestion, but even many days
after it had ceased to be found in the urine ; 3d, that they have seen
the antimony reappear in the urine. follow a true iniermittence in its
elimination, and remain in the economy for periods much beyond
what we could have imagined.

The fact of the intermittence fixed our entire attention. We are
not without hope of showing relations between this peculiar progress
of elimination of a metal, as shown by chemical analysis, and the
parallel intermittent course of many phenomena, which are common
in pathology, and yet very obscure. [Journal de Chimie Medicale,
Dec, 1845, p. 656. New-Orleans Journal.

On Abstinence from Drinlcs in the Treatment of some Diseases.
Dr. Bourge thinks that the quantity of drink administered in disease
is not a matter of indifference, that it ought to be regulated by the
medical attendant, and should not be left to the taste of the patient
or the caprice of the nurse.

Thus, in all affections accompanied by a predominance of the
serous or aqueous element in the blood, this physician thinks that we
ought to diminish very much the usual quantity of drink, or even to
suppress it altogether. Such are, for example, c;ises of dropsv, pro-
fuse sweatings, chlorosis, suffocative catarrh, abundant diarrhoeas,
diabetes, organic diseases of the heart, and, finally, asthma, whenever
this malady owes its existence to a pathological condition of the
central organ of the circulation. [Dublin Hospital Gazette, Bos-
ton Medical and Surgical Journal.

Sulphate of Quinine not absorbed when applied Endermicalhj. By
M. Martin-Solon. Many medicines when applied to the skin,
either whole or deprived of its cuticle, act energetically on the econo-
my, and may be detected in the secretions, thus showing they have
been absorbed. Sulphate of quinine, when given internally in th
dose of one grain, may easily be detected in the urine by means of
the ordinary tests, as iodide of potassium, &c. Martin-Solon, how-
ever, 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

370 Poisoning by Quinine. Hemoptysis and Menorrhagia. [June,

slightest traces of the medicine in the urine. The sulphate of qui-
nine was applied by friction to the sound skin, and to that denuded
of cuticle, in baths, and by means of ointments. The effect is null
in all. [New Orleans Med. and Surg. Journal ', from Bulletin de
Tkerapeutique.

Poisoning by Sulphate of Quinine. M. Desiderio communicated
to the February sitting of the Royal Academy of Medicine, there*
suhs which he had obtained relatively to the action of this substance,
by means of numerous experiments on animals as well as by obser-
vations at the bed-side. The effects upon animals are in every respect
similar to those observed in the human subject; namely : drowsiness,
an indisposition to motion, unsteadiness of gait, dimness of vision,
and drooping of the eyelids. An alcoholic solution of morphia pro-
duces analogous effects. Hence, when given with sulphate of
quinine it increases its action. On the contrary, laurel water coun-
teracts to a certain extent its effects, and may be considered as an
antidote. Bleeding is still more efficacious, and digitalis also has
appeared to be useful. [ Western Journal of Medicine and Surgery.

A Case of Hemoptysis and Menorrhagia successfully treated by
Tartrate of Iron By i). E. Harbison, M. ])., of Kentucky. Mrs.
King, a3t. 40 years, of feeble constitution, the mother of eight chil-
dren, the youngest of which being two years old, was attacked sud-
denly on the 16th of November last with spitting of blood, and in a
few hours discharged what was supposed to amount to half a gallon.
I found heron the same day pale, insensible, pulseless at the wrist,
breathing quick, and with cold extremities. No abnormal sounds
could be detected on percussion in any part of the lungs. Stimulants
and astringents having been administered, the hemorrhage soon
ceased, and the patient regained her consciousness. On inquiring
into the history of her case I was informed that she had been subject
to hemoptysis during the long period of fifteen years, the hemorrhage
being very much increased at her catamenial terms; and I was also
told that the complaint was hereditary. Her health has suffered
seriously by the drain, as well, probably, as by the long-continued
use of medicines prescribed for its suppression. The uterine dis-
charge, it was stated, consisted of blood which coagulated like that
from the lungs:

Having just read the lectures of Dr. Buck, published in the West-
ern Journal, I was encouraged to try chalybeates and a nourishing
diet, with a view to the improvement of the quality of her blood.
Accordingly I put her upon the use of the tartrate of iron, in doses of
8 grains, gradually increased to 12 grains, three times daily, in pills
combined with a little rhubarb, so as to keep the bowels soluble.
The improvement in her case was speedily manifest. Her complex-
ion became healthful; her strength increased daily; she had no
return of the pulmonary hemorrhage: her menses became regular,

1846. J Ulcers. Caustic in Burns. 3T

and on the 13th of the present month I ceased to attend her, consid-
ering her cured. [Ibid.
March 23d, 184G.

Mode of curing obstinate old Ulcer*. By J. Bkbbciahi de Borsa.

When 1 have met with very old ulcers, especially those of the leg,
which resist every other method of treatment, I have obtained their
sound cicatrization by instituting, by means of caustic potass, a new
ulcer in the vicinity. I make in a piece of plaster a hole,

somewhat smaller in size than I wise the artificial ulcer to be, and
then apply it one or two fingers' breath from the old Sore. Caustic
potass is rubbed on this space until an eschar is formed : and 1 have
constantly observed that, during the c natory and

suppurative processes, the old solution of continuity, which h
obstinately resisted treatment, has closed up, and the cicatrix has in
general continued sound.

" If the healed ulcers had resulted from a disordered constitution,
to the appropriate internal treatment, I add either an issue in some
usual spot, .or place a small portion of wax in the artificial ulcer itself
when nearly healed, so as to convert it into a common issue, which
contributes much to efficient treatment, as by such prudential pre-
caution I have never seen any mischief produced in the constitution
of those who had long been subject to obstinate ulcers. If the nicer
was produced by a traumatic cause, after it has become healed the
artificial one may also be cicatrized as soon as possible, without any
injury resulting.

i4In my practice I have cured more than a hundred cases in this
matter, and many instances have occurred in the hospital where I
have cured ulcers of twenty or thirty years' standing."- [Medico-
Chirurgical Recicw.

Lunar Caustic in Bums. By F. II. Gordon-, of Tennessee.
During the autumn of 1840, while the writer was performing a sot
of experiments in chemistry before a class, a burn was accidentally
received in the following manner. In getting out some phosphorus
to light a spirit lamp, a little of it dropped into a box of mineral spe-
cimens under the table. Being unable to find it readily it was left
in the box and forgotten until it got into a blaze. To save the min-
erals from injury, I attempted to run my left hand under them and
the phosphorus and throw all out together: but instead of this. I ran
the index and middle linger directly into the blazing phosphorus.
The piece, about an inch long, stuck to my fingers, and before I
could plunge them into the pneumatic trough, it completely ruasie.l
them from their extremities to the second joints. The pain exceeded
in intensity any thing thai e\ < r I suffered.

Hut silver and its compounds being the subject of the lecture, there
was fortunately a solution of the nitrate on tie- table, and as soon as
reflection returned 1 plunged my fingers into the caustic liquid. Ke-

378 Brochieri Water. Porrigo. Hernia. Anatomy. [June,

lief was prompt, and so great that in a few minutes the lecture was
resumed. It was then about 3 o'clock, P. M. ; there was slight pain
in the fingers till 9, when I fell asleep and suffered no more from it
afterwards. Hard crusts of sphacelus shielded the diseased parts till
they were thrown off by reproduced flesh beneath. My fingers are
now as perfect as ever in shape and motion, and no one could dis-
cover a cicatrix. [Western Journal of Medicine and Surgery .

Composition of Br or eliieri Water. (Archiv. der Pharm., 1845, and
Chemist, March, 1846, p. 135.)

R. The wood of the fir, cut small and bruized, . 1 part.

Water, 2 parts.

Let it macerate for 12 hours, and distil over a portion of the product.
It is then left at rest for 24 hours, and we remove the essential oil.
This water must be shaken before used. [Southern Journal M. <$* S.

Tincture of Iodine in the treatment of Porrigo. Dr. F. W. Todd,
of Port Gibson, Miss., informs us that he has found the tincture of
iodine, employed locally, "invaluable in the treatment of that obsti-
nate disease, porrigo." He has used it in all forms of the disease
whether mild or severe, and in no instance has it failed to effect a
cure. In the more active forms, poultices and fomentations preceded
the application of the iodine. [ Western Journal Med. and Surg.

Belladonna in Strangulated Hernia. By J. Besciaxi de Boesa,
ofVerona. R. Ext. Belladon. 3ii.; Axung. ii. M. bene. 1 an-
noint the tumor at least every half hour. Alter a while the pain, and
then the tension of the sac, diminish, and the possibility of reducing
the hernia by taxis occurs. The various other means usually em-
ployed, as bleeding, baths, cold, tobacco, &c, ar6 not to be neglected ;
and, although these will frequently not succeed alone, they will do
so in many cases when aided by the belladonna. [Medico- Chirur-
gical Review.

Disinfection of Bodies for Anatomical purposes. We learn from
a report in a late number of the Gazette Medicate, that a new method
has been discovered for the preservation of dead bodies. The sub-
jects used for dissection at the Ecole Pratique have been preserved
by this process, and so perfectly had it succeeded, that the bodies
were in exceedingly good condition after having been in the hands
of the pupils for several weeks. The plan consists in injecting into
the arteries a strong solution of the sulphite of soda in water. Pu-
trefaction is thereby arrested for several weeks, and, for further pre-
servation, lotions of the chloride of zinc may be used. When subjects
are thus treated, the organs preserve their form and natural color;
the steel instruments used in dissection undergo no change, and there
is no smell even at a short distance from the body. This important
result is likely to have a beneficial inlluence on the health ofmedical
pupils, and on the pursuit of anatomy.

184C] Vapour Bath. Mercury Pill. Anodyne for Ulcers, <fyc, 379

We cannot answer for the success of this plan, but the reporter
speaks most confidently of it. The sulphite of soda probacy acts-
by absorbing oxygen and becoming converted to sulphate, The
sulphite is easily made by passing sulphurous acid gas (obtained by
boiling copper-clippings in oil of vitriol) into a saturated solution of
carbonate of soda, uniil effervescence ceases. [London Med. Gaz..r
and Southern Journal of Med. and Pharm.

A cheap substitute for a Vapour Bath. Dr. Serre (d'Alais) re-
commends the following means of inducing abundant transpiration z
''Take a piece of lime about half the size of your fist, and wrap-
around it a wet cloth, sufficiently wrung to prevent water running
from it. A dry cloth is to be several times wrapped around tins.
Place one of these packets on each side of the patient when in bed.
An abundant humid heat is soon developed by the combination of the
lime with the water, which quickly induces copious transpiration
the effect of the apparatus lasting for two hours at least. When
sweating is fully established, we may withdraw the lime, which is
now reduced to a powder, and is easily removed. In this way,
neither copious drinks nor loading the bed with coverings, is re-
quired. [Gazette Medicale.

Ferrugineous Pill of Mercury. The following formula for pre-
paring the above is recommended by Prof. McLean, in the Illinois
Medical Journal, of June, 1845 :

Mercury, 1 oz. ; Confection of Roses, 14 oz. ; Sesquioxide of Iron,
i oz. ; Liquorice Root in powder, -| oz.

Mix the iron and the confection of roses, then add the mercury, and
rub till the globules disappear ; lastly, add the liquorice, and tho-
roughly incorporate the whole into a mass.

The object of this preparation is to obtain the united effects of the
iron and mercury where both are indicated, to serve as a substitute
for the blue pill alone when required, and to possess a mixture of cer-
tain and uniform strength, and consequently uniform in its operation ;
while the addition of the iron renders the reduction of the mercury
an easy matter, requiring but five or ten minutes trituration for that
object. Country practitioners may accordingly find this formula
occasionally of essential service to them. [British Amcr. Journal.

A new Anodyne Prescription for Ulcers, by Mr. Callaway, of Lon-
don.An application composed of lime-water, mucilage and laudanum,
alleviates the, agony, and affords comfort in painful ulcerations.

Devcrgie's Ointment for Chilblains. Lard scvon drachms and a
half ; Creosote ten drops; solution of sub-acetate of lead, ten drops ;
watery extract of opium, one grain. [Lancet.

Formula of the Ointment used as a remedy O gains! Eczema, By

380 Chlorotic Pills. Ointment. Medical Convention. [June,

Devergie. The following is the composition of an ointment which
has been recognized, with justice, by all practitioners as particularly
useful in quieting the violent itching sensation in eczema:

R Lard 1 ounce.

Calomel .... from 30 to 40 grains.
Camphor .... from 3 to 7 grains.
The camphor must be dissolved in a few drops of alcohol before it
is mixed with the lard.

After the eczema has reached its last stage, the object is to restore
the skin to its natural color, to give it its former firmness, to restore
its tone as it were. For this purpose various kinds of ointment may
be employed, in one of these tannin is introduced.

R Lard 1 ounce.

Tannin .... 70 grains.
Or tar may be employed, but, in that case, ointments a fourth or
fifth of their weight of lard must not be prescribed, but a composition
after the following formula :

ft Lard. 1\ ounces,

Tar, from 7 to 15 grains.
The tar has great resolving power, hut it is also extremely exci-
ting to an eczematose surface. [Journ. de Pharm. Southern Jour.
Medicine et Pharm.

M. Bland's Chlorotic Pills. Let equal parts of sulphate of iron,
and sub-carhonate of potass be finely powdered separately, and ihen
intimately mixed. Beat them into a mass with tragacanth mucilage,
and make pills of six grains each. Commence with two three times
a day, and then gradually increase until six r.re reached, making
eighteen daily. [Translated.

Ointment for Blistering in half an hour. By M. Co^t>ret.
R. Hog's lard, 32 parts; oil of sweet almonds, 2 parts; strong solu-
tion of ammonia. 17 parts. Melt the lard, add the oil, then the
ammonia, which must be strong; and keep the contents of boltio
well mixed by shaking them until cold. [Translated.

MEDICAL INTELLIGENXE.

We copy from the Boston Medical and Surgical Journal, the following pro-
ceedings of the account of the meeting of the National Medical Convention :

National Medical Convention. Th<> delegates to this Convention met at
(he Medical College of the University of New Y< the 5th instl

At the preliminary Organization, Dr. Bell, r.f Philadelphia, was Chairm;
Dr. Buel, of New York. Secretary. The committee appointed m examine the
credentials of the delegates, reported that all aa 'many

regularly organized society, local and voluntary a>-< < iations as well as regular
colleges, institutions and sew onsidered members of the convention,

which report was eccepl en States Mere found to be represented (hy

National Medical Convention. 381

ate or other societies), and a committee of one from each State

ipointed to nominate officers of the Convention, who presented the follow-
ing nominations, w hich were unanimously confirmed, viz : For President, Dr.
J. Knight, of New Haven, Conn.; for Vice Presidents, Dr. Edward Delafield,
ot New York City, and Dr. John Bell, of Philadelphia ; for Secretaries, Dr.
Arnold, of Savannah, Geo., and Dr. Stille, of Philadelphia. Dr.G.S. Bedford,
representing the University of New York, thou moved that whereas the original
object of the Convention, that of a National representation, for the good of the
profession, had b< i by the non-representation of many of the States,

and most of the Medical Colleges and Societies, the Convention adjourn, sine

This motion was seconded by Dr. Pattison, alsooftheNew York Univer-
sity. The vote was taken individually, and not by States, and was decided by
On account of this motion. Dr. Clviner, of Philadelphia,
moved that the future sittings of the Convention be held elsewhere than at the
i rsity College; and another member proposed an amendment, that an

adjournment imtm made to the College of Physicians and Surgeons,

prs. Bedford and Pattison disclaimed all intention of opposing the Convention,
and it was decided that Dr. Clvmer's motion belaid on the table. A committee
of nine was appointed to bring the subject of Medical Education before the
Convention, consisting of Drs. Davis, March. Hays, Walter, Bush. Bell, Hax-
hall, and the President.

The accredited delegates on Tuesday were from the following institutions:
Vermont Casilcton Medical College, Vermont Medical College ; IN*. Hamp-
shireCentre District Medical Society; Connecticut State Medical Society
and Medical Institution of Yale College ; Xew York State Medical Society ,

al Society of City and County, Bloomingdale Asylum, College of Physi-
cians and Surgeons, King's Co. Medi< al Society, University ol'theCitv of New
York. Buffalo M Nation, Erie < << Me lical Society, Albany Medical

College, Gen< .,. Co. Medical Society, Geneva Medical College, Madison Co.
Medical Society, New York Hospital; Pennsylvania Philadelphia Medical

, Pennsylvania College; IV private individuals ; Delaware

State Medical Soci vsociation of "Wilmington ; Maryland Med-

ical College of Baltimore; Virginia S ; Georgia State

ciety; Mississippi State Medical Society; Indiana La Porte
University; Illinois Medical Department of Illinois College; Tennessee-
Island State Society. And on Wed-
nesday, the State \ 5 of Vermont and Missouri were represented,
also the Lunatic Asylum oi S w York Lunatic Asylum.
The following resolutions were preset sday by Dr. Davis, of

amittee on Medical Education, and after discussion" were unanimously
adopted :

"" - v he experience that the association of persons

gaged in the same pursuit, facilitates the attainment of their common objects;

that it is expedient for the Medical Profession of the United

al Association, for the protection of their in-
jbr the maintenance of their honor and respectability, for the advance-
of their kn nsion of then useful] :

be appointed to report a plan of
organizati.n , iation, at the meeting to be held in Philadelphia,

on the first V\ [847.

"3d. Resolved that a Comm unfed to prepare and i

the different regularly orga ies, and chartered

N al Schools, in the Unit ; setting forth the objects of the National

Medical Asso iati n a viting them to send delegates to a Convention, to

beheld in Philadelphia y in May,

"4th. R lard of

quir< i , 11 the Medical

Schools in the United Si I , be appoi

jjeport on th ting to beheld in Philadelphia, on the first

in Maw 1S17.

382 Prize Essays. [June,

'5th. Resolved, that it is desirable that young men, before being received as
students of medicine, should have acquired a suitable preliminary education,
and that a Committee of seven be appointed to report on the standard of acquire-
ments, which should be exacted of such young men, and to report ai the meet-
ing, to be held on the first Wednesday in May, 1847,

- 6th. Resolved, that it is expedient"' that the Medical Profession in the United
States should be governed by the same code of Medical Ethics, and that a Com-
mittee of seven be appointed to repdrt a code for that purpose,, at the meeting to
be held m Philadelphia, on the first Wednesday in Mayr J847-fl

Dr. O. S. Bartles, of New.York, offered the following ^resolution, which after
considerable discussion was referred to a committee of seven, by a vote of fifty-
eight to twenty-three.

" Resolved, That the union of the business of teaching and licensing, in the
same hands, is wrong in principle, and liable to great abuse in pr-aetke. Instead
of conferring the right to license on medical colleges, and Stats and eounty
medical societies, it should be restricted to one board, in such State,- composed,
in fair proportion, of representatives from the medical colleges,, and the profes-
sion at large, and the pay for whose services, as examiners, shwikLin-nsaegree.
depend on the number licensed by them/'

The Chairman announced the Various committees on Dr. Davis's resolution*
as follows :

" On the Organization of the National Medical Institution" D?rs..Jv Watson,
Stearns, Campbell Stewart, Stille, Davis, Cogswell, Fenner.

"On the Address" Drs. Knight, Ives, Dow, Sumner, McNaugfctoa, Blatch-
ford, Boswell, Baxlev.

il On the Requirements for a Degree" Drs. Haxhall, Cullen, Patezson (>Va>,
JNorris, Flint, Perkins. Wing. ' '

" On Preliminary Education" Drs. Cowper, Bush, Thompson (Del.Y March.
Atlee, Brainard, Mead. V

The closing business of the session, on Wednesday, as we gather frem the
New York papers, was as follows:

Dr. Thompson's resolution of thanks to the Colleges, for the offer of their
rooms for the Convention, was taken from the table and adopted. A member
moved a resolution to call on the different medical societies, in the different
States, to report the births, marriages and deaths in their several States. Car-
ried.A vote of thanks was then proposed to the officers of the Convention, for
the manner in which they had discharged their duties. Carried unanimously.
A vote providing for the publication of the proceedings of the Convention, m
pamphlet form, was then offered and adopted. A resolution was passed, provi-
ding for the arrangement of a system of nomenclature of diseases, with reference-
to the registration of deaths. An invation from Dr. Delafield (V. P.) to the
members of the Convention, to visit him at his house to-morrow (Thursday)
evening, was accepted, with thanks, and unanimously. Dr. Bell (V. P.) moved
that this Convention approve the designs and publication of the Sydenham
(publishing) Society, in England. Adopted. Dr. Cogswell offered a vote of
thanks to the chairman for the manner in which he had discharged the duties of
his office Adopted. Prof. Knight (P.) briefly returned his acknowledgments.
And the Convention then adjourned, sine die.

Prize Essays. The Louisiana Medico-Chirurgical Society, offers a gold
medal, of the value of one hundred dollars, for the best Essay on Strictures of the
Urethra, with their treatment. " This prize is offered to the competition of the
Profession in all countries ; but the essays must be written in the English or
French language. The communications must be accompanied with a letter and
corresponding mottoes, to the President of the Louisiana Medico-Chirurgical
Society, New Orleans, La., and should be received by the 1st Feb., 1847."

At a meeting of the Alabama Medical Society, held on the 12th February last,
it was resolved to offer a silver cup, as a premium for the best Medical History

1846.] Statistics of Medical Institutions. Electric Girl $c. 383

of the State of Alabama : the Essay, with the name of the writer, to be deposit-
ed with the Secretary of the Society, on or before the first Monday in December
next. A. G. Mabrt, Sec. Alabama Med. Soc.

Selma, March 1st. 1846.

Statistics of Medical Institutions of the United States, for the

Session- of 1845-6.
We have collected the following :

Name of College. No. of Students. No. of Graduates .

Medical College of Ohio, " 195 46

Willoughby Medical College. 164 30

al Department of Transylvania University, 171 58

Medical Institute of Louisville.
Jefferson Medical College.
University of Pennsylvania.
Albany Medical College,

Medical Department of "Western Reserve College.
Rush Medical College,
Pennsylvania Medical College,
M- dical College of Maine,
Harvard University.
Medical Department Yale College.
University of New York,
College of Phvsiciansand Surgeons,
Medical College of Geneva,

al College of Louisiana.

al College of South Carolina,
Philadelphia College of Pharmacy.

Department of University of Missouri,
al Department of St. Louis University,
Indiana Medical College,
Berkshire Medical Institution.
University of Maryland.

ton Medical College,
Medical College of Georgia. i\

Electrical Girl, again. We admitted an article from the Medical Times
into our last No., stating that the distinguished philosopher, M. Arago, had
ademy of Sciences of Paris, the appointment of a committee
to in v. -titrate certain singular phenomena he had witnessed in a young girl,
who by the mere touch of her apron, could overturn tables, chairs. &c. "\Ve
now learn by the last European Journals, that these wonderful performances
have been proven to be nothing more than "a clumsy piece of jugglery.'1

345

78

469

170

464 (bona fide 411)

168

115

41

161

10

38

73

180

31

53

4-25

131

200

38

178

103

19

214

74

16

92

30

11

81

18

112

35

117

140

36

112 (bona fide)

33

\ Advertisements by regular Doctors. "We have received, as we
mentioned in our last No., a notice of a hand-bill issued by two physicians of
this State, recommending a secret composition of theirs for Dyspepsia. We
perfectly agree with our correspondent in the views which he takes of such con-
duct on the part of regular practitioners. The ignorant empiric who stumbles
upon a combination which proves valuable, may be excused from withholding
from the public a knowledge of jte mode of its preparation at least something
might be said in palliation of hisconduct ; but the physician is not only bound
by the ordinary obligations of humanity, to make public his discoveries, but

384

Meteorological Observations. . Errata.

there is superadded a professional obligation, which he cannot honorably dis-
regard. We gi\re the composition, &c, of this powder, as furnished by our

correspondent

T$c Senna, loz.

Liverwort, ------- 1 oz.

Rad. Senega, or Serpentaria, - - - 1 oz.

Black Root, (Leptandra Virginica.) - - 1 oz. M.
Pour on two and a half pints of boiling water, let it stand from sixteen to twenty
four hours, according to the heat of the weather it' warm, sixteen hours. Then
strain, and add half-a-pint of Brandy. Dose, a lablespoonful three or four times
a day.

METEOB

OLOGIC

A.L OBSERVATIONS.

or April, 1846. at Augusta,

Ga. Latitude 33 27' north Long

itude 4 32' west "W ash. Altitude above

tide 152

feet.

> l Sii;i R

3, P. M.

WlND.

Remarks.

tfjTHER.

13AR.

Ther.

47~~

CAR.

29 87-100

1 44

29 85-100

N. .

Rain all day and night 5^ inch.

2

4-2

" 91-100

47

" 91-100

N. E.

Rain A-lOof an inch.

3

42

30

59

30 2-100

N.E.

Fair.

4

44

30 11-100

59

30 8-100

X. E.

Cloudy.

5

46

30 23-10!)

59

30 23-101

, N. E.

Cloudy.

6

49

30 23-100)

69

30 20-100

\ S. E.

Clondy.

7

53

30 12-100

70

30 3- lOt

| S. E.

Cloudy.

8

58

30

60

30

N.W.

Rain all day, 2-10 of an inch.

9

50

30 2-100

59

30 2-101

N. I"..

Cloudy drizzly.

10

51

29 97-100

60

29 95-101

N. E.

Cloudy do.

11

56

82-100

72

s.

Cloudy do.

12

64

" 67-100

63

; 55-101

s. w.

Haiu all day, 3-10 ol an inch.

13

48

; 71-100

58

" 71-10;

) V.'.

Cloudy.

n

42

;; 91-100

GG

93-101

I E.

['air. '

15

42

- 89-100

71

85-10!

VI E.

Fair.

16

48

;< 95-100

76

oo-i o<

1 8. E.

Fair.

(7

55

30

75

30 2-101

1 S. K.

Fair.

18

56

30 5-100

75

30 2- lot

) s. v..

Cloudy.

19

60

29 96-101

v..

Fving clouds.

20

57

30 1-100

83

30 6-101

I E.

Fair.

21

54

30 6-100

78

20 90-101

I s. E.

Fair.

22

54

29 92-100

75

- 87-10

) s. E.

Cloudy.

23

61

< 81-100

76

" 71-10

1 S. E.

Cloudy.

24

64

" 74-100

81

': 67-101

' s.

Cloudy.

25

63

;< 64-100

-1

60-101

I| s.w.

Cloudy Eclipse not seen.

26

GG

;: 54-10!)

74

47-101

) S. E.

Clom

27

62

58-100

64

" 58-10'

V E.

Cloudy. [rain 2 in. and 2-10.

28

57

38-100

61

- 30-10

) E.

Rain storm all night and day,

29

60

': 35-10!'

77

': 45-10

1 S. W.

Fair.

30

66

49-100

80

39-10

1

I-Iazv rain 1-10.

Only 8

Fair days.

Qua

itity of r

tain 3 inch

es and 4-10. 22 days wind east

of N. and

S., and on

ly 5 da

ys west ol

'do.

Errata. With all our care, mistakes will occur.. In the original communi-
cation of our last (May) No., on page 276. Une 10, insert a between "of and
"vera causa." Page 280, line 24, for "authe
line 13, for "me" read we.

: authentic" read asthenic.

Page 286,

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 1.] NEW SERIES. JULY. 1846. [No. 7.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXIII.

Cases connected with Pregnancy and Childbed. By John M. B.
Harden, M. D., of Liberty county, Geo.

Pregnancy, it is well known, induces very important changes in
the condition of the general system. At this time the animal and
Organic functions are stimulated to greater activity, and the vital
forces seem to be increased : hence the animal heat and the pulse
are very frequently above the normal degree the blood is increased
in quantity, and it is reasonable to suppose that the transformations
which it undergoes are greatly augmented important changes also
take place in the blood itself. The foetus being entirely dependent
Upon it for its nourishment and growth, we might anticipate an
increase in it of nutritive materials, and hence examinations have
detected a greater amount of fibrine and phosirfiatic salts, which be-
comes more obvious as pregnancy advances. A certain resemblance
has long been remarked between the blood of pregnant women and
that which occurs in inflammation. Mr. Hunter* says that " women
who are breeding and are in perfect health, always have sizy blood."
He observes also in the blood a peculiar deposit which, he supposed,
originated in the serum; he describes it as "a white scum, like
crcaiii."-\ Having remarked it more frequently in the blood of
breeding women, he "conceited, it might have some connection with
that state." It is possible that this may be the same substance de-
tected in the urine, to which M. Xanche has applied the term
Kiesteine.i and which has attracted so much attention of late as an

* on tin' Blood, vol. 2d, p. ii. t Op. cit., vol. 1st, p. 34

;m interesting paper on this subject by Dr. Kane, in Am. Jour. Med.
Sciences, tor July, J .

25

386 Cases connected with Pregnancy and Childbed. [July,

infallible sign of pregnancy. It is generally regarded as nothing
more than a modified form of caseine, one of the protienaceous com-
pounds, and the chief ingredient in milk.

Pregnancy, however, should never be looked upon as a morbid
condition of the system, but on the contrary as a natural, healthful,
invigorating process, and the disorders incident thereto should rather
be ascribed to a previous morbid state brought on by the injudicious
or improper habits of individuals. Indeed, the state of pregnancy
seems often to arrest, for a time at least, the march of many chronic
diseases, and induces a certain immunity from the attack of many
that are acute. Hufeland* says "Nature has wisely conceded a
certain immunity from diseases to this situation, and experience
proves that a pregnant woman is less liable to infections and other
disorders, and that the life of a female is never more secure than as
long as she is pregnant."

But notwithstanding this partial immunity enjoyed by pregnant
women, it is nevertheless true that they are sometimes attacked by
our ordinary endemic diseases, and it is important to know what is
the mode of treatment best adapted to such cases. It is for this
reason I have selected from my Journal the following, which are
connected with this condition. In relation to the treatment pursued,
I would remark, that if success be any criterion it may be considered
good ; but I beg here to suggest one word of caution to the younger
members of the profession in regard to the use of bloodletting. The
apparently inflammatory character of such cases seems to render it
absolutely necessary to a certain extent ; yet 1 would advise that as
little blood be drawn as we may consider consistent with a successful
termination, and for the reason that the loss of the child is to be taken
into the account, and it is demonstrable both from reason and expe-
rience, that if bloodletting be pushed beyond a certain extent, abor-
tion or miscarriage will be inevitable.

I am in the habit of using quinine freely in common cases of our
autumnal fevers, and always with marked good effects; but in regard
to its use in cases connected with pregnancy, I cannot say much.
From a single trial of it in a case of this kind I have been afraid to
use it since, and although my fears may be groundless, yet from the
course which the fever has pursued under my observation, and the
success attending another plan, I am disposed to believe that we may
dispense with it in these cases, and a judicious use of the lancet,

* Makrobiotik. Zweiter ThicI p. 107.

1846.] Cases connected with Pregnancy and Childbed, 387

cold applications, and gentle emetics or cathartics, as occasion may
require, will in general constitute the best mode of treatment. ^

With these remarks, I submit to the readers of the JournlWhe
following cases, in almost the exact words in which I find them re-
corded in my casebook.

Case I. Remittent Fever of double tertian type Pregnancy
three months advanced Recovery.

Oct. 11th, 1333. Called at night to visit Mrs. H. A , set. 18

years ; rather delicate, blue eyes, complexion pale, hair light ; preg-
nant the second time, about three months advanced ; had miscarried
last spring about the same period of pregnancy : she was taken with
fever on Sunday the 8th inst., after having been unwell a day or two
previously; she has a double tertian fever coming on every day at
irregular hours; she was largely bled on Monday, and moderately
again on Tuesday ; has taken two doses of oil ; her pulse is now 116,
of moderate volume it fell in two hours to 104; skin dry, tongue
a little furred, bowels loose; she complains when the fever is highest
of oppression in the chest and pain in the back and head. M. M. I
gave her 1 grain of tartar emetic in a tumbler of water, to be taken
in divided doses during the day, (12th,) and 10 grains of blue mass
at bed-time. About the time of the expected chill, apply sinapisma
to her extremities, and remove them from place to place.

13th. The tartar emetic produced vomiting after the second dose,
but was continued in smaller portions until bed-time. Blue mass
has not operated fever increased towards evening, but declined
again at midnight. Pulse now 104, of moderate volume ; skin cool,
other symptoms as yesterday. M. M. A dose of castor oil immedi-
ately, and continue the tart, antim. in small doses.

20th. Have not visited her since the 13th, but am informed to-day
by her husband that her fever has not entirely left her, although it
has never been very high. She has been worse on alternate days,
the fever increasing every evening. She has followed the directions
last given ; yesterday vomited two or more times after it took a
dose of castor oil which operated wellj to-day is better fever low.
She has had two or three chills since my last visit. M. M. I advised
Mr. A to apply a blister over the epigastric region, and give the fol-
lowing mixture : Tart, antim., gr. \ ; carb. soda, 3iss. in a tumbler
of water, to be taken in small and repeated doses. Diet simplo
and light.

388 Cases connected with Pregnancy and Childbed. [July,

She had some fever afterwards, but gradually improved, and has
finjjiy recovered.

Case II. Catarrhal Fever implicating the bladder Pregnancy
seven months advanced Miscarriage Uterine Hemorrhage
Death.

Dec. 24th, 1838. Mrs. E. G , set. between 20 and 30 years,

of good constitution, seven months advanced in her first pregnancy,
was taken with catarrhal fever about a week ago. I saw her on the
17th, and took about \\\. of blood from her arm ; saw her again on
the 22d, when I found her laboring under violent dysury, with pains
in the loins, increased upon lying down, particularly on her back.
The pain is throbbing and intermittent, although never entirely off;
urine deep-colored and of a gelatinous consistence; pulse 104, full,
hard. I bled her again, and prescribed a mixture of carb. sodae and
tinct. camphor in flaxseed tea. She passed again a restless night,
and on the next day her symptoms remaining the same, I took lli.
blood from her arm, and gave immediately 2 grs. of opium, which
soon relieved her. I left, with directions to drink freely a solution
of carb. sodas. She was very much alarmed when I left, (by the
chimney in her room taking fire,) and her pains returned as before ;
she complained afterwards of giddiness in the head. M. M. I took
fti. of blood from her arm this day, and gave her 60 drops of lauda-
num and a tea-spoonful of sweet spirits of nitre, which again relieved
her ; dose of oil.

25th. Spent a bad night; perspires freely; tongue very little
furred ; pains only severe at times : oil has operated well ; hands*
disposed to swell ; pulse 104, full ; perspiring; pain still in the back
throbbing as before ; dysury a little relieved ; bowels loose ; coun--
tenance good. She complains now of sore throat, which she says she
has had from the beginning. M. M. Mustard poultices to the back
and throat; laudanum to be repeated ; diet low.

26th. She has a troublesome cough ; pulse 104; skin perspira-
ble ; other symptoms same. M. M. No change in treatment.

27th. She has passed a bad night; perspired a good deal ; pulse
90. She took 20 or 30 drops of laudanum. She says she feels badly ;
inflammation of the throat better. M. M. Continue treatment if the
pains are severe; take 50 drops camphor.

28th. Bad night; the camphor did not relieve, although she took
two doses of 50 drops each. She took 20 drops of laudanum ; her

184C] Cases connected with Pregnancy and Childbed. 389

bowels were moved once, and caused great pain from griping ; urine
scanty; dysury increased ; pulse 96, full. M. M. A tea-spoonful of
magnesia and the same quantity of paregoric ; a blister on the inner
part of each thigh; gum-tea.

29th. Slept very little during the night, which she ascribes to the
drawing of the blister.'-. She took a tea-spoonful of paregoric ; the
magnesia operated without pain ; she vomited a quantity of bile.
The strangury and pain in the back less than they have ever been ;
pulse 90, full and strong; inflammation of the throat continues;
tongue clean. M. M. I took about ftss. blood from her arm; skin
became moist directly ; paregoric, if the pains return or she is rest-
less.

30th. She passed a comfortable night, no pain in the back or
strangury; urine not gelatinous; tongue clean ; pulse 90, full ; ap-
petite better ; throat still a little inflamed. Rff. M. A wine-glass of
lime-water morning and night ; bowels to be kept soluble by magne-
sia. I dismissed the case.

This unfortunate lady, I am informed by another physician who
was called to her assistance, was taken in labor on the 11th day of
January, 1839, and after a tedious time was delivered of twins on
the 15th. She was then attacked with hemorrhage, by which she
lost a large quantity of blood, and died exhausted on the 17th, just
eighteen days after my last visit.

Case IIP. Double Tertian Remittent Fever connected with Pregna?i-
cy four months advanced Miscarriage Recovery.

Aug. 14th, 1839. Called to day to visit Mrs. H -, in consulta-
tion: she is between 18 and 19 years of age, four months advanced
in her first pregnancy she was attacked with chill and fever on the
6th inst., which has assumed the double tertian type, attended with
great irritability of the stomach, and discharge by vomiting of a
large quantity of bile she has been bled four times from the arm ;
has taken one or two large doses of calomel, and other medicines.
I found her with a very high fever, pulse 128, full; uneasiness;
tongue dry, but not much furred; no pain ; skin soft ; bowels have
been moved three times to-rlay. M. M. I look .ywiii. blood from
her arm, and immediately gave % gr. of morphine, and left her for the
bight.

loth. Pulse to-day 92 ; passed a good nigh! ; skin cool ; perspired
profusely during the nighl ; bled a litile from tliG nose this morning ;

390 Cases connected with Pregnancy and Childbed. [July.

bowels have not been moved since I left ; tongue moist; no pain.
M. M. A dose of oil, unless her bowels are moved before 12, M. ;
blister over epigastric region. At 3, P. M., half hour hefore her ex-
pected chill, give | gr. of morphine, and apply mustard plasters to
extremities.

16th. The blister has drawn. Her fever increased yesterday,
her pulse rising to 116 ; but perspiration soon came on, and she
passed a comfortable night. Pulse this morning 90 ; skin soft and
cool, tongue clean and moist, countenance cheerful. M. M. Diet
moderate^-rno medicines.

Oct. 21st. This lady has been steadily getting better, but wa3
still paler than usual. She has, however been able to go about and
attend to her domestic duties until last evening, when, after a slight
disorder of the bowels, without any obvious cause or premonition, a
sudden discharge of liquor amnii took place, and at half-past 7 this
evening she was delivered of a dead foetus, much emaciated. The
presentation was a footling, and no difficulty occurred except a slight
obstruction in the inferior strait, whioh was easily obviated by a
change in the position of the head. The placenta came away in an
hour afterwards, and she was doing very well, and apparently recov-
ering rapidly until the 1st of November, when I was again called to
see her, I found that she had been going about the house ; her appe-
tite good, no fever, no inflammation of mammae. There had been
some secretion of milk at first, but it has ceased. For anight or
two past she has complained upon awakening of being chilly, but no
fever until this morning, when she was attacked with fever, preceded
by chilliness, which has continued all day. Her puise is now 130,
not full, nor hard, nor voluminous ; headache; slight nausea ; bowels
regular; tongue furrred; abdomen soft, not painful on pressure;
skin dry; respiration hurried, and attended with sighing at times;
countenance and intelligence good. M. M. Gave an emetic com-
posed of ipecac and tart, antim., and after it a Seidlitz powder, and
left her. I ought to remark that the lochial discharge has been
regular.

22nd. Rested a little towards morning ; pulse 02, respiration cor*
responding; skin dry, cool; little or no headache ; tongue clean and
moist; bowels not moved; says she feels much better. M. M. Re^
peat the Seidlitz powder, and be moderate in diet. She afterwards
recovered.

1846.] Cases connected with Pregnancy and Childbed. 391

Case IV. Double Tertian Remittent Fever connected with Pregnan-
cy six months advanced Miscarriage Recovery.

Sept. 7th, 1839. Mrs. H. S , set. about 20, six months ad-
vanced in her second pregnane)', was attacked with fever on Sunday
the lstinst., it returned on Monday, and has never been ofTsince,
but presents the characters of a double tertian, preceded by a chill
every other day she was bled, but has taken very little medicine.
I saw her to day she was very much distressed with headache,
nausea and vomiting, throwing up large quantities of bile. I assisted
the vomiting by small portions of ipecac in a large quantity of warm
water. After the fever rose, I took about gxii. blood from her arm,
and allowed her the free use of cold water. In the evening, I found
her relieved of the nausea, with less headache, moist skin, pulse 108,
bowels torpid. M. M. 12 grs. blue mass to-night, to be carried off
by oil, if it does not act alone. Soda water for drink.

8th. Morning. Threw up the blue mass last night ; took a dose
of oil this morning, which has acted twice, and she feels more com-
fortably; pulse 108, tense; skin soft, perspirable. Evening. In-
crease of fever, pulse 118, tense; headache, tongue moist. M. M.
Took gxviii. blood from her arm, and immediately after gave a dose
of morphine. Diet, gum-tea Drink, Soda powders.

9th. Chili returned this morning, with nausea and vomiting of
bilious matter great restlessness and apparent exhaustion, while her
pulse is hard and full. M. M. I took about gx. blood from her arm,
just after the chill, which seemed to prostrate her ; her pulse rose to
135, with pallor of the countenance, and I feared a collapse from
which she would not recover ; but her system reacted, and after 2
o'clock, P. M.,she became moist and her fever declined, pulse falling
to 104 in the course of the evening with profuse sweat ; her tongue
became moist from being very dry. She took nothing during this
time but gruel and water at 10 o'clock, P. M., I gave gr. of mor-
phine, and applied a blister over the epigastric region.

10th. Morning. Pulse 104, tense ; skin most, tongue dry, bow-
els torpid, some headach. M. M. A Soda powder mixed with gss.
common salts. Evening. Medicine had not operated, fever in-
creased, pulse 120, tense, hard. M. M. Took gxvi. blood from her
arm she was restless, and apparently very much prostrated. Left
her, and returned again at 8, P. M. She was still very restless and un-
easy ; pulse 120, or above ; beating of carotids very great ; tongue
dry; rather pale. M. M. Took s\ to gxit. blood from same orifice.

392 Cases connected with Pregnancy and Childbed. [July,

The cathartic having acted only once, I ordered an enema, but before
it was given she had a large evacuation; I then gave her a large
dose of morphine, say % grain, after which she passed a comfortable
night, her pulse being down to 104.

11th. Pulse rose in the course of the clay to 120, but her skin was
moist and soft ; tongue dry, husky. An enema, given this morning,
has operated once. M. lVf Took gxiv. blood from her arm, after
which she became faint, but soon revived, and I left her in the even-
ing with a pulse varying from 108 to 112.

12th. Passed a good night, fever low, her pulse this morning 104
and varying to 108; skin pleasant, soft, moist. Her pulse increased
in the evening in force and fullness, and her tongue from being moist
and nearly natural, returned to its former dry and husky state ; ap-.
petite better ; no pain, but uneasiness in the head. Took the oil,
which was afterwards repeated, and acted once copiously ; face pale,
but countenance natural. 3f. M. Diet to be nourishing; Soda water;
morphine at night.

13th. Passed a good night ; pulse this morning 112 ; tongue dry ;
thirst. This feverish state lasted till evening, when it abated with
perspiration, and I left her at 7, P. M., with her pulse at 100 ; appe-
tite better : skin pleasant; tongue moist, of natural color, not furred ;
bowels moved once to-day. M. M. Large quantity of Soda water ;
moderate diet, but nourishing.

14th. This morning I find her in every respect better rpulse 94 ;
but she had a return of fever in the afternoon, her pulse rising to 128,
and tense ; thirst great, headache, bowels soluble. M. M. Took
gx. blood from the arm ; ordered warm pediluvium and a pill contain-
ing gamboge and aloes, 1 gr. each.

15th. Her fever was very high after I left, and she was delirious :
it moderated at 3, P. M., and I found her at 6, A. M., with hardly
any; pulse 96 to 100, at which it has continued all day. She has,
however, a very troublesome pain in her neck, increased upon mo-
tion ; skin is pleasant, tongue good, bowels torpid. She threw up
the pill given last night, but it was repeated this morning. M. M. Or-5
dered a dose of oil, pediluvium at bed-time, and after an action on
the bowels, a dose of morphine ; neck to be rubbed.

lGtli. I was sent for early this morning to see her, and found her
in labor, which commenced a half hour ago, immediately after an
action on the bowels. The pains are violent and continual. I gave
an opiate, but soon found that it was impossible to prevent miscar-

1840.] Cases connected icith Pregnancy and Childbed. 3d3

Wage. The water soon came away, and the feet and body of the
child protruded. Being fearful of haemorrhage, I did not hasten the
delivery, which did not take place until 12, M., seven hours after the
commencement of labor. She had no pains after the delivery of
the body ; but during the violence of her pains, I feared she would go
into convulsions, her hands and arms being rigidly contracted. I
gave a few grains of acet. plumb, in the interval between the delivery
of the body and complete expulsion. After this she was very com-
fortable, pulse being 100 all day; but during the evening she had
some increase of fever as evidenced by a dry tongue, thirst, and a
senseofheat. Bowels were moved about 10, P.M. M.?I. Quietude*
low diet, cold water.

17th. No unpleasant symptom, and she is apparently' convales-
cent. Pulse 100 ; skin cool, pleasant. M. M. Same treatment.

19th. She is gaining strength: her appetite better ; tongue clean ;
no pain, but there is an uneasiness in the head, attended with throb-
bing; her pulse 108, with some quickness and tension. M. M,
Treatment continued.

26th. She has had more or less fever every day since I last saw
her, and she now has oedema of legs and face in other respects bet-
ter. M. M. I advised a combination of supertart. potash and rhubarb,
in laxative doses.

Oct. Gth. She has now pains in her ankles and knees, and mus-
cles of the calf. Jtf. M. Ungs. tart, antim. and infusion of Aristo.
jochia serpentaria.

^2nd. The disorder has left her, and she is much better.

Case V. Double Tertian Remittent Fever connected with Preg-
nancy six months advanced Recovery.
July 13th, 1840. Mrs. W. R , &. about 20, of good consti-
tution, rather robust, about six months advanced in her second preg-
nancy, was taken about a week ago with fever, on every other day
preceded by a chill, which has gradually passed into a regular double
tertian, with chill and fever everyday, but at different hours on alter-
nate days. The reaction is very violent: her pulse to-day is 132,
full, with great throbbing of the carotids ; hurried respiration ; heav-
ing of the chest; complains <,f hAgfa the region of the stomach and
pain in the pubic region; skin sor^crspirable ; countenance dis-
tressed ; moaning. 31. M. Took g-xvi. blood from arm her bowels
having been moved by medicines before given, 1 prescribed nothing
but thin gruel and cold water.

'94 Cases connected with Pregnancy and Childbed. [July,

14th. Found her in a chill which did not last Jong ; her pulse
soon rose to 140, and was full ; tongue red, clean ; otherwise as yes-
terday. M. M. Took gxvi. blood from arm ; then gruel, cold water.

15th. No fever, pulse 88, skin cool. Her fever rose, however,
in the afternoon, her pulse going up to 116, with nausea, burning at
the stomach, and headach. M. M. Poultice of the root of sassafras
to epigastrium ; thin gruel ; cold water.

16th. She was very sick last night, and has a return of fever to-
day ; pulse 112; burning at stomach; tongue red, clean; bowels
were moved early this morning; skin warm, moist; respiration hur-
ried. M. M. 9 grs. of blue mass to-night, to be followed by oil if
necessary.

17th. Medicine operated well six or seven times. Fever renew-
ed to-day at 10, A. M., with chill ; pulse 130, full; tongue clean,
red; face flushed ; skin moist. M. M. Took gxvi. blood from her
arm ; then gruel, cold water.

18th. Better pulse 103; no chill to-day; skin soft, warm;
bowels not moved to-day. M. M, If the bowels are not moved before
morning, dose of oil ; after this, an infusion of dogwood bark, (cornus
fiorida.) She rapidly recovered without miscarriage.

Case VI. Double Tertian Remittent Fever connected with Pregnan-
cy seven months advanced Miscarriage Recovery.

August 29th, 1840. Mrs. M. J , act. about 30, ofgood consti-
tution,? months advanced in her fourth pregnancy, was taken with
fever on the 2d inst., which has all the characters of our autumnal
double tertian. It has been attended with the discharge of larjre
quantities of bile. On the 31st, she was extremely ill : her pulse
rose to 144, and continued so for 5 hours. She has been troubled
with pain in the region of the liver, which has always been tempora-
rily relieved by a free vomiting of bile. She had been bled once
before I saw her. Her skin has been soft, dry, or moist, according to
the state of the fever. M. M. I treated this case by mild emetics of
hippo or tartar emetic, in small portions, dissolved or mixed with large
quantities of warm water, which always acted well and greatly re-
lieved her present distress. When the fever rose very high, I bled
her, particularly on the rise or d^pline of the paroxysm, and sponged
with cold water ; and in order to procure sleep or allay restlessness,
I gave minute portions of sulph. morphine, with good effect.

Sept. 2d. To-day her fever ought to have renewed, but it has not ;

1846.] Cases connected with Pregnancy and Childbed. 3P/">

her skin has been moist, and last night, after bleeding and a dose of
morphine, the perspiration was profuse. For three nights past she
has been threatened with labor, bat it has been prevented by mor-
phine. I have not dared to use quinine. Her bowels have been kept
soluble by mild laxatives, such as castor oil, Seidlitz powders, or
enemata. I have bled her three times, and having been bled once
before I saw her, I think she has lost in all 2^ lbs. of blood.

3rd. Had to day a little increase of fever, pulse rising to 106,
with warm dry skin, uneasiness about the region of the liver and
stomach, and she has thrown up a few mouthfuls of bilious matter.
The fever continued most of the night, but after the action of a Seid-
Jitz powder it began to decline ; and,

4th. This morning it is entirely off. M. M. I now directed a
cold infusion of chammomile flowers, (Anthemis nobilis,) and dismiss-
ed the case.

7th. Yesterday she walked across the room ; but to-day, without
obvious cause, she was taken in labor, and was safely delivered of a
seven months child, after which she convalesced rapidly, and soon
recovered..

Case VII, Double Tertian Remittent connected with Pregnancy four
months advanced Recovery.

Sept. 23d, 1840. Mrs. G. D- *; aet. about 22, rather delicate,
four months advanced in her fourth or fifth pregnancy, was taken with
fever on the 17th inst. On the 18th she was very ill. On the night
of that day, about 12 o'clock, she had a chill, after which the fever
rose, and has assumed the double tertian type. On the 20th she
had been seen by a medical gentleman who bled her. She was again
bled yesterday, losing in all about Ibiss. blood. Her pulse is now
120, full ; skin cool, soft, and alternately moist and dry. I gave her
at bed-time, h gr. sulph. morph., applied mustard plasters to her
feet, and allowed her nothing but flaxseed tea all night as a drink.

24th. Passed a comfortable night; was again bled by her hus-
band; has had all the morning what are called fainty turns ;" pulse
120, full. M. M. Took gvij. or gviij. blood from the arm. Gave
\ gr. sulph. morphia?, and ordered paregoric and gum-tea during the
night.

25th. Passed a good night, but her fever is unabated; pulse
120, full. M. M. Took same quantity of blood from her arm, Bow-
els not having been moved since day before yesterday, gave a mix-

396 Cases connected with Pregnancy and Childbed. [July,

ture of salts and snakeroot, (Aristolochia). Drink gum-tea; dose of
morphine at night.

26th. Fever moderated after I left, going nearly off by perspira-
tion ; headache was a little increased, which she attributed to the
snakeroot. The medicine did not operate until this morning. Had
a chill at 11 o'clock, P. M. ; after it took the morphine, and had a
goodnight. Pulse now 112; skin moist and soft, of natural tem-
perature. M. M. Took ij. or ^iv. blood from the arm ; gum-tea;
low diet.

28th. She was better yesterday, but I was sent for to see her
to-day. Not being able to go on account of an attack of fever under
which I was suffering, I obtained the services of a medical friend,
who tells me that her fever was not very high, and that he found it
unnecessary to do more than give her some simple medicines. She
soon recovered.

Case VIII, Double Tertian Remittent Fever connected with Preg*
nancy three months advanced Recovery.

Oct. 1st, 1942. Mrs. S. H , ret. about 20, three months ad-

vanced in pregnancy, was taken with fever on Thursday, 22d Sept.,
and on the next day she had to take her bed. She has been worse
every other day. On her worse days the fever returns at 11 o'clock,
with excessive bilious vomitings and slight chill: on the alternate
days, it renews at 4 o'clock, P. M., with a slight chill. Mr. H. bled
her once before I saw her. I visited her on the 27th her better
day : she then had little or no fever. On the 28th, I found her in a
chill, and vomiting bile. M. M. I assisted the emesis by giving
warm water and hippo, and after the fever came on, I took ft>j. blood
from her arm.

29th. Fevorcame on as usual at 4 o'clock, P. M., and was very
high that night, so much so that Mr. H. took by direction ibss. of
blood from her arm.

30th. The fever did not begin to increase until about 2 o'clock,
P. M., when she had a chill and vomited some bile. Pulse 120, full,
but not hard. Her pulse has never been above this, but has been at
85, and has varied between these extremes ; her bowels have been
confined, tongue nearly clean, intellect good, headache. This morn-
ing I received the following notes of the case, taken during mv ab-
sence by Mr. H. "She rested well all night, and complains only of
slight headach this morning. Yesterday afternoon^ 5} o'clock,

184C] Cases connected with Pregnancy and Childbed. 397

she was in a fine perspiration, with inclination to sleep, pulse 111 }
at G\, fine perspiration, sleeping souiHly, pulse 110; 7^-, skin dry,
disposition to sleep, pulse 110 gave a little chicken broth did not
sit well on stomach ; 8J, gentle perspiration, sleeping well, pulse 109.
9, P. M. Gave the pill of blue mass, (5 grains) ; moist skin, desire to
sleep, pulse 107.

"Get. 1st, 2 o'clock, A. M. Pulse 93, dry skin, slight headache,
sleeping well. 4, A. M. Pulse 96, moist skin ; gave the second pill
of blue mass, (5 grains). 9, A. M. Medicine not having acted, gave
a dose of oil; skin pleasant, pulse 106. 10, A. M. Medicine acted
well. 10$. Since the operation, fell into a sound sleep, fine skin,
pulse 97."

2nd. I found her this day free of fever, and in every respect so
much better, I dismissed the case.

Case IX. Tedious Labor Fever occurring on the fourth day after
parturition Loch ia arrested Recovery 4

November 24th, 1841. Mrs. S. R , eet. about 18, of good

constitution, was taken in labor with her first child on the 14th inst*
On the 15th, I was sent for to see her ; but not being well, could not
go until next day. She was not delivered when I arrived. On ex-
amination,! found the presentation correct, and in order to hasten1
the labor, I immediately ruptured the membranes. After two or
three hours, she was safely delivered of a healthy female child she
was doing very well until the 20th, four days after delivery, when she
/Was taken with fever and violent headache, which, not being reliev-
ed by some simple medicines, I was sent for to-day. She has now
violent fever, pulse 140, tense but small; tongue moist, not much
furred ; respiration hurried, irregular ; headache very severe ; lochia
arrested, very little secretion of milk; skin bathed in perspiration;
no pain in the bowels or abdomen on pressure ; bowels have been
acted on by some pills which had been given to her; no appetite, no
thirst. M. M. I took nearly gxvi. blood from her arm, when she
became faint ordered some simple drink, low diet, and left her.

25th. Little or no change in the aspect of the case : her pulse is
134. She complains of a very troublesome cough, and pain in the
course of the trachea : her head was relieved in the early part of the
night, and she slept very well, but the pain returned about 9, A. M.,
this morning, and is at times very violent ; bowels soluble. M. M.
Low diet, simple drink.

398 Cases connected with Pregnancy and Childbed* [July,

26th. Passed a good night, fever low ; pulse this morning is 124.
She is calm, and says she feels much better; appetite good; skin
cool. M. M. No medicines; dismissed the case ; she recovered;

Case X. Fever after Parturition, with a cklorotic condition of the
System Recovery.

March, 12th, 1839. Mrs. H. A., the subject of case 1, was deliv-
ered of a healthy child on the 3th inst., after which fever came on,
with most distressing cough ; her countenance is pale, and her con-
dition anaemic ; pulse 120 to 140, full and hard ; secretion of milk
normal as well as lochia; nipples sore; skin dry, hot. M. M. I
took 8 ounces of blood from her arm, and gave 1-3 gr. sulph. morph.

1 -" t h . No change, great pain in her head, restless nights. M. M.
Took 4 ounces of blood from her arrm Another dose of the morphia,
which did not agree with her.

16th. Pulse 140, hard, bounding; disposition to diarrhoea; milk
secretion stopped* M. M. Took 16 ounces of blood from the arm ;
gave a mixture of tart, antim. and carb. potass, at intervals of a half
hour.

17th. After taking two doses of the mixture, she vomited and was
taken with a diarrhoea, which continued to increase. The medicine
was immediately discontinued, and 10 drops of laudanum given ac-
cording to my directions, but the discharges from the bowels became
continual and involuntary. Ten drops more were given about mid-
night, when she fell asleep and slept till morning. The diarrhoea
to-day is very bad the discharges being still involuntary. Pulse
128; breathing 30, easy; tongue furred; anorexia. Every thing
that she swallowed seemed to pass immediately through her bowels.'
Skin dry, intelligence good. M. M. Chalk, 3i; paregoric, 5i ; to
be mixed and given in broken doses. Apply a blister to the inner
part of both thighs. In the afternoon, I found that she had had no
passage from the bowels after taking two or three doses of the mix-
ture. Pulse and respiration as before; blisters not yet drawn ; skin
perspirable. M. M. Continue cretaceous mixture food to be solid
blisters to remain until they have draWn.

18th. The blisters have drawn well and discharged freely. Slept
a little, but did not spend a very pleasant night. Muscular strength
increased ; no evacuation from the bowels since yesterday morning -r
milk secreted in small quantity ; lochia natural ; skin dry, face pale J
anorexia, pulse 120 ; breathing easy ; slight headache. M. M. Give

18-16.] Cases connected with Pregnancy and Childbed. 399

one of the following powders every three hours : R. rhubarb grs. 24,
creta praepar. grs. 48 mix, and divide into pulv. Xo. 12. Other
directions as yesterday.

19th. Sent for in haste early this morning. She had been a little
delirious during the night, and suffered from palpitation of the heart.
Pulse is now 120, full ; respiration 30 ; bowels had been moved after
taking 7 powders ; evacuations natural, but she is depressed m
spirits; tongue furred. M. M. A blister on each arm and leg, and
7 drops sesquichloride of iron ter in die.

20th. I find no alteration in the case. She complains of having
had during the night \evy unpleasant yet undescribable sensations,
whenever she attempted to fall asleep. Pulse, respiration and tongue
as yesterday. M. M. Took about 7 ounces of blood from her arm,
which although not properly colored, after coagulation had some
firmness and consistency ; 10 drops of a strong solution of sesqui-
chloride of iron ter in die.

21st. Pulse 116, not so hard; lips have more color; counten-
ance better; bowels not moved since yesterday morning, when she
had a small evacuation of hard consistence. Perspired yesterday
after I left. Did not rest well last night : at one time her toes were
observed to be cold, and at the same time she was complaining of
heat and removing the covering, but says she recollects nothing of
it. Her skin is cool ; appetite better ; tongue more natural in color ;
complains of pains in the lower part of her bowels, particularly
when she coughs ; cough troublesome ; pain in head at times violent ;
milk secreted in greater quantity. M. M. Continue iron, and give
a dose of oil if her bowels are not moved before 12 o'clock to-night.

22d. Took the oil, which brought away, at three different times,
hard, dark-colored, and offensive faeces. Complains of palpitation
of heart. Tongue and lips rather more pale than yesterday. Pulse
118, full, hard; some pain in the head; breathing 28, easy; secre-
tion of milk less; perspired yesterday and last night. M. M. Took
about G ounces of blood from arm; continue iron; diet, any thing
that she fancies.

23d. Better. Pulse 112; appetite better; slept well; tongue
and lips of more natural color; pain in the head slight. M. M. In-
crease the sesquich. iron to 15 drops ter in die.

21th. Pulse 116, full; slept well. Bowels not moved since the

.day before yesterday ; tongue of nearly natural color ; vomited after

taking the medicine and eating which I ascribed to the increase in

400 Cases connected with Pregnancy and Childbed. [July,

the dose of medicine. M. M. Took 10 ounces of blood from her
arm blood of a dirty color. Diminish the medicine to 10 drops, as
before.

23th. Pulse 120; nausea and vomiting this morning; appetite
bad ; bowels not yet moved ; tongue clean and nearly natural in
color; headache violent. M. M. 10 grs. blue mass, immediately to
be assisted in its action by oil, if necessary. Omit the iron,

26th. Pulse 108. Took some oil, which acted twice this morn-
ing. Headache very bad she thinks if it were not for that, she
would be well. M. M. Give a pill to-night, containing 1 gr. of gam-
boge and 1 gr. of aloes, and the same to-morrow night.

28th. Bowels were moved once this morning slightly. Pulse 120,
full ; appetite better. She is very pale. Other symptoms as before.
Mi M. Took 6 ounces blood from arm blood muddy ; 2 pills of the
kind last given every night.

30th. Pulse 104 to 108 ; skin cool, dry ; appetite very good 5
rests well at night ; head aches at times violently. Mi M. Continue
the pills for two nights longer.

April 27th. She has been gradually improving since my last visits
and is now going about, although still pale and enfeebled.

Case XI. Retained and adherent Placenta Excessive Il&mor'
rhage Puerperal Fever, terminating in death on the seventh day.
Jan. 8th, 1843. Rose, belonging to J. S. Fleming, set. about 35,
mother of many children, constitution good, was delivered this morn-
ing about 8 o'clock of twins, who were very small, probably immature,
and have since died. I was called to see her at l0 o'clock found
her laboring under the effects of great loss of blood her pulse was
scarcely perceptible, extremities cold, placenta retained ; the blood
was still flowing. M. M. I ordered immediately mustard plasters
to the extremities ; frictions of the feet, hands and abdomen ; the
application of cold vinegar, gin and water; and gave 3 grs. of acet;
of lead combined with 1 of opium, every fifteen minutes until she'
had taken three doses. In the mean time I introduced my hand, and
found the os tincse contracted the placenta adherent to the fundus,-
which was flacid, and not at all disposed to contract. I concluded
to wait and attempt to excite the natural contractions by frictions,
and consequently merely used my hand for a time as a tampon, until
1 could get something more suitable ; but in a short time she became*
pulseless, and appearing to be sinking. I boldly introduced my hand

1846.] Cases connected with Pregnancy and Childbed. 401

through the orifice into the fundus, and by tearing away the placenta
succeeded in delivering the most of it. The hcemorrhage now ceased,
and the womb began to contract so that it might be felt through the
walls of the abdomen as a hardened globular mass. Gave her ano-
ther dose of act. plumb, and opium, and left her.

9th. She has had no more hcRmorrhage there was a discharge
of clotted blood, and what was supposed to be another portion of
placenta. There is considerable febrile reaction, pulse 120, and
her tongue is covered over with a dark fur. M. M. Dose of castor
oil; after which, give in broken doses a mixture of salts and tart,
antim. ; 35 drops of laudanum at night.

10th. Pulse 130 she spent a restless night respiration hurried ;
great pain on pressure over the-region of uterus. M. M. A large
blister over the uterus, and one on each thigh.

11th. Had a severe chill last night ; pulse this morning 100;
lochial discharge free ; tongue cleaning. M. M. Gave some sim-
ple directions.

12th. Had a chill again last night. This morning she was taken
with severe pains in her abdomen, which is so exceedingly tender she
cannot allow the least pressure. Bowels confined ; pulse 110, some-
what full and tense. M. M. From her having lost so much blood, I
did not dare to bleed her, but prescribed a dose of oil with gr. mor-
phine, and warm poultices to abdomen. In the afternoon, as the oil
had not acted, the dose was repeated, and the blisters reapplied on
the abdomen and thighs. J gr. morphine to-night, to be repeated if
the first does not procure sleep.

13th. Passed a restless night quite delirious; had two chills,
and is disposed to be chilly on the least motion ; pulse 100, not tense ;
countenance hippocratic, voice weak, respiration jerking, irregular;
not so much pain on pressure ; tongue whitish oil acted three times.
M. M. Perfect rest, and blister to each leg and forearm. In the
evening, blisters had drawn so that she complains of them; bowels
loose ; pulse 100. Prescribed now a powder of calomel grs. 2; mor-
phine gr. ,\, to be iven at 8, P. M.,and another at 10, P. M., unless
the first produced sleep : in that case put otf the second dose until
morning, Warm poultices over the abdomen.

14th. She appeared lo be a little better; her pulse was at 06;
pains less. The symptoms, however, soon became alarming, and in
the afternoon I found her sinking. She died that night.

26

402 Cases connected with Pregnancy and Childbed. [July,

Case XII. Fever after Parturition connected with a chlorotic con-
diiion of the system Recovery.

June 26th, 1843. I was called this morning to visit Mrs. O. B ,
set. about 22, mother of two children, the last born on the 23d.
During her pregnancy, she was in very bad health, with swelling of
the face and symptoms of chlorosis. The labor was natural, and
every thing went on well. Since her confinement, she has had con-
stant fever. She lost after delivery a larger quantity of blood than
usual, as I am informed, for which 3 grs. of acet. plumb, were given.
I saw her about 3 o'clock this morning. She had not slept during
the night. Pulse 132; respiration about 30; no pain; some uneasi-
ness about the region of the uterus. Countenance sallow, anaemic ;
tongue and lips pale; face swojlcn ; bowels loose; restlessness.
M. M. Took about gxii. blood from her arm the blood was watery ;
gave \ gr. morphine. At 9 o'clock she was very nearly in the
same state. Gave the following: sulph. magnesia 3 i., carb. sod. 3i,
tart, antim. gr. i. mix in 6 ouncesof water, of which give 3i. every
hour. In the evening I learned that the medicine had caused vomit-
ing of bile. She had been very restless, and her pulse had risen to
150. It is now at 132, still full ; slight action of the bowels. M. M.
Took s v i i j . blood from her arm; gave 20 grs. of carb. potass, in a
tumbler of water, to be taken at intervals, ^gr. morphine at bed. time.

27th. Pulse 148 ; respiration 36 ; skin perspirable ; passed a more
pleasant night than usual; bowels soluble, tongue nearly clean; in-
tellect clear. M. M. 1 gr. of carb. potass, every hour.

28th. Passed an unpleasant night, unable to sleep. Pulse 132,
not tense; breasts enlarged, hardened, painful: other symptoms as
yesterday. M. M. Blisters over each mamma, and one on each
thigh ; potash, as before. She spent a quiet day, but in the after-
noon, after getting up, she had a chill and an increase of fever her
pulse rising to 156, and becoming tense. M. M. I now took vj. of
blood from her arm, and ordered 5 grs. blue mass to-night.

29th. Passed a comfortable night; pulse now 132; respiration in
proportion; blisters had drawn well; mamma soft, not painful;
tongue nearly clear; bowels confined. M. M. A dose of castor
oil. Evening Pulse 144 ; has been quiet all day ; some cough,
which is always troublesome upon an increase of fever. Skin cool,
rather dry; medicine has acted well. M. M. 1 gr. carb. potass, and
TV gr. tart, antim. every hour.

30th. Pulse has been at 132 most of the day she has, however,

1846.] Cases connected with Pregnancy and Childbed. 403

been quiet ; skin cool, tongue soft, moist, no pain. M. M. Same
medicine continued, and application of a poultice of red oak (Quercus
Rubra) bark and acet. plumb, to hasemorrhoids from which she is
suffering; gr. morphine at bed-time.

July 1st. Spent a comfortable night. Pulse this morning 130;
skin cool; tongue more natural in color, and clean. M. M. 3 grs.
rhubarb every 3 hours; paregoric at bed-time.

2d. Comfortable night ; pulse 125 ; skin cool, soft ; tongue nearly
natural; no pain. M. M. Continue rhubarb.

3d, Puke 120. Passed a comfortable night. Bowels confined ;
cough troublesome. M. M. A dose of oil, and continue rhubarb.

4th. Bowels well acted on, and she slept well last night. Pulse
120; appetite increasing; countenance good. 31. N. Continue
pills and I dismissed the case.

This lady completely but slowly recovered, and enjoyed good
health but was again attacked in a similar manner after labor with
her third child, in April, 1845, and died. I saw her only once, a3
consulting physician.

Case Xfir. Pregnancy Death of the Foetus about the Sfh month
of Utero -gestation Child born dead at the end of full term.
May 29th, 1843. About a month ago, I was consulted by Mr. A.,
in relation to his wife, (the subject of cases 1st and 3d,) who was 8
months advanced in pregnancy, and who supposed, that from a cause
unknown the child had died, inasmuch as she had felt no motions for
several days, and my advice was asked. I directed her to do nothing
but wait, and not be uneasy at her situation. On the 26th inst., sho
was delivered of a dead child, of the ordinary size, well formed,
without any symptom of putrefaction in any part. The surface was
of a purplish hue, amounting in some places to lividity. For the
last month she had felt no motion of the child, but occasionally an
upward and downward motion of the tumor, which may have been
due to the action of the womb itself. I was sent for to see her to-
day, on account of some neuralgic pains in the region of the uterus,
which were soon relieved by anodynes.

Case XIV. Pregnancy Death of the Pectus previous to quick-
ening Child born dead at the end of the full term.

Aug. 80th, 1815. I was called to-day to visit Klsy, a negro wo-
man belonging to .Mr. L. T,o Conte mother of five oj six children.
The following is the account which I obtained from her at the time.

404 Cases connected with Pregnancy and Childbed. [July,

From the fallacious nature of this kind of testimony, full reliance
cannot be placed upon it, at least so far as regards dates ; but I have
no doubt of the general fact that she carried a dead foetus in her
womb for several months. She has not menstruated since November
or December last ; and although she has had an obvious enlarge-
ment of her abdomen, she has never had any other reasons for be-
lieving she was pregnant. She has never felt any motion of a foztus
in uiero. Last night she suffered greatly from pain in the region of
the uterus, and I was sent for this morning to examine into the na-
ture of a tumor she had in her abdomen, which was the cause of her
suffering. I found a tumor about the size of a distended bladder in
the pubic region, ^vhich was painful on pressure, and she has regular
intermittent pains and a slight discharge of blood, which she supposes
to be menstrual. Her mother having died of schkrus of the uterus,
I must confess I began to think the daughter was about to follow. I
however, proceeded to make a more careful examination ; but before
introducing my hand, she told me she felt something coming away
from her whereupon she sat upon a chamber-pot, in order to facili-
tate its descent. After some time, as it did not come away, I made
an examination, and felt what I supposed was a polypus tumor; but
was soon convinced that I was wrong ; I then ruptured the membrane,
which enclosed a dead fcetus and the mystery was then revealed
in a short time it was expelled : its length was about 9 inches, greatly
emaciated, but well enough developed for a child of five months.
The sex was readily discernable its gender masculine.

Case XV. Prolapsus Vaginaz during labor Haemorrhage from
the Vaginal Mucous Membrane Delivery by natural means,
Aug. 5th, 1842. I was called to see Peggy, belonging to Dr. S.
Way, whom I found in labor, and strange to say, the mucous coat of
vagina greatly distended was protruded far beyond the vulva, and she
had lost (as I am informed by the nurse,) for three or four days past, a
considerable quantity of blood. The head of the child could be felt
low down in the pelvis, and the vagina seemed to be advancing before
it. I at first thought it might be procidentia uteri, but I am now con-
vinced that, although low down the os uteri was not beyond the
vulva. Labor went on naturally, and she was delivered and after-
wards did well. This affection appears to me to be very near akin to
that of the conjunctiva in severe opthalmia, which is known as che-
mosis, and may be considered chemosis of the uterus.

1846.] Th* Morbid Effects of Tight- Lacing. 405

ARTICLE XXIV.

The Morbid Effects of Tight-Lacing. By Thos. W. Carter, M. D.,
of Abbeville District, So. Ca.

Since I entered upon the duties of my profession, I have frequently
been called on by elderly ladies to answer the following questions :
"What is the cause of the modern prevalency of uterine derange-
ments, and more especially of prolapsus uteri ? Why, in our youthful
days, was it of rare occurrence, to meet with a woman thus affected
while of late it is equally rare to find one who is not at times more or
less troubled with falling of the womb." Such questions naturally
suggested to my mind, as the cause, some impropriety in the habits
of females of the present day. I knew it to be an unequivocal fact,
that cases of prolapsus uteri and uterine derangements, generally, in
modern times, compared with those of former days, (with due regard
to increase of population,) were greatly in excess, if not in the ratio
of three to one.

My being at first unable to give a decisive answer to these frequent
and very rational inquiries, actuated me to inquire into the subject
of the modern causes of the diseases under consideration, which
brought me to the following conclusions: 1st. That the excessive
prevalence of uterine derangements, in modern days, is owing to the
unnatural and destructive practice of tight-lacing, so general among
the female sex. 2nd. That such a practice does induce constitutional
debility in the female economy. 3rd. That this constitutional
debility is transmitted from the mother to her offspring, or at least
the effects wrought upon the constitution of the mother affect her
offspring.

I now propose examining each successively in the order in which
they occur.

I. That the excessive prevalence of uterine derangements, in mod-
ern times, is attributable to Tight-Lacing.

In enumerating the uterine diseases which appear often to be
engendered by this destructive fashion, we find the various displace-
ments of the uterus viz: prolapsus, procidentia, retroversion, dec,
standing first in the catalogue. 2nd, abortion ; 3rd, menorrhngia ;
4th, the various derangements of the uterine functions viz : amenor-
rhea, dysmenorrhcea, leucorrhcea, dec, dec.

1st. The various displacements of the Uterus. The manner

406 The Morbid Effects of Tight-Lacing. [July,

ia which tight-lacing is instrumental, in the production of these
loathsome maladies, is plain and obvious. The cruel compres-
sion exerted by an unyielding bodice, environing the inferior por-
tion of the thorax and the superior portion of the abdomen, can not
but act injuriously. It forces the contents of the abdominal upon
those of the pelvic cavity. From the long-continued and almost
constant intrusions of the abdominal viscera, the ligaments which
support the uterus become relaxed and so much weakened as no
longer to be capable of sustaining that organ, together, with the
weight of the whole contents of the abdomen thus forced down : con-
sequently the uterus, by degrees, is forced lower and lower into the
pelvic cavity, until prolapsus, or some other displacement, is the una-
voidable result.

2d. Abortion. Abortion maybe produced by plethora of the uter-
ine system, which, from the engorged state of the capillaries of the
uterus, is adequately calculated to induce a separation of the ovum at
any period of gestation. Such a condition of the uterus is known to
be inimical to the existence and safe repose of the ovum in its cavity:
consequently, under such circumstances, conception is not likely to
take place, and if it do lake place, is likely soon to be followed by a
separation and expulsion of the germ. This condition of the uterus
may be readily induced during gestation, (even in those who have
previously enjoyed good health,) by the impediment offered to the
free return of the blood to the heart, by compression necessarily em-
ployed in tight-lacing, as well as the mechanical pressure of the
uterus upon the pelvic veins, when that organ is more compressed by
the detrusion of the abdominal viscera.

Ahortion may also be induced by an opposite condition of the
uterine system to that above described that of anaemia, relaxa-
tion, &c.

In ladies who have been tenacious in adhering to the modern
fashions from early life, this condition of the system is of common
occurrence. In them we find an ample evidence of the debilitating
and relaxing influence of modern fashion on the female economy,
and more especially upon the functions of the uterine system.

Abortion may likewise be induced by an "inability in the uterus
to extend itself beyond a certain size." We can readily imagine this
condition of the organ, in the victims of the modern laced-iackct.

3rd. Menorrhagia. This hemorrhagic discharge may be either
active or passive, or at least connected with a plethoric or hyperergic

1846.] The Morbid Ejects of Tight-Lacing. 407

condition of the uterus, or with a debilitated or antemic state of the
general system. The former condition may be the immediate result
of the mechanical impediment offered (by excessive lacing) to the
free passage of the blood to the centre of the circulatory system,
thereby inducing an engorged condition of the capillaries of the
uterus. The latter condition (that of anecmia) may be the mediate
or secondary result of this impediment offered to the circulation.
The plethoric condition may not in every instance result in hemor-
rhage, but, by inducing menstrual irregularities and derangements,
the general system will become chlorotic, and so much debilitated,
the uterine capillaries relaxed, and the whole mass of blood so much
vitiated and attenuated, as to result in passive menorrhagia.

4th. Amenorrhea.) Dysmenorrhea, Leucorrhaia, <5*c, fyc. That
the many menstrual irregularities which appear to be so very preva-
lent, of late years, are in a great degree owing to the infatuation of
modem fashion, no one of observation and information will deny.
It is true, there are other causes which are very efficient in the pro-
duction and perpetuation of menstrual irregularities and derange-
ments, but I think it will be conceded by the reflecting mind that
many of those derangements are attributable to female dress, and that
much of the suffering and inconvenience to which many females are
subject might be obviated, if they would but dispense with the laced-
jacket.

IE. That excessive lacing does induce constitutional debility in
females.

The practice of tight-lacing, we have seen, is very efficient in the
production of uterine derangements, in which the general system of
necessity must participate. The whole mass of circulating fluid ap
pears to become deteriorated.

The female, notwithstanding all her native beauties and perfec-
tions of form and constitution, is now compelled to lie down upon the
bed of affliction and deplore the loss of all her fascinating charms.
Where is the rosy tint that once decorated these pale and blanched
cheeks ? Where is that sprightly, bouyant, and benignant expression
that once sat upon this dejected countenance? Where that sym-
metrical, that beautiful, that lovely form? Alas! how changed.
We now behold the pallid check, the lusterless eye, the distorted coun-
tenance, indicative of pain and suffering the emaciated frame and
incurvated body immaturely and untimely drooping into the grave,
before half the days allotted to woman have parsed away.

403 The Morbid Effects of TigJit-Lacing. [July,

Perhaps it may be proper, while upon this division of our subject,
to notice some of the evil effects of tight-lacing upon the various
organs of the body, and the multifarious diseases that may result
therefrom.

The lungs appear to suffer materially from this practice. Any
person of observation may satisfy himself of the truth of this asser-
tion by observing the motions of the chest during respiration. He
will observe that it is impossible fully to inflate the lungs. The res-
piration is short and quick, inspiration is about half as long as expira-
tion, and that there is a considerable interval between expiration and
inspiration. During this interval, the lungs are inactive and blood is
passing through them, without the benefit of the oxygen of the atmos-
phere, and thus proceeds unoxogynized to the heart from thence to
be distributed to the various organs of the body throughout the gen-
eral system.

May not such a perversion of the function of respiration and conse-
quent unfitness of the blood to subserve the important purposes of
nutrition, be considered a very efficient cause of the early develop-
ment and maturation of tuberculous deposition in the lungs ? May it
not be regarded a prolific source of that irritable and cachectic con-
dition of the system which appears to characterize the modern fash-
ionable lady. The heart, the stomach, the liver, and indeed almost
all the viscera of the thorax and abdomen, appear to be obnoxious to
injury from the improper encroachments of the laced-jacket, by which
are induced, directly and indirectly, a host of diseases known to de-
pend upon a deteriorated quality of the circulating fluid, together
with a perverted and deranged nutrition.

Lacing, when carried to excess, is unfavorable to longevity in a
high degree, terminating life ere the span be half measured. Show
me the matron, who has attained her three score years and ten, and I
will show you a lady who was a stranger to fashion in her youthful
days.

For the purpose of corroborating the position I have assumed, let
us draw a contrast between the rustic maid, and the city belle, the
victim of modern fashion in mature life, when the duties of wife
and mother devolve upon them. The former is sprightly, active, and
vivacious her countenance lively, animated, and expressive of good
health her mind buoyant amidst all the troubles and vexations ne-
cessarily attendant upon the duties of a mother and housewife : she
enjoys the blessings of health, and the society of friends she pos-

1946.] The Morbid Effects of TighuLacing. 409

sesses a calm, serene mind, and is capable of meeting any reverse of
fortune with fortitude she is blessed with healthy offspring, and gen-
erally lives to see them grown up and acting for themselves. But
the votary of modern fashion, how reversed her condition in after life I
Her corporeal powers at an early period hegin to evince decay her
intellectual faculties to manifest imbecility her mind becomes
irascible, and her temper fretful and peevish. Such women are gen-
erally sterile, or at most conceive but a few times. The first may
possibly reach the full term of gestation, after which abortion is a
common result. The functions of the generative organs finally be-
come entirely or so nearly suspended as to render all possibility of a
future offspring extremely doubtful.

II f. That constitutional debility is transmitted from the mother to
her offspring, or at least, the effects wrought upon the constitution of
the mother are felt by her offspring.

The practice of excessive lacing interrupts to some extent the
sympathetic communication between the uterus and mamma,', and
when the functions of the latter are called into action, they are feebly
and but imperfectly performed, consequently those unfortunate vic-
tims to the trammels of this delusive fashion, after the cares and du-
ties of mothers devolve upon them, in many instances, find it impos-
sible to nourish at the breast their tender offspring. And besides the
deprivation of that maternal pleasure, which all mothers find in nour-
ishing their own offspring, she is constrained to witness as the conse-
quence of artificial nourishment, the tortures and pains of disease,
and frequently the agonies of death, from the supervention of colic,
diarrhoea, or some of the many gastric and intestinal derangements
to which children under such circumstances are peculiarly obnoxious.
Here it is evident the sins of the mother are entailed on her innocent
offspring.

And farther, it is reasonable to suppose from the morbid condition
of the system, met with in such women, that even when milk is
secreted in sufficient quantity for nourishment, it is of a very deterior-
ated quality, calculated to ruin the health and undermine the con-
stitution of her child.

I have now answered, to the best of my humble abilities, the ques-
tions so often propounded to me; if satisfactorily, I shall he truly
gratified if otherwise, I hope a better explication will be furnished
by some one better qualified than myself to do justice to so interest-
ing and important a subject.

410 Arachnitis, or Hydrocephalus acutus. [July,

ARTICLE XXV.

Arachnitis, or Hydrocephalus acutiis : with a few Remarks. By
Wac. Williamson, M.D., of White Plains, Benton County, Ala.

Arachnitis is not an im frequent form of encephalic inflammation,
and may be justly looked upon as a very dangerous and fatal disease
of early life. It has of late years become a subject of great interest,
not only on account of its fatality, hut also from the great diversity of
opinion that exists with regard to its pathology. Several very emi
nent physiologists and pathologists, have elaborately and carefully
investigated its nature, and have generally come to the conclusion
that its true pathology consists in an inflammation; which in many
instances is followed by effusion upon the brain or into its cavities.
But this is not invariably the case ; in some, the inflammation may, by
appropriate treatment, be overcome and not arrive at the point when
much effusion takes place. Cases may occur where there is no active
inflammation existing; the pathological condition of the parts con-
sisting in a congestive or an engorged state of the arachnoid vessels,
hut such cases are probably rare, even in attacks where the progress
of the disease is quite slow, there seems to be a chronic or subacute
grade of inflammation, which gradually augments in intensity and
clanger, in proportion to the degree of irritation producing it and the
neglect of appropriate treatment. I purposely avoid giving the
general causes and symptoms, as they are laid down fully in different
authors, and the detail would only serve to extend this communica-
tion beyond its proper length. Arachnitis generally occurs during
childhood, but the most of physicians of observation have seen cases
that might be placed under this name in subjects past childhood, if
certain symptoms will serve to establish or designate this abnormal
condition of the encephalon. It must be confessed, however, that
there are in many cases great difficulties in the proper diagnosis of
this disease. I have seen a considerable number of cases of cholera
infantum, which were attended with, and some sunk under, the gen-
eral symptoms of hydrocephalus internus, such as stupor, starting and
screaming, dilated pupils, paralysis of the extremities of one side,
paralysis of the upper eyelids, strabismus, eyes drawn to one side or
towards the nose, green stools, &c. Yet among those laboring under
these symptoms of effusion and compression, some have recovered
and remained free from any of the effects of effusion on the brain.
I have seen cases classed under the general term of fever, that pro-

1840. J Arachnitis, or Hydrocephalus acid us. 411

bably might with more propriety have been designated arachnitis,
and some again, during the course of fever, assume the form of hy-
drocephalus. I will abstract a case or two from my note-book, illus-
trative of these views, which may be of service to others under
similar circumstances:

During 1343, I was called to see a little girl aged about 6 years;
her parents stated to me, that about two weeks previous to my visit,
she had fallen and struck her head with considerable force against a
log; that she complained a good deal at the time, but afterwards only
of some pain or head-ache every day. She gradually lost her appe-
tite, became melancholy, &c, and which was succeeded by feverish
symptoms, with considerable prostration of strength. The family
treated her for a few days with common domestic remedies, and then
called me in. I found her laboring under fever of the typhoid type,
great prostration of strength, loss of appetite, flushed cheeks, fre-
quent and contracted pulse, pretty constant pain in the head, mind
correct when aroused, but at times there was slight delirium. I pur-
sued such a course of treatment as appeared most appropriate at the
time ; (the acute stage of the disease having principally passed over,)
viz., rubefacients, blisters, purgatives, diaphoretics, cold applications
to the head, small doses calomel, &c. But the disease continued its
course unchecked the pain in the head increased greatly, with pros-
tration, delirium, stupor, dilated pupils, some paralysis of the extrem-
ities, then coma and death.

On the 18th Sept., 1844, I was called to a negro boy aged about
11 years. His master stated that he had appeared very drowsy for
a few days, but had not complained of being unwell, and his appetite
was good. On the loth, he was taken with stupor, continued sleepi-
ness, muttering delirium, chilliness, &c; which symptoms were
treated with common domestic remedies. On the third day of his
confinement, I was sent for to see him: he had become less stupid,
and had marked paroxysms of fever of the typhoid type. His case
was a very lingering one, and during its progress there was pretty
constantly low delirium. About the 21st or 22d day of his sickness,
there were evident symptoms of convalescence. He continued to
improve about ten days, at which time his appetite was good, bowels
tolerably regular; he could sit up half the day, without apparent in-
jury ; could bear lobe takes out a half mile in a carriage, without
fatigue; and as far as symptoms of convalescence were to be de-
pended on, he appeared to be recovering. At tins stage of his

412 Arachnitis, or Hydrocephalus acuius. [July,

sickness, the nurse let him strike the posterior part of the head upon
the floor, with considerable force; yet he complained but little of it
at the time; he was put to bed and rested pretty well through the
night. Next morning he appeared rather more dull and drowsy than
usual, but which did not create any uneasiness until his breakfast
was taken to him, when he was discovered to be completely coma,
tosed, with muttering delirium, pupils dilated, &c. I had discontinu-
ed my visits, but was immediately sent for, but before my arrival
he expired, in about six hours after the change was discovered. No
examination was made. I do not say that in these cases there was
effusion on the brain I only give them with their symptoms, and
leave others to form their own opinions.

The following case is one of such severity, attended by so many
symptoms generally denominated fatal, and withall a recovery from
a state apparently hopeless, is so unusual, I think it my duty to publish
it in your valuable Journal; so that if it should fall to the lot of others
to have such cases, they may not despair :

E. B., was born March 1st, 1341, was a healthy, lively child,
and tolerably corpulent. About the 1st of September following,
she was somewhat indisposed; had slight feverish symptoms, some
bowel affection, starting and disturbed sleep, fretful, &c. For these
symptoms the child took small doses of calomel and James' powder,
which appeared to give some relief. On the 7th Sept., she was sud-
denly seized with convulsions, which were very violent. I was from
home when the message arrived ; but on my arrival, about three
hours after the attack, I found my little patient still in strong con-
vulsions extremities rigid and variously distorted, the eyes drawn
upwards, so that the pupils could not be seen only at times when the
paroxysms would slightly relax, and they were found greatly dilated,
apparent insensibility to all external impressions. Before I arrived,
another physician was called in, who had used the warm bath and
applied sinipisms largely to the breast and abdomen, and also to the
extremities. I cupped the child pretty freely, and repeated it twice
afterwards, with some apparent benefit. I used also the warm bath
and such other external applications as appeared proper in the case,
and as soon as my little patient could swallow, which was not under
30 hours, I gave calomel and James' powder in small doses every two
hours, while cold was freely applied to the head. I also had a bath
prepared with cinchona, and used occasionally, and in the course of
the disease there was a blister applied on each temple and on the
back of the neck, which drew7 well.

1846.] Arachnitis, or Hydrocephalus acutus. 413

One thing I neglected to mention The sinipisms on the chest and
abdomen were neglected until they completely vesicated the whole
surface to which they were applied; so that the greater part of the
breast and abdomen was denuded of the cuticle.

8th. The little sufferer still had convulsions ; the skin is pale,
has cold extremities ; the pulse is sometimes imperceptible ; the eyes
have a dry and glassy appearance ; and the patient is comatose and
insensible. It appeared almost impossible for the child to live until
morning.

9th. Symptoms nearly the same. Patient's strength is greatly
exhausted, consequently the convulsions were less violent.

10th. Same, only lighter ; the vision is apparently lost, but when
the nipple was placed in the mouth, the child would draw a little.

11th. Same state.

12th. Same, until night, when the symptoms moderated, with the
exception of the eyes, which were still convulsed. The little
patient was left in a very feeble and exhausted condition. The
sight appeared to be completely lost for about two weeks. The left
extremities were paralyzed they did not partake of the growth
of the child, but rather appeared to diminish in size for a considera-
ble time.

At twelve months, the child could scarcely move the leg and foot
of the left side, and was unable to grasp any thing in the left hand.
At fifteen months, she began to walk, by dragging the foot ; and at
two years, the left lower extremity appeared to be without power, and
in walking she draped it so as to wear off the skin from the upper

ODD

part of the toes.

At this time, 1846, she is a lively, hearty child ; her head does not
appear unusually large, nor her intellectual powers impaired. But
she has still considerable lameness in walking, the foot turning out-
wards, and still some dragging of it. She cannot use her left hand
and arm near so well as the right. I might mention that, after the
convulsions ceased, I used while the symptoms of effusion continued,
principally, calomel, James' powder and absorbents, which treatment
was continued for a considerable time, so as to keep up an aperient
and alterative effect on the system.

414 Sulphate of Quinine. [July,

ARTICLE XXVI.

The Endermic Application of the Sulphate of Quinine, By H.
V. Wootex, M. I)., of Lowndesboro', Alabama.

I have noticed an article going the rounds of our medical journals,
headed, "Sulphate of Quinine not absorbed when applied Endermi-
cally" by M. Martin -So] on, (from the Bulletin de Therapetique,) in
which it is stated, that of twenty individuals on whom the author
experimented, the sulphate of quinine was not detected in the urine,
and that "the effect was null in all." The patients were afflicted
with various diseases, and the medicine was applied in various ways,
though the quantity used is not stated.

The legitimate practical deduction from this doctrine, and these
experiments, is, that the employment of the quinine endermicaliy is
wholly useless in all cases. I think this conclusion erroneous, and
calculated to lead to a practice, which in some cases would be highly
detrimental to the patient, and as my experience is rather in conflict
with the doctrine, and goes to establish a different practice, I have
thought it a fit occasion to offer it to the profession.

In July, 1842, I was called to a lady affected with intermittent
fever, of a rather grave type. She had suffered several paroxysms,
and the fever now continued through the apyrexia. She was enter-
ing upon the fourth month of pregnancy, and suffering extreme irri-
tation ofstomach. A physician had been prescribing for her several
days, during which time the sulphate of quinine had been given in
combination with morphine and various other anodynes, and aromat-
ics, but all had been instantly rejected. The bare effort to swalrow
produced retching, and it appeared that nothing could remain on the
stomach, not even a small quantity of the ordinary secretions. Ano-
ther paroxysm was expected in about four hours. I advised the
administration of sulphate of quinine xx grs., sulph. morph. | gr.,
in 51. gum arabic mucilage, to be thrown into the rectum, and re-
peated in three hours. I had found this mode of administration to
answer'an admirable purpose, in a few cases before, but the rectum
seemed as irritable as the stomach, and the enema was promptly
rejected. It was repeated and rejected three times, which I learned
on my visit next day, and the paroxysm occurred at the regular hour.
At every chili she was attacked with uterine pains so severe as to
threaten abortion : and aside from that danger, her general condition
presented rather an alarming aspect. The remedial powers of the

1846.] Sulphate of Quinine. *

quinine seemed to be absolutely necessary in the ease, and the only
remaining way of introducing it was by endermic application. It
was about twenty-six hours to the time for the next paroxysm. There
was already a blistered surface over the epigastrium about seven
inches square. VVe.cut a piece of adhesive plaster large enough to
cover it, laid the plaster upon the bottom of a warm waiter, and when
it was sufficiently soft, poured the quinine upon it, and rubbed it on
with a spatula, until it formed a complete covering of the plaster, and
applied it over the blister. We prepared another, twenty inches long,
and three wide, which we applied to the spine, from the cervical ver-
tebra downwards, after sponging the skin with warm water. These
plasters were kept carefully applied, (enough of the margin being left
uncovered to adhere to the surface,) and nothing taken into the
stomach but a few drops of water occasionally, when thirst rendered
it absolutely necessary, until after the hour for the paroxysm, with
the happiest effect. She had no chill, and as the chill was the
cause of the uterine pains, and greatly aggravated the other symp-
toms, with it, she got clear of most of her distress, and improved
very finely.

I have applied the sulphate of quinine endermically in four other
cases, where, from various circumstances, I could not introduce it in
a more direct way, and in every case with effect. I could detail
them, but the practical result being so similar to the foregoing, it is
unnecessary. I may mention, however, that in two cases, the reme-
dy was applied over a blister on the epigastrium, and in these it was
successful in arresting the first paroxysm. In the two other cases,
there was no blister, either on the epigastrium or spine; in one, it
failed to arrest the first paroxysm, and succeeded on the second; in
the other, it arrested the first, as in those cases where it was applied
over a blister.

I have found it very rarely necessary to resort to this mode of using
the remedy, but when it is necessary, I resort to it with much confi-
dence. I have never tested the urine, or any other secretion, to
ascertain whether or not it was absorbed, but it evidently impressed
the system with its peculiar powers, in some way. The quantity ap-
plied in each case was not weighed, but I think it could not lie less
than 5ii. I pretend not to say whether or not the medicine was ab-
sorbed, or whether or not it could act without absorption, but that it
made its impression upon the system is certain.

416 On the Cause of the Circulation of the Blood. [July,

PART II. REVIEWS AND EXTRACTS.

ARTICLE XXVII.

"On the Cause of the Circulation of the Blood." By Jonx W.
Draper, M. D., Prof, of Chemistry in the University of Xew York.

We find in the London, Edinburgh, and Dublin Philosophical
Magazine, for March, 1S46, an interesting paper on this suhjectT
from the pen of one of the most eminent American chemists, and
we regret that its length precludes the possibility of our giving the
reader the benefit of all the ingenious reasoning which it contains*
We have endeavored, however, so to abridge it as to retain its most
important parts. The clearness with which Harvey and his succes-
sors developed the doctrine of the circulation of the blood, "not
only fully established his views, but," in the opinion of the author,
"gave rise to a serious error which is scarcely removed in our times."

"That error relates to the action of the heart. These earlier
writers regarded the circulation of the blood as a hydraulic phenom-
enon, supposing that the heart simulated e.tactly the action of a
pumping machine. It is now on all hands conceded that this organ
discharges a very subsidiary duty. The whole vegetable creation,
in which circulatory movements of liquids are actively carried on
without any such central mechanism of impulsion ; the numberless
existing acardiac beings belonging to the animal world ; the accom-
plishment of the systemic circulation of fishes without a heart; and
the occurrence in the highest tribes, as in man, of special circulations*
which are isolated from the greater one, have all served to demon-
strate to physiologists that they must look to other principles for the
cause of these remarkable movements. I am persuaded that the
phenomenon may be accounted for upon physical principles in asat^
isfactory manner; that we can co-ordinate together, and arrange as
examples of one common law, the various forms of circulatory
movements, whether they occur among vegetables or animals, among
insects, or fishes, or mammals; and that the facts which we meet in
derangements of these motions, or their cessation, as in fainting,
coughing, and the different forms of disease, or such as take place
after hanging, the inhalation of protoxide of nitrogen, or alcoholic
drunkenness, or in that most remarkable of all results, the restora-
tion from death by drowning*; in all these and many other such
cases we can give the most felicitous explanation."

The principal facts which Professor Draper designs here to estab-
lish, are

1846.] On the Cause of the Circulation of the Blood. 417

First. The systemic circulation is due to the deoxidation of ar-
terial blood.

Secondly. The pulmonary circulation is due to the oxidation of
venous blood.

And, in conclusion, he offers some explanatory remarks on the
phenomena of the coagulation of the blood.

Several physiologists, particularly Drs. Alison and Carpenter, have
already made an approach to the doctrine which the author has de-
veloped in this memoir. "But these views," he continues, "do not
communicate a definite idea of the true mechanism of the motion,
nor do thev exhibit that phenomenon as clearly connected with well-
known chemical changes occurring in living systems. Should it
appear, as I shall endeavor to prove, that the circulation is a neces-
sary result of the alternate oxidation and deoxidation of the blood,
we exchange at once a loose and ill-defined conception for a precise
and definite fact."

Prof. Draper here speaks of the oxidation and deoxidation of the
blood as the great facts to be regarded, and leaves out of considera-
tion the spontaneous changes which that fluid itself undergoes;
those minor effects which it impresses on the tissues, and those which
they reciprocally impress on it.

" The ultimate products of these metamorphoses include, of course,
all the results of the intervening stages, and those ultimate products
are chiefiv water, ammonia and carbonic acid. We are justified,
therefore, in these physiological discussions in looking at the whole
process as one of oxidation, and neglecting intermediate metamor-
phoses we regard onlv the final action, and that action is the transmu-
tation of oxygen into carbonic acid, of hydrogen into water, of nitro-
gen into ammonia."

Explanation of the general physical principle. "If, in a vessel
containing some" water, a tube of small diameter be placed, the water
immediately rises to a certain point in the tube and remains sus-
pended."

" Let the tube be now broken off below that point, and replaced in
the cup of water; the liquid rises as before, hut though it reaches
the broken extremity it does not overflow. A capillary tube may
raise water to its highest termination, but a continuous current can-
not take place throx

" Now, suppose a rapid evaporation of the liquid to ensue from the
broken extremity of the tube, as fast as the removal of one portion
is accomplished others will rise through the tube, and in the course
of time the vessel will be emptied. By evaporation from the upper

27

418 On the Cause of the Circulation of the Blood, [July,

extremity a continuous current is established ; a spirit lamp, with its
cap removed, is an example of this fact."

"Or, if the liquid which has risen to the upper end of the tube be
of a combustible nature, oil for example, and be there set on tire, as
the process of combustion goes on a current will be established in
the tube, as in the common oil lamp in the act of burning."

"The principle which I wish to draw from these well-known facts
is, that though ordinary capillary attraction cannot determine a con-
tinuous flow of a liquid through a tube, there are very many causes
which may tend to produce that result."

Prof. Draper illustrates this point by supposing any given tube,
A C for example, to be formed of combustible matter of any kind,
and at the point A an oxidizing liquid enters it. The liquid, as it
traverses the tube, exerts its oxidizing agency, which at the expense
of the tube, is gradually satisfied. In successive portions of such a
tube the affinity is constantly declining. It is greatest at A, dimin-
ishes as it passes along, and ceases altogether at C. Under these
circumstances, a continuous current will be established along the
tube.

"A tube with an included liquid," he continues, "which is thus
incessantly varying in its relations, will give rise to a continuous
movement. At the point of entrance, the liquid, powerfully attracted
by the tube, rises with energy; but the chemical changes that set
in, satisfying and neutralizing that attraction, to use a common ex-
pression, it loses its hold on the tube as it goes, and new quantities,
arriving behind, continuously press out those which are before them.

" These various results may be expressed in the following general
terms :"

"If a given liquid occupies a capillary tube, or a porous or paren-
chymatous structure, and has for that tube or structure at different
points affinities which are constantly diminishing, movement will
ensue in a direction from the point of greater to the point of less
affinity."

" Or thus: If a given liquid occupies a capillary tube, or a porous
or parenchymatous structure, and whilst in that tube or structure
changes happen to it, which tend continually to diminish its attraction
for the surface with which it is in contact, movement will ensue in a
direction from the changing to the changed fluid."

Application of this principle to the Circulation of the Blood.
Prof. Draper then proceeds to apply these principles to some of the
circulations which take place in the human system, and selects for
this purpose, the four leading forms, the Systemic, the Pulmonary,
the Portal and the Placental circulation.

The Systemic Circulation. "The arterial blood," he says,

134G.] On the Cause of the Circulation of the Blood. 419

" which moves along the various aortic branches, contains oxygen
which has been obtained in its passage over the air-cells of the lungs,
an oxidation which is indicated by its bright crimson tint. On
reaching its final distribution in the tissues, it effects their oxidation,
producing heat: and as it loses its oxygen, and receives the meta-
morphosed products of the tissues, it takes on the blue color charac-
teristic of venous blood."

'If now we contrast the relations of arterial and venous blood to
the tissues, it is obvious that the former, from the tact that it can
oxidize them, must have an intense affinity for them ; but the latter,
as it is the result of that action after all affinities have been satisfied,
must have an attraction which is correspondingly less."

u Arterial blood has therefore a high affinity for the tissues ; venous
blood little or none. But the change from arterial to venous blood
takes place in the manner I have just indicated; and therefore, upon
the first of the foregoing general rules, motion will take place, and
in a direction from the arterial to the venous side."

"By the deoxidizing action of the tissues upon the blood, that liquid
ought upon these principles to move from the arteries to the veins,
in the systemic circulation. The systemic circulation is therefore
due to the deoxidation of arterial blood."

The Pulmonary Circulation. " In this circulation," continues
Prof D., " venous blood presents itself on the sides of the air-cells of
the lungs, not to carbonaceous or hydrogenous atoms, but to oxygen
gas, which being the more absorbable of the constituents of the air,
is taken up and held in solution by the moist walls of those cells.
Absorption of that oxygen takes place, and arterialization is the re-
sult. The blood from being blue turns crimson."

11 What now are the relations between venous and arterial blood
and oxygen gas ? For that gas venous blood ha* a high affinity, as
is shown by its active absorption: but this affinity is satisfied and
has ceased in the case of arterial blood."

'The change from venous to arterial blood, which takes place on
the air-cells which are charged with oxygen gas, ought upon these
general principles to be accompanied by movement in a direction
from the venous to the arterial side."

'The pulmonary circulation is duo to the oxidation of venous
blood, and ought to be in a direction from the venous to the arterial
side. These considerations therefore explain the cause of the flow
in opposite directions in the systemic and the pulmonic circulation ;
in the former the direction is from the arterial to the venous side, in
the latter from the venous to the arterial. It arises from the oppo-
site chemical reactions which are taking effect in the system and in
the lungs; in the former, as respects the blood, it is a deoxidation,
in the latter an oxidation.

The Portal Cjr< dlation. According to Prof. Draper, two sys-
tems of forces conspire to drive the portal blood out of the liver into
the ascending cava.

420 On the Cause of the Circulation of the Blood. [July,

1st. "The blood which is coming along the capillary portal veins,
and that which is receding by the hepatic veins, compared together as
to their affinities for the structure of the liver, have obviously this re-
lation, the portal blood is acted upon by the liver, and there are
separated from it the constituents of the. bile; the affinities which
have been at work in producing this result have all been satisfied,
and the residual blood over which the liver can exert no action con-
stitutes that which passes into the hepatic veins. Between the portal
blood and the structure of the liver there is an energetic affinity,
betrayed by the circumstance that a chemical decomposition takes
place, and bile is separated ; and that change completed, the residue
which is no longer acted upon, forms the venous blood of the hepatic
veins. In the same manner, therefore, that in the systemic circula-
tion arterial blood in its passage along the capillaries becomes deox-
idized, in consequence of an affinity between its elements and those
of the structures with which it is brought in contact, and the inert
venous blood before it, so loo, in the portal circulation, in conse-
quence of the chemical affinities and reactions which obtain between
the portal blood and the substance of the liver, affinities and reactions
which are expressed by the separation of the bile, that blood drives
before it the inert blood of the hepatic veins."

2nd. "The blood of the hepatic artery, after serving for the
economic purposes of the liver, is thrown into the portal plexus.
Hence arises a second force. The pressure of the arterial blood in
the hepatic capillaries upon this is sufficient not only to impel it into
the capillaries of the portal veins, but also to give it a pressure in a
direction towards the hepatic veins; for any pressure which arises
between the arterial blood of the hepatic, and its corresponding venous
blood, must give rise to motion towards the hepatic veins, no regurgi-
tation can take place backward through the portal vein upon the
blood arriving from the chylopoietic viscera, because along that
channel there is a pressure in the opposite direction, arising from the
arterial blood of the aortic branches. The pressure therefore arising
from the relations of the hepatic arterial blood conspires with that
arising from the portal blood, and both together join in giving rise to
motion towards the ascending cava."

The Placental Circulation. " The umbilical arteries carry in
their spiral courses, as they twist round the umbilical vein, the effete
blood of the foetus, and distribute it by their ramifications to the pla-
centa. In that organ it is brought in relation with the arterial blood
of the mother, which oxidizes it, becoming by that act deoxidized
itself. The foetal blood now returns along the ramifications of the
umbilical vein, and finally is discharged from the placenta by a sin-
gle trunk."

"That this is truly a change similar to that which is accomplished
m the adult lungs, is shown by the circumstance that the blood of
the umbilical arteries becomes brighter on its passage into the umbili-
cal vein."

1846.] On the Cause of the Circulation of the Blood. 421

" As the venous blood of the foetus is thus oxidized by the arterial
blood of the mother, movement must of necessity ensue in it, on the
same principle that it ensues in the adult lung, and must take place in
the same direction, that is to say from the venous to the arterial side."

"The fetal circulation oilers a very close resemblance to the cir-
culation of fishes, and is merely a refined variety of that type. The
true difference is that in foetal life the condition of immobility is ob-
served. In fishes the venous hlood is brought to the gills, and
subjected in their fibrillary tufts to the oxidizing agency of the air
dissolved in the surrounding water. In these organs it therefore
becomes arterialized, and is pushed into the pulmonary veins. These
empty directly into the aorta, no systemic heart intervening, and the
mechanical impulse received by the blood during its oxidation is
found sufficient to carry the aortic circulation : the heart therefore
may be and is dispensed with. A fish, by spontaneously changing
its position, or by the mechanical establishment of currents in the
surrounding medium, can obtain new surfaces of water for the oxida-
tion of its blood; but for the motionless fcetal mammalian a higher
mechanism is required, a mechanism which can bring the oxidizing-
maternal- arterial blood in relation with the branchial or placental
vessels. It is true, an intricate apparatus consisting of five different
classes of vessels is the result, but the play of that apparatus is pre-
cisely the same as in the simpler contrivance of fishes."

Of the Mechanical Force with which these Motions are accomplish-
ed. Prof. Draper maintains that, the force by which these motions
are established, is not only in Vae proper direction, but also of suffi-
cient intensity. In proof of this, he cites the experiments made by
him in 1838, with a view of establishing this point* "I found,* says
he, M that water, under such circumstances as are here considered,
would pass through a piece of peritoneum, though resisted by a pres-
sure ofnearly two atmospheres; and the same facts were observed
even in the ease of gases. Thus sulphurous acid gas would pass
through a piece of India rubber against a pressure of 7} atmospheres ;
carbonic acid against a pressure of 10 atmospheres; and sulphuret-
ted hydrogen, though I by more than 24 atmospheres."

Explanatory Remarks on the Coagulation of the Blood. Prof.
Draper observes that, physicians generally look upon the coagulation
of the blood as a mysterious phenomenon. as in some manner con-
nected with its death or loss of vitality. "But it is very doubtful,"
remarks Prof. D., "whether any such special power as a vital force
exists. In the instance under coj >n, I cannot comprehend

bow a Loss of vitality in the blood can in any manner elucidate, or
indeed, have any thing to do with the fact of its coagulation."

422 On the Cause of the Circulation of the Blood. [July,

11 It appears to me that what occurs to the blood when drawn, is
precisely the same as that which occurs to it continually when in the
system. It* its fibrine coagulates in the receiving cup, it tends
equally so to do in the peripheral circulation. I can see no differ-
ence in the two cases. And if this be true, it obviously is a fruitless
affair to be seeking for an explanation ofa difference in habitudes in
and out of the system, when those differences in reality have no ex-
istence in nature."

"If,, when blood flows into a cup, we could by any mechanism
withdraw the particles of fibrine as they agglutinate together, the
phenomenon of coagulation would never be witnessed; and this is
precisely the result in the living mechanism. The fibrine, as it
pisses into the proper condition, is removed by a series of events
which will be hereafter explained. But whether it be in those states
which physiologists designate living or dead, it exhibits continually
the same tendency."

"When we remember that the average amount of fibrine in blood
scarcely exceeds one 500th part of its weight, and that this minute
quantity is sufficient* by entangling the blood-discs, to furnish so vo-
luminous a clot, we have little difficulty in understanding the cause
of the false importance which has been attached to the fact of its co-
agulation. When we also remember that the phenomenon is one
which, far from taking effect instantaneously, requires a considerable
length of time, and estimate duly the demand that is made for fibrine
by the system upon the blood, we shall have no difficulty in perceiv-
ing the truth of the observation which I thus wish to bring into a clear
point of view, that the tendency to coagulation in the system is as
great as it is out of it, and that the true difference in the two cases is,
that in the former the resulting solid is taken up and appropriated to
the wants of the economy ; in the latter it remains undisposed of, and,
entangling the blood-discs in its meshes, produces a voluminous and
therefore deceptive clot."

"It is with this matter of the coagulation of blood precisely as it
was formerly with putrefaction. Many of the older physiologists
defined a living body as a mechanism having the quality of resisting
external changes. After death its parts were ultimately resolved
into water, ammonia, and carbonic acid. But better views on these
topics are now entertained, and we know that the living body under-
goes these putrefactive changes just as much as the dead, but then in
it there are appointed routes by which the resulting bodies may
escape; the carbonic acid through the lungs, the nitrogenized com-
pounds through the kidneys, the water through both these organs
and the skin. It is in this as in the coagulation of the blood, there
is no difference in the chemical changes taking place, the difference
consists in the disposal finally made of the resulting products."

"That coagulation tends to take place equally in the living system
as out of it, there is abundant proof. What are all the muscular tis-
sues which constitute by far the larger portion of the soft parts, but

1846.] On the Cause of the Circulation of the Blood.

423

fibrine which has thus been separated from the blood ? And those
muscular tissues every moment are wasting away, and giving origin
to the metamorphosed products that we find escaping from the lungs,
the kidneys, the liver; from what source then do thev repair their
waste, if not from fibrine coagulated from the blood during the act of
life? Every muscular fibre is a living witness against the doctrine
that it is death that brings on the coagulation of the blood.

"That the truth of this view, which at first sight may appear inde-
fensible, may be more clearly made out, let us consider under what
circumstances the blood is placed whilst moving in the system. We
have to remember that coagulation is not an instantaneous phenome-
non, but one which requires a considerable lapse of time. And now,
assuming the doctrine which I am advancing to be true, there are
very obvious reasons that the blood, so long as it moves in the system,
has its tendency to coagulate satisfied in a very partial manner.
Let us observe its course. It leaves the left ventricle of the heart
one pulse-wave succeding another with rapidity, and is distributed
through all the aortic branches. It takes but a few seconds for this
movement to be complete, a period far too short to allow coagulation
to take place; it now passes on through the capillaries, or moves
through parenchymatous structures ; and here, even though a great
delay "may occur, inasmuch as the passages are so sinuous and otten
so minute that the discs can move but in a single file at a time, how
is it likely, under such circumstances, that coagulation should ensue t
For that to take place, it is needful that there should be a free com-
munication throughout the mass, that each particle of fibrine brought
into relation with those around it may exert its plastic power and
join itself to them. But in the peripheral circulation it is isolated,
the cells over which it is moving, or the narrow tubes through which
it goes, protect it from other particles around, and on escaping into
the commencement of the venous trunks, it is hurried in the torrent
of the circulation at once to the heart. Without delay the right
auricle and ventricle pass it forward to the lungs, and if any tendency
to set bad been exhibited during the brief moment of its passage, it
isa-ain distributed upon the capillaries of the lungs, and is situated
precisely as it was when in the capillaries of the peripheral system.

" In this manner 1 regard the coagulation of blood as a simple me-
chanical result, having no connection with life or death, or the ficti-
tious principle of vitality. At the two extremes of the circulation,
the peripheral and the pulmonary, there is a sorting process continu-
ally going on. If a man were to agitate a quantity ot this liquid in
a tube, having a contrivance at each extremity to keep the particles
of fibrine as they passed, apart from one another, their plastic tenden-
cy to cohere could never be satisfied, and coagulation could never
ensue. And this condition of things is, to a certain extent, approxi-
mated to in the mechanism of the body."

"It thus appears that by the intervention of two capillary circula-
tions, one m the lungs and the other in the system, the coagulation of

424 On the Cause of the Circulation of the Blood. [July

blood must be greatly retarded, though the tendency to produce that
result is quite as great as when the fluid is removed from the system.
And with such an obvious explanation hefore us, why should we resort
to an occult agency, or envelop the phenomenon in mystery, when it
is plainly a mechanical affair?"

"Physiologists have never given a full value to the facts, that the
setting of the blood requires time and a free communication through
all parts of the fluid mass. If it be subjected incessantly to a me-
chanism which divides it into portions of inconceivable tenuity, and
every moment isolates each particle from all its fellows, its coagula-
tion must be greatly restrained. It is upon the same principle that
the expressed juices of carrots and turnips deposit a fibrmary clot, as
M. Liebig and others have observed. Whilst they are enveloped in
the cells of those vegetables coagulation cannot take place, for each
granule of fibrine is shut out from the others. What need is there to
resort to a vital principle to explain for the human economy a result
which equally obtains in the case of those humble plants, or why with
some physiologists impute to the nervous system the quality of main-
taining fluidity in the blood? These vegetables have no nerves."

Prof. Draper then proceeds to show, that the application of the prin-
ciples here set forth, furnishes a very felicitous explanation of a great
number of effects which we witness.

"It is well known," he remarks, "that after ordinary death, whilst
the arteries are empty, the systemic veins and also the right cavities
of the heart are full of venous blood. The reason is clear, although
the ordinary theory, that the heart acts like a pumping machine, fails,
as is well known, to explain it. As long as arterial blood is deoxi-
dizing it will move to the venous side, a movement which must con-
tinue until the arteries are empty/'

41 But it may be asked, why do not the right auricle and ventricle
relieve the veins, and by their hydraulic action in the last moments
of life push the accumulating blood through the pulmonary system?
Again the reason is clear. Movement through the lungs cannot take
place except when oxidation is going on. The systemic capillaries
continuing their action long after the last breath is drawn, they
make the blood accumulate in the veins, and from them there is no
escape."

41 In the same way, in fainting, the blood leaving the arteries accu-
mulates on the venous side, and as its flow is dependent on the push
of the arterial blood entering the capillaries, so soon as no more enters
no pressure is exerted on the venous trunks, and if a vein is opened
there is no discharge, and under such circumstances hemorrhages at
once stop."

"After ordinary death, although the systemic arteries are empty,
the pulmonary artery is full. That this should be the case is indica-
ted upon our principles, for the blood cannot pass from the terminal

1846.] On the Cause of the Circulation of the Blood.

4-25

ramifications ofthe pulmonary artery into the veins except by being
oxidized. Respiration having ceased oxidation cannot take olace,
the movement is checked, and the blood remains in the artery.

"In a paroxysm of asthma the lungs become obstructed with mu-
cous secretions, and the rapidity of oxidation is therefore interfered
with. Under such circumstances the passage ofthe blood is retarded,
as is shown by the great dilatation of the jugular veins.'

'Whatever, therefore, deranges the progress of oxidation, deran-
ges the flow of the blood. In violent expirations, such as in cough-
ing, the observations of Haller show that the blood moves tardily in
the lungs, and in delicate persons its retardation is so complete that
it regurgitates in the jjreat veins." ,

-In a violent and continuous explosion of laughter, the jugular
veins become excessively distended; the right cavities of the heart
having no power to push the venous blood through the pulmonary
capillaries, and owing to the expulsion of air from the air-cells, the
blood itself fids to effect the passage with its usual speed. In this
instance it must again accumulate in the veins/'

"The various cases here cited depend on retarded oxidation. 1
mi"ht now consider the reverse of this, or where oxidation goes on
toorapidlv, as when protoxide of nitrogen is breathed. Owing to
the great solubility of this gas in serum, and its power of supporting
combustion, we should expect to find it exert that control over the
circulation which is well known to be one of its peculiarities. 1 his
paper is however extended to so great a length, that here I must stop,
though I have made no allusion to the movements in the lymphatics
or Ucteals, or to the flow of sap in trees, or to the circulatory move-
ments ofthe lower animals. These can all be explained upon the
same principle; thus the descent of the sap follows as a necessary
consequence of the decomposition of carbonic acid in the leaf. -Nor
have 1 said anything of the obvious control which certain classes ot
nerves have over the systemic oxidation. There are many facts
which prove that the nervous system regulates this operation, and
can either facilitate it or keep it in check. In this there is nothing
extraordinary. A piece of amalgamated zinc exhibits no tendency
to oxidize in acidulated water, but by the touch of silver or platina it
is made to submit itself to the action of that medium. 1 he act ot
blushing, and all local inflammations, show that changes in the rela-
tions ofthe nervous system control the oxidizing action of arterial
blood; but to these things 1 propose to return on a future occasion.
What is here stated is sufficient to illustrate the general principle to
which I wish to draw attention, that the chemical rnieh are

impressed on these circulating fluids are the true causes of their flow.

Such are the novel views entertained by Dr. Diaper, concerning
several interesting points in physiology, and we look with anxiety for
the results which the promised renewal of his investigations on
kindred subjects, will develop. It remains for physiologies to dead*

426 On the Nature and Treatment of Deformities. [July,

whether these views are sufficiently established, or under what modi-
fications they are to be accepted. There is no department of philos-
ophy around which so much unnecessary mystery has been cast, as
the investigation of the character and laws of the phenomena of
life. For a long period, physiologists endeavored to explain them by
taking refuge in talismanic verbal abstractions. By setting out with
the erroneous principle, that vital phenomena are to be studied in a
manner totally different from those of inorganic matter, a sufficient
check was placed upon further inquiry. We now know, that many of
the operations of organization, if not identical with physical phenome-
na, are at least analogous to them; and we, therefore, hail with plea-
sure, every effort which is made to trace these instructive analogies,
as tending to elucidate many obscure points in physiology.

J, LeC.

BIBLIOGRAPHICAL NOTICES.

I. Lectures on the Nature and Treatment of Deformities ; delivered
at the Roval Orthopaedic Hospital, Bloomsbury square. By R.
W. Tampmn, F. R. C. S. E., Surgeon to the Hospital. With
numerous illustrations, pp. 216. Barrington & Haswell, Phil-
adelphia. 1846.

The work above named constitutes the January number of Dr.
Bell's valuable "Select Medical Library." The republication in
our country of works eminently practical as this is, without the
extra cost incident to the addition of "Notes by the American Edi-
tor," is a feature peculiar to the undertaking of Dr. Bell, and as such
should secure to him extensive patronage. Tamplin's work on De-
formities must be favorably received by the profession, not only be-
cause of its intrinsic merits, but also because it comes to us at a
moment when we are alive to the vast importance of the subject on
which it treats, and desirous to keep pace with its rapid advances.
This work is practical in the strictest sense of the word, being confi-
ned to facts and illustrations of principles, furnished in a plain, brief
and systematic style. The author dwells mainly on deformities of
the foot and knee-joint, being the most common, and "the treatment
of these being the ground-work of the treatment of deformities in gen-
eral." The deformities of the hip, spine, nock and upper extremities,
are, however, treated with sufficient detail to direct the practitioner
in the management of such cases understandingly. The work as a
whole is an excellent manual. D.

1846.] Elements of Physiology, <fyc. Auscultation, <$'C. 427

It. Elements of Physiology, including Physiological Anatomy, for
the use of the Student . By Wm. B. Cabpbnteb, M. D., F. R. S.,
Fullerian Professor ofPhysiology in the Royal Institution ofGreat
Britain, &c. &c. With 180 illustrations. Philadelphia: Lea $c
Blanchard. 1846. pp. 560.

The rapidity with which physiological knowledge is advancing is
such that no work on the subject can long continue to represent it
fairly. It is therefore that for the last ten years we have had almost
an equal Dumber of new works on Physiology, yet eac^ containing
something new.

The work before us is from the pen of one of the most accomplished
physiologists of the day, the author of the "Principles of General and
Comparative Physiology," and of the "Principles of Human Phy-
siology,'5 both works of great erudition and sterling merit. It is a
concise expose of the leading features of the author's previous pro-
ductions, and as such is valuable to the beginner or to those members
of the profession whose leizure hours do not permit the perusaj of a
more extended treatise. It is especially distinguished from other
elementary works on Physiology by its researches in physiological
and microscopic Anatomy. The development and metamorphoses of
organic cells have of late years attracted much attention, and this
work presents a faithful account of the actual state of our knowledge
on the subject.

We cannot too highly recommend this work to students and to the
profession generally. D.

III. A Clinical Introduction to the Practice of Auscultation, and
other modes of physical diagnosis, intended to simplify the study
of the Diseases of the Lungs and Heart, By II. M. Hitches,
M. 1)., Fellow of the Royal College of Physicians, Assistant
Physician to Guy's Hospital, e\:c. 12 mo., pp. '270. Philadel-
phia: Lea & Blanchard. 1846.

This little work, dedicated " To the pupils of Guy's Hospital," is
precisely what was needed by medical students in our own country ;
a work which, like the tracts on Languages, recently published, will
enable them to learn auscultation and percussion, "without the aid of
a master." It is not a work on the discuses of the chest, but simply
one on the means without which no one can possibly form a correct
diagnosis in this important class of affections. The perusal of this
small volume cannot fail to awaken, even with many of our elder
practitioners, a desire to study the more extensive publications of

428 Natural History of Insects. On Antidotes to Poison, [July,

Laennec, Andral, Hope, Stokes, &c, and it will certainly facilitate
very much the appreciation of these. There can now be no excuse
for the wofal neglect of these explorative means which exists in our
country. D.

