Digitized by the Internet Archive in 2Q12 with funding from LYRASIS Members and Sloan Foundation http://archive.org/details/southmed1846medi 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, -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, 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, ith. 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, 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 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 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 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, 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 c7,785 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¶ta 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, 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 "// 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, ci. 25, 1845. : Lanc< t. ( let. 35, 1845. n Lancet, ( > 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< :\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, -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 fc, 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, 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, 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,