Southern Medical and Surgical Journal, 1847

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SOU T II E K N

MEDICAL AID SURGICAL JOURNAL

EDITED T.Y

PAUL F. EVE, M. D.,

AND

I. P. GARVIN, M. D.

Medical College of Georgia.

\ Je preyirfs Ic bicn ou je le trouvc."

VOL. HI. 1847. NEW SERIES.

Augusta, (a.

JAMES McCAFFERTY,

PRINTER AXD PUBLISHER.

1847.

SOUTHERN

MEDIGAL AND SURGICAL

JOURNAL.

Vol. I] NEW SERIES. JANUARY, 1847. [No. 1.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE I.

Remarks on the use of Quinine in Intermittent and Remittent
Fevers. By L. A. Bugas, M. D., Professor in the Medical Col-
lege of Georgia.

Having received during the past season a number of communica-
tions requesting my views on the use of quinine in the treatment of
our autumnal fevers, I beg leave to reply to them through the medi-
um of this Journal.

The fevers of this section of our country, being almost exclusively
paroxysmal, it may be. well to premise, very briefly, my views of
their pathology, by which it will be perceived tfiat I regard them as
essentially different from those continued fevers more commonly en-
countered in colder latitudes, and which have been denominated
Typhoid, Typhus, Follicular enteritis, Dothenenteritis, Jail fever,
Ship fever, &c.

Our paroxysmal fevers are either intermittent or remittent at their
onset; but, if not arrested, the former may, more or less early, be-
come remittent, or the remittent assume the intermittent type ; thus
showing them to be only different degrees of the same disease.
They both present the same paroxysmal phenomena, that is to say,
have regular periods of recurrence or exacerbation, and of declen-
sion ; they are both preceded and accompanied by a general disturb-
ance, more or less marked, of all the functions of the system, but
more especially of those usually termed nervous, as those of sensi-
bility and muscular motion. Lassitude, pains in the limbs, back and
head, loss of muscular strength, are premonitory and persistent in
both. The activity of the circulation, however great, is not continu-
ous as in the phlegmasia?, but partakes of the same paroxysmal char-
acter as the other phenomena. Indeed it may be established as a

1

Quinine in Intermittent and Remittent Fevers. [January,

maxim, that no inflammatory disease ever assumes the paroxysmal
character, inasmuch as all inflammations pursue an uninterrupted
course, whether they terminate in resolution, suppuration or gan-
grene. Wherever inflammation is exposed to occular observation,
it is never seen suddenly to disappear and to return at stated inter-
vals, or otherwise ; but it runs a uniform course which cannot be
suddenly modified by the efforts of nature nor by any agent with
which we are acquainted. Pure inflammation of internal parts, as
pneumonia, pleurisy, acute articular rheumatism, enteritis, &c, ob-
serves the same course ; there is nothing paroxysmal in these diseases ;
the febrile action is not attended with daily or periodical exacerbations,
but gradually progresses to a certain point, and then gradually declines
with the subsidence of the inflammation. Periodicity or the paroxys-
mal peculiarity is characteristic of the neuroses properly so called
of diseases of the nervous system, which modify the functions of
remote organs, and which may be dependent upon congestion, but
certainly never upon inflammation. We know of no organ, whose
inflammation could furnish us any rational explanation of the varied
phenomena of intermittent or of remittent fever. Let us however
look to the nervous system for the solution of the problem of these
fevers, and all becomes perfectly plain. The languor, lassitude, gen-
eral and local pains, tremor, modifications of the capillary as well as of
the general circulation and of the secretions, and, above all, the abrupt
transitions from a normal state to one of great perturbation, and from
this again to comparative health, together with the periodical returns
of the morbid manifestations all indicate manifestly great disturb-
ance of that pervading system whose condition is reflected in every
part of the body the nervous system. There is no other system
whose impairment could by any possibility yield us the phenomena
above related; still less is there any single organ that could by any
modification of its condition, produce such general perturbation of
the acts of the economy. Intermittents and remittents then are un-
questionably the manifestations of deranged innervation ; and if
arrested sufficiently early will be attended with but little injury to
any organ. A continuance or frequent repetition of this derange-
ment, however, may more or less seriously implicate the parenchy-
matous and secerning structures, inducing inflammatory action, and
may even terminate in fatal congestions.

With these views of the pathology of paroxysmal fevers, we are
ed naturally to the use of such remedies as are calculated to arrest

1847.] Quinine in Intermittent and Remittent Fevers.

or to modify the perversion of innervation. Theory alone would
indicate a resort to any agent known to blunt the nervous sensibili-
ties, and thus to diminish their mobility or tendency to perturbation.
Narcotics would present themselves in the first line. Every one
knows that opium, morphine, camphor, alcoholic liquors, sulphuric
ether, &c, are valuable remedies in intermittent fevers. Indeed, a
favorite prescription with me in such cases is a combination of 2 parts
of sulphuric ether, 1 part of tincture of camphor and 1 part of tinc-
ture of opium, of which I give a tea-spoonful in a wine-glass of cold
water two hours before the expected paroxysm, and half this quantity
again at the expected hour of attack ; the patient remaining in bed
during the effect of the remedy. This rarely fails in uncomplicated
cases of intermittent fever ; if it does not completely succeed the first
day, it will the next. I have frequently averted, or favorably modi-
fied even a paroxysm of remittent fever by the administration of a
full dose of morphine {\ to J gr.) half an hour before the expected
exacerbation. But the efficacy of narcotics is not so fully borne out
by experience as is that of quinine, an agent which as yet holds a
position unique in the materia medica. The most striking peculiari-
ty of quinine is its power to prevent the return of periodical affec
tions, and this appears to me to be effected by blunting the susceptibili-
ties of the nervous system. The senses whose acuteness of perception
we can most easily observe, are manifestly blunted. Audition is
very soon impaired, and so is vision, if the dose of the remedy be
large. The effect of quinine on the heart, in our fevers at least, is
unquestionably to diminish the force and frequency of its action, and
if the quantity administered be large, a general relaxation, attended
with a profuse cold sweat, will be produced, resembling and therefore
mistaken by the inexperienced for a collapse of fatal tendency.
Having tried it in cases of pure phlegmasia, in pneumonia and acute
articular rheumatism, for example, without any aggravation of the
febrile action, I cannot regard it as a stimulant.

There is, I believe, no difference of opinion in relation to the value
of quinine in the treatment of intermittent fevers. I will, therefore,
now confine my remarks to Remittent fevers, comprehending under
this term, bilious, malignant, congestive, and country fevers. These
are usually preceded by premonitions, which if properly attended to,
would enable us to avert their development with great ease. It is,
however, exceedingly rare that medicai aid is invoked thus early, and
the physician is generally called in only during the first or second

Quinine in Intermittent and Remittent Fevers. [January,

strong paroxysm ; often much later. The paroxysm, when once fully
developed, will usually run its course despite of any efforts we may
use to check it. I therefore generally direct merely a foot-bath, and
the free us&of cold drinks, as water, lemonade, or soda water, until the
period of remission. Should there be, however, such a determina-
tion to some vital organ as to threaten serious injury before the
equilibrium of the circulation be restored by the subsidence of the
exacerbation, I abstract blood with cups to the spine, sometimes
(though rarely) deplete from the arm, and urge the use of revulsives,
as hot and stimulating pediluvia, and sinapisms to the spine, epigas-
trium, feet, &e. ; if the head be congested, the affusion of cold water
to it, continued until the pulse be depressed, and repeated as this
reacts, is the most efficacious application I know of. Saline enemata,
especially if the bowels are full, should not be omitted, as cathartics
will very rarely act during the stage of excitement. If the conges-
tion be attended with cold clammy skin, a small and feeble pulse,
and prostration of the vital energies, I advise, in addition to the re-
vulsives, large and repeated doses of the above-mentioned combina-
tion of ether, laudanum and camphor, until reaction take place.

The exacerbation having subsided, our treatment should be direct-
ed to the prevention of its return, and my invariable rule is never
to permit the occurrence of another paroxysm after I see the patient.
But, it will be asked, can this rule be carried out? I answer that it
can in the great mcjority of cases, and that in those in which we fail
to accomplish all we desire, we yet so modify the state of things that
success is almost certain on the day following. If we be fully im-
pressed with the belief that the fever being once arrested the patient
will rapidly return to health, the importance of the rule cannot fail
to be appreciated ; and that such is the fact will not for a moment
be denied by any one who has ever tried the practice we recommend.
I repeat, that if all our efforts be directed to the prevention of another
paroxysm if we resolve never to allow a patient to have another
exacerbation after we see him, the cure of remittent fevers will al-
most invariably be effected in a day or two.

In the accomplishment of our resolve, quinine must be regarded as
the sheet anchor of our dependence, for although we may resort to
other means, these can never be but of secondary value. Nor is it
necessary in ordinary cases to use such large quantities of the quinine
as are recommended by some. The quantity I use in one remission is
usually from 15 to 20 grs., but I have sometimes given 30 or 40 grs. ;

1847.] Quinine in Intermittent and Remittent Fevers.

never more. It is rare that less than 15 grs. will prevent the expect-
ed paroxysm. Whatever be the quantity we may estimate as neces-
sary, this should be given in such a manner as to have the system
fully under its influence an hour or two before the time of the previous
exacerbation, and to continue its influence a couple of hours after
this time. If the period of remission be eight hours, we may admin-
ister 2 grs. hourly if it be five hours, we may give 3 grs. hourly
if three hours, 5 grs. hourly and if only one hour, we should give
20 grs. at once, and smaller doses subsequently, if necessary, to insure
success. According to my observation the number of doses is a
matter of but little moment the quantity given in a remission is all
important. This will depend upon the violence of the attack, the
number of paroxysms that have occurred before we see the patient,
and the kind of treatment to which he may have been previously
subjected. As a general rule, the quantity should be increased as
the period of remission is shortened, and in proportion to the number
of paroxysms that have preceded its use. I am inclined to think also
that it requires more quinine to prevent a paroxysm in one who has
been depleted or acted on by emetics and cathartics than in one who
has previously been subjected to no medication. The convalescence
is certainly more rapid when no debilitating process has been insti-
tuted, and health is almost immediately restored if the disease be
arrested with quinine on the occurrence of the very first paroxysm.
There is some choice in the mode of administration, for the sulphate
of quinine will act more slowly if given in powder than in solution,
and still more so in pills than in powder. Whenever, therefore, a
prompt effect is necessary, the solution should always be preferred.
If the stomach will not retain it, it may be thrown up tlse rectum
with a little flax-seed tea or thin starch, in about the same dose as if
given by the stomach. In this way it acts remarkably well, and, in
the treatment of children, who evince great reluctance to its taste,
this mode of administration is peculiarly happy.

But the query is often made : would you give the quinine in cases
of remittent fever in which the head is evidently affected, when
there is intense cephalalgia, or coma, or delirium ? in cases in which
the stomach seems implicated the patient vomiting frequently and
rejecting every thing he takes ? in cases in which the bowels are too
loose, or very easily disturbed ? in ca*es in which the liver is either
torpid or secretes inordinately? incases in which one paroxysm
runs into the succeeding so completely as scarcely to leave any re-

Quinine in Intermittent and Remittent Fevers. [January,

mission of consequence? I answer, unequivocally, yes and that
the stronger the tendency of the disease to localize itself, the more
urgent is the necessity to arrest it ; for this tendency will increase
with every paroxysm, and cease as soon as their return be checked.
Let us always bear in mind that the paroxysms are not occasioned
by the affection of the head, stomach, bowels, or liver, but, on the
contrary, that these are the consequences of a deranged innervation
and of the paroxysmal condition, and our duty is plain. Let us not
be alarmed by the bug-bear inflammation and vitiated secretions, nor
be deterred from the use of quinine because some still believe it a
stimulant, and our success will very soon eradicate every vestige of
former prejudices on this subject. It was not without much difficulty
that I succeeded a few years ago in persuading a planter, who had
long been in the habit of looking on bilious fever as occasioned by
the presence of vitiated or superabundant bile, and who consequently
treated his negroes with emetics, cathartics and mercurials, that if
he would use quinine at the outset, his hands would be in the field in
a few days, instead of losing from ten to fifteen days whenever at-
tacked by fever. And yet, after he had fully satisfied himself of the
advantage of the proposed change of treatment, his first observation
on meeting me was always " what becomes of the bile? I am afraid
that it is still in the system and will again do mischief!"

In order to illustrate some of the positions I have assumed, I will
relate a few cases in which the remission was very slight, and the
tendency to localization imminent.

On the 12th of October, 1841, I was called to see a lad about 10
years of age, and found him in the height of the second paroxysm of
a most violent attack of remittent fever. The pulse was full, strong
and active ; the heat of the surface intense ; he complained of violent
head-ache, yet was incessantly tossing himself about the bed in wild
delirium ; his stomach and bowels were quiet. I had but a few
days previous seen a patient about the same age, and in the same
neighborhood succumb (without quinine) in the third paroxysm of a
similar attack, and I had every reason to apprehend a similar issue in
this case, if another paroxysm were permitted to occur. It was now
2 o'clock, P. M. and the next paroxysm was expected to commence at
8 in the evening. He had taken a cathartic the day before I saw
him. I immediately opened a vein, to prevent increased injury to the
brain, and abstracted blood pretty freely ; then applied a blistering
plaster over the dorsal region of the spine, and commenced the use

1847.] Quinine in Intermittent and Remittent Fevers.

of quinine in doses of 2 grs. every hour. At my evening visit (7
o'clock,) I found him quiet, free from delirium, and with very little
fever. Ordered (he quinine in doses of 1 gr. hourly through the night.
The next morning I found him sitting up, without fever, and wishing
something to eat. He had no return of fever, took no more medi-
cine, and was perfectly well in a few days. I would remark that the
delirium entirely suhsided only, after he had taken several doses of^
quinine. I have since given it during delirium, without bleeding,
and with equally good effect.

On the 28th October, 1841, I was requested to visit a gentleman,
about 45 years of age, on the 5th day of a severe remittent fever. I
found him with high fever, lying on his back, and so comatose that it
was with considerable difficulty that he could be made to notice ques-
tions, to which he would then make incoherent replies. His surface
was moist with perspiration, though warm. His pulse was frequent,
and somewhat strong, but not sufficiently so to warrant bleeding at
so advanced a stage of the case, and especially as he was of intemper-
ate habits. He had taken two or three cathartics and the onset of
the next paroxysm was expected in three hours. The case was such,
that death must of necessity attend the supervention of another par-
oxysm. Under these circumstances I ordered 5 grs. quinine in
solution every hour, and remained to watch the effects, for I was not
at that time as well acquainted with them as at present. Indeed I
had not before ventured ihe use of quinine under a similar determi-
nation to the head. The administration of each dose, was attended
with manifest improvement, so that when the time arrived for the
recurrence of the paroxysm, my patient was perfectly lucid, had no
stupor, and but little fever. I then left him, with orders to take 1 gr.
of the quinine hourly, for twelve hours. On the following morning
he was sitting up, without fever, and had none afterwards. A mild
laxative was all he took during the rapid convalescence.

During the same month, I attended a girl 8 years of age, whose
remittent fever was marked by great gastrin irritation, so as to cause
her to reject every thing she took ; quinine solution administered per
rectum as readily controlled the disease in this as it did in the above
cases.

More recently, I saw a gentleman who had been seized at 9 o'clock
A. M. with a chill, which was soon followed by the most intense
head-ache, intolerance of light, pain in the back and limbs, as well as
at the epigastrium. Being of a sanguineous and plethoric habit, I

8 Quinine in Intermittent and Remittent Fevers. [January,

bled him ; then applied sinapisms to the spine and epigastrium, and
prescribed a beverage of cream of tartar and cold water. In the
afternoon I found that the fever was still high, that he had vomited
repeatedly, was much distressed with nausea, and had been gently
purged. The sinapisms were ordered to be repeated, the cream of
tartar to be discontinued, and small quantities of iced water to be
used to relieve thirst during the night ; doses of 5 grs. quinine (in
powder) were left, one to be taken in very little water at 4 o'clock
the next morning, and repeated every two hours thereafter. I visited
him at 8 A. M. and found that the fever had continued high during
the night, and remitted only towards morning. He had taken 15
grs. quinine, and now had but little fever, although the nausea still
persisted, and had caused him to reject the quinine twice, but which
being repeated was finally retained. During this day the febrile
exacerbation was much less intense, and he was kept on the use of
iced water with a little lime water added to it. On the following
morning, the nausea still being troublesome, and, apprehending that
the quinine in solution or in powder would be rejected, I gave it to
him in pills, 4 grains every two hours until he had taken 16 grains.
These were retained, the nausea gradually subsided with the fever,
and in the afternoon he was convalescent. He suffered a little from
debility, but without further treatment, he was out in a few days.
In this case head ache and gastric irritation instead of being increas-
ed, subsided under the use of quinine.

We are frequently called to cases in which we cannot ascertain
the periods of exacerbation and of remission because of the ignor-
ance of the patient cr of his attendants, or because those periods
are not very strongly defined. In such cases we may safely pre-
sume that the remission, if there be any, will occur in the morning,
as this is most usually the case in these affections. And, under this
presumption, I always prescribe about 20 grs. of quinine to be given
in 5 grs. doses at intervals of two hours, commencing at the dawn of
the next day, without regard to any incidental circumstances. This
last injunction is added because without it, the attendant may upon
some trivial change assume the responsibility of omitting the remedy
at the only time when it might be given with decided advantage.
I have known several cases to terminate fatally by such omission to
carry out the prescription ; the excuse being that the patient had too
much fever, or head-ache, or nausea, &c. We not unfrequently see
cases so late that the life of the patient depends entirely on our abil-

1847.] Quininein Intermittent and Remittent Fevers.

ity to prevent another paroxysm. No circumstance then must be
allowed to interfere with the use of the only certain preventive with
which we are are acquainted. If it cannot be given in one form it
must be given in another ; if the stomach rejects it, throw it upon
the rectum. At all hazards, give it. If by this course you happen
to give the quinine before the remission have been fully established*
it will not increase the fever, but on the contrary lessen its intensity,
and consequently hasten the establishment of the remission. We
frequently induce a very decided remission in cases in which it has
previously been very slight, by the administration of quinine a short
time after the fever has reached its acme of intensity, as may be
seen by reference to the cases just related.

Having thus far restricted my remarks to the use of quinine in
fevers uncomplicated with true phlegmasia or inflammation, it is pro-
per that I say a few words in relation to cases we occasionally en-
counter, in which genuine phlegmasia? are complicated with remit-
tent fever or the paroxysmal peculiarity. I allude now specially to
the form of Pneumonia and Pleuro-pneumonia which has prevailed
more extensively in Georgia and South Carolina, (and perhaps in
other southern states) during the last year or two than formerly, and
which has been attended with an extraordinary degree of mortality.
From what I have seen of such cases, and learnt from my professional
brethren here, and elsewhere, I am satisfied that whilst the most
striking element of the disease is an inflammation t)f the pulmonary
organs, this is complicated with remittent fever. Indeed they pre-
sent regular diurnal or tertian exacerbations and remissions of such
decided character as to mislead the friends of the patient, and even
his physician, into a degree of security which has often proved fatal.
Seized with a violent attack of pneumonia, the patient finds himself
at once quite ill, but is soon relieved from anxiety by an apparent
amelioration of his condition. This continues until the next day, or
perhaps the third, when another exacerbation supervenes and rapidly
aggravates the condition of the lungs ; but the intensity of the symp-
toms again abates, and the patient is flattered with the hope af ap-
proaching convalescence, until a repetition of the paroxysmal affec-
tion places his life in imminent peril, if not beyond the reach of
remedial means and all this notwithstanding a vigorous antiphlo-
gistic course of treatment. This disease has been particularly fatal
on our plantations, where the daily or tertian amendments of the
patient have induced the owners or overseers not to call in medical
aid as early as they would have otherwise done.

10 Calomel in Dysentery and Cholera Morbus. [January,

In all the cases of pneumonia, complicated as above stated, that
liave come under my observation, I have not hesitated to combine
the use of quinine with that of the lancet, antimonials and opiates,
and have uniformly had every reason to be entirely satisfied with the
result. They do not require, nor can they bear, the same amount
of depletion usually regarded as necessary in common pneumonia
and pleurisy, and they very rarely yield to antiphlogistics alone. In
furnishing my own testimony to the efficacy of the suggested com-
bination, I might add that of other practitioners of distinction, who,
entertaining the same views with myself, have met with similar suc-
cess. It is scarcely necessary to add that the quinine should be given
during the periods of remission, and as liberally as though there
were no organ in a state of inflammation.

I have now freely and without reserve, given my views in relation
to the use of quinine in our remittent fevers and in lauding, as I
have done, its efficacy, I cannot but apprehend that the charge of
ultraism will be preferred against me by those who are still unac-
quainted with its properties. Be this as it may, I fear nothing from
the test of time and experience, and will be amply compensated for
the temporary odium, if this article will induce any who may have
been backward in the use of quinine to give it a fair trial under the
circumstances here recommended. It should be borne in mind, how-
ever, that we occasionally meet, even in this latitude, cases of typhoid
fever, or of enterkic fever, in which quinine possesses no peculiar
efficacy. But these fevers do not present the paroxysmal type, and
can therefore be easily distinguished from those in which it is useful.

ARTICLE II.

The propriety of large doses of Calomel in Dysentery and Cholera
Morbus. By W. F. Barr, M. D., of Greenville, Tennessee.

If we examine the standard works upon practice, in the treatment
for dysentery and cholera morbus, we find small doses of calomel, in
combination with opium, recommended. For reasons which will be
made known, I have been induced to depart from this mode of
treatment.

In endeavoring to give the reasons for this deviation from a system,
recommended by some of the first men in the profession, it will be-

1947.] Calomel in Dysentery and Cholera Morbus. IX

come necessary to speak first, of the influence of the bile upon the
intestines; secondly, of the pathology of these diseases.

The influence of ike Bile upon the Intestines. From time immemo-
rial to the present period, the opinion has been entertained that the
bile acts as a stimulant upon the intestines, and thereby keeps up
regular peristaltic motion. A denial of this opinion may appear, to-
the minds of many, as heterodoxical ; but fair reasoning, founded
upon truth, ought to satisfy the most sceptical.

The bile is not a stimulant, but a sedative; and to its sedative
influence the intestines owe their healthy action and regular peristal-
tic motion.

Although many contend that the bile is a stimulant, and that it is
to an increased quantity in the intestines, which causes them to be-
come excited, yet we find many others, equally as learned and expe-
rienced, asserting that such a condition is owing to a deficiency of
bile. This, then, is our opinion : from sudden suppression of perspi-
ration, the influence of malaria, cold, vicissitudes of weather, &c,
the liver becomes torpid, and, consequently, there is a deficiency in
the quantity of bile. The intestines thus being deprived of an accus-
tomed sedative, are excited, and irregular and diseased action are
the consequence.

This is proven from the fact, that in the early stages of the diseases
spoken of, the stools are not of a bilious color, but white, pale, &c. ;
and that in the treatment dark, or bilious discharges are hailed as
ominous of improvement. Now, if this excited condition of the in-
testines be owing to too great a quantity of bile, why are dark, or
bilious colored discharges looked for with such anxiety ? To believe
that the bile acts as a stimulant, and that it is owing to the presence
of too great a quantity of this stimulant, and then use medicines to
make the discharges of a bilious color, seems too much like curing a
burn by placing the person injured in the fire !

In those diseases in which the intestines are in an excited condi-
tion, and the stools are of a pale or white color, their recovery to a
dark or bilious cotor, (at which time there will be an improvement,)
proves, incontestibly, this excited condition is owing to the absence
of the bile, and that when restored, its action as a sedative allays the
irritability and excitement. From these facts, we contend that the
bile is a sedative.

Pathology of Dysentery and Cholera Morbus. Believing that the
bile is a sedative, we contend that the excited condition of the intes-

12 Calomel in Dysentery and Cholera Morbus. [January,

tines in these diseases is owing to the absence of the bile to the
abstraction of an accustomed sedative.

Treatment. Entertaining the views advanced in relation to the
influence of the bile, and the pathology of dysentery and cholera
morbus, the main and important indication to be fulfilled, is to pro-
cure, or increase the secretion of bile, in order to have its sedative
influence to allay the excitement of the intestines. To accomplish
this object we give calomel in large doses. We know there is no
remedy which acts so certainly and powerfully upon the liver as calo-
mel. If, then, we wish to increase the quantity of bile, shall small or
large doses of the article which we know will accomplish our object,
be given ! Although Dr. Eberle, in his system of practice, contends
that in cholera morbus there is a deficiency of bile, yet he recom-
mends calomel in two grain doses. But, under this opinion, is such
practice correct? This can be answered, by referring to efforts to
excite any secretion. If, for instance, we desire to increase the flow
of saliva, will a small or a large quantity of an article be taken in the
mouth ? Would not every one use a large quantity ? Upon this
principle of reasoning, we argue, in these diseases we wish to in-
crease the secretion from the liver, then, of course, we would not
recommend a small dose of the remedy we know will do so, but rather
a large one. Therefore, in dysentery and cholera morbus, where
there is deficiency in the quantity of bile, we wish to increase it,
for which purpose we give large doses of calomel. In those cases
which I have attended, I have administered it not in larger doses
than 20 grains, though the quantity should be modified, or increased,
according to circumstances. I give 20 grains every six hours, until
the stools become dark and fetid.

Case. Mr. M. had been confined some ten or twelve days with
dysentery. When I saw him he was very pale, pulse small and weak,
tongue furred, disagreeable taste in the mouth; the discharges were
frequent and painful. I prescribed calomel in 20 grain doses every
six hours until the discharges were dark and fetid. He took but two
doses, which had the desired effect, and in two days he was able to
attend to his business.

Other cases of both diseases could be given, but it is deemed un-
necessary, as the treatment and results were the same as the one
given.

I hare endeavored to be brief but it is thought enough has been
said to convince anv one.

1847. Mechanical Obstruction in the Bowels. 13

It is due to the learned and talented professor to say, that for the
above views I am principally indebted to Dr. Cross, formerly Profes-
sor of Institutes in Transylvania University, but now of Memphis
Medical College. Although Dr. Dick, in his treatise M On the Organs
of Digestion," advances the opinion that the bile " has a sedative
effect on the intestines," yet to Dr. Cross is the credit to be given for
having first advanced the opinion and taught the doctrine, and also
having recommended the practice which should be pursued under
this theory.

ARTICLE III.

A Fatal Case of Mechanical Obstruction in the Bowels, (conglom-
eration and adhesion of the ileum above a reducible hernia,) with
the 'post-mortem appearances. By Paul F. Eve, M. D., Professor
of Surgery in the Medical College of Georgia.

The frequent occurrence of obstinate constipation, and too often
unfavorable termination in such cases, give an importance and inter-
est to the subject, which should lead every honest and candid physi-
cian to record and publish every thing he may meet with in his
practice bearing upon this point. The writer is aware there is
nothing very peculiar in the case he is about to report, but it will be
adding another fact to the many causes producing obstruction to the
bowels, and even to a fatal extent ; and it may besides possess some
novelty and interest.

Thomas Newell, aged 30 years, entered the Augusta Hospital on
the 14th November, for constipation of the bowels; having had no
evacuation from them since the 10th. He was a laborer on the Au-
gusta canal, had had intermittent fever during the fall, and some
time ago was attended by a physician for some difficulty in urinating.
From his wife I learn, since his death, he was ruptured, but had
never worn a truss. In his last sickness, catheters or bougies, or
probably both, were used. From sickness in my own family, Dr.
Garvin visited this patient for me the afternoon of the day he enter-
ed the hospital, and prescribed 15 grs. calomel, to be taken at bed
time.

Sunday, 15th. Had, in addition to the calomel, taken a dose of
castor oil before visited. Complains of soreness and pain over the
abdomen, has no fever, borborygmus, considerable tympanites, with

14 Mechanical Obstruction in the Bowels. [January,

eructations and anorexia. Prescribed a large warm mustard poultice
over the abdomen, and salt-w\trr injections, to be administered at
once. In the evening, no relief being obtained, the long stomach
tube was added to the glyster pipe,

16 th. Was called to patient. Has now copious stercoraceous
vomiting; indeed the quantity ejected was enormous. Has had
little or no evacuation downwards from the intestines. A concealed
inguinal hernia of the right side was now detected, but it was reduci-
ble, and had no symptoms of ii flammation or strangulation. The
patient though asked, never located his sufferings in this part of the
abdominal contents. The finger in the rectum, pushed high up, met
with resistance towards the bladder, offered apparently by the intes-
tines impacted in the pelvis. Difficulty being experienced in pass-
ing the tube into the colon, the patient was placed upon' his elbowV
and knees, and it then entered much easier. Cold water was freely
injected, with a view to condense the flatus. It was returned with but
little faecal matter. Melted lard was now freely given in half pint
closes, and was retained for some hours. At the evening visit, a
blister to cover the abdomen was put on, and when it acts, a drop of
croton oil is to be given every hour.

17th. Patient is worse. Took eight drops of the croton oil with-
out any relief. Dr. Ford called in consultation. Table-spoonful
doses of pulverized charcoal were given. Injections still continued*
Wine and good nourishment ordered.

18th. Vomits still occasionally is much weaker has hiccups at
times. The blister has acted well. No increase, but diminution of
tympanites. The hernia descends whenever he assumes the position
to evacuate the enemata, but is restored by pressure. Recommended
still to use the long injecting tube with warm water or stimulating,
fluids, and such nourisment as the stomach would bear.

19th. Died at 4, P. M.

Post-mortem at 8, A. M., on the 20th, by Dr. Campbell, Demon-
strator of Anatomy, and in the presence of the medical class.

No great emaciation. Blistered surface over the entire abdomen.
No great distention of it. Removed the anterior abdominal wall.
The small intestines, particularly the ileum, were distended and were
very red, near the ccecum of a dark, approaching to a black color,
and seen through the peritoneum. The hernial sac was laid open,
and a small knuckle of intestine found occupying it. This sac was
quite thick, much condensed tissue forming its parietes. The pro-

1S47.] Mechanical Obstruction in the Boirels. 15

truding viscus was loosely attached to its internal surface by recent
exudation of plastic matter or fibrin. These attachments were readi-
ly broken up, and the hernia was reduced. The sac was of ancient
formation, but the agglutination of the intestine to its internal face
was recent. The hernial tumor was a portion of the ileum, about
four inches above its termination at the ileo-ccecal'vale. It was
gangrenous, and the same condition continued up for several inches
in this intestine, which was found convoluted and agglutinated, and
formed an irregular tumor as large as a common sized apple pressed
down into the pelvis. The adhesions of this portion of the ileum were
firm, and required the knife for separation. They were evidently
ancient, and not the result of the attack from which the patient died.
There were neither recent affusions of much serum or of any fibrin,
(except that mentioned in the hernial sac,) or other symptoms of
peritonitis. Some eight to twelve inches of the ileum constituted
this mass or ball. The internal surface of the obstructed portion
was gangrenous, and its mucous membrane detached at places by
ulceration or mortification. Its calibre could not well be judged of,
as the adhesions had previously been divided, before laying open the
intestine, but their conglomeration amounted to a perfect stricture,
judging from the accumulation of flatus and fluids above it. The
ileum contained a muddy, semi-fsecal or semi-purulent matter, be-
sides flatus. The rectum and colon were much contracted, emptied
by the injections.

This patient then evidently died from an obstruction in the bowels
existing above the reducible hernia. The adhesions of the ileum
may have occurred at the time of the difficulty he experienced in his
urinary apparatus, for they were situated just above, if not upon the
bladder, and the complete stricture of which he died on the 19th, was
superinduced upon this condition of the parts on or about the 10th,
probably by some imprudence. The hernia of itself had nothing to
do with his death directly.

Knowing a hernia existed in this case, the operation of Callisen or
Littre, recently revived, and one of them performed successfully by
Amussat, was not proposed.

10 Researches upon the Blood. [January,1

PART II. REVIEWS AND EXTRACTS.

ARTICLE IV.

Researches vpon the Blood. By M. Doias. (Translated for this
Journal, from the August number of the Annales de Chimie et de
Physique : by J^o. M. B. Harden, M. D., of Liberty Co., Ga.)

The blood contains three nitrogenized organic principles which
are essential to its nature and its functions, viz., fibrine, albumen,
and the red globules. Their abundance in the blood or the import-
ance of their offices has long drawn to them the special attention of
chemists and physiologists.

But if it has been a very easy matter to separate the fibrine from
the blood by the simple process of beating (battage) after obtaining it
from the vein ; or no less easy to procure the albumen by allowing
its serum to separate by spontaneous coagulation ; this is not the
case when we wish to obtain the red globules free from all fibrine
and albumen.

Recently, however, a peculiar process first pointed out by Berzeli-
us, and afterwards more fully developed by M. Muller, has suggested
to MM. Lecanu and Fisuier* a method of obtaining the globules-
free from all mixture. This method is founded upon a modification
which the blood undergoes, by its admixture with certain salts, in its
transmissibility through the pores of our filtering paper. If we pour
some blood, which has been beaten and deprived of fibrine and con-
sequently fluid upon a filter made of Joseph paper, we see the glo-
bules of this blood pass through the filter, and the filtered fluid will
be of a deep red color. The filtration, which in such a case is slow
and tedious, leaves upon the filter nothing but a residue of globules,
altered in appearance and so small in quantity as to render it impos-
sible to study their properties.

But if, before filtering the blood, we mix it with three or four times
its volume of a saturated solution of sulphate of soda, this mixture
will so modify the properties of the liquid in which the globules float
that it passes through the pores of the paper, leaving behind all the
globules upon the filter. It drains off completely colorless and alto-
gether limpid, and as the process is generally rapid the globules may
be collected in a satisfactory state of purity and integrity.

The application of this process, however, is not devoid entirely of
some difficulties, which are worthy of attention, because of some cir-
cumstances connected with the nature and office of the red globules
which they make manifest.

For example, if we take blood deprived of fibrine, but kept for many
hours, and attempt to filter it after the addition of even an increased

* An interesting paper upon this subject, from the pen of M. Figuier, may
be found in the 11th vol. of the Ann. de Chimie et de Phys., page 503.

1347.] Researches upon the Blood. 17

quantity of sulphate of soda, the fluid passes with difficulty and is
always colored.

It is necessary, therefore, that we operate upon blood recently
drawn from the animal. As soon as it has been well beaten *nd all
the fibrine is coagulated, we should pass ft through a line piece of
linen and receive the fluid into a solution of the sulphate of soda.
The mixture bein^ bow thrown upon a filter, we obtain a fluid per-
fectly limpid with a slightly yellowish tint, and all the globules will
remain upon the filter.

But soon, however, the liquid which has been drained offbeing re-
placed by a fresh solution of the sulphate of soda for the purpose of
washing the globules, we see it pass through colored, feebly at first,
afterwards a little more so, and, at last, the color becomes so deep
that we cannot doubt that the globules have been greatly altered in
their properties.

Yet it is necessary, in order to obtain the globules pure, to wash
them many times with the solution of the sulphate of soda without
which they will remain impregnated with the serum of the blood, that
is to say, with an albuminous fluid whose presence will entirely con-
ceal their true characters.

After a good many useless attempts, I have found in the globules
of the blood a remarkable property by means of which this difficulty
may be avoided.

As long as the globules of the blood are in contact with air or aera-
ted water ; as long as, in one word, they are in the arterial state the
solution which contains them passes colorless through the filters and
leaves them all behind.

But, on the contrary, as soon as these same globules have taken
the violet color which characterizes venous blood, the filtered fluid
becomes colored.

It is necessary, therefore, to maintain the globules in the arterial
state during the continuance of the filtration and the washings.
This I have been able to do in a satisfactory manner, by plunging
into the filter a slender tube, by means of which I direct a constant
and rapid current of air through the fluid.

Thus treated, the globules are deposited with some difficulty from
the fluid, which is now maintained in a state of aeration favorable to
the permanence of the arterial condition.

I throw, therefore, upon a large filter moistened beforehand with a
solution of sulph. sodae, the blood just after its passage out of the
vein, but deprived of its fibrine, and diluted with a solution of sulph.
of soda a continual current of air passes through the liquid which
is contained in the filter a tube connected with a solution of the
sulphate of soda supplies continually the loss of the fluid which is
drained off.

By means of the^e precautions, the globules of the blood may be
completely separated from the serum. Nevertheless, when we wish

2

18 Researches upon the Blood. [January,

the operation to succeed, it is necessary to neglect nothing that can
ensure its rapid execution.

As soon as the globules have had time to be deposited upon the
sides of the filter, and form there a layer of sensible thickness, those
which are in contact witn the surface of the paper cannot be longer
acted upon by the air and pass immediately to the violet, whilst those
which make up the exterior layer preserve the arterial state, and evi-
dently arrest all the air contained in the washings.

In consequence of this the fluid passes colored, and if we do not
immediately remedy this difficulty, its increasing coloration will soon
demonstrate that the globules have undergone a great alteration.

Under these different circumstances the globules of the blood be-
have as if they were truly living beings, capable of resisting the
solvent action of the sulphate of soda, as long as their vitality contin-
ues, but yielding to the action as soon as they become asphyxiated,
which results in this case from a deprivation of air, and which is
manifested with singular rapidity, either by a change of color, or
by their prompt solution.

Hence the object of the chemist must be to preserve the vitality of
the globules, and among the means which present themselves to the
mind we may mention the agitation of the fluid, its constant aeiation,
and lastly, the keeping of the blood at the same degree of tempera-
ture at which it was found in the body of the animal.

All these precautions being followed, we are furnished in a few
hours with pure globules, provided we do not undertake to prepare
more than five to six grammes at one time.

This rapid alteration of the globules, as soon as they are deprived
of the direct contact of air, or of aerated water ; the extreme energy
with which, in a layer of globules, those which occupy the surface
appropriate to themselves the whole of the oxygen, causing a fluid to
pass to those below, which is entirely unfit to arterialize them, are
circumstances well calculated to fix the attention of physiologists.

In the discussions in which the respiration has been the object of
our inquiries, the blood has always been regarded as a homogeneous
fluid, receiving the contents of the air in the lungs, and undergoing
there more or less rapid alterations.

Doubtless the serum of the blood does constitute such a fluid, nor
will I dispute the part which it may take in the phenomenon of res-
piration ; but the globules of the blood compose so many vesicles
floating in this serum, having a respiration peculiar to themselves,
whose effects, connected with those resulting from the respiration of
the serum, produce by their ensemble the general phenomenon of the
respiration of the blood.

We may say, therefore, laying aside for the present the proper ac-
tion of the serum upon the air, that the respiration of one of the
superior animals, and particularly of man, has for its object the con-
tact of oxygen with the globules of the blood and the expulsion of the
products into which they are converted.

1847.] Researches upon the Blood. VJ

Hence, if we wish to calculate the effects of respiration, we must
take into consideration the membranes which form the envelope of
these glohules, for we know how very different from a pure and sim-
ple solution of a gas are those strange phenomena of endosmose which
take place through membranes which separate two reservoirs filled
"with different gases, or with fluids saturated with these gases.

Respiration, in order to be well understood, must therefore be stu-
died in these vesicles or blood-globules, the principal seat of those
phenomena which it is destined to produce, and whose organization
complicates so strongly the physical laws which govern it.

The manner in which these blood-globules act upon the surround-
ing or dissolved air, and the conditions under which they preserve
their normal character, become, when thus regarded, subjects of the
highest interest.

To determine the integrity of the globules and the existence of their
fundamental property, we have two means, both of which are equally
exact, the microscope and the agitation of them with oxygen as
long as the globules are entire the microscope will indicate it: as
long as they may be arterialized they will redden in contact with
oxygen.

Now every body knows that the blood possesses these two charac-
ters whilst it is circulating; nor does it lose them after its escape
from the animal. The beating of the blood, by which the fibrine is
separated, does not injure the globules nor deprive them in any way
of the property of becoming arterialized.

In this phenomenon the albumen is no more needed than the fibrine.
When we gradually replace the serum in which the globules are
suspended, by a solution of sulphate of soda, they preserve no less
their integrity, and they become no less reddened by being agitated
with oxygen.

Thus the faculty of assuming the brilliant color of arterial blood
belongs to the globules ; it is independent of the albumen, of the se-
rum, of the fibrine of the blood, and of the vital action of the animal.

But if the sulphate of soda preserves this property of the globules,
will this be the case with all the alcaline salts? By no means ex-
periment proves this.

The common phosphate of soda which exists in the blood, may,
like the sulphate, saturate the blood without in the least destroving
in it the property of becoming arterialized. Blood saturated with
phosphate of soda, when agitated with oxygen, receives a brighter
arterial tint than it would have done without it.

In regard, therefore, to this property at least, the blood may with-
out inconvenience have added to it much larger quantities of the
sulphate or phosphate of soda than it naturally contains.

The salts formed from the organic acids, such as the salt of Seig-
nette, are similar in their effects, which leads us to believe that the
lactate of soda may exist in the blood, even in large proportion, with-
out producing any ill effects in this respect.

20 Researches upon the Blood, [January,

Bnt is this the caso with common salt or chloride of potassium ?
Experiment shows that these salts are altogether different in their
effects.

If we saturate blood deprived of fibrine, although fresh, with com-
mon salt, and agitate it immediately with oxygen gas, it remains of a
sombre violet hue. Sal ammoniac produces the same effect.

Does there not exist an iutimate connection between these phe-
nomena and the supposed injurious effects of salted meats in the
production of scurvy ? Must we not also find some agreement be-
tween the action of sal ammoniac, upon the blood, and the poisonous
properties of this and other ammoniacal salts upon the body ?

But however this may be, it is certain that there are some salts
which leave the blood the property of becoming arterialized, whilst
there are others which entirely destroy this property. The sulphate
and phosphate of soda and the salt of Seignette belong to the first
division ; the chlorides of potassium, sodium, and ammonium to the
second.

With these results, there is one circumstance connected which
cannot fail to arrest our attention. Those salts which maintain in
the blood the property of becoming arterialized, are at the same time
the best adapted to preserve the integrity of the globules, and they
give it the property of furnishing a colorless serum by filtration. On
the contrary, those which take away this property cause the filtered
serum to be more readily colored.

The whole of these experiments lead us to believe that the coloring
matter of the blood is peculiarly fitted to take on the characteristic
tint of arterial blood, when it is connected with the globules them-
selves, of which it forms a part. This character is modified, or lost,
when by the alteration or destruction of the globules, the coloring
matter enters truly into solution.

By comparing with great care specimens of the same blood, brought
into contact with alcaline salts, and allowed to be saturated with
these salts in the cold it appears to me that generally these saline
solutions, agitated with oxygen, act in the following manner :

Those salts containing complex organic acids, as the tartaric and
citric, preserve the integrity of the globules much better than the salts
formed from the mineral acids.

Those salts which have soda for a base, are better fitted to main-
tain this integrity than those with potash or ammonia as the base.

There appears, therefore, to exist an unexpected relationship be-
tween the integrity of the globules, the arterial state cfthe blood, the
phenomena of respiration, and the nature or the proportion of salts
dissolved in the blood.

It requires only a few experiments of this kind to be convinced that
asphyxia may be induced in the midst of air, or of oxygen gas, with-
out any apparent change in the phenomena of respiration, by the
simple introduction into the blood of those salts which modify the
action of the oxygen upon the red globules.

1S47.] Researches upon the Blood. 21

We cannot but call the attention of physicians to this order of
phenomena. At a time when the analysis of the blood attracts with
bo much reason their regards, it is to be hoped that the study of the
^lobules, in certain well understood diseases, should become the ob-
ject of peculiar investigation.

Every thing leads us to believe that, in their less or greater, and
slower or quicker alterability, there exist degrees which may be ascer-
tained and measured by receiving the blood from a vein into a solu-
tion of sulphate of soda, for the -purpose of subjecting it to different
trials, or even after defibrinization, by attempting to alter it by grad-
uaied doses of well chosen salts, such as common salt (chloride of
sodium), or sal ammoniac (chloride of ammonium).

The greater or less resistance of the globules to the alterative
operation of these salts, would furnish indices which nothing could
replace at present in our diagnosis of Diseases of the Blood.

The elementary analysis of the blood globules, when once they arp
isolated, is so easy that I have been ante to go through it with full
confidence in the results. The globules of the blood, deprived of
serum and collected on a nat d:-h, placed in the vacuum of an air-
pump on which is pure sulphuric acid, yield in a short time a residuum
perfectly dried. This, treated by ether and alcohol, at the boiling
points, becomes insoluble in water which may now be used to remove
any sulphate of soda remaining in the globules. It is after this pre-
liminary treatment that I have made an elementary analysis. The
following are the results, neglecting the ashes :

GLOEULES OF BLOOD,

Of

a Female.

Of a

Dos.

Of a Rabbit

Carbon,

55-1

55-1

55-4

51-1

Hydrogen,

7-1

7-2

7-1

7-1

Nitrogen,

17-2

17-3

17-3

17-5

Oxygen,

20-6

20-4

20-2

21-3

100-0 100-0 100-0 100-0

It appears evident from these analyses, as we may have concluded
from their properties, that the red globules belong to the family of
aibumenoid bodies. If the carbon whieh they contain is a little great-
er than that of caseine and albumen, it is because in the red globules
there exists a coloring matter which accounts for this excess.

I will examine, however, in a subsequent memoir, the question,
whether the matter of the red globules may be confounded with albu-
men or caseine, or whither, as appears probable, it may not be distin-
guished from these substances altogether, as well as the fibrine itself.

22 Seven Cases of Traumatic Tetanus cured. [January,

History of Seven Cases of Traumatic Tetanus, treated successfully
by Strychnine. By J. W. Fell, of New, York. (New York
Journal of Medicine.)

Dear Sir :

In compliance with your request, I herewith furnish you
with the histories of seven cases of tetanus (six of them certainly
traumatic, and most probably the seventh), which have been treated
by strychnine with success. The first two were published in the New
York Medical and Surgical Reporter, but as they will be more inter-
esting in connection I send them to you. The 6th case was furnished
me by Dr. Botsford, the 7th by Dr. Vanderpool, of Fourth-street.

You will observe that in every case, as soon as the specific twitch-
ing was produced, the tetanic spasms abated, and they convalesced
rapidly. I have found this distress over the diaphragm (caused, no
doubt, by its spasmodic contraction) the most troublesome symptom
in all the cases.

I would, from the experience I have now had, administer the
strychnine as follows. I should at once give an eighth or tenth of a
grain, then, in two hours, the sixteenth, then reducing the dose just
sufficient lo produce its effect after each one. The great object is to
produce the twitchings as soon as possible, they can then be kept up
by a much smaller dose than the one which first produced them.
Hoping they will meet your approbation,

I remain yours very trulv,
New York, Oct. 9th, 1845. j'. WELDON FELL, M. D.

Doctor Lee.

On the use of Strychnine in Tetanus.

Case I. Aug. 1st, 1845. Visited William Ellsworth, aged 7
years, living with his parents, in Hudson county, New Jersey. Found
him in a kind of stupor, but upon his father's taking hold of him, he
was thrown into a violent spasm which lasted a few minutes, during
which his body was curved backwards, jaws set, countenance distort-
ed, and his body resting entirely upon his head and heels. After the
spasm ceased, he complained of pain and distress over the diaphragm,
jaws stifT, and almost closed, difficulty in swallowing, pain along the
spine, and soreness in the left groin. The spasms were excited by
touching him, or by his attempting to swallow. During the spasms
the muscles were so rigidly contracted that he could be raised by his
head alone.

About ten days ago he injured his left knee with a thorn. While
playing a few days after, it commenced swelling, and to be painful;
but by the application of some domestic remedies, the swelling was
reduced, and the pain allayed. Soon after he became restless and
uneasy, complained of distress about the precordial region, pain in
the masseter and temporal muscles ; his voice changed, he had diffi-
culty in swallowing, and these symptoms were attended with slight

1847.] Seven Cases of Traumatic Tetanus cured. 23

fever. These symptoms increased until yesterday, when the charac-
teristic spasms of tetanus set in. His mother immediately applied a
blister to the knee and one to the spine. The glands in the left
groin were enlarged and tender.

The case was evidently one of traumatic tetanus, well developed
and rapidly advancing, and demanding the most vigorous treatment.
Iat once determined to administer someone remedy, and tocontinue
its use until some decided effect was produced by it. I reviewed in
my mind the many remedies heretofore used, viz., opium, alcohol,
turpentine, iron, digitalis, tobacco, aconite, &c. &c, and knowing
they had all failed, in the majority of cases in which they had been
used, I, from a suggestion of Professor Mott's, during the previous
winter, determined to use the strychnine, and at once prescribed it in
doses of the fourteenth of a grain, every two hours. I also ordered
a poultice to the knee, and the spine to be rubbed with ung. tart, anti-
moni. The strychnine produced its peculiar twitching effects after
the fifth dose. It was given as above for two days, each dose after
the fifth producing the specific effect. The intervals between the
doses were now increased, until, on the sixth day, he only took it
three times. He had no spasm after the second day ; he convalesced
slowly, until the sixteenth day, when the strychnine was discontinued,
as he had entirely recovered.

I have frequently seen his father since, and he informs me the boy
lias enjoyed perfect health.

Case "II. Oct. 4, 1S46, 10 o'clock, P. M. Was called in haste

to see 3Iiss M , of Sullivan street, aged 25 years, under the care

of Dr. E. Vanderpool. Found her in a spasm ; the muscles of the
left side only being in a contracted state ; jaws set, left leg and arm
stiff, body bent to the left side, extremities cold, pulse feeble, and
left side of the face distorted. Ordered some wine, as soon as the
spasm passed off, and she could swallow. Dr. Vanderpool having
been at once sent for, now arrived, and gave me the. following history
of the case. Miss M. had been suffering for several months with a
bad toe, the nail of the great toe of the left foot having grown under
the flesh. She had not been out of the house for months, she refusing
to have the nail removed. A few cays ago, however, she consented,
and Dr. Vanderpool removed a part of the nail; the next day she
went out riding, and directly after her return, the toe commenced
swelling, and to be very painful, the pain extending up the ieg, side,
arm, and soon affecting the temporal and masseter muscles of the
left side.

Dr. Vanderpool and myself examined and found the toe and foot
much swollen and tender, the lymphatic glands of the left groin en-
larged and painful, the muscles of the left side contracted, jaws stiff,
but not entirely closed, difficulty in swallowing, masseter and tem-
poral muscles contracted and painful, and uneasiness about the pre-
cordial region ; during the spasm the diaphragm was powerfully
contracted. Considering this also a case of traumatic tetanus, I

24 Sev?n Casen> of Traumatic Tetanus cired. [January,

suggested to Dr. V. the use of strychnine in this case ; he preferred,

however, waiting until morning. He made a free incision upon the

toe, and prescribed the following:

R Tinct. Assafcetidee ) c , ,

n r\ \ a teaspoonful every two hours.

Oct. 5, 10 A. M. Upon visiting the patient this morning, we found
her much worse. Spasms more severe and frequent, jaws nearer
closed, and the difficulty of swallowing greater. We gave her

R Strvchnin. gr. jss. ) c, ,, . ,

E." , 7 f i -, T > it. pill no. xvi. one every two hours,
xtract. JuglandisC, 3ss. $ v J J

10 P. M. Was called in haste to see the patient, as her friends
thought her dying. We found her under the specific effect of the
strychnine. Ordered the pills discontinued until morning.

Oct. 6, 10 A. M. The patient slept well from 12 to 4 o'clock this
morning, being the first sleep she ha:; bad i.i some days. She is much
improved ordered one pill every three hours.

7 P. M. Has had some slight spasms during the day ; jaws a little
relaxed ; gave her wine whey, to be continued as above.

Oct. 7. Miss M. slept well during the night, and the irritability
which had been so marked, has in a great measure disappeared. The
twitching is produced by each pill : it commencing about twenty
minutes after taking the pill, and hasting about fifteen.

Oct. 8. No spasm since yesterday ; ordered one pill every six
hours ; continue the wine whey.

Oct. 10. Discontinued the pills, as the tetanic symptoms have all
disappeared.

Oct. 16. Miss M. is going out as usual, quite well.

The only peculiarity about this case, was the contraction being
confined to the left side, making it a case of Pleurosthotonos.

Case III. Nov. 15. Visited Mrs. J., of Thompson street, aged
27 years. About ten days ago she ran a needle into the palm of her
hand ; it breaking, a piece was left in the wound. This was remov-
ed by a barber in the vicinity within a few days; but the hand and
arm continued sore and painful. Yesterday she complained of hav-
ing taken cold, as her jaws were stiffand deglutition painful. During
last night she had hot flushes and chills. I found her complaining of
difficulty of swallowing : jaws very stiff, and nearly closed : pain and
distress in the diaphragm, and some slight spasms. Ordered the
following :

v ? t i ' ? ," tit i in pill nos. xiv one every two hours,

liXt. Juglandis 3ss. M. $ * J '

the hand to be bathed frequently in hot water and ashes.

Nov. 16, 9 A. M. The third pill produced the twitching. This so
much alarmed the family, that they have discontinued them since.
I immediately ordered them to be given again. They produced the
twitching in about ten minutes, it lasting sometimes as long as half
an hour.

4, P. M. Patient some better, still slight spasm.

1847.] Seven Cases of Traumatic Tetanus cured. 25

Nov. 17. Has had no spasm since yesterday : the swelling in the
hand and arm is much rediced : still painful. Ordered a pill every
Jour hours, and a poultice to the hand.

Nov. 18. Thj patient slept well last night for the first time since
she has been unwell. Jaws relaxed. One pill every six hours.

Nov. 19. Patient about the house as usual. Arm stiff*. Ordered
two pills per day.

Nov. 21. Each pill produces the twitching; but as the patient has
completely recovered, 1 ordered them discontinued.

The hand now did well, and healed rapidly.

Case IV. May 9, 1846, 8 o'clock, P. M. Thomas Brown, of
Hoboken, New Jersey, called at my office, and requested me to visit
his sister-in-law, Miss Jane Savage, aged lfi years, then at his house,
suffering with lock-jaw. On my arrival at his house, I learned that
Dr. Julien had been in attendance. I at once had him sent for, and
upon his arrival we visited the patient. Upon our entering the room
she was thrown into a violent spasm, which lasted about a minute,
during which her body was bent backward, resting upon her head
and heels, her countenance distorted, and her pulse quick and irregu-
lar. After the spasm passed off, we found her jaws were entirely
closed and set : pain along the spine, and over the region of the
diaphragm: difficulty of deglutition and respiration, and her pulse
still quick. Learned the following history: Some days since she
ran a carpet-tack into her right thumb; soon after she took a cold in
it while washing. It commenced swelling and to be painful. It
grew worse until about forty-eight hours since, when she was seized
with the tetanic spasm. Dr. Julien was then sent for : he bled her,
and ordered counter-irritation to the spine. This morning she was
worse, the spasm more frequent and severe. He ordered an injec-
tion, and invited Dr. Hosack to see her. They visited her at 12 M.,
and at once ordered her to take large quantities of Sherry wine and
arrow-root, and a poultice of herbs to the spine, but as she has a very
regular set of teeth, and her jaws being set, and as it is very difficu-t
for her to swaliow, it was almost impossible to give it, up to the
present time, and about nine o'clock P. M., her mother informs me
that she has taken about a wine-glassful of the wine and arrow-root.
The patient is evidently growing worse. I informed Dr. Julien of the
result of the three preceding cases, and advised the use of the strych-
nine in this. After due consideration he wrote as follows : R Strych-
nin, gr. j., Spts. Yin. Rectf. I]. M. : Of this 30 drops to be given
every two hours. The strychnine was procured and the first dose
given, at half-past ten, P. 31. In about fifteen minutes the twitching
commenced : it lasted about twenty : the patient then fell asleep.
At half-past twelve she took the second dose, with about the same
effect, again falling asleep. She continued to take the drops every
two hours, until twelve o'clock M., Sunday.

Sunday, May 10. The patient, at eight o'clock this morning, sat
up in the bed and fed herself with a tea-spocn, her jaws having re-

28 Seven Cases of Traumatic Tetanus cured. [January,

laxed very much, and the spasms almost ceased. A 12 M., Drs.
Julien and Hosack called, and from some cause, carried the strych-
nine away with them, giving as a reason to the family that it would
injure her health ever after, if she continued to take it. They then
ordered her (now she could swallow) to take a gallon of Sherry wine
a day ; and said she would certainly recover. At 9 P. M., Mr. Brown
called at my office, and communicated the above to me; he also said
Jane had eaten a piece of beef-steak just before he left home. He
asked me to give him a prescription for another bottle of the strych-
nine, as he was satisfied it had produced the great change in the
patient. I did so, with directions to give it as before, if there was a
return of the spasms. But as they did not return, the drops were
not given.

Dr. Julien continued to visit the patient, and ordered the wine to
be given in large quantities for some days.

May 16. 1 visited ?Jiss S. to-day, and found her in a state of in-
toxication. I at once advised the wine to be discontinued.

June 10. Mrs. Savage and her daughter Jane called at my office
to-day. Jane is in a complete state of fatuity. Dr. Julien has been
treating her for some days without any benefit. Mrs. S. now wished
me to prescribe for this difficulty. I, with the advice of Professor
Mott, put her upon a course of Sub. Mur. Kvdrarg., and applied
counter-irritation to the hack of the neck. This course was pursued
until it produced gentle ptyalism : this was kept up for about two
weeks, with decided improvement.

June 28th. Mrs. S. and daughter called to-day. Jane has en-
tirely recovered. She continued perfectly well, and was married
September 20, 1846.

This was undoubtedly a case of traumatic tetanus from a punctured
wound, yielding at once to the strychnine ; but whether the wine or
the strychnine produced the fatuity, I leave for others to decide.
Why Dr. Julien carried away the strychnine (without consulting me)
while the patient was improving under its use, I also leave.

Case V. May 10, 1846. Visited Mrs. Andrews, of Robinson
street, aged 55, under the care of Dr. Condit. Dr. Conger, Sen.,
having been called in consultation yesterday, found her suffering
with completely developed tetanic spasms, occurring every few min-
utes, during which her body was bent backward, countenance dis-
torted, violent contractions of the diaphragm, and jaws set during the
remissions, her jaws were nearly closed, deglutition very painful and
invariably exciting a spasm, pain and rigidity of the right temporal
and masseter muscles : the head was drawn to the right side, and the
right arm and shoulder painful, the glands in the right axilla swollen
and tender. The patient, some time since, bruised her right elbow,
but the pain ceased in a day or two and was forgotten. A few days
since the right elbow and arm commenced to be painful, the pain ex-
tending up to the shoulder and side of the neck. She thought she
had taken cold, and did not feel alarmed until the spasm commenced.

1847.] Seven Cases of Traumatic Tetanus cured.

This patient had been bled, and had taken tincture opii, &c, &c.
She however continued to grow worse to the present time. I sug-
gested to the above named gentlemen the use of the strychnine.
They at once gave their assent, and it was given in dose* of one-
twelfth of a grain every two hours. It produced its peculiar effect
after each dose. She was also ordered injections from time to time,
as her bowels would not move without it. On the next day the dose
was somewhat diminished, as its effects were very powerful. The
spasms ceased after the fourth day. This patient convalesced very
slowly, her arm being weak and painful for some time : this, however,
may have depended upon her age.

August 21. Called and found Mrs. A. had just returned from th<^
country ; she has quite recovered. I have called several times since,
and she continues quite well.

Case VI. This case occurred in the practice of a gentleman in
Sullivan Co., X. Y., and as he has kindly furnished me with a history
of it, I will insert it here.

"Dear Sir: Miss , of this village, aged 14 years, robust and

healthy, ran a piecg of bone in the sole of her foot, about the last of
October. There was a little irritation about the foot for three or four
weeks after the reception of the injury, and two or three times during
the period there was slight ulceration; but little pain was felt by the
patient until about the time she was attacked by the tetanic symp-
toms.

"She had, however, from time to time, after the injury and previ-
ous to the tetanic attack, more or less ' stiffness and numbness' in the
injured leg. She states, also, that at different times during this peri-
od, 'her leg was hot and had red streaks upon it ;' these lasted a day
or two and then disappeared. She lirel nothing buf some slight do-
mestic remedies applied, until her case became alarming by the spas-
modic action.

"It had been my determination ever since reading the result of
your cases published in the 'Reporter,' if calied to a case of tetanus,
to treat it with strychnine. When my attention was called to this
case, I was destitute of this medicine, and none could be obtained in
the vicinity; accordingly the case progressed for forty-eight hours
before the remedy was obtained and administered.

"In the meantime. I pursued the following course : There were
violent pain and spasms at intervals, commencing in the affected leg,
and extending along the muscles on either side of the spine to the
head and jaws, violent distress about the diaphragm, with consider-
able sympathetic fever.

"My first effort towards subduing the disease was making an in-
cision with a bistoury, about an inch and a half in length, and of
sufficient depth to thoroughly divide the plantar aponeurosis, which
was wounded by the piece of bone. I then filled the incision with lint
saturated with ol. terebinth, and a bread and milk poultice to be ap-
plied over it. I then used V. S. gx.xvj. on the leg, and administered

S8 Sevan Cases of Traumatic Tetanus cured. [January,

the following : ft Calomel, grs. xx., Jalap, xv., to be followed by sal.
Epsom in two hours. After this had operated briskly and freely, I
gave her a teasponful of Tinct. Opii every hour, with a view to sub-
due the* spasms. After she had taken two or three doses, the spasms
were somewhat relieved nnd the pain less. This truce lasted four or
five hours. She became worse, although the Tinet. Opii was con-
tinued as above; her btidy curved more backwards, her joints were
set and the spasms more severe. The dose of Tinct. Opii was in-
creased, but it failed to subdue the disease. By this time, I obtained
the strychnine, and administered it with complete success ; so soon
as it produced its peculiar twitching effect, the spasm abated and the
patient rapidly recovered : in a few days she was about as usual.
The dose given was T\ of a grain every two hours, at first, gradually
increasing the intervals.

"Dear Sir: I send you above a history of a case of traumatic
tetanus I lately treated with strychnine. You are at liberty to make
what use you please of it.

"In great haste, yours, &c,
" To J. Weldon Fell, M. D. (signed) CifeMENT Botsfoed.

" Bloomingburgk, Sullivan Co., N. Y."

Case VII. This case was furnished me by my friend, Dr. E.
Yanderpool, and although it was not so well marked as some, still I
think that there can be no doubt of its having been an incipient case
of traumatic tetanus.
" Dr. Fell :

"Dear Sir: The case of tetanic rigidity you request a history
of, though only partially developed, is, I think, sufficiently interesting
to be published,. as tending to commend the use oi'strychnine in this
most alarming malady.

"The 2d of Sept., 1846, I excised an elliptical piece of the cutis,

on the radial side of the metacarpal joint of the thumb of Mrs. ,

in view of removing a cicatrix from the point of a scissors with which
it had been punctured some three months previously, in hope of
curing a neuralgic condition of the arm, which had been thus pro-
duced.

"On the 10th Sept., 1846, just eight days after the operation, the
wound having healed, a slight but permanent contraction of the arm
was noticed, with rigidity of the flexor muscles, particularly the biceps,
which was painful upon pressure. That night she was unable to
&kep, from the uneasiness and increase of this rigidity involving the
muscles of the neck and jaws, accompanied by a 'violent cramp or
drawing' in the region of the diaphragm on the affected side. These
symptoms all became aggravated by attempting to extend the arm,
or by any motion of the body, and produced great general distress,,
with nervous tremors, 'shuddering and shaking' of the whole body.

"The arm fell on the inner side, as she expressed it, corded in its
whole length. Next day there was a little abatement of the a Dove
symptoms, hut on (he 12th she became decidedly worse, the ( cramp
and drawings' being more severe.

1847.] Insensibility during Surgical -Operations. 29

" Sept. 13th. I was sent for at 3, P. M. I found her sitting up ;
said she could not sleep on account of general uneasiness and a dis-
position to move the arm. which brought on an increase of the symp-
toms enumerated. On examining the arm, [ found it a little, but
firmly flexed; the biceps was contracted, cord-like, and hardened,
and somewhat tender upon pressure. Slight rigidity of the muscles
of the neck on the affected side, also a feeling of 'tightness' extend-
ing from her hand to her head. From the tetanic character of the
symptoms, I at once prescribed strychnine in doses of y1^ of a grain,
in solution, every two hours (when awake) with a sinapism to the
biceps.

"Sept. 14, 10 A. M. Patient has slept well through the. night for
the first in some time, arm a little relaxed, otherwise as yesterday;
continued the strychnine as above.

"7, P. 31. Xo improvement ; ordered T]T of a grain of the strych-
nine.

" Sept. 15, 10, A. M. Patient has slept but little during the night ;
complains of the 'rigidity, tightness, and drawing' of her arm;
her head is drawn down towards the shoulder of the affected side,
with inability to extend the jaws to the full extent, and distress over
the diaphragm; ordered her to take strychnine T1^ of a grain every
two hours.

"7, P. M. Has had a few twitches, characteristic of the effects
of the strychnine ; a little yielding of the tetanic symptoms ; con-
tinued the strychnine as above.

"Sept. 16, 10, A. 31. Patient has slept well, general improvement,
contracted muscles relaxing; has taken considerable nourishment,
having been unable to do so for some days.

"17. Dicontinued the strychnine, as the tetanic symptoms have
all disappeared.

"From this time forward, the patient continued to mend rapidly,
and bythe 21st was perfectly well.

" Respectfully yours, &c.

New York, Oct. 1, 1846. "Edw. Vaxperpool."

Insensibility during Surgical Operations produced by Inhalation.

In a recent Xo. of the Boston Medical and Surgical Journal,
(Xov. 18th, 1846,) Dr. H. J. Bigelow drew the attention of the pro-
fession to the fact, that the leading surgeons connected with the
Massachusetts General Hospital, had operated upon a few patients
while in a state of insensibility produced by inhaling a new gas, said
to be discovered, or invented, by Dr. Charles T. Jackson, a chemist,
and Dr. Morton, a dentist of Boston. On the reception of this intel-

30 Insensibility during Surgical Operations. [January,

ligence here, a letter was addressed to Dr. Smith, editor of the above
journal, offering to test the article before the profession and medical
class of this city, upon patients in the Augusta Hospital. The follow-
ing is the reply :

"Boston, Dec. 2, 1846.
Dr. Paul F. Eve :

Dear Sir Dr. J. V. C. Smith has kindly shown to Dr. W. T. G.
Morton, of this city, your letter of Nov. 23. It will afford Dr. Morton
much pleasure to permit you to make trial of his discovery. He has-
written a letter to Dr. John C. Warren, of this city, requesting him to
name theTnost respectable and charitable hospitals of the United
States, and it is Dr. M.'s intention to give to such the free use of his
discovery for the benefit of the poor. As soon as measures can be
taken, such hospitals will be licensed. In order to use the article
employed, it is necessary to have a proper apparatus which costs,
with a quart bottle of the preparation, $25. If the hospital you
mention desires such, and will render the above amount in a letter, it
can have it to use for the poor, and you can employ it, to test the
same to your satisfaction. We hope soon to effect arrangements
whereby all the surgeons can avail themselves of its use. The dis-
covery is of great value to the world. If you desire to use the same
in your practice, I have no doubt Dr. 3Iorton will give you an appa-
ratus and license to do so for five years, for $100.

Yours, respectfully, R. H. EDDY,

Attorney for Dr. Morion."

Surgical Operations with the aid of the " New Gas."
To the Editor of the Boston Medical and Surgical Journal :

Dear Sir The two following cases, occurring in my practice
during the past week, are of interest as supporting the claims to con-
fidence of Dr. Morton's anodyne compound.

Case I. Nov. 19th. An Irish girl, under 20 years of age, in at-
tempting to step into the cars at Hamilton, while they were in motion,
fell, with her arm upon the track, and had a compound, comminuted
fracture at the elbow, from the wheel of the car. At about 9 in the
evening, I amputated in the middle of the humerus. The operation
lasted a little longer than if done by daylight, although it was a flap
operation and quickly executed. Three vessels were tied. Dr. Fisk,
dentist, of this city, accompanied me and caused the patient to inhale
the vapor of the compound, about three minutes before the operation
commenced. By this time she appeared to have yielded entirely to
its influence, and became pale, silent, and perfectly passive and man-
ageable, whereas she had before exhibited evidence of great physical
suffering and uncontrollable grief. Before the arteries were all tied
she appeared to be returning to consciousness, when, on offering the
apparatus to her mouth, she seized it with avidity, respired rapidly,

1847.] Insensibility during Surgical Operations. 31

and soon seemed to relapse into the unconscious state. It was thus
renewed four or five times before she was placed in bed. Her own
statement is that she suffered no pain during the operation, that she
was asleep, and when she awoke she breathed again of what was
offered to her and fell asleep again that she remembers to have
done this three times. She says she did not know what we were
doing to her, but in her sleep she thought she had got a reaping hook
in her arm, and that she heard the noise 6f sawing wood. She says
she was not sensible of any thing till she was laid in bed, when she
became quite talkative, and evidently somewhat excited. She slept
some hours during the night. On dressing the stump on the third
day, she made a violent outcry at the slightest pain. I was convin-
ced that her statements with regard to her freedom from pain during
the operation, were to be believed.

II. Nov. 21st. An intelligent tanner, about 30 years old, had,
with a fracture of both bones in the middle of the left leg, his ancle
crushed by the cars engaged in building the Salem and Methuen
Railroad. I amputated the leg just below the knee. The patient
respired the vapor under Dr. Fisk's directions. He says he was not
conscious of feeling any pain and after the operation was finished
and the ligatures applied, his consciousness returned, and, with great
apparent sincerity, he asked if his limb was taken off. He says,
though he felt no pain, he was conscious of the presence of those
around him, and he was obedient to the directions given him. The
operation was performed at about 3, P. M., and the stump was dress-
ed at about 9, when, he says, the pain of a few sutures far exceeded
that of the operation.

In both these cases the pulse became somewhat accelerated after
the operation, the countenance assumed a vacant expression, although
in the first case there was working of the brows, and the pupils were
dilated. They both appear to be doing well, and exhibit no symptoms
worthy of note. Respectfully, yours,

Salem, Nov. 24th, 1846. A. L. Pijirsox.

Postscript. Xoiwnber 25//*, 1845. Yesterday, I made further
trial of the ethereal vapor, upon a middle-aged female, from whom I
removed an adipose tumor, by an incision four inches long over the
clavicle and scapula. She was an unimpressible subject, and was
less perfectly under the influence of the vapor than the others, but she
was entirely bewildered and not able to realize the nature of what
we were doing to her. She was much more quiet than patients
usually are. although the dissection was somewhat protracted, by the
dipping down of the tumor into the supra spinal fossa of the clavicle,
and confinement by fascia. She says she felt no pain, and did not
evince any perception of the puncture of the needle in dressing the
wound a sensation which usually calls forth complaint, as it is com-
monly unexpected.

It needs, no doubt, still further careful observation of its effects, to

32 Insensibility during Surgical Operations. [January,

establish medical confidence in the new remedy, a confidence which
must be of slow growth. From the results I have seen at the
Massachusetts General Hospital, and in my own practice, I am led
to expect the following advantages from its exhibition :

1st. Uniformity of its effects, unlike any mode of intoxication by
stimulants in the stomach, or respiration of nitrous-oxide gas. My
three patients were as unlike in age, temperament and habits, as
could well be imagined, yet all exhibited the same appearance of pas-
sive endurance.

2d. There was no instinctive or voluntary resistance, which is so
embarrassing to an operator. This, next to its power of preventing
the perception of pain, is the greatest merit claimed for it.

3d. The securing the patent from the severity of the great shock
which a capital operation inflicts on the sufferer. It was quite
noticeable, in all the patients I have seen, that there was none of that
extreme depression which sometimes follows a severely painful im-
pression on the nervous system.

4th. Its effects pass off rapidly, and, as far as I know, no bad results
follow.

5th. It can be repeated several times during the operation, except
the mouth or jaws are the parts to be operated on. The repetition
of the close is always sought by the patients with avidity.

6th. The last and most important of its effects, is, that it either
wholly annuls pain, or destroys the consciousness of it, so that it is
not remembered ; and thus the sentiment of fear is wholly obliterated.
The patient appears to have been dreaming, and in the second case
said that "he was in a distinct existence" (i.e., distinct from his for-
mer experience), thus illustrating the theory of double consciousness.

These are recommendations enough to ensure it a fair trial among
the humane and enlightened members of our profession, and for their
decision we must wait, and by it be governed in its future use. Dr.
Morton and Dr. Jackson, at least, are entitled to the hearty thanks
of the profession for their discovery, and the liberal manner in which
they have offered it to all the subjects of surgical operations, both in
and out of the Hospital. If some hunter up of obsolute theories
should prove that such a thing had before been thought of, or tried,
still these gentlemen are entitled to the credit of having made it, for
the first time, perfectly available to the suffering, and submitted it to
the test of those competent to decide on its merits, without being
content to rest its pretensions on non-professional credulity or popular
notoriety. A. L. Peirson.

Salem, Nov. 2Qth, 1846.

The Inhalation of an Ethereal Vapor to prevent senibility to pain

during Surgical Operations.
To the Editor of the Boston Medical and Surgical Journal :

Sir, That which has always been a desideratum in surgery,
seems, at length, to have been discovered. And if the effects of the

1847.] Insensibility during Surgical Operations,

agent or agents be such as has been reported, of which there is little
room to doubt since the appearance of the article in a late No. of your
Journal, by Dr. Bigelovv, Jr., every one who has any sympathy for
human suffering must rejoice in the discovery ; and all who are called
upon professionally to perform painful operations must feel desirous
to avail themselves of the means of diminishing or destroying that
state of consciousness which recognizes all violence done to the sen-
sitive tissues of the body, while such operations are in process.

But it appears, from numerous statements, and through your cor-
respondent, Dr. B., who speaks with much authority on the subject,
that the article used is a secret, or patented affair.

Now the enlightened and regular medical faculty of Massachusetts
(as well as of other parts of our country), are associated and have
arrayed themselves against all secret remedies, or patent medicines,
and this for the just and laudable purpose of protecting the commu-
nity, as far as might be, from imposition, and of preserving the integer
rity and standing of the profession ; they cannot, therefore, feel
themselves at liberty, as I judge, to seek aid for their patients through
the adoption of such articles and means.

If I wish to furnish those by whom I am called upon to operate in
painful cases with the relief which this new discovery may afford, I
am told I must obtain it and use it as a secret, or purchase the
patented article and employ it as such. But I ask why? It is said
to be, by those who really do, or who assume to know what it is, the
vapor of sulphuric ether only. This was judged to be the agent by
several who witnessed some of its earliest public exhibitions under the
hands of Mr. W. T. G. Morton. Dr. E. R. Smilie, of this city, with
all due candor and liberality, has given, in your Journal for Oct. 28th,
an account of his experience with sulphuric ether and opium, the
effects of which he says are similar to those* produced by the "new
gas."

The free use of the article has been ceded to the surgeons of the
Massachusetts General Hospital, and these gentlemen would receive
it or adopt its use, on no other condition, of course, than that of know-
ing what it was, and having the full and free control of it for that
institution. Hence, I ask, why, if I wish to avail myself of any of
the possible effects of an article of our materia medica an article
which I have administered to patients hundreds of times, which I
have often swallowed, and have inhaled till I was all but lost in sleep
why I must now purchase the right to use it, and use it as a patent
medicine. %

But we are still told that it is patented. What is patented? A
power? A principle? A natural effect ? The operation of a well-
known medicinal agent? I doubt the validity of such letters patent.
It would seem to me like patent sun-light or patent moon-shine.

To my mind it seems unfortunate, to say the least, that the dis-
covery has not been brought to public notice in a ditferent manner
and under different circumstances. And I am sorry that Dr. Bige-

3

34 Insensibility during Surgical Operations, [January,

low, in his article above mentioned, has attempted to apologize for
the arrangements which he says have been made by Dr. C. T. Jackson
as one of the parties, to secure by patent the control of a medicinal
agent like the one in question. The doctor seems to feel very fully
his position in relation to this point, when he says,

" For various reasons, discoveries in high science have been usually
rewarded, indirectly by fame, honor, position, and occasionally, in
other countries, by funds appropriated for the purpose. Discoveries
in medical science, whose domain approaches so nearly that of
philanthropy, have been generally ranked with them ; and many will
assent with reluctance to the propriety of restricting by letters patent
the use of an agent capable of mitigating human suffering."

Of the three reasons which he offers as worthy of consideration in
this behalf, two are, to my mind, entirely without force sufficient to
be any excuse for such a measure ; and the total incorrectness of the
,Amain part of the third, must be apparent to all who are at all acquaint-
ed with the subjects on which it is made to bear.

"1st. It is capable of abuse, and can readily be applied to nefari-
ous ends."

If, however, the right is to be sold, and every opportunity is to be
improved to make money of it, and all may buy who please, I do not
see how the abuses to which it may possibly be put by evil-minded
persons are to be restricted by a patent. And any one vile enough
to use such an agent for nefarious purposes, would not stop to ask
about his right to do so.

" 2d. Its action is not yet thoroughly understood, and its use should
be restricted to responsible persons."

Who are the most responsible persons to be trusted with this
agent? All will assent, no doubt, that they are such as are most
likely to be acquainted .with the properties of the article, with the
nature of those unpleasant symptoms which may occur from the use
of it, and have occurred in certain constitutions, and with such anti-
dotes or remedies as should be used if required ; or, in three words,
regular physicians, surgeons and dentists. And I am at a loss to see
why the use of the discovery would not be as safe in such hands as in
those of " the proprietor" so called.

"3d. One of its greatest fields is the mechanical art of dentistry,
many of whose processes arc by convention, secret, or protected by
patent rights."

Who is there that bestows a thought on the subject, who will not
see at once, that this narcotizing process of inhaling the ether has
nothing to do with the mechanical operations of dentistry, but only
with those which are strictly surgical, those which Dr. B., in speak-
ing of the importance of this process, couples with amputations.

As to that part of this third apology, which charges dentistry or its
professors with holding secrets, by convention, or by the security of
patent, I must view the writer as being entirely in error ; for if there
is truth in the charge, I cannot find it. I do not know of anything

1847.] Observations on Croup.

which is practised in dentistry, in our own country, even relating to
the mechanical department, which is kept secret by or from the duly
educated dentists. [How this is with the host of ignorant pretenders,
and advertising impostere, I know not.] And with regard to a
patent for any process in the art, or even for an instrument, I do not
know that such a thing exists, nor am I willing to believe, without
greater evidence than the doctor's assertion, that a patent can be
found that has any especial bearing on the subject of dentistry.

I have been asked, by a member of the Massachusetts Medical
Society a respectable and excellent dentist of this city, what I in-
tended to do about using the M new gas," stating that he had used
it and knew what it was, and when questioned by me directly, did
not hesitate to say, M it is simply sulphuric ether " ; but added, "the
discovery is patented." My reply to him was, ul shall not obtain
and use it as a secret medicine I shall not purchase and use it as a
patent medicine. If it is simple sulphuric ether, and it will produce
the desired effect, I shall use it, and so will others who wish to do so."
If it is a compound, as stiil advertised to be by Mr. Morton, it is said
to be ceded to the surgeons of the Massachusetts General Hospital.
These gentlemen, it is to be presumed, will not consent to hold it as a
secret or patent medicine ; and if known to the medical students who
are privilodged to attend that institution for the purpose of acquiring
information and obtaining instruction in all that is clone there pertain,
ing to their profession, no one, as I judge, can rightfully restrict them
from using what is there used for the relief of suffering humanity ;
and it will become, as it ought to be, free to all who should be trusted
to do good with it, or who can receive relief from suffering by it. To
patent it would be, what it would have been for the immortal philan-
thropist Jenner to have patented vaccination.

These, Mr. Editor, are some of my thoughts on the subject; and if
I am in error for holding them, or for thus giving them to the public,
you are able, no doubt, and will be ready, to set rne right.

J. F. Flagg.

Xo. 31 Winter sired, Boston, Xov. 23d, 1846.

Observations on Croup : a paper read before the Fellows of the Col-
lege of Physicians and Surgeons. By Alexander H. Stevens,
M. D., President of the College. (The Annalist.)

The frequent occurrence of croup, and its not unfrequent fatality in
the northern and maritime regions, especially those of the United
States, render important every addition to our knowledge of the na-
ture and treatment of this formidable disease. Up to the time of Dr.
Bayley, of New York, no modern writer appears to have entertained
correct pathological notions of this malady. It had previously been
confounded with anginose affections of the fauces. It was, however,

36 Observations on Croup, [January,

known to Hippocrates, who describes it in these remarkable words:
" Ab angina homo suffocalur oculi affecti sunt, ac velut strangulatis
prominent ; facies et fauces incendunter, imo etiam collum intumesci-
tur vero nihil mali habere videtur"

We owe to the late Dr. Hosack of this city, the best description of
the various stages of croup, and, probably, the best practical direc-
tions for the treatment of it. Yet there are important points, both of
pathology and practice, which he leaves wholly untouched; and
others in which, if I am not mistaken, he is inaccurate.

It is usual among the medical men of this city, to speak of genuine
croup, meaning that in which a membrane is formed in the trachea
and of spasmodic croup, many of them believing that inflammation
either does not exist at all in the latter species, or that it is not the
prior or primary morbid condition. These views I hold to be erro-
neous; and, if carried out in practice, highly dangerous.

Professor Ware, of Boston, (the most recent writer on croup,) has
recently presented another view of the subject, in a well-reasoned
paper, wherein he records numerous cases and dissections, knowing
how little that is truly valuable to American physicians, in relation to
croup, is to be found in European publications, more especially among
the continental writers ; or, rather, how far they fall short in estab-
lishing those rules of practice, by which alone the American physician
can successfully contend with the formidable malady. I am led to
infer that it may present itself under different aspects in different
regions. Be this as it may, the division of croup proposed by Profes-
sor Ware into four species viz., catarrhal, membranous, inflamma-
tory and spasmodic, does not accord with my own experience, or with
that of the most sagacious and experienced practitioners of this city,
with whom I have conversed on this subject.

The forms under which croup has presented itself to my observa-
tion in this city, during a period of more than thirty years, are the
following :

1. A child with coryza and occasional cough of the ordinary char-
acter, as in bronchitis, is playing about without sore throat, or redness
of the fauces, or glandular swelling. He appears more than usually
animated his countenance, especially his eye, is unusually bright,
and his mind exhilarated. His skin, at this time, is not heated during
the day, but rather harsh to the feel and dryer than natural. To an
acute observer, with a nice ear, his voice will be a little sharper than
usual ; and if he cries for a time, the peculiar inspiration will excite
alarm. On the second or third night the attack of croup commonly
comes on, after a few hours sleep, the symptoms being a ringing
cough, hoarse inspiration and great roughness of the voice. If the
patient dies, a membranous formation is found in the trachea, and,
more or less, in the bronchial lubes. This is what all admit to be
genuine inflammatory croup.

2. Without any noticeable illness whatever, a child suddenly wakes
up in the night with spasmodic suffocating cough, of the peculiar

1847.] Observations on Croup.

croupy sound, the same inspiration as in the former case and the
same hoarseness. A drink of some kind is given : the next cough is
less sonorous, but the croupy symptoms as before described remain.
The case is usually relieved by an emetic and some stimulating appli-
cation to the throat, both of which are kept for that purpose in almost
every well regulated family in the city, where there are many children
under eight years of age. If not so relieved, the patient may die
within twenty-four hours or less, or after a lapse of two or three days,
or even a week. Where the disease terminates quickly in death, no
well-formed false membrane is seen, but only mucus in the trachea,
more or less thick, and redness about the glottis. This is the form
to which the term spasmodic croup has been given. Spasm of what ?
Of the glottis, undoubtedly! And from what cause? From the
presence of vitiated secretions and undigested decomposed food in the
stomach, it is answered. And how does this act? By sympathy?
Now, this cannot be either proved, or even rendered probable. It is
true, when the stomach empties itself by vomiting, the symptoms, for
a time, at least, and often permanently, are relieved. But vomiting
does more than unload the stomach : it relaxes the system, reduces
the action of the heart, determines the fluids to the skin, which pos-
sesses so remarkable an antagonism to the mucous surfaces: above
all, it induces a copious secretion from the fauces, and thereby un-
loads the congested vessels of the glottis. It is admitted, that an
acid state of the stomach ofien causes irritation in the pharynx, which
thence extends to the posterior part of the upper portion of the
larynx. In adults this is beyond all doubt, and in children it is every
way probable. Is the impression of these acrid matters, eructated
from the stomach or secreted in the pharynx under particular circum-
stances, upon the larynx the cause of the sudden occurrence of croup ?
It would be difficult absolutely to disprove these propositions. In my
mind they are not improbable ; but, on the other hand, admitting the
connection between disordered stomach and croup (established, as it
is, by the most extended observation), may it not be attributable, in
part, at least, to the fact that continued coldness of the surface is pre-
cisely the condition which fits the system, as well in childhood as in
age, for the action of cold and moisture in producing inflammatory
diseases ?

But, stating aside these considerations, and, under any view of the
subject, what is the morbid condition of the glottis, which gives rise
to the croupy symptoms? If from cold, it is inflammation ; if from
acrid secretions acting for more than a few minutes, it is. and can be,
nothing else. There is, therefore, no spasmodic croup, if, by spasm,
it is intended to exclude inflammation as a cause of that spasm.

But, I am asked again, how are the two kinds of croup above de-
scribed, to Ihj explained pathologically. The itn&wer to this query
will appear in the classification of the forms of croup now proponed.

Under t he term croup, properly so called, are included two atfec-
tions, which may exist cither separately or together.

88 Observations on Croup. [January,

1. The cynanche tracheal is, or trachitis, in which membranous
exudation is more or less former! in the trachea, before any affection
of the larynx, and, more especially of the glottis, takes place.

2. The cynanche laryngea, or laryngitis, or glnttitis, in which the
laryngeal, or spasmodic symptoms occur first or exteriorly.

3. Between these two, there are varieties of combination, and these
constitute the great majority of the cases met with in actual practice.
In the most pure case of the so-called spasmodic croup, no practitioner
can say beforehand that no fatal inflammation of the glottis will occur,
or that no obstruction of the trachea, by false membrane, or solid
mucus, is to be apprehended.

Is the disease, croup, a specific disease? Is there any peculiarity
in the inflammation which gives rise to that secretion in the trachea?
Let us look to anatomy and physiology, and the observation of disease,
and to dissections, for answers to this question.

In the first place, between the most firm tubular form of false mem-
brane and inspissated mucus, and mucus of an ordinary consistence,
we see, in dissection of croup, every grade and variety. If specific,
its character should be more marked.

When a child attempts to swallow hot water, the membranous exu-
dation is produced in the posterior fauces and upper part of the larynx.
Here, then, is an ordinary cause of inflammation producing what
some consider a peculiar and specific secretion.

This question has a bearing upon practice, because it is contended
by some that the specific effect of mercury is the proper remedy for
this specific secretion.

It remains f>r those who deny the specific character of the tracheal
secretion, to account for its existence there, rather than in'the larynx
and trachea. In the larynx it is more rarely met with ; in the trachea
it gradually becomes less tenacious, and more rrscmbles*ordinary or
inspissated mucus. May it not be merely inspissated mucus in all
cases? mucus, inspissated by rapid desiccation? If a portion of
mucus is left in the trachea, the increased rapidity of respiration, and
the narrowed calibre of the tube, must necessarily remove its watery
particles in a doubly augmented ratio ; less so in the trachea, because
the same volume of air in proportion to surface does not pass by, and
the air, also, is more charged with the moisture, in its previous pas-
sage through the trachea less so in the larynx, becar.se that tube is
larger. Rarely is the membrane seen upon the glottis, because death
arises from spasms, ere it has time to form on that irritable part.
Rarely in adults, because in them the trachea is double the size it is
even in advanced childhood, and because they exert a stronger
volition to detach by hawking the first tenacious mucus that is ad-
herent to the trachea.

The surface of the trachea is very unirrifable. Where foreign
bodies enter by accident, as when a tube is forced into it from an
artificial opening, no coughing is induced, unless, by its rising up. the
glottis is touched. A email foreign body has been known to remain

1847.] Observations on Croup. 89

for years quietly lodged in one of (he ventricles of the larynx. The
trachea, and the comparatively unim table parts, are those in which
inflammation may be going on for a considerable length of time, with-
out exciting any very marked symptoms. This constitutes the truo
explanation of the two modes of invasion in croup.

Besides these three foims of idiopathic, primary, or true croup
the laryngeal, the tracheal and the mixed there are forms of secon-
dary croup, such as occur in measles, scarlet fever, and, more
especially, in the malignant ulcerated sore throat, the diphtherite of
Bretonneau. This last occasionally occurs sporadically with us, and
is, I apprehend, very generally, the disease, which, under the term
croup, carries off, in quick succession, two or more children in the
same family. I .have treated it successfully with calomel and opium,
followed hy wine whey, in conjunction with nitrate of silver, to the
throat :but my experience is too limited, for me to assume to instruct
others in regard to its nature and treatment. The French writers do
not appear to discriminate between this affection and croup, as known
here and in Great Britain.

Before speaking of the proper medical treatment, I will say a few
words on a point of Ilygeine.

1st. What is the best method of bringing up children, with a view
to their exemption from this disease?

Two systems are adopted for this purpose one is to allow free
exposure and exercise in the open air, except in the very worst
weather. The children, being well guarded with warm clothing, are
not suffered to cease their exercise until they re-enter the house.
The second is to confine them within doors, during the whole of the
winter and the early part of the spring. My observation leads me to
think that, although the first plan, if it is followed with great care, is
the best, yet the second is more easily pursued, and, upon the whole,
is the safest.

2d. Under what circumstances should especial precautions bo
taken, with a view to ward off the attack?

A child, between the ages of two and five years, with catarrh and
cough, however slight and unfrequent, is a fit subject fjr croup: and,
if that disease is prevailing at the time, an attack, after any exposure
to cold and moisture, or any excess in eating, is almost probable.
The child should be confined to the house an

The treatment of croup should be prompt and decided ; for, left to
itself, the disease would probably, in genera!, prove fata!. But, al-
though prompt and decided treatment is necessary, it does not follow
that the heroic treatment is always, or omen gem-rally, required.
But the existing symptoms must always be met by remedies adequate
to subdue them. The great skill of an oxprs ionr-ed practitioner is
shown in determining what amount of active I it is tssentihtxn

any given case ; how much is requisite to remove the tlircatehin*
symptoms, and to induce a favorable clianre, an 1 hnwaoon ho mrtst
recur to I he more severe remedies, after Iho i has been lor a

time meliorated.

40 Cancer of the Stomach, [January,

Cancer of the Stomach. By Professor W. H. H. Walshe, M. D.

(British and Foreign Medical Review.)

The mortality from cancer of the stomach is very considerable.
In this respect it yields to no organ but the uterus. Of the 8289 deaths
in Paris, 2303 are referred to the stomach. In 67 cases, MM. Her-
rick and Popp found this organ diseased in 19. Cancer of the stom-
ach may exist alone, but is usually associated with similar affections
of other organs, more especially of the liver. It is almost invariably
primary. All the varieties of the three species of carcinoma occur
in this organ ; it is the special site of colloid cancer; and the milt-
like variety of encephaloid is more common here than elsewhere.
Infiltration is essentially the mode of deposition in this place, and,
indeed, throughout the alimentary canal ; and the seat of the deposit
is the submucous cellular tissue, though the mucous membrane, par-
ticularly when hypertrophied, may become a nidus of formation.
The pylorus is the part most commonly affected ; next the cardiac
orifice; then the greater, and, lastly, the lesser curvature. Dr.
Walshe has not met with an instance in which the disease was limited
to the fundus a fact of importance as bearing upon the supposed
origin of the disease from the ingestion of irritants. Three-fourths,
or even more, of the organ may be disorganized ; and this is particu-
larly the case when colloid is the species.

The mucous membrane long resists the disease, and its chief ten-
dency is to become irregularly hyperlrophous, giving rise to the
apparent formations of vegetations, &c. The cellular structure
undergoes very marked thickening, and this occurring between the
muscular fibres produces the striated appearance so commonly ob-
served. The muscular coat of the sound parts of the organ is often
enormously hypertrophied. The peritoneal coat is seldom affected,
excepting in cases of colloid.

The size of the organ varies extremely. When the pylorus is af-
fected it is often greatly enlarged; when the cardiac orifice, it is
contracted ; when the body of the organ is alone diseased, the gene-
ral bulk commonly remains unchanged. It is a curious and unex-
plained fact, that, where the pyloric orifice undergoes dilatation, the
walls of the stomach become hypertrophous.

The progress of the disease presents nothing peculiar. Ulceration
is slow to commence ; but when once begun, its ravages are extensive.
In most cases, adhesions, especially to the liver and pancreas, take
place before the peritoneum gives way.

The disease is more common in males than in females, and between
the ages of 35 and 60. It is often hereditary, and has apparently, in
many cases, been induced by mental distress.

Cancer ofthe stomach, in the early stages especially, may be con-
founded with other affections; the most practically important of which
are gastrodynia and chronic gastritis. We subjoin the following
sketch of the chief points of distinction :

1847.]

Cancer of the Stomach.

41

Gastrodynia.

Tongue variable, but
often pale, and pitted at
the edges.

Eructation frequent of
air, without disagreeable
smell.

Appetite depraved, ir-
regular, capricious.

Sensations, sometimes
of heat, sometimes of cold
in stomach; thirst not
common.

Solids more easily di-
gested than liquids.

Digestion completed,
though with much labour
and suffering.

Pain variable, occurs
in irregular paroxysms;
is often relieved by inges-
tion of food or pressure.

Epigastric pulsation not
uncommon.

Never runs a complete-
ly latent course.

Chronic vomiting is
most frequent in females,
and is almost confined to
persons affected with hys-
teria.

Chronic Gastritis.

Tongue dry, red, con-
tracted, smooth, shining,
or saburral.

Eructation not a promi-
nent symptom.

Sensation of heat in sto-
mach; thirst.

Gastric Cancer (early period.)

Tongue pale or natu-
ral.

Eructation of air more
or less fetid, sometime^
horribly so, a prominent
symptom.

Appetite diminished, or
even totally suppressed.

These symptoms not
observed.

Digestion imperfectly
completed.

Epigastric pain not ve-
ry severe, and scarcely
ever felt when the stom-
ach is empty ; increased
by pressure.

It is not observed.

Never completely lat-
ent.

Vomiting of sudden and
severe character some-
times the very first symp-
tom; occurs irregularly
before or after eating.

Vomiting of coffee-
ground-looking matter
does not occur, unless
from accidental and rare
haematemesis.

Bowels generally con-
stipated, but not obstinate-
ly so.

Febrile action acciden-
tal and rare.

In females the chlorotic
tint is often present.

Often accompanied with
various nervous or hys-
terical symptoms.

Hypochondria occa-
sionally present.

Is more frequent than
the other two.

Is more common in wo-
men than men.

May exist in very young
persons (e. g. act. 15.)

Coffee-ground-looking
matter sometimes vomit-
ed ; but this is rare and
exceptional.

Irritation, colic, and di-
arrhoea irequent, from ex-
tension of inflammation
to intestine.

Evening fever not un-
common.

Violet discoloration of
the lips,conjunctivse, face,
&c, often present.

Not so attended.

Liquids more easily di-
gested than solids.

Digestion not properly
effected.

Epigastric pain maybe
agonizing; the lancina-
ting character sometimes
marked ; often increased
by pressure.

It is not observed.

May for a va riable time
be completely latent.

Vomiting of sudden and
severe character is never
the first symptom ; it oc-
curs generally early in
the morning, subsequent-
ly at variable periods af-
ter eating, or at periodical
intervals.

The matters vomited
are a first glairy, then
half-digested food, then
coffee-ground or soot-like.

Bowels habitually and
obstinately constipated ;
occasional severe diar-
rhoea.

Fever absent.

Straw-coloured tinge of
skin may be obvious.

Not so attended.

Hypochondria not cau-
sed by chronic gastritis.

Is rarer even than can-
cer.

Is probably equally fre-
quent in both sexes.

Occurs at all a<rcs.

Hypochondria not an
effect ofgastriecancer.(])

[8 much rarer than gas-
trodynia.

Occurs more frequently
in men than women.

is excessively rare be-
fore art. 30.

42 Treatment of Orchitis. [January,

Gastrodynia. Chronic Gastritis. Gastric Cancer (early period,)

Is often hereditary. Is not hereditary. Occasionally runs in

families.

Is rarely referrible to Is often referrible to :- Is rarely, if ever, refer-
any distinct local exciting some distinct local exci- rible to local agencies,
frause. - ting cause.

Is relieved or cured by Is relieved or cured by Is not cured, but is re-
stimulant, tonic, and an o- antiphlogistic treatment. lieved by special treat-
dyne treatment. ment.

As the disease advances the diagnosis becomes Jess obscure, but
cases do now and then occur which present all the ordinary combina-
tions of symptoms, and yet are not cancerous; so (hat the detection
of tumour is the only absolutely certain sign. This is most easily
discovered when seated in the pylorus or great curvature : it is much
more difficult to detect when occupying the lesser curvature or the
cardiac orifice. It must be remembered that the situation of the
tumour changes continually; and it is of the last importance to
bear in mind that the whole course of the disease maybe of an inter;
mittent character.

In regard to treatment but little can be said. Conium is the only
supposed specific which is applicable. Dr. Walshe has derived bene-
fit from a combination of trisnitrate of bismuth and extracts of hop,
.stramonium, and conium, in pil! ; and he believes that the treatment
generally should be such as is applied to nervous, rather than inflam-
matory affections. Leeches and blisters may be used to relieve oc-
casional local irritation. Opium is contraindicated by the constipa-
tion ; but the Indian hemp may be tried. A drop or two of oil of
cajeput on sugar is the safest carminative. Cold applications or a
blister sometimes also relieve the flatulence, and a dose of morphia
has been found useful id the same way. But most is to be done by
regulating the diet, observing what agrees with the patient, making
the quantity taken at each meal small, securing perfect regularity in
the hours, and complete mastication of each morsel. Sickness ma)r
lie relieved by effervescing draughts, prussic acid, blisters, rough ice
allowed to melt in the mouth, the application of ice in bladders to the
epigastrium, or an occasional dose of creosote. The bowels are best
kept open by encmata : drastic purges are quite inadmissible.

M. Recamier narrates a case of pyloric tumour, "possibly cancer-
ous," which was reduced in bulk by pressure, applied by means of a
folded napkin secured by a bandage round the body. It may be well
to try some such plan as this.

On the Treatment of Orchitis hy division of the fibrous tunic of the
Testicle. [Gazette des Hopitaux, from St. Louis Medical and
Surgical Journal.]

M. Vidal de Cassis is a partisan of division of the fibrous tunic of
the testis in some forms of orchitis, attended with severe suffering

1647.] Treatment of Orchids. 43

The following is a resume of M. Vidal'sl opinions, for which we are
indebted to his interne, M. Bouteiliier.

J)efinitions and Complications. Parenchymatous orchitis, which
may likewise be designated as orchitis properly so called, is inflam-
mation of the testis itself. It exists, according to M. Mica rd, scarcely
ever without affection of the epididymis. This last inflammation
precedes orchitis properly so called. In fact, \n order to extend
itself to the testis, the inflammation must affect the epididymis. Let
it be well understood, that we are speaking of affections of the testis
consequent on gonorrhoea. In casus following blows on the organ,
or of wounds of its structure, the reverse may happen that is to say,,
we may meet with parenchymatous orchitis before we have epididy-
mitis. We can easily conceive the existence of the first inflammation
in such cases as these, without the coincidence of the second.

Parenchymatous orchitis often accompanies effusion into the tunica
vaginalis, the consequence of inflammation ; hut in all these cases
we are not to conclude there is inflammation of the serous membrane:,
we believe the inflammation has more frequently a passive rather
than an active character.

Lastly, sometimes we may find in the same person, parenchymatous
orchitis, epididymitis, effusion into the tunica vaginalis, inflammation
of the subcutaneous cellular tissue, or even of the skin of the scrotum.
Frequency. Orchitis, properly so called, is much more frequent
than is generally believed, and merits a description in our noso-
graphical chart. If M. Vidal has observed more than any other
surgeon, one ought not to be so much surprised when acquainted with
the large number of patients who apply for admission at the Hopital
du Midi. Each surgeon can there make his selection. While one
receives a large number of patients affected with diseases of the
scrotum, in order to confirm his views on those affeations, another
admits cases which bear most on syphilis. So that it cannot be said
that parenchymatous orchitis is only met with in the wards of M.
Vidal. Or:e case presented itself in the service of M. Ricord, in the
commencement of this year.

Causes. Parenchymatous orchitis, like epididymitis, recognizes
as its cause, most frequently, an existing gonorrhoea, or one that has
recently disappeared ; in fact, it is most frequently gonorrhoea!. We
have attempted to push our inquiries further, and aseertain why. in
certain individuals, gonorrhoea induces the affection of tile epididymis,
and in others (hut much less frequently), orchitis, properly so called.
To this end we have most minutely interrogated our patients on the
circumstances of the gonorrhecal affection. But we have been una-
ble to find any aggravating cause constant in all.

Local Symptoms. The tumor formed by the inflamed testis is less
voluminous than when caused by the epididymis. We have already
stated that Dupuytren was wrong, when he advanced an opposite
opinion. In the general sw< lling, I he enlarged epididymis forms the
larger portion, next the testis and, lastly* the ( {fusion into the tunica

44 Treatment of Orchitis, [January,

vaginalis. The form of the partial tumor we are speaking of, is that
of the testis, exagerated, it is true. The inflamed organ presents a
swelling in front ofthe epididymis, behind the serous effusion ; neither
elasticity nor resistance remains; the swelling is as if containing
coagulated fluid. When the tunica vaginalis is emptied, the testis
appears to occupy the place ofthe liquid ; and the general swelling,
previously pear-shaped, assumes a rounder form. The pain and
local heat are of the most violent description. The pain has this
peculiarity, that it spreads upwards and downwards, extending to the
kidneys, and to a corresponding point below. The color of the skin
is slightly modified ; but in some cases it is exceedingly red, or even
of a violet color. It has been remarked, that the cord is less liable
to be affected in cases of parenchymatous orchitis, than in instances
of simple epipidymitis.

General Symptoms. Fever is generally ofthe most violent form ;
there is sleeplessness, nausea, colic; and vomiting comes on, adding
considerably to the suffering of the patient, so as to induce him to
call for treatment which silences him at once.

Prognosis. The prognosis is not severe, when we destroy that
which gives it a particular character namely, the strangulation ; but
is very severe, on the contrary, when the disease is allowed to run its
own course. In that case, suppuration or mortification speedily
comes on in the parenchymatous structure ofthe testis.

Treatment. Local and general bleeding, poultices made with
laudanum, narcotic embrocations, purgatives lastly, puncture of the
tunica vaginalis, produce but slight amelioration of the symptoms of
the patient. It is necessary, in many cases, after having recourse to
all these remedies, to have recourse to the division ofthe tunica albu-
ginea, and it is better to perform it early.

This little operation presents nothing very alarming to the patient ;
hitherto, it has never been followed by an untoward event. Never-
theless, before resorting to it, it may be as well to puncture the tunica
vaginalis, when that membrane contains fluid, and, if that allays pain,
allow the patient to remain quiet; but we are obliged to admit that
temporising in such cases has too much danger to be long excusable*
We have always remarked that pain, after the division, ceases imme-
diately ; the fever decreases, and the patient Hills asleep in a quarter
of an hour, although he may have been unable to rest for several days.

After the division of the membrane, no further application is ne-
cessary other than a laudanum poultice applied to the scrotum, which
should be kept in its place by means of a loose bandage. In the seven
cases of division, which we have collected, the cure was rapid ; in
the instance ofthe patient operated on by M. Cullerier, the recovery
took place in eighteen days ; in a case we have seen this year, a cure
was^ffected in ten days, in one instance in sixteen, in another.

The division ofthe tunica albuginea should not be more than a
centimetre or a centimetre and a half; cicatrisation sometimes takes
place by union ofthe skin, tunica vaginalis, and albuguinea, to this

1847.] Hydropathy, or the Cold Water Cure. 45

extent; but very often this adherent point which is in no respect
injurious completely disappears, and the testis recovers its freedom,
its ordinary volume, and normal consistence ; its functions are sub-
sequently in no respect altered.

Hydropathy, or the Cold Water Cure.

The following conclusions on thissuhject, we meet with in Forbes'
British and Foreign Review :

1. We should be glad to see Dr. Currie's practice revived (for the
sake of experiment, at least) in all its boldness, for the suppression of
the general febrile paroxysm. On carefully looking over the evidence
published by Dr. Currie and his cotemporaries, it is impossible to deny
that they attained a larger amount of success in treating fever by*
water than other practitioners have done by other means. We have
already pointed out how their practice can be misunderstood by mo-
dern writers. But. while we regard this practice as well adapted
for treating general fever, we find no proof that it is competent to
meet the dangerous local complications with which fever is so often
accompanied. These complications may reasonably be expected
less frequently, when the early treatment of fever is rendered more
efficacious. But when they do occur, we find nothing in hydropa-
thic writers to show that lancets, leeches, blisters, &c., can be dis-
pensed with.

2. In a large proportion of cases of gout and rheumatism the water-
cure seems to be extremely efficacious. After the evidence in its
favour accessible to every body, we think medical men can hardly be
justified in omitting in a certain proportion of cases, at least a full
trial of it. No evidence exists of any special risk from the water-
practice in such cases.

3. In that very large class of cases of complex disease, usually
known under the name of chronic dyspepsia, in which other modes
of treatment have failed or been only partially successful, the prac-
tice of Preissnitz is well deserving of trial.

4. In many chronic nervous affections and general debility we
should anticipate great benefit from this system.

"). In chronic diarrhoea, dvsenfery and hemorrhoids, the sitz-bath
appears to be frequently an effectual rem* dy.

G. We find nothing to forbid a cautious use of drugs in combina-
tion with hydropathic measures. On the contrary, we are convinced
that a judicious combination of the two is the best means of obtain-
ing the full benefit of each. The water cure contains no substitute
for the lancet, active purging, and many other means necessary for
the relief of sudden and dangerous local maladies. The banishment
of drugs from his practice was necessary, and perhaps natural, on the

46 Hydropathy, or the Cold Water Cure. [January,

part of Preissnitz : the like proceeding on the part of qualified medical
men superintending water-establishments in this country, evinces
ignorance or charlatanry, or both.

7. With careful and discreet management, in the hands of a pro-
perly qualified medical practitioner, the water-cure is very rarely
attended with danger.

8. Many of the principal advantages of hydropathy may be ob-
tained in a private residence, with the assistance of ordinary movea-
ble baths. Therefore, it can easily be brought under the direction of
Ihe regular medical practitioner.

9. In many cases, however, it is evident that what may be termed
the mere accessories of the water-cure, are of extreme importance in
bringing about a favorable result; and these accessories are frequent'
ly not available or available in a very inferior degree inordinary
practice. Among the more important of these accessories we may
mention the following as having relation to most of the chronic cases
treated in hydropathic establishments: 1, relief from mental labours
of an exhausting or irritating kind, from the anxieties and responsi-
bilities of business, from domestic irritations of various kinds, from
mental inaction or ennui, &c. ; 2, change of locality, air, scene, so-
ciety, diet, &c. ; 3, the fresh mental stimulus involved in the almost
constant occupation of the patient's time, in the performance of the
numerous and various dabblings, paddlings, sweatings, washings,
drinkiugs, rubbings, &c, imposed by the water treatment; 4, the
frequent and regular bodily exercise taken in the open air, or within
doors; 5, the powerful mental stimulus supplied by the confidence
generally reposed by the patients in the means employed, and by the
consequent hope, alacrity, cheerfulness, &o. ; 6, the total abandon-
ment of vinous and other stimulants, and of drugs, all of which
have, in a large proportion of cases, been tried and found, not only
useless, but probably, productive of disadvantage.

10. A certain and not inconsiderable portion of the benefits de-
rived from hydropathic establishments are, however, attainable with-
out them, by other means, as by travelling, &c, &c. For example,
we suspect that many of the most striking results witnessed in such
establishments, as in the case of Sir Edward Bulwer Lytton or Mr.
Lane, would have probably been obtained, if the patients had chosen
to hire themselves, and had worked as agricultural labourers, in a
dry, healthy district, and had lived on agricultural fare, sufficiently
nutritious in quantity and kind, for a sufficient length of time.

11. Notwithstanding the success of the founder of hydropathy,
its practice by non-professional persons can neither be fully advanta-
geous nor safe. At the same time, it is true that very little experi-
ence is necessary to enable an educated medical man to acquire
sufficient insight into it for purposes of practice. Many of the best
hydropathic physicians have, in the first instance, devoted very few-
weeks to studying the subject in Germany.

12. Many advantages would result from the subject being taken

1847.] Application of the Sulphate of Quinine. 47

up by the medical profession. The evils and dangers of quackery
would at once be removed from it. Its real merits would soon be
known. The tonic portion of its measures might then be employed
in conjunction with special remedies of more activity, which, no
doubt, would often prove exceedingly beneficial.

13. The benefits ascribed to hydropathy, but arising indirectly
from the abandonment of drugs, vinous and other stimulants, &c,
may certainly be%btained without sending patients to Graefl'enberg.

14. Finally, it must always be remembered that the distinction
between quacks and respectable practitioners is one, not so much of
remedies used, as of skill and honesty in using them. Therefore, let
our orthodox brethren be especially anxious to establish and to widen,
as far as possible, this distinction between themselves and all spurious
pretenders. 4> Artem medicam denique videmus, si a, naturali philo.
sophia destituatur, empiricorum praxi haud multum prazstare. Medi-
cina in philosophia nonfundata, resinfirma est."

On the Topical Application of the Sulphate of Quinine.
(New. Orleans Med. and Surg. Journal.)

The following correspondence having been submitted to us, we
have thought it might be interesting to our readers, and therefore
insert it in this place :

To A. J. Weddehbuen, M. D., New-Orleans.

Dear Sir Having observed, with much interest, some remarks
by you in the last number of the New Orleans Medical and Surgical
Journal, on the subject of the treatment of ulcers, with quinine, 1
take the liberty of suggesting to you, that during the last five years
1 have frequently treated chronic conjunctivitis and urethritis, by-
direct applications of quinine dissolved in distilled water in the
latter cases, believing that the inflammation usually extended to the
bladder, I have directed the injection to be thrown into it.

1 would beg leave to remark also, that for ten or twelve years I
have treated chronic ulcers, especially those resulting from burns,
with a preparation of quinine, prep, chalk and pulv. rhei, with very
marked benefit.

I am, most respectfully, your obedient servant,

Richard Lee Fearn, M. D.

Mobile, Sept. 5th, 1846.

New Orleans, Sept. 10th, 184G.
Dear Sir : In answer to your letter, dated the 5th instant, I have
to inform you that I have never used the sulph. quinine, in the treat-
ment of conjunctivitis, or in urethritis, as a local application, but I
have frequently noticed from its internal administration the relief
afforded, in the course of a few hours, in a case under treatment for

48 Inverted Displacement of the Urinary Bladder, [January,

a soft cataract, the person being subject to frequent violent attacks of
inflammation of the conjunctiva. In these attacks, I have always
used opium with the quinine, when the latter has been given, and I
have, at times, used the opium alone, but never with the same effect
as when given in combination. I have administered this remedy in
cases of urethritis, for chordee, in ten gr. doses at bed time, with
marked success, when the same quantity of camphor has failed to
give relief. M

I cannot doubt, for a moment, the good results that must attend
the topical application of quinine in the affections mentioned above.
I have often thought of its application in such cases, but have not
resorted to the treatment, in consequence of the relief I have always
seen follow the use of the nitrate of silver in inflammations of the con-
junctiva. If you will refer to the January number of the New Orleans
Journal, you will find a case reported of a sloughing ulcer from pri-
mary syphilis, in which the ulcerative process was immediately ar-
rested by the topical application of quinine, when other remedies had
failed.

Erysipelas prevails in the Charity Hospital, during the winter, in
the form of an epidemic. During the last winter, after a number of
cases in which I had used the knife, were attacked with this disease, I
was induced to resort to dressings saturated with a solution of quinine,
about 5 grs. to the ounce of water, immediately after an operation,
and in no case in which this remedy was used, did the disease occur.

I have lately used an ointment of quinine in a case of Eczema
Capitis. The excessive inflammation attending the eruption was
relieved in a few hours, and the disease entirely subsided in four or
five days. The ointment used in this case was composed of sulph.
quinine Sj; laudanum gtt. xv ; oi. lavender gtt. iij ; simple cerate gj.
The laudanum was used chiefly with the view. of dissolving the
quinine.

I shall take the earliest occasion to follow your treatment, and
inform you concerning the same.

I am, very respectfully, your obedient servant,

A. J. Wedderburn.

To Richard Lee Fearn, M. D., Mobile, Ala.

Case of Inverted Displacement of the Urinary Bladder, By J. G.
Crosse, Esq. (British and Foreign Review.)

Mr. Crosse's paper gives the history of a case of rare occurrence,
and is important, as exhibiting the value of a careful examination
and consequent just diagnosis, and the dreadful risk attending a mis-
take in this particular. We extract the more material points of the
narrative :

"In the year 1829, a highly respected colleague of mine, since

1817.] Inverted Displacement of the Urinary Bladder. 49

deceased, received under his care a healthy-looking female child,
aged between two and three years, on account of a tumour, ahout
the size and shape of a walnut projecting visibly at the external labia
pudenda, ft was of a florid red colour, and somewhat granulated
upon its surface, so as to resemble a large strawberry ; and the surgeon
entertained a notion that it was a vascular tumour, which might be re-
moved by ligature, on which account he requested me to inspect it.

44 After a slight examination, I expressed my doubts as to its being
a vascular tumour, and dissuaded him from the hasty application of a
ligature. I could not, however, immediately explain its nature, ha-
ving no conception how such a tumour could be formed by the dis-
placement of parts only, without any superadded^ morbid growth.
Towards the posterior part of the tumour, and on its sacrai aspect,
there was an aperture, which was conjectured to be the entrance
into the displaced urethra. A very small female catheter easily
entered this aperture, and passed along a channel a little to the left
side of the median line: urine distilled in drops through the cathe-
ter but there was not a gush, although the instrument had entered
so far that we concluded it must have reached the cavity of the blad-
der. Besides what thus oozed through the catheter, slightly tinged
with blood, there was an oozing of urine from another source, which
was not explained until a second and more strict examination, insti-
tuted a few days afterwards, on my casually coming to the patient's
bedside, just as the surgeon was prepared to apply a ligature round
the neck of the tumour.

"I now found concealed in a fold of the tumour, and near to the
posterior junction of the labia, two orifices not far asunder from which
the urine oozed, and which were evidently the vesical terminations
of the ureters. On pressing the tumour firmly, as if to reduce it like
a hernia, I found it yield and pass gradually behind the symphysis
pubis, and within the labia; and under a continuance of the taxis it
all retired, leaving the external parts in their proper shape and posi-
tion. A passage remained, through which the tumour on retiring had
taken its course, which was actually the dilated urethra, into which
I could and did introduce my little finger, until it fairly entered the
cavity of the replaced bladder ; for it now became clearly demonstra-
ted that the vascular red tumour, externally presenting itself as first
described, was the urinary bladder in its entire thickness, including its
mucous, muscular, and peritoneal coats, prolapsed through the dilated
urethra, and at the same time inverted or turned inside out. The
proper lining membrane of the bladder became, in the progress of
this displacement, the external covering of the tumour. As fast as
th'1 -iirine was secreted by the kidneys, it oozed from the terminating
orifices of the ureters, which were concealed within a fold of the ex-
posed surface of the tumour, and approximated to each other. The
neck, or deepest and narrowest part of the tumour, just concealed
witbill the labia, was covered by the inverted lining of the urethra,
the inversion being complete.

4

50 Ejects of Emetics on Young Subjects. [January,

" In this instance, had a ligature been efficiently applied to the
neck of the tumour, as was contemplated, the bladder would have
been removed, including all its coverings, the ureters cut through just
above their terminating orifices, and the peritoneal cavity largely
opened, with a necessarily fatal result.

"As the friends of the child could not be applied to, the history
was imperfect. It was stated that the tumour had existed for a con-
siderable time, and been always attended by stillicidium urinae ; also
that it had been once replaced, but descended again, shortly before it
came under my observation. During the short period that the child
remained under my notice, after the replacement of the bladder,
there was no re^ipse ; and since this account was, sent to press, I
have been fortunate enough to ascertain, and to be enabled to add,
that the patient is still living, after an interval of sixteen years, and is
a healthy young woman, save only the affliction of the incontinence
of urine, with which she has been constantly troubled, but without
any relapse of the vesical displacement."

On the Effects of Eme.'ics on Young Subjects. By John B. Beck,
M. D. (New York Journal of Medicine.)

Dr. Beck remarks that children remit with greater facility than
adults; this he ascribes to the more conical shape of the stomach in
children, in consequence of which the contents are more readily
forced out. Active and debilitating emetics, the author adds, are
often injurious; he alludes especially to the antimonial emetics. In
the first place, tartar emetic is a powerful sedative, and children do
not bear well this class of agents. The following are ihe author's
conclusions:

1. As a general rule we need not be afraid of vomiting the youngest
child, provided the means used are mild such as ipecacuanha, &c.
The mere act of vomiting is attended with no clangor, while the
remedial agency of an emetic is one of great power and value. Be-
sides acting on the stomach, it extends its influence to the mucous
membrane lining the pulmonary organs, promoting secretion in the
first place, and then aiding in dislodging and ejecting morbid accu-
mulations ; accordingly, in pulmonary arFections, there is nothing so
efficacious.

2. The vomiting induced by the preparations of antimony ought to-
be resorted to with great caution in very young children, and should
never be used except in those cases where a sedative effect is required,
and can be borne with safety. Inflammatory excitement ought then
always to be present to justify its use in a young child. Where the
object is simply to evacuate the stomach, it ought never to be thought
of. In such cases as croup and pneumonic inflammation, it may be
justifiably and beneficially used. In these cases it will be found, that

1847.] Effects of Emetics or. Young Subjects. 51

the system can bear the sedative influence of the article much better
than it can in the ordinary conditions of th ri. Even here,

however, care should be tak^n not to pi:=h the article too far, as
dangerous collapse has been known sometimes to be the result.

3. The continued use of Tartar Emetic in young subjects cannot
be too specially guarded against. Ft is in this way, probably, that it
is so apt to prove injurious. A single dose, even though it vomits
very freely, may be borne with comparative impunity, while the
repetition of it may keep op nausea and intestinal irritation, so as to
cause injurious prostration. This is very likely to happen in cases
of a chronic character, like hooping cough. Although mild emetics
are among our best remedies in this disease, and where the suhject is
old enough, a single emetic of antimony is frequently exceedingly
beneficial, yet the repeated use of antimonial emetics, as is too cften
the case, appears to me to be a great error in practice. It is not in-
dicated by the nature of the symptoms, and violates a great rule
which ought always to be observed in the management of chronic
cases, and that is not to break down unnecessarily the strength of the
patient.* Again, in ordinary catarrhal affections in children, a good
deal of mischief is frequently done by the continued use of expectorant
mixtures containing this active article. The Hive Syrup of Dr.
Coxe, which is now in every family, and is given on the slightest
occasions to infants, without even consulting a physician, has, I am
convinced, done a great deal of harm. I say this without wishing to
undervalue this preparation. In proper cases it is really a useful
article, but persons out of the profession ought to know that its
principal efficacy is owing to the quantity of Tartar Emetic which it
contains, and that the indiscriminate use of it in cases where mild
articles are required, must be injarious.f

4. As the effect of Tartar Emetic on the system cannot always be
measured by its emetic operation, even in the adult, this fact ought
to serve as a caution against the too common practice of giving re-
peated doses of it to produce vomiting in children, when they happen
to be narcotized. While it fails to vomit, it may still operate as a
poison to the system. In all cases of this kind, the proper method of
treatment is. not to push the emetic, but to endeavor to restore the
sensibility of the patient, and then sometimes vomiting comes on at
once.

5. In using Tartar Emetic in children, especial regard should be

* Dr. Armstrong says mat "it isaaiost notorious fajet, that the hoopittg-

is far more fatal in London than in the country; and I believe," he adds, ' that
this arises from th of antimonial wine in London/' Lectures, p.

ry ounce of Coxe's Hive Syrup contains one grain of Tartar Emetic.
( 'ready has communicated to me the particulars of a case in
.i child bet a us ol age, laboring underlie

-ink under the too frequent ; rticle. Tl

it eight d; testinal irr

general pr. i bich in a few days ended

ace.

Bibliographical. [January,

had to their constitutions. In those naturally delicate, and especially
where the scrofulous diathesis exists, it should never be used if it can
be avoided. Prostration is much more apt to ensue in them, and
where the article is persisted in for any length of time, it is sure to do
harm, ft is in such constitutions, when laboring under hooping-
cough, and where the use of this article has been too long continued,
that the baneful effects of it are most strikingly observed.

6. It is perhaps hardly necessary to say that if Tartar Emetic be
an article of such danger, the younger the subject to whom it is given,
the more likely is it to do harm. In children under a year, I should
say, as a general rule, it ought never to be used. During that period
the powers of life are too feeble to bear so active a remedy, at the
same time that all the beneficial effects of an emetic may be gained
from the use of ipecacuanha, or even milder means.

BIBLIOGRAPHICAL NOTICES.

1. Chemistry of the Four Seasons. By Thomas Griffiths, Prof.

of Chemistry in the Medical College of St. Bartholomew's Hospi-
tal : author of "Recreations in Chemistry," &c.

This interesting and attractive volume is designed to illustrate by
easy and familiar experiments, and in popular language, many of the
phenomena going on in the realm of nature through the ever-varying
year, and to exemplify and explain many beautiful scriptural allu-
sions involving the play of chemical and philosophical laws. Nor
has the gifted author failed in accomplishing his laudable purpose.
His agreeable style, the correctness of his philosophical views, and
especially the high moral and religious bearing of his work, cannot
but secure for him the commendation and patronage of the intelligent
and virtuous.

2. Draper's Chemistry. We have just received, through the cour-
tesy of the enterprising publishers, Messrs. Harper and Brothers, a
copy of " A Text Book on Chemistry, for the use of schools and colle-
ges, by John William Draper, M. D., Professor of Chemistry in the
University of New York, Member of the American Philosophical So-
ciety, &c." It is comprised in an octavo volume of 408 pages, and is
what it purports to be "a compendious book which sets forth in plain
language the great features of the science." With the exception of
some change in the order of arrangement, the general plan resem-
bles that of Fownes' Introductory Treatise, published during the past

1947.] Bibliographical. 53

year, and of Graham's larger work a method having decided ad-
vantages, as we suppose, over the one adopted by Turner. Kane. &c,
where the salts are all reviewed separately and apart from these bases
and bi-elementary compounds. Without attempting to examine the
importance of every hypothesis maintained by the author, it is enough
to remark that Dr. Draper's familiarity with that department of phys-
ics upon which he treats, lias enabled him to condense and bring up
the subject to the present day, and to furnish a correct synopsis of
the leading /arts and principles in Chemistry, while his established
reputation is a sufficient guarantee for the scientific character of the
work.

3. Adulterations of various substances used in Medicine and the Arts,
with the means of detecting them, intended as a Manual for the
Physician, the Apothecary and the Citizen. By Lewis C. Beck,
M. D., Prof, of Chemistry in Rutgers College, &c. New York:
Samuel S. and William Wood 1846 ; 333 p. I2mo.

The design of the work is fully set forth in the title, and we doubt
not it will prove highly useful, for much injury results from the em-
ployment of adulterated articles. The processes proposed for the
detection of adulterations are generally quite simple and may be
managed by any one, as they are in most instances free from tech-
nicalities The work appears to have been carefully prepared, and
the typography is excellent.

4. The Preserver's Pharmacojiria. containing all the Medicines in
the London Pharmacopoeia, arranged according to their action,
with their composition and doses by a practicing Physician, al-
tered to correspond with the U. S. Dis]>ensaiory, revised and im-
proved by an American Physician. Second American from the
third Lonlon edition. New York: Samuel S. and William Wood
144 p. 18mo.

This little work we are persuaded will be found a very convenient
reference by many of the junior members of the profession, and to
others who may be troubled with a defective memory. It is too often
the case that the attention of the young physician is almost exclu-
sively confined to the study of the nature and diagnosis of disease.
He gives but a slight consideration to the means which may modify
or control morbid action, and as a consequence the range of his re-
sources is quite confined. Many physicians for the want of such
knowledge Buffer in their reputation. Whilst this work will not sup-
ply a lack of knowledge of the action and doses of medicines, it m;iv
often serve as valuable purposes at the bed-side of (he sick.

54 Digestion. Bile. [January,

PART III. MONTHLY PERISCOPE.

Digestion in 1846. At Inst the phenomena of digestion are en-
lightened: digestion is no more to he considered a simple but a
complex function. There are as many digestions as organs. First,
the stomach, by which animal food is dissolved; it is in carnivorous
animals almost the only intestine and they require no other; their
digestion is gastric; it is intestinal in herbivorous tribes. After the
incisors and cuspidati come th.-j. molares : in the same manner after
the carnivorous intestine we' find the intestines which digest grains
and vegetables masticated by the molares. In the small intestines,
feculent substances are absorbed and saccharified a fact proved by
a simple experiment ; fecula taken in the stomach immediately above
the pylorus wiil become blue when placed in contact with iodine, and
will, on the contrary, not change color after its passage through the
pyloric orifice. It is this, the principal phenomenon of digestion in
the duodenum, which has led to the discovery of bbe saccharifying
power of the pancreatic secretion. Hence not only a change in the
theory of digestion, put in the pathology of diabetes; we can no
longer admit that the kidneys secrete sugar, but that they allow the
passage of the saccharine matter contained in the blood.

All these discoveries are in themselves important scientific acquisi-
tions; but their importance is doubled when their practical conse-
quences are reflected upon. The whole history of gastralgia, rudis
indigeslaque motes, must begin anew. No theories can be compared
to the recent discovery of the following facts. Eat meat, the urine
becomes acid ; eat vegetables, it immediately becomes alkaline.

The gastric juice is a powerful acid which readily gives birth by-
fermentation to gaseous products. In dyspepsia it is therefore a mis-
taken practice to recommend the use of alkaline Salts, by which the
digestion of animal food is retarded. The corrosive nature of the
fluid accounts for gastric pain, pyrosis, (kc, most probably the result
of its contact with dry portions of the mucus membrane. By fermen-
tation in the stomach, foul breath and flatulency will be produced;
alkaline medicines will be of no avail, but mild laxatives are fully
indicated. The digestive power of the gastric juice varies with its
heat : below 10 degrees and above 35 degrees, that power diminishes
and is completely lost beyond 50 d?.g. It is therefore not proper to
eat very hot substances. Rcautoiur s scale.

The stoHriach being the organ in which animal food is dissolved,
meat should not be given in gastric affection ; whereas feculent sub-
stances, digested in the jejunum, can be safely permitted. [Medical
Times from Jour, de Med.

Bile. The most careful examinations of the urine and blood of a
patient with intense jaundice did not enable Schorrr to detect in cither
of them a trace of any constituent of bile except the colouring matter

1847.] Vomiting from Injections. Accuracy in Diagnosis. 55

and cholestearine. In evidence of the speedy transformation which
the biline would probaly undergo in the blood, he mentioned that in a
large quantity of green fluid vomited, and containing abundant biliary
colouring matter, he could not detect a trace of the biline which it
must previously have contained. In the same essay he gives an
accurate account of his analysis of the biliary colouring matter which
he collected from his patient's urine.

The conclusion respecting the non-existence of the essential prin-
ciples of the bile in the feces is confirmed by the delicate test for
bile invented by Pettenkofer. To the fluid supposed to contain bile
f of its volume of sulphuric acid are added by drops, that the temper-
ature may not rise above 140 F., and then from two to five drops of
a solution of sugar (one to four parts of water.) Presently a reddish
violet colour appears, intense in direct proportion to the quantity of
biiic acid. By this test no biie (except the colouring matter) could
be found in healthy faeces; but the feces of diarrhoea and those dis-
charged after purgatives contain complete bile. So alo, by this test,
bile could always be found in the urine of the pneumonic. [New Or-
leans Med. and Surg. Journal.

Vomiting of Castor Oil injected into fhe rectum. Dr. Griscom re-
ported a case of colic arising from indigestible food. The patient,
who was under the charge of Dr. J. R. Wood, was seized with severe
pain, with short intermissions, pulse 130 to 140, tongue dry and
brown, bowels obstinately constipated, no passage having been ob-
tained by the administration of calomel and jalap, salts and senna,
croton oil, and enemata : a large enema was given, which produced
evacuations, but this was followed by vomiting, which continued in
spite of remedies. The patient was seized on Thursday; on Mon-
day evening following, the vomirino- became stercoraceous, and so
completely was the peristaltic action inverted, that an injection of
castor oil was returned by the month in lour hours after it was given.
He had been taking calomel and opium. Supposing that the opium
might have had an influence in causing the vomiting, it was discon-
tinued, and morphine substituted. The pain and vomiting were
immediately relieved, and in 21- hours the patient was decidedly
convalescent; 20 drops of morphine were given. [New York Jour,
ef Medicine.

Necessity for Accuracy in Diagnosis. A case is mentioned by
M. llostan, which affords a good example of how much the right
treatment of a disease depends on a methodically conducted exami-
nation into all the particulars likely to bear on the affection. A
female became the subject of an obstinate constipation. The first
medical man who saw her suspected the existence of some inflamma-
tory affection, and prescribed the application of leeches. No bene-
ficed effects resulting from this plan of treatment, another physician
was consulted, who ordered purgatives: these, however, produced

56 Diagnosis of Chlorosis. Rubeola and Scarlatina. [January,

only temporary relief, and a Third medical man was accordingly sum-
(Boned. He \\v,ni more methodically to work in his endeavor to find
out the real cause of the complaint: he examined the abdomen, and
found an ovarian tumor, which was compressing the rectum, and so
mechanically caused constipation. The position of the patient in
bed was altered so as to relieve the rectum from pressure, and the
bowels at once acted. Gazette des Hopitaux, April 18, 1846.

M. Gintrac on Diagnosis of Chlorosis. M. Gintrac's object is to
recognize a condition of the economy, characterised principally by
paleness of skin, feebleness and palpitations, but yet quite distinct
from that of true chlorosis, and intimately connected with irritation of
the digestive canal. The pallor of the skin is of a dead-white instead
of the yellowish green of that disease; and the debility and palpita-
tions are less marked. The bruit de souffle too are less constant.
The abdomen is found to be tender on pressure, and the digestive
functions are entirely disordered there being loss of or depravation
of appetite, nausea, eructations, constipation or diarrhoea, and some-
times hysterical symptoms. The tongue may be pale, but at other
times it is partially red, either at its tip, or in the middle. There is
almost always amenorrhcea. M. Gintrac regards these symptoms
referrible to the digestive organs as not resulting from pure inflamma-
tory action, but from a complex state of inflammatory irritation and
nervous hypersthenia. Preparations of iron and other anti-chlorotic
remedies usually aggravate it, while it yields to those of an anti-
phlogistic and calming character ; such as tisans, milk, infusions of
poppies, baths, laxative and emollient enemata, and cupping-glasses
to the abdomen. When the symptoms of irritation have ceased, we
may resort to tonics and even to iron: but the symptoms then fre-
quency disappear of their own accord. Gazette Medicale, No. 33.

[The distinction here pointed out is an important one: for there
can be no doubt that tonics, and especially steel, are frequently hurt-
ful in consequence of sufficient attention not being paid to the
removal of a condition of irritation of the digestive organs.] Medico-
Chirurg. Rev.

A point of Diagnosis between Rubeola and Scarlatina. It occa-
sionally happens that there is some difficulty of diagnosing the
eruption of scarlet fever from that of rubeola, for in the former affection
the rash, instead of being, as it usually is, uniformly diffused, occa-
sionally occurs in minute red points and spots, not unlike those of
measles. In such cases, when there is difficulty in deciding which
disease a particular patient is labouring under, M. Chomel is in the
habit of forming his diagnosis by an examination of the sputa. In
rubeola, the sputa are invariably, he says, in opaque nummular masses,
of a grayish colour, and floating in an abundant liquid. At first
sight, they closely resemble the sputa of patients in the second stage
of phthisis, yet differ from them in the fact, that the liquid in which

1847.] Fever. Sea-sickness. Chorea, or St. Vitus' Dance. 57

they float is turbid and milky, whilst that in which the sputa of
phthisical patients float is clear and transparent. Lond. Med. Gaz.,
from Encyciop. des Sci. Med.

On the Types of Intermit lent Fevers. M. Nepple has endeavored
to determine under what circumstances intermittent fevers may
manifest a quotidian, tertian, or quartan type. It would appear that
the relative frequency of these types varies with the latitude. Out of
3,il4cases of fever treated at Bona and Algiers, and out of 954 cases
treated in the Canton of Monthiel (Ain), the types were ps follows :
Bonn and Algiers. Ain, France.

Quotidian fevers . . . . 2,181 443

Tertian 901 420

Quartan 32 91

All medical writers who have written on fevers, as it exists in north-
ern climates, agree in regarding the tertian as the most common
type; while the above facts prove that the quotidian is more frequent
in warmer latitudes. The quotidian type, according to M. Nepple,
occurs most frequently in warm years, while the tertian form is, on
the other hand, most frequent id cold years. The quotidian type of
fever appears to be less dependent on marsh miasmata than on ac-
cessory circumstances. Gaz. Med., from Lond. Med. Gaz.

Remedy for Seasickness. (Gazette Medicale de Paris.) M . Jo-
bard, of Bruxelles, has addressed a note to the Academy of Sciences
at Paris, in which he proposes a remedy against sea-sickness. He
observes that this is not a pathological affection which can be pre-
vented by medicines. The cause of sea-sickness is purely mechani-
cal ; it is not the air of the ocean, neither the odor of the ship which
provokes it. Whether sitting or lying down one experiences an
alternate movement of elevation and depression while at sea, and it is
always during the sinking of the vessel, and never at its ascension,
that the sickness occurs; from which circumstance M. Johard con-
cludes that sea-sickness is produced by the mass of the intestines
rising up against the diaphragm and exciting hiccup or vomiting,
with compression of the gall-bladder and expulsion of bile from the
stomach. It is at the plunge of the ship that the sickness is felt,
while a respite is experienced as she rises out of the sea.

The means then to prevent sea-sickness is to prevent the intestines
rising up against the diaphragm ; and this is accomplished by sus-
taining them upon the pelvis by a belt. A broad bandage or belt,
so as not to compress the stomach, moderately tight at first, and then
more forcibly applied, was found to relieve all the passengers of a
ship during a long and painful voyage.

The use of the preparations of Nux Vomica against Chorea or St.
Vitus' Dance. (Gazette Medicale de Paris.) Professor Trousseau
read a memoir to the Academy of Medicine in Paris on the 3rd

58 Therapeutic action of Chloride of Sodium. [January,

of last November, on the employment of the preparations of Nux
Vomica in the treatment of St. Vitus' dance. He said Messrs.
Lejeune, Niemann, and Cazenave, had cited some isolated facts,
but to Messrs. Forcilhoux and Rouyier, of Lyons, and himself,
were due the present mode of using this article. M. Trousseau
states that he was lead to this treatment of chorea by two mo-
tives : one, because there was almost always incomplete paralysis of
one side of the body in this affection ; and the other, because the pre-
parations of nux vomica provoked tonic contractions resembling those
of tetanus. Retreated thirteen patients, ten with complete success.
An amelioration was ordinarily manifested after eight or ten days of
treatment ; the cure affected the oftenest at the end of one month.

The author insists upon the necessity of great care in the prepara-
tion of this medicine and upon the mode of its administration. He
rejects the extract of nux vomica and strychnine, and adopts exclu-
sively the sulphate of strychnine which he dissolves in simple syrup
in the proportion of 5 centigrammes to 100 grammes o-f syrup. He
gives at first 10 grammes of the syrup or 5 milligrammes, equal to a
tenth of a grain of the salt of strychnine, divided into four or six doses
in the course of twenty-four hours. Every day increase 5 grammes
up to the moment wjien the patient manifests itching in the head and
slight muscular stiffness. lie always goes to the extent of this de-
gree of muscular action. The dose must be increased or diminished
according to the effect produced by the medicine. When the disease
is nearly cured, the same dose is continued for some days; then it is
diminished, and finally left off when there only remains a slight
grimace which so often continues in these cases.

While M. Trousseau considers the syrup of the sulphate of strych-
nine the principal medication in chorea, he stiii prescribes for other
indications that may occur in this affection bleeding for amenor-
rhea with plethora; the martial preparations for chlorosis; anti-
spasmodics for hysteria.

Dr. Hogan, in the New Orleans Medical and Surgical Journal for
September, recommends strychnine for chorea in ^th to th of a
grain for a dose, three times a day. [Edts.

Therapeutic action of Chloride of So'lium [common salt]. (Gaz.
Medicale de Paris.) M. Plouviers, of Lille, stated to the Academy
of Sciences, that since 1842, he has been experimenting with this
article. He found that after taking during six weeks, a tea-spoonful,
then a tea-spoonful and a half of this salt every morning in a cup of
milk, he became stronger, more active and weighed 5 kilogrammes
(about 15 pounds) more than he did before. In continuing the use
of the salt, he became plethoric, and had to cease taking it. Subse-
quent experience multiplied and varied, has convinced him that
common salt possesses a high importance in assisting digestion. He
thinks in persons of a sanguine temperament or apoptetic tendency

1847.] Diarrheca. Chlorosis. Dysentery Hooping-cough. 59

it is dangerous ; but to weak constitutions without disease, it is
incontestable useful: and to labourers and the poor, it would assist
much in their nourishment.

The employment of preparations f row. the IValnut tree againsf
Diarrhoea and Dysentery. (Gazette Medicate de Paris.) M. Scott i
having observed among scrofulous patients who used the prepara-
tions of the Walnut tree, an habitual constipation, concluded he could
find in tins remedy an agent against diarrhoea. In thirty patients
he either ohiained a cure or at least an immediate amelioration in
those not affected by organic lesion. The preparation he prefers is
an extract from the green walnut shell or the fresh leaves, obtained
by decoction and successive evaporation. Dissolve from 8 to 12
grammes, about 2 5, of this extract in a kilogramme, about 2 pints,
of mineral lemonade, and take a third or a half tumbler of this drink
four times a dav.

T 'annate of Iron in Chlorosis. ?,I. Benedr-tti considers that the
tannate of iron (ink) is one of the host remedies in the treatment of
chlorosis. The dose may be from about eight to thirty grains daily ;
and the patient commonly recovers in from twelve to twenty-five days.

The tannate of iron employed by him is prepared by dissolving
iron filings in dilute sulphuric acid, precipitating by carbonate of
soda, so as to obtain a pure carbonate of iron. Forty-four parts of
this carbonate, in a state of dry powder, are to be added to nine parts
of pure tannic acid, dissolved in boiling water. The mixture is
stirred and evaporated until the tannate is obtained as a dark, insipid,
uncrystalline compound. It may be given suspended in syrup, or in
the form of pilis. Land. jled. Gaz., from Gaz. Med.

Dysentery Syrup. The Boston Med. and Surg. Jour., gives the
following as an approved recipe for Dysentery: " It is made of a
decoction of the rubus vi'iosa, spina tormentosa, slippery elm, iceland
moss, rhubarb, sugar, and a small portion of brandy, in such propor-
tion as experience justifies/' Western Lancet.

Alkalies in the Treatment of Hooping-cough. Dr. Allnat, Lon-
don, attributes the spasmodic action of the glottis, which occurs after
the febrile action has somewhat subsided, to the presence of acid in
the stomach ; to relieve this, alkalies ammonia, carb. potass, &c.
are advised. lie says :

After preliminary purgation with calomel, (conjoined with antimo-
ny, if the febrile symptoms run high,) and an occasional emetic to
clear the stomach, nothing in my experience is so efficacious as
small and repeated doses of the carbonate of potassa. The following
combination has been extensively distributed to the poor in seasons
when hooping-cough lias raged as an epidemic, and I can attest the
almost invariable success which has attended its administration

60 Iodine. Remittent Fever. Diarrhea. [January,

what portion of the merit is due to the cochine.il I do not know :
Take of carhonate of potassa, one drachm; cochineal, ten grains;
boiling water, half-a-pint. For an infant, one teaspoon ful to be taken
thrice daily, the dose increased according to age. [London Lancet.

Internal administration of Iodine. M. Marchal de Calvi. of the
Hospital of Val-de-Grace. has been employing for some time past
iodine in a new form. The iodine is dissolved in oil, in the propor-
tion ofl grain to 18 grains. He takes afterwards a certain fixed
quantity of the solution, mixes it with gum in a mortar, and forms
an emulsion.

M. Marchal commences by prescribing one grain of iodine, or
eighteen grains of the oily solution. The dose maybe gradually
augmented to six grains. Notwithstanding so large a dose has been
used no unpleasant effects have been produced on the digestive tube.
The patients preserve their appetite, and digestion is performed pro-
perly. This new preparation has been used with remarkable success
in many cases of scrofulous swellings of the glands that had attained
very great volume. Iodine in this form remains for a much longer
time in the economy than the iodine with potassa. In place of iodide
of potassium, M. Marchal uses the iodide of sodium, because he thinks
it more active, from its containing a greater equivalent of iodine than
the preparation containing potassa. [ West. Jour, of Med. and Surg,

Combination of Carbonate of Iron icifh Sulphate of Quinine in
Remittent Fever. Prof. Lippich, of Padua, recommends the addition
of the carbonate of iron in the sulphate of quinine, in the treatment
of periodical fevers. The following is his formula: R. Carbonate
of iron, one gramme ; sulphate of quinine, one gramme ; extract of
taraxacum, q. s. To be made into a mass of proper consistency, and
divided into thirty pills, two of which are to be taken every two hours.
The carbonate of iron may be gradually increased to two grammes.
[Gaz. Med. de Paris, from Boston Med. and Surg. Jour.

Hydrate of Lime in Diarrhoea. Simple syrup, saturated with
hydrate of lime, has been employed by Dr. Capitaine as an antacid,
in doses of from one scruple to half a drachm : and at the hospital
Neckar, it has been given with much benefit instead of cow's milk in
the diarrhoea of children. [St. Louis Med. and Surg. Journal.

Prescriptions of Prof . Linton, of St. Louis, for Dropsy.
R Sup. Tart. Potas. . . 2 dr.

Jalap, \ dr.

Gamboge, . , . gr. 1 M.
The preparations of iron are, we believe, the best tonics which can
be used in those cases of dropsy, (and they are numerous) in which a
roborant treatment is indicated.

We cannot help regarding a sort of old woman's prescription, a

1847.] Scrofula. Cure for Rattlesnake Bite. Gonorrhoea. 61

roughly prepared acetate of iron made by putting a handful of rusty
nails into a pint of old cider, as one of the best, if not the best, pre-
paration for this invaluable tonic. We have "seen with our eyes"
its happy effects in scores of cases, to say nothing of that less to be
credited testimony what we have " heard with our ears." [Ibid.

Dr. W. L. Sutton of Georgetown, Kentucky, in an able article on
Scrofula, submitted to the Medical Society of Tennessee in May
1840, and published in the November No. of the Western Journal of
Medicine and Surgery, draws the following conclusions on this
subject :

Conclusions. After such reflections as I have been able to make,
I arrive at the following conclusions :

1st. That in a vast majority of instances scrofula owes its exist-
ennce to inheritance ; yet

2d. That there is no absolute necessity that a child having a scro-
fulous parent shall be scrofulous; on the contrary,

3d. That when one parent is scrofulous and the other not, a child
which resembles the scrofulous parent will be much more apt to have
scrofula than one which resembles the other parent ; in fact, that the
latter may have a well-grounded hope of escape.

4th. That the liability by inheritance depends upon a general, not
upon a specific law, which is applicable to other diseases besides
scrofula.

5th. That whilst a child born of scrofulous parents may escape,
one horn of parents not at all scrofulous, may have the disease.

Gth. That scrofula depends upon an undue preponderance of the
white parts of the blood, and the white tissues in the body.

7th. That in our treatment we should endeavor to restore a due
proportion of the red particles to the blood, and of the red tissues to
the body.

8th. That to effect this there is no specific : but we must be guided
by general principles and rational views, precisely as is necessary to
treat successfully any other disease.

9th. That how important soever medicine may be in the manage-
ment of the disease, hygienic rules are by no means less so.

Cure for Bite of Rattle Snake. Dr. Nathan Holmes, ofSt. Louis,
Mo., announces that whiskey, or any other stimulus, freely given till
there is a high pulse, will cure the bite of the rattlesnake. He says
that he doubts whether fifty ratllesnakes could poison a man when
fully drunk. [Boston Med. and Surg. Journal.

Alum and Nitre for Gonorhcea. Dr. Foster reported having re-
cently U9ed alum pulv. and nitrat. potass, grs. xv. andx., three times
a day, with the most happy effect, in two cases of gonorrhoea. In
one case the discharge had existed ten days; in the other, two
months. [Xcw York Journal of Med.

62 Hemorrhage. Aneurism. White Swelling, [January,

Mode of cures! big Hemorrhage from Leech bites. Dr. Houston
recommends the following plan for preventing excessive bleeding
from leech-bites, which he has found invariably successful. Take a
small pinch from the felt of a beaver hat, pile it on the bite ; or if
there be several points, pile one respectively on each, and spread over
the whole a piece of thin muslin, drawing it tightly, so that any blood
that flows must pass directly through both ; then with a fine sponge
drying up the blood as it oozes out, and in a short time both felt and
muslin will have become dried by the coagulation of the blood in the
thin fine meshes, and the hemorrhage arrested. The muslin may
then be all cut away, except the adhering points, which, in the course
of a couple of days, will of themselves drop off, leaving the parts
healed, and free from any such disfiguring marks as those which ne-
cessarily follow cautery, caustics, or needles. [Dublin Hosp. Gaz.

Operation for Aneurism. The following conclusions, as the result
of his experience in operations for aneurism, are drawn by Mr. Guth-
rie, in a lecture delivered by him at the Royal Westminster Opthal-
mic Hospital :

1. That the theory of the operation of aneurism, as dependent on
the collateral circulation, cannot be applied with safety to spurious
aneurisms of recent occurrence dependent on wounded arteries.

2. That it is inapplicable to wounded and bleeding arteries.

3. That the length of time a spontaneous aneurism has existed is
of consequence, as connnect^d with the collateral circulation ; al-
though an aneurism should never be allowed to attain that size which
may render it injurious to the surrounding parts.

4. The collateral vessels are at all times and under all natural cir-
cumstances capable of carrying on the circulation in the upper ex-
tremity, whatever disease or injury may affect the principal trunk,
provided a due degree of care be taken to maintain the temperature
of the part. Whenever the reverse lakes place, it is an exception to
the general rule.

5. After operations for aneurisms in the lower extremity, the colla-
teral branches are almost always equal to carry on the circulation
through the limb.

6. When the principal artery of the lower extremity is suddenly
divided, without any previous disease having existed, mortification is
not an uncommon occurrence, and is more likely to take place in old
than in young persons.

7. When under such circumstances the principal vein is also divi-
ded, mortification seldom fails to be the consequence. [Med. Times.

Treatment of White Swelling. Dr. Blakey details two cases of
the successful employment of the Chimaphila Umbellata (pipsissewa,
wintergreen) in the treatment of white swelling. The first case, a
boy of a scrofulous family, is thus described :

" When I examined my patient, I found one of his knees three

1347.] Diseases of the Skin. Deligation of Arteries, 63

times its natural size, the skin of the leg of an unnatural why color,
the boy bein^r tolerably black for one of bis race: considerable wast-
ing of the limb, pulse 9o, and some white fur upon his tongue. I
looked upon the case as scrofulous while swelling, and concluded in
my own mind there could he little done towards effecting a radical
cure, as I had often treated and seen such cases treated, but had
never known a cure to follow, hut more or less lameness to inevitably
succeed all our efforts, if we did not ultimately have to resort to the
knife to rescue the sufferer from the grave.

I commenced giving my patient the infusion of pipsissewa, a pint
to be drank each day. The formula for making it I took from Wood
and Bache's Dispensatory, and twice a day, morning and night, I had
a fresh poultice made out of oat-meal and the infusion, and applied to
the whole knee ; diet light, and to keep the recumbent position."

The treatment was continued from Feb. 5th to April 15th> when
the patient was discharged cured.

Topical Treatment of Certain Diseases of the Skin. M. Cazen-
ave prescribes, often with success, the use of simple acidulated
lotions-, in certain slight cases of achne, behen, pityriasis, herpes and
even eczema. He often, also, in cases of impetigo, when the crusts
have fallen, employs with advantage a solution of alum, as follows :

Alum, two drachms.

Infusion of roses, .... ten ounces.
The alum may be increased to three drachms, but the lotion that
succeeds the best is the following :

Bichloride of mercury, . . . two grains.
Chlorohydrate of ammonia, . two grains.
Emulsion of almonds, . . eight ounces.
When in eczema, the eruption is chronic, M. Cazenave makes use
of the following :

Azotic acid, . . . . . . 25 drops.

Chloro-hydric acid 25 drops.

Distilled water, 9-i ounces.

[Jour, de Pharm., from South. Jour, of Med. and Pharm.

Prof. Porta on Delegation of Arteries. Of 000 cases of the liga-
ture of the large arteries on record, gangrene has occurred in 50.
Of 132 operations in the carotids, it occurred in 1; of 150 cases of
ligature of the innominate, subclavian, axillary and humoral, in 7 ;
and of 302 operations in the lower extremities, in 42. [Medico-
Chirurg. Rev.

\cw Sign of Death. M. Ripault has called the attention of the
French Academy of Science, to a new sign of death, which consists
in the flaccidity of the iris; the pupil losing its circular form when
the globe of the eye is pressed in two opposite directions; hut remains
found, notwithstanding the compression, when life is not extindP

[Western Lancet.

64 Medical Intelligence. Meteorological Observations.

MEDICAL INTELLIGENCE.

Notice of the HI. Volume. In issuing the first No. of a new volume, we again
3olicif the assistance and kind co-operation of our subscribers, to sustain this
Journal. Our experience has taught us, that the labour of conducting the work
is sufficient to occupy our time and attention, without being compelled to write
articles and essays for it. We' would much prefer, moreover, to publish com-
munications coming from our friends. We respectfully ask our subscribers to
increase the usefulness and importance of the Southern Medical and Surgical
Journal, by contributing to its pages. Essays on any subject connected with
medicine, report of cases, or facts relating to the profession, will be thankfully-
received from any source.

Our Publisher will be obliged to any one for an increase to the subscription
list.

A new prescription for Burns and Blisters. During a recent visit to Aiken, we
learnt from a medical friend, a domestic preparation used in that neighborhood
for burns, blister^ and denuded surfaces. It is an ointment made of equal parts
of white of egg, beaten up to a froth, and fresh lard. A little morphine or* chlo-
ride of sodium we think might be added with advantage.

METEOROLOGICAL OBSERVATIONS, for November, 1846, at Augusta,,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

3

c
<

"Sur

TlIER.

l Rise.
Bar. I

2,

TlIER.

P.M.
Bar.

29 78-100

Wind.

Remarks.

~T

62

29 80-100

72

S. E.

Cloudy drizzle.

2

64

" 75-100:

76

" 76-1001

s. w.

Rain at 3 a. h., 1 in. and 5-100.

3 58

u 84-100

76

" 85-100

N. E.

Cloudy.

4

64

M 81-100

75

" 76-100.

N. E.

Flying Clouds.

5

56

82-1001

53

" 74-100

X. E.

Rain.

6

50

< 65-100

51

" 65-100

N. E.

Rain.

7

51

i[ 65-100

56

" 62-100

X. W.

Rain.

8

55

" 71-100

67

" 71-100

S. E.

Cloudv.

9

50

" 83-100,

78

" 83-100

8. W.

Fair.

10

52

" 90-100

79

" 90-100

s. w.

Fair.

11

53

' 90-100'

78

M 84-100

s. w.

Fair.

i a

49

" 85-iao;

72

80-100

N.

Fair.

13

46

" 80-100

70

87-100

N.

Fair.

14

40

" 83-1001

70

" 81-100

E.

Fair.

15

45

" 83-iQOi

74

' 83-100

W.

Fair.

16

46

85-100;

70

" S9-100

E.

Fair.

17

47

i: 91-100

70

" 92-100

E.

Fair.

18

45

92-100

69

" 86-100

S. E.

Fair.

19

55

': 5S-100.

55

;: 55-100

W.

Rain in morning.

20

37

" 82-100

60

85-100

N. W.

Fair first frost.

21

33

" 85-100

64

85-100

X. w.

Fair ice.

2-}

33

" 61-100

55

" 47-100

W.

Rain heavy blow storm.

23

32

" 91-100:

58

" 94-100

X. W.

Fair.

24

33

" 87-100

64

" 66-100

S.

Fair storm atnightr. 80-100.

25

45

< 30-100,

48

': 47-100

X. w

Fair severe blow last night.

26

30

92-1001

47

97-100

X. w.

Fair stiff breeze.

27 21

" 30-100;

45

30

s.

Cloudv.

28| 45

30-100,

51

29 97-100

S. E. '

Rain, 30-100.

29 53

<: 97-100

72

97-100

W.

Fair.

30

*42

30 5-100

62

30 3-100

1 E. 1

Fair.

18 Fair davs. Cluantitv of Rain 2 inches and 15-100. Wind East of N. and
S. 12dav. "West of do. 14 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I.] .NEW SERIES. FEBRUARY, 1847. [So. 2.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE V.

Alcohol. By A. Means, M. Dm Prof, of Chemistry and Pharmacy
in the Medical College of Georgia, and Prof, of the Physical
Sciences in Emory College, Oxford, Ga.

This singular and wonderful compound, now extensively known
throughout the civilized and a large portion of the savage world, and
employed under some form or other, as a stimulating beverage by so
many millions of the human race, cannot but present a subject of
interesting consideration to the medical profession. Its prompt,
powerful, and peculiar effects upon the animal economy, and the la-
mentable evils which its habitual use has for centuries entaiied upon
the physical, mental, and moral man often ruinously involving the
fame, fortunes, and happiness of thousands, and hurrying myriads of
victims to an untimely grave, challenge a scientific examination into
its History, Pharmaceutic origin and uses. Chemical constitu-
tion, Medical claims, and Modus operandi : together with the
Physiological and Pathological Phenomina consequent upon
its administration, and the Antidotal treatment required. For
while, from its solvent, stimulant, styptic and antisceptic properties
it has strong claims to a respectable position upon the list of thera-
peutical agents, yet the frequent, fearful, and often fatal derange-
ments organic as well as functional, which it superinduces in the
animal economy has sufficiently warranted its classification among
narcotico-acrid poisons the place assigned it by Dr. Orfila. in his
valuable and extensive work on Toxicology, and since adopted by
the distinguished Edinburgh Professor, Dr. Christison, in his moro
scientific and elaborate treatise upon the same subject.

5

6G Alcohol [February,

Its History. The lime of the discovery of (he alcoholic princi-
ple is not reported by the most ancient writers, nor can it be found
even in Vna legends of tradition. The knowledge of its existence,
however, can be traced to a very remote period in the history of our
race. By the oldest and most veritable of histories we are informed
that the patriarch Noah cultivated the vine, and was inebriated with
its fermented juice immediately after the deluge, which is fixed by
the best chronologers in the 1056th year from the creation, or B. C.
2348 years, giving an antiquity to this beverage (i. e. wine) of 4194
years. From, {'he same authentic source we learn that the Jews were
for centuries acquainted with its use. The venerable Lot's incestu-
ous debauch, NabaPs wine-maddened feast, Belshazzar's bachanalian
revel, Ammon's drunken murder, Renhadad's bestial inebriation,
and Uriah's stupid sottish ness on the night before befell all, all
seem to have been preserved upon Revelation's page to inspire the
disgust of posterity against the loathsome and damning evils of
intemperance, and to signalize the righteous retributions of Heaven
against its iniquity, whether found in a patriarch, a king, or a depend-
ent. From profane history we also glean some relevant facts.
Homer reports the use of trine in one of his immortal poems, i.e. the
Odyssey, written according to Velleius Paterculus about 960 years
before the Christian era, and Herodotus, the oldest accredited histo-
rian, who completed his celebrated work 445 years before Christ,
mentions the use of malt liquors in Egypt, five years anterior to that
date (i. e. 450 B. C).

The first distillation of Alcohol, has been attributed by some to an
Arabian chemist who lived about nine centuries ago. About the 13th
century, Dr. Raymond Lully, a learned native and divine of the
island of Majorca, whose pharmaceutical knowledge seems to have
been in advance of the age in which he lived, and who is known to
have prepared the Oil of Rosemary, the Acetate of Lead, and several
of the salts of Mercury, has also indicated his acquaintance with the
Spirits of Wine, which he reports under the appellation of "Aqua
Ardens." Although the French chemist, Thenard, is disposed to
attribute its discovery to Arnold de Villenue, at Montpelier, "early in
the 14th century." So that this singular and powerful chemical
compound has an authenticated existence of at least 500 years.

lis Pharmaceutical origin and uses. Alcohol, although
formed from organic matter, yet is never found in the natural and
healthful condition of any product of the animal or vegetable king-

1847.] Alcohol. 67

doms. It is only when the laws of life have ceased to act, and the
elements of the organized tissues, no longer under their control, are
excited hy the presence of putrescible nitrogenous matter, to abandon
their former relations, and unite in the formation of one or more
new compounds, under the action of new affinities, that this strange
and important fluid is obtained. The peculiar metamorphosis refer-
red to, is effected in the vinous fermentation, and this must be prece-
ded by t fie saccharine fermentation, or the presence of sugar and
water, or, at least, of some amylaceous substance, as malt, potatoes,
&c, readily convertible into sugar, from the starch which it con-
tains.

It seems indispensible to the production of the result that some
azotized body, as albumen, or gluten in a certain stage of decay, be
present to commence the fermentative action. This is effected, not
by a combination of the yeast or ferment with the elements of the
liquid, but by what has been denominated by Berzelius a catalytic
force, which seems to operate by disturbing the molecular equilibrium
of the compound mass, and breaking up its existing affinities, and
allowing no relapse to its former condition, but propagating through
the whole the same corpuscular motion, which characterizes the
catalytic agent: thai, in the mean time, maintaining its unimpaired
and independent identity. This change goes on most rapidly at the
temperature of 75 or 80 of Farenheit's thermometer. The products
formed are purely carbonic acid gas and alcohol. But after tho
effervescence, occasioned by the liberation of the gas, has terminated
and the liquid has become clear, the process must be arrested by the
exclusion of air, or exposure to cold, or the acetous fermentation will
supervene, by the presence of the Alcohol and Oxygen 1 atom of
the former absorbing 4 atoms of the latter, and by affinitary change,
turning out 1 atom of anhydrous acetic acid and 3 of water. At
this stage, then, the mass should undergo distillation^ which ought to
be repeated several times till the resulting spirit has a specific gravi-
ty of .838 water being 1000. This is the strength of Rectified
Spirit or the commercial Spirit of Wine, which still retains 13 or 14
percent, of water. By distilling with half its weight of quicklime,
to absorb the water, absolute alcohol may be obtained of .703 specific
gravity, whose boiling point is about 173 Farenheit. This sub-
stance, however, save for purposes of chemical analyses, where it
acts a most important part in determining the purity of other sub-
stances, as Iodine, the vegetable Alkalis, Castor Oil, &c, is never

68 Alcohol. [February,

employed ofthe strength ordered in the pharmacopoeias. When used,
therefore, ns an article of officinal pharmacy, for preparing tinctures,
spirits, extracts, &c, Rectified Spirits (sp. gr. .838) or Proof Spirit
(sp. qr. .920) is the form almost universally preferred.

The different descriptions of spirituous liquors sold in the commer-
cial world, and which have for centuries constituted the fruitful source
of crime and wretchedness over a large portion of the civilized popu-
lation ofthe globe, are derived from a variety of substances, and
exhibit but so many different forms of diluted Alcohol from the
more pungent and fiery fluids, as Brandy, (Cognac.) Rum, Scottish
and Irish Whiskey, &c, containing from 53 to 54 per cent, of the
pure spirit, down through the list of stronger wines, as Lissa, Madeira
and Port, with from 24 to 25 per cent, to the milder c'ass, as Goose-
berry, Champagne, &c, with 11 or 12 per cent. and farther still,
till we reach the cheaper fermented liquors consumed by the peasant-
ry of many countries, embracing Ale, Porter, Small Beer, &c, &c,
and furnishing an alcoholic per centage of only from 10 to 1.2.

Indeed almost every fruit and saccharine juice may be made to
yield this valuable spirit in some form. Arrack, the popular drink
in Batavia, is obtained from Rice Palm wine in Ceylon, from the
Cocoa Nut, and the Koumiss, a common beverage of Tartary, from
Milk, while in any country which grows them, the Sugar Maple,
Beets, Parsnips, Potatoes, &c, yield it in abundance when tortured
by the various processes which art has devised.

Its Chemical Constitution, &c. Alcohol has been ranked by
some chemists among the Oxyhydrocarbons a class of bodies in-
cluding the Ethers, many ofthe vegetable Acids, Creosote, Petro-
leum, &c.

According to this view, the elementary composition of Alcohol is
expressed by the formula, C4 H6 02 .* But since the adoption of
the hypothetical radical, Ethyl, existing in Ether and its compounds,
the aggroupment of the elements is believed to be different, and
Alcohol is regarded to be the Hydratcd Oxide of Ethyl. Ethyl
itself being a Hydrocarbon and represented by the formula C4 H5
leaves 1 atom of Hydrogen and 2 of the Oxygen, as contained in the
first formula to be appropriated thus viz: 1, of the 2 atoms of Oxy-

* As the cliemical constitution of bodies depends upon molecular attractions, it is
supposed that 4 atoms of Carbon, 6 atoms of Hydrogen, and 2 atoms of Oxygen,
unite under their affinitary habitudes to form 1 atom of Alcohol.

1847.] Alcohol. 69

gen goes over to oxydize the comp. radical, Ethyl, while the other
atom of Oxygen unites with the atom of Hydrogen to form water
which combining with the now oxydi . hydrates it, and gives

the following formula for the live; rated Oxide of Ethyl, or, Alcohol
viz : C4 Hs O -J- II O. Now, grape sugar, into whose aggroup-
ment of elements all other sugars must be turned, before they can
generate the spirituous fluid in question, consists, according to the
best authorities ofC, H]0 019, and when the play cf affinities
commences under the fermentative action, these elements will be
found to he converted into precisely 2 atoms of Alcohol, i.e., 2
(04 H5 O -|- HO) and 4 atoms of Carbonic Acid, i.e., 4 (C 02)~
the one, a fluid, the other, a gas embracing together the same
simple constituents, but under new atomic arrangements, and each
new compound, in form and character, totally distinct from the bland
and nutritive solid (sugar) to which both are indebted for their pater-
nity. Alcohol boils at the temperature of 173 Far. when the baro-
metrical pressure is 29.5 inches, but has never yet been subjected to
a degree of cold sufficient to congeal it. Prof. J. K. Mitchell, of
Philadelphia, who by evaporating the compound of solidized Carbo-
nic Acid and Sulphuric Ether in the vacuum cf an air pump lias
procuredthe lowest thermometries! temperature hitherto attained,
has succeeded in reducing the consistency of Aicohol ofsp.gr. .793
to that of oil or melted lard at 130 below zero, and at 146 it
44 flowed like melted wax,1' and should chemical research ever dis-
cover a mode of effecting a depression in temperature a few degrees
farther, there is no question that this volatile, spark Hog, mobile fluid,
would be transformed into a frigid, motionless, massive solid, proba-
bly as malleable as quicksilver at 4.0. Wnen vaporized at the
usual pressure of the barometer, it expands so as to occupy C39 times
its former volume its vapor weighing ''half as heavy again as air,"
which is estimated at 31.0117 grs. to the 100 cubic inches. It is
familiarly known to be highly combustible, and in burning emits
intense heat, with little light and no smoke the chemical action
being prompt and perfect between the Oxygen of the air and the
Hydrogen and Carbon of the liquid, transforming them rapidly into
voter and carbonic acid, which constitute the entire products of the
combustion both being sent ( .;'. vapor, but the former

readily made visible by allowing it to se upon a cold plate or

polished ball of metal, held over the flame. It unites with water in
all proportions, and in the act of combination, evolves heat. Its

70 Alcohol. [February,

strong affinity for water, and its great solvent powers, exercised over
many organic substances, render it a valuable agent in Pharmacy.
Hence those salts which are insoluble in this menstruum, but have
been dissolved in water, are precipitated immediately upon the intro-
duction of Alcohol, which has a stronger affinity for the water
than the latter has for the suspended salt. On the contrary, those
substances which are readily soluble in Alcohol, as Gum Camphor,
Oils, Resins, &c, are instantly liberated by the addition of water,
and from a state of invisible diffusion, instantly appear in the form of
an opake, heavy precipitate.

The anti-putrescent properties of Alcohol, which have long made
it a valuable agent in the preservation of anatomical specimens, is
probably owing, first, to the exclusion of the Oxygen of the air, whose
presence always hastens the putrefactive fermentation ; secondly, to
its capability of dissolving the extractive matter, ozmazome, from
animal muscle, and coagulating the albumen and fibrin ; and, thirdly
and mainly, to its great affinity for water, which is known rapidly to
promote decomposition, and which it absorbs powerfully from the
tissues exposed to its action rendering more compound their texture,
and reducing their volume.

Its Medicinal Claims. As a therapeutic agent, Alcohol is
generally used in some of its diluted forms, and in none, perhaps,
more frequently or effectively, than in that of the *' Spiritus Vini
Gallici" of the London pharmacopceia, (the " Eau de vie" of the
French,) being an ardent spirit distilled from wine, and differing
somewhat in strength, color, and flavor, owing to the quality of the
wine, mode of manufacture, &c.

The brandys of Bordeaux, Cognac and Armagnac are, perhaps,
most in repute, but all of them may be found to contain from 53 to
55 per cent, of Alcohol, diluted with water, and in combination with
a volatile oil, now called CEnanthic Ether (itself a hydro-carbon)
which gives to wine that peculiar flavor and odor, that contradistin-
guishes it from all other fermented liquors. Acetic acid is also
found, together with a small quantity of Acetic Ether, coloring mat-
ter and Tannin. Whether the latter article, is obtained from the
wood of the surrounding cask, or from some astringent added to
heighten the color, is not known. The Spiritus Sacchari " or Rum,
such as is distilled in Jamaica from Molasses, or the drainings and
washings of sugar boilers, has about the same strength, and though
generally considered as moro sudorific, is popularly employed for the

1817.] Alcohol. VI

same, purposes. In either of these forms however, the physiological
effects depends upon the presence of the reigning spirit, (Alcohol)
which is a rapidly diffusible stimulant, making a prompt and power-
ful impression upon tl ach, and through that vise us and its
appendages transmitting its action to the most remote organs and
tissues of the human body. As a remedial agent it has been various-
ly classed by different pharmacologists! By Eberle, it is ranked
with the third class of o" . which he denominates Incitanls.
By Dunglison, it is classed with stimulants, but under the subordin-
ate division sjecial excitants ; and by Pereira, with his cerehro-
spinants of the llh order, comprizing other "inebriating, paralyzing
stupefacients," as Ether, Protoxide of Nitrogen* Cannabis Indica,
&c. the same general action upon the animal organism, being,
however, ascribed to it, by them all. And here, perhaps, we may be
allowed to remark, that while its pharmaceutical value is indisputable
in effecting the solution of many gum-resins, balsams, essential oils,
&c. thus furnishing an appropriate menstruum for their preserva-
tion and exhibition, for which their is no adequate substitute now
known, yet there is scarcely a case within the range of professional
practice, requiring the action of excitants at all, in which its admin-
istration may not be waived by the vicarious employment of some one
or more articles of the class. It is nevertheless, a convenient and
efficient drug when in the hands of a discreet and skillful therapeu-
tist, but from the insidious and stealthy inroads which it rarely fails
to make upon the physical and moral constitutions of its unsuspecting
victims: effected too, under the plausible pretentions of its hygienic
or restorative properties, and often with the imposing and prevalent
passport of professional authority, it should be kept like the fleet, but
disciplined grey-hound, constantly under coliar, only to be slipt
when game is in sight, and forthwith restored to its leash when the
chase is over. Its medicinal properties, however, may be made
available internally in cases of asthenic dyspepsia, where the want
of proper contractility in the muscular fibres of the stomach, involves
a defective assimilation of its ingesta to the purposes of the animal
economy a disease too often superinduced by the habitual use of
the very article under consideration. Here the remedy acts by
whipping up the languid energies of the organ to more vigorous
muscular action, and by inducing a temporary increase of the gastric
secretions. And yet, probably, in nine cases out of ten, where this
adynamic condition of the digestive apparatus requires the interfcr-

73 Alcohol. [February,

ence of incitants at all, the continued use of pulverized capsicum with
appropriate food, or in conjunction with an equal quantity of gentian,
would yield decidedly more permanent and happy results. In the
form of Wine or bottled Porter its use is sanctioned in the last stages
of fever, or in low and exhausted conditions of the system, origina-
ting from other causes. In ataxic diseases, tetanus, metastasis of
rheumatism, Ice, it sometimes manifests its best powers. When in
the active practice of the profession, several years ago, I was called to
a painful case of acute rheumatism in the knee joint of a servant boy.
The high vascular action and great geiu ral excitement, clearly in-
dicated, as I thought, the propriety of venesection. Fearing a
transfer of the disease to some vital organ, I Lied carefully and
moderately; laid an emollient fomentation to the joint; gave some
other directions, and then went to my room (about 200 yds. distant)
and was in the act of retiring to rest, when a messenger came in haste,
requiring my immediate presence again with the patient. I had not
been absent, perhaps, more than 15 minutes, when on my return, I
found him supported with difficulty in an erect posture upon his bed,
his respiration, interrupted, labored and noisy, his abdomen, and
especially the epigastric region, swollen and tympanitic, and the
whole man suffering an intensity of agony which must soon have
extinguished life. A sudden and fearful metastasis of the disease
from the knee to the stomach was clearly developed, and required
prompt and bold treatment. In the emergency, and perhaps within
the space of two hours, the patient drank one pint of hot strong Rum
toddy, with 2 ounces of Laudanum, which together with the external
application of a large mustard cataplasm, entirely overcame the
gastric distention and spasm, and opened the way for a speedy
recovery. Here it is true, the alcoholic principle was only expected
to act the part of an auxiliary in the cure, but did so decisively and
satisfactorily.

In atonic and tetanic cases, alcoholic drinks may be given in large
quantities without producing the slightest intoxication. In the form
of wine it has been successfully employed in the latter class of disease,
and according to Dr. Rush's authority, "should be given in quarts,
and even in gallons daily." Mr. Carrie reports a case of tetanus
cured in the Liverpool Infirmary "by drinking nearly a quarter cask
of Madeira wine." In chronic Diarrhoea, or where there exists great
feebleness of the vital powers, either from age, or as the consequence
of acute, but subdued disease, the rod wines constitute an agreeable

1847.] Alcohol 73

and effective form of administration for the remedy. To such cases
the red Port wine seems peculiarly adapted from the larger proportion
of tannic acid which it contains (j robably derived from the hu>ks
and seeds of the grape which are allowed to remain during the pro-
cess of fermentation) and from i\s consequently greater astringent
action upon the relaxed animal fibre.

In that terrific malady of drunkard*, Delirium Tremens, the physi-
cians judgement has, perhaps, too frequently yielded to the insatiate
cravings of the miserable inebriate, and he has continued to prescribe,
though in more limited potions, the same fiery excitant which has
already turned his stomach into a furnace, and his brain into a Bed-
lam, under the apprehension that without it, a dangerous collapse
would supervene and the wretched sufferer sink. Such fears, how-
ever, we regard as without sufficient foundation, and in 99 cases out
of 100 which occur, we believe, w.th Prof. Dunglison, that alcoholic
excitants "are by no means indispensible, and the disease admitsof
cure without the use of any of them." Hundreds of those who with-
in the last ten years have been safely rescued, by the "temperance
pledge, from the vortex of ruin, and who ceased their stimulating
potations, suddenly and forever, in the midst of the horrible sequellse
of a debauch, with a blazing stomach and a frenzied brain, amply
sustain the correctness of this professional opinion. This temporizing
mode of treatment, we are glad to learn, is losing favor with many
scientific practitioners, and even the stimulus of wine, in the lan-
guage of Pereira, "is much less frequently and copiously employed,
than formerly." While, therefore, we believe, that prescribed under
the decision of a discriminating judgement, and guarded by the
imposition of suitable restraints, these stimulating liquors may be
made subservient to the purposes of the profession, yet in accordance
with the expressed view of some of the ablest and best physiologists
and chemists of the age, we cannot but regard every fluid of alcoholic
impregnation to be unnecessary or absolutely pernicious in a state of
health its dietetical use, therefore, as calling for the discourage-
ments of the profession, and even when medicinally employed, as
requiring much care and circumspection, lest greater evils be entail-
ed upon the patient, than it purports to cure. In short, in relation to
the volatile spirit of which we treat, we are constrained to adopt the
language of Dr. A. T. Thompson, viz: "it is a medicine, or a
poison, according to the discretion or moderation with which it is
used, and the skill and judgement which direct its medicinal employ-
ment."

74 Alcohol. [February,

- .

Its exteexal use. The decided and powerful impression made
by Alcohol upon the living tissues, bcth bv a dynamical and chemical
action, gives it some claims to the attention of the profession as an
externa! application. Its utility as a lo'ion in some forma of cutane-
ous disease, as a colhjrium in tia, as a counter-stimulant
upon the phest, or upon the umbilical and hypogastric region, to
excite respectively the action of the heart, the uterus, or the bladder,
in a debilitated or atonic condition of either of those organs, probably
depends on its dynamical activity, by which we mean its capability
to exert a strong influence upon the animal organism, without effect-
ing any mechanical or chemical changes in the tissues. Guided by
our own experience, however, we deem it proper to say, that when
employed by way of warm embrocation for the above purposes, or in
cases of feeble circulation or an asthenic condition of the extreme
vessels childblains, &c. &c, its volatile nature, aided by an eleva-
ted temperature, will result in such rapid evaporation from the
exposed surface, as materially to counteract its excitant properties,
and even make questionable the propriety of its use, unless the con-
sequence be avoided by making the friction under cover, enveloping
the parts in warm flannel <kc, precautions which should not be
neglected. But in cases of hyperemia of the dermoid surfaces, where
the engorged and distended capillaries cannot propel their languid
contents, and local inflammation supervenes, as in erysipelas, or
severe sprains, or in burns, or scalds, (where the cutirle remains
sound.) upon the same principles advocated by Mr. Kentish in his
"Essays on Burns," hot alcoholic frictions give tone to the feeble
vessels, contracting their calibre, and relieving their engorgement,
while the process of evaporation which ensues continues to favor
these desirable results, and leaves an agreeable sensation of coolness
upon the surface. Perhaps, however, its most valuable properties as
a styptic, in restraining haemorrhages from weak parts, are attributa-
ble to its chemical action upon the albumen and fibrin of the blood,
in the production of a coagulum which mechanically checks its flow
from the relaxed vessels. Its well known action in hardening the
cuticle in the case of tender nipples, where the repeated application
of ardent spirits for a few weeks before the close of pregnancy,
secures freedom from soreness when lactation commences, is proba-
bly dependent also upon a chemical change effected in the dermic
tissue.

1847.1 Alcohol

The Physiological and Pathological Phenomena consequent
upon its administration. The extent of our foregoing remarks upon
its external use, has necessarily led us to anticipate in some degree.
the physiological action of cur agent, and yet something more
must be said, before its effects upon the internal organs can be well
understood. For our general views on the jiodus operandi of
poisons upon the animal system, the reader is respectfully referred
to ihejirst article in the Southern Medical and Surgical Journal for
January, 184G. At no distant day in the history of the profession,
the action of stimulants, narcotics, and other powerful and poisonous
articles of the materia medica, was attributed exclusively to the
sympathetic transmission of their several peculiar impressions to
remote organs through the medium of the nervous tissue.

The progress of physiological and chemical science, however, has
completely unsettled these theoretical views, and after a deliberate
survey of the 'whole field oi^ argument, we are still constrained to
adopt the sentiments ad /anced in the article of the Journal above
referred to, viz : " While, there fore, we could hardly feel justified in
unequivocally denying the sympathetic action of all poisonous agents
through the nervous tissue alone, yet we must regard the burthen of
facts and experiments as opposing the existence of such action, while
their venous distribution has been established in many instances be-
yond question."' Without therefore admitting or denying the propa-
gation of the alcoholic impression by nervous impulse, it is sufficient
for our purpose to say that Alcohol is in many instances, and beyond
the possibility of doubt, absorbed and circulated through the sanguif-
erous channels, and that most, or all of the phenomena attendant
upon its use may be readily solved by this authenticated view of its
action.

One striking and uniform consequence, resulting from a free
indulgence in intoxicating potations, cannot have escaped the most
careless observation : I mean the high animal heat, accompanied by
great muscular relaxation and enervation, after the first stage of ex-
citement has passed away. These phenomena, we humbly conceive,
are attributable to the absorption and subsequent decomposition of
the fluid in its passage through the arterial tubes, where its Carbon
and its Hydrogen, both positively electrified elements coming in
contact with the Oxygen of the blood a highly negative principle,
which has reached the current of the circulation through the cellular
structure of the lungs, enter upon a vigorous chemical combination

76 Alcohol. [February,

with it, when by a sort of slow combustion, carbonic acid and water
are produced ; the same result, only attended with less vived phenom-
ena, which would follow were these elements (i. e. Carbon and
Hydrogen) allowed to combine with Oxygen at an elevated temper-
ature in the open air. Adopting the luminous and satisfactory views
of the Professor of Giessen upon this subject, we believe that the
vital forces necessary to supply the increase of mass, and to maintain
the voluntary and involuntary motions of the human body depends
upon the continued metamorphosis of the organic tissues effected by
the combination of the circulating Oxygen of the blood-globules with
the carbonaceous matter of those tissues, and in the normal condition
of the corporeal functions, always accompanied by the extrication of
beat. But in the case before us, the alcoholic elements, i. e. Carbon
and Hydrogen seize upon the absorbed Oxygen, intercept its passage
to the animal tissues, converting, perhaps, (for the time being) the
whole of it into Carbonic acid and water, necessarily evolving heat
in ample abundance, as is indicated by the hot skin and bounding
pulse of the saturated toper, but accompanied by languor and inac-
tion throughout the whole muscular system, for want of the renewed
supply of vital force, which the Oxygen, if undiverted, would have
furnished by the healthful transformation of the elementary con-
stituents of the tissues.

Its Pathological Phenomena. The intemperate use of a stim-
ulent so powerful and so diffusible, might well be expected to make
wide and signal ravages upon the human constitution. Nor can it
be otherwise ; and accordingly the established and prolonged habit of
inebriety, leaves scarcely one organ or tissue of the whole physical
man, unimpaired and normally active.

It wages a perpetual war with life, whether under vegetable or
animal organization, and in the latter, the very inflammation which
it engenders, and the tumult which it excites, is hut the consequence
of the prompt and vigorous attempt of the vis concervatrix natura, or
the aroused vital powers to resist Vne inroads of the desolating intru-
der, and repel its chemical attack upon the invaded tissues. In regard
to its hostility to vegetable life, we need only remark that arsenic is
scarcely less speedy and fata! in its action upon animals, than Alcohol
upon the vitality of plants. It acts like Hydrocyanic Acid, but while,
in an experiment reported by Mr. Griffiths of the Medical College of
St. Bartholomew's Hospital, "Beans were killed by Prussic Acid in
the course of a single Jay and deadly Nightshade in four days," the

1847.] Alcohol 77

*4 Spirit of Wine killed the plant to winch it wag applied in 2, few
fiours."* It shall be our province, however, briefly to notice its pa-
thological effects upon the animal organism.

Stomach. Repeated potations act upon this organ by obtundiffg
its sensibilities altering its structure inducing a state of sub-
acute inflammation, arid in some instances a scirrhous condition of
the pylorus." followed by repeated eructations, Pyrosis, and Dijspep.
sia, with all the category of morbid and distressing symptoms which
follow in its train. A post mortem examination, after poisoning with
Alcohol from a single debauch, sometimes exhibits a natural state of
the stomach, but M in animals killed by Alcohol, Orfila says be found
the villous coat of the stomach constantly of a cherry-red color" a
statement confirmed by Dr. Cbristison's experience. f In one case,
however, reported by Orfila, after 6 drachms of Alcohol had resulted
in the death of a dog, his stomach presented " many longitudinal
streaks of a darkish red color, formed by blood extravasaled between
the two membranes.":}: Mr. Brodie's examinations also "demon-
strate a visible inflammation of the stomach. " In old drunkards
the mucous membrane of this organ "is often injected and thick-
ened."||

The Liver. The crippled and deranged condition of the great
central assimilating organ of the animal economy, the stomach,
could not otherwise than result in the propagation of diseased
action to the most remote organs, if from no other -cause than the
defective chymefaction of its ingesta and the consequent impov.
erishmentof the blood. But more than this : The repeated draughts
of ardent spirits, swallowed by the dissipated-- long faithfully resist-
ed by the lacteals and absorbents of the stomach and duodenum, at
length overcome their declining powers of repulsion, break over the
barriers, which active vitality had opposed, and the alcoholic princi-
ple makes its way through the current of the circulation, and comes
in contact with the structure of every organ ; for in such cases the
circulating oxygen of the blood-globules cannot decompose the whole
of this burning tide, and it has therefore been detected as unaltered
Alcohol in the various tissues and serous cavities after death. Un-
der its stimulating contact, then, the liver becomes first functionally
deranged, elaborating a deformed, thick, pitchy, secretion, instead

* Chemistry of the Four Seasons, p. 83.

t Christison on Poisons's, vol. ii. p. 732. : Orfila on Poisons, p. 34 1.

% Orfila on Poisons, p. 347. II Pereira M. Med., vol. i. p. 321.

78 Alcohol. [February,

of healthy bile then undergoes structural lesion, and becomes tuber-
culous and enlarged in volume. I was several years ago permitted
to examine, after his death, the liver of a reputed drunkard. Instead
of presenting the sm >olh surface, and chocolate hue of the healthy
organ, and weighing 5 or G lbs., the whole parenchymatous mass was
disfigured by large bluish-white protuberances, completely disorgan-
ized and indurated, and weighed, I think, between seven and eight
pounds.

The Brain is also the seat of great physical and mental disturb-
ance from the action of our poison. Supplied with large bloodvessels
and highly excitable, this great central organ of the nervous system
is subjected, under the powerful stimulus of intoxicating drinks, taken
in large quantities, suddenly, or within a short space of time, to pro-
found coma, engorgement of its larger vessels increased vascular-
ity in the membranes, effusions of serum and the extravasation of
blood into its ventricles presenting every variety of functional
aberration, from the most stupid and revolting idiotism, to the most
wild and furious paroxysm of Delirium Tremens. While, in long
continued habits of intoxication, the whole medullary mass of the
encephalon loses its natural softness and elasticity so indispensable
to the highest activity and loftiest efforts of mind becomes more
firm and unyielding, and if the unhappy victim of his cups is not
carried off in some drunken fit, corresponding mental and moral
phenomena soon manifest themselves. A growing insensibility to
the dearest interests and kindliest sympathies of life, and an evidently
increasinglanguor and imbecility in his intellectual operations, follow-
ed by a soulless apathy and a stolid indifference to all the claims of
earth and heaven are the miserable sequellce of his unrestrained
sensuality. To give plausibility to these deductions, let it be remem-
bered that the action of our agent upon the entire cineritious and
medullary matter of the brain, is so well understood by every anato-
mist, that the organ when designed for dissection is removed from
the cranium and immersed for a day or two in a dilute solution of
Alcohol, to give greater consistency and firmness, preparatory to the
use of the scalpel. Again, its stupefying, deadening power upon the
nervous tissue, impairing or destroying its irritability, and thereby
preventing its healthy functional manifestations, either in the branch-
es applied to sensation or motion, has been satisfactorily tested by a
variety of experiments. Fontana found that when half the body of
a leech was plunged in spirit, this part lost all motion, whilst the

1347.] Alcohol. 79

other half continued in action.* The same experimentalist ascer-
tained that plunging the heart of a frog " into spirit caused its motion
to cease in 20 seconds." Turtles were killed by its administration
either through the stomach or anus, or when introduced under the
skin, "before death the animal became motionless: and applied to
the heart of these animals it destroyed the contractility of this vis-
cus.f Monroe applied alcohol to trie hind legs of a frog and found
the pulsation of the heart to become less frequent, and sensibility, as
well as mobility to diminish. Administered by Flourens, to birds, it
resulted in the loss of their "senses and intellectual faculties."
Again, the reduction of functional capability in the nervous system
under the action of alcohol, is exemplified in the fact, that any por-
tion of that exceedingly delicate and sensitive tissue, so readily ex-
citable in its normal condition by the powers of the Voltaic pile,
when soaked in alcohol, loses all susceptibility to Galvanic impres-
sions. Now the cerebral mass is but the radix the medulla oblongata
and the medulla spinalis the trunk, and the multifarious nervous dis-
tributions the branches, of one continuous growth whose chemical
constitution may be regarded the same, and whose physiological
relations are ever in harmony. The elementary vital manifestations,
therefore, made in one part of this great system, may be regarded as
characteristic of the whole. All the forms of human power and
activity intellectual life, sensation and consciousness, are, in the
language of Liebig, M dependent not only on the existence, but also
on a certain quality of the substance of the brain, spinal marrow, and
nerves; insomuch," continues he, "that all the manifestations of the
life or vital energy of these modifications of nervous matter, which
are recognized as the phenomena of motion, sensation or feeling,
assume another form, as soon as their composition is altered "% No
wonder then, that the presence of Alcohol in the brain should signally
modify or change the functional manifestations of that organ, and
propagate its own de-vitalizing impression along the nervous cords.

The only question, then, it seems to us, now is Can Alcohol, by
venous absorption, enter the circulation and he detected in the brain,
or other remote organs? The advocates of Solidism have for years
pertinaciously resisted the force, or avoided the point of accumula-

* A Treatise on the Venom of Ike Viper, translated by Skinner. See Pereira,
vol.1. 317 p.
1 See Pereira, vol. 1, page 317.
jLiebeg's Animal Chemistry, p. 26.

80 Alcohol, [February,

led facts which have long since amply warranted an affirmative an-
swer to this interrogation.

Without entering upon the defence of the general subject of venous
absorption, we content ourselves with the exhibition of a few facts
illustrative of its truth in the history of the agent under investigation.
Dr. Cook, (on the authority of Mr. Carlisle) in his "Treatise on
Nervous Diseases" says that, "a few years ago, a man was brought
dead into the Westminister Hospital, who had just drunk a quart of
gin, for a wager," and upon examination, "within the lateral ven-
tricles of the brain was found, a considerable quantity of a limpid
fluid, distinctly impregnated with gin, both to the sense of smell and
taste ; and even to the test of infi 'mmabilfoy." This case has been
reported by Eberle, Pereira and Christison, the latter of whom (a
patient and scrupulous enquirer after truth,) at first, for physiologi-
cal reasons, questioned the correctness of Mr. Cook's observation
upon the subject of the inflammability of the fluid found, but has
since, in his own experience had ample cause to admit it, and has
done so.

Dr. Ogston, in the Edinburgh Medical and Surgical Journal, vol,
40, p. 282 ct. seq., "adverts to an instance in which after death by
drowning, during intoxication, he found in the ventricles, near\y four
ounces of fluid, having a strong odor of whiskey ."* Br,. WolfTe re-
ports another case when from the surface as well as the ventricles of
the brain, a strong smell of Brandy was inhaled. The late "exper-
imental researches" of Dr. Percy, however, confirmed by Dr. Chris-
tison, go to put the question of the venous absorption of Alcohol and
its detection not only in the brain, but throughout the whole animal
system, forever at rest. Dr. P. found it " in the blood of animals to
whom he had administered it."f Also in the urine, in the bile, and
in the liver. And in the case of "a man who died during the night
after drinking a bottle of rum, he detected it " in the urine and also
in the brain, by cautious distillation, and removing the water from
the distilled fluid by means of dry carbonate of potass^." Dr. Chris-
tison adds, "Dr. Per y gave me an opportunity of verifying his re-
sults with the brain of the man, and I had no difficulty in obtaining
from a few ounces of brain a sufficiency of spirit to exhibit its com-
bustion on asbestus repeatedly. "$ After these interesting cases to

* See Christison on Poisons, Part 2nd., p. 733.
t Pereira Materia Medica, vol. 1, p. 320.
J Christison on Poisons Part 2d 734 p.

1847.] Alcohol. 81

report in detail the facts related by different writers, in which con-
gestions of the arachnoid membrane, effusion ofserosity, and extrav-
asation of blood in the ventricles of the brain, and even the laceration
of some of the lobes, is deemed superfluous.

From the extensive survey which we have been led to take of the
action of Alcohol upon the animal organism, in our investigalion'of
its influence upon the important organ, the Brain, we feel constrain-
ed to study brevity in the remarks which are to follow.

The Heart. -The muscular contractility of this solitary, but
central organ of the circulation, excited by the stimulating tide which
passes through its cavities, charged with suspended Alcohol, labors
with increased vigor to hurry it onward swelling the arterial tubes
and giving a bounding pulse and bloodshot eye ; or under large and
sudden draughts whose narcotic effects reach the whole nervous cen-
tres, suffers the entire destruction of its irritabilty ceases to con-
tract or dilate, and death ensues.

The Lungs. The blood circulating through the pulmonary tis-
sues, by its alcoholic impregnation, irritates the delicate membrane
which lines the air cells, induces a free secretion from its mucous
surface, excites cough and throws off a large quantity of inflamma-
tory (?) vapor, strongly charged with the odor of spirit or, in some
cases may superinduce an apoplexy of the organs, likely to termin-
ate fatally.

The Absorbents, too, under the long-continued use of this delete-
rious beverage, lose their tone and their consequent activity, and fail
to perform their accustomed functions. The balance between the
absorbent and secernent systems, being thus destroyed, serous effu-
sions take place in the cellular tissue or in the thoracic or abdominal
cavities, and all the horrors of Dropsy pale, swollen dropsy, haunt
the inebriate to bis grave.

But enough of these detailed views of the pathological effects of
our poison. A few words as to its Antidotal treatment, and we
are done.

When comatose or asphyctic symptoms have come on from deep
drinking, the prompt use of the Stomach pump is not only advisable,
but, perhaps, indispensable, as,- in cases of poisoning by narcotico-
acrids, such as Alcohol, Opium, &c, the obtunded sensibility of the
gastric surface seems unimpressible by emetics, and the contained
fluid (much of it perhaps yet unabsorbed, should the physician be
called in at an early stage of these symptoms) can be removed rcadi-

6

82 Irritation of the Spinal Marrow, c. [February,

ly in no other way. If this, however, is quickly done, the stupor
sometimes rapidly disappears and the patient recovers.

Dr. Christison reports the case of a boy who had been insensible
for two hours before he was called to visit him, from having swallow-
ed a large quantity of raw whiskey ; when under his direction, " the
stomach pump was immediately applied, brought away a large
quantity of fluid with a strong spirituous odor, and he recovered his
senses in fifteen minutes, but remained very drowsy for the rest of
the day."*

When consciousness is not then restored, the regulation adopted
by the Edinburgh Police in such cases, viz., the injection of cold
water into the ears, is often powerfully instrumental in effecting the
object. It is recommended, however, with confidence, only when
the head is preternaturally warm, and the body not too cool.

The secondary stage of reaction which sometimes ensues, must be
treated as its violence seems to require, but generally with antiphlo-
gistic remedies. Happy is that physician whose sensibilities have
never been shocked by professional calls to these self-sacrificed vic-
tims of sensualism, and thrice happy he whose clear head, and calm
heart, have never been disturbed by the wild throes of a Bacchanal-
ian revel.

ARTxCLE VI.

Irritation of the Spinal Marrow and Ganglia of the Sympathetic
Nerve, with Cases. By W. F. Bakr, M. D., of Greenville, Tenn.

Whilst there are such works extant as those of Marshall, Teale,
and others, on diseases dependent upon irritation of the spinal mar-
row, it may appear superfluous a work of supererogation to some,
to say any thing more upon the subject, or take up the pages of a
medical journal in the publication of cases. Although this subject
may be very familiar to some, and although the works referred to
have been so long published, yet I have been surprised to find so
many in the profession who are entirely ignorant upon the subject.
I find many graduates and those who are not who never refer to
the spinal marrow, either as the origin or modifier of diseases.
When we reflect that the nerves are distributed throughout the whole
* Christison on Poison, Part 2, p. 730.

1847.] Irritation of the Spinal Marrow, <5fC. 83

system that there is not a part but is under their influence, and
that these nerves originate from the brain and spinal marrow, it is a
matter of great surprise that so little attention has been, and yet is,
paid to the subject.

It is quite common for physicians to make but a slight examination
of their patients. Is there pain in the head, and delirium, then, of
course, the brain or its membranes are inflamed! Does a patient
complain of pain in the right hypochondrium and shoulder? here
is a case of inflammation of the licer ! Is there pain and tenderness
in the abdomen? this is a case of inflammation of some membrane
of the intestines ! If there be pain and tenderness in any part, it is
immediately pronounced to he inflammation of the part ! I have had,
and now have, under my care, cases of two, four, ten, and twenty
years standing, which have been considered chronic hepatitis,
gravel, &c.

The means by which we ascertain the existence of irritation of
the spinal marrow, &c, are pressure, percussion, and the application
of a warm sponge, upon each vertebras.