IV. An Introduction to Entomology, or Elements of the Natural
History of Insects. By Wm. Kirby, M. A., F. R. S. and L. S.,
Rector of Barham, and Wm. S pence, Esq., F. R. S. and L. S.
From the sixth London edition, which was corrected and considera-
bly enlarged. 8vo. pp.600. Lea & Blanchard, Philadelphia, 1846.

It affords us much pleasure to notice the publication of any work
calculated to cultivate a taste for natural history. The name of
Kirby, the distinguished author of the Bridgewater treatise on the
"History, Habits and Instincts of Animals," is sufficient to insure a
ready sale of the present work. It is more extensive than the de-
lightful little volume on " Insect Miscellanies," comprehended in the
Library of entertaining knowledge, or the " History of Insects," of
Harper's Family Library, yet it is equally adapted to the comprehen-
sion of the general reader. It comprises an account of noxious and
useful insects, of their metamorphoses, food, stratagems, habitations,
societies, motions, noises, hybernation, instinct, &c, &c, with plates.

D.

Abstract of a Lecture on Antidotes to Poison. By Alfred Baring
Garrod, M. D. (Pharm. Jour., from Dublin Med. Press.)

The lecturer having defined the term antidote, divided antidotes
into two classes; first, those which alter the nature of the poison,
and thus prevent its injurious action ; and, secondly, those which
counteract the effect when once produced. The latter class he pass-
ed over as being more within the province of the medical practitioner.

The first class, which may be called direct antidotes, should be
understood by chemists, and their efficacy depends on their immediate
administration, which, however, should not supercede the use of ihe
stomach-pump or emetics for the removal of the poison from the
stomach.

Dr. Garrod classified poisons into inorganic and organic. Among
the former, the mineral acids and the caustic alkalies should be neu-
tralized by substances harmless in themselves and capable of pro-
ducing inert or inocuous compounds, a circumstance which should
always be considered in the selection of an antidote. For instance,
solution of caustic potash should not be given as an antidote for oil

1S4G.1 On Antidotes to Poison. 4"29

of vitriol; but chalk, magnesia, or bicarbonate of potash or soda.
Tor oxalic acid, lime water or chalk should be given, not potash or
soda. For the caustic alkalies, such acids as are harmless should be
selected ; for instance, citric or tartaric acid, or vinegar, with mucil-
aginous drinks. For sulphuret of potassium, the best antidote is
chloride of soda. , ,

As an antidote for iodine, starch is efficacious when given in suffi-
cient quantity, as it produces an insoluble and inert compound.

Arsenic being a poison more frequently used than any other, many
antidotes have been tried, among which are sulphuretted hydrogen,
sulphur, lime water. &c, but this class of substances are less effica-
ciousthan the hydrated peroxide of iron, which, however, must be
given in such quantities that there shall not be less than eight or ten
grains for every grain of arsenic. Unless given in excess it is not
likely to succeed, and emetics or the stomach-pump should also be
employed.

Among the mercurial poisons, corrosive sublimate is the most
dangerous, and the best antidotes are albumen, gluten, and the proto-
sulphuret of iron. Eggs and flower being generally at hand should
be given in considerable quantities. The proto-sulphuret of iron is
prepared by adding hvdrosulphuret of ammonia to a solution of pro-
tosulphateofiron. When this is within reach it is useful, as it forms
an inert compound of mercury when added to corrosive sublimate.

For the salts of antimony decoction of oak, elm, or other bark,
containing tannin, has been recommended, as this forms an insoluble
tannate of antimony.

The salts of lead" and baryta may be counteracted by sulphate or
soda or magnesia. Albumen and ca seine form insoluble compounds
with salts of lead ; milk may therefore be given. No sure antidote
is known for the salts of copper. Sugar has been recommended as
an agent capable of reducing copper salts, but it requires for this pur-
pose a higher temperature than that of the stomach. Albumen in
excess has been proposed ; but albuminate of copper is soluble if
excess of the sulphate be present. Common salt is the antidote for
the nitrate and other salts of silver, as it forms an insoluble chloride.
The next class namely, organic poisons, are much more numer-
ous than those above mentioned; comprising prussic acid, the alka-
loids (strychnia, morphia, &c.) as well as all other vegetable and
animal poisons. On this part of the subject the lecturer dwelt more
at length, and detailed the result of a course of experiments which
has led him to recommend animal charloal as an antidote for vegeta-
ble poisons in general, as weil as for some of the mineral poisons. It
has long been known that charcoal (either animal or vegetable) ex-
erts a peculiar action on colouring matters and absorbs gases, on
which account it is used in filters for purifying water. It has also
been observed to throw down certain substances from their solutions,
for instance, lime, iodine, dee.', as stated by Professor Graham in his
Elements of Chemistry. Mr. Warington lately read a paper, at a

430 On Antidotes to Poison. [July,

meeting of the Chemical Society, on the removal of the bitter prin-
ciple from infusions by animal charcoal. Makers of morphia and
other alkaloids are aware that the product is diminished if much
charcoal be used. Bertrand tried wood charcoal as an antidote for
arsenious acid, corrosive sublimate, and the salts of copper ; but in
quantities so small as to be inert.

The lecturer had recently introduced the use of animal charcoal as
an antidote for some of the inorganic poisons, but more especially for
tiie organic. Before commencing his experiments it had occurred
to him that the gastric juice might possibly interfere with the absorp-
tion of the poison by charcoal ; but this he found not to be the case.
His first experiments were with strychnia, which he administered to
two guinea-pigs, in one case with animal charcoal, in the other with-
out; and also to several rabbits. In all cases those animals which
took the poison with a proper quantity of the antidote, were not at all
affected, while the others died. But it appeared that to saturate
half a grain of strychnia, two drachms of the charcoal were required,
and unless given at least in this quantity, it was not efficacious. The
same results were observed in the case of dogs and other animals;
one-sixteenth of a grain of strychnia was found sufficient to kill a frog,
but with a proper quantity of charcoal a quarter of a grain was given
without any poisonous effect. From half a grain to one grain was
found to be enough to kill a dog in about ten or fifteen minutes; but
when animal charcoal was given in the proportion of half an ounce
to each grain of strychnia, no effect was produced.

Nux vomica, which in closes of twenty or thirty grains will kill a
dog of average size, was rendered inocuous by the administration of
halfan ounce ofanimal charcoal.

In the experiments with the pure alkaloids the antidote was given
with the poison; in the case of the more mild vegetable poisons, the
antidote was administered ten or fifteen minutes afterwards, and
mostly with a favorable result.

Similar experiments were tried with opium and its preparations
In giving the tincture of opium it was necessary to take into consid-
eration the effect of the alcohol, two drachms of which are sufficient
to kill a dog, and this result is not prevented by charcoal.

The emetic properties of ipecacuanha were found to be counteract-
ed by animal charcoal : and the antidote was found equally success-
ful with elaterium, tincture of aconite, aconitine, belladonna, stramo-
nium, hemlock, cantharides, and other vegetable poisons, as well as
hydrocyanic acid.

The success of these experiments had induced the lecturer to try
the efficacy ofanimal charcoal as an antidote for the mineral poisons,
and with several of them he had found that when given in a large
quantity it was more successful than the antidotes usually recom-
mended. In many cases it was found to counteract or lessen the
effects of arsenic, corrosive sublimate, the salts of lead and copper;
but not so completely as to supersede the necessity of administering

1846.] Remarks on Tris^fs Nascentium. 431

such substances as are capable of forming insoluble and inert com-
pounds with the poison.

From the above experiments, the lecturer had come to the follow.
in" conclusions: First, that animal charcoal has the power of com-
bining with the poisonous principles of animal and vegetable sub-
stances, and forming innocuous compounds: second, that it will
absorb and render inert some mineral substances, but, except in the
case of arsenic, is not so generally applicable to those poisons as their
special antidotes, the quantity required being very great; third, that
a certain amount of animal charcoal is required to neutralize the
poison for morphia, strychnia, &c, half an ounce to the grain for
the substances from which these alkaloids are obtained, half an ounce
to a scruple ; fourth, that the charcoal itself exerts no injurious ac-
tion on the body. ,
The kind of charcoal employed in the experiments was the punned
animal charcoal, prepared according to the directions of the London
Pharmacopoeia namely, ivory-black, digested in dilute hydrochloric
acid, washed and dried. It is improved by heating it to redness in
a covered crucible. Ivory-black, if not purified, must be used in
much larger quantity, and vegetable charcoal is efficacious only to
a comparatively small extent.

In administering the charcoal it should be triturated with lukewarm
water, so as to form a fluid of slight consistency, in this way the anti-
dote may be given in ounce doses, or more, according to circumstan-
ces. In the selection of emetics, those only should be used which
are not rendered inert by charcoal. Ipecacuanha would not operate
In contact with it ; but sulphate of zinc should be substituted.

In conclusion, the lecturer suggested the propriety of trying animal
charcoal as an antidote for other subtile poisons, such as rabies,
syphilis, the venom of serpents, &c, applied as a poultice to the part
affected, also as a remedy for diabetes, and some other disorders
arising from noxious or unhealthy secretions.

Remarks on Trismus Nascentium. By F. M. Fitziiuoh, M. D.,
of Madison County, Mississippi; and II. V. Wootbn, M. D., of

Lowndeshoro', Ala. (From New Orleans .Med. and Surg. Journ.)

[In compliance with the call made in our January number, for in-
formation concerning this fatal disease, we have been favored with
the following letters, which we take pleasure in laving before our
readers. We have but little doubt that the cause of the disease is
intimately connected with the management of the umbilicus ami
therefore think our correspondent's suggestion valuable. In connec-
tion with this subject we will mention, that a Creole professional
friend recently informed us, that Trismus Nascentium was much
more common amongst the plantations below the city a few years

432 Remarks on 'Mjjismus Xascentium. [July,

ago, than it is now ; and that the present exemption is attributed to
a plan of managing the navel adopted within the last few years: it
consists simply in dressing it with balsam copaiba. We learn, that
since the adoption of this, the disease is scarcely known in that
neighborhood. We should be pleased to receive farther facts and
suggestions on the subject. We had expected to insert Dr. Fiiz-
hiiiih's communication in our last number, but it was unavoidably
postponed. We now have the pleasure of adding Dr. Woo ten's in-
teresting letter on the same subject, which has arrived just in time for
the press. Dr. W. seems to doubt the correctness of the opinion
we expressed in our last number, that this disease is more common in
this city than anv where else in the United States* Our remark was
solely based upon the large number of cases found among our bills
of mortality. We should be pleased to receive farther facts and
observations in relation to its prevalence throughout the southern
States, and especially as to its comparative frequency among white
and black infants. The disease certainly occurs among both classes
in this city, but to what relative extent we are not prepared to state
at present. We repeat our invitation for farther facts. Edts.]

Messrs. Editors Having observed in your valuable journal, the
great mortality in your city from Trismus Infantum, or Tetanus
Nascentium. I am induced to offer the following view of its cause.

I have seen three cases only, all of which proved fatal. The
symptoms were precisely those stated by Dr. Eberle in your January
number: I therefore deem it unnecessary to repeat them.

The treatment which I adopted in these cases was somewhat differ-
ent in each. I, however, blistered the abdomen, gave calomel, tinct.
opii, oil, <5cc, without any good effect whatever. I doubt not, if
taken in time, the treatment recommended by Dr. Eberle would be
very efficient.

It is the cause of this alarming disease, however, which I wish to
consider. Believing it proceeded from some mismanagement in
dressing the navel, I requested the owner of that plantation to let me
know when the next accouchement took place. He did so. I attend-
ed particularly to the dressing of the navel ; following plan usually
pursued, that is, folding a piece of linen three or four times, making
a hole in it for umbilical cord, then applying bandage three inches
wide, and three or four feet long, drawing it pretty tightly, so as to
give sufficient support to abdomen, passing it around two or three
times. This child never had an attack of/z'9, as they termed it, and
is now in fine health. In a few weeks I had another opportunity,
which resulted, under the same management, with equal success.
Previous to this there had been some fifteen or twenty deaths from
this disease on this plantation. I have every reason to believe that
it depends upon the manner in which the abdominal bandage is
applied.

The dressing of the infant is generally I might say always left

13-10.] Remarks on Trismus Nascentium. 4a3

to some female present, and for fear of hurting the navel she applies
the bandage too loosely ; the consequences are, when the child cries,
ihe umbilicus is protruded, producing, in some cases, slight umbilical
hernia, and otherwise irritating the navel, although it may externally
appear perfectly cicatrized.
* The navel should not he troubled or examined under four day*,
; removing it : the bandage should again be applied, and worn for
three or four weeks, or as marfy months would not he amiss.

It has been supposed by some lhat the diseai produced by

using old rusty scissors to" divide the cord : this 1 am confident is not
go, havin . the nicest instruments used with no better success.

I hope physicians having an opportunity of testing this, will give it
their attention. Respect fully, F. 3\I. Fitzhugh.

Madison County, MissM Jan. 20, 1840.

Low>-di:sboeo\ Ala., March 20th, 1S46.
Messrs. Editor* After stating the mortality of New Orleans in
1815, you remark concerning Trismus Nascentium* that "this af-
fliction is doubtless much more common here, than anv where eUe
in the United States, and demands careful investigation." ^

After assuring you that the results of such "careful investigation
would form a chapter in your Journal of the highest interest to me. at
least, I must beg your - ice in the expression ofa doubt ofthe

correctness of your opinion in regard to the disease being moro
common in New Orleans than any where else in the United States.
It is a disease of fearful frequency on the cotton plantations in this
section of Alabama. I am not prepared to compare it with other
maladies in respect to frequency, but I b at it destroys moro

negroes than anv other single disease, in this region of country. In
a practice often years am,. ie plantations. I have seen a great

many cases. Sometimes, I have found it of such frequent occurrence
as to present the appearance of an epidemic. Yet 1 have never seen
awhile chile h the disease. Is this the case in New

Orleans I

Again : I have never seen a case of decided Trismus Nascentmm
that did not prove fatal. lodeed, so well is this characteristic ofthe
disease now Known, (hat it is very generally deemed utterly useless
tbcall in medical aid,afler the initiatory symptoms are well developed.
I have tried every plan of treatment which books, or the most anx-
ious study on my part could suggest, but all wholly in vain.

I have made poet mortem examinations in several ca.es, and found
the patl noes as uniform as in any other disease.

They are as follows : Heavy vascular engorgement ofthe peritone-
um throughout its whole extent, denoting the highest inflammation.
All the portion surrounding the entrance of the umbilical cord into
ihe abdomen, for a circumference of from one to three inches, was
in a gangrenous condition- The liver was unnaturally heavy and
stiff, with its veins fully injected with ftuid Wend. 'I here was At*

434 On the Employment of Cold Cataplasms. [July,

heavy engorgement of the substance and membranes of the base of
the brain, and along the medulla oblongata, and cervical portion of
the spinal marrow.

I have usually observed the first symptoms to make their appear-
ance about the time the umbilical cord comes away, and from this I
at first supposed that it was the effect of awkwardness in dressing the
navel by the ignorant midwives who usually attend on the planta-
tions, but careful investigation led to nothing conclusive on this point.

Having taken the liberty to offer you these few facts, under the
hope that they will not be entirely useless to you, allow me to sub-
scribe myself, Your obedient servant,

H. V. Wooten, M. D.

M. Reveille-Parise on the Employment of Cold Cataplasms.
(From Medico-Chirurgical Review.)

Every one acknowledges that, in medicine and surgery, as in every
thing else, we frequently follow practices from habit, prejudice, or
routine, in contradiction to the most evident and best established
principles. An example is found in the constant use of warm, so
called emollient cataplasms, in numbers of cases in which a high
temperature is entirely opposed to the indication, which teach us to
diminish the excitement and the activity of the circulation, by pre-
venting the excessive development of caloric. Upon the occurrence
of a wound or bruise wc have recourse to refrigerants, in order to
diminish as much as possible inflammatory reaction ; but suppose
this has already commenced, we then apply warm poultices. Calor-
ic is the most powerful exciter of vital action, and to apply it in these
cases is to follow in the steps of the homceopathists, without however
adopting their infinitesimal doses. So far from being emollient, the
great heat at which they are applied renders them stimulant. They
may in a few cases act advantageously by augmenting the inflam-
matory action, and thus hasten on the formation of pus; but, in
the great majority of cases, this is not the object which we have in
view, but the removal or the diminution of inflammatory action.

M. R. P. cites some cases in which he substituted cold for hot cat-
aplasms with the greatest advantage: among others, some instances
of panaris, in 'which, after incising and disgorging the parts with
tepid water, the greatest ease attended the use of cold cataplasms,
while warm ones only aggravated the suffering. We employ cooling
drinks and other means of lowering the temperature in fevers, and
in eruptive diseases, and we know how hurtful heat is in an excited
condition of the skin, as in pruritus; and yet we pursue an opposite
practice in phlegmon, traumatic inflammations, acute rheumatism,
&c. Formerly, warm poultices were applied in cases of ophthalmia,
but judicious surgeons have long substituted cold applications ; and

1846.] On the Employment of Cold Cataplasms. 435

Dr. Tanchou has also employed these with advantage in certain tu-
niours of the breast, &c., threatening to degenerate into cancer.

The cataplasm, however, need not at first he absolutely cold, as it
might excite pain in the morbidly sensitive inflamed surface, especially
in women, children, and nervous or delicate persons. Many persons,
from the effects of habit, can only gradually accustom themselves to
bear it quite cold, the same application causing pain at first which
afterwards produces ease. So that we must gradually adapt the
means to the patient's sensibility. iMoreover, a cold poultice must
not be left too long unchanged, as if produces then a very disagree-
able sensation. When the inflammation is active the poultice soon
becomes heated, and, although some patients feel no speedy inconve-
nience from this, others, owing to the evaporation being impeded by
the thickness of the cataplasm, are uneasy if it is retained for long.
If however, the patient complains of no uneasiness, the poultice may
be left on with advantage for hours.

After the cataplasm has been applied for a while, the patient usu-
ally feels much easier, the pain, heat, irritation, tension, and pulsation
abating markedly. On examining the part, we find the redness much
diminished, and oftentimes a pale patch here and there announces
the commencement of resolution. Cold is in fact the most powerful of
sedatives, and its action upon our tissues is far more efficacious than
is usually believed. It prevents, by contracting them, the engorge-
ment of the smaller vessels, it condenses the fluids, moderates the
circulation, benumbs the sensibility, and diminishes irritation. More-
over, in the above gradual mode of employing it, we do not find that
reaction of heat and redness which generally follows its sudden ap-
plication to the surface. If, notwithstanding our care, suppuration
does take place, this is always less abundant than when the inflam-
matory action is stimulated by hot poultices. The beneficial action
of these cataplasms may also sometimes be increased by mixing medi-
cal bodies with them, such as a solution of acetate of lead, the various
narcotics, &c. " In cases of inflammatory swelling and acute neu-
ralgia, I have anointed the parts with belladonna ointment, and, leav.
ing a layer on the surface, have applied over it cold cataplasms. This
practice is almost certain to be successful, if the cause of the affection
does not continue in operation." Bull at in de Therapeulique,

There can be no doubt that hot cataplasms are too indiscriminate-
ly employed, and indeed the practitioner usually contents himself with
ordering a poultice withoutgiving any directions as to its temperature.
Patients look on with the same incredulity as did the host of the Satyr,
when they are told tin; same means may prevent or hasten suppura-
tion, according as it is applied in a cold or hot condition. We aro
surprised M. Reveille-Parjse takes no notice of water dressing, which
is in most cases so elegant and useful a substitute for cataplasm.

436 On the use of Galvanism in Lumbago, Sprains, dye. [July,

On the use of Galvanism in Lumbago, Sprains, and some other
painful affections of the Muscles and Joints. By M. Racibokski.
(Gazette Medico-Chirurgicale from Med. Chir. Review.)

M. Raciborski observes that the utility of Galvanism in paralysis
of particular nerves is well known, and that Magendie has proved by
many recent cases its service in neuralgia generally, but especially in
that of the branches of the fifth pair. Having witnessed many suc-
cessful applications of this kind, mostly in the wards of M. Bouillaud,
the author was led to believe the employment of galvanism might be
advantageously extended to other affections characterized by violent
pain and the absence of signs of inflammation, as muscular rheuma-
tism and lumbago. His experiments have been highly successful,
the suffering of this last painful affection being frequently forthwith
relieved, after the patient had long tried other remedies in vain.
The same may be observed of rheumatism affecting the muscles of
the extremities. It is not easy perhaps to state the modus operandi
of the remedy ; but it would seem to be by directly subduing the
pain, which prevents the contraction of the muscles, that galvanism
produces the instantaneous relief seen in some cases. " Certain it is
that, in many cases, we have applied galvanism with seme success,
even to painful swellings of the knees, rendering walking, if not im-
possible, at least very painful. Certainly galvanism did not cause
the swelling to disappear, but the pain became dissipated, or so
diminished, as to allow the patient to walk about We do not doubt
that the forced contraction which the galvanic shock produces in the
fibres of the muscles, rendered motionless by the rheumatism, must
contribute considerably to the good effects derivable from this means.'*

Four or five cases are given which were relieved almost immedi-
ately by galvanism, or rather, perhaps, we should call it galvanic
acupuncture, inasmuch as needles were inserted in the parts where
pain prevailed, and then brought in contact with the galvanic batte-
ry. A very few shocks, which usually themselves caused consider-
able temporary pain, sufficed to give relief, and enable the patient to
exert muscular action without suffering. One or two of the cases
seem to us, however, to have had all the characteristics of hysteria
but this matters little, inasmuch as an effectual means; of relieving the
pain of that troublesome affection is a desideratum.

" Since our notes were taken, we have had other opportunities of
applying galvanism in analogous cases, and always with the same
success; but, as at present we merely desire to draw the attention of
practitioners to this new mode of treatment, we need not extend the
paper by citing the particulars. Nevertheless we cannot terminate
it without signalizing the admirable effects which galvanism produces
in the treatment of Sprains. Every one knows that a sprain, al-
though apparently a slight affection, often exacts much time for its
cure. When it implicates the ankle or knee, it is not uncommon to
see patients deprived of the use of their limbs during two or three

1846.] Diagnosing B iffy Blood. Albuminuria illustrated. 43"

months. It is the violent pain felt upon the slightest motion of the
part (we are speaking only of simple, uncomplicated sprain,) which
retards the cure. The other symptoms are of little consequence, and
are usually dissipated promptly. New, just a3 we have seen in lum-
bago, so in sprain, galvanism relieves this pain instantly, and allows
the patient to walk without lameness."

fif. Raciborski suggests that the galvanism may act by restoring
the contraction and tension of the fibres of the articular capsule, (and
perhaps those of the tendons,) which had been inordinately distended
and elongated by the accident.

PART III. MONTHLY PERISCOPE.

Mode of Diagnosing Buffy Blood. -Dr. Wharton Jones has point,
ed out a very ingenious method of determining whether the blood is
huffy or not, from the examination of a very minute portion of thin
fluid. It consists of quickly enciosinga drop between two pieces of
glass, and observing, with the naked eye, the quickness with which
it assumes a mottled appearance, and the smallness or largeness of
the interspaces. In buffy blood the mottling is almost instantaneous,
and the interspaces large ; while in healthy blood it is delayed for
half a minute or more, and the reticulation is minute. [Dr. Cowan s
Address.

The Causes of Albuminuria illustrated. M. Fourcault, being of
opinion that albuminuria was a morbid result of suppression of the
cutaneous function, instituted an examination of the urine of those
animals whose surface he varnished or coated. He found that when
dogs so treated began to exhibit symptoms of suffering and difficulty
of breathing, the urine first became albuminous; the albumen being
often mixed with blood-globules. Very generally when the animal
succeeded in removing the substance with which it was coated, the
albuminuria ceased, and the urinary salts re-appeared in large quan-
tities. A shaved rabbit was coated with dextrine, and so inclosed in
an apparatus that the urine could be collected unmixed with f<ce*.
A considerable quantity of albumen appeared in the urine. In ano-
ther rabbit so treated, the pericardium was found to contain an albu-
minous fluid. The urine of dogs thus coated, previously acid, became
gradually less acid, then neutral ; and when it contained a large
quantity of albumen, a tendency to alkalinity. M. Fourcault flayed
Guinea-pigs and rabbits alive, replacing the skin in its proper posi-
tion, and he was astonished to find that they lived two or three times
longer than if they had boeo incased in an impermeable coating.
They maintained their natural temperature, and were lively and

438 Yellow Color of Bile, Kertnes in Diseases, 6fc. [July,

vigorous to within a few hours of their death! If, however, a layer
of dextrine was laid over the flayed surface, albumen appeared. From
these and other facts, M. Fourcault infers that the skin is solely an
excreting organ. Its function is to throw off the free lactic and lac-
tates already present in the blood. If this acid be retained it is in
excess, and, destroying the equilibrium of the organic affinities, pre-
cipitates albumen upon the urinary organs, when the soda of the
urine renders it soluble. The cutaneous salts being also thrown
back into the circulation, pass off by the kidneys, and render the
urine alkaline.

According to the preceding hypothesis, the introduction of lactic
acid into the circulation would be followed by albuminuria, and M.
Fourcault details some experiments which, in his opinion, prove the
fact decisively. These experiments do not, however, appear to be of
more than questionable value. The same remark applies to the
comparison of the phenomena of the Cholera Asiatica with those of
suppressed cutaneous excretion. [British and Foreign Med. Rev.

The Yellow Coloring Matter of the Bile. M. Polli read a paper
at the Congress of Italian Savans at Naples last year, detailing cer-
tain experiments made by him on the yellow coloring matter of the
bile, and on the coloring matter of the blood, from which he draws
the conclusion that these two principles are identical in their nature,
but differ in their degree of oxidation, that of the blood being at the
maximum, and that of the bile at the minimum. [London Medical
Times.

On the use of Kermes Mineral in Diseases of the Respiratory Or.
gans. By Dr. Herpin, of Geneva. Dr. Herpin has diligently
observed the effects of this medicine during eight years, and has
arrived at some interesting conclusions respecting it. If we consult
dictionaries, dispensatories, &c, we find this substance stated as be-
ing chiefly indicated in chronic and suffocative catarrh, humid asth-
ma, and at the termination of pertussis and pneumonia, especially in
aged persons. Dr. Herpin reports differently. He says he has nev-
er seen its use followed by even temporary benefit in the latter stages
of pneumonia in the aged, when the mucous rales are abundant, and
asphyxia imminent. Given too at the commencement of pneumonia
following capillary bronchitis, it is far inferior to tartar-emetic : and
alterative doses of this same remedy are also far superior to it in the
capillary bronchitis of old persons and children. The same want of
success attended its trials in asthma and pertussis.

But when the disease, instead of being situated in the parenchy-
ma and smaller bronchi, occupies the larger passages, the result is
very different. Laennec and all those who have come after him
have repeated the erroneous statement that bronchi/is, from its very
commencement, when a mere coryza, imparts to the ear a loud rale.
Dr. Herpin some time since showed that bronchitis at the upper part

184C] Kermes in Diseases, Sf>c,

439

f the tube, accompanied by considerable secretion, gave no auscul-
tatorysign whatever. It is in these cases, where no anormal sound
exists, that Kermes is so useful, and is most so in the acute stage.
He does not mean to say that it will arrest the progress of every put-
monary disease beginning without auscultatory signs, for hooping
cough, pneumonia and phthisis are among such. The catarrhs com-
mencing at the upper part of the tube are soon arrested ; but it rales
announce the supervention of deep-seated bronchitis, other medicines
must be resorted to. In tracheitis, (denoted by pain opposite the
top of the sternum, sometimes difficult deglution, a hoarse, tearing
paroxvsmal cough and hoarseness,) the Kermes is still more indicated.
No other medicine produces so rapid an effect in laryngitis, a few
\ grain doses often removing the hoarseness in a ^w hours when the
disease is recent. In this way it is of great service to singers.
False-croup is very advantageously treated by it, and if seen early
enough, it may be of good service in the true disease. Chronic
laryngitis, when not dependent upon phthisis, may be benefitted by
tbU medicine, but in an inverse proportion to its duration. Even
when it does not cure (for relapse is very frequent), it gives at least
great relief. In the only case oUhymous asthma, Dr. H. has had an
opportunity of trying it, and which was a very bad one, it succeeded
completely. In affections of the pharynx no success followed the
use of the medicine, unless indeed these were connected with disease
of the larynx. A frequent cause of deafness is a catarrhal condi-
tion of the extremity of the Eustachian tube, and in this case the
Kermes effects a cure if the deafness has not existed beyond some
weeks, and even alleviates it frequently when of very old standing.
From his observations, Dr. H. believes he may deduce the conclusion,
that Kermes is to some extent a specific for the affections of the upper
portions of the air-passages.

The dose has varied from 1 to 12 grs. in the 24 hours. M. H. has
never exceeded the latter quantity, and, as a general rule, from 3 to
6 grains suffice. If we except infants less than 1 or 2 years old, the
dose need not be much varied on account of age, children tolerating
the remedy almost as well as adults. It may be given in an emulsion,
powder with sugar, lozenges, or pills. At the commencement of the
affection, or when the respiration is much oppressed, it is desirable
to excite vomiting. Three grains will certainly affect this, as will
sometimes one ortwo in adults, and half a grain in children. To
avoid purging or vomiting, we should give only very small doses,
and after meals. When tolerance is once established, the Kermes
does not irritate the stomach again. When first given it causes a
sense of heat and dryness in the throat, which soon becomes relieved
by an increased humidity and expectoration. Dr. Lombard, who has
employed this medicine with excellent effects, has often observed
rose-coloured streaks in the expectoration ; but these soon disappear.

[Med. Chir. Rev,

440 Rheumatism. Chlorosis Hydrocephalus. Sec. tScc. [July,

Opium Treatment of Rheumatism. The most important rule to
be remembered in employing opium for the cure of acute rheumatism
is, that full and sufficient dotes shall be exhibited. I have heard of
the opiate treatment having disappointed those who have tried it.
On inquiry, I have learned that in those eases it has been given only
to the extent of a grain every fourth or sixth hour. This is not the
treatment of rheumatism by opium; it is making the patient worse
than before; it is inflicting on the patient the mischief arising from
the stimulant effects of the drug, 'and withholding from him all the
benefits of its sedative influence. The opium should always be in-
creased in dose, both as to frequency and quantity, until the patient
feels entire relief; and should be then kept up at that dose until the
Complaint is steadily declining. [Dr. Corrigan in Med. Exam.

Citrate of Iron and. Sulphate of Quinine in Chlorosis and other
Anaemic states. By Dr. Meigs* (Loud. Med. Gaz., Sept., 1845.)
I have made most advantageous use of citrate of iron, conjoined
with sulphate of quinia, as in the following formula, which I subjoin
ns a very convenient and successful one in the disorders dependent
upon anremia. Take of citrate of iron 2 drachms ; sulphate of qui-
nia I drachm ; water 1 fluid ounce. Mix, and direct from 20 to 30
drops for the dose, in syrup and water. Agreeably to M, Raciborski's
method, I advise the patient to tnke the draught after each meal,
within half an hour of the breakfast, dinner or supper, so that it may
be carried with the chyme along the course of the bowels. The ad-
dition of the quinia to the ounce of water renders the citrate and the
sulphate perfectly soluble, as docs also the addition of a few drops of
ammonia to a solution of the citrate alone; without seme addition,
a part of the citrate of iron is not dissolved.

Iodide of Potassium in Hydrocephalus. M. Woniger, of Ham-
burg, observed symptoms of effusion in the ventricles, following
acute inflammation of the brain, ordered a drachm of the iodide of
potassium, in half an ounce of water; of this forty drops were given

every second hour the first da}', increased to fifty drops with tho
same frequency the second day. In three days the patient was con-
sidered out of danger. [West. Lancet.

Antiphlogistic properties of Opium. Dr. Griffin, (Med. and Phys.
Problems,) expresses great confidence in the powers of opium to sub-
due enteritis and peritonitis. He first en-ploys bleeding, when the
patient will bear it, and also frequently uses calomel, especially when
the disease is intense. The calomel, however, is suspended as soon
as the symptoms begin to yield, and the opium is then employed alone,
which avoids the risk of troublesome ptyaiism. [Ibid.

lieUadwnd ds a. Preventative of Scarlatina. By JonN S. Ihwt.v,
VI. I). In tho admirable language of .Or. Green, whatever be the

IS 46. J Strumous Ophthalmia. 441

view taken of the manner in which Belladonna acts, there seems
little room to doubt of its prophylactic powers in scarlatina : those
who have taken this medicine generally escaping the disease alto-
gether, or, if they do become affected, having it m the mildest possi-
ble form.

Now this statement accords precise]" with what I know to be
facts. During the prevalence demic, which has been my

guide in the present crude treatise. Dr. Hardy gave notice that ho
would prepare the belladonna for all those who wished to try the ex-
periment. Anxiety, of course. Jed many parents Jo avail themselves
of this their only hope. He followed the original mode of prescrip-
tion, dissolving three grains of the extract in one nunc? of cin. water,
and directing two or three drops morning and night to a child under
one year old, and one drop more for every year above that age. Ho
and myself kept an account of two hundred and fifty children who
took it thus, and of that number less than half a dozen had the dises
and they had it very mildly. After eight or ten days' use of the
medicine, there was an eruption over most of the surface, in some
cases profuse and troublesome from itching. Those families which
did not take the preparation, had the disease with scarce an excep-
tion. I recollect a remarkable instance which occurred in a partic-
ular neighborhood. A poor woman with a family of sixteenchiidren
used it carefully according to directions, and it is notorious that her
family alone escaped when hundreds were attacked. 3Iany other
striking cases might be enumerated to prove its efficacy, both there
and elsewhere, but to avoid prolixity they must be omitted.

Dr. McKee, in the extension of the same epidemic, exhibited bella-
donna with the same astonishing rowers of prevention. These facts
coming under my own observation, I cannot but believe it to be almost,
an infallible prophylactic when properly used. [South. Journ. of
Medicine and Pharmacy.

Strumous Opltihalmia. (From Prof. Parker's Clinique.) Boy.
This boy is suffering from strumous conjunctivitis. Let us now ex-
amine the symptoms of this form of ophthalmia. There is great
intolerance of light ; this is out of all proportion to the other symp-
toms, it is a diagnostic mark. ss of the conjunctiva
is but alight, gradually increasing in intensity as ihc disease pro-
gresses; the palpebral portion of the conjunctiva is first attacked,
the sclerotic and corneal portions become subsequently involved.
V> e also have small vesicles on the conjunctiva, and small specks on
the cornea; the vesicles or pustules are most frequently found just
at the margin of the cornea, these are frequently absorbed, but more
generally run into ulcere. An ulcer over the cornea is painful, and
often runs into the anterior chamber of the eye, causing protrusion
o{ the iris. It also gives rise to onyx and hernia of the cornea.
The iris sometimes becomes involved in the inflammation. Other
symptoms are epiphora and itching of the eyelids. The vascularity

442 Injections. Gonorrhoea, Tertiary Syphilis. [July,

of the conjunctiva is much less in this, than in many other forms of
ophthalmia. The predisposing causes of this disease, are a scrofulous
diathesis ; bad food and bad air. Children are more frequently
affected than adults.

The exciting causes are various. Prognosis is generally good, if
properly treated. The disease may continue for a long time, and
may result in opacity of the cornea.

The treatment in this case, should consist in a strict attention to
diet, which should be nourishing and of easy digestion, milk with
farinaceous substances, and small quantities of fresh meat ; all sweets
and gravies should be carefully avoided.

Locally, tepid lotions or fomentation with warm water, may be
employed. Once for all, let me caution you against the use of poulti-
ces about the eye, they do more harm than good. Stimulants to the
conjunctiva not to be employed in the first stage of the disease.
"When the cornea is ulcerated, apply a solution of argent, nit., with
a camel's hair pencil, to the ulcer only, and immediately wash it off.
An ointment of the red oxide of mercury, applied to the edges of the
lids, is often beneficial. He should be bathed night and morning in
salt and water, and exercise freely in open air. It is not well to keep
him in a dark room, a green shade worn over the eye will be a suffi-
cient protection from the light.

Internally, the following powder may be taken at night :
ft. Pulv. rhei, gr. ij.,
Mass. hydrag.,gr. ss.
Protiod. ferri, et
Pulv. doveri, gr. ij. M.

[New York Med. and Surg. Rep,

Water of Copaiba for Injections. Dr. Cattell recommends the
following formula for the preparation of this article, ft. 01. Copai-
ba), two ounces ; magnesiae carb., six drachms. Rub together and
add four gallons, or less, of water. Filter. Cubebs may be prepared
in the same way. This preparation is employed by injection in those
cases, where the article is indicated, such as gonorrhoea, leucorrhoea,
&c. By using injections, the nauseating effect of the remedy is
avoided. [West. Lancet.

Treatment of Gonorrhoea. Mr. McDonald, (Lancet,) recommends
the following treatment in this affection. Smear a bougie with oint-
ment of the nitrate of silver, (ft. Argent Nitratis 3j ; adipis gj;)
introduce it into the urethra for about three inches, and allow it to
remain two or three minutes. Two or three applications have been
found to cure the disease; and if used in the acute stage, one appli-
cation is generally sufficient. [Ibid.

Tertiary Syphilis. Female. Here we observe the existence of
an ulcer upon either cheek, partially involving the ear. This woman

1646.] Hemorrhage. Operation of Hare-Lip. 443

confesses that she has had syphilis ; if, however, she should stoutty
deny that she had ever had the primary disease, I should unhesitatingly
pronounce these ulcerations to he syphilitic. I should judge from
the round shape of the ulcer, from its elevated edges, and from the
peculiar glairy discharge. Also, from the rheumatic pain, of which
she complains in the frontal region ; this pain, she says, comes on
after dinner, and is most severe in the afternoon. This is a valuable
diagnostic mark. Syphilitic rheumatism may be distinguished from
true rheumatism, by the fact, that the pain in acute rheumatism is
most severe after the patient has retired, and is warmly covered up in
bed; whereas, in the syphilitic form, it is more intense in the afternoon.

Treatment; in the tertiary form of syphilis, the iodide of potassium
is the best remedy; it is good for nothing, however, in the primary
and secondary forms of the disease. The formula which I use, is
this: ft. Iod. potass. 3iv., Ext. conii. gr. xvj.. Aquae, siv. M.

Dose, a table-spoonful twice a day; after a time it may be taken
three times a day. [Prof. Parkers Clinique. N. Y. Medical and
Surgical Reporter.

Cleans of arresting Hemorrhage after excision of Tonsils. It is
well known that occasionally after the operation for excisiun of the
tonsils, hemorrhage is troublesome and has even proved fatal. Prof.
Hamilton stated at a recent meeting of the Buffalo Medical Associa-
tion, that he had always found cold applications to the neck exter-
nally, immediately effectual in cases of this accident. He prefers,
when circumstances will permit, snow enveloped in a neck cloth.
Astringent gargles, he thinks often do as much harm as good by dis-
turbing the formation of coagula. [Buffalo Med. Joum.

Early Operation for Hare-Lip. In the Xo. of this Journal for
July. 1942. p. 188, we gave an abstract of a communication made to
the Surgical Society of Ireland, by Dr. Houston, the object of which
was to show the expediency of operating very early for hare-lip. In
a subsequent communication to the same Society, Dr. H. adduced
some further evidence in support of his views. (See this Journal
for Oct. 1*43, p. 478.) Dr. Hullihen of Wheeling, also advocates
the same doctrine, (see this Journal for Oct. 1S44, p. 547.) and >till
more recently. M. P. Dubois, in a paper read before the French
Academy of .Medicine, on the 27th of May last, adduces his experi-
ence in its favor. He details a considerable number of cases of infants
operated on by himself or his friends, at intervals varying from a
few minutes, to several days or weeks after birth, and all of which had
proved completely successful. Dr. Dawson advocates, also, the same
practice, and relates, in the Dublin Medical Press, lor M irch 23, I 8 12,
a case in which he operated successfully on a child four days old, and
in the same Journal (Dec. 3, 1845,) the following, in which he opera-
ted with the most satisfactory result, on a child seven hours old.

"At nine o'clock on the morning of Wednesday, the 18th of Sep-

444 Self- Emasculation. New Sign of Pregnancy. [July*

tember last, Mrs. Irwin was delivered of a fine healthy girl, which,
on examination, was found to have a hare-lip on the left side without
any fissure or palate. The mother being very delicate, it was at once
agreed that she should not see her offspring (the first) until the de-
formity should be removed. I was requested to operate, which I
performed in the usual way at four P. M., exactly seven hours after
its birth. The pins I removed in forty-eight hours after the opera-
tion, and in two days more (Sunday) the union was so perfect, that
the adhesive straps were removed, and then, for the first time, was it
exhibited to its mother, who could scarcely credit us when told all
that had occurred. The loss of blood was trifling, but to guard
against the possibility of any finding its way in the stomach, I placed
a. slice of sponge inside the gums. I should add, that up to the pre-
sent time the child is in the best of health, and confirms me in my
determination to operate in similar cases soon after birth."

[Am.Journ. of Med. Sciences.

A Case of Self -Emasculation. By C. Gltddon Young, M. D.,
of Greenwood, La. I was called in the fall of 1887, to see Mr. P.,
a married man, in respectable circumstances, aged about 35 years, the
father of five children, who, in a state of mental despondency, pro-
duced by religious excitement and domestic troubles, had emascula-
ted himself. He was an exemplary member and class leader in the
Methodist church, and was much in the habit of shouting, which was
so disagreeable to his wife that she required him to desist, on pain of
forfeiting his connubial rights. Shortly afterwards she discovered
that he had deliberately sharpened his knife and maimed himself as
above mentioned ; taking out first one testicle and then the other,
afer the manner of castrating pigs. As he was ignorant of the dan-
ger of hemorrhage, or the means of guarding against it, he had cut
the cord directly across, and both spermatic arteries were bleeding
when I got to him. I found him almost exhausted from the loss of
blood; he had fainted several times; the scrotum was filled with
coagula. I quickly cleared the coagula from one side, and found
that the cord had retracted so far within the abdominal ring as to be
scarcely within reach; but a tenaculum introduced by the side of
my finger enabled me to bring down and secure the bleeding arteries,
which I did successively. By a little stimulus he was revived, and
his recovery took place without a single untoward symptom.

[ Western Journal M. S.

New Sign of Pregnancy. Dr. Pallender states that during a.
practice of 18 years, he has observed a peculiar smell of the vaginal
mucus to be a constant and unnerring sign of pregnancy. The
smell is musty, something like that of spermatic fluid or liquor amnii ;
and, after a vaginal examination, it cannot be mistaken for any other
odour. In a great many cases of pregnancy, during the first, second,
and third months, when the condition of the patient was doubtful,

1946.] Premature Interments. Insanity and Quackery. $c. 445

owin* to the earliness of the pericd, the author never, in a single
instance, failed to discoves the true state of the party by means ot
this sign. According to his latest observations, this odour is percep-
tible as early as the eighth day of gestation. [American Journal.

Premature Interments. -It is stated that the cases of premature
interments in France, prevented by fortuitous circumstances, amount,
since the year 1S33. to 94. Of these G5 persons awoke o. themselves
from their lethargy at the moment the funeral ceremony was about
to commence; ^recovered in consequence of the affectionate car
of their families; 7 in consequence of the fall of their coffins in which
they were inclosed ; 9 owed their recovery to wounds inflicted oy the
needle in sewing their winding sheet; 5 to the sensation of suffoca-
tion ihey experienced in their coffin ; 19 to their interment having
been delayed bv fortuitous circumstances; and 6 to their interment
bavins been delayed in conseouence of doubts having been enter-
tained of their death. [Prov. Med. and Surg. Jour. Med. Exam.

Insanity and Quackery. Who can expect that imposture and
quackery will meet the proper punishment of their sins, when such
insane puffs as the following, extracted from the advertising columns
of The London Times, of Jan. 17th, are allowed space in influential
public journals ? How extravagant is the reliance which the quacks
place on the gullibility of the English public, when such an absurdity
is expected to find geese amongst them for its authors to pluck.
Lancet, March 7, 1848, .

"The Ackebleian Purifcation of the Bones, as liquifying tne
chilled marrow by flame-light electricity, causing re-flow of joint-oil
lubrication, for stiffened joints, ossific gout, rheumatism, cancer os
and ulcer'os contractions, without confinement or alteration of diet.
Sun-like expanding, as in plant animal physiology, the nervous
fibrils these respirative tubes being incorporeal for aireal circula-
tion, giving cartilagen'os' expansion for sleep. 3, S street,

Piccadilly. Consultations 6 to 8, A. M.,and 11 to 1, P. M."

Purification of Dissecting Rooms. Although we noticed this sub-
ject in our last No., still its importance induces us to add the follow-
ing minute particulars, obtained from the Medical News. [Edt*s.

"Dr. Sucquet has communicated to the Acad. Sci. of Pans an
interesting memoir on this subject. Dissecting-rooms have been
hitherto deplorable centres of infection. The noxious emanations
from putrescent organic matter have not only rendered the neigh-
borhood of anatomical theatres an intolerable nuisance to the inhab-
itants, but have every day compromised the health, and occasionally
endangered the lives" of "those engaged in the practical pursuits of
science. Few members of the medical profession have not had to
watch anxiously the sickfbed of a friend, wounded at the dissecting
table, or riving of a typhus produced by too zealous attendance at

446 Purification of Dissecting Rooms, [July,

the anatomical school. The warmest feelings of gratitude are, there-
fore, undoubtedly due by the profession, to those who, like Dr. Suc-
quet, endeavor to diminish the risks incurred in the acquirement of
practical knowledge. Many attempts have been made to ward off
the dangers and sufferings to which all medical men are more or less
exposed, and which the public does not always take into sufficient
consideration ; but hitherto the methods proposed have been rejected,
either because, like the injection of alum, corrosive sublimate, and
pyroligneous acid, they change the colour and aspect of the tissues
in such a manner as to render their discrimination extremely difficult,
if not altogether impossible; or because, like arsenical preparations,
their use is not without some degree of danger. Most of the sub-
stances hitherto employed were also open to one very great xepronch,
that of blunting and otherwise injuring the instruments of dissec-
tion. Dr. Sucquet's plan has now been for three monibs in full
operation at the Ecole Pratique de Medecine in Paris, and bas effec-
ted the most complete and beneficial change in the state of the place.
The pavilions were formerly, as all medical gentlemen who have
visited Paris can testify, in a most filthy condition. The emanations-
were perfectly intolerable, even to the most inured anatomists, who
often preferred prosecuting their practical studies at great expense
of time and money in the far-distant, but well-ventilated, theatres
of Ciamart, to exposing their health, and perhaps endangering their
lives, in the pestilential atmosphere of the official school of dissec-
tion. Thanks to Dr. Sucquet, the aspect of the Ecole Pratique is
now altogether changed. The rooms present no appreciable odour ;
they can be heated to a proper degree, and subjects are preserved a
much longer time than heretofore, without manifesting any signs
whatever of putrefaction ; in fact, the problem seems to be solved in
the most satisfactory manner. These results are due to the use of
two substances the hyposulphate of soda and the chloride of zinc.
The first is a transparent inodorous fluid, marking 18-1-0 by
Beaume's areometer; its reaction is neutral, and it is obtained by
passing sulphurous acid through a concentrated solution of carbonate
of soda. One gallon (4 litres) of this liquid injected into one of the
carotids, into the brachial or popliteal arteries, completely arrest du-
ring thirty or forty days the progress of decay, and renders the subject
fitter for injection of the vascular system. Within three months
no less than two hundred subjects have been thus prepared, with the
most unvarying and beneficial results. The chloride of zinc enjoys
even more powerful antiseptic properties than the hyposulphate of
soda ; it is a colourless liquid, marking -]- 40 by Beaume's areometer,
and is obtained by the saturation of muriatic acid with zinc filings.
The abandoned and uncovered parts of the bodies are washed with
this preparation, and the most foetid remains are instantly rendered
inodorous by its contact. Even those which testify by their greenish
hue an advanced state of decomposition, are instantaneously restored,
and after a few moments recover their proper colour. The first-

1840.] Sugar on the Teeth. Medical Intelligence. 417

mentioned salt is supposed to act by the absorption of o.wgen an
active cause of putrefaction for the formation of sulphurous acid.
The second, by the coagulation of all the soluble organic manner
susceptible of putrefaction, which it changes into a compound insolu-
ble and imputrescible even under water, and at a temperature of 15
or 20 centig. (GO0 or 70 Fahr.) This great reform this invaluable
boon conferred upon the profession, for such we must consider it
is due to Dr. Sucquet's researches, promoted and encouraged by the
illustrious Dean of the faculty of Paris.

Action of Sugar on the Teeth. From researches made on this
subject, M. Larrey has come to the following conclusions:

1. Refined cane, or beet-root sugar, is prejudicial to the teeth
more from its direct contact than from the evolution of gaseous
matter during digestion.

2. If a tooth be allowed to macerate in a saturated solution of su-
gar, it is so decomposed as to acquire almost a gelatinous character,
while the enamel becomes opaque and spongy, and crumbles down
under the slightest pressure. Sugar ought not, therefore, to enter
into the composition of tooth-powder.

3. The erosion of the teeth by this substance does not depend on
an acid, for none is present in sugar; but on the affinity which this
organic principle has to enter into combination with the calcareous
base of the tooth.

4. If the enamel be less attacked than the osseous part of the tooth,
the reason is that it contains fluoride of calcium, a body which resists
chemical agency even more than the sulphate of lime. [London
Medical Gazette. Ibid.

MEDICAL INTELLIGENCE.

We ::ive space to the following letter from Dr. W.H.Robert, of Madison, Ga.

"I notice in the present No. (June) of your Journal, the prescription for mak-
ing Blaud's Chlororic Pills. Allow me to give my experience in the forming of
this pill, as we have used thern largely, and find them a capital remedy in the

"After pulverizing each of the ingredients, (the sulph. of iron and the carb. of
potash.) mix them intimately, then add the crumb of fresh-made corn bread:
enough to make a proper mass of the ingredients. If fluid be added, they will
bo found to be entirely too soft to be divided into pills. Again, 1 add, they are
by far the best remedy we have used in chlor

lor of the late National M Convention. In addition to our de-

I Davis . inst an unprovoked attack bv a New- York Professor, we

cl rfuJly publish the following extract from a dance at the Convention by

Dr. John Bell, editor of the Bulletin, Philadelphia :

It would be unjust to close any general notice of the National Medical Con-
vention, especially if. ;i> a large majority of its members belies eedings
?-hall open the way to ben< ficial i 'U, without distio

4 IS

Trismus Xascentiu7ii. Meteorological Observations*

honorable mention being made of the gentleman to whose benevolent zeal and
perseverance we are all indebted for its inception and present growth. We re-
l'er, of course, to Dr. Davis, of Binghauipton, New- York. This gentleman was
present at the Convention, and by his intelligence and unobtrusive yet anima-
ted industry, won the favorable regard of its members."

Trismus Naseentium a novel trt '. In the April No. of the

American Journal of the Medical Sciences, will be seen an article on this sub-
ject, by Dr. J. Marion Sims, of Montgomery, Ala. The Doctor has since then
issued this communication in pamphlet form, and given it a popular dress, &c.
We acknowledge the receipt of a copy, with the regards of the writer.

The object of Dr. Sims is to prove that Trismus Naseentium is owing to a
congested, &c., state of the spinal veins, and in its treatment, he says, "the plan-
ter has only to provide a nice soft pillow of feathers for each infant, and give the
mother or nurse directions to keep the child on its side on the pillow, changing
sides occasionally, but never allowing it to remain for any length of time on its
back. Follow this simple direction, and, my word for it, in a few years our
knowledge of this disease will be almost wholly confined to its past history." We
know not how the planter may succeed in this practice, but we have given the
above directions a fair trial, and like every other treatment for lock-jaw in in-
fants, we have to write :: Tekel" See our extract on this subject.

METEOROLOGICAL OBSERVATIONS, for Mav, 1846, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

I

Sun
Ther.

Rise.
Bar.

3,1
Ther.

?. M. |
Bar. j

Wind.

Remarks.

1

~w

29 41-100

71

29 45-lOffl

s. w.

Fair flying clouds.

2

58

:i 51-100

75

i! 53-100

w.

Fair, do. do.

3

55

" 01-100,

77

" 69-100

N.'W.

Fair, do. do.

4

56

" 72-100:

82

" 77-100

E.

Fair, do. do.

5

60

77

" 82-100

S. E.

Fair, do. do.

6

58

76

S. E.

Cloudy rain at night 2.J-10.

/

62

76

' 60-100

S.

Fair living clouds.

8

64

" 17-100,

67

" 36-100

': 35-100

B.

and light. 5-10.

9

59

" 36-100

72

S.W.

iCloudy a light shower.

lit

58

" 36-1001

74

" 38-100

w.

Fair clouds breeze shower.

1]

56

" 53-100!

76

w.

ia

54

78

11 71-100

r

Fair.

13

51

" 78-100!

79

" 82-1-00

S. E.

(Fair.

L4

66

" 82-100,

79

" 73-100

fc!. E.

Cloudy breeze rain 2J-10.

15

66

" 69-100,

78

" 67-100

S.

Cloudy -oin *-l0.

16

61

75

' 77-100

W.

Fair flying clouds.

17

60

69

" 80-100

N.

Cloudy showery.

18

59

" 73-100

78

N. W.

Cloudy.

19

60

" 69-100J

79

" 7(5-100

N. E.

Fair flying cloudsrain 3|-10

20

62

" 82-100

72

" 78-100

8.

Cloud'-.'

.ij

61

" 75-100]

84

" 80-100

S. E.

Fair. "

22

62

" 85-100

79

" 90-100

S. E.

Cloudy rain 5-10.

23

63

98-100

80

" 95-100

S, E.
S.

> s.
! S. E.

Fair, generally.

24

66

" 95-100]

80

<: 95-100

Fair, do.

-::>

64

;' 93-100

, 85

;( 93-100

[Fair.

26

66

" 93-100

! 88

" 79-100

some clouds.

27

68

" 71-100

92

<; 59-10)

w.

Fair, do. do.

28

79

52-100

90

" 47-100

s. w.

'Fail' flying clouds.

29

70

52-100

89

" 48-100

w.

'Fair, "do. do. [rain 9-10

30

70

,; 51-100

86

" 52-100

w.

) w.

{Fair. Evening, thund. light, and

31

69

" 65-100

83

" 65-100

;Fair. do. do. do. 5-10.

32 Fair days. Quantity of Rain 3 inches and 3-10. Wind East of JX. and S
davs. West of do. 13 davs.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 1] SEW SERIES. AUGUST, 1846. [No. 8.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXVIII.

Observations on Cutaneous Diseases Lupus, with Cases. By
H. F. Ca3ipbell, M. D., Demonstrator of Anatomy in the Medi-
cal College of Georgia.

The little attention paid to diseases ofthe skin renders it important
that every fact which might tendtocaii the attention,of the profession
to the subject should he recorded. In other branches of the science,
physicians have been ever eager to improve nnd cultivate with dilli-
gonce whatever of light or suggestion has been offered, but with
regard to this important class of diseases, there appears to be a de-
grce of indifference almost unaccountable, when v.e consider the
extreme frequency of their occurrence in all parts of our country,
and the very improved state of the diagnosis and treatment of these
diseases in the various hospitals throughout Europe; and it is perhaps
remarkable, that as prolific as the American medical press has been
during the last century, no work on Dermatology has appeared by
an American author. For the last few years, Northern physi-
cians seem to he turning their attention to this subject; Dr. John
Bell of Philadelphia, and Dr. II. D. Bulkley of New York, have,
with a laudable spirit of enterprise, republished two of the most val-
uahle French works on Dermatology, incorporating many very
judicious practical notes which greatly enhance their value.

From the neglect with which the profession in this country, and
especially at the South, have treated cutaneous diseases, the treat-
ment of such cases, if at all obstinate, has generally either fallen
into the hands of empirics, or become the subject of domestic
medication, hence the unbounded success of cancer doctors,
blood- medicines, specifics, &c, &c. ; purporting to render that

29

430 Observations on Cutaneous Diseases. [August,

relief which naturally should be afforded by the skill of the family
physician.

Diseases of the skin occur so frequently in the practice of every
general practitioner that ample opportunities are afforded to every
one of becoming sufficiently well acquainted with many, if not all
of them, did each one study carefully the characteristic peculiarities
of every case coming under his observation. For accuracy of diag-
nosis, they afford a better field than any other class of diseases,
from the fact that, the signs and peculiarities of the case, by which
we are to be guided in our conclusions, are appreciable to the naked
eye or to microscopical investigation, when necessary, and many of
them can be well delineated for the assistance of the student; and
lastly, Dermatology has the advantage of a beautiful classification
which is, perhaps, the most perfect of the medical Nosology. The
above preliminary remarks I felt it necessary to make, as an apology
for submitting the few following cases from notes which, though
accurate, can claim but little of novelty or interest.

Lupus. From the great variety of conditions of the system in
which Lupus exists, and consequent frequent irregularity in its
charac^rs in different cases, much confusion is liable to occur in the
diagnosis of this disease; for instance, we find it occurring regularly
by a small tubercle upon some part of the face, say the ala nasi,
lip, or cheek, this excrescence remains unchanged perhaps for
months, or may be removed by the patient's nails ; another is soon
formed on the spot which is again displaced, till finally the removal
of one of these scabs discovers an ill-conditioned, corroding ulcer,
which soon produces for itself a thick, laminated covering, under
which there will be found a loss of substance in the tissues subjacent.
The ulcer finally extends to the surrounding parts, which it often
destroys with frightful rapidity, leaving the unfortunate patient a
deplorable object of deformity for life.

Again, we have this disease occurring in a very different man-
ner, as under the appearance of a simple inflammation of the
part, or the result of an injury, or a simple ulcer, under certain cir-
cumstances, may degenerate into genuine lupus. Furthermore, the
ulcerations of syphilis frequently appear to assume a lupoid condi-
tion becoming identical wiiti this disease in the sharpened and jutting
disposition of their edges, as well as in the peculiarly disagreeable
whey-like discharge so offensively characteristic of lupus.

1846.] Observations on Cutaneous Diseases. 4ol

Treatment. U is now pretty generally ascertained, that in the
treatment of lupus and other cutaneous affections of the like nature,
but little can be expected from constitutional medication without
availing ourselves of the important advantages of local applications
to the affected surface.

In his lectures on this subject, Mr. Listen reports many cases of
lupus, wherein the disease was successfully treated by cauterization
with the chloride of zinc, and in his conclusions deduced therefrom,
he condemns entirely the use of all arsenical preparations in the
treatment of the disease. Having within the last few years had an
opportunity of observing the results of both plans of treatment in
several cases of lupus, my experience would tend to inculcate a pre-
ference for the use of arsenical preparations, or at least I feel fully
convinced, that bv their exclusion, we would be deprived of remedial
agents, highly valuable for certain advantages which it appears to
possess over any other mode of cauterization yet suggested. In the
treatment of lupus, it would appear that simple cauterization does
not always answer the purpose, hence one cause of the frequent
failure in the actual cautery ; a specific action, upon the parts subja-
cent to that destroyed by the cautery, seems to be necessary for their
progressive cicatrization after the removal of the eschar, and so far
as my observation extends, cautious cauterization with the arsen-
ical paste more fully answers this requisition than any other mode I
have ever applied. It is mote certainly beneficial in its results, and
causes much less pain than any other caustic, and that it is a potent
poison, is I conceive but a trivial objection to its use, by the enlight-
ened members of a profession that claims tribute of all the medici-
nal virtue in every substance under the sun.

I have reported the following cases only with a view of corrobor-
ating the opinion of the profession in favor of arsenical preparations
as valuable and perfectly safe remedies for lupus, and not with a de-
sign of establishing a prejudice against any other mode of treatment
ina disease so malignant and obstinate, and so often resisting every
curative plan, that it becomes our interest not to exclude any agent
that offers even a faint hope of relief.

Case I. J. M i aged G5 years, a planter, of regular habits,

about fifteen years previous to his application to me, had been thrown
from his horse, and by the fall his face was much injured and abraded,
but soon recovered its natural appearance. In a few months after
there appeared several tubercles upon the forehead, cheek and afa

452 Observations on Cutaneous Diseases. [August,

nasi, which would soon fall off and leave the surface beneath smooth
and of the natural appearance, these incrustation*- would again bo
produced, and finally on being reir.oved, several of them were dis-
covered to have ulcerated. Most of these ulcers were relieved by-
various simple applications; but the one on the right cda nasiy
about a year before he applied to me, had shown a disposition to ex-
tend, and upon the removal of each scab, a loss of substance was
found to have occurred. He had been under the treatment of seve-
ral physicians, and though the other ulcerations were removed, this
one seemed to be rather increased than diminished by every applica-
tion r.iade for its relief. When I first saw J. M., which was about
fifteen years from the time that he first discovered the lupoid tenden-
cy of his affection, there were several tubercles in different parts of
the face, and the ulcer on the right side of the nose had completely
destroyed the wing ofthat side, leaving a vacancy extending to within
a short distance of the eye above, to the median line internally ; and
externally, it was bounded by a line drawn in the direction of descent
of the levator labii snperioris. The mucous membrane of the sep-
tum was thus left exposed, and the ulcerated surface extended
entirely around the free margin of the remaining portion of the nos-
tril ofthat side, and emitted the very disagreeable discharge peculiar
to this form of lupous ulceration. There still remained upon the
face many of the indolent tubercles above described indeed there
appeared to be a disposition in the general cutaneous surface to pro-
duce the same sort of exfoliating incrustations as upon the face. The
skin was harsh and dry, there being but little perspiration even under
violent exertion ; patient's general health bad, being frequently the
subject of much gastric irritation. After improving the general
health of my 'patient by tonics, and the daily use of the vapor bath,
I subjected him to the exhibition of 5 drops of the liquor arsen.
potassse terindie, to be increased gradually to ten drops, should no
symptom of gastric disturbance occur. Diet, nourishing. To the
ulcer t freely applied the lunar caustic in substance, and directed
that it should be kept bathed in a strong solution of the chloride of
soda.. The use of the Fowler's solution was continued for more than
a month, when the ulcer had somewhat improved in appearance and
in the character of the discharge ; but finding that it had not been
progressive in its amendment for some time, I applied, after the prac-
tice of Mr. Liston, the chloride of zinc paste to its whole surface.
April 2nd, one day after the application. The parts surrounding

1846.] Observations on Cutaneous Diseases. 453

the ulcer appear to be in a state of very high inflammation, with
much fever. The patient complained of severe pain extending high
into the forehead.

April 6th. The eschar had become loose, and on it3 removal, I
found that though the entire surface of the ulcer had been destroyed,
it still presented the same unpromising aspect as before the applica-
tion, and from the inflammation produced by it, several of the small
indolent tubercles surrounding its edges had ulcerated. After the
discouraging result thus obtained, I was averse to the application of
a remedy as violent in its effects as the chloride of zinc appeared to be.
From the evi ent improvement resulting from the use of Fowler's
solution, I was induced to apply to the surface of the ulcer a layer of
the arsenical paste of the thickness of a ten cent piece, covering its
surface afterwards with a piece of fine spider's web. according to the
plan ofMons. Merat. The application was followed by little or no
inflammation, and the eschar was removed on the tenth day, leaving
a surface of more than two inches around the border above described
completely cicatrized. At intervals, along the seat of the ulceration
there still remained several small ulcers which readily yielded to a
few applications of the paste. Several times after the cicatrization
of the ulcer there appeared a disposition in the healed surface to
ulcerate ; and there was a foetid discharge from the nostril of the affect-
ed side, closely resembling that of lupous production. The general
health of the patient seemed much impaired by the removal of the
ulcer, evinced by loss of appetite, languor, and a state of general
febrile irritation, all of which unfavorable symptoms were relieved
by the establishment of a copious issue by a s-^ton in the left arm.
The cicatrix, even after this, would occasionally become somewhat
inflamed, but this tendency was finally entirely overcome by the re-
peated application of the arsenical paste to the unhealthy spots. In
about a month after its introduction the seton was allowed gradually
to close, without being followed by any unpleasant symptoms.

Case II. This very striking case of the beneficial effects of this
plan of treatment, I had an opportunity of witnessing. It occur-
red in the practice of my friend, Dr. P. F. Eve, and with his
permission I have reported it. C. G., aged about 50 years, when
he applied to the Doctor, had an ulcer of noarly the size of a half
dollar, situated over the zygomatic process of the malar bone, extend-
ing anteriorly upon the cheek, and superiorly it reached into the tern-
pornl fossa. Like mo6t affections of this nature, this case had been nub-

454 Observations on Cutaneous Diseases, [August,

jected to various plans of treatment, without their affording any relief
whatever. Dr. Eve, having prepared his patient, directed the applica-
tion of the arsenical paste to the surface of the ulcer upon a piece of
patent lint ; an imperfect eschar was thrown off in a few days, and
the patient finding the ulcer so much benefitted, of his own accord,
made repeated applications of the remedy, till he had corroded the
tissues so deeply as to expose the bone. The ulcer, which was after-
wards treated with water dressing of the solution of chloride of soda,
granulated vigorously and without an unfavorable symptom has com-
pletely cicatrized. *

Case III. Hannah, a negro woman, aged about 30 years. The
disease in this case commenced by inflammation of the mucous mem-
brane of the nose, attended with a discharge as if from the effects of
cold. Shortly, after, the nose became tumefied, and there appeared
upon the free margin of the septum an indolent tubercle, which,
upon being removed, discovered an ulceration which was pronounced
to be syphilitic, and treated accordingly, but only with an aggrava-
tion of the symptoms which characterized it. The ulcer continued
to destroy the part affected, and when I saw her, the entire septum
had been removed, in consequence nf which, the nose had considera-
bly flattened. There were also many indolent tubercles, and a few
ulcers upon its external surface, and upon the upper lip, at the root of
the nose, was another ulcer all of which were very plainly of a
lupoid character. There were several cicatrizations upon the upper
lip and cheek, evidently the remains of the superficial form of the
disease. Both ala nasi were much hypertrophied and covered with tho
greyish granulations of lupus. General health of the patient, good.

Treatment. Ten minims of Fowler's solution ter in die, to be re-
duced or omitted, should symptoms of gastric irritation supervene.
Diet, nourishing. I applied the arsenical paste to the ulcers after
the manner ah*ve described. I saw the patient only for a few days
after the application : it had been followed by but little inflamma-
tion and the surrounding parts seemed much improved, before the
eschar had fallen off, she removed cut of the State, and the further
progress of the case was beyond my personal observation ; but
through letters from her owners, I am informed that she has entirely
recovered, and is now hiring for full wages.

The following case I report only with a view of showing the bene-
flcial effect of this mode of treatment, even at a very advanced period
of the disease.

1846.] Observations on Cutaneous Diseases. MB

Case IV. D. F , a carpenter, aged 40 years, of intemperate

habits. He had had for some years a corroding ulcer on the tip of the
nose, which had been treated by both physicians and empyrics with
but little benefit, at any time, but most frequently the disease seemed
aggravated by every application made for its relief. When I saw
him, almost the entire organ had been destroyed, and the ulcer ex-
tended upwards to within half an inch of the internal angle of the
right eye-lid, and extending downward, had passed between the su-
perior maxilla and the upper lip ; several of the teeth had fallen out,
the upper lip was everted, and his whole face much distorted.

Treatment. \ made for this patient the following prescription :
ft Ferri Arsencatis, - - gr- 1

Piper. Nig. Pulv. - - grs. 13

Gum.Acac. " - 12

Aqua Q. S. to make a mass.
Which divide into 12 pills ; take one, ter in die.
To the edges of the ulcer, I applied the arsenical paste as in the pre-
ceding cases ; an eschar was thrown off in a few days, and the surface,
though not cicatrized, was very much improved in its appearance.
There was scarcely any inflammation in the surrounding parts.
The same application was made repeatedly during the space of two
months, when the entire margin of the ulcer, and as far within as
could be attacked by the cauterization, was entirely healed and pre-
sented the appearance of healthy tissue. And even the ulcerations
within the cavities of the nose and mouth, though not removed, seemed
arrested by the application of the paste to the external ulcerations,
and when the patient left the city, the entire- margin of the triangular
vacancy left by the removal of the nose was completely cicatrized.

Case V. Mrs. S., aged 32 years, whose father had been the
subject of a large lupous ulcer for fifteen years, about three years
ago discovered on the left side of the upper lip a small vesicle resem-
bling very much those of Herpes lahialis, whrch soon desiccated, and
was^removed by the nails of the patient ; but it shortly returned, and
finally after frequent formations and removals, became an established
ulcer. This ulcer was repeatedly subjected to treatment such as cau-
terization with the nitrate of silver, ccc, Ace., continued gradually to
increase till it became of the size of a ten cent piece, extending up
under the corner of the nose, in which condition I first saw it.

After the first application, the paste remained ten days, but tKc
etcher was very imperfect from the great mobility of the part affect-

456 Locality, Climate and Diseases of East Tennessee, [August,

ed. Upon the removal of the paste and eschar, the surface of the
ulcer was much benefitted, though the ed^es still remained indurated
with an inflamed areola. The paste was applied a second time, but
from the constant motion of the lip, it was soon removed. No in-
flammation followed the application of the arsenical paste either
time. As the^disease was in a part so accessible to ihe knife, and
as its further extension would inevitably involve the ala of the nose,
upon consultation with Dr. P. F. Eve, the entire excision of the
affected part was determined upon. Although I bad removed a large
portion of the lip, '.here was but a very slight irregularity in its ap-
pearance, and the wound was completely cicatrized by the fifth
dressing. Since, there has been no return of the disease whatever.
The above very imperfect observations and cases, gleaned from the
opportunities of a limited practice, I submit without further com-
ment, humbly hoping that perchance they may elicit something truly
valuable from some abler pen, and more experienced source.

AXTICLE XXIX.

The Locality, Climate, and Diseases of East Tennessee, By
Samuel B. Cunningham, M. D., of Jonesboro', Tennessee.
(From the proceedings of the second annual meeting of the Medical
Society of East Tennessee.)

East Tennessee, bounded by North Carolina on the east, and ex-
tending to Cumberland Mountain westward, embraces some two
hundred miles in length. From the mountains on its southern bor-
der, to the line dividing it from Virginia and Kentucky, it has a
medium breadth of fifty miles. It is interspersed with mountains and
valleys, and every intermediate variety of surface and geological
structure.

In the highest parts of the upper counties, it presents high ridges
and precipitous mountains, with a small proportion of valley, or even
arable land. Here the rocky formation is principally primitive.
The water is the purest freestone. The streams having rapid cur-
rents, speedily drain the soil which is almost destitute of marshes,
and the dense forests and hills everywhere interpose to neutralize
the action of heat in summer. Thus, miasmatic influence can hardly
be said to exist at all. The atmosphere is consequently pure and
salubrious, except from thormomctrica! and hygrometrical influence.

1940.] Locality, Climate and Diseases of East Tennessee. 457

Following the western slope, we find the country less precipitous and
primitive, though still broken. Here agricultural industry has bro-
ken in upon and measurably dispersed the dense shades of (he forest.
The atmosphere is consequently less humid, but the country is more
exposed to the scorching sun in summer, and to the bleak and chilling
blasts of winter, and to the daily vicissitudes of our climate. In this
region the geological structure is secondary or transition, the water
chiefly pure limestone, except on the waters of Lick creek, and
Horse creek, both of which streams collect from the Southern and
Eastern declevities of Bay's Mountain. These streams, as well as
some others, from their having percolated slate lock, or soap-stone,
(which is the striking formation of that mountain.) and of the region
through which they pass, present constantly a muddy and impure
water, unpleasant in taste, and possibly exert some influence on the
health of the inhabitants, though until late years there was no
marked evidence of this. The inhabitants, as far as we are in-
formed, enjoy as good health as in other localities.

But of late, the extensive marsh and meadow lands bordering these
streams, which were densely timbered, so as to obstruct the rays of
the sun, and prevent miasmic effluvia, have been extensively cleared
for cultivation. The overflowing from the heavy rains leaves pools
of water with a copious deposit of vegetable matter, which, when ex-
posed to the summer heat, enters rapidly into decomposition. In
addition to this the substratum is either slate rock, or clayey struc-
ture, through which water sinks with difficulty. It must of course
dry up more by evaporation than by absorption ; consequently there
is great increase of miasmatic influence, which readily accounts for
the great increase, of sickness which has prevailed there for the last
few years. Still farther down are some extensive plains, but the soil
being porous, there is but little malaria. Yet on the rivers, afford-
ing, as they do, a greater expanse of surface, relaxed in currents and
in high tides, during wet or rainy seasons overflowing their banks,
they may leave standing water and a saturated soil composed of allu-
vial and vegetable matter. The climate is also hotter here may
be the elements for the production of fever during seasons when their
combination of causes are brought into full exercise whilst it will
appear that in the upper counties a large proportion of cases aro
fever : in their etiology they differ materially from those in the lower
counties. Between the summit level of Johnston county, imbedded
in the highest mountainous region of the state, and the lowest point

458 Locality, Climate and Diseases of East Tennessee. [August,

of East Tennessee, where the Tennessee river breaks through the
Lookout Mountain, there is a difference in elevation of about 1000
feet. The mountain range bordering it on the south, recedes so as
to leave the western counties of this division of the State open and
exposed to the southern breezes of Georgia and Alabama, so that
similar natural causes must to a good degree operate on both, and it
is therefore reasonable to suppose their character of diseases would
approximate each other more nearly than those of the two extremes
of East Tennessee itself. But the producing causes of fever in the
one, are very different from those of the other ; hence we have con-
firmation of the (so to speak) polygeneric causes of fever; and if it
be an axiom that cause and effect are steadily related to each other,
it would seem fair to conclude, that a difference in kind, in develop-
ment, or character, and in treatment also, exists. Until reports,
however, shall have been made by the physicians throughout East
Tennessee, from careful bedside observation, our conclusions are to
some extent inferential. How important is it that we should have
such statistics ; because without them no general consent among the
profession can ever exist no uniform plan of treatment could or
should be universally applicable. Our up-county fevers arc charac-
terized most generally by high inflammatory action, frequently de-
manding the most energetic and active depletion. What we most
fear and labor to avert, after the first shock of impingment has pass-
ed off, is local determinations to vital organs. Some, it is true, appear
1o sink under first impressions, into a state approaching asphyxia, or
if excitement is developed at all, it is so imperfect, and so slow to
subside, as scarcely to be observed as a stage of excitement at all.
The prominent symptoms are those of rapid subsidence and functional
inertia, or insensibility and death. Some cases take on the recu-
perative action but imperfectly, and run on indefinitely to a recovery,
or assume the character of typhoid fevers. These of course demand
a plan of treatment very different from the former class, yet as a
general thing, when predisposing circumstances do not intervene
to subvert the powers of the system, or render it to a high degree
unequal to the impressing cause, or to enervate it so as to disable it
from setting up and sustaining recuperative action, a strong reaction
is expected, which demands the promptest depletion ; but in sections
that are under miasmatic influence, gastric and biliary derangements
become a more prominent feature. The type is generally either
intermittent or remittent, and less inflammatory, and requiring more

1S4G.] Locality, Climate arid Diseases of East Tennessee. 456

generally (he febrifuge power of quinine or bark, and less of the
lancet, antimonials and blisters.

But as it is our intention to confine ourselves more to the sphere
of our own observation, we shall speak more particularly of the dis.
eases of the upper counties.

We have already said that the air was pure and salubrious in
these counties, being without marsh effluvia ; we are therefore led to
the conclusion that a different cause must exist for thei genera-
tion, and this is found in the vicissitudes of our climate more than
any thing else. The mercury in the hottest day? of summer seldom
rises higher than 85 or 68 Farenheit, and rarely falls below 10 in
the coldest days of winter ; but the changes are very sudden ami
great. It may be 80 or 85 at noon, and at 50. or below, in a few
hours, at 10, in the morning in winter, and at 40 by night. Snow-
is often in full view on the high mountains in the month of April,
whilst vegetation is advanced, and leaves are out in the low land;* at
their base. As the woodlands are cleared off, tiiere is now less to ob-
struct the chilling breezes from these alpine summits, and it is not
uncommon to have a frosty night succeed a day of almost summer
heat.

Vegetation is at least ten days later than at Knoxville, although the
latter place is on a parallel of latitude only about 20 miles south of
Jonesboro'. Besides, our most obstinate cases of fever are even more
rife in winter, and on the highest points of exposure, far removed
from any apparent local cause of origin, and among the best livers
of our county, and almost always may be traced to occasions of ex-
posure, or to the effects of sudden changes of weather; yet, there
fever is one of our most common diseases. We have been surprised
at the result of our own examination of this subject. On reviewing
a list of cases occurring during the years 1841-2, 3, which present
us with a fair average, out of some 400 acute cases, worthy to be
mentioned as falling under the head of Clinical practice, we find at
least 50 or GO of remittents of children, sometimes denominated
gastro-intt stinal fever ; and about the same number amongst adults.
Next in order of frequency, are diseases of the respiratory organs,
such as pneumonia, pleurisies, pleurodinia, bronchitis, &c. We omit
the review of the following year, because in the fall of '43 commenced
the ravages of those extensively prevailing maladies, scarlatina and
erysipelas which continued during the winter and spring following,
and were peculiar in character, obscuiing other cases, or stamping

460 Locality, Climate and Diseases of East Tennessee. [August,

them with the impress of their own peculiarities, it being difficult to
say in some cases to what class they might belong, or whether they
are only modifications of the same disease. According to some the
erysipelas is only a modification of the bilious remittent. On re-
suming the enquiry in October, 1844, when the erysipelatous diathe-
sis had passed away, and continuing it up to the present time, (May,
1846,) out of near three hundred cases, we have from 60 to 80 of
infantile remittent, and about 80 or 90 of adults, or about 160 cases
of fever, considerably more than one third of the whole number of
acute cases, occurring during those winter months.

True, many cases were mild, recovering within a few days; yet
no other name, from the tiain of symptoms present, could, as we
believe, appropriately express them.

It may be objected that we have taken into this account the fevers
of childhood which are inapplicable to such a comparison; but leav-
ing these out, and counting all over the years of 14, and of the cases
within the last mentioned period, and there remains more than a
fourth of the whole belonging to the class of fever proper. Next
again to fever in the order of frequency, as in the former period, wc
find diseases of the chest. It is worthy ofremark, that from the fall
of '43, there seems to have been a considerably increased number of
fever cases. May this not have been owing to som;1 general diathesis
produced by atmospheric influence? From the examination of the
weather for a number of years, it maybe proper to state, as regards
the heat, rain, and electrical state, and on comparing the same
months during each year, there was not more variation than in
years that were known to have been healthy. We have been en-
abled to make this examination from having had access to a register,
very faithfully kept during the last twelve or fifteen years. What
was the barometrical state, we had no means of ascertaining. It
was our intention to have pursued this subject much farther, to have
given the symptoms and general treatment, and modification of
views, either from personal observation, or the views of others as
promulgated in the Journals of the day, but already it has extended
perhaps to a wearisome length, and taken up more than a fair pro-
portion of the time of the Society. The subject may be extended
should it seem proper at some future session. In conclusion, we
would observe that we should be pleased to hear from others, on this
as well as many other subjects, such observation as experience would
authorise them to mako#

1840. J On the use of the Sulphate of Quinine, $c. 461

ARTICLE XXX.

Observations and Remarks on the use of the Sulphate of Quinine,
and other remedies in the permanent cure of Hebdomadal Inter-
mittent Fever. By Thomas W. Carter, M. D., of Abbeville
District, So. Ca.

The sulphate of quinine is a medicine the efficacy of which in
arresting the paroxysms of periodical diseases, and particularly those
of miasmatic fevers, is well known at this time, I presume, to the
civilized world. But notwithstanding the high character it has at-
tained, and the vast amount of good it has accomplished in behalf of
suffering humanity, yet there are those who, from ill judgment in
the proper administration of the medicine, having imbibed erroneous
views, regarding its therapeutical action and intrinsic value in the
treatment of intermittent?, are disposed to raise some objections to
its employment objections of a negative character.

Although the efficacy of quinine in arresting the paroxysms of an
intermittent is incontestible, it will not even in a majority of instan-
ces, according to the present method of administration, effect a per-
manent cure. Speaking from my own experience with this article,
I think I am correct in stating that physicians are often perplexed in
witnessing their own abortive efforts in attempting to effect a perma-
nent cure and final eradication of an attack of intermittent fever.
Often have I administered sulphate of quinine, and apparently cut
short the disease, when on the slightest exposure of the patient, and
even without any appreciable cause, the disease would return with
the same characteristics of the former attack.

The conclusions to be drawn from a knowledge of these facts, are
that quinine is capable 'of subverting an anticipated paroxysm, but,
that when administered according to the customary method (large
doses and the use of the medicine suspended), it is in the majority of
cases inadequate to the removal of that disposition to return which
appears to be so indissolubly engrafted upon the normal system.

It is evident, then, that in the usual method of administration there
exists a defect, (in the action of quinine there is none,) to supply
which defect or supposed inefficiency in the action of the medicine,
is looked upon by many of the profession as a desideratum, the ac-
quisition of which would be quite a contribution to the science of
medicine. From this very cause, quinine is losing, to some extent,
that reputation it has so meritoriously won for itself in the cure of

462 On the use of the Sulphate of Quinine, <fyc. [August,

intermittents ; for some are inclined to believe that it favors the
hebdomadal recurrence of the di?ease. They should not stigmatize
the medicine and charge it with inefficiency, but rather blame the
method of administration.

Those who prescribe quinine for the radical cure of ague, should
recollect the nature of the disease they are treating, and always keep
in view its hebdomadal periodicity ; for in the majority of instances,
if this be neglected, an ounce of quinine will scarcely cure an ague
permanently. But if this hebdomadal recurrence be properly anti-
cipated, and the introduction of the quinine properly timed, its efficacy
will be equally as great, and the result equally as pleasing, as when
administered to prevent the daily paroxysms.

The best plan that I have adopted to secure this end, in those who
are not too bitterly prejudiced against its use, is by the daily admin-
istration of quinine in small doses, commencing a few days after the
cure of the primary attack, and continuing its use for weeks, or a
month, or more. This will be found a successful plan a plan which
insures the permanent cure of the disease.

To illustrate the above, I will give my own case.

In the fall season of 1845, after having been exposed to the causes
of intermittent fever (a miasmatic atmosphere) for some time, and
the duties of my profession necessarily calling me to the sick cham-
ber, I was attacked in the month of October, with intermittent fever,
which was readily relieved by the use of quinine, &c, but in the
course of two weeks I was again attacked. In this instance the dis-
ease assumed a milder form, and as readily yielded to the sulphate
as at first. After three weeks I experienced a third attack. From
this to the seventh attack, it observed strictly the form of a tri-
hebdomadal, occurring regularly every third week. Each attack
was successfully treated with quinine. During the intervals 1 en-
joyed tolerably good health, but the tri-hebdomadal recurrence was
regular.

It might be proper for me to remark that after the second attack,
I was not exposed to the influence of a miasmatic atmosphere, hav-
ing changed my residence to a locality where miasmatic fevers were
not prevalent.

Having discovered the true nature of the exact period of recurrence1
of my disease, I resolved to anticipate the attack by the use of qui-
nine in the mode proposed. The attack was prevented, and the
disease totally eradicated. From that time to the present, May, '46v

1846.] On the use of the Sulphate of Quinine, $c. 463

I have licit! no return of disease. This case shows the promptness
with which quinine, when properly administered, will cure chronic
agues, as they are termed by many. In those cases where doubt
exists as to the exact period of recurrence, the better plan is to pre-
scribe the sulphate, daily, in small doses, commencing a few days
after the cure of the primary attack ; for, until the disease by repeat-
ed attacks has shown its regularity of recurrence, it is impossible to
prevent its periods ; for it may return at the first, second, or third
weekly period. This, time and the repeated recurrence of the dis-
ease, alone will reveal.

Respecting the opinion entertained by some, that the use of qui-
nine favors the hebdomadal periodicity of intermittent fever, it is
scarcely worth notice. How is it possible, that a medicine possess-
ing such undoubted antiperiodic properties, could be instrumental in
pring periodicity] Such ideas are preposterous in the extreme,
e more philosophical plan of reasoning upon this subject, accord-
ing to my judgment, would be this: that previous to the use of quinine
as a therapeutical agent, and its administration for the care of inter-
mittents, the medicines used in their treatment, were tonics of more
permanency than quinine, but not possessing such antiperiodic pro-
perties; consequently, when those remedies did succeed in prevent-
ing a paroxysm, from imparting tone to the general system, they
left it in a more favorable and fortified condition for resisting the
encroachments of the hebdomadal chill quinine having more anti-
periodic, but less* tonic powers, than the remedies formerly employed.
To this fact, then, may be ascribed the more frequent recurrence
of the disease under the hebdomadal form in later than in former
times.

There are other useful adjuvant remedies that might be associated
with benefit, or employed separately, in the treatment of the hebdoma-
dal form of intermittent fever. For instance, the repeated applica-
tion of cups to the spine. It is generally admitted, I presume, at the
present day, that the primary lesion of this disease is in the nervous
centres. This fact is demonstrated by pathological investigation,
and by the evidences of pain and tenderness evinced in almost every
case, on pressing carefully and firmly each vertebra of the spine. I
will venture the assertion, that if a rigid examination of the spine bo
instituted, in this disease, nine-tenths of all cases, will to a greater or
less extent, exhibit tenderness of some one or more of the vertebra.
I have scarcely known it to fail, even in those who complained of no

464 On (Ac use of the Sulphate of Quinine, ^v. [August,

uneasiness in that region whatever, and who were utterly astonished
at being compelled to shrink from the pressure exerted, to avoid the
exquisite pain induced by the examination.

Concurring in my opinions with Prof. Ford, and I believe, the
entire faculty of the Medical College of Georgia] respecting the
pathology of intern itlent lever, I was led to the employment of revul-
sives to the region of the spine, and more especially in those cases of
hebdomadal recurrence. I have regarded cupping as one of the most
permanent and effectual plans of revulsion ; and consequently have
almost invariably employed it in preference toother revulsive appli-
cations.

1 have found it to hold good, that those cases submitted to cup-
ping were more exempt from a recurrence of the disease in the heb-
domadal form. Were it necessary. I could give cases in corroboration
of the above statement, showing the difference of success betwi
cupping and other revulsive treatments.

There are many cases which, after having assumed the chronic,
or hebdomadal type, resist ail the ordinary methods of treatment ;
these will readily yield to cupping, and the exhibition of quinine, on
the plan before recommended, viz.. small doses frequently repeated,
or by anticipating the hebdomadal paroxysm by the administration
of thi* article. Indeed such cases may be cured effectually and per-
manently without the aid of quinine. For instance:

A. M . a youth aged 13, previous health tolerably good, had

been laboring under repeated attacks of ague forthe last eighteen
months had been often cured by quinine, ccc. ; but the disease
still persisted in returning in the hebdomadal form. His spine being
examined, two or three of the dorsal vertebra? were found to be ex-
ceedingly tender on pressure. He was subjected to one single cup-
ping, and put upon the use of the Tinct. of Queen's Delight, (an
article of which I desire making a separate communication at some
future period.) The result was a total eradication of the disease;
for from the spring of 1S45 to the present, he has not suffered an
attack, and now enjoys good health.

Such cases as the above establish at least two facts :

1st. That if cupping the tender spine is not adequate of itself to
the cure oMntcrmittcnt fever, it is at least an useful auxiliary in the
treatment.

2nd. They corroborate the views entertained by modern patholo-
gists, viz., that the primary lesion of intermittent fever is located in
tiie s inal column.

1840.] Remark? on the Statistics of Amputation. 465

ARTICLE XXXI.

Remarks on the Statistics of Amputation. By Paul F. Eve, M. D.,
Prof, of Surgery in the Medical College of Georgia.

In the 3d Vol. of the first series of this Journal, published in 1639,
will be found the following remarks on the mortality after amputa-
tion, which I sent home while in Paris during that year: "M. Vel-
penu. in preparing the second edition of his Medicine Oneratoire,
wrote to Dr. Mott, requesting him to give :: >me idea of the success
of American surgeons. This Dr. Molt soon furnished; hut M.
Velpeau, I learn from his chief interne, M. Perischaud, does net give
credit to it. He says this is contradicted by the statistics of Dr.
Norris, one of the surgeons of the Pennsylvania Hospital. I recollect
being impressed with the great error which Dr. Norris' statement
was calculated to produce, by those who take it as the basis of suc-
cess of amputations in the United States. It no more conveys a
correct history of American surgery on this, than it does on any
other subject. No surgeon of our country will consent to its being
a correct foundation of statistics in surgical practice. All it can
pretend to, and all that Dr. Norris undoubtedly intended by it, was
the practice of the Pennsylvania hospital, and nothing more. I re-
spect the surgeons of this charitable institution, but I am sure they
will acknowledge that they erred, and that greatly, though on the
side of mercy, in delaying amputations during the period referred
to by Dr. Norris. Who, in reading these statistics, will admit them
as correct, as applied to the United States. And being the only
ones yet published in our country, it is not astonishing that a man
of M. Velpeau's industry and penetration, should have noticed the
contradiction to it in Dr. Mott's letter to him."

Soon after my return from Europe, I noticed in the Medical Ex-
aminer of Philadelphia, then edited by Drs. Biddle, Clymer and
Gerhard, some comments on the above quotation, which was repub-
lished in their Journal. They commence by saying, " we regret we
differ in many respects from the writer," but admit, that patients in
the Pennsylvania hospital are liable to erysipelas and purulent ab-
sorption, and also to the unfavorable circumstance of "the late pe-
riod at which surgeons perform some of the amputations ." Again,
in this same Journal, May, 1840, they observe, " many of us were
under the impression that these operations were extremely insignifi-

29

466 Remarks on the Statistics of Amputation. [August,

cant, so far as the mortality was concerned. One of the Editors of
the Examiner labored under this impression, and stated his convic-
tions to some of his surgical friends in Paris; after his return to
America, he found that the amputations at the Pennsylvania hospital
were often fatal ; that. is, during a portion of the period alluded to
by Dr. Norris, as that of the grea at mortality after amputations,
1834-K."

As I have made no attack upon the correctness of the report of
Dr. Norris, but simply stated my belief that it ought not to be taken
as a just statistical basis for calculating success of amputations in
the United States, no reply was deemed necessary to the comments
made upon my letter. Indeed, after the explanations given by the
Editors of the Examiner and quoted above, it is difficult to determine
wherein we differ on this subject : and I have now merely referred
to the matter, because by a rerent report of Dr. Betton of German-
town, published in one of the last Nos. of this very Journal, the
Medical Examiner, and by my own statistics of amputation, the po-
sition I have assumed is abundantly strengthened.

No one will pretend to deny that the mortality after amputation is
far greater than it was supposed to be, previous to recent statistical
investigations, or that this is not true, even of our own country ; but
what I maintain is that Dr. Norris' report of this operation as it occur-
red in the Pennsylvania hospital from Jan. 1830, to Jan. 1838, is not
a correct basis of the success of American surgeons. This report,
it will be recollected, was published in 1838, in the August No. of
the American Journal of the Medical Sciences; it was of course to
it, and to it alone, that my letter written from Paris in 1839, alluded,
and to it also M. Velpeau had reference, when he said it contradicted
the assertions made to him by Dr. Mott. During these seven years,
(from 1830 to 183S.) of 56 amputations performed in the Pennsyl-
vania hospital, 21 died or nearly one half of those operated upon.
Who, I ask, is ready to admit that this is our mortality after this
operation? Who will attempt to prove this to be a correct estimate
of deatlfs after amputation in the United States?

Fortunately for me, Dr. Norris, two years subsequently, published
another statistical account of these operations as performed in the
same institution, (Pennsylvania hospital,) during 1833 and :39. In
this second report, we learn that of 24 amputations, only one died%
What a remarkable discrepancy, and how opposite to the first state-
ment ! By one table, we are made to lose 1 in about every 2 that

1846.] Remarks on the Statistics of Amputation. 467

we amputate, and by the last only 1 in 24 Was I not then justified
in saying the impression produced by the first report was erroneous?
Was I not right in supporting the assertion of Dr. Mott, that in
America our amputations are generally successful? Would M.
Yelpeau, had he seen this second report of Dr. Norris, have slated
to his hospital surgeon, I cannot credit Dr. Mott on this subject,
though he is sustained '* by Drs. Gibson, Warren, Paul Eve, and
some physicians of Philadelphia."

Dr. Mott stated to M. Yelpeau, "our amputations at New York
are rarely followed by death ; I cannot recall to mind at present, but
four cases of amputations which have thus terminated."

Dr. Gibson also wrote to the same author, "the greater number
of amputations that I have performed for diseases of the articulations,
wounds from fire-arms, and complicated fractures, have been followed
by complete success."

In Dr. Reese's last edithn of Samrel Cooper's Surgical Die-
tionary, he states the fact that of IS amputations performed in
private practice by Dr. J. C. Warren, of Boston, he lost but
one. Dr. R. also adds, that several surgeons of this country
many of them in extensive practice, have never lost a patient after
amputation.

Dr. Thoma* F. Betton, of Germantown, has just published his
cases of amputation, amounting to 16, with the loss of only one.

Dr. Norris himself admits the error of too great delay in perform-
ingthe operation in t ^Pennsylvania hospital ; and by the statistical
report of Dr. George Hayward. of the Massachusetts general hospi-
tal, at the same period, wo find the mortality was less than in the first
named institution. While these reports show the proportion of deaths
up to 1840, to be after amputation about 1 in 4, yet in private prac-
tice it must be considerably less.

Life will always be endangered in an operation like that of ampu-
tation, but full and correct statistics, could they be arrived at, would
no doubt exhibit the success of the operation in the United States as
good, if not bolter, than in any other country. By a glance at the
following tables, a comparison may be made.

The 1st, represents the mortality after amputation in general.

The 2d, that of the inferior extremity.

And the 3d, statistics of my own operations.

468

Remarks on the Statistics of Amputation, [August,

TABLE I. Statistics of Amputation in general.

No. of Cases

Where occurring or by whom Reported.

Faure, alter the battle of Fontenoy,

Edinburg Royal Infirmary,

Dr. Guyon, French African Army, 1837,

At siege of Con stan tine, Africa, 1837

At Bildah, Africa,

Guthrie, Toulouse and New Orleans,

Dr. Norris, Pennsylvania Hospital, 1838,

Do. do. do. 1840,

Dr. Hayward, Massachusetts General Hospital, 1840,
Mr. Benjamin Phillips, in all countries,

Do. do. in Great Britain,

Do. do. private cases in London,

Guthrie, on the field of battle,

Do. secondary in hospitals,

Glascow Infirmary, Dr. Lawrie,

Northern Hospital, Liverpool,

Gendrin, Paris.

University College Hospital, London,

Emery, after battle of Navarino,

Dupuytren,

Do. by Meniere at Hotel Dieu,

Scotch hospitals out of Edinburgh, 1844,

Larrey and Roux,

Roux in 1814,

Dubois,

Dr. J. C. Warren, Boston, (private,)

Do. do. hospital,

Dr. N. R. Smith, Baltimore,

Dr. Betton, Germantown,

Malgaigne, Paris, 5 years, ending 1841,

Paul F. Eve, Augusta,

Deaths.

* Probably only those who died immediately after the operation.

t This includes' all kinds of amputations, and the same remark applies to my own.

TABLE II. Statistics of Amputations of Tilt Inferior Extremity.

Where occurring or fry whom Reported.

Markham. reporter Dupuytren,

Alex. King, reporter Guthrie, at Toulouse,

Alcock, Spain and Portugal,

John Phillips Potter, 1841

Dr. F. N. Machardy, 1841, London,

Dr. Bullen,

Dr. Lawrie, Glascow,

Dr. A. Trowbridge, State of New York,

Dr. Lawrie, by Thos. Inman,

Thos. Inman. France,

Dr. Norris, Pennsylvania hospital. 1838,

Do. do. do. ' 1840,

Dr. Havward Mass. general hospital, 1840,

Edinburgh, I ill,

Velpeau, 1842,

In Paris, during 5 years, 1841,

Dupuytren, by Meniere, at Hotel Dieu,

Dr. Betton, Germantown, 1846,

Paul F. Eve, Augusta

\o. of

Cases.

Deaths.

high.

Leg.

Thigh.

| Leg.

36

21

78*

27*

42*

14*

22

26

4

4

202

56

55

11

19

32

6

3

36

27

19

9

85

11

128

62

46

30

107*

69*

13

16

6

9

15*

1*

34

23

9

5

18

20

13

2

6

4

4

2

201

192

126

106

11

3

9

3

4

6

1

none

7

7

none.

none.

The figures thus marked *, indicate simply the inferior extremity without the
distinction into thigh and leg.

1846.]

Remarks on the Statistics of Amputation.

469

TABLE III. Statistics op Amputation of the Inferior Extremity occur-
ring IN THE PRACTICE OF THE WRITER.

THE LEG.

No.

Name.

Age.

Sex.

1

Soldier

40

Male.

2&3jL?n

11

Male.

4 IMoses

5 Simon

30

35

Male.
Male.

G J Daniel

27

Male.

>

Ned

22

Male.

Caries from ball thro'
ankle-joint.

Gangrene from frost-
bile.

Aneurism from inj a ry
Caries liom injury.
Necrosis of Tibia fr'm
a burn.

Hypertrophy, &c.

Result.

Sukey

35

Female

Turknett's boy

15

xMale.

Jonakin's man

35

Male.

Bill

10

Male.

C.B.

21

Male.

William

28

Male.

Lewis

21

Male.

THE THIGH.

Scrofulous ulceration

of leg.
Gangrene of leg from

inj ury.

Gangrene from injury

Necrosis of Tibia.
Gangrene from injury

to knee-joint.
Do. do. do.

Vlalign'nt ulcerations
from an old cicatrix
of a burn.

Speedy recovery.

Both legs nt the same
time rode out on the
eighth day.

Speedy recover}'.

Vv'ell in three weeks.

Healed slowly, but en-
tirely.

Healed in about three
weeks.

Well in live weeks, &,
lived for three years.

Well in a month.

Well in lour or five

weeks.
Well in three weeks.

WTell in three weeks.

Well in four weeks.

Healed in three weeks.
The disease subse-
quently attacked the
glandular system, &
destroyed the patient,
the stump remaining
sound for two months.

Total, 14 cases of successful Amputation of the inferior extremities.
* This was partial of the foot, including the metatarsal of the great toe.

There is nothing peculiar in my mode of performing amputation.
The triple circular operation is preferred for the thigh and arm, the
single flap for the leg, and the double flap for the fore arm. Animal
ligatures (made of deer's tendons) are used, and adhesive plaster,
oiled compress, or the compress welled with cold water and the roller
bandage. Much importance is placed upon the proper application of
the latter means, as a preventive to both hemorrhage and inflamma-
tion. With a bandage to a stomp secondary bleeding is never ap.
prehended. Opiates, when pain continues, are administered.

No selection has bsen made in the above cases, no operation per-
formed without previous consultation, none declined when one was
decided upon, and these aro all I have operated upon.

470 Report on the Diseases of Infants and Children. [August,

PART II. REVIEWS AND EXTRACTS.

Report on the Diseases of Infants and Children. By F. Batters-
by, M. D. (Chiefly extracted from the Foreign Periodicals.)
From Dublin Journal of Medical Science.

DISEASES OF THE BE A IN A>'D NERVOUS SYSTEM.

Hypertrophy of the Brain. it is only when the intellect or the
motory powers of fine-looking children exhibit symptoms of derange-
ment, that we may, in the absence of other appreciable cause, suspect
the existence of partial hypertrophy. This is found in connection
with an unyielding, but normally-sized, Fkull ; the cranial bones are
very compact ; (be sutures and fnnfannelles are ossified early; the
occipital prof u be ran ce^is prominent; the whole b. dy is thick-set and
strong: while, the intellectual activity Icing feeble, there is often
stupidity or fatuity.

General Hypertrophy of the brain may bethus distinguished from
chronic hydrocephalus : In hypertrophy, the posterior part of the
skull is the first to become prominent ; in hydrocephalus, the fore-
head. The fontanelles are widened more in the latter. In hyper-
trophy the children lie horizontally, or throw the head backwards,
whilst in hydrocephalus they lie in general on the belly, with the
head low. In the latter the face is aged looking and emaciated ; in
the former it is puffed, and the eyes arc without expression and staring.
The constitutional symptoms of hypertrophy are slow in shewing
themselves, and even then are indistinct; whilst peevishness, start-
lings, sleeplessness, and vomiting, are present at an early stage in
hydrocephalus. Children with the latter affection are lean, those
with hypertrophy are fat, or leucophlegmatic; the last arc of a rach-
itic, the former of a lymphatic habit. Convulsions, stupor and rest-
lessness, attend the early stages of chronic hydrocephalus, whilst
spasmodic affections, seldom found in the latter until an advanced
stage, are among the earliest indications of hypertrophy of the brain.

A new and important sign of Meningitis. For more than two
years past, Trousseau, at his clinique in the Hopital Necker, has
been in the habit of drawing attention to a new sign of meningitis.
This sign, which we give not only on Trousseau's authority, but
after having convinced ourselves of its reality, consists in the possi-
bility of producing a lively redness of the skin by very slight jrirtion.
M- Trousseau shewed his class, thai in a case of meningitis it was
only necessary to pass the finger slightly once or twice over a part
of trie skin, in order to produce in the spot a circumscribed and al-
most erythematous redness. This phenomenon exhibits itself many
days before death, and in a practical point of view, is of great im-
portance, for it is pres< nt ev n when the symptoms of meningitis are
not so manifest a- to make the nature of the disease evident to any
one.

There is no part in which this redness may not be produced ; it is

1846.] Report on the Diseases of Infants and Children. 471

bet exhibited in the face. It does not depend on the state of fever,
for children with strongly marked febrile symptoms did not present
this phenomenon. It is plain that this sign is of the greatest im-
portance in a practical point of view, for it isueasily ascertained ; and
Trosseau has found it constant in every case of meningitis which has
come before him for some time past. The cause of this phenomenon
has not yet been explained. It must be studied further for the pur-
pose of knowing whether it is exhibited in all cases of meningitis, and
whether it makes its appearance at certain stages only, or is present
from the commencement.

DISEASES OF THE RESPIRATORY ORGANS.

Pneumonia. One of the most important contributions that has
been of bite made to our knowledge of infantile disease, is the essay
of MM. B lilly and Legendre, on what is usually termed lobular pneu-
monia. They attack the generally received opinion of the inflamma-
tory nature of this condition, which they regard as analogous to the
state described by Jorg as atelectasis pulmonum. They conceive
that this, which they call the u fatal stale ," is not invariably congeni-
tal, but that it may supervene afterwards under certain circumstan-
ces. The following conclusions embody the most important results
of their researches: 1. In the bodies of children who have been
rachitic, weakly, or exhausted by previous diseases, a number of
lobules of the lungs are found in a peculiar state of condensation,
similar to that of the foetal liing. 2. This foetal state, which consists
in occlusion of the vesicles, may result from the mere contractility of
the tissue, or may depend on congestion of the vascular network
extending to the vesicles. The former in the simple, the latter the
congestive form of this affection. The congestive form is usually
met with along (he posterior border of the lungs, and generally ac-
companies the catarrhal inflammation of the pulmonary vesicles.
3. In cither of these forms of the foetal state, insufllition reproduces
more or less completely the natural condition of the lobules. 4.
Though occasionally met with, unassociated with inflammation, yet,
in by far the majority of cases, this condition becomes developed
under the influence of catarrh and catarrhal pneumonia. 5. When
unattended with catarrh, and involving only isolated lobules, this
condition cannot be detected until after death ; but in the new-born
infant, it usually affects the lobar form, is attended by the physical
sign of deficient respiration, and associated with the absence of all
signs of constitutional reaction. 6. It is essentially different from
hepatization ; is produced by causes which interfere with the free
performance of respiration, and is to be treated by remedies the re-
verse nfantiphlogistic. 7. Lobular pneumonia has, strictly speaking)
ire the action of inflammation is never confined to a
e lobule, as is the case with the foetal state of the lung. Partial
pneumonia would, therefore, be a fitter term. 8. Insufflation does
not modify the patches ol true hepatization, while the bronchi leading

472 Report on the Diseases of Infants and Children. [August,

to such hepatized lobules, are exempt from catarrh, two characters
which distinguish partial pneumonia from the lobular engorgements of
catarrhal pneumonia. 9. Free partial pneumonia is by no means
common in children, though when hepatization does occur in children
under five years of age,- it almost always affects the partial form.
The statements, therefore, that have been made with reference to
the rarity of lobar pneumonia in infancy are correct; but almost all
that has been said about the extreme frequency of lobular pneumo-
nia at that age. must be taken as referring to the fceial state of the
lung. -10. Catarrhal pneumonia consists in the extension of the
catarrhal inflammation from the bronchi to the pulmonary vesicles.
This inflammation may effect healthy lobules, or those in the fcetal
state. In the latter case it gives rise to appearances which have led
to the supposition that those lobules were the seat of a parenchyma-
tous inflammation. 11. Capillary bronchitis and generalized lobular
pneumonia are but two forms of catarrhal pneumonia, which differ
according as in the one the catarrhal element, or as in the other the
lobular congestion predominates. 12. These facts explain why de-
pletion was seldom appropriate in the treatment of what was called
lobular pneumonia. Simple as the process was by which these results
were obtained, no one had previously employed insufflation as a
means of ascertaining the real nature of lobular pneumonia and car-
nification of the lung in children. Dr. West has repeated the ex-
periments of Cailly and Legendre on many occasions, and can fully
substantiate the correctness of their statements. An assertion has
been made by M. Bouchut, that even true hepatization may be re-
moved by insufflation ; in this, however, he is decidedly wrong.
The hepatized portion may sometimes be made to assume a brighter
colour, but not to resume the texture of the healthy lung, as is the case
nigs in the foetal state. Dr. Posner, in some remarks on the
treatment of pneumonia in children, observes, that the strictly anti-
phlogistic treatment, suitable to the inflammatory affections of the
adult, is no longer appropriate in early life. He applies these obser-
vations especially to pneumonia, in course of which an adynamic
stage comes on, requiring the discontinuance of other remedies, and
the use of wine and stimulants, such as polygala senega and ammonia.
Dr. Behrend, of Berlin, has noticed a nocturnal periodic cough in
children, which has not heretofore been described. This cough is
most prevalent in spring and winter, but is often met with in autumn,
rarely in summer. Infants at the breast are, perhaps, not liable to
it; with this exception, it affects children of all ages, and boys more
than girls. Children without any cough, or the slightest trace of
catarrh during the flay, fall asleep tranquilly at the usual hour in the
evening; but after two or three hoursr rest they become restless, and
awake during a violent fit of coughing ; they cry, and the cough be-
comes more and more severe, so as sometimes to induce vomiting.
After being thus harrassed for one, two, or three hours, they again
fall asleep, and pass the rest ef the night well. The cough returns

1846.] Report on the Diseases of Infants and Children. 473

at the same hour the succeeding night, and persisting sometimes
during weeks and months, it ends by diminishing and disappearing
completely ^and spontaneously. The fits become by degrees shorter,
and appear at a later period of the night, so that the sleep preceding
them is always gaining in duration. The children are pallid; they
appear fatigued ; and they have cold feet in the evening ; though they
play, drink, and eat, and in other respects seem in good health, yet
they are not so fresh and lively as when nothing ails them. This
nocturnal cough is often catarrhal, and frequently accompanied hy
mucous rale; hut it is sometimes dry, croupy, and sonorous. The
cough occasionally consists of a single, short, uniform cfTort, which
is repeated every five minutes, or in one or two longer fits of cough-
ing, which put an end to it for the night.

The author considers this cough as the result of an affection of the
nerves, probahly of the par vag.;m. He has formed this opinion
principally from the nature of the symptoms, and partly from the
circumstance of its being observed frequently to follow upon epidem-
ics of hooping-cough, and to be common during the prevalence of
intermittent fevers amongst adults. This cough is not of a serious
nature, as all (he cases he observed terminated favorably.

Dr. Braniss, during a practice of fifteen years, has often observed
in children a cough having many of the characters of the above. In-
stead, however, of looking on it as a distinct species, he considers it a
mere accidental occurrence ; thus, the heat of the bed relieving the
chill attendant on catarrh, the irritation which produces cough is not
sufficient to destroy the soundness of the first sleep. The children
cough in their sleep, and the loosened mucus not being ejected, collects
in the back of the throat, where, irritating the larynx, it gives rise to
a violent fit of coughing, which continues until the irritation subsides.

DISEASES OF THE DIGESTIVE OKGAXS.

Pure Muriatic Acid in the Treatment of Aphtha. Dr. Coudray
reports several cases of aphthae, in which the topical application of
pure muriatic acid was followed by complete success. In many cases,
when the exudation did not occur in thick laminae, and when it oc-
cupied the tongue and lips only partially, it sufficed to use the acid
diluted by an equal proportion of water, or two parts of the latter to
one of the former. But whenever the pseudo-membrnnous material
was thick, resisting, and yellowish, and the child refused the breast,
he had recourse to the pure acid, one or two applications of which
caused the separation of the false membranes. Its use, he states, is
attended with very little pain, and infants who had been unable to
take the breast for several days before, became capable of sucking in
a lew hours afterwards.

Bretonneau, many years ago, extolled the use of muriatic acid in
this form of stomatitis ; and again, last year, Trousseau and Delpech
called attention to the great efficacy of the fuming acid as one of
the most powerful modifying remedies in severe aphthae. Dr. Cou-

474 Report on the Diseases of Infants and Children. [August,

dray, therefore, proposes nothing new. His eases, it may be also
mentioned, belong to the symptomatic species, which supervenes
generally in Cachectic children, in whom the cure of the stomatitis
itself is of much less importance (hnn when it is idiopathic. In the
latter instance, it is usually mild, except when epidemic, in which
case the most energetic local treatment is of little avail.

Diarrhcea. Professor Romberg, of Berlin, is fond of using nitrate
of silver in both acute and chronic diarrhoea in children, according
to the following formula :

ft Crystallized nitrate of silver, 25 to 50 milligrammes.
Distilled water, q. s. for solution. Then add :
Mucilage of salc-p, 75 grammes.
Syrup of poppies, 15 do.

From a tea to a table-spoonful to be given four times a day.
M. Weisse, physician to the children's hospital in St. Petersburg,
proposes a novel remedy for. the cases of diarrhcea, with emaciation,
coming on after weaning. If it be not possible to procure for the
children a good nurse, he advises the use of a remedy which, he
says, has often succeeded in his hands, namely, raw beef finely shred*
of which they should take two table-spoonfuls, divided into four
parts, in the course of the twenty-four hours. The quantity is in-
creased, daily, until finally they are left to eat it at discretion. He
states, what is hardly credible, that in general this food is taken with
great pleasure, and it is only on the first few occasions that there is
any hesitation shewn. This is easily overcome by a little manage-
ment. In ense of absolute refusal, small bails made of it are intro-
duced into the mouth ; or it is mixed, very finely minced, with the
drink.

Cooked substances are, as a general and well-established rule,
more easy of digestion than those which have not been submitted to
the action of fire, so that this remedy of Dr. Weisse is opposed to the
most vulgar principles of science. However, there is no rule with-
out its exception ; and we must admit I hat of all the functions that of
digestion presents, in its accomplishment, the most frequent anoma-
lies; so that we would not beat all surprised to see a child, whose
stomach could not bear lighter nourishment, much benefitted by ani-
mal substances, or even by the raw flesh recommended by Weisse.
We are well aware that, under certain circumstances, milk should not
be boiled, and that some persons prefer using raw eugs. potatoes, and
even meat which is little better than raw. All this' is matter of ob-
servation; but the remark is only referable to certain individuals,
and it is not proper to convert into a general rule that which is only
the result of an exception, and that a very limited one.

The green evacuations of Children, like many other subjects of
common occurrence, have attracted little attention further than beinrr
considered as an evidence of the irritating elects of mercury upon
the liver and intestinal canal, when this medicine has been exhibited.
Dr. Bird having lately made a careful chemical examination of these

1840.] Report on the Diseases of Infants and Children. 475

evacuations, has established it, as a fact, that the preen colour is not
owing io discoloration by bile, as he failed to detect more than the
ordinary quantity of this fluid in very marked specimens of the
"spinach-coloured" stools. Me is disposed to regard the colour as
depending on the presence of modified blood.

Believing that the green stools alluded to are but a form of melnsna,
Dr. Bird has often closely questioned the nurses of children voiding
them, regarding the appearance of the evacuations before and after
the development of the green colour, and has been almost' constantly
told that streaks, or even clots, of blood had been observed.

He regards, then, the presence of green stools as indicative, not of
a copious secretion of bile, but of a congested state of the portal sys-
tem, in which blood is exuded very slowly and in small quantities, so
as to allow of the color bein^ affected by the gases, and secretions,
pre-ent in the intestines; a state of things capable of readily ending
in malaena. in which t he effusion of blood is so copious and sudden,
as not to give time for the occurrence of the changes alluded to.

There is, moreover, a peculiarity \n the green dejections of chil-
dren and others whose portal circulation is congested, which, so far
as he knows, is quite distinct from any property presented by mere
bile under similar circumstances. When first voided, the "chopped
spinach" stools are, in the majority of cases, of a bright orange color,
and they assume their characteristic grass green hue only after expo-
sure to air. The time required for this change varies remarkably.
He. has seen an orange-colored stool become green in a few minutes ;
and in the same patient, only a day or two afterwards, many hours
have been required to effect the same change.

Dr. Sobotka, of Vienna, has drawn attention to the dangers attend-
ing the, administration of opium in diarrhoea and other complaints of
children, and gives several cases to shew the great caution which
should be observed in ordering it. Dr. Beck's advice is very j'idi.
cious, viz., to use tinct. opii. camph., laudanum, and Dover's powder,
all of which are unvarying preparations in the treatment of children's
diseases, in preference to other opiates, such as syrup of poppies, the
strength of which often varies. D\. Sobotka considers that, in case
of narcotism, abstraction of blood, cold applications to the head, and
acids, do more harm than good, as congestion in such cases is pas-
sive rather than active.

The Semina Lyropodii Clavati is a popular remedy in Silesia for
diarrhoea. Hufelnnd recommended it in the painful diarrhoea of
children. Behrend has found the following formula of service :
IJ. Sem. Lycopodii, 3ij.; Aq. Foenie. giv.; Gum Arab, simpl. q.s. M.
Two tea-spoonfuls every hour. For new-born infants, R. Sem. Ly-
cop. Gum Arab, aa 3ij ; Syr. Amy-gel. q. s. M. Opium may be
added or not, according to necessity. Lvcopodium is also given in
smenta, combined with white of egg. The lvcopodium of com-
merce is often adulterated with the pollen of various kinds of trees,
yellowish powders, chalk, sulphur, and the dust of worm-eaten or
rotten wood.

476 Report on the Diseases of Infants and Children. [August,

Atrophia Mesenteric a. Dr. Zettwach extols the early use of a
mixture of milk and broth (first recommended by Bretonneau) for
atrophia in children. Spoon-fed children should have, during ihe
first months, nothing hut a mixture of equal parts of cow's mi-Ik and
weak fennel tea, and afterwards a mixture of milk and veal-broth.
In case of necessity the milk may be beaten up with the yolk of an
egg* instead of the broth.

Polypus Recti. Dr. Ha user, of Oimufz, has detailed a case of
polypus of the rectum, which, he says, is a rare disease, and one
almost exclusively confined to children under six years of age.

A fine lit lie girl act. 6 years, had been for some weeks liable to
attacks 'of diarrhoea, and latterly was affected with tenesmus, accom-
panied with the passage of much mucus, tinged with blood. Various
rem dies had been used to no purpose, before she was brought to
Dr. Hauser, who found there was a small, pediculated. moveable tu-
mour attached to the left wall of the rectum. This tumour gener-
ally descended when the patient was at stool. Having procured its
descent by an enema, he was able to see that it was of a reddish co-
lour, somewhat uneven, fleshy, about the size of a bean, and with a
very narrow pedicle. Dr. Ha user having applied a ligature to its
neck, at once cut away the polypus, fastening the ligature over the
sacrum by means of sticking plaster. At the end of a week the
patient was perfectly free from every complaint. She suffered no
inconvenience from the operation, except some slight pain, at first,
when the bowels were being moved.

In confirmation of Dr. Hauser's remark, as to the rarity of poly-
pus recti in children, it may he observed that, during the last five
years, we have witnessed no more than two cases of it at the Institu-
tion for Diseases of Children.- Our practice differs from Dr. Hauser's
in that we prefer allowing the polypus to drop off of itself after the
application of the ligature, which we are in the habit of cutting short,
instead of fastening externally. In the method pursued by him, we
would be inclined to fear the probability of the ligature becoming
loose, and the danger of subsequent haemorrhage, while in it we can
discover no possible advantage.

FEVERS.

M. Legendre has investigated the very difficult subject ofthes??n-
ultaneous existence of variola and vaccinia, of which he has observed
ten instances. His conclusions, which are founded on a comparison
of fifty-six observations derived from different sources, are to the
effect that vaccination almost always modifies the characters of vari-
ola, but that the performance of vaccination in a child previously ex-
posed to the contagion of small-pox, seems to favour the appearance
of that disease, though in children above four years of age it usually
appears in a favorable and greatly modified form. That while vacci-
nation, performed during the incubation of small-pox, modifies the
characters of that disease, the vaccine vesicle itself is usually modi-

1846.] Report on the Diseases of Infants and Children.

477

fied in a degree directly proportionate to the shortness of the interval
between the performance of vaccination and the appearance of small
pox When vaccination is performed after the appe irance of vario-
la, the vaccine vesicle sometimes runs its course, but does not modify
the variola The practical inference which he deduces is, that in
young and weakly children who have been exposed to the contagion
of variola, the performance of vaccination only increases their dan-
ger, and is, therefore, to be avoided.

M Tardieu has given a case which, with others, he thinks goes to
prove that vaccination may modify variola, not only when performed
during the primary fever of the latter, but even at the commence-
ment of the variolar eruption. The method of vaee.nnat.on resorted
to was that introduced by E.chorn, consisting in making twelve or
fifteen puncture, in each arm. Still, for us, the problem oftbe mod-
ification of variola by vaccina is not yet resolved. M. M. Kayer
and Bosquet (the latter the most practised vaccinator in Prance)
entertain an opinion diametrically opposed to that of M. Tardieu.

Varicella. M. A. Delpech has given an interesting history of an
epidemic of varicella, which prevailed in Trousseau's wards during
the early months of the year 1844. The epidemic was extremely
mild, scarcely requiring any treatment, but, towards its close, ine
eruption, which previously (with few exceptions) exhibited nothing
remarkable, became singularly modified. The bull, in place of pre-
serving their ordinary size, enlarged considerably; some of them
assumed the appearance of pemphigus, and left behind large suppura-
ting surfaces. This peculiarity, hitherto unobserved. M. Delpech
seems inclined to attribute to the influence of individual modification
of constitution. Of the identity of this pemphigoid varicella with
simple varicella he is convinced, from the sort of indifference with
which certain children contracted the one or the other separately, or
both together. These phemphigmd bullae commence just like the
simple eruption, but the epidermis in the former case separates with
facility, and the bullae present exactly the same character as that
caused by the application of an ammoniacal pommade. The bullae
are tense, transparent, and of a light yellow hue, like that of ordinary
varicella; the surrounding skin retains its usual colour. In size the
bullae vary from four or five millimetres to two ami a-half centime-
tres; at the end of twenty- four hours the bulla is generally abraded,
leaving the dermis exposed, of a red colour, analogous to that pro-
duced!^ ammonia, or with a greyish surface. When there is
tendency to cutaneous suppuration, it often happens that the bulla
continues to extend at its base, so as to assume a more or less irregi lar
outline. Delpech observed no worse consequences from these bull
than abundant suppuration. The following case fell, at the end of
last year, under the notice of the writer of this report. A healthy
infant, aged ten months, had been eight days ill with, a vesicular
eruption on the lower extremities, when placed under the care of
his colleague, Doctor McClelland, at the Institution jjtf diseases of

I

473 Report on the Diseases of Infants and Children, [August,

Children. This eruption bore a great resemblance to varicella, of
which, at the time it was considered a modification. The vesicles
were scattered over the front of the limbs principally, and in num-
ber did not exceed a dozen ; some of them had dried into scabs,
others were recent ; there \ve\& two or three small ones filled with
clear serum on the trunk or arms ; those on the legs were larger
(indeed larger than the vesicles of varicella usually are), and one at
the upper and anterior part of the thigh was at least the size of a
shilling; the cuticle being broken, the skin underneath was exposed,
of a deep red colour, wilh a central spot of mortification. The day
following the cuticle had peeled off a large portion of the surrounding
surface, and the mortified part was also more extended. There was
much tumefaction of the thigh and irritative fever. After death,
which occurred at the end of a fortnight from the commencement of
the illness, it was found that the mortification had spread from the
thigh to the labia pudenda, and that it had run trp the abdomen, de-
stroying a stripe of the integuments on both sides within the cristas
illii. The vesicles which had dried up had been also attacked by the
mortification; there was nowhere any commencement of separation
of the sphacelated parts.

Scarlatina ; Abscess of the Neck; Fatal Haemorrhage. Dr. De
Bal, of Sweweghern, has given a case of this kind. A girl, aged 12
years, was afiected with swelling of the neck, most marked at the
left side, the consequence of scarlatina which had run its course favor-
ably. An indistinct sense of fluctuation being perceptible, the abscess
was opened by the lancet, which gave exit to a large quantity of pus
and serum. On the seventh day afterwards, when every thing seem-
ed to progress favourably, there took place a copious haemorrhage"
from the abscess. The patient having fainted, the bleeding ceased ;
but this returned in the evening, and was succeeded by almost im-
mediate death. On examination, the tumour appeared to be the size
of a man's closed hand, and, being cut into, it was found that the
suppuration had destroyed a part of the internal jugular vein, to the
extent of a finger's breadth. The observations appended to this
case (namely, that as there was no gangrene present, the destruction
of the vein is to be accounted for by the peculiar corrosive properties
of the pus), are in contradiction to the fact, that these abscesses have
a great tendency to assume a gangrenous action. If more frequent,
ly happens that the large vessels do not open into these abscesses of
the neck until several days after the spontaneous, or artificial, open-
ing of the latter. Dr. Adams of Glasgow, however, has reported
the case of a female child, aged 16 months, in whom there remain-
ed, after scarlatina, an inflammatory tumefaction situated behind,
and a little beneath the angle of the jaw on the right side. No
fluctuation was perceptible, and poultices were kept applied, when
suddenly the, child discharged, from the mouth, pus and blood to the
amount of sixteen ounces. Death ensued. It was not discovered
whether the haemorrhage proceeded from an artery or vein.

1846.] Report on the Diseases of Infants and Children. 479

Dr. Hughes has just communicated to the Surgical Society the
verv interesting particulars of the case of a child six years of age,
in which he tied the internal carotid artery to arrest arterial haemor-
rhage from an abseess of the neck succeeding scarlatina. The
abscess had been opened ten days before the haemorrhage occurred,
and the ligature of the artery succeeded perfectly in arresting the
haemorrhage, which did not again return, but the child sank at the
end of the fifth day after this operation.

Of haemorrhage succeeding ahscess of the neck in children who
have been debilitated by other causes as well as scarlatina, Dr.
King has given an instance, in the London and Edinburgh Monthly
Journal; and the following case was lately under the care of Dr.
Carteaux. A child aged twenty months, remained, after measles,
affected with dyspnoea, cou^h. and enlargement of the tonsils, and
there was, in addition, an ahscess, the size of a pigeon's en, behind
and beneath the angle of the jaw, on the right side. This was
opened, and in four days more a second one on the left side. In two
days afterwards there occurred a copious haemorrhage from the first
opening. The little patient soon sank.

URINARY DISEASE.

Nocturnal Incontinence, of Urine. There is no infirmity, the
treatment of which is so much influenced by individual peculiarities
of constitution as this is. In some cases tonics succeed, while in
others, presenting to all appearance quite similar conditions, it is ne-
cessary to have recourse to stimulants of the muscular fibre, such as
the ergot of rye, and mix vomica; blistering in (he latter, cold bath-
ing in the former. Finally, there is a class of cases (which cannot
aprioribe distinguished from others,) in which the incontinence can
be properly treated only by medicines which appear to act specially
upon the bladder, and, what is very remarkable, amongst these agents
some are evidently sedative, others diuretic, &e. This would induce
us to believe that incontinence, though regarded generally as a sign
of debility of the bladder, consists sometimes, and this more fre-
quently than is commonly imagined, in an excessive degree of nerv-
ous and muscular susceptibility of this reservoir. Success has more
than once followed the use of sedatives, camphor, digitalis, nitrate
potash, benzoic acid, &c\, where tonics and stimulants, which at
first appeared to be rationally indicated, have failed.

Dr. Morand has long been in the habit of using belladonna, inter-
nally, in the nocturnal incontinence of urine in children, and with
very satisfactory results. It is, however, in the incontinence from
debility, only, that this remedy is of use. Its mode of action he is
not able to explain; he gives it in increasing doses, which must be
continued sometimes for two, three or four months in succession;
and administers it in pills containing each one centigramme ( of a
grain) of the extract, beginning with one pill, night and morning,
for children between four and six years of age. If no effect be pro-

480 Report on the Diseases of Infants and Children. [August,

duced at the end of a week, he orders a third pill daily at noon ; and,
after fourteen days, a fourth, if necessary. With children between
eight and fifteen years he begins with three pills, increasing the
number as above. If signs of narcotism supervene, the medicine
must of course be for a time suspended.

Dr. Berenguieur has observed that in his neighborhood, in the
department of Tarn, incontinence of urine is ofien caused by an ob-
stinate, intractable form (/intermittent fever. The children brought
to him for treatment were aged between seven and fourteen years.
They were anaemic and debilitated. The remedies he found most
successful were copaiba, laudanum, and protoxide of iron, made into
pills, in the proportion of three parts by weight of the former to six
of the latter. Of this mass one pill, weighing from two to three
grains, was taken at each meal ; and after two or three days an ad-
ditional one. until the patient came to take ten daily. He found,
with Trousseau, that iron, particularly in the case of children, de-
ranges the stomach less when taken after than before meals. Along
with these pilu/ce balsamka, an infusion of the Folia Juglandis was
ordered as a common drink.

Lithotomy; Bilatral operation. Guersant exhibited at the So-
ciete do Me lico-Pratique of Paris, an interesting preparation, shewing
the parts, divided in the sectio bilateralis, in their natural progress
towards cicatrization. A boy, six years old, died forty-five days
after the operation, in consequence of measles complicated with dou-
ble pneumonia. He made water freely by the urethra on the fifteenth
day. The wound was closed externally ; internally there was a
small fistulous opening. The preparation was interesting, as it
shewed that the prostrate was only grazed by the incision, and that
the verumontanum and ductus ejaculatori were uninjured. This
confirms the observation of Dupuvtren, namely, that when the
ejaculatory ducts are wounded in this operation, it can only happen
by accident, or bv the sheer awkwardness of the operator. Guer-
sant does not absolutely reject lit hot rity in children, but gives the
preference to the bilateral operation, because of the great success
he has obtained from it. Of twenty-four cases thus operated on, he
has lost but four. It is only when the stone is small that he has re-
course to luhotrity, for then one sitting is all that is nee ssary to rid
the patient of it. If many sittings be required, the young patients
become exhausted, and so are brought into greater danger than if
they had been cut In one case the stone was too large for extrac-
tion, and he was obliged to enlarge the wound upwards. He wound-
ed the rectum once, but no bad consequence resulted, it healed
quickly and effectually.

SCEOFULA.

Bons-bons of Iodine and Coffee for scr of ulovs Children. In the
Piedmontese Pharmacoepia is to be found the following prescription:
Hydriodate of potash, 4 parts; finely ground roasted Mocha coffee,

1846.] Report of Cases for Diseases of the Skin. 481

2 parls ; powdered sugar, 122 parts ; mucilage of gum tragacanth
and powdered coffee, of each as much as may be sufficient to make
300 lozenges.

Each of these lozenges, which are very agreeable to the taste,
contains about one-fourth of a grain of iodide of potash.

Chloride of Silver in Scrofula. Dr. Sicard announces, in the
Clinique de Marseilles, that he has during many years observed the
best results from the use of chloride of silver in scrofula.

He gives, internally, pastilles formed of chloride of silver and
chocolate, twelve of which contain five centigrammes of the former
(i. e. about one grain) ; one pastille is taken half an hour after each
meal. The dose can be so far increased that ten, and finally only
eight, pastilles contain one grain of the chloride.

With these he combines frictions, externally, with an ointment
composed of five grains of the chloride to the ounce of lard.

Scrofulous Photophobia. Dr. Seidel. of Breslaw, has been long in
the habit of using the following prescription in this affection with
success :

R. Extracti Cicutas recens parati
Sacchari albi aa paries dtias.

Contritis exactissime adde sub trituratione continuata guttatim aq.
destiliat. partes quindeeim. M. in vitro bene clauso.

Of this solution, from four to ten drops, according to the age of the
patient, are o;jven daily, in any suitable vehicle. So much as twenty-
five drops can be given to adults. Dr. Seidel has never observed
symptoms of narcotism to follow the use of this remedy.

Dr. Aforand recommends the cauterization, by solid nitrate of silver,
of the mucous membrane of the nose in scrofulous ophthalmia, as an
inflammatory state of that membrane is, he says, always in such case
present, and is often, in fact, the source of the ophthalmic inflammation.

Uepnrf of Cases frpafed at the Infirmary for Diseases of the Skin,

York. By (iiakles D. Smith, M. D.

From May 1. 1844, to May 1. 1846, eight hundred and eighty
three individuals applied at thi institution for treatment ; two

hundred and forty were women one hundred and twenty-five men,
and five hundred and twenty children. Seventy-eight cases cannot
properly he arranged under ihe head of diseases of the skin, consist-
''" irns, bruises, and abscesses, although they were en-

tered on our books. The remaining eight hundred and seven were
Red in the1 following order:
Of tie' Exanthemata. There wereofUrtricaria, 2G ; Erythema,

Erysipelas, 7 : Roseola. 5.
Of the \ i-.sk i Li:. There were of Eczema, 22G ; Scabies, 53 ;
Herpes, 4G ; Varicella, 38.

31

482 Report of Cases for Diseases of the Skin. [August,

Of the Bulla. Pemphigus, 10 ; Rupia, 4.

Of the Pustule. Impetigo, 135; Ecthyma, 41; Acne, 15;
Sycosis, 2 ; Porrigo, 10.

Of the Papula. Lichen, 86 ; Prurigo, 12 ; Strophulus, 3.

Of the Squama. Psoriasis, 20; Pityriasis, 25; Lepra, 1.

Purpura, 2 ; Syphilitica, 20 ; not classified, 6.

Great pains were taken to ascertain precisely the habits, avoca-
tions, and nutriment, of our patients, with a view to establish the
causes of these diseases. Whilst it was seen that certain employ-
ments, poverty, and constitutions enfeebled by intemperance and
other vices, induced them, and in some cases hereditary predisposi-
tion could be traced, yet, for the most part, they appeared rather
obscure, and no very satisfactory conclusion was arrived at.

Any one who has given much attention to cutaneous affections
must appreciate the utility of a correct diagnosis. The difficulties
in acquiring it are not easily set aside, and many, in consequence,
are deterred from entering upon a systematic study of their peculiar
characteristics, especially when few opportunities present themselves
for becoming familiar with cases. It is very essential, however to
be able to recognize the different varieties ; not only to arrange
them in the order to which they belong, but also to know what treat-
ment is applicable. Our first step, then, was to seek for the elemen-
tary form. In this we were often disappointed, either owing to the
disease having existed a long time and a consequent alteration in its
symptoms, or complications with other eruptions, which occurring,
rendered it necessary for us to see the cases often, and watch them
strictly before they could be assigned to their appropriate classes.

With regard to the treatment, we meet with frequent discourage-
ment in fully carrying out our plans. Many, from the extreme ob-
stinacy of their complaints, would become weary and discontinue
their attendance; others, in menial situations, lacked the time to
devote that attention to themselves, which was requisite ; but by far
the greater number have been cured, or so far relieved as to pursue
their avocations without annoyance. It is to be regretted that
many, from want of means, were deprived of the advantages of bath-
ing, which is so essential in assisting the action of remedial agents,
if not rendering permanent their good effects. A considerable num-
ber have availed themselves of the cheap bathing establishments
about our city, and in that way, no doubt, accelerated their cure.
No arranged plan of treatment has been adopted. We endeairored
as closely as possible to follow the indication presented. It was con-
sidered of the first importance to ascertain precisely the condition of
each organ of the body, if any one were diseased, or their functions
impaired. In several instances, medicines addressed to disordered
viscera alone, resulted so immediately in an amelioration of the dis-
ease as to obviate the necessity of any external application whatever.

A few cases will serve to show the usual course which has been
pursued.

1846.] Report of Cases for Diseases of the Skin. 483

The Urticasls were mostly all in children ; the consequence of
intestinal irritation. They yielded readily to warm baths, alkalies,
and gentle laxatives. There were included among these cases, sev-
eral females who exhibited large whitish blotches elevated above the
surface, accompanied with intense burning and stinging, which was
attributed to some indigestible substance they had eaten. Emetics
were prescribed, which produced relief in a short time.

The Erytiiem.e were of the species E. Nasi, E. Papulatum, and
E. Intertrigo. The frrst two were in women, the last in children.

A child six months old was atttended with the latter form of this
eruption, situated in the folds of the neck, and excepting a slight red-
ness, cojild only be seen by separating them, when was exposed an
excoriated surface for some considerable extent. Every application
in the way of stimulating ointments and astringent washes proved
ineffectual. At the suggestion of my colleague, Dr. Osborn, a
weak preparation of black wash was used, which, in a day or two,
effected a cure. Similar cases were benefitted in a like manner.

The cases of Erysipelas were without much interest. The
Roseol.e were instructive from the fact of having been suddenly
developed after vaccination. In most of them the deep rose-red
color was very perceptible. Little or no treatment was adopted.

Of all the cutaneous affections presented to us, by far the most
numerous, as well as intractable, were the Eczemas, occurring in
every variety, as to form and character, situated on various parts of
the body, attacking both sexes and all ages. Infants during denti-
tion were the more common subjects, and when located on the scalp,
which in them was the usual seat of it, were found generally with
fever, the head extremely hot, a viscid exudation flowing from the
scalp, and glueing the hair together in masses; in some, brown or
yellow incrustations covered the top of the head, which varied in
thickness, and was more or less adherent to the skin ; frequently
the eruption would extend to the face and ears, the glands about the
neck were swollen, indurated, and oftentimes suppurating. The plan
pursued was first to scarify the gums, if swollen and painful. Emol-
lient cataplasms were then directed to be applied to the part until the
scabs were removed, or the scalp cleansed, followed by alkaline
washes of sup. carb. soda or potash, to relieve the excessive pruritis.
01. lini et aq. calcis for this, was also found very serviceable. Inter-
nally small doses of rhubarb and soda often repeated, and when the
stomach and bowels were much deranged, hydr. cum creta, or calo-
mel combined with ipecac, and soda, were prescribed. In this man-
ner we proceeded until all inflammatory symptoms had subsided,
when alteratives and stimulating ointments or lotions were substitu-
ted, which varied according to the constitution or condition of the
patients. In the chronic form, the several preparations of bark, iron,
mercury, and iodine, were employed. Some of the mineral acids
were frequently required, and sarsaparilla also resorted to as an im-
portant auxiliary. This plan generally proved successful. There

48-4 Report of Cases for Diseases of the Skin. [August,

were cases of this disease in adults as well as children, which resisted
the most determined treatment. Patients of strumous habits were,
for the most part, rather unmanageable ; still many were decidedly
benefited.

One of the most usual varieties of Eczema was its local form oc-
curring on the arms, hands, or legs. A young man, twenty. five
years of age, came under treatment for an Eczema on the back of
both hands, from which he had suffered for one year, having tried
many celebrated remedies for salt-rheum, as it was termed. When
first seen, his hands, from his wrist to his finger-nails, were swollen,
inflamed, and excoriated, from which an ichorous fluid was secreted,
accompanied with a burning sensation. It was found, upon a^n exam-
ination of his case, that he was laboring under torpid liver. The ol.
lini et aq. calcis was used as an application to his hands until inflam-
mation ceased, and pills of mass, hydrarg. and aloes were prescribed.
At the end of a week the swelling subsided and the secretion ceased,
but left the skin dry and hard, and in some places cracked and fis-
sured. The vapor douche was recommended to be applied twice a
day, and the fuligokali* ointment (as advised by Wilson in his lecture
on Eczema) was prepared for him. The protiodid. hydr., in the
form of pills, the ^ to of a gr., three times a day was substituted
for the others In this course he continued for some weeks, gradually
improving, and as his general health advanced, his hands resumed
their natural color and appearance.

Scabies were seen occurring in two or three of the same family.
It assumed different forms and varieties, sometimes well marked with
distinct and acuminated vesicles. At other times, it was complicated
with Lichen, Eczema, or Impetigo, making its diagnostic si^ns very
obscure. The treatment was generally tedious, but yielded to sul
phur internally administered, and Biett's ointment, composed of
sulphur and carb. potas. Dilut. sulphuric acid, two or three drops
given twice or three times a day, was often of service in children.
The hydriodate of potass ointment proved to be an excellent applica-
tion in a few cases. Simple baths were recommended to these
patients, three or four times a week.

Of the Hekpes there were three of H. Zoster, one of H. Labialis,
and the remainder were of the species H. Phlyctaenodes and H.
Circinnatus. A young female was seen and attended during the
progress of a Herpes Zoster, and being of a delicate constitution, she
was put upon a course of tonics, and the most soothing applications
employed ; but notwithstanding the course pursued, the vesicles ter-
minated in ulcerations extending over her breast (which had been
the seat of the eruption) giving her considerable pain. The part was
dressed repeatedly with stramonium ointment, and a continuance of
the tonics recommended, which, after some little time, produced a
favorable result.

Twelve cases were entered bearing the marks of Pemphigus ;

* Tuligokali soot and potash. [Edts.

1S46.] Report of Cases for Diseases of the Sliiu 485
)

although not seen in the early stages of the eruption, yet sufficient
signs were observed to allow of their being arranged in this class.
The resemblance to Impetigo and Ecthyma often confounded them
with those diseases. Young boys, with constitutions impaired by
previous disease, or affected by some hereditary complaint, appeared
to be the most common subjects of it. No affections yielded better
than these to the preparations of bark or iron, especially the iodide
of iron.

The cases of Rupia were of no special interest, not having been
seen often enough to know the result of the treatment.

It will be seen that bii'ETiGO forms a large proportion of the cases;
and. like the Eczemas, attacked the head and face of children.
Many adults, however, especially females, were included in the num-
ber of those affected by this complaint; as a general rule it yielded
better to medicines than others. Disordered bowels, or some de-
rangement of the digestive organs, were found in many instances to
exist, and remedies addressed to them, resulted in a favorable change.
There were several cases that occurred in young females, which
proved somewhat obstinate, one of which will be mentioned. A
young girl, 15 years of age, of strumous habit, had several pustules
break out on the top of her head, preceded by redness and burning
two or three days before. Her hair was ordered to be cut close to
the head, she was put on a strict diet, and poultices were constantly
applied; but notwithstanding, the pustules became more numerous,
ran together, and a greenish yellow fluid oozed from the sores, which
formed into scabs. She had been laboring under dyspeptic symp-
toms for some months. Was first put upon small doses of calomel,
rhubarb, and soda, which she continued for a week, and which seem-
ed to produce some effect upon the disease the discharge not being
so great, but in other respects not much improved. Various oint-
ments and washes, as well as internal remedies, were employed for a
period of three weeks, without any marked change. It was then
noticed that her system began to be seriously atlected by the con-
stant irritation of the eruption. She was recommended the hydrio-
date of potash with sarsaparilla, and an ointment was prepared for
her of ox. zinci and ring, picis. From the time she commenced the
use of these, she began to improve, and in three weeks more was
entirely restored. The ointment mentioned above has been fre-
quently used in private, as well as Dispensary practice, and found to
be one of the very best applications in affections of the scalp with
discharge. It was used of the following strength : ox. zinci impur.
9ij.,ung. picis = j.

A variety of eruptions was met with in children following vaccina-
tion, which generally exhibited appearances resembling Impetigo,
although other forms were seen to result from it. By the parents it
was usually ascribed to the introduction of impure matter. Physi-
cians are. oftentimes, highly censured for this unfortunate occur-
rence, but unjustly so. Several causes may exist in tl

486 Report of Cases for Diseases of the Skin. [August,

about the period when vaccination is performed, such as derange-
ment of stomach and bowels, dentition and hereditary tendency to
eruptions, which predispose them to these diseases, and which any
irritation of the skin will develope. A great number of children
were vaccinated with the same virus which was used in these cases,
and no such result ensued. Out of two hundred vaccinations in
private practice, only four were affected with eruptive diseases, and
in these either the skin was pre-occupied by an eruption which, at
the time, was unobserved, or there existed an hereditary predisposi-
tion to them.

The cases of Porrigo were so very irregular in their attendance
that all interest was lost in them, and it is doubtful whether they
were true porrigo. The diagnosis is so perplexing in these cases,
that they require to be seen many times before any degree of cer-
tainty can be entertained with regard to them.

Among the other pustular affections, there were cases of Ecthy-
ma, which occurred in children of bad constitutions, and yielded to
courses of alterative tonics such as the iodide of iron, and prepara-
tions of bark, &c. There were likewise a few cases situated on the
hands, produced by the application of irritating substances. One
or two cases of acne rosacea, which seemed to resist all kinds of
treatment; one of acne punctata, which was cured by the iodide of
sulphur ointment, alteratives, and strict diet ; several of acne sim-
plex ; and two of sycosis.

Several different species of Lichen were seen ; the simple form
(Lichen simplex) was invariably cured by remedies addressed to the
digestive organs which were usually impaired, and by the application
of an ointment almost a specific, suggested first by Dr. Crane (for-
merly of the Dispensary), composed of nitrate of bismuth 5ij. ung.,
nit. hydr. j.,axunga? ss.

Lichen urtricatus and circumscripta, were the ordinary forms, be-
sides the one first mentioned, which were observed and proved the
most intractable. A colored woman, 60 years of age, presented
herself at the infirmary with the external surface of the arms and
legs covered with an eruption. The skin was rough and thickened,
hard and resisting to the touch. No patches or papula3 appeared,
but the surface was uniformly elevated. Very fine scales would
fall from the part when rubbed, and was attended with intolerable
itching. Several physicians saw the case, who thought it one of
Psoriasis; Dr. Bulkley, who also saw it, considered it Lichen cir-
cumscriptus; although somewhat obscure, yet the excessive itching
and general roughness were, he thought, almost certain marks of
this form of eruption. She was ordered pills composed of the sulph-
uret potash, rhei and ipecac, with alkaline baths and lotions of the
sulphuret of potassa. Under this treatment she continued for two
months, at the end of which period her symptoms were much im-
proved, the skin being in some places soft and quite natural, and the
itching in a great degree diminished. From some cause she discon-

184G.] Report of Cases for Diseases of the Skin. 487

tinued her visits. The sympathy between the skin and digestive
^organs was exhibited in some of the local forms of this disease. A
case of chronic Lichen of the hand was cured by overcoming a con-
gested condition of the liver ; and one of Lichen circumscriptus, situ-
ated in the popliteal space, by remedies which relieved acidity of the
stomach.

Some of the cases of Pkurigo were benefited by an ointment
recommended by Dr. Bulkley, composed of nit. bismuth, ung. citrin.
and ung. picis. This disease is always difficult to relieve.

The squamous affections were longer under treatment than any
others, resisting almost every remedy externally applied or internally
employed. In young subjects medicines were found to exert some
influence upon the disease after long continued use ; but the advanced
in life were scarcely ever benefited, especially when affected with
Psoriasis. Constitutional predisposition could, in some instances, be
traced ; but on the whole the causes were rather obscure. P. pal-
maris in three cases was cured by the vapor douche ; and the oint-
ment of the iodide of sulphur, increasing it gradually from 12 up to
20 grains, to oz.j. lard. Leeches were applied in one case, followed
by tartar emetic ointment, as proposed by Rayer, and were of service.
A young girl with P. guttata, was nearly cured by the continued use
ofTinct. Cantharides, for a considerable period, but unfortunately it
returned again, and she is now going through the same course with
advantage.

There were cases entered as those of Lepra ; but from the close
similarity, amounting almost to identity with Psoriasis, the two were
frequently confounded.

There were two varieties of Pytiriasis, P. versicolor, and P.
capitis. A case of the former in a young girl, was cured by a wash
of the carb. potas. made with very warm water, and directed to be
applied to the discolorations frequently. The sulphuret of potas.
was also found to be an excellent application. The digestive appa-
ratus is more or less deranged in these cases, and medicines are re-
quired to improve them. Children with P. capitis were benefitted
by stimulating washes and ointments of the iodide of sulphur, or
nitrat. hydrarg. The good effects of our remedies were oftentimes
counteracted in these cases, by the constant combing which mothers
persist in subjecting their children to, with a view to remove the
dandruff, which keeps up a continued irritation of the scalp and ag-
gravates the disease.

The Purpura seen at the infirmary, were of no particular interest ;
but a case of Purpura Haemorrhagica may be related, as it furnishes
some little instruction, although not belonging to this report. A
child four weeks old had a few small patches of a livid color, some-
what resembling flea bites, scattered about on the legs and arms.
The skin appeared puffed out and full of blood, so that pressure upon
it would leave a mark for some considerable time after. A slight
scratch on the face had bled so freely as to alarm the mother ; ac-

488 Repartof Cases for Diseases of the Skin. [August,

companying these symptoms was a hemorrhage from the kidneys.
The pulse was rather fuller than natural. In every other respect^
the child was Wealthy The only treatment adopted was (after the
bowels had been freely evacuated by medicine) rnur. tinct. of iron,
two or three drops three times a day, in a little mucilage, which
gradually lessened the bleeding, and in four weeks the eruption had
disappeared, and the skin became of a white and natural color. The
mother stated that a former child, when about the same age, had bled
so profusely from the gums as to defy, for several hours, the most
powerful styptics.

Syphilitica. Many cases presumed to belong to this order were
witnessed, but from the most positive asseverations of our patients
(which in many instances we are obliged to believe), together with
obscurity in their symptoms, we could not enter them as such. The
twenty included in this class, however, were too characteristic to be
disputed. Six were in infants, and fourteen in adults. The forms
of this malady met with in adults, were papular, squamous and exan-
thematotis, the former being the most common. Our treatment was
in accordance with age, condition, temperament, and duration of the
disease. With some, mercury was found to be wholly inadmissible,
and with others absolutely necessary. Hydriodate of potash was
more to be relied on than any other remedy, from the fact that the
subjects of this disease were of bad constitutions, debilitated by in.
temperance or long continued vices. Iodide of iron also, in patients
of strumous habit (particularly children), was of the greatest service.
The preparations of mercury were resorted to only in constitutions
comparatively robust, and not broken down by the disease. The
protoiodide of mercury was always preferred, except in cases of chil-
dren, where the hydiarg. cum creta seemed to answer a better pur.
pose. These remedies, assisted by the compound decoction of sar.
saparilla, formed our general plan of treatment.

A man had a squamous eruption on his forehead and face, the re.
suit of syphilis. He suffered two years the most excruciating pain
in his head, and labored under other symptoms. He had tried every
preparation of mercury without any beneficial effect, and the only
article that relieved him was hydriodate of potash in five grain doses,
on discontinuing which, the pain and eruption would recur.

A female had patches of a scaly eruption on her legs which resem-
bled psoriasis, accompanied with rheumatism, and had gone through
several courses of mercury without any advantage whatever. She
was benefited by hydriodate of potash, and the last time seen, was
greatly improved, the eruption having disappeared in a great meas.
ure, and the rheumatic pains subsided. These two cases had been
under the influence of the venereal poison so long, that no hopes of
an entire cure could be entertained.

An aged female, with the papular and pustular form combined, was
cured by pills of protoiodide of mercury, continued for three months,
alternated at times with hydriodate of potash and sarsaparilla.

1S4G.] On the proportion of Nitrogen^ c. 488

One case of the disease in a child will close this report. An infant
two months old came under our observation, presenting the following

tonus. She was very small, emaciated and feeble, head large
in proportion to her body, scalp without hair, smooth and shiny, the

corrugated, maculae of a circular shape and coppery hue, visible
on ail parts of body, the voice hoarse, and the peculiar expression
on the countenance. The mother furnished no positive
evidence of having had the disease, except that she had given birth
to two still-born children in succession. Two grains of hydrarg.
cum crta with one-sixth of a grain ofipecac. three times a day. and
continued w ithout intermission for six weeks, when sarsaparilla was
directed, constituted the only treatment. Six months after, the child
was brought to the dispensary to be vaccinated, entirely restored, and
looking fat and healthy.

yportion of Xitrogen contained in alimentary substances
n from both the organic kingdoms as a comparative measure of
iritive powers. By Dr. J. Schlossbekger and Alex.
ml Chemical Teachers in the University of Edin-
burgh. (Edinburgh Med. and Surg. Journ., April, 1846.)

"The distinction between the elements of the reproductive and
re-piratory functions, is probably one of the most fertile
. hich physiology is indebted to modern chemistry; even
. v. ii> t admit that division in its full extent, nevertheless we

it to be a beautifully conceived idea, and one founded on
of observation. It may be assumed with safety that
er classification of the substances comprised under the vague
nation of alimentary bodies, has in an equal degree represented
the essentia] differences in their chemical composition and their
logical effects, or has presented to the eye of the mindthe im-
portant part which these substances perform, as the above-mentioned
distinction, which is also identical with that of azotized and non-
azotized bodies.

"In order to give some indication of the state of confusion which
existed, even in this most elementary proposition of dietetics, previ-
ous to that distinction being made, it may not be more than necessa-
ry to mention the idea of that classical author, Dr. Prout. that the
nutritive power is in direct proportion to the quantity of carbon. At
the present day not a single fact is known which can support the idea
of the animal body being able to form azotized from non-azotized
substances, possibly, under the influence of ammonia or of nitrogen
from the atmosphere; on the contrary, all experiments, as well as
daily observation, seem to prove the absolute necessity of azotized
food for the preservation of the individual. Chemistry has likewise
demonstrated the presence of a more or less high, but constant propor-

490 On the proportion of Nitrogen, Spc. [August,

tion of nitrogen in all the tissues and fluids of the animal body,
while in all those substances which, according to our modern ideas,
are the most nutritive, namely, the proteine compounds, the carbon
is present in medium quantity. Those substances esteemed by Prout
the most nourishing, because richest in carbon, as the fats and oils,
must be altogether excluded from the list of reproductive bodies, ex-
cept in so far as fatty matter is necessary to the formation of animal
cells. The chemical physiologist could make use of the theory of
Prout, in measuring the fitness of the bodies necessary to respiration,
if along with the carbon could be taken into account the quantity of
combustible or unoxodized hydrogen contained in them ; but for those
substances, which in the strict sense of the word are capable of be-
ing transformed into blood and animal tissue, according to our pre-
sent knowledge, the capability for these purposes may be estimated
relatively by the amount of nitrogen. This has been already done
to a certain extent by the researches of several chemists and physi-
ologists, but, so far as we are aware, it has been confined to vegeta-
bles ; and it therefore appeared to us not to be without interest to
make use of the same principle in extending the investigation to the
various alimentary substances taken from the animal kingdom, and
so to give to the physiologists a basis founded on facts in a depart-
ment which has hitherto been so defective in the mysterious doc-
trine of nutrition.

"Already Boussingault and Leibig have demonstrated, that in
general the amount of proteine compound, and therefore that of nitro-
gen, is in a direct ratio to the phosphates ; this proposition has as yet
been extended only to vegetable matters, but will most probably pre-
serve its value when applied likewise to those derived from animals.
In so far as the nitrogen may be taken as an indication of the quan-
tity of these salts, we could not find any observations as to how far
it might be also applied to the gelatinous compounds; and we
have alluded to this as a very interesting field for future research,
particularly with regard to the phosphate of lime, which seems so
universal and so necessary to the whole animal economy.

" It seems to be at present a proper time to overcome an objection
which, if not alluded to, might have been made against our attempt
to determine the nutritive power of animal aliments; it is with re-
gard to the delicate question of the use of animal gelatine, which
seemed to Mulder, and likewise to us, as not at all decided by the
experiments lately made at Paris. It is a fact sufficiently proved by
the experiments of Magendie, Tiedemann and Gmelin, that any sub-
stances, even the most nourishing, if very simple and used without
admixture, cannot sustain animal life for any length of time; and if
it was proved at Paris that dogs fed exclusively on gelatine perish, it
is far from being just to conclude that the substance is not nutritive,
as we should be compelled to apply the same rule to albumen and
fibrine, by the exclusive use of which an animal would no less
speedily perish. At all events gelatine has a high value as nutri-

1S46.]

On the proportion of Nitrogen, c,

491

ment, if even that value arises alone from its being useful in
the formation of gelatinous tissues ; in addition, the gelatinous
tissues, as well as those containing proteine, in regard to their forma-
tion and chemical constitution, seem to lie in close relation, although
that relation is at present not perfectly understood. The experience
of our best physicians at the bedside of the patient tends to prove
that during convalescence a well prepared gelatinous diet, but not
exclusively gelatinous, is highly nutritious.

"All organic alimentary substances, as presented to us by nature,
are mixtures, but seem to be pretty constant in their composition,
although variously modified by our different modes of cooking them.
Of such natural mixtures, the greater part taken from vegetable
bodies have already had the proportion of nitrogen contained in
them determined by previous observers ; and we believe we shall
best introduce the subject by a concise representation of that which
has been done in regard to the vegetable part of our aliments, which
will likewise afford the best means of comparing the results of our
experiments on animal substances.

"The following table shows the amount of nitrogen contained in
100 parts of the dry vegetable bodies named in it :
Rice,
Potatoes,
Turnips,
Rye, .
Oats,
Wheat,
Carrots,
Barley,
Maize,
Peas,
Lentils,
Haricots,
Beans,

White Bread, .
Brown Bread,

Glasgow unfermented bread
Essex flour,
Canada flour, .
Lothian flour,
United States flour,
Agaric us deliciosus,

" rnssula,

" cantharellus,

Boussingault, Economic Ruralc.
Paris, 1844. tome 2me, p. 438.

R. D. Thomson, in the London and
^Edinburgh Philosophical Magazine tor
November 15, 18-13.

46 1 SchlossbergerandDcrpping.'Liebig's
4 -2 >Anna2en for October, 1844, Chemical
3/2 S Gazette, Julv, 1845.

"Boussingault has calculated from the results of his experiments,
that which he calls the equivalent nutritive powers of these sub-
stances for the domestic herbivorous animals, and Thomson has also
given one for those bodies which he examined."

The following, is condensed by the editor of the American Jour-
nal of the Medical Sciences :

The authors then give an account of their own experiments. All
the substances made the subject of observation were first carefully

492

On the proportion of Nitrogen, Sfc.

[August,

dried at 212 F., and then analyzed according to the method of Yar-
entrapp and Will, slightly modified to overcome some practical
difficulties.

In each experiment the amount of ammonio-chloride of platinum
yielded, with its correspondent equivalent of nitrogen, is given. We
shall present the results for the sake of brevity in a tabular form.

Per cent, of Nitrogen.

Per cent, of IS

ritrogen-

Cows' milk,

3-78

Double Gloucester cheese, very

Human milk,*

1-59

old, and abounding in mites

Dun lop. cheese,

603

and mould,

5-27

Gonda cheese,

711

Yolk of the egg of the com-

Cheshire cheese, .

6.75

mon fowl,

4-86

Double Gloucester do.,

6-98

Oyster (O. cdvlis),t

5-25

Yellow matter ("liver and bile)
from the crao-fish, C. com-

Flesh of the flounder, (Platcs-

sajlessus,)

14-28

munis, ....

752

Boiled flounder, .

15-18

Common mussel, (Mijtihis

Purified muscle of flounder,

15-71

edulis) ....

8-44

Flesh of the skate, (Raia bates,)

15-39

The same previously boiled,

10-51

Boiled skate,

15-22

Ox liver, ....

10-66

Boiled muscle taken from the

Pigeon liver,

11-80

claw of the crab-fish,

13.66

Portable soup,

12-16

Flesh of the pigeon,

12.15

Common eel, raw flesh,

6.91

Boiled pigeon,

12.33

Do. do. boiled flesh,

6-82

Purified muscle of the pigeon,

13.15

Do. do. first washed in

Lamb, ....

13-26

distilled water, and after-

Purified fibre of lamb,

14-56

wards boiled in alcohol as

Mutton, ....

12-30

long as any mat. separated,

14-45

Boiled mutton,

13-55

Flesh of salmon, (S. farioj,

12-35

Purified fibre from mutton .

14-76

Do. do. do. boiled,

9-70

Veal, ....

13-89

Do. do. do. purified

Veal, boiled,

14-50

muscular fibre,

15-62

Veal, purified fibre,

15-78

Raw herring, (C harcngus,)

14-48

Ox-beef, ....

1400

Boiled herring,

12.85

Ox.beef, boiled, .

14-98

Purified muscle of herring,

14-54

Purified fibre of beef,

14-88

Milt ot the herring

14-69

Lungs of the ox,

14-81

Flesh of the haddock, .

14-64

Pork-ham, boiled,

12-48

Boiled haddock,

l2-98t

Do. do. purified fibre,

14-21

Purified muscle of the haddock.

15-72

White of fowls' egg, .

1344

* Human milk is, according to most analysis, one of the poorest in caseine,
and in this respect is very far inferior to that of the cow, but in consequence of
this may probably be more easily digested. The amount of nitrogen in milk,
which corresponds to that of caseine, comes much nearer to the proportion con-
tained in vegetables than any other kind of aliment from the animal kingdom.

t Whereas, the authors observe, in the case of the herring, salmon, haddock,
and eel, the proportion of nitrogen was considerably diminished by boiling the
flesh for about half an hour, the reverse of this occurred in some of the other
cases; for example, in the mussel, the flesh of the ox and calf. These are mere
observations of facts, arising probably from accidental causes: the modifica-
tion which meat undergoes by boiling not being sufficiently understood by chem-
ists at present, although Mulder has proved the formation of oxide of proteine
by it ; from the observations just made, no general conclusion can be drawn, be-
cause they do not seem to coincide, at least at first sight.

X As this seemed a low result, the analysis was repeated, which confirmed the
first experiment.

In this case, the authors remark, it was found extremely difficult to separate
mechanically the whole of the fat ; it is necessary to notice this, as the numbers
are somewhat lower than might have been expected.

1846.] On the proportion of Xitrogen, <fyc. 493

To these experiments the authors add to the following remarks :
"The proportion of nitrogen in putrified muscular fibre seems to be
identical, from whatever part of the animal kingdom it may be ob-
tained; and the differences given by the results of analysis may be
fully explained by the difficulty, or even impossibility, of analyzing it
in an equally pure or impure condition, as obtained from different
animals, in which it is always mixed with cellular tissue, minute ves-
sels, and nerves. Moreover, it is extremely difficult to get rid of
traces of fat and hermatine.

"That the chemical properties of muscular fibre in the whole ani-
mal kingdom are identical, one of us endeavored to prove in a former
research (Schlossberger Yerglechende Untersuchungen uber das
Fleisch verschiedener Thiers. Stuttgardt, 1340). In contradiction
to a very generally received opinion, it appears to us that the mus-
cles offish are as rich in nitrogen as those of higher animals ; at first
sight, however, owing to the presence of a greater quantity of water,
and in some fishes, as the eel, to a difficulty of separable fat, its amount
appears very much lower. Further, as the proximate principles are
essentially the same in both classes of animals, it seems to us that
they should be equally nutritive, although this proposition is also
directly opposed to another very general prejudice. According to
our scale, the oyster does not seem nearly so nourishing as it is gen-
erally reputed to be by common opinion, although it is possible that
the proteine compounds in the lower classes of animals may be found
to be much richer in phosphorus, in sulphur, and in phosphates, than
in the higher. Should this prove to be the case, we can see that
although the proportion of nitrogen may not be so great, nevertheless
that they might act more powerfully as stimulants, which, as regards
the oyster, is believed by some of our best physicians. We intend
in a future series of experiments to direct^our attention to this part of
the subject.

M In order that our views on this subject shouid not be misunder-
stood, it is nocessary for us to state, that we do not consider the
proportion of nitrogen, taken alone, to be an absolute measure of the
nutritive power of our aliments; but as there is a total want of any
positive data in regard to this subject, and as so many different and
contradictory opinions are given in the works on dietetics,* it must be
granted that any attempt to fix a standard for comparison is not
without interest.

" With respect to the capability for nutrition, we are far from de
nying that the physical condition, the state of admixture, the peculiar
kind of poteine compound, the amount of water and other inorganic
matters, of fat, and lastly, the effects of cookery, must necessarily
have a very great influence on the physiological effects of our ali-
ments.

* See all works fromPlenk's Bromatohgia to the latest, as Pari-'.- Treatise on
- well as our standard works on Materia Midica, and we think it will be
allowed that we have not asserted too much.

494

On the proportion of Nitrogen, &$c.

[August,

"There is one consideration in particular which requires to be
noticed, namely, the distinction between the absolute amount of the
nutritive matter, and that portion of it which is in such a state as to
be easily digested and assimilated by the system, in the same way as
a soil produced from minerals abounding in alkaline salts is not al-
ways the most fertile as regards plants with a predominance of alka-
line bases, but the fertility of which depends on the amount of these
bodies contained in a state in which they can be taken up and made
use of by the plant. Thus an aliment abounding in nutritive matter
may be inferior to one with a much smaller quantity as regards the
nourishing effects produced by it; if in the first of these cases only a
part, in the second the whole may be easily absorbed and assimila-
ted. Here we must rely upon the experiments of the physiologist
as to the degree of digestibility of different substances: and there
already exists an excellent basis in the researches of Beaumont and
of Blondlot. This is one of the questions, in which, by the co-oper-
ation alone of the physiologist and chemist, any progress can be
expected to be made in the elucidation of this point. If the work
were once fairly begun by the physiologist, chemistry would not be
long in rendering that assistance which would then be found neces-
sary ; for example, in the various experiments which might be made
in artificial digestion, from the results of which as one element in
the calculation taken along with the proportion of nitrogen as the
other, it would at once be possible to determine scientifically the real
nutritive value of the different kinds of aliment ; the importance to
our dietetics of this method of determination, which at present exists
only in idea, would then not only be felt by the patient, but by the
whole human race.

"Table of the comparative proportion of nutriment in our organic
aliments. If we assume th^ amount of nitrogen in human milk, per-
fectly dried at 212 F.. to be represented by 100, we can then ex-
press the degree of nutritive power of the other alimentary substan-
ces by the following numbers :

Vegetable.
Rice, ... 81

Potatoes, . 84

Turnips, . . . 10G

Rye, . . . .106

Maize, . . 100 to 125

Barley, . . . .125

Unfermented bread of Glasgow, 131
Oats, . . .138

White Bread, . . . 142

Wheat, . . 119 to 144

Carrots, . . .150

Brown bread, . . 166

Agaricus cantharellus, . 201

Peas, ... 239

Agaricus russula, . . 264

Lentils,

Haricot beans, .
Agaricus deliciosus,

Beans,

Animal.

Human milk,
Cow's milk,
Ovster,

Cheese,
Eel, raw,

" boiled, .
Liver of crabfish,
Mussel, raw,

" boiled, .
Ox-liver, raw,
Pork-ham. raw,

" boiled,
Salmon, raw,
283 1 " boiled,
289 Liver of pigeon;
Portable soup,

320

100
237
305
305
331 to 447
434
428
471
528
660
570
539
807
776
610
742
764

184G.] On the Curative Medication of Intermittent Fever. 495

White of egg,

Crabfish, boiled,
Skate, raw,
Skate, boiled,
Herring, raw,

" boiled,

" milt of
Haddock, raw,

" boiled,
Flounder, raw,

boiled,
Pigeon, raw,

" boiled,
Lamb, raw,
Mutton, raw.

'* boiled,
Veal, raw.
Veal, boiled,
Beef raw,

" boiled,
Ox-lung,

845

859
859
95G
910
808
924
920
816
898
954
756
827
833
773
852
873
911
880
942
931

Purified muscular fibre from various

animals.

ibreofeel,

908

" salmon,

. 982

" herring,

,

914

" haddock,

. 988

" flounder,

988

" pigeon,

. 775

" lamb,

916

" sheep, .

. 928

" calf,

993

11 ox,

. 935

M sow.

;

893

Proximate principles of animals calcula-
ted from the quantity of nitrogen as
determined by Mulder,

Pure proteine, . . 1006

" albumen, , . 996

" fibrine, . . .999

" caseine, . . 1003

" gelatine, . . 1128

" chondrine, . . 910

On the Curative Medication of Intermittent Fever. By M. Breton-
neau. (Dublin Hospital Gaz., from Jour, de Med.)

A sort of drunkenness, more or less painful, produced by a single
and suitable dose of sulphate of quinine, repeated, if necessary, two
days afterwards, suppresses for eight days simple intermittent fever.

In the same way, that with a person who is in the habit of intoxi-
cation, we find that much wine may betaken without producing this
condition ; so we every day see individuals affected with ague taking
great quantities of quinine, without the fever becoming suppressed,
or its return being prevented.

M. Bretonneau agrees with the Jesuits who first imported cincho-
na, and learned how to administer it ; and with Torti, who for thirty
years practised in the hospital at Tours, that every sufficient dose of
bark loses its febrifuge power by fractioning it, exactly as a dose of
wine loses its intoxicating property by being divided.

It has been stated that the prolonged administration of many doses,
whose sum altogether amounted to several efficient doses, has com-
pletely failed. M. Bretonneau has seen a quartan fever, which had
resisted two ounces of bark, yield to two drachms of the same medi-
cine ; but the two drachms were given at once, while the two ounces
were taken in very small quantities at a time, and during fifteen
days.

Small doses, which habituate a patient to the action of cinchona,
injure the beneficial results of adequate doses ; they hurt the digestive
apparatus, and render the febrifuge intoxication more difficult to
obtain.

496 On the Curative Medication of Intermittent Fever, [August,

M. Bretonneau corroborates the statements of Sydenham and
Morton that the dose of bark which has suppressed a paroxysm, if
repeated before the supposed epoch of its return, will prevent it ; and
moreover, that the immunity thus procured may be prolonged by re*
newed doses exhibited at gradually lengthened intervals, until a per-
manent immunity from relapse becomes established. The progres-
sion recommended in the giving of these preservative doses, is the
following: A second dose equal to that which suppressed the fever
is to be exhibited, according to the nature of the fever, on any day
from the first to the sixth interval, then to be repeated after intervals
of 7, 8, 9, 10, 12, 14, 16, 18, 22, 30 days. The best time for giving
each preservative dose is immediately after a light dinner ; and the
first dose had better be given shortly after the decline of the suppressed
access, so as to be as distant as possible from the next threatened
paroxysm. A relapse will render it necessary to renew the treatment
from the commencement. The preservative doses should be approx-
imated if it is found that the accesses become more frequent.

Unusual exercise, the prolonged impression of cold, indigestion,
purging, &c, provoke the return of the fever which ordinarily, with
the precautions indicated, does not return till spring. Occasionally,
at Tours, the fever which had been suppressed, but its relapse not
guarded against by the preservative trealment mentioned above,
was accustomed to become renewed during twenty or thirty months.

M. Bretonneau has observed that an adequate dose of sulphate of
quinine commonly produces vertigo and noises in the ears; subse-
quently, at a. period more or less elongated from the first effi cl there
frequently supervenes a febrile state which ihere is danger of cop-
founding with a return of the intermittent fever. This sortol
is of good augury. During its continuance the skin is hot. the pulse
elevated, and this state corresponds to that condition of febrile reac-
tion which it ie> so very erroneous to dread in paludial afFei.'tions.
With extreme sagacity. Dr. Bailly discovered, in 1821, that in Paris
agues became developed in the spring, in subjects who had spent the
autumn in localities where the fever prevailed. Evidence the most
irrefragable bore out this assertion, not bin: having been ob-

served in persons who had not left Paris. M. Bretonneau has found
that a fever developed under these circumstances has all the tenacity
of the kind prevalent in the district where it was contracted.

From fifteen to twenty grains of the sulphate of quinine, or from
three to four drachms of good cinchona, suffice to suppress the fever
of an adult, and to keep it suppressed during eight or nine days.
Many reasons lead to the belief, that it is useful that the nee
dose should not be exceeded.

Intermittent fever is endemic in the locality ^vhere these observa-
tions have been a multitude of times repeated ; and the number of
fever patients admitted into the hospital has been so great, that in
this establishment, previously to the discovery of quinine, 1200 lbs.
of cinchona have been prescribed in the course of ten years, and

1846.] Thrombus or Bloody Tumor of the Vulva. 497

since that discovery, frequently 50 oz. of sulphate ofominine have
been prescribed in the pharmacy during the three rnont^ of autumn.

If a serious and unusua! symptom shows itself for the second time
in the course of a fever, whoe paroxysms have been in general but
little marked : if a lethargic torpor, fainting?, alvine evacuations,
either bilious, or like the washings of flesh, or melanic ; if a severe
epigastric pain, a superabundant sweat, a marble coldness, shiverings,
symptoms exceeding an ordinary severity, accompanied by prostra-
tion, nearly complete abolition of the pulse; if these symptoms be-
come developed, and prolong the paroxysm beyond the previous term
of its duration, the doses should be doubled and given before the
complete decline of the paroxysm the fever has now become 'per-
nicious. It is necessary to guard this large dose with a third of a
grain of watery extract of opium, or four or five drops of wine of
opium. If tolerance on the part of the stomach cannot be obtained,
it will be necessary to inject the febrifuge into the rectum. The
intestinal injection is most easily retained if it produces neither a
sensation of heat nor cold, if it is deposited above the second
sphincter a region less excitable than that which is below it, if is it
small in bulk (from three to four ounces), and if made to traverse a
large pipe slowly ; a mixture of two drachms of powdered cinchona
and a scruple of sulphate of quinine is more easily retained than a
solution of half a drachm of sulphate of quinine.

A moderately abundant and substantial diet aids powerfully the
good success of preservative treatment. This is what Sydenham
and Morton, one hundred and fifty years ago, expressly affirmed.

Thrombus or Bloody Tumor of the Vulva ; its nature and treatment.
By M. Velpeau. (Journal de Chiruigie, from the New-York
Journal of Medicine.)

This tumor sometimes exists on both sides of the vulva; for the
rnost part, however, it is confined to one of the labia mnjora, or to a
portion of the interior of the vagina. It is ordinarily of the size of a
walnut, an eirg. or the fist; but occasionally grows so large as to
equal in dimensions the head of a new born infant. Its color is a
dark purple, and it usually presents a globular, spheroidal, or elliptical
form, which projects from the mucous surface of the vulva or from
the interior of the vagina.

Of an indolent nature, these bloody tumors are generally soft, and
presents the sensation of fluctuation where they point internally.
When the most prominent portion of the tumor, however, is on the
pubic or femoral side, it is found to be so dense and resisting that fluc-
tuation cannot be detected with anything like positive certainty. By
pressing it between the fingers, or attempting to draw the tumor out-

32

498 Thromhus or Bloody Tumor of ihe Vulva* [August,

wards, it ma^be easily ascertained that it is wholly independent of,
and has no mtachment to the hones of the pelvis; i. e., it may be
easily moved along with the labium with which it is connected,
around the whole circuit of the inferior strait, showing that its rela-
tions are only with the soft parts.

When, together with the characteristic signs just indicated as be-
longing to it, the tumor has been rapidly produced in the course of
a few hours, for instance the diagnosis is rendered very easy. Ab-
scesses, cysts, and all other tumors, are developed in so different a
manner, and vary so materially in their anatomical characters, that
"confusion in diagnosis would appear, under these circumstances, to
be impossible.

This disease is of very frequent occurrence, and if it has been
described by writers as being rare, it is undoubtedly because it has
been often mistaken for tumors or diseases of another kind.

Thrombus of the vulva has been considered by some writers as be-
ing peculiar to lying-in women, or those who have already borne
children ; it is now, however, a well established fact, that females are
subject to it at all periods, and in every condition of life. I have
myself seen as many as six cases in one year, and I know of nearly
twenty that have occurred in women who had never been pregnant.
I have seen it in a young girl fourteen years of age, whose person had
been violated. I have likewise seen it in young women of eighteen,
twenty, twenty-five, and thirty years of age ; women, thirty-five,
forty, fifty, and even sixty years old, have also been under my care
for it. I consider it, then, to be a disease of almost as frequent oc-
currence in women who have never had any, as in those who have
borne children. It is only necessary for us to reflect for a moment
on the nature of the disease to be convinced that delivery can only
be one, and not the sole cause of these tumors. Thrombus of the
vulva, in effect, is simply the result of a rupture of small vessels,
sometimes accompanied with, but almost always independent of, any
wound of the integuments ; and no one can deny but that a collec-
tion of blood, occasioned by such a lesion, may be established on the
vulva under the influence of every variety of mechanical chause that
would produce it elsewhere. In unimpregnated women, Thrombus
in this locality may be occasioned by a fall on the corner of a chair,
or over a log of wood ; from a kick which I have known several
times to give rise to it ; astride the wheel or shaft ofa carriage ; the
sharp edge ofa bucket ; the edge ofa bathing tub ; all of which cau-
ses I have known produce it ; but probably the most frequent of all
the producing causes, and one that will be but rarely admitted, is too
great indulgence in coition. I have seen several cases in prostitutes,
or young women who gave themselves up without reserve to the
indulgence of their venereal appetite, and in these instances it has
been impossible to detect that the disease had been occasioned by
any other cause.

When once formed, Thrombus of the vulva progresses in the same

184G.J Thrombus or Bloody Tumor of the Vulva. 499

manner as other bloody tumors. It may undergo various transforma-
tions ; either the effused blood gradually disappears and the disease
terminates by resolution ; or the fluid portion only may be absorbed,
and the clot remain, to constitute in the end a concrete tumor, the
exact nature of which it will be in some instances very difficult pre-
cisely to ascertain. In other cases, the more solid portions may dis-
appear, leaving the fluid part, which will be gradually added to and
occasion the formation of a cyst, which may be filled with a reddish
pultaceous matter; an oily demi-transparent substance; or simply
with serum. Finally, in some instances it becomes heated, inflames,
and is converted into a true sanguineous abscess.

These latter varieties of character of the tumor are met with in
non-pregnant women, for they rarely# consult their physician at the
commencement of the disease, either hesitating to speak of it at all,
or being prevented by feelings of modesty, or for other reasons, from
declaring the true cause of its origin. When Thrombus occurs du-
ring labor, however, it is different ; the tumor is then formed, as it
were, under the eyes of the surgeon, and proper therapeutic means
can be resorted to, to arrest its progress. At the period of delivery,
Thrombus of the vulva generally occasions severe pain, which is,
however, independent of any inflammatory action. With some few
exceptions, no real suffering is occasioned by bloody tumors of the
labia roajora after the first three or four days following delivery; and
it may, like every other variety of Hematocele, exist for an indefinite
period as an indolent swelling.

It is important that practitioners should be made acquainted with
the fact, that when a Thromhus about the perineum inflames and is
converted into an abscess, it gives issue, on being opened, to matter
which is generally very foetid, and from its peculiar odor might give
rise to the supposition that the tumor communicated with the intes-
tines. This is a fact that I have noticed very frequently, and one
that I first indicated in the year 1830. The smell is caused simply
by the proximity of the abscess to the rectum, for it is well known
that a purulent collection will have imparted to it the peculiar odor
of any substance that stagnates in the vicinity of parts lined with a
mucous membrane. Thus forewarned on this point, the surgeon
should entertain no apprehension, and need not be alarmed by the
fear of the formation of a fistula in ana,

The prognosis in cases of bloody tumor of the vulva, although a
little more so than when the disease is situated on other parts of the
body, is by no means very unfavorable. The danger has been ex-
Bggerated ; and if death has followed their formation in some instan-
ces, it has boon occasioned by the hemorrhage being very great.

When sufficient time has elapsed for a Thrombus to be converted
into a solid tumor, a pultaceous, or a serous cyst, the disease then
belongs to another order, and should no longer be classed with bloody
tumors proper; my present remarks, therefore, in regard to progno-
sis being favorable, should apply only to such as are of very recent

500 Thrombus or Bloody Tumor of the Vulva. [August,

formation ; in other words to Thrombus proper, and not to the tumor
after it has become inflamed and degenerated.

The treatment of Thrombus of the vulva necessarily varies, ac-
cording as the tumor is large or small, with or without a solution of
continuity of the skin, or diminution in the thickness of the integu-
ments, and accompanied or not by inflammation. It would be super-
fluous to indicate the treatment of simple sanguineous infiltration, as
it requires no particular care, and will yield to the .same means that
are resorted to in simple ecchymosis or infiltration of blood in any
other part of the body; the indications are the same, and the same
plan of treatment should be adopted for Thrombus in this locality as
elsewhere.

Provided there is no external wound, simple discutients are the
only means that should be first tried. Pledgets wet with lead water
should be applied for one or two days, in order to lessen any tenden-
cy to inflammation, to relieve pain if it exists, and to produce slight
pressure. At a later period saline washes, especially one of carbon-
ate of ammonia, may be advantageously substituted for the solution
of acetate of lead. These simple means generally suffice, with time,
to discuss the tumor, which, it should be borne in mind, will disappear
spontaneously in a number of cases. When, however, at the expira-
tion of fifteen or twenty days, the size of the Thrombus remains un-
altered, and there is at the same time no appearance of inflammatory
action going on, other means will become necessary.

Except in a few rare cases, where the tumor is small and not pain-
ful, and occurs in non-pregnant women, rupture by ecrasement, with
or without previous puncture, should be rejected as insufficient and
not to be relied upon.

Caustics do not at all suit in these cases. Their action is too slow
and unequal, and an enlightened practitioner would scarcely give
them the preference over other means, unless it mijjht be in some
exceptional cases, where, for instance, the disease existed in women
who were too timid to permit the use of the knife, and who were at
the same time not near their confinement.

I consider that incision is the remedy against bloody tumors of the
vulva that resist an absorbent treatment, and which, either on ac-
count of their size, or because of the accidents which they occasion
or which accompany them, do not admit of delay. This, however,
is not the universal opinion amongst surgeons. Many practitioners
think that the resolution of a Thrombus is always possible, and that
for this reason, it is, to say the least of it, useless to resort to the bis-
toury. Others again, are of opinion that the operation is a danger-
ous one. Forming an estimate from the results of my own practice,
I should say that both opinions are wrong if adopted exclusively. I
have seen blood}7 tumors of the vulva, when abandoned to themselves,
and when treated by every variety of discutient, persist for an inde-
finite period, either remaining stationary, continuing to increase in
size, or undergoing various transformations.

1846.] Thrombus or Bloody Tumor of the Vulva. 501

Hemorrhage is regarded as the chief danger to be apprehended in
the operation of incision, and it has been asserted to have been so
abundant that death has been the consequence in several instances.
It seems to me that in these cases the cause of the accident has been
misunderstood ; I do not think it possible that any serious hemor-
rhage could follow incision of a Thrombus of the vulva, inasmuch as
in that locality there is no artery, and indeed no vessel at all of
sufficient importance to give rise to it. It would appear to me to be
much more reasonable to conclude that the hemorrhage was only a
continuation of the accident that gave rise to the effusion of blood
into the Thrombus. For this reason I should not refer the bleeding
to the incision of the tumor, but look upon it simply as a continuation
of the cause that operated to produce the disease. One thing is
certain, viz., that I have incised more than twenty of these tumors of
the vulva, and in no instance has any hemorrhage followed the oper-
tion. Suppose, however, that a hemorrhage was to ensue, what is
there to prevent the application of proper pressure? It may be ac-
complished either by plugging up the interior of the cyst, or by grad-
uated compresses applied to its sides; both the form and situation of
the parts are favorable for its use: recourse might also be had to
cauterization under very unfavorable circumstances, when the flow of
blood was so abundant as to cause serious apprehension, and where
the more simple means had proved ineffectual to arrest it. Hemor-
rhage, however, is not at all likely to ensue from the incision of a
Thrombus of the vulva.

But another question presents itself in connection with the subject,
and it is as to whether a large or a small incision should be made.
I am decidedly of opinion that when once the use of the bistoury has
been determined upon, the incision should be a large and not a small
one; if small, it will permit the escape of the fluid portions of the
effused matter only, and will thus fulfil but imperfectly the indica-
tions. A large opening scarcely increases the risk of inflammation,
whilst at the same time it admits of the contents being entirely
emptied, and of the cavity of the cyst being properly cleansed. The
vessels which might be divided in either case, are too small and
trifling to influence the decision of the surgeon in regard to a long or
a short cut; should they bleed freely they may be easily seized and
tied, or twisted, in the lips of the wound.

The incision being once made, some surgeons have thought, with
Dewees, that the tumor should be allowed to empty itself, and that
no pressure should be made upon it. Such a course should not be
imitated there is no plausible reason in favor of adopting it. If
practised in this manner, incision would be productive of no other
beneficial results than relieving the pain which might be occasioned
by distension. The cyst should be emptied of all the clots that it
may contain, be freely washed, then filled with of lint, and

have, where there is pain or inflammation, a !a:\. I poultice

applied all over it, or else a plaster of simple cerate, and compresses
wet with lead water.

502 The Practice of Surgery. [August,

It is important to determine at what portion of the cyst the incision
should be made. There is both a point of election and one of neces-
sity. If any particular part of the Thrombus is found to be very thin,
salient, and about bursting, the opening ought to be made at that
point; it is the lieu de riecessite. Under other circumstances, as
when the parietes offer at all points the same degree of thickness,
more advantage will be found to follow an incision made on the out-
side, or at all events near the free margin of the labium, than on the
insideof the vulva near the vagina. The wound should be prolonged
as far as possible towards its inferior extremity, and down to the
lowest point ofthe tumor.

Before ending this short article, I will state mybelief that where it
exists in pregnant women near their confinement, Thrombus ofthe
vulva should be incised at as early a period as may be practicable, for
if left to itself it will present a serious obstacle to delivery. When
it exists in women who have been recently confined, it generally oc-
casions so much pain that prompt relief is rendered necessary; in^
these cases, likewise, I unhesitatingly recommend incision as the most
rational method oftreatment.

In conclusion, then, I consider that, with the exception of such
peculiarities as I have indicated, Thrombus of the vulva should be
regarded as similar to bloody tumors in other parts ofthe body ; the
causes producing it, the mechanism of its formation, the prognosis,
and the treatment appropriate to it, are the same as in other localities.

I deem it unnecessary to enter minutely into the consideration of
bloody tumors of the vagina that occur exclusively during the pro-
gress of, or immediately after labor, a number of cases which have
been collected by M. Deneux, inasmuch as I look upon nearly all of
them as assimilating to the disease, such as it has just been described.

In regard to the termination, by gangrene, of Thrombus of the
vulva, two cases of which are mentioned by M. Vidal, [Pathol. Chir.y
vol. v., p. 7o2 ) I may state that I believe it to be very rare ; when it
does take place, however, there are no special indications to fulfil, and
it must be treated on good general principles. The same remark may
be made likewise in reference to the inflammation and suppuration
that will occasionally supervene on simple incision of the tumor.

BIBLIOGRAPHICAL NOTICE.

The Practice of Surgery. By James Miller, F. R. S., F. R. C.

S. E., Professor of Surgery in the University of Edinburgh, Sur-
geon to the Royal Infirmary, Author of "The Principles of Sur-
gery," &c, &c. Philadelphia: Lea & Blanchard. 1846. pp. 496.

We cannot define more accurately the character of the above
work, than the author does himself, in the following brief preface :
"This volume is not put forth in rivalry of the excellent works on

1946.] Effects of Sulp\ate of Quinine on the Pulse. 503

Practical Surgery which already exist; but as a companion to the
"Principles of Surgery," lately published. It is intended to exhibit
the application of these principles to the details of injury and disease ;
and has been undertaken by the author at the request of his pupils
to whom the two volumes nre now respectfully offered as a complete
text-hook of Surgery." The present volume contains an epitome
of practice which cannot fail to be acceptable to the student and to
members of the Profession who, though well versed in the principles
of Surgery, may desire to refresh their memory on subjects of rare
occurrence.

PART III. MONTHLY PERISCOPE.

Some observations on the effects of Sulphate of Quinine on the
Pulse. By George Mexdenhall, M. D., of Cincinnati, Ohio.
G. M , aetat. 31. Dec. 2():h, 1845, 4 o'clock. P. M. Thermometer
56 Fahrenheit. Pulse 72 lying. 77 sitting, 96 standing: took two
grains of sulphate of quinine. 4^ o'clock, half hour after taking it,
pulse 74 lying, 80 sitting, 100 standing. 5 o'clock, pulse 07 lying,

79 sitting. 95 standing.

Dec. 23d, :H o'clock, two hours after a hearty dinner, thermome-
ter at 60. Pulse 72 lying, 77 sitting, 92 standing: took 5 grains.
4 o'clock, half hour afier, pulse 76 lying, 83 sitting, 101 standing.
4 o'clock, pulse 75 lying, 82 sitting. 95 standing. 5 o'clock, pulse
70 lying. 77 sitting, 66 standing. 6 o'clock, pulse 70 lying, 76 sit-
ting. 87 standing.

Dec. 29th, Ik o'clock, half hour after dinner, thermometer at 60,
pulse 71 lying. 77 sitting, 93 standing: took 10 grains. 2 o'clock,
half hour after, pulse 73 lying, 88 silting, 103 standing. 2| o'clock,
pulse 71 lying, 80 sitting, 101 standing. 3 o'clock, pulse 68 King,

80 sitting, 100 standing. Sh o'clock, pulse 66 lying, 73 sitting, 93
standing. 4 o'clock, pulse 66 lying, 79 sitting, 98 standing. 4
o'clock, pulse 06 lying, 79 sitting, 93 standing.

January 2d, 1846. 2-h o'clock, lj hours after dinner, thermome-
ter 60 : took 20 grains of quinine; pulse then before taking it 72
lying, 77 sitting, 100 standing ; 10 minutes after, 82 sitting, 15 min-
utes after, 84 sitting ; 20 minutes alter, 35 sitting ; 25 minutes after,
86 sitting. 3 o'clock, half hour after, or 30 minutes, pulse 77 lying,
85 sitting. 107 standing. 3$ o'clock, or 45 minutes after, pulse 80
sitting. 3g o'clock, one hour alter, pulse 7(5 lying, 30 sitting, 102
standing. 8} o'clock, or 75 minutes after, pulse 80 sitting. 4 o'clock,
1 .1 hours after, pulse 75 lying, B0 sitting. 100 standing. 5 o'clock,
2 hours after, pulse 75 lying, 80 sitting, 93 standing. 6 o'clock,
pulse 80 sitting.

504 Precocious Children. Ague g,nd Consumption. [August,

In all cases the pulse was increased in fullness and hardness, even
when it decreased in frequency. When ten grains, and also twenty
grains were taken, the ringing in the ears was very great, with some
considerable deafness for several hours. Also a general feeling of
the body, such as would be excited by riding on a rail-road car.

[American Jour, of the Jled. Sciences.

Precocious Children. To the Editor of the Boston Medical and
Surgical Journal. Sir, Dr. S. W. Shepard, near Lawrenceville,
N. Y., sends me the following description of two precocious children
residing in his vicinity. The cases are those of a boy and girl. Dr.
S. says "The boy is about 4 years and 11 months old. He is
three feet and four inches high, and weighs fifty. eight pounds. His
head is very large. He has considerable beard, as much as boys
generally have at 19. His voice is a heavy bass. His intellect does
not seem to be prematurely developed. In this respect he does not
differ from other children of his age. His countenance is that of an
adult it has no childish look about it. His testicles and penis are
of the usual size of the adult organs; the hair upon the pubes is
long but thin. In fact, he appears like an adult dwarf.

'The girl I cannot describe so well, as I never was allowed an ex-
amination. She is 3 years and 7 months old, rather large of her
age. Her mammas are preternaturally developed. In this respect
she has the wonted appearance of a girl of 18." The doctor has
been unable as yet to find out whether or not the girl menstruates.
He adds, "Their animal desires are fully developed; as a proof of
this, they are often seen in the act of coition."

I have only to add, that I know Dr. Shepard to be perfectly relia-
ble, and that his report of these cases agrees with that given me by
others. The cases are, I believe, without parallel all their peculiar-
ities considered. If they are worthy of publication, please give them
a place in your widely-circulated Journal. As ever, yours, &c.

Castleton, Vt., June 27, 1846. Middleton Goldsmith.

M. Bricheteau on the Antagonism of Ague, and of Pulmonary Con-
sumption This question has been much discussed of late by French
medical practitioners, as our readers are well aware. M. Bricheteau,
physician to the Hopital Neckfer, analyzes the various communica-
tions that have appeared on the subject, including documents from
different parts of Algeria, from Bordeaux, Strasbourg, Lyons, the
department of the Ain, Rochefort, Rome, &c, all localities in
which intermittent fever is rife, and appears to come to the con-
clusion that there cannot be said to be antagonism between the two
diseases that is, exclusion of the cne by the other; although the
circumstances which favor the development of intermittent* may be,
and in all probability are, unfavorable to the development of phihisis.
M. Bricheteau thus concludes his remarks :

"Although, on examining the etiology of these diseases, we do not

1846.] Stale of the Urinary Organs in Scarlatina, 505

find incompatibility between the causes of phthisis and intermittent
fevers, it is impossible not to recognise, either in the climate of
marshy districts, or in the influence of marshy miasmata over the
economy, conditions favorable to tubercular patients. Our knowl-
edge of this fact is to be referred to the authors of the labours which
we have enumerated. But instead of calling to our assistance some
obscure antagonizing tendencies, would it not be possible to account
for this kind of prophylaxy, by attributing it to the moist uniform
heat which reigns in some marshy districts, and which, by favoring
the development of fever, may impede that of pulmonary tuberculi-
zation. Does not this appear proved by what takes place at Stras-
bourg, where the climate being both damp and cold, the town is rav-
aged by intermittent fever and by phthi4s; whereas the more south-
ern departments of L'Ain, La Nievra, Le Var, &c, are decimated by
intermittent fevers, but offer very few phthisical patients? We may
also add, that it is impossible to deny that in all countries intermittent
fevers preserve from other affection?. The Dutch appear to be
aware of this fact, as Boerhaave informs us, that they are in the
habit of congratulating themselves on the return of their fevers.
The same Boerhaave, along with Hoffmann, Lancisi, and Sydenham,
thought that intermittent fevers freed us from various diseases, and
even predisposed to longevity : * Febres intermittentes, nisi maligna?,
ad longevitatem disponunt, et depurant ab inveteratis malis.' Some
recent writers think that typhus fever is rarely met with in countries
ravaged by endemic intermittent?. " [London Lancet.

State of the Urinary Organs in Scarlatina. By M. Schoexlein.
There is a peculiar phenomenon that occurs in the convalescent stage
of this exanthem, which is interesting and worthy of notice in many
points of view. That there is an exfoliation of the mucous mem-
brane of the mouth and fauces, is known to every medical man ; but
few are aware that a similar process not unfrequently takes place
along the whole course of the urinary organs. That such is the case,
may be discovered by examining the urine with the microscope. If
this be done, we shall often find a large number of epithelial scales,
which, to the unassisted eye, look, in the mass, like a mucous sedi-
ment or opalescent muddiness. Schoenlein is of opinion that this
exfoliation of the mucous membrane of the uropoietic organs, is the
real cause that predisposes the patient to that form of dropsy which
is so apt to occur after scarlatina, and in which the urine is well
known frequently to contain a number of blood-globules, as well as
a quantity of albumen. Such a condition of the urinary secretion
may very reasonably be regarded as indicating a state of high irrita-
tion of the mucous surface along which it flows. It is, therefore, a
very natural and obvious deduction, that a patient should never be
pronounced quite convalescent by his physician until not only the
cutaneous desquammation has entirely ceased, but the urinary se-
cretion also has resumed its healthy condition in every respect. If

506 Heart Diseases. Discoloration of Palate. tyc. fyc. [August,

this rule were more uniformly followed in practice, many of the most
unpleasant sequela of scarlatina might unquestionably be avoided.
The patient should be strictly guarded from cold, and the state of the
urine be sedulously watched for several weeks after the decline of the
eruption. Med. Chir. Review; notice of Schaenlein's Clinical
Lectures.

Connection of Heart Disease with Rheumatism, In 136 cases of
rheumatism, according to Dr. Latham, the heart was affected in 90.
Of these 90 cases, the endocardium alone was the seat of disease in
63; the pericardium alone in 7; the two membranes combined, in
11; three cases doubtful. These momentous facts warn us that
acute rheumatism is a formidable disease ; at least, its almost constant
extension to the heart, renders it one of the most fatal maladies we
encounter. [Guy's Hospital Report.

Discoloration of the Palate in Jaundice. M. Lonjun states, that
a yellow discoloration of the palate invariably precedes the icteric
tinge of the other portions of the body. This may be a valuable
means of diagnosis. [Western Lancet.

Chronic Capillary Bronchitis. Tartar Emetic and Balsam of
Copaica. A young woman had been for a long time suffering from
a severe attack of a capillary bronchitis. She was exceedingly pale
and thin, but auscultation and percussion failed to detect the slightest
trace of tubercles. The pulse was small and frequent. M. Legrouse
(of the Hopital Beaujon) directed that she should take Horn 3 to 4
grains of tartar emetic daily, in syrup of ipecacuanha ; this acted
as an emetic, and its use having been continued for a few days, it
was found that the bronchitis had almost entirely disappeared, and
what was still more remarkable, the chlorotic appearance of the pa-
tient changed as the cough left her. Her present condition is highly
satisfactory ; her cheeks have regained their color, and she appears
to be perfectly healthy. In order to prevent the recurrence of the
bronchitis, however, she is requested to take about a scruple of
balsam of copaiva every day, administered in pills. Annates de
Therapeuiique, from New York Jour, of Med.

A new method of arresting obstinate Singultus. Hiccup some,
times occasions serious inconvenience to those who are affected with
it, and is often so obstinate, as to resist all means that may be used
to overcome it ; hence any new method that promises success, should
be generally made known. The following plan for arresting it,
temporarily at least, is recommended by Dr. Rostan, and a case in
which it was successfully tried, is reported in the Annates de
Therapeuiique, as having occurred in the wards of the uHotel-Dieu."
The patient in this case was a hysterical young woman, who had
been harrassed by the complaint for so long a lime, that serious fears

1846.] ' Lithotomy. 507

were entertained for her life. The means employed for her relief
consisted of constant pressure upon the epigastrium, made with a
large pad the size of the fist, attached to the spring of a hernia truss.
Immediately on the application of the instrument the spasmodic ac-
tion of the diaphragm ceased, and the patient was so much relieved
as to be able to attend to her usual occupations, and cat and sleep in
comfort. The most remarkable feature in the case, however, was
the fact, that although its use had been continued for several days,
so soon as the bandage was removod, the hiccup returned: if the
pressure was partially suspended, there was a partial recurrence of
the trouble, but it was always arrested so soon as a sufficient degree
of force was used, to press pretty firmly upon the region already-
indicated. In the case of this female almost every remedy that has
been recommended as useful, was previously had recourse to, but
without producing the slightest beneficial effect. [New-Tori Jour-
nal of Medicine.

Lithotomy. Signer Bresciani de Borsa, in hlsSaggidi Chirurgia
Teoricopralica, states that of one hundred cases of stone operated on
by Sig. Manzoni, of Verona, and himself, only one has died, and that
from causes irrespective of the operation ! This is certainly a degree
of success calculated to excite our astonishment. It exceeds much
even that of our countryman, Prof. Dudley, hitherto considered the
most fortunate of lithotomists, he having operated it is said, success-
fully in 180 out of 185 cases. Sig. Manzoni's operation consisted in
cutting into the spongy portion of the urethra only, and then dilating
the bulbous and prostatic portions sufficiently with the finger to ad-
mit of the introduction of the forceps and the removal of the stone.
Dr. B., however, judging it more reasonable to cut into the more
dilatable portion of the urethra, carries his incision from the bulb to
the prostrate, and even unavoidably sacrifices the latter when it ad-
vances more than usually forwards. As the admission of such an
operation depends upon the dilatability of the prostrate being satis-
factorily proved, the author advances several reasons for this, founded
on the nature of its anatomical structure, and cites various facts ob-
served by himself and others.

The following are the details of the various steps of Sig. de Borsa's
operation as given by himself, and which we copy from the Medico.
Chirvrg. Review for April, 1846.

"Having placed the patient in the usual position, (it is much pre-
ferable to retain him in this by means of assistants than by ligatures,
for the mere ceremony of adjusting these, causes a great dread to the
patient which may alone suffice to induce a low and fatal form of
fever,) introduced the catheter, and made a sufficiently large external
incision, I open, with a small, lancet-pointed, double-edged, strong
scalpel, the whole of the membranous portion of the urethra, so as to
expose the instrument to the extent of about 10 lines, in doing which
it may in some cases easily happen that the apex of the prostate is

508 Lithotomy, [August,

also cut, although in the case in which the patient died it was found
entire. I now take hold of the handle of the catheter, and passing
my left fore-ringer into the wound, feel the groove exposed ; and as
others would pass some form of gorget through the prostatic portion
of the urethra and nerk nf the bladder, I only introduce my finger
into the bladder, being certain it never can make a false passage,
since I keep it in contact with the metallic instrument. I take care,
nevertheless, not to pass my finger along the groove, because I should
then thrust it against the internal or posterior angle of the wound,
and then against the great bulk of the prostrate. Scarcely do I
touch the groove before, instead of following it, I pass my finger upon
the right side of the staff (as regards the patient) and carry it quietly
and without any obstacle into the bladder. One of the advantages
of this modification is, that it enables me, in most cases, to come at
once in contact with the stone.

"I then remove the staff, still, however, retaining my finger with-
in the track of the incision, and gently moving it about in a semi-
rotary manner, effect a much greater dilatation of the prostatic
urethra and neck of the bladder. Next, I pass in the forceps behind
my finger and seize the stone. It has to pass along a track of only
from 12 to 15 lines, or even less, since the inverse cone formed by
the forcepts approximates the neck of the bladder and urethral aper-
ture, for which reason the space is shorter and more easily dilated.
I remove the stone with two, or at most three semi rotations, per-
formed with circumspection and care, along an axis, which, com-
mencing at the centre of the bladder, should pass through its neck,
and following the centre of the prostatic urethra, terminated in the
centre of the perineal aperture.

"I am in general not more than a minute after opening into the
urethra before I have extracted the stone, and the operation has
already succeeded in my hands. Safety, simplicity, and celerity, I
have already said are desiderata of every operative process, and I am
in a condition to prove that they attach to this one recommended by
me. All I employ are simply a bistoury and the forceps simplicity,
surely, in comparison with the multiplicity of complicated instru-
ments which has been recommended in the various and numerous
modes of performing Cystotomia. By passing my finger along the
staff, I secure that safety which is not usually a characteristic of
operations for stone. It is related that even the celebrated Scarpa
passed the gorget, which was looked upon as the palladium of his
fame, in between the bladder and the rectum. The same thing has
occurred to many otherwise skilful operators. * * * * lam
certain of not injuring either the pudendal artery, the prostatic ven-
ous plexus (so frequently in a varicose condition in the aged), the
body of the bladder, or the rectum. Farther, by the preservation of
the whole, or nearly the whole, of the prostatico-vesical canal, in-
flammations between the rectum and bladder are avoided, inasmuch
as urinary infiltration is prevented, in consequence of the prostate

1846.] Nitrate of Silver in Acute Opthalmia. 509

not being divided. ***** Tne rapidity of the
operation is shown by the fact, that instantly after I have opened
the urethra I have the stone in my hand ; and any one who has ever
once performed this operation, will bear witness to my assertion. 1
mav observe that it seems almost impossible that so many operators,
at all periods, have written so much, and cudgelled their brains to
invent new operative procedures for lithotomy by deep prostatico-
cystic incisions, while, with a simple urethrotomy, the desired ^end
may be obtained, as I can prove by so many cases.' [Amer. Jour.

A Case illustrative of the beneficial effects of the Nitrate of Silver
in strong solution, in Acute Opihahnia. By O. F. Mansoic, M.D..
North Carolina. J. N., set. 40, of sound constitution and robust
frame, had been suffering for two days from an eruption of large
pustules over the scalp and face, induced by eating enormous quanti-
ties of butter of which he was passionately fond ; one of the pustules
had formed near the margin of the inferior palpebra, from whence
the inflammation rapidlv extended over the whole eye. W hen 1 first
saw him he was suffering the most agonizing pain, the pun darting
-through his eyes and through his head" as he expressed it, and ot
such intensity as to elicit loud cries from the patient every minute,
the darting pain being paroxysmal. The eyelids were so completely
closed and swollen that the eyeball could not be seen by attempting
to open them. The patient had high fever, hot, drv skin, furred
tonrrue and fixed pain in the forehead and temples. I bandaged his
arm", and bled him upwards of two pounds; when symptoms ot
syncope appearing the flow of blood was stopped; at bed time,
several hours after, 20 grs. of calomel were exhibited, to be followed
in the morning by a large dose of Sulph. Magnesia. 10 A. M. next
morning fever has abated somewhat, hut the pain and inflammation
have nol perceptibly declined ; eve still completely closed and can
be but very slightly separated by the fingers. Applied 80 leeches in
the course of an hour (the medicines have operated well) but without
beina followed by an apparent diminution of the symptoms. Fain
still excrutiating, causing the patient to contort his whole body; even
to witness the agony of the sufferer was painful to the bystander.
All must own from this imperfect description, that this was a case o
the most aeute character, and that the practice adopted was well
calculated to relieve it; but I am verv certain that the patient was
Buffering as greatly, and that the symptoms of inflammation were as
well developed, with the exception of a slight decline in the general
excitement, as they were before the treatment was had recourse to.
I now determined 'on using a strong solution of the caustic, and
mixed 10 grs. to the ounce of water ; four or five drops of the solution
were introduced into the external corner of the eyelids, the patient
only complaining for a verv short space of time of a slight smarting
sensation which could not properly he termed pain. In five minutes
the patient expressed himself relieved of pain, and alter the reappli-

510 Royal Estimate, $c Prescription for Gonorrhea. [August,

cation of the collyrium three or four hours afterwards, the pain en-
tirely subsided to return no more, the patient falling asleep for the
first time in 50 or 60 hours. Since treating this case, I rely upon a
strong solution of Lunar Caustic alone in the treatment of acute
opthalmia. I have introduced it into the eye of my own infant, 16
months old, and can recommend it as a safe and effectual remedy ;
but at the same time would reprehend a weak solution, except in cases
f a chronic character, in which I have found it more usefuhthan
Che 10 grs. solution. [~\. O. Journ.

Royal Estimate of the value of Medicine. It is a source of no
little satisfaction in these degenerate days, when "Quackery reigns
triumphant," and the world seems mad on the subject of Mesmerism,
Homoeopathy, and Hydropathy, to find so just an estimate enter-
tained of our profession, by the wise and enlightened King who now
occupies and adorns the French throne, as is expressed in his reply
to the committee of the Royal Academy of Medicine, of Paris, on
the occasion of their presenting him the annual congratulatory ad-
dress of the academy, at the last "jour de Tan." We find it in a
copy of the official journal, the Moniteur Parisienne, from which
we translate it :

" I am highly gratified, and much moved, gentlemen, by the kindly
sentiments expressed by you, in behalf of the Royal Academy of
Medicine. I appreciate fully the importance of the labors of your-
selves, and your colleagues, and I am much flattered to learn that the
patronage which I so willingly extend to the Academy, has contri-
buted to augment the just consideration that it commands. No one
can better appreciate the services which you render, than myself;
I am a striking example of the good that you are capable of perform-
ing; for in despite of my great age (72), I am indebted to some
among you. for enjoying the good health that you now see me bless-
ed with. May you all, gentlemen, be long spared to continue your
exertions in the cause of science and humanity." [N. Y. Jour.

Prescription for Gonorrhoea. The following prescription for
Gonorrhoea was suggested some years ago, and having stood some
experience in this quarter, is recommended to the profession :
Take Balsam Copaiva. }

Pulv. Cubebs, > each, - - ounces n.

Gum Arabic, y

Syrup of Euchu, or Uva Ursi, " iv.

Cinnamon Water, pint i.

Mix. Dose, an ounce, three times a day. p. r. eve.

To produce Vomiting at any time. A pint of vinegar conveyed
into the stomach by a tube, and then four tea-spoonfuls sal. aeratus,
dissolved in a half pint of warm water.

1846.] Appoin'menfs in the Army. Trismus Nascentium. 511

MEDICAL INTELLIGENCE.

The following appointments in the Army of the United States, have been
made by the President, by and with the advice and consent oi the Senate, viz :

/>'RANK.' LGEONS.

V l. Paul F. Eve. of Georgia, July 7. 1846.

'2. Edward B. Price, of Illinois, July 7. 1 -

3. Seymour Halsey, of P ' July 7, 1846.

4. William Trevitt, of Ohio. July 7, 1846. '

5. Robert F. Richardson, of Illinois. July 7. 1846.

6. William M. Gluinn, of Illinois, July 7, 1846.

7. James Mahan, of Illinois, July 7. 1846.

8. Benjamin Stone, of Ohio, July 7. 1846.

9. James S. Athow. ol Indiana. July 14, 1846.

10. Thomas L. Caldwell, of Kentucky, July 14, 1846.

11. E. K. Chamberlain, of Ohio, Jul v 11. .

12. Robert P. Hunt, of Kentucky, July 14, 1846.

13. Alexander Henslev, of Kentucky, July 14, 1846.

14. Caleb V. Jones, of Indiana, July 14, I -

15. Daniel S. Lane, of Indiana, July 1 1. 1846.

16. John W. Moore, of Alabama, July 16. 1846.

LNT SURGEONS.

1. William B. Herrick, of Illinois, Jul v 7, 1846.

2. Henrv Bragg, of Illinois. July 7. i

3. Daniel Turney, of Illinois. Julv 7. 1846.

4. Robert McNeal, of Ohio. Julv 7. 1 -

5. P. H. Mulvaney, of Ohio. July 7, 1846.

6. John Thompson, of Mississippi, July 7, 1846.

7. Washington J. Gibbs, of Illinois, July 7. 1846.

8. Alexander Blanton. of Kentucky, July 14. 1846.

9. William Fosdick, of Indiana, July 14." 1846.

10. A. E. Heighway, of Ohio. Julv 14. 18-16.

11. John G.Dunn, of Indiana, July 14 1846.
l-J. James B. Snail, of Kentucky, July 14, 1846.

^-^13. John J. B. Hoxey, ot Georgia, Julv 14. L846.

14. John T. Walker, of Indiana, July 11. 1846.

15. John J. Mathews, of Kentucky, Julv 14, 1846.

16. C. J. Clark, of Alabama, July 16, 1Mb.

Such of the above named Surgeons and Assistant Surgeons as may now be
serving with their regiments, will continue on duty with them; and those not
attached to regiments, will forthwith proceed to join the army in Mexico, where
they will be assigned by MajoivGeneral Taylor, for duty with the several bat-
talions of volunteers, according to the States in which they have been respective-
ly raised and appointed. Commissions will be forwarded to Major-General
Taylor, who will cause them po be delivered to the Surgeons and Assistant Sur-
geons on their arrival at the Head Quarters of the Army in Mexico."

Trismus Nascentium. Letter from Dr. J. S. Sullivan, of Darien, Ga. The
following interesting communication we have received within the lastfewdays:

I find in the July number of your Journal a request, for "further facts" in
relation to the disease ': Trismus Nascentium."

During the winter of the year 1841, I was called to a plantation in this neigh-
borhood to visit a child with lock-jaw. It is planted in cotton, on an island, and
situated a mile and a half from the family's residence. This residence is on the

* Mrs E. having had a renewal of her illness since her return home from the Madison
Springs, preparatory to the Doctor's joining the Army in Mexico, a committee decided,
unanimously, that it was his duty to decline the appointment cODterred upon him

512

Meteorological Observations*

main, and both it and the plantation are very healthy. The child died before
my arrival, and I was informed that every one born upon the place for the two
preceding years had died of "lock-jaw." I was urgently solicited to ascertain the
cause, and find a remedy for this mysterious mortality among the infants. I
advised the owner to have every woman that was enceinte brought to the yard
of his residence before her time of pregnancy hadfully expired, and to give his
attention to the following directions :^

1st. That the child was not too hastily separated from the mother. 2d. That
the cord should not be divided at a less distance than an inch and a half from the
umbilicus.

I called yesterday upon the proprietor of this place, and was informed that
my directions had been faithfully observed, and that there had been since the
period of my visit (for the purpose above stated) no case of the disease.

The disease arises from the too hasty separation of the child, before the foetal
circulation is extinguished, and the individual circulation of the infant estab-
lished, or, from the division of the cord too near the umbilicus both may co-
operate. The post-mortem examinations of Dr. Wooten have strengthened my
conviction as to the true source of this very prevalent and fatal disease viz. the
separation of the child before the puliation of the cord has ceased.

METEOROLOGICAL OBSERVATIONS, for June, 1846, at Augusta,.
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

a

Sur

Ther.

l Rise.
Bar.