The symptoms vary according to the particular part of the spine
that is affected. There is either acute or obtuse pain in the scalp;
stiffness in the neck ; pain, numbness, prickling and creeping sensa-
tions, and often a sensation as if cold water was running over the
part are felt in the extremities and shoulders; the arms, hands, fin-
gers, legs and feet sometimes become so benumbed that they feel
enlarged. When the pains are acute, they become intermittent,
which is an evidence that the disease is nervous.

In cases of neuralgia of the bladder and kidneys, the nervous ex-
citement sometimes becomes so great as to cause an effusion of
blood, and the urine will be found tinged with it. In cases of bowel
affections, the discharges will sometimes become frequent, painful,
mucous and tinged with blood, and the abdomen will become tym-
panitic and tender. These circumstances are apt to influence us to
believe that inflammation does really exist. But we must make the
true character of the disease our guide. In some cases of neuralgia
of the head we will find redness of the eyes, intolerance of light and
sound, and, during the paroxysms, violent deliriOfm.

By close examination we will find cases of angina pectoris, palpi-
tation of the heart, hysteria, flatulence, colic, dyspepsia, gastralgia,
pyrosis, hysteralgia, dysmenorrhcea, and supposed cases of phrenitis,
arachnitis, hepatitis and pneumonia, depending entirely upon irrita-

84 Irritation of the Spinal Marrow, fyc. [Fberuary,

tion of the spinal marrow and ganglia of the sympathetic nerve ; and
I would add, as I have found them, supposed cases of rheumatism,
white-swelling and gravel,

I make it an invariable rule, whenever called to a patient, to ex-
amine the spine as carefully as I would the pulse. I care not what
the disease is, or what it may be called by others, this I never neglect.

Case 1. Intermittent Fever. Some, I have no doubt, will be ra-
ther astonished to find, among cases dependent upon spinal irritation,
a case of intermittent fever. But to others (those who have attend-
ed the Lectures of Dr. Ford, of the Georgia Medical College) it
will not be a matter of so great astonishment. However, I believe
the doctrine : for it was satisfactorily proven by Dr. F. in his lec-
tures, and my own experience has also established it-^at least in my
view. I will give only one case, though I could give many, both of
remittent and intermittent fevers.

S. B., aet. 10, was confined with intermittent fever. I was sent
for to see him, as soon as I could. In an hour or two I saw him.
The chill had passed off, and the fever pretty high. Among other
symptoms, found the dorsal vertebra? tender. Prescribed a purge of
pills, sinapism to spine, and left quinine to be given when exacerba-
tion had abated. After the pills had operated, and the sinapism had
irritated the skin, the patient felt so much better that the parents were
induced to postpone the administration of the quinine. He chilled
no more, and recovered without the aid of any other medicine.

Case 2. Miss N. S., aet. 14, had been attacked, about fifteen
months previously to my being called in, with intermittent fever.
Since then she had been afflicted with what she called "bad spells,'9
during which she would fancy she saw ghosts, witches and hobgob-
lins f She would have nine or ten of these "spells" everyday.
When first taken, her face would become very red when the paroxysm
was on ; but towards the last, her face would be very pale. During
the paroxysm, she could not speak, nor work at her sewing or knit-
ting; she would think old witches were throwing ashes at her!
though when the paroxysm was off, she said she knew it was all im-
aginary.

Application had been made to four different physicians, and she
had taken medicine for twelve months, but was not relieved. When
her mother spoke to me about her situation, I remarked I could cure
her but she refused to take any medicine, as she had taken so much

1847.] Irritation of the Spinal Marrow, 6fc. 85

and found no relief. As I did not wish her to take much internally,
she agreed to place herself under my care. As she had had intermit-
tent fever, I felt satisfied the disease was owing to spinal irritation,
and in tiiis I was not mistaken. The lower dorsal and the lumbar
vertebras were found to be tender. I g've her a dose of purgative
medicine, and applied ung. tart, antim. to the spine. So soon as
pustules made their appearance, she was cured. It has been about
two years, and she has felt no symptoms of the disease since and
she says she is not now, as formerly, haunted by witches and ghosts!

Case 3. I was called to see, in great haste, a negro man belong-
ing to D. H., Esq. He had got wet a few days before, and when
taken, the pains in his breast were so violent as to cause him to
scream out loud enough to be heard several- hundred yards. I found
him in this situation : violent pains throughout the chest especially
through the mediastinum: tongue but slightly furred; and pulse
nearly natural. The pains were intermittent, and he was compelled
to lie on his back for he said it would kill kirn to lie in any other
situation, or to move. His young master, who was then studying
medicine, accompanied me to see him. After asking the boy a few
questions, the young gentleman asked me what I thought was the
disease. I remarked, it was dependent upon irritation of the spinal
marrow. We turned the boy on his side, as easily as could be done,
and the cervical and dorsal vertebrae were very tender. The least
pressure would cause insupportable pain. I prescribed a dose of pur-
gative pills, and a blister to the spine. This was at night. On next
morning, he was walking about, and nothing else was done, only he
was told to take a dose of salts.

Case 4. I was requested by Mr. S., to visit his wife, whom he
said had been afflicted with Dyspepsia, for nearly three years. I
visited her, and she informed me of her situation. About three years,
previously, she was taken with a violent pain in the stomach, flatu-
lence, pyrosis, and the general symptoms of dyspepsia. She had
taken medicine from several physicians, who considered her disease
dyspepsia, but she found no relief, in fact, she said she got worse.
She now, complained of pain in the right hypochondrium. Upon
enquiry, I found the pains in the stomach and liver, were intermit-
tent. Upon examination, the cervical and upper dorsal vertebrae
were found to be very tender. I then informed her, she had neither
dyspepsia nor inflammation of the liver ! but a!l her suffering was
owing to irritation of the spinal marrow and ganglia of ihe sympa-

80 Irritation of the Spinal Marrow, $c. [February,

thetic nerve. I prescribed the compound tincture of Iodine internal-
ly, and the spine to be kept irritated with ointment, composed as
follows :

Iodide Potassium, 3i.

Iodine, 3i.

Ungt. Hydrarg. Fort., . . . . . ss.

In a few weeks she was well.

Case 5. Numbness of I he arm and hand. I was requested by a
lady to give her something to cure her arm, which she said had been
numb for several days, her fingers felt enlarged. I examined the
spine, and found the cervical vertebrae tender. Prescribed purge,
and blister upon the back of the neck ; which cured her.

Case 6. Irritation of the dorsal and lumbar vertebrate, simula-
ting cystitis, nephritis, peritonitis, and enteritis. I was requested to
visit Mrs. Tongue healthy appearance; pulse natural ; she

complained of pain in the fundus of the bladder, and the corres-
ponding portion of the abdomen was very tender. The desire to
urinate was frequent, but the discharge was small, attended with
pain, and of a deep red color, on several occasions it was tinged with
blood. The lumbar vertebra? were tender. Gave purge, and applied
a blister to the spine. In a day or two she considered herself well,
and went to church, and on her return she got her feet wet. On
next day, the pain in the bladder returned, with pains in the abdo-
men and kidneys. The abdomen was slightly swollen the desire to
urinate was frequent the quantity small, and on several occasions
tinged with blood. The dorsal and lumbar vertebrae were tender.
Gave purge ; applied blister to spine. This seemed to give but little
relief. I then prescribed ext. stramonium : she was soon narcotised
with it, but no relief. I then narcotised her with acetate of morphine.
No relief yet. The bowels now became very painful, the abdomen
tympanitic and tender; the stools were frequent, painful, mucous
and tinged with blood. From all these circumstances, I was induced
to believe inflammation existed ; but in this I was mistaken. The
swelling of the abdomen diminished in half an hour, under the appli-
cation of warm fomentations. I reapplied the blister to the spine,
and as the patient said she would die before she would take any
other medicine I consented for her to take a dose of salts ! After
the blister drew, and the salts operated, all the pain and soreness of
the abdomen, kidney and bladder, were relieved. I then used ext.
belladonna, until she was narcotised. Her recovery was then rapid.

1847.] Irritation of the Spinal Marrow, <fyc. 87

Case 7. Mrs. , was attacked with neuralgia of the scalp.

Cervical vertebrae tender. Prescribed, purge, blister to the tender
vertebrae, and extracts of belladona and stramonium in combination,
until vertigo was produced. She did not recover, until she had been
narcotised three times. The narcotics were given in doses of one-
quarter of a grain each every three hours, until vertigo was produced,
at which time they were to be discontinued, but to be resumed so
soon as this disappeared.

Case 8. Hysteria, numbness in extremities, flatulence, <$fc. The
patient, Mrs. D., was confined to her bed with hysteria. During the
day she complained of flatulence, and she was very much annoyed
by a creeping sensation in the right groin ; this would continue du-
ring the morning, but in the afternoon would cease, when she would
have pain in the right hypochondriac region, or in the right leg.
The tongue was slightly furred, with disagreeable taste in the mouth ;
pulse small, quick and weak ; bowels constipated ; pain in the head ;
the desire to urinate somewhat frequent ; but the quantity was small,
(and sometimes only a few drops would be discharged,) which was
attended with severe burning heat, and some pain. When the med-
icine operated upon the bowels, the same sensations attended the
discharges. At night she would have a hysterical paroxysm. She
had on a former occasion been attacked with (as she was told by a
physician,) " the gravel" For three or four years she had been sub-
ject to numbness and obtuse pain in the shoulders, arms and legs.
On several occasions, she lost the use of her right arm. Owing to
having pain in the right hypochondrium and right shoulder, she was
said to have the "liver complaint."

It was with difficulty I induced her to abandon her notions of
being afflicted with "gravel" and "liver complaint." Upon exam-
ination, I found the cervical and lumbar vertebrae slightly tender.
I prescribed a purge, and a blister to be applied to the tender por-
tions of the spine laudanum and ether, to be given on approach of
paroxysm. After the blister drew, she had no more paroxysms, but
the creeping sensation in the groin, pain in the right hypochondriac
region, and the disagreeable sensations attending the discharge of
urine and feces remained. To keep the bowels open, gave pil. hydr.
The patient was then put upon the use of the comp. tinct. of iodine
internally, and after the blister healed, to keep the spine irritated
with the ointment, according to formulary in case 4. With the use
of these remedies she began to improve, until the creeping in the

88 Irritation of the Spinal Marrow, <SfC [February,

groin, pain in the side returned only on every Monday. In every
other respect, she had entirely recovered. To prevent the periodical
occurrence of these symptoms, sulph. quinine, in doses of 5 grains
three times a day, was given. This had the desired effect. She is
now well.

Case 9. I was called out at night to attend a negro woman, who
it was said was in labor. Soon after my arrival, I found the pains
occurring frequent and regular; and the old woman said the child
would be born in a few minutes. After a close examination, I found
tbe pains to be false. I then examined the spine, and found the
lumbar vertebrae very tender. She was surprised, and would not
believe me, when I informed her she would not have a child in less
than two weeks which would be the time for delivery, according to
her reckoning. Gave purge, and applied blister to the lumbar ver-
tebrae. She recovered, and in about two weeks I delivered her of a
fine child.

Case 10. Mrs. W., about six months advanced in pregnancy,
complained of violent cramping pains in the stomach. They were
intermittent. The whole of the spine was very tender. Gave purge,
and applied a blister to the whole length of the spine. Laudanum,
30 drops every half-hour, until relieved. Under this treatment she
recovered.

Case 11. Mrs. H., set. about 50, complained of flatulence, colic,
numbness, prickling sensations, and dull pain in the shoulders and
extremities ; pain in the right hypochondriac region. She had been
under medical attention, on several occasions, for chronic hepatitis
which had now existed for twenty years! The whole length of the
spine was very tender. In order to dissipate her gloomy feelings, at
the thought of having the "liver complaint " as she was quite an in-
telligent old lady, I informed her of the true nature of her disease.

Mild laxatives, (Dewees's laxative pills.) comp. tincture iodine, and
the ointment according to formulary in case 4, to irritate the spine,
were prescribed. Under this treatment she had so rapidly recovered,
as to pronounce herself well. J5ut as the spine was yet some-
what tender, I requested her to continue the medicines a short time
longer.

Case 12. Mrs. E. F., the mother of two children, informed me,
while attending upon one of her children, that she had "sick spells"
very often, sometimes every day. When attacked, she would be
sick at the stomich, have swimming in the head, &c, and she

1847.] Natural History of the Alligator. 89

would be compelled to sit down, or she would fall. She also com-
plained o? pains in the right shoulder, arm, side, leg and foot. The
pains in the foot would he at times violent. She was also subject to
hysteria. At night she would be afflicted with nightmare. She had,
on a former occasion, when complaining of the same kind of symp-
toms, been treated for hepatitis.

In a few days after she informed me of her situation, she was con-
fined to her bed. She was now entirely helpless, and was so tender
she would cry out if touched. The whole extent of the spine was
v-ery tender. I prescribed purgatives, and blister to be applied to the
spine. This treatment so far improved the disease, as to cause the
symptoms to be felt only in the afternoon. I then prescribed sulph.
quinine, 5 grains every three hours. Under this treatment she re-
covered.

Case 13. Mrs. F., aet. 28. When called to see this patient, she
informed me she had been afflicted with the "liver complaint" for
tea years. She had been under (he care of several physicians for
this disease, and her case was considered incurable. I found the
cervical and dorsal vertebras tender. Prescribed purgatives, and
blisters to spine under this treatment she recovered.

I have now extended this article to a greater length than I desired,
but I hope the reader will be compensated for the time consumed in
reading it. Many other cases of chronic hepatitis, nephritis, calculus,
&c, &c, could be given, but 1 will net take up more of the pages of
the Journal with them.

PART II. REVIEWS AND EXTRACTS.

ARTICLE VII.

Contributions to the Natural History of the Alligator, (Crocodilus
Mississippiensis,) with a Microscopic Addendum. By Bennet
Dowler, M. D. pp. 30. Reprinted from the New Orleans Medi-
cal and Surgical Journal, Nov. 1846.

Dr. Dowler is favorably known to the medical world as the author
of several original views in physiology. His interesting trains of
researches on " Febrile Caloricity," and on the "Post-mortem Con-
tractility of the muscles," have not failed to elicit the attention of

90 Natural History of the Alligator. [February,

the profession. In the pamphlet before us, the author proposes to
give us an outline of the Natural History of the great Saurian of
Louisiana. Physicians have always been foremost in the cultiva-
tion of the various departments of Natural History ; and we are
always gratified to observe that the minds of the most gifted are
generally directed towards these rich and interesting fields of inquiry.
On the present occasion we intend to pass in rapid review Dr. Dow-
ler's "Contributions to the Natural History of the Alligator;" and,
if it should be made apparent, that the author, in his zeal to expose
and correct the errors of others, has sometimes fallen into mistakes
and misapprehensions,it will not be considered as detracting materi-
ally from the value of his investigations. A long residence on the
coast of Georgia, has afforded me numerous opportunities of observ-
ing the habits of this curious reptile, and of making frequent exam-
inations and dissections of it.

Dr. Dowler remarks :

"That the Alligator is identical with the Crocodile, can scarcely
admit of a doubt. Even those naturalist, who have labored most to
establish a difference, have admitted directly or indirectly, that there
is none of a radical character. As this animal is, nevertheless, mod-
ified to some extent by climate, it may be advantageous to adopt
names characteristic of the same, or at least, of the locality where
this great Saurian is found as the Nilotic Crocodile, (crocodilus
JVilolicus), the Gangetic, (c. Gangeticus), the Mississippi, (c. Mis-
sissippiensis), and so on. This topographical nomenclature will, for
the present, leave the question of scientific classification open, as it
ought to be, until vague and contradictory descriptions shall be re-
placed by exact observations."

It is very obvious from the above, that Dr. D. considers our Alli-
gator to be specijically identical with the Nilotic and Gangetic
Crocodiles, as he designates the different names which naturalists
have bestowed upon them, as a mere "topographical nomenclature."
Nothing can be more clearly established in Herpetology, than that
the Alligators and Crocodiles constitute distinct species of reptiles.
Indeed, since the admirable researches of Cuvier, naturalists have
made separate genera or sub-genera of the Crocodiles, Alligators and
Gavials. That this classification is neither fanciful nor unfounded,
will be manifest to any one who will compare the slender elongated
muzzle of the Gavials, with the broad obtuse muzzle of the Alliga-
tors. The specific distinctions are, of course, less marked, but suffi-
ciently characteristic and constant to constitute distinct species.

1947.] Natural History of the Alligator. 91

Accordingly, modern naturalists have established 6 species of true
Crocodiles, 6 species of Alligators, and 2 species of Gavials. These
specific distinctions will be pointed cut more particularly when treat-
ing of the dental system of this reptile.

Prof. J. E, Holbrook notes the following characters as peculiar to
our Alligator, (Alligator Mississippiensis,) each of which, I have veri-
fied by observation and comparison. "Nostrils separated from each
other by a long partition ; forehead divided by a short, prominent,
longitudinal carina ; four large tubercles along the neck, arranged
in rows on each side of the vertebral line." (Vide. North American
Herpetology by John Edwards Holbrook, M. D., vol. 2, p. 53.

Dr. Dowler gives the following description of the dental system of
the Alligator :

"The upper jaw is wider than the under, which it overlaps. The
latter has forty teeth, none of which are grinders, as asserted by
Professor Owen none are cutting or incisor teeth, as they are
described to be by Goldsmith. The teeth of the upper jaw are
similar in number and structure.

" The Cuvierian classification is based on the teeth, which this
author says, ' are for the Alligator, thirteen on each side of the upper
jaw. The fourth tooth, on each side of the under jaw, enters a hole
in the upper.'

"Professor Edwards, of Paris, in his work on Zoology, (p. 367)
characterises the Nilotic Crocodile by its dental organization, but in
the very same page, gives these identical characteristics, by which to
distinguish the Alligator. Both are recognised by the fourth tooth,
one on each side of the lower jaw, as entering sockets in the upper ;
an excellent example of a distinction without a difference, not unlike
Shakspeare's two lovers :

1 Two distincts, division none."

"Professor Owen, of London, is quoted in the British and Foreign
Medical Review, for January, 1846, as maintaining, in his recent
work on Odontography, that 'the Crocodile has as many as four
generations of molar teeth.1 BufTon's account of the teeth agrees with
Cuvier's. GcofFroy St. Hilaire, naturalist to the Egyptian Expedi-
tion, enumerates 36 in the upper, and 30 in the lower jaw, all of
which, according to his engraving, (pi. 2, croc, vulg.) are long and
conical. Now, the facts are these : in both jaws there are 80 teeth,
nearly half of these, that is 36 or 38, are short blunt teeth, rising but
little above the gum, wholly different from grinders never being
worn occupying the interspaces between the long conical teeth,
which latter amount to 42 or 41, and are round, white, polished,
tapering, salient, and project from the gum nearly an inch, usually
exceeding a quarter of an inch in diameter. As the lower jaw is less
expanded than the upper, its long teeth, 20 to 22 in number, are re-

92 Natural History of the Alligator. [February,

ceived, not only within the dental range of the upper jaw, but^ into
as many holes in the latter. Instead, therefore, of two long teeth
fitting into two sockets, there are never less than 20 long teeth fitting
into as many sockets in the roof of the mouth an arrangement which
totally prevents the possibility of using grinders, did any really exist.
Moreover the teeth of the two jaws are not opposite each other.
Hence, grinders would be wholly useless. It is evident that these,
as well as all the other naturalists whose works I have seen, are
wrong in every essential particular relating to the dental apparatus.
"Both sets of long, pointed teeth, penetrate plank and wood of all
kinds, unless extremely hard. The crushing power of the jaws is
vertical, not lateral or grinding. Both jaws present, along their
dental or alveolar margins, an undulating or curving line, which, in
the Nilotic Crocodile, seems more salient, if I may judge from the
engravings of St. Hilaire, and a few others. The teeth correspond
to this undulation, as does one jaw to the other. The general bear-
ing of this line is several degrees above the horizon, commencing at
the muzzle, and running backward to the posterior angle of the mouth.
The form and situation of the dental organs, together with the osteol-
ogical configuration of the jaws, render grinding operations quite
impossible. The animals found in the stomachs of Alligators, exam-
ples of which will be given, show that their prey is killed by pene-
trating bayonet-like wounds, and are swallowed without mastication.
The crushing and prehensory power of the jaws and teeth, is as
remarkable as it is unquestionable."

The above paragraphs afford a curious and instructive illustration
of the confusion produced by the assumption of erroneous premises,
and of the false deductions which flow therefrom. As we have pre-
viously shown, Dr. Dowler sets out with the erroneous assumption
that the Crocodile and the Alligator are specifically identical, and he
forthwith detects a number of differences between the specimens of
the Alligator before him, and the descriptions of the African Croco-
diles given by distinguished naturalists. Dr. D. is correct in his
descriptions, and so also are Geoffrey St. Hilaire and Cuvier: but
they are describing different rejrtiles. Justice demands that some
notice should be taken of the charge which is brought against Prof.
Owen, of London, viz : that he asserts that the Crocodile is furnished
with grinders. It would, indeed, have been remarkable, that so ac-
curate and distinguished an observer, who is justly esteemed the
highest living authority in comparative anatomy, should have com-
mitted such an obvious blunder. The accusation is based upon the
following quotation from the British and Foreign Medical Review,
viz : " the Crocodile has as many as four generations of molar teeth."
From a careful examination of Prof. Owen's work on Odontography,

1847.] Natural History of the Alligator. 93

I have been able to discover but one passage relating to this point.
It is as follows: " In the Crocodiles there are three and sometimes
four generations of teeth, sheathed one within the other, contained
in the same socket." (Owen's Odontography, or a Treatise on the
Comparative Anat. of the Teeth, p. 187; London, 1340-45.) Here
no mention is made of molar teeth. But admitting that the term was
applied to the dental system of the Crocodile, it by no means follows
that Prof. Owen asserted that this reptile is furnished with grinders.
Naturalists frequently speak of the molar teeth of the feline and other
carnivorous animals, and yet, " the crushing power of the jaws is ver-
tical, not lateral or grinding." Dr. D. has evidently confounded a
dental nomenclature derived from the situation of the teeth, with one
based upon the function of these organs. The teeth situated behind
the fourth or large canine tooth, and corresponding in position with
the true grinders of many mammalia, might be appropriately called
molar by way of distinction. That Prof. Owen is accurately inform-
ed in regard to the dental apparatus of these reptiles, will be made
apparent in the sequel.*

Dr. Dowler proceeds :

"To classify the crocodilian family by its dental organization, is
altogether erroneous, so long as the shape, situation, arrangement
and number of the teeth are not as yet ascertained. Scarcely any
two authors agree in so simple a matter as the number of the teeth.
Goldsmith says that there are 27 in the upper and 15 in the lower
jaw, and the authors already quoted, all give different aggregates."

Our author is very much mistaken in supposing that very little is
known of the dental organization of these reptiles. The illustrious
Cuvier did not fail to direct the energies of his gigantic mind to this
point. He examined 60 individuals of both sexes, from 12 to 15 feet
long, to those just from the egg. (Vide. Recherches sur les Osse-
mens Fossiles, 4th Ed. in 10 vols. Svo. ; Paris, 1836, vol.9, p. 42.)

* Since the above was written, the subjoined paragraph in the work of Prof,

Owen has attracted my attention. It was doubtless from this passage, that Dr.

Dowler gathered the erroneous inference, that Prof O. asserted that the Crocodile

'. us or grinders. This will be apparent to the reader, from a perusal

of the whole paragraph.

Prof Owen is treating of the succession of teeth in the mammalia. The follow-
in? extract relates to the cases in which the gemmiparous process allows the
newly-formed teeth to come up by the side of the parents, as in the case of the
2d and 3d true molars of man:

" In this successive germ-production, we find repeated the muciparous proper-
ty ot the dental matrix: of the crocodile; but the concomitant growth of the jaw
allows the 2d, 3d, and sometimes even 4th generation of true molars to i
and come in place side by side. En the unguirulatc and most of the ungulate
species of the placental division of the mammalian class, the QS&iparous repro-

94 Natural History of the Alligator. [February,

Prof. Owen observes that, the ancient writers on Natural History
appear to have been much struck with the great number of teeth in
the Crocodile ; and their descriptions were exaggerated to the tone
of the impressions thus produced. According to Achilles Tatius, the
Crocodile has as many teeth as there are days in the year : Alkazuin
assigns it 200 teeth ; Abuhamed was more reasonable and allowed
80. How many teeth a Crocodile may develop through the whole
course of its life in uninterrupted succession will never perhaps be
determined they, then, would doubtless far exceed in number the
liberal allowance of Tatius; but with regard to those teeth which
are in use in the jaws at any given time, the number is now well
established. The Crocodile of the Nile (Crocodilus vulgaris) has
if if = 6S >' tiiat f the West Indies (C. acutus) has if if =- 66 ; our
Alligator (Alligator lucius, or A. Mississippiensis has |f |f = 80 ; the
great Gavial (Gavialis gangeticus) has |f ff = 118. Thus the dif-
ferent species and genera of Crocodiles differ from each other in the
number of teelh. and also the individuals differ within small limits.
(Vide. Owcns's Odontography, pp. 285, 286.) Indeed, the best and
most readily recognizable characters by which the existing Crocodil-
ians are grouped in appropriate genera, are derived from modifica-
tions of the dental system. In the Caimans (Genus Alligator), the
teeth vary in number from if if = 72 to || || = 88 : the 4th tooth
of the lower jaw, or canine, is received into a cavity of the palatal
surface of the upper jaw, where it is concealed when the mouth is
shut ; in old individuals the upper jaw is perforated by these inferior
canines, and the fossa? are converted into foramina. In the Croco-
diles (Genus Crocodilus), the 1st tooth in the lower jaw perforates the
palatal process of the intermaxillary bone when the mouth is closed ;
the 4th tooth of the lower jaw is received into a notch excavated in
the side of the alveolar border of the upper jaw, and is visible exter-

duction of horizontally-succeeding teeth stops at the 3d generation ; in other
words, they have not more than 3 true molars on each side of the upper and un-
der jaws. In the marsupial series the same process extends to a 4th generation
of true or horizontally-succeeding molars; and in most of the species, the 4th
true molars are in use and place at the same time; but in the kangaroos, the
anterior ones are shed before the posterior ones are developed. This successive
decadence is still more characteristic in the grinding teeth of the elephant, which
consists exclusively of true molars." (Vide. Owen's Odontography, p. 308.)

It is obvious from the connection, that Prof. Owen merely compares or points
out the analogy between the successive reproduction of teeth in the mammalia
and the crocodile. The '; true molars' alluded to, have reference to the former
class of animals, and not to the latter. This is clear from the fact, that he'points
out distinctly a remarkable difference in the mode of succession of the teeth in
the two classes. In the crocodilians, the teeth succeed each other vertically,
whereas the "true molars" of mammalia succeed each other horizontally, as is
apparent from the paragraph quoted.

1847.]

Natural History of the Alligator.

95

nally when the mouth is closed. In the two preceding genera the
alveolar borders of the jaws have an uneven or wavy contour and the
teeth are of unequal size. In the Gavials (Genus Gavialis), the
teeth are nearly equal in size and similar in form in both jaws, and
the 1st as well as the 4th tooth in the lower jaw, passes into a groove
in the margin of the upper jaw, when the mouth is closed. (Owen,
op. cit.,p. 280.) Prof. Owen remarks that, "Id all the genera of
Crocodilians the teeth of the upper and lower jaws are so placed that
their points, instead of meeting, interlock." (Vide. p. 287.) This
distinguished comparative anatomist cannot, therefore, be accused of
maintaining that these reptiles are furnished with grinders, for the
dental arrangements which he describes and delineates with so much
accuracy, " render grinding operations quite impossible."

To proceed with a more particular account of the dental apparatus
of these remarkable reptiles. In all the species of each genus, the
teeth are present in the intermaxillary, superior maxillary and pre-
mandibular bones, and are confined to these bones, the palate being
edentulous. The teeth are relatively larger and stronger in the Al-
ligators and Crocodiles, than in the Gavials ; they are almost always
conical, and slightly recurved ; the crown has generally a sharp
border before and behind, and it is longitudinally striated. (Vide.
Owen, op. cit., p. 287.) The subjoined formulae, taken from Prof.
Owen's work, will exhibit the dental arrangement of each species.

Alligator Mississippiensis,

" palpebrosus,

" sclerops,
" cynocephalus,
" trigonatus,
" niger,

Crocodilus rhombifer,
11 Gravesii,
" vulgaris,
" biporcafus,
" acutus,
" intermedins,

Gavialis gangcticus,
Schlegelii.

20 CO
20 i!0
19-19
2121
1913
1318
19-19
18 IS
20 20
2121
IS IS
19-19

7^ = 64.

= 80.
= 80.
= 72.
= 74.
= 82.
= 74.

1, 3,4, 11, 12, 13

2, 3, 7, 8

largest.

largest.

1,4

4,5.10 , .

largest.

3,4, 9

a,

-= largest

6. 7

largest.

66.

15-

18 It
15 lc
'9~'9 no

18 18 or 19-19

4,5, 11,12

3, 4, 5, 9 , ,

i;ttti2 = larsest-

75 = largest.

' largest.

= largest.

i:

1818
1515
18-18

15

66.

1,4, II

z 66 or 68
= largest.

2,3, 8. 9
1,4

largest.

4, 10

4

jg^ = 06. ~^ = largest.

= 118,

(Owen, pp. 287, 238, 289 )

96 Natural History of the Alligator. [February,

From the period of exclusion from (he egg the teeth of the Croco-
dile succeed each other in the vertical direction ; some are added
from behind forwards like the true molars in Mammalia. It follows,
therefore, that the number of teeth in the Crocodile is as great when
the animal first sees the light as when it has acquired its full size ;
and owing to the rapidity of their succession, the cavity at the base
of the fully-formed tooth is never consolidated. (Vide. Owen, op.
cit, pp. 294, 295.) This fact gives additional value to the dental
system, as a basis of classification in the Crocodilian family ;; since
the distinctions are equally recognizable at all periods of life, an ad-
vantage which does not obtain in the mammalia.

We have thus endeavored to show, that Dr. Dowler has committed
a great error in assuming the specific identity of the Alligator and the
Crocodile, the differences being so marked, that modern naturalists
have made three distinct genera out of what was formerly termed
Crocodilus. We have also shown, that there is a striking difference
in the dental organization, as well as the general appearance of the
several genera and species of this family of reptiles ; and that Geof-
froy St. Hiliare, Cuvier, Edwards, Owen, and other distinguished
naturalists were accurate observers of nature. A mere glance at the
plates given by Cuvier in his Ossemens Fossiles, and by Frof. Owen
in his magnificent work on Odontography (Plates 75 et 75 A.), is
sufficient to show that the genera are well-characterized and to place
misapprehension out of the question.

There can be no doubt that Dr. Dowler is correct in attributing to
Herodotus most of the errors concerning the Natural History of the
Crocodile. But in the exercise of wholesome and legitimate cen-
sorship, he has sometimes overstepped the bounds of strict justice
and propriety. Thus, he says :

"In the huge folios of Natural History, produced by the French
expedition into Egypt, there is an elaborate history of the Crocodile,
and which might be entitled, A Defence of the Errors of Hero-
dotus ; by GeofTroy St. Hilaire, naturalist to the expedition. It is
doubtful whether any of the savans of the expedition saw or examined
a Crocodile in Egypt. Certain it is that they have added nothing
original to its natural history. St. Hilaire appears to have picked
up all his information at the fisheries, from people more likely to
deceive him than otherwise. "

This is rather a serious charge to bring against so eminent a nat-
uralist as M. GeoffVoy St- Hilaire. It is well known that he made a
number of accurate dissections of the Egyptian Crocodile, and that
he sent many specimens to Paris.

1817.] Natural History of the Alligator. 97

Again, Dr. D. remarks:

11 This able physiologist, lately numbered with the mighty dead,
mny have excelled his predecessors in certain branches of natural
history, especially that portion so peculiarly his own, relating to Mon-
strosity, or the deviations of nature in the animal kingdom, which he
has reduced, in a great degree, to order, regularity and harmony.
With all his reverence for Herodotus, he sometimes differs from the
old Greek, but never when the latter is wrong, and nearly always
when he is right. Herodotus says, the Crocodile is truly amphibi-
ous; no, says St. Hilaire, not kua veritable amphibieS And how
does the French Herodotus prove this? Answer, ye who import
facts, philosophy, and logic from Pari* the modern Athens! The
Crocodile is not a true amphibinm. Hence, says he. it is in a false
position among animals! It is unsuited by nature either to live in
the air or in the water! Hence, it is never satisfied, and is always
restless; and this, says the great naturalist of the expedition, is the
reason why the Crocodile is always ferocious, always cruel ! And
this is the argument of one of the principal savans, whose works,
otherwise very learned and valuable, have on the title pn^cs the fol-
lowing words: 4 Public par les or dres de sa Majeste L'Empereur
Napoleon. Le Grand.'

"Herodotus satisfied St. Hilaire, and St. Hilaire has satisfied the
later naturalists, who continue to copy the blunders of the former and
the latter, occasionally adding some on their own account, as will be
seen hereafter. These errors have increased, are increasing, and
ought to be checked, or rather, consigned to oblivion."

There we have another illustration of the misapprehension grow-
ing out of the want of a correct appreciation of the meaning of the
terms used. Strictly speaking, amphibious animals in modern zoolo-
gy, are such as are capable of living exclusively either on land or in
water: that is, such as possess organs enabling them to breathe both
elements, or are furnished with gills and lungs conjointly. The Al-
ligator certainly docs not come under this category ; for it breathes
air exclusively, and would perish if submerged a sufficient length of
time. There is, however, a small family of perennibrenchiate rep-
tiles which have lungs lijse the batrachians, "so that they may bo
considered," as Cuvier observes, "the only vertebrate animals
which are truly amphibious." (Animal Kingdom. Amer. Trans.
New York, 1831, vol. 2, p. 83.) The Siren lacerfina which inhabits
the Southern States, is a reptile belonging to this family. "The
simultaneous existence and action of the hrae.ehir.l tufts and of the
lungs in these animals, are as incontestable as any one of the most
indubitable facts presented to us in natural history." (Cuvier.) It
is very obvious, therefore, that the Crocodile is not "un veritable

7

98 Natural History of the Alligator. [February,

amphibie" ; and, consequently; the French savant is right, and Her-
odotus and Dr. Dowlcr are wrong.

Our author proceeds to give a minute and correct account of the
tongue of the Alligator.

" Herodotus declared the Crocodile could move the upper jaw only.
Pliny copied the statement. ' The Crocodile only moveth the upper
jaw or mandible, wherewith he biteth hard. (Holland's Pliny b.
VIII.) St. Hilaire is much embarrassed with this statement, which
he does not fully admit, and which he tries to explain in a very un*
satisfactory way.

"Herodotus denied a tongue to the Crocodile. Pliny says, 'the
river Nilus nourishes the Crocodile, a venomous creature, as danger-
ous upon water as upon land. This beast alone, of all that keep the
land, hath no use of a tongue unum hoc animal terrestre lingua usu
caret.' (Lib. VIII.) Scarcely dissenting from Herodotus, St. Hilaire
says that the Crocodile seems to have no tongue. The Professor of
Natural History to the Royal College of Henry IV, H. Milne Ed-
wards, in his new work EJemens de la Zoologie, says that the tongue
is indistinct Kpeu distincJe /'

"The tongue at its tip, including its outer third with its frenum is
pale, thin, flabby, wrinkled and adherent underneath, along its whole
width, appearing to have but little motion. It is truly tongue-tied.
The middle third becomes massive, and begins to assume a roseate
hue. The base or inner third is enormously developed, being thick,
wide and strong, filling the mouth, and being moveable upward and
backward. When the mouth is forcibly opened, even to the greatest
extent, the posterior portion of the tongue is thrown up against the
roof of the mouth, just before the palatine arches, so as to act as a
valve, completely closing the passage to the pharynx, presenting from
one angle of the mouth to the other internally, an even horizontal
line. This arrangement must completely exclude water and the like
from entering the posterior fauces a wise provision of nature, be-
cause, having no lips, the water must always enter the mouth, when
the animal is in its favorite element. It is very seldom that this
valve falls, even when the mouth is widely opened for a long period,
as an hour or more. This pressure I have often overcome, with a
slight force, when passing the thermometer and food into the poste-
rior fauces and gullet. The upper surface or dorsum of the tongue
is rough, from large papillary elevations, which are less developed at
the tip, but larger or redder towards the base, where, also, the salivary
secretion begins first to show iiself, but the isthmus of the palate, and
the posterior fauces only, are well supplied with that fluid. The roof
of the mouth is white, dotted over with a few dark spots, rough, firm,
almost leather. like, and almost dry, except near the velum or palate,
where it is lubricated with mucosity."

Since the commencement of the present century, no naturalist of
any note has ever believed that the crocodile could move the upper

1847.] Natural History of the Alligator. 99

jaw. The ancient error seems to have originated from the circum-
stance that the lower jaw continues hehind the cranium; the upper
one thus appears to be movable, although it only moves with the en-
tire head. As regards the tongue of the Alligator, Prof. Holbrook
has given a very clear and accurate description of this organ, which
agrees with that of Dr. Dowler in a remarkable manner. He says
that, " Having no prehcnsible organs but the mouth and the strong
teeth with which they seize their prey, drag and retain it under wa-
ter, and breathing as they do, only atmospheric air, and with lungs,
it follows that they might soon be suffocated, when thus submerged,
as their struggling prey. A curious arrangement of the soft palate
prevents this ; it hangs down to meet a broad cartilaginous plate that
projects upwards from the lingual bone, so as to close completely the
fauces, (in which the trachea is placed) when the mouth is widely
opened, and effectually prevents the introduction of water to the
lungs, which would cause the death of the animal." (Herpetology,
vol. 2, p. 57.)

The following extract is curious as well as characteristic :

" Herodotus says, that insects (jBfeXXa, hirudo,) or, as the translators
have it, leeches, by getting into the Crocodile's mouth, suck its blood,
and it dies exhausted. In good faith, he naively relates, that the
Trochilus is the only animal that lives in peace with the Crocodile,
into whose mouth it is in the habit of going to pick out these insects
in consideration of this service, the grateful Crocodile never injures
the Trochilus. St. Ililaire believed, nay proved this story, if we are
to credit the Royal Professor of Natural History, in the College of
Henry IV, at Paris. He says in his Zoology (1837), That the
enemies which the Crocodile fears are feeble insects; but, singular
thing! little birds go to deliver him from this plague, and entering
his mouth without fear, destroy these insects. 4 Cefait, observe par
Herodote et ensuite traite de fable, a tie confirme de nos jours par M,
Geoffroy Salute Hilaire qui accompagna VEmpereur en Egypte.
Cest vne espece de pluvier qui rend au Crocodile du Nil ce service
interesse, et aux Antilles le todier a dcs habitudes analogues/' (p.
367). A modern sailor, who, returning home, told his mother that
in his travels he had seen flying fish, was reproached for telling a
falsehood, whereupon he said, that one day in drawing up his anchor
in the Red sea, he brought up one of the wheels of Pharaoh's chariot,
a statement which his mother admitted without hesitation. Yerbum
uipienti.

" It is a pity to spoil so good a story one so honorable to the
politeness of the feathered race, and so creditable to the reptilian
character. An English Baronet, Sir G. Wilkinson, in his late
superb work on Egypt, (London, 1843,) avers that letches do not
abound in the Nile!1 :'

100 Natural History of the Alligator. [February,

I have frequently found leeches on our Alligators ; but have never
observed them in the mouths of these reptiles. Neither have I ob-
served them relieved by the feathered lace ; but it is well known, that
our cattle quietly permit the crow (Corvus americanus) to extract
the parasitic grubs from their backs. The Trochilus may do an
analogous service to the Nilotic Crocodile.

Dr. Dowler gives accurate descriptions of the eye and ear of the
Alligator, which accord generally with those given by Prof. Hol-
brook. Dr. D. judiciously observes that :

"Among the many fabulous accounts of this reptile, not the least
defammatory and false is that concerning its want of Sincerity. It
is said to be a hypocrite, and that its tears are false. Hear an old
poet :

'As cursed crocodile most cruelly can tole,

~\Vith truthless tears unto his death, the silly pitying soul/

" Fuller declares that ' the crocodile's Tears are never true, unless
forced by the influence of saffron.' I have seen the detestable juice
of tobacco tried, by a negro, who, spirted his saliva in its eyes, as
correctly as Boz could wish, but without producing any tears ; it only
enraged the animal an example worthy of the imitation of the great
Primate, concerning whose spitting Mr. Dickens has written so well.
An alligator has no deceit. If he hates you, he will hiss you to
your face."

In describing the feet of this reptile, our author has fallen into an
error in supposing that they have not been accurately described by
modern naturalists. He says :

" The Hands, feet, or' paws bear some resemblance to those of man
and of some birds. The forefeet have five ringers, of which the three
first or inner, have Ions: bird like claws; the two outer, none. The
hind feet have four fingers, the three first or inner of which have
strong, curved, tapering claws. There is a slight webbing between
the second and third, and a full one between the third and fourth
fingers of the fore feet, counting from within. The outer or little
finger of the hind legs, joins the next or ring finger, with a web for
half its length or one inch. Now whoever will take the trouble to
consult authors, will find nothing but confusion and contradiction on
this simple matter even by those who base their classifications on
the feet.

"In the London Encyclopedia of 1845, there is an incorrect en-
graving of the Alligator, representing all the toes completely webbed.
In the new Parisian editions of the works on Natural History, by
Lacepede, and by Prof. Edwards, not a vestige of webbing is seen
among the toes at all ! The Encyclopedia Americana says, all the
fingers or toes have claws/ 'Their feet,' says Cuvier, 'are only
semipalmatc,' None of these accounts are correct. The Skin has

1847.] Xatural History of the Alligator. , 101

numerous, longitudinal, transverse seams, dividing the integument
into square figures. Notwithstanding these seams or fissures, which
render the skin uneven, it is rather smooth, polished and not very
hard, except where the bony plates are found, that is upon i\e upper
part of the trunk."

Much of this confusion has arisen from confounding the Alligator
with other genera of Crocodilians, some of which as the Cavials
have the feet completely pal mated. Prof. Holbrook gives the follow-
ing description of the feet of our Alligator: ''There are 5 fingers,
the 2d and 3d, and 3d and 4th, slightly palmate ; the 3 internal only
are furnished with nails. The posterior extremities are nearly twice
the size of the anterior ; they are rounded and covered in the same
manner, but with larger plates. The tarsus is flattened and sustains
4 toes, the 3 external semipalmate, and the 3 internal armed with
nails." (Vide. Herpetology, vol. '2. pp. 55, 56.)

Dr. Dowler has given a very minute description of the integu-
mentary Plates of the Alligator, which he seems to have studied
carefully. He very justly ridicules the common opinion that "this
animal's hide is generally impenetrable to a leaden musket ball."
The bony plate which surmounts the cranium, will sometimes turn a
rifle ball when shot very obliquely, but it will usually penetrate any
other porttan of the animal. Accident led me to discover a curious
mode of managing a wounded Alligator. The animal had had its
spine broken in the middle of the dorsal region by a buckshot, and
was drawn out of the water by the tail. Wishing to dispatch my
victim, I endeavored to strike him over the head with a heavy stick ;
but he suddenly turned over, and the blow fell across his throat. He
was immediately thrown into convulsions. the feet were extended
and the toes expanded, and the animal remained apparentlv insensi-
ble for one or two minutes, and then gradually revived. Upon re-
peating the stroke, the same effect was produced, and I deliberatelv
cut his throat with a pocket-knife before he revived. Since then, I
have frequently resorted to this mode of stunning the Alligator, and
with invariable success. The trachea is probably the organ which is
most affected by the blow : a distressingly Buffocating sensation will
be produced by a comparatively Blight blow across the trachea of a
man below the larynx. To produce the full effect in the A!
the blow must be quite severe: t! ssion ifl only temporary,

soon passing off'.

When Alligators are wounded by a shot nnssing through the ab-
dominal viscera, I have several times known them to run out of the

102 % Natural History of the Alligator. [February,

water; apparently incommoded by the introduction of the fluid into
the abdominal cavity. As the diaphragm is merely rudimentary in
these reptiles, and as the abdominal muscles are the agents in the
respiratory movements, it is manifest that, under such circumstan-
ces, inspiration would be attended with the introduction of water into
the cavity of the pleura as well as the abdomen.

Dr. Dowler gives the following case cf poisoning in an Alligator :

" The following case, which may be fully relied on, shows that
Alligators do not bear herculian doses of physic : Mr. I., an educa-
ted gentleman, engaged in the study of medicine, living near Fort
Pike, in Louisiana, having observed in 1845, a recent "Alligator's
wallow," and having at the same time killed a snake, he opened its
abdomen, into which he inserted about three grains of strychnine,
carefully enveloped in several folds of letter paper, which, being pro-
perly secured, the snake was left for the Alligator, which, the next
day, was found dead, with its abdomen turned up. The snake had
disappeared. The Alligator had been poisoned."

He notices some remarkable peculiarities in the inflammatory pro-
cess as observed in these animals :

"I have examined several wounds which Alligators have received
during the conflict in which they were captured. The following is a
good example of Crocodilian hyperemia or inflammation : A torn
and contused wound, of two or three inches in length, between the
fingers, was tumefied, but without redness. Granulations appeared,
coated over with a dense transparent exudation, not flakey, but re-
sembling half coagulated albumen. On touching these, the animal
expressed great pain, withdrawing its limb and blowing loudly.
Another foot which had been bruised and swollen, without any
breach of the skin, presented extensive exfoliations of the cuticle,
leaving the true skin white. Some recent bruizes on the muzzle and
in the mouth, together with an incision which I made in the back
with the lancet, discharged a little thin, pale, scarlet colored blood.
The general hue incidental to inflammation in man, did not occur.
It was while analagous types of which do sometimes happen in
.ordinary practice, as in white swelling, phlegmasia dolens, and in
some fatal cases of glottidian and laryngeal hypersemia, in which the
submucous tissue is white, though swelled and infiltrated with lym-
phy, serous, and purulent matter. I have found the epiglottis a mere
sac, containing pus, though blanched. Hence, the necessity of
changing the technology of pathological anatomy. Inflammation is,
to some extent, a theoretical word, implying redness and so forth,
which may not be essential to its physical history, an evil which may
be greatly lessened by using words designating physical changes
only, as cohesion, softening, brittleness, induration, size, figure, vas-
cularis, injection, collapse, infiltration, and the like. In medicine,
words, [prescriptions], are things, which blacken the body with leech-

1317.] Natural History of the Alligator. 103

es, blanch it with venesections, or modify its organization with the
concentrated preparations of medical chemistry."

Our autfior has made some interesting observations on the Respi-
piration of the Alligator.

"The Crocodilian Respiration is very irregular; I might say,
sometimes altogether suspended for indefinite, or at least, very long
periods, when the animal is not disturbed. The method I have
adopted to prove this, is as perfect as could be desired. For several
days, two large Alligators were so placed in their cages, that the wa-
ter covered the mouth and nostrils completely. They lay perfectly
still. There was no movement of the walls of the trunk. The
least movement must have agitated the water. Every steamboat or
dray that came near, caused slight undulations or waves the Alli-
gators none, when left unmolested, which, however, seldom happened,
as persons frequently come near. On several occasions no interrup-
tions occurred for half an hour, or even an hour. When they are
annoyed, and wish to scold or frighten their enemies, they make
deep inspirations, inflating their bodies very largely this air they
discharge in low bass notes, or rather with a bellows hissing sound,
several times in a minute. There can scarcely be a doubt that one
inspiration supplies a stock of air for hours, if not for days. * * *
By maltreating the Alligator, its inspirations and expirations may be
produced at pleasure, but contrary to the chemical doctrine of pul-
monary combustion, animal heat is not thereby augmented, as will
be shown in the experiments on the temperature of this saurian."

In one instance in which I tormented an Alligator in his burrow
or hole, (which was deeply submerged,) by means of a long pole ;
at the end of two hour.'] he found it necessary to come to the surface
for breath ; which was done by seizing the pole with his teeth, and
following so gradually when it was withdrawn, that his approach was
unsuspected until his nose protruded. There can be no doubt that
temperature has a great deal to do with the time which respiration
can be suspended in reptiles. When the circulation is vigorous, the
necessity for receiving the air in the lungs is more urgent, than when
approaching the state of hybernation.

So far as we know, the researches of Dr. Dowler on the Circala'
lion in this animal, arc original. He says :

"The Circulation in this animal, after all my attempts to inves-
tigate it, appeared to me, at least, a perfect enigma. On several
occasions I explored different regions, wherein I expected to find
arterial pulsations, but without much . This seemed the

more surprising, as the axillae, flanks and limbs were sufficiently soft
and flexible, to induce the belief that the pulse mighl readily be de-
tected. The muscles of the limbs are small, cord-like, and pliable.

104 Natural History of the Alligator. [February,

Either from policy or politeness, the animals allowed the fullest ex-
aminations without resistance.

" I will give the details of one experiment : April 3d : noon ; air,
68; the axilla? and groins, each 65: a search for the pulse began,
and continued for three hours without intermission or disturbance.
The whole attention was directed to this one object. In the futfc
half hour I felt three strokes like those of an artery, in the part cor-
responding to the wrist. Similar pulsations were noticed in the hind
leg, near the foot, amounting in all, to fifteen in three hours none
were felt in other regions. When a stroke occurred, two or three
followed in as many minutes or less. The animals were now irri-
tated. The limb \*as held in my hand. They puffed and raged,
but no increased arterial action was perceived, fa their circulation
voluntary , paroxysmal, suspensible ? Does the blood flow equably,
without arterial impulsion, as in the veins and capillaries? Is not
the quantity of red blood, very small in this animal? Doctor, now
Professor Le Conte, of Georgia, in decapitating an Alligator, on
which he made some interesting experiments, recently, noticed that
"not more than two ounces of blood flowed from the wound. (Vide
N. York Jour. Med. Nov. 1846-)

I have several times observed thread-like worms in the blood which
flowed from the Alligator. They were quite obvious to the unassisted
eye, and continued to move about briskly until the eoagulum became
so firm as to interfere with their motions. Their presence might,
however, have been accidental.

With regard to the diet of these reptiles, Dr. D. says:

"A curious fact is mentioned by Mr. Audubon, and is directly in
point, though shocking to the tr-je disciples of Isaac Walton, namely
that the ornithologist was in the habit of killing Louisiana Alliga-
tors, for the purpose of getting fresh fish out of their stomachs. He
says, " in those 1 have killed, and I have killed a great many, when
opened to see the contents of the stomach, or take fresh fish out of
them, I have regularly found round masses of hard substance like
petrified wood. These masses appeared to be useful in the process
of digestion, like those found in the maws of some species of birds.
I have broken some of them with a hammer, and found them brittle
and as hard as stones, which they outwardly resemble. And as
neither our lakes, nor rivers, in the portion of the country I have
found them in, afford even a pebble as large as a common e^g, I have
not been able to conceive how they are procured by animals if posi-
tively they are stones, or by what power wood can become stone in
their stomachs " May not these masses be indurated clay? Are
not Alligators, to a certain extent, dirt-eaters? Dr. Lindsay informs
me that he has had many opportunities of knowing that these ani-
mals defecate large indurated masses, having all the physical proper-
ties of the mad banks in which thev make burrows or dens."

1847.] Natural History of 1ke Alligator . 10-")

I have almost invariably found these fragments of stones in the
stomachs of Alligators. They are evidently intended to assist in the
trituration of the food, in the muscular gizzard-like stomach. Their
teeth being nothing more than le organs, the food is swal-

lowed in an unmasticated condition; this process being effected in
the stomach as in birds. The muscles of the stomach arise from two
white, shining, tendino >>n opposite sides of the organ, as in

the rapacious birds. This organ has all the characters of a true giz-
zard, with the exception of the absence of an epithelium. That its
function is that of a real triturating organ, is obvious from the fact
that the stones are frequently worn by long attrition. I have ex-
tracted an Indian arrow-head of hornstone from the stomach of an
Alligator, which was highly polished. I do not think this saurian can
be considered a Geophagist, any more than the granivorous birds.
Our author continues :

u Many authors assert, that alligators cannot swallow under water.
In offering some facts to disprove this assumption, the sagacity of
these animals will be more or less illustrated. A gentleman, on
two occasions, watched alligators while catching sunfish, which were
swimming in shoals, in shallow water. The alligator placed his long
body at a suitable distance from the shore. As soon as the fish came
between him and the land, he curved his body. so that they could not
pass ; the tail was moored on land; the mouth was opened under
water, and brought so close to the shore, that the fish had no method
of escaping, but through the mouth, where they were entrapped.
Incidit in ScyUam, qui vult vitare Charybdin."

We have never had an opportunity of testing this question defini-
tively, but are disposed to accord with the opinion of Dr. Dowler,
from various observations.

We heartily concur in most of the following sentiments :

'The learned and the unlearned, seem never tired of telling about
crocodilian ferocity Cuvicr, among the rest. Professor Edwards,
in his new work on Zoology, says 'this animal is very ferocious and
dangerous, even toman.' So says the New London Encyclopaedia,
which gives a very dramatic story about an alligator, that invaded a
South American city, and in the presence of the governor, carried off,
in his capacious jaws, a living man! .Mrs. Trollope's story, which
follows, has become classical, and is quoted as authority. The scene
is laid in Louisiana, the hero is a. squatter. The poet is a lady: 'to-
wards day-break, the husband and father was awakened by a faint
cry, and looking up, beheld relies of three of his children scattered
over the floor, and an enormous crocodile, with several young ones
around her, occupied in devouring the remnants of their horrid meal.
He looked around for a weapon, but finding none, and aware that he

106 Natural History of the Alligator. [February,

could do nothing, he raised himself gently on his bed, and contrived
to crawl from thence through a window, hoping that his wife, whom
be left sleeping, might with the remaining children, rest undiscovered
till his return. He flew to the nearest neighbor, and besought his
aid ; in less than half an hour, two men returned with him, all three
armed; but, alas! they were too late! the wife and her two babes
lay mangled on their bloody bed.' (Six killed.) Captain Alexan-
der, a voluminous writer of travels, who visited Louisiana in 1831,
says, the people 'are obliged to keep a sharp look out lest their chil-
dren should be snapped up by alligators.' In Laeepede's Natural
History, just from the French press, an engraving is given, repre-
senting an alligator as swallowing a negro! This work, quotes M.
de la Coudreniere's account of the Louisiana crocodile, (Journal de
Physique, 1782), in which he sets forth, that this animal feeds on
men, particularly negroes * particulierement les negresJ and that
it roars as loud as a bull! Other writers say, that this animal pre-
fers negroes to all other kinds of diet. If this be true, the fondness
is mutual. A gentleman of New Orleans, once a planter, assures
me, that his slaves were in the habit of eating alligators, which, in-
variably made them sick. All his authority was insufficient to pre-
vent this practice. The sickness was so frequent and so peculiar,
that he could readily recognize it without difficulty. He gave eme-
tics for its cure. The suspected substance was always brought up ;
though the negroes always denied having eaten the same. The
fondness extends to dogs, which are often fed with the tail of this
animal, which is the choicest part. A physician, who once tasted
this animal's flesh, informed me that its flavour, in some degree, re-
sembled that offish, though unpalatable."

I have never known any ill effects to result from eating the flesh of
the Alligator. To me it is exceedingly insipid, and, indeed, requires
high seasoning to render it barely eatable. This animal is much
more timid than is usually supposed. Where they are unaccustomed
to man, they are apparently bold. Prof. Holbrook says that there is
no well authenticated instance in Carolina, of their having preyed
on man. (Vol. 2, p. 58.) J. Hamilton Couper, Esq., of Hopeton,
near Darien, Georgia, informs us that he has known a strong mastiff*
to whip an Alligator in three different instances. The dog would
raise himself in the water and spring directly upon the head of the
reptile. He also mentions the case of a negro, who, while asleep on
the banks of the St. Johns river in Florida, was seized by an Alliga-
tor and dragged into the water, but succeded in extricating himself
by plunging his fingers into the eyes of the animal. lie was bitten in
the thigh, and was so much injured as to remain a cripple for life. We
have heard of several analogous cases ; but they are very rare, and on
the whole, we are disposed to agree with Dr. D. when he snys :

1847.] Natural History of the Alligator. 107

"Admitting (hese statements as altogether true, it may be truly-
said, that there is scarcely an animal, wild or domestic, which has
committed so few injuries upon man a position worth illustrating,
as even twenty-two centuries cannot make a falsehood, true. Be-
sides, it is right to give the alligator, as well as the devil, his due."

Again, Dr. D. remarks :

"The absurd story, that alligators eat their own young, cannot be
believed for a moment. A gentleman informed me, that one of his
negroes having caught a young alligator, which whined like a young
puppy, the parent came towards the negro with a rapidity he had
never witnessed on other occasions a kind of jumping motion, which
caused the boy to run, after dropping his captive. I have been as-
assured, when danger is imminent, that very young alligators run
into the parent's mouth for safety. I have this statement from a
highly respectable physician."

The young reptiles would certainly fare badly if they should get
into the muscular stomach of the parent, amidst fragments of stones !
We have never heard that this is a custom among Alligators, but it
is a very universal opinion, that such is the practice among the ophi-
dian reptiles. Perhaps, the impression has arisen from the circum-
stance that several snakes are not oviparous* All the Crotalaloidea
are viviparous, that is, the eggs are hatched in the female, and the
young afterwards extruded. A gentlemon of high authority informs
us, that he saw a Water-snake killed, from which 52 young snakes
escaped by means of a rupture in the side! ?*lost likely they came
from the womb of the parent.

We close our hurried and imperfect notice of this pamphlet, with
the following extract in relation to the temperature of this saurian :

"The following experiments illustrative of the temperature of the
alligator, made with an accurate thermometer, which was tested by
freezing, boiling, etc.; and may be relied on. I have omitted to enu-
merate the duration and repetition of the experiments, for the sake of
brevity. The thermometer was seldom changed short often or fif-
teen minutes, and never until it appeared stationary. These experi-
ments, which might have been gieatly augmented, are, if I may
judge, quite sufficient to show, that Cuvier and his disciples greatly
err, when they assert, that this animal approaches the hot blooded
quadrupeds in temperature. It approximates not the hot blooded
animals, but the mercurial column of the thermometer!

" March 31st, noon air 02 ; one alligator in the groins, etc., 57
another 57 ; the water in which they reposed, about two inches
deep, gave 57. At 6, p. :.i., air 02 ; the Hanks, axilla;, under the
tongue, pharynx, and gullet, each 01 ; both the water in which their
abdomens rested, and oilier water near at hand, gave exactly the
same temperature. The day was cloudy.

103 Remarks on Gastrotomy. [February,

"April 1st, sunrise cloudy, humid, air 60 ; alligator's flanks,
etc , 59i3 ; gullnt nearly 60 ; a little water in which they lay, 59| ;
other water, near, 6(3. Xoon. air 03 ; alligators, and the water in
which they lay, 61 ; other water 62. At 5, p. M., air 67 ; alliga-
tor's 65 ; water two inches deep 64 ; other water 65.

'April 2d, sunrise air 59^; alligator's flanks and gullets, pos-
terior fauces, each 63 : the water in which they lay, and which was
now removed, gave 6S^ ; other water 50.

"April 3d, 7, a. m, the animals and their cages are quite dry :
air 64; groins, gullet, etc., each 63. Xoon, air 69 ; alligators
65. Sunset, air 64 ; alligators nearly 65, and dry.

"April 4th, 1. p. x. air 63; flanks" 60^; gullet 61. Sundown,
air, flanks and gullet, each 64 : animals dry.

" The following experiments are deemed relevant to this subject :
While engaged in making a most extensive series of thermometrical
observations, illustrative of the diurnal and annual temperature of the
Mississippi River, I have had a few opportunities of experimenting
on its fishes, immediately after they were taken out of the water an
example of which is here subjoined. 1S45, July 29, air at 5|, at 0,
and at 6h, a. M., 76 ; River 85^ . a fish (jierca) weighing about
three pounds, was (after crushing its brain) placed on a plank, in a
shade, with a thermometer thrust into the gullet. In two minutes,
the temperature was 81, in 3 m. 81, in 5 m. 80, (dead) 5 m. 80,
(body flexible) 10 m. 80, 10 m 79, 20 m. 79|, (now one hour
body somewhat rigid) 10 m. 79^ (universal rigidity) 10 m. 79|.
During these experiments, the air of the spot had raised to 83 ; and
had now, in one and a half hours, begun to communicate its caloric
to the fish."

In almost every respect, this is a most remarkable reptile. If the
heart and lun^s of an Alligator be removed together, and the latter
be inflated, the former will continue pulsating for 24 hours.

J. LeC.

Remarks on Gastrotomy. By. John P. Fof.d, of Nashville, Tenn.
Read before the Tennessee State Medical Society, and ordered to
be published. (from New-Orleans Med. and Surg. Journal.)

I do not so much expect to present new ideas on this subject as to
collect, and perchance arrange those which are scattered through the
pages of surgical writers. The importance of the operation will com-
mend itself to the mind of every medical man. on account of the diffi-
culty which often meets us in our efforts at diagnosis as well as the
dangerous tendency of those affections which we may think require its
adoption, and the capital character of the operation itself. There are
many affections which have, by common consent, been denominated

1847.] Remarks on Gastrolomy 109

epprobria medicorum ; and if any efforts on our pnrt can tend to
reduce the number of (hem or in any way lessen the certainty oftheir
character, they will be well applied. The consciousness of having
mitigated human suffering and prolonged human life, is the fullest
and most grateful reward incident to the practice of our profession.

The operation of gastrotomy for the delivery of the fcetus from the
mother's womb, when from any cause the effect cannot be produced
through the natural passage, is, according to the generally received
opinion, of ancient origin. That it is often successful is abundantly
attested by the numerously recorded cases scattered along the history
of surgery, and particularly in our medical periodicals of late years.
Dr. Churchill has collected the number of csesarean operations, and
finds 409 cases in which 223 mothers were saved.

Another class of diseases often calls for this operation, much more
commonly than the first mentioned, and on account of the nature of
the parts implicated, is much more successfully treated for while in
the caasarian section, not only the walls of the abdomen are penetra-
ted by the knife, but the no less important organ (the uterus also) ; in
hernia our incision only reaches the cavity of the abdomen, and not
ordinarily afflicting injury on other important viscera. Yet in some
instances, even here, the intestinal tube does not escape the surgeon's
cut, and success stands ready to crown his efforts.

In this, as well as the former class of affections, the operation is
only mentioned to show, that gastrotomy may be performed in num-
berless instances without being necessarily fatal. And we may not
reasonably say, that the operation for strangulated hernia, is not in
the full sense gastrotomy. To all practical intents, it is the same
with that operation properly called gastrotomy.

In the one as well as the other, the incision is made through the
skin, the cellular substance, tiie muscles, and peritoneum down to
the intestines. The best authorities as well as our own observations,
prove that the operation for strangulated hernia, if properly perform-
ed, and performed sufficiently early, is one of comparatively little
clanger.

It is an opinion supported by ancient and somewhat modern au-
thority in surgery, that in all operations involving the parieties of the
abdomen, peritoneal inflammation was more to be dreaded than any
other consequence. But it has been left to recent investigation, to
establish the fact, that such fears have been by our surgical fathers
greatly overrated. Travers, many years Hgo, and lately Dr. Gross,
have proved by their experiments, that if the wounds of the intes-
tines were properly attended to, inflammation of the peritoneum was
not regarded as of very serious importance if escape of foecal mat-
ter was prevented, peritonitis rarely supervened to a dangerous
extent while it cannot be denied, that wounds of any important
organs of our system are accompanied by danger to the sufferer;
the idea I would advance is, that peritoneal inflammation does not
now stand pre-eminently and necessarily fatal in wounds of the ab-

110 Remarks on Gasirolomy. [February,

doraen, whether inflicted extensively by accident or made more
neatly and sparingly by the surgeon's knife.

The diseases to which I would call the attention of the Society, as
justifying and even sometimes loudly demanding the operation of
gastrotomy for their relief, belong to that class which may be denomi-
nated obstructions of the intestinal tube from mechanical causes.
All along the track of medical record, for a long time back, may be
found here and there an isolated instance of daring surgery, which
has tended to relieve the patients in some cases or to establish in my
estimation, the practicability and justifiableness? of such an operation
in later days; especially since, by a careful collection of facts, we
may better understand the value of the operation and its modified
application to the various affections which we may be called to treat.

Invagination of the bowels is an afTeciion of exceeding interest
to the medical profession. However much medical science has ad-
vanced towards perfection in early days, to the present time, on many
points, this disease, then as now, has been looked on generally in the
light of a fatal one. Dr. Bigelow says, "internal strangulation, we
have reason to believe, is a fatal disease, except in rare instances, in
which a spontaneous restoration of the parts, under favorable circum-
stances, may have taken place." Dr. Dunglison says, in speaking of
intessusception, the only hope we can have is, that the invaginated
portion may be thrown of}', and a cure thus obtained ; although such
a result, it must be admitted, is extremely rare. Heberden says, in
such cases physicians should try to disarm death of some of its terrors:
and if they cannot make him quit his prey, they may still prevail to
have life taken away in the most merciful manner. Alluding to the
administration of opium as the only means of soothing the pangs of
death, Parr expresses the same opinion ; and in fact it is the tone of
almost all writers on the subject, that the disease is necessarily fatal
unless purgatives relieve. There are some exceptions to this remark,
as I shall show presently.

It is a matter of interest in the present inquiry to ascertain, if pos-
sible, the condition of the parts involving such serious consequences
as we see in this affection. The symptoms of invagination are pain
ia the bowels, costiveness without lever and without tenderness, at
first; often an elongated tumour may be felt in some part of the
abdomen ; as the case advances there appear disturbance of the circu-
lation, enlargement of the abdomen, and soon comes on those alarm-
ing symptoms, such as small rapid pulse, distress of countenance,
difficulty of respiration, vomiting of stercoraceous matter, cold
tremulous extremities, cool skin bathed in clammy sweat, which be-
coming more violent, loudly proclaim to the physician that death is
at hand. From the discovery, that gangrene has often affected the
bowels in intussusception, it was readily supposed that that was the
cause of death; and were the fact of its presence universally estab-
lished, it would tend greatly to lessen the chance of successful treat-
ment by an operation. But it can be shown, I think, that such is

1847.] Remarks on Gastrolomy. Ill

not alvvavs the case ; andwhen that condition of the bowels doe9
exist, it is only incidental. The autopsy of Mr. ' Legare, late
Attorney-General, showed the abdomen greatly distended, sigmoid
flexure of the lar^e intestine in such a state of distension that its
external circumference was it) one place 15 inches. It had a dusky
green color as if from commencing gangrene, but there seemed to be
nosoftning nor diminution of its natural polish.'"'

Lawrence in his work on Rupture says, " above the obstructed
part the bowels is found after death inflammed and greatly distend-
ed from the contracted part downward the bowel is smaller than
usual, and not inflamed." Mr. Stephens, in a work on Hernia, pub-
lished in London, in 18*29, gives the history of a case in which, on
post-mortem examination, the bowel was found doubled on itself, so
os to obstruct peristaltic action and the passage of its contents; yet
there was no stricture nor inflammation of the bowel or peritoneum.

Sir Charles Bell says, "the symptoms depend on the obstruction
to the descent of the contents of the bowels and not on the state of
the intestines of the sac," (speaking of Hernia), and says, "it is
shown by dissection, that distension and the consequent excitement
of the muscular coat produce those very symptoms which attend
strangulated hernia ; consequently all the symptoms will be rendered
milder, and the life prolonged, by the ease with which the stomach
ejects its surcharge. By the inverted action, and vomiting of ster-
coraceous matter, the distended canal is in a certain measure relieved.

It is within the recollection of several members of this society, that
such was pre-eminentlv the case with a patient, attended by my col-
Jeague, Dr. Winston, Mr. Craig's negro girl, of this neighborhood
it was a case of obstinate obstruction, in which all the symptoms
advanced to the last stage of distress and danger stercoraceous
matter was vomited freely, and at every discharge, which was ex-
ceedingly copious, the patient expressed herself greatly relieved.
No doubt the free evacuation of the bowels above the obstructed
point was one of the chief means of her ultimate recovery.

The details of the case I have not at band, nor would they be of
unusual interest, except to illustrate this point. A case occurred in
the practice of my friend, Dr. R. C. K. Martin, which was shown on
dissection to be a complete obstruction, by the passage of a knuckle
of the ilium through another bend of the same bowel. There was
great distension and no gangrene and of such character, may it be
seen, is the testimony o all who have made post-mortem examina-
tions in this disease ; not in every case of course, I would be under-
stood, but in enough to show, that although gangrene may exist, it is
not a neces omitant of diseases of obstruction, which even

end in death. It can be easily coi that that amount of ob-

struction might exist which would allow the circulation of the
blood to sonv extent, and still prevent the passage of the con-
tents of the bowels enough circulation going on in the parts to
prevent gangrene; but still enough of pressure and distension capa-

112 Remarks on Gastroiomy. [February,

hie of bringing about those symptoms of which we speak, and death
itself.

When an obstruction exists in any portion of the intestinal tube,
which prevents the passage of its contents beyond that point, and it
is of such a character as not to cut off the circulation of the obstruct-
ing point entirely, the consequence is, the accumulation of matter
above, distension and a corresponding pressure of the vessels of the
neighborhood this distension and pressure produce the strange,
perhaps unaccountable lesion of the nervous system, as evinced by
the rapid pulse, the gastric disturbance, and in a later stage ail the
urgent symptoms of collapse and speedy death ; it may require a few
days or as many hours to produce these effects. If the obstruction
is entire and sudden from the beginning, these nervous symptoms
supervene suddenly, as in the case of strangulation of the bowel, in
hernia; whether produced suddenly or gradually, the condition of the
nervous system will be the same, sooner or later. Now, it the cir-
culation be cut off by the intensity of the strangulation, gangrene
necessarily supervenes, though not as a certain connexion with the
cause of death. To show that distension may produce those symp-
toms which will end in death, you will revert to the case of Craig's
girl mentioned above. Again, in the case reported at the last annual
meeting of ! his Society, by Dr. ?Ianlove, the same train of facts was
clearly exhibited. It will be recollected, that the boy was suffering
under those symptoms which denote with unerring certainty, the ap-
proach of dissolution ; and when the distension was relieved by the
incision made in the bowel and by the discharge of its contents, they
gave way as by magic.

Petit is said to have punctured several limes ihe sacs of strangula-
ted hernia, and thereby relieved the distension caused by the super-
incumbent mass, and the patients were cured (although in one case
there was evidently gangrene) without artificial anus. A charlatan,
not understanding the nature of strangulated hernia and supposing
them to be abscesses, is said by Velpeau to have gained a brilliant
reputation by puncturing them, and effecting a cure in many cases.
The intestines being {real from distension by the puncture, soon
recovered from the symptoms of strangulation.

Mr. Velpeau alluded, in the Academy of Paris, to a case of tym-
panitis, when a variety of means had be.en resorted to without success,
in which he plunged a trochar into the intestines, and gave vent to a
large quantity of gas through a canula. In the course of five days he
made four punctures ; the man recovered perfectly. These cases are
mentioned only to show the great influence of distension as a promi-
nent cause of the distressing symptoms.

It will be, perhaps, always a source of difficulty to determine with
absolute certainty, the existence of a mechanical obstruction in the
bowels. But in regard to diagnosis in almost all important and seri-
ous diseases, we may not expect to be without difficulty.

Velpeau says, if the affection attack suddenly upon a strain or vio-

1347.] Remarks on Gaslrotomy. 113

lence, if (be patient thought he perceived a tearing, accompanied with
crepitation and pain, propagated from a given point to the rest of the
abdomen if from tin's moment vomiting, first of mucous and alimen-
tary substances and then of stercoraceoua matter continues, while
alvinc evacuations have been impossible, and the usual signs of
evident peritonitis are absent, it would be very difficult not to admit
the existence of internal strangulation. The distinctive symptom to
which Dr. Watson, of the Royal College of Physicians, attached more
value than any other was, that the intestines rumble and roli, and
propel their contents downward to the same spot, and no further.
But it will be of necessity left to the judgment of each practitioner
to determine the Value of all the symptoms which may be present in
the case, and which may point his mind to the conviction of the
existence of strangulation his practice must be modified by circum-
stances impossible for me to enumerate in this paper. I would, that
I could here point out that correct diagnosis which would lead us
aright in all cases.

Should we still continue to view these cases as beyound the reach
of remedial means? Shall we stand silently by and witness those
results without any effort to relieve them? who does not regard a
case of invagination or torsion of the bowels as necessarily fatal? It
is so taught in the books it is so practised by physicians.

Called to attend a case presenting the symptoms generally des-
cribed above, in which all the remedies have been used which may
be suggested to the mind, and still seeing the slow but certain ap-
proach of death, what should be done? We cannot doubt, but that
this condition is brought about by a temporary injury to the bowels,
nor can we doubt the fact, that if by any means we could remove the
injury of the bowels, the symptoms would disappear as by a charm.
Gastrotomy is the resort which I would recommend, an incision made
into the cavity of the abdomen, would almost certainly reveal the
point of mischief, and the course of conduct should be directed by
circumstances. If, on reaching the intestines, it is found that a
portion of the bowel is invaginated, a relief of that condition will
probably be easily effected, when it will be seen that nature will
again pursue her usual track and health will be restored. To this
result, the greatest impediment will be the wound in the walls of the
abdomen; and in the presenttate of medical science, I presume, no
one will contend that such a wound, inflicted by a surgeon's knife,
must be fatal.

Samuel Cooper, speaking of hernia, says there seems to be ample
cause to believe, that the generality of Fatal events consequent to the
operation, are attributable to the disease and not to the attempt to
relieve it. Mr. Potts' opinion was, that the operation when perform-
ed in a proper manner and in due time, does not prove the cause of
death oftener perhaps than one in fifty cast -.

Again, should it, on reaching the bowels, be found that there ex-

114 Remarks on Gastroiomy. [February,

ists torsion or a passage of a portion of the bowels through the mes.
entery, the course is plain, the position should be corrected.

But suppose it is found, that there is neither invagination nor tor-
tion, but a stricture of the bowels, producing permanent obstruction
or impacted faeces or other substances forming an insuperable barrier
to the passage of matter from above, and this distension exists to
which I have attributed so much mischief; what is the plan to be
adopted? I should puncture the bowel as near and above the point
of obstruction as convenient, and relieve the distension by the escape
of the distending matter, taking care to avoid, by the usual means
recommended by the best surgeons, the escape of fsecal matter into
the cavity of the peritoneum, thereby forming a temporary artificial
anus, if the symptoms would justify me in attempting the operation
of gastrotomy.

I would believe, that unless relief were speedily afforded, death
would ensue. And, although, an artificial anus, permanent or tem-
porary, may be justly considered as a great evil, yet it must be view-
ed as a less one than death. By puncturing the bowel, under these
circumstances, we would gain lime for the future administration of
remedies suited to the character of the obstruction. With these
views in the performance of the operation, 1 would hold myself au-
thorized by the best dictates of humanity and science.

In the performance of this operation, there are many obstacles to
success which will need to be met by the ingenuity and firmness of
the operator ; the opposing coats of the invaginated bowels some-
times become agglutinated by the deposition of lymph if the con-
nection be slight, but little tractile force will be required to disengage
the bowel, or a careful dissection may become necessary. The same
line of conduct should guide us in the event of finding the bowel in a
gangrenous condition. It does not comport with the character of
this paper to elucidate the plan to be pursued in minutiae that is
sufficiently laid down by our excellent late surgical writers, as how
the sphacelated portion is to be cut ofFand the sound ends united;
by what sutures, whether the glovers' or interrupted suture, whether
cylindrical substances should be used to sew the two ends of the
intestines on or not these are not the subjects ; they are to be deter-
mined by the taste of each one who reads the views of those who
have written on the subject My object has been to bring to the
consideration of the Society, what I consider to be leading points in
the subject, hoping to attract their attention to a condition of things
seemingly to be too much neglected.

I will not tire the patience of the Society by the enumeration of
the cases ofgastrotomy which are scattered (rather sparingly I ac-
knowledge) through the surgical books and journals. There are,
however, many to be seen, and they may serve us as beacon lights
to guide our professional conduct in similar cases.

In this paper I have endeavored to show, that distension above the
point of obstruction being one of the prominent causes of danger, the

1847.] Plague and Quarantine. 115

success of the operation may be calculated on- with more certainty
than if a gangrenous condition of the bowels were always present.
That invagination, torsion, and even permanent obstruction of the
bowel may he relieved by the operation ofgastrotomy the last men-
lioncd, perhaps, imperfectly ; the two first perfectly, with a restora-
tion to health. That the operation, under proper circumstances,
need not be necessarily fatal oftener than many other capital opera-
tions, undertaken by the most prudent surgeons, as every day occur-
rences.

I am aware I have trodden on somewhat forbidden ground. I
think that good authority may be quoted to prove, that under any
circumstances, the operation ofgastrotomy is an unjustifiable opera-
tion ; that it has been said to have been wisely discountenanced by
almost all therapeutists, and condemned as the procedure of unen-
lightened quackery, and wholly inadmissible. Notwithstanding these
things, let us go on and diligently add one mite of information to
another until we shall have collected such an amount as we shall be
able to draw and be served from in time of need, in professional con-
duct. No subject is at once cleared of its difficulties ; and may we
not hope that the period of investigation is now dawning, when not
only this, but others, equally intricate and important, may be so far
divested of their darkness and their doubts, that we may not err
therein.

The most I can hope for in such a paper as thi*. with views so
crudely and hastily thrown together, is to incite inquiry and experi-
ment among the members of the Society, by which this subject may
be brought to light in its various bearings on some of the direct ills
to which the human system is liable.

Plague and Quarantine.

The abolition and modification of the quarantine laws by England
and Austria, in 1841, has produced a strong sensation in France,
and has led to strong and just remonstrances against her sanitary
system. The government submitted the question to the Academy of
Sciences, which made no report. The Academy of Medicine, har-
rassed incessantly, with communications on the subject of the Plague,
named a commission of fifteen members to investigate the subject.
This commission has been indefatigably engaged in the investigation,
and have left no means unemployed to enable them to arrive at sat-
isfactory conclusions. These are fuund in the Archives Generates
de Medicine, and are a-> follows :

1st. The Plague originates spontaneously, not only in Egypt,
Syria and Turkey, but in a great many other parts of Africa, Asia and
Europe.

2nd. In every country where it originates its development may be

116 Plague and Quarantine. [February,

rationally attributed to causes acting on a grreat part of the popula-
tion. These causes are, a residence on the alluvial and marshy
lands near the ?vlcditerrnnean sea ; or certain rivers, the Nile, the
Euphrates, and the Danube ; low, imperfectly ventilated and crowd-
ed houses; a hot and moist atmosphere ; the action of animal and
vegetable matters in a state of putrefaction ; unwholesome and insuf-
ficient food, and great physical and moral misery.

3rd. All these conditions united, exist every year in Lower Egypt ;
the Plague is endemic in that country, and it is found every year
in a sporadic form, and about every ten years it prevails as an epi-
demic.

4th. The absence of any pestilential epidemic in ancient Egypt,
for a long time, during which an enlightened and vigilant adminis-
tration, and a good sanitary police struggled victoriously against the
causes of the Plague, justifies the hope that the same means will here-
after produce the like results.

5th. The condition of Syria, Turkey, Tripoli, Tunis and Morocco,
being about the same as at those epochs, when epidemics of Plague
spontaneously manifested themselves, authorises the belief that simi-
lar epidemics may again burst forth in those places.

6th. There is little room to fear that Plague will appear sponta-
neously in Algiers, because the Arabs and the Kabyles living, the
one under tents, and the other on the summits and sides of rocks,
cannot engender the malady, and moreover the draining of many
marshy places, and the ameliorations, in the construction and police
of the few existing towns seem to offer a sufficient guaranty against
the spontaneous development of the disease.

7th. The progress of civilization, and a general and constant ap-
plication of the laws of hygiene, of themselves furnish sufficient
means to prevent the spontaneous development of Plague.

8th. Whenever the Plague has raged in Africa, Asia, or Europe,
it has always presented the characteristics of an epidemic disease.

9th. Sporadic Plague differs from that which is epidemic in the
smaller number of its subjects, but more especially in the absence of
the usual characters of an epidemic.

10th. The plague propagates itself in the manner of most epidem-
ic diseases, that is to say by the air, and independently of any influ-
ence which can be exercised by its subjects.

11th. The inoculation with blood drawn from a vein of an indivi-
dual laboring under the disease, or with the pus from a pestilential
bubo, furnishes but equivocal results. Inoculation with the serositv
taken from a pestilential carbuncle, has never produced Plague ; it
has not then been proved that the disease can be transmitted by
inoculation.

12th. A rigid and attentive examination of facts shews that in the
midst of epidemic foci, immediate contact with thousands of individ-
uals laboring under this disease, may take place without danger to
those who can exercise in the open air, or in well ventilated places,

1847.] Plague and Quarantine. 117

whilst no rigorous observation has demonstrated the transmissibility
of Plague by contact with its subjects.

13th. Facts in a great number prove that the furniture and cloth-
ing which have been used by persons laboring under the disease, have

not communicated the Plague to those who have utc-d them without
any previous purification, end that too in a country where a pesti-
lentive constitution had recently existed. Facts which seem to fur-
nish a different result possess no value until they are confirmed by
new observations made beyond the epidemic or miasmatic foci of
infection, and from those countries where Plague is epidemic*

14th. The transmissibility of the disease by merchandise, in coun-
tries where it is endemic or epidemic, has net been proved.

15th. Plague is transmissible in places where it is epidemic, by the
exhalations given out by persons who are laboring under the com-
plaint.

16th. It is incontestible that Plague is transmissible beyond the

sources of its epidemic origin, in ships, or in the lazarettoes ofEurope.

17th. There is no proof that it is transmissible beyond such

sources, by the immediate contact of individuals laboring under the

disease.

18th. It has not been proved that Plague is transmissible,. beyond
its epidemic foci by the furniture or clothing which have been used
by Plague patients.

19th. It has not been established that merchandise can carry
Plague beyond the sources of its epidemic origin.

20th. The classification adopted in our lazarettos, of articles sus-
ceptible or not susceptible, does not rest upon any fact or observation
worthy of confidence.

21st. The study of the means by which the pestilential principle
contained in furniture, clothing, or merchandise, may be destroyed,
will be useless, until the presence of this principle has been demon-
strated.

22nd. Plague may be transmitted beyond its epidemic foci by
miasmatic infection, that is, by air charged by pestilential miasma.

23rd. Plague is more or less transmissible according to the inten-
sity of the epidemic, its peiiod, and the organic dispositions of those
subjected to the action of pestilential miasma.

24th. Individuals laboring under the disease, by vitiating the air
of the places that they occupy, may create ibci of pestilential infec-
tion which will produce the complaint.

25th. Persons who labor under sporadic plague, do not appear to
create foci of infection as active as when the disease is epidemic.

26th. Foci of pestilential infection may continue after the removal
of plague patients.

27th. Foci of infection once ship, by the presence

of one or more ; iboring under tl ty be transport-

ed to a great distance, and often acquire a fearful intensity oov<
with troop* and travellers.

118 Case of Doubtful Sex. [February,

28th. Moveable foci of infection cannot become the sources of
secondary foci, unless they meet with the conditions necessary to
the development of Plague in the countries whither they are trans-
ported.

29th. The ordinary time of incubation of Plague, is from three to
five days. The duration of this incubation does not appear to have
ever exceeded eight days.

30th. When a country becomes a prey to epidemic Plague, the
inhabitants are exposed both to the pestilential constitution and to
the influence of the subjects of the disease. Isolation preserves from
the last, but not from the first. Beyond the epidemic foci of which
the limits are generally easily determined, the influence of the pesti-
lential constitution ceases. Isolation in this case secures from all
danger of the disease.

Case of Doubtful Sex. By Wm, James Baeey, M. D., of Hartford,
Conn. (from N. Y. Journal of Medicine.)

In March, 1843, I was requested to examine the case of Levi
Suydam, aged 23 years, a native of Salisbury, Conn. At the exci-
ting and warmly contested election of the spring of this year, almost
everything bearing the semblance of the human form, of the male sex,
was brought to the ballot-box. It was at this time, and under these
circumstances, that the above mentioned person was presented, by
the whigs of Salisbury, to the board of Select-men, to be made a free-
man ; he was challenged by the opposite party on the ground that he
was more a female than a male, and that, in his. physical organization,
he partook of both sexes.

The following was the result of the first examination. On expo-
sing his person, I found the Dions veneris covered in the usual way,
an imperforate penis, subject to erections, and about two inches and
a half in length, with corresponding dimensions, the dorsum of the
penis connected by cuticle and cellular membrane to the pubis, leav-
ing about one inch and a half free, or not hound up, and towards the
pubic region. This penis has a well formed glans with a depression
in the usual place of the meatus urinarium, a well defined prepuce,
with foramen, &c. The scrotum not fully developed, inasmuch as
it was but half the usual size, and not pendulous. In the scrotum,
and on the right side of the penis, one testicle of the size of a common
filbert, with spermatic cord attached. In the perineum, at the root
of the corpora cavernosa, an opening through which micturition was
performed, this opening lar<re enough to admit the introduction of an
ordinary sized catheter. Having found a penis, and one testicle,
though imperfectly developed, and without further examination, I
gave it as my opinion, that the person in question was a male citizen,
and consequently entitled to all the privileges of a freeman.

1847.] Homceopaihy. 119

On the morning of (he 1st Monday in April (Election day) I was
informed that Dr. Ticknor would oppose Snydam's admission. Suy-
dam came forward, Dr. Ticknor objected. I then stated to the
meeting, that from an examination I had made, I pronounced the
person in question to be a male, and requested that Dr. Ticknor
might, with the consent of Suydam, retire into an adjoining room,
and examine for himself. This was done, when Dr. Ticknor stated
to the meeting that he was convinced that Suydam was a male.
Suydam accordingly was admitted a freeman voted and the whig
ticket carried by one majority !

A few days after the election, it was told me that Suydam had
regular catamenia. I then commenced further investigations, and
learned from Mrs. Ayres, the sister of Suydam, that she had washed
for him for years, and that he menstruated as regularly, but not as
profusely, as most women. I next saw Suydam, who very unwilling-
ly confessed that such was the fact. I then requested him to meet
Dr. Ticknor and myself the next day at my office ; when the follow,
ing additional particulars were elicited. Said Suydam is five feet
two inches in height, light colored hair, fair complexion, with a
beardless chin, and decidedly of a sanguineous temperament, narrow
shoulders, and broad hips; in short every way of a feminine figure.
Well developed mammae, with nipples and areola. On passing a
female catheter into the opening through which micturition was
performed, and through which, he again stated, he had a monthly,
periodical, bloody discharge, instead of traversing a canal and draw-
ing off urine, the catheter appeared to enter immediately, a passage
similar to the vagina, three or four inches in depth, and in which
there was considerable play of the instrument. He stated that he
had amorous desires, and that, at such times, his inclination was for
the male sex; his feminine propensities, such as a fondness for gay
colors, for pieces of calico, comparing and placing them together,
and an aversion for bodily labor, and an inability to perform the
same, were remarked by many.

I further learned from an old lady who was present at the birth of
Suydam, that on the second day after his birth, Dr. Delamater, who
attended as accoucheur, made with an instrument, the opening
through which he has ever since performed micturition.

Homoeopathy. (Illinois and Indiana Med. and Surg. Jour.)

Prof. Linton thus describes Homoeopathy; we take this extract
from his article on that subject in the Western Lancet :

We assert that Homcepathy, whatever of truth there may be in
some of its speculations, is perfectly inert in practice; and if we fail
in proving this assertion true, then facts are mere illusions ; logic a
humbug, and reasoning a fare;'. To proceed. In the fir>t place,
our disposition to try all things, has induced us to try "Globules ."

120 Homoeopathy. [February,

We have used them to ascertain their pathogenetic effects; we have
taken the sulphur, but it caused nothing like the itch, which was
promised us; we have used the quinine without experiencing the
slightest symptoms of a chill ; the belladonna, and nothing like hy-
drophobia followed. This we did at the suggestion of a Homoeopathic
practitioner. We have also tried these articles on some friends,
without the slightest result. We have used the "globules" in affec-
tions which we were confident would gel well of themselves. Here
they were successful, the patient got well! But then we tried ano-
ther experiment. We selected several cases which we felt confident
would not get well of themselves, and these we subjected to the treat-
ment of one who ranked high as a Homeopathic practitioner. The
result was in every instance a complete and triumphant failure.

The following gives trie author's opinion of the shaking, rubbing,
and spiritualizing process:

But again say the defenders of small globules, the rubbing the
trituration of the medicines increases their power and activity. Some
of them say that it spiritualizes matter to rub it ! Hence they grind
their medicines very fine, and shake the vial of drops they rub about
six minutes at each trituration, and shake about six times at each
dilution, though Hahnemann says that he had to reduce his shakes,
so powerful did six make them ! ! ! ! !

Now, any one that is in danger of believing this monstrous non-
sense, can easily test its truth or falsehood. A certain amount of
arsenic will kill a dog a small dose, say half a grain, will not hurt
him. Give the dog then a half grain of arsenic and watch its effects.
Then take another half grain and triturate, and grind it, and rub it,
until it is spiritualized and strengthened as much as it is possible by
this process. Then dilute it. and shake it well six times six, and give
to the aforesaid dog. If Homoeopathy be true, it will kill him in a
very short time; if Homoeopathy be false, the dog will go about his
business. An easier test would be to ascertain if shaking a tea-
spoonful of brandy would enable it to make a man drunk. It would
do so if Homoeopathy be true.

Why, if this principle were sound, then the apothecary might dou-
ble his stock at an hour's warning, not by the difficult and expensive
process of importing fresh medicines, but by the easy one of shaking
what he had on hand.

The liquid that was worth but one dollar, the dose being twenty
drops, would be rendered of double that value by a few shakes, which
would so strengthen it that ten drops would suffice ! Sailors and
soldiers would find this principle of great value ; they would put a vial
of whiskey in their pockets, and, by shaking it, have grog enough for
a voyage or campaign ! Nay, armies might subsist on a little porta-
ble soup, increased in power and spiritualized by shaking! What an
invention for starving Ireland ! what a great trade shaking would be
il Homoeopathy were not a humbug! Instead of endeavoring to ac-
cumulate, the world would sit down satisfied to shake what it has
already gotten.

1847.] Sense of Vision. Int. Fever. Neuralgia. Ergotine. 121

PART III. MONTHLY PERISCOPE.

A Case of Uncommon Acutcness of the Sense of Vision. There is
Jiving in this region a young man of 23 or 24 years of age, who is
reported as being able to see, with his natural eye, animalcule in
common well and spring water. This faculty was noticed when he
was some 15 or 16 years of age, by persons for whom he was at
work, in consequence of his refusing very often to drink water hand-
ed to him, in which nothing could be discovered by common eyes,
I made some experiments with him, enough to be satisfied that his
case was no hoax; and did intend to make more, but have lost sight
of him, and suppose he lias left the neighborhood. His complexion
is fair; temperament sanguine ; eyes blue, less than the common
size, with very small pupils, [Western Jour, of Med. and Surgery.

Tincture of Iodine in obstinate Intermittent Fever. Dr. Seguin, in
(he Bulletin General Therapeutique, speaks very favorably of the
effects of the tincture of Iodine in obstinate intermittents. He was
led to its employment in such cases from its effect in a case of inter-
mittent fever, protracted to eighteen months, in which he prescribed
it for an enlargement in the spleen. This visceral engorgement was
not removed, but the fever was promptly cured. . Some months after-
wards the disease returned, and was treated with sulphate of quinine
without success; the tincture of iodine was again given, and the dis-
ease was soon removed. He relates several other cases, in which it
succeeded, after the quinine had failed. He states, however, that it
is not uniformly successful, but that was always so in cases where the
quinine failed. He gives to adults thirty drops of the tincture in three
doses, during the pyrexia, at intervals of one hour. He increases
the dose, according to the effects produced, to forty, fifty, and even
sixty drops, and continues its use for several days after the disease
has disappeared.

Ext. of Tobacco in Neuralgia. For a number of years Dr. Gower
has been in the habit of employing, with great success, topical appli-
cations of the infusion and alcoholic tincture of tobacco in prosopalgia,
and he was not sure whether it acted as an excitant or sedative, until
M. Chippendale discovered that the active principle of this vegetable
was nicotine. Dr. G., of all the various preparations of nicotiana, is
most partial to the extract. He has seen three cases of this obstin-
ate neuralgia yield instantly and permanently to a single application
of the aqueous solution of this extract. And its success when rub-
bed upon the diseased jaw was no less marked in a case of tooth-ache.

[Western Journ. Med. and Surg.

Ergotine as a Hcemostalic. On the occasion of M. Bonjean's pre-
senting the Academie des Sciences with an account of an additional
experiment he made with Ergotine, in which the bleeding from the

122 Relapse of Cancer. [February,

carotid of a horse, divided through a third of its circumference, was at
once arrested by the application of ergotine, M. Velpeau delivered
the following sensible and pertinent observations :

"What M. Bonjean says of Ergotine has been said by an infinity
of other persons concerning different substances. Haemostatic means
of a real efficacy are nevertheless as rare as ever. The error arises
from these authors having forgotten two things in their experiments.
1. In animals, the plasticity of the blood is much greater than in
man, whence it follows that means which will arrest haemorrhage in
the one, may easily fail to do so in the other. All those who have
made experiments on living animals know that, in the horse, the.ox,
the sheep, for example, the largest wounds of arteries rarely give rise
to mortal haemorrhage. The blood, ceasing to flow almost of its
own accord, leads the public and inexperienced authors to believe
that it is the means or remedy employed which has closed the artery.
Thus, what powders, waters, liquids, what arcana of every kind have
been vaunted at first as infallible ; and then, after a searching exam-
ination, rejected as useless ! 2. In man, many arterial haemorrhages
also cease either spontaneously or under the exertion of mere com-
pression, without our being obliged to have recourse to the ligature;
so that it is easy to attribute to a pretended haemostatic substance a
result which takes place quite independently of its employment.

"I have neither cause nor desire to throw any doubt upon the
value of M. Bonjean's experiments; but practice has been so often
deceived by similar anouncements, that it behoves the Academy to
accept them with due reserve. I must add, that the practitioners
who have tried ergotine or the ergot of rye have as yet derived
nothing conclusive from its use. When, in uterine hemorrhage, the
ergot proves useful, it does so by inducing contraction of the uterus,
and not by any special action it exerts on the blood or on the arteries.
Thus we see the question of surgical haemostatics is at once a very
complex and a delicate one : and we should not receive facts con-
cerning it without a certain degree of distrust, and only give them a
very limited publicity, until they have been tested by a more mature
examination.'* \_Compies Rendu*.

Relapse of Cancer. True as it is that relapse is much to be fear-
ed after operation for cancer, it is no less so that we may sometimes
mistake the effects of inflammation for such. M. Lisfranc has made
the part which inflammation acts in cancer the subject of very atten-
tive study. A woman had her left breast removed recently. Cica-
trization at first took place rapidly; when, all of a sudden, the
wound broke out again, the surrounding skin assuming a slate-colour,
and lancinating pains reappearing. Here was every appearance of
a relapse; but M. Louis ordered a dozen leeches to the margin of the
wound, the pains ceased, the slate-colour disappeared, and cicatriza-
tion was soon complejted. [Gazelle des Hopitaux.

1847.] Cancer. Hemorrhoids. Vagina. Ophthalmia. See. 123

Opium dressing for Cancers. M. Tanchou speaks highly of the
relief from pain to he obtained from employing the following dress-
ing in cancerous ulcers. Digest, during 24 hours, at a temperature
of about 78, a certain quantity of rough-powdered or bruised opium
in a sufficient quantity .of water to form a thick paste. Cover the
ulcer with this a line or two in thickness, once or twice a day accord-
ing to the severity of the pain, and place over it a piece of thin
gummed paper or court-plaster to prevent evaporation. [Medico-
Chirurgical Rev.

Tinct. Iodine to Hemorrhoids. Dr. Vandervoort stated that he
had used Tinct. of Iodine as an application to Hemorrhoidal Tu-
mours, with highly satisfactory effects in a case to which it had been
applied. [Sew- York Jour, of Med.

Occlusion of Vagina. Dr. Post gave an account of an operation
performed by Dr. J. Kearney Rodgera, for congenital occlusion of the
vagina. The patient was 24 years of age. There had been efforts
at menstruation ; the external organs were well formed, and half an
inch of vagina existed. The uterus could be felt through the rec-
tum. A catheter having been introduced into the bladder, and a
finger into the rectum, an incision was made between them with the
scalpel. The operation was continued in part by the handle of the
scalpel, and of sufficient depth to admit the whole forefinger, when
the cul-de-sac was reached. This was distinguished by fluctuation.
An incision was now carefully made through the membrane. A thick
dark fluid escaped. A sponge was then introduced to dilate open-
ing. [Ibid.

Solution of common Salt in- Ophthalmia. (Jour, des Connaissances
Medico-Chirurg.) Dr. Moraes, of Lisbon, reports that having suf-
fered a chronic ophthalmy which resisted ail the means he had
employed, he then tried a solution of common salt which procured a
complete cure. He has since employed this article in his clinic.
The degree of concentration he regulates according to the sensibility
of the patient. He uses common water, warm in winter and cold in
summer.

Congenital Dropsy (Ascites.) This case was that of a female
child nine weeks old. I saw it October 23th, 1844, when the mother
informed me that, at its birth, the abdomen seemed to be unusually
protuberant, and that shortly afterwards it became subject to par-
oxysms of restlessness and crying, for which anodynes were adminis-
tered without producing any relief. At my examination the general
system was not emaciated, nor was there any anasarca of the extrem-
ities. The skin was rather soft and moist. It sucked heartily, had
more thirst than natural, and had a slight coat upon the tongue.
The abdominal tumor was so great as to extend down over the pubis,

124 Nervous Vomitings. Engorgement of the Uterus. [February,

and also upwards and backwards over the ensiform cartilage and
false ribs.

I prescribed diuretic and purgative medicines, and directed iodine
ointment to be rubbed on the abdomen twice a day. No amendment
followed this prescription. The child fell into the hands of another
physician, who tapped it and drew off a considerable quantity of water.
It eventually, however, died. [Western Jour, of Med. and Surg.

Nervous Vomitings of Pregnant Women. (Bulletin General The-
rapeutique.) There are i'ew affections for which a greater variety
of medications have been proposed than the vomitings which occur
during pregnancy. The multiplicity cf therapeutical means indicate
their insufficiency. M. Bretonneau has recently discovered a pro-
cesses simple as it is efficacious to combat this derangement. He
supposes that the vomitings like those in analogous conditions, as in
hernial subjects for example, where there exists no strangulation, are
purely sympathetic, and should be attributed to a difficulty in a dili
tation of the uterus, from a defect in the proportion between the
dilatability of that organ, and the development of the embryo. This
theory, whether erroneous or otherwise it matters but little, led M.
Bretonneau to institute the following medication. He caused fric-
tions to be made to the abdomen of the patient, with a pomade com-
posed of five grammes of the extract of Belladonna to thirty of lard,
or what is preferable, with a solution of the extract of Rhatany in
water, made into the consistence of a syrup. The absorption in the
last mode is more prompt and complete than when the pomade is
employed. The internal administration of the belladonna, in what-
ever form it may be used, does not produce the same results. Ordi-
narily the vomitings continue until the belladonna inunctions are
resorted to. Another fact which should be noticed, is that other
stupefiants, as opium, &c, have not a similar effect. We invite the
attention of practitioners to this treatment, as it has uniformly suc-
ceeded in the numerous cases in which we have seen it employed.

M. VeJpeau on Flexions and Engorgement of the Uterus. " A
proof of how often the term engorgement has expressed an error of
diagnosis is found in the fact that of late years, and in proportion to
the progress of science, engorgements of the uterus become more and
more rare, while the number of vicious flexions is augmented. I do
not fear to state, that of50 women reputed to have uterine engorge-
ment, 45 will be found upon examination to be suffering from some
deviation from the normal position of the organ. How can we
explain this error of diagnosis being committed by well-educated
practitioners? The reason is simple. The woman is examined in
the recumbent posture, and the finger meets, in a certain direction of
the neck, forwards if there be anteflexion and backward if there be
retroflexion, with a tumour of considerable size and sensible, which is
declared to result from an engorgement. But the tumuur is simply

1847.] Permanent relief of Toothache. 125

the body of the organ bent nt a more or less obtuse angle, and some-
times at a right angle. We can easily assure ourselves of this,
especially when, as is the case with most women who have borne
children, the walls of the abdomen are neither tense nor thick. By
gently depressing the hypogastrium, we may grasp the body of the
womb between the two hands, and appreciate its volume as accurately
as if we could see it. Engorgement is one of the least usual condi-
tions of the organ that we meet with, and on the contrary the body
of the org;in is often found somewhat atrophied.

" Accurate diagnosis, in consequence of the treatment it designates,
is here of great importance; for when we have to do with a simple
deviation we dispense with the use of means proper for resolving a
tumefaction which does not exist, of debilitating remedies each more
mischievous than the other, and with confining the patient for months
in the recumbent posture. We order for her, moderate exercise, a
substantial and tonic regimen, antispasmodic, ferruginous drinks,
saline baths, astringent vaginal injections, and lastly an abdominal
bandage which may support the viscera and prevent their weighing-
down the deviated organ." [Gazette des Hopitaux.

Treatment of Chronic discharges (gleet) from the Urethra by the
application of a blister upon the lenee. (Gazette Meclicale.) Dr.
Deane, instead of placing the blister as is generally advised near the
seat of the disease, pursues a different practice. Having to treat a
case three years ago, for a discharge from the urethra which had
lasted nineteen months, and had resisted various kinds of medicines,
he thought of trying a blister around the knee. The same evening
there was a distinct strangury the following morning the discharge
had considerably diminished, and at the end of 24 hours it had disap-
peared completely. Since then the author has treated in the same
manner twenty cases. Nine were cured as promptly as the one
mentioned above, and not one resisted the treatment. In some the
blister was renewed twice, and in one only three times.

THE PERMANENT RELIEF OF TOOTHACHE.

To the Editor of the British American Journal :

Sir, In a country where so many are martyrs to this species of
suffering, you will, I think, be conferring a general benefit, by making
known through the medium of your journal, the following simple,
and, as I have found it, successful method of securing carious teeth
from the effects of cold and changeable weather, and keeping them
perfectly free from pain at all times. This wonder-working remedy !
consists in the daily and habitual use of a weak solution of creosote,
saturating the tooth-brush with it and using it first ; alter which cold
water and whatever tooth-powder the individual may be in the habit
of employing.

This practice, in my own experience, and i\i that of others at my
suggestion, I have found a very successful preventative to toothache
arising from the presence of carious teeth. I am rather disposed to

126 Leeches. Mystery of Nature. Opium. Insanity. [February,

believe, too, (contrary to the opinion of some dentists,) that the cari-
ous process is suspended by its employment ; but on this head I would
not be confident, although Reiehenbach has recorded cases of caries
cured by the use of the watery solution of creosote. M Bulletin Gen.
de Therapeutique for May, 1835." M. Fremanger is also of the
same opinion as to its effects, and considers that it acts " by combin-
ing with the calcareous sails of the bones and forming a new com-
bination, which, by its solubility, tends to disengage the areolar tissue
and stop the ulceration at the proper point for the commencement of
cicatrization." "Cormack on Creosote." I wish the profession in
Canada would take up ihe subject.

Yours respectfully, J. 1). MDiarmid,

Staff-Surgeon, PrescotL

B Crosote, 3i.; Spt. Rectificat, gss.; Aq. Destiilat, gviiss. M.

It may be colored with cochineal.

Method of malting Leeches Bite. Dr. Boursier says, that by
placing leeches in a mixture of two parts of wine and one of water,
they are in a few minutes very active, and take hold instantly ; and
that if they are gorged with blood they disgorge themselves and will
draw again. [Journ, de Chimie Med.

Mystery of Nature explained. The mystery of nature, advertised
to be seen in Boston, and declared to be the wonder and admiration
of the medical and scientific men of Europe and the United States
the right hand representing an eagle's claw and the left a lobster's
is simply a malformation ; one hand is furnished with a thumb and
one finger, and the other with three no more resembling the ex-
tremity of a lobster's leg, or an eagle's, than the horn of a rhinoce-
ros. [Boston Med. and Surg. Journal.

Opium not poisonous to the Rabbit. By M. Lafargue. (Comptes
Rendu s des Seances deVAcademie des Sciences, March, 1845.) M-
Lafargue, having observed that the poppy was a favorite food with
the rabbit, on which it throve and got fat, felt some curiosity to ascer-
tain whether that animal would be affected by opium. For this
purpose he dissolved three grains of the acetate of morphia inaquan-
titv of water, and mixed with a certain quantity of bran, which a
rabbit cat in two days, but was not in the least affected by it.

[Edinburgh Med. and Surg. Journ.

Number of the Insane in France. The most recent account of
the insane in France, which we have seen, is that contained in the
great work on statistics, published by the Minister of Agriculture
and Commerce for 1843.

According to this the population of France in 1835, was - - 33,540,910

And the number of the Insane, was 14.4SG

Io.l841,the'pbpulatioii was 34,213,927

And the number of the Insane, was - 19,778

Death amon^r the Insane in 1S35, was ------ 1,394

1811, " 1,770

1847.] Genitals in Children. Trismus Nascent ium. c. 127

In 1841, there were in the various public establishments for the
Insane in France, 10,111 patients.

The following are the assigned causes of th'i3 disease.

Effects of age,

541

Onanism,

293

Idiotism,

2,234

Diseases of the skin,

80

Excessive irritability,

655

Wounds and blows,

154

Excess of labor,

176

Syphilis,

148

Destitution,

329

Hydrocephalus,

92

Epilepsy and convulsions,

1,137

Chagrin,

1,186

Fever-Pthisis, Disease of the

Political excitements,

118

heart,

245

Ambition,

314

Breathing deleterious g?ses,

88

Pride,

291

Abuse of wine and liquors,
Love and Jealouslv,

792

Religious anxiety,

471

767

Total.

i

10,111

MEDICAL INTELLIGENCE.

Epidemic disease of the Geniialsin Children. Dr. J. S. Peacocke, of Louisiana,
in a letter to the Editors, describes a disease which prevailed quite extensively
among the young negroes in the section of the state in which he resides. "It
consisted in the discharge of a puruloid matter, resembling that of gonorrhoea,
from the vagina. None over ten years of age were the subjects of the disease.
The males discharged a similar matter, and it seemed to issue from the inner
lining of the prepuce. At first the discharges looked healthy, but ultimately
became streaked with blood. There was no pain, and the general functions
were in a normal state. The disease was periodical, returning at irregular
intervals. It yielded at first to simple tepid water, followed by some vegeta-
ble astringent. When the disease returned the metallic astringents, as the
acetate of lead, &c., were emploj-ed, but although they acted beneficially atfir&t,
the disease continued to return until cool v/eather. Tinct. of Cantharides, Bal-
sam Copaiba, and Tinct. of'Ouiac all succeeded in arresting it, but only tem-
porarily. This disease was observed at several places at the same time."

Trismits Nascentium. Dr. W. H. Robert, of Madison, Ga., in a letter to one
of the Editors, relates a case of this usually fatal disease, which terminated fa-
vorably. He says: " The case occurred last winter. The child had been sick
two days before I saw it it could only open its mouth sufficient to take fluids.
Tetanic spasms were very frequent, and at each spasm the umbilicus was forced
out by the contraction of the muscles, it (the umbilicus) had not healed in the
least, and presented a very sore surface. To prevent as much as possible the
pressure of the intestines against the umbilicus, a piece of adhesive plaster 3 by 2
inches, with a hole in the centre, just sufficient to let the chord pass, was applied
over the abdomen, and it was dressed with Turner's Cerate; small doses of a
mercurial, passed offwith Castor Oil, were given for three or four days, during
which time the child was nourished with milk poured into its mouth, which was
readily swallowed. The child recovered entirely."

Extraction of apiece of Pewter from the Ear. We have received from John B.
Bowers, M. D., of Barnwell, S. C, a piece of pewter which he extracted from
the ear of a negro man. The general appearance of the metal shews very clear-

128

Meteorological Observations. Errata.

ly that it must have been poured into the ear while in a melted state. Dr. B.
says: "A negro man came to me to do something lor him, saying that his wife
had attempted to kill him, by pouring melted lead into his ear, he being intoxi-
cated at the time when she committed the act. I paid no attention to his story,
supposing he was mistaken. I frequently saw him afterwards, and he always
would say that if I did not take the lead from his ear that it would kill him. His
master consulted me on the subject, but I told him that it was only an idle tale of
the negro. Fifteen months after, the ear became so painful that his master re-
quested me to examine and see if there was any thing in it. On laying him on
his side, so that the sun shone in his ear, I discovered the metal, which was ex-
tracted-wifh considerable difficulty. The pain ceased immediately on the remo-
val, but he cannot hear as well in that ear as in the other."

METEOROLOGICAL OBSERVATIONS, for December, 1846, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

Sun Rise.

2, P. M.

Wind.

Remarks.

p

Thkr.

Bar.

Theii.

BAR.

~T

~43~~

30 6-100

67

30 3-100

S. E.

IFair.

2

45

30

72

29 91- 10C

S.

Cloudy.

3

59

29 87-100;

69

" 92-100

W.

Fair.

'1

38

30

68

30 3-100

N.

Fair.

B

38

30 10-100!

61

30 12-100

N. E.

Fair.

<;

47

30 10-100

CS

30 8-100

N. E.

Cloudy.

7

46

30

71

29 87-100

S.

Fair. f

8

54

29 68-100

74

" 55-100

S.

Cloudy wind and rain 80-100.

9

56

<: 60-100

76

< 66-100

W.

Fair.

10

59

" 55-100

66

" 65-100

N. W.

Fair rain 10-100, at night.

n

38

" 90-100

57

" 95-100

N. W.

Fair.

12

31

30 3-100,

55

" 99-100

S. E.

Fair.

13

30

29 90-100

62

" 94-100

W.

Fair.

11

38

" 95-100

52

" 90-100

W.

Cloudy.

15

44

" 90-100

61

" 90-100

N. E.'

Fair.

16

41

" 75-100

40

;< 44-100

N. E.

Rain 95-100 of inch'.

17

41

30 7-100,

53

" 20-100

N. W.

Fair moschitoes now killed.

18

34

29 47-100

48

" 47-100

s. w.

Cloudy.

10

36

" 59-100

42

" 80-100

N. W

Fair some clouds wind.

20

29

" 97-100

49

30 2-100

X. W.

Fair.

21

27

30 7-100

55

30 7-100

W.

Fair some clouds.

22

27

30 10-100

60

30 14-100

S. E.

Fair.

23

34

30 20-100

60

30 20400

N. E.

Fair.

24

28

30 20-100

57

30 12-100

N.

Fair.

23

32

30 4-100

59

29 90-100

S. W.

Cloudy.

26

38

30 3-100

64

30 7-100

s.

Fair foggy morning.

27

34

30

6(5

29 91-100

s. w.

'Fair.

2S

52

29 83-100

68

" 81-100

s. w.

Cloudy during morning.

20

49

; 90-100

70

" 86-100

S. E.

Cloudy during morning.

3D

58

80-100!

68

" 86-100

S. W.

,Cloudy.

31

55

" 92-100;

76

" 90-100

S.

;Fair.

21 Fair days. CXuantUy of Rain 1 inch and 85-100. Wind East of N. and
S. 9 days. West of do. 15 days.

ERRATA.- The reader will please correct the following errors in the Review Depart-
ment of this No. viz: page 91, line8, for long read bony. Page 96, line 2, for some read n<m.
Tage 99. line 7, for prehensible read prehensile the same correction on page 105, line 4. Page
103, line 34, for receiving, read renewing. Page 104, line 20, for 184G read 1845.

SOUTHERN

MEDICAL AND.SURGICAL

JOURNAL.

Vol. I] SI I SERIES 3IAXCH, 184L [No. S.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE VIII.

Intermittent Fever its various forms their treatment :lie abortive
treatment of Remittent Fever. By Lewis I). Ford, M. I)., Pro-
fessor of the Institutes and Practice of Medicine in the Medical
College of Georgia.

In continuation o[ this subject, commenced in No. 9, Vol. I., of
this Journal, the writer passes to that form commonly called Remit-
tent fever.

If, as has been shown, it is the duty and interest of the practitioner
of this climate to understand the lineaments and the pathology of
malignant Intermittent fever ; how much greater is the obligation
upon him, to know well the nature of Remittent the former being
of comparatively rare occurrence, whilst the latter may be called,
emphatically, the disease of the Southern climate, constituting, as it
does, the great ihass of his cases, in the summer and autumn; and
the result of his treatment of this fever determining his professional
reputation.

The popular, almost universal name of Bilious fever, it may be re-
marked, in passing, is highly objectionable a name suggested by the
marked disorders of (he biliary secretion usually present, and by the
pathology which regards it as dependent essentially, upon disease of
the liver. Manifestly inappropriate to those cases not characterized
by bilious disorder, it is, at best, an unfortunate name, because of
the prejudice it creates in weak minds, that vitiated bile or a diseased
slate of the liver is its proximate cause. There is a peculiar propri-
ety in the simple name of Remittent ; this describing the prominent
characteristic feature of its every variety, thus directing the mind to

9

130 Intermittent Fever. March,

this paroxysmal character as the most essential feature, and giving
a bias to enquiry into the nature of paroxysmal fever, which directs
to the knowledge of their nature.

Remittent fevers are characterized by an abatement of all their
symptoms, at regular periods, generally once in twenty-four hours.
This state of remission differs from an intermission, in that there are
still present the febrile symptoms, but these diminished in violence.
Individual cases, having this one feature of remittency in common,
yet vary in their other symptoms, and in the organ or organs promi-
nently affected ; so that it is impossible to give a general description
of Remittent fever, which shall embrace all its varieties. It is there-
fore proposed to notice very generally the simplest form and then its
most difficult and dangerous varieties. The object of the writer being
rather to develope the pathology and treatment, it will not be neces-
sary to give at large, the symptoms of simple Remittent fever, and
therefore he merely refers to the description of this to be found in
systematic writers. The remark upon reading these descriptions is
obvious, that they do but detail the symptoms of a paroxysmof Inter-
mittent. Collet], for example, embraces both forms under the one
head of intermittent?, alluding to the difference in the duration and
degree of the intermission, as the only difference in their external
characters. And, when described by others as different forms, yet
it is but the reproduction of the symptoms of the intermittent form.
So that it may be considered a fact, that cases of simple Remittent
fever do occur in this climate, and this is generally in the early
summer, and run their course, for many days, without any more pro-
minent local affection than in intermitlents, and often terminate in
intermittents.

In referring to the graver forms of this fever even up to the most
malignant, it may be remarked, that all these are marked by some
predominating affection of one or more vital organs, thus giving indi-
viduality of character to each. Thus, a common form is that, which
may be called cephalitic Remittent in which there is violent pain in
the head and giddiness and intolerance of low degrees of light and
sound ; these symptoms alternating with high maniacal delirium, and
accompanied with nausea and even vomiting- these latter symptoms,
evidently, not dependent on a gastritic state, but having the same
relation to the state of the brain as they have in idiopathic phreni-
tis, uncomplicated with gastritis sympathetic gastric disturbances,
capable of being calmed by antiemetics. If unrelieved, this form

1S47.] Intermittent Fever. 131

has a rapid course, and terminates with the symptoms of the last
stage of fatal Phrenifis.

A still more common form is that marked hy head-ache and even
delirium; but these are not as prominent and distressing symptoms
as persevering .nausea and violent, uncontrollable vomiting, with a
red, dry tongue, or furred yellow, or brown in the middle, its edges
and end only, red and dry, with pain at the epigastrium increased
by pressure, the bowels generally loose constituting gastric Re-
mittent. Another is Enteritfc Remittent, characterized by diarrhea
which is notably increased, at every succeeding paroxysm, and by
even mild laxatives. Each one of these forms is pretty uniformly
accompanied with disorders of the biliary secretion. But there are
other forms, characterized chiefly by these bilious derangements; as
by an excessive secretion of bile of a healthy color, a bright yellow
color, poured out in such quantity as to regurgitate into the stomach
and produce nausea and vomiting of this bile, and by bilious purging.
Another variety in the biliary secretion is the entirely opposite of
this, dependent on a more serious and more controlling disorder of
the liver a suspended secretion, accompanied with nausea and vom-
iting, but no bile discharged. With fulness, heaviness, and oppres-
sion of the epigastrium, sighing and general restlessness, a dull, head-
ache, dingy color of the skin, torpid bowels, which under the operation
of saline and even drastic cathartics, do not discharge bilious stools.

Each one of these forms of Remittent, may terminate in the
typhoid state, with its characteristic symptoms of delirium, subsultus
tendinum, extremely frequent pulse, diarrhea and tympanitis.

The most fatal, or most rapidly fatal, is the algid form character-
ized by imperfect reaction, unequal distribution of animal heat, cold
extremities, and coldness of the general surface, and disordered sen-
sation a sense of heat at the surface as well as internal heat, with
oppression of the chest and epigastrium, laborious respiration, jacti-
tation, &c. This old form is now better known under the new name
of Congestive Fever.

In reviewing the opinions of the profession on the pathology of
Remittents, it strikes the writer that too much importance has been
given to the local congestions and inflammations, which form univer-
sally a part and parcel of the more serious cases of the disease that
too much reliance has been placed upon jwst-morlem appearances, as
indicative of original and substantial disease that the accidents and
consequences of the disease have been mistaken for its original basis.

132 Intermittent Fever, [March,

Allowing for a moment that the evidences of gastro-intestinal inflam-
mation were much more frequent than observation determines them
to be that they were found in every case ; the conclusion is by no
means warranted, that the disease is substantially a gastro-enteritis ;
it is as absurd as would be the opinion that variola is a cutaneous
phlegmasia, founded upon the uniformity of its characteristic pustu-
lous eruption as absurd as the conclusion that gastro intestinal
inflammation formed no part of Infantile Remittent fever, merely
because autopsic examination found the physical traces of disease
in the cavity of the cranium, and the stomach and intestines sound.
Whilst the information of pathological anatomy in this disease has
a great value, yet the interpretation of the functional symptoms is
more to be relied upon, in determining the location, at least, of its
primitive irritation.

However the forms of Remittent fever may be varied by the pre-
dominance of local symptoms, this character of periodicity marks
them all the disease is equally paroxysmal, when characterized by
encephalitic symptoms as by gastric paroxysmal in the thoracic
varieties, and still paroxysmal in the simple form, which is character-
ized by no more prominent local disease than exists in the paroxysm
of the simplest intermittent ; and therefore this periodicity cannot he
dependent upon anyone of these local affections, it must depend upon
some affection of some part of the system, as uniformly present as
this remittence. These local affections, then, how violent soever
they may be how controlling soever their influence upon the pro-
gress and final termination of Remitting fever, may, with great
propriety, be called complications or accidents, in reference to the
fever itself. As to the relation of these complications to periodical
fever, the writer referring to the cases adduced in the previous No.
of this Journal, to prove the independence of the fexer upon them,
xvould remark further, that these accidents are manifestly not imma-
terial, but on the contrary, exert the most decided control over the
regularity of the paroxysms, and are the immediate causes of their
fatality. Thus, simple remittents are most regular in their parox-
ysms, and preserve this regularit}' throughout their whole course
the paroxysms more distinctly separated from each other; and, again,
as the local affection becomes more fixed and more violent, in the
same degree is the regularity of the paroxysms interrupted, the
remissions are shorter and more obscure, until finally, with the com-
plete establishment of the phlegmasia! state upon the organ, the

1847.] Intermittent Fever. 133

remissions cease and the case passes to the continued form. Thus
it may be perceived, that so far from phlegmasia! disease determining
the Remittent fever, the very opposite is true it destroys the type.

It is true of malignant remittent as of Intermittent fevers, that
they preserve their character of mild Remittents, for some paroxysms,
and gradually pass into the malignant ; and of these the remark is
universally true, that the local phlegmasia or congestion is increased
by each succeeding paroxysm that while the paroxysm is comple-
ted within its natural period of twenty. four hours, the local symptoms
increase and abate with the increase and abatement of the paroxysm.
To adopt the beautiful simile of Torti "these wait upon the parox-
ysm, like the shadow upon the substance." So true is this, that in
the vast majority of cases, when the paroxysm is broken up, the local
affection subsides, without the necessity of addressing remedies to
it just what might reasonably be expected from observing its de-
pendance upon the paroxysm.

That the local congestion or inflammation has no influence in de-
termining the periodicity of Remittent fever, will be manifest from
the fact, that cases of mild Remittent fever do sometimes run their
whole course of seven or ten days, without any local phlegmasia or
congestion greater than is found in simple intermittenls ; that such
cases used to be treated in former years, among us at least, greatly to
the comfort of patients, by small repeated doses of tartar emetic a
medicine by the common consent of the profession, proscribed,
wherever there is the remotest suspicion of the existence of gastritis;
to which latter affection it has been so fashionable of late, to refer as
the primitive irritation in Remittent fever.

If the Remittent fever be independent of local congestions or in-
flammations, the proper cases to select for illustrating its pathology
are the simplest cases, those uncomplicated by any adventitious acci-
dents.

The characters of simple Remittent fever show it to be essentially
an intermittent. The simultaneous occurrence of intermittents and
remittents, in the same locality nay, in different members of the
same household, all under common circumstances of living and of
exposure, proves satisfactorily their dependence upon one and the
same common cause. The symptoms of the paroxysm of simple
Remittent and Intermittent fevers are so similar, that the most pene-
trating observer cannot with confidence, determine, during the pas-
sage of a first paroxysm, whether ibe case will dcvelope itself m an

134 Intermittent Fever. [March,

intermittent or remittent. Again, what more common than the
change of type from intermittent to remittent and vice versa. And
the appeal is fearlessly made to practitioners Is it not common to
meet with cases of paroxysmal fever, beginning as intermittents,
continuing as remittents, and ending fatally by the supervention of a
paroxysm marked by symptoms of the utmost malignancy?
/ As in intermittents so in remittents, one of the most uniform symp*
toms is tenderness to pressure in some portion or portions of the
spinal chord ; and, further, the controlling influence of spinal disease
over the symptoms manifested in the head and in the various abdomi-
nal viscera and over the muscular disorders, is illustrated by the
efficacy of revulsives to the spinal column, in relieving all these dis-
tressing symptoms of the paroxysm. )

The essential identity of Intermittent and Remittent fever is shewn
from another character of the latter form, alluded to by all practical
writers, viz: its tendency to increase in the violence of its symptoms,
on alternate days at the tertian period. In fine, an inspection of
the character of simple Remittent fever shows no more difference
between it and a quotidian intermittent, than between a quotidian
and tertian intermittent a difference merely in the interval that
they are all essentially the same disease.

The conclusion to which the writer arrives as to the pathology of
Remittent fever in all its varieties, from the simplest to the most
malignant, is, that Remittent fever is an intermittent, rendered irre-
gular by some complicating accident that these complications, such
as congestion and inflammation of one or more of the vital organs,
so far from determining tiie remittency, tend to destroy it that when
existing, whether produced by the paroxysm or by some peculiarity
in the organs, they are increased by every succeeding paroxysm-^-
that such is their dependence upon the paroxysm, that when this is
checked these accidents disappear, without requiring subsequent
local treatment : and that the fundamental lesion upon which de-
pends Remittent fever, is in the nervous centres-r-the spinal marrow
and the brain.

Tnis view of the nature of Remittent fever indicates the same
grand object to be accomplished in the treatment of each of its varied
forms, viz: to prevent the recurrence of the paroxysms and to mod-
erate the violence of their symptoms when present. Thus, as inter-
mittents, the treatment naturally is divided into two parts the one
appropriate to the remission, the other to the exacerbation. Now, if

1847.] Intermittent Fever. 135

an enlightened experience will sustain the course of practice, which
this pathology indicates, it will add confirmation to its truth. To
this test at last, must every system of treatment submit itself; for the
writer is ready to acknowledge, in the face of all that has been writ-
ten against the empiric method, that the so-called rational method
ultimately rests upon empiricism that all we know of the operation
of medicines and of remedial methods is the result only of experience.

1. To prevent the return of the paroxysms. This distinct indica-
tion to be accomplished in the treatment of Remittent fever is of
recent origin, and contrasts strikingly with the objects set forth in
almost every system of practice, with which the writer is acquainted.
In the light of an experience of twelve years' faithful adherence to
this object, it is lamentable to look back upon his own previous prac-
tice and that of the whole body of medical men, directed according to
the teachings of the many popular "Practices of Physic," these
founded manifestly upon the notion, that Remittent fever once fairly
commenced, cannot be arrested in its course teaching that symp-
toms are to be palliated as they arise, the fever all the while being
permitted to renew its paroxysms, with all their increasing and fatal
concomitants. The writer, conscious that he will be doing a service
to his brother practitioners, whose attention may not as yet have
been directed to this important point, turns to some of the most popu-
lar and recent of these hand-books, to substantiate his declaration.

Look, e. g., at the objects proposed in the treatment, in Eberle's
Practice a work which has had so large a share in forming the
opinions of medical men and shaping their practice : "In the treat-
ment of this disease, there are three primary pathological conditions,
according to which the general indications of remediate manage-
ment must be directed, viz : 1. Functional derangement of the liver
and alimentary canal. 2. Redundancy of morbid or vitiated secre-
tions, and consequent irritation in the intestinal tube. 3. An irritated
increased action of the heart and arteries. Hence, the principal
indications in the treatment are : 1, to moderate t he febrile reaction
of the arterial system ; 2, to remove out ofthe alimentary canal, the
vitiated and irritating secretions which may he lodged in it; 3, to
restore the healthy functions of the liver and alimentary canal; and
4, to obviate gastro-intestinal irritation." Among the methods of
treatment, not a wool is said of an effort to arrest it.

In Du'nglison's practice, the whole roulino system of bleeding,

136 Intermittent Fever. [March,

puking, purging, sweating, refrigerating, blistering, &c, is examined,
but not a word as to the abortive treatment.

The writer turns to the treatment of Remittent fever in a work
published in 1845, by Dr. Clymer, whose aim has been, "to adapt it
particularly to the necessities of the American Practitioner,'"' and
reads "The indication of treatment in Remittent fever do not mate-
rially differ from those of continued {ever. The points more particu-
larly to be attended to, are the reduction of the general fever, the
obviating the effects of congestion and inflammatory action in th8
liver," and other organs. In a note, we are informed, that the simple
expectant plan, is the one, which has been generally of late recom-
mended by the experienced ! At the end of the note the indication
is stated, in the Congestive fever, to prevent the recurrence of the
paroxysm.

In Watson's Practice by Condie, Remittent fever forms the sub-
ject of a note in which it is announced that the most important
question that presents itself in the treatment is the propriety of direct
depletion by the lancet ! And in Professor Dickson's Lectures, com-
mended especially to the Southern student and practitioner, there is
the same minute remark upon bloodletting, emetics, cathartics, calo-
mel, cold, &c, &c, but not one word upon what must be regarded
as the leading rational object the checking of the paroxysm. In-
deed upon this point, the necessary continuance of the disease when
once formed is distinctly, though incidentally asserted. "Could
we reasonably hope to prostrate the disease by a single blow, as is
often done in the cure of the phlegmasia?, in pleurisy, &c, we might
more implicitly trust to the lancet : but the case is far otherwise.
Here the atmospheric and climatic predispositions are permanent,
and the poisonous cause is still diffused around the patient, impressing
the tissues with a continuous and unavoidable agency. Success
does not depend upon, nor can we hope or expect to attain it, by any
single measure, however judicious and energetic."

In Professor Chapman's Syllabus, by Kennedy, published in 1816,
quinine, the specific remedy for jugulating Remittent fever, is classed
among the adjuvants of the old routine system of practice.

And in Bell &. Stokes' Practice, even in the latest edition, although
the efficacy of the quinine practice is fully shown the early un-
conditional use of quinine plainly set forth and triumphantly vindi-
cated, yet in the treatment of the milder forms of remittent, this
cardinal object of checking the recurrence of the paroxysm is not

1847. J Intermit lent Fever. 1 37

even hinted at. The writer, however, in passing, would pay the
trihute of his high respect to the author nfthe articles on paroxysmal
fevers, in this work; and express his sense of the obligations of the
profession and of society to that author, for the general diffusion ot
modes of treatment, so admirably calculated to check the mortality
of that hitherto fatal and always dangerous disease, congestive in-
termittent and remittent fever.

But where the propriety of confining the use of quinine to Con-
gestive Remittent fever? where the propriety of allowing simple
remittent to run its course unchecked, whilst we hold in our hands a
remedy so safe, so gentle, so certain as the sulphate of quinine? If it
have the power of arresting the paroxysms of malignant remittent, in.
which, on the Remittent fever is superadded the disturbing influences
of extensive congestions and local inflammations, surely it must be
able to control and arrest the simple form ; and if so, there can be
no propriety in allowing it to run its course unchecked ; for who,
that has lived where remittents are endemic, does not know, that a
malignant paroxysm often supervenes, after many paroxysms of a
mild and simple character; and that this paroxysm is dangerous in
proportion to the previous duration of the fever: and, further, that
simple remittent often lapses off into the typhoid state, to the immi-
nent danger of the patient. Why run the hazard of these dangers
by allowing its continuance?

To prevent the recurrence of the paroxysms to jugulate the
disease. An analysis of the symptoms points to this then, as the
prominent object, in every stage and every degree of the disease, as
long, at least, as it preserves a paroxysmal character. Whilst it
generally happens, that opportunity is afforded for the use of deple-
tion, by bloodletting and other evacuations, during the paroxysm, yet
the pathology which teaches that the Remittent fever is the main
affection, forbids us to allow the first remission to pass without at-
tempting to accomplish this primary indication, even if evacuations
may not have been previously employed. This object may be ac-
complished hy the use of sulphate of quinine universally acknow-
ledged to be the specific of intermittent fever, indicated also, as the
specific of Remittent, by the fundamental similarity of these two
affections, and known to be so, by all who have thus used it. The
interval between the paroxysms being shorter than in the intermittent
form, the doses must necessarily be larger, in order to administer the

138 Intermittent Fever, [March,

requisite quantity, before the period of the next accession from five
to ten grains, hourly, according to the length of the remission, to the
extent of fifteen, twenty, or fifty grains. For in determining the
quantity, the rule laid down in the treatment of malignant intermit-
tents, serves for the guide here, viz: the quantity to be directly
proportioned to the degree of danger apprehended from the coming
paroxysm ; thus, in malignant remittents, the largest, and in simple
remittents, the smallest quantity.

Thewriter must be content with stating the result of his own ex-
perience, in this mode of treatment: that generally it checks the
first paroxysm, almost universally the second, in the milder forms of
the disease that the average time of attendance upon such cases is
about three or four days that, when the quinine fails to arrest a
coming paroxysm, it mitigates its violence, shortens its duration ;
and although in some rare cases, the nervous symptoms produced by
the remedy, are distressing to the patient, during the paroxysm, these
are soon relieved by the treatment appropriate to this state that he
has almost forgotten the features of the typhoid state of fever, so-
painfully familiar to him, previous to the last twelve years, when
using the treatment then generally taught by authority and sanction-
ed by the profession.

Of this result the writer would say those who have not fairly
tried this mode of practice, have no right to question the justness of
his conclusion those who have, he confidently believes, will con-
firm it.

The writer does not undervalue the minute estimation of the cir-
cumstances, under which bloodletting, emetics, cathartics, mercurials
and others, should and should not be used, which is to be found in all
the works on Practice ; yet he declares his conviction, that the prac-
titioner, holding steadily to this prominent indication, will find little
need of availing himself of such instruction that in the great ma-
jority of cases of simple Intermittent fever, by the use, during the
paroxysm, of bloodletting or not, and of that safest and surest emetic,
water, (cold or warm, according to circumstances,) ingested into the
stomach in such liberal quantities as to produce detergent vomiting,
and this followed by a large saline injection to evacuate the bowels,
and sinapisms to the vertebral column ; the comfort of the patient is
better secured, than by the administration of much physic, until the
time arrives for the administration of the specific. If after the sub-
duclion of the fever, there remains the evidence of disease in the

1847.] Intermittent Fever. 139

liver or stomach or bowels, then this maybe corrected by appropriate
remedies, more readily, more safely and effectually than during the
fever. The writer would insist upon this subsequent treatment of
any remaining disease, as a necessary part of this abortive treatment.

How totally different the treatment here recommended for incipient
Remittent fever, from that in recently published books of Practice,
may appear by the following quotation from Professor Dickson's,
issued as late as lSio : "During the Remission which the manage-
ment above detailed as requisite throughout the course and progress
of the exacerbation is intended to hasten, to render more perfect, and
to prolong, you must not allow your attention to your patient to
slacken. Xay. you are now called upon, perhaps, for a still nicer
and more assiduous exertion of diligence and skill, as the improved
circumstances often afford a better opportunity of useful interference.
Purgatives, if formerly rejected, will now probably remain upon the
stomach and act kindly. Diaphoretics, too, are less apt to nauseate,
and may be exhibited in fuller doses, and procure a more free and
(diffused sweating. It is thus that you may hope to diminish the
vioJence of the returning exacerbation, if you cannot altogether pre-
vent it. To subtract as much as possible from its intensity, time the
administration of your prescriptions so as to bring your patient most
completely under their effect, freely operated on by your purgative,
fully sweated by your sudorific, just at the period of its expected inva-
sion. Let his windows then be darkened, his apartment kept fresh
and cool by ventilation, and, if necessary, by evaporation, sprinkling
his floor with water, vinegar, or ardent spirits, and prevent any ex-
citement by noise or by cpnversation with him. It is always advisable
farther, to meet a coming exacerbation with revulsives so applied as
to counteract or diminish the local determinations to important or-
gans." The writer declares his greater' confidence in the silent
operation of fifteen or twenty grains of quinine, during the remission,
in the absence of the physician, than in the strictest surveillance of
a whole College-faculty, armed with their Cathartics, Sudorifics and
Mustard-plasters.

The value of this treatment, if it be as successful as herein declared,
will be the more highly appreciated, if . it one view, the

various terminations of Remittent fever of the milder kind that the
most favorable is in convalescence at the end of a week or ten days,
after the patient shall hat . not only all the anguish of

fever, but in addition thereto, the annoyance of emetics, cathartics,

140 Intermittent Fever. [March,

nauseous sudorific draughts, perhaps ptyalism, perhaps flaying with
vesicatories, and moreover, agitated, day after day, patient and
friends, by the uncertainty of the final result that another termina-
tion is the unexpected development of a malignant paroxysm, almost
uniformly fatal, certainly so, with the continuance of the treatment
which permitted it that another is, the gradual loss of the remitting
character and the establishment of the typhoid state, not as uniform-
ly fatal, but imminently dangerous. The abortive treatment secures
an early convalescence, saving the patient many days of vexation
from fever and physic, with his strength but little impaired by deple-
tion it secures him from the hazard of a malignant paroxysm
from the doubtful issue of the typhoid state doubtful under any of
the many modes of treatment; and it will never impose upon the
physician the fearful alternative of allowing the disease to run its
course towards a doubtful issue, or to adopt a heroic course of mer-
cury, which may end in salivation an artificial disease, infinitely
more annoying and of longer duration than the one it may have sub-
stituted which may at last end in the loss of the patient's teeth or
of his lips or of his life. Fearful indeed is the choice of the latter
alternative; and far better, that the profession should lay under the
reproach of impotency to save human life, than the more terrible one
of sacrificing it.

When it is remembered that Remittent fever is the endemic dis-
ease of Southern climates, the necessary exposure of the population
in the summer and autumn, and the universality of its attacks, and
the high rate of its mortality, under every mode of treatment hitherto
adopted, and if the success of the abortive method has been here
truly represented ; then it may not be deemed extravagant to say
that its universal adoption throughout the Southern country, would
confer blessings, within that sphere, proportionate to those conferred
upon the world, by the discovery of Vaccination. It is gratifying to
know, that it is fast winning its way to this universal adoption ; and
the claim to the honor of diffusing the knowledge of this treatment,
in this region of the Southern country, set forth in behalf of the
Medical College of Georgia, by Professor Dugas, in his recent intro-
ductory lecture, is unhesitatingly endorsed by the writer. Here, the
principle of this method was distinctly and publicly announced, as
early as 1836, and ever since, its alumni, fully indoctrinated in the
principles of this method, scattered through this and the neighboring
States, have freely used the influence, which their unprecedented

1847.] Observations on various Diseases. 141

M .

success in the treatment of bilious fever, lias secured to them, in ex-
tending the same principles far and wide among their brethren of
the faculty. It wins its way readily to the willing and candid en-
quirer, and compels the assent of the reluctant.

2. To moderate the violence of the paroxysm. If the congestions
and inflammations manifested with increased violence during the
paroxysms are accidents, they do yet materially affect the issue of
the case, and must command attention. But it is not the intention
of the writer, at present, to enlarge upon this part of the treatment,
the circumstances under which the various means of the antiphlogis-
tic method may or may not be used, having been so judiciously de-
fined in the works on Practice. It was his intention to have added
cases, to show how fairly the principles of pathology and practice,
here advocated, are deduced from facts ; but circumstances forbid the
extension of this article.

ARTICLE IX.

Observations on various Diseases. By Robert Edmonds Little,
M. D., of Quincy, Florida.

We trust that no apology will be deemed necessary for the publi-
cation of the following notes: they were made at the bedside the
only situation in which disease can be read with fidelity : and although
they may by many be esteemed tiresome, they are presented with
the hope that others may be induced to follow up the plan of observ-
ing for themselves, and not rest altogether contented with the
delineations of theoretical systematists ; and although we recommend
the accumulation- of facts as the basis of excellence, we would not
be understood as desiring to abandon inductive reasoning. Facts
and speculations are mutually dependent on each other for without
theory facts would be of little value ; while on the other hand, in the
absence of facts, speculation would be positively harmless : a just
appreciation of both cannot fail to render the intelligent observer an
ornament to the profession a benefit to society

Abscess of the extremities, the result of constitutional irritation.
The influence exerted by constitutional derangement in the produc-
tion of local diseases is acknowledged by all ; and although this is

142 Observations on various Diseases. [March,

more particularly witnessed in the progress of febrile diseases, we
have in some few instances encountered a severe form of abscess of
the extremities, induced, we have every reason to believe, by a pecu-
liar condition of the general system, the contour of body, presenting
many of the characteristics of good health ; yet on more close exam-
ination defects may be perceived by the professional man which
would altogether escape the notice of the superficial observer. As to
the relationship existing between this condition of the system, which
we shall hereafter notice, and the disease in question, we are not
perfectly satisfied yet so far as our observation extends, they are
concomitant ; and as it is not our design, through force of imagina-
tion, to convert fancies into facts, or to substitute one for the other,
we shall present our observations through the medium of cases, leav-
ing the reader to put whatever estimate upon them which experience
and judgment may dictate.

, a boyj eight years of age, in the beginning of September,

1844, without any apparent previous indisposition, complained of a
severe pain in the region of the external malleolus of the right leg ;
but as he was subject to what is denominated in the southern country
" toe itch," little attention was paid to his complaints, until the foot
and ankle had become considerably enlarged. The swelling increased
so rapidly that within thirty. six hours the leg, from the knee down,
was enlarged to double its natural size, presenting a tense shining
appearance. Various domestic remedies were resorted to prior to
paying me a visit, but without any mitigation of either pain or swel-
ling. Nine days from the commencement of the disease he was
brought in a carriage to my office. Although no fluctuation could be
perceived, we determined to puncture the most prominent point on
the leg accordingly a deep incision, an inch in length, was made
immediately over the external malleolus, from which escaped six or
eight ounces of pure pus, with the effect of procuring instant relief
from the extreme pain under which the little patient had labored for
more than a week. With the design of arresting the inflammatory
action, the tincture of iodine was directed to be applied every twelve
hours over the whole limb, from the knee down at the same time a
mild antiphlogistic course was pursued. For several days the tinc-
ture of iodine was continued, without any other effect than that of
slightly arrestingthe progress of the disease. The inflammatory ac-
tion, after a temporary arrest, again commenced its march, attacking
And destroying the skin and cellular substance, so as to leave fully

1817.] Observations on various Diseases. 143

exposed to view, the external malleolus of the fibula, the astragalus,
the anterior fasciculus of the external lateral ligament attached to
the astragalus, and a portion of the middle and fasciculus attached to
the os calcis and astragalus. From the appearance of the pus dis-
charged, it was apprehended that a carious bone was the cause of the
continuance of the disease. A minute examination was made, which
resulted in the discovery of the carious condidion of the astragalus,
which was easily removed. We were unable to detect any thing
like disease in any of the other tarsal bones, and a speedy recovery
was anticipated, from the effect which the treatment adopted seemed
to produce an anticipation which was not destined however to bo
realized. The external use of the tincture of iodine, various kinds
of injections, and the bandage, were all tried, with the effect of caus-
ing the cavity to fill up, and an almost entire disappearance of the
discharge. Notwithstanding the favorable progress of the case, on
a sudden the sore again assumed an unhealthy appearance, with an
increase of the matter discharged. Convinced that this diseased
condition of the parts depended on some state of the system of which
we were not cognizant, a more vigorous course of general treatment
was adopted, although, in connection with the local treatment, meas-
ures for improving and invigorating the little patient's health had not
been neglected.

Having observed the good effects of tonics, and especially those of
a ferruginous kind, in the treatment of the diseases incident to chil-
dren in this latitude, and as our patient exhibited many of the symp-
toms characteristic of serous polyaemia, he was subjected to a tonic
course of treatment at the same time' the local use of iodine was
resorted to. He was allowed a generous diet of animal food, and two
pills, each composed of three grains of aloes and the sulphate of iron,
were administered night and morning. Under this course, pursued
for a week, we had the satisfaction of perceiving an improvement,
not only in the general appearance of the patient, but also of the
nicer, which had entirely healed. A slight deformity only exists in
the ankle joint, and he is now using it with as much facility as he
does the opposite limb*

Since the dismissal of the patient, we have had two cases of a pre-
cisely similar kind, in one of which the disease attacked the fibula,
and in the other the os calcis, both of which bones were exsected. In
each case, the usual remedies were used in vain, and the aspect of
the disease changed, not until the treatment similar to that resorted

144 Observations on various Diseases. [March,

to in the first case was tested. From the circumstance of all three
cases occurring in boys, having the same characteristic symptoms of
a depraved condition of the general system, and the inefficiency of
the usual mode of treatment, and the success of the one finally adopt-
ed, the conclusion as to a relationship existing between the forms
of abscess and a sero-polyasmic disposition is to our mind clear.
To others, the coincidence may appear accidental ; yet, so well are
we convinced to the contrary, should other cases present themselves
to our consideration, our treatment would be almost wholly constitu-
tional, and we should expect success to be in a direct ratio with the
perseverance maintained.

A remark as the extent to which the preparations of iron, and es-
pecially the sulphate, may be persevered In large medicinal doses,
it is said to produce pain, heat and other uneasiness, at the pit of the
stomach, and not unfrequently nausea and vomiting. We have
used the article very extensively in the treatment of a variety of
affections, and can confidently assert that in fifteen and twenty grain
doses, (having frequently extended its use to that quantity,) we have
never observed any thing of the kind, even when used daily for
weeks, save in a few irritable systems. In small doses of from one
to five grains, it may prove astringent, but in large doses we always
anticipate from its use an aperient action on the bowels. These ob-
servations as to its action, are the result of an extensive acquaintance
with the remedy.

Case of Ischuria Renalis, in a mulatto ; in which the secretion of
urine was suspended entirely, for several days Recovery of the pa-
tient. 'The following remarkable case ofthis most dangerous disease
occurred in our practice several years ago, and is presented with a
view of showing to what extent the malady may progress and yet
terminate favorably. The patient, a mulatto girl, about eighteen
years of age, was visited for the first time, on the 11th day of Nov.
1843. She complained of pain in the head and back, and constipa-
ted bowels ; her pulse was full and strong, and the temperature of
the skin very much increased. She was bled to the amount of twelve
or fourteen ounces, and an active cathartic ordered. For the two
subsequent days she was entirely free from any symptoms of disease,
but on the third she complained of vertigo and excessive pain in the
lumbar region, and for the first time disclosed the scanty secretion of
urine, not more than a half-gill being secreted in the twenty-four

1847.] Observations on various Diseases. 145

hours. Towards evening the sensorium seemed affected ; the patient
being drowsy evinced an indisposition to exertion of any kind ;
the eyes yellow and suffused ; pulse slow and full ; with a slight ten-
dency to stiffness in the limbs. The catheter was introduced into
the hladder, hut no urine was discharged. The symptoms indicating
the abstraction of blood, eighteen ounces were drawn from the arm,
a mercurial cathirtic administered, and a blister applied to the lum-
bar region. From this date, the lith, until the 24//*, not a drop of
urine passed from the bladder, although the catheter was introduced
daily. During the whole of this time, the sensorium was more or
less affected ; the patient at one period was delirious, and again ap-
parently comatose. On the 16th, she was attacked with stiffness of
thelimbs, which increased until the fore-arm became flexed, the fing-
ers closed on the palms, and the legs spasmodically extended, when
the paroxysm would gradually disappear after a continuance of some
two* hours. The paroxysms recurred at irregular intervals for about
three weeks, several days afier the secretion of urine was restored.
During a paroxysm, the whole muscular system seemed to be affected
the face flushed the pulse full and hard the skin hot and bathed
in profuse perspiration ; but towards its termination, an opposite state
of things would prevail, and the patient awake up, completely pros-
trated in mind and bodv. The high state of excitement under
which she labored, induced us to resort to venesection, the warm
bath, &c, hut without effect ; in fact, all the remedies used appeared
rather to increase than diminish the violence of a paroxysm. At
last, an unusually severe paroxysm having occurred on the 24th, re-
course was had to an enema of tobacco, made by infusing two
drachms of tobacco in a pint of boiling water. In a very few min-
utes after its administration the patient became intensely sick, and
made violent efforts to vomit, while the rigidity of the muscular sys-
tem speedily disappeared. It became necessary to repeat the injection
daily as long as the spasms continued. Immediately after the close
of the paroxysm on the morning of the 24th, the patient complained
of fulness in the supra-pubic region ; the catheter was introduced into
the bladder and six ounces of pure pus, without any admixture of
urine, were discharged. In the evening, about two ounces more were
drawn mixed with urine the first she had passed since the 14th, a pe-
riod of eleven days. From this time her improvement was manifest,
the spasms becoming less frequent and violent, and the urine increas-
ing in quantity, until about the middle of December, when she was dis-
charged as cured. 10

118 Observations on vcrious Diseases. [March,

The foregoing case is certainly remarkable for its duration ; as-
very few cases of this sure and usually fatal disease are extended
beyond the eighth or ninth day, death most commonly terminating
the patient's sufferings even before that period. So far as we are
aware, the period of time between the cessation and the reappear-
ance of the secretion of urine, is longer than that of any recorded
case, in which recovery took place.

The administration of tobacco for the relief of spasm of an hys-
terical and tetanic nature, although of ancient origin, is not, we
believe, general with the profession. Its use in the present instance
was of undoubted utility, as was evinced by its power in controlling
the paroxysms, after other remedies had failed, and in several instan-
ces since we have observed its good effects. The cases in which we
have exhibited the tobacco, were such as were possessed of a vigor-
ous constitution, with a full, tense pulse, and in short all the evidences
of high arterial excitement. To such, and such alone, is the remedy
applicable. Cases of an opposite description we need not say would
be injured instead of benefitted by its administration.

II( mat ernes is, the result of diseased liver ; death; inspection.
Within the last three or four years, we have met with several cases
cf this form of disease ; all of which occurred in individuals whose
constitutions were impaired by dissipation. Two of the cases ter-
minated fatally, and of these two, only one was examined. The
subject of this case was a man aged about forty years, and of dissi-
pated habits. For three months before his death he was confined to
the house, the subject of ascites, from which he had in a measure
been relieved, when he was suddenly attacked with vomiting and
purging of blood, in small quantities, however, which continued for
three days notwithstanding the use of appropriate remedies, when the
patient expired, completely exhausted from loss of biood.

Autopsv, eight hours after death. The lungs were found healthy ;
heart soft and flabby; stomach and small intestines very vascular,
and containing a quart of dark coagulated blood ; the liver presented
an irregular appearance, and was evidently very much diminished in
size. When cut into, small globular bodies were seen, divided by
partitions of a fibrous character; the former probably the acini in a
slate of enlargement, and the latter the cellular tissue thickened.
Its peritoneal covering was altered in structure, being thickened and
of a darker hue than usual. The weight of the organ was diminish-

1947.] Creosote in Diarrhoea and Dysentery, 147

cJ. while its blood-vessels were much lesseaed in size, in many points
obliterated.

From the above appearance?, the pathology is easily understood :
an impediment to the vena porta discharging its contents into its
proper reservoir, inducing congestion of the branches forming this
vessel, and as a consequence, the heemorrhage.
(to be continued.)

ARTICLE X.

Application of Creosote to the treatment of Diarrhoea and Dysentery.
By J. A. Mayes, M. D., of Sumter District, So. Ca.

In the October number of this Journal, for 1846, I reported two
cases of protracted Diarrhoea, which yielded in a very short time to
the internal use of Creosote, after resisting all other remedies which
had been prescribed. The success which attended its administration
in these cases, encouraged me to make a more general application of
the article; and, though opportunities sufficient have not occurred
for making any extensive trial, yet the result of its employment has
been to give me a most favorable opinion of its efficacy. For the
purpose of inciting others, more competent than myself, to the task
of making a full investigation of its therapeutical action, IofTer below
the result of my experience with the creosote in the treatment of
diarrhoea and dysentery.

The form of diarrhoea to which creosote appears particularly
applicable, is that, unaccompanied by much pain and febrile ex-
citement, but which, after the operation of a mild aperient re-
quires the use of absorbents and astringents to check the frequent
watery alvine dejections. These cases are common enough, and
the physician is seldom called in to prescribe for them ; never,
indeed, unless the diarrhoea resists for some time, all the various as-
tringents used in domestic practice. In such cases, I can confidently
recommend the creosote as being speedy and certain in its effects ;
restraining the discharges, but not producing constipation. This
efTect has been produced in all the cases in which it has been pre-
scribed, and is in my opinion its chief recommendation. Everv
physician knows by experience, that after the use of the ordinary
astringents, catechu, kino, briar root, &c, considerable difficulty is

148 Creosote in Diarrhcea and Dysentery. [March,

found in restoring the bowels to their natural state ; more or less
constipation resulting from their use. I have not yet observed con-
stipation to be produced by the creosote, and should its effect in all
the cases in which it may he hereafter prescribed, be that of simply
diminishing the frequency of the discharges, it will, of course, bo
ranked as an important adjunct in many cases, and in a great ma-
jority of cases, the principal remedy.

Asa general rule of pracfice, I would prescribe the creosote, either
alone or in combination, in all cases of diarrhoea, after the operation
of a mild aperient. This aperient, I recommend, for the purpose of
removing from the bowels all irritating matters; since the disease is
caused oftener than otherwise by the presence of imperfectly digested
food in the bowels, or by the ingestion of unwholesome substances,
as fruit, unripe, or in the incipient stages of decomposition. As a
remedy in the bowel affections of children, the creosote is worthy of
attention ; the smallness of its dose, and the consequent facility of
its administration, being of itself a matter of importance, and so
far as I have noticed children make very little objection to it, but
take it readily notwithstanding its disagreeable odour.

Case I. A child, under my care at this time, had been laboring
under diarrhoea, about two months; the cause of the disease being
evidently the irritation of dentition. The symptoms, in this case,
were by no means alarming, and presented no peculiarity worthy of
note. After prescribing several of the more common astringents
with little or no benefit to the patient, I directed the following pre-
scription : ft. Gum Arabic, 3i.; loaf sugar, 3i. ; creosote, iv. gtts.;
water, fii. mix intimately in a mortar. A teaspoonful three times
daily during the continuance of the diarrhoea; and once daily for
some time afterwards, as a prophilactic. I prescribed the creosote in
this case without much confidence in its efficacy, and I did not be-
lieve the remedy had the power of calming the irritation which caused
the disease ; but, contrary to my expectations, the medicine acted
very promptly, arresting the disease in the course of twenty-four
hours: and up to the time of writing this, (nearly three weeks after
the prescription was given.) there has been no return of the disease.

In dysenteries of high inflammatory action, fever, strong and full
pulse, I have not yet ventured to prescribe the creosote until those
symptoms were overcome by other means, though I am inclined to
think that a cautious use of it, would be productive of advantage.
We frequently, however, meet with cases, attended by great pain and

1847.] * Creosote in Diarrh&a and Dysentery, 149

tenderness of the bowels, constant griping and disposition to stool,
but with little or no fever: in such cases, I would prescribe, at once,
the creosote in combination with opium, without any fear of unpleas-
ant consequences.

Case II. Miss M. G was attacked on the 20th of September

with dysentery. For the first two or three days she had high fevers,
but afterwards the fevers were light, constant nausea and occasional
vomitings incessant griping, frequent but small bloody discharges
from the bowels, &c. She had taken several doses of castor oil
herb teas of various sorts, burnt brandy, and a variety of other arti-
cles. Her disease did not appear to yield to such remedies, and on
the 26th I was called in to prescribe for her.

Found her suffering great pain throughout the abdomen, bowels
very tender under pressure, constant disposition to vomit, griping al-
most incessant, bloody discharges small but very frequent, little or
no fever, the pulse being rather too frequent, but soft and compressi-
ble, tongue furred, and rather dry excessive thirst. Prescription.
U. Opium viii. grs. ; creosote v. gits. ; powdered liquorice sufficient
to make eight piiis one to be taken every three hours, and after the
last pill, a dose (table-spoonful) of castor oil a strong pepper cata-
plasm, large enough to cover the whole abdomen, to be kept con-
stantly applied mucilage of slippery e!m to be drank very freely.

27th. Found my patient to-day much improved; very little pain
and tenderness of the bowels, bloody discharges had ceased after the
third pill yesterday, little or no thirst, pulse not too frequent, skin
warm and moist castor oil had operated once, discharge very dark
and appeared to consist chiefly of coagulated blood. Prescription.
ft. Opium viii. grs. ; creosote v, gtts. ; liquorice powder sufficient to
make twelve pills one to be taken every four hours ; slippery elm
as before.

29th. Patient doing well. No further treatment thought neces-
sary, but the diet to be properly regulated.

It may be well to remark here that this patient was attacked a few
days afterwards with intermittent fever of the quotidian type. One
active purge was administered in the' course of the treatment, but
there was, in consequence, no disposition of her former disease to
return ; quinine and ext. cinchona?, soon restored her to good health.

Cask III. VV. II. C was attacked by bilious remittent fever
on the 30th Qctnber : the fever was ushered in hv sev which

lasted three or four hours. The most ymptoms during

150 Creosote in Diarrhoea and Dysentery. [March,

the course of the fever, were severe headache, pain in the right side,
and nausea. These symptoms did not abate much until the first
apyrexia, which occurred on the 1st of November. Quinine then
arrested its course, and the prospect of a speedy recovery was very
flattering. - On the 3d of November, however, he was attacked with
dysentery. Being recalled to prescribe for him, I found him suffer-
ing great pain in the bowels, griping incessant, frequent but small
bloody discharges from the bowels, no fever, pulse soft and compres-
sible, skin rather dry had taken two doses of laudanum, 25 drops
each ; the last dose about three hours before I arrived, but no abate-
ment of the symptoms had been perceived. Prescription. R. Opi-
um v. grs. ; creosote iii. gtts. ; powdered liquorice sufficient to make
six pills one to be taken every three hours, and a table-spoonful of
castor oil after the last pill ; warm cataplasms to cover the whole
abdomen, and the free use of mucilaginous drinks.

Nov. 4th. Found my patient perfectly relieved castor oil had
operated, bringing off a large discharge of dark matters, resembling
coagulated blood mixed with mucus. Directed the mucilnges to be
used as before ; diet mild and unirritating. His recovery was very
rapid, and he has since enjoyed very good health.

The form of administration, I prefer, is that of emulsion, made ac-
cording to the formula above ; though in many cases the form of pill
is preferred by patients. The average dose for adults is about half a
drop, repeated pro re nata ; for children |- to of a drop.

In "Dunglison's new remedies," I find the dose recommended to
be about one or two drop?. This quantity, for ordinary cases, seems
to be too large, and my experience, as seen above, is decidedly in
favor of smaller doses. Administered in combination with opium in
painful dysenteries, the effects of both appear to be increased, as the
relief afforded is generally much quicker than could be expected from
either alone.

A great deal of the discrepancy of opinion concerning creosote
amongst writers on the subject, has probably arisen from the quanti-
ties administered at a dose. Thus in vomiting, not proceeding from
inflammation or organic disease, some eminent physicians affirm it
to excel all known medicines : others derived no ad\antage from it ;
and Dr. Dungiison remarks that, "in many cases, indeed, it has de-
veloped irritability of the stomach, where it did not previously exist."
My own opinion is, that this difference of opinion is caused by the
doses administered being too large in those cases where it failed or

1847.] Remarks on Ccmp Diseases in Sn;thern Climates. 151

developed irritability. Having had no experience with the article in
those cases, of course, I am not prepared to speak positively ; but I
would recommend to all who prescribe the creosote, the use of frac-
tions of a drop to commence with, as the prospect of obtaining favor-
ble results is much better when administered in small doses than in
large. Creosote being, as is well known, a posverfully acrid sub.
stance, no surprise need be manifested when it is asserted that it
produces irritability of the stomach in doses of two drops.

In the foregoing remarks, I have endeavored to give the result of
my own observations, unbiassed by any prediiection in its favor, or
by the favorable reports received from others. Whether the favora-
ble opinion I have formed of the powers of creosote as a remedy for
diarrhaeea and dysentery, will be confirmed by time and experience,
remains yet to be seen.

PART II. REVIEWS AND EXTRACTS.

Some Remarks on Camp Diseases in Southern Climates. By
Samuel A. Cartwright, M. D , of Natchez. (New Orleans
Medical and Surgical Journal.)

War and Medicine are more closely allied than is generally sup.
posed. I\Jany of the greatest armies hive been ruined in a few davs
by diseases that might have been avoided. Unfortunately it is too
common for commanders of armies to look upon physicians as mere
prescribes of pills and powders, and to take fcr granted that they
have nothing to answer on the great questions connected with exten.
sive military operations. Although many of them have not, yet it by
no me an 8 folio ws that the science of Medicine is limited by the bounds
of their knowledge. The first step in the science, is to learn to cure
such diseases as are curable ; but a higher to learn the secret of pre-
venting them. Health is indispensible to the efficiency of an army,
particularly a large one. Without health, M numbers etfect nothing,
but multiply distress." The case is worse if the army is far from
home, in an enemy's country, and strangers to the climate and its
influences. In such a case, the secret of preventing disease, can
seldom bo found hv the commander of the army alone, unless he is
aided by the light of medical science. Captain Cook, who sailed
round the world so often, and kept his crew healthy, at a time that
scurvy was destroying whole fleets, had learned the secret, so import-
ant for every commander to know, of preventing disease. He knew
nothing about curing diseases, i. c, he was no doctor, in the common

152 Remarks on Camp Diseases in Southern Climates. [March,

understanding of the term, but he was a great physician in regard to
preventing disease. He borrowed light from Medicine, and reflected
light on the science he borrowed from. Physicians studied Captain
Cook like a medical author. His discipline, his dietetics, hours of
rest, and every thing that passed on board his ship, was studied.
Aided by his book, physicians soon banished scurvy from the navy.
The camp dysentery is as much the plague of large armies on the
land, as the scurvy ever was to mariners. King Henry V. invaded
France with fifty thousand men, in August. In September, the camp
dysentery swept off nearly half of them, and so disabled the balance,
that a disgraceful retreat was the consequence of King Henry's not
having learned the art of preventing disease. In 1792, the hundred
thousand Austrian and Prussian soldiers, who invaded France, were,
in one short month, so much disabled by the dysentery, as to be un-
able to do any thing but retreat. The dysentery has been an attend-
ant on all military operations, on a large scale, in every instance
where the- commander has not learned the secret of preventing it.
That disease alone, the last century, has destroyed more soldiers than
all the weapons of war that have ever been invented. That science
which is too poor to cure a single case of organic disease, an ulcer in
the lungs, for instance, or any disorder of structure in a part essential
to life, is rich in materials for preventing diseases among armies, and
curing them promptly when they happen. The disease of armies
are nearly ail functional, not structural, as they often are in private
practice. , Those who have any organic or structural derangement
are not received as soldiers. The young and vigorous fill up armies.
Their diseases are nearly all owing to derangement of function, not
structure, and are mostly curable when they happen, and* by proper
management can generally be prevented from happeningv Too low
an estimate will be put upon the value of the science of Medicine to
armies, to judge of it simply by the curable and incurable case- in
private practice. Thus, a physician in private practice must, from
necessity, Ios"e every case of confirmed consumption, and every case
of dysentery, or other disease connected with any organic derange-
ment of structure essential to life but the same physician could cure
every case of cough, and every case of dysentery, occurring among
soldiers, because fie has no organic derangement to contend with,
their diseases being all functional; that is, some organ has become
deranged from some temporary cause ; it is whole and entire, but
cannot perform its functions from some temporary obstruction. In
private practice such cases are readily relieved under almost any
kind of treatment, or will generally get well, after so long a time, by
the efforts (/filature, under good nursing and the comforts of home.
Not so in the army. They are deadly without the timely and judicious
aid ot medicine. At home, under ordinary circumstances, the mea-
sles are not commonly fata! with or without treatment. In the army
it is deadly without treatment and deadly with it unless directed
by a physician acquainted with its new laws under the new circum-

1847.] Remarks on Camp Diseases in Southern Climates. 153

lances. The same may be: said of dysentery, nnd bilious fcreT. If
the.^e, and similar diseases, occurring in the army, are not promptly
cured, the fault does not lie in the science of Medicine, but in the
physician not having studied the science thoroughly, or in the com-
manding general not aiding nor abetting him in the treatment. The
l apidity with which disease, particularly dysentery, spreads through a
camp, in southern latitudes, often strikes terror into the stoutest
hearts. Far from home, and deprived of all the comforts of home, as
soon as the soldier finds himself helpless by disease, he loses the man
and becomes a child ; a feeling of despondency comes over him, un-
less he has some one to look up to as a protector in his weakness.
Fear or despondency will baffle the best directed treatment of the
physician, unless the commanding officer drives fear from his camp
by winning the affections of his soldiers. If the soldier finds that his
officer takes a deep interest in his welfare, be neither fears nor des-
ponds. General Jackson walking and a sick soldier riding his horse
dispelled fear and despondency, not only from the favored sick man
and ali others on the sick list, but also acted as a preventive of dis-
ease in those who were well. One great secret of preventing disease
among soldiers, is "to keep the vital and animal powers in uniform
confederacy." Fear, like a bad diet, want of comfortable clothing,
or over exertion, lowers the vital energies, and opens wide the door
to diseases of all kinds particularly dysenteries and fevers. When
bad diet, want of tents, and clothing, and over exertion, have been
encountered, and no sickness followed, physicians have only to read
attentively the history of the commanding general, on those occasions,
to read .Medicine. Napolean had the power of preventing disease,
in an eminent degree, by infusing his spirit into his soldiers, and
making them feel as he feit, and thus enabling them to resist the
natural causes of disease fatigue, hunger, and exposure, by sup-
plying them with a mental stimulus to make up foi the want of the
usual animal stimuli, as food, drink, sleep, and rest. If, under great
privations, without tents, clothing, or a regular supply of food, and
under forced marches, in inclement weather, disease can be prevent-
ed by the commanding general, how much more can it be prevented
in the ordinary ctacumstances of camp life? But it is chiefly in what
might be called camp luxury that sickness is most rife. Good tents,
a plenty to eat, and nothing to do, is sure to bring on disease unless
the commander adopt measures to counteract it, by giving his whole
attention to the subject of preserving the health of his soldiers. When
an army is on the march to meet the enemy, the amor jmtrim closes
up the avenues to disease, but when encamped the love of country is
not so strongly felt, and hence one powerful brace against morbid
influence becomes relaxed. Besides, the malaria, or eifluvia, arising
from a great number of men, stationary, particularly in warm wea-
ther, become a cause of pestilence. Those commanders w ho will not
open then- eyes to tin* recorded medical proofs of this source of dis-
ease, will sco their men suffer much unnecessary evil, which could

154 Remarks on Camp Diseases in Southern Climates. [March,

easily, in the most of cases, have beer, avoided, by moving the camp
half a mile, or a mile, before the air around it had time to become
pestilential. Pestilential hospitals are also the prolific causes of un*
necessary sacrifice of human life in an army and want of sufficient
nursing another. If a sick man has a friend, (and most of them
have,) that friend had better be permitted to attend to him, if his ser-
vices can be dispensed with ; not so much as a drudge nurse, as to
see that the disabled soldier has every comfort his situation will ad-
mit of. Measures to find out the particular friend of each individual
on the sick list, could be taken without putting the commanding offi-
cer to much trouble. Men recover much quicker from sickness in
booths or sheds, with only something to keep the sun and rain off,
than they do in large hospitals, or where many are crowded together.
The success in treating diseases in the large European hospitals, is
very indifferent. The most bungling country surgeon in America
has better success with operations, than the most skilful European
operator. The foul air of the hospitals, and the pure air of our Ame-
rican cabins, makes the difference. There is such a thing as dodg-
ing a disease. The history of armies affords many instances of a
short removal, only a few hundred yards, being sufficient to cut short
the pestilence, whether cholera, fever, or dysentery. The want of
sufficient attendants to prevent the sick from making exertion, is a
great evil. The sick soldier should be made to husband his strength,
and not waste it by getting up, or making unnecessary exertion. It
would be all the better if he were not to leave his bed from the time
he is taken sick until the disease, comes to a crisis. In private prac-
tice, in acute diseases, absolute rest is very important, but in hospital
practice much more so. Many lives are lost by the soldiers resisting
the disease, and not giving up in time. I found when I was in the
army against Great Britain, last war, that the majority of the soldiers
had a holy horror of a hospital, and would ho'.ththeir places in the
ranks when they ought to have been a-bed. When they did, at
length, yield, their chance of recovery was much diminished, the dis-
ease being so (irmly fixed en them. I think the usual course, of
sending every sick man to the hospital or calling a doctor to see him,
a very injudicious one. In the army, diseases, for the time being,
are all generally alike, requiring the same treatment. I mean when
there is much sickness prevailing. The physician could make known
what was the first medicine to begin with. When the soldier com-
plains, he should take the first dose on the spot, and lie down in his
tent without going to the hospital. If he did not get well, it would
be time enough to go to the hospital when it was ascertained the dis-
ease was about to prove obstinate. I found, by experience, that sol-
diers often secretly attempted to cure themselves by taking medicine
of their own, and not reporting themselves, so fearful were they of
the hospital. If a soldier knew that he would not go to the hospital
until a trial to cure him in his tent had failed, he would not be so
backward in letting his indisposition be known in time. If also the

1917.] Remarks on Camp Diseases in Southern Climates. 155

formality of being examined by a physician, could be dispensed with
there still would he less reluctance to give up in time. The Import-
ance of yielding or giving up to disease at its first onset thou Id he
duly impressed on the mind of the troops in order that recovery might
be speedy. The diseases of autumn are marked by more debility
than in any oilier season and they generally do not bear bleeding or
evacuating remedies well. A serious and hard spell of sickness,
disables a soldier too much lo be of any service in ihc campaign so
far from being useful, he is in the way. How necessary, therefore,
to prevent long spells of sickness, by attacking the disease before it
has got too firm a hold. It would be well, also, for the commanding
officer to bear in mind, that new troops, or any other kind of troops,
cannot endure as much exertion in a warm as in a cold climate.
Discipline, with new troops, should not exceed the proportion of ex-
ercise necessary to health. Ail over exertion or excessive fatigue
should be avoided, or reserved for an important object. All drudgery
should be avoided as much as possible, or be performed by negroes, or
the natives of the climate. The wisdom of such a measure, has
been purchased by dear experience in the British campaigns in warm
climates. It is cheaper to give a native two prices to perform drudg-
ery work in a hot climate, than have the same work done for nothing
by the soldiers. Unless sickness be prevented no army will make
any figure that will gratify its officers. Hence the commanding
general will not find his time badly employed in studying the secret
of not exposing his men to the causes of disease. Too little exercise
as well a.; too much, should be avoided. The time of day for parading
is not unimportant. The dress should be less for show than com-
fort. The soldier is sometimes troublesome and refractory, yet when
he sees his' officer interested in his welfare and believes that he will
not be exposed to unnecessary perils, or have unnecessary burdens
imposed on him, he becomes enthusiastic and will face any danger,
endure any fatigue, and is ready to make superhuman exertions, at
the bidding of his cfriceF. But to come to the main point of prevent-
ing disease. Enthusiasm in military matters, like enthusiasm in
religion, can only be kept up to a certain degree of intensity for
comparatively a short time when, like the passions, it requires
repose when too intense, and kept up for too long a time, it is not
easy to wake when it falls into repose. Enthusiasm is a thing which
has its fits and starts. It is a powerful weapon in the hands of a
commander who studies how to use it one who does not ride it to
dratii when there is no occasion to use it, but keeps it in rcsene for
high occasions, and then knows how to command it to come forth at
his bidding and give him aid. When a soldier lias plenty to eat and
drink, he does not require to be fed on glory, if nothing is to be done
no enemy about no fortress to storm, his enthusiasm should be
suffered to repose. If permitted to take rest, until the occasion comes
when it may be needed, there are a thousand ways of making it up.
When gaunt famine stalked through Jackson's camp and pestilence

156 Remarks on Camp Diseases in Southern Climate*. [March,

threatened to cut off' all his men, that great commander found a sub-
stitute for meat and bread in awakening a spirit ofenthusiasrn among
his men, which also banished pestilence from his camp, by giving the
body power to resist disease. He awoke the spirit ofenthusiasrn in
one remarkable instance in a very simple way by merely offering
to divide a few acorns with an exhausted soldier. This simple inci-
dent soon spread through the camp, and the spirit of chivalry began
to swell every bosom; making his troops forget that they were with-
out food or the prospect of food in a distant wilderness; and nerved
them to renewed exertion. The men, who a short time before, were
ready to sink to the earth exhausted, and to fall a prey to a pestilen-
tial fever, forgot they were hungry on finding themselves heroes.
Napoleon always fed his men on glory when meat was scarce, or
some great fatigue was to be endured, or whenever he wanted to
drive disease out of his camp. High enthusiasm, and epidemic disea-
ses are incompatible. The secret of great military commanders in
preventing disease seems mainly to consist in awakening a spirit of
enthusiasm on perilous occasions. Some degree ofenthusiasrn is at
all times a healthful stimulant against morbid influences and which
it is always well to encourage, but the higher or more intense exalta-
tion of mental excitement not being durable, should only be called
up on great occasions. If it would always come on being bid, it
would be an easy matter to banish a pestilence from an army by that
agency alone, but as it is a fire which cannot always be kindled at
will, none of the natural causes, giving rise to disease, should be per-
mitted to haunt the camp when they can be driven out. The British
owe many of their large possessions in warm climates to Moseley's
discovery of treating camp dysentery successfully. Before a suc-
cessful plan of treating the disease and banishing it from" camp was
discovered, Great Britain was in a fair way of losing her southern
possessions by having no men to defend them; the dysentery killing
them as last as they could be sent out. The same mode of treatment
did not succeed in the cold latitudes of Europe. The wars of the
British, French, and Spaniards, during the latter part of the last
century, in the West Indies, brought it forth. Our northern medical
schools and northern writers, having no occasion for it, have neglect-
ed to teach it. It is a treatment adapted to the dysentery of camps
in hot climates. For more than twenty years I'have found it suc-
cessful in plantation practice in the south. In communicating it I
am giving nothing new, and I claim no credit but that of calling
attention to a very successful practice that is almost forgotten.

The one dose cure for Camp Dysentery. From twenty to forty
grains oflpecacuanha, and fifty drops of Laudanum mixed together
in little sugar and water, molasses, or toddy, and taken at one dose-
immediately the dose is taken, the soldier should lie down and be
covered over with his blanket, to keep the air off. He should con-
tinue thus covered up with his blanket for 24 hours, drinking hot
mint tea, or hot sage tea, or anv other agreeable aromatic tea, as

1847.] Remarks on Camp Diseases in Southern Climates. 157

balm, sassafras,. or orange-leaf tea. The drink should be taken as
hot as table tea is commonly used. The object is to promote perspi-
ration and to turn the fluxion of blood from the bowels and liver to
the skin. No drinks should be taken, for an hour or two, unless tho
patient vomit3. After each spell of vomiting he should drink ihehot
tea. The medicine has the best effect when it neither vomits nor
purges. It commonly vomits once or twice, and the next day pur-
ges once or twice. It cures the disease in half an hour, if given
early in the complaint. That is, it stops the bloody stools on the
spot, relieve the pain and tormina of the bowels, determines the blood
from within, to without causes perspiration and carries off fever.
And if the perspiration be kept gently up for a sufficient length of
time, the disease will never return. It is important after taking this
medicine, that the patient be kept for some days out of a draft of air,
and the first day or two be covered over with a blanket ; though not
to be kept too hot, or in too close an atmosphere. When the pain in
the bowels is severe, the quantity of laudanum should be a little
more, say a tea-spoonful. A full dose to allay spasm and pain is
better than a small dose. The Sydenham laudanum is better than
the common laudanum ; if that is used, 30 drops will be sufficient, as
it is stronger than the common laudanum. If the ipecac is very good
and fresh, and has never been exposed to the air or light, 20 o.r 30
grains will be sufficient, and may be made into pills with the lauda-
num and taken all at once. If the patient lies on his back, and
holds a table-spoonful of water in his throat, and will open his
mouth, seven large pills can be swallowed at one swallow, if they be
pitched in Indian file, down'to the root of the tongue, the patient at
that instant swallowing them with the water previously held in his
throat. But the patient must lie fiat on his back to swallow so many
pills at one swallow. The dose taken in the pill form, is Jess apt to
vomit. Should sweat not occur in an hour, the complaint may re-
quire the loss of a little blood from the arm, or another half dose in
the pill form ; but in nine cases out often, nothing more is required
than the hot aromatic tea, above mentioned. It is essential for the
success of the one dose cure, that it be commenced at an early period
of the disease. Different physicians, seeing dysentery under differ-
ent circumstances, are too apt to conclude that all other plans of
treatment arc wrong but their own.

Thus, in private practice, in mountainous districts, bleeding is
generally necessary. In marshy districts, bloodletting is not well
borne. When connected with much bile, the purging or calomel
plan succeeds after so long a time. In some epidemics the patient
is so suddenly reduced by the first onset of the disease, as to fall into
cold sweats, Huntings, laborious breathing, etc., requiring instantly
the strongest aromatic stimulants to keep him from falling at once
into a state of collapse and death. But generally speaking, the one
dose cure, for the dysontery in camps, is the best, safest, and quick-
est. If it fails to cure in an hour, no harm is done : the purging, or

158 Remarks on Camp Diseases in Southern Climates. [March,

any other plan may be adopted. The misfortune of the purging
plan is, th?, soldier who is cared by if, is .seldom worth any thing in
the campaign. Half the fluids in hi.s bony have to be e/acuated by-
purging', before the plethora of blood in the viscera, causing the dys-
entery, enn be removed. Whereas, by the one dose cure, the fluids
are saved instead of being pureed out, they are thrown from the
viscera to the surface, kpt in the circulation and saved. All, or
nearly all the camp dysenteries, have a single cause, a retreat of the
blood from the surface, without, to the viscera, within. In private
practice, the stomach or liver or some other organ may be at fault
and constitue the first links in the morbid action ; but among soldiers,
it is almost always the skin. The scorbutic dysentery is an excep-
tion, where acids, lemon juice, and sour vegetables become the best
remedies; and in dysenteries' connected with remittent and inter-
mittent fevers, the quinine is an important adjunct. After the
patient has taken the one dose cure, the next day, if any remnant
of the disease still remains, from a tea-spoonful to a table-spoon-
ful of the following mixture, should be taken without being mixed
with any thing whatever. To be taken on an empty stomach,
viz: white vitriol 90 grains, common alum 60 grains, cochineal (the
cocci netla of Mexico) 3 grains, boiling water half a pint. When the
solution is cold, strain through paper. From a tea-spoonful to a
table-spoonful of this mixture every morning, fasting, or three or four
times a day, will of itself cure mild cases and rs one of the best reme-
dies for the chronic form of the complaint. It can be made to operate
on the bowels by lessening the quantity of alum in the solution, or
to bind the bowels when the discharges are too frequent, by increas-
ing the quantity of alum in the solution. In table-spoonful doses it
nauseates and has all the advantages of nauseating medicines and
in smaller doses than a table spoonful, it is tonic and astringent and
aperient at the same time, partaking of the character of small doses
of rhubarb.

The author of the above practice is Benjamin Mosely, who pub-
lished it in the West Indies in 1789. The practice was so successful,
that his treatise on the dysentery went through many English edi-
tions, and was re-published in Latin. After a long experience in
Southern diseases I am confident that it is more successful in the
great majority of dysenteries than any other method of treatment
before or since adopted. Dr. Mosely gave the ipecac first and the
laudanum afterwards. According to my experience it is best to give
them together, making one dose of it. I have tried the medicine in
broken or divided doses, but find it not to succeed as well as the full
dose. The aromatic teas to keep up the determination to the skin
are important. To follow up the medicine by strong purgatives would
defeat the object in view, of determining to the surface. Aromatic
waters, or the odour from burning aromatic substances, are better
than vinegar or the chloride of lime to correct the atmosphere about
dysenteric patients.

18-17.] Influence of Malaria and Malarial Diseases. 159

On ihe Influence of Malaria and Malarial Diseases. By A. G.
Lawtox. M. D , of Marshall, Saline County, Mississippi. Coro-
municated id a letter to the Editor. (N. Y. Jour, of Medicine.)

When we survey the past history of this country, from its 6rst
diseovery up to the present lime, we find thai tin's invisible and mys-
terious agent called Malaria, has been mere widely disseminated,
more pervading in its influence, and more efficient in the causalives
of diseases and death, than all other causes combined.

It was the remark of the celebrated Volney, when travelling in this
country, that every valley in America produced malarial fevers; and,
although this observation is far from holding true at the present day,
yet (here has been a time when it would be strictly just, when under-
stood in the broad sense, which it was originally designed to convey.
According to Macculloch, one half, at least, of human mortality is
owing to this cause. He says: "At Walcheren, we lost 10,000
men, and the Antwerp fleet to boot. And when the French army
attempted Naples in 1528, out of an army of 28.000 men. 24,000
died in a few days by choosing an injudicious encampment at Baix.'

All past history goes to show the deadly influence of this invisible
poison ; and how it has occasioned the loss of armies the failure of
expedition* the frustrations of plans and national movements the
depopulation of countries, towns and cities cities that were once
populous and powerful, where now the atmosphere is so pestilential,
that it is dangerous even to visit the spot where they stood.

In 1610, the colony of Virginia consisted of nearly 500 persons,
but in consequence of want of food and malaria, at the end of six
months, only sixty of the whole number remained.

The early settlers of new countries suffer more from malaria than
those of older countries. When the Spaniards settled Cuba, and the
other VV. India islands, great multitudes fell victims to miasmal
fevers. Paludal exhalations are often prevalent, and the cause of
fevers where they are not suspected. For example, during December
and January last, I attended six cases of fever, of a malignant and
typhoid character, in one family who lived on a high. dry. and
hitherto healthy spot in Saline county, Mississippi. I regarded the
fever as one produced by a specific cause; and, after searching in
vain in and around the house, I suspected it might be under the house,
the floor being of loose boards, between which were wide cracks, a3
is common in this country. I raised a board, and sure enough there
it was. The house, which was of logs, was built on the grass, the
floor being about 12 inches from the ground, and this spice was fiiled
with old bones, grass, crumbs of bread, dirt and sweepings, that had
been accumulating for eight or ten years, forming a mass altogether
about one foot deep. And this had been kept constantly wet by
wash-water, and heated by fire in the room, on which floor a large
family slept and ate. And this mass under the floor, in contact with
the decaying house-logs, on the ground, formed a perfect hot bed, just

160 Influence of Malaria and Malarial Diseases. [March,

fit for the extrication of poisonous efiluviag, which are more effectual
in cold weather, because the house is more constantly shut and a hot
fire in the room.

Often have 1 seen whole families die off in a few days* and the
population of neighborhoods generally thinned, when a timely knowl-
edge of the true cause might have saved them all. In Holmes
county, Mississippi, on the banks of a small stream, on one farm, in
1836, forty negroes and a whole white family, except the father, died
in three months, leaving but one living soul on the place. And I am
acquainted with many instances of a similar kind in Michigan, Illinois,
Missouri (in this county), in Lousiana, Texas, and many other places.

According to authors, the circumstances calculated to generate
miasmatic exhalations or malaria, are the ploughing of lands for the
first time. They are also developed by the action of water on wood
in casks at sea, bilge water in holds of ships, marshes, stagnant pools,
moist meadow lands, etc. A mixture of salt and fresh water in pools
or marshes, the drying up of lands that have been inundated, also
give origin to this poisonous agent. Ploughing the western prairies,
for the first time, is generally followed by more or less sickness.

The following are the results of my observations made in a small
part of Saline county Mississippi : Of owe hundred and fee families,
who have settled here from 1836 to 1843. fifty five ploughed fieids on
the south and east of their houses ; these had fevers, bilious remitting,
or intermitting, or some other disease. During the first, second, and
third years, indeed, scarcely one of them escaped some kind of sick-
ness. Sixteen of them ploughed fields on the west of the houses; of
these, many had intermitting, some few bilious remitting fevers, but
of a tractable character, and generally on the second or third years.
Eighteen ploughed fields on the north, and but a few of these had
intermitting fevers, and these during the second or third years. Six-
teen did not plough around their houses at all, and none had any of
these kinds of sickness, more than might be expected in any healthy
country.

It takes the sod two and three years to rot, and it generates mala-
ria every year, until it is well rotted. Log houses built on the ground,
as soon as the logs begin to decay, especially if they have no cellars
under them, produce an immense amount of the poison in question.
And where they have loose floors, as the poorer. classes generally do
in these countries, two-thirds of every thing that falls on the floor is
swept through. This accumulates by slow degrees, and is wet three
or four times a week, by wash-water on the floor, until it forms a
perfect hot bed, just fit for the generation of poisonous exhalations.

And these houses have no windows, nor means of ventilation but
the door, which is constantly kept open for light to come in, except
in the coldest weather of winder. Then is the time for this putrefy-
ing mass under the floor, and the rotting house-logs, always moist and
hot by fire in the room, to generate fevers of the most malignant
character and grade. The malignancy and awful fatality of these

1847.] Influence of Malaria and Malarial Diseases. 161

fevers are well known to practitioners of these countries. I see no
reason why these very causes would not produce a genuine typhus.

Maccullocb says, that a remittent will become, or perhaps produce,
in any given individual, a contagious typhus under confinement.

But I think the most, if not ail these cases, may be traced to a
combination of the two poisons, animal and vegetable exhalation, and
these cases generally occur in, or immediately after, very cold
weather.

There is a stream running through our county, called the Salt
Fork, the head of which is a salt spring, large enough to turn a mill
a half mile below its source, in which I am told a lead has been
dropped 300 feet without finding bottom. This stream has many
other salt springs running into it in its course. It is a mixture of
mineral salt and fresh water, and a beautiful clear and running
stream. As far hack as I can trace, the people living on the banks
of this stream have suffered with fevers every year, and with many
other diseases ; sometimes the greater part of the population are sick.
But for three years past it has been more than common sickly. In
my practice on this stream last season (1843), out of a population of
63 persons, there were 53 cases of fever, mostly bilious remitting.
Of these none died. Malarial diseases are often masked; it is dif-
ficult to discern their true type and character; the fever being low,
and sometimes wanting. According to authors, malaria induces, or
produces, fever, neuralgia, dysentery, cholera, tic-douloureux, or
headache, &c, &c. M'Culfock. But I would not stop here, but
would include congestion, inflammation of the uterus, assimilating
cancer, and cured by iodine, hypertrophy of the liver and spleen,
chronic diseases of the mesenteric glands, anasarca, &c. ; also in-
cludes a tendency to venous congestion, imbecility both of bodv and
mind : especially in those who live on improper or scanty food, in old,
decaying houses, without windows or proper means of lighting and
ventilating, abortion, flooding, ovarian dropsy, <jcc, &c*

* While oa a recent visit to a part of New England, remarkable for health,
we became acquainted with an instance which illustrates very strongly the in-
fluence of malaria, when of not sufficient intensity to cause regular paroxysms
of lever. A family of seven persons, old and young, lived in a house, in the
cellar of which wSs a large quantity of decaying . partially covered

with water, which stood upon the bottom of the cellar to the depth of nearly six
inches. The family, though not confined to their beds, were, nevertheless all
so indisposed as to be almost wholly unable to attend to their ordinary duties.
The most prominent symptoms, and which existed in every individual of the
family, were nausea, want of appetite, furred tong: te in the mouth in

the morning, muscular debility a] lion, universal malaise, headache,

pain in the spinal cord, shooting pains in different parts of the bodv. depression
of spirits, languid, sluggish circulation, torpor of the surface, and ail the secre-
ilarityof bowels, etc. These symptoms existed for several weeks
before the cause was discovered, and without resorting to any other measures
than removing the cau the cellar and cleaning it out, they al

jual healih. Such facts certainly ought to convince those who
arc still sceptical as to the existence of any such agent as malaria. [Ed. N \ .
Juvr. nl M i i

11

162 Influence of Malaria and Malarial Diseases. [March,

I was recently called to see a young man in the family J. G., on
the 9lh day of fever. When I arrived at the house there were three
other persons down with the same fever, which was of a typhoid
grade. On the next day when I arrived at the house, I was much
surprised to find three more boys, still younger, down, which made
in all seven cases. They all got well except the one I was first call-
ed to see, Oct. 22. He died on the thirteenth day ; had black sordes
on the teeth, bleeding from the nose and gums, and delirium.

On inquiry, I found the facts to be as follows : A year or two ago
they had built a brick house, under the wing of which was a cellar,
in which water had stood for the last eighteen months, open on the
south by a door and window. Some weeks ago these boys had dip-
ped out this water and mixed brick with it in hot weather, and it had
a very bad smell. The oldest, who died, was the most exposed; he
moulded the brick, and stood on the wind side of the bed where the
brick was drying.

It appears that these boys took the fever one after the other, as
they were exposed, or according to the intensity of exposure to the
exhalation in making and drying these brick. All that assisted in
making and drying these brick, took the fever. The others were all
well and hearty, and had no sickness that year worth mentioning.

This is one of the many instances of the kind I have witnessed. I
will now offer a few remaks on symptoms, but they will generally be
confined to the sickness on the two streams, the Salt Fork, and a
tributary of Blackwater. Both are salt water in part.

These streams often overflow their banks, and spread over grassy
bottom land. This generally happens in June or July, after which
it is generally sickly.

After exposure to miasmal exhalations, for a longer or shorter
time, it may be a week, three weeks or three months depending on
other existing causes, or the constitution of the patient, the signs of
disease appear. The first thing noticed will be, after a hard day's
work, getting wet, going without dinner, or eating too much, exposure
to hot sun, &c. On the next day, unexpectedly, and without any
ostensible cause at the time, the person feels an unaccountable weak-
ness in the back and legs, slight aching in the head, eyes and
stomach, accompanied with a little coldness of the fingers; drowsy,
dull, and listless ; sometimes he experiences a slight trembling: after
a few hours it goes off and he thinks no more about it, until it comes
again, which will be on the next day, or odd day, at the same hour,
which is generally in the fore part of the day; hut it may occur at
any stated hour. This may continue for a week or more, getting
better and worse. After a while he finds himself unable to attend to
business, and concludes to doctor; he takes a heavy dose of Cook's
pills, or some other drastic purge, after which he gets a hard ague or
chill, or finds out that he has an attack of fever, of which he may get
well in afewdays. This is the beginning of the mildest cases. They
get well, but being constantly exposed to the original cause, they
soon get down again.

1847.] Influence of Malaria and Malarial Diseases. 163

At a certain time of day they will have great weakness, blindness,

or throbbing in the head, palpitation 6f the heart, feet and hands
swell every afternoon. They will take a pain in or over one eye, or
over one side of the head (this they call sun pain): the eye inflaming,
is red and painful, with the fever on that side of the head ; after three
or four hours it goes off, to be renewed on the next day or odd day.
But sometimes the pain and fever are more severe, rising with the
sun and going off as the sun goes down, and they sleep well as usual
at night. And in the same way, occur sick-headache, neuralgia,
toothache, and vomiting. I have seen vomiting occur at ten o'clock
for a week, every day, often mixed with blood. But sometimes
weakness is the only symptom, and this increases for weeks with a
tolerable appetite all the time.

As the season advances, the attacks are more violent and sudden,
the fever gets stronger as the cold weather approaches, when many
of the cases become strong bilious fever, or they will take a chill
that will prostrate them at once, and the fever rises high, or the fever
may fail to come at all; if so, the exterior assumes a bloodless ap-
pearance. There is more or less congestion, sometimes complete if
the congestion is partial; there may be vomiting, sometimes, of
blood. In females, vomiting matter, tinged with blood and flooding
at the same time, especially about, or at the turn of life. In girls the
disease is ushered in, many times, by uterine irregularities or uterine
flux. Vomiting blood is a common occurrence in many grades of
those fevers. Congestion may take place in the first chill, but more
commonly in the second ; it is often brought on by overpurging, after
which there is no fever, for that is the end of the race; they either
die or get well, that is, when congestion takes place suddenly and
extensively.

Congestion may take place in the lungs, spleen, liver, bowels, and
sometimes in the head, but not often. In congestion of the lungs,
the veins of the extremity assume a dark color, and sometimes black;
respiration short and oppressed, and a feeling of great weight across
the chest ; the pulse gets weaker as congestion becomes more estab-
lished, until it is finally lost; the skin on the extremities assumes a
leaden hue; cold perspiration oftentimes is extreme; cold feet and
bands, and the patient complains of nothing but heat. There is con-
gestion of the bowels, liver and spleen, and this is by far the worst
complication; the pulse sinks, the extremities grow cold; as the cold
advances the skin assumes a bluish cast, or leaden hue, and dimpled
like goose-flesh ; the tongue may be dry and clean, or a little furred,
or it may he coated thick and dark, if the fever has run a number of
days before congestion took place : the respiration is short and op-
pressed ; there is great weight and heat across the siomach and bow-
els; cold perspiration, and sometimes delirium. In fatal cases the
perspiration is excessive, the skin becomes relaxed and cold ; the
patient is restless and constantly changing from one position to ano-
ther, often complaining. Ask bim what pains him, he will shv,

164 Influence of Malaria and Malarial Diseases. [March,

nothing, no pain, but so hot, and yet he is of an icy coldness every-
where but on the stomach and bowels, which are very hot. As death
approaches he becomes more composed and tranquil, and dislikes
going to sleep. Congestion may take place any time in the course
of a fever, especially on the ninth clay, but always on the day and
hour according to the manner and type of the fever.

As to the treatment of malarial fevers all agree that quinine is an
antidote, or a specific, some give it in large doses, some in smnll, and
both are mostly fortunate. I have given it in all ways, and I am
fully convinced that one grain of quinine, combined with other sub-
stances, will effect more than five will by itself. Three years ago I
adopted a plan of combining it it in a manner that I never yet have
had cause to change. The combination has two advantages. One
is, it is more effectual, safer, and leaves the system in a better condi-
tion ; the other is a great saving of the article. In intermittent and
all mild malarial fevers, I give a purge if it is needed, generally a
mild one, as blue mass, ten grains of calomel, with Dover's powders,
or Lee's pills, according to the circumstances of the case. Then I
give the following powders, changing them to meet the indications as
near as possible. I never bleed in these cases in the warm season,
and very seldom in the winter, for bleeding is very apt to induce con-
gestion. The constituent principles of these powders may be in-
creased or lessened according to the circumstances of particular
cases.

T$c Gtuinice Sulphate, gr. i., or GUiinioe Sulphate, gf. if.

Camphor Pulv., gr. i., " Camphor Pulv., gr.

Pnlv. Doveri, gr. ij., " Carbonate Ammonia, aa gr. ij.

Fiat Pulvis. " Fiat Pulvis.

fy GUrinioc, gr. ij., or Gluinige, gr. i., orGluinke,

gr.ij.

Camphor, gr. ij., " Camphor, gr. i., " Camphor,

gr. ij.

Myrrh, gr. ij., " Capsfe. gr. ij., "Morphine,

gr. 1-8

G. Opii, gr. 1-4. " Opii gr. 1-4 " Ferri Carbonas,

gr- ij-

Mx.

Mx.

In intermittent fever, I begin with these powders soon after tho
fever begins to go oil*, and give one every two hours until six or
twelve are taken, according to the type of fever. Then if needed, I
give one or two pills at night, made of aloes, soap, and rhubarb, and
the next day give the powders as before ; and I seldom have to leave
medicine but once for these cases,. In bilious remitting fever, I gen-
erally lessen these powders, beginning early in the morning, and give
four, five, or six of these powders through the day, with directions to
stop when the fever gets high, give a dose of calomel at night, and
nothing more till morning, when I commence the powders again.

In those cases where the fever runs high, I give calomel, or blue
mass, every other night, or every night until the biliary secretion is
established, when other purgatives are stopped, and I continue the
powders, and sometimes the above named pills at night. In the most
of these cases there is much visceral irritation, and here blisters, and
counter-irritants of mustard must be used. Sometimes there is ex-

1847.] Excision of the Inferior Maxillary Bone. 103

cessive vomiting in these cases, when I find nothing better than what
has been long in use, that is, a mustard plaster over the stomach,
and sometimes around the ankles and wrists. With this treatment I
have been so far very fortunate, and seldom lose a patient. In win-
ter fevers I increasethe Dover's powder, and lessen the other parts in
these powders, and the effect has been perfectly satisfactory.