29 72-100

3,1
Ther.

~~~ 8~8~"

?. M.
Bar.

29 67-100

Wind.

Remarks.

1

72

s. w.

Fair thund., light., rain 5i-l0.

2

68

" 71-100

86

" 73-100

s. w.

Fair.

3

72

" 82-100

85

" 79-100

s. w.

Cloudy sprinkle.

4

67

" 80-100

76

73-100,

S. E.

Rain, 5-10.

5

68

68-100

78

" 53-100

S.

CI o udy showery.

f>

69

<: 59-100

83

" 66-100

W.

Fair flying clouds.

7

69

" 78-100

75

< 82-100

E,

Rain all day, 1 inch and 2^-10,

8

66

' 80-100

72

80-100

N. E.

Rain at night, 1 inch and 2-10.

9

66

74-100

76

71-100

N. E.

Rain all da v.

10

68

" 68-100

70

<; 65-100

E.

Rain 34-10.

11

66

" 55-100

76

" 55-100

S. E.

Cloudy rain 2-10.

12

67

" 60-100

81

63-100

S. W.

Fair flying clouds.

13

67

" 75-100

82

<< 78-100

S. E.

Do. do. do.

14

67

77-100

81

" 68-100

S.

Cloudy showery.

15

67

" 69-100

74

" 62-100

S. E.

Do. do. thund. and light.

16

63

" 69-100

83

" 66-100

N. W.

Fair.

(7

67

" 69-100

87

" 74-100

E.

Fair thvind. in afternoon.

18

70

" 79-100

89

" 77-100

S. E.

Fair flying clouds.

19

70

" 77-100

88

" 69-100

S. W.

Cloudv rain at night 4-10.

20

71

" 68-100

86

" 67-100

s. w.

Do. Rain 3-10.

21

68

" 66-100

85

" 64-100

N. W.

Fair some clouds.

22

70

" 77-100

78

" 79-100

N. E.

Cloudy.

23

61

" 87-100

76

" 92-100

N.

Fair.

24

56

" 99-100

78

" 99-100

E.

iFair some clouds.
Fair.

25

58

;< 99-100

82

" 87-100

ft.

26

60

" 83-100

84

" 79-100

S.

Fair some clouds.

27

64

" 78-100

82

" 76-100

S. E.

Fair, do. do.

28

66

" 76-100

86

" 76-100

S. E.

Fair, do. do. spririk.,thun.

29

70

<: 75-100

86

" 71-100

S. E.

Do. do. do.

30 72

66-100

93

"058-100

s. w.

Do. do. do.

16 Fair days. Quantity of Rain 4 inches and 7^-10. Wind East of N. andS.
15 days. West of do. 10 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 8.] NEW SERIES SEPTEMBER, 1816. [No. 9.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXXII.

Remarks on Tumours of the Neck ; with Cases. By L. A. Dugas,
M. D., Professor in the Medical College of Georgia.

The anterior aspect of the neck may be the seat of a variety of
tumours of more or less frequent occurrence. Presenting not only
the thyroid body and salivary glands, but also superficial and deep-
seated series oflymphatic ganglia, all of which are exceedingly prone
to disease, this region is also subject to tumours of abnormal for-
mation, similar to such as occur in other parts of the body, to aneu-
risms, to abscesses, to aeriform tumours, ccc. It is not surprising,
therefore, that tumours should be more common in this than in any
other region of the body. The diagnosis of these tumours, although
generally easy, is in some instances obscure. Yet it is always im-
portant, inasmuch as on it must depend the treatment to be instituted.
We meet in this region, enlargements, acute and chronic, of the
parotid, sub-maxillary and suh. lingual glands, of the lymphatic glands,
and of the thyroid body. The affections of the salivary glands, as
well as of the thyroid body, arc readily recognized by their position,
which is fixed and superficial ; whilst those of the lymphatic glands
may be sometimes confounded with other tumours. Simple abs<
of the cellular tissue are not always easily distinguished from those
acute glandular enlargements which run on rapidly to suppuration.
Yet the diffusion of simple abscesses contrasts strongly with the more
circumscribed limits of suppurating glands. The diagnosis is much
more obscure in relation to chronic enlargements of the lymphatics,
for these being frequently deep-seated, may simulate aneurism, schir-
rus, and the various forms of malignant carcinoma. If situated near
the carotid artery, they may partake of its pulsations to such a dc-

39

514 Remarks on Tumours of the NecJc, <^c. [September,

gree as to be mistaken for an aneurism ; but by auscultation, carefully
made, the peculiar whizzing sound of aneurism will not be detected ;
nor will the volume of the tumour be affected by pressure of the
carotid below, as frequently occurs in cases of aneurism. Chronic
enlargements of the lymphatic glands generally differ from schirrous
and malignant tumours in being more symetrical, of an oval form,
in presenting a smooth surface and uniform consistence, and in being
usually exempt from any other pain than that consequent upon pres-
sure of surrounding tissues, larynx or trachea. But tumours of the
lymphatic glands may recognize a purely sciofulous diathesis, or pre-
sent a tendency to malignancy more or less marked ; and it is here
that our means of diagnosis are most unsatisfactory. If there be a
number of them, or more than one, in the same patient, the proba-
bility is very strong in favor of their scrofulous origin ; but if there
be but one, and there be no other indication of scrofula, we know of
no certain diagnostic symptom or sign, by which we may pronounce
positively upon its real nature. Hence the wise recommendation of
all prudent authorities, to endeavor to discuss such tumours before
resorting to the knife, unless they be presented to us at such an ad*
vanced stage as to render extirpation necessary to relieve the patient
from the bad effects of their pressure. The failure of the ordinary
constitutional as well as local discutients, furnishes us then the only
means by which we may infer the true nature of such tumours; and
the sooner they are energetically resorted to, the sooner will the pro-
priety of extirpation be ascertained. We are aware that, in view of
the danger of all operations in this region, especially by unpracticed
hands, it is insisted by some that extirpation should always be
deferred until necessitated by pressure of important parts. But
when we reflect that the danger is increased in a direct ratio with
the volume of the tumour, we must regard it the duty of the surgeon
to operate as soon as he has ascertained that it cannot be dispersed.
By procrastination we are satisfied that many cases have terminated
fatally which would have otherwise been treated with success. We
have present to our mind a striking illustration of this, in the case of
a man who had thus been advised to defer submitting to extirpation
as long as possible, until, finally, being threatened with suffocation,
he came to the city to request us to remove the tumour, but died the
night of his arrival.

Having premised these general remarks, we now proceed to offer a
few cases, not only to elucidate the diagnosis of tumours of the kind

1846.] Remarks on Tumours of the Neck^'C. 515

last referred to, but also to furnish their pathological anatomy, which
has not been often correctly recorded, and to urge their early extir-
pation.

Case I. Rosetta, a negro woman about 25 years of age, in ap-
parent good health, consulted me in April, 1840, in relation to a
tumour about the size of a walnut, situated in the triangular space
just above the upper end of the sternum, and between the sternal
attachments of the sterno-cleido-mastoideus muscles. It had been
gradually increasing two or three years, was the seat of no pain, but
now occasioned considerable annoyance from its pressure on the
trachea, especially at night. It was just beneath the skin, was not
painful on pressure, nor very firm to the touch, and could be moved
as though it were attached only at the extremity contiguous to the
thyroid body. Indeed it resembled very much a prolongation of the
lower portion of this body. The patient was put upon the use of the
usual discutients, without any effect whatever, until the 14th of July
following, when I proceeded to extirpation. This was done in the
usual way, and offered no other difficulty than that of arresting con-
siderable hemorrhage from the nutritious artery which had not been
ligated during the operation. The cellular tissue between the tumour
and the thyroid body was very much condensed, and difficult to divide
W'ith the blunt instrument used. The wound healed kindly, and
there has been no return of the disease since.

Case II. Minny, a colored woman about thirty years of age, had
a tumour situated precisely in the same locality as that of ihe case
just related, and presenting the same peculiarities, with the excep-
tion that it was movable in all directions. It had been increasing
for four or five years, during the last of which I occasionally saw the
patient, and advised the use of the preparations of iodine, &c, local-
ly as well as internally. The treatment proving of no avail, I re-
moved the tumour on the 4th June, 1845.

Case III. Mr. A. D., 20 years of age, presented himself to me
with a tumour about the size and form of a turkey's egg, and stated
that it had been growing upwards of two years, had never been pain-
ful, had been treated with iodine, &c, in Pennsylvania, and that no
remedy ever seemed to exert the least influence over it. It was
situated deeply beneath the belly of the right sterno-cleido-mastoideus,
projected beyond the anterior and posterior margins of this muscle,
was movable in all directions, and partook so strongly of the pulsa-

516 Remarks on Tumours of the Neck, <$fc. [September,

tions of the carotid artery with which it was in contact, that it resem-
bled very much an aneurismal tumour of this vessel. It was impos-
sible to compress the carotid below it sufficiently to suspend the pul-
sations, but no whizzing sound was heard by auscultating the tumour,
nor could its volume be diminished by compression. It was decided
to be a glandular tumour, and extirpated June 4th, 1846. An inci-
sion five inches in length was made along the anterior margin of the
sterno-cleido-mastoideus, the external jugular vein being carefully
avoided, the tumour exposed and detached by means of a scalpel
handle, and finally removed after ligating three small vessels. A
length of two inches of the carotid artery, or rather of its sheath,
was exposed to view. I succeeded without dividing the sternal
attachment of the muscle, as I had apprehended might be necessary.
By giving the neck a proper position, the muscle was readily drawn
aside with the bent handle of a tea-spoon, which I use in preference to
the bent spatula, as having a less cutting edge. The sides of the wound
were brought together with adhesive strips, but owing to the great
size and depth of the chasm, as well as the movements of the larynx
and neck, although the edges adhered by first intention, a slight sup-
puration occurred beneath and continued until the ligatures came
away.

The anatomical peculiarities of the three tumours in question,
being identical, the description of the last will apply to all. On ex-
posing the tumour it was found enveloped in the proper investing
membrane of the gland, which though generally very much thick-
ened, was not uniformly so, for the surface of the tumour presented a
number of small prominences which were transparent and contained
a viscid lymph-like fluid. The transparency of these resulted from
the thinness of the coat at these points, which seemed on the eve of
being ruptured. In some places these prominences were small cysts;
in others a number ofthem communicated with a larger and common
cavity, so that in plunging the hooks into the tumour for the purpose
of aiding its removal, a quantity of the fluid would escape. The
nutritious vessels of the tumour were few in number, and so small
that no ligature would have been deemed necessary in a locality
more remote from the heart. In the first case, it was only some
hours after the operation that a ligature was applied : in the second
none were used ; and in the third they were applied more as precau-
tionary measures than because of their size. On laying open the
tumour, no lymphatic nor blood vessels could be distinctly detected ;

1846.] Injury of the Foot, $c. 517

its cellular element was greatly hypertrophied and disposed in thick
shreds, between which were to be seen many of the cysts above
described, some of which contained a dark grumous matter; also
tubercular matter of a cheesy consistence, both white and brown.
In some places the cellular tissue was so condensed as to approximate
to the schirrous character. The tumour of the first case was that in
which was found the greatest quantity of the dark grumous matter,
notwithstanding it was the smallest. In neither of them was there
any trace of pus, nor was there any evidence of inflammatory action
in the surrounding cellular tissue, nor in the super-imposed skin. Yet
the appearance of all was such as to lead to the belief that had they
remained much longer, their capsule must have been ruptured, and a
malignant disease established in the adjacent ^issues. We deem it
fortunate, therefore, that their extirpation was not longer deferred,
and hope that this slight contribution to the periodical press may point
out the importance of an early resort to the knife in all such cases.

ARTICLE XXXIII.

Injury of the Foot, followed by anomalous constitutional symptoms.
By Wm. Williamson, M. D., of White Plains, Alabama.

On the 14th of June, 1842, I was called to see Mr. A. N , of

this State : he was probably about 30 years of age ; of robust consti-
tution, fair complexion, light hair, and by occupation a farmer. He
gave me the following history of his case : Some years previous to
1842, he wounded his foot with an axe, dividing it obliquely nearly
the whole length, and injuring some of the bones. The wound healed
up, leaving a lameness of the foot, which would become painful if he
walked much, or wore a tight boot, and it would sometimes become
swollen and inflamed. He informed me that eight or ten days pre-
vious to the time I was called in, he had worn a new shoe on his foot
two or three days ; that it compressed it very much, and afterwards it
became quite painful and swollen, and for the relief of which he used
a variety of means, as bathing, poultices, &c. ; that these appli-
cations did not subdue the inflammation, hut that it ran on until
suppuration took place, and he had it lanced. When I saw him the
foot and leg were greatly enlarged; they were of a dark red color,
approaching to a purple, very painful, and tiie whole system was

518 Injury of the Fool, <fyc. [September,

very irritable, with daily exacerbations of fever, loss of appetite, and
nausea. There was only one opening into the abscess, which dis-
charged a bloody purulent matter. I ordered such medicines as the
constitutional symptoms seemed to require the abscess to be inject-
ed with tinct. myrrh, and the foot and leg to be enveloped in a
poultice of elm and dogwood barks.

19th. I found other places required to be opened. The anterior
part of the foot, to within about an inch of the ankle, was one large
abscess, involving the bones and running in sinuosities in various
directions, so that a probe could be passed in among the bones,
which felt rough as though deprived of their periosteum. The foot
and leg were still greatly swollen and of very dark color; the dis-
charge from the abscess was thin and sanious, with no healthy suppura-
tion. There were daily paroxysms of fever, followed by profuse per-
spiration, and occasionally there was delirium. I ordered solution of
super-acet. plumb, with spts. camph., to be kept constantly applied
over the whole of the inflamed part, and the poultice over this ; con-
tinued the injections into the ulcer, alternating occasionally with the
lead solution. The patient to take cinchona pulv. with elixor vit.,
and nourishing diet.

21st. The symptoms are worse, with greater appearance of
gangrene. The whole of the cuticle, on the under surface of the
foot, as far as the abscess, had extended, separated, with some
sloughing, and no improvement in the discharge from the ulcer.
Ordered an injection of vegetable caustic (prepared from the ash bark)
as strong as the patient could bear, to be thrown into the sinuses
twice a day. Opium was given to relieve pain; and the other
directions to be continued.

24th. Great prostration of strength, profuse sweats, no appetite,
with cadaverous appearance of the countenance. The injections
produced intense pain for a few minutes, but had effected a very
salutary change in the ulcer, for it now discharged a quantity of
well formed pus. An increase of the tonics was ordered, with other
directions, as before.

26th. There was less prostration some little appetite ; the swel-
ling is subsiding; the foot has rather a better appearance, and free
discharge of pus continues. Same directions.

From 23th to June 3d. Same treatment. For some days there
have been tumors forming on different parts cf the body, but owing
to the alarming nature of his other symptoms, very little attention

1846.] Dysmenorrhea. 519

was paid to them. They are situated on the thighs, sides, shoulders,
&c, and are about the size of a common walnut, without any disco-
loration in the skin, and very little pain ; but firm to the touch, and
slightly movable. Two of these tumors I opened with a scalpel, and
on the 5th two more were thus treated : they were well encysted
and contained healthy pus. They soon healed after their contents
were evacuated. On the 7th, I omitted the caustic application to the
foot, but found the discharge to become worse, and therefore imme-
diately resumed its use. Other abscesses were opened up to the 23d,
after which my patient steadily improved, and was soon after restored
to vigorous health.

From this time he continued steadily to improve, until he acquired
vigorous health, with the exception of a weakness of the diseased foot.

I cannot but think that the caustic injections, made from the ashes
of the ash-bark, had a very salutary result in the local treatment of
this case. The development of external abscesses was no doubt a
crisis to the constitutional symptoms.

ARTICLE XXXIV.

Dysmenorrhcea. By W. F. Barr, M. D., of Greenville, Tennessee.

In the March number of the "Southern Medical and Surgical
Journal" was published a case of Dysmenorrhcea reported by myself,
which was cured with the Extract of Stramonium, and Prussiatc of
Iron. As it is empiricism to prescribe for a case without knowing
the indications to be fulfilled, and the means by which this is to be
done, it seems proper that I should give my reasons for treating the
disease with such remedies as I do.

In the spring of 1845, I attended a lady who was confined with a
severe attack of neuralgia of the face and scalp, which was suc-
cessfully treated with stramonium and quinine. While in attend-
ance on this lady, she informed me that she had been afflicted with
dysmenorrhcea, for some years and desired I should cure her of the
disease. In a few weeks the catamenia returned; mid much to
her astonishment she did not suffer with pain, as formerly and re-
marked that she was not pained in the hast. This induced me to
reflect upon the pathology of the disease. I then examined the
spinal column, and found the lumbar vertebrae tender upon pressure.

520 Dysmenorrhea. [September,

From the facts in relation to the case, I was induced to believe the
disease to be neuralgia of the uterus, owing to spinal irritation. I
applied a blister upon the lumbar region : to this, and the ext.
stramonium and quinine, which was used for her head, 1 ascribed
the cure of dysmenorrhcea.

A short time before I had been called to attend the case reported
in the Journal. Believing that the cure of the case alluded to, was
to be attributed to the stramonium and quinine, and considering the
same indications to be fulfilled the lumbar vertebrae being tender on
pressure I prescribed stramonium, and prussiate of iron, instead of
quinine. Under this treatment, as reported, the lady was cured.

Several other cases have come under my notice, which yielded to
the same treatment.

From the facts connected with these cases, I was induced to come
to the conclusion that dysmenorrhcea was a neuralgia of the uterus,
from spinal irritation, the paroxysm returning at each menstrual
period.

Believing this to be the true pathology of the disease, the indica-
tions to be fulfilled are the reduction of the spinal irritation, and the
consequent prevention of a return of the paroxysm. The first I have
always effected with blisters; the second with narcotics and tonics,
or anliperiodics. In ail cases of neuralgia, in any part of the system,
I have used extract of stramonium, this I have used in the intermis.
sio?i, with either quinine or prussiate of iron. As carb. of iron has
proven useful in neuralgia of periodical paroxysms, it might prove
useful in dysmenorrhcea.

This opinion of the pathology of dysmenorrhcea may be old to
some, and I may expose myself by saying it was new to me. I
have read many different authors upon the disease, but before I came
to the conclusions I did, I never saw or heard of any one advancing
the opinion, that it was neuralgia of the uterus, until a few days
since, in looking over Dr. Dickson's practice, I find that he has
placed it among the list of neuralgic diseases. He is the only
Physician, or writer I have found, who entertains such views of the
disease. "Whether it be old to others, or new to me, it deserves the
consideration of the Profession.

In the investigation of the pathology of diseases, I must say, in
justice to the able and talented Professor, that my attention was first
drawn to spinal irritation as the source of many diseases, by Doc-
tor Fokd, of the Medical College of Georgia. Many diseases

1846.] Cases of Foreign Bodies in the Air-passages, 521

whose pathology, before, were entirely hidden to my view, are, since
attending the lectures of this Professor and particularly those upon
intermittent fever, very apparent.

ARTICLE XXXV.

Cases of Foreign Bodies in the Air-passages. By Paul F. Eve.
M. D., Prof, of Surgery in the .Medical College of Georgia.

The following cases will illustrate the different plans of treatment
which may be successfully resorted to, in obviating the unpleasant and
distressing effects produced by foreign substances getting into the
larynx, trachea or bronchiae.

Case I. A water-melon seed in the bronchial vomited months after-
wards. In August, 1840,1 received a pressing message to see a son of
Col. C, of South-Carolina, who had accidentally swallowed a seed,
as it is commonly said, the wrong way, i. e., into the wind-pipe, while
eating a slice of water melon. Before arriving at the house, a dis-
tance of 25 miles, the symptoms of suffocation had subsided, and the
patient, a boy of four or five years old, was breathing apparently
quite naturally. As there was no distress or indication for immediate
interference in this case, after examination and consultation with
three intelligent physicians of the neighborhood, it was agreed to
adopt the following course of treatment we could not define the
actual location of the foreign body, but concluded it had passed
through the larynx and trachea, and had been arrested in the bron-
chia? no active plan was to be pursued, unless the symptoms of
suffocation should recur, when an emetic was to be administered,
and if no relief was afforded by it, a second consultation was to be
holden. I heard nothing further of the case until some months after
this, and then learnt that during a paroxysm of coughing, the water-
melon seed had been vomited.

The course here adopted was undoubtedly correct, not simply be-
cause it was successful in the end to the removal of the cause threat-
ening life, but justified upon sound principles in surgery. The
foreign body in this instance was innoxious, at least it possessed no
active agency in exciting inflammation. It simply was an error
loci, and in this consisted the whole danger. Now a sufficient num-
ber of cases have proven that when the substance has passed through

522 Cases of Foreign Bodies in the Air-passages. [September,

the air-passages down to the bronchia?, is not acrid or poisonous in
its nature, when it does not produce immediate and distressing
symptoms, it may be left to the spontaneous efforts of nature for its
removal. And when we do operate, it is not because a foreign body
exists in the respiratory organs, but we are alone justified on account
of the urgency of the symptoms. This we hold to be the true prac-
tice in these accidents, and it is now sanctioned by experience.

Case II. A half -dime in the Larynx removed by Inversion of
ihebody and Coughing. Mr. L., a well-known painter, of this city,
came in great distress, (nearly three years ago,) into my office, to
consult me about a five cent piece which had gotten into his wind-
pipe. While amusing his children a la Brunei, (or rather, the
celebrated engineer after him, for my patient claims priority of
date,) by tossing up a half-dime into the air, and catching it
in his mouth, it suddenly, and to his surprise, dropped into the
larynx. At each respiration the foreign body could be heard
impeding that function, and its situation marked distinctly in
the upper part of the thyroid cartilage, about the laryngeal pouch-
es. I advised Mr. L., before adopting other treatment, to place
himself upon a bed, crawl out upon his hands, making his head the
most pendent part, and then to have cough excited by a blow on the
back, between his shoulders. To his great gratification, at the first
effort, the piece of money was dislodged from its unnatural position,
and at once transferred, if not to as secure, at least to a more agree-
able receptacle.

Case III. A water-melon seed in the Larynx Laryngotomy
successfully performed for its removal. The 21st August, 1845,
Annette, belonging to Maj. G., was brought by her mother to my
bouse, having a water-melon seed in the larynx, which she had at-
tempted to swallow a few moments before. She was two years old,
and, like children of her age, was very fat. A paroxysm of suffoca-
tion had just subsided when she was brought in. and as the symptoms
were not very urgent, and the physician of the family to whom the
child belonged was not present, I gave an emetic to the mother, with
directions that while vomiting she should place the head of the patient
in a pendent position. A paroxysm had occurred, and the emetic
affording no relief, I again saw the child at 8, P. M. of same day.
She was now asleep, and on consultation, it was thought best to
wait and take the advantage of day-light for the operation.

At 7, A. M., 22d, the child had passed a restless night, and the

1846.] Cases of Foreign Bodies in the Air-passages.

respiration being now laborious, with an irregular rhonchus, the op-
eration of larynxgotomy was decided upon. Some embarrassment
was experienced in performing it, owing to the obesity of the little
patient, her distress, the shortness of the neck, and a considerable
venous hemorrhage. This latter, however, instantly ceased as soon
as free respiration was established thrjough the opening made in the
crico-thyroid membrane, and during a violent expiration, assisted by
a probe in the larynx, the water-melon seed was expelled through the
mouth.

The wound was dressed by adhesive plasters, but during the
treatment I had reason to regret not having used sutures. At 4, P.
M., the patient had some fever, and for which she took salts and
nitre. Understanding too she had probably worms, a saline injection
was ordered at G, P. M.

23d. Is sitting up. The plasters having become loose fresh
ones were applied. Only a small quantity of air was observed to
pass out of the artificial opening, and that only during forced expira-
tion. The medicines have operated, and the fever is lessened.
Diet, to be moderate.

24th. The breathing is somewhat impeded, and her voice is
hoarse. The weather still continues damp.

25th. Found no union in the wound of the skin, while a small
opening still exists in the larynx. A suture was now applied in the
centre of the incision, through the skin. The patient has symptoms
of worms, hut is at times quite cheerful.

Sept. 2d. There has been but one fair day since the operation.
The wound has been djressed every day, and there has been no
union by the first intention. It is now healing slowly by granula-
tion.

6th. Have had to administer calomel, oil, turpentine, and then
decoction of pink root, for worms. Several were evacuated, and on
the 8th I discharged my patient, entirely well.

I have frequently it-tn Annette since, and remarked the depressed
cicatrix over the larynx. The union was effected by granulation
alone, and only alter the weather proved favorable.

It wiil thus be seen that in the treatment of these three cases a
very different course was pursued, regulated by the effects produced
by the foreign body in the air-passages. One was left to the spon-
tan la of nature; the second was assisted by a very simple

devise, suggested years ago, and not as the recent English Journals

524 Observations on the use of Quinine, <fyc. [September,

would have us believe, was first brought into successful practice in
the case of Mr. Brunei ; and in the third case, an opening was
made into the wind-pipe. There is yet a fourth plan, which under
favorable circumstances has succeeded in a few cases, and that is
after tracheotomy has been performed, to attempt to remove with
forceps the foreign body lodged in the bronchiae. Should free and
active emesis, inversion of the body and striking between the shoul-
ders while in this position, fail, and the substance introduced be of a
poisonous nature, then this hazardous operation may be resorted to,
but with no great prospect of success.

PART II. REVIEWS AND EXTRACTS.

Observations on the use of the Sulphate of Quinine in Remittent and
Intermittent Fevers, as they occur in Cleveland, Ohio. By George
Mendenhall, M. D., of Cincinnati, Ohio. (From the American
Journal of the Medical Sciences.)

It is unnecessary here to insist upon the fact that the proper ap-
plication of the sulphate of quinine in remittent and intermittent
fevers is a matter of great consequence. The subject has attracted,
and is now attracting, the attention of the profession throughout our
country ; and although the reports appear to be somewhat discrepant,
they may be reconciled by the circumstances which attend the ad-
ministration of the article, differing in the various sections of our
widely. extended territory.

While the direction for its exhibition in southern fevers maybe
entirely applicable to the disease as found in the south, they may
not be appropriate to those of more northern latitudes. On the other
hand, the rule of practice founded on northern observation may be
fatal when applied to the southern fevers ; so much are the condition
of the system and disease modified by climate. It is only by being
furnished with data from different portions and localities, widely dis-
tant from each other, and variable in regard to local conditions, that
we can hope to arrive at correct conclusions.

So far as my own observation has extended, and from reliable re-
ports, I think there can be no doubt but that different localities, and
different seasons vary the condition of disease, in such a manner that
it is necessary to vary our remedies to suit these particular changes,
and that the proper use of the sulphate of quinine is not an exception
to this rule in its applicability to remittent and intermittent fevers.
The reports, therefore, of southern practitioners respecting its use
in southern malarial fevers ought to be received with great caution,

18-16.] Observations on the use of Quinine, $c, 525

and with some qualification when we attempt to applv their treat-
ment in cases occurring in more northern regions. Upon their au-
thority the tendency of the profession at the present time is strongly
inclined towards the adoption of their practice without regard to
locality, latitude, or the epidemic constitution of the season. But
little has been published in the north on the subject, and from this
fact it is inferred that thesj southern precepts are of universal appli-
cability, which, in my opinion, is a very serious error. From eight
or nine years' experience in a northern malarial district, I do not
hesitate to say that the directions for the use of quinine as adopted
by most southern practitioners, and in some instances by the north-
ern, on the authority of their southern brethren, are seldom proper
or called for in northern fevers, either in regard to the period of its
use or in the quantity of the article administered. That there are
cases in the south, and a vast majority perhaps of them too, which
will admit of its early application, without much if any preparation,
and may even demand it, and also in very large doses. lam not dis-
posed to deny : yet this does not prove its universal adaptation to all
cases of malarial fevers, and under all conditions.

For the purpose of illustrating these differences. I will attempt to
describe the form of remittent and intermittent fevers, and their pro-
per treatment, as they occurred in Cleveland, Ohio, and its neighbor-
hood, from the year 1835 to 1843. inclusive of the years named.

This place is situated on the southern shore of Lake Erie, at the
northern termination of the Ohio canal, and at the mouth of the
Ciusahoga river.

Without describing particularly its topography, I will merely state
that the causes which are generally supposed to be productive of
remittents and intermittents exist here to a considerable extent, and
they are very common diseases, particularly in the months of July,
August, September, and October. In addition to low stagnant
marshes and a sluggish stream, the hills are being cut do#n in making
streets, whereby large quantities of comparatively recent deposit are
exposed, and which is one fruitful source of disease.

It is said that while the canal was being made in 1827 and 1928, a
fever prevailed of unusual fatality, carrying off large numbers of the
workmen and the old citizens of the place. Of the particular char-
acter of this fever I am uninformed, except that in f a t a I cases it seldom
continued more than four or fixe days. Whether this was a form
such as occurs in southern lattitudes and could have been cured by
quinine, I cannot, therefore, saw

I am not aware that the fevers of Cleveland differ in any respect
from those which occur in the northern part of the State of Ohio
generally and in the State of Michigan, except tiiat, perhaps, the
malarial influence may act with more power and concentration at
some localities than it does at Cleveland.

Symptoms. The attack of autumnal fevers, as they occurred
there, were generally ushered in by an irregular chilliness, often

526 Observations on the use of Quinine, fyc. [September,

accompanied by heat of skin at the same time ; pain in the head and
loins; thirst; anorexia; an indescribable feeling of malaise; costive-
ness in most cases; often slight tenderness over the region of the
liver; eyes mostly somewhat injected, with a yellowish tinge of the
conjunctiva; skin often of a yellowish hue ; and the urine scanty
and high-coloured. These were the usual symptoms in the forming
stage. On the following day they were sometimes followed by a
distinct chill, fever, and sweating stage, without any violent or pro-
tracted .symptoms of congestion ; although during the hot stage there
existed severe pain in the head and loins, and sometimes delirium.
The fever sometimes passed off almost entirely after the sweating
stage, but not always; occasionally there would remain a dry, furred
tongue, headache until the following chill, either on the next day or
the day succeeding. In other cases the (ever continued with a more
or less marked remission, without any distinct chills. Generally the
exacerbations occurred in the afternoon and evening ; they were not,
however, always regular, sometimes occurring in the morning, and
sometimes twice a day. The thirst was seldom absent before treat-
ment, even when there was a diminution in the heat of the skin, and
in the force and frequency ofth'e pulse, although it might have beerr
somewhat abated. This fact of the continued presence or occasion-
al absence of thirst we considered always important in influencing
us in the use of the sulphate of quinine, in all the different stages.
During the first two or three days of this last or remittent form, its-
type might have been changed in many instances to the intermittent
by venesection, (which was generally demanded by the local deter-
minations to the head, liver, or mucous membranes,) and by the use
of active mercurials, followed by saline cathartics. Frequently, for"
a iew days the symptoms were such that it was impossible to deter-
mine which form would be developed, as there might exist irregular
chills, fevers, and even the sweating stage ; but with the dry tongue,
thirst, headache, and other febrile symptoms continuing.

Here it was that the course of medication often determined the
result, whether the intermittent, remittent, or continued forms would
be developed.

The intermittent, when distinctly marked, could, almost without
exception, be cured very easily by a proper course. Neither were
the remittents often attended with a fatal result, unless from some
cause or other they were changed to the continued. I have occa-
sionally seen cases of the remittent attended with a severe pain in
the bowels or some other part, which assumed a regular periodicity,
occurring at a particular hour every day. These cases would bear
the use of quinine sooner than those where the periodicity was not
so well marked. In the remittent form, as the disease progresed,
unless influenced by proper treatment, the local determinations be-
came more evident. The fever, also, became more continued, or
marked with a slighter remission, unless we succeeded in obtaining a
more perfect remission, in which case the tongue was cleaner and

1846.] Observations on the use of Quinine, $c. 527

more moist, the secretions from the bowels were improved, and the
sulphate could generally be tolerated. Those cases that ran into a
more continued form of fever, were seldom, if ever, characterized by
a distinct crisis. The disease went gradually on until it had acquired
its height, and then receded in the same manner, when it termina-
ted favorably so gradually that it would be impossible to say precisely
when a change for the better did take place. The improvement
might be first manifested by a change in some one function, whilst
the rest of them remained diseased, which rendered it extremely un-
certain whether there was any real change towards convalescence
or not. It was not, therefore, until we found several of the functions
resuming their healthy activity that we could confidently say a
crisis had taken place in the disease. I do not recollect a single
case which was marked by a clear and distinct crisis or critical dis-
charge of any kind.

Treatment. As the use of the sulphate of quinine in the treatment
of these fevers was so intimately connected with the other means
used, each of which had its appropriate application, I must be per-
mitted briefly to detail the course we generally pursued.

The sulphate of quinine formed a very important item in their
management, and could not be dispensed with ; but in very few-
cases could it be relied upon as the only treatment.

Venesection. In a majority of cases this was borne well, and, in
fact, was often clearly demanded, but in some seasons more than
others. It generally produced an abatement of the feeling of fullness
in the head and liver, as well as afforded some relief to the feeling of
oppression which was felt throughout the system generally. Atter
its employment emetics were better borne; cathartics operated more
freely and affected the secretions more favorably. I am fully per-
suaded, also, that it was a powerful means of changing the remittent
and doubtful forms of attack into the more favorable condition of
intermittents. It hastened the period of remission and intermission
and of course sooner brought about the time when the sulphate could
be used without risk of producing, or aggravating if they existed,
those local inflammations which have always to be guarded against
in treating our northern fevers. If these local inflammations had
already commenced, it was one of our most powerful means in re-
ducing them, without which the use of quinine would be extremely
hazardous. The extent to which it was found proper to carry this
remedy was to produce a decided impression, and to do this it was
sometimes necessary to repeat it.

Local bleeding. This was al<o found very beneficial in lessening
the effects of, and removing local determinations. It appropriately
followed the general use of blood-letting ; and when, perhaps, in
debilitated subjects, the general abstraction of blood was inadmissible,
this form could always be used when any symptoms existed calling
for its employment. Cups were in most cases preferable to leeches.
Emetics. These were applicable frequently in the early stages of

528 Observations on the use of Quinine, <fyc. [September,

the attack, and could he used advantageously, but they were often
omitted, and could be dispensed with in most, if not all cases. I have
not myself been in the habit of using them much, from a prejudice
which I contracted against them from witnessing the unfortunate
and fatal effects of a large dose of tartarized antimony, but I am not
aware that I have been any less successful than other practitioners
have been. I frequently used emetic substances in nauseating doses
in combinations which will be spoken of under another head, and
have thought that the effect upon the secretions was quite as well
marked and as beneficial as if given in full and decisive doses.

The effect of long-continued nausea in reducing the force of the
pulse, equalizing the circulation, determining to the surface, and
acting upon the secretions, is a very powerful means of reducing
disease, when properly adapted to the case. The use of tartarized!
antimony as a depressing agent is second only to the use of the
lancet; and it is one of our most powerful auxiliaries in the treat-
ment of a portion of the inflammatory diseases we are called on to
manage.

Cathartics. It appears to me to be difficult indeed, if not impossi-
ble, to succeed without the use of cathartics in this class of diseases,
in some stage or other, in any climate, whether north or south. Dr.
Porter, in noticing them in his very judicious and able report in refer-
ence to southern fevers, says that "they are always beneficial;'''
they are particularly so in these forms of which we are speaking,
and in fact were indispensable to success. When constipation ex-
isted there was no substitute for them, and in fulfilling the indica-
tions of correcting the secretory action of the liver, and the removal
of irritating secretions from the alimentary canal, a proper selection
from this numerous class was always necessary. They also acted as
depletant to the general system, equallized the circulation, and were
useful in relieving and removing local congestions and inflamma-
tions. The form of their administration, which we often found use-
ful, was the following prescription: R. Hydr. chlor. mit. gr. x;
Tart, antim. gr. ss ; Nitr. potassae 3ss; div. in chart, iij. M. One
to be taken every third hour, commencing generally at six o'clock
P. M. This should he followed by castor oil on the following morn-
ing sufficient to operate actively on the bowels. The effect of this
was to produce, almost universally, dark-coloured stools, characteri-
zed as bilious; in fact, in many cases the discharges consisted of a
large admixture of nearly pure bile. The evacuations from the liver,
as well as the corrected state of the secretions from it, effected by the
mercurial, very soon produced a change in the appearance of the
conjunctiva and skin, with an amelioration of all the symptoms in
most cases. When the inflammatory symptoms were not so high.it
was proper to substitute for the nitrate of potash and tartar emetic,
the Dover's powders. This last combination was frequently very
proper, hecause it often had the effect of allaying the general irrita-
bility of the system and disposing to a quiet sleep with a gentle per-

1846.] Observations on the use of Quinine, <$fc. 529

spiration. In these combinations it will he perceived that by the
manner which the mercurial was administered in divided portions,
and allowed to remain in the stomach for ten or twelve hours, the
alterant effect upon the secretions was more fully secured than if
pureed off" immediately, by union with a more active cathartic. The
diaphoretic effects of the other part of the prescription are also more
certainly produced by the continued manner of its exhibition, and by
being given during the usual period of rest ; at which time it is pro-
bable that its influence will be exerted more favorably on the skin.
This form of ad ninistering mercurial cathartics I prefer to giving
them simply with the view of the immediate cathartic effect. I think
when we administer the more active cathartics a few hours after this
course, that the operation is much more free, and the effect on the
secretions more satisfactory than when given together. But free
active purging was indispensable, and when properly applied seldom
or never did harm. Where the bowels were irritable, an anodyne
was proper ; it first lessened the irritability of the mucous membrane,
and coincided in its effects with the cathartic in producing a more
healthy secretion from it. Cathartics were always indispensable in
remittents, and primary attacks of intermittents, in preparing the
system for the use ofthe sulphate of quinine, at least to permit us to
get the full and entire benefit of it, both as to its immediate safety,
and its permanent beneficial effects on the system. This part of our
subject will be alluded to again when we speak of the particular ap-
plication of quinine, which will he done more at length in the latter
part of this paper. This cathartic, alterant and diaphoretic course
was, as a general rule, continued for two or three days; and in fact
was found necessary before the secretions were sufiiciently restored,
and the local determinations removed, so as to permit the use of this
invaluable remedy, after which they were occasionally called for;
but a repetition of the mercurial was seldom necessary. When it
was, the blue mass would answer all the purposes we wished, and
was properly used with the quinine when indicated. In the use of
mercurials it was always proper to avoid ptyalism, although a very
slight aclion on the gums appeared sometimes to he useful in effect-
ing a favourable change in the disease. I am. however, strongly in-
clined to the belief that its slight aclion on the gums is merely an
indication that the system has responded to the action of the medi-
cine, or that a genera! impression has been made by it upon the secre-
tions, and is not in itself of any importance in a curative point of view.
In the very able essay on remittent fever published in this Journal
for April, 1842, by Dr. Stewnrdson, it is stated that he generally
relied upon the blue mass in rather small doses as a mercurial in the
fevers which he treated in the Pennsylvania Hospital. It may have
been quite sufficient in these cases, but I think the etf-cts of calomel
in medium dose neral rule, are to be preferred. Some of his

cases had taken calomel, however, previously to their admission into
the hospital, and in these there was less need for its use.

84

530 Observations on the use of Quinine, <fyc. [September,

Diaphoretics were almost always necessary in placing the system
in a proper condition to bear the employment of quinine ; and as we
have before stated in speaking of cathartics, they were appropriately
combined with them in the early part of treatment. It was also often
necessary to continue them after we had used cathartics freely, when
the tongue remained dry, and the skin hot, with thirst, pain in the
head, and full or quick pulse. In selecting a diaphoretic it was
necessary to be governed by the condition in each individual case,
whether we used antimonials, ipecac, the saline diaphoretics, or the
sweet spirits of nitre. When these were continued until the tongue
became moist, and showed a commencement of cleaning, we could
use quinine profitably, but not until then.

The appropriate use of alterants was often necessary after we had
used them in conjunction with cathartics, and in these cases they
were combined with diaphoretics.

Revulsives. They were often necessary when there were local
determinations or pain in any particular part of the body. Cupping,
blisters and sinapisms were generally used.

Opium, in its various forms, was often useful in allaying irritability
of the bowels when it existed, and in preventing the calomel from
passing off, before it had time to act upon the secretions. It also
favoured the action of diaphoretics, allaying the irritability of the
system, and promoted natural rest, unless, perhaps, in some few
cases, where from constitutional peculiarity, or the particular condi-
tion of the brain, it might have had a different effect. It always
operated better after the employment of the lancet, in cases admitting
of depletion. Very frequently this remedy was found useful conjoin-
ed with quinine ; and sometimes quinine could be given with Dover's
powders or sulphate of morphia advantageously when the propriety
of its use, without this combination, was extremely doubtful.

Diet, drinks, 6fc. In the remittent form there was very little
disposition to take nourishment of any kind before convalescence
took place, after which mild farinaceous articles were found most
proper until the lapse of a few days, when the lighter kinds of animal
food might be used at first, and succeeded by those of a more stimu-
lating description. The premature use of animal food was very apt
to produce a return of fever, and its consequences; and sometimes
the relapse would be very tedious, resulting in a continued form of
fever. In the intermittent there was seldom any disposition to eat
in primary attacks, but occasionally a case of some standing occurred
where the appetite was voracious between the paroxysms. The
drinks proper were the mild mucilaginous preparations, such as
barley-water, rice-water, slippery elm-water; and, in some cases,
warm thin gruel would tend to produce an action of the skin that
was beneficial. The acidulated drinks were also very grateful to
the patients in allaying thirst and fever ; of these cremor tartar dis-
solved in water, with or without sweetening, lemonade, tamarind
water, &c, were used. Acidulated drinks should, however, always

1846.] Observations on the use of Quinine, tyc. 531

be avoided while patients are taking calomel or any mercurial, as
they are very apt to cause salivation. I have known profuse and
severe salivation produced merely by taking castor oil in a little vin-
egar and water, a Caw hours after taking calomel. Of all drinks,
cold water, and even iced water, appeared to be the most grateful,
and I did not hesitate to allow it in small quantities, (one swallow at
a time.) often repeated, say every ten minutes, while I was using
mercurials. When the thirst was very great and this frequent swal-
lowing of small portions did not allay it, I would permit the patients
to take cold water into their mouths, retain it for a short tin*e and
then eject it. In this way much could be done in allaying thirst.
So far as I have noticed the effect of cold water in producing ptyal-
ism while taking mercury, depends upon the use of large draughts
of it, while it may be taken in small partions, as above, without much
if any danger. At any rate I have been in the habit of allowing it
in this manner, and I do not now recollect a single case of ptyalism
from its use.

Quinine, I will premise the remarks I have to make on the use
of this remedy by stating that the fevers of this region are mostly of
an intermittent and remittent character, with some cases of the con-
tinued type, and they are often changed from one of these to another.
These different forms exist also from the distinctly marked intermit-
tent to the continued, in such gradation that at the connecting point
it is impossible to say certainly to which of them it belongs ; this is
the case particularly for the first four or five days. As before stated,
the form which is ultimately developed very often depends upon the
treatment pursued. In the employment of quinine great care was
necessary in regard to the time of its commencement, and in the
preparation of the system for it, and it was a nice point to determine
when it could be used with benefit.

As a general rule a depletory and cathartic course was necessary.
These, with the other means which have been mentioned, had to be
continued until a decided remission or intermission in the febrile
action should take place, unless the system became too much redu-
ced to bear them further. When the periodicity was well marked
and the tongue began to clean, quinine could be borne, and almost
invariably with advantage. The quantity which we have been in
the habit of giving during an intermission or distinct remission was
from ten to fifteen grains, dividing it into about five equal portions,
and watching the effects of each dose (which were given about two
hours apart.) until after the administration of the firs;; two or three.
When perspiration followed its use there could be no question of the
propriety of its exhibition, and the result was then in all cases satis-
factory. On the other hand, when the skin became drier with in-
creased heat, increase of thirst, cephalalgia and delirium, we did
not dare to proceed with it. Occasionally it could with great cer-
tainty be predicted whether the results of its employment would be
favorable or unfavorable ; but, as a general rule, if wc were unable

%

532 Observations on the use of Quinine, <SfC [September,

to see the patient after the remedy was commenced, it was necessary
to leave provisional directions in regard to its continuance. If the
quinine was borne, it was seldom necessary to repeat it on another
day in intermittents, as it scarcely ever failed in arresting the parox-
ysm. If it did not, the febrile stage of the paroxysm generally ran
higher; but the next could be easily interrupted by a repetition of
the same course with almost absolute certainty, and even without a
repetition of the remedy the paroxysm would seldom return. In
remittents we had to proceed with great caution, the effects had to be
more closely watched, and when the remedy was borne, a longer
use of it was necessary, but generally in smaller doses. Our experi-
ence in cutting short remittents was not near so satisfactory as it
was in intermittents.

Patients are generally very anxious to have the paroxysms broken
up, and it is therefore desirable to commence the use of quinine as
early as possible. When doubt existed as to the propriety of using
it, it might often be given combined with some diaphoretic ; and of
these the sweet spirits of nitre is one of the best, if not the very
best. I always use it unless there is the most perfect certainty that
quinine will be tolerated without the unpleasant symptoms spoken
of. I was first led to its use by the recommendation of Professor
Chapman, in his lectures ten or eleven years ago, and I have been
highly gratified with the result. I am confident that I have, by con-
joining it with quinine, broken up cases ofchills and fevers, in feeble
and debilitated patients particularly, where the febrile stage ran on
without any great abatement until the commencement of the suc-
ceeding chill that must have succumbed to the effects of the repeated
paroxysms. But in these cases the preparatory treatment had been
instituted, the fever was moderated, the tongue was somewhat clean-
ed, the secretions were generally more or less restored, and the only
indication remaining to be fulfilled was the interruption of the debili-
tating paroxysms. It was these paroxysms which were wearing the
patient out, and not the local determinations, for they were removed.
This combination of a diaphoretic with quinine often has the happiest
effects; it appears to determine in a great measure the excitant
effects of the quinine to the secretory action of the skin, and what
under other circumstances might have produced dryness and heat of
the surface results in a profuse perspiration like the sweating stage of
an intermittent. Here, instead of coinciding in its effects with the
disease, a crisis is forced upon it, and the train of morbid associations
is broken up.

The dose which we have mentioned never disappointed us in our
expectations of its effects when it could be tolerated, and we there-
fore considered that its employment in larger quantities was at least
unnecessary if not injurious.

When it was used before the system was prepared for it, the
danger consisted in converting an intermittent into a remittent or
continued fever, and in the case of remittents there was great liability

1846. J Observations on the use of Quinine, djfc. 533

of their being converted into the continued form. In such cases we
had inflammatory determinations to the brain, and other local inflam-
mations. The fever thus converted into the continued form was
with great difficulty controlled by medicines; the local determina-
tions were developed or increased; the patient would not generally
bear the use of the lancet, and our hands were in a great measure
tied. I am confident that I have seen cases conducted to a fatal
termination by the too early use of quinine, which in all probability
might have recovered by the use of other means. In that region we
seldom or never had cases of the sudden and alarming character
which we have reports of from the south; few or none ever died in
the paroxysm, but when death did take place it was nearly always
from a continuance of the fever, and from the local inflammations
that were developed during the progress of the disease; and unless
there was well-marked periodicity, the use of the sulphate of quinine
generally did harm.

The reports of southern practitioners are opposed to this course of
treatment and these views, which they characterize as "behind the
age." They claim to be correct, which doubtless they are when
their treatment is applied to southern fevers, or even to fevers more
northern, when they are characterized by the peculiarities of those
fevers, instances of which are described by my friend, Dr. Parry, of
Indianapolis, in the July number of this Journal for the year 1843.

It might be an important inquiry to ascertain whether even these
forms might not be cured with smaller portions of the medicine ; but
it is an inquiry I cannot soK'e. Medicines should be administered
with a view to a particular object, to fulfil an indication or indica-
tions, to produce a decided effect, and we should use them in such
doses as will accomplish this; but, when this is done, we ought not
to go beyond it, or perhaps we may produce disease by our therapeu-
tic remedies worse than the one we are trying to cure. This error
has already been committed in the excessive doses of the great Sam-
son of the materia medica, calomel, recommended by our southern
brethren. Their confidence in it was not much if any less than it
now is in sulphate of quinine, and if I am not greatly mistaken, those
practitioners of the north who adopted their practice had good cause
to repent it. It is to warn them against this error in the indiscrimi-
nate use of the present very valuable remedy, sulphate of quinine,
that I would insist here.

It is, however, principally to the applicability of their treatment to
the fevers of the north, as they generally occur, that I am opposed.
Here the system is not depressed, the diathesis is inflammatory, and
the continued type of fever is much more apt to be excited. There,
there is a great depression of the nervous influence, the periodicity
of the disease is strongly marked, and the local complications are
such as would be excited by great prostration of the system. This
was also i he case with the (ever described by Dr. Parry, but these
are far from being a true type of the majority of the northern fever.
They are confined to particular localities where the causes which

534 Observations on the use of Quinine, fyc. [September,

produce them operate with peculiar violence, and exhaust the ner-
vous energy with great rapidity.

The excitant and anti-periodic effects of quinine render it peculiar-
ly applicable to the condition of system existing in these southern
malarial fevers, and also in fever where similar symptoms are exhib-
ited. In them the system is overwhelmed by sudden disease, and it
must be immediately counteracted, or death will ensue in the par-
oxysm. The concatenation of diseased actions hns not yet taken
place-; it is, therefore, to this sudden prostration nnd oppression that
our remedies must be directed, and fortunately we have that remedy
in the sulphate of quinine. As we have endeavored to show in the
preceding part of this paper, the fevers of the district we have en-
deavored briefly to describe are of a different kind. The attacks are
more gradual, and present a forming stage, in which the complica-
tions soon occur, and require at once the main artillery of our treat-
ment. A partial acknowledgment by some of the southern army
practitioners of the views we have here expressed, is made by their
admission in regard to northern recruits, who, they say, will not bear
quinine well in their first attacks of fever in the south ; and this
position attains still more strongly when they are attacked and re-
main in the north, where the system has not undergone, in any
degree, the effects of southern exposure and influences.

Jn regard to the propriety of the use of quinine in northern remit-
tents and intermittents, under proper restrictions, there can be no
doubt ; in short, it would be impossible to treat them successfully
without it. It is the great anti.periodic remedy of the materia medi-
ca, not only applicable to remittent and intermittent fevers, but to all
cases, under proper regulations, where there is periodicity. But the
proper use of mercurials is generally necessary to place the system in
a situation to get its most beneficial effects. They go hand in hand,
and he who would strike either from our list of remedies, inflicts upon
us an injury that cannot be repaired by the substitution of any others
in the whole catalogue.

When quinine was given prior to the correction of the secretions,
its effects appeared to coincide with the tendencies of the disease,
while if the system was put in order for its use, it counteracted the
train of morbid associations. To my own experience, and that of
most northern practitioners, I am happy to add that of Prof. Kirtland,
of the Cleveland Medical College, who has had about twenty-five
years experience in the treatment of these fevers ; and it is also
known that he is a close observer of the effects of remedies. In
speaking of the fevers of northern Ohio, he says, "in regard to the
coinciding tendencies of bark and its preparations, in malarious dis-
orders, if used before the morbid action in the hepatic system hns
been changed, and a proper condition of the whole system established,
they are too evident to admit of a doubt-"

In this Journal for October, 1841, there is a paper by Prof. Flint,
of Buffalo, in which he speaks of the use of quinine in large doses in

1846.] Observations on the use of Quinine, 6$c. 535

intermittent fever. From the fact that he, as a northern physician,
highly extols the use of the remedy in large doses, without much, if
any preparation, it might perhaps appear to be judicious practice in
other than southern intermittents. But there are circumstances in
regard to the cases treated by him, which, when taken into account,
materially modify our conclusions when we attempt to apply his
treatment to general practice. He says that "the majority of cases
of intermitting fever which occur in this city," (Buffalo,) "are con-
tracted in other localities: that the quantity of malaria seems to be
insufficient to induce an attack, excepting in those peculiarly predis-
posed, or in conjunction with other concomitant circumstances. Not
having resided in any locality where the disease is endemic to a
greater extent than here, I cannot speak of the success of remedial
measures, when the patient is exposed to the continued concentrated
action of the morbific principle."

The cases, therefore, which he treated in Buffalo, were of foreign
origin, being mostly recruits in the army from Michigan and the
northern parts of Ohio, where they contracted the disease. I under-
stand him to use (he sulphate as the remedy to cure intermittents,
without any preparatory treatment, and prefer it in this way both for
the interruption of the paroxysms, and its permanent curative effects.
Now it will be understood that nearly or quite all the cases which he
treated so successfully with large doses of quinine without prepara-
tion, contracted the disease at some other place, and that in their
removal to Buffalo they were removed away from the "continued,
concentrated action of malaria." In these cases, then, one curative
means was complied with, which of itself is often sufficient to accom-
plish a cure, viz., a removal from the cause of the disease. As the
patients took the disease at some other place, a considerable time
necessarily elapsed from the first attack, before application was made
to him ; or else it was a relapse from a former attack brought on by
fatigue or some indiscretions, which are verv common among sol-
diers. If it was the first attack, then time was given them in travel-
ing to Buffalo, to avail themselves of those preparatory means which
we have recommended, and which are so well understood in these
districts, that they are very often used without application to a physi-
cian ; and no doubt but that in ninety-nine cases in a hundred,
resort was had to them in these cases, whether in the army or out of
it, and if so, this preparatory treatment was nevertheless resorted to,
although not advised by a physician. The system then, in these
cases, was prepared, and the quinine acted favorably. His large
doses may or may not have done harm, but they were at least, I
conceive, unnecessary, as I have repeatedly seen the effects of it quite
n< favorable in less than one-half the quantities, and that in malarial
districts, and under its concentrated influence. The probabilities are
that, in the majority of these cases, thi y were relapses from inter-
mittents previously had, either the same Beason, or perhaps during a
previous year. In all cases of intermittents there is an intermittent

536 Observations on the use of Quinine, <fyc. [September,

diathesis or disposition to periodical attacks set up in the system,
which, continues in some cases for years, and is liable to be called
into play from very slight causes. This applies not only to the de-
velopment of a relapse of intermittent fever, but other diseases may-
attack the system and observe this law of periodicity, such as neural-
gia, &c, &c. Under these circumstances periodical attacks are
easily induced, and without that derangement of the secretions and
local determinations which almost invariably attend primary attacks
of intermittens.

Persons familiar with districts where intermittents originate, will
recognize the frequency of this kind of cases at once. A dose or two
of quinine will break up the paroxysm, and unless the secretions are
usually deranged, or there is some inflamed or enlarged organs, little
or no cathartic medicine is called for. The liability to relapses is
much diminished also by a removal from the district where the poison
is generated. Therefore let the paroxysms be interrupted in what-
ever manner they may, there is much less liability to a recurrence
of the disease, unless from the most manifest imprudence. This I
believe is the true explanation of the success of the treatment as
adopted by Dr. Fint, in a region as far north and situated as Buffalo.
Dr. Flint in his paper says, ' we are to be guided by the considera-
tions which will arise from the following inquiry: Will the excitant
properties of the tonic," as he calls it, " tend more to exaggerate the
accompanying disease than the series of morbid actions which con-
stitute the paroxysms of fever ]" His answer is in the negative in
nearly all cases. I must here differ from him in the general rule in
northern fevers; although I admit that perhaps cases may happen
occasionally where it would he otherwise, but these can generally
be distinguished by the nature and violence of the paroxysm. In
most cases of northern primary attacks the local determinations and
fever precede even the first regular paroxysm, to a considerable ex-
tent; and the condition which is opposed to the immediate use of
quinine occurs before the paroxysms are developed at least with
regularity. His favorable experience can very easily be explained
by considering the kind of patients which he treated and the circum-
stances attending them. Of one thing I am quite certain, that his
experience is opposed to that of almost or quite the entire mass of
the profession practicing in northern districts, where the disease is
generated. I have myself often seen the symptoms previously men-
tioned, supervene on its use by being ventured upon at too early a
period, or prior to a proper preparation of the system for it. I know
of no disease upon which the effects of proper remedies are so certain
and satisfactory as in intermittent fever. The effect of every mer-
curial cathartic in the beginning of the disease is dearly visible in
the improved appearance and removal of the yellowness of the eye
and skin, in the improvement of the secretions ; in the equalization
of the circulation ; in the * of the tongue; and in the general

improved appearance of the patient. At this period quinine comes

1846.] Scrofula ; its Nature, Causes, Prevalence, <$-c. 537

in, raises the drooping energies of the system, puts a stop to the par-
oxysm, and the patient improves rapidly from that moment. Here
is no room for skepticism in regard to the action of remedies: the
effects of every dose are apparent, and take place with that certainty
that you can predict beforehand what will be the result, and assure
your patient of it. I would not dispense with either mercurials or
quinine in these diseases ; take away either of them and you are
crippled in your curative process; and use either of them out of
their proper adaptation and you may do much harm. They are not
specifics, either of them, in any particular disease, hut combine them
properly in the treatment of malarial fevers, and you can almost with
certainty cure them.

In preventing a recurrence of attacks pf intermittens, quinine and
bark are often useful. For this purpose I generally use the tincture
of cinchona combined with that of gentian and serpentaria, in which
is put sufficient aloes or rhubarb to keep the bowels in a free, soluble
condition.

In some cases I have used the quinine with small portions of blue
mass and aloes or rhubarb for the same purpose: these to be taken
in sufficient quantities to keep the bowels quite open, but not so as to
purge actively. This will generally prevent subsequent attacks, un-
less there is some very great dereliction from a proper course of liv-
ing and exercise by the patient.

Scrofula ; its Nature, its Causes, ifs Prevalence, and the Principles
of Treatment. By Benjamin Phillips, F. R. S., Assistant Sur-
geon to the Westminster Hospital. London, 1846. 8vo. pp. 379.

This very valuable work, on a most important subject, we find fa-
vorably reviewed in the recent Journals of Great Britain. Not
having access to it, we have concluded to make the following extracts
from the July No. of the British and Foreign Medical Review :

t

The signs of a scrofulous constitution, as generally stated by au-
thors, are fairly open to the objections advanced by Mr. Phillips.
They are too indefinite ; in a lar^e proportion of cases they are not
present; in another large proportion they exist, but without signs
of scrofula. The following is Mr. Phillips's account and it is a
masterly one of the qualities most commonly met with in those
who are tainted with the disease :

"In the form of the body there is usually observable a want of
muscular development ; but even this is often absent. There is often
an appearance of plumpness, or roundness, which is Ihe result not
of muscular development, but simply of an hypertrophied, or infiltra-
ted condition of the cellular tissue, and which rapidly disappears

538 Scrofula; its Nature, Causes, Prevalence, <fyc. [September,

under fatiguing exercise, privation, or disease. Commonly there is
a general paleness and coldness of the surface of the body, which
is owing to a feeble circulating apparatus ; but in a large number of
cases, about one-fifth of the whole, that paleness does not extend to
the face. The colour of the hair is very variable, but for the most
part it inclines to a dark tint. Of nearly nine thousand scrofulous
children I have myself examined, a little over thirty-two per cent,
had light hair and eyes. The alae nasi may be broad, but for the
most part they are not so. There is not, as some persons have sup-
posed, anything constant in the shape of the lower jaw, or in the
appearance of the teeth. The abdomen is commonly tumid. The
whole of the mucous surfaces are especially liable to derangement ;
discharges from the nose, the eye, and the ear are common. The
digestive mucous membrane affords early indications of suffering ;
the tongue has commonly a dirty whitish coating; the tonsils are
usually enlarged, and they are often so tumid as to impress a disa-
greeable and frequently husky character upon the voice, and to cause
snoring when the patient is asleep. A still more deleterious influ-
ence is exercised by these tumid bodies; they lessen so much the
channel for the passage of the air in respiration, that the sufficient
development of the chest may be interfered with. The stomach
and bowels are frequently disordered, and digestion is ill performed;
acrid eructations are common ; flatulence is often very troublesome ;
and the action of the bowels is very irregular, sometimes relaxed, at
others constipated. Sometimes the evacuations are clay coloured,
very offensive, and of varying consistency ; at others having a re-
dundancy of bile. Similar evidences of derangement are observed
in the air-passages, commencing at the nose (which exhibits increased
secretions upon the occurrence of very slight variations in the tem-
perature), and passing through their whole length. Similar phenom-
ena are observed in the mucous tissue of the genito-urinary system ;
the bladder often shows an impatience of the presence of the urine,
and the desire to void it is often frequent. The skin, though often
dry and hard, is sometimes the seat of a considerable greasy exhala-
tion ; sometimes it is found to be fetid and sour. The acidity of the
exhalation may be so decided as to determine a reaction upon litmus
paper. In many of the cases observed by Mr. Kaye, on the Medi-
terranean coast, it was so. The scalp and other parts of the cutane-
ous integuments are often the seat of eruptive affections. The
absence of vascular and muscular energy often causes the child to lie
and sit about much, and indisposes him to enter into the energetic
games of his playfellows. As to the intellectual development claim-
ed for scrofulous persons, I am bound to say that it is usually wanting.
That many scrofulous children present that character is quite true;
but the result of very careful observation has convinced me that the
overwhelming majority are without those superior intellectual qual-
ities which have been pointed out as their ordinary character. Among
the better classes the feebleness of a scrofulous child attaches to him

1846.] Scrofula ; its Nature, Causes, Prevalence, tyc. 539

an interest which, without it, he might not have enjoyed. To com-
pensate for his physical inferiority, the anxious parent seeks to make
him mentally superior to his bodily stronger fellows, and frequently
succeeds; but often the limit of healthy action is passed, the nervous
and intellectual systems have, the vital action concentrated on them
too intensely. The sufferer loses flesh, the general health languishes
and the intellectual faculties may give way, destroyed by an opposite,
but not less sure, method than that which breaks down the poor man's
child."

We have not yet got to the author's ideas as to the nature of scro-
fula : we have the pathognomonic signs, and we have the constitu-
tional signs. But the scrofulous constitution is not scrofula ; there
is a wide divergence from the state of health the constitution is
fitted for the development of scrofula but the scrofulous constitu-
tion is only a reality when the deposit occurs. Mr. Phillips observes :

"That condition of economy, then, which is favorable to the for-
rnation of scrofulous matter is not scrofula, but a diathesis, or dispo-
sition ; it may exist long, it may cause the tumefaction of many
glands, but, under favorable circumstances, it may disappear without
the deposit of a single particle of that product, whose presence in
the glandular structures is, I conceive, necessary to constitute scrofu-
la. Again, I say, the condition of the system favorable to this
deposit is marked by no certain external signs, up to the moment
when the glands become tumid. The child may be fair or dark,
pallid or ruddy, well Ced, clad and lodged, or all these may be the
worst possible ; he may be the child of wealth or of poverty ; he may
live in town or country; he may be the child of old or young, of
healthy or sickly parents; he may be born and live within the tro-
pics, or in the arctic circle ; under all these circumstances, as we
shall see hereafter, scrofula may be developed."

The scrofulous deposit : its physical characters. This is the sub-
ject of the third chapter. At its commencement we have at last a
real definition of scrofula. " We," observes Mr. Phillips (meaning
J, Cor only Kings and the Vehmgericht of the critics claim the dig-
nity of the We), "define scrofula to be a disease manifested by a
peculiar deposit in the subcutaneous lymphatic glands." The quali-
ties of this peculiar deposit are thus described by Professor Albers,
Mr. Dalrymple, and Mr. Gulliver: the two latter made their obser-
vations by the special request of the author.

First, Mr. Albers :

"The tubercle presents, under the microscope, separate minute
tubes, which under a linear enlargement of five hundred and fifty
times, prove to be cells. This is not the case with scrofulous matter,
which is granular."

Secondly, Mr. Dalrymple:

" The whole material is composed of disintegrated tissue, granular
molecules, irregular exudation-corpuscles, and in which the nucleolus
is seldom to be recognized, and a considerable quantity of oil-globules,

540 Scrofula ; its Nature, Causes, Prevalence, c. [September,

which may be abstracted by boiling in ether, and recovered by evap-
oration on a plate of glass.

44 In acute or chronic inflammation of the glands, in otherwise
healthy subjects, in whom no particular morbid disposition exists, the
exudation-corpuscles, by what appears to be a law of vitality, pro-
ceed to the development of a cyst around the nucleus, or cytoblast ;
and this nucleus even splits into two or more, and hence a pus-globule
is formecK At this point, however, the process stops, and the pus-
globule subsequently disintegrates, and is resolved into granular and
fluid matter. During the development of the cell and fissure of the
nucleus, a pus-globule may be said to be an organic and vitalized
body, deriving its means of increase from the blastema around.

"The exudation. corpuscle, however, is capable of a much higher
degree of organization, and, under favorable circumstances, the cell-
germ produces its cell, the cell elongates, and either fibre or filament
is produced, as in the healing of a wound.

"In this scrofulous matter it appears that the exudation-corpuscles
do not possess even that feeble vital power, which induces the further
change into pus, and therefore it passes from the nncleolated cyto-
blast into an irregular granular body (disintegrated), the elements
of which, by some further che/nico-vital process, resolve partially
into oil, or fat-globules."

Thirdly, Mr. Gulliver his observations upon tubercular and scro-
fulous matter have been very extensive :

"In the human subject, it appears to me that crude tubercular
matter, from whatever organ obtained, differs as little in its microscop-
ical as in its general and chemical characters. When examined by
the aid of the microscope, crude tubercular matter can scarcely be
said to present any regular structure, as it is merely made up of
minutely granular matter, oily spherules, some shapeless albuminous
flakes or shreds, and a few irregular corpuscles; the lattsr are pro-
bably nothing but effete, or shrunken primary cells."

The chemical characters of scrofulous matters are not very clearly
made out. It is certain, however, that a large proportion of albumen
enters into their composition, and that they may vary considerably
in the proportion of chemical elements.

Stale of the organ in which scrofulous matter is about to be depo-
sited. It is well known that there is considerable hypertrophy of
tissue and increased vascular action in the glandular structures pre-
viously to the deposit of the scrofulous matter. Mr. Phillips raises
the question, whether this morbid state is dependent upon the blood
circulating through the structures, or whether it is of local origin.
Mr. Dalrymple thinks the glands are in an inflammatory condition.
He thus describes the microscopic appearance of a scrofulous cervical
gland.

"This enlarged gland appears to consist of a general parenchyma
in a state of chronic inflammation, Surrounding irregular masses of
yellowish white matter more immediately the subject of examination.

1846.] Scrofula ; its Nature, Causes, Prevalence, fyc. 541

In direct proximity to the edges of this white material, the blood-
vessels are seen to be more enlarged and oowgested than elsewhere,
and in some parts, the capillaries were occluded with coagulated
blood. The parenchyma, which at first sight appeals healthy, is, on
examination with high powers, found to be infiltrated with exudation-
corpuscles resembling lymph-globules. The natural texture of the
gland consists of its proper corpuscles, filamentous tissue, blood-
vessels, lymphatics, and nerves. In this morbid specimen, every-
where is the filamentous tissue infiltrated, and its fibres separated by
innumerable exudation-corpuscles, and the proper corpuscles of the
gland are similarly surrounded and imhedded. As the parenchyma
is nearer to the white matter, so proportionally do the proper corpus-
cles of the gland become more indistinct, the filamentous tissue more
obscure, the blood-vessels irregularly dilated and filled with red
globules, and they at last disappear insensibly. The exudntion-cor-
puscles are more numerous, but irregular in size and shape, and
interspersed with minutely granular matter."

Mr. Phillips agrees with Mr. Dalrymple, and probably with the
great majority of pathologists in the opinion that the glands are in-
flamed.

"This congested, inflamed, or hypertrophied condition of the sub-
cutaneous glands is of very frequent occurrence. It can be detected
in one-filth to one-sixth of the juvenile population of this country.
If we examine the necks of delicate children, we very commonly ob-
serve that the lymphatic glands of this region are enlarged. In the
state of health, the eye and the finger fail to detect them at all, and
when they are thus cognizahle, the proof is complete that they have
undergone the change of structure to which I have referred. A tu-
mour of considerable size may result from the ajiirieiiation of a clus-
ter, or a chain of such glands; that tumour mav completely subside,
so as to leave no trace of its existence behind it, and this is the result
in probably nine cases out of ten where such swellings have been
observed. This is proved by the fact that they are enlarged so as
to be felt in more than 20 per cent, on the juvenile population in
England and Wales, and that they are not found to proceed to sup-
puration in more than 2 percent, of that population ; and I regard
this fact as a satisfactory proof of two circumstances the hypertro-
phied or inflamed condition, on the one hand, and its entire subsidence
on the other. And that subsidence I assume to be a proof that no
scrofulous matter was deposited, because I have no reason to think
that when scrofulous matter is deposited in any structure, it can be
removed by any process of absorption; therefore, when the deposit
his once taken place, the swelling it occasions must remain until the
matter is ejected, because complete recession does not take place
while the deposit is present in the part."

It is generally in the largest and reddest gland, that the scrofulous
deposit is found, but this is not invariably the case.

Whence is Ike scrofulous matter derived ? Mr. Phillips investi-

542 Scrofula ; its Nature, Causes, Prevalence, fyc. [September,

gates the theory of infarction of the glands by inspissated lymph, or
chyle (in the case of mesentric glands). He sets it aside, however,
for the more modern theory that morbid products are derived directly
from the blood, and raises these questions : "Has the blood previ-
ously undergone a change in its elements, the part in which the
deposit is made remaining unchanged? Or, does the blood remain in
a healthy condition, the part in which the deposit is made exercising
a specific influence upon the blood, and determining the character of
that deposit ? Or, are both removed from a healthy condition before
the product is deposited?

In answering the first question in the affirmative, Mr. Phillips dis-
plays, as indeed he does everywhere, great research both literary and
experimental. The two following sentences contain the final results
of his own investigations:

"I have examined the blood in sixty-seven instances of scrofula,
and though I have almost always observed a considerable deviation
from the condition of healthy blood, the changes have not presented
sufficient uniformity to induce me to regard any particular condition
as specially characteristic of scrofula ; the changes are such as s-eem
to belong to a tolerably extensive group of affections, all, it is tru-e,

being connected with disordered nutrition and debility

I am not, therefore, in a condition to point out any particular state
of the blood which is certainly characteristic of scrofula; but it is
certain that if we examine the blood when the marks of scrofula are
evident, its altered condition is also evident ; but I know no particu-
lar condition of the blood which clearly marks the existence of scro-
fula. However, the occurrence of similar changes, at the same time,
in different regions of the body, seems to point to some other than a
local agent, as producing the change in the organ in which the depo-
sit is made, and that agent the blood."

The "summing up" is given more decisively than is usual with Mr.
Phillips, for, like many other philosophical inquirers, he has oft times
kept us oscillating between two conflicting opinions, and left s at
last in possession of neither.

" So much may, I think, be fairly assumed, that the blood is chang-
ed before the deposit is made, that the accumulation of certain morbid
materials in the blood constitutes what is known as the scrofulous
diathesis or constitution, and that their deposition in the subcutane-
ous lymphatic glands constitutes what we know as scrofula."

Causes of Scrofula. We now come to a much discussed ques-
tion, What are the causes of scrofula? They have been sought for
in hereditary transmission, contagion, defective alimentation, imper-
fect aeration, deficient clothing.

The hereditary cause. The doctrine that scrofula (or scrofulous
diseases) may be transmitted hereditarily is founded upon both
theory and experience. No one can pay ordinary attention to the
physiology of propagation of animals without noticing that the most
minute characteristics of parents are transmitted to their offspring.

1846.] Scrofula ; its Nature, Causes, Prevalence, 6fc, 543

Hence it is fairly argued that if any of the strictures are so constitu-
ted in the parents, that scrofulous products shall he formed on a suf-
ficient exciting cause occurring, such a constitution may be certainly
expected in the offspring, as certainly as the characteristic form or
individual features.

Observation has shown, too, that it is not always the features of
the parent, but often those of the grand-parent, that are reproduced
in the offspring. Such facts are well known to the breeders of
domestic animals, who term the process " breeding back." Hence it
has been inferred that the morbid predispositions of the grand-parent,
and not those of the parent, may be reproduced in the offspring.
The reference that a morbid predisposition of parent, or grand-parent,
may be transmitted to offspring, is founded upon the axiom that the
whole is equal to the sum of all its parts ; that as every line and fibre
that make up the parent are represented in the offspring, so the
qualities of every tissue will be represented.

It has been usually granted that those characteristics which mark
the species, and are natural to it, are transmitted to the offspring;
but it has been doubted whether acquired characteristics, or acquired
predispositions, can be transmitted. But of this fact there can be no
doubt : the pup3 of well-bred pointers will point like their parents,
before they have received a lesson. Examples of a similar kind
might be multiplied. The fact of hereditary transmission of acquired
instincts, or predispositions, is certain ; it only remains to determine
the limits within which the law operates, and which are as yet inde-
terminate.

Holding it, then, as established that a predisposition in the tissues
to disease may he transmitted, it remains to determine whether a dis-
ease with which one or other of the parents was affected at the time
of conception of the offspring, or the mother during the period of
utero-gestation, can be transmitted. This is certain ; but the limits
Within which this law operates are also, as yet, indeterminate. We
know that small-pox and syphilis may be transmitted under these
circumstances; and it is not improbable that examples of transmis-
sion of other diseases may be detected on more minute observation,
and particularly of those diseases which are dependent on an animal
poison. But we think that it is not necessary to the production of
scrofula, or of any other constitutional disease in the offspring, that
one or both the parents should have been suffering from the disease
at the time of conception of their progeny. There are grounds for
believing that a previous impregnation at a time when one or other
parent was actually diseased, will exercise an influence on subse-
quent conceptions. A seven-eighth arabian mare, belonging to the
Earl of Morton, had her first foal by a quagga ; subsequently she had
three other foals by a black Arabian. Now, the first two foals of
these three by the Arabian had a striking resemblance to the quagga
in the markings of their coat and in the form of their mane. Simi-
lar facts might be adduced.

544 Scrofula ; its Nature, Causes, Prevalence, fyc. [September,

On a careful perusal of Mr. Phillips's observations on this point, as
respects scrofula, we feel inclined to believe that he has carried his
numerical scepticism too far. Probably too great stress has been
laid upon the hereditary transmission of diseases, or the predisposi-
tion thereto, but the fact of such transmission is based on a much
higher order of proof than fallacious statistics. Even in reference
to insanity, observes Mr. Phillips, "the case of all others in which
the truth of the hereditary influence might be most easily tested, and
in which the conviction of its existence is, perhaps, the strongest, I
know no conclusive evidence." But has Mr. Phillips carefully look-
ed for it? It must be observed that in an investigation of this kind
positive facts must be admitted to have a most preponderating weight.
"Of 191 patients admitted into Bethlehem Hospital, in 1844, an
hereditary cause could only be discovered in 26 cases." Such is an
example of the facts on which Mr. Phillips grounds his scepticism.
At best it is only negative. But is not such a small proportion (so
decidedly at variance with all experience) a warranty rather for
doubting the acumen of the observe!, than the known and long-
cherished dogma ? Of 415 insane persons admitted into the Retreat,
near York, since, its foundation, and connected with the Society of
Friends, the disease was connected with an hereditary predispostion
in 142 cases, or in the proportion of 1 in 3. And of the remaining
273 cases there were, doubtless, some in whom the hereditary predis-
position existed, although not made out. Now, unless Mr. Phillips
is prepared to assert that insanity is a natural and spontaneous dis-
ease in one of every three families of the Society of Friends, such a
connexion between it and the hereditary predisposition must be
something more than a mere accident ; there must be a causal rela-
tion. With regard to scrofula, our author has instituted some im-
portant and extensive inquiries ; an account of which we subjoin :

"The means which I have taken to acquire accurate data as to the
extent to which hereditary causes operate, in the propagation of
scrofula, are the following: I examined myself, and procured to be
examined by others, in the metropolitan, the factory, and in rural
districts, upwards of 2000 families, each consisting of from three to
five children, and living, as nearly as may be, under similar circum-
stances. In one portion of the cases, both parents were apparently
free from scrofulous taint; in another portion there was reason to
think that both parents were tainted ; in another, that the father was
tainted; and in another, the mother. The number of families ex-
amined was 2023, the number of children was 7587; and the num-
ber bearing such marks of scrofula as I have already indicated was
1738, or nearly 23 per cent. In 506 instances, derived from many
localities, and under the most varied circumstances, both parents
were apparently untainted, and their offspring amounted to 2021.
Of these, 421, or something less than 21 percent., presented marks
of scrofula. In 270 instances, there was reason to think that both
parents laboured under scrofulous taint ; their offspring amounted to

1846.] Scrofula ; its Nature, Causes, Prevalence, <fyc. 545

1092 children ; of these, 271, or nearly 25 per cent., bore the ordi-
nary marks of scrofula. In 589 instances, the father carried about
him marks of having suffered from scrofula, whilst the mother was
free from them ; their children amounting to 2107, those having
marks of scrofula to 483, or nearly 23 per cent. In 652 instances,
the mother having bore upon her person the marks of scrofula, whilst
the father did not ; their children amounted to 2307, and of these,
563, or nearly 24 percent., presented marks of scrofula.

" In glancing over these results, it must be kept in mind that the
offspring of the tainted, on the one hand, and of the untainted, on the
other, are not intended to represent their relative fecundity, for means
Were taken to collect only such families as were represented by no

less than three, nor more than five children < . I do

not pretend to regard these results as an accurate representation of
the influence of scrofula, when existing in the parent, to reproduce
itself in t ho child. I would even admit that, as the cases were seen
with many eyes, the data may be more defective than if they had
been the result of one person's examination ; but however defective
they may be, they are the only approach I know of to a reasonable
amount of evidence, to enable us to judge how far it is probable that
scrofula in the parent will reproduce itself in the child. And from
that evidence it would seem that in children subjected after birth to
similar circumstances, the hereditary influence does not appear to be
exerted beyond 4 per cent. This result is in opposition to two parties
1 one maintaining that the disease is always hereditary, and never
acquired; the other, that no diseases are hereditary, but that they
are always the result of circumstances which come into action after
birth." x

We fully participate in the sentiments expressed by Mr. Phillips as
to the imperfection of the data here given. The whole question is
so complicated that its solution by such simple numerical results is
hot to be expected.

The question of predisposition. We judge from the context that
Mr. Phillips questions the actuality of an hereditary predisposition to
scrofula. We cannot say that we participate in his doubts, although
he is quite correct in stating that it is difficult to test numerically. It
may even be doubted if the proofs can ever be derived so clearly
from statistical inquiries as from ratiocination on observed facts.
We see the children of highly scrofulous parents, who are not simply
of a weakly constitution, but who are truly scrofulous, and who be-
come so, although placed under the most favorable circumstances for
prophylaxis and the preservation of health. Such families come oc-
casionally under the notice of most practitioners, and furnish extreme
instances or (he law of hereditary predisposition. This predisposition
to scrofulous deposit has its analogue iri the hereditary predisposition
to arthritic deposit. As in the highly scrofulous families, so with
highly gouty families, we find the hereditary predisposition develops
the disease, in spite of the most careful prophylaxis. This is a matter

35

546 Scrofula ; its Nature, Causes, Prevalence, <fyc. [September,

of fact. We have ourselves carefully noted it. But in all these
examples of predisposition to a particular family of diseases, whether
they be the neurotic, the arthritic, or the strumous, the predisposition
varies in every degree from the two extremes. The scrofulous pre-
disposition may be so slight as to be developed into scrofula when the
causes which excite it into activity are so powerful that they would
develop like diseases in an untainted constitution; or the proclivity
to scrofulous deposit may differ in different organs in the same indi-
vidual, so that, although in childhood the lymphatic glands may escape
all disease, at puberty the lungs will be inevitably involved.

Will any other disease in the parent develop scrofula ? There can
be no doul3t that a delicate constitution favours the development of
scrofula, whether that be derived from parents, or be a deteriorated
constitution. Long continued indigestion in a parent seems to favour
the development of scrofula in a child, as well as the other causes
enumerated by Sir James Clark, whose opinion Mr. Phillips contro-
verts. In doing this, he observes that the marks of scrofula do not
commonly appear during the first two years of life. This is scarcely,
we think, correct, even if the marks of scrofula be allowed to be none
other than those which Mr. Phillips has laid down, but decidedly in-
correct, if we consider disease of the mesenteric glands a mark of
scrofula. We are more in accordance, however, with our author in
his views as to the independence of scrofula and syphilis ; indeed we
fully concur with him. It appears to us that much error has arisen
with regard to the relationship between the two diseases, from the
fact, that persons of scrofulous constitutions suffer severely from
secondary syphilis, especially from syphilitic affections of the throat
and bones. This probably results from the circumstance that the
same class of tissues is the seat of both diseases.

Mr. Phillips thinks the children of old men are more likely to suffer
from scrofula, but principally because they are weakly, and not be-
cause there is any power in the debility of age to transmit the scro-
fulous diathesis. He also thinks that too much injurious influence
has been attributed to intermarriages; at least they do not tend
among healthy persons to the production of scrofula.

Can lactation by a scrofidous nurse develop scrofula in a child 1
or can it be communicated by contagion ? or by inoculation with pus
taken from a scrofulous person? Mr. Phillips answers all these
questions in the negative. It does not seem probable a priori that
vaccination from a scrofulous child will communicate scrofula to a
healthy one, but it is far from improbable ; indeed we should feel
inclined to think it certain that vaccinia, or variola, may exercise
such a powerful influence on the mucous tissues as to develop the dis-
ease, if it do not already exist; or (paradoxical as it may appear) to
remove it, if it do. We know very well that many remedies display
this antagonism of action, and we need not deny the same mode of
action to morbid poisons. It need not, however, be granted that
variola and pulmonary tubercle mutually repel each other (as Rilliet

1846.] Scrofula ; its Nature, Causes, Prevalence, <Src. 547

and Barthez think), because there has been a larger proportion of
phthisical cases since vaccination was practised ; it is a more reason-
able inference that by an improved hygiene, scrofulous children have
been enabled to survive until puberty, then to die of phthisis.

General causes of scrofula. These are specially considered under
the heads of food, air, climate, humidity, temperature, occupation, &c.
In discussing the question of defective nutrition as a cause of scrofu-
la, Mr. Phillips refers extensively to the statistics of foundling hospi-
tals, especially those of the Continent, to demonstrate that the nature
of the food administered to infants has a most important influence on
their health ; and that the bringing up a child " by hand," as it is
termed, conduces to a high infantile mortality. If the food be not
suitable to the infant, or if it be taken in an unnatural manner, it
acts injuriously upon nutrition. It appears, indeed, that a larger
proportion of scrofulous disease is found among children who have
been brought up by hand than among those who are suckled by a
mother, or even a foster-mother ; and that, therefore, the system of
bringing up children by hand deranges nutrition, and adapts the con-
stitution for the deposit of scrofulous matter in the child.

In order to test the influence of food on the development or pre-
vention of scrofula, Mr. Phillips collected extensive materials for a
comparison between children in union workhouses, or in certain
charitable institutions, and a similar class not so well fed at their
own homes. The author's summary ot his results is as follows :

"To ascertain how far scrofula prevails in union workhouses, 9342
children, the inmates of 63 houses, in dilferent districts were examin-
ed ; and of these 2139, or nearly 23 per cent., presented marks of
scrofula.

"In a large town I examined 734 children, in endowed and other
schools, who, for the most part, had been well cared for before ad-
mission, and judiciously managed afterwards; and the i marks of
scrofula' could be detected in 127 instances, or 16 per cent.; 500
children in national schools, brought up at home, of whom the most
part were not well ied and lodged, and of these 164, or 32 per
cent., bore similar marks of scrofula. And 500 children examined
in the workhouses yielded 126, or 25 per cent., bearing marks of
scrofula.

If we compare the children in the St. Marylebone workhouses with
the children of the national school in High-street, St. Marylebone,
there will be no question of the physical superiority of the former;
for while the children in the workhouse are a tit-. c ted with scrofulous
swellings to the extent of 26 percent only, those of the national
school are affected in the proportion of 32 per cent.

In the same districts with those of the 63 union-houses, 22,704
children living at their own homes, or in institutions other than poor-
houses, have been examined; of these 8,353, or 37J per cent., had
marks of scrofula.

The dietaries of union workhouses, as contained in the Poor-law

548 Scrofula; its Nature, Causes, Prevalence, <fyc, [September,

circular, having been compared with the food of the agricultural la-
bourer, and the prevalence of scrofula in each condition having been
shown, we arrive at this result, namely, that the workhouse child is
better fed, and less subject to scrofula than the child reared in the
cottage of the peasant; and when it is considered that many pauper
children are received into the workhouse when suffering and destitu-
tion have probably developed disease, and have almost certainly pro-
duced debility, the comparison is even less favorable for the child of
the independent labourer, than the result which is shown by the
numbers actually examined. Now, with the exception of food and
clothing, the workhouse child enjoys no advantage of which the child
reared in the cottage is deprived. The rooms he inhabits may be
larger and better ventilated, but a greater number of persons is collec-
ted in these rooms, and the breathing space for each person may even
be less than in the narrow limits of the cottage."

The result of Mr. Phillips's inquiries in Ireland, on this point, and
amongst the schools both on the Continent and in the United States,
are detailed also at length.

An impure atmosphere as a cause of scrofula. Mr. Phillips thinks
it due to his subject to enter upon a discussion of the question how
far the overcrowding of the population ih large towns is detrimental
to health. We do not think our author handles his statistics cleverly
in this section. For example, he argues that if density of population
be assigned as an exclusive cause of the excessive mortality of towns,
it should be found to act uniformly, and the mortality should be in a
direct ratio to the density. But it is not so. The metropolis has a
denser population than either Bristol or Leeds, yet the mortality is
less. Now a little consideration mi^ht, we think, have led Mr. Phil-
lips to the conviction that the term density of population is extremely
vague. It is well known to practical inquirers into the sanitary
condition of the people, that the indefinite use of the term has led to
the grossest mistakes. A population may be crowded into narrow
courts, and be as densely packed as possible, yet because of the sur-
rounding superficies being surrounded by factories, warehouses,
streets, squares, &c, the number of people per square mile, may be
inconsiderable. The plain truth is, that the attempt to ascertain the
effects of overcrowding, or of uncleanness, or of poverty, from the
bare statistics of the public registries, is altogether vain. The more
experience we have of statistical deductions, the more convinced we
are of the multitudinous fallacies to which they give rise, except
when they are thoroughly sifted, and studied in all their relations, by
persons conversant with the particular details from which the data
are taken. That pure air is necessary to health we know certainly ;
that the air of an apartment occupied night and day by a family,
situated in a confined court, surrounded by high buildings, and ventil-
ated from an atmosphere impregnated with smoke and exhalations
from sewers and graveyards, must be impure, and therefore injurious
to health and life is a proposition the truth of which cannot be

1846.] Scrofula ; its Nature, Causes, Prevalence, $c. 549

doubted. To what degree it is injurious no one can possibly state
numerically ; the feat is simply impossible. We, therefore, think it
unnecessary to follow Mr. Phillips through his long chain of statisti-
cal evidence on this head. We think the pith of the whole may be
put into a nutshell. It simply amounts to this, that in those districts
in which there is an excessive infantile mortality, fewer sickly chil-
dren survive to die of scrofulous disease ; that is, to die of scrofulous
disease of the articulations, &c. So that, in fact, the greater the
number of deaths from scrofula, the more healthy we may conclude
the district to be. But this inference must be received with divers
modifications.

Influence of Climate. The belief that one climate is more favora-
ble than another is universal, and is no doubt well founded, although
no one has demonstrated (or, we believe, can demonstrate) the fact
numerically. The salubrity of climates is relative. The adapta-
bility of constitution to climate is an important element in the ques-
tion. The Hindoo perishes prematurely in England ; the European
6ickens or dies prematurely in India. Mr. Phillips can make out no
facts which show that light, electricity, humidity of the atmosphere,
or temperature, have any influence on the development of scrofula.

" When considering the prevalence of the disease, it was shown
that we have no proof that climate, whether the temperature be
high or low, variable or uniform, or the atmosphere be dry or humid,
has any very obvious influence of itself, in producing or preventing
scrofula. At St. Petersburg, with a mean temperature of 3*23, and
a general mortality of 3*770 ; and Moscow, with a mean temperature
of 3*6, and a general mortality of 4*010; and Iceland, where the
Centigrade thermometer in winter indicates 20 minus there appears
to be less scrofula than at Lisbon, with its temperature of 71 -2. or
than at Amsterdam, Berlin, or Calcutta. So at Maderia, with its
high mean temperature and low range, there is as much scrofula as
among the juvenile convicts in Parkhurst prison. Other causes than
climate must, then, in ail these countries, exercise a most important
influence in producing the disease ; and among the causes of scrofula,
we have seen that [innutritious] food holds the first place."

Employment as a cause of scrofula. In considering this question,
Mr. Phillips devotes his principal attention to the litigated question
of the influence of factory labour in developing scrofula. lie has
secured several valuable and extensive statistical returns from the
manufacturing districts; the substance of which we subjoin in his
own words :

"In Leeds, Dr. T. Smith very kindly examined, at my request,
1095 children, employed in different factories, and examined 548
children of the sameclass, not employed in factories. The result is,
that those not employed in factories exhibited marks of scrofula in
8 per cent, more instances (ban those whose days are spent in such
establishments. [n Manchester -Am] other great manufacturing
(owns, a similar result lias been obtained by examinations, made at

550 Scrofula ; its Nature, Causes, Prevalence, fyc. [September,

my request, and on so large a scale that there is every reason to feel
confident in the opinion already expressed. Again, from his Dispen-
sary practice, Dr. Smith has made me the following report: 'Of
916 persons, between seven and fourteen, the children of factory
operatives, but not themselves employed in factories, 365, or 39 per
cent., had enlarged glands, and 75, or 8 per cent., had scars resulting
from scrofula. Of 567 persons, all under twenty-one, and employed
in factories, 124, or 22 percent., had scrofulous scars.'

"Mr. Poyser, the intelligent surgeon of Winksworth, kindly exam-
ined for me the people employed in Mr. Arkwright's mills, and the
following are the results which he communicated : 'Persons exam-
ined, 793 ; total number having marks of scrofula, 29.'

" I have obtained, through the kindness of Messrs.

Horner and Saunders, the results of the examination of 6754 factory
children, from which it appears that marks of scrofula were found in
only 905 instances, or only 13^ per cent. The returns of Mr. Fere-
day, Mr. Davis, and that of other friends, who have kindly made a
comparative examination of a large number of children, exhibits
similar results; and they leave no doubt on my mind that children
employed in factories are more free from scrofula than the average of
children in England and Wales."

Treatment. We now come to a more congenial, because a less
controversial, subject. Mr. Phillips considers the treatment of scrofu.
la under two heads, the prophylactic and the therepeutic. The pro.
phylactic treatment insisted upon is a well-assorted marriage as an
important aid in preventing the occurrence of scrofula. Then the
dietetics of infants should be regulated ; they should be supplied
plentifully with fresh air ; and should be encouraged in all the active
exercises in which young animals generally delight ; and the games
should be spontaneous, and left to the guidance of their own instincts,
Mr. Phillips objects to infant schools as constraining young children
in this respect. He observes:

M I know that the health of those infants, who are suffered to amuse
themselves as they please during the day is better, cozier is paribus,
than that of those children who have been for many months regular
attendants at infant schools. And the reason of the difference I ap-
prehend to be this, that in children the blood is vigorously circulated
through the entire frame, by means of the exertion of the muscular
system, and this exertion of the muscular system can only be main-
tained by providing such amusement as will keep the body in motion.
The listless walk around the school-rooms, though repeated many
times a day, will not quicken the heart's action, and will not warm
the hands and feet. And so long as the hands and feet, and the sur-
face of the body remains cold for many hours of every day, so long
the child will have congestion of some internal organs, and a state of
permanent disease is readily induced; digestion is ill performed,
nutrition is defective; and if this state of things be long continued,
scrofula may be the consequence."

1846.] Scrofula ; its Nature, Causes, Prevalence, $c. 551

We entirely agree with Mr. Phillips, in these statements, and have
always denounced infant schools conducted on the plan here referred
to. But we believe, at the same time, that any plan involving such
manifest disregard of all hygienic laws constitutes no necessary part
of the system of infant schools. On the contrary, we believe that
Ihey may be made as directly conducive to bodily health, as to the
regulation and improvement of the mind. And we are happy to know
that some infant schools are so conducted.

We cordially agree with the following opinions, quoted from a
communication by Mr. Turnbull, who reported on the Austrian
School at Neustadt.

"Amid modern theories of education, and which prevail in other
countries beside Germany, few perhaps are more particularly errone-
ous than the system which would be always teaching something;
always in every form of play seeking to impart instruction. The
gymnastics and equitations at Neustadt become thus as completely
matters of study, and are probably performed with as much gravity
of attention as the task of mathematics, or the history, because they
are performed under the eye of the teacher. In the inaptitude of
youth for any long continued application, nature herself points out
the expediency of alternate repose to the mind, of entire vacancy of
thought; but man too often endeavours to counteract this wise dis-
position by endeavouring to engage the attention by some new object
of instruction. The animal spirits, those delightful harbingers of
health and energy, mental and corporeal, are stunted in their very
spring when the boy is debarred from those alternations of idle, thought-
less independence in his sports, which is not less essential to the for-
mation of his future character than the practice of his severer studies.
The mind is fritted away by the multitude of pursuits, and filled with
a number of crude and confused ideas. It becomes paralysed by
over-work, or precociously and morbid!}' active by over-excitement.
A being of dull and orderly correctness may be produced by such
discipline ; or the memory may be overcharged (to the probable ruin
of the reflecting power), so as to delight unthinking relatives with the
multitude of acquired ideas: but as the lad was wanting the fresh-
ness of youth, so he will probably in after years be without the vigour
of manhood."

Curative treatment of scrofula. Mr. Phillips devotes several pa-
ges to the history of the cure of scrofula by the royal touch, in which
much literary research is displayed. He thinks that the popular no-
tion as to the remedial powers of the monarch were founded on post
hoc ergo propter hoc evidence, the fallacy of which we have taken
some pains to expose and denounce. Wiseman declares he was "a
frequent eye-witness of manv hundreds of cures performed by his
Majesty's [Charles II.] touch alone, without any assistance of chirur-
gery, and those many of them such as had tired out the endeavours
of able chirurgeons before* they came thither, [t were endless to
recite what I myself have seen," &c. Wiseman was a courtier ; is

552 Scrofula ; its Nature, Causes, Prevalence, fyc. {September,

it an unfair imputation on his character to add, that he knew his part
well, and played it well? Mr. Phillips observes :

"The truth is, that of the scrofulous patients who suffer from en-
larged glands in the neck, nine out often do get well under almost
any rational plan of treatment. The tendency to improvement is
most remarkable in spring and summer months, those being the sea-
sons of the year at which a large portion of the persons touched by
Charles II. were presented to his most gracious Majesty, and who,
whether touched or not, might be reasonably expected to he much
better by the end of summer. Ignorant as even many professional
persons were at.that time of the natural history of the disease, it was
not surprising that they should attribute the cures which followed
the touch to the ceremony itself. But with increased knowledge we
may form other judgments, and can, without presumption, refer those
cures to other causes than the imposition of the king's hand."

Iodine. Mr. Phillips thinks its virtues have been much overrated,
and observes that the 35 cases reported by Lugol as cured, out of
105 treated, would hive been as well cured without it, if no other
means than suitable food, air, clothing, and exercise, had been em-
ployed, and the season had been favorable. He further states:

"In my own practice I have exhibited every form of iodine exten-
sively in cases of scrofula, and supposing the patient to remain exposed
to the influence of the same conditions in winch the disease was first
manifested, and the period of the year to be that which has not been
found favorable for the cure of the disease under other modes of treat-
ment, I cannot say that I have reason to estimate the curative pow-
ers of iodine so highly as many others have done. I know that,
among the out-patients of hospitals, whose circumstances remain un?
changed, and who apply at the latter end ot autumn or the beginning
of winter, we may often exhibit iodine in every form for weeks or
months without producing any sensible amelioration of the patient's
condition. I know also that at the beginning of the summer, a par
tient similarly affected and similarly treated, will, often in a few
weeks, exhibit a marked improvement but how much of this should
be referred to iodine? How much to season?"

Mr. Phillips, in common with all experienced practitioners, objects
to the use of the simple tincture. He has found the iodide of iron a
useful tonic, given in syrup, to the amount of four grains in the
twenty. four hours. In whatever form the remedy be administered
he thinks it imprudent to continue its use longer than a fortnight, or
three weeks, at a time. "At the end of that time the preparation
should be set aside, aperient medicine should he employed, and its
use should then be resumed with the same precautions. In this way.,
any virtues which the medicine possesses are. more surely brought
out, and the inconveniences sometimes experienced from its adminis-
tration will be, as nearly as possible, avoided."

We have known numerous instances in which a scruple of the
hydriodate of pota-s was taken daily for many weeks without any

1846.] Scrofula ; its Nature, Causes, Prevalence, Sfc. 553

perceptible effect. The only rule we have for its discontinuance is
the development of catarrhal symptoms, which in some people super-
vene on its administration even for a short period.

Barium, or rather t\\e chloride of barium (the old muriate of bary-
ta), is a remedy, in Mr. Phillips's opinion, little inferior to iodine :

"Barium, however," he observes, "seems to he a more certain
stimulant than iodine, or, rather, we might say, irritant; and, in my
judgment, its use is clearly contraindicated where there is much free
inflammatory excitability of the system. But in those cases where
the tallow. like complexion, the pale tongue, and the languid circula-
tion, accompanied by irritability of the mucous surfaces, are present,
the virtues of the barium are often very remarkably demonstrated.
I usually give it in solution, a grain to an ounce of distilled water,
with ten drops of compound tincture of gentian. Of the solution, I
commence with half an ounce twice a day, and on no occasion have
I exceeded three grains in the day; and up to this moment I have
not experienced any check in the administration of the medicine."

The hydrocholate of lime is the basis of the anti-scrofulous nostrum
of Nieumann. Mr. Phillips has frequently used it in the following
form: a drachm to twenty drachms of distilled water, of which a
teaspoonful was taken in milk two or three times a day. He has
carried the dose up to two teaspoonfuls, but has not exceeded that
dose. He is not convinced that it has any very evident action on
scrofulous glands, but in moderate doses it is more generally tolera-
ted than the chloride of barium.

The alkalis are of doubtful value ; so also burnt sponge.

Cod-licer oil is useful, Mr. Phillips thinks, rather as an animal oil,
than because it contains infinitesimal doses of iodine or bromine:

"The conviction on my mind is, that when good is derived from it,
it is to be referred to the effect of the animal oil in improving diges-
tion and nutrition, rather than to the presence of iodine ; and if Pop-
kins's impression be correct, that he has observed quite as much good
to follow the daily use of fried bacon in such cases, and if it be fur-
ther true, which 1 by no means admit, that butchers, oilmen, tallow-
chandlers, tanners, and other persons who are continually coming in
contact with fatty matter, are particularly robust and well nourished,
and are known to be remarkably iva' from scrofula, then the case in
favour of the oily principle is so much the stronger. If the impres-
sion be correct, that cases are occasionally presented in which the
good effects of cod-liver oil are remarkably apparent, and if the
amelioration seem to concur with a much improved condition as to
nutrition, 1 conceive myself justified in assuming that the one is the
consequence of the other without being required to frame a theory
why animal oil improves nutrition."

Sea water and sea bathing. Mr. Phillips is full of doubts as to the
merits of these remedies. Change of inland air and cold bathing
may be equally, if not more, useful. Some years ago, an experiment
as to the value ol'sea air was made in nine obstinate cases of scrofu-

554 Scrofula; its Nature, Causes, Prevalence, tyc. [September,

la, in the St. Marylebone infirmary. They were sent to Margate,
and remained there several months.

** On their return their condition was carefully ascertained. The
glandular tumours had very nearly, but not completely subsided; of
the sinuses one was dried up, the other nearly so. In the former two
cases of joint affection no amelioration was experienced in the local
disease, but the general health was improved ; the third patient, after
remaining at Margate some weeks, came home to die.

"The eight surviving children had returned home at the close of
the Margate season. In the succeeding November, three of them
were again under treatment : one with glandular tumour, which had
re-appeared; one with a re-opened ulcer; the other with a single
sinus, still discharging. These results are, I conceive, in perfect
accordance with the experience of careful observers ; and certainly
they do not tend to support the prejudice which exists in favour of the
superior efficacy of sea-side residence in cases of scrofula. That
those ganglia in which scrofulous matter had been deposited should
continue foci of irritation is natural, because I know no satisfactory
evidence that scrofulous deposits are ever absorbed. They, there-
fore, continue to exist, and, like any other foreign body, may excite
new irritation from very slight causes. That a sinus should heal when
properly treated, provided all the scrofulous deposit be removed, is to
be expected ; hut whether the sea-side did much'to determine the
subsidence of irritation around the gland in one set of the cases above
noticed, or to heal the fistula in the other, is with me a matter of
doubt."

Mineral waters are in as little estimation with Mr. Phillips as sea
bathing. We subjoin some therapeutic statistics of French mineral
waters used for the cure of scrofula, together with Mr. Phillips's re-
marks. The facts are derived from the reports of the inspectors of
mineral waters in France :

" SCROFULOUS ENLARGEMENTS.

Cases obsen

-ed.

Cures,

Ameliorations.

No benefit.

Deaths.

Bourbonne

29

2

16

11

0

Balaruc

. 46

14

1(1

11

2

u

13

0

5

8

0

Montd'Or . ' .

19

3

5

11

0

Neris . .

4

0

2

2

0

Bagnoles (Lozere) .

41

14

10

17

0

Bagneres de Luchon

78

17

38

23

0

230

50

92

86

2

ABSCESSE:

3, ULCERS,

FISTULJE.

Bourbonne

132

57

62

13

0

Bourbon l'Archambai

it 43

18

15

10

0

175 75 77 23 0

"The above table implies, I believe, as favorable an estimate as
can properly be made of the influence of mineral waters in the cure
of scrofula, and certainly the result does not show that they exercise
any very decided curative influence over the disease.

1846.] Scrofula; its Nature, Causes, Prevalence, c. 555

" That they have heen more indebted for the credit they possess
to the enthusiasm of friends, than to the faithful register of the cures
which it is alleged have resulted from their employment, is, I think,
true. And no doubt M. Patissier was near the truth when he said,
1 Les eaux miner ales naturelles guerissent quelquefois, soulagent et
cunsolent toujours.'"

The season of the year has, in Mr. Phillips's opinion, much influ-
ence in the development and amelioration of scrofula:

"1 have fully satisfied myself that scrofulous cases are most nu-
merous and most aggravated in spring and the beginning of summer ;
that they are least frequent and most ameliorated at the commence-
ment or the middle of autumn ; and that at the one period they have
been aggravated by the cold of winter, at the other they have been
ameliorated by the warmth of summer ; and this has happened when
all other influences have been apparently unchanged.

"When do we send patients to the sea-side? Precisely at that
season when they would improve anywhere. When do we find any
remedies best succeed? Precisely when the season is becoming
favorable. When do we find all medicinal agents comparatively
powerless? Precisely when we get no help from the season. True
it is, we may take a poor child from the streets in the depth of winter,
and give him good food and lodging, and his disease will be improv-
ed, and this without reference to the season ; but then we have
improved nutrition. But let a poor child remain at home, and we
shall usually find every specific fail to improve his condition until
favored by season ; and let almost any one of the unsuccessful reme-
dies be used when the end of spring comes, and its apparent good
effects will soon he obvious enough. Now, if that position beconect,
it must be evident how defective the estimate of every plan of treat-
ment is which does not include the influence of season."

The Appendix contains many of the returns in exfenso, which Mr.
Phillips so industriously obtained from a numerous and wide circle of
correspondents. One of the first of these documents is a short essay
by Professor Albers, on the difference between scrofula and tuber-
cles the latter term being used to signify not only tubercles of the
lungs, but also phthisis. In looking over this we could not avoid
remarking how completely Professor Albers had mistaken the point
at issue. The differences which he lavs down are simply differences
in semeiology, and not in pathology differences which arise from
the difference in the organ affected, and not from a difference in the
nature ofthe two diseases. The symptoms of disease of the lymph-
atic glands and ofthe lungs must necessarily differ ; the one is a
"noble organ," intimately connected with vital action, the other of
secondary importance.

In concluding our review of Mr. Phillips's work, we feel we can-
not estimate too highly the industry and perseverence with which he
has pursued his researches into so important a subject, and we think
the mass of valuable facts he has collected gives such a value to his

556 New Orleans Medical <fy Surgical Journal, SfC, [September,

work as will secure it a place amongst the important class of "books
of reference." We trust Mr. Phillips will not only continue his re-
searches, but will also adopt a still more comprehensive plan. He
should, we think, carefully avoid narrowing in any way the field of
his inquiry. Scrofula should he investigated as " a disease of the
constitution." It should be traced step by step through each class
of organs, and as well in their histological constitution as in their
successive development from infancy to old age. The prosecution
of the inquiry on this philosophical hasis may raise a monument to
his fame, which shall match if not overshadow the labours of Louis
on a kindred suhject, and possibly merge them into a higher general-
ization. The scrofulous diseases of the glandular structures of in-
fancy might form one group : of youth another ; of puberty another ;
of middle age another; of old age another. And although the main
inquiry should be directed to the glandular and parenchymatous
organs, the cutaneous cellular tissue, and the structures imbedded in
the epidermis should not he forgotten. There would thus be a large
family group of diseases investigated in their general and natural
relations, comprising not only mesenteric disease, scrofulous diar-
rhoea, enlarged submental and cervical glands, and scrofulous arti-
culations, hut also scrofulous disease of the gastro-enteric mucous
memhrane and its diverticula into the Eustachian tube, salivary
glands, liver, kidneys. &c, (constituting ohscure forms of indiges-
tion, &c); scrofulous hydrencephalns, hypertrophy of the lips, ala?
nasi, and general subcutaneous tissue ; scrofulous ophthalmia, cuta-
neous eruptions, ahscesses, ccc. We are convinced that anything
short of a comprehensive and philosophical inquiry lik% this of
which the ahove is a meagre outline will be insufficient to deter-
mine the litigated questions connected with the pathology and rela-
tions of scrofula, or materially advance the treatment of tubercular
diseases in general.

The New-Orleans Medical and Surgical Journal No. 1, Vol. III.
July, 1846.

Western Lancet and Medical Library No. 2. July, 1846. Lex-
ington, Ky.

The periodical Medical literature of our country is rapidly increas-
ing in amount and character. Journals devoted to the Medical
Science are springing up in every direction, all of which seem to
be zealously engaged in promoting the interest of the profession, and
in contributing something to the general stock of knowledge. In the
absence of our usual proportion of original matter, we propose to
furnish a brief analytical notice of some of the periodicals published
in the West and Southwest among these, there is none which has

1846.] New Orleans Medical <fy Surgical Journal, $e 557

acquired so high a rank among Southern physicians as the New Or-
leans Medical and Surgical Journal, nor is there in the country any
work which is more justly entitled to the high consideration which
it enjoys. The last No. (July. 1S46) is before us, and contains its
usual variety of interesting matter.

"The remedial powers of the Sulphate of Quinine, is the title of
an article by Thomas D. Mitchell, Professor of Materia Medica and
Therapeutics in Transylvania University.

The discovery of the sulphate of quinine, and its application to
fevers of almost every grade and type are amon** the most brilliant
achievements of modern science. In the South, at least, fever has
been in a great measure robbed of its .terrors : cases which under
the old methods of treatment would have either proved rapidly fatal
or have brought the patient to the verge of the grave, are now so
certainly and rapidly arrested in their course, that the physician gets
no credit for the cure, as the patient cnnnot be persuaded to believe
that the disease was any thing more than a slight attack. Although
We have already devoted a large space to the subject in our journal,
yet such is the importance of our subject to the Southern practF*
tioner that we feel bound to keep it prominently before our readers,
and bring before them all the facts and authorities which bear
upon it. We shall therefore proceed to notice the article already
referred to.

Prof. Mitchell was one of the earliest advocates of the use of qui-
nine, in remittent and other periodic fevers. In 1825, he published
an article on this subject in the American Medical Review, in which
he says :

" But the opponents of the sulphate of quinine have proscribed its
Use, chiefly, in the remitting fevers that lately prevailed so exten-
sively. And here I feel myself authorized to say, the medicine man-
ifested its superior excellence more decisively, to my mind, than in
the ordinary intermitlcnts. So confident was I in the powers of the
sulphate in the remittents (called the bilious remittents), that if a
choice of fever cases had been presented to me, I would have taken
all the remittents, in preference to the intermittents. The course of
treatment was plain, easy and successful. If called in immediately,
I cleansed the prims vise at once by calomel and ipecaycuhana, and
then, by means of spiritus mindereri, set up a free perspiration, and
so obtained a palpable remission. Occasionally, it was needful to
precede the cal. and ipecac, by a moderate Weeding, especially if
there was obvious cerebral determination. All this seldom consumed
over twenty-four hours, and the favorable opportunity then present-

558 New Orleans Medical <fy Surgical Journal, fyc. [September,

ing, I gave the sulphate as rapidly as possible. In two hours I gen-
erally hud the patient under the influence of a sufficient quantity of
the medicine to prevent a return of fever, or to postpone it for hours,
or to abate its severity, so as to insure its subduction, wholly, by a
second use of the sulphate. Thus have I seen many cases (I might
safely speak of hundreds) which at first seemed to be alarming, com-
pletely checked in a few days, so that the patient was about in less
than a week, while others similarly attacked, perhaps under the same
roof, but badly treated, were confined to their chambers from six to
eight or nine weeks. In short, I did not meet a single case of fever,
during the last season, that gave me any serious trouble, excepting
such as had been previously under the care of a neighboring practi-
tioner, who decried the sulphate as poisonous, and whose practice
was inert, and consequently unsuccessful."

Prof. M. enters into an examination of the properties of the quinine.
He deems it a tonic.

" On the tonic power of the sulphate, it is not needful to be at all
prolix. We give it in convalescence, as a remedy for pure debility,
from any and every cause. We say it is a tonic, because it obvious-
ly augments the general tone and vigor of the system. It displays
this feature, very frequently in the stomach, before we perceive any
decided constitutional manifestation. The appetite is revived, the
digestive powers excited into more healthful action, and the work of
assimilation is more complete and natural, It might be affirmed, that
the remedy in these developments is truly an alterant, because it is
gradually affecting most happy changes. We are aware, that every
tonic is necessarily an alterant, and the persistent use is essential to
the desired result. Hence, we give the sulphate, as a tonic, not for a
few days, but for weeks, in small doses at first, and then gradually
augmented. Ordinarily, we prescribe from half a grain to a grain
per day, or oftener, according to circumstances; and slowly increas-
ing, we give it, at length, in doses of two or three grains. This
course of procedure is safe and successful, in ordinary cases."

To this view of the properties of the article we are disposed to dis-
sent. We do not think that it can with propriety be ranked as a tonic.
The principal power seems to be expended upon the nervous system?
and it does not seem to exert so durable an influence as tonics pro-
per. It undoubtedly revives the appetite and quickens digestion, but
many other articles, which have not the slightest claim to tonic pro-
perties, produce these effects.

" As an anti-periodic, we hold the sulphate in much higher estima-
tion. Does any one inquire, what we mean by anti-periodic? We
have already eschewed theory and speclation, and shall reply by re-
ference to palpable facts. Ague and fever is held to be a periodical
disease, or a disease of periodicity. Nobody doubts this. A man

1846.] Xew Orleans Medical fy SurgicalJournal, <$c. 559

has it one day, is well the next, and sick on the third day, and so the
chain continues for months, unless you strike out a link or two, by
remedial agency. On the well day, the man takes sulphate of qui-
nine, and is cured. A thousand do the same, and all get well. The
facts prove that periodicity was the grand basis of the morbid action,
somehow or other ; and they equally prove, that the sulphate of
quinine has broken the morbid associations, and this is exactly all
we mean by an anti-per iodic."

The anti-periodic properties of the quinine is that about which
there is no dispute, and which imparts to the remedy its greatest
value in the treatment of disease. Its utility in fevers, attended by
marked intermissions, has been long urdisputed, but it is not the
case with remittents and other diseases of decided periodicity. It is
only of late that experience has shown its powerful effect in breaking
up morbid action in the whole of that class of diseases which mani-
fest periodicity. This includes almost, if not quite, all our fevers,
and many of the phlegmasia. Prof. M. properly says :

" The fevers of the United States are essentially periodical ; and
if you would treat them successfully, the doctrine of periodicity must
never be forgotten ; ?w, not for an hour."

Prof. M. very justly, we think, dissents from the opinion of many
physicians, that the quinine is a sedative. When given to a healthy
subject in full doses, it increases the heat and quickens the circula-
tion. Any one who doubts this, may easily verify the fact. In
febrile cases it often reduces the frequency of the pulse, not however
by any sedative property, but solely by its febrifuge action. It puts
an end to the febrile movement, and in so doing, lessens the action of
the heart which is one of the concomitants of the fever.

"We have not met with facts in our own experience, that would
positively sustain the sedative action of the remedy. Some intelli-
gent practitioners think it acts thus, even when given in large doses,
in the stage of high febrile excitement; they suppose it abates the
excitement, and thus controls the morbid action. Others regard it
as a sedative, when it succeeds in allaying high irritability of the
stomach, as seen in ordinary remittents, and in the most malignant
form, known as yellow fever. That it has acted most happily in
such circumstances, there can be no doubt; and it would seem to
operate then either as a counter-irritant, or contra-stimulant or seda-
tive Nausea and vomiting have been arrested by it, as occurring
in the more ordinary remittents, and even the black vomit of yellow

fever has yielded to its potent sway."

********

11 The facts cited by Professor Harrison, of New Orleans, in his

560 New Orleans Medical <$> Surgical Journal, $c. [September,

paper on yellow fever, published in the medical journal of that city,
in November last, are supposed by some, to prove the sedative opera-
tion of the sulphate. lam not ahle to come to a like conclusion.
Certainly, the experiments of Dr. Hunt, as detailed in that paper, do
not establish a sedative action. They were performed on convales-
cents, who, of course, were debilitated. The reduction of pulse, un-
der the use of the sulphate, was, no doubt, accompanied by a corres-
ponding augmentation of volume, and was precisely what we usually
observe to follow the administration of tonics. But the cases of
yellow fever, noticed by Prof. H., in which the sulphate Was given
attheonset of the fever, presented a widely different state of the sys-
tem; and although, after a general or local bleeding had induced a
remission, the sulphate cut short the fever most astonishingly, I do
not regard the facts as developing a sedative, but rather an anti-
periodic agency. 'The breaking up of the whole condition upoft
which the morbid actions depend," (the language employed by this
writer,) is an effect so like the usual action of the sulphate of quinine',
as an anti-periodic, that I can refer it to no other power. It is true,
the concentration of the poison in yellow fever, changes the intensify
of the phenomena, or exalts it, so as to disguise, to a certain extent,
the ordinary operation of this heroic medicine."

There are some "observations of the Stillingia Sylvatica," by A*
Lopez, M. D., of Mobile. Dr. L. has used the " queen's delight,'*
as this plant is familiarly called, with very decided benefit in second-
ary syphilis, primary syphilis, mercurial erythema, chronic hepatitis
and hemorrhagica petechialis cases of which he reports. In every
case, however, the article was used conjointly with other remedies*
He uses a decoction of the root prepared as follows :

"R. Rad. Stillingia? Sylvatica? ) inch:

Rad. Sarsaparilla $ aa 5iij.

Fol. Sennse 5ij.

Aq. fbntan. gxxxij.

Conque usque ad 3xvi. Cola. Sumat gij. dulcific. cum melf< Opt;
ter in die."*

J. B. Wilkinson, M. D., of Louisiana, also furnishes an article
"on the use of the Sulphate of Quinine." Dr. W. does not much
differ from other late writers, either as to the value or application of
the remedy. He employs it in remittent fevers, but he objects to the
large doses which are so frequently given, that they are not free from
danger. He does not look upon it as a sedative, and he believes
that injury sometimes results from its stimulant action, when it has
been given in the stage of excitement. He quotes cases to prove

* This is the formula adopted by Dr. Simons.

1846.] Western Lancet and Medical Library, fyc. 561

the occasional injurious effects of the article. We entirely agree
with Dr. A. in the following remark :

"In the great majority of cases, quinine, given in moderate doses,
will effect every useful purpose, and without hazard to the patient,
whereas, in 20, 30, or 40 grain doses, although generally successful
in its operation, dangerous and sometimes fatal consequences occur."

This number contains several other interesting original articles
which we cannot now notice, further than to name their titles. An
examination of the Riddellian philosophy by Welles Ely, M. D., of
New Orleans. Practical remarks on the Epidemic of Yellow fever,
which prevailed at Opelousas in the years 1837, '39 and '42 by T.
A.Cooke, M. D. A Case of old unreduced laxation of both Radii,
backwards, with bony union of the Radius and Ulna; observed in
the dead subject by R. J. Farquharson, H. Y., M. D. On Magneto-
Electricity as a Derivative, and as a Parturient by Dr. N. Walkly,
of Ala. An inquiry into the existence of a "Vital principle/' con-
sidered as an entity, independent of the phenomena of life by J.
Harrison, M. D., Prof, of Physiology and Pathology in the Medical
College of Louisiana.

The leading article in the Western Lancet, is a "Lecture on Vio-
lation or Rape ; by Prof. Mitchell, of Transylvania University.
The writer makes no " pretensions to originality," but has published
it in consequence of the repeated calls which have been made for it.
One of the most interesting questions connected with the subject is
"whether a single male can accomplish the violation of a woman,
possessed of ordinary health and vigor, of mature age, and enjoying
her full mental powers." Prof. M., in common with most medical
writers, answers this question in the negative.

"On this point, the sentiments of medical men are decisive, how-
ever much lawyers may disagree. The just reply is, * he cannot.'
Hence, it is pretty much agreed, that there are but three conditions
in which the crime can be perpetrated. 1st. Under the full influence
of narcotics. 2d. Under the force of several males at the same time.
3d. By a very strong man, the woman being very feeble, and there-
fore unable to resist, effectually.

" A case is recorded by Maynard, of a young man who was accused
of the crime ol rape, but resolutely denied the charge. He was sen-
tenced to pay the injured party, in the presence of the judges, a large
sum of money, wiih this important proviso appended. The fine was
to be entirely remitted, if, on the exertion of all his power, he could
really effect complete intercourse. The effort was fairly made, and

36

562 Western Lancet and Medical Library, <fyc. [September,

it was found impossible to succeed. The judges therefore decided
that it was equally in the power of the female to have resisted in the
first instance, and they at once remitted the fine."

Another question of great importance is, whether a female can be
violated without her consciousness, or knowledge. That a female
being accustomed to sexual indigencies might be violated during
profound sleep, Prof. M. does not doubt ; but that a virgin could be
violated, during natural though profound sleep, he thinks highly im-
probable. Yet the Professor admits the possibility of such an occur-
rence, and quotes the following very remarkable cases in corrobora-
tion :

" A girl living at a country tavern, worn out by unusual fatigues of
the day, threw herself down on the floor, close to a warm stove, (the
weather being cold,) and fell into-a profound sleep. She was held to
be a perfectly virtuous girl, by all who knew her. After a time, her
catamenia failed, she began to enlarge, and was at length delivered
of a child. On being required, according to law, to make oath to
identify the father, who would be required to support her and the
child, she swore solemnly, that she had no knowledge of ever having
had sexual connexion. Just at (his time, the affair of course being a
subject of talk, a post rider, employed on that route, came forward
voluntarily, declared that on a certain cold night he stopped at the
tavern to warm himself and to rest. The girl was lying alone on the
floor in a deep sleep, and he gratified himself by intercourse without
rousing her. He offered to marry her forthwith, and did so.

"But we have another case, that is even yet more decisive. A
beautiful girl died, as was thought, rather suddenly, and was laid out
in the usual way ; a Romish priest called at the house, being on a
journey, and insisted on setting up with the corpse, as (he family had
been a good deal fatigued. Smitten with the beautiful form before
him, and having long abstained, he made out to have actual connec-
tion with the body. In the morning, very early, he departed. The
female revived, got well, and in nine months was delivered of a child.
The priest hearing of the astounding issues forthwith repaired to the
spot, repudiated his profession, and married the girl."

These are certainly strong cases, if true ; but to us they seem en-
tirely unworthy ef credit. It is more reasonable to suppose the girl
in the first case endeavored to screen herself by a lie, than that sex-
ual intercourse should have been unconsciously effected. In the other
case, the act is entirely abhorrent to every principle of our nature. We
utterly disbelieve that any sane man could become so debased as to
violate a corpse. Even had it been done, we know of no theory of
generation which could explain the mode in which a female could
conceive, under such circumstances the thing is impossible.

1846.] Western Lancet and Medical Library, fyc, 5G3

The subject of Rape is of much importance, and deserves more at-
tention than it has generally received from medical men. The charge
is one easily made, and difficult to disprove, and it is frequently made
by designing females for the purpose of extorting money, or to shield
themselves from the consequences of their licentiousness. The phy-
sician should therefore be exceedingly cautious in forming an opin-
ion in such cases.

"Thoughts on Congestive Fever," is the title of an article from
B. Rush Mitchell, of St. Louis, Missouri. The term congestion, as
applied to fever, is of modern origin. In our section, it is now ap-
plied by many physicians to all cases of fever which are likely to
"prove fatal. Such is the dread of this disease, that the physician is
absolved from all responsibility as soon as the case is pronounced
congestive. If the patient dies, no blame attaches to his medical
advisers if he recovers, the physician is covered with glory. A
similar state of things, it appears, has existed at the West.

"Even the unlearned in Medicine, have been taught by experience
to regard ' Congestive Fever' as the surest and most trusty agent of
death, if not synonymous with it. So general is the belief in its fa-
tality among the people, that, we regret to say, we have known many
physicians to avail themselves of it, to call every fatal case in their
practice by that appellative, because assured that the portentous
name would exempt them from blame or comment, with the relatives
of the deceased. In the section of country, however, where we know
this fraud to be most extensively practised, the term 'congestive'
has heen dropped to give place to that of 'typhoid' the physicians
having, by some means discovered that typhoid fever was not pecu-
liar to France, nor to Europe."

Dr. M. advances some views in relation to the pathology of con-
gestive fever, which are not in accordance with those generally held.
His opinion is "wo fever at all that there is not a trace of febrile
action in all its history."

" It is one of the Neuroses, using that term in the wide sense of
Encephalo- nervous lesion ; and so far as we can see, nothing else.
We regard it to he a congestion of the encephalic and spinal systems,
as truly and definitely, as apoplexy itself, is of the brain. We are
aware, that in the avowal of such opinions, we run counter to the
almost universal belief of the profession ; and we would put them
forward, therefore, in an ex cathedra style, but, believing them
true, we would urge them plainly and forcibly, only because we
think they are true. How true, let us examine.

"Confessedly, a perfect definition of fever, is yet a desideratum;
but while this is so, we think that even our present idea of its mean-

564 Western Lancet and Medical Library, 8$c, [September,

ing repudiates, as febrile, the disease we are investigating. All the
phenomena of the disease, are those of depression and reaction. We
have not the febrile pulse, the febrile reaction, the febrile heat of skin,
the febrile crisis, the febrile sedimentary deposits, the febrile delirium ;
and in the malignant form, none of the febrile thirst is present. So
far then as our present notions of the essentials of fever go, the disease
in question, is entirely destitute of febrile characteristics ; and hence,
it is not only irrational, but absurd and false, to class it among mala-
dies, with which it has no affinities. But, ' our notions of what fever
is, are limited our views, contradicted.' Granted ; then so much
the more reason why we should not regard that to be fever, which
directly antagonizes those views. We must have some standard, or
none. If we erect a standard, we must, to preserve anything like
order in our science, rigidly adhere to that standard, until the demon-
strated falsity of it, and the truth of another, shall have become the
subject of general assent. Either bilious and typhoid are fevers, and
congestive not; or else congestive is, and they are not, all these
cannot at present be.

"While* however, there are some things of which we are ignorant,
some of which we have not unassailable opinions, there are, fortu-
nately, others which are fixed and definite, about which, we can
have no doubt. And, although there may be cavil and incertitude
about what fever is, we presume all will admit Dr. Fordyce to be cor-
rect in the definition of what fever is not. * When a disease of a
part of the body produces an affection of the whole system, in which
there are many appearances similar to those which take place in
fever ; if, upon removing such disease the affection does not immedi-
ately gooff: but begins to subside, and continues gradually to subside ;
such an affection cannot be called fever. '* Try the so-called conges-
tive fevor by the rule thus given by the best author on fever in the
English tongue, and what becomes of its febrile claims ! Upon re-
moving the cause of the disease, to-wit : the intense congestion of
the cerebrc-spinal system, and after counter-poisoning by quinine,
the affection does not immediately go off, but begins to subside, and
continues gradually to subside ;' and hence, we say with Dr. For-
dyce, 'such an affection,' thus relieved, 'cannot be called fever.'
Without entering into more extended argumentation then, we think
we may deduce, that the foregoing description effectually excludes
congestive, from the category of fevers. Derivants applied to the
extremities, abstraction of blood from the arm, or by cups from the
spine, followed by quinine, we have found, in all curable cases, to
induce the gradual subsidence into health, spoken of by Fordyce.
If then his definition be regarded as correct, we may not, unless dis-
regardful of truth and consistency, class the disease of which we are
speaking among the pyrexia. Where then shall we place it ; and
what shall we call it?"

In accordance with these opinions, Dr. M. applies to the disease

* Fordyce on Fever, (American Edition of 1823,) p. 14.

1846.] Western Lancet and Medical Library, Qc. 565

the name of "Toxical Apoplexy of the Cerebro-spinal system." We
quote his argument in favor o{ his position :

"The prime causes of this disease are, solar impression, atmos-
pheric vicissitude, and what we are agreed to call, malarious influ-
ence. The latter because of its observed effects upon the animal
economy, all consider to be of a poisonous nature ; hence, the propri-
ety of our prefix, 'Toxical.' But the name we have given conveys
another idea, great nervous lesion or disturbance. Now, the whole
history of an attack of the disease we are examing, we consider to
be this. An individual living in a malarious region, with his nervous
system thereby affected and oppressed, and his blood tainted by the
aerial poison, is exposed to some sudden morbid impression, the action
of a nervous depressant, cold, checking perspiration, intense solar
heat, or a violent mental emotion which completely, and speedily,
exhausts the powers of the nervous system. This exhaustion, by
weakening the tone of the blood. moving powers, congests the ex-
treme capillaries, thereby centering the mass of the blood internally,
producing a lesion of the cerebral, spinal and ganglionic systems,
apoplectic in character, as indicated by the respiration, etc., etc.,
which is superadded to the preexisting nervous depression. From
these conditions, by the inherent power of resistance of the system,
or by the aid of medication, the patient may recover in a degree ;
but, owing to the general exhaustion, the malaria becomes capable of
producing its intensest impression ; and acting without any other aid,
reinduces the state of collapse. That something like this last occurs
is evident from the fact, that the second paroxysm is infinitely more
strongly characterized than the first an occurrence that we can only
satisfactorily explain, by admitting a new depressant, to have come
into active employment. Hence, to cure, we must do one, or all of
three things; rouse the nervous energies, expel the poison, or nullify
it. The first, we do by the cold dash, the second, by full bleeding,
when it can be tolerated, and we effect the third, by the administration
of the appropriate antidote, sulph. quinine.

How do the symptoms we have narrated, accord with this patho-
logical view 1 To our mind, perfectly. The respiration of the patient
is always more or less apoplectic in character; and the pulse, during
the stage of reaction, presents evidence of an irritable, though weak
state of the nervous system such as often occurs after compressive
concussion of the brain. The interval between two paroxysms, ex-
cept in a few cases, is not of sufficient length to allow the powers of
the system fully to rally ; and hence we rarely find the intermissional
pulse, up to the natural standard. The feeling of fullness in the
central spinal region, often amounting to a dull pain, the obtuse
headache, the idiotic, besetted countenance, the external coldness, the
general suspension of the pr presided over by the nervous

cretion and excretion, all evince a profound sedation of
powers of the system, the nervous in particular, such as we find in

560 Western Lancet and Medical Library, <fyc. [September,

other cases, where that system is confessedly primarily engaged.
The malignant form of the disease, as it has occurred to us, has uni-
formly simulated the appearances of narcotic poisoning ; and usually
so closely* as would have led a superficial examiner to say, that a
narcotic had actually been taken. As regards the congestions of
the disease, we hold that there are usually three. The first is the
local hyperemia of the nervous system induced by residence in a
malarious region, which, after a time, so disturbs the balance of the
circulation, as to render it easy for any sudden nervous depressant to
set up the second, or congestion of the capillaries ; which, in its turn,
causes the third, or apoplectic congestion of the whole nervous sys.
tern. The first congestion is not necessarily an element of the dis-
ease ; nay, it is not commonly in the disease of new settlers in the
malarious district, for in them, the second congestion in order, is
almost always the first. And, if the emigrant be a person of broken
down constitution, and debilitated nervous system, the third conges-
tion, ox the essentia morbi, may be his first intimation that he is ill.
These last are the cases, where the patient is seized with a sudden
prostration of sense and motion, as though struck with a blow, and
rarely survives a second attack."

"Remarks on Epidemic Erysipelas," is the title of a short article
by W. H. Scoby, of Russellville, Ohio. The conclusions of Dr. S.
alone are given these we extract entire :

44 1. Erysipelas is not contagious, but is propagated by the inexpli-
cable laws of epidemics generally.

"2. The throat is primarily affected in a great majority of cases,
and is essentially a membranous inflammation.

" 3. The appearance of the disease upon the skin is favorable.

"4. The fever is of a typhoid, inflammatory, or mild character,
according to the constitutional powers of the patient.

"5. The treatment should be special, having reference to the ac-
companying fever, blood-letting should be practiced early, in good
constitutions, but in the majority of cases that I saw, it was not de-
manded. Solution of nitrate of silver appeared to moderate the
inflammation ; blisters had no effect ; the same is true of the tincture
of iodine. I am informed that some of the prdfession regard iodine
as useful, but it failed in my hands. Muriate of Ammonia did good
in some of the cases, as did also quinine, and wine and brandy, in
the sinking stage of those cases of a typhoid character. I derived
benefit from a syrup of polygala senega, squills and antimony, in
cases in which the respiratory organs were affected."

There is also an article on the Physical signs of pulmonary Em-
physema, by Prof. Samuel Annan, of Transylvania University, and
an interesting letter from Prof. Bartlett, who is now in Europe.
These we cannot now notice. We had intended to have noticed
other Journals at this time, but the extent of this article renders it
necessary to defer it for the present.

1846.] Scrofula. Mortality of Male Children, 567

BIBLIOGRAPHICAL NOTICE.

Scrofula ; its Nature, its Causes, its Prevalence ; and the Principles
of Treatment: By Benjamin Philipps, F. R. S., Assistant Sur-
geon to the Westminster Hospital. Illustrated with an engraved
Plate. Philadelphia : Lea & Blanchard. 1846. pp. 350, 8vo.

Since our extracts from a foreign Journal of a notice of this work,
we' have received a copy of an American edition, issued by the cel-
ebrated Publishers of medical books in Philadelphia. We need only
to add, that this volume is presented to the profession in the usual
excellent style of Messrs. Lea & Blanchard, and being not only the
most recent, but certainly the best work on a most interesting and
important subject, must command general attention.

PART III. MONTHLY PERISCOPE.

On the excessive Mortality of Male Children. Dr. Emmerson
observes that, ever since correct mortality registers have been
kept, a larger proportion of males have been found to die in the
early years of life than females. In Europe, the male births exceed
the female ones by about 5 or 6 per cent., and in Philadelphia by
more than 7 per cent., and yet the number of boys and girls are
found very near equalized by the 10th year, while by the 15th, the
females out-number the males almost as much as the latter did the
former at the time of birth. In Philadelphia the deaths of boys to
the 15. h year exceed those of girls by about 15 per cent.

Upon examining the question more in detail, Dr. E. found that
inflammation of the brain and its consequences, convulsions, hydroce-
phalus, and inflammations in general, were the diseases which espe-
cially proved fatal to mile children, while pertussis, scarlatina and
phthisis were those which proved generally fatal to female children.
That is to say, that the males perish from the sthenic, the females
from the asthenic, class of auctions. On examining the London
Tables he found the same disposition nearly prevailed, and the prac-
tical deduction he draws from the whole is, that the treatment of the
diseases of males should be more prompt and vigorous than that of
those of females.

The result of his observations upon temperature leads him to con-
clude that the hot months in America act as injuriously upon infantile
life as do the winter ones ; but that, after the child has weathered the
first few months of its existence, neither the one nor the other seems
to especially determine mortality. [American Jour. Med. Sciences,
from Medico- Chir. Review.

568 Granular D is ease of the Pharynx. Opiates. [September,

On the Granular Disease of the Pharynx. During a year or so
IhatM. Chomel's attention has been directed to this affection he has
seen, or collected accounts of, about 30 cases. Of these, none has
been observed in persons younger than 15. Of 22 cases occurring
in his own practice, 17 were males, most of them (like women sub'
ject to uterine granulations) being also liable to herpetic eruptions,
and especially to acne. In most there is also a peculiar form of the
palatine arch, narrowing the nasal fossae, and contracting the lips, so
that these are never completely closed. Such persons sleep with the
mouth half open, and awake with it in a very dry state, the pharyn-
geal follicles becoming, under these circumstanees, excessively de-
veloped, in consequence of the constant evaporation of the buccal
fluids produced by this contact with the air. Thus, also, the persons
in whom the complaint is most frequently met with, are those who
employ their vocal organs considerably, as orators, singers, advocates,
professors, &c.

The affection usually comes on slowly, and excites little uneasiness
at first, save from the constant hawking it gives rise to. This some-
times becomes quite sonorous, and is accompanied by involuntary
attempts at deglutition, and if the irritation is propagated to the oeso-
phagus, a frequent desire to drink. There is a dryness or itching in
the pharynx, and the voice is more or less affected. The expectora*
tion consists of transparent viscous globules of a slight opaque tinge,
or streaked black or slate color. On examination, we find the pha-
rynx covered with little red points the size of hemp-seed, but some-
times being much more voluminous. They may he grouped into
arabesque-like forms, into little discs, or as nipple-shaped projections.
Granules are also usually found upon the palate and uvula, but then
they are more discrete. The mucous membrane retains its normal
characters.

The course of the disease is always chronic and remitting, it being
especially troublesome in cold and damp weather. It never sponta-
neously disappears, and often obstinately resists treatment. Of 14
cases which M. C. had occasion to see at more or less remote periods
after treatment, but 4 remained cured, the others being only relieved.
The diagnosis of the affection is easy enough, as it obviously consists
in hypertrophy of the numerous muciparous follicles of the pharynx.
In treating the disease, M. Chomel has tried all descriptions of as-
tringent gargles, &c, with but indifferent success, and when it proves
obstinate, cauterizing the mucous membrane is the only means likely
to prove serviceable, fluid caustics having been found more useful in
his hands than solid ones. [Gazette Medicate, from Ibid.

Opiates to Children. "Thus we have three druggists, all of ac-
knowledged respectability (!) in one district of Manchester, soiling
respectively five and a halfj three and a half, and one in all, nine
gallons weekly, two of them testifying that 'almost all the families'
of the poor in that district habitually drug their children with opiates,

1846.] Ammonia as a Remedy in Asthma, 569

and the third, after a lengthened examination of all the customers
who attended a pawnbroker's shop, kept by a relation of his own,
giving as a statistical result, that five out of six families in his dis-
trict were in the habitual use of narcotics for children."

In Rochdale and other towns, similar evidence is given. " A. B.
is in disgust at the assertion that the practice prevails to a great extent
in Rochdale, stating as the result of his inquiries, that out often fam-
ilies of the operatives, not more than six are in the habitual use of
opiates;" while another druggist, who also had abundant opportuni-
ties of knowing the custom, consider "one third of the working peo-
ple used these sleeping-stuffs." At Clitheroe, 4,000 poppy heads are
annually sold for making "sleeping tea" for children. In Rochdale,
the poor, finding Godfrey and Dalby (society will heavily curse these
men some day) too expensive, have got into the practice of buying
at a time a pennyworth of solid opium, and a pennyworth each of
anise and caraway seeds; these they boil with sugar and treacle, and
dose the children with the mixture. And so Dr. Playfair goes on
with fact after fact all alike, yet all different; dwelling upon them
with a praiseworthy but sickening minuteness. The little victims,
with a wonderful precocity, are described as stretching out their tiny
hands for the bottle, "for they know it, and when they get it, drink
it as eagerly as a drunkard empties his glass!" Equally deplorable
is the description given by a druggist, who says, " I have seen the
little children in the shop put the neck of the bottle in their mouths
and bite the cork, so fond are they of the preparation ; for, coming
to the shop so often, they know the bottle !

Dr. Playfair found it difficult to write as calmly as became a com-
missioner upon such facts as these." [Brit, and For. Med. Rev,

Ammonia as a Remedy in Asthma. M. Rayer has recently pub-
lished his experience of the effects of strong water of ammonia appli-
ed to the velum palati for the cure of asthma. M. Monneret and
others have previously employed this mode of treatment, but they ap-
plied the caustic to the back part of the pharynx, and in some instan-
ces death had nearly ensued from suffocation, owing to the action of
the volatile alkali on the glottis. 31. Rayer's method of employing
this remedy is as follows : He dips a roll of lint, about the length
of the middle finger, in a mixture of four parts of strong aqua ammo-
niae and one of water, pressing out the superfluous liquid, and imme-
diately applies it for a few seconds to the velum palati, as if about to
cauterize the part. The patient is immediately seized with a feeling
of suffocation ; a fit of coughing ensues, with much expectoration,
and this is soon followed by a great feeling of comfort and facility of
respiration. Should any return of the fit occur on the day following,
the ammonia is again applied. The degree of tolerance of this rem-
edy by patients varies very much ; it is, therefore, always well to
use it weak at first, which is easily done by moving the piece of lint,
dipped in the solution, three or four times rapidly through the air,

570 Hooping Cough. Puerperal State. [September,

and then smelling it, when the strength is readily ascertained. In
M. Rayer's experience, extending to over a hundred cases, a single
application rarely failed to afford relief, and in many instances pre-
vented a return of the attack for three or four months. This mode
of treatment is alone applicable to simple or idiopathic asthma, that
form which is so often dependent on emphysema, and is attended
with catarrh; it has, nevertheless, afforded relief in some cases of
symptomatic asthma. [Annates de Therapeutic de Rognetie, from
Bulletin of Med. Science.

. Nitrate of Silver in Hooping. Cough. The following mode of
treating hooping-cough has !>een very successful in the hands of M.
Berger. In the first stage he employs moderate antiphlogistic treat-
ment, purgatives and repeated emetics, particularly ipecacuanha in
combination with tartar emetic. In the convulsive stage, in which
the indication is to combat nervous irritation, not being satisfied with
the results that he obtained from the use of the remedies ordinarily
employed, he was induced to administer nitrate of silver, the effects
of which, he states, are singularly beneficial. He prescribes it in
doses of from a sixteenth to a twelfth of a grain three times daily at
first, and afterwards four times a day ; of course, it should not be
given in cases where the state of the digestive organs contra-indi-
cates its employment. [Annuaire de Therapeutique, from Ibid.

Management of the Puerperal State. In M. Piorry's ward at La
Pitie are women suffering from fever producing eschars on the sa-
crum, and others brought from the Maternile laboring under puerperal
peritonitis, and yet, although the ceiling is low and the beds crowded,
no instance of phlebitis, phlegmasia dolens, or peritonitis, putting on
the dangerous character so common in the puerperal state, has ever
been observed among the women delivered therein during the ten
years he has had charge of it. In this same ward five women have
been brought from a maison d'acouchcment suffering from utero-
peritonitis, and of these three died. At the Maternite the mortality
has been such as to lead to the distribution of the remaining patients
among the other hospitals. M. Piorry, regarding any ill effects
which may result from the admission of cold air as minor evils, has
all the windows, however, near the heds, kept wide open and the bed-
curtains drawn back, taking care, however, that the woman's expos-
ed person does not become subjected to the currents. Immediately
after delivery, he orders the vagina to be carefully injected with tepid
water every hour or two. He has the abdomen rubbed with olive
oil, orders good diet, and keeps the bowels open with aperients and
enemata. He thinks lying-in women should be admitted into the
general hospitals, and not congregated together in special ones.

\Gaz. des Hopileaux, from Med. Chir. Rev.

1846.] Prolapsus Ani. Fracture, $c. Diseases of the Eye, 571

Extract of Nux Vomica in Prolapsus Ani, Prolapsus ani, so
troublesome a complaint in the young after diarrhoea, &c, and so
often rebellious to treatment, M. Barez says he has succeeded in ea-
sily removing by means of an aqueous solution of nux vomica. His
formula is this: four scruples of salep are boiled for twenty minutes
in three ounces and a- half of water, and after being strained there
is added three-fourths of a grain of the aqueous extract of nux
vomica. A spoonful of this mixture is given at intervals, so that the
whole is taken in 24 hours. [Edinburg M. <fy S. Journ.

Fracture of the lower end of the Fibula. M. Robert recommends
the following means of distinguishing this accident from a sprain of
the ankle-joint, after waiting two or three days for the swelling to
subside, if necessary. Apply one thumb upon the external malleolus
and the other over the supposed fracture, and transform the fibula
into a lever, having its fulcrum at the inferior perineo-tibial articula-
tion. A certain degree of pressure is to be exerted by the thumb on?
the malleolus externus. If the fibula is uninjured, its entire length rs
felt to slightly and uniformly bend under the pressure; but if there
be a fracture, the lower fragment moves more or less, and projects
under the finger, so that even its form may be distinguished. The
fracture in these cases is almost always oblique from above down-
wards and from behind forwards, occurring at only a short distance
from the ankle-joint.

Mr. R. observes that the fracture may thus always easily be de-
tected, and is surprised the mode has not occurred to others. Dupuy-
tren was not aware of it, but used to seize the leg with one hand and
the foot with the other, which means will however only suffice to
detect a fracture when situated at a considerable distance from the
malleolus. [Gazette des Hopitaux, from Medico-Chir. Rev.

On the Use of Turpentine as a Collyrium in various Diseases of
the Eye. By Dr. Laugier, Surgeon of Hopital Beaujon. M. Serres
D'Alais having mentioned to Dr. Laugier the success he had met
with in the application of the Essence of Juniper to the eye in
chronic keratitis, with an anormal development of the corneal and
conjunctival vessels, it occurred to him that Venice Turpentine might
have a like good effect in similar cases, and he therefore gave it a
trial upon several cases of acute; and chronic conjunctivitis, keratitis,
&c, he had under his care. All these patients were already using
the nitrate of silver lotion, and the substitution of the turpentine was
attended with marked benefit. Other cases have also been treated,
and justify the author in declaring the utility and harmlessness of
this remedy. He has also found it of service in opacities of the cor-
nea. M. L. allows that his experiments with this lotion have not
yet been frequent enough : but they have been sufficiently so to jus-
tify his publication of their results. " After various trials he has found
the following formula that best adapted for use, although some pa-
tients can bear the pure essence without any admixture.

572 Paralysis. Epistaxis. Iodine, fyc. Sfc. [September,

\enice Turpentine, 20 parts,

Essence'of Turpentine, 10 parts.
Place the turpentine in a marble mortar and gently heat it; and
when it has become fluid, add the essence gradually. Drop three or
four drops into the eye night and morning. [Arch. Gen., from Ibid.

Local Paralysis from Pressure. A woman under M. Guerard's
care has complete paralysis of the fore-arm and hand, from using
crutches for a fortnight. During the few days the patient has kept
her bed the finders have somewhat regained their motility (Gaz. des
Hop.) M. Pigeolet relates the case of a person who having slept
during a journey with his arm compressed between his head and the
edge of a carriage, it became paralyzed for six weeks. Every kind
of counter-irritant was unavaiiingly tried until an embrocation, com-
posed of ol. oliv. and a few drops of tr. lyttte, was prescribed, which
was speedily successful. An Italian surgeon has also of late met
with several cases in which paralysis has been induced by lying upon
the arm in bed. [Gaz. Med., from Ibid.

Compression of the Carotid in Epistaxis. Two cases are related
in which obstinate epistaxis was effectually arrested by tpmporary
compression of the common carotid artery. [Gaz. Med. Chir.,
from Ibid.

Endermic use of Iodine. Dr. Diver recommends the following
formula as an excellent application in scrofulous enlargement of the
glands of the neck. R. lodin. 1 p., Bals. Canad. 3 p. Picis Abietis
3 p. Triturate the Iod. with the B. C, and melt the pitch at a gen-
tle heat, mixing the whole together just as it is about to cool. Spread
on kid for immediate use. [Phil. Med. Exam,

Extemporaneous Vesication for Endermic Medication. Place a
piece of silver money on a plate, and lay upon it two circles of old
linen of rather less diameter. Saturate these with liq. ammon. and
then apply the apparatus, with its linen surface downwards, to the
skin, and maintain an equable pressure with the finger. In 10 min-
utes the skin is observed to redden at the circumference of the mo-
ney, and on the apparatus being removed vesication will take place.
[Bulletin de Therapeutique. from from Medico-Chir. Rev.

M. Tuson, Surgeon to the Middlesex Hospital, London, has found
the following ingredients serviceable in many tumors of the breast :

Plaster for Tumors of the Mamma. "Mercurial ointment, one
ounce; gum ammoniacum, six drachms; extract of deadly night-
shade,four drachms ; prussic acid, one drachm: reduce the gum to
a fine powder, and with the extract and a lit'lc water form a thick
mass, and then add the ointment previously mixed with the acid, and

1846.] Scrofula. Prescriptions. Arseniateof Quina. 573

unite them by means of a pestle and mortar. This composition is
to he thickly spread upon leather, and a piece cut to the size of the
tumour and applied carefully over it."

New Compound of Chlorine. Iodine and Mercury, in Scrofula
Mr. Rochard has communicated to the Academic des Sciences, Paris,
a paper entitled "Trial of a New Compound of Chlorine, Iodine and
Mercury, in the treatment of Scrofulous Affections."

The author reports a considerable number of cases, the results of
which seem to him to prove that this composition, which M. Boutigni
has made known, and designated by the name of " iodhydrargiriie
dp chlorure mercureux," exercises an efficient action in scrofulous
affections of the most serious character, and also in inveterate cu-
taneous diseases. He states that after having obtained some rapid
cures in psoriasis lichen, chronic eczema, herpes, maculae. &c, the
idea occurred to him of extending its employment to the treatment of
scrofula. He cites, amongst others, some successful cases of white
swelling, with caries, and fistulous canals; of numerous enlarged in-
durated or ulcerated ganglia; of chronic ophthalmia, complicated
with ulcerating keratitis; of ulcerated lupus; of goitre; and finally
of large scrofulous abscesses, succeeding to an anti-syphilitic treat-
ment. In these several cases the action of the remedy was quick and
permanent, though varying in the various forms of the disease. M.
Rochard employs the medicine externally in the form of ointment.
[Prov. Med. and Surg. Journ. from Gaz. Med. de Paris.

ANODYNE PILLS.

ft. Opium, gr. j.

Golden sulphuret of antimony, . . . gr. j.

Nitrate of Potass ij.

Syrup, q. s. Make one pill.
These pills are recommended by Recamier as a substitute for
Dover's powders.

ANTI-SYPHILITIC BOLUS.

R. Sub-mur. hydrarg gr. ss.

Ext. Cinchona, gr. x.

Opium, gr. ss.

Ptilv. cinchona, q. s. Make 1 Bolus.
These pills are highly recommended by Dupuytren in the treat-
ment of syphilis, the opium and bark being considered as aiding
materially the action of the mercurial. One pill may be given twice
or thrice a day.

Arseniate of Quina. This salt, first prepared by M. Bourieres,
has latterly been much used in France in the treatment of obstinate
intermittent!, and. it is stated, with much success; the chief obstacle
to its more general employment being, according to Dr. Boudin, its

574 Aphorisms in Medicine. [September,

extreme bitterness. (Annaire de Therapevtique, 1846.) It is read-
ily prepared as follows : Dissolve half an ounce of sulphate of quina
in boiling water, and precipitate it with ammonia; wash and dry the
precipitate, and dissolve it with the aid of heat in three ounces of
distilled water, containing two scruples of arsenious acid in solution ;
as the solution cools, crystals of arseniate of quina are deposited,
which are to be dissolved in distilled water, and recrystallised. It is
a light, white salt, crystallised in brilliant satinny needles. It is
soluble in water, but more so in boiling than in cold water; it is also
soluble in weak alcohol, but is insoluble in absolute alcohol or in ether.
The dose of it is from one to two grains in divided doses in the course
of twenty-four hours. It is usually given in solution in distilled
water, to which a little simple syrup may be added.- [Journal de
Chimie Medicale.

Aphorisms in Medicine. We extract the following aporisms from
Von Dr. F. Pauli, of Leipsic:

A medical journal is wanted which should communicate only casear
that have ended unfavorably. It would be of more service than a
number of others.

In all medical narratives the subjectivity of the observer plays its
part, and injures the objectivity.

One hears often of favorite medicines ; but can disease have to-
day a partiality for one medicine, to-morrow for another? Partiality
is a weakness in men. Partiality in science arises from defective
knowledge and one-sided views.

Thick darkness besets the subject of etiology. Not (infrequent-
ly causes are found for diseases which, after a time, are found to be
completely false. How often are colds and wettings cited as causes
of disease! In the course of the musical festival which took place
in the Palatinate, under the direction of Hofzollmeister Frank Lachna,
a party of at least 20.000 was assembled near the ruins of Magde-
burgh castle. The whole of them, with scarce an exception, were
wet through without any disease ensuing, as many feared there would.

In stomatitis, peppermint drops allowed to melt in the mouth pro-
duce a feeling of coolness, and are a good palliative.

Cold foot-baths at bedtime are a valuable remedy in that sleepless-
ness caused by loss of blood.

Ergot has such a specific action on the uterus that it should be
more variously employed. In painful menstruation, accompanied by
spasms, it acts like a charm, as also in the eclampsia of childbed.

Specific medicines are generally too little employed Thus tinc-
ture of cantharides, judiciously employed in retention of urine froro
cold, and where no organic diseases exist, will often obviate the
necessity of catheterism.

Persons, especially men, who eat and drink freely, are threatened
with apoplexy when, though their general embonpoint remains, their
arms and less bejrin to waste.

1846.1 Suit for Malpractice. 575

The therapeutic skill of many physicians consists in prescribing
oleum jecoris aselli. Would it not be well henceforward to name it
oleum jecoris asini ?

I would lay down the following as an axiom which may be easily
proved: " In every local inflammation, unaccompanied with fever,
general bleeding, if not absolutely hurtful, will be at least useless.
Half the cases of ophthalmia are examples of this.

Not unfrequently medical men repent of their choice of a profes-
sion ; this arises from their being unable to find a compensation in
the science for the daily toil in the practice of their art. A physician,
to be happy, must love science with the admiration of a lover. She
must fill his whole soul ; she must be incorporated with his whole
being; and then she will daily appear to him new and interesting.
Medicine is exciting, precisely because no man can ever arrive at a
complete knowledge of her; and in this she differs from sciences
which are complete in themselves. Whilst in them at best one
yawns over quiet undisturbed possession, in medicine there is daily
new life, new excitement. I shudder when I fancy myself a jurist
or a theologian. Heinrich Heine says somewhere, the Frenchman
loves liberty as his bride, the Englishman as his wife, and the Ger-
man as his grandmother. I say that jurists, mathematicians, theo-
logians, &c, can at most love their science as a wife ; to the physi-
cian alone is it granted to love his as a bride with all the ardor of
first love. [British and Foreign Med. Rev.

Suit, for Mil -practice. Another case of prosecution for mal-
practice has heen reported in the Boston Medical Journal, in which
(the parties residing in New York) the defendant was triumphantly
acquitted. The case was a comminuted fracture of the femur near
the condyles, in a man of bad constitution, aged 64 The result was
that the leg was shortened two, or two and a half inches. The de-
fendant was sustained by the testimony of Drs. Parker, Reese, Post,
Wood, Mott, and Cheesman. Some parts of the testimony of these
men deserves to be recorded, as remarkable for its clearness and truth
"truth," we say, because there arc not a few surgeons of less ex-
experience and reputation than either of the above surgeons, who
never, if their assertions are to be believed, make shortened limbs ;
and who consequently arc always prepared to bear testimony against
their less fortunate neighbours.

Says Dr. Reese, "there could be no doubt that it was an oblique
and comminuted fracture, which is always unfavourable and renders
a shortening of the limb inevitable."

Says Dr. Post : In all such cases a very considerable shortening
of the limb takes place under the best treatment."

Dr Cheesman "found the limb shorter than the other, as it uni-
formly is in such cases. He never knew an exception."

Dr. Mott testified that " more or less shortening of the limb is the
result after fractured thigh, even in the, most favorable circiunsfances.

Prof. Parker, thought " the patient was exceedingly well off to

576 Medical Intelligence. Meteorological Observations.

have recovered from such an accident with both his life and limb, and
with no other disaster than a shortened leg." Buffalo Med. Journ.

MEDICAL INTELLIGENCE.

Dr. John Le Conte, of Savannah, one of the able collaborators of this Jour-
nal, was elected Professor of Natural Philosophy and Chemistry in Franklin
College, University of the State of Georgia, located at Athens. We consider
the Doctor eminently qualified for his new duties.

Dr. H. V. M. Miller, of Cass County^ we have incidentally learned, has
been appointed Professor of Obstetrics and Diseases of Women and Infants, in
the Medical College at Memphis, Tennessee; This too, will no doubt prove a
very judicious selection.

. t+i

A New Truss. Dr. B. W. Hard, of Charleston, S. C, has within a few
days, presented us a Truss, having the block or hernial pad mounted on springs.
Four ordinary spiral springs sustain the pad placed upon the internal ring or
opening in the abdominal wall, and this secured to a common spring and strap
around the hip, allows free motion of the body, without the intestine or omentum
being so liable to protrude. We are promised in our next number, further re-
marks on the subject.

METEOROLOGICAL OBSERVATIONS, for July, 1846, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

c

Sun Rise.

3, P. M.

Wind.

Remarks.

Ther.

5AR.

29 55-1 001

Ther.
~88~

tJAR.

29 56-100

~1

70

s. w.

Fair some clouds.

2

71

" 62-100!

82-

" 57-100

S. E.

Fair light showers.

3

80

" 64-1001

86

64-100'

S. E.

Flving clouds a light shower.

4

72

" 75-100

82

" 73-100

s. w.

Cloudy, 1 do. [and -10.
Rain, $ 1 day & 2 nights, 2 in.

5

72

" 73-100

79

" 69-100

s.

6

71

': 53-100

88

" 62-100

x. w.

Fa ir flying clouds.

7

69

" 67-100

88

' 71-100

N. W.

Fair, ' do. thunder.

8

72

" 70-100

90

" 70-100

N. W.

Fair.

9

70

" 72-100

90

" 75-100

N. E.

Fair flving clouds.

to

71

" 80-100,

90

" 84-100

S. E.

Fair.

u

71

" 92-100,

90

" 91-100

S. E.

Fair cloudy in afternoon.

12

72

" 88-100:

91

" 83-100

S. W.

Fair.

13

75

" 77-100

88

" 70-100

S. W.

Fair flying clouds.

14

72

" 70-100,

92

" 77-100

W.

Fair, do. [from n. w.

15

72

" 86-100}

70

" 89-100

N. E.

Rain 4-10 in. storm at 5, a. m.

11")

68

" 86-100.

76

" 89-100

E.

Cloudy. [die ot day.

17

62

" 92-100

66

90-100

N. E.

Misty fire comfortable in mid-

18

60

93-100

66

" 95-100

N. E.

Mist' and rain 2-10 of inch.

19

56

" 85-1 00|

75

" 78-100

W.

Fair.

20

61

" 71-lOOj

66

72-100

E.

Rain.

21

62

" 75-100

81

" 76-100

S. E.

Fair flying clouds.

22

66

" 81-100
11 78-1 OO!

85

" 81-100

N. E.

Fair flying cl'ds in afternoon.

23

69

88

" 74-100

S.

Fair fllying clouds.

24

72

" 72-100;

93

" 72-100

W.

Fair, do. breeze.

25

73

;< 77-1001

94

:' 77-100

w.

Fair flying clouds.

26

74

" 83-100

86

" 83-100

w.

Cloudy thunder.

27

70

" 83-100

80

" 80-100

w.

Do. do. sprinkle.

28

70

80-100

89

" 76-100

S. E.

Pair rain in afternoon 2-10.

29

72

" 78-100

90

" 74-100

S.

Fair thunder in afternoon.

30

71

" 73-100

88

68-1 Or

s.

Pair cloudy in afternoon.

31

72

" 76-100

89

" 65-100

S. E.

Fair do. do. and sprikle.

21 Fair days. Quantity of Rain 2 inches and 9-10.
14 days. West of do. 13 days.

Wind East of N. and S.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. i] NEW SERIES OCTOBER, 1S46. [Hto 10.

PART L ORIGINAL COMMUNICATIONS.

ARTICLE XXXVI.

Prarfical Observations on Cutaneous Diseases Resolutive Power
. of the Skin Eczema Pityriasis, <*c. By H. F. Campbell,
M. D., Demonstrator of Anatomy in the Medical College of
Georgia.

"In the August number of this Journal, will be found an article on
Lupus, with a similar caption to the above, it being my design tore-
port from time to time whatever may occur under my observation of
interest in this brancfi of practical medicine, without reference to
any regular order, as such would necessarily involve a much longer
time and the collection of a greater number of cases, and in reality
possesses no advantage over the desultory report of cases in a period-
ical like the present, devoted to practical purposes.

Since the days of Hippocrates, the resolutive power of the skin
over internal disease has been known, and in some measure appreci-
ated,* and there are but few cases wherein the phenomena of cutane-
ous disorder can with propriety be termed idiopathic, the origin of
which, if carefully investigated, will not be found due to some internal
derangement of the system. The constant antagonism between the
functions of the skin and those of all the other secernm:; organs,
renders it peculiarly obnoxious to disease, and frequently this substi-
tution which is indeed a wise provision of nature, results in the entire
solution of diseases oftentimes the most alarming and obstinate. So
intimately blended is the study of this class of Diseases with general

* "Which solutions," he says, " are announced by tubercles, tumour*, pustules,
ulcers, alopecia, &c, in proportion to the rapidity of the development of
which, is that of the solution itself in any given case." Rayer on Diseases of the
Skin. J. Bell, M. D.

37

578 Observations on Cutaneous Diseases, Sfc. [October,

Pathology that the prudent Dermatologist will be ever cognisant of
the internal condition of his patient, examining every indication with
circumspection and even curing with a degree of caution, for fear of
establishing some visceral lesion of a graver nature than that for
which his attention is solicited- So frequently indeed, does the skin
take upon itself the solution of internal derangement, that there is
perhaps nothing more familiar to the general practitioner in his in-
tercourse with the sick and their attendants, than the oft-repeated
solicitation, " to give something to drive the disease to the sur-
face," and in truth we might often find our advantage in attending,
at least occasionally, to the ingenuous suggestion, for it is not infre-
quent to notice the most marked relief by the efflorescence of the
different exanthemata, from the distress immediately preceding their
attack, and on the other hand the increased disturbance upon their
subsidence. So with regard to the more chronic forms of cutaneous
disease: we find them almost invariably the result of some internal
irritation, and however obscure it may be, perhaps almost inapprecia-
ble at first, still a continued and systematic investigation of the
cases will almost invariably result in the final detection of the true
seat of the disease in some one of the internal organs, the derange-
ment of which keeps pace in an inverse ratio with the degree of
intensity of the endermic aberration. Of this fact the daily experi-
ence of every practitioner furnishes abundant testimony, and which
the few cases reported herein will tend in soma measure to corrobo-
rate, showing, that such diseases, while they may be much benefitted,
and often entirely cured, by the external application of remedial
means, are perhaps more safely treated by the administration of
constitutional remedies, and that in some cases, at least, it is even
dangerous to the well-being of the patient, to treat them exclusively
upon the topical plan. The following cases I have reported, not so
much for any novelty in themselves, but more for a peculiarity in
their origin, which in a striking degree goes to establish a pathological
fact which, in itself, may not be wholly devoid of interest to the
profession.

Eczema. Eczema is perhaps of all the vesiculae the most common.
Dr. John Bell, in his excellent edition of the work of M. Rayer, on
Cutaneous Diseases, quotes the following from Mr. Phillips's lectures
on Surgery : " Of the diseases of the scalp which I have been called
upon to treat during the last twenty-eight months, amounting to
above 280 cases, more than 180 were cases of eczema." It is found

1846.] Observations on Cutaneous Diseases, <$*c. 579

to attack subjects of all ages and conditions, and though in itself, a
disease generally comparatively easy of management, from the fre-
quent errors in its diagnosis it is often rendered most formidably
obstinate. The difficulty in the diagnosis of eczema, when compared
to other affections of a similar nature, arises most probably from the
great variety of form under which this disease is found to manifest
itself, and in manv cases, the productions of the disease, from being
allowed to remain upon the affected part, become altered in their
characteristic appearance, and by their collection, serve to obscure
the peculiar diagnostic characters of the vesiculae again; we fre-
quently find all the different degrees of the disease presenting them-
selves in a single case, and moreover, the disease in its different stages
often differs widely from what marks it, in its simple and uncompli-
cated form, as described in most works on Dermatology. Under
these circumstances, although most of the affected part may be so
obscured as to be scarcely discernable, still there are always certain
districts, most frequently around the edges of the furfuraceous crust
marking the disease, in which the elementary vesicle may be easily
recognized, and it is this precept of modern dermatologists which
greatly facilitates the diagnosis of this disease. It is advised careful-
ly to bathe the parts under these circumstances, or to remove the
crusts by fomentations upon which the vesiculae will be readily re-
vealed. Eczema is a non-contagious affection, characterized by
innumerable vesiculae of various sizes, occurring either in groups or
sparsely, on certain parts of the body, or upon the cutaneous surface-
generally : it may be either chronic or acute, and lastly, it may be
constitutional, or only the result of external irritation. The etymol-
ogy of the term (derived from the Greek word ex^eiv, signifying to
boil forth) should awaken our suspicions as to the most frequent
origin of the affection ; and verily there is, perhaps, no happier
application of a term in the whole nomenclature than the present, for
it is under this form of cutaneous elimination, that certain internal
disorders are found most frequently to evince themselves externally;
and further, we are at once supplied with a valuable suggestion as to
the treatment of the disease in most cases viz. that it being often-
times an effort on the part of the skin to relieve some important
internal organ from irritation and impending disease, we should not
overlook the constitution of the patient in the application of our cu-
rative management : and that such is almost invariably the case, daily
experience and a sedulous attention to the details of cases, most

580 Observations on Cutaneous Diseases, 6$c [October,

plainly inculcate. The affection seems to depend upon some anormal
modification in the fluids of the animal economy, rendering the tis-
sues in certain localities prone to disease, which the skin, either from
some accidental irritation, or by virtue of its restorative function,
either wholly or in part eliminates under the peculiar form of vesicu-
lae which characterize eczematous effusion.

These cases, though but one of them is eczema, I could not well
avoid noticing, as they are so intimately connected in their origin
with the disease under consideration, and are also illustrative of the
internal origin of cutaneous disease by the resolutive quality of the
skin.

In the summer of 1839, when our city was the district of yellow
fever, Mrs. J. was the subject of one of its most violent attacks, and
in the course of the treatment adopted in her case, she was very deep-
ly salivated with mercury; the effects of the ptyalism upon the
glands ofthe mouth remaining during the entire period of her con-
valescence. After her recovery from the fever, she was affected
with mercurial ulcerations upon different parts of the cutaneous
surface which would commence under the form of small bullse,
afterwards ulcerating. Of these, under judicious management and
change of air, &c, she was finally relieved, though her constitution
still bore evident marks of mercurial detriment manifested by occa-
sional swelling and puffiness of the face, and a certain degree of
glandular irritation, and even now, so long a time elapsed, her con-
stitution has not recovered its wonted tone of health.

At the time of her attack, Mrs. J. had a child about six months old,
which, upon her recovery, she resumed nourishing by the breast.
This child, a boy, shortly after became affected with pityriasis capitis
of a very severe nature, and which, though subjected to very active
treatment, has persisted ever since, with only an occasional mitiga.
tion in its intensity, and this is always followed by inflammation of
the eye-lids and a discharge from the external meatus. The child is
now about eight years old, and, with this exception, of remarkably
robust and vigorous health.

Since her salivation, Mrs. J. has had three children : the first was
very feeble and did not long survive. The second, in a few months
after its birth, became affected with eczema capitis. The particu-
lars of this case I will report, as it was the subject of treatment under
my own observation, and also in some mea-ure, points the danger of,
suddenly removing these affections by a plan of treatment wherein

1846.] Observations on Cutaneous Diseases, <fyc. 581

the constitution of the patient has not long enough been the subject
of our remedial attention.

M , a girl child, aged about eighteen months, had been affected
with eczema of the scalp for some time, and had been subjected to
various plans of treatment, both under the care of physicians and by
the various popular patent nostrums presented to her parents by the
recommendation of friends and by advertisements. When I saw her,
her general health was pretty good with the exception of occasional
diarrhoea. The scalp-was covered with a thick crust, interrupted
throughout its extent with frequent cracks down to the skin, which,
on being exposed, appeared very, red and inflamed. Around the
edges of this crust, the elementary vesiculae of eczema rubrum could
very easily be recognized ; and upon its removal by a poultice or
warm douche, the scalp was found covered with them. The pruritus
sometimes very troublesome.

Treatment. Prescribed 3 grs. of hydrarg. cum creta, to be taken
every night for a week afterwards 5 drops of Donovan's solution
of the iodide of arsenic and mercury to be continued three times
daily in a syrup of sarsaparilla, unless contraindicated by gastric or
intestinal irritation.

As an external application, an ointment of the iodide of sulphur in
proportions of 15 grs. of the iod. sulph. to the ounce of lard, was
applied twice a day, previously washing the scalp well with castile
soap and warm water. An oiled silk cap was constantly worn to
promote and to retain the cutaneous exhalation which by keeping the
surface moist, acted in some measure as an emolient poultice. Under
the above treatment, the case improved very rapidly ; the vesiculae
became more sparse, and the highly inflamed state of the general
surface of the scalp changed to its natural color and appearance.
The deposite upon the surface was but inconsiderable.

Shortly after the improvement in the disease, and without any ap-
parent external cause, the child became affected with bronchitis, and
the inflammation ran so high as to endanger the life of the patient.
The eczema still continued in its improved state, notwithstanding the
fever of the bronchitis which was treated upon the usual plan, a
blister to the chest being necessary, which acted effectually in re-
lieving the inflammation in the mucous membrane of the lungs.
During the bronchitis, the treatment of the eczema was of course
interrupted, but without any aggravation of the disease, which was
afterwards entirely relieved by the administration often drops of the

58*2 Observations on Cutaneous Diseases, fyc. [October,

liquor potas>ae, ter die, in a syrup of sarsaparilla, continued for three
or four weeks, and externally was applied the following lotion :
R. Hydrocyanic acid, . . 3iv.

Acetate of lead, . . grs. xv.

Alcohol, 3iv.

Water, iviii.

Mix, and apply three or four times daily. Recommended by Dr. A.
T. Thompson, in impetigo.

Since her recovery some months have elapsed, and there has been
no return, though there is a remarkable irritability in the general
cutaneous surface evinced by the frequent eruption of varicella
upon any intestinal irritation, or upon the appearance of the teeth.
The last child of Mrs. J., soon after its birth, also evinced a re-
markable tendency to furfuraceous inflammation in the scalp, but
as it became older and more robust, this spontaneously subsided.
She has four other children, born previous to her salivation, remark-
able for the clearnesss and beauty of their complexion, as well as
their entire exemption from all endermic vitiation.

Remarks. Above I have briefly sketched four cases of cutaneous
disease, each differing in character from the others, each assuming
a form milder than the preceding, and this as it became more and
more remote from the common constitutional modifying cause that
evidently gave origin to the whole of them. Thus, we find the mo-
ther, in the first instance, manifesting the constitutional detriment
from the salivation by the frequent occurrence of hydrargyric ulcera-
tions, some of which required months to relieve, the first child is
affected with pityriasis capitis, which is both violent and obstinate;
the second, with comparatively a much milder form of cutaneous
disease eczema ; and in the last, the morbific cause had become so
altered by the effects of time and the improved health of the mother,
that it could evince itself, so to speak, only by an abortive attempt
at a cutaneous eruption, which was speedily counteracted by the
inherent robustness of the child. The exemption of the older chil-
dren very strongly corroborates the opinion of the mercurial origin
of the diseases in the cases above cited.

1846.] Cases of Diarrhcea, with Emaciation, <Src. 583

ARTICLE XXXVII.

Cases of Diarrhcea, with Emaciation, coming on after weaning,
successfully treated with Creosote. By J. A. Mayes, M. D., of
Sumter District, So. Ca.

Every thing connected with the therapeutical application of a new
remedy is intensely interesting to the physician, actively engaged
in the practical duties of his profession; and the more intense does
that interest become, when the new remedy under experiment
promises to become a safe and certain cure for some of the most ob-
stinate diseases of children.

The therapeutical application of creosote is now becoming a sub-
ject of much interest. The communication of Dr. Wragg, in the
second number of the Southern Journal of Medicine and Pharmacy,
has established conclusively the utility of creosote in the treatment
of hemorrhages ; and for this valuable and practical essay, Dr. Wragg
is entitled to the gratitude of the profession: since, by his experi-
ments, physicians have come into the possession of a styptic, more
uniform and certain in its operation, than any ever before used.
Prior to the appearance of Dr. Wragg's communication, several
short notices of the application of creosote to the treatment of the
latter stages of diarrhcea and dysentery, appeared in the Medical
Journals of the day. Acting under the influence of a love for experi-
mental inquiry, I was induced to give the , remedy under considera-
tion a trial in two cases of diarrhcea, with very great emaciation,
coming on after weaning. The result of the two cases I give be-
low, with no other remark than that, I believe the remedy to be
infinitely preferable in every point of view to that proposed by M.
Weissc viz. raw beef, finely shred ; of which the patients are direct-
ed to take two table-spoonsful in twenty-four hours.

Case I. Jessie, a little girl, aged about 15 months, was attacked
in April last with diarrhcea, a short time after weaning. She had
previously enjoyed good health, and was as lively and fond of play as ,
children of her age usually are. The diarrhcea was easily controlled
by the usual remedies; -but she was much weakened, and reduced in
flesh. An astringent and tonic regimen was prescribed for a few days
after the more urgent symptoms were relieved. She-did not, how-
ever, gain in flesh or strength, but gradually became leaner. In the
course of a fortnight fever supervened, with great irritability of

584 Cases of Diarrhcea, with Emaciation, Arc, [October,

stomach, vomiting every thing as soon as swallowed. The fever
was marked by regular exacerbations arid intermissions. Quinine
enemata in a few days arrested the fever; these being the only
means that could possibly be used ; the irritability of the stomach
being excessive. There was throughout the fever no pain or ten-
derness on pressure of the stomach or bowels, and the existence of
gastro-enteritis was, therefore, thought doubtful. Water or tea acid-
ulated with tartaric acid, after a few days, could be retained ; and
by using acidulated drinks, elixor vitriol particularly, and the phos-
phate of iron, the appetite improved somewhat, but the emaciation
still increased gradually. The bowels were generally in a very
bad state. For a month she continued in this situation, when her
appetite failed, and was growing rapidly worse. Being recalled to
prescribe for her, I found her symptoms and appearance as follows :
Pale, leucophlegmatic countenance ; abdomen tumid and very hot,
complaining of much pain under pressure; stools excessively foetid
and dark colored, also frequent; constant harrassing dry cough;
great emaciation, so much so that the integument on the extremities
seemed sufficient for a second covering; no appetite at all, and some
irritability of stomach ; cold drinks could be retained, but everything
else was refused. This assemblage of symptoms was indicative of a
fatal termination of the case, and that speedily, unless some power-
ful remedy could arrest the progress of the disease. Prescription
R. Creosote, 5 drops ; loaf sugar, 1 drachm ; gum arabic, 1 drachm ;
water, 2 ounces. Mix intimately. Of this mixture, a tea-spoonful
was administered three times daily ; at the same time the tepid bath,
medicated by an astringent infusion, was used two or three times
daily; after a few days the cold bath was used, medicated in the same
manner. In less than three days the beneficial effects of this treat-
ment were perceptible in the improved appearance of the alvine dis-
charges. Her amendment from this time was rapidly progressive.
The last mixture made up for her was R. Creosote, 6 drops; loaf
sugar, gum arabic, aa. 1 drachm ; carbonate of iron, ^ drachm ; water,
4 ounces. Mix. The vial to be well shaken before measuring a
dose. A tea-spoonful was directed three times a day. After using
this mixture, no further medical treatment was thought necessary ;
but a nourishing diet and exercise advised.

Case II. Billy, a little negro child, had the misfortune to be
weaned at six months. Being deprived of his natural food, his health
soon suffered much. The bowels were very generally out of order*

1846.] Report of a Case of Triplets. 585

and he soon became very lean. His situation vas such that for
eight months, or more, he required constant medical attention. In
that time his disease, of course, varied much, being sometimes better,
or even nearly well. In the month of January last he became dropsi-
cal. The swellings, however, disappeared under a course of chalybe-
ate and vegetable tonics. From his first indisposition, there were
great debility and extreme emaciation ; impaired appetite, or mor-
bidly excited appetite; looseness of the bowels; but with little
fever.

Having witnessed the excellent effects of creosote in the former
case, I determined to give it a trial in this. At the time of prescribing
it for him, the emaciation had become even greater than in the other
case, but the symptoms generally were not so severe : he had some
appetite; his bowels were as usual very much disordered. The
same prescription was used, and the good result was as plainly visi-
ble, though the amendment was not quite so rapid.

At the time of writing this, he takes but little medicine ; nourish-
ing diet and exercise seems to be sufficient for his case ; and the
prospect of a speedy and entire recovery is infinitely better than it
has been in ten months.

ARTICLE XXXVIII.

Report of a case of Triplets. By John F. Hammond, M. D., of
Silverton, S. C.

Mrs. S , was taken with symptoms of labor, August 26th, at 4

o'clock, A. M. I was called to her at 5, P. M., and found, lying on
a pallet, a woman above the average size, bilious temperament, and
who had had nine well formed, healthy children. Having been in
labor for thirteen hours, and in the care of a colored midwife, she was
necessarily discouraged, and the uterus had begun to (lag, though
not from want of capability. I found all else in an admirable state ;
pulse good, head clear, bowels just evacuated, bladder emptv; the
vertex in the first position, (Velpeau) and the os tincce fully dilated ;
the bag of waters projected largely into the vagina. A tew words
revived her spirits and restored her energy ; she was placed upon her
silo, I ruptured the membranes with my thumb and finger nails,
which, from their toughness, I found very difficult to do, and a few
minutes after six o'clock, the second stage (Deuman) was completed ;

586 Report of a Case of Triplets. [October,

she gave birth to a fine boy. He was removed, and a second was
found presenting by the breech, in the fourth position; the bag of
waters soon formed and was ruptured, and at half-past seven she was
delivered of a girl; the head passing in the second position, the
change occurring spontaneously ; there was no necessity for inter-
ference. Up to this time there was not a drop of hemorrhage, except
from between the ligatures around the cords when the cords were
severed. On examination, a third foetus was discovered in the first
position of the breech. There was now an intermission of the pain
of some minutes' duration, and their recurrence during the remainder
of the labor was less frequent though not less protracted, and though
wearied, she was cheerful. Giving time for the bag of- waters to
form, it was ruptured, the breech passed, and the shoulders with the
trunk carried over the mother's abdomen, two fingers against the
occiput, and two eliciting it upon the upper maxillaria, the head was
delivered in the first position before eight o'clock, after full half a
minute's compression* of the cord in passing the inferior strait. The
cord was unusually short. A little hemorrhage followed. The ute-
rus being free of all but -the placentae, the saturated vinous tincture of
ergot was given freely, kneading, cold wet cloths, compresses and a
bandage were employed on the abdomen, and gentle traction by the
cords ; blood was flowing, though not copiously ; the foot of the pal-
let was elevated by pillows, her head lowered; the placentae perfectly
attached to each other, passed into the vagina and from the vulva in
about forty minutes after the delivery of the last foetus. The ending
of the third stage was followed by a profuse flooding, which in a few
minutes prostrated the patient almost completely. By the former
means and titillation of the uterus, it contracted rapidly, she rallied,
the pulse revived, and in a few minutes she was carefully placed
in bed, with her hips elevated. The sixth of a grain of sulph. morphia
soon induced a quiet sleep, and another dose relieved a few pains
which came on in the course of the night. The next morning, she
was doing well ; had slept well but little discharge. The children
were all well. The following are their several weights: 1st, male,
5 lbs. ; 2d, female, 4 lbs.; 3d, male, 4| lbs. Total, ISf lbs.

These weights appear small, but upon re-weighing, they were found
correct. The 1st of September, being the 7th day, mother and chil-
dren were all doing well.

[Note. The extreme rarity of triplets, and the great particular-

1846.] Removal of portions of Bone, <fyc.,from the Bladder. 587

\

ity with which Dr. Hammond describes the process of parturition in
this case, renders the above communication very interesting. Trip-
lets do not occur oftener than about one in six thousand cases. The
late Professor Dewees, in his extensive practice in the city of Phila-
delphia, met with only one case. We only know of two cases ever
having occurred in this city one in the practice of the late Professor
Antony, some twenty or twenty five years ago the other, in the
practice of the present Professor of Midwifery, in 1837 : in the latter
case, the heads of the second and third child became locked in their
passage through the pelvis, and were expelled together. An account
was given in the 2d volume, 1st series of this Journal, p. 180. Eds.]

ARTICLE XXXIX.

Successful removal of portions of Bone, (probably the pubis,) with a
large calculous mass from the bladder. By Paul F. Eve, M. D.,
Prof, of Surgery in the Medical College of Georgia.

In January last, I received a letter from an intelligent physician
of this State, who mentioned that while on a recent visit to Alabama,
he had seen a negro woman laboring under symptoms of stone, and
that he had recommended her to be sent to my Infirmary. Upon the
arrival of the patient on the 8th of this month (January), the follow-
ing history of the case was obtained She is now twenty-four years
old, is married and has borne one child : is of good constitution, well
made, and has enjoyed uninterrupted health up to the time of her
accident. About four years ago, while in a stable loft, she fell, and
in descending got astride a projecting pin, which injured her very
seriously. She states that her external organs of generation were
greatly contused, and that it was nearly a year before she could walk
much or with ease. Her master, writes : " There was great contu-
sion of the soft parts, but a fracture I never could detect. After the
fall, she was confined to her bed six months, unable to walk, and for
twelve months could not labor." Although her owner is a physician,
I do not understand he is a practitioner of medicine; and all will
acknowledge how obscure is the diagnosis of fractures of the pelvis.
Without, therefore, any reflection whatever upon his intelligence or
knowledge of anatomy and surgery, the pubis or ischium, or both,
may have been broken by the fall which the patient sustained, with-

588 Removal of portions ofBo?ie, $c.,from the Bladder. [October,

out being detected. If no fracture occurred, bow account for the
long confinement and inability of the patient, even to walk for
months? After her recovery, she was hired out, but becoming una-
ble to labour, she was returned home. For the past four months the
catamenia have failed, and she has experienced great difficulty and
irregularity in urinating. On examining per vaginum, the finger
encountered a rough body projecting into that canal through a vesico-
vaginal fistula, an inch and a half behind the orifice of the urethra.
A sound in the bladder came in contact with a calculus. The urine
was bloody, and discharged every few minutes, and could not be re-
tained. The neck of the uterus was soft, irregular, and enlarged.

Jan. 9th. A dose of oil was given, which operated well; a warm
hipbath was prescribed twice a day, flax-seed tea and moderate diet.

10th. Operated at one o'clock, assisted by Drs. Dugas, Means,
Martin of Cobham, Shaw of Covington, and in the presence of the
Medical Class. As a vesico-vaginal fistula, (so much to be appre-
hended in lithotomy in the female,) already existed, a groved director
was passed through the urethra and fistulous opening into thevngina,
and by a probe-pointed bistoury it was cutout. By the section thus
made, a finger was introduced into the bladder, and with the calcu-
lous forceps, a piece of bone, coated with uric acid was extracted.
This was the foreign body projecting into the vagina, and was irreg-
ular in shape, and about three-fourths of an inch square. The blad-
der was now found filled with a soft calculous deposit, which would
allow the blades of the forceps to close through it. After breaking up
this mass, another and a larger piece of bone was felt lying behind
the pubis. From its position and size, much difficulty was encoun-
tered in removing it. The urethra was incised towards the clitoris,
and Dr. Dugas also attempted to dislodge it. By the finger it was
fortunately thrust from behind the pubis, and then withdrawn in the
forceps. This fragment was much more voluminous than the first one
extracted, and resembled somewhat the body of the pubis. It was
closely impacted in the position described, but the coats of the bladder
felt to the finger entire. The only opening in its membranes besides
the incisions, being the fistula mentioned, and which was about the
size of a rifle ball. Injections were now employed to wash out the
bladder, and the patient placed in bed.

The duration of this irregular, and as is believed singular operation,
was nearly an hour, and few thought the patient could so soon or so
completely recover. Incontinence of urine from the free incisions in

1846.] Isopathia: or tlie Parallelism of Diseases. 589

the urethra, as well as from the previously existing vesico-vaginal
fistula, was certainly expected.

11th. Called in baste to 'the patient, at G, A. M. Found her
complaining of pain and soreness throughout the region of the blad-
der. Prescrihed, a tepid bath, morphine, diluent drinks, and repose.
In the afternoon she is easier.

12th. Doing remarkably well, even retaining the urine better than
could have been expected so soon. Sat up in bed a few minutes.

13th. Is decidedly improving.

17th. Has continued to get better. Examined the bladder, and
detected a calculus. Failed to remove it. Failed again on the 18th,
when she was instructed to retain her urine as long as possible, and
then to pass it while in the hip-bath. A calculus weighing 45 grains
was thus expelled on the 20th.

30th. The tip of the finger can only be introduced into the bladder.
No foreign body can be detected in it. The urine has become clear
and healthy, and the patient can retain it an hour or two. She takes
moderate exercise in the house.

February 5th. Has gained much flesh. Complains only of in-
continence while walking. She left today for the country, prepar-
atory for returning home to Alabama.

The foreign bodies extracted from the bladder in this case, were
subjected by Dr. xAIeans, Prof, of Chemistry and Pharmacy, &c, to
an analysis. The calculous mass was chiefly composed of uric acid.
The pieces supposed to be bone were sawed in two, and presented a
cancellated appearance, and were reduced by chemical tests to ani-
mal matter and phosphate of lime. I regret not preserving the total
weight of all the matter extracted by the operation.

PART II. REVIEWS AND EXTRACTS.

ARTICLE XL.

Isopathia : or the Parallelism of Diseases. I>y John M. B. Harden,
M. D., of Liberty county, Georgia.

In the American Journal of the Medical Sciences, published in
Philadelphia, will be found two articles on this subject. The first
one wis published in the 8th volume, new series, or October \<>.
for 1844; and the second is in the last, or July No. of this year.
They occupy fifty-four pages of this excellent periodical.

590 Isopathia : or the Parallelism of Diseases, [October,

The author of these articles will be recognized by our readers, as
one of the earliest and staunchest friends of the Southern Medical
and Surgical Journal, and is one of the brightest ornaments to the
medical profession of our country. There are few who have done so
much, or so well, for our calling at so early a period of life, as has Dr.
Harden. We believe no one in our own state, has contributed more
to the literature of medicine. That he has not written more for our
pages, we learn, with deep and sincere regret, is owing to the fee'ble
state of his health, and especially of late, to severe illness. Having
just received the last article referred to above, with his own correc-
tions, we rejoice in the hope of his speedy recovery, and pray he may
be long spared to his numerous friends, and be enabled to enrich the
barren wastes of Southern medicinal science.

Dr. Harden has ever exhibited a commendable spirit of industry
and zeal, and been ready at all times to publish his experience and
researches in medicine, for the benefit of his profession. While
many, too many, well qualified by talent and observation, to enlighten
their associates through the medical journals of the day, are absolute-
ly too indolent or unwilling to write, he has fully contributed his
proportion of labour. The besetting sin of the South isslothfulness,
a want of patient toil and industrious perseverance, especially a mis-
erable indisposition to record what is observed, and a morbid sensi-
tiveness to appear in print: this incubus rests as heavily upon the
medical profession here, as upon any calling in life. And yet we
are the cultivators of an enlightened science we belong to a liberal
profession. Alas, for the medical literature of the South, when such
apathy to write exists among us.

It will be perceived that Dr. Harden's first Article, was published
before this Journal was revived, or before the establishment of the se-
cond series of it. The second, he designed should also appear in
this periodical for this purpose he has revised and corrected it. The
first was reviewed very favorably in the Medico-Chirurgical Review,
or Johnson's Journal, of London, and the writer concludes with the
remark "Avery valuable pap/er on an interesting subject. We
trust that Dr. Harden will follow it out."

We propose in this article to notice the first, and may carry out the
author's design, by publishing the second entire, but we shall be
compelled from its length, to divide it.

Dr. H. thus defines his subject :

"The disposition of diseases to 'anastomose with one another,' or

1846.] Isopathia : or the Parallelism of Diseases. 591

to wear each other's livery, has long been remarked by some of the
most eminent medical observers. Sydenham, Balfour, Cleghorn,
Lind, Clarke and Rush, have all recorded the fact in their notices of
epidemic fevers. Indeed, the former is said to have insisted on the
doctrine, that 'epidemics of continued fevers, although resembling
each other in respect to many of tlieir symptoms and general charac-
ters, are often very different from each other, for a mode of treatment
which is useful in one, may be decidedly pernicious in another.'*
Hence the importance which he has attached to the epidemic consti-
tution of the air, in determining the true character of these diseases.
Hunterf declared that 'diseases of the same specific nature not only
vary in their visible symptoms or actions, but in many of those that are
visible, arising, probably, from peculiarity of constitution and causes,
which will make the effects of application vary almost in the same
proportion.' Dr. AlisonJ says, 'when changes in the structure of
the body, that take place in the course of disease, are examined during
life, and more especially after death, it appears that different combina-
tions of symptoms are often apparently excited by the same funda-
mental diseased action, and, consequently, found in connection with
the same alteration of organic structure ; and again, that very differ-
ent alterations of structure may be attended, in different individuals,
by symptoms, the greater number of which are very nearly the same :'
and Andral, in his recent work <m Pathological Hcenatology, has
advanced the same sentiment. 'These various facts,' says he, 'are
not inconsistent with one another: they only throw more light on
one of//*e most important of medical truths, namely, that two diseases
may have identical symptoms without being of the same nature, and
that however close their resemblance, they may still require different
modes of treatment, because very different conditions of the econo-
my may give rise to or maintain them.'

"So great a bar does this substitution of one form of disease for
another offer to a correct diognosis and classification, that it is not
surprising that Brown and Rush should have adopted the maxim,
'Nosologia delenda,' nor that the latter should have declared that,
4 however varied morbid actions may be by their causes, scats and
effects, they are all of the same nature,' and that 'to describe them
by any fixed or specific characters, is as impracticable as to measure
the dimensions of a cloud on a windy day, or to fix the component
parts of water by weighing it in a hydrostatic balance. '||

"We might cite other authorities in support of the same general
truth, but this subject has never received that particular attention
which it really deserves. There can be no doubt that this is the true
ground of most errors in the diagnosis and treatment of diseases, and
of the many differences of opinion among medical men concerning

* Med. Chir. Rev., 31th, 631. + On the Blood, 2d, 53.

: Outlines of Pathology.

On the Blood in Disease, p. 129, translation by Meigs and Stille.
II Inquiries and Observations, 3d, 34.

592 Isopathia : or the Parallelism of Diseases* [October,

the nature and proper treatment of the same supposed disease, as well
as the various success of the same remedies in the same supposed
cases. It shall be our object, therefore, in the following remarks, to
bring this matter distinctly before the notice of the profession, by at-
tempting to show that there are many symptoms and groups of symp-
toms which have been, and still are, regarded as distinct diseases by
practitioners, and arranged as such by systematic writers, which may
be referred to the same pathological state of the system, and

3IAY MUTUALLY REPLACE ONE ANOTHER IN THE SAME OR IN DIFFER-
ENT individuals. To this law or feature of disease, we have applied
the term isopathia * or Isopathy. and we proceed to point out as
briefly as we can some cases of this parallelism from our own as
well as from the observations of others."

The following is his division of diseases :

"In order to give method to our remarks, we beg leave to divide
diseases into the following generic types, under which we will treat
of the individual species and their modifications, Febrile Types,
Inflammatory Types, Purulent Types, Tuberculous or Strumous
Types, Scorbutic or Hemorrhagic Types Exanthematous Types,
Hydropic Types, and Gouty or Podagric Types. We will confine
our remarks in this paper to the first or febrile types, reserving what
we hnve to sav upon the others for some future communication.

11 Febrile Types. Fever is confessedly the most common form of
disease to which the human system is subject. Almost all diseases
are more or less connected with it, and it is even probable that ali
morbid forms have their prototype in some essential fever. This
seems to have been the opinion of many, if not most of the older
writers. The essentiality of lever was the doctrine of Sydenham,
Morton. Morgagni. Fordyce, Cullen and others. Marcus, we believe,
was the first who identified them with inflammation, and seated them
in the blood-vessels. Clutterbuek afterwards fixed their seat in the
head. Mills placed them indifferently in the head, the lungs, the
liver, the stomach, or in any other organ which happened to be at-
tacked with inflammation. Edward Miller directed the attention
more particularly to the stomach as the seat of these fevers, and this
view was adopted in France by Prost,f Cafbn. Alard and Petit, and,
under the fostering genius and unremitted labors of M'. Broussais,

* iffoi- TraOof. crqua affectio. The term isomerism, in chemistry, while it furnish-
es an analogy in etymology, affords, also, a good illustration of our use of the
above. It is known that there are many inorganic bodies with different exter-
nal appearance, which consist of the same elementary parts, while others, es-
sentially distinct in composition, present the same external form. To these last
the term isomorphic has been applied, and even here the analogy holds in dis-
ease, for, as we have seen, there are "many so called diseases, with the same
external form or type, so far as regards their seats and symptoms, which are
still pathologically distinct. To such diseases uV term isotypic might be very
properly applied. Diseases, then, may be isopothic and taiaroiypic, or esotypic
and hdcropat/w, as we hope to make appear in the course of our remarks.

t Broussais, Exam, des Doctrin. Med. torn. 2d. and 4th passim.

1646.] Isopathia : or the Parallelism of Diseases. 598

has been extensively diffused in modern times. But at present there
appears to be a tendency among medical men to revive the former
doctrine, and the essentiality of fever finds advocates in such men as
Andrai, Chomel, Tweedic, Christison, Copland, Alison, and others.
As we have already hinted, we are inclined to adopt this view of
fever, although we are willing to admit that, in most of the essential
fevers, some lesion of the alimentary canal is very generally an at-
tendant. 'These Jesions of the viscera, however, whether of the
cranial or of the thoracic or abdominal cavities, are all secondary or
consecutive phenomena of the disease, their occurrence being attri-
butable rather to the cotemporaneous influence of other atmospheric
agencies, to the idiosyncrasy, habits, and previous state of health of
the patients affected, or perhaps to the differences in the nature and
degree of the aerial poison that has acted upon the system.'* The
discrepancy among authors in regard to the seal of the same fevers
is sufficient evidence that they have no determinate or invariable seat.
'If we were to judge,'" says Andrai f 'by post-mortem examinations
only, we should often believe that inflammatory, bilious, catarrhal or
mucous, typhoid or adynamic, nervous or ataxic fevers were one and
the same disease.

' Fevers have been variously divided and arranged by different
authors. The most common division has been into intermittent,
remittent and continued, including under the last thesynocha, syno-
chus and the typhus. We prefer to divide them into the intermittent,
synocha or inflammatory and typhus, and our reasons for this will
appear in the course of our remarks. We shall first consider the
intermittent or marsh fever, as it has been called. We believe it is
generally conceded that the intermittent and remittent are only dif-
ferent types of the same fev'er. Sydenham^ believed in this identity,
and so did Dr. Rush. Dr. Cullen|| made no distinction between
them. Dr. Parrll says, ' Interrnittents and remittents arise from the
sarnecaus(S, are relieved by the same remedies, and pass into each
other,' and Dr. Good,** who wished to make a specific distinction,
has given the same proof of their identity. Dr. Fothergiliff speaks
of, remittent Aeeoming interrnittents, and being cured by bark. - Dr.
BoothT says, ' It is transitions of this nature that justify the idea of
the types of these fevers being modifications of one disease, varying
in the same individual, and frequently assuming a difference of char-
acter in successive seasons, gradually approximating to a typhoid
form, without any difference of cause beyond atmospheric influences.'
Dr. !VfcDivitt. in Ids able report of the Kent and Canterbury Hos-
pital, has also pointed out this connection. Dr. Crngic|||| is disposed
to allow the 'interchangeable nature, the identical origin, and the

Chi r. Rev., vol. 40th, 5T6. tlbid., 23d, 236.

J Exam, des Dock Med., torn. -2d, 9G. . -I Med. In. and Obs.
II First I. U Med. Diet., Art. Fibris.

Study of M< GO. t1 :. : Hh, 7&

26th. Life of Armstrong.
Am. Jour. Med. Scf, 46th., 414. m. Jour. Med. Sc, 46th, 414.

88

594 Isopathia : or the Parallelism of Diseases. [October,

simultaneous existence of intermittent and remittent.' Drs. Bright
and Addison* admit that they are very closely allied, having the
same origin, and in many respects the same phenomena, the chief
difference consisting in the character of the paroxysm. M. Maillot, "j*
the chief physician of the Military Hospital at Bon, in Africa, in
speaking of the fevers in Algiers, says: ' Whoever will consider the
facts now stated, cannot hesitate surely to admit, that the remittent
and continued fever of the hot season, in such a climate as that of
the northern coast of Africa, are in truth intermittent fevers, compli-
cated with a local mischief, which has the effect, sometimes, of merely
obscuring the features of the original disease, and at other times of
masking them altogether, so that they cannot be recognized ;' and
again, in speaking of the treatment, he holds the following emphatic
language: 'C'est 1'idee qu'on se formera de ces intermittentes, de
ces remittentes, et de ces fievres continues se succedant tour a tour
se remplacant, se chassant, puis reparaissant, tournant, pour ainsi
dire, dans le cercle annuel : c'est de la filiation que Ton verra ou non
entre ces maladies si diverses en apparence, si indentiques pour le
fond que dependra le choix d'un traitement vrai ou faux.' From
our own observations of these fevers, we are disposed unhesitatingly
to adopt the opinion of Rush, that the tertian is the original type, and
the double tertian the form in which al! our autumnal remittents pre-
sent themselves, and the difference in the intermissions depends upon
the lengthening or shortening of the paroxysms, so as to run into
each other or make a complete interval.

M But it is to Dr. McCulloch.J of England, that we are mainly in-
debted for a clear exposition of this connection, as well as the relation
of this fever with other diseases, hitherto regarded as specifically dis-
tinct, and to this author we owe many of the views set forth in the
following pages. In order to point out more clearly this parallelism,
we will divide the pathognomonic symptoms of this fever into the
depressing or sedative, the neuralgic or painful, the convulsive or
spasmodic, and the critical. The vascular excitement and functional
disturbances in general cannot be considered pathognomonic, since
they occur to a greater or less extent in almost all forms of disease.
So, too, the researches of Andral and Gavarret have shown that the
state of the blood in these fevers is entirely negative. The dissolved
or putrescent state of the fluid which is found in some cases, is com-
mon to most diseases, and may either be primary or come on in their
progress. This condition of the fluids, however, is an important
complication, and is intimately connected with those malignant forms
of fever and other diseases which we will notice as we proceed."

Dr. Harden then goes on to notice the symptoms of depression or
sedation. He says:

* Elements of Pract. Med. t Med. Chir. Rev.: 26th, 510.

X On Remittent and Intermittent Diseases, where he says, they are virtually
the same, p. 59.

1846.] Isopathia : or the Parallelism of Diseases. 593

"These symptoms are all connected with what is known as the
cold stage or fit of this fever, and our object now is an analysis of
the modes in which this cold fit may present itself. The decree of
coldness manifested in this stage may vary from a mere sensation on
the part of the patient to a coldness of the surface appreciable by
others. Sometimes the sense of coldness amounts to a mere M aura"
in some particular spot. We have heard it referred to the head and
to the side. Dr. McCulloch says, 'The sensation of -cold maybe
so partial as to occupy but a limb or a single spot, and even but for a
few minutes; while, if more universal, it may be equally short and
slight.' These symptoms may make up the whole of the patient's
disease, so fir as is apparent to the physician ; and in such cases
they are usually regarded as nothing more than a form of hysteria.
The same may be said of the 'aura epileptica, which we are in-
clined to regard as a symptom of this character.

"The cold fit may also show itself in simple drowsiness, which is
very frequently the precursor of fever in children; but by far the
most alarming and fatal form m which this stage is ushered in, is by
coma and apoplexy. Fevers connected with soporose, apoplectic and
paralytic symptoms, forming the 'fievres intermittent pernicieuses'
of the French, and the ' febres perniciosse,' of Torti and other authors
have long ago been noticed. WerlhofT* has found examples of such
fevers in the works of Galen, Paulus Eginetus, JEtius, Amatus Lasi-
tanus, Avicenna, Prosper Alpinus, Lomnius, Eugaiinus, Forestus,
Bonetus and Cohansen. Ramazzani describes the same fevers as
happening at Rome and Lancisi and Torti at Modena Sydenham,
WerlhofT and Morton were the first, however, who regarded them as
modifications of intermittents. In our own climate, it sometimes
happens that intermittents come on in this form. 'Somef years since,
autumnal fever appeared in the interior of the southern states in this
form, and was, in many places, denominated the 'cold plague.''
We have never seen a particular description of this fever, but from
what we have heard, we conclude that it was identical with the Ital-
i an form of this disease.

As in epidemics so in particular sporadic cases, the first symp-
tom of an intermittent or remittent may be in apoplectic seizure
which may constitute the whole apparent disease and should no
time he given for a development of its true character, the case might
be treated as ope of apoplexy, and the patient die under that treat-
ment. Anclral, in;: his 'Clinique Medicale.' gives a very interesting
case in point. Whilst considering the subject of ' masked intermit-
tents,' he details the case of a patient who exhibited all the phenome-
na of intermittent apoplexy,' which, in its return, observed the same
regularity as the fevers of this name, and presented itself uniformly
and regularly with precisely the same types. The sulphate of qui-
nine was administered, and the individual perfectly recovered. A

Exam. desDoctrin. Med.. 3d, 177. t Daniel on Fever.

; Med. Chir. Rev., -27th, 103.

596 Isopathia: or the Parallelism of Diseases. [October,

fimilar case is recorded in the Journal des Connaissances, and re-
published in the Medico-Chirurgical Review. The case is given by
Dr. Combes,* and was, as in the preceding, cured by the exhibition
of quinine."

The painful or neuralgic symptoms of fever, next claim our au-
thor's attention: These, it is well known, in the early or forming
stage, are located most usually in the back or head. All writers and
observers must acknowledge they are often intermittent in character-

" Dr. McDivitt, in the report already alluded to, says, 'that cer-
tain neuralgic affections originate in the sume cause which produces
intermittent fever, cannot well be doubted ; for they prevail in the
same localities with it, put on the same intermittent form, and are
cured by the same remedies. Jf In the 'Bulletin General de Thera-
peutique,' there is a paper on intermittent neuralgia, in which the
writer says, 'most cases of neuralgia have an affinity more or less
distinct and decided with intermittent fevers.' 'Within the last six
months there have been observed at Paris a number of cases of
masked aguish neuralgia, which, on many occasions, have simulated
other diseases, and whose true nature, therefore, has been not unfre-
quently mistaken.' The editors of the Med. Chir. Rev. if say, "that
an intimate connection exists between intermittent fevers and various
forms of neuralgia, is sufficiently obvious from the genuinely periodic
character of numerous cases of the latter disease.' ' It is scarcely
necessary to add that the same remedy, bark, which is a specific for
the one, affords as infallible relief for the other;' and they refer, k for
some excellent remarks on the analogy between intermittent fever
and neuralgia,' to Dr. Billing's 'First Principles of Medicine,' a
work which we are sorry we cannot consult. M. Piorry says, 'if
we consider the intermittent and periodic character of neuralgia, in
connection with that of paroxysmal fevers, the manner in which both
diseases yield to sulph. quinine, the frequent coincidence between
certain neuralgic and paroxysmal fevers, we shall be led to the con-
clusion, that the ' point de depart' of these fevers is most probably in
the nervous system."

On the subject of these symptoms it is stated that convulsions m
children are often a substitute for rigor, and it is laid down as an
axiom, that the rigor of an adult is the convulsion of a child in our
climate fevers.

We conclude this imperfect notice of Dr. H's first article in his
own language.

"The question then comes up, how may fevers be distinguished?
Were it possible to ascertain what has been called the proximate

*Med. Chir. Rev., 42, 219. t Med. Chir. Rev., 35th, 545.

i Ibid., 38th, 206. Ibid., 43d, 193.

1846.] On the Utility of Electro-Galvanism, $c. 597

cause of disease, the distinction would be easy, but, as Dr. Johnson
has well remarked, so far as we yet know, there is no proximate
cause to any disease, but every disease seems to consist in a series
of causes and effects.' We have then- to come to a knowledge of
the nature of diseases appro\imatively, or by considering those cir-
cumstances connected with them, which may develop their true
character, and I think all the necessary conditions of the problem
will be found in the remote or exciting causes so far as we can know
them, the epidemic constitution of the season, or prevailing habit of
diseases; the peculiar and specific changes in the blood and other
Jluids, the antagonism and coincidence of certain diseases as lately
noticed by some French physicians, and above all, that feature of dis-
eases which we have been examining, viz., their mutual convertibility.

" We have a word or two to say in relation to yellow or congestive
fevers. We have had no opportunity of observing properly the for-
mer disease, but if the observation of Rush, Bancroft. Frank, Good,
Craigie and others may be depended on, it is identical with the inter-
mittent and remittent fever, and we refer to these writers for the
arguments in support of this view.

The fever known as congestive has assumed a great degree of in-
terest of late from its ravages in some parts of our country, particu-
larly at the West. This fever sometimes occurs among us,* and
from my own observation, I am clearly of opinion that it is nothing
more than a form of the cold stage of inlermittents, and this view
seems to be supported by the remark of Dr. Parry, of Indianapolis,
and Wharton, of Grand Gulf, Miss.f Dr. Wharton pointedly says,
4 there is some analogy between the cold stage of an intermittent and
the state of the system in congestion ; the difference consisting in the
greater and more permanent capillary torpor which exists in conges-
tivefever.' It evidently, therefore, should not be considered a dis-
tinct fever, but properly comes under the head of symptoms of de-
pression or sedation of intermittents."

On the Utility of Electro-Galvanism in Amenorrhea and, Dysmen-
orrhcea. liy R. L. MacDonnell, M. D. (From the British
American Journal of Medical and Physical Science.)

Although Electro. galvanism has been for some years past employ-
ed in Europe, in cases of amenorrhoea and dysmenorrhcea, yet I
believe I am correct in stating that it was never used in Montreal
until introduced by me, within the last year.

* In 1842 I saw a case of this f< . r, in which he discharged

from his Btomaeh and bowels before death, a fluid in every way similar to "black

vomit." In 1840, 1 alti in one of which, alter death, there

black fluid blood from the mouth and nose, This was told

me, howevei . by others.

their papers in Amer. Journ. Med. Sciences, vol. 5th. N. S. 08, and 7th,
N. 8. 33<).

598 On the Utility of Electro-Galvanism, <$fc. [October,

Having been requested to meet a physician of this city, in consul-
tation,in a ease in which I recommended a trial of electro-galvanism,
in order, if possible, to induce a return of the catamenia, he mention,
ed that he had no experience of the remedy, or of the class ^6f cases
in which it should be employed, or of the method of employing it;
and, as many of my readers may be similarly circumstanced, I have
thought that a few practical remarks on the utility of this agent, and
on the peculiar cases to which it is suited, would not be useless or
uninteresting.

In an early number of Guy's Hospital Reports, Dr. Golding Bird
published a paper shewing the value of electro galvanism in various
diseases; and amongst others, in derangements of the uterus. Since
then, it has been extensively employed in Dublin by Drs. Gravesand
Stokes, and other eminent physicians; end whilst acting as clinical
assistant to those gentlemen, as well as in my own practice, both in
Dublin and in this city, I have had many opportunities of witnessing
its good effects in these troublesome diseases.

The practitioner often meets with instances where females have
suffered for months, and even years, from complete arrest of the
menses, or from their being secreted scantily, and with difficulty and
pain, or where the discharge comes on abundantly and without
pain at one time, whilst at the next period the patient suffers exces-
sively, and scarcely any discharge presents itself; and in anothoj
class, severe dysmenorrhea* has existed for years before the physician
is consulted. Now, there are not, perhaps, any diseases in which
the ordinary courses of treatment are more unsuccessful; for long
before we are consulted, the usual effects of such derangements have
become well marked upon the constitution; the system has become
reduced and debilitated; and the ordinary features of chlorosis or
hysteria have become well established. In such cases, our treatment,
however judicious, often fails completely; and we not unfrequently
meet with disappointment, from the difficulty of enforcing on our
patients an exact observance of our directions as to medicines, exer-
cise, diet, &c. In other cases the constitutional symptoms have pre-
ceded the uterine derangements, but in both, it often happens, that
the disease becomes more and more confirmed ; and little or no
benefit being derived from the advice of the regular practitioner, the
patient resorts to quack medicines and nostrums; and, after a waste
of time, of money, and of health, the physician is again applied to.
It is under such circumstances, and in such cases, that electro-gal-
vanism acts with the greatest success ; inducing a return of the
menses, when arrested, or producing an easy and abundant secretion
of them, in those cases where this process has been inefficiently and
painfully performed, perhaps, for many years previous; and this
change is soon followed by an amelioration of all the distressing
symptoms under which the patient has laboured.

The best and most convenient method of applying elect rd-galva ft-
ism, is by means of the machine sold at New York, under the name

1846.] On the Utility of Electro-Galvanism, <$-c. 599

of the " Vibrating Magnetic Machine," or with the apparatus made
by Clarke of London, tor a similar purpose. Each of these machines
is accompanied by a short treatise explanatory of the principles upon
which it is constructed, and containing directions for its employment.
Tiie former instrument will he found cheaper, more convenient, and
less likely to go out of repair than the latter.

Two insulated wires are connected to the apparatus, one being
attached to each pole ; at the free extremities of these wires are two
platina buttons. When the machine is in operation, one of these
buttons is applied hy the physician to the lower portion of the spinal
column, corresponding to the point of exit of the sacral nerves, and
the other button is applied by the patient herself, or by a female at-
tendant, immediately over the os pubis. In order to protect the
patient from the inconvenience of getting the shock through the hand
which holds the button, a thick glove should be worn.

Having desired that one button be kept firmly pressed upon the
os pubis, the physician commences, by passing the other button along
the spine, from the occiput to the os coccygis. After this has been
done slowly four or five times, the button is kept for five or six
minutes immediately over the sacrum, and the electricity is thus
passed in an uninterrupted current through the uterus. It is by no
means necessary to put our patients to great torture by increasing
the strength of the shocks; more benefit will be derived from an un-
interrupted and steady transmission of a moderate quantity of electro-
galvanism, than by occasional shocks of great intensity. The
current may also be sent transversely through the pelvis, by placing
a button on each hip, above the great trochanter.

Of course, it is needless to add that, with ordinary care, there
need not be the least exposure of the person of the patient, for all the
necessary manoeuvres can be completed without removing the bed-
clothes the patient lying on her side, with her back turned to the
physician. In some cases it may be useful to carry the current more
directly through the uterus, which can be easily done by applying
one button to the sacrum, and having the other wire attached to a
curved brass rod, which can be introduced into the vagina so as to
touch the cervix uteri. This is the plan I have advised a medical
friend to adopt in the case of bid wife, who has for years been a martyr
to dysmenorrhaea.

It is not proposed to employ electro-galvanism to the exclusion of
those remedies, whose efficacy in the condition of the system accom-
panying derangements of the uterus is so well established; on the
contrary, they should always be employed during the intervals be-
tween the menstrual periods.

My usual practice is, to administer a combination of sulphate of
quinine, and sulphate of iron, in small quantities for in these cases
both the stomach and head are easily deranged by large doses and
if (as often happens,) the patient be subject to constipation, I com-
bine with the foregoing, one ounce of the sulphate of magnesia to

COO On the Utility of Electro-Galvanism, tyc. [October,

eight ounces of water. This I find to be the best and most pleasant
way of combining, in the same mixture, the properties of a tonic, a
chalybeate, and a mild aperient.*

In Graves's "Clinical Medicine," the reader will find the history
of some cases that fell under my own observation, of which I shall
here introduce a few particulars:

1. Anne Cummins, admitted with ptosis and amaurosis of right
eye, and in a lesser degree of the left eye. She had also amenor-
rhcea of ten months standing. Electro-magnetism was employed
for the relief of the two former symptoms : and on the 20th, as well
as for a short time on the 18th, 1 also applied electricity to the
region of the uterus, and on that evening she menstruated. This
action continued on the 21st and 22d, and the fluid was natural both
as to color and quality. In this case not a grain of medicine of an
emmenagogue nature was administered.

2. At page 423, the details of Cunninghame's case are given.
She was of an extremely hysterical habit, and was frequently an
inmate of the hospital during the period of my connexion with thut
institution June 15th, 1842. She labored under an attack of hys-
terical paralysis of one leg, for which electricity was recommended.
Whilst this remedy was being applied to the region of the sacrum,
the catamenia returned, having been suppressed for the thirteen
months previous.

3. Carroll Suppiession of menses for 18 months. From 16th
to 19th of August, applied secondary electricity according to my
usual practice. 20th. Learned that she had menstruated on the
previous evening after I had left her.

4. Smith. Irregularity of catamenia for many months. 23d
August. Yesterday, the 22d, she bad a trifling manifestation of the
catamenia, being then six weeks since their last appearance. Elec-
tro-magnetism was applied ; and for the next two days the discharge
was more abundant than it had ever been.

Since my arrival in this city, I have employed this agent with the
greatest success in numerous cases of amenorrhcea and dysmenor-
rhcea, the details of which would be highly instructive, did space
allow of their insertion. The four following examples, however, so
clearly and satisfactorily demonstrate the advantage to be derived
from this remedy in these diseases, that 1 shall make no apology for
laying them before the reader :

I. An unmarried lady, aged 25, of dark complexion, and spare
habit, consulted me, on March 20th, for severe palpitations, accom-
panied with pain in the cardiac region, headache, dyspnoea, and pains
and weight in the lumbar region. She had commenced to menstru-
ate at the age of seventeen; and, for two years afterwards, the
catamenia were quite regular, and she enjoyed good health ; but for
the last five years they were very irregular in their returns, and were

* The following is the usual mode in which I exhibit these remedies:
IJfc Sulph: Gluina? sr. iv. vel vi: Sulph: Ferri gr. viii.; Sulph: Magnesia- 51' ;
Acid Sulph; dil. m. x. Aquae viii.; of this half an ounce four times a-day.

1846.] On the Utility of Electro-Galvanism, fyc. G01

accompanied by excessive pains in the uterine and lumbar regions.
For the last ten months she had not observed any discharge. As
the period when the menses ought to appear was expected in a few
days, I immediately commenced the use of electricity ; and, after
two applications, the discharge returned, and continued to flow for
four days. She has since menstruated regularly, and her general
health is quite restored.

II. A. B., a widow aged about 33, of sallow complexion, consulted
me many months ago, for suppression of the menses. Since the
death of her husband, which took place 7 years ago, the catamenia
have heen very irregular, always secreted with pain; and for many
months past, has been completely absent. She had. been at various
times under medical treatment for these symptoms, but never ob-
tained any relief. When she applied to me, I recommended elec-
tricity, but she begged of me to try something else first ; and, should
it not succeed, that she would then consent to this remedy being
employed. She was placed under the ordinary treatment ; hut, as
the discharge did not return at the end of three months, she again
consulted me on the 1st of June, two days before the menstrual
period was expected. After two applications of twenty minutes'
duration each day, the catamenia came on profusely, and lasted for
five days. I have no doubt whatever, that henceforth they will
appear spontaneously.

III. About the, end of May, I was consulted by Dr. Evans of
Richmond, C. W., concerning a young lady, in whose case he was
deeply interested. It appeared that about seven months previously
she had had a violent attack of pleuro-pneumonia, for which she was
very actively treated, both by general and local hlood-letting. After
remaining in a precarious state for some time, she recovered ; but
continued in a very delicate condition, with all the symptoms of
anosmia. The menses had not appeared for four or five months
previous to my seeing her, although she had been most judiciously
treated, with a view to their restoration. I advised electro-galvanism
to he employed, to which hoth Dr. Evans and his patient consented ;
and as the menstrual period was not expected for ten days, I recom-
mended her to spend the interval with some friends in Quebec, and
to return to Montreal on the 9th of June. Accordingly, on the 9th
I applied electro-galvanism in the way I have already described.
The menses almost immediately appeared, and continued to flow
from the 9th to the 16th. She says she never had such an abundant
discharge before, nor did she ever pass a menstrual period so free
from pain and uneasiness. In fact, whilst menstruating, she took more
exercise than she was ever before capable of doing. This ease affords
an apt illustration of what [ have stated above viz., that eleetro-
galvanism is equally suited to cases where amenorrhcea has followed
as a consequence of severe derangements of the general health.

IV. The following ease more convincingly exhibits the value of
this remedy than any I have yet adduced, or, indeed, than any I have

602 On the Utility of Electro -Galvanism, <fyc. [October,

ever seen : A lady, aged 32 of pale complexion, and delicate con-
stitution, consulted me in the middle of March, for severe constitu-
tional symptoms, produced by long-continued derangement of the
uterine functions. She belongs to a family in whom this tendency
is hereditary. Her mother suffered from dysmenoi rhcea during the
whole period of her menstruation ; one sister died at the age of
twenty, without having ever menstruated, although for four or five
years she was under the able treatment of Dr. Robert Nelson, whose
skill and talents were so well appreciated in this city, and she her-
self had, for six or seven years, the benefit of that gentleman's advice.
At the age of fourteen the menses appeared, and continued regular in
their returns for three years or so. She was usually unwell on the
20th of each month ; but, from the first menstruation up to the
present time, the discharge was so exceedingly scanty as never to
have required the use of a napkin. After the first three years, up to
the present, the discharge has hardly ever been so abundant as to
leave the least trace on her linen ; and were it not that at such
periods pains of an agonizing character, referred to the lower portion
of the abdomen, tormented her, she could not have known that the
catamenia were being secreted. On these occasions she was always
obliged to make strong pressure over the pubis, and frequently one
of her female relatives has had to sit or lie over the lower portion of
the stomach to mitigate her suffering. These attacks usually lasted
for three days, during which she used to have almost incessant
vomiting. For the last four years, intervals of five, seven, ten, and
even thirteen weeks have occurred between each menstruation.

Having learned, from personal experience, that in cases exhibiting
such irregularity as the foregoing one, it is useless to employ electri-
city, except as nearly as possible at that part of the month on which
the discharge used to appear when the function was in a healthy state,
I determined to give it a fair trial on the 18th of April. Accordingly
on that day, and for the next four, it was administered, but did not
produce any discharge: the period, hcwever, was passed over free
from all uneasiness. She was then placed on the chalybeate and
tonic mixture, above mentioned, and on the 19th of May I again
submitted her to the influence of the remedy. For two days no dis-
charge appeared, but on the third it came on most abundantly, and
continued to flow for seven days, requiring the frequent change of
napkins each day; and during the whole of this time she enjoyed
excellent health, was without the least pain, and was enabled to walk
three or four miles daily, and to nurse-tend a sister, who was attacked
with severe rheumatic fever. This change was followed by an al-
most instantaneous improvement in her general health, and she was
soon after enabled to undergo the fatigues of a long journey, which
she bore remarkably well.

The foregoing cases I have given in detail, because they exhibit,
in a convincing manner, the great utility of electro-galvanism where
all other remedies had failed ; and (as in the last one) where the dis-

1846.] On Disorders of the Cerebral Circulation, $c. 603

ease was of such duration as to afford but little prospect of success
from medical treatment. I may be told that mony measures, such as-
sea-bathing, horse exercise, travelling, residence in the country,
change of scene, enjoyment of society. &c, have frequently produced
as speedy cures in cases equally obstinate. True ; but how many
times are we consulted by females whose avocations and circumstan-
ces do not admit of such remedies being employed ? In this country,
as elsewhere, the object of the physician should be, to avail himself
of all means which, without abandoning in toto the powerful adju-
vantsjust mentioned, will render him and his patient, so to speak,
independent of them ; and, in the class of diseases now under con-
sideration, electro. galvanism comes inopportunely to our assistance.

It must be borne in mind that electro-galvanism acts in these dis-
eases, not specifically, but just as it does in all other cases where
there is a manifest depression of nervous power nnd vascular action.
Our general experience of the remedy clearly shews that it is not in
instances of exalted nervous power, or of great arterial excitement,
that it acts beneficially ; but, on the contrary, its powers are best
exemplified where these functions are. as it were, below the ordinary
standard. Bearing this fact in mind, we are not likely to be misled
as to the cases of amenorrhcea and dysmenorrhcea, in which it should
be employed, wiih the greatest prospect of success ; nor shall we
recommend it in thoe instances where the above indications are ab-
sent, to the exclusion of active remedies, which both the pathology
of the disease, and our own experience, point out as the most appro-
priate.

Montreal, June, 20, 1846.

On Disorders of the Cerebral Circulation, and on the Connection
between Affections of the Brain and Diseases of the Heart, By
George Burrows, M. D. 8vo. pp. 280 Plates London : 1846.
(Medico-Chirurgical Review, for July, 1846.)

On the Circulation of the Brain. The opinion that the brain un-
der all circumstances of health and disease contains absolutely the
same quantity of blood, seems so contrary to common sense and daily
experience, that its disproval would seem scarcely to require the
careful elaboration Dr. Burrows has bestowed upon it; but when we
consider it has been and is entertained by men of the highest emi-
nence in the profession, when names such as Monro, Abererombie,
and Clutterbuck can be cited in its favor, it is evident that something
beyond a mere negation of its correctness is called for. lis defence
is based upon the mechanical structure of the cranium, and experi-
ments upon animals. The cranium, it has been said, is a perfect
sphere, the contents of which are protected from the effects of atmos-
pheric pressure. Allowing that the bony case prevents that direct

604 On Disorders of the Cerebral Circulation, fyc. [October,

effect of pressure upon its soft contents which some other portions
of the body are exposed to, the indirect effect exerted upon the blood
entering at the orifices of the base is no less obvious.

In regard to the experiments upon animals, those which were per-
formed by Dr. Kellie, and recorded in the first volume of the Medico-
Chir. Trans, of Eclin., have been quoted, first by Abercrombie,
and subsequently by various other writers. The following are Dr.
Kellie's propositions :

" 1. That a state of bloodlessness is not discovered in the brains
of animals which have died by haemorrhage ; but, on the contrary,
very commonly a state of venous cerebral congestion 2. That the
quantity of blood in the cerebral vessels is not affected by gravitation,
or posture of the head. 3. That congestion of the cerebral vessels
is not found in those instances where it might be most expected ;
as in persons who die by hanging, strangulation, suffocation, &c. 4.
That if there be repletion or depletion of one set of vessels (arteries
or veins) in the cranium, there will be an opposite condition of the
other set of vessels."

Dr. Burrows submits these experiments of Dr. Kellie to a renew-
ed examination, and is naturally surprised at finding that, in contra-
diction to the first proposition, instances of a sheep and dog are given
whose brains, after they were bled to death, contained considerably
less quantity of blood than did that of a dog wlio was killed by tying
the jiigulars and carotids. In the face of such a contradiction Dr.
Burrows saw no other resource than the institution of new experi-
ments He killed two rabbits, the one by opening the blood vessels
of the throat, and the other by strangulation. On examining the
brains of each, 24 hours after, he found that of the former completely
blanched, and that of the other as completely congested. Plates re-
presenting these conditions are appended to the volume. "In fair-
ness to Dr. Kellie I should state, that I have attended at the slaugh-
tering of sheep by butchers, and find the brains of those animals
much less depleted than the brains of rabbits which have died of
haemorrhage. But the sheep did not die of simple loss of blood ; but
partly from the division of the pneumo. gastric nerves and cervical
portion of the cord. These lesions, no doubt, influenced the appear-
ances." The experiments which Dr. Burrows made in reference to
the influence of posture are also in contradiction with the conclusions
of Dr. Kellie; for animals placed under the same circumstances
after death, excepting the dependent condition of the head, presented
very different appearances of the brain as regards congestion.

"It may now be asserted that the encephalon is not exempted from
the law in physics the gravitation of the fluids to the lowest part of
the corpse. The discovery of the operation of this force on the blood
within the cranium after death, suggests a precaution very essential
to be followed, when it is desired to ascertain the precise amount of
congestion of the cerebral vessels at the time of death. In such
cases, a ligature should be placed around the throat, and drawn suffi-

1846.] On Disorders of the Cerebral Circulation, 6fc. 605

cientlv tight to compress (he cervical vessels, nod arrest all flow of
blood through them. TJiis precaution will be most required in the
examination of bodies, where, from the kind of death, the blood may-
be suspected to remain fluid in the heart and groat vessels. The
depending or elevated position of the head during the examination
of the body, will not then induce deceptive appearances, which mis-
lead us in our conclusions as to the previous amount of congestion in
the cerebral vessels." P. 21.

To support this third proposition, Dr. Kellie adduces some instan-
ces of the brains of persons who had been hung presenting no remark-
able congestion. Dr. Burrows, although maintaining that congestion
of the cerebral vessels is generally produced by this or any other
description of death which kills by obstructing respiration, admits
that such congestion is occasionally absent. He attributes this to
the rope having imperfectly compressed the external jugular on one
side, and still more to the subsidence of the fluid blood during the
subsequent suspension of the body, through the unobstructed cervical
vessels, as also through the vertebral sinuses and spinal veins. In
examining the bodies too, of those who have died from strangulation,
the neck is usually cut across, and the thoracic organs inspected prior
to the brain, the blood from which last thus becomes discharged
through the divided cervical vessels.

Dr Kellie's fourth proposition is founded upon the assumption that,
the amount of blood contained within the cranium is always the same.
This, we have seen. Dr. Burrows denies ; and therefore does not ad-
mit the necessity of the adjustment of (he equilibrium between the
two classes of vessels. He believes, indeed, that the amount of extra-
vascular scrum in the cranium is very variable, depetiding upon the
amount of blood in the arteries or veins being more or less than
normal.

On Vascular Pressure within the Cranium, and its Influence on
the Functions of the Brain. Dr. Abercrombie denied the existence
of such pressure 1, because "the cerebral substance is composed
of inelastic fluids which are incompressible; and 2, "because the
brain is incompressible by any such force as can be conveyed to it
from the heart through the carotid and vertebral arteries." In reply
to the first of these, Dr. Burrows observes that the brain, although
very incompressible, is highly elastic. The existence of an outward
pressure produced by the passage of the blood in the vessels is seen
when a portion of the cranium has been destroyed by accident or
disease. Movements of the brain, dependent upon the arterial pulse
and upon the respiration, have long been observed and commented
upon under these, circumstances. Whatever diminishes the acces-
sion of arterial blood to the, brain, diminishes also the former of these,
while ligatures around the external jugulars much enfeeble the latter,
in the ordinary condition of the cranium this pressure is reflected
back upon the brain.

606 On Visor rlers of the Cerebral Circulation, <$fc. [October

"In conclusion, I believe it to be most important to bear in mind,
when considering various pathological states of the brain, that its
substance not only contains a variable amount of blood at different
times, but that it is also subjected to a constant vascular pressure.
This pressure arises partly from arterial and partly from venous dis-
tension : also, it is increased during expiration, and diminished
during inspiration : and although the substance of the brain is very
unyielding and incompressible, nevertheless it sustains, and is influ-
enced by, this vascular pressure. I consider it essential, in studying
the physiology or pathology of the brain, to have constantly in re-
membrance the existence of this vital force. Now vital forces, just
as the most efficacious remedies, when they exceed or fall short of
their proper amount, are capable of producing the most serious ill
effects in the animal economy. Numerous causes may affect this
momentum of the blood in the vessels of the head, and hence give
rise to very different degrees of vascular pressure: at one time it
may become excessive, oppress the organ, and suspend its functions :
at another time, it is insufficient, and seems to be inadequate to sus-
tain the cerebral functions. The injurious effects of modifications of
this pressure on the brain would be much more often exhibited, were
it not for the ample development of the venous system in the crani-
um and spinal canal, which affords such ready exit for redundant
blood; and for another peculiarity in the anatomy of the parts con-
tained in the cranium. The peculiarity to which I now advert, is
rarely pointed out by teachers, and is not sufficiently estimated by
pathologists. I allude to the large amount of extra -vascular fluid in
the cranium, even in health, and which, in the form of serum, is
found in the ventricles and membranes of the brain, as well as dis-
seminated through its substance. This fluid, very appropriately de-
signated cephalo-rachidean, or cerebrospinal, varies greatly in
amount at different times : and, from the anatomy of the parts, as
well as from experiments, it would appear that a portion of this fluid
readily changes its site from the cranium to the spinal canal, and
conversely." P. 50.

The existence of this serum during life has been shown by the ex-
periments of Magendie, Longet and others, and anatomy exhibits
the free communications which exists between the ventricles and the
cavities of the spinal and cerebral membranes. The vivisections of
Ecker and others show us also that the situation of this fluid may be
subjected to considerable change by modifications of pressure. Dr.
Burrows regards this fluid as supplemental to the other contents of
the cranium increasing or diminishing in quantity inversely to the
quantity of blood and serous matter contained within it. It may also
be a means of equalizing pressure over the whole cerebrospinal mass.
When arterial or venous congestion of the brain is suddenly induced,
the increased pressure which is exerted expels a portion of this serum
into the spinal canal, while, when blood is abstracted from the crani-
um, the vacated cranial space is occupied by the spinal serum.

1846.] O/i Disorders of the Cerebral Circulation, <fyc. 607

When the cranium is healthy and normal, the cerebral substance
may in this wav accommodate itself to a temporary increase of blood;
but when the increased determination to, or obstruction of return
of blood from, the brain becomes more permanent, or the cra-
nium contains other abnormal substances, the additional pressure will
not be borne. Whenever there is an increased amount of solid mat-
ter in the cranium, whether from hypertrophy, tumours, extraversa-
tion, &c, whatever excites the heart's action and temporarily in-
creases the degree of vascular pressure must increase the disturbance
of the functions of the brain. "It seems to me probable that many
permanent structural lesions within the cranium do not affect the
functions of the brain by pressure, except when there is some cause
in operation capable of inducing vascular congestion, or when the
lesion is of a mechanical nature, or is gradually increasing."

On the other hand, whatever diminishes the heart's power in these
morbid conditions of the brain mitigates the cerebral symptoms ; but
if such deficiency prevails in the healthy state of the brain, this or-
gan suffers then from insufficient vascular pressure, and syncope
results, this state being produced by such deficient pressure of the
brain, and not, as usually supposed, from the inadequate supply of
blood furnished to it. Thus, in its most simple form, it may be in-
duced by a mere moral emotion diminishing the heart's energy, so
that the blood is not propelled with sufficient energy to maintain an
adequate pressure upon the cerebral substance. On account of the
additional labor imposed upon the heart, the syncope is more likely
to occur if the person is erect, and is relieved by his assuming the
horizontal posture. The greater rapidity with which this state is
induced by the abstraction of blood in the erect posture proves
that the posture rather than the amount of blood lost is the efficient
cause.

44 1 am the more anxious to direct attention to the foregoing ex-
planation of the phenomena of syncope, because a very different
opinion has been advanced in a recent work (Lib. of Medicine, vol. 2)
in extensive circulation among the junior members of the profession.
Thus, in an Essay on Apoplexy (p. 92), it is asserted that syncope
differs from apoplexy only in the extreme feebleness of the heart's
action ; but the cause producing loss of consciousness, sensation and
motion, is stated to be the same in both affections. In either case,
it is said, owing to the peculiarities of the circulation within the
cranium, pressure is exerted on the brain ; and in some cases it is
difficult to distinguish the states of apoplexy and syncope from each
other. *Thus either from increased or diminished action of the
heart, pressure on the brain may be produced by over-distension of
its vessels ; in the first case, of its arteries, and in the second, of its
veins.5 Here we find it promulgated that apoplexy and syncope are
to be attributed to the same physical cause, viz., pressure on the
brain ; and that in syncope the pressure arises from the diminished
action of the heart occasioning fulness of the cerebral veins. Now,

608 On Disorders of the Cerebral Circulation, 6fc. [October,

I believe, that so far from syncope being occasioned by pressure on
the brain, ir will be found, as I have stated at some length, that every
method of diminishing vascular pressure on the brain to any great
extent, whether it he accomplished by depressing moral emotions by
sudden loss of blood, by the erect posture of the body, or by contri-
vances which diminish the momentum of the blood flowing towards
the brain, will almost certainly induce syncope.

"But if syncope be produced by venous congestion, causing pres-
sure on the brain, would any practitioner of experience attempt to
overcome it by the use of those remedies most likely to diminish ve-
nous congestion of the brain, and the consequent pressure on that
organ ? Would he be bold enough to place his fainting patient in
the erect posture, or draw blood from the jugular vein ? I have also
shown by experiments, that when an animal is bled to the point of
fatal syncope, that, so far from rinding venous congestion of the brain
after death, all its vessels are. on the contrary, ex-sanguine. It ap-
pears to me, that syncope differs from apoplexy in every respect but
in this one, viz., that in both there is a total temporary abolition of
the functions of the brain. The causes producing the abolition, and
the means to be employed to restore the functions of the brain, are
generally quite opposite. Without presuming to be hypercritical,
there is cause to regret (hat such erroneous doctrines as to the nature
of so alarming a condition (jf the system as syncope should have been
disseminated by modern writers." P. 64.

Dr. Burrows does not attribute the disturbance of the functions of
the brain which takes place in ancrrnia. so much to the actual defi-
ciency of blood in the organs, as to the defective amount of vascular
pressure exerted upon it. Thus, in ancemia. from hypertrophy of the
brain, in which the dense cerebral mass is dry and destitute of blood,
none of these symptoms are present : but in general anaemia, result-
ing from loss of blood, the various severe nervous symptoms are all
at least temporarily mitigated by posture, stimuli, and whatever fa-
vours the momentum of the blood entering the brain.

The effects which have resulted from the ligature of one or both
carotids also illustrate the doctrine here laid down. Mr. Key tied
the right common carotid in a woman aet. 61, and she died in four
hours, having manifested sterforious breathing. The carotid on the
right side was found nearly obstructed and the vertebrals small. The
brain wa- healthy, and the sudden diminution of the momentum of
the blood in the cerebral arteries seems the only mode of explaining
her rapid death. Although such a result does not usually follow the
ligature of one common carotid, yet a reference to the numerous
cases, collected by M. Longet and Dr. Chevers, show the frequency
of the speedy supervention of marked disturbance of the cerebral
functions or the subsequent occurrence of hemiplegia dependent upon
cerebVal disorganization.

"These subsequent phenomena appear to me to arise from two
causes; partly from the insufficient supply of blood to the disorgan-

13 10. J On Disorders of the Cerebral Circulation, <$fc. G09

ized hemisphere of the cerebrum, nnd portly from the compression
of the exsunguined hemisphere by its fellow, the vessels of which
still continue to he liberally supplied with blood. Tn healthy states
of the circulation within the cranium the forces distending the blood-
vessels in either cerebral hemisphere are equal, opposite, and coun-
terhalance each other : but so soon as the free supply of blood to one
hemisphere is cut offby the ligature of the common carotid, the vas-
cular distension in the other hemisphere becomes a source of pressure
on the exsancruined side. Hence probably the cause of the com-
mencing hemiplegia, which gradually increases with the disorganiza-
tion of the cerebral substance. I am inclined to attribute the suc-
cessful termination of this operation in some cases to the opportune
loss of blood from a wound in the throat prior to the application of
the ligature ;* or the same happy result may be ascribed to a cautious
preparatory venesection before the common carotid has been secured.
By such loss of blood the circulation has been quieted, and the differ-
ence in the momentum of the blood in different parts of the brain has
been, if not obviated, at any rate very much diminished. It might
be objected that the effects upon tying one of the carotids in the
human subject are too diversified to admit of the foregoing explana-
tion ; but. in reply to sueh objection, it may be urfred, that, although
certain effects are usually produced by larp^e abstractions of blood,
still the results of blood-letting are very dissimilar in different indi-
viduals." P. 77.

The effects which result from obstructing the circulation of blood
through the carotids have induced some practitioners to seek from it
a remedial agency. Thus, Mr. Prescott of Calcutta, has tied the
carotids for the relief of severe epilepsy and cephalea in two cases;
and Dr. Parry employed compression of these vessels in mania,
headache, vertijjo, &e. When, however, we consider the irremedia-
ble disorganization which is often present in obstinate cases, the dif-
ficulty of assigning in many the precise causes of their production,
and the temporary character of the remedy, by reason of the quick

An interesting esse in which both c were successfully tied has been

recently recorded by Dr. Ellis in the New York Journal of Medicine, Sept. 1845.
Pettish Hill, ret. 21, was accidently shot. Oct. 21, 1844. The ball passed from
just above the spine of the lefl scapula alon'/ I iDto the mouth, making

its exit through the upper Lip. There was little haemorrhage, and he was trans-
ported twelve miles in a litter. On the seventh day haemorrhage from the
wound of the tongue occurred but was rea*dily suppressed by compressing the
left carotid. On the eighth day, haemorrhage recurring, the left carotid was
tied below the omo-byoideus. No unpleasant symptoms followed, but on
the eleventh day. when a slight pulsation of the temporal artery was felt,
haemorrhage recurred, and again the next day, being temporarily arrested
by pressure on the right carotid and on the orifices of the wound. This, how-
ever, caused too much pain to be borne, so that, four >'< lalf after the
first operation, the right as tied. The only bad symptoms which fol-
lowed were some dyspnoea and cOugh, which were reli< ved bya small depletion
and then giving small i . 1845, the young
man enjoyed comfortable health, and wi . No pulsation
could then he felt in either temporal a]

39

610 Chronic Abscess of the Tibia. [October,

re-establishment of the circulation by anastomosis, we are surprised
that so careful a practitioner as Dr. Burrows should recommend this
operation.

"Although the ligature of the common carotid is attended with
risk to life in some cases, (perhaps in the proportion of one death in
four operations,) still experience proves that, where proper precau-
tions have been taken, the operation is not so dangerous as many
suppose. Therefore, in violent and hopeless cases of epilepsy and
some kindred maladies, which are characterized by extreme cerebral
congestion, it appears to me that, other remedies failing, this opera-
tion may be fairly resorted to. I am aware of the responsibility of
advocating a remedy attended with risk of life ; but are not all our
best remedies most violent poisons in the hands of the unskilful ? But
this truth does not forhid their use to the more expert. So may this
powerful method of influencing the cerebral circulation be justifiable
in aggravated cases of the class referred to, and where the precept of
Celsus salius est anceps remedium experiri qudm nullum, may be
fairly put into practice." P. 79.

Lectures illustrative of various subjects in Pathology and Surgery,
By Sir Benjamin C. Brodie, Bart., F. R. S., &c. &c. 8vo.,
pp. 411. London : 1846. -(Med. Chir. Rev., July 1846.)

Lecture XXI., the last in the volume, is on Chronic Abscess of the
Tibia. A case is related of extremely painful enlargement of the
lower end of the tibia which led to amputation ofthe limb. A cavity,
as large as a small chesnut and containg pus, was discovered in the
diseased bone. This occurred in 1824. It was clear that, if an
opening in the tibia had been made with a trephine the limb might
have been saved. In a case of painful enlargement ofthe tibia, in
which Sir B. Brodie was consulted about two years after the occur-
rence of the preceding case, he made an opening into the cancellous
structure ofthe bone with a trephine, and having given vent to some
pus, the patient became cured. Four other cases, three of enlarge-
ment of the lower end of the tibia, and one of the upper, are related.
They were all trephined with a successful result in giving exit to pus
and curing the patient of a most painful affection. The operation
has also been twice successfully performed by Mr. Liston. The fol-
lowing important questions present themselves. What are the cir-
cumstances that would lead the surgeon to suspect the existence of
abscess in the tibia? And, supposing it to be probable that such an
abscess exists, what are the exact steps of the operation to be per-
formed for its relief?

"When the tibia is enlarged from a deposit of bone externally
when there is excessive pain, such as may be supposed to depend on
extreme tension, the pain being aggravated at intervals, and these

1846.] Chronic Abscess of the Tibia. Gil

symptoms continue and become still further aggravated, not yielding
to medicines, or other treatment that may be had recourse to, then
you may reasonably suspect the existence of abscess in the centre of
the bone. You are not to suppose that there is no abscess because
the pain is not constant ; on the contrary, it very often comes on only
at intervals, and in one of the cases which I have related there was,
as I then mentioned, an actual intermission of seven or eight months.
After the disease has existed a certain number of years, indeed, the
pain never entirely subsides, but still it varies, and there are always
periods of abatement and of exacerbation. The combination of cir-
cumstances which I have described will fully justify you in making
an opening into the bone with a trephine. But how will it be if you
are mistaken 1 This will not often occur ; but if it should, the taking
out a circle of bone can be of no consequence ; no injury follows the
operation : it is unattended with danger. The operation itself is very
simple. You expose the surface of the bone, and make a circular
opening with a trephine at that part where there seems to be some
tenderness and some pain on pressure. One principal thing to be
attended to is that you have a proper trephine. You do not want so
large a one as for the cranium, and it must be somewhat differently
constructed. Those which lie on the table are made for the purpose.
One is of very small diameter, but, generally, it is quite sufficient.
The common trephine is made with a projecting rim or shoulder, and
if there be much enlargement of the bone, it will not penetrate deep
enough to reach the abscess. It is true that you may break away the
bone afterwards, by means of a chisel, but the operation may be more
easily performed with a trephine having no projection, which will at
once penetrate to the abscess, however deep it may be, and render the
chisel unnecessary."

After the operation, the bone soon granulates, the space is filled
up by a sort of fibrous substance, and the wound cicatrizes. Sir B.
Brodie states that, if the operation were not performed, the patient
may continue in torture for a great number of years, losing all the
best part of his life; or a worse event than that may take place.
The abscess may lead to disease in a neighbouring joint and in this
way prove destructive to life. Cases are given in which abscesses in
the head of the tibia had caused serious disease of the knee-joint.
These cases "show that it is not safe to leave an abscess in the ex-
tremity of the tibia beyond a certain time ; that the joint is always in
danger, and that the perforation of the bone is the only remedy.
Even if you were mistaken in your diagnosis, no harm can arise
from the operation."

A case is mentioned of a young gentleman who had a painful en-
largement of the middle of the humerus. It was trephined freely,
but no matter escaped. The bone was very hard and compact, and
the trephine was with difficulty made to penetrate through it. The
wound healed, tin; relief was complete, and the patient continued
quite well. Sir B. Brodie supposes "that this was a case of chronic

61*2 On Calculi of the Nasal Fossa. [October,

inflammation of the humerus, and that taking out the piece of bone
from the centre, probably, partly by relieving the tension, and partly
by a discharge of matter from the hone unloading the vessels, ac-
counted for the relief which the patient obtained from the operation."
Notwithstanding the result of this case, it cannot be questioned
that the greatest care and caution are required in determining the
necessity for an operation for the evacuation of a supposed abscess
in the substance of a bone. We have been informed that, not long
since, a limb was amputated by a hospital surgeon, in consequence
of a suspected abscess in the head of the tibia of a painful character,
and implicating the knee-joint. On examination of the limb after
removal, the joint and tibia were found to be quite healthy, and the
complaint proved to be hysterical.

On Calculi of the Nasal Fosses. By M. Demakquay. (Archives
Generales de Medecine, June, 1845 from Edinburgh Med. and
Surg. Journal.)

The occurrence of a case of calculus of the nasal fossa in a patient
admitted into the Hotel Dieu, under the rare of M. Blandin, attract-
ed M. Demarquay's attention to the subject. The subject of this
case was a woman, 35 years of age, who, for a couple of months,
had been troubled with considerable impediment to breathing through
the left nostril. For some time past fetid purulent matter had been
discharged from that nostril. She brought with her a calculus about
the size of a pea, which M. Barth had extracted a few days before.
She remained four days in the hospital, during the first three of which
a few very small calculi, varying in size from a pin's head to that of
a pea, were abstracted. On the third day one of the size of a bean
was removed. Its surface was rough, and on being sawed through
its nucleus was found to consist of a cherry stone. On analysis these
calculi were found to consist of phosphate of lime and magnesia, car-
bonate of lime and of magnesia, chloride of sodium, with traces of
the carbonate of soda.

On examining the literature of this very rare disease, M. Demar-
quay found that fourteen cases had been recorded in which calculi
of various sizes escaped from, or were removed, from the nasal cavi-
ties. The following is a short abstract of these cases :

1. Bartholin, in 1654, stated that a young girl of distinction, when
blowing her nose, expelled several calculi, among which was one of
the size of a date stone.

2. The same author relates, that a woman of Helsimbourg by mis-
take swallowed a cherry stone, which remained several weeks in the
fauces. It occasioned acute pain, and the formation of a tumour,
which, however, did not suppurate ; but one night, in a fit of cough-
ing, the cherry stone was ejected, and was found covered with a

1846.] On Calculi of the Nasal Fossce. 613

pretty thick coating of a calcareous looking substance. The tumour
after this rapidly disappeared.

3. Clauder, iq 1685, related the following case : A woman, 60
years of age, subject to colds, began to be annoyed with an abundant
discharge of thin mucus from the right nostril, with difficulty of
breathing through it. A resisting object was felt on probing the
nostril. During a fit of sneezing this body got dislodged, and was
extracted. It was the size of a walnut, and was so hard that it could
with difficulty be broken with a hammer.

4. Kerne, in 1700, published a case in which acute headaches were
caused by nasal calculi. A young girl for about a year and a half
had been subject to obstinate frontal headache, for which various
remedies were used without success. Kerne ordered a sternutatory,
which had scarcely began to act before he was called in haste to see
her as she was threatened with suffocation from somebody obstruct-
ing the nostrils, in which also violent pain was felt. More of the
sternutatory was given, when a calculus of the size of a pea was ex-
pelled, followed shortly by several others. After the expulsion of the
calculi the headaches disappeared.

5. Vitus Riedlinus, in 1706, stated that a young married woman
suffered from obstruction of one of the nostrils, which was swollen,
and emitted a most offensive odour. On probing the nostril, a hard
substance was felt, which was seized with the polypus forceps and
removed. Several calculi were thus removed, the largest the size of
a bean. From this moment the patient recovered.

6. Wepfer, in 1727, published the history of a calculus which he
removed from the right nostril of an old lady in 1680. It obstructed
the nostril and caused a considerable mucous flow from it. It was
situated in a large ulcerated hollow tumour, resembling a polypus,
which filled the nostril. The tumour appeared to be connected with
the roots of a carious front tooth, as pulling on it caused the move-
ment of the tumour, and the calculus resembled the incrustation
which forms on the tooth, but was harder.

7. Ruysch, in 1733, related that a young girl of five introduced
into the nostril a piece of amber. It gave considerable annoyance
till she was fourteen years of age, when, in a fit of sneezing, it was
expelled, surrounded with a thick coating of cretaceous matter.

8. Horn, in 1788, published a case in which a cherry stone, which
escaped into the nostrils, gave rise to symptoms of polypus, inconse-
quence of becoming encrusted there with a voluminous coating of
cretaceous-looking substance.

9. Saviales, in 1814, published the history of a case in which a
man, 42 years of age, suffered from continued headaches and pain in
the nostril. After an attack of erysipelatous inflammation, an abun-
dant purulent secretion was discharged from the nostril, which seem-
cd to he filled will) a polypus. On seizing it, it turned out to be an
earthy concretion an inch and a half long, which filled the nostril, and
on being broken was found to contain as a nucleus a cherry-stone.

614 Diagnosis and Treatment of Abdominal Affections. [October,

10. Graeffe, in 1828, related a ease in whioh an earthy concretion
formed in one of the nostrils, not only giving rise to frontal pain, but
also serious affection of the corresponding eye. Before the concre-
tion was discovered and removed, the tears appeared to possess a
caustic acid nature; and M. Graeffe thought that the calculus was
produced from matter deposited by tfiem, modified as they probably
were by the person possessing an arthritic constitution.

11. In another case narrated by the same author, in which tolera-
bly similar symptoms were present, the calculus which was of an oval
form and about an inch long by half an inch broad, contained a
cherrystone as a nucleus, around which the calcareous matter was
deposited.

12. M. Flouret, in 1829, in dissecting a subject who died at the
Hospital of la Charite, found a nasal calculus of an inch and a half
in diameter occupying the right nostril.

13. In 1829, Dr. Axman met with a curious case, in which severe
attacks of hemicrania occurred periodically for many years, but were
not amenable to treatment till after taking a pinch of snuff, when a
calculus of the size of a bean was discharged. The hemicrania dis-
appeared, but after a time returned, when severe fits of sneezing
artificially produced, caused the evacuation of a large number of
calculi with much fetid purulent matter. From this period the pa-
tient completely recovered. These calculi on analysis were found
to consist of animal matter, 3.5; phosphate of lime, 8.0; carbonate
of lime, 32.5; carbonate of magnesia, 12.5; with a trace of muriate
of soda and oxide of iron. _

14. Brodie published in 1844 the history of a case in which from
infancy there had been an offensive discharge of matter from the
nostril, with the usual symptoms of diseased bone ; and the case was
accordingly treated as such. One day, when about twelve years
old, in blowing her nose, a calculus escaped, which on being exam-
ined by Dr. Prout, was found to be composed of inspissated mucus
penetrated with phosphate of lime.

Hints on the Diagnosis and Treatment of Abdominal Affections.
By Dr. Griffin. (From Braithwaite's Retrospect.)

In the treatment of acute inflammation of the bowels by purga-
tives, there is a danger of the irritation being propagated from the
mucous to the serous surfaces, consequently their use as derivatives
cannot be taken advantage of, as in affections of the head and chest.
The danger Dr. Griffin points out, and believes th.it "people do not
recover because they are purged, but they are purged because they
recover."

Of the use of opium in peritoneal enteritis, Dr. Griffin entertains
the highest opinion, and relates several cases in which very large

134G.] Diagnosis and Treatment of Abdominal Affections. 615

and frequent doses wore given with the happiest results. In one case,
first two grains anu1 tnen one grain doses were given every two hours,
until thirty-two grains had brjen taken, two or three grain doses hav-
ing been resorted to on the occurrence of a relapse. In the case of
a girl, ten years of age, whose condition had been previously much
aggravated by the use of purgatives, and who appeared to be sinking,
twenty drops of laudanum were given, and in half an hour a grain of
opium. Sound sleep ensued, and the patient, who had seemed almost
moribund, was saved, the opiate being continued for some time at
longer intervals. To a bov, set. five, in whom peritonitis occurred
during the last stage of typhus fevenj probably from perforation, grain
doses were given with a successful result. Dr. Griffin does not pro-
pose opium as a substitute for general or local bleeding where these
can be borne, but as a most useful remedy where this is not the case;
or where the disease continues in spite of their institution. The state
of the bladder should be carefully watched, as retention of urine is
Dot of unlikely occurrence during the use of full opiates.

Dr. Griffin does not entirely condemn the use of purgatives, even
in the early stages of enteritis, but the greatest advantage is to be
derived from them when the force of the disease is broken, and we
wish to empty the bowels of their contents. This he effects by mild
purgatives, combined with henbane, but he would feel disposed to defer
doing this till a later period, if there was no injurious distension
present. He concludes, and general experience confirms the con-
clusion, that in the early stages of enteritis, purgatives do not act until
the inflammation has been subdued by depletion, or the disease has
otherwise subsided : while, as soon as this has been accomplished, the
bowels act spontaneously, or by the use of mild purgatives: that if
purgatives are exhibited early, and act freely, death may neverthe-
less ensue, unless (he disease is arrested by other remedies ; that pur-
gatives may, per se, occasion inflammation, or cause its recurrence ;
and that inflammation of the bowels may be subdued without any
evacuation at all, and the bowels may continue confined for three or
four days, without any injurious distension. In distinguishing nervous
affections of the abdomen from inflammatory, by tenderness on
pressure, Dr. Griffin points out the simultaneous existence in the
former of tenderness in a corresponding portion of the spinal column ;
and where this exists there is a state of system scarcely compatible
with inflammation. He says :

In determining the diagnosis of abdominal inflammation, where
both pain and tenderness on pressure exist, we should always endeav-
or to ascertain 1. Whether there be any pain or tenderness on
pressure in the corresponding portion of the spinal column : because,
if there be, although it may not absolutely decide whether inflamma-
tion be present or not, it is quite sufficient to account for both the
pain and tenderness, without assuming the existence of any inflam.
mation. 2. Whether if there be no spinal tenderness or pain, the
soreness of tiie abdomen be superficial or deep-seated, which may be

616 Diagnosis and Treatment of Abdominal Affections. [October,

ascertained with tolerable certainty in all cases, by an examination
directed to that end. And whether, if both superficial and deep-
seated as it usually is in peritoneal inflammation, gentle, steady
pressure with the flat of the hand can he easier home, than with the
points of the fingers. In pain and soreness from atfection of the
spmal nerves it commonly can he so home, while in peritonitis every
kind of pressure, and even the weight of the bed-clothes, is very
distressing. (And yet one of the hest means of distinguishing hys-
terical tenderness will often be found to he the observation of how
the slightest degree of pressure gives rise to the expression of intense
suffering, although the countenance does not alwavs corroborate this.
The tenderness in these cases is quite cutaneous. Rev.) 3. Whe-
ther the boundaries of the pain or soreness extend beyond what the
suspected inflammation could produce. Thus, if inflammation of the
liver he suspected, and we find the soreness extending to the ileum
or groin, or to the opposite side of the abdomen, it is obvious the
soreness cannot be attributable to mere disease of that organ.
Again, if the whole abdomen be tender to the touch in a case other-
wise closely resembling peritonitis, and we find the tenderness is not
confined to the abdomen, but extends over the hips and lower ex-
tremities, it is obvious we can attach no importance to the abdominal
soreness as a sign of inflammation. (This is a most valuable sign
from which we have often derived the greatest assistance. Rev.)
Finally, it should be recollected that constipation may depend on
mere loss of power in the intestinal nerves, as well as on spasm, ob-
struction, or inflammation, since the treatment in each case must
necessarily be modified, or directed by the supposed cause of this
symptom.

The reviewer remarks that

Of the antiphlogistic powers of. opium, Dr. Griffin expresses his
high opinion : and states that for many years he has almost entirely
relied upon it for the subdual of enteritis and peritonitis. He bleeds
first, however, in subjects who will bear depletion, employing calomel
also when the disease is very intense, and resists opium powerfully
suspending this as soon as the symptoms give way, and giving the
opium alone, whereby troublesome salivation is usually prevented. In
rheumatic inflammation it is as useful. In acute inflammation of the
mucous membranes opium was formerly supposed to be contra-indi-
cated ; but the cases published by Dr. Stokes and others, of cure of
inflammation of the mucous membrane of the bowels with exhausting
diarrhoea, show the propriety of the practice. Dr. Griffin attributes
the evil effects which have followed the use of opium in these inflam-
matory affections to its having been given in too smail doses, which,
in cases of mucous phlegmasia?, suppress the diarrhoea without sub-
duing the inflammation to which this had even acted as a relief.
But in these, as well as in serous inflammations, bleeding must be
premised where the strength will admit of it, applying at the same
time warm poultices to the abdomen. In other cases, in which

1 846 . ] The Natural History and Treatment of Wounds. G 1 7

bleeding is out of the question, and opium seems powerless, as in bad