Pills containing camphor I keep corked up in vials, and make but
few at a time. Thus kept I think the camphor is retained sufficiently
for all practical purposes.

Excision of the Inferior Maxillary hone for Osteo-Sarcoma. By
William II. Dladekick, M. D., of Athens, Tennessee. (West.
Journal Med. and Surg.)

The operation of which I propose to give a very brief account, was
performed nearly thirty-seven years ago, and at that period, so far as
I am informed, was unknown in surgery. Since that time it has
been repeatedly executed, and the claim of having originated it has
been set up by a foreign surgeon. By comparison of dates it will be
seen that my operation preceded that of Dupuytren by two years.

On the 6th of February, 1810, Jesse Lay, a lad of about fourteen
years of age, was brought to me on account of an excrescence which
gradually arose from his gums, and which, in consequence of long
neglect, completely enveloped the lower maxillary bone of the left
side. It filled the inside of his mouth to such nn extent as greatly to
interfere with respi/ation and deglutition. Externally, the tumor
exhibited the appearance of a wen of considerable size, and as it was
daily augmenting it was evident that nothing short of its entire re-
moval, with the portion of the bone it occupied, could save the life of
the patient. Accordingly an incision was commenced just below the
left ear, and continued aiong the course of the bone to the centre of
the chin ; a second one was made at right angles to the first. The
integuments were then di.-sectcd from the tumor, and the bone sawed
off at the angle of the jaw, and I alf an inch from the centre of the
ch:n nearest the angle divided. The integuments were united in the
usual manner, and the boy had a speedy and perfect recovery. The
youth, at the time of the operation, although fourteen years of a<je,
was not larger than boys usually at ten or eleven ; but immediately
afterwards he commenced growing, and attained the ordinary stature
of manhood. A well trained whisker hides, in a great measure, the
scar left by the incision, and at a short distance the effects of the
operation would not be '.bserved.

Athens, Nov. 1st, 1646.

Note. Dupuytren is the generally accredited author of the opera-
tion above described. Tuis distinguished surgeon removed a portion
of the lower jaw for a cancerous affection of the gums in 1813. The

166 Excision of the Inferior Maxillary Bone. [March,

operation of Dr. Deaderick, it will be seen, was performed two years
prior to that time. Dupuytren's case was reported to the Faculty of
Medicine at Paris, by Lisfranc, in 1313. The report of Lisfranc is
republished in the Dictionnaire cles Sciences Medicales, vol. xxix. p.
480. Dr. Deaderick did not give to the public any account of his
operation before 1823, when he described it in the American Medi-
cal Recorder.

Dr. Mott, in a letter to Mr. Liston, has preferred a claim to prior*
ity in this operation. He says, "I claim for myself and my country
originality in the operation of exsection of the lower jaw at the
temporo-maxillary articulation, and in different proportions for osteo-
sarcoma. I avow and declare solemnly that before my first exsection
of the lower jaw for osteo-sarcoma, I never saw, read or heard of
anything of the kind ever having been done in any country." He
adds, " We repeat and aver, that the exsection of the lower jaw of
even a fourth part, much less a half or two-thirds of it, for any form
pf sarcoma involving the whole texture of the bone, has never in our
opinion been performed by any surgeon, past or present, until by
myself at the time above stated."

The operation of Dupuytren is admitted not to have been for
osteo-sarcoma, but for a cancerous sore situated over the angle of
the jaw. Rihes, in the Diet, des Sci. Med., referring to this opera-
tion, has the following words: "These facts lead to the hope that
fungus, or osteo-sarcoma of the lower jaw, a disease so formidable
that it has in many cases been vainly attacked with the iron and fire,
will henceforward, since the operation of M. Dupuytren, be removed
by amputation of a portion more or less considerable of the lower jaw,
without the danger of any accident, and, if the disease be local, with
a certainty of success."

Many years before these predictions were uttered in Paris, the
operation had been successfully performed by a young surgeon in the
backwoods of Tennessee.

In a lecture delivered by Dr. Houston, of Dublin, in 1844, and
published the same year in the London Lancet, the honor of having
originated this operation is claimed for Mr. Cusack, .who has perform-
ed it twelve times. The lecturer says, "The grand exploit of
amputating the lower jaw, even from its articulations, the boldness
of which has been only equalled by its success, has now become a
standard operation in surgery. Persons afflicted with the distressing
and loathsome disease for which this operation is undertaken, were
formerly allowed to die, without any idea being entertained of the
possibility of saving them ; but now that a great mind, relying on a
sound knowledge of the capabilities of the human frame, has set the
example of extirpating the diseased mass in toio, many surgeons have
fearlessly followed in the path thus laid open for them, and have
derived honor from the success which crowned the enterprise. The
success of this operation, both as regards immunity from danger,
rapidity of convalescence, and the useful quality of masticatory ap-
paratus which follows, is almost incredible."

1347.] On the use of Quinine in Florida, 167

Upon this passnge Dr. Townsend, in his edition of Velpeau's Sur-
gery, comments thus : " To whomsoever, therefore, the honor of this
great triumph belongs, mutatis mutandis, the eulogium ought to apply
equally well in Dr. Huston's conceptions, who, doubtless, would not
desire to diminish one iota of it, because a name of different ortho-
graphy from that of the justly respected Mr. Cusack, should happen
to be found by a species of anaplastic substitution, to dovetail more
completely than his with the historic facts in the case. We say
cheerfully with all our heart, pahnam qui meruit ferat /"

Dr. Deaderick's is the name which seems " to dovtail" most "com-
pletely with the historic facts," and to him, therefore, must the palm
be awarded. True, he operated but once, and his operation was not
made known to the world for many years afterwards ; but it was
undertaken for what appears to have been osteo-sarcoma ; it involved
the excision of nearly one-half of the lower jaw bone, and was crown-
ed with perfect success. Dr. Deaderick did not call the disease
osteosarcoma, but, in his account of his operation published in the
Medical Recorder, described it as "a cartilaginous tumor." In the
brief notice of it given above he applied no name to the affection, and
the title prefixed to his communication is ours. Every medical read-
er knows how vague is the term "osteo-sarcoma," and what a
diversity of morbid growths are called by that name. From the
description of the tumor in Dr. Deaderick's case we have no doubt it
would be styled osteo-sarcomatous.

It appears, then, that Dr. Deaderick preceded Dupuvtren in the
operation of excising the lower jaw bone two years, and that he an-
ticipated Dr. Mott by eleven years, although he neglected to publish
an account of the operation until after Dr. M. had communicated the
results of his to the world ; consequently Dr. M. was unapprised of
what had been done by his countryman. He may still claim "for
his country " if he cannot for himself, " originality in the operation,"
for Cusack's operations were performed two or three years subse-
quently to Dr. Mott's first. The operation has been performed by
Dr. M. seventeen times. In a note appended to his letter to Mr.
Liston Dr. Deadriek's operation is referred to, and this brief, ob-
scure notice, is all the allusion to it that we have found in looking
through the American edition of Velpeau's great work on surgery.
We have deemed it but an act of justice to a modest and worthy
member of the profession to give these dates in connection with the
history of his case. Y.

On the use of Quinine in Florida. Bv R. S. Holmes, M. D., Med.
Staff, U. S. A. (Am. Jour. Med. Sci.)

We extract from Dr. Holmes' article his appreciation of "north-
ern precepts" in the practice of southern diseases.

From experience in Florida one is almost disposed to believe, that

163 On the use of Quinine in Florida. [March,

there is a certain rule which though apparently too mechanical in its
operations, to some extent is applicable; it is this, in proportion to
the amount of miasmata in the system as shown by its effects, so
niv.st the dose of quinine, for the core, be increased ur diminished.

The largest amount of quinine I have ever given at a single dose
has been eighty grains ; this is the extreme dose : the average quan-
tity is about twenty grains.

Let us commence with intermittent fever. The first question I
always ask a patient who complains of this disease concerns the state
of his bowels. I am careful never to give quinine with the intes-
tines in a torpid or gorged condition, for its effects then seem to be
comparatively lost. I have given it, however, when the bowels were
actively purged and irritated. It seems not to be governed by the
general rule that medicines will not affect the system properly when
the bowels have not been well attended to. Having then in a com-
mon intermittent fever freely opened the bowels, if they have not
been already purged, by means of oil, magnesia, calomel, or rhubarb,
I give the quinine generally on the evening of the day on which the
purgative has been taken, fifteen grains, say, as a general dose, at
once (not in divided doses), in water with a few drops of vinegar or
of some acid, so that it may he readily dissolved. Suppose this to be
given in the afiernoon at 0 ?. M., the patient having had an attack
of intermittent on the same day, commencing a 9 o'clock, A.M.,
and ceasing at 2 P. M. The fever, being a quotidian, will come on,
the succeeding day at the same time, despite the quinine ; both the
chill and fever will be of a lighter grade, but will be as distinctly
marked, and will remain as long; but on the third day the patient
will be entirely free from the disease, and will not experience, during
any part of the day, the slightest symptom of it. In treating
many hundred cases of fever in Florida I do not think I have met with
twenty exceptions to this rule in cases of pure intermittent fever.

On my arrival in Florida, knowing nothing of southern diseases
from practice, and being stationed alone at a distant and unhealthy
post, I learned the rules by experience alone, guided by which I have
since successfully administered quinine. I practised on northern
precepts, annoying the patient without arresting the disease, by a
continued succession of two grain pills; occasionally at long inter-
vals checking the disease, by these means, but much more frequently
vexed for weeks by the continued sickness of the soldier. I rose
finally to ten grains, and continued to give this quantity at once; I
more frequently succeeded by this practice, but not yet to my satis-
faction. If the patient had a quotidian, I gave the quinine on the
day of the chill; if a tertian, also on the same day; if successful
with the ten grains, I was surprised to find the quotidian manifested
itself in a modified degree on the succeeding day, and on the next
was entirely absent ; whilst of the tertian on the third day, not a
symptom appeared ; hence I drew the rule which I have often verifi-
ed since, and from which I have never varied, or had any reason to

1847] Treatment of Pneumonia. 1G9

doubt, that the full effects of quinine are not manifested until about
(eighteen hours after its administration. Finally, convinced that
large doses of quinine are necessary in the south, I increased my
minimum dose tor intermittent fever to fifteen grains given at once.
Congestive fever is of course. a disease of much greater danger
than the one we have been contemplating, and appears to be the dis-
ease proper in which the powerful and successful effects of this agent
have been most apparent. This disease is remittent in its character ;
the grade of its violence, to the most casual observer, will appear
much greater than any stage of intermittent fever ; there is complete
prostration ; the faculties are benumbed, the countenance anxious
and haggard, andlhemind desponding; all these symptoms are often
present an hour after the first attack, and when you see the patient
ior the first time. Here it is evident two plans oftreatment must be
pursued simultaneously :- to rally the patient for the time being, and
to provide for a periodical return. Frictions, mustard poultices, and
stimulants, will answer the first design ; but 1 know of no other agent
than quinine, in the materia medica, that will do for the second ; you
cannot wait for its operation, if the prostration of the patient is so
complete, that you dread the return of the chill, lest it prove fatal;
and in the first few minutes after seeing the patient, I have given him
from thirty to sixty grains of quinine in one dose, in water or bran-
dy ; the brandy for the present contingency, but the quinine for
several hours ahead.

Treatment of Pneumonia. By Anthony Todd Thomson, M. D.
(London Lancet, Nov. 1846, from Western Lancet.)

The chief object of Dr. Thomson is to examine the comparative
merits of blood-letting on the one hand, and tartar emetic on the
other, as remedies for pneumonitis. His observations are based on
the results of 62 cases, 38 of which occurred at University College
Hospital. The author resorts to blood-letting in the beginning of
the disease ; but he condemns its repeated and profuse employment
in other stages, and is more inclined to rely on tartar emetic. This
latter remedy, he is of opinion, produces its beneficial influence by
virtue of counter-irritation ; and this countcr-iirilation, which is no-
thing more than sub-acute inflammation, prevents the absorption of
the remedy, and it may then be largely used without producing nau-
sea; in other words, "tolerance" of the tartar emetic is merely its
non absorption. The following extract will convey an accurate view
of the author's practice :

My practice, as soon as I have fully satisfied myself of the exist-
ence of the disease, and if the attack has not run on to the second
stage, is to order one bleeding to the amount of sixteen or twenty
ounces ; to follow this, immediately, with three or four grains of calo-

170 Two Cases of Double Vagina. [March,

mel and one grain of opium, with the view of preventing that nervous
irritability which oftemsuccceds the use of the lancet, and of sustain-
ing the beneficial impression made on the system by the blood-letting.
In two hours afterwards, I gave one grain of petassio-tartrate of anti-
mony in a fluid ounce and a half of emulsion of bitter almonds, and
repeat this dose every third or fourth hour, until a decided diminu-
tion of inflammatory action takes place that is, until the crepitation
has nearly disappeared, and the sputa are no longer rusty and tena-
cious. The intervals between the doses of the tartar emetic are then
extended to six hours, and afterwards to eight hours, and so continued
until convalescence is confirmed. I prefer the bitter almond emul-
sion, on account of its containing hydrocyanic acid, which has a
sedative quality, and a more decided influence in quieting the ner-
vous system, and abating the cough, than small doses of opium.
When the pneumonia is uncomplicated, this plan, with the occasional
aid of some mild aperient, has, in my hands, seldom failed to carry
the case to a successful termination. When the attack has passed
beyond the first stage, when dullness on percussion indicates hepati-
zation, then the object of the second indication namely, to excite
the capillaries and prevent farther depositions requires attention;
and, in order to fulfil this indication, I order four or five grains of
mercury with chalk, or one grain of calomel, to be given in each inter-
val of the administration of the tartar emetic.

Two Cases of Double Vagina. By Professor Meigs. (Medical
Examiner.)

On the October, 1846, I was called to Mrs. , aged 20

years, in labor of her first child. She is a remarkably well formed
and comely woman.

The pains were sharp and frequent, evidently of the kind called
dolores procparantes, or grinding pains. After some time, as they
had become more viulent, I examined the state of the os uteri, which
was of the size of a half-dollar, the head of the child presenting, and
the ovum unruptured. In the course of an hour more, I examined
again, and the os uteri was then nearly dilated. While pressing the
pulp of my index finger to the left side of the pelvis, it caught in a
seeming bridle, which at the instant made me fear the cervix uteri
had been broken, so as to detach a semi-circular portion of the os
uteri, for the pains had been exceeding sharp, and their returns had
been announced by violent cries. It was but a moment that I in-
dulged the idea of a rupture of the cervix, for upon pushing the index
farther, and flexing the finger, I found I could draw the point of it
outwards, pulling along with it the bridle in question. Still I did not
understand the case until, having withdrawn the indicator, I examined
with it the structure of the externa! parts, and then learned that the

1847.] Two Cases of Double Vagina. 171

lady was possessed of a double vagina. Supposing that such a reve-
lation would not be : to her, I kept my own counsel, hoping
that the child's head would come down through the right or the left
channel without injuring the lept.um. But after the head escaped
from the circle of the os uteri, the bridle or partition would not go
definitely to the right or to the left, although I thrust it first one way
and then the other. The tie was so strung that the fleshy septum
extending from the anterior to the posterior columna of the vagina,
would not admit of the dilatation of the lower or outer third of the
tube. And as the lady was very strong, and had powerful uterine
pains, I began to perceive some danger of the vagina being ruptured
by the vain efforts for expulsion.

I now explained to the monthly nurse, and to a relative of my
patient, the cause of the delay, and the necessity that had arisen. I
therefore procured the requisite permission to expose the parts to an
inspection. Upon this, the two orifices of the vagina v,Lie seen to
be exactly alike, and the partition stretched across the head from
front to rear of the passage, which by it was wholly prevented from
dilating.

I now, with a strong scissors divided the wall by a single stroke of
the instrument, whereupon the child's head advanced, dilated the os
magnum, and was speedily delivered with safety to both the mother
and her infant. She never complained afterwards relative to the
operation, and within a month I met her on foot in the streets.

A week later I was called to a lady in her 30th year, in labor of
her first child. Upon examining the state of the os uteri, 1 found the
circle not much bigger than a quarter of a dollar, with thin margin,
and within it the penis of the child : the scrotum being detected with-
in the os uteri after the pain ceased. As it was night, I went to
another apartment and slept an hour, when being called, I found the
os uteri very much dilated, and a buttock, near which was the right
foot, presenting.

While inquiring into the sta(e of the cervix, I hooked my finger
into a bridle, just as I had done in the case above mentioned, and I
confess that the same thought was obvious to me, viz: that she had
broken off a half ring of the circle of the os uteri, but I immediately
afterwards discovered that I had another case of double vagina under
management. In this case the partition was very firm and thick,
extending from the os magnum almost up to the os tineas. I inspect-
ed the eiternal structures, and the two vaginas were each perfect and
alike, included within labia pudendi common to both.

I was glad to find that only one foot of the child would come down,
being fearful that if both should descend, I might not readily prevent
one from entering the right and the other the left vagina.

I now disengaged the right foot and brought it down the right
channel, the left leg was flexed upon the belly and thorax (-1" the
foetus. With a little assistance the foot was delivered and the but-
tock of the child coming downwards, thrust the vaginal wall to the

172 Prodigious Fcecal Accumulation in the Rectum. [March,

left, and so the trunk was delivered. I had great difficulty to extri-
cate the head of the child, which remained long in the vagina; the
infant breathing from time to time the air that I admitted through
the hollow of my hand and fingers to its mouth and nostrils. The
child, a male, was alive and in good health ; the mother is quite well
recovered.

Some years ago I was called by the late venerable Dr. Ruan to
consultation upon a case of double vagina in a primiparous woman.
I delivered the child, with the forceps, through the right canal, with-
out difficulty or any injury, and had some five weeks later an
inspection of the parts, which, as I remember, were very similar to
those described in my second case above.

Prodigious FcBcal Accumulation in the Rectum.

To the Editor of the Boston Medical and Surgical Journal:

Dear Sir, On the 17th July, 1845, I was called to see F. C, a
young lady aged about 15 years. Was informed that she had seve-
ral times menstruated imperfectly, that she was somewhat troubled
with costiveness, and that she had had no evacuation from the bowels
during the three days last past. Tongue coated, white, not dry,
skin hot and dry, pulse somewhat too frequent, and complained of
pain in her head, with perfect loss of appetite. Prescription. Direct-
ed her to take six grains of the following pill mass every six hours.
Ii. Soc. aloes, 5iij.; g. scammony, 3iss.; pulv. jalap, 3iij.; hyd.
proto-chlo., 5i. ; sapo. cast., gr. xv. ; nit. pot., 3ss. ; tart, ant., 3j.;
ol. anise, arab. muc, aa q. s. to make a mass.

July 18. Being about ten miles distant, I received a very urgent
call to visit her; found her in pain, like the last pains of labor, the
intermission being very short, yet very perfect; urgent and painful
desire to pass urine, yet none had passed since the morning before
(now 4 o'clock, P. M.) Cathartic pills have not operated, and was
now informed that all the evacuations during the past two weeks had
been but an occasional scanty discharge of mucus, and that such dis-
charges were now being produced, the consequence of the excessive
tenesmus. Deciding to introduce a catheter I attempted to pass a
finger into the vagina, but was prevented by what appeared to he an
unyielding mass, filling the whole pelvis, and pressing upward and
forward so as to make it very difficult to pass the finger between it
and the pubes. I accordingly carefully insinuated the point of a
silver catheter, into the urethra and passed it into the bladder, and
discharged a quart or more of urine. The tenesmus still continued,
and the acuteness of the pain was somewhat relieved, but the invol-
untary straining effort which characterizes the closing throes of labor
still continued. With considerable difficulty I now passed a large
sized gum-elastic catheter into the rectum, and through a mass of

1847.] Iron in Cachexia. 173

faeral matter, somo ten inches, when adapting a syringe to the exter-
nal end of the tube, [succeeded by dint of perseverance in forcing
warm water through the plugged orifice of the upper end. After
Sanding up about a quart of fluid, the catheter was withdrawn, and
in two or throe minutes more than a gallon of faecal matter foilowed,
consisting almost entirely of the seeds of raspberries. After another
small evacuation, which followed in a {ew minutes, she became en-
tirely comfortable. The next day I was again culled, and finding
much the same symptoms, resorted to the same means, and obtained
a similar result. After this the urinary bladder and the rectum eva-
cuated themselves without aid, and raspberry seeds continued to
appear in the faeces for several days longer, though none had been
eaten during the week previous to my first calling upon her. Since
that time she has enjoyed her usual health.

I present this case to the notice of the profession, not on account of
any peculiarity of the practice; indeed I think it was but what was
indicated, anrl would have readily suggested itself to any reflecting
physician; but 1, To show (hat a vast amount of fecal matter may
accumulate in the rectum, and also above the sigmoid flexure of the
colon, while the sensibility of the mucous membrane remains low as
in cases of constipation, but that when this sensibility is increased, as
it was in this case by the cathartic, violent symptoms are the conse-
quence ; and 2, That when the pelvis becomes sufficiently full to
distend the perineum, the action of those muscles associated in the
function of expelling the contents of the pelvic viscera is excited, and
if this distension be proportionally increased their action becomes
intermittent and involuntary. This phenomena we have all so fre-
quently witnessed in parturition, when the head of the child fully
occupies the pelvis and rests on theperineum, that we find it difficult
to view it as but a specific accompaniment of that series of phenome-
na, the aggregate of which constitutes labor. Indeed so strong did
this influence operate upon my mind, in this case, that when prepar-
ing to introduce the catheter, notwithstanding the youth of my pa-
tient, and the character of the family being above suspicion, I could
not divest myself of the feeling that, upon the finger entering the
vagina, the head of a feet us would present itself. S. A. Cook.

Buskirk's Bridge, N. F., Jan. 4th, 1847.

Iron in Cachexia. (Medico-Chir. Review.)

Iron is an agent almost exclusively employed in the treatment of
cachexia, and its use has been in part recommended on the ground of
the deficiency of its normal proportion in the blood. It is believed
that the administration of ferruginous preparations may restore the
normal quantity of the metal to this fluid, and on this ground the most
soluble preparations are recommended, and, according to M. Mialhe,

174 Case of bad Compound Fracture. [March,

those chiefly should he chosen which are susceptible of decomposition
by the alkalis of the blood.

M. Beau doubts the correctness of this view of the direct agency
of iron, although the benefit of the substance is incontestible. Tho
iron of the blood is contained only in its globules, and there will be-
more or less of it as these globules prevail. To cure hydraemia,
therefore, and augment the proportion of globules, it can never suffice
to introduce one element of the globule only. The diminished pro-
portion of globules is maintained by the defective condition of the
digestive functions, and iron acts only by restoring these to their
integrity. In fact we daily witness cases of chlorosis treated by iron
in its most soluble forms without any success whateverj--i-the digestive
organs in such cases being in a condition not admitting of their
benefitting by its agency* The iron is abundantly absorbed into the
blood, and yet the globule is not constituted. On the other hand,
when the metal acts beneficially, the earliest effect it produces is upon
the digestive organs. We see other patients again recover under the
use of aloes, change of air, or the removal of moral causes, &c, with-
out even taking iron at all, or after abandoning it as useless the
dyspepsia having yielded to other means after the iron had failed in
relieving it. Our primary indication then must be to attack the
cause which produces the dyspepsia. M. Trousseau has already pro-
tested against this indiscriminate treatment of the' cachexias by iron ;
and, in fact, we can only reconstitute the blood by re-establishing
the digestive functions, and removing causes which operate injurious-
ly upon them. It is not by the direct agency of this medicine, but
by the greater amount of aliment it enables the digestive organs to
master, that iron is useful; and cachexia induced by mere haemor-
rhage may be at once removed by the rapid administration of
aliment alone.

Case of bad Compound Fracture. By Otis Hoyt, M. D. (Commu-
nicated for the Boston Medical and Surgical Journal.)

Since reading the excellent address of W. J. Walker, M. D., on
compound fractures, whose opinions on this subject are peculiarly
entitled to a favorable reception by the profession, I have thought a
case which occurred in my practice, while at Framingham, might not
be altogether uninteresting to the readers of the Journal, in corrobo-
ration of his views relative to saving limbs which are badly fractured.
I have no doubt many limbs, which might have been saved, have
been sacrificed to the shrine of ambition by the young surgeon, who
may wish the fame of being a good operator. 1 have noticed in the
vicinity of some surgeons who have the reputation of being good
operators, there are more people who have lost a leg or an arm than
in other regions. I will not say that these limbs have been unneces-
sarily sacrificed; but it proves one of three things, viz., that accidents

1847.] Case of bad Compound Fracture. 175

occur more frequently in these regions, requiring operations of the
kind; or that the patients of other surgeons have not recovered; or
that limbs have been unnecessarily amputated.

In the month of February, 1843, I was called to see a son of Na-
thaniel S. Falkner. of Framingham, aged 6 years. A few minutes
before I saw him, he was in the street, when a team was passing with
n heavy wagon loaded with a cord and a half of green chestnut wood,
and, as roguish boys are apt to do, he stepped up behind one of the
oxen and struck him. The ox, resenting the blow, kicked the boy
immediately before the wheels, both of which passed obliquely across
the thighs. The road was composed of hard gravel, and a narrow
rut worn down from three to four inches deep. The place of injury
of the left thigh was near the middle, and that of the right below the
middle, including about one third of the whole length of the thigh.
In viewing the limbs sidewise, they appeared about as thick and as
flat as the open hand. No pulse could be felt in any part below the
place of injury in the right limb. It was cold and livid. In examin-
ing the place of injury, I found the bone crushed in pieces, the integu-
ments torn through, and the lower fragments had been driven through
the pantaloons into the gravel. Some of the marrow of the bone was
found on the pantaloons. The left limb was not so severely injured.
Pulsation could be detected in the foot, and the osfemoris was broken
in two places, corresponding in distance to the width of the wheels.
I had no fears but this limb would do well enough, provided there
was no other injury. But what was to be done with the other limb.
The boy was cold and pulse feeble, evidently in such a state that the
shock of the operation of amputation would not be borne well. I
therefore decided to place the left limb in as good a position as possible,
and accordingly dressed it with the many-tailed bandage, and suita-
ble splints, and laid it over a double-inclined plane. I then removed
ail of the pieces of bone appearing to be loose in the right thigh, and all
of the sharp points likely to prick the soft parts, and laid it in nearly a
straight position, and enveloped it in cotton to keep it warm, leaving
the opening through the integuments in such a position as to allow the
draining of the wound, determining that if, when the boy revived
from the first shock of the accident, circulation and sensation did not
return, to amputate. In about six hours the limb became warmer,
feeble pulsation could be felt in the ankle, and sensation had partially
returned ; the leg was less livid.

As the circulation at this time seemed to indicate that the large
vessels and nerves were not so injured as to prevent their proper
functions being performed, and relying very much on the previous
healthy condition of the boy, and the intelligence of his parents to
take suitable care of him, I determined to make an effort to save this
limb. 'I 'here was sufficient discharge of blood from the wound fur
forty-eight hours to prevent much fever or much inflammation of the
part injured. He was gently purged every day during the first
week with sulph. mag., and his diet for the first four days, one half

170 A Case of Concussion of the Brain, <^c. [March,

pint of wafer, and one half of a common cracker per clay ; and daring
the next four days, he was allowed the whole of a cracker per day,
with as much water as he chose to take. After the first eight days
he was allowed to take rye mush and milk, and other light food in
abundance. On the tenth day the right limb was placed over a dou-
ble-inclined plane in the same manner as the other, with the provis-
ion of an opening in the board to facilitate the draining of the wound.
Abundant suppuration took place, the wound filled up rapidly by
granulations, and not a single unfavorable symptom occurred during
the whole course of treatment, and in twelve weeks from the day of
the accident the boy walked to school, a distance of thirty rods, with
as good and handsome pair of limbs as any other boy possesses, with
the exception of the right limb being about half an inch shorter than
the left. I make no comments on the case, merely stating the facts,
and shall let others judge as they may as to the correctness of the
practice.

A Case of Concussion of the Brain followed by Mental Derangement
and Paralysis, successfully treated by Sulphuric Ether. By Joan
Travis, M. D., of Melville, Tennessee. (Western Journal.)

M. P. eEt 25 years, was thrown from a horse against a dwelling
bouse with great force; he was apparently dead for4 half an hour.
His head was bruised and the integuments lacerated. When he
revived he was found to be deranged in mind, in which state he con-
tinued for six weeks, notwithstanding he had two medical attendants
with hint daily. On examination, it was ascertained that there was
no fracture of the cranium. So soon as his reason returned, his arms
to the elbow, and his legs to the knees, became paralysed ; he could
move neither, which proved that the nerves of motion had lost their
power. The function of the nerves of sensation remained unimpair-
ed. In this condition his health otherwise was good. His physicians
gave him a variety of medicines, and applied various rubefacients,
blisters, &c, for several weeks, 'but the patient remained in statu quo.
I was now called upon ; I prescribed different articles of the materia
medica all in common use, in fact, except strychnia. This I in-
tended to use as a dernier resort; bat learning that ardent spirits
would in a slight degree excite the nerves of motion, I sent the pa-
tient eulphuric ether, and directed him to take a large tea-spoonful in
cold water, three times a day. After using this medicine three days
he could bear his weight on his feet; and in two weeks he could walk
without any assistance, and is now in a manner well", having the use
of his arms and legs.

I have thought it proper to make these facts known, as it is a mode
of treatment that I believe has not hitherto been pursued, and one
which has proved eminently successful in a case which was deemed
hopeless by the patient and his friends.

1947.] Electro-Magnetic Currents in Paralysis, 177

On thp. Employment of Electro 'Magnetic Currents in the Treatment
of Paralysis. By Goldizvg Bird, M. D., F. R. S., &c. (Rank-
ing's Abstract.)

[Dr. Bird, whose experience of the therapeutic powers of electro,
galvanism appears to have been considerable, gives the following
classification of the varieties of paralysis in which he has found it
decidedly beneficial.]

1. Case of partial paralysis resulting from congestion or other
cerebral mischief admitting of successful treatment. The congestion
or effusion is removed, but a more or less palsied state of some part of
the body remains. Cases of this kind are common enough ; and al-
though (he paralysis in general slowly disappears with the cause of the
cerebral disorder, still the axiom of sublala causa tollitur effectus,"
does not always apply. Every now and then, although the blow has
ceased, the bruise (if the expression be permitted) remains. Time,
friction, change of air, restoration of the general health, strychnia,
dec, will all succeed : but when with improved general health the
stimulus of the electro-mngnntic current be employed, success is
much more general and certain. All that is required here, is to
apply one of the conductors, covered with wet linen, over the trunk
of the largest nerve of the part affected, and to pass the other, simi-
larly covered with linen, over the region of the palsied muscle, so ns
to keep them actively contracting for some minutes. In recent cases,
a single application will often succeed; in more chronic ones, the
remedy may be continued for weeks, until the paralysis disappears.
Ono of the first eases in which I used this remedy occurred, about
nine yoars ago, in a gentleman holding a prominent position at the
bar. I saw him with Mr. Freeman of Spring Gardens, under whose
care he was. This gentleman had palsy of the left side of the face,
the relic of an hemiplegic attack following cerebral congestion, the
result of intense study and anxiety. His cerebral disease had been
cured, his general health restored, but the paralysed nerves of the
face alone refused to resume their functions. The electro-magnetic
current was applied daily, the patient's footman being the "medical
electrician," and in a few weeks he quite recovered.

2. Paralysis of muscles supplied by theportio dura, following ex-
posure to cold. This form of local paralysis, when independent of
cerebral mischief, generally yields readily to treatment. Cases,
however, occur, in which the nerve remains inactive, and the patient
walks about for a long time with a distorted face. The electro-
magnetic current is here of great value. I have seen many cases of
this kind ; one to which I was recently called resulted from exposure
of the left cheek of a lady for some hours to a current of air from a
broken window. She recovered readily from the accompanying
bronchitis, but was left with her features distorted, being drawn to the
right side. I at once suggested the current from the apparatus; her
muid-scrvant was the operator, and cured her mistress in a week.

12

178 Electro-Magnetic Currents in Paralysis, [March,

3. Local Paralpsis involving the whole or a part of a limb from ex-
posure to cold. This variety resembles the last, and is probably of a
rheumatic character ; although, it must be confessed, it is often a diffi-
cult task to define the line separating rheumatic from some paralytic
affections. The following is one of many I haAre seen : The actu-
ary of one of the large assurance offices consulted me, with nearly
complete paralysis of motion of the left arm, sensation being pretty
perfect ; no pain whatever in moving the limb. During a cold win-
ter he had been in the habit of sitting at his desk, with the right side
of his body roasting by a large fire, whilst the left was chilled by blasts
of cold air from a frequently-opened door. Gradually, pain and
stiffness appeared in the left arm, but no swelling. The pain gradu-
ally vanished, and the limb was left palsied. Other remedies proving
useless, the electro-magnetic was applied. I ordered a conductor to
be placed over the lower cervical spinal region, to influence the origin
of the axillary plexus, the other being passed down the arm. After
a few weeks he quite recovered. This gentleman was his own oper-
ator; he fastened the spinal conductor in its place by his neckcloth,
and thus had the right hand at liberty to apply the other.

4. Paralysis affecting one side of the body, or a single limb, the
result of exhaustion. These cases are not unfrequent, and before
their nature was understood they used to be fearfully mismanaged, the
paralysis being looked to, rather than the cause producing it, and de-
pletion and mercury employed when nutritious food and stimulants
were really indicated. It often happens that these cases are directly
traceable to an obvious cause, and then the diagnosis becomes easy.
The insidious exhaustion and enervation produced by excessive lac-
tation is a not unfrequent cause. I saw a well-marked case of this
kind five or six years ago, in a patient under the care of Mr. Pretty,
now residing in Mornington road. This lady, a person of weak
frame and strumous diathesis, had become exhausted by nursing her
third infant, and the left arm became gradually palsied as far as mo-
tion was concerned. A generous diet, weaning the child, and the
electro-magnetic current, were ordered. I had lost sight of this lady
until a few days ago, when I was called to see her sinking from
phthisis. I then learnt that, under the treatment suggested, the par-
alysis had soon disappeared.

Paralvsis. from enervation, has occasionally followed sudden loss
of blood at flooding labours. I have witnessed complete hemiplegia
as the result. A case of this kind I once saw with my friend Mr.
Law, of Finshury, who had most properly treated the lady with gen-
erous diet and iron, under which she did well. When under this
treatment, in spite of the restoration of the general health, paralysis
remains, the electro-magnetic stimulus promises, from what I have
seen, to be of much service.

5. Cases of Rheumatic Paraplegia. To this category I refer
cases of rheumatism, affecting chiefly the lower extremities, the pain
and acute action disappearing, while more or less complete paraple-

1947.] Electro ^Magnetic Currents in Paralysis. 179

gia remains. In these cases I have seen the greatest benefit result
from electro-magnetism, as well as from ordinary electricity. I have
witnessed so many of these cases thus treated do well, that I can
speak with great confidence of its influence. One case will suffice
as an example. A man came last summer into Luke's ward, at Guy's,
under my care, with complete paralysis of motion of the lower ex-
tremities. He was totally unable to move his feet or knees, and was
carried into the ward. This state of things had followed the dashing
of ice cold water on his legs and thighs whilst sweating profusely.
But little medicine was ordered for this man, and in less than three
weeks he, under the use of electro-magnetism, walked about the ward,
aided by one crutch and his- stick. In these cases one conductor
should be firmly pressed against the sacrum, whilst the other is placed
in a basin of salt and water, in which the feet are emersed.

6. Paraplegia the result of enervation? I am not quite sure of
the pathological correctness of the title I have thus assumed. By it,
however, I understand a series of cases in which paraplegia, both of
motion and sensation, results from excessive fatigue, from sitting for
weeks and months together, during the greater part of the twenty-
four hours, with the spine somewhat bent. I knew of one case in
which a distinguished physician actually became thus palsied, after
assiduously devoting his time to the study of certain phenomena by
the microscope, in doing which he, for hours together, used to lean
over the instrument. There is, however, another cause, unhappily
too rife, of these cases, the miserable result of the utilitarian dogma
which makes human labor a marketable commodity, without any
regard to the conservation of health. I may perhaps startle some by
announcing the fact, that I have, in several instances, seen more or
less complete paraplegia among a class of laborers of the most op-
pressed and most unprotected character. I refer to the needlewomen
of this metropolis a class of girls and women who, to earn enough
of the wretched pittance they receive from the agents who employ
them, to procure the commonest necessaries of life, are often com-
pelled to work for fourteen, sixteen, eighteen hours, or even some-
times longer in the twenty-four hours. They toil on indeed, at the
needle until their sight fails as they drop asleep, waking, after snatch-
ing a short slumber, to resume their work. These poor creatures
receive from three-half pence to four-pence halfpenny for making a
shirt (for the latter price producing such as is worn by respectable
mechanics and others). They are unable to procure proper food, and
are often driven to intemperance to forget their miseries, or to pros-
titution to add to their wretched income. Xo wonder that they
become exhausted, enervated, bloodless; and paraphlegia is not un-
frequently the result. I had under my care in the hospital this last
summer, a young woman who had once moved in a respectable
sphere. She was quite paraplegic. She had been exhausted by
working in the way I have described, and declared to me, that ex-
cepting dozing in her chair, she had often not slept for two nights

180 Syphilis Infantum, [March,

together. She iifst folt vague pains in the toes, then in the knees;
rigidity came on. and ultimately she became as I .saw her, the lower
half of her body being as powerless as if made of marble.

In many of these cases no organic lesion exists; and by due nourish-
ment, rest in the fecumhent position, iron or zinc, and the subsequent
application of the electro- magnetic stimulus, recovery generally lakes
place. These cases are little* known, and will continue (we must fear)
to occur, so long as the labour of the friendless and dependent female
is regarded with no more feelings of sympathy or humanity than the
amount of duty performed by a steam-engine or any other machine.

In thus advocating the electro-magnetic current as an important
nnd most valuable excitant of paralysed muscles, I must stiil acknowl-
edge that it is anything but a universally successful remedy. In the
great majority of forms of palsy above described, it is indubitably in
some the actual curative agent ; in all it expedites and aids the cure,
in none is it injurious. As a general rule I think it will be' found,
ccpfrris paribus, to act most effectually in proportion to the acoteneas
of the case. In chronic paralysis we must recollect that any new
tissue deposited during, perhaps, many months* or longer, although
organized like the healthy structure, and provided with its due supply
of nerves, is still composed of fibres which have never obeyed the
influence of the will have never moved at the volition of the patient.
This I believe to he the reason of our not at once rousing a long
paralysed muscle into action. We can here only expect to succeed
by submitting the paralysed part for a long period to the influence of
the remedy. I cannot conclude without urging upon the profession
the impropriety and mischief of using electricity in some cases merely
because paralysis exists. In true spina! paralysis, depending upon
organic lesion, the electro-magnetic current often does mischief,
especially where there is subacute inflammation, era highly irritable
state of the spinal marrow a state of things shown,, among other
symptoms, by the involuntary and unconscious starting of the legs.
In all such eases the remedy dots no good, and in some it does great
harm, the effect of its local irritation, when applied to the legs, ap-
pearing to be reflected to the spine, and greatly increasing the
patient's suiTerings.

Syphilis Infantum,

To the Editor of the Boston Medical and Surgical Journal :

Dear Sir The case about to be recited has several peculiarities,
which render it one of more than usual interest.

1st, The disease showed itself n few days after birth ; it common-
ly does not manifest itself till the fourth or fifth month.

2d, The copper-colored ulcers were diffused over the whole surface
of the body; th<* face and feet having the most blotches, and the
anus and pudenda the fewest.

1847.] Bibliographical 181

3d, Three previous children had died young of (he disorder, that
had been treated with mercury, <kc; thi*. the fourth chiid. survived
under a somewhat modified and different treatment.

Casb Mrs. S. was delivered of her fourth child. On the next
day I found holh mother and child doing well. On the fourth day I
was desired to sen the child, the messenger stating that it was taken
like all the rest "and likely would not stand it Ion<r." It will he
proper for me here to say that this family was respectable, and both
parents apparently healthy. I had no acquaintance with Mrs. S. un-
til her last confinement.

Found the child, which was at first strong and plump, now weak
and shrivelled. The infant was hoarse, surface cool, the eyes and
nostrils discharging a filthy ichor, and the body covered with ulcers
of a copper color, f prescribed ft. Pulv. Doveri, gr. j. ; protochlo.
hydraror., gr. jv. M. Div. in chart No. xvj. Give a powder every
three hours, until the infant appears to he under the influence of an
anodyne, then give a tea-spoonful of castor oil; when the oil moves
the bowels, resume the powders under the same directions. Also
apply the following ointment to the ulcers. R. Protochlo. hyd.,
grs. x. ; adip., gss. M. Ft. ungt.

The above plan was pursued for six days, at the end of which time
the ulcers were nearly healed, the voice was natural, the spasms had
subsided, the extremities warm, &c. Then prescribed ft. Syr.
rhei aromat., f 3j. ; to he given every evening. At the end of five
days discontinued the syr. rhei, and substituted small doses of calcined
magnesia, as the child needed some, aperient medicine.

The opium and calomel ointment were in this case strikingly bene-
ficial. The first as a sedative, diaphoretic and antispasmodic, flraa
very useful as a stimulant, it seemed to arouse the general prostra-
tion of the system in a gentle and salutary manner. The latter kept
the skin soft; it was applied to the eyes and nose, and, s no other
local remedy was employed, its alterative action was obviously ser-
viceable to a high decree.

BIBLIOGRAPHICAL NOTICES.

1. The Half -Yearly Abstract of the Medical Sciences: being a
practical arid analytical Digest of the contents of the principal
British and Continental Medical Works published during the pre-
ceding six months, &c, &?. Edited by \V. H. Ranking, M. D.,
Cantab, &c. Vol. II. No. 2. July to December, lS4o. pp.
411. Philadelphia: Lindsay & Blakiston.

In our first volume, we noticed the appearance of this new period-
ical in the British Medical world, and its re. publication in this coun-
try. Since then, (probably through some neglect or error.) the
two preceding Nos. were riot senl us. The present Mo., for whi h
We are indebted to the kindness of the enterprising publishers in

182 Bibliographical. Medicated Milk. [March,

Philadelphia, fully sustains the high opinion we have already express,
ed of its character. The sincerity of our estimate of this half-yearly
periodical, may be judged of by our numerous extracts from it.

2. Encyclopaedia Americana : Supplementary Volume. A popular
Dictionary of Arts, Sciences, Literature, History, Politics, and
Biography. Vol. XIV. Edited by Henry Vethake. L. L. D., Vice
Provost and Prof, of Mathematics in the University of Pennsylva-
nia, &c.,&c. pp. 663. Philadelphia : Lea &Blanchard. 1847.

Our kind friends, Messrs. Lea & Blanchard, have placed this
volume in our hands, through Mr. Richards, Bookseller, of this city.
Although not a medical work, yet in the biographical department,
we are pleased to see that in this supplementary volume, the names
of Physick, Dupuytren, Hosack, &c, may be found. From a
cursory examination, we have formed a high estimation of it's
worth.

3. Lectures on Subjects connected with Clinical Medicine : Com-
prising Diseases of the Heart. By P. M. Latham, M. D., Fellow
of the Royal College of Physicians, Physician extraordinary to
the Queen, &e. pp. 365. Philadelphia: Ed. Barrington & Geo.
D. Haswell. 1847.

This, as the reader will perceive by the cover of the work, is one
of those valuable republications, which Dr. Bell, editor of the Bul-
letin of Medical Science, has so frequently favored the American
world. The character of Dr. Latham requires no commendation of
ours. The work before us is made up of thirty-eight lectures on
Diseases of the Heart, delivered at St. Bartholomew's Hospital, Lon-
don. It is designed to present these diseases as they occur in the
living man, to the medical student, and faithfully has he accomplish-
ed his task. This volume should be studied by every practitioner of
medicine.

PART III. MONTHLY PERISCOPE.

Medicated Milk. The Editor of Gazette Medicale (for June,
1846.) mentions that there has been lately established at Montrouge,
near Paris, an establishment of a novel kind. The physicians who
superintend it, thought proper to treat certain diseases by the use of
cows' and goats' milk, having first subjected these animals to the medi-
cation necessary to give their miik the therapeutic properties which
may be required for the cure of these diseases. Southern Journal of
Med. and Pharm.

1847.] Human Skull. Salivation. Bowel Complaint. <5pc. 183

Strength of the Human Skull. Practised anatomists are eloquent
in their osteological comments upon the carpentry of the skull. Who
that lias listened weeks in succession to lectures on the bones, does
not recollect how much is said on the arrangement of the arches in
the interior of the cranium, which give it great power of resistance:
in short, were the frame-work of the head constructed upon any
other principle than the one nature adopted, such are the shocks and
blows to which it is constantly exposed, the wall would be frequently
broken, and the functions of the brain destroyed. But no lecture
room demonstration, however ingeniously illustrated, hypothelically,
can compare with the following fact. A few days since," says the
Amherst Express, " a son of Mr. Dudly, of Shutesbury, Mass., about
five years old, accidentally fell from a cart containing about twelve
hundred pounds weight, which passed directly over his head. He
received no apparent injury except a slight bruise near the ear made
by the wheel. Boston Med. and Surg. Jour.

New remedy for Mercurial Salivation. Dr. Robertson, of Har-
rodsburg, Ky., reports several cases successfully treated by a domestic
remedy which he has recently discovered. The plant is known by the
common names of horseweed, richwecd, horsemint and horsocane.
Dr. Griffith, of Philadelphia, to whom the plant was submitted, thinks
the plant is the Ambrosia Trifida. It was employed in the form of
decoction. American Jour. Med. Sci., and West. Lancet,

Iodine Liniment in Bowel Complaints. By J. Duncan Macdiar-
mid. The iodine, in the proportion of a scruple to the ounce of olive
oil, is freely smeared over the entire surface of the abdomen, and the
operation is repeated as soon as the liniment is absorbed, and the
skin has again become dry and colorless, or almost so. In infants
two or three applications may, I think, be safely employed in the
twenty-four hours, and in the adults more frequently, if necessary
that is, in acute cases; while in those of a chronic form, probably its
free application once a day would be the more advisable plan. But
in all, I would only employ the liniment as an adjunct to the ordinary
treatment, which, however, by itself, is often very unsuccessful in the
bowel complaints of children during the hot months. Brit. Amer.
Jour. Med. and Phys. ScL, and Ibid.

Castor Oil in Diseases of Mucous Membranes. Dr. Thompson
recommends an emulsion of castor oil, in bowel complaints. The
following is his mode of employing it for young children : Jt. Castor
oil, 3j jss ; Yolk ofegff. ss.; fennel water, sj. Mi*. Take a small
spoonful twice a day. This mixture, it is alledged, will change the
character of.ovacuations more readily than mercury. Laudanum is
sometimes added. It is even recommended when inflammation \s
present. Of course the dose would vary with njre nnd other circum-
stances. [Monthly Jmim. Mel. Science, an I Ibid.

184 Quinine, Skin Affections. Drastic Potion. c. [March,

Mode of using Quinine. An opinion is rapidly gaining credence
in the United Slates, that large doses of quinine given at long inter-
vals, are more efficacious than the same quantity in small and fre-
quently repeated doses. Foreign experience corroborates this view.
Dr. Graves is now disposed to give it in large doses, and these only
when the paroxysm recurs. He is of opinion that the practice of
giving quinine after the fits have ceased, is injurious, because the
system becomes accustomed to the medicine, and its anti-periodic
influence is measurably lost. M. Bretonneau advocates large doses ;
and he is of opinion that small, frequently repeated doses impair the
digestive function, without so effectually curing the disease. [West-
ern Lancet.

Efficacy of Creosote on Papular Affections of the Skin. M. Max.
Simon has recently published some observations relative to the treat-
ment of papular diseases of the skin when they have become chronic.
The application which lie has found most beneficial is an ointment of
creosote, made as follows :

ry ' " ?, > To be made into ointment.

Creosote, - dr. J

[Ranking' s Abstract,

Drastic Potion. (Journal des Connaissances Medico-Chirurg.)
Dr. Tessier has often proved the excellent effects of the following
formula in the paraphlegic:

Take, Water of the Linden tree, - 125 grammes.

Brandy, 30 do.

Wine of Colchicum, - - 30 do.

Syrup of Buckthorn, - - - 30 do.

Tartar Emetic, .... 25 centigrammes.
Make a potion for three doses, halfan hour apait. M. T. omits one
day, and then prescribes again this drastic potion, which he continues
every second day until a cure is affected.

Comparison of the efficacy of Tr. Iodine diluted and vinous injec-
tions in Hydrocele. In the January No. of the Journal des Connais-
sances Medico-Chirurg. just received, is an interesting case on this
subject, published by M. Bouisson, Prof, of Clinical Surgery to the
Faculty of Medicine at Monfpellier. A patient entered the hospital
having double hydrocele, and for which he was operated simultane-
ous, on one side with red wine injected into the tunica vaginalis testis,
and on the other with diluted tinct. of iodine. There was much pain
and inflammation, with great tumefaction, developed on the side to
which the wine was applied, and neither were appreciable in the
other. The iodine too, had cured one side long before the other.
Altogether, this case proved most decidedly the superiority of the
modern (iodine injection), over the old (vinous) mode of treating
hydrocele.

1847.] Tr. Iodine. Benzoic Acid. Urethra. Rectum. 185

Tincture of Iodine in Inflammation of Hones. In cases of inflam-
matory swelling of the hones, M SieWever commences by making
in<:i*inn; then he applies twice a day frictions with the tinclure of
iodine until the epidermis assumes a deep brown color. Before each
friction, he slightly detaches with the finger nails the epidermic crust
which covers the incisions. The author has obtained numerous suc-
cesses by this mode of treatment. [Jour, des Connais. Med. Chir.

Treatment of incontinence of urine by Benzoic acid. (Gazette
Medic ale.) M. de Fracne, accoucheur at Tubize, reports the case
of a tfirl of 15 years, who after several attacks of acute gout, had
incontinence of urine, which, owing to a false delicacy on the part
of the mother, was neglected for the space of four months. A tonic
and aromatic treatment was adopted, hut without effect. She was
then put upon the use of the benzoic acid, night and morning, for four
days, but the complaint persisted. The do.ses were then doubled, and
after the first dose the disease immediately ceased. The medicine
was continued for some days in the same doses, and afterwards in
quantities gradually diminishing. She had no return of the disease.

Process for finding easily the urethra after amputation of the Penis.
(Jour, de Med. de Bordeaux Gazette Medicale.) The difficulty of
finding the urethra after amputation of the penis, is one of the most
serious obstacles in this operation, and one which has most called into
exercise the inventive genius of surgeons. To the we!! known pro-
cess of M. Barthelemy, M. Chaumet prefers the following:

Before amputation, a catheter is introduced to evacuate the urine,
through which an emollient fluid should be injected into the bladder.
The urethra is compressed at the root of the penis by an assistant.
The penis is now amputated, and to find the orifice of the canal, all
that is necessary is to suspend the compression, and to direct the pa-
tient to yield to the desire which he feels, to urinate. The flow of
the liquid indicates the urethral orifice.

Prolapsus of the Rectum treated with concentrated Acids. (Allge-
meine Medicinische Central Zeitung Journ. des Con. Med. Chir.)
Dr. Jaesche of Minsk, having tried the means proposed for the
cure of prolapsus ani, by Dupuytren, in four cases without success,
was led to employ the sulphuric acid. Me applied a pledget of char-
pie, wet with this acid, to the anus of a young man affected with this
disease, and also with hypochondriasis. This tampon was introduced
into the bowel to the depth of several lines. It produced great pain,
which ceased in some hours, and the excavations produced by the
cauterization promptly disappeared. The prolapsus reappeared at
the end of a week. It was again successfully treated by this cauteri-
zation. This was repeated several times with success, and during
four months that the patient remained in the hospital, the complaint
did not reappear. Dr. J. employed tho acid in several other cases,
and the cures were permanent.

180 Erysipelas. Midwifery. Corrosive Sublimate. [March,

The niiric acid produces the same curative effect as the sulphuric,
and it possesses the advantage of producing less pain and excoriation.
In an old woman laboring under ascites, there existed a prolapsus
ani which was treated with applications of nitric acid, and the disease
did not reappear for six weeks, notwithstanding the use of drastics
given for the relief of the ascites. The disease was soon reproduced
by a diarrhoea with tenesmus, but was again cured by the application
of the nitric acid, which produced no pain. The fuming nitric acid
employed in another case produced violent pain, and excoriations, but
the cure was rapid and complete. These and other facts have led
the writer to regard the nitric acid as an excellent means of treating
prolapsus ani without producing much pain. He does not recom-
mend it as absolutely certain, but as at least superior to all others,
especially to the extract of nux vomica.

Ung. Hyd. Potassa in Erysipelas. Dr. Griscom stated that he
had occasion to prescribe Ung. Hydrarg. to be applied to an erysipe-
latous surface, and that the apothecary made a mistake, and gave
Uug. Hyd. Potassse, which had been applied, with the effect of re-
moving the erysipelas almost immediately. [N. Y. Jour. Medicine
and Surgery.

Midwifery Statistics. A reviewer in the March number of the
Archives Generales gives the following general results of Midwifery
Statistical Tables, recently published in the Italian and English Jour-
nals. In 47,116 labors, twins occurred 446 times, (9 4-10 per thou-
sand,) triplets four times. (1 in 10,000.) There were 40,233 head
presentations, (969 per 1000,) of which 40,046 were vertex, and 187
face. There were 1065 breech or footling presentations, (27 per
1000,) and 154 transverse ones, (4 per 1000,) Of these labors,
46,632 terminated naturally, (989 per 1000.) and 484 (11 per 1000,)
artificially, viz: 221 by means of the forceps, 89 by craniotomy,
54 by turning, and 20 by vaginal or uterine hysterotomy. [Medico-
Chirurgical Review.

Incompaiibles with Corrosive Sublimate. It may be useful to know
the vegetable infusions, decoctions, and tinctures, which decompose
corrosive sublimate. Any pharmaceutical preparation containing
one or more of the following substances will produce this effect; but
the rapidity with which the decomposition takes place varies in
different instances. 1st. Substances that decompose corrosive subli-
mate slowly, .throwing down calomel: marsh mallows, bitter sweet,
columba, oak bark, sarsaparilla, quassia, gentian, resin of guaiacum.
2d. Substances that decompose corrosive sublimate instantly, forming
particular mercurial compounds: opium, cinchona. The result of
the decompositions produced by the first group is to diminish ex-
tremely the activity of the corrosive sublimate: thus, this medicine
mixed in ordinary dose, with decoction of sarsaparilla, and adminis-

1947.] Cupping. Asiatic Cholera. Stereoscope. Castor Oil. 187

tered for an indefinite period, will rarely salivate. The decomposi-
tion produced by cinchona does not, on the contrary, seem to interfere
materially with the virtues of the medicine: we know that one of the
most favorite modes of administering corrosive sublimate is, dissolved
in tincture of cinchona. [Southern Jour. Med. and Pharm.

Employment of Gun- Cotton in Cupping. The Provincial Med.
and Surg. Journal of Dec. 9th, contains the following announcement :
44 It may be useful to know the value of gun-cotton in exhausting the
air from cupping glasses ; having so employed it myself on several
occasions, I can recommend it as possessing a decided superiority
over spirit; besides, its lightness and portability is an advantage at
times. A very small portion is placed within the glass, and before a
piece of lighted paper can be well introduced, from its highly inflam-
mable nature it becomes ignited, imparting to the surface enclosed
merely an agreeable warmth.'' [Medical Examiner.

The Asiatic Cholera in Persia. According to the Gazette Medi-
cale, six Princes and several Princesses of the Court of Persia have
been cut off by the Asiatic cholera. The mother of the Prince Royal,
and the only daughter of the Schah, had been attacked, but had re-
covered under the treatment of Dr. Cloquet. Among the victims is
the celebrated Mirza-Aboul-Assan-Khan, minister of Foreign Affairs,
who was ambassador to this country in the year 1820. Another
minister of the Schah, the Visier of the Prince Royal, and other high
functionaries of the Court, have also been cut ofT by cholera. The
disease appears to have been particularly fatal among the upper
classes. It was spreading in all directions, and had taken the course
of Astrachan and Moscow. It was expected, however, that its pro-
gress would be arrested by the cold of winter. [London Med. Gaz.

The Stereoscope is a new instrument invented by M. Cornay, for
applying auscultation to the detection of vesical calculi, and even of
foreign bodies in the soft parts of the body. The instrument resem-
bles a common catheter, and presents at its free extremity a sort of
broad pavilion, somewhat resembling that of a speaking-trumpet.

[Medical Times.

Method of Disguising the JVauseous Taste of Castor Oil. In order
to obviate the nausea so frequently produced by castor oil, M. Righini
proposes to mix it with syrup and gum arabic in the following pro-
portions

Castor oil 30 parts

Sugar 30

Water 100

Powder of gum arabic - - 8
This is made into an emulsion, and the juice of an orange is squeezed
into it. [Medical Gazette.

188 Prescriptions. Hydrophobia. Teeth. [March,

Preservative from the cicatrices of the variolous 'pustule. (Journal
de Pharroacie Journ. ties Oonnaissanees Medieo-Chirurjiicalesi*)
Dr. Thieimann prescribes the. following coliyriuin when .-mnll-pox
has reached (lie period of suppuration, when the eyelids were cover-
ed with pustules, and much swollen :

R. Bichloride of Mercury, - 5 centigrammes.
Distilled water, . . . 180 grammes.
Sydenham's Laudanum, - 4 grammes. M.
This colls Hum may he applied once n day by means of compresses.
Dr. T. has seen I his application dry Up voluminous, confluent and
inflamed pustules, without leaving the slightest trace.

Combination of Bichloride of Mercury with Tartar Emetic. (Bul-
letin de Therapeutique.) M. Bertini, of Turier, has obtained very
good effects from the following formula, proposed by Sienay :
R. Purified Ho^'s lard, - - - 48 grammes.
Tartar Emelic. in powder, - 8 grammes.
Bichloride of Mercury, - - 30 centigrammes.
Mix well together. After two, or at most three frictions, this ointment
developes numerous pustules, which suppurate more rapidly, than
those produced hy the tartar emetic alone.

The Marchand Remedy for Hydrophobia. For more than forty
years a family hy the name of Marchand, residing in western Penn-
sylvania, has had great notoriety for making and vending a nostrum
for the prevention and cure of hydrophobia. Quite recently I had
an opportunity of examining this nostrum, and send you the result.

The potion consists of three boluses, and in each bolus is a pellet
of paper closely rolled. On unrolling the pellet carefully I was
enabled to read the following words written in a fair hand : " Mar-
garat, Feragat, Magulat." Of course the efficacy of the bolus re-
sides in the magical words.

A fatal case of hydrophobia occurred last month in Alleghany;
the friends had procured the Marchand nostrum, and 1 was thus en-
abled to see the bolus for the first time. [Medical News.

Short Rules for the Preservation of the Teeth. By A. C. Dayton,
Dentist, Shelbyvtlle, Tennessee. The first, and by far the most
important rule is this : Preserve perfect cleanliness of the teeth, and
the parrs around them. In many mouths this cannot be accomplish-
ed without much care and trouble. It is not enough that the brush
be passed over the outer surface of the teeth, (or that next the cheek
and lips.) but the grinding surfaces, and the surfaces facing inwards
towards the tongue, should be brushed with equal eare. And even
this is far from being sufficient, for particles of food and the secre-
tions of the mouth are liable to lodge and remain between the teeth,
where the brush cannot touch them. The best method to remove
these is that suggested by that eminent dentist, Dr. Parmly. He

1647.] Rules for the Preservation of the Teeth, 189

advises to pass a little floss silk through each interspace, at least
once every day. If the fl<>-.s cannot be procured a good substi-
tute may be prepared by taking the twis? out of sewing ^ilk. This
will cleanse those surfaces which the brush cannot reach, if this lie
considered too troublesome, h t every particle of lood he carefully re-
moved with a tooth pick, made of a qui!!, after earn meal.

2nd. Do not useptff*, needles, knives, or metallic tooth picks.
They are liable to break the enamel, or wear il away. If th-r>.- are
plugs in the mouth, they roughen th< ir surface, or, it may be, start
them from their places.

Srd. Do not expose your teeth to sudden and extreme changes of
temperature by taking alternately very hot and very cold articles
into the mouth. The pulp or nerve of the tooth may take on inflam-
mation from this cause, or the sudden expansion and contraction of
the enamel may cause it to crack, and so to admit the fluids of the
mouth to act upon the hone of the tooth, which the enamel was de-
signed to protect. It is well to rinse the mouth after eating, hut the
water should not he very cold, and you should wait until your teeth
have had time to cool a little before applying it.

4th. Do not eat exclusively on one side of the mouth. Nature
intends the teeth for use. They require exercise as much as any
other part of the body. Their proper exercise is in the mastication
of the food. Those which are not used, become, after a certain
time, slightly sore, or tender to pressure, are often heavily coated
with tartar, and feel as though tbey were slightly loose in. their sock-
ets. l\ possible, treat both sides alike.

5th. Take special painsto cleanse the mouth in sickness. A neg-
lect of this is a frequent and most effective cause of the loss of the
teeth. Many persons date the commencement of decay back to some
spell of sickness; and they often attribute to the medicine, a result
which is the consequence of their own neglect. The secretions of
the mouth are then more acrid and more liable to act upon the en-
amel. And yet it often happens, that during the whole period of
one's confinement by disease, not the slightest attention is given to
this matter. If the strength of the patient will at all permit, the
same means should be used to secure perfect cleanliness which I
have recommended to those in health, and they should be employed
more frequently.

As soon as practicable after recovery from sickness, the teeth
shoujd be carefully examined by a dentist in whom you have confi-
dence, and any incipient decay checked at its commencement.
Much mischief may in this way be prevented by a little trouble.
This is especially necessary when the patient has been salivated.

6th. Avoid the free or frequent use of acids. These act upon the
enamel chemically, and decompose it. Very sour fruits, as green
grapes, lemons, &c, "set the teeth on edge." The sensation des-
cribed by this expression is produced by the decomposition of a very
small portion of the enamel. Some of the stronger acids act more

190 Itomceopathy. Medical Intelligence. [March,

rapidly. The common solution of quinine is prepared by the aid of
a small quantity of sulphuric acid. The elixir of vitriol is also com-
posed in part of this acid. Both these medicines are in common use
as tonics. In some cases of diseased liver, a solution of nitric acid is
given by physicians. All these, and other preparations of the kind,
exert a fatal influence upon the teeth. It is not our province to in-
terfere with the medical treatment of disease, but it cannot be amiss
to suggest a remedy for the ill effects of these medicines, when it is
thought necessary to prescribe them. It is this : Have close at hand
a quantity of water in which a little salseratus, pearlash, or carbonate
of soda has been dissolved, arid the moment you have swallowed the
acid medicine, linse your mouth thoroughly with this solution. It
will neutralize the acid, and prevent its continued action. It is not
sufficient to imbibe the medicine through a quill or tube, as is gen-
erally practised. Every one who will try it, will be conscious that,
in every act of swallowing, more or less of the fluid spreads over the
whole mouth. It may slightly diminish the evil, but it will not pre-
vent it.

7th. Abandon the silly resolution which many persons adopt
" that they will not trouble their teeth, while their teeth do not trou-
ble them." In a majority of cases, when a tooth has become painful,
it is too late to save it. In many instances, they decay away, and
often affect the general health in an alarming decree, without be-
coming painful at all. If you desire to shun the consequences of
diseased teeth, you must not wait until pain forces the disease upon
your attention. The best time, and often the only time, to restore a
decaying tooth to perfect health, is before the caries has reached
the nerve. Consequently, if you have decayed teeth, and intend to
preserve them at al!, do not delay. If you can have access to a dent-
ist in whose skill you can confide, go to him at once. Very often a
slight and simple operation, costing little in pence, pain, or patience,
will prevent disease which it might be very difficult to cure.

[Dental Intelligencer,

HOMCEOPATHY.

" The homoeopathic system, sir. just suits me to a tittle,
It proves of physic, any how, you cannot take too little:
If it be good in all complaints to take a dose so small,
It surely must be better still to take no dose at all."

[ Western Lancet.

MEDICAL INTELLIGENCE.

Our Journal. We cannot but be gratified with the many kind expressions of
encouragement in our work, which have recently reached us from many sources.
We seldom take up a medical journal, of the twenty now published in this
country, without, finding in them, some extract or notice of matter derived from
the Southern Medical and Surgical Journal.

IS 17.] Medical Intelligence. 191

yearly Abstract, is an article credited to this source. While we propose to labour
diligently in our enterprise, we respectfully remind our friends that we cannot
succeed without their aid and efficient co-operation. Now that accounts have
been collected and professional business not very urgent, we solicit the report of
cases, observations on diseases, &c, &c.

Discontinuance of the Bulletin of Medical Science. Edited by John Bell, M.
D., &c. &c, of Philadelphia. The December No. of this Journal contains the
farewell of Dr. Bell. For twenty-five years he has been actively connected, as
editor of a Medical Periodical or select Medical Library, and has his name iden-
tified with the medical literature of his country. He will long be gratefully
remembered by his numerous friends, for his valuable contributions to our noble
calling, and we but utter the prayer of all, that he may live to reap the fruit and
reward of his faithful labours.

A fifth School of Medicine in Philadelphia. For nearly half a century one
school of medicine located in Philadelphia, was amply sufficient, not only for
that city and the State of Pennsylvania, but for nearly all the other United
States combined. About 1Su5, a second one was incorporated in the same place,
and now within as many years, three more have been chartered by this one
State and all located in the same city. The fifth and last one is called the Phil-
adelphia College of Medicine, and judging from the number of the Faculty, one
might suppose that Professors were getting scarce after so liberal a supply of
late. The two eldest institutions have each seven Professors, the third and
fourth six a piece, and the last has only four. They are Drs. T. D. Mitchell,
James McClintock, W. H. Allen, and J. R Burden the two first named
known by their public works to the profession.

National Medical C01 vention. We perceive by our exchange Journals, that
the profession at the North is fully aroused on this subject. Even the University
of Pennsylvania has appointed delegates, among whom is the venerable Dr.
Chapman. We sincerely hope the south will not be remiss in its duty on this
important subject, but that every State and medical association in this section of
our country will be fully represented at the meetingof this body.

It will be recollected by our readers, that a preparatory Convention was held
last year at New-York, which, after appointing various Committees, &c, ad-
journed to meet next May in Philadelphia. These committees, we have reason
to know, have been active in endeavoring to obtain information, and to excite
an interest on the subject of Medical Reform throughout the United States.

The Medical College of Georgia, claims to have early urged the propriety of
an extension of the present course of Lectures; indeed, she commenced by es-
tablishing six months, from October to April.

Drs. Dugas and Garvin are the D< legates ;.ppointedonfhe part of the Faculty.

Dr. Lamar, Surgeon in tlic U. S. A . Dr. John T. Lamar, who has been
acting as assistant Surgeon to the Georgia Regiment, now in Mexico, has, we
are pleased to learn, been appointed by the President, Surgeon, under the Ten
Regiment Act just passed by Congress, lie is a native of our city, and a
graduate of our Medical College.

192

Medical Intelligence. Meteorology.

O'jUuary of Tommasini. Ben.ro, Bostock and Thompson.

We notice in the Foreign Journals the death of the celebrated Itplian physi-
cian, Prof. Tonmasini, author of the Contra-stimulant doctrine of Medicine.

Also, that of Augustus Berard, one of the Professors of Clinical Surgery in
the School in Paris. Ke was, we believe, a younger brother of the present
Professor of Physiology, in the same institution, Philip Berard.

Dr. Bostock. known as the author of a work on Physiology, died recently in
London, aged seventy-three.

And at Edinburgh, Dr. John Thompson, late Professor of General Pathology
in the University of that city, aged eighty-two years. He left a collection of
colored pathological drawings, with the histories of the diseases attached, worth
&10,<K)0. His two sons are Professors.

A Triplet Rib. We have received from our esteemed contributor, Dr. Mayes,
the drawing of a Triplet Rib, the history of which, with the specimen, has been
promised for the Museum of the Medical College of Georgia. As the rib pro-
ceeds forward from its angle it separates into three bodies, and they are attach-
ed by asmany cartilages to the sternum.

METEOROLOGICAL OBSERVATIONS, for January, 1847, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wkish. Altitude above
tide 152 feet.

Sun Rise.

Thkr.

07
58
48
56
47
34
55
18
20
32
40
20
27
38
44
60
40
46
57
42
35
24
29
41
44
48
46
35
40
37
31

Bar.

29~8<M00
" 90-100
" 95-100]
i; 7f>-l00
" 75-100!
" 81-100
40-100

30 10- 100
;- 30-100

29 90-l00i

" 80-100;!

30 19-100!

2, P. M.
Ther. J Bar.

!0-100

" 3-100JI
20 89-100

" 79-100

30

29 92-lOOi
" 80-100;

30

" 2-1 00':
" 20-100
" 5-100

29 90-lOOj
" 91-100'
" 92-100'!
" 82-109,

30 19-100fl
29 58-100fl

" 70-100!!
" 76-100,1

74
56
51
GCy
63
64
39
35
46
44
49
53
56
60
64
70
50
55
56
40
15
45
34
46
48
50
57
47
52
54
54

Wind.

29 86-10

" 86-10 j
93-100
" 59-100
<: 80-100
" 77-100 i
< 53-100'

30 18-100 1
" 15 100!

29 84-100;

30

" 21-100
" 15-100|

29 95-100
" 85-100
" 80-100

30 4-100
i29 78-100

;- 82-100
" 97-100
30 10-1OO
" 18-10

29 95-10
<: 79-10
" 92-10
<: S3- 10
93-100

30 14-100
-2[) 50-100

" 73-100
70-100

s.
w.

N. W.
8. W.
N W.

N. W.
N. W.

W.

W.

H W.

N. W.

N. W.

B.

s. w.

s.
s. w.

E.

s.

s. w.

N. E.
N. "W.
S. E.
S. E.
N. W.

E.
S. E.
N. W.
N. .

W.

W.

E.

Remarks.

.Fair blow and dusty.

Rain 65*100.

[Ciondy.

Cloudy rate 20-100.

IjFair.

Fair. [55-100.

Fair gale in morning rain

Fair.
(Fair.

Cloudy. [night 15-100.

IjFair blow rain during last
'Fair.
.Fair.

Cloudy.
. Cloudy.

Cloudy rate 70-100.

Cloudy.

Drizzly.

Drizzly.

Rain '65-100.

.Fair.

[Fair.

!(;] ""

! Cloudy drizzly.

1 Cloudy drizzly.

IjFair. '

jCloudy 2rale at ni;

I Cloudy drizzly.

Fair.

[75-100.
'hi rain

14 Fair days,
S. 8 days. West of do

Fair, but light floating clouds.

Quantity of Rain 4 inches and 50-100. Wind East of N. and
10 days.

SOUTHERN

MEDICAL ANDSTTRGXCAL

JOURNAL.

Vol. 8.] NEW SERIES APRIL, 1847, [No. 4.

PART L ORIGINAL COMMUNICATIONS.

ARTICLE XI.

An Essay on Turning. By Francis S. Colley, M. D., of
Hancock county, Ga.

Turning is the rectification of a mal-presentation of the foetus
in ufero, or its entire version by which some other presentation is
substituted for one less favorable to delivery.

Systematic writers on Midwifery divide turning or version into
three kinds, to wit: 1. Cephalic, 2. Pelvic, 3. Podalic.

By the term cephalic version is meant the grasping of the head of
the foetus, and bringing it over the superior strait of the pelvis of the
mother. This process of turning is attended with some danger to
the mother, but it is, perhaps, the most safe to the child. It was the
modeprincipally practiced by the ancients, from the belief, that a
majority of children were born head foremost, and that consequently
it was the most natural. They, therefore, pursued this exclusive
practice, except in cases where the foetus proved to be dead, previous
to the time of Ambrose Pare. Guillemcau and others, who demonstra-
ted its fallacy.

Pelcic Version consists in bringing the pelvis of the child to the
superior strait, and deliveringthe foetus as in a common breech case.
This mode of version, like that already described, is not exempt from
danger to the mother and child, but the child most frequently suffers.

Podalic Version is effected by grasping the knees, or one or both
of the feet of the foetus, and making an entire version of the child,
and delivering the woman by means of traction upon the child. This,
like the other versions, is dangerous to mother and child, but most
dangerous to the child. In a majority of cases in which turning is

13

194 An Essay on Turning. [April,

necessary, the podalic version is to be preferred. It has the advan-
tage of giving the entire control of the case to the practitioner, thereby
enabling him to terminate it earlier, by being able to act, in many
instances, independently of the uterine pains or contractions.

The examination into the situation of his patient should be the
early duty of the practitioner of Midwifery, and although he may
have had years of experience in his profession, too much reliance is
not to be placed on external signs manifested at the time of parturi-
tion. He should, therefore, as early as convenient, after his arrival,
make a vaginal examination, not only to ascertain the progress of
labour, but in first cases of delivery, to ascertain the capacity of the
pelvis and condition of the parts generally.

By this;, or a subsequent examination, he may find the head, breech,
knees, back, abdomen, breast, neck, shoulder, arm, or hand present-
ing.

Before attempting to rectify a mal-presentation of the head, breech,
feet, or other parts, it is necessary to wait until a partial or complete
dilatation of the mouth of the uterus takes place, or until it becomes
soft and dilatable, together with the soft parts, and to act before the
rupturing of the membranes.

Dr. Churchill says we are "not to interfere rashly on the one
hand, nor to delay too long on the other : of the two errors, it i:s hardly
too much to say, that excessive delay is the more serious. " After
ascertaining the presentation, and waiting as before indicated, we
proceed to make such version as the case requires.

In tranverse presentations the head having been ascertained. to be
the most dependent part, the pelvis of the mother of sufficient size, or
slightly contracted antero-postcriorly, the head of the child of the ordi-
nary dimensions, or if there should be a slight obliquity, or mal-pre-
sentation of the head, or should the neck and shoulder present, and
there are no untoward symptoms present indicating immediate
delivery, the cephalic version should be preferred.

We can not, however, terminate labour by this species of turn-
ing. Auer our manipulation it would progress as a natural case, if
we did not use the forceps.

Cephalic version is not to be relied on in cases in which prompt
delivery is necessary.

In those cases in which the pelvis of the child is most dependent,
or near to the superior strait, with but little or no distortion of the
pelvis of the mother, neither an abnormal enlargement of the fcttal

18-17.] An Essay on Turning. 195

cranium, nor complete ossification of its bones or where, in short,
the symptoms present do not indicate immediate delivery, the pelvic
version is to be preferred.

Podalic Version should be preferred generally to all other modes
of turning, and should be performed, if possible, in cases ofmal*
presentation of the superior extremities, or trunk of the foetus, pla-
centa-pravia, flooding, exhaustion, convulsions, prolapsed funis,
rupture of the uterus, or in any case requiring speedy delivery.

There must be, however, a just proportion between the mother and
the child, or a capacity of pelvis sufficient for the child to pass.
Many reasons might be assigned for giving this mode of version the
preference, and I cannot do better than quote from Dr. Churchill on
this subject. The Dr. says, that " the peculiar advantages of version
by the feet are :

1. That it gives to the operator the. entire control over the whole
process of the labour, so that he can regulate its duration, either act-
ing with, or independently of the pains.

2. That though inferior in its results to labour with the head pre-
sentation, it is about equal to any other and superior to some.

3. That in some cases it is the only chance of saving the child's
life, or avoiding evisceration.

4. That in certain cases it affords a probability of saving the mo-
ther's life, when other means are hopeless.

On the other hand, continues Dr. C, its disadvantages are not to
be overlooked ; for

1. From the distance the hand has to traverse, and the difficulty
of seizing the feet and of turning the child in utero, there must ever
be a fearful risk of injury to the mother.

2. The mortality amongst the infants thus brought into the world
is very great : about one to three."

Podalic version may probably be divided into four stages or periods :

1. The introduction of the hand into the uterus.

2. The searching for the feet of the child.

3. The grasping and bringing down the feet.

4. The delivery of the woman.

Before the practitioner of Midwifery decides upon performing this,
or any of the other modes of version, it is indispensably necessary for
him to weigh well the case, for a mistake in diagnosis might not only
prove dangerous to the parturient female and her offspring, but even
fatal to both.

196 An Essay on Turning. [April,

It would be well for him to attend to the following general rules,
before he attempts to perform any of the modes of version, to wit ;

1. If the case be difficult, let him call in a professional friend to
consult.

2. Having determined upon performing the operation of version,
he should inform his patient what he is about to do and encourage her
as much as possible.

3. Next let him ascertain what position the child occupies in utero,
if he can : this knowledge may save time and prevent pain and in-
convenience, it will also enable him to make the selection of which
hand he should use.

4. The selection of the hand will depend upon the position of the
child, "if the occiput," says Dr. Churchill, "is to the left, whether
posteriorly or in front the left hand is to be employed ; when to the
right, either in front or posteriorly, the right hand must be selected.

5. If not previously done, the bladder should be evacuated with the
catheter, and the rectum by saline injections, and the system other-
wise prepared as circumstances may require.

G. The practitioner should divest himself of his coat, without show
or parade.

The above rules having been attended to, so far as they are appli-
cable to any given case, the practitioner may then proceed to the
operation.

He will select such position for the patient as shall best comport
with her ease and comfort, compatible with his own duties, one
which will allow him, at the same time, the greatest freedom of ac-
tion. The most common position for the woman is on her back,
with her nates upon the side or edge of the bed or matrass, and the
extremities supported by two assistants upon two chairs. Other posi-
tions have also been recommended, as the side, and hands, and knees.
The operator should lubricate well, with lard, fresh butter, or oil,
the dorsal surface of the fingers, hand and forearm, and place himself
in front, or some other position convenient to the patient, and gently
insinuate his fingers and hand edgewise through the labia majora
and other soft parts into the vagina. After having reached the
vagina, which is done during the absence of pain, the thumb and
fingers are to be brought in apposition, in the form of a cone, and
gently and slowly passed through the mouth into the cavity of the
uterus. The operator should introduce the hand first in the direction
of the inferior, and then of the superior strait.

1847.] An Essay on Turning. 197

Having thus entered the uterine cavity, we may proceed to rectify
any mal-presentation of the head of the child that properly and most
appropriately belongs to cephalic version, or we may, by pushing
forward, bring down the breech, or we may search for and seize the
knees or feet, make the ion by bringi i these

parrs, and deliver the patient as speedily as . and pro]

may dictate.

If uterine contractions should come on whilst our hand is in the
cavity, the hand must be extended, and permitted to remain perfect-
ly quiescent until they have subsided, or we run the risk of rupturing
the uterus, and rendering the case more complicated and more dan-
gerous. Oar efforts at turning, therefore, must be exerted in the
absence of pain, and cease upon its return. During our manipula-
tions within the cavity of the uterus our unoccupied hand should be
placed upon the abdomen to assist in the turning.

The practitioner of Midwifery should ever be vigilant in tiie dis-
charge of his various duties, and when at the bed-side of his patient,
watch and mark well every symptom which may present itself. In
this way, he may be enabled at an early period of labour to detect
any case which may require any of the modes of version proposed,
and those in which neither are practicable.

The version cases may be divided into three classes or kinds, to wit :
1. Easy, 2. Difficult, 3. Impracticable.

In the first instance, a slight inclination of the head of the child
from its natural direction, the membranes whole or recently ruptured
can be easily rectified. The breech or feet may, in a capacious or
well-formed pelvis, and where there is no deformity of the child, be
easily seized and brought down just after the rupturing of the mem-
branes. If the waters have been evacuated for several hours, and
by the downward contraction of the uterus the child is partially
wedged into the pelvis, the case becomes one of difficulty.

In cases of distortion of the pelvis, lessening the antero-posterior
diameter to two inches or under ; a mal-formation in the inferior
strait ; the waters having been evacuated for many hours ; the uterus
firmly contracted down on the child, which is tightly wedged into
the pelvis; a shoulder, arm, hand, foot, or some other part present-
ing; an enlarged head completely ossified, or filled with fluid, neither
a cephalic, pelvic, or podalic version may be practicable.

Fortunately indeed is it for the parturient female, that version of
any kind is seldom necessary or proper. In ninety-nine out of one

198 Pregnancy and Parturition with Cancer. [April,

hundred cases in which it becomes necessary to perform it, the case
has been previously in the hands of some ignorant empiric or med-
dlesome old woman, and the unfortunate female is not seen by the
scientific physician until the powers of nature are nearly, or quite
exhausted, and she almost in ariiculo mortis.

It should be a pleasing reflection to the educated, the high-minded,
and the honorable members of the profession, that the veil of ignor-
ance is being withdrawn, that science is beginning to be appreciated,
that superstition flies before it, and that in a few more years this
charlatanism will cease< then the practice of Midwifery will be con-
fined to those qualified to discharge the various duties incumbent on
them, with honor to themselves and benefit to their patients.

ARTICLE XII.

A Case of Pregnancy and Parturition during the existence of
Cancer of the Uterus. By Joseph A. Eve, M. D., Professor of
Obstetrics, &c, &c, in the Medical College of Georgia.

Carcinoma of the uterus was formerly supposed to be incompatible
with pregnancy ; but the possibility of this complication with this
disease in all its stages is acknowledged, and its influence in hasten-
ing its progress admitted, by all or nearly all authors who have re-
cently written on the diseases of females. A record of cases, or an
allusion to this unfortunate complication, will be found in the works
of Clarke, Davis, Ashwell, Churchill, Ramshotham, Waller, Fergu-
son, Duparcque, Colombat, Boivin & Dugcs, Velpeau, Siebold, and
many others. But it ij, in an excellent practical treatise on Organic
Diseases of the Womb, by Mr. Lever, of London, that we find the
most satisfactory account of pregnancy in connection with cancer,
and the most extensive reference to cases.

Pregnancy and cancer have each a prejudicial influence over the
other the former hastening the progress and fatal termination of the
latter ; and the latter in a considerable number, I believe in a large
majority of cases, causing either an abortion or the death of the fcetus
when delivery occurs at the full term. The fcetus sometimes per-
ishes in utero, its farther development being prevented, and abortion
the necessary consequence; in other instances the death of the
fcetus is the result of impediment to delivery, from the schirrous
enlargement of the mouth or neck of the uterus.

1847.] Pregnancy and Parturition with Cancer. 199

Of one hundred and twenty cases of malignant disease of the
uterus, referred to by Mr. Lever, abortion occurred in forty per cent. ;
in twenty-seven of delivery, fifteen children were born dead, ten living
and in two the result was not known, or we may say fifteen out of
twenty-five were lost.

The object of the present communication is to give a brief history
of a remarkable case of pregnancy and parturition in connexion with
cancer of the uterus.

July 28th, 1845. I was called in haste, eleven or twelve miles in

the country, to visit Mrs. , who I was informed had been some

time in violent labour. There was considerable time lost in conse-
quence of my absence from town. On my first examination I found
the head very low in the pelvis, the mouth of the womb extinguished,
except a small portion, which had a tumid, hard, rough, unnatural
feel. This labour was far more difficult, painful, and protracted than
her two preceding labours, in which I had attended her. The child
was expelled about a half hour after my arrival. I remarked a smell
very similar to that of cancer of the womb, but did not at the time
suppose it possible that it could be identical with it, for she was appa-
rently in most excellent health, remarkably robust and stout, weigh-
ing not less than two hundred and fifty pounds, and being about
twenty-eight years old, and furthermore, as the child to which she
gave birth was large and healthy.

Two or three months previous to her confinement, I was consulted
by her family physician in reference to a sanguine discharge to which
she had been subject for some time, and which I feared might de-
pend on placenta prcevia, but which I have no doubt now was conse-
quent on carcinoma. I have since learned, upon enquiry, that as
early as January, she complained of severe pains in the region of the
uterus, and that in the very commencement of gestation she experi-
enced unusual sensations that caused her for a long time to doubt
whether she was pregnant.

After her confinement Mrs. had an offensive discharge

from the vagina. On expressing the opinion, when consulted in
reference to it, that she was laboring under organic disease of the
uterus, I was requested to visit her, October 5th, with a professional
friend, and make an examination with the speculum.

The touch discovered an extensive schirrous enlargement of the
neck of the uterus. We could not determine satisfactorily the ex-
tent of the ulceration by the speculum, because, before we could

200 Pregnancy and Parturition with Cancer. [April,

make a proper inspection, we were compelled to remove the speculum,
for she became so excessively alarmed and agitated that we feared
an hysteric convulsion would have been induced.

As she was young and remarkably robust, we considered this was
a case in which every possible effort should be made, although even
under such favorable circumstances we had scarcely the slightest
shadow of hope favorable, I mean, in reference to her age, consti-
tution and general health, but quite the contrary when viewed with
respect to her recent gestation.

We put her on the internal use of proto-iodide of mercury, and
chloride of soda as a vaginal injection, with an occasional resort to
the sulphate of morphine, whenever pain might call it into requisi-
tion ; she was however at this time, and for a considerable time
after, comparatively free from suffering. We proposed to apply
some cautery, at another visit, when she might be sufficiently com-
posed to bear its application, either the nitrate of silver or nitrate of
mercury.

I was requested to visit her again, the 21st of the same month,
sixteen days after my first visit. She had not yet lost her embon-
point, but the cancerous ulceration had made most frightful and
destructive progress, having involved not only the posterior lip,- but
the posterior part of the cervix and body. It was now too late to
think of any thing beyond palliative measures. We advised a lotion
of the nitrate of silver, with the view of correcting the fetor and
improving the condition of the ulcers, perhaps in some degree check-
ing their course. After this she became subject to most alarming
and exhausting haemorrhages at each menstrual period. She now
began to lose flesh and strength rapidly, and to suffer severe lancin-
ating pains.

I visited her again the 6th of November. The disorganization
was still more rapid, far exceeding anything I had ever before wit-
nessed. We endeavored to support her strength by tonics, to alleviate
her sufferings by opiates, to restrain the haemorrhages by styptics
and astringent lotions, and to correct the horrible fetor by the chlor-
ide of soda.

After the destruction of the posterior lip, posterior portion of
the neck and body of the uterus, the ulceration extended through the
vagina and rectum, allowing the faeces to pass from the latter
through the former, and must have involved even the sacral plexus of
nerves from the excruciating paroxysmal pains she suffered in that
region.

1847.] Pregnancy and Parturition with Cancer, 201

I never saw her after (he 23d December, but was informed by my
friend that she continued to linger in the most painful and deplorable
condition until the 25th of June, when death kindly released her from
Bufferings indescribably severe, almost beyond endurance.

It is impossible, from any thing we could learn of the history of
this case, to determine how long the schirrns may have preceded
the commencement of gestation : it is probable not very lopg, from
the excellence of her general health and the fact that shoe did not
complain of pain or any unusual sensation in the pelvis, until about
the time she became pregnant.

This case is rematkable, from having occurred in so young, healthy
and robust a subject, from the fact that the process of gestation
was conducted most perfectly, notwithstanding the presence of schir-
rus certainly, and I think we may safely say cancerous ulceration,
from the discharge and the characteristic fetor, parturition only being
rendered somewhat more tedious and difficult. But if it is remarka-
ble for the absence of any obvious effect of the cancer on the gesta-
tion, it is stiil more so for the very marked influence of the latter
over the former. After delivery, the progress of the disease was
extremely rapid, although in the early age, health and vigor of the
patient, it might have been expected to have run a slower and longer
course.

Mr. Lever considers twenty months to be the usual or average
duration of uterine cancer. Dr. Ashwell concurs with him, if he
refers, as he doubtless does, to the stage of ulceration. I would
suppose, from my own comparatively limited observation, that the
ulcerative stage generally lasts at least twenty months. In this case,
there intervened only eleven months between her confinement and
her death, although she posessed uncommon vigour of constitution
and appeared to resist death much longer than any person could have
supposed, considering the ravages of the disease and the intensity of
her sufferings. I cannot speak positively with respect to the com-
mencement of ulceration : I would infer, from the haemorrhages
during gestation, and the foetid discharge during labour, that it ex-
isted previous to her confinement; but it certainly had net progress-
cd far, even at my first visit, more than two months afterwards; it
was so superficial that it was not evident to the touch, and, as I have
remarked, in consequence of her extreme agitation and excitement,
the examination by the speculum was not satisfactory. It is singu-
lar that ulceration had made comparatively so little progress, between

202 Gun-shot Wound. [April,

the time of her confinement and my first visit, and so much between
my first and second visit. It is probable if I could have made a sat-
isfactory examination at my first visit, a larger ulcerated surface
would have been discovered; but after making all due allowance, I
am confident, it was very limited compared with the progress made
at my second visit.

If I had had an opportunity of examining this patient, during ges-
tation, at the commencement of labour, and a month or six weeks
after delivery, these details would have been more satisfactory; but
I have related them as particularly as I could under the circum-
stances.

ARTICLE XIII.

Gun-shot Wound carrying away a portion of the right Clavicle,
and passing through the summit of the Lung and Scapula : patient
recovered. By L. B. Beal, M. D., of Richmond county, Ga.

On the 18th of April, 1846, R. D , a youth of fourteen years,

while on a hunting expedition, was shot by the accidental discharge
of a comrade's gun, charged with elven buck-shot, and others of a
smaller size. I was immediately called to him in great urgency, as
the wound he received was supposed to be mortal ; being distant
three miles I reached him in about an hour. As he was in the woods,
when the accident occurred, his friends were removing him home
when I arrived. I observed an oozing of blood from the wounds
through the temporary dressing which had been applied, and which
I was unwilling to disturb for fear of hemorrhage. Arrived at his
father's house, I proceeded to the examination of the injury sustained.
The shot had entered through the skin, platisma myoides and cellular
tissue, then the clavicle of the right side, a little nearer the acromion
than its sternal extremity, passing obliquely backwards and down-
wards, coming out by making four openings in the skin covering the
scapula, one of these being above and the other three below the spine
of this bone. The opening of entry was an inch or more in diame-
ter, cutting the clavicle completely into two fragments, which were
more than an inch apart. In probing this wound, it commenced to
bleed, and apprehending from this circumstance and the situation of
the injury, that the subclavian artery or some of its branches might

1847.] Gunshot Wound. 203

require the ligature, I deemed it prudent to desist and ask for assist-
ance and consultation. i)r. Paul F. Ere, Professor of Surgery,
was sent for, and while waiting his arrival, cold astringents were
applied to restrain the hemorrhage. But to my astonishment he now
vomited a half pint of florid frothy blood, by hawking and coughing.
I instantly tied up his arm and bled to 20 5., and gave opium grs. ii.,
combined with sugar of lead grs. x. By these means, the hemop-
tysis was arrested.

When Dr. Eve arrired we went into a more thorough examina-
tion of the parts injured, and he removed, as well as I recollect, four
fragments cf bone, (clavicle,) and no shot were discovered. As the
hemorrhage, both by the mouth and the wound had ceased, mild cold
poultices to the wounds, cooling drinks, perfect quietude, &c, were
strictly enjoined. I was to remain with the patient, and Dr. Eve
was to return on the third day, Augusta being distant fifteen miles.
The day after the accident, he took a dose of Epsom salts, and on the
next day, his pulse was 110, 20 less than it was after the accident.
There was not much inflammation or discharge from the wounds.
"We again proposed to continue the same mode of treatment, emollient
poultices and chloride of soda injections to the opening made where
the shot had entered as a mass, moderate diet and careful watching
of the patient. Lime water this with olive oil and charcoal poulti-
ces were also employed during the treatment. The sloughing pro-
cess advanced regularly for six weeks, when after the removal of
some specula* of bone from the opening of entry, it finally healed up.
The space between the ends of the clavicle is completely filled up,
and nodeformity of the shoulder-joint can be detected. One of the
openings on the back, where the shot came out, suppurated. I open-
ed it and extracted a flattened buck-shot, pieces of clothing, and a
piece of paste-board, used for wadding the gun.

The patient is now in perfect health.

Remarks by Paul F. Eve, M. D. The restoration of this patient
from so critical a wound, is mainly due to his own admirable forti-
tude, and the assiduous attention of his intelligent physician, and
father. That the clavicle was cut in two, I know, since a portion of
its whole circumference was removed. And that the lung was
wounded, is also proven by the free and copious discharge of blood
l)y the mouth. This young man was directly behind his companion,
find within a few feet of him when the gun was fired. He was also
lower down a hill, which will account for the direction of the wound.

204 Amputation of the Fore-arm. [April,

ARTICLE XIV.

Amputation of the Fore-arm for injury sustained by machinery in
motion death. By Paul F. Eve, M. D., Professor of Surgery
in the Medical College of Georgia,

Subscribing the aphorism of a German physician set forth in this
Periodica! last year viz., that a Journal was needed by the profes-
sion; which would communicate only unsuccessful and unfavorable
cases, I have had it in contemplation for some time to make my con-
fessions on this subject. And as by the article on the Statistics of
amputations, published in the August No., my success was made to
appear to the best advantage, there is propriety in commencing my
acknowledgments on this very point. Fortunately, however, my
failures thus fir have here been but few.

By reference to the paper alluded to, " Remarks on the Statistics
of amputations," page 465, of the last volume of this Journal, it will
be seen that up to that period I had amputated 51 times. This in-
cludes all the varieties of this operation. Since then I have removed
1 big toe, 1 leg, (making 15 consecutive successful amputations of
the thigh and leg, including 1 partial of the foot,) and 1 of the fore-
arm total, 54 cases, of which 53 were successful, and 1 death. It
is the details of this fatal case that are about to be submitted.

Stepney, a black boy, aged 13, and belonging to Dr. T., a highly
respectable and intelligent ph}rsician of South Carolina, was brought
to my Infirmary on the evening of the 15th January, by the owner,
in his carriage. He had that morning been injured by the machinery
of a cotton-gin, propelled by horse power. The right fore-arm was
drawn into the wheel, and the momentum expended upon it and the
hand. Its radial or external edge was extensively lacerated, the
tendon of the long supinator was detached, and the radio-carpal arti-
culation opened, making a compound dislocation at the wrist-joint.
The integuments on the dorsum of the hand were also torn up from
the metacarpophalangeal articulation of the fore-finger around to
the pissiforme bone. The Doctor had dressed the wounds soon after
the accident, and found it necessary to apply fourteen sutures. This
account of the injury was only confirmed by an examination after the
amputation, which revealed also a comminuted fracture of three
hones of the carpal row viz., tiie trapezium, magnum and unciforme.

As the wounds had been dressed with a view to union by adhesion,
they were not disturbed until Monday the 18th, the fourth day since

1847.] Amputation of the Fore-arm. 205

the accident. The night previous, the patient had complained great-
ly, ami had now considerable fever. Upon removing the dressing
and ail the sutures, no union had occurred, but a dirty muddy dis-
charge flowed out, tinted yellowish about the joint by the sinovial
fluid. Chloride of soda, compresses, a splint and light bandages were
applied.

January 19th. Decided upon the propriety of amputation, and
wrote the next day for his master to return and see him. From the
great anxiety to save the limb, naturally enough to his owner, and
from unavoidable circumstances, the consultation was not definite
and decisive until the evening of the 21st. Amputation was then
yielded to, chiefly upon the apprehension of tetanus, entertained by
Drs. Dugas and Ford, but on my own part, from the nature and char-
acter of the wounds and the effect they had exerted upon the patient's
system, independent of any accidental circumstance that might
arise.

At 10, A. JVf., the 22d, exactly a week after the injury, the double
flap amputation was performed before the class in the Medical Col.
lege. The bones were divided about two inches below the elbow
joint, 8 to 10 arteries were li gated, and after waiting an hour, the
stump was dressed as usual. There was considerable tumefaction at
the part amputated.

23d. The patient is doing pretty well. A call up the Rail-road
prevented my seeing him until the morning of the 25th. Contrary
to instructions, Stepney got up and walked into the garden on the
24th, the third day after the operation, and repeated the same before
I saw him on the 23th. The weather during this whole time was
very inclement. He had had some fever attended with nausea, and
had vomited a live worm, ascaris lumbricoides. Took a dose of oil
and turpentine, which acted well.

25th, fourth day, dressed the stump; found the bones well covered
and soft parts united over them, but no union of the integuments.

2Gth. Has fever; gave 10 grs. of calomel in two doses, followed
by magnesia and rhubarb. Bowels well operated opon.

27th. Dressed the stump, which looks badly. Tho edges are evert-
ed and much tumefied, though the bones are still perfectly covered.
The ligatures (animal) are all dissolved. Applied chloride of soda
and a flax-seed poultice.

28th. No improvement. The patient has little or no appetite.

29th. He is thought to be better this morning, and there appears

20G On the Diagnosis of Urinary Changes. [April,

to be some little improvement in the stump. At 9. P. M. was sud-
denly called to Stepney. He had drank his tea and eaten a piece of
breid, but soon became sick and vomited, complaining of pain in the
epigastric region. He died in a few minutes after my reaching him.

Post-mortem eleven hours after death. Stomach and bowels emp-
ty, five or six live worms in the latter and one in the former. Stump,
its edges everted, soft parts tumefied, bones completely covered by
adhesion of deep seated muscles over them, with some infiltration of
serum in the cellular tissue, but no suppuration. Arm quite natural.

No perforation of the intestines, &c, having been discovered, the
immediate cause of sudden death in this case, is somewhat obscure.
My opinion is, he died from the exhaustion of the general system,
produced by the two weeks constant irritation of the wounds and the
amputation, operating upon a constitution rather feeble originally*
He had the appearance of a lad of 10 years, but was, as stated, 13.

PART II. REVIEWS AND EXTRACTS.

On the Diagnosis of Urinary Changes, By Austin Flint, M. Dv,
Professor of Principles and Practice of Medicine and Clinical Medi--
cine, Med. Dep. Buffalo University. (Buffalo Med. Journ.)

In view of the importance with which late chemical and physiolo-
gical researches have invested the disorders of the urinary secretion,
it has occurred to us that a succinct account of the more prominent
circumstances involved in their diagnosis would prove acceptable to*
our readers. It is convenient for the physician, whose attention
must necessarily be directed almost simultaneously to the different
departments of practical medicine, to have at hand a synopsis of facts
appertaining to this, and other branches of his art, by means of which
lie can occasionally refresh his memory, and to which he can refer
when cases occur requiring their application. It is to subserve these
ends that we take the trouble of preparing the following brief sum-
mary of the chief circumstances to be borne in mind in interrogating
the urine for pathological changes. The claims of urinary disorders,
as constituting in themselves a class of interesting affections, but,
still more, as furnishing important manifestations, or symptoms of
diseases located elsewhere, or affecting the system at large, have
assumed too important a character to admit of their being overlooked
or neglected by practitioners who aim, we will not say to keep pace
with, but to follow in the track of pathological progress. The time
must soon arrive, when, to omit examination of the urine in the ma-

1847.] On the Diagnosis of Urinary Changes. 207

jority of diseases, will be as disreputable as to despise the stethoscope
in affections of the lungs and heart. Prudence, therefore, as well as
other considerations of a higher and more disinterested character,
dictate to every practitioner the necessity of acquiring knowledge of
urinary changes, and familiarity with the methods of distinguishing
them, sufficient for ordinary practical purposes. This is by no means
an intricate and difficult task. Doubtless a false impression on this
point repels many from directing their attention to the subject. It
is a current belief that to test the various alterations which the urine
undergoes, requires minute acquaintance with the details of chemis-
try, and no small skill in analytical manipulations. This is an en-
tirely erroneous idea. Very little attention and practice Mill enable
the practitioner to determine all the more important facts involved
in diagnosis; and the time and trouble which the necessary exam-
inations will demand are but trifling obstacles.

In the following brief synopsis we shall include the rules and me-
thods of analysis which are required to furnish, in most cases, all the
information to be desired by the practitioner. The authorities con-
sulted are Prout, Robert Willis, Christisou, Bird and Simon. With
this general acknowledgment we need not refer to them for the parti-
cular facts taken from them severally. The more important disor-
ders of the urine, nosological!}' arranged as such, are as follows:

1. Aqueous Urine, Hydruria, Diabetes insipidus, Diuresis.

2. Superabundance of Urea, Azoturia.

3. Undue diminution of Urea; Arazoturia.

4. Excess of Lithic Acid and the Lithates ; Lithuria, Red Gravel.

5. Excess of the Phosphates, White Gravel.

6. Presence of Oxalic Acid.

7. Diabetes Mellitus or Melituria.

8. Albuminaria, or Blight's Disease.

9. Mucus, Pus, Blood, &c, in the Urine.

We will take up these several classes of changes in the foregoing
order, and state brieily the means by which they are severally to be
distinguished.

A. Increase of the Aqueous port ion of the Urine. This is hardly
to be considered a disease. It occurs transiently after free indul-
gence in alcoholic or other beverages (urina potus,) during mental
excitement or anxiety, in some persons from intellectual activity, in
hysteria, from a peculiar idiosyncracy in which at the same time a
constant craving for drinks is experienced. The chief advantage of
recognizing it as a pathological condition is, that it may be distin-
guished from other affections of a much graver character, which are
attended with an increased secretion of urine.

When the quantity of urine is increased, without an increase of
the solid constituents, the specific gravity should be correspondingly
low. The specific gravity is most readily determined by a hydrome-
ter made for the purpose, called the tirinomclcr or grav'imcter. The
quantity of urine passed in 24 hours is to be ascertained, and com-

208 On the Diagnosis of Urinary Changes. [April,

pared with the average standard, which is from thirty to forty ounces.
If the sp. grav. he lessened in proportion to the increase of the
quantity, it is presumable that the excess is in the aqueous portion.

To obtain the exact relation of the solid ingredients, collectively,
to the whole quantity of urine, the following method is to be pursued:
A given quantity is to be carefully evaporated, and the solid residue,
after being completely desiccated, accurately weighed. Then, by
the arithmetic rule of proportion, we are able to arrive at the precise
amount of ingredients in the whole quantity of urine. In order to
spare this trouble, the ratio of solid and fluid matter to a given quan-
tity of the whole fluid (1000 grs.) has been calculated for given num-
bers expressive of the specific gravity, and the results have been
thrown into tables, so that having ascertained the specific gravity by
the urinomeier, on reference to the tables, we can in a moment de-
termine the whole amount of solids contained in the quantity passed
in 24 hours, with sufficient accuracy for most practical purposes.-
[For the table, see R. Willis, on Urinary Diseases ; Bird, on Urinary
Deposits ; Bell and Stokes' Practice.]

Diminution of the aqueous portion of the urine is to be determined
conversely in the same manner. This, like the former, is seldom,
if ever, a disease. It is present in febrile and inflammatory affec-
tions; and, within the limits of health, may be occasioned by increas-
ed transudation from the cutaneous surface, and various other
circumstances. The specific gravity of healthy urine, it is to be
recollected, is about 1,020.

B. Superabundance of Urea. The density of the urine is in-
creased in this disorder, provided there be not at the same time an
excess of the aqueous portion. It frequently co-exists with diuresis,
forming a species of Diabetes insipidus. Hence it is important to
ascertain the whole quantity of urine passed in 24 hours in order to
determine the amount of absolute increase of the urea. The relative
excess of urea may be ascertained with sufficient accuracy for ordin-
ary practical purposes in the following manner : A small quantity
of urine is to be poured into a watch glass, and half or an equal
quantity of nitric acid added, so that the latter will fall to the bottom
of the glass; the glass is then to be allowed to float on cold water.
If only the normal proportion of urea be present, no striking effect
will be produced. If the urea exceed considerably the normal pro-
portion, crystals of the nitrate of urea are shortly observable at the
bottom of the glass; or the mixture may become more or less solidi-
fied. The degree of excess is to be estimated, in part, by the time
occupied in the formation of crystals. This may vary from a few
moments to several hour3. Healthy urine does not yield crystals in
this mode except it be concentrated by evaporation. To ascertain
precisely the quantity of urea in a given quantity of urine, a more
intricate, but not difficult process, is required. For this, Simon's
Animal Chemistry may be consulted.

Urine holding an excess of urea is generally straw-colored or pale.

1847.] On the Diagnosis of Urinary Changes. 209

It may be brown like porfer. It speedily gives off a strong ammoni-
acal odour, owing to the decomposition of the urea.

This form of disorder is found associated with emaciation and
debility, which are otherwise unaccountable. Examination of the
urine will therefore frequently throw light on cases which were be-
fore obscure.

C Diminution of Urea. If the urea be diminished, the specific
gravity will be correspondingly low, unless diuresis accompany it,
which is nol unusual. It is therefore, as in the former instance, im-
portant to take into consideration the whole quantity of urine passed
in the 24 hours, so as to estimate the absolute as well as relative de-
ficiency. The urine, under these circumstances, acquires on stand-
ing a putrid, sour odour compared to cabbage. water. The usual
ammoniacal smell is deficient or absent, owing to the smaller quanti-
ty ofureatobe converted by decomposition into ammonia.

The pathological relations and general symptoms of this form of
disorder are but little known. It is doubtless connected with some
fault in the processes of assimilation, (primary or secondary) by
which the urea is formed.

The disorders re'ating both to the excess and deficiency of urea
are of less frequent occurrence, and practical importance than those
which are to follow.

D. Excess of Lithic Acid and Lithafes. It is still a question
among chemical observers in what form or forms Lithic acid exists
in the urine. The majority, however, adopt the opinion of Dr. Prout
in opposition to that of Berzelius. Dr. Prout thinks that it does not
exist in a free state, but in combination mostly with ammonia, form-
ing the lithafe of ammonia. It may exist in combination with soda.
Lithic acid and the lithates (ammonia and soda) when present abnor-
mally in the urine, are presented in the form of a sedimentary deposit.
Lithic acid is much more rarely observed in an isolated sedimentary
form, but it is occasionally presented. It is always in crystals, some-
times large enough to be discerned with the naked eye, but generally
requiring the microscope. Their peculiar characters under the mi-
croscope are described and figured in the work of Guiding Bird. In
this synopsis we must omit microscopical appearances of these and
other deposits, as they would occupy too much space. The reader is
referred for facts relating to this v<ry interesting and valuable de-
partment of examination of the urine to the work just referred to.
Lithic acid crystals assume different colors between a crimson red
and fawn color. They may he set free and studied with the micro-
scope in healthy urine by adding nitric acid. The addition of nitric
acid sometimes occasions a copious deposit, which, without care, may
be confounded with albumen. The presence of lithic acid crystals
does not necessarily denote an excess of this urinary principle; for if
any acid be superabundant, (muriatic, sulphuric, lactic, dec.,) it mny
combine with the ammonia already in combination with the lithic,
and set the latter free. To determine in doubtful cases whether it bo

14

210 On the Diagnosis of Urinary Changes, [April,

absolutely in excess, the whole urine passed in 24 hours mint be col-
lected and measured ; a definite quantity must then be tested
quantitively Tor the lithic acid which it contain?. By the rule of
proportion, the whole amount contained in the whole quantity is read-
ily ascertained. If this exceed considerably the average healthy
quantity, which is a fraction over 8 grs. in the 24 hours, it is in ex-
cess. For the details of the quantitive analysis, which is not diffi-
cult, see work of Bird, or Simon's Animal Chemistry.

The most common form in which it is in excess is in combination
with ammonia or soda ^constituting what is usually called the
Lilhafqs. These form a non-crystalized, amorphous, or pulverulent
sediment. The sediments of the lithate of ammonia have different
colors red. pink, and sometimes, but rarely, nearly white. The red
sediment is familiar as the lateritious or brick-dust deposit. The test
of these is sufficiently simple. Urine holding the suspected deposit
in a test-tube or common vial is to be held over a spirit lamp or near
the fire. If on becoming warm the sediment dissolve and the urine
be rendered transparent, it consists of the lithates. If, on the other
hand, it is unaffected, or the urine be rendered turbid, the disorder is
of a different character. The deposit of the lithates occurs transient-
ly from indigestion, or a common cold. It characterizes the termin-
ation off vers and inflammations, and sometimes continues through
the course of levers. It occurs in a marked degree in gout and
rheumatism, and in some forms of dyspepsia. In general terms it
denotes mal-assimilat ion, either primary or secondary, or both, but
the sppcific aberrations upon which it depends are yet to be determin-
ed. The lithic acid crystals constitute the concretions called red
gravel. They occur in the kidney, and parsing into the bladder may
constitute a nucleus for stone. The lithic acid diathesis, therefore,
with reference to this possible result should be known and remedied.

E. Excess of Phosphates.- The saline constituents of the urine
are of several kinds, but the phosphates predominate, and for most
practical purposes, it is sufficient to include them under this generic
term. The more important of the earthy salts are phosphate of am-
monia and magnesia, called frequently the triple phosphate; the
phosphate of lime; and the carbonate of lime. They are nearly
insoluble, unless an acid be present. Tne ammonio phosphate of
soda i another triple salt which is soluble, and therefore not so easily
determined to be in excess. The phosphates in excess (with excep-
tion of the salt last mentioned.) manifest themselves by a white
sediment, which may from nppearance alone be mistaken for the
lithates, mucus, pus, or albumen. It is to be tested first by heat.
Heat applied in the same way as when testing for the lithates,
produces no change, or if any, it increases the deposit. Nitric acid
is then to be added, (a few drops will suffice.) If the sediment con-
sists of the phosphates, it will be found to dissolve, and render tho
urine clear. Urine holding the phosphates in excess is usually pale
frequently resembling whey, and sometimes milky in appearance'

1847.] On the Diagnosis of Urinary Changes. 211

In all other disorders of ;he urine it has an aci;l reaction upon litmus.
: i disorder the acid reaction is faint, or it may be neutral, or it

may be decidedly alkalescent. Alkalescent urine necessarily throws
down phosphatic deposits, because the phosphates are insoluble if no
acid be present. A white deposit occurring in urine presenting }m
alkaline reaction may therefore be known to consist of the phosphates.
To lest the acidity of the urine the practitioner should be provided
with blue and red test paper.

This disorder is connnected with some bad forms of dyspepsia. It
generally denotes great loss of constitutional vigor, and the breaking
up of the constitution. It is therefore an unfavorable sign. * There
tre, however, striking exceptions to this remark. The phosphatic
sediments are amorphous, with the exception of phosphate of ammo-
nia and magne-ia. Tr.is is presented in minute crystals, which
frequently collect on the surface of the urine forming an irridescent
scum. Crystals of this salt forming in the kidney constitute what is
called white-travel. Caiculi with these crystals for nuclei are very
rare. They generally proceed from crystals oflithic acid as nuclei,
but the latter frequently increase in size from phosphatic accretion.

F. Presence of Oxalic Acid. The foregoing disorders have r dated
to principles which exist in the urine in a state of health ; but oxalic
acid is not present in healthy urine. lis existence in ever so small
proportion is therefore a mark of disease. It is a rare disorder; but
since (he investigations of Golding Bird it has been found not to be
so extremely infrequent as has been heretofore supposed. It does
not usually form a deposit and its presence is to be determined by the
microscope. Its pathological relations are obscure. The ox a lite of
lime constitutes the rare form of calculus called mulberry calculus.

G. Presence of Sugar in the Urine. Diabetes Melliius. Sugar
does not exist in healthy urine. Until lately it was supposed not to
exist in the b!rW>d even of diabetic patients. Its presence under the
latter circumstance ts, however, now well ascertained. Diabetes
may be suspected when the quantity is greatly increased, and when
it has a high specific gravity. The density of diabetic urine is
seldom under 1.025, and may be as high as, 1.050. It is usually of
a pale color, and froths on agitation more than healthy urine.

There are numerous tests for sugar in the urine, but the two fol-
lowing will suffice for all practical purposes:

1st te>t. A lew drops of the suspected urine are to bo placed on a
porcelain dish, and carefully evaporated. When dried add a few
drops of dilute sulphuric acid, (one part of acid to six or eight of
water) and heat gently for a few moments. If the urine contain
suiar, the spot soon turns black, owing to the carbon of the sugar;
otherwise it assumes an orange color. This is an easy and very
delicate test.

2d t^st. Put two teaspoon fuls of yeast into a vial, and pour upon
it three or four ounces of the suspected urine. Place the mixture in
a warm place. If sugar be present fermentation will soon take place.

212 On the Diagnosis of Urinary Changes, [April,

If sugar be not present it will remain unaffected. A good way to
illustrate the significancy of this test is to take three vials each con-
taming the same quantity of yeast. Add to one vial the suspected
urine; to another, water holding in solution a few grains of sugar;
and to the third, urine not supposed to he diabetic. Place them all
together in a warm place. The difference will show the value of the
test. An acquaintance with these simple methods of determining
the presence of sugar renders tasting quite an unnecessary sacrifice
of inclination. To taste of a patient's urine is therefore to be re-
garded as an evidence of an unusual want of fastidiousness, or a
confession of ignorance.

II. Presence of Albumen. Bright' s Disease. Albumen is not a
principle of healthy urine. Its presence is therefore a sign of dis-
order. It is occasionally noticed in connection with a variety of
diseases; when it is considerable in quantity, and persistent, how-
ever, it is a pretty certain criterion of granular degeneration of the
kidneys, or Blight's disease. Under these circumstances it coexists
with anarsaca and other dropsical effusions ; and may be associated
with numerous other affections. The tests of its presence are heat
and nitric acid. If a quantity of urine in a test tube or common
vial be heated to near the boiling point, the albumen, if present, is
coagulated and precipitated. A suspicion may possibly exist that
the deposit thrown down in this way consists of the phosphates.
To settle this point a little nitric acid should be added, which, if the
phosphates are deposited, will cause them to dissolve; otherwise the
deposit will remain. Nitric acid added at first will, also, coagulate
nnd throw doivn the albumen. This, from appearances alone, may-
be confounded with deposit of lithic acid, which sometimes occurs on
the addition of nitric acid. To obviate this mistake the urine should
also be tested by heat ; or the white deposit examined with the
microscope, which, if it consists of lithic acid, will Wemonstrafe its
crystalized form. For all practical purposes it suffices to estimate
the relative quantity of albumen by noting how high the deposit
extends up the vial or test-tube, after being permitted to stand for
several hours.

I. Mucus, Pus and Blood in the Urine. The presence of blood, if
in considerable quantity, is easily enough detected by the eye alone.
If diffused through the urine in small quantity it is more difficult to
be ascertained. The color of the urine is blood red. A white rag
dipped in it is colored red. In very doubtful cases the microscope
must be resorted to, when the appearance of the blood disks will set-
tle the question.

It is sometimes useful to distinguish pus from mucus. Mucus
generally falls to the bottom of the vessel, and when the urine has
been gently poured away, remains with greater or less tenacity. If
the urine be agitated with the mucus, the latter does not commingle,
but appears in the form of long shreds or jagged portions. Pus, on
the other hand, is capable of being readily mixed with the urine on

1847.] Remarks on Foreign Bodies, 6fc. 213

agitation ; it does not form a viscid tenacious mass, and t ho super-
natant urine cannot so rendily be poured away from it. These
characters will suffice whenever either exists in any considerable
quantities. The microscope, in cases of a doubtful character, fur-
nishes a ready test, the appearance of the pus globule being sufficient-
ly characteristic.

The foregoing synopsis, it it believed contains the necessary rule3
and mi thods of testing urine, in so far as is requisite for the general
practitioner to be acquainted with the subject. As we have said,
our object in presenting them in this form is, that it may serve to
refresh the memory, and for convenience of reference. If it should
be made to appear that the subject is not a difficult one, but, on the
contrary, only requires a little attention to be understood sufficiently
for all practical purposes, the little trouble which this brief summary
has cost us may answer another good end viz., it may convince our
readers that there is no good apology for neglecting to avail them-
selves of the knowledge to be derived from examinations of the urine.

Remarks on Foreign Bodies found in the Sub-lingual region, and
regarded as Salivary Calculi. By Dr. Stanski. (Translated
from the Archives Generates for October, 1846.)

The object of the article referred to in the above caption is to
establish the fact that foreign bodies which occur in the neighbor,
hood of the sub-lingual glands have been hitherto erroneously regard-
ed as salivary calculi. The author proceeds to give the symptoms
usually attributed to salivary concretions.

"The disease usually manifests itself slowly and insidiously, by a
tumefaction more or less hard of the sub-maxillary gland, or rather
of i's surrounding tissue, beneath the angle of the lower jaw. This
swelling is attended with pain more or less acute, which is increased
by pressure, by the movements of the tongue, and by deglutition, and
which sometimes may simulate angina. The patients have some-
limes experienced a sense of numbness in the lower jaw and in the
auricular and temporal regions of the affected side. These symp-
toms cease and reappear sometimes for months and even years. In
a case seen by the writer, the. patient, aged 36 years, had suffered
since the 10th year of his age. In the case related by Sabatier, the
patient was suddenly seized with pain during an effort of the voice
whilst fencing.

44 These temporary tumefactions are evidently produced by the ir-
ritation of the foreign body, and terminate in small abscesses beneath
the tongue, which open and give issue to pus. But when, Prom any
cause, these bodies are shocked, or become moveable, they irritate

214 Remarks on Foreign Bodies, 6fC. [April,

the soft parts, and by approaching the buccal cavity, provoke an
eli minatory inflammation and suppuration. It is i Inn that the swell-
ing and pain, and consequently the impediment to the movements of
the tongue arid of deglutition, become intense ; the saliva becomes
thick and viscid, the month unpleasant, the sublingual gland and the
mucous membrane covering it swollen and edematous. On press-
ing these parts, a tumor more or less voluminous is found beneath
the tongue ; within the soft parts is felt a body of stoney hardness;
and if the inflammation has existed for some time, pus may be forced
from an' opening near the frenum of the tongue. Finally these
symptoms cease only when the foreign body has been eliminated by
the efforts of nature or removed by the surgeon.

"Before estimating the value of these symptoms, it should be ob-
served that the presence of a calculus in the salivary passages must
occasion their obstruction, their dilatation from accumulated saliva;
in short the disease termed Ranula. In order to show the difference
between the symptoms abuve related and those of Ranula, let us see
what these are.

"Ranula appears in the form of a flattened, globular or oblong
tumor, soft, compressible, slightly transparent, situated beneath the
anterior portion of the tongue, near its frsenum. I? is at first small
and indolent and impedes but slightly the motion of the tongue ; but
in time it grows, the impediment increases, and articulation hecomes
difficult. In a lew months the tumor sometimes fills the buccal cav-
ity, presses back and hides the tongue, and if not timely relieved may
be attended with serious consequences.

" It must be seen that the symptoms of Ranula are essentially
different from those of concretions. Ranula is unattended with the
intense pain which accompanies these ; its tumor is soft, indolent,
transparent, and situated under the tongue, instead of beneath the
angle of the jaw. Motion of the tongue is impeded by the volume
of the sub-lingual tumor and not by the pain it occasions, as in con-
cretions. It is difficult to admit the formation of such large calculi
within canals almost capillary, without obstruction to the flow of the
saliva and consequently the production of Ranula.

11 Now in none of the subjoined cases were the patients afTected
with Ranula; and although J. L. Petit affirms having seen small
calculi in one or two old and violent esses of Ranula, those concre-
tions were sandy and friable and formed by the stagnation and
thickening of the saliva; i:i most of the cases recorded, there is no
mention made of calculi.

"The tumefaction of the region of or even of the sub. maxillary
gland itself, is no ev'uU nee of the presence of calculi in the salivary
gland, for 'a foreign body in the neighborhood might, by irritating the
surrounding tissues, occasion the same state of things, as is seen in
other parts of the body. YVc cannot admit the explanation offered
by Sabatier, who says that the tumefaction is produced by the saliva,
which not being able to escape, Hows hack to the gland, for, it might

1847. J Remarks on Foreign Bodies, j*c. 215

be asked, why does this tumefaction not occur in Rannla, in which
Ibe saliva is certainly retained in ihe (fact of Wharton and ought to
flow hack towards the gland ? The intense pain experienced under
the tongue and the consequent impediment lo the, motions of tho
tongue and especially of deglutition, would rathei indicate the pre-
sence, of these concretions between the muscles that concur in these
functions, than in the excretory duct of the salivary gland moreover
those intense naios, felt only very late and when the foreign body is
about to be eliminated, do not exist in Ranula, even when very large.
The reason is that these pains are not occasioned by an accumula-
tion of saliva in the duct, but by an inflammatory action in the soft
parts preparatory to the elimination of the calculus.

"Those authors who have related cases in detail observe that pus
flowed from these sublingual tumors, not by the duct of Wharton,
but by an opening near it ; nor do they allege that saliva flowed
from them. In the case seen by the writer, the pus issued from an
orifice near the frenum, a little in front of the orifice of the duct ; no
saliva flowed from the orifice of suppuration, as would have happened
if the duct had been occupied by a foreign body."

Dr Stanski now furnishes the analyses of saliva made by Berzelius
and Mitscherlich, to show that its constituents are not adapted to the
^formation of calculi. He then presents a series of cases illustrative
of his position. We translate the one observed by himself, our lim*
its not allowing us to lay them all before the reader, and this being
deemed sufficient to convey his views.

"Joseph .... a servant, aged 36 years, of a good constitution,
lean and nervous, was subject from childhood to a swelling beneath
the angle of the lower jaw; this swelling had continued some
time, was tender on pressure, and occasioned during mastication and
deglutition a sharp pain along the same side of the throat. These
symptoms were always attributed to a tumefaction of the lymphatic
glands ; emollient applications would be made, and the disease would
disappear to return again some time after. With these symptoms
the patient would generally experience an uneasy sensation in the
temple and cheek of the right side, and a numbness which he refer-
red to the lower jaw of that side. On the 12th of July, 1840, being
at the Hotel Lambert, the patient consulted me for a pain beneath
the angle of the lower jaw, in the glands, which he stated were
swollen. Upon examining hi m, I found neiiher swelling, redness,
nor induration sufficient to account for the intensity of the pain ho
suffered. I therefore determined tn look into bis mouth for the
cause, and accordingly, on eli vating the tongue I found in the region
of the sublingual gland a considerable induration and tumefaction ;
yet no pain was produced upon pressing it, nor had Ihe patient even
inspected its existence \ he merely stated that his saliva wis viscid
and thick. Not being able to determine the nature of the disease, I

216 Remarks on Foreign Bodies, c. [April,

prescribed poultices and frictions with iodated ointment, intending to
see the patient again, which I did a few days after. He then told
me that he had suffered considerably beneath the tongue the two pre-
ceding nights, that deglutition was very painful, his saliva very thick,
and the temple and right side of his (ace felt tender and benumbed.
On examination I found a tumefaction and redness occupying the
position of the sublingual gland, which upon pressure was quite
painful and yielded pus from an opening on the side of the orifice of
the duct of Wharton. I found in it also a body of stoney hardness.
The patient suffered very much and incessantly begged to be relieved.
Having become convinced that a foreign body, probably a salivary
calculus, was the cause of all the symptoms, and that the patient
could only be relieved by an operation, I made a longitudinal incision
of two centimetres on the inner side of the sublingual gland and as
near as possible to the tongue, and with dissecting forceps I removed
a body, irregularly globular, hard, whitish, rough on most of its sur-
face, and concave and smooth on one side. The patient having
been fatigued, I made no further exploration on that day, but on the
following, upon probing the wound, I found at its bottom a hard body,
the extraction of which I made with some difficulty, as it was at-
tached to the soft parts.

"During the last extraction, the wound filled with saliva and the
patient was immediately relieved after the operation. This bod\%
was fifteen millimetres in iengih, was whitisfi, less rough than
the former; from its shape it could be readily recognized as one of
the small molar teeth.

44 Had I not removed the second body, having evidently the form of
a tooth, I would have examined with less attention the first, which
bad an irregular form, (its rough surface being cf a brownish yellow,)
and have mistaken it for a salivary calculus. But I had already,
before extracting the second, observed as above stated, that the first
presented on one side a concave and smooth surface, resembling the
crown, whilst the opposite side presented a point resembling the root
of aiarge molar tooth which had not yet parsed out of the alveola.
The extraction of the second tooth completely confirmed me in the
opinion. I should add that these teeth touched each other by their
crown, which seemed to he moulded on each other, that the patient
has all his teeth in a good state, and that after the extraction I could
without pain introduce into the wound a probe to the depth often or
eleven centimetres, carrying it horizontally towards the pharynx. It
may be remembered that I have said that the wound filled with sa-
liva during the operation. This phenomenon, in another case, might
have been regarded as a proof that the foreign body was lodged in
the salivary duct, had not the true nature of the body been recogni-
zed. As to the abundant and sudden secretion of the saliva, this
may be explained by the irritation cf the glands incident to the op-
eration, and perhaps also by the temporary stagnation in the duct,
consequent upon compression, for as soon as the foreign body was

18-17.] Remarks on Foreign Bodies, df-c. 217

removed, the saliva flowed from the orifice of the duct and filled the
wound which was then the most dependant point.

"The reader most have observed the remarkable fart, that of the
two extracted teeth, the first was in crusted wwh an 'earthy rtihatanre,
whilst the other was hut slightly so. I think that this may be ex-
plained by the prolonged s<-j"urn of this looth in the midst of pus,
wherens such was not the; ca*:e with the second, '['his case proves
clearly that these foreign bodies may lie covered with calcareous
concretions without being at all contained in a salivary passage-'*'

The author concludes his interesting paper as follows:

"Our object has been thus far to show that the foreign bodies re-
moved spontaneously, or by art. from beneath the tongue, and which
were regarded as salivary calculi, were not located within the salivary
apparatus. From the case we have seen, and from the fact that it
resembles in most respects thoge recorded by ethers, we believe that
thev were teeth more or le>s developed, whose surface being either
corroded, worn smooth, or covered with incrustations, prevented their
recognition. Let us see how these dental productions may occur in
the soft parts cf the mouth. Their presence under the tongue may
be explained in two ways: they might be foetal remains with which
the individual was born, as has been observed in other parts of I he
bodv. This view is especially applicable to those cases in which the
origin of the disease may be traced back to early childhood and in
which several of such teeth have been removed, and more particular-
ly if other foetal remains existed. .Meckel cites Dr. Si-hill, who Baw
in the course of three months three teeth developed under the tongue
of a man 50 years of age. They were contained in a cyst.

"Another and a more plausible explanation is this: it is well
known that there are individuals in whom teeth are formed beneath
those ordinarily permanent, so as to constitute a third series ; these
most usually fail to be developed, and remain in the alveola?. Now
if these teeth do not force out those above then*, they become as for-
eign bodies, and make their way through the tables of the maxillary
bone, and even between the muscles, where they may remain enc\ st-
ed,anel finally be eliminated as in the cases we have related. Max-
illary bones have been seen containing such supernumerary trmlars,
and others in which the walls were worn away or perforated by such
teeth; the museum of the Faculty contains an inferior maxillary of
this kind. As the sub-maxillary gland is on a line with the large
molars, and as these? are the teeth most subject to this peculiarity, it
is not surprising that the tooth having passed out of the alveola,
should irritate the gland and muscles, producing tumefaction of the
former and pain during deglutition.

M When consulted for this affection, the physician should examine
carefully the sub. maxillary region, find determine whether the tume-
faction be scrofulous or whether it depends upon the presence of a
foreign body. He should never omit to extend his researches be-

218 Effects of Mercury on the Young Subject, [April,

neath the tongue, Tor the foreign body might already be near the
fraenura and still occasion tumefaction of the sub-maxillary glands.
It the foreign body has advanced so !ar as !o be covered only by a
thin stratum of soft parts, he may either await its spontaneous elimi-
nation, which is however always very painful, or extract it by making
an an tero- posterior longitudinal incision as near the tongue as possi-
ble, so as to avoid injuring the sal-vary duets.

On the Effects of Mercury on the Young Subject. By Joux B. Bxck,
M. D., Prof, of Materia (Viedica and Medical Jurisprudence in the
College of Physicians and Surgeons, of New York. (From the
Annalist.)

In some previous papers,* I endeavored to point out the peculiari-
ties attending tne operation of Opium and Emetics, on the infant
subject, as distinguished from the effects of these agents on the
adult. I now propose to make some remarks on another article of
even still greater importance, and that is Mercury. That Mercury
is an ajjent of immense power, either for good or evil, upon the hu-
man constitution, cannot be questioned. While in many cases it is
the means of saving life, in not a few it unquestionably destroys it.
If this he so, it becomes a question of the deepest practical interest,
to determine whether its action is modified in any way by the age of
the patient, and particularly so, when it is recollected that it is given
by too many phvsic'ans, even more freely, and may I not add indis-
criminately, to the young subject than to the adult.

The first and most striking peculiarity attending the action of mer-
cury is that in young subjects, it does not produce salivation so readily
as it does in adults. Indeed under a certain age, it appears to be
exceedingly difficult to excite salivation at all in them. On this
point, besides our own experience, we have abundance of testimony.
Dr. Clarke says, "under various circumstances he has prescribed
mercury, in very large quantities, and in a great number of cases;
and he never produced salivation, except in three instances, in any
child under three years of age.'1! Dr. Warren, of Boston, observes,
"that he has never known an infant to be salivated, notwithstanding
he has given in some cases, large quantities with this view. "J Mr.
Colles, of Dublin, says, ''no man in the present day requires to be
told that mercury never does produce pytalism, or swelling and ulcer-
ation of gums in infants '" Drs. Evanson and Maunsell speak still

* New-York Journal of Medicine and the Collateral Sciences. Vol.2, p. 1.
Vol. 7, p. 153.

t Commentaries on some of the most important Diseases of Children. By
John Clarke, M. D., p. 182.

; View oi the Mercurial Practice in Febrile Diseases. By John Warren, M.
D., p. 14G.

Practical Observations on the Venereal Disease and on the use of Mercury.
Ey Abraham Colles, M. D., p. 171. Amcr. edition.

1 647. ] Effects of Mercury on the Young Subject. 2 1 9

y]y. Thov say, "mercury does not seem capable, of sali-
vating Rti infant. \Ve have never sven it Ho so, fsor are we aware of
any such case being on record." '* We have never succeeded in
Salivating a child under three years of age."*

The same general fact seems to be applicable to the external use
cf mercury. Dr. Percival, of Manchester, remarks, that be " repeat-
edly observed that very large quantities of the Unguentum Cceruleum
may he used in infancy and childhooA without affecting she ^ums,
notwithstanding (!.e predisposition to a flux of saliva, at a period of
life incident io dentition. "f

That salivation does not take place so readily in the infant as in
the adult, would seem then to be wei! established. Thai it never can
or does take place, as might be inferred from some of the preceding
quotations, is by no means, however, true ; and the statement, if im-
plicitly relied on, is calculated to be the cause of much mischief.
Thai very young subjects do sometimes become salivated, is unques-
tionable. One case, and only one, however, has occurred in my
experience, in which a child of two years of age was salivated, and
that by a very moderate quantity of calomel, viz., five grains, /riven
in three portions, at intervals, within the space of about twelve hours.
In about, two days after, the gums became inflamed, the tongue
swelled, several ulcers appeared in the month, and the flow of saliva
was free ; after continuing about three days in the same state, it
gradually yielded, and disappeared without any further inconveni-
ence. In this case every thing seemed favorable to the development
of mercurial action. The child had been laboring under hooping
cough for several weeks, and was a good deal reduced. It vomited
freely with every paroxysm of coughing, and this no doubt aided in
bringing on salivation, in a constitution peculiarly sensitive and evi-
dently scrofulous Nor is this a solitary case. Dr. Clarke, already
quoted, admits that in throe cases salivation was produced in chil-
dren under three years of age, and similar cases have been observed
by others. Br. Blackall relates the case of a child, two years of age,
who was salivated in consequence of taking two grains of calomel for
several successive nights. The child was a poor scrofulous subject,
and it sunk under the effects of the mercury.

This, then, is a remarkable peculiarity in the action of this agent
upon the infant subject, and the observation of it has doubtless led to
the belief, too prevalent among some physicians, that it may be given
to them to a I modi any extent with perfect impunity ; an error, which,
if not in its immediate, yet certainly in its remote effects, has been
the prolific source of more mischief, probably, than any of us are
aware of.

Although mercury so seldom salivates infants, yet, notwithstanding
this, if cannot be doubted that it affects the system profoundly, and
even more so proportionally than it docs the adult. That it should do

Trei lis on the Managem< nt and l bildren, p. 88.

t Essays, Medical and Philosophical. By Thos. Percival, M.D., vol. 2, p.3l8.

220 Effects of Mercury on the Young Subject. [April,

so appears perfectly natural, when we reflect upon the mode of its
oper itmn on the human system. On this subject, I am aware that a
great difference of opinion exists. By some, mercury is looked upon
as a stimulant ; while others view it as a sedative. A familiar ac-
quaintance with iis effects, however, will show, I think, that it may
he the one or the other, according to circumstances according to
the dusa in which it is given the length of time it is continued, and
more especially, the condition of ihe system at the time of using it.
A single large dose of calomel will cause nausea and relaxation, and
sometimes unpleasant prostration, while if it be given in smaller
doses and repeated frequently, it will occasion irritation of the intes-
tines, and general disturbance of the vascular and nervous systems.
In the former case acting as a profound sedative, and in the latter as
a stimulant, or rather irritant. That calomel given in large doses
operates as a sedative, seems to be proved, not merely by the nausea
and prostration which it frequently produces, but by other consider-
ations. In dysentery, for example, in the adult, a dose of twenty
grains of calomel will sometimes allay pain and irritation, with as
much certainty as a dose of opium. For the purpose of testing the
effects of calomel, some interesting experiments were made by Mr.
Annesley, which would seem still further to show, that in large doses
the action of this agent upon the mucous membrane of the stomach
and intestines, is that of a sedative. He took three healthy dogs, and
gave to one 3j. of calomel, to a second, 5ij., to a third, 3iij. After
this they were tied up in a room.

*"The dog which took 3j. did not appear to feel any kind of sick-
ness, till six or seven hours afterwards, when he vomited a little. He
was lively the whole time, and ate his food well; had been purged
two or three times; dejections of a black grey color.

The dog which took 3 j. was likewise lively, and ate his food well,
vomited two or three times, and was purged more than the other; he
passed tape worms and the dejections were black.

The dog which took 3iij. was heavy, and apparently uncomforta-
ble the^whole day, and did not vomit at all ; he was purged, and pass-
ed a very long tape worm ; dejections also black."

Twenty-four hours after they had taken the calomel, the dogs were
all hung, and five minutes after they were dead, they were examined,
and the vascularity of the stomach was found to be in the inverse
ratio of the calomel they had taken ; i. e. in the dog which had taken
3iij , the vascularity was the least, and so on. For the purpose of
comparing this with the condition of the stomach of a dog which had
taken no calomel at all, an examination of another dog was made;
and here the stomach was found to be more vascular than in any of
the others. From these experiments, Mr. Annesley drew the con-
clusion, that "the natural and healthy state of the stomach and
intestinal canal is that of hij^h vascularity, and that the operation of
calomel in large doses, is directly the reverse of inflammatory."*

Transaction? of the Med. and Physical Society of Calcutta, vol. 1, p. 211.

1847.] Effects of Mercury on the Young Subject, 221

The foregoing considerations would seem to show that ralnmrl in
full doses is a local sedative, and in its general effects, is debilitating
to the system at large. Elence its great utility and value as a reme-
dy hi many inflammatory diseases.

When, on the other hand, it is given in small and repented doses,
it acts not un frequent as a local, ns well as a general irritant, pro-
dueing immoderate action of the bowels, and general irritation of the
nervous and vascular systems. Now these, we know, are the effects
observed continually in the adult, and it is but reasonable to suppose
that all of them must, as a matter of course, be aggravated in the
more delicate and sensitive system of the infant.

What shows incontestibly that the action of mercury is actually
more energetic on the infant than the adult, is the fact, that when
salivation does take place in the former, as it sometimes does, its
effects are most disastrous. Sloughing of the gums and cheeks,
general prostration and death are by no means uncommon occur-
rences. On this subject, Dr. Blackall justly remarks, "a general
opinion prevails, that the constitutions of young subjects resist mer-
cury. Its entrance into the system they certainly do resist, more
than we could expect ; but they are greatly overcome by salivations,
and the possible occurrence of such accidents may well set us con-
stantly on our guard."* Dr. Ryan. too. says, " Ptyalism of infants
is often followed by sloughing of the gums and cheeks; and this I
have known to occur after the use of it in Hydrocephalus. "-j-

Besides being more energetic in its action on the infant, mereury
is also more uncertain. This must necessarily be the case, and for
the same reasons that every other active agent is so. In the adult we
know that mercury varies in it effects, according to the condition of
the system, and the peculiarities of the patient's constitution. Thus
some persons are salivated by the smallest quantity of this metal,
while others resist the influence even of the largest quantities. In
some, febrile action ; in others, diarrhoea and exhaustion take place
even from moderate doses. Hence it is, that every prudent phy-
sician, if unacquainted with the previous history of bis patient, makes
it a special subject of inquiry to ascertain whether he has ever taken
mercury previously, and how it affects him. Now, in the young
infant, of course, as we cannot so well have the benefit of this infor-
mation, more uncertainty must necessarily attend its operation.

These, then, are the peculiarities attending the operation of mer-
cury on young subjects, viz : that they are salivated with great diffi-
culty, and that notwithstanding this, the effects of it are frequently
more energetic and uncertain, than they are in the adult. And it is
upon these as the basis, that I propose to make a few remarks, bear-
ing upon the practical application of it in young subjects.

1. If salivation occurs so rarely in children under a certain ego,

Observations on the Nature and Cure of Dropsies. By John Blackall, M.
D. p. 126.
t Manual of Midwifery. By Michael Ryan, M. D. p. 477.

222 Effects of Mercury on the Young Subject, [April,

then it is evident that it can never be made a criterion by which to
judge of its influence on their systems. To attempt, therefore, to
produce this effect, as we do in adults, is manifestly improper. In
cases where it is desirable to get the system under the full influence
of the remedy, other modes must be resorted to for the purpose of
judging to what extent the use of the article should be carried. Now
this is by no means easy. Even in adults, where we have the benefit
of salivation as a test, nil practical physicians are aware how diffi-
cult it is frequently, to decide when it is proper to stop the use of the
remedy. How much more so must the difficulty be increased in the
young infant, where we are left without this guide. The only modes
of judging, of course, are the character of the evacuations from the
bowels, and (he general impression made upon the disease for which
it is administered. Both these are evidently, however, uncertain.
It is to he feared, therefore, that for the want of a more certain guide
than we at present possess, the use of this remedy is, in many cases,
unnecessarily protracted to the great detriment of the little patient.
From all this the conclusion is obvious, that in the use of this article
in the young subject much greater caution is neces-ary than in the
adult.

2. The fact that mercury may prostrate and destroy a young child,
even though it does not cause salivation, it is to be feared is not suf-
ficiently appreciated, at least by some. We have known calomel
given without weight or measure, to a young child, and the reason
assigned to justify it was. that it could do no harm, because it would
not salivate. Now it appears to me that no opinion can be more un-
founded, and no practice more mischievous. Although a single dose
of calomel, even though large, may be well borne by children of or-
dinary strength of constitution, yet even this is not entirely safe in
all cases. And when these doses are frequently repeated, particu-
larly indelicate habits, the most serious consequences may result.

3. The use of mercury in young subjects as an alterative, should
in all cases be conducted with great caution. There is no practice
more common than that of continuing the use of this agent in small
doses, for a considerable time, and certainly none which is more
liable to abuse. Under the idea that the dose is so small and from
no salivation appearing, we are apt to infer that even if the medicine
is not doing any good, it is certainly not doing any harm. Any
improvement too, which occurs during the use of the article, is sure
to be attributed to the silent operation of it on the system. Now
although this is not unfrequently the case, yet it is not invariably so ;
and every unobserying physician must have been aware of cases, in
which, in this way, the article has been unnecessarily and injuriously
continued. In bowel complaints, under the idea of altering the
secretions, it has frequently, no doubt, helped to keep up the very
intestinal irritation which it was given to correct. In other cases it
has developed the latent tendency toother diseases, such as Scrofula,
Phthisis Pulmonalis, etc. In adults we know this to be very often

1847.] Effects of Mercury on the Young Subject. 223

the case. Hew much more likely is all this to happen in the young
infant.

4. In the use of mercury in young children, gr^r.L care should be
exercised in ascertaining, u^ far as possible, their constitutional pecu-
liarities. This, of course, is not in ali cases easily !o be done. A
good deal, however, may be iparned from an acquaintance with the
tendencies of the parents. Wherever the parents show indications
of scrofula, or where there is an hereditary predisposition to consump-
tion, great caution ought to be exercised in the use of mercury in
their offspring

5. Mercury should be administered with great caution, in cases
where a child has been sick for a considerable length of time, and
when the strength of the child has been very much reduced. In this
6tate of constitutional depression, a single cathartic dose of calomel
sometimes proves fata!. We think that we have seen more than one
case, in which a child has been irretrievably prostrated under the.se
circumstances, under the false impression that calomel is an innocent
purgative to a child.

6. The too common practice of giving calomel as an ordinary
purge, on all occasions, is certainly unjustifiable. From the facility
with which it may be given, it is unquestionably resorted to in a great
numher of cases, where it is certainly unnecessary, and in a great
number where it positively does harm. The misfortune is, that its
use is not limited to an occasional dose, but it is too often given in
every slight indisposition of the child. Now, in this way, there can
be no question that the use of it has laid the foundation for the ruin
of the constitutions of thousands. It ought to be a rule laid down
and rigidly followed, that in very young children, mercury ought
never to be used as a cathartic, unless there is a special reason for
resorting to it. In a great majority of cases, milder cathartics are
decidedly to be preferred.

In concluding these observations, I trust it may not be supposed,
that my intention has been to undervalue the importance of mercury
es a remedy in the diseases of children. On the contrary, no one
appreciates it more highly than myself. In many cases noihing ran
supply its place, and its judicious use has been, and is. the instrument
of saving multitudes of lives. Notwithstanding, however, the many
cautions to the contrary, it is to lie feared that the use of it is still too
general and indiscriminate. Indeed, the amount of it which is taken
by the human race in one way or other, is incalculable. What is
given by regular physicians, is perhnps.the smallest quantity. If the
public really knew how much of this article is swallowed unknown to
themselves, in the shape of bilious pills, worm lozenges, and t lie white
powders of the Homoeopaths, they would be amazed at their credulity
in deserting their old medical advisers, because they have the bold-
ness to give them an occasional dose, and the honesty to tell them so.

220 Insensibility to pain by the vapour of Sulphuric Ether. [April,

sium. It consists of sublimed sulphur half an ounce, carbonate of
potassa two drachms, lard two ounces; one half of this quantity is
to be used daily.

Zinci Praiparata. The ointment of the oxide is useful in many
eruptions ; in some more benefit is derived from the lotion at the
same preparation. The chloride of zinc is used as an escharotic in
various strengths; it is made into a paste. (For mode of forming
and using this paste, see abstract, Vol. I. p. 07.)

Insensibility to pain from the inhalation of the vapour of pure
Sulphuric Ether.

It will be recollected by our readers that we early directed a letter
to Boston, asking information on the subject of a new narcotising
gas said to be discovered in that city. The reply was any thing but
satisfactory ; and allusions have since been made to a controversy
between Drs. Jackson and Morton, and the secret attempted to be
kept by a patent obtained by the latter from our government.
We have been watching the matter with considerable interest, and
by recent arrivals from Europe, we find the production of insensibili-
ty to surgical operations by the inhalation of pure Sulphuric Ether,
has been received there with acclamation by the profession. In Lon-
don, Paris, Edinburgh, Publin, in fact, every where, both medical and
commercial papers are filled with commendations on the subject.

Below we give details which will no doubt prove interesting to our
subscribers. After reading Dr. Jackson's communication, sent by
himself, we have performed some experiments, in which we are still
engaged, and tbeir result may be given under the head of Medical
Intelligence, which please see.

The first article is a copy of a paper addressed to the American
Academy of Arts and Sciences.

Mr. President : In reply to numerous inquiries which have been
addressed to me from scientific gentlemen in various parts of the
country, I beg leave to submit to the Academy, the following com-
munication.

Although it will be impossible for me to condense all I may have
to say upon the subject, within the limits of this paper, I shall endea-
vor to state those points, that are most interesting.

I have long been impressed with the importance of Medical Chem-
istry, and being both a Chemist and Physician, it is natural that I
should seek among the resources of the Laboratory, the means of al-
leviating suffering. I was early impressed with the remarks of Davy

1847.] Insensibility lo pain by the vapour. of Sulphuric Ether. 227

concerning the remedial agency of gaseous matters, and felt disap-
pointed lo find so few practical results growing out of the Medico-
Chirurgical experiments. It seemed to me quite strange that no
adequate researches had been made on the inhalation of vapors of
such volatile and peculiar matters as the Ethers, and thus I was
induced to institute the experiments which led to my discovery.

We are aware that Ether ranks in the Pharmaceutic books and
Dispensatories, as a diffusible stimulant, and that its fumes or vapor
produce intoxication of short duration; but it was unknown, until
my experiments were performed, that it rendered the body insensible
to pain, and threw the mind into a pleasant reverie or dream,
so as to disregard the tortures of the knife and cautery. So
far from recommending its inhalation, all the authorities strenuously
advised against breathing it, as" " fraught with danger." Perhaps
there may be danger in the prolonged inhalation of the ordinary
Ethers of Pharmacy, which are liable to be impure. We know that
commercial Ethers may contain Sulphurous Acid Gas, Acetic, For-
mic, and Aldehydic Acids, the three latter being produced by absorp-
tion of Oxygen from the air.

The presence of a considerable proportion of alcohol in these
Ethers causes them to produce mere intoxication followed by head-
ache and prostration of nervous energy.

Although others may have experienced these effects, still the higher
stage, viz: perfect insensibility and unconsciousness of pain was
never reached, and the thin veil which concealed this discovery from
the world had not been raised until my experiments were instituted.

A short description of the best processes of preparing Ether to
produce the effects which I proposed to attain will not be irrelevant.

The basis of all the Ethers is a hypothetic radical, called Ethule,
which is represented by the formula, C4 H5 and symbol Ae. Pure
Sulphuric Ether is regarded as an oxide of Ethule, and is represent-
ed by the formula C4 H5 O, its symbol is, therefore, Ae O. It is
prepared by decomposing highly rectified Alcohol by means of Sul-
phuric Acid, or Oil of Vitriol. Five parts of Alcohol of 90 percent,
are mixed with 9 parts of Oil of Vitriol in a vessel of copper or iron,
placed in cold water, so as to cool the mixture. The action of Sul-
phuric Acid on Alcohol is catalytic, bi-sulphate of Oxide of Ethule is
formed, which by elevation of the temperature and brisk ebullition is
decomposed, and the oxide of Ethule passes over in vapor; the Sul-
phuric Acid remaining with a portion of undecomposed Alcohol, the
water which passes over in vapor no longer uniting with the Ether.
Alcohol is repeatedly added to the Sulphuric Acid, which would de-
compose an indefinite quantity of it, were it not diluted by the water
introduced; 10 per cent, of which is conveyed to it by common
Alcohol.

The distilled liquid is next to lie treated with an alcoholic solution
of potash to neutralize the acids, and to render it slightly alkaline.
It should then be redistilled in a water bath, and the operation is to

226 Insensibility to pain by the vapour of Sulphuric Ether. [April,

bo nr roster! as soon as I he El her has attained a specific gravity of 0 72
at 80 F. The specific gravity mav be si ill farther reduced by allow,
ing it to stand for some days over dry chloride of Calcium and then
re-distilling ii in contact with that hygromotric substance. Its boiling
point is at 96 F. It has a penetrating aromatic odour and is highly
inflammable. It should not change the color of blue litmus paper.

The pure vapor of El her as thus produced, will not support respi-
ration, and bv excluding air from the lungs would produce complete
asphyxia. Therefore, I inspired it in such a manner, that there was
mixed with the vapor a sufficient quantity of common air, to enable
the lungs to perform their usual functions, but slightly disturbed by
the Etherial vapor; and I would- caution all who may administer it
in future, carefully to fulfil this important condition so essential to
success. In cases where alarming symptoms of asphyxia may occur
from the accidents of improper administration, or from impurities of
the Ether employed, and in those persons of high nervous suscepti-
bility, or of determination of blood to the brain and pulmonary dis-
eases, (though in the latter cases it may have been improper to ad-
minister it,) I have prescribed the inhalation of pure Oxygen Gas,
which, acting on the blood, immediately renders it arteiial, and this
gas should be kept in readiness to meet any such emergency. It
may be preserved in a gasometer, and be drawn off in a large India
rubber bag for use at any moment. The administration of the Ether
with all the above-mentioned precautions, will produce the kind of
insensibility required. Its production is immediate, of short duration,
and the effect passes off in a very short time.

In my first successful experiment the conditions as stated above
were fulfilled, though the mode of administration was of the simplest
kind, it is true, but yet efficient. A folded cloth saturated with the
highly rectified Ether was placed over the mouth, the air being drawn
freely through it, and the inhalation was continued till I lost all power
over myselfand sank back in my chair in a state of peculiar slcepor
reverie. 1 exper.enced at first a sense of coolness, then of exhilara-
tion and warmth followed by loss of consciousness. But it was not
until a subsequent trial that I became aware that this loss of con-
sciousness was accompanied by insensibility to pain; and a severe
bronchial irritation produced by the inspiration of a large quantity of
Chlorine gas was for the moment relieved, and the peculiar distress
occasioned by that gas was not felt, as long as I was under the influ-
ence of Ether, though as that passed offit returned. I had several
times occasion to mention these facts to my friends, and it is now a
year since I urgently advised Mr. J. Pea body, who was associated
with me as a pupil in Chemistry, to inhale the Ether vapor as a
means of preventing pain, which would arise from the extraction of
two of his teeth. He consented to try the experiment, and was pre-
paring some Ether for the purpose, but on consulting the works, in
which the effects of Ether are mentioned, he found all the authorities
arrayed in opposition to my views, and that they warned against its

2647.] Insensibility to pain by the vapour of Sulphuric Ether. 229

inhalation, as I have before stated, and he therefore did not complete
the experiment.

About the last of September, or early in October last, I communi-
cate! my discovery to ])r. W. T. G. Morion, an enterprising and
skilful dentist of this city, whom I occasionally advised, and who
called at my Laboratory to borrow an India rubber bag, which be
said he intended to fill with atmospheric air, and to cause a refracto-
ry patient to breathe it, hoping to act on her imagination, and induce
her to allow him to extract a tooth. I dissuaded him from this at-
tempt, and explained to him that I had discovered a process by which
real insensibility to pain might he produced. I showed him Sulphu-
ric Ether, and described the method of administering it, and also its
effects on the system assuring him, that if my directions were care-
fully followed no danger would ensue. I advised him to try its effects
on himself, in order that he might better understand its mode of oper-
ation. He followed my instructions and was successful in the first
trials, in the extraction of teeth unattended with pain, the results
proving exactly as I had predicted. I also furnished him with a large
glass flask with a bent glass tube as an extempore inhaling apparatus.
I then proposed to him the trial of the Ether in a surgical operation
at the .Massachusetts General Hospital, where it was admislered by
Dr. Morton, and it proved successful : but some persons who witness-
ed the first operation doubted the entire freedom from pain, since the
patient said "he felt a scraping." I was therefore desirous of testing
it in a capital operation, the severity of the shock being the best test
with regard to the degree of insensibility. Dr. J. C. Warren politely
consented to have the trial made, and its results proved entirely sat-
isfactory, an amputation having been performed under the influence
of Etherial vapor without giving any pain to the patient. Drs. J. C.
Warren, Hay ward, Town send and J. M. Warren performed the first
successful operations that are recorded. Since then the most eminent
surgeons in Europe and others in this country have confirmed by nu-
merous trials the reality of the discovery. Occasional failures were
to be expected, but they mostly have arisen from imperfect modes of
administration, though some may be attributed to idiosyncrasies.
Medical, as well as surgical science will probably derive advantage
from this new practice. It may be worthy of trial in Tetanus and
other spasmodic diseases. Intermittent headache, I believe, already
to have been relieved by it. and the chills of intermittent fever may
possibly be broken. The relaxation of the muscles effected by free
inhalation of Ether vapor may enable the surgeon to reduce disloca-
tions, and dispense with the powerful force of puiiies and other violent
m ana of extension. Already it has found its way into the Royal
Ve'rinary Colleges of A I fort in France, and Camden in England,
where severe operations have been performed on horses, sheep, and
dogs without the manifestation of any pain or struggles in these
animals. Even division of nerves has been performed on a horse, to
which the Ether had been administered, and although the animal wax

230 Insensibility to pain by the vapour of Sulphuric Ether. [April,

in no way restrained, not a struggle was made, or any sign of pain
perceived. This precludes the idea of the effect being due to the
imagination.

How far this new practice may extend is yet unknown, but there
cannot be any reason to believe that the limits of its applications have
been conceived. CHARLES T. JACKSON.

Another experiment with the inhalation of Ether was made in tho
Royal Infirmary yesterday, by Professor Miller, and proved eminent-
ly successful.

The patient was a middle-aged Irishman a " navvy," who had
sustained compound fracture of the leg nine weeks before. The
fracture had not united, in consequence of the presence of a dead
piece of bone, and it became necessary to remove this by a painful
operation. The patient was seated on a table, and the inhalation
was applied by means of. a very beautiful yet simple apparatus, made
by Squire, of London, and which, we understand, had been sent to
Professor Miller by Mr. Listen a very suitable gift, under present
circumstances, from that eminent surgeon to his old pupil. At first
little effect was produced, but after some minutes the patient fell
backwards, as if in a swoon. The operator was then about to pro-
ceed ; but the man immediately objected, saying that he was not
asleep, and that he trusted nothing would be done till he was asleep.
For full 20 minutes more the inhalation went on; the man confused
and talkative, but wide awake, and occasionally expressing very
emphatically his conviction that ' it would not do.' At length, how-
ever, while in this wakeful state, the operation was begun. Incisions
were made on the shin, and flaps were dissected oft' so as to expose
the bone beneath. A portion of this was sawn and clipped through,
and then the dead bone was removed. Only during the clipping of
the bone with strong straining pliers did any sign of feeling escape
from the patient, who was busy inhaling all the while, and now and
then protesting that ' it wouldn't do.' The operation occupied about
10 minutes, and, from the highly sensitive nature of the parts impli-
cated, must have been attended with excruciating suffering under
ordinary circumstances. After it was over, the professor said to the
patient, 'I suppose you won't let me operate to-day.5 'Certainly
not,' said the patient; 'it won't do; I must be asleep. The thing
hasn't succeeded with me, and I am sure it can't succeed with any
one else, fori did everything I could to get asleep for my own sake,
and I'd do anything to please you.' You won't even let me make a
cut into the leg?' 'No; I must be asleep; we can try it another
time.' This plain proof of his utter unconsciousness of the operation
having been performed was acknowledged by the spectators in a
hearty round of applause. The patient then sat up. and seeing the
wound, burst into an immoderate fit of laughter, saying, ' No doubt
there's blood, or something very like it; but I havn't felt a single
thing done to my leg. That bates the globe;' and, on being asked

1847.] Employment of the vapour of Sulphuric Ether. 231

decidedly as to his having ' felt any thing,' he repeatedly answered,
4 Not a ha'porth.' He got into amazing spirits, and refused to leave
the table until he had told 'all about the toldrums of the business.'
And then, with the manner of a tipsy man, and very happy, he kept
surgeons and students in a roar of laughter for some minutes with a
narrative of his condition during the inhalation, which, Irish-like,
seemed to have been a strange medley of imaginary rights and
'killings' going on around him, but wholly irrespective of his own leg
and the operation. On being carried out, he declared triumphantly,
'This is the very best thing that has ever happened in the three
kingdoms.' The professor stated that he considered this case quite
conclusive as to the powers of the ether, because there was no more
painful operation in all surgery, and because the patient, having been
avowedly a hard and habitual drinker of spirits, was one of those
persons who are least susceptible of the ether's influence. The
whole proceedings seemed to give the greatest satisfaction to the
medical and surgical officers of the institution, and to a large assem-
blage of interested spectators. Perhaps the most remarkable thing
in such a strange tale is, the circumstance of a man being so wide
awake and talkative, while all the while quite insensible to the cut-
ting of his limb."

In the last No. of the Dublin Quarterly Journal of Medical Science,
we find the following notice of Sulphuric Ether, by the Editor :

The Employment of the Vapour of Sulphuric Ether, as a Means
of rendering Surgical Operations painless. Since the publication
of our last number, a most important and valuable discovery has
been made, in usiug the vapour of Sulphuric Ether for the purpose of
rendering patients insensible to pain during surgical operations. All
the professional journals, and the public press, have teemed with in-
stances in which this great discovery has been tested and applied at
most of the large hospitals in Great Britain and Ireland ; and al-
though the final conclusion to which the profession will come, as to
the precise value of this discovery, the cases to which it is applica-
ble, the constitutions over which it exerts its peculiar influence, the
precise mode of administering it, and the exact amount of narcotism
or intoxication which it is necessary to produce, cannot yet be stated,
still we think the following facts and conclusions may be drawn from
the experiments which have as yet been instituted.

I. The stupifying effects produced by the inhalation of the vapour
of sulphuric ether appear to have been known to chemists for some
years past, and to have been occasionally exhibited at chemical
lectures. Its therapeutic agency iu relieving pain was also proved
more than twelve months ago. M. Ducros, at a meeting of the
Academic des Sciences de France, on the 10th of March last, pro-

233 Employment of the vapour of Sulphuric Ether* [April,

sented a memoir on the effects which sulphuric ether produces on
man and some of the lower animals: his mode of Applying it was
by rubbing the palate, fauces, and interior of the mouth with the
fluid, but, no doubt, the effects were produced by inhalation of the
vapour. M. Ducros described with great accuracy the sporific and
anodyne effects of the ether; drew attention to the advantages
which might be derived from it in a therapeutic point of view, and
pointed out to the Academy the best means of removing the narco-
tizing influence, which sometimes remains longer than is desirable.
This antidote is opium and its preparations. (? How administered.)

II. Doctor Morton, a dental surgeon at Boston, appears to have
been the first to make use of this agent as a means of relieving pain
during surgical operations, and he soon acquired great and just ce-
lebrity in that city, by extracting teeth without the patients, who had
previously inhaled the ether, being conscious of the operation. In
October last it was applied in the General Hospital, at Boston, with
the happiest results ; Dr. Morton administering the ether, and Dr.
Warren performing the operation. Upon (he 3d of November, Dr.
H. J. Bigelow read an account of this discovery (which had by that
time been tested by many experiments) before the American Acade-
my of Arts and Sciences. This account, and several private letters,
having communicated the facts to several peisons in Great Britain,
it was taken up very warmly in these countries, and the results are
already before the public; several capital operations have been so
performed by the surgeons of this city ; and there has been a public
exhibition of its effects at a meeting of the Surgical Society. This
discovery has been claimed by R. II. Collier, M. D., but the most
which his claim amounts to is that of having published, in 1843, an
account of the unconsciousness which may be produced by the inha-
lation of ether ; but this, as we already stated, was long since known :
its application to surgical operations is undoubtedly due to the Amer-
ican dentist, who, with Dr. Jackson, has, we understand, taken cut
a patent for its discovery.

III. The mode of application consists in the patient's inspiring the
vapour by the mouth, while the nostrils are closed and expiring into
the surrounding atmosphere ; or inhaling through the nose, and expir-
ing through the mouth, as practised at some of the Parisian hospitals.
To effect this, various ingenious contrivances have been invented,
which have been described and figured by most of our contemporaries.

IV. On commencing to respire it, the patient generally coughs,
and fee's at first considerable difficulty in continuing the inhalation,
but after half a minute or so becomes more reconciled to it. Imme-
diately before narcotism or insensibility takes place, there is often
some struggle, and the application has to be continued by force. Its
effects are various, and are very likely influenced by the peculiarity
of constitution in different individuals, in some, producing decided
narcotism (as it has been termed) in two minutes from the com-
mencement of the inhalation, and causing insensibility for about the

1847.] Employment of the vapour of Sulphuric Ether. 233

same period of time, from which stale the person quietly awakes as
if recovering from an ordinary faint, and leaving no other ill effects
than slight giddiness and headach, which go off in a couple of hours.
During this process the following phenomena occur : At first the
face becomes flushed, the vessels of the head swollen and turbid,
and the pulse accelerated, as the narcotism proceeds, and immediately
after the person becomes unconscious to every Ihing hut sound, and
insensible to pain ; the pulse diminishes in frequency, intermits with
irregular pauses, and becomes much slower than it was prior to the
commencement of the inhalation; the action of the heart is at t he-
same time laboured, and in some cases irregular ; the voluntary
muscles of the bony relax as in sleep; the fice then becomes pale
and clammy, and the breathing more or less stertorous. At the
commencement of the insensibility the eye-balls are spasmodically
affected, and in some cases roll in a remarkable manner. As the
insensibility proceeds the pupils are dilated and turned upwards.

What would a physiologist, or practical physician, pronounce
such a train of symptoms to arise from ? By what term could he
designate them? Hysteria, syncope, intoxication, asphyxia, or apo.
plexy ?

In other cases it requires to be inhaled for a quarter of nn hour
before producing its effects. Again, there are persons over whom it
exercises no influence whatever.

In a few cases that we have heard of, both here and in Paris, it
does not appear to have produced unconsciousness, or any of the
effects just described, but it rendered the patient quite insensible to
pain. This is the most useful effect we have yet heard of; and if it
should be discovered by what means this result may be brought about,
then, indeed, it will prove one of the greatest biessings conferred on
suffering humanity.

Some persons describe their feelings while under its influence as
of a most pleasing description, having hf;d pleasant dreams during
their state of insensibility. Others, again, say they were conscious
of all that was going forward, though thev felt no inconvenience
from the operation to which they were submitted; almost all say
that they were conscious of sound, though unable to distinguish con-
venation, &c.

In other instances, however, persons do not recover from their in-
sensibility, in the quiet easy manner we have described; a violent
struggle takes place, and even a slight convulsion occurs, and move-
ments of the body, quite involuntary, continue for some minutes
after. Again, although the effects may in some constitutions wear
off within an hour or two, as already mentioned, in others they are
much more violent and of far longer duration, conaisting in great
prostration of strength, irregular action of the heart, great restless-
ness and anxiety, headach. sickness of stomach, depression nf spirits,
and (as uccuredinone case) even convulsions; in tact, all the phe-
nomena which some constitutions evince from any great nervous

234 Employment of the vapour of Sulphuric Ether. [April,

shock, and particularly from an over-dose of intoxicating fluid. It
is stated that the blood drawn during the state of insensibility is dark-
er than natural,

In a third class of persons a totally different but not less formida-
ble exhibition of morbid symptoms occur, best described as the
incoherent madness of inebriety; the eyes roll, the passions are
aroused, and a state little short of frenzy ensues. What proportion
the latter class of patients bear to the first remains yet to be decided ;
and by what test we can discover beforehand (except by experiment)
what the probable effects of inhalation will be, has yet to be stated.
But then it must be acknowledged that several other medicines pro-
duce in some individuals effects just as extraordinary.

Independent, however, of all idiosyncracies, the surgeon is daily
required to perform painful and dangerous operations, not only when
the suddenness of the shock recently received is such as to preclude
the use of a remedy so overpowering, but also when the condition of
the constitution has been, by protracted disease, reduced to a state
that would render the exhibition of this substance, should it prove
deleterious, highly hazardous.

V. Supposing the mildest case, in which the effects are total in-
sensibility for two or even three minutes, with quiet, easy return of
animation, what is the benefit, as far as we yet know, which this
discovery has conferred on mankind, and what facilities does it afford
the operative surgeon, and to what operations is it applicable ?

In capital operations, such as the removal of limbs, lithotomy, and
all such operations as can be performed within a minute or two by
the great manual dexterity of the surgeon, and particularly tooth-
drawing, &c, &c, it appears to be of the greatest value ; it has been
successfully employed in operations for strabismus, and may be use-
ful in other operations (if they be worth the risk) on the eye-lids, &c,
but in extraction of cataract,* or other ophthalmic operations where
the globe of the eye is concerned, we should fear that it will be highly
hazardous. In any operation which may occupy a greater length of
time than the ordinary duration of insensibility, it is less applicable,
for the action of recovery, and the involuntary struggle which ensues,
might prove very hazardous at perhaps the most critical moment;
and ^ew have yet been hardy enough to renew the inhalation so as
to prolong insensibility beyond a few minutes. Moreover, cases
have been recorded, in which the patient, awaking during the opera-
tion, suffered as usual.

To the timid, however, and to those also who would not otherwise
submit to any operation, it may prove of very great value.

Finding the subject discussed in the public prints, we lately pub-
lished some remarks upon it in one of our morning papers. These
were offered not for the purpose of decrying this valuable means of

* A case of extraction has just been mentioned in the Lancet, in which the
vapour was used effectually ; yet this in no wise alters our opinion on this sub-
ject.

1 847.] Physical Diagnosis in Diseases of the Chest. 235

relieving pain, and lessening the great nervous shock during severe
* operations, in some of which, performed on a particular class of
patients, and capable of being accomplished within a very short
space of time, it is highly serviceable, but in order, if possible, to
prevent its indiscriminate use. It is possible that accidents may
occur in the inhalation of ether, and when they do, the present rage
for its application may receive a check. Its ultimate, perhaps per-
sistent, consequences on the constitution have not yet been tested, as
also i:s value in relieving pain and suffering induced by disease. It
may also be found highly useful in the reduction of dislocations.

We have here endeavored to present our readers with a brief sum-
mary of what really is known upon the subject at present.

On the Fallacies attending Physical Diagnosis in Diseases of the
Chest. By Thomas Addison, M. D. (Guy's Hospital Rep.)

1. It is well known that many persons while under examination
entirely fail to perform the respiratory act efficiently either from
nervousness,, or from mistaking the manner of accomplishing it.
This may lead to an erroneous belief that the respiratory murmur is
deficient, or even absent, while the lungs are perfectly healthy.

This source offallacy is avoided by desiring the patient to cough,
and to inspire deeply, so as to cough a second time. This done on
both sides of the chest, the actual state of either lung may be ascer-
tained with tolerable precision.

2. Whatever lessens the freedom, mobility, or elasticity of the ribs,
renders the sound en percussion more dull. Kence it is that in
rickety persons, where deformity of the chest has taken place subse-
quent to birth, the signs furnished by percussion are often extremely
unsatisfactory ; and, indeed, under such circumstances, neither per-
cussion, nor in many instances auscultation, can be much relied upon.

3. Some persons with actual deformity have naturally such fixed-
ness of the ribs, that the fest very imperfect reson-
ance, as well as considerable feebleness of the respiratory murmur.

4. The rigidity of the cartilages of the ribs in advanced life has a
similar effect ; and, moreover, often tends to throw obscurity over
hypertrophy of the heart by preventing the usual heaving of the ribs
at each systoleofthe hypertrophied organ.

5. When exploring the chest in a case of recent disease, we may
be misled by the permanent effect of an ancient pleurisy.

0. When, as usually happens, rickety deformity of the chest con-
sists in lateral flattening of the ribs, with projection of the sternum,
the action of the heart is liable to beat with such violence, and over
so diffused a space, as to lead to the unfounded apprehension of or-
ganic disease of the organ.

7. The dullness on percussion caused by pushing up of the dia-

238 Physical Diagnosis in Diseases of the Chest. [April,

phrngm l>y an enlarged liver, or fluid in the peritoneum, is liable to
be mistaken for dullness caused by fluid in the pleura.

8. Bronchitis is a frequent source of fallacy, it may greatly ob-
genre pneumonia, phthisis, and pleurisy, as well as other chronic
diseases of the organs.

9. When the bronchitic complication of phthisis is considerable
we often f.iil to detect some or all of the physical signs of the latter
such as dullness '<n percussion, tubercular respiration, and even
bronchophony Jind pectoriloquy. This is more especially the case in
the earlier stages.

10 Dullness of sound on percussion, tubular respiration, broncho-
phony, pectoriloquy, and gurgling, are not necessarily conclusive of
phthisis. All these signs may result from changes induced by a for-
mer pleurisy, from phuro-pneumonia, or whooping-cough, or even
from recent pneumonia or pleurisy associated with considerable
bronchitis.

11. When, in phthisis, the larynx is so involved as to impede the
entrance of air and give rise to permanent sonorous tale in the tube,
the reverberation of this rale through the entire chest is apt to lead to
the erroneous suspicion f disease in the lungs.

12. Complete loss of voice from disease of the larynx almost com.
pletely nullifies the results of auscultation.

13. The existence of a cavity may be overlooked if the bronchial
tubes leading into it are plugged with mucus.

In every case of suspected phthisis the patient should be made lo
breathe and cough with violence ; (his will dislodge mucosities and
render the existence of a cavity perceptible.

14. A patient may have all the rational sijrns of incipient phthisis
while auscultation does not reveal any change in the lungs.

Similar symptoms may arise from relaxed uvula, and in hysteria.

15. Dilated bronchial tubes surrounded by indurated pulmonary
tissue, cannot be distinguished from phthisical lesion by auscultation
alone, especially if situated in the apices of the lungs.

In such cases the diagnosis is chiefly formed by the history of the
case.

16. Malignant disease of the lungs cannot be distinguished from
other lesions by auscultation alone.

17. If acute pneumonia have proceeded to complete hepatization
when we first examine the patient, the physical signs are frequently
insufficient to distinguish it from tubercuiar consolidation or ancient
pulmonic induration, This is especially the case it the apex of the
lung be the seat of the induration.

18. Pneumonia may occur without cough, and so closely resemble
simple continued fever that both the stethoscopist and the non-stetho-
scopist are apt to be deceived.

In such a case the steihoscopist has infinitely the advantage, and
will rarely fail to detect pneumonia by the physical signs.

19. When the anterior and inferior portion of the left lung is con-

#

1847.] Physical Diagnosis in Diseases of the Chest, 237

solidated by pneumonia, it may not be defected by percussion on
Recount of the proximity of a flatulent stomach. Under similar cir-
cumstances a mnked amphoric respiration rs produced, with metalic
tinkling, leading to the erroneous conclusion that pneumothorax is
present.

The respiration acquires its amphoric character by reverberating
through the solid parts to the inflated stomach or bowels.

20. It cannot be determined by physical examination whether
pneumonia have or have not supervened upon tubercles, although the
prognosis in the two cases would be very different.

2J. [doubt whether physical examination can in any instance de-
termine with certainty, the existence ofsimple tubercles in the lungs.

22. When serous effusion is very considerable, giving rise to une-
quivocal bronchophony, tubular respiration,- and want of resonance
and vocal vibration, physical examination has repeatedly led to a
mistaken belief that these signs resulted from pneumonic or other
consolidation of the lung.

23. When a patient presents himself with febrile affection of any
kind, we may, on examination, detect dullness or percussion, tubular
respiration, bronchophony, and a ra'e not distinguishable from the
submucous crepitation commonly observed in pneumonic hepatiza-
tion ; and yet physical examination should not enable us to deter-
mine whether the chest affection be recent or of ancient date.
When a portion of lung has been compressed by pleuritic effusion,
and has been prevented from expanding again by adhesions, the
physical signs may remain permanently, and be found to resemble
precisely those which result from recent pleuropneumonia.

24. Experience leads me to the conclusion that pleuritic friction-
sound cannot in all cases be distinguished from the rubbing produced
between the inflamed peritoneal surfaces of the liver and diaphragm ;
neither can the croaking sounds produced in the bronchi be always
distinguished from the pleuritic rub.

25. A- simple pericarditis is rarely attended with pain, and as the
other symptoms of that disease are equivocal, the physical signs are
chiefly to be relied upon in forming a diagnosis. Nevertheless,
when effusion has taken place to a certain amount the friction-sound
commonly disappears, and as auscultation fails to recognize the
disease.

20. Enormous accumulations of fluid in the pericardium cannot
always be distinguished from effusion into the cavity of the pleura.

27. When the pericardial friction-sound is single, auscultation may
fail to distinguish it from a valvular murmur, especially if it be situ-
ated over the region of the valves.

28. The double pericardial friction-sound may be confounded with
the see-saw murmur of imperfect aortic valves, and vice versa.

This question may be almost decided by the characters of the
pulse alone.

29. A sound closely resembling a murmur appears sometimes to

238 Treatment of Urinary Diseases. [April,

be produced by the stroke of the heart against a portion of lung
interposed between it and the parietes of the chest. Under such
circumstances auscultation may lead to the erroneous conclusion
that the heart is diseased.

This sound is most commonly heard at some point at the edge of
the left lung, and resembles the bruit de rape. It may occasionally
be made to disappear by a deep sustained inspiration. The author
thinks it may be identical with the sound described by Dr. Latham
as present in phthisis.

30. Auscultation fails to distinguish an aortic murmur depending
on organic change from one which results from other causes ; neither
can it decide whether what has been called a mitral murmur is or-
ganic or functional. *

31. In certain diseases of the heart it is difficult or impossible to lo-
calise the murmurs with accuracy, however pronounced they may be.

32. Auscultation cannot distinguish the murmur of an aneurismal
artery from the murmur produced by external pressure upon the
vessel.

33. Physical examination does not enable us to distinguish congen-
ital malformation from disease of the heart or large vessels.

Treatment of Urinary Diseases. By Jonx Aldridge, M. D.
(Dublin Hospital Gazette.)

Treatment of Diabetes hisipidus. This is the name given to a
symptom of urinary disease, in which an excessively increased quan-
tity of water is habitually secreted from the kidneys, without any
alteration of the solid elements of the urine. The specific gravity of
this liquid becomes consequently very much reduced. This symp-
tom appears to depend on altered innervation, and it is best treated
by the internal use of antispasmodics and mineral tonics, with the
external employment of stimulating liniments to the spine.

Treatment of Lithic Acid Deposits. These deposits are either
crystalline or amorphous. When the urine for any length of time
continues to deposit, after each emission, the rhombic prisms of lithic
or uric acid, this circumstance is an evidence that the kidney is affect-
ed with gout : under such circumstances the immediate danger is the
formation of a calculus; and to obviate this it is desirable to exhibit
either bicarbonate of soda or potash, in doses of ten grains or a scru-
ple dissolved in half a pint of water, three times a day, so as to render
the urine neutral or alkaline : but, this efTect being obtained, the
practitioner ought to direct his efforts to subdue the gout which is the
cause of the symptom, if the urine be albuminous or sanguinolent,
and there is much pain in the loins, it shows the attack to be of an
inflammatory character, and to require a treatment locally antiphlo-
gistic; otherwise recourse maybe had to colchicum, or whatever
remedy the practitioner prefers in the treatment of podagra.

1347.] Treatment of Urinary Diseases. 239

If the lithic acid deposit be amorphous, its precipitation may de-
pend either upon an excessive secretion of the solid constituents of
the urine, or upon a deficiency in the secretion of water. In the
former case the specific gravity of the urine becomes normally in-
creased in proportion to its quantity; and this symptom is usually
dependent on rheumatism of the kidney. The treatment should, of
course, be directed to the rheumatism, at the same time it is desirable
to hold the excess of lithatesin solution by means of alkalies. Iodide
of potassium is a medicine that fulfils both indications, and, given in
doses of five or ten grains, three times a day, will usually be found
serviceable.

When the amorphous lithates become deposited from a deficiency
of water, the quantity of urine will be ascertained, upon inquiry, to
be less than usual. Sometimes, however, the patient is deceived as
this point by the concentrated and stimulating secretion, demanding
frequent evacuation : under ail circumstances it is most desirable,
for diagnosis, that the daily discharge of urine should be measured.
Diminution of the watery part of the urine may be produced by ir-
ritation of the kidneys, either idiopathic or symptomatic ; or it may
be the result of a lesion of innervation ; or it may be the consequence
of a vicarious mattery secretion from some other organ. When the
deposited lithates are of a brick-red colour, the scanty secretion of
water which produces their subsidence is the effect of the first of these
causes ; in that case a fever, either essential or symptomatic, exists,
and the remedies calculated to remove the fever are those fitted to
increase the urinary secretion and diminish the lithic deposit. If the
deposited lithates be pale or buff-coloured, the chances are that they
are caused by a nervous diminution of the watery element, connected
with that weakened action of the ganglionic nervous system to which
the name of dyspepsia is given ; if such be the case, the internal
exhibition of a scruple of alum in half a pint of water three times a
day will soon remove the tendency to lithic acid deposit. A pink
colour of the sediment is usually found in connection with an imper-
fect discharge of the biliary functions.

Treatment of Phosphaiic Deposits. These deposits, when prin-
cipally crystalline, generally depend upon the urine being deficient
in acidity : in that case the treatment will be described under the
head of alkaline urine. Sometimes, when the bladder has been long
diseased, a copious deposit of amorphous phosphates subsides from
the urine ; it is always, under such circumstances, accompanied with
pus; and the indications which are thus afforded for treatment I
shall hereafter mention.

Treatment indicated by weakly Acid, Neutral, or Alkaline Urine.
If the urine be neutral or weakly acid, from a vice of secretion, it
usually shows that the kidneys are inflamed. In acute nephritis the
employment of local and general depletion, as well as the exhibition
of emollients and contrastimulants, must be regulated by the severity
of the disease and the state of the constitution, according to the

240 Treatment of Urinary Diseases, [April,

ordinary principles by which inflnmmni ions are compiled. I am
persuaded thai I have seen much benefit from large (3) doses of
hvdriudate of potash in this disease. In chronic nephritis you will
find great hone fit from local depletion and counter-irritationi espe-
cially from the establish in en I of setons in the neighborhood of the
affected glands. In the renal complication of typhus, large blisters
(o the loins, and the internal administration of wine, are usually
indicated : small doses of oil of turpentine will, in these cases, often
increase the quantity and restore the acidify of the urine.

Treatment of the Oxalate of Lime Deposits. Although there can
be liltle doubt t hat oxalic acid is generated in the urine by the pu-
trefactive decomposition, and often occurs subsequent to secretion in
a manner totally independent of disease, yet it is also certain that
this decomposition frequently results from an essential vice of se-
cretion. The morbid conditions which give rise to this change are
not yet known ; but one thinir is well ascertained, that in every in-
stance of the kind there is frequent desire to pass water, pain in
passing it, and that the secretion is commonly loaded with epithelium.
These phenomena proclaim the existence of irritation of the mucous
membrane. Sometimes the crystals of oxalate of lime, like those
of uric acid, cohere in the calyces and infundihula, forming calculi,
which produce paroxysms of nephritic colic by their descent into
the bladder. In such cases inflammation of the lining membrane
may be mechanically produced; but it is doubtful whether the
symptoms of mucous irritation which usually accompany the oxalate
of lime deposit are due to the irritating contact of the sharp crystals.
"Whatever is the cause of the mucous irritation, it consiiiutes the
lesion which, in oxalate of lime diathesis, you are especially called
on to remove ; and its successful treatment requires no liltle delicacy
in the application of therapeutical agents. Unlike acute mucous
irritation, depletion and emollients will act in this irritation injuri-
ously, if employed in the first instance; you must have recourse to
tonics immediately, such as the mineral acids, vegetable bitter astrin-
gents, &c; and, having employed those means for some time, you
will then find the greatest benefit from alkalies largely diluted, It
will be often necessary to alternate these methods of treatment for
a considerable period, but you will generally find that ultimate bene-
fit will be derived from steady persistence in their use. The form of
tonic mixture which I usually employ in these case is the following;

ft. Infusi cascarillce . . . vj.
Xitratis potassse 3j.

Acidi nilrici diluti . . . 3 iss.
Tincturaeopii . . . 5j.

M. Sumat cochlearia quo ampla ter in die.

Treatment of Diabetes Mel/itus. I look on saccharine urine as
depending on a modification of the epithelial secretion produced by
an asthenic condition of the urinary conduits. If this be the case,

1517.] latic Ft. 241

medicines : \ to exalt the tone of the secre;..

are those L n. Accordi

experience

excitants, are the rr.: leficial when the perspira-

MM of

rived fix
: other metallic

the capiUa-

. It is
well, therefore.
icc.. ismocfa

funct; d recomm

some. :
fit.
Trc ire on the

pathology of di ire been

sources of pus in the arin

nentioned "... ingaishing

pathological ca - each other. We have seen tiiat the urinary

mucous membranes pour out pus when in a ..:c inrlam-

n, and this eircnms the appropriate

treatment. Tonics !.ed on in

zoction of the leaves of chimaphila corym
ma crenata. or arctystaphylos, awn nrsi, or the root of cissampeloa
pareira. combi:.- nineral ac md service-

able; cha ire aiso often of efficacy in these cases.

Treatment of Harmatmria, The fficacious treatment of

essen:. n of astringents, such

as tannin. latter

is very apt, however, to conv; tl iria into

r affords
accurate test forpoin

exhibition cf the medicine an

Statistics of Cases of Mi 'treated in

L. I a (Medical -

and Record of Med. Science.)

Darn -ntic fever came under

my care. Of I were Intermittent, and 22 Remittent. Of

the intermitte': 15 tetl .:an. and 5

1 Oft: m of neuralgia, and four

simulated hystt

;mcnt chiefly employed was the sulphate ofquinia

242 Statistics of Cases of Miasmatic Fever. [April,

ministered in large doses, without regard to the stage of the disease.
In one case a quotidian occurring in a youth aged 16, of sanguine-
ous, excitable temperament, I administered 15 grains just as the cold
stage was passing off. All the symptoms were ameliorated ; the hot
stage lasted but one hour, and the patient had no return of the
disease.

In 25 cases, I gave 30 grains in five hours, during the height of the
febrile stage. The pulse was lessened in force and frequency in
every instance under this treatment, and the paroxysm cut short by
the speedy appearance of perspiration. In only one of these cases
was the remedy preceded by other treatment. The exception was
the case of an exceedingly robust man, in whom there existed, even
in his ordinary health, a strong tendency of blood to the head. I
bled him to twenty ounces before administering the quinine. He
returned to his work (that of a baker,) forty-eight hours afterwards,
and had no return of the fever during the season. He told me that
for several years past he had not escaped an attack of bilious fever
in the autumn, and that he was usually kept in his bed by it for three
weeks. Said that he had taken the quinine before, but not while the
"fever was on,"

In one case, the patient was partially comatose during the first
paroxysm. This condition was relieved, in a measure, by a cathar-
tic of calomel and aloes. Three hours before the second chill was
expected, I administered 25 grains of quinine, and followed this by
15 grains more two hours afterwards. The patient missed the par-
oxysm and went to work the next day.

In 14 cases there was a recurrence of the disease. The recur-
rence in ten of these, however, could be positively traced to a second
exposure to the causes of the affection.

The masked forms of the disease yielded readily to the quinine
treatment. One of the cases which simulated hysteria was remark-
ably severe in its character, the patient being seized every afternoon
with violent convulsions, accompanied by flushed face and considera-
ble excitement of the circulation. She was treated at first by active
purgation, and vesicants to the nucha, with only slight abatement in
the intensity of the paroxysm. The regularity with which the attacks
came, coupled with the fact that the patient resided in a part of the
city where intermittent fever was prevailing, suggested the employ-
ment of quinine. She commenced early in the morning with five
grains every hour, and took thirty grains. The paroxysm was much
milder in the evening, and did not recur at all on the next day. She
remained well for seven days, when she was again attacked as in the
first instance, and again relieved by the same treatment. She sub-
sequently had a third attack which was cured in the same manner.
Her catamenia had been interrupted for six months previous to her
sickness, and did not return until six weeks after the last attack.

I was not called to a single case of remittent fever at the begin-
ning of the disease. In one case the patient had been ill eleven days

1847.] Statistics of Cases of Miasmatic Fever. 243

without any treatment whatever; she was much emaciated, and had
suffered from diarrhoea for six days. I gave her a table-spoonful of
the following mixture every hour:

R. Quinias Sulph. . . . 3ss.
Morph. Sulph. . . . gr. ss.
Aquse f. giij. M.

In the course of five or six hours she perspired freely, fell into a
quiet sleep, and in two days after was entirely free from disease.
This was the sole treatment of the case, except the tinct. hydro-
chlorid. ferri, which was given for ten days after convalescence was
established.

The other cases were managed after the same manner the large
doses of quinine being preceded by a simple cathartic of jalap and
bitartrate of potassa in those cases only where there was great torpor
of the bowels.

Not one of the 105 cases died, and all together did not take a
drachm of calomel, or other preparation of mercury.

I observed unpleasant symptoms in only three cases, where they
seemed to be at all dependent upon the large doses of quinine.

1. A delicate, nervous female, aged 36, was ordered 5 grains every
hour, for a second attack of quotidian intermittent. When she had
taken 20 grains, she became suddenly nauseated and vomited up
three mouthfuls of scarlet blood. This occurred in the morning, and
the chill was expected late in the afternoon. The medicine was
suspended immediately, and she missed the paroxysm, and recovered
without any other untoward symptom. She was treated with quinine
for the first attack and also for a third, without any such effect being
produced. The hsematemesis was not vicarious of the menstrual
discharge, as the catamenia had not been interrupted.

2. In this case the quinine vomited the patient like full doses of
tartar emetic. She took twenty grains in five grain doses in solu-
tion, combined with spt. eeth. nit. There was no gastric derangement
prior to the exhibition of the medicine.

3. In the third case the patient, a female aged 40, who had but
recently recovered from a very severe attack of lichen agrius, was
rendered deaf, or nearly so, for ten days, by taking forty grains of
quinine in eight hours. The intermittent, a tertian, was perma-
nently cured.

I was never deterred from giving the quinine by the existence of
diarrhcea, irritability of the stomach, or headache, provided the case
was urgent, and it was absolutely necessary to put an immediate
stop to the paroxysm. In cases of great torpor of the bowels, if there
was time to spare, I preferred to begin the treatment by purging
freely, because the quinine is not readily absorbed if there is much
constipation. Usually, however, the safer practice is to put an end
to the paroxysms first, and afterwards attend to the local affections.

I have found great benefit from combining the sulphate of morphia
with quinine, especially in those cases complicated with diarrhoea

244 Curability of Opacities of the Cornea. [April,

and irritable stomach. I also gave in many cases where the skin
was very dry and the thirst urgent, the spt. seth. nit. combined with
a solution of quinine, with great benefit.

My experience in the treatment of miasmatic fever in 1846, leads
me to the following conclusions:

1. In a large majority of cases, no matter of what type the fever
is, the " preparatory treatment," so called, is worse than useless,
causing a loss of time which is often fatal to the patient.

2. A large dose of quinine, (15 or 20 grains,) administered at once,
produces a more certain and permanent curative impression upon the
system, than small doses (1 or 2 grains) frequently repeated.

Quinine in large doses, when administered in the hot stage, so far
from exciting the circulation, acts as a decided sedative upon it the
pulse in every instance lessening in force and frequency under its
influence. The dogma, therefore, that "quinine in fever is poison,"
must be discarded.

4. In uncomplicated miasmatic fever, mercurials are not at all
essential to a complete and permanent cure. They may sometimes
be given with advantage in cases where cathartics are indicated at
the onset of the disease.

Observations on the Curability of Opacities of the Cornea. By
Henry Howard, M. D., M. R. C. S. L., Surgeon of the Montreal
Eye and Ear Institution. (British American Jour, of Med. and
Physical Science.)

It will readily be allowed that our information on the therapeutics
of the eye, is still in its infancy, and consequently that there is wide
scope for investigation under this head. My attention was forcibly
arrested by an article quoted from a Dublin Journal, which appeared
in the June number of the British American Journal of Medical and
Physical Science, headed "Prussic acid in opthalmic diseases."

Opacities of the Cornea and their removal, have engaged my at-
tention for a considerable period ; and I have for some time kept a
record of such cases, with the results, as have been treated by myself.
Dr. Jacob's name must ever secure respectful attention with deference
to any of his promulgated opinions ; yet, if we always deferred to
authority, where would be the boasted progress of the nineteenth
century. Ought we blindly to bow to authority, and not seek to
extend the bounds of knowledge?

Before proceeding further, I would beg to state that 1 highly ap-
preciate the honour and opportunity I enjoyed of acquiring the
opthalmic art under Dr. Jacob s tuition, and that I now feel grateful
to him for the instruction imparted; and although, the statements
which follow directly impugn his assertion, I appeal only to facts, at
the same time sensible that without his previous advances this point

1847.] Curability of Opacities of the Cornea. 245

could not have been attained, viz. : the curability of opacities of the
cornea.

Dr. Jacob, after alluding to the cases of opacity of the cornea,
stated by Dr. Bigger to have been cured by prussic acid vapour, con-
eludes by saying, " That the cures might be only apparent, and might
perhaps with more justice be referred to the natural salutary pro-
cesses of the animal economy, which in the course of time succeed to
the formation of those opacities, whether it be the mere subsidence
of inflammatory action, or the agency of the absorbents ; but for my
part, the conviction on my mind, for many years, has been, (and
nothing that I have heard lately tends to shake it,) that however dense
these opacities become, even were they as white as paper, they will
be obliterated in time, unless the product of destructive ulceration in
the cornea consequent on wounds or ulcers ; unless in fact, they are
actual cicatrices."

Cold comfort this to give to a poor fellow blind of both eyes from
nebulae or leucomata, that if he will only have patience, nature will
cure him before he dies, or perhaps not ; for, says Dr. Jacob, surgery-
can do nothing for him.

Now, from considerable experience, I assert that a majority of cases
of opacity of the cornea are curable or susceptible of great ameliora-
tion, and even in many of those opacities caused by cicatrices, their
extent may be diminished, and vision restored to a greater or less
extent.

If a case of blindness from opacity of the cornea presents itself to
me, of many months or years standing, and that under treatment the
opacities are removed, and sight restored in from four to six weeks,
have I not a right to conclude that the treatment operated the cure,
if not, then no fact in therapeutics is sure : a fortiori, if many such
cases present themselves with similar results, the inference must be
irresistible.

I propose to give two cases severally of albugo, leucoma. and
nebula, their treatment and results. During thirteen months, forty-
eight cases of opacity of the cornea have been treated at the Montreal
Eye and Ear Institution, of which twenty-three were nebulous. Of
these, eighteen were cured and five relieVed : of eighteen with al-
bugo twelve were cured and six relieved : of seven with leucoma
six were relieved, and one abandoned as incurable. In selecting the
following cases, I wish it to be understood that, if desirable, I could
furnish many more.

Case 1. Albugo. Mary Harrigan, act. 30. wife of a labourer,
April, 2, 1846, had had sore eyes for three years; for a year had
merely distinguished the light, and the outline of large dark ol
and had not been able to go alone through the streets. She had an
albugo on the right eye and three on the left, completely obstructing
vision. Perfectly cured in six weeks. Treatment fumigations with
hydrocyanic arid every day for ten minutes; nfter lbs Iff
another ton minutes, put one drop of a solution of nil

246 Curability of Opacities of the Cornea. [April,

x. a gi. into the eyes. For first fortnight took a wine glass full of
the following mixture every morning

ft Infu-si Gentianse, 3 v i i i .
Sulphatis Magnesias, i.
Acid Sulph. Arom., 3ss. m.

Case 2. Albugo. Feb. 8, 1846. Ann G'Berne, aet. 26, a ser-
vant, had been gradually losing the sight pf the left eye for sometime,

but had lost it completely for the last eight months. Dr. -, to

whom she had applied, told her nothing could be done. On exami-
nation, I found an albugo completely obstructing the pupil of the left
eye, in fact, occupying the whole cornea. Cured in two months.
Treatment as in preceding case.

Case 3. Leucom a. Dec. 26, 1846. John Gillaland, set. 23, a
ploughman, had leucoma of both eyes, completely occupying the left
cornea, and preventing all ingress of light. The lower third of the
right cornea was imperfectly clear, allowing of sufficient light to pass
to enable him to guide himself through the street. Sufficiently cured
in three months to guide the plough, a very small spot only remaining
on the right cornea, and that not over the axis of vision ; a small
round spot over the axis of vision on the loft cornea was removed.
Treatment daily fumigation of the eyes with hydrocyahic acid, and
the subsequent application of Janin's opthalmic ointment, and every
ten days the application of the solid nitrate of silver to the cornea.
Internally took gentian and salts.

Case 4. Feb. 11, 1S46. David Wark, set. 14, some time pre-
viously had received a severe blew on the left eye with a stick, which
had ruptured the cornea horizontally, and in healing had left a cica-
trix about three lines broad across the eye ; to the outer side of the
cornea the iris had prolapsed and become attached to the cicatrix.
He saw only the upper and under part of each object. Dismissed in
six weeks with the cicatrix reduced to a mere line, and, by his
description, the vision as good as in the right. Treatment daily
fumigations with vapour of hydrocyanic acid, and a small portion of
the following ointment put into the eyes each day
R Ungt. Opthal. Jan.
-*- Hyd. nit.
Cctacei aa 3i. m.

Case 5. Xebula. June 11, 1348. Robert Hughes, aet. 55, a
veteran, was led to the Institution by his wife; the right eye was
destroyed, and vision in the left was completely prevented by nebula,
both the result of inflammation. He had just arrived from New
York, where he had been under the surgical treatment of the most
eminent practitioners in that city, and hitherto the case had only
gone on from bad to worse. After two months' daily attendance, ha
was discharged with very fair vision, sufficient to enable him to
transact his ordinary business. Before returning to Wales, his native
country, he left a certificate with me (as a voluntary effusion of
gratitude), stating the benefit he had received under my care.

1847.] Bibliographical Notices. 247

The treatment consisted in daily fumigations with hydrocyanic
acid, a drop of 10 grain solution of nitrate of silver, and after insu-
lating him, drawing electric sparks from the eye and surrounding
orbit.