dysentery, a combination of ipecacuanha and opium acts sometimes
surprisingly. Dr. Griflin alludes to two cases in which he gave three
grains of opium with from three to five of ipecacuanha every two
hours with the best effect.

Although opium is contra-indicated in inflammatory affections of
the cerebrospinal system, from its tendency to produce congestion,
yet when combined with sufficient doses of tartar-emetic, it allays
nervous irritation, quiets the action of the capillaries, and procures
sleep. Its effects are wonderful in many cases of puerperal mania,
delirium tremens, and the advanced stages of fever. It is to Dr.
Graves we are indebted for pointing out the value of this combination.

Dr. Graves directs four gr. of emat. tart, and two drachms of
laudanum to be mixed with half a pint of camphor mixture, two table-
spoonfuls of which are to be given for the first dose, and one every
half-hour afterwards, until the delirium abates, or some signs of
drowsiness appear.

Dr. Griffin believes that the restorative power of opium in exhaus-
tion from haemorrhage, depends principally upon its property of pro-
ducing congestion of the brain, and thus restoring tension to the
cerebral vessels.

The Natural History and Treatment of Wounds. By Isaac Gil-
christ, M. D., of VVoodside, Aberdeen. (British and Foreign
Medical Review.)

In the case of an external injury, we are invariably met with the
demand, what application will heal or cure it; in former days they
had sarcotic or flesh-creating ointments, and in our own days we
have healing cerates, and other similar preparations without number.

Let us first inquire what Nature can accomplish in the matter of
wounds; and then, how she may be aided in her operations. Dr.
Macartney states, that as to the effects of injury in the different
classes of animals, he found, "that the powers of reparation and re-
production are in proportion to the indisposition or incapacity for
inflammation, and hence that inflammation is so far from being
necessary to the separation of parts, that in proportion as it exists
the latter is impeded, retarded, or prevented ; and that when inflam-
mation does not exist, the reparative power is equivalent to the ori-
ginal tendency to produce and maintain organic form and structure ;
that it then becomes a natural function, like the growth of the indi-
vidual or the reproduction of the species." This is quite different
from the doctrine formerly taught under the terms adhesive, suppu-
rative, ulcerative inflammations. There is no countenance here given
to Sir As t ley Cooper's statement "No wound can be repaired with-
out inflammation.

618 The Natural History and Treatment of Wounds. [October,

Dr. Macartney describes the modes of reparation as follows:
1. Immediate union without any intervening substance, such as blood
or lymph. 2. The union by the medium of eoagulable lymph, or a
clot of blood. 3. The modelling process, or reorganization without
any medium of lymph or granulations, the cavity of the wound be-
coming obliterated by a natural process of growth. 4. The repara-
tion by means of a new, vascular, and organized substance, called
granulations. In the treatment of wounds, therefore, the great object
of the surgeon must be to prevent inflammation, and thereby secure
reparation by any of the first three modes ; if he is successful in this
object, granulation and suppuration, which go together, will be obvia-
ted. The following simple rules seem to embrace all that is necessary
to facilitate nature's operations: approximate the edges of the
wound gently and without much traction (after having cleaned it and
removed foreign bodies); use as few stitches as possible; use as little
adhesive strap as possible; apply a pledget of cloth soaked in cold
water, and bandage loosely ; inculcate obsolute rest"; preserve the
part moist and cool, by the assiduous changing of cloths wrung out
of cold water, and applied over the bandage; the part must not be
allowed to become heated, so that for the first few days the cloths
must be changed every two or three minutes, or a minute continuous
stream must be directed on the part, by any of the simple processes
recommended for the purpose. By the use of the cold-water dress-
ings, incised wounds heal immediately, and lacerated wounds detach
sloughs, and are repaired by the remodelling process without suppu-
ration, at the same time presenting the most excellent cicatrix. In
the latter kind of wounds, when poulticing is used, profuse suppura-
tion is established, inflammation being excited by the hot, rancid, op-
pressive irritating poultices, much of the previously sound tissues are
wasted away, and the resulting cicatrix is rigid and puckered, and
contracted.

We read that Hippocrates himself used water dressing most suc-
cessfully, but that afterwards Celsus introduced a variety of absurd
and complicated medicines. In the 14th century, the system of
secret dressing was in fashion, each practitioner having a remedy
which he. considered universally applicable. When at a still later
period water dressings were used, they were accompanied with in-
cantations, to which the good effects were attributed. It is stated
that Ambrose Pare, a pious but superstitious man, used the same ap-
plication, but astonished at his extraordinary success, deemed the
remedy nothing less than miraculous, and therefore not to be used
by mortals, and accordingly he abandoned it.

This mode of treating wounds has received at my hands a very ex-
tensive trial, and has been followed with great success. I must,
however, confess that I have had no inconsiderable difficulty in
overcoming the prejudices of the people against so simple a method ;
and, in ordinary private practice, it is not unlikely 1 might have been
obliged to discontinue it, or at any rate, substitute the usual more

1846.] The Natural History and Treatment of Wounds. C19

formal perfumed lotions; but the nature of my appointments in con-
nection with the extensive manufactories in this district, has enabled
me to carry forward the simpler practice, and that, too, at least, to
the entire satisfaction of the people themselves. Such prejudices are
not confined to our locality, and have been, I fear, too much fostered
everywhere by the more mysterious proceedings of the scholastic and
orthodox practitioners. If this is so, we need be less astonished at
the success of quackery, which is conducted upon similar principles.
When we let all our patients see and comprehend that we are treat-
ing them upon scientific and simple principles, then may empiricism
prepare for its downfall without any interference on the part of gov-
ernment.

I shall conclude with a brief note of a few cases which have occur-
red recently, in illustration of the foregoing observations.

T 4 or?

I. A man received an injury by the machinery in a large paper
mill, which laid open the wrist-joint. The hand was half separated
from the fore-arm, the tendons were torn, and the inferior end of the
radius, which is naturally related to the carpus, was exposed. The
arm and hand were placed straight upon a pillow, the wound was
cleaned, and two stitches taken ; a pledget of cloth soaked in cold
water was applied, and a bandage rolled, not too tightly, round the
hand, wrist and fore-arm ; a large basin of cold water was placed
conveniently by the bed-side, and directions left to apply freshly-
soaked cloths over the bandage every two or three minutes, to prevent
any heat or inflammation ensuing. No inflammation took place;
the modelling process was uninterrupted, without suppuration, and
an excellent cicatrix formed in little more than a fortnight.

II. A girl had the whole of the soft parts on the palm or surface
of the four fingers, as it were, scraped oil' by tiie machinery of a flax
mill ; the tendons were torn, and the phalanges exposed at different
places, Each finger was dressed as follows every day : being first
bathed in cold water, a piece of soft cloth was placed round the finger,
and a narrow roller to keep it appjied ; when the fingers were all
thus dressed, a large cloth soaked in cold water was wrapped round
them together, and changed as frequently as the slightest tendency
to become heated appeared. The modelling process advanced stead-
ily without suppuration, and cicatrization was completed in about
four weeks. The fingers gradually acquired flexibility.

A great number of similar accidents have occurred among boys
and girls employed in the cotton and flax factories in this district
during the last six or seven years; and the same simple treatment
has been adopted, so that, although obliged occasionally to amputate
fingers in part or in whole, cases of very remarkable injury of soft
parts and hones have recovered, and members have been saved, which,
in all likelihood, would have been sacrificed by a treatment less cal-
culated to prevent inflammation and suppuration. Flabby granula-
tions are seldom seen, unless w here the prevention of inflammation is
carelessly attended to ; so that caustic applications, astringent lo-
tions, and stimulant ointments are not used.

620 Clinical Lectures on Diarrhoza of Infants. [October,

III. A little boy had scrofulous disease of the bones of the ankle-
joint, on account of which I amputated, by the flap operation, below
the knee. Two stitches were used for two days; a strip or two of
plaster, and cloths wrung out of cold water were the sole applications.
The wound was whole in a week. Other amputations have been
similarly treated, with equal success.

IV. A girl received a sharp instrument into the hall of the eye, at
the Woodside works. The cornea and sclerotic coat were ruptured,
the iris was lacerated, and prolapsus followed. Rest in bed, continu-
ed persevering use of cloths wrung out of cold water, and simple
laxative medicine, constituted the treatment. The treatment was
effectual in preventing inflammation, which was clearly the only in-
dication in the case. The termination was as favorable u& tuii.u be
under such circumstances. .

A multitude of cases might be recorded in tms place in which the
same simple natural treatment was adopted ; but these instances suf-
fice to show what Nature can accomplish herself, and thj iiitle we
have to do to facilitate her operations.

Clinical Lectures on Diarrlicea of Infants. By Prof. Trousseau.
(London Medical Times.)

The influence of the change of seasons is very strongly felt in
hospitals destined to infants. During the course of the winter a
numerous series of pulmonary and cephalic disorders has passed be-
fore us; we are entering now into spring, and the coming heat will
bring with it intestinal affections. Soon, perhaps, you wijl not in
one month meet, in these wards, with a single case of pneumonia,
twelve or fifteen cases of which were admitted during every month
of the winter. Thoracic diseases will he replaced by abdominal
symptoms, and amongst these diarrhoea being the most frequent,
the most difficult to treat properly, and the least understood, we will
endeavour to prepare you beforehand for its observation by some
remarks upon it pathology and treatment. The subject is extremely
difficult, and although I have for eight years devoted myself to a daily
study of the maladies of infancy, I feel myself in the dark with re-
gard to many of its details, and do not therefore, pretend to give you
a completely satisfactory description, but merely to impart the little
I do know of the matter. In order to introduce some regularity in
the following remarks, we deem it necessary to establish a practical
division between the various sorts of diarrhoea which are observed in
children. We acknowledge only four primary forms of diarrhoea.
1, bilious diarrhoea; 2, mucous diarrhoea; 3, lienteric diarrhoea;
and 4, choleriform diarrhoea, or cholera infantilis. These forms are
peifectly distinct from each other, and all the varieties of diarrhoea
which may be observed in children, and which do not seem at first to

1846.] Clinical Lecture on Diarrhcca of Infants. 621

have a place in our classification, will be found to consist of combina-
tions of several of these original forms, or of deviations from these
elementary types.

Causes. Bilious diarrhoea may consist in a simple increase of the
biliary and pancreatic secretions, or in a perversion of their qualities.
Both may result from local irritation, but the first is often produced
by mere physiological excitement. We will find a double illustration
of these pathogenic influences, in the abundant flow of saliva deter-
mined by simulation of the mouth with mercury, and in the increase
of the secretion of tears caused by sorrow. Thus, slight inflamma-
tion of the stomach or duodenum will occasion a discharge of bile
into the intestine; thus, fear, anger, nervous excitement, in a word,
will also produce an increase of the biliary, pancreatic, and some-
times the renal secretions. We mav sav we meet with daily exam-
ples of the great power of physiological stimuli on the conglomerated
glands. The diarrhoea of the young soldier who goes into action for
the first time, is another common instance of the same kind, a fur-
ther illustration of which we find in the influence of dreams on the
spermatic organs. Violent exercise, abundant perspiration in many
persons bring on diarrhoea. In the water-cure, a method of treat-
ment too advantageous in some diseases to be entirely left to quacks,
we find that during the process of packing, if the patient is made to
drink several tumblers of water, abundant perspiration is thrown out,
but if diaphoresis does not appear, the mucous surface of the intestine
substitutes its action to that of the skin, and relieves the system by
diarrhoea. One of the most frequent causes of diarrhcea will be
found to reside in the quality of the food. The presence of globules
of colostrum in the nurse's miik, due, as Donne hns proved, to latent
irritation of (he mamma, sudden weaning, the exhibition of improper
food, are all circumstances by which diarrhoea mav be occasioned in
the infant. The habit of covering the child in bed with too warm
clothing, is also a frequent cause of disease. This is unfortunately a
habit very prevalent amongst the lower classes in this country. So
many as four blankets are thrown over the child, who is besides en-
veloped in swaddling clothes ; and to add to the child's comfort, the
mother not un frequently adds her pillow to his other clothing.
Abundant perspiration is thus produced, and, without any regard for
the consequences, the child is extracted from his bed to be suckled or
cleaned, thus being exposed several times a day to sudden changes of
temperature, the result of which is pulmonary disease in winter, and
intestinal derangement in summer.

SemeioJo^j/. Bilious diarrhoea generally follows slight feverish-
md is often preceded or accompanied by vomiting. The mouth
is bitter, the tongue foul, and the appetite absent. The color of the
motion varies from yellow to green, according as the biliary secre-
tion is changed in its quality, or only increased in quantity. Its du-
ration is from three to six days, and its termination favorable, unless
the case is mismanaged. It is in fact a slight catarrhal condition of

622 Cljnical Lecture on Diarrhoea of Infants. [October,

the mucous surface. Mucous diarrhoea is marked by the discharge
of a new secretion from the bowels ; it is often the consequence of the
first variety of disease, or of indigestion. The nutriment acts as a
foreign body upon the intestine, producing local irritation, and the
excretion of a slimy mucus. This is a very common, and fortunately
not very dangerous form. But when the irritation of the digestive
tube is carried beyond certain limits, matters take a more serious
aspect ; enteritis sets in, and the products of inflammation are passed
with the motions. Colitis occasionally makes its appearance, attend-
ed with intense pain, betrayeclby cries uttered two or three minutes
before the motions, with which a small quantity of blood is sometimes
mixed, the dejections assuming a dysenteric character. When the
small intestine alone is inflamed, our third form of diarrhoea, lientery,
appears. In this variety the food passes unaltered through the di-
gestive organs, and is recognisable in the dejections, in which grains
of rice, vegetable substances, curdled milk, can be readily distin-
guished. This is an extremely dangerous derangement, on account
of the impossibility'of refection.

After one of the above kinds of diarrhoea, occasionally without
them, the cholera of children that almost invariably fatal affection
is observed to show itself. After dejections of a bilious or mucous
character, the infant is suddenly seized with violent vomiting, against
which the efforts of art remain unavailable. A watery diarrhoea of a
greenish hue is at the same time discharged from the bowels, and
alarming general symptoms are noticed. The eyes sink in the orbits,
the features are decomposed, the complexion becomes livid, and the
nose, tongue, extremities, and even the breath, grow cold ; the cry is
acute, small, and incessant; the skin loses its elasticity, and when
pinched in any part of the body, retains the folds made by the fin-
gers, as if it were become an inert membrane. The child is sleep-
less, but without convulsions. Such are the first symptoms of the
formidable malady. In its second period the vomiting, and some-
times the diarrhoea, cease, but no amendment follows. The collapse
increases, and the infant almost invariably dies. We have, however,
occasionally had the consolation of saving some few cases ; one is
at present in the wards, to whose case we called your attention, and
who owes his recovery, under Providence, to the double tartrate of
soda and potass.

Treatment. We have found few drugs of any avail in the treat-
ment of the bilious diarrhoea in children. It is a convenient plan to
call the malady a gastro-enteritis, because the denomination leads to
an invariable line of treatment, accessible to understandings of the
meanest capacity. We take, however, a different view of diagnosis
generally, and deem it unprofitable unless it leads to some practically
useful indication. Some forms of diarrhoea are doubtless less difficult
of cure than others, but we must say that the varieties we have des-
cribed often combine with each other, so as to cause the practitioner
no small embarrassment, and to reduce him, in many cases, to a

1846.] Clinical Lectures on Diarrhcea of Infants. 623

blindfold empiricism ; not but that we profess much respect for that
empiricism which teaches us to exhibit mercury in syphilis, steel in
anemia, and bark in ague; hut the empiricism we deprecate as a
contemptible method is that which is not guided by diagnosis. The
method we refer to mav become a useful guide to the detection of
the nature of disease, and it then acquires a considerable degree of
utility. Let us remind you of a case of hemicrania at present in the
wards. The attacks were periodical, and we tried sulphate of qui-
nine without success; thus acquiring the knowledge that it was not
governed by miasmatic influence. We exhibited then mercurial
preparations, and the nervous headache having yielded at once, we
were led to attribute the disease to syphilis. This is the empirical
method we adopt; it is not the empiricism of experiment, but of ex-
perience. Thus, if we say that a patient is affected with neuralgia,
we express a diagnostic opinion which is as elementary, and, let us
add, as useless, as to say that he is affected with a corn on his foot ;
but it is quite another sort of thing to say that the patient is laboring
under gouty, syphilitic, miasmatic, rheumatic, orchlorotic neuralgia,
because this kind of diagnosis leads us to the real therapeutic indica-
tions. To return to the treatment of diarrhcea: Let us not forget
that, to arrest the superabundant intestinal secretion is not by any
means to cure thecomplaint which caused it. It is our opinion that
bilious diarrhcea is only a very superficial catarrhal derangement of
the intestine. The most efficient treatment consists in the exhibition
of neutral salts, such as the double tartrate of potass and soda, phos-
phate of soda, Epsom or Glauber salts. We do not wish you to un-
derstand that we recommend the use of purgatives. Xo ; castor oil
and magnesia, or manna, you will usually find unsuccessful, whereas
the neutral salts generally produce a speedy amendment. We have
also derived benefit from the exhibition of ihe pulv. ipecac, at doses
varying from two to ten grains, and mixed with a little jam, milk, or
simple syrup. The action of this medicine i.s threefold: it is a sub-
stitutive, a discutient, and being a diaphoretic deviates towards the
skin those vital energies which are occupied in the production of
morbid symptoms in the alimentary canal. But when the bilious
diarrhcea is the consequence of mere nervous excitement when it
is caused by fear or anger, as tears by grief, or salivation by appe-
tite opium gives relief in a very short time. In these cases, which
you will find to be characterised by the absence of any sort of suffer-
ing during the first twenty. four or thirty-six hours, the disease will
speedily yield to the influence of hypnotic medicines. Half a drop
of Sydenham's laudanum is a sufficient dose for a child under six
months ; others, it is true, will bear two or three drops, but that dose
is too powerful a narcotic for the manv. The laudanum should bo
dissolved in an ounce mixture, whereof the infant shall take a tea-
spoonful every three or four hours: but when the disorder has lasted
beyond the specified time, opium ceases to possess its salutary effect,
because the mere presence of the increased secretions on the mucous

624 On Typhoid Fever. [October,

surface has sufficed to bring on an irritation which did not exist at
first. Then we must again have recourse to neutral salts.

In mucous diarrhoea we have generally derived benefit from three
sources: saline purgatives, calomel, and rhubarb. The dose of calo-
mel we recommended is one-fifth of a grain daily, mixed with half a
drachm of sugar. This should he continued two or three days at
furthest. As to rhubarb, it is the "syrup" we use, the so-called
" sirop de chicoree" a good preparation in every thing but its absurd
name, which insinuates the idea of the efficacy of the endive, which
is, on the contrary, perfectly inert. Great attention should be paid
to the child's diet ; his food, less abundant than usual, should be cho-
sen with great care. Milk is the most proper food for young children ;
fecula and broth also may be given after the expiration of the first
year, and the drink should he in small quantity. In the choice of
food the physician must also allow himself to be guided, in a great
measure, by the idiosyncracy of the child, and the mother's remarks
on the peculiarities of his appetite.

On Typhoid Fever. By M. Bricheteau. (Gaz. Med. Chir., from
Medico-Chirurgicai Review.)

M. Bricheteau has recently published some interesting papers upon
this subject, of which our limits, however, forbid any prolonged no-
tice. He maintains that the history of the disease proves that, forty
years since, the intestinal canal did not present the lesions now so
commonly remarked, for these must have been noted by such observ-
ers as Beyle, Dupuytren and Lacnnec. It may be laid down as a
principle, therefore, that typhoid fevers, without absolutely changing
their nature, present at certain epochs notable modification, sufficient
to effect a. change in their diagnosis and treatment. An illustration
of this is also derived from the fact of no such considerable changes
being observed in the epidemic fevers of Great Britain and Ireland.
Even in France such lesions are absent in some epidemics, and are
in others no-wise in proportion to the gravity of the symptoms; so
that they cannot be considered the essential feature of the disease
and its point of departure, although, from their dangerous character
they naturally have excited much attention. g

M. Bricheteau observes that the contagious character of typhoid
is not admitted in Paris, although believed in some of the provinces ;
but he is certainly in error in stating that the contagion of typhus is
generally admitted in this country, and that a vigorous sequestration
is consequently insisted upon. He is more correct as to the treat-
ment which prevails here, for certainly the bleeding and antiphlogis-
tics employed by many in Paris, would meet with few approvers in
London. In explanation, he observes that inflammatory lesions are
more common in Paris, as its climate is less debilitating than that of

1846.] On Typhoid Fever. . 625

London. Sydenham, who had studied disease at Montpeiier, ac-
knowledged that his practice was too vigorous at the commencement
of his gareer in London ; and many other practitioners have ob-
served that bleeding is much less easily borne in that capital than
in P;iris.

E. Bricheteau believes, however, that typhoid cannot be looked
upon as a phlegmasia, inasmuch as neither the season of the year at
which it occurs, the treatment it requires, the order of sequence of
the abdominal symptoms, or the measures which relieve these, favour
this view. " By seizing on this inflammation as a basis of treatment,
we commit the error of nejrlectinn the cause for the effects of the
disease." M. Delaroque, of the Hopital Necker, and others, believe
the symptoms of typhoid are due to the irritating effects of vitiated
bile and other secretions which are thrown out upon the intestinal
mucous membrane, and are then absorbed, poisoning the economy.
Andral. Bouilland, and Louis, are cited in proof of the enormous
quantities of such secretions which are found after death, while the
success of the purgative treatment pursued by M. D., is adduced in
corroboration of this view. Other observers explain all the symp-
toms of typhoid by a primary alteration in the condition of the blood.
The dissolved >tate of this fluid has been often observed by both the
older and modern practitioners, and svmptoms identical with those
of typhoid have been induced by injecting putrid matters into the
veins the blood losing its plasticity as in typhus.

Conclusions. The placing the seat of typhoid in the intestinal
canal, the cerebro spinal system, the blood or its secretions, seems to
me of very little consequence, since this disease affects simultaneous-
ly or successively every portion of the economy. We find, first, the
phenomena incidental to a disturbance of the nervous system, in
which disturbance the circulation soon participates. Almost imme-
diately afterwards, diarrhoea and other symptoms of intestinal irrita-
tion present themselves, as also the rale which proves the pulmonary
organs are not unaffected. Other symptoms soon show that the va-
rious secretions are either perverted or temporarily suspended. The
affection seems to prevail in some degree everywhere, and to have its
speci;tl seat nowhere. It is truly the morbus tot ius substantial of the
old physicians. It is often epidemic, and sometimes contagious, pre-
senting much analogy with many pestilential fevers, typhus, sweating-
sickness, and intense epidemic influenza diseases to none of which
a precise seat can be attributed It follows that the treatment of
typhoid should be mixed, being composed of measures as various as
the lesions to be combated. Sometimes diluents and antiphlogistics,
sometimes evncuanls. at others alteratives, tonics, anti-septics, or
sedatives may be required. In fact, to adopt any exclusively cura-
tive method would be fo apply a determinate medication to an un-
known pathological condition.

40

626 Fracture of the Lower Extremity of the Radius. [October,

Fracture of the Lower Extremity of the Radius. By M. Blaxdix.
(Gaz. des Hopitaux, from Med. Chir. Rev.)

M. Blandin, in a clinical lecture upon this accident, observed that
authors erroneously represent pronation to be impossible, while in
iact it can be effected, but induces great pain. Another gratuitous
assertion is, that the interosseous space is destroyed, when indeed it
can scarcely be said to exist at all at the lower part of the fore-arm.
This it is important to bear in mind, in order to avoid the injurious,
or at least useless, practice of applying graduated compresses for the
purpose of maintaining the space between the two bones.

#The history and appearance of the case usually suffice for the diag-
nosis, a fall on the wrist, or rather on the palm, being the most
common cause of the accident. It is, however, not unfrequently
confounded with sprain, in which deformity of the joint from effusion
also takes place. There is, however, much less mobility of the part
than in fracture, and the characteristic depression of the edge of the
limb (le coup de hache) is absent. The mere absence of crepitation
does not indicate any thing, as it is not often perceived in this frac-
ture. The confounding this accident with luxation of the wrist has,
in a great degree, arisen from the minute description given by surgi-
cal writers of this last, as if it were of common occurrence, whereas
it is very rarely met with, and indeed ne\er, except as the result of
great external violence, when it is also accompanied by more or less
injury of the soft parts or fracture of hones. At all events it is never
produced by a simple fall on the palm of the hand.

We have placed the limb upon its ulnar side. Some surgeons
only continue the splints to the lower end of the fore-arm, but if we
wish to act upon both fragments we must support the hand also in
the apparatus. When there is antero-posterior displacement, the
mere cubital splint will not suffice, and we have seen Dupuytren
much surprised at its ill success. Compression is required at the
anterior and posterior faces of the fore-arm. To supply this, we
employ broad, but not graduated compresses, merely doubling them
where most pressure is required. Thus, e.g., if they are so folded
as to present but one thickness opposite the lower fragment, and four
or five thicknesses opposite the upper one in front, the disposition
may be reversed behind, so as to give us a double purchase upon the
broken ends of the bone. When inflammation and swelling have
subsided, these may be covered with the staich bandage.

M. Robert, lecturing upon the same accident, observes that, like
in fractures of the other pyramidal bones, the upper fragment
is frequently impacted in the lower one, more or less completely.
At the palmar face of the limb, near the carpus, the anterior edge of
the upper fragment forms a projecting crest beneath the skin, while
posteriorly there is a corresponding depression : on this account, and
because of the obliquity of the fracture, the lower part of the limb
much resembles the letter Z in form furnishing a very characteris-

1846.] Instructions for making Unfermented Bread. 627

tic mark of the accident. M. Vefpeau represents it as a constant
one: bill it may he absent, until produced by the following manoeu-
vre. Embrace the upper fragment with one hand and the lower one
with the other, and exercise a certain degree of pressure at the pos-
terior part of the arm where the fracture is supposed to be situated.
This projects the fragments forwards upon the palmar surface, and
exhibits the characteristic plainly. The displacement from within
outwards, noticed by Dupuytren, is proved by the experience of sub-
sequent surgeons to be a far less frequent sign than he supposed it
to be.

It is important to remember that fractures of the radius consolidate
very rapidly, i. e., in from 20 to 25 days. At this period the appa-
ratus should be removed and the joint exercised; for, if this be too
long neglected, adhesions of some of the numerous tendons and liga-
ments of the part may ensue, producing a degree of stiffness or semi-
anchylosis of the joint a matter of especial consequence to a work-
in": man.

PART III. MONTHLY PERISCOPE.

Instructions for malcing Unfermrnted Bread, with Observations, by
a Physician. In the year IS 16, Dr. Thomas Thompson published,
in an article on Baking in the Supplement to the Encyclopaedia
Britannica, the following directions for making bread without yeast,
yet light and spongy. Supposing a quartern loafto contain one ounce
of salt, or 437 grains of muriate of soda, then a method of substituting
tor the salt the chemical elements of that substance is the following :
Dissolve in water two ounces five drachms and forty-fwe grains of
crystal ised carbonate of soda, and mix the solution well with dough ;
add then seven ounces two drachms and twenty-two grains of muria-
tic (hydrochloric) acid. ofsp. gravity, 1.121, and knead rapidly. It
will rise immediately, fully as much, if not more, than dough mixed
with yeast.

To this prescription for making bread without yeast not much at-
tention was given for many years, although it is unquestionably
elegant, simple, and, within certain limits, effectual. Within the
last two or three years, however, several bakers have announced to
the public that they prepared a species of unfermented, or, strictly
speaking, unyeasted bread, which they represented to be light, very
ible, and [\r^. from the acescent properties and effects which
have been generally ascribed to bread fermented by yeast, and lea-
vened. This bread, also, they have distinguished by the name of
Patent Bread.

The author of the present tract states that the method was at the
time tested by several other persons, and found to answer perfectly,
but that it was regarded in the light of a philosophical curiosity.

628 Instructions for miking Vnfermen'ed Br a&. [October,

It always appeared to ns that the proportion of 'Hydrochloric aci 1
recommended by Dr. Thomson was too great, and, from recent trials,
we are convinced that this is the case. If we calculate, in any of the
ordinary systems of chemistry, the proportions in which hydrochloric
acid should he united to soda in order to form salt, it will he found
that seven ounces of hydrochloric acid is too large a quantity to be
united with two ounces and a half of carbonate of soda.

Without adverting to this fact, the present author publishes a for-
mula, which he has found by experience to answer best, and in which
the proportion of hydrochloric acid is reduced to about one-third of
that which it is in the formula of Dr. Thomson. The new formula
is as follows, for white bread and brown bread:

White Bread. Take of flour, dressed or household, 3 lbs. avoir-
dupois; bicarbonate of soda, in powder, half an ounce Troy, or 4
drachms; hydrochloric acid^sp. gr. 1.17) 5 fluid drachms; water,
about 26 fluid ounces; salt, two-thirds of an ounce Troy, or 4
drachms.

Broun Bread. Take of wheat meal 3 lbs. avoirdupois; bicarbon-
ate of soda, in powder, 4 drachms; hydrochloric acid (sp. gr. 1- 17)
5 fluid drachms and 25 minims; water, about 30 fluid ounces; salt,
two- thirds of an ounce Troy.

First, mix the soda and flour as thoroughly as possible, which is
best done by shaking the soda from a small sieve over the flour with
one hand, and stirring the flour all the time with the other. This
answers, in general, well ; but the equahle distribution of the soda
through the flour, which is important, is most certainly attained by
passing the mixture once or twice afterwards through a sieve. Next
dissolve the salt in the water, and add to it the hydrochloric acid,
stirring well with a wooden or glass rod. Then mix the whole inti-
mately and perfectly as speedily as possible, stirring well by a wood-
en spoon or spatula. The dough thus formed makes two loaves
somewhat larger than half-quarterns. They should be placed in the
oven without loss of time. The author recommends them to be
baked in long tins, and the oven to be much hotter than for common
bread. The tins are not absolutely necessary. The loaves may be
baked in ordinary fire-proof earthen-ware dishes. About one hour
and a half is required for the baking.

The author states that the proportions of soda and acid are those
which, when united chemically, make common salt. To this they
come nearer than the proportions given in the formula by Dr. Thom-
son. But we have found by trial, that even a little more soda may
be used to saturate the acid thoroughly, and if not used the bread is
rather acid. The author himself admits that an excess of soda does
much less harm than an excess of acid. The union takes place im-
mediately, and, at the same time, carbonic acid is extricated from the
carbonate of soda. But this extrication does not take place so as to
cause the dough to rise immediately, as Dr. Thomson represents, but
chiefly after and during the application of heat. The dough then

1846.] Instructions for making Unfermented Bread. 629

rises; and as it is expanded by the carbonic acid extricated, it is
converted into spongy, porous, and comparatively light bread.

The water should be used cold, and care should be taken not to
use too much water.

Such is the process used for making patent bread, or bread porous,
yet without being leavened or fermented. The bread thus baked is
well tasted, and it is said to he lighter and more digestible than bread
baked with yeast, [t is certainly more dense, not quite so porous,
and we think, from observing its formation several times, that it is
not so perfectly and thoroughly raised or inflated as bread baked with
good yeast.

Bread baked in the manner now described contains nothing hut
flour, salt, and water; and it is thought by its patrons that, being
made without yeast, it is less acescent. This is not universally true.
Bread baked with yeast of inferior quality is certainly rendered more
or less sour, or is liable to become sour; but this seems to be the
fault of the process or mode of making the yeast, and not that of the
baking. Many of the complaints brought against fermented bread
are manifestly applicable to the yeast with which it is fermented, or
ti.e mode in which the fermentation is carried on.

It is said that the Edinburgh bread is much better baked than the
London bread; and the French bread is said to be better than either.
But there is no bread equal to the Belgian ; and, supposing the flour
to be nearly the same, this superiority is to be ascribed chiefly to the
superiority of the Belgian and Dutch yeast.

The author of the present tract is of opinion that the unyeasted
bread is much more salubrious and more safe lor the dyspeptic than
the fermented bread of the baker. And he farther thinks, that bread
baked from wheat meal, or unboulted flour of wheat, is much more
nutritious nnd salubrious than bread baked from fine white flour. It
is impossible to deny that the different processes to which the ground
powder of wheat is subjected, are not only unnatural, but in many
respects uneconomical. By screening, sifting, and houlting, not only
is the brn removed, but a good deal of what mijrht be used as whole-
some food is lost. By the practice of separating the fine flour, and
baking only that, great waste is caused, and it is doubtful if the
practice be not hurtful to digestion. On the other hand, it must not
be denied that it is impossible, either by yeast or by carbonate of soda
and hydrochlor.c acid, to raise bread from brown or wheat meal, so
completely as that from flour which has been screened, sifted, and
boulted.

In the northern counties of England, as Yorkshire and Northum-
berland, it is the practice to employ, in the manufacture of bread,
the mere ground wheat that is. wheat ground and the coarsest part
only separated, and the bread so baked is palatable, light, and
nutritious.

The' great purpose of the present author in recommending the use
of brown unfermented bread, is to obviate constipation and to dimin-

630 Prolapsus of the Uterus. Venereal Vegetations. [October,

ish the violence of dyspeptic symptoms, or entirely remove them.
He has been himself an invalid, and speaks with the weight which
experience gives.

Another argument which he employs in its favor is, that, by the
process of separating, screening, and refining, there is incurred a loss
of twenty-five per cent. We have no doubt that great loss is incur-
red ; and surely, in an article so necessary, it would he most prudent
to employ the flour as formed from wheat in the most simple, natural,
and economical mode. [Edinburgh Med. and Surg. Journal.

Two cases of Prolapsus of the Uterus cured by excision of a portion
of the vagina. By M. Ltjloutre. (Archives Generates de Medi-
cine, 1845.) A married woman, 43 years of age, the mother of five
children, suffered from prolapsus uteri brought on by a fall on the
fundament. Pessaries gave intolerable pain, and for several months
the woman was in a deplorable slate. Between the thighs there was
a tumour of a pyriform shape, 11 inches 9 lines in circumference,
and 5 inches in height, composed of the uterus with a portion of the
vagina. Three longitudinal portions of the mucous surface of the
vagina, extending from the os uteri to the vulva, were cut out, one
on each side and one behind. The edges of the wounds were then
cauterized and the uterus replaced in the vagina. No unfavorable
symptoms followed. A month after cicatrization was complete, the
vagina was considerably narrowed, and the uterus remained in situ.
Forty-four days after the operation the patient got out of bed, and at
the end of eighteen months the prolapsus had not returned.

The second case was a woman 50 years of age. who had led an
irregular life, and who had a complete prolapsus of the uterus with
inflammation. After the inflammatory symptoms were subdued four
longitudinal portions of the mucous surface of the vagina were remov-
ed, and the wound treated as in the former case. On the fifty-fourth
day the cure was complete, the uterus being retained in its proper
situation. Two years after this woman died of an apoplectic attack,
when the condition of the parts were examined. The vagina pre-
sented four greyish-colored resistent lines corresponding to the incis-
ions. The mucous membrane had acquired considerable hardness,
especially that towards the orifice of the vagina, which had lost much
of its ordinary dimensions. The uterus preserved its normal struc-
ture, but its volume was evidently much increased. [Ibid.

On the Treatment of Venereal Vegetations. By M. Vidal. (Jour,
de Pharmacieet.de Chimie, Sept. 1845.) The venereal vegetations
which occur on the penis, and which so frequently resist a long time
the ordinary treatment, returning even after being removed by the
knife or by caustics, M. Vidal has found may be successfully removed
by a powder consisting of burned alum and powder of saviue. These
in equal parts are laid over the vegetations twice daily, and without
producing any pain cause them to shrivel and disappear. The pow-

1846.] Syphilis. Use of the Cerebrospinal Fluid. 631

der is applied dry, when the discharge causes it to adhere and exert
its curative action. [Ibid.

Can Syphilis be communicated to the lower animals ? By M.
Cullerier. (Archives Generales de Medecine, May, 1845.) M.
Cullerier having great doubts as to whether the ulcers on the face of
the ape, which M. Anzias exhibited to the Chirurgical Society of
Paris, really resulted from syphilitic inoculation, he made a great
numher of experiments to ascertain whether human syphilis can be
communicated to the lower animals. In his paper on the subject,
M. Cullerier relates the history of eight inoculations of guinea pigs
with syphilitic virus, both by pricking and by incision, but all without
communicating the disease. Syphilitic virus was in various ways
introduced into wounds on the bodies of rabbits, dogs, the cat, and
ape, amounting in all to 25 inoculations, but without in any instance
communicating the disease. -The wounds healed as quickly as if
they had been simple incised wounds. The virulence of the matter
used was in many cases tested by inoculating with it parts of the
body of the persons from which it was taken, when it produced the
characteristic sore. The want of result in all these cases led him to
invite M. Anzias to endeavour to repeat his experiments on the ani-
mals which were the subject of the above attempts. He accordingly
repeated them in the presence of M. Cullerier on the dog and ape,
and though every precaution was used, and the wounds were irrita-
ted and re-opened and fresh matter applied, no syphilitic sore was
produced. M. Cullerier, however, found that ulcers precisely similar
to those which JVf. Azias had exhibited on the face of the ape, and
termed syphilitic, could be produced by repeated applications of ni-
trate of silver or the actual cautery to the skin of any of the lower
animals. The base of these ulcers was indurated, and the surface
presented the peculiar aspect of syphilitic sores. Besides, the ape
which was the subject of M. Anzias' experiment fell a victim to
phthisis, and nojf to syphilis, as the minute examination of its body
showed, for tubercles were detected in all their varied stages in the
lungs, liver, spleen, mesentery, and intestines. From all this M.
Cullerier concludes that "syphilis in all its forms is still the exclusive
sad portion of the human race." [Ibid.

On the use of the Cerebro -Spinal Fluid. By M. Longkt. (Comp-
tes Rendus des Seances de V Academic lloyale des Sciences.) The
common opinion of physiologists for many years has been that the
removal of the cerebrospinal fluid very materially interferes with
the powers of locomotion. The common mode in which the opera-
tion for this purpose has been performed was by opening the dura
mater and arachnoid membranes between the occiput and atlas, after
having cut through the parts which cover the occipito-atlandoid
space. When this operation is performed, the animal walks with a
staggering gait, as if under the influence of alcohol.

632 The Inocul ability of Tinea Favosa. [October,

M. Longet, in order to ascertain whether any of the effects ob-
served depended on the incision of the soft parts, cut through these
parts alone in the horse, dog, cat, guinea pig, and rabbit, without
incising the dura mater, or giving issue to the cerebro-spinal fluid.
When this was done and the animals were allowed to rise, he was not
a little surprised to find that all the effects said to be caused by evac-
uation of the cerebro-spinal fluid had heen produced that the animals
staggered as if under the influence of alcohol. He therefore endeav-
ored to draw off the fluid without interfering with the parts at the
nape of the neck, in order to ascertain what effects were produced
by such a loss. For this purpose he removed the lamina of one of
the dorsal vertebrae, about the middle of the dorsal region. In con-
sequence of this operation marked feebleness of the hinder extrem-
ities was produced ; hut this weakness was not increased by removal
of the cerebro-spinal fluid, and, moreover, the animals did not pre-
sent that symptom of staggering so remarkable in those in which
the soft parts of the nape of the neck were interfered with.

M. Longet therefore concludes that preceding experimentalists were
wrong in attributing to the cerebro-spinal fluid an important influ-
ence over the locomotive function; and that the staggering walk of
animals operated on hy section at the nape of the neck is to be at-
tributed entirely to the effects of cutting through the parts there, and
not to the removal of the cerebro-spinal fluid. [Ibid.

The Inoculability of Tinea Favosa. By Dr. John Hughes Ben-
nett. "John Bangh, aged eight, applied to the Royal Dispensary
last June, labouring under the usual symptoms of tinea favosa iif the
scalp, in its most advanced stage? The disease was of three years'
duration, and the crusts, when examined microscopically, exhibited
the usual cryptogamous branches and sporuies. After explaining the
present state of our knowledge of this disease to the Poly-Clinical

class, one of the gentlemen in attendance, Mr. M . volunteered

to permit his arm to be inoculated. I accordingly first rubbed a por-
tion of the crust removed from Bangh's head upon his arm, so as to
produce erythematous redness, and to raise the epidermis. Portions
of the crust were then fastened on the part by strips of adhesive plas-
ter. The results were regularly examined at the meetings of the
class every Tuesday and Friday. The friction produced considerable
soreness, and, in a few places, superficial suppuration. Three weeks,
however, elapsed, and there was no appearance of tinea favosa. At
this time, there still remained on the arm a superficial open sore,
about the size of a pea, and Mr. M. suggested that a portion of the
crust should be fastened directly on the sore. This was done, and
the whole covered by a circular piece of adhesive plaster about the
size of a crown-piece. In a few days, the shin surrounding the in-
oculated part appeared red, indurated, and covered with epidermic
scales. In ten days, there were first perceived upon it minute,
bright, yeliow-coloured spots, which, on examination with a lens,

1 846 . ] New Means of D Isinfecting f i ?rec ' 'ng Rooms. t> 3 3

were at once recognised to be spots of fnvus. On examination with
the micro-cope, they were found to lie composed of a minute granular
matter, in which a few of the mycodermafous jointed tubes could be
perceived In three days more, (he yellow spots assumed a distinct
cupped shape, perforated by a hair; and in addition to tubes, numer-
ous sporules could be detected. The arm was shown to Dr. Alison ;
and all who witnessed the experiment being satisfied of its sucrose, I
advised Mr. M. to destroy each favus with nitrate of silver. With a
view of making some further observations, however, he retained them
for some time. The capsules were then squeezed out. and have not
since returned. Air. M. has light hair, blue eyes, a white and very
delicate skin. There is every reason to believe that the strips of
placer employed in the first attempt shifted their position, and that
the crust was only properly retained by the circular piece of plaster
employed in the second experiment." [Xorthem Journal.

New Means of Disinfecting Dissecting Rooms. M. Sucquet has
presented the Academy of Sciences with an account of his new mode
of impeding the putrefaction of subjects used for dissection. He ob-
serves, the means which at present imperfectly accomplish that object,
as arsenic, corrosive sublimate, &c. either injure the edges of cutting
instruments, or prove detrimental to the health of those who use them.
He employs two substances, namely, a solution of sulphite of soda
and one of chloride (chlort/re) of zinc. The first of the^e is injected
into any large artery, returns by the veins, and even fills the lym-
phatics. It exerts no chemical effect upon the blood, but effectually
cleanses out the minutest capillaries, so that other injections may be
used afterwards. The volume, consistence, colour, (Sec . of parts are
all preserved, and remain so, if the integument be undisturbed, so that
air does not obtain access, for a month as an average period, but
sometimes even for 40 or 50 days, and that in a moist atmosphere
at a temperature of 54. The sulphite absorbs the oxygen given
off by the tissues, and prevents it taking part in the putrefactive
process.

This substance, however, does not protect from putrefaction for
more than 20 days, when the integument is destroyed and the tissues
exposed to the air; but the parts may be preserved for ever free from
putrefaction by the u-e of the chloride of zinc. Parts required for
further dissection should be immersed in it : and all those in which
putrefaction is about to commence, should be daily* sponged with it.
Its action is instantaneous. Parts which have become green and
softened are at once disinfected, all the tissues it comes in contact
with becoming white and hard. It acts bv precipitating the soluble
portion of the animal fluids, as albumen, fibrin, dtc, and it coagulates
cerebral and fibrous tissue.

Both substances are expensive to purchase, but their preparation
on a large scale, (he formulae for which the author supplies, may be
conducted very economically ; so that three or four shillings will

634 New mode of Administering Sulph. Quinine. [October,

defrav the expenses of preserving each subject. Archives oV Anato-
mie, 1846, p. 122.

(In the Annales d' 'Hygiene for April, is a short paper by M.
Guerard, who was one of the Commissioners appointed to examine
into the success of the experiments with these substances, which were
carried on during several months at the Ecole Pratique. The field
is a wide one, for during 1845 there were upwards of 1500 bodies
received for dissection. At Clamart, where the process is also about
to be adopted, the average exceeds 2800 ; so that the annual number
of bodies dissected at Paris, considerably exceeds 4000 an enormous
number when compared with that furnished to the London Schools,
where the difficulty in obtaining subjects seems to be annually in-
creasing, and the supply of which is entirely inadequate for the pro-
per teaching of anatomy. The more limited the supply, however,
the more important the means here proposed for economizing it, pro-
viding it prove as efficacious as represented. M. Guerard's state-
ment is most unequivocally favorable to it. He states that he has
repeatedly visited the dissecting-rooms since it has been in use, and
finds them utterly devoid ofall offensive odours, and the complaints
which used to be made on account of these, by the inhabitants ofthe
locality, have entirely ceased. Bodies may be dissected for from 15
to 40 days, according to circumstances, without any attendant incon-
venience. [Medico- Chir. Rev.

New Mode of Administering the Sulphate of Quinine. A memoir
on the use of sulphate of quinine in intermittent lever, by friction on
the mucous surface of the mouth and fauces, has been addressed to
the Academie des Sciences, Paris, by M. Ducros. The following
are the conclusions at which he has arrived :

1. The sulphate of quinine administered in sulphuric ether, by
frictions on the tongue, the velum pendulum, the inside of the cheeks,
and back ofthe pharynx, causes an abundant salivation with a strong-
ly marked bitter taste, in the dose of five centigrammes.* The re-
action on the spinal marrow excited by this dose is stronger than
would have been produced by two grammes"]" taken into the sto%iach
or intestinal canal.

2. The action of sulphate of quinine, administered in this manner,
is almost instantaneous, whether employed in malignant intermittents,
in simple agues, or in temporo-facial neuralgia.

3. This immediate therapeutic action is especially important in
malignant intermittent, since given in other methods the sulphate of
quinine requires to be taken several hours before the paroxysm, while
by this method it is sufficient if it be administered half an hour before
the access.

4. A still greater advantage of thus employing the quinine in small
doses, is the avoiding ofall risk of poisoning by the remedy.

* About three quarters of a grain. t Half a drachm.

1846.] Effects ofSulph. Ether. Bromide of Potassium, <fyc. 635

5. The rapidity of (his action of the quinine in temporo-facial
neuralgia is also a most important advantage. [Provincial Med. and
Surg. Journal, 1846.

Physiological Effects of Sulphuric Ether administered by Friction
on the Mouth and Fauces. A memoir on this subject has been ad-
dressed to the Academie des Sciences by the same author. The fol-
lowing are his conclusions:

1. Sulphuric ether, employed in frictions on the mouth and fauces,
causes, in gallinaceous animals, instantaneous sleep, characterized by
closing of the eyes and setting up (hissement) of the feathers.

2. If morphia, acetate of morphia, or extract of opium, be given
during this sleep, the sleep, instead of being augmented, is instantly
destroyed : whence M. Ducros concludes that, in the gallinaceae,
opiates are the antidotes to sulphuric ether.

3. If either be given in poisoning by opium, the symptoms of
poisoning are increased.

4. The soporiferous effects of ether thus administered to fowls, are
also manifested in other animals and in man.

5. In cases of hypochondriasis attended with want of sleep, with
wandering pains in the chest and abdomen, sulphuric ether employed
in frictions on the tongue, velum pendulum, tonsils, and back of the
pharynx, procures an agreeable sleep and calms the pains, and espe-
cially possesses these advantages in the midst of nervous excitement,
when narcotics only tend to augment the general irritability.

6. In the convulsions of pregnant or child-bearing women, in the
convulsions of the new-born, in hysterical attacks, in epileptiform
paroxysms complicated with trismus (setting of the teeth,) and spasm'
of the oesophagus, where swallowing is impracticable, if the cavity of
the mouth and pharynx be rubbed by means of a camel's-hair pencil
dipped in sulphuric ether, the nervous attacks which, by long dura-
tion, might prove fatal, may generally be arrested. [Ibid.

Use of the Bromide of Potassium in Secondary Syphilis. The
low price of the bromide compared with that of the iodide of potassium,
has induced M. Ricord to substitute that salt for the iodide in the
treatment of secondary syphilitic affections. The dose of the brom-
ide is (he same as that of the iodide of potassium. It has produced
the same therapeutical effects, but more slowly. [Joural tie Phar-
macie, April, 1846 from N. Y Jour, of Med.

Treatment of Diabetes Mellitus by Balsam of Peru. Dr. Vaughes
reports in the Jour, des Connaissances Medico-Chirurg., a ease of
diabetes mellitus cured in five weeks by balsam of Peru. The medi-
rine was given in the dose of fifty drops four times a day, and in-
creased to five drachms daily. [Ibid.

636 Structure and Functions of the Placenta. [October,

Conclusions relative to the structure and functions of the Placenta,
by Mr. John Goodsir.

1. The placenta, as has long been admitted, consists of a foetal and
a maternal portion intermixed. But the maternal portion, instead of
consisting of a part of the vascular system of the mother only, in-
cludes the whole ot the external cells of the villi.

2. The external membrane of the placental villi is a portion of the
vascular system of the mother, continuous with the rest of that wall,
through the medium of the placental threads and lining membrane of
the placental cavity.

3. The system of the external cells of the placental villi belongs to
the decidua, and is continuous with the parietal division through the
medium of the cavities of the placental threads. This portion of the
decidua has been named the central division of the placental decidua,
and the threads decidual bars.

4. The function of the external cell of placental villi is to separate
from the blood of the mother the matter destined for the blood of the
foetus. They are, therefore, secreting cells, and are the remains of
secreting mucous membrane of the uterus.

5. Immediately within the external cells of the placental villi,
tbere is a membrane which I have named the internal membrane of
the villi. This membrane belongs to the system of the foetus, and
is the external or hounding membrane of the chorion.

6. Inclosed within the internal membrane of the placental villi, is
a system of cells which belong to the system of the foetus, and are
the cells of the placental villus.

7. The function of the internal cells of the placental villi is to ab-
sorb through the internal membrane the matter secreted by the
agencv of the external cells of the villi.

8. The external cells of the placental villi perform, during intra-
uterine existence, a function for which is substituted in extra uterine
life, the digestive action ofthe gastro-intestinal mucous membrane.

9. The internal cells of the placental villi perform, during infra-
uterine existence, a function for which is substituted in extra uterine
life, the digestive action of the gastro-intestinal mucous membrane.

10. The placenta, therefore, not onlv performs, as has been always
admitted, the function of a Ittng, but also the function of an intestinal
tube. [Anatomical and Pathological Observations. Ibid.

Treatment of SmalLpox by Iodine. By Samufl Jackson, M. D.,
of Philadelphia. In April, 1845, I was led to make an experiment
of aborting smalipox by the tincture of iodine, from contemplating
its wonderful influence over erysipelas. I applied it to one arm of a
child 11 months old, in confluent smallpox, on the third day of the
eruption, and to the arm which appeared the worst, rubbing it freely
on with a sponge three times that day and twice the next. On the
11th (\;\y, when the pocks over the whole body were at their height,
elevated with hard bases, those of the medicated arm were entirely

184G.] Syrian Medical Practice. 637

flat, with thin, purulent matter under the dead cuticle, without any
swelling of the part. In this state was the disease when I showed
the case to Drs. Bond and Nancrede. who agreed with me that there
was a complete abortion. There are, however, some very slight pits
now to he seen, but they are very inconsiderable when compared
with those on the other arm.

I have not had an opportunity of repealing the experiment, for
during the late epidemic I saw nothing lmt varioloid, and that so
slight that no trial could he made. I mentioned the child's case to a
number of physicians, hut [ do not know that any of them tried the
medicine, except Drs. Goddard and Sargent, whose written reports I
send you.

Dr. Sargent used the iodine on one side of the face in 25 cases
" the swelling, soreness and tenderness were very much less than on
the side not covered; each pock remained flattened; but I cannot
say that it prevented pitting."

Dr. Goddard writes that he had tried the medicine in five cases
" not one of the patients shows the least pit or mark ; none of them
had been vaccinated, and the disease was confluent in most of them."

Dr. Sargent's experiments are not as favorable as Dr. Goddard's
and rnv own possibly from using a feebler medicine. That which
I used was taken from mv own closet, made by myself.

One advantage of this treatment is, that it removes the cuticle and
leaves the part free from those disgusting discolorations which com-
monly remain for months.

It might be well to consider how far it would be prudent to extend
the application over the body, in order to mitigate the disease, in ma-
lignant or even in severe cases No fair trial can be had without
applying it on the first day of the eruption, and continuing it for
several days, say five or six.

I have found the same medicine an admirable remedy in the irrita.
ble ulcer with an inflamed surface, and ervsipelatoid margins. It
soon kills the cuticle, and with this the whole inflammation disap-
pears, when a little lunar caustic to the ulcer disposes it to granulate.

[Med. Examiner,

Syrian Medical Practice. Mole of remunerating Medical Prac-
titioners. The physician of the late lady Hester Stanhope gives the
following account of the state of medical practice in Syria. He
was railed in to attend the son of Ahmed Bey. "There were three
physicians present a Turk, and two Christians. The boy was about
thirteen or fourteen, uglv, of diminutive stature, and somewhat
humpbacked. He was laboring under anasarca, consequent on a
long intermittent fever. After examining him, I said I saw no rea-
son to doubt the possibility of curing him. I was then asked how I
would do it, which I declined telling; for I had no one but my serv-
ant for an interpreter, and the little Italian which he knew made it
impossible to explain my intention clearly. The Bey told me that

638 Cure for Hydrocele. An Acknowledgment. [October,

nothing had been left unaftempted which the faculty of the city
could think of. His son had been sewed up in a sheep's skin, fresh
from the warm carcase : he had taken pills made of powdered pearl :
he had lived for six days on nothing but goats' flesh : he had had
pigeons' skins put hot to his feet, but all had proved unavailing! I
merely observed, that these remedies mi^ht have much merit in
them, but that the practice of medicine in England was somewhat
different, and if he wished me- to prescribe, my first condition was
that I should not be controlled by any body. After some conversa-
tion, I went away. About three hours afterwards I was summoned
again, and desired to act as I chose. I was fortunate enough to re-
store the boy to perfect health ; and the father signified to me that he
would thank me in the Eastern way. On an appointed day, I was
conducted to the vestibule of the bath, where Suliman Bey. attended
by half a dozen servants, awaited my coming. We undressed and
entered the bath, having each a silk apron on. About an hour was
consumed in the ceremonies of shaving the head, washing, depletion,
&c, after which he returned to the dressing room, where we were
enveloped in embroidered napkins, and lay down to repose. Pipes,
coffee, and sherbets were served. When it was time to dress, the
Bey ordered a page to invest me with a dress of honour, which had
been prepared for me. It consisted ofan entire suit ofTurkish clothes,
with a pelisse and three pieces of Damascus silks, not made up. The
whole might be valued at fifty pounds." [London Med. Gaz.

Cure for Hydrocele. Dr. Alfred A. Harvey, of Bristol, has for
thirty years successfully employed the following treatment in hydro-
cele, obtaining a radical cure without injection. His mode of treat-
ment is as follows : First, discharge the fluid with a trocar, or pock-
et lancet, and then apply a warm vinegar poultice all over the scro-
tum, in order to bring on inflammation, which generally takes place
in a few hours, and becomes pain.ful. When sufficient inflammation
has been excited, remove the vinegar poultice, and apply a bread and
milk poultice. In a short time the pain and inflammation generally
subside, and the cure is completed. Give a few smart doses of pur-
gative medicine. [London Med. Gaz., June, 1846,

MEDICAL INTELLIGENCE.

An Acknowledgment. In theAugust No. of this Journal, may be seen a pre-
scription for Gonorrhoea, to which my name is attached. In looking a few days
since into the 3d Vol. (1838, '39,) of the Eclectic Journal of Medicine, I find a
very similar recipe contained in an article taken from the Boston Medical and
Surgical Journal. This communication is from Dr. George Hayward, Surgeon
to the Massachusetts General Hospital. I think it probable, therefore that my
prescription is rather a reminiscence than an invention. Paul F. Eve.

1846.] Mat-practice. Dr. Waterman. Baltimore College. 639

Prosecution for Mai- Practice. The Western Journal of Medicine and Surgery
(August, 1846,) contains the details of "A case of Aneurism of the Brachial
Artery, on which an action was brought for mal-practice, with recovery of dam-
ages." The artery was punctured by Dr. Geohagan in performing the operation
of venesection, which caused a false aneurism, requiring the ligation of the
brachial artery. An action for damages having been brought in one of the
Circuit Courts of Kentucky in 1844, the Plaintiff recovered damages to the
amount of $215.

Another Prosecution for Mal-practice. An action for damages in the Circuit
Court of Kalamazoo, Michigan, against Dr. Nathan M. Thomas, resulted in a
verdict of $300 in favor of the plaintiff. A new trial had been granted, but at
the same time it was taken out of Court, and referred to Dr. Z. Pitcher, of De-
troit. Mich., and Dr. Dan'l Brainard, of Chicago, 111., as arbitrators. We copy
the following aAvard from the Illinois and Indian;. Medical and Surgical Journal.

"The undersigned, to whom was submitted the matter in difference between
John Beals and Nathan M. Thomas, having carefully examined the injured
limb of Daphne Beals, and heard the testimony adduced in relation to the injury
and its treatment, and the arguments of council in the cause, respectfully report
to the Honorable Chief Justice of the State of Michigan, presiding over the
Circuit Court of Kalamazoo County,

"That they agree in the opinion, that the said injury was a dislocation of the
upper end of the radius forwards not detected at the time of its occurrence, and
that the defendant is therefore liable to the imputation of mal-practice, from de-
fective anatomical knowledge.

" Taking into consideration that this dislocation is one of rare occurrence,
and has in several cases been found to be incapable of reduction, and that it
was not in this instance attended by the usual distinguishing signs, and was
obscured by considerable swelling.

" Considering farther, that ihe study of anatomy essential to the proper treat-
ment of such cases, is by the laws of the State' of Michigan a penitentiary
offence; together with the fact, that the limb is still highly useful and may, in
our opinion, be essentially improved by judicious treatment, we award that the
defendant in this case, is not justly liable to any damages, and (if it belongs to
the board to decide this question.) we further award that each party shall pay
his own costs. Zina Pitcher.

"Kalamazoo, June 13, 184G. Daniel Brainard."

Dr. Waterman pardoned. We learn with pleasure, that the sentence of Dr.
Waterman, to three years' imprisonment in the New York State Prison, for
disinterring bodies for dissection, has been remitted by the Governor. When
will our legislators cease to be less mindful of the living than the dead, and
legalize the study of Anatomy'? We believe that Massachusetts is the only
state of our Union in which the enlightened and liberal policy of Europe on this
subject has been imitated.

Baltimore College of Denial Surgery. We are gratified to perceive that this
valuable institution, the only one of the'kind in our country, or perhaps in any
other, is rapidly advancing in its career of usefulness. The Chair of Opera-
tive and Mechanical Dentistry hitherto vacant, has been recently filled by the
appointment of Amos Westcott, M. D., of New York a gentleman of distinc-
tion in his profession. A new edifice is also expected to be completed for the

640 A place without Quacks. Meteorological Observations.

ensuing session, combining all the conveniences required for Lectures and
practical instruction. It is only by sending forth enlightened Dentists, that the
practice of this interesting department of Surgery can be placed upon that foot-
ing of respectability to which it is justly entitled.

The Faculty now consists of Chapin A. Harris, M. D., Prof, of Principles
and Practice of Dental Surgery ; Thos. E. Bond, Jr., M. D., Prof, of Special
Pathology and Therapeutics; W. R. Handy, M. D., Prof, of Anatomy and
Physiology; Amos Westcott, M. D., Prof, of Operative and Mechanical Den-
tistry ; and Cyreneus V. Cone, D. D. S., Demonstrator of Mechanical Dentistry.

A place v:ithoiit Qvacls. Dr. Hagood, of Barnwell, S.C., in a communication
to the Editor of the Western Lancet, states that, "In relation to the progress of
empiricism, I am happy to be able to say, that the soil is too poor for it to flour-
ish. Large cities, where there are a great many wealthy fools, where newspa-
pers are always ready (for money) to vaunt and puff, and lend their aid to this
diabolical trade; and where thousands of people of easy gullibility, with months
wide open, are ready to swallow any pill or nostrum that may be presented to
them by any designing knave; these are the places for the medical rogue to
walk, and strut, and flourish, and when he has amassed a princely fortune, to
sit down quietly and laugh at the gullibility of the human family."

METEOROLOGICAL OBSERVATIONS, for
Ga. Latitude 33 27' north Longitude 4 32'
tide 152 feet.

~~ 3,"p7m;

Bar.

August, 1846, at Augusta,
west Wash. Altitude above

^

Sun

63

Ther.!

1

72

2

71

3

72

4

70

5

68

6

70

7

72

8

70

9

70

10

71

11

70

12

70

13

68

14

GO

15

71

10

70

17

69

IS

71

19

74

29

73

21

72

22

73

23

73

21

72

25

70

86

70

87

68

08

68

29

68

30

71

31

70

Bar. [Ther.
29T>8T00 ~84
08-100
82-100;
93-100.
87-100'
82-100
86-100'
91-100'
85-lOGj
71-100,
72-100
78-100':
83-100 I
80.100
79-100
75-100
77-100
71-100
78-100!!
85-100

84- 1 on"

80-1 00
75-100
73-100,
G5-1001
82-100
87-100
90-100
87-100
83-100
79-100

84
83
82
86
82
80
88
88
86
84
86
86
90
90
86
80
86
86
89
89
89
85
77
78
82
84
87
85
87
84

Wind.

29 65-100,:
i! 6M-100;
" 80-100.!
" 89-100:

" 78-iOOJ
" 82-100 j
< 83-100!

88-100;

82-100:

62-100!

69-1001

80-100

81-100,

75-100'1

73-100

70-100

70-100

73-100

81-100

85-100

82-100

70-100

72-1 on

70-10"

70-1 00

84-10"

87.100

87- 10-0

83:100

78.10

80-lOC

S. E.
N E.
N. E.
N. E.

E.

E.
S. S.
S. E.
S. E.
S. W.
N. E.
N. E.
N. W.
S. W.
N. W.
S. W.

S.
S. E.
S. E.
S. E.
S. E.
S. E.

S. E.

N. E.

N. E.

E.

Remarks.

Rain 35-100.
Showery 35-100.
Showery.
Showery.
Showery.

Showery rain 05-100.
Do. rain 90-100.

Fair flying clouds.
Fair. [4 inches.

Showery rain storm from n.w.
Showerv in morning.
Fair flying clouds.
Hazv.

Fair flvingcl'ds. [rain 35-100
Fair showery in afternoon
Cloud v showery rain 20-100.
Cloudy sprinkle.
Cloudy.

Cloudy sprinkle thunder.
iFair some clouds sprinkle.
Fair some clouds,
^air in morn .showery in after.
Cloudy thunder sprinkle,
"""loudvand rain 1 in. and 5-100.
Cloudy showery.
Cloudv showery, [die of day.
Drizzle in morning--fair in mid-
Pair rain 70-100.
"a ir some clouds in afternoon.
Fair, do.
(Cloudy showery. ^

12 Fair days. Quantity of Rain 6 inches and 45-100. Wind East of N. and
S. 19 days. West of do. 5 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I] NEW SERIES. NOVEMBER, 1846. [No. 11.

PART L ORIGINAL COMMUNICATIONS.

ARTICLE XLI.

On the Treatment of Hernia. By D. B. W. Hard, M. D.,

of Charleston, So. Ca.

Atari early period of my professional labors, as a practicing phy-
sician and surgeon, a variety of circumstances co-operated to direct
my attention to a much neglected branch of surgical practice, viz :
the treatment of Hernia. It appeared to me a matter wanting ex-
planation, why a malady that is so common in both sexes, in which
there is so much suffering and danger, should receive only a passing
attention from the physician or surgeon, and its treatment surrender-
ed to empyrics. With these views I entered upon the treatment of
hernia, as a legitimate branch of surgical practice.

With regard to the pathology of hernia, anatomical research has
left us little indeed to wish for; the conjoined labors of anatomists,
seem here to have accomplished a perfect work. But when we turn
from its pathology, and make a review of its treatment, we meet
with so little that is satisfactory, that we feel disappointment, and
look about for other resources, other remedies, upon which we may
rely. A variety of operations have been proposed and undertaken,
having a radical cure for their object. It is not my purpose here to
discuss the respective merits of any of these doubtless a field 13
open here to the enterprising surgeon, who has the boldness to un-
dertake, and the courage to assume the responsibility, intimately
associated with them all. Leaving this part of the subject here, I
pass on to consider the treatment of hernia by compj'cssion, which I
purpose to examine more in detail.

A variety of bandages have been constructed, which under the
name of Truss, arc familiar to the profession, and if these be ex ami n-

41

642 On the Treatment of Hernia. [November,

ed, a striking feature of difference will be found to exist in tbe hernial
pads. One class of these pads is constructed in reference to the pro-
perty of hardness, and are made of wood, ivory, bone, horn, &c.
Another class is formed of materials of a soft, yielding nature such
as padding, wadding, curled hair, &c. This latter class has been in
use from time out of mind ; while the former has been more recently
thrust upon society, with an emphatic assurance of their effecting
invariably a cure a new theory of their modus operandi heralded
forth their advent, and the birth was complete. This child of empy- ,
ricism thrived and grew apace : at length, however, a marasmus
overtook it, and it fell into a decline ; and what was this said theory ?
why, that pressure made upon the hernia by one of the hard blocks,
would exert a certain unexplained influence, which influence would
extend inwardly, through the integument, through the adipose tissue,
through the tendon of the external oblique muscle, through the infe-
rior edge of the transversalis muscle, besides through sundry fascia?
not here enumerated enter the hernial sac, where, without pro-
ceeding any further inward, the said influence would come to a dead
halt, and in that particular spot, that particular process of the perito-
neum, create an adhesive inflammation, and a consequent obliteration
of the cavity of the sac. This inflammation too, was of so singular
and extraordinary a kind, that after having diffused itself throughout
the interior of the hernial sac, and reached the internal ring, it would,
with a species of intuitive intelligence hitherto unknown to physiolo-
gy or patholog3% there stay its progress, and presume not to invade
the sound and healthy peritoneum, lining the cavity and covering the
viscera of the abdomen. Now it would be an object of much interest
to the pathologist to inspect this place of termination : as it is, how-
ever, we must be satisfied with endeavoring to imagine to ourselves
its appearance, which it would seem must either be a gradual shading
0 Tof the vivid red issuing from the internal ring, and loosing itsel
by degrees in the paler color of the healthy peritoneum, or a distinct
line of demarkation, analogous to that which takes place between
sphacelated and living parts, and this too by a somewhat extended
stretch of the imagination.

The former appearance would probably be denied as unworthy and
discreditable to their theory of cure, as it would imply danger ; while
the latter would probably be approved as sound and judicious !

Having looked at the theory, we will examine a little into the re-
sults of the practice, and endeavor to ascertain if these confident

1846.] On the Treatment of Hernia. 643

promises and professions have been realized. And first I will inquire
of the professional reader, if out of the fifty or hundred of the wood,
ivory, bone, or horn pads, that have been applied under his own
superintendance, or within his knowledge, he can select one single
adult case, and present to the profession for examination, which has
been cured by their use. The writer of this does not ask for a dozen
cases, but simply for one, and he feels that his request is very reason-
able. Where are the scores of cases that have been cured ? The
acknowledgment, though tardy, is every where being made "I have
been disappointed In this matter; the result of my experience has
been a universal failure." I will not, however, press this interroga-
tory ; for it is not my object to make the most out of it, but to com-
pare my own observations with that of others. A solitary case here
and there, out of hundreds, I believe have been cured by their use ;
but in candor, I must confess that I have not met with any of these
fortunate cases, or met with a physician who could show me one :
had they failed as a curative remedy, and good results only grown
out of their use, they would have stood in the light of a palliative
mode of treatment which would have placed the class beyond censure.
But an evil of a very serious nature, in a great majority of cases,
occurs where the pad is worn in immediate contact with the integu-
ment, and this is proportioned to the degree of pressure made by the
instrument, and the length of time the pressure is continued. This
evil consists in a thinning by absorption of that part of the abdominal
wall to which the pressure is applied. After this event has taken
place, the protrusion of the hernia is increased in a double, three or
four fold degree, proportioned to the extent of injury done by the
truss. It cannot fail of being comprehended by every intelligent
member of the medical profession, that when pressure is made with
a hard substance upon a part, and maintained for a length of time,
absorption takes place. If for instance an ounce ball were pressed
upon the thigh by means of a retentive bandage, absorption would
take place underneath, and the ball would become imbedded in the
soft parts, this absorption is not limited to the adopose tissue, as some
have asserted ; but muscle, tendon, and bone yield to pressure, and
are removed by absorption, of which the annals of surgery furnish
us with numerous examples. It is a very common observation, that
when a truss is worn, having a back pad, for a few months, that the
pad forms for itself a bed in the "hollow of the back." Nothing is
more easy than to ascertain the truth of this observation, by extimin-

644 On the Treatment of Hernia. [November,

ing the back of any man who has worn a back paded truss twelve
months : in this instance the base of the spine presents the hard sur-
face, though the pad of the instrument be a soft one between these
two the soft parts are compressed, absorption follows by virtue of an
organic law. When the use of the hard pad is persevered in for a
length of time, under the fallacious hope of a cure being effected, the
thinning of the abdominal wall will take place to an alarming extent.
The common integument covering the hernial tumor will sometimes
not exceed in thickness a piece of parchment, and so much weakened
is the abdominal wall in this place, and so little resistance will it
make to the escape of the hernia, that when the truss is removed,
the hernial tumor will instantly puff out as if it had been suddenly
inflated with a puff of wind ; the shape and size of the base of
the tumor corresponding with the shape and size of the pad.
Some of the hard pads that I have found already applied when I have
been consulted, did not exceed in size a 12 cent piece others about
the size of a cent, and very convex, both of which were designed to
enter the orifice at the external ring, on the principle of a plug, the
object being to prevent the escape of the hernia below that point, and
the more surely to excite the desired inflammation in the hernial
passage. These small pads, if possible, are more injurious in their
effects than the larger kind their effect is to enlarge the opening at
the external ring, while the internal ring and inguinal canal is filled
and dilated with the descending viscera ; in this way an enlargement
of the opening is in a few months produced, that where it would not
in the first instance admit the end of the finger, will allow two or
three fingers, carrying the integument before them, to pass easily
into the abdomen. Trusses constructed with a back pad, designed
to rest upon the base of the spinal column, cannot, in my opinion, be
too strongly reprobated. Take a view of the spinal column posteri-
orly, and satisfy yourself whether it bears any analogy to other
parts of the body designed by nature to sustain pressure. But we are
not left to grope in uncertain speculations, while we can have access
to so many living testimonials. Constitutional weakness, a general
feebleness and inability to undergo much fatigue, fatigue following
little exertion, are symptoms met with in almost every one who wears
a back pad resting on the spine : these are the usual symptoms, and
the mildest kind arising from this cause. The greater evils seem to
bean augmentation of these lesser ones I have mentioned, resulting
in confirmed spinal irritation and constitutional disease ; and all this

1846.] On the Treatment of Hernia. 645

without the patient, and frequently without his physician, suspecting
the cause. I believe that hundreds have been made miserable, and
life has been shortened, by wearing trusses that have made perma-
nent pressure on the spine.

These objections may be obviated, by modifying the construction
of the truss, so as to do away with the back pad. There is no ne-
cessity to construct trusses with them, for nothing is gained ; it is
only necessary that the spring which encircles the back should ex-
tend across its whole width, and "fit" on so as to bear every where
with an equal pressure, except on the spine, over which it ought
always to arch. The hernial pad should be constructed sufficiently
large to extend from the superior margin of the pubis upward so far,
as by its pressure to close both the external and internal ring, and
the canal between them ; and while a degree of firmness is necessary
in order to retain the hernia, the materials should be of a soft and
yielding nature, that it may not interrupt the circulation in the
capillary vessels; for when circulation in the capillaries is cut off,
nutrition is supended, and absorption takes place. If the truss be
adjusted, so as effectually to prevent the viscera from entering the
internal ring during a period varying from six to eighteen months,
the prospect of cure is almost certain, not by exciting adhesive
inflammation, (this much abused and trampled hobby, created only
in the imagination, and not in the hernial sac,) but by a gradual
narrowing and closing of this preternatural opening. In by far the
greatest number of hernial cases, whether they occur suddenly or
gradually, I am entirely convinced that lesion does not take place,
but only a dilatation of the natural passage traversed by the sperma-
tic cord. I am acquainted with more than one hundred cases of
hernia that occurred during the debility attending or following sick-
ness ; it is also oftener met with in individuals of feeble and delicate
habit of body than in the robust; also in persons that have passed
middle life; when there is a yielding of tension and rigidity of fibre,
jto the flaccidity attending upon advanced life. Under these circum-
stances the parts yield, gradually dilate, the viscera makes an enter-
ance, and a hernia is formed. If now a truss is applied, which will
eventually close this passage, it will not merely prevent the descent
of the viscera, but give support and rest to the part ; the numerous
small vessels will resume their function of nutrition, and with it fibre
will regain its tension and elasticity, and thereby a narrowing and ob-
literation of this preternatural opening will effect restoration ;\j^\ cure.

646 On the Treatment of Hernia. [November,

In recent cases that have come on suddenly, that portion of the
peritoneum which forms the hernial sac, is often reducible along
with the intestine or omentum ; every case of this description is
curable by the means pointed out. Let it be borne in mind that the
peritoneum, in its normal state, is an exceedingly thin membrane,
and when not preternaturally thickened offers but a small obstacle
in the way of cure, though it remains in the inguinal canal; for if
the viscera be permanently excluded, (and success depends entirely
upon this permanent exclusion,) the narrowing and contraction of
the rings and canal will approximate the sides of the sack, and oblit-
erate its cavity, the internal ring closing around its neck, will reduce
it at this point to the size of a small cord. I have examined, post
mortem, two such cases as above described that had been cured with
a truss cases that I had treated four years previous to their de-
cease : they were so similar, that to describe one will be a description
of both. I here copy from notes taken at the time.

The internal ring of the left side viewed from within the abdomen,
presented a superficial indentation peritoneum instead of passing
over and covering the ring, entered it : took a small bougie and en-
deavored to force it downward into the inguinal canal ; did not suc-
ceed took a small probe, and pressing the end gently in the centre
of the indentation, entered slowly and glided smoothly about two
inches, when its further progress was arrested made dissection of
the inguinal canal ; external ring natural, internal ring had passing
into it a portion of peritoneum extending downward parallel with the
spermatic cord and in juxtaposition, terminating half an inch within
the opening in the tendon of the external oblique muscle withdrew
the probe and introduced the blow pipe ; lower portion of the sac
distended a little when the air was pretty strongly pressed into it
through the blow-pipe ; middle and upper part of the sac unyield-
ing ; dissection of the sac from surrounding parts tedious and diffi-
cult. The inferences to be drawn from these cases, are made suffi-
ciently plain by what I have previously said respecting the mode in
which hernia is cured.

We have analogous occurrences in other parts. When the blood
is cut off from entering arteries, they become converted into ligament-
ous cords, and their calibre is obliterated. When the fasces escape
from some preternatural outlet before reaching the rectum, this latter
becomes nairo\Ved to such a degree, as to admit the passing of a
small bougie with the greatest difficulty. The annals of surgery

1846.] On the Treatment of Hernia. 647

furnish numerous examples of these and similar occurrences. It
seems to be a law, that when a canal or aperture is not either
perpetually or periodically dilated, it becomes narrowed and in a
little time obliterated. Those who undertake the radical cure of
hernia by compression, will meet with embarrassment at the very
outset, growing out of the imperfection of compressing instruments.
Trusses are generally constructed so as to exert a strong pressure on
the external ring, and lower part of the inguinal passage, while the
internal ring and superior portion of this passage is left to form a part
of the abdominal cavity, or they are so constructed, that if the
hernial passage is well closed while the patient is standing in an erect
posture, that varying the posture of body changes the relation be-
tween the direction of the pressure exerted by the truss, and the part
upon which the pressure is required so that it is only a part of the
time, the pressure is made in a proper direction : at one time, the
greatest on the lower part of the pad, then on one side, then again
on the side opposite ; the hernia at one time entering the superior
portion of the canal, presently to be forced back into the abdomen
entering again, and again forced back. Under such circumstances,
cure is impossible.

Having for a long time noticed these difficulties, and feeling ex-
tremely desirous to surmount them, I was led to construct a pad, as
I will describe. I made the hernial surface to present a moderate
degree of convexity, and large enough to extend from the external
ring, upwards, beyond the internal ring, and formed of materials
soft and yielding ; a circular metallic plate concavo-convex in its
form, determines its shape and forms the foundation of the pad ; four
spiral springs fill the concavity of this plate, and are attached to its
outer edge at four points opposite to each, other the other end of
the springs is attached to another plate about the size of a dollar.
It will be understood that the four springs stand endwise between
these two plates, which are separated from each other about ono
inch ; a cover of chamois leather encloses all these parts. The other
parts of the instrument consists of a belt, which passes around the
body, enclosing a steel spring, of about the usual width, and long
enough to extend from the inguinal region, around the hip and across
the whole width of the back, upon which it makes its bearing without
the intervention of aback pad. Attached to the inguinal end of this
steel body spring is the pad above described, and connected with its
attachment thereto, is an arrangement by which the pressure of the

648 On the Treatment of Hernia. [November,

pad can be increased or diminished, so as precisely to adopt tho
amount of pressure to the wants of the case.

In constructing this instrument, I have carefully avoided the ob,
jections existing in other trusses, which I have labored to point out.
The object of the peculiar construction of the pad is to keep perma->
nently closed the internal ring and inguinal canal, with the greatest
certainty and surety. The inguinal region may be regarded as a
plane, the pad is applied to this plane, and pressed upon it ; the
springs yield and remain in a compressed state. Now as this plane
will be constantly varying its inclination, in the varied movements
made by the individual by the interposition of these springs, the face
of the pad will vary with it, and conform to it, for their action resem-
bles that of a universal joint. The whole tract of the canal, from
the external to the internal ring, is equally compressed, and thus
equal pressure is continued under all circumstances connected with
change of posture. The degree of pressure, required in the treat-
ment of different cases, is exceedingly various : a pressure of two
pounds is as much as many cases require, and it is found necessary
to increase it from this, upwards, to ten or twelve pounds. It is on
this account, that I have combined this pad with an arrangement for
graduating the pressure, which, with the aid of two or three days
experience, any individual can judge of, and adopt the amount to the
want of his own case. The use of the instrument as a means of
effecting radical cure, has been attended with the most encouraging
success, as the cases of cure considerably outnumber the cases where
it has failed of effecting this most desirable result. If all those who
use it could be impressed with the great importance of never leaving
it off at times, or being otherwise careless in its use, allowing the
hernia to descend at times, and again dilating the passage, I cannot
see why the cases of failure should not be of very rare occurrence.
I do not expect that every one who reads this article will adopt, and
at once enter into my views, as old theories and preconceived opin-
ions will stand in the way ; but all I ask of such is, that they will not
reject and discard them without examination. It is easy to make a
trial without incurring any possible risk, and if trial be made, let it
be a fair one. Take up for treatment, say ten, or one dozen cases,
and if this be done, the lapse of twelve months will throw a light on
the matter, that will place it beyond controversy. The instrument is
a surgical instrument, and as such, I present it to the medical pro-
fession alone.

1646.] Aneurism. Compound Fracture of the Cranium. 049

ARTICLE XLII.

Aneurism, spontaneously cured. By W. H. Robert, M. D., of
Madison, Ga.

Mr. T. Harris, aged about 35 years, was bled by a neighbor on
the 17th April last. On seeing him a few days after, he stated that
immediately after his arm was bound up he observed a tumour where
he had been bled, which had continued to increase ever since. The
arm now presented all the symptoms of an aneurism : diminished
temperature, indistinct pulsation of the radial artery at the wrist, a
pulsating tumour which subsided on pressure, and filled again when
this was discontinued, which ceased to pulsate when the brachial
artery was compressed, and in which the bellows sound was distinct-
ly heard.

I explained to Mr. H. the nature of the operation usual in such
cases, and advised him to submit to it. Finding, however, that he
was unwilling to adopt this course until he could gather in his crop,
I advised him to keep the arm perfectly quiet. In July the tumour
had attained the size of a hen's egg, but about the second week in
August it began to diminish, the pulsation became less distinct in the
tumour and stronger at the wrist, the arm grew warmer, and this
state of things has been gradually progressing until the present time.
The arm now presents the following appearance : it is as warm as
the other ; the pulsation at the wrist is normal ; there is no pulsation
whatever in the tumour, which is about the size of a filbert and ap-
parently perfectly encysted, being easily moved about under the
skin, and which does not diminish on pressure. I attribute this un-
expected result to the quiescent state of the limb.*

Madison, Oct. 3d, 1846.

ARTICLE XLIII.

Compound Fracture of the Cranium loss of a portion of Brain
Recovery. By Paul F. Eve, M. D., Professor of Surgery in the
Medical College of Georgia.

In the July No., for this year, of the Provincial Medical and Sur-
gical Journal, (England,) Mr. F. P. Smith relates a case of com-
pound fracture of the skull in a child of four years old, who perfectly

Compression would have assisted In the euro. Edts.

650 Compound Fracture of the Cranium. [November,

recovered, notwithstanding there had been the loss of a portion of
the brain. The boy while playing under a wagon, had his head
caught between the spokes of the hind wheel, and the horses starting
at this moment, he was carried round and his head forced between
one of the spokes and a projecting iron bolt, a space of not more
than three inches and a half.

" On examining the head, I found a most frightful lacerated wound
of the scalp, extending from the right temple across the forehead, and
terminating in the left eye-brow ; the frontal bone was laid completely
bare, and the right superciliary ridge from its external to its internal
angle, including a portion of the orbitar plate, was torn up. On
removing this, which laid loose in the wound, I found attached to it
a portion of brain, of the size of the end of the little finger, and
weighing about thirty grains ; four other smaller portions of bone
were also removed. After cleansing the wound, I brought the flaps
together, retained them so by means of several sutures, leaving a
depending opening at the outer angle. Lint, dipped in cold water,
was kept constantly applied over all, including the eye, which ap-
peared to have received irremediable injury. The little patient was
placed in bed, an active purgative was given, and he was confined to
a milk and water diet, which was continued for a fortnight. On
the following day I found he had passed a tolerably quiet night, the
medicine had acted freely, and in all respects he was very much
better than I expected to find him.

"To be brief, the case progressed most favourably, without a sin-
gle bad symptom ; in three weeks the wound had healed, excepting
a small opening at the outer angle ; and at the end of six weeks he
was playing about in his usual health. The sight of the right eye
is gone and he is unable to raise the eyelid. After recovery, this
boy exhibited the same restless and mischievous disposition as before
the accident, which caused the loss of a portion of the cerebral
substance."

Cases of recovery after portions of the brain have been lost do,
occasionally occur both in civil and military practice. Some most
remarkable instances will be recalled by those familiar with the re-
cords of surgery. These, however, will not vitiate the principle long
established, that death is the usual result when the substance of the
brain is injured in compound fractures of the cranium.

The only case where recovery took place under these circumstan-
ces within my observation, is the one about to be detailed, and the
reader will remark how similar in many respects it is to the one quo-
ted above.

A son of one of our physicians, aged six years, while leaning out

1846.] Compound Fracture of the Cranium* 051

of a window, fell the distance of nineteen feet upon a brick pavement.
Those who saw him fall, stated he first struck his forehead, then re-
bounded, and was taken up for dead. This happened in September,
1840. When seen a few minutes after the accident, the left super-
cilary ridge or process of the os frontis was found fractured, and lying
loose in the upper eye-lid. It seemed to have but one attachment,
and that near the nasal process of the same bone. A portion of the
brain was oozing out of the lascefated wound made in the integu-
ments near the external angle of the left eye. Our attention too,
was directed to some cerebral substance at the spot where the fall
took place. I estimated the quantity of brain which escaped at the
time of the accident and during the subsequent dressings to amount
to a tea-spoonful, or about forty grains weight. In addition to the
compound fracture of the cranium with the accompanying symptoms
of depression, &c, the patient sustained, a dislocation of both hands
backward. These were reduced, but his father objected to the remo-
val of the loose fragments of the superciliary process from the eye-
lid, or even to an attempt by pressure to replace them. The treat-
ment pursued in the case was essentially negative, reaction sponta-
neously occurred without much inflammation, and in the course of a
few days, the patient was sitting up.

Up to the present date, six years after the accident, Robert has
continued to enjoy good health with the exception of occasional
convulsions. His physical and mental faculties have been steadily
developing, and he remains what he was previous to his fall, a very
active restless boy. There is still a marked fullness in the left eye-
lid, produced by the superciliary process which is felt near its tarsal
cartilage. The sight of his eye is good, but the lids often inflame
and ulcerate. Above this is a large space unoccupied by bone, and
where pulsations can be seen and felt. Pressure, or a blow, upon
this spot at any time has produced convulsions, and his parents think
he cannot confine his mind to close application or study.

J[n operating with the trephine, I have injured the brain, without
unpleasant consequences to the patient.

652 hopathia : or the Parallelism of Diseases. [November,

PART II. REVIEWS AND EXTRACTS.

Is<ypaihia : or the Parallelism of Diseases. By John M. B. Har-
den, M. D., of Liberty County, Georgia.

In resuming the subject of the parallelism of diseases, "I feel like
the clown who, after several unsuccessful attempts to play upon a
violin, threw it hastily from him exclaiming, at the same time, that
there was music in it, but that fte could not bring it out."* I have
waited thus long in hopes of being better prepared to follow it out,
but limited as my own field of observation is, and must necessarily
continue to be, and restricted as I am in my researches into the
recorded experience and observations of others, I fear that that time
may never arrive, and I have, therefore, determined to throw out the
following remarks as hints and suggestions towards the development
of the Isopatkic Law.

Before proceeding farther, however, in order that I may be clearly
understood, I beg leave to make a few preliminary remarks ; fore-
warning my readers at the same time that, although many of the
principles adranced in the following pages are of a debateable char-
acter, I shall have to assume them as postulates for the present, hold-
ing myself ready, upon proper occasions, either fully to defend, or
freely to renounce them.

The defects of all nosological systems hitherto attempted are readily
seen, and will be as readily admitted by all. The most superficial
examination will serve to show that diseases the most closely allied,
have been violently forced asunder, while others, equally distinct,
have been grouped together under the same family or specific desig-
nation. This has, no doubt, arisen as much from the intrinsic dif-
ficulty of the subject itself, as from the exclusive methods which have
been adopted as the basis of classification. Disease, abstractly con-
sidered, is not an entity or substantive thing, possessed of distinct
qualities or properties by which it may be distinguished and arranged
like the objectsf of natural history, but rather a mere mode or con-
dition of the living organism, consisting in a certain change or
series of changes in the solids and fluids, the external manifestations
of which are the phenomena, whether vital, physical, mechanical or
chemical, presented during its continuance, or after the death of the
individual subject of it. The difficulty under which the nosologist
labours, therefore, may be appreciated by reflecting that the classifi-
cation of diseases is but a classification of modes or conditions of the
living system, or more properly, perhaps, the varying phenomena
connected with ihose conditions.

* R.ush. Inquiry into the relation of Tastes and Aliments.

t This seems to have been the opinion of the earlier nosologists who adopted
it as a maxim, that " Symptomata se habent ad morbum ut folia et fulcra ad
Plantain." "Ce qui," says Broussaii. ;; suppose que les maladies tiennent
dans la nature le meme ran? que les vgetattx.

Isopathia : or the Parallelism of Diseases. 653

The methods, also, which have been adopted, or the principles
which have formed the grounds of nosological distinctions, have been
far too exclusive. The etiological method employed by Boerhaave
and Hoffman, is certainly not applicable to all diseases, on account
of the impossibility of ascertaining and distinguishing, in many cases,
the predisposing and exciting causes. It is certain that there are
some affections brought on by the operation of specific causes, but it
is also very certain that there are many identical diseases induced by
very different general causes acting%upon a system with a certain
predisposition which is not understood.

The same may be said of symptomatology, which formed the basis
of the systems of all the earlier writers, as Sauvages, Sagar, Linneus.
Vogel, and Cullen, together with McBride and Selle, for it is evident
to any practised physician, that many diseases, distinct in their na-
ture, when seated in the same organ, will exhibit themselves in phe-
nomena so identical as to be confounded together by the most expe-
rienced. "Thus we have seen softening of the brain mistaken for
typhoid fever by the most profound diagnosticians ; because in the
instance alluded to, the symptoms to which the former gave rise so
nearly resembled those usually characterizing the latter, especially,
we presume, in reference to the brain, as to have led, if not necessa-
rily, at least very easily, into error. Many cases analogous to the
above in fact occur, in which we must depend chiefly for our diagno-
sis not upon what may be called the physiological symptoms, but upon
a knowledge of the circumstances under which the disease arose, its
commencement, course, invasion, collateral circumstances.* &c."
The same objections apply with stiil greater force to the functional
or physiological plan adopted by Dr. John Mason Good.

The tissual, organic, or topographic system which originated with
Bichat, and has been embraced to a greater or less extent by MM.
Broussais,f Prost, Bo.sseau, Bouiliaud, and others, seems to me to be
surrounded with still greater difficulties. The localization of all
essential diseases, although declared by the latter to be "the most
beautiful conquest of modern medicine," yet, founded as it is upon
the erroneous notion which refers disease entirely to an altered vital
action without regard to the mechanical and chemical actions of the
system, must necessarily be defective. If all diseases are lecal, and
merely differ according to their differences of seat, then, unless all
diseases are an unit, " we should soon be acquainted with all the dif-
ferent inflammations in the same person, at the same time, and even
in the same wound ; for instance, in an amputation of a leg, where
we cut through skin, cellular membranes, muscles, tendon, perioste-
um, bone and marrow, the skin should give us the inflammation of
its kind, the cellular membrane of its kind, the muscles of theirs, the

* Amer. Journ. MeJ.Sci.

t It is truo that Brous^ai.s direct
study in:- the nature
knowledge. Examen, vol. ii. p.

654 Isopathia : or the Parallelism of Diseases. [November,

tendons of theirs, the periosteum, bone, marrow, &c, of theirs; but
we find it is the same inflammation in them all. It is the adhesive in
them all, if the parts are brought together ; it is the suppurative, if
parts are exposed."* Now as the same morbid action may attack
different tissues or parts of the body, so it is equally true that different
morbid actions may attack the same tissue or part of the system,
and although " pathological formations or types are slightly different
in diiferent parts of the body, as is the case with animals or plants in
different climates or soils, yet the species is invariable and always to
be recognized. "f

Pathological anatomy, the offspring of Bonetus, Valsalva, and
Morgagni, which has been highly advanced by the labours of Laen-
nec, Hope, Cruveilhier, Carswell, and many others, although offering
greater claims upon our attention than any other isolated method for
investigating and distinguishing diseases, is still defective. % Patho-
logical anatomy is not pathology, the lesions left after death are not
disease^ but simply the effect of the morbid action which had been
going on in the system during life, and should be considered as
nothing more than a kind of special symptomatology. "Physicians
open a body and find hypertrophy of the liver or hardness of the
spleen, and conclude that the patient died from one or the other of
these affections ; but they are blind to the fact that hundreds pursue
their daily avocations with enlarged livers and hypertrophied spleens,
and that women can walkabout with ovaria enlarged to the size of a
child, till^at last, being found in the dead body, it is presumed that
death has ensued in consequence of these enlargements! Shall we
never learn from such facts that diseases do not originate from dis-
eased masses and products, but that these same bodies are the effect
of disease, and the token that it has heen present ? Shall we never
learn that the patient died not from these pathological growths, but
from the process of disease which called them into existence ! and
farther, that we are not to direct our attention to the mere residues
of disease and the products of death, but rather to the destructive or
death process itself ?" But, besides all this, "there are numerous
cases arranged into diiferent genera of disease ; some of them very
important and even rapidly fatal, for example, different forms of
fever, certain cases of apoplexy and syncope, tetanus, hydrophobia,
&c, &c, which do not necessarily nor uniformly leave behind them,
so far as is yet known, any alterations of textures, or other change
perceptible to the anatomist, the pathology of which diseases, there-

* Hunter on the Blood, vol.i. p. 257.

t Cruveilhier. Amer. Journ. Med. Sci., Oct., 1844, p. 512.

t We are happy to find our remarks upon this point so happily accordant with
those of the reviewer of Schultz's General Pathology in the London and Edin-
burgh Monthly Journal of Medicine for Aug., 1845. Indeed Ave might be accus-
ed of plagiarism, did we not state that the above remarks are precisely as I find
them in mv manuscript notes, taken downnearlv two)vears ago.

Amer. Jour. Med. Sci., Oct., 1815, pp.473, 474.

1346.] Isopathia : or the Parallelism of Diseases. 655

fore, although it may derive assistance from, cannot possibly be
founded on, the knowledge of former appearances. 5J*

But a more important and interesting mode of investigating disea-
ses consists in the application of chemistry and the microscope to the
study of the state of the fluids and morbid products of the body before
and after death. We rejoice to see the humoral pathology revived
under such auspices. Already have the labours of Magendie, An-
dral, Dumas, Donne, Prout, Liebig, Raciborski, Muller, and others,
thrown important light upon our path, and it is to be hoped that dis-
eases will, ere long, be brought within the range of physical laws, and
be treated upon philosophical principles. But even here caution is
necessary in the application of these methods, for although it has
been most clearly demonstrated that medicines as well as morbid
agents operate upon the system through the medium of the blood as
well as through the nerves, it would be rashness to look for traces of
all diseases in the blood and other fluids. In many, the alterations
to be discovered are either entirely nugatory or accidental complica-
tions in the progress of the morbid actions.

The question now comes up, by what method are we to distinguish
and classify diseases ? Our answer emphatically is, by a rightful
combination and use of all the methods passed in review, so far as
they may be applicable to the case before us, by an investigation of
the causes, so far as they may be known to us, whether predisposing
or exciting, by a careful observation and comparison of symptoms,
as they present themselves in connection with the seats or organs
whose functions may be disturbed during the progress of the disease,
by a critical inspection of the lesions which may be presented after
death, by an examination of the state of the blood and other fluids,
and lastly, by all those collateral aids which may be afforded by the
history of the disease and other circumstances already alluded to in
a former paper.

With these remarks, we now proceed to take up in order the types
into which we have divided diseases, for the purpose of tracing, so
far as we may be able, the isopathic connection that may exist
among them.

Inflammatory types. The term inflammation,f besides being ob-
jectionable in itself, has been used in a sense so vague and uncertain,
that it is difficult, if not impossible to define its meaning. According
to the doctrine of the physiological school, which makes inflamma-
tion consist in nothing more than an increase in the normal vital
action of a part under the influence of the morbid cause, the term
would embrace the most of the diseases to wiiich the human body is
subject, and we are not surprised that Broussais should have con-
tended that pus and tubercle, and the matter of carcinoma, and, in

* Allison's Outlines of Pathulogy.

tThe term hyperemia, substituted by M. Andral, we do not consider less ob-
jectionable, in apathn:

656 Isopathia : or the Parallelism of Diseases. [November,

one word, that all degenerescences of structure were the product of
inflammatory action. But even in the more restricted sense of the
term, as used by John Hunter, it appears to me that several distinct
morbid species have been united together. He evidently regarded
simple inflammation as a specific affection, and that adhesion, suppu-
ration, ulceration or gangrene, was nothing more than a mode of
termination of the same morbid action.* Now it appears to me that
the following should be regarded as axioms in pathology.

1. That unless all morbid actions and processes are general, and of
the same nature, and hence, all diseases an unit, every disease must
be of a specific character, specific in its incipiency, specific in its
progress and specific in its termination.

2. That there are certain changes in the fluid which, from their
constancy and uniformity, may be regarded as specific characteristics
of the specific morbid condition, and hence, whenever they occur,
determine at once the nature of the disease.

3. That a disease which terminates in adhesion or the effusion of
coagulable lymph is a specific disease that, left to itself and not
modified in its course by remedial agents, could have terminated in
no other way ; so also a (disease ending in suppuration has affixed to
it that specific characteristic, and its tendency from its incipiency
was to that result. The same may be said of any other disease with
a specific termination.

I can have no doubt that an open wound may be attended with a
kind of suppurative action, or that the mucous membrane of the
urethra may ulcerate from the continued irritation of a bougie, or
that a part may mortify under the operation of violent causes, as in-
tense cold, &c, and in neither case can these results be regarded as
peculiar or specific. But these local effects of local causes cannot
be considered as invalidating the truth of the last proposition in its
application to constitutional affections in which the termination must
be considered as one of the most decisive tests of the true nature of
the disease.

Using the term inflammation, therefore, as a specific appellation,
we would restrict it entirely to the adhesive form of Mr. Hunter, but
adhering to general usage, we will consider under the head of inflam-
matory types one form of suppurative disease and gangrene or mor-
tification.

Let us now trace out the pathognomonic symptoms of adhesive
inflammation. The causes are of a general character, and their
mode of operation not well understood. There is fever with a full
pulse and a tolerance of blood-letting. The blood exhibits a buffy
coatf and an evident increase of fibrin. The termination is by an

* On the Blood, vol. i. p. *254.

t Mulder supposes that the bufFy coat is formed from the albumen of the blood,
and consists of the deutoxide and tritoxide of proteine ; and from the fact that the
albumen is relatively diminished, MM. Becquerel and Rodier have adopted the
opinion that the increase of fibrin is brought about bv a transformation of the
albumen. Med. Cbir. Rev., April, 1845, p. 521, and July, 1845,. p. 263.

1846.] Isopalhia: or the Parallelism of Diseases, 657

effusion of coagulable or plastic lymph, and the formation of false
membranes or carnification. Of these symptoms there is none more
uniform, more constant, nor more important than the increase of
fibrin in the blood. MM. Becquerd and Rodier state that "the pro-
portion of this element is invariably increased above the normal stand-
ard in all genuine phlegmasia:. This, in short, is the fundamental
and essential character of all inflammatory diseases; without it an
inflammation cannot exist. This increase in the quantity of the fibrin
is invariably found to exist, whatever may be the composition of the
blood in other respects, and the proportion of its other constituents."
And to the same end we might cite the experiments of MM. Andral
and Gavarret : "Not long since," says Andral,* "Meckel defined
inflammation to be congestion with a tendency to new production ."
The study of the blood shows the justness of this definition. For
what else than a new production is this excess of fibrin which sud-
denly appears in the blood of a person attacked with pneumonia or
erysipelas, with an inflammation of the tonsils, of the tongue, of the
bronchia, or of the peritoneum ? " A new and redundant production
of fibrin in the blood is then the least variable sign of a certain num-
ber of diseases which present further analogies in the nature of the
general symptoms accompanying them, and in the uniformity of the
treatment which they require." So great is the stress which M.
Andral lays upon this " increase upon the spontaneously coagulable
matter of the blood," that he is led to regard all diseases, however
different their seats, as being of the same nature if this characteristic
is to be found, j

Of equal importance is the exudation of the blood plasma in deter-
mining the species of inflammation. Dr. Bennetti "regards the
anormal exudation of the liquor sanguinis or blood plasma as the
essential phenomenon of inflammation." And the reviewer of Dr.
Bennett's work goes on to say that exudation of blood-plasma is then
the only positive proof we have of inflammation ; and the want of a
recognition of it as the essential phenomenon hassurrounded the des-
cription of the disease with vagueness and inconsistencies."

We think we are justifiable, then, in concluding that all diseases
possessed of the above characteristics, however different in their seats
and some other symptoms, are pathologically the same, and we will
now attempt to analyze those types which we suppose to hold to each
other this isopathic connection.

The prototype of this disease is evidently the essential fever which
18 commonly known under the name of inflammatory fever, and is in
all respects the same as the " imputrid synochus" of Galen ; the u im-
putrid continued fever" of Boerhaave ; the " imputrid continent
fever" of Lomnius : the " sanguineous continued fever" of Hoffman ;
the " synocha" of Sauvage, Linnanis, Cullen, &c. ; the "cuma" of
Drs. Young and Good ; the " rheumatic fever" of Sarcone ; the "r-

* Essay on the Blood, p. 60. 1 1 Ip. cit., p. G8

% Med. Chir. Rev., Jan., 1845, p. 93.

42

658 Isopathia : or the Parallelism of Diseases. [November,

geioienic fever" of Pinel, and the " hcemitis" of M. Piorry. We will
now point out, as briefly as possible, the various types or forms in
which this fever may manifest itself.

When it attacks the joints, and seems to be seated in the muscular
or fibrous tissue of the system, it has received the name of rheumatic
fever or acute rheumatism. This disease, has always, we believe,
been regarded as one of highly inflammatory character, and agrees
in every essential particular with the fever above-mentioned. An-
dral* found the fibrin of the blood invariably increased in quantity,
and it is universally admitted to be a disease which never terminates^
in suppuration. The disease, when confined to the joints, so rarely
terminates fatally, that we are not well acquainted with its patholo-
gical anatomy, but in those cases where it has ended in death by a
translation or metastasis to some vital organ, an exudation of coagu-
lable lymph has always been found. %

When this disease attacks the heart or its investing membranes,
it has received the name of pericarditis, carditis or endocarditis.
This extension or metastasis of rheumatism was first pointed out by
Dr. Baillie, and many instances of the kind have since been record-
ed by various authorities. Dr. Odier, of Geneva, in his " Manuel
de Medecine Pratique," mentions, among the various symptoms
which are apt to supervene on acute rheumatism, an affection of the
heart that frequently degenerates into a chronic complaint. Dr.
Wells has collected several cases of this kind in the 3d vol of Trans-
actions for the Improvement of Medical and Chirurgical Knowledge,
which may be consulted with advantage.^ Sir David Dundas, in a
paper read before the Medico-Chirurgical Society in Nov., 1808,
draws the attention of the faculty to the subject. He met with no
less than nine cases in the course of thirty-six years. Dr. Marcet
met with two cases of rheumatic metastasis from the extremities to
the chest. They proved fatal. " My worthy friend, Dr. McArthur,"
says Dr. James Johnson, " writes to me thus : ' In a few instances I
have noticed pain in the intercostal muscles, and palpitations of the
heart to an alarming degree in acute rheumatism : but I do not know
whether they could properly be called metastasis, because the origi-
nal inflammation of the joints had not previously receded ; they
were, however, decidedly rheumatic, and declined 'pari passu,' with
the other local symptoms. The disease might be termed extension
of the rheumatic action to the heart. "

This intimate connection between acute articular rheumatism and
disease of the heart has been also referred to by Hughes, || Bouil-

* Op. cit., p. 74.

1 1 know that exceptions are given to this rule. I am of opinion , however, that
in such cases the disease had lost its original character.

% See cases by Dr. Johnson, on Liver ; also, Med. Ch. Rev., vol. xxxviii. p. 67

The above "cases I have taken, in the words of the author, from the work
of Dr. James Johnson, " On Derangements of the Liver, Internal Organs, and
Nervous System," pp. 139, et seq.

II Med. Chir. Rev., April, 1836, p. 547.

184C] Isopcthia : or the Parallelism of Diseases. 659

laud,* Brachet.f Carswell.i Macleod, Todd,|j Choiriet.Y Latham,**
and many others. Indeed so constant and uniform has been this
relation in the practice of M. Bouillaud, that he has written a work
with special reference to this lawft of coincidence, in which he avers
that he has satisfied himself that both these affections (viz., pericar-
ditis and endocarditis), constitute in some measure natural elements of
the disease, (articular rheumatism.) which, regarded in a juster and
more comprehensive point of view, consists of inflammation of the
flbro-scrous tissues in genera]."" This same view has also been taken
by Dr. Macleod. The latter says : " I have no hesitation in express-
ing my conviction that the pericarditis supervening during rheumatic
iever may more correctly be regarded as an extension of the disease
than as true metastasis.'"

In the same manner rheumatic fever may also show itself upon the
peritoneum, giving us a form of peritonitis, or upon the pleura, when
we have a form of pleurisy. M. Bouillaud says, "Rheumatism is
in fact nothing else than a pleurisy of the synovial membranes," and
in his "Treatise on Diseases of the Heart," he says, "rheumatism

so to speak, nothing else than pericarditis of the joints," by which
language he evidently intends to convey the idea that these diseases
are mutually convertible, and may replace one another.

Baglivi'4+ it appears, led by the similarity in the appearance of
the blood drawn incases of rheumatism and pleurisy, held that a
similar mode of treatment was applicable to both, and of course that
they belonged to the same pathological type. "On the ground,"
says he, "of this analogv alone we may safely reason from the

* - Rev., July, 183G, pp. 83, 5, April. 1836. p. 337; Jan.,

1841, p. GG, 193. y ' ,k

+lbid, April, Ibid., July, 1839, p. 276.

Ibid., April. 1842, p. 109. :3. p. 476.

IT American Jou . 161.

** Med. Chir. Rev., July, 1845, p. 173.

Rheumatisme articulaire aign en General et
Specielement sur la loi de coincidence de la Pericardiio et de l'Endocarditeavec
cette maladie. Paris, 1 336.

ir. Rev., Ji 86.

Dcieat date, having been made

; from Broussais' Eiamen

arerune maladie actuelle

aux derniers pour tons les cas ordi-

tutres oil nolle jent

aii recours dire

mnUe ou nun".

amies qui paraissaient avoir le pin-

nouvelle ce qu'on savait dea anciennes

est que l'on appellait la sufoti-

Ue '

,'efondementou
and i m ^r

u,1K!l . and pn

i-vifc a r la

660 Isopathia : or the Parallelism of Diseases. [November,

treatment of the one disease to that which would be proper in the
other, so as, in fact, to find that the same remedies are applicable to
both." Sir John Floyer would appear to have entertained the same
opinion, for he alleges "that pleurisy is nothing else than a hind of
rheumatism" The symptoms and anatomical characters of the dis-
eases leave no doubt on our mind of their perfect identity.

But this fever may also seat itself upon the parenchymatous struc-
tures of the various organs, giving rise to as many distinct diseases
according to the nomenclature of nosologists. I can have no doubt
that the most common form in which pneumonia presents itself to us
is entirely isopathic with the rheumatic or inflammatory fever. The
fact has long been known that peripneumony very rarely, if ever,
terminates in suppuration. Abscess of the lung is a very rare thing
as a sequel of this complaint. Dr. Chambers,* in the London Med-
ical and Physical Journal for September, 1827, asserts " that during
fifteen years he had been physician to St. George's Hospital, the num-
ber of deaths from pulmonary disease had amounted to above six
hundred, (600,) and that the bodies of all these persons, with a very
few exceptions, bad been carefully examined after death, and amongst
them, according to the best of his recollection, there had been found
only three cases of pure phlegmonous abscess in the lungs." Laen-
nec, it is said,f only met with five or six cases of it, Andral only one.
The termination of the disease is always by an effusion of blood-
plasma or coagulable lymph, forming what has been called hepatiza-
tion or carnification of the lung. Reasoning, then, upon the princi-
ple of the " iransitus ad simile" how can we resist the conclusion
of its intimate association with this type or species of disease?

But farther, the reviewerf of Dr. Latham's "Lectures connected
with clinical medicine, comprising Diseases of the Heart," holds the
following language. "While every physician in the present day
knows full well that pericarditis and endrocarditis are very common
accompaniments of this disease (rheumatism), not many, probably,
are aware that inflammation of the lungs, we use this term to com-
prehend pneumonia, pleuritis, and bronchitis, is also a not unfrequent
complication at the same time. Of Dr. Latham's 130 cases of acute
rheumatism, the heart was inflamed in 90, or in two-thirds of the
whole : while the lungs were inflamed in 24, or 1 in 5J. These 24
cases consisted of 4 of bronchitis, 18 pneumonia, and 2 of pleurisy.
Of the four cases of bronchitis the affection was no mere catarrh,
but an inflammation largely diffused through both lungs, producing
deep oppression and dyspnoea. Of the two pleurisies one was single,
and the other double. The single pleurisy produced a large effusion
into one side. The double pleurisy produced a double hydrothorax.
Of the eighteen instances of pneumonia, in nine the disease was of
one lung, and in nine it was of both." Now the mode of reasoning

* Am. Journ. Med. Sci., Feb., 1828, p. 475.

t Med. Chir. Rev., Jan., 1844, p. 168, and April, 1844, p. 465.

; Ibid., Julv, 1845, p. 172,

1846.] Isopathia : or the Parallelism of Diseases. 661

by which we would apply the facts to prove the identity of these dis-
eases is simply this. If pericarditis, pneumonia, and pleurisy may
exist as a secondary effect or complication of the disease known as
acute articular rheumatism, then acute articular rheumatism may
arise as a complication of these first named affections, or a secondary
result. The diseases, then, are mutually convertible, and if, although
being mutually convertible, acute articular rheumatism may exist
simply without implicating the internal organs, so also the same dis-
ease, originating primarily in the pleura, lungs, or pericardium, may
not be complicated with disease of the joints, and still maybe the
same disease as though it had originated in the joints.

M. Rayer,* in his " Traites des Maladies des Reins" describes a
rheumatic form of nephritis, and points out very accurately the post-
mortem appearances exhibited in the kidney, and M. ChomeI,f in
bis " Lecons de Clinique Medicale" has called attention to the
rheumatic character of several other visceral affections heretofore
included under the sweeping term inflammation ; but we need not
pursue this branch of our subject farther.

I fear I shall excite the smile of my reader when I attempt to
trace out this disease upon the tegumentary tissues of the body; but
I have myself no doubt of the fact that it may manifest itself upon
these organs. It may appear upon the cutaneous surface io the form
of a scarlatinous or erysipelatous eruption. I do not pretend to say
that every form of erysipelas belongs to this type. The phlegmon-
ous I regard as entirely and specifically distinct from the true or
inflammatory erysipelas, and I will treat of it under the head of
purulent types: but that the latter is identical with the inflammatory
or rheumatic fever, is proved by the treatment which is best adapted
to its cure, and the state of the blood of those who are attacked by it.
In cases of acute febrile erysipelas, M. AndralJ has determined an
increase of fibrin e equal to that which takes place in the most highly
inflammatory diseases, and represented by the numbers 6 and 7 in a
thousand parts.

This form of erysipelas may extend to the mucous membranes of
the different internal cavities. When it attacks the mouth and fauces
it produces that peculiar disease first descrihed by M. Bretonneau.
of Tours, under the name of diphtherite, or angina membranacea.
When lower down, involving the larynx and trachea, we have the
disease known as croup, the " cymanchc trachealis" of Cullen, the
" empresma bronchlemmitis" of Dr. Good. The identity of these two
last-mentioned atXections has been fully confirmed by several observ-
ers. " M. Gendron|| regards diphtherite and croup as the same dis-

* Med. Chir. Rev., Jan., 1842, ] p. 58, 59.
t Amer. Journ. of Med. Sci., FeD., 1-37, p. 451.
: Pathological Hemtology, p. "

See a notice of Mr. Ray'and's nd Injuries of the

Larynx," inAjner. Journ. , Feb., 18>, p. 143.

II "Med. Chir. Rrv., vol. xxiii , p

662 Isopathia : or ike Parallelism of Diseases. [November,

ease, only occupying different parts. In the one case the cavity of
the mouth and fauces is chieHy affected ; in the other the larynx and
trachea. In both, the character of the inflammation is the same,
and there is the same disposition to the deposit of the false mem-
branes." Mr. Rayland* says that M. Bretonneau "considers the
ordinary croup of children, the cynanche maligna, and the plastic
angina or angina coucnneitse of the French, are ail precisely the
same disease, but producing different effects according to the seat and
degree of the morbid action." This same view of these diseases was
also taken by Guerqsent and Laennec.f Br. Ruppius, of Freiburg,
very justly remarks that "the morbid action or process in this disease
(diphtherite), is essentially the same as characterizes the well-known
disease of croup or cynanche trachealis. In both the inflammation
of the affected mucous tissue has a very marked tendency to cause
exudation of a membraniform lymph on its surface. In the. one this
phenomenon is usually limited to the trachea and lower part of the
larynx ; while in the other it is observed chiefly on the velum palati,
the tonsils and hack part of the fauces." Med. Chir. Rev , from
the Zeilschrift fur die Gesam Med., vol. xxxiv. p. 595. Dr. Stckest
holds the following language upon this subject : "This diphtheritis
is a most formidable disease. It is analogous, in many of its most
prominent features, to that affection which the old medical writers
called cynanche maligna; at all events it resembles it in this, that
in both there is the formation cf a dense albuminous pellicle, and I
think that as far as it goes, we may call it a species of croup in the
cavity of the mouth and pharynx." Diphtherite sometimes attacks
the external surface when it is known as cutaneous diphtherite.
"This curious affection, noticed by Bretonneau, has been especially
described by Trosseau. It consists of a pseudo-membranous inflam-
mation of the skin prevailing during the epidemics of pseudo-mem-
branous angina, affecting any part which becomes denuded of the
cuticle as by blisters, excoriation, friction, &c,"

We pass on to notice one more affection which we suppose to be
connected with this species. I allude to the diarrhoea tabularis of
Dr. Good. This disease was first arranged in a nosological classifi-

* Med Chir. Rev., Jan.. 1838, pp. 52, 53. t Ibid, Jan., 1838, p. 53.

; I am aware that diphtheritic angina has sometimes been found to be symp-
tomatic of scarlatina, and hence, according to our mode of rersoning, we might
conclude that these two diseases are isopathic with one another, and with the
species we are now considering. Hpw faT this may be true, I will not take
upon me to say, but I have been tempted to believe that the scarlatina of children
was the erysipelas of the adult, and properly belonged to this species. The fact
that in children there must be a great disposition lo an increase of fibrin for the
purposes of growth, renders probable a greater tendency to a morbid alteration
in this process, and hence, their greater liability to the'd the apparent

contagious nature of scarlatipa renders the connection doul

It must be admitted, Nnvevcr. that ^- relation to the red disease?

there is so much confusion and dij ! with all i

of the tegumentary tissues, that the determination of the precise relation which
ihev hold to one another, must be a matter of more or less doubt.

1846.] Isopathia : or the Parallelism of Diseases. 663

cation by Good, who says in regard to it that " It appears to depend
on a peculiar irritability of the mucous membranes of the large intes-
tines, which in consequence secrete an effusion of coagulating fibrin,
fibrin mixed with albumen instead of secreting mucus. It has a
striking resemblance to the fibrous exudation thrown forth from the
trachea in croup, but is usually discharged in longer, firmer, and
more compact tubes." Study of Med., vol. i. p. 252. Blumenbach
has shown that a like effusion of fibrin sometimes takes place into
the uterus through the excitement of an aphrodisiac passion alone,
without copulation or impregnation, and "Morgagui has given ex-
amples of so perfect a formation of the same membrane by the irri-
tation that takes place in painful menstruation, as to render it difficult
to be distinguished from that belonging to an ovum." I remember
to have attended a lady once who, after suffering violently from
strangury, passed a membraniform substance from the urethra, which
was represented to me as being of a tubular character.

Having now passed through some of the modifications of our first
species of inflammation, we propose to consider under the same gen-
eral head two affections which, although regarded universally as were
terminations of inflammation, are, in our opinion, distinct species of
disease. We allude to suppuration and gangrene or mortification.
We will take up the last mentioned, first in order.

We can readily believe that gangrene or mortification may be a
termination of any violent acute disease, under peculiar circumstan-
ces, and, of course, in all such instances, it cannot be regarded as a
specific feature, although, like the putrescent state of the blood, on
which it no doubt depends, it must always be regarded as a fearful
complication. But there certainly is a kind of gangrene which must
be considered primary and specific, and so far as we can discover,
not the result of inflammation, or, at least, of that species which we
have above described.

Most authors in treating of this disease, seem to consider it, for the
most part, as a local affection, or, if they refer it to a general state of
the system, they seem not to connect that condition with the local
disease, except in a very general or indirect manner. Even in cases
of spontaneous gangrene, various causes have been assigned for its
origin which are entirely of a local and mechanical character. Ossi-
fication of arteries or their obliteration by coagula of fibrin, ossification
of the valves of the heart, a disturbance of the nervous influence, &c,
&c, have been said to give rise to it. Baling those case?, however,
where the local affection has been induced by the application of such
local causes as would tend, at once, to produce the immediate death
of the part, as heat, cold, &c, there is good reason for believing that
the disease is dependent upon a morbid, constitutional process,
which may be considered to he a putrescent frver, or a putrefactive
fermentation of the fluids, whose tendency is to bring about the death
of those parts where the force of tl v spend i;

I am happy to find this opinion ithorily s i

664 Isopathia : or the Parallelism of Diseases. [November,

as that of Mr. Travers. He says, "gangrenous inflammation is,
therefore, to be regarded as essentially of constitutional origin in all
circumstances: Its local termination is the same disorganization as
follows from the work of destroying agents: in this extreme result
only, do the inflammation of gangrene and the state of gangrene
touch and analogize. When we speak of an inflammation passing
into gangrene, we convey that the system is the medium through
which such a change is effected, and that, thereby, the whole char-
acter of the action is changed." Again, "gangrenous inflammation
is often secondary to intense cutaneous and cellular inflammation,
and so common is this association, that the terms 'gangrenous ery-
sipelas' and 'carbuncular abscess' are in practical use to denote these
combinations, and the distinction of gangrenous from adhesive and
suppurative inflammation. It is an acute inflammation directly dis-
organizing, because the resisting power of the parts affected by it is

inadequate to sustain the circulation That it is a

substantive mode of inflammation, is shown by its occasionally idiopa-
thic existence, as well as its distincly marked primary characters ;
by its supervention in decayed or diseased habits on very slight forms
of injury ; and, especially, by its tendency to spread along the neigh-
boring parts, from the extremities to the centre ;" and again, " gan-
grenenous inflammation may be primary, that is, no other mode of
iuflammation going before it. The circulation of the part and neigh-
borhood becomes stagnant, and the vessels, both arteries and veins,
are choked with broken and semi-solid coagula. It is due to the
vehement intensity of the local inflammation and consequent ex-
haustion of the nervous life of the part, or to a constitutional condition
which renders the solid and fluid elements incapable of entertaining
the functions of the part, on which depend its temperature and prin-
ciple of resistance to external agents, in other words, its life ? In all
cases, not produced by external injury, and in many that are so pro-
duced., I believe, the latter is the true explanation.*

The explanation which is given by Liebig of the action of putrid
poisons upon the body, seem to me to apply here with remarkable
force. In all such cases a morbid agent is introduced into the sys-
tern, which, by its presence, excites an action allied to the fermenta-
tive, by which certain parts of the blood are transformed into new
products. If the poison or exciting body meet in the blood, a princi-
ple from which, in its action upon the first, it may be renewed, the
disease is contagious. If this principle do not exist, then the poison
itself is lost in the transformations which ensue, and, of course the
disease is not contagious. f The small-pox and the measles may
serve as examples of the first, while the common gangrene or spha-
celus is an example of the second class of cases. This same view

* See a review of Travers and Bennett on Inflammation. Med, Chir. Rev.,
Jan., 1845; pp. 106 and 107.

t Vide Chemistry in its Application to Agriculture and Physiology, by Justus
Liebig.

1846.] Isopathia : or the Parallelism of Diseases. 665

seems to be adopted also by M. Dumas* in his Lectures on Organic
Chemistry.

That substances may act in this way upon the body is fully shown
by the examples given to us of the poisonous properties of sausages
in a state of putrefaction, when introduced into the stomach. Liebig,
op. cit., p. 388, tells us that in such cases "all the substances in the
body capable of putrefaction are gradually decomposed during the
course of the disease, and after death nothing remains except fat,
tendons, bones, and a few other substances which are incapable of
putrefying in the conditions afforded by the body." This "gangren-
ous infection,''' as it has been called by Rokitanski, is beautifully
illustrated in a case related by Dr. Budd, in his treatise " On diseases
of the Liver." We take pleasure in transcribing the following
comments of the author. " In this case," says he, " the existence of
gangrene both in the liver and in the lungs, was clearly shown by
the defined line surrounding the gangrenous portions. The source
of the mischief here, was, no doubt, the gangrene of the toes pro-
duced by cold. The man was in the prime of life, of spare habit,
muscular, florid, and in good health at the time of the frost bite.
The case shows us what a serious thing a small patch of gangrene
in any part of the body may become. The dissemination of the
gangrenous masses, the existence of a number of them isolated and
at a distance from one another, proves that the septic agency was
conveyed by the blood. The noxious matter thus disseminated de-
stroyed the vitality of the tissues on which it acted most strongly.
The chemical theory of these septic changes is now well known.
All parts in which they are taking place have a tendency to affect
other parts brought into contact with them with the same mode of
transformation. The case just related, and it is by no means a soli-
tary one, offers one of the most interesting illustrations of this theory
in the whole range of pathology."

The reason why an action of this kind is not always general may
be explained in the words of Liebig. Op. cit., p. 404. " The action
as well as the generation of the matter of contagion is according
to this view a chemical process participated in by all substances in
the living body, and by all the constituents of those organs in which
the vital principle does not overcome the chemical action. The con-
tagion (or putrid poison) accordingly either spreads itself over every
part of the body, or is confined particularly to certain organs, or only
a few of them, according to the feebleness or intensity of their resist-
ance."

The rule which has been laid down by some surgeons in regard to
the exact time when amputation should be performed in cases of mor-
tification of a limb, proves that at times it is a constitutional affection
and does not stop by the removal of the offending member. The
rule to which I refer is that the operation should never be performed

* Med. Chir. Rev., July, l&iJ, p. 163.

666 Isopathia : or the Parallelism of Disease ** [November,

"before the mortification has stopped and a line of separation ap-
pears between the dead and living parts," a rule which should never
be violated except when the mortification is clearly local.

But I presume that it will hardly be denied that mortification is
very often a constitutional disorder, and it is not very important to
our present purpose whether the mode of explanation which we have
given of the manner in which the morbid cause operates be received
or not, but surely it is reasonable to suppose that in all cases in which
the blood seems to play so important a part in the disease, some
morbid transformation of the kind to which we have above alluded
should take place. For my own part, I am inclined to apply this
explanation of the morbid process to most of the diseases that we
will allude to in the remaining part of our paper.

The first disease which we shall notice as belonging to this type
or species is the gangrena senilis, or dry gangrene of Pott. In this
affection (he gangrene or mortification appears to come on with
no previous symptom of inflammation, and is for the most part
confined to the lower extremities. It was at one time attributed to
the eating of ergot or spurred rye (secale cornuium), but probably
without sufficient reason.* Mr. Pott says of it that "it is very un-
like to the mortification from inflammation, to that from external
cold, from ligature and bandage, or to that which proceeds from any
known and visible cause. It frequently happens to persons advanced
in life, but it is by no means peculiar to old age."

Of a nature identical to this type is the disease commonly known
to surgeons as \l hospital gangrene." Delpech defined it as " a pe-
culiar disorganization of the soft parts so that they disappear without
leaving any trace of their primitive tissue, and become a putrid
homogeneous gluten." M. Vidal accepts the definition, but not with-
out criticising it. "This definition," says he, "which has not only
all the defects of surgical definitions, but also those which character-
ize the style of the author, may serve, however, to give an idea ot
the singular disease of which we are treating. "f The disease is so
well known that it is unnecessary to enter upon its description,
which can be found in almost any surgical work, and is lucidly given
by Hennen in his "Principles of Military Surgery" It seems to
be peculiar to hospitals, where it is aided in its progress by "an im-
pure and unventilated atmosphere." Dr. Good J supposes that it may
be propagated by contagion. M. Devergit is of opinion that the
cause of the disease in the St. Louis Hospital, in Paris, is its exposure
to " the unhealthy emanations from Montfaucon, (where there is a
large abattoir or slaughtering-house, and where there is often collect-
an immense accumulation of most offensive animal refuse.) as the

* Practice of Medicine, by M. Hall, p. 112. I cannot but believe, however,
upon the authority of authors, that a similar, if not identical, disease is produced
by the action of ergot.

t Med. Chir. Rev., July, 1842, p. 175. t Study of Med., vol. iii. p. 49G.

Med Chir. Rev , vol xxxviii. p. 140.

1846.] Isopathia : or the Parallelism of Diseases. 667

patients in those wards which were on the other side of the building
seemed to be quite exempt from it."

This species of disease may show itself in a milder form, as an
erysipelas upon the skin. This was observed by Dr. Riberi,* of
Turin, "who, in describing a hospital gangrene in the hospital of
San Giovanni in that city, during the years 1817-1820, tells us that
it often alternated from a sphacelating to an erysipelatous inflamma-
tion, the latter appearing as the former began to cease on the return
of a cooler or drier air, or where both co-existed, the slighter or ery-
sipelatous affection being limited to the more robust patients, or
those who were fortunate enough to lie in the best ventilated parts
of the sick wards."

The next form of disease which we must associate with this type
or species is pulmonary gangrene or gangrene of the lungs. This
disease, we believe, was first distinctly described by Laennec, who
says of it,f "It can hardly be regarded as one of the terminations
of inflammation of that viscus, and still less can it be regarded as a
consequence of the intensity of the inflammation. In truth, in such
cases the inflammatory character is very little conspicuous either in
the symptoms or in the morbid condition of the injured organ. I
would, therefore, say that this disease it allied to those affections
which are essentially or idiopathically gangrenous, such, for instance,
as the different varieties of anthrax, and that the inflammation exist-
ing around the gangiened part is rather the effect than the cause of the
mortification." M. GuislainJ has adopted in part this opinion of
Laennec. " M. Chomel has described a gangrenous condition cf
the lung which he has found occasionally in the bodies of those who
have died from the effects of exposure to the effluvia from cesspools
and sewers."

M. Boudet's observations upon this disease have led him to the
following conclusions, fust, that "gangrene of the lungs appears to
be more frequent in childhood than at any other period of lite. Se-
condly, it is essentially of the same nature as those other forms of
gangrene that are developed spontaneously or under the influence of
putrescent fever. Thirdly, in the child, gangrene, when it affects
the lung, is rarely /.'/.. is organ ; usually several other parts

of the body are similarly affected at the same time. Fourthly, (7)
local causes, such as inflammation, the existence of tubercles, &c,
do net seem to have any ice on the production of pulmo-

nary gangrene."

Another affection which we regard as identical in character is the
gangrene of the mouth of children, usually occurring about the period
of dentition, and here! ribed under the names < tous

stomatitis or gang: cane rum or/- ia of

the mouth, gangr* rr atyuaticus or . &c.

Good, o[). cit., -193.

t Dia ; Med. Chir. Rev.;0< 509.

S Am, Jo urn, M 15.

668 Isopathia : or the Parallelism of Diseases. [November,

"This disease* commences with a purple spongy appearance of the
gum, either of the upper or lower jaw ; to this state speedily follows
ulceration, which eats deeper and deeper until the alveolar processes
are quite exposed. The ulcerated surface is much disposed to bleed,
so that its character is often with difficulty ascertained. In severe
cases the ulceration rapidly passes into a state of gangrene and
sloughing, and these morbid changes extend from the gums to the
lips and inside the cheeks. The diseased surface becomes quite
black, the teeth drop out, the jawbone becomes carious and even
the tongue may become partially destroyed, fn some cases the disease
commences in the lips or cheek, and extends thence to the gums.
The accompanying constitutional symptoms are usually an irritative
feverishness and a greater or less degree of diarrhoea, which quickly
reduces the young patient's strength and carries him off." This
gangrene may attack any of the tissues of the economy. It is saidf
to be most common in the mouth, the pharynx, the lungs, and the
skin, but wherever it occurs it must be looked upon as the same disease.
As belonging to this type, we would enumerate the various cases
of softening or ramollissement of the tissues. "Drs. Klaatsch and
Hesse have attempted (and I think rightly) to prove that the gangrene
affecting the gums and soft parts surrounding the mouths of children
is to be attributed to a decomposition of these textures similar to that
which occurs in softening of the stomach, uterus and other organs
independent of and altogether unconnected with true gangrene. "J
I can see no reason except in the colour of the parts, why this soften-
ing should not be regarded as true gangrene. It is evidently a partial
or total decomposition of the tissues affected, similar in every other
respect to that which occurs in gangrene. There is, also, a form of
true gangrene of the external surface, which, from the pale appear-
ance of the skin and other parts involved, has been denominated
"white gangrene." A case of this kind has been narrated by Du-
puytren in the Revue Medicate, and occurred at the Hotel Dieu in
Paris. Mr. Mayo says in regard to the disease, "white gangrene is
an affection of the skin in which, without any assignable cause or
preliminary symptoms, patches of skin of the area of one, two or
three square inches suddenly die. It occurs sometimes on the breast.
In the Museum of King's College there is a model of white gangrene
in which the disease attacked the arm ; several patches of cutaneous
gangrene successively formed ; the sphacelated parts were white
from the commencement of the process to their separation, when
healing and healthy granulating sores were left."|| An interesting
case of this kind occurred in St. George's hospital in September, 1830,
and is detailed in the Med. Chir. Rev., April, 1836, p. 341.

* Med. Chir. Rev., Oct., 1837, p. 527.

t Vide Review Bouchut, Rilliet and Barthez, On Diseases of Children, Med.
Chir. Rev., July, 1845, p 102.

I Am. Journ. Med. Sci., No. xli. p. 205.

Am. Journ. Med. Sci., May, 1835, p. 228.

II Rev. of Mavo's "Outlines of Human Pathology."

1846.] Isopathia: or the Parallelism of Diseases, 669

Dr. Abercrombie has related a very interesting case of what he
calls black ramollissement of the liver" which his reviewer says,
44 is unquestionably not the result of any inflammatory action ; it is
more allied to gangrene.'' And a c^e of white softening of the
brain has lately been reported by Dr. Todd* in the Medico-Chir.
Transactions, " in which its analogy to senile gangrene is very dis-
tinctly shown."^ How far the author may be correct in attributing
tiie disease to an arrested flow of blood through the right carotid in
consequence of a dissecting aneurism of the aorta, I will leave others
to judge.

Gasiromalacia, or ramollissement of the stomach, is another form of
softening which we consider as belonging to this species. "There
are various degrees of this morbid process. In the first the mucous
membrane is found to break or tear across whenever we attempt to
raise it with the lingers or forceps. In the second the softening is so
much greater, that by merely scraping it lightly with the edge of the
scalpel, it is converted into a soft, opaque, creamy-looking pulp ; and
in the third extreme degree it is so loose and soft that a stream of
water is sufficient to detach it from its subjacent connections. In
this last stage portions of the mucous membranes are found on dis-
section partially or entirely destroyed, and the sub-mucous cellular
tissue is laid bare in irregular or round patches of different sizes. "f

Various causes have been assigned for this degenerescence. Dr.
Carswell says, "that it depends on the chemical action of the gastric
juice." This seems to have been the opinion of John Hunter, who
published a paper in the " Philosophical Transactions," on the "di-
gestion of the stomach after death." Dr. J. Gardiner believed it to
be owing to the action of "the fluids contained in the stomach and
intestines," but that it took place also "in consequence of a peculiar
disease of the canal whereby portions of it are rendered more easily
soluble by the action of the contents." A different view has been
taken of it by some of the best German and French anatomists.
Cruveilhier and Louis regards it as being "a peculiar diseased alter-
ation of the affected tissue" and the Med. Chir. Rev. has the follow-
ing passage : "That this morbid process takes place without pre-
ceding intlammation is admitted by all the best writers, but whether
it is always the effect of the solvent power of the intestinal juices, or
occasionally the result of an idiopathic and vital process is not defi-
nitely settled. Andral leans to the latter opinion, and thus confirms

* Rankings Abstract, vol. i. ]>. *20 4.

t This disease is considered, by Rustan and others, as a peculiar change not
of an inflammatory character. Dr. Abercrombie supposes that it may be some-
times the result of inflammation, and at other times consist in a change
hi', a- morUflcation iu///< other tissues, and arising from disease of the . I

n by Dr. Carswell. Vide M. Hall's Practice of Medicine,"
p. 121, and Kxamen desDocti vol. iv. p. 651 et seq. Olliver mentions

gangrenous eschars as being common in ramollissement of the spinal marrow,
[bid, vol. iv. ]). '

X Med, Chir. Rev., July, 1837, p. 216.

670 Isopathia : or the Parallelism of Diseases. [November?

the views of Cruveilhier and Guernsent, and of the German anato-
mists." What else can be this peculiar diseased action but a pro-
gressive transformation of the tissues, effected by the putrefactive
fermentation ?* *

The last disease which we will mention in this connection is the
anthrax or carbuncle. This is senile gangrene in another form, and
the only difference consists in (he circumstances in which the patient
is placed and his previous state of health. The chief feature of this
painful affection is the gangrenous state of the subjacent cellular
tissue. The malignant pustule is evidently the same thing, and is
brought on by the introduction into the system of animal matter in a
state of transformation or putrefactive fermentation. Hence, slaugh-
ter-men, tanners, fell-mongers, tallovv-melters, &c, are peculiarly
liable to the disease.

With regard to the nature and cause of malignant pustule, M.
Bourgeoisf remarks: "The disease is essentially of a gangrenous
and septic character, and is the result of direct absorption of an
animal poison into the system. This poison seems to be generated
in the bodies of most of our domestic animals, at least in those which
are herbivorous, as in the sheep, ox, horse and ass ; and is capable of
being transmitted by direct contact to mankind." He thinks, also,
that the poison may be conveyed from the sick animal to man by
insects, and that the hair or wool of an animal who has had the
disease, will retain the poisonous matter for a great length of time,
notwithstanding they had been washed. He says he saw a man
" who seemed to have caught the disease by handling the horse hair
:i out of an old sofa."

We come now to the subject of suppuration, and, in deference to
common usages, we will consider under tbe head of inflammatory
types, one species of disease attended with this result. We will con-
fine ourselves here, however, to a* mere notice of this diseased type,
reserving, for our succeeding division, some remarks upon the general
subject. We wish it, however, to be understood, that the explana-
tion which we may give of the mode of formation of pus and the
process of suppuration, is entirely applicable to the present case.

The types of this disease is phlegmonous inflammation or common
phlegmon. This inflammation is, for the most part, confined to the
cellular tissues, and has been, heretofore, regarded as the type of all
inflammatory diseases, but if our postulate be granted, that the form-

* We deem it unnecessary to investigate in detail the various groups of symp-
toms which may arise fi 'ibid process according to the organs affected,
and the functions disturbed in its course, as these may readily suggest them-
selves to the mind of the reader. Softening of the brain may show itself in
symptoms truly 'typhoidal, and be considered typhus, or it may put on another
form andbecoijiean apopteoyj of the spine, as tetanus or some form of paralysis ;
of the stomach, as an irritative fever, or gastritis, and dysentery, &c.

t Med. Chir. Rev., Oct., 1843, p. 485. See also an interesting paper on the
subject by Dr. Pennock, Amer. Journ. Med. Sci., for Nov., 1836, in which, he
,' bears "a striking analogy to dry mortification:1

1846.] Isopathia: or the Parallelism of Diseases. 671

ation of pus is a. specific termination of a disease whose tendency
from the begining was to such a result, it surely cannot belong to
either of the species above described. Andral,* I am aware, contro-
verts what he has called the dogma of Tommassini, " that a disease
commenced with one diathesis cannot change it during its course,"
and attempts to show " that inflammation, the essence of which is to
make the blood more consistent by increasing its fibrin, may bring
about, remotely, the liquefaction of the blood by the destruction of its
fibrin," and its conversion into pus.

This view of morbid transformations is unsupported by any analo*
gy in the transformations effected in different substances out of the
body. Diastase in contact with starch or dextrin produces an action
which transforms them into sugar and nothing else. The action of
synaptase upon amygdalin results in the production of peculiar pro-
ducts which are invariable. Yeast converts sugar into alcohol and
carbonic acid, and is limited to this result. Why then should we be-
lieve that a morbid agent in its action upon the blood first transforms
proteine into an excess of fibrin and then the fibrin into pus globules?

The pathognomonic symptoms of this disease are a fever of an
inflammatory character, if any; an increase of fibrin in the blood,
but moderate ; the exudation of blood plasma by which a sac is form-
ed, and the pus is confined ; the pus laudable, with no disposition
to cause ulcerations, or infect by contagion, and when discharged,
the abscess readily incarns.

The disease, I believe, to be of a constitutional character, and to
depend on, or, at least, to be intimately connected with, a transform-
ation of the fibrinous parts of the blood into pus. This is certainly
an elementary feature. If this be admitted, it seems to follow, as a
matter of course, that in whatever part of the body it may seat itself,
it should be regarded as essentially the same disease. In what can
an abscess, with the above characters, of the liver, for example, differ
from an abscess of the brain or lungs 1 To show, however, the great
disposition of systematic authors to multiply, unnecessarily, species
of disease, we need only refer to Dr. Good, who has made of suppu-
rative tumours no less than three genera, and sixteen distinct species;
besides the cases where suppuration takes place as a supposed result
of that inflammatory action, distinguished by the term empresma.

It is needless to enumerate the different seats and forms of phleg-
mon. The above characters will sufficiently distinguish it wherever
located. Suffice it to say, that it must never be confounded with the
gangrenous species of disease, to which it makes a near approach in
the furuncle or phyma, nor with those suppurative diseases induced
by a specific contagion, such as the bubo, nor with those extensive
depositions of purulent mattter which seem to be connected with a
scrofulous condition of the system, and form the most of the species
under the genus apostema of Dr. Good, of which we will treat in our
next general division.

(Tb V.'.)

Op. cit.f p. 90.

672 Glucosuria, or Diabetes Mellitus. [November,

Glucosuria, or Diabetes Mellitus. (From Dublin Medical Journal.)

M. Bouchardat conceives, that an enormous appetite, an insatiable
thirst, an extreme desire for saccharine and amylaceous aliment, the
suppression of perspiration, and the passing of a large quantity of
urine containing glucose, are among the most established phenomena
of the disease we are considering. His own researches lead him to
believe that, first, the thirst is proportionate to the quantity of sac-
charine or amylaceous food taken ; and secondly, that the proportion
of glucose contained in the urine bears a constant relation to the
saccharine or feculent matter contained in the food. These relations
we find very distinctly exhibited in severe cases, but they are less
evident where feculent substances form but a small proportion of the
food; and when a patient has for some time been kept from using
substances capable of forming sugar, the system seems to lose the
habit of converting starch into glucose, and the urine may remain
normal for some time after amylaceous diet is resumed, but matters
eventually go on as before, and then the rule will be found to apply.

It seems rational to suppose, a priori, that the elements of sugar
being denied to the patient, no sugar can be found in the urine. M.
Bouchardat has endeavoured to ascertain whether sugar can be
formed from proteinaceous substances ; but all his experiments have
been contradictory to the idea, that at the temperature of the human
body, such a transformation can be effected ; and the instances of
patients kept exclusively on animal food continuing to pass glucose
in their urine, he prefers explaining by the supposition, that the
vigilance of the physician had been evaded, and bread, or something
of the kind, really made use of.

The blood in glucosuria has been said to contain glucose by Rollo,
Ambrosiani, Maitland, MacGregor, Guibourt, Christison, and Kane;
whilst that it ever does so has been most roundly denied by Nicholas
and Gueudeville, Vanquelin and Segalas, Soubeiran and Henry,
D'Arcet, Wollaston, Marcet, and many others. M. Bouchardat's
experiments enable us to reconcile these glaring contradictions. He
finds that the presence or absence of glucose depends very much on
the time at which venesection has been performed. The blood drawn
in the morning contains little or none, all the glucose formed during
the digestion of the last meal having been eliminated in the urine
during the night. There is another very fruitful source of error in
the pathology of the blood. If the blood drawn be not examined
immediately, the glucose it contains, is rapidly converted into lactic
acid, and the whole of the sugar may have disappeared from this
cause, a fact which was amply verified by many experiments.

Alkalinity of the Blood. M. Mialhe maintains that the alkalinity
of the blood is diminished, or even altogether disappears, in glucosuria.
But M. Bouchardat is of a contrary opinion, although he admits that
it rapidly loses it alkalinity after being drawn from a vein.

Composition of the Blood. Nicholas and Gueudeville, Soubeiran

1846.] Glucosuria, or Diabetes Mellitus. 673

and Henry, jun., found the blood of diabetic patients somewhat altered
in diabetes ; and their observations were confirmed by those of Le
Canu, and the former researches of Bouchardat ; the latter observa-
tions, however, of the last-mentioned chemist, lead him to doubt the
constancy of this change.

Contents of the Stomach in Glucosuria. M. Bouchardat availing
himself of some cases in which it had been thought judicious to ad-
minister an emetic of ipecacuanha, before commencing the regular
treatment, has been enabled to study the nature of the contents of the
stomach in diabetes mellitus. The fluid thus procured did not in any
instance convert into glucose any of the compounds of proteine, whilst
it acted powerfully on starch, even in the crude state, and by a very
simple process a substance was obtained from it, in every respect
identical with diastase a principle which neither M. Bouchardat nor
M. Blondlot, in numerous experiments made to determine the point,
have in any instance found to form a constituent of the gastric juice
of a healthy animal. In this last assertion, however, M. Bouchardat
seems to be in error, since it was found by Bernard and Bareswil*
that gastric juice, when rendered alkaline by a little carbonate of soda
loses the property of dissolving flesh, but becomes as active as either
saliva or pancreatic juice in the conversion of starch into glucose;
whilst, on the other hand, the pancreatic and salivary fluids undergo
a similar conversion into gastric juice by the addition of a little acid.

Patients affected with glucosuria either die gradually of exhaustion,
tubercles being developed previous to the fatal termination, or they
are suddenly cut off without any symptoms leading to an apprehen-
sion of such an issue. In cases arranged under the first category, no
trace of sugar can be found in any of the animal fluids, or in any part
of the body, after death. The same remarkable fact is observable in
the other class, where the patients have been struck down suddenly.
We have only room for one illustration. A young man from the
country, about twenty years of age, and of very limited intelligence,
had been affected with glucosuria for a very long time, and was
notorious in his native place for the voracity with which he devoured
enormous quantities of flesh, raw vegetables stolen from the fields and
swallowed undressed, &c, &c. During the first twenty-four hours
that he was in the Hotel Dieu, he swallowed a pound and three-quarters
of bread, more than ten ounces of boiled beef, an equal quantity of
potatoes, nearly a pint of wine, a pint and a third of broth, and nearly
nine pints of tisane. During the same period he passed eleven pints
of urine, containing 22954 grains of glucose, being the largest pro-
portion ever met with by M. Bouchardat, in his very extensive re-
searches on this subject. The following day the patient stole some
bread, and, going into a cold damp place, to get an opportunity of
eating it, he caught cold, and died, in eight hours, of pleuro-pncumo-
nia. The stomach, of enormous size, was found full of an acid pap,
in which portions of bread were visible; but the most careful ex a mi.

* Comples Rendus, t. xxi. p. 88.

43

674 Glucosuria, or Diabetes MeUitus. [November,

nation could not detect in it any trace of glucose, nor could that
substance be discovered in the blood or the other fluids. M.
Bouchardat infers from such cases that since the pouring out of the
gastric juice has been found to depend on the state of health of the
individual, they afford additional proof that the formation of glucose
in diabetes is referrible chiefly or solely to the diastase contained in
the gastric juice.

Of the Nature of Diabetes. The last article of our summary of
digestion really contains M. Bouchardat's views of the nature of
glucosuria. Diastase is secreted by the stomach abnormally, or, at
least, in abnormal quantity; this reacts on the starch of the food,
converting it into glucose; and a quantity of water equal to eight
times the weight of the starch being necessary for the purpose of ef-
fecting this chemical change, this explains the insatiable thirst (so far
as two facts without apparent connexion can explain the reason of
their conjuncture). The glucose thus formed, being absorbed by the
intestinal and gastric veins, passes to the liver, but is in too large
quantity to be all thrown off in the bile ; it, therefore, enters the cir-
culation, and is got rid of by the kidneys. M. Bouchardat supposes
that the lower temperature of the bodies of glucosuric patients, re-
sulting probably from the large quantities of cold water drunk, and
the loss of caloric in converting the starch into sugar, may also pre-
vent the destruction of glucose from being effected in the blood. He
looks on the sudden suppression of perspiration as one of the most
frequent causes of the affection, and seems evidently disposed to re-
gard a too amylaceous diet as another predisposing cause ; whilst he
suggests to pathologists to inquire whether affections of the pancreas
have any connexion with it.

The illustrative experiments are, many of them, very interesting;
but we have not room for them. Attempts were made to remove the
pancreas, but the animals always died of the operation. In one case
glucose appeared in the urine after ligature of the pancreatic duct,
but on dissection, it was found that communication of the pancreas
with the intestine had been re-established by ulceration. In the
urine of animals fed exclusively on malt (which we know abounds in
diastase), glucose occasionally, but by no means invariably, was found
in very minute quantity in the urine. Great thirst or a ravenous
appetite was, however, in no case thus produced. Even fully admit-
ting the correctness of the theory, this is what should be expected,
since it is quite impossible, though the fact is denied by homoeopaths,
to produce, artificially, all the conditions to be met with in disease.
We have heard it stated that Dr. Golding Bird had found glucose in
the urine of many perfectly healthy persons in London ; and that
saccharine urine is endemic in particular parts of the country. This
circumstance, if our information be correct, i3 deserving of careful
examination. We know that in London, at least, malt liquors are
used more freely than probably in any other part of the world; and
if any connexion between such habits and the production of glucose

1840.] Glucosuria, or Diabetes MelliUis. 675

in the urine could be satisfactorily made out, it would go farther to
establish the theory of M. Bouchardat, than all his ingenious, though
cruel, experiments on animals.

In the previous part of this paper we have made no allusion to what
takes place after the fluid aliment is mixed with the circulating fluid,
because, as yet, we have no means of following it thither, and all that
has been advanced on the subject is mere theory and guess work.
Liebig, indeed, has made a most able attempt to cut this Gordion
knot, but it has proved too much even for his bold genius. Though
many and imbelJe telum has been hurled at this system, there can be
no doubt that on a great number of points it is discordant with the
facts which pathology, physiology, and experience bring to our know-
ledge, and its very foundations have been sapped by the discovery by
Redtenbacher of sulphur in taurine ; by Boothe and Boye that uric
acid is not changed into hippuric acid by the ingestion of benzoic
acid ; by Mailhe that glucose is not eager to combine with oxygen,
but that, by the action of an alkali on it, it acquires the property of
reducing certain metallic oxides, even when the access of air, or of
any source of oxygen, is most carefully excluded,* and by very many
of the facts laid before the reader in the commencement of this pa-
per. It really requires as much philosophy to believe that the many
pounds of potatoes swallowed by the countrymen in the course of a
day, find their full nutritive equivalent in the thimble-full of nitrogen-
ized elements which forms but an infinitesimal part of his apparent
food, as it does to adopt and follow out the doctrines of Bishop Berke-
ley. Knowing, as we do, that both water, and carbonic acid, and
urea, and many other salts, are formed in the body, and having a
still longer list of real chemical compounds which are decomposed
in the system, it seems very much in contradiction to those notions
of design and uniformity which we leam'from all that we see around
us, to suppose that of the mere mechanical mixture of oxygen and
nitrogen, which it is the business of our lives to introduce into our
lungs, the minor element alone is of any use; and that the immense
quantities of starch swallowed in our food, although an elaborate
glandular apparatus and complex organs are provided to render it
capable of absorption, after which we can trace its progress into tho
blood itself, is, notwithstanding:, intended merely to be burned off to
supply us with heat. If carbon and hydrogen, and the organic acids,
not to speak of the great acidifier itself) form fresh compounds in the
body, we have not yet seen any valid argument to show why the
same privilege may not be extended, as believed by Dr. Prout, to
nitrogen ; the latter view is supported by many powerful analogies.
We certainly do believe that starch contributes to nutrition ; and the
views of digestion that we have been employed in illustrating strong-
ly support that opinion. Animals, indeed, have been found to die
when fed exclusively upon starch ; but it was found equally impossi-

+ Gazette Medicale, No. xviii., p. 311; and Comptcs llcndus do l'Acadomie

676 Glucosuria, or Diabetes Mellitus. [November,

ble to prolong life on a diet of fibrine. Nay, it has been shewn by
M. Magendie's experiments, that even any artificial combination of
gluten, albumen, fibrine, gelatine, &c, united in the proportions to
form flesh or any other natural substance, was equally incapable of
ministering to nutrition when used exclusively. Chemists in pro-
posing their theories but too often forget that the animal body is
something more than a moving laboratory ; many of the phenomena
of life may indeed be generalized by assimilating them to chemical
processes, but they are still too many gaps to be filled up, to permit
us to regard them as identical. Thus, although we feel convinced
that the views of digestion developed in this paper are in general cor-
rect, so far as they go, yet we are very far from regarding the pro-
cesses they are meant to explain as purely chemical, nor do we think
that any ulterior investigations will make us to understand why it is
that we can digest some substances (as, for instance, fruit) at peculiar
times of the day, and not at others ; why, fish of which an individual
is very fond, and which he digests perfectly well, will yet bring out
over his whole body an eruption of urticaria in ten or fifteen minutes
after being swallowed ; why a patient may be cured of dyspepsia by
a diet of turnips, which we knew to be the case in one instance ; why
the smallest portion of albumen, carefully concealed, may give rise to
the most alarming sickness, as occurred in a patient of Dr. Graves',
&c. Again, in diabetes insipidus, what chemical theory will ex-
plain the facts? In hysteria, what chemical processes require the
large amount of water which in such cases we often see passed ?
And, again, in diabetes insipidus, what explanation does chemistry
afford? A patient of Dr. Benson's is at present passing urine of the
specific gravity of 1.002, and without a trace of glucose or albumen,
yet eighteen pints are voided daily. Need we refer to albuminuria,
&c. ? In fact, the cases beyond the reach of a chemical solution are
far more numerous than those to which such explanation applies.
Different animals seem fitted to digest very different substances ; we
also find taste and mental impression have a powerful influence on
the digestive process, and we very much, doubt whether the most nutri-
tive compound swallowed with disgust, would not utterly fail of being
properly assimilated. We are confident, therefore, that although
every intelligent mind must admit that chemical research has been
of the most invaluable service to pathology and therapeutics, we must
still say of most chemical theories of organic processes, as was said
by Cuvier,* of a similar attempt to explain the phenomena of organi-
zation by analogies drawn from the inorganic kingdom, half a
century ago, " Quelques vraisemblance que puisse avoir le principe
en general, et quelque esprit que ces auteurs aient mis dans son
emploi nous avons trop vu ci-devant combien la chirnie des corps
organizes est encore peu avancee, pour que nous puissions en esperer
une application detaillee." Without knowing all, we may, however,

* Memoires de l'lnstitut. Rapport Historique sur les Progres des Sciences
Naturelles, 1810.

1846.] Glucosuria, or Diabetes Mellilus. 677

know something of what takes place within us : we may sketch out
some of the leading facts, without pretending to fill up all the de-
tails; and this is what has been done by M. Bouchardat in applying
to the treatment of diabetes, some of the knowledge which he had
acquired respecting the changes which accompany rather than con-
stitute digestion.

Treatment of Glucosuria. Most of our readers are probably aware
that, for many years past, M. Bouchardat has been engaged in the
most careful and continued study of the phenomena and treatment
of diabetes. The knowledge of his being thus occupied has caused
him to be consulted, in numerous cases of the kind, by country prac-
titioners ; and the vast hospital (Hotel Dieu, at Paris) to which he is
attached as pharmacien en chef, has furnished him with the means
of pursuing his researches on a very extended scale. For this task,
the extent of his knowledge of chemistry, physiology, pharmacy, and
practical medicine, render him qualified in an unusual degree, and
an examination of his work will prove that he has not belied our ex-
pectations. His observations are singularly free from that exclusive-
ness, to which the mere chemist or physiologist is so liable, and the
whole of his suggestions have a practical and common sense charac-
ter, which bespeaks less of theory than of actual induction from
facts. Forty-two cases of well-marked glucosuria are detailed at the
end of the essay, and are well worth a careful perusal : but we can
only state that of these, eleven terminated fatally, most of them from
advanced phthisis, some from misery, others from intercurrent affec-
tions; fourteen others, having followed the regime recommended,
with more or less strictness, experienced decided benefit ; and the
remainder, sixteen in number, were perfectly cured. The first ele-
ment and basis of M. Bouchardat's treatment of glucosuria is, the
exclusion from the diet of all substances capable of conversion into
glucose. At first, in all the enthusiasm of a discoverer, he thought
that this alone was sufficient, but he soon found that the means of
cure are by no means so simple, and that they really embrace atten-
tion to a great number of minute particulars, the influence of which
requires to be united, and carefully continued for a considerable
length of time, in order to produce the desired effect.

Diet. All farinaceous substances and their compounds, or those
into the preparation of which starch in any way enters, must be
most strictly prohibited. In enforcing this prohibition the greatest
address is required, as the longing of the patient for such articles is
very great; and it is above all things essential to successful treat-
ment, that disgust for food, and consequent anorexia, should, if possi-
ble, be avoided. To satisfy the cravings for feculent substances,
M. Bouchardat has invented a kiud of bread, containing nothing that
is convertible in the stomach into glucose. The mode oC preparing
this gluten bread is given below,* and of its value in the treatment of

* (ilvitn Bread. Th
40 parts of water and [(0 oi

678 Glucosuria, or Diabetes Mellilus. [November,

diabetes we have ourselves seen several very striking proofs in the
practice of medical friends.

Animal food of all kinds, as well as eggs, milk, butter, nnd cheese,
may be freely used, subject to the usual restrictions as to digestibili-
ty, &c.

The following vegetables are also proper to form a part of the diet
of a diabetic patient : spinage, endive, lettuce, sorrell, asparagus,
hqficots verts, cabbage of all kinds ; the last may be very usefully
combined with fat pork or salt bacon. Cresses of every kind, dress-
ed" with a large proportion of oil and hard boiled eggs.

A very agreeable and useful dish may also be prepared from fresh
gluten, carefully deprived of starch, and combined with butter, and
some kind of cheese grated.

The desert may be composed of olives, almonds, filberts, and wal-
nuts. The following may also be allowed from time to time, but
always in very moderate quantity, viz., apples, pears, cherries, cur-
rants, gooseberries, strawberries, raisins, and pine-apples.

Drinks. Great importance in the treatment is assigned by M.
Bouchardat to a proper selection of alimentary drinks. Theoreti-
cally, he regards spirituous liquors as belonging to the same category
as oil and fecula, viz., ministers to respiration ; and, by a judicious
combination of the two extremes, oil, which burns away slowly, and
alcohol, which is rapidly consumed, to obtain the effect of the inter-
mediate substance, fecula. Experience proved that stimulants in
moderate quantities are useful ; but that they require much discrim-
ination and very careful management. The red French wines, such
as those of Bourgogne and Bordeaux, which have a certain degree
of astringency, he has found to answer best; and of these he admin-
isters about a pint in the twenty-four hours. It is sometimes neces-
sary, but under peculiar circumstances, to increase the allowance of
wine to three or four times this amount ; but the least approach of
inebriation is always injurious. A patient of our friend, Dr. Hunt,
who has been remarkably relieved by M. Bouchardat's mode of
treatment, and who is still under Dr. Hunt's care, is invariably ren-

bread, and then laid aside for about half an hour in summer, or an hour in win-
ter, in order to allow time for the water to combine with the flour. The dough
thus prepared is laid on a fine metal sieve, on which several fine streams of wa-
ter are playing from a vessel suspended above, and being thoroughly worked
with the hand, as in baking, until the water flows off uncolored, the starch may
be collected in the washings, and gluten to the amount of about one-fourth the
weight of the flour employed will remain on the sieve, though of course the
quantity varies with the nature of the flour. The gluten to be made into bread
must be fresh prepared, as it begins to alter in a few hours. It is mixed with
one-fifth its weight of the finest flour, and kneaded for a very long time with the
proper proportions of salt and leaven, by which a very light and elastic bread,
without odour, and very agreeable, is readily formed.

Gluten bread is highly nutritious, and, in addition to its use in the treatment
of diabetes, has been found of the greatest value in those cases of dyspepsia,
gastralgia, or whatever else they may be called, in which the simplest aliment
is found to sour upon the stomach, giving rise to acid eructations, pain, and
epigastric constriction.

1S46.J Glucosuria, or Diabetes MellUus. 679

dered worse by even a single glass of wine ; and the same circum-
stance was observable in another case that we had under observation
for some weeks.

Beer and all the saccharine liquors have been found injurious, as
might be supposed ; and, if used at all, should be taken very sparing-
ly indeed.

Coffee is useful to almost all diabetic patients, and should be taken
without sugar, or the quantity of the latter ingredient must be very-
small indeed.

Lemonade, and the other cooling drinks, give but temporary re-
lief to the thirst, are, in this respect, no better than pure water, and
are decidedly injurious.

Clothing ranks next to diet among the means of curing glucosuria.
The whole body must be protected from sudden chills, and the insen-
sible perspiration must be encouraged by being clothed in flannel.

Exercise, carefully regulated, and progressive, so as to avoid too
great fatigue, and of such a kind gymnastic exercises or manual
labour, for instance as is accompanied with pleasure, will, in all
cases, be found of very great service in promoting the cure.

Baths have not been found by M. Bouchardat of much general
utility. Tepid baths are occasionally useful, when there is no dan-
ger of the patient catching cold; and swimming baths, especially in
the sea, when they can be borne at all, are often attended with the
most rapid and beneficial results.

Medical Treatment in glucosuria, though useful and never to
be neglected, can only be considered as subsidiary to the other means
employed.

Carbonate of Ammonia, ~S1. Bouchardat has found of very great
utility ; but its use should always be united with the constant wear-
ing of very warm clothing, or the medicine passes off by the kidneys,
and gives rise to an alkaline state of the urine. It is exhibited in the
following combination : Carbonate of ammonia, 77 English grains ;
rhum, 310; water, 1550. One-third to be taken half an hour be-
fore each meal. Or it may be prescribed in the form of a bolus,
each containing eight grains of the carbonate, with an equal quanti-
ty oftheriaque; from two to ten to betaken each night on going to
bed. M. Bouchardat was unable to determine whether, in glucosuria,
the ammonia acts as a stimulant or a diuretic, or what is the mode
of its action ; but of its efficacy in the treatment of rebellious cases
he has fully satisfied himself.

Vichy water has, in some cases treated by MM. Jadioux and Bou-
chardat, been found of very decided efficacy. The alkaline bicarbo-
nates generally, and especially that of soda, have been very highly
recommended by MM. Contour and Mialhe. The latter gentleman,
indeed, places bis chief reliance on alkalies given in some form ; and
he has brought before the Academy, at different times, cases of glu-
cosuria successfully treated by thai means almosl M. Mialhe
is, however, so v< i chemical notions, \( we may

680 Glucosuria, or Diabetes Mellilus. [November,

judge from the work that he has published, that we fear his medical
observations must be very much modified by his chemical enthusi-
asm ; and. that his notions of what ought to take place will as often
happens with greatest men and the most would-be impartial observ-
ers, make him very blind to the real facts, and most ready to adopt
as proofs what are really very far from being such. Besides being
found by M. Bouchardat (whose extensive experience in diabetes
renders every observation of his on this subject of very great weight)
very much inferior in therapeutic efficacy to the carbonate of ammo-
nia, MM. Honore and Gueneau de Mussy have found it in some cases
actually injurious.

Dovers Powder and Opiates. Every practitioner has experienced
the benefit of these medicines in some cases, as palliatives, though
many regard them as capable alone of affecting a cure. M. Bou-
chardat employs them only as diaphoretics. Morphia, or pure opium,
he never prescribes in diabetes, lest the stomach should be put out
of order ; but Dover's powder, in doses of ten or twelve grains at bed-
time, he has found most efficacious ; though, of all the opiates, he
regards the theraica (divina) as that from which by far the most
favorable results have been obtained. He gives this preparation, the
absurd complexity of which be does not pretend to be able to reform,
in doses of from half a drachm to a drachm every evening. The
last-mentioned quantity contains about one grain of crude opium.

Chalybeate and Tonic Remedies. When the pallor and other
symptoms give the case a great similarity to chlorosis, the tonic bit-
ters, alone or combined with iron, will be found of much therapeutic
value. The preparation of iron most valued by M. Bouchardat, viz.,
the pulverized iron, or the metal reduced by hydrogen, has been but
recently introduced into this country ; but if the price could be ren-
dered more moderate, we have no doubt that it would speedily be-
come a general favorite with physicians.

Common salt was formerly regarded by M. Bouchardat as a useful
remedy from the diminution of thirst which diabetic patients experi-
ence after partaking of salt meats; but although, under such circum-
stances, the quantity of glucose passed also diminishes no permanent
or decisive benefit has been obtained from the employment of this
means of treatment.

Evacuants. M. Bouchardat commences his treatment by the ad-
ministration of an ipecacuanha emetic, followed by a purgative to free
the bowels of any thing injurious that maybe detained there; but he
finds evacuant medicines, though so highly recommended by authors,
of no real use afterwards, except to combat particular symptoms.

In speaking of digestion, we mentioned that certain substances
have been found at once to put a stop to the action of diastase, and
it is curious that these are chiefly the very medicines which have
been most highly vaunted, by the older authors, as the proper remedies
for diabetes. They have all, however, been found of little or no real
value, except where, being unable to submit the patient to any regular

1846.] Glucosuria, or Diabetes Mellitus. 681

treatment, we seek only to procure a temporary relief; the remedies
of this class are lime water, calcined magnesia, alkales, nitric, phos-
phoric, and sulphuric acids, alum, tannin, and the other astringents;
and some of the writers, by whom they have been found successful,
we have mentioned in the notes at the bottom of the page.*

Bleeding is the last therapeutic means we have to consider. Gen-
eral bleedings have been recommended by a long list of writers, from
Aetius downwards; but M. Bouchardat has found them, as indeed
might have been expected, invariably injurious. Abstraction of
blood, by leeches and cupping, from the epigastrium, as recommend-
ed by Sir H. Marsh,-)- Bardslcy, Forbes, <Scc., from the loins, as
advised by others, and from the anus, when the appearance of the
disease has coincided with the suppression of haemorrhoids, has been
occasionally had recourse to by Bouchardat, and often with benefit.

In concluding our abstract of the researches on the theory and
treatment of saccharine diabetes, we would repeat the caution so
often given by M. Bourchardat, that the practitioner is to place his
chief reliance on the dietetic and hygienic means advised ; and that
it is from a combination of favouring circumstances, and not from
any one single means that any decided benefit is to be obtained.
For ourselves, having had several opportunities of seeing patients
treated successfully on the above rules, both by M. Bouchardat him-
self, and by other practitioners, we feel convinced that whatever may
be the truth of the theory, the practice is, in very many cases, the
best that can be pursued.

* Calcined Magnesia, by Trailer (New England Journal of Med. and Surg.,
1824,) and Hufeland (Journal, 1833). Lime Water, by Willis (Works). Zorn
{Sobernheim ArzaneimitteU, 1836). and Schutz {AUg. Med. Ann., 1801). The Am-
moniacal Salts, by Hufeland {Enchirdium Med., It'SG). Peter Frank {De Cvr-
andis Hominum Mortis)] Diirr Hufel Jov.ni., 1833); and Newmann, who,bv-the-
by, entertains the curious and very original notion that the testicles are supple-
mental to the kidneys, and that the main indication in diabetes is to excite the
procreative powers {Spec. Path. u. Ther., t. 2, Chrtm. Rrankenh., 1832); Alum,
by Mead {Opera Omnia, &c), Brocklesby, (Med. Obs. of Soc.of Phvsicians of
London); Meyers {Diss. Lunar, de Diabetide, Ed. 1709); and Herz (Sctte, Neve
Beitracge, &c., t. i.) We have both ourselves prescribed alum with most deci-
ded benefit, and, when residing in Jems-street Hospital, we remember to have
seen two very remarkable cures effected by Dr. Hunt with that remedy. In all
instances, however, cupping to the loins" was also simultaneously employed.
Kino has been found efficacious by Meyer Abrahamson (Meckel, Neves. Arch,
dcrpr. Am., 1781;), andShee (Schmidt, Recepte). Tannin, by Giadorow (Annali.
Univ. di Med., 183-2). Creasote,by Hufeland {Enchiridian)] Corneliana (E
rienze, &c., del Creosote, Pavia, 1835); Elliotson (Lond. Med. Gaz., 1835, and
Medico-Chirurg. Trans., vol. xi.v.) ; and Berndt (Lancet, July. 1835). Carbon-
ate of Soda, by Hufeland. Sulphuret of Lime. byHai I". Carsh*
rue, 1833). Phosphate of Soda, by Sharkey (Tr. K. and O. College of Physiri
in Ireland, 1824). Sulphuric acid, by Fraser (Ed. a'l. 180G.)
Nitric acid, byBrera (Bibl. Ital. t. vi. 1817); Gilby A I 902), &c.
&c. In short, like all inveterate maladi _rot well under every
treatment, and consequently, as in hydrophobia, the as nu-
merous as the cases treated.

t Dublin Hospital l! . in.

X Cyclopaedia of Practical Medicine.

682 Ipecacuanha, in Emetic Doses. [November,

Ipecacuanha, in emetic doses ; as a powerful restorative in some ca-
ses of exhaustion and sinking.* By John Higginbottchi, F. R.
C. S., Nottingham. (From Prov. Med. & Surg. Joum.)

In the year 1814, I was first led to see the extraordinary beneficial
effects of ipecacuanha as an emetic, in a female 40 years of age,
who was in a sinking state, in the last stage of cholera; her coun-
tenance was shrunk, extremities cold, cramp in the legs, and other
symptoms of approaching dissolution. I had previously attended
two similar cases, where I had given opium, brandy, and medicinal
cordials, and both patients died. I was induced, in this instance, to
give a scruple of ipecacuanha, from having frequently seen the gootf
effects of it in the early stage of the disease. After the lapse of
two or three hours, I again visited my patient, fearing I should
find her dead, but, to my great pleasure and surprise, so great a
change for the better had taken place as to appear almost incredible;
the whole of her body was of a natural warmth, the dangerous
symptoms had disappeared, and she made no complaint, except that
she was very weak. She had no further unfavourable symptom of
the disease, and was soon convalescent.

My confidence in the ipecacuanha, as a remedy in such cases, has
now been confirmed during the practice of thirty years ; the purging,
vomiting, and cramp, often entirely cease after the emetic operation
of the ipecacuanha, but I have thought it proper to give, in about
two or three hours after the emetic, a pill with a grain of opium and
five grains of the blue pill, to allay an)' remaining irritation of the
stomach and intestines, and an aperient with one scruple of rhubarb
and two of the sulphate of potash, to assist the natural action of the
bowels, and a simple saline effervescing draught every two or three
hours afterwards; weak tea, well boiled gruel, milk, with sago or
arrow-root, as nutriment and diluents.

Uterine Haemorrhage. The next case which attracted my par-
ticular observation, was the utility of ipecacuanha in severe uterine
haemorrhage. I attended the patient three times in labour, in the
years 1821, 1823, and 1826, and each time with most severe flood-
ing immediately after the separation of the placenta. I employed
the usual remedies, such as the sudden application of cold water to
the abdomen, pressure to cause Contraction of the uterus, with the
administration of opiates, wine, and brandy, which were at that time
common remedies. These were cases of great anxiety, and I had
to remain with my patient several hours before it was safe to leave
her.

In her third confinement, I was afraid she would die. After having
used all my remedies, and having given her half-a-pint of brandy and
a pint of Port-wine, which was of no avail, it occurred to me, that in
the former cases in which I had attended her, when I had used the
same means to check the haemorrhage, there was no amendment

* Read before the Nottingham Medico-Chirurgical Society, May 23, 18-15.

1840.] Ipecacuanha, in Emetic Doses. 663

until she had ejected the contents of the stomach. I was, then, most
anxious that vomiting should take place, in hope of relief, as she was
rapidly sinking. I thought that as vomiting had been so beneficial
to her before, I was in this case justified in producing it by giving
an emetic. I directly gave her half a drachm of ipecacuanha ; a full
vomiting soon succeeded, and a large quantity of fluid was ejected.
I was much struck with an expression of my patient, which I. had
several times heard before in similar cases after vomiting. After a
deep sigh, she said, " Oh ! lam better; I am better now. " The
haemorrhage ceased directly, and did not return ; the symptoms of
sinking abated, and the patient appeared in her natural state of body,
but very feeble. A little plain gruel was all the nutriment given
her, and she recovered gradually from her weak state. I attended
the same patient three times afterwards, in the years 1827, 1829,
and 1831, and what is very satisfactory in favour of the secale cor-
nutum, which was about that time becoming more used in this local-
ity, I gave, in every case, half a drachm of the powder before the
birth of the child, a similar close after the birth, before the separation
of the placenta. This remedy had the desired effect of preventing
the haemorrhage, so that I had no further need of the ipecacuanha, or
indeed, of any other remedy.

Several years ago, I had a patient, on whom the secale cornutum
had no effect in preventing the haemorrhage, and I gave the ipecac-
uanha with a favorable result.

For nearly twenty years, I have lost all confidence in the diffusible
stimulants, such as wine, brandy, &c, in uterine haemorrhage, from
a conviction that they increase the arterial circulation, and, conse-
quently the haemorrhage, and I find that opinion corroborated by the
writings of Drs. Clutterbuck and Ramsbotham.

The utility ofipecacuhana in uterine haemorrhage has been proved
by Dr. Osburn, of Dublin, but I am not aware that he has recom-
mended it in extreme cases of exhaustion or sinking.

Bronchitis. I have found an emetic dose of ipecacuanha a very
valuable remedy at that stage of bronchitis where a sudden, low, or
sinking state has come on with oppression at the chesty and the
expectoration difficult, endangering suffocation. Vomiting with
ipecacuanha 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 never have
seen the same good effects in such circumstances produced by any
other remedy. The two following cases are of that description :

Mr. D , aged GO, an innkeeper, of a gross habit, but not con-
sidered intemperature, 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 expecto-
ration. A sudden state of sinking came on, with increased dyspnera,
and a feeble quick pulse. I gave half a drachm of ipecacuanha in a

684 Ipecacuanha, in Emetic Doses. [November,

little water ; he vomited at different times for two hours ; the lovv-
ness and dangerous symptoms were much relieved ; he had no relapse
of the low or sinking state, and he gradually recovered under a com-
mon 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. 1 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 a half-
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," p. 492,
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 the 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 week or two."

Case of Suspended Animation. I was called about 10, P. M., to

visit Miss S , aged 18. The messenger, her sister, informed me

that she was afraid she was dying. I saw her in about ten minutes ;
my first impression was that she had taken poison, until assured of
the contrary by her mother. She appeared in a state of asphyxia.
Her extremities were cold, face livid and swollen, or the appearance
of being puffed up; no pulsation at all perceptible in either wrist;
her mouth was open, and her lower jaw fallen ; indeed, she appeared
to be dead. I ordered her feet and legs to be fomented directly with
hot water by means of flannel, and a hot oven-shelf, inclosed in flan-
nel, to be placed under the legs. I poured down her throat half a
drachm of ipecacuanha in water, for she was incapable of swallow-
ing, then I rubbed very freely the whole length of the spine with
the acetum cantharidis. The emetic not operating in a few minutes,
I gave another half-drachm of ipecacuanha, and shortly after there
was a convulsive motion of the diaphragm, followed by vomiting
she ejected some very thick, slimy mucus. On still rubbing the blis-
tering vinegar along the spine, she gave signs of uneasiness in her
countenance, and expressed her pain by saying "O?" I remained
with her until after midnight. Before I left her, she had become
generally warm throughout her body, and could speak in a very low
voice, but there was no pulsation in either wrist. I prescribed a
mixture with aromatic confection and camphor mixture, to be given

1846.] Ipecacuanha, in Emetic Doses. 695

every hour, and a little gruel, or other light nourishment, occasionally.
I left particular directions to send for me if she had any unfavorable
change. The following morning she was quite recovered, but very
feeble ; she had no recollection of her illness, and could give no ac-
count of the cause. She had been sewing during the evening, sitting
with her back to the fire, and had only a potatoe for supper, and on
going out of doors into the yard, she became suddenly chill and faint,
complained of pain between her shoulders, and felt very ill indeed.
She then went to bed and became sick, and vomited a little watery
fluid, and said she was going to die. A sudden swelling of the face
came on, succeeded by a convulsive motion and stretching of the
whole body ; then followed the state in which I found her. No fur-
ther medical treatment was required but an occasional aperient ; the
swelling of the face was several days in subsiding.

Sinking during the 'puerperal state. Mrs. B , aged 23 years,

very delicate, and pale complexion, I attended in her first labour on
the 12th of March last, which was very protracted and severe, and
being attacked with puerperal convulsions, I had to take about twen-
ty ounces of blood from the arm, and found it necessary to perform
embryotomy. She was exceedingly low afterwards, but gradually
recovered for about eight or nine days, requiring no other-medical
treatment than mild aperients and injections. About the ninth day
she complained of severe pains in the course of the colon, particular-
ly at the caput coli and the sigmoid flexure. Mustard plasters were
applied, and active purgatives, with benefit, but a continued vomiting
came on, attended with considerable lowness. Dr. Hutchinson was
called in to visit her with me. Injections of half a pint of beef-broth
with half an ounce of spirit of turpentine were administered every
four hours ; a common blister of cantharides was applied to the scro-
bicules cordis ; plain gruel or other light nutriment was given, as
most likely to remain on the stomach. The vomiting still continued ;
the turpentine injections occasioned much pain after they were ad-
ministered, and there was a very alarming increase of the exhaustion
and sinking.

In this case it occurred to me that an emetic dose of ipecacuanha
was the most probable remedy to rally the sinking powers, and with
the concurrence of Dr. Hutchinson, I gave half a drachm, and re-
mained with her during its operation. A fuller vomiting was pro-
duced than 1 could have expected, although it was small in quantity,
yet it occurred to me that the natural eifort had long been exerted in
vain to accomplish what the ipecacuanha directly affected that of
completely emptying the stomach. I remained with my patient an
hour, and left her somewhat better. After I had gone she turned
herself on her left side, and remained so still for several hours as to
alarm her husband, who sent for me directly, fearing she was dying.
I found her pulse much improved ; she was still lying on the left side ;
the sickness had abated. A little plain gruel was given, and a half-
pint injection, with equal parts of milk and gruel, was administered

686 Hooping Cough. [November,

every four hours. A slight vomiting came on after this time, but did
not continue ; her appetite improved so much that there was a diffi-
culty in restraining her from taking improper food, such as beef-
steak, &c. Her stomach was disordered twice during her recovery
from this cause, so as to require two emetics of ipecacuanha, which
were given with advantage. The patient fully recovered, and is now
in her usual health.

I was impressed in the above case, not only with the great value of
the ipecacuanha, but also from the benefit arising from the glysters,
in conveying nourishment to the system when in an anaemiated state,
and when food could not be received or retained in the stomach ;
indeed, I have often thought, from the great absorbent power of the
colon, that glysters might supersede the necessity of transfusion, hav-
ing this advantage the perfect safety and facility of the operation.

Hooping Cough. (From Trans. Phila. Col. Phys.)

At a meeting of the Medical Society of London, held January,
1845, Dr. Waller stated that he had recently employed the extract of
belladonna, in two cases of hooping cough with the best results. He
gave it, in the dose of one-twelfth of a grain, three times a day to a
child four years of age. In these cases there was simply the spasm-
odic cough, without any indication whatever of the existence of in-
flammation. Mr. Crisp remarked, that in the majority of cases, he
had found the antiphlogistic plan of treatment to be the one best
adapted to the early stages o{ hooping cough. He viewed the dis-
ease generally as inflammatory, or at all events congestive. Con-
trasting the antiphlogistic treatment (leeches followed by blister and
the use of tartar emetic with that which he had formerly pursued,
he had every reason to be satisfied with the change he had made.
The prussic acid he had usually found to be of service only for a day
or two.

Dr. Wiltshire had treated, at the Infirmary for Children, simple
uncomplicated hooping cough with two or three emetics of ipecacu-
anha one every morning or second morning followed, for two or
three days, with nauseating doses of antimony, and had found this
plan of great service in the early stages of the disease. Hemlock
and ipecacuanha were of benefit afterwards in relieving the cough.
With respect to belladonna, he was fearful of its employment, for
notwithstanding the evidence in its favor, adduced/ by some of the
German physicians, others had found that this medicine had a ten-
dency to increase vascular acriion in the brain, and to produce hydro-
cephalus.

Dr. Chowne laid particular stress, in the treatment of hooping
cough, on the necessity of keeping the patient in a warm temperature,
and using every means to prevent his taking cold nauseating doses

1346.] Hooping Cough. 687

of ipecacuanha, he considered to be frequently of benefit. With
reference to the production of emphysema by hooping cough, he did
not believe it possible.

Dr. Clutterbuck viewed the disease as one of a specific character,
resulting from a specific cause it was a specific inflammation of the
bronchial membrane, but apt to induce inflammation of other organs,
as the lungs or head, and it was these complications that constituted
the dangerous character of hooping cough. He had little confidence
in any remedy for this affection. The disease should be narrowly
watched, with the view of prevention, rather than of active treat-
ment if mild, nothing was necessary to be done, it would terminate
spontaneously if inflammation of the brain, lungs, or other organs
was threatened antiphlogistic measures were demanded.

Dr. Golding Bird regarded hooping cough, in its first stage, as in-
variably an inflammation of the bronchial tubes, larynx and trachea,
of a specific character^ and implicating, in some peculiar manner,
the par vagum. This inflammation lasted for a definite period, which
is influenced by constitution and other causes. In its second stage,
the disease is nervous the specific irritation of the par vagum being
kept up, altogether independent of inflammation ; or when this is
present it is merely accidental : the disease is afterwards kept up by
the influence of habit. In the first stage the remedies for bronchitis
(emetics, diaphoretics, the warm bath, and a warm temperature) are
advisable. When the inflammatory stage is passed, attention should
be directed to subdue irritation in the par vagum by narcotics s^ch
as conium, in conjunction with carbonate of potash, hemlock, and
hydrocyanic acid. Embrocations to the spine and chest are also
useful. When bronchorrhce becomes troublesome, small doses of
alum, with sedatives, are of advantage. When the bronchorrhoea
has ceased, tonics are indicated the kind of tonic to be determined
by the constitution of the patient. Emphysema does not occur as
the consequence of hooping cough.

The president of the society had found in some cases where bella-
donna was given, that the poisonous, rather than the curative effects
of that remedy developed themselves, even though the doses adminis-
tered were remarkably small. With reference to the irritation of
the par vagum in hooping cough, he related 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 the air, a spasmodic cough resembling that of pertussis was
produced ; when the nerve was covered over by a cicatrix, the spas-
modic cough ceased.

Dr. Golding Bird remarks (Guy's Hospital Reports, April, 1845,)
that, in the second or nervous state of pertussis after all inflamma-
ry symptoms have subsided ; and when, with a tolerably cool skin
and clean tongue, the patient is still distressed by the more or less
copious secretion of viscid mucus from the bronchi ; each attempt to
gel rid of which, produces the exhausting and characteristic cough;

688 Calcined Magnesia as an Antidote to Arsenic. [November,

no remedy will be found to act so satisfactorily, or to give such
marked and often rapid relief to the child as alum. He has not yet
met with any other remedy which is equally efficacious. Dr. Bird
generally gives the alum in doses of from two to six grains in chil-
dren of from one to ten years of age, repeated every four or six hours.
For a child of two or three hours, he employs generally the following
formula :

R. Aluminis gr. xxv. ; extr. conii gr. xij.; syrup rhaedos. 3ij. ;
aq. anethi giij. M. Dose a medium sized spoonful, every sixth hour.
Dr. B. has never met with any inconvenient stringent effects on the
bowels during its exhibition ; on the contrary, in more than one in-
stance he produced, he says, diarrhoea. The only obvious effects
resulting from its use were, diminished secretion, and of a less viscid
mucus, with a marked diminution in the frequency and severity of
the spasmodic paroxysms.

Observations and Experiments on the Use of Calcined Magnesia as
an Antidote to Arsenic. By Robert Peter, M. D., Professor of
Chemistry and Pharmacy in the Medical Department of Transyl-
vania University. (From Western Lancet.)

We extract from the above article, the following important para-
graphs :

The attention of the writer was drawn to this subject by the peru-
sal of the following summary of facts, submitted to the French
Academy of Science, by M. Bussy, as the results of his labors, and
published in the Comptes Rendus, 18 Mai, 1846, p. 845, viz :

"1. That purified animal carbon, recently proposed, cannot be
successfully ernplo}^ed as an antidote to arsenic.

"2. That pure magnesia, which has not been intensely heated,
absorbs arsenious acid in solution, and forms with it a compound
which is insoluble even in boiling water.

"3. That in the gelatinous state it absorbs it still more promptly ;

"4. That animals to which arsenic had been administered, were
always saved when we caused them to take sufficient doses of mag-
nesia ;

"5. That this antidote presents the following advantages over
those which are at present employed, viz : that it can always be
obtained at the apothecary's shop, that it easily and completely neu-
tralizes the poison, and maybe administered in a large dose without
inconvenience, its general therapeutical effects being in accordance
with the indications in this kind of poisoning.

"6. That magnesia decomposes tartar emetic, the salts of copper,
and corrosive sublimate ;" and there is reason to believe that we may
employ it with success to counteract the effects of those poisonous
substances, as well as those of the metallic salts generally ;

1846.] Calcined Magnesia as an Antidote to Arsenic. 089

"7. That the salts of the organic alkalies, morphine, strychnine,
&c, being also decomposed by magnesia, the administration of that
substance in cases of poisoning with the organic products which owe
their activity to the presence of the vegetable alkalies, might retard,
and cause to be more difficult, the absorption of the poison, this
supposition it is proposed to verify by ulterior experiments."

Wishing to ascertain how far the results of M. Bussy, in relation
to arsenic, could be verified, by the use of the ordinary calcined
magnesia of the shops, the writer of the present article performed the
following experiments."

Prof. Peter then furnishes the details of three series of experi-
mental tests, made with the view of determining the chemical effect
of magnesia upon arsenic dissolved in distilled water ; and finally
adds :

"It is evident from these facts, that magnesia would be a most
useful agent in the treatment of poisoning with arsenic. Mixed
with water, and administered continually, and in sufficient quantity,
until all the poison is removed from the stomach, it would combine
with thearsenious acid as soon as it became dissolved in the fluid in
the stomach, and by withdrawing- it immediately from solution, pre-
vent its absorption into the living tissues. Even when the poison
is taken in solution, we could doubtless succeed, by the speedy ad-
ministration of a large quantity of this antidote, in gaining time to
remove it from the stomach by the ordinary emetic means.

"It is believed to be always desirable to evacuate the stomach freely
after the use of any of the antidotes; more especially in poisoning
with metallic substances ; for, although the poison may, for the time
being, be converted into a compound insoluble in water, yet it might
not be safe to allow that substance to remain long in contact with the
secreted acids of the stomach.

" Many persons may be disposed to think that, having in the hy-
drated peroxide of iron, a good antidote to arsenious acid, it would be
folly to throw it aside for another. which has not yet been sufficiently
submitted to the severe test of experiment on the living subject. But
the writer would suggest that the compound of iron is not always to
be procured in time when it is wanted, and moreover is often inert
from the improper manner of its preparation, while magnesia is al-
most always at hand, and can, grin rally, be procured in quantity,
and it presents a range of antidotal power over various poisons not
equalled by any other known substance. It is therefore to be
strongly recommended as a substitute for the peroxide of iron, when
the latter cannot be easily obtained.

44

690 Uterine Polypi and Ulceration. [November,

In the August No. of the Dublin Journal, W. F. Montgomery,
3VI. D., Prof, of Midwifery, &c, has published a number of cases of
Uterine Polypi and Ulceration, from which he draws the following,
conclusions :

"That very small uterine polypi, or polypoid excrescences are of
frequent occurrence.

That they are often net discoverable by touch alone, and so es-
cape notice.

That they may even elude detection with the speculum, especially
if the instrument used is not capable of separating the lips of the
os uteri.

That they are a common cause of ulceration and menorrhagia, one
or both ; the cure of which requires, as a preliminary step, the re-
moval of the polypus.

That while thus, on the one hand, a small polypus may escape
detection, there is, on the other hand, a peculiar condition of the
anterior lip of the os uteri liable to be mistaken for a polypus, and
requiring a long time for its removal.

That the very small polypus of the os uteri is seldom solitary, and,
in common with polipi of other kinds, is very often combined with
other diseases of the uterus, especially with fibrous tumour.

That these small polypi of the os uteri, when occurring in women
of advanced age, especially if they are of the vesicular kind, are often
the precursors of a malignant form of uterine disease.

That polypus being very frequently accompanied by ulceration of
the os and cervix uteri, and its concomitant pain and structural alter-
ation, the symptoms are occasionally mistaken for those of cancer;
which error is most likely to be committed if an examination should
happen to be made just when a polypus of rather large size is pass-
ing through, but still engaged in, and distending the os uteri.

That in cases of larger sized polypi, ligature is the means most
generally eligible, as being safer than excision, though not so expe-
ditious ; its application having, in general, the immediate effect of
restraining the morbid discharges, and alleviating other symptoms,
and ultimately curing the disease.

The polypi and polypoid excrescences of small size are best re-
moved by torsion ; or in some instances their destruction may be
conveniently effected by caustic.

That with large polypi torsion is unsafe and should not be attempted.

That even with a polypus of small bulk, and slender pedicle, ex-
cision is not free from the risk of troublesome hemorrhage, while
with those of large size, there is great reason to apprehend such an
occurrence taking place to a very dangerous degree, even though
the precaution may have been taken ot firmly constricting the pedicle
with a ligature previous to its division.

That in ordinary cases of benign polypus, when no other disease
exists in the uterus, the removal of the tumour by ligature, or other

to* ^

1846.] A Practical Treatise on the Diseases of Children. 691

suitable moans, is, in the vast majority of cases, completely success-
ful, even under circumstances apparently quite hopeless.

That in malignant growths, such as cauliflower excrescences, re-
moval by ligature will sometimes effect a complete cure ; and that,
where the success is not so decided, much good may be done by the
operation.

That the situation from which a polypus springs makes a consider-
able difference in the symptoms which it produces: a polypus of the
lip of the os uteri giving rise to fewer symptoms and much less dis-
charge, than one of very inferior size growing from any part within
the os uteri.

That a polypus of only moderate size growing from the lip of the
os uteri is not likely to interfere, injuriously, with gestation or deliv-
ery, and its removal may be effected by, or as a consequence of, the
pressure which it sustains during the expulsion of the child.

That if a polypus, already detached, be too large to pass readily
out of the vngina, it ought not to be allowed to remain there ; but
should be removed with the least possible delay, as its putrefaction
may be attended with very unpleasant consequences.

That a fibrous tumour, originally formed in the substance of the
uterus, may thence descend, pass through the os uteri, and form an
ordinary pediculated polypus in the vagina.

That in the unimpregnated state of the uterus, this change will be
effected gradually, and in general very slowly ; but that, should preg-
nancy occur, the descent and expulsion of the tumour may take place
quickly under the expulsive action of labour.

That a polypus, even of Inrge size, may thus make its appearance
for the first time, immediately after delivery, no suspicion having
been previously entertained of its existence.

That the cure of long-standing polypus, with large discharges, is
liable to be followed by a condition of the system requiring precau-
tions against determination to the head."

BIBLIOGRAPHICAL NOTICES.

1. A Practical Treatise on the Diseases of Children. Bv James
Milman Coley, M. D., Member of the Royal College o'f Physi-
cians of London, &c, &c. Philadelphia: Barrington & Haswell.
1846, p. 414.

This is one of the valuable reprints issued with the Bulletin of
Medical Science, by Dr. John Bell. In the Introduction to the
English edition dated London, March, 1846, the author says' " The
principal object I have had in view in writing the following pages,
has been to present to the medical profession and the public a com-

692 The U. S. Dissector. The Med, Formulary. [November,

prehensive work on the Diseases of Infants and Children ;" and in
the table of contents and index he seems to have embraced every
thing connected with his subject. From a hasty glance over the
pages of this work, we have not formed a very exalted opinion of its
character, but have little doubt it will prove a useful reference to the
general practitioner. The x^merican reader will no doubt be often
amused at the truckling spirit of the author, who gravely refers to
Masters and Misses of even a fete monthsold, by which terms of dig-
nity and title, we presume we are to understand the children of the
nobility.

2. The United States Dissector, or Lessons in Practical Anatomy.
By Wm. E. Horxer, M. D., Professor of Anatomy in the Univer-
sity of Pennsylvania. Fourth edition, with numerous illustrations.
Edited by Henry H. Smith, M. D. Philadelphia : Lea & Blan-
chard. 1846, p. 444.

The first edition of this work was issued from the press twenty-
three years ago, by Dr. Horner, under the title of Lessons in Practical
Anatomy. This, the fourth edition has been revised and published
by his son-in-law, Dr. Smith, and with the additional title of the
United States Dissector. The character of these two editors, the
one for his long known familiarity with Anatomy as a practical
teacher, and the other for his fondness for this science, is a good
recommendation of this manual to American students. We are
indebted to the publishers for this volume.

3. The Medical Formulary : being a collection of Prescriptions, de-
rived from the writings and practice of many of the most eminent
physicia?is of America and Europe with an Appendix of Dietetic,
Pharmaceutic and Medical Observations. By Beivj. Ellis,
M. D., &c. Eighth edition, with numerous additions. By Sam-
uel George Morton, M. D. Philadelphia : Lea & Blanchard.
1846, p. 272.

We are also under obligations to the publishers for this work.
The reader will recollect that it was an error in a prescription taken
from this book that caused the death of Dr. Baber of Macon, Ga.
This no doubt has had its influence in producing its revision by Dr.
Morton, and like the safety produced by extra caution after an explo-
sion in a steamboat, we think the accuracy of the prescriptions may
be now relied upon, especially as we have the character of Dr. Mor-
ton involved in their revision.

1846.] Absence of Corpus Callosum. Dislocation, 693

PART III. MONTHLY PERISCOPE.

Absence of Corpus Callosum. M. Paget has communicated fo the
Med. Chirurg. Society, the details of a case in which the middle por-
tion of the fornix and the whole of the septum lucid um were absent,
and in which, in place of the corpus callosum, there was only a thin
fasciculated layer of white nervous matter, inch in length, but of
which the fibres extended into all those parts of the brain into which
those parts of the healthy corpus callosum can be traced. Behind
the imperfect corpus callosum, the optic thalami, the middle commis-
sure (which was very large), the posterior commissure, and the pine-
al gland lay exposed after removal of the velum. The lateral parts
of the fornix and the rest of the brain were quite healthy. The
patient was a servant girl who died of pericarditis. She had dis-
played during life nothing very remarkable in her mental condition
beyond a peculiar want of forethought and power of judging of the
probable event of things. Her memory was good, and she possessed
as much ordinary knowledge as is commonly acquired by persons in
her rank of life. She was of good moral character, trustworthy,
and fully competent to all the duties of her station, although some-
what heedless ; her temper was good, and disposition cheerful.
From these facts Mr. Paget is inclined to regard the functions of the
corpus callosum as connected with the highest operations of the mind,
especially as in the few cases in which it has been found deficient, or
altogether absent, the mind has possessed a moderate average power
and capacity for knowledge, and all the lower functions of the nerv-
ous system have been perfectly discharged. [Ranking'' s Abstract.

Brief account of a case of simultaneous dislocation of both femurs
in the same individual. (Gazetta Toscana-Gazette Medicale.) Not-
withstanding the brevity with which the following case is related, it
still merits to be considered as one of the most rare and curious ex-
amples of this affection which the science possesses. We give the
case as it is related by the author :

"A peasant, aged 30 years, was walking beside a vehicle loaded
with furniture, when one of the wheels having encountered a stone,
it upset and threw the conductor violently against the ground. He
endeavored to rise by the aid of some assistants, but could not, and
during these efforts he experienced acute pain in the right groin. He
was carried to the hospital and confided to the care of M. Andreini,
who notwithstanding a considerable swelling of the parts, recognized
the existence of a luxation of the right femur upwards and outwards.
At the same time he perceived something abnormal in the left limb,
but as there was no breach in the continuity ofthe bone, and as the
patient declared that he felt no pain in it, and moreover stated that
this limb had always presented some differences from the other, poul-
tices were applied to the right side alone, and were continued tor

I

694 Cataract. Deafness. Hydrocele. Aphtha. [November,

three days. He was also bled to the extent of 8 ounces. On the
lfitb of February, four days after the. accident, the luxation of the
right femur was promptly reduced. It was now found impossible to
bring the right to the left thigh the last appeared also to be longer
and turned outwards. The surgeon having again interrogated the
patient, who repeated that he felt no pain in the left side, ascertained
that the difference between the limbs to which lie had referred as
existing before the accident was mereJy an enlargement of the knee.
The left ilco-femoral articulation was then examined, and the femur
found to be luxated downwards and inwards. Though surprised at
the singularity of the fact. Rf. Andreini did not hesitate a moment,
but immediately changed the direction of his extension and counter-
extension, and reduced this second luxation with as much rapidity as
the first. The patient was entirely recovered in a few days, and
returned to his family.

Treatment of Cataract (Gazette Medicale.) At the session of
the Congress of Italian savans, held in Naples last year, Prof. Pali-
otti recommended as a remedy for Cataract the internal use of the
Iodide of Potassium, and ammoniacai cauterization on the temples.
He declared that even in the cases where this treatment did not effect
a cure, it rendered the success of the operation more certain. M.
M. Quadri and de Ho rat us were appointed to make experiments
with this method and report the result of their observations at the
next session.

Complete Deafness caused by a comminuted fracture of the Crani-
um. (Gazette Meriicale.) M. Bonnafont related to trie Academy
a case of complete deafness which supervened upon a comminuted
fracture of the cranium. The affection was so complete, that for
eight months the patient was unable to hear the report of a cannon.
The disease yielded to the action of galvanism and ammoniacai insuf-
flations through the eustachian tube.

Hydrocele treated with Alcoholic Injections. (Gazette Medicale.)
M. Dupuy states, that at the Hospital of Beaujon, in the service of
M. Langier, hydrocele has been treated with alcoholic injections,
with entire success. This treatment was unattended by pain, and
the cure was as prompt as when iodic injections were employed.
The injection was composed of one part of alcohol at 30 and two
parts of water.

Sulphuric Acid in Aphtha. (Gnzette Medicale.) Prof. Lippich,
of Padua, employs with success, the sulphuric acid against aphthae,
and in syphilitic mercurial stomatitis, when the mucous membrane
of the mouth and lips are covered with ulcerations which render de-
glutition difficult. He uses the following formula :

fi. White Honey, ... 30 grammes.
Sulphuric Acid, ... 2 grammes.

,

1846.] Constipation. Arsenic in a Fcetus. Anecdote, <Jv\ 695

Mix, and make a liniment. In grave cases, the proportion of the
sulphuric acid may be increased to eight grammes to the same quan-
tity of honey. The ulcerated surfaces are to be frequently touched
slightly with this liniment by means ofa soft pencil.

Treatment of Nervous Constipation. Prof. Lippich combats con-
stipation, when it obstinately resists the means ordinarily employed,
by the use of the following lavement :

ft. Asafoetida, .... 12 grammes.

Common Vinegar, . . 30 grammes.

Honey, 60 grammes.

Barley Water, . . . 300 grammes.

Yolk of Eggs, . . . q. s.
Mix thoroughly, and divide into two lavements, to be administered
with an interval of an hour.

Arsenic found in a Fatus. (Gazette Medicnlc.) It is stated, in
the Bulletin of the Medical Society of Ghent, that the chemists, in
an autopsic examination ofa pregnant female who died of arsenical
poisoning, detected arsenic in the substance of the foetus, which had
reached its fourth month. The uterus and the placenta also con-
tained arsenic, the last in greater proportion than the embryo. The
amniotic liquor did not contain any, at least in any appreciable
quantity.

Anecdote of the pay of Physicians. One day, old Kien-Long,
Emperor of China, asked George Stanton how Doctors were paid in
England. When he comprehended the system, he exclaimed, can
there be a single Englishman in good health? Let me tell you how
I treat my physicians. There are four to whom my health is confi-
ded. They receive a certain sum every week; but the moment I
am taken sick, their salaries are stopped until I get better. It is
scarcely necessary for me to add that my complaints do not last long.

The Culture of Rice removing the salt of marshes. The culture
of rice has been attempted with perfect success upon the salt marshes
at the mouth of the Rhone, in France. It has had the effect to re-
move the salt entirely from the soil an experiment in vegetable
chemistry of the greatest interest.

Chronic Articular Inflammations. M. Bieckly prefers the follow-
ing formula :

Nitrate of Silver 3iv.

Water, sufficient to dissolve this salt.

Lard 3xxxii. Mix.

Frictions are to be made twice a day, with four or five scruple* each
time. The third or fourth day the skin will have the aspect of shin-
ing black polished leather. These frictions produce no pain nor

696 Sulph. Quin. on the Blood. Quinine in Ulcers. [November,

tegumentary irritation, if we except some few vesicles. The treat-
ment ought to be stopped now for a few days, until the black epiderm
peals off, and the skin resumes its normal color. Under this oint-
ment, deep articular alterations are modified ; the heat and pain sub-
side, the effusion is absorbed and the swelling dissipated. M. B.
thinks the preparation is absorbed.

Effects of Sulph. Quinine on the Blood. According to M. Le-
groux and M. Magendic, the sulphate ot quinine given in large doses
diminishes the propotion of fibrine and augments the fluidity of the
blood. [ Archives Centrales.

Quinine to Ulcers. By A. F. ^Vedderburn, If. D., Prof, of
Anatomy in Med. Col. of Louisiana. (X. O. Med. and Surg. J.)
* * * Since the report of the January number of this Journal,
concerning the treatment of indolent ulcers, in my ward, in the
Charity Hospital, with the sulph. quinine, I have continued its topi-
cal application, not only to indolent ulcers, but have used it with
marked success in other varieties.

I have noticed the following facts, that when applied to the surface
of an inflamed ulcer, the redness surrounding the part has been sub-
dued in leu than 24 hours and the same holds good concerning the
pain in an irritable ulcer, whilst almost invariably in the same space
of time the surface is made to present an healthy, granulating ap-
pearance, secreting healthy pus. When this remedy is applied to a
small indolent ulcer, its effect is not so prompt as when applied to a
large ulcer of the same variety. Now this would lead us to suppose
that the remedy is absorbed ; but from experiments, I have ascertain-
ed that the statements made by 31. Martin Solan, in the Bulletin de
Thcrapeutique, and republished in the March number of this Journal,
are entirely correct; viz: that the sulph. of quinine when applied
to the surface is not absorbed ; i. e., if its not being detected in the
urine is evidence of this fact. I have always been able to detect it
when given internally in small quantities, when I have failed at the
same time in testing the urine of those when it had been applied to
the surface. In a case of phlegmonous erysipelas of the thigh of a
woman in the Hospital, extending over a surface of 8 or 10 inches
in length, and occupying the entire breadth of the external part of
the thigh ; with an opening in the centre about an inch in diameter ;
under the inflamed surface the cellular tissue was so completely de-
stroyed, that a probe could be passed freely in any direction. Into
this large sinus an ounce of water, holding in solution 10 grs. of the
sulph. of quinine was placed, three times during the day, making in
all 30 grs. The woman was placed in such a position, that the es-
cape of the solution was entirely prevented. The next day, the
pain and redness of the surface had almost entirely disappeared ; and
it was clear that the three ounces of the solution had permeated the
tissues. The urine voided before the administration of this remedy,

1846.] Electro-Magnetism in Intermittent Fever. 697

and that passed during the administration, were tested with all the
tests for quinine, and the effect produced upon both was the same, no
precipitate being afforded in either case. This case recovered in a
very short time, no other remedy having been used during the treat-
ment.

Although I could mention a large number of cases exhibiting the
superiority of this over any other remedy as a topical application to
ulcers, I will only mention one case which I had under treatment.

A. B. Was admitted into the Hospital, with an extensive syphil-
itic ulcer extending from the upper part of the sacrum to the anus,
exposing a large portion of the ligaments covering the sacrum this
case had been under treatment for more than ten days various ap-
plications had been made without the slightest effect, when I determ-
ined to resort to the topical application of the sulphate of quinine. I
ordered the part to be washed with a solution of tannin, 8 grs. to the
ounce of water, and lint to be constantly applied, saturated with a
solution of quinine, 10 grs. to the ounce. The constitutional symp-
toms under which she wras suffering, with the excessive pain of the
part, was much relieved in about 24 hours, and in three days the en-
tire surface was covered with healthy granulations. The quinine
was applied about 20 days; the ulcer improved since its first appli-
cation daily, and entirely cured in a few days, as the granulations
soon became even with the surface of the skin.

Electro -Magnetism in Intermittent Fever. An esteemed corres-
pondent, to whom we have heretofore been indebted for interesting
facts, communicates the following cases of intermittent fever cured
by electro-galvanism :

I had been laboring under intermittent fever from August, 1845,
until April, 1846. Several of the best physicians had been consulted
without benefit. Quinine, the usual remedy, seemed to have lost its
effect; the chill frequently returning in three or four days after its
suppression. In April, being at Louisville on business, the weather
suddenly turned cold with rain, and immediately I began to experi-
ence the peculiar nervous depression, which every one similarly situ-
ated feels in such weather, and, calling on a medical friend, we
amused ourselves some time in his office with an electro-magnetic
battery. Immediately I found myself free from all nervous debility,
and felt nothing of the kind for some hours. On my return, in re-
flecting on the circumstance, I determined on the next occasion of
the paroxysm to test the efficacy of a battery at home. In a few
days the opportunity was afforded, and the chill was completely ar-
rested in six minutes; and even after the nails were blue and the
hands cold above the wrists. I have had no chill since, and have
taken no quinine.

Some time after this, Mr. B., who had been laboring under inter-
mittent fever for the last three months, called on me. The usual
remedies had been prescribed without effect ; the chills continued to

698 Leucorrhcea* Death from Cold Water treatment, [November,

return at short intervals, and when I saw him he had had a return
each day for more than a week. I administered a cathartic of blue
mass and compound extract of coiocynth, but from some cause with-
out effect ; and expecting a chill next morning, I placed him under
the influence of the battery, and the time passed by without any
chill, though some evidences of its approach were apparent.

In my own case, the biliary organs were in good condition, and the
paroxysm seemed to recur more in virtue of habit than otherwise ;
but in the case of Mr. B. the liver and spleen were both evidently and
badly deranged.

Do not these cases authorize us to expect something from electri-
city in protracted intermittents? In recent cases the remedy would
not seem to me to promise so much. I hope physicians will give it a
trial in some of their obstinate cases, and communicate their experi-
ence to the public. [Western Jour, of Med. and Surg.

Shelbyville, Ky., Sept., IS4G.

Treatment of Leucorrlicea. Dr. Osborne, of Erie, Alabama, has
found the following treatment of Leucorrhcea uniformly successful :

To 2 ounces of a decoction of red oak bark add 10 drops of the
tincture of muriate of iron, and inject into the vagina two or three
times daily. I am apprized of the incompatibility of the two articles,
but my experience is that they form a compound which acts like a
specific in this troublesome affection. I cannot help regarding the
remedy as one entitled to the confidence of the profession. [Ibid.

Death from Vie Ejects of Cold Water Treatment. The London
Lancet, for August, 1846, contains an account of a patient who was
killed by the improper use of cold water, also the trial and conviction
of the doctor for man-slaughter. It seems that the patient had con-
gestion of the lungs, and applied to the Hydropathic Institution kept
by one Dr. Ellis, who pronounced it a case of hepatitis of the sub-
acute character, and put him in the sheets wet in cold water, which
caused his death in a short time.

Upon making a post-mortem examination the lungs were found
to be in a highly congested state, which was no doubt much increased
by the application of the cold water treatment, causing the death of
the patient ; but the liver was not diseased, as the hydropathic man
had said.

It is a great pity that some of the evils of this catch-penny system
in this country, could not be brought to light. They tell of all their
successful cases, but we never hear of their bad cases, by them. The
idea of taking a delicate female with disease of the heart, or any
other disease, it makes no difference with them, and placing her in
cold wet sheets, and obliging her to drink four or five tumblers of cold
water three times a day, is too absurd for sane people to believe to be
the best mode of treatment; yet we find many following the plan,
whom we believe to be sane on all other subjects. Cold bathing is

\

1846.] Sulphate of Iron. Bed Sores. Acidity. 699

an excellent thing for those in health, and should be used daily, but
not in the manner that it is by the hydropaths. But as to drinking
cold water, we should be very careful, for all kinds of drinks taken
in excess are injurious to the system. New-York Med. and Surg.
Reporter.

Sulphate of Iron for excessive perspiration, prescribed in the fol-
lowing manner, is highly recommended by Professor Lippich :
R. Gray cinchona, 30 grammes, or nearly gj.
Water 300 " gx.

Boil for eight or ten minutes, filter and add

Sulphate of iron, 40 centigrammes, or about gr. vi.
Simple syrup 30 grammes " gj.

Mix, to form a drink, of which a half coffee-cupful is to be taken
every two hours. [Day's Report in Ranking's Abstract. Journal
de Chimie Medicale.

Means of preventing Bed Sores. Dr. T. Purefoy has employed
partially inflated bladders with success as a support to parts long and
unduly subjected to pressure. The bladder is to be previously moist-
ened in tepid water, afterwards oiled and subsequently partially infla-
ted. He has found this means to promote the comfort of the patient
and to obviate sloughing of the integuments. [Dublin Med Press.

Acidity. Dr. Robert Dick, in an article in the Lancet, (Aug. 22,
1846,) remarks that there is a difference between acidity which is
merely in the stomach, and acidity which \sfrom the stomach ; and
the treatment of these is also different. Acidity of the former sort
arises usually from natural changes in the food, or from improper ar-
ticles of diet. If from the former of these, we may infer that there
is functional debility of stomach, probably associated with, or depen-
dent on, anaemia of the mucous coat, and a consequent deficiency in
the secretion of the gastric juice, bile, pancreatic fluid, and the mu-
cus; that hence digestion is feeble and tardy, so much so that the
ordinary chemical, non-vital changes in the food, which the mere heat
and moisture of the stomach are apt to favour, take place. The
cure of this kind, and from the causes just named, is obviously de-
pendent on tonics, with food stimulant in itself or rendered so by
condiments.

Acidity from the stomach that is, consisting of morbid matters
actually secreted by the organ itself, requires other measures. And
here it may be observed, that sometimes the feelings of acidity, or,
to use the familiar word, heartburn, is caused by secretions extremely
slightly acid, sometimes not appreciably so. Acrid, however, they
must be. In other cases, the feeling of acidity does not seem to
depend either on acidity or acridity of the stomachic contents or
secretions, but either on a peculiar state of the gastric nerves, or on
morbid sensibility, with or without hypcrajmia of the gastric mucous

700 Vomiting of Pregnant Women, [November,

membrane. These several kinds of heartburn require separate and
different treatment.

1. Acidity caused by morbid secretions. These morbid secre-
tions are, in fact, one or more of the following acids : the hydro-
chloric, lactic, oxalic, butyric, acetic, carbonic. The last is, per-
haps, seldom the cause of heartburn.

In most cases, heartburn of this nature requires alteratives. This
is more especially the case if the acidity be owing to excess of the
hydrochloric or lactic acids, or to the presence of the butyric. The
alteratives from which we may principally select, are, mercury,
iodine, potassio-tartrate of antimony, nitrate of silver, bismuth, ipe-
cacuanha, &c; several of these may be combined with advantage.
That the iodide of mercury may be chosen ; and ipecacuanha may
be usefully allied to mercury, iodine, or nitrate of silver, severally ;
all of them may also be united, if necessary, with purgatives, such
as the extracts of rhubarb, aloes, or colocynth, with scammony, &c,
and sometimes, most beneficially, with the extract of colchicum.

Meanwhile much attention must be given to the state of the urine,
and the action of the skin. The condition of the urine is a matter of
much importance. It must be our care to detect and re-adjust any
departure from the normal equilibrium of that important excretion,
any excess or deficiency of its constituents. In general, it may be
remarked that morbid stomachic secretions are more often associated
with and dependent on a deficiency of some of the constituents of
the urine, than with excess of these.

2. When heartburn is attended with a red tongue, thirst, pain at
the epigastrium, and a distinct sensation of coolness in the stomach,
on cold fluids being swallowed circumstances indicating hyperaemia
and erythema of the mucous membrane solutions of the acetate of
ammonia, nitrate of potass, borax, and even dilutions of the acetic,
tartaric, and sulphuric acids, are to be employed. Seltzer water, iced
drinks, lemonade, grapes, ripe apples and pears, &c, may also be
used as ordinary drink and food.

3. That species of heartburn which is a mere variety of gastro-
dynia, and is accompanied with no derangement of secretion, no
hyperaemia or tumidity of the mucous membrane, is best treated
with pills of the tris-nitrate of bismuth and hyoscyamus, nitrate of
silver and conium, oxide of zinc and extract of chamomile. To
these may be conjoined draughts of the infusions of orange peel, of
taraxacum and of gentian. [American Jour, of Med. Sciences.

Vomiting of Pregnant Women. Dr. Stackler has communicated
to the Medical Society of the Bas Rhin two cases of obstinate vom-
iting in pregnant women, in which the symptoms yielded to the
black oxide of mercury, given in the dose of five centigrammes
(three-quarters of a grain), daily. There was not the least trace of
salivation nor any other inconvenience after the use of this medicine.
Dr. Jauger referred to cases of hysterical convulsions and vomitings

1846.] Knife Swallowing. Infusion of Honey Bees. 701

sympathetic with the condition of the uterus, which had been cured
by the black oxide of mercury. According to this physician the
medicine is equally appropriate in irritated states of the organ, whe-
ther in pregnancy or otherwise. Should further experience confirm
this property of the black oxide of mercury, its importance will bo
readily comprehended by those who recollect how extremely severe
are the obstinate vomitings with which females are occasionally at-
tacked during gestation. Professor Forget took occasion of the
communication of Dr. Stackler to quote the case of a woman who
had been reduced to the last degree of emaciation by these nervous
vomitings, and at length died during the sixth month of pregnancy.
[Prov. Med. and Surg. Journ., from Gaz. Mid. de Strasbourg.

Knife Swallowing. By Wm. George Gill. John D r , aged
seven years, residing at 10 Salisbury-terrace, Islington, on the even-
ing of the 6th of August, swallowed an open penknife, three inches
long. The lad, a very sickly one, was subsequently visited by my
father and myself; the symptoms afterwards were slight, chiefly fe-
brile, with occasional griping pains, and some tenderness in the region
of the bowels. The treatment enjoined was perfect quietude, foment-
ations, saline febrifuges, sedatives, the occasional exhibition of slight
aperients, castor oil, &c. On the morning of the sixth day, contrary
to the opinion of some eminent physicians, to whom I had related the
case, the knife appeared with an evacuation, blade downwards, some-
what corroded, and not at all improved in appearance by its change
of residence. [London Lancet.

Infusion of Honey Bees. An infusion of the apis mcllifica or
honey-bee was recommended in the Western Journal of Medicine and
Surgery, for Nov., 1845, for the treatment of strangury. It was
directed to be prepared by sweeping from 40 to 60 bees into a pan
of water, put them into a teacup, pour one gill of boiling water
on them, and cover the cup securely. When it has stood 20 minutes,
pour off the infusion, and let the patient take the whole at a draught.
This remedy is said to relieve the worst cases of strangury, in from
two to fifteen minutes. A writer in the last No. of the American
Journol of Med. Sciences speaks highly of this remedy in such cases;
and Dr. Flint, in the last No. of the Buffalo Journal, states that the
prescription was recently tried in that city witli immediate relief, in
a casein which the introduction of the catheter was attempted with-
out success, and states " it was subsequently repeated daily, with the
same results, until the occasion tor its administration ceased." It
has been found to succeed very generally at the South, where it was
first introduced into practice, in cases of retention of urine from in-
flammation of the bladder, and from the effects of cantharides. It is
supposed that the material which gives efficacy to the bee-tea, is the
virus ejected by its sting, as the tea, when recently made, has a taste
and smell identical with the odour of the incensed bee ; and if allow-

Mil**-***

702 New Formula. Strang. Hernia. Gargle. [November,

ed to stand, (lie infusion loses its characteristic odour and taste, and
its efficacy is destroyed. It remains to be seen whether this virus
may not be collected and preserved, so as to be employed where the
bee itself is not to be obtained. [Neuc-York Jour, of Med.

New Formula. The following formulae, not generally in use in
this country, are taken from n recent French work, "Traite de Ma-
tiere Medicale, by Dr. Foy, (Paris, 1842, 2 vols. 8vo., pp. 628, 714.)

Ammoniacal Beer. Take of muriate of ammonia, 3jiss. ; table
beer, 3xvi. Mix. To be administered in doses of a wineglassful
in scrofula, typhoid fevers, diabetes, abscesses.

Purgative Biscuits. Take of jalap, 3 v.; sugar, 3xxx\; flour, 3iv.;
make into 15 biscuits, one to be taken in the morning for a dose.

\ [Boston Med. and Surg. Journal.

TREATMENT OF STRANGULATED HERNIA.

To the Editor of the Boston Med. and Surg. Journal :

Sir I have seen some articles in your Journal, recently, on stran-
gulated hernia, which induces me to give some of my experience in
that distressing difficulty. I do not know that the method to be de-
scribed will be new to most of your readers, though it was so to me,
as I never heard of the treatment by the remedy until I used it my-
self. About three years since I was called to see a lad about 5 or 6
years of age, laboring under strangulated inguinal hernia, in great
distress. Every means were U9ed that I was acquainted with, but
without any relief. After using these means for more than twenty-
four hours, I was sent for to see a lady in labour, and gave the lad
about two grains of sulphate of morphine, and left him. On my re-
turn, in about three hours, to my surprise, and the joy of the family, I
found the boy in a profound sleep, and a complete spontaneous reduc-
tion of the hernia. I then applied a truss, and there has been no
return of the hernia since. Since that time I have used the same
remedy some four or five times, with equal success; in fact, I have
never failed to be able to reduce the hernia very easily, if it did not
recede spontaneously, after a full dose of morphine. I have also re-
commended it to physicians in this vicinity, and have been informed
by them that it succeeded well.

As I have often been aided by the able contributors to your excel-
lent Journal, perhaps the above may be of advantage to some one, if
you think fit to allow it a place in your pages.

Yours, sincerely,

Edwardsville, III, Sept. 21, 1846. John H. Weir.

Gargle to counteract certain effects of Secondary Syphilis. For-
mula of M. Ricord. (Journ. de Chem. Med. Jan., 1846, p. 56.)
Decoction of Hemlock, - - 3| ounces.
Corrosive sublimate, - - from to 1| grains.

[Sn. Journ. of Med. and P harm.

1846.] Protiodide of Iron. Electro-Galvanism. Deglu'iticn. 703

Tincture of Pro-ioJide of Iron. The tincture of protiodide of
iron is made as follows :

>hate of iron, . ... 12 grains.

Iodide of potassium, .... 23 "

Alcohol, at 85, h oz.

Triturate the two salts in the dry state tojjether, add the alcohol and
filter. Keep the solution in bottles, completely filled. A little excess
of iodide of potassium gives more stability to the preparation. [lb.

Electro-magnetism as a Remedial Agent. Dr. Prosch,*)f Ham-
burgh, has applied the electro-magnet in a variety of nervous affec-
tions and disorders cf the muscles. He gives the result of his treat-
ment in 53 cases. The average duration of the sittings was fifteen
minutes. The following table presents a condensed view of the cases
referred to.

Diseases.

False Achylosis, ......

Atrophy of Limls

Peculiar Disorder of Vision, ....
" ' Speech, ....

Stammering, . .

Deafness,

Peculiar Sensitiveness ol Face,

Anaesthesia of Skin,

Feeling of Dryness in Mouth and "Weakness of

Buccinator Mu-cle,

Cramp proceeding from Nerve Vagus, .

Pain of Face 7

Twitchings of Neck and Face,

Cramp in writing,

"Weakness ar.J Tumbling of Hand in writing,
Trembling of Arms, ....

Weakness of Arra>;, after fall, blow, Stc.
Peculiar Tingling of Arm, ....
Rheumatism of Muscle and Facia,

- Kuee, ....
Rheumatic Contraction of Hip Joint, .

" Pain in Hip, ....

Rheumatic Paralysis, ....

<Jout, ."

Disease of Skin

Nocturnal Discharge of Urine,

Pain in region of Urethra and Kidnev,

Dura:
Disc.

Several months
Congenital
ii

10 years
Congenital
Many years
5 yenrs
1 year

(Several weeks
iFor years

1-2 and 4 years

Kor vtars

I 1-:' years

3 months

Over a year
17 months
j Various

Months

For years

I year

1 year
For years
For years
Fr'm childhood

2 and 5 years

3 2

SB =

-

I

B

0

r*

.-

-

1

o

:

1

i

1

i

2

1

9

1

1

1

l

1

1

i

3

0

l

I

I

1

1

1

]

4

1

2

i

1

1

H

1

3

l

1

l

3

3

2

1

J

o

1

1

3

I

3

3

2

I

1

No. times
Electrified.

12
74 and 2-3
10
17
9
20 and 50
25
16

9
13

3-16

20-74

33

13

11

f-27
26

2-56
16

4-13

5-18

2-41

31

42-52

6-14
Often.

Deglvtion excited by dashing Cold Water in the Face Xote ad-
dressed to Dr. Marshall Hail. You will remember my communi-
cation to you, in which I described a novel mode of making patients
swallow, which you deemed worthy of publication in the Lancet
(December, 1842, page -137). and, afterwards, in the appendix to your
new Memoirs, 1843. which I had the honor of illustrating.

On Monday last, the 3rd inst., a further most felicitious illustration
of that action occurred to me. A poor creature, who had attempted
self destruction by cutting his throat, was rapidly sinking from loss
of blood. His pulse could not be felt, and his heart scarcely; the
respiration also was exceedingly slow and feeble. It was desirablo

704 Medical Department in the Army. Meteorology.

to administer stimulants, and his mouth was accordingly filled with
spirits and water. But the patient was unconscious, and therefore
did not swallow. Cold water was dashed in his face for the purpose
of making him swallow, when the contents of the mouth were in-
stantly gulped down. The effect of the stimulant was soon evinced
by the state of the circulation. By this application, then, of your
discovery, we not only have the means of provoking respiration in
the half-asphyxiated, but also of administering stimulants at a mo-
ment of vital importance, by exciting deglutition. [Lond. Lancet.

MEDICAL INTELLIGENCE.

Medical Department in the Army. The Army Medical Board, at its recent
session in New York City, approved the examination of our correspondent, Dr.
John F. Hammond, and recommended his appointment in the regular service of
our country. Dr. H. is the youngest brother of ex-Governor Hammond of
South Carolina, and we predict for him a high and honorable rank of useful-
ness in his profession.

METEOROLOGICAL OBSERVATIONS, for September, 1846, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

Cl

Sun
Ther.

Rise.

Bar.

3,

Ther.

P.M.
Bar.

Wind.

Remarks.

1

69

29 81-100

86

29 82-100

s.

Rain 5-100.

2

71

" 84-100

84

" 82-100

8. E.

Rain 30-100.

3

72

" 80-100

81

74-100

S. E.

Rain.^

4

72

" 76-100

1 80

" 75-100

S. E.

& [35400.

Rain. J

5

72

" 82-100

78

" 87-100

S. E.

6

72

(: 92-100

78

92-100!

E.

7

70

" 89-100

88

' 83-100

E.

Cloudy.

8

63

" 78-100

90

" 74-100

S. E.

Clear.

[cloudy.

0

70

" 72-100

87

" 72-100,

a. e.

Clear in morning in alternoon

10

73

" 76-100

80

" 84-100,

E.

Cloudy.

11

70

" 89-100

84

95-100,

W.

Cloudy.

12

69

" 94-100

88

'' 86-100,

w.

Clear.

13

72

" 81-100

92

" 82-100

N. E.

Clear.

11

70

<: 82-100

92

" 82-100;

N. W.

Clear.

15

68

" 75-100

92

<: 6H- 100

N.

Clear.

16

67

" 74-100

77

" 71-100

N. E.

Cloudy.

17

62

" 71-100

83

" 70-100,

N.

Clear.

18

m

" 65-100

88

" 64-100

B. W.

Clear.

in

60

" 68-100

82

" 69-100!

N. E.

Clear.

20

65

" 80-100

80

" 91-100

N. E.

Cloudy.

21

62

91-100

86

" 91-100

N. W.

Clear.

22

62

" 90-100

87

" 89-100

S. E.

Cloudy.

23

62

" 88-100

88

| 88-100

S. E.

Clear.

24

62

" 87-100

87

s 85-100

S. E.

Clear.

35

61

:< 84-100

86

" 79-100

S. E.

Clear.

36

59

" 70-100

88

" 63-100

S. B.

Clear.

o7

57

" 59-100

66

" 59-100

N. E.

Cloudy.

o3

57

80-100

70

83-100

N. E.

Clear.

99

53

" 85-100

76

" 88-100

N. E.

Clear.

30

53

" 85-100

82

" 82-100

N. E.

Clear.

17 Fair davs. Quantity of Rain 65-100 of an inch
22 days. West of do. 5 days.

Wind East of N. and S.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 2,] . SERIES. DECEMBER, 1846. [No. 11

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XLIV.

Observations on Morbid Sensibility of the Stomach* By I. P. Garvin,
M. D., Professor of Materia Medica and Therapeutics in the Medi-
cal College of Georgia.

Chronic gastritic affections are among the most common of those
which come under the observation of the physician. Neither age,
nor sex, nor condition, seems to be exempt from their invasion, and
yet they are among the most intractable which the physician is call-
ed to treat. The difficulty in these cases may in some degree be
attributed to an injudicious treatment, founded upon an erroneous
diagnosis. It is not that error in this matter is often unavoidable,
but the physician too frequently underrates the importance of the
case, and prescribes for it, without much examination into its nature.
The patient seems, on a superficial observation, to be in the enjoy-
ment of good health, and his tediously minute descriptions of his
symptoms are received as the complaints of a disordered imagination.
Reports of sufferings are heard, either with the smile of incredulity,
or treated as unworthy of more than a passing notice, which have
almost driven the sufferer to suicide. Too often, no effort is made to
ascertain whether the complaint originated in a diseased condition
of the gastric innervation, in sub-acute inflammation, or other de-
rangements. Even the treatises found in the books, make a verv
imperfect distinction between the different forms, but group them all
under some general head, such as indigestion, dyspepsia, &c. terms
which convey no meaning, save that the functions of the stomach
are imperfectly performed. Another, and probably more common
source of difficulty, is found with the subject himself. The disease
may have been insidiously creeping upon him for years, yet he ex-

45

708 On Morbid Sensibility of the Stomach, [December,

pects medicine promptly to restore him to health, and upon the fail-
ure of one article, even after a very insufficient trial, he quickly flies
to another, and another, in the anxiety for relief, at the same time
that he continues to indulge in the very course which has produced
the disease. Even when a long and painful experience has convinced
him that it is only by restraining his morbidly increased or perverted
appetite that he can expect any relief to his sufferings, he will occa-
sionally break through all restraint, and allow himself indulgences
which destroy all the good effected by weeks of previous self-denial.
It is useless to reason with him his organic instincts, morbidly ex-
cited, assert their supremacy.

These causes, with some others of minor importance, tend to pro-
tract these cases, and it is not unfrequent for them to continue for
years, rendering their victim a source of profit to the charlatan, and
the nostrum vender, and an annoyance to his physician, and a bur-
then to himself and his friends. Having been long, and severely
afflicted with that form of gastric derangement which seems to de-
pend upon a morbidly sensitive condition of the gastric nerves, and
having treated many similar cases, the writer has been induced to
present some brief practical remarks upon this form of the disease,
which he hopes will not prove unacceptable to the readers of this
Journal. This task has been more readily undertaken, because, with
the exception of Dr. James Johnson's work on Morbid Sensibility of
the Stomach and Bowels, we do not recollect any essay which fully
describes the affection, or suggests an appropriate treatment. Most
of the writers upon the subject, evidently have had no personal expe-
rience of the complaint, and it has been said, that no one should
write of dyspepsia who has not suffered from it ill his own person.
" How can he speak of scars who never felt a wound."

Morbid sensibility of the stomach always makes its approaches
insidiously. The subject occasionally feels some discomfort after
eating, but he refers it to some improper article of food which he has
taken. In a few hours the unpleasant feelings pass off, and are for-
gotten. These occurrences, however, gradually increase in frequen-
cy, and last longer, whilst the number of articles which disagree with
the stomach, becomes more numerous, until after the lapse of time,
of greater or less duration, every article of food, however simple,
or however small in quantity, produces some distress. Occasional
slight paroxysms of the disease may occur for years with considera-
ble intervals of comparative health, and as the subject retains his

1846.] On Morbid Sensibility of the Stomach. 707

usual embonpoint and strength, he entertains not the most remote
suspicion of the mischief which is brewing. At length, however, the
disease assumes a continued and severe form, and he finds himself a
prey to a malady which might render Titan, with his vulture and
rock, an object of envy.

In noticing the symptoms which characterize this form of dyspep-
sia, for various reasons we prefer to speak of them as they affect the
Various organs and functions. In the early stage, as we have already
remarked, there is considerable gastric distress for some time after
eating there is a -sense of fulness and distension in the stomach,
with occasional eructations of acid, or acrid fluid, mixed with some
minute portions of the food. In some instances, the fluid is not at
all acid. There is more or less flatulence, slight headache, and some
excitement of the circulation. When the disease becomes more severe,
there is generally a sense of burning heat in the stomach. It is very
different from that produced by the presence of acidity, and exists en-
tirely independent of it, although acidity always aggravates it. This
burning sensation we have known to be accompanied by a similar
one on the inner surface of one of the fore-fingers. There was
no redness nor sensible heat, but the painful sensation was always
most severe, when the stomach suffered most. It finally disappeared
as that organ regained its healthy condition. Whilst some degree
of thirst occasionally exists in the slighter cases, in the severer forms,
there is often an entire absence of all desire for drinks of any kind.
The morbid sensibility of the stomach seems to extend to the salivary
glands, and the mouth is always filled with fluid. The flatulence
increases greatly, and in some persons, there is a frequent eructation
of a colorless insipid fluid, whilst in others, mouthful after mouthful
of the food is eructated, until the stomach is nearly emptied. Vomit-
ing is not of frequent occurrence ; there are cases, however, in which
this symptom proves very troublesome. The bowels are always
costive, and the scanty faecal matters assume the form of scybalce.
When these accumulate in a considerable quantity, they often so
irritate the bowels, as to give rise to a diarrhoea, which ceases, how-
ever, as soon as they are unloaded. The foeces are in most instances
of a healthy color, though at times they look rather pale. From the
quantity of flatus which is generated, there is a groat liability to at-
tacks of flatulent cholic, often so severe as to excite some alarm in
the minds of the patient and his friends.

The liver we have rarely found much disordered. Occasionally

708 On Morbid Sensibility of the Stomach. [December,

in the progress of a case it will exhibit symptoms of temporary dis-
order, but it is never the primary seat of the disease, as some have
supposed, and though we will not assert that in no case is a continu-
ed derangement of the liver found to exist, we can declare that we
have not met one of that character.

The action of the heart never fails to become deranged. There
are frequent palpitations and intermissions, which, though not posi-
tively painful, are peculiarly distressing, and lead the sufferer to fear
that organic disease of the heart exists. Soon after the ingestion of
food, the pulse becomes more frequent, sometimes running up to 110
or 120 in a minute ; but at night, when the patient is in bed, or when
the stomach is empty, it is usually quite feeble, and slow. The
functions of the kidneys are uniformly disturbed. Sometimes the
urine is scanty, and deposites a reddish sediment. This, however, is
rarely found to be the case, except in the earlier stages, or where
hepatic derangement exists. In the worst cases it sometimes assumes
the appearance of milk, and in every case its quantity is largely in-
creased, and is perfectly limpid whenever the nervous derangement
is greatest. The functions of the skin are always imperfectly per-
formed ; there exists nothing like a healthy and steady perspiratory
action. The skin acquires a remarkable susceptibility to the impres-
sion of cold, and in cold, damp weather, in despite of any quantity of
clothing, the patient feels chilly. The blood is driven from the sur-
face upon the internal organs, and the urinary secretion increases to
such an extent, that the morbid imagination of the patient is over-
whelmed with the conviction that diabetes is added to his other com-
plaints. Coldness of the hands and Ceet is rarely absent in any case.
The lungs are rarely affected in dyspepsia, although cases have been
noted, in which there was considerable cough, and other signs of
pulmonary distress. The most marked disorder that we have noticed,
has been a sense of oppression, and so that for a Cew moments, it seems
to the patient that he will never be able to take another breath.
These feelings come on suddenly, and as suddenly pass away, and
in some cases occur several times in the course of the day.

The functions of the brain also come in for their share of disturb-
ance. Headache, usually slight, will be present in many cases, but
it is not a constant symptom, in some instances being entirely want-
ing. There is usually a considerable degree of dizziness, often so
great as to cause the patient to stagger under it. Some complain of
a senso of fulness ; the head seems as if it were enlarged to twice its

1846.] On Morbid Sensibility of the Stomach. 709

natural size. There are unusual sounds in the ears, such as roaring
and ringing, and when all is quiet, there is a constant frying sound.
The whole nervous system appears to be deranged. Sleep is dis-
turbed by unpleasant dreams, and the patient wakes unrefreshed.
In some cases there is a most distressing watchfulness, and for
weeks together, not more than two or three hours sleep can be
procured in the course of the night. The slightest unusual ex-
citement takes away all ability to sleep, and the patient passes
the night without closing his eyes. There is always present a
most distressing malaise, even when no pain exists. There is
no part of the frame which, at some time or other, is not the seat
of some uncomfortable sensation. In some persons there are exacer-
bations of the nervous disorder, attended by a disposition to cry or
to scream. We have seen several cases where the patient would ex-
perience an indescribable, but never to be forgotten, sensation in the
stomach, followed immediately by its radiation to the surface, which
very much resembled the auraepileptica. This would be succeeded
by a general trembling. We have seen shock after shock of this
kind, at intervals of a few minutes, until a general reaction of the
vascular system put an end to the paroxysm. At the close of these
attacks, there is always a copious discharge of colorless urine. John-
son evidently refers to these symptoms when he says, " the bilious
secretion is sometimes so acrid that the patient is sensible of its de-
scent into the duodenum, and experiences the most indescribably
disagreeable sensations at the time, producing a kind of shudder
through the whole frame, and a radiation of morbid feelings from the
region of the duodenum in every direction." Any irritation of the
duodenum will produce them, as certainly as bile. The acrid, half
digested matters from the stomach, are much more frequently the
cause. We have seen these symptoms produced whenever a cathar-
tic, or even laxative was given. The shocks are indiscribably
alarming to the patient, and one has declared to us, that though many
months have elapsed since he has had an attack, scarcely a day pass-
es over his head in which memory does not vividly recall their horrors,
and inspire him with a dread of their return. Tiiese attacks aro
most frequent in cold damp weather, and are preceded by a cold
skin, and a shrunken state of the superficial vessels.

The debility which attends the advanced stages and severe forms
of dyspepsia depending upon morbid sensibility of the digestive or-
gans, is often very great. As has been justly remarked, "it is a

710 On Morbid Sensibility of the Stomach. [December,

sense of debility, rather thai} actual debility," and is really more dis-
tressing. Whilst the miserable sufferer cannot be still for a moment,
every movement is painful. This debility is much greater at some-
times, than at others. It is usually least considerable when tho
stomach has been for some time empty. We have always found it
greatest when the bowels were loaded with fcecal matters. It is
usually accompanied by great emaciation.

The intellectual functions suffer as well as the physical. The
patient becomes gloomy and desponding. Even when for a time the
patient is in a cheerful mood, suddenly, like a cloud before the sun,
the deepest melancholy overshadows his mind. His attention be-
comes fixed upon his symptoms with a tenacity which seldom relaxes.
He broods over his sufferings, despairs of a cure, and becomes a prey
to a thousand imaginary ills. Others may treat his complaints as
the phantasies of a disordered imagination, but he looks upon them
as the climax of human misery. Life becomes a burthen which he
is often tempted to throw off as too heavy to be borne. His temper
becomes irritable, and small matters which would not have ruffled
it in the slightest degree when he was in health, now rouse him
to anger. livery thing annoys him, and he annoys every one. His
memory fails, and often in conversation his thoughts become con-
fused, and he forgets what he was saying. The wildest thoughts
rush unbidden into his mind, and then he imagines that his reason is
about to be dethroned. He is restless ever in motion, but soon
tires of any employment or amusement.

The train of symptoms we have described will be found pretty
generally to exist in the more aggravated cases, though every one of
them must not be expected to present itself in all cases. Sometimes,
though rarely, they will be found to exist without any gastric distress,
or so little as to impress the patient with the belief that the condition
of his stomach has no connection with his disordered feelings.

The symptoms we have enumerated point out pretty distinctly the
true nature of the form of dyspepsia we have under consideration,
and demonstrate the propriety of the appellation of morbid sensibility
of the stomach, which Johnson has bestowed upon it. The disease
evidently consists in a morbid condition of the gastric nerves, which
generally extends to the duodenum, and sometimes to a large portion
of the intestinal canal. The stomach may eventually become the
seat of organic lesions, but we are persuaded that this rarely occurs
even in the worst forms, and when its course has been most protract-

184G.] On Morbid Sensibility of {he Slomaeh. 711

ed. The tenderness of the epigastrium upon pressure, which is rarely
absent, has led to the supposition that there was some degree of sub-
acute inflammation; but the existence of this symptom is the only
circumstance which lends the least plausibility to the opinion, and of
itself is inconclusive. The exalted sensibility of the stomach readily
accounts for the tenderness under pressure, without supposing the
existence of any degree of inflammation. The liver is believed by
some to be seriously involved, if indeed it is not the primary seat of
the disease. It is doubtless true that in some instances the liver acts
irregularly, at one time being torpid at another, pouring out an
unusual amount of its secretion, but the appearance of the stools, as
well as the absence of other symptoms indicating hepatic derange-
ment, indicate that the derangement is slight, and only sympathetic.
In a work of Dr. Brigham, the idea is suggested that the disease in
question may originate in an undue activity of the brain, produced
by over-excitement. We are very much disposed to the belief that
the complaint mav be thus originated. We are convinced that the
undue excitement of the brain produced in children by overtasking
their mental strength, has in many instances laid the foundation for
a morbid activity of the whole nervous system, which in mature life
has prepared the individual for dyspepsia and other nervous com.
plaints.

The obvious injury and discomfort which result from food of an
improper quality, or in undue quantity, point out errors in diet as the
most prominent cause of gastiic derangement. There are some other
causes, however, which also contribute much to the production of the
disease. Among these we may rank climate as an important agent,
at least a strong predisposing cause. It is a well known fact, that
dyspepsia prevails in our country to an extent unknown in most other
sections of the civilized world. Something may be due to the dirier-
ence in the habits of our people, but the European lives as luxuriously,
eats and drinks as freely, and exposes himself quite as much to most
of the causes of this complaint, and yet he seems to enjoy a greater
immunity. The most rational explanation of this fact will be found
in the difference of climate. How it operates in the production of
the disease, we are not prepared to say, but wo do not doubt that it
is to the sudden and great transitions of temperature which charac-
terize our climate, that the dilli-renco h mainly owing. Sedentary
habits also exert a considerable agency in bringing on the disease.
li is certainly met with more frequently in persons of such habits

12 On Morbid Sensibility of the Stomach. [December,

than in those who lead an active or a laborious life. The use of
tobacco, either by smoking or chewing, but more particularly the
latter, is a prolific source of injury to the digestive functions. It
seems to do mischief by a double action first by depriving the food
of the saliva which should pass into the stomach with the food, and
aid in its digestion ; and secondly, by its effect upon the nervous sys-
tem, not only by its absorption from the surfaces to which it is appli-
ed, but by its contact with the mucous coat of the stomach, when
carried into that organ with the saliva a consequence which is in*
evitable, although the tobacco chewer himself is often unaware that
any of the narcotised saliva is swallowed. The quality of the food,
as wo have already remarked, has a most important agency in the
production of the disease of the stomach. The hot breads, the high
seasoned meats, the rich pastries, the unripe and raw vegetables,
articles used in such profusion by our people, with many other arti-
cles which we cannot stop to enumerate, are all injurious. The
quantity also, if more than the stomach can digest, exercises an
equally deleterious influence. Most persons are in the habit of eating
more than is necessary, and too often the stomach is urged to de-
mand far more than its wants require by the use of condiments and
stimulating drinks. No practice can be more absurd, for the stom-
ach, without any unnatural goading, will always call for at least as
much food as it can properly digest. Every mouthful taken beyond
this, does harm. The mode of eating also is of much importance,
Food half masticated and hastily swallowed, rarely fails to produce
some uneasiness during its digestion. Besides, when food is hastily
swallowed, appetite has not time to subside, until after an unnecessa-
ry quantity has been taken. It has been said that some persons,
before employing a laborer, enquire if he bolts his victuals; if he
answers in the affirmative, they look upon him as a "huge feeder,"
and consequently refuse to receive him.

There are also moral causes which play an important part in the
production of dyspepsia. All the depressing passions weaken the
digestive powers, and even those which are of an exciting nature, if
much indulged, produce a similar effect. Hence it is found that
commercial men, and the inhabitants of cities generally, are more
frequently the subjects of dyspepsia than those who pursue " the even
tenor of their way," amid the quiet scenes and pursuits of a country
life. Want of mental occupation also exercises an injurious influence.
Individuals who have been slightly affected with dyspeptic symp-

1840.] On Morbid Sensibility of the Stomach. 713

toms, often become the victims of the most intense form of the disease
as soon as they abandon their accustomed pursuits for the oiium clulce
for which the van of business usually pines. The almost entire ab-
sence of amusement and mental recreation so necessary to enable
the mind to regain the elasticity which is lest by unremitting atten-
tion to the more exciting pursuits of life, exerts a considerable influ-
ence in preparing the system for the disease.

The number of articles occasionally prescribed for the cure of this
complaint is very considerable. Every old woman has her remedy,
and it would prove at least amusing if one could peruse the long list
of incongruous prescriptions which have been kindly tendered to the
dyspeptic, every one of which is "warranted to cure." It frequently
happens, when a dyspeptic seats himself at a public table, and calls
for such simple articles of diet as will best suit his diseased stomach,
that at the close of the meal some sympathizing individual will seek
him out, and inform him of a remedy which has cured himself, or
some friend, after all the most eminent physicians had failed. The
frequency with which this occurs would prove annoying to any other
than a dyspeptic patient, but he is ever anxiously en the look out for
some new remedy, and he too often tries the prescription with no
other effect than a temporary exasperation of his symptoms. The
truth is that medicine exerts but little influence on the disease, and
he who takes least generally fares best. Medicine must only be
looked to as an auxiliary to other means of cure.

Purgatives are among the articles most commonly employed. The
continued constipation which always exists, seems to call for such a
medication ; yet, we are persuaded that the action of irritating or
drastic cathartics rarely fails to prove injurious. 3Iercuria! purges
so frequently employed, are peculiarly pernicious : they are usually
given, under the impression that the whole derangement depends
upon a torpidity of the liver, and with the design of rousing it into
action, but their sole effect too often is to rouse into activity most of
the distressing symptoms which it was intended to remove. Even
blue mass, though given in small doses, if long continued, is usually
improper, as, like ail other mercurials, it increases the irritability of
the nervous system. We do not pretend to say that these medicines
are never beneficial, but we do assert that the cases in which they
will prove useful are comparatively rare. Whilst we would condemn
the employment of active cathartics, we would advocate the use of
mild laxatives, especially those that act but slightly upon the stomach.

714 On Morbid Sensibility of the Stomach. [December,

Aloes and rhubarb are among the best, but others more irritating
may be given if we combine with them some anodyne or narcotic.
The extract of hyosciamus is generally preferred, butflthe extract of
belladonna will ba found equally useful. A formula given to us by
a medical friend has been found very efficacious. It is prepared
with one grain of aloes, one grain of quinine, and one-eighth of a
grain of extract of belladonna made into a pill, and taken at bed-time.
If this pill is not sufficiently active, or if it loses its activity from
frequent use, the quantity of aloes may be increased, or a grain of
the extract of jalap may be added. When the morbid sensibility of
the digestive organs has been considerably subdued, the narcotic may
be omitted. The use of mild enemata must not be omitted, as they
are a most important means of evacuating the bowels. If the bow-
els can be sufficiently moved by an unirritating enema, it is to be
preferred to the mildest laxative administered by the mouth. Cold
or warm water, or weak soap-suds, will generally be found sufficient-
ly active, and may be thrown up once every day. A little practice
will soon enable the patient to administer it himself, and this will
obviate one of the principle objections to its employment. We have
advised the unirritating enemata, because the daily use of those
which are more actively cathartic, might eventually produce disease
in the rectum, whilst no such consequences will arise from the mild-
er kind.

Emetics were at one time in frequent use, but observation has
shewn conclusively that they are almost always pernicious, and they
are now pretty generally abandoned. Occasionally some article
will be taken into the stomach, which will produce unusual distress,
and under these circumstances a mild emetic of warm chamomile
tea, or even warm water will be proper. But even in this case the
more active emetics are to be avoided.

Tonics are among the medicines most frequently employed in the
treatment of dyspepsia. They form the basis of most of the nostrums
and empirical prescriptions for the disease. It would seem at first
sight, that of all other remedies, these would prove the most
valuable. The loss of power in the stomach, with the general wast-
ing of the bod}', and the prostration of the strength, lead naturally to
their employment, but the derangement of the stomach is not one of
debility, neither is the prostration of the muscular power from this
cause, and consequently we are most frequently disappointed when
we rely upon a tonic medication. At best they arc but auxiliaries,

1846.] On Morbid Sensibility of tJie Stomach. "715

and we hesitate not to say, if not used with great caution, auxiliaries
which too often aid the enemy. In the more intense grades of the
affection they are always inadmissible. When, however, the morbid
sensibility is but moderate* we will find benefit from the use of some
of the bitter tonics, such as the gentian, columbo, quassia, &c. Un-
der such circumstances some advise the use of quinine in smali doses.
The benefit which may be derived from this article, however, must
not be attributed to any tonic action, for it possesses no such power.
In the severer forms we would rely more upon the ferruginous pre-
parations, particularly the precipitated carbonate, than upon any
other article usually ranked with tonics. We have employed it with
advantage, but we attributed its good effects to the known power of
lessening nervous sensibility. It should be given in pretty full doses,
repeated two or three times a-day, but care must be taken to prevent
its accumulation in the bowels, which is peculiarly favored by the
existing constipation. The sub-nitrate of bismuth has been frequent-
ly employed, and will be found beneficial in cases accompanied by
eructations of watery fluid, but in other forms we have not found it
particularly useful.

The use of the shower bath will often be found highly efficacious
in imparting tone to the system, and particularly in lessening its
morbid impressibility. The best time for its application is mid-day.
If the patient is much emaciated and debilitated, its use must be
commenced very cautiously, for in some instances the reaction which
follows is imperfect. When such is found to be the case, its use
must be abandoned at once. We have, however, a very efficient
substitute, in daily frictions of the skin, with a coarse towel, or what
is better, hair gloves. The frictions should be carried to such an
extent as to produce some warmth or redness of the surface, and their
use continued for a long period.

Among the palliative remedies, we may rank the alkalies opium,
ether and assafoetida. When there is a considerable formation of
acid in the stomach, the bi-carbonate of soda will be found advan-
tageous. It may be given in full doses, and should be taken just
after eating. Its use should be suspended whenever acid ceases to
be generated. This, the patieut will generally be able to ascertain
from the character of the eructations. Lime water alone, or in
union with milk, is a good article when the acidity is inconsiderable.
The most prompt palliative for the tremblings and other anomalous
nervous symptoms, is opium, or its preparations. It is, however, a

716 On Morbid Sensibility cf the Stomach. [December,

dangerous article for the dyspeptic, for though it gives relief, it acts
injuriously upon the stomach, and as its effects are very prompt, the
patient will fly to it on all occasions, and in the end the medicine will
produce a train of morbid nervous actions equally distressing and
more dangerous than that which it was designed to remove. We
recollect one case of the kind, in which the patient, after years of
suffering, fell a victim to the habitual use of morphine. Instead of
opium we prefer either the sulphuric or the chloric ether. These
diffuse the nervous excitement, quicken the vascular action, and
promptly produce a general calm. These effects, though beneficial,
are quite evanescent, and are soon null, when frequently employed.
Assafcetida is one of our most valuable palliatives. When the pa-
tient is suffering with those nervous disturbances which depress his
spirits, and fill him with apprehension and gloom, or when he is
threatened with a paroxysm of those nervous shocks of which we
have spoken, this medicine will often restore the system to a state
of calm, and his mind to serenity, and, it may be, to cheerfulness.
However frequently it may be given, it can work no injury. It not
only quiets the nervous disturbance, but it is one of our best carmin-
atives, and it often acts as a gentle laxative. The only objection to
it, is its disagreeable odor, but the relief it affords will soon overcome
all repugnance to its use, and the patient will soon swallow it as a
" sweet morsel." Other antispasmodics will doubtless be found use-
ful, but those we have indicated will best answer the desired purposes.

Counter-irritation to the epigastrium has been advised. We have
never employed it. Johnson advises the application of a burgundy
pitch plaster, to which a small quantity of tartar emetic has been
added. Leeches have also been recommended, but we have never
applied them, nor can we imagine a case dependent upon morbid
sensibility of the stomach in which they would prove serviceable.
In derangements of the digestive functions which originate or are
connected with sub-acute gastric inflammation, they would doubtless
prove efficient remedies. Many other medicines are in occasional
use, though of doubtful efficacy, which cur;limits forbid us to notice.

The most important remedial means, that without which all others
will prove unavailing, is a proper regulation of the diet, and this is
precisely the remedy which of ail others is the most difficult of appli-
cation. Patients will readily swallow the most nauseous drugs ; but
require them to restrain their morbid appetites and live for months
upon a small quantity of simple food, and they will often declare it

1846.] On Morbid Sensibility of the Stomach. 717

to be impossible. In general, it is only after a long course of suffer-
ing, that the necessary self-control is acquired. Whilst in the form
of dyspepsia connected with gastric inflammation, a vegetable diet is
to be preferred, in that now under consideration, farinaceous articles
are the only vegetable matters which will be found advantageous.
Bread should constitute the great bulk of the dyspeptic's food. It
should always be stale, never less than two days old. Nothing is
more pernicious than hot or fresh bread. All breadstuffs in the form
of biscuits, waffles, fritters, muffins, et id omne genus, must be care-
fully eschewed. Wheat bread is generally preferable to that made
of corn meal, for although the latter has some effect in keeping the
bowels open, this advantage is more than counterbalanced by its
greater tendency to produce acidity. Rice will be found an excel-
lent article of food, and if not taken in too great quantity, rarely fails
to sit well upon the stomach. When there is no tendency to acidity,
grits or small hominy is preferable to rice. When the disease has
assumed an intense form, a total abstinence from animal food will be
necessary, but in less severe cases, and where the morbid sensibility
of the stomach is diminished, some animal food should be taken at
least once in the day. Chicken is probably the most digestible of
all animal food duck, goose and turkej', are more indigestible. The
white meat of fowls is preferable to the dark. Tender beef, either
roasted, boiled, or broiled without butter, and mutton and lamb, are
meats which may be generally eaten, if the quantity taken be not
too great. Pork, in any form, is utterly inadmissible. Roasting and
boiling are the best modes of preparing animal food, but rich and
oily gravies should never be eaten. Fried articles are always hurt-
ful. Soft boiled eggs will be found to agree well with many stomachs,
but with some persons they will be found always to disagree. Soups
are generally thought to be very digestible, but we believe the opinion
to be erroneous. We have always found them difficult of digestion.
AL1 kinds of pastry, and most puddings, and sweetmeats must be
avoided.

But little drink should be taken at meals in general, however,
the patient does not desire it. It was once quite tho fashion to advise
weak brandy and water, or good wine in small quantity, to be taken
at dinner. These drinks may not be hurtful where some progress
has been made towardj a cure; but when the complaint is at its
height, all alcoholic drinks are unquestionably pernicious. When
taken into tho stomach they often produce a sensation of intense

718 On Morbid Sensibility of the Stomach. [December,

burning. The same remarks will apply to malt liquors. The best
drink is plain water. At breakfast and supper, the patient may take
milk, if it be found upon trial not to disagree, or black tea of these,
the milk is certainly preferable in most instances. With some per-
sons cream is found to agree remarkably well if taken in moderate
quantity. Fresh butter, if used in moderation, may generally be
allowed. After all, however, it must be said, that no very strict
rule can be laid down in relation to the articles of food which a dys-
peptic may safely take. There are often peculiarities that render an
article which sits well upon one stomach highly pernicious to another,
and vice versa. We have recently read of a case in which the pa-
tient recovered upon a diet of boiled turnips ! The patient must
notice the effect of the various articles of food he takes, and avoid
such as he finds to be always followed by much discomfort.

In severe cases the quantity of food should be small, and at such
intervals as will ensure the digestion of what has been before taken.
Nothing can be more erroneous than the advice so often given, to
" eat but little and often." It is impossible to determine how much
may be properly taken, except by careful experiment in each indi-
vidual case, as this will be found to vary with individual peculiarities,
and the degree of derangement in the digestive functions. Johnson
lays down the rule that the patient must " reduce and simplify until
he comes to that quantity of food which will produce little or no al-
teration in his feelings, whether of exhileration immediately after
dinner, or of discomfort some hours after the meal." This rule
though good in the general, is rather stringent. We have seen cases
where even the half-pint of "grit gruel" upon which he declares that
a man may live for twenty-four hours, would cause much discomfort*
The rule however should be observed as closely as the nature of the
case will permit. The food should be eaten slowly and well mastica-
ted. If the patient's self denial be not of a very unyielding char-
acter, it will be best for him to eat by himself, and even then to
have only such articles set before him, and such quantities as he may
safely eat. "Lead us not into temptation," is a very appropriate
prayer in the mouth of the dyspeptic. It is often advised that the
dyspeptic should take his morning meal as soon as he rises from bed.
We have found this plan uniformly hurtful; it is far better to take
some exercise in the open air before breakfast. This meal should
always be moderate, for if more be taken at that time than the stom-
ach can manage, it invariably lays the foundation for an uncomfort-

1846.] On Morbid Sensibility of the Stomach. 719

able day. Each of the subsequent meals, whatever may be the
quantity or quality of the food, will produce more or less discomfort.
Dinner should always be the principal meal, and should not be taken
until at least six or eight hours after breakfast. Suppers are to be
avoided. A cup of black tea, or of milk, and a soda cracker or small
piece of dry toast, are all-sufficient for any dyspeptic. If more be
eaten, an unrefreshing sleep, and an aggravation of all the symptoms
during the next day, will be the result.

Next to a proper regulation of diet, a judicious system of exercise
is of the greatest value. The organic instincts call for exercise in a
language which cannot be misunderstood. At his worst moments
the patient suffers least when he is in motion. The best kind of
exercise* when the strength will permit, is the pedestrian the next
is horseback. Riding in a carriage, except for such as are extremely
debilitated, is entirely profitless. Bodily labor of any kind which the
patient is able to undergo, will prove highly beneficial. The patient
must keep regular hours, rise early in the morning, and retire to bed
also at an early hour. Whatever mode of exercise be adopted, it
should be persevered in steadily, and not suspended until some fatigue
be produced.

Some years since a method of treating dyspepsia was proposed by
Mr. Oliver Halsted of the city of Xew-York, which he had success-
fully employed in his own case, (a protracted and severe one,) and
also in those of many other persons, who subjected themselves to a
similar treatment. The peculiarity of his method consists principally
in the agitation of the stomach and bowels for a minute or two every
half hour through the day, beginning about an hour after each meal.
We extract from his work on the subject his mode of operation.
" The patient should be placed in the position that will favor most the
relaxation of the abdominal muscles. A sitting posture will be the
best for this purpose. Then the practitioner seated on the right of
the patient, and facing him, places his right hand upon the lower part
of the abdomen in such a manner as to effect a lodgment, as it were,
under the bowels, suffering them to rest directly upon the edge of
the extended palm, from the tip of the thumb to that of the fore-finger.
When the muscles have been properly relaxed, there will be no diffi-
culty in doing this. Then by a quick, but not violent movement of
the hand in an upward direction, by which the bowels are thrown up
much in the same manner as in riding on horseback, a sort of pulsa-
tory action will be communicated to the stomach, and a sensation

720 On 3Iorbid Sensibility of the Stomach. [December,

experienced, similar to that produced by a slight blow upon the region
of the organ. By continuing this action for one or two minutes, a
sense of warmth, and a feeling somewhat like that experienced from
a slight electric shock, will be felt at the stomach, and a general ex-
citement or gentle glow throughout the system. The pulse will most
frequently be increased in strength and frequency; the extremities,
when cold, will have a little return of warmth ; and not unfrequently
there will be a gentle perspiration all over the body. When flatu-
lence has been a prominent symptom, large quantities of wind will
be thrown up to the great relief of the patient, indicating an internal
and natural contraction of the organ upon its contents."* We have
undergone this treatment with decided benefit, but it was not perse-
vered in as long as it should have been, to give the method a full
trial. During its employment the bowels became regular, whirh had
not been the case for many months previous. The relaxation of the
abdominal parietes which Mr. H. requires as a preliminary to the
agitation of the viscera is of great importance. If an individual will
acquire the art of doing this, which he can easily do, and relax them
when he takes exercise, either on foot or on horseback, he will find
it highly beneficial. It will never fail to procure a discharge of the
flatus which sometimes forms so rapidly, and not only retards the
process of digestion, but produces great oppression and distress.

In urging the importance of exercise we must not omit to state
that its benefits are very much restricted, unless the mind is at the
same time kept employed with something to interest and divert it.
Hence the great advantage which travel affords. It rarely, if ever
happens, that the dyspeptic returns from a journey, without having
experienced great benefit. No matter what may be the amount of
fatigue and annoyance he may have had to undergo, it will be all
the better for him. A long voyage, if with agreeable companions,
exerts a wonderful influence in restoring tone and regularity to the
action of the nervous system, and in invigorating the digection.
Every one however cannot travel, but one of its great ends is attain-
ed whenever bodily exercise and mental occupation and amusement
can be combined.

+ Mr. H. has since invented a chair, which is co contrived that by the action
of two handles, to be worked by the patient himself, a full agitation of the
abdominal viscera is effected. This contrivance is admirably adapted to the
cases of persons whose general health and occupations forbid exercise in the
open air, and of females generally, who are always necessarily much confined
within doors.

1846.] Tumour of the Mamma, spontaneously cured. 721

The dyspeptic patient should be warmly clad. Flannel should be
worn next to the skin, and the feet protected against damp and cold
by warm stockings and thick boots or shoes. If thus protected, it
will not be necessary to confine himself to the house in any weather,
but he may at ail times take his accustomed out-door exercise.

The course of treatment we have advised, if steadily pursued for a
sufficient time, will rarely fail to effect a cure. Let not the dyspep-
tic despair his fate, in some measure, is in his own hands. If he
suffers not the cravings of appetite to draw him from the proper
course, in the end he will reap the reward of his perseverance and
self-denial. But he must not relax his efforts because he does not at
once find relief. A disease which probably has been for years, mak-
ing a stealthy yet steady progress, is not to be arrested at once.
Months will elapse, it may be years, before an entire restoration is
effected, but this will at length occur, and even long before he is per-
fectly cured, he will find himself in comparative health and comfort.
This, however, is often a critical moment, for too often he begins to
indulge in forbidden articles or practices, and then he either relapses,
or protracts the cure. Even when fully restored, he must beware how
he trifles with his stomach, for if he does, he may bring back upon
himself the whole of that train of disease and suffering which had so
long rendered life a burthen.

ARTICLE XLV.

A large Tumour of the Mamma, spontaneously cured. Reported by
A. B. Greene, M. D., of Sumter County, Georgia.

The subject of these remarks is a negro woman belonging to Col.
M. A short time after she arrived at the usual age for the full devel-
opment of the sexual organs, the right mamma was observed to be
largest, and increased in dimensions gradually and continuously, un-
attended with pain, except what was induced by its suspension, when
not properly supported. About twelve months preceding her preg-
nancy, my attention was first called to an examination of the enlarged
mamma, and I found all the usual evidences of simple sarcoma
present, with nothing of a malignant character. The skin and
subjacent tissues seemed as healthful to the touch, and as free from
uneasiness when handled, as any other mass of flesh about the body.

10

722 Tumour of the Mamma, spontaneously cured. [December,

Its size already amounted to great deformity, and was obvious to
any passing observer.

I did not hesitate to advise her intelligent owner, that an immedi-
ate operation was the only certain cure ; and pointed out the danger
should amputation be deferred, that might result from pregnancy and
accouchement, in the development of some malignant tendency, or at
least, subjection to severe suffering.

The force of my suggestions was appreciated ; but fearing the
operation, and trusting to some happy, fortuitous change, it was neg-
lected. She became pregnant, and at the full term of gestation in
January last was delivered without any unusual difficulty, and soon
felt pain in the enlarged breast for the first time. At the expiration