Case 6. Xebula.S. M., ast. 13, called on me, May 2, 1846,
complaining of dimness of vision of right eye, which had existed
since he had had the measles in infancy. Had heen treated unsuc-
cessfully in Xew York by several oculists. The whole cornea was
obscured by nebula ; was perfectly cured in six weeks. Treatment
daily fumigations with hydrocyanic acid, and application of 10 grain
solution of nitrate of silver. During the treatment, he took a con-
siderable amount of the ioduretted solution of the iodide of potassium.
Xotc. Janin's opthalmic ointment is made as follows :
E Bol. Armen.

Tutiee Prep, aa 5ii.
Hyd. Precip. Alb. 3i.
Axungiae, l'\. m.

EIBLIGGRAPHICAL NOTICES.

Materia Medica and Therapeutics, including the Preparations of
the Pharmacopoeias of London, Edinburgh and Dublin, and (of
the United States,) with many new Medicines. By J. Fokbes
Royle, M. D., F. R. S., &c, &c, Prof, of .Materia Medica and
Therapeutics, King's College, London. Edited by Joseph Carsox,
M. D., Prof, of Materia Medica in the Philadelphia College of
Pharmacy, Member of the American Philosophical Society, etc.,
etc., with ninety-eight illustrations. Philadelphia: Lea & Blan-
chard, 1847. l" vol. 8vo. pp. 659.

Prof. Royle stands deservedly high in the medical profession, and
the foregoing work is not calculated in the least to detract from his
reputation. He states that he was induced to undertake the work
from the conviction that " the student of Materia Medica required
something systematic to study, which brought up to the present time,
should be sufficiently full for information, and yet as short and con-
densed as was compatible with the avoidance of being superficial."
The author has successfully performed the task imposed upon him-
self, and has produced a full manual, containing no1 ices of many new
articles, which will prove of great utility particularly to the medical
student. It contains numerous well executed illustrations which add
much to its interest and value. Prof. Carson, the American editor,
has added such matter in connexion with the Pharmacopoeia and
indigenous Materia Medica of the United Stain a* ndaptt the work to
the wants of the American student iwid practitioner.

248 Bibliographical. Quinine on the Spleen. Deglutition. [April,

Life and Trial of Dr. Abner Baker, Jr. (a monomaniac.) who was
executed October 3d, 1 845, for the alledged murder of his brother-
in-law, Daniel Bates, including letters, <?fc. By C. W. Ceozier.
Trial and Evidence by A. R. McKee. Louisville, Ky. : Prentice
& Weissinger, 1846. pp. 152.

We have perused the above pamphlet with considerable interest,
and we fully concur with the medical gentlemen to whom all the tes-
timony was submitted, in the opinion that mental derangement was
as conclusively proven in this as in any case upon record, and that
the execution of Dr. Baker, under all the circumstances, was a judi-
cial murder. What motive could have influenced the Governor of
Kentucky to withhold a pardon from this unfortunate man, when the
testimony, and the opinions of so many eminent physicians and
jurists, pronounced him to be insane, we cannot conceive.

PART III. MONTHLY PERISCOPE.

Action of Sulphate of Quinine on the Spleen. Dr. Pagis, interne
of the hospitals of Paris, having undertaken a series of experiments
for the purpose of ascertaining the application of sulphate of quinine
on the spleen, publishes in the " Gazette des Hopitaux" the results of
his researches.

On a middle-sized dog the spleen was uncovered by two incisions
perpendicular to each other. The transverse diameter of the viscus
measured twenty centimetres, and the longitudinal six. The jugular
vein was opened, and twenty-three grammes of alcoolat of quinine
were injected ; instantaneously the spleen diminished in every direc-
tion, its surface became rough and wrinkled, and its diameters were
reduced to 14 cent, by 5.

On another animal the experiments were repeated, with a view of
comparing the results of several injections: with w<2ter they were
negative, with alcohol the spleen was very slightly corrugated, but
with the solution of quinine the viscus contracted instantaneously in
the most evident manner. [Medical Times. Med. News.

Deglutition excited by dashing Cold Water on the Face. The
following suggestion by Mr. Simpson, of Stamford, founded upon the
invaluable principles of the excito-motory system, is worthy of more
general application in cases in which the power of voluntary deglu-
tition is lost. The suggestion is well illustrated in the subjoined
case.

A poor man, who had attempted suicide, was sinking from the
effects of loss of blood; his pulse was imperceptible, and the action
of the heart could scarcely be felt. It being desirable to administer

1847.] Formation of Fat. Phthisis. Pruritus Aniet Yulvce. 249

stimulants, his mouth was filled with spirits and water, but the patient
was unconscious, and therefore did not swallow. Cold water was
dashed upon his face, for the purpose of making him swallow by ex-
citing reflex action, when the contents of the mouth were instantly
gulped down. London Lancet.

On the Formation of Fat in the Animal Body. The following fact,
related by M. Koss, is valuable, when taken in conjunction with the
recent discussions which have been held in relation to the formation
of fat in the animal economy. A workman was killed on a railroad,
just after partaking of a full meal, consisting entirely of bread and
grapes. His body was subsequently examined. The process of chymi-
fication was found in full activity, and at those portions of the small
intestines which the chyme had reached, the mucous membrane was
found dotted with white points, which, on closer examination, were
seen to depend on the presence of drops of oil in the epithelial cells
surrounding the extremities of the villi. Here is an example of the
abundant formation of fat from substances which, at the most, could
contain but a very small quantity of fatty elements, being composed
almost entirely of gluten, starch and sugar. [Lond. Med. Gaz.,
from Encyclop. des Sc. Med.

Phthisis Cod-liver Oil in. The efficacy of the oil of the cod's
liver in phthisis pulmonalis has recently been attested by several
observers. Dr. Thompson, who is one of the physicians of the Hos-
pital for Consumption and Diseases of the Chest, at Brompton, states
that he has derived more benefit from it than any other medicine
which he has tried. He has exhibited it in thirty. seven cases with
the following results. In three cases it was found necessary to dis-
continue it, in consequence of the nausea which it occasioned; in
twelve there was no perceptible effect ; in ten the increase of strength,
plumpness, and energy were remarkable. When benefit was derived
it was generally to be observed within a fortnight.

Dr. Toogood, of Bridgewater, and M. Delstanche, have likewise
spoken of its value.

Dr. Huss, of Stockholm, speaks favourably of moxas below the
clavicles in the treatment of phthisis. [Ranking's Abst.

Treatment of Pruritus Ani el Vulva. M. Cazenave treats the
above obstinate symptom by one or other of the following lotions :

1. Subcarbonate of potass, ... - 3ij-3iv.
Distilled water, ..... 3XVJ.

2. Sulphuret of potass, .... 3j.
Distilled water, ..... 3X.

3. Cyanide of potassium, .... grs. ix.
Distilled water, 3 v i i j .

4. Bichloride of mercury, .... grs. iij-iv.
Distilled water, 3v''j

[Hanging's Abstract.

250 Ascarides. Ascarides of the Rectum. Hysteria. [April,

Treatment of Ascarides. M. Sehultz employs enemata of infu-
sion of quassia with great success for the expulsion of ascarides
the strength employed is 3j to an ounce. Gaz. des Hop.

Ferri Cyanuretum in the treatment of Ascarides of the Rectum.
A correspondent, who does not wish his name given, he not now be-
ing engaged in the practice of medicine, writes to us to invite the
attention of the medical profession " to the use of the Ferri Cyanure-
tum, or Prussian Blue of commerce, in the treatment of ascarides in
the rectum."

"From present observations," he writes, "lam disposed to believe
that upon a fair trial it will be found more effective in the treatment
of the inveterate cases of the disease, than all other remedies.

" Commence with five grains of the Prussiate rubbed up in two
ounces of rain water or mucilage of gum arabic, (the pure water is
preferable, except in cases where much irritation of the mucous mem-
brane exists ;) throw this into the rectum, and retain it until the
next regular defecation.

*' Repeat this daily, gradually increasing the quantity of the Prus-
siate until perfect and permanent relief is afforded. I believe the
greatest relief will be experienced after using it once or twice."

[American Journ. of Med. Science.

Hysteria. The following conclusions respecting the pathology
and treatment of hysteria appear in a memoir offered by M. Gen-
drin (Archives Gen., Sept. 1846,) to the Academie de Medicine :

1st. Hysteria is not universally characterized by convulsive par-
oxysms: it is a continuous malady, the symptoms of which are always
to be recognized during the interval between the paroxysms, as well
as in the fit.

2d. In all cases of hysteria, without exception, a general or partial
anaesthesia exists. In the slighter degrees, the anaesthesia occupies
only particular parts of the integuments; in the more aggravated
forms the whole integument is implicated, as are also such portions of
the mucous membranes as are amenable to examination.

3d. There is no accordance between the degree of anaesthesia and
the severity of the hysteric paroxysm.

4th. The greater number of patients experience over a limited
part of the body a degree of hyperesthesia which is in many cases
the immediate cause of the fit.

5th. Paralysis is a freqent hysterical symptom, and may be pro-
longed for an indefinite time. This paralysis is the source of many
serious errors in diagnosis.

6th. It is a mistake to consider the sensation of a ball in the throat
as a constant accompaniment of hysteria.

7th. All the marvels related of late days as the production of ani-
mal magnetism are witnessed in spontaneous hysteria: so tho insen-
sibility which will allow a painful operation to be performed may be
seen in hysteria.

1847.] Bright'* Disease. -Diarrhoea. -Bed Sores.-Epitaxis, <%-c. 251

8th. Of all medicinal agents there are none which is so efficacious
as opium in large doses. [Ran king's Abstract,

Tincture of Cantharides in Bright* s Disease. This medicine, in
the dose of from fifteen to twenty drops, "par pot de tisane," com-
bined with the use of decoction of hark and chaiybeates, is the rem-
edy which has given the best results in the treatment of albuminous
nephritis (Bright's Disease.) Many cases have already been cured
by this treatment. [Month. Journ. Med. Science.

Employment of Bismuth in Diarrhcea. M. Raver speaks in praise
of the trisnitrate of bismuth when used in the diarrhoea to which
phthisical patients are so liable, and in that which occurs during the
progress of typhus. This remedy has for many years been employ-
ed, and often with great advantage, in the simple form of diarrhoea
which affects young children. [Gaz. de Hopitaux, from London
Medical Gaz. South. Journ. Med. and Farm.

Bed Sores. To prevent these, Sir. B. C. Brodie recommends a
lotion composed of two grains of bichloride of lime to an ounce of proof
spirit, the parts to be washed two or three times a day, beginning at
an early period ; it acts by generating a thicker cuticle, and may be
employed in other cases where a patient suffers from pressure.

[Banking's Abstract.

Treatment of Epistaxis by Insufflations of Alum. When hemor-
rhage from the nasal cavities assumes a dangerous aspect, recourse
is generally had to plugging, a measure both inconvenient and pain-
ful. M. Lecluyse has successfully employed means far more simple,
and at the same time, according to his own account, more certain
namely, the insufflation, by means of a quill, of equal parts of powder-
ed gum arabic and alum. In one case this succeeded after three-
repetitions; other means, and plugging among them, having entirely
failed. [Gaz. des Hopitaux.

Application of Ether Vapour to the practice of Midwifery. Pro-
fessor Simpson has employed ether vapour in the practice of mid-
wifery, and is the first, we believe, who has made the application of
this agent. The case was perfectly successful, as the following ex-
tract will show:

"A few days ago Professor Simpson stated to his class tfTat he had
practised with entire success the inhalation of sulphuric ether in a
case of the most difficult form of labour, and where otherwise the
sufferings of the patient would undoubtedly have been extreme.
The mother was lame and deformed. At a former accouchment, the
labour lasted three or four days, and, from the necessarily protracted
use of instruments, the patient's agonies were very great. On the
present occasion, Dr. Simpson had previously determined to avoid, if

252 Sulphuric E (her in Surgical Operations. [April,

possible, the use of all instruments, and to attempt to extract the
infant by the feet. He expected to be aided in this by the use of the
ether inhalation. Accordingly, when labour had set in for a few
hours, the patient was put under the influence of ether, and in a few
minutes the child was turned and extricated, while the mother was
altogether unconscious of the operation, and that, too, although the
delivery was rendered excessively difficult, by the degree of compres-
sion to which the child's head required to be subjected. On after-
wards awakening, or passing from her ' etheralised' condition to the
state of common consciousness, one of the first circumstances of which
the patient became aware, was the noise attendant on preparing a
bath to resuscitate the infant. A remarkable circumstance pointed
out in the case by Dr. Simpson was, that whilst breathing the ether,
the labour pains or throes continued, and yet the mother (to speak
paradoxically) felt no pains. We hear she is rapidly recovering.
This is, we believe, the first instance in which this new and extraor-
dinary agent has been employed in the practice of midwifery."

[London Med. Gazette.

MEDICAL INTELLIGENCE.

Inhalation of Sulphuric Ether in Sur.gical Operations. In devoting a consid-
erable portion of this No. of our Journal to this subject, we feel that we are doing
our readers essential service. Having now satisfied ourselves by actual experi-
ment, that very painful operations can be performed while the patient is made
insensible and unconscious by the inhalation of pure Sulphuric Ether, we enter-
tain the opinion that a new era is about to dawn upon Surgery, produced by
this important discovery. While we have been sceptical and are still so, with
respect to the effects of Mesmerism in the alleviation of pain and disease,
and hope ever to continue the uncompromising opponents to all species of
quackery and patented remedial agents, we are free to admit our convictions
concerning the value of this new mode of preparing patients for surgical
operations. It is true, that in its first introduction to the profession, it was at-
tempted to be veiled in mysticism and a patent obtained by a dentist in Boston,
to whom the subject was presented by Dr. Jackson, its discoverer; but now all
secrecy is removed, and no one entertains a doubt as to the identity of the so-
called Letheon, with pure Sulphuric Ether. The only questions now agitating
the. profession are its best mode of preparation ; and secondly, is there any dan-
ger in its general administration 1

We have given Dr. Jackson's mode of preparing the ether he first employed,
and which he recommends, and are happy to be able to add the views of two
distinguished Professors of Chemistry found below, in answer to interrogato-
ries propounded to them. That which we have used in our experiments was
washed in cold water, to remove the sulphuric acid and alcohol contained in
the ether of the shops.

To the second question the danger of its general application to surgical
operations, our limited experience will not warrant a reply. It may be years
before it can be fully and satisfactorily answered. Direct experiment can alone

1847.] Sulphuric Ether in Surgical Operations. 253

decide this question. This much, however, can be said : up to the present time
no very unfavorable effects have been produced in any case certainly none has
proved fatal from the ether. Its extended application to relieve or extinguish
pain in Surgery and Midwifery maybe judged of, by consulting what has been
published already in this No.

Our mode of preparation is water iii., ether iii. to iv., liquid potash 3i.,
well agitated in an eight ounce vial. Administration, two to four drachms
poured on a handkerchief, and inhaled from two to four minutes.

Reply of John Le Conte, M. D.r Professor of Natural Philosophy and Chem-
istry, in Franklin College, University of Georgia.

Athens, March 16th, 1847.

In reply to the questions propounded in your letter of the 13th
instant, in relation to Sulphuric Ether, I must premise, that chemists
are not quite agreed concerning the precise changes and reactions
which take place during the process of etherification. You are aware,
that ether may be prepared by the abstraction from alcohol of one
half of its elemental water. Thus, if potassium be placed in contact
with absolute alcohol, hydrogen gas is evolved, and a compound of
ether and potash crystallizes, C4 II5 0.-|-H. O., and K. giving
O H5 O.-j-K. O. and free H. (Kane.) But it is by the action of
sulphuric acid upon alcohol, that ether is, for practical purposes, al-
ways obtained. It was formerly thought, as first suggested by MM.
Fourcroy and Vauquelin, that the sole principle concerned in the
formation of ether was the attraction of sulphuric acid for water, by
which the alcohol was directly converted into ether. But, from more
accurate researches, it is now obvious, that the process is of a far
more complicated nature. That the sole or efficient cause of the
conversion of alcohol into ether is not the mere abstraction of the
water, by the affinity of the sulphuric acid for that liquid, is proved
by various circumstances, of which the following are some:

1. Water may be abstracted from alcohol by alkalis and chloride
of calcium, yet nothing like ether is the result.

2. Water passes over, during the whole process, along with the
ether, with which the acid ought to combine in preference to dehy-
drating the alcohol.

3. Ether is not produced by the action of anhydrous sulphuric
acid on alcohol.

4. Ether is never produced except bv the aid of heat. (Vide.
Brande's Manual of Chem., p. 1284, 5th Ed., 1841.)

Recent discoveries in organic chemistry have induced Berzelius
to regard ether as the oxide of a compound inflammable body called
ethule or elhyle ; and this opinion has been ably advocated by Liebig.
On this supposition, ethule consists of four eq. of carbon and five eq.
of hydrogen, C4 H5, so that the formula of ether is C4 H5 O. Alco-
hol is regarded as the hydrate of the oxide of ethule. This will be
rendered obvious by throwing the formula) together:

Hydrate of the oxide of ethule; alcohol, C4 H5 O, H O
Oxide of ethale; ether, C> II5 O

Ethule ; a hypothetical compound, C4 II5

254 Sulphuric Ether in Surgical Operations. [April,

On the ethule hypothesis, the following is an explanation of the
changes attending the formation of ether. When sulphuric acid
acts on alcohol, the water of both is disengnged, and the sulphuric
acid and ether unite to form Sulphate of Ether, C4 H5 O-j-Aq.
and S 03-|-Aq., giving C* H5 0-|-S O3 and 2 Aq. The ether ob-
tained by distilling a mixture of oil of vitriol and alcohol results,
therefore, not from the water being seized on by the former, but from
a decomposition of ils compound with sulphuric acid, the sulphate of
ether. If absolute alcohol and strong oil of vitriol be employed in
the preparation of ether, it is found that the distilled product con-
sists of ether and water, forming two distinct layers in virtue of their
different specific gravities, but in quantity identical with those which
constitute alcohol ; 100 parts of the mixed liquids consisting of 19.5
water and -79.5 ether. The oil of vitriol remains in the retort in its
original state of concentration, and hence might be applied to etherifv*
an infinite quantity of absolute alcohol, introduced in a continuous
stream. (Kane.) To explain this very remarkable result, Mitscher-
lich advanced that the action of the sulphuric acid on the alcohol is
merley catalytic ; that it splits it, as it were, into ether and water,
and these pieces not being table to re-unite, come over in vapor,
merely mixed with each other. This idea is, however, quite inad-
missible, as the whole quantity of ether is proved to be united with
the sulphuric acid in the flijst place, and to distil over only after the
decomposition of the compound jLhat had been so formed. The ob-
servations of Liebig and Rose have removed the difficulty, which
this simultaneous evolution of water and ether presented to the
adoption of the theory, which supposes the ether to be expelled from
its combination with the sulphuric acid by the water. In fact, it is
only at a particular temperature that the ether and water come over
in atomic proportions. The production of ether depends, therefore,
upon the facts, that when alcohol and oil of vitriol are mixed, sulphate
of ether is formed and water is set free; but on the application of
heat, this action is inverted, and the ether is expelled from the acid,
with which the water recombincs. If the distillation be conducted
so that the mixture boils, the dilute sulphuric acid concentrates itself,
at the same time, by giving off an atom of water, which condenses
mixed with the ether, but had its origin in a perfectly independent
action. (Kane, Graham, Turner, Fownes, Brande, etc.)

The ether-producing temperature is circumscribed within narrow
limits. Below 260 no ether is produced ; from 260 to 310, ether
passes over; and lastly, when, by the addition of a large quantity of
oil of vitriol, the boiling point of the mixture is made to rise to 320
and above, defiant gas makes its appearance.

The ether formed by the ordinary process is rendered impure by
admixture with alcohol and water, and generally sulphurous acid.
To separate these impurities, the ether should be agitated with a
strong solution of potassa, which neutralizes the acid, while the water
unites with the alcohol. It is then distilled by a very gentle heat,

1647.] Sulphuric Ether in Surgical Operations. 255

and may be rendered still stronger by distillation from chloride of
calcium. Ether is rniscihle with alcohol in every proportion, but is
very sparingly soluble in water ; 10 volumes of water dissolving one
of ether, while 36 volumes of ether dissolve only 1 of water. When
agitated with water, the greater part separates on standing, a small
quantity being retained, which imparts an ethereal odor to the water.
The ether so washed is very free from alcohol, which combines by
preference with the water; but some water still remains dissolved in
the ether, which must be removed by adding some fresh burned lime,
and distilling a second time.

The specific gravity of pure ether has been variously estimated.
According to Loviiz it is 0.700, or 0.632; according to Dumas and
Boullay its sp. gr. at 63 is 0.713 ; according to Gay Lussac's obser-
vations its density is 0.715 at 0S, and 0.724 at 54. The ether of
the shops always contains alcohol; but it is a monstrous error to in-
fer that its exhilerating effecls is due to the presence of alcohol. A
single fact is sufficient to show the absurdity of this idea, viz : that*
the effects are proportionate to the purity of the ether, or to its yVfee-
dom from alcohol. The admixture of the proper quantity of atmos-
pheric air seems to have a considerate influence on its action on
the animal economy. If the air be tlo strongly impregnated with
ether stupefaction ensues. 2^

Answer of Professor A. Means, 2*^^, of ^niory College and the Medical
College of Georgia. ^^W

OxfordIGa., March 16th, 1847.

1st then: " Is there any Alcohol in Ether?"

There is. Almost all the ether found ib the shops has some alco-
hol. The simplest mode to get rid of whllh is to wash the ether by
agitation with twice its bulk of water, liet it stand a little the
alcohol will combine with the water then'pour off the ether which
will have imbibed a little water. To*^at it free from this, add a little
unslacked lime, and re-distill the ether.

2nd. "Does it contain Sulphuric Acid ?"

It contains, before rectification, sulphurous acid ; but the ether of
commerce, has generally, I believe, onjy some alcohol and water.

Here, perhaps, I may remark, that when ether coagulates the serum
of the blood it may be known to contain1 alcohol, as it does not coagu-
late it when pure. **

3rd. " Can the exhilirating effects be'obviated ?"

I know of no means by which this An be entirely effected, nor
from the chemical constitution of the ai^cle and its physiological
action, do I believe it possible to avoid syiie manifestation of an ex-
citant power in some constitutions. But when the alcohol is removed
and a pure ether is employed by inhalation, I am persuaded that the
excitant effect upon the cerebral functions, &c, are extremely tran-
sient, and sometimes not manifested at all, and the narcotic and
depressing consequences, which art; always secondary, when both are

.merer do ce qm

254 Sulphuric Ether in Surgical Operations. [April,

On the ethule hypothesis, the following is an explanation of the
changes attending the formation of ether. When sulphuric acid
acts on alcohol, the water of both is disengnged, and the sulphuric
acid and elher unite to form Sulphate of Ether, C4 H5 O-J-Aq.
and S 03-|-Aq., giving O H5 0-|-S O3 and 2 Aq. The ether ob-
tained by distilling a mixture of oil of vitriol and alcohol results,
therefore, not from the water being seized on by the former, but from
a decomposition of its compound with sulphuric acid, the sulphate of
ether. If absolute alcohol and strong oil of vitriol be employed in
the preparation of ether, it is found that the distilled product con-
sists of ether and water, forming two distinct layers in virtue of their
different specific gravities, but in quantity identical with those which
constitute alcohol ; 100 parts of the mixed liquids consisting of 19.5
water and '79.5 ether. The oil of vitriol remains in the retort in its
original state of concentration, and hence might be applied to etherily
an infinite quantity of absolute alcohol, introduced in a continuous
stream. (Kane.) To explain this very remarkable result, Mitscher-
lich advanced that the action of the sulphuric acid on the alcohol is
merley catalytic; that it splits it, as it were, into ether and water,
and these pieces not being fable to re-unite, come over in vapor,
merely mixed with each other. This idea is, however, quite inad-
missible, as the whole quantity of ether is proved to be united wiih
the sulphuric acid in the fir^t place, and to distil over only after the
decomposition of the compound hat had been so formed. The ob-
servations of Liebig and Rose have removed the difficulty, which
this simultaneous evolution of water and ether presented to the
adoption of the theory, which supposes the ether to be expelled from
its combination with the sulphuric acid by the water. In fact, it is
only at a particular temperature that the ether and water come over
in atomic proportions. The production of ether depends, therefore,
upon the facts, that when alcohol and oil of vitriol are mixed, sulphate
of ether is formed and water is set free; but on the application of
heat, this action is inverted, and the ether is expelled from the acid,
with which the water recombines. If the distillation be conducted
so that the mixture boils, the dilute sulphuric acid concentrates itself,
at the same time, by giving off an atom of water, which condenses
mixed with the ether, but had its origin in a perfectly independent
action. (Kane, Graham, Turner, Fownes, Brande, etc.)

The ether-producing temperature is circumscribed within narrow
limits. Below 260 no ether is produced ; from 260 to 310, ether
passes over; and lastly, when, by the addition of a large quantity of
oil of vitriol, the boiling point of the mixture is made to rise to 320
and above, oleflant gas makes its appearance.

The ether formed by the ordinary process is rendered impure by
admixture with alcohol and water, and generally sulphurous acid.
To separate these impurities, the ether should be agitated with a
strong solution of potassa, which neutralizes the acid, while the water
unites with the alcohol. It is then distilled by a very gentle heat,

1647.] Sulphuric Ether in Surgical Operations. 255

and may be rendered still stronger by distillatiqn from chloride of
calcium. Ether is miscible with alcohol in every proportion, but is
very sparingly soluble in water ; 10 volumes of water dissolving one
of ether, whiio 36 volumes of ether dissolve only 1 of water. When
agitated with water, t he greater part separates on standing, a small
quantity being retained, which imparts an ethereal odor to the water.
The ether so washed is very free from alcohol, which combines by
preference with the water; but some water still remains dissolved in
the ether, which must be removed by adding some fresh burned time,
and distilling a second time.

The specific gravity of pure ether has been variously estimated.
According to Lovitz it is 0.7G0, or 0.632; according to Dumas and
Boullay its sp. gr. at 63 is 0.713 ; according to Gay Lussac's obser-
vations its density is 0.715 at 68 , and 0.724 at 54. The ether of
the shops always contains alcohol ; but it is a monstrous error to in-
fer that its ex h derating effects is due to the presence of alcohol. A
single fact is sufficient to show the absurdity of this idea, viz : that*
the effects are proportionate to the purity of the ether, or to \ts free-
dom from alcohol. The admixture of : the proper quantity of atmos-
pheric air seems to have a considerarA influence on its action on
the animal economy. If the air be Ao strongly impregnated with
ether stupefaction ensues. 2

Answer of Professor A. Means, ^^^, of ^mory College and the Medical
College of Georgia. ^^F

OxfordIg^., March 16th, 1847.

1st then: " Is there any Alcohol in Ether?"

There is. Almost all the ether found to the shops has some alco-
hol. The simplest mode to get rid of whwh is to wash the ether by
agitation with twice its bulk of water, jjet it stand a little the
alcohol will combine with the water then-'pour off the ether which
will have imbibed a little water. Tcfgsi it free from this, add a little
unslacked lime, and re-distill the ether.

2nd. "Does it contain Sulphuric Acid ?"

It contains, before rectification, sulphurous acid ; but the ether of
commerce, has generally, I believe, onjy some alcohol and water.

Here, perhaps, I may remark, that when ether coagulates the serum
of the blood it may be known to contairiaico/io/, as it does not coagu-
late it when pure, **

3rd. " Can the exhilirating effects be'obviated ?"

I know of no means by which this An be entirely effected^ nor
from the chemical constitution of the article and its physiological
action, do I believe it possible to avoid style manifestation of an ex-
citant power in some constitutions. But when the alcohol is removed
and a pure ether is employed by inhalation, I am persuaded that the
excitant effect upon the cerebral functions, &c, are extremely tran-
sient, and sometimes not manifested at all, and the narcotic and
depressing consequences, which are always secondary, when both are

158

Meteorological Observations. Gun Cotton.

present, will speedily supervene. Indeed, from some cases on record,
I should think care and close observation necesssary to prevent (in
some instances) too great depression of the pulse, and too deep and
obstinate stupefaction.

You will allow me to remark, also, that when ether has been kept,
for some time, and especially if frequently opened, it absorbs oxygen
from the atmosphere and forms some acetic acid. This may be
known by its turning litmus paper red on contact.

Ether, too, if pure, will not discolor water when mixed with it ;
old ether will frequently turn it to a feeble milky white hue.

Gun Cotton. We have received the following mode for preparing the Gun
Cotton, from Dr. E. H. Oakman, of Columbia County, Ga.

Take a portion of cotton, as free as possible from trash and other
impurities, immerse it for thirty minutes in equal portions of nitric
and sulph. acids, of the ordinary strength as sold by the apothecary ;
then, wash the cotton in water until no acid test remains, and allow
it to remain a minute or two in a solution of nitrate of potash (20
grs. to an ounce of water.) jgxpress; dry it carefully before a fire,'
and it is readv for use.

METEOROLOGICAL OBSErJ^TIQJnS, for February, 1847, at Augusta,

Ga. Latitude 33

27' north IMnginwJpt0 32' west Wash. Altitude above

tide 152 feet.

T.

a

Sue
Ther.

Rise.

Bar.
29 75-100

2,3

Ther.

5. Mf [

if.
29 #-100

^Kfr Remarks.

~~\

37

07

s. w. i.Fair.

Q

37

" 85-100,

61

" -l00! s. J Cloudy light.

3

58

30

46

" Sl-li#rfc w. Storm" at 7, a.m. rain 30-100.

4

18

29 80-100;

50

"#-100

w. Fair.

5

29

S7-1O0

44

'-100

e. \ Cloudy.

6

" 78-100

54

'TO-100

W.

Cloudy light.

7

43

" 70-100,

52

"161-100

s.

Rain 10-100.

8
9

42
44

" 65-100!
" 66-100]
" 46-100!

62
62

j 50^T>9
fi 56-100

' S. E. .

Fair.

Cloudy.

10

58

59

N. W.

Fair.

11

34

" 89-100!

46

" 92-1 m

N. Vr.

Fair blow.

1-2

27

94-100!

43

V 93- J 00

n. vr.

Fair blow.

13

31

" 95-100

60

"85-100 s. w.

Fair.

H

35

" 00-100,

63

" 92-JM
" 93pW

" ten oo

'mm*

s. W.

Fair smokey.

15

3-2

" 95-100

68

s.

Fair, do.

lii

44

" 96-1(30

70

s.

Fair, do.

17

53

" 94-100,

68

s. vr.

Cloudy.

IS

48

" 88-100,

74

90^

8. w.

Clbm

19

GO

" 93-100

72 i

s. w.

'Cloudy ^rain 10-100.

20

59

" 95-100i

76f

" gjfcoo

s.

Cloud v. [35-100.

sa

59

" 81-100

72

"jgoo

S. W.

Cloudy tliund. & light. rain

22

54

" 57-100

57

"Woo

v.-.

Fair blow.

23

34

" 90-100

55

" iPioo

N. Wj

Fair. *

24

33

30 3-100

56

30

E.

Cloudy.

25

47

29 84-100;

70

29 81-100

s. w.

Fair.

26

46

" 79-100

51

" 69-100,

E.

Rain 1 incfand 10-100.

27

54

* 24-100J

60

" 27-1001

W.

Fair blow.

38

36

" 66-100]

51

" 74-1001

S. W.

-

o,

lantitv of Rain f inch and 96400. Wind EastlBfN. and

'

lavs.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I] NEW SERIES. MY, 1847, [No. .

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XV.

[Note. 'We are compelled to omit the Hebrew and Greek employed in this
Article. We learn that the talented and indefatigable author studied* the former
language for the express purpose of comprehending this very subject The
Medicine of the Bible. Edts.]

Notes on ike Medicine of Moses, By John M. B. Harden, M. D.,

of Liberty County, Georgia.

1. Physicians. The early history of Medicine is necessarily-
involved in much obscurity, and in regard to its doctrines and practice
we shall probably always remain in our present state of ignorance,
inasmuch as no writings expressly upon the subject earlier than those
of Hippocrates have come down to us. Hence, although it is gener-
ally conceded that much is due to the Egyptians for their knowledge
in this as in other Sciences, writers upon this subject following the
example of Celsus and of Pliny, always regard him as the "Princeps
Medicinal" or "Father of Medicine"; and it seems to be the gen-
eral impression, that previously to this time the art of healing was
confined entirely to the Priesthood, and the discovery of remedies
the result of accident or random experiment. This sentiment is
distinctly avowed by Dr. Parr,* and stiil more recently by Broussais,f
who uses the language of LeClerc,J and the former goes on farther
to declare that Hippocrates "seems to have been the first to whom

Medical Die. Art. Med. tExamen. des doc. Med. tome premier.

: The opinion of LeClerc upon this subject, may be gathered from the follow-
ing passage : " Si Hippocrate n' a pas tout-a-fait passe pour le premier inventcur
de la Medicine, il a, pour le moins, eu, de l'aveu de loute l'antiquete, la gloire
d'etre le jpremicr, apr6s Esculape & ses fils qui l'ait relablie; ce quiestlameme
chose que si Ton disoit quil-l'a in ventre, rommc on le pcut inferer do ce qui 1'

17

258 Note* on the Medicine of Moses. [May*

the appellation of Physician in its modern acceptation is due."*
Now, we may differ in the use of this term, and if by Physician be
meant a true medical philosopher, we cannot question the correctness
of the remark, although by it many shall be proscribed in our own
day who lay claim to the appellation, but if it mean, as we are dis-
posed to think is its most usual signification, a healer or curer of
Diseases, by profession, there can be no doubt to the reader of the
Pentateuch, that such a class of men has existed in the earliest
times of which we have any knowledge.

My reasons for this belief, are briefly these :

First, That the original word, translated Physician, can mean
nothing else than a healer of Diseases ;

Secondly, That they are referred to as distinct from the Priests,
whose office generally was of a very distinct character; and

Thirdly, That as in all subsequent periods, they were remunerated
for services rendered in cases of sickness.

1. The word Physician, occurs for the first time in Genesis, c. 50,
v. 2, where it is said that Joseph "sent for his servants the Physicians
to embalm his father." From the fact that nothing is said of their
having attended him during his sickness, it is inferred that their sole
occupation was the embalming of the Dead for burial, and hence the
Septuagint, which is certainly high authority in the interpretation of
the Hebrew Scriptures, has rendered the word by entaphiaslai, liter-
ally these who intomb, or prepare the body for being intombed ; but
the original word (rapha), from which is derived (rophim), translated
Physicians, has no such signification. The leading idea conveyed
by the word is that of healing or restoring to health, and the literal
translation would be healehs or curers, and this is indeed the ren-
dering given to the same word by the Septuagint, in 2d Chronicles,
c. xvi. v. 12, where the word iairos, is very properly used as ex-
pressive of its meaning. It cannot, however, be denied, that at this
time, as for a long time subsequently, an important part of their
business was to embalm the dead. But this process was expressed

cte dit ce devant." Histoire de la Medecine prem. part, page 113. The author,
however, cites many examples of the practice of the art long before the time of
Hippocrates Vide the work above referred to passim.

Hippocrates himself was disposed to concede more than this to his predeces-
sors In his book on ancient medicine, he says: We ought not to suppose that
the healing art did not exist in former times, nor ought we to think, because \vc
do not everywhere meet with the requisite accuracy, that its laws were investi-
gated without skill. On the contrary, we have reason to be astonished* at the

1847.]

by a \ t ) and it is to be presumed

;his had been the sole occupation of Physicians, some deriva-
tion from the I to designate them.

2. It is to which
the IJ Egypt, they were denied i ilege, in a
preat degree, at iog the *Arts and Science* cultivated

r them, and hid of these subjects

her with the aid of inspi-
ration, led in all the wisdom of the Egypt-
It is not to be v at, therefore, that in the passage
througl he treatment c( diseases should have been
:ed to the Priests under the direct superintendance
ses, who laid down certain rules and regulations by which they
were to however, after the possession of
the Promi* again referred to as a distinct

. xv:. 12, thai in the sickness of
Asah, "he sought not u Lord, but unto the Physicians,''

where the word (. ised.

3, 1 ofPhjsici rendered is cer-

ctorj proof oftl ing pursued the practice as a

ioa rem one rated may be clear-
ly de,: le to it in the following enactment
of the Levities] Law. M [fmea strive together, and one smite ano-
ther with a stone or with his list, and lie die not, but keepeth his bed,
if he r. id upon hii staff, then shall he that

ths loss of time and shall
\lmtobe xxi. 19). ThsSeptua-

without doubt,
original.
We have the quali-

when Moses wrote. It

ncision implies somo

o{ burs told that Zipporah per-

i operation arp stone, (Exod. i?. 25.)

we are induced to believe fhat it was regarded then as now, to be a

ration, and on could be performed by the most

important discoveries I times

- the result of
iiion.
of their h I way other than;

Lrts I . Lie. 14 \ t Jshn's \

2G0 Notes on the Medicine of Moses. [May,

unskillful.* The elaborate trea ise upon the Leprosy in the 13th of
Leviticus, gives evidence of much accurate knowledge of Cutaneous
Diseases, and the ability to recognize hi diagnostic signs of these
affections must have required a considerable degree of study and
close observation.

The process of embalming the dead, which we have said was an
important part of the business of Physicians in those days, was so
simple that it could not have required any great extent of learnings
and it Was most probably an hereditary art, descending from father
to son.

'\ Herodotus describes three methods of embalming among the
Egyptians, differing chiefly in the amount of care bestowed and the
value of the materials used. In the first they removed the Brain
through the nostrils by means of a curved metalic instrument^ and
filled the cavity with various medicaments. They next used a
sharp iEthiopean stone in making an opening into the abdomen,
through which they drew out the bowels; they then washed the
cavity with Palm wine, and filled it with bruised Myrrh and Cassia,
and other aromatics, after which they sewed up the opening. The
body was then kept salted with Nitre during seventy days, at the
end of which time it was well washed and enveloped in Linen which
was smeared over with a kind of Gum.

In the second, they used an injection prepared from the aromatic
oil of a species of Cedar, which was thrown into the bowels by the
rectum. The body was then kept in common salt for the same
number of day?, (seventy,) after which they removed the injection,
which is said to have had the strange property of bringing away with
it the contents of the abdomen destroyed by its action.

In the last, and most simple way, they cleansed the Bowels by ob-
lations, and kept the body well salted for the space of seventy days.J

* The Practice of Surgery is distinctly alluded to by the Prophet Ezechiel in
the following passage " Son of Man I have broken the arm of Pharoah, King
of Egypt ; lo, it shall not be bound up to be healed, to put a roller to bind it, to
make it strong to hold the sword." xxx. 21. See also xxxiv. 4, 16.

f Euterpe, 8G, 87, 88.

J The JEthiopeans had a much more elegant method of treating their dead.
After all the moisture is exhausted from the body, by the Egyptian or some
other process, they cover it totally with a kind of plaster, which they adorn with
various colors, and make it exhibit as near a resemblance as possible to the
person of the deceased. They then inclose it in a hollow pillar of crystal, wh ich
is dug in great abundance and of a kind that is easily worked. The deceased

1847.] Notes on the Medicine of Moses. 261

These, or some one of them, were probably the methods employ-
ed in the time of Moses, and although rude and unscientific in
appearance, answered well the purposes for which they were intend-
ed. Bodies treated in this way have been preserved for many cen-
turies without having-undergone decomposition.*

Leaving for a while the writings of Moses, we may be able to
form some estimate of the state of Medical Science at this time, by
considering the progress which it must have made some centuries
after. About five hundred years before Christ the Egyptians were
considered to be the most renowned Physicians in the world, and if
a division of labor in any Art or Science may be taken as evidence
of the degree of perfection to which it has attained, they were right-
ly entitled to this distinction ; for we are informed by Herodotus that
there was a Physician for every disease to which they were subject. f

In the luxation of the foot of King Darius, occasioned by a fall
from his horse, he sent immediately for the Egyptian Physicians,
and although the cure of the King was attributed by the Greek His-
torian to his countryman, Democedes, there can be no doubt that it

is very conspicuous through the crystal, has no disagreeable smell, nor any
thing else that is offensive. The nearest relations keep this pillar, enclosing
the deceased, for a twelve-month in their houses, offering before it different
kinds of victims, and the first fruits of their lands. These are afterwards re-
moved and set up round the city. Herodotus Thalia. 24.

Ctesias of Cnidus considers the account of Herodotus as incorrect. His own
statement is as follows:

They first embalm the body, but do not, immediately after that, inclose it in
the transparent substance (crystal) mentioned by Herodotus;- for since this can
be done only whilst the substance is in a state of fusion, the action of the h*at
would destroy the body, so that nothing would remain of its original appear-
ance. They therefore make a hollow statue of gold, into which they place the
body, and then pour the transparent substance round it. The golden statue,
therefore, which bears a near resemblance to the deceased, and not the body
itself, is seen through the crystal. The rich only are disposed of in this way ;
those that do not leave great treasures obtain silver statues, and the poor, statues
of clay. DiodoriLS Bibl. Hist. lib. 2.

* The valuable collection of the crania of Egyptian mummies from the Cata-
combs of Thebes, now in the possession of Dr. Morton, at the Hall of the
Academy of Natural Sciences, Philadelphia, confirms in a remarkable manner
the account given by Herodotus. Two of these crania present the appearance
of having been gilded over, and no doubt belonged to persons of high rank. They
must be 3000 years old, and are yet in a good state of preservation.

t Every physician attends to one disease only, and not to any more.

EuUrpel 81.

263 Notes on the Medicine of Moses. [May,

had been reduced before he was called in, for Demoeede did nothing
more than use soothing applications to the part for the violent pain
which the King suffered. That Demoeede was a good Physician,
however, is shewn in the skill which he afterwards displayed in the
treatment and cure of an ulcer of the mamma,- under which Atossa,
Darius's wife, labored, and which seems to have been of a malignant
character.

II. Apothecaries. Pharmacy, or the art of preparing and com-
pounding drugs or medicines, was evidently practised in the time of
Moses, and under the phrase " Art of the Apothecary." Maaseh
rokeahh* is referred to by him as a thing well understood long be-
fore. The art at this time was confined mostly, perhap?, to the
preparation of -[ointments and perfumes for religious as well as medi-
cal purposes. The " anointing oil" and the '"pure incense" were
commanded to be made according to the formulee of this art. The
word rokeahh is derived from the root rakahh, which Mr. Parkhurst
says means in Kal, to Compound, and is rendered in the Vulgate, by
the Latin, Cornponere. It means also to spice or season, and the
marginal readings renders it by the word "Perfumer," and in 1st
Samuel, viii. 13., by "Confectioner."

Among the articles of their Materia Medica, or more properly,
Pharmacopoeia, may be included their "Spicery" or Perfumes,
necoih, called also bosem and sammim, and their healing Medicines*
rephuoth, which seem to have consisted for the most part of external
applications.

We will briefly enumerate the most conspicuous of these articles,
premising that we by no means intend to signify that they all were
considered medicinal, or used as medicines.

* Literally " work oft/ie ApotJiecary"

t Pliny (Natural History 13. 1.) seems to say that ointments were never used
until after the time of Troy, and gives the credit of first preparing them to the
Persians. He says that the first notice of them that he had seen was an account
of a box of ointment found by Alexander in the Camp of Darius after his defeat
among the other articles of the King's baggage. Herodotus, who is the oldest
Greek Historian whose writings have come down to us, and who has been
styled' the "father of History," mentions an oil (Euterpe, 95) called "Kiki,"
with which the Egyptians anointed the body, and tells us that the Scythean wo-
men made use of an ointment prepared by bruising under a stone the wood of
the Cypress, Cedar, and frankincense and pouring water upon it until it became
of a certain consistency. (Melpomene, 75.) It is very evident too, that a com-
pound ointment is referred to in many places in the Old Testament, as used
among the Jews.

1 847.] Notes on the Medicine of Moses. '2&8

Shemcn zaeih, Oleum olivarum, Oil of olives.

At the head of the catalogue may be reckoned the olive oil, so
generally and so variously used from the remotest antiquity. Be-
sides being used by the Hebrews for domestic purposes in the stead
of Butter, and for the burning of Lamps, dec, it entered into and
formed indeed the chief Ingredient in all their ointments and per-
fumes. There can be no doubt that the tree from which it was
obtained is the same as that from which we now derive it, the Olea
Europea of Botanical writers.

Tseri, Balsamum, Balsam or Balm.

This is generally supposed to be the opobalsamum of Pliny, which
is the Resin exuding from the tree by incisions made in the Bark.
The small twigs which were sometimes used instead of the Resin, in
the preparation of ointments, were called by him Xylobalsamum.

The tree from which it was obtained was supposed by Linneus to
be the Amy ris, to which he gave the trivial name of Gileadensis.

*Pliny describes it as being in habit more like the Vine, and hav-
ing leaves like the Rue. He mentions three species, the Eutheriston,
Trachq, and Eumices. It was an article of commerce with tha
Gileadites, who exported it in quantities into Egypt. (Gen. 37. 25.)

Mor, Myrrha, Myrrh.

The Myrrh of the ancients was probably the Myrrh of the
present day, with which we are well acquainted, but the tree which
yields the drug is not known. It has been variously attributed to
a species ofAcacia, A my ris, and Scandix. It is described by the
fRoman Naturalist, as growing to the height of 7 to 10 feet, hav-
ing a harsh, crooked and thorny trunk, larger near the root than
higher up.

The Nataph, or Stactc of the Greeks and Romans, is only a purer
variety of Myrrh. It was that Gum which exuded spontaneously
from the Myrrh tree, and was considered highly valuable. Sudant
autem sponte prius quam incidatur stacten leesam, cui nulla pracfer-
tur."i

Lebonah, or Thus, Frankincense.

This is the Olibanum of the Shops, still used by the Greek and
Roman Churches in the burning of incense. It must not be con-
founded with the common Frankincense or Thus of the London

Hist, Nat. ia 64. + Op. cit. 12. 34.

; Pliny. Dioscorudes regarded il to be a cei tain oil expressed from Myrrh
macerated in water. [Some suppose ii to he oil of cinnamon.

264 Notes on the Medicine of Moses. [May,

Pharmacopoeia, more generally known as Burgundy Pitch, which is
obtained from the Pinus Abies.

There is a contrariety of opinion in regard to the tree yielding this
article. Linneus supposed it to be the Mimosa Nilotica, the same
tree which produces Gum Arabic. Others suppose it to be the Juni-
perus Lycia. Dr. Parr considers it most probable that it is the
Amyris Kataf of Willdenow.

Herodotus mentions the tree or trees as growing abundantly in
Arabia, and says that they are usually so infested with serpents that
the Arabs, in order to collect the Frankincense, are obliged first to
drive them away by burning under them the wood of a species of
Styrax, the smoke of which they cannot endure.*

Lot, or Ladanum or Labdanum.

This word, used only in Genesis xxxvii. 25 and xliii. 11, is ren-
dered in the Septuagint, by the Greek, eidktc, and Myrrh in the
present authorized English version. The Syriac and Chaldaic ver-
sions interpret it Pistachio Nuts, the Arabic Chestnuts. f Mr. Park-
hurst says "that the most probable interpretation of the word seems
to be that of Junius and De Dieu, who take it to mean Ladanum or
Labdanum, which is a Balsam or Gum oozing from the leaves of the
Cistus tree, which is common in Cyprus and some parts of Arabia/'

I was for a time under the impression, from the obvious analogy
in the orthography, that it might mean some variety of the Lotus
plant, and the impression was strengthened by the fact that the name
of this plant is of Egyptian origin. J But inasmuch as the Lotus
afforded a very substantia! kind of bread upon which a whole nation
(the Lotophagi) is said to have subsisted, it is not probable that Jacob
should ha /e had enough of it to make a present of it to the Governor
of Egypt, while at the same time his family was so pressed with the
famine as to make it necessary to send under any sacrifice to buy
food, that "they might live and not die." The habital of the plant
also seems to militate against such a conclusion.

The more probable inference, therefore, would appear to be that
since the Hebrew Letters, Tail and Dawleth, are in many instances
convertible ; the Greek is derived immediately from Lot quasi Lod
or Led, and that it is the same as Ladanum, a name applied by the
Arabs to a fragment substance which was found upon the beard of

* Thalia, 107. t Vide. Gesenius tie verbo.

; There grows in the water an immense quantity of plants of the lily species,
which the Egyptians call the lotus. (Herod. Evter. 92 )

1847. J Notes on the Medicine of Moses. 99

Goats, collected there as is supposed whilst eating the leaves of the
Cistus Ladaniferous.*

Skelbenah or Chzlbenah, Galbanum.

This is considered to be the gummy resinous substance, derived
from the Bubon Galbanum. The plant grows in Syria, and some
parts of Africa. It is an umbelliferous plant allied to the Ferula,
from which plant Pliny Bays it was extracted. It is a medicine of
some considerable powers, being allied in its properties to its cognate
Gum Asafcetida.

Kinnamon, Cinnamomum, Cinnamon.

This Aromatic was probably the same as that now used by us and
obtained, as is well known from the Laurus Cinnamomum of Linneus.
-{Herodotus says the Arabs did not know any thing about the tree
which yielded it, and tells the following strange story about the man-
ncr in which they collected it. It was said to be one of the chief
ingredients in the nests of a certain large bird which were built in
places inaccessible to man. In order to get the nests, therefore, tho
birds were fed with dead asses and cows, the flesh of which they
would carry up in such large quantities as by its weight to cause the
nests to fall.
Kidah, Cassia.

There is some doubt about the plant designated by this name. It
is supposed to be the same called in Psalm xlv. 9, Ketsioih, from
Kaisa, whence the Greek and Latin Cassia. The Septuagint has
it iris, and it would seem correctly if Herodotus may be believed,
who speaks of it as an equator plant. (It grows in shallow, stagnant
water.) Pliny, however, doubts all that Herodotus says upon the
subject, and describes it as grow b the Cinnamon, and even

upon mountains ; and following him it is generally believed to be the
Laurus Cassia of Linneus.

Kenebosem, Calamus odoratus, sweet scented Calamus.
The Hebrew root from whence the name of this plant is derived
signifies to hold, contain, and, as Mr. Parkhurst observes, it is proba-
ble that the Greek, Kenos, and perhaps the Eng., Cane, may be
derived from it. It was no doubt applied to a plant wilh a hollow
stem. The plant designated by it is most probably the Asiatic Cala-
mus Aromaticus, and not the Calamus Aromaticus of the shops,

Vide. Herod. Thai. 112. Our object in the notice we have given above of
this plant, is tashew the distinction between it and Myrrh,
t Thalia, iii.

200 Notes on the Medicine of Moses. [May,

which is the Acorns Calamus of Linneus. " The names of Calamus
Aromaticus and the Acorus differ: the first is a stalk of an Eastern
reed which is slender, hollow, white and of a fragrant smell. It is
also called Calamus Odoratus and Arundo Syriaca, but is only pro-
bably a variety of the Acorus."*

AhaUm, Aloes.

This word is only used once in the Pentateuch that I am aware of,
and then it is spoken of in such a manner as to leave no room to
conjecture what kind of a plant it was; but in Proverbs vii. 10,
where it is again used, we learn that it must have been a fragrant
aromatic plant, and although translated, in our Bible, Aloes, does not
mean the substance so called at the present day. It is supposed to
be* " the wood of a tree growing in the East Indies, with red fruit
resembling pepper corns, called by Linneus Excecaria Agallocho."
It seems to have been used entirely as a Perfume. f

Erez, Cedrus, Cedar.

The term Cedar has been indifferently applied to many species of
the Natural Order of the Coniferte, and as originally used may have
embraced them all. From the allusion made to it in 1st Kings, it
appears that the Cedar of Lebanon was the most noble and majestic
of all the trees of the East. It is supposed to be the Pinus Cedrus
of Linneus. The Cedar was used in Architecture,^: in embalming
the dead, and in Medicine. || In Leviticus it is spoken of as having
been used for the cleansing of the Leper, but how far this, together
with the blood of a bird, the Scarlet wool and the Hyssop, was re-
garded as medicinal, or merely typical, it is difficult to determine.
It is certain that the Leprosy was considered as healed before it was
used, but still its detersive cleansing qualities are implied in the fact
that it was considered as emblematic of the cleansing of the Leper
from a disease which was then considered as incurable.

Ezob, Hyssopos, Hyssop.

The Greek, Latin and English terms above given, seem evidently
derived directly from the Hebrew, but it is evident that our word is
applied to a plant which was not designated by the original. It is
spoken of in 1st Kings, in contrast with the Cedar of Lebanon, which

* Dr. Parr, de verba.

t Our object in noticing this plant is simply to shew that it does not mean the
Aloes used by us.

; I. Kings, c. vi. Herodotus. ' I! Lev. xlv. 4. Pliny Celsus.

1S47.] Notes on the Medicine of Moses. 26

would imply that'll was regarded then as the humblest of all plants. *
It is said to have grown out of the wall, and in ail probability it was
a plant belonging to the Cryptogam's and of the Natural Family of
the Fiiiees or Musci of Lbineus. Those who regard it as being the
' Wall Polypody" seem to me to be near the truth. This plant we
have already snid was used in the cleansing of the Leper. From its
cleansing purifying qualities arose, no doubt, the ejaculation of the
Psalmist, "Purge me with Hyssop and I shrill be clean," (Pa. li. 7.),
but, as in the case of the Cedar wood, we have no means of ascer-
taining how far it was regarded as medicinal in the cleansing or
healing of the Leprosy.
Tenah, Ficus, Fig-treo.

The fig-tree, although chiefly celebrated for its delicious fruit, was
nevertheless used in Medicine, and it is one among the few remedies
whose mode of application, as well as the disease to which it was ap-
plied, is clearly told. It was the application of a lump of figs to the
bile of Hezekiab, (Shehkm,) by the advice of Isaiah, that cured him
of his malady. The fig forms a very important article in the Materia
Medica of Census, and it is curious to remark that he recommends
its use in a disease probably of a similar character, viz., a kind of
ulcer, "quod a favi similitudine kerion a Graecis ncminatur."

_r the name of Fig, various species of the Genus Ficus of Lin -
neus are included: some with nd others non-edible fruit.

The former seems to bate

-lihelelh, (Sept.), Onyc

a is the only substance used in th ion cf the fumes or

ointments which was obtained from the animal kingdom, if indeed it
be so, and it seems to be the general impression of those who have
examined the subject so far as I can ascertain. The particular ani-
mal or animals are net known, but it is believed to have been shells
of various species of the Testacece, which, when burnt, yielded a
fragrant odor. I have not been abl few helps that I have,

to satisfy myself upon the subject. f

* Le Clerc supposes it to have been a small tree, from the fact that it is men-
tioned among the trees of which Solomon wrote, but it is evident that this expres-
sion is general, including both trees and plants of cv

t There are several other words used in the Pentateuch, representing sub-
stances probably of highly active medicinal properties, but they are used in
such a general and figurative sense tfiat we shall only refer to them. Thus the
word Rash, translated in the Septaagint by Gall, or Venom, wns used pr

268 Notes en the Medicine of Moses. [May,

The most celebrated of all the above articles in a medicinal point
of view seems to have been, from the frequent references made to it
in the Sacred volume, the Balm or Balsam of Gilead. The follow-
ing passage, among many others of a like kind substantiating my
remark, will occur to the reader: " Is there no Balm in Gilead ; is
there no physician there ? why then is the health of the daughter of
my people not recovered?" (Jeremiah viii. 22.)

III. Midwives. From allusions made to it in the Pentateuch, we
may reasonably infer that the Practice of Midwifery was pursued as
a distinct profession, long before the time of Moses. The first men-
tion that we have of Midwives is made in Genesis xxxv. 17, where
we are told that Rachael, in her journey from Bethel to Ephrath,
was taken in labor with her last child, Benjamin, during which she
died. The names of two Egyptian Midwives are given in the first
chapter of the Book of Exodus.

The origin of their appellation, and the notice taken of them in
these places, sufficiently explain the nature of their occupation. The
word Meyalledeth, translated Midwives, is a participle, used as a
noun, from the word Yaledh, to bring forth, and in Piel, from which
form the participle is borrowed, has the force of helping to bring
forth ; so that this noun really, literally signifies helpers or assist-
ants in parturition, a word far more expressive than that used in
our own language. The word being in the feminine gender, we
may presume that it was a business practised only by the female sex,
although this is by no means certain.

What may have been the amount of information possessed upon the
subject must remain a matter of conjecture. The fact that the
Egyptian Midwives were recognized by the King, is sufficient evi-
dence, I think, that they must have been legally qualified and that
they had gone through some probationary course preparatory to

for Foison of any kind. So also the words Laenah and Merorim, Wormwood
and Bitter Kerbs, are so general in their signification that it is impossible to
know, with any degree of probability, what kinds were intended. They seem
only clearly to mean herbs or plants that were disagreeable to the taste, or bitter,
and even poisonous; for Bitterness and Poison were intimately associated in the
minds of the Hebrews. The bitter' water (Me ha marim) used in the trial of
jealousy, was prepared by mixing the dust of the floor of the tabernacle in holy
water. When it took effect it seems to have caused abortion and barrenness.
(Num. v. 28.) May not the properties of this water have been due to the fun.
gues growing on the floor, and mixed with the dust of the tabernacle !

1848. J Notes on the Medicine of Moses. 269

- '

entering upon the Practice of the Profession. The prognosis of the
one who attended upon Rachael "Thou shalt have this also," although
it was evidently a case of great difficulty and danger, shews that
she must have understood the mechanism of the Labor.

It has been and still is a matter of doubt among commentators,
what is the true signification of the word Abhnayim. translated
"stools." Two opinions are entertained in regard to it, one that it
intends a stone bathing trough, in which the mother and infant were
washed soon after delivery : the other that it was a stone seat for the
parturient woman, "Sella mulieris parturientis."

It is evident, from the signification of the original word, that the
utensil was made of stone. In Exodus vii. 19, it means vessels made
of stone for holding water. In Jeremiah xviii. 3, it is called a Pot-
ter's wheel, which Dr. Clarke says is even now made of stones. It
is also evident from the force of the particle al, in the sentence where
it is used, that the woman must have been placed upon and not by it,
as Mr. Parkhurst supposes; for although it may have such a signifi-
cation, it is by no means the most usual one. We think, therefore,
that there can be no impropriety in supposing that it was a stone
vessel made on purpose for such occasions, on which the parturient
female sat during at least the first stage of Labor, and into which the
Liquor Amnii was received. I have found that the sitting posture is
the one most readily chosen by parturient women, and indeed it is
not an easy matter to get them to assume any other, except in cases
where manual interference becomes necessary. Some I know have
had Chairs made for the purpose, with perforated seats. I recollect
the first case to which I was called in my practice: I found the pa-
tient (a negro) seated on the front edge of a chair, with her hands
suspended above; a midwife under her, and waiting to receive the
infant, whilst the patient was yeliing at a most furious rate. I did
nothing, and in a short time afterwards she was safely delivered.
In consequence of this mode of conducting a labor, the frequent
lacerations of the perineum which occur among us may in great
part be due.

The expression, therefore, seems to be equivalent to our *' brought
to bed," or the French "accoucher." I must, however, agree with
Gesenius in the remark that "a greater knowledge of ancient
manners and customs is necessary to determine the true meaning of
this word1'' as used in this connexion.

270 Cases cured by Blistering the Spine. [-May,

ARTICLE XVI.

Cases Cured by Blistering the Spine. By Jen?; Davis, M. D., of
Abbeville C. H., South Carolina.

Since reading the excellent articles of Professor Ford, of the
Medical College of Georgia, on Intermittent and Remittent fevers,
their pathology and treatment, whose opinions on these subjects are
peculiarly entitled to a favorable reception by the profession, I have
thought a few cases which occurred in my practice, (which I have
not hitherto designed for publication) might not be altogether un-
interesting to the readers of this Journal.

I shall confine my remarks to a simple, unvarnished statement of
the facts of each case, and leave the reader to draw his conclusions
Cot himself. It may not be amiss, however, to observe here, that
those who have paid particular attention to the nervous system, in
the treatment ef our autumnal fevers, and in fact a host of other
diseases, are alone capable of appreciating the importance that is
now being attached to this subject, by a respectable portion of the
profession, and which is destined, at no great period, to effect an
entire revolution in the principles of their cure.

Case 1st. Mrs. C. applied to me (April 5th, 1S4I.) for advice i:i
the case of her daughter, aged 20 years : says she has not been regu-
lar in her monthly sickness for four years; sometimes more than
natural is discharged, then again scarcely any appearance at all, and
again an entire suppression for eight or twelve weeks; bowels cos-
tive ; appetite bad ; pain in the right shoulder and side ; shortness of
breath on the least exercise; pain, and at times swimming in the
head; has been subject to attacks of the third day chills more or less
frequently for the last three years, both winter and summer; occa-
sional fevers, attended with a burning in the soles of the feel and
palms of the hands ; dry, bilious tinge of the bkin ; sick stomach;
urine scanty and high colored ; pain in the small of the back and
hips ; very much troubled with keen pains about the chest, attended
with twitching of the muscles of the breast. I am informed that (he
cause of her general bad health cannot be easily accounted for, un-
less it be an imperfect recovery from a severe attack of, what the
medical gentleman who attended her called, * congestive fever,"
previous to which she had enjoyed remarkably good health.

Having, but a short time previous to this, returned from the North,

1W7.] Cast* cured by Blistering the Spine.

where I had received a thorough drilling on spinal irritation, by Prof.
Revere, then, of the Jefferson Medical College of Philadelphia, and the
patient having exhausted the entire catalogue of remedies usually
prescribed for "liver complaint," &c. le or no benefit, my

attention was directed to the . \e. C.i examination it was found
very tender at different points, but more particularly at the two first
dorsal and first lumbar vertebras. The slightest pressure on the
lumbar vertebras gave the most excruciating pain. Prescribed a pill
composed of equal portions of rhubarb and aloes, to be taken at
bed-time, as circumstances might require. Applied a blister three
inches broad, extending from the nape of the neck down the side
of the spine to the sacrum, to remain till it draws well, then to be
dressed in the usual way.

This prescription was made on the 2* ~rne month, and on

the second of May, (just five days) there was a decidedly favorable
change, in all the symptom". The blister was now applied to the
other sice of the spine, an -Sed frm cne s^e to the

other, till its (\flh application, when the lady declared she felt so well
that she did not think it necessary to c;aw another, at least for a day
or two. It will be recollected that there was a blister, running on
one or the other side of the spine, for a little over six weeks, when
the case was discharged cured . as quite weak, for \

I prescribed the tr. of iron. She has ever since enjoyed the most
uninterrupted heall

In about two or three months after I pronounced this case well, I
requested an examination of the spine, which I made, very minutely,
but could net discover the slightest tenderness. It may be proper
also to state that tins lady had taken medicine, from various physi-
cians, during a great part of her bad health, for "liver complaint,"
unci various other "complaints," with no perceivable benefit.

Casi: "2. VY. R , sent for me, on the 8th Sept., 13411 found

him laboring under the following symptoms: great oppression at the
stomach; difficulty of breathing ; great thirst ; dry, hot skin; yel-
low, bilious tinge of the eves; pulse quick and tense ; pain in the
head ; furred tongue, ecc. Had a chill about three hours ago, and
says it was the severest one he has had in his life. However, he got
better in some three hours, and gave me the following history of his
case : About one year ago he had a chill the first one he ever had
that he sent for a physician, who gave him quinine freely for three
days; when he missed the chill, and got up, but by no means felt

272 Cases cured by Blistering the Spine. [May,

well in about two months afterwards took another chill, which was
also checked by the quinine; but about the middle of December
following, he took the " third day chill," and it lingered about him,
occasionally, till about one month ago, but did not confine him to
bed, yet he was unable to take much exercise, owing to a fulness
about the chest, and a shortness of breath : says his bowels during
the whole time have not been costive, but, at times, rather the reverse.
Ordered, five Cook's pills, and went to bed, In the morning I ex-
amined the spine, and found the second dorsal vertebra quite tender,
or in other words, he said when I pressed on it, it excited rather an
agreeable sensation than otherwise. He also complained of weak-
ness of the whole back, with an occasional soreness when he bent it,
or moved suddenly.

This patient having a great aversion to quinine, from the large
quantity he had taken during the last year, and believing as I did,
that the blistering would "break the chill," I resoived on its imme-
diate application, and accordingly it was applied as in case 1st. The
pills operated quite gently, and I ordered nothing farther to be taken
that day. The next day, being the one in order for the chill, I pro-
mised to return and do all I could to prevent it.

10th. Blister lias drawn well; patient feels much belter; at
breakfast took a little milk and mush ; at 2 o'clock, P. M., the time
for the chill, there was discovered slight febrile action : no chill.

11. Patient feels quite smart ; difficulty and oppression much re-
lieved ; appetite much improved ; skin cool and soft.

12th. Has had no chill to-day, nor fever ; much relieved, and now
says he feels, for the first time in six months, that he will get well.
I now dieted him, and prescribed the application of the blister to the
other side, so soon as the first began to dry ; but it was not attended
to, as he had improved so rapidly and found he could do without it.
The chills did not return in this case; and in three months from the
time I first saw him, he enjoyed as good health as he ever did.

Case 3rd. Sept. 28th, 1844, I was sent for to see Mrs. R ,

aged 33 years the mother of four children general health delicate
has taken a great deal of medicine during the last six or eight
years, for the chills, dyspepsia, liver complaint," &c; has now had a
chill every other day for three days ; has considerable fever; sick
stomach ; pain in the head and right side ; furred tongue ; costive
bowels, &c. Examined the spine, but found little or no soreness.
Prescribed, 10 gr. calomel, to be taken and followed with cast, oil, in

1-47. j Cascj cured by Blii pi*e. t73

four hours, if necessary. Left 26 gr. ml. qui., in 3 gr. doses, to be
taken every two hours the next day, in tablespoonful of snake-root
tea.

23th. Medicine operated w ; chili and very little fever.

Left 20 gr. sal. qui., to be taken the day followi

30th. Patient has had do chill to-day, but is unable to set up in
bed. Prescribed, pi lb of aloes and rhubarb, to be taken at bed-
time, as might bo necessary, al lr. of iron, three times a
day. from which she slowly improved.

Oct. 17th. Again called to see Mrs. R. She has had another chill
to-day in fact, has been a good part of her time ronfined to bed
since previous attack. Examined spine again, and now found it
very tender at several places, particularly over the dorsal vertebrae.
Patient informs me that always, tor the last four or five years, after
being sick five or six days, the ick is often so great

that she cannot lie on it with ease. Gave a dose of oil, and applied
the blister as above.

19th. Blister has drawn well ; slight fever, but no chill.

21st. Patient much better in every respect. Ordered the appli-
cation of the blister to the other side of the spine, on to-morrow, and
to be kept running as long as possible.

25th. Discharged.

Nov. 5th. Mr. R. informs me. to-day. that Mrs. R. is quite smart
able to be up and about ; feels more like she is well than she has
for a great while ; has had no chill since blistering.

It will be perceived that, in this last attack, this patient took no
quinine, not that I object to tiie moderate use of it. in such cases ; but
rather because I wished to give the blistering a fair trial.

Case 4th. Oct. 10th. 1845, Mr. If. brought a negro man (a^ed
24,) to me to be examined. He inform? me that his boy has been
under the care of an intelligent physician for the last six months, has
taken a vast deal of medicine, and instead of getting better is on the
decline. I found him laboring under the following symptoms red
tongue, but moist : redeyes: bowels rather loose than otherwise;
discharges from the bowels of a rather thin, whitish appearance;
appetite bad ; cannot rest at night ; pains shooting through the breast,
bowels, arms and legs: very much emaciated; quick weak pulse;
Fpine more or less tender from the second cervical i 'own to the

fourth dorsal ; third lumbar vertebra quite painful un
pressure.

274 Cases cured by Blistering the Spine. [May,

Believing that this patient had been taking such remedies as the
more prominent symptoms of his case indicated without any benefit,
and it being a chronic case, and since I had now become a strong be-
liever in Spinal Irritation, I concluded nothing could be lost by
applying the blister, and awaiting its effects, for a few days. In this
case the blister was five inches broad, and was placed over the spine
instead of to the side of it. On the 14th (just four days) there was
evidently a favorable change. All the shooting pains had subsided ;
rests well at night ; appetite improved. 18th, still give no medicine ;
tongue and eyes of the natural, healthy, color ; bowels more regular,
and operations of a good colour, and healthy consistence.

20th. Gave Carbonate of Iron to be taken freely as a tonic.

27th. Able to do jobs about the yard, without the least inconveni-
ence. From this time on, he continued to improve till the 15th of
December when the medicine was discontinued.

It may be necessary to mention, that, the blisters were repeated
several times, and that he took nothing but the carb. of iron, and an
occasional dose of castor oil, during the whole time.

These are a few cases among hundreds of others in which I have
witnessed the most astonishing effects from blistering the spine. In
intermittent and remittent fevers, where they do not yield to the
ordinary remedies, and assume an aggravated character, I have never
known a blister applied to the spine, as in the above cases, fail in
immediately checking, or very materially changing the nature of the
case for the better. In all those malignant cases, if we will examine
the spine closely, we will almost invariably find more or less tender-
ness to exist. And he who will make it an invariable rule to examine
it, in every case to which he may be called to prescribe, will not only
be surprised at the extent to which he will, often, find it diseased,
but will be most agreeably surprised at the success of the above
practice, if he will adopt it.

I now have in my possession a number of cases of what may be
called chronic chilis with enlarged spleen of long standing which
yielded readily to one single blister, after the quinine had been freely
given, with little or no permanent effect. In these cases I have
always found more or less spinal irritation to exist, and when the
cure was thus effected it was permanent ; which I cannot say has
been my experience with the quinine.

It would indeed be useless here to enumerate the vast amount of
disease that I have cured by blistering, or otherwise irritating the

1S47.] Cauliflower Excrescence of the Os Tinea, cured. 275

spine; and I do hope that medical gentlemen, generally, will give
more attention to this subject than it has unfortunately hitherto re-
ceived.

ARTICLE xvii.

A Case of Cauliflower Excrescence of the Os Tincce, cured. By
Franklin Branch, M. D., of Abbeville, S. C.

If the following account of successful treatment, in a case of cauli-
flower excrescence of the womb, can subserve the cause of human-
ity, by casting one flickering ray upon the science of medicine, the
end designed in communicating it will have been accomplished.

On the 24th cf May, 1844, being called to visit a female servant

of Col. M , I found her exhausted and fainting, from supposed

uterine hemorrhage. Five weeks previous to my visit, she had been
delivered of a living child. Her midwife was also a female servant,
from whom I learned, that the patient had for many months been
laboring under a discharge from the vagina, at times bloody, but ge-
nerally watery and tolerably copious. When taken in labour, the
old servant who acted as midwife made an examination per vaginam,
and, as she expressed it, " found a great lump there, which she had to
tear away, to let out the child." This laceration was followed by a
profuse hemorrhage, which ceased with the birth of the child.

After delivery, the patient was laid in an easy posture, and suffer-
ed but little from hemorrhage until the night on which I made my
first visit. I examined per vaginam, and with the finger, detected a
large tumour, growing from three-fourths of the circumference of the
os uteri. It had a smooth or glossy feel externally, but upon pressure
it felt somewhat granular, and evinced a strong tendency to hemor-
rhage.

A thorough, but sad experience, gained from two previous cases of
cauliflower excrescences, (both of which terminated fatally,) enabled
me to detect the nature of the disease.

I gave the patient anodynes and astringents, internally, introduced
the tampon, and directed cold applications to the loins, and left for
the night.

On the day following I visited her, and, by the aid of a speculum, I
discovered a tumour, as above described, attached by a broad base to

276 Cauliflower Excrescence of the Os Tincce, cured. [May,

the os uteri, of an oval form, with an uneven surface, of a bright red
color, as large as an apple of ordinary size. It gave no pain on
pressure, but was easily made to bleed.

The patient, who had been healthy a year before, was now exceed-
ingly weak and emaciated.

Although the disease was considered incurable, by most of the au-
thors which I had consulted, 1 believed differently, and acted upon
that belief. Aided by the speculum, introduced and extended, I
passed a ligature of catgut around the base of the tumour, as near
the os uteri as possible, and, bringing it through a canula, fastened it.
The ligature was tightened every twelve hours, until the tumour was
removed.

After the removal of the tumour, and cleansing the orifice, I dis-
covered, by the aid of the speculum, that a portion of the diseased
surface remained. To this surface I applied the nitro-muriatic acid,
upon a pleget of lint attached to the end of a stick, passing it through
the speculum, by which means the cautery could be applied to any
particular point, without injury to parts adjacent. No pain was
complained of upon the application of the acid, and no subsequent
treatment prescribed, except tepid injections per vaginam occasion-
ally, and an occasional dose of neutral salts.

After four days, another examination was made with the specu-
lum, and on discovering a small point of diseased surface remaining,
the cautery was again used, and the simple plan of treatment con-
tinued.

After six days, another examination was made, and not a vestige
of the disease was there. The os uteri presented its natural appear-
ance, with the exception of that purplish color always present in a
cicatrix recently formed. Six months passed away, another exami-
nation was made with the speculum, and perfect health was restored
to the diseased organ. The system was invigorated. I saw the
patient, ten months after the cure was performed, laboring in the
field as faithfully as another hand, asserting that she was perfectly
restored.

1847.] Diseases of the Army of Occupation. 277

PART II. REVIEWS AND EXTRACTS.

Medical and Surgical Reports from the Army in Mexico.

Denied, ourselves, being participators in the active and interest-
ing campaign in Mexico, we have made every exertion to obtain
medical news from those who have been, and are now, engaged in this
foreign service. If as yet we have derived nothing direct from the
scenes of operation, it is not our fault ; and to supply the omission of
our promised correspondents, we publish below what we have derived
from the sources credited. We are still without, the New-Orleans
Journal for March, and may derive more recent information from it,
should it come to hand in time.

Of Dr. Jarvis' report, we make this comment. Of the three Divis-
ions of the Army attacking and capturing Monterey, commanded
respectively by Generals Twiggs 1st, Worth 2nd, and Patterson 3rd,
(volunteers); in the 1st and 3rd, there were 24 amputations, while
in the 2nd there were only 4. Does not this indicate plainly where
the fighting was done and yet Gen. Worth is alone looked upon as
the hero of the taking of that city, and he alone has been rewarded
by the President with a brevet. Has no injustice been done Twiggs
of the regulars, and Patterson of the volunteers ?

The Diseases of the Army of Occupation in the Summer of 181G.
By H. R. Robards, M. D., of Memphis, Tennessee. (Western
Journal of Medicine and Surgery.)

The following abstract from notes taken while the writer was act-
ing aa Surgeon to a regiment of volunteers from Tennessee on its
march to Mexico, and during a few weeks while stationed at Mala-
moras, is presented to the profession, in the hope that its details will
be found interesting and useful. The notes were penned in camp,
and my short military experience has taught me that the camp is not
a place for easy or finished composition.

As early as May last, in anticipation of a call for volunteers for the
war then just breaking out with .Mexico, the stirring notes of the fife
and drum were heard in Memphis; in a few weeks, five companies
were made up, and remained in organization until the final lots were
drawn in June, when only three were admitted into service.

The requisition made upon Tennessee was for three regiments
two of infantry, and one of cavalry; the latter, to which 1 was at-
tached, was ordered to rendezvous at Memphis by the Kith of June,
or as soon thereaftei le. This f three

companies from East, live from MidcHe, and two from West Tenncs-

278 Diseases of the Army of Occupation. [May,

see. I am particular in locating the different companies, in order to
show the varying influences of a southern climate upon constitu-
tions from different sections of the State.

Three companies only had arrived at Camp Carroll, the place desig-
nated for the encampment, two miles east of Memphis, on the day
appointed ; on the 24th of June, the whole number were there ; and
on the 27th of July, we took up the line of March for Mexico ; the
entire distance about fifteen hundred miles, to be travelled by land.

Our camp near Memphis, so far as could be observed, was free
from local causes of disease ; the situation was elevated, and both
men and horses were furnished with excellent water from a single
large spring. The weather, during a greater portion'of the time,
excessively warm and dry, and the roads and whole encampment
disagreeably dusty. For the first three weeks after the arrival of the
troops at this place, we had little else, in the way of disease, to con-
tend with but diarrhoea, intermittents, colic, etc., brought on chiefly
by exposure and imprudence in. diet. The companies from West
Tennessee, being acclimated, suffered least; t*vo-thirds of the men
from other parts of the State, were attacked with one or the other
form of these diseases soon after their arrival. The treatment was
simple, and only varied with the cause. If diarrhoea, and the cause
imprudence in diet, a dose of castor oil relieved most of them; if it
did not, broken doses of calomel, ipecac, and morphia invariably put
a stop to it. This was a favorite combination with me in this disease,
and throughout the entire march never failed, when the patient
could be restrained in his diet. The cases of intermittent fever were
cured with equal certainty by administering two doses of quinine, of
ten grains each, one given six hours before the chill, and the other
two. As colic was often brought on by gorging with indigestible
food, emetics were frequently administered, and gave instant relief.
If the indications did not call for this remedy, calomel and opium,
followed by a brisk purgative, were given; and if, as is often the
case in this disease, an operation could not be procured in time by
purgatives, then I had recourse to an expedient which with me has
never failed, and I have used it in numerous cases of obstruction-
from various causes : this is forcing large quantities of lukewarm
water into the intestines by injection. If the obstruction is caused
by impacted fceces, the water reaches them, they are moistened and
pass off. If it be partial hernia, as I have known in one instance,
where a knuckle of the intestine is retained in the internal ring, the
gradual and powerful pressure of the water draws the bowel out,
straightens it, and thereby removes the obstruction. I have often
been astonished at the immense quantity of water that can be forced
into the bowels without the slightest injury to the patient, but often
with the effect of affording instant relief.

About the 20th of June a most troublesome camp disease broke
out. I refer to measles, which, notwithstanding every precaution
that could be used, remained among the men fur three months; there

1947.] Diseases of the Army of Occupation. 279

were not less than three hundred and fifty cases of the disease, and
yet all recovered. The treatment adopted was chiefly expectant.
Sometimes the patients took stimulating diaphoretics, and often
during the march drank freely of hot whisky toddy, even while the
fever was on, without any bad effects that could be perceived: pur.
gatives were decidedly injurious in any form. Diarrhcea, which
often occurred as a sequel to this disease, was sometimes obstinate,
but yielded to external irritants, mucilaginous drinks, anodynes, etc.

About the first of July, a few cases of continued fever occurred in
camp ; but they were confined to one company, which was stationed
in an elevated part of the encampment, and in which the usual degree
of cleanliness was observed. This company was from a region in
Middle Tennessee noted for its insalubrity ; two of these cases proved
fatal, in consequence, I believe, of the dread of the hospital that ex-
isted in that company, which deterred the men from calling for medi-
cal aid until the disease had made considerable progress. The brain
was the organ that suffered most, delirium being a constant attend-
ant. The treatment consisted of cold applications to the head,
blistering, alteratives, etc* One fact I observed in the management
of this fever, which strikes me as worth recording; that is, that
quinine invariably aggravated all the symptoms. If experience
should prove this to be always the case, will it not go far to prove
that the cause of intermittents and remittents differs from that of
continued fever ?

During the time we were at Camp Carroll, the companies from
East Tennessee suffered most from diarrhcea, colic, and such other
diseases as are brought on by exposure and imprudence in diet, their
constitutions seeming as yet to resist the causes of fever in any of
its forms. It will be remembered that East Tennessee is for the
most part a high, broken and healthy section of the State. In the
companies from Middle Tennessee there were many cases of remit-
tent fever, at the same time that diarrhcea, colic, etc., were common.
The two companies from West Tennessee suffered but little from
any other disease except intermittent fever.

From the close proximity of the camp to town, and the freedom
with which soldiers, when unrestrained, are known to indulge in
every kind of dissipation, the number of cases of syphilis and gonor-
rhoea which I have to report will not seem extravagant, namely :
twenty-three of the former, and eighty-four of the latter.

The first stages of syphilis were treated with calomel in combina-
tion with sarsapanlla ; without waiting for the gums to be touched,
this form of mercury was laid aside after a few days, and the euro
completed by giving in full doses the proto-iodide of mercury, and
sometimes the hydriodate of pota^sa. The latter was always ued
when thecums had been previously touched with mercury: dry lint
or calomel was applied to the chancres, and iodine ointment to the
buboes. The patients rrenerallv recovered in a few days

Gonorrhoea was treated with equal succoss, by adm.nister:n_: two

280 Diseases of the Army of Occtqiation. [May,

parts of the comp. extr. buchu and one of balsam copaiba in tea-
spoonful doses three times a day, in the first stage : in the second,
that is, after using the above four or five days, injections of a strong
solution of nitrate of silver or acetate of lead were employed, and
generally affected a cure at once.

On the 20th of July, our encampment was changed to the bank of
the Mississippi river opposite Memphis. After this, we had but one
or two cases of continued {ever, while the intermittents and remit-
tents assumed a much more malignant form.

But before I proceed farther, it may he as well to state that a little
upwards of a thousand men, either belonging to or in some way at-
tached to the regiment, came under the surgeon's care ; out of which
number, on the 4th of October, there had been more than twelve
hundred cases reported. Of course, some of the men were several
times on the sick list ; but the case was never reported unless it was
a different disease from the one previously treated ; relapses were
never reported the second time. This regiment, as I have before
mentioned, consisted of volunteers from different sections of the
State, of various professions and callings; many were educated gen-
tlemen ; many belonged to the respectable class of farmers and
mechanics, and not a few were loafers. With all, the habits, cus-
toms, diet, etc., of a camp life were different from what they had
before known. The sickly season was just approaching when they
arrived at Memphis ; the country through which they traveled was
one of the sickliest in the United States. Is it wonderful, then, that
so large a number of cases should have occurred ? Is it not aston-
ishing that only five had died up to the 4th of October, when I tem-
porarily left the regiment? It will be admitted that this success was
almost if not entirely unprecedented, and I attribute it greatly to the
efficacy of a single remedy, quinine. This was our sheet-anchor,
and, without it, my opinion is that our regiment, now by far the
largest and most efficient in the service, would have been complete-
ly disabled.

From the accumulated experience of the profession, it is clear that
quinine acts in some manner specifically upon the nervous system,
producing, as I have lately seen, when given at improper times and
in over doses, complete derangement of that system. May this not
throw some light upon the vexed question as to the organ primarily
affected by the remote cause of fever ? If quinine cures fever, and
the action of the article is specifically upon the nervous system, does
it not follow that the cause of fever must act primarily upon that
system? But I return from this digression to my notes.

I mentioned before that the remittent and intermittent fevers as-
sumed a more malignant form on the bank of the river, but did not
state that diarrhoea almost entirely disappeared from the camp, except
when induced by drastic purgatives, which was so common an oc-
currence that we had to guard scrupulously against their use.

The symptoms that ushered in intermittent or remittent fever

1847.] Diseases of the Army of Occupation. 281

were very similar, and such as usually occur in that section of coun-
try. However threatening the premonitory symptoms might be, it
was not often the case that medical aid was called for until the pa-
tient found himself shivering with a chill ; then he was let alone until
the stage of excitement passed off. If at this time the tongue, skin,
etc., indicated a very disordered state of the secretory organs, a
mercurial in some form, in combination with a gentle purgative, was
given during the sweating stage ; the kind of purgative to be given
was always suggested by the nature of the case, the constitution of
the patient, etc. Very often, indeed, they were not used at all, and
the cure proved equally effectual. We usually commenced with the
quinine eight or ten hours before the chill ought to return ; ten grains
were given, and repeated four hours afterwards ; the thir,d dose was
given or not as the case seemed to require.

Ten grains of quinine I regard as a maximum dose, if to he repeat-
ed. I however frequently gave as much as thirty grains ; but it was
always when the case was seen for the first time a few hours before
the chill was expected, and it constantly kept it off. I prefer giving
the remedy in ten grain doses, for the reason that its effects are al-
ways certain and it acts more effectually upon the skin, and not so
frequently as an emetic as when given in larger doses. My manner
of giving it was simply to mix it with water. To some this is a bit-
ter, nauseous dose, and caused vomiting at once ; then it had to be
made into pills, but I think the solution much more effectual and
rapid. The doses I have mentioned invariably put a stop to the chill,
whether simple or malignant ; but to guard more certainly against a
return, we usually ordered five or ten grains, according to circum-
stances, every morning for three or four days. If, after the chill
was checked, the secretions remained vitiated, an alterative was
given at night, and repeated if necessary.

The cases of remittent fever were treated differently, and it is in
the treatment of this disease that quinine is most frequently abused.
It is very much the custom in the South, at this time, to administer
quinine in all the stages of fever and in large doses. My experience
justifies me in saying that such a course is not only unnecessary, but
altogether unjustifiable. In my opinion, quinine should never be
given unless the remissions are very distinct, and never in the hot
stage. I usually, in this form of fever, commenced the treatment,
after the first exacerbation had passed off, by administering a gentle
purgative, in combination with some article that would keep up an
action upon the skin without irritating the stomach and bowels.
Ipecacuanha generally answered the purpose remarkably well. Most
frequently the combination was of calomel and ipecac, given in
broken doses, which course, varied as circumstances required, was
kept up for two or three days, when the remissions usually became
more distinct, and quinine had the effect of arresting the disease.
These cases rarely continued on hand longer than four or five days.

There arc some other diseases which many southern physicians

282 Diseases of the Army of Occupation. [May,

regard as having a malarious origin, and treat indiscriminately with
quinine; I allude more particularly to dysentery and diarrhoea.
Now, I have not found such practice judicious, but, if I mistake not,
have seen very injurious consequences result from it. But when
these diseases assume, as they sometimes do, a periodical form, then
quinine, in combination with morphia, is the remedy. I should
never recommend it in these diseases unless they did assume such a
form. This combination I have found exceedingly useful in the
treatment of other diseases attended with the nervous irritability very
common in the fevers in the South. The fevers on the Rio Grande
at this time are so constantly attended with disordered stomach and
bowels, that the morphia is indicated in almost every case requiring
quinine.

As I before observed, our regiment took up the line of march on
the 27th of July. We were under the necessity of leaving twenty-
five sick men at the hospital in Memphis; most of them, however,
were convalescent and followed in a few days. The direction of our
march was a little south of west, passing entirely through Arkansas
from north-east to south-west, and through the whole of Texas in
the same direction. A geological and topographical history of this
country would be a valuable and interesting work. My duties in
another capacity were too arduous to allow much time for such in-
vestigations. From Memphis to Little Rock, the capital of Arkansas,
the road passes througe a low, flat, marshy country, pregnant with
local causes of disease; and our troops suffered more, perhaps, in
performing that distance of one hundred and fifty miles than on any
other portion of the route. The weather was excessively warm, the
roads dusty, and the water disgustingly bad; this was felt most
severely in the Mississippi swamp, a distance of forty-five miles.
Here, exposure to the sun, bad water and imprudence in diet brought
on many cases of severe diarrhoea ; the form of fever was principally
malignant intermittent. I found it necessary not only to give as
much as thirty grains of quinine at a dose, but to assist it with stimu-
lants, external irritants, etc. Congestion was the symptom most to
be feared, and there was no time to "prepare for quinine;" it must
be given at once, and boldly given, or the patient was lost. It is
astonishing how soon the worst cases recovered. Our conveniences
for transporting the sick consisted of an ambulance fixed upon springs,
and as many common wagons as were required. A great many pre-
ferred remaining on horseback, on account of the closeness of the
wagons and the extreme heat. Measles on this account gave us
much trouble; but notwithstanding all these inconveniences, we ar-
rived at Little Rock in good time and without the loss of a man.

On this route an accidental case of surgery occurred, which, from
its novelty in one particular, may be worth mentioning: A soldier,
in taking a carbine from among some bridles, accidentally discharged
it, the ball taking effect upon his comrade, who was standing so near
that his clothes were set on fire. It entered the anterior inferior

1347.] Diseases of the Army of Occupation. 283

lor

part of the axilla, ranged upward, and passed out at the anten
edge of the scapula. Not being near at the time myself, the assist-
ant surgeon, Dr. Washington, examined and dressed the wound.
He reported to me that he thought the ball had passed above the
axillary artery, fracturing the humerus at the head or neck. I had
only time the next day to make a superficial examination of the
wound, which I did without taking the bandages off. I discovered
that the bone was evidently fractured, hut at what point I could not
determine, in the situation in which the arm then was. Dr. Wash-
ington was left in charge of the case, and reported to me, a short
time afterwards, that on a more minute examination, he had discov-
ered that the humerus was fractured, not at the head or neck as he
had at first supposed, but three cr four inches below, near the inser-
tion of the latissimus dorsi and pectoralia major muscles; the
axillary artery had remained uninjured, and could be distinctly felt
pulsating when the finger was introduced into the wound. Suppura-
tion was free, and the wound healed about the time that the bone
united. In this case, the ball passed below the artery, but what
broke the bone so far from the place at which it entered I do not
clearly perceive; there was no fall or jar of any kind except that
made by the ball itself.

At Little Rock we remained five or six days, recruiting; here the
diseases assumed a milder form, intermittents being most common,
and on the whole the number of cases was considerably diminished.
Our march was now through a high, broken country, to Washington,
in Arkansas, a distance of one hundred and twenty miles. The
health of the regiment continued to improve until we crossed Red
River, at Fulton, and encamped upon the edge of the swamp. Here
my notes show a large increase in the number of cases of malignant
intermittents and remittents, requiring even a more vigorous treat-
ment than before. Congestive fever, in its worst form, prevailed at
this time; remittents were also more obstinate, and required a more
liberal use of mercurials. As the sick had to be hauled, these were
given invariably at night, and in every case of fever where there was
a remission, quinine was given in the morning, and repeated once or
twice if necessary, regardless of (he effect of the purgative given the
night before. The condition of the bowels was attended to after the
fever was broken, and quinine would do this whether the bowels
were acted upon or not.

It may be worthy of remark, and I noticed it in a hundred in-
stances, that though intermittent or remittent fever often preceded
measles, it never accompanied or succeeded it during the march ;
diarrhoea, on the contrary, almost invariably followed it. The num-
ber of cases of fever occurring during the march through Texas was
immense; this may be attributed in a great measure to exposure to
the rays of an ardent sun during the day, and encamping upon the
marshes and swamps of creeks and rivers at night. In the prairies,
the heat of the sun was most intense, and was especially oppressive
to persons from the North.

234 Diseases of the Army of Occupation. [May,

About the first of September, many cases of jaundice occurred ;
this was often though not always preceded by an attack of fever.
The complaint was never serious, but excessively annoying to the
patient, in consequence of the languor and general feeling of indispo-
sition which it induced. It was almost invariably accompanied by
a ravenous appetite. An emetic was given in the onset of the
disease ; this was followed by a brisk purgative, and then vegetable
tonics were relied on to effect the cure. This course I persevered in
for some time, but the cases did not recover as rapidly as we like to
see them in the army. Another remedy must be sought for, more
certain and rapid in its effects. Iodine struck me as coming nearer
to fulfilling all the indications than any other I could think of, par-
ticularly the proto-iodide of mercury. This was given in the form
of pill, in combination with rhubarb and aloes, twice a day, each dose
containing two grains of the proto-iodide. My expectations were
more than realized ; indeed, it acted like a charm, and I had no
further trouble with the disease.

I have now in a hurried and rather superficial manner referred to
all the diseases we had to contend with in large numbers; of course
there were many other isolated cases of rheumatism, dropsy, neural-
gia, paralysis, etc., which recovered under the usual treatment. In
giving the treatment of the different diseases encountered, I have
left out all such remedies as are used merely as auxiliaries, and con-
fined myself to such as were mainly relied on. Indeed, on a march
through a wild country like that through which we passed, where
both sick and well had to move at the sound of the horn in the morn-
ing, there was no time nor opportunity allowed for dealing in those
minor remedies, so often used in domestic practice, more with a
view of amusing the patient than with a hope of benefitting him.

Three deaths occurred on the road, one from each section of the
State. No perceptible difference could be observed in the number
or violence of the cases in the different companies after getting fairly
into a southern climate, for there cannot now be found three men from
anv company who have not been under the care of the surgeon.

At Lavacca, a small town on' the Matagorda Bay, now used as a
depot for one division of the army, the regiment remained stationary
ei^ht or ten days ; here my own health became so feeble that I ob-
tained permission to go on to Matamoras by water. On the first of
November the troops crossed the Rio Grande, and encamped on the
bank of the river five miles above town.

Here the diseases have been chiefly of an intermittent form,
accompanied in almost every case by gastric and intestinal derange-
ment, and, owing to this, more difficult to treat than heretofore.
Quinine alone almost invariably vomits; but rarely ever does so in
combination with morphia, particularly if the precaution is used of
applying a mustard plaster over the epigastric region at the time it
is given. Owing to the frequent changes in the weather, relapses
often occur, and the stape of convalescence is always protracted.
Mercurials are often indicated, and are used with great advantage.

1847.] Surgical Cases at Monterey. 285

Abstract of a Letter from Dr. N. S. Jarvis, Surgeon U. S. Army,
dated Monterey, Mexico, Oct., 1846, embracing several Surgical
Cases, which fell under his Treatment and Observation. (N. York
Journal of Medicine.)

After stating matters of a private nature, Dr. Jarvis continues:
11 On the 19th of September we encamped within four miles of Mon-
terey, in a grove of Peccan trees, called ' Walnut Grove,' where we
were abundantly supplied with clear and cold water, from a stream
of considerable size, and rapidity, formed by the junction of numer-
ous springs, which took their rise in the surrounding lime-stone rocks.
The combination of wood and shade rendered this spot admirably
fitted for an encampment. On the following day parties were em-
ployed in reconnoitring the enemy, and in observation of the fortified
position of the town. Towards evening my Regiment, 3d Infantry*
with another, were advanced a mile towards the town, to cover a
party of engineers, engaged in the erection of a Mortar Battery, but
returned to camp about 9, P. M., having been relieved by another
regiment.

On the morning of the 21st the whole division was thrown forward
towards the city, with a view, as we supposed at the time, of making
a diversion in favor of the 2d Division, under Gen. Worth, which was
moving on the western side of the city by the Saltillo road. Few of
us supposed, as we silently marched along, occasionally passing
through cornfields and by the side of hedges, or whatever could con-
ceal our movements from the enemy in their batteries, that we should
so shortly be engaged in a fierce and deadly strife. As soon as, or
in fact before, we emerged from under cover, the batteries from
either end of the city opened their fire upon us, completely sweeping
the plain in every direction, and enfilading the advancing columns
of our troops, now rapidly marching towards the suburbs. The en-
gineer officer having reported the practicability of attacking with
success the rear of some of their forts, the 1st, 3rd, and 4th Infantry
were ordered to advance rapidly by separate roads, and now it was
my professional labors commenced ; the nearest and only shelter
that presented itself to me for the wounded, falling every moment
under a most destructive fire, was a quarry pit, four or five feet in
depth, and the same in breadth. Several of these were contiguous,
and to them I directed the wounded to be carried. By stooping we
were protected from the shots, which, however, became every moment,
thicker, owing to the fact, that our troops had by this time advanced
within range of the enemy's fire, and the moment they perceived a
party of men bringing the wounded to us, they directed all their guns
upon it. I had already performed one amputation, and was prepar-
ing for a second, when two or three fugitives rushed into the pit, Kill-
ing over the wounded that lay there crowded together, saying that
a large body of lancers were approaching. So little credit did I at-
tach to their report, which I ascribed rather to their fears l!:;;;i tin-

286 Surgical Cases at Monterey. [May,

actual presence of this dreaded description of troops, that I never
raised my eyes to observe them ; which circumstance doubtless saved
us all. Had I been discovered, all would have been massacred, as in
their headlong fury, they would neither have delayed to ascertain our
character or profession, nor have paid much respect to our patients.
Several soldiers who had sought an adjoining pit with an officer were
slain. They were soon after repulsed by a regiment of Ohio and
Mississippi Volunteers, marching to reinforce those already in the
town, and their retreat was farther quickened by a shower of grape
opened upon them by our artillery.

I commenced with a determination of giving you a surgical history
of the actions of the 21st, 22nd, and 23rd September, but have unin-
tentionally thus far given a military narrative. This, however, will
show, in the incidents above narrated, that the military surgeon is
at times somewhat unpleasantly situated, when in the discharge of
his professional duties, deprived as he is of the security, and many of
the appliances enjoyed by his fellow practitioner in civil life.

The first wounds were received in crossing the plain, and were in-
flicted by grape and cannon-shot. This was of course before we had
approached within reach of their musketry. These wounds were all
low : generally at, or just above the ankle, according to distance and
direction. Of the first three men brought to me, two had received
wounds from twelve pound shots just above the ankle, which had
nearly severed the limbs, which were hanging only by a portion of
integumenls. The other had his heel torn off by a six pound shot.
Shortly after, our troops having advanced within reach, and under
the fire of the Mexican Infantry, numerous cases of wounds by mus-
ket and escopette* balls were brought to me; these latter are one-
third larger than our musket-balls, and consequently inflict a more
severe and formidable wound. So numerous at this time became the
wounded in our pit, and so constant and heavy the fire, directed
towards #the parties approaching with the wounded, as to compel us
to remove our hospital several hundred yards farther in the rear.
We had not long been in our new position, when some covered wa-
gons bringing the wounded attracted the attention of the enemy,
who immediately re-opened their fire, compelling us a second time
to remove beyond the range of their shot.

Among the numerous projectiles, occasioning severe and fatal
wounds, were grape, canister, fragments of iron and copper shells,
and stones knocked by the balls from the buildings and walls. Their
shells were thrown with great accuracy, frequently in the midst of a
body of troops, but fortunately killing and wounding but few.

Before speaking of any particular wounds, I will here take occa-
sion to make some remarks respecting the character they assumed,
and the peculiar causes acting to prevent a favorable result, so far a3

* An escopette is a shoit carbine, similar to a blunderbuss, and carries a ball
one-third larger than our musket.

1847.] Surgical Cases at Monterey. 287

regarded the healing of all, even the most slight. The first annoy-
ance we experienced, and which no doubt exerted an injurious
effect, was one little anticipated at the time. The moment a limb
was amputated numerous flies would alight on the stump, and must
have deposited their eggs, for when it became necessary to dress the
stump, myriads of maggots were found buried in it, which could be
expelled with great difficulty ; rendering it necessary in some in-
stances to re-open the flap, for their complete extermination. A
much more formidable enemy made its appearance in an erysipelatous
inflammation of the integuments, covering the stump, which general-
ly set in two or three days after the operation ; and notwithstanding
all the means made use of to arrest it, most commonly ended in
sloughing, and either proved fatal or rendered a second amputation
necessary. That some influence existed previously, either external
or internal, from causes connected with the state of the atmosphere,
or habits of the men, arising from diet or water, was manifest. The
slightest wound or scratch became in every case a tedious ulcer, in
some instances proving a cause for serious alarm. Apparently the
most trifling wounds required an unusual time for healing, and even
those that had previously healed would break out again, and present
greater difficulty in their cure than in the first instance.

At this period no atmospheric causes apparently existed to produce
this unfavorable aspect of things. Nothing could exceed the loveli-
ness of the weather, if I may .so express myself, and if the middle of
the day were warm, the morning and evening refreshed us by a most
delightful temperature and cloudless sky. No rain had fallen, with
the exception of one or two showers, for nearly a month, and conse-
quently little moisture existed to produce its well-known morbific
influence. Immediately after the capitulation of the city, on the25lh
of September, all the wounded of the different divisions entered the
town, and suitable buildings were provided for their accommodation.
Upwards of two hundred officers and men from the 1st and 3d Di-
visions, who had been most severely wounded, were conveyed thither
on the same day in litters and wagons. The wounded of the Second
Division already occupied the city.

Our camp afforded no comfort nor shelter for them beyond a few
small tents and a solitary blanket laid on the ground : and many were
destitute of even this apology for a bed, having lost them on our
march. Many had no other clothing than that in wear, which was
not only torn and soiled in climbing over the hedges, walls, &c, du-
ring the battle, but was stiff and saturated with blood from their
wounds. A few days after their reception into the hospitals, tertian
intermittent fever made its appearance, attacking many of the
wounded, and in a majority, retarding or completely arresting con-
valescence. On many of those severely wounded it exerted a
decidedly pernicious influence, and no doubt contributed, in some
cases, to a fatal termination. It not only attacked the wounded in
the hospitals, but prevailed extensively in camp and among the popu-

288 Surgical Cases at Monterey. [May,

lation of the town and neighboring country. I cannot say to what
extent, this may he attributed to the putrid exhalations arising from
the numerous bodies of men and horses slain in the different combats,
and which had been slightly covered with earth, and emitted a most
sickening and offensive effluvia. This, doubtless, contributed largely
towards infecting or destroying the purity of the air, and establishing
a poisonous miasm.

With these preliminary remarks, I will now give you an outline of
a few of the most interesting cases resulting from gun-shot wounds,
received during the three days' attack on Monterey, and which came
under my observation at the time. With a view to some order and
classification, I will describe first those of the head and face.

Case 1. Corporal Sherridan, 1st Infantry, was struck by a mus-
ket-ball on the anterior and central portion of the os frontis, destroy-
ing it for a distance of two inches. Considerable portions of the brain
issued from the wound, and notwithstanding the severity of the case,
the patient appeared to suffer little or none until the third or fourth
day, when, coma supervening, followed by delirium, he died.

Numerous wounds of the scalp, accompanied in three cases by de-
struction of the periosteum and outer table of the skull, came under
my observation, but presented nothing new or different in their
character and progress from ordinary cases.

Case 2. Private Redville, of the 3d Infantry, in passing a stone
wall, received a wound in the right eye, as he supposed, from a frag-
ment of stone broken from the wall by a cannon-ball, and which
struck him with force sufficient to knock him down. I saw him two
or three hours after the injury was received, and found his eyelids so
much swollen, as to render it very difficult to ascertain the condition
of the eye itself. In placing my finger over the inner canthus, I
felt a sharp point, apparently of some hard substance. This I im-
mediately extracted with a pair of common forceps, and found it to
be a fragment of grape, three-quarters of an inch in length, and one
half an inch in width at the centre, of an oblong or elliptical shape.
It was of copper, or an alloy of that metal, and had evidently been
broken off by striking the wall. On examining the eyeball I found
it uninjured, the fragment having passed between it and the inner
canthus, and penetrated to the posterior wall of the orbit, destroying
the lacrymal sac, the os unguis, and wing of the sphenoid bone.
Considerable inflammation and suppuration followed, and although
at the present time the wound has entirely healed, the pupil remains
permanently dilated, and vision destroyed. This seems to indicate
an injury of the optic nerve, which the missile from its length must
have reached and destroyed.

Case 3. Private Jones, of the same regiment, was wounded about
the same time by a musket-ball striking him near the angle of the
inferior maxilla, on the right side, fracturing the bone, passing directly
through the tongue and the corresponding portion of the bone on
the opposite side. The tongue was completely severed at its base,

1847.] Surgical Cases at Monterey. 269

hanging only by a few muscular fibres. The patient was almost
moribund when brought in, and died shortly from excessive haemor-
rhage.

Case 4. Major L., commanding the 3d Infantry, received a
wound from an escopette-ball directly in the centre of the upper lip.
The ball passed obliquely backwards and to the left, tearing away
the bony palate, and completely destroying the upper maxilla and
malar bone of that side, and fracturing the condyle of the inferior
maxilla, passed out behind the ear near the mastoid process. The
velum pendulum palati was completely separated from its superior
connections and rested on the tongue. The whole of the alveolar
process, together with the teeth on the left side, was carried away.
To enable him to articulate, as well as swallow, I contrived to fasten
up the pendulous palate by a stitch, and afterwards by a ligature
around the remaining incisor tooth, with a view of afterwards endea-
voring to effect a union with the parts from which it was torn. I
subsequently secured it more completely by a strong ligature passed
through it in two places, the ends being brought together, and by
means of a probe carried up through the nostril and fastened with
adhesive plaster to the forehead. Intense inflammation followed,
involving tiie whole side of the head, and during several days pieces
of bone were being constantly separated and discharged. The pre-
vious ill health of this officer rendered his case the more unpromising.
He had suffered for two or three years from severe and repeated at-
tacks of Asthma, which had so enfeebled his general health that the
least exposure or fatigue was attended by intense suffering and dan-
ger of death. Up to the present time nature has made but little re-
cuperative effort, in consequence perhaps of an attack of intermittent
fever, which, in many cases, thus acts in retarding the healing pro-
cess.*

Case 5. A private of Col. Hays' mounted Texan Rangers was
wounded on the 21st in an attack made on the eastern side of the
city. A copper grape-shot striking him at the same point as in the
preceding case, passed obliquely backwards and downwards wound-
ing the tongue and fracturing the lower jaw on the left side near its
angle ; then coursing along the neck, beneath the integuments and
muscles, lodged near the insertion of the left sterno-cleido mastoid
muscle into the clavicle, where it was cut out. Fragments of bone
came away, and considerable inflammation, with difficulty of swal-
lowing, followed, but the wound progressed favorably, and notwith-
standing the size of the shot and destruction of parts, is at the present
time nearly healed. His head is considerably drawn down, and a
rigidity of the jaw, with inability to speak, remain.

Case 6. The sergeant-major of the 5th infantry was wounded on
the 22d, the ball entering near the same point as in the two former
cases, but passing obliquely backwards and upwards above the roof

* This officer died a few days afterwards. M.
19

290 Surgical Cases at Monterey. [May,

of the mouth, and lodging near the articulation of the jaw on the
right side, between the coronoid process and masseter muscle. It
was subsequently extracted, and the wound at the present moment
has entirely closed, leaving, however, as in the former case, more or
less immobility of the jaw.

Case 7. Private Lewis, of the 1st Mississippi Regiment, was
wounded on the 22d September. The ball struck him at the lower
point of the lobe of the ear, and posterior edge of the ramus of the
inferior maxillary bone on the left side. After fracturing this bone
midway between its angle and articulation, the ball passed trans-
versely inwards, tearing away the back part of the palate, and came
out through the right malar bone. This case progressed favorably,
and the wound at the present time is nearly healed. Some deformity,
arising from ossific matter thrown out in the union of the jaw, and a
certain degree of immobility remain. The close vicinity of the car-
otid artery to the point of entrance of the ball, and its entire escape
from injury, renders this case doubly interesting.

The next order of wounds are those of the neck, thorax and abdo*
men, many of which, of an interesting character, presented them-
selves during the engagement, but the limits of my letter warn me I
must reserve them for a future occasion. I will, however, describe
a few cases of wounds of the pelvis and bladder, presenting some
singularity in the direction and force of the balls, and interesting in
the nature and result of the injuries they inflicted.

Case 8. Lieut. G , 4th Infantry, was wounded in three
places about the same time, on the morning of the 21st September.
The most severe wound, however, was one, in which the ball, striking
the upper and anterior portion of the thigh, entered the pelvis, wound-
ed the fundus of the bladder, and passed out at the sacro-ischiatic
notch. The femoral vessels, in the course of the ball, escaped being
wounded in a most remarkable manner. The urine passing freely
through the wound necessarily produced considerable infiltration and
inflammation of the cellular tissue of the thigh. By changing his
position so as to lie on the left side, and introducing a catheter, which
was constantly maintained in the bladder, no more urine escaped
through the wound, and the inflammation rapidly subsided. No
unfavorable symptoms followed. The usual separation of the parts
destroyed in the course of the ball took place, succeeded by a healthy
suppuration, at the usual period of gun-shot wounds, and a hope was
entertained by his friends of his speedy recovery. This hope was
still more strengthened when, on the tenth day after the wound was
received, the catheter, by some accident, became obstructed, and re-
mained so some time before it was discovered, and on its withdrawal
and re-insertion, upwards of twelve ounces of urine were drawn off,
showing conclusively that the wound in the bladder must have en-
tirely closed, to enable it thus to retain so large a quantity of fluid.
The expression of his countenance, and cheerfulness of manner, would
hardly have indicated any great pain or suffering. It was only on

L847.] Surgical Cases at Monterey. 291

the twentieth day that any alarm was excited in the minds of his
friends, by his suddenly being attacked by rigors, followed by fever
and profuse night-sweats, which, notwithstanding all the means made
use of, rapidly reduced his strength, and he expired on the night of
the 13th October, and on the twenty -second day after being wound-
ed. A post-mortem examination of this case would have proved
highly interesting, showing how far wounds of this description, affect-
ing internal hollow organs, may heal, and the manner in which a
restoration of the parts destroyed takes place; but the pressure of
professional duties at the time has prevented so desirable a finish to
the history of the case.

Case 9. Private Capers of the Baltimore Battalion, was wound-
ed early on the 21st September. The ball entered directly above
the os pubis, and taking a direction downwards and obliquely back-
wards, wounding in its course the bladder, passed out of the pelvis
between the sacrum and tuberosity of the ischium on the left side.
It was found lodged between the integuments and glutei muscles,
from which point I extracted it. Urine passed freely at the time,
from the wound over the pubis, but ceased shortly after the intro-
duction of the catheter, which was constantly maintained in the
bladder, as in the former case. Very little tension or tenderness of
the abdomen followed, nor any symptoms of peritoneal inflammation,
showing that the ball had entered the bladder without wounding the
peritoneum.* Neither were there any signs of extravasation or in-
filtration of urine, and but little or no febrile action. About the tenth
day after its reception the wound over the pubis, which had by this
time entirely closed, broke out again, discharging urine, this was
shortly afterwards followed by the opening of that in the nates, made
for the exit of the ball. Through the latter, both fasces and urine,
passed, showing that sloughing had taken place, and a communica-
tion formed between the rectum and bladder. The contents of both
of these were occasionally discharged from the anterior wound. The
patient lingered in this miserable situation until the sixteenth day,
when he expired, worn out by pain and suffering.

Case 10. Private Young, of the 1st Tennessee Regiment, was
wounded nearly at the same time and place as the above. The ball
entered just above the os pubis, and about one inch to the right of the
symphysis. It ranged diagonally across the pelvis, inclining down-
wards, wounding both the bladder and rectum, and passing out
through the left sacro-ischiatic foramen, just above the os coccygis ;
urine and fasces passed out from both orifices of the wound. When
brought in, it was supposed, from his general appearance, that he
would survive his wound for a very short time. A catheter was in-
troduced immediately, which was retained with considerable difficul-
ty. The wounds were dressed in the usual manner ; urine and fceces

* The ball entered the bladder below the point where the peritoneum fa
in- wall of the abdomen upon the fundus of the bladder

M.

293 Surgical Cases at Monterey. [May?

continued, however, to pass out of the wounds, attended by consider-
able irritation and febrile action. In this condition he lingered
twenty-three days, when he expired, worn out, as in the case of Ca-
pers, by long-continued suffering.

Having given a brief description, of a few of the gun-shot wounds
in the different assaults on Monterey, I will conclude my communi-
cation, with a statement of the number and results of the larger am-
putations, performed on those occasions. The total number in the
three divisions of the army was twenty -eight viz: ten in the first
division, four in the second, and fourteen in the third or volunteer
division. Twenty were performed on the field, or on the following
morning, in the camp; the remaining eight, at subsequent periods,
varying from five to twenty days. Twelve of the number, including
two in those taken prisoners and operated upon by the Mexican sur-
geons, proved fatal, and the remaining sixteen, have nearly or quite
recovered. This average of mortality was not confined to our wound-
ed. I was told by Dr. Hidalgo, surgeon in charge of the Mexican
military hospital, that of thirteen amputations performed there, five
had proved unsuccessful, and one case, that had recently been opera-
ted upon, appeared to me to be in a critical condition, but whether
the patient died or recovered I have not learned.* In addition to
unfavorable causes, not enumerated among those I have heretofore
noticed, and from which the Mexicans were happily exempt, was the
repeated removals to which our wounded were subjected. In carry-
ing them from the field to the camp, a distance of three or four miles,
they suffered greatly ; and the subsequent removal to town, still far-
ther increased the pain and danger, and in one or two cases, evidently,
was productive of a fatal termination.

With a few remarks, on the appearance and condition presented
by the two cases of amputation of the thigh, performed by the Mexi-
can surgeons, in their hospital alluded to above, I will close. One of
these had been operated upon on the same day with the injury, and
the other some four or five days after. Neither stump on examina-
tion, after the removal of the dressings, presented any unusual ap-
pearance; on the contrary, the flaps had been neatly adjusted and
brought together, and kept so by a number of interrupted sutures and
adhesive straps, encircling it in every direction, and adhesion had
apparently taken place, in one case along the line of divided integu-
ments. No one judging by the external appearance of the wound, if
we except a degree of paleness of the integuments of the flap and
some fcetor, would have suspected the condition and extent of dis-
ease within. On dressing the first case and removing the lint and
adhesive straps, which had become somewhat offensive, the edges of
the flap receded or partially separated, so as to reveal a large cavity
or excavation, the whole surface of which was dark and ill-condition-
ed, and from the centre projected the end of the bone. There were
no signs or appearances of suppuration or granulation having ever

* This case subsequently proved fatal.

1847.] Medical Topography of Texas. 293

taken place in the divided muscles; on the contrary, they appeared
absorbed or attenuated by previous discharge, of which none existed
at this time. The patient rapidly sunk, and died on the fourth day
after his admission into the Division hospital.

Private Alexander, of the Baltimore Battalion, the other case, was
brought to our hospital some two days after the one above. His
stump presented nearly the same appearance as the first, with no in-
dications whatever of the diseased condition within. Eleven days
after his admission the flap gave way, disclosing the same appear-
ance as in the former case, with most intolerable fcetor. Gangrene
rapidly extended, and he died on the twelfth day after his admission,
and the thirteenth from the time of the operation.

Among other consequences arising from gun-shot wounds, in my
hospital, were two cases of traumatic tetanus, both of which proved
fatal. The first case manifested itself seven days after the injury,
which was a wound of the knee-joint, with a fracture of the patella
by a grape-shot. The man was brought from the camp of the 4th
Infantry to the Division hospital, and was attacked a few hours after-
wards, by opisthotonos, followed by trismus and severe spasmodic
action of all the muscles of the body. He died the same night. The
other case originated from a gun-shot wound of the left thigh, in
which the ball passed down to the femur, six inches below the
trochanters, and taking a direction upwards on the outer side of that
bone, denuded it entirely of the periosteum for the distance of three
or four inches, and was cut cut from beneath the gluteus maximus
muscle of the same side. Here the first symptoms manifesting an
attack of this dreadful disease was violent spasmodic action of the
muscles of the injured limb, which soon extended to those of the
whole body, followed by trismus and a certain degree of opisthotonos.
He expired on the fifteenth day after receiving his wound, and nine
days after being received from the Mexican hospital ; having been
taken prisoner and carried thither on the 21st September, the day on
which he was wounded.

Remarks on the Medical Topography of Texas, and on Vie Diseases
of the Army of Invasion. By George Johnson, M. D., late
Surgeon in the United States Army. (St. Louis Medical and Sur-
gical Journal.)

The Brazos Santiago Island, Texas, has become a place of much
importance since the present war with Mexico commenced. From
May last to the present time, all troops, destined for the "army of
occupation and invasion," have been landed at the Brazos, and on
account of the difficulties of transportation at the commencement of
the war, many of tlio regiments remained encamped upon the island
for several weeks. During the la mer, most of the volunteer

294 Medical Topography of Texas. [ May,

regiments have been stationed along the banks of the Rio Grande,
between Matamoras and the mouth of the river. Much has been
said in the newspapers, and elsewhere, on the unbealthfulness of this
region, but I have not seen the true causes assigned for the great
mortality which has occurred amongst our troops on the Rio Grande ;
I will, therefore, at your request, give you a brief sketch of the medi-
cal topography of this region, together with some of the causes which
have led to this mortality. Hereafter I hope to see this subject dis-
cussed by the medical officers of the army, many of whom have had
far better opportunities, than fell to my lot for obtaining correct in-
formation on this head, particularly those accomplished surgeons,
Drs. Wood and Wells, at Point Isabel, and Dr. Wright and his as-
sistants, at the general hospital at Matamoras.

The Brazos Island, it might be inferred from the many statements
that have been made, is particularly unhealthy, from its location.
This, I think, cannot be the case. Though a dreary and uninterest-
ing sand-bar, I believe it to be as healthful as Galveston, or any
other spot along the Gulf coast. This island is about four miles in
length, and one and a half in breadth. It would be almost level with
the Gulf, but for the sand hills which line its southern extremity for
half a mile. There are some two or three ponds on the island, called
on the maps of the country, fresh water ponds, though I found them
quite salty on trial. These ponds are situated about a mile and .1
half from the sand hills, (the place of encampment of the troops,) and
to the north. The sea breeze blows almost continually from the
south-west, so that no deleterious effects can arise from them. This
breeze usually commences about 9 A. M., and continues throughout
the night, making sleep delightful and refreshing. By it the sun's
heat is rendered less oppressive, and there was not a day so warm,
during our stay upon the island, which was during the month of
June, as to prevent the men of our regiment from perambulating it
from end to end, on fishing and hunting excursions. Here, too, the
men enjoyed the pleasure and benefit of bathing. I have understood
that the Mexicans considered the Brazos healthy, prior to the arrival
of our troops, and 1 learned from an American woman, a native of
North Carolina, who has lived upon the Island for several years, that
her family, consisting of six children, had enjoyed excellent health
since her residence there. Yet she had occupied, during the whole
lime, a miserable little shed, only partially covered with ox-hides.

The Mexicans who were taken prisoners at Palo Alto and Resaca
de la Palma, were employed in the Quartermaster's department, at
the Brazos, and though these men were exposed, day after day, to
the heat of the sun, in their labors about the shipping, yet I never
knew a case of sickness to occur amongst them. The other employ-
ees of the Quartermaster's department, such as teamsters, carpen-
ters, etc., also retained their health, whilst the troops at the same
period, were suffering with diarrhoeas and dysenteries. I accounted
for this circumstance, thus : these teamsters were making daily trips

1-47/ Medical Topography of Tests.

to the month of the Rio Grande, (nine miles,,) and they sent their

TT.Hv--.--. < ~ . . : ' ::'.-.:-.:-- 7. : : -.'.: i :-.' : ' ' ' i : - " h '

I hey had learned to cook their load properly, and they alept in

,. r .. .. , . : . . _..._. ., ,.....,.__._._. , . . . , . . . _ , ... . s ::.-.:-..;:!

lying under tents, upon the wet sand, eating food that was only par-

t,a ycy.^:.:-.: ::.-.': r : " : -... - . - l : ' : :'". ". ' . -. - -. ::. i : . :
,, ,. , ,, _.. ........ r .. .... .........

It is known to all military men, and to the professon, that dysente-
ries and diarrhoeas are eamp diseases, and are common to every
location where troops are encamped for a few weeks. Oar regiment
was encamped for about a week at Algiers, opposite Xew Orleans,
and it was very rainy weather during the time; in consequence,
dysenteric affections became numerous. At the present time, the
lr:::s :*: :r.r: i: Si.v.r 7: i*r s:fr- r : ~t-- - .:.. : ^r
aes, and it will not be denied that Santa Feisa healthy town.

The water used by the troops at the Brazos, is obtained by dig;
small wells in the sand, usually to the depth of two feet. The
ter obtained from a well recently made was not very
being the rain water contained in the upper surface of the sand, but
in a short time the salt water from beneath would be mixed with it,
t'.;i:}::r-.r.e' ::e - -. .'. :?-t. ?:.*. 5 : -.- \: - - - -r :: :::.-:i::j
t-z'.r.z r.zir. '-.T.i i* ::.-. sziiz :: .-.i : :; "" :- ::::? -: : - j !::::
half a mile in extent, and one hundred and fifty yards wide, (in rainy
and stormy weather all the rest of the Island being covered withwa-
r-r-. ir.i is :'... 5 sin: 2. ; .:r-r ;.:? :^r. :::: =-: :t ::::..-= ; ::*:::
20th of May last, even as many as three regiments have been sta-
tioned here at one time, it can readily be understood how the water
of:"- - r.izr s -fr::: ;.

The troops that have, from time to time, sojourned at
have been for the most pert volunteers, and they have
more to learn than the drill and discipline. They have been com-
pelled to take a lew lessons in the culinary art particularly so far
as related to the cooking of pork and
: is r. :::: 2 -.-::: :- - \ : : :' : - .: \:
than once. It would be fair to say that the
regiment are not half cooked, for, at least, the first month of service.
Besides, the voung soldier is apt to indulge in every excess. He
will lie down* 00 the wet ground without his blanket. Theold sol-
dier is more prudent be may drink a little too much whisker, (if be

_
heat at mid-day, in fishing or banting. Neither will he eat the
coarse and unwholesome food that a recruit will swallow with avidi-

-
not indulge in eating red fish, oysters and crabs, whilst on the Island.
Titer were influenced, in part "by the example of the Mexicans, who
eschew these luxuries daring the summer months.

The country between Matamoras and the mnatfc <n>f ihe R5a Grande,
is low. with lakes every few miles, between w2in-!b is interspersed

296 Medical Topography of Texas. [May,

the chapparel and prairie the only elevation being the ridge of Bu-
rita, upon which the village is situated, and one nearly parallel with
it on the opposite side of the river. These ridges, commencing at
Burita, extend up the river about a mile. These elevations have
been occupied by troops during the last summer, and I can speak for
those encamped upon the ridge of Burita, as having enjoyed a good
share of health. There was a marked improvement in the health of
the St. Louis Legion, after they encamped here. Red fish, oysters
and crabs, could not now be obtained. Good water was within reach,
and the beans were boiling in the camp kettles at an earlier hour
than formerly. Here, too, was felt the delightful and invigorating
sea-breeze, but sleep was not so sweet as at the Brazos. Centipedes,
(some of them six inches in length.) tarantulas, and other venomous
and creeping things, would travel over a man's nose, occasionally,
and wake him up before reveille.

Immediately south of Burita, there is a fresh water lake of con-
siderable size, and about half a mile on the opposite side of the ridge
there is a salt lake. Fresh and salt lakes may be seen in close con-
tiguity in this vicinity.

The Mexicans in Matamoras, and those who live at the ranchos in
the neighborhood are as healthy a looking people as I ever saw. 1
visited, during the months of July and August last, many ranchos,
where I saw children, and I do not remember to have seen one child
that had an unhealthy appearance. In many regions of this (Missis-
sippi) valley, during the same months, it would not be surprising to
find half the members of every family laboring under remittent and
intermittent fevers. The only sick Mexican I saw whilst in the
country, (except the wounded in the hospital at Matamoras,) was a
woman, with intermittent fever, at Brazos Island. I was afterwards
informed by an old Frenchman, who had lived for many years on a
rancho near Matamoras, that the fever and ague was the only disease
that prevailed in the neighborhood, but that the "chills" were not as
severe as those he used to have in Louisiana here the patient got
well in a few days, without, perhaps being obliged to keep the bed.

I hnve remarked that the Mexicans have, universally, good teeth
an indication, certainly, of good health, and I venture the assertion,
that there are as many old people, according to the population, as can
be found in any part of the United Slates. I will further state, that
in Matamoras, I became acquainted with several American merchants
who had resided in that city for several years. They informed me
that the country was healthy that they had enjoyed better health in
Mexico than in the United States. I therefore believe that the great
mortality amongst our troop?, upon the Rio Grande, during the last
summer, was owing to the imprudence of the men the bad cooking
to a neglect of proper police, in most of the volunteer regiments,
and to the necessity which compelled the soldier to lie upon the wet
ground during a rainy season.

In order to show the number of diarrhoea cases, in comparison with

1847.]

Medical Topography of Texas.

297

all other diseases, I will here give an extract from my monthly report
of "sick and wounded" for June. The regiment during that month,
was stationed at the Brazos Island.

NAME OF DISEASE.

-'

BEMA1X-

MEAN

-
-

i me.

_

-'

-

f

-.

' 5

>

'

jj~

*

-'.

-

r.

a

E

-

-

s

|

-

u

1

-=

-

"s.

-.

-

-

u

m

c

.-

g

-'

e

i

-
>

I

i-
-.
-

od
o

z.

-

-

-

-

-

a

-

<

-

-

W

-

-

u

i

H

170

9

36

18

6 2

7

1

:

a

o\ 8

K9|ia l|J38

is

30 601

631

Most of these cases of diarrhoea were preceded by colic, and could
bo traced to some imprudence in eating. The most successful mode
of treatment I found, was to empty the bowels with castor oil, parti-
cularly when there was tenderness or pain over the region of the ab-
domen, and then to administer large doses of opium. 3 or 4 grains,
at intervals of four hours, until the bowels were constipated, and,
after waiting forty-eight hours to give a dose of castor oil and lauda-
num. This was the only plan of treatment that was curative. Ilyd.
cum. craeia., dovers powder, with calomel, etc., were given without
success at first. Though the cases of diarrhoea were so numerous,
yet we did not lose a man out of our regiment with that disease.

Most of the cases of remittent and intermittent fevers supervened
upon diarrhoea. The remittent fevers were of a low form and very
obstinate in their character. What retarded recovery, especially in
these cases, was a despondent state into which almost every patient
sank. After a man had suffered with fever for a week, he cither
made up his mind to die, or became so dejected that it was almost
impossible to persuade him that he would recover, or to rouse his
feelings in any way. I saw a few cases of pure nostalgia, and I be-
lieve there were many such, during the fiist six months of service,
amongst the young men of the array. The marasmus, after remittent
fever, was striking, and convalescence remarkably Blow. These pa-
tients had the same cadaverous appearance and haggard expression
of countenance as is common to children who are laboring under
tabes mesenterica. There was also that loose and wrinkled condi-
tion of the skin of the abdomen which is common in such cases.
Diffusible stimulants were very freely given in these cases, and with
the most happy effect ;.

Two cases of wounds came under my notice that are worth men-
tioning, on account of the result. The first occurred in the Fifth
Louisiana Regiment, (Col. Peyton's,) whilst stationed at Burita.
Two men, previously good friends, had been drinking together, when
an altercation ensued, and oue of them drew a largr Bowie knife and

298 Report from Illinois Brigade. [May,

plunged it into the breast of the other. I reached the wounded man
at the same moment with the surgeon of his regiment. On examina-
tion, we found apiece of the lung, two and a half or three inches in
length, protruding from the wound, which was about an inch below
the left nipple the knife passing between the ribs, downwards and
outwards. The wound was at least three inches in length. After
consultation, we concluded to introduce the wounded portion of lung
within the thorax, and to close the external wound with the interrupt-
ed suture. The man was kept upon the most strict antiphlogistic
treatment, and some twelve or fifteen days after, when I last saw
him, there was every reason to believe that he would entirely recov-
er. The knife with which this wound was given was two inches wide,
and it must have penetrated the lung, four inches. .On reflection I
am not convinced that our practice in this case was the best that
could have been adopted. The wounded portion of lung had only
an attachment of three-fourths of an inch, and would it not have been
better surgery to have clipped it off than to have replaced it within
the cavity of the chest?

The other was a case of gun-shot wound, which occurred accident-
ally. A man was shot in the left axillae, with a musket ball ; the
man who fired the gun being immediately opposite, and about one
hundred and twenty yards distant. Being absent from camp I did
not see the wounded man until the evening of the second day after
the accident. On examination I could find no signs of the ball.
The man was laboring under distressing dyspnoea. I learned that
he had expectorated blood freely, when first shot, but now his cough
was suppressed and he could not expectorate at all. The left cavity
of the chest seemed to be half full of blood, and on raising the man
and turning him on the left side, at least half a pint of blood escaped
through the wound. The following day he was bled twice, and the
treatment was strictly anti-phlogistic. About a week after, the track
of the ball was plainly to be seen. After passing through the chest
it made its exit half way, and just below the spine of the scapula ;
thence glancing inwards and downwards, lodged near the spinous
process of the twelfth dorsal vertebra, where I extracted it. Beattie,
the man whose wound I have just been describing, lives in this city.
Prior to the accident he was a robust and healthy man, but he has
now become thin and wan, and is frequently troubled with a cough.

From Professor William B. Herrick, M. D., of the Rush Medi-
cal College at Chicago.

Ih Camp, near Mon Clova, Mexico, >
November 5, 184G. $
I am now writing in the vicinity of a Mexican town, containing
about 5000 inhabitants, situated between, and nearly surrounded by,
mountains.

1347.] Report from Illinois Brigade. 299

The distance from San Antonio, Texas (the point where the column
under General Wool was organized), is about 400 miles. We start-
ed from San Antonio the second day of October, and arrived here
the 2d of November, thus making a march of thirty days without
stopping.

This marching, day after day, so far into the interior of Mexico
without meeting with any opposition, and with no prospect of a fight,
causes a great deal of dissatisfaction, and is the subject of constant
complaint with our Illinois Volunteers.

When on the march, we start in the morning by sunrise, go from
12 to 15 miles without halting, excepting for a short time now and
then, and encamp for the rest of the day and following night, gener-
ally about 11 o'clock, A. M. As I remarked in a former letter, we
pass through all the towns in our way with drums beating and colors
flying. In the towns of most importance we take formal possession,
and plant the American Flag in the most public and conspicuous
position.

A few miles from each town we have, in every instance so far,
been met by the Alcalde, or ruler, with the principal men of the
place, as a deputation from the citizens; and it is by means of such
deputations that the people throughout this section of country, have
unanimously, as I believe, expressed their determination to offer no
opposition to our progress. In truth, it seems to be their wish, not
only to remain neutral in the contest between the United States and
their central government, but many of them openly express a desire
to become separated from it, and a wish to form a republic of their
own, or to come under the protection of that of the United States.

As an evidence of their oppressed condition, and to show from
whence this feeling originates, it may be stated that, according to
their representation, the ?flexican army, in marching through their
country, would live by robbing and plundering the inhabitants. The
officers of ours, on the other hand, treat them as friends when they
are friendly, and pay them fair prices for the means of subsistence.

With regard to the question, will it be good or bad policy to admit
this portion of ?riexico into the Union? intelligent men will of course
differ in opinion. For my own part, I do not believe the Mexicans,
as a mass, are, as yet, sufficiently far advanced in civilization and
intelligence to admit of their establishing and sustaining a truly le-
publican form of government ; and therefore it would be not only bad
policy, but dangerous, to endow them, at once, with the rights and
privileges of citizens of the United States.

As examples of their barbarous customs, and tyrannical laws, the
following may serve as specimens.

In many parts of the country matrimonial engagements are tem-
porary merely : it being a common custom, as I am informed, for
parties to agree to live together as man and wife for a few months
only, at the end of which time either is at liberty to dissolve the com-
pact. As an excuse for this demoralizing custom, they say that the

300 Report from Illinois Brigade. [May,

Indians have, in many parts of the country, destroyed so many of the
men, that there are to every male inhabitant five or six females, and
that unless such an indulgence be permitted, the population of their
towns will rapidly diminish, and eventually become entirely extinct.
Whether this be a sufficient reason or not for such an absurd and
ridiculous custom, our readers can, for themselves, determine.

One example of their oppressive laws, and we are done for this time
with Mexican institutions, and the character of the people.

In marching through this part of Mexico, we find the inhabitants,
not scattered over the country as in the United States, but collected
together, in towns from 20 to 50 miles apart, in the rich valleys
between the mountains. We frequently meet with a collection of
rude buildings surrounded by a wall, and inhabited by numerous
slaves who, like the herds of cattle, and many square leagues of land
in the vicinity, are owned by a single tyrant. An establishment of
this kind is called by the Mexicans, a hacienda.

The slaves thus condemned to servitude and a life of bondage are
not, like ours of the United States, marked by nature as a different
race of beings from their masters, but in many cases, the Mexican
slave is as well formed, physically, and is as intelligent as the tyrant
who owns and governs him.

This being the case, the question naturally arises, why is it that
people of the same race, not differing materially in natural endow-
ments, are a few of them masters and the rest slaves?

This state of society results from a most tyrannical law, which
provides that whenever one person becomes indebted to another, the
debtor, unless he is able to make immediate payment, becomes at
once the slave of the creditor, and is obliged to labor for him at a
rate not exceeding 3 or 4 dollars per month, till the demand is can-
celled. The amount earned, in this way, by the debtor, is often less
than the sum required for his subsistence, consequently he is obliged
to purchase on credit still more of his master, and thus to perpetuate a
life of bondage.

The worst feature in this system of slavery for debts is, doubtless,
that which provides for the perpetuation of this life of bondage ; for
it is not the debtor alone that is bound thus to give up his liberty, but his
children inherit his debts, and with them loose the rights of free men.

Having thus given a few hints concerning the customs and laws
of the Mexicans, we will now proceed to the consideration of a sub-
ject which more immediately interests the people of Illinois, especially
the medical men of our State.

Since joining the army, I have, for the most part of the time, been
the only medical officer attached to the 1st regiment of Illinois Vol-
unteers, and can of course speak with entire confidence, with regard
to the diseases which have prevailed among the volunteers of this
regiment.

On entering upon the duties of my office at Camp Crocket, near
San Antonio, Texas, I found from 69 to 70 on the sick report. Of

1347. J A New Plan of Medical Reform. SOI

the cases thus reported, a majority were miasmatic fevers of a mild
grade, which yielded readily to gentle laxatives and quinine, in doses
of from 10 to 15 grains in the course of 24 hours.

This kind of treatment soon reduced the number of sick from 75 to
40, in a command of about 800 men. My experience, so fir, in the
army, with this ciass of diseases, has fully confirmed my belief in the
utility of administering large doses of this most efficient remedy in
miasmatic diseases. 1 have given it in all stages of these fevers,
with uniform success, and without, at any time, producing unfavora-
ble results. Diarrhoea is another disease very prevalent in the army ;
but, in most cases, it is of a mild form and yields readily to some mild
mercurial, such as blue pill followed by, or combined with, opium and
camphor. There are a few cases of a chronic form however, that
do not yield so readily, but continue obstinately to debilitate the
patients and produce emaciation. Many of ihese, I have no doubt,
are dependent upon an ulcerated condition of the mucous membrane,
whilst others perhaps result from torpid or diseased livers.

But of all the diseases to which the volunteers have been subject,
those of the lungs consequent upon measles, have been the most de-
structive to life. From what I could learn of the diseases, previous
to my joining my regiment, nine-tenths of those which proved fatal
were of the lungs, and in all the cases, the patients had had measles
whilst on the march, or in camp, in cold tents and sleeping upon the
ground. To those acquainted with the progress of this cutaneous
disease, and its tendency to produce lung affections under any circum-
stances, it will not appear strange that it was the cause of fatal results
in so many cases, nor will they be surprised to learn, that all kinds of
treatment under the circumstances proved of little or no avail.

We are now on our march through the high lands of Mexico,
where there are, probably, as few causes of disease, as in any section
of the world. It is to be expected, therefore, that unless we get into
a brush with the Mexicans, and as a consequence, have a few surgical
cases, we shall have but little of professional interest to communicate.
Still, we shall not let any opportunity pass, of giving to our readers
interesting intelligence, whether it be of a professional or general
nature.

To those who are hypochondriacal or who can enjoy a hearty
laugh, we recommend the following professional witticism :

A New Plan of Medical Reform.

To the Editor of the Boston Medical and Surgical Journal :

My Dear Sir, The causes that contribute to the origin and sus-
tenance of empiricism, are subjects of interesting investigation at the
present time. I think it a matter of regret, that many influential

303 A New Plan of Jledical Reform. [May,

persons, fired by an ill-judged scientific zeal, have endeavored, by
sober argumentation and rules of logic, to demolish the prevailing
systems of quackery. All past experience proves, very conclusively,
that to convince a man's judgment when his prejudices are enlisted
on the opposite side, is a hopeless undertaking. Who ever heard of
a single convert being made by a religious controversy? The an-
tagonists themselves commence their set-to in all the over-boiling
exuberance of christian charity like a couple of friends sparring.
One finally gives the other a dab which sets his nose to bleeding; he
retaliates, and their light sparring becomes a serious matter of fist
and scull.

Our friends of the schools militant commence their attack upon
the quacks, by the declaration of sundry sound and indubitable aphor-
isms such as " truths are stubborn things," &c. To this I reply,
" and so are asses ;" there is nothing more difficult than to drive one
of these long-eared gentry one way, when he pertinaciously sets his
mind upon travelling another. Send a country lad to drive a pig:
does he endeavor by compulsion to get the contumacious brute to
walk offin the desired direction ? Not he ; he knows by experience
that he would only gel his labor for his pains the pig, like FalslafF,
will "give no man a reason on compulsion." The only way to suc-
ceed easily is to make the spirit of insubordination subserve his pur-
noses, and he catches the animal by the tail to pull him in the opposite
direction. Any other plan, he will tell you is all gammon.

The wrong plan has been adopted for the opposition of homoeopa-
thy. Denunciations have been forged, and hurled with thundering
sound, to no effect, and the credulity which enshrouds men's faculties,
leaves them blind and willing victims to the doctrine of infinitesimal
doses. The system has been handled with rough ceremony, and the
monstrous faith in less-than-nothing doses assailed with the fury and
indignation so easily excited by a threatened invasion of pecuniary
interest; but the gaping crowd still swallow the little powders, and
Herr Homoeopath laughs in his sleeve as he pockets the fat fees so
easily fished from the pockets of credulous hypochondriacs and hys-
terical women.

You are wrong, gentlemen! Cease your opposition; admit the
truth of Hahnemann's nonsense ; nay, outstrip him in fertility of
invention and deception. If a homoeopath tells you that a globule of
sugar, moistened with the 30th dilution of a given remedy, and ap-
plied to the nostrils of a patient in extremis, will relieve him, reply to
him, and shout to the world that we have a remedy, so exquisitely
powerful in its influence upon the animal machine, and only known
to allopathic physicians, that the same globule moistened with the
300 dilution (! ! !) and applied to the nether end of a dead man, will
bring him to life! You must learn the game of brag, and always
"go better." Try your d st (excuse Kentucky vernacular) to per-
suade people that there is really nothing strange in homoeopathy,
compared with some half-hatched system with which you arc about

18-17.] A New Plan of Medical Reform. 803

to astound the world, catch the pig by the tail, and two to one the
" Dutch doctors" will soon be found upon some other hobby, de-
nouncing their quandam favorite as the most insignificant, irrational,
and transparent hoax that was ever devised and attempted.

So with hydropathy. If Priessnitz swears that he cures his pa-
tients by pouring cold water by the gallon down their throats, turn
up your noses at him, and tell the world that you are much more suc-
cessful by squirting buckets full of hot water up the back way.

He assails the enemy in front, you behind he carries the citadel
by storm, you by surprise; and I appeal to all authority to decide
which manoeuvre is the safest and best. If he publishes tables of
cases that show a success amounting to 75 per cent., you publish
larger tables, and claim 95 per cent. ! Admitting that you do not
adhere to veracity, and that you are charged with it; you may be
thankful that it is so, raise the cry of persecution, and your fortunes
are sure.

A good while since, after Harvey had enlightened us concerning
the circulation, it was announced to the world that life might be pre-
served, ad infinitum, by the process of transfusion. Old people prick-
ed up their ears, and eagerly stretched out their emaciated arms to
receive a-new the vital current from a sheep! What a captivating
idea! 'The grand secret of earthly immortality resting upon the
piston of a pewter squirt ! How the sublime blends down into beau-
tiful harmony with the ridiculous! For a time syringes "looked
up." But it was soon discovered that this great idea was "as the
baseless fabric of a vision." And yet this was the wisdom of Solo-
mon, compared with some notions fashionable in our day of new
lights.

Homoeopathy is certainly a very popular delusion, and, like some
other delusions, exceedingly agreeable, if we could only persuade
ourselves of its truth. Who would not rather be cured, " cito et
juncunde" by the sugar of milk, than to die, " secundem artem"
under the remorseless fire of a "regular practitioner's" prescription?
What if a man is told, by sneering opponents of the system, that the
homoeopathic medicine is a very near approach to pap, and that it is
exceedingly appropriate to his infantile credulity!

Let those laugh that win. There has been a good deal of specula-
tion concerning the origin of homoeopathy. It has been attributed to
ignorance, superstition and craft, and some are even uncharitable
enough to believe that Hahnemann himself acknowledged, before his
death, that it was all a humbug. I profess, Mr.' Editor, to be an ob-
serving man, and I think lean explain the matter to the satisfaction
of every reasonable individual, of course including yourself in the
category.

You remember, doubtless, that in old times people had no nerves
the old gentleman in the play said that he never had any in his life.
Nerves and hysterics are things of purely modern invention. The
" vapors" and the " blues" owe their existence to the " conventionali-

30-4 A New Plan of Medical Reform. [May,

ties of fashionable society." The hyper-sensibility which has, in
these latter days, come to be considered the indispensable of refine-
ment and fashion, seems to have extended to the stomach and bowels.
A while since, an honest, rousing dose of physic was required to
make an impression upon the sturdy organs of a patient the en-
counter between the doctor and the disease was a fair stand-up fight,
soon ended with hard blows, and no favors asked. But the fashion
of us moderns, which makes a man the creation of starched dickies,
high-heeled boots and starched waistcoats the thing of a barber's
brush. and a tailor's yard stick; and angelic woman, a swaddling
lusus a heterogeneous compound of wad of cotton, French chalk,
buckram, and strips of whalebone, has drawn so exquisitely fine the
delicate cords of sensibility, that the " 30th dilution" applied to the
nose proves perfectly overpowering. There are thousands of per-
sons, now-a-days, of both sexes, who under proper circumstances,
can die Pope's aromatic death. Of course they come to life again,
modestly expecting the performance to be encored ! Great heaven !
What is the world coming to, when sacred sensibility is worn as a
harlequin's dress, to amuse an audience, and monkeys are become
the highest objects of emulation to mankind? "Just to that point
[remarks an ill-natured friend at my elbow] which so far divests them
of common sense, as to make men credulous of infinitesimal agen-
cies." Softly, my dear sir, we must take the world as we find it.

Do you not perceive that Hahnemann's system is the offspring of
necessity and of nerves? You would begin your reformation where
it ought to end: if you restore mankind to a state of health, bodily
and mentally, and blunt by proper education the morbid sensibility of
the nerves, homoeopathy will die a natural death; but destroy at
once the little globules, and what becomes of human nature!

Besides all this Mr. Editor, we profess to be a little wiser than our
fathers. I fancy, sir, that we require something a little more pre-
tending than sheep saffron and barn-yard poultices to suit the taste of
the present generation. If we cure disease by conjuration which
they encountered with the awful list of pills, portions and plasters;
why not? We can even quote precedent for our practices. There
was a famous pill, celebrated in Pindaric verse, which, with your
permission, I will copy.

" A bumpkin came among the rest,

And thus the man of pill addressed:

1 Zur, hearing what is come to pass,

That your fine pill hath cured the king,

And able to do everything,

D'ye you think, zur, t'will make me find my ass?

I've lost my ass, zur, zo should like to try it ;

If this be your opinion, zur, I'll buy it.'

' Undoubtly!' the quack replied,

' Yes, master Hob, it should be tried.'

Then down Hob's gullet, cure or kill,

The grand imposter pushed the pill.

Hob paid his fee, and off he went ;

And traveling on about an hour.

1847. J Bloody Vesicle of the Vagina. SOfl

lowelssore with paitss were rer.t;
Sue:. rprising power,

;nger able !
Hob in a hurr lame,

And sought the grove where Hob's two eyes,
"Wide staring, saw with huge surprise
His long-eared servant Jack, his

I!' quolh Rch;
1 Yes, yes, the pill Lath done the jc

"Globules (remarks again my crusty friend) have discovered more
asses in these times than did Pino -ir's pills; and what is stranger, all
are affected with the mange, the itch, or something worse!" But,
my good sir, this is not the fault of the system of Hahnemann. That
fact dues not condemn, by any means, the sugar of milk; only the
mal-practice, and filthy habits of the times. We must do penance,
in mercury and sulphur, for past peccadilloes, and thank God if this is
the nearest acquaintance we are destined to have with brimstone.
Alopathy has done nothing more (we are told,) in 2500 years, than
to discover these two specifics, and homoeopathy, forsooth, must teach
her to employ these properly! It remains to he seen what* the
Young Physic,1' recently born under Dr. Forbes' obstetric man-
agement, will accomplish. Until then, with an apology for the
length of this straggling epistle, allow me to subscribe myself, with
great respect, Y'our ob't servant,

Lexington, Ky., Nov. 11th, 1843. Old Physic.

Bloody Vesicle of the Vagina. By John A. Gotten, M. D., of
Greenwood, Mississippi. (Western Journal.)

July 7th, 1837, Dr. Stokes and myself were called to see a servant
girl of Mr. E. II. Stone, then of Madison county, Miss. The patient
was aged about twenty-three years, decidedly above ordinary size,
well proportioned, and of sound constitution. She was between seven
and eight months advanced in pregnancy, and complained of an in-
cessant itching and burning sensation at the vulva, accompanied by
general constitutional disturbance. Upon examination, we found
situated within the vagina, about one inch from the sphincter, an
exceedingly vascular tumor, very elastic, of an oval form, about one
inch in diameter. The woman informed us that the growth had been
very gradual, and the uneasiness -proportioned to its size, the pain
increasing with the growth of the tumor. To be more specific, the
tumor had been about a month acquiring the size to which it had
attained when we saw it. In appearance and consistency it resem-
bled more than any thing else a bloody vesicle filled to its greatest
capacity. Thinking as we did that the gravid uterus afforded the
best rationale of the complaint, we took from the arm of the patient
about twenty ounces of blood, ordered a saline cathartic, cold astrin-

20

30G Use of the Hydriodale of Potassa. [May,

gent washes to the parts, low diet and the recumbent posture. This
plan of treatment was persisted in for about ten days, without check-
ing in the least the progress of the disease.

Having failed in this attempt to disperse the tumor, and no pulsa-
tion being perceptible, it was proposed to evacuate the tumor by
puncture, and accordingly Dr. Stokes made a small opening with a
thumb lancet. A stream of dark venous blood, of fully the size and
force of that in venesection from the arm, followed the operation.
We suffered the blood to flow to the extent of about ten ounces, with-
out the slightest diminution in the size of the tumor, the supply being
fully equal to the loss. We began now to suspect that the tumor
was aneurismal in its nature. All efforts to arrest the flow of blood
by compression proved abortive. I finally proposed strangulation
with the ligature, and, Dr. Stokes concurring in the suggestion, I
immediately passed a curved needle, armed with a strong thread, be-
low the base of the tumor, and divided the ligature so as to embrace
the posterior half with one portion of the thread and the anterior with
theother. The ligature was tightly drawn around the respective
portions of the tumor, and the hemorrhage immediately ceased.

On the fourth day the strangulated portion sloughed, and the pa-
tient appeared to be doing well for a few days ; but in a little while
the same itching, burning sensation which characterized the pain of
the first tumor began to manifest itself still higher up the vaginal
canal. Careful examination brought to view another tumor of the
same appearance and about half the size of the first. After much
difficulty, we succeeded in embracing with a double ligature the base
of this tumor also, as we had practised in the first. In due time it
sloughed, and all unpleasant symptoms subsided. At the full term,
our patient gave birth to a well grown and healthy child.

It is now more than nine years since the removal of the tumors,
and though the woman has given birth to three or four children
since, there has been no return of the disease.

On the Use of the Hydriodale of Potassa. By Augustus Van
Buken, M. D., Assistant Physician to Bellevue Hospital. (N. Y.
Journ. of Med.)

John Daly, aged 38, native of Ireland. Admitted in the Peni-
tentiary Hospital, Blackweli's Island, with a primary chancre, near-
ly healed, and three large and deeply-excavated buboes, with jagged
and indurated edges, nearly resembling cartilage.

He had had syphilis four years before, but has never enjoyed good
health since, being much affected every spring and fall with rheum-
atic pains ; complains now of aching pain in bones, and severe head-
ache, with partial remissions in the morning; has been salivated in
the city before entering the hospital.

1847.] Aneurism by Compression. 307

He commenced taking sixty grains a day of the iod. potass, in
solution with syrup and water ; this dose was in a few days increased
to one hundred and twenty grains ; the sores were dressed with
poultices of bread and flax-seed, and the pulv. cantharides sprinkled
on some three or four times; in a few days healthy granules were
seen peeping up, and the s-ores began to take on a healthy action.

The dose of 120 grains per diem was kept up for twenty days
without any apparent ill effects, or the usual results of large doses
of the hydriod. potass.; the skin, instead of breaking out in pimples,
gradually assumed a dusky brown colour, somewhat resembling the
effects of long-continued doses of the nitras argenti.

The sores were now healing rapidly, pains much diminished, appe-
tite good, and able to rest very well at night.

On the thirty. first day after admission, and the twenty-first of the
120 grains, thinking to expedite his cure, he swallowed during twelve
hours, the remainder of a solution containing about 300 grains.

Six hours after he was seized with violent pains in the head and
6tomach ; countenance anxious, tongue coated, pulse small and very
quick. These symptoms, notwithstanding all treatment, gradually
increased to delirium, which lasted for 48 hours, after which they
slowly abated, and in twelve days more he was discharged cured.

The sores were now completely healed, leaving that depressed,
shiny, and dusky brown color, peculiar to syphilitic cicatrices ; the
pains in bones had disappeared, and he was now able to rest well at
night ; since then he has been daily employed working out stone in
the quarry, and is apparently in possession of good health.

This is one of a number of cases of the same kind, where the
dose of the hydriodate was carried to a great extent; but the only
one where it was not followed by those peculiar eruptions on the
skin, which in this institution are found to be one of the common
accompaniments of large and continued doses of the iodide of po-
tassium.

The above case is in corroboration of the experience of Dr. El-
liotson, as described by him in the London Lancet, for the years 1831
and 32, page 728. And also of Dr. Buchanan, in the London Med-
ical Gazette, Vol. XVIII., page 519. Dr. E. states, that on many
occasions he exhibited two drachms of the iodide three times a day,
not only without any injurious effects, but with decided and marked
improvement to his patients. Dr. B. is stated to have given it to
the great extent of 1J oz. a day' with similar results.

Aneurism by Compression. (Dublin Quarterly Journal.)

On this subject wo notice the accidental discovery, by a patient
of Dr. Harrison, of the application of a number of clamps (such as
used by joiners and cabinet-makers, to secure their glued wood- work,)

303

Aneurism by Compression.

[May,

along the course of the artery, proving it not to be necessary com-
pletely to arrest the pulsation in the tumor; but by causing a lessen-
ed current of blood through it, produce coagulation and a contraction
of the sac. (Mr. Wilde.)

Dr. Bellingham applies two compressing instruments upon sepa-
rate parts of the limb, one tightened, the other not ; and by thus
alternating the pressure, producing the same effect as if constant
compression were maintained at one point, the patient being enabled
to bear it for a much longer period than other instruments.

Tabular arrangement of all the Cases of Femoral and Popliteal An-
eurism which have been treated by pressure on the Femoral Arteries
in Great Britain and Ireland,

No.

Date.

Surgeon.

Locality.

Description
of

Age of

Result.

Aneurism.

patient

l

2
3

1820

Mr. Todd

CI

1 Dublin

Popliteal

30

27
36

Fern. Art. tied.

la

1825

ii

<(

it

Cured.

4

1824

Mr. Dnggan

N

Femoral

33

"

5

1826

Mr. Cusack

14

Popliteal

ii

Fern. Art. tied.

6

1813

ii

"

<<

55

Cured.

7

1844

"

11

"

26

it

8

1S4G

u

"

(<

33

u

9

1830

Sir P. Crampton

(1

Femoral

36

"

10

1842

Mr. Hutton

"

Popliteal

30

u

11

1843

Dr. Bellingham

((

"

32

((

12

18 44

<(

"

Femoral

35

"

13

1846

K

"

Popliteal

40

Doubtful.

14

1843

Mr. Liston

London

Femoral

30

Cured.

15

1844

a

ii

ii

53

"

16

1843

Dr. Harrison

Dublin

Popliteal

29

ii

17

1814

Mr. Kirby

"

ii

28

R

18

Mr. Allen

Haslar Hosp.

"

32

11

19

Mr. Greatrex

London

(C

27

II

20

it

Mr. Porter

Dublin

((

29

"

21

1845

u

ii

II

"

"

22

1844

Mr. Jolley

Torbay

<(

28

SI

23

1843

Mr. Harrison

Bristol

"

42

Fem. Art. tied.

24

1845

Mr. Dartnell

Chatham

II

38

Cured.

25

1846

Mr. Mackern

Litherland

Femoral

30

"

26

1845

Mr. Storks

London

Popliteal

32

(c

27

1846

<<

"

"

24

ti

28

1845

Mr. O'Farrell

Dublin

it

32

(<

29

1S46

c:

r

u

37

ii

Thus 29 cases of aneurism 6 femoral and 23 popliteal have
been treated by pressure upon the artery leading to the sac; in 4
the femoral artery was tied, chiefly from want of confidence in
pressure, on the part of either surgeon or patient, and in 25 instances
this mode of treatment was successful. Mr. Todd's three cases.
Sir Philip Crampton's case, Mr. Duggan's case, Mr. Cusack's case
in 182G, and also that of Dr. Molloy and Mr. O'FarrelPs two cases,

1847.] Hydrocephalus treated by Iodide of Potassium. 309

have not been before introduced into any of the notices or tables of
this operation which have appeared in the periodicals.

In ten instances, local pressure on the aneurisraal tumor by means
of pads and bandages was used, in addition to the pressure by the
instrument. An examination of the published cases will show how
irregularly the pressure was applied ; and it is quite apparent that its
removal at a particular time, even for a few minutes, and allowing
the flow of blood through the sac again to take place, will undo all
that had been before effected. It is, moreover, very possible, that in
many instances the pressure has been continued far longer than was
necessary.

Case of Hydrocephalus successfully treated by Iodide of Potassium.
By Lyman Bkackett, M. D., of Rochester, Fulton co., Indiana.
(Illinois and Indiana Medical and Surgical Journal.)

Josephine S. aetat 6 years, was seized on the first of April, 1846,
with the usual symptoms of Hydrocephalus, which continued to pro-
gress, in defiance of the most active treatment, given with a view of
checking the inflammation and preventing the effusion of serum, the
symptoms of which have given the name of hydrocephalus to this
truly obstinate and at times, fatal disease. The inflammation con-
tinued, and effusion took place (as indicated by the symptoms) after
the usual course had been steadily and perseveringly tried for the
space of two weeks. During the last six days of this time she had
been lying insensible to sight and sound ; pupils very widely dilated
and insensible to the strongest light. Continually rolling her head
from side to side. Hemiplegia of right side and partial paralysis of
the left. Incessantly moaning, except when she would throw her
left hand to her head, and cry out as if in great distress. This hap-
pened about every half hour. Vomiting would almost invariably
happen when she was raised in bed into a sitting posture. Involun-
tary passage of fasces and urine. Then after having tried all other
customary remedies, I resolved on using the iodide potassium, know-
ing she could not long survive in her then condition.

I began by giving an aqueous solution of the iodide (composed of
iodide of potassium, 3i to 5 water,) gtt. xv. every three hours in-
creasing the dose gradual!}' to 30 gtt. An evident amendment was
the next day perceptible, when some soreness o[ the mouth and
bleeding of the gums took place. From thence forward she improv-
ed rapidly, and on the fourth day from commencing the iodide, I had
the satisfaction of pronounci ng her out of danger. The loss of power
over the muscles of locomotion and of speech was not, however, per-
fectly relieved by it. but was restored by the epidermic application
of a solution of strychnine along the course of the spinal column.

310 Bibliographical [May,

The solution of strychnine was of the following composition:
Strychnine, grs. viii. ; acetic acid 3i. ; alcohol i : If you think the
preceding case is worthy of a place in your Journal you will please
publish it. 1 have made it a3 brief as possible that it might not
occupy too' much space.

BIBLIOGRAPHICAL.

1. A Practical Treatise on Inflammation, Ulceration and Indura-
tion of the Neck of the Uterus. With remarks on the value of
Leucorrhoea and Prolapsus Uteri, as symptoms of Uterine Disease.
By James Henry Bennet, M. D.

A small monograph bearing the above title, has recently been
republished by Messrs. Lea & Bianchard, Philadelphia. The many
able works that have recently issued from the press, on the Diseases
of Females, especially those of Churchill, Lever, Ashwell Lee and
Colombat D'lsere, seemed to have left little to expect or desire on
the pathology and treatment of uterine diseases; but this little book
cannot be regarded otherwise than as a valuable acquisition.

The excellent opportuniiies Dr. Bennet enjoyed, as Physician
"interne" in some of the principal Hospitals in Paris, of observing
the practice of some of the most eminent physicians of that metrop-
olis, and of investigating uterine diseases, has enabled him to explain
more satisfactorily than has hitherto been done the nature and causes,
and to furnish some useful information on the subject of the thera-
peutics of inflammation, induration and ulceration of the cervix uteri,
which he justly considers the most common of all uterine lesions.

The extreme frequency with which the speculum is employed in
Paris, not only in investigating diseases of the womb and vagina, but
in examining all licensed prostitutes and all women who, after being
brought before the police, are not claimed in a certain time by two
respectable citizens, affords physicians opportunities for studying
uterine pathology, which they cannot obtain in the United States or
Great Britain, especially in private practice, where female delicacy
in itself most laudable, when not carried to a culpable degree, and
the more criminal remissness of physicians, in not urging the impor-
tance of such examinations, often cause them to be delayed until too
late to profit by the information furnished by them. Many deplora-
ble instances in this city might be adduced, if it were necessary, to
prove this position.

From the customs referred to in Paris, diseases of the mouth and

1847.] Bibliographical 311

neck of the uterus are often detected in their incipiency, sometimes
even before they are suspected by the patients themselves ; in which
stage they generally yield promptly to iocal applications, with little
or no constitutional treatment.

In private practice in the United States, local applications by in-
unction and different kinds of cautery, are too much neglected, but
the practitioner cannot expect ihe same satisfactory success that Dr.
Bennet enjoyed in the Parisian Hospitals, inasmuch as he has to
contend with more inveterate cases which will call in requisition as
adjuvants the preparations of mercury and of iodine, chalybeate
tonics and other internal remedies.

We cannot recommend too highly this little book to the attention
of all physicians who desire to understand the pathology and treat,
ment of some of the most frequent diseases peculiar to women.

J. A. E.

2. Lectures on Natural and Difficult Parturition. By Edward
William Murphy, A. M., M. D., Professor of Midwifery in the
University College, London, &c, &c.

A work bearing the above title has recently been issued from the
press of Messrs. Samuel S. & William Wood, New York. This is
not a complete system of Midwifery, but a series of lectures on natu-
ral and difficult parturition, and several important subjects connected
with the principles and practice of obstetrics.

The author's views and principles are sound, judicious and highly
practical : he treats every subject on which he touches in a scientific,
able and masterly manner. We only experienced one regret after
reading this work, an unusual one, that he had not written more
that he had not comprised in his lectures other important subjects on
which we desired to have his opinions and the result of his ample ex-
perience. We hope the next edition will be more comprehensive.
In its present form it is a valuable work, and worthy the studious
perusal of every practitioner, as well as student of Midwifery.

J. A. E.

3. Velpcau's Operative Surgery. Mott. vol. III. New York, 1817.
Samuel S. and William Wood, publishers, pp. HOC. With an
Atlas of 21 Plates.

In a previous and recent Xo. of this Journal, we took occasion to
give our opinion of this work. The translation of Vdpeau's iironf.
est publication issued in Paris 1839, baa mow been comjh ted by Dr

312 Bibliographical. Asphyxia Neonatorum. [Ma>\

Townsend of New York, with the addition of several hundred pages
furnished by Dr. Mott of the same city. The work has been pub-
lished in three immense volumes, numbering over 3000 pages, besides
the Atlas of plates.

We have nothing to add to our former opinion, which is one of
regret and mortification too, that Dr. Mott should have condescended
to play second to his junior, M. Velpean, instead of publishing a Sur-
gery of his own. We have believed, and still consider him second
to no man living as a surgeon ; and we are greatiy surprised in ex-
amining the plates to find not a single instrument added by him.
The Atlas is literally an exact copy of Velpeau's, issued in Paris eight
years ago.

4. Scrofula: its nature, its canoes, its prevalence, and the principles
of Treatment. By Be:\\t. Phillips. F. R. S., &c. Illustrated
with an engraved Plate. Philadelphia: Lea & Blanchard, 1848,
pp. 350.

This work has also been noticed in our Journal from the English
edition, and we have only referred to it, to acknowledge the renewed
obligation we are under to its generous publishers, for a copy issued
by them. This is the best work extant on the all-important subject
of Scrofula.

PART III. MONTHLY PERISCOPE.

Asphyxia Neonatorum. ?vl. Depaul has written a very elaborate
paper on the subject of artificial respiration, as a means of rescussi-
tating still-born children. Ke instituted a series of experiments on
the dead subject, with the view of determining the amount of danger
of injuring the lungs by the insufflation of -air. He satisfied himself
that this danger is almost an imaginary one, since, even after the
lungs were removed from the body, it required several most forcible
insufflations, far stronger than would ever be made in the case of a
still-born child, to produce rupture of the pulmonary vesicles. On
the other hand, he was struck with the great force needed thoroughly
to inflate the lungs, while their resiliency was sufficient to expel the
greater part of the air. Pie found, moreover, in many cases where
children had Hied suddenly after breathing for several hours or days,
no other morbid appearance than an unexpanded condition of a large
portion of the lungs. With reference to the mode of practising arti-
ficial respiration, lie condemns the mere blowing into the mouth as

1847.] Results of Drinking. Blindness caused by Quinine. 313

inadequate, and recommends the use of n trachea] tube. He is of
opinion that there is more danger of failing j'rom imperfect insuffla-
tion than of doing harm by its too forcible performance. It is of
importance, likewise, that it should net he suspended on the first sign
of breathing;, but continued until the child cries loudly and respires
well. [West's Report. American Journ. of Sciences.

On the Results vf Drinking. By W. Ormbbod, Esq. Of all dis-
eases of internal organs produced by drinking, the granular liver
seems to have attracted most attention perhaps justly ; but there is
no doubt, that of all organic diseases, the two most to be feared in
intemperate persons with recent surgical injuries, are the granular
kidney, and slight, but general emphysema, with a dilated, but not
always much diseased heart; and in persons past the middle of life,
dying rapidly in hospitals, after operations and surgical injuries,
combined with much loss of blood, these two affections of the urinary
and respiratory organs are very far from uncommon.

The three chief affections destroying patients after operations and
injuries, namely, the genera! habit produced by drinking ; secondly,
organic disease of the lungs and kidneys, especially emphysema in
the former, and granular disease in the latter: and, thirdly, tuber-
cle, act verydii, nd at different periods. During the early
period, and often for weeks after operations, patients laboring under
tubercular disease do well ; and it is often only at the absolute return
to health, rather than during the recovery of the patient from the
operation itself, that the effects of tubercle begin to chow themselves.
Organic disease produced r-y drunkenness, and habitual drunkenness,
act differently : the organic disease presses heavily at every period,
and may destroy life early or Jate : but the mere habits of the drunk-
ard show themselves chiefly at a very early period. The patient
who nearly sinks from his unsound organs within the first few days,
often lags on for weeks and months in danger ; but the man who has
simple delirium tremens is taken ill directly, and often dies ; but if he
recovers from his delirium, he generally gets well from the operation,
and sometimes quickly. [London Lancet,

Blindness caused ly the use of the Sulphate of Quinine. Bv Joiin
M'Leaxt, M. D., Prof, of Mat. "Med. in the Rush Medical College.

Four cases of blindness are reported by Prof. M'Lean, which he at-
tributes to the use of Quinine. In these cases the medicine was
administered in large doses; in one, sixteen grains were ordered
every hour, and continued until nearly an ounce was taken. The
report closes with the following remarks: We think it clear that
the blindness in the foregoing cases was the eflect of the quinine ;
for we see it in each, coming on suddenly during its administration
in large quantities, and at a tunc, when no other medicine was given
that would be likely to produce such results. Here, cause and * fleet
appear to be closely connected, and are so plain, ns scarcely to admit

314 Irritable Stomach. Whooping Cough. Rheumatism. [May,

of the possibility of a doubt. From the symptoms acccompanying the
foregoing cases, we should judge that the proximate cause of the
blindness, was mainly an affection of the retina or optic nerve, pro-
ducing amaurosis. [lll.andlnd. Med. and Surg. Journal.

Treatment of Irritability of the Stomach. In irritability of the
stomach, with the deposit of earthy phosphates, arising from derange-
ment of the functions of the spinal cord, and evinced by emaciated
countenance, burning, gnawing pain inscrob. cordis, and heavy pain
across the loins, tongue clean and red, pulse quick and sharp, skin
dry and imperspirable, with vomiting after meals; try strychnia, as
in the following formula: Strychnia gr. j., acidi nitrici dil. 3i.,
aquae xij., solve, at sumat seger, flat gj. ter in die, and rub the scrob.
with a liniment of croton oil ; milk dietary, consisting of eighteen
ounces of bread, one ounce of butter, and two pints of milk daily.
The medicine to be taken fifteen minutes after each meal. The
strychnia acts particularly upon the spinal marrow ; and it is suppos-
ed that when alkaline urine is secreted, independently of the charac-
ter of the ingesta, there is always some lesion of this part. (Dr. Bird.)

Unfermented bread is said to be useful where there is habitual
headache, acidity of stomach, flatulence, eructations, sinking at the
pit of the stomach, and pain after meals; in fact, in confirmed indi-
gestion, and to all who are subject to gout and gravel. [Braithwaite's
Retrospect.

_____

Whooping Cough. Purgation with calomel; if febrile symptoms,
calomel and antimony ; an occasional emetic, and small and repeated
doses of carbonate of potassa, or the following formula: Potassae
carb., 3j.; coccus cacti, gr. x.; aq. fervent, q. s. The dose accord-
ing to age ; for an infant, a tea-spoonful thrice daily. (Dr. Allnatt.)

Dr. Wachtl, of Vienna, recommends the ammoniated tincture of
cochineal.

In the first stage, mild antiphlogistic^, daMy emetics, and strict
confinement to the house, except in summer months. In the latter
stages give the following : Tincture of cantharides, tinct. of opium,
comp. aa. gss.; tinct. cinch, co. gvss. A tea-spoonful to be taken
three times a-day in a little boiling water; the dose to be increased
if no strangury is produced. Be careful, however, at all times, not to
give opium if it can be avoided. (Drs. Graves and M'Gregor.) lb.

Chronic Rheumatism. A man 40 years of age, complained of
chronic rheumatic pains. He was directed the following mixture:
ft. Syr. Sarsaparilla, ... siii.
Tinct. Colchici, .... i.
Hyd. Potassa, . . . . 3iii. M.
Thirty drops to be taken three times a day. [N. Y. Medical and
Surgical Reporter.

1847.] Treatment of Diabetes. 315

Treatment of Diabetes. Glucosuria. Diet. Strictly forbid all
farinaceous substances, as those into which starch in any way enters.
Gluten bread is of great value; it satisfies the cravings of the appe-
tite. Animal food, with eggs, milk, butter and cheese, are proper.
Also the following vegetables: spinage, endive, lettuce, asparagus,
sorrel, haricots verts, cabbage of all kinds, along with fat pork or
salt bacon ; cresses with oil, and hard-boiled eggs. Fresh gluten,
with butter, and cheese grated upon it, is an excellent dish. For
dessert, allow olives, almonds, filberts, and walnuts ; occasionally,
and in small quantities, allow apples, pears, cherries, currents, goose-
berries, strawberries, raisins, and pine-apples. Drinks : The French
wines, Bourgogne and Bordeaux, about a pint in t-he twenty-four
hours ; they are astringent ; sometimes the quantity is to be increas-
ed, but the least approach to inebriety is injurious. N. B. Some
patients are made worse with wine. Beer is injurious. Coffee is
good, and should he taken without sugar, or the quantity of sugar
should be \ery small. Lemonade and drinks of this class are injuri-
ous. Clothing : Protect the body from sudden chills, by clothing it
in flannel. Exercise should be carefully regulated ; the patient
should engage in those exercises in which he takes pleasure ; but
fatigue is to be avoided. Baths are not of much use ; occasionally
a tepid bath may do good ; swimming in the sea has been found very
useful.

Medical Treatment. Carbonate of ammonia, 77 grains ; rum, 310
grains; water, 1550 grains. One-third to betaken half an hour be-
fore each meal : or give it as a bolus (eight grains), with treacle, from
two to ten to be taken every night.

Give Vichy water. The alkaline bicarbonates, particularly soda,
are very useful.

Dover's Powder and Opiates. The former is very useful ; ten
grains at bed-time. Crude opium and morphia often disorder the
stomach.

Theriaca divina, 3ss. to 3i., every night: a drachm contains one
grain of opium.

Cliahjbeates and Tonics. When there is decided pallor of skin,
resembling chlorosis, give tonic bitters with iron. The pulverised
iron, or iron reduced by hydrogen, is the best form of chalybeate.

Ei:acuants. Commence the treatment by giving an emetic and
afterwards a purgative, to clear away any thing injurious in the
prima viae. Evacuants are of no use afterwards, except to combat
certain symptoms.

Lime water, calcined magnesia, alkalies, nitric, phosphoric, and
sulphuric acids, alum, tannin, and other astringents, are of little if
any use.

Bleeding. General bleeding is always injurious. Leeches or
cupping to different parts, as the stomach or anus (as symptoms in-
dicate), will be found useful, viz., where there w epigastric tenderness
or suppressed haemorrhoids.

316 Pain in the side. Div. of Sphincter Ani. Gonorrh&a. [May,

The chief reliance must be placed on dietetic and hygienic means.
(M. Houchardat.) Braitkwaite's Retrospect.

Pain in the Side in thoracic inflammations, generally correspond?,
according to the indication of the patient, not to the precise point of
the organ affected, but to one a little below it, that is, the painful
sensation experienced is in a situation inferior to the lesion. When
local evacuations of blood, therefore, are ordered, or blisters, they
should be directed to be applied a little higher than the painful part.
(Rostan.) This precision is not without importance in certain cases,
for it may happen that, following the indication of the patient, reme-
dies are often applied to the abdomen, when the disease is at the lower
part of the chest. [Lond. and Edin. Month. Journ. of 7)led. Sci.

Subcutaneous division of Sphincter Ani. Dr. Post stated that, he
had recently operated at the Hospital, for the cure of a fissure of the
anus, by the subcutaneous division of the sphincter ani. The first
time, he believed, the operation had been performed in this country.
Nitrate of silver had been previously applied to the ulcer without
benefit. A small incision was first made in the skin about one-fourth
of an inch from the anus. The finger then being introduced into
the rectum as a guide a director was introduced through the external
incision, and forced through the cellular tissue alongside the rectum,
with its groove directed from the mucous membrane. A very narrow
bistoury (tenotome) was then passed along the director, and the
sphincter divided. Some tension being still left, the opposite side
of the sphincter was divided in the same manner. So far the opera-
tion promises to be perfectly successful, the fissure appearing dis-
posed to heal, and the patient's bowels being moved without pain.
There has been, at no time since the operation, complete incontinence
of fajces, though the patient as he expressed it at first, had to be very
quick in his movements. If the operation prove snecessful, it will
be a very great improvement upon the open section of the sphincter
as independently of the great difference in amount of the pain and
suffering caused by the two operations, the old method frequently left
the patient unable to retain his faeces for a twelve-month. [<V. York
Journal of Medicine.

Treatment of Goner rhesa. Dr. Green stated that he has been \n
the habit of arresting gonorrhoea, by introducing a small bit of sponge,
fastened to the end of a bougie, and saturated with a strong solution
of nitrate of silver, (40 grs. to oz.) for a couple of inches into the
urethra. Dr. Stewart stated that he would at the next meeting ex-
hibit to the Society a little instrument, by which he was accustomed
to effect the same object. [Ibid.

Treatment of Ganglions. A puncture with a point of a s mall
lancet is a less painful and more certain remedy than a blow. The

1S-17.J Syphilis. Engorged Womb. Protracted Lactation, S$c. 317

puncture may be sufficiently large only to allow the contents to be
pressed through. A pad of lint, bound down with adhesive plaster
firmly applied, will almost invariably destroy the cavity in twenty-
four hours. [Medical Gazelle.

Syphilis within the Gs Uteri. In consequence of several individ-
uals affirming that they had been infected with the venereal disease
by a young woman apparently in perfect health, M. Delmus instituted
a very minute examination. The exterior of the genital organs, as
well as the margin of the anus, were in a normal condition. On
employing the speculum, nothing abnormal could be perceived in the
vagina. The os tincce and neck of ihe uterus did not vary from
their natural appearance in a female who had not borne children.
There was nothing which indicated either inflammation or syphilis.
On pressing the neck of the uterus in various directions, to ascertain
the degree of sensibility of the parts, and the nature of the liquid
which proceeded from it, an almost transparent albuminous matter
was observed, mixed with a whitish liquid of a doubtful aspect.
Some of this matter being collected with a curette, a lancet was
charged with it, and four pricks made on the thigh. On the fourth
day, the wounds assumed the form of four well marked chancres, and
subsequently almost the whole body, not excepting the face, became
covered with flat pustules, some dry, and others running. The erup-
tion rendered the woman almost hideous, and it was not until after a
mercurial course of three or four months' duration, including the use
of strong sublimated baths, that she was cured. [Braithwaite.

Treatment of Engorged Womb. The treatment in this case con-
sisted in scarifying the cervix, and thus bleeding the womb; taking
from one to two ounces of blood at a time, which was repeated on
several occasions, She was kept at rest; the bowels were relieved
hy saline aperients, and she used the following injection : Dec.
Papav. vj.; Ext. Conii. 3j.; Liq. Plumb, diac. 3ij. Speedy relief
followed the use of these means, and I did not see her for some time.

r London Med. Gaz.

Protracted Lactation. Dr. I. P. Smith, of Gloucester, relates in
the Boston Medical and Surgical Journal, a case in which lactation
was protracted for nearly twenty years, the patient never weaning
one child, till the birth of another compelled her to do so. During
the period mentioned she gave birth to eight children. [i!f. News.

Castor Oil Emulsion. R, 01. Ricini,

Syr. fruct. Aurant. aa $i
Yitellus ovi, No. 1.
Aq. flor. Aurant. i.

M. ft. emulsio.
This makes a very pleasant emulsion which is readily taken by
adults as well as children. [M. Delluc, New York Jour.

318

Vermifuge Syrup Medical Intelligence.

[May,

Vermifuge Syrup. Sxtr. Spigelia Maryl. fl. fviii.

Syr. Sennas compos. (Lond. Ph.) lb. ii.
Mix while hot, and evaporate to a proper consistence. Dose, a small
teaspoonful, for a child one year old [Ibid.

MEDICAL INTELLIGENCE.

Graduates of the Medical College of Georgia March, 1847. We publish be-
low the catalogue of Graduates at the last conferring of the Degree in the
Medical College of Georgia. The bona fide number of Students in our College,
exclusive of M. D's., &c, was 106. Though not quite so numerous as the pre-
vious Class, we can safely say there never has been a better one in this Institu-
tion. Among the number were those who had been engaged for 15 or 20 years
in the active duties of the profession. The leading article in the last No. of
this Journal was furnished by one of these, whose noble zeal and untiring de-
votion to his calling will long be remembered here.

Thesis,

P. T. Trammell, of Harris co., Ga.

Richard Olive, Oglethorpe co., Ga.

A. A. McKee, Jasper co., Ga.

J. M. Couch, Coweta co., Ga.

F. M. Brantlv, Merriwether co., Ga.

T. B. Phinizy, Augusta, Ga.

J. P. Hillhouse, So. Carolina.

A. W. McCoy, Alabama.

T. C. Davis, ISewton co., Ga.

A. M. Spalding, Gainesville, Ga.

J. D. Cooper, Wilkes co., Ga.

T. C. Hitchcock, Canada.

H. A. Shaw, So. Carolina.

W. B. Shaw, So. Carolina.

J. R. Price, Jefferson co.. Ga.

H. R. J. Long, Madison co., Ga.

John Rambo, So. Carolina.

T. J. Darling, Richmond co., Ga.

W. T. Zachry, Columbia co., Ga.

J. W. Hewell, Merriwether co., Ga.

S T. Brunson, So. Carolina.

N. R. Fleming, Florida.

F. S. Colley, Hancock co.,
Robert Campbell, Jr., Augusta, Ga.
Robert Parker, Alabama.

G. W. West, So. Carolina.
W. J. Johnson, Fort Gaines, Ga.
J. W. Holt, Alabama.

J. M. T. Gullett, Baker co.,Ca.
F. O Dannelly, So. Carolina.
J. D. Long, Madison co., Ga.
J. C. Sims, Oglethorpe co., Ga.
J. A. C. Wynn, Talbot Co., Ga.

Pneumonia.

Cynanche Trachealis.

Digestion.

Hysteria.

Cerebro-Spinal Irritation.

Pneumonia.

Water.

Scarlatina.

Iodine.

Fever.

Pneumonin.

Chymification.

Scarlatina.

Blood-letting.

Menorrhagia.

Dyspepsia.

Malignant Int. Fever.

The Tourniquet.

Dysentery.

Bilious Pneumonia.

Lobelia.

Disease.

Turning.

Signs of Pregnancy.

Amenorrhoea.

Spasmodic Asthma.

Congestive Fever.

Digestion.

Hemorrhage.

Typhoid Fever.

Cynanche Trachealis.

Erysipelas.

Schneiderian Membrane.

Notice of a Globular Body found in t/ie Stomach of an Ox. By H. H. Caret,
M. D., of Antioch, Troup county, Ga. A few days since a gentleman of this
place having shown me, what I regarded as quite a physiological curiosity, I
take pleasure in giving you a brief account of it.

1847.] Medical Intelligence. 319

In the month of November last, Mr. McH. having killed a beef, on opening
the stomach, a globular body two and a half inches in diameter was found in
its cavity. The external surface of this ball was smooth, of a dingy brown co-
lor, somewhat resembling the lithic acid calculus, in appearance, and of about
the same hardness. On piercing it with an instrument, it was found to consist
of a shell, two lines thick, whose cavity was filled with hair, very firmly com-
pacted. The hair resembles that of ordinary beeves the shell was apparently
composed of a mixture of earthy and vegetable matters.

This hair was, I conclude, invested with its calcareous coat, while in the stom-
ach. The rationale of the whole process of formation of this singular body I
conceive to be this: The animal by licking himself, or others, accumulated
a quantity of haii-, which having assumed a globular form by the action of the
buccal apparatus, passed into the stomach; hair not being susceptible to the
digestive action of that viscus, it then remained till incrustedby an insoluble
deposit, in the same manner that the urinary calculus is formed around its
nucleus.

A large Calcvlus. We have just learnt from a Knoxville paper, that Doctor
Baker, of that city, had recently removed from a man aged 28, a stone measur-
ing 13 by 5| inches in its greater and lesser circumferences. Its weight, how-
ever, was only 5f ounces, being of lime formation, which are generally light
and porous. The operation was the lateral, and the calculus was broken in its
extraction. The patient utterly refused any nourishment after it was perform-
ed, and died on the night of the third day.

Milk a Purgative. During the night of the 4th, we saw an Italian who had
received the stilktlo of his comrade, near the junction of the eighth rib with its
cartilage of the right side. Having had, up to the fourth day after the wound,
but one motion from his bowels, a laxative dose of medicine was proposed; to
which he objected, stating milk was his only physic. He took a common size
tumbler of sweet milk, and at the next visit he had had 5 or 6 evacuations. We
made particular inquiry on the subject, of himself and others around him, and
were satisfied that this article of diet operates upon his bowels.

Number nf Medical Institutions in the United States. There are now, thirty-
seven Medical Colleges in the United States, and we may add, a few more of the
same sort still in contemplation.

Partial Report from the great Battle of Bucna Vista. We have just derived
from a letter of our friend, Dr. Hitchcock of the United States Army, and for-
merly stationed at the Augusta Arsenal, the following items : He has the super-
vision of eleven hospitals, eight American and three Mexican; in all 400
American and 200 Mexican patients.* He cut out over sixty balls on the field
of battle, and has performed eighteen capital operations, besides those of a minor
character without number.

Mr report this morning, was 370 soldiers, ?(t olricers total 396, Americans. Mexican'
183 soldicis, 4 officers total 169.

320

Medical Intelligence. Meteorology.

National Medical Convention. At a meeting of the Delegates to the National
Medical Convention from the city and county of Philadelphia, held at the Hall
of the College of Physicians, Mai ch 9th, 1847* it was resolved to accept the polite
offer made by the Academy of Natural Sciences, of the use of their spacious Hall for
the meetings of the Convention ; and the following committee was appointed to
make the necessary arrangements for the meetings and deliberations of that body :
Drs. Hays, Condie, Emerson, Fox, Bridges, Norris, Morris, "West and Paul.

The above committee, in furtherance oi the objects of their appointment, in-
vite the delegates to the National Medical Convention to meet at the Hall of the
Academy of Natural Sciences, west side of Broad-st., near Chesnut-st., on "Wed-
nesday. May 5th, at 10 o'clock, A.M.

The several standing committees appointed at the last Convention, are invited
to meet at the same place on Monday morning, May 3rd, at 10 o'clock.

To facilitate intercourse between the delegates, they are invited to report
themselves as soon after their arrival in Philadelphia as convenient, to the
committee of reception and arrangement, named above, who will be at the Hall
of the Academy of Natural Sciences on the 1st, 3rd, and 4th of May, from 10,
A.M. to 3, P. M., and on the evening of the 4th ot May, from 7 to 10 o'clock.

The secretaries of the associations who will be represented are requested to
transmit, at an earlv day, the names of their delegates to the chairman of the
committee, Dr. I. Hajs.---[Medical News.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide 152 feet.

for March, 1847, at Augusta,
32' west Wash. Altitude above

5-
3

Sua

TlIF.R.

l Rise.
Bar.

2, 1
Ther.

3. M.
Bar.

WlHD.

Remarks.

1

32

20 9U-VSJ

69

29 91-100

N. W.

Fair.

2

31

30

57

" 9:5-1 00

E.

.

3

1

36
47

29 92-109
" 62-100

55

40

" 81-100
" 64-100

E.

X.

^oin' ? 05-100 of an inch.

5

42

" 93-100

62

30 1-100

N.

Fair.

fi

30

30 9-100

64

30 5-100

S. E.

Fair.

7

46

30 3-100

67

29 92-100

S. E.

, Cloudy sprinkle.

8

58

29 87-100

63

" 87-100

.

Cloudy sprinkle.

9

53

': 90-100

72

90-100

S.

L0

58

<: 89-100

80

<: 83-100

S.

Rain, i thunder, lisrlit.

11

03

" 71-100

60

" 63-1 (JO

X. W.

Rain, > 1 inch and 35-100.

12

40

;: 57-100

41

" 35-100

X. B.

Rain, ) Freshet in the river.

13

39

:- 54-100

46

" 65-100

X. w.

Cloudy.

11

34

" 87-100

48

': 95-100

X. w.

Cloudy.

15

33

30 2-100

51

30 1-100

X. w.

Fair some clouds.

16

33

30 7-100

50

30 7-100'

x. v,-.

Fair blow.

17

30

29 33-109

5i

30 6-l00;

X. w.

iFair.

is

33

30 3-100

68

30 7-i:-.

s. w.

Fair.

19

42

30

72

w.

Fair.

23

48

29 92-109

74

29 77-100

s.

Pair blow, rain at night 90-100

21

52

2S-100

s. w.

Cloud)- blow.

22

42

" 58-100

60

<! 65-100

s. w.

Fair.

23

51

" 69-109

" 72-100

s. w.

Cloudy.

24

37

" 88-100

64

" 89-100

w.

Fair,

2.'.

38

" 91-1001
" 43-100

66

" 87-100;

s.

Fair, [blow.

26

52

47

" 46-109.

w.

Cloudy rain last night 40-100,

27

33

" 83-100!

54

" 89-100

x. w.

Fair blow.

28

33

30 6-100

64

30 7-100

s. w.

Fair.

29

48

29 91-100

74

29 77-100

s. w.

Cloudy breeze.

30

52

75400

70

" 69-100!

s. w.

Cloudy breeze.

31

60

" 6-109

i: 97-109;

X. w.

Fair breeze.

16 Fair davs. Quantitv of Rain 3 inches and 60-100.
S. 6 days. West of do. 19 days.

Wind East of N. and

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 3,] HEW SERIES. JOE. I [No. 6.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XVIII.

Cases and Comments. By H. V. Woote>", M. D., of Lowndes,
boro', Alabama.

Cask I. Complicated Inguinal Hernia Strangulation Tobacco
Injections Operation, $c. I was called on the 14th of June, at 3
P. If., to see Alfred, a negro man aged 25, who was suffering with
strangulated inguinal hernia. Two years previously, while lifting a
heavy weight, the intestine came down, and had occasionally de-
scended since that time, but never had before caused any serious
inconvenience. Twenty-four hours before I saw him, he was seized
with all the usual symptoms of strangulated hernia, of which a des-
cription is unnecessary. At the time of my visit he was suffering
intense pain, and vomiting frequently : the tumor was about the size
of a hen's egg, and lying directly over the course of the inguinal
canal. I made immediate efforts to reduce it by the taxis, but failed ;
I bled him to approaching syncope made another diligent effort,
and again failed ; warm enemata and ail ihe usual appliances were
resorted to in vain, and I could discover that the tumor was gradu-
ally increasing in size. I then determined to resort to tobacco injec-
tions I prepared a pint of the infusion, made from a drachm of good
tobacco, as directed by Listen, Gihson, dec, injected one half of it,
and no effect being exhibited in thirty minutes, 1 threw up the other
half: an hour elapsed, and no efilct was yet produced. I then pre-
pared another pint, made from two drachms of tobacco, and this pint
was used in a similar manner to the other, and no effect was pro-
duced. After waiting a proper time, I prepared another pint made
from three drachms of the tobacco, which I took from another lot,

21

322 Cases and Comments. [June,

(and it was certainly of fall strength). I was here compelled to leave
the case for a short time, and directed this pint of the infusion to be
injected, one half at a time, thirty minutes apart, which was faithful-
ly done ; I returned to the case four hours after, which was at seven,
A. M., on the 15th. The whole three pints of the infusion had been
injected and well retained, and not the slightest effect produced by it.
The pulse was hard, and very frequent, (140,) skin dry and warm,
great restlessness and frequent stercoraceous vomiting. I again re-
sorted to the taxis, assisted by the warm bath, but all to no purpose,
and at 10 o'clock, A. M., I determined to operate. I should doubt-
less have operated earlier, but I had never performed the operation
alone, and was out of reach of assistance, and of course felt reluctant
to undertake it so long as there was any prospect of saving the pa-
tient otherwise. The lowest part of the tumor was not more than
an inch below the external ring ; thence it lay upwards and out-
wards, and was at this time, about twice as large as a hen's egg.
There appeared neither testicle or cord on the hernial (left) side, but
there was a contraction and adhesion of the scrotum which obstructed
the descent of the hernia, and gave it an inclination in the direction
above stated. The boy stated, that when he was " about half grown"
he received an injury of the testicle on the side, which produced much
swelling and pain for a long time, and that when it subsided the tes-
ticle and cord disappeared. It is useless to describe the operation,
further than the peculiarities of the case require. I found the sac
to contain an unusually large quantity of serous fluid, which was
rather suspiciously dark colored ; this was discharged by freely
dividing the sac; I found the fold of intestine very livid, completely
strangulated, and half-twisted upon itself. From the manner in
which it was driven upward, over Pouparts ligament, and firmly
banded by the fascia above, whilst the old adhesion confined its
movements below, I began to understand the difficulty of reducing
it by the taxis. On further examination, I found that it was strict-
ured at both the external and internal ring3, and the blighted cord
adherent to the canal, from the external ring, inwards. The strict-
ures were divided, and the intestine returned. The blighted testicle
(about the size of a large bean) was found, adherent, just below the
external ring, and immediately behind the protruded intestine. The
double stricture, adhesion of the cord, and twisted condition of the
intestine, rendered it somewhat difficult of reduction without an ex-
traordinary degree of cutting. The wound was closed by suture

1847.] Cases and Comments. 323

and dressed in the usual manner; an enema of warm gruel was or-
dered, and the patient left under the usual injunctions.

16th. Morning. Pulse, which after the operation yesterday was
140, was found at 135, and rather full, skin moist and rather warm,
thirst, no appetite, complains of constant pain u like colic'"' just below
umbilicus, no nausea since operation, and no action yet of the bowels,
wound appears to be doing well ; ordered mush and mustard poul-
tice to the abdomen, and a U'ee dose of castor oil. The oil operated
in three hours, producing a free discharge of faecal matter, but no
particular appearance of the injections.

18th. Pulse 120, regular; no thirst, very little appetite, pain in
abdomen still exists, but moderated, bowels acting regularly, wound
appears to be healing well.

20th. Pulse 110, regular; pain in abdomen only occasional, ap-
petite improved, bowels regular, wound united, but somewhat swol-
len, sutures coming away.

The patient continued to improve gradually, the pulse falling in
frequency about five beats per day until it reached the natural stand-
ard, and on the 6th of July he was well, when I applied a truss and
he got up.

I deem it unnecessary to give a more minute description of the
above case, my object being simply to note such things as are pecu-
liar, and therefore interesting; -amongst these are the peculiar rela-
tion of the parts arising from the old injury, and the consequent
adhesions; the extraordinary tolerance of the tobacco injections,
which were given in such large quantities, and actually absorbed ;
and the great arterial excitement which followed the operation, whilst
the injury appeared to be rapidly recovering, and the patient other-
wise doing well. I have heard of several hernial patients who per-
ished from strangulation, under the eyes of physicians, who deeming
the operation one of great difficulty and danger, refused to operate;
and one object I have in publishing this case, is to encourage othera
to perform the operation, when they can do nothing else, rather
than let their patients die, as they may see that it may be successful,
even when all things are unfavorable, both as to case and operation.
I had no professional assistance, no time to prepare myself, and no
experience in such performances.

Case II. Bleeding with a Poisoned Lancet, and its consequences.
In August, 1843, I was asked to sec a negro boy, aged 9 years, who

324 Cases and Comments. [June,

was said to be strangely afflicted with abscesses ; I found his right
arm, from his shoulder to the ends of his fingers, much swollen, with
three discharging abscesses arising, one from each metacarpal space,
one on the inner surface of the wrist, one on the under surface of
the forearm, about midway, and a very large one over the inner
condyle of the humerus just over this, and about three lines from
the orifice made by the lancet, was the cicatrix of a small abscess
which had healed. This one, I was informed, was the first which
appeared, and the general swelling of the arm which preceded the
other, did not commence until after this had discharged, and was
nearly well. The right side of the neck, from the shoulder to the ear,
was much swollen, but no suppuration had taken place. His right
leg and thigh were distended from the upper part of the thigh to the
foot, and this latter was greatly swollen and had several abscesses
already formed on it, one in the metatarsal region, and two between
the toes. The right side of the trunk, from the shoulder to the hip, ap-
peared perfectly well, there being in it neither soreness or swelling j
the whole of the left side was, and remained entirely sound. I was
at great loss to account for the occurrence of so strange a disease.
There was considerable febrile heat, thirst, loss of appetite, dry
tongue, and arterial excitement, pulse 140, and firm. I bled him
gxii. and gavebi-tartrate of potash to purge. To the swollen parts,
I applied poultices, after wetting them over with lead water. Two
clays after I saw him again, and found him in about the same condi-
tion I had left him, except that there was less fever, and the abscesses
were discharging more freely. During my absence, in my endeavors
to satisfy myself in relation to the nature of the disease, I remembered
to have noticed the cicatrix of a recent pupcture by a lancet, and it
occurred to me, that the boy might have been poisoned in that way.
I enquired, at my second visit, when he was bled, and his master
informed me that he bled him about four days before the first little
abscess, above mentioned, appeared. I then enquired, if he had ever
used the lancet with which he bled him for any other purpose ; and
after a little reflection, he answered, that on the evening before the
bleeding, he opened a small bile on the neck of one of his children
with the same lancet, which he remembered to have wiped well, as
he thought, with a piece of cotton. I was then satisfied that the in.
jury was produced by the poisoned lancet, and on enquiry, I learned,
that the first small abscess which formed, was not opened freely, but
after discharging a little from a spontaneous opening, it "shrunk
away and dried op."

1847.] Cases and Comments, 325

I now directed chloride of soda 30 drops, morning, noon and night,
and charcoal poultices to the arm and leg.

In four days more, I discovered that the general cellular inflamma-
tion of both the leg and forearm, was rapidly resulting in suppuration.
Several new openings formed, through the skin, which discharged
great quantities of pus, and many of these openings were found to
communicate with each other by the subcutaneous sinuses. Into
these openings, I injected twice a day, by means of a glass syringe,
tepid water containing an ounce of chloride of soda to the pint.
The febrile symptoms had now given place to a cool skin, feeble and
frequent pulse and general prostration. I gave decoction of sarsa-
parilla and sulphate of quinine in full doses three times a day, and
continued charcoal poultices. It was now the twelfth day of the
disease, counting from the time the general swelling of the arm
commenced. This course of treatment was steadily pursued six days
more. At the end of this time, the swelling had diminished consid-
erably, and the discharge cf matter was lessened, except at the wrist
and ankle, and was of a more thin and transparent character, and
the openings and sinuses had become slack and indolent. The gen-
eral strength and appearance of the patient not materially changed.
I now commenced injecting into the openings, once a day, a solution
of the sulphate of quinine, 10 grains to the ounce, dissolved by nitric
acid very slightly in excess, and using bandages moderately tight.
The wrist and ankle joints were now evidently affected, and some of
the naked bones could be distinctly felt with the probe. For the
quinine heretofore given internally, I substituted the iodide of po^s-
sium in four grain doses, given in the decoction of sarsaparilla threo
times a day.

Four days after this, the patient's general appearance was better,
and all the parts were in a much more healthy condition, except the
wrist and ankle, which were now each discharging by several open-
ings, a thick ichorous fluid, which gave off a very offensive odor.
Finding one of the bones of the wrist loosened from its attachments,
I extracted it with small forceps. It was the Cunneiforme. Con-
tinued same treatment, with charcoal poultices to wrist and ankle.
The fourth day from this another bone, the Pisiforme, was extracted.
The arm and leg were both much improved ; the injections and band-
ages were continued, with the internal treatment. Three davs after
this, one of the tarsal bones, the Naviculare, was easily drawn out,
and from that time, both anklo and wrist improved regularly, but

326 Cases and Comments. [June,

slowly. The boy was confined to his cot, in all, about three months,
before the discharges all ceased, and the openings healed, during the
remainder of which time the same course of treatment was continued,
in principle, the remedies only varied to suit circumstances. After
recovery, both arm and leg were rather hard and stiff, and the ankle
and wrist joints disfigured of course, neither of which he will ever be
able to use freely. Kis general health recovered entirely.

I give this case as a warning to the great number of persons who
so indiscriminately and carelessly use their lancets, as well as for the
other interesting points it presents. Why was the effect of the poison
confined to the side in which it was introduced, and to only the ex-
tremities of that side ?

The disease appeared to have a sort of regular course to run, and
was perhaps very little influenced by remedies. In regard to the use
of the quinine, topically, I must remark, that I have long been in the
habit of using it as an application to indolent ulcers, and other dis?
charging surfaces of that character, without thinking that there was
any thing new in the practice. When I first commenced practice,
and long before, the poultice, and decoction of Peruvian bark, were
very commonly used in such cases, and the substitution of the more
refined and potent alkaloid was very natural, yet it is spoken of re-
cently, as a new mode of using this our great medicine.

Case III. Idiopathic Tetanus, unsuccessfully treated with Strych-
nine. On the 20th of February last, I visited Prince, a negro man,
of stout, muscular habit, aged about 30 years. He had been com-
plaining two days with pain in the back of his head and neck, and
in the lumbar region of the spine. Pulse 90 and full; some thirst
and other febrile symptoms, though light. He had been minding a
coal-kiln, in very wet and cold weather, and I viewed it as a case
very common to be seen under such circumstances. I bled him two
pints, before the pulse softened, gave a cathartic, and directed a
large blister to the upper part of the spinal column, if the pain con-
tinued after the operation of the medicine. I was informed next day
that he was getting worse, and visited him again. While I was ex-
amining him, a violent and decided tetanic spasm seized him, and on
enquiry, he informed me that he had had them about once in five
hours, since he was first taken, though in a much milder form than
the one I saw, until the night before this visit, when they increased
greatly, both in frequency and violence. The spasms now came on

1847.J Cases and Comments. 327

every hour with considerable violence, and the jaws were nearly-
closed. The cathartic had acted well, and the blister was fully
drawn. I had recently been reading of the treatment of tetanus
with strychnine very successfully in New York, and having no rem-
edy on which 1 could rely with confidence, I determined to try it. I
gave one-twelfth of a grain every two hours, to be extended to three
or four hours, according to the effect produced.

On the 22nd, I found him decidedly under the influence of the
medicine, and ceased giving it, but during the existence of the influ-
ence, the tetanic spasms continued with undisturbed violence, as they
did after its cessation. I renewed the attack, so to speak, three
several times, without the least benefit, but with increased pain and
difficulty to the patient. After the third trial, (barely allowing the
influence to remit between them,) I determined to abandon it, and
used large doses of quinine and opium with some soothing effect.
This was commenced on the 25th, and forty-eight hours afterwards
the patient died.

Like Prof. P. F. Eve, I think there ought to be a Journal for fatal
cases; and also that when new notions and new remedies are intro-
duced, and urged into practice by much boast of success, that it is
the duty of every member of the profession who tries them, and
meets with disappointment, to make a report of the facts, so that
others may have the advantage of his experience, on what may be
very inviting, but dangerous ground. I have known successful cases
reported, and others of equal importance, in which as great skill was
displayed by the practitioner, withheld, for no other apparent reason,
than a want of success. When we know these things to be so, we
can but look upon the reported success, as only a seif-laudatory ad-
vertisement, to attract customers. A surgeon may perform a similar
operation on each of two patients, an operation requiring both cour-
age and skill of a high degree, but one patient will die, and the other
get well, and the successful case will be conspicuously set forth in
the Journals, and even in books, to invite the less bold, and perhaps
less skilful operator, to venture upon dangerous ground, which he
would not do were both cases set before him.

I will close this miscellaneous paper, with a remark or two on

Trismus Nascenlium. About a year ago, a letter of mine, on this

gubject, was published in the New Orleans Journal, and copied in

several other?. In that letter I stated that I had never seen a white

child afflicted with the disease. Since then, however, I have seen

828 Treatment of Pneumonia. [June,

two, both of them finely developed male children. Besides these, I
have seen four cases of negro children suffer and die from it, as did
also the whites. Having previously found no successful remedy for
it, I was very glad to meet with Dr. Sims' view of the disease, but
have been in every instance disappointed in deriving any practical
benefit from it. One of the white children had decided depression
of the occiput, and also tumidity and tenderness of the umbilicus;
with this exception, the heads were all quite symmetrical and as firm
as is natural, presenting no evidence of unusual displacement, or
other injury about the head ; nor did there appear to be any visible
injury about them whatever. In every instance, I made faithful trial
of the "soft pillow of feathers" and keeping "the child on its side
on the pillow"; but they all died. So that I still feel as much in
the dark in regard to the cause of the disease, as before, and, if pos-
sible, more so, in regard to a reliable treatment. I believe that Dr.
S's plan of laying them on the side, and changing the position pretty
often, is a very good one, in this or any other disease, and in fact
where there is no disease at all. One of the cases above referred
to, was kept on its side with special care, and the sides changed regu-
larly, from its birth, but the disease appeared on the seventh day,
and it died on the ninth.

The reader will, of course, not understand me as attempting to re-
port any of the foregoing cases with that accuracy of detail which
is necessary in a full illustration of the disease and treatment. My
object has been simply to present certain points of special interest in
the several diseases, or cases of disease; taking it for granted, that
all readers will have read, and very probably seen, much better ex-
positions of the general character of the diseases, as svell as the
remedies employed, than any which I could offer them.

ARTICLE XIX.

Treatment of Pneumonia. By John Davis, M. D., of Abbeville
C. H., South Carolina.

It is not my intention to endeavor to add any thing new, either as
to the history, pathology, or treatment of pneumonia; but merely to
shew what has been my practice and experience, in a considerable
number of cases which have come under my care during the last
five years. During this time this disease has prevailed, and is at this

1847.] Treatment of Pneumonia. 329

moment prevailing, more or less extensively throughout this and
some of the adjoining districts, and proving fatal (as near as my
means of observation go.) in about one-fifth the cases.

The cases which I have seen, have generally been ushered in with
a chill, and the ordinary symptoms of what is often called, " taking
cold ;" coryza, cough, violent oppression of the chest. In some
cases rheumatic symptoms predominate, with severe pain in the
chest, back and limbs. Again, I have seen the head very much
affected, the patient complaining of great debility and oppression
throughout the whole course of the disease. The pulse, even, in
the milder cases, is very much affected the heart sympathizing
largely with the suffering of the other organs. The skin is almost
invariably found hot and dry, with great thirst, red tongue, which in
two or three days, if there is no change for the better, becomes dry,
furred, and of a dark muddy appearance. The fever in all the cases,
which I have seen, has been remittent, and in some few cases, espe-
cially during convalescence, intermittent. The bowels in the main,
have been either very difficult or unnaturally easy to move.

It is generally conceded that pneumonia is an active, inflammato-
ry disease ; but to say that the profession is unanimous as to the
surest and safest means of its cure, would not be correct ; for while
some rely almost entirely for success on the free use of the lancet,
others reject it almost entirely, as unsafe, whilst others again resort
to it pretty constantly, but so sparingly as to derive little or no ben-
efit from it.

When the breathing is difficult, skin dry and hot, flushed face,
quick and tense pulse, I invariably, under all other circumstances,
draw blood from the arm till there is a decided impression made upon
the system, regardless of the stage of the disease the seeming
prostration of the vital powers, or the influence of epidemic agency ;
for this is a disease of a rapidly disorganizing inflammation, of a
very vital and important organ of the system, and if suffered to
thoroughly develope itself, will, in nine cases out often, prove fatal.
In fact, I have found the lancet, in the more violent cases, when
pushed to its fullest extent, not only entirely safe, but the only rem-
edy to be relied on. It relaxes the lungs, produces a favorable and
salutary change on the pulmonic inflammation, removes the over-
whelming congestion and consequent oppression, facilitates the oper-
ation of expectorants, (tart, ant.) and, in short, arouses all the vital
powers of the system, to the more effectual action of all the remedies

330 Treatment of Pneumonia. [June,

that may follow in the train. In cases where the subject is of a stout
and robust constitution, it may, and indeed should, often be resorted
to, even during the fifth or sixth day succeeding the attack. Even
at this advanced stage of the disease, if the skin is dry and hot,
pulse oppressed, with pain in the chest, I am in the habit of taking
as much blood as will relieve the pain and sensation of congestion in
the lungs, which may be known by requesting the patient to make a
deep inspiration, from time to time, during the operation. Here I
have found it difficult to produce fainting, and I continue the bleeding
till the pain is removed, regardless of the quantity taken; when the
pulse will become more vigorous, the surface moist, followed with an
obvious abatement of the violence of all the symptoms. But I have
often known injury done here, by not taking a sufficient quantity to
afford immediate and prompt relief to the affected lung, which is not
to be judged of by the number of ounces abstracted, nor, in all cases,
by the pulse, for the pulse will often rise and become, as it were, nat-
ural, in some cases under the lancet, before the pain and other violent
symptoms subside ; and if we stop the blood too soon, it will again,
in the course of an hour or two, become oppressed, and no benefit is
gained, but often much injury is done. If necessary, I continue the
bleeding till the pulse flutter under the finger and syncope supervenes,
which I have found will, in a large majority of cases, check the fur-
ther progress of the disease, followed by free expectoration of the
desired character ; or it has placed the disease so completely under
my control as to be easily managed by counter-irritation and well
chosen expectorants, &c. The intense congestion, or capillary para-
lysis of the lungs, in this affection, always succeeds more or less in-
flammation, and if it is extensible and suffered to continue three or
four days, it will, in a large number of cases, result in fatal disorgan-
ization of the structure of the lungs. So our duty is plain, and we
should not be deterred from the discharge of it by the bug-bear
hobby of debility, upon which hundreds and thousands have ridden
into an untimely grave. I know it is sometimes contended that "the
fluids are too stagnant to be drained off by venesection." This I
confess often proves to be the case, but it is owing to nothing but
the postponing of the lancet till too late, or otherwise, if resorted to
in time, too sparingly so. I never have seen the debility and exhaus-
tion, so much harped upon by medical gentlemen, follow active bleed-
ing in this disease ; on the contrary, I have almost always found free
venesection to throw off, as it were, instead of producing, the over-

1847.] Treatment of Pneumonia. 331

whelming oppression and consequent debility, so peculiarly frighten-
ing to some practitioners. The strength is not gone it is still in
the system, and will show itself if the obstruction and oppression of
the lungs be removed ; and till it is removed there are no well grounded
hopes of recovery. Is it not fair to conclude, if bleeding will not
remove the congestion, even in those desperate cases, that all other
remedies usually employed will fail to do so, and the disease progress
rapidly to a fatal termination ? What can stimulants do in this state
of the lungs? What can cupping, blistering, mustard, and purga-
tives, all do? Nothing. Shall we stand stiil, without making an
effort to save ? Under the most adverse circumstances in which this
disease can present itself] if the pulse be not very quick and weak,
and the sensibility is considerable, skin hot, with even the fierce, wild
look of the eye, and delirium at times, noisy, and the face hectically
flushed, if there be pain in the chest, it may still be altogether possi-
ble to prevent the disorganization of the lungs from advancing, by
bloodletting. In a proper knowledge here, however, it must be borne
in mind, consists much of the skill, judgment and success, in .the
treatment of those desperate cases. The practitioner should know
how much is requisite to subdue the threatening symptoms and to
effect a cure, with the least expense to the constitution of the patient,
and I am thoroughly convinced from my experience in bleeding, in
those even seemingly hopeless cases, that there is not half so much
danger in bleeding the patient to death, as there is in the certainty
of bleeding the disease to death. In short, I have never sheathed
the lancet in this disease, and resorted to stimulants, before the dis-
ease was subdued or rendered manageable by other means, unless
there was great depression, loss of energy in the vascular system, as
well as in the nervous and sensorial, indicated by an extremely fee-
ble, quick, and easily compressed pulse, skin cool and perspiring,
attended with low muttering incoherence. Here I have frequently
derived great benefit from brandy, opium and quinine, where further
bleeding would not be admissible.

From the few remarks I have made in relation to the treatment of
pneumonia, one might concede that the lancet is all I use. I do
look upon it as my chief reliance ; but tartar emetic often completes
what the lancet has commenced. If it were not for the tartar emetic,
I would often bleed even more fully, in some cases, than I do. Given
in doses sufficiently large to produce a slightly nauseating effect, this
article is of undoubted utility in pneumonia, as well as all other pul-

332 Malignant Disease. [June,

monic inflammations. From my experience with it in those diseases,
it seems to have rather a specific tendency than otherwise. It also
seems to combine with its antiphlogistic effect a very happy and ob-
vious expectorant influence, in loosening the tenacious secretion
from the lungs, which are freely thrown up, very much to the relief
of the patient. It should never be given, however, where there is
much irritability of the mucous membrane of the bowels. In fact,
it should not be continued too long in any case in this climate, for
fear it may produce such a state of the bowels, which if it does, we
may expect the patient will die in despite of every thing.

The above, with the occasional use of quinine, brandy, gentle pur-
gation, expectorants, with counter-irritation, &c, after the disease
has been mainly subdued by venesection, has been my practice for
the last five years, during which time, I know, I have treated, in all,
at least ninety or a hundred well marked cases, with success.

ARTICLE xx.

A brief notice of a highly Malignant Disease. By B. H. Pearson,
M. D., of Powelton, Ga.

Dec. 5, 1346, was called to see Green, a boy about 13 years of age,

belonging to the Rev. Mr. . On or about the 1st of October

he had a slight attack of fever, from which he gradually recovered
under domestic prescriptions, so as to be able to resume his work on
the plantation. He seemed, however, not to recover strength, but
appeared weaker every day, until he finally left off work again, al-
though still not confined to the house. He complained of great
prostration and want of appetite. This, his master attributed to his
having over-strained himself in carrying home his cotton, being ex-
tremely active, and picking more cotton than he could well carry ;
and for which he prescribed an occasional dose of Cook's pills, and
tartar emetic ointment to the spinal column. I found him greatly
emaciated ; pulse extremely feeble, 175, rather irregular ; the sounds
of the heart were very weak, yet natural ; respiration was feeble;
no abnormal sounds ; there was slight cough, with frothy expectora-
tion in small quantities; appetite much impaired; bowels a little
loose ; stools dark ; slight tenderness of the lower cervical vertebra.
Prescribe blue mass gr. j. at night, cups over the cervical vertebrse,
and an easily assimilating diet.

1847.] Malignant Disease. 333

9th. Green says he is better, which continued to be his answer,
when asked how he was, until the day of his death. A careful ex-
amination showed slight dullness under the left clavicle ; bowels
natural ; no other change in the symptoms. Upon enquiry, I find
he descended from syphilitic parentage, his grandfather, on his mo-
ther's side, having had that disease; and also that most of the male
children from the same descent died in infancy. Prescribe hydrio-
date of potash grs. ijss. three times a day, which was gradually
increased to grs. iv. This was persevered in for about three weeks,
when, seeing no improvement, but rather a gradual increase of his
cough and his weakness, a resort was had to tonics, quinine, and
stimulating expectorants, but with no benefit except relieving his
cough a little at night.

Feb. 14. A neighboring physician was called in, who pronounced
his disease to depend on torpidity of the nutritive system. Prescribed
hydriodate of potash grs. iij. three times a day, under which prescrip-
tion he remained until his death, which took place the last of Febru-
ary, being confined to his bed but three or four days before he died.
He complained of no pain except a neuralgic affection of his knees
for about a fortnight, and soreness of his hips from lying in bed. His
bowels remained natural to the last.

Post mortem examination fifteen hours after death. Body extreme-
ly emaciated. Upon laying open the cavity of the thorax, the left
pleura was found adherent throughout its whole extent ; the heart
and lung upon this side was perfectly studded with tubercles, of a
cheese-like consistency, about the size of small buck-shot; the
right lung was tuberculous, but not to the same extent as the left ; a
few tubercles on the upper surface of the liver, otherwise it was toler-
ably healthy; the spleen and peritoneum were equally affected ; the
pancreas, stomach and bowels healthy.

This case is given as an example of several occurring in the same
family, four of whom have died, one is now at the point of death,
and the disease seems to be extending to other families. I have not
had an opportunity of seeing those sick in other families yet, but doubt
not from the description of the symptoms that they are affected in
the same way.

Thus far every one who has been attacked has died in a time
varying from five weeks to four months their symptoms varying in
some particulars. One's bowels were badly affected for several
weeks before death. In another, a large vomica bursted, and consid-

334 Experiments with Opium. [June,

arable matter was coughed up on the day preceding her death, which
was probably the immediate cause of it. They all seemed to be
taken sick by surprise, and died thinking they were getting well,
except the mother of the family, who lived but five weeks after she
first began to complain, and but two after she first felt sick enough
to take to her bed, and she supposed she was " tricked."

Dr. Terrel, of Sparta, recommends the use of iodine to the remain-
ing members of the family,- as the only means of preventing the
extension of the disease. Possibly it might be of service if used in
season. But the probability is, that the disease may be advanced
to an incurable state before the first symptoms appear,-^and besides
it is so insiduous in its approach, that it is some time before the pa-
tient knows the nature of the attack. A disease similar to this pre-
vailed some years ago in Maj. 's family, of Wilkes county,

and between twenty and thirty died. I hear also it is prevailing in
Tennessee, to an alarming extent in some neighborhoods.

ARTICLE XXI.

Experiments on Rabbits with Opium and its preparations. By
Erwin H. Oakman, M. D., of Columbia county, Ga.

Having observed in the February No. of this Journal, for the
present year, an extract (by M. Lafarque) in the Edinburgh Medical
and Surgical Journal, showing the harmless effects ofacet. morphine
upon Rabbits, and feeling rather inclined to doubt the accuracy of
his statements as the explanation hinted at was not altogether satis-
factory I thought I would make a few experiments upon these
animals, to satisfy myself more completely, and give the result of
my investigations to my professional brethren.

To No. 1, I gave within the space of five hours, four and a half
grs. of pulv. opium, and one gr. of sulph. morphine. Five hours
after the last dose was given, the appearance of the animal and pul-
sation of its heart, were the same as when the first dose was given.
It died during the night, but not from the narcotic.

To No. 2, gave twenty grs. of pulv. opium, within the space of
eight hours. No more effect produced than if it had taken the same
quantity of its ordinary food.

To No. 3 and 4, four grains each of sulph. morphine at one dose.
No effect produced.

1817.] Ophthalmic Medicine and Surgery. 335

To No. 5, four grs. of acet. morphine at one dose. No effect
produced.

No 1 was very feeble and ]ean, with a fracture of one hind leg.
Death in this case I think was produced from the irritation of the
wound, together with want of food, it having been kept two or three
days without food, before coming into my possession.

These experiments, so far as they go, prove the assertion of M.
Lafarque.

I cannot account for the exemption of these animals from the in-
fluence of this powerful narcotic, unless opium produces its peculiar
effects in proportion to intellectual endowment. Contrast the men-
tal capacity of man with that of a rabbit also the effects of opium
upon each, and the exemption of these animals from the influence of
opium ceases to be a wonder.

PART II. REVIEWS AND EXTRACTS.

ARTICLE XXII.

The Principles and Practice of Ophthalmic Medicine and Surgery.
By T. Wharton Jones, F. R. S., Lecturer on Anatomy, Physiolo-
gy and Pathology, at the Charing Cross Hospital, &c, &c, with
one hundred and two illustrations. Edited by Isaac Hays, M. D.,
Surgeon to Wills Hospital, &c., pp. 509. Philadelphia : Lea and
Blanchard. 1847.

By the American Editor, we are informed that this work is one
of a series of Manuals designed chiefly for students, and those review-
ing, to obtain in a small compass, the principles and practice of the
medical professio*n. It may not be uninteresting to the reader to
know that the authors secured to co-operate in this undertaking, are
all fellows of the Royal Society; and the volumes issued up to the
present date, are Surgery, by Mr. Ferguson ; Physiology, by Dr.
Carpenter; Anatomy, by Mr. Erasmus Wilson ; Medical Jurispru-
dence, by Mr. Taylor ; Chemistry, by Dr. Fowns; Materia Medica
and Therapeutics, by Dr. Royle ; Natural Philosophy, by Dr. Gold-
ing Bird; and lastly, the one now about to be noticed. The series
thus far have proved to be most valuable works on the respective
subjects of which they treat, and most of them leave but little more
to be desired, so complete arc they, and so numerous, that as manuals

336 Ophthalmic Medicine and Surgery, [June,

they excel all similar enterprises. He who undertakes to write a
single volume on Medicine or Surgery must fail, so vast is the science
before him ; but when a number are engaged, each taking a parti-
cular department, but all co-operating and harmonizing to obtain the
same object, then manuals may become not only respectable, but be
sought after by those desiring to review at a glance, or examine in a
small compass, the important facts on a given subject.

Jones's Ophthalmic Medicine and Surgery, is issued by the Ameri-
can publishers in a large Duodecimo volume, and in a style worthy
the matter it contains. The author states his aim to have been to
produce a text-book for students, and a book of reference for prac-
titioners. To make his subject more clear, definite and precise, he
has resorted to illustrations hence the numerous wood-cuts contain-
ed in this manual. And as ophthalmic medicine is included with the
operations on the eye, it also abounds with many valuable prescrip-
tions.

The work is divided into XI. Chapters, each one having its separate
sections. The introduction embraces the peculiarities, the history
and literature of ophthalmic medicine and surgery. We are no great
friends to pictures of diseases; an instrument may be exhibited by a
plate very correctly, provided it be not complicated, but illustrations
of pathological conditions generally fall far below the original thing
itself. Our ideas on this subject have not been changed by an exam-
ination of the wood engravings in this manual. These, while they
have added to its expense, have not enhanced its value in proportion
as designed they should. We have no objections to the cuts of instru-
ments and descriptions of operations ; we allude alone to the attempt-
ed illustrations of ophthalmic diseases by plates.

The style of our author is concise, such as it should be in a manu-
al. All speculation is carefully avoided, and the facts plainly pre-
sented to the reader; and to facilitate reference each paragraphia
numbered.

We give the commencement of the first chapter, that our readers
may judge of the character of this work.

11 Ophthalmoscopy, or exploration of the eyes in order to a diagno-
sis. This exploration is of two kinds, viz., subjective and objective.
The subjective exploration of the eye comprehends an inquiry into
the patient's sensations in the affected organ, such as pain, tolerance
of light, and state of vision. The objective exploration is directed
towards the morbid conditions which admit of being perceived by
the surgeon himself.

1847.] Ophthalmic Medicine and Surgery. 337

" Subjective examination of the eyes. Pain ; its seat and charac-
ter. Pain, as if a foreign body were in the eye, with itchiness and
smarting of the edges of the eyelids, and sometimes pain across the
forehead, indicates conjunctival inflammation. Rheumatic pain,
around the orbit, or in the temples, occurring in nocturnal paroxysms,
points to inflammatory congestion of the sclerotica, as in iritis, &c.
Deep-distending pain in the eyeball, with or without circumorbital
or temporal pain, marks deep internal inflammation of the eye.

" Intolerance of light, or photophobia. Intolerance of light, in a
greater or less degree, is a very frequent symptom in the ophthalmiae ;
but that in which it occurs in the highest degree is the scrofulous
ophthalmia of children. Intolerance of light may also occur in other
affections not coming under the head of the ophthalmiae.

" State of vision. Is the sight short (myopia), or long (presby-
opia) ? The pupil being greatly dilated, (mydriasis,) with indis-
tinctness of vision, are objects seen more distinctly by looking
through a small aperture in a card, blackened on the surface, held
next the eye ? Are objects seen distorted ? Are they seen of anoth-
er than their true colour, surrounded by a colored halo (chroopsia) ?
Is vision dim? if so, is it defective by day (day-blindness)? or it is
defective by night (night-blindness)? or it is defective both by day
and night? Do the eyes soon become fatigued, and the vision con-
fused, when near objects are examined (asthenopia)? Are objects
seen double (diplopia) ? And if so, is the vision double when one
eye only is used ! or is it double only when both eyes are used? Is
the half or a part of objects only seen (hemiopia. &c.) ? Is there an
appearance of motes or flies floating in the field of vision (musccp
volitantes)? Do objects continue to appear before the eyes, but of
an opposite tint or colour, for a few seconds after they are no longer
looked at (ocular spectra) ? Are flashes and scintillations of light
ever seen (photopsia) ? Such are the principal questions which
may suggest themselves in the course of an inquiry into the state of
vision.

" Objective exploration of the eyes In this exploration, the eyes
should be first examined without touching them. This it is of im-
portance to do, especially in inflammations, in order to avoid causing
an increased determination of blood, lachrymation, &c, which in
such cases are apt to be occasioned by the slightest touch, and which
might complicate the appearance natural to the inflammation, and
give an erroneous view of the nature of the case. In an hospital,
the pupils should not, on any account, be permitted to touch the eyes
of a patient, before the surgeon has made his examination.

"The surgeon should, in succession, glance at the eyebrows and
orbital margins, the eyelids and their movements, the borders of the
eyelids and state of the eyelashes, and the corners of the eyes, and
note the presence or absence of lachrymation, the form and appear-
ance of the eyeballs generally their size and degree of prominence
movements and direction the correspondence of their axes: the

338 Ophthalmic Medicine and Surgery. [June,

appearance and colour of the white of the eye, the appearance of the
cornea, the colour of the iris, and the state of the pupil.

"Besides this direct examination of the eyes themselves, the gen-
eral bearing of the patient, and the expression of his features should
be carefully observed. The information thus obtained will some-
times reveal the nature of the case, or will guide in the further
exploration of it. By the general bearing of the patient, and the
expression of his features, it will be seen, for example, if he is affected
with intolerance of light if he be blind from amaurosis, or blind
from cataract.

"The patient, intolerant of light, keeps his head bent down, and
covers his eyes with his hands, in order to protect them from the
light. The eyelids are spasmodically closed, and at the same time
the eyebrows are knit and depressed, and the cheeks drawn up, so
that there is great distortion of the whole features. There is greater
or less lachrymation.

" Whilst the confirmedly amaurotic patient moves about with an
air of uncertainty, his head erect, and the eyes wide open not con-
verged and fixed on any object, but staring forward as if on vacancy
perhaps moving about in a vacillating manner or squinting, the
cataractous patient is more steady in his gait; and with his head bent
forwards, his eyes half-closed, his eyebrows knit and depressed, he
moves and directs the eyes naturally and steadily, in an exploratory
manner.

"This survey, constituting the first step in the objective explora-
tion of the eye, may be taken during the time the patient is coming
into the room, relating the history of his case, and describing his
present sensations in the eyes. In the subsequent steps of the ob-
jective exploration, attention should be carefully directed to the
relations which may exist between the subjective and objective
phenomena of the case.

" Most probably the result of the preceding objective survey, in
conjunction with the subjective examination, will have been such as
at once to direct the practitioner to the part affected, on which he will
accordingly fix his attention, and subject it to the necessary explora-
tion in order to an exact diagnosis, not neglecting, however, to take a
rapid, but methodical survey of the other parts of the eye, lest any-
thing should be overlooked. The account of the mode of conducting
the objective exploration of the different parts of the eye in detail, to
which I now proceed, will necessarily include references to the prin-
cipal morbid conditions of the organ."

The author then proceeds to the exploration of the eyebrows, eye-
lids, conjunctiva, lachrymal organs, movements of the eyeballs, state
of the cornea, state of the iris and pupil, &c.,&c.

In regard to the mooted question, whether the conjunctiva covers
the cornea, he says :
"The ocular conjunctiva is connected to the sclerotica underneath

1847.] Ophthalmic Medicine and Surgery. 339

by cellular tissue loose enough to allow the former to slide somewhat
upon the latter, M the margin of the cornea the cellulo-vascular
and nervous basis of the sclerotic conjunctiva stops what of the
conjunctiva extends over the cornea being reduced to the epithelium.
This epithelium, however, forms a thicker layer than on the sclerotic
conjunctiva. It is, of course, intimately adherent to the proper sub-
stance of the cornea."

To distinguish whether the redness, that almost pathognomonic
symptom of inflammation, be situated in the conjunctiva orsclerotica,
he illustrates the question by a diagram, which we confess is very hap-
piiy done. This cut represents sclerotic vascularity by straight faint
lines on one side, and conjunctival vascularity by larger, deeper co-
lored and tortuous irregular lines on the other. The text is,

" Conjunctival vascularity Sclerotic vascularity. If the white of
the eye is red from inflammatory congestion, it becomes a question
whether the congestion be in the conjunctiva or sclerotica. In con-
junctival inflammation, the vessels of the sclerotic conjunctiva are
large, somewhat torturous, and arranged in a reticular manner ; the
color is scarlet, or brick red, and it may be deeper towards the orbit,
but more or less, shaded off" towards the cornea. In sclerotic injec-
tion, the redness is in the form of a pink or lake-colored zone, en-
circling the cornea ; the injected vessels being very minute, and
disposed in straight radiating lines, as if from its margin, where the
tint is deeper, whilst it is shaded off, and disappears towards the orbit,
the converse of what occurs in the injection attending conjunctival
inflammation. The seat of the injected vessels, whether in the sclero-
tic conjunctiva or in or on the sclerotica itself, is easily proved, sup-
posing any doubt exists, by making the conjunctiva slide on the
sclerotica, when the vessels, if seated in the conjunctiva, will be
observed to move along with it, whereas, if seated in the sclerotica,
or closely applied to its surface, they will remain stationary. When
both conjunctiva and sclerotica are injected at the same time, the
pink hair-like vessels of the sclerotica are seen stationary through the
larger meshes of the sliding conjunctiva. But when the conjunctiva
is very much injected, the state of the sclerotica cannot be seen."

Our author sets down the usual diameter of the cornea at ^V" of
an inch transversely, and a little less than this vertically.

For the artificial dilatation of the pupil, he speaks more favorably
of the solution (ext. belladonn. grs. xx., aq. destillat. gi., solve et per
linteum cola,) dropped into the eye, than the same extract reduced
to the consistence of honey, smeared upon the eyebrow and outside
of the eyelids. He also alludes to the active principles (atropine
and hyoscyamine,) of belladonna and hyoscyamus, originally recom-
mended, he says, by Dr. Reisinger. With iho solution of the com-

340 Ophthalmic Medicine and Surgery. [June,

mon ext. belladonna, he says the pupil is dilated in a quarter of an
hour or so. Having recently been embarrassed by the tardy dilata-
tion of the pupil in more cases than one, and wherein both the solu-
tion and paste of this preparation, were freely applied, we have
obtained the ext. of belladonna from various sources, and in no in-
stance have we succeeded in effecting a dilatation in the time men-
tioned by Mr. Jones. We prefer smearing the paste over the eyelids
and rubbing it into the eyebrow, two hours before operating, for cata-
ract. To the solution we object, because most of the extracts contain
some gritty particles, and the article itself irritates the conjunctiva.
Of the applications of remedial agents to the eyes, he thus speaks :

" Cold lotions. Cold spring water is the best cold lotion. It is
applied by means of compresses of old linen or lint, which should be
broad enough to extend over the neighbouring parts as well as over
the eye, but not so heavy as to press unpleasantly. When once com-
menced, the application of the cold lotion requires to be assiduously
kept up as long as is necessary, one compress, as soon as it becomes
warm, being replaced by another just taken out of the water.

" Cold douche bath. This consists in a fine stream of cold spring
water allowed to play on the closed eye and neighboring parts. The
application may be continued for about a quarter of an hour at a
time. There are particular douche apparatuses. A simple form of
one may be readily constructed with a glass tube of the thickness of
a barometer tube, and from three to three and a half feet long, bent
like a syphon six inches from one end, whilst at the other it is drawn
out small, and also bent, but only for about two inches ; the short
limb of the syphon being immersed in a vessel of water placed at a
convenient height, the air is sucked out at the small end, when a fine
stream of water will issue from it."

" Warm cataplasms and fomentations. As applications to the eye,
fomentations are much more convenient and elegant than poultices.
Warm water simply may be used for the purpose, or chamomile
decoction, poppy decoction, and the like. The application is made
by means of compresses, as just described for cold lotions. The ap-
plication requires only to be made occasionally, and that merely for
a period of from five minutes to a quarter of an hour at a time.
Warm cataplasms and fomentations should never be allowed to be-
come cold on the eyes. After their removal, the eyes are to be
gently dried with a soft linen cloth, and care taken that they be not
exposed to a draught of air."

" Eye-waters properly so called, are the weaker solutions, and are
used to bathe the eye occasionally in the course of the day. The
fluid is to be put into a cup in sufficient quantity and made tepid.
The patient, holding his head over the vessel, is to lave his eye with
the water by means of a piece of sponge or soft linen rag; and after
this has been done for a few minutes, some of the fluid may be drop-

1847.] Ophthalmic Medicine and Surgery. 341

ped fairly into the eye by an assistant squeezing the soaked rag over
it, while the patient lies on his back, and endeavours to hold his eye-
lids apart. After this, the eye may be laved again for a minute or so,
and then carefully dried with a soft linen cloth. An eye-glass is not
to be recommended.

"A principal object in the process above described is to remove
any discharge from the eyes. The blennorrhoeal ophthalmia, when
the eyelids are enormously swollen and cannot be opened, it may be
necessary to inject the eye-water between the eyelids, after they have
been cleansed as much as possible by means of the bathing simply.
In using the syringe, however, care must be taken not to injure the
patient's eye by pressure or the like, and on the other hand, the opera-
tor should guard his own eyes from receiving any spirt of matter."

His examples of eye-waters are

ft. Belladonnae extract 3ss., Aquae purse fviij. Solve et per linteum
cola. Sig. Sedative eye-water, to be used tepid.

ft. Aluminisgr. xvj., Aquae ros. ^viij. Solve. Ft. aquaophthalmica.

ft. Sulphat. zinci gr. xvj., Aquae ros. j^viij., Acid, sulph. dilut. gr. xvj.
F. Solutio pro aqua ophthalmica.

ft. Hydrarg. bichlorid. gr. j., Ammoniae hydrochlorat gr. vj, Aq.
ros. ^viij. Solve, &c.

ft. Lapidis divini* gr. xvj., Aquae destillat. gj. Solve et cola.
Colaturae adde aquae rosarum gvij. Misce, &c. Sig. Eye-water.

" N. B. To any of the four last solutions, a drachm of vinum opii
may be added. The following may be mentioned as directions for
use : To a vvineglassful, add as much hot water as will make the
whole lukewarm. With the quantity thus prepared, the eyes are to
be bathed as thus directed.

" Drops. These may be applied by means of a quill or glass tube,
but a large camel's hair pencil will be found the most convenient in-
strument. It is to be remembered, however, that to avoid accidents,
each patient should have a separate pencil, which ought to be well
washed every time it is used. The lower eyelid being slightly evert-
ed, its inner surface is to be touched with the loaded pencil, when
the fluid will be immediately drawn off and diffused over the lower
part of the conjunctiva. Pains must also be taken to allow the drop
to make its way underneath the upper eyelid by drawing this from
contact with the eyeball, and then moving it slightly up and down.
It is frequently necessary to evert the upper eyelid, and to pencil its
conjunctival surface directly.

" In order to apply drops to the eye of a child with the least possi-

* Take Sulph. of Copper, Nitrate of Potash and Alum, each xvi. parte.
Triturate together and liquify in a glass vessel over a sand bath. After they
are melted, add pulverised camphor 1 part Mir. When tin' mass is cool, it
is known under the Dame of the dii ine tone. (Trans. Edts. S. M. and S. J |

312 Ophthalmic Medicine and Surgery. [June,

ble trouble, the surgeon is to seat himself on a chair, with a towel,
folded longways, laid across his knees. On another chair, on the
surgeon's left hand, and a little in front of him, the nurse with the
child sits in such a way, that when she lays the child across her lap,
its head may be received on the towel, and between the knees of the
surgeon, and thus held steadily. The nurse confining the hands and
arms of the child, the surgeon easily draws down the lower eyelid
and drops in the fluid ; he then draws the upper eyelid up a little, and
also from contact with the eyeball, in order to allow the drop to get
underneath The eyelids are then alternately to be drawn from
each other, and made to approach so as to favor the spreading of the
fluid over the whole conjunctival surface."

" Examples of eye drops.

" Vinum opii, pure, or diluted with one or two waters, is often used
for dropping in the eye.

R. Nitratis argenti gr. iv. x., Aquas dcstillatas gj. Solve.

R. Hjdrarg. bichlorid. gr. ss., Aquas destillatas 3vij. Solve et cola.
Colaturas adde vini opii 3j. Mince.

R. Lapidis divini gr. v. x., Aquas destillatae 3vij. Solve et cola.
Colaturas adde vini opii 3j. Minse.

R. Extract, belladonnas gr. xx., Aquas destillatae j. Solve et per
linteum cola.

R. Atropiassulphat.gr. ij. iv., Aquae destillatas $j. F. Solutio.

Janin's ointment for the eyes, he says, is composed as follows :
R. Prascipitat. alb. gr. xv., Tutias prasparat, Boli armen. ppt. aa 3ss.,

Adip. suilli 3i. 3ij. M. exactissime : ft. ungt. ophthalmicum.

For the local abstraction of blood from the eyes, or rather its
neighborhood, he recommends half a dozen leeches as the average
number to be applied for an adult. Dr. Hays, the American editor,
in a note, says the author alludes to the European leech, but of the
domestic variety fifty or sixty may be used. This must be a mistake.
One leech applied to the temple, we have known to cause death to an
infant, and we confess a dozen ought to produce sufficient effect in
almost any case of ophthalmia.

To remove sparks, as they are called, or detached portions of iron
from the ocuio-palpebral space, he recommends a toothpick or a small
silver spatula. We employ, as Dr. Hays does for this purpose, a
cataract needle. Indeed, under another section the author also re-
commends the same instrument. We have never yet seen good
result in a single instance from the magnet. A diluted solution of
tincture of iodine, may oxydize the metal and facilitate its extraction,
as has been suggested ; but delay might be very injurious under these
circumstances.

1847.] Ophthalmic Medicine and Surgery. 343

Besides sweet oil mentioned in the text to decompose caustic and
alkaline substances introduced between the eyelids, diluted acetic
acid has also been proposed.

We pass over the author's views regarding inflammation in gener-
al, because not one by any means peculiar to the eye itself. We
may be permitted, however, to extract the four following postulates,
which require no comment:

"1. That the constriction and dilatation of the calibre of the small
arteries at least, if not of the capillaries, are owing to contraction
and relaxation of their walls by virtue of the vital endowment of
contractility or tonicity which they possess ; the exercise of which
contractility is dependent on nervous influence.

"2. That the constant moderate exercise of this endowment on
which the ordinary state of tone of the vessels depends, is determined
by the constant moderate discharge of nervous influence.

"3. That whilst a greater state of constriction of the vessels than
ordinary is owing to an increased discharge of nervous influence, the
relaxation, atony, or paralysis of the walls of the vessels on which their
dilatation depends, is owing to the suspension of nervous influence.

"4. That the relaxation, with dilatation of the vessels from suspen-
sion of nervous influence, is the precursor of the retarded flow of
blood and stagnation."

Of ophthalmic inflammation in general, the author makes the
following orders, viz :

"1. Ophthalmia Externa. 2. Ophthalmia Interna Ante-
rior. 3. Ophihalmia interna Posterior. 4. Panophthal3HTis.

"The genera of these orders are distinguished and designated ac-
cording to the particular structure which is the chief seat of the in-
flammation I say the chief seat, for the inflammation is seldom con-
fined altogether to a single structure.

4i Ophthalmia externa thus comprehends, according as the conjunc-
tiva, sclerotica, or cornea is the chief seat of the inflammation, the
genera Conjunctivitis, Sclerotitis, Corneitis.

"Ophthalmia interna anterior, on the same principle, comprehends
the genera Aquo -capsulitis, Iritis, Crystallino-capsulitis anterior.

"Ophthalmia interna posterior, again, comprehends the genera
Choroiditis, Retinitis, Vitreo -capsulitis, Crystallino-cepsulitis pos-
terior.

"Panophthalmitis is both order and genu3."

It is not our design, as it would lead us too much into detail, to
examine this beautiful classification, but we propose to take a rapid
glance over these different varieties of ophthalmia?; and simply note
any new or important fact that may arrest our attention.

In certain cases of conjunctivitis, phlyctenule like pin's heads are

344 Ophthalmic Medicine and Surgery. [June,

observed on the palbebral conjunctiva, and on the conjunctiva of the
sinuses. These are the result of small collections of exuded matter
under the epithelium. We think this condition is particularly ob-
served about the caruncula lachrymalis.

To the membrane lining the internal surface of the cornea, the
name of Descemet is given, and Mr. Jones states he has known par-
tial opacity of the cornea to be produced by the cataract needle pass-
ing through the iris and touching it posteriorly.

Of iritis, he says:

"In consequence of the coloration of the iris, it does not, like the
conjunctiva, for example, when inflamed, appear red, but of a colour
which is a compound of its own natural colour, and that of the stag-
nant blood. Thus a blue iris becomes green, a brown iris reddish
brown. The brilliancy of the iris is at the same time impaired or
lost. Subsequent changes in the colour of the iris are owing'to ex-
uded matter and to changes in the pigment."

Is the lens ever regenerated ? To which he replies

"Pauli, Lowenhardt and Textor have repeated the experiments on
regeneration ofthe lens in animals with success. Textor communi-
cates some new cases of regeneration of the lens in man after oper-
ations for cataract. The proof that the newly formed substance
possesses the same intimate structure as the lens has at last been sup-
plied by Valentin's microscopical investigation of the subject."

He thus classifies the causes of ophthalmic inflammation.

?'The practical advantage of being acquainted with the causes of
ophthalmic inflammation is to know how to avoid them, and thus to
prevent the inflammation, or, if they have already produced inflamma-
tion, to know how to remove them if still in operation and removable.

" The causes of ophthalmic inflammation may be referred to three
heads, viz: 1st. Those which operate directly on the eyes. 2nd.
Diseases of other parts with which the eyes sympathize, or which
spread to the eyes. 3rd. States of constitution and constitutional
diseases which, though they do not necessarily determine inflamma-
tion of the eyes, at least predispose them to be affected by other
causes.

"To the first head belong : Direct injuries direct influence of
cold the direct action of very strong light, or of this and strong heat
together the irritation of reflected light over-exertion of the sight,
especially in bad light, either too weak or too strong, with much
stooping of the head the direct influence of acrid vapours, epidem-
ic or endemic influences the direct application of contagious mat-
ters. n These are all exciting causes; but some of them require to
be assisted by other causes, so that they operate partly as predispos-
ing causes also.

1847.] Ophthalmic Medicine and Surgery. 345

" To the second head belong diseases of the skin, especially the
exanthematous diseases.

" To the third head belong the scrofulous, rheumatic or gouty
diathesis, and constitutional syphilis.

"Under the influence of these causes, different forms of ophthal-
mic inflammation are produced."

The peculiarities to be observed in the treatment of ophthalmic
inflammation, he sums up as follows :

"In consequence of the peculiarity of the structure and functions
of the eye, its usefulness is ant to be interfered with by such effects
of inflammation as in most other organs would be of little or no mo-
ment. Hence, though the treatment of ophthalmic inflammation
must be conducted on the same general principles as that of inflam-
mation of any other part of the body, it is necessary, ceteris paribus,
to push it with more activity, and at the same time to attend to nu-
merous special details. Thus in iritis, blood-letting and mercuriali-
zation require to be pushed to a greater extent than might in another
organ be thought advisable for the same kind and degree of inflam-
mation. But supposing blood-letting and mercurialization thus
pushed have been successful in subduing the inflammation, the neg-
lect of such details as the application of belladonna to keep the pupil
dilated, may have allowed it to become closed, or the lens spotted
over with depositions of lymph, in which case vision will be lost or
greatly impaired.

"In the treatment of ophthalmic inflammation, the first points to
be attended to (besides, as a matter of course, the removal of the
exciting cause, if still in operation and removable), are the protection
of the eyes from every thing which can cause or keep up irritation
such as using them or exposing them to strong light and the avoid-
ance of whatever is calculated to operate injuriously on the system in
general, such as exposure to the weather, corporeal exertion, errors
of diet, &c.

"When ophthalmic inflammation is sympathetically connected
with disease of some other organ, as the exanthematous ophthalmias
are with the inflammation of the skin, or symptomatically connected
with some general diathesis, as scrofula, or disease, as syphilis, the
treatment of the ophthalmic inflammation ought not to be delayed
until the removal of the disease with which it is sympathetic, or of
which it is symptomatic.

"It is true that the local disease cannot always be cured or allevia-
ted until the removal of the general disease, and that the removal of
the general disease will, of itself, often determine the subsidence of
the local. This, however, ought not to prevent us from at least at-
tempting to relieve the eyes as quickly as possible.

"'For the cure of ophthalmic inflammation, as for that of inflam-
mation generally, different plans of treatment are required according
to the structure or structures affected, the degree and stage of the
inflammation, &c."

346 Ophthalmic Medicine and Surgery. [June,

To general and local bleeding; mercurialization, especially in acute
iritis, emetics, purgatives, diaphoretics, and nitre are added to subdue
and prevent the bad effects of inflammation upon the eye. But bel-
ladonna is the remedy and medicine most peculiarly appropriate to
the eye. It not only dilates the pupil, but subdues intolerance to
light, and thus obviates inflammation.

But we must hasten on to complete our notice of this work. We
find about sixty pages of this manual devoted to the interesting sub-
ject of cataract. With a few extracts and remarks on this topic, we
propose to close this review.

After the usual definition of cataract ; its varieties into lenticular,
capsular, and capsulo-lenticular ; into hard, soft, and fluid; its size
and color ; we find the following questions thus answered :

" When one eye only is affected zvith cataract, and the vision of
the other good, should an operation be performed ? Under such cir-
cumstances, the practitioner will not recommend recourse to an
operation, and indeed the patient is not likely to desire it, except, as
is sometimes the case with youn persons, generally females, when
the cataract is white and very evident, for the sake of getting rid of
the deformity.

" When in one eye useful vision is lost, and in the other, vision has
become misty from cataract, should an operation be performed on the
former ? The usual advice is to wait until useful vision is lost in the
latter also; but it is better to operate at once on the blind eye,
though the determination of the point may be left to the convenience
of the patient.

" When in an elderly person double lenticular cataract has become
so far developed as to interfere with useful vision, when should an
operation be had recourse to 1 If extraction is to be performed, oper-
ate as soon as possible, for there is more chance of the vitreous body
being sound than at a later period ; if, on the contrary, displacement
is to be performed, the operation may be deferred until the cataracts
be more developed.

" When cataract is fully formed in both eyes, may both be operated
on at the same time ? As a general rule, the answer is in the nega-
tive, if extraction is to be performed; in the affirmative, if displace-
ment or division.

11 In cases of congenital cataract, at what age should the operation
be performed? It ought to be performed in infancy, and, if possible,
before teething commences ; if not, soon after teething is completed."

He relies upon the catoptric examination in the diagnosis of cata-
ract, and we should have been pleased had the full credit of its
introduction into practice been given to its discoverer, the late Mr.
Sanson, of Paris. And this would have been done, had but the

1847.] Ophthalmic Medicine and Surgery. 347

moiety of the zeal for the honor and merits he evinces for his own
countrymen been bestowed upon others.
This examination is thus described :

"Cafoptrical examination of the cry st aline body. The pupil being
dilated by belladonna, and the patient sitting with his back to the win-
dow, if a lighted taper be held before the pupil, three images of it are
seen situated one behind the other, if the cornea and crystaline are of
their natural transparency. Of these images, the anterior and posterior
are erect, the middle one inverted. The anterior is the brightest and
most distinct, the posterior the least so. The middle one is the
smallest, but it is bright. If the tapor be moved, the two erect ima-
ges follow its motions in the same direction, but the inverted image
moves in the opposite direction, though not so quickly, nor through
so great a range as the other two. The anterior erect image is pro-
duced by the cornea, the posterior by the anterior surface of the lens,
and the middle or inverted ima^e is produced by the concave surface
of the posterior wall of the capsule.

"The posterior erect and inverted images are not produced, if the
anterior part of the crystaline body be opaque, whether the rest be
opaque or not, but if it is the centre of the posterior part only which
is opaque, the posterior erect image is produced, but not the inverted
one. When the opacity is as yet slight, the images may be produced,
but will be more or less indistinct. Of course the anterior erect or
corneal image is not affected, unless the cornea is diseased."

We observe nothing new concerning the preparation of the patient
for the operation, the position of the surgeon and assistants,. &c. ;
but in a note on page 287, the needle for couching or reclination is
recommended to be introduced through the sclerotica neither above
nor below the transverse diameter of the eye, because the long ciliary
artery of the temporal side divides at an acute angle into two branch-
es, about a quarter of an inch from the iris : to avoid wounding it or
these branches, therefore, the transverse diameter is the point select-
ed. The curved needle too, is to be first introduced with its covexi-
ty up, its concavity down, and to enter the point well, let the handle
be lowered and Jhen gradually be brought horizontally and rotated
one quarter upon its own axis, to change the convexity forwards and
the concavity backwards. This we conceive to be an important im-
provement over the old method of puncturing with the couching
needle. The chief difficulty of this operation has been in the intro-
duction of the instrument. For the first years of our practice, in
some 40 or 50 cases of cataract operated upon, generally by couching,
the success was not satisfactory; but during the last twelve months,
the result has been better. Of the last 9 cases occurring within two

348 Ophthalmic Medicine and Surgery. [June,

months, we expect to succeed in 7. We attribute the change in the
result to the facility of puncturation and introduction of the needle ;
to using it in the eye as little and as quickly as possible ; and then to
the immediate and energetic means of subduing the consequent in-
flammation to the operation.

Of the comparative advantages and disadvantages of extraction,
displacement and division, Mr. J. remarks

"By the operation of extraction, the cataract is removed wholly
and at once from the eye, and very good vision restored ; but the
operation is a nice, if not a very difficult one, and liable to the occur-
rence of the various untoward circumstances above mentioned, by
which its success is readily marred.

" The operation of displacement, which may be performed in the
same cases as extraction, is neither so nice nor so difficult an opera-
tion, does not expose the eye to the same risk of immediate destruc-
tion, and though the cataract is apt to return to its former place, the
operation may be repeated ; but though displacement may have suc-
ceeded as an operation, and vision be restored, the eye is not so safe
as after successful extraction, but, as above mentioned, is liable to
become affected with internal inflammation, which ends in amaurosis.
" Extraction thus posesses a decided advantage over displacement,
and is therefore generally preferred, except when the unfavourable
complications above mentioned exist.

"The degree of softening of the vitreous body requisite to admit
of safe displacement of the lens is not so great as to forbid extraction,
but of course, if, in the cases in which the vitreous body is so much
dissolved, that the displaced lens is apt to float up again, displace-
ment be contra-indicated, extraction is much more so.

"All other things being equal, it might perhaps be laid down as a
general proposition, that in the very cases in which displacement
admits of being most readily and safely performed, extraction is less
safe, whilst, on the other hand, in the cases in which, in consequence
of the soundness of the vitreous body, extraction is most safely and
easily performed, displacement is least so.

"As the cases for which division is best fitted are different from
those in which extraction or displacement is indicated, there is no
comparison to be made between them. It is, however, to be observed,
that a combination of division and extraction is sometimes had re-
course to in cases of common lenticular cataract of old people. The
object of having recourse to this compound operation is, as above
mentioned, that the lens may, by solution and absorption of its soft
exterior part, be reduced to its hard nucleus, which, in consequence
of its small size, will admit of being extracted through a small section
of the cornea."

On the subject of Pterygium we have nothing new, and as the suc-
cess of the common modes of treatment are not very satisfactory,
this is much to be regretted.

1847.] Bibliographical 349

At the end of the volume, a glossary of ophthalmic terms occupy-
ing nearly six pages will be found.

This imperfect notice, prepared under many interruptions, we here
close, and commend this manual as a book of reference containing
much new and highly useful matter on the diseases and operations
of the eye.

BIBLIOGRAPHICAL.

1. Handbook of Human Anatomy, general, special and topographi-
cal. Translated from the original German of Dr. Alfred Von
Behr, and adapted to the use of the English student, by John
Birkett, Fellow of the R. C. of S., and Demonstrator of Anatomy
at Guy's Hospital, pp.487. Philadelphia: Lindsay and Blackis-
ton. 1847.

As there never has been but one superintendent of this Journal
since its revival, and having failed, after many appeals, to secure the
co-operation of even those pledged to its support, it cannot be ex-
pected that more than one review for each No. can be prepared, or
even that much, by one who has had and still has the almost entire
labor of this monthly publication on his hands more especially as
he is at times overwhelmed with professional business. But though
thus treated, he is still determined to do his utmost to extend the
usefulness and value of the Journal. If even ten, yea five faithful
contributors be found in this whole region of country, the South-
ern Medical and Surgical Journal can be sustained.

For the work, the title page of which is given above, we are in-
debted to its publishers for a copy. It is a very neat volume of large
duodecimo size,and its typographical execution is good. From the
translator's preface we learn that this, like the one we have already
reviewed for this No. of our Journal, is a manual, forming a series
now in the course of publication at Erlangen, by Drs. Von Behr and
Minding, entitled the " Pocket Encyclopaedia of the Medical Scien-
ces." From a hasty examination, we are prepared to recommend
this little volume, as a handbook of Anatomy.

2. The Pathological Anatomy of the Human Body. By Julius
Vogel, M. D., Professor of Clinical Medicine at the Uuiversity of
Giessen. Translated from the German, with additions, by George
E. Day, M. A. and L. M., Cantab. Member of the Royal College

350 Bibliographical. [June,

of Physicians, dec, dec, dec. Illustrated by upwards of One Hun-
dred plain and colored Engravings, pp. 534. Philadelphia: Lea
and Blanchard. 1847.

This is a large octavo volume, constituting a complete treatise on
general morbid anatomy, and issued in Messrs, Lea and Blanchard's
best style. Its contents are distributed under ten Chapters, embrac-
ing abnormal development of gasseous matters pneumatoses ; ab-
normal collections of aqueous fluids dropsies; pathological rela-
tions of the blood ; general and special relations of pathological
epigeneses ; pathological changes of the tissues and organs of the
body; combination of morbid changes; independent organisms in
the human body ; malformations; and post-mortem changes. Alto-
gether we consider this work a most valuable acquisition to our
library, elucidating as it does morbid anatomy by chemistry and the
microscope.

3. A Treatise on the Diseases of the Eye. By W. Lawrence, F.
R. S., Surgeon Extraordinary to the Queen, dec, dec, die : new
edition. Edited, with numerous additions, and One Hundred and
Seventy-six Illustrations, by Isaac Hays, M. D., Surgeon to Wills'
Hospital, dec pp.859. Philadelphia: Lea and Blanchard. 1847.

This is a new American edition from the second London. In
1833, Mr. Lawrence first published a volume, consisting of Lectures
on the Anatomy, Physiology and Diseases of the Eye, which be
had delivered at the London Ophthalmic Infimary. In 1840, he
issued a second edition, in which the first was carefully revised and
much valuable matter added. Dr. Hays has contributed to the mer-
its of this large volume, which is without doubt our best treatise on
diseases of the eyes.

4. A System af Human Anatomy, general and special. By Eras-
mus Wilson, M. D., Lecturer on Anatomy, London. Third
American from the third London edition. Edited by Paul B.
Goddard, A. Af., M. D., Professor of Anatomy, dec, in the Frank-
lin Medical College of Philadelphia, with Two Hundred and Thirty-
three Illustrations, by Gilbert, pp. 610. Philadelphia : Lea and
Blanchard. 1847.

We have alluded to this work as one of a series of manuals now in
the course of publication by Messrs. Lea and Blanchard, whose lib-
erality we have had occasion so often to acknowledge under our head
of Bibliographical notices. It has already passed through several
editions, both in this country and in Europe, where its author

1847.] Diagnosis of Nervous Diseases. 351

ranks with the highest on anatomy. This last edition is issued
in a beautiful octavo form, filled with illustrations, and making a
very handsome volume. Of the merits of Wilson's Anatomy, we
need only state the facts, that 5000 copies were sold in London with-
in five years of its publication ; that in the same period a third edition
of it is called for in this country ; and that it has been translated into
the German language.

5. Philosophy of Animated Existence ; or Sketches of Living Phys-
ics: with discussions of Physiology Philosophical To which is
added a brief Medical account of the Middle Regions of Georgia.
By John B." Gorman, M. D. pp. 570. Philadelphia: Sown and
Ball. 1845.

The author of this volume has had the kindness to present us with
a copy. With every disposition to do him full justice, and, as Geor-
gians, feeling a deep interest to proclaim the merits of our own
immediate professional brethren, still we shrink from the task of
reviewing this book. We can but express the wish that Dr. Gor-
man's style were different, and that his talent and labor, worthy of
all praise, had been employed in preparing a more useful, practical
and profitable work.

On the Diagnosis of Nervous Diseases. By Alexander H. Ste-
vens, M. D. Read before the New York State Medical Society
Feb. 3, 1847. (New York Journal of Medicine.)

The usual nosological classification of diseases, is not that which
the practitioner is first led to ascertain, when he seeks to discover the
nature of an obscure case presented to him for diagnosis. He rather
wishes to deternmine if the malady be nervous, inflammatory or
organic, and if so, if it be malignant. If he can advance no further,
he yet will have done much, after all, that is necessary, therapeuti-
cally, in having advanced so far as to have settled to which of these
classes of disease his case belongs.

It is my purpose to offer a few practical remarks, designed to aid in
the diagnosis of nervous diseases. The first view of a patient suffer-
ing under a nervous disease, is not unfrequently sufficient to lead
to a strong presumption as to the nature of his case. He has to nar-
rate his sufferings and his symptoms, and often to use his eloquence
to impress upon you that he is indeed a very sick person. His aspect
is not that of emaciation, there is not the haggard look that comes of
sleepless nights, or the wan countenance of an internal suppuration,
or the leaden look of internal disorder. With faith in physic un-

352 Diagnosis of Nervous Diseases. [June,

bounded, he yet seems to reproach his former attendants for their
want of skill in bringing its resources to bear upon his case. Ner-
vous diseases present the far larger portion of strange, out-of-the-way
symptoms, not to be embraced within the nosological definitions of
other maladies.

Accustomed as I have been to be extensively consulted in nervous
diseases, I early began to ask myself, when a case presented itself,
did I ever see such a case in the hospital, or among dispensary pa-
tients, or among the poor in ar.y of the walks of life. If not, I soon
began to discover that generally it was a case of nervous disease I
had to deal with.

An emaciated young man presented himself to me some years
since, and in answer to my question, " What is the matter with you?"
replied, "I have a stricture of the oesophagus. " "And pray, my
good friend, how did you find that out?" "Because 1 can't swal-
low." "And where did you learn that you had an oesophagus to
swallow with ?" Rather irritated, he replied, " I did not come all the
way from Vermont to learn that here in New York, you may be sure ;
but our doctors have tried me with the probang, and I want you to do
so too." " Well, tell me first, how this difficulty began?" "Why,
sir, it began all at once; I could not swallow any solid food, and I
cannot now." " Will you try for me?" After a very long struggle,
I got him to take some roasted mutton from my table, and he went
his way rejoicing. It was not a case of feigned disease, for the argu-
ment that ultimately prevailed with him, and broke his firm resolve
not to endeavor to swallow, was an explanation of the real symptoms
of stricture of the oesophagus not an inability to swallow, but an
arrest of the swallowed food in the course of the oesophagus.

An only child, a girl about twelve years of age, met with a fall, and
bruised the lower right side of the abdomen. The family physician
made the usual applications, and treated the case as rather a serious
one. Without being apparently very sick at the end often weeks,
she yet did not appear to be improving, but maintained her position
all day with the feet on the sofa, being carefully carried to bed at
night. At this time I was consulted, and being unable to detect any
local injury, did nothing. At the end of six weeks the family physi-
cian retired, and desired me to take the case exclusively into my
hands. Another examination discovered nothing, except that her
general aspect was that of good health, the legs and abdomen drop-
sical. In the utmost consternation, the family demanded my opin-
ion. I asked to defer expressing it, till I had made a second visit.
I cannot pretend to describe the scene, when I then said that the
patient only wanted the will to get up and play as well as any of her
fellows. But this opinion I had not imparted to her, and the grand-
mother and myself finally compromised matters, by proposing to her,
to have a dance as soon as she was able to write the notes of invita-
tion, ten days from the date of the second visit. The prescription
was entirely successful, and she danced at her own ball as merrily as
any of her guests.

18-17.] Diagnosis of Nervous Diseases. 353

There is a fashion in nervous diseases. Some years since, spinal
irritation was much in vogue. Nervous persons are apt to adopt as
their own, the latest forms of fashionable maladies. I have seen an
incredible number o[ such cases, some of them bed-ridden for months
and years.

Stricture of the rectum has had its day. I have seen three cases
in one family, which had been treated for months, and finally got well
by the failure of the bead of the family in hi? business; thus leaving
the female members no time to think of their imaginary diseases.
Nervous disorders appear to be adopted either in revenge of some mis-
fortune, or in despair from some blighted hope. They require, more
than any thing else, moral treatment. The physician should en-
deavour to penetrate into the innermost recesses of his patient's heart,
that he may fulfil the great indication, which is, to present a powerful
motive for recovery; and he should never sutler his patient to doubt
for one moment that such a recovery will take place.

During the prevalence of spinal irritation, I was asked to see a lady
recently from England by way of Jamaica, whither she had been sent
for a supposed consumption, with spinal irritation at the same time.
She had been confined to the bed, with few exceptions, for more than
two years. Perceiving, after a few visits, that lively conversation
made her forget her ailments, and that the general assemblage of
symptoms did not belong to any nosological disease, I obtained from
her married sister some matters of her private history, that led me to
be quite sure that her case was purely nervous. " My dear Doctor, do
you know any thing that would cure my poor sister?" "Yes, I do,
I am sure of it." "What! pray tell us what." That cat-o'-nine-
tails hanging over your fire-place." I will not detain you by des-
cribing the scene that followed. About six weeks afterwards I was
stopped in Broadway by two highly dressed ladies, one of whom
tapped me on the shoulder, and introduced my patient to me, saying
with a smile, in which the patient joined, "that last prescription
cured my sister."

OHocal nervous or neuralgic affection?, these, when not organic,
are seated, either, 1st, in the part where the symptoms are perceived ;
or, 2d, at the origin of the nerves of that part ; or, 3d, in the nerves
of some part going to the same portion of a nervous centre for their
origin. Thus, a malady of (he brain will cause a pricking, or numb-
ness in the fingers of one side. And, as an illustration of the third
class of cases, nervous pain is felt in the spine from disease of the
viscera corresponding to the part, the nerves of each having a proxi-
mate origin, through the great sympathetic and the spinal marrow.
So too, affection^ of one eye are felt and sometimes extended to the
other. External injuries, and the internal injuries suffered by the
organs of digestion by errors in diet, are among the more common
exciting cnuses of local nervous affections. The joints are especially
liable to these disorders. They are not unfrcqucntly the sequelae
of sprains and of slight inflammatory affections ol the joint?, from

354 Diagnosis of Nervous Diseases. [June,

other causes. As a general fact it may, I think, be stated, that they
are the result of bad treatment, hyper-medication.

In regard to sprains, I have seen much deformity arising in the
ankle-joint from a fracture of the fibula, and in the wrist still oftener
from a fracture of the radius, treated as sprains. This is among the
poor. But in sprains, strictly so called, it is exceedingly rare to find
very long continued injuries from these accidents, except among those
who can afford to nurse them.

A lady twisted her ankle severely in coming down stairs. Cold
applications and rest were the prescriptions for four weeks. Her
health in the meanwhile had suffered from want of exercise. The
part was preternaturally cold, painful on pressure, and but very little
swollen. A consultation was called, and a blister to the instep fol-
lowed. When this got well, gentle exercise was recommended.
This gave pain, and rest was again resorted to, and friends now came
in with a thousand and one applications, a goodly number of which
were tried. At the expiration of two years, her health being appa-
rently as bad as ever, her husband, a naval officer, was lost at sea ;
she retired to the country, devoted herself to the education of her
children, had no time to think of her lameness, and got well.

A young lady, engaged to be married, had an affection of the
knee-joint, following a bruise of the part. It was kept quiet, rubbed
and blistered for many months, and every suggestion was followed
with all the solicitude which a strong desire of recovery could inspire.
Instead of improving, the joint became rather more tender and pain-
ful, after exercise ; it was swollen and cold. She now came under
the care of a practitioner, who rubbed and fomented it, and directed
steady exercise, and saw that such exercise was effectually taken.
In three weeks she got well and was married.

I visited, some twelve years since, a lady with an active inflamma-
tion of the knee-joint, and treated it successfully by rest, cupping,
and blistering. Some slight injury in walking about three years
since, occurred, and the same treatment was repeated, although there
were very slight inflammatory symptoms. Somehow or other, the
period of rest was protracted until the joint became very stiff. In this
posture of affairs, I was again consulted. I directed the limb to be
left to fix itself by its own weight, and used passive motion and fric-
tions, and this, although the pain was great at times, even when the
part was at rest. For I argued, that if there was any inflammatory
or organic disease of the joint, going on, she would show it in her
countenance, which she did not. She, too, stopped me in the street
the other day, saying, "Doctor, you promised me I should dance as
well as Fanny Elssler ; I can't do that, but I can walk as well as any
one." I am quite convinced that joint not only got stiff, but also
neuralgic for want of use.

Of the frequency of neuralgic affections of the joints, the highest
authority now living in a matter of this kind, (Sir Benjamin Brodie,)
declares that no less than four-fifths of all the cases of diseased joints

1847.] Practical Remarks on Congestive Fever, 355

occurring among the higher classes of society are neuralgic. Of
diseases of the breast, more than half that have fallen under my ob-
servation have been of the same character.

Practical Remarks on Congestive Fever. By E. F. Bocchelle, M.
D., of Columbus, Miss. (Western Lancet.)

In perusing the last edition of Stokes and Bell's Practice of Physic,
a work embodying many valuable principles of medicine, with great
experience and learning, I am forcibly impressed with the views of
Dr. Bell, as almost coincident with my own, as it regards the efficacy
of opium in the treatment of congestive fever. I have long been
satisfied in my own mind, that the usual mode of treating congestive
fever, the plan pursued by most of the physicians of the South West,
is not only improper but dangerous, as its direct tendency is to
strengthen the disease and hasten the stage of collapse. The views
which I now entertain on the subject of congestive fever have been
promulgated throughout the sphere of my acquaintance, since the
summer of 1837.

It is perhaps unnecessary to advance, in detail, a theory of the dis-
ease in question ; suffice, for all practical purposes, to remark, that all
the leading phenomena of the disease are referable to derangement of
the organic system of nerves, more particularly; the excitement of
congestive fever is irritable excitement, and in most cases so exces-
sive, that it soon sinks the system into collapse, unless moderated.

Such being a syllabus of my pathology, it necessarily follows that
in its treatment I invariably call in requisition those remedies whose
known tendency is to allay nervous irritation, tranquilize the system,
and produce sleep. Such remedies are to be found under the class of
narcotics, and in another great remedy belonging to no particular
class, which the hand of a merciful and all-wise Providence has dis-
seminated throughout the universe; a remedy equally accessible to
the rich man and the poor man, as it abounds in all places, and can
be procured "without money and without price." I allude to cold
water. The most powerful combination, however, to prevent the
recurrence of a paroxysm of congestive fever, when the disease
observes a remittent or intermittent character, is morphine and qui-
nine. In the whole course of my observation I have never known
the congestive fever to observe any other than the intermittent or
remittent type ; unless the constitution is so frail, or the disease so
violent as to destroy the patient in the fust paroxysm, which it oftert
does; moreover it is a rare circumstance if an individual, with the
most robust constitution, survives a second or third paroxysm. Most
usually, during the paroxysm, I prescribe laudanum and cold water,
which rarely fail to conduct the patient safely through ; and during
thr interval, morphine and quinine, t<< prevent a recurrence. The

356 Practical Remarks on Congestive Fever. [June,

following is the prescription usually observed : ft. Sulph. quinine,
grs. xxiv. ; Sulph. morphine, grs. ij. ; M. f. 12 pills, to take one
sufficiently often to keep up a slight state of stupor or narcotism ;
that is, every hour or two, pro re naia.

I, for one, am unfriendly to large doses of quinine, and am certain
that two or three grain doses repeated at proper intervals, will insure
all the good effects of that potent salt, without incurring the risk of
loosing them ; not only loosing, but inflicting an injury to the nervous
system. Our firm belief is, and that opinion is founded on experi-
ence, that, as an antiperiodic, two grain doses of quinine are as
efficacious as large doses ; and that in the same proportion that we
augment the dose, in the same or a greater degree do we diminish
the specific action of the article ; also, that its combination with a
narcotic enhances its antiperiodic powers in an eminent degree.

There is a secret in connection with quinine, which, probably, very
few physicians have observed ; that is, that its adminstration during
the stage of excitement in fever is often hurtful, and, at best, uncer-
tain; in order to ensure a favorable influence in such cases, we have
only to combine it with an anodyne. It is rare that quinine will
exert any other than a favorable influence during the hot stage of
fever, provided morphine be blended with it. Its most common
effect under such circumstances, is to lessen the force and frequency
of the pulse, relax the skin, and produce sleep. The above combina-
tion is an admirable prescription in summer fevers attended with
great gastric irritability, it must be given in the form of pills.
Another valuable combination, where the excitement is inordinate, is
quinine, tartar emetic, and morphine provided there is no great
nausea. The above remarks refer only to summer and autumnal
fevers, of open excitement.

Before leaving this subject, I will remark that 20, 60, and 100
grain doses of quinine are very common these days. However, such
doses are not prescribed, or if so, by very few of the scientific phy-
sicians of Mississippi and Alabama. In the meanwhile I will not
presume to deny that peculiar modifications of disease, may render
such doses applicable in more southern latitudes; generally speaking,
these huge doses are given by that numerous class of mountebanks
and imposter^ who infest our country ; men who recognise no es-
sential difference between the stomach of a human being than that
of an ostrich ; between the constitution of a man and that of a horse!
Would to God that the prescribing of lar^e doses of quinine was the
only species of quackery practised in the West ! Calomel, and other
remedies, are given in equally as large quantities ; the success of
which energetic empiricism, our numerous grave-yards bear melan-
choly though silent testimony, to say nothing of the thousands of
constitutions literally destroyed by as many anomalous diseases!

There is a maximum and a minimum dose for any article of the
materia medica a fact which should never be forgotten in clinical
practice and when we transcend either degree, we either produce
no effect at all, or wo do mischief.

1847.] Practical Remarks on Congestive Fever. 357

There is no class of remedies, however, whose dose is more varia-
ble than that of narcotics. Indeed, we can sometimes give them ad
libitum, with very little effect ; as we all know that under certain
states of the nervous system arising from excessive pain, the system
can scarcely be composed by opiates. Who has not seen this veri-
fied in prescribing for acute gout, the passage of biliary calculi,
spasmodic cholic, tetanus, &c.,&c. One of these peculiar condi-
tions of the system occurs in congestive fever, as we are certain
that during one of its paroxysms nothing short of mammoth doses
will conduct the patient safely through, and prevent collapse; which
extraordinary resistance to the usual influence of opiates only argues
the propriety and necessity of such remedies. I do hope, for the
sake of human life, and the honor of medicine, that the day will ere
long arrive when physicians will be convinced, that calomel, and
purgatives generally, French brandy and other stimulants, mustard
cataplasms, blistering plasters, &c, are not the remedies for conges-
tive fever, the endemic of the Mississippi valley, whose very name in
many places, is associated with all the horrors of the grave, in con-
sequence of its great fatality. All purgatives, all stimulants, internal
or external ; all irritants are injurious in congestive fever. So long
as I pursued the plan of correcting the secretions, and stimulating by
brandy, camphor, camphor and quinine, ammonia, pepper, fyc, (j-c,
I lost patients. But when, on the other hand, after much reflection,
I had changed my pathology of the disease, and adopted the cold
water and anodyne practice, my labors were crowned with success,
and have been ever since. In truth, the most violent forms of con-
gestive fever will as certainly yield to the anodyne treatment, as will
a local inflammation yield under depletion. I do not regard quinine
as a stimulant, it has tonic properties, and in combination with an
anodyne, is the most powerful sedative in general use. (There are
many sedatives very active, which are not used in the common
routine of clinical practice.)

We have said nothing definite as yet about cold water in conges-
tive fever, but will do so in very few words. How is the cold water
used in congestive fever? Internally and externally; a pleasant
remedy, and one which any patient will grasp eagerly, and without
much persuasion. I use the cold douche in collapse to arouse the
system to reaction, which it will more often do than any other means
that I have overseen essayed. I have seen many patients, as it were,
moribund; cold and clammy skin, thready pulse, sunken features,
blue finger nails and lips, great epigastric oppression, and breathless-
ness, rescued, as it were, from the grave, by the magic influence of
the cold douche. The cold water is not less useful during the par-
oxysm, to allay general an: rcssing vomiting, thirst, and
internal heat. I allow the patient to drink it freely, it gives great
relief; it removes, in connection with laa ,-ritution of the
ganglionic
and gastrin irritabili

358 Practical Remarks on Congestive Fever. [June,

safely through the paroxysm. How much more rational such treat-
ment is, and, at the same time, how much more grateful to the
languishing sick man, that the opposite plan of tormenting him unto
death with heating stimulants and blistering plasters ! How much
more rational, than the opposite vile system of cramming his stomach
with horse doses of calomel " to remove congestion" of the darkest
and foulest of all places, "the venous cavity ! ! " Would to God that
Mississippi and Alabama could be relieved of the curse of R. A. C.
quackery ! Oh ! ye shades of departed worth ! ye ghosts of Hippo-
crates, iEsculapius, and Galen, how long will ye endure such hum-
buggery ! Oh! "venous cavity!" Oh! calomel, and R. A. C.
pills! inexorable monsters, who have slain your hundreds, why seek
to demolish thousands ! I am not jesting ; no, I am serious.*

But, for the purpose of illustrating the most rational practice in
congestive fever, I will submit one of the most violent cases I ever
saw in Mississippi.

Case. A particular friend, of vigorous constitution, was seized
about midnight, on the 20th of September, 1845, with a slight chill,
which was succeeded by vomiting and profuse liquid evacuations from
the bowels. I saw the patient about 9 o'clock on the 21st ; his head
was hanging over the side of the bed, and he incessantly vomiting or
heaving; his features were sunken and pale ; breathing rapid and
difficult from congestion of the lungs,; pulse feeble and very rapid,
almost imperceptible at the extremities; lips blue, and tongue pale
and moist; with a clammy exudation of viscid perspiration all over
the surface. Indeed, I was surprised to find my friend on the very
verge of the grave: that he was sinking rapidly into a deadly col-
lapse. He complained of great thirst and universal heat ; he would
cry out, " my God, I must have fresh air, or I'll die, I am burning
up!" when the pulse was gone at the extremities, and the skin cold.
The friends around implored me to stimulate him, and apply sina-
pisms to the extremities : I refused, and immediately went to work
in my own way. I gave him 100 drops of laudanum forthwith, and
in a half hour gave 50 drops more, which he drank ; seeing that the
irritability of the system was so excessive, that the laudanum would
not take effect unless repeated at short intervals, in a half hour
more, I gave him 100 drops by enema. In an hour the vomiting
stopped. My friend drinking cold water by the pitcher-full. He very
soon became tranquil, and fell into a deep sleep, with his mouth and
eyes half closed, the spectators around thought that he was dying;
but I knew better, when I took hold of his hand and found that it
was getting warm, and that the pulse was rising at the wrist. In
the course of two hours more, my patient was under a full reaction ;
his skin warm and pulse full, beating eighty in the minute. He did
not wake until sundown when he got uj), dressed himself, and went
about his usual business !!

* 1 don't allude to Prof. Cooke; but to those who endeavor to treat the fevers
of Mississippi, Alabama, &c, according to his theory. I respect the Professor ;
at the same time I am convinced of his delusion.

1847.] Practical Remarks on Congestive Fever. 359

The next morning (22d,) I entreated him to take to his bed, and
commence with the quinine and morphine, to prevent a recurrence
of the paroxysm, which would take place about midnight he de-
clined, stating that he was well. However, the poor fellow was
seized again at 1 o'clock on the 23d.

In two hours he was vomiting forcibly, with frequent liquid dejec-
tions from the bowels ; great dyspnoea, and small and rapid pulse,
with cold skin. At daylight I saw him, and gave the first dose, which
was 100 drops of laudanum. Seeing that he became worse, com-
planing of indescribable epigastric heat and oppression, I repeated
the dose, which had no effect, and he soon became wild and unman-
ageable. I ordered 100 drops more by enema, in starch ; at the
same time allowing him to drink freely of cold water acidulated with
citric acid, which he drank in his derangement with all the avidity
of a famishing animal. He soon became cold from head to foot ; no
pulse, skin cold and bathed in a viscid sweat, lips blue, eyes sunken,
and features shrivelled ; breathing slow and oppressed from conjes-
tion of the lungs. Indeed, the dyspnoea was so great, that he looked
very much like a man suffocating. I ordered 100 drops more in
enema, and applied two small sinapisms to the neck, one over each
pneumogastric nerve, recollecting to have read of such things being
useful in asphyxia, &c. In a short time the patient seemed more
quiet drinking freely of cold water occasionally. At this juncture,
a medical friend of experience, formerly of the United States Navy,
stepped in and pronounced my patient in articulo mortis ; however,
before he had been present one hour, the pulse was rising at the
wrist, and the skin began to get warm, and the patient to breathe
with more ease.

In two hours more, my patient was lying in a profound sleep, with
hot skin, and good pulse ; with the warm sweat standing in great
drops on his forehead. He awoke late in the evening, very much
prostrated indeed. In a short time, I put him under the morphine
and quinine, keeping up a slight narcotism until the next period had
passed in safety ; when I gave a little blue pill occasionally, to re-
store the secretion. It is proper to mention here, that the use of
laudanum and quinine, as above recommended, almost always leaves
the system in a torpid condition, as manifested by a coated and dry
tongue ; so that convalescence will be tedious without the occasional
use of a little blue pill, &c.

The patient whose case I have given, cannot bear the smallest
quantity of laudanum when we!!. I could, if necessary, adduce
other cases, showing conclusively that laudanum, cold water, and
quinine, are the remedies for congestive fever. It is probable that
the above patient would have died, had it not been for the plaster
(size of a dollar) to the neck ; or it may be that the laudanum had
not taken effect until then.

The treatment which has just been detailed in a nYfnrhed and
hurried manner. ' ! i-> mv

360 Observations on Spinal Irritation. [June,

form of summer and autumnal fever in Mississippi. There is no
prescription better, in common fevers, to prepare the system for qui-
nine, than morphine and tart. emet. in solution. Ordinary febrile
excitement can resist its influence but a few hours. In conclusion :
There is no class of remedies which exerts so favorable an influence
in all of the fevers of this latitude as the class of narcotics.

Observations on Spinal Irritation. By Ciiables Favell, M. D.,
Physician to the Sheffield General Infirmary. (Provincial Med.
and Surg. Journ., and Ranking's Abstract.)

[The subject of spinal irritation is also ably considered in a clinical
lecture by a physician whose early and lamented death has recently
been recorded. His observations are to the following effect :]

Spinal irritation is characterized by morbid sensibility of certain
nerves proceeding from the spinal cord, and by a preternatural sus-
ceptibility of the cord or its coverings to external impressions. You
will observe that both these features of the affection were very well
marked in the cases which have been already detailed : in one case
the morbid sensibility of the nerves was evidenced by painful cramps
in the lower extremities, and in the other by constant and severe
pain in the side ; whilst pressure over the same portion of the spinal
column occasioned pain and uneasiness in both.

It is further worthy of remark, that whilst the nervous centre is
the seat of tiie disorder, the pain is situated in some distant part.
On what, then, does this abnormal state of things depend ? In other
words, what is the immediate and efficient cause of spinal irritation?
On this subject we find that pathologists entertain very different
opinions. Some regard it as consisting in nothing more than mere
functional disturbance ; whilst others believe it to be the consequence
of some organic lesion of the cord or its coverings. For my own
part, I believe the affection depends upon a hyperaematous condition
of the blood-vessels at the origin of the spinal nerves, and I am chiefly
induced to adopt this opinion from two considerations the influence
of pressure, and the effect of treatment.

Now let us notice these two particulars. 1st. Pressure. You are
of course aware that when any of the tissues of the body are the seat
of acute or chronic inflammation, the pain which results is augment-
ed by pressure. Thus, in cases of peritonitis, the abdomen is intol-
erant of even very slight pressure; in cases of gastro-enteritis, the
effect of the pressure often determines our opinion respecting the
nature of the disease ; and in pleurisy and pericarditis also, pressure
in the intercostal spaces, or even upon the ribs, greatly aggravates
the pain ; and in like manner, in the cases under consideration, pain
and tenderness are experienced by the patients when pressure is ex-
erted upon a portion of the spinal column. But there are two cb-

1847.] Observations on Spinal Irritation. 301

jections which may be urged against the value of the indication we
are at present considering the influence of pressure in causing an
increase of pain. It may be urged first, that the spinal cord, with its
membranes, is too securely protected by the ocny canal through which
it passes to be liable to he influenced by any moderate amount of pres-
sure which may be employed above it ; and, secondly, that in many
cases of simple hysteria, the apparent szifering occasioned by pres-
sure on the spine is quite as great as in the cases under consideration.
Let us briefly notice each of these objections.

1st. The spinal cord and its membranes are removed from the
influence of pressure by the bony canal through which it passes. Now
to this objection, a threefold reply may be returned. In the first
place, iUmay be remarked, that if the cord be really so completely
removed from the influence of pressure as the objection assumes,
then, except the vertebras themselves be diseased, every portion of the
spinal column should be alike sensible or insensible when pressure is
exerted along the course of it. But this we know is not so. In two
cases which have been recorded, the tenderness, or increased sensi-
bility, was circumscribed. It existed over one particular portion of
the spinal column, and when the same amount of pressure was ex-
erted over all the rest, it occasioned no tenderness, no pain, no incon-
venience. Hence, we may fairly infer the possibility of affecting the
cord of its membranes, in certain morbid conditions of one or the
other, by pressure being exerted along the vertebral column.

Secondly, the peculiar anatomical arrangement of the blood-ves-
sels of the spinal cord render it extremely probable that the cord
should be influenced by external pressure. "The spinal cord and
the nerves which emerge from it," says Dr. Todd, "are surrounded
by a venous anastomosis of remarkable complexity. These veins do
not possess valves; they communicate freely with the superficial
veins, and with the numerous muscular veins in the region of the
back." Now the very circumstance of this free communication ex-
isting between the blood-vessels of the cord and the superficial veins
of the back, is not only an a priori argument in proof of the possi-
bility of affecting the cord or its membranes by external agency, but
it also satisfactorily accounts for the facts for which I am contending.
In other words, we see not only why such should be the case, but
also the mode in which it operates.

Thirdly, in cases of unequivocal spinal meningitis, pressure or
percussion along the course of the vertebrie increases the local pain
from which patients suffer. I can vouch for the correctness of this
remark from cases which have fallen under my own personal obser-
vation.

But 1 hasten to notice the second objection to which I have adverted.

2d. In many cases of simple hysteria it is contended the apparent
suffering occasioned by pressure on the spine, is quite as great as in
the particular class of cases at present engaging our attention. Now,
to this objection I may return again a threefold reply. In the tir^t

362 Observations on Spinal Irritation. [June,

place I remark, that in cases of pure hysteria, the pain of which pa-
tients complain when pressure is made upon the spinal column is not
circumscribed it is not confined to some particular locality, but, on
the contrary, is equally great over every portion of the vertebras ; and
moreover, rt is not confined to the spinal column, but is of equal
severity when the pressure is directed upon the fleshy parts of the
back, on each side of the vertebras.

Secondly, I observe, that whilst in cases of spinal irritation the
suffering of the patient evidently increases with the increase of pres-
sure which is employed, this is not the case in hysteria. In this latter
affection, the apparent suffering of the patient bears no proper pro-
portion to the pressure. Hence we not unfrequently find that in
hysterical subjects, the slightest touch with the finger over tiny part-
of the back will cause them to cringe and give way, to sob, and gasp,
and exclaim, whilst a considerable addition to the pressure scarcely,
if at all, increases their distress. But we must further bear in mind
that this morbid sensibility in cases of hysteria is not confined to the
back, but is manifest in other parts of the body; pressure on the
sternum or on the sides will occasion precisely similar indications of
uneasiness or pain. We often perceive in these cases, that merely
placing the hand, or even the finger, on the sternum or abdomen,
without exerting the slightest pressure, the patient shrinks in a mo-
ment, as if the suffering which was induced was almost intolerable.

Thirdly, I remark that the immediate seat of the morbid sensibility
which exists in hysteria, is obviously the common integument ; hence,
if a portion be taken up between the finger and thumb, as much dis-
tress is occasioned to the patient as if any amount of pressure were
exerted upon the spinal column.

Having thus disposed of the two objections which are most fre-
quently urged against the indication which is afforded by pressure
on the spine, I proceed to notice, in the next place, the effect of treat-
ment, as corroborative of the view I have taken of the nature of the
affection which is the subject of our present observation. And here
I may observe, in general, that the method of treatment which affords
the most speedy and effectual relief, is precisely that which is best
adapted to relieve a state of local hyperaemia. I direct your atten-
tion to three remedies in particular rest, the abstraction of blood,
and vesication.

1. Rest. In all cases of local hyperaemia rest is an important
means of cure. So long as patients are going about their usual oc-
cupations and work, especially so long as they are actively employ-
ing the organ which is the immediate seat of disease, the use of
remedies is fruitless. The truth of this remark is abundantly con-
firmed by what we witness every day ; and it is also corroborated by
what we often see incases of spinal irritation. In these latter cases
the general health is frequently so little disturbed, that persons are
unwilling to submit to the degree of confinement which is necessary,
and the consequence is, that they do not obtain the relief which they

1847.] Observations on Spinal Irritation. 363

desire. I need scarcely observe, that in order to secure the greatest
amount of rest in all cases where the spinal marrow, its membranes,
or the nerves proceeding from it, are the seat of morbid irritability, a
patient should be confined as much as possible, to the recumbent
posture. But I must further remark that, according to my experi-
ence it is not a matter of indifference whether a person lies prone or
supine. The former position is decidedly preferable, and hence I
generally have my patients placed on a prone couch. The advanta-
ges which appear to me to result from this practice are, first, that the
common effects of gravitation are obviated : and, secondly, that the
necessary remedies are much more conveniently applied.

2. Abstraction of Blood. The relief which is afforded by topical
bleeding in cases of spinal irritation is generally very great and often
immediate. It was so in the first of the cases which 1 have detailed.
The cramps ceased, and the tenderness on pressure disappeared im-
mediately after the patient had been cupped. The previously consti-
pated state of the bowels of this man (they had not been moved for a
week, and only nine times during the preceding nine weeks), may
possibly, by some persons, be regarded as sufficient to account for
the symptoms under which he was laboring at the time of his admis-
sion. But that this was not the cause of his sufferings is obvious from
the immediate relief which followed the abstraction of blood, more
than twenty-four hours before the purgative medicine had produced
any effect upon the bowels. The simultaneous disappearance of the
cramps in the extremities, and the pain and tenderness over a limited
portion of the spinal column, is further sufficient to connect the two
together in the relation of cause and effect. But although the relief
which results from bleeding is often so speedily manifest, yet it is not
so in all cases. Sometimes the operation has to be repeated several
times before any mitigation of the symptoms takes place, and in
other instances relapses occur, which render it necessary to have
recourse to the same means again and again. In the case of Bilton,
we perceive that although he was so perfectly relieved by the cup-
ping, yet some days afterwards he complained of numbness of his
legs, which prevented him walking, and there was.at the same time
a return of the tenderness over the spine. For the relief of these
symptoms, which I believe were occasioned by congestion of the
vessels of the spinal cord, leeches were applied to the tender portion
of the spine, and it was subsequently necessary to apply two blisters.
In a case which fell under my observation a short time since, the
cupping had to be repeated more than a dozen times, but on each
occasion the relief afforded was very marked and considerable.

3. Vesication. The application of blisters in cases of spinal irrita-
tion is often productive of great relief: but in these cases, as in cases
of inflammation of internal organs, they are not equally serviceable
at every period of the diseases. If blisters be applied at too early a
period, before the congested blood-vessels have been relieved by the
abstraction of blood, they do not. in recent cases at least, afford an

384 On the Management of Convalescence, <Sfc. [June,

adequate amount of relief, but, on the contrary, they produce a con-
siderable degree of irritation, and occasion a very much greater
amount of pain than they do if they are employed later. I have more
than once seen persons who were very tolerant of pain, and accus-
tomed to the application of blisters, who, nevertheless, when suffer-
ing from spinal irritation, complained of the pain arising from a blis-
ter applied at too early a period, as being exceedingly severe, and
almost intolerable. It is frequently found to be desirable to emplo)7
counter-irritation for a while after the more urgent symptoms have
been overcome. Hence, you will recollect, that in the case of Sarah
Ann Hooper, after she had been greatly relieved by leeches and
blisters, as some uneasiness remained about the side, and slight pain
was occasioned by pressure over the upper part of the dorsal portion
of the spinal column, she was ordered to have the back rubbed with
the croton-oil liniment, which had the effect of producing a plentiful
eruption, and ultimately removing the disease.

With respect to medicines in this affection, I shall only observe,
that beyond regulating the state of the bowels they are of no use.

On the Management of Convalescence from Acute Diseases. By
M. Reveille Parise. (Etudes de THomme dans l'Etat de Sante,
&c, in Medico-Chirurg. Rev., and Ibid.)

M. Parise remarks that after serious and prolonged illness every
organ suffers more or less from exhaustion, and its function is feebly
performed. This condition of the economy results from violent ex-
citement of the antecedent disease and the privation of food. The
former, of course, no longer operates, and food may be given to re-
plenish the waste, and recruit the forces, the stomach is therefore the
organ with which we have to do.

M. Parise lays it down as a maxim that, after disease, the sensibili-
ty of the stomach and intestines is exalted and their tone diminished.
The indications* therefore are obviously to diminish the sensibility
and to augment the tone of the stomach, and consequently to enable
digestion to be properly performed ; but our means of accomplishing
this are not so efficacious as might be imagined. If the subject be
young and vigorous, health is soon restored, and digestion establish-
ed ; but even here, if the tormenting hunger which accompanies con-
valescence be appeased by injudicious supplies of food, various dis-
turbances of the digestive organs ensue. "But if the convalescent is
naturally delicate, nervous, or irritable, if his digestive powers are not
strong even in health, if he has reached a certain age, or been worn
by anxiety, we must expect a tedious convalescence."

At first sight, the fortifying the stomach by tonics would seem to be
a natural means of procedure; but every reflecting practitioner has
seen cases in which an irritable and sensitive condition of the stem-

1847.] O/i the Management of Convalescence, c. 3G5

ach renders the establishment of its powers a matter of nicety, as
well as difficulty. If we employ a soothing means and a debilitating
regimen, the tone of the organ is further diminished ; while if we
exhibit stimulants, uneasiness and thirst, dryness of the mouth, &c,
prove that we are injuriously exciting the organ. Diarrhoea occur-
ring during convalescence often misleads the practitioner, for he has
difficulty in determining whether it is caused by some source of irri-
tation still remaining, or whether it is the consequence of simple
atony of the intestinal canal. In these cases it may be stated as a
general rule, that the diarrhcea of convalescence is connected with
defective tonicity, which will be yet further diminished by abstinence
and local depletion.

The following indications from the basis of a judicious convales-
cent regimen : 1. To allow only as much food as the stomach can
digest. 2. To advise the patient to eat little and often. 3. To
submit the food to effectual mastication. 4. To keep the general
surface, and especially the extremities, warm during digestion. 5.
To adapt the food to the peculiar sympathies of the stomach. 6. To
introduce a judicious variety in the diet. 7. To advise change of
air. 8. To avoid vivid moral emotions.

It is certain, notwithstanding, that however properly the above in-
junctions be carried out, the recovery may be impeded by various
accidents. Only two of these are alluded to by M. Parise, and that
because of their frequency, viz., diarrhcea and gastro-enteralgia.
When the first of these is present we must endeavor to ascertain
whether it is produced by errors of diet or by some moral cause. Is
there any inflammation, or does it depend on simple atony of fibre?
Even when symptoms believed to be inflammatory are present, we
must still be very cautious in recommending abstinence and leeching,
which may produce a degree of exhaustion and loss of contractility
of parts, which may take years for its reparation. Diminution of
food will, however, be required, as well as counter-irritation, in the
form of dry cupping, or sinapisms to the abdomen. When the irrita-
tion has subsided, mild tonics and an improved diet are indicated. In
passive diarrhoea, M. Parise speaks of the theriacum (a miscellaneous
compound containing opium) combined with calumba.

Gaslralgia, or enteralgia, is far more frequent after severe disease,
especially when the alimentary conal has been affected, than is gen-
erally believed. The irregularity forms one of its most distinguish-
ing features. The acute feeling of hunger suddenly changes into a
state of insupportable languor. In this state a superabundant nour-
ishment is injurious, but in a far less degree than a too scanty one.
Abstinence cannot be borne, nor do the epigastric pain and sinking
cease until a certain quantity of food has been swallowed ; while, if
its administration be too long delayed, digestion does not take place,
and diarrhcea is apt to ensue. First among medicines adapted to
this state is bismuth alone, or with opium and calumba. Blisters,
sinapisms to the epigastrium are also beneficial, as is also the ender-
mic use of morphia.

386 On the Abuse of Alkaline Remedies. [June,

Whatever means we have recourse to for the restoration of the
energy of the alimentary canal, their prolonged employment is ne-
cessary. " Perseverance and variety," says M. Parise, " must never
be lost sight of in a troublesome convalescence, during which health
and disease are constantly vibrating."

On the Abuse of Alkaline Remedies. By Professor Trousseau.
(Journal de Medicine, from Ibid.)

The object of this paper is to caution practitioners against the abuse
of alkalies. These remedies exercise an immense influence on the
economy. If by their use the alkaline state of the blood is increas-
ed, all the secretions from that fluid are modified. The secretions
which are naturally alkaline become more so, those which are neuter
will become alkaline, and those which are acid will become either
less acid, or more or less alkaline. The presence of acids being one
of the conditions for the digestions of food in the stomach, it cannot
be a matter of indifference to neutralize the acids which the economy
wants for the transformation of fecula into glucose, for instance.
The digestion of amylaceous substances becomes, therefore, incom-
plete, or extra-natural, if we may use the expression. The presence,
also, of alkalies in the blood in due proportion, gives to this liquid the
means of burning, to a certain extent, the carbonaceous elements
absorbed in the process of digestion. An imperfect combustion gives
rise, without doubt, to morbid symptoms ; but a too great or too rapid
combustion, on the other hand, is not the less attended with incon-
venience, as it gives rise to important mutations in the composition
of the blood, and consequently in the texture of the organs.

It is, therefore, under no circumstance unimportant to administer
alkalies. Taken without any real indication for a few days, they
only give rise to momentary disturbance, but, taken in large quanti-
ties, they occasion a cachectic condition, followed by a deplorable
state of emaciation. The ancients have admirably indicated the
influence of alkalies on the composition of the blood: they had re-
marked that it became more fluid, being paler than in the normal
state; and that at last a cachexia became established, characterized
by paleness, general puffiness of the tissues, and passive hemorrhage ;
moreover they had also perceived, that these symptoms were follow-
ed by emaciation. Within the last few years, the abuse which has
been made of the mineral waters of Vichy and Carlsbad, in the treat-
ment of gout, has proved the above fact. The abuse of alkalies has
certainly done more harm than that of iodine.

How is it that physicians do not see that a remedy powerful to
cure is also powerful to do evil ? Alkaline remedies are daily ad-
ministered with inconceivable indifference, A physician prescribes
to a patient one or two months' use of the waters of Vichy, Carlsbad,

1S47.] O/i the Use of Quinine. 307

or Ems, as he would barley-water to drink. Is it a matter of so little
importance to change all the secretions of the economy? Other
alterative medicines are wielded with more prudence. Mercury and
iodine, for instance, are administered with care and precaution, be-
cause the danger which attends their use is known.

In conclusion, Prof. Trousseau unhesitatingly states, that the dan-
ger of alkalies is greater than that of mercurials, because the danger
is less suspected, and that their administration is often only arrested
when the health of the patient has been irreparably destroyed. This
is not so often the case with mercurials, because the experience of
three centuries has told us that mercury could not be taken long with
impunity. It behooves us, therefore, to make generally known both
the immense utility and the extreme danger of alkaline remedies.

On the Use of Quinine. By A. W. Benton, M. D., of Sterling,
Whitesides county, 111. (111. and Ind. Med. and Surg. Journ.)

What is the condition of the system, and what the indications
which require the use of quinine ?

As much as has of late been written upon the use of quinine, the
answer to the above question seems still to be a desideratum in the
practice of medicine. The science of medicine can be improved
only by a long and careful observation of facts and phenomena as
they occur around us.

These facts have to be collected, compared, and their different re-
lations and bearings carefully noted, before any definite law, or rule
of action, can be established.

As these facts and phenomena are not confined to the observation
ofa favored few, but are spread abroad upon the open page of nature,
it often happens that a man in the humbler walks of life may discov-
er some important truth, which the far directed ken ofa more emi-
nent man may have overlooked. Or, if he is not so fortunate as to
make any new discovery, he may at least observe some trifling cir-
cumstance, that may go far to establish the truth of some previous
discovery.

This being the case, it is the duty of every physician to be vigilant
at his post, however limited the sphere of his observation.

It seems to me that some are too indiscriminate in the use of qui-
nine, while others are too cautious. That quinine has a decided and
specific action upon the system, under certain circumstances, is a well
established fact.

This being the case it must be adapted to some peculiar state of
the system, indicated by a certain train of symptoms. What this
state of the system is, and what are its symptoms, have been subjects
of study and observation with me for the last seven years, the length
of time I have resided in Illinois.

368 On ilie Use of Quinine. [June,

The result of my observations is, that an impoverished and morbid
state of the blood, causing a diminution of the contractility of the
heart and arteries, and functional action of the capillary vessels, con-
stitute that state of the system which calls for the use of quinine.
And that this state is indicated by a more or less well marked tenden-
cy to exacerbation and remission, if not intermission : and never
characterized by that hard, unyielding, and bounding pulse which
attends acute inflammation.

In the height of a paroxysm of fexeT, the pulse may approximate to
the character of an inflammatory pulse, but still I have always found
it to lack that hardness which it assumes in inflammation. The
coats of the artery do not feel so rigid, and tense, and unyielding.
The action of the heart and arteries seems to be more of a tumultu-
ous action, as if it proceeded from irritation, as I believe it does ; and
that irritation caused by an accumulation of blood in the large ves-
sels; and this accumulation, in its turn, produced by the previous
diminished action which proved insufficient to carry on the natural
circulation through the capillary system of vessels ; which are, at the
same time, laboring under, or rather ceasing to labor under, a dimin-
ished supply of nervous energy or influence.

The true theory of intermittent fever seems to me to be something
like the following :

A vitiated state of the atmosphere, consisting probably in the ad-
mixture of some exhaled gaseous matter, together with a changed
electrical condition, imparts to the blood an unhealthy, or morbid
quality. This morbid blood, together with 'the electrical change,
produces a diminished energy in that portion of the nervous system
which presides over the circulating and organic functions of the body.

The consequence is, the blood does not stimulate the heart and
arteries sufficiently to keep up their accustomed contractility, and
elasticity. The capillaries at the same time are incapacitated for
the performance of the functions assigned them.

From all this results a diminished action of the heart, arteries, and
capillaries, insufficient to carry on the circuit of the circulation the
blood ceases gradually to find its way into the small vessels, and
gradually accumulates in the large vessels.

When the capillaries get sufficiently empty, the consequence is a
rigor or chill. When the large vessels get sufficiently full, or full for
a sufficient length of time, the consequence is irritation and reaction,
which forces the circuit of circulation till an equilibrium is estab-
lished; then the reaction ceases, leaving the system in comparative
health.

Then again, during the intermission, commences and continues
the same diminished action, and gradual accumulation of blood in the
larger vessels, and emptiness of the capillaries, till the same phenom-
ena, in a longer or shorter period, are again produced ; thus account-
ing for the periodicity of agues.

The action of quinine I conceive to be to neutralize the sedative

1847.] Result of Drinking. Diet when Iodine is used. 369

poison of malaria, and restore to the blood its appropriate stimulus
for callng into' action the heart, arteries and capillaries, giving them
tone, vigor, and stability of action.

PART III. MONTHLY PERISCOPE.

On the Results of Drinking. By W. Ormerod, Esq. Of all dis-
eases of internal organs produced by drinking, the granular liver
seems to have attracted most attention; perhaps justly ; but there is
no doubt, that of all organic diseases, the two most to be feared in
intemperate persons with recent surgical injuries, are the granular
kidney, and slight, but general emphysema, with a dilated, but not
always much diseased heart; and in persons past the middle of life,
dying rapidly in hospitals after operations and surgical injuries, com-
bined with much loss of blood, these two affections of the urinary
and respiratory organs are very far from uncommon.

The three chief affections destroying patients after operations and
injuries, namely, the general habit produced by drinking ; secondly,
organic disease of the lungs and kidneys, especially emphysema in
the former, and granular disease in the latter ; and, thirdly, tubercle,
act very differently, and at different periods. During the early
period, and often for weeks after operations, patients laboring under
tubercular disease do well ; and it is often only at the absolute return
to health, rather than during the recovery of the patient from the
operation itself, that the effects of tubercle begin to show themselves.
Organic disease produced by drunkenness, and habitual drunkenness,
act differently; the organic disease presses heavily at every period,
and may destroy life early or late ; but the mere habits of the drunk-
ard show themselves chiefly at a very early period. The patient who
nearly sinks from his unsound organs within the first few days, often
lags on for weeks and months in danger ; but the man who has sim-
ple delirium tremens is taken ill directly, and often dies; but if he
recovers from his delirium, he generally gets well from the operation,
and sometimes quickly. [London Lancet.

The proper Diet when Preparations of Iodine are used* Dr.
Moj'sicovics subjects his patients to the following alimentation, when
they are under the preparations of Iodine : At breakfast, pure milk
or mixed with an infusion of green tea broth or coffee and milk.
He prefers, however, tea, because of its diaphoretic properties. At
dinner, broth or soup, beef well cooked and vegetables. If the
appetite is considerable, cooked fruits may be permitted. No bread,
but if the patient cannot do without it, allow a hard biscuit. Dinner
ought then to be taken three hours after a dose of the medicine.
Foi drink, water; bul if necessary a !;!t!? generous wine If any

24

370 Death. Hooping-cough. Poisoning. [June,

supper, let it be milk and tea, or cooked fruit. Children and feeble
patients ought to live chiefly upon milk. [Arch. Generales de Med.

How few patients are subjected to any alteration of diet when
they take iodine? And yet, how easily is it decomposed! [Edts.

To distinguish apparent from real death. M. Mandl has declared
to the Academy of Sciences in Paris, that apparent death can be dis-
tinguished from real by a burn to the second degree. In the first state
a blister will be formed, and in the second, or when death has occur-
red, nothing of the kind will be produced. [Archives Gen.de Med.

Vapor of Ether in Asthma and Hooping-cough. Dr. Willis makes
the following observations on the subject in the Medical Gazette :

11 Ether, given by the mouth, has long been familiarly employed
in the treatment of asthma. I have for many years been aware of
the fact that it has been vastly more efficacious administered direct-
ly in vapour by the breath. My plan of using it is extremely simple.
I have had recourse to no kind ofapparatus for this purpose, but have
been content to pour two, three, or four drachms of the fluid upon a
clean handkerchief, and to direct this to be held closely to the mouth
and nostrils; a single short and difficult inspiration is hardly made
before the effect is experienced ; and I have occasionally seen the
paroxysm ended in six or eight minutes, the respiration having in
that brief interval become almost natural.

*" It is not otherwise with hooping-cough ; the paroxysms of cough-
ing are positively cut short by having the ether and the handkerchief
in readiness, and using them when the fit is perceived to be coming
on. So effectual have I seen their immediate application, that I have
even found it necessary to suffer the patient to have an occasional fit
of coughing to its natural termination, with a view to clearing the
chest from accumulated mucus." [Medical News.

Case of Poisoning by Camphor. By Dr. E. O. Brown, of Ky.
The following case of convulsions, brought on by an overdose of
camphor, will probably interest the readers of the Journal. It is the
second case of the kind that has occurred within a short time in
Bradenburg. [Western Journ. of Med.

Mr. A., a stout, robust man, on the 27th January, 1847, bought an
ounce of gum camphor, had it put up in paper as usual, placed it in
his pocket, and went to church. While there he would frequently
pinch offsmall pieces and chew and swallow them, not noticing the
quantity taken. After church he, with his father and brother, left
town for home. When they had proceeded about one mile on their
way, the two brothers were riding together, when suddenly the one
who had taken the camphor drew up his bridle, as though he was go-
ing to stop his horse, threw himself back and fell to the ground.
Upon going to his assistance they found that he was powerfully con-
vulsed ; in a short time a second and a third convulsion followed. A

13-17.] Belladonna for Neuralgia. Arsenic and Mercury. 371

gentleman passing at the time who was in the habit of bleeding, bled
him, conveyed him to the nearest house, placed him in a warm bath,
and gave some medicine. He remained speechless, and perfectly
unconscious of all that was going on for several hours. After some
hours he gradually recovered his speech, but stated that he could not
recollect any of the transactions of the evening on which the acci-
dent happened. He remained stupid, languid, and rather wandering
all next day, but gradually recovered his former condition, and has
enjoyed his health and spirits as usual since.

The foregoing history I derived from the father of the individual
affected. The weight of the camphor sold by the druggist was as-
certained, and on weighing it again it appeared that it had lost one
hundred and ten grains. It may be concluded, therefore, that the
young man swallowed something like that amount of the substance.

The endermic application of Belladonna for Neuralgia. Prof.
Lippich, of Padua, employs the following formula when he desires to
have recourse to the ext. of Belladonna:

Take Mucilage of Gum Arabic, 300 grains.

Extract of Belladonna, 8 grains. Mix well

together. Apply upon the surface previously denuded by a blister.
M. Lippich in this manner has seen rapid and complete success in
various cases of rheumatismal lumbago, cephelalgia, &c, &c.

[Gazette Medicale.

Solution of Hydriodaie of Arsenic and Mercury. Arcenici et
hydrargyri hydriodatis, liquor of Mr. Donovan, of Dublin. lodo-
arseniate of mercury of Soubeiran. Arsenic, mercury, and Iodine
being in some respects similar to each other in some of their effects,
and occasionally prescribed in a solid form, Mr. Donovan was indu-
ced to propose the more perfect form of a chemical solution. This
is of a yellow colour, with a tinge of green, styptic in taste. Each
f 3j of solution (water) contains protoxide of arsenic gr. , protoxide
of mercury gr. ^, iodine (converted into hydriodic acid) gr. J- , chem-
ically combined together. Mr. Donovan gives the following direc-
tions for preparing it :

Triturate 608 grs. of finely levigated metallic arsenic, 15*39 grs.
of mercury, and 49*02 grs. of iodine, with f 3 j of alcohol, until the
mass has become dry, and from being deep brown has become pale
red. Pour on aq. dist. f g viij, and after trituration for a few moments,
transfer the whole to a tiask ; add ss. of hydriodic acid, prepared
by the acidification of gr. ij of iodine, and boil for a few moments.
When the solution is cold, if there be any deficiency of the original
f 3 viij, make it up exactly to that measure with distilled water.

Action. Uses. Alterative, stimulant, effective in various obsti-
nate skin diseases, as lepra, psoriasis, A:c.

I). x f :> ss, three limes a day in distilled water. Externally,
I 3 j, to aq. dist. I '" i. as a lotion. (Royle.) Ranking,

372 Disease of Vulva. Ascites. Diagnosing Tumors. [June,

Follicular Disease of Vulva. Arg. nit and nitric acid are of no
use. Hydrocyanic acid lotion is serviceable, or an ointment made of
two drachms of prussic acid and a scruple of diacetate of lead, with
two ounces of cocoa-nut oil. The parts are to be first washed with
infusion of roses, and the ointment applied two or three times a-day
on lint.

Or try a lotion of lime water with opium ; or make a poultice of
bread, saturated with decoction of conium leaves, to a pint of which
add two drachms of the liq. plumbi diacet.

When irritation is excessive, prescribe vapor-baths, either simple
or medicated with sulphur. Attend to general health, ordsr a nutri-
cious but unstimulating diet ; avoid wine and porter; give milk with
lime water; keep the patient at rest; forbid sexual intercourse.
There should be change of air. Give the vegetable tonics, as cas-
carilla, calumba, cinchona, sarsaparilla, &c; keep the bowels open
with small doses of magnes. sulph., in infusion of cascarilla or cham-
momile. When the symptoms are decidedly abating, give a mild
mercurial course with sarsaparilla. (Mr. Oldham.) Braithwaite.

Remarkable Case of Ascites. (N. Y. Journ. Med.) Br. Lee :
Agreeably to your request, I send you the short memorandum of
the case of Mrs. Hurlburt, which I took from Mrs. H., with the as-
sistance of her son, Rev. W. Hurlburt.

Castleton, July 15, 1841. Mrs. Hurlburt, a widoi? lady, in
middle walks of life, aged 49 years, had paracentecia abdominis per-
formed on her nine years since, for the first time, since which she
has been tapped no less than forty-three times.

The average quantity of water drawn was fifty-five pounds, the
greatest quantity at any one time was seventy-seven pounds.

For the last three or four years, preceding October, 1840, theoper-
ation was performed about once every four weeks. As the average
was fifty-five lbs. it follows that the whole amount drawn, was two
thousand three hundred and sixty-five pounds! being nearly three
hundred gallons. It should be added that the water ceased to collect
from October, 1840.

I am, sir, very respectfully, your most obedient and humble serv-
ant, &c. E. Barnes, M. D.

Geneva, Dec. 23, 1846.

New Mode of Diagnosing Tumors. Dr. Kuss, Prof, of Physiology
to the Faculty of Medicine at Strasburg, proposes a small trocar or
needle with a small furrow, by which tumors are penetrated and the
small quantity of matter they contain thus extracted, is subjected to
a microscopical examination. The editor of the Gazette Medicale
says he has known in three cases the diagnosis furnished by this
little instrument prevent an operation already decided upon, when the
cancerous nature of the tumors were demonstrated by it. [Gazette
Medicale.

1847.] Extracting a Pin. Removal of Cataract. Jfc, Jfc. 373

Extraction of a Pin from the Urethra. M. Raynaud relates the
case of a child 8 years old, who, two days before, had introduced a
pin, the head first, into his urethra. He now experienced acute pain
in the perineum and anus, with frequent desires to urinate. Nothing
was detected in the urethra by external palpation, but the finger in-
troduced into the anus felt the head of the pin. M. R. succeeded in
extracting it, by introducing a large metallic catheter down to it,
pressing gradually behind the pin as he slowly withdrew this instru-
ment, he had the satisfaction to see it appear at the orifice of the
urethra. [Ibid.

Removal of Cataract by Aspiration. In the Archives Generates
de Medicine, we find M. Laugier, a young surgeon of some emi-
nence in Paris, proposing a small hollow needle, with which to pene-
trate the eye and the crystaline lens, and then to adapt to its external
extremity a small sucking pump, and by this means extract fluid cata-
racts. He speaks of one successful operation by his instrument.

On Extraction of the Placenta before the Child. At the termin-
ation of a paper on the "History, Causes, and Treatment of Placen-
ta Previa," Dr. Edwards thus speaks of Dr. Simpson's proposal :

Experience will decide in what varieties of placenta previa this
practice is most admissible ; but from what we can glean at present,
it seems peculiarly indicated

1. Where the patient is of so weakly and delicate a constitution
that loss of blood to any great extent would be attended with pre-
sent danger, and subsequent injurious effects.

2. Where the child is well ascertained to be dead.

3. In cases in which the powers of life have been excessively low-
ered by the hemorrhage, and the os uteri remains firm and unyielding.

4. In cases in which, although the os uteri is dilatable, the powers
of life would be unequal to the shock of turning.

5. In primiparae, when the soft parts are so contracted that they
would be liable to be bruised or torn in turning.

6. In contracted pelvis. [Lancet.

Exhibition of Assafoetida during Pregnancy. Dr. G. Laferla, of
Malta, recommends strongly this substance in doses gradually increas-
ing from two grains to 3j. daily, for the purpose of preventing the
death of the foetus in utero. The cases which Dr. Laferla particu-
larly points out are those in which before labor the foetus ceases to
live without any appreciable cause a circumstance which some-
times shows itself in several successive gestations. Dr. Laferla re-
ports several cases in which the patients had two, three, and four
times been delivered of still-born children, and afterwards under the
influence of assafoetida, gave birth to living infants. [Revue Medico-
Chirurg., and Med. Nacs.

374 Ether. Bromide of Potass. NcA. Med. Convention. [June,

Fatal Effects of Inhalation : Inquest. An inquest has been held
on a young woman, the wife of a hair-dresser, at Spittlegate, in
the county of Lincolnshire, from whom a tumor had been removed
while under the influence of ether. She never rallied, and died with,
out the slightest reaction having taken place, sixteen hours after the
operation. The following verdict was returned : " That the deceas-
ed, Ann Parkinson, died from the effects of the vapor of ether, inhaled
by her for the purpose of alleviating pain during the removal of a
tumor from her left thigh, and not from the effect of the operation, or
from any other cause." The surgeon who performed the operation
stated that he fully concurred in the verdict, as he had no doubt what-
ever that the ether alone was the cause of death, and it was a duty
he owed to the public to say so. [Prov. Medical Journal.

We are not certain that the ether producd death in this case.
What was the size of the tumor what its nature? Did the operation
produce no effect upon the patient's system? If she died from the
ether alone, ought it not to have been before the lapse of sixteen
hours. But it may have been the sole cause of this death. [Edts.

Bromide of Potassium as a substitute for the Iodide. The low price
of the bromide compared with that of the iodide of potassium, has in-
duced M. Ricord to substitute the former for the latter in the treat-
ment of secondary syphilitic affections. The dose of the bromide is
the same as of that of the iodide of potassium. It has produced the
same therapeutical effects, but more slowly. [Journ. de Pharmaciet
from Am. Journ. Med. Sciences.

MEDICAL INTELLIGENCE.

NATIONAL MEDICAL CONTENTION.

We trust that no apology to our readers is necessary for the space which is
occupied by the proceedings of the National Medical Convention which has
recently been held in Philadelphia. The high character of that body, the im-
portance of the subjects upon which it was called to deliberate, and the deep
interest which medical men must feel in the great movement to elevate their
profession, has induced us to give the whole proceedings as reported by the
Philadelphia Press. In the next number we will proceed to publish such reports
of the committees as will be of general interest, accompanied by such remarks
as in our judgment may be called for.

Wednesday, March 5, 1847,
This mGrning, at ten o'clock, the Delegates to the Second Annual Convention
of the above named body, whose object is to devise measures for the protection
of their interests, the maintenance of their honor and respectability, the advance-
ment of their knowledge, and the extension of their usefulness, assembled in the
hall of the Academy of Natural Sciences, at the corner of Broad and George
streets.

The Convention was called to order by Dr. Isaac Hays, Chairman of the Com-
mittee of Arrangements of the Philadelphia delegation, who nominated for tern-

1847.] yalioaal Medical Convention. 375

porary organization, Dr. J. Knight, of Connecticut, as Chaii man, and Dr. RicKd

D. Arnold, of Georgia, and Dr. Alfred Stille, of Philadelphia, as Secretaries.
Dr. Hays moved that a Committee of five be appointed to receive and exam-
ine the credentials of the Delegates, and report the same to the Convention ;
which was agreed to.

The chairman then appointed the following gentlemen Drs. R. D. Arnold,
of Georgia, T. W. Blatchford, of New York, Robert W. Haxall, of Virginia,

E. H. Bishop, of Connecticut, Thompson, of Delaware.

On motion of Dr. Smith, ol New York, a committee of one from each State
represented in the Convention, was appointed to nominate officers for the per-
manent organization of the Convention.

Dr. Hall, from Vermont; Dr. Holmes, Massachusetts; Dr. Twitchell, N. H.;
Dr. Dunn, R. I. ; Dr. E. Ives, Conn. ; Dr. Stearns, IS. Y. ; Dr. Cole, N. J. ; Dr.
Norris,Pa.; Dr. Baker, Del.; Dr. Gibson, Md. ; Dr. Welford, Va. ; Dr.Lindlev,
Dist. Col.; Dr. Mitchell, Ky.; Dr. Garvin, Ga.; Dr. Moultrie, S. C. ; Dr. Bu-
chanan, Tenn.; Dr. Pierce, Mich.; Dr. Frye, 111.; Dr. Carpenter, La.; Dr.
Keirn, Miss.; Dr. Bullitt, Mo. ; Dr. Shipman, la. ; Dr. Butterfield, Ohio.

The States of Maine, Alabama, Arkansas, Wisconsin, Texas, Iowa and
Florida, were not represented.

The committee appointed to examine the credentials of Delegates to the Con-
vention, reported through their chairman, Dr. Arnold, the followiDglist of dele-
gates present.

New Hampshire Medical Society Drs. Josiah Crosby, Amos Twitchel, F. P. Fitch, A. O
Dickey, J. Bartlett.

Dartmouth Medical College Dr. Edward E. Phelps.

Vermont Medical College Dr. Alonzo Clarke.

Vermont Medical Society D. C Hall, C. W. Horton, A. G. Dana, D. Story.

Faculty of Castleton Medical College Dr. T. M. Marcoe.

Massachusetts Medical Society Drs. Z. B.Adams, A.L. Picrson, W. Bridgman, S. Parkman,
G. C. Shattuck, J. Jeffries. S. W. Williams, E Huntingdon.

Middlesex District Medical College Drs. J.Curtiss, N. Cutler, J.W. Graves.

Faculty of Medicine in Harvard Univetsity Dr. O. W. Holmes,

Berkshire Medical Institute Dr. Alonzo Clark.

Rhode Island Medical Society Drs. Theop. C. Dunn, Usher Parsons.

Connecticut Medical Institution of Yale College Drs. J. Knight, Eli Ires.

Connecticut Medical Society Drs. George Summer, N. B. Ives, B. F. Barker, E. Baldwin
J. C. Hatch, W. B.Carey, A. Skinner, E.Middlebrook.

New Haven Medical dissociation Dr. E. H. Bishop.

Medical Society of New Jersey Drs. Linden A. Smith, E. J. Marsh, W. Forman, F. S
Schenck,W. Pierson, B. P. Howell, J. F. Garrison, J. Parrish,0. H. Taylor, R. M. Cooper.

District Medical Society of Burlington F. N. W. Cole, It. H. Stratton, Z. Read.

Medical Society of the City and County of New York Drs. T. Cook, A. Smith, John B.
Beck, J. K. Rodgers, J. M. Smith, J. Foster, F. N. Johnston, G. Buck, G. P. Camman, W. M.
Blackeman, A. G. Thompson, J. Green, J. R. VanKleek, S. T. Hubhard.

New York Academy oj Medicine Drs. F. Campbell Stewart, J. R. Wood, H. D. Bulkier,
Valentine Mott, A- B. Stout, S. C. Connaut Foster, R. S. Kissam, D. M. Reese , E. L. Beadle,
J. Linsly, O. S. Bastles, C. D. Smith. M Hoit,W. H. Van Buren, J. O. Pond,

College of Physicians and Surgeons in the City uf New York Drs. J. Stearns, J. W Francis,
J. 11. Manley, E. G Ludlow, J A. Wing, D A} res, T. W. Blatchford, D.Clark, M. Snvder,
J. S. Sprague, J. McCall, A. Willard, N. S. Davis, P. H. Hurd, M. Strong, Alex'r Thompson,
L. R. Teft, G. W. Bradford, E. Barnes.

Renssalaer County Medical Society Drs. A. Watkyns, S. A. Cook.

Troy Medical Society Dr. A. Watkyns.

Erie County Medical Society Dr. B. Burwell.

Courtland County Medical Society Dr. B. Burwell.

New York Medical and Surgical Society Drs. J. A. Sweet, J. G. Adams, A. Dubois, P. Earle,
J. McDonald.

University of New York Drs. V. Mott. G. S. Pattison, J W. Draper, G. S. Bedford.

Medical Department of the University of ' Buffalo Dr. A. Flint.

Medical Faculty of Geneva College Dr. C.A.Lee.

Albany Medical College Drs. A. Marsh, J. McNaughton, T. R. Beck, Thomas Hun, D.
Ay res, jr.

New York Pathological Society Drs. J. Y.Metcalf, H.Walsh, T. M. Halsted, I. Moses.

New Yoik Hospital Drs .) . H. Griscom, .J. Watson.

Pennsylvania Jefferson Medical Collet Drs. J. Mitchell, Franklin Bache, Thos.D. Mutter.

Medical Institute of Philadt Iphia Dr. John Neill.

Northern Medical Association of PhiUid-lphiuDm. Wilson Jewell. B. S Janney. M. B.
Smith, J.Uhler, A Nanrlain, J. PenningtonJH. J. Brown, J. R Bryan. W. S Haines. W Msv-
berry, A. C. Hart. J. D. Stewart

Ptnntyhmnia College- n i- r ttcrson rohn Wiltbanli '.'' I \ I <

376 National Medical Convention. [June,

College Physicians, Philadelphia Drs . D. F. Condie, C. D. Meigs, J. Carson, R. La Roche,
C. R. King, Isaac Hays, J. Jackson, J. Rodman Paul, Alfred Stilk', William Pepper, George
Fox, Robert Bridges, Jacob Randolph, J. Wilson Moore, Casper Morris.

University of Pennsylvania Drs. Nathaniel Chapman, Samuel Jackson, George B. Wopd.

Pailadelphia College of Medicine Drs. J. R. Burden, J. McClintock.

Lancaster City and County Medical Society Drs. J. R. Eshelman, J. Winters, Samuel
Humes, Samuel Duffield, J. L. Atlee, G. B. Kerfoot, Henry Carpenter.

Franklin Medical College Drs. J. B.Rodgers, D. F. Tucker, L. S. Joynes.

Philadelphia Medical Society Drs. J. Bell, G. Emmerson, J. Parrish, G. A. Norris,"T.
West, W. Ashmead, B.H. Coates, H.Bond, S.G.Morton, T.H.Yardley, G. D. Griscom,

Medical Society of the State of Delaware Drs. J. M. Thomson, J. Cooper, W. N. Hamilton,
W. W. Morris, G. Saulsbury,W. Cummins, W. W. Wolf, W. W. Stuart, W. M. L.Risavds.

Medical Association of the City of Wilmington Drs. H. F. Asken, G. W. Baker, L. P. Bush,
R. R. forter.

fyedico Chirurgical Faculty of Maryland Drs. C. M. Roberts, J. R. W. Dunbar, A. C.
Robinson, J.H. Briscoe, R. A. Durkee, J.Hopkins.

Association of Medical College of Frederick City Dr. S. Tyler.

Washington University of Baltimore Drs. Charles B. Gibson, W. T. Leonard.

Medical Society of tht District of Columbia Drs. F. Howard, H. Lindsly. Joseph Burrows.

Medical Department of the Columbia College Drs. Thomas Miller, J. R'il'ey, J. F. May.

Medical Convention of Virginia- Drs. B. R. Wellford, H. H. McGuire, J.L. Cabell, J. F.
Peebles, M. H. Houston, H. Massie, W. Selden, G. L. Cprbin, D. Trigg.

Medical Sp piety of Virginia--Drs. R. W. Haxall, S. A. Patterson, J.Conway, Charles S.
Mills, F. Marx, James Beale, J. Dove, T. Nelson. J. A. Cunningham, F. H- Deane, George G.
Minor, John N.Brooks, R. G. Cabell, Carter P.Johnson, H. P. Taliaferro, W. A. Patterson.

Petersburgh Medical Faculty Drs. J. F. Peebles, J. J. Thweatt, B. H. May, J. E. Cox,
R. E. Robinson.

Medcial Society of Montgomery Co. -Drs. G. W. Thomas, H. Corson, J.L. Foulke.

Medical Society of South Carolina Drs. J. Moultrie, W. T. Wragg, J. P. Jervey.

Peorgia Medical Society Drs R. D,. Arnold, J. B. Tufts.

Medical College of Georgia Drs. 1. P. Garvin, L. A. Dugas.

Mississippi State* Medical Society Drs. G. Kern. W. Leake, J. May.

Indiana Medical College Drs. A. B. Shipman, G. W. Richards, M. L.Knapp, Dan'l Meeker.

Medical Department vf the T,ansylvaiua University of Kentucky Drs. E. Bartlett, T. D.
Mitchell, S. Arunan.

Medical Society of the State of Tennessee Dr. A. H Buchanan.

Medical Department of the University of Louisiana -Drs. J. Harrison, W. M. Carpenter,
A. J. ffedderburn.

Medipal Department of the St. Louis University Drs H. M. Bullit, A. Linton.

St. Louis Association of Physiciajis Dr. D. E. Meade.

Rush Medical College, Chicago Dr. J. C. Frye.

State Medipal Society of Michigan Dr. J. Pearcr,

Medical Chirurgical Society of Cincinnati Dr. David Judkins.

Ohio Medical Convention Drs. S. St. Johns, J. Butterfield.

Willoughby Medical College Dr. John Butterfield.

The committee on Credentials made a report, which was accepted, and the
.committee was directed to continue to receive the credentials of such delegates
as may hereafter arrive.

Dr. Holmes, chairman of the committee on offices, reported the following
named gentlemen as the permanent officers of the Convention:

Dr. J. Knight, of Connecticut, President.

Vice Presidents-^ Alexander H. Stephens, of New York ; G. B. Wood, of Phil-
adelphia; A-H. Buchanan, of Tennessee; John Harrison, of Louisiana.

Secretaries-^R. D. Arnold, of Georgia; A. Stille, of Philadelphia; F. C.
Stewart, of New York.

The Convention unanimously agreed to the report of the committee.

Several propositions were made to admit gentlemen of the Medical profes-
sion^ not delegates to the Convention, to seats in the body, all of which were
yoted down.

The Convention then proceeded to the consideration of the report on the sub-
ject, (which was referred to a committee at the last meeting of the Convention,
in 1846,) of instituting a National Medical Association, for the protection of
the Medical Profession, &c. The name of the Association to be the American
Medical Association.

On motion of Dr. Watson, ofN.Y.. the report was laid on the table, and the
same ordered to be printed.

The Convention next took up the report, accompanied by an address of the
committee of the last Convention appointed to consider the expediency, &c, if
deemed expedient, of the mode of recommending and urging upon the several

1847.] National Medical Convention. 377

StaAe governments, the adoption of measures for a registration of the births,
marriages and deaths of their several populations.

The Report was accepted, and the address adopted, and ordered to be printed.

On motion, the Convention adjourned till 7 o'clock in the evening.

EVEN'IN'G SESSION".

7, o'clock, P. M. The Convention met, when reports of several committees
appointed at the meeting in 184G, were read, laid upon the table, and ordered to
be printed. The Convention, then adjourned to 9 o'clock Thursday morning.

Thursday Morning, May 6th.

The Convention re-assembled at 9 o'clock this morning, in the saloon of the
Academy of Natural Sciences. The attendance was very full. The committee
.on credentials submitted the names of the following gentlemen as additional
delegates to the Convention :

Castleton Medical College, Vermont^-Dr. Green.

Medical and Chirurgical Faculty of Maryland Dr. John H. Briscoe.

Centre County Medical Society Dr. Wm. J. Wilson.

Montgomery County Medical Society Dr. George W. Thomas.

Brooklyn Hospital Dr. Daniel Ayres.

The minutes of the last meeting were read and approved. After which, Dr.
Stewart, one of the secretaries, called the roll of the members.

Dr. Grisconx, of New York, offered the following resolution :

That a committee of five be appointed by the chair to consider and report to
the Conventioa measures for defraying its expenses.

The chair appointed the following committee: Drs. Bell, of Philadelphia;
March, of Albany; Smith, of New York; Welford, of Va.

An invitation from the managers of the Institution for the Instruction of the
Blind was received, asking the members to visit that place.

Dr. Bell, of Philadelphia, presented a letter from Dr. Lewis W. Chamber-
layne, of Hampden Sydney College, Va., as the representative of the Medical
Faculty of that Institution, explaining why a delegation from their body was
not present, and expressing their concurrence in the objects that have brought
the Convention together.

Dr. Bell, from the committee on Medical Ethics, reported the introduction
to the code, submitted on Wednesday evening, which report was ordered
to be printed.

Dr. N. S. Davis, of New York, offered the following resolution:

That a committee of one from each state represented in the Convention be ap-
pointed, whose duty it shall be to investigate the indigenous medical botany of our
country, paying particular attention to such plants as are now or may hereafter,
during the time of their service, be found to possess valuable medicinal proper-
ties, and are not already accurately described in the standard works of our coun-
try, and report the same in writing, giving not only the botanical and medical
description of each, but also the localities where they may be lound, to the next
annual meeting of the American Medical Association. Laid on the table.

Dr. McNaughton, of Albany, from the committee to whom had been referred
the resolution passed by the last Convention, which states " that the union of the
business of Teaching and Licensing in the same hands, is wrong in principle
and liable to great abuse in practice. Instead of conferring the right to license
on Medical Colleges, and State and County Medical Societies, it should be re-
stricted to one Board in each State, composed in fair proportion of representa-
tives from its Medical Colleges and the profession at large, and the pay for whose
services as examiners should in no degree depend on the number licensed by
them," made a report in reference to the subject, mainly sustaining the above
resolution. The report, however, states that the committee do not desire to say
that the union referred to is wron? in principle the objectionable conduct which
may have occurred, is, in their opinion, attributable to some other cause. The
committee in all other respects express their accordance with the sentiments con-
tained in the resolution. The report and the accompanying resolutions were
ordered to be printed.

378 National Medical Convention, [June,

Dr. Parrish, of Philadelphia, submitted a majority report on the same subject,
and in opposition to a change in the present order of things in relation to licens-
ing, and recommending that some additional checks be put upon the exercise of
the right.
The report and accompanying resolutions were ordered to be printed.
Dr. Shipman, of N. Y., moved that Dr. Thos. Spencer, of Geneva, N. Y.,now
visiting the city, be requested to take part in the proceedings, but not to vote
agreed to. A similar motion prevailed in regard to Professor Hare, of this city.
Dr. Thompson, of Delaware, from the committee to prepare a nomenclature
of diseases adapted to the United States, having reference to a general registra-
tion of deaths, made a report containing some interesting comparative statis-
tical information in regard to various diseases, and concluded with a deserved
tribute of praise to Mr. Emanuel Shattuck, of Boston, who drew up the report.
The report was ordered to be printed.

Dr. Cooper, of Del., moved that the report of the committee on Preliminary
Education, with the appended resolutions, be taken up for the consideration of
the Convention.
A debate arose on the question of a postponement of the subject at present.
On motion, the report was again read. The report states that the object to
which the committee has directed its labors, it is believed, can be best effected by
the following resolutions :

1st. Resolved, That this Convention earnestly recommends to members of the
medical profession throughout the United States, to satisfy themselves, either by
personal inquiry or the written certificate of competent persons, before receiving
young men into their offices as Students, that they areot good moral character,
and that they have acquired a good English education, a knowledge of Natural
Philosophy and the Elementary Mathematical Sciences, including Geometry
and Algebra ; and such an acquaintance, at least, with the Latin and Greek lan-
guages, as will enable them to appreciate the technical language of medicine,
and read and write prescriptions.

2d. Resolved, That this Convention also recommends to the members of the
medical profession of the United States, when they have satisfied themselves
that a young man possesses the qualifications specified in the preceding reso-
lution, to give him a written certificate, stating that fact, and recording also the
date of his admission as a medical student, to be carried with him as a warrant
ior his reception into the medical college in which he may intend to complete his
studies.

3d. Resolved, That all the medical colleges in the United States be, and they
are hereby recommended and requested to require such a certificate of every stu-
dent of medicine applying for matriculation; and when publishing their annual
lists of graduates, to accompany the name of the graduate with the name and
residence of his preceptor, the name of the latter being clearly and distinctly pre-
sented, as certifying to the qualification of preliminary education.

The first resolution was taken up, and gave rise to a very animated debate, in
which Drs. Watson, Stevens, Davis, Hearn, Atlee, Haxall, Manley, and others
participated.

A number of amendments were made, and were severally acted upon and
lost. The original resolution was passed.
The second resolution was then taken up.

Dr. Reese, of New York, moved to strike out the word "complete," and in-
sert the word "pursue."

The resolution, as amended, was passed.
The third resolution was taken up, and amended as follows:
Resolved, That all the medical colleges in ihe United States be, and they are
hereby, recommended and requested to require such a certificate of every student
of medicine applying for matriculation, and if it shall appear that any applicant
has notpreviously read with a preceptor, medical colleges are hereby requested
to satisfy themselves that the applicant possesses the qualifications specified in
the first "resolution, &c.

The amendment was passed.

1347.] National Medical Convention. 379

A motion to reconsider was made, and while pending, the amendment was
withdrawn by Dr. Cabell, of Va., its mover, and the original resolution was
passed.

The report of the committee and the resolutions were passed. Mr. Hopkins,
of Maryland, moved that no gentlemen shall be permitted to speak more than
twice on the same proposition, and not to occupy more than ten minutes at one
time. Several amendments were made and lost. The resolution was agreed to.

On motion of Dr. Hays, two hundred and fifty copies of the report and resolu-
tions on Preliminary Education, as passed by the Convention, were ordered to
be printed.

Dr. Haxall, of Va., read to the Convention a communication, received from
the Medical and Chirurgical Faculty, of Baltimore, inviting the Convention to
hold its meeting in the year 1848, in the city of Baltimore, which was laid on
the table for the present.

.On motion, the Convention adjourned to meet again at 5 o'clock, P.M.

AFTERNOON SESSION.

The Convention met at 5 o'clock.

Dr. Pierce, of Michigan, offered the following resolution: That the members
of this Convention be requested to ascertain, as far as may be practicable, and
report to the next annual meeting, the number of practitioners of medicine in
their respective States, designating the number who may have received a diploma
from a Medical College, the number who may have been licensed by a Medical
Society, and the number who practice medicine without any authority whatever.
Passed.

Mr. Hays moved to take up the report under the fourth resolution.

Dr. Davis, ot New York, moved that the Convention proceed to the consider-
ation of the resolution attached to the report, as follows:

Resolved, 1st. That it be recommended to all the colleges to extend the period
employed in lecturing from four to six months.

2d. That no student shall become a candidate for the degree of M.D. unless
he shall have devoted three entire years to the study of medicine, including the
time allotted to attendance upon the lectures.

3d. That the candidate shall have attended two full courses of lectures, that
he shall be twenty-one years of age, and in all cases shall produce the certificate
of his preceptor, "to prove when he commenced his studies.

4th. That the certificate of no preceptor shall be received who is avowedly and
notoriously an irregular practitioner, whether he shall possess the degree of M.
D. or not.

5th. That the several branches of medical education already named in the
body of this report, be taught in all the colleges; that not less than one hundred
lectures be delivered by each Professor, and that the number of Professors be in-
creased to seven.

6th. That it be required of candidates that they shall have steadily devoted
three months to dissection.

7th. That it is incumbent upon Preceptors to avail themselves of every oppor-
tunity to impart clinical instruction to their pupils; and upon Professors to
connect themselves with Hospitals whenever it can be accomplished, for the ad-
vancement of the same end.

8th. That it is incumbent upon all schools and colleges granting Diplomas,
iully to carry out the above requisitions.

9th. That k be considered the duty of Preceptors, to advise their students to
attend on ly such institutions as shall rigidly adhere to the recommendations here-
in contained. *

All the resolutions were agreed to except the 7th, which was amended and
passed as follows: Thatit is Incumbent upon preceptors to avail themaehn
every opportunity to impart clinical instruction to their pupils; and thai Medi-
cal Colleges require candidates for graduation to show that they have attended
on Hospital practice for one season, whenever it can be accomplished, for the
advancement of (he same end.

380 National Medical Convention. [June,

Dr. Stewart, of New York, offered the following additional resolution, which
was unanimously agreed to.

Resolved, That it be suggested to the faculties of the various medical institu-
tions to adopt some efficient measures for ascertaining that their students are
actually in attendance upon their lectures.

On the passage of the first resolution reported by the committee a warm debate
arose, in which Professors Patterson and Hare and Doctors Kerfoot, Mitchell,
Reese, Stevens, Haxall and others took part, Several amendments were also
proposed to be made to it, which were severally acted upon and lost.

A letter of invitation was received by the Convention, to visit the Pennsylva-
nia Hospital for the Insane.

The Convention adjourned until to-morrow morning at 9 o'clock.

Friday Morning, May 7th,

The Convention met to-day at 9 o'clock, A. M., in the Hall of Natural Sci-
ences. The minutes were read and approved. The calling of the roll was
dispensed with.

Drs. J. Redman Cox of this city, and Cheyney How of St. Louis, were invi-
ted to take seats on the floor.

On motion of Dr. Haxall of Va., the Convention reconsidered the following
resolution, passed on Thursday;

That the several branches of medical education already named in the body of
this report, be taught in all the colleges : that not less than one hundred lectures
be delivered by each Professor, and that the number of Professors be increased
to seven.

On motion of Dr. Haxall, the Convention agreed to an amendment to the
resolution, by striking out the words " that not less than one hundred lectures be
delivered by each Professor."

The committee on Credentials reported the names of the following additional
delegates.

Centre County Medical Society, Drs. W. M. Wilson, John McCoy, Frank-
lin R. Smith.

Medical andChirurgical Faculty of Maryland, Drs. P. Worth, James, Bord-
ly, Solomon Jenkins.

Lebanon County Medical Society, Drs. John W. Gloninger, David B. Mar-
shall, Nathaniel Bank, Seth R. Smith, Benj. F. Schrech, Samuel Behn, Jeremiah
Breidenback, Cyrus D. Gloninger, George Rex, Jonathan Jerbe, Henry Strine,
D. S. Cooper, Dr. King of the U. S. Army.

On motion of Dr. Naudain. the report of the committee on the organization of
the National Medical Association as ordered by the National Medical Conven-
tion held in the city of New York in May, 1846, was read. The report included
the following resolution :

Be it resolved, in behalf of the Medical Profession of the United States, the
members of the Medical Convention held in Philadelphia in May, 1847, and all
others who, in pursuit of the objects above mentioned, are to unite with, or suc-
ceed them, constitute a National Medical Association, the name and title of the
Institution to be " The American Medical Association."

On motion of Dr. Hays, the resolution was agreed to.

Dr. Hays moved the following :

Resolved, that the report be referred back to the committee, with instructions
to report a plan of organization in accordance with the following schedule:

1st. The society to consist of members to be elected by the association direct-
ly, or through its council.

" 2d. Members before admission into the association, to sign a promise to con-
form to the laws of the association.

3d. Members who violate this pledge, to be liable to expulsion, and to be de-
prived of the rights of brotherhood.

4th. For the appointment of a council, to consist of the officers of the society,
and a number of councillors, to be elected annually ; the councillors to have
the general superintendence of the concerns and publication of the associations,
and to report proceedings to the association at its annual meeting.

1847. J National Medical Convention. 331

Considerable discussion arose on the resolution, which was finally lost.

The Convention then resumed the consideration of the rules and regulations
submitted by the committee, and after some amendments made by members
which were accepted by the committee, the entire report was adopted.

On motion of Dr. Bush, of Delaware, the Convention proceeded to the consid-
eration of the report of the committee on Medical Ethics, embraced in the fol-
lowing:

Of the duties of physicians to their patients, and of the obligations of patients
to their physicians.

Of the duties of physicians to their patients.

Of the obligations of patients to their physicians.

Of the duties of physicians to each other, and to the profession at large.

Of the duties for the support of professional character.

Of the duties of physicians in regard to professional services to each other.

Of vicarious offices.

Of the duties of physicians in consultations.

Of the duties of physicians in cases of interference with one another.

Of the duties of physicians when differences occur between them.

Of the duties of physicians in regard to pecuniary acknowledgments.

Of the duties of the profession to the public, and of the obligations of the pub-
lic to the profession.

Of the duties of the profession to the public.

Of the obligations of the public to physicians.

The report of the committee was adopted.

On motion, the Convention proceeded to consider the report of the committee
appointed by the National Medical Convention, held in May, 1846, to consider
the expediency and (if expedient) the mode of recommending and urging upon
the several State governments the adoption of measures for a Registration of the
Births, Marriages and Deaths of their several populations, respectively.

On motion of Dr. Griscom, of New York, the subject was referred to a Stand-
ing committee, to be appointed by the chair, to make a general charge of the
subject, and report annually to the Convention.

The committee consists of Dr. S. Griscom, N. Y., Lee, Clark, Emerson, Ar-
nold, Russ, Shattuck.

On motion of Dr. Stephens, of New York, a recess often minutes was taken,
for the purpose of collecting the individual assessments for defraying the expen-
ses of the Convention.

The Convention proceeded to consider the reports on the subject of the union
of Teaching and Licensing.

Dr. Reese, of New York, offered the following :

Resolved, That the report of the majority of the committee, on the subject of
separating the Teaching and Licensing power in Medical Colleges, be adopted
by this Convention and publish its transactions.

Resolved, That the report of the minority be laid on the table, and printed in
like manner.

Dr. Leonard, of Baltimore, offered the following amendment:

Resolved, That the two reports of the committee upon the subject of Teaching
and Licensing be referred to the committee on Medical Education, with instruc-
tions to report to the next annual meeting of the " American Med. Association."

Dr. Reese accepted the amendment ; after much debate the resolution was
passe 1.

The Convention adjourned to meet again at 5 o'clock, P. M.

EVENING SESSION.

The Convention again met at 5 o'clock, P. M. On motion of Dr. Smith, of
Boston, it was resolved that the thanks of the Convention was due to officers and
directors of various institutions, who have politely invited the members to visit
them at their own convenience; to the committee on Reception and Arrange-
ment, on behalf of the Philadelphia Delegation, for the spacious and elegant
accommodations provided, and to the whole Medical profession of the city, for
the marked kindness, personal attention, and general hospitality whi<-h have

3S2 National Medical Convention. [June,

characterized their intercourse with this body, since the commencement of its
deliberations, and to the Academy of Natural Sciences, for the use of their room.

The following resolution was offered by Dr. Reese, of New York :

That a committee be appointed to draft a memorial to the Congress of the
United States, asking that a portion of the Smithsonian fund maybe annually
appropriated to the uses of the American Medical Association. Laid on the
table.

The following resolution was offered by Dr. Carpenter, of Lancaster :

Whereas, The difficulties which sometimes arise between physicians in their
attendance upon the sick, are frequently owing to improper procedure or repre-
sentations on the part of the patients or friends, from an ignorance of the etiquette
which .should govern the conduct of the respective parties towards each other ;
therefore,

Resolved, 1st, That the President of this Convention appoint a committee of
three, to select such parts of the code of Ethics adopted by this body, as they may
deem expedient, and report the same to the Convention for approval, at its
session to-morrow morning. 2d, That the committee of Publication have a
sufficient number of copies of the same printed and delivered, or send to each
delegate a suitable number. 3d, That delegates request the editors of the public
journals in their respective localities, to publish the same, as proper and useful
information for the people. Laid on the table.

On motion of Dr. Garvin, the thanks of the Convention were presented to its
officers, for the very efficient manner in which they have discharged the onerous
duties imposed upon them.

Dr. Stewart, of New York, offered the following :

Resolved, That all unfinished business be referred to the American Medical
Association, about to be organized.

Resolved, That this Convention do now resolve itself into the "American
Medical Association," and that the officers of the Convention continue to act as
officers of the Association, until others are appointed. Agreed to.

On motion, the chairman appointed the following committee, consisting of
one person from each State represented, to nominate officers of the Association.

Committee Drs. Ashew, Delaware ; Mitchell, New Hampshire ; Hall, Ver-
mont; Adams, Massachusetts ; Dunn, Rhode Island; Ives, Connecticut ; Man-
ley, New York; Smith, New Jersey ; La Roche, Pennsylvania ; Dunbar, Mary-
land; Riley, District of Columbia; Garvin, Georgia; Keirn, Mississippi;
Buchanan, Tennessee; Harrison, Louisiana; Linton, Missouri ; Frye, Illinois-,
Shipman, Indiana; Judkins, Ohio ; Annan, Kentucky.

On motion of Dr. Stewart, the committee on Registration appointed by the
Convention, at its morning session, was confirmed by the Association.

The committee on Nominations reported the names of the following gentle-
men, as officers of the "National Medical Convention"

President Dr. Nathaniel Chapman, of Pennsylvania.

Vice-Presidents Drs. J. Knight, New Haven; A. H. Stephens, New York;
Moultrie, South Carolina; Buchanan, Tennessee.

Secretaries Drs. Stille and Dunbar, of Philadelphia.

Treasurer Dr. I. Hays.

On the ballot being taken, the above nominees were elected officers of trie
Association for the ensuing year.

A committee was appointed to wait on Dr. Chapman, and inform him of his
election. . .

On motion, the invitation from the delegation of Baltimore to the Association,
to hold its next meeting in that city in May, 1848. was accepted.

The President was empowered to appoint the Standing committee of the As-
sociation. .

The President elect was announced, and on taking the chair Dr. Chapman
said It has been my good fortune on many occasions to be complimented in
the same manner, though not in the same degree I confess my incompetence to
serve vou.

I love my profession, and I should be ungrateful if I did not. Whatever \
possess in ibis lite has been bestowed by her (avors: when I forsrt her and her

1847.] Statistics. Prize Essay. La Lancette Canadienne. 383

disciples, may Almighty God forget me. The speaker concluded with an ex-
D of his ardent wishes for the success of the cause, and said it would
always be his great pleasure to advance the interests and maintain the dignity
of the profession. On motion of. Dr. Stewart, 2000 copies of the proceedings
were ordered to be printed.

The Association adjourned to meet again in May, 1848, in the city of Balti-
more.

STATISTICS OF MEDICAL INSTITUTIONS OF THE UNITED STATES, FOR
THE SESSION OF 1846-7, PREPARED FOR THIS JOURNAL.

Xante of College .

M. D.*

No. Students.

No. Graduates.

Memphis Medical College,

3

64

9
10

55
493
216
170
349
194
106
412
131
101

203

204
410

95

over 100
100

84

70

216

Jetferson Medical College,

Western Reserve Medical College,

Medical College of Ohio,

181
53

University of Louisville,

75

College of Physicians and Surgeons, N. Y.
Medical College of Georgia,

51
33

University of Pennsylvania,

Castleton 'Medical College,

42

Willoughbv Medical College,

38

Geneva Medical College,

43

Medical College of South Carolina,

Franklin Medical College, . . .

Transylvania University,

Universitv of New York,

74

5

64

123

Universitv of Missouri,

26

St. Louis University,

13

Pennsylvania Medical College,

Baltimore Dental College,

34

to

Indiana Medical College,

19

Albanv Medical College,

30

Medical Institute of Yale College,

Richmond Medical College,

21
2L

Rush Medical College,

16

Cleveland Medical College.

* Graduates attending the Lectures.

Prize Essay of the Louisiana Medico- Chirurgical Society. At the anniversary
meeting of this society held on the first Wednesday of April, it was ascertained
that two essays had been received for the prize oi* one hundred dollars offered
for the best essay on strictures of the urethra, but neither of them had come to
hand within the time prescribed. It was therefore resolved to postpone award-
ing the prize for twelve months, and to continue the offer to the medical profes-
sion at large. Communications must be directed to the President of the Society,
and be received by the 1st day of February, 1848. Those now on hand will be
retained as competitors, unless otherwise ordered. [New Orleans Medical and
Surgical Journal.

La Lancette Canadienne, Journal Medico- Chirurgical. We have just received
the 9th No. of this new Journal, published at Montreal, by Dr. J. D. Leprohon.
It appears on the 1st and 15th of each month, is issued in newspaper form of six
pages, at four dollars per annum, payable invariably in advance. Its motto is,
" One cannot be truly a doctor who lias not the d 'imposition always to work." Velpeau.
A sentiment well for us lazy Southerners always to remember, especially those
who do not write.

We have added the Canadian Lance! to onr lisl of exchanges.

334

Obituary. Meteorological Observations.

OBITUARY. During the month of May the hand of death has fallen heavi-
ly upon the Medical Professors of our country. From the papers of the day, we
learn the demise of no less than three in this period of time, viz:

Dr. George McLellan, of Philadelphia, for several years Professor of Surgery
in the Jefferson Medical College, and long recognized as a most distinguished
Surgeon.

Dr. Augustus Warner, Professor of Surgery in the Medical College located in
Richmond, Virginia.

And Dr. John Revere, Professor of the Theory and Practice of Medicine in
the University of New York.

METEOROLOGICAL OBSERVATIONS, for April, 1847, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

Sun
Ther.

Rise.
Bar.

4i

Ther.

~68~

?. M. i
Bar.

29 97-100

Wind.

Remarks.

1

50

29 98-100

s. e.

Fair. [ing.

2

55

" 88-100

61

" 70-100'

s. w.

Cloudy-I^ght shower this morn-

%

52

" 70-100;

78

" 71-100

s. w.

Fair.

\

59

" 71-100!

82

" 72-100

s. w.

Cloudy.

5

62

" 72-100

87

" 73-100

s.

Fair. [noon.

6

60

" 80-100

81

" 75-100

s. w.

Cloudylight shower in after-

7

5G

" 85-100

84

!< 90-100

S. E.

Fair.

8

51

" 88-100

84

" 76-100

s.

Fair.

9

G6

<: 72-1 oo;

84

72-100

s. w.

Fair some clouds.

10

58

" 72-1001

71

" 71-100

w.

Cloudy.

ii

56

" 78-100

76

" 84-100

s.

Cloudy. [95-100:

12

59

" 80-100

69

<: 61-100

s.

Cloudy blow rain at 3, p. m.

13

50

" 76-100

80

" 75-100

w.

Fair, [and e'ven'g rain 95-1 00.

14

53

" 83-100

77

" 83-100

X.

Fair thund. storm in afternoon

15

58

" 78-100

77

" 56-100,

N.

Cloudy storm, rain 60-100.

16

46

" 89-100

61

" 90-1001

N. W.

Fair,

17

40

" 90-100

62

" 90-100!

N. W.

Fair,

18

48

" 90-100

70

" 97-100

N. E.

Fair.

19

50

30 2-100

67

30 15-100

S. E.

Fair.

20

50

30 15-100

74

30 10-100

S. E.

Fair.

21

55

30 7-100

74

30 5-100'

S. E.

Cloudy.

22

60

30 5-100

77

29 97-100

S. E.

Fair some clouds.

23

58

29 84-100

84

" 75-100

W.

Cloudy.

21

62

" 77-100

69

" 81-100

N.

Cloudy.

25

50

30 5-100

68

30 4-100.

N. B.

Fair after 12.

26

46

30 2-100

73

29 92-1001

N. W.

Fair.

27

47

29 81-100

80

" 75-100

W.

Fair breeze.

28

48

" 74-100

82

i 75-100

s. w.

Fair.

29

54

" 67-100

80

" 57-100

s. w.

Cloudy blow dusty.

30

60

" 60-1001

70

" 60-100

w.

Cloudy.

18 Fair days. Quantity of Rain 1 inch and 90-100. Wind East of #. and
S. 8 days. West of do. 15 days.

The month of May has been noted by the most remarkable hail storms ever
known to have occurred in this region. Judging from the news-papers, they
seemed to have extended over nearly the whole Southern States. The hail fell
here during the evening of the 15th,*at half-past 8 o'clock, and continued to fall
for 20 minutes. Some of the stones were as large as English walnuts. We
have seen them reported having measured in other localities 9 and 10 inches in
circumference. The crops have been extensively injured by the hail. The
month has been very ceol for M?v.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I.] NEW SERIES. JULY, 1847. [So. 7.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXIII.

The Locality, Climate, and Diseases of East Tennessee. By
Samuel B. Cunningham, M. D., of Jonesboro', Tenn.

[Note. In the August No. of this Journal for the past year, (1846.) p. 456,
will be found an article having the above title, and written by the same author.
The following one is a continuation of the same subject, read, we are informed,
by the Corresponding Secretary, (Dr. Frank A. Ramsey,) before the Medical
Society of East Tennessee, on the 7th of May, 1847, at Jonesboro', and ordered to
be forwarded tor publication in this Journal. Our acknowledgments are due
this body for selecting our Journal to become the medium of its valuable com-
munications to the profession. Ed.]

At a former meeting of the Society, we endeavored to present a
brief view of the climate, locality, and diseases of East Tennessee:
proposing at a subsequent time, to speak more at length of their treat-
ment. To effect this object, we have communicated with many
gentlemen, for the purpose of ascertaining whether there was any
uniform system of practice among us; and whether there was any
modification of disease peculiar to the different sections of this State.
As the result of our enquiries we find in every county heard from,
that fevers compose a large portion of the catalogue of diseases. I
will not attempt to discuss the question what is fever? and whether
the division into orders and genera is proper. Classifications have
been made, and intelligible terms, marking varieties which we all
understand. Wershall therefore adopt the old nomenclature.

That form by Cullen called Synochus, or by Smith defined Ty-
phoid, prevails in districts, between water-courses, on the more broken
and elevated portions of country ; whilst Intermittents and Remittents
are generally confined to the streams, with but few cases of primary
intermitting typhoid, especially during the prevalence of the former

25

386 Locality, Climate, and Diseases of East Tennessee. [July,

varieties. Indeed many physicians inform us that they rarely meet
with the typhoid form at all ; whilst in the periodic varieties, they
may have had an extensive practice, and when they do meet with it,
it is during the winter season, or at a distance from rivers or other
malarial sources. The first variety does not seem to be limited at
all by the season, prevailing winter or summer, and is common alike
on hills and in valleys. Localities apparently most healthy, often
become the seat of this fever.

For upwards of twenty years, we have had frequent opportunities
of meeting with it, and observing its phases. Patients generally
complain for days, or sometimes for weeks, before the attack, of loss
of appetite, headache, listlessness and dullness. Sometimes these
symptoms steal on gradually, until the patient goes to bed without
any marked chill or fever, or much increase of pulse, or other symp-
toms which attend the stadium prodromorum of the other fevers.
There is merely an increased indisposition, gradually developed,
some excitement of pulse, the secretions failing almost unobserved,
so that it is difficult to fix any precise period of accession. The ap^
petite and other functions seem to fail pari passu with the gradual
increment of fever. When these premonitory symptoms are early
attended to, the danger is pretty easily averted. A purge or two of
calomel, and oil, with light diet and rest; or a few powders,
daily, of ipecac, and calomel restore the functions. But when neg-
lected until fever is fully developed the issue is often serious. During
the progress there is accelerated pulse from day to day, with very
little diurnal remission ; towards morning there is generally an alle-
viation, but not a marked remission of symptoms. The pulse may
diminish its number some 5 or 10 beats per minute. Pains in the
head and back (especially the latter, which never fails to be present,)
are for some days all that is complained of. The heat is but slightly
increased, and the sudorous discharge diminished but little. The
tongue, too, alters but slowly: at first clammy, then white, next
brown or black, then all secretion for a time suspended, and nothing
but a fiery redness in the middle, and as clean as if scalded and
scraped dry, chapped and tremulous. Then follows colliquative
stools, incoherence of thought, and without a change, the patient is
lost. In others, it advances with a fiercer step, yet rarely without
predisposing illness, shorter but more impressive, before being seized
with rigors. Pains in the back and head become almost excruciating ;
pulse sometimes corded ; hot skin, sometimes perspiring, but which

1847. J Locality, Climate, and Diseases of East Tennessee. 387

soon declines into dryness, hard to be overcome. In this variety,
pleuritis is a frequent concomitant, or pneumonia, or some other in-
flammation, which confuses the symptoms, and urges the adoption of
active depletion. Bleeding in these cases at the earliest advice after
the chill is over, is the binge upon which reasonable expectation will
turn. We bleed in an erect position, if syncope is difficult to effect,
to the extent of 16, or 20, or 30 ounces. Then a full dose of calomel,
say 20 or 30 grains, followed by 2 gr. doses in continuation with half
a gr. ipecac, every two hours, until the bowels act freely. If in
eight or ten hours this should not take place, then some other active
purgative may be used, with clysters.

After venesection, we give immediate attention to the spinal pain,
adopting the view that the nervous system is first in the circle of
morbid action, and the cord, the great trunk which supplies its im.
portant parts with sensation and motion, cannot suffer long without
bad consequences, not only to the nervous system in general, but to
all the dependent organs supplied by its branches. It is accordingly
examined, fomented with hot mustard water, or poulticed with must-
ard, or cupped and scarrified. Nor will this in the least interfere
with or retard internal administrations, but rather favor their action.
In all cases too, it is of early consideration with us, to equalize both
circulation and temperature. Hot mustard pediluvia are excellent
baths for the feet in it they may be placed for twenty or thirty
minutes, to be repeated pro re nata. The covering will answer tho
rest of the indication. Cold water is freely admitted, but only a
mouthful or two at a time. The nauseating results of the calomel
and ipecac, kept up through the whole day and night, are greatly
beneficial. This course, if early pursued, will in a few days greatly
mitigate the symptoms, which may induce the use of quinine.

If, however, these have been neglected, the prospect of success is
greatly lessened. After the lapse of two or three days, we have
rarely witnessed any beneficial results from bleeding; or if tempora-
ry advantage is gained, yet there is great danger of an earlier col-
lapse. Abdominal tenderness on pressure, rarely present at tho
beginning, is a pretty constant symptom after it has advanced but a
few days ; and it is one of the most difficult to meet of all the attend-
ing symptoms. Whatever is the cause of this determination, whether
a congestion of the vena portarum and branches, or a more idiopathic,
like form of inflammation be established, and the lesion of tho glands
ofPrycr and Brunner the centre of (hat action, or whatever othe?

388 Locality, Climate, and Diseases of East Tennessee. [July,

theory may be adopted, of one thing we feel satisfied that the
main hope of cutting off the disease at once, or of arresting its vio-
lence, depends upon the vigorous application of active anti-inflamma-
tory treatment during the first day or two. If the period has passed
unimproved, cupping and scarifying may be tried; yet we acknowl-
edge they have not answered our expectations. Active purging, espe-
cially if drastic, seems to aggravate the symptoms : the pulse quick-
ens and abdominal tenderness increases. Opiates, and ipecac, and
calomel, and blisters, and demulcents answer a better purpose of
defence. The blisters should be stripped as much as possible of the
cuticle and converted into suppurative surfaces, and if ordinary appli-
cations will not prevent healing, new blisters may be raised, and the
surfaces washed with a decoction of phytolaccadecandra or poke root.
We never fail also on a remission, however imperfect, to use the
quinine, in doses of one and a half or two or more grains every two*
hours. When the case is alarming, we have given 5, 10, and even
30 grains at once. The opinion that acids, when in an uncombined
state, almost always exercise an irritating influence on inflamed mu-
cous membrane, have induced us to adopt the disulphate, or the
common article, without the acid, because, in making the addition,
it is rarely found without an excess of the latter, and it has, more-
over, appeared to rest easier on the stomach in substance, than when
it has been given in solution. We have used it freely in both condi-
tions, and in many cases with marked advantage, but in many others
we are bound to declare our total disappointment. In intermittents
and remittents, generally, we can attest its utility. We however have
met with cases of a synochal variety, where there were chills amount-
ing to severe rigors and shakes, like those of intermittents, occurring
irregularly for days, in which the quinine was administered very
freely, even until deafness was produced, and dimness of vision, but
without arresting the recurrence of the symptoms, and the patients
sank in a few days into a fatal collapse. Some cases of apparent
rigors seem to be unattended with the sensation of cold at all, and
are therefore more properly belonging to neurotic phenomena, to
which quinine does not appear to be so applicable as opiates or seda-
tives. Mercurial action, when mildly induced, has rarely failed of
being a good omen ; yet there is so much apprehension of intestinal
irritation in protracted cases from a continued use of calomel, in any
combination, sufficient to overcome febrile lesions, that it has been
used with caution : even necessary evacuations are sometimes haz-

1847. J Locality, Climate, and Diseases of East Tennessee. 389

ardous, superinducing irritation of the bowels, if not fatal diarrhoea.
Too often, we feel compelled to adopt the defensive rather than
offensive plan of treatment, and instead of jugulating the disease, to
husband the resources of nature whilst we fulfil obvious indications,
until the force of the disease is exhausted. As the result of our own
experience we must say, that however strong the hope of quinine has
been in this form of fever, it has not proved an antidote in our hands,
but like calomel, ipecac, opium, the lancet, and many other useful
agents, it is only the auxiliary. In these views, we find others, in
whose experience great confidence may be placed, strongly coin-
ciding. From answers to interrogatories on these points, we take
the liberty of quoting from a few out of the many agreeing substan-
tially in the same things.

The first is from Wm. N. Vance, M. D., of Kingsport, in the
vicinity of Holstein river, and in a locality where intermittents and
remittents often prevail. He says: "My experience in typhoid
fevers, so called, has been quite limited. I have had some cases of
that class of fevers, in the treatment of which I have been induced,
by inviting circumstances, to try quinine; but I have never been
satisfied with its effects. I have no faith in quinine as a febrifuge,
except in fevers that observe well defined periodical paroxysms, and
are at the same time unattended with high inflammatory symptoms.
These are conditions scarcely ever found in what is called Continued
fever. You know that owing to some hidden or mysterious influence,
all forms of fever, whether idiopathic or symptomatic, observe more
or less periods of exacerbation and remission. I have in some in-
stances imagined the paroxysms well enough defined to use the anti-
periodic, but was soon taught by bad results, that Medicine was not
an exact science. If bad results were not the direct consequence, I
have at any rate observed 710 good to grow from it. The reason why
it has done no good in these cases may be that there was inflamma-
tion. If typhus or typhoid is an essential fever, we will, in all cases,
I believe, during the progress of disease, meet with secondary lesions
which add to the intensity of the symptoms, and aid in preserving the
continued form of the disease. Or the reason it has done no good in
my hands may be, that I have not given doses sufficiently large. I
have had no experience in storming diseases by the heroic doses of
quinine used by some of our Southern brethren. The shock produced
by these doses might, in some cases be revulsive, but in many, fatal.
So far would I be from using large doses of quinine in typhoid fever,

390 Locality, Climate, and Diseases of East Tennessee. [July,

that (if I could put flaith in the motto of Hannemann ' Similia
similibus curantur,') I would consider infinitesimal closes the very
remedy. Pariera, in his Materia Medica, says, large doses of disulph-
ate of quinine, produces three classes of effects, viz : 1st, 'Gastro-
enteric irritation ; 2d, Excitement of the vascular system, and 3d,
Disorder of the cerebro spinal functions.' Almost an artificial Ty-
phoid Fever! an array of morbid phenomena that embraces all the
prominent points in that disease. Whilst treating a case of remittent
fever last fail, in company with Dr. , we had some conversa-
tion on the use ofquinine in the treatment of fever. His own expe-
rience was unfavorable to the use of this article as a therapeutic
agent in the treatment of fevers of a continued form. He informed
me that those who uniformly gave it w eve particularly unfortunate
in that branch of practice. * * * * With regard to the propor-
tion of typhoid fever to other fevers, I do not know that I can give
3'ou any satisfactory information: it certainly must vary very much.
A physician practicing in a malarious district must meet with a very
small proportion of cases of typhoid fever. In my practice, the pro-
portion of typhoid to intermittent and remittent would not amount to
so much as one in twenty. I have no particular plan of treatment
for this disease. My object is to avoid danger in whatever direction
it may come looking at the different modes of dying as the great
landmarks to guide me in my pathway."

The next I shall quote is a letter from M, R. May, M. D., residing
at Athens, in the lower section of E. Tennessee. Athens is situated
in the interior, some twenty miles perhaps from the river, in a dry,
rolling country.

He writes " The fevers incident to our locality are of the typhoid
tendency : in fact, the disease called typhoid, has prevailed exten-
sively during every season of the year, though principally in the
summer and fall. I dont consider that it differs from the common
continued fever, so far as its pathology is concerned ; neither do I
think that the intermittent and remittent fevers differ pathologically
from continued."

He then speaks of the views of different authors on the pathology of
fevers, and believes them similar. He says, " I also consider inter-
mittents and remittents and typhoid, to be similar in pathology, from
the fact of their often running into each other. I am at this time
attending a case which was purely typhoid, * ab initio, ,' which termin-
ated in intermittent. If typhoid fever is dependent upon dothinenteri-

1847.J Locality, Climate, and Diseases of East Tennessee. 391

tis, why do we have remittent periods more distinct than occurs in
any other disease purely inflammatory?"

After discussing the doctrine of their essential sameness, he speaks
of the treatment, "I bleed," says he, "when the pulse will justify.
In some cases, where the constitution is good, and the patient has
not been confined too long, I bleed regardless of the condition of the
pulse. I can judge after a few ounces have been abstracted, whether
it is proper or improper, and act accordingly. I use quinine freely
during the remittent period, for several reasons : 1st, to brace up the
vascular system, through the nervous, to prevent veinous congestion.
2dly, to enable the patient to convalesce more rapidly, after the dis-
ease has been subdued. If the liver is torpid I combine calomel.
I am not one of those who consider the medical virtues of quinine to
depend upon its sedative properties. It is strange that quinine should
be recommended to prevent collapses, or even when the patient is
extremely prostrated, by those who contend for its sedation. Who
ever heard of an intelligent physician warding off prostration by ad-
ministering sedatives? I believe nearly every physician of note
recommends quinine under such circumstances. There is great dis-
similarity of opinion about the proper dose of quinine. I generally
give 5 gr. doses every two hours, during the remittal period, until 15
or 20 grains have been administered, and I have no disposition to
enlarge the dose, for it seems to have the desired effect. In fact, I
have succeeded in anticipating a paroxysm with much smaller doses
in some constitutions. At certain stages of the disease, I have ob-
served that the administration of quinine produced considerable con.
stitutional irritation, manifested by delirium, jactitation, &c, condi-
tions that could hardly be produced by sedatives. Under certain
circumstances it has a tendency to equalize the circulation to con*
vert an irritated and quick pulse, into a full and soft one. From this
I suppose some are lead to view it a sedative. Every observing
physician has seen the same result brought about by the administra-
tion of stimulants under certain circumstances."

J. G. M. Ramsey, II. D., a physician of extensive experience and
observation, and member of our Society, occupies a river location,
and in a region where interna ittents and remittents greatly prepon-
derate. He writes-" I have never seen, since I left the Marine Hos-
pital, at Charleston, genuine Typhus. Typhoid disease or at least
a typhoid tendency frequently characterizes our autumnal and vernal
affections especially those oflhp crup'ion kind." These, of course,

392 Locality, Climate, and Diseases of East Tennessee. [July,

are not the typhoid, or simple continued fevers, of nosological wri-
ters, nor the same kind that prevail in sporadic cases thoughout East
Tennessee, at any or all seasons of the year. He adds, "The typhus,
so called by many practitioners, is only a form of disease induced by
the depletory system of treatment carried to excess," &c. He, how-
ever, does not describe at all the typhoid of the upper or interior
country. With regard to quinine, he barely remarks, "I consider
it only an anti-periodic and tonic, and not at all of any value in its
febrifuge properties otherwise."

Another very respectable practitioner, Dr. Carriger, ofTazwel],
says, in his response, with regard to quinine, "I have used quinine
during the fever, and have found but little benefit from it, so long as
the skin remained permanently dry and hot, accompanied with a dry,
red tongue; but whenever a complete remission takes place, or the
skin becomes moist and soft, and the tongue loses its redness and
dryness, and thirst is less urgent, I have administered the quinine
with the happiest effects. The form I usually give it in, is the fol-
lowing, viz. from 3 to 5 grs. quinine with half agr. to 1 gr. ipecac,
combined, or if the cerebral condition does not forbid, with from 5 to
8 grs. Dover's powder, every two hours, always keeping in view the
effects of the first dose, and the condition of the important organs."
These are compounds, it may be observed, at war with the opinion of
the action of quinine being a sedative, but compatible with the oppo-
site notion of its powers: at all events, they are intended to obviate
undue stimulation. He goes on to say "The principal fevers I have
met with, are remittents and intermittents, and few sporadic cases of
scarlatina." He then details his treatment, which would extend this
article to an undue length. The result of his views is, that quinine
could not properly be used until a decided remission should occur.

With these quotations, sustained by the opinions of many others
of the profession expressed in private conversation, we feel justified
in the following conclusions :

1st. That whether any essential difference exists in the several
classes of fever, or whether they are only modifications of a diseased
action, developing a class of symptoms which, when taken collective-
ly, we call fever, is not at this time our object to decide. That
known as simple continued or typhoid, is the form usually prevailing
in the more elevated and usually healthy localities, where the inter-
mittents and remittents are rarely found ; and on rivers and large
creeks, intermittents and remittents prevail to the almost entire
absence of the former varietv.

1847.] Locality, Climate, and Diseases of East Tennessee. 393

2dly. That these fevers differ in character, if not in essence, in
several material points for example : they differ in the producing
cause, which cannot be the same in all localities and seasons, and
in their periods and remissions in their treatment, especially under
the action of the article, quinine, which will scarcely ever effect the
jugulation of the typhoid as it will the two other varieties.

3dly. It is the prevailing experience of physicians throughout East
Tennessee, that in none of the three varieties is the practice consid-
ered proper, of giving quinine until there is some remission unless,
indeed, it be in cases of imminent congestion, and where exhaustion
is rapidly advancing.

4thly. The opinion is general, that it possesses tonic and stimulant
powers, and is approved of as such, and not on the principles of sedation

5thly. That in doses of from 5 to 10 grains, repeated every two
hours during the period of remission, we gain the most satisfactory
results of the medicine.

6thly. That quinine, in typhoid, should be held subject to, and
used under the same kind of restriction as we would feel bound to do
in its use in other inflammatory diseases.

Before closing this article, embracing the prevailing diseases of
East Tennessee, many of which we cannot even touch upon at pre-
sent; yet there are some which occupy a pretty prominent place in
our catalogue, and to which we must give a passing notice.

Rheumatism, both acute and chronic, and Dysentery, are dis-
tressing accompaniments the former occurs in the winter and spring
seasons, and the latter in our autumnal months. The Scarlet fever,
for the first time, made its appearance in the year 1831-2. It com-
menced its frightful ravages in the mountains of the upper counties,
extending towards the vallies, sometimes sweeping offhalf a family or
more, within a few days. In its attacks it was principally confined
to children. Persons apparently in good health, were prostrated
within a few hours : many died in from eight to twelve hours after
the first symptoms appeared. The powers seemed overwhelmed, as
by paralysis, producing all the symptoms of a hopeless congestion.
It extended through the winter, and spring ensuing, mitigating in
violence and intensity, until it disappeared, having borne off some
hundred trophies. We then heard but little of it until the winter of
'43, when, as in '31, it commenced its career in precisely the same
mountainous region, and in the same neighborhood, but became much
more extensive, and involved a wider field. It was computed that

394 Locality, Climate, and Diseases of East Tennessee. [July,

some hundreds fell victims to its fury that year in Washington coun-
ty; and scarcely had its characteristic features disappeared, until a
malignant erysipelas followed it, attacking and carrying off adults
with alarming rapidity. Bleeding, in both these epidemics, was con-
sidered by many, one of our cardinal remedies ; but where it was
most fatal, reaction never sufficiently developed itself to justify the
use of the lancet, or if development of arterial action did afterwards
take place, it was, nevertheless, too imperfect to hope any thing from
its use. It was oftentimes met, in mild cases, by some supposed
successful remedy, destined, however, to disappoint the next individu-
al, perhaps, who might be prompted to its use. The light of science
sheds but a flickering ray on the practitioner's path. The fact was,
in mild cases it passed through whole families, sometimes attended
with as little danger as the measles, and scarcely requiring any active
treatment at all; whilst with their neighbors it was the opprobrium
medicorum of every treatment. Since that period we may hear
every year of some cases, in particular neighborhoods, though of a
much milder type.

I will here give one more extract, whilst on this disease, from Dr.
Vance's letter, on the treatment of the epidemic erysipelas which
followed scarlatina, as it prevailed in the neighborhood of Kingsport,
in 1845.

"In the treatment of Erysipelatous fever, which visited our neigh-
borhood last winter, I relied on quinine almost entirely, and was
richly rewarded by the happy results that followed its use in every
case. The attending fever was typhoid, according to the literal
sense of the term, accompanied in the earlier part of the disease with
well marked adynamic symptoms. Here I used it to support the
system, not as a febrifuge. After evacuating the bowels by means
of mild cathartics, (generally calomel 8 or 10 grains, followed by oil,)
I put my patients on the use of small doses of quinine, regularly
administered, together with something of a nourishing diet, (broths
mostly); towards the latter stage of protracted cases, I brought in
wine to the assistance of the quinine. By this treatment, expression
was given to the countenance, force and fullness to the pulse, and
n healthy feeling oficarmth diffused throughout the extreme parts of
the body. After the first two or three days the bowels were opened
by enemas. I used spts. nitre, dulc, in company with quinine in
some cases ; also eupatoriam infusion, where there was a pulmonary
indication. All I have to say in praise of the plan is this : My

1847.] Locality, Climate, and Diseases of East Tennessee. 395

patients (between 35 and 40) all got well many of them suffering
much from the ravages of the local disease."

This account ofDr. Vance is certainly interesting and flattering.
No treatment has hitherto afforded results so flattering, and as to the
correctness of his statements I entertain not a particle of doubt ;
yet we think that, had the same treatment been pursued in this place,
(Jonesboro',) in the spring of '44, when the disease first made its ap-
pearance in Tennessee, the results would have been less favorable.
The quinine was used both by myself and others, and according to
my own recollection, in some cases freely, without such marked
effects. In the writer's own case it was given, and he distinctly
remembers that the impression made upon his feelings at the time,
was, that it was too stimulating, increasing and diffusing heat and
excitement, and but a few doses were taken. His attending physi-
cians, however, who ought to have been the better judges of its effects,
were pleased with it, believing it had done good. In a number of cases,
before being confined ourselves, and in fact in almost all, we bled
freely at the early stages, and with relief in some most marked.
In our own, under the most violent cephalalgia, blood was drawn in
an erect posture ad syncope; and the change from extreme of suf-
fering to perfect relief was instantaneous- the transition was like
magic. The pain and fever, however, returned, less violent, the suc-
ceeding night, and we repeated the bleeding, but the good effects were
not at all so clear as at first, though some relief was gained. In
several instances, where the strength of constitution was good, and
reaction strong, nothing affords equal relief to cold water freely ap-
plied to the head and face. Discrimination of course was important
in its application. When the powers were weak, or the disease re-
cedent, or the disease of the adynamic tendency from the first, mischief
might have followed its use, and in those kind of cases perhaps nothing
would have so well fulfilled the indication as quinine, wine, &c. In
most cases, where cold water was resorted to, it was eagerly kept up
by th-e patient himself it acted the part of a succedaneum to his
feelings, soothing him to rest; that he was unwilling afterwards to
relinquish it until the urgent symptoms had subsided. With us the
inflammatory typo prevailed, but frequently congestive. But few
cases of well marked congestion ever recovered. Is it a fact, that all
epidemics are most violent at their first outbreaking, and afterwards
degenerate into a milder form ? Such would would seem to be the
case from observation with us. Perhaps it may be owing to constitu-

305 Malignancy. [July*

tional changes, adapting the system better to sustain the shock. But
we hasten to a conclusion, almost conscious of the trespass we have
committed upon the patience of the Society. In conclusion, let us
urge upon each other the importance of a closer and more minute
observation of facts for ourselves. Books are composed from facts,
or assumed facts. We have no oracles like those of Delphi to con-
sult. Books may give us great doctrines or principles founded on the
observations of others. But Science is progressive. Let onward,
onward, be our motto ; and let us all first merit, and then demand
the respect due to the merit of our profession.

ARTICLE XXIV.

Malignancy. By Wesley C. Norwood, M. D., of Cokesberry,

Abbeville District, South Carolina.

So far as my limited reading has extended, there appears to be
nothing definite, published by any author, on the malignancy of dis-
ease. Certainly it is, a very important niche that should be filled
up. I know of no subject that has not been specially investigated of
more importance to the medical profession, and none by which a
monographical writer could more probably distinguish himself, mes-
merism not excepted. All men of talents cannot become authors.
Many have not the time and others have not the inclination. But
surely some of our most eminent physicians should not permit the
medical public to be longer ignorant of this important condition
of disease. There are so many terms used to mark this feature of
disease that it rather adds to the confusion and makes darkness visi-
ble. Putrid is a term often used to denote malignancy. Now every
professional man of reading and experience knows that putrid diseases
are often manageable, and much under the control of medicinal
agents particularly if we include the synochus of Cullen, and other
authors ; if so, is it not an appropriate term. Nervous is used for the
same purpose, and with as little propriety. As an illustration on the
one hand we may take jail fever, (typhus carcerum) which is ex-
tremely mortal or malignant, and on the other hand influenza
(catarrhus epidemicus) of some seasons when it is almost universal
and at the same time requires no other treatment but rest, pediluvia
and diaphoretics. Typhus is frequently used to express the same,
but many of the diseases ranged under the head t)'phus, are putrid or
nervous, and under many circumstances are readily managed with

1347.] Malignancy. 397

almost any treatment short of poisoning or killing, consequently this
is not sufficiently definite. But in the present day, congestion is the
term principally laid hold on to distinguish malignancy, but certainly
the most exceptionable, inapplicable and indefinite term made use of
to point out this condition of disease : We have in fearful array,
congestive, intermittent, remittent and continued fever, congestive
pneumonitis, $c, S$c. The fact is, disease depends on irregular,
unequal, and morbid action of the functions or organs of the system ;
and whenever this disordered, unequal and irregular action exists, it
matters not how or by what produced, we find the fluids unduly ac-
cumulated in certain organs. If so, the organs receiving more than
their due proportion must be congested. Congestion, perhaps, is al-
ways an effect on incident, and never a primary affection. This
being the view taken, it should be cast out as improper and unsuita-
ble. If congestion were the cause, or the main circumstance that
required attention in the treatment of disease, it wonld be obvious to
every one, if we could empty the vessels engorged, it would cure the
disease. But all know how little it would avail to unload the vessels
of accumulated blood, and nothing more. It would advance the
cure about as much as emptying the bladder in diabetis.

The irregular distribution of the fluids depends upon a pathological
condition of the system, and that state or condition must be changed
and overcome before we can restore health to the body. If disease
depended on entony or atony alone, Brown with his lancet and
bottle of brandy, would have stopped the progress of disease of every
kind, and death long since would have starved for want of victims.
It is common to speak of the danger of congestion in vital organs.
It is often the very salvation of the patient. In the common affec-
tion of fainting, if the fluids were to remain in the capillaries and
superficial vessels, there would be few, and perhaps no cases of re-
covery ; all are well acquainted with the course pursued in such
cases. Notwithstanding the superficial vessels are empty, and the
surface pale, and the blood thrown upon the internal and vital organs,
yet we wish to increase the fulness of the already loaded organs, by
laying the patient prostrate, to counteract even the effects of gravi-
tation. It is not a deficiency in the supply of blood, but it is the pe-
culiar condition of the brain and nervous system which is the cause
of the syncope. Let a person unaccustomed to witnessing capital
operations, be suddenly and unexpectedly brought into the place
where such an operation is being performed, he grows pale and faints.

398 Malignancy. [July,

Certainly congestion is not the cause, but the impression made on
the brain, through the organ of vision* The brain receives the
shock, and requires more blood to restore itself, and the treatment is
in perfect accordance. In syncope, it may be doubted whether the
brain has a less quantity or supply of blood than before the occur-
rence. It is true there is a general pallor of the surface, and from
the erect position the inference would be there was a deficit in the
supply of blood to the brain. As just observed above, perhaps it is
not so. If we reflect but a moment, we find the brain is entirely
surrounded by a bony paries and perfectly excluded from the influ-
ence of atmospheric pressure. This being true, whatever diminishes
the strength of heart's action will necessarily increase the quantity
of blood in those organs offering the least resistance to that action,
and lessen it in the organs offering most resistance to it. The brain
offers least resistance to the admission of blood. So that congestion
in the above condition, is increased as a restorative measurer If
congestion constitutes malignancy, it would be very unphilosophical
and dangerous to rely on its increase for safety in any case whatever.
Any person being skeptical in regard to atmospheric pressure, illus-
trated in the history of those who have ascended the highest moun-
tains, where the pressure of the air was so light that the blood was
ready to issue from the pores of the skin, or they can have a very
familiar example in the application of a cupping glass and exhausting
it of air. I think it is Pringle, who mentions the fact, by bleeding
an animal, slowly and gradually, to death, and afterwards examining
the brain, a person would be led to the conclusion that it died of en-
gorgement, or congestion of the vessels of the brain. Showing how
little resistance the blood meets with and with what facility it is sent
to the brain. I venture the assertion, that before the examination
was made from the gradually weakened action of the heart from the
drain of the vital fluid, it was not even dreamed of finding the blood
accumulated in any other organs than the heart and the large blood-
vessels in its immediate vicinity. Those who believe the heart to be
overwhelmed by blood in syncope would find themselves quite as
much mistaken ; showing that there is no diminution in the quantity
of blood, but that the condition of the brain and nervous system is
such as to require more blood to resist the shock and to sustain their
action, than when every organ is healthy and their action normal.
In putrid and nervous fevers, I allude to the malignant, or what is
styled congestion; if the blood was to remain in the capillaries and

1847. j Malignancy. 309

superficial vessels, and the condition of the brain and nervous system
should not be changed, death would be the result in every instance.
This assertion is fully sustained by the most violent and rapidly mor-
tal disease ever known in the United states. I allude to the spotted
fever of the North (typhus gravior), in many cases of which there
was a perfect suffusion, engorgement or stagnation of blood, in the
capillaries of the surface. All cases in which the above condition
predominated, died. Further, I believe, in the cases in which the
vital organs are congested, that the safety or life of the patient de-
pends upon this dreaded congestion of these organs, and the belief is
based upon the fact that the condition of the organs engorged re-
quires more blood for their support and existence, and that Providence
in his wisdom has so arranged the system, that when any injury of
moment is received, that the blood immediately rushes to the parts
injured, or to those organs which are essential to the development of
nutrition, motion and intellect, or in other words, are essential to life.
The question might be asked, [{congestion is a beneficial occurrence
in disease, why not increase it? I have just stated that nature has
made ample provision on this head, and that the quiet and recumbent
position of the patient comes to her aid. I would further in reply,
say, sleep is beneficial or necessary to preserve the health and vigor
of the system ; but no man in his senses would think of sleeping his
life-time.

One word while on the subject of sleep the object of which no
doubt is to restore the exhaustion of the system ; for which restoration
we find the blood accumulated in greater quantity in the brain and
other vital organs. If a large amount of blood is necessary to re-
store the organs to their accustomed strength and vigor, when ex-
hausted or wearied by study, exercise or labor, there is an admirable
arrangement of nature to accomplish this end, by darkness and the
removal of every stimulus that would be a hindrance to the comfort,
and the facility that the recumbent posture afFords for its consumma-
tion is another fact to be considered. How much more urgent will
the demand be when the system is suddenly overwhelmed or exhaust-
ed by the poisonous shock of disease or agents creating disease.
Nature, the vis medicatrix, or instinct, if you prefer, performs the
part assigned her, by supplying an abundance of blood to the organs
essential to life, and the part the physician has to act when these
momentous cases occur, is to change and modify the condition of the
system, and then the necessity for this vast accumulation and con-

400 Malignancy. [Jufy

centration of the vital fluid will no longer exist. But some doubt,
and deny that the blood is thrown in a larger quantity on the vital
organs during sleep, and base their position on the fact that sweating
is more profuse during sleep than when awake, which they consider
to depend on increased action in the circulation. The very want of
action to a certain degree is the cause of the perspiration, the insen-
sible becoming sensible, or, in other words, the vapour becoming wa-
ter, owing to the temperature of the surface of the body becoming
lower when sleeping. Diseases that often terminate fatally, are not
by any means necessarily malignant. Malignant cases are never
protracted, under ordinary treatment ; obstinate and severe cases are.
Malignant diseases never require reducing and antiphlogistic treat-
ment; in fact, they will not tolerate it; obstinate and severe diseases
may. In putrid and nervous disease, under these titles I include in-
termittent, remittent, and continued fever, when of these types, also,
all of the pneumonitides, when of the putrid or nervous type, or what
is generally understood by Pneumonitis Typhoides. In any of the
above diseases, severe pain in an extremity or some unimportant part
of the system, without redness, swelling or tenderness, constitutes
great malignancy, not congestion. Sometimes a patient will be at-
tacked in these cases with what is termed the ear-ache ; but on in-
specting the organ, we find neither swelling, redness or tenderness on
pressure; the patient dies certainly, from the first to the third and
seventh day. In such cases, it is thought that inflammation has ex-
tended to the brain and is the immediate cause of death ; but the
brain is as free from inflammation as the ear. As we have more
apparent symptoms of malignancy in the pneumonitides of the ty-
phoid type, I shall mention them as occurring under this head, with
this explanation, that whenever they occur in any other disease, they
indicate an equal degree of malignancy.

Mr. C. was attacked with violent pain in his knee, and died within
twenty-four hours. Mr. R., was attacked with violent pain in a
tooth : the tooth was extracted, which was as efficacious as amputa-
ting the glans-penis for stone in the bladder; he died in seventy. two
hours. Mrs. B., was attacked with pain in the cheek, which finally
extended to the eye ; she died in seventy-two hours : there was a pe-
culiarity in this case after the pain subsided, the palpebrse, upper
and lower swelled and became red, but there was no redness of the
eye. Mr. W., was attacked with slight delirium ; there were no
other symptoms sufficiently urgent to confine him to bed ; he denied

1847.] Malignancy. 401

being sick, and yet died on the seventh day from the first attack, and
the third after confinement to bed : in this case, the delirium appear-
ing in the forming stage and there being no other symptom of urgen-
cy, constituted the whole malignancy.

The above symptoms, perhaps, invariably indicate a mortal issue.
A pulse, the beat of which is peculiarly short and quick, and at the
same time weak, indicates malignancy. It is frequently the only
symptom indicative of danger in nervous fever, the overlooking of
which is frequently attended with fatal consequences, particularly if
the patient should be treated with drastic emetics and cathartics, or
the usual antiphlogistics. It is often mistaken for that peculiar
condition of the pulse, when the system is being brought under the
influence of a mercurial action. A thin, saffron colored fluid expec-
torated in great quantity and with little effort; an expectoration of a
thin, sanieous fluid, resembling brine; also a short catch of the
breath, producing about as much effort or agitation as a quarter of a
hiccough, are all symptoms of extreme malignancy, not congestion,
and the issue will be fatal. The catch of the breath alluded to, is
not of that kind produced from pain in the pleura, lungs, or diaph-
ragm, but exists after all pain has ceased. There is a yellow, tough
matter, somewhat resembling melted sulphur, and expectorated with
great difficulty, in which the disease is obstinate and the patient some-
times dies; but it is very different from the yellow watery serum, or
whatever else it may be, of which I speak; the yellow and sanious
fluids appear to be crude and undigested. A negro woman died,
who complained of nothing but a pain in a finger the proprietor,
with some of his neighbors, thought she was poisoned. Why a pain
in an eye, tooth, finger, knee, or toe, should constitute malignancy, I
know not. Some consider the symptoms of malignancy as a part of
the disease ; some of them may be, but many of them are not.

How symptoms that are not necessary to diagnosis, or the nosolo-
gical place and character, should be part of the disease under whose
dynasty they may appear, I am not for the present prepared to ex.
plain; however, be this as it may, if extreme tenderness, redness
suppuration, ulceration and gangrene, or mortification took place,
from the violence of the symptoms, and in the parts so occupied by
pain, we might have probable grounds for assigning the cause of
death to many of the above peculiarities, in the location of pain.
One fact worthy of particular notice is, that none of the symptoms
mentioned aro essential or peculiar to the disease, delirium and the

20

403 Malignancy. [July

fluid expectorated perhaps excepted. Severity and obstinacy depend
on the urgency of the symptoms peculiar to the disease ; malignancy
on symptoms not essential nor necessary. Symptoms peculiar to
the latter stages of disease, appearing early or in the first stage, con-
stitute malignancy, in proportion to their number and severity. In
this case the symptoms peculiar to the disease show it to be malig-
?iant, merely by appearing out of their regular order of appearance.
A peculiar susceptibility of the system to the impression of remedial
agents, irrespective of temperament or the common state of suscep-
tibility ; for example, when any mild emetic or cathartic, in small
doses, will operate harshly and drastically. When one or two oper-
ations produce an unusual degree of exhaustion, and not witnessed
under ordinary circumstances, by an indefinite number of discharges
from the intestinal canal, and the almost utter impossibility of re-
straining the disposition to run down by copious colliquative discharges;
where astringents produce no sensible effects, and the various prepa-
rations of Papaver produce narcosis, in small doses, without restrain-
ing the exhausting discharges brought on by a single mild cathartic,
clearly point out malignancy surely not congestion.

There is a set of cases of an opposite character of extreme torpor,
where emetics, cathartics and venesection are used unsparingly.
Where there is very little exhaustion, the torpor may be broken up
by such treatment, and the patient recover. But if there is much
exhaustion accompanying the torpor, the patient dies suddenly, before
it is broken up, or immediately after the torpor yields. We frequently
hear of persons dying before medicine can be made to operate ; or
when it begins there is no restraining the emesis or catharsis. So
that extreme torpor with exhaustion on the one hand, or extreme sus-
ceptibility with exhaustion on the other, at the outset, equally denote
malignancy, and not congestion, by any means. It may not be out
of place, to notice a set of cases which are frequently termed ma-
lignant. They are cases of torpor without exhaustion, and are ac-
companied with stupor, coma, and insensibility. These are cases in
which nothing short of poisoning will kill, and are the cases we fre-
quently meet with on record; where immense quantities of blood
had been taken, without much present detriment to the system and
with very little or no impression on the disease. These are the cases
which are said to bear bleeding well ; truly said ; for I am no way
certain, if such treatment was pursued, in an entonic, sthenic or
phlogistic disease, but that it would be attended with serious conse-

IS 17. J Malignancy. 403

quences, if it did not kill. I suppose they may be styled, Armstrong's
cases of venous congestion ; if I mistake not the term in which he
bled without apparent injury, in contradistinction from the cases in
which he found bleeding to be attended with immediate death. In
the one set of cases, the disease was principally confined to the san-
guineous system, and connected with torpor of the brain and nervous
system ; and in the other, exhaustion accompanied. Without some
such explanation, we could never account for the quantity of the
vital fluid that may be wasted in the one set, without any immediate
apparent injury to the system, and the mischief and sudden death
from bleeding in the opposite set of cases. This will in a measure
account for the clashing testimony of physicians of integrity; one
set using venesection as the sheet-anchor in congestion, and the other
class rejecting it as an unsafe and deadly remedy; it further shows
the unfitness of the term, to denote malignancy.

The principle feature in all cases of Malignancy, is exhaustion in
the energies of the vital, organs. The brain and nervous system
suffer most ; the circulating system frequently. While on the subject
of torpor and exhaustion, I will notice a set of cases called malignant,
in which the circulating system is disturbed and there is torpor in the
brain and nervous functions, as indicated by coma, lethargy, and in-
sensibility ; in periodical diseases, where large quantities of blood are
taken, and the system suffers but little present injury, when followed
by large and repeated doses of the Di Sulphate of Quinine. Not-
withstanding the vast quantity of the vital fluid taken, how is it that
the coma, insensibility, &c, is never, or but very partially relieved,
until the period for the usual termination of the paroxysm arrives?
How is it that such cases recover, where venesection is omitted ?
One item further in these cases of so-called Malignant Intermittent.
The first ounce of Quinine ever imported into the United States, was
by a particular friend. A medical student had intermittent fever,
gradually growing worse ; about the third or fourth paroxysm, he be-
came comatosed and insensible ; his room-mate grew alarmed at the
great severity of the symptoms, and called in medical aid. The
whole treatment consisted in pressing open his under jaw and giving
twenty grains of Quinine. He had no return of the paroxysms and
took but the one single twenty grain dose. I could specify numer-
ous cases of Intermittent Fever, in which coma and insensibility oc-
curred ; also cases accompanied with convulsions, the breathing ster-
terous cases in which it was impossible to introduce medicine,

404 Malignancy. Uutyi

without first pressing open the under jaw, and then exciting degluti-
tion, by pressing a spoon-handle on the side of the tongue all of
which cases were treated successfully by large and repeated doses
of Quinine, assisted by Morphine, or papaver in some form, and
epispastics or sinapisms to the spine. Many or most cases of reputed
inflammation of the stomach, are nothing more than cases of ex-
treme irritability, accompanied with nausea, emesis or catharsis, and
nervous tenderness of the muscles of the abdomen, or epigastric re-
gion. I have attended on Mrs. P., for more than ten years, during
which period of time, she has had repeated attacks of Intermittent
Fever, accompanied with violent emesis and a rejection of almost
every thing swallowed ; with a tongue perfectly dry and red, exces-
sive thirst, tenderness of the epigastrium on the slightest pressure,
difficulty of breathing, and the most intense restlessness and jacti-
tation, and frequently with a violent pain in the stomach. The only
treatment adopted to subdue the above symptoms, is a drachm of
Quinine in the twenty. four hours, in the worst attack, and a suffi-
cient dose of Morphine to subdue the morbid irritability, the pain
and restlessness. I might have given the symptoms more in detail,
but all are conversant with the condition of patients laboring under
an attack of Malignant Intermittent. I omit bleeding ; because I
do not consider it indicated in perhaps a single case of pure and
genuine Malignant Intermittent. Who would ever think of bleeding,
in casesof great exhaustion of the vital organs? Who would think
of abstracting from twenty to sixty ounces of the vital fluid, let
what incidental symptom occur that might, where all the energies of
the brain and nervous system were laboring under the most intense
pain, irritability and exhaustion, with any other prospect than killing
his patient. Malignant diseases do not belong to the catalogue of
maladies that are even palliated by great losses of blood, much less
relieved. Such treatment is invariably fatal. By dispensing with
it, a great many of the evils consequent on excessive bleeding, are
avoided, (and I must be permitted to say, that from twenty to sixty
ounces is excessive.) For example, dropsy, obesity, paralysis,
dyspepsia, mania, delirium tremens, &c, &c.