of six weeks, it had grown so rapidly, that while sitting upright the
enlarged mamma rested on her lap. It was enormously distended,
and of such weight, that however well supported, her chest was
strongly inclined forward. I could never detect any circumscribed
induration, nor any other evidence of the formation of abscess. She
was put upon strict antiphlogistic treatment, medicinal and dietetic.
General and local depletives, emollient fomentations and poultices,
to relieve turgidity; and the occasional application of the pump and
cup to the nipple to encourage a discharge of the milk, should any
possibly be secreted.

While these means were being applied, a spontaneous discharge
occurred from about an inch above the nipple in a continued stream
it incessantly poured out, until one gallon and a half of a milk-like
fluid had come away. Immediate and complete relief was expressed,
and no appearance of debility, or other adverse symptom, as a con-
sequence of the sudden and almost incredible quantity dislodged,
was observed.

From that time, the breast gradually assumed the size it bad at-
tained before her accouchement. Her general health and strength
improved daily, and in a short time she was out on the farm at labor,
though of an easy kind, and self-imposed. While thus employed, she
was exposed to a drenching rain, and in a few days I was summoned
to visit her again.

I found her now laboring under an acute rheumatism, in its mo&t
dangerous and painful form. The pleura was implicated, and a
manifest tendency to low typhus rendered her condition very criti-
cal.

When we found that she might possibly survive the attack, my

1846.] Tumour of the Mamma, spontaneously cured. 723

attention was again directed to the condition of the diseased breast.
Upon examination an ulcer was found, situated near the nipple the
breast again greatly increased in size. The ulcer discharged matter
of a thin purulent character, and most noisome odour. Other ulcers
were formed, and they soon numbered seven, emitting vast quantities
of insupportabiy horrid pus. like fluid. By patient perseverance In
the use of the chloride of lime, charcoal poultices, and a variety of
astringent injections, the discharges assumed a more healthy appear-
ance and less offensive odour.

The patient was now a miserable looking object of emaciation ;
and to every one her death seemed inevitable. It would be needless
to dwell upon the treatment here, constitutional and local.

The largest and most pendent ulcer presented a prominence in the
centre, which I found to be insensible. Upon raising it with the for-
ceps, I was surprised to find that by gentle traction a considerable
mass was drawn out without any pain. I applied the scissors and
separated that portion. There was not a drop of blood discharged.
I then seized the remaining mass with a small tenaculum, and readily
drew out in a string-like form, a connected volume of flesh-colored
substance, until by the pain produced, I supposed the mass too large
to pass through the ulcer, and again detached it with the scissors.

I now found a large hollow chasm left under the ulcer, and changed
the position of the breast to examine the other ulcerated openings,
but as they were situated above, nothing unusual presented at them ;
but when restored to the same situation again, I found the chasm
occupied, and another mass presenting. By pulling gently with the
forceps at different points, I succeeded in starting another slough
through the ulcer, which passed easily, until one entire mass of large
size fell from it without the use of any excising instrument. No
blood followed, except what escaped from the edges of the dilated
ulcer.

There was now an extensive, unoccupied space, left by the large
volume of detached slough ; and by the aid of the light admitted
through the several ulcerated openings, (I fancied.) was seen the
original "bona fide" gland, bounding the upper part of this space.

As nature had performed the amputation so well, thus far, I deter-
mined not to interfere!, in the already exhausted condition of the
patient, by removing the now redundant skin.

Our next care was to ascertain the amount of the self-amputated
masss, which was attached to the hook of a pair of 4i draw-spring

724 A Case of Probable Absence of the Uterus. [December,

steelyards, (the only means of weighing at hand,) and weighed one
and a half pound.?. The small fragments, not weighed, Col. M. sup-
posed would amount to at least a half pound more.

We were surprised, at first, that so much bulk and volume should
weigh no more ; but upon careful examination, I found it composed
of a cellular structure, comparable to honey-comb, interspersed
with fine particles of a "coffee-ground" color. The breast was
bathed with infusion of red-oak bark, and covered with a large poul-
tice of the same excellent astringent, moistened with solution chloride
of lime, and secured by means of bandages, bound on so as to exert due
compression on the now flaccid parts. General directions were giv-
en for future management, and I did not see the patient from that
time, which was 24th of April last, until a few days since, when I
visited her, in order to report upon her present condition.

She has been doing the labor of a hand upon the farm, for some two
months now. The remains of the mamma are about half the size of
the well-formed natural one the skin is regularly contracted and
adherent the ulcers are all healed soundly, except a very small per-
foration, still giving exit to some discharge, of inoffensive appearance.
Her general health is perfect in all respects, having recovered her
former flesh, activity and cheerfulness of mind.

ARTICLE XLVI.

A Case of Probable Absence of the Uterus. By Pafl F. Eve, M. D.,
Prof, of Surgery in the Medical College of Georgia.

About four years ago, I was consulted by a gentleman from a
neighboring state concerning the condition of hiss'wife. She was a
lady twenty years old, had been married more than eighteen months,
and as she was in easy circumstances, was very anxious to have chil-
dren. She had never menstruated, and for four or five years past
had had at pretty regular monthly periods, an efflorescence and mot-
tled appearance on the skin. These would continue for a few days,
during which she suffered great malaise, and then subside. This
lady was well made and well proportioned, having developed mammae
and the other characteristics of the female sex. On examination, the
external organs of generation were found to be natural, but the
finger, introduced up the vagina, encountered beyond an irregural
contraction a perfect cut de sac. The contraction alluded to, was

1846.] On the Mechanism of Resjxiralion. 725

situated about three inches from the os externum, and may have been
an imperfect attempt at an os tincae, though it felt more like the re-
mains of the hymen or caruncula myrtiformis, and readily admitted
the finger. Nobody resembling the womb itself could be detected
by the most careful palpation over the lower part of the abdomen,
while the finger was in the vagina, or by the finger introduced up
the rectum. She never, too, has been troubled with leuchorrhcea.
Her husband stated she enjoyed his society con amcre. If the uterus
be absent, as I suspect is the fact in this case, might not this mar-
riage involve a question in medical jurisprudence?

PART II. REVIEWS AND EXTRACTS.

We are under great obligations to Prof. John Le Coste, M. D.,
of the University of Georgia, for the following valuable and inter-
esting articles :

"On the Mechanism of Resjriration." By Francis Sibscn. Commu-
nicated by Thomas Bell, Esq., F. R. S. Read before the Royal
Society, Feb. 19th, 1846.

This paper is almost entirely occupied with anatomical details,
collected from an extensive series of dissections of the muscles and
bones concerned in the act of respiration in man and the lower ani-
mals, for the purpose of elucidating the mechanism of their action
both in inspiration and in expiration. The author commences with
the serpent tribes, which present the simplest form of ribs, being at-
tached only at their vertebral ends, while their anterior ends are
free. When these ribs are brought forwards by the action of the
levatores costarum and external intercostal muscles, the chest is
expanded ; and when drawn backwards by the long depressors, in-
ternal intercostals and transversalcs, expiration is effected. In birds
there are added to the former apparatus a sternum, and a series of
sternal ribs, the respiratory movements of which are performed in
directions the reverse of those of the vertebral ribs. During inspira-
tion, the angles between the vertebral and sternal ribs become more
open ; the sternum moves forwards, and the spinal column slightly
backwards, by the combined action of the scaleni and sterno-eostal
muscles on the first vertebral and first sterna! ribs respectively; of
the levatores costnrum and external intercostal on all the lower ster-
nal ribs. On cxpiiation, these moi Ned bv the action

72fi On the Bloic -hole of the Porpoise. [December,

pf the internal intercostal?, the external and internal oblique, recti,
transversals and other muscles. The mechanism in the Mammalia
is further assisted and modified by the addition of a large and power-
ful diaphragm. The thoracic ribs are articulated with the sternum
by the medium of cartilages corresponding tc the sternal ribs of birds:
those ribs which are connected with the inferior curve of the dorsal
arch have floating cartilages, and may be considered as a diaphragma-
tic set of ribs. When raised, the former approach each other, and
the latter recede from each other anteriorly. Intermediate to these
are the longer ribs connected with the dorsal arch, having their cartil-
ages united, and articulated with the lower end of the sternum. The
scaleni muscles invariably act during the whole time of inspiration.
The external intercostals between the thoracic ribs are also through-
out inspiratory; but those portions which are situated between their
cartilages are expiratory ; and those between the diaphragmatic ribs
are inspiratory behind, expiratory to the side and in front, and in-
spiratory between their cartilages. Between the intermediate ribs,
they are for the most part slightly inspiratory between the ribs, and
expiratory in front, between the cartilages. The external intercos-
tals of the thoracic ribs are expiratory behind, and inspiratory in
front, if the ribs approach these, and are inspiratory between their
costal cartilages. Between the diaphragmatic and intermediate sets
of ribs, and between their cartilages they are throughout expiratory.
The levatores costamm draw the posterior portion of the lower ribs
backwards. In the ass and the dog, the upper fasciculi of the serra-
tus magnus are expiratory, the lower inspiratory, and the intermediate
neutral. In man, the greater part of the fasciculi of this muscle is
expiratory. In the ass, the lower fibres of the serratus posticus infe-
rior are inspiratory, and the upper fibres expiratory. In the dog and
in man, all are throughout expiratory. (Phil. Mag. for July, 1846,
pp. 48 et 49. J. Le C.

t'On the Blow-hole of the Porpoise." By Francis Siljson, Esq..
Communicated by Thomas Bell. Esq., F. R. S. Read before the
Royal Society, March 12th, 1846.

The external opening of the air-passage of the porpoise is so situa-
ted at the upper part of the head, as to admit of the animal's breathing
while only a small portion of its head is above the water. In its de-.
scent through the skull, between the cranial and facial bones, the
tube is divided by a thin plate of bone into two nasal canals, which
form, below this partition, a single muscular tube opening at its lower

1846.] On Motion of the Lumbar Division of the Spine in Birds. -727

part into the pharynx by a constricted aperture, through which the
larynx projects upwards quite through the pharynx, dividing it into
two channels. A series of pouches, five in number, capable of great
dilatation, and provided with a muscular apparatus for retaining or
expelling their contents, communicate by large orifices with nasal
canals, and appear to correspond in situation with the antra, frontal
sinuses and ethmoid cells. The author gives a minute anatomical
description of these muscles, and an account of their modes of action ;
the adjustments of the apparatus being such that the outer passage
may be closed or opened above or below the anterior pouches. When
the outer passage is closed, the posterior pouches can be distended
q.nd the anterior emptied ; while the converse may be effected when
the passage is open. The use of the pouches appears to be to buoy
up the head, so that on the porpoise rising from deep water, the open-
ing for breathing comes first to the surface and admits of the animal's
sleeping in that position, while its whole body remains immersed in
the water. (Phil. Mag. for July, 184G, pp. 50 et 51.) J. Le C.

"On Motion of the Lumbar Division of the Spine in Birds." By
George Oaklev Flemming, M. D., F. R. S. Communicated by
Thomas Bell, Esq., F. R. S. Read before the Royal Society,
March 12th, 1846.

The author gives quotations from the works of Cuvier, Blumen-
bach, Tiedeman, Macartney, Vicq d'Azyr, Carus, Earle, and Roget,
in proof of its being the prevalent opinion among comparative physi-
ologists that the dorsal and lumhar portions of the spine form alto-
gether a rigid structure, not admitting of the least perceptible flexion.
But from his observations of the form of the articulating surfaces of
the lumbar vertebra?, which appear to be adapted to lateral motion,
the author was led to conclude that, although flexion in the mesial
plane is effectually prevented, some degree of lateral flexion actually
takes place. The number of articulations in this part of the spine,
he observes, varies in different birds: thus in the sea-gull, there are
several articulations in the dorsal and lumbar portions; while in the
peacock, there is only one moveable vertebra; the remaining dorsal
being united together, and all the lumbar vertebrae being consolidated
and anchylosed with the sacrum; thus forming two firm and immova.
ble pieces between which the movable vertebra i; placed. The flexion
of the spine forwards is prevented by the great breadth of the spinous
processes, and their projections at rieji? uncles to tbe bodies of the
vertebra: ; and frequently nlso by the addition of a number of ihiri,

723. Muscularity of the Iris. Chemistry of the Urine. [December,

flat, long bones which are applied by their flat surfaces on each side
of the spinous processes; and also by strong flat ligaments, situated
between the spinous process, like the ligamentum nuchjs of herbivor-
ous quadrupeds. For the purpose of guarding against pressure on
the spinal cord during the lateral flexion of this part of the spine, the
spinal canal is enlarged laterally at the centres of motion. (Idem,
p. 51.) J. LeC.

" On the Muscularity of the Iris." By Prof. Maunoir, of Geneva.
Communicated by P. M. Roget, M. D., Sec. R. S, Read before
the Royal Society, March 26th, 1846.

The author has satisfied himself from Vne result of his own dissec-
tions, as well as from the concurrent testimony of a great number of
anatomists, that the iris is provided with two sets of muscular fibres,
the one orbicular, immediately surrounding the pupillary margin
and acting as a sphincter ; the other, extending in a radiated direc-
tion from the exterior circumference of the former to their insertions
into the ciliary ligament, their action being to enlarge the pupil.
One-fourth of the disc of the iris is occupied by the orbicular, and the
remaining three-fourths by the radiated muscle. The author ha3
examined the structure of the iris in a great number of animals, and
states the results obtained by M. Lebert, whom he applied to on this
occasion, from numerous dissections of the eyes of animals belonging
lo each class of the vertebrata. He also refers to a work which he
published in 1812, entitled "Mgmoire sur 1 'Organisation tie I'lris,"
for evidence of the muscularity of the iris which he obtained by ap-
plying galvanism to the human eye immediately after decapitation;
and he concludes with the narrative of the case of a woman in whose
iris there had been formed, by an accidental wound with the point of
a knife, a triangular aperture below the pupil. This aperture be-
came dilated when the pupil was contracted, and vice versa ; thus
furnishing a proof that its movements were effected by muscular ac-r
Hon. (Phil. Mag. for July, 1816, p. 53.) J. Le C.

" Contributions to the Chemistry of the Urine." Part 2d. " On the
Variations of the Alkaline and Earthy Phosphates in Disease."
By Henry Bence Jones, M. D., Fellow of the Royal College of
Physicians. Communicated by Thomas Graham, Esq., F. R. S.
Read before the Royal Society,* April 2d, 1846.

The analyses of which the results are given in a series of tables,
were made by the author, chiefly from the urine of patients laboring

1846.] Chemistry of the Urine. 729

under different diseases in St. George's Hospital, and therefore near-
ly under the same circumstances, as far as exercise was concerned.
He found that the variations in the earthy phosphates were in general
independent of the nature of the disease. In fractures of the spine
and paraphlegia, however, the total amount of the salts was slightly
above the healthy standard during the early period, and when inflam-
matory action might be considered as prevailing; but when this ac-
tion had subsided, and the affection had become chronic, the total
quantity of phosphatic salts was less than natural. In chronic dis-
eases of the brain, and in chronic and even in acute diseases of the
membranes, no increase of these salts was observed. In fractures of
the bones of the skull, when inflammation of the brain supervened,
there was a slight increase of the total amount of phosphates ; but no
such increase occurred when the head was not affected ; even al-
though acute inflammation of other organs existed. In acute inflam-
mation of the brain there was an excessive secretion of phosphates,
which returned to the natural quantity as soon as the inflammation
passed into the chronic state. In some functional diseases of the
brain, attended with delirium, the secretion of the salts was excessive ;
but the excess ceased with the disappearance of that symptom. In
other functional diseases, as in fevers, no excess was observable. In
delirium tremens, when food could be taken, there was neither ex-
cess nor deficiency ; but in the most violent cases, where no food
could be taken, the quantity of the phosphates was diminished in
a most remarkable degree. In the general paralysis of the insane,
no increase of phosphates was observed. One case of acute par-
oxysm of mania showed a small increase during the paroxysm;
in two other cases of mania there was a diminution cf phosphates
approaching to that occurring in delirium tremens. Blight's dis-
ease, even attended with acute inflammation, showed no increase.
When only a few ounces of urine were secreted, as in dropsy, no
increase was observed ; and none also in a very extreme case of
exostosis. In the case of mollifies ossium. there was a decided
increase of the earthy phosphates; and at last, the alkaline phos-
phates were also in excess, although there was no indication of
affection of the nervous structures.

The following are the general conclusions which the author draws
from his inquiries : first, that acute affections of the nervous sub-
stance, organic and functional, are the only diseases in which an
excess of phosphatic salts appears in the urine; and in acute inilam-

730 On the Effects produced by Poisonous Fish, S$c. [December,

mation of the brain, its amount is proportional to the intensity of the
inflammation; secondly, that in a large class of functional diseases
of the brain, of which delirium tremens presents the most marked ex-
ample, the secretion of the phosphates is most remarkably diminish-
ed ; and, lastly, that no chronic disease presents any marked excess
in the total quantity of phosphatic sails secreted, as far as the mode
of analysis employed by the author can be regarded as conclusive.
{Phil. Mag. for July, 1846, pp. 53 et 54.) Does not the amount of
food taken have a marked influence on the quantity of phosphatic
salts secreted by the kidneys? According to the above researches
of Dr. Jones, the amount was natural in cases of delirium tremens
where food could be taken, but there was a remarkable diminution in
the quantity of these salts when food could not be taken. Would not
fasting produce the same result in a healthy individual ?

J. LeC.

" On the Effects 'produced by Poisonous Fish on the Human Frame."
By Sir William Burnett, M. D., K. C. H., Vice-President of the
Royal Society. Read April 2d, 1846.

The author communicates a report which he lately received from
Mr. Jameson, the surgeon of the flag ship at the Cape of Good Hope,
of the rapidly fatal consequences ensuing from eating small portions
of the liver of a fish, known at the Cape by the name of the Bladder
or Toad fish, the Aptodactylus punctaius, or Telrodon of Cuvier.
The symptoms were chiefly pain and burning sensation at the
epigastrium, constriction and spasm of the fauces and muscles of
deglutition, rigidity of the tendons, coma, paralysis and convulsions,
following one another in quick succession, and terminating in death
within twenty minutes after the poisonous food had been taken.
Several other instances of the same kind are next related ; and a
narrative is subjoined of the case of a seaman who lost his life, with
similar symptoms, from the bite of a water-snake in Madras roads;
the Coluber laticaudalus of Linnasus (Hydrus colubrinus of Shaw);,
and also of a ship's company who were severally affected by eatmg
portions of a large Banacuda (Perca major). The author ascribes
the symptoms induced by these deleterious substances to their action
on the nervous system alone, tiiere being evidence of congestion only,
but not of inflammation in the stomach and other viscera. [Phil.
Mag. for August, 1846, pp. 128 et 129.) Perhaps, it may be proper
to remark in this connection, that throughout the Southern States,

1.S46.] On the Nervous System of the Uterus. 731

the reptile, commonly called the "Wafer-snake (Coluber sipedon, or
Tropidonolus sipedon), is very generally confounded with a venom-
ous species of Moccasin (Trigonoccphalus piscivorus). The former
is a perfectly harmless snake. Doubtless many of them have fallen
victims to an indiscriminate antipathy, growing out of a resemblance
to their dangerous congener. Ignorance on such subjects sometimes,
leads to very serious consequences. I knew a casfcin which a negro
woman nearly pioduced gangrene of the leg by tying a cord above,
the knee, for the purpose of arresting the diffusion of the imaginary
poison of a Water-snake, on which she had accidentally placed her
foot ! ! It is needless to add, that as soon as the ligature was remov-
ed, which was effected with considerable difficulty, for it had been
drawn so firmly that it was scarcely visible between the overlapping
skin and flesh, all unpleasant symptoms disappeared.

The number of species of poisonous serpents inhabiting our coun-
try is comparatively few, and several of them quite rare. Of the
whole number of snakes found in our State, there are probably, not
more than six species which are in the slightest degree venomous ;
and some of them are so rare, that they are scarcely ever seen, even
by the industrious herpetologist. Yet how indiscriminate is the
hatred and destruction of these unfortunate reptiles ! ! A very slight
examination of the dental apparatus will serve to distinguish the
innoxious from the poisonous serpents in the first instance, and after-
wards, the shape and general appearance are,sufficient marks of dis-
tinction. The fangs, or tubular poisorting teeth of the venomous
species are readily detected. J. Le C.

44 Further Researches on the Nervous System of the Uterus." By
Robert Lee, M. D., F. R. S. Read 'before "the Royal Societv,
April 2d, 184$.

The author states that on the 8th of April, 1833, he discovered, in
dissecting a gravid uterus, structures which had a striking resemb-
lance to ganglionic plexuses of nerves ; and, it) the following Decem-
ber, he traced in another gravid uterus, the sympathetic and spinal
nerves into these new structures. lie requested several distinguished
anatomists to examine these dissections, and to compare them with
similar dissections of the. unimpregnated uterus, which he had made
in the course of the same year. lie then quotes, at some length,
the opinions given by these several references after their examina-
lion; and which appear, for the most part, to be favorable to the
views of the author, namely, that the structures in question are not

732 Anatomy and Physiology of the Joints. [December,

mere fibrous tissues, but that they possess the character of nerves,
and that they augment in size with the enlargement of the uterus
during pregnancy. Among those to whom the preparations were
submitted for examination, however, two persons declared it to be
their opinion, which they founded on observations with the micro-
scope, that the filaments regarded by the author as nerves, are bands
of elastic tissue or*-,, and not plexuses of nerves; and the author, on
receiving this intimation, withdrew a paper which he had presented
to the Royal Society, and which had been read on the 42th of Dec,
1839, in which paper the appearances displayed in his dissections
were minutely described and delineated. The author next proceeds
to give the history of his subsequent researches on the same subject,
which he extended to the corresponding parts in some of the larger
quadrupeds ; and from all these he obtained accumulated evidence of
the truth of his original opinions. He also adduces the testimony of
various observers, in addition to those he had before cited, which are
all in accordance with his own views, as they are expressed in his
paper, printed in the Philosophical Transactions for 1841, an Appen-
dix to which was published in the volume of the same work for 1842.
Later observations and dissections have served only to confirm his
opinions; and he considers them as establishing the fact that nerves
of the uterus are considerably enlarged during the gravid state of tha,t
organ.

The author concludes his paper by giving a report, drawn up by
Mr. John Dalrymple, of the results of his microscopic examination
of the uterine nerves in preparations furnished by the author, which
tend to corroborate his views. {Phil, Mag. for August, 1846.,
pp. 129, 130.) J. LeC.

" On the Anatomy and Physiology of the Vascular Fringes to Joints,
and the Sheaths of Tendons.'" Bv George Rainey, Esq., M. R.
C. S. Communicated by John Simon, Esq., F. R. S. Read
before the Royal Society, May 7th, 1846.

It has been generally believed that the folds of synovial membrane
which project into the articular cavities in the form of fringes, con-
tain merely globules of flit, and are subservient only to the mechani-
cal offices of filling up spaces that would otherwise be left vacant
during the movements of the joints. By a careful examination of
their real structure with the aid of the microscope, the author has
found that they present an arrangement of vessels quite peculiar to
themselves, and bearing no resemblance whatever to that of the ves-

1846.] Desquamation and change of color in a Negro. 733

sels which secrete fat ; together with an epithelium, remarkable by
its form and disposition, and < endowed with

the function of a special secretion. He has traced the presence of
these synovial fringes in all the cavities which contain synovia; that
is to say, not only in the joints, but also in the sheaths of tendons, and
in the bursas mucosae. When well- injected they are seen, under the
microscope, to consist of two parts ; namely, a convolution of blood-
vessels, and an investing epithelium. These convoluted vessels do
not inclose, by their anastomoses, spaces like those capillaries which
secrete fat, and which are of a much smaller size than the former;
and the epithelial investments, besides inclosing separately each
packet of convoluted vessels, sends off from each tubular sheath
secondary processes of various shapes, into which no blood-vessels
enter. The lamina itself, forming these folds and processes, consists
of a very thin membrane studded with flattish oval cells, a little
larger than blood corpuscles, but destitute of nucleus or nucleoli;
presenting none of the characters of tessellated epithelium, but cor-
responding more to what Mr. Goodsir has termed germinal membrane.
From all these facts, the author concludes that the proper office of
this structure is to secrete synovia ; an office which Clopton Havers
had assigned to them as long ago as the year 1C91, although his opin-
ion has not been generally adopted by later physiologists. (Phil.
Mag. for August, 1840, p. 130.) J. Le C.

" An Account of the Desquamation and change of color in a Negro
of Upper Guinea, West Africa." By the Rev. Thomas S. Sav-
age, M. D., Corr. Member ofthe Boston Natural History Society,
etc. Communicated by Richard Owen, Esq., F. R. S. Read be-
fore the Royal Society, May 28th, 1846.

The subject of this narrative, named Tahtoo Duari, is a member
of the Grcbo tribe, the aboriginal inhabitants of Cape Palmas and its
vicinity. His parents were members ofthe same tribe and natives
of the same region. The father was of a decidedly black complexion,
while the mother was what was termed yellow, the two extremes ob-
servable in the tribe, and between which there is found every variety
of shade. In March, 1844, when about 25 years of age, Tahtoo was
attacked with a quotidian ague, having previously been in perfect
health. The febrile symptoms subsided in the course of a week, but
were followed by a general desquamation ofthe cuticle, leaving the
subjacent skin of a dingy yellow hue. A month afterwards, the same
process, preceded by a similar febrile attack, recurred, and was fol-

734 On the Physiology of the Human Voice. [December,

lowed by still greater whiteness of the newly-formed skin, resulting
in the complete conversion of a negro to a white man, retaining the
characteristic features and hair of an Ethiopian. This change was
accompanied with great sensibility of the skin to the heat of the sun
and of fire, exposure to which readily excited irritation, and even
inflammation ; but the general health soon became completely re-
established. In the course of three months, subsequently to tins
change, numerous spots of a chestnut-brown color made their ap-
pearance, first on the wrists, then on the back of tiiearms, head and
neck, and successively on the other parts of the body, forming by
their extension dark patches of various sizes ; which, being scattered
over the whole surface, presented a singularly mottled appearance ;
and as the black color became predominant, the white portions of the
skin seemed like patches of irregular shape formed in the natural
negro skin. With the color of the skin, that of the hair, which had
also become white, has been generally restored to its former black
hue. During this process of return to the natural color the health
has been remarkably good. (Phil. Mag. for August, 1846, pp. 131
ct 132.) A detailed account of this curious case, may be found in
the American Journal of the Medical Sciences for July, 1848, illus-
trated by a colored delineation of the mottled appearance presented
during the transition stage. It is manifest that the change of color
was owing to a disease involving the coloring layer of the skin ; it
was only temporary, the black hue returning very soon after the der-
moid system resumed its appropriate and healthy function.

J. Le C.

11 On the Physiology of the Human Voice." Bv John Bishop, Esq.,
F. R. S. Read before the Royal Society, June 11th, 1846.

After premising a brief description of the system of organs which
are subservient to the voice, the author proceeds to consider the seve-
ral theories which have been devised to account for its various modi-
locations. These theories have, for the most part, been founded on
the laws which regulate the vibratory movements of stretched mem-
branous surfaces ; and the investigation of those laws has accordingly
occupied the attention of many eminent mathematicians, such as
Euler, Bernoulli, Riccati, Biot, Poisson and Herschel ; but it is a
subject requiring the most profound analysis, and involving the reso-
lution of problems of much greater complexity than the laws of the
vibrations of either strings or bars. The assumptions which are
necessary in order to bring the subject within the reach of analysis,

181(3.] On the Physiology of the Human Voice. 733

namely, that the membrane is homogeneous in its substance, and of
equal thickness and elasticity throughout its whole extent, are at va-
riance with the actual conditions of the vocal organs, which are
composed of tissues differing in thickness, density and elasticity, and
of which the tension is indeterminate ; circumstances which present
insuperable obstacles to the attainment of a mathematical theory of
their vibrations.

The author, after giving a critical account of the experiments
made by Biot, Willis, Muller, Cagniard la Tour and De Kempelin on
the vibrations of membranous laminae, examines the various actions
of the vocal organs during the production of the more simple tones ;
and considers more especially the office of the vocal ligaments, in
regulating the pitch of the voice, which he considers as resulting from
variations in their length and tension conjointly. By applying to
the chorda? vocales the formulas of vibrating cords, he traces the in-
fluence which is exerted on their movements by the mucous mem-
branes; and finds that they obey, to a certain extent, the laws of
vibrating strings.

The analogy between the action of the glottis and that of a reed
is next examined, and an opinion expressed that the movements of
the glottis in the vocalization of sound, partake of the nature of the
reed, during the partial opening and shutting of the rima-glottidis.

The author next investigates the acoustic relations between the
actions of the glottis and that of the vocal pipe, and the acoustic
effects of flexible membranous tubes on a column of air vibrating
within it, and finds that the structure of the trachea and of the soft
parts above and below the larynx is adapted to vibrate synchronously
with any note that may be formed in the larynx. The falsetto voice
maybe produced either by the partial closing of the glottis, or by a
nodal division ofthc vocal chords; the pitch of the sound in the pro-
duction of this peculiar modification of the voice, being such that the
column of air in the vocal tube is of the precise length requisite to
vibrate in unison with the larynx. The inquiry is further extended
to the sources of the various tones of the voice in singing, such as the
base, tenor, contralto, and soprano ; together with their subdivisions of
barytone, mezzo-soprano, and soprano -sfogato ; and to the places
which they occupy in the musical scale. Independently of the fal-
setto, the compass of the natural voice rarely exceeds two octaves ;
although in some cases, as in those of Mali bran and Catalini, it may
extend even beyond three. The voice in singing is modulated by

736 On the Physiology of the Human Voice. [December,

the contraction or relaxation of the velum, i vula and fauces. The
author lastly adverts to the attempts that have, at various times,
been made by the Abbe Mica!, Faber, Kratzenstein, DeKempelin,
Willis, Wheatstone and others, to imitate articulate sounds by
mechanism.

Having thus examined the human voice as resulting from the
vibration of membranous ligaments, in obedience^rsi, to the laws
of musical strings ; secondly, to those of reeded instruments ; and,
thirdly, to those of membranous pipes ; he arrives at the conclusion:
that the vocal organs combine, in reality, the actions of each of these
instruments, and exhibit in conjunction, the perfect type of every
one of them. (Phil. Mag. for August, 184G, pp. 132 et 133.)

The attempts made to imitate the articulation of the letters of the
alphabet, words, and even sentences, by means of speaking machines,
have been more or less successful. All are acquainted with the his-
tory and fate of the ingenious contrivance which the unfortunate
Faber exhibited in New-York. Mr. Willis, of Cambridge, adapted
cylindrical tubes to a reed, whose length he varied at pleasure by
sliding joints. Upon drawing out a tube while a column of air from
the bellows of an organ is passing through it, the vowels are pro-
nounced in the order, i, e, a, o, u. On extending the tube they are
repeated, after a certain interval, in the inverted order, u, o, a, e, u
After another interval they are again obtained in the direct order,
and so on. When the pitch of the reed is very high, it is impossible
to sound some of the vowels, which is in perfect correspondence with
the human voice, female singers being unable to pronounce u and o
in their high notes. From the rapid advancement of science and art,
it may be presumed that ultimately the utterance or pronunciation
of modern languages will be conveyed, not only to the eye, but to
the ear of posterity. Had the ancients posssessed the means of
transmitting such definite sounds, the civilized world would still have
responded in sympathetic notes at the distance of many ages !

The investigations of Mr. Bishop show, however, that the me-
chanism of the human voice is so exceedingly complex, the appa-
ratus is an assemblage of so many parts or elements, so variable, and
yet so nicely adjusted, that it is reasonable to conclude, that all
attempts at imitation by mechanical means, will be more or less
imperfect, and probably, nothing more than rude approximations.

J. Le C.

184G.] Isopathia : or the Parallelism of Diseases. 707

Isopathia : or the Parallelism of Disease. By John M. B. Har-
den, M. D., of Liberty County, Georgia.

(Concluded fromXo. 11.)

Purulent types. The nature of pus and its mode of formation are
questions which have not yet been satisfactorily determined. The
difficulties in regard to its true characters may probably arise, in a
rood degree, from the fact that the term has been applied to m
products which are essentially different, at least, in a pathological
point of view. There can be no doubt that there are many diseases
specifically distinct which result in this formation, and that this fluid
has, under such circumstances, a very different effect upon the system
when introduced, or in any other way applied to it. Who can believe
that the bland, inodorous", innocuous fluid flowing from a he;
granulating surface or collected in a simple phlegmon, is not specifi-
cally different from the corroding matter of a syphilitic chancre, or
the contagious matter of a variolous pustule! and yet they are all
considered as pus, and may have the same external appearance, and
possibly, the same chemical reactions. The diseases which produce
them, however, are evidently distinct, and the morbid action of the
fluid effused is also very different.

From these facts it follows, then, that pus must differ in its chemical
and physical properties, and consequently may differ also in its
chemical and physical constitution. We know that two bodies or
substances may have the same physical properties and a different
chemical composition, or the same chemical composition and different
physical properties, or in other words, they may be isomorphic and
not isomeric, or isomeric and not isomorphic. The only evidence we
can have of the perfect identity of any two substances is, that they
are both isomeric and isomorphic. Simply isomorphic or isomeric
products of two diseases cannot, therefore, establish their identity,
but if those diseases should result in products which are both isomor-
phic and isomeric, they must be considered as isopathic, no matter
how they may differ in their seats and symptoms. The identity,
therefore, or dissimilarity of diseases may be determined by determin-
ing the physical and chemical nature of the morbid products. This
is to be achieved by chemistry and the microscope, but we are sorry
to say that as yet, we have not advanced far enough in this study to
accomplish this end with perfect success.

It was the opinion of Boerhaave, Platner,* and most of the old
writers, that pus consisted in a "dissolution of the blood-vessels,
nerves, muscles, and other solids, in the fluids of the parts in which
inflammatory tumours occur." This opinion, however, we believe,
is upheld by no well-informed physician of the present day. M.
Gcndrinf supposes that the "globules of pus are those of the blood
deprived of their colouring matter and somewhat enlarged and de-

B ft be, p. 110.

47

73S Isopathia : or ike Parallelism of Diseases. [December,

formed." Dr. Hake* seems also to believe, that in certain cases,
pus may be nothing more than " a degradation of the blood globule. "
Dr. Hodgkin, Mr. Liston,f MM. Magendie.J and Andral think, on
the contrary, that the globules of pus and of blood are totally dissimi-
lar. Andral says, "I cannot admit, as has been maintained by
some, that the globules of pus are a transformation of those of the
blood. Nor is the pus formed at the expense of the serum, the albu-
men of which is found unchanged, the pus being merely suspended
in, without being, in the least, confused with it. May not, then, the
pus globules be nothing more than a modification of fibrin, which
instead of reaching the net-work form has remained in the serum, in
that state of granular corpuscles whose origin and nature I have al-
ready pointed out]" Mr. Carpenter|| supposes that pus is produced
by a transformation of the "exudation corpuscles" which are found
in the fibrin after being effused and exposed to the contact of the air.

From experiments performed by M. AddisonH on pus, he has been
led to believe in the identity of pus-cells with the white corpuscles of
the blood. By the action of liquor potassae the pus-ceils were rup-
tured and transformed into a substance having all the appearance of
"fibrous tissue or of mucus." By the action of dilute acetic acid
upon this fibrous coagulum of pus, the pus was changed into "an
opaque, white, friable substance resembling tubercle." These ex-
periments are interesting, and prove the intimate relation "between
the plastic element of the blood and the elements of pus and tubercle,
but we do not see that they add much to our knowledge of the exact
nature of that relation, since we have no reason to think that the
process of transformation by the agency of liquor potassa3 and acetic
acid is identical with that which takes place in the living body, but
only bears a certain degree of analogy to it."

The advocates of the various theories which have been advanced
in regard to the mode of formation of pus may be arranged as fol-
lows : Those who suppose it formed from the fluids after extravasa-
tion into the infiamed parts ; those who suppose it formed in the
capillar 1/ vessels, and by the action of those vessels ; and lastly, those
who suppose it formed directly in the blood.

The experiments of Sir John Pringle and Gaber led to the belief
that pus was formed, in the langunge of Benjamin Bell,** who adopts
the opinion, by "a change produced by a certain degree of ferment-
ation upon the serous parts of the blood after its secretion into the
cavities of xdcers and abscesses." This opinion has been very gen-
erally entertained, and although differently expressed, has recently

* Med. Chir. Rev., Oct., 1839, p. 353. t Hall, op. cit., p. 110.

t Lecons sur le sang. Op. cit., p. 83.

Principles of Human Physiology, p. 45G.

IT British and Foreign Med. Rev., for July, 1845, pp. 122, 123.

** Treatise on the Theory and Management of Ulcers, p. 55. By "serous
parts of the biood," is here meant serum with more or less coagulable lymph or
"liquor sanguinis."

13-1G.J lsopalhia : or the Parallelism of Diseases. 739

been advanced by Travers and Bennett* in their respective works
on inflammation. M. Travers sa}s, "pus I believe to obtain its
characters of consistency, opacity, and colour, after exudation, and
to consist of the superfluous or waste lymph which has been separa-
ted, during the adhesive stage, from the mass of the blood held in
solution by serum, being thus a chemical modification of the constitu-
ents of the liquor sanguinis; in short, the latter fluid deprived of its
original characters and property of spontaneous coagulation. Pus
particles resemble those of lymph seen in the vessels under inflam-
mation, except that the? appear broken down and partly dissolved
in their texture, instead of compact, and of less regular figure; and
if, when suspended in a drop of fluid, compared with the elastic blood
corpuscles, to which they bear no analogy whatever, utterly inert
and devitalized. We never see pus in the blood-vessels but in fatal
phlebitis, and if introduced into the circulation by injection, it is des-
tructive to life.'' In relation to tills theory, I would merely observe,
here, that I believe there is a form of pus or purulent matter which
may be produced in this way, as, for instance, in an open, healthy,
granulating wound : but that the blood-vessels never contain pus ex-
cept * in fatal phlebitis" we hope to show, hereafter, is contrary to
the observations of many high authorities.

The next opinion, alluded to above, is that which refers all suppu-
ration to a secretory action of the vessels of the parts inflamed. This
opinion was first advanced by Dr. Simpson, of St. Andrews, in the
year 1722. De Haen announced a similar opinion in the year 1756,
from having observed on expectoration of pus in persons affected with
phthisis. ,4in whom, after death, no marks of ulceration could be
perceived, not even the place in which the pus had been formed."
This view was adopted by Hewson, Pienciz, Schroeder, Home, Ctuik-
shank, .Morgan and John Hunter. There is, however, a wide dif-
ference in the idea attached to this secretory process by these different
writers. While Simpson and De Haen, as I imagine, suppose the
vessels to separate or secrete a matter already formed in the blood,
Hewson, Hunter, and others, have assumed for the vessels themselves,
a new power, by which they convert the coagulable lymph into the
matter of pus. De Haen. in the language of Carswell, "was led to
believe that pus. in the cases above alluded to, was immediately se-
cteted from the blood, and adds, that although the blood appears to be
a homogeneous fluid, yet it is manifest, that there is something in it,
when collected, which is of a tenacious consistence, of a whitish or
yellowish colour, and which might be called the matter of pus."
Hunter, f on the contrary, maintained that this process was effected
by the poiccrs of /he arteries alone. "Pus," says he, "is not to be
found in the blood similar to that which was produced in the first
stage, but is formed from some change, decomposition, or separation
of the blood, which it undergoes in its passage out of the vessels, and

Review i B nnett, in Mecl.Ci.ir. K< v.. vol. _\h i.. p. 102.

t On the Blood, p. icK vol. ii.

740 Isopathia * or the Parallelism of Diseases. [December,

for effecting which the vessels of the parts have been formed, which
produces it subsiding of the inflammation from which it took its dis-
position : hence, it must appear that the formation of pus consists of
something more than a straining of juices from the blood."

This doctrine, as maintained by Mr. Hunter, has been, for the most,
part, embraced by nil the vitalisU of the past and present day. Rea-
soning, however, a priori, it is difficult to conceive how the simple
mechanical action of dilation and contraction, which is all that can
be allowed to belong to the vessels alone, can effect an alteration in
the fluids except in the separation of principles already existing in
them, and again in his view of this action there is no analogy in the
secretory or excretory acts of the economy as now understood. All
the secretions* and excretions are now known to be principles alrea-
dy existing or produced from transformations effected in the mass of
the biood,f and eliminated by means of the glandular apparatus, so
that in truth the word secretion now possesses its original meaning
of separation and not creation. If, then, we consider the inflamed
part as acting the part of a gland, it only separates particles already
transformed or in the act of passing intopus.^

But farther, the fact of extensive purulent deposits taking place in
the body without any previous symptoms of inflammation, as in cases
of chronic or cold abscesses and metastatic or secondary abscess,
offers a great drawback to the entire correctness of this theory.
MY. Hunter was aware of the difficulty, but got over it by declaring
that the matter effused in such cases was not true pus. Others, how-
ever, have contended that there was, even here, a previous inflam-
mation. This is the opinion of Morgagni, Boyer, Rose, Lawrence,
Cruveilhier and Mr. Travers. While Chaussier, Marjolin, Ribes,
Velpeau, and others are found arrayed upon the negative side of the
question. Mr. Travers|] says, " the suppuration in diffused cellular
inflammation, in cold abscesses after typhus and other cases of con-

* Carpenter, op. cit., pp. 508, 50'.).

t Liebig supposes that the organized tissues are subject to transformations,
and he seems to believe that " the animal secretions must of necessity contain
the products of the metamorphosis of these tissues/'' (Animal Chemistry^. 126.)
It is time, I think, that this Pythagorean dogma was abandoned. There is no
good reason for believing that there ever is any change or metamorphosis of the
elementary parts of the animal tissues after organization. After the complete
growth of the body is effected the fibrin of the blood is of no use in the organism
except to repair solutions of continuity or be converted into the secretions. Me-
tamorphosis, therefore, must be confined to the fluids of substances deposited in
the tissues.

X Mr, Earle has recently controverted this doctrine of Mr. Hunter in regard to
the formation of pus, and seems to think that it is not a secretion as he under-
stands the term, but a mere mechanical separation of some component part of
the blood, most probably the red globules deprived of their colouring matter.
The manner in which they are convened into pus, however, does not appear.
(Vide an interesting; paper by Martin Paine, on the Theory of Inflammation,
Am. Journal. May, 1838, p. 69.)

Vide a paner 'bv Dr. Nasse, of Eonn, u On Secondary Abscesses," Med.
Chir. Rev., April, 1836, p. 531.

II On Inflammation. Med. Chir. Rev., Jan., 1845, p. 103.

1846.] Isopathia: or the Parallelism of Diseases. 741

stitutional exhaustion, as especially erysipelas and animal poisons,
are the cases which appear to authorize the belief that pus may be
formed independently of adhesive inflammation. }5ut it is my belief
that in these cases the effused fibrin dies before its organization is

accomplished, as granulations perish in certain ulcers

It is, therefore, no pathological exception, unless indeed, an exception
establishing the rule, since the same order of actions is preserved,
but the constructive are cut short or overpowered by the destructive
from the diseased state of tiie blood and the general habit. . . .
The phenomenon of late years brought under the notice- of patholo-
gists of what are called secondary dejyosits, and of which I have seen
many examples, require only to be referred to here. So far as the
question whether inflammation be indispensable to the production of
pus bears upon such cases, I consider them to form no exception to the
universality of this law*" It is with diffidence that I dissent from
the statement of an authority so high, but from my own observations
and the statements of others, I can have no doubt that in many of
these cases there is not the least trace of what is commonly under-
stood as inflammation, to be observed either before or after death.

But a stiil greater difficulty presented to the advocates of this ex-
clusive theory, is, that since the blood in diseases has come to be
more carefully studied, it is found in many instances vitiated by pus.
J)e Haen long ago admitted that "pu s might be found in the blood in
certain circumstances ," and the fact is now established beyond con-
tradiction. Mr. Gulliver* and other:- have detected it in many cases
of disease. This condition of the blood is now commonly known as
"purulent infection" or "purulent diathesis" and Mr. Piorry has
applied to it the appellation of "pyohemic" or "entorrhee pyohem-
ique" This difficulty has been met, however, by supposing that in
all such cases there either existed an inflammation of a vein from
which the pus was eft used or the existence of purulent depots from
which it was absorbed after it had been formed. In the case of
li secondary abscesses " MM. Blandin, Dance, Arnott, Cruveilhier,
and many others adopt the former view, Marechal, Legailois, and
Kochoux the latter. To the first mode of explanation it may be re-
plied, that in many cases of the kind no phlebitis ^n be detected.
M. Velpcauf says, "For my part I. feel convinced that inflammation
of the vein does not constantly exist, but that the affection (metastatic
abscesses) may be produced either as a consequence of phlebitis or

of simple absorption How often have I found large

collections of pus in the viscera without being able to detect the
slightest trace of inflammation in any part of the venous system 1
Upon this point, I am positive, having determined it so frequently by
the most careful examination." He gives if as bis opinion tint in
these cases the "pus may be introduced into the torrent of the circa-
lation either by the lymphatics, the vein:; which open on (ha wound,

* Am.. Tour. Med. Sci., Fed., 1840, p. ill.

t A\n. Jour. Me I, Sci., ' . . < >cl 1811, p 181.

744 Isopathia : or the Parallelism of Diseases. [December,

red colour of their lining membrane, so frequently seen in fatal cases
of typhus fever."

"In support of this opinion, I might allude to the aceidents which
are apt to follow dissection wounds. In these cases all the phenome-
na, from the earliest local symptoms observed during life, to the most
serious anatomical lesions discoverable alter death, might seem to
justify the appellation of phlebitis which has been usually applied
to this state; and yet, what is more manifest than that there is a
primary alteration of the blood under the influence of a fluid in a
state of decomposition ?"

This, or some similar mode of accounting for the formation of pus,
appears to me to comport most closely with the facts which have
been observed in regard to this process, and it is the one, upon the
whole, which we are most inclined to adopt. But whether it arise
from a fermentation or zymotic action produced by the introduction of
a putrid poison into the system, or from mat 1 -assimilation on the part
of the nutritive apparatus, we still regard it as highly probable, if not
absolutely certain, that the formation of pus is, in most cases, a co?2-
stitutional disorder ; that a disturbance of the blood is a primary
phenomenon, and the local symptoms of inflammation, such as tho
dolor, calor, rubor and tumor, are entirely secondary.
In the diseases which we are about to consider, under this head,
we regard a purulent diathesis, or tendency to the production of pus,
as an essential feature, and we believe that this alteration begins in
the blood. Pus globules, may not, in all cases, be detected in this
fluid while in the torrent of the circulation, and yet they may exist
there in a nascent* state, and may be supposed to assume their proper
form either in passing out of the vessels or after they have been actu-
ally extravasalecL This disposition characterizes, however, several
other diseases, one of which, the common phlegmon, we have already
noticed, and others shall be treated of under the head of exanthema*
tous tppes. We propose, in this place, to speak of two forms of dis-
ease, which, although allied in several particulars, we must regard as
distinct species.

The pathognomonic symptoms of our first species are, fever of an
adynamic or typhoidal character, the existence of purulent matter or
the materies pur is in the blood, deposition of pus in various parts of
the body, disease, for the most part acute, and disposed, under favour-
able circumstances, to spread by contagion.

The followingafTections we would refer to these species, and we will
now attempt to point out their isopathic connection.

This essential fever, to which we would apply the term M pyogenic,"
of Voillemier, sometimes manifests itself in that form of disease

* Our idea can be very well illustrated, by having recourse, for one moment,
to the doctrine of cell-formation. Supposing that the globules of pus or pus
cells are derived from the elements of the blood, they may exist in the circula-
tion as cytoblasts or cell-germs, or even in the form ol ultimate granules, and be
formed after exudation.

1946.] Isopathia : or the Parallelism of Diseases.

known an phlebitis. This disease was first described by Mr. John
Hunter, many years a^o, but very little attention seems to have been
paid to it until of late, when, as we have seen, it was appealed to by
the pathological anatomists, as a mode of explaining the purulent
infection of the blood, and those metastatic or secondary abscesses
which take place in various parts of the system after amputations or
other surgical operations. We need not enter into a description* of
the disease further than to say, that one of its most important features
consists in the disposition to the formation of pus. It is said to occur
either from injuries done to the veins, or spontaneously. Dr. Chap-
man says, "it very rarely happens that it originates spontaneously."
It most commonly proceeds from some injury done to the vein. It
sometimes, however, originates from the most trifling exciting cause.
"The slightest incision or puncture or even a scratch will had to the
most disastrous results of this nature from the cleanest instruments.''
This proves conclusively that there must exist, in such cases, a con-
stitutional predisposition produced by some cause of which we are
ignorant. That predisposition, I must believe, consists in the ""puru-
lent diathesis" of M. Tessier.

The almost constant association of this disease with secondary ab-
scess, is a clear demonstration of their perfect identity, and we
proceed to give the observations of different writers upon this point.
This coincidence is, indeed, so common that it has induced some
pathologists to attribute the secondary abscesses, in all cases, to the
previous existence of phlebitis. This, as we have seen, was the opin-
ion of such men as Blandin, Dance, Arnott and Cruveilbier. So
convinced is M. B!anciin| of this necessary connection, that in those
cases in which the phlebitis cannot be detected in the soft parts, he
directs to the examination of the "veins of the osseous texture" under
the impression that the disease may have its origin there. Dr.
Nasse,:f of Bonn, says, the results of very numerous dissection* have
satisfied him "i\mt phlebitis in some part of the body, and most gen-
erally in the immediate vicinity of the original disease, is, in the
majority of cases, an accompaniment of secondary abscesses. Of-
ten, when this morbid appearance has not been discovered, he is of
opinion that it might have been so " had the blood-vessels of the bones
been minutely examined ." Mr. Douglas|| says, in every case of
secondary abscess above detailed, which I dissected since I met with

*For an excellent description of this disease, I would refer to a paper on the
subjeet by Professor Chapman, of Philadelphia, in the number for July, 1843, of
the Amer. Journ. Med. Sciences, p. 13.

t Med. Chir. Rev., April, 1838, p. 548. : Ibid., April, 1836, p. 538.

This preconceived notion of the necessary existence of a certain phenome-
non as a cause of another, is a great bar to correct observations upon any sub-
ject. Men who look/or any thing, will be almost sure to find it. and it may aol
be considered uncharitable to suppose that the advocates of phlebitis, aaacause
of secondary abscesses would be satisfied with theleast lamina-

tion, and could they hut find in a vein a red spot larger than that produced bj a
/lea-bite, it would be called phlebitis.

II Ibid., Julv, 1846, p. 268, et seq.

746 Isopathia : or the Parallelism of Diseases. [December,

the inflamed vena portse, I have been able to trace inflammation of
the minute veins of the part," and the following seem to be the facts
established by his observations, first, that * phlebitis is the invariable
cause of the secondary abscesses," and secondly, " that those second-
ary abscesses are themselves the result of a secondary phlebitis, the
inflammation being seated in the venous radicles." We need not,
however, insist further on this point. The frequent association of
the two conditions is acknowledged by all who have paid attention
to the subject. We conclude, therefore, our remarks upon it, by the
following extract from the Med. Chir. Rev,, for April, 1833. p. 4Q4,
a work to which ice feel ourselves very greatly indebted. " With re-
ference to the co-existence of phlebitis and the purulent deposits, it
seems to us that we may venture on the following conclusions. First,
that the symptoms of phlebitis and the purulent deposits are very
similar, if not identical in kind. Secondly, that in a considerable
number of cases, phlebitis and the purulent deposits are found by
examination after death, toco-exist. Thirdly, that in many cases, a
careful inspection can detect no traces of phlebitis, while the puru-
lent deposits are present. Fourthly, that in many cases, phlebitis
exists without the purulent deposits." We believe that this is suffi-
cient evidence of the mutual convertibility of these two affections,
and, of course, of their isopathic connection.

The next form in which this "pyogenic fever," or "suppurative,"
ns it has been called, may manifest itself, is erysipelas. By erysipe-
las here, we of course mean an entirely distinct disease from that
already spoken of under the head of ** inflammatory types" although
we believe that these forms may show themselves, in some cases, so
nearly isotypic as to be with difficulty distinguished. It may be su-
perficial or deep-seated cases of which are noticed by Dr. Corbin*
in a paper published in the "Journal Complement aire" or it may
be external or internal. Dr. Warren, in his excellent work on tu-
mours, pp. 255, 256, after giving an account of an operation after
which the patient died unexpectedly, attributes the result to erysipe-
las, which was prevailing in the hospital at the time, and goes on to
say "no cause we are acquainted with can so well explain this sud-
den and unexpected termination. Nor is such an occurrence new to
me. I have seen numbers of patients perish in a few days after oper-
ations, at the time that erysipelas prevailed in the hospital, without
the slightest external erythema. In such instances, I have been in
the habit of stating that these patients died of erysipelas as truly as
if they had been covered with an erythematous eruption. This dis-
ease is constitutional. It may affect the skin, and it generally does
so. It may affect the internal organs without affecting the skin, and,
in such instances, is most dangerous."

If the disease be slight there may be no evidence of the purulent
infection ; the erythema will be superficial, and the disease soon pass
off. If, however, it prove more violent, it soon shows itself as a puru-

* Amcr. Jour. Med. Sci.; for Nov., 1831, p. 205.

1940.] Isopalhia: or the Parallelism of Diseases. 747

lent disease, having all the characters belonging to phlebitis. Exten-
sive suppurations take place in the subcutaneous cellular tissue or in
some deep- seated organ. In the first case it is known as "phlegmon-
ous erysipelas " "diffuse phlegmon" "diffuse inflammation of the
cellular texture," &e. We believe that it will not be doubted that
this latter disease is truly a form of erysipelas ; the existence of these
various forms in the same hospital, at the same time, during the pre-
valence of the erysipelas, proves their isopathic connection,* and it
appears to me that whoever will attend to the history, progress, and
termination Gf phlegmonous erysipelas and phlebitis, cannot fail to
perceive that they are identical in their nature. The description so
graphically given by Dr. Chapman, of phlebitis, corresponds precisely
with that of those cases of diffuse cellular inflammation which I have
myself observed.

When this disease attacks the internal organs it may assume the
form of Arachnitis. The sudden metastasis, which occurs of trau-
matic erysipelas to the head, proves that the brain may become the
seat of the affection. Dr. Chrestienj" of Montpelier, mentions "a
case of erysipelas of the leg disappearing and followed by delirium,
which was subdued by calling the eruption to its primitive seat by a
blister. A similar case is recorded by Mi B'andin." M. NunneleyJ
has also described a form of Arachnitis which, he thinks, belongs to
this tyno.

Cut I pass on to a more interesting form of disease, which I have
long believed to belong to this species, I allude to "puerperal fever."
This disease has received the various appellations of M metritis,"
" puerperal peritonitis."' "metro-peritonitis/' ki uterine phlebitis," &c.
That it is the same disease as those we have alluded to above, ap-
pears to me to be susceptible of the clearest proof. In the first place,
it is like them a disease whose anatomical character " consists inthc
existence of purulent matter in some part or oilier of the body.'' So
constant is this character, that it is to this disease that Yoillemier has
applied the term ''pyogenic fever," par excellence. Dr. Nona<
lias found the pus, in these cases, in various parts of the system. In
some, it was deposited in the substance of the uterus. In others, it
was found in the veins and lymphatics; again, in the cavity of the
peritoneum, and even in the tendinous sheaths of the forearm, in the
lungs and mediastinum. M. Tonnelle supposed that this disease was
"connected with the circulation of pus in the veins." Dr. Ferguson||
generalizes this proposition, and supposes that it "originates in a
vitiation of the fluids." In an epidemic of puerperal fev r which ap-
peared in the Parisian hospital^! in 1843, the post-mortem examine-

*Med. Chir. Rev., vol. xxvi. p. 162, vol. xxvii. p.316.

tlbid, vol.xl.p. 158.

J A Treatise on the Nature, Causes and Treatment of Erysipelas. Am. ed.,
p. 10. This, like every other essential fever, may affect thi I ormucous

coat of the bowels, giving fs enteritis or dysentery.

Med. Chir. Rev., April, 1838, p. 545. " H Ibid., April, 1839, pp.468, 467.

IT Am. Jour. Med.Sci .. Oct., 1845, p. 509. See also a paper by VaUlemier, in
same Journal, Jan., 1811, p.

746 Isopalhia : or the Parallelism of Diseases. [December,

the inflamed vena porta?, I have been able to trace inflammation of
the minute veins of the part," and the following seem to be the facts
established by his observations, first, that " phlebitis is the invariable
cause of the secondary abscesses," and secondly, " that those second-
ary abscesses are themselves the result of a secondary phlebitis, the
inflammation being seated in the venous radicles." We need not,
however, insist further on this point. The frequent association of
the two conditions is acknowledged by all who have paid attention
to the subject. We conclude, therefore, our remarks upon it, by the
following extract from the Med. Chir. Rev-, for April, 1833. p. 4Q4,
a work to which ice feel ourselves very greatly indebted. " With re-
ference to the co-existence of phlebitis and the purulent deposits, it
seems to us that we may venture on the following conclusions. First,
that the symptoms of phlebitis and the purulent deposits are very
similar, if not identical in kind. Secondly, that in a considerable
number of cases, phlebitis and the purulent deposits are found by
examination after death, toco-exist. Thirdly, that in many cases, a
careful inspection can detect no traces of phlebitis, while the puru-
lent deposits are present. Fourthly, that in many cases, phlebitis
exists without the purulent deposits." We believe that this is suffi-
cient evidence of the mutual convertibility of these two affections,
and, of course, of their isopathic connection.

The next form in which this "pyogenic fever," or "suppurative,"
as it has been called, may manifest itself, is erysipelas. By erysipe-
las here, we of course mean an entirely distinct disease from that
already spoken of under the head of " inflammatory types" although
we believe that these forms may show themselves, in some cases, so
nearly isotypic as to be with difficulty distinguished. It may be su-
perficial or deep-seated cases of which are noticed by Dr. Gorbin*
in a paper published in the "Journal Complementaire" or it may
be external or internal. Dr. Warren, in his excellent work on tu-
mours, pp. 255, 256, after giving an account of an operation after
which the patient died unexpectedly, attributes the result to erysipe-
las, which was prevailing in the hospital at the time, and goes on to
say "no cause we are acquainted with can so well explain this sud-
den and unexpected termination. Nor is such an occurrence new to
me. I have seen numbers of patients perish in a few days after oper-
ations, at the time that erysipelas prevailed in the hospital, without
the sligheest external erythema. In such instances, I have been in
the habit of stating that these patients died of erysipelas as truly as
if they had been covered with an erythematous eruption. This dis-
ease is constitutional. It may affect the skin, and it generally does
so. It may affect the internal organs without affecting the skin, and,
in such instances, is most dangerous."

If the disease be slight there may be no evidence of the purulent
infection ; the erythema will be superficial, and the disease soon pass
off. If, however, it prove more violent, it soon shovys itself as a puru-

* Amer. Jour. Med. Sci., for Nov., 1831, p. 205.

1940.] Isopalhia: or the Parallelism of Diseases. 717

lent disease, having all the characters belonging to phlebitis. Exten-
sive suppurations take place in the subcutaneous cellular tissue or in
some deep-seated organ. In the first case it is known as "phlegmon-
ous erysipelas" "diffuse phlegmon" "diffuse inflammation of the
cellular texture" &c. We believe that it will not be doubted that
this latter disease is truly a form of erysipelas ; the existence of these
various forms in the same hospital, at the same time, during the pre-
valence of the erysipelas, proves their isopathic connection,* and it
appears to me that whoever will attend to the history, progress, and
termination of phlegmonous erysipelas and phlebitis, cannot fail to
perceive that they are identical in their nature. The description so
graphically given by Dr. Chapman, of phlebitis, corresponds precisely
with that of those cases of diffuse cellular inflammation which I have
myself observed.

When this disease attacks the internal organs it may assume the
form of Arachnitis. The sudden metastasis, which occurs of trau-
matic erysipelas to the head, proves that the brain may become the
seat of the affection. Dr. Chrostienf of Mont pel ier, mentions "a
case of erysipelas of the leg disappearing and followed by delirium,
which was subdued by calling the eruption to its primitive seat by a
blister. A similar case is recorded by M. Blandin." M. Nunneleyij:
has also described a form of Arachnitis which, he thinks, belongs to
this type.

Cut I pass on to a more interesting form of disease, which I have
long believed to belong to this species, I allude to " puerperal fever ."
This disease has received the various appellations of " metritis,"
" puerperal peritonitis," "metro-peritonitis,"' "uterine phlebitis," &c.
That it is the same disease as those we have alluded to above, ap-
pears to me to be susceptible of the clearest proof. In the first place,
it is like them a disease whose anatomical character " consists in the
existence of purulent matter in some pari or other of the body." So
constant is this character, that it is to this disease that Voiiinmier has
applied the term " pyogenic fever," par excellence. Dr. Nonat
lias found the pus, in these cases, in various parts of the system. In
some, it was deposited in the substance of the uterus. In others, it
was found in the veins and lymphatics; again, in the cavity of the
peritoneum, and even in the tendinous sheaths of the forearm, in the
lungs and mediastinum. M. Tonnelle supposed that this disease was
" connected with the circulation of pus in the veins." Dr. Ferguson||
generalizes this proposition, and supposes that it "originates in a
vitiation of the fluids." In an epidemic of puerperal fev< r which ap-
peared in the Parisian hospitals in 1843, the post-mortem examine-

*Med. Chir. Rev., vol. xxvi. p. 162, vol. xxvii. p.!31G.

tlbid, vol.xLp. 158.

J A Treatise on the Nature, Causes and Treatment of Erysipelas. Am. cd.,
p. 10. This, like every other essential fevt ^maj affect the peritoneal or mucous
coat of the bowels, giving ts enteritis or dysentery.

Med. Chir. Rev., April, L838, p. 545. " I., April, 1839, pp.468

IT Am. Jour. Med. Sci., Oct., 1845, p. 509. See also a ps voillemier, in

same Journal, Jan., 1811, p. 213,

748 Isopaihia: or the Parallelism of Diseases. [December.

tions uniformly revealed the existence of pus in some part. The
lymphatics of the uterus or its appendages were, in some, filled with
pus. Sometimes the ovaries or Graafian vesicles, or peritoneal cavi-
ty, or cellular tissue of the pelvis, were the seat of purulent matter.

But in the second place, they co-exist at the same time and under
the same circumstances. Dr. Gordon* in his Treatise on Puerperal
Fever, p. 48, says, "tha*t the puerperal fever is of the nature of
eysipelas, was supposed by Peautau forty years ago, and has been the
opinion of Drs. Young and Home of Edinhurg, since that time. I
will not venture positively to assert that the puerperal fever and ery-
sipelas are precisely of the same specific nature, but that they are
connected, that there is an analogy between them, and that they are
concomitant epidemics, I have unquestionable proofs. For these two
epidemics began in Aberdeen at the same time, and afterwards ktpt
pace together; they both arrived at their acme together, and they
both ceased at the same time. This is the testimony of Heyf and
Ferguson, and many others, and it is unnecessary to dwell upon the
point.

But in the third place, a stronger proof of their identity is found in
the fact of their mutual convertibility. It would require more space
than we can at present devote to it to mention the numerous facts
which support this proposition. A very few must suffice. "The
same connection," says Dr. Gordon, op. cit., p. 49, "is evident
from this circumstance, that a very frequent crisis of the disease is
by an external erysipelas, which is a proof that there is a metastasis
of the inflammation from the internal to the external parts," and
again, "this critical erysipelas is most commonly fixed on the extrem-
ities, but in a few instances on the external surtace of the abdomen,
which happened in a case of puerperal fever which I attended in
1788." The following facts are narrated by Dr. Lee, (who, by the
Way, is no believer in their identity.) which, .-ays he, "may seem to
prove that there is some connection between erysipelas and puerperal
fever. In the autumn of 1829, a yhort time before. the epidemic
broke out in the. British Lying-in Hospital, which led to its being
closed for several months, two children died of erysipelas. Another
fatal case occurred in the course of the epidemic, and on examining
the abdomen I found the peritoneum extensively inflamed, with a
copious effusion ofsero-purulent fluid. Another infant was attacked
with gangrenous erysipelas of the right forefinger, whose mother had
died of uterine phlebitis. Mr. Blagden related a similar case to mo.
A midwife of the hospital had a severe attack of erysipelas of the
lace a few days after attending in labour a fatal case of inflammation
of the absorbents and uterine appendages. During the prevalence
of inflammation of the uterus among the patients of the same hospi-
tal in the winter of 1831 and 1832, two children died from inflamma-

* Treatises on Puerperal Fever, edited by Meis*

tOp. cit.. p. 82. : Med. Chir. Rev., April, 1839, p. 4G5.

Op. cit., p. 381.

IS 16. j Isopalhia: or the Parallelism of Diseases. 749

lion and suppuration of the umbilical vein, and in both there were
patches of erysipelatous inflammation on different parts of the body."
Mr. Storrs,* of Doncaster, relates the following among many other
interesting facts. "On Feb. 18th," says he, "I attended in labour
a Mrs. Barret, of Cleaveland street, a neighbor of Mrs. Pearson, who
did well, but her child was seized with erysipelas of the abdomen,
from the navel to the genitals, of a gangrenous character, and died
on Feb. 4th. Mrs. Pearson laid out this child, and was confined her-
self on Feb. 19th, attended by Mr. Loxley ; she was seized with
fever (puerperal) on the 21st, and died on the 24th. Her infant was
sent out to a nurse at a neighboring village, and was seized with ery-
sipelas when a fortnight old, which also assumed a gangrenous cha-
racter, and the infant died on 27th March. Another of the cases of
puerperal fever was also incidentally connected with erysipelas, viz.,
Mrs. Briggs (case 8th). She was delivered, and continued on the
same bed in which her husband had fain who had only just recovered
from a severe attack of erysipelas and typhoid fever." But we have
not space for any further extracts. Many more facts of the same
import might be adduced. We would refer for further information
on this point to a paper by Dr. Elkington, of Birmingham, published
in the Provincial Med. Journal,^ for Jan., 13-14, also one by Dr.
O. W. Holmes, in the New England Quarterly Journal of Med. and
Surgeryt for April, 1843. and to the account by Hall and Dexter of
the erysipelatous fever of Vermont and New Hampshire, in the Jan-
uary number of the Am. Jour. Med. Sciences.^ for 1844.

We conclude what we have to say on the subject of puerperal fever
with the following extracts. "'The Provincial Journal contains
several papers in which puerperal fever is carefully reviewed by Dr.
Blftckmore, who subscribes to the opinion now very general, that it
has in its more fatal form at feast, the closest analogy to tvphoid
erysipelas. The same view is likewise taken by Mr. Svmonds, to
whom we are indebted for an excellent paper upon the subject, and
by M. Storrs. Mr. Svmonds, however, in acknowledging the ery-
sipelatous nature of the epidemic (ever agrees with the general expe-
rience of the profession, that there is a form of the disease which is
purely inflammatory, and which, according to him, may attack all the
tissues. Tne same writer speaks also of a third form, which he calls
remit'ent puerperal fever. Mr. Storrs lays down the following pro-
positions in relation to puerperal fever, that it is capable of imparting
to any person not in the puerperal state by actual contact of dose
approximation, any of the following diseases. 1. Inflammation of the
peritoneum or other serous membranes, accompanied by a low type of

* Am. Jour. Med. Sci. for Jan.. 1843, p. 234.

t [bid., April, I

See alsopapers by Mr. Storrs, in Am. Journal for Jan.. 16 16, p. 345; by Dr.
Peebles, ibid., p. 23; "by Dr. Meeker, ibid., for July, !- ! !. p. 273; by Dr.Sutton,
ibid., for Jan., 1844, p! 217; by Osiander, ibid., for August 1839, p. 447; by
Rognetta, ibid., for Jan., 1845 ; by Kneeland, ibid., for Jan. and April. 1846;
Peddic and Reid in ibid., April, 1840*.

'50 Isopalhia : or the Parallelism of Diseases. [December,

fever. 2. Erysipelas, cHlier local, such as arises from dissection
wounds, or general, as on the face or person. 3. Typhus fever, with
various accompaniamevds, and in a variety of forms.''* And to sum
up in relation to all the foregoing diseases, Mr. Xunneley says,! " if
it can be shown that the causes which produce them are the same,
that by one form of affection another may be induced; that two or
more forms of the complaint exist together, not only as epidemics
hut at the same time, or in some instances, interchangeably in the
same individual, that some of them run so much one into another,
that those who are most anxious to separate them are unable to doso;
that the constitutional symptoms are for the most part the same ;
that, allowing for the variety in the organization and functions of the
different textures, the local changes are the same; and that one plan
of treatment is adopted for ail : it may, I think, be fairly assumed as
proved, that the affections are identical in their nature, at least ac-
cording to all the rules of philosophy, which forbid us to admit separa-
tions and distinct tins where phenomena are the samc.''%

This disease also presents itself at times under the form of typhus
fever. That typhus or typhoid is a form of purulent disease, is shown
from the fact that it frequently terminates in critical abscesses in dif-
ferent parts of the body, and that, it is connected with erysipelas is
.shown by its being attended at times with an erythematic eruption.
Bouillaud says this eruption may be either '"papular, exantkematic,
or pustular." It is known that M. Bretonneau has given the name
of dothinenterite to the affection known as typhoid fever on account
of the furuncidar or pustular character of the inflammation of the
small intestines, and particularly of the glands of Peyer and Brunner.
M, Bouillaud|| considers this inflammation as erysipelatous. We
have already alluded to the fact that Qildebrand regarded typhus as n
specific 'exanthem, and that Dr. Roupell had adopted the same opin-
ion.^ Among the serious complications of this fever, he mentions
"erysipelas, and suppuration, and gangrene," and he goes on to say,
"during the prevalence of the epidemic in various years idiopathic
erysipelas has been a very common and a very serious addition to
other complaints in persons exposed, from their situation in hospitals

* Am. Jour. Med. Sci., Jan., 1846, p. 245.

t A Treatise on the Nature, Causes and Treatment of Erysipelas.

; Of the same nature apparently is the disease commonly known as Phlegma-
sia alba dolens, and by some pathologists ir has been ranked with this species
under the name of crural phlebitis, but there is such an intimate connection be-
tween this disease and the state of the mammary secretion, as has been stated
by M. Gerardin, that I am inclined to view it as a kind of milk fever by trans-
lation connected possibly with a morbid transformation ofcaseine, but I am not
satisfied about its pathology.

Mr. Gulliver has detected pus in the blood of patients affected with low t)r-
phoidfever. (Am. Jour. Med. Sci.. Feb.. 18-40, p. 443.)

II Am. Journ. Med. Sci., Aug., 1834, pp. 465 and 467.

IT Ibid., April, 1830, pp. 07 and 110. We were at one time inclined to the
opinion of the specific nature of typhus, and we will speak of the disease again
under the head of exanthematous types, but we believe most cases may be refer-
red to this species, and hence it properly comes under this division of our subject.

IS 10. J hopathia: or the Parallelism of Diseases. 731

and elsewhere, to the vicinity and infection of typhus, and so common
was it in the progress of the fever during the present year, as well
as during thnt of 13:31, that no douht could be entertained that it was
essentially connected with and incident to this disorder. Dr. Bate-
man noticed it in the house of recovery, and considers it an acces-
sory disease. M. Louis observes that shivering rarely took place in
the course of the disease except to usher in some new calamity, such
as erysipelas. It prevails at the same time with typhus, is preceded
by the same symptoms, and arises amongst nurses or those in attend,
a nee upon the patients ill with the fever.''' M. Storrs, in the paper
already referred to, establishes his proposition that typhus fever, ery-
sipelas, and puerperal fever arc t-he same disease, by narrating several
cases in which these diseases showed themselves to be mutually
convertible. In the practice of M. Louis* six cases occurred in
which erysipelas appeared in the course of the typhoid affection, and
in four of them extended to the subcutaneous cellular tissue, and it
is a remarkable fact that in these cases there was but slight and
partial alterations in the mucous membrane of the small or large in-
testines, proving that there was here a metastasis of the disease.

The last form of disease which we will mention as belonging to
this species is pneumonia typhoides. This disease in the United
States has been known under various names, as u malignant pleuri-
sy," "pe'echial or spotted fever," "bilious epidemic fever," "bilious
pneumonia" &c., and I have no doubt that at least two distinct dis-
eases have been comprehended under them. One is the true pneu-
monia, with typhus or pneumonia typhoides, which prevailed at Long
Island in the winter of 1749, and was described by Dr. Bard in the
first volume of the Am. Med. and Philus. Register, and again appear-
ed at Medfield, in Massachusetts, in the year 1808, after which "it
continued to show itself for several years in different parts of New
England, and extended itself into some parts of New York, Pennsyl-
vania, and Canada." The other I suspect to be a form of " marsh
fever." In this form it has been known as "cold plague," and has
for the most part shown itself "among labourers employed on canals
and similar works in miasmatic districts of the United States. "f This
latter species we suppose to be the same fever as that of Rome and
Modena, already alluded to in our former paper, and the " congcslive
fever" of the West."

The former or true typhoid pneumonia we believe to belong to our
present species. The accounts which I have seen of the morbid
anatomy of this affection do not enable me to speak with confidence
upon This point. Dr. Ilosacki speaks of " the. overloaded state of
the vessels of the lungs, the large effusion of scrum and sometimes
purulent matter." Dr. l)ickson mentions hepatization of the lungs

* Vide his Recherches sur la Ficvre typhoide, torn- - p. 120.

t Practice of Med., l.yM. Hall, p. 281.

>n various subjects of Medical Science, vol. ii. p. 891.
9 Essay "ii Pathology and Therapeutics, vol. i. p. 111.

'52 Isopathia : or the Parallelism of Diseases. [December,

and "effusions of serum, of coagnlable lymph and even of purulent
looking fluid" into the ventricles of the brain and "within the cer-
ebral substance."

Dr. Stokes* has described this disease as being frequent in Dub-
lin, and he "classes under the same head the varieties of acute
pneumonia which occur during the course of typhus and typhoid fe-
ver, as well as in phlebitis erysipelas, or diffused cellular inflamma-
tion." Such is also the view taken of this disease by Dr. George
Sutton, of Aurora, la., who ranks it with the erysipelatous fever
which has so extensively prevailed in the United States within a few
years past under the common name of "black tongue." For my
own part I feel at present convinced that this last-mentioned affec-
tion, so far as I can form an opinion from the statements of others
concerning a disease which I have never seen, is nothing more nor
less than typhoid pneumonia in another form, and I am happy to give
in corroboration of this opinion, the following extract from Dr. Sut-
ton Vf paper published in the " Western Lancet" "This disease
(epidemic erysipelas) has either assumed several characters or we
have bad several epidemics traversing the country together. One
was an erysipelas connected with cynanche tonsillaris or swelling of
some of the lymphatic glands. Another was what we considered a
typhoid pneumonia, sometimes connected with swelling of the axillary
glands. These, two diseases have been so intimately connected in
my practice, and wherever I can hear ofthc epidemic prevailing, that
it has been a question with me whether the last was not a pulmonic
erysipelas.^ The premonitory symptoms in each disease were alike ;
the character of the fever in each was the same; it was often the case
that one form of the disease changed into that of the other ; and we
frequently had in different members of the same family, the two
forms of the disease at the same time" It appears to me that we
can want no better proof of the isopathic connection of these affec-
tions.

Having now passed over some of the most important diseases be-
longing to this type or species, we will take up the consideration of
those which come under the second species of this division, and, on
account of the space we have already occupied, we can do little else
than enumerate the types or forms under which the species may mani-
fest itself. The pathognomonic characters are as follows: fever, a
hectic, constitutional disturbance, at first slight, or even impercepti-
ble; purulent infection of the blood, terminating in immense collec-
tions of pus in certain parts of the body; pus innocuous, and often
laudable, disease chronic, abscesses not disposed to heal readily after

* Treatise on Diagnosis and Treatment of Disease of Chest, as quoted by Am.
Journ. Med. Sci. for Feb., 1838, p. 43 1.

t Am. Journ. Med. Science, for Jan., 1814, p. 248.

X Sarcone, Ludwig, and Planchon also regarded this disease as a pulmonic
ervsipelas, and Dr. Good thought them probably right in their conjecture. 3tudy
of Med., vol. ii. p. 439.

1846.] Principal Cases treated by M. VeJpeau. 753

the matter is evacuated. Like the former species, one of the chief
characteristics of this is the purulent infection of the system, or the
disposition to the formation of pus. It differs, however, in its origin
and progress, as well as in the fact that it seems not to have a ten-
dency to spread by contagion.

Among the forms which we would enumerate, are those immense
apostemes which are found, at times, in different parts of the body ;
such, for instance, as the lumbar abscess, abscess of the liver, empye-
ma or lodgment of matter in the chest, and the disease called vomica,
by Dr. Good, which, by the way, is nothing more than a symptom
of the bursting of some internal aposteme. Of the same nature with
the above, we are inclined to believe, are the scrofulous diseases of
the hip -joint, known as " hip disease" or "morbus coxarius," and of
the knee-joint commonly called "white swelling," which we cannot
make room to describe.

The last form under this species which we will notice, is the apos-
tematous consumption, or " phthisis apostematosa" of Dr. Good. We
will speak more particularly of phthisis under the head of " tubercular
or strumous types." All that we can say here is that we have no
doubt that under the name of phthisis have been comprehended at
least three distinct species of disease, one of which belongs to our
present species, and is, in all respects, a purulent and not a tubercu-
lar affection. The secretion of tubercle and the secretion of pus are
separate acts of the system, each of which must exist separately.
Tubercular consumption may terminate without the formation of pus,
as I think I once witnessed, and apostematous consumption is not
necessarily connected with the previous existence, although I will
admit that it may come on after the deposition of tubercles in the
lungs. De Haen, as we have before seen, was unable to discover in
persons who died of purulent consumption any "mark of ulceration,
or even the spot in which the pus had been formed," and in cases of
the kind, so completely was the blood transformed into pus, that Dr.
Hake observes, that " in the last stages of phthisis, the blood was
found by Dr. Carswell and myself, to contain no other globules than
those of pus." I cannot help believing, however, that all these dis-
eases are intimately connected with a strumous or tuberculous disposi-
tion in the system, and they lead very naturally to the next general
division of our subject.

Report of the principal Cases treated by 31. Velprau, Surgeon to the
Hospital " La Charite" from Sept. 1845, to Sept, 1846. (Boston
Med. and Surg. Journal.)

There have entered M. Velpeau's wards, the past vear, 846 patienN,
163 of whom offered nothing of interest, leaving 678. Of these 678,
423 were males, and 255 were females: the number of males being

48

754 Principal Cases treated by M. Velpeau. [December,

nearly double that of females. If this were the result in all the hos-
pitals, we should conclude that females were less frequently sick than
males, and Velpeau thinks there is a foundation for this opinion. In
the hospitals there is a greater proportional number of beds for males
than females, and more males than females enter the hospitals, be-
cause the greater proportion of males are laborers, who, having no
families, enter the hospital as soon as they become sick, and because
the females among the poorer classes have a greater repugnance to
entering a hospital. It must also be observed, that each year, like
the pastr there are more diseases than patients, because many pa-
tients present several diseases at once. This consideration has also
its importance in enabling us to avoid those errors of judgment into
which we might fall when deciding upon the gravity of any disease,
the truth of which assertion we shall frequently have occasion to
verify.

The different groups of diseases have been divided thus : 169 cases
of diseases of the eyes ; 74 of the continuity of the bones ; 72 of the
articulations ; 105 diseases of the genital organs (70 of which occur-
red among males, and 35 among females) ; 48 inflammatory diseases
(they would be even more numerous, because they were found with
others as a complication) ; 57 phlegmons ; 25 cases of diseases of the
lymphatic system; 40 affections of the anus in the two sexes; 24
diseases of the mammae ; 20 cases of cancer in different regions ; 30
tumors; 11 burns; and 6 cases of simple erysipelas (5 of these pa-
tients entered the Hospital for erysipelas alone, but there were many
more cases complicated with other affections). The number of pa-
tients the past year is much smaller than that of previous years.
Ordinarily, the number ranges from 1000 to 1200 ; it seldom amounts
to less than 900, and sometimes to 1400 and even 1450.

We will first consider the fractures.

There have been 41 fractures among males, and 11 among fe-
males, and 4 deaths, two of which were from fracture of the lower
jaw. It must not be concluded from this result, that the fracture of
the inferior maxillary is extremely dangerous; we will soon explain
the death of these two patients. We notice this year, as in the pre-
ceding, two remarkable facts: first, the absence of any unfavorable
complication during the treatment of simple fractures; neither gan-
grene nor grave accidents have occurred. Secondly, the simplicity
of the treatment, which permits the patient with fracture of the leg
to walk with crutches as soon as the dressing is applied and com-
pletely dry. Hardly any special treatment, such as bloodletting,
diet, medicine, &c, has been prescribed, tor Velpeau does not think
they are needed. The greatest care consists in the application of a
well-prepared dressing. Indeed, this application requires some pre-
cautions, and by fai^t of not knowing them one does not gain all the
advantages from the treatment that he has a right to expect. Thus,
it is indispensable that the compression made by the bandage should
be perfectly regular; that the projections and depressions of the parts

1840.] Principal Cases treated by M. Velpeau. 755

should be well protected, and the dressing should be supplied with
proper splints, avoiding especially any compression upon osseous pro-
jections ; in a word, to maintain the fragments immovable and in
apposition. Such are the conditions that the dressing ought to fulfil
when properly applied, without fear of any accident being caused by
it. If the fracture occupies the leg, the dressing should mount even
above the knee, and the foot should be placed at an angle with the
limb, in order to prevent any motion of the fragments. The acci-
dents that one would naturally fear, from an immovable dressing,
such as pain, swelling, inflammation, gangrene, &c, never arise when
the bandage is properly applied ; on the contrary, as soon as the
dressings are applied and are completely dry, the pain is less, because
it is principally caused by the motion of the fragments. Almost al-
ways, the swelling subsides : if it existed before the bandages are
applied, it is seen at the end of the foot, which takes a peculiar aspect,
and subsides as the swelling cf the tissues diminishes. This diminu-
tion of the swelling as an immediate consequence of the application
of the dressing, has been so well verified, that it has been raised as an
objection to the use of permanent bandages. We are asked how this
bandage can be efficacious, since, when there is swelling, it subsides
after its application? Evidently, if the bandage is too loose it does
not insure the immobility of the fragments, and this objection, plausi-
hie as it may seem, can be easily refuted. If we reflect upon the
disposition of the dressing, we see that the bandage, reaching beyond
the knee, prevents by its form the superior end experiencing any
movement from above downward; while the starch bandage, enve-
loping the foot placed at an angle with the limb, prevents any up-
ward movement of the inferior fragment. It results, then, that
although the disappearance of the swelling would prevent the bandage
from remaining as exactly applied as at first, yet a derangement of
the osseous fragments is impossible, and there remains a state of con-
tinued extension and counter-extension. It is understood that the
limb is demi-flexed. It is evident that the diessing can be easily
re-applied if the relaxation be too great ; it is only necessary to cut
the entire bandage with snssors, or moisten it, in order to remove it.
If the bandage be applied before the swelling takes place, little or no
tumefaction will supervene; if the swelling has taken place, the
bandage will prove die best resolutive that can be employed. It is
not only in fractures without complications that the immovable ban-
dage presents its real advantages ; it is also used in cases of compli-
cated fractures with no less utility to patients. The immovable
bandages are no less valuable for fractures of the thigh, though when
used the patients should not be permitted to walk; consequently the
dressing loses a part of its advantages. These bandages are less
suited to fractures of the superior limbs, but for the leg particularly
their utility is incontestable.

The fractures of the cranium by themselves have not ordinarily
given rise to any grave consequences; it is on account of the lesions

756 Principal Cases treated by M. Velpeau. [December,

which accompany them that serious accidents and fatal terminations
occur.

There has been this year an example of fracture of the os ungis,
with emphysema of the eyelids ; a rare case, and worth remembering.

Fracture of the superior maxillary has been observed once, and
was so evident that one could feel the crepitus and easily move the
maxillary. These fractures appear grave, but in reality are less so
than those of the cranium. In this case the man was well cured,
and the jaw became perfectly consolidated.

Of three fractures of the inferior maxillare, two were followed by
death. In one of these cases the fracture of the jaw was accompa-
nied with a compound fracture of both thighs; the patient died of a
suppuration of one of the inferior limbs after the fracture of the jaw
had united. In the second the fracture was attended by wounds; a
severe inflammation supervened, suppuration followed ; and the pa-
tient died from purulent infiltration. It is evident that the fracture
was not the direct cause of this unfortunate termination ; it existed
in the middle of the jaw, and would certainly have united with fa-
cility, had it not been for this formidable complication. The frac-
tures of the ribs have shown this year, what has been noticed before,
that they are easily to heal. One death occurred recently of a poor
mason who was bruised by the falling of an enormous stone upon
him, producing a compound fracture of the forearm (which was at-
tacked by gangrene), a fracture of the thigh, and an injury also of
the thoracic viscera. The fracture of the ribs was not the principal
trouble, nor was it the cause of his death. Velpeau says, that frac-
tures of the ribs are generally easy to cure, and insists upon it more
particularly, because some surgeons have lately asserted the contrary.
They have thought that this kind of fracture demanded particular
precautions, and have proposed to cover certain points of the thorax
with a great quantity of compresses, with the view of preventing
accidents that, according to Velpeau, never occur. The most fre-
quent complication is emphysema, which is not generally very severe,
and subsides of itself; but if there are lesions of the viscera or great
vessels, the cases are more dangerous.

The fractures of the clavicle, less numerous than ordinarily, have
been only four. They have proved these three often -repeated propo-
sitions : first, that, contrary to the general opinion, the patients can
carry the hand to the head when they have a fractured clavicle ;
secondly, that the consolidation of the bone demands only from fifteen
to twenty-five days, and not six weeks or two month* ; thirdly, that
with all the bandnges imaginable, we cannot prevent fracture of the
two internal and oblique thirds from leaving a deformity. All the
treatment consists in preventing any movement for about twenty
days.

There were four fractures of the humerus, three of which were of
the neck. This is an exception to the general rule, for fractures of
the body are generally more frequent than those of the neck. Of

1S4G.] Principal Cases treated by M. Velpeau. 757

these three fractures, two occupied the anatomical neck, and the
other presented nothing worthy of notice.

There were 11 fractures of the forearm, classed in the following
manner : 2 included both bones, 4 had for their seat the elbow, 5 the
radius. Two of the fractures of the forearm were compound. In
two cases the fracture of the olecranon was accompanied by sanguin-
eous effusion ; in a third, the union was established by a solid fibrous
band. These fractures have shown that moderate compression only
is necessary ; the dressing was removed at the end of a month, and
thus was avoided the stiffness which follows the two prolonged em-
ployment of bandages.

The fractures of the radius have demonstrated these two well-
known points: first, that the Z deformity of the wrist, like tae heel
of a fork, is one of their characters, although thev mav exist without
the sign; second, that they ought not to be treated with bandages,
the results of which are more unfortunate than the real injury itself.
It is better that the patient should have no treatment at all, than
that he should be treated by improper bandages, which often produce
a stiffness which the patient retains for a long time, and perhaps for
life. This year has been tried the treatment of a Danish surgeon,
in which the wrist is placed in a forced flexion. The result has not
been very satisfactory. The experiment, however, has not been de-
cisive upon this mode of treatment.

There have been two fractures of the os ilium. What has been
said of the fractures of the cranium, is applicable to them. They
are not dangerous themselves, but are apt to be accompanied with
formidable visceral lesions. In one of the patients the fractured
portion, the crest of the bone, had considerable mobility. The pa-
tient recovered.

There were five fractures of the neck and two of the body of the
femur. Two of these were compound fractures. The fractures of
the neck have all been treated without extension ; the limb has been
simply placed upon the double inclined plane, and the patients were
permitted to walk in proper season. Ali have been discharged, not
exactly cured, but in a satisfactory condition, excepting the lameness
which is unavoidable. The reasons why continued extension has
not been used, are, first, because it does not prevent 'amen nd,

the shortening is not diminished, and the employment of extension
infallibly produces sloughs, oedema and considerable stiffness. More-
over, and this io an important con si leration, force ol llehts^o
keep their beds for two or three n nd a fractures of the neck

le femur occur mostly in persons advanced in life, they si
into an adynamic slate and sink. On the contrary, wit! ;>!e

treatment of Velpeau. ; as well at the - as

they could be at the expiration of six months und< r the
g^s and continued extension. It is necessary to know that raising
up the patient does not prevent the union : as lh< ywalk witbcrul
es, the pain warns them not to; d limb on the ground,

758 General Erethism produced by injury of Ear. [December,

and the suspension which it occasions, produces a sort of extension
by the weight of the limb itself. Ought all patients to be put under
this treatment? No. If the subject is young, in order to obtain a
good consolidation, it is necessary to employ suitable dressings.

There have been two fractures of the patella. As for the treat-
ment, the parts are brought together moderately, the patient remains
in bed two or three weeks, and then gets up, and fifteen days after-
wards his bandage is removed.

There have been ten fractures of the leg; five of both bones, four
of the tibia alone, and one of the fibula.

The fractures of the foot by crushing, offer nothing of importance;
they are cot grave, except from the lesions of the soft parts.

General Erethism produced by injury of the Membrana Tympani.
By Joseph B. Cottma>t, M. D., of Whitehaven, Md. (From the
Medical Examiner.)

March 23/7*, 1846. Mrs. J., on the night of the 28th, while pick-
ing her ear with a knitting needle, accidentally passed it in too far,
so as to injure the membrana tympani ; the effect of the injury was
instantaneous; she seized hold of the nearest object to prevent her
from falling from the chair, and called for assistance. With some
difficulty she was carried to an adjoining room in a state of insensi-
bility ; being placed on a bed, she recovered her reason sufficiently in
a little while to tell what had happened to her. State at this time :
Expression wild, pupils very much dilated, face flushed, the least
motion of the head seemed to give the most excruciating pain ; she
would scream aloud ; tetanic twitching of the muscles of the arm ;
pulse strong, full and bounding ; violent throbbing of the carotids.
In the course of fifteen or twenty minutes, this state of things was
succeeded by general syncope ; her face would become blanched,
her extremities cold, long and laboured respiration, with occasional
sighing; this would continue for half an hour or more, before she
could be aroused ; when aroused, her conversation was incoherent,
her face flushed, pupils preternaturally dilated, violent sick stomach,
with occasional vomiting ; rigors; extremities cold. This state of
things continued alternately from 10 o'clock at night until 3 o'clock
in the morning, when she fell asleep. Slept about three hours.

March 29fh, 6 o'clock, A. M. Still complained of pain in her
head ; the lenst motion aggravated it; said that her mind was very-
much confused, that she could not think ; face flushed; pupils dila-
ted ; tetanic twitching of the muscles of the extremities ; occasional
flushes of heat and cold as she described it; pulse full, strong and
curded ; conversation at times incoherent. I lied up her arm, and
took about a quart of blood with decided benefit ; her pulse became
natural; her mind clearer; talked more rationally; said that her

1846.] Child with a Tail. 759

head felt better, that she could hear a little in the injured ear. Up
to this time she had not heard at all in that ear from the time of the
accident. She felt so much better that she desired her female atten-
dants to take her dress off: in attempting to do so she was placed in
an upright position, this produced syncope which continued for nearly
an hour; during this time her breathing was stertoriousand labored;
her extremities cold ; occasional twitching of the muscles of the
arm ; pulse very slow and feeble ; it was with the utmost difficulty
that she could be aroused, and when aroused complained of being
very chilly : violent sick stomacjj and a constant disposition to
vomit. In the afternoon, two small blisters were applied behind the
ears; these drew well, and produced a general amelioration of all
her bad symptoms ; she fell into a quiet sleep at night, and slept well
until morning.

March 30/A, G o'clock, A. M. On awaking in the morning she
had considerable fever ; restless; thirst urgent ; nausea with a dis-
position to vomit ; about 12 o'clock the fever passed off, and she
said she felt much better ; could turn in bed without producing any
unpleasant feeling about her head ; mind clearer; talked more ra-
tional ; expression better; thought she could hear better. In the
afternoon she fell asleep, and slept till near night ; at this time I left
her; I saw her again about 9 o'clock, P. M.; at that time she was
decidedly better than she had been ; expression natural ; talked
rationally ; says she is entirely free from pain.

March 31s/, 6 o'clock, A. M. Did not sleep well last night; re-
turn of fever, restlessness ; thirst very urgent ; craves ice ; complains
of a roaring in the injured ear like distant thunder; says that she
sometimes loses her senses; cephalalgia very great, confined to the
forehead; fever passed off about 10 o'clock, when she fell asleep ;
slept about an hour with decided benefit ; says she always feels bet-
ter after sleeping. In the afternoon I gave her 8 grains of blue mass.

April 1st, G o'clock, A. M. Slept well ; fever very slight ; a gen-
eral improvement in her situation ; slight roaring in the injured ear ;
blue mass has not operated ; took half an ounce of calcined magnesia;
this produced a gentle action on the bowels. From this time, she
gradually convalesced without a return of any of her unpleasant
symptoms, and is now perfectly restored.

PART III. MONTHLY PERISCOPE.

Child with a Tail. Dr. J. D. Plunkett, of Shelby county, Tenn.,
writes to us that he "was requested to visit a female infant, six
months old, from the extremity of whose coccyx there issued some-
thing much resembling a tail, four inches long, gradually tapering,
and the small end adherent lathe middle of tie thigh. Finding that
it contained neither bone nor cartilage, 1 removed it by applying a
iigalure to each end of the loop." [ Medical News.

760 Tubercle. Camphor on the Teeth. Arsenic. [December,

Chemical Composition of Tubercle. After a lengthened review of
the numerous analyses which have been made of tubercle by different
observers, Dr. Hughes Bennet arrives at the following conclusions :

11 1st. That tubercle consists of an animal matter, mixed with
certain earthy salts.

"2nd. That the relative proportion of these varies in different
specimens of tubercle. That animal matter is most abundant in re-
cent, and earthy salts in chronic, tubercle.

"3rd. That the animal matter certainly contains a large amount
of albumen. Some chemists haye also detected caseine, the exist-
ence of which is probable ; others gelaiinc, the presence of which is
more doubtful. The statement of Gucterboeck, that it contains a
peculiar animal matter, (phymntine.) has not been confirmed by
other analysis. Fibrine and fat exist in small, but variable propor-
tion, as constituents of tubercle.

** 4th. The earthy salts are principally composed of the insoluble
phosphate and carbonate of lime, with a small proportion of ihe solu-
ble salts of soda. The statement of Boudet, that cretaceous concre-
tions are principally formed of the latter, is directly opposed by other
chemists, and is quite incompatible with their long persistence in
the body.

"5th. That very little difference in ultimate composition has yet
been detected between recent tubercle and other so-called compounds
of protein." [Bulletin.

Effects of Camphor on the Teeth. During a minute attention paid
to affections of the teeth for several years, I have met with very
many cases of unnatural brittleness, (fragilitas deniium,) and on
inquiring of the individuals subject to it, what dentifrices they used,
they have invariably answered, " camphorated chalk." The quan-
tity of camphor is very small in the powders generally vended; but I
have been induced to make a few experiments, to ascertain the action
of camphor on the teeth. I have allowed teeth to remain in chalk
impregnated with this substance, for a few days, when I have found
the enamel to be appreciably altered. I have put teeth in camphora-
ted spirits, and have perceived a similar result ; the enamel becomes
more brittle, and more readily removed by an instrument in fact,
it appears to be rendered somewhat lighter and porous; and finally,
if teeth are exposed to the fumes of camphor, morbid condition is
found to supervene to a still greater extent.

As seven tenths of the dentifrices now employed, contain more or
less of this destroying agent, no time should be lost in cautioning
society respecting the use of camphor in this way. [London Lancet .

Absence of Arsenic in the Feet us, the Mother having been poisoned
by Arsenic. in a recent case in Belgium, arsenic was delected in
the fcfetus carried by a female, who had been poisoned by arsenic.
M. Benoist of Amiens, lately communicated to the Society of Phar-

1846.] Ecirolic Treatment of Small-Pox. Remittent Fever. 701

macy of that town the following case, in which the contrary was
found to be the fact.

M. Benoist was charged with the examination of a young woman
six months pregnant, who had poisoned herself by swallowing a con-
siderable quantity of arsenic. The results of all his experiments per-
fectly demonsrrnted the cause of the mothers death. Net only was
arsenic detected by means of Marsh's apparatus, but the poison was
collected in substance on the internal surface of the stomach, and
readily reduced to the metallic state.

Thefcetus was at the sixth month of development, and was care-
fully examined in order to ascertain whether it had died in conse-
quence of absorbing the poison which had destroyed the mother. All
the experiments with Marsh's apparatus, however, gave a negative
result. The combustion of the gas yielded by. the apparatus was
continued for upwards of an hour without obtaining a trace of arse-
nic. Dublin Med. Press, from Gaz. Medicate.

Ectrotic Treatment of Small-Pox by Tincture of Iodine. Dr.
Samuel Jackson, (late of Northumberland.) was led in April, 1845,
to make an experiment of aborting small-pox by the tincture of iodine,
Horn contemplating its wonderful influence over erysipelas. He ap-
plied it to one arm of a child eieven months old, in confluent small-
pox, on the third day of the eruption, and to the arm which appeared
the worst, rubbing it freely on with a sponge, three times that day
and twice the next. On the 11th day, when the pecks over the whole
body were at their height, elevated with hard bases, those of the
medicated arm were entirely flat, with thin, purulent matter under
the dead cuticle, without any swelling of the part. There are, how-
ever, some very slight pits now to be seen, but they are very incon-
siderable when compared with those on the other arm.

Drs. Goddard and Sargent have since tried the application.

Dr. Sargent used the iodine on one side of the face in twenty-five
cases " the swelling, soreness, and tenderness were very much less
than on the sides not covered ; each pock remained flattened; but I
cannot say that it prevented pitting."

Dr. Goddard writes that he tried the medicine in five cases " not
one of the patients shows the least pit or mark ; none of them had
been vaccinated, and the disease was confluent in most of them."

One advantage of this treatment, Mr. Jackson remarks, is, "that
it removes the cuticle and leaves the part free from those disgusting
discolorations which commonly remain for months." [Med. Exam-
iner, from Am. Journ. Med. Sciences.

Remittent Fever Bronze Liver. Dr. Moses stated to the New
York Pathological Society, that there had been in the New York
Hospital a case of pure southern remittent fever, in a sen man who,
arriving perfectly well after an eight days passage, was immediate-
ly attacked with (congestive) remittent fever, and was comatose

762 Nitre. Bismuth. Erysipelas. Opium. [December,

I

when brought into the hospital. The liver presented one of the finest
specimens he had ever seen of the " Bronze Liver," described by Dr.
Stewardson, of Philadelphia, in his paper in the American Journal of
the Medical Sciences. It was enlarged, softened, and its internal
structure had a deep olive tinge. The spleen was four times its na-
tural size, and remarkably soft and diffluent. There was excessive
congestion of the vena portae and cava, and more or less of the veins
of the brain. There had been, during life, intense burning heat of
the epigastrium ; the tongue was moist, soft and white ; uneasiness
about the stomach and constant vomiting, like that from corrosive
poison, for some hours before death. The stomach was slightly in-
jected. The bile in the gall-bladder dark as molasses, and very
thick and tenacious. [The Annalist.

Two ounces of Nitrate of Potash taken at once. Mr. Gillard com-
municated to the S. W. branch of the Prov. Med. and Surg. Asso-
ciation, an account of a case in which two ounces of nitrate of potash
were taken by a man in mistake for epsom salts. Five minutes after
taking it a burning pain in the stomach was felt, which was follow-
ed by sickness. The mistake was then discovered. A mustard
emetic was administered, followed by carbonate of magnesia and
opium. Under this treatment the patient speedily recovered. [Med.
News.

Subnitr ate of Bismuth in Gastralgia. Dr. Bertini, of Turin, has
lately employed this medicine in numerous cases of gastralgia, be-
ginning with a dose of five centigrammes (= 077 grains), and
gradually raising it to twenty centigrammes (= 3*08 grains). It
was mixed with calcined magnesia, and given three or four times a
day. In most instances the neuralgic pains disappeared under the
use of this medicine; and in cases where the gastralgia appeared to-
be connected with organic disease, the symptoms were always much
alleviated. [London Med. Gaz.

Nitrate of Silver in Erysipelas. M. Jobert recommends the ap-
plication of nitrate of silver in erysipelas, in the form of ointment
rather than of the caustic itself. He' gives three formulae, of various
strengths, for preparing this ointment. To 32 parts of lard, the
strongest ointment has 12 parts of nitrate of silver, the next has 8
parts, whilst the weakest has only 4. [Gaz. des Hup, from Medical
News.

Dr. Graves' prescription of Opium in cerebral excitement.
Ii. Tartar emetic, . . . gr. ti. to iv.
Tine, of opium, . . . 3i. to ii.

Boiling water, . . . viii, M.

Dose a table-spoonful every two hours.

1846.] Solution. Black Drauglit. Poisoning. <%c. 70 3

Internal Antiphlogistic Solution. The following solution will be
found highly available for general antiphlogistic purposes in practi-
cal surgery : R. Tart, antimonii. . . gr. ii.

Sulph. magnesia?, . . 3ii. to gi.

Sulph. potass et soda?, gi.

Bitart. potassa?, . . 5ss.to5i.

Aqua?, lb ii. M.

A tea-spoonful, or a table-spoonful, or a wine glassful, may be giver?
every two hours, according as we wish the effect to be slight or other-
wise. The circulation is cnlmed. the skin determined to, exhalation
from the bowels maintained, and the flow of urine increased; in
short the result proves sedative, evacuant, and thoroughly antiphlo-
gistic. James Miller,

Prof, of Surgery in the University of Edinburg.

Black Draughts a purgative. The following is the celebrated
mixture, so extensively used by the English, called the Black
Draughts :

Take, Senna leaves, drachms 6,
Ginger bruised, drachm ~h,
Ext. of Liquorice, drachms, *2,
Boiling Water, ounces 9.
Pour off after three hours, and add spirits of aromatic ammonia,
drachms 2, tincture of senna, tincture of compound cardamon, each
ounce half. Dose, one ounce and a half. This is the common for-
mula. But the draught is greatly improved, both In flavour and
efficacy, by the addition of a few caraway seeds, one ounce of buck-
thorn juice, one of tincture of jalap, and six of moist sugar. [Druit's
Surgery.

Poisoning by Lead-shot left in a Bottle. An individual was seized
with violent colic and symptoms of poisoning, after having drunk
several glasses of liquor. Dr. Hohl, who was called to the patient,
examined the liquid, and found it to be turbid instead of clear ; and
on pouring it out into a jilass, he discovered at the bottom of the bot-
tle two pellets of shot which had become firmly fixed and converted
by corrosion to carbonate of lead. On examining them, he found
only a very small nucleus of metallic lead in the centre of each : so
long as the liquor was clear, no ill effects had followed its use, these
had only occurred when the turbid portion, near the bottom of the
bottle, had been taken. The liquor was proved to hold suspended a
salt of lead, from which the symptoms of poisoning had undoubtedly
arisen. This shows that great care should be used in cleansing bot-
tles; and that a few shot left in them may give v\<c to all the symp-
toms of lead-poisoning. [London ITcdical Gazette.

Treatment of Nocturnal Pollutions,. Dr. Rousse lauds much the
infusion of wormwood for this affection. 'Jake 4 grammes of worm-

764 Large Goitre, cured by sub-cutaneous ligature, [December,

wood to 150 grammes of boiling water. Make an infusion and press
out the water. This is for one dose taken on going to bed, and con-
tinued for some time. The good effects are soon manifested.

[Jour, des Connaissances Medico- Chirurg.

Large Goitre, cured by sub -cutaneous ligature. By Dr. Ballard.
(Translated from the " Archives Generates de Medecine/"' T. xi.,
p. 22.) A girl 19 years of age, residing in the village of Estere,
near Bareges, was affected since the 11th year of her age, with an
enlargement of the thyroid body which had resisted every treat-
ment, and which especially for the last four years, occasioned serious
inconvenience, particularly a degree of oppression sometimes threat-
ening suffocation. She begged as a great favour to be relieved. The
writer determined on sub-cutaneous ligation, which was practised on
the 8th of August, 1845, in the presence of M. Rigl, de Gayac and
several other physicians. Four lines were traced across the goitre so
as to divide this transversely into three equal parts. The patient
being seated in a high chair, the skin covering the goitre was pinched
up so as to approximate the two upper ink lines. The skin thus
doubled up was transfixed from above downwards on the median
line, by a needle four inches long with waxed thread. The skin was
now released, and the needle carried deeply beneath the upper divi-
sion of the tumor, so as to emerge at the point it had entered. By
a similar process threads were carried around the two other divisions
of the tumour. The three nooses thus formed were now drawn
tightly over bits of wood after the manner of the quilled suture, so
as effectually to strangulate the respective portions of the tumor.
The operation was not painful and occupied but 10 minutes, and in
half an hour the girl returned home, a distance of two leagues-
Considerable inflammation occurred on the following day, which
was reduced by active antiphlogistic means. On the 6th day a con-
siderable fullness was observed at the lower part of the tumour. M.
Rigal punctured it with a lancet, which gave issue to a little pus
and a great deal of fetid gas, resulting from the mortification of the
tumour. On the 12th day the inflammatory symptoms had disap-
peared, an abundant and fetid suppuration was flowing from the
openings in the skin. On the 28th August, the central ligature
come away having divided the compressed tissues; the two others
were tightened without pain. On the 15th Sept., the last ligature
came away, and the cure was complete on the 30th of this month.

The editor of the "Archives," very judiciously appends the fol-
lowing observations :

"Ought the remarkable success obtained bj" Dr. Ballard in this
cage, to lead to the general adoption of this mode of treatment for
goitre, even when sufficiently circumscribed to permit its being em-
braced in a ligature? We think not. Yet we think with Dr. B.,
that it would be wrong, after such a result, not to consider this a
surgical process of importance ; but it should be resorted to only

1 846 . ] ye v Method of applying Taxis. Ulcers of the Leg, 765

when the compression of the larynx and blood-vessels of the neck is
such as to endanger the life of the patient.

\eic Method of applying Talis. M. Grynfeltt proposes to effect
the reduction of hernia by applying mechanical force to the contain-
ed viscera in order to drag the protruded intestine back into the ab-
domen, instead of adopting the usual proceeding of endeavoring to
push it back through the opening at which it has made its exit.

The following is the description given by M. Grynfeltt of the man-
ner in which he has applied his taxis, in the case of a female, who had
suffered from a strangulated inguinal hernia for five days:

" We flexed the thighs as much as possible on the pelvis, leaving
room, however, to grasp the tumour easily. The loins, thorax, and
head, were also bent forwards to the full extent, so that the whole
body was, as it were, coiled up. The patient, being placed in this
position, it is easily imagined, that complete relaxation of the abdomi-
nal parietes was produced. Next, with the fingers of the left hand,
we seized the hernial tumour at its base, and compressed it slightly.
At the same time, with the right hand, we brought the coverings of
the abdomen as much towards the external inguinal aperture as was
practicable, when, by a simultaneous movement with the fingers ap-
plied over the parts, we produced a traction on the hernial contents
sufficient to bring them back into the interior of the abdominal cavi-
ty. At the first attempt we had the satisfaction of feeling under our
left hand, which supported the hernial tumour, the movement of fecal
matter, and of the gas contained in the protruded portion of the intes-
tines; when, combining compression of the hernia with the traction
of the intestines in the abdomen, we succeeded in the reduction in a
few seconds.

*' Our operative proceeding, then, consists in drawing back the
protruded portion of intestine into the abdominal cavity, instead of
trying to push it back." [Monthly Jour. Med. Sci., from Gaz. Med.
de Paris, May 30, 1846 and Amer. Journ. Med. Sciences.

Ulcers of the Leg cured by the internal administration of the Oil
of Turpentine. Case 1st. John D., a coal heaver, admitted 22ftd
January, 1844, under the care of Mr. Hancock, with a large ulcer in
front of the tibia; has had an ulcerated leg for the last four years.
At present the sore was sluggish, without any appearance of granu-
lation ; of a greenish yellow color, and watery discharge; edges of
ulcer callous and rounded, and the surrounding skin of a bluish pir.k
color. He complains that the ulcer, which was caused by grazing
the skin, is extremely painful. To have calomel, three grains : com-
pound extract of colocynth, six grains ; oil of caraway, two drops
in the form of two pills, directly. And the following mixture : half
an ounce of the oil of turpentine, three drachms of powder of gum-
acacia, and eight ounces of camphor mixture one ounce to be taken
three times a day.

766 Hemorrhage. Gonorrhoea. Placenta Pravia. [December,

24th. Much better ; wound covered with healthy granulations, and
good healthy pus ; pain considerably lessened. Repeat the mixture.

Feb. 25th. Has gone on well up to this date; granulations are
now too luxuriant. Omit the mixture, and apply the following lotion
often to the sore : twelve grains of nitrate of silver and eight ounces
of distilled water.

March 10th. Has discontinued the turpentine mixture since last
report, and is not so well ; the granulations are disappearing and be-
coming flattened ; the wound is larger and more painful, and the
discharge is thin and watery. Repeat the mixture three times a day.

lltk. Better; granulations healthy and covered with pas; dis-
position of the ulcer to increase in size appears to be arrested. Re-
peat medicine.

31st, Much better; sore not half its original size. He left the
hospital -three weeks after this report cured.

Three other similar cases are reported, but cured in much less
time. [London Lancet.

Mode of arresting Hemorrhage from extraction of a tooth. The
editor of the London Med. Gazette, states that he has known the
most obstinate bleeding, following the extraction of a tooth aiKl con-
tinuing some, hours, arrested by the use of the oil of turpentine on a
pledget of lint, kept over the bleeding surface for a short time by
moderate pressure, [Med. News.

Ointment for Gonorrhiea. Mr. McDonald, (Lancet,) recommends
the following treatment in this affection. Smear a bougie with
ointment of the nitrate of silver, (R. Argent Nitratis 3j ; adipis j;)
introduce it into the urethra for about three inches, and allow it to
remain tsvo or three minutes. Two or three applications have been
found to cure the disease ; and if used in the acute stage, one appli-
cation is generally sufficient. [W<es/. Lancet.

Treatment of Placenta Prccvia. "In five (out of 401 deliveries, a
.small proportion) cases the placenta presented, and in all of these,
except one, the foetus was still-born. The case in which the fcetus
was born alive, the placenta preceded, and, as it were, covered the
head. There was but one case of hemorrhage unconnected with
placental presentation. Including the cases now particularized, the
writer possesses a record of twenty-two placental presentations, treat-
ed, not by galvanism, nor by the detachment of the placenta, but by
the version of the foetus ; and with success to the parent in all of
them, with one exception, in which more than six pounds of blood
were lost before the patient was visited. [Dr. Campbell's Report,
Northern Journal.

Ijead Lotion. R. Liquoris plumbi diacetatis f 3 i. ; acidi acetici
diluti, spiritus rectificati aa f gss.; aquae f gix. Misce, fiat lotio.

[DruiCs Surgery.

184G. j Stojypingfor the Teeth. Address of the Editors. 767

Stopping for the Teeth. By M. Bernoth, of Warasmn.
ft. Powdered mastic, . . 90 grammes.
Sulphuric ether, . 40 ki

Digest for several days, strain it through a cloth, then add native alum
in fine powder, in sufficient quantity to form a plastic mass, with
which small phials, holding 8 grammes, are to be filled, having first
poured into each

Camphorated alcohol, . 2 grammes.
Essence of cloves, . . 1 "
This stopping introduced into the cavity of a carious tooth, first
well cleaned and dried, is extremely useful on account of the great
degree of hardness it acquires. [Chemist, from Archiv. de Pharm,

MEDICAL INTELLIGENCE.

ADDRESS OF THE EDITORS TO THE SUBSCRIBERS OF THE
SOUTHERN MEDICAL AND SURGICAL JOURNAL.
With this number of the Southern Medical and Surgical Journal the second
volume of the new series is completed. In reviewing their labors during the
past year, the Editors find many imperfections, but they feel confident that they
will receive a lenient judgment from those who properly appreciate the difficul-
ties with which we have had to contend. To conduct a scientific journal in such
a manner as will render it useful and interesting, is a work of no ordinary mag-
nitude under the most favorable circumstances. It cannot be effected by a few
men, but all who are engaged in the cultivation of the science must lend their
aid, and contribute to that general fund in which all are at liberty to draw.
This fact, though obvious to every one who has given the subject a moment's
reflection, seems to be entirely disregarded by our friends. They love their
profession they desire to see its usefulness and respectability advanced they
seize with avidity every improvement which the genius and industry of others
may propose, but they fold their own arms and do nothing. This backwardness
to perform an obvious duty does not spring from any want of ability on the part
of our Southern physicians, or from any lack of valuable material, for among
them are men whose literary and scientific attainments would do honor to any
profession, and whose stores of observation are of the richest order. We have
many such among the six hundred subscribers which our Journal numbers, and
yet during the past year we have received original communications only from
eighteen, besides our colleagues. To those gentlemen who have aided as we
tender our most grateful acknowledgments, and trust that they will con-
tinue their favors. We hope that their example will stimulate otheis to
give us the results of their observations. If but a tithe of our subscribers will
do but a tithe of what they are capable of performing, they will place their
names in the catalogue of those who have done somethiug for the promotion of
the noblest of all sciences, and make our Journal an honor to the South.

Notwithstanding the difficulties and discouragements which the Editors

708

Meteorological Observations,

have encountered, they have determined to persevere. From many quarters
they have been urged to continue the work, and have received proffers of aid
upon which they can confidently rely. They have come to this determination
from no expectation of pecuniary profit. The entire subscription is expended
upon the work, and its Editors expect no other reward for their labors beyond
the consciousness of having labored, ineffectually though it may have been, to
promote the best interests of a profession to which they are ardently attached.

The forthcoming volume will be issued with punctuality. In no instance,
since the establishment of this Journal, have we failed to forv:ard it on the first day
of each month. This course we expect to continue. If it is not regularly receiv-
ed we hope the fact will be made known to the publisher at once.

For the terms, we refer to the prospectus of Mr. McCafferty and we may be
allowed to remark here, that the Southern Medical and Surgical Journal con-
tains a larger amount of reading matter, for the price, than any medical periodi-
cal in the country.

Augusta, December 1st, 1846.

METEOROLOGICAL OBSERVATIONS, for October, 184(5, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

24 Fair days. Quantity of Rain 3 inches
S. 17 da vs. "West of do. 12 davs.

and 70-100. Wind East of N. and

/3J>

INDEX.

Page.
Abdominal Affections, diagnosis and

"treatment of G14

Abstinence from drinks in treatment

ot diseases 37.")

Acidity of stomach, 099

Acid rain, 120

Aconitum napellus, therapeutical ac-
tion of 247

-Address Editors S. M. & S. Journal, 767

Air in the veins, treatment of 1*25

Air-passages, foreign bodies in 581

Albuminuria, its causes 437

Albuminuria, treatment of 119

Amenorrhea and dysmenorrhea,

utility of electro-galvanism in 597

Ammonia, carbonate, in scarlatina, 248

Amputation, statistics of 405

An Acknowledgment, by P. F. Eve. 638

Anaemic Murmurs '. 303

Aneurism, cured by compression,. . 58

Aneurism, spontaneously cured, G49

Aneurism, treated by electro-galvan-
ic action .' 185

Anica montana, new uses 245

Antagonism of ague and pulmonary

consumption \ 504

Antagonism of Phthisis and Inter-
mittent Fever 121

Antidotes to Poison, Lecture on 42>

Antiphlogistic, internal solution 763

Aperient Biscuit- 318

Apthae, sulphuric acid in G9 1

Arachnitis, or acute Hydrocephalus, -iin

Arresting bleeding from leech bio s, !2!

Arsenic, absence of. in the Fretus, . . 700

Arsenic in Intermittent Fevers. .").")

Arsenic found in a foetus C95

Arteries, trunks and branches, ex-
periments on 330

Arteries, wounded 1 1 12

Asthma, ammonia as a remedy in. . . 509
Aural disea.-es.suitistical summary of 38

Ayer's cornp. eh. Pectoral . . . 255

Baker. Dr. E. L. on Hog's Lard in

obstruction ot the bowels 71

Baker. Dr. E. L. on Onanism 335

Barr, Dr. W. Franklin, eases in Ob-
stetric practice, II.".

Barr, Dr. W. F. on dysmenorrhea, 519

Bed-sores, means of preventing, .... 099

Paee.

Bile, coloring matter of 438

Black-Draurrhts a purgative 763

Blood-corpuscle, 110

Blood, diseases of. 349

Blood, effects of food on 117

Blood, effects bfsulph. quinine on.. 696

Blood, mode of diagnosing buffy 435

Blood, new mode of analysing'. 244

Blood, on the cause of circulation of 410

Bolus, anti-syphilitic 573

Bone and calculus in female bladder 5^7

Bread, unfermented 627

Bronchitis, alum in 249

Brouchitis. chronic capillary 506

Bronchoccie 61

Bums, lunar caustic in 377

j Burns, treatment of 314

i Caesarian operation, successful 310

j Campbell, Dr H. F. on Eczema, Fi-

] tvriasis, &c 577

Campbell, Dr. H. F. en Lupus, with

- 449

Cancer, statistical researches on 257

Cancerous ulcer, nitrate of lead in . . 186

Castor Oil. prescription of 3!9

Carpenter's Elements of Physiology, 427
Carter. Dr. T. W. on hebdom;

intermittent fever 461

Carter, Dr. T. W. on the morbid ef-

- of Tight Lacing 106

j Cataract, treatment of 69 I

j Catheters, injurious effects of the eyes 2T1

' Cauterization of the Pharynx .".7

Cerebral Circulation, dis . . fiftf

Cerebro-spinal fluid, ii^ nse 631

! Chapman, Prof, compendium oi'Lec-

tures on Medicine 311

I Chemistry, by George Fownes. . .

Chilblains, Devergie's ointment for 379

Children, dis v Coley KM

Children, dis 17<>

Children, mortality ot male 507

Children, opiates to

Children, precocious 504

Child with a Tail 759

Chlorosis, citrate of iron and sulj h-

ate quinine in 440

Chlorotic Pills, BlaudThow best m;.

Chlorotic Pills, Bland

Cholera, Asiatic, treatment of 247

IT

INDEX.

"Page, t
Cod liver oil in laryngismus stridul as GO j
Cod liver oil in strumous affections, 196
Cold Cataplasms, on employment of 434 j
Cold water treatment, death'from . . . 698 j
College of Dental Surgery. Baltimore 639

Colic, bilious, treatment of 181

Copaiba in the cure of Gonorrhoea, 124

Copaiba for injections 442 j

Constipation, its treatment 293

Constipation 33 j

Constipation, treatment of nervous. . 695

Corpus Callosum, absence of 693

Coryza, chronic, iodide of potass, in 188
Cox, Dr. J. R. on Hippocrates and

Galen 127

Cranium, compound fracture, &c. . . G i9

Croup 120

Croup, tracheotomy in 3! 3

Cmap, treated by sulphate of copper, 246
Cunningham, Dr. S. B. on the local-
ity, climate and diseases of East
Tennessee 436

Davis, Dr. projector of the national

medical convention, 447

Deafness, complete from fracture of

cranium 694

Decendens noni nerve, anomaly of. . 309
Deglutition excited by dashing cold

writer in the face, 703

Diabetes mejlilus, or Glucosuria, . . 672
Diabetes mellitus, treated by balsam

of Pern, 635

Diagnosis of Gout and Rheumatism, 312

Dian ; ite 219

Diarrhoea of Infants 620

Diarrhoea, with emaciation, 583

Digitalis, method of ascertain in? its

activity, 245

Disease, causes of 147

Diseases in which opiates are indi-
cated 310

Diseases of the skin, by Cajeenave

and Schedel 49

Dislocation of both femurs simulin-

neousiy 693

Disinfection of bodies for anatomical

purposes 378

Dissecting rooms, disinfection of. . . 446

Dissecting rooms, disinfecting of 633

Dissector, United States, &cT 692

Dothin enteritis, laudanum in its last

stages 188

Dropsical affections treated with su-
gar 56

Dugas, Dr. L. A. Extirpation of schir-

rous tumours 72

Degas, Dr. L, A. On tumours of the

neck, with cases 513

Dusas. Dr. L. A. Pathological anat-
omy of the liver 129

Page.

Dysmenorrhea 519

Dysentery, creosote in 186

Dyspepsia, treatment of 179

Eau Brocchieri 189

Eau Brocchieri, composition of 378

Eczema, cases of 577

Eczema, ointment for 379

Electricity, therapeutic application of 51.

Electrical girl 309

Electrical girl again 383

Electro-magnetism as a remedial a-

gent 703

Electro-physiological researches .... 112

Emasculation, case of self 444

Epidermis, its growth and develop-
ment 114

Epistaxis. compression of carotid in . . 572
Epoch of elimination of metallic sub-
stances from the system 375

Ergot of rye, conditions for its em-
ployment 316

Ergot, of rye. effects on the child 191

Erysipelas, epidemic 566

Erysipelas, nitrate of silver in 762

Ether, sulphuric, by friction to mouth

and fauces 635

Eve. Dr. P. F. Case of bone and cal-
culus in bladder 587

Eve. Dr. P.P. on compound fracture

of the cranium

Eve, Dr. P. F. on foreign bodies in

the air-passages

Eve, Dr. P. P. on gun-shot wound . .
Eve, Dr. P.P. on lithotrity and litho-
tripsy

j Eve, Dr. P.P. on probable absence

of uterus 724

Eve. Dr. P.P. on strangulated hernia

of omentum 338

! Eve, Dr. P. F. on statistics of ampu-
tation 465

Exanthemic liniment 315

' Experiments illustrating the seat of

volition in the Alligator 19

Eye, diseases of, use of turpentine in.. 571

649

521
15

65

Ferruginous pill of mercury 379

Fever, congestive 563

Fever, Int. curative medication of... 495
Fever, Int. electro-magnetism in.. . 697
Fever, hebdomadal int., use of sulph.

quinine, &c., in 461

Fever, remittent 761

Fevers, remittent, typhoid and typhus,

distinctive characters 91

Fevers, remittent and intermittent,

sulph. quinine in 524

Fever, remarks on J 69

Fever, sleeplessness during 248

I Fever, typhoid, nourishing diet in . . 122

INWEX.

Page.

Fever, typhoid 024

Fever, yellow 70

Fish, poisonous, on the human frame, 730

Formulas, anthelmintic 192

Fistula, vesico-vaginal 187

Foot, injury of 517

Formulae, new 702

Fracture, diagnosis of 184

Fracture of fibula 571

Fracture of the radius 626

Fungus Haematodes 142

Ho;

Page.

\s lard again successfully used

Garvin, Dr. I. P. on morbid sensibil-
ity of the stomach 705 j

Gastralgia, subnitrate of bismuth in. . 702 j
Glanders and farcy in the human sub-
ject 191 !

Gland in tip of tongue 244

Glossitis, acute case of 333 j

Goitre, cured by sub-cutaneous liga-
ture 764 i

Gonorrhoea, ointment of 766 !

Gonorrhoea, prescription for 510 i

G^ene, Dr. A. B. on tumor of mam-

ma,spontaneously cured 721 I

Gums, epidemic ulceration of 221 '

Gums, scarifications of 52 I

Gun-shot wound 15

Haemoptysis, fumes of belladonna in, 250
Hall- Yearly Abstract, by Ranking . . 308
Hamilton, Dr. Thos. on acute glos-
sitis 333

Hammond, Dr. J. F. case of triplets, 585
Harden, Dr. J. M. B. on cases con-
nected with pregnancv and child-
bed " 385

Harden, Dr. J. M. B. on the areas of

arteries 330

Hard, Dr. D. B. \V. on the treatment

of hernia 641 1

Hare-lip, early operation for 4 13

Hare-lip, operation for 252

Headache, accompanied by alkaline

urine 246

Headache 1 22

Heart, puncture of 250

Hemorrhage from exL teeth, mode ol

arresting 7GG

Hemoptysis and menorrhagia, treat- i

ed by tartrate of iron 376 [

Hermaphrodism 50 '

Hernia, belladonna in strangulated. . 378

Hernia, cold douche with taxis 189

Hernia, strangulated inguinal of the

omentum 338

Hernia, strangulated, morphine in . . 702

Hernia, treatment of Gil

Hernia, umbilical, treated with ad-
hesive bands 56

in obstruction of the bowels 11

Hog's lard successfully used in ob-
structed bowels 74

Hook, Dr. E. B. on hog's lard in ob-
struction of the bowels 11

Hooping cough, nitrate of silver in . . 570

Hooping cough, tar-vapour in 219

Hooping cough 686

Honey bees, infusion of 701

Hughes' auscultation 427

Hydrocele 60

Hydropathy on the blood 311

Hydrocephalus, iodide of potassium

in 440

Hydrocele cured by electricity 125

Hydrocele, cure for 638

Hydrocele treated with alcoholic in-
jections 694

Imagination in cure of disease

Indian diseases and remedies

Inflammation, chronic articular

Inflammation, phlegmonous, abor-
tive treatment of

Insanity, its symptoms, diagnosis and
treatment

Interments, premature

Intermittent fever complicated with
purpura hemorrhagica

Iodide of potassium, adulteration of. .

Iodine, adulteration ol

Iodine, endermic use of

Iodine for fragments of iron on the
cornea

Iodine used to distinguish arsenical
from antimonial stains

ipecacuanha in emetic doses. &c. . . .

Isopathia : or parallelism of diseases,

310
176

695

219

297
445

13

60

318

573

Iris, i is muscularity
Iron, protiodideof ..
Itch, ointment for ..

Jaundice, discoloration of palate in
Johnson, Dr. Wm. J. on Pneumonia
Joints, their vascular fringes

Kermcs mineral in diseases of the
respiratory organs

Kidneys, both on the same side of the
spinal column

Kirov's entomology .

187

252
662
589

652
737
728
703
191

506
193
732

438

118
428

Lead Lotion 766

Leak, Dr. W. W. on Intermittent
Fever complicated with Purpura

Hemorrhagica 13

LeConte, Dr. appointed professor . . 576

VI

INDEX.

Page.

LeConte. Dr. J. on cancer 257

LeConte, Dr. J. notice ofnewmetals, 117

Leuchorrcea, treatment of 698

Letter of Dr. Harden, on Botany, &c. 107
Letter of Dr. LeConte,on the Alligator 127
Lithotrity and Lithotripsy in the U.S. 65

Lithotomy, new operation for 507

Liver, diseases of. by Dr. Budd 241

Liver, pathological anatomy of 129

Liver, secretory apparatus and func-
tion " 374

Little, Dr. R. E. on spinal irritation,

with cases 2EJ1

Lupus exedens, treatment of 251

Lupus, with cases 449

Magnesia calcined as an antidote to

arsenic 688

Mal-practice, prosecutions for 639

Mal-pract ice, suit for 575

Mamma, tumor of, spontaneously

cured 701

Mayes, Dr. J. A. on Diarrhoea with

emaciation 583

Means, Dr. Alex, on the modus oper-
andi of Poisons 1

Medical College of Georgia, gradu-
ates of 1840 r 256

Medical convention, national 254

Medical convention, national 3^0

Medication, endermic, extemporane-
ous vesication 570

Medicine, aphorisms of 371

Medicine, royal estimate of 510

Medical department in the Army. . . 704
Medical Formulary, byJEllis, &c. . . 692

Medical practice in Syria 637

Membrana Tympani 758

Mercurial Ointment, preparation of 63
Mercury found in a urinary calculus 61

Menorrhagia, nitrate of silver in 250

Meteorological Observations, by Dr.

P. F. Eve at the end of each No.

Menstruation, its true nature, and

office, &.c 231

Milan Flies 63

Miller. Dr. appointed professor 57G

Modus Operandi of the poison of ve-
nomous reptiles, vie 1

Morphine in odontalgia, frontal and

facial neuralgias 183

Motion of the lumbar division of the
spine in birds 707

Nsevus, injections in 314

Nasal Fossa?, calculi of 610

Negro, change of color in 733

New Ca ustic, Velpeau's 315

New Medical Journals 103

New metals 117

New test for bile and sugar 183

Pa^e.

Neuralgia, ext. tobacco in 050

Nitrate of Potash, over dose of 762

Nitrogen, proportion contained in al-
imentary substances 489

Nocturnal pollutions, treatment of. . . 763

Obituary of Dr. Baber 319

Obituary of Dr. James Johnson 64

Obstetrics, by Churchill 243

Obstetric practice, cases of 145

Odontalgia, remedy for 253

Ointmenr. blistering in half an hour 380

| Onanism, its ill effects 335

Ophthalmia, strumous 441

Opium, antiphlogistic properties 440

j Opium in cerebral excitement 762

Paralysis from pressure

Perspiration excessive, sulph. iron in

Pharynx, granular disease

Physical education and the preserv-
ation of health

Physicians, pay of

Pills, anodyne

Pityriasis

ta, its structure and functions

Placenta previa, treatment of

Pneumonia in children

1 Pneumonia, its treatment

! Pneumonia, its differential diagnosis

ing by Cherry Kernels

. i a g by poppy heads

mea, thoughts on serous

Polypi and ulceration, uterine

ing by lead shot left in a bottle

Porpoise, the blow-hole of

! Porrigo decalvans, lotions in

_ >, Treatment by Tincture of

Iodine

nd Childbed, cases con-

i with

Pregnancy, causes of disorder in. . .

Pregnancy, extra uterine

Pregnancy, new si^rn of

Dt 'women, vomiting of

Prize e-savs

Prof. Paine's defence of the Medical

profession

Prolapsus Ani, extract of nux vomi-
ca in '

Prolapsus uteri cured by excision of

portion of vagina

Pruritus Vulvae, treatment of

Puerperal state, management of

Purpura hemorrhagica, turpentine in

570
69!)
568

310

6:'5

*73
577
636
766
172
193
302
^60
313
361
690
763
706
253

373

3-5

96

36H

444

700
378

320

571

630
2 53
570
246

Q.uackerv and insanity 445

Q.uack advertisements by regular

D actors 383

Quacks, a place without 640

Q/ainia, arseniatc of 573

INDEX.

Page. ;

Cluinine. enikrmic application 114

Gluinine. sulphate and ferrocvanate

of 201

Cluinine, sulph., not absorbed when

applied endermically 375

GLuinine, sulph., poisoning by 37b'

Gtninine, ferrocvanate 61

Gluinine, sulph., effects on the pulse, 503
Cluinine, sulph., remedial powers of.. 557

Gluinine, sulph., the use of 560

Gluinine, sulph., new mode of ad-
ministering 634

Rape or violation 561

Respiration, mechanism of 725

Rheumatism, condition of heart in . . 506
Rheumatism, opium treatment of . . . 440
Rice, culture of, removing the salt of

marshes 695

Robert, Dr. W. H. on aneurism spon-
taneously cured 649

Salacine and quinine in intermittent

fever 53

Scabbies, treatment of 313

Scalds, treatment of 190 j

Scarlatina, belladonna as a preven-
tive 440

Scarlatina, state of urinary organs in 505 '

Schirrous tumors, extirpation of 72

Scrofula, by Phillips 567 ;

Scrofulous diseases, their treatment, 307 j
Scrofula, its nature, causes, preva-
lence and treatment 537 j

Scrofula, new compound of chlorine,

iodine and mercury 573

Scrofula, treatment of 310 j

Scrofulous ulcers, treatment of 60 !

Singultus, new method of arresting.. 506

Skin, diseases of 481

Small-pox, ectrotic treatment of, by

tinct. iodine 761

Small-pox treated by iodine 636

Spermorrhoea cured by pressure to

the perineum 123

Spina-bihda 165

Spinal irritation, with cases 321

Squills 63

Statistics of medical colleges of the

United States 383

Stillingia sylvatica 56:)

Stomach, morbid sensibility of 705

Strangury, new remedy for 186

Supra-renal, thymus and thyroid bo-
dies 373

Surgeons, appointed by the President, 511

Surgery, Sir Benj. Brodie's 374

Surgery, by Liston and Mutter 2 13

Surgery, Mott'sand Velpeau's, &<-.. 346

Surgery, by James Miller 509

Suture in divided tendons 252

Page.

Swallowing a knife 7'>i

Syphilis, gargle 702

Syphilis, can it be communicated to

the lower animals 631

Syphilis, tertiary 442

Syphilis, use of bromide of potas-
sium in 635

Tamplin on the nature and treatment

of deformities 426

Tape-worm expelled 187

Tartar emetic, disadvantages in so-
lution in large doses 319

Taxis, new method of applying of. . 765

Teeth, action of sugar on 447

Teeth, effects of camphor on 760

Teeth, stopping for 767

Temperature of man 113

Tennessee, locality, climate and dis-
eases of east 456

Tetanus, strychnine in 190

Tibia, chronic abscess of 610

Tight-lacing, morbid effects of 403

Tinea favosa, the inoculability of. . . 632
Tonsils, enlarged, ext. of walnut in . . 57
Tonsils, means of arresting haemor-
rhage after excision 443

Tooth-powders 317

Triplets, case of 585

Trismus nascentium 511

Trismus nascentium, a novel treat-
ment 448

Trismus nascentium 431

Truss, new . 576

T ubercle, chemical composition oi . . 760

Ulcers, anodyne prescription for... 379

Ulcers, mode of cure 377

Ulcers of the leg, cured by oil of tur-
pentine 765

Ulcers, quinine to 696

Urine, chemistry of 788

Urine, chemistry of 116

Uterine hemorrhage, compression of

abdominal aorta in 125

Uterine hemorrhage, sub-carbonate

of iron in 44

Uterus, its nerves 731

Uterus, probable absence of 724

Vapour bath, a cheap substitute .... 379
Variola and vaccination, modifica-
tion of 371

Velpeau, M. cases treated by 753

Venereal vegetations, treatment of... 630

Venereal vegetations, treatment of... 249
Vernice caseosa. or unctuous depos-

ite on the skin 239

Voice, human, its physiology 73-1

Vomiting, to produce at any time . . 510

Vulva, thrombus or bloody tumor of. . 497

Vlll

INPUX.

'5

Page.

Waterman, Dr. pardoned 639

"Williamson, Dr. Wm. on Arachni-
tis, or acute Hydrocephalus 410

Williamson, Dr. Wm. on Fungus
Hoematodes 142

Williamson, Dr. Wm. on injury of
the foot, &c 517

Page,
Wooten, Dr. H.V. on endermic ap-
plication of sulph. quinine 414

Wooten, Dr. H. V. on the sulphate

and i'errocyanate of quinia 204

Wounds, natural history and treat-
ment of .... , 617