One word on contra-indications in malignant Intermittent, where
inflammation, as gastritis, enteritis, splenitis, hepatitis, or phrenitis
supervenes and observes its periodicity. I much doubt whether
such cases ever occur. That organs of such vital importance as
some of them are, should have excessive paroxysms again I cannot

1847.] Malignancy. 405

believe. But as this is a point I do not intend to moot, I will just
say, if such cases should occur, I believe the indications would be
fully met by quinine, morphine, epispastics, and perhaps calomel. I
believe it to be unphilosophical and not true in fact, that quinine and
venesection are indicated at the same time, in any case of Intermit-
tent whatever, during the stage of reaction or exhaustion ; or that
any symptoms, or set of symptoms, could arise where the primary
affection required quinine, and the incident required bleeding and
antiphlogistics. It would be folly to study and make ourselves
acquainted with the pulse, type, stage and diathesis, if such were the
fact. The general condition of the system can never be altered,
while laboring under disease, by the local affection of any organ su-
pervening. According to all medical philosophy, the local affection
would partake of the general condition. The general condition of
the system being caumatoid, the local inflammation could never be
atonoid. The general condition being atonoid, the local could never
be caumatoid. Diseases of Atony, are as acute as diseases of En-
tony ; the most rapidly fatal disease we are acquainted with belong
to the asthenic diathesis ; if rapidly fatal, surely acute. Pneumoni-
tis Typhoides frequently terminates in forty-eight hours, and who
would consider it less acute or the inflammation less active than
Pneumonitis caumatoides^ that rarely terminates any way until
about the seventh day ? There may be cases in which the incidents
occur that would bear bleeding, and where any strong impression of
a reducing nature would relieve the urgency of the symptoms^
where the disease was not truly malignant. But such can never
be asserted where pure malignancy exists ; the chief feature of
which being an exhaustion of the vital energies of the brain and
nervous system, would never tolerate reduction and antiphlogist-
ics. I will mention one or two symptoms of Malignancy, belong-
ing to Cholera Infantum : Thrusting the fingers into the mouth and
fauces. Certainly putting the fingers into the mouth and fauces
cannot be a part of the disease. The above is certainly a fatal
symptom. Another is an effort between gaping or gasping and retch-
ing, or rather an opening of the mouth, as if going to retch. This
also is a sure harbinger of a mortal issue.

In conclusion, I have extended my remarks much beyond what I
intended. My intention was not to criticise any man's opinions or
practice, but merely to call attention to the circumstance of disease
with which their remarks are headed, and the unfitness of any other
terms made use of to express it, and to elicit light from some physi-
cian of eminence who may be disposed to handle it with a systematic
and masterly hand.

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1847. J Remarks on the Report of Dr. Hitchcock. 407

REMARKS OX THE PRECEDING REPORT BY PAUL F. EVE, M. D.

Of the several monthly reports of the army in Mexico under Gen'l
Wool, to whose corps or column our friend, Dr. Hitchcock of the
U. S. army, was first attached, and which he left with us to use as
we thought proper, the one embracing the battle of Buena Vista, it is
supposed, would most interest our readers. This, it will be recollect-
ed, was commenced on the 22d of February, and terminated by the
repulse of the Mexicans the next day late in the afternoon. The
number of combatants, on that severely contested field, could not
have been less than 25,000. Santa Anna, in his summons to Gen'l
Taylor to surrender at discretion, admitted his force to be 20,000.
The deserter from the Mexican troops, during the night of the 22d,
stated their number to be 15,000 infantry and 6,000 cavalry. Gen'l
Wool says they numbered 22,000. It has been estimated as high as
24,000. In Gen'l Taylor's official despatch to government, he makes
his whole force at Buena Vista to have been short of 5,400 deduct
the reserve at head-quarters, to protect the camp equipage, ammuni-
tion, &c, and we have 4,820 according to Gen'l Wool, only 4,610,
the exact number of the actual participants, in this dreadful engage-
ment which resulted in so glorious a triumph to the American arms.

The loss sustained by the Mexicans in this battle, and during
their retreat, will probably never be correctly reported. From 1500
to 2,000 were left dead or wounded on the field, 294 prisoners were
taken, and before reaching San Louis do Potosi, there is good reason
to believe that more than one half of that immense army had disband,
eo*. Gen'l Taylor reports 292 killed, 4S1 wounded, and 26 missing-
making a total loss of 799 Americans.

It will be perceived, by reference to the table on the opposite
page, that Dr. Hitchcock puts down only about 300 wounded; but
lo account for the difference between this number and that contained
in the official despatch of the commanding General, it must be borne
in mind that from two regiments no return had been made to the
Medical Director of the Division; and then again, that wounds of a
trivial nature may have been dressed on the field of battle during the
engagement, the men resuming their places in the ranks.

We find the folilovving memorandum made by the Doctor on the
24th February, 1847 : M Number of wounded brought from the bat-
tle field of Buena Vista, 2(13 slightly wounded, 121 severely ditto,
1:33 mortnlly ditto, i. Many others were injured, but required no

408

Remarks on the Report of Dr. Hitchcock.

[July,

dressing, such as slight contusions, &c, &c." I presume these were
all transported to Saltillo.

It is well known that this battle was fought chiefly by volunteers,
and that two or three regiments greatly distinguished themselves.
Among the number of which honorable mention has been made,
were the two from Illinois, the 1st commanded by the lamented
Col. Hardin, who fell at its head ; and the 2d by Col. Bissell.
I am permitted to present our readers with a full report of the 2d
regiment, made by its surgeon, Dr. Ed. B. Price, and dated March
1st, 1847.

MEAN STRENGTH.

Month.

Officers.

Enlisted Men.

Total.

February.

39

771

810

Report of Wounded dressedon the field, during the action of the 23d, and sent to Gen-
eral Hospital same night, by order of Maj. Gen. Taylor, without a formal report.

RANK.

Companies.

Captains.

1

Lieutenants.

Sergeants.

Corp'ls.

Privates

Total.

A.

1

1

14

17

B.

3

3

C.

l

2

13

15

E.

1

7

8

G.

1

1

H.

1

10

11

I.

1

8

9

K.

1

7

8

i Texian.

i

1

2

3

3

4

1

G3

74

Adju

tant of the Regiment,

Total.

1

75

It will thus be seen that 75 were alone wounded in this regiment,
besides the killed of which no return is here made. Companies D
and F. were, I think, sent to Saltillo, under Maj. Warren, to de-
fend that post, and from the mean strength (810,) we are also to
deduct the sick, &c.

Of the renowned Mississippi Regiment, under Col. Davis, it is re-
ported that originally it was composed of over 900 men. In an
attack upon one of the forts of Monterey, the order given was
countermanded, but being unheard or unheeded by 15 men, they con-
tinued the assault, when 13 of their number were killed, one was shot
through the thigh and borne off by the 15th man, who alone escaped.
By the combats at this city and other casualties, and by the selection
of two of its companies to guard the Head-quarters of Gen'l Taylor,
this regiment entered the battle of Bucna Vista with only 341 men
and officers. Of this small number 41 were killed and 58 wounded,

1847.] Remarks on the Report of Dr. Hitchcock. 409

total 99 making nearly a third of the whole, either killed or wound-
ed. Gen'l Wool, in his official report, says this regiment alone, with
one howitzer, boldly charged some 4,000 of the enemy, and checked
their march upon Saltillo. And yet this same regiment escorted
Gen'l Taylor to and from Saltillo, during the nights of the 21st and
22d, which he visited twice during the fight to secure that important
post.

In this same battle the Kentucky regiment of infantry, command-
ed by Col. McKee, lost 45 killed and 57 wounded, total 102; in-
cluding nearly all its officers.

There were no less than 64 commissioned officers killed and
wounded at Buena Vista viz : 3 Colonels. 1 Lieut. Colonel, 9 Cap-
tains, 14 Lieutenants, killed total 27. 1 Brigadier-General, 1 Colo-
nel, 1 Major, 9 Captains, 29 Lieutenants, wounded total 37.*

But independent of the Mexicans, our soldiers have had to encoun-
ter a far more dreaded ana more universal enemy in the diseases of
the climate and camp-life. If some have been slain in battle, a great-
er proportion have died from internal maladies. The first regiment
from Tennessee, under Col. Campbell, when they passed a year ago
through New Orleans, numbered about 900 men. On their return
home a few days ago, only 350 remained in it to be mustered out of
*he service. They were, however, at the taking of Monterey, but
disease had far more to do in thinning their ranks than the cannon
or the sword. From the Georgia regiment no report has been re-
ceived, but I learn the companies from the mountainous regions of
the State were the greatest sufferers. Our own company, the Rich-
mond Blues, stood the campaign comparatively well, 52 passed

* It is proper to state that the wounded, and even die few prisoners made, were
most barbarously treated by the Mexicans. No doubt many a gallant man might
have been saved, or his life prolonged, by proper treatment, after he fell on that
bloody field. The American army had unfortunately just been paid off a few
days before it occurred, and some of the officers had many hundred dollars
about their persons. The bit of the bridle of Col. Yell's horse broke, and he was
carried headlong into the enemy's ranks, where, instead of being made prisoner,
he was most brutally murdered. Col. McKee and Lieut. Col. Clay both fell at
the head of the brave Kentucky infantry, and v.hen last seen were using their
pistols and swords against those who were stabbing them to death. Col. Hardin,
with his own sword, had cut the lance in twain that had been thrust through
his body. A witness says he saw a mutilated American begging on his knees
for life, while he was butchered by surrounding Mexicans. The dead were
even stripped; and the prisoners taken by the Mexicans were, in the emphatic
lancru; ta Anna, all dead but four!

410 Case of Rupture between Cervical Vertebra. [July,

through it and were honorably discharged at New Orleans. Some,
however, like those who returned from Florida a few years ago, under
similar circumstances, present, besides the bronzed face, marks of
great internal derangement of the system.

A detail of the principal wounds and their subsequent treatment
would have added value to this report, still we hope the facts will not
be devoid of interest to our readers. And whrle on the subject of
military surgery, we may venture the surprise, why it is that Sur-
geons and Assistant Surgeons hold no rank in the United States
Army ? In Europe, if we mistake not, the Surgeon ranks as Major,
and his title is Sargeon-Major to such a regiment. During a recent
conflict in Africa, we learn from a Medical Journal of Paris, that
after all the staff-officers of a French regiment were shot down, the
Surgeon claimed his place in the line, and led on the men to battle
and victory. That wise and patriotic King of France, Louis Philip,
rewarded him for his conduct with the cross of honor. During the
battle of Buena Vista, the Medical Director of Gen. Taylor's Divis-
ion, Dr. Hitchcock, not only discharged his duties as Surgeon, but
acted as aid-de-camp to the commander-in-chief. We wait his pro-
motion by the President for gallant and efficient services.

ARTICLE XXVI.

Case of Rupture of the Fibro-cartilage and ligaments between the 3d
and 4th cervical Vertebra, with Paralysis of all the depending
portions of the Body. By E. M. Pendleton, M. D., of Sparta,
Georgia.

Lucy, a negress, belonging to Rev. W. J. Sasnett, about 60 years
old, and very corpulent, had a fall from a cart on the 20th March,
the occiput striking the ground first, which brought her chin forcibly
upon her breast, with the weight of her whole body. She was brought
immediately to Sparta, a distance of six miles, and I saw her about
two hours after the accident. She was incapable of motion, except
with the muscles of the head and neck, and insensible to stimuli
throughout nearly the whole system. As an evidence of the com-
plete loss of sensibility, the nurse applied a hot iron to her hand,
which she could not feel, and it burned her so severely, as to produce
a deep eschar. Her mind was very clear, and she gave a lucid ac-
count of the accident from beginning to end. She said the cart was

1847.] Case of Rupture between Cervical Vertebra. 411

iIoiri at a brisk rate, and ran over a sturr her

balance, and was precipitated on her head. The moment she struck
the ground, she felt as if her head was severed from the body, a com-
plete numbness shot through her whole system, like the sensation
produced by retarded circulation. She often expressed herself as
taring no body, nor arms, nor le^s. There was however a slight
degree of sensibility in the stomach and abdominal viscera, produced
no doubt by the pneamogastric nerves given off above the seat of
injury, and by the great sympathetic nerve. Her respiration was
slow and labored, i a few qqi to do the work proper

to many. She complained of severe pain at the nape of the neck,
about the 3d and 4:h cervical vertebrae : was natural ail

below was dead. The course of the pectoralis major muscle might
be traced with a pin : the muecle having sensation the surrounding
integuments none. This was repeatedly te;

There was complete paralysis, wilh, however, retention of mine,
and rendered the daily use of the catheter necessary, with the ex-
ception of ile few last days, w hen liie sphincter relaxed and the urine
was passed iscjantinently. She had an operation on the fourth day
after the injury, (the first and la>t.) as the result of a full dose of oil
and copious ghsters. Her pulse was rery little accelerated daring
the whole course of the treatment, and, if anything, was feebler and
slower than natural, particularly towards the termination of the case.
The few last days she appeared to be in a grat deal of pain where
she could feel pain, and vomited large quantities of bilious matter
from the stomach, which was so irritable as to prevent the retention
of any thing taken per ore? . - succumbed on the morning of the
tenth day, retaining her mental (acuities almost entire to the last.

AIk sath I examined h< I by Drs. Con-

neil and Powell. We confined our observations to the seat of the
injury, as we had been so instructed. Upon making the first incision
the blood Btrenmc might have been expected from a living

person, and there was considerable warmth throughout the svstem,
as though she bad just died. We removed nearly all the cervical
vertebra-, together with the medulla spinalis. There was also con-
siderable extravasated blood exterior to the vertebral column. The
mininges of the cord ea ong marks of inflammation, and their

veins were greatly distended with blood. The cord itself had under.
iration, and pus oozed out in ron^id^rablc
amount ly incisions made in it.

412 Case of Rupture between Cervical Vertebral. [July,

The impression was manifest to all, that there was a rupture of the
fibro. cartilage between the 3d and 4th cervical vertebrae. When
we first removed the muscles and exposed the vertebral column, Dr.
Connell took hold of the spinous processes approximating each other
and pulled them in opposite directions, passing up and down the ex-
posed vertebrae. When he came to the 3d and 4th, he found that
there was a considerable yielding, which all of us tested, as did stu-
dents Ryan and Green, so much in fact as astonished every one.
Some five or six of the vertebrae were removed, and then it was evi-
dent that these vertebrae were only united by some of the external
muscles that yet adhered to them. The bodies of the bones them-
selves were as essentially torn asunder, and the cartilage ruptured,
as could possibly have been done by the hand. I do not remember
that any of the processes were fractured ; on the contrary I think
we examined every one carefully, and found them sound. There was,
however, I think, a rupture of the capsules of the oblique articular
processes, and the ligaments of the spinous processes were either rup-
tured or greatly extended. On cutting loose the muscles which held
the 3d and 4th vertebrae together, a space opened of its own accord,
and we could perceive over the face of each of them the prominences
and indentations occasioned by the ruptured cartilage adhering more
to one side than the other. We merely inferred that a partial or
perhaps complete luxation existed from the bones having been so
violently separated, as it could not be determined from a post mortem
examination, owing to the flexible or movable state of the parts after
death. In connection with this, it may be proper to state that during
life, at one period, in attempting to turn her over to relieve her posi-
tion, a peculiar sound, like the slipping of one bone over another,
was heard to proceed from her neck, both by myself and the attend-
ants.

I deem this case interesting, simply from its being of rare occur-
rence, as it is not probable that much light can be thrown upon the
treatment so as to render even alleviation practicable. The autop-
sic observations exhibited exactly what I expected to find, and con-
firmed the diagnosis and the practice pursued in the case. The
remedies used were simply palliative, with the exception of the
strychnine, which was given several days, as a forlorne hope, simply
to be doing something. The patient was kept in one position as
much as possible, counter-irritants freely used over the spine, particu-
larly to the injured portion, and warm stimulating frictions over the

1847.] Large Tape-worm expelled from a Child. 413

extremities. The only wonder is that she lived so long with such a
complete paralysis of the nerves both of motion and sensation, and
those too which were so essential to the vital functions of digestion
and respiration.

ARTICLE XXVII.

Case of Tape-worm over thirty-six feet in length, expelled from a
child aged 4 years. By John D. Twiggs, Student of Medicine,
of Augusta, Ga.

In drawing comparisons of the length this species of worm (the
Taenia solium) sometimes attains, I find by consulting authorities,
that in the 17th century it is said to have far exceeded those observed
at the present day. The case about to be related is a fair specimen
as regards the size of the worm, and is not one of common occurrence,
it may, from these circumstance?, not be devoid of interest.

The mother of this child, a negro on a neighboring plantation, had
noticed his vitiated and irregular appetite, and gradual emaciation
for some weeks, when a dose of a domestic remedy for worms, the
decoction of the China (Smilax China) root was given, and revealed
the cause. This medicine was continued for five weeks, during which
time he passed several portions of tape-worm, measuring from six
inches to three feet. His appetite at times it would seem impossible
to satisfy, and his whole desire was for more food. His medicine
was now changed, and a dose of oil and turpentine substituted in its
place. In a few hours he passed, at one evacuation, thirty-three feet
of tape-worm, besides several smaller pieces. Since then his appetite
has not been so great, and his hunger easily appeased. Now, if we
consider the length of time the child had been passing pieces of worm,
though in smaller quantities than at the last stool, the entire length
must have been very great, if the Taenia solium is always solitary as
its name indicates, and no more than one worm existed in the intes-
tines of this child. Dr. Tyson, in the Philosophical Transactions,
No. 146, remarks that the Taenia is always single, being sometimes
as long, and sometimes exceeding the length of all the intestines.
But this is contradicted by Dr. Good, who says, the records of medi-
cine prove that the several varioties of worms have been voided
simultaneously by the same patient. In the Cyclopaedia of Practical
Medicine I find it stated, that the length which the Ticnia is capable

414 Diagnosis in Diseases of the Chest. [July,

of attaining, is very considerable, though quite indefinite: those
passed now-a-days rarely much exceed twenty feet. A case is re-
corded by Olaus Borrichus, (Rees' Cyclopaedia, vol 36,) of one eight
hundred feet long, voided in a year's time. If the pieces passed by
the child mentioned in the case above, belonged to several worms,
the part, or say even the whole worm voided at the last evacuation
is a thing now of rare occurrence, since they seldom exceed twenty
feet, and this was at least thirty-six or forty feet long.

PART II. REVIEWS AND EXTRACTS.

Propositions on the " Fallacies of Physical Diagnosis in Diseases of
the Chest.''' By Thomas Addison, M. D. Critically Examined
by Robert L. MacDonhell, M. D., Lecturer on the Institutes of
Medicine, M'Gill College, Physician to the Montreal Genera! Hos-
pital, Consulting Physician, Montreal Eye Institution. [British
American Jour, of Med. and Physical Sciences.]

In the last number of "Ranking's Half- Yearly Abstract," the
reader will find a series of propositions from the pen of Dr. Addison,
Physician to Guy's Hospital, London, purporting to point out numer-
ous errors in diagnosis, which those who practice auscultation and
percussion are liable to commit, if too exclusive reliance be placed
on physical signs.

We do not deny, that the science of auscultation is imperfect, but
we do maintain, that without its assistance, we cannot have accuracy
in diagnosis, and consequently success in the treatment of thoracic
diseases. We have always insisted upon the necessity of comparing
the general symptoms, the history of the case, and the mode of suc-
cession of the physical phenomena, with the signs actually existing,
as indispensable to accuracy of diagnosis, and in this, we have but
followed the example of the many distinguished writers who have
devoted attention to this subject.

But in reading the aphorisms of Dr. Addison, one would suppose
that auscultators invariably ma8e a diagnosis from physical signs
alone, and not from a comparison and combination of these signs,
with every other particular, capable of elucidating the nature of the
malady. Auscultators do not make a diagnosis because they hear
certain abnormal sounds, but because they reason on the physical
changes which have produced these sounds. If an observer be per-
fectly ignorant of the necessity of studying the modifications and
combinations of physical signs; the importance of comparing the
sounds heard in diseased parts, with those produced in a healthy or
less diseased portion of the lung; the value to be attached to a par-

18-17.] Diagnosis in Diseases of the Chest. 41.3

ticular sound occurring at a certain stage of the disease ; and, above
all, if he be as ignorant of pathology as Dr. Addison takes it for
granted that auscultators usually are, then, but only then, are the
alleged errors he has pointed out likely to be made.

In the ohservations we are about to offer, we feel it our duty to
expose the many fallacies put forward by Dr. A., and in doing so we
shall follow him through each proposition, and as briefly as possible,
rely to his alleged objections to physical diagnosis. We would, how-
ever, observe, in limine, that Dr. A. commences with objections to
the stethoscope, as if auscultators never employed percussion ; and
he then objects to percussion, as if those who practice it, never use
the stethoscope. His object is but too apparent. He has proposed
to himself the task of underrating the stethoscope, and, where the
attempt can be made, he neglects not the opportunity seemingly
not aware, that in his efforts, he displays remarkable ignorance of the
actual state of our knowledge as regards physical diagnosis. The
truth of what we now state, we hope to be abie, satisfactorily to prove,
and we at once proceed to our task.

A few of the propositions have been so glaringly absurd, that Dr.
Ranking has himself pointed out their refutation. We regret he did
not criticise more closely the remaining ones; for doubtless, many
an inexperienced physician has already been deceived by Dr. A.'s
plausible sophistry.

1. It is well known that many persons while under examination
entirely fail to perform the respiratory act efficiently, either from
nervousness, or from mistaking the manner of accomplishing it.
This may lead to an erroneous belief, that the respiratory murmur is
deficient, or even absent, while the Jungs are perfectly healthy.

This source of fallacy is avoided, says Dr. Ranking, by desiring
the patient to cough, and to inspire deeply, so as to cough a second
time. This done on both sides of the chest, the actual state of either
lung may be ascertained with tolerable precision.

It could hardly have occurred to any writer, except one whose
object was to undervalue the stethoscope to urge such an objection.
It is, in fact, tantamount to this, that an objection to the use of the
stethoscope consists in the necessity of learning how to employ it ;
for if this preliminary step be taken, the above objection falls to the
ground.

2. Whatever lessens the freedom, mobility, or elasticity of the ribs,
renders the sound on percussion more dull. Hence it is that in
rickety persons, where deformity of the chest has taken place subse-
quent to birth, the signs furnished by percussion are often extremely
unsatisfactory; and, indeed, under such circumstances, neither per-
cussion, nor in many instances auscultation, can be much relied upon.

Admitting the truth of this proposition, the rarity of the cases to
which it applies, weakens its value ; and, besides, the same alteration
of the chest affects not only the physical signs, but also the general

416 Diagnosis in Diseases of the Chest. [July*

symptoms of thoracic disease ; for in such cases we have difficulty of
breathing, cough, palpitations, and congestion of the lips and extrem-
ities, owing to the embarrassment to the circulation through the heart
and lungs resulting from the malformation.

3. Some persons with actual deformity have naturally such fixed-
ness of the ribs, that they at all times manifest very imperfect reson-
ance, as well as considerable feebleness of the respiratory murmur.

The remarks upon the second proposition apply equally to this one.

4. The rigidity of the cartilages of the ribs in advanced life has a
similar effect ; and, moreover, often tends to throw obscurity over
hypertrophy of the heart, by preventing the usual heaving of the ribs
at each systole of the hypertrophied organ.

The answer to this is easily given, by proposing two questions
Is heaving of the ribs truly pathognomonic of hypertrophy of the
heart? Have we not more unequivocal signs of this lesion? If so,
we can dispense with one of questionable value.

Had Dr. Addison consulted a small work on auscultation, written
by one of his colleagues, he would have found the following passage,
snowing the importance which auscultators attach to mere impulse,
as a sign of hypertrophy :

11 But does the student may inquire a powerful impulse necessa-
rily indicate hypertrophy? No! Is, then, hypertrophy always
accompanied with a strong impulse? Assuredly it is not. In ex-
planation of the negative to the former questions, it may be stated
that an aneurism of the descending, or even of the left side of the
ascending aorta, may push the heart aside, and by dilating and pro-
ducing partial absorption of the parieties, may communicate a power-
ful heaving impulse to the part in which the natural impulse is felt.

"In explanation of the negative to the second question, it may be
observed, that though the heart be powerful, and the parieties of the
ventricles very thick and strong indeed, the action of the heart may
be so hampered by the consequence of obstruction in the valves, and
its contractions may be so impeded, and so overpowered by fluid
accumulation either within or without its cavities, as to be almost
entirely mastered, and to be only just enabled to flutter a little, and
thus to rid itself of its load. Such, indeed, is very commonly the
condition of the organ in long standing diseases, of the valves, and
particularly in that of the mitral valve, when the nervous energy of
the individual is considerably reduced 5 even though the muscular
power of the heart, abstractedly considered, be much greater than
in health.

"Such is commonly the condition of the impulse in the last days
of the life of persons affected with disease of the valves, accompanied
with hypertrophy. If they do not die suddenly, as persons so affected
frequently do, it may indeed be considered to be the natural termina-
tion of such cases.

1847.] Diagnosis in Diseases of ike Chest. 417

"A very large and powerful heart, therefore, may be accompanied
by avery feeble, irregular, and f uttering impulse; and a very small
and feeble heart may be, and usually is, accompanied with a very
smart and 'smacking' one." A Clinical Introduction to the Prac-
tice of Auscultation ; by H. M. Hughes, M. D., p. 198.

5. When exploring the chest in a case of. recent disease, we may
he mislead by the permanent effect of an ancient pleurisy.

No one in the habit of making examinations of the chest, and
familiar with the pathological changes resulting from ancient pleurisy,
can be easily deceived by the phenomena alluded to.

6. When, as usually happens, rickety deformity of the chest con-
sists in lateral flattening of the ribs, with projection of the sternum,
the action of the heart is liable to beat with such violence, and over
so diffused a space, as to lead to the unfounded apprehension of organ-
ic disease of the organ.

True ; but in such cases the diagnosis can generally be made from
the presence or absence of more unequivocal signs of organic disease.
Dr. A. seems to attach by far too much importance to increased
action, as pathognomonic of organic cardiac disease a mistake ex-
ceedingly general.

7. The dullness on percussion, caused by pushing up of the dia-
phragm by an enlarged liver, or fluid in the peritoneum, is liable to
be mistaken for dullness caused by fluid in the pleura.

Such a mistake can only be made by an examiner who has paid
but little attention to the progress of our knowledge on this subject.
The diagnosis between these affections was clearly pointed out by
Dr. Stokes many years ago, and has been so lucidly explained by
subsequent writers, that it is very unlikely that, with ordinary care,
such a mistake can be made. In any case, the objection only applies
to the right side of the chest.

8. Bronchitis is a frequent source'of fallacy, it may greatly obscure
pneumonia, phthisis, and pleurisy, as well as other chronic diseases
of the organs.

Every pathologist is aware of this; yet we do not recollect having,
in our (by no means limited) experience, found any difficulty in
diagnosis from this cause. On the contrary, the existence of
bronchitic rales have, in more instances than one, greatly assisted in
establishing the diagnosis, as, for instance, in cancer of the lung, em-
physema, <Sic. We have no hesitation in stating that an experienced
auscultator will suffer but little annoyance from this alledged source
of fallacy.

9. When the bronchitic complication of phthisis is considerable,
we often fail to detect some or all of the physical signs of the latter,
such as dulless on percussion, tubular respiration, and even bronch-

27

418 Diagnosis in Diseases of the Chest. [July,

ophony and pectoriloquy. This is more especially the case in the
earlier stages.

Dr. Addison seems to forget that a brochitic rale, accompanied by
dullness, is one of the most valuable signs of the first stage of pul-
monary consumption. This was shown many years ago by Dr.
Stokes, and it has more recently been insisted upon by Mons. Louis.
In another place we have stated that " A bronchitic rale, confined to
the upper lobe of one or both lungs, resisting treatment, and accom-
panied or followed by dullness, at first slight, but gradually increasing,
is as valuable a physical sign of phthisis as any we possess." So
far, then, from bronchitic rale obscuring the signs of phthisis, it is,
on the contrary, one of the most valuable indications of the early
stages of that disease, particularly if occurring at the apices of the
lungs. Moreover, it is not easy to understand how a bronchitic rale,
produced by the passage of air through diseased bronchial tubes, ran
mask dullness on percussion. But even supposing it capable of
doing so, could not percussion be practised whilst the patient is made
to keep in bis breath. Dr. Addison states that his proposition ap-
plies particularly to the earlier stages of phthisis ; but surely he does
not consider tubular respiration, bronchophony, and pectoriloquy,
characteristic signs of the earlier stages. The first two are never
heard in the earliest stage, and the latter is never heard but in the
last stage ; consequently a bronchitic rale cannot be considered as a
fallacious sign, but one of extreme value in the earliest stage of
phthisis the only period in which our efforts to arrest the disease,
are likely to be attended with success.

10. Dullness of sound on percussion, tubular respiration, broncho-
phony, pectoriloquy, and gurgling, are not necessarily conclusive of
phthisis. All these signs may result from changes induced by a
former pleurisy, from pleuro-pneumonia, or whooping cough, or even
from recent pneumonia or pleurisy associated with considerable
bronchitis.

The diagnosis is not so difficult as seems implied in the above state-
ment. When pectoriloquy and. gurgling are heard in pleuritic
effusions, they are accompanied with other unequivocal signs of that
affection, as for instance, dilatation of the side, protrusion of inter-
costal spaces, displacement of the heart or liver, loss of vocal vibra-
tion, dec, and they indicate the removal of the fluid of an empyema,
through a perforation in the lungs, and consequently are attended by
signs of this communication, such as "spalshing," metallic tinkling,
amphoric cough, and pneumo-thorax. The possibility of confound-
ing cases of phthisis, in which the physical signs alluded to, are
presented, with pleuro-pneumonia, we do not deny, if no attention be
paid to the history of the case, the rapidity of progress, and the
presence or absence of other signs of phthisis.

We have never heard dullness of sound on percussion, tubular
respiration, bronchophony, pectoriloquy, and gurgling in whooping

1847.] Diagnosis in Diseases of the Chest. 419

cough ; and, until we saw the present proposition, were always under
the impression that the last mentioned disease was remarkable for
the absence of physical signs. A view in which, we believe, almost
all observers coincide.

11. When, in phthisis, the larynx is so involved as to impede the
entrance of air, and give rise to permanent sonorous rale in the tube,
the reverberation of this rale through the entire chest is apt to lead
to the erroneous suspicion of disease in the lungs.

This statement is open to two objections. In the first place, if the
disease in the larynx have advanced so far as to impede the entrance
of air, the quantity of air thus admitted is not likely to cause much
reverberation. Secondly, Dr. Addison must be aware that in phthisis
the laryngeal symptoms rarely set in till towards the close of the
disease, when, of course, no embarrassment in diagnosis can arise
from the occurrence of rale. He must also be aware, that even sup-
posing his statements true, (which we are far from allowing), the
occurrence of such a complication must be so rare, that none but a
prejudiced writer would urge such an objection to physical diagnosis.

12. Complete loss of voice from the larynx almost completely
nullifies the results of auscultation.

When loss of voice occurs as a complication of thoracic disease,
the latter has always preceded the former. We know of no case
where aphonia has obscured the diagnosis, but we know of many
where it is of the greatest service in assisting us to form a correct
one.

In any case, loss of voice can only affect the vocal auscultatory
signs, and these are so perfectly valueless, taken by themselves, that
the ausculator can, without disadvantage, dispense with them. We
know of no signs which so constantly mislead the inexperienced, as
the different modifications of the voice. A slight resonance, so com-
mon in women and young men, with shrill voices, is constantly put
down as pectoriloquy and bronchophony. It is now generally admit-
ted that Laennec attached too much importance to these signs. We
wonder that Dr. A. did not at once discard them as useless compli-
cations.

13. The existence of a cavity may be overlooked if the bronchial
tubes leading into it are plugged with mucus.

In every case of suspected phthisis, says Dr. Ranking, the patient
should be made to breathe and cough with violence; this will dislodge
mucosities and render the existence of a cavity perceptible.

Has Dr. A. ever known a mistake made under the above circum-
stance? It seems to us that the merest tyro would have desired his
patient to cough a simple and ready method of dislodging the plug
of mucus, the cause of so much confusion.

This fallacy seems to have suggested itself to the Doctor at his
desk, and not at the bedside.

420 Diagnosis in Diseases of the Chest. [July,

14. A patient may have all the rational signs of incipient phthisis,
while auscultation does not reveal any change in the lungs.

Similar symptoms may arise from relaxed uvula, and in hysteria.

In a note appended to an essay on empyema, published four years
ago, we stated

"I am not ignorant of the fact, that in some rare cases of phthisis,
the constitutional symptoms may continue for a long time before the
slightest traces of the physical phenomena of the disease become
manifest, owing, most probably, to the morbid processes being con-
fined to the central parts of the lung. I have now seen many such
cases, and have observed in some of them a peculiarly foetid odour
from the breath, after coughing, and from the expectoration. The
diagnosis, in these obscure cases, rests upon the want of correspond-
ence between the presence of all the symptoms of phthisis and the
total absence of the physical phenomena. We are not, however, in
such cases, left long in doubt, for very soon the lesion becomes dis-
coverable by auscultation and percussion." Dublin Med. Jour.

We do not contend with Dr. A. for the originality of the propo-
sition; but though we have, even more fully than he, stated our
experience of these cases, we never fancied that because they form a
rare exception, he or any one else should have considered them as
invalidating the rule.

15. Dilated bronchial tubes surrounded by indurated pulmonary
tissues, cannot be distinguished from phthisical lesion by auscultation
alone, especially if situated in the apices of the lungs.

In such cases the diagnosis is chiefly formed by the history of the
case.

It i9 true, that a careless or inexperienced auscultator may not be
able to make the diagnosis, for there are many signs common to the
two affections. In both, we may have dullness on percussion, pec-
toriloquy, gurgling, and absence of respiratory murmur; but in
dilated bronchial tubes, there is a want of accordance between those
sig7is and the general symptoms. There is no hectic emaciation, or
rapid sinking, as in phthisis. Moreover, the history of the case shows
us clearly that its slow progress is not reconcileable with our notions
of the course of phthisis; and this view is still further strengthened
by the fact, that in dilated tubes the physical phenomena remain un-
changed fa- years, whereas, in phthisis, their mutations are rapid and
progressive. There are other points of dissimilarity, but enough has
been stated to prove that, with ordinary care, the * fallacy" alluded
to, may be avoided.

16. Malignant disease of the lungs cannot be distinguished from
other lesions by auscultation alone.

True; but does Dr. A. pretend that the diagnosis can be made
without auscultation ? If so, he is highly culpable for keeping his
professional brethren ignorant of this important fact. It is certainly

1847.] Diagnosis in Diseases of the Chest. 421

quite true, that we cannot rely solely upon physical signs for a diag-
nosis of malignant disease of the thoracic viscera. But has any
writer on the subject maintained (hat they alone are sufficient for that
purpose ? Do the observations of Stokes, Walshe, Taylor, or Graves,
assert the affirmative of the proposition? Certainly not; they, and
all subsequent observers, have insisted on the necessity of connecting
the general symptoms with the physical phenomena, and thence
deducing a diagnosis. It had been more wise had Dr. A. waited
until auscultators/tacZ asserted what he has undertaken to disprove.

17. If acute pneumonia have proceeded to complete hepatization
when we first examine the patient, the physical signs are frequently
insufficient to distinguish it from tubercular consolidation or ancient
pulmonic induration. This \3 especially the case if the apex of the
lung be the seat of the induration.

That it is extremely difficult, indeed we may say impossible, to
distinguish complete hepatization when wefrst examine the patient,
from tubercular consolidation or ancient pulmonic induration, we
freely admit. But we would ask, does Dr. A., or any other physician
of equal experience, always make a diagnosis on the first examina-
tion of his patient, without inquiring into the origin, mode of suc-
cession, and modification of the symptoms and physical signs.

If we neglect to inquire into these particulars, and rely on physical
signs alone, we shall not be able, from their assistance, to make an
accurate diagnosis; but if we recollect that pure pneumonic consoli-
dation is by no means frequent at the apex of the lung, and that
"ancient pulmonic induration/' or. in other words, " carnification"
of the lung is a condition of the organ very rarely observed, and par
consequence, still more rarely met with at the apex of the lung, it
must be admitted that the value of proposition, No. 17, is very ques-
tionable.

18. Pneumonia may occur without cough, and go closely resemble
simple continued fever that both the stethoscooist and the non-
stethoscopist are apt to be deceived.

Of all cases in which the stethoscope has been employed, its vast
utility has not been more indisputably proved, than in the very in-
stances alluded to by Dr. A., namely, latent pneumonia; in such a
case wc unhesitatingly assett that without the stethoscope & correct
diagnosis cannot be made ; and if the disease has been overlooked by
Dr. A., or any physician, it is because auscultation has not been
employed. The reader will observe, that Dr. A. started with show-
ing how the use of physical signs may mislead the practitioner; in
the above proposition, he inad 7 points out how we may bo

deceived by not employing them. lie has, unintentionally, proved a
little two much.

19. When the Anterior and inferior portions of the left lung i*
consolidated Uy pneumonia, ii may not fw detected by percussion on

422 Diagnosis in Diseases of the Chest. [ July,

account of the proximity of a flatulent stomach. Under similar cir-
cumstances a marked amphoric respiration is produced, with metallic
tinkling, leading to the erroneous conclusion, that pneumothorax is
present.

We may here observe that solidification of the anterior and inferi-
or portions of the lung is not very common; indeed, we doubt much
if Dr. A, has met with many examples of it.

Be that as it may, we would ask Dr. A. has he known the mistake
alluded to, to have been frequently made ? or has he not more gen-
erally remarked, that even inexperienced auscultators recognize the
source whence the amphoric sound proceeds. Under such circum-
stances we have frequently made the patient swallow a few drops of
water, in order to instruct a class in the detection of these sources of
fallacy; the water dropping into the flatulent stomach produces a
sound closely resembiing metallic tinkling; but we do not recollect
to have heard metallic tinkling spontaneously produced in these
cases, as seems implied in Dr. A.'s remarks.

In any case, a few drachm's of any carminative mixture, by expel-
ling, or displacing the flatus, will remove the source of error.

20. It cannot be determined by physical examination whether
pneumonia have or have not supervened upon tubercles, although the
prognosis in the two cases would be very different,

With due deference, we do not see how the prognosis can be much
affected in the manner alluded to by Dr. A. For if we are satisfied
that phthisis is unquestionably established, the supervention of pneu-
monia can only affect the prognosis, as far as the probable duration
of life is concerned, it does not render the disease more fatal, though
it no doubt shortens the duration of the sufferer's existence.

21. I doubt whether physical examination can in any instance de-
termine with certainty, the existence of simple tubercles in the lungs.

We do not purpose trying to convince Dr. A.; we would, however,
advise him to apply himself to this branch of auscultation ; and as he
appears to be far behind the age, we recommend to him the manual
published by Dr. Hughes, his colleague.

22. When serous effusion is very considerable, giving rise to une-
quivocal bronchophony, tubular respiration, and want of resonance
and vocal vibration, physical examination has repeatedly led to a
mistaken belief that these signs resulted from pneumonic or other
consolidation of the lung.

Setting aside altogether the fact that when serous effusion advan-
ces to the extent alluded to by Dr. A., it generally produces a dis-
placement of the heart, to the right side, when the effusion is situated
on the left side of the chest, and a displacement downwards of the
liver, when the effusion occurs on the right side : it must not be for-
gotten, that enlargement of the side and bulging out of the intercostal

1847.] Diagnosis in Diseases of the Chest. 423

spaces, signs so characteristic of extensive serous effusion, are never
noticed in pneumonia ; but as they occur in some cases of cancer of
the lung, the diagnosis might be rendered obscure. As I have alrea-
dy drawn the attention of the profession to the points which will
enable them to form a correct diagnosis in such cases, I shall content
myself by merely alluding to those observation. A consolidation of
the lung from pneumonia never yields absolute dullness on percus-
sion, and as this sign attends all cases of pleuritic effusion of any
extent, it alone would serve to distinguish the one from the other.

Besides, in extensive pleuritic effusion, there is complete absence
of tussive and vocal vibration over the affected part, signs which are
never absent in pneumonia.

23. When a patient presents himself with febrile affection of any
kind, we may, on examination, detect dullness on percussion, tubular
respiration, bronchophony, and a rale not distinguishable from the
submucous crepitation commonly observed in pneumonic hepatiza-
tion ; and yet physical examination should not enable us to determine
whether the chest affection be recent or of ancient date. When a
portion of lung has been compressed by pleuritic effusion, and has
been prevented from expanding again by adhesions, the physical signs
may remain permanently, and be found to resemble precisely those
which result from recent pleuro-pneumonia.

We are sorry to appear so captious, but we really cannot allow
another gross blunder to pass unnoticed. Firstly, we maintain that
submucous crepitation is not heard in hepatization of the lung, but
after the hepatization has commenced to pass into the stage of reso-
lution. Secondly, ' when a portion of the lung has been compressed
by pleuritic effusion, and has been prevented from expanding again
by adhesions a process of contraction commences in the parietes of
the affected side, which quickly and very perceptibly produces a flat-
tening of the chest, corresponding to the seat of the disease, accom-
panied, moreover, by depression of the shoulders, and tilting outwards
of the angle of the scapula. Has Dr. A. ever seen such consequen-
ces follow recent pneumonia ? or is he in the habit of making a diag-
nosis without inquiring into the history ofthe case ? Ifso, we wonder
not at his alluding to sources of fallacy, which we venture to say, no
nuscultator but himself ever encountered. We are not surprised,
that if Dr. A. attach but a little importance to the pathology of tho-
racic disease, and to the order of succession, combinations and modi-
flcations of physical science as it appears he does, that he should have
derived but little assistance from the stethoscope.

24. Experience leads me to the conclusion, that pleuritic friction,
sound cannot in all cases be distinguished from the rubbing produced
between the inflamed peritoneal surfaces ofthe liver and diaphragm ;
neither can the croaking sounds pioduced in the bronchi be always
distinguished from lUe pleuritic rub.

A Imilting the probability ofthe error alluded to, in the (\ist part

424 Diagnosis in Diseases of the Chest. [July,

of the above sentence, (although it has never occurred to us to meet
with friction-sound, arising from the rubbing of the inflamed perito-
neal surfaces of the liver on the diaphragm, except when the liver
presented tumors on its surface,) yet it can only occur on the right
side. Sometimes there is, no doubt, difficulty in discriminating be-
tween the rubbing sounds and those generated in the bronchial tubes,
yet the accompanying symptoms and the history of the case will
always enable us to distinguish the one from the other.

25. A simple pericarditis is rarely attended with pain, and as the
other symptoms of that disease are equivocal, the physical signs are
chiefly to be relied upon in forming a diagnosis. Nevertheless, when
effusion has taken place to a certain amount, the friction-sound com-
monly disappears, and auscultation fails to recognize the disease.

If friction-sound has been heard in a case of pericarditis, and has
suddenly disappeared, the change indicates, either a return to a per-
fectly healthy condition, adhesion of the opposed surfaces of tho
membrane, or effusion of serum into its cavity. If the first or second
of these changes has taken place, the sound on percussion over tho
heart will present its usual character; but in the latter case, the loss
of friction-sound is followed by extensive, complete, and absolute dull-
ness all over the cardiac region, and even beyond it. Being aware
of these facts, we are not likely to be misled by the disappearance of
the rubbing sounds.

26. Enormous accumulations of fluid in the pericardium, cannot
always be distinguished from effusion into the cavity of the pleura.

Here is another great error.

Has Dr. Addison ever tried the diagnostic test of Laennec for effu-
sions into the pleura, viz : the changing of the position of the patient ?
If so, how can he suppose that we are to accede to the foregoing pro-
position. Effusion into the pericardium cannot be displaced by the
position of the patient, but that which is produced by the pleuritic
inflammation readily changes its position, if that of the patient be
changed. Moreover, as before stated, extensive effusion into the left
pleura commonly produces dislocation of the heart to the right side.
Has Dr. A. ever known this phenomenon produced by effusion into
the pericardium ? We answer no ! Again, effusions of great extent
into either pleura are usually attended with dilatation of the side
protrusion of the intercostal spaces, cedema of the integuments (fre-
quently) and loss of vocal and tussive vibration signs which are not
noticed in pericarditis with effusion.

27. When the pericardial friction-sound is single, auscultation may
fail to distinguish it from a valvular murmur, especially if it be situa-
ted over the region of tho valves.

To the young stethoscopist this difficulty mignt present itself, but
the historv of the case, the lon.^ existence of cardiac disease, the ab-
sence of febrile symptoms and of pain over the cardiac region, &c,

1817.] Diagnosis in Diseases of the Chest. 425

would point out the difference between an old and recent attack of
the heart. Surely Dr. A. does not mean to assert that it is common
to find valvular murmur as rough as friction-sound, and still remain
single! But even so, there are many distinguishing marks between
them. Valvular murmur, when single, is always situated over one
or other set of valves, strictly accompanies the first sound, is not
influenced by position or by pressure of the thoracic walls against
the heart, conveys to the ea? the idea of being generated deep in the
substance of the heart, and is not removed or modified quickly by
treatment in all these particulars a strong contrast exists between
the two sets of sounds; moreover, friction sound is superficial, and
is increased by making the patient lean forward, (i. e., if no effusion
have already taken place into the sac,) so as to bring the opposed
surfaces of 'serous membrane into close contact, whereas valvular
murmur remains unaffected by these manoeuvres.

23. The double pericardial friction-sound maybe confounded with
the see-saw murmur of imperfect aortic valves, and vice versa.

The diagnosis of the disease of the aortic valves does not rest sole-
ly on the see-saw sound nor has any auscultator asserted that it did.
Besides that sound, we look for the bruit de soufflet in all the arteries
of the upper extremities, that sound proceeding from the aorta to the
smaller branches: the visible pulsation of the vessels of thef neck and
arm, and the jerking pulse at the wrist, or as Dr. Hope termed it, the
"pulse of unfilled arteries." We have also combined with these,
evidence of hypertrophy of the heart in many cases. Moreover, the
see-saw sounds are most intense over the aortic valves, whilst those
from pericarditis are most intense corresponding to the junction of
the auricles with the ventricles. It will be noticed, that Dr. A. again
assumes what we have so frequently contended against, that auscul-
tators rely solely on physical signs, for he must be aware, that the
history of the case, will, in many instances, afford assistance in our
diagnosis.

29. A sound closely resembling a murmur appears sometimes to be
produced by the stroke of the heart against a portion of lung inter-
posed between it and the parietes of the chest. Under such circum-
stances, auscultation may lead to the erroneous conclusion, that the
heart is diseased.

As we have never heard this sound, wc make no remarks on the
above proposition.

30. Auscultation fails to distinguish an aortic murmur depending
on organic change from one which results from other causes ; neither
can it decide whether what has been called a mitral murmur is or-
ganic or functional.

We admit ihnt, occosiojmlly, difficulty does exist in making a differ-
ential diagnosis in the cases alluded to, but auscullators have always
(except, perhaps, Dr. Hope) admitted this difficulty ; yet here also,

420 Strychnine in the cure of Chronic Bronchitis. [ July,

attention to the accompanying symptoms, the origin of the disease,
and above all, the changes produced by exercise, and medical treat-
ment, will enable the practitioner to arrive at a correct conclusion.

31. In certain diseases of the heart it is difficult or impossible to
localise the murmurs with accuracy, however pronounced they may be.

We also admit the difficulty, but are the prognosis or treatment
affected by it? provided we are enabled to distinguish between
organic and inorganic diseases of the heart, we hold, that the refined
diagnosis between an affection of this or that valve, however useful
in establishing accuracy of observation, is but of little importance
in practice.

32. Auscultation cannot distinguish the murmur of an aneurismal
artery from the murmur produced by external pressure upon the vessel.

This has also long since been admitted by stethoscopists ; but is
the diagnosis imperfect? by no means.

33. Physical examination does not enable us io distinguish con-
genital malformation from disease of the heart or large vessels.

Physical examination fails here, and so do general symptoms:
congenital malformation may be guessed at, but cannot, with accu-
racy, be detected.

We have now performed the task we proposed to ourselves, and
we dare say, our readers will agree with us, that a more agreeable
one, might have been selected; but we felt it our duty to expose the
shallowness of argument, the very evident special pleading, and
above all, the assumption on the part of Dr. A., that all his read-
ers are as little acquainted with the present state of auscultation,
as we trust we have shown him to be. The ignorantia elenchi, is the
species of reasoning, upon which Dr. A., evidently relies in his argu-
ment throughout. That Dr. A. has rendered great service to the
cause of science, we gratefully acknowledge ; that he may be an ex-
cellent practical physician, we readily admit but that he is a sound
or skilful stethoscopist, we very much doubt. The stethoscope has
had many enemies to encounter; but we know of none, pretending
to familiarity with its employment, who has made such a determined
effort to throw discredit upon it, and to discourage others from learn-
ing its application.

On the powers of Strychnine in the cure of Chronic Bronchitis. By
Dr. Henry Clarke, of Port Washington, W. T. (Illinois and
Indiana Med. and Surg. Journ.)

In the treatment of no disease, or class of diseases, have I expe-
rienced more difficulty than in bronchial affections. And the utter
failure of the practice, recommended by authors, proves conclusively

1847.] Strychnine in the cure of Chronic Bronchitis. 427

the absolute necessity of more attention being bestowed upon this
subject. With this view, I offer to the consideration of the profes-
sion, a few remarks, not however preferring any claim to originality,
but rather wishing to impress upon the minds of those afflicted, the
actual necessity of making due exertions for relief, notwithstanding
such disease may, perhaps, be pronounced incurable.

Strychnine was discovered by Messrs. Pellitier and Caventou, in
the year 1818, and named by them Vauquelin, in honor of that dis-
tinguished chemist. After which they changed the name to Strych-
nine. It is so intensely bitter that it is said to give a decided taste
to 600,000 parts of water by weight, and is but sparingly soluble in
alcohol. It is one of the most virulent poisons; and, perhaps, infe-
rior to none, except the highly concentrated prussic acid. Majendie
killed a dog, by the administration of one-eigth of a grain. Its ef-
fects are to produce tetanus, and consequent immobility ofthe thorax,
asphyxia and death. The curative effects of Strychnine in cases of
Paralysis, both general and partial, as in hemiplegia and paraplegia,
aiso in tetanus, obstinate cases of amenorrhea, in chronic diarrhoea
without pain and with thin serous discharges, which produce exhaus-
tion, and in nearly all the various diseases to which the eye is sub-
ject, are too well known to require an insertion here.

My method of administering it is principally in powder, suspended
in mucilage as a vehicle, or by making it into pills, preferring either
to the tincture, owing to the insolubility of it in alcohol. In anhy-
drous alcohol it is perfectly insoluble, consequently no tincture can
be prepared that will give an equal strength.

Having been afflicted severely for quite a number of years with
Bronchitis, and finding no medicines which gave me relief, I was
induced to try the effect of strychnine, which resulted in a perfect
cure. My symptoms, when I commenced using it, were emaciation,
night sweats, and continued mucous expectoration, attended with
cough, at times very severe, after which the muscles ofthe larynx
were so completely relaxed, that I could not utter a sound above a
whisper, but unattended with pain. I commenced the use of the
strychnine as advised, by taking one-twentieth of a grain, suspended
in mucilage, three times in a day, and increased the dose every third
day until I took one-fifth of a grain. I used the remedy about four
weeks, and have never experienced any difficulty since. I was
much astonished at its results, and more especially at the effects it
produced upon the contractility ofthe muscles ofthe larynx, as well
as upon the muscles of the extremities.

Case II. A. B. S., an attorney after delivering an address, and
exercising unusually hard the organs of speech by talking very loud,
in returning home was caught in a shower, and drenched to the skin.
Immediately after he wns attacked with Acute Bronchitis. I knew
nothing in regard to his treatment, but it resulted in Chronic Bron-
chitis, and he was unable to speak, for over three years, above a
whisper. I prevailed upon him to make use of strychnine, and gave

423 Treatment of Primary Syphilis. [July,

it in pills made with flour, and ext. liquorice, and one-thirteenth of a
grain of strychnine, increased until he took one-eighth of a grain;
which amount he continued to take for nearly two months. He now
experiences no difficulty in speaking, and thinks he has obtained a
complete cure.

Case III. E. W. L., set. 52, an itinerant preacher, was by de-
grees entirely deprived of speech, and remained thus for twelve or
fifteen years. He had some cough and expectoration, slightly tinged
with blood. He was, by my recommendation, last spring, induced
to make use of the strychnine. Two or three months since I received
a note from him stating that he was not perfectly cured, but suffi-
ciently so to be able to speak in public, if he used moderation. After
speaking he felt still an oppressive weakness in his chest, and slight
tracheal irritation, but not sufficient to produce cough. He was
directed to continue the use of strychnine as before. I have not
heard from him since.

Case IV. A lady afflicted with occasional loss of speech, with
neither cough or expectoration, but extreme emaciation, and had, as
she expressed it, a continued "tickling and hacking." She was or-
dered to take strychnine. This I gave in tincture, six grs. to the
fluid ounce of diluted alcohol. She commenced with three drops
three times a day, and increased as in the other cases. This was at-
tended with the most decided success.

Where there is a local determination of blood to the head it is ne-
cessary to deplete until that is removed, before using the strychnine.
Morphine, to a certain extent, is an antidote to strychnine. Lembert
introduced three grains of strychnine under the skin of a dog on one
side of the spine, and six grains of morphine on the other side, with-
out any visible effects following it ; either of which alone would have
caused death. ******

But in regard to strychnine as a remedy in Bronchial affections,
and even in the forming stages of Phthisis Pulmonalis, I have the
most implicit confidence in it, and think that the time is not far dis-
tant when Pulmonary Consumption shall be stripped of its manifold
terrors, by the sanitary influence of this powerful remedial agent.

Treatment of Primary Syphilis. By W. C. Axdehson, M. D., of
the Seaman Retreat, Staten Island, New York. (New York Jour-
nal of Medicine.)

From the ample opportunities afforded at this institution to ascer-
tain the best method of practice to be pursued in the treatment of
syphilis, I think some important results have been obtained, from
which I have been led to adopt a mode of practice not generally
known, or at least, as far as I am aware of, not generally resorted to.
Mv attention was first called to this mode by an article in the Medical
and Surgical Reporter, for June 27th, 1846, by Dr. A. L. Cox, of

1847.] Treatment of Primary Syphilis. 429

this city, which, however, that gentleman does not claim as original,
but gives the credit of its first suggestion to Dr. S. A. Cartwright,
of Natchez, Miss. It consists in the administration of calomel in
large doses, followed by purgatives, and repeated daily. Not given
with a view to salivation, although that result did happen in two or
three cases out of fifty treated by this method. Previous to adopting
the calomel treatment, I was in the habit of giving in specific ulcera-
tions of the genital organs, the per-chloride of mercury, in combina-
tion with the compound syrup of sarsaparilla ; an eighth of a grain of
the former to two ounces of the latter, twice a day. Under the use
of this, indurations were removed, and sores took on a healthy char-
acter in from fourteen to twenty days. Occasionally the gums be-
came sore, but this result did not take place with any thing like the
uniformity which it did when the pil. hyd. was used. Local dress-
ingsof sol. chlor. calcis with lint was the only application in general
resorted to, although it sometimes happened that mercurial washes
were found to expedite the cure ; and again, in very irritable soreB a
wash of the solution of opium was frequently required.

The method of giving the calomel was to begin at once with scru-
ple doses, followed in six hours by the compound infusion of senna.
This course was repeated every morning until the character of the
sore was ehanged, unless it was found to produce too much cathartic
effect, or to affect the gums.

The following cases will illustrate the mode of procedure, and its
success.

Case 1. H. C, tet. 20. Admitted September 7th, for pains in
his bones of three weeks' duration, and chancre on the prepuce of
ten days, being the re-appearance of a sore which had a short time
previously been dried up by the application of sulph. cupri, but which
left an induration. He had a bubo last winter, when the sore was
first contracted. Treat. : cal. 3j. followed by inf. senn. comp. ij.
9lh, Repeat same. 10th, Repeat same. 11th, Repeat same. Dis-
charged cured Sept. 14th. Duration of treatment, seven days.

Case 2. J. S. W., a?t. 23. Admitted September 7th, with phy-
mosis and chancres on the edge of the prepuce of five days' duration.
Slight enlargement of the glands of left groin. Treat. : cal. 3j.
R. Inf. senna: comp. 9th, Cal. 3j. R. Inf. senn. comp. 11th, R.
Cal. 3j. followed by eccoprotic mixt. 12th, Has had chills, follow-
ed by fever, pulse 120, tongue furred. R. Inf. senna:. R. Pulv.
Doveri, gr. i i j . , pulv. ipecac, gr. j. Repeat every three hours. 18th.
Had another paroxysm of ague yesterday. R. Emetic, followed by
quinine. Discharged cured September 23d, The sore had been
healed several days. Duration of treatment, sixteen days.

Case 3. J. W., blk., set. 24. Admitted Oct. 9th, for chancre on
the glass, of one week's duration, and bubo in the right groin. Treat.:
cal, >j., followed by ipf. senna: comp. The sore readily healed un-
der the use of simple dressings. Discharged cured Oct. 16th. Du-
ration of treatment, seven days.

430

Treatment of Primary SypJtilis. L^u'y

Case 4. J. M. B., set. 27. Admitted Oct. 1st, for ulcer upon
the pubis, of forty-two days existence; overhanging, livid edges and
fetid discharge. Treat.: cal. 9j., followed by inf. sennas comp. ij.
3d, Repeat same. 5th, Complains of soreness of gums; the ulcer
has put on a healthy character ; red granulations are shooting up;
for a local wash the sol. chlor. sodas has been used. Discharged
cured October 17th. Duration of treatment, sixteen days.

Case 5. J. L., cet. 19. Admitted Sept. 10th, having a large
syphilitic sore on the lower side of the penis, of three weeks duration.
Treat.: poultice to sore. ft. Cal. ^., followed in six hours by mist,
eccoprotic. 13th, Repeat cah and eccop. 15th, Repeatsame. 19th.
Repeat cal., with inf. sennas. 21st, Mouth slightly touched; omit
medicine. Apply ung. hyd. rub. to sore. Discharged cured, Oct.
26th. Duration of treatment, 46 days.

This sore was of that species of ulceration, which is generally
very obstinate, healing in the centre, and spreading on the edges in
the crescentic form, and sometimes requiring months to effect the
healing process.

Case 6. T. E., ast. 36. Admitted Nov. 3d, for ulceration of the
extremity of glans penis, of three weeks' duration, with partial para-
phymosis ; the ulcer about the size of a shilling piece. Treat.: poul-
tice, ft. Cal. 3j. 5th, Repeat cal. 3>j., followed in six hours by
inf. sennas comp. 6th, Repeatsame. Discharged cured, Nov. 11th.
Duration of treatment, 8 days.

Case 7. A. P., ast. 26. Admitted Nov. 5th, for fistulous bubo,
of twenty days duration, and chancres on corona glandis, which
appeared a few days before the former. Treat.: poultice to bubo.
8ol. chlorid. calcis to sores, ft. Cal. 3>j., followed by inf. sennse
comp. 7th, Dilated sinus in groin, and dressed with lint. Repeat
cal. 3j. and inf. sennas comp. 9th, Repeat same. 11th, Repeat
same. 13th, Repeat same. Discharged cured, Nov. 19th. Dura-
tion of treatment, 14 days.

Case 8. B. F., ast. 35. Admitted Nov. 3d, for chancre on
corona glandis, of two weeks duration, and bubo in the right groin,
of seven days. Treat.: cal. 3j. The treatment was pursued after
the same manner as the above. The bubo did not suppurate, having
been dispersed by the application of Ricord's caustic. Discharged
cured, Nov. 26th. The chancre having been well for several days,
but he was detained for the purpose of healing up the issue. Dura-
tion of treatment, 23 days.

Case 9. C. W. E., ast. 20. Admitted Nov. 7th, for phymosis
and ulceration underneath the prepuce, which is indurated and cede-
matous, and cannot be retracted sufficiently to view the ulceration.
A copious dark brown fetid discharge issues from the onfice. He
has also a bubo in the right groin, which has suppurated. The
whole of three weeks' duration. Treat.: poultice to bubo and penis.
The calomel treatment with purging was continued for six days,
when the prepuce could easily be retracted, affording a view of the

1847.] Typhoid Fever. 431

ulceration underneath, which extended half way around the corona
glandis, with elevated edges and brownish discharge. Discharged
cured, Nov. 30th. Duration of treatment 23 days.

Numerous cases of this description could be given, but the above
will be sufficient to illustrate the manner in which syphilis, in its
primary form, is here treated. Another advantage, which I have not
observed under other methods, is that the worst and most forbiding
cases of phymosis are reduced without the necessity of an operation,
which is sometimes followed by unpleasant consequences, such as the
cut surfaces taking on the same character as the original sore ; and
always more or less oedema and infiltration, which greatly retards
the cure.

Typhoid Fever, as it appeared at Geneva, in the fall and winter of
1846-7. By Geo. C. Hay, M. D., of Geneva.

As the subject is attracting considerable attention at present, par-
ticularly in our large sea-port towns, where crowds of emigrants are
daily landing with this form of fever, the following excellent descrip-
tion, &c, of it is taken from the last No. of the New York Journal of
Medicine:

Fevers of a remitting type have prevailed quite extensively during
the latter part of the last summer, and during nearly ail the fall
months, but not a single case, as I can ascertain, died of it at that
time. In December, the first cases of the low form of fever showed
themselves. All the cases which have occurred seem to be confined
to a neighborhood of from one to two miles square; and beyond the
limits of this, as far as I can learn, no cases have appeared. The
symptoms in the forming stage differed but little from an attack of
ordinary fever, commencing with loss of appetite, sense of lassitude
and disinclination to exercise of any kind, chilliness, pains in bones,
etc. After twenty-four or forty-eight hours headache came on inva-
riably in all the cases, and in many it was the first symptom, and
continued very obstinate through the whole course of the disease.
About the third day the patients were generally obliged to take to
their beds, the headache increasing, attended with vertigo, dimness
of vision, ringing in the ears, suffusion of the conjunctiva and deaf-
ness. The tongue was at first covered with a thick white fur which
changed by the fourth or fifth day into a brown, and finally into a
black during the latter stages of the disease. In a great majority of
the cases diarrhoea was a prominent symptom from the commence-
ment, so much so that even the use of the mildest febrifuge medicines
was inadmissible ; this was controlled with great difficulty by opiates,
and in some cases astringents had to be resorted to. Accompanying
this diarrhoea, we found considerable tenderness of the abdomen in
nearly all the cases. The discharges from the bowels were generally

432 Typhoid Fever. [July,

very watery, of a dark color, very fetid, the urine scanty, sometimes
entirely suppressed, and of a very red color. The skin was generally
quite dry, although not very hot at any time, and in no case could I
discover any of the *' calor mordax" spoken of by writers, and which
I have frequently felt in similar cases. As the disease progressed, in
many cases delirium was a constant attendant through the whole
course of the fever, and none were entirely free from it. In many
cases the collapse came on very suddenly, and in others a gradual
sinking came on, and steadily progressed until the patients died.
The collapse seemed to bear no relation whatever to the severity of
the first stage, as is generally the case, as sometimes in those who had
been attacked but slightly, the collapse was sudden and fatal, while
in those whose stage of excitement had been very severe the collapse
came on very gradually, and progressed slowly, and vice versa. As
to the post-mortem appearances I can give you but little information,
as owing to the prejudices existing among the people it was next to
impossible to procure an examination. After I had left, however, one
examination was made of a boy aged fourteen, who died very sud-
denly, and I understood from a physician who was present, that his
bowels were a complete mass of mortification. As to the treatment
it was very various. All the patients, however, had in the commence-
ment mercury, in some of its forms, and in two cases which have
since recovered, it was carried to the extent of slight salivation.
Some cases were bled generally, and some not, but it seemed to make
but little difference in the continuance or violence of the disease.
The local treatment consisted in cold applications, leeches, and blis-
ters to the head and nape of the neck; cups and blisters to the
chest, when the symptoms seemed to demand; hot fomentations,
poultices, leeches, and blisters to the abdomen, etc. In some cases
we ordered the patients to be washed over the whole body with a so-
lution of nitro-muriatic acid made as strong as they could bear it ;
this was done twice in twenty-four hours, and seemed at least to give
considerable temporary relief to the patients. The general treat-
ment was at first calomel, hyd. cum creta, or pi 1. hyd., followed by
the liquor amrnoniae acetatis, or spiritus 8Stheris nitrici, with the
potassas nitras, or vinum ipecacuanhas or antimonii ; but in some
cases, and indeed in many, their use was impossible, on account of
the tendency to diarrhoea, as every thing taken into the stomach ran
off by the bowels in a short time. In all the cases stimulants and
tonics had to be resorted to sooner or later, but generally with little
benefit, although at first the patients seemed to rally under their in-
fluence, yet they seemed to have no permanent effect in many cases.
Those used were the infusum sepentarice, or columbae, camphor, am-
monia, etc., together with sulphate of quinine, port wine and brandy,
with a nourishing diet of beef-tea, chicken-jelly, arrowroot, etc. I
forgot to mention that the pulse was in most cases very frequent,
from the commencement, ranging from 100 to 130 and 140 during
the whole time. Insome cases the pulse was quite full and hard in

1847.] Cold Water in over doses of Opium. 433

the commencement, but generally it was quite small and very easily
compressed. I may say in conclusion that it seemed to matter little
what course of treatment was pursued, the patients in a large major-
ity of cases died, some during the first week, others runing on four,
six, eight, and ten weeks. In one family, five persons died, all be-
tween the ages of fourteen and thirty; indeed nearly all the cases
have been young persons.

Cold Water in over doses of Opium.

To the Editor of the Boston Medical and Surgical Journal.

Sir, I have been a reader of your valuable Journal for several
years, and do not recollect seeing any communication respecting the
application of cold water to the cranium in cases of over doses of
opium, when taken for the purpose of committing suicide ; or when
injudiciously administered. As several cases of the kind have come
wnder my observation, I take this opportunity to report them, and you
are at liberty to do with (hern as you please.

Case I. A healthy child, aged 6 months, son of P. W., December
Sd, 1845. A few days after confinement, the mother was troubled
with abscess of the breast, for which six or eight powders of acet.
morph., of one sixth of a grain each, were prescribed by the attend-
ing physician, to be taken as circumstances required. About four
arid a half months afterwards a swelling appeared about the groin of
the child, and the mother remembering the good effects of the morph.
upon herself, administered a powder to him, at 4 o'clock, P. M. Two
nours had elapsed before I had arrived. I found the child as follows :
Entirely insensible ; countenance pale and Hippocratic; breathing
stertorious; extremities cold; pulse scarcely perceptible; and, in
fact, every appearanceof immediate dissolution. An emetic of sulph.
zinc and ipecac, was turned down, but the stomach did not respond
to it. Hot flannels, wet and dry, were wrapped about the child, with
sinapisms to the extremities and spine. We then commenced pour-
ing cold water from the height of about four feet. This was contin-
ued at short intervals (or five hours, when sensibility began to return,
and the child recovered.

Case \[. Mrs. C, of Dickinson, a robust woman, ait. 50 years,
August 9, 1840, 11 o'clock, A. M., took full one drachm of best
Turkey opium, after shaving to a powder, for the purpose of commit-
ting suicide. She told her daughter, (18 years of age) that she felt
unwell, and would go and rest herself in an adjoining room for two
hours, and did not wish to be disturbed during that time. Half-past
2, the daughter entered her room, and finding her insensible, sent for
me. I arrived at 4, P. M., and found her extremities cold and clam-
my ; entirely senseless ; great prostration ; feeble and irregular pulse;
stertorous breathing in the extreme. From particular inquiry I be-

434 Accidents which result from the Puncture of a Nerve. [July,

came satisfied that these symptoms were caused by an over-dose of
opium as she afterwards confessed. Hot sinapisms, stimulating
frictions and active flaggelation to the extremities; cold water from
the well was then poured in a large stream from a hole in the chamber
floor. Not having a stomach pump at hand, an emetic of sulph.
cupri. and ipecac, was forced, with some warm brandy and water,
but it was some time before it would operate, with the assistance of a
feather to the fauces. No remains of the drug were evacuated that
we could discover. The water was continued almost constantly for
nearly six hours, before she began to arouse from the lethargic state.

Case III. Infant of A.S., of Moira, aged 14 days, December 5tl),
1846. Being restless, a neighbor gave it two drops of highly con-
centrated laudanum, at 10 o'clock, A. M. I saw it at 1, P. M., and
found its countenance pale and ghastly; eyes open and set in their
sockets, with occasional winking of the lids ; surface generally cold ;
breathing stertorous and exceedingly irregular, and having frequent
convulsions. Treatment. 'Hot sinapisms and hot flannels were ap-
plied, as in the former cases, with an occasional warm bath. Cold
water was applied by means of wet cloths, and continued twelve
hours, when the narcotic effects having subsided, recovery followed.

In regard to the above cases, I would remark, that I consider the
success owing to the thorough application of the water to the head,
thereby prolonging the powers of life until the suspension of the nar-
cotfc effects of the drug. From the experiments of Sir B. C. Brodie,
who has clearly demonstrated that opium produces death by paralyzing
the nerves of respiration, is it not possible that partial, if not entire
congestion of the brain takes place in fatal cases? If so, may we
not rationally come to the conclusion that the refrigerating applica-
tion has a powerful tendency to prevent such congestion, and there^
fore deserves the attention of the profession.

Moira, N. Y., April 8th, 1847. F. H. Petit, M. I>.

On the Accidents which result from the Puncture of a Nerve. Cause
of Neuralgia. By M. Arc Berard, Surgeon to La Pitie. Con-
densed from La Nouvelle Encyclographie. (New Orleans Medi-
cal and Surgical Journal.)

At the moment when a nerve is pricked the individual experiences
an extremely sharp pain at the site of the wound, which radiates
through the divisions of the nerve to the parts where it terminates.
Sometimes the pain proceeds upwards towards the origin of the nerve.
Having continued some days, rendering the motions of the part
difficult, or preventing motion, it usually subsides, but is sometimes
followed by more or less serious accidents, as excruciating pains, con-
vulsions, tetanus, spasmodic contractions ; usually confined to the
parts to which the wounded nerve is distributed, and occurring in
paroxysms accompanied with more or less suffering, occasionally ex-

16-17.] Accidents which result from the Puncture of a Nerve. 435

tending over the whole body ; and if the inferior limbs are involved,
the patient is unable to walk or to support the motion of a carriage ;
or obstinate neuralgia may occur a considerable time after the inflic-
tion of the injury.

M, Berard, in his own person, experienced neuralgia from a prick
of the frontal nerve. For the purpose of a galvanic experiment a
needle was forced into the external branch of the ophthalmic nerve,
as it proceeds from the supra-orbital foramen, and an electric current
was directed throughout the division of the nerve. At the instant,
violent pains were felt over the forehead and crown of the head. The
pains ceased when the needle was withdrawn, but some months
afterwards a fresh attack of neuralgia was experienced in the division
of the wounded nerve. The pain had the quotidian intermittent type,
and gave way to the use of sulphate of quinine. Since this period
repeated attacks of neuralgia have occurred, with many years' inter-
val, some of which were excessively violent and long-continued, and
always seated in the frontal branches, but sometimes extending to
the nasal and lachrymal branches of the ophthalmic nerve.

A young person met with a cut with a penknife, in the forearm,
above the wrist. A violent pain was felt in the forearm, wrist, and
fingers; this was soon followed by spasms, while the voluntary
motions of the fingers were either incomplete or impossible. Subse-
quently the spasms became general, and for two years the individual
led a most miserable existence ; the case being ultimately cured by
repeated applications of the*actual cautery. Similar symptoms oc-
curred in a young woman, from a wound above the wrist, inflicted
by a piece of glass, probably injuring the median nerve; and the
following detail is drawn up from the case of a woman at present in
La Pitie, with a similar affection, having been bled at the fold of the
arm some time previously.

Diagnosis. The symptoms of a puncture of a nerve cannot be
confounded with those of any other disease. A wound correspond-
ing with the site of a nerve, the pain propagated along the nervous
filaments, tremblings, and convulsive movements, which resist all
ordinary remedies, leave no doubt of the nature of the affection.

Prognosis. The accident is in general exempt from danger, the
pain ordinarily ceasing after a few hours, or at most a Cew days, but
the disease becomes very serious when spasm, convulsion, and neural-
gic pains continue. The patient may become the subject of contin-
ual torment for many years, and of sufferings which produce their
influence over the whole economy. Happily these results have been
observed in a few cases only.

Treatment. When the wound is recent rest, antiphlogistics,
and opiates, the latter being indicated when the symptoms persist ;
friction in the course of the nerve, with oil and laudanum, or hyos-
cyamus, bathing the limb with decoction of poppies or of belladonna,
the application of morphine by the omlermic method, etc. But the
disease, when fully established, most frequently resisting these mca-

436 New Method of Treating Fractured Ribs. [July,

sures, there remains no other resource but to destroy the affected
nerve; for which purpose cauterization or incision may be employed.
The first, although most painful, destroys a greater portion of the
nerve; one application rarely succeeds. When incision is resorted
to it should be done two or three centimetres from the wound, to-
wards the nervous centre. The purpose may, perhaps, be equally
well effected hy subcutaneous section. In the few cases in which
this operation has been resorted to the symptoms have subsided the
moment the nerve was divided.

Pathological Anatomy. The puncture of a nerve produces a cir-
cumscribed tumefaction in its substance, with effusion of blood into
the cellular tissue between the nervous filaments and within the neu-
rilemma. When the symptoms of acute inflammation have subsided,
and the absorption of the effused fluid has taken place, there remains,
according to Wolff, Beclard and Descot, either in the whole
thickness of the nervous cord, or, if the puncture has been very
limited, at one point of its circumference only, a hard, opaque swell-
ing, of a fibrous consistence, which is invariably formed by a thick-
ening of the cellular-fibrous tissue. This tumefaction may furnish a
useful indication where accidents of this kind have resisted ordinary
curative means.

New Method of Treating Fractured Ribs. By A. J. Hannay.-
(London Med. Gaz. Am. Jour\i. Med. Sciences.)

For many years I have made use of adhesive straps as the restrain-
ing girdle around the chest, and with happy effect. The following
is the mode of applying them : I cut the most adhesive and best
made diachylon plaster I can procure into strips four inches broad;
and of sufficient length to surround the thorax with a tail, which,
after meeting around the cavity, will reach fully a foot beyond the
point of meeting. I place the patient in a warm apartment, and
close to a good warm fire, so that the plaster may be readily and
thoroughly warmed, and kept perfectly soft during the application of
it. Having ascertained the seat of the fracture, and having the
plaster thoroughly softened, I place the middle (the sailor would call
it the bight) of the strap on the fractured points. An assistant and
myself each pull the ends of the strap very tightly, whilst another
assistant supports the patient by preventing him from yielding in the
direction we are drawing the plaster. The patient also empties his
chest by expiration, as forcibly as he can, at which conjuncture the
strap is brought in contact with, and made to adhere to the chest,
encircling it tightly all round ; the ends are crossed over each other.
This first strap, or girdle, is followed by a succession of them, laid
partly over each other, or imbricated ; each strap should cover a third
of the width of the one next it; they are applied in the same manner
as the first, which, in the end (from the straps reaching up to tho

1847. j Use and Abuse of Mercurial Preparations. 4oT

axilla, and down to the lower part of the chest, compressing that
cavity powerfully) becomes slack, and another one is required to put
round over it. I then, to9ecure the firm adhesion of this cuirass of
plaster at every point, smooth it over with an Italian iron sufficient-
ly, but mod&rately, heated.

I have now adopted this practice for many years in private, and
have taught it to the pupils of the Glasgow Royal Infirmary, some
of whom, with myself, can bear testimony to its facility of applica-
tion, and its perfect efficiency. It is immediate in its relief, and does
not generally slacken till its support is no longer needed. I need
hardly add, that it enjoys its advantages from the adhesion every
where diffusing over the whole surface of the chest a most equable
pressure; whereas the sliding bandage usually employed comes to
press most on the prominent parts, and is therefore inefficient. Be-
sides, the stiffness of the strap affords a certain and very suitable
amount of support, which the bandages hitherto employed to encircle
the chest do not afford. Indeed, a piece of plaster is often put on
the surface over the broken point below the cinctures in ordinary use
in these cases. I have just recalled to mind the circumstance which
led to my adoption of this method of treating fractured ribs. I was
laboring under the most agonizing neuralgic pain of the thoracic
parietes during my convalescence from continued fever. Many kind
professional friends who visited me, suggested diverse remedies, but
all in vain ; the late Dr. Abercrombie at length suggested a broad
strap of plaster to be wrapped tightly round the chest. It proved
instantaneously and permanently effectual, and pointed out to me the
value of the strap in all cases requiring a firm girdle round the chest,
to check, or altogether prevent its respiratory movements. I have
employed it also in cases similar to my own, since, with like success.

On the Use and Abuse of Mercurial Preparations. (Medico-Chir.
Review, from Revue Medicale.)

Dr. Sichel gives the following cautions as necessary in the exhibi-
tion of mercurial preparations :

1. The diet must be in no-wise stimulant, and as little nourishing
as possible. If this is not attended to the plasticity of the blood be-
comes augmented.

2. All notable change of atmospherical temperature should he
avoided. Unless this rule be observed, numerous disappointments
will occur, and premature salivation is especially likely to be induced.

3. It is a general law that the special physiological action, or the
toxical effects of a medicinal substance, only manifests itself after its
action upon the pathological condition has become exhausted.

The operation of this law is well seen in the employment of nar-
cotics in those affections of the nervous system which afford distinct
indications for their use, as neuralgia and tetanus. This last, we
Jtnoiv, demands large doses of opium, but the point of saturation must

438 Digitalis in Diseases of the Heart. [July,

be carefully watched so that the drug may be laid aside when the
precursors of narcotism begin to replace the tetanic symptoms ; un-
less we wish to see, as I have often seen in the hospitals, the patient
cured of the tetanus to die by opium. The physiological action of
mercury is exerted upon the salivary glands, and with, the earliest
precursory symptoms of salivation, the blood has already lost some
of its morbidly plastic character. It is indeed remarkable to what
an extent acute inflammation becomes relieved, upon the appearance
of the precursors of salivation, and how long these are in making their
appearance in intense and essentially exudative inflammations, as
iritis, peritonitis, and especially puerperal peritonitis. In this last
we are sometimes surprised at finding the abdomen, which the evening
before would not endure the weight of the clothes, supporting next
day firm pressure of the hand, the precursory symptoms of salivation
having manifested themselves in the interval. These are indeed the
signs of the system having become sufficiently saturated with the
mineral, which must be left off as soon as they appear, our object not
being, save in very rare and obstinate cases, to excite actual saliva-
tion. Instead of then pushing on the -mercury, if the disease does
not yield, we must, in the case of inflammation, have recourse to
other antiphlogistics ; and in the case of syphilis, to iodine, sudorifics,
&c, carefully limiting the regimen, and avoiding exposure to cold.
When, however, the precursory symptoms are dissipated, and the
disease has not yet yielded, we may turn again and again to tho
mercurial treatment. In syphilis this is almost always necessary.

It is from the non observance of the above rules, that so much
mischief has been caused by this remedy, and so much prejudice has
been raised against it. The excitement of profuse salivation is espe-
cially mischievous. The anti-plastic action of the drug may, after
long use, so diminish the coagulability of the blood, as to produce a
mercurial scorbutus, very difficult to cure. Marasmus may likewise
be produced, especially in children and aged persons, if mercury be
employed sufficiently long to induce ptyalism or diarrhoea, or the two
conjointly. Calomel, particularly, must be given to such subjects
with great care. It is not sufficient to withhold it when salivation
or purging already exist ; but at every visit the condition of the sali-
vary organs and digestive tube must be carefully enquired into.
From neglect of this precaution, infants often suffer severely from the
prolonged use of calomel.

On the action of Digitalis, and its uses in Diseases of the Heart.
By W. Munk, M. D-., Physician to the Tower Hamlets Dispen-
sary.-(British and Foreign Rev.)

This is one of those performances which we hail with the greatest
satisfaction ; were they more numerous we should be in a better posi-
tion to contend with disease, and (what is of far smaller importance,
but still of some moment) to answer the frequent taunts of our hom-
ceopalhic opponents.

1847.] Case of Partial Double Monstrosity Bipenis. 439

Dr. Munk has drawn his conclusions from upwards of 400 experi-
ments with this drug, made with care, and recorded with accuracy ;
and he has, we think, established some very important points.

It is well known that digitalis exerts its influence specially on two
organs the heart and the kidneys. Now it appears from the re-
searches before us, that these results depend very much upon the
preparation employed the tincture affecting the heart the infusion
acting upon the kidneys. If it be desired to lower the action of the
heart decidedly, as in cases of hypertrophy, the tincture should be
given alone, in moderately full doses. If we wish to relieve the pal-
pitations, dyspnoea, &c., which form so large a portion of the dis-
tress of those who suffer from valvular disease, dilatation, &c, the
tincture should be given in combination with camphor, assafioetida,
musk, or other antispasmodics. In either case the patient should ab-
stain from all exertion of mind or body. A plethoric condition is
unfavorable to the action of the drug, and should be removed before
its administration.

When the diuretic action is required, the infusion should be given
in doses of from half an ounce to an ounce every six or eight hours,
and the patient should take moderate exercise, and have the loins
warmly clad, avoiding the production of diaphoresis.

Dr. Munk suspends its use if the pulse falls below 60, and does not
persevere longer than a week, if the medicinal effects are not readily
produced. With these precautions he has rarely seen any injurious
effects frooi its employment.

A Case of Partial Double Monstrosity Bipenis,

In the April No. of the Medico-Chirurgical Review, is noticed an
account of a curious lusus naturce, by Wm. Acton, Esq., Surgeon to
the Islington Dispensary. The child has also been exhibited in Paris,
and the French surgeons agree with the author that the third leg (not
one of the penes) ought to be cut off*.

The subject of this curious case was a Portuguese child, six months
old, exhibited in London during last Spring, and rendered sufficiently
notorious by a placard not remarkable for its decency, in which the
infant is characterized as " the Human Tripod, or three-legged child,
and first Bipenis ever seen or heard of." The monstrosity is thus
described by Mr. Acton.

" Below the umbilicus, and to the right and left of the mesial line,
are two distinct penes, each as large as the penis of a child six months
old : their direction is normal. I may mention that water passed
from both organs at the same moment, during the time that Dr. Cur-
sham and Mr. Perry were examining the infant with me. Each penis
i.s provided with a scrotum, the outer halfof each scrotum containing

440 Sense of Smell connected with posterior nares. [July,

one testicle, the inner half of the scrotum is far removed from the
outer, and the two inner halves appear like another scrotum between
the two penes. Between and behind the l?gs of the child, we see
another limb, or rather two lower extremities united together in their
whole length. The upper part of this compound limb is connected to
the rami of the pubis by a short narrow stem half an inch in length,
and as large as the little finger, apparently consisting of separate
bones or cartilage, for. on moving the compound limb, at the same
moment the finger is kept on the stem, crepitation is felt, but I could
not detect any pulsation. Immediately beyond this stem, and con-
cealing it, the compound limb assumes a size as large as the compound
natural thighs of the child, and within the upper part irregular por-
tions of bone may be felt (probably a portion of a p*lvis and the heads
of the thigh bones), which may be traced down, united together into
one mass, to a leg of comparative small size, though still larger than
either of the healthy legs, and terminating by a double foot in the
position of talipes, with the sole turned forwards, and furnished with
ten toes, the two great toes being in the centre of the others : the two
outer toes on each side are webbed.

" When the child is placed on its belly, the spine and back present
a perfectly normal appearance : the anus is in its usual situation;
the functions of the bowels are duly performed. Viewed in this
position, the compound limb assumes a roundness and fullness equal
to the buttocks of a young child, and a slight depression is observed,
as if for the anus. Tracing the limb downward, we find only one
patella, which is pn the same aspect of the limb as the anas, the joint
bends freely, and the compound extremity terminates as above de-
scribed. This compound limb is quite motionless, the upper portion
alone appears endowed with sensibility, its vitality seems low, as the
toes have a bluish appearance ; the upper portion, however, is of the
same temperature as the body of the child."

PART III. MONTHLY PERISCOPE.

The sense of smell destroyed by closure of the posterior nares. -
M. Hutin presented an ex-officer of the army of Africa, who had lost
the tonsils from an ulcerated sore throat. Since then the soft palate
has contracted adhesions with the pharyn.vdirectly backwards thus
closing completely the posterior nares. Respiration is no longer ef-
fected through the nose ; the closure is complete; he is not able to
blow his nose, and when he feels the necessity of expelling the gather-
ed mucosity, he is obliged to incline himself forward, his head down-
ward, and wait till it falls out by its own weight. Xot being able
to breathe naturally, he perceives no odour, and is not conscious of
the taste of what he eats, though he knows when food is sweet, salt,
or acid, but he cannot tell when it is prepared, for example, with
onions or orange flower water, drc. [Trans. Archives Gen. de Med.

1-847. j Protracted Lactation. Ascites. Quinine. 441

Remarkable Case of Protracted Lactation. Mrs. P., aged 39
years October 23th, 1846, never had a sick day since her marriage,
December 9th. 1626, except the usual sickness consequent on partu-
rition. During this period she has given birth to eight children, all
of whom are now living and in perfect health. The order of their
births is as follows: Sept. 5th. 1627, female; Sept. 5th, 1 829, fe-
male ; March 28th, 1832, female; April 1st, 1634. female; Novem-
ber 11th, 1S37, female; April 3d, 1841. male; April 17th, 1844,
male ; November 3d, 1846, female. Mrs. P.'s only brother and
sister lived to adult age, and both died of tubercular phthisis. Both
parents also died of the same disease. She was married young, and
at the time considered a remarkably slender girl, being subject to
cough upon the slightest exposure. She has been constantly nursing
for a period of nearly twenty years never weaning one child till the
birth of another compelled her to, for the convenience of the infant.
More than once, when in labor, I have seen her child of the last birth
at the breast.

From a solitary case of this kind I would not draw a single infer-
ence ; but should some of your numerous correspondents, from the
abundance of their experience, contribute for the Journal similar cases
with a like favorable result, might we not infer, contrary to the gen-
erally received opinions of medical men, that protracted lactation,
especially during pregnancy, possesses a prophylactic power, even
when there exists a well-marked hereditary predisposition to pulmo-
nary disease. [I. P. Smith, M. D., in Boston Med. and Surg. Journ.

Iodide of Starch for Ascites. The 21st September, a man affected
with dropsy entered the ward of M. Burguet. Having failed to re-
lieve him by the ordinary means, M. B. proposed to try the external
application of iodine, inasmuch as it was stated to cure puerperal
peritonitis. The abdomen of the patient was covered with a pretty
thick layer of iodine and starch, in the proportion of 3ss. of iodine to
iii. and grs. x. of starch. From the very first day, this article was
easily recognized in the urine, sweat, dec., by its exhalation the
infiltration in the limbs gradually diminished, and then the ascites
very rapidly disappeared. [Trans. Jour, des Con., Mtdico-Chirurg.

f An easy mode of removing the bitter taste of Quinine, without injur-
ing its therapeutic action. M. F. Des Youves, Student at the St.
Louis Hospital, Paris, states that, by accident, he discovered a way by
which quinine can be taken, even by infants, not only without repug-
nance, but with pleasure, so completely is its bitter taste destroyed.
Being in Martinique in 1842. and about to take a dose of quinine as
a cup of coffee was handed him, he put five grains of the article in a
spoonful of this beverage: swallowing it down he was surprised to
find it had no bitter taste. The other doses were taken in the same
way, and his fever was cured. He has subsequently administered
quinine in the same manner, and always with like results. [Trans-
lated. Idem.

442 Oil of common Fish. Neuralgia. Hooping -Cough. [July,

[We find by the latest French Journals, this subject is now under-
going investigation by the chemists and pathologists of Paris some
contending that roasted coffee destroys or injures the therapeutical
properties of quinine, and others that it does not.]

The Oil of common Fish instead of the Oleum Jecoris Aselli.
M. Bretonneau (one of the most distinguished living physicians of
France), was one of the first to experiment with the oil derived from
the liver of the Cod-fish : he has now established, after a long series
of researches, that this costly article can be replaced without any dis-
advantage by the oil of common fish. This is important; for the
former is almost always uncertain, and extremely high-priced when
obtained pure. The oil of common fish, that is of the whale, is cheap ;
is administered in the same dose and under the same conditions, and
is not more disgusting than cod-liver's oil. Already has the observa-
tions of M. B. been verified by some of the physicians of the hospitals
in Paris. [Translated. Bulletin de Therapeutique.

Coffee as a remedy for Neuralgia. It is stated that a female under
the care of M. Piorry, had, after parturition, being attacked with a
neuralgic affection of the frontal branch of the fifth pair of nerves,
which after resisting a number of the ordinary remedies, yielded com-
pletely to a continued use for many days of a very concentrated
decoction of coffee.

Another case also is mentioned in which the success of this reme-
dy was generally marked. A woman affected with the same form of
neuralgia, which had been unavailingly treated with the valerianate
of zinc and quinine, became cured by combining the use of strong
coffee with the above remedies. The therapeutic effects of the drug
were well marked in her : a draught of a very strong decoction of it
at the commencement of a paroxysm of pain being quite sufficient to
prevent its continuance. [Gaz. des Hopiteaux Med. Gaz.

Hooping Cough. Purgation with calomel ; if febrile symptoms,
calomel and antimony ; an occasional emetic, and small and repeat-
ed doses of carbonate of potassa, or the following formula: Potassae
carb. 3j.; coccus cacti, gr. x.; aq. fervent, q.s. The dose according
to age; for an infant, a teaspoonful thrice daily. (Dr. Allnatt.)

Dr. Wachtl, of Vienna, recommends the ammoniated tincture of
cochineal.

In the first stage, mild antiphlogistics, daily emetics, and strict con-
finement to the house, except in summer months. In the latter stages
give the following: Tincture of cantharides, tinct. of opium, comp.
aa. gss.; tinct. cinch, co. vss. A teaspoonful to be taken three
times a-day in a little boiling water; the dose to be increased if no
strangury is produced. Be careful, however, at all times, not to give
opium if it can be avoided. (Drs. Graves and M'Gregor.)

1847.] Poisoning. Stramonium Seed. ArseniateofQuinia. 443

Case of Poisoning from swallowing Percussion Cays. By T. W.
Foster, M. D., of Keene, Jessamin county, Ky. Not long since I
was called in great haste to attend an infant, aet. 14 months. Upon
entering the room, I was informed by the parents that they had ob-
served their child, about two hours previous to my visit, playing with
a box of percussion caps, and they supposed she had swallowed some
of them, as signs of acute suffering were exhibited soon after.

The little patient appeared to be sinking very fast. The eyes had
a hollow, glazed appearance ; there was great heat in the epigastric
region, and coldness of the extremities; there had been eight or nine
discharges from the bowels in an hour, and her general aspect denoted
approaching collapse. Before my arrival free emesis had been pro-
duced by some domestic remedy, yet I continued the vomiting by
administering ipecac, and large draughts of warm water, (of which
the patient greedily drank,) with the hope of discharging at least a
portion of the offending matters. The discharges became so debili-
tating, however, that I threw up an injection of eight drops of lauda-
num, suspended in starch mucilage, and immediately afterwards gave
a large dose of calcined magnesia. An alkaline purgative was se-
lected for the purpose of neutralizing any acid which might be found
in the stomach or intestines, and thus prevent any chemical change
in the copper. In the course of an hour the child became perfectly
composed, and fell into a pleasant slumber, though it had previously
suffered excruciating pain, attended with spasms. Dr. Spilman, the
family physician, now took charge of the case, and applied counter-
irritation to the abdomen. On the next day four caps were discover-
ed in the faecal matter, which were found to be devoid of their ful-
minating powder. The child is now enjoying very good health.

[Medical Examiner.

The effects of one Stramonium seed. Dr. Ashmead related a cu-
rious case of impaired vision, with dilatation of the pupil of one eve.
The patient had the day previously taken up a dry head of stramon-
ium and shook it several times, to cause a rattling of the seeds con-
tained in it. On the ensuing morning, an irritation was felt in the
affected eye, which caused the patient to rub it, when he perceived
a foreign body beneath the lid ; this, when extracted, was found to be
a seed of the stramonium. Soon after its removal the impairment
of vision and dilation of the pupil disappeared. [Summary of Col.
of Physicians of Philadelphia.

Arseniate of Quinia. This salt, first prepared by M. Bourieres,
has latterly been much used in France in the treatment of obstinate
intermittents, and, it is stated, with much success ; the chief obsta-
cle to its more general employment being, according to" Dr. Boudin,
its extreme bitterness. It is readily prepared as follows: Dissolve
half an ounce of sulphate of quinia in boiling water, and precipitate
with ammonia ; wash and dry the precipitate, and dissolve it with the

444 Erysipelas. Syphilis in Infants. [July,

aid of heat in three ounces of distilled water, containing two scruples
ofarsenious acid in solution; as the solution cools, crystals of arse-
niate of quinia are deposited, which are to be dissolved in distilled
water and recrystallized. It is a light, white salt, crystallized in bril-
liant satiny needles. It is soluble in water, but more so in boiling
than in cold water; it is also soluble in weak alcohol, but is insoluble
in absolute alcohol or in ether. The dose of it is from one to two
grains in divided doses in the course of twenty. four hours. It is usu-
ally given in solution in distilled water, to which a little simple syrup
niay be added. [Philadelphia Medical Examiner.

Treatment of Erysipelas by the application of Camphor in Ether,
For the ointment of nitrate of silver, which furnishes good results
in cases of erysipelas among very young children, but which is not
always exempt from inconvenience, M. Trousseau has substituted
the following : He covers the parts affected from the first day and
during the continuance of the disease, with a strong solution of cam-
phor in ether. This solution is composed of one part of camphor to
two of ether. It is applied by means of lint wet five or six times a
day, and then touching all the parts. The ether evaporates and
leaves the surface covered with a light coat of camphor, which appears
to possess great powers over the progress of the erysipelatous inflam-
mation. [Translated. Bulletin de Therapeutique.

Treatment of Constiiuiwi.il Syphilis in Infants. M. Trosseau has
treated for some years, with success, the divers forms of constitutional
syphilis in sucking children, as follows: He administers daily to
the mother and child a bath of corrosive sublimate of the following
proportions, viz., corrosive sublimate from to 1 ounce, alcohol 4
ounces, to an ordinary bath. Moreover, if the child is nursed by its
mother, he gives her daily a pill of one grain of protoiodide of mer-
cury; but when on the contrary the child is not suckled, he orders
the child every day 2| drachms of syrup of sugar, and 20 drops of the
following solution : Corrosive sublimate, 20 grs.

Water, - - 2lb. 8$. Mix.

Each dose will thus contain -Jth of a grain of corrosive sublimate.

Ever since M. Trousseau has had recourse to this mode of treat-
ment, he affirms never having seen the least accident result from the
administration of the baths of corrosive sublimate or from the solu-
tion. In a practice where he prescribed each day a great number of
these baths for cutaneous or syphilitic affections, he never met with
a single case that justified the apprehensions commonly entertained
from their use. The baths of corrosive sublimate have no other im-
mediate effect than to compose to sleep. It is rare that children, and
even adults, after having taken a bath of this kind, are not compelled
to yield to the desire of sleep which overcomes them. There are
perhaps some special conditions, wherein they would be improper, but
in most instances they are advantageous, and never dangerous.
[Translated. Jovrn. de Med , from La Lancefie Canadicnne.

1 847.] Hemorrhage. Paraphimosis. Phimosis. Na:vi. 445

Hemorrhage from the Nose. Introduce the little finger into the
nostril, and press upon its floor until the bleeding stops ; then take a
dossil of lint, and roll it upon powdered alum, and press it upon the
floor of the nostril with the little finger. Introduce pieces of lint,
in this way, until the roof of the nostril supplies the pressure of the
finger. (Dr. Oke.)

New mode of reducing Paraphimosis. A man entered the wards
of M. Blandin, then in charge of M. Chassaignac, affected with
paraphimosis, of eight days standing, and having an induration semi-
cartilaginous of the prepuce. M. C. employed in this case a practice
which he had used with success a dozen of times before. The penis
was held in the fist of one hand, while the pulp of the thumb alone
of the other was applied to the glans. The thumb compressed the
glans penis, and the other hand embracing the body of this organ,
gently drew the retracted prepuce forwards. These manoeuvres it is
necessary sometimes to continue for half an hour, and the surgeon
may even require assistance to apply the requisite degree of force.
Since the introduction of this mode of reduction, M. Chassaignac
has met with no irreducible paraphimosis. Some days after the pa-
tient is thus relieved, and when the inflammation has been subdued,
the operation of phimosis may be performed to prevent the return of
the former affection. [Translated. Joum. des Connaissances Medi-
co-Chirurg.

An ingenious Operation for Phimosis. M. Vidal (de Cassis)
draws the prepuce in front of the glans penis, passes a fine needle
armed with a long ligature before the head of this organ and through
the fore-skin stretched over it, making five or six points one-quarter
of an inch apart the redundant prepuce is then cut off just anterior
to these threads. The part retracts, the loops of the ligature are
now cut as they lie over the glans penis, and by tying each one sep-
arately, the skin and lining membrane of the remainiug fore-skin are
brought accurately in contact. Reunion is almost always affected
by the first intention. This operation is now regularly performed at
the hospital to which M. V. is attached. [Translated. Bulletin de
Therapeutique.

Cure of N&vi. In flat neevi up to the size of a crown-piece, lint
steeped in pure liquor plumbi is fastened over the part with a ban-
dage, and wetted by fresh applications of the lead, without frequent
removal. After days or weeks, the swelling becomes whiter, flatter
and firmer; soou afterwards little firm, white spots form on the sur-
face, and the cure is certain. By means of a solution of alum and
compression, noevi so large that extirpation would have been impos-
sible, have also been cured. It may be necessary to keep the remedy
constantly applied for six months. f Diefenbach's Operative Surge-
ry. from Ranking' s ibslract.

446 Bifid Vagina. Prescriptions. Medical Intelligence. [July,

Bifid Vagina. Prof. Dickson says that, Mrs. came to the

city, 1839, to consult him. She has been two years married has
always suffered from irregular and scanty menstruation ; it is but a
few months since she has become aware of the existence of some
genital malformation. The vagina is divided -neither longitudinally
nor transversely, but obliquely by a membranous partition. Both
tubesare long and narrow. Coition is difficult, particularly if the right
(and somewhat anterior) opening be entered. [How is this ascer-
tained? Can the patient tell ? Edt.] The left, which is obliquely
posterior, leads to the uterus, the os tineas presenting ; the right con-
ducts to the side of the uterus in which the membranous partition
looses itself; the cul de sac is not to be reached by the finger ; a long
probe or bougie may pass up six inches or more, but gives pain, and
when withdrawn, is coated with bloody mucus. The dividing mem-
brane lies in loose folds; is smooth and well lubricated ; it projects
slightly between the labia. It possesses very little sensibility.

[Southern Journ. of Med. and Pharm.

Prescriptions. For Coryza by M.Deschamps. Injections of-
ten repeated, of three grains Ext. of Opium to water one ounce.

For nervous, sleepless and hysterical cases-* by A. Brigham, M. D.-,
Editor Amer. Journ. of Insanity, &c. Tinct. of Lupulin and Hyos-
cyamus, each, 4 ounces ; Gum Camphor, 1 drachm ; Oil of Valerian,
32 drops. Mix. Dose one to two drachms.

For violent Mania, with deficient urinary secretion by Dr. A. B.
Tinct. of Digitalis and Squills, each, half an ounce; Wine of Anti-
mony and Xitric Ether, each, 1 ounce. Mix. Dose 30 to 60 drops.

For debility and loss of appetite by Dr. A. B. Tinct. of Bark
Comp., 1 ounce; Gentian, 3 ounces; Capsicum, 2 drachms; Sulph.
of Quinine, half a drachm; Sulph. Acid, 15 drops. Mix. Dose one
drachm in tfater, or better in ginger tea.

MEDICAL INTELLIGENCE.

Dr. Garvin's vithdrawal as co-Editor. -Dr. Garvin having withdrawn from'
the Journal, it will hereafter be under the direction of Dr. P. F. Eve.

In parting with the Doctor, as co-editor, he has my thanks for what he has
done for the Southern Medical and Surgical Journal, and my sincere wishes for
a long life of useful application of his eminent talents and great acquirements.

1^= In assuming the control and management of the Soitthern Medical and
Surgical Journal, the Editor will say but little. The work has been revived
and sustained thus far by the kind and fostering care of its friends. Having
now been established upon what is believed to be a solid foundation, it must
stand or fall by its own merits. If the matter it contains is not worth the sub-
scription price, let the enterprize fail it will no longer solicit patronage alone

1847.] The Annalist. Medical Miscellany. 447

for the sake of support, but will strive to demand it, by its own intrinsic worth.
It commends itseifto the Southern practitioner of medicine, as the oldest Journal
in this section of our country ; since its revival in 1845, although issued monthly,
it has never once been behind time, a circumstance unparalleled any where 5
no other similar work presents the same variety of professional intelligence ; it
is one of the cheapest medical periodicals in any country, not only as regards
the number of its pages, but especially in reference to the quantity of matter it
contains.

The present editor was the first to suggest a Southern Medical and Surgical
Journal, for which he issued a prospectus, more than twelve years ago. He is
fully sensible of the work before him; knows the many hours of toil he must
endure ; the task to be monthly performed ; the privations to be undergone ; and
how much he has to accomplish, by industry and perseverance alone. Believ-
ing he is in the path of duty, relying upon the co-operation of the friends of
Southern literature and medicine, claiming indulgence for his many imperfec-
tions, and depending upon Divine Providence for continued health and disposi-
tion to labor, he will try to redeem the pledge by conducting the Journal as
heretofore. He desires, as long as he lives and belongs to the profession, to be
connected with it; for he loves work, whether it be with the lancet or pen. for
work's sake.

The Annalist. Since our last issue, 17 Nos., inclusive from the first, have
been kindly sent us. This new Journal purports to be a record of practical
medicine in the City of New York. It is edited by Win. C. Roberts, M. D., and
was commenced last October. Each No. contains 24 pages, and one is publish-
ed the 1st and 15th of each month. Price, S3 per annum in advance. The
publisher, Mr. D. Adee, assures the medical profession, that the permanency of
the Journal is beyond the contingency of failure.

The June No. came in good time ; and having examined the pages of this
periodical from its origin, we recommend it as worthy the liberal patronage of
the profession.

Medical Miscellany. Mr. Sibson, of Nottingham, says he has seen several
cases of facial neuralgia relieved by the inhalation of ether. Thirty Sur-
geons of London have sworn that their annual income by practice amounted to
S50,000 each, and three to upwards of $100,000. Sir Astley Cooper's business in

his best days was about 23,000, or SI 15,000 per annum. The Moniteur,

government paper of France, states that during ten years, there were tried in
the various criminal courts 41679 male prisoners, above the age of twenty-five
years; among them were 33 priests, 33 lawyers, 75 notaries, 65 tipstaffs, but not

a single medical practitioner. During the past twenty-one years, 33 students

belonging to the Faculty of Medicine of Paris, died from dissecting wounds.
In the same city, the rate of mortality among students of law, is 1 in 80; in the
military school, 1 in 75; in the medical school, 1 in 50. The mean annual
mortality in Paris is 1 in 51 ; in the prisons it is 1 in 15, and in the hospitals 1

in 6. The London Lancet says, that the number of surgical operations have

been double in the London hospitals since the introduction of the etherial inhala-
tion. A lady of Alabama, is said to have presented her husband with 5

children in 10 months the first three died, but the twins were living. A ne-
gro girl 18 years old, was recently delivered, in our of the upper counties of
< ieorgia, "I 1 -till boi children,

448 Death of Lisfranc. Meteorological Observations.

Death of the great French Surgeon, Lisfranc. By recent arrivals from Eu-
rope, we learn the death of this justly celebrated Surgeon. He was born in
1786, in a small village near Lyons. In 1812, at the age of 26, he held the post
of Surgeon of the first class, and served in several campaigns under the great
Napoleon. After the peace of 1815, Lisfranc settled in Paris, and soon obtain-
ed the place of Surgeon to La Pitie Hospital. Although not a professor in the
school of Medicine, he regularly delivered clinical lectures, and had a large
private class which he instructed in Operative Surgery. "We are indebted to
him for many valuable improvements in the profession ; in fact, as a medical
Siirgeon, he has probably left no equal.

He was a man of great athletic powers, and possessed a stentorian voice.
Under a rough exterior, and exceedingly blunt manners and harsh expressions,
particularly towards his rivals, he had kind feelings and much goodness of
heart. He was a friend to the poor and needy, and his services were ever
ready at the call of sickness and distress.

He fell a victim to pseudo-membranous croup, at the age of 61 ; ami left the
regret that his work on operative medicine was not complete.

METEOROLOGICAL
Ga. Latitude 33 27'
tide' 152 feet.

OBSERVATIONS, for May, 1847, at Augusta,
north Longitude 4 32' west Wash. Altitude above

2~
V-

Sui
Tker.

l Rise.
Bar.

4,

Ther.

P.M.

Bar.

29 66-100

Wind.

Remarks.

"1

57

29 65-100

72

w.

jCloudy blow dust shower.

2

611

" 64-100

76

" 70-100

s. w.

Cloudy light shower.

8

62

<: 80-100

64

" 86-100

N-. E.

iCloudy rain all night 55-100.

4

54

" 89-100

62

" 90-100

N. E.

: Cloudy drizzle.

5

51

" 92-100

64

" 92-109

N.

jCloudy light breeze.

6

49

" 93-100

70

" 86-109

N. E.

Fairbreeze.

7

49

" 75-100

76

" 60-100'

S. W.

Fair. [-inch and 50-100.

S

60

" 45-100

66

" 37-100

s. w.

Cloudv hail storm at 8 p. m., I
Some fly'g clouds rain 40-100.

9

57

<: 34-100

67

36-100

N. W,

10

SB

" 41-100

70

" 47-100

N.

Cloudy.

il

58

" 51-100

76

" 52-100

N. E.

|Fair large clouds. [storm.

12

60

" 46-100

6G

33-100

S. E.

jCloudy light shower thund'f

13

60

" 35-100

64

*' 41-100

N. E.

iCloudy rain 20-100.

14

52

'' 55-100

70

" 56-100

N. W.

Cloudy.

75

57

" 65-100

72

" 70-100,

N. W.

Cloudy.

in

55

" 73-100

76

" 76-100

N. W.

Fair.

17

60

" 63-100

74

" 60-1001

N. E,

Cloudy rain atnight 95-100.

(8

58

" 48-100

72

" 48-100

W.

Cloudy showery in the even'g.

19

56

" 58-100

74

" 63-100

N. W.

Fair some clouds.

tfd

53

" 73-100

80

" 75-100

W.

Fair.

21

56

" 77-100

80

" 75-100

s.

;Fair.

S3

61

;< 73-100

66

" 70-100

S. E.

Cloudy and showery.

23

62

" 70-100

75

" 75-100

S. E.

Cloudy.

24

59

" 77-100

82

" 76-100

S.

Flying clouds.

25

63

" 80-100

86

" 78-100;

S. W.

Fair.

26

66

M 80-100

73

" 83-100J

N. W.

Cloudy showery, [and 5-1 00.

27

65

" 82-1 00:

6G

85-1 00!

N. E.

Rain all lastnight & to-day, 1 in.

2S!

62

" 88-100

71

" 88-100)

N. E.

Cloudy.

29

59

" 85-100

81

" 75-100)

N.

Pair flying clouds.

30

59

" 83-100

84

u 70-100i

S. E.

Fair, do. do.

5ft I

63

" 71-100.

88

" 71-100|

W.

Fair, do. do.

11 Fair days.. Quantity of Rain 4 inches and 65-100.
S, 2 -lays. 'West of do. 11 days.

Wind East of N. and

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol, I] NEW SERIES. AUGUST, 1847. [No. 8.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXVIII.

Practical Observations on Cutaneous Diseases, No, 3 Erectile
Tumours : their Pathology and Treatment, with Cases Ligation
of Primitive Carotid Artery, fyc. By H. F. Campbell, M. D.,
Demonstrator of Anatomy in the Medical College of Georgia.

The great frequency of erectile tumours renders it proper that our
observations should be made public, even though we add but little of
novelty to what is already known on the subject.

Aneurism by anastomosis may occur at any age; and though
ordinarily a disease of but trivial importance, it at times, either by
neglect, or from its locality, presents a case of the gravest nature,
and worthy the most serious surgical consideration.

The term, vascular or erectile tumour, denotes a diseased forma-
tion of the tissues of a part, in which the increase in its vascularity
is the chief characteristic. Now, though in the beginning, this in-
creased vascularity forms but one of the prominent features of the
tissue, later, it either entirely monopolizes the whole structure of the
part by causing the removal of its parenchyma, or by a process, to be
described, produces changes in the tumour altogether peculiar, ren-
dering its structure truly erectile, like that of the corpus spongeosum
penis, &c. The tumour, in these cases, is formed almost entirely of
blood-vessels, whether principally venous or arterial, may be readily
determined by its colour and appearance.

That form of this tumour designated, by Bell, Anastomotic Aneur-
ism, proceeds entirely from the arteries, and consists in a dilatation
of their smaller ramifications, which enlarge in such a manner as to

29

450 Practical Observations on Cutaneous Diseases, <SfC. [August,

form a circumscribed, pulsating tumour, generally deep under the
surface of the skin, though it may occur in almost any of the soft tis-
sues of the body.* With regard to the formation of these tumours,
there exists a contradiction among pathological anatomists, i. e.
fHasse, JM. P. Rayer, and a few others, stating that the intervascu-
lar cellular tissue is, in a great measure, removed, while Mr. Eras-
mus Wilson, whose dissections and authority are highly reliable,
contends that, this tissue is developed and enlarged by the telangi-
ectasis, with the growth of the tumour, and always constitutes an
important element in its anatomy.

Reasoning from an attentive observation of rather a limited num-
ber of cases, I am disposed to believe that both of these very adverse
conditions occasionally obtain in these vascular growths, and that
the anatomical condition of the intervascular tissue may, with pro-
priety, be considered a characterizing feature, by which we may
divide these tumours into two distinct classes : the pulsating and
non-pulsating erectile tumours. In the first of these, the dilatation
of the capillaries, being very rapid, far outstrips the development d
the intervascular cellular tissue, which latter does perhaps, as stated
by Rayer and Hasse, become absorbed or otherwise removed, thus
affording little or no resistance to the arterial diastole, and allowing
a thrill to be communicated to the finger, when applied, like true
pulsation. In the non-pulsating erectile tumours, the exact converse
of the above obtains ; here, the dilatation of the vessels has been
slow, constituting for a length of time nothing more than a simple
hyperemia ; that is a degree of increased vascularity, only adequate
to the rapid growth of the part. In this, the vessels go on enlarging
gradually, and always preceded in their dilatation by the increase
in their investing tissue, which becomes indurated by pressure of the
surrounding parts; and thus, the pulsation of these small arterioles

* It is denied by some, that the arrenrismal tumour described by Scarpa,
occupying the place of the superior apophysis of the tibia, is really of this nature.

f " Whenever erectile tissue is developed, the cellular texture or parenehyma
of organs is ere long removed, and the tumour consists exclusively of vessels
closely interwoven and intimately communicating with each other.

j "Theoretical and Practical Treatise on Diseases of the Skin."

"As far as my observations have gone, and I have dissected many vascu-
lar naevi, the vessels are enlarged in calibre with corresponding hypertrophy
of their coats, enlargement of their meshes, with hypertrophy of the intervascular
tissiLe." [Practical and Theoretical Treatise on the Diagnosis, Pathology and
Treatment of Diseases of the Skin, p. 254.

1847.] Practical Observations on Cutaneous Diseases, 6fc, 451

is completely nullified, by the resistance therein presented. In a
word, the first is a fibro-vascular tumour, in which the vessels are pre-
dominant, producing appreciable pulsation, while in the latter, the
fibrous tissue prevailing precludes it. The first is eminently a vas-
cular tumour, with some fibrous tissue the second n fibrous tumour,
with much increased vascularity.

The pulsating variety, for a time, may be reduced by pressure and
the emptying of its vessels, while compression produces but little or
no reduction, even temporarily, in the non-pulsating form. And if
this be continued for a time, as treatment, it tends much to increase
them in both size and hardness, by adding to the irritation and effu-
sion of coagulable lymph in their cellular tissue.

Both these forms of erectile tumour are subject to variations in size,
colour, density and general appearance, still preserving their distinc-
tive marks through all these changes. They are both frequently
subject to haemorrhages, though, in the pulsating variety, these are
more immediately dangerous on account of their greater vascularity.
Neither of these tumours is often the subject of treatment, yet both
occasionally require attention, and are sometimes the source of much
peril to the patient and embarrassment to the surgeon.

As an instance in each of these varieties, the two following well-
marked cases may not be devoid of interest. Although the first, from
the location of the disease and treatment required, may belong more
legitimately to the surgeon than the dermatologist, yet from the
anatomical structure of the morbid tissue, and also from the fact that
such are treated of in works on this subject, I have felt justified in
adducing it, as illustrative of the position here assumed.

Case I. Richard, a free man of colour, aged 21 years, had from
early childhood been known by his parents to have a very small
tumour on the left side of his tongue, near the apex. This tumour had
never given any trouble, remaining stationary in size till within a
year or two previous to my being consulted. Attention was then
called to it by its rapid enlargement, darker colour and strong pulsa-
tion, which continued to increase, till in a short time, by its bulk and
extreme sensibility, it materially interfered with mastication and
enunciation. During the last two years, it had bled frequently, and
of late, the haemorrhage had been so profuse as to threaten the pa-
tient's life. When I first saw him, he was pale, anaemic and emaci-
ated to the proportions of a skeleton, as much from starvation as

452 Practical Observations on Cutaneous Diseases, <5fc. [August,

depletion, he not being able to take any thing but cold gruel, on
account of the enlarged condition and great sensibility of the tongue,
as well as its liability to alarming bleeding, if impinged upon. The
tongue itself was occupied, on the left side, to the median line, and
even encroaching on the right of it, by a strongly pulsating, nodula-
ted tumour of a dark red hue. This filled entirely the buccal cavity
on that side, and pressed outward against the teeth, which, by ab-
sorption of its tissues from pressure, had caused a deep ulceration
from which the bleeding occurred so frequently. Upon pressure, the
tumour could be readily much reduced in size, by evacuating its
vessels of blood, but this was an experiment of some hazard, on ac-
count of its active hemorrhagic tendency. The base of the tongue
also participated in the enlargement, especially at its under surface,
and from the continued irritation, the neighboring glands of the
mouth were much swollen and painful. The case had been consid-
ered cancer of the tongue had been treated as such, and I was con-
sulted for that disease, and indeed, the whole appearance of the patient
strongly simulated that of the carcinomitous cachexia.

The ulceration on the surface of the tumour was oblong in shape,
and covered with dark coagula of the haemorrhages it gave out. The
patient had been using astringent washes, to check the bleeding, and
at present was under no other treatment. The day after my first
visit to this man, I was called to him, in haste, to restrain the profuse
haemorrhage from the ulcer, which had caused repeated syncope, and
brought him to the extreme of debility. His condition was the fol-
lowing: Haemorrhage very profuse, and only ceasing during the
relaxation of deliquium, which supervened whenever he attempted to
rise ; pulse almost imperceptible at the wrist ; patient of course much
alarmed at his condition.

On consultation with Drs. J. A. and J*. F. Eve, ligation was de-
termined upon ; and as the most convenient and practicable, we
chose the Primitive Carotid of that side, both on account of its
more easy access than the external carotid or lingual, and further,
because pulsation in it was more appreciable in the exhausted condi-
tion of the patient. I performed the ordinary operation in the lower
part of the anterior superior surgical triangle, making an incision of
nearly three inches, which extended somewhat below the omo hyoid
muscle. The needle and ligature were passed without difficulty,
the artery separated from its accompanying nerve and vein, and tied
with a piece of saddler's silk. No blood was lost at the wound of

1847.] Practical Observations on Cutaneous Diseases, fyc. 453

the operation, and the hemorrhage from the tumour ceased immedi-
ately.

Day after the operation. Pulse, though much improved, still feeble
and accelerated on any trivial exertion ; tumour on tongue somewhat
smaller and quite dark ; ulcer covered with clotted blood ; little cr no
pain in the tongue. Prescribed as diet, cold gruel and cold chicken
soup.

Fourth day. Dressed the wound, which had healed by first inten-
tion, to within an inch of the ligature a little healthy pus under the
plasters: pulse much improved; tumour considerably flattened ; in
ulcer, no apparent change. Diet, as before.

Fourteenth day. Wound in the neck entirely closed, with the
exception of a small aperture that gave egress to the end of the liga-
ture, this was thrown off on the twenty. fifth day no haemorrhage
followed : the noose was entire on the thread. There had been no
absorption of the ligature, but it had divided the remaining coat of
the artery. A few hours after, I was called in haste to the patient,
and found he had lost a small quantity of blood from the wound,
though I think it most probably came from the very vascular granu-
lations around the orifice made by the ligature. This healed rapidly
without further accident or mishap. The tumour on the tongue had
entirely disappeared the tongue was of its natural colour and vol-
ume, except that where the deep ulceration had existed, there was a
depression and whitish cicatrix speech and mastication were perform-
ed with facility, and the restoration of the organ seemed complete.
General health of the patient better than it had been for several
years previous.

For nearly a year after the operation, the patient continued free
from any return of his disease. At the end of that time, he com-
plained of some pain, and there was also slight tumefaction on the
opposite side of the tongue. He did not reside in this State, and it
was somewhat over three months before I again saw him, during
which time (it is by no means strange to relate), he had been under
the treatment of various Charmers, Cancer Doctors, and Conjurers.
When I did see him, his condition was fully as bad as when he first
applied to me. The tumour now occupied both sides of the tongue ;
having passed from right to left, filled nearly the whole mouth, and
had several small ulcerations upon its surface which bled frequently
and profusely.

I proposed the ligation of the other common carotid, to which the

454 Practical Observations on Cutaneous Diseases, <fyc, [August,

patient, but reluctantly, acceded. On consultation, the measure was
abandoned as inexpedient. This miserable being died, a few months
after, entirely worn out by successive haemorrhages, starvation and
hectic irritation.

Remarks. Reflecting upon the origin, progress, and termination
of this case, it is perhaps sufficiently apparent that, in its commence-
ment, it was one of simple anastomotic aneurism of the ranine
artery ; and its symptoms viz., its pulsation, occasional flaccidity,
yielding to pressure, its active and profuse haemorrhages, and al^o
its rapid increase, clearly characterize it as belonging to the pulsating
variety of these erectile tumours. Its appearance on the opposite
side of the tongue, its rapid growth ihere, and the facility with which
it recurred in its original locality, may find an easy explanation in
the disease having extended to the inosculating ends of the ranine
branches, previous to the operation. After the ligation of the left
artery, the impetus of the circulation being augmented, these already
predisposed branches were readdy dilated, and the disease thus fully
established. The recently obliterated branches of the opposite
side were, with facility, re-opened,* and thus the disease re-establish,
ed on the right side. The great rapidity with which this second
dilatation took place, resulted from the fact that, the whole tissue of
the organ was already inclined to that kind of degeneration, by the
previous recent existence of the same disease in the part. And for
this, we find a still more satisfactory explanation, as well as for the
malignant ulcerative tendency of the tumour, in the observations of
-(-Rokitansky on this subject. "There is an affinity," says he, "be-
tween aneurism and cancer. The aneurismal diathesis is never
extinguished ; and frequently when, from some cause or other, one
aneurism dwindles away, a new one immediately forms, either in the
same artery or in a remote one. Frequently, too, the aspect of the
patient and the decay of the organism bear the impress of cancerous
cachexia." This last assimilating general characteristic was pre-
eminently existant, in the case above related.

The second case differs materially from the foregoing, though evi-
dently in its generic characteristics it is pathologically the same.

* A thing by no means impossible, after the observations and examples re-
lated by Stilling, and others, on Thrombus,
t Rokitansky, Ocst. Jah., vol. xxvi. pp. 2 and 3.

1847.] Practical Observations on Cutaneous Diseases, fyc. 455

Case II. Eliza, a colored woman, aged 27 years, belonging to Mr.
A. W. W., of Burke county, had, for many years, a small indurated
tumour in the cicatrix of the umbilicus, which she said was the result
of pressure from the end of a corset-board. This remained apparent-
ly stationary for years, and gave no uneasiness or trouble, save the
inconvenience its presence occasioned in the arrangement of her
dress, &c. About three years previous to the application of her
master to me, her menstruation became irregular, and occasionally
she was subject to attacks of hysteric lethargy, the tumour at each
menstrual period became fuller and much firmer, till at length, during
one of these, it discharged from a minute opening on its surface,
a small quantity of blood. This discharge, and the progressive in-
crease in the tumour, continued up to the time that she was brought
to me.

When I saw her ghe was quite thin, and of an unhealthy complex-
ion with but little appetite; bowels constipated; pulse natural,
though feeble. She was of the nervous temperament: her menstrual
discharge was almost entirely absent. The tumour at the umbilicus
was of the size of a large walnut, dense and resisting to pressure, and
had upon its surface several small pits from which, on pressure, there
oozed a small quantity of darkish blood. Her menstrual period had
just ended; and, by her estimate, she had lost nearly a gill of blood
by the tumour during the five or six days, and said that she had had
one of her hysteric attacks during the time, or just before the dis-
charge commenced. During her next menstrual period, she discharg.
ed from the tumour nearly four ounces of blood, after which it shrank
considerably, and became much softer to the touch, though still quite
firm and resisting. The discharge per vaginam was but inconsider-
able. The case had been treated by compression applied to the
tumour, but with no reduction in its size whatever: indeed, it was
found rather to aggravate the disease than otherwise, insomuch that,
when I examined it, she had on a contrivance by which the contact
even of the clothes was prevented.

Removal oC the tumour being determined on in consultation, the
patient was subjected to the following treatment, previous to the
operation, in order to restore as far as possible the tone of the general
health, as well as that of the uterine system. The bowels were kept
well open with comp. cath. pills, or an occasional dose of the comp.
tinct. of jalap, and as an emmenagogue, the following prescription
was put in requisition viz :

456 Practical Cbservations on Cutaneous Diseases, ?c. [August,

R. Gf Gum Myrrh, pulv.

44 Foetid, "

44 Aloe. Soc. "
Canthar. Hispan. 44
Sulphas Ferri, 44 aa. grs. 24.

01. Menth. Pip. gtt. 24.
Syr. Simp. q. s. to make 24 pills.*

Of this, one pill was taken in the morning and at bed-time, till slight
burning was experienced during micturation, when they were discon-
tinued for a day or two, and again resumed, and continued till the
supervention of the next menstrual period, at which time her general
health was sufficiently improved for the performance of the operation.

The tumour was removed in the presence of Dr. P. F. Eve, and
of my brother and associate, Dr. R. Campbell, of this city, by the
application of a double ligature through its base, drawn sufficiently
on either side, as entirely to destroy the circulation in it, and in four
hours after I completed its excision with the knife. Very profuse
haemorrhage was the immediate result, but this was readily arrested
by compression and the application of creosote, after which the
wound healed rapidly. One or two applications of the actual caute-
ry were necessary to destroy a few vascular granulations that seemed
disposed to organize upon the cicatrix, but further, no after-inter-
ference was required. After the healing of the wound no discharge
occurred from the umbilicus, and the uterus gradually resumed its
function of menstrual elimination. She has had no hysteric symp-
tom since, and now (six months after the operation) enjoys excellent
health.

Upon dissection, I found the tumour to consist of a congeries of very
minute blood-vessels ramifying through a remarkably dense cellular
structure ; in this there were but few cells, and the walls of these were
not dilatable, but hard and resisting. The pits on its surface, as far
as I could discover, did not communicate with any of these cells, but
had the appearance of being superficial. On desiccation the tumour
has become much reduced in volume, though those cells not destroy-
ed have not become obliterated, but still remain open, proving the
inextensibility of the intervascular cellular tissue.

* A prescription, of my own combination, I believe, which I here take occa-
sion to recommend as an efficient emmenagogue, in all cases where there is no
organic lesion of the uterus, as engorgement, &c. I have found it particularly
beneficial, where the irregularity depended upon an atonic condition of the uter-
ine vessels.

1847.] Operation fcr Sarcomatous Tumour of Antrum* 457

In the foregoing I have endeavoured to shew the difference, so far
as my own observations have pone, in the pathology, &c., of those
two forms cf erectile tumour, and in the above cases, I hope a perti-
nent illustration will be found to nave been adduced. They were
both very plainly of this order of morbid growth ; and yet, that, in
many points, they very essentially differed from each oilier, further
comment is not needed, to elucidate.

From what has been shown in dwelling apon my first case, I should
perhaps regret that the right carotid artery had not been ligated as
well as the left ; the signal success of the first ligation, the long
immunity after, from the disease, amounting for a time to complete
restoration, all impel the conviction that, much benefit would have
accrued from a second ligation perhaps either entire relief, or a
much more considerable protraction of life. Or would not ligation,
with complete excision of the diseased tissue, have been more suc-
cessful ?

Case second requires but little or no comment; the tumour's vica-
riously eliminating the menstrual discharge is by no means singular,
as such cases occur frequently, as also the influence of this uterine
derangement on the nervous system ;* but my object in the foregoing
has been more, to discuss the pathological condition of these external
developments, and to urge the determining cause of difference be-
tween their varieties, than to adduce any thing new or before undis-
covered, on a subject that has so long occupied many of the ablest
and most distinguished of our profession.

ARTICLE XXIX.

Resection of a portion of the Upper Maxillary Bone, for a Sarcoma-
tous Tumour of the "Antrum Highmorianum." By P. M.Kollock,
M. D., of Savannah, Ga.

Jenny, a negress, aged 50, presented herself to me about the latter
part of December, 1846, to be treated for a swelling of the right side
of her face, at that time about the size of a hen's egg, extending from
about the junction of the malar bone with the upper maxilla, to the
teeth, involving the alveolar process. On raising up the soft parts

* The well known case of Hysteria, caused by a subcutaneous tumour of the
mamma, and relieved by its removal, may possibly bear some analogy to this,
so far as the nervous symptoms extend. [Vide. Warren on Tumours, p 40,

458 Operation for Sarcomatous Tumour of Antrum. [August,

of the cheek, there was exhibited a vascular swelling of the gum
above the teeth, elastic to the touch, and apparently containing a fluid.
The molar teeth remained, but were all loose. On extracting one
or two, a pretty free haemorrhage ensued, and a trocar passed easily
through the alveolar process into the antrum, without encountering
any bone.

The tumefaction of the gum extended into the roof of the mouth
several lines beyond th palatine raphe.. At this part the tumour
was more firm ; but a sharp instrument could be passed into it without
encountering any bone, and produced free haemorrhage also.

About one inch of the alveolar process in front, extending from the
median line, aud containing the two incisors and the canine tooth
of the right side, remained sound. This was likewise the case with
the gum in the roof of the mouth, extending from the alveolar process
backward about one half inch; but the gum on the outside, above
the teeth named, looked very vascular, and contained one or two
small prominent points resembling tubercles.

A lancet thrust into the most prominent part of the tumour, on the
outside, over the molar teeth, and which seemed to fluctuate, gave
issue to blood, and not pus.

A temporising treatment was pursued for a few weeks, consisting
for the most part, in the administration of a solution of hydriodate of
potash.

Neither the patient, nor any one who has known her, can give any
very distinct account of the origin and progress of this disease; but
it seems probable, from all that can be ascertained, that it had been
progressing to the condition in which I found it when first consulted
by her, for some years. Nor can it be ascertained that it was the re-
sult of the operation of any external cause or accident.

Having watched the progress of the case for three months, and
having obtained the opinions of all the medical men of Savannah,'
who are conversant with surgical cases, and also being convinced
that the disease was extending, and involving other parts, I determin-
ed (notwithstanding the frequency of failure in such cases to eradicate
the disease) to remove, as far as practicable, en masse, the portion of
the upper maxilla which seemed to be involved in the disease, cutting
into sound parts on every side; and in order to accomplish this, I
foresaw the necessity, as well as the difficulty, of including a part of
the palatine process of the left side, (the diseased part extending be-
yond the raphe.)

IS 47. J Operation for Sarcomatous Tumour of Antrum. 459

Accordingly, on the 18th of Marc. . 1847, at 12 o'clock, M., in the
presence ofDra. Habersham. Rich:.

other physicians an . ded to the operation fa

ving manner :

incision through the soft parts was commenced a little outside
of the external canthus of the eve, at the junction of the malar with
the upper maxilla, and carried down in a slight curve to the angle of
the mouth, in front of the orifice of the duct of Steno. The flap, con-
g of tl>e whole thickness of the cheek, and including the ala of the
nose, J turned over the forehead, one or two small

arterial bra: firing ligation. An incision of an inch in k

ied from the commencement of the first, backwards, paral-
lel with the zygoma, and the p ti lutfi back, bo as to expose
the zygomatic fossa. Finding that the lip and ala nasi could not be
elevated, another incision was dropped from the colurana
trough the median line of the upper lip, and the right half of
p and ala nasi were then turned up sufficiently to expose the
nostril. The two incisor teeth of the right side were then extract J
with ( gum in front divided with the scalpel, as

also the soft covering of the palatr :ne or two lines beyond

the margin of the tumour, and the velum pendulum palati separated
from the palate bone. A v was now applied to the alveolar

process formerly occupied by finfl incisor tooth, and the thick
part of the bone divided. A \ ill r.g pair of bone-nippers, with
sharp points, was now applied, and the palatine process, together with
the septum narium. divided.

Owing to the necessity of extending the incision beyond the pala-
tine raphe, for the purpose of completely encircling the tumour, this
part of the operation consumed more time than is usual. The bone-
nippers were next applied to the nasal process of the upper maxilla,
then just below the junction of this last with the malar, and the
incisi< :n extended through the anterior wall of the antrum, just below
the infra orbitary foramen, and backwards to the tuberosity of the
maxilla. The remaining attachments of soft parts were divided with
the scaipcl. and a slight blow with a chisel completed the separation
of the remaining bony attachment behind, which enabled me tore-
move the whole mass.

There was little or no haemorrhage from deep seated parts. The
actual cautery was applied to several suspicious points. The only
vessel of any importance, which required a ligature, was the labial,
ided by the incision through the middle of the lip.

460 Operation for Sarcomatous Tumctir of Antrum. [August,

The parts were exposed for an hour, when the cavity was filled
with lint, and the flap united at the edges by 9 or 10 points of twisted
suture. . The patient was put to bed, and soon there occurred haem-
orrhage from the nose and mouth to rather an alarming extent ; but
this was arrested by stuffing more lint into the cavity through the
mouth, and applying cloths wet with cold water to the cheek.

At 6 o'clock, P. M., I visited the patient, and found her as com-
fortable as circumstances would permit ; pulse pretty good,
ft. Gruel, with brandy ; and laudanum to procure rest.
19th, 20th, 21st. Patient has been doing well. The incision
through the soft parts has almost entirely healed by the first inten-
tion it has been dressed altogether with cold water. There has
been some swelling of the face, which has been reduced by the cold
applications. There was some febrile exacerbation on the 19th,
which subsided after the bowels were moved by an enema.

Her diet has consisted of beef soup and arrowroot. Laudanum
freely given to procure rest and allay pain.

22d, 23d. Continues to improve. As the weather became
cooler, and the cold applications unpleasant, simple serate was sub-
stituted.

There has been considerable foetor from the wound in the mouth.
The lint was removed from the cavity on the 22d, and fresh lint wet
with sol. chlor. sod. substituted. None of the pins have been remov-
ed. The swelling of the cheek has subsided. She takes arrowroot
and soup, with a little wine ; laudanum to quiet nervous irritation.

24th. The pins were all removed to-day, and the whole tract of
the incision, with the exception of one or two very small points,
found to have united very neatly by first intention. Adhesive strips
were substituted for the pins, in order to support the parts. The
general treatment, and dressing for the inside of the mouth, were
continued.

April 7th. The patient has continued to improve parts involved
in the operation nearly all healed. She takes mush, &c, walks
about, speaks with great difficulty and almost unintelligibly.

May 13th. Jenny has continued to improve in health. The
parts on the inside of the mouth are pretty well healed. A thin
cartilaginous plate has been formed, like an arch, beneath the soft
part of the cheek, which supports them admirably, uniting itself to
the palatine process at the line of incision, and preventing the falling
in of the cheek !

1847.] Operation for Sarcomatous Tumour of Antrum. 461

The opening between the mouth and nose is very much contracted,
but not sufficiently to prevent the passage of food into the nose,
which she finds rather annoying.

A semi-transparent, reddish, granular mass has been thrown cut
from the mucous membrane lining the remains of the cavity of the
antrum beneath the orbit of the eye, which has given me some unea-
siness, lest it should prove a nucleus for the regeneration of the dis-
ease. But I am in hopes, from its healthy appearance, that it is only
an effort of nature to fill up the remains of the cavity, and promote,
as much as possible, the convenience of the patient. The patient's
articulation is improving, so that she can be more easily understood
when speaking.

June 6th. I had an opportunity of examining this day the subject
of the case above detailed. I find pretty much the same appearance
of the parts as when last examined. The parts within the mouth are
well cicatrized ; the granular mass in the upper part of antrum
bears very much the same appearance it does not completely
fill up the cavity. I cannot believe that it is any part cf the
disease for which she underwent the operation. She has contrived
to obviate the inconvenience resulting from the deficiency of the
roof of the mouth, by stuffing in cotton. I recommended to her a
piece of sponge as a substitute. I have no doubt that the defect
might be very much relieved, by an ingeniously contrived gold or
silver plate. She masticates very well with the teeth which remain
in the maxilla of the left side.

The tumour which was removed by this operation, is sarcomatous ;
but in some respects, resembling brain, particularly since it has been
immersed in spirits. When incised, the surface is smooth, and is
similar to the incised surface of brain, which has been hardened in
alcohol, interspersed here and there, with minute bony spiculae.

The subject of the operation has returned to her former occupation
(not very laborious) in the country ; and from present appearances,
may reasonably hope to be remunerated for her fortitude in submit-
ting to it; and modern surgery may, without much presumption,
number the case among its triumphs.

Note. While we sincerely hope our friend may realize his expectations re-
garding the non-return of the disease, the effects of which he has so skilfully
extirpated in this case, we cannot divest ourselves of the apprehension that it is
malignant in its character, and may in the end destroy life. Of eleven opera-
tions on the jaws, in our practice, there has been a return in every instance
where malignancy was clearly determined. [Ed.

462 Colic relieved by Balsam Copaiva. [August,

ARTICLE XXX.

A case of Colic, relieved by Balsam Copaiva. By Henry Gaither,
M. D., of Oxford, Georgia.

Mr. D. M., a sturdy, well-proportioned Irishman, remarkable for
strength and activity, enjoyed almost uninterrupted health up to
about his fiftieth year, when he began to suffer some inconvenience
from frequent but slight attacks of colic, especially after any error in
diet, or during moderate torpor of the bowels, for he was never trou-
bled with such a degree of intestinal inaction as would be called
constipation, neither was he subject to diarrhoea. Under this condi-
tion of the bowels, almost perfectly healthy as to action, the colic
symptoms gradually increased in violence until he had to call in
medical aid. The writer, who was the family physician, being sick
at that time, a neighboring " Thompsonian" was sent for, whose
steam soothed for a while, but whose pungent preparations of pepper
and other fiery compounds aggravated the pain. Failing to get relief
from these remedies, a physician was called in, under whose treat-
ment he was relieved for a time. On all subsequent attacks I was
with him, and by the use of anodynes, cathartics, sinapisms, warm
bath, &c, preceded sometimes by venesection, the paroxysms passed
off in the course of a few hours. Still slight and frequent twinges
would generally recur before many days had elapsed, harrassing the
patient and keeping him in constant dread of his frequent torture.
The paroxysms which were sometimes excessively violent, came on
at irregular periods of from one to three months. During the inter-
vals various remedies were used, being such as were suggested by
the conflicting pathological views of the case, to-wit, tonics, deriva-
tives, alteratives, &c, and among the last mercury, which was given
until ptyalism was induced, but without any manifest benefit. A
year or so after this, when in one of his best intervals, jocund, happy
and hopeful, improved in feeling and in flesh, (for his constitution
was yet as elastic as a boy's) he fell into temptation, and neither con-
science nor consequences restraining, he yielded, and came out
worsted. A few days revealed to him the existence and nature of
his new malady. He commenced the use of Bals. Copaiva with
some unimportant adjuncts, and in two or three weeks was cured of
both gonorrhoea and colic, or rather, permanently cured of the former
and perfectly relieved of every twinge of the latter, for more than
two years. But this may be viewed as a spontaneous change the

1847.] Colic relieved by Balsam Copaica. 463

result of natures efforts as an instance of the post hoc and not of
the propter hoc. Let the progress of the case decide the douht.
After this long exemption, the symptoms gradually returned with
increasing violence, until they became as distressing as at any former
time ; when under my advice, he resumed the use of the Balsam,
and continuing as before, a like period of immunity ensued ; and
he is now so fully assured of the benefits derived therefrom, that,
without being urged to it by a medical attendant, he resumes the
remedy on the slightest indications of his returning malady, and al-
ways with long, but varying periods of exemption, and has now re-
mained for several years secure from violent seizures.

Now, what is the nature of this case ? what is the disease? where
its seat? and what its pathology? It would consume too much time
and space, tire my unaccustomed hand, and be unacceptable to the
reader, to show or attempt to prove that it is not neuralgic, nor from
biliary calculi, &c, &c. But is it bilious colic ? I think not. It is
true the patient had a liver, as all of our patients have, and it is a
fine thing, a matter to be rejoiced over, that if we get a patient
we know he has a liver. This hydrargyric target, scape-goat
of the viscera, great hiding place of all manner of ills and errors,
yes, this grand, magnificent organ being where it is, and doing
what jt does, has relieved many an iEsculapian from a world
of embarrassment, and it does it so easily, so rationally, and so in-
visibly, that there is neither doubt of the truth, nor appeal from the
decision. The thing is done on thiswise: if after due searchings
and explorations we fail to find the disease elsewhere, we know, as
a matter of course, it must be in the liver. And I believe it is an
admitted fact among the fraternity, that it is always right to find a
disease before we cure it, on the same high and philosophic ground,
that it is right to catch a hare before we cook him.

But dropping bagatelle, I proceed to the investigation. The liver
has been accused of a great many sins that it never committed ; but,
like other organs, it may sometimes beat fault it may be disorder-
ed in structure or function, and when so, its secretion may be re-
dundant, deficient or vitiated. Evidence of these or other morbid
conditions should appear, before we locate disease there. It is not
enough that the patient is sick, and we know not what else ails him,
to justify us in pronouncing it "liver disease," any more than it is,
to pronounce every fever congestive that terminates fatally. It is
not enough that we can puke or purge out bile, for it is no more

464 Colic relieved by Balsam Copciva. [August,

evidence of diseased liver, that bile flows copiously under certain ex-
citants in the stomach or bowels, whether food or physic, than that
the cclivary glands are diseased because they secrete copiously when
excited. I have admitted that the liver may be at fault. Well, sup-
pcG3 it is diseased and pours out an acrid secretion, the intestines,
though in a healthy condition, are fretted by it, and resent the mor-
bid infiux, by taking on a dysenteric, diarrhosal or colical action,
thio sometimes occurs; but, by the way, these effects are not suffi-
cient evidence that the primary disease is seated in the liver. But
on the contrary, suppose the intestines are out of order, (say the
mucous membrane,) and the liver pours into them its accustomed
healthy secretion, is it any more strange that they should resent it,
by showing colic or something else, than that healthy tears should
smart an inflamed eye, or healthy urine an inflamed urethra? Before
procseding further, however, that I may not be misunderstood, I
would say, whatever organ may be primarily affected, in any case,
the contiguous ones, or those more intimately associated in office or
sympathy, and even the system at large, may become more or less
involved in the progress of the disease. But in the case before us
there were no symptoms indicating extensive diseased action, and I
believe the primary, the chief, and perhaps the only disease, was a
morbid irritability of the mucous membrane of the intestinal canal,
confined probably to the colon, evidently there was no liver disease,
or it came without a single one of its numerous retinue; there was
no bilious tint of skin or eyes, no enlargement, hardness, or tender-
ness of the epigastric or hypochondriac regions, no pain in the
shoulder or other remote part ; he could lie on either side or back
with equal comfort ; no cough, no melancholy, and indeed, not to
dwell longer on the symptoms, there was no evidence at all of he-
patic derangement, and although his digestion continued good, he
had to be careful as to his diet, more in reference to the effects on the
colon produced by the residuum of digestion, than from the impres-
sion made during that process on the stomach and small intestines.
That the stomach, liver and the other associate organs, more imme-
diately concerned in digestion, were in a healthy state, is further
rendered probable by his resiliency from the debility induced by
severe attacks, and his keeping in a healthy fulness of habit, under
the almost constant harrassings of disease. And again, these views,
as to the seat and nature of the disease, are further corroborated by
the effects of remedies, particularly those like the Balsam, which have

1817.]

Febris Tt/phoides of New* York.

4G5

long had an established reputation in affections of the mucous mem-
branes.

I claim to have made no discovery in this case; but was led, as
before stated, to the use of an old remedy, in a disease which had
not before been treated by it, so far as I know ; although administered
frequently (if my pathology is correct,) in diseases of a kindred
nature. I do not pretend to say, for I do not believe it is adapted to
any large proportion of colic cases, but there are doubtless those
occasionally occurring in every one's practice, in which bals. copaiva
and similar remedies would be found useful.

I am aware that I have not positively established the truth of my
views or the correctness of my position, but if the one is correct and
the other untenable, I nevertheless flatter rrfyself, that the facts will
interest the medical public.

ARTICLE XXXI.

Febris Typlioides, as at present prevailing in the Alms House and
Prison Hospitals of New* York. By Chas. T. Quhntard, M. D.
of Athens, Clarke county, Ga., late Assistant Physician to the Alms
House and Prison Hospitals of the City and County of N. York.

The New-York Journals have of late been filled with accounts of
the rapid spread of the Ship and Typhoid Fever, in those parts of the
city where poverty, vice, and filth encourage the development of dis-
ease. The hospitals are crowded : at the Quarantine there are more
cases than have ever before been known ; at the New-York hospital
it is the same ; while at the Bellevue Institution there are so many
cases that temporary buildings have been erected for the accommo-
dation of the convalescing patients. The number of patients treated
in Bellevue, from January, 1846 to January, 1847, was 4132; the
deaths, 521 or 12j per cent.

Males.

i\ males.

Total.

Foreigners.

Natives.

Remaining January 1st, L846,
Admitted during the year,. ..

996

1906

307
1694

539

3600

288
3000

244
GOO

Total,....
Discharged and died,

2132

1833

2001
18! il

4132
3627

3288

L880

717

Remaining January 1st, 1847,

299

206

505

408

97

30

4G0

Febris Tyyhoides of New- York,

[August,

A.DMISSIONS.

From England,

1G0
2202

85
470
154
41G

83

205

11 Ireland

237

" Scotland, . .

" March .

267

" Germany,

" April,

264

" United States,

M;iy

294

' State of New- York,

" June,

308

" Other Countries,

" July ......

355

326

Total,

3600

" September,

389'

" October,

332

" November,

281

" December,

342

Total,

3600

Of the whole number of deaths that occurred during the year, 31
were from Acute Dysentery; 24 of Congestion of the Brain ; 20 of
Puerperal Peritonitis; 168 of Phthisis Pulmonalis, and 58 of Typhoid
fever or 301 deaths out of the total 521.

January, .,
February, .

March,

April,

May

June,

July,

August, ...
September,
October, ..
November,
December,

Diseh.-irged.

Died.

245

30

204

31

213

40

261

60

198

44

294

50

2(57

50

250

47

303

40

352

49

203

36

286

38

310G

521

The Resident Physician, in his report, rendered January, 1847,
states * that a large number of ship or Typhoid Fever cases have
been admitted, many of them in a dying condition, and while quite
a number have died ; still the proportion of recoveries has been
great and the fever has not generally been marked by the contagious
character usually assigned to it." In consequence of the state of
some parts of Europe, Ireland in particular, emigration increased
so rapidly towards the spring, that the cases of Typhoid fever ex-
ceeded the amount of all the other diseases in the Institution, and
while the number of deaths from Jan. 1846 to Jan. 1847 amounted
to 58, there have been half that number dying weekly of this disease.
The contagious character of the disease is well marked, and this we
presume comes from the fact that a great number of passengers are

1847.] The American Journal of the Medical Sciences. 467

crowded into the ship-holds, from which the malaria generates a poi-
son of greater intensity and of a decidedly contagious character.
At one time it was difficult to obtain nurses willing to superintend
the wards, and when we remember that the nurses at the Bellevue
Institution, are taken from among the convicts at Blackwell's Island,
we cease to be astonished at the fatality ofthe disease. Several nurses
and orderlies died, and of the attending physicians, Drs. Stone, Reilay
and Van Buren contracted the disease. The latter gentleman fell a
victim to it. At the Bloomingdale Hospital, three of the physicians
have likewise died, among whom was Dr. Farrer of Virginia. So
soon as Dr. F. was taken, he was removed from the hospital to the
city, and attended by Professors Revere and Pattison. Prof. Revere
contracted the disease, and he too fell in the midst of his usefulness.
In the lower part of the city, where a large number of emigrant
boarding houses are kept, the disease has been very abundant, and
has spread to the neighboring streets of the city. Of its nature or
character we are unable to speak. That this fever is contagious
we are assured of by the fact that it can be communicated by vessels
being in the neighborhood of the patient, or by passing through the
wards where it exist, as well as by breathing constantly the atmos-
phere by which they are surrounded. Its action is of course modi-
fied by the peculiarities of the constitution, of those exposed to the
atmosphere, depraved by the matter of the miasm on ship board, but
the poison appears to be as contagious from a mild case as from a
very severe one, and the disease is as readily contracted.

PART II. REVIEWS AND EXTRACTS.

ARTICLE XXXII.

The American Journal of the Medical Sciences, for April, 1847.
Edited by Isaac Hays, M. D., &c, &c. Lea and Blanchard,

Publishers: Philadelphia.

Of the twenty Medical Periodicals of our country, this one has the
best claims to the title it has assumed. American it is by seniority,
by its size, and by its worth. Indeed, if we are not mistaken in our
estimation of it, this Journal merits a more extended and significant
appellation. Since the lamented (loath of Dr. James Johnson, the
able and distinguished editor of the Mcdico-Chirumcal Review : and

468 The American Journal of the Medical Sciences. [August,

the more lamentable fall of Dr. Forbes, of the British and Foreign
Medical Review, to a recommendation of homoepathists, hydropa-
thists, &c, of the day, we have no hesitation to pronounce the Ameri-
can Journal of the Medical Sciences, to be by far the most valuable
now published in the world. The Edinburgh Medical and Surgical
Journal is not to be compared to it. Of the same date, and both
Quarterly, the Edinburgh has thirteen original articles, and but twelve
selected ; while the American numbers twenty-five in one depart-
ment, and about one hundred in the other. The Dublin Quarterly
Journal of Medical Science we prize most of those now published in
Europe; but still we deem it inferior in the character and value of
its communications, a3 also in its reviews and selections, to the one
now under consideration. We know of no French or German, and
still less Italian or Spanish medical periodical that we would exchange
for the American.

This is the only medical Quarterly of the United States. Published
originally twenty-nine years ago, and subjected to the control of dif-
ferent editors, it has always preserved the highest character among
medical practitioners in every State of our wide spread Union.
And notwithstanding the ability with which other similar works have
been conducted and are now managed, it still retains undiminished"
its enviable reputation.

The first part of each number is devoted to original communica-
tions, memoirs and cases; then follow its review department and
bibliographical notices; nest a quarterly summary of the improve-
ments and discoveries in the medical sciences; and lastly, American
intelligence. Each No. contains about 256 pages, but frequently
much more. Connected with the Journal is another publication,
called the Medical News and Library, issued monthly, containing
20 pages of the re-publication of some foreign standard work of
the profession, and eight pages of recent medical intelligence. This
is as an avant-courier of the larger and more important Journal ; and
both are furnished to subscribers for 85.00 per annum, invariably in
advance.

The April No. of the American Journal of the Medical Sciences,
although received a month or so ago, contains so much interesting
matter rn the original department, that we propose at present to con-
dense from it such intelligence as no doubt will be profitable to our
readers.

The first article in it is from John Forsyth Meigs, M. D., Lecturer

1847.] The American Journal of the Medical Sciences, 469

on Obstetrics, and Diseases of Children, in the Philadelphia Medical
Association, &c, and is entitled, " History of seven cases of Pseudo-
membranous Laryngitis, or True Croup; with remarks on the
treatment, and on the distinction between it and the other laryngeal
affections of children.'" The father of the writer of this communi-
cation was graduated in Franklin College of this State in 1809, and
having taken his medical degree in the University of Pennsylvania
in 1817, commenced the Practice of Medicine in Augusta. He
subsequently moved to Philadelphia, where he soon after married,
and is now the distinguished Professor of Obstetrics, &c, in the Jef-
ferson Medical College. The son seems to be following closely the
professional footsteps of his illustrious father, and the name of Meigs
promises to be long associated with the profession.

After claiming the attention of the profession, if for no other reason,
on account of the fatality of croup, Dr. Meigs, Jun., proceeds to a
minute and no doubt faithful narration of his cases. We give the first :

Case I. D , girl aged 3 years. Called first on the night of

January 1st, 1845. Dr. Godon, of this city, was in attendance when
I arrived, and we attended the case together. The child had had
cough for three days, gradually increasing in violence and frequency,
and changing from a dry hack to the peculiar shrill cough of croup.
The parents were not at all alarmed until the evening I was called
upon, at which time the case first assumed the features of croup.

When I arrived the case appeared to be one of mild croup. The
respiration was not stridulous, except during a forced inspiration, or
just before and after coughing. The cough was loud, frequent and
characteristic, the voice very hoarse. The temper was scarcely
changed, and the inflammatory symptoms very moderate, showing
that the local disease had made but little impression on the constitu-
tion as yet.

On account of the gradual approach of the attack, and the hoarse-
ness of the voice, it was agreed upon by us to treat the case actively,
as we feared it would prove to be membranous croup. The child was
bled to the amount of five ounces from the arm : it was put in a warm
bath, and an emetic administered.

The next day there was no decided improvement, and a number of
leeches were applied to the throat. Fiom this time to the ninth
day, when the child died in a state of asphyxia, the treatment con-
sisted in the emplopment of emetics of alum, of large doses of calo-
mel with Dover's powder, of decoction of Seneka, and in the appli-
cation of a blister over the larynx and trachea.

On the sixth day a decided amelioration occurred. This improve-
ment followed the use of an emetic of alum, which had been prece-
ded by considerable doses of calomel. The action of the emetic

470 The American Journal of the Medical Sciences. [August,

brought away a large quantity of very viscid glairy phlegm, inter-
mingled with portions of membranous looking matter, which we be-
lieved to be pseudo-membrane, enveloped in recently exuded fibrine.
She expectorated for some time after this a good deal of the same
kind of substance. It may be well to remark, however, that though
the breathing and general condition of the patient improved at this
time, the voice remained very weak and hoarse, and the cough retain-
ed its smothered sound. The case soon resumed its course, and not-
withstanding resort was had to the same means, death occurred in a
shape of the most distressing asphyxia.

At a post-mortem examination^ the larynx and a few inches of the
trachea were found occupied by a false membrane of moderate thick-
ness and consistency, beneath which the mucous membrane was
inflamed and reddened. The parts about the rima glottidis were
swelled and thickened, so as to have contracted considerably the size
of the orifice. This contraction was independent of the pseudo-
membrane, and from the appearance of the parts we were convinced
that it was the result of a chronic inflammation, dating from some
time previous to the attack of croup. As the child had just recover-
ed from a severe and long-continued hooping-cough, we felt satisfied
that the contraction of the orifice had been caused by inflammation
developed in the progress of that disease; and moreover, we could
not but think that this complication was a chief cause of the death
of the child, by preventing the ready expulsion of the contents of the
larynx, after they had been softened by the action of our remedies.

Of the seven cases two proved fatal.

We find the following remarks made on the different forms of
laryngeal affections in children:

Before passing to the subject of the treatment employed in the
above cases, we are desirous of making a few observations upon the
divisions made by different authorities, of the laryngeal affections of
children. We are prompted to do this, by the hope of attracting the
attention of our medical brethren in this country to the necessity of
making a correct distinction in their diagnosis of these different
affections.

After a careful study of some of the highest authorities on these
points, we are induced to believe that the descriptions given by MM.
Barthez et Rilliet, in their work on diseases of children, are the
most accurate. These gentlemen describe first, pseudo-membranous
laryngitis, of which the cases reported in this paper are instances.
They next consider spasmodic laryngitis, the same as thestridulous
laryngitis of Guersent and Valleix. This disorder is very common
throughout the United States, and is the one to which the term croup
is familiarly applied. It is the disease which commonly attacks child-
ren previously in good health, suddenly, during the night; which is
generally cured by an emetic ; and which seldom lasts more than a

1847.] The American Journal of the Medical Sciences. 471

few hours, or one or two days. It does not come on slowly and in-
sidulously like pseudo-membranous laryngitis ; it is not accompanied
with exudation of fibrine, and lastly it is a disease of really little,
though apparently of very great danger. It is not the laryngismus
stridulus of the English authors, though the two are classed under the
same head by Williams, in Tweedie's Library of Practical Medicine,
and by Dr. Condie in his work on Diseases of Children.

Both MM. Rilliet et Barthez and M. Valleix, are very careful in
drawing the distinction between the two diseases, the pseudo-mem-
branous laryngitis or true croup, and spasmodic laryngitis or false
croup. Indeed the difference is so marked, that we are surprised it
is not made out by all recent writers. Those who fail to make the
distinction, seem to think that both diseases are the same in the
commencement; that they are characterized by the same pathologi-
cal features in the early stages, and that after differences depend on
fortuitous circumstances of age, of epidemic influence, of treatment,
&c. ; whereas they are two widely different and distinct diseases,
presenting a different array of symptoms, running a different course,
and requiring a different treatment; one, so fatal as to have led some
to deem it incurable; the other, very seldom leading to a fatal ter-
mination. In one, the chief pathological element is spasm, deter-
mined by a very moderate degree of inflammatory affection of the
larynx in most cases; in the other, there is violent inflammation of
the mucous membrane of the larynx, trachea and even bronchia, with
effusion of fibrine and consequent formation of false membranes.

The peculiarity in the treatment of croup offered by Dr. Meigs is
the emetic property of alum. This, he says, was first used in Phila-
delphia, by his father. The dose is a tea-spoonful of the finely pulv-
erized sulphate of alumina mixed with honey, syrup, or molasses, and
repeated every ten to twenty minutes, until full emesis is produced.
One dose, however, is generally sufficient. The reader will recol-
lect how powdered alum is prized by Velpeaufor common sore-throat.
No doubt there is something specific in it in anginose affections. He
also alludes to the fact of the recommendation of the turpeth mineral,
the sub-sulphate, or yellow sulphate of mercury, by Dr. Hubbard of
Maine. He gave it one case, (three grains diffused in syrup,) which
produced free emesis in a few minutes, followed by relief, but the
child subsequently died from the violence of the attack.

This is a highly creditable article for a young man of eight years
standing in his profession.

The next is a deeply interesting article on the poisonous properties
of the Sulphate of Quinine ', by Wm. O. Baldwin, M. D., of Mont-
gomery, Alabama.

472 The American Journal of the Medical Sciences. [August,

So much has been published in our Journal on the subject of this
heroic article of the modern materia medica, and the opinions ex-
pressed concurred in so generally by the profession in this section of
our country at least, that individually we have nothing to add at
present. For it will be perceived that though Dr. B. entitles his arti-
cle, *' Observations on the poisonous properties of the Sulph. Quinr
ine," he entertains and publishes the same views respecting its proper
dose, mode of administration, &c, which we have for some time
maintained and taught. It is proposed then to quote this article
without comment, where it cannot be condensed.

Everything calculated to throw additional light upon the modus
operandi of a remedy which occupies such a conspicuous position in
the therapeutics of the age, as does the sulphate of quinine, must be
received with some degree of interest by the medical profession at
large. Under this conviction I propose to narrate some facts and
experiments relative to the nature of quinine as a poison. Though
an unfortunate one, it may yet be stated as a fact, that in our medi-
cal periodicals we much oftener meet with reports of cases showing
the successful application of particular remedies, or modes of treat-
ment, than such as illustrate their pernicious influence or misapplica-
tion. Through this means, however, we have in a few instances
been advised of the baleful effects of quinine in producing deafness,
amaurosis, hematuria, violent gastralgia, sudden prostration, deliri-
um, epilepsy, palsy, &c, and in a few instances death is reported to
have occurred, under circumstances so obvious as to leave no doubt
of its being the result of the poisonous operation of quinine. Yet
these have been so completely obscured by the reports of those indi-
viduals who declare their entire conviction of its harmlessness, under
all circumstances, and when given in almost any quantity, that the
former seems to have made but little impression upon the mind of the
profession in regard to its dangers. In none of our systematic works
do we find the subject treated of with anything like gravity. In
Orfila, and even in Christison's work on Poisons, where the noxious
properties of many very simple substances (and among them common
table salt) are dwelt upon at length, quinine is not mentioned as a
poison, nor are any of the preparations of cinchona.

A case is then given of a negro girl about six years of age, to whom
her master gave S grs. of quinine in the course of three hours. She
was laboring under remittent fever, and during the previous treatment
of the case, had taken repeated doses of the sulphate, but in smaller
quantities. * * * * *

Shortly after he gave her the last dose her skin became dry
again, succeeded by restlessness. About G o'clock she had a convul-

1847.] The American Journal of the Medical Sciences. 473

sion. After this he noticed that the pupils of her eyes were dilated,
and soon discovered she was totally blind. When asked if she knew
her mother, and other persons who were placed before her in a bright
light, her eyes would wander about she apparently endeavoring to
fix them on some object and then she would reply "I can't see
them." The dilatation of the pupils, blindness, restlessness, convul-
sions, &c, continued until 8 o'clock, when she died. The convul-
sions were described by Mr. E. as being of a most violent character,
hut notwithstanding she retained in the intervals perfect possession
of her mental faculties, and an unusual degree of pertness for child-
ren of her age.

I was not prepared to make a thorough post-mortem examination,
and therefore made a partial one, only of the stomach and bowels.
Found considerable vascularity in portions of the small intestines and
stomach, the former containing secretions of a yellowish and greenish
substance, intimately blended with mucus no worms. Pupils enor-
mously dilated.

A review of this case leaves no doubt, upon my mind, of the direct
agency of the quinine in producing death. The quantity given im-
mediately before death (grs. 8), would not of itself (I am disposed to
think) have produced the fatal result, separate from the agency of that
whieh had been given previously, but at the time these last portions
M'ere given, it must be remembered that the system was still charged
with the quinine to some extent, for up to 4 o'clock that morning it
had been regularly introduced into the stomach, at intervals, for nearly
two days. The accession of fever which should have taken place on
the 4th was prevented. Now it is very sure that the patient either
died from the effects of the quinine, or that the paroxysm of fever
which had been arrested or suspended on the 4th, came on on the 5th
and killed her. The latter could not have been the case, for we find
her an hour or two before she commenced taking the quinine (the
second time) in a warm, free and diffused perspiration. The most
conclusive evidence, however, to my mind, that the quinine did kill
the patient, is the characteristic train of symptoms which immediate-
ly followed its administration, and preceded death : the extreme rest-
lessness, dilatation of the pupils, blindness and convulsions. The
exacerbating feature of the disease had been broken up, after which
there was nothing to forbid the hope of her recovery, and, apart from
the effects of the quinine, there was certainly nothing in her condition
to account for her death at that time.
****** ***

Symptoms which followed the ingestion of large doses ofquinino
into the stomach of dogs: restlessness generally preceded all other
symptoms, as was indicated by the animal changing its position of*
ten, and constantly moving from place to place. Vomiting, or, in
those cases where the oesophagus was tied, efforts to vomit succeeded.
Purging was noticed occasionally, but in no instance except where
the medicine was taken by the stomach, Then came on muscular

474 The American Journal of the Medical Sciences. [August,

agitation, ox tremulous movements of the body and extremities, with a
constant motion of the head, resembling somewhat paralysis agitans.
In attempting to walk, the dog would totter from side to side
and fall, or if be maintained his feet would walk in a direction differ-
ent from the one which he seemed to desire. When under the full
operation of the poison, the power of locomotion, or even the power
of standing in the erect position was lost altogether, the extremities
apparently completely paralyzed. This state was accompanied with
more or less excitement of the vascidar system ; the pulse increasing
in frequency and rising from 110 to 160, and in one instance even as
high as 240 per minute. Great oppression of the breathing was pre-
sent, and sometimes frothing at the mouth. The dyspnoea in all
instances was excessive, sometimes panting, at others slow and la-
boured, resembling in a most striking manner an acute attack of
asthma; countenance expressive of great distress and anxiety. The
pupils of the eyes were invariably dilated, and generally to an enor-
mous extent, leaving but a small ring of the iris perceptible, and
vision, as well as could be judged, was entirely lost. Convulsions
were observed in every case (except one), which was watched to its
termination, where the dose given was sufficient to produce death,
and in one or two instances where the medicine failed to produce
this result. Furious delirium was present in one case, as was mani-
fested by the dog barking and biting at every thing about him.
Sometimes a. profound coma would ensue, accompanied with slight
muscular agitation, slow and heavy breathing, terminating in death
in a very few minutes after the poison had been taken, and in a few
instances the subject seemed as if stunned by some sudden and
powerful blow or violent fit of apoplexy. This latter effect, however,
was only observed when it was given to young dogs (half grown and
under) through the jugular vein or peritoneum. Its effects upon
puppies seemed to be proportionately much greater than upon dogs
fully grown.

The time required to produce death varied very greatly with the
quantity given and the age of the subject, as well as the mode and
manner of its administration, and in some instances it varied con-
siderably when the dose, mode, and all other circumstances of its
administration were supposed to be equal ; for whilst in some in-
stances fifteen or twenty grains produced the uniform and peculiar
train of toxical symptoms, succeeded by death in a very short time;
in other instances it required these quantities doubled and repeated
until 120 grains had been taken, and a much longer time to produce
the same results. This fact is in accordance with my experience
relative to its remedial action upon the human subject, showing that
it is governed more, perhaps, in its modus operandi by inherent
idiosyncrasies, or created predispositions, than any other remedy.
The modes of giving it adopted, were by the stomach, the cavity ot
the abdomen, and by the jugular vein. When given by the stomach
it produced vomiting, and was thrown back generally before a suf-

1847. j The American Journal of the Medical Sciences. 475

ficient amount to produce death could be absorbed. By dissolving
and largely diluting it with water, a sufficient quantity was absorbed
to produce death, in this manner, in one instance. In almost all of
the experiments with it by the stomach, however, the oesophagus
was ligatured. When dissolved and given by the stomach its first
effects were observable in about twenty minutes, sometimes shorter
or longer, and death resulted in from one to thirty-six hours, usually
in four or six. An empty stomach facilitated its operation greatly.
When injected into the peritoneum in full doses (40 grs.) its effects
were appreciable in from four to six minutes, and death occurred in
from thirteen to thirty minutes. When injected into the jugular
vein (in giving it by this mode great care was taken to prevent the
admission of air), its first effects were manifest in a space of time
so short as to be almost inappreciable ; not more than a few seconds
after the nozzle of the syringe was withdrawn, and death occurred in
one or two minutes. In all instances, except one, the quinine wa9
dissolved in water by the addition of sulphuric or other acid in quan-
tities barely sufficient for this purpose.

When the experiment went far enough to produce amaurosis,
short of death, the vision was regained after a time. In one in-
stance the dog remained toially blind for two weeks, and afterwards
regained his vision slowly. This is also a feature in the second case
reported in the commencement of this article. The man regained a
yery useful degree of vision after a short time. From these, as well
as other cases of the kind reported, it would seem that amaurosis
from this cause is not likely to be permanent.

Though it operated much more promptly when injected into a vein
or the peritoneum, yet I did not observe that it operated with more
power or force : that is, I did not discover that a given quantity ad-
ministered in this way would produce death more certainly than
when given on an empty stomach. 28 grains injected into the cav-
ity of the abdomen in one instance, and 20 grains injected into the
jugular vein in another, failed to produce death, yet these quantities
did produce death in other instances, as well when given by the
stomach, as by these modes.

The post-mortem appearances were equally uniform with the
symptoms before death. The most prominent and characteristic
appearances were the dark, fluid and dejibrinated condition of the
blood, and the congested state of the parenchyma of the lungs, re-
sembling very much red hepatization. The vessels of the membranes
of the brain were engorged, so also were the liver and kidneys in a
few instances. The stomach and bowels were vascular and highly
injected in patches. The membranes of the spinal cord were more
or less vascular and, in one instance, a semi-fluid coagulum of blood
was found in' the upper half of the theca vertebralis. This was pro-
bably owing to the subject being very young, and the convulsions
being more violent and frequent than in any other instance.

Thus it seems clear that quinine is 8 powon, and one which may be

476 The American Journal of the Medical Sciences, [August,

made directly fatal to life, and if these experiments upon the dog,
in themselves, are not conclusive of that fact, which the concurrent
testimony of toxicologists would justify us in believing, they at least
become so when it is remembered that the symptoms which its exhi-
bition gave rise to, are not only strongly corroborated by, but were
almost identically the same with those observed in the human sub-
ject, in the few instances were poisoning from this substance is
known to have been produced. There is not a symptom noticed in
these experiments which has not, at one time or other, been observed
in its operation upon the human subject, and the two cases of poison-
ing in the human subject reported in the commencement of this
article, where the same striking and peculiar assemblage of symp-
toms which followed its administration, were so completely identical
with those observed in the dog, most clearly establish the fact that
the manifestations of its poisonous operation, at least upon the dog,
are identical with those observed in the human subject, or at any
rate do not differ more than they do in different instances on " man
and man."

Its operation as a poison, as well as a remedy, is certainly peculiar,
and it seems difficult to assign it to any particular class of poisons,
differing in some respects from all of them. It appears to resemble
in its action, more closely than any other, those of the "second
class" of Orfila, or the class of "narcotic poisons." It does not
seem to possess any hypnotic properties ; in this it differs from most
of the substances included under this head. I do not mean to touch
the much agitated question of the mode of its remedial operation,
but desire to speak of its poisonous action only ; and, on this head
will only add, farther, that its operation seems to be principally upon
the nervous system, as is clearly demonstrated in the derangement
of the senses of vision and hearing, and respiratory functions, as also
in the general muscular agitation, convulsions, &c. As it has been
detected in the urine there can be no doubt but that it enters and
mixes with the circulating masses of the body, and through this
means exerts a direct influence upon the nervous system, which, as
we have seen, is eminently excitant when given in quantities calcu-
lated to destroy life.

As yet I am aware of no antidote which will, with any certainty,
negative the injurious effects of quinine. I have given the sulphate
of morphine to patients rendered very restless and uncomfortable
from a high state of quininism having been induced, but cannot
speak with any confidence as to its effects. I have not known it to
produce an immediate alteration in the state of the patient's feelings,
but have witnessed an improvement in the course of a few hours, and
in no case do I remember to have seen the patient get worse under
such circumstances ; but how far this may have been dependent
upon the suspension, or partial withdrawal of the quinine (which ge-
nerally takes place under such circumstances), and how far upon
the morphine, it is difficult to say. This, however, at best, can only

1- 1 . . J The American Journal of the Medical Sciences.

be a partial antidote, palliating the effects of the poison, and of course
can in no wise alter its medicinal, poisonous or chemical qualities or
constitution. And, did \vc possess an agent of the kind, whose pro-
perties would render speedily inert those of the quinine, it would
avail us but little ; for, it is not a substance of that character which
would be likely to be administered with the wilful intention of de-
stroying life, and an antidote will, generally, only be wanted when
the physician fines he has pushed his remedy too far, and its injurious
effects are already being manifested, and, in that case, the medicino
has already passed the limits where an agent ofthe kind could reach it.

As it is altogether likely that quinine is absorbed, and enters into
combination with the circulating fluids ofthe body, and in all proba-
bility produces its impression upon the system in this way, its opera-
tion is thus a remote one, and the means adopted to prevent or relieve
its injurious effects should be such as are found available in combat-
ing the poisonous impressions of other substances, supposed to act
through the same medium. Thus, if symptoms arise during the ad-
ministration of quinine calculated to create alarm, or to excite suspi-
cions of its poisonous influence, it would be well to premise all treat-
ment by the administration of a full and prompt emetic, in order to
free the stomach of any remaining portions, which may not have
been absorbed. The next step, then, should be to eliminate as
rapidly as possible, that portion which has reached and mingles with
the fluids ofthe body, and for this purpose, it has been recommend-
ed in other instances of an analogous character, to augment the natu-
ral secretions ofthe body.

This mode of treatment, which is based altogether upon the infer-
ence that the poison is absorbed and enters the circulation, and
recommended as applicable or efficient only to poisoning from sub-
stances deemed to act in this way, seems to be a most reasonable
one. I have certainly never witnessed or heard of any injurious, or
seriously unpleasant effects from quinine, when the functions ofthe
skin and kidneys were being actively performed during its influence
^-especially the former. For this purpose, the copious administra-
tion of warm diluent drinks, and hot pediluvia, or warm bath, would
seem advisable. When the state ofthe pulse is such as to justify it,
blood-letting, it would seem, is another channel through which the
quinine may be abstracted from the system, not only by freeing the
system of so much as may be contained in the quantity of blood ac-
tually drawn, but as assisting also in promoting the secretions of the
skin and kidneys.

I am of opinion, that its poisonous effects may generally, if not
always, be avoided by proper attention to the mode of its admistra-
tion. A very common mode of administering it, and one very much
insisted upon by patients generally, on account of its disagreeable
taste in any other way, is in the form of pills. And, it is a practice
with apothecaries, and with physicians who are in the habit of dis-
pensing their own medicines, to keep a quantity of pills constantly

478 The American Journal of the Medical Sciences. [August,

on hand. These, when made from a mass, formed by the addition
of gum arabic, or common paste, get very hard before they are used,
and when given under such circumstances, I have known them to
pass through the bowels entirely undissolved* And, when combined
with substances calculated to keep them soft, or even when prepared
as administered, they may, and no doubt do occasionally become
entangled or enveloped in flakes of mucus or other contents of the
stomach and bowels, and thus pass off undissolved, and without effect,
or they may meet with some obstruction in the bowels, and be re-
tained. When this is the case that the medicine is not dissolved,
or absorbed regularly, nor yet does not escape from the bowels, from
some cause or other, and still being introduced into the system at
irregular intervals a large quantity in this way may collect, until
suddenly meeting with a solvent, (as first supposed by Briquet,) its
whole force is spent upon the system at once, and it thus becomes
the cause of serious mischief, when, if the same quantity had been
given in such a way as to insure its timely absorption, such a result
would not have happened. Of all the fortns of giving it that of the
pill seems to me to be the most decidedly objectionable, and should
never be adopted in cases of much importance, where it can be avoid-
ed. Another very common mode of giving it is by suspending it hi
syrup, mucilage or water. This is certainly less objectionable than
that of the pill, though not equal to that of the solution, made by the
addition of some acid in quantities barely sufficient to dissolve it. I
prefer sulphuric acid to any other. This mode of giving it has been
recommended by Briquet, on account of its safety. In my estima-
tion, it possesses a most decided preference over every other mode of
administering it, and is the only one from which we can with cer-
tainty expect the timely and full effect of the medicine.

When the stomach is in a condition to bear it, its absorption and
activity can be greatly facilitated by largely diluting it with warm'
water. When dissolved and diluted in this way, even when given
in what may be termed " heroic doses," provided the quantity to be
iaken is divided and given at intervals of one, two or three hours, its
#leleterious effects may always be avoided and the remedy persisted
in with safety in the absence of any manifestation of its influence,
which we should never feel safe in doing when giving the " insoluble
<le sulphate," whether in the form of pills or powders; for, in the
former case we will always be advised of its unfavorable influence
early enough for a timely withdrawal or modification of the dose.
When given in this way, a given quantity seems to produce a greater
effect and in a much shorter time, than even a larger quantity when
prescribed in either of the other forms; so that besides being a much
safer mode it is a more economical one, both as regards time and
medieine; and, the reason seems entirely obvious, for by dissolving
and diluting it largely in this way, besides being dissolved ready for
the absorbents, it is brought in contact with a much larger absorbing
surface, and many particles which otherwise might lodge about the

1^17. J The American Journal of l he Medical Sciences* 179

contents of the alimentary canal and thus pass off with them, in a state
of solution would readily be taken up and appropriated by these vessels.
This mode of giving quinine cannot be urged too strongly, for
besides being a saving of a valuable and costly drug, and a prevent-
ive of its poisonous effects, it will be found of great assistance in
prescribing it generally. In cases requiring much delicacy and dis-
crimination in their management, and where the propriety of the
prescription is a matter of debate with the physician himself, and he
wishes to be made sensible of the effect of the first dose of his rem-
edy, in order to determine upon its continuance, it becomes a matter
of great moment that the medicine should be administered in that
form in which it will be most certainly and speedily appropriated by

the system, and its operation made manifest to the physician. *

****** ***

In a practice of nearly ten years in the South, the greater part of
that time I have employed the sulphate of quinine, as a principal re-
medial agent, not only in Southern fevers, but in Southern diseasf?
generally. Accustomed as I have been to witness the most satisfac-
tory results from its exhibition, and familiarized as I thought I was
with the minutest impression which it was capable of making upon
the animal economy, I was prepared to believe every report in its
favour, and had almost fallen into what I fear is becoming to be a
popular error that, "if it does no good, it will do no harm." I say
this much by way of showing that I entertained no prejudice to it
as a remedy, or anxiety, or even willingness, that it should be found
to possess properties which might tend somewhat to circumscribe its
useful application. On the contrary, I entertained a fondness for it,
not equalled by my attachment to any other remedy. And, though
occasionally my enthusiasm in regard to its virtues was somewhat
abated, and my confidence in its inodiousness was somewhat equivo-
cal, as it failed to produce the results anticipated, or as some unlook-
ed-for symptoms were developed under its administration and influence
soon farther experience would restore my former admiration of its
sanative powers, and dispel all fears of the probability of its having
exerted an injurious influence: attributing its failure to meet the.
indications which it was designed to fulfil to negligence in its ad-
ministration on the part ofthe nurse, and the unlooked-for symptoms
which occurred under its operation as an awkward or anomalous
manifestation ofthe disease itself.

Notwithstanding this acknowledged partiality for it, I have never
administered it in the enormous doses prescribed by those who boast
of having given their thirty grains, repeated every half hour until
240 grains were introduced into the system, or their several ounces
in the treatment of one case of fever. I have very rarely given
more than ten grains at a single dose. My usual mode having been
to give from four to six grains, and repeat at intervals of two, three
or lour hours, until *J t or 36 grains had been introduced into the
system (in adults). Occasionally 1 have gi?eo it in larger doses, but

480 The American Journal of the DIedical Sciences. [August,

these cases have been extremely rare, believing that the quantities
specified above, given in one intermission or remission at the proper
periods, and aided by suitable auxiliaries, could accomplish, ordinari-
ly, all that the remedy was capable of, and these enormous doses, to
say the least of them, unnecessary. Sometimes, owing to want of
time, I have given from 20 to 2i grains at one dose, but in such
cases have never repeated it in the same dose.

Second to none other, quinine must ever hold the first rank in our
materia medica, in the treatment of Southern diseases. I arn accus-
tomed to witness its peculiar and almost wonderful influence in ar-
resting certain forms of diseases, but yet that it has gone far beyond
its proper bounds, and is now being used too recklessly and indiscrim-
inately, I feel most fully persuaded, and that it may be directly and

fatally poisonous I am entirely convinced. *

* # * # * # * * *

From all that I can gather, I am disposed to think from fifty to
eighty grains of a pure article of quinine, given in solution at one
dose, will produce death nine times out of ten, in healthy adults, and
occasionally even smaller quantities. How fir its operation may be
modified by morbid action is a matter for consideration at the bed-
side.

Dr. Baldwin concludes this valuable paper, which should be read
by every practitioner of medicine, by relating a case wherein 36 grs.
of quinine taken by an adult in two hours, produced exhilerating
effects resembling those of the protoxide of nitrogen.

Montgomery, Ala., is remarkably blessed with a number of highly
scientific physicians. There are no less than three regular contribu-
tors there to the American Journal of the Medical Sciences men of
decided abilities and great professional zeal. And besides these,
(Drs. Baldwin, Sims and Boling,) we have a personal acquaintance
of several others in this small town, now, however, become the cap-
itol of the State, who enjoy distinguished reputation for skill in the
healing art. The 3d Art. in this No. of the Journal, is by J. Marion
Sims, M. D., and is the honest narration of a case of tumor of the
antrum. The operation for it was twice performed, but however
skillfully done, proved, as is too often the case, not to be effectual.
We are exceedingly pleased with the candor and free confession of
what the author considers to be errors, with which this communication
is marked. It augurs well for the profession, and comes with good
grace from a highly promising young surgeon.

We next have an article on Laceration of the Perenium, by John
P. Metiaeur, A. M., M. D., L. L. D., of Virginia. The details of two

1847. J On the Application of Ligatures to Arteries. 481

of seven cases, six of which were completely cured, are here related.
The leaden suture is preferred, and every case of this loathsome af-
fliction is considered curable. The character of Dr. M. as a surgeon
is too well known to need remark from us.

We pass over several articles, which time and space will not allow
us to dwell upon; including a case of the sudden formation of Hy-
drops Pericardii, to the extent of two quarts of limpid water ; and
another similar one of hydrocele, by Dr. S. Jackson of Philadelphia,
formerly of Northumberland ; and we close with a brief notice of
Blood-letting from the Jugular in Diseases of Children. This is by
Dr. Hildreth of Zanesville, Ohio, and known to the readers of that
Journal by his numerous valuable contributions to it. After alluding
to the general neglect of letting blood from the external jugular, he
says, / would make this operation the rule instead of the exception, in
many of the acute affections of children under two or three years of
age; and also in older subjects, in certain diseases of the brain and
trachea. He declares, (and what will readily be admitted,) that
venesection is here more simple, safer, and more efficacious in arrest.
ing certain acute diseases of early life, than by opening a vein in the
arm. His apparatus for bleeding from the jugular consists of a cup,
a compress and lancet, and with the aid of one assistant. The child
being secured across the lap of the nurse, the operator confines its
head between his knees, compresses the vein with the thumb of the
left hand, makes the requisite opening into the vein, and by pressure
with the edge of the cup regulates the flow of blood. The compress
may be applied for a few moments, and then replaced by a piece of
court or adhesive plaster.

When we consider how difficult it is to bleed from the arm of cer-
tain children, the necessity under many circumstances for the ab-
straction of blood from them, and then remember how simple the
operation is when referred to the external jugular vein, our thanks
are due to Dr. Hildredth for calling our attention to the subject.

On the Application of Ligatures to Arteries. Bv G. J. Guthrie,
Esq., F.R.S. (Medical Times.*)

[After an admirable set of practical lectures delivered by Mr.
Guthrie, at the Westminister Hospital, on this subject, he gives us
the following conclusions, as being a bird's eye view of his extensive

31

482 On the Application of Ligatures to Arteries. [August,

experience on one of the most important subjects connected with
surgery.] Braithvvaite's Retrospect.

1. The Hunterian operation for the cure of an aneurism is not
applicable to the treatment of a wounded artery, inasmuch as the
wound of the artery communicates with the external parts, and noth-
ing intervenes to prevent blood flowing from the wound in its side, or
from its cut extremities.

2. When a large artery is divided and bleeds, the wound should be
enlarged if necessary, and a ligature placed on both the divided ends ;
but if the artery be only injured and not quite divided, the ligatures
should be applied, one immediately above, the other below the injured
part. The artery may or may not be then cut across, at the pleasure
of the operator, but the limb or part should be placed in a relaxed
position. A bandage should not be applied, and the edges of the
wound should be simply brought together by adhesive plasters, which
do not extend completely round the limb.

3. No operation is to be performed on any artery unless it bleeds
at the moment of its performance, inasmuch as hemorrhage once sup-
pressed may never return.

4. The intervention of muscular fibres, or of whole muscles, is not
a sufficient reason for tying the artery at a distant part. They must
be divided, if it be possible, to the extent required for a due exposure
of the injured artery and its accompanying veins and nerves.

5. If the wound pass indirectly to the principal artery, from the
back of the thigh for instance to the femoral artery in front, or from
the outside of the arm to the humeral artery on the inside, the sur-
geon may (on satisfying himself of the part likely to be injured, by
the introduction of a probe) cut down on the vessel opposite that
supposed to be wounded, by the most simple and approved method.
When the artery is exposed, the probe will point out the spot at
which the vessel has in all probability been wounded. Pressure
made below this spot on the artery, will cause it to be distended and
to bleed, if the flow of blood be not prevented from above; the artery
is then to be secured by two ligatures, and the lower one should if
possible be applied first.

6. The tourniquet should never be applied in an operation for
aneurism or for a wounded artery. Compression by the hand in the
course of the wounded vessel is allowable.

7. The blood from the upper end of a divided artery, or that near-
er the heart, is of a scarlet arterial colour.

10. The blood from the lower end of a divided artery, or that which
is further from the heart, is of a dark or venous colour, when it hap-
pens to flow immediately after the division of the ressel. At a
subsequent period it ma^ assume more of the colour of arterial blood,
but it rarely does so for several days after the receipt of the injury,
and always flows, or at least until a very late period, in a continued
stream.

11. This regurgitation or flow of blood from the lower end of a

1847.] On the Application of Ligatures to Arteries. 483

divided artery is a favourable sign, inasmuch as it shows that the
collateral circulation will probably be sufficient to maintain the life
of the extremity.

12. The collateral circulation is in almost every instance capable
of maintaining the life of the upper extremity when the axillary
artery is divided, and the colour of the blood which flows from the
end of the artery, on its being divided, is not always as dark as in
the lower extremity, and it sooner resumes its arterial colour.

13. The collateral circulation is not always capable of maintain-
ing the life of the limb when the femoral artery is injured. The
best assistance which art can give is to rub the foot and leg in the
gentlest manner, between the hands of one or two strong young
women, for several hours, or even for the first three or four days ;
relaxing this process very little, even during sleep. When the vein
is divided at the same time, or rendered impervious, the limb usually
mortifies.

14. The collateral circulation is sufficient to maintain the life of
an extremity in almost every case in which an aneurism has existed
for eight or ten weeks, although it may be incapable of doing this if
the principal artery have been suddenly divided, without any previ-
ous disease having existed in the part,

15. The theory and the operation for aneurism are never to be
applied to the treatment of a wounded artery, which has caused a
diffused or circumscribed aneurism, whilst the external wound commu-
nicates with the artery, unless it be impossible or impracticable to tie
the bleeding vessel.

16. When an artery has been wounded, and the external opening
has healed for weeks and months, so as to give rise to a diffused or
circumscribed aneurism, it may be treated according to the theory
of aneurism occurring from an internal cause, if the case will permit
it without danger, although with this difference, that as the artery is
sound the operation may be performed close to the tumor. If any
doubt exist as to the capability of the collateral circulation to support
the life of the lower extremity, when the external iliac is secured by
ligature, the operation should be performed at the injured part by
opening the swelling and enlarging the wound, as in the case of a
Wounded artery.

17. When a circumscribed or diffused aneurism which has formed
after a wound has been opened, whether by accident or design, it is
placed in the situation of a wounded artery, and should be treated
as such. If the aneurism has arisen from disease of the vessel, and
the wound or opening into it cannot be permanently closed, the limb
is in a worse state than if the artery had been wounded by accident ;
because a ligature or ligatures placed on a diseased artery are little
likely to be successful. They are liable to all the difficulties and
inconveniencies attendant on the old operation for aneurism. If a
case of the kind should occur in a popliteal or femoral aneurism,
situated at or below where the artery passes between the triceps and.

48 4 On the Application of Ligatures to Arteries. [August,

the bone, amputation, if it can be done low down, will be the best
remedy. If the aneurism should have formed higher up, and the
opening can be closed with any prospect of its healing, a ligature
may be placed upon the artery above it; but on the recurrence of
hemorrhage which cannot be restrained by moderate pressure, the
artery must be tied below, or recourse had to amputation. It is,
however, to be observed, that amputation under these circumstances,
when resorted to as a third operation, rarely succeed.

18. When an artery is wounded with a simple fracture of a bone,
or with a comminuted fracture of the smaller bones, with an external
communicating opening, both ends of the artery should be secured,
and the limb treated in the usual manner.

19. When the bone broken is the femur, and the artery divided is
the femoral artery, the operation of amputation will generally be
advisable. It will always be so if the fracture is a comminuted one,
or the shaft of the bone is extensively split.

20. When "the broken bone injures the artery and gives rise to an
aneurism, the treatment is to be first of the fracture and then of the
aneurism, as soon as circumstances render it advisable or necessary
to have recourse to the operation for aneurism, and which can only
be after time has been given for the collateral branches to enlarge, so
as to maintain the life of the limb.

21. When mortification takes place in addition to, or as a conse-
quence of, a wounded artery, amputation should be had recourse to
forthwith.

22. The place of operation should be in almost all cases at the seat
of the original wound; but there may be an exception, viz.

23. When the injury has been a mere cut, just sufficient to divide
the artery and vein immediately below Poupart's ligament, and mor-
tification of the foot supervenes, amputation should be performed
below the knee, or at the part where the mortification more usually
stops for a time.

This rule is founded on the observation, that great efforts are made
by nature to arrest mortification a little below the knee. Sometimes
they succeed; when they fail, death is almost inevitable. The advice
to amputate at this part is founded on the fact of its being infinitely
less dangerous, when done there, than on the thigh, independently of
saving a joint.

24. When mortification has continued for several days, and is
spreading without having once stopped, the constitution of the patient
being implicated as marked by fever, amputation should not be per-
formed until the mortification has been arrested and the line of
separation has been well formed. In many cases, where there is
great weakness or of irritability of constitution, it will be advisable to
defer the operation to a later period, particularly if there be hope of
the patient's becoming stronger and more tranquil.

25. If the mortification has once stopped and then begins again to
spread, it will never again cease to extend, and amputation may give
some chance of life.

1847.] Congestive Fever. 485

26. Amputation of the arm should never be had recourse to, in
consequence of a wound of the axillary artery, unless mortification
takes place.

27. When mortification takes place after the operation for aneur-
ism, the surgeon must be guided by the state of the patient's consti-
tution, in resorting to or refraining from amputation.

28. When hemorrhage takes place from the surface of a stump,
the artery should be tied at the part from which the blood comes in
the first instance, if it can be easily done. If this should not suffice,
the artery must be tied higher up, just at such distance as will afford a
fair hope of its not having been affected by the derangement of the
stump, which has led to the failure of consolidation in the extremity
of the artery, and yet not too high to admit of the junction of any
large collateral branches. If the bleeding proceeds from several
small vessels, and cannot be arrested, the principal trunk should be
tied above the diseased part, and the patient removed to a purer
atmosphere, without which, the operation rarely succeeds in any case.

29. When an aneurismal tumour mortifies, it is unnecessary and
improper to tie the artery above the tumour, because it will be oblit-
erated if the mortification be arrested by the efforts of nature, which
the operation may interfere with, and even prevent, whilst, if the
mortification spreads, it will be a matter of superorogation, and only
hasten the patient's dissolution. When an aneurism inflames, is
opened by ulceration, and bleeds profusely, it is a proper case for
amputation, if such an operation can be performed.

Congestive Fever. By Thomas Barbour, M. D. (Missouri Medi-
cal and Surgical Journal.)

The term congestive fever is objected to, on the ground that it
rather expresses a concomitant, than the true cause of the peculiar
phenomena which distinguish the disease. By this title I mean to
designate that peculiarly malignant modification of intermittent or
remittent fever, which ischaracterized/rom its incipiency by strongly
marked symptoms of deep internal congestion, and in which the
ganglionic system of nerves seems to be especially implicated. Its
universal occurrence in localities and seasons which are favorable to
the production of malaria, and its co-existence with all the common
varieties of malarious fevers, conclusively demonstrate, that it is
caused by some concentrated poison which is generated by the de-
composition of organic matter.

It requires but a superficial observation of the phenomena of this
disease to be convinced that this cause, whatever it mav be, makes
its primary impression upon the nervous system ; and that all of its
characteristic symptoms am the immediate sequences of diminished
nervous sensibility. The suddenness of the attack, the numerous
indications of nervous derangement, and the rapidly fataJ tendency

486 Congestive Fever. [August,

of the disease, conclusively show, that the brain and the whole ner-
vous system the main springs of life are almost overwhelmed in
the very first assault of the enemy.

The impression made upon the nervous system is proportionate to
the intensity of the poison applied ; and the effects on the constitu-
tion are various, according to the relative force of vital resistance;
hence, whenever it prevails, there is every gradation of the disease,
from the slight manifestations of congestion, to the most malignant
cases, in which the vital forces are completely overpowered. This
leads me to the consideration of the pathology of congestive fever,
which I will point out in a few words.

The whole nervous system being oppressed by a powerful morbific
poison, ns necessary consequences, all of the vital functions over
which it presides, as respiration, circulation, secretion, &c, become
greatly impaired; the capillary circulation throughout the entire
system becomes much impeded ; and there is a centripetal movement
in the circulating fluid, in consequence of which the pulse becomes
weak, and the general surface cold and contracted, whilst the inter-
nal organs become gorged with blood.

The phenomena dependent upon internal engorgements are various,
according to the seat and extent of the congestion. When the brain is
the chief seat of congestion, the countenance appears contracted, op-
pressed, and besotted ; there is pain or giddiness, or a sense of heaviness
in the head ; and there is a strong tendency to coma and insensibility.
When the lungs and heart are principally congested, there is a great
praecordial oppression ; the respiration is short, hurried and oppressed ;
and there is generally a peculiar livid appearance in the face ; the pulse
is irregular and oppressed ; and there isgeneral coldness of the surface.
WThen the abdominal viscera are the chief seats of congestion, there is
a sense of great heat and oppression in the region of the stomach, at-
tended with great thirst, and a constant disposition to retching and
vomiting ; there is.also indescribable restlessness : sometimes the bow-
els are torpid, but most generally they are very loose thin, serous dis-
charges passing offin enormous quantities, which contribute rapidly to
prostration and death. Autopsy usually reveals the true source of all
the foregoing symptoms. The various organs are found more or less
gorged with blood; which was the cause of their oppression and
embarrassment during life.

With this brief view of the pathology, I pass on to the considera-
tion of the symptoms of congestive fever. The premonitory symp-
toms, which are, generally, of short duration, are those which com-
monly precede other forms of fever, such as languor and lassitude, a
sense of weariness, and general uneasiness, loss of appetite, and
disturbance of the stomach and bowels. Next to these succeed chilly
sensations alternated by flashes of heat, soon after which the patient
has a regular paroxysm, characterized by a protracted cold stage
the system, most generally, being unable to recover its natural tem-
perature before the occurrence of the second paroxysms.

1847.] Congestive Fever. 48"

The type of this fever corresponds with the double tertian of the
old authors, being subject to quotidian paroxysms, but on each alter-
nate day to an increased aggravation of the symptoms. Thus, on
the third and the fifth days, the paroxysms are usually very severe,
and followed by a protracted cold stage, from which the system reacts
very slowly. The anxiously looked-for hot stage is rarely or never
fully developed, even in what might be called mild cases. But, in-
stead of it, the temperature of the whole surface is greatly diminish-
ed and irregular the extremities being much colder than the trunk.
The pulse becomes exceedingly weak and quick ; the respiration is
short, hurried, and difficult ; the patient complains of a painful sense
of heat and weight in the epigastrium, accompanied with insatiable
thirst; there is uncontrollable restlessness; the patient tosses him-
self from side to side, and often rises up, as if to relieve the oppression
of the lungs ; there is either pain or giddiness, or sense of weight in
the head ; and the countenance looks contracted, pale, anxious, and
often livid ; the tongue is generally moist ; and the bowels, in a large
majority of cases, are loose, and the dejections serous.

The above sketch presents a tolerably correct delineation of the
symptoms of ordinary congestive fever, as they present themselves
at an early period of the disease.

They are, however, subject to considerable modification, according
as the brain and spinal marrow, the lungs, or the abdominal viscera
are the chief seats of congestion ; the most prominent symptoms in
each case being particulrrly referable to the chiefly engorged organs.

If the condition above detailed is not soon removed by the recuper-
ative efforts which nature makes to throw off the oppressive load
under which she is laboring, aided by proper remedial agents, there
is a rapid tendency to fatal collapse. This usually occurs either on
the third or the fifth days, when, as has been remarked, the paroxysms
are unusually severe. This condition is marked by all the symptoms,
which indicate profound congestion. The extremities, and, indeed,
the whole surface, become as cold as ice ; the whole body is bathed
with cold clammy sweat ; the skin loses its elasticity, resuming, very
6lowly, its natural situation, when pinched up ; the pulse is very
quick, and scarcely perceptible ; the thirst is insatiable ; and there
is uncontrollable anxiety and restlessness; the respiration becomes
shorter, more hurried, and oppressed ; and there are strong marks of
diminished sensibility, as a disposition to lethargy, and even to coma,
with great muscular prostration. If unchecked, these symptoms
increase with a rapid pace, and soon terminate in death.

But congestive fever does not always follow the regular course
above described. Sometimes, instead of suffocated excitement, after
the first or second regular paroxysms, there is full and violent reac-
tion, and the stage of excitement continues for twenty-four, thirty six,
or forty-eight hours, with little or no remission, when the system,
seeming to be exhausted by the violence, of the excitement, rapidly
sinks into collapse.

488 Congestive Fever. [August,

t

This modification generally occurs when there are internal inflam-
mations, as indicated hy pressure over the epigastrium, the right
hypochondriac region, or over some portion of the bowels.

In other instances, the first regular paroxysm is succeeded by the
strongest marks of deep congestion, and complete collapse of the
powers of nature.

So far as my observation has extended, this last modification
almost universally occurs either in aged persons, of feeble and broken
down constitutions, or in those who have debilitated themselves by
the use of harsh purgatives, or by the use of a too common remedy
among southern planters, the emeto-cathartic salts and tartar, which
most generally causes great gastric and intestinal irritation, which
induces a rapid fluxionary movement in the circulating fluid towards
the chylopoietic visecera, which causes inequality of the circulation,
and rapidly prostrates, by the copious serous discharges which ensue.
We now come to the most important part of our subject the
treatment of the different modifications of congestive fever. What
are the leading indications of treatment in this disease, founded on
the pathological views which have been taken of it? The great ob-
jects at which we should aim in the use of therapeutic means, are
first, to restore the lost balance of the circulation ; second, to coun-
teract the tendency to a recurrence of the paroxysms ; and third, to
restore the suspended secretions.

What are the best means of fulfilling the first indication, namely,
the equalization of the circulation 1 There is great discrepancy of
opinion among medical men in relation to this. We are informed
by Armstrong, that the hot vapour bath, or the common hot bath,
with bottles of hot water to the feet and hands, &c, together with
calomel and opium, dry brandy and hot ginger tea, are incomparably
superior to any other agent for the promotion of reaction.

With due deference to such distinguished authority, I would re-
mark, that whilst I do not doubt the efficacy of the above treatment
in the congestive diseases of the great metropolis of England, my
experience convinces me that it is, in a large majority of cases, alto-
gether inadequate to the removal of the malignant congestive fever
which is incident to unhealthy localities in southern climates.

In the first cases of congestive fever which I ever saw, I confident-
ly relied on the treatment of Armstrong, because I knew of no better
practice, and because it seemed to be altogether consonant with rea-
son to give internal stimulants, and apply external heat. The con-
clusion to which my observations have led me is, that this treatment
is adequate to the restoration of the lost balance of the circulation,
only in those cases which are occasioned by common causes; or in
the mildest cases of congestive fever. In all the worst cases of this
disease which have come under my notice, the hot bath and most
diffusible stimulants have done injury rather than good, the patients
appearing, generally, more relaxed and oppressed after they had been
used. The remedy which I estimate above all others, in the treat-

1847.] Congestive Fever. 4?9

ment of congestive fever, is the affusion of cold water. My own
comparatively limited experience, and the ample experience of many
intelligent practitioners in the South, sustain me in the declaration,
ihat tbe affusion of cold water upon the naked body is capable of
producing the most beneficial effects; and in a large majority of
even the most malignant cases, of ind',:< most complete and

permanent reaction. I acknowledge, that when I first used this po-
tent and novel agent, I rather distrusted its propriety, because I
could not very fell understand how cold, applied to a surface already
as cold as ice, could effect any good purpose. But no sooner had 1
tried it, and witnessed its effects, than I became convinced of the
erroneous view which I had taken of its modus operandi, and which
had deterred me from adopting it sooner. So well am I assured of its
invaluable efficacy as a powerful excitant to the nervous system,
that I now feel no more hesitation in its adoption than I do in the
use of the lancet in inflammatory affections : for the principle upon
which it operates is just as obvious to my mind.

Who would hesitate to dash cold water on a patient who was over-
whelmed by the effects of opium ! Surely no practical medical man
would, if he knew its efficacy. Why ? Because it is known to be
capable of arousing and sustaining the oppressed nervous system, by
the stimulant impression which it makes upon it. Why, then, should
there be a doubt about its applicability to a disease which we believe
to be dependent upon a poison which oppresses and paralyzes the
whole nervous system ? The analogy, as regards the condition in
the two cases, is perfectly just ; and the principle on which the rem-
edy acts is identical. That this is the fact, its almost universal effects
abundantly testify.

The modes of application which I have adopted are the following :
Have a broad plank placed upon two chairs, at a convenient distance
apart, and place two vessels of hot water on each side, corresponding
with the feet and hands; then strip the patient, and lay him on his
back on the plank, with his extremities in the hot water, and having
at hand twenty or thirty gallons of spring water, or, what would be
Letter, water made colder by ice or salt; pour the water from a
pitcher, in a full and rapid stream, over the chest and abdomen. The
advantage of this mode is, that the cold is directly applied over the
most common scats of congestion, whilst the circulation is invited to
the extremities by hot water.

The second mode which I adopt, particularly in cases where the
brain and spinal marrow are the chief seals of congestion, is to place
the patient upon a blanket upon the floor, and cause him to turn upon
his side, and dash cold water as forcibly as possible over the head and
down the spinal column. This method is often the most effectual,
because its influence is more immediately felt by the great nervous
centres. Having applied the water, the patient should be quickly
wiped and placed in bed, and be covered with two or three blankets.
I have sometimes had the patient surrounded with hot stones, or hot-

490 Congestive Fever. [August,

ties filled with hot water, after being placed in bed ; but I am now
satisfied that it is improper to do so, on account of the relaxing influ-
ence of the heat, and the debilitating effects of the copious perspira-
tion induced by it. Instead of heating the patient, I cause him, as
soon as he has received the cold dash, and is placed in bed, to be ex-
tensively and forcibly rubbed, either with dry mustard flour, or salt,
or with spirits of turpentine.

The effects of the cold dash are frequently permanent, and com-
plete reaction takes place, followed by rapid convalescence. In
many instances, however, the effects of the first affusion subside,
and the patient relapses into his former condition of coldness, restless-
ness and insensibility. I such cases, it is proper to repeat the affu-
sion, until complete and permanent reaction takes place, which may
be confidently anticipated in a large majority of the worst cases,
provided it is applied sufficiently early.

Unfortunately for the reputation of this invaluable remedy, it is
deferred too long, and most generally resorted to only as a dernier
resource ; in consequence of which, the system loses all susceptibili-
ty of its impression ; or some vital organ or organs become irrepara-
bly injured, and hence its use proves abortive.

There is no just reason why its adoption should be delayed. If it
is capable of producing such salutary effects in the latter periods of
the disease, when the vital principle is almost extinguished, how much
more triumphant would be the success attending its use at an early
period, when the vital organs, most generally, are not seriously injur-
ed, but only burdened with an udue quantity of blood, and when the
susceptibility of impression is but little impaired.

Next in importance to the cold affusion, with a view to the estab-
lishment of healthy reaction, are opium and sulphate of quinine. My
usual practice is to give, at once, 100 drops of common laudanum ;
or the same proportion of the following compound tincture, which 1
estimate very highly : Ii. Gum opii, gum camph., cort. cinnam.,
ol. caryophyl, aa one oz. ; capsic. pulv., half oz. ; Hoffman's ano-
dyne liquor, one pint. Macerate for twenty days, and filter. The
above portion may be repeated once or twice, according to circum-
stances, at intervals of two or three hours; after which I make use of
sulphate of quinine, in combination with morphia and calomel, ac-
cording to the following ft. : Sulph. quiniae, one drachm ; hydrarg.
prot. chlorid., half drachm; sulph. morphia?, grs. ii. ; m. ft. chart,
xii. One to be given every hour or two, until full reaction is induced.

Some practitioners, especially in the South, make use of enormous
doses of calomel as 50 to 200 grains and repeat them often, with
the view of unlocking the liver and inducing reaction. My own ex-
perience is opposed to calomel in such large doses. I am satisfied
that small portions, as three to five grains, repeated every two hours,
are better calculated to fulfil the indications for which it is given.
When administered in large doses, it is apt to induce copious watery
discharges a consequence which might be very reasonably expect-

1^47. J Conre-:iLE Fever, 491

ed, when it is remembered that the liver and bowels are in an en-
gorged condition, and of course not possessed of their natural bus*
cepubiiitv or' impression : hence, such large quantities become a
source of great irritation. It is verv doubtful whether calomel, in
any deses. is capable ofprcduc i g its specific effect upon the liver, so
long as it continues gorged with blood ; and when reaction takes place,
and this viscus becomes disburdened, small portions much more cer-
tainly affect it. bee- I to pass otfbythe
bowels. As a o to the above means, I generally apply cups
aiong the course of the spine, over . ,m. ri^ht hvpochon-
dnum, or chest, according to the indications: and ft . m with
large sinapisms. When there are strong marks of cerebral conges-
tion, a blister over the cervical portion of the spine is often productive
of good effects.

la regard to the propriety of general blood-letting in this form of
{ever, there is much diversity of opinion : some, guided by the plausi-
ble speculations of Mackintosh, regard venesection not only as a safe
means of cure, but an indispensably necessary one to relieve the
various internal organs that arc oppressed by an undue amount of
blood; otl) light! their own observation and ex-

perience, consider the use of the lancet not only of doubtful efficacy,
but hazard'. .-extreme. My own impression is, that general

blood-letting is very rar- *ary, ?-<id that in most cases it is

nd injudicious, curing I .on account of

the great depression of the nei nt tendency

to collapse.

en complete reaction is established, what course of treatment
should be porsu< . which is usual

ill that will be necessary, generally, wi!i be to administer alter-
ant portions of blue pill, in combination with opium or morphia, to
prom- nervous excitement, and quinine

to sustain the weakened : 'nature, and prevent the recurrence

of the paroxysms, :ch there is always a great liability. The

following prescriptioi I calculated to fulfil the indications of

treatment : R. Mass., hydrarg., sulph. quina?. each a half drachm ;
sulph. morphia?, one . \\i. two to be given every three

hours, [f the blue pill d - - set gently on the bowels, a seidlitz
powder may be g casionally; or the bowels maybe evacuated

by means of stimulal sta. Should the reaction become rio-

i be neces excitement, as the

organs which have b 'ood, and conseque:

ened and irritated, - i sed to inflammation, which

would be difficult of removal, on account of the inability of the sys-

bear depletion to r ener-

nt to apply c the various seats

administer calomel : peatedly use the cold or tepid affu-

sion. If the above meam eqoate, it may be proper

to draw blood to a mode: from the arm: but this shou

492 Death by Strychnine. [August,

done with great caution, as the power of resistance in these cases is
so low, that not unfrequently high excitement is suddenly followed by
great prostration. The pulse should be carefully watched, and upon
the slightest manifestation of failure, the orifice should be closed, and
some diffusible stimulant administered. As soon as the excitement
begins to abate, the pills of blue mass, quinine and morphine, as above
prescribed, should be given, and continued for several days, in order
to excite healthy biliary discharges and prevent a relapse.

During the progress of the disease, as well as during convalescence,
strict attention should be paid to regimen. It is very necessary to
adapt the aliments to the weakened digestive organs: rice, barley, or
chicken water may be allowed, until the disease is arrested. During
convalescence, chicken broth or well-boiled rice, with milk, will be
appropriate. For drink, nothing is so grateful or salutary as simple
cold water, it tending in an eminent degree to allay gastric irrita-
bility and general restlessness, which is usually so very distressing.
With the same view, small pieces of ice may be occasionally swal-
lowed.

Death by Strychnine. Report on the Case of the late Dr. W. C.
Waexee. (Boston Med. and Surg. Journal.)

At a late meeting of the Addison County Medical Society of Ver-
mont, the undersigned were appointed a committee te ascertain the
facts in the case of one of their members, the unfortunate William
Cullen Warner, M. D., of Bristol, who deceased, suddenly, at Mont-
pelier, October 11th, 1846, in the thirty-ninth year of his age, while
he was a member of the Legislature.

On account of there having been considerable discrepancy in the
published reports in relation to this melancholy event, the committee
addressed letters of inquiry to the Hon. Daniel O. Onion, M. D., of
the Vermont Senate, and to Charles W. Horton, M. D., member of
the House, each of whom, they had learned, were present during
most, if not all, the period of the sudden and tragical event. To the
inquiries of the committee, each of these gentlemen have given
prompt and satisfactory replies, which in substance are here subjoined.

1. In your opinion how much sulphate of strychnia was taken ?
To this Dr. Onion answers, "I think probably from one-fourth to

one-half a grain. As he intended to take, and supposed he was taking,
morphia, he would be likely to use the same quantity he was in the
habit of using of that article, although there was no evidence at the
time of the quantity taken." To Dr. Horton, who was called into
the room immediately after the accident, Dr. Warner said, " Doctor,
I have taken, by accident, an over-dose of morphine ; help me if you
can," at the same time handing him the phial enveloped in paper.

2. How soon after was any effect produced?

Dr. Horton says, ' It is my opinion, from facts subsequently ob-

1847. j Death bij Strychnine. 493

tained from Gen. W. Nasi], who occupied the same room with him,
that he felt the effects in less than five minutes."

3. What was the first symptom ?

Dr. H. replies, "constriction of the throat and tightness of the
chest, with rigidity of the muscles in attempting to move." Dr. O.
says, " He first complained of a want of air, and requested the win-
dow to be raised ; whether it was from faintness or a constriction
about the respiratory organs, I do not know, although I think the
latter."

4. What symptoms ensued from the first till death occurred?
Says Dr. O., "When I first saw him, he was lying upon the bed

in a complete tetanic convulsion ; his head somewhat drawn back;
his countenance completely livid, with some frothy matter issuing
from his mouth, with frequent moans. The palpebra constantly in
motion. This first paroxysm may have lasted some five minutes,
which was succeeded by an interval of partial calm." " During this
interval," continues Dr. O., " it was somewhat difBcult for him to
articulate with distinctness. He made several attempts to vomit in
this interval, by exciting the fauces with his ringer. There seemed
to be some constriction about the throat, as it was difficult for him to
swallow. This interval lasted perhaps five minutes, when another
paroxysm commenced by a little starting and stiffening of the ex-
tremities, and immediately the whole body was thrown into a tetanic
paroxysm, in appearance like the first, and lasted two or three min-
utes, when death ended the struggle."

"In about three minutes from the first paroxysm," says Dr. H ,
"the tetanus again returned, and in the space of two minutes death
closed the scene, with terrible spasms of the entire system. The
pulse remained unaffected till the last struggle. It is my opinion that
the immediate cause of death was suspension (?) from spasm."

"His appearance," says Dr. O., " led me to believe that death en-
sued from asphyxia or suffocation. There must have been great
congestion of the brain, which of itself might have proved fatal."
5. How soon after taking the article did death occur?
Dr. H. says, "From the best information which I could obtain, I
should judge that death ensued in fourteen minutes." "The time
from taking the article till death ensued," Dr. O. remarks, "could
not have been over twenty minutes."
' G. Did his mind remain clear till the last struggle?

"I think," replies Dr. II., "that he was perfectly conscious from
the first to the last, except in the paroxysm of tetanus, from the fol-
lowing facts: 1. His appeal which he made to me, as noted in the
first article. 2. On loosening his cravat, he requested me to unbut-
ton his vest, at the same time desiring me to take out his gold watch
and take care of it. 3. An emetic having been administered, he ap-
plied his finger to his throat to provoke a nausea. 4. And, from the
last words he uttered, * I fear, I fear, O God deliver mc.' "
7. What means were used to prevent the fatal result ?

494 Death by Strychnine. [August,

Dr. H. says, "On witnessing the first symptoms, I left the room
for the purpose of obtaining medicine. I procured an emetic of sul-
phate of copper and ipecac; but returning and finding him in a
tetanus, I immediately dashed cold water on his head, face and breast,
and used the most powerful friction on the extremities. He returned
to a state of perfect consciousness. I then proceeded forthwith to
administer the emetic, making use of diluents copiously. I sent a
messenger for some vinegar and ground mustard, and another for a
stomach pump. I used the ground mustard, in warm water freely,
to all of which the patient submitted, seeming to be very grateful for
the efforts which I was making for his relief. The means were used
without any apparent effects." " When death had ensued, a number
of the medical fraternity being present, we retired into an adjoining
room, when the fatal bottle was produced, with the wrapper still
around it. On removing this, it was found labelled 'strychnine.''
Dr. O. states, that "till this time, we were in ignorance of what he
had taken." Dr. H. avers, " that here I wish definitely to state,
that before the last paroxysm came on, I was fully convinced in my
own mind that the fatal drug was not morphia, but strychnia, and I
so declared to those present at the time."

From facts before the committee, derived from reliable sources, it
appears that on the afternoon of the second day before the fatal acci-
dent, Dr. Warner called at an apothecary store in Montpelier, and
asked for and purchased what he supposed to have been a bottle of
sulphate of morphia. This was handed to him by the apothecary
enveloped in brown paper and twisted at both ends. That on the
fatal morning Dr. W. tore off the envelope surrounding the mouth
of the bottle, and took a portion of what he supposed to have been
morphia. He then proceeded to pour some of the supposed morphia
into a small phial into which he had been in the habit of carrying
sulphate of morphia, when he was suddenly arrested by the symp-
toms narrated. It is quite clear that he never entertained any idea
of the fatal drug he had taken. "I am certain," says his afflicted
brother, " that he never for a moment suspected that he had taken
strychnia, and was wholly unconscious of the agency which had pro-
duced his awfully unprecedented sufferings."

Dr. W. had never possessed very firm health, and for about two
years before his death he had suffered from an inordinate action of
the heart, for which he had occasionally taken morphia. This affec-
tion of the heart bad been the sequence of an inflammatory affection
of the chest, which he had early in the year 1844.

The committee has taken considerable pains to ascertain the facts
in this melancholy instance of death from a mysterious mistake. The
mistake was certainly a singular and mysterious one, both in relation
to the apothecary and the unfortunate man. It appears that Dr. W.
asked for sulphate of morphia ; the apothecary intended and supposed
he had sold him morphia till after the fatal event, when he found,
through mistake, he had given him, enveloped in a paper, a bottle of

1847. J Croup cured with Solution of Nitrate of Silver. 495

sulphate of strychnia in lieu of morphia. This exposition of facts
appears to be demanded injustice to the character of the deceased, to
tiie apothecary and to the medical profession.

In a medical point of view, the case is one of much and deep inter-
est, since it so clearly manifests the true and energetic character of
this somewhat new medicinal agent. And in a medico-legal con-
sideration, it may prove of immense importance. In the suddenness
of the effects, and in the quickness of the fatality, from the use of
strychnia, this case is probably without a precedent. Christison,
Pereira, and several monographical writers, in the periodicals, have
recorded some bad results, and some fatal cases, from over dosing
with this agent; but no instance has fallen under our notice in the
human subject in which its administration, either accidentally or
otherwise, has so speedily and terrifically proved fatal.

"No poison," says Christison, "is endowed with more destructive
energy than strychnia." "I have," he adds, "killed a dog in two
minutes with the sixth part of a grain, injected in the form of an
alcoholic solution in the chest. I have seen a wild boar killed in the
same manner with the third of a grain, in ten minutes ; and there is
little doubt that half a grain thrust into a wound might kill a man in
less than a quarter of an hour. It acts in whatever way it is intro-
duced into the system, but most energetically when injected into the
veins."

With the exception of prussic and oxalic acids, there is probably no
agent possessing an equally destructive power. Strong prussic acid
is well known to be sufficiently energetic to destroy cats or dogs,
when properly administered, in less than a minute. And Pereira
examined the body of a man who had accidentally taken oxalic acid
in lieu of Epsom salts, and died in twenty minutes.

Jonathan A. Allen, M. D.

Erasmus D. Warner, M. D.

Wm. P. Russell, M. D.

Two Cases of Croup cured by Cauterizing the Larynx with a Solu-
tion of Nitrate of Silver. By Wm. N. Blakeman, M. D. (New
York Medical and Surgical Reporter.)

On the 10th November, 1846, 1 was called to see a child of Mr. A.,
about two years old, very fat, large for his age, and of leuco-phlegma-
tic temperament. I first saw him at 10 o'clock in the evening, five
hours after the commencement of the disease, with a hot, dry skin,
quick pulse, great restlessness, laborious breathing, and the hoarse
barking or crowing sound peculiar to croup. The family had, previ-
ous to my arrival, given freely of Coxe's hive syrup.

I gave tinct. sang., comp. syrup scilke, with pulv. ipecac, which
caused vomiting, but no relief to the patient. At 3 o'clock on the
morning of the 11th, I gave six grains prot. chlor. hyd., and after

493 Croup cured with Solution of Nitrate of Silver, [August,

waiting two hours, began with the above mixture, to which I added
five grains of tart, antim. ; more free vomiting was produced, and a
copious discharge from the bowels, at 8 o'clock, but without any miti-
gation of a single symptom. I then stopped using the above mixture,
and gave per-sulph. of mer., in doses of qu. grain, the second dose to
be given in half an hour after the first, and then at intervals of an
hour. The child drank freely of warm water, and vomited some
after each repetition of the medicine, but none of that peculiar, heavy,
glairy substance, which is the secretion of this specific inflammation.
At 5 o'clock, P. M., the remedies having done no good, and with the
symptoms of suffocation becoming alarming, I resolved to try the
effect of cauterizing the larynx with a solution of nitrate of silver, a
drachm to an ounce of water.

The application was somewhat difficult, and the dyspncea very
great. A quantity of the thick tenacious substance was brought away
by the sponge, &c, a large quantity by vomiting, which followed.

After waiting ten minute?, I made a second application, bringing
away a larger quantity of membranous matter on the sponge than
before, and a much more copious discharge accompanied the vomit-
ing, caused by the application.

The disease now seemed to be arrested, as very great relief was
apparent to all the family. The breathing was less laborious, the
crowing sound less sharp, and the child more quiet.

I saw the boy at half past 10 o'clock, same evening, five hours and
a half after the first application ; he had improved in all the symp-
toms, breathing decidedly better, the barking sound heard only at
intervals, and he had asked for drink.

I now made a third application of the same solution, which brought
as before, on the sponge, some thick tenacious matter differing from
the first in being of a yellow colour. The boy vomited several times
after this application, each time throwing off a large quantity of the
same yellow-coloured, thick substance, so tough that it could be raised
from the bowl by the fingers. Soon after the vomiting ceased the
child was so much better he fell asleep, in which situation I left him,
with directions to be called if required before morning.

12th, 7 o'clock, A. M., I found him sitting on the bed calling for
food ; he had slept pretty well, asking for drink occasionally, a slight
hoarseness left, for which he required no further treatment.

Case II. I was called on the 20th of January, at 12 o'clock at
night, to see a boy six years old, of sanguine temperament, and florid
complexion, who was taken about two hours before with croup. The
pulse quick, skin hot and dry, the breathing hurried and difficult, the
crowing noise loud, and the child very restless. I determined that
the remedy used last in the former case should be first in this. I
made two applications of the same solution used in the former case.
Some tough phlegm came away on the sponge, and free vomiting
followed, which relieved the patient so that he fell asleep.

21st, 7 o'clock, A. M. The boy has slept well all night, and says
he is quite well, only a little hoarse.

1847.] Action of Ammonia in Hooping -Cough. 497

On the Action of Ammonia in Hooping- Cough. By R. H. Allnatt,
M. D., London. [Lancet, from Braithvvaite's Retrospect.)

[Dr. Wachtl, of Vienna, recommends the employment of ammoni-
ated tincture of cochineal in hooping-cough. Dr. Allnatt thinks that
the spasmodic action of the glottis which remains after the febrile
action has subsided, arises from morbid irritability of the stomach,
engendering a morbid secretion, which stimulates the exhalent ves-
sels of the trachea and bronchi to inordinate action. Dr. Allnatt
adds:]

The excretions of the stomach in this state of disease, if tested, will
be found, almost invariably, to be of extreme acidity, sometimes so
intense, as to excoriate in their passage the oesophagus, and roughen
the teeth, as effectually as would a dose of dilute hydrochloric acid.
Emetics, so greatly extolled for their virtues in subduing the parox-
ysms of hooping-cough, act as temporary alleviants, by ridding the
stomach of its acrid secretion ; but the relief is transient, because the
organ speedily resumes its disordered action. Many years ago, du-
ring a temporary visit to a populous town in the west of England,
while the hooping-cough raged as endemic to an alarming extent,
many children falling victims to its attacks, I had an opportunity of
testing the merits of practice founded upon the views I have taken,
and the result fully justified my anticipations, as the cases, however
urgent, were rapidly and permanently relieved.

Dr. Wachtl, by his ammoniacal mixture, is stated to have "cured
nine cases in from three to eleven days," and I may fully believe the
assertion to be quite consistent with truth. The liquor ammonias, the
active ingredient of the formula, neutralized, in some degree, the
acid matter with which it came in contact, and hence arose the bene-
fit ; but we have other alkalies, less stimulating in their action, and
much more effectual, than ammonia.

After preliminary purgation with calomel, (conjoined with antimo-
ny, if the febrile symptoms run high,) and an occasional emetic to
clear the stomach, nothing in my experience is so efficacious as small
and repeated doses of the carbonate of potassa. The following com-
bination has been extensively distributed to the poor in seasons when
booping-cough has raged as an epidemic, and I can attest the almost
invariable success which has attended its administration what por-
tion of the merit is due to the cochineal I do not know : Take of
carbonate of potassa, one drachm ; cochineal, ten grains ; boiling wa-
ter, half-a-pint. For an infant, one tea-spoonful to be taken thrice
daily: the dose increased according to age.

In violent cases, much benefit will often accrue from the simulta-
neous employment of the following liniment, which is to be well
rubbed, morning and night, over the whole course of the spine:
Hartshorn and oil of amber, of each half an ounce. Mix for a lini-
ment.

32

498 Poisoning by Arsenic, successfully treated. [August,

Case of Poisoning by Arsenic, successfully treated with freshly pre-
pared Hydraied per -oxide of Iron. By C. A. Hall, M. D., of
Northampton, Mass. (Buffalo Med. Journal.)

White oxide of Arsenic had been obtained for destroying rats.
The label and the paper containing it haji been partially destroyed
by the corrosive action of the Arsenic, and it had been poured out
into a tea-cup, and put aside to be re-labelled at some future time.
Subsequently, the family removed to another house, and, in the con-
fusion arising therefrom, the Arsenic was placed near a tea-cup of
the same color containing super carbonate of soda.

On the 25th of December, 1S46, half a tea-spoonful of the Arsenic,
probably about 80 grains, mistaking it for the sup. carbonate of Soda,
was put into a pudding, the greater part of which was afterwards
eaten by two persons. In less than half an hour, severe and dis-
tressing sickness came on, with vomiting and great prostration. Be-
ing alone in the house, and unable even to ?aise a wrndow to call
assistance, they remained for some time in this dangerous situation.
Fortunately a sister, who had been absent, returned home, and in a
few minutes afterwards I was at the house. Finding that Arsenic
had been taken in so large a quantity, and knowing of but one per-
fectly effectual antidote, I at once proceeded to prepare a quan-
tity of the hydrated peroxide of Iron, which I administered with
an unsparing hand. In less than half an hour, decided relief was
obtained, the retching and vomiting, though still kept up, occurred at
longer intervals, and with less severity. The pain and faintness con-
tinued more or less during the night, yet the relief already apparent,
induced me to continue the use of the antidote. The next day the
vomiting occurred but once or twice, and in one only of the persons.
In the meantime, however a new train of symptoms came on. The
tongue was swollen, there was a burning pain and considerable in--
flammation in the throat, accompanied with great thirst, and in one
of the cases with hiccough, and much tenderness of the epigastrium.
The evacuations from the bowels were dark and offensive, and attend-
ed with pain and tenesmus. There was for a long time great pros-
tration of strength ; indeed, neither of the persons have felt quite
well until within a few days.

I am induced to make these cases public, not only to give additionaF
evidence of the efficacy of the freshly prepared hydrated peroxide of
Iron, as an antidote to poisoning by white oxide of Arsenic ^ but,
also, since it is well known that the remedy is of little use except
when freshly prepared, to urge it upon every medical man, not only
to bear in mind how it is prepared, but actually to go through the
manipulations, and prepare it, once at least, for himself. Then, when
it is wanted, as it always is in haste, and when there is no time to
look for specific directions, he can prepare it more dexterously, and
with no doubts or misgivings as to its purity.

Lest there may be some one of your readers who has not a formula

1817.] Fever a Disease of the Spleen. 499

for preparing the Hvdrated peroxide of Iron, I subjoin that of the last
edition (1845) of the U. S. Pharmacopoeia. It has been well sug-
gested that the articles for making it should be kept in vials, in the
proper proportions, ready for use at a moment's notice: ft. Sulphate
of iron, oz. iv. ; sulphuric acid, f. dr. iiiss. ; nitric acid, f. dr. vi. or
q s. ; solution of ammonia, q. s. ; water, oii ; dissolve the sulphate of
iron in water, add the sulphuric acid, and boil the solution ; then add
the nitric acid in small portions, boiling the liquid for a minute after
each addition, until the acid ceases to produce a dark color. Filter
the liquid, allow it to coo!, and add solution of ammonia in excess,
stirring the mixture briskly; wash the precipitate with water until
the washings yield no precipitate with chloride of barium."

In the foregoing case, I used no sulphuric acid. I did not filter
the liquid, or wait for it to cool, nor did I stop to test it with chloride
of barium ; but washed it three or four times with water, poured it on
cotton cloth, and administered it while hot. Doubtless the better
pian would be to follow exactly the directions of the Pharmacopoeia.

Fever a Disease of the Spleen.

To the Editor of the Lancet:

More busied in the "sport of musing" than in the "labour of
thought," a sentence in a past number of a contemporary suggests
to me the following reflections.

Dr. Williams, of University College Hospital, lecturing on the
subject of intermittent fever, in noticing the " poor, impoverished
state of the blood," which attends the disease, adds, "It has been a
matter of doubt (question?) among physiologists, as well as patholo-
gists, how it is that disease of the spleen so peculiarly produces this
anaemia." {Gaz , Oct. 24th, 1845.) In elucidation of this point, I
may observe that it has been long a matter of conviction with me
that the spleen is the laboratory of the hsematosine of the blood.
Harvey, indeed, disclosed how the biood is distributed ; but philoso-
phers appear very generally to have forgotten to ask themselves
whence it is got? where it is made? The heart pumps, the vessels
convey, the lungs aerate, the liver and kidneys depurate, and chyle-
milk renovates, the blood; but, <lc novo, where is it generated?
whence is it originally derived? where is it that the chylous sup-
plies are converted into red globules? Most certainly, to my appre-
hension, in the passage through the spleen.

There are those with whom it has been a favorite theory that
fevers are disease of the blood. I believe that fevers are diseases of
the spleen. Of this I think there exists adequate evidence. Of
course I do not allude to symptomatic or nervous "fevers." A
lesion of the function of the spleen vitiates its product i. e., vitiates
the manufacture of ha)matosine. I have even an idea that the rigors
of ague have some relation to a crisis of puruloid secretion in the

500 A Case of Poisoning from Nitric Acid, [August,

splenic apparatus a vitiation of the splenic process of the formation
of the red principle. It would not appear difficult to account in this
way for the translation of purulent deposits. I have an idea that the
production of animal heat takes place whenever and where ever arteri-
al blood becomes venous viz., in the capillary transit; and that the
splenic product, the hasmatosine of the blood, plays an important part
in the process. If the functions of the spleen, then, be those not
only of the generation of new globules, but also of the renovation or
regeneration of the old, exhausted, or deteriorated red particles,
alike the renovation of the old, and the production of the new mate-
rial of the elementary constituents of the blood, the hasmatosine,
haematin, or cruorin, it is easy to perceive in what way "disease
of the spleen so peculiarly produces anaemia." By the objectionable
term "anaemia," an absence of the red particles, the radical con-
stituent ot blood, is properly indicated. In the history of fevers, after
a review of the facts which connect fevers with the spleen and the
blood, it will not be difficult to come to the conclusion that fevers are
diseases of the spleen, in reference to the functions of that organ as
the laboratory of the elementary constituent of the blood, the haema-
atosine.

I have the honor to be, Sir, your obedient servant,
Hamilton, Nov. 1846. B. Haygarth.

A Case of Poisoning from Nitric Acid vomiting of a considerable
portion of the stomach, and yet no effusion into the peritoneum.

We find the following singular and most remarkable case record-
ed by Dr. C. F. Basse, of Heidelberg, and it is translated from the
review department of the Archives Generates de Medicine of Paris.

A workman, aged 50 years, and addicted to drink, swallowed two
ounces of nitric acid weakened with water. This he did on the 9th
of May, 1845; and with the intention to kill himself. He immedi-
ately experienced dreadful pain in the mouth, pharynx and oesopha-
gus, and vomited a portion of the poison. Several hours after this
he walked to a hospital and solicited relief; but ho was taken to
prison, and an oleaginous emulsion given him. The next day, his
sufferings having increased, he was transferred to a hospital, 36 hours
after swallowing the acid. The mouth and tongue were lined with
a whitish membrane ; the pharynx and tonsils were considerably
tumefied and injected ; the epidermis of the lips, particularly the
inferior, was marked by yellow lines; the respiration was difficult;
thirst intense; pain in the epigastrium with retraction of the belly;
pulse small and frequent. Treatment, antiphlogistic. The follow-
ing clay the patient was in the same state. Eight days subsequently,
he commenced to have appetite. During the night of the 6th to the
7th of June, he vomited what he had eaten, and the nausea and desire

1847.] Conclusions relative to the Placenta. 501

to emesis became constant. The matter vomited was very foetid
and had a gangrenous odour, and with black fluid blood he ejected
a broad piece of membrane a foot long, of a black color, pierced with
holes of different diameters, of a fibrous structure and having a very
thin epithelium. This membrane was recognized as the vascular
and serous coats of the stomach. The vomitings were followed by
very abundant blackish and foetid dejections. He continued in this
state to the 1st of June, when he died.

Autopsy. Upon raising the left lobe of the liver, the anterior part
of the stomach, from the oesophagus to the duodenum was found want-
ing. Its anterior wall was supplied by the concave surface of the
liver, by the transverse colon, and some remains of the coats of the
stomach. The posterior portion of the gastric organ was not des-
troyed, but its walls were soft and gangrenous. Notwithstanding
this condition of the stomach, there had been no effusion into the peri-
toneum, because the liver adhered to the colon and the remains of
this organ were agglutinated to the spleen and diaphragm. Thus a
new cavity was formed, leading from the oesophagus to the duodenum.
The oesophagus was deprived throughout its whole extent of epitheli-
um, and the surrounding parts of the new sac or artificial stomach,
were blackish, softened, and exhaled a foetid odour.

Here is an instance of the destruction of more than half of the
stomach, without the escape of alimentary substances into the perito-
neum. The patient too vomited a part of his own stomach, and lived
a month and five days. This case strengthens M. Magendie's theory
of vomiting viz., that this function is owing to the influence of the
diaphragm and abdominal muscles, and not to the action of the stom-
ach, which is purely passive.

Conclusions Relative to the Structure and Functions of the Placenta.
By John Goodsir, Esq. (Med. Gaz., from Braithwaite.)

[In vol. xii., p. 539, we briefly gave the opinions of Mr. Goodsir on
this subject. In the following extract, however, they are a little
more in detail :]

1. The placenta, as has long been admitted, consists of a foetal and
a maternal portion intermixed. But the maternal portion, instead of
consisting of a part of the vascular system of the mother only, in-
cludes the whole of the external cells of the villi.

2. The external membrane of the placental villi is a portion of the
wall of the vascular system of the mother, continuous with the rest
of that wall, through the medium of the placental threads and lining
membrane of the placental cavity.

3. The system of the external cells of the placental villi belongs
to the decidtia, and is continuous with the parietal division through
the medium of the cavities of the placental threads. This portion of

502 Disputed Period of Gestation. [August,

the decidua has been named the central division of the placental
decidua, and the threads, decidual bars.

4. The function of the external cells of placental villi is to separate
from the blood of the mother the matter destined for the blood of the
foetus. They are, therefore, secreting cells, and are the remains of
the secreting mucous membrane of the uterus.

5. Immediately within the external cells of the placental villi,
there is a membrane which I have named the internal membrane of
the villi. The membrane belongs to the system of the foetus, and in
the external or bounding membrane of the villi of the chorion.

6. Inclosed within the internal membrane of the placental villi, is
a system of cells which belong to the system of the foetus, and are
the cells of the villi of the chorion. These are the internal cells of
the placental villus.

7. The function of the internal cells of the placental villi is to ab-
sorb through the internal membrane the matter secreted by the agency
of the external cells of the villi.

8. The external cells of the placental villi perform, during intra-
uterine existence, a function for which is substituted in extra-uterine
life, the digestive action of the gastro-intestinal mucous membrane.

9. The internal cells of the placental villi perform, during intra-
uterine existence, a function for which is substituted in extra-uterine
life, the digestive action of the gastro-intestinal mucous membrane.

10. The placenta, therefore, not only performs, as has been always
admitted, the functions of a lung, but also the function of an intesti-
nal tube. [Anatomical and Pathological Observations.

Disputed Period of Gestation.

To the Editor of the Lancet:

Sir, I should be much obliged if yourself, or some of your numer-
ous correspondents, could throw some light upon this case, which
involves the welfare, almost existence, of a young and at present a
deserted child :

Two men, A and B, had intercourse, unknown to eacb other, with
a young woman of delicate health; and alter many years, she was
delivered of a female child, nine calendar months and three days
after sexual intercourse with A, and nine calendar months less five
days after similar intercourse with B ; or at the end of 279 days after
intercourse with A, and at the end of 271 days after the intercourse
with B, that is, a period of eight days elapsed between the periods
of intercourse with the two men; and the woman had no female
ailment in the meantime, and it is not believed she knew any other
man. She went her full time, had a good labour, and produced a
fine healthy girl ; had a plentiful supply of milk, and had better
health during her pregnancy and suckling than at any other time.
She, however, suckled her child too long, got excessively low and

1847.] On the Frequency of the Pulse, $c.t of the aged. 503

nervous, it is believed worried herself as to which of the two men was
the father of her child, and has since died.

During her last illness, she said that she always thought that the
child must be the child of A., as she had once before miscarried by
him, and had great affection for him, and her feelings made her think
it was his ; but that she did not know, as the time was beyond nine
calendar months, (she entertaining the opinion that a woman could
not go beyond nine calendar months.)

These circumstances have now become known to both A and B,
and both refuse to maintain the child. A contends, that as the wo-
man was not delivered until nine months and three days after con-
nexion with him, it is physically impossible the child can be his. B
contends that that has nothing to do with it; that 280 days, and not
nine months at all, is the period of gestation ; and that the child,
being born at 279 days after the connexion with A, and only at 271
days alter connexion with B, the probabilities were, that the child was
the child of A, particularly coupled with the fact, that the woman
had once before miscarried by A, and that she had stated, during her
last illness, that her feelings told her it was the child of A.

There is no perceptible likeness of either of the men in the child,
but a marked likeness of the mother.

Either of the men would maintain the child if he could be satisfied
he was the father of it ; and in the hope that you or your correspond-
ents will kindly give such information upon the subject that may
satisfy one of them, I remain, Sir, your constant reader,

London, April 1847. Gilbert Smith.

PART III. MONTHLY PERISCOPE.

On the frequency of the Pulse, fyc., of the aged.-~Dr. Pennock has
instituted quite a number of observations on the pulse and respiration
of the aged. The pulses of 170 men were observed, the aggregate
of whose ages is 10,895, and that of the pulsation, 12,211. The res-
pirations were counted in 140 instances, the total number of inspira-
tions being 3045.

The medium age is therefore 64*09 years-

The medium pulse 71*83 per minute.

The medium respiration 20*51 " "

Ratio of respiration to pulsation, as 1 : 3*51
The pulses of 203 females was noted, the aggregate of whose ages
is 14,326, and that of their pulses 15,838. The respiration was
counted in 143 individuals, and its aggregate is 3,154.
The medium age is 70*57 years.

The medium pulse is 78-02 per minute.

The medium respiration 220G " "

Ratio of respiration to pulse, as 1 : 3*53

504 Case of Doubtful Sex. [August,

From the preceding facts and researches, which appear to have
been carefully observed, it is evident that the frequency of the pulse of
the aged is much greater than that usually assigned to it ; whilst that
of the respiration is equal to that generally admitted in reference to
the adult of middle age. {American Journal Med. Sciences.

Case of Doubtful Sex. Dr. Harris (Am. Journ. Med. Sciences)
reports a case of doubtful sex, the subject of which is now living in
Mecklinburg County, Virginia.

"Ned, a slave and house servant, wearing man's apparel, is about
eighteen years of age and probably five feet eight or nine inches high ;
and though not corpulent, is rather robust than otherwise. His head
is large, with a coarse masculine face, wide mouth, thick lips, femi-
nine voice, and a chin entirely destitute of beard. His skin is soft
and delicate, with upper and lower extremities well formed and
rounded, with the exception of his feet, which resemble very much
the males of the African race. Thus far, however, his general ap-
pearance presents nothing very remarkable, or anything to excite
doubts as to his sexuality. His shining ebony skin and rounded
limbs, are not uncommon with negro boys, trained up as house serv-
ants among the luxurious livers of the South. But on opening his
vest and shirt bosom, there are presented two large and well develop*
ed protuberant mammae, having all the external characteristics of the
breast of a healthy well-formed young woman. His neck, shoulders
and chest partake likewise of this feminine character, having thesoft
and voluptuous outline of the female. On examining the external
genital organs, which, by the way, are exhibited with marked reluc-
tance, a strange and anomalous appearance is presented. The pubis
is large, prominent, and covered with hair as in the female, and but
for the conspicuous projection of a dwarfish-looking penis, about an
inch long in the usual situation of that organ, the creature would at
once be pronounced a woman. This penis is naturally formed in
every respect, and eminently endowed, as he informed me, with virile
sensibility. Immediately below it is a cleft or fissure running back
as in the female organ, to the perineum, the sides of which are formed
of thick folds of skin, resembling somewhat the scrotum, and shaded
with long hair, representing tolerably well the external labia of the
female. No testicles can be found. On separating the thighs the
fissure is found to be from an inch to an inch and a half deep, smooth
at the bottom and exactly in the situation of the vagina. The cav-
ernous portions of the penis may be distinctly felt through the walls
of the cavity near the bottom. The membrane lining it appears, in
fact, to be only a continuation of the outward skin, but is more soft
and delicate ; without, however, any of the characteristics of the vagi-
nal mucous membrane. Pressing the finger on the bottom it yields
so readily, as to induce a belief that there is a cavity within, the out-
let to which is merely closed up by the skin or membrane stretched

1547.] Tying the Carotid Arteries and Arteria Innominata. 505

across the bottom of the fissure. But the anomaly does not stop here.
Tkifl singular creature has been regularly menstruating Tor three or
four years through tlie penis, attended in its inception and prog ss,
by all the symptoms which commonly characterize the catamenia in
young females. So well marked are the returns of this monthly dis-
charge by the usual disturbance of the :he elder mem-
bers of the family are never at a loss to determine when he is under
its influence. As in most females in every station of life, there is
likewise at such periods a shrinking from observation, and the con-
stant exercise of a sleepless vigilance in preventing exposure. The
amount or character of the discharge has never been clearly ascer-
tained, but from his own imperfect account of it. and the evidences
furnished by his linen, it differs not very materially either in quantity
or quality from that of a young woman.

Statistics of Mortality following the operation of tying the Carotid
Arteries and Arteria Innominate. In the July number of the Ameri-
can Journal of the Medical Sciences, Dr. Xorris has presented some
interesting tables, which demonstrate that the dangers resulting from
the ligature of these important vessels are much greater than is
erally supposed. In thirty. eight cases in which the carotid was tied
for the relief of aneurism, twenty-two recovered and sixteen died.
Of these last, two died from inflammation of the sac ; one from in-
flammation of the brain ; five from hemorrhage; one from spasm of
the glottis ; two from apoplexy and congestion of the brain, and
one from exhaustion. In four cases, the cause of death is not men
tioned.

Of thirty cases in which the ligature was rendered necessary by
wounds, fifteen were cured, and fifteen died. In eighteen cases, the
ligature was applied previous to, or at the time of the extirpation of
tumors. Of these six died. In forty-two cases the carotid was tied
with a view to arrest the flow of blood to erectile tumors of the head
or face, or of firm tumors of the jaw, maxillary sinus, or neck.
Of these cases thirteen died. Of these, one died from ulcera-
tion of the tumor; four from hemorrhage; one from convulsions;
one from inflammation of the brain: one from phlebitis of the
internal jugular; one from lock-jaw; one from inflammation of
the chest; two from long continued constitutional disturbance oc-
casioned by disease, and one from apoplexy. In six cases the opera-
tion was performed for the removal of cerebral affections, all of which
terminated favorably. In fifteen instances the ligature was applied
according to Bradsor's method for the cure of aneurism, and four
died. From these tables it appears that of one hundred and forty-
seven cases in which the carotid was ligated that ninety-three sur-
vived the operation, and fifty-four died, showing a mortality of more
than one-third. The ligation of the arteria innominata has been
performed in eight cases, and in everv instance the termination was
fatal.

506 Treatment of Ulcers. Physical Sign of Pneumonia. [August,

Treatment of Ulcers by Firing.
To the Editor of the Lancet :

Sir, In consequence of having lately observed in your journal sev-
eral communications relating to the use of the method called " firing,"
by Dr. Corrigan, I am induced to call the attention of your readers to
another method of applying dry heat, which I have repeatedly witness-
ed in the practice of M. Malgaigne at the Hopital de Clinique.

This method is chiefly useful in procuring cicatrization of unheal-
thy ulcers of the skin, such as are left after the evacuation of the
pus of buboes. The heat is applied by heating to redness one of the
numerous irons used for actual cautery in the Paris hospitals, and
holding it over the sore at such a distance as to produce an agreea-
ble sensation of warmth to the part. In proportion as the iron cools,
it is carried nearer and nearer, until, at last, it may be entrusted to
the patient himself to hold, with instructions to continue approaching
the iron to the ulcer as the iron cools.

I have not seen this method of treating obstinate ulcers employed
anywhere else but in the wards of M. Malgaigne, although, from the
excellent effects I witnessed from its use, I think it is deserving of
being more generally tried. The first visible effect of the applica-
tion is the assumption of a cleaner appearance by the sore, then a
shining white pellicle of lymph spreads over the surface, and frequent-
ly within twelve hours of the first application, cicatrization has made
some progress around the edges of the sore. In two cases I noted
the complete cicatrization of unhealthy looking ulcerations resulting
from large buboes in the groin, in eighteen hours.

Notting Hill, Jan. 1847. Robert Babxes, M. B.

Physical Sign of Pneumonia in the Apex of the Lungs. Dr. Wm,
Boling (American Journal) has suggested a sign by which the exist-
ence of pneumonia in the apex of the lungs may be ascertained.
He says: "This is a fine mucous or crepitant rhonchus, seemingly
seated in the larynx, loud enough to be heard distinctly at the distance
of two or three feet from the patient, and so persistent, that it is not
removable, or but momentarily, by any effort to expectorate which
the patient may make, while at the same time there are present none
of trie signs of bronchitis or laryngitis. Though it is exceedingly an-
noying to the observer to hear it, because it impresses him with the
belief that it is distressing to the patient, and he looks with a feeling
rather of impatience for an attempt, by an effect to expectorate, for its
removal ; the patient seems perfectly indifferent to its presence, which
would not be the case were it really produced by the presence of a
small quantity of tenacious mucus in the larynx itself. The sound,
then, is only seemingly produced in the larynx, for on applying the
stethoscope immediately under or just above the clavicles, it will be
discovered to proceed from the apex of one or the other lung, which
will be found the seat of inflammatory action. It would seem that
the sound there produced in the pulmonary vesicles, must be conveyed

1847.] Vomiting caused by Relaxation. -Nit. of Silver in Colitis. 507

by the larger bronchial ramifications, numerous and superficial at
this point, to the larynx, where, in consequence of the thinness of the
tube, or rather the thinness of its covering, and its proximity to the
surface, the deceptive impression of its production in this organ, from
the presence of a small quantity of viscid mucus, is created.

It is the indifference of the patient to the presence of the sound, but
still more especially its persistence, which constitutes its peculiar and
distinctive feature, and upon which its value as an evidence of pneu-
monia commencing in the apex of the lung depends. In other af-
fections of the lungs and air passages, more especially in bronchitis,
we may have a somewhat similar sound produced in the larynx itself,
by the play of the passing air through a small quantity of viscid mu-
cus there collected ; but under such circumstances, it is removable by
coughing, or an effort to expectorate, and once removed may not re-
turn again, or only after a considerable interval, when a fresh collec-
tion of mucus has taken place. The patient, too, does not manifest
the same indifference in regard to its presence, but the mucus pro-
ducing it soon excites an effort for its removal."

Vomiting caused by relaxation of the Abdominal Parietes ; band-
age ; cure. M. Greppo relates the case of a woman whose abdominal
parietes were considerably relaxed in consequence of pregnancy.
"\ arious remedies had been unsuccessfully employed against the hab-
itual vomiting by which she was exhausted. M. Greppo applied a
bandage, and the vomiting disappeared, but returned whenever the
bandage was removed.

This fact demonstrates clearly the origin of certain cases of ob-
stinate vomiting which are combated in vain by every imaginable
method, and the efficiency of the most simple mode when it is ad-
dressed directly to the cause of the accident. How many errors
would be avoided in medicine if the connection of symptoms with
their causes could always be appreciated as clearly as in this case.
[Translated from Bulletin Tkerapeutique, May, 1847.

Injection of Nitrate of Silver in Jkute Colitis. We frequently
meet in very young infants with a particular form of diarrhoea caused
by an acute and always superficial inflammation of the mucous mem-
brane of the large intestine, the small intestine remaining perfectly
healthy. This diarrhoea in its most simple form is ordinarily unat-
tended by fever, and can generally be distinguished by particular
signs from the catarrhal inflammation of the small intestine. Vari-
ous remedies, particularly opium and its different preparations, are
employed in such cases, frequently, it is true, with good effect, but
they are almost always uncertain.

Professor Trousseau, appreciating the utility of the topical and
substitutive medication whose action and power are always in some
degree under the control of the physician, conceived the idea of em-
ploying in colitis this medication, by administering injections of the

508 Chlorate of Potassa in Cancerous Ulcers. [August,

nitrate of silver, so that it might come in immediate contact with the
inflamed mucous membrane. The treatment has been generally-
happy, and meets every day with new success. It is important, how-
ever, that it should be employed with great care and not inopportune,
ly, as for example in cases where the phlegmasia is confined to the
small intestine. The following case shews the advantage of this
treatment, and the course to be adopted.

An infant of 15 months was brought into the ward Sainte-Julie.
The constitution was tolerably robust, and the health had been good
until within the two last months, when it had been weaned and nour-
ished by improper food. During this time it had been subject to
diarrhoea ; the evacuations were numerous, (8 or 10 per day,) of very
slight consistence, of a deep green color, without any mixture of yel-
lowish matter, and often preceded by violent colic ; the abdomen
was painful upon pressure, in the direction of the colon, and scarcely
any fever existed. In this state the infant was brought to the hos-
pital. The following injection was prescribed : Cristalized nitrate
of silver 4 of a grain; Water about a ^ pint. An injection of sim-
ple lukewarm water was first administered, and after it returned
bringing away the matter which had covered the surface of the intes-
tine, the injection of the nitrate of silver. was given in an ordinary
pewter syringe. On the first day the evacuations were reduced from
ten to four. The injection was repeated, and on the second day there
were only two evacuations, of a yellowish color and ordinary con-
sistence, and the colic had disappeared. The patient left the hospital
perfectly cured. [Ibid.

Chlorate of Potassa, employed externally in Cancerous Ulcers.
In our last number we mentioned the happy application which Dr.
Hunt has made of the chlorate of potassa to the treatment of the
gangrenous ulcers of the mouth of infants. Dr. Tedeschi has re-
cently tried successfully the same remedy in a case of cancerous
ulcer of the face. The following is his account of the application
and of its results. A man aged 26 years, of a scrofulous diathesis,
had upon the superior lip an the wing of the nose an ulcer of about
one square inch in extent, with elevated and callous margins ; the
glands of the neck were engorged and painful. A great number of
remedies, both internal and external, had been employed in vain the
flowers of zinc, the muriate of lime, the decoction of hemlock, the
deuto-chloride of mercury, the red oxide of mercury ointment, the
aqua phagedenica, the arsenical powder, &c. After three months
thus uselessly expended, M. Tedeschi employed the chlorate of potas-
sa in the following manner. He applied to the ulcer lotions made
by dissolving 130 grains of the salt in about 5 ounces of water, con-
tinuing the internal use of emollient decoctions and of iodine pre-
parations. In the course of a few days the ulcer presented an evident
amelioration; the margins were less elevated, the suppuration be-
came healthy, and in twenty days a good cicatrix was formed. The

1847.] Secale Cornutum. Operation of Tracheotomy. 509

glandular engorgements gradually disappeared, and in less than two
months the cure was complete. This fact is of such a nature as to
encourage new attempts. [2! 7

Hemostatic Property of Secale t ornutum veseeninXo. 9

of the ward St. Lazare a man of ^5 years ol a vigorous con-

stitution, but laboring under considerable debility and even extreme
anemia, in consequence of bleeding piles. According to the state-
ment of the patient he had been much afflicted for several years with
hemorrhoidal tumors which were frequently protruded during defeca-
tion, and with the fseces he discharged a sufficient quantity of blood
to produce the exhaustion under which he was then suffering.

M. Martin Solon put the patient upon a tonic regimen, and after
having employed unsuccessfully the extract of rhatany and other ar-
ticles, he prescribed six, eight, and then nine grains of secale cornu-
tum, to be taken four times per diem. The discharge of blood ceased
immediately, defecation became more easy, and in three weeks the
patient left the hospital perfectly cured. ^-[Ibid.

Introduction of Air into the Veins during the Operation of Trache-
otomy. The occurrence o this dreadful accident during an operation
of tracheotomy is an unusual fact, to which it is important to call the
attention of practitioners.

A female, by occupation a mattress maker, and about 50 years of
age, was attacked, in January, 1847, by vague pains and sensations
of uneasiness, soon followed by pains in the larynx ; deglutition was
embarrassed, and a frequent cough brought up often small threads of
blood. On the 3d of March, being attacked by an intense dyspnoea,
she was admitted into the Hospital Beaujon, in the service of M.
Bouvier, who, believing tracheotomy urgently necessary, consigned
the patient to M. Robert. The respiration was exceedingly difficult
and presented the characters assigned to cedematous inflammation of
the superior extremity of the pharynx. Inspiration was long, sonor-
ous, and excessively laborious. Expiration, on the contrary, was
prompt and easy. The pulse was very small and frequent, the coun-
tenance pale, the skin covered with a cold and clammy sweat, and
the anxiety of the patient was extreme. M. Robert believed it to be
his duty to perform tracheotomy in all haste. A vertical incision
having been made downwards from the laryngeal projection through
the skin, the sub-cutaneous cellular tissue and the superficial cervical
aponeurosis were divided ; but at this moment an anastomotic branch
between the two anterior jugular veins having been divided, a very
acute sound of aspiration was heard in the wound while the patient
was making an inspiratory effort, and immediately afterwards, during
expiration, a considerable quantity of venous blood with many bubbles
of air escaped with a gurgling sound from the left lip of the incision.
M. Robert immediately applied his finger upon this point ; but while
causing the finger of an assistant to be substituted for his own, in

510 Substitute for the Vapour of Ether. [August,

order that he might continue the operation, a new sound was heard,
followed by the same reflux of venous blood, and immediately the
patient, exclaiming (hat she was dying, became pale and remained
almost inanimate. While an assistant compressed more exactly the
iips of the wound, the surgeon hastened to finish the operation. The
incision of the trachea having been made with all possible celerity,
he introduced a canula into its cavity.

The patient continued in a state of syncope ; cold water was dash-
ed upon her face ; she was exposed in a current of air, and exciting
frictions were made upon her chest ; after some instants she made a
slow and protracted inspiration ; a second followed after a short
interval; the pulse revived, and the skin became slightly warm.
During the entire diy the woman preserved a certain degree of pros-
tration, and it was only by degrees that these serious symptoms dis-
appeared.

As we perceive, this case, which we have transcribed with all its
details, can leave no doubt of the reality of the introduction of air
into the veins. If the patient did not succumb, it was owing, doubt-
less, to the small calibre of the vein which had given admission to a
very small quantity of air. The first introduction did not seem to
produce much disturbance ; the second caused* very serious accidents ;
another inspiration would probably have made death inevita-ble. We
have cited this interesting case in order to put practitioners upon their
guard against a similar accident. The extreme difficulty of the res-
piration by accumulating the black blood in the veins increases theif
volume and renders the introduction of air very easy whenever an
incision made into a greatly distended vessel empties it of the blood
which it had contained before it has time to return to its normal
dimensions. We would be almost tempted in such cases, when the
respiration is so greatly embarrassed, to cut down to the trachea
directly, in order to re-establish at once the respiration, and thus re-
move that congestion of the veins which has the double inconvenience
of rendering their lesion more inevitable and of increasing the danger
of the operation. [Ibid.

Substitute for the Vapour of Ether to annul sensation during oper-
ations. By Dr Datjriol. At midsummer, when vegetation is at its
height, solanum nigrum, hyoscyamus niger, cicuta minor, datura
stramonium, lactuca virosa, are gathered, and a sponge is plunged in
their juice freshly expressed. The sponge is then dried in the sun,
the process of dipping and drying is repeated two or three times, and
the sponge is then laid up in a dry place.

When the sponge is required for use, it is soaked for a short time
in hot water ; afterwards it is placed under the nose of the person to
be operated upon, who is quickly plunged into sleep, more or less
deep, according to the susceptibility of his nervous system. The
operation may then be proceeded with without any fear that the pa-
tient has any sensation of pain. He is readily aroused from the stupor
by a rag dipped in vinegar, and placed to his nose.

1 847.] Action of Scammony. Death of the Mother. Prescrip. 511

M. Dauriol records five cases in which he has successfully employ-
ed this means of bringing about insensibility during operations.

[London Lancet, from Am. Journ. Med. Sci.

The Action of Scammony. M. Raver has recently tested the action
of this medicine in his wards at La Charitie Hospital, Paris. Hehas
decided that it is neither a drastic nor hydragogue purgative. In
his hands its action was mild, it was easy of administration, and if nny
thing it rather proved itself cholagogue, for the discharges were not
serous, but yellowish from the increased quantity of bile. He gave
it in from 4 to 30 grains in a single dose enveloped in unfermented
bread, and at 4 o'clock in the morning. In cases of constipation or
w'herein purgation was indicated, it generally produced from two to
seven evacuations in the space of three or four hours. It possessed
no special effect over dropsies. [Journ. des ConnaissanceMedico-
Chinurg.

Death of the Mother Delivery of the Child by the Caesarian
section: it lives. M. De Pelayo, in the Anales de Cirugia of Ma-
drid, says, that on the 8th February, 1847, he was called to a woman
aged 30, who was in labour. During the progress of the case, she
suddenly exclaimed I am lost, and died. Without delay, and assist-
ed only by a female, the Doctor performed the ccesarian operation,
and in five minutes after the death of the mother he extracted asmall
female infant. By blowing in its mouth and using frictions to the
chest and spine, she began to breath, and eight days afterwards was
doing remarkably well.

This woman was not married until the day of her accouchment,
and her husband thus in the space of a few hours, passed successive-
ly through the positions of bachelor, married man, widower and
father. [Translated from Gaz. Medicale de Paris.

PRESCRIPTIONS.

For Constitutional Syphilis. By M. Gibert, of the St. Louis
Hospital. Take, Iodide of Mercury 2 grains; Iodide of Potash 100
grains; Gum Arabic Powder 10 grains ; Honey enough to make
twenty pills. Dose two pills before breakfast.

For Gonorrhoea. By M. Pons y Guimera. Catechu 2 drachms,
dissolved in 5 ounces of distilled water. Inject into the urethra and
retain it a minute and a half.

For Syphilitic Eruptions of the Skin. By M. Cazenave, of (ho
St. Louis Hospital, Paris. Protoiodide of Mercury 10 grains; Liquo-
rice powder 30. Make twenty pi lie. Dose one to four pills in
twenty-four hours.

Protoiodide of Mercury 2 3 ; Liquorice powder 4 3. Make forty
pills. To be given as above. He recommends this preparation of
mercury as high as 4 grs. per diem. It should never be combined
with opium.

512

Medical Intelligence.

Meteorological Observations.

MEDICAL INTELLIGENCE.

To our Readers. In our next number we intend to bet: in the publication of
such of other proceedings of the late National Medical C

tion, a the] Th would have bean sooner

performed, but a c i t body, did not reach us

irnaL In our next
wc pi Ethics which was adopted unani-

mously by the Convention, and which must prove of vast utility to physicians
as embodying ample regulations for professional intercourse by which all differ-
maybe adjudicated. We have many treatises on Medical ethics, but it
required the adoption of a code suited to the profession in America, by
competent body to give efficiency to it. This has been done by the late Conven-
tion, and in our next number we will place their work before our readers.

.1/ Meal Miscellany. By the M ' Collegium of Prussia, no apothecary in

the kingdom can dispense any prescription of a physician containing a ;

ous article, beyond its maximum Ass, without the Doctor expressly states the

condition requiring it. At a recent trial at Essex in England, it ap;

man by the name of BentJey, had strangled at least twenty-four horses in various
parts of that country. His object was -fin, for though sold ostensibly to dealers
in horse-Oesh for dogs, yet they arc often disposed of for human food'.

METEOROLOGICAL OBSERVATIONS, lor June, 1847, at Augusts,

Ga. Latitude o,)'27 north Longitude 4 32' west Wash. Altitude ,
tide 159 feet.

2

Sun

-.

TlIKR.

1

GO

2

70

3

70

4

70

5

G9

6

68

7

70

8

62

!

0 2

Lu-

62

ll

To

12

69

13

63

l 1

68

15

66

16

01

11

70

IS

73

19

68

20

69

21

63

...i

63

63

>> |

63

25

68

70

71

>

71

- v

:;.)

71

use.

Bar.

! P. M.

iTher.

JO 7.')- 1 oo

" 7.V 1 00

71-10. i

' 09-100

" 71-100

70-100

77-100

90-100

90-100

" 88-100

<; (JO. 1 00

" 65-100

" 68-100

<< 65-100

66-100

" 72-100

8U00

85-100

B7-100

;i mi

" 71-100

19-100
BO-100

81 10 I

85-100

68-100

;.l lOOil

88
no
90
81
80
84
81
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83
B2
B3
82
83
90
85
83
B8
-1

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80
80
66
80
-

36

M

D I

Bar.

Wind.

!fl 75-10O|
;i 75-100)

': OS- 1 00

00-100

;: 72-100
;; 75-100
82-100
88-100

90 100
72-100

59- 1 00

07-ioo
70-100

65-100
70-100
: 77-100
82-100
B5-100
B5-100
" 00-100
75 100
-i LOO
' SI -| 00
82 100

83 100
- 90-100

so. ion

00 100

w.
w.
w.

a.
s.

w.

N. B.

S. E.

E.
ft, B.

w.

w.
s. w.

s. w.

\. W.
W.

V.'.

\. B.

S. K.

s. B.

\. W.

-

B. w.

R::. marks.

Fair flying clouds.
Fair, " do, [40-100.

Fair, do. rain at 10, p. m.

Showery, 15-100.

Showery.
Showery,

Cloud v.'

Fair. '

Cloudy.

Cloudy.

Cloud'v rain last niuht 75-ioO.

Fair. '

Showery blow.

Fair blow rain 05-100.

Fair. [15-100,

Fair Morm at 7, p. m. rain

Fair.

( 'loudy.

Cloudy rain at night,

Rain,

fair.

Cloudy.

1 inch.
Rain, 30-100.
Flying clouds sprinkle.

Do do.

Cloudy thunder, (
Cloudy thunder, i

D Bprinkle,
Cloudy sprinkle.

;,,

100.

Bui i rained on II Quantity of Rain 4 inches

and 5-10. Wind lla-t ofN.andS. 13 days. \\ esl ol do. 13 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 8.] NEW SERIES. SEPTEMBER, 1817. [No. 9.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXXIII.

Cases of Convulsions and other Nervous Affections, during Pregnan-
cy, Parturition and the Puerperal state. By Joseph A. Eve, M. D.,
Prof, of Obstetrics, &c, &c, in the Medical College of Georgia.

Of all the diseases to which pregnant, parturient, or puerperal wo-
men are liable, there is none more frequent in its occurrence, more
terrific in its invasion, or more truly dangerous in its results, than
convulsions, and consequently none that requires to be met with
more promptness and decision, or combatted with more boldness and
energy ; it is therefore of the very first importance that every practi-
tioner, however young and inexperienced, should be thoroughly
informed, that he maybe prepared to meet such dangerous emer-
gencies. His reliance must be on his own resources; for should he
wait for the counsel or assistance of others, -the favorable opportunity
may be lost : then any efforts, however well directed, will not avail,
and it will only remain for him to witness sufferings that he cannot
relieve, and destruction that he cannot avert.

My object in the following pages is to give some details of my own
practice and to make some comments thereon, with the hope of being
able, in some degree, to benefit my younger professional brethren,
and particularly to oblige the former pupils of our Medical College,
who have kindly and frequently expressed a desire to have our views
on certain subjects in a more permanent form, than oral instruction.
We are induced the more readily to yield to their request, because
we remember with gratitude their patient attention to our efforts to
instruct them, and because we feel the same desire to serve them
now, as before.

33

514 Cases of Puerperal Convulsions, <fyc. [September,

It is my design to avoid, as far as practicable, all theoretical
discussion, to confine myself to details of my own practice, and to
make such deductions as may be legitimately drawn from the facts.
But it is not my intention to restrict myself to cases which properly
come under the head of puerperal convulsions, for whilst some of
these shall be omitted to prevent the unnecessary and tiresome repe-
tifion of cases in all respects identical, and some that were not seen
until they were beyond the reach of medicine; other cases will be:
included, in which convulsions, although imminently threatened,
were averted, and some other nervous affections which it is hoped
will not be deemed altogether irrelevant or devoid of interest, as they
may serve to throw some light on the subject under consideration.
It may however be proper to remark that in all the cases omitted,,
the result was favorable, except in two, which occurred at a consider-
able distance in the country, in one of which the patient was moribund
and in the other, in a desperate condition, before they were seen.

It would be much easier, and more in accordance with the course"
usually pursued, to present my views first, and then to refer to au-
thorities and to adduce cases in support of the positions assumed ;
but an opposite procedure is preferred, not only because it is more in
obedience with the dictates of the inductive philosophy, the most cer-
tain, rational and profitable method of investigating any subject ; but
because most of my opinions being the result of personal observation,
it seems most in order to state the facts observed, and then the con-
clusions deduced from them.

The cases will generally be stated in the most concise manner;
for whilst it may be proper to be sufficiently particular in some, to
develop fully the plans and principles of treatment adopted, it will be
tiresome to descend to the same minuteness in all.

After presenting a summary of cases, I will give my views of the
nature and treatment of puerperal convulsions, and refer to those;
cases in confirmation of the opinions entertained.

The term Puerperal Convulsions shall be used, according to the
application made by most obstetric authors, as comprising all cases
of convulsions, occurring not only during parturition and the period
immediately subsequent to it, but at any time during pregnancy.

Cases of puerperal convulsions may be divided into those which
occur before the termination of the eighth month, those which occur
any time after the eighth month or which anticipate labour, those
which occur during labour, and those which take place after delivery.

1847.J Cases of Puerperal Convulsions, fyc. 515

Cases occurring before the termination of the eighth month.

Case I. .Mrs. B. M., a lady of nervous temperament, small stat-
ure, but large head, highly intellectual and accomplished, subject
to determination of blood to the head, long before marriage, from
too close application to study, about 13 years of age, six months
advanced in her second pregnancy, suffered during the night of the
13th April, 1S43, with an intense headache, which continued to
increase until daylight, when she was seized with a violent convul-
sion. On my arrival, one hour after, she had a second convulsion,
she was immediately bled to the extent of making a decided impres-
sion on her pulse, her feet were placed in a hot mustard bath, cold
water poured on her head from a height, and sinapisms applied to her
extremities and along the course of the spine. She remained com-
posed until 12 o'clock, M., when she had another convulsion, quite
as severe as either of the preceding: she was again bled, and the
warm pediluvia, cold dash to the head, sinapisms, &c., repeated, her
hair was cut off and ice applied to her head during the intervals of
pouring the cold water. About 6, P. ?!., she had another, but much
less violent convulsion. A scruple of calomel was administered as
soon as it could be swallowed, and its operation promoted by the
sulphate of magnesia and purgative enemata.

This patient remained free from disease and comparatively com-
fortable until the morning of the 13th, when labour pains came on
and she expelled a foetus evidently some days dead, the death doubt-
less caused by the convulsion. From this time she continued gradu-
allv to regain her health and strength.

The following year, this lady became pregnant again, and suffered
exceedingly from various nervous affections, such as painful spas-
modic seizures of the muscles of the arms, followed by a most dis-
tressing numbness of the hands and arms, partial paralysis of the
tongue with an inability to articulate distinctly. Her sufferings at
times were indescribably severe. Great apprehension was enter-
tained that she would have convulsions, when parturition should come
on, if not during gestation. But the most careful attention was given
to her diet, to the state of her bowels and to exercise. She was in-
duced to take a ride or walk every afternoon ; she was bled once,
took calomel two or three times, and saline laxatives whenever there
was a tendency to constipation. Plethora of the sanguine system and
too great accumulation of nei excitability were thus prevented,

and notwithstanding she suffered, bo frequently and intensely durin^

516 Cases of Puerperal Convulsions, eye. [September,

pregnancy, she went her full time, and had a natural and rapid labour
and a prosperous convalescence. Previous to the supervention of
the convulsion, her face, hands and arms, feet and ankles were con-
siderably swollen.

Case If. Mrs. R.,a lady of sanguine temperament, of remarka-
bly large and robust frame, inclining to obesity, about 30 years of age,
six months advanced in gestation, had been for some days complain-
ing of abdominal pains, resembling colic, for which she took the
sulphate of morphine. On the morning of November 17th, 1840,
she took a large portion without medical advice, in all probability a
grain or more : not very long after taking this dose, she was seized
with a violent convulsion, which soon resulted in profound coma.

My friend, Dr. Garvin, was aiso called to this patient. She was-
bled to a decided effect upon her pulse ; cold water poured from a
height upon her head ; sinapisms applied to her spine and extremities ;
her feet placed in a hot mustard bath, and purgative enemata admin-
istered. In about two hours she recovered her speech and her senses
so far as to understand and answer questions; she was threatened
with a return of convulsions through that day and night, and did not
have any recollection of what passed for forty-eight hours. She took'
a dose of calomel, the day she had the convulsion and for several
days subsequent, her bowels were acted on by magnesia, salts, oil,
&c. She was also bled again on the 18tb. After this her health'
became good, but she felt no fcetal movements. On the 15th Decem-
ber, about one month after the convulsion, labour pains came on and
she expelled a foetus, from its appearance, some time dead. There
was no recurrence, nor even a threatening of convulsions during
labour.

Case III. Mrs. C, 19 years of age, of highly nervous tempera-
ment and slender frame, six months advanced in her first pregnancy,
had become, contrary to her ordinary habit, very fleshy and plethoric.
This lady had on the night of the 1st August, 1845, a most intense
headache her eyes had a peculiar wildness of expression and her
countenance indicated extreme suffering; she was bled immediate-
ly to the extent of thirty. two ounces, with prompt and decided relief:
an active cathartic was prescribed the next day, and she continued
tolerably comfortable, with however occasional spells of headache of
milder grade, until the afternoon of the 7th, an interval of six days,
when during the absence of her husband from home she had a con-
vulsion; but as none except servants were present, her husband,

1847.] Cases of Puerperal Convulsions, <^c. 517

himself a physician, and myself, could not learn any thing satisfacto-
ry as to its nature and degree of violence, and were even left in doubt
as to the fact of her having had a convulsion, as she had recovered
from it before we saw her ; we did not therefore adopt any very ac-
tive plan of treatment. After waiting some time, there being no
return, I left her in charge of her husband. Not long after my
leaving the house, she had a violent convulsion. Dr. C. immediately
took away not less than forty ounces of blood. Sinapisms were
applied to her spine and extremities; cold water poured on her head
from a height ; her {eet placed in a hot mustard bath, and as socn as
she could swallow, a large dose of calomel was administered. She
had only one more convulsion, and that much milder than the second.
She continued in feeble health, without foetal movements, until the
26th, nineteen days after the convulsions, when parturient pains
came on, and she expelled a foetus that presented transversely, and
from its appearance, sometime dead : after this she regained good
health. The following year she became pregnant, and passed hap-
pily through gestation and parturition.

Case IV. Mrs, S. G., a lady of decidedly sanguine temperament,
very robust and plethoric, 34 years of age, the mother of eight chil-
dren, six months advanced in pregnancy, after suffering pain and
fulness of the head, on the 25th July, 1845, had a violent convulsion,
which terminated in insensibility ; her husband immediately opened
a vein in her arm with his penknife, and took between thirty and
forty ounces of blood : sinapisms, &c, were applied. She recovered
her senses in forty-five minutes. A scruple of calomel was adminis-
tered, to be followed in four hours by sulphate of magnesia.

The day after, she was quite comfortable, having had no return of
convulsions. She was directed to live chiefly on vegetable diet ; to
obviate constipation, to which she was much disposed, by gentle
laxatives when required, and to take exercise daily in the open air.
By adopting this course, she passed happily through pregnancy and
parturition, and gave birth to a fine healthy child. This lady had
had convulsions in her last confinement, which will be subject of
case 9th, coming under the head of Convulsions anticipating labour.
Case V. Mrs. S., a lady of nervous temperament, of very small
and delicate stature, but more plethoric than usual, aged 2G, married
four years,, had had several abortions about (lie second month, was
now five months advanced in pregnancy. Abortion had been threat-
ened, two weeks, by a sanguine discharge and intermittent pains.

518 Cases of Puerperal Convulsions, <fyc. [September,

Mrs. S. was detained in Augusta by her situation, having arrived
hero by rail-road on the 2d February, on her way to her residence
some hundred miles distant. The night of the 12th she complained
of severe pain in the abdomen, supposed to be colic, for which she
took, without medical advice, a table-spoonful or two of brandy and
twenty or thirty drops of laudanum. Early next morning, the 13th,
she complained of intense headache, and at 8 o'clock, A. M., was
seized with a violent convulsion. My first visit was in a half hour
after the convulsion intelligence was very imperfectly restored : her
pulse was full and strong; I endeavored to anticipate another con-
vulsion by a copious abstraction of blood ; but it was too late ;
twenty ounces were taken ; convulsions continued to occur at inter-
vals of about a half hour, notwithstanding the vigorous employment
of the most powerfully active means, practiced in the preceding cases,
until she had seven, when the pulse becoming again more developed
and tense, sixteen ounces more of blood were taken half-past 11
o'clock, A. M., after which the convulsions ceased, her mind became
much clearer, her countenance and expression much more natural,
and she remained free from pain and comparatively comfortable,
until about 12 o'clock at night, when labour came on, which she
passed through without the slightest indication of convulsions. In
this case, although miscarriage had evidently commenced a fortnight
before the supervention of the convulsions, (as *vas evinced by uterine
pains and sanguine discharge.) the womb remained quiescent during
the convulsions, and for twelve hours after, until her system had
somewhat recovered from the shock occasioned by them, nor was
there, as I have remarked, dining the agitation of labour, which last-
ed eight hours, the slightest tendency to a return of convulsions.

Case VI. Mrs. D., a lady of nervous temperament, of large stat-
ure, but feeble health, about 32 years of age, had had one living
child and several miscarriages, and was now six months advanced in
pregnancy. On the morning of December 22d, 1842, had a convul-
sion, from which she recovered promptly. Neither the state of her
head nor her pulse indicated the loss of blood. The usual remedies,
with the exception of blood-letting, were employed, and in addition
an emetic and antispasmodics, as assafoetida, tec.; were administered.
Convulsions continued to recur at irregular intervals until she had
eight. In the evening, after a suspension of some hours, a \ grain
of the sulphate of morphine was administered with the view of pre-
venting their recurrence during the night. The next morning she

1847.] Cases of Puerperal Convulsions, $c. 519

was comfortable, but had no recollection of what had passed the day
befora. Dr. Dugas saw this patient in consultation after the second
convulsion, and fully concurred in withholding the lancet, and pur-
suing the course above stated. This lady soon recovered her usual
health, but did not perceive any motion of the foetus, which however
was not expelled until the 2d January, 1843, one month after, bear-
ing the evidences of having'beena long time dead.

This is the only case of convulsions either during pregnancy or
parturition that I could regard as hysteric, the only one in which
bloodletting has not been clearly indicated.

Case VII. Mrs. D., a lady of sanguine, nervous temperament,
aged twenty years ; health generally delicate, but at the time of at-
tack more plethoric than usual; about 7 months advanced in preg-
nancy, about 7 o'clock P. M., Feb. 16th, 1842, had a violent con-
vulsion followed by insensibility. As she resided at a distance of
eight miles, several hours had elapsed before she was seen ; she was
still in profound coma. Bloodletting was carried to the fullest extent
that prudence would justify the most energetic application of cold
to the head and sinapisms to the spine and extremities were repeat-
edly put in practice during the night. About daylight, she began to
speak incoherently and unintelligibly at first, but soon recovered her
senses. Her condition when I left her, was as comfortable and pro-
mising as could have been expected.

On the morning of the 20th, being called to her again, I found her
labouring under intense pneumonia, caused by exposure to extreme
cold in her reduced state, having been removed, contrary to my ex-
press orders, into a most uncomfortable room without a chimney,
-during a very inclement spell of weather. The recent abstraction
of blood precluded all farther depletion : a blister was applied
emetic tartar, warm pediluvia, and all such means and appliances as
her symptoms indicated and her condition admitted, were employed.
She could not be regarded otherwise than in a desperate state.

On the 22nd, at 9 o'clock, A. 3U., the pneumonia had not abated,
and labour had commenced. Before the expulsion of the foetus, she
began to sink. A forlorn hope was indulged that the system might
rally when the uterus was relieved of its contents the foetus was
promptly extracted by the crotchet and the placenta quickly removed ;
but in vain.

There was no renewal of the original disease no convulsive
movement distorted her dying face. As ; the convulsion, this

520 Cases of Puerperal Convulsions, <$fc. [September,

case may fairly be considered a recovery: 'he premature delivery
and death are justly attributable to the subsequent pneumonia.

Cases anticipating Lahour.

These constitute a less numerous, but a more dangerous class of
cases. According to my observation they occur generally during
the ninth month and can very rarely be' arrested until alter delivery.

Case VIII. Mrs. VvT., of nervous temperament, and small, feeble
stature, 16 years of age, 8 months advanced in her first pregnancy,
contrary to her ordinary habit had become very fleshy and plethoric,
March 4th, 1844, feeling very unwell, she had visited a friend a
mile from home, in hope to be benefitted by the walk in the even-
ing she was too sick to return, and suffered all night from headache,
which became intolerable in the morning, on which account I was
called to her.

Before she could be bled, a violent convulsion came on she was
bled as soon as practicable, to the extent of thirty. two ounces, and
of making a decided impression on the pulse. Sensibility was par-
tially restored in a short time. But another convulsion ensued,
another and another, in rapid succession, through the day, each one
rendering the coma more and more profound. They continued to
recur at longer intervals during the night, notwithstanding the em-
ployment of cold to her head, sinapisms to her spine and extremities,
the administration of calomel and purgative enemata, and the ab-
straction of blood, carried to an extent far beyond what I have ever
known in any other case. I bled her twice copiously, but as I was
unavoidably detained away a considerable portion of the time by an
obstetric case, she was visited in ray absence by two of my profes-
sional friends, who judging, and perhaps correctly, from the violence
and continuance of the convulsions, that she had not lost blood
enough, each bled her once or twice more. Cups were also applied
to the occiput and neck. The last general bleeding which was from
the temporal artery, I was informed, exercised a decided influence
over the convulsions as respects their frequency. In the afternoon,
by examination per vaginam, the os tinea? was found beginning to
dilate. Early in the night, the dilatation was still inconsiderable.
At 8 A. M., next day, about 24 hours from the first convulsion, the
os tinea? being dilated, and the head resting on the perineum, the
foetus was extracted by the forceps dead, as might reasonably be cal-
culatfid on after so many convulsions. A very intelligent lady, who

1647.] Cases of Puerperal Cojivulsions, <$fc. 521

was present all the time, counted forty-one convulsions, the greatest
number I have ever known : it is possible, though not probable, that
she may have made a mistake, but her veracity is unimpeachable.
Although absent more than half the time, I witnessed a consiiera-
ble number. After the removal cf the foetus, there was no further
convulsion, but she continued extremely ill for many days, her
pulse scarcely perceptible and innumerably frequent. Three days
elapsed before she could speak at all, and five more her speech was
wild and incoherent. It was not until the tenth day that she regain-
ed intelligence sufficient to realize her situation. After this her
convalescence was as rapid as could have been expected ; she was,
however, for a year, more subject to headache than formerly. The
following year, May 23th, she was confined again, having passed
through pregnancy and parturition without the slightest indication
of convulsions. Every care was taken during gestation to prevent
sanguine plethora and an undue accumulation of nervous excitability
by exercise, diet, and attention to the state of her bowels,

Case IX. Mrs. S.G., the subject of case 4, during the night of the
22d September, 1844, suffered intensely from headache, which in-
creased in the morning, attended with dazzling and flashes of light.
At breakfast, she said the butter-cup appeared like a ball of fire, and
immediately was seized with a violent convulsion. Her residence
being some miles distant, nearly two hours passed before she was
seen. I arrived in time to witness the third convulsion abstracted
fifty ounces of blood immediately; directed sinapisms to spine and
extremities; applied cold water to her head from a height; admin-
istered twenty-five grains of calomel, and prescribed warm mustard
pediluvia, purgative enemata, &c. In about two hours, took away
again from sixteen to twenty ounces of blood. After the second
blood-letting, Drs. Hook and P. F. Eve arrived, and assisted me in
the management of this case. In the afternoon the womb began to
act. About sundown, the os tincae being pretty well dilated, it was
determined, in consultation, depletion having been carried as far as
prudence would justify, to administer 5iij. vin. ergot, and remove the
fcetus by the forceps. While placing the patient in a proper position
for the introduction of the forceps, the tenth convulsion came on,
during which the fcetus was expelled dead. Sometime during tho
night, while the attendants were changing her position, she had
another convulsion, making in all eleven. Seidlitz powders and .salts
;vcre prescribed the next day to promote the operation of the calo-

522 Cases of Puerperal Convulsions, <$>c. [September,

mel. Intelligence was sufficiently restored to understand and answer
questions; but she did not wake up to the reality of her situation
until the fourth day, when she became very much excited at the
thought of having given birth to her child, in a state of unconscious-
ness, and not knowing what had passed for several days ; she, howe-
ver, soon became composed, and possessing an excellent constitution
rapidly regained her health and strength. The ensuing year this
lady became pregnant, and when six months advanced, had another
convulsion, which constitutes case 4th.

Case X. Dec. 31st, 1846, called to visit Mrs. R., a lady of ner-
vous lymphatic temperament, aged 30 years, eight months advanced
in her third pregnancy, much more fleshy and plethoric than usual,
found her suffering from a violent headache which had existed seve-
ral days. Notwithstanding the intense cephalalgia and the manifest
signs of great plethora, her pulse was rather feeble and below eighty
per minute. The depressed state of the pulse, doubtless, depended
on the condition of the nervous system. She was bled at 3 o'clock,
P. M., to thirty-two ounces, with immediate relief to her head ; during
the flow the pulse became more developed. A close of calcined mag-
nesia and warm sinapized pediluvia were prescribed.

At 6, P. M., three hours after the bleeding, she had, from the des-
cription of those present, a violent convulsion. A half hour after, I
found her in a state more like natural sleep than coma, from which
she was aroused by the puncture of the lancet, made for a second
abstraction of blood, which did not exceed twenty ounces. Intelli-
gence was apparently restored, but she had scarcely any recollection
of what had passed that whole clay, even before she had the convul-
sion. She was so blind, that evening and the next day, Jan. 1st,
that she could not discern the light of a candle held near her eyes,
except for a short time, immediately after pouring cold water on her
head, which was repeated hourly for a considerable time, twenty-four
to thirty-six hours, and afterwards at longer intervals. Her bowels
were acted on by calomel, magnesia, salts, &c, but such was their
torpor that immense doses were required. Her sight gradually im-
proved through the 2d and 3d, and by the 4th, was perfectly restored ;
her pulse also became natural and her system apparently free from
all morbid action. During the night of the 4th labour came on, and
early the morning of the 5th, she was safely delivered of a living
child, small and feeble at first, but it has survived and grown rapidly.
During labour, there was not the slightest disturbance of the brain
or nervous system.

1847.] Cases of Puerperal Convulsions, Qc. 523

This case might be said not to come properly under the head of
convulsions, anticipating labour, inasmuch as there was an interval
of four days between the convulsion and the labour; but it is confi-
dently believed that the labour was induced prematurely by the con-
vulsion, and that, had this patient not been most opportunely bled,
a short time before and almost immediately after it, there would have
been a repetition of the convulsions, which would have ushered in
labour during their continuance, to the almost certain destruction of
the child, and great peril of the mother. This is, at least, the only
case I have known of a convulsion in the ninth month without a re-
petition, and without the induction of labour ; the convulsions con-
tinuing to recur with irresistible pertinacity until delivery has been
effected, and sometime afterward.

Case XI. Nancy, a negro woman, the property of Dr. J. B.
Walker. Early in the morning of September, 23d, 1845, this patient
was found in a convulsion : it was not known when they commenced
or how many she had had. Dr. P. F. Eve, soon after being called,
found on examination that labour had commenced. It was impossi-
ble to determine which had precedence, the-convulsions or the labour ;
hut as the os tineas was very little dilated and rigid, it is most likely
4he convulsions had occurred first. She was seven or eight months
pregnant. The Doctor bled her as freely as her pulse and the state
of the system demanded, and applied sinapisms extensively to her
spine and extremities.

A consultation was held at 12, M. Turning was impracticable,
even if deemed expedient. Emetic tartar, in divided portions, was
prescribed with the hope of promoting dilatation as well as of arrest-
ing the convulsions. Farther bleeding was inadmissible. Her bow-
els had been operated on during the forenoon by oil, taken the day
before.

At 3, P. M., her symptoms becoming more alarming, although the
dilatation was very little, if at all, increased, it was determined, if
possible, to deliver by the crotchet. Through courtesy, the delivery
was kindly committed to me. It was rendered very difficult by the
mobility of the head, the unsteadiness of the patient and the want of
dilatation of the os tinea}, and farther embarrassed by the protrusion
through it of the arm and umbilical cord. It occupied about twenty-
five minutes, no convulsion occurring during its performance, and
only one more, some hours afterwards.

After the delivery, 5ij. wine of ergot was administered to promote

524 Cases of Puerperal Convulsions, Sfc. [September,

uterine contraction and prevent hemorrhage. At 8, P. M., we found
her in a state of great jactitation, pulse feeble and frequent ; she
could drink, and articulate a few words. Fifty drops of laudanum
were given, and in two hours twenty-five more.

Sept. 24th 8, A.M. She had slept some during the night, ap-
peared much better, was tranquil, pulse 80 per minute ; large blisters
on her thighs having failed to draw last night, were reapplied and
drew well ; appeared better all day. At 8, P. M., she was more
restless, and her pulse increased in frequency. Five grains of calo-
mel and a half grain of opium, every three hours.

25th 8, A. M. Patient was worse ; breathing hurried, pulse more
frequent : gave the calomel alone, and applied blisters to arms and
neck. She became constantly worse through this day and the fol-
lowing night, and died about daylight the next morning.

Permission could not be obtained to make a postmortem examina-
tion. This patient had had convulsions in a confinement some years
before, and her health appeared to be feeble at the time of the last
attack.

Convulsions during Parturition.
Case XII. Mrs. W., a lady of nervous temperament and deli-
cate frame, 17 years of age, had taken little or no exercise for some
months past, and become more than usually plethoric. At 10, P. M.,
Dec. 1846, labour commenced so gently that, although a primipara,
assistance was not called for some hours. The labour progressed as
favorably as could have been reasonably desired. At daylight, the
os tincae was fully dilated, the head resting on the perineum. She
complained of some headache, but not sufficient to excite alarm,
especially as the pulse was under eighty per minute and soft and the
labour was so far and so well advanced. Bloodletting did not appear
to be indicated. When a speedy and happy termination was expect-
ed, she was seized with a convulsion. A vein was immediately
opened; my friend, Dr. P. F. Eve, entered the room in time to
conduct the bleeding whilst I attended to the delivery. The employ-
ment of the forceps was considered and declined, as it was believed that
the delivery would be accomplished without instrumental aid, in as
short a time and with much less hazard to mother and offspring.
The child was born alive, in from twenty to thirty minutes. During
the delivery of the placenta, which was hastened by the introduction
of the hand, as it was deemed expedient to disburden the womb

1817.] Cases of Puerperal Convulsions, c. 525

thoroughly of its contents as soon as possible, she had another convul-
sion. Between one and two hours after the second, she had a third
convulsion. A pint more of blood was taken, and 25 drops of laudanum
given, after which she slept naturally ; when she awoke, a scruple of
calomel was given, to be followed by salts, in four hours. Cold water
to her head, sinapisms, &c, were also employed, as in other cases.

Her convalescence was prompt and satisfactory. This is the only
instance in which convulsions have occurred during labour, in a case
in my hands. I have seen cases under the managemeut of midwives,
said to have supervened during labour, but nothing very certain could
be learned of their previous history.

Convulsions after Parturition.

Case XIII. Mrs. G., temperament not well marked, about 23
years of age, primipara, had been for some months subject to an
affection of the head, attended with temporary loss of speech, con-
fusion of thought and sense of numbness on one side, for which I
was consulted about two months previous to labour. She was advised
to confine herself to a light diet, to take as much exercise in the open
air as she could without inducing pain, and to use gentle laxatives?
whenever the state of her bowels required them ; it was also advised
that she should be bled promptly if she should have another attack.
She had only one slight and very transient return, for which she was
not bled.

At 7 o'clock A. M., 20th Ma\r, 1345, labour which had commenced
about midnight moderately, and progressed slowly, became very
severe, attended with headache, which excited considerable appre-
hension in my mind, as she had complained so much of her head during
gestation. She would have been bled for this headache ; but her
pulse did not warrant it, and I feared it might so depress the energies
of her system as to retard labour. Cloths dipped in cold water and
ice were applied to her head. At 10 A. M., she gave birth to a largo
and healthy child. The danger I hoped was now passed. Ice was
ordered to be kept to her head as long as she had any headache,
which after vomiting had become very much relieved. At 1 P. M.,
she had a convulsion and was thought to be flooding, but upon exam-
ination, there was not much, if any, more than the natural quantity
of lochial discharge, which was very thin, exhibiting very little, if
any, coagula.

She was fust visited by Dr. Cross, who cupped over the epigastri-

52 G On Purpura Hemorrhagica, [September,

urn. Her bowels were freely operated on by salt enemata. Sinap-
isms, &c. were also applied. She had another convulsion at half-past
2 o'clock, another at 4 o'clock, and a fourth at 6 o'clock. Previous
to this, intelligence returned in the intervals. She had another in a
few minutes, and several more in rapid succession, until 7, P. M.
\ gr. sulph. morph. was given, after which she had no convulsion
until half-pasf 10, P. M. Sinapisms were frequently applied. Ene-
mas of the watery solution of assafcetida and wine of ergot, were
administered. Cups were frequently applied to the back of the
neck and base of the brain and temples. Cold water was frequently
poured on her head, and in the intervals, bladders of ice applied*
Calomel and oil were administered. Drs. Carter and Ford were
called in consultation, at 8, P. M. Convulsions recurred at short
intervals until 12, when } g. morphine was given, after which there
was no more convulsion. The patient continued ill all night, her
pulse becoming more feeble and frequent.

About 6, A. M., 21st, she appeared to be sinking; but between 8
and 9, A. M., she seemed somewhat to revive had some little ap-
pearance of intelligence, swallowed water. In a short time, again
she became worse, and expired at 11, A. M.

The convulsions in this case must have depended on a pre-existing
morbid state of the brain. Unfortunately, permission could not bo
obtained to make a post-mortem examination. Her complexion,
although unhealthy was not that generally indicative of anemia, but
such was the state of her pulse and the thinness of her blood, that it
was not proposed by any of the physicians in consultation to practice

general bloodletting.

[to be continued.]

ARTICLE XXXIV.

On Purpura Hemorrhagica. By I. P. Garvin, M. D., Professor
of Materia Medica, &c, in the Medical College of Georgia.

Hemorrhage, whether from accidental or other causes, is generally
alarming, and demands prompt relief. This remark applies with
peculiar force to those hemorrhages which depend upon a depraved
state of the system, as the nature of the depravation is usually ob-
scure, and the treatment uncertain. Among such diseases, probably
the most alarming and intractable, yet fortunately the most rare, is

1847.] On Purpura Hemorrhagica. 527

hemorrhagic form of Purpura. So rare indeed is this affection, that
many old practitioners have never met with a case. From this
cause, and from the obscurity which prevails as to the true nature of
morbid changes in the blood, but little progress has yet been made in
determining the most judicious treatment. Having met with four
cases of this disease, we have determined to give the results of our
observation, in the hope that they would prove not unacceptable to
the readers of the Journal, though they should suggest nothing novel
either in its pathology or treatment.

The term Purpura is generally confined to " an efflorescence of
small distinct purple specks and patches, attended with general debili-
ty, but not always with fever." Under this name some writers
include every variety of petechial eruption and spontaneous ecchy-
moses. We design however only to notice that form which is unat-
tended with fever or other acute disorder.

This disease has not been noticed by any of the ancient writers.
Riverius is said to have been the first to allude to it, which he did in
a publication made in 1G74. Very little attention was directed to it
until the latter part of the last century, since which time it has been
accurately described by Willan, Bateman and others. Beyond a
mere description, however, very little progress has been made, and
at this day its true nature is involved in as much obscurity, and its
treatment is nearly as uncertain as it was half a century ago.

The description of this affection by Bateman is highly accurate,
so much so indeed, that we cannot do better than to quote it entire.
"In purpura Simplex (the form of the disease in which hemorrhage
is wanting) there is an appearance of petechias without much disorder
of the constitution, except languor and loss of the muscular strength,
with a pale or sallow complexion, and often with pain in the limbs.
The petechias are most numerous on the breast, and on the inside of
the arms and legs, and are of various sizes, from the most minute point,
to that of a flea-bite, and commonly circular. They may be distin-
guished from recent flea-bites, partly by their more livid or purple
color, and partly because in the latter there is a distinct central punc-
ture, the redness around which disappears on pressure. There is no
itching nor other sensation attending the petechias. Purpura hemor-
rhagia is considerably more severe ; the petechias are often of a
larger size and are interspersed with vibices and ecchymoses, or livid
stripes and patches, resembling the marks left by the strokes of a
whip or by violent bruises. They commonly appear first on the leg?,

o28 On Purpura He?norrhagica. [September,

and at uncertain periods afterwards, on the thighs, arms, and trunk of
the body; the hands being more rarely spotted with them, and the
face generally free. They are usually of a bright red color when
they first appear, but soon become purple and livid; and when about
to disappear, they change to a brown or yellow hue ; so that as new
eruptions arise, and the absorption of the old ones slowly proceeds,
this variety of color is commonly seen in the different spots at the
same time. The cuticle over them appears smooth and shining, but
is not sensibly elevated ; in a few cases, however, the cuticle has
been seen raised into a sort of vesicle, containing black blood. This
more frequently happens in the spots which appear on the tongue,
gufns, palate, and inside of the cheeks and lips, when the cuticle is
extremely thin, and breaks from the slightest force, discharging the
effused blood. The gentlest pressure on the skin, even such as is
applied in feeling the pulse, will often produce a purple blotch, like
that which is left after a severe bruise.

The same state of habit which gives rise to these effusions under
the cuticle produces likewise copious discharges of blood, especially
from the internal parts which are defended by delicate coverings.
These hemorrhages are often very profuse, and not easily restrained,
and therefore sometimes prove suddenly fatal. But in other casea
they are less copious ; sometimes returning every day at stated peri-
ods, sometimes less frequently, and at irregular intervals ; and some-
times there is a slow and almost incessant oozing of the blood. The
bleeding occurs from the gums, nostrils, throat, inside of the cheeks,
tongue and lips, and sometimes from the lining membrane of the
eyelids, the urethra, and the external ear ; and also from the internal
cavities of the lungs, stomach, bowels, uterus, kidneys and bladder."

The disease sometimes appears without any marked premonitory
derangement, the hemorrhage manifesting itself before the patient ia
aware of the existence of the petechial efflorescence. Such was the
case in two of the instances which have come under our notice. In
most cases, however, the disease has been preceded by much languor
and debility, and pain in the limbs, with considerable derangement of
the general health. There is a form of the disease known as Purpura
Febrilis, a case of which we have never seen, in which the pulse is
frequent and the skin dry and hot, but in the form of which we are
speaking, the pulse is generally feeble and somewhat frequent and
vibratory. Pains or some uneasiness are often felt in various parts
of the body, particularly in those parts from which the hemorrhage

1847.] On Purpura Hemorrhagica. 529

is about to occur. The appetite is not much impaired, but the bowels
are almost always in a torpid condition.

The duration of the disease is exceedingly uncertain. It has been
known to continue for months, and even years. In one of our cases
it disappeared in ten or twelve days in another it continued for
three weeks; but a relapse was several times threatened, during the
course of the succeeding year. In another case, hemorrhage occur-
red but twice, and the petechia? and ecchymoses disappeared in about
a fortnight. In the fourth case the patient succumbed on the sixth
day.

Autopsic examinations have been made of subjects who have fal-
len victims to this disease, but they have Bhed but little, if any light
Upon its nature. No lesions have been found which could satisfac-
torily explain the. phenomena of the disease. Petechial spots were
found on the surface of all the internal organs, some of which evinced
considerable vascular tumescence. It has been suggested that the
disease may result from tenuity of the blood from dilatation of the
mouths of the superficial extremities of the minute arteries from
incieased impetus of the blood rupturing vessels which were healthy
from obstructions in healthy vessels, without increased impetus and
from a combination of two or more of these causes acting simultane-
ously or successively. Parry supposed that it was produced by
"over distention of certain blood-vessels, arising probably from their
relative want of tone, of the due contraction of their muscular fibres."
Plumb believes that it originates from " tenderness of the coats of the
minute vessels which give way from the ordinary impetus of the
blood. "That this tenderness is the result of deficient nourishment in
the superficial vessels," he says, " is equally clear ; and it may fairly
be suspected that such deficiency is consequent on congestion in the
hepatic and gastric circulation." .Mcintosh thinks that the disease
is possibly owing to general functional derangement of many organs
which at last produces changes upon the blood : and that it may
probably be owing to disease primarily seated in the lungs. We
think there can exist no reasonable doubt that the most striking
and uniform morbid change is that presented by the blood, from what-
ever cause this change may result. Although some cases have been
reported in which blood drawn by the lancet coagulated strongly
and exhibited a sizy appearance, in a large majority of instances,
the blood has evinced great fluidity, and when it did coagulate, it was
in "a soft, tremulous mass." In Dr. Gardiner's case, "the blood

34

530 On Purpura Hemorrhagica. [September,

first drawn coagulated imperfectly, and on the following day resem-
bled a tremulous jelly with a greenish surface interspersed with
brownish spots. What was discharged afterwards, was more like
turbid lymph, or a fluid in which some reddish coloring matter was
suspended." We have no hesitation in expressing the opinion that
the disease depends upon a depraved state of the blood, caused proba-
bly by functional derangement of the organs of assimilation. In
some of the cases which we have seen, such a state of these organs
evidently existed, and in every case, the blood was remarkably thin.

Purpura most frequently manifests itself in females and persons
who have not attained the age of puberty, but no age >s entirely
exempt from its attacks. It is most frequently observed in persons
of a delicate habit employed in sedentary occupations, in crowded
places, and nourished with a bad diet, or exposed to the action of
fatigue or other depressing causes. It is said sometimes to occur as
a sequela to other diseases, as measles, small-pox, &c. It must not,
however, be concealed, that it occasionally attacks persons who have
not been subjected to the action of any of the causes just mention-
ed, and who are apparently in tolerable health.

There is usually very little, if any difficulty in forming a correct
diagnosis. The existence of the red or purple spots, which do not
disappear under pressure, together with the occurrence of hemorrhage,,
give the complaint very marked characteristics.

Some diversity of opinion prevails as to the best mode of treating
Purpura, originating from the frequent failures of every plan which
has been proposed. Bleeding has been recommended by Parry, and
some others. Doubtless a few cases have occurred in which this
remedy was employed with advantage, or at least without obvious
injury, but that it is at all admissible in most cases, we do not believe.
The derangement in the general system which usually exists, and
the anemic condition which soon supervenes, forbid the employment
of the lancet. A case may occasionally occur, in which the health:
of the subject is but slightly impaired, and there have as yet been no
profuse hemorrhages, when venesection would not prove hurtful, but
its employment should be restricted to such cases, and even then it
must be used with great caution. A medical friend has just men-
tioned to us the case of a gentleman laboring under Purpura, who-
was bled for a catarrhal affection by a medical man, under whose
charge he was accidentally placed, and the consequences were fataL
In our objections to the lancet in this disease, we believe that we-

1847.] On Purpura Hemorrhagica. 531

are fully sustained by most practitioners who have treated the
disease.

Among the remedies winch enjoy the most reputation, are active
cathartics, frequently repeated. We have used them with decided
benefit, but we think reliance should not be placed upon them to the
exclusion of other remedies. Raver, and many others, employ cal-
omel combined with jalap, whilst others give a preference to castor
oil in union with the oil of turpentine. This last article has attract-
ed considerable attention, and enjoys some reputation as a purgative
in this disease. In the case of a child of seven years of age, the
only case ever seen by Eberle, he found benefit from small doses of
turpentine together with the nitrate of silver, twenty drops of the
former to a quarter of a grain of the latter, every six hours.

The use of the mineral acids will be found of great advantage,
particularly the sulphuric, which is among the best hemostatics that
we are acquainted with. In one case, a comparatively mild one it
is true, we effected a cure with the diluted sulphuric acid, aided by
frequent laxatives.

Some of the best remedies have, in our opinion, been too much
overlooked : we allude to chalybeates. Tonics we are aware have
been fully tested, without any satisfactory result, and their use is
generally condemned ; but the preparations of iron are not merely
tonics; they obviously effect changes in the blood, and to these
changes we attribute their efficacy in this, as in some other diseases.
We have treated two cases successfully with these remedies. In
one very alarming case, the precipitated carbonate of iron was given
in as large and often repeated doses as the stomach would bear, fol-
lowed by frequent cathartics. Lnder this treatment, marks of
amendment were Boon visible, and the patient soon recovered. Sev-
eral slight relapses which afterwards occurred, were promptly arrested
by the iron alone. We have great faith in its efficacy. The cases
in which we would expect the least from it, are those which occur in
subjects in good health, and presenting some vascular fulness.

Astringents, internal as well as external, are in frequent requisition
for the hemorrhages which take place. We have employed the ace-
tate of lead and other articlesof established reputation as astringents,
without their usual marked effects ; still, when hemorrhages occur,
we are compelled to resort to these remedies.

It may be laid down as a general rule, that the hemorrhages which
accompany Purpura, arc to be arrested by the same means that we

532 Proceeding of the National Medical Convention. [September,

would employ to arrest such discharges from the same sources under
other circumstances internal astringents, &c, when the hemorrhage
is from some inaccessible source, and cold, styptics, compression, &c.
when these can be efficiently applied.

We have met with a few cases of the Purpura simplex. It always
yielded quite readily to the use of laxatives, together with a fre' use
of the diluted sulphuric acid.

PART II. REVIEWS AND EXTRACTS.

ARTICLE XXXV.

Proceedings of the National Medical Conventions held in New Yor%
May, 1846, and in Philadelphia May, 1847.

There is no profession entitled to a higher place in the estimation:
of mankind, than that of Medicine. Among the contributors to
science, the votaries of learning, and the enlightened philanthropists
of every age, physicians have occupied a prominent place. For many
ages, with Theology and the Law, Medicine was known as one ef ths
learned professions. But whatever may have been its former rank
or its present claims, it must be obvious to the most superficial obser-
vation, that it has undergone a gradual decadence, and at this time,
in our own country at least, it has fallen from its high estate, and is
looked upon by many, even of the intelligent, as a mere art which
any dolt may easily acquire. Medical men have long seen and de-
plored this state of things, and have at length united in an effort to
rescue their profession from the reproach which has fallen upon itv
In the proceedings of ihe National Medical Conventions, which em-
bodied a large amount of talent and respectability, we have before
us the caue?s which in their view have brought about the present
order of things, and the remedies which they propose for their remove
al. From these proceedings it is to be inferred that the Convention
suppose the evils complained of, to arise principally from three cau-
ses: first, from the want of a suitable preliminary education among'
those who apply themselves to the study of Medicine; second, from-
the lowness of the standard of strictly medical acquirements, which
is generally adopted by the Colleges ; and third, from the failure on
the part of these institutions, to require from those who seek their
honors, a full conformity to that low standard.

1847.] Proceedings of the National Medical Convention, 533

That each of the causes enumerated contribute to lower the pro-
fession of Medicine cannot for a moment be doubted, although some
diversity of opinion may prevail as to the part which each performs.
Our own opinion is, that the want of a proper preliminary education
is the most efficient of those enumerated in degrading the profession.
When we speak of a proper preliminary education, we wish to be
understood as going far beyond the recommendations of the Conven-
tion. "A good English education,. a knowledge of Natural Philoso-
phy and the elementary Mathematical Sciences, including Geometry
and Algebra, and such an acquaintance, at least, with the Latin and
Greek languages as will enable them to appreciate the technical lan-
guage of Medicine, and read and write prescriptions," will do much to
facilitate the acquisition of Medical Science, but it will not prove of
very essential service in elevating one whose knowledge is thus limit-
ed, in the estimation of the intelligent ana cultivated men of the land.
We admit that with this, or with even something less, a man of good
mind, and untiring perseverance, may become a useful and safe prac-
titioner, but the people at large have no means of estimating his
fitness to exercise the functions of his profession, but by his general
intelligence, and acquaintance with those branches of knowledge with
which well educated men are familiar. If his knowledge goes not
beyond what is strictly professional, they will suppose him ignorant
in that, or as is too frequently the case, they will deem Medicine itself
as a mere art which requires neither learning nor intelligence for its
successful application. This test is the only one which the unpro-
fessional can apply, and we hesitate not to say that a man of general
learning will do more to render the profession honorable in the public
estimation, than one much superior in medical skill, but deficient in
every other species of knowledge. How can a man of cultivated
intellect respect either the physician or his occupation who betrays a
gross ignorance of the very rudiments of school-boy learning. We
may lengthen the collegiate course add new branches of science to
the curriculum, and adopt the most stringent measures to secure a
more thorough instruction in the Medical Sciences, but the profession
will never be respected as it should be, until the great body of phvsi-
cians is composed of well educated men. In view, therefore, of these
reasons, we would advocate a high standard of preliminary education
es a requisite for the degree of Doctor of Medicine. It has been ob-
jected that such a course would induce great numbers of young men
to engage in the practice without the degree. Be it so. The public

534 Proceedings of the National Medical Convention. [September,

would learn the difference between these, and the thoroughly educa-
ted physician. Moreover, many young men of proper ambition,
would be induced to acquire the requisite education even by their own
unaided efforts, who now are contented to remain ignorant because
ignorance upon these subjects is common. We do not agree with
the Convention, however, in their recommendation that practitioners
should not receive pupils into their offices, and the Colleges should
not matriculate such as have not attained the standard of prelimina-
ry education they have prescribed. Many young men, we have
known several such, could carry on their scientific and literary stu-
dies at the same time. It is quite a common occurrence in France,
for young men engaged in the study of Medicine to devote a portion
of each day to lectures, and other instruction in those departments of
knowledge, without which they would not be eligible to the honors of
the Medical profession. It will be sufficient, and indeed all that is
practicable to require conformity to the prescribed standard, of those
who seek the honors of the Colleges. We cannot make every prac-
titioner a man of general learning, but we can require all to be such,
who are honored with the Doctorate.

That the standard of medical education is too low, is a fact which
no one is disposed to deny.' It is certainly lower than in the most
.enlightened countries in Eurcpe, and as a consequence a large por-
tion of our medical practitioners are inferior to their foreign cotempo-
raries in the extent, and minuteness of their scientific knowledge. It
is equally true, and indeed what might have been reasonably expected,
that a large portion of those who are thus imperfectly educated, make
no sufficient effort to supply the defect, and fail to keep pace with the
improvements of the age. We therefore heartily concur in the sen-
timent that, " it is indispensable that the standard of medical educa-
tion should be elevated." It may not in so considerable a degree
increase the respectability of the profession, as would a high standard
of preliminary education, but it would render it more worthy of public
confidence. We believe, however, that the defect in the present
system of medical education does not consist solely in a lack of in-
struction, but that the shortness of the period into which the whole
amount of instruction is crowded, also exert a prejudicial influence.
The report upon this subject justly remarks, "the shortness of the
time devoted to the delivery of Lectures, we believe to be an evil of
no small magnitude. It is next to an impossibility that the strongest
intellect can receive, and well digest some half a dozen or more dis.

1847.] Proceedings of the National Medical Convention* 535

courses a day, embracing subjects which have oftentimes little or no
immediate connection with each other. The mind becomes wearied
withihe multiplicity of its occupations, and the thoughts of to-day are
forgotten in the constantly recurring duties of the morrow. A proper
allotment of time cannot be given to that deep reflection which the
importance of the subject demands, and without which no solid ad-
vancement can be made." For these reasons we approve of the
extension of the course of Lectures, not only because new subjects
may be taught, but because fewer lectures will occupy the attention
of the student daily.

The Convention has not advised the introduction of new branches
of science into the curriculum, if we except Medical Jurisprudence,
which is now a distinct professorship in some few Colleges, and to
some extent incidentally taught in all. There are doubtless some
collateral sciences, instruction in which would add much value to the
collegiate course, yet, under present circumstances, we think the Con-
vention did well, in not requiring such branches to be taught.

Clinical instruction is also deemed by the Convention to be an
indispensable element in a proper medical education. Of course they
do not refer to thatkind of clinical instruction to be derived from a case
placed once or twice a week in a large amphitheatre, and surround-
ed by several hundred young men, many of whom are unavoidably at
such a distance, as to be unable to distinguish the color of the patient's
yes. Such clinical instruction is a mere farce. In view of the fact
that in many of our cities, the hospitals and alms-houses are not un-
der the direction of the Faculties of the Colleges, the Convention
has not urged it as a prerequisite to graduation.

On the subject of dissection, the Convention says, "to enter into
an argument to prove its absolute necessity, not only to the surgeon,
but to the physician, would be a work of supererogation," and it is
therefore very properly recommended that it be required of candidates
for the degree, that they shall have steadily devoted three months to
dissecting. It certainly speaks but little for the state of medical
education in this country, that of the twenty colleges who reported
their rules to the Convention, tiiirteen do not require candidates
to have dissected at all. We are pleased to say that the Medical
College of Georgia is not among this number.

In relation to the influence which a failure on the part of the col-
leges to exact a full conformity to their own standards, exerts upon
the character of the profession, and the remedy for the removal of

536 Proceedings of the National Medical Convention, [September,

this evil, the Convention has expressed no opinion, but has referred
the whole subject to the American Medical Association. But the
two reports of the committee on the question of separating the bu-
siness of teaching and licensing, doubtless embody the views of $
large portion of that body. These reports alledge that the active
competition of the Medical Colleges, and the desire to swell the
number of their pupils, naturally produces a relaxation of their
rules, and a consequent depreciation of the degree. To remedy this
evil, it has been proposed to unite with the Faculties of the Colleges,
medical gentlemen unconnected with any institution, and let aboard
thus constituted decide upon the application of candidates. This
plan we deem objectionable. Whilst we admit that man is fallible,
and that the promptings of interest, or friendship, may cause him
sometimes to forget or disregard the responsibilities of his position,, it
is equally true that the same proclivity to evil may induce these new
examiners to err upon the other side, and let professional rivalry or
personal ill will influence their decisions. The experiment of re-
quiring candidates for graduation to submit to an examination by
persons unconnected with the faculty, we believe was made some
years since in Charleston, but it did not succeed, and was soon
abandoned. There seems to be quite an anxiety on the part of
many members of the profession, to take from the colleges the power
of conferring degrees, or in their own mode of expressing their idea,
to separate the business of teaching from licensing. Whether the
colleges will consent to any such arrangement, remains to be seen ;
but we believe that they will not. If an applicant complies with
their regulations, and they are satisfied with his proficiency, it is
their right, nay, more, it is their duty, to give him a testimonial to
that effect. What is a Diploma, more than this ? It is not a license,
properly speaking it is only so in States where some special enact-
ment has made it such. A diploma from the Medical College of
Georgia, cannot confer a right to practice medicine in any State of
the Union except that in which it has been granted, unless the Legis-
latures of such State choose to make such diploma a license. If it
is believed that the colleges graduate men who are not qualified to
practice physic, let the proper authority in each State create boards
of examiners, and require every one who desires to practice, to sub-
mit himself to their examination, whether he has a diploma or not.
To such a plan, no College, we presume, would object.

Upon t'ne whole, we are much pleased with the recommendations

1847.] Code of Medical Ethics. 537

of the Convention, and we doubt not that so much of them as is prac-
ticable, will eventually be carried out. We say eventually, because
moderate as are the reforms proposed, they cannot be effected at
once, but will require time and concert of action for their successful
introduction. But that these changes will rescue the profession from
its present position, and place it where it should be, we do not be-
lieve, although they will effect some good. In our country there is a
deep-rooted prejudice against all privileges, and every science and
art must make its way unaided by legislative enactments. The law
gives no encouragement it confers no privileges upon him who de-
votee every energy to improve the science of Medicine, but recognizes
every empiric and ignorant pretender, as much as the man of science.
Under such discouragements few are found to struggle for a high order
of attainment, and many a young man who sat out with lofty aspira-
tions and resolves, has yielded to their influence and settled down into
indolence and indifference. We need expect no change in this re^
spect. Theevil is incident to our institutions. We may recommend
what we please : every man who desires to do so, may enter upon
the practice of Medicine, and the mass of the community will recog-
nize him as a physician. In the Medical Colleges of the country
the power alone resides to elevate the professional character. Let
them impart fuller instruction, and establish a high standard of pre-
liminary and medical education, to which every applicant for their
honors shall be required strictly to conform, and though the medical
profession will still continue to be incumbered with ignorant pretend-
ers, the intelligent part of the community will soon rank them as
they deserve, and will require as a prerequisite to their confidence,
the possession of a Diploma from some respectable Medical Institu-
tion. G.

Code of Medical Ethics, adopted at the late Meeting of the
National Medical Convention.

CHAPTER I.

OF THE DUTIES OF PHYSICIANS TO THEIR TATIENTS AND Of THE OB-
LIGATIONS OF PATIENTS TO THEIR PHYSICIANS.

Art. I. Duties of Physicians to their Patients.
1. A Physician should not only be ever ready to obey the calls
of the sick, but his mind ought also to be imbued with the greatness
of his mission, and the responsibility he habitually incurs in its dis-

538 Codeof Medical Ethics. [September,

charge. Those obligations are the more deep and enduring, be-
cause there is no tribunal other than his own conscience, to adjudge
penalties for carelessness or neglect. Physicians should, therefore,
minister to the sick with due impressions of the importance of their
office; reflecting that the ease, the health, and the lives of those
committed to their charge, depend on their skill, attention and fidel-
ity. They should study, also, in their deportment, so to unite tender-
ness with firmness, and condescension with authority, as to inspire
the minds of their patients with gratitude, respect and confidence.

2. Every case committed to the charge of a physician should be
treated with attention, steadiness and humanity. Reasonable indul-
gence should be granted to the mental imbecility and caprices of the
sick. Secrecy and delicacy, when required by peculiar circum-
stances, should be strictly observed ; and the familiar and confiden-
tial intercourse to which physicians are admitted in their professional
visits, should be used with discretion, and with the most scrupulous
regard to fidelity and honor. The obligation of secrecy extends
beyond the period of professional services ; none of the privacies of
personal and domestic life, no infirmity of disposition or flaw of cha-
racter observed during professional attendance, should ever be divul-
ged by him except when he is imperatively required to do so, The
force and necessity of this obligation are indeed so great, that pro-
fessional men have, under certain circumstances, been protected in
their observance of secrecy, by courts of justice.

3. Frequent visits to the sick are in general requisite, since they
enable the physician to arrive at a more perfect knowledge of the
disease, to meet promptly every change which may occur, and also
tend to preserve the confidence of the patient. But unnecessary
visits are to be avoided, as they give useless anxiety to the patient,
tend to diminish the authority of the physician, and render him liable
to be suspected of interested motives.

4. A physician should not be forward to make gloomy prognos-
tications, because they savour of empiricism, by magnifying the im-
portance of his services in the treatment or cure of the disease.
But he should not fail, on proper occasions, to give to the friends of
the patient timely notice of danger, when it really occurs ; and even
to the patient himself, if absolutely necessary. This office, however,
is so peculiarly alarming when executed by him, that it ought to be
declined whenever it can be assigned to any other person of sufficient
judgment and delicacy. For, the physician should be the minister of
hope and comfort to the sick ; that, by such cordials to the drooping
spirit, he may smooth the bed of death, revive expiring life, and
counteract the depressing influence of those maladies which often
disturb the tranquillity of the most resigned, in their last moments.
The life of a sick person can be shortened not only by the acts, but
also by the words or the manner of a physician. It is, therefore, a
sacred duty to regard himself carefully in this respect, and to avoid all
things which have a tendency to discourage the patient and to de*
press his spirits.

1847.] Codeof Medical Ethics. 539

5. A physician ought not to abandon a patient because a case is
deemed incurable; for his attendance may continue to be highly
useful to the patient, and comforting to the relatives around him,
even in the last period of a fatal malady, by alleviating pain and other
symptoms, and by soothing mental anguish. To decline attendance,
under such circumstances, would be sacrificing to fanciful delicacy
,and mistaken liberality, that moral duty, which is independent of,
and far superior to all pecuniary consideration.

6. Consultations should be promoted in difficult or protracted
cases, as they give rise io confidence, energy, and more enlarged
views in practice.

7. The opportunity which a physician not unfrequently enjoys
,of promoting and strengthening the good resolutions of his patients,
suffering under the consequences of vicious conduct, ought never to
.be neglected. His counsels, or even remonstrances, will give satis-
faction, not offence, if they be proffered with politeness, and evince a
genuine lore of virtue, accompanied by a sincere interest in the wel-
fare of the person to whom they are addressed.

Art. II. Obligations of Patients to their Physicians,

1. The members of the medical profession, upon whom are en-
joined the performance of so many important and arduous duties
towards the community, and who are required to make so many sacri-
iices of comfort, ease, and health, for the welfare of those who avail
themselves of their services, certainly have a right to expect and
require, that their patients should entertain a just sense of the duties
.which they owe to their medical attendants.

2. The first duty of a patient is, to select as his medical adviser
one who has received a regular professional education. In no trade
or occupation, do mankind rely on the skill of an untaught artist ; and
in medicine, confessedly the most difficult and intricate of the sciences,
(he world ought not to suppose that knowleege is intuitive.

3. Patients should prefer a physician, whose habits of life are
regular, and who is not devoted to company, pleasure, or to any pur-
suit incompatible with his professional obligations. A patient should,
also, confide the care of himself and family, as much as possible, to
one physician, for a medical man who has become acquainted with
the peculiarities of constitution, habits, and predispositions, of those
he attends, is tnore likely to be successful in his treatment, than ono
who does not possess that knowledge.

A patient who has thus selected his physician, shoirid always apply
for advice in what may appear to him trivial cases, for the most fatal
results often supervene on the slightest'accidenls. It is of still mora
importance that he should apply for assistance in the forming stage
of violent diseases; it is to a neglect of this precept that medicine
owes much of the uncertainty and imperfection with which it has
Jjeen reproached.

4. Patients should faithfully and unreservedly communicate to

540 Code of Medical Ethics. [September,

their physician the supposed cause of their disease. This is the more
important, as many diseases of a mental origin simulate those de-
pending on external causes, and yet are only, to be cured by minister-
ing to the mind diseased. A patient should never be afraid of thus
making his physician his friend and adviser ; he should always bear
in mind that a medical man is under the strongest obligations of se-
crecy. Even the female sex should never allow feelings of shame or
delicacy to prevent their disclosing the seat, symptoms and causes of
complaints peculiar to them. However commendable a modest re-
serve may be in the common occurrences of life, rts strict observance
in medicine is often attended with the most serious consequences,
and a patient may sink under a painful and loathsome disease, which
might have been readily prevented had timely intimation been given
to the physician,

5. A patient should never weary his physician with a tedious
detail of events or matters not appertaining to his disease. Even as
relates to his actual symptoms, he will convey much more real infor-
mation by giving clear answers to interrogatories, than by the most
minute account of his own framing. Neither should he obtrude the
details of his business nor the history of his family concerns.

6. The obedience of a patient to the prescriptions of his physician
should be prompt and implicit. He should never permit his own
crude opinions as to their fitness, to influence his attention to them.
A failure in one particular may render an otherwise judicious treat-
ment dangerous, and even fatal. This remark is equally applicable
to diet, drink, and exercise. As patients become convalescent they
are very apt to suppose that the rules prescribed for them may be
disregarded, and the consequence but too often, is a relapse. Patients
ghould never allow themselves to be persuaded to take any medicine
whatever, that may be recommended to them by the self-constituted
doctors and doctresses, who are so frequently met with, and who pre-
tend to possess infallible remedies for the cure of every disease.
However simple some of their prescriptions may appear to be, it
often happens that they are productive of much mischief, and in all
cases they are injurious, by contravening the plan of treatment
adopted by the physician.

A patient should, if possible, avoid even the friendly visits of a
physician who is not attending him, and when he does receive
them, he should never converse on the subject of his disease, as an
observation may be made, without any intention of interference,
which may destroy his confidence in the course he is pursuing, and
induce him to neglect the directions prescribed to him. A patient
should never send for a consulting physician without the express
consent of his own medical attendant. It is of great importance that
physicians should act in concert ; for although their modes of
treatment may be attended with equal success when employed
singly, yet conjointly they are very likely to be productive of disas-
trous results.

1847.] Code of Medical Ethics. 541

8. When fi patient wishes to dismiss his physician, justice and
common courtesy require that he should declare his reasons for so
doing.

9. Patients should always, when practicable, send for their physi-
cian in the morning, before his usual hour of going out : for, by being
early aware of the visits he has to pay during the day, the physician
is able to apportion his time in such a manner as to prevent an inter-
ference of engagements. Patients should also avoid calling on their
medical adviser unnecessarily during the hours devoted to meals or
sleep. They should always be in readiness to receive the visits of
their physician, as the detention of a few minutes is often of serious
inconvenience to him.

10. A patient should, after his recovery, entertain a just and en-
during sense of the value of the services rendered him by his physi-
cian ; for these are of such a character, that no mere pecuniary
acknowledgment can repay or cancel them.

CHAPTER II.

OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO THE PRO-
FESSION AT LARGE.

Art. I. Duties for tlie support of professional character.

1. Every individual, on entering the profession, as he becomes
thereby entitled to all its privileges and immunities, incurs an obli-
gation to exert his best abilities to maintain its dignity and honour,
to exalt its standing, and to extend the bounds of its usefulness. He
should therefore observe strictly, such laws as are instituted for the
government of its members; should avoid all contumelious and sar-
castic remarks relative to the faculty, as a body; and while, by un-
wearied diligence, he resorts to every honourable means of enriching
the science, he should entertain a due respect for his seniors, who
have, by their labours, brought it to the elevated condition in which:
he finds it.

2. There is no profession, from the members of which greater;
purity of character, and a higher standard of moral excellence are
required, than the medical ; and to attain such eminence, is a duty
every physician owes alike to his profession, and to his patients. It
is due to the latter, as without it he cannot command their respect
and confidence, and to both, because no scientific attainments caff
compensate for the want of correct moral principles. It is also in-
cumbent upon the faculty to be temperate in all things, for the prac-
tice of physic requires the unremitting exercise of a clear and
vigorous understanding ; and, on emergencies for which no profes-
sional man should be unprepared, a steady hand, an acute eye, ancT
an unclouded head may be essential to the well being, and even to
{he life, of a fellow creature.

3. It is derogatory to the dignity of the profession, to resort to*

542 Code of Medical Ethics. [September,

public advertisements or private cards or handbills, inviting the at-
tention of individuals affected with particular diseases publicly
offering advice and medicine to the poor gratis, or promising radical
cures ; or to publish cases and operations in the daily prints or suffer
such publications to be made; to invite laymen to be present at
operations, to hoast of cures and remedies,-^to adduce certificates
of skill and success, or to perform any other similar acts. These are
the ordinary practices of empirics, and are highly reprehensible in a
regular physician.

4. Equally derogatory to professional character is it, for a physi-
cian to hold a patent for any surgical instrument, or medicine ; or to
dispense a secret nostrum,, whether it be the composition or exclusive
property of himself, or of others. For, if such nostrum be of real
efficacy, any concealment regarding it is inconsistent with benefi-
cence and professional liberality ; and, if mystery alone give it value
and importance, such craft implies either disgraceful ignorance, or
fraudulent avarice. It is also reprehensible for physicians to give
certificates attesting the efficacy of patent or secret medicines, or
in any way to promote the use of them.

Art. II. Professional services of physicians to each other.
1. All practitioners of medicine, their wives, and their children',
while under the paternal care, are entitled to the gratuitous services
of any one or more of the faculty residing near them, whose assist-
may be desired. A physician afflicted with disease is usually an
incompetent judge of his own case ; and the natural anxiety and
solicitude which he experiences at the sickness of a wife, a child, or
any one who by the ties of consanguinity is rendered peculiarly dear
to him, tend to obscure his judgment, and produce timidity and irre-
solution in his practice. Under such circumstances, medical men
peculiarly dependent upon each other, and kind offices and profession-
al aid should always be cheerfully and gratuitously afforded. Visits
ought not, however, to be obtruded officiously ; as such unasked civ-
ility may give rise to embarrassment, or interfere with that choice,
on which confidence depends. But, if a distant member of the facul-
ty, whose circumstances are affluent, request attendance, and an
honorarium be offered, it should not be declined ; for no pecuniary
obligation ought to be imposed, which the party receiving it would
wish not to incur.

Art. III. Of the duties of physicians as respects vicarious offices,
1. The affairs of life, the pursuit of health, and the various acci-
dents and contingencies to which a medical man is peculiarly exposed,
sometimes require him temporarily to withdraw from his duties to
his patients, and to request some of his professional brethren to offi-
ciate for him. Compliance with this request is an act of courtesy,
which should always be performed with the utmost consideration for
the interest and character of the family physician, and when exer-

1847.] Codeof Medical Ethics. 543

cised for a short period, fill the pecuniary obligations for such service
shuuld be awarded to him. But if a member of the profession neg-
lect his business in quest of pleasure and amusement, he cannot be
considered as entitled to the advantages of the frequent and long-
continued exercise of this fraternal courtesy, without awarding to the
physician who officiates the fees arising from the discharge of his
professional duties.

In obstetrical and important surgical cases, which give rise to un-
usual fatigue, anxiety and responsibility, it is just that the fees accruing
therefrom should be awarded to the physician who officiates.

Art. IV. Of the duties of physicians in regard to Consultations.

1. A regular medical education furnishes the only presumptive
evidence of professional abilities and acquirements, and ought to be
the only acknowledged right of an individual to the exercise and hon-
ours of his profession. Nevertheless, as in consultation the good of
the patient is the sole object in view, and this is often dependent on
personal confidence, no intelligent regular practitioner, who has a
license to practice from some medical board of known and acknow-
ledged respectability, recognized by this association, and who is in
good moral and professional standing in the place in which he resides,
should be fastidiously excluded from fellowship, or his aid refused in
consultation when it is requested by the patient. But no one can be
considered as a regular practitioner, or a fit associate in consultation,
whose practice is based on an exclusive dogma, to the rejection of the
accumulated experience of the profession, and of the aids actually
furnished by anatomy, physiology, pathology, and organic chemistry.

2. In consultations no rivalship or jealousy should be indulged ;
candour, probity, and all due respect should be exercised towards the
physician having charge of the case.

3. In consultations the attending physician should be the first
to propose the necessary questions to the sick ; after which the con-
sulting physician should have the opportunity to make such farther
inquiries of the patient as may be necessary to satisfy him of the true
character of the case. Both physicians should then retire to a pri-
vate place for deliberation : and the one first in attendance should
communicate the directions agreed upon to the patient or his friends,
as well as any opinions which it may be thought proper to express.
But no statement or discussion of it should take place before the pa-
tient or his friends, except in the presence of all the faculty attending,
and by their common consent; and no opinions or prognostications
should be delivered, which are not the result of previous deliberation
and concurrence.

4. In consultations, the physician in attendance should deliver
his opinion first ; and when there are several consulting, they should
deliver their opinions in the order in which they have been called in.
No decision, however, should restrain the attending physician frotn
making such variations in the mode of treatment, as any subsequent

544 Code of Medical Ethics. [September,

unexpected change iri the character of the case may demand. But
such variations and the reasons for it ought to be carefully detailed at
the next meeting in consultation. The same privilege belongs also
to the consulting physician if he is sent for in an emergency, when
the regular attendant is out of the way, and similar explanations must
be made by him, at the next consultation.

5. The utmost punctuality should be observed in the visits of
physicians when they are to hold consultations together, and this is
generally practicable, for society has been considerate enough to
allow the plea of a professional engagement to take precedence of all
others, and to be an ample reason for the relinquishment of any pre-
sent occupation. But as professional engagements may sometimes
interfere, and delay one of the parties, the physician who first arrives
should wait for his associate a reasonable period, after which the con-
sultation should be considered as postponed to a new appointment.
If it be the attending physician who is present, he will of Course see
the patient and prescribe ; but if it be the consulting one, he should
retire, except in case of emergency, or when he has been called from
ft considerable distance, in which latter case he may examine the
patient, and give his opinion in writing and under seal, to be deliver-
ed to his associate.

6. In consultations, theoretical discussions should be avoided, as
occasioning perplexity and loss of time. For there may be much
diversity of opinion concerning speculative points, with perfect agree-
ment in those modes of practice which are founded, not on hypothesis,
but on experience and observation.

7. All discussions in consultation should be held as secret and
confidential. Neither by words nor manner should any of the parties
to a consultation assert or insinuate, that any part of the treatment
pursued did not receive his assent. The responsibility must be
equally divided between the medical attendants, they must equally
share the credit of success as well as the blame of failure.

8. Should an irreconcilable diversity of opinion occur when sev-
eral physicians are called upon to consult together, the opinion of the
majority should be considered as decisive; but if the numbers be
equal on each side, then the decision should rest with the attending
physician. It may, moreover, sometimes happen, that two physicians
cannot agree in their views of the nature of a case, and the treatment
to be pursued. This is a circumstance much to be deplored, and
should always be avoided, if possible, by mutual concessions, as far
as they can be justified by a conscientious regard for the dictates of
judgment. But in the event of its occurrence, a third physician
should, if practicable, be called to act as umpire, and if circumstan-
ces prevent the adoption of this course, it must be left to the patient
to select the physician in whom he is most willing to confide. But
as every physician relies upo the rectitude of his judgment, he should,
when left in the minority, politely and consistently retire from any
further deliberation in the. consultation, or participation in the man-
agement of the case.

1847.] Code of Medical Ethics. 545

9. As circumstances sometimes occur to render a special con-
sultation desirable, when the continued attendance of two physicians
might be objectionable to the patient, the member of the faculty
whose assistance is required in such cases, should sedulously guard
against all future unsolicited attendance. As such consultation re-
quire an extraordinary portion both of time and attention, at least a
double honorarium may be reasonably expected.

10. A physician who is called upon to consult, should observe
the most honorable and scrupulous regard for the character and
standing of the practitioner in attendance : the practice of the latter,
if necessary, should be justified as far as it can be, consistently with
a conscientious regard for truth, and no hint or insinuation should be
thrown out, which could impair the confidence reposed in him. or
affect his reputation. The consulting physician should also carefully
refrain from any of those extraordinary attentions or assiduities, which
are too often practiced by the dishonest for the base purpose of gain-
ing applause, or ingratiating themselves into the favour of families
and individuals.

Art. V. Duties of physicians in cases of interference.

1.- Medicine is a liberal profession, and those admitted into its
ranks should found their expectations of practice upon the extent of
their qualifications, not on intrigue or artifice.

2. A physician, in his intercourse with a patient under the care
of another practitioner, should observe the strictest caution and re-
serve. No meddling inquiries should be made ; no disingenuous
hints given relative to the nature and treatment of his disorder ; nor
any course of conduct pursued that may directly tend to diminish the
trust reposed in the physician employed.

3. The same circumspection and reserve should be observed,
when, from motives of business or friendship, a physician is prompted
to visit an individual who is under the direction of another practi-
tioner. Indeed, such visits should be avoided, except under peculiar
circumstances, and when they are made, no particular inquiries
should be instituted relative to the nature of the disease, or the reme-
dies employed, but the topics of conversation should be as foreign to
the case as circumstances will admit.

4. A physician ought not to take charge of, or prescribe for a
patient who has recently been under the care of another member of
the faculty in the same illness, except in cases of sudden emergency,
or in consultation with the physician previously in attendance, or
when the latter has relinquished the case or been regularly notified
that his services are no longer desired. Under such circumstances
no unjust and illiberal insinuations should be thrown out in relation
to the conduct or practice previously pursued, which should be justi-
fied as far as candour, and regard for truth and probity will permit ;
for it often happens, that patients become dissatisfied when they do
not experience immediate relief, and, as many diseases arc naturally

36

54G Code of Medical Ethics. [September,

protracted, the want of success, in the first stage of treatment, affords
no evidence of a lack of professional knowledge and skill.

5. When a physician is called to an urgent case, because the
family attendant is not at hand, he ought, unless his assistance in
consultation be desired, toresign the care of the patient to the latter
immediately on his arrival.

6. It often happens, in cases of sudden illness, or of recent acci-
dents and injuries, owing to the alarm and anxiety of friends, that a
number of physicians are simultaneously sent for. Under these cir-
cumstances, courtesy should assign the patient to the first who arrives,
who should select from those present, any additional assistance that
he may deem necessary. In all such cases, however, the practition-
er who officiates, should request the family physician, if there be one,
to be called, and, unless his further attendance be requested, should
resign the case to the latter on his arrival.

7. When a physician is called to the patient of another practi-
tioner, in consequence of the sickness or absence of the latter, he
ought, on the return or recovery of the regular attendant, and with
the consent of the patient, to surrender the case.

8. A physician, when visiting a sick person in the country, may
be desired to see a neighbouring patient who is under the regular
direction of another physician, in consequence of some sudden change
or aggravation of symptoms. The conduct to be pursued on such an
occasion is to give advice adapted to present circumstances ; to inter-
fere no farther than is absolutely necessary with the general plan of
treatment; to assume no future direction, unless it be expressly de-
sired ; and, in this last case, to request an immediate consultation
with the practitioner previously employed.

9. A wealthy physician should not give advice gratis to the
affluent; because his doing so is an injury to his professional breth-
ren. The office of a physician can never be supported as an exclu-
sively benificent one ; and it is defrauding, in some degree, the
common funds for its support, when fees are dispensed with, which
might justly be claimed.

10. When a physician who has been engaged to attend a case of
midwifery is absent, and another is sont for, if delivery is accom-
plished during the attendance of the latter, he is entitled to the fee,
but should resign the patient to the practitioner first engaged.

Art. VI. Of differences between Physicians.

1. Diversity of opinion, and opposition of interest, may, in the
medical, as in other professions, sometimes occasion controversy and
even contention. Whenever such cases unfortunately occur, and
cannot be immediately terminated, they should be referred to the arbi-
tration of a sufficient number of physicians, or a court-medical.

As peculiar reserve must be maintained by physicians towards the
public, in regard to professional matters, and as there exist numerous
points in medical ethics and etiquette through which the feelings of

1847.] Code of Medical Ethics. 547

medical men may be painfully assailed in their intercourse with each
other, and which cannot be understood or appreciated by general soci-
ety, neither the subject matter of such differences nor the adjudication
of the arbitrators should be made public, as publicity in a case of this
nature maybe personally injurious to the individuals concerned, and
can hardly fail to bring discredit on the faculty.

Aiit. VII. Of Pecuniary Acknowledgments .

$> 1. Borne general rules should be adopted by the faculty, in every

town or district, relative to pecuniary acknowledgments from their

patients : and it should be deemed a point of honour to adhere to these

rules with as much uniformity as varying circumstances will admit.

CHAPTER IIL

or TEE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF THE OB-
LIGATIONS OF THE PUBLIC TO THE PROFESSION.

Art. I. Duties of the profession to the public.
. As good citizens, it is the duty of physicians to be ever vigilant
for the welfare of the community, and to bear their part in sustaining
its institutions and burde: should also be ^ver readv to give

1 to the public in relation to matters c appertaining to

their profession, as on subjects of medical police, public hygiene, and
legal medicine. It is their province to enlighten the public in regard
to quarantine regulation?, the location, arrangement, and dietaries
of hospitals, asylums, schools, prisons, and similar institutions, in
relation to the medical police of towns, as drainage, ventilations. 6cc.
and in regard to measures for the prevention of epidemic and conta-
gious diseases; and when pestilence prevails, it is their duty to face
the danger, and to continue their labours for the alleviation of the
sufierir.g. even at the jeopardy of their own iives.

Medical men should also be always ready, when called on by
the legally constituted authorities, to enlighten coroners' inquests
and courts of justice, on subject e edical, such as involve

questions relating to sanity, legitimacy, murder by poisons or other
violent means, and in regard to the various other subjects embraced
in the science of Medical Jurisprudence. But in these cases, and
especi re they are required to make a post-mortem examina-

tion, it is just, in consequence of the time, labour and skill required,
and the responsibility and r incur, that the public should

award them a proper honorarium.

3. There is no profession, by the members of which, eleemosvn-

rvices are more liberally dispensed, than the medical, but
justice requires that some limits should be placed to the performance
of such good offices. Poverty, professional brotherhood, and certain
public duties referred to in section 1 of this chapter, should always
be recognized \ \ou ; tral

548 Code of Medical Ethics. [September,

neither institutions endowed by the public or by rich individuals,
societies for mutual benefit, for the insurance oflivesor for analogous
purposes, nor any profession or occupation, can be admitted to pos-
sess such privilege. Nor can it be justly expected of physicians to
furnish certificates of inability to serve on juries, to perform militia
duty, or to testify to the state of health of persons wishing to insure
their lives, obtain pensions, or the like, without a pecuniary acknow-
ledgment. But to individuals in indigent circumstances, such pro-
fessional services should always be cheerfully and freely accorded.

4. It is the duty of physicians, who are frequent witnesses of the
enormities committed by quackery, and the injury to health and even?
destruction of life caused by the use of quack medicines, to enlighten
the public on these subjects, to expose the injuries sustained by the
unwary from the devices and pretensions of artful empirics and im-
posters. Physicians ought to use all the influence which they may
possess, as professors in Colleges of Pharmacy, and by exercising
their option in regard to the shops to which their prescriptions shall
be sent, to discourage druggists and apothecaries from vending quack
or secret medicines, or from being in any way engaged in their man-
ufacture and sale.

Axt. II. Obligations of the public to physicians.
1. The benefits accruing to the public directly and indirectly
from the active and unwearied beneficence of the profession, are so
numerous and important, that physicians are justly entitled to the
utmost consideration and respect from the community. The public
ought likewise to entertain a just appreciation of medical qualifica-
tions; to make a proper discrimination between true science and
the assumptions of ignorance and empiricism,-* to afford every en-
couragement and facility for the acquisition of medical education,
and no longer to allow the statute books to exhibit the anomaly of
exacting knowledge from physicians, under liability to heavy penal-
ties, and of making them obnoxious to punishment for resorting to
the only means of obtaining it.

Nora. The committee on presenting this code, stated that justice ieonired
some explanatory remarks should accompany it. The members of the Conven-
tion, would not fail to recognize in pans of it, expressions with which they were
familiar. On examining a great number of codes of ethics adopted by ditferent
societies in the United States, it was found that they were all based on that by
Dr. Percival, and that the phrases of this writer were preserved, to a consider-
able extent, in all of them. Believing that language which had been so often
examined and adopted, must possess the greatest ot merits for such a document
as the present, clearness and precision, and having no ambition for the honours
of authorship, the Committee which prepared this code have followed a similar
course, and have carefully preserved the words of Percival wherever they con--
vey the precepts it is wished to inculcate. A few of the sections are in the
words of the late Dr. Rush, and one or two sentences are from other writers.
Bat in all cases, wherever it was thought that the language could be made more
explicit by changing a word, or even a part of a sentence, this has been unhesi-
tatingly done; and thus there are but few sections which have not undergone
some modification: while, for the language of many, and for the arrangement
of the whole, the Committee must be held exclusively responsible.

1847.] Employment of Ether in Obstetric Practice, 549

On the Employment of Ether by Inhalation in Obstetric Practice ;
with Cases and Observations. By Protheroe Smith, M. D.,

Member of the Royal College of Physicians ; Assistant Teacher of
Midwifery at St. Bartholomew's Hospital. (Lancet.)

The power of the vapour of ether, when inhaled, to diminish, or
even to destroy sensation, and consequently pain, has been placed
beyond doubt by the results of hundreds of surgical operations. Its
safety in surgical cases may also be considered as established, espe-
cially when the administration of the ether is conducted with attention
to the precautions indicated by experience. We may, I think, fairly
consider that the instances in which ether will be administered before
surgical operations, will be the rule those in which it will be omitted,
the exceptions. We may also, expect its use to be general in dislo-
cations, hernia, spasmodic strictures, &c. In the first two of these
cases, it acts in a twofold manner: 1st, it relieves the pain; and
2ndly, it relaxes the muscles, whose contraction opposes reduction.
We shall see that in midwifery, also it possesses the latter advantage,
by its action upon the perinatal muscles.

Ether has been but little employed in painful medical cases; and
yet it has already been proved to give instant ease from the agony of
neuralgia, and from the horrible dyspncea of spasmodic asthma. A
case of colica pictonum, which had resisted the usual means for three
days, was cured by ether. A case of puerperal mania was immedi-
ately and permanently relieved ; and several cases of dysmenorrhcea
have been recorded, in which this agent has acted like magic. Pro-
bably, many spasmodic diseases will be benefitted by inhalation of
ether; and we may confidently expect many forms of intractable
hysterical pains to yield to it. In a few cases published by M. Piorry,
which appeared unfavorably affected by it, the ether was probably
impure. It is not my intention, however, to discuss the effects of
ether in medical and surgical practice.

But though the disease?, as hysteria and dysmenorrhcea, which are
commonly regarded as belonging peculiarly to the obstetric practi-
tioner, will probably derive very great benefit from the etherial treat-
ment, I would proceed to the inquiry, whether its exhibition will ever
be habitually employed in daily obstetric practice.

To answer this question, we may examine- 1st, the d priori
physiological probabilities; and 2ndly, the results of the cases in
which ether has been tried.

Labour is a complex process, in which every part of the nervous
system is concerned. Now ether affects, in succession, every por-
tion of the nervous system, unless we except the ganglionic. '

In labour, the brain is in action, as is proved by the presence of
thought and special sensation ; so, also, the pons Varolii (or whatever
the seat of pain may be) i> also active as are the cerebellum, the.
medulla spinalis, the medulla oblongata, and the ganglionic system.
But though all these portions of the nervous iivstem are concerned

550 Employment of Ether in Obstetric Practice. [September,

in ordinary labour, they are not all necessarily, or, as it appears to
me, advantageously so.

It is proved beyond a doubt, by cases of paraphlegia, that the pa-
tient may be sensible, and yet feel no pain, though the uterus contract
regularly. The same absence of pain is seen in puerperal convul-
sions, in which unconsciusness is superadded : and in some cases of
paraplegia, even the reflex actions of the abdominal muscles have
been wanting, so that labour has been terminated by the efforts of the
uterus alone. Gases have occurred in which the patient has been
unconsciously delivered, without accident or apparent delay, when in
a state of extreme intoxication.

Thus, then, of the usual nervous concomitants of labour, conscious-
ness, pain, and spinal reflex action, may be wanting, and yet partu-
rition proceed uninterruptedly.

But though they may be absent, can they be artificially abolished
without danger? Can this be accomplished by ether and if so, is
it justifiable on Christian principles ? as I have frequently been asked.

I will answer the last question before entering upon the considera-
tion of the others; because, if we have reason to believe that an
attempt to relieve the pains of labour would be in opposition to the
will of God, all discussion of the other questions must at once be
abandoned.

I think it is obvious that the same principle which would lead us to
view any attempt to remove the dreadful and dreaded pains of labour,
as opposed to the Divine will, would induce us to neglect every means
of relieving human suffering. Though from different motives we
should, like the Turks, passively bear evils easily removable, as dis-
ease and suffering are alike dependent on the event which elicited
the decree "In sorrow thou shalt bring forth." In fact, precisely
the same objections have successively been made to most of the great
discoveries and improvements in medicine. Some may remember
that one of the great arguments against vaccination and in the last
century, against inoculation was, that the practice was a presump-
tuous contravention of the Divine will. With far more reason might
the objection be urged to the practice of inducing premature labour,
and still more strongly against that of destroying in utero a living
foetus. And yet it is now universally admitted, that to risk the life
of the mother by refraining from these operations is not only unjus-
tifiable, but highly criminal. Certainly, (hen, ifit is justifiable t.o
attempt the relief of pain, it is especially imperative upon us to do so
in the most intense of all pain.

I am induced to offer these observations in the hope that they may
satisfy the scruples* of those who have opposed the employment of
ether in ordinary cases of labour, from a feeling that its use is not
justifiable on Christian principles. Time has often hallowed what
science and advancing knowledge have proved to be but the offspring
of habit and prejudice ; and in support of this assertion, I would
quote a recent publication cf Dr. Simpson, in which he says, 'The

1847.] Employment of Ether in Ohstetric Practice. 551

idea of its inevitable necessity makes both the profession and our
patients look upon the amount and intensity of pain encountered in
common cases of natural labour as far less worthy of consideration
than they in reality are."

These observations, will, I trust, be deemed conclusive on this part
of my subject. Pathology then, has proved that parturition will pro-
ceed without material interruption or injury by the ganglionic nervous
influence. I do not enter into the question, whether the uterus is
exclusively under the control of the ganglionic system. It is suffi-
cient that it is very largely so.

Ether will first derange, and then temporarily suspend, in succes-
sion, consciousness, special sensation, common sensation, pain,
(which is certainly something different from common sensation
i. e., tact,) power of muscular combinations, spinal reflex actions,
and respiration.* It is doubtful whether it will not, in some cases
at least increase ganglionic nervous power. f It is certain however,
that if the medulla oblongata is completely etherized, and, conse-
quently, the movements of respiration stopped, the action of the
heart is speedily arrested also, and life becomes extinct. :f

The chief authorities for enabling us to decide the question of the
safety of ether from the actual results of its exhibitions are, Professor
Simpson, and Baron Dubois; and both maintain that they have
observed no bad effect on either the mother or child. M. Dubois
distinctly "states that none of the women who inhaled ether expe-
rienced any bad effects attributable to ether. " These gentlemen
differ, however, in reference to the probability that ether will become
universally, or even generally applicable to ordinary midwifery prac-
tice. The Baron states his "profound conviction that ether will be
applicable to but a limited number of peculiar cases;" whilst the
Professor entertains much more sanguine views. As yet, general
.experience favours the opinion of the latter.

The pain of labour (incomparably the greatest which human na-
ture is called upon to bear) must, I think, be viewed as an unmixed
evil. I will not quote the descriptions given by eminent accouch-
eurs of the agony and anguish of the final throes; they are univer-
sally acknowledged, as are also the bad effects of intense pain. Pain
acts injuriously in several modes. Thus, its severity is very greatly
dreaded, and the depression caused by the anticipation of its inevita-
ble occurrence, preying for months upon the spirits, has been known
to produce very injurious effects.

The hope thatether will substitute tranquil dreams for the dreaded
suffering would obviate this evil. Again : pain is one of the greatest
elements in the shock of labour. It is probable that all parts of the
nervous system share in this shock. Now, if the effects of ether can
be so regulated as to be confined to the brain and spinal marrow,

* British and Foreign Medical Review, April, 1817. p. 571.

t Ibid, p. 572. M.Longet. t Ibid, p.572. M.Flourens.

} The Lanckt, fox May, 1847,

551 Employment of Ether in Obstetric Practice. [September,

(here would he left only those portions of the shock which are seated
in the medulla oblongata and ganglionic system. I think we should
not be justified in refusing the abolition of part, because we cannot
destroy the whole of any evil. Again : do we not know the exact
proportion in which the various parts of the nervous system share
the shock ; we only know that pain is a large element of it.

To the question, how far should we carry our etherization, I would
answer, in ordinary cases of labour, merely till the cerebrum and pons
Variolii are under its influence, as shown by the suspension of intel-
lect, and of the perception of pain ;* but in cases requiring extraor-
dinary manipulation or operations, we ought to bring the cerebellum
and medulla spinalis into temporary narcotism, to prevent as far as
possible, the violent muscular movements which, when the control of
the will is suspended, might be productive of mischief. Conscious,
ness is certainly no advantage to the obstetrician ; for the patient can
do little or nothing to assist him, and frequently may do much harm
by her involuntary efforts to bear down, and by her restlessness, which
latter often greatly debilitates and exhausts her.

It is obvious, assuming the power of ether to produce these effects,
that unless we can regulate the dose, or other circumstances which
modify its effects, so as to limit the action to the cerebrum, pons
Varolii, cerebellum, and medulla spinalis, ether would be a dangerous
agent. Fortunately there is no reason to doubt that, with proper
apparatus, and common observation of the symptoms induced, we
may invariably prevent the medulla oblongata from being involved.

Though causing the patient to breathe atmospheric air, ether pure,
or mixed with the etherial vapour, has hitherto been sufficient to
check any approach to stertor or coma, and also to relieve such con-
ditions when induced, I have observed, with much pleasure, that Mr.
Hooper has adapted to his inhaling apparatus an appendage for ad-
ministering oxygen. This will be a most valuable adjunct in cases
where there exists an unusual degree of susceptibility to the effect of
ether on the medulla oblongata.

Complete insensibility to pain exists only when the pons Varolii
or seat of pain is narcotized ; and M. Longet slates (in a paper quo-
ted in the last number of the British Foreign and Medical Review)
that no operation should be attempted until this effect is produced.

On the patient awaking from the state ofetherization, the nervous
functions return in the same order that they were suspended. This
explains the fact ofraany patients being perfectly sensible, and hold-
ing rational cenversations, but being the whole of the time uncon-
scious of pain.

The following observations by Dr. Simpson will serve to explain
my reasons for venturing to enrol myself amongst the advocates of
the new remedial agent :

lie says, " A careful collection of cautious and accurate observa-
tions will no doubt be required before the inhalation of sulphuric ether

* British and Foreign Medical Review, April, 1817, p. 571.

1847.] Employment of Ether in Obstetric Practice. 552

is adopted to any great extent in the practice of midwifery. It will
be necessary to ascertain its precise effects both upon the action of
the uterus and the assistant abdominal muscles; its influence, if any,
upon the child ; whether it gives a tendency to hemorrhage or other
complications; the contra-indications peculiar to its use; the most
certain modes of exhibiting it ; the length of time it may be employ-
ed, &c."

In the hope that some of these desiderata may be supplied, I now
beg to lay before the profession the following interesting cases of
instrumental labour which have occurred in my practice within the
last few days, and in which I have employed ether by inhalation :

Case 1. On the ofternoon of Sunday, 28th ult., I was summon-
ed by Mr. Alder Fisher, to a lady on whom he had been in attendance
.all day. The expediency of being prepared to employ ether by inha-
lation, should it be deemed advisable, having been suggested, I gladly
availed myself, as on previous occasions, of the valuable services of
Mr. Tracy, of St. Bartholomew's Hospital, who has not only invented
an ingenious and simple apparatus for administering this agent, but
has successfully applied it in several hundreds of surgical cases. On
our arrival at the residence of the patient (about four p. m.), we
found her in strong labour with her first child. We were informed
that her age was forty, and that she had been married eleven months.
She is a woman of spare habit and lax fibre : apparently well formed
and about five feet three inches in height. From the age of fourteen,
at which the catamenia first appeared, she has always been "regu-
lar;" and although not of a robust frame, has enjoyed uninterrupted
good health ; her last menstruation was in the end of June. I learned
from Mr. Fisher, that premonitory labour pains- had commenced at
half-past twelve a. M., and had gradually increased, both in severity
and frequency, until three a. H., when they recurred regularly every
twenty minutes. At five a. m., the intervals became shorter, the
uterine contractions coming on every ten or fifteen minutes, and the
suffering they occasioned, even at this early period of labour, was
very considerable. When first seen by Mr. Fisher, at eight a. m.,
although the os uteri was only dilated to the extent of half-a-crown,
the head, still in the uterus, rested on the perinaeum. At four r. ic,
the pains which had been frequent and energetic since eight a. K.,
were now both strong and expulsive, recurring every four or five
minutes, and the patient complained greatly of her sufferings. Hav-
ing been informed of the benefit resulting from the employment of
ether by inhalation, she was very urgent For its immediate adoption.
The bowels had been well acted upon during the day; the tongue
was moist and clean ; and she was perspiring profusely. On a vagi-
nal examination, the passage was found to be cool and well lubrica-
ted ; the os uteri dilated to the size of the rim ofa tea-cup ; and the
child presenting in the first cranial position. The head rested on
the lluor of the pelvis, and forcibly pressed, during each pain, against

553 Employment of Ether in Obstetric Practice. [September,

the covering tuberosities of the ischia, the distance between which
was barely four inches. The membranes were entire and distended
with liquor amnii ; they protruded through the opening os, the mar-
gins of which were rapidiy yielding; the uterine structure was soft
and dilatable. Being satisfied that there existed no abnormal appli-
cations to forbid the inhalation of ether, its exhibition was commenced
by Mr. Tracy, at a quarter-past four p. m., immediately after the
spontaneous rupture of the membranes. At this time a pain was
coming on, which proved to be very violent, and was attended with
considerable straining, and some retching. The ether in three min-
utes, produced insensibility to suffering, although the pains continued
as strong as previously to its application, and recurred regularly
every three minutes. The patient occasionally gave rational answers
to questions, and stated that she had scarcely been conscious of any
pain since the administration of the etherial vapour ; her friends who
were present could hardly credit her report, as no difference in the
violence of their efforts, or in the character and severity of the uterine
contractions could be remarked.

The following notes of the farther progress of the case were taken
on the spot: At half-past four p. M., the uterine contractions have
recurred at intervals of three minutes only, though the patient has
remained perfectly narcotized for the last quarter of an hour. Du-
ring these pains, which were very powerful, the legs were at times
forcibly extended, and the right arm raised, and all the usual strain-
ing exclamations during expiration, continued as before. On placing
my hands upon the abdomen, I became sensible of the powerful con-
traction, not only of the uterus, but also of the abdominal muscles.
The os was now fully dilated. Forty-three minutes past four p. BE. :
Since the escape of the waters, she has had pains every two or three
minutes, and her cries are loud, sharp, and expressive of severe ex-
pulsive efforts. In the intervals of pain, the child's head rests on the
perinaeneum, (producing a distension of its right side, and of the cor-
responding labium pudendi,) and is closely embraced by the bony
outlet. The pains are of short duration. Pulse 84, soft and com-
pressible ; skin freely perspiring. Fifty-three minutes past four p.m. :
During the last fifteen minutes, the inhalation has been discontinued,
and there has been an intermission of uterine contractions for four
minutes. In reply to inquiries, she again says she has felt scarcely
any thing since the ether has been employed Thirteen minutes past
five P.M. : For the last twenty minutes the ether has been adminis-
tered only during uterine action, the intervals between which have
been only two or three minutes. She occasionally cries out as if in
slight pain, but when interrogated, states she is "perfectly easy and
comfortable." Fifty minutes past five p. M. : The pains have continu-
ed every three minutes, but have produced no apparent effect on the
head, which is firmly fixed at the outlet; the amount of straining
effort, the peculiar cry, and the expression of the face, seem to beto-
ken great suffering during her pains, but she again asserts that she

1847.] Employment of Ether in Obstetric Practice. 554

is "easy." The ether was now again suspended for ten minutes,
when she had three uterine contractions, and became sensible to
pain. Half-past six p. M. : Under the influence of the ether, in the
last half hour she has had twelve pains, and has been wholly uncon-
scious of them. The head is still fixed at the outlet. Forty-five
minutes past six r. Bff. : During the last ten minutes the ether has
not been employed, and the pains have been precisely of the same
character as when she was inhaling; he also states that they are
productive of much agony. As the head had made no advance, and
had been firmly impacted for half an hour, the cranial bones overlap-
ping considerably, I determined after ascertaining by the stethoscope
that the child was alive to apply the short forceps. This was accom-
plished at seven p. m., after emptying the bladder, and again narcot-
izing the patient. It was evident, from the extent to which the
handles of the forceps were separated, that the head was a very
large one, and that it would require considerable compression, as
well as traction, to bring it through the d^proportioned outlet. To
accomplish this with safety to the mother, and with a prospect of
saving the life of the child, I made my efforts at intervals of two or
three minutes, during which 1 relaxed my grasp of the head, and
held the handles of the forceps loosely, in order that the brain might
recover from the effects of the severe pressure to which it was sub-
jected during traction. By these means the head was delivered in
fifty- five minutes from the first application of the instrument, and at
.fifty-five minutes past seven r. iff., a living male child was born.
After the introduction of the forceps, some difficulty was experienced
-in consequence of the forcible extension of the patient's legs, and the
constant disposition to straighten the body during the strong expul-
sive efforts. With the assistance of Mr. Fisher and another gentle-
man the pelvis was held in a favorable position ; the right leg was
.separated from the other, and fixed on the abdomen, so as to admit
the handles of the instrument between the thighs. By these means,
and by occupying a position in front of the patient, I could easily em-
ploy traction in the direction of the outlet with my right hand, whilst
with the left I supported the perina3iim. The placenta quickly follow-
ed, and at eight r. ai., the uterus was felt, firmly contracted, through
the abdominal walls ; a bandage was immediately applied round the
abdomen and pelvis, and the ether, which, during the whole period
of the operation had effected complete narcotism, was discontinued.
Five minutes past eight p. iff. : Consciousness is restored ; she ex-
presses a hope that she shall soon be delivered, adding that she is
very comfortable. She says she feels as if just awoke from a painful
dream. When informed of the termination of her labour she burst
into an hysterical laugh, and exclaimed, " It is a dream ! It must
be a dream ! Oh what a good thing it is that I had the ether !" She
also observed she bad not been sensible of the circumstances attend-
ing her delivery. Quarter past eight p. M : Appears somewhat ex-
hausted, and her face being still flushed, it is ordered to be bathed

55,5 Employment of Ether in Obstetric Practice. [September,

in cold water. From this period she became rapidly restored to her
usual state of mind and sensibility. Farinaceous nourishment and
perfect quiet are enjoined.

Theohild weighed eight pounds and a half; it is twenty-two inches
and a half in length. The dimensions of the head are as follows :
round the head and face, in the direction of the oblique or occipito-
mental diameter, sixteen inches ; around the forehead and occiput, in
the longitudinal or fronto-occipital diameter, fifteen inches : from one
parietal protuberance to the other, across the vertex, six inches.

It is worthy of observation, that neilher the character nor the fre-
quency of the pains was affected by the use of the ether ; that all the
efforts of the abdominal and other muscles which aid in expulsion,
and also the characteristic cries, continued unaltered ; that though
consciousness remained, excepting during the last hour, in which the
forceps were employed, she was wholly insensible to pain, except
when the ether was suspended for a time ; that with the exception of
this rest, she continued under its influence for three hours and three
quarters, without experiencing the least injurious result ; and that
she inhaled, in all, eight ounces and a half of pure ether.

Notwithstanding the advanced age of the patient, and the dispro-
portion between her pelvis and the child's head, delivery was effected
within twenty-hours from the time premonitory labour pains com-
menced, and with perfect safety to both mother and child.

In referring to the rigid condition of the extreme muscles of the
trunk and inferior extremities, I would direct attention to the position
of the operator and the patient, as well calculated to overcome the
difficulties created by these circumstances in instrumental labour.
The result of this case also shews the importance of observing atten-
tively the space between the blades of the forceps during compression,
as with little practice it will enable the accoucheur to determine with
accuracy the diameter of the child's head, and its relative proportion
to the passages of the mother; and thus he will be better able to
decide the important question of delivery by means of the forceps or
perforator. From a conviction that the life of a child may some-
times be sacrificed by forcibly tying the. handles of the forceps
together, and by thus keeping up uninterrupted pressure on the head
during the operation, I now usually adopt the plan mentioned in this
case, by which the head is free from compression, save only during
the efforts of traction.

It is to Professor Naegele, of Heidelburgh, that we are indebted
for having first pointed out the true mechanism of parturition, and
for showing that the head of the child passes through and emerges
from the pelvis obliquely. Dr. Rigby observes, in his "System of
Midwifery," that in the first cranial position, the right parietal protu-
berance lies, in the early stage of labour, lowest and deepest in the
pelvis; whilst the superior and posterior quarter of this bone is the
part which first comes under the public arch and enters the external
passages. I am not, however, aware that any one has observed a

1847.] Employment of Ether in Obstetric Practice. 556

fact of some practical interest, in reference to this subject,, which I
have long known, and which I have alluded to in the above notes
Vhz., that in the first cranial position the right side of the perinaeum
and corresponding labium pudendi are chiefly subjected to pressure
during the distention of the soft parts, and therefore principally de-
mand the support which may be necessary to save the perinaeum
from the accident, and vice versa when the head passes in the second
position. From my own observations, I am induced to believe that
future experience will prove, that as the first cranial position is the
most common, so rupture of the peri n sum usually occurs on the
right side of its raphe, and that this accident may most effectually be
prevented by acting on the suggestions I have here ventured to make*

March 29th. Eleven a. M. : Has passed a comfortable and tran-
quil night, and has slept without creaming a very uncommon occur-
rence with her; the lochia are natural in quantity, &c. ; pulse 70,
soft and regular; tongue dean; is very cheerful, and entirely free
from ailment, with the exception of inability to evacuate the bladder ;
a pint of healthy urine was accordingly drawn off by the catheter.
She observed this morning that she had a most vivid recollection of
severe suffering previously to the inhalation of the ether, and also a
slight impression of having felt some pain during the intervals of its
exhibition, which entirely ceased after a few inspirations ; that with;
these exceptions, she was not at all aware of the birth of the child,
or of any circumstance attending her confinement; and that it was
not until after her face and temples had been bathed with cold water
that perfect consciousness was restored, when she felt as though she
had awakened from some strange and painful dream, the subject of
which she could not call to memory. Eleven p. K, : Has passed her
nrine spontaneously ; is doing well in every respect. The child 19
healthy, and takes the breast readily.

"3 0 1 1 i Xoon : Has had a good night : the milk is increasing ; and
with the exception of feeling rather stiff, she is perfectly well.

April 19th. Both mother and child continue perfectly well, and
since the delivery no medical aid, beyond the passage of the catheter
on one occasion, has been required.

Case 2. April 1st, 1847. Mrs. , aged thirty-three; married
ten years and a half; has had six children, of which the last was born'
in February, 1846; is a robust looking woman, with florid complex-
ion; states that her general health is good, and that, with the excep-
tion of slight chronic cough, she has been free from ailments during
the term of utero-gestation ; says her family is of a consumptive and
rheumatic, tendency, her mother having died at forty, and a brother
at twenty, of phthisis : has always been "regular" from the age of
sixteen, except when pregnant or nursing. Her first five labours
were ordinary in their character; the fifth lasted forty-eight hours,
and was attended with great Buffering; and the sixth and last, five
hours: in each the child was a female. In the last, the head was
arrested at the brim for some time, and in consequence my assistance

557 Employment. of Ether in Obstetric Practice. [September,

was called for; but as the labour terminated before my arrival, I did
not make any examination. She last menstruated at the end of
June. The bowels have been freely opened, and the bladder has
been lately relieved. Premonitory symptoms of labour commenced
on Sunday, 28th ult., recurring about every two hours. On the fol-
lowing day, 29th, they abated in frequency and power; but became
more urgent on Tuesday, 30th, towards evening, with intervals of
only half an hour. The pains were felt chiefly in the groin and hy-
pogastrium. On Wednesday morning, 31st ult., she had an interval
of rest until about eight o'clock, when a strong pain ruptured the
membranes, and what she described as a " good deal of water" escap-
ed. From this time the pains recurred about every half hour, until
six a. M. of the following day, when they became slack. Mr. Orford,
who attended this patient, first visited at eight p. m. of the 31st ult.
The os uteri was then soft and dilatable, but not at all dilated. An
enema was given, which emptied the rectum. He visited her again
at half past twelve o'clock, when the dilatation of the os uteri was
nearly complete. The pains having been very powerful and fre-
quent, without any effect on the head of the child, Mr. Oxford gave
tincture of opium, half a drachm, at five a. m. During thtj early
period of labour, he could not detect the true position of the head in
consequence of its high situation in the pelvis. Mr. Campion, who
was called to the patient, first saw her at 6 a. m., when the head was
resting on the pelvic brim, and was moveable ; and as the symptoms
at that time were those of arrest, he administered three doses of ergot
at half-past six, seven, and half-past seven a. m. successively. This
treatment had the effect of increasing the strength and frequency of
the pains; but without producing any advance of the head, which
became firmly fixed in the brim.

The above history was given to me on my arrival at ten a. M.-
On making a vaginal examination, I found the passages cool and
well lubricated; the head resting on the brim, and firmly fixed du-
ring a pain ; slightly moveable in the intervals. A very large caput
succedancum, and an evident malformation of the pelvis, rendering it
difficult to diagnosis the true position of the child. On carefully ex-
amining, however, I ascertained that it occupied the first cranial
position, the posterior fontanelle being turned in the direction of the
left foramen ovale.

The pelvis, in this case, formed a remarkable example of that con-
dition so faithfully described by Professor Neagele, of Heidelburgh,
under the appellation of " pelvis oblique ovato." In this instance
the pelvis was twisted, so that the symphysis was inclined to the right,
and the secrum to the left. The left side of the pelvis was flattened,
as though driven inward, and the left linea ilio-pectinea presented
almost a straight line from the sacro-iliac synchondrosis to the poste-
rior margin of the foramen ovale. From this point, the body of the
pubic bone abruptly inclined backwards, so as to present a distinct
ridge of the size of a finger. This ridge was formed by the angle,

1847.] Employment of Ether in Obstclric Practice. 558

perpendicular surface, and inner margin of the ramus, and projected
backwards so as to contract the conjugate diameter of the brim.
This projection at first conveyed to the touch the impression that it
was a considerable exostosis; but on further investigation, the true
nature of the malformation was detected. Anteriorly, I could feel a
narrow rim of the uterus, (the remains of the anterior lip.) and by
introducing two fingers this rim could be traced backwards, encircling
the head of the child, and pressed between the projection of bone and
the brim of the pelvis. The pains were coming on every three or
four minutes; but were not at all powerful, lasting from a quarter to
three quarters of a minute. It having been ascertained by the steth-
oscope that the child was alive, I determined to administer ether by
inhalation. The patient was very urgent to be relieved from her
sufferings, which were beginning to tell upon her strength and nerv-
ous system. At a quarter to eleven a. m., the ether was accordingly
administered by ?Iessrs. Campion and Oxford. At first it induced
slight cough, which entirely disappeared in about five minutes. At
the end of the first eight minutes durinjr which she continued to in-
hale, but not uninterruptedly, she became conscious of a pain the
ether having been very imperfectly taken, from her frequent efforts
to talk and to interrupt the process of inhalation. In ten minutes
she was quite reconciled to its use ; but owing to its imperfect exhi-
bition, she became rather inebriated than narcotized. In this state
she continued until a quarter to twelve, uterine contractions recur-
ring every three or four minutes, but unattended by any efforts on
the part of the abdominal muscles. From this time the ether pro-
duced more effect, and she became unconscious of her pains, though
they were much increased in power, and were aided by distinct action
of the assistant abdominal muscles. These were felt to contract
forcibly under the hand. She was at times very loquacious. At
every vaginal examination the " pains" became more frequent, re-
turning every minute, and were much increased in intensity. fifty-
five minutes past eleven : Is completely narcotized ; the hand drops
powerless when lifted up ; the eye is turned up under the superior lid ;
her face is flushed; pulse 92, soft and smaller; skin profusely per-
spiring. The narrow rim of the cervix uteri can no longer be felt;
the head is firmly impacted in- the upper strait ; the bones of the
cranium overlapping.

Having determined on employing the long forceps, from the im-
pression that, notwithstanding the great deformity, there was room
to bring the head through the contracted brim by cautious traction,
having previously introduced the catheter, I accordingly applied this
instrument at a quarter to twelve. Tor about half an hour, my re-
peated, but interrupted, efforts to extract were apparently unavailing ;
but in a few minutes afterwards, the head slipped suddenly over the
projection before described, and fairly occupied the true pelvis. Du-
ring this process, I passed two fingers of my left hand one on each
side of the projection, so as to guard it effectually from undue pres-

558 Employment of Ether in Obstetric Practice. [September,

sure during traction. A few more efforts brought the head through
the os externum, when the child cried loudly. The body quickly-
followed, and the placenta was thrown off by the same pain that ex-
pelled the child. The uterus contracted well, and there was very
little haemorrhage. The ether, which had been employed with but
little interruption for two hours, was discontinued immediately after
the birth of the child ; and the patient recovered her consciousness
in two or three minutes. Though apparently aware of the presence
of pain in the early part of the process, she expressed herself very
grateful for the use of the ether, and stated that she was entirely
ignorant of the biith of the child, and of the means which had been
adopted for its accomplishment. The pains instantly ceased on the
expulsion of the secundines, but were immediately induced on the
introduction of my finger, after the completion of the labour, in order
to ascertain with more accuracy the true state of the pelvic deformity.
So powerful were the expulsive efforts thus induced, that the uterus
was forcibly driven down to the outlet ; but these after-pains sudden-
ly ceased with the withdrawal of the fjnger, and a state of perfect
repose followed. The child is a very large and vigorous boy ; the
head presented a perfect cast of the deformed pelvis of the mother;
it is very oblong perfectly flattened on its left 3tde from the lamb-
doidal suture to the temporal ridge of the frontal bone; whilst the
opposite side describes a hemispherical, or rather semi-oval, figure,
elongated by a very large caput succedaneum, which occupies the
superior posterior angle of the right parietal bone.

April 2nd. Has passed a tranquil night. Both child and mother
are in every respect well. She states that she has no recollection:
of any circumstance from the time the ether was first administered,
until the escape of the placenta from the vagina, of which she was
Conscious, though she felt no pain. She is most profuse in her
grateful acknowledgements of the blessing of the ether, which she
hopes will be employed again, should she become pregnant.

6th. Is sitting up in bed, and observes that she has suffered less
after this confinement than in any previous one in fact, that she
has experienced no exhaustion, and, to use her own expression-,
"never felt so well in her life." The unusually healthy condition
she attributes to the use of the ether. Her cough is almost gone,
and everything is going on favourably. The child is vigorous, and
takes the breast eagerly ; and its head has recovered from the mis-
shapen state in which it was born.

Case 3. Mrs. II , aged twenty-four; primipara; of delicate
appearance, and weakly constitution. From the age of fifteen years
and a half, when menstruation first occurred, her health suffered from
the sedentary nature of her occupation that of dress-making. But
from the period of her marriage, twelve months since, she has re-
linquished her business; and has enjoyed better health, though she
lias occasionally experienced pain in her chest, and has had at times
black mucous expectoration. Her last menstruation was in July,

1847.] Emj^loymerU of EtJtcr i:i Gbsietric Practice. 559

1846. Labour commenced at ten p. :<i. on the 14th of April. She
was first visited \>y Mr. Oxford, at seven a. x.. oft the 15th. when
the os was dilated to the size of a crown piece; an3 the pains were
slight, and recurred at long interval. Tjwl bowels having been con-
stipated for some days, an enema was administered. At ten a. m.,
the uterine efforts were powerful and frequent, and the os fully dila-
ted. The child was presenting in the first cranial position. The
membranes ruptured during a pain at noon, at which time the head
had not entered the true pelvis. The uterine contractions then he-
came very forcible, and the intervals short, until two v. &, when the
head descended to the outlet, where it remained stationary. At half-
past three r. M., Mr. Oxford gave > drachm of the ergot, the
uterus having been in a state of inertia for an hour and a half.
From this time until eight p. x., notwithstanding very frequent and
expulsive ctlbrts, the head made no advahhee. Mr. Campion having
seen the case at this juncture, concurred with Mr. Oxford in the ne-
cessity for instrumental assistance, and my attendance was accord-
ingly requested. On my arrival, I found the patient much exhausted,
and very desirous to be relieved of her pain by the agency of ether.
For nearly four hours the head bad iy impacted at the outlet,
the transverse diameter of which did not exceed three inches and a
half. The cranial bones were overlapping to a considerable extent,
and the caput secedaneum was very rj . Having satisfied myself
of the healty condition of the thoracic viscera, and that the child was
alive, the use of the short forceps and the inhalation of ether appeared
to me to be clearly indicated. After the bladder had been emptied,
the ether was administered by Messrs. Campion and Oxford at ten
minutes to nine p.m. In three minutes, she became perfectly nar-
cotized, when I introduced the forceps and extracted the head in
twelve minutes aficrwards. The body of the child followed in five
minutes more, and the placenta \vr.> expelled by natural efforts in
about ten minutes after wards.

When I first visited this patient, I found that her pains were re-
curring every two or three minutes; but when she became under
the influence of ether, their force and frequency were evidently aug-
mented ; the abdominal muscles, as well as the uterus, contracted
powerfully, and each effort was attended by the cries peculiar to the
last stage of labour. During the period of etherization, the breathing
at first was stertorous for a few moments, and the thighs and legs
were forcibly flexed, and drawn towards the abdomen. Having
adopted the mode of operation proposed in Case 1, the extraction
was accomplished with great ease. The head of the child (a male)
was much flattened by the action of the forceps, and was still-born,
but the usual means for restoring animation were successful before
the separation of the funis. The maternal surface of the placenta,
which was very large, presented a beautiful net-work of white, thread-
like lines, apparently calcareous ; this diseased condition of the pla-
cental cotyledons appeared to have exerted no injurious influence on

36*

560 Employment of Ether in Obstetric Practice. [September,

the child, or to have impeded the separation of the after-birth. I
much regret that, owing to some misunderstanding, the placenta was
destroyed. It is worthy of remark, that the perineum presented no
obstacle to the passage of the head, being perfectly relaxed, and
yielding readily to its pressure. In both this and the first case, the
usual rigidity of the soft parts was entirely wanting, and I think we
may venture to attribute this condition to the influence of the ether.
Indeed, in both instances, and more particularly in Case 1, where the
patient was a primipara, and forty years of age, this favorable condi-
tion was sensibly effected in the narcotized state. The uterus con-
tracted firmly after the completion of parturition, and the loss of
blood was trivial.

On restoration to consciousness, which was expedited by bathing
the face with vinegar and water, she observed that she had been
asleep, but yet was strangely impressed with the conviction that she
had been " travelling very far on a railroad ;" she was totally igno-
rant of all which had occurred during her state of narcotism. She
expressed the hope that her labour would soon be terminated, and
when I intimated to her that it was already accomplished, she replied,
14 Oh I wont believe that!" nor couid she be convinced of the fact,
until her infant, a fine, squalling boy, was called upon to witness to
its truth.

Eleven p. m. : Is quiet and comfortable ; says she only feels weak ;
lochia and urine have been passed freely ; the child has taken the
breast ; she has asked for something to eat ; she has had some after-
pains.

April 16th. Both mother and child are well; the former has passed
a tranquil night. Towards evening the after-pains became trouble-
some, but disappeared after the expulsion of a few coagula.

17th. The mother and child are going on well in all respects.

During traction on the head, which was in the first position, the
bulging of the right side of the perineum and labium pudendi, as
mentioned in Case 1, was very evident to Mr. Campion, whose office
it was to support the soft parts. In this case, it is remarkable that
the legs were flexed, as extension of the lower extremities has been
usually observed under the influence of ether.

The result of the foregoing cases will, I think, bear out Mr. Du-
bois's summary viz :

1. Ether prevents pain during obstetric operations.

2. It may momentarily suspend the natural contractions, but

3. It does not suspend them, nor the contraction of the abdominal
muscles, when energetically set up.

4. It appears to lessen the natural resistance of the perinaeal mus-
cles.

5. It does not appear to exert any bad influence on the life or health
of the child.

6. It does not prevent or retard the subsequent contraction of the
uterus.

1847.] Employment of Ether in Obstetric Practice. 561

To these conclusions, I would add

1. That ether produces freedom from pain during natural labours,
as well as during obstetric operations.

2. That it is very probable that the momentary suspension of uter-
ine action, which sometimes occurs when ether has been administered
in the earlier stages of labour, may be caused by the novelty, not
unmixed with fear, of the inhalation, just as the arrival of the ac-
coucheur will often temporarily suspend the contractions.*

3. That it will be a most powerful agent in preventing rupture of
the perinaoum, especially in primipara? advanced in life; firstly, by
producing relaxation of the perinatal muscles; and secondly, by ren-
dering the woman incapable of sudden movements, during the support
of the soft parts, under the intolerable pain when the head is emerg-
ing from the os externum.

4. There is no evidence to show that the ether has any bad influ-
ence on the mother. If it has, the proof remains to be adduced.

Thus, then, I agree with Professor Simpsonf in anticipating great
advantages from the use of ether, not only in cases requiring manipu-
lations or operations, but also in natural cases ; and the chief advan-
tages* which I think we are entitled to expect are

1. The saving of suffering perhaps the greatest borne by human
beings, and in no way contributing to the happy termination of the
case. Possibly as a drawback from this advantage, we may admit
that an experienced practitioner may occasionally pinch or bruise the
maternal soft parts, from the inability of the patient to give any
warning by her complaint.

2. The saving of a considerable portion of the shock, or that por-
tion of it dependent upon the brain, which always occurs, and which
can certainly not be looked upon in any light but that of an evil, and
which is sufficient, in some cases, to destroy life.

3. The obtaining sleep, or at least quiet, during the progress of the
case.

4. The more speedy relaxation of the os uteri and perinseal muscles.

5. During operations, the very great advantage of having the pa-
tient lying perfectly still.

6. The removal of the dread which many patients entertain during
the whole of their pregnancy, and which, by its depressing effects,
may prove injurious.

In all the cases published, (he relief has been great and immediate.
In none has there been any untoward event no hemorrhage, no
convulsions, no collapse, which could fairly be chargeable upon the

* I observed this to occur in Mr. Skv . inn operation, at which

I assisted, thefatal termination of which was the combined result of peritonitis
and previous shock.

t Dr Simpson, who was the first to employ this agent in midwifery practice,
has used it with perfect safety aridi forty orpfty cases, in some of which

the etherization wnsk-q>t up forhouTs.

1 Let ii be remembered, however, that two of Haron Dubois' cases, which ter-
minated fatally from metro-peritonitis, were forceps cases; but puerperal favej
was ]'i u.'.ciit in the wards of La, Matcrnite.

562 Movements of the Heart, <$r. [September,

ether. Baron Dubois distinctly says, that he could trace no bad
effects in his five cases to the ether ; and my own experience con-
firms this account. He bases his opinion, that ether will never be
habitually employed in ordinary cases, upon two main grounds ; 1st,
the small number of cases which he had to refer to ; and 2nd, the
impossibility or probable danger of keeping a woman etherized for
several hours. Both these grounds have been removed ; the latter
especiall}'', by the result of Dr. Simpson's cases and my own; and
it is very doubtful if the Baron would not at this time greatly modify
his opinion.

A point which may become of great interest and importance is,
whether other agents cannot be combined with the ether; for in-
stance, laudanum where the pains are dangerously violent ; or tinc-
ture of ergot where they are insufficient. In one of Dr. Simpson's
cases, the patient inhaled a volatile solution of ergot. The pains,
which had previously been languid, almost immediately became
strongly expulsive, and the child was born in a quarter of an hour.
The woman had been in labour from forty to fifty hours.

In conclusion, I would state it as my opinion, that with perfectly
pure ether, carefully administered by skilful persons, and with good
apparatus, and especially by one containing an appendage with a
supply of oxygen, the operation not being commenced until efficient
etherization is produced, the employment of ether is not only justifia-
ble, but promises to be instrumental in materially diminishing the
dangers of operative midwifery. Probably, in natural cases it will
be both sufficient and safer to carry the etherization only to the
second stage, in which partial consciousness remains, but sensation
is abolished ; and towards the end, when the pains are ordinarily
intolerable, to induce perfect narcotism. From the results which I
have already obtained, it is my intention to continue the use of this
valuable agent, and I do not hesitate to state my belief, that future
experience will fully confirm mv present opinion.
John-street, Bedford-row, April, IS 17.

PART III. MONTHLY PERISCOPE.

Are the movements of the Heart dependent upon the Brain and
Spinal Marrow? By Dr. Julius Budge. We translate from the
Gaz. Med. de Paris, the following condensation of an article inserted
in the Archiv. fur Physiologische Heilkunde, by Dr. Budge.

In the first chapter the author notices all the theories that have
ever been advanced in relation to the movements of the heart.
These movements have been attributed

1st. To the fire and innate heat of the blood ; to the dilatation of
the blood by heat (Hippocrates, Descartes, Sylvius.)

2d. To the power of the parenchyma of the heart; to muscular
irritability (Galen, partly by Senac, Kaller, Winter, Passavant.)

1847.] Effect of Various Substances injected into the Arteries. 563

3d. To the nervous influence (Borelli). and 1st to the influence of
the cerebellum (Willis) ; 2d to the soul (Stab] and his school, Potter-
fields, R. Whytt, Sauvages) ; 3d to the medulla spinalis (Legallois) ;
4th to the medulla oblongata (Budge) ; 5th to the ganglia (Lancisi,
Bichat, Reil, Brachet, Yolkmann).

In the second part of his work, the celebrated physiologist gives a
detailed description of the heart find of the cardiac nerves of the frog;
in the third part he analyses the influences of the brain and spinal
marrow upon the muscles of voluntary motion, the influence of air
and blood upon the heart, and finally the influence exerted by the
brain and spinal marrow upon the motions of the heart. Dr. Budge
relates numerous experiments made upon frogs, and arrives at the
end of his lengthy work to the following conclusions :

1st. The medulla oblongata is the central organ of the heart s
action, inasmuch as it presides over the irritability of the voluntary
muscles.

2d. The medulla oblongata is also the central organ of the reflex
movements of the heart, but its influence is not very marked,
because,

3d. The movements of the heart partake very slightly of any of
the reflex actions of other parts of the body, and are principally
mere movements of irritati

4th. The ganglia of the sympathetic nerve are not the central
organs of the heart's action, neither produce nor keep up its rhythm,
but they seem to destroy the influence of volition and of reflex ac-
tion.

5th. The brain of the frog evinces no direct influence upon the
motions of the heart, but a marked indirect one.

Effect of Various Substances injected info the Arteries. Read
before the Academy of Sciences (Paris) by M. Flouhens. (TtaVis-
latcd from the Gaz. Med. de Pa/is, Jun, 1S47.) I have already
made known the effects of Ether injected into the arteries. Its ef-
fects when injected and when inhaled are opposite. When inhaled,
it destroys sensibility before motion, whereas when injected, the de-
struction of motion precedes that of sensibility. In my former ex-
periments 1 had employed only sulphuric Ether; but I have since
obtained similar results with acetic Ether, oxalic ether, alcohol,
sulphuric acid and ammonia. I have successively injected into the
arteries of different dogs ace. ic ether, rectified alcohol,

diluted sulphuric acid, ammonia diluted with water, and in every in-
stance motility has ! ropletely
whilst sensibility was perfect. I will | the experi-
ments: 8 decigramn nia in 4 g of water, were
injected towards the heart into the crural ai .. The mo-
tility of the poster, The
sciatic nerve was e: cbed, win:. rial cried aloud,
but without moving the ' plight contrac-
tions of the muscular fil i

564 On the Cretinism of large Cities, $c. [September,

The experiments made with the acetic and oxalic ethers, alcohol
and sulph. acid furnished results similar to the above-mentioned, viz.,
sudden loss of motion in the posterior extremities and sometimes total
annihilation of fibrillary contraction, with unimpaired sensibility.

The injection of a gramme and a half of spirits of Turpentine in
the right crural artery of a dog, forced towards the heart, produced a
different effect. There was loss of motion and retention of sensibil-
ity, but the paralyzed muscles instead of being relaxed and flaccid
as in the other cases, were now in a state of violent tetanic rigidity.
The injection of a gramme of nitric ether was followed by immediate
death.

Having found substances which when injected into the arteries
abolish motion but not sensibility, I sought for some that would des-
troy sensibility without affecting mobility. The powdered root of
Belladonna produced fully the desired effect, although the extract of
Bellad. seemed inert. 3 decigrammes of pulv. Bellad. root suspend-
ed in 13 grammes of water thrown towards the heart into the right
crural arterv of a dog, produced immediately complete paralysis of
motion in the posterior extremities. Thus far the result is the same
as in the other cases. It is necessary to mark the distinction between
the general motion of the limb which is abolished in all and the con-
traction of the isolated muscular fibrils which persists in some of the
experiments. In this case the nerve being exposed and pinched ex-
cites the fibrillary contractions, but is utterly insensible. It is pinched,
lacerated, cut, and torn away without eliciting from the animal any
indication of sensibility.

The powder of Hemlock, of Valerian, of pepper, of Spanish tobac-
co, &c, yielded results similar to that of Belladonna. The fact that
the powder alone of Belladonna would produce the effects, led me to
try other powders more or less inert. The powder of oak bark, of
liquorice, &c, were tried with the same results as powdered Bellad.,
Hemlock, pepper, <kc. M. F. concludes by observing that there are
no experiments in physiology more astonishing ; yet they are true.

On the Cretinism of large cities, its cause and analogy with that
of the Alps. By Dr. Behre^d. (Translated.) The study of au-
thors and the daily observations of Dr. Behrend, of Berlin, have led
him to admit :

1st. That there exists a cretinism of large, populous and crowded
cities as well as a cretinism of the Alps.

2d. That the cretinism of cities exists in the contracted dwellings
located in deep, narrow, and obscure lanes, as it does in the ravines
and narrow valleys of the Alps.

3d. That the cretinism of cities differs very little from that of the
Alps : its progress is perhaps more rapid, and it more frequently ends
in marasmus.

4th. That its causes arc a confined, cold, humid atmosphere, satu-
rated with pernicious agents; the absence of solar light ; insufficient

1847.] Intermittent Fever. Hydrocephalus. '565

heat; nourishment of a bad quality, and not containing sufficient
animal matter; solitude and deficient intellectual culture; unclean-
liness and privation of other comforts.

5th. All these circumstances pervert the act of hematosis, produce
a scrofulous, rachitic, anemic, and chlorotic diathesis, and blunt the
energies of life.

6th. Cretinism is therefore a scrofulous, rachitic diathesis, compli-
cated with chlorosis and stupidity ofthe intellect and senses. [Gaz.
Med. de Paris, from Journal fur Kinder kranJcheilen.

Strychnine in Intermittent fever. By Daniel Brainaed, M. D.,

Prof, of Surgery in the Rush Medical College. (Ind. and 111. Med.

and Surg. Journal.) From the 20th of February to the 1st of April,

the strychnine was prescribed in 83 cases of intermittent fever.

Of those it had no influence over, - - - 14 cases

It arrested the paroxysms for one week, in - - 3 "

For two weeks, in------ 6"

It arrested it permanently, or to May 1st, in - 60 "
Of the above, two cases had taken quinine without the smallest
effect, but were relieved by the strychnine. Nearly all, and probably
every one, had taken quinine from time to time with only temporary
relief. All were old cases in which there had been from two to
twenty returns of the disease in twelve months. The mode of ad-
ministration is as follows : One-eighth of a grain is given thrice a
day, after meals, in the form of powder or pill, until one grain is
taken. If the pills are used, they should be recently made and not
allowed to become dry and hard. There is an advantage in giving
it after meals, as it then becomes mixed with the contents of the
stomach, and is less likely to produce unpleasant effects. In but three
of these cases referred to were there any such effects in these,
symptoms of nausea and vertigo occurred.

From the facts here stated, we are justified in concluding that in a
very large number of cases of ancient agues, attended with debility,
and unaccompanied by local inflammation, the strychnia is very
nearly equal to the quinine in arresting the paroxysms, and much
superior to it in removing that state of debility and derangement of
the secretions which we believe constitutes the first and persisting
pathological state of the disease.

Hydriodate of Potass in Hydrocephalus. Dr. Mead, in the Indi-
ana and Illinois Med. and Surg. Journal, relates some cases of this
disease, successfully treated with the hydriodate of potass. Calomel
wns also freely administered between the doses of the hydriodate.
The most marked effects in all the cases were diuresis, dribbling of
saliva, arid generally the rapid disappearance of the convulsions and
the insensibility. "The conditions of the I5rain," says Dr. M., "in
which 1 have mostly usee! (his agent, are Hydrocephalus and Hyper-
emia. For the former, I consider it as much of a specific as any
thing in medicine can be."

506 A New Method of Excising Bones, $c. [September,

Anew method of Excising Bones, the periosteum being allowed to
remain and the bone being, reproduced. The ''Gazette IVIedicalede
Paris," (3d June, 1847,) contains a notice of the very interesting disr
covery of " le chevalier Bernardin Larghi," surgeon-in-chief to the
* honital de Verceil," of a substitute for the method usually adopted
in the excision of bones. We condense this article instead of trans-
lating it literally.

The desire to dispense as much as possible with the ampu-
tation of limbs has led modern surgeons to resort not unfrequently
to the extraction of portions of bones and even of joints ; but
although less objectionable than amputation, such operations are
always serious and not devoid of danger. They moreover frequently
leave considerable deformity. The periosteum, like the bark of
plants, constitutes the matrix of the bone which it encloses and
nourishes. Yet by the operation as at present practiced, the
surgeon removes not only the bone, but also the periosteum, whereas
M. Larghi thinks tbat reflection should dictate the preservation of
the matrix, by which alone a new bony deposit may be secured.
M. L. censures the servile disposition of surgeons to imitate rather
than to examine for themselves, and denies the validity of the reason
given for the removal of the periosteum, viz: that it is usually found
partaking of the disease of the bone. According to him, in neither
of the cases of exsection hitherto performed is there any evidence
that the periosteum was diseased : it was merely hvpertrophied, and
this hypertrophy so far from being a morbid condition requiring its
removal, was on the contrary a physiological state, destined to the
preservation or rather to the reproduction of a new bone. When a
bone is affected, it would seem that nature takes care to increase the
thickness and energy of the periosteum, whose secretion becoming
more abundant tends lo separate it from the diseased bone and ulti-
mately to substitute for it a new bone. The periosteum in such cases
becomes hvpertrophied like the uterus, in order to minister to the
development of the embryo it contains. Now, since no one has ever
thought, in difficult parturition, of removing both the product and the
uterus, let the matrix of bones no longer be " barbarously" destroyed ;
but on the contrary let the eti'ects of nature for the expulsion and
regeneration of the bone be seconded. If a fungus or cancer invade
the periosteum as well as the bone, the conduct of the surgeon will of
course be different. In such a case he will think neither of removing
the bone without nor with the periosteum, nor indeed even of ampu-
tation, for the disease will certainly be reproduced, and art is una-
vailing.

Hf. Larghi proceeds to animadvert upon the unsparing injury in-
flicted upon the muscles in effecting the exsection of bones in the
usual manner, and insists upon the importance of leaving then*
as much as possible in a state of integrity. By destroying the
muscles, and bloodvessels adjacent to the portion of bone removed,
the operation is made more seripqs and any process of reparation

1847.] A New Method of Excising Bones, $c. 567

effectually prevented. If a portion of the humerus, for example, be
removed, and with it the periosteum and the muscular attachments,
the motor powers of the arm are seriously impaired ; yet this seems
to have been overlooked by surgeons. The object being the removal
of the bone and the preservation of the periosteum, this should be
injured as little as possible. It should be slit open only so far as
may be necessary to permit the extraction of the bone. If the por-
tion of bone to be removed be short, it will suffice to make a longitu,
dinal incision of the periosteum over the bone, taking special care to
penetrate through the intermuscular space so as not to injure the
muscles themselves. The edges of the incised periosteum are then
to be separated, (which is facilitated by the gelatinous deposit usually
found between it and the bone,) and the membrane carefully detachr
cd from the entire circumference of the bone. A flexible needle can
be carried under and around the bone with a bit of tape, which being
drawn along the bone at the same time that the muscles attached to
the periosteum instinctively contract and elevate it, renders the sepa-
ration easily accomplished. The preservation of the muscular at-
tachments is therefore important. If there is any difficulty in thus
effecting the separation, a little tepid water may be injected with
advantage. The separation being complete, the exsection is effected
in the usual way.

If the portion of bone to be removed be long it should be cut off at
each end, the periosteum having been previously separated at these
points, as above stated. By seizing one end of the bone with a pair
af forceps it can then be readily drawn out of its envelop. In this
manner a considerable length of bone may be extracted by making
but a small incision down to each end, and consequently preserving
the integrity of the intervening skin and soft parts. If the bone were
already deprived of its periosteum, or if this membrane were partially
affected, the exsection should be practised at this point, and the bone
removed in one or more fragments as might be necessary. If the
bone be unequally enlarged so as to present a knotty surface, it will
be necessary to lay open the periosteum in its entire iength, and after
the removal of the bone to approximate its edges. This was done
by M. L. in IS 15, for the extraction of portions of the 7th, 8th and
9th ribs, with success. He also removed in this way the entire hu-
merus from another patient, who recovered and retained the motion
of the limb. In a third case he removed a portion of the right ileum,
and restored the use of the leg which had been affected. The inferior
portion of the ulna was also removed without injury to the move-
ments of the wrist ; and frequently the first phalangeal bone of the toe.

If. L. furnishes at length hit reason* in favor of this method ofoper,
ating in cases involving the ribs. The process he details is essentially
such as above recited, and therefore need not be repeated here.

The Editor of the Gazette Me.licale claims for M. BJandin the
credit of having once removed a considerable portion of the clavicle,
which wa3 reproduced, the periosteum, having been left. He does

568 New Instrument. Iodide of Mercurial Chloride. [September,

not however furnish the date of the operation. An operation similar
to that of Blandin was successfully performed by Prof. P. F. Eve,
during the last winter. D.

31. Kilns New Instrument for the Diagnosis of Tumours. M
Klin, Professor of Physiology in Strasbourg, presented to the Medical
Society of that city, an instrument, the application of which is likely
to produce the most benefmial results in the diagnosis of various kinds
of tumor. It consists of an exploring needle, having at its extrem-
ity a small depression with cutting edges. On plunging this instru-
ment into a tumour to any depth, we can extract a minute portion of
the tissue of which its various layers are composed. In this manner
a microscopic examination of the tumor can be practised on the liv-
ing subject, and its nature ascertained before having recourse to an
operation. We have proved the utility of this method of diagnosis
on three occasions, and seen conscientious practitioners renounce an
operation previously determined on, when the cancerous nature of the
tumor has been demonstrated by the microscope. \N. Y. Journ. of
Med., from L' Union Medicale.

On the preparation of the Iodide of Mercurial Chloride. A skilful
chemist, M. Boutigny, has been led accidentally to the composition
of a new mercurial medicament, which seems already to have pro-
duced very advantageous effects in certain scrofulous affections.

For this preparation: R. Iodine (2at.) 1579,5.

Proto-chloride of mercury (4at) 5948,5.

The calomel is pulverised, introduced into a matrass and heated
gently, shaking it until it begins to sublime; the iodine is then added
in small quantities, and the combination takes place with some sound
and without any sensible loss of iodine. If, on the contrary, the
iodine were added to the calomel before the latter was introduced in-
to the matrass,*a considerable portion of the iodine would be volatil-
ised, and the compound thus obtained would be of unknown propor-
tions and consequently of uncertain effect. The preceding prepara-
tion is employed externally by friction in the form of an ointment,
or internally, in pills. The following is another formula, which con-
tains two instead of four proportions of calomel:

Iodine (2at.) 1579,5

Proto-chloride of mercury (2at.) .... 2974,5

The mode of preparation is the same. This combination is in-
tended to be run into cylinders, like the nitrate of silver, and we
think that these cylinders will be employed with great success to
deterge scrofulous ulcers, certain syphilitic chancres, &c.

The proportions given above may be altered, so as to diminish the
quantity of iodine, if deemed advisable; but if the proportion of
iodine were greater than that indicated in the second formula, a por-
tion of the iodine would remain free and thus destroy the stability of
the combination, a stability so necessary in order to secure a product
which shall always be identical.

1847.] Iodide of Mercurial Chloride. 569

As to the name given by M. Boutigny to this product, iodide of
mercurial chloride and bi-iodide of mercurial chloride, it is intended
only to indicate the fact that it results from the direct action of
iodine upon the mercurial chloride.

The two following formulas are recommended by M. Boutigny to
the attention of physicians :

Ointment of the Iodide of Mercurial Chloride or anti-Scrofulous
Ointment.

&. Iodide of Mercurial Chloride in powder, 75 centigrammes.
Fresh Lard, .... 60 grammes.

Pills of the Iodide of Mercurial Chloride.

R. Iodide of Mercurial Ointment, pulverized, 25 centigrammes.
Gum Arabic, .... 1 gramme.

Crumb of bread, - 9 grammes.

Orange flower water, - - - q. s.

Make 100 pills.
Doctor Rochard has published in the Union Medic ale some re-
markable cases of scrofulous affections cured by the salt of M. Bou-
tigny. He states that the energy of this salt is extreme, and that he
has thought proper to use it only externally in the form of ointment.
He recommends 15 grains of the salt to 3 v. of lard. The quantity of
this ointment to be employed must depend upon the degree of sensi-
bility which varies much in different persons, but generally he uses
at each friction a portion equal to the volume of a small pea. In
general one friction per day will be sufficient, to be repeated for two
or three successive days, and renewed afterwards at intervals of from
eight to fifteen days, according to the effect produced. Great cau-
tion is necessary to avoid accidents. It is important to spread the
ointment lightiy, and not to persist in its use if, as sometimes hap-
pens, there should supervene pain, redness and signs of a too intense
reaction. He employs it sometimes as a local, sometimes as a gen-
eral remedy, and at other times endeavors<o combine both modes of
action, by exerting the friction alternately, directly upon the engorge-
ments and ulcers, or upon the internal surface of the thighs, upon
the back, the chest, &c. These general frictions have the effect of
improving the entire organism, by increasing the activity of nutri-
tion and assimilation. He begins almost always with them in invet-
erate diseases of a grave and hereditary character. The local effect
is soon manifested ; the portion of the skin upon which the ointment
is applied begins to turn red, becomes the seat of itching and after-
wards of smarting sensations, and finally of a true inflammatory ten-
sion ; but this tension has but a short duration. It begins about an
hour after the application of the ointment and disappears completely,
with the smarting and redness, in the course of two or three hours.
The epidermis scales offas occurs after erysipelas, and the skin then
becomes very smooth and soft. In a greater degree of intensity it
would produce vesication and even cauterisation. I.Tpon ulcers there

570 Medical Intelligence, [September,

is formed a small scab which is detached in the course of a few days,
and leaves exposed a vermiliion surface, instead of the violet and
livid surface which previously existed. Unless the suppuration be
very abundant, it is better to leave the parts naked than to dress them.
The general or constitutional modifications are less prompt, but
can be gradually perceived in the increased activity of all the func-
tions. [Translated from the Bulletin de Therapeutique.

MEDICAL INTELLIGENCE.

At a meeting of the President and Vice-Presidents of the American Medical
Association held on May 8th, 1847, tlie following Standing Committes were
were appointed in pursuance of the order of the Association :

" Committee of Arrangements. Dr. G. C. M. Roberts, Bait., Chairman ;
Drs. A. C. Robinson, Bait. ; J. H. Briscoe, Bait. ; J. R. W. Dunbar, Bait. ;
Wm. Power, Bait.; W. T. Leonard, Bait. ; C. Bell Gibson, Ball.

" Committee on Medical Sciences. Dr. S. Henry Dickson, S. C, Chairman ;
Drs. J. P. Jervey, S. C; Robert Bridges, Philada.; J. W. Francis, N. Y.; Wm.
T. Wragg, S. C. ; Wm. Power, Bait.; T. Romeyn Beck, N. Y.

" Committee on Practical Medicine. Dr. Joseph M. Smith, N. Y., Chairman;
Drs. Rene La Roche, Philada.; John Harrison, La.; H. M. Bullitt, St. Louis,
Mo. ; J. B. Beck, N. Y. ; Isaac Wood, N. Y. ; G. S. Camman, N. Y.

" Committee on Surgery. Dr. George W. Norris, Philada., Chairman ; Drs.
Isaac Parrish, Philada.; John Watson, N. Y. ; A. L. Peirson, Salem, Mass.;
J. Randolph, Phila. ; H. H. McGuire, Petersburg, Va. ; C. Bell Gibson, Bait.

" Committee on Obstetrics. Dr. Harvey Lindsley, D. C. Chairman; Drs. G.
CM. Roberts, Bait.; J. Riley, D. C; R. W. Haxall, Richmond, Va.; W.
Channing, Boston ; CR- Giluian, N- Y-; S. Annan, Lexington, Ky.

" Committee on Medical Literature. Dr- Oliver Wendell Holmes, Bost-, Chair-
man; Drs. E. Hale. Boston ; G C Shattuck, Jr., Boston; D- Drake, Louisville,
Ky.; John Bell, Phila-; Austin Flint, Buffalo; W- Sel den, Norfolk, Va-

''Committee on Medical Education. -Dr- Alexander H- Stevens, N- Y-, Chair-
man; Drs. Amos Twitchell, Keene, N- H ; B- R- Wellford, Fredericksburg,
Va-; Arnold Naudain, Phila-; R. D- Arnold, Savannah; F. Campbell Stewart,
K-Y.; L- P. Bush, Wilmington, Del-

tl Committee on Publication Dr. Isaac Hays, Phila-, Chairman ; Drs. Alfred
Stille, Phild-; J*V- C Smith, Boston; I- P- Garvin, Augusta, Ga.; J. R- W.
Dunbar, Bait-; Governor Emmerson, Phila-; Caspar Morris, Phila-

Committe on Indigenous Botany, under the Resolution of Dr. N. S. Davis. Dr.
N- S. Davis, Binghampton, N- Y-, Chairman; Drs- S- VV. Williams, Mass.;
Eli Ives, Conn-; Engleman, Mo-; W- A- Cheetham, Tenn-; Jos. Carson, Penn.;
Charles Short, Ky-; E- E- Phelps. Vt-; A- Twitchell, N.H; T-C Dunn, R.I.;
Lyndon H Smith, NJ-; James Couper, Del; A- C- Robinson, Md-; Frederick
Marx, Va.; J- P- Poreher, S-C-j J- Le Conte, Ga- ; Cartwright, Miss-; Car-
penter, La-; John M- Bigelow, Lancaster, Ohio-; G- Norwood, Ind.; Merry-
man, Springfield, 111-; Russel, Detroit, Mich-; J- Riley, D. C-"

Some dissatisfaction has been expressed, that a number of gentlemen have
been appointed to places in the various committees, who are not members of the
Association. The New- York Journal of Medicine says>- "In regard to the
' Standing Committees' appointed in pursuance of the order of the Association,
by the President, it strikes us as somewhat remarkable that seven at least of the
gentlemen appointed, are not members of the Association, while many who
have distinguished claims to such a distinction, have been entirely passed by.
For example, the committee on ' Practical Medicine' embraces four gentlemen
of this city, only one of whom is a member of this Association, and the same of

1847.]

Medical Intelligence.

571

ether committees. We doubt net those physician?, thus honored, Trill see the
propriety of declining to serve, until they belong to the body, on whose commit-
tees they have been chosen, probably through inadvertence; and we have no
doubt that the worthy President, when he is made aware of the dissatisfaction
to which such irregularity inevitably gives rise, will speedily correct the error
into which he has fallen. But few of the numerous Colleges represented in
Convention, are honored by a place on any of the committees, while one school
in this city furnishes chairmen for two committees. ' Honors divided ' should be
the motto in an Association, which assumes the title of National." Our Charles-
ton friends seem to have been in high favor, for of the three gentlemen who
represented the Profession in Charleston, one has been made a Vice-President,
and the others are placed on an important committee, whilst a distinguished
Professor of the same city, not a member of the Convention, has been placed at
the head of the same committee.

a!

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Total number of

968.

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IZflt

- -- r J7

0 2 SB g

Tl

. , J"

tc * . ti

i.

1

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cans.

<3

52

I!

"7!

to

o

1*

All other Foreign-
ers and unknown.

?5

5 <1

1

ft

a

-?

-

Mexicans.

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CD

~ 1

8

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to
-1

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1

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to

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to

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all others.

x,3

m

p

;

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Other Foreigners.

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p

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o

L.

*

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Mexicans.

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E.

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all others.

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10

Other For-
and unknown.

00

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to

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Mexicans.

5"

o
1

J"5

CO

CO

(0

Average daily
mortality.

572 Medical Intelligence. [September,

On Medical Reform. Medical Reformation appears to be engaging the atten-
tion of the profession in Canada, as well as in our country. It may not be
uninteresting to our readers to see what steps are taken on the subject by our
neighbors ;" we therefore copy from the British American Journal of Medical
and Physical Science, a few of. the clauses of a bill entitled "An act to incorpo-
rate the members of the Medical Profession in Lower Canada and to regulate
the Study and Practice of Physic and Surgery therein":

"And be it enacted, That from and after the passing of this Act, no person
shall practise Physic, or Surgery, Midwifery, or shall vend any drugs, medicines,
or patent medicines by retail, or shall act as a Chemist or Druggist, in Lower
Canada, unless he be a person duly licensed so to practise, or so to vend drugs
and medicines or patent medicines, or to act as a Chemist and Druggist, either
before or after the passing of this Act, under a penalty of currency,

for each day on which any person shall so practise, or shall act as a Chemist or
Druggist, or sell any drugs, medicines or patent medicines contrary to the pro-
visions of this Act: And such penalty shall be recoverable on the oath of any
two credible witnesses, before any Justice of the Peace for the District in which
the offence shall have been committed, and in default of the payment of such
penalty on conviction, the offender may be committed to the Common Gaol of
the District, until the same be paid: Provided always, that nothing herein con-
tained shall extend to prevent any person duly licensed to practise Physic, Sur-
gery, or Man-Midwifery in Upper Canada, from practising the same in Lower
Canada, according to the provisions of the Act hereinbefore cited.

" To cause every member of the profession now practising or who may here-
after practise in Lower Canada, to enregister his name, a^e, place of residence,
nativity, the date of his license and the place where he obtained it, in the books
of the College.

" To appoint a Committee in each District for the purpose of occasionally in-
specting druggist establishments and other places where drugs, medicines or
patent medicines are sold, to ascertain that poisons are carefully labelled and
kept apart, and that the drugs or medicines generally are of pure quality.

"And be it enacted, That the qualification to be required by the Board of
Governors from a person about to commence the study of Medicine in this
Province, shall be: A good moral character, and a competent knowledge of
Latin, History, Geography, Mathematics and Natural Philosophy; and that
from and after the end of the year one thousand eight hundred and fifty, a gener-
al knowledge of the French and English languages shall also be indispensable.

" And be it enacted, That the qualifications to be required from a candidate
for examination to obtain a certificate for a license to practise shall consist in
his not being less than twenty-one years of age; that he has followed his studies
uninterruptedly during a period of not less than four years under the care of one
or more general practitioners duly licensed; and that during the said four years
he shall have attended at some University, College, or Incorporated School of
Medicine within Her Majesty's Dominions not less than two six months'
Courses of General Anatomy and Physiology of Practical Anatomy of Sur-
gery of Practice of Medicine of Midwifery of Chemistry and of Materia
Medica and Pharmacy, one six months' Course of the Institutes of Medicine,
one three months' Course of Medical Jurisprudence, and one three months'
Course of Botany, if obtainable in Lower Canada; also, that he shall have at-
tended the general practice of an Hospital in which are contained not less than
fifty beds under the charge of not less than two Physicians or Surgeons for a
period not less than one year, or two periods of not less than six months each ;
and that he shall also have attended two three months' or one six months' Course
of Clinical Medicine, and the same of Clinical Surgery.

"And be it enacted, That the qualifications to be enacted from a person in-
tending to study to become a druggist shall be: the possession of a competent
knowledge of Latin, with a liberal French or English education; his being at
least sixteen years of age, and of good moral character.

IS 17.] Medical Intelligence. 573

" And be it enacted, That the qualifications to be exacted from a candidate for
a certificate to obtain a license to sell drugs or medicines shall be : his being not
less than twenty-one years of age; his having attended not less than two six
months' Courses ot Chemistry two six mouths' Courses of Materia Medica and
Pharmacy one three months' Course of .Medical Jurisprudence and one three
months' Course of Botany, if obtainable in Lower Canada; and moreover, that
he shall have been uninterruptedly engaged in the compounding and dispensing
of drugs and medicines during a period of not less than four years under the
superintendance and care of some duly licensed general practitioner or druggist.

"Provided always, and be it enacted, That nothing in this Act contained
shall be construed to prevent or prohibit any competent female from practising
midwifery in Lower Canada, such female proving her competency before any
two members of the College of Physicians and Surgeons and obtaining their
certificate to that effect.

"And be it enacted, That any person vending spurious or adulterated drugs
or medicines, or neglecting to correctly label the poisons in his shop and to have
them carefully set apart in some place especially devoted to that purpose, or
vending any poison without prescription or license of a duly licensed medical
practitioner or the certificate of a clergyman recommending the purchaser for
the purchase of the same, shall, on conviction thereof before one Justice of the
Peace, upon the oath of any one of the Committee to be appointed by the Gover-
nors of the said College for the especial purpose of inspecting druggist establish-
ments and other places where drugs or medicines are sold, incur a penalty not
exceeding for the first offence, and a penalty not

exceeding for each and every subsequent of-

fence, and may be committed to the Common Gaol until such penalty be paid."

Mortality in New Orleans. From the 16th of April to the 2Gth of June, being
nine weeks, there occurred 1019 deaths, 750 whites and 2G3 blacks. 01 the deaths
334 were children under ten years. Among the most common causes of death
we find Apoplexy 22 ; Consumption 107; Convulsions 24 ; Diarrhcea50; Dys-
entery 80 ; Fevers 39 , Typhoid Fever 54 ; Typhus Fever 49.

Mortality in Prisons. In the Pennsylvania, where solitary confinement has
been long practiced, 1 prisoner in 23 has died yearly; whilst at Charlestown,
where the prisoners are allowed to mix together, only 1 in 84 has died during
the same period.

Buffalo University. At the first Commencement of this Institution held in the
city of Buffalo, N. Y., on lGth June, the degree of M. D. was conferred upon
seventeen approved applicants. This fact demonstrates that this infant institu-
tion enjoys the public confidence in a high degree. Our able and accomplished
friends, Drs. Flint and Lee, are members of the Faculty of the University.

Resignation of Professor Hare. Robert Hare, M. D., who for many years has
occupied the Chair of Chemistry in the University of Pennsylvania, has re-
signed his professorship. In accepting his resignation the Trustees have adopt-
ed a complimentary resolution exprersivc of their sense of the eminent services
which he has rendered to Science, and to the University.

University of New-York. We learn from the Charleston Courier, that the va-
cancy in the Faculty of this University, occasioned by the death of Dr. Revere,
has been filled by the election of Prof. Dickson of Charleston, who has accepted

574 Medical Intelligence. Meteorological Observations.

the appointment, and resigned his professorship in the Medical College of the
State of South Carolina.

Obituary. At Berlin, aged 55, Prof. "Wagner, of that University. On the
4th May, at Tottenham, England. John Ramsbotham, M. D., in the 80th year of
his age. In London^ on the 3d May, John Read, the inventor of the Stomach
Pump.

METEOROLOGICAL OBSERVATIONS, for Julv, 1847, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

fen

<

Sur
Ther.

Rise.
Bar.

29 b8-100

4, ]
Ther.

3. M.
Bar. i

Wind.

Remarks.

"l

67

82

29 73-100!

n. e.

Cloudy.

2

68

" 77-100

71

" 81-100;

n. e.

Rain, 60-100 of an inch.

3

62

" 87-100

78

" 66-100',

N. E.

Cloudy.

4

66

" 85-100

82

11 83-100!

N.

ICloudy.

s

64

" 83-100

84

" 84-100

M. W.

'Fair some clouds.

G

61

" 85-100

83

" 85-100,

E.

Cloudy.

7

66

" 82-100

80

" 78-100:

S. E.

Cloudy sprinkle.

8

OS

" 73-100

80

" 68-100

N. W.

Cloudy sprinkle.

9

68

<: 09-100

88

" 67-100

N. E.

Storm rain 2 inches 5-10&

10

66

" 66-100

78

" 65-100

S.

Cloud v sprinkle.

11

G8

" 68-100

78

" 74-100

S.

Rain, 1 inch 70-100.

12

68

" 80-100

82

" 87-100

S. W.

Cloudy sprinkle.

13

68

" 90-100

84

" 87-100

w.

Fair some clouds.

11

70

" 82-100

86

" 86-100

s. W.

Fair.

15

72

" 75-100

88

" 75-100

S. E.

Fair some clouds.

16

70

" 83-100

85

" 84-100

N. E.

Cloudy sprinkle.

IT

68

'' 93-100

76

" 93-100

N. E.

Raitt, 54-100 of an inch.

18

72

98-100

76

30 2-100

S. E.

JRain, 1 inch 45-100.

19

68

30 5-100

80

29 98-100

S. E.

jCloudy shower at 3, p. m.
Cloudy sprinkle.

20

70

30 4-100

72

96-100

S. W.

21

71

29 96-100

81

94-100

S. E.

Cloudy sprinkle at ll,Aa&

22

68

;< 94-100

78

93-100

S. E.

Rain, "68-100 of an inch.

as

70

98-100

78

" 93-100

S. W.

Rain.

24

70

30 2-100

82

" 98-100

S. \V.

Cloudy.

25

72

29 97-100

82

" 96-100

S.

Fair.

36

70

" 87-100

84

" 77-100

S. W.

Fair.

27

71

" 72-100

80

" 67-100

N. W.

Fair some clouds.

88

66

" 75-10-

75

" 77-100

N. W.

Fair some clouds.

29

66

" 79-101!

80

77-100

N. E.

Fair.

30

64

77-101'

83

<; 73-100

W.

Fair.

?1

69

<: 75-00C

70

" 75-100,

N. E.

Rain, 2 inches 26-100.

10 Fair days. Quantity of Rain 9 inches and 28-100. Wind East of N, and'
. 15 days. West of do. 12 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 8.] NEW SERIES. OCTOBER, 1847. [No. 10.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XXXVI.

Of Mercury and its Compounds. By Jonx M. B. Harden, M. D.,
of Liberty County, Georgia Correspondent of the Academy of
Natural Sciences, Philadelphia.

There is no substance probably to be found either in the organic
or inorganic kingdoms of Nature which possesses more interest and
importance than Mercury, whether we consider the beauty and va-
riety of its Compounds, or it., utility in the Arts and Sciences. The
Chemist can experience ever new delight in studying its varied com-
binations. The Philosopher, by its means, is enabled to measure the
temperature and weight of the atmosphere to foretell with some
degree of certainty the approach of typhoons and hurricanes, and to
determine the relative heights of different localities on the Globe.
The Artist employs to great advantage many of its amalgoms. The
votary of the toilet finds in them a just representative in the reflected
image, and in the daguerrian prooess it brings out the photographic
likeness with the magic of Aladdin's wonderful lamp. But it is in
Medicine that it has attained its highest reputation, and it is to some
of its more simple compounds and their effects upon the animal sys-
tem, that we design in this article to direct attention.

Mercury seems not to have been familiarly known to the ancients,
although it is distinctly alluded to in the writings of Aristotle, Dios-
corides and Pliny, the latter of whom gives us a very correct method
of obtaining it from its ores. He speaks of it under the names of
" Argent um Yivum" and "Hydrargyrum" and evidently intends to
make a distinction between the substances designated by these terms,
but I think we may cuncludo from the very little that he says upon

37

576 Mercury and its Compounds. [October,

the subject that they were identical. The " Argentum Vivum" he
denominates also, from its fluid properties, " Vomica liquor is aeterni"
and says it was found in an ore obtained from veins of Silver.
The following are the properties he ascribes to it : it corrodes and
destroys all vessels (probably meaning only metallic). All things
float upon it, except Gold (proving that next to Gold it was the heavi-
est substance known). The best way, to purify it, was by shaking
it well in earthen vessels into which cloth or articles of wearing appa-
rel were thrown (these last absorbing its dross). To separate it from
Gold, the amalgam was thrown into skins that were strongly pressed
or kneaded with the hands so as to cause the Mercury to escape by
the pores, and leave the Gold pure.

The "Hydrargyrum" compounded of two Greek words, $sUp and
apyvpos signifying fluid Silver, was obtained from an ore called by
him "Minium" or more correctly, the " Secundarium" a kind of
refuse ore of Minium. It is plain, however, that the Minium spoken
of by him is not the Minium of the present day, which is nearly a
pure peroxide of Lead ; but that he must have intended the ore known
to us as " Cinnibar" consisting for the most part of Sulphur and
Mercury, forming the Sulphuret of Mercury. The word " Cinnibar"
however, as used by Pliny, he tells us, was of Indian origin, and was
applied to designate the mixed Blood of a Dragon and Elephant who
had been mutually hilled by each other. The process, which he gives
for procuring the Mercury from this ore, is so similar to that employ-
ed at the present day, and shows, withal, so great a degree of chemical
knowledge, at so early a period, that I must beg to have it here re-
corded in his own words : He says, "fit autem duobus modis : aere-
is mortariis pistillisque trlto minio ex aceto : aut patinis Jictilibus im-
positum ferrea concha, calice coopertum, argilla superillila : dein
sub patinis accensum follibus continuo igni, aique ita calicis sudore
deterso, qui fit argenti colore et aquae liquore. Idem guttis dividi
facilis et lubrico humore confluere."

It is now, as formerly, obtained by distillation from native Cinni-
bar or Sulphuret of Mercury. In order to purify it, it is recommend-
ed to re-distil it with half its weight of iron turnings, or by digesting
the metal with a small quantity of Nitric Acid or with a solution of
Chloride of Mercury, which rids it of the metals more oxidable than
itself. (Graham.)

The name Mercurius or Mercury was first given to this metal by
the alchemists, from some fancied resemblance to the planet of that

1847.] Mercury audits Compounds. 577

name, as they gave the name of Mars to Iron, Saturn to Lead, Luna
to Silver, and Venus to Copper or more probably in honor of the
god Mercury on account of its extreme mobility. It is well known
to be perfectly fluid at the ordinary temperatures of the atmosphere
and has a silvery metalic lustre. Its constant fluidity has caused
some philosophers to consider it as a peculiar metallic water, and in
consonance with the Greek " Hydra gy rum" they have denominated
it "Aqua non madcfaciens manus."

Its chemical symbol is Hg. Graham gives its equivalent as 1265.8,
or adopting the Hydrogen scale 101.43, but a very recent and care-
ful examination of this metal by M. Millon, has determined its true
equivalent to be an exact multiple of Hydrogen by 100, making it
1250.6. This result has been confirmed by the experiments of
Erdman and Marchand. It has a density varying according to
temperature from 13.5 to 14, which is said to be its density in a state
of congelation which takes place at about 39 or 40 below Zero of
Fahrenheit's thermometer.

Mercury forms two compounds with Oxygen. The first is the
Black oxide, Sub oxide, Mercurous oxide, and is the same substance
as that called JEthiops per se by the older writers, consisting, as is
now believed, of two equivalents of Mercury and one of Oxygen. It
is obtained in various ways. The easiest and most common are to
triturate the metallic mercury with conserves or unctuous substances,
as is done in the preparation of the Blue mass or Blue pills and
Mercurial ointment, or probably better by mixing briskly together
a cold solution of Caustic Potash and Calomel. This seems to be,
however, a very uncertain and unstable combination, and has a great
disposition to be reduced to the state of metallic mercury and the
binoxide or simple oxide. Indeed it has recently been announced by
M. Guibourt, that in this mixture nothing was formed but the bin-
oxide and metallic mercury, and M. Lefort has confirmed the opinion.
I have taken a little pains to test this point myself, and having pre-
served the precaution suggested by M. Donovan of keeping it ex-
cluded from the light, I have set aside the oxide thus formed for
many days, and after that time have not been able to detect, by the
aid of a glass, the least globule of Mercury in it thus tending to
prove that the Oxygen had really entered into combination with the
black panicles ; nor could I discover the least appearance of the red
oxide.

In the case of the pharmaceutical preparations above alluded to,

578 Mercury and its Compounds. [October,

however, the state of things appears to be very different. From the
experiments given to us by Dr. John Warren in his View of the Mer-
curial Practice and indeed from the general belief, we had con-
cluded that in these there was the formation of the Black oxide. I
was therefore somewhat surprised to see it stated by Mr. Graham,
"that there can be no doubt that it is in this divided state, and not
as the Black oxide, that Mercury is obtained by triturating it with
fat, turpentine, syrup, &c, in many pharmaceutical preparations.'5
I therefore put it to the following simple experiment : I poured a
strong solution of Caustic Potash repeatedly upon a portion of strong
mercurial ointment that had been standing fully 17 years. After
dissolving out all the fatty matters the residue seemed to consist for
the most part of metallic mercury and the black oxide. I did not
determine the relative proportions, but certainly a large quantity of
Mercury was found in the metallic state but that a good portion also
remains as black oxide, I could not deny without doubting the evi-
dence of my senses. Besides, the experiment does not even make
it necessary for us to suppose that any of the Mercury was in the
metallic state while the compound remained as mercurial ointment.
For it is possible that the presence of the Potash in the mixture in-
duced the formation of some highly oxidized organic acid, whose
oxygen was obtained at the expense of the Black oxide, and which
afterwards united with the Potash.

However this may be, it is very certain that these preparations act
upon the system, and produce all the peculiar effects of Mercury ;
and it seems more reasonable to suppose that the oxide would act
more readily than the metal, because more soluble; but we must
confess that upon this point there is great uncertainty, for from all
that we know of their properties, the Oxide is as insoluble as metallic
Mercury, and Calomel more insoluble than either.

This same Oxide is formed when Limewater is poured upon Calo-
mel in place of the Potash, and is the way indeed in which the London
Pharmacopea directs the preparation of this black oxide. I know
not whether it has ever been recognized as an officinal preparation ;
but this mixture of Limewater and Calomel is familiarly known
among practitioners as the "Black wash," and has been much used
for the cleansing of venereal ulcers, and I believe with good effect,
but surely its good effects must be more attributable to the Chloride
of Lime which is formed, than to the Oxide of Mercury, and appears
to me to be one of those incompatible compounds made by those

1847.] Mercury and its Compounds. 579

unacquainted with Chemistry where the effects are ascribed alto-
gether to a wrong agent.

This Oxide of Mercury in the form of Blue Pills is applied to
most of the purposes for which Calomel is used, and seems to produce
very nearly the same effects. They are both of them, in my opin-
ion, very uncertain in their operation, but when I have had occasion
to use them, I have generally given a preference to this, believing it
to be probably milder in its action.

The other combination of Mercury with Oxygen has usually been
regarded as a binoxide, although it is now found to contain one equiva-
lent of each ingredient. It is known under various names, as the
red oxide, red precipitate, oxide of mercury, mercuric oxide, and is
prepared either by oxidating the Mercury at a high temperature, or
by expelling all the Nitric Acid from the Nitrate of Mercury by the
application of heat. The same Oxide is obtained by mixing together
a solution of Caustic Potash and Corrosive Sublimate, but instead of
being red, it is precipitated as a powder of a lemon yellow color.
When Limewater is used in place of the Potash, we have the same
precipitate formed ; and this mixture is the Aqua phagedenica of the
older writers, and is familiarly known as the Yellow wash, which,
like the Black wash already spoken of, has been used for the treat-
ment of ill-conditioned ulcers of various kinds, more particularly those
of a venereal character.

It is interesting to inquire into the caue of this difference of color.
My own impression had always been that the red precipitate was
anhydrous, while the yellow was thrown down as a hydrate, and that
this presence or absence of wate.- \v:;s the sole cause of the change.
M. Millon has recently declared, however, contrary to the observa-
tion of M. Schanffrur, who has described a hydrate of the peroxide
containing three equivalents of water, that a "hydrate is not to be
found among the interesting modifications which are presented by the
red oxide of Mercury." From his experiments it appears that the
two oxides are entirely isomeric, and the difference In color depends
altogether upon their states of molecular aggregation, the red beinor
crystalline, while the yellow is amorphous. This change of color
from a simple change in the arrangement of alternate molecules is
certainly an interesting fact, and is not confined to this combination
alone. It is remarkable in Charcoal and the Diamond, and I have
seen the Iodide of Mercury suddenly change its color from a simple
touch by which its least particle was moved. A similar phenomenon

580 Mercury and its Compounds. [October,

is witnessed in those toys of unannealed glass, known as Poince Ru-
perts drops, where the least particle broken off, will cause a sudden
and complete disaggregation of the whole mass.

Notwithstanding this perfect identity of composition noticed by
M. Millon, these two Oxides exhibit another curious anomaly worthy
of notice, and that is a difference in their chemical reactions. For
example: While Oxalic Acid will attack the yellow Oxide directly
and produce a white Oxalate, the red Oxide resists completely its
action. It may be made to boil in the same solution which attacks
so readily the yellow Oxide, without changing in the least degree the
red color. So also, in an alcoholic solution of the Bichloride of
Mercury, the yellow Oxide is converted by boiling into a black
Oxichloride while the red Oxide suffers no change by the same
treatment. A similar difference is shown also in the reactions of the
Bichromate of Potash.

This red oxide, or red precipitate, as it is more commonly called,
acts with great energy upon the body, and is among the most pow-
erful escharotics used in Surgery. It corrodes the part to which it is
applied, and may be used with advantage in the cure of all indolent,
ill-conditioned ulcers, particularly where we have reason to suspect
a venereal taint, and for the destruction of fungous growths,

Probably the most interesting compounds of Mercury, in a medical
point of view, are produced from its combinations with Chlorine,
forming the well-known substances Calomel and Corrosive Sublkn^
ate. The first, or Calomel, is a sub-chloride, formed of two equiva*
lents of Mercury and one of Chlorine. It is obtained by various
processes, and I need not stop here to specify them as they may bo
found in any of our dispensatories, and for a good account of Calomel
and its history, I refer with pleasure to an article which was publish-
ed, by Professor Means, in the first volume, N. S., of this Journal.

Calomel is absolutely insoluble in water, Alcohol and Ether, and
upon the maxim that " Corpora non agunt nisi sintsoluta," it is diffi-
cult to see how it can act at all upon the human body. The only
rational explanation is, that it meets in the alimentary canal with
some fluids in which it is partially dissolved; and the fluids in the
stomach most likely to bring about such a result are the Hydrochloric
Acid and the Chloride of Sodium, both of which, with free acetic
acid, have been found in the gastric juice. " According to Mialhe,
Calomel is in part converted into corrosive sublimate and metallic
mercury by muriate of ammonia and by the Chlorides of Sodium

1347.] Mercury and its Compounds. 581

and Potassium, even at the temperature of the body, and hence he
believes that the conversion may take place in the primae viae."
( Woods Sf Bache.) "Dr. Gardner denies the assertion of M. Mialhe,
that Calomel is converted into Corrosive Sublimate by Chlorides of
the alkalifiable metals, maintaining that it is merely rendered soluble
by their solutions." (Ibid.)

However this may be, one thing seems to be certain, that both this
compound and the Blue mass depend for their operation entirely
upon the state of the stomach and bowels at the time when they are
given, and it is upon this ground that maybe explained the impunity
that many enjoy from its toxicological effects after the ingestion of
the enormous and uncalled for doses of which we have heard and
read as having been given in yellow and low typhoidal fevers. In
such cases we may reasonably suppose that there is no secretion of
normal gastric juice ; and again, so completely paralysed are all the
parts of the system that there cannot be an absorption by the lacteals
or other vessels. In such conditions of the system the Calomel
would have no more effect than so much sand, whereas in an oppo-
site condition, when every thing favors, a very few grains would
produce effects the most violent. It is said that salivation has been
induced by 1^ gr. of Calomel, and I have had my salivary glands
very sensibly affected by less than 3 grains.

When Calomel is suspended in water or other fluid, and we pass
through the mixture a stream of Sulphuretted Hydrogen, there is
immediately formed a black compound, the sub-sulphuret of Mercury,
and in cases in which a large quantity has been introduced into the
bowels the same result takes place, by which of course the contents
of the bowels are blackened, and there is a discharge of very dark
colored and generally very offensive faces. Now this effect of Mer-
cury appears to me to have been very badly interpreted oftentimes,
as may be seen by reference to the books. These stools have been
regarded as the consequence of depraved secretion from the violence
of diseased action, and as the harbinger of the peculiariy successful
operation of the Calomel : so apt are we to substitute effects for
causes. Dark coiored stools are often produced in a similar way,
under the use of the Subsalts of Iron, as I have often witnessed.
The iron may either unite so as to form a subsulphnret, or the better
explanation probably is, that it meets in the alimentary canal with
gallic acid, derived from the vegetable food taken at the time by
which a sort of ink is actually formed. While upon this point, I

582 Mercury and its Compounds. [October,

would here make the following general remark, and this is, that the
color of our evacuations are more frequently owing to the nature of
our ingesia than to the nature of our disease, and consequently that
in studying to estimate their semeiological values, we should be care-
ful to distinguish' diseased secretions and chemical reactions.

Calomel is certainly the preparation of Mercury, which has been
most extensively used in Medicine, and has been given in every dis-
ease in which this mineral has ever been supposed to be beneficial.
Like the Blue pill of the Black Oxide, it is cathartic in its operation
when given in doses to an adult of 15 or 20 grains ; but as we have
already said, it is uncertain in its action, although many persons pre*
fer it to any other cathartic for the .certainty and mildness of its
operation. I have known other persons who are very much sickened
by it at all times, and are made to faint at the time of its action upon
the bowels. Calomel is often very beneficial, as an external appli-
cation, in powder, to obstinate indolent ulcers.

The other combination of Mercury with Chlorine is composed of
one equivalent of each ingredient, and consequently is a simple
Chlorine of Mercury. It was atone time known as the Bichloride,
while Calomel was considered to be the Chloride, but a more care-
ful examination has led to the change of opinion. This is the Cor^
rosive Sublimate or Corrosive Chloride of Mercury of the shops, and
is certainly one of the most corrosive poisons with which we are
acquainted. It is most commonly obtained by sublimation from a
mixture of Sulphate of Mercury and common Salt or Chloride of
Sodium, and the chemical changes are beautifully expressed by the
following formula :

NaCl-|-IIg0, S03 = HgCl-|-XaO, S03.

When this salt is mixed with the Muriate uf Ammonia, Chloride of
Ammonium, or Sal Ammoniacum, there is found the well known
triple salt, the Chloride of Mercury and Ammonia, a salt which was
highly esteemed by the Alchemists, and has received from them the
names of Sal Alemhroih, Salt of Wisdom, Salt of Art. We are not
exactly apprized of those peculiar qualities which entitled it to such
distinction. It is said to have been intended " to facilitate the dis-
pensing of Corrosive Sublimate in small doses." If the Corrosive
Sublimate is only made milder in its operation by the Sal Ammoniac,
it is a preparation still worthy of our attention.

Corrosive Sublimate forms a dense crystalline mass which is very
soluble in water, alcohol and ether. It forms an insoluble compound

1847.] Mercury and its Compounds* 583

with albumen, and hence this substance affords the very best antidote,
to its poisonous operation, that we possess while, at the same time,
itwarns us of the very disastrous results that must necessarily follow
the introduction of this Poison into the Biood, even in quantities the
most minute. It is estimated by Mulder, that to form this compound
with fibrine so as to destroy its vitality, it is only necessary for them
to unite in the ratio of 6361 parts of the fibrine to 1 of the corrosive
sublimate, or in other words, one part of the salt introduced into the
blood would convert 6361 parts of fibrine into this insoluble compound,
which must either bo eliminated by the natural emunctories or be
deposited in the tissues as a kind of foreign matter. Now who does
not see the great analogy that, must exist between this product and
that which is commonly known as scrofulous and tuberculous matter,
and who is not led reasonably to suspect that the indiscriminate and
wanton use of Mercury, in all its forms, may be swelling annually
the list of victims to tubercular Phthisis, whose increasing ravages
seem to me in some measure to have been proportioned to the increased
use of Mercury in the Practice of Medicine. Let those who tamper
with this article of the Materia Medica, as a harmless drug, weigh
well the question which is here submitted. Liebig says, "It is obvi-
ous that ifarsenious acid and corrosive sublimate are not prevented
by the vital principle from entering into combination with the com-
ponent parts of the body and consequently from rendering them
incapable of decay and putrefaction, they must deprive the organs of
the principal property which appertains to their vital condition, viz.,
that of suffering and effecting transformations; or, in other words,
organic life must be destroyed." (Agricultural Chemistry.) This
subject is possessed of a tenfold interest, when we take into consid-
eration the recent experiments of M. Millon and Laveran, on the
permanent retention of metallic substances, but more particularly
of Antimony in the vital organs. We will revert to it again when
examining the effects of Mercury upon the Body. In regard to this
particular form of the remedy, however, we must remark that in those
cases where we wish to introduce it slowly into the system, more
especially in the Venereal disease, we decidedly prefer the Corrosive
Sublimate to any other preparation of Mercury. I have had within
a few years past an opportunity of demonstrating its decided value in
the disease.

These ordinary compounds of Mercury have of late been super-
ceded in part by a number of new and more fashionable remedies,

584 Mercury and its Compounds. [October,

which have been brought to light by the labors of Chemists, and like
every thing new, each has had its admirers and an appendix of suc-
cessful cases. I need not do more than briefly to allude to them,
making such casual remarks as may be suggested in passing. They
will all be found described by Dr. Dunglinson, in his work on New
Remedies and their principal virtues, so far as known, pointed out.
The most of them are combinations of Iodine and Bromine with
Mercury. Among the new remedies of Dr. Dunglison, I was sur-
prised to find the Cyanide of Mercury, a compound which has been
long known to the chemist, if not used by the physician; and has
afforded the best means of procuring the Hydrocyanic or Prussic
acid. The best way of obtaining this acid is by heating in certain
proportions the Cyanide of Mercury with Hydrochloric acid, or to
obtain it, anhydrous Sulphuretted Hydrogen may be used in the place
of the Hydrochloric acid. The reaction in this case is expressed by
the following formula :

HfiCy-|-H,Cl=HgCl-|-HCy.
the product being Chloride of Mercury and Cyanide of Hydrogen.

Among the preparations of Mercury and Iodine is one which
was first brought to the notice of the physicians of this country by
Dr. W. Channing, of New York, in a paper published in the "Amer-
ican Journal of Medical Sciences," many years ago. It was so
highly recommended in the paper referred to, that I immediately
prepared some of it according to the formula given by Dr. Chan-
ning, and used it in a few cases. My experiments with the remedy
have been few, and by no means satisfactory. It seems, however, to
be an interesting compound, consisting of Iodine, Mercury and
Potash, probably of an equal number of equivalents. I am not ac-
quainted, however, with its chemical formula. It is called by Dr.
C. the IodoHydrargyrate of Potash.

Of the Bromides, we can say nothing from our own observations.
It appears that Bromine unites with Mercury in two proportions,
forming the subbromide, and the Bromide. They are both colorless
compounds, and bear in many respects a close analogy to the two
compounds of Mercury with Chlorine, of which we have already
spoken.

Mercury unites also in several definite proportions with Nitric
acid. It forms with the black oxide the Nitrate and Subnitrate, the
first of which may be obtainee by simply pouring the Nitric acid
upon metallic Mercury iu the cold. It is insoluble except in an ex-

1847.] Mercury and its Compounds. 585

cess of Nitric acid, and I have found it a useful application to some
foul ulcers of a phagedenic character. Tiieir formulae may be
found by consulting Graham or Kane.

Bat, besides these, M. Millon has detected and described four
others formed by the action of Nitric acid on the bio.\ide of Mercu-
ry, whose formulae I beg leave to give here, as the result of the latest
investigations :

1. Syrupy Nitrate, - - - Az05-|-HgO-|-2HO

2. Nitrate, crystallized in needles, Az05-!-HgO-|- HO

2

3. Nitrate, crystal, in rhomboidal laminae, Az05-|-2HgO-|-HO

4. Nit. in crystalline white powder, Az05-|-3HgO-|-HO
The most interesting compounds of Mercury to the philosophic

chemist, however, are probably after all those produced by its com-
binations with ammonia. Long ago, the Ammoniacol Amalgam
gave rise to doubts in regard to the true character of the ingredients
of Ammonia and it has led necessarily to the adoption of a hypo-
thetical radical ammonium (NH4) which is entirely isomorphous
with Potassium and which, playing, as it does, so completely the
part of a metallic base, in many other instances is supposed to unite
with Mercury in the formation of the amalgam. So completely iso-
morphous is the alum formed with ammonium, with the Potash alum,
thay Gay-Lussac has made the remark, " that a crystal of potash-
alum transferred to a solution of ammonia-alum continued to in-
crease without its form being modified, and might thus be covered
with alternate layers of the two alums preserving its regularity and
proper crystalline figure."

Another view, however, has been taken of the composition of this
Ammoniacol Amalgam, suggested by " the remarkable and apparently
peculiar aptitude of Mercury to combine with Amidogen, and by the
position which Hydrogen holds among elementary bodies which is
(hat of a metal of the magnesian class. According to this view,
then, the Mercury forms the amalgam by uniting directly with
Hydrogen, and the Amide of Mercury by uniting with amidogen,
so that these two compounds are mixed together. It is here seen
how forcibly these combinations of Mercury tend to establish the
existence of that class of compounds which are known as Amides,
in which the radical is Amidogen (NIT,) containing one atom less
of hydrogen than ammonia and making ammonia indeed an Amido
of Hydrogen,

586 Mercury and its Compounds. [October,

We proceed now, in the second place, to notice the effects of Mer-
cury upon the animal system. It seems to have been universally
considered by the ancients as a dreadfully destructive poison. Dios-
corides describes it as a corrosive that destroyed the stomach and
bowels, by eating holes through their coats. Pliny applies to it the
words " Yenenum rerum omnium" and yet he does most explicitly
speak of the use of the Minium or Sulphuret of Mercury in the
practice of Medicine. It seems that it was applied to wounds of the
abdomen and head, for the purpose of stopping the flow of blood,
provided care was taken not to allow it to penetrate internally. His
words are as follows : " Quod cum venenum esse conveniat, omnia
quae de minis in medicinae usu traduntur, iemcraria arbitror : prae-
terquam foriassis illito capite ventreve, sanguinem sistendum, dum
ne quid penetret in viscera, acvulnus, ailing i! : cliter utendum non
equidem censeam." Galen, it is said, considered it as a poison,
*' which was unfit for use as a medicine."

The credit of first introducing it i; to general u?e, as a remedy, is
ascribed to the Arabians, who are said to have cured diseases of the
skin, by an external application of it in the form of ointment. From
analogical reasoning, it was afterwar J* adopted as a remedy in Syph-
ilis. It seems to have been confined principally to those cutaneous
diseases until the year 1733, in which year it was used by the phy-
sicians of Xew England, in the treatment of a febrile disease attend-
ed with ulcerations in the throat, which was known as the " Throat
Distemper." After this, it was used in the treatment of small-pox
and gradually its use was extended to febrile and inflammatory dis-
eases in general, such as Pleurisies, Perpneumonies, Quinsies, Rheum-
atisms, &c, &c. (Vide View of the Mercurial Practice, by John
Warren, M. D. Boston: 1813.) It seems to have gained an im-
portant advance in reputation among medical men, from its supposed
utility in the treatment of that most formidable disease the Yellow
fever. Physicians began at one time to believe that, although they
had to deal with a Herculean disease, they had a remedy whose pow-
ers were entirely adequate to its complete expulsion out of the sys-
tem and the reputed success of Dr. Chisholm and others in the
West Indies, and of Dr. Rush in Philadelphia, in the year 1793,
soon established for a time the Mercurial Practice in the treatment
of all our climate fevers ; and by an easy transition it has been since
applied to all diseases attended by visceral derangements and more
particularly to hepatic affect iona.

1847.] Mercury and its Compounds. 537

Since that time Mercury has b2en regarded as the "Sampson"*
of the Materia Medica by many practitioners, without which they
could hardly practice Medicine at ail, and it is almost incredible,
the extent to which it has been used in the treatment of almost all
the diseases! to which "flesh is heir" In the use and recommenda-
tion of the Poison, it seems scarcely to have entered into the minds
of its advocates, that if it was powerful for good it might also be
powerful for evil ; but on the contrary, it seem3 to have been the
general impression, that if it did no good it could do no harm. The
use of Mercury in diseases of the East Indies, and tropical climates
in general, is well known, and could we trust in full the statements
of the many writers upon the diseases of those climates, we must
consider it as a sovereign remedy for all Hepatic affections incident
to those localities. We remember no writer from Dr. Johnson to
Dr. Budd, who has not recommended it highly in these case3, although
we are under the impression that there have been some misgivings
in the minds of the more recent authors in regard to all the good
previously anticipated from its use. Was the bile secreted in too
great quantities, as in some fevers "mail mcris" Mercury was given
to check the inordinate action of the liver was there torpor in the
system and a want of action in this last named viscus, Mercury was
given to stimulate the blood-vessels, and the glandular system parti-
cularly, se as to arouse the liver from its lethargy, and induce the
normal secretion of bile, giving to the remedy in this way " a sort of
equalizing or balancing influence over the system"

Xow when we come to examine into the evidence in favor of all
these reputed advantages of Mercury, it will be found to be exceed-
ingly unsatisfactory to a philosophic inquirer after the truth. Evi-
dence either for or against a remedy must be founded upon statistical
data, or facts carefully collected by competent observers ; and these
facts should be collected, not as against some other remedy or course
of treatment, but as against no remedy at all, and no treatment ex-
cept that which is strictly Hygienic. Or, in other words, to determine

* "We are of opinion that the symbol under which Mercury should be repre-
sented in Medicine, would be Sampson holding in his right hand the jaw-bone
ot'an ass, with the inscription " the Sword has slain its t/wusaiuls, but Mt/xurij -its
tats oftlurust

t To show the extent to which Mercury is used at present by some, I would
state that in a late work on Southern Practice, it is recommended in 5-Gth of all
the diseases treated of, in some form or other of the remedy, and in some stage
or other of the disease. 4

59S Mercury and its Compounds. October,

the value of a remedy, we must not compare it with another remedy,
but ascertain whether the case has been at all modified by its power,
so that without its use the patient must have died. It is by compar-
ing the ratio of a number of cases of the same diseases recovered, to
those which terminate fatally, without any treatment except good
nursing, to the ratio of the number of cases of the same disease re-
covered, to those which terminate fatally, where the treatment pursued
has been with Mercury and Mercury alone. It must be evident,
that to compare one remedy with another, will only give us the rela-
tive effects of the two, without establishing the absolute good or bad
effect of either, and in this way we may propagate from generation
to generation the use of a very bad and hazardous remedy, by con-
trasting its operation with some other modes of treatment even more
incendiary and destructive. Whereas, were we to compare either
or both modes of treatment with the treatment which Nature sug-
gests, or even with the nugatory systems adopted by the Homoeopath-
ists, we might be led speedily to discard them both.

Now such appears to me to be the blind evidence on which rests
the reputation of Mercury in many diseases. It will be found upon
a careful examination, that in all cases where it has gained the ascen-
dency it has been by contrasting it with other modes of Practice
which were not as good. It may be replied to me, that of two evils
we must choose the least, and of two remedies choose the better,
upon the ground that " anceps remedium potius quam nullum ;" but
I answer that it is the part of prudence and wisdom to choose no evil
when you may avoid it, and the maxim is only correct when we must
choose the one or the other. Let us refer for an example of the tes-
timony in favor of Mercury to the declarations of some whose expe-
rience, as given to us by Dr. Warren, in his work above referred to
in the treatment of Yellow fever. In the Island of Trindad, Dr.
Clark observed that in the Yellow fever of 1793, " where there was
time for salivating Mercury was always successful." In order for his
testimony to have full force, he should have been prepared to tell us
how many, under similar circumstances, would have died under the
care ofa nurse. In Dominica, Dr. Fullin asserted that the propor-
tion of the mortality under the treatment by Mercury was about 1 to
5, and 1 to 2 under any other treatment. From this we only legiti-
mately draw the conclusion that the other modes of treatment were
exceedingly bad, because farther on we learn that in Antigua, where
D. Byam used Mercury, in the decline of the epidemic, the propor-

1817.] Mercury and its Compounds. 589

tion of deaths was 1 to 2. In the Island of St. Thomas the success
with Calomel was not great. " In the Royal Artillery the mortality
was greater than had ever been known in a tropical climate ; yet,
compared with other modes of treatment, it was on the whole the most
successful." This last quotation is peculiarly in point, and most
clearly shows that in the use of Mercury we have not yet arrived at
the best mode of treatment.

But the chief support of the Mercurial Practice is to be found in a
by authority, prophetical, ipse dixit, passing from generation to
generation, and not upon the true basis of well-attested and collated
facts. This evil in Medicine has long existed, and I am glad to say
has been detected, and its total abandonment may soon be predicted
when we see the effects which are being made by M. Louis and his
associates to bring about the "numerical method" and other correct
modes of observation. This being the case at present, however, we
may adduce similar evidence against its use that we have found in
favor of it. The views of Dr. R. Jackson were directly opposed to
its use in Yellow fever, except as an evacuant. "From the use of
it in St. Domingo, he concluded, that in slight cases of Yellow fever
when the mouth is affected, the fever is observed to be diminished,
but this seldom tales place till the disease has abated ; for when the
disease is violent, no salivation can be produced. Hence he advan-
ces the opinion that salivation instead of being the cause of the abate-
ment of the disease, is only a signal of its departure." With these
views we perfectly coincide, as will be perceived by our remarks
already made when speaking of Calomel. Dr. Lind's experiments
are also corroborative of this opinion. "Fifteen cases were treated
with Mercury from the first day five died, in three of whom salivation
took place five, who were not salivated, recovered. The other five
who recovered were salivated, but, as usual, not till the violence of
the symptoms had passed off." Other cases might be brought for-
ward of a similar kind, but we forbear our object now being simply
to show the equivocal nature of the evidence in favor of Mercury as
a remedy in Yellow fever. The same remarks will apply, however,
with equal force to it as a remedy in all our idiopathic or essential
fevers.

But is there better evidence in favor of its powers as an anti-
syphilitic ? There has been a time when, to question this, would have
been to subject ourselves nearly to the suspicion of lunacy. This
has been heralded as one of the great triumphs of Medicine, and we

590 Mercury and its Compounds. [October,

had congratulated ourselves that we had found at least one specific in
the cure of disease but oh ! the inquisitorial daring of French Phi-
losophy / Even this is denied as an achievement of our Divine Art ;
and the sensualist is deprived of the satisfying reflection that, if it is
easy to he poxed, it is easy to be cured ! ! !

Some have gone so far as to assure us that Mercury is entirely un-
necessary in the treatment of this disease. Others have labored to
prove that many of the very worst symptoms connected with the
secondary forms of the disease are entirely the effects of mercurial
remedies although it is admitted on all hands, I believe, that these
symptoms do sometimes occur where Mercury was not used, proving
the very close resemblance, in external form, between venereal and
mercurial diseases. Most of the anli-mercurialists admit, however,
that there are some cases which yield more readily to the mercurial
than to any other mode of treatment.

We have not time nor space to enter fully upon this question here.
It must be acknowledged that it is still in a very unsettled state.
We have not the data upon which we may rest any thing like a just
conclusion in regard to the comparative merits or advantages of the
two modes of Treatment. Nor have practitioners carefully distin-
guished between the Symptoms which are truly venereal and those
which have resulted from the poisonous operation of the remedy
itself. I think, however, that the following propositions will be gen-
erally admitted to be true:

1. That there are many simple cases of the Venereal Disease
which may be treated successfully without Mercury .

2. That there are many cases of so called secondary Syphilis where
the symptoms are hardly distinguishable from those of true Syphilis,
which are entirely the result of the poisonous effects of Mercury.

3. That there are secondary symptoms resulting from the vene-
real virus alone, where no Mercury had been used.

4. That there are many cases of the Venereal which will not yield
to the simple treatment, which are found to yield speedily to the use
of Mercury.

5. That injudicious hands Mercury may still be considered as the
best and most efficacious remedy which we possess in the treatment of
Syphilis.

Let us now take a hasty glance at the peculiar modus operandi of
this Medicine and a few of its more peculiar and specific effects.
Mercury, like all other medicines, must now be considered as act-

1847.] Mercury and its Compounds. 591

ing upon the system through two media the Nerves and the Blood-
vessels. No one has ever doubted the sympathetic action of this or
any other remedy ; but it has been common to deny its entrance into
the blood-vessels. Experiments and observations have, however,
completely refuted the objections urged against it, and I believe that
none who has kept pace with the progress of Science will now oppose
the opinion. "Dr. Hamilton long ago detected globules of Mercury
in the milk of a salivated woman. Fourcroy's authority may be ad-
duced to confirm a similar fact, when he declares it as his opinion
that the Mercury found in the bones arises from the superabundant
part of the oxygen being absorbed by the stomach.'7 (Warren op.
cit.) Orfila declares that Corrosive Sublimate is absorbed in certain
cases, and says that it " may even change its nature in such manner
as to appear under the form of globules in the large cavities of the
body, in the viscera, in the joints, in the bones, in the sheaths of ten-
dons : as has been proved by a number of authentic facts. " (A gen-
eral system of Toxicology, by M. P. Orfila, vol. 1, p. 47.) " M.
Pickel, Professor of Chemistry at Wartsburg, obtained metallic mer-
cury on distilling the brain of a person who had been long taking
mercurial preparations." (Ibid.) " Zeller states that he found
Mercury in the Bile; and Wepfer, Laborde, Brodbelt, and others,
mention instances in which this metal was found in the bones of per-
sons who had died after several tedious mercurial courses. " (Eberle.
Therapeutics, vol. 2, p. 299.)

M. Oesterlen has performed a number of experiments on animals
with the view of determining this question, and the results obtained
are as follows :

1. "It is indubitable that Mercury may pass in the metallic state
through the parietes of the blood-vessels, since minute globules of it
have been found in the subcutaneous cellular tissue and in the veins
permeating it. The globules have never been discovered in the
epidermic layers, but only in the deep-seated layers of the dermis,
near the blind extremities of the hair follicles, also in these follicles
and in the sudoriferous canals. 2. The metallic mercury rubbed in
the skin or introduced into the intestinal canal, may give rise to
injurious effects by passing into the current of the circulation. It is
not ensy to determine in what manner the metallic mercury, when
once introduced into the circulation, becomes changed and modified,
or how it then acts. At the side of the shining globules, M. Oesterlen
found always a number of dull and dark colored corpuscles, which

39

592 Mercury and its Compounds, [October,

resemble a good deal the granules of a mercurial oxide : these were
found to be not acted upon by alkalis, but to be dissolved slowly in
nitric acid after being ground down into a fine powder. In the urine
and in the bile, the mercurial globules did not exhibit any appearance
of decided change. 3. Minute globules of this metal, in the state of
fine division, may traverse the capillaries without producing any in-
flammatory stasis : their presence in the vessels does not seem to
influence the formation of the blood, or the development of the san-
guineous corpuscles. 4. Small quantities of Mercury, taken inwardly
or applied to the skin, appear to pass chiefly into the parenchymatous
substance of the spleen, liver and kidneys, and to be discharged by
the last two emunctories." (Med. Chir. Rev., vol. 45, p. 500.)

But the most interesting mode of introduction into the system is
by the skin and lungs, of the mercurial vapor which seems to be con-
tinually passing off from this metal even at the common temperatures
of the air. This is obvious from the effects of Mercury upon the
systems of the " workmen employed in mercurial mines, gilders, sih
verers of looking-glasses, constructers of barometers, thermometers,
<^*c." In corroboration of these effects Orfila gives a most interest-
ing observation. " A man was in the habit of gilding from morning
to night in a room sufficiently large, but low, where he slept, himself,
his wife, and his children. Having taken but little precaution to
guard against the effects of mercurial vapors, he was first visited with
chancres on the mouth in very great numbers; his breath at this
time became fetid ; he could neither swallow nor speak without
dreadful pains. Similar accidents, cured by cessation from his em-
ployments and appropriate medicines, appeared three or four times in
succession, without any other symptoms ; but in a short time this
evil was accompanied with a very violent trembling, which first at-
tacked the hands, and afterwards the whole body. Agitated by per-
petual convulsive movements, he was neither able to speak nor to raise

his hand to his mouth without striking himself. At

the expiration of a certain time there formed an abscess in which
globules of Mercury were manifestly perceived." (Orfila. op. cit.
1st: p. 93.)

Orfila asks, after narrating this case, whether metallic mercury
ou^ht to be considered a poison ? and answers it, very properly, as
follows: "It appears to me that metallic mercury acts as a poison,
whenever it remains sufficiently long in the alimentary canal to un-
dergo a considerable degree of division, or to be absorbed. It is well

1947.] Mercury and its Compounds. 593

known that moisture and grease are capable of attenuating exceed-
ingly the molecules of .Mercury to such a degree that they become
black." He believes that in this state it may be absorbed, and its
poisonous action developed, and cites the effects of mercurial oint-
ment when rubbed upon the external surface of the body. (Ibid.,
p. 97, 98.)

Among the peculiar effects of Mercury is certainly that of Mercu-
rial Tremor, of which the above is one case ; and similar cases are
by no means uncommon. A case of a man 34 years of age, who
dealt in Mercury, was admitted into LaCharite Hospital in May,
1834, with the exact symptoms above descrihed. Dr. Christison
mentions the case of a barometer maker and one of his workmen,
who were accidentally exposed one nigiit during sleep to the vapors
of Mercury, from a pot on a heated stove, from which the latter was
affected with salivation, which caused the loss of all his teeth, and the
former with shaking palsy, which lasted his whole life. Dr. Darwin
describes the case of a man 62 years of age, in whom the disease had
existed for 25 years. Many of the symptoms of this disease assimi-
late it to the Chorea of young people, and the analogy to some of the
symptoms of poisoning in dogs, by using antimony, as shown by the
experiments of M. Millon, is most striking. (Med. Chir. Rev. vol.
29th, p. 230.)

Salivation is an effect of Mercury which should be considered as
peculiar; for although other remedies may excite it, yet none so
surely as this. How it is brought about we do not certainly know,
or whether it be a local or very general effect of the metal. It has
commonly, I know, been supposed to show the general constitutional
operation of Mercury. Some have supposed the action specifics-
others, who deny the existence of any specifics in Medicine, suppose
that salivation is brought about by a general stimulant operation of
the medicines, by which all the glands were alike excited to increas-
ed action, and that the bile from the liver is equally increased in
quantity by it. From our views of the operation of a gland in the
act of secretion, we cannot suppose that a simple increase in the
mechanical actions of dilatation and contraction, would be sufficient
to explain an increase in the bile.

Salivation is produced with much more difficulty in some constitu-
tions than in others, and it seems indeed impossible to produce it at
all in very young children. When pushed to such an extent as to
produco it in them, it is sometimes attended with the most disastrous

594 Mercury and its Compounds. [October,

consequences. Instead of causing salivation, and passing out of the
system in that way, it seems to get into the bones, and causes the
most fearful caries and sloughing of the bones of the cheeks, alveolar
processes, cheeks and gums. Cases of this kind have been narrated
to me by medical men, and others, as having occurred in this county,
when the Mercurial Practice was most in vogue, in the treatment of
our autumnal fevers.

It was at one time a prejudice among medical men, that the use of
cold water, while under the influence of Mercury, would bring on
salivation and other evil consequences, and I have heard of children
dying in our autumnal fevers who were never allowed a drop, and
whose last intelligible cry was water! water ! I have no doubt that
exposure to cold and moisture, which checks suddenly the transpira-
tion of the skin, might prove injurious while using Mercury, but I
know that there is no danger from the simple drinking of cold water.
We beg leave to give here a few remarks of Dr. Beck, upon the
Effects of Mercury in the Young Subject. " If," says he, " salivation
occurs so rarely in children under a certain age, then it is evident
that it can never be made a criterion by which to judge of its influ-
ence on their system. To attempt, therefore to produce this effect,

as we do in adults, is manifestly improper The

fact that Mercury may prostrate and destroy a child, even though it
does not cause salivation, it is to be feared is not sufficiently appre-
ciated at least by some. We have known Calomel given without
weight or measure to a young child, and the reason assigned to justiy
was that it could do no harm because it would not salivate. Now it
appears to me that no opinion can be more uufounded, and no prac-
tice more mischievous The use of Mercury in young

subjects, as an alterative, should in all cases be conducted with great
caution. There, is no practice more common than that of continuing
the use of this agent in small doses for a considerable time, and cer-
tainly none which is more liable to abuse. Under the idea that the
dose is so small, and from no salivation appearing, we are apt to infeF
that even if the medicine is not doing any good it is certainly not

doing any harm Every practitioner must have been

aware of cases, in which, in this way the article has been unneces-
sarily and injuriously continued. In bowel complaints, under the
idea of altering the secretions, it has frequently, no doubt, helped tc
keep up the very intestinal irritation which it was given to correct.
In other cases it has developed the latent tendency to other disease^

1847.] Mercury and its Compounds. 595

such as Scrofula, Phthisis PuJmonaJis, <**c. In adults we know this
to be very often the case. In the use of Mercury in young children
great care should be exercised in ascertaining as far as possible their
constitutional peculiarities. Whenever the patients show indications
of Scrofula, or where there is an hereditary predisposition to Con-
sumption, great caution ought to be exercised in the use of Mercury
in their offspring. Mercury should be administered with great cau-
tion in cases where a child has been sick for a considerable length of
time, and when the strength of the child has been very much reduced.
In this state of constitutional depression a single cathartic dose of
Calomel sometimes proves fatal. The too common practice of giv-
ing Calomel as an ordinary purge on all occasions is certainly unjus-
tifiable. From the facility with which it may be given, it is unques-
tionably resorted to in a great number of cases where it is certainly
unnecessary, and in a great number where it positively does harm.
Now in this way there can be no question that the use of it has laid
the foundation/or the ruin of the constitutions of thousands." (Amer.
lean Jour. Med. Sci., No. 26. y. s.. p. 509.)

Salivation has been very commonly supposed to effect a complete
revolution in the system, and this opinion has been distinctly ad-
vanced by Dr. Warren. He says, "a necessary consequence of the
highly stimulating power of mercurial oxides upon the system is the
universal revolution which the constitution must undergo whilst sub-
jected to their influence," and he goes on at some length to explain
the reason of this necessary change. The grand principle upon
which it is effected seems to be the breaking up of all old morbid
associations, by the substitution of a new and more powerful action,
brought about by the Mercury. Intimately connected with this gen-
eral revolution in the system, is the notion of the alterative action of
Mercury, when given in small doses for a long time, even without
producing salivation. It must be admitted that, at best, these opin-
ions are hypothetical, and appear to me to indicate clearly a sort of
blind credulity in an occult operation of the remedy which is totally
inexplicable and peculiar to it. I have never been able to discover
any greater alterative or revolutionary tction from Mercury in the
cure of diseases, than from any other rei;: . erv retnedv must

be supposed .to alter, more or less, the actions of the system, when-
ever it effects the cure of an-.

In the same way that Mercury riivary glands has it

been supposed to excite the liver, and consequently, in most diseases

596 Mercury and its Compounds. [October,

of this organ, it has been held up as the chief remedy. From my own
observation, I must say, that I have not been able to discover any
particular difference in their action on the liver, between Mercury
and any other active cathartic, and consequently do not believe that
its action on this organ is either peculiar or specific. I have seen
as much bile pass off under the use of milder cathartics, and
more under the use of Tartar Emetic, than that of any other remedy
I have ever .used ; and were I to judge from my own experience alone,
I would not hesitate to declare that this preparation of antimony
acted generally more decidedly upon the liver than any preparation
of Mercury I have ever used.

Among the toxicological effects of Mercury may be mentioned a
peculiar fever, which has received the name of Hydrargyria, a form of
Neuralgia or Chronic Rheumatism known as Mercurial Rheumatism,
in which the metal is deposited in the fibrous tissues and cartilages
c-f the joints- various eruptions upon the surface of the body in the
form of Eczema, Herpes, Meliaria, &c. The Mercurial Tremor we
have already mentioned and this sometimes passes into a state of
complete Paralysis.-^-(Med. Chir. Rev., vol. 38, p. 510.)

But among the worst effects of Mercury is a kind of Erysipelas or
Erythema, which is known as Mercurial Erythismus. I am inclined
to believe that this is nothing more nor less than the Hydrargyria or
Mercurial fever, attended with erysipelatous symptoms, which, ac
cording to its severity, may be simple or phlegmonous, and I will
terminate what I have to say upon the effects of Mercury by nar-
rating the following cases of this affection, in which is shown at the
same time a most unaccountable susceptibility to the action of this
poison. The following are my notes of the cases, taken down from
the mouth of the individual in August, 1838.

Mrs. R -, a respectable lady of this county, aet. about 50 years,

presents a curious example of idiosyncracy of constitution, in regard
to the action of Mercury. The following instances can hardly be
regarded as accidental coincidences, but must be looked upon as
effects produced from bare contact with th'\s poison.

A. The first time she ever had Erysipelas was after taking a doso
of Calomel, which had been prescribed by a physician. The Calo-
mel was taken at night ; and the next day, "from her head all over
her body she was as red as scarlet ."

B. Thu next time, a vial containing Calomel was broken. She
emptied the Calomel into a plate, and, in order to free it from pieces

1847.] Traumatic Tetanus cured by Strychnine. 597

of glass, she sifted it through cloth. The next day her neck was
covered over with splotches of Erysipelas.

C. She once made use of a solution of Corrosive Sublimate, for
the purpose of destroying bed-bugs, (Cimex lectularius,) and of course
her hands were more or less wet by it. In a short time, after this,
she had the same erysipelatous eruption.

D. After weighing ofTsome Calomel one day she got some on her
hands the next day she was affected with the Erysipelas.

E. The last time that she had been affected in this way, was in
consequence of being in a close room with an individual (a lady)
who was salivated. While in the room she was taken with a Chill
and Nausea. She returned home, went to bed immediately, and
spent a restless night on the next day she was covered with Ery-
sipelas, which was so violent as to confine her to bed for three months.
It assumed the phlegmonous character. The inflammation termina-
ted in abscesses over the glutei muscles, and sinuses were formed
which were healed with difficulty. She, however, eventually recov-
ered, and is now enjoying good health.

ARTICLE XXXVII.

Case of Traumatic Tetanus cured by Strychnine. By P. M. Kol-
lock, M. D., of Savannah.

Juba, a negro girl, belonging to J. B. B., of Savannah, while run-
ning about without shoes, stepped upon a piece of board which hap-
pened to contain a nail, and received a punctured wound of the sole
of the foot the nail entering near the heel, and penetrating to a con-
siderable depth. Disregarding the accident, she continued to go
about for three days, when she began to feel pain which induced
her master to scarify the part slightly and apply a poultice. This
treatment failing to relieve the pain, which continued to increase
with rapidity ; on the 4th of July last I was called in to her. I found
her in great agony, and immediately incised the part freely and
deeply, inserting lint moistened with iptl. terebinth, over which a
laudanum poultice was applied, and a tenspoonful of laudanum ad
ministered by the mouth. In about an hour from this time I was
summoned to her, and found that Tetanus had commenced. The
paroxysms of spasm came on at intervals of two or three minutes and
lasted two and a half or three minutes.

598 Traumatic Tetanus cured by Strychnine. [October,

During the paroxysm (which was generally ushered in by a slight
tremor of the eye-lids and the discharge of tears from the inner can-
thus of tlie left eye) the head and body were bent backwards and a
little to the right side the hands were clenched the upper and
lower extremities somewhat rigid, and the jaws firmly closed. Res.
piration extremely slow, and at times almost imperceptible intelli-
gence extinct.

IJ. Calomel gr. x. Tr. Opii 3j., every two hours tobacco poul-
tices to spine and abdomen. After continuing these poultices for
some time, they were removed, and a blister was applied, extending
the whole length of the spinal column.

This treatment was continued without any abatement of the
paroxysms in force, or any extension of the intervals between them,
for the space of six hours when a tobacco enema (two leaves of to-
bacco steeped in half-a-pint of boiling water,) was administered.
This was followed by vomiting, great distress, clammy sweat, great
prostration, insensibility, and stertorous breathing.

In a short time these symptoms became less intense -produced a
perfect subsidence of spasm but the insensibility and stertor con-
tinued.

R. 01. Ricini j.; blisters to calves of legs ; cold applications to
head ; enema of sol. mur. sod. Discontinued calomel and laudanum.

She remained in this state about three hours, when the spasms
returned with increased violence.

July 5, 8 o'clock, A. M. The treatment was resumed. R. Cal.
and Tr. Op., as before. In a short time after the administration of
the first dose, the tobacco enema (made rather weaker) was repeated.

Up to this time, she had taken 50 grs. cal. and 3vj. tr. opii.

12 o'clock, M. Spasms continue ; but rather diminished in force
and frequency, ft. Repeat tobacco enema; continue calomel and
laudanum. Diet, gruel and rum, rich soup.

Half-past 5 o'clock, P. M. Very much the same.

Finding that the treatment had not advanced the case beyond a
point of very slight improvement, believing that it had received a
very fair trial, and forming an extremely unfavorable prognosis of
the case, I determined to resort to a different remedy, viz., Strychnine,
and accordingly, made the following prescription :

R. Strychnin, gr. j. Pulv. G. Arab. gr. xiv. M. Divid. in pulv.
No. xiv., one powder every two hours. Discontinue all other reme-
dies.

1847.] Traumatic Tetanus cured by Strychnine. 599

10 o'clock, P. do alteration in
her condition a very severe par ecurred while I was with
her, which lasted twenty-two. minutes. Continue the treatment,
unless the peculiar effects of the remedy are manifested by a twitch-
ing or jerking of the extremities, or there is a cessation of the parox-
ysms of spasm.

July 6, half-past S o'clock. A. M. lad no severe parox-

ysm for several hours; has taken gr. as. which has pro-

duced little or no twitching. A short paroxysm occurred during my
visit.

I dressed the wound in the foot, inserting lint moistened with spts.
terebinth.

12, M. Has had no spasm since last visit.

I had directed the medicine to be given every hour until twitchiDg
or jerking of the extremities should be produced ; but through some
mistake, this was not done, and only one dose had been given since
last visit.

R. Strychnine gr. TV every two hours.

11 o'clock, P. M. Juba has had no spasm for five hours ; she has
taken T52 gr. of strychnine since two o'clock. She is very much dis-
posed to sleep, which sleep seems natural, and she is easily aroused.

R. Continue the medicine every two hours.

July 7, half-past S o'clock, A. M. Juba has passed a quiet night ;
no spasm for fourteen hours ; is entirely sensible ; says that she feels
better. Has had a free operation from the bow els. Has taken T92 gr.
strych. since 2 o'clock yesterday.

R. Continue treatment.

July 8, 9 o'clock, A. M. Juba has passed a quiet night is very
much disposed to sleep. Can this be the narcotic effect of the laud-
anum ? ^>hc has taken none since the 5th. She has had no spasm
for thirty-four or thirty-five hours. The bowels have been freely
acted upon through the night. She has taken the medicine every
three hours. She is salivated. The medicine has produced very-
slight twitching.

R. Continue Strychnine gr. T\ every four hours.

9th. Juba has continued free from spasm.

R. Strych. four tim-.'s during twenty-four hours.

10th. Same. Continue the medicine three times a day for three
or four day<.

12th. Has had no spasm for six days. The medicine has produ-
ced no twitching.

600 Traumatic Tetanus cured by Strychnine. [October,

R. Discontinue the medicine after to-day.

July 19th. I visited the patient to-day, and found her sitting up,
sewing ; complained of no pain nor any uneasiness whatever. The
wound of the foot has healed entirely, and there is no tenderness in
any part of the foot.

At 3 o'clock, P. M., of this day, I received a message, stating that
she had a return of her spasms. On visiting her, I found her in a
pretty strong tetanic paroxysm which was said to have supervened
soon after drinking freely of iced water having complained first of
pain at the praecordia, and vomited.

I immediately resumed the Strychnia gr. T\ every two hours; the
first two doses to be given at the interval of one hour.

I called to see her at half-past 7 o'clock, P. M., at which time she had
taken three doses. She had no return of spasm after the first dose.

R. Continue the medicine every two hours.

July 22. There has been no return of spasm.

R. Continue the medicine three times a day for a few days.

August 18th. I have heard of no return of the disease up to this
date, and presume that she may be considered cured.

It was suggested to me by a medical friend, who had failed to cure
a case of traumatic Tetanus with strychnine, and who feels more
confidence in calomel and opium, that it was probably the combina-
tion of the three which proved efficacious in this case ; and I was
obliged to admit the possibility; but the occurrence of the relapse,
and its very speedy termination under the use of strychnine alone,
without the intervention of a single grain of calomel or opium, will
doubtless warrant us in the belief that the cure in this case, at least,
is due to strychnine. I am not prepared to assert that the like for-
tunate result will occur in every case of tetanus, or even in the
majority of them, treated with this alkaloid ; but I am disposed to
speak favorably of it and as it is pretty well ascertained, that the
failures, in such as are treated with other remedies, so vastly outnum-
ber the cures, that the former have become the rule, and the latter
the exception ; it would be well to resort to it more frequently.

I have employed the remedy without success, in one or two cases
of trismus nascentium. They were pretty well advanced before I
was permitted to see them. As this is a disease very closely resem-
bling tetanus in many respects, it might be well to make farther
trials with the remedy.

In regard to trismus, I may be allowed to remark, en passant, that

1847.] Traumatic Tetanus cured by Strychnine. 601

I believe the most fertile cause of the disease to be, the manner in
which the navel is treated after the separation of the umbilical cord.

The practice of midwifery in this neighborhood, and I believe, at
the South, generally, is almost entirely in the handi of females
those most usually negroes and where, in some rare cases, a physi-
cian is called upon to officiate, the treatment of the navel is left
entirely to the nurse by whom, as soon as the cord separates, a
piece of "scorched rag," or some other irritating substance is appli-
ed ; and in the majority of cases this is the only attention which the
uavel receives. Of course, a very considerable collection of foul
matter must occur at this part, a powerful cause of irritation to the
very sensitive nervous system of a new-born infant.

it has always been my custom to enquire, particularly, into the
condition of the navel to make repeated occular examinations, and
to prescribe the mode of dressing, myself, notwithstanding the occa-
sional broad, and not to be misunderstood hints, on the part of the sage
femmes, that I was meddling with what was no business of mine ;
and that they did not thank me for my officiousness. The dressing
which I direct for the navel, after the separation of the cord, is simple
cerate; and I cannot recollect a single instance of trismus, occurring
in a child which has been delivered by me.

In confirmation of the opinion which I have expressed, in regard
to the importance of employing a suitable dressing for the navel, I
will relate the following incident.

The negro midwife of a neighboring plantation, was instructed by
myself; and among the directions which I gave her, was that of
dressing the navel with simple cerate (after the separation of the cord)
twice a day, sponging off each time, the purulent discharge with warm
water, and applying over the dressing a good compress and bandage.
For some time after she commenced practice she was sufficiently
successful ; but after a time trismus made its appearance, and every
child which was born, died with it in 8 or 10 days after birth, I was
generally sent tor, and arrived in time, either to find the infant dead,
or in articulo mortis.

After this had occurred rather too often, to be considered the result
of unavoidable accident, I instituted an investigation into the conduct
of the midwife during her attendance, and enquired particularly, in
regard to her manner of treating the n.tvel ; and I was informed
that she had been, latterly, in the habit of dressing it with "burnt
rag!" She was severely reprimanded, for this departure from the

602 Treatment of Ilooping-Cough. [October,

instructions which she had received from me, and threatened with
punishment, if they were not attended to in future cases. It is now
two years since this occurrence the usual number of births have oc-
curred on the place, and there has not been an instance of trismus.

This may be called a coincidence ; and I may be reminded, that
" post hoc, ergo propter hoc " is not always a good rule. But I am
disposed to think, that the majority of medical opinions are not based
on any better evidence.

ARTICLE XXXVIII.

Treatment of Hooping -Cough with the Iodide of Potassium. By
H. F. Campbell, M. D., Demonstrator of Anatomy in the Medi-
cal College of Georgia.

Iodide of Potassium, at the present day, may be said, with some
degree of qualification, to be used in some form of almost every dis-
ease. Its great efficacy in the multitude of Syphilitic disorders is
indisputable, and since the memoirs of M. Lugol, its applicability in
the treatment of the vast number of diseases arising from a certain
state of constitution termed the Scrofulous Diathesis, is fully estab-
lished. Many forms of Neuralgia also, not due either to a syphilitic
or scrofulous origin, yield readily to its use,* and of late its success in
the treatment of Spasmodic Asthma has been i'ndeed cheering to those
afflicted with this truly distressing malady.

The close pathological affinity between Spasmodic Asthma and
Hooping-cough, and the success of the remedy in the former disease,
induced me, during the prevalence of the latter in our city, to use
Hydriodate of Potash in a very violent and obstinate case that came
under my treatment.

Case. Mr. N. G., a gentleman of nervous temperament, aged
about 30 years, had had hooping-cough for about six weeks previous
to my seeing him, and had been fully treated after the ordinary plan
of emetics, nauseants, demulcents, antacids, sedatives, &c, with but
little temporary and no permanent benefit whatever. His condition
was then one of extreme suffering; he had frequent and violent at-

* The control of Hydriodate of Potash over the nervous system, in disease, is
amply attested by Drs. Elliotson, Bardsley, Hudson, and many others. Vide,
also, article by Dr. Bennett, in the London Lancet, and one by Prof. J. K.
Mitchell, in the Medical Examiner.

1847.] Treatment of Hooping-cough. 603

tacks of spasmodic coughing, which, as is characteristic of the disease,
would end in complete exhaustion of air from the lungs, leaving the
patient much fatigued and almost poweiless ; but superadded to these
ordinary symptoms there was an unusual irritability of the mucous
membrane of the fauces, pharynx and larynx, which indeed was the
most distressing item in his ailments. This irritability was so great,
that in swallowing or speaking, and even in ordinary respiration,
unless these acts were performed with some degree of care, he would
experience an attack of suffocation, amounting almost for the time
to complete asphyxia. His attacks of coughing were frequent and
violent, often terminating as above described in spasmodic closure
of the glottis.

Treatment. On first seeing the patient the following prescription
was made :-^-R. Extract : Belladonna, - - - grs. viii.
Syrup: Scilla3, comp., - - gij.

Mix, and add of Acid Hydrocyanic, - gtt. 16.
Of this take one drachm, three times daily.

This prescription produced little or no mitigation in the symptoms,
and was finally discontinued on account of the unpleasant effects of
the belladonna, viz., vertigo, blindness, efflorescence, &c. The above
symptoms being still as decided as ever, the following emulsion was
given : R. Potassii Iodidi, - - grs. 80
Gummi Acacire,

Sacch, Alb. aa - - 3ij.

Water,' . . - gij.

Mix, and take one drachm (equal to 5 grs.), three times daily.

In a short time all the symptoms had considerably amended, and
at the expiration of ten days the patient was so much better that he
thought he could omit taking medicine; but experience proved the
contrary he was obliged to resume it again, and continued about
two weeks longer, (though not so frequently or in such large doses as
before,) at the end of which time he was entirely relieved of the
cough, and also of tho spasmodic contraction in the muscles of
the glottis.

Re3Iarks. From the works of Dr. Marshall Hall, and others, we
may infer as the pathology of hooping-cough, a highly excitable con-
dition of a portion (the superior laryngeal) of the pneumogastric
nerve, together with an inflammation of the mucous membrane of the
larynx, pharynx, &c. It is also known, that in this disease the
secretions of the stomach and bowels become much vitiated and

604 Treatment of Hooping -Cough. October,

irritating, (almost invariably acid) ; and also, that these secretions,
after their formation, serve very much to protract the disease, by the
irritation they produce in the excitor nerves (filaments of the pneu-
mogastric) of the stomach, being conveyed by the reflex function of
these nerves to those supplying the mucous membrane of the respi-
ratory apparatus ; hence, in these cases we generally have a paroxysm
of vomiting simultaneous with that of coughing because on such
occasions, the latter act is produced by a common cause which is
adequate to excite equally, coughing and vomiting. The cough may
at other times be excited by externa! causes applied to the mucous
membrane of the larynx, or perhaps by an accumulation of excite-
ment in the nerves that supply it. Further: these deranged secre-
tions, which are most probably the result of disordered innervation
in the secretory filaments of the sympathetic which supply the mu-
cous membrane, by the irritation they produce in the excitor branch-
es of the pneumogastric ramifying in this same membrane, become
in turn a cause of the continuance of the disease*

Now for many years the bases of the most successful plans in the
treatment of hooping-cough have been emetics and alkalies, the
first giving temporary relief by the removal of the disordered secre-
tions, and the second by neutralizing them in the stomach, prevented
the further derangement of this organ by their irritation. More re-
cently, the oxide and nitrate of silver have been found beneficial, the
efficiency of which, reasoning from their application in other diseases,
(epilepsy, for example,) depends upon their tonic effect on the ner-
vous system.

Considering the above pathology of hooping-cough as correct, in
connection with its heretofore therapeutics, the curative action of the
iodide of potassium is readily comprehended viz: it fulfils, in some
degree, the indication of an antacid? and above all, as is well estab-
lished, it is an excellent alterative tonic to the nervous system.

In conclusion it may be said, that though rationally, we would
consider the iodide of potassium a very useful remedy in hooping-
cough ; still, no doubt, there are many cases wherein, from constitu-
tional peculiarity or other causes, it would be not only nugatory, but
wholly inadmissible,-)- and while these observations on its use have

* That is, when there is free acid in the stomach, sufficient to displace the
hydriodic acid. The effect of this agent upon the absorbent and secretory appa-
ratus has not been here dwelt upon, as it is sufficiently apparent not to require
remark.

t As is known to be the case in its application to some cases of syphilitic disease.

1847.] Poisonous Properties of Sulphate of Quinine. 605

been somewhat extended, the object lias been more to instigate fur-
ther trial of the remedy during the present prevalence of hooping-
cough in our vicinity, than to claim for it anything like infallible
efficacy in the disease.

ARTICLE XXXIX.

Poisonous Properties of Sulphate of Quinine. By E. M. Pendle*
ton, M. D., of Sparta, Ga.

In the August No. of the Southern Medical and Surgical Journal,
in the Review of the American Journal of the Medical Sciences, is
the notice of a cose of Poisoning by the Sulph. of Quinine, from the
pen of Dr. Baldwin, of Montgomery, Ala. This case, though some-
what unique, reminded me so forcibly of a singular one in my own
practice, that I have been induced to lay it before the medical world,
as confirmatory of a very important and dangerous property, existing
in a medicine, more extensively used perhaps than any other in the
Southern latitudes.

On the 17th of October last, I was called to visit the child of Mr.
J. D. S., sub node, several miles in the country. I found my pa-
tient (a lad about four years old) laboring under a severe fever, which
had supervened upon a slight chill. The usual alterative and anti-
phlogistic treatment, for autumnal fevers, was instituted on the 20th,
which was his best day : I found him measurably clear of fever, and
left a iew powders of quinine for him to take the next morning, to
prevent, if possible, the exacerbation of fever. I forget the size of
the powders, but do not suppose there was over a grain in each, to be
taken every hour.

On the 21st, about noon, I was sent for in great haste, with the
message that my patient was much worse. I found him in about the
following condition : His pulse remarkably slow, with a full heavy
beat; his tongue perfectly clean and natural ; his breathing, if I re-
member right, rather labored. He was not remarkably restless, but
lay in a dull comatose state, except when aroused, and then he evin-
ced no disposition to talk or notice anything. The pupils of his eyes
were dilated, beyond any thing I have ever seen. In fact this was
the first symptom that alarmed the parents, so striking was it to
every one that saw him. I doubt not that he was totally blind, but
could not ascertain, owing to the age of the child, and his indisposi-
tion to notice any thing. If I remember aright he was deaf also.

606 Preparation, Physiological Action of Ether, <$c. [October,

X learned that he was entirely free from fever during the night and
early in the morning, and seemed quite lively and much better.
But after he had taken the second or third powder, (I forget which,)
these alarming symptoms began to come on, when they stopped the
medicine. I was forced to attribute the symptoms to the quinine,
as he had taken nothing else, though I had never seen such an effect
produced by it before, yet I could conceive how it might be done in
certain constitutions, especially of children. An experienced physi-
cian, to whom I communicated fears, referred it to worms, which I
doubted at the time, and now feel confirmed in my diagnosis, from
the case recorded by Dr. Baldwin.

I instituted no treatment whatever, only cold applications to the
head, of which he complained very much, (if I mistake not,) with the
suggestion that he take pink-root tea freely, after the unpleasant
symptoms had subsided. They remained, I think, about two hours,
when the pupils began gradually to assume a natural appearance,
and all the other symptoms to give way. I found him quite conva-
lescent the next morning, free from fever and cheerful. The spigelia
was given freely, but no worms were brought, which served still far-
ther to confirm me in the belief that the unpleasant effects in this case,
were superinduced by an over-dose of the sulphate of quinine.

PART II. REVIEWS AND EXTRACTS.

Preparation, Physiological Action of Ether, Sfc. (Half- Yearly-
Abstract of the Medical Sciences.)

Nature and Mode of Preparing the Agent. The agent by which
insensibility to pain has been achieved is rectified sulphuric ether ;
other ethers have also been used, as the chloric and acetic ; the former
is said to be equally potent, and less disagreeable. We have person-
ally tried perfectly pure nitrous ether, but we found it to produce a
painful oppression of the chest, with incessant coughing which re-
mained for an hour or two, but subsided after a few inhalations of the
pure sulphuric ether. In order to produce satisfactory results, it is
necessary that the ether should he perfectly pure ; the sulphuric ether
of commerce, which contains sulphuric acid, alcohol, or the acetic or
formic acids, is quite unsuited for the purpose. The mode of pre-
paring pure ether is thus laid down by Dr. Jackson. "The basis of
all the ethers is an hypothetical radical called ethule, which is repre-
sented by the formula C4, H., and symbol Ac. Pure sulphuric ether
is regarded as an oxide of ethule, and is represented by the formula

1847.] Preparation, Physiological Action of Ether, S^c. 607

C4,H5,0; its symbol is Ae O. It is prepared by decomposing
highly rectified alcohol by means of su acid. Five pi

alcohol of 90 per cent, are mixed with nine parts of oil of vitriol in
a vessel of copper or iron, placed in cold water. The action of sul-
phuric acid on alcohol is catalytic ; hisulphate of the oxide of ethule
is formed, which, by elevatit temperature and brisk ebulli-

tion, is decomposed, and the oxide of Pthule passes over in vapours,
the sulphuric acid remai- a portion of un decomposed alcohol,

the water which passes over the vapours no longer uniting with the
ether. The distilled liquid is next to be treated with an alcoholic
solution of potash to neutralize the acids, and to render it slightly
alkaline. It should then be redistilled in a wnter-bath, and the oper.
ation should be arrested as soon as the other has attained a specific
gravity of 0-72 at 80 F. The specific gravity may be still further
reduced by allowing it to stand for some days, over dry chloride of
calcium, and then redistilling it in contact with that substance.
Ether thus prepared should not change the colour of "litmus paper."*

Mode of Exhibiting the Ether ; Precautions. However trifling
the amount of injury has been in proportion to the frequency with
which ether inhalation has been practised, there cannot be a question
that an agent capable of inducing such remarkable and potent effects
ought not to be regarded as a "scientific toy," or even to be employ-
ed at all by persons unacquainted with the principles of physiology
and pathology. Thi ions which we are disposed to consider

requisite are as folk

1st. Never to exhibit the ether vapour without having previously
auscultated the heart and lungs.

2nd. Never to employ it in persons who have signs of obstructive
disease of the heart to any amount, or of dilatation of its cavities, or
whose heart is feeble even though not disproportioned.

3rd. Never to employ it in persons who have any considerable por-
tion of a lung unfitted for respiration, as from hepatization, tubercu-
lar deposit, pleural effusion, &c.

4th. In persons with short necks, with tendency to cerebral con-
gestion, its employment is not without risk; also, (perhaps) in those
with disposition to insanity, or other recurrent disease of cerebral
origin.

5th. No operation of consequence should be performed under the
influence of ether without a preliminary "trial" exhibition.

Rules for exhibition. Directions as" to the method of exhibiting
the ethereal vapour have been given by Mr. Robinson,* who was one
of the earliest experimenters in this country, by Mr. Braid, M. Bur-
guieres,f and others; these are, however, all in effect nearly the
same, and may be thus briefly stated.

1st. The ether employed should be the purest washed sulphuric
ether.

2d. The patient should be allowed to respire atmospheric air alone

* Lancet, Fob. 13. Med. Times, May 1$.

39

608 Preparation, Physiological Action of Ether, <fyc. [October,

for a few moments if the apparatus is so formed as to allow of it, if
not the nose should not be closed until several respirations have been
taken, and the patient continues to breathe without trepidation.

3d. The ether should not be turned on in a full jet at once, but the
stopcock should be so regulated as gradually to accustom the bron-
chial tubes to the vapour.

At this time coughing is apt to ensue, especially if the ether be not
perfectly pure ; this symptom, however, soon subsides, or can be
moderated by a regulation of the jet of the ether.

4th. Surgeons differ in opinion as to the exact point at which in-
halation should be suspended ; we believe that for surgical purposes,
Mr. Robinson's test as afforded by the state of the eye, will be a suffi-
ciently good guide.

5th. Id prolonged operations, it is necessary to alternate respira-
tion of pure atmospheric air with that of ether vapour; this is ac-
complished by removing the clip from the nose, or still better, in
those instruments which are so made, by shutting off the ether and
turning on the air.

Oxygen, <$*c. an Antidote. Under the impression that the specific
effects of ether vapour upon the system are due to its power of pro-
ducing a state analogous to asphyxia, it has been suggested by Dr.
Jackson, and subsequently by Mr. Robinson, that oxygen gas should
be kept ready to be inhaled in case of the occurrence of formidable
symptoms. Mr. Hooper, acting upon the suggestion, has supplied
his inhaler with the means of furnishing oxygen at pleasure.

On the other hand, Dr. Gull concludes, from a series of experi-
ments on the lower animals, that oxygen has no antidotal power, that
in fact if an animal be etherized and then made to inspire oxygen, it
does not recover more speedily than if it respired atmospheric air
alone.* Nearly the same opinion is expressed also by Dr. Snow."|"

We believe that the best treatment for hyper etherization, if we may
be allowed to coin the word for the occasion, would be the adminis-
tration of diffusible stimulus, friction over the region of the heart,
dashing cold water on the chest so as to excite deep inspirations, and,
in aggravated cases, blood-letting to a. small amount.

Administration of the Vapour of Ether by the Rectum. M. Piro-
goffhas stated that all the narcotic effects of ether may be as readily
produce;! by causing the vapour to pass into the rectum, as by inhala-
tion, and he believes that this latter mode of exhibiting it will speedily
be superseded. His proceeding is first to empty the rectum by a
common enema, and then to introduce an elastic pipe, which is con-
nected with some receptacle, as a syringe, which is half filled with
ether. This reservoir is then covered with a towel wet with warm
water, and evaporation speedily commences, and the vapour mixed
with air passes into the bowels. The professor states that the breath
is impregnated with the odour of the ether in ten minutes, and that
all the symptoms cf narcotism are induced in five minutes. This

~TMea\ Gazette, April 30, 1817. t Lancet, May 29, 1847.

1 SIT. J Preparation, Physiological Action of Ether, cfc. OO'J

modification is undoubtedly worthy of trial, as by it all the objections
heretofore brought against the ether inhalation on the score of as-
phyxia are completely done away with.*

General Ejects. The effects' of the inhalation of ether, as of the
nitrons oxide, vary considerably in different individuals. In some,
but we believe a comparatively insignificant number, great excite-
ment is manifested at the commencement of the process; we have
seen patients exhibit all the violence and even fury which is occa-
sionally produced by the nitrous oxide ; if, however, inhalation can
be persisted in, this excitement speedily yields to a state of torpor
and ultimate insensibility. The writer of an article on ether inhala-
tion, in the "British and Foreign Med. Rev.," (April, 1847,) pro-
nounces his belief that the excitement is frequently attributable to
the too gradual administration of the vapour, and advises that in all
case^ it should be given in as full a jet as the bronchial tubes will
tolerate. In by far the majority, however, no such excitement is
manifested, the patient passing gradually into a state of profound in-
sensibility.

By some experimenters, and more particularly those of the French
school, the process of etherization is divided into three periods.

In ihejirst period, the inhalation is accompanied by a sensation of
stinging or heat in the bronchia, which excites coughing. This,
however, speedily subsides, and the patient passes into the second
period, in which any movements which the patient may have been
making are replaced by perfect quiet. The respirations are short,
and the expirations prolonged and forcible. The arms fall relaxed,
and the eyelids begin to tremble in a manner very characteristic, and
if the eye be uncovered, the pupil will be seen to oscillate, with a ten-
dency to turn upwards and inwards. At this time perception of
external objects fails, the head drops on one side, and the patient
passes into the third period, or period of complete insensibility. The
pupil is now completely turned up under the eyelid, and the patient
takes no notice of pinching or other means of rousing his attention.
This has been termed the surgical period, and is the moment usually
chosen to commence an operation.

The first effect of ether upon the circulation is to accelerate it ; the
pulse subsequently falls, and in the third period loses power as well
as frequency.

The physical effects of ether are remarkable, and, as in the case
with the nitrous oxide, appear to be modified according to the age,
habits, or propensities of the individual. Thus the little child dreams
of its playthings; the sportsman is following the hounds or catching
the imaginary salmon ; the game-keeper we have known to dream
of a conflict with poachers; the laborer that he is getting drunk in
a pothouse of which he is a habitue. In females, especially those of
a warm temperament, emotions have been manifested which are ill
adapted for general inspection ; in some it has been evident by their

Med. Ga

6L0 Preparation, Physiological Action of Ether, <fyc. [October,

movements that they were under the influence of the fully-developed
sensations of the venereal orgasm. These Untoward displays are,
however, we believe, very un frequent ; but it is well that the opera-
tor should he aware that their occurrence is not impossible.

A difference of opinion exists as to the conditions of the sensorium
during etherization. Some maintain that the sensation of pain is not
abolished, but that tne recollection of it only is lost, and certainly
this opinion is in some degree countenanced by the cries and contor-
tions manifested by patients who have, when their sensibility has
been restored, asserted their perfect ignorance of the operation per-
formed upon them. But, on the other hand, it must be remembered
that neither ejaculations nor struggling is a proof of sensation, as we
witness both in the epileptic, whom no one, we presume, will main-
tain to be conscious during the paroxysm. This question is, however,
after all, one of mere curiosity ; whether the patient be utterly un-
conscious of the knife or only forgets its pang, the effect is the same
upon his mind ; he believes, at Jeast, that he has not suffered, and the
subsequent condition of his system in the majority of cases would
lead to the conclusion that he has not.

Time required to produce Insensibility. This varies mainly, we
believe, according to the degree of skill with which the vapour is ex-
hibited. We have seen it produced in two minutes, and only imper-
fectly induced at the expiration of twenty ; in the latter instance we
have generally observed some imperfection, either in the instrument
or in the application of the mouth-piece. Insensibility is more rapidly
produced in children and women than in men, and the period appears
to be abridged by repetition of the inhahtion.

Period during which Insensibility remains. This also is subject
to variation ; the average dun; 'ion may be stated to be from two to
six minutes. Sometimes, and especially in those ill-managed cases
in which the patient is mere suffocated than etherized, he does not
perfectly recover his consciousness for half an hour or more. The
restoration is sometimes gradual, at others sudden, the patient in-
stantly starting up ag from a dream. He s for a moment or two
somewhat incoherent and staggers about as if half drunk. No ill
effects are left behind in the majority of cases; but in some, more or
less headache remains for the rest of the day.

Physiological Effects. No point in connection with the inhalation
of ether has given rise to more discussion than that of its physiologi-
cal action some regarding it as identical with asphyxia, others with
intoxication, others again as different from either. We shall not at-
tempt to recocile these conflicting opinions, for the reason that we
believe that our present acquaintance with the subject is not suffi-
ciently advanced to enable us to do so ; we shall content ourselves
with the analysis of the principal communications which relate to the
subject, leaving our readers to draw their own conclusions.

M. Longet has executed a very elaborate series of experiments upon
dogs and rabbits, the results of which aregiven in a lengthened paper

1847.] Preparation, Physiological Action uf Ether, <%>c. 611

published in fhc " Archives Generates," Mars, 1847. These may be
thus briefly recapitulated :

1st. There is complete momentary suspension of sensibility as well
in all the parts of the cerebrospinal axis which usually manifest sen-
sation as in the nervous trunks themselves.

2d. The action of ether is more stupifving than that of alcohol,
which latter merely deadens without abolishing the sensibility of tho
nervous centres.

3d. Ether abolishes momentarily but completely the reflex action
of the spinal marrow and medulla oblongata.

4th. In animals this effect of ether on the spinal marrow may be in
a measure controlled or prevented by strychnine.

5th. The cerebral functions are constantly suspended before those
of the spinal marrow, and are re-established before them.

6th. Ether, in the living animal, enables us to isolate the seat of
sensibility from that of the intelligence and of the will.

7th. The action of ether on the nervous centres may be so gradu-
ated as to produce two stages, which I demonstrate respectively
1, the period of etherization of the cerebral lobes ; 2, period of ether -
ization of the annular protuberance.

8th. The true surgical period corresponds to the etherization of
the cerebral protuberance.

9th. The death of animals from ether seems to be due to asphyxia.

10th. As soon as complete insensibility declares itself the arterial
blood becomes of a dark colour.

11th. From experiments performed in conjunction with M. Blan-
dm, it would appear, that the continuation of inhalation for eight
minutes after complete insensibility lias been induced will causo
death.

M. Flourens has likewise experimentalized upon the effect of ether
upon the nervous centres; and as respects the order of succession in
the phenomena of insensibility agrees closely with M. Longet. Bv
a more extended study of tiie effect of the agent upon the spinal
marrow he decides that sensation is first abolished, and then motion ;
but that in some instances both functions are lost simultaneously.*

In an essay on the physiological action of ether, read before the
Glasgow Medical Society, Dr Buchanan expresses his belief that the
vapour is absorbed by the hmgs, and becoming mixed with the biood,
operates directly upon the heart and brain. He explains the differ-
ence of action of the vapour inhaled and ether taken fluid into the
stomach, upon the known immiscibility of ether with water, and the
fact that when taken into the stomach' it becomes after absorption so
diluted by the various currents of blood which it meets with in its
upward conrse.to the heart, as I i be rendered almost inert. Whett
inhaled, on irect to the heart, mixed with the

b i od of the pulmonary veins only.+

A paper on the physiological action of ether, by Dr. Black, of
* Encyclog. des Sciences M t Med! Gazette, April, 1847.

613 Application of Ethereal Inhalation in Surgery. [October,

Manchester, appears in the "Provincial Medical Journal,"* in which
its modus operandi is explained upon the theory that the vapour id
made to permeate the air-cells in virfue of the increased tension pro-
duced by 4he temperature of the body. When it has gained access
into the circulation, he conceives that this tension still continues,
and "when the distending agent roaches the brain in the current of
the circulation, the elastic force meefs with a counter-pressure in the
resisting case of the calvarium ; its tension, therefore, becomes in-
creased, and the consequence is that the cerebral mass suffers com-
presston even to paralysis of some of its functions."

Effects of Ether vpon the Blood. Some direct experiments to
elucidate the effect of ether inhalation upon the blood have been
recorded by Mr. Pring;j but they merely tend to confirm what
many, the writer among the number, have observed during operations,
viz., that the arterial blood loses its florid colour. The fact, however,
it must be stated, is denied by M. Leassaigne, who has given an
analysis of blood before and after inhalation. He decides:

1st. That specimens of blood taken before and after inhalation
[it should have been taken during the process] does not differ sensibly
jn colour or as to coagulation.

2d. The serum and clot offered the following difference:

r> r k I- ? Clot> - 65*46

liefore inhaling, > a ' . ~.

& K berum, - - 34-54

After ditto,

100-00
Clot, - . 59-69

Serum, - - 40-31

100-00
3d. The clot appears less consistent before than after inhaling.
4th. The globules, fibrin and albumen are unaltered. J
Our personal experience as regards the colour of the blood, is in

accordance with that of Mr. Pring; the same fact is also distinctly

confirmed in the experiments of M. Amussat.

Application of Ethereal Inhalation in Surgery.

It is not our intention here to take any notice of the numerous
instances of the successful applications of ether vapour in the art of
dentistry, but to allude only to the more severe operations in which
it has been employed. We may remark, however, en passant, that
the general exhibition of so potent an agent by a class of men the
majority of whom have no pretensions to physiological or pathological
knowledge, without repeated accidents, is one of the strongest proofs
of its comparative innocoity.

It is impossible to give anything like a correct statement of the

April 7, 1847. t Lancet, May f, 1847,

X Prov. Med. and Surg, Journal, May 5, 1817.

1847.] Application of Ether Inhalation in Surgery. 613

Dumber of cases in which ether has been employed in surgery, for as
soon as the first blush of novelty had passed away, practitioners ceased
to record their operations. We have, however, notes of upwards of
one hundred cases in which ^halation has been followed by the most
perfect success as re-ards the abolition of p.-Jr, and the majority of
which have been represented as progressing favourably at the lime of
their report. Of the ultimate result of many of these cases no men-
tion has been subsequently made, and we are, therefore, bound to
conclude either that they terminated successfully, or, at all events
that death, when it did occur, was at a period so distant from the
time of operation as to preclude the idea of its connection with the
administration of ether. Among these operations are several of the
most formidable character, such as liihotomy, amputation of the thigh,
leg and arm, hernia,' reduction of old dislocations, urethroplasty, &c,
besides the minor but equally painful operations for removal of tu-
mours, removal of venereal warts, phymosis, evulsion of nails, necro-
sis, castration, &c. ; operations have also been successfully performed
for cataract, entropium, squinting, and other affections of the eye.

M. Burguieres gives a table of 211 operations in the. French hos-
pitals, in which ether has been administered, and appends to it some
remarks on the comparative mortality of the different classes of oper-
ations with and without ether, which are much in favour of its exhi-
bition. For instance, in the case of amputations, he shows that the
general mortality of cases operated upon in the ordinary way has
been, between the periods of January, 1836, and January, 1841, 332
in 858, or 2 in 5 cases nearly. Of amputation performed with the
aid of ether he records 45, of which 12 proved fatal, being an average
of 1 in 4. Again, descending to particulars, M. Burguieures analyzes
a series of amputations of the same kind, including the thigh, leg,
and arm ; in those performed with the ether the deaths have been 2
in 5; without it, in the period above alluded to, the mortality was
3 in 5.*

We are not able to offer any definite account of the effect of ether
inhalations upon the consecutive phenomena of operations, but it may
be stated that in the few instances in which such effects have been
recorded they are of a satisfactory character. Many surgeons have
noticed that the depression of the system immediately succeeding
capital operations has horn much le?s than where the patient has not
had the pain annihilated, that, in fact, the "shock" has been less;
others have seen reason to believe that the reaction, the traumatic
fever, is less than in ordinary cases. M. Jobert has, moreover, stated
that the local inflammation has proved less, and that union by first
intention has thus been prevented. This cannot be looked upon as
in its favour.

On the other hand, it i? but fair to state that it has been thought
by some that abolition of contractility in the muscles is adverse to
the formation ofa good stump, and others have feared that consecu-

M 1. Times. May S3, 184'

614 Application of Ether in Practical Medicine. [October,

tive hemorrhage is rendered more probable by the increased fluidity
of the blood. We have not, howe er, met with any record of a case
which justifies this apprehension.

Application of Inhalation of Ether in Practical Medicine*

The vapour of ether as yet has been used therapeutically in but a
small .number of diseases, and in comparatively few cases only of
these; we shall therefore be able, without much sacrifice of space, to
give a tolerably comprehensive account of its effects in this depart-
ment of the profession.

Tetanus. From the consideration of its prominent property of
abolishing pain, the attention of medical men was naturally soon
turned towards its exhibition in those diseases in which pain is a mark-
ed feature ; and among these tetanus was suggested as a disease in
which its powers were especially worthy of trial. An opportunity of
making the experiment having offered itself in the writer's own prac*
tice within a very short time of the introduction of ether inhalation
into this country, it was readily adopted as an experiment, but with-
out any anticipation of benefit, as he was at that time of opinion that
the effects of ether were not able to reach the spinal marrow. The
result proved that as far as its effects upon the disease is concerned
that opinion was correct, for, instead of alleviating the spasms, the
act of inhaling most distinctly induced and aggravated the paroxysms.

The case, which is reported elsewhere,* is as follows: A man
aged about 60, but of remarkably fine and athletic proportions, ran
a nail through his boot into the sole of his foot, near the ball of the
great toe, while walking across some old timber. The accident gave
him no uneasiness until the expiration of a week, when he complain-
ed of stiffness in the neck, and placed himself under the care of Mr.
Coe, a surgeon of Bury St., Edmunds. The next day the tetanic
symptoms were general, and my co-operation in the treatment of the
case was requested. On visiting the patient, about eleven in the
morning I found the jaw completely locked, the spasms frightfully
violent, and considerable opisthotonos; in fact, every symptom was
present of tetanus of the most acute character. Our treatment was
commenced with the Cannabis Indica, full doses of which were with
difficulty got down ; but this medicine was for a period omitted in
favour of the ether inhalation, which we determined to essay. A
common bladder and pipe being furnished, and two ounces of the
purest ether we could obtain being put into it, the patient was got
into a bath at 180, and the inhalation commenced. The warm wa-
ter had partially relaxed the beard-like rigidity of the body, and the
poor fellow expressed some relief, when the at-lempt to insert the pipe
again excited a strong spasm. Being, however, anxious to per-; re,
he contrived to nto his mouth ; hut the first breath he drew

aggravated thespa3ms in a tenfold degree, the body became perfectly

* Prov. Med. and Surg. Journal, April 21. 1817.

1 647.] Application of Ether in Practical Medicine. 615

opisthotonic, foam issued from the mouth, and the man altogether
presented so frightful a spectacle that we might fairly have been ex-
cused had we desisted from that moment. We, however, after
allowing the effects to subside, made \me more attempt, when the
recurrence of the same symptoms convinced us of the worse than
uselessness of the proceeding.

It is, however, in reference to this case, important to state that, as
it happened before any more effectual apparatus had been devised,
the ether was exhibited by means of a common bladder and pipe.
Whether, with one of the inhaleis now in use, the result would have
been different, it is, of course, impossible to state.

The above is not the only case of tetanus recorded, in which the
symptoms have been aggravated by ether inhalation ; one has recent-
ly been mentioned by M. Roux, in which death was, in his opinion,
evidently hastened by the remedy.

On the other hand, we have some cases of tetanus to relate, in
which inhalation either relieved only, or, to all appearance, was the
means of cure. Thus Dr. Brady relates the following case :

" A man, ast. 26, after a fall, by which he hurt his back, complained
next day of a feeling of stiffness of his neck and throat, which gradu-
ally increased. After a restless night he awoke suddenly, complain-
ing that his jaws were closing. This increased with rapidity, and on
the following day became under J)r. Brady's care, in a state of com-
plete tetanus. The inhalation of ether was suggested and tried.
When he had inhaled for about a minute and a half, his eyelids were
observed to drop suddenly, and his face to assume an expression of
repose ; upon which the mouthpiece was withdrawn, and being asked
how he felt, he said he was relieved. The mouthpiece was then re-
applied, and he continued to inhale until befell back in the bed with
his muscles relaxed. He lay thus, apparently in a calm sleep, for
about four minutes, during which he exhibited no feeling of pain
when pinched. Upon waking the spasms returned, when it was
deemed advisable to have recourse to more energetic treatment, and
the inhalation was, without, as it appears to us, any sufficient reason,
omitted. A few hours terminated the case."*

Another case, in which ether relieved the paroxysms, is reported
by Mr. Broughton. The patient was a man whose arm had been
shattered by the falling of a stone, and for which amputation had
been performed. The symptoms of tetanus came on some days after,
and were at first treated with opium and belladonna, but without re-
lief. Ether was then inhaled, and he was soon under its influence.
All contraction and spasm ceased, and be slept for ten minutes. As
soon as he became sensible the spasms returned, but not with such
violence. He again inhaled with the same beneficial result. He
took it a third time, and it again relieved him. A subsequent spasm
instantly destroyed him.j

* Dublin Med. Press. t Prov. Med. Journ., May 5, 1847,

016 Application of Ether in Practical Medicine. [October,

In the two succeeding cases the inhalation of ether in tetanus was
followed by recovery.

The first case is extracted from the " Clinique de Marseilles," and
is stated .to have been under the care of M. Pertusco, surgeon to the
Hospital of St. Maurice, at Turin, The disease was, we presume, of
the idiopathic form, as no mention is made of any wound. The teta-
nic symptoms appeared on the 4th of February, and on the 13th had
attained their greatest intensity, when the ether inhalation was adopt-
ed and repeated several times; the spasms became gradually less
severe, until they ceased altogether.*

We do not look upon the above instance to be one in which much
confidence is to be placed, as the details are far from satisfactory.
The second, which is reported in the "Provincial Journal," is better
authenticated.

"Charles White, set. 12, became the subject of a scalp wound,
which gave rise to tetanic symptoms. The ether was exhibited by
Mr. Hawkesworth, and its narcotic effects were speedily induced.
In a few minutes the jaw fell, and the whole body assumed a relaxed
and passive condition. He remained quiet for a short time, but in
about an hour the spasm and rigidity returned, but not so violently
as before. Recourse was had to the ether a second time with good
effect; and during each successive application the patient became
more relieved. His recovery was speedy, and no medicine, beyond
an occasional aperient, was exhibited."")"

Insanity. Ether inhalation has not yet been tried to any extent
in insanity. M. Cazenave, of Pau, and M. Jobert, being the only
persons who, to our knowledge, have employed it. It was given by
the former to a female patient, who had rested neither night nor day
for five months, and was the means of inducing tranquility, without
being followed by any injurious consequences.^:

M^ Jobert also used it in a case of simple insanity, with the effect
of inducing sleep, and restoring, temporarily, a state of rationality.

Neuralgia. Cases of the beneficial influence of this agent in neu-
ralgic affections have been recorded by Mr. Morris, Mr. Semple, and
one also by M. Henore.

Mr. Morris's first case was one of neuralgia of the first pair, for
which, in former attacks, all known remedies had been unsuccessful-
ly tried. In using ether, Mr. Morris did not find it necessary to pro-
duce complete insensibility, but it had the effect of dissipating the
pain almost instantaneously.

The next case was one of neuralgia of the testicle, in which the
pain was removed with equal success, though, from some imperfec-
tion in the apparatus, the effects of the ether were not so rapidly
induced ||

Mr. Semple's pr.tient suffered from severe neuralgia of the head

* Revue Medico-Chirurs;.. Avril. 1847. t Prov. Med. Journal, May 19, 1847.

* Reported in Med. Gazette, May, p. 878. Br. and For. Med. Rev., April, 1847.
II Medical Times.

1847.] Nature and Treatment of Sea Sickness. Gl

and fare, to an aggravated degree, and had derived no benefit from
any Medicine, internal or external, which she had taken. At the
time of inhaling the pain was of a most excruciating character; but
on her recovery from the ethereal narcotism it had lost its severity,
and subsided into a dull but bearable feeling of pain. The acute
pain did not return.*

Spasmodic Asthma. Dr. Willis f and Mr. Cantrell^: have both
mentioned their success with the vapour of ether, in the treatment of
spasmodic asthma. The former writer further states that he had
)ong been in the habit of using it previously to its recent introduction
into practice.

Hooping-cough. Dr. Willis also speaks favourably of its powers
in this disease.

Laryngismus Stridulus. An instance has recently occurred in the
writers experience, in which benefit was derived in a very severe case
of laryngeal spasm, by the use of a sponge saturated with ether.
This case is reported by Mr. Image, of Bury St. Edmunds, with
whom the case was seen by the writer in consultation.

Inhalation has also been used successfully in Colica Pictonum, by
M. Bouvier, and in Dysmcnorrho2a.\\

The Nature and. Treatment of Sea Sickness. By F. Willis Fisher,
M. D., Paris. (Boston Med. and Surg. Journal.)

If we were to judge of a disease from the painful sensations that it
causes, rather than from the danger it involves, we should be forced
to class sea sickness in the rank of the scourges of humanity. This
affection kills no one, but causes those affected by it to suffer severe-
ly. Many marine officers have been compelled to give up the life
they had chosen, because the habit of navigation could not relieve
them from the occurrence of nausea every time the sea became rough
and agitated. Some persons have renounced revisiting their country
and their families, sooner than expose themselves again to what they
suffered from sea sickness on their first voyage. Every scholar
knows that Cicero preferred giving his head to the assassins of the
triumviri, rather than remain a few moments longer a prey to the
pain of sea sickness on the vessel which bore him far from the shores
occupied by his enemies. A morbid state, capable of imposing the
sacrifice of all that man holds most dear, the sacrifice of ambition,
that of the natural affections, and even of life, surely merits the atten-
tion of the physician. Upon the nature of sea sickness, and the ra-
tional means to employ with the vubw to avoid and combat it, nothing
positive is as yet known ; a proof of which lies in the diversity of

* Lancet, March 27, is 17. t Lancet, March 30.

t Prov. Med. and Surtr. Journal, May 1!). Prow Journal, June 2.

(I Brit, and For. Med. Re vie w, April, 1847.

618 Nature and Treatment of Sea Sickness. [October,

opinions on this subject. We do not think that the true theory of it
has as yet been given.

Nearly a!l writers have considered the affection in a reverse sense
of what is really the case : for example, in attributing sea sickness
to a sanguineous congestion of the brain ; or, assigning it a cause in
fact incapable of producing it, in referring it to shocks or agitations
that are communicated to the intestines bv the motion of the vessel.
To form an estimate of these two opinions, the experience and theory
of iM. Pellarin during his service as marine surgeon, seem deserving
of attention, as approaching nearer to the true cause and theory of
this disagreeable affection. The invasion of sea sickness, far from
being acccompanied by the ordinary symptoms of congestion, a flush-
ed countenance, vascular turgescence, full pulse, sensation of heat
and tension in the cranium, throbbing of the temporal arteries, the
eye brilliant and injected, dec, is rather characterized by the opposite
state a paleness of the face and hands, a retreat of the blood from
the surface, a depressed pulse, general hyposthemia, a dull, glassy
eye when the affection is at its highest point. M. Pellarin has never
observed any of the accidents of cerebral hyperemia in individuals
affected by sea sickness. If during great efforts of vomiting the blood
flows to the head for the moment and colors the face, it is only th8
instantaneous result of these efforts; the paleness soon reappears,
with all the other characters of the anaemic state, just as it happens
when one is under the influence of tartar emetic, taken in such a dose
as to produce vomiting.

Another consideration which ought still more to remove the idea of
the sanguineous cerebral congestion, is that one suffers less when
lying down, than when standing ; and less still, if, instead of remain-
ing simply in a horizontal position, he has his head lower than the
rest of the body.

As to the explanation which would make this affection to depend
upon the shocks impressed upon the intestinal mass, this resists ex-
amination no better than the first. The trotting of a horse shakes
the bowels much more than the pitching and rolling motion of a ves-
sel, yet it never causes anything that resembles sea sickness. Sick-
ness from riding in a carriage is of the same nature as the last ; it is
like the disagreeable sensations caused to some persons by swinging.
This sickness is sooner felt in a carriage suspended with springs,
than in a hard jolting cart, which shakes the organs much more than
an easy carriage. One may make upon himself the experiment of
the mechanical shock impressed on the intestinal mass, by agitating
the floating portion of the abdominal viscera in his hands, by giving
them successive impulsions, either from below upwards, or in any
other direction, and he can never cause by these manoeuvres any-
thing analogous to sea sickness. Compression, a kind of kneading
of the stomach when distended by food, may sometimes cause the
expulsion of a portion of its contents, but it does not resemble that
strange uneasiness and profound prostration which characterize sea
sickness.

1847.] Nature and Treatment of Sea Sickness. 619

The other explanations ordinarily given For sea sickness such as
the Sanguineous congestion of the brain, the shaking of the abdominal

viscera ; thai this affection has a cause altogether nervous, depending
principally upon the nerves that excite the epigastric and abdominal
viscera, &., throw no light on the question.

M. Jobard, of Brussels, without doubt has reason in saying that the
essential cause of sea sickness is purely mechanical. However, he
goes too far when he adds that the odor of the vessels does not the
least contribute to excite it. Although this state of uneasiness may
be caused by the movements of the vessel, yet it is not less true, that
whatever excites repugnance, the odor of the tarry materials, the
emanations that come from the hold and other low parts of the vessel,
the sight of persons vomiting, all these impressions second the nause-
ous influence of the mechanical cause of sea sickness, and tend to
produce it, from sympathy. .Moreover, the proofs that sea sickness
depends essentially upon the motions of rolling and pitching, are so
evident that it is not worth the trouble to cite them. The nausea
arises under the influence of these movements, and is generally pro-
portioned to their extent and quickness. It is felt less in the centre
of the ship, near the foot of the mainmast, because the double motion
is less there than at the ed<ie, especially at the extremities where the
pitching is most considerable. In a hammock or frame suspended
so as to have as little friction as possible, which rests always in the
direction of the perpendicular, and consequently not subject to the
different inclinations of the vessel, one nearly escapes being sick.
The production of vertigo and nausea which precedes the vomiting,
may in part be imputed to the impressions resulting from the sight of
objects which appear to rise and fall Alternately in relation with the
vessel. Regarding the horizon continually oscillating and moving,
or the steerage of the vessel, ot the water that seems to fly along its
sides, is sometimes sufficient to determine the crisis of sea sickness.
From this follows the opinion that it is especially by the eyes that
sea sickness affects the economy. Nevertheless, as some have pre-
tended, the visual impression is not the essential cause of the nausea,
for it is equally experienced in obscurity of night, and by blind per-
sons.

M. Pellarin has not remarked so striking a difference as M. Jo-
bard, and many others, between the influences of rising and falling,
nnd he affirms that when one is forward, the crisis of the nausea takes
place at the moment this extremity rises. Whatsoever it may be,
M P. is disposed to admit what a marine officer recently told him.
It is in the rising motion or ascension that the nausea commences,
but it is in that of descending that the nausea is exasperated and ac-
quires all its intensity. The following is the theory of M. Pellarin.
Sea sickness ought to be attributed to the trouble caused in the circu-
lation of the blood by the alternate movements of inclination that the
ship undergoes ; either lateral rolling ; or antero-posterior, pitching.
This trouble has for a result, not to congest the brain, as YVolla9ton

620 Nature and Treatment of Sea Sick?iess. [October,

pretends, but, on the contrary, to deprive it of a sufficient quantity of
blood for the normal stimulation of the nervous centre. That which
is experienced in sea sickness is in fact analogous to what often hap-
pens in arresting the flow of blood in persons who are bled while
sitting or standing, and who at the time thev faint are taken with a
disposition to vomit, and really do vomit. M P. does not deny that
by. reason of the general diminution of the circulation there may be a
stagnation of the venous blood in the cerebral sinuses, but it is espe-
cially in the want of a sufficient excitation of the nervous centres by
the arterial blood that tjie primordial phenomenon of sea sickness
seems to consist. Observe a person seized by sea sickness ; his face
becomes pale, his extremities cold, his nails turn blue as at the debut
of intermittent fever. What he experiences resembles much the
effects produced by the smoking of the pipe or the cigar, on persons
who are not accustomed to smoke. The pulse becomes small, and
there is an extreme prostration of the intellectual and physical facul-
ties. There is a hypothenic influence in both cases, by the narcotic
action of the tobacco in one case ; by the diminution of the circula-
tory force of the blood in the other. What individuals best resist sea
sickness? Very young children, those who are at the breast, in
whom the heart is relatively more voluminous, and the circulation
more active than in adults, are not sensibly incommoded by the affec-
tion. Without being wholly exempt, animals experience it less than
men, because with them the brain is nearly in the same horizontal
plane as the heart, and it is not rare to see the poultry in their first
voyage, present nearly ail the signs of this affection, almost to vom-
iting, when the sea is rough. Among the adult passengers, those
who take the least exercise, and who go on deck in the breeze the
least, remain the longest under the influence of sea sickness. And
among persons equally habituated to sea life, those who by their
functions or rank have the least corporeal activity, are more liable to
return of nausea than the common sailor who works the vessel, who
mounts the masts and yards, and is exposed to more tedious move-
ments than those on deck. Dulness of spirits and lassitude, a cold
drizzling rain that cools the skin, and diminishes the circulation, are
predisposing causes. Towards the close of sea sickness, when the
nausea and vomiting begin to leave some respite, one is inclined to
somnolence, as after hemorrhages. Is it not by a sedation of the
same kind that infants are quieted and put to sleep by rocking them ?
In fine, M. P. concludes that whatever raises the force and acceler-
ates the rhythm of the circulation, prevents or diminishes the liabili-
ty to this affection. Strong and frequent respirations act thus,
according to the testimony of M. Arango, who warded off sea sick-
ness until the fatigue of the respiratory muscles obliged him to re-
nounce this prophylactic means. M. Jobard and many others have
recommended a girdle which compresses the abdomen at the base of
the chest. This in truth alleviates, but not because it confines the
intestines, but because it contributes to push the blood towards the

1847.] Nature and Treatment of Sea Sickness. 621

brain It acts in the same manner as a person lying down wi(h the
head low, a position that is sufficient to dissipate the nausea of per-
sons affected by syncope, or that after blood-letting, which state pre-
sents a striking analogy to sea sickness. Moreover, a proof that
compression of the chest and abdomen is not a sovereign remedy, is,
that corsets do not prevent women from being affected by it. In
these two comparative states (hypothymic nausea, after blood-lettinij
and maratime nausea), the impression of a sharp breeze is equal!?
favorable, and the first symptoms have been sometimes overcome bv
going on deck, and receiving the direct action of a brisk current of
air. To verify the theory of M. Pellarin, if those who are placed in
circumstances that cause sea sickness should have large cuppings
from the lower limbs, they would experience the first attacks sooner,
as in this case there would be two concurring causes to deprive the
brain of the normal afflux of blood that is ordinarily received. Ano-

annhVl0?6,? ierifiCatin /^ ?" P' haS "0t ^P1^, is auscultation
applied to the large vessels of the neck ; we are inclined to think that
he bruit desoufflet ought to be heard in individuals who are affected
by sea sickness.

M. P. recognizes an analogy between the nausea produced by (be
fir. mS , VeSSel' a"d 'he nausea and ornilinBof women during (he
co'LTiT fPree,n'y i '^t is, at an epoch when (he womb be-
ZZV u e 0| asangineous afflux, and consequently diverts
from the brain a portion of (he vivifying liquid that it received.
me" have decli,red "" nothi"S resembled more the nausea

first fUT.n"",fmen' / P^Snancy than that they experienced (ho
tZaXi. T. Sea' ., An'her " which strengthens this
ilJl , .1 ge"era Y PreSnant womc "rely taken with vom-

XS ley rema,"uin M' and' on ,he co""a^ n taken,

when they change the horizon(al to an upright position. Why are

2 ,nf '. P?od of pregnancy ? Is it not because (he nervous
every nt I i "<** supplied wi.h blood, and (hat the blood, as

every one knows, is the moderator ef the nerves. A similar cause
sTrtueVill8^1 su'ceP,iw'7 "">ng women during the men-
slalk ZL 6 a" eXamPler* lady. "ho uU been

l.W r g TV vo>'a?es' experienced it severely in crossing (he
English Channel who she had one of her periodic evacuations."
son LreTe ' concl"s''ns. First the sickness produced by (he

same,,J,rS!Varr,af'TS'l>-VSWi',?inS'are "" Phenomena of (he

same nature, determined es.entlally by the influence exercised on

he circulatory roarch ofthe bloo(| jn movemen,s |fc , ' "

undergoes under these different circumstance,. Second, this S.
exci KorvM ^JITT ' ""^ '" *?"**! * lending force of (he
"his Z I1 ' u ' ''"' a"d lh'; ar'eri-S l-'.->'>c!,ing from it ; from
Third thli" h-,ffipns,hric ?* oi "l0 lmii" bJ an <" hypoxemia.

Ihird, the insufficient excita i of (he cerebral organ determine.

"v sympathy, spasmodic contractions ofthe diaphragm, vomitin--

622 Nature and Treatment of Sea Sickness. [October,

which have a particular tendency to reconvey the blood which is
wanting towards the nervous centre. These efforts are a crisis
which takes place in a conservative end. They manifest themselves
not only in sea sickness, but in many other circumstances where the
brain becomes suddenly deprived of its normal supply of blood ; for
example, in persons not affected by phlegmasia who are bled.

Treatment. There are two orders of means to be employed. The
first consists in removing one's self as much as possible from the
cause, i. e., from the motions of the vessel, in remaining in a recum-
bent position, in a hammock suspended without sensible friction at
its points of attachment. The second has for an end to combat the
effects of the cause on the organism. It acts especially to this end
in stimulating the circulatory" function by all the agents susceptible
of increasing its energy. Thus, a tonic regimen, active corporeal
exercise for some days preceding embarkation. At sea, if the wea-
ther permits, one ought to keep on deck, in the breeze, make large
inspirations, walk quickly and until he perspires or is fatigued; or,
better still, to engage in some hard exercise, even with the sailors in
working the vessel. Hard work, that which requires great muscular
effort, is the surest prophylactic against sea sickness. The girdle
has also its advantages in contributing to force the blocd towards the
head, and perhaps in seconding the contractile force of the heart.
Before the manifestation of the nausea, warm and exciting drinks are
favorable. Thus coffee, tea, with the addition of a little brandy,
may give a greater disposition to resist it, in stimulating the circula-
tion and maintaining a diaphoretic state of the skin. Among the
medicines, those which have an analogous effect on the economy
may be administered with advantage, such as opium, saffron, acetate
of ammonia, &c. When the sickness is declared, recourse is only to
be had in the palliatives; lemons, exciting aromatics, relieve some
persons ; also the horizontal position, especially with the head low, in
a hammock or bed suspended like a compass. But if one wishes to
shorten the duration of the nauseous influence of the sea and diminish
the tribute he must pay to a nautical acclimation, he must struggle
with all his energy against the tendency to inaction.

Therapeutic emjilqijment of sea sickness A cause which deter-
mines in the economy so great a commotion as sea sickness, without
leaving any unhappy consequences, as a therapeutic agent merits
more attention than has been given it. M. Pellarin thinks that it
may be possible to obtain from it valuable results in many acute and
chronic affections. This observation was familiar to the ancients.
We read in Pliny, "Vomitings, produced by the motion of a vessel,
act as a salutary remedy in many diseases of the head, eyes, chest,
and in all affections for which hellebore is given." In more modern
times, Esquirol and Blanche have judiciously advised its employment
in cases of recent mania. But in the few attempts that have been
made, there has happened, what might have been easily foreseen,
from the true theory of maritime nausea, that the maniacs, highly

1847.J Bibliographical. 623

excited, have not been affected by sea sickness, whilst the physicians
who accompanied them have been a prey to it during the whole
voyage. From the knowledge already acquired of the nature and
etiology of sea sickness, there seems nothing in the way to second, to
aggravate voluntarily its influence in a curative end. Even an ap-
paratus might bo made to produce all the effects of rolling and pitch-
ing. without the necessity of a sea voyage. By reason of the pow.
erful sedative and hyposthenic influence of sea sickness, may we not
draw from its employment the greatest advantages, not only in acute
cerebral affections, but also in certain pneumonias, pleurisies, and,
Anally, in a great number of inflammatory diseases?

BIBLIOGRAPHICAL NOTICES.

Medical Botany, or a description of the most important plants used in
Medicine, with their history, properties, and mode of administration.
By R. Eglesfeld Griffith, M. D., Member ofthe Amer. Phil.
Soc.,&c. Philadelphia: Lea & Blanchard, 1847. 8vo. pp.704.

Our country has furnished many valuable additions to the Materia
Medica, and we doubt not many more highly useful plants exist of
which we have no cognizance, and of which we are likely to remain
in ignorance so long as the Science of Botany is so generally neg-
lected by our medical men. The additional facilities which the work
of Dr. Griffith will afford to such as may desire to engage in the study
of the vegetable articles composing the Materia Medica, we trust will
excite an increased interest in this delightful science* This work
supplies a want which has been long felt. The author modestly
calls it a compilation, but he is entitled to high credit for the manner
in which he has selected and arranged his materials. The articles
are arranged according to the natural orders ; and for the benefit of
such as are not familiar with the subject, a short introduction on the
structure and composition of plants has been prefixed, with a copious
glossary of terms, and a conpcctus of the natural orders of plants
which furnish medicinal substances. The whole is illustrated by
more than 300 well executed wood engravings. The work is highly
creditable both to the author and publishers, and we cordially recom-
mend it to the attentive study of our readers.

Observations on Aneurism and its Treatment by compression. By
O'Bbybr Bellingham, M. 1)., Edin., Fellow and Professor in the
School of the Royal College of Surgeons in Ireland ; &c. &c<
London: John Churchill, ] s 17. Pp. 181.
The above is the title of a very interesting and valuable little work

we have just received from the publisher. The nature of the work

40

624 Bibliographical. Diseases of Joints, [October,

does not admit of an extended review, and we cannot convey an idea
of its contents better than by subjoining the following extract from
its preface :

"The following pages contain a sketch of the history ot the treat-
ment of aneurism by compression, from the rude attempts of its
earlier advocates to its present improved state; accompanied by an
abstract of every case that has been reported, in which compression
has been hitherto used at least of every case which the author has
met in a rather extensive reading. The various instruments which
have been employed for making pressure are described ; and the theo-
ries upon which it has at different times been supposed to effect the
cure of aneurism are noticed. The author has also endeavored to
point out some of the advantages which compression, as a mode of
treating aneurism, possesses over the ligature, when the position of
the sac permits its application ; he has added some rules for the
guidance of the surgeon in its application ; and it has been all through
his aim to refer every invention to its proper author, and every im-
provement, either in the theory or practice of this method of treating
aneurism, to its legitimate source."

The Virginia Springs, with their analysis, and some remarks on
their Character, together with a Directory for the use of the White
Sulphur Water: to which is added a Review of a portion of Wm.
Burke's book of the mineral springs of Virginia, dpc, and an ac-
count of the different routes to the springs. By John T. Moor-
KAim, M. D., Resident Physician at the White Sulphur Springs.
Philadelphia: Lindsay & Blackiston, 1847. pp. 219, with maps.

The title page of the above work so fully sets forth the "burthen
of its song" that we need say nothing more than to express our satis-
faction at its perusal and to recommend it to all who would like to
know the history and remedial efficacy of the most fashionable wa-
tering place in the Southern States.

Treatment of Diseases of Joints. M. Bonnet, Prof, of Clinical Sur-
gery at Lyons, published in 1844 a "Treatise on the Diseases of
Joints," which obtained one of the highest prizes of the Academy
of Sciences of Paris. The work abounds in practical views of
great importance, a few of which we will note.

In the treatment of Sprains, M. Bonnet observes that the usual
plan of covering the part with warm or even with cold poultices or
saturnine lotions, &c, is objectionable inasmuch as these applications
soon acquire the heat peculiar to the joint, and then add to it as
would anv other covering. He prefers a continuous current of cold
water or evaporating lotions kept up so as to reduce the temperature,
until all inflammation shall have subsided or have been prevented.

1S47.] Influence of Electricity, 625

In old cases, which have impaired the movements of the joint, he
urges the importance of forced movements frequently repeated until
the patient cat: accomplish them without pain, and affirms having by
this means effected the restoration of many joints which had become
useless. This reminds us of the plan pursued by the celebrated
Sweet, the " natural bone-setter" of New York. This notorious
charlatan owes much of his reputation in the treatment of stiff joints
to the forcible and daily repeated movements he practices in such
cases. These manipulations, although at first very painful, soon
cease to be so, and the patient recovers the use of a joint he had
thought irretrievably lost. The same plan has been successful in
some cases of paralysis of long standing, in which the effusion about
the nervous origins had been absorbed, and in which therefore the
persistance of the paralysis was the result of mere habit or the
conviction of the patient that motion was still impossible. Similar
success has attended the use- of this method in retractions and dis-
tortions occasioned by rheumatic affections.

For acute arthritis, commonly called articular rheumatism, M.
Bonnet recommends most highly the repeated application of poultices
made with alcohol saturated with camphor, cold, of course. In
chronic arthritis, M. B. insists upon the importance of daily move-
ments in order to prevent anchylosis or shortening of the ligaments
and muscles. This should be combined with the use of general
remedies calculated to improve the constitution, as the iodides, &c.
He objects strongly to al! local applications in the form of poultices,
and indeed does not know of any entitled to much confidence.

D.

PART III. MONTHLY PERISCOPE.

Influence of terreslial and atmospheric Electricity upon the human
system. M. Pallas, principal physician in Algers, presents the re-
sults of observations he has recently made in Africa, in order to study
the influence of atmospheric and terrestrial electricity upon the
human system and to modify the pernicious influence of this physi-
cal agent by isolation. This work, which is interesting to the
etiology, nature and treatment of the diseases of warm climates,
may be condensed into the following propositions:

1st. The majority of the disease*, especially those which belong
to the class of neuroses, are occasioned by the influence of increased
general electricity, of which the thunder clouds and marshy districts
are the most abundant sou re

2d. The marshes, by their geographical arrangement and fhe ef-
fects they produce upon the animal economy, present the greatest
analogy to the Galvanic pile. Indeed their action is pernicious and
fearful in proportion to the organic and saline matters which their
ivaters hold in solution; henco the reason why salt marshes and

626 Insanity, Effects of Etherization upon Respiration. [October,

those near the sea-coast are peculiarly injurious to health. The
drying up or submersion of marshes present conditions analogous to
a galvanic pile deprived of moisture or overflowed, the effects of
which are null or very trifling.

3d. Thy works of naturalists and physiologists have demonstrated
that the electricity produced by our machines exerts a special influ-
ence upon the nervous system ; experience and close observation of
facts prove that the diseases developed in a marshy atmosphere
are always primarily nervous ; and when they become inflammatory
it is always by the reaction of the nervous system upon the heart
and blood vessels that local and general phlegmasia? are produced :

4th. The neuroses and intermittent fevers being occasioned, not
by the action of a miasm that has never been detected either in the
air or in the water of marshes, but through the influence of the exag-
gerated electricity, any means by which this morbid influence can be
modified must naturally and reasonably be the best.

5th. Electric isolation happily fulfils this indication. This isola-
tion may he obtained by fixing to the bed-steads, sofas and chairs,
glass or resinous feet. A large number of observations have proven
to me that all the patients thus isolated have been cured or relieved
of distressing diseases, many of which have resisted all other known
means.

The striking analogy between marshes and the galvanic pile, the
nature of the affections produced under the influence of atmospheric
and terrestrial electricity, and the method of combatting them by
isolation, lead us therefore, naturally to the conclusion that not only
the diseases of which we speak, but all those which appear epidemic-
ally and whose etiology is unknown, are to be attributed to an ex-
aggeration of general electricity, the intensity of which must produce
those varied electro-magnetic conditions which disturb the harmony
so necessary of the continuance of human health.

[Translated from Gazette Medicale de Paris.

Hereditary Transmission of Insanity. M. Baillarger, in his "/a-
tislical researches upon the Hcriditary Transmission of Insanity,
arrives at the following exclusions :

1st. The insanity of the mother is more readily transmitted than
that of the father.

2d. The moiher's insanity is more apt to affect her daughters than
her sons ; that of the father is more apt to affect the sons.

3d. Sons are not more apt to derive insanity from the mother than
from the father; but daughters are most subject to the insanity of
the mother. Translated from Gaz. Medicate de Paris.

Effects of Etherization upon Respiration M. Ville, furnishes a
statement of researches undertaken by himself and M. Blandin,
on etherization, at the " College de France.'' They desired to study
only the act of respiration during that singular state, and, as though

1847.] New Method for the Union of Wounds. 627

nothing can be foreseen in these singular phenomena, they have dis-
covered the opposite to what they expected. Indeed in that state of
complete insensibility in which sight is abolished, in which the cold
limbs have lost all power (o move, respiration produces more carbonic
acid than when the organs are in the full exercise of their natural
functions. During etherization the carbonic acid produced by res-
piration increases as the sensibility diminishes, and lessens as this
returns. The following are the results of a number of these exper-
iments :

Carbonic acid produced Carbonic acid pro- Preparation of ether Duration of
during nuiraal respi- duced during in- contained in the inhalation
ration. sensibility. air inhaled.

No. 1. 2,41 4,84 6,70 22'30"

2. 3,05 4,33 2,17

3. 2,79 3,11 12, 4'

4. 1,36 3,32 12,68 4'

5. 2,04 4,42 14,11 2'30"

[Translated from Ibid.

New method for the union of Wounds. M. Baudens, surgeon in
chief at the " Yal-de-Grace," addresses a letter to the Academy, in
which he presents a method for uniting wounds, which he has recently
discovered, and which he daily practises with complete success at the
hospital of "Val-de-Grace." This simple and efficient method is
not, according to M. Baudens, liable to the same objections as adhe-
sive plasters and sutures. The following is the author's description
of his method : Ff we have to unite the flaps resulting from a tibio-
tarsal amputation, we fix in the bandage carried circularly above the
amputation two strong pins, the one in front and the other behind,
taking care to leave their heads and points free. The middle of a
long cotton thread is now passed like a noose under the free ends of
the pins. The threads are then brought down so as to cross each
other upon the flaps approximated by the ringers of an aid, and car-
ried up to the pin of the opposite side, to be again brought down so
as to operate as a uniting bandage as often as may be necessary,
sometimes parallel with the axis of the limb and sometimes crossing
each other so as to form a figure of 8. The threads ligating the arte-
ries are also attached to the pins so as not to be torn away when the
dressing is removed. The cotton threads exercise a gentle pressure,
they are not easily impregnated by liquids, and may maintain their
position a long time. The air and the spaces between them permit
the humors of the wound to flow readily, and the traction they exert
upon the circular bandage placed above the amputation tends to
bring down the flesh and to prevent its forming a cone.

This mode of union is applicable to all wounds in general, but it is
necessary to know how to place suitably the bandages for the pins.
M. B. succeeded remarkably in thus effecting a lineal and prompt
union of the wound resulting from the removal of a large wen from
the head. [Translated from Ibid.

628 Protracted Hiccough. Burns. [October,

Protracted Hiccough relieved by pressure upon the epigastrium.
This method, as simple as it is energetic, appears to be purely mechan-
ical. It consists in effecting a stro^n; pressure on the epigastrium with
the fist, or any other body adequate to the same result. The com-
pressing body may be retained in its place by means of a common
truss, should it be necessary to prolong its use. M. Rostan, to whom
this plan was suggested by seeing a female subject to this disease
always relieve herself by strongly compressing the epigastrium with
her hands, has resorted to it ever since with decided advantage, what.
ever may have been the cause of the hiccough. M. Rayer has also
used it with happy effect. It coukl hardly be expected that such
means should prove equally efficacious in all cases, but its simplicity
recommmends its trial in preference to all others. -[Translated from
Gaz. des Hop. Revue Med- Chir. Bull. Gen. de Therap.

Burns treated with Ammonia. M. Guerard, Physician to the
" Hotel Bieu,7' has used, for upwards of twenty years, a concentra-
ted solution of ammonia* in burns of the first and second degrees.
He has frequently happened to burn himself with charcoal, phosphorus,
gunpowder, &c, and the immediate application of this remedy has
always arrested any further development. When the ends of fingers
are burnt he plunges them in the liquid without admixture of water.
Jf the seat of the burn was such as to prevent this immersion, he
would cover it with a compress dipped in the ammonia, and would
prevent its evaporation by covering it with dry cloth. In such cases
it is necessary to repeat the application from time to time, whenever
the heat or sensation of burning returns. As soon as the ammonia
is applied the pain ceases, and the relief continues longer, in propor-
tion to the strength of the solution. According to what M. Guerard
has himself experienced, he believes that the application should be
continued at least an hour, in order to give permanent relief, after
which the burn maybe left without any further dressing. If the
burn be extensive, one hour will not be sufficient, but then the patient
will be apprized of it by the return of pain. M. Guerard does not
believe this application adapted to cases in which the skin is removed.
The pain is immediately relieved, no phlyctaena are developed, and
the cuticle dries and finally falls off like parchment. It is well to
observe that if the application has been made to an extensive surface,
the compresses should be handled with forceps, for concentrated am-
monia very rapidly vesicates the skin in the healthy state. The
patient, as well as dresser, should also avoid breathing the vapour,
and the vessels used should be made either of tin or of earthenware,
inasmuch as copper is readily acted upon by ammonia.

The us$ of ammonia in burns is not new. Physicians have long
since observed that, if prevents in such cases the development of in-
flammation. It has been seen, however, that it is especially for burns
of small extent, and in which the skin is not excoriated, that M.

* Aqua Ammonia, we presume. Trans.

1947.] Camphorated Blistering Ointment. 629

Guerard advises the use of this caustic. Thus far we see no objec-
tion to recommending its trial to practitioners. As to burns involv-
ing a large surface, it requires more circumspection. There are
efficacious means in more common use, such as the oleo-caicareous
liniment and carded cotton, prolonged cold baths and fomentations
with iced water. There is at this time a case at the " Hopital St.
Louis,'''' in which the most happy results have been obtained with
cold water. [Translated from Journ. des Conn. 3Ied-Chir. Bull.
Gen.de Therap., April, 1847.

CampJiorafed Blistering Ointment. M. Mialhe, in an article pub-
lished in "l'Union Medicale" upon Epispastics in general and Can-
tharides in particular, establishes the following principles:

1st. That the most active epispastics should be preferred ; 2d,
that epispastic plasters should not be allowed to remain in contact
with the skin any longer than is absolutely necessary to effect the
detachment of the epidermis; 3d, that the addition of camphor to
blisters is of acknowledged usefulness and ought to be generalized.
The action of cantharides upon the bladder is lessened in proportion
to the rapidity with which the serous exhalation is produced, because
there is less cantharidine absorbed. By the addition of camphor,
which has the property of softening resins, the blistering ointments
are made more fluid, they adhere better to the skin, and consequently
act more promptly. Among the means proposed to prevent the spe-
cific action of cantharides upon the bladder, none is so good as that
indicated by M. Bretonneau, which consists in the interposition be-
tween the plaster and the skin of blotting paper dipped in olive oil ;
the cantharides being soluble in unctuous bodies, the olive oil facili-
tates its introduction into the system, but this introduction diminishes
as soon as the serous effusion takes place, inasmuch as oils are not
miscible with aqueous fluids. Hence by this method the irritating
influence of cantharidine upon the urinary organs is rarely felt.
The following is M. Mialhe's formula:

Be. Cantharides, ....

Hog's Lard, -

Veal suet, ....

White resin, -

Yellow wax, . , - -

Snlph. Ether, ....

Camphor, ....

Pulverize the cantharides without having previously dried them, pass
them through a sieve and suspend the pulverization as soon as you
have obtained one hundred parts of fine powder; place this powder
in a large mouthed bottle and add to it the sulphuric ether; put the
remainder of the cantharides in a tinned basin wilh the lard, the suet
and a sufficient quantity of water to float the whole, boil gently one
hour, continually stirring the mass, then set asid;^ to cool in the same
vessel. Now separate the compound which floats on the surface

400

parts.

25

it

25

ii

50

it

100

ii

100

u

40

u

630 Remarks on the Alnus Serrulala. [October,

from the matters that have settled at the bottom of the vessel ; melt
this fatty compound, filter throngh cloth into a tinned vessel upon a
sand hath. Add the resin, the wax and the camphor; heat until all
be completely melted; th^n add the powdered cantharides and
ether, and heat until the ether be completely evaporated, that is to
say about an hour. Finally pour the ointment into a marble mortar
and stir until it be completely cold.

This ointment, being rather soft, should be spread thinly upon
cerecloth (sparadfap*) instead of sheep-skin, as is yet customary
with some. The vesicating effect of this application is very prompt.
It takes place in from two to three hours at most, according to the
susceptibility of the skin, the temperature of the part to which it is
applied and the care with which it is kept in contact with the surface.

Although this ointment contains a good portion of camphor, it will
be prudent to interpose the oiled paper whenever the action of the
cantharides upon the urinary organs is objectionable ; or, what will
answer as well, the plaster should be left upon the skin not exceeding
two hours or two hours and a half, a sufficient quantity of canihari-
dine being absorbed in that time to produce the local without the
general effect. [Translated from Bui Gen. de Therap.

Remarks on the Alnvs Serrvlata, common Blade Alder by
Jas. Helmich, M. D., of Ohio. I noticed in the July No., for 1846,
of the New- York Journal of Medicine and the Collateral Sciences,
an article on Indigenous Medical Botany, by S. W. Williams.
Among the indigenous medical plants named by Dr. Williams, and
to which he has called the attention of the readers of your valuable
Journal, is the " Alnvs Serridata" or common Black Alder. It is
not my purpose to gainsay a word that Dr. W. has said in describing
its medical use, nor am I certain that he has said all that he has to
say about it ; but I am sure he has not said all that should be said in
its favour. Dr. W. has pointed out several uses of the Black Alder
entirely new to me, viz: repelling the milk in the female breast the
inner bark of the root being emetic a decoction of the cones for the
suppression of hemorrhage and in hematuria.

1 have long been in the habit of prescribing a decoction of the
Black Aider, and more recently of the extract (a more convenient
and eligible form) in chronic affections, and more particularly in
scrofula and secondary syphilis. I have seen some of the most hap-
py results from its use in both these forms of disease. Mrs. S was
admitted into the county alms house, with secondary syphilis of long
standing, and a constitution broken down with the disease and the
use of mercury ; she had ulcers in the nose and palate, nodes on the
head, legs, and arms; and unable to walk from stiffness of joints;
indeed she seemed to be a hopeless case. She was ordered a strong
decoction of the Black Alder, and a milk and vegetable diet, to which

*The French "sparadrap" is somewhat similar to our patent adhesive plaster.
Oil-silk would answer. 'frans.

1847.] Influence of Coffee upon Sulphate of Quinine. 631

she rigidly adhered for six months, when she left the institution per-
fectly cured, and remains well up to the present time, a period of
three years.

A clergyman's lady of this vicinity had scrofula, with open ulcers,
large and ill-conditioned ; she was entirely cured by t he use of a de-
coction of the Black Alder. This lady was removed a distance of a
hundred miles from this place, and although cured, she continues to
use it occasionally as a preventive ; she has twice sent to this place
to procure, as she snys, the "genuine article."

1 was acquainted with an intelligent old gentleman, (since dead,)
who cured in his own person a cancer of the lip with a beer made
from the bark and small branches of the Black Alder.

I mention the above, not as the only cases of cure with this medi-
cine, but as prominent cases in three different forms of disease. 1 am
persuaded that the Alnus Semdaia is one cf our most valuable veg-
etable alteratives, and deserves the careful and attentive investigation
of the physician, pharmacian, and medical botanist.

More recently I have witnessed the valuable properties of the ex-
tract, prepared by the evaporation of the decoction to the consistency
of thick tar; it makes a very convenient form for pills and solution.
I prescribed a strong decoction of the extract, two months ago, in a
case of impetigo of long standing, and which had proved very obsti-
nate, refusing to yield to all the various plans of treatment, both gen-
eral and local, persisted in for more than three years. The lady was
of full habit, somewhat corpulent, but general health good ; the dis-
ease affected both ankles over the instep. She was directed to drink
a decoction of the black alder, and gj. of the extract dissolved in gviij.
of water for a local application twice a day. In two week her hus-
band reported to me " that the gj. of extract hnd done more for her
than all other remedies put together*" At the present date, two
months since the first application, she is entirely cured.

Impetigo is in my experience a very intractable form of disease;
yet, in this case it yielded readily to the extract of Black Alder. It
is the first and only case I have ever prescribed it in as a local reme-
dy ; I intend however to give it a more extended trial in some other
diseases, where its tonic and astringent properties will be more fully
tested.

I am informed by the individual who prepares the extinct, that it
is an invaluable remedy for dyspepsia, taken in doses of 5ss. three
times daily. [New- York Journal of Medicine.

Influence of Coffee upon Sulphate of Quinine. According to the
experiments of M. Dorvault, the sulphate of quinine, with the excep-
tion of a very small quantity, remains unchanged by the action of
coffee. According to him, the disappearance of the bitter taste is
due partly to the transformation of the portion of quinine which is
/dissolved into a tannate, and partly to the action of the other princi-
ples of coffee. M. D. thinks that it is only the dissolved portion of

632 Syrup of Iodide of Iron. ]October,

the sulphate which affects the organ of taste, and that this is decom-
posed hy the tannin of the coffee, whilst the undissolved portions of
the sulphate of quinine remain unchanged.

Sulphate of quinine dissolved by the aid of sulphuric acid or alco-
hoi, looses but very little of its bitterness by admixture wilh coffee.
Experience appears to have established the fact that the medicinal
properties of the sulphate of quinine are not impaired by the action
of coffee.

M. D. recommends the following formula for the administration
of "quininized coffee."

R. Coffee, parched and ground, 10 parts.
Boiling water, 100 "

Treat by displacement, filter and add sulphate of quinine 1 part and
sugar 15 parts. [Trans, from Bui. Gen de Therap., April, 1847.

On the Syrup of Iodide of Iron. By Messrs. T. and H. Smith,
Edinburgh. The process used by us for the syrup of iodide of iron is
a modification of the formula of the Edinburgh Pharmacopoeia, and,
as we have by repeated trials long proved its value, it is here given
for the use of the renders of the Pharmaceutical Journal.

Let a solution of iodide of iron be made in a flask with six hundred
grains of iodine, two hundred grains of pure iron filings, and six
ounces of cold water. The action being finished, after smart agita-
tion for a few minutes, let the liquid, while yet hot from the intense
chemical action, be boiled over a gas flame, or in any other more
convenient way, till its brown colour has disappeared, which is easily
known by the froth becoming white. Let the liquid be now at once
filtered through a small filter into a bottle, which has previously been
marked, by pasting on the outside of the bottle a small slip of paper
at the level of eighteen fluid ounces, and containing thirteen ounces
and a half of refined sugar, broken down into pieces about the size of
peas. When the solution has all passed through, which fortunately
takes place with unusual rapidity, let the filter be washed with boiling
water, a further quantity of which must also be poured into the bottle
till the liquid reaches the level of the mark. Let the bottle then be
introduced into a hot water-bath and briskly shaken at short inter-
vals, till the sugar is quite dissolved : and having adjusted the level
of the syrup to the mark by the addition of water, after again shaking
the bottle, let the syrup, without a moment's delay, be bottled into
small phials, and secured as much as possible from contact with the
air and light, by careful corking, and covering the bottles with some
dark-coloured paper. These are the proportions adopted in the
Edinburgh Pharmacopoeia, and the syrup contains one grain of the
iodide in twelve minims, or five grains in one drachm ; but as the
syrup first proposed by Dr. A. T. Thomson is weaker by two-fifths,
containing three grains to the drachm, and which we believe is the
strength of the syrup used in England, it is evident that the propor-
tions must be varied accordingly. They will therefore stand thus :

1847.] Cajeput Oil as a Remedial Agent, 0:*3

252 grains iodine,
100 grains iron filings,
2| ozs. cold water,
10 ozs. pure sugar.

Let the syrup, when finished, measure twelve ounces and a halfr
the level occupied by this quantity having been marked oil* on the
bottle beforehand. It is advisable that the bottle used in the prepa-
tion of the syrup should not have a capacity more than about a third
above the quantity to be made. [Pharmaceutical Journal.

Cajeput Oil as a Remedial Agent by .T. A. Preston, M. D., of
Long Island, N. Y. In submitting the subjoined remarks upon the
use of the oi. cajuputi, I am influenced less by the desire of commu-
nicating than eliciting information. I am not aware to what precise
extent it has been used in this country, neither have I been able to
learn the indications which other practitioners have found it to an-
swer. The expense of the article, and the consequent temptation to
adulteration, doubtless, have deterred physicians from using it to any
extent. This valuable oil is principally manufactured on the island
of Buoro, and thence exported to Holland. From Holland it is re-
exported to the United States, paying a heavy duty, which correspond-
ingly enhances its price. At the distilleries in Buoro and Ambovna,
the oil is sold for about Si per bottle, averaging f gxxiv. each. But
the commerce being entirely monopolized by the Dutch, it is rarely
that other nations can obtain it at this low rate. At Batavia, upon
the island of Java, about 400 miles distant from Buoro, it is sold as
high as $5 per bottle. But I leave its history to speak of its uses.
Having obtained a couple of bottles of the pure oil direct from the
Moluccas, I proceeded to experiment with the same whenever an op-
portunity offered in which I judged it could be used with advantage.

It was at first prescribed endermically for several cases of chronic
rheumatism, which had hitherto resisted other treatment. Its success
in tbese cases induced me to use it in others, which I have since done
with like success. I should remark that the oil was applied freely,
regardless of the restrictions so religiously enjoined by the Malays.
From its almost instantaneous action in relaxing muscular spasm, in
relieving spasmodic colic, and persistent singultus, I am induced to
conceive that it operates directly upon the nervous system as a pow-
erful antispasmodic. I have administered it in several cases of flatu-
lent colic, invariably with the happiest results. The effect has been
instantaneous in relaxing the spasm, and the regurgitation of flatus
has given immediate relief. A few drops, four to six, taken in water
or upon a piece of sugar, will arrest the spasmodic action of tho
diaphragm in singultus, with the greatest certainty. Conjointly with
its internal administration, fifteen or twenty drops may be applied
externally to the epigastrium. Diluted with three or four parts of
ol. amyg. dulc. I have found it an excellent application for deafness
resulting from deficient or hardened cerumen. For this purpose a
few drops of this mixture may be placed within the external meatus

634 Assafoetida to prevent death of the Faius-in-utero. [October,

upon a dossil of cotton, while the pure oil is applied anteriorly to the
ear, directiy over the facial nerve. As an odontalgic it is far superior
to the ol. creosoti, and, applied directly to the exposed nerve, often
relieves the pain entirely.

But I am trespassing upon your patience, and forbear enumerating
further indications, lest your readers suspect me of wishing to immor-
talize myself as the discoverer of another "golden drop." I confess
my aspirations are not restricted to success in the practice of my pro-
fession, but compass the acquisition of those golden drops more
essential to life than the far-famed elixir of Paracelsus.

In conclusion, allow me to suggest that, if lam correct in my views
of the modus operandi of the article under consideration, might we
not hope some more signal advantage from its use in colica pictonum,
spasmodic cholera, tetanus, and other spasmodic diseases. [Boston
Med. and Surg. Journal.

Assafoetida used to prevent the death of the foetus -in -utero. The
fcEtus-in-utero may die at any time between the commencement and
full term of gestation, independently of the process of parturition, or
of any appreciable accident, and apparently in many instances from
B pathological condition of the uterus, partaking of the nature of de-
bility or want of tone. Dr. Gaetano Laferla, of Malta, in endeavor-
ing to adapt a suitable treatment to such cases, has arrived at the
conclusion that assafoetida will best answer the indications of exciting
the uterus and of restoring its tonicity and vigour, without risk of
producing dangerous contractions of this organ. But before resort-
ing to it he considers the mother's temperament and the period
which her previous abortions have occurred. To those of a san-
guineous or bilious temperament, he administers from 2 to 4 grains
less of the assafoetida per day than he would to others. He also
takes care that the female shall use, up to the period of her other
abortions, an aggregate of assafoetida equal to from 10 to 15 grammes
(from 160 to 240 grains). He gives the assafoetida in doses of 2
grains, made into a pill with the extract of chamomile,* morning and
ni^ht, with a cup of coffee or other beverage. This dose should be
increased as follows: if abortion has previously occurred during the
first three months, the dose should be increased every two days; if
during the second three months, it should be increased every four or
five days ; and, finally, if during the three last, it should be increased
every six or eight days.

According to Dr. Laferla, the chance of success is increased by
commencing the treatment before pregnancy. He then prescribes
from 3 to 4 grains, morning and night, until conception have occur-
red. When this is ascertained, he reduces the dose to 2 grains, and
continues at this, provided the movements of the foetus are of the
natural strength and that there are no threatening symptoms, until
a month before the time of previous abortions. The author reports

* Ext. Gentian would be a good substitute. Translator.

1847. J Premature Delivery. Alcohol, $c. 635

a number of cages illustrating the efficacy of his method. [Transla-
ted from Revue Med -Chir. Bull. Gen. de Therap., Ann!, 1847.

New Method of E idling Premature Delivery. The manifestation
of contractions occasioned by injections made into the uterus during
the treatment ofan obstinate affection of this organ by Dr. Cohen, of
Hamburgh, suggested to him the idea of provoking premature delive-
ry by this method, which is painless, certain and expeditious. He
proceeds as follows: a small pewter syringe, containing from 2 oz.
to 2 oz. of fluid, with a canula a line or two in diameter and 8 or 9
inches long, bent like a female catheter, is used. The patient being
placed upon the back, with her hips elevated, he introduces the canula
between the anterior wall of the uterus and the ovum, guiding the
instrument with two ringers c irricd as far as the posterior lip. The
free extremity of the syringe is depressed, and the canula projected
beneath the pubes until it has penetrated about two inches into the
uterus; he now commences the injection, which is forced up gradu-
ally, taking care to elevate the syringe a little so as to prevent the
end of the canula from resting against the uterine walls, and to
change its position whenever there seems to be any obstacle to the
flow of its contents. The syringe is then gradually withdrawn, and
the female may walk about in ten minutes; if no symptoms occur
in six hours, the injection is to be repeated. The liquid used by Dr.
Cohen is tar water, but he thinks that various others might answer
equally well. The author relates but one case in support of his plan,
but this is as satisfactory as possible. Two injections, at intervals
of five hours, without giving any pain, were sufficient to induce de-
livery without any unpleasant consequence. [Translated from Bul-
letin Gen. de Therap., April, 1847.

Means of ascertaining if Alcohol be perfectly pure M. Cassoria
employs the anhydrous sulphate of copper to determine if alcohol
contains any water. The salt will remain white, if put in anhvdrous
alcohol in a well stopped bottle, but will become blue if the alcohol
contains any water. [Translated from Journ. de P harm. Bulletin
Gen. de Therap.

Means of preventing the corroding action of Urine upon the Skin.
Urine in its normal state contains, as is well known, salts of potash,
soda, lime and ammonia, as well as acids, free or combined with
urea. According to the food taken, the proportion and nature of
these elements vary more or less. In some cases the alkaline pre-
dominates, in others the acid elements. In the latter state of things,
should accident or disease occasion the urine to remain in contact
with the skin, this would be corroded by the excess of acids. This
not unfrequently occurs during incontinence of urine. In order to
obviate this serious inconvenience, M. Maurat, "interne" at the
" Hopital St. Louis," resorted to a topical application capable of

630 Detecting Cotton in Linen. Letter from the Editor. [October,

absorbing and neutralizing the acid so as to form salts that were very
nearly insoluble and unirritating to the skin. Iron and magnesia
seem to -promise most. For this purpose he formed a paste with an
admixture of equal parts of calcined magnesia and of sesqui-oxide of
iron with tepid water, with which he covered the parts exposed to
the action of the urine. Those parts which, from their inclined po-
sition, might prevent the paste from adhering, he previously powdered
with dextrine. In the two only cases in which M. Maurat has been
able to use (his paste, he has attained the desired result. [Translated
from Rev. Med-Chir. de Paris. Bull. Gen. de Ther., April, 1847.

Method of detecting the presence of Cotton in Linen. M. Kindt,
a Bohemian apothecary; proposes to detect the presence of cotton in
linen, by a process based upon the principle that the fibre of cotton
is more rapidly dissolved in concentrated sulphuric acid than that of
either hemp or flax. The cloth having been thoroughly deprived of
its dressing by being boiled some time in water, should be well dried.
One end of the piece should then be plunged in concentrated sulpha,
ric acid, and left in it from one to two minutes. The cloth becomes
transparent, and should he well washed in water, rubbing it with the
fingers, if necessary, to favor the removal of the gummy matter which
has been produced. It should now be rinsed in water holding in solu-
tion a small quantity of potash or other alkaline substance to neu-
tralize any acid it may still contain, and again in pure water, and
finally dried. If the cloth contains any cotton this will have been
dissolved, and its absence may be readily detected by comparing the
portion subjected to the acid with that which was not.

If the specimen were allowed to remain too long in the sulphuric
acid, the linen fibres would also be acted upon, but if the cloth were
made entirely of flax the corosion would be uniform. The cotton
however is always first acted upon, and is converted into gum whilst
the linen threads still remain white and opaque. [Translated from
Journ. de PJiarm., 1847. Bull. Gen. de Therap.

MEDICAL INTELLIGENCE.

LETTER FROM THE EDITOR, DATED,

PARIS, August, 184?.
l\i the Editors, pro. tern., of the Southern Med. and Surg . Journal :

Gentlemen Thanking you, as I have done privately, and now do publicly,
for your kind offer to conduct the Journal during my unexpected, and I trust
brief absence, I propose to send you a few items of Medical Intelligence by the
steamer of the 19th. My sojourn here, however, has been yet so short, that I
have but little to communicate.

Epilepsy. You are aware that it is a case of this affection that has brought
me here, and which supervened upon premature delivery. I left for the Journal
a short article translated from M. Trousseau, containingthe wonderful cures he
had affected by prolonged warm baths, with a small current of cold water fall-
ing at the same time upon the head, in acute diseases within the cranium. I had
come to Paris to consult Professors Velpeau, Rostan and Trousseau, and have-

1847.] Lellerfrom the Editor. 037

already accomplished my object. The latter gentleman, could not, because of
previous engagements, meet at the consultation, and therefore made his visit
alone. Aiier obtaining a history of the case, which is briefly this the first at-
tack of convulsions coming on about three weeks after the premature aecouch-
ment, then the second about the end of the same interval, with subsequent
recurrences varying from lour to nine weeks a permanent pain in the head,
which has never yet been entirely relieved failure of all medication, as nitrate
of silver, oxide of silver, arsenic, quinine, valerianate of zinc, hydriodate of
potash, active purgation, ptyalism, seton to the neck, issues to the arm and leg,
cold affusion to the head, diet, narcotics of various kinds. &c., &c, visit to the
Madison Springs, Saratoga Springs, travelling, a sea voyage of thirty days
nothing as yet having interrupted the attacks. Prof. Trousseau recommended
one medical and one surgical means the powder of the root or leaves o\' bella-
donna in small regulated and guarded doses for several months, and ligatures to
the primitive carotids. He was aware the latter proposition would not be sanc-
tioned by the profession, but he repeatedly said were it his own son affected with
epilepsy, he would not hesitate a moment to ligate these arteries. We do not
know what this disease is, he remarked, and so profound a change in the nutri-
tion of the brain would be produced by closure of the carotids, that I know no
means in this affection more available, or which promises as much as their
ligation. Prof. Rostan assumed, in the consultation with Prof. Velpeau, the
management of the case, and promised very kindly to write out in full, direc-
tions for it. These I shall not get until too late for "this mail. The plan, how-
ever, agreed upon by them, consisted in prolonged sedative baths to the skin,
hot pediluvia, with cold stream of water to the head, regulation of the bowels,
and the powdered root of belladonna.

There being no hereditary tendency in this case, and no permanent external
symptom of disease in the brain, they all think, by great care and perseverance
in the treatment, that it will be cured. They consider it a severe one, especially
on account of its persistence, now sixteen months; and that it is cephalic, and
not now dependent on the uterus

Each of the above named gentlemen utterly refused any compensation for
their services in this case.

I may also obtain the opinions of Drs. Marshall Hall. C. J. B. Williams, and
Watson, of London, in reference to this case.

Case of Extra Uterine Conception, This is a female, some 30 to 35 years of
age, in one of the wards of M. Velpeau. Portions of the foetus having passed
from the bladder per urctram, a caustic issue has been established below the
navel, through the abdominal wall. The case has not apparently been benefit-
led, and the patient seems to be sinking. (Died.)

Aneurism at bend of Elbow, patient never having been bled. This is a curious
case, and has been presented to nearly all the surgeons of note in Paris, no two
of whom agreed in the diagnosis. M. Velpeau made a small puncture into the
tumor; size of a common apple, and observing its diminution by pressure upon
the humoral artery continued for several hours, diagnosticated an aneurism.
There was no pulsation in the swelling. He tied the brachial artery, and the
patient is doing well. The ligature has fallen ami the tumor has diminished.

I have as yet witnessed no capital or impotant operations since my arrival
here. In the fashionable circles this is know;) as the dull season of the year,
and gvery occupation of life seems to feel the influence. There are fewer lectures
going on, and fewer surgical operations in Paris, than I have ever known.

Of course, one of my fust visits was to La Charite Hospital, to see and hear
that renowned surgeon, M. Velpeau. He at once recognized me and welcomed
me cordially to Paris, expressing his sympathy for the cause which had brought
me here, and offering his services to aid me in any way.

Of four operations he performed, therfAerwas inhaled in two tothe two others,
(polypi of the nose,) it was inapplicable. The first was that most horrible of
operations, the evulsion of the nail oi the greattoe. Theether was inhaled from
a very simple apparatus, a hog's bladder covered with a piece of silk like a bag,
and the nose and mouth embraced by the opening and secured as a lady's com-
mon reticule. The second case was one of tumors in each mammce of a country

638 Death of Broussais. Meteorological Observations.

girl, aged 19 years. They were steatomatosis in character, and about the size
of a turkey egg; one in each breast, and their origin unknown. Both these pa-
tients declared themselves to be insensible and unconscious to pain or to what
was passing around them. The openings left by the removal of the tumors
were crammed full of coarse lint, and then well wadded and compressed upon the
surface this is the month of August, and suppuration abounds in the hospital.

M. Velpeau's Lectures have been on di ft used phlegmonous inflammation, and
a recapitulation of the fractures received into his wards during the last six
months. He stated that diffused phlegmonous inflammation could not be ar-
rested after the third or fourth day. There was a destruction of the cellular
tissue at this period of the disease, a sort of gangrene or even sphacelus, and it
must be gotten rid of by an opening or openings through the skin. To arrest
or abort the inflammation in the early stage, he recommended first, compression
by a well applied roller bandage; 2d, topical and general bleeding; 3d, mercu-
rial ointment; 4th, blisters to cover the whole surface inflamed. He dwelt
especially upon the first means, the therapeutic effects of a roller bandage in
external inflammations.

Death o/M. Broussais. Casimir Broussais, son of the late illustrious physi-
cian of that name, recently died at the age of 44 years. His death was caused
by Cancer of the Rectum, the same disease that destroyed his father. The de-
ceased was high in rank in the Army, and succeeded Desgenettes in a Professor-
ship in the Faculty of Medicine of Paris.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide 152 feet.

for August, 1847, at Augusta,
32' west Wash. Altitude above

>

Sui

Ther.

~69~

Rise.
Ear.

29 74-100

4, 1
Ther.

~7l

?. M. I
Bar. ,

Wind, j

Remarks.

"I

29 77-lOOj

N. E.

Rain, 1 9-100 of an inch.

2

68

' 75-100

70

;i 73-100

N. E.

Rain, 1 26-100 of an inch.

3

70

" 73-100

80

" 75-100

N. W.

Cloudy.

4

68

" 76-100

84

" 74-100:

N. W.

Fair.

5

65

" 72-100

81

" 58-100]

S. W.

Fair rain during night.

6

68

" 45-100

76

" 44-100,

S. W.

Cloudy rain 11 a.m. 40-100 in.

7

69

" 45-100

84

" 51-100;

N. W.

Fair some clouds.

8

70

" 08-100

84

" 67-100,

s. w.

Fair.

9

68

(: 86-100

76

88-100,

S. E.

Rain, 18-100 of aft inch.

10

67

" 94-100

70

" 95-100:

N. W.

Rain, 57-100 of an inch.

11

67

" 95-100

84

" 93-100!

N. E.

Fair shower at 4 p.m.

12

OS

" 93-100

86

" 87-100!

S, E.

Fair shower at 11 p.m.

13

69

" 87-100

83

11 83-100

S. E.

Rain, 45-100 of an inch-

14

68

" 84-100

87

" 84-100

N. W.

Rain, 10-100 of an inch.

15

71

" 86-100

80

" 85-100

N. E.

Fair.

16

69

" 87-100

77

" 84-100

N. W.

Cloudy thunder.

17

68

" 84-100

77

82-1 00!
" 77-100-

s. w.

Rain, 35-100 of an inch.

18

65

" 81-100

78

s. w.

Rain.

19

67

" 77-100

77

<c 77-100;

s. w.

Fair sprinkle at 3 p.m.

20

64

" 79-100

86

" 78-100;

N. E.

Fair.

21

70

" 8-2-100

85

" 75-100

s, w.

Fair rain at 5 p.m. 1 inch.

22

71

" 85-100

84

<: 83-100

s.

Fair.

23

69

i: 83-100

89

" 83-100
" 84-100

N. W.

Fair rain at 6 p.m. 32-100ofin.

24

69

" 84-100

88

N. W.

Fair.

25 G7

;( 90-100

70

" 90-1 00]

N. W.

Cloudy.

26 64

" 93-100

76

" 92-100

N. E.

Cloudy.

271 66

" 91-100

69

" 84-100

W.

Rain.

28 1 65

84-10!

78

" 83-100]

N. W.

Fair.

29

67

" 81-100!

83

" 87-100!

N. E.

Cloudy. [an inch.

30

69

87-100

86

" 88-100]

S. E.

Fair rain at 10 p.m. 15-100 of

31

68

(: 88-OOCj

83

" 89-100!

a. e.

Fair.

16 Fair days. Quantity of Rain 5 inches and 87-100. Wind East of N. and
S. 12 days. West of do. 18 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. I] NEW SERIES. NOVEMBER, 1817. [No. 11.

PART L ORIGINAL COMMUNICATIONS.

ARTICLE XL.

Random Thoughts on Febris Typhoides. By C. T. Quintakd, M.D.,
of Athens, Ga.

Every writer on this disease, seems to have arrived at different
conclusions, not only as regards its pathology, but the treatment
indicated ; each deciding according to his own favorite theory : nor
does this difference depend so much on a deficiency of critical judg-
ment as on the different characters the disease assumes under variable
circumstances. Reasoning from analogy, as physicians are neces-
sarily obliged to do. v. 3 would naturally presume, that the disease
would at least he described accurately, and that those persons en-
gaged in the pursuit of pathology, would be enabled to give us clear
ideas of the morbid state induced by the action of the poisonous
miasm. But inasmuch as we have as yet no clear notions concern-
ing typhoid fever, we see how slippery a foundation our conclusions
have, when they are'bascd on analogy only, and yet there are col-
lateral evidences which ought to guide and direct us not only in
determining the action of the exciting cause, but in providing us with
a treatment adapted, in its general outlines, to the variable states of
the body when suffering under the disease. In the retirement of the
study, medical men arc too apt to neglect the facts observed at the
bed- side and allow the imagination to run wild before reason. This
leads them to practice upon theory without giving proper weight to
the experience gleaned from close observation. "That every thing
is easy when you know it," sounds like a simple truism ; when, in
fact, it is a wise apothegm. It declares that, be an object never so
difficult to be attained in the oul>et, we may, by the necessary pains

41

640 Random Thoughts on Febris Typhoides. November,

and labour, obtain such a mastery over it as to be surprised that we
were ever discouraged in its pursuit. It too often happens that
medical writers stop in medias res arrive at conclusions sum up
arguments and without hesitation "make books," with which to
train medical shoots. There is a fondness in the use of the personal
pronoun "I," which leads them to neglect, or pass lightly over the
experience of others, and depend solely on their own resources. We
very seldom see among medical philosophers, the modesty which
characterized the distinguished Dr. Hartley, when offering the result
of his labours to the world desiring his readers "to expect nothing
but hints and conjecture in difficult and obscure matters, and a
short detail of the principle reasons and cyidences in those that are
clear," &c.

Persons reviewing a disease in different latitudes, notice the same
general characteristics, while there are many of the symptoms which
vary exceedingly.

Thus with Typhus : In cold climates, when it terminates favora-
bly, it generally abates towards the close of the second, or commence-
ment of the third week ; but in warm climates it seldom continues
above a week or ten days, if so long. It is an unimportant matter
in the general description of a disease, as to what local affections
predominate, and add intensity to the constitutional symptoms, since
the malady affects every portion of the animal economy. The usual
name of the disease under consideration, leads us to look for the most
prominent symptom, viz., disturbance of the nervous system (Ty-
phus fever, t^oj, stupor) and although the names of s/up-fever,
hospital. fever, typhus-fever, typhoid-fever, jail-fever, putrid-fever,
adynamic-fever, camp-fever, and petechial-fever, have all been used
in describing the disease, we nevertheless find the same general out-
lines characterizing it, be it in the north or the south on ship-board
or on land in the rich man's home or the poor man's hut, the disease
is ushered in by nervous derangement; intestinal irritation follows,
the secretions become vitiated, in fact " we have the morbus totius
substantia of the earlier physicians. In the course of the disease,
we may have local inflammations we may have the lungs promi-
nently affected or cerebral disturbance may be the most prominent
symptom or irritation of the intestinal canal may predominate.
These local affections oftener occur in the severer forms of the
disease.
No person can walk the wards of a hospital in which there are a

1847.] Random Thoughts on Febris Typhoides. 641

number of cases of this disease, without noting the low muttering,
the delerium mite, or the fierce and incoherent ravings, thesubsultus
tendinum, the redness of the eyes -all indicating the immense shock
sustained by the grand seat of nervous power. Now these symptoms
all occur with different degrees of intensity, as has been the action
of the specific cause that produced the disease, and those consecutive
causes, such as mental depression, cold and fatigue, or venereal ex-
cesses which assist, aid, and determine the action of the specific
cause. With these general remarks, we shall offer a few hints rela-
tive to the particular character of Typhoid fever, as observed in the
cases under cur care at the Bellevue Hospital, New-York, Let us
first ask, what is Typhus fever 1

"Typhus fever is the action of a specific poison, generated in de-
caying vegetable or animal substances, producing general mal-aise,
imperfect or suffused vascular reaction, with depressed vital power,
manifested especially in the nervous, vascular and muscular systems,
and giving rise to changes more or less evident in the circulating
fluids and soft solids." (Copland's Defin., Fever Typhoid.)

" It will be observed that I treat of typhus and typhoid fever under
the same general head. I am satisfied of the identity of all the modi-
fications of continued fever, collected by writers under these names,
and am persuaded that the more closely the subject is examined the
more this opinion is destined to prevail. " (Dickson's Practice, vol. i.
p. 401.)

" There is every variety in continued fever ; both as to the degree
of excitement, and the degree of strength; from the very highest
excitement, and a high degree of strength, down to the most absolute
prostration that can be present ; and from no putrescency, up to a
high degree of it." (Elliotson's Practice, Am. Ed., p. 289.)

" A species of continued fever, characterized by great debility, a
tendency in the fluids to putrefaction, and the ordinary symptoms of
fever." (Encyclopaedia Americana, vol. v. Art. Fever.)

"There is but one species of continued fever, although there are
many varieties." (Watson.)

" Intermittent, remittent, and continued fevers, arise from the same
cause, and are the same disease, with certain modifications." (Arm-
strong.)

The term "fever" is by itself vague and indefinite, for the same
disorder is baptized by a dozen different names ; hence, for the same
diseaso we have the appellations of typhus, typhoid, continued, and

642 Random Thoughts on Febris Typhoides. [November,

remittent fever, &c, &c. This would be of no practical importance
if diseases were not sometimes prescribed according to the names
they bear,, without reference to the morbid states of the body. Ty-
phus fever originates in any locality where men are deprived of pure,
respirable air, as in crowded vessels contaminated hospitals dark
narrow lanes, such as are not uncommon in the great metropolis of
the Union. The patient first loses his appetite, a slight fur covers
his tongue, and he complains of a bad taste in his mouth ; great las-
situde and debility, disinclination to any exertion either mental or
physical, occasional chills, anxiety, sighing, and oppression at the
chest, mark the forming stage of the disease ; the skin becomes hot ;
the pulse small, frequent and weak ; pain is felt across the brow, ac-
companied with throbbing at the temples ; dizziness and stupidity,
with an unnatural brilliancy about the eyes, indicate the action of
the miasm upon the nervous system. These are the symptoms which
indicate the period of invasion, which authors describe as belonging,
not only to the typhus, but the typhoid, and which in the subsequent
determination they receive from consecutive causes, especially the
condition of the animal economy at the time of the attack, mark the
two varieties which some authors insist on so strenuously.

Michael Owen, aged 37, arrived in this country per ship Pontiac,
and admitted to the Bellevue Hospital Jan. 14th, 1847, together with
eighteen other cases from the same ship. Patient exhibited on ex-
amination a severe attack of constitutional disease. Among the
most prominent symptoms were excessive debility, pain of head, total
anorexia, tongue dry, black, cracked, and mouth lined with sordes ;
pulse frequent, small and weak, and unconscious stools. On the
second day after admission I noticed petechia?, and a somewhat flatu-
lent state of the abdomen. These symptoms rapidly increased in
severity, and the patient died on the fourth day after admission.
The post-mortem revealed considerable affusion into the ventricles
of the brain, and vascular turgescence, but no softening or other
morbid condition of the cerebral mass ; old adhesions existed between
the pleura costalis and pleura pulmonalis of the left side. The liver
was slightly congested ; the mucous membrane of the stomach was
injected, while that of the colon, in its transverse and descending
portions were corroded and gangrenous in spots. The glands of
Peyer were ulcerated and the mucous follicles enlarged. This was a
case of true typhoid fever, exhibiting not only the every day symp-
toms of the disease, but also the anatomical characters attributed to
it by Petit, Louis, Andral, Chomel, and others.

1847.] Random Thoughts on Febris Typhoides. 643

Patrick Flynn, aged 30, admitted the morning after his arrival,
from same ship. Had slept in the same berth with Owen, and had,
during the passage, b^rn exposed to the sai e miasm. Presented on
examination the folio wing appearances : Tongue coated with a yel-
lowish fur; pulse small, frequent, and easily compressible; great
prostration of the vital powers; pain about the upper divisions of the
abdomen, with such complete stupidity, that it was with great diffi-
culty he could be roused to reply to any simple question ; counten-
ance very yellow. This patient went through the disease, which
terminated favorably about the third week. During its course his
bowels were torpid, and were but seldom moved the tongue was as
well marked as in case 1st, and all the symptoms were the same,
except the flatulent state of the abdomen and the unconscious stools.
Petechias were observed during the attack. This was also a case of
pure typhoid, but of a milder nature.

Michael Healy, aged 23, was admitted same day from same ship.
Strong constitution and very great muscular development. In this
case the poison appeared to act solely on the nervous energies ; the
patient was nearly in a state of coma somnolentum, not having the
power of wakening spontaneously, and when aroused, slowly open-
ing his eyes and answering incoherently, and immediately falling
into the same state of profound torpor. No petechias or exanthema-
tous eruption was noticed the abdomen was tense, and the bowels
constipated. Cups were applied ad nucha, and brisk cathartics ad-
ministered ; but no favorable symptom was evident, and the patient
died on the fifth day after admission. So great was the shock sus-
tained by the vital powers, that the patient sunk without any effort
of the vis medicatrix to respond to any remedy slight hemorrhage
from the gums occurred on the third day. In examining the brain,
six hours after death, I found considerable effusion of serum in the
arachnoid, and a general fullness of the bloodvessels. There was
also about two drachms effused into the ventricles, and numerous
bloody spots in the cerebrum. The tunga were slightly congested, and
Peyer's glands a very little enlarged. These were all the morbid ap-
pearances revealed by the autopsy of (his pure nervo-typhus case.

John Shannon, aged 30, admitted two days after from same ship,
exhibited, on examination, all the symptoms detailed in case 2d, but
not of so great intensity; complained of a "smothering about the
heart," and some nausea, but began convalescing at the end of the
second week.

644 ' Random Thoughts on Febris Tyvhoides. [November,

Here we hare the same cause acting differently in each case;
and as it is natural fey us io judge of things of this nature by analo-
gy, we will endeavor to trace the similitude which existed between
all the cases. We believe they were all originated by the same
miasm, its action being mod circumstances, and that this

miasm is subject to the same laws. The same symptoms marked
the irritatory stage of each, except case 3d, where the action of the
miasm was felt with much intensity, and concentrated upon the ner-
vous energy. In cases 1st, 2d and 4th, the fever was accompanied
by chills. In case 1st, the action of the miasm was exhibited very
speedily on the intestine canal, as seen in the ulceration of Peyer's
glands in the erosions of the mucous membrane of the colon, &c.
Here a like cause produced a rapidly fatal effect, which in cases 2d
and 4th exhibited nothing peculiar in its action. Must we notattri-
bute these varieties to the different states of the system at the period
of attack, as well as the different idiosyncrasys of the individuals?
It is at least a problem in this type of fever which has not yet been
solved. Why should animal miasm produce under like circumstan-
ces typhus mitior and typhus gravior ? Why does it not act alike
in all cases? What effect has temperament in modifying its action 1
These questions may in time be solved by zealous and unwearied
observation, but they demand freedom of thought and a scrutinizing
eye. They are the mysteries of nature, crippled and prevented in
its workings.

With a few remarks concerning the contagious nature of this dis-
ease we will close.

Dr. L. H. Stone, of the Bellevue Hospital, writes me as follows :
"I believe Typhus fever is as truly contagious as smalKpox, but it is
necessary for a person to be longer subjected to the influence of the
miasm the specific cause." Contagious diseases are produced
either by a virus capable of transmitting them, or by miasmata pro-
ceeding from a sick individual. In typhus gravior, no person will
doubt the fact, that this miasm is produced and will generate the same
.disease, or that this disease may be produced at any time when a
large number of persons are crowded into a confined space and de-
prived of pare air, proper nourishment, and the means of cleanliness
for in such a case, the specific cause is generated and will act in
the ratio of its intensity. Hence the jail fevers formerly so de-
structive; hence, also, the black assizes of the Old Bailey, Exter,
Oxford, and Cambridge, io which the infection spread with deadly

1847.] Random Thoughts on Febr is Typhaides. 645

results to the lawyers and people in ihe courts. That Dr. Stone
has reference to circumstances similar to those which produced the
old jail fever, is evident, for he continues "The poison is about as
certain in its effect, as that which emanates small-pox where there
is such a mass congregated a*s we have had at the Hospital for the
last few months I could mention fifty cases in which persons have
contracted the disease by exposure to the noxious air of the wards of
Bellevue." "About the first of June we had overf.ve hundred cases
of Typhus fever in the Hospital and in all over one thousand pa-
tients in the Hospital proper."* We can readily conceive how active
the miasm may prove in rooms so crowded with this disease that the
patients lay side by side on the floor. " At one time," says Dr. S.,
"I had 87 patients in one ward," and this, a ward containing usually
30 beds.

"Contagion is by far the most active agent in the propagation of
fever ; but, when terror, hunger, cold and moisture, in fine anything,
as Hufeland remarks, which tends to weaken the vital powers, and
to act as a predisposing cause, operate, it becomes truly influential ;
and it is then, that a single focus of infection may involve thousands
and entail the worst results. Let the current crop fail, starvation
and beggary result; the complaint soon springs up and is circulated
in every direction on the persons of houseless wanderers. Eighty
thousand are reported to have perished in 1740, and again in 1817,
of fever in Ireland; and if we suppose one died in thirty, it yields
each time, an aggregate of nearly two millions and a half, and
affords some conceptions of the desolation, misery and suspension of
human pursuits, such a scourge inflicts." Methodus Medendi, Lon-
don, 1842.

What are we to expect from the present state of Ireland ! But
not only is it certain that this disease is generated under circum-
stances favorable to the development of the exciting cause; it is
probable that it may be contracted when no local circumstances
generate animal or vegetable miasm, but be "circulated on the per-
sons of houseless wanderers."

We find the following in the Albany Argus of 31st June: "We

The buildings at Bellevue are divided as follows:
1st, the Alms house, containing 1 etwees 2 and 3000 inmates;
2d, the Ulcer . ntsj

3d, the north and south win ' thisis and chronic diseases.

lth, the main Hospital, in which all acute diseases are kept and in which the
typhus fever cases are aco-.

648 Random Thoughts on Febris Typhoides- [November,

regret to learn that the family of Mr. Mead, of Duauesburgh, Schen-
ectaday county, have been severe sufferers bj the accidental intro-
duction of ship fever into their house. V/e understand that a patty
of emigrants, proceeding on foot along the Cherry Valley Turnpike,
and passing the house of Mr. M., one of the party, an elderiy person,
was observed to be very unwell. The party was asked by some of
the members of Mr. M's family to remain over night, and having
been served to an evening meal, slept in an out-building adjoining
the house. On the following day one of Mr. Mead's family was
taken siek, and the sickness pronounced by their medical attendant
to be ship fever, under which disease they learned the sick emigrant
was laboring. The disease spread to other members of the family,
and yesterday morning our informant learned that three were dead
and a fourth so seriously unwell that recovery was hopeless."

Dr. Douglass, the health officer, stationed below Quebec, has
written to the authorities of Montreal and other places in the Pro-
vinces. The following is an extract from his letter, dated Grosse
Isle, June 8th : '-Out of the 4000 or 5009 that left this since Sun-
day, at least two thousand will fall sick somewhere before three weeks
are over. They ought to have accommodations for 2000 sick, at
least, in Montreal and Quebec, as all the Cork and Liverpool passen-
gers are half dead from starvation and want before embarking; and
the least bowel complaint, (which is sure to come with change of
food,) finishing them without a struggle. I never saw people so in-
different to life. They would continue in the same berth with a
dead person until the seamen or captain dragged out the corpse with
boat hooks.

" Good God ! what evil will befall the city where they alight!
Hot weather will increase the evil.

"Now give the authorities of Quebec and Montreal fair warning
from me. Public safety requires it."

Subsequently the Montreal Herald remarks: "Dr. Douglass's ap-
prehensions are already fulfilled here."

In the alms house at Albany, one physician and four nurses have
lately died of tills disease, contracted in attending the patients.

Dr.McCormac, of the Belfast Hospital, in his chapter on fever,
writes as follows :

"Some would distinguish typhus from typhoid fever, confining the
latter to large towns as Paris, and referring the former to the febris
bellica or castrensis, and the Krigspest of the Germans. Lombard

1847.] Random Thoughts on Febris Typhoides. C17

and Gerhard insist largely on (his, and affirm not merely that typhus
and typhoid fever are distinct, but that the latter is not contagious,
and that it presents exclusively the pustular alteration of the follicles
or dothinenteritis, already signalized. No such distinction, howev-
er, subsists; all known varieties run into each other; every modifi-
cation may present itself concurrently or successively in the same
individual, and similar alterations are met with in all." Methodus
Medendi, p. 11.

Dr. McCormac then, believes in the identity of typhus and typhoid,
and in the contagious nature of the malady. If we were to admit
a distinction a typhus and a typhoid {ever the one contagious and
the other not so, how greatly would it modify our ideas of the exten-
sion of the malady. We see the diseases generated in the same
manner, showing no difference except in energy of the exciting
causes and the violence of their symptoms. Both ushered in by the
same symptoms, and both in the end exhibiting the same anatomical
characters varying only, according to the violence of the disease.
" Both are owing to impure air, uncleanliness, over-fatigue, depress-
ing passions, &c, &c, and display the same meteorism, abdominal
tenderness dry, red tongue subsultus tendinum stupor delerium
deafness, cough, viscous expectoration, livid surface, foetid excre-
tions, and petechia?." Ibid, p. 15.

If we are to consider typhus and typhoid, as one and the same
disease, we must certainly admit its contagious character and that
it may be transmitted from person to person, and circulated in every
direction by "houseless wanderers."

To what else are we to attribute the fatality in the family of Mr.
Mead, and the many other instances which might be quoted? We
think it doubtful, whether sporadic cases will produce epidemics
unless want and misery predispose. Slight fear, therefore, is to be
entertained, that our cities or villages will be desolated by this disease
and while here and there individuals who are exposed to the con-
tagion will fall victims to it, the character of our nation is such and
the medical police of our towns and villages so well regulated as to
ward off general diffusion of the disease.

With reference to the origin, causes, and mode of propagation of
the fever of the present season, introduced into all our large Pea- port
towns by the emigrant:-; from the old world we hope before long to
have full and satisfactory information, from a committee lately ap-
pointed by the New York Academy of Medicine. The committee

48 Report of the Georgia Medical Society, fyc. [November,

are directed, also, to enquire into its distinctive characters; its autopic
phenomena its statistics and the course of treatment which has
been attended with the most satisfactory results. The character of
the gentlemen composing this committee leads us to look for a report
which, will prove a most interesting document and valuable record,
with reference to this disease.

When want, wretchedness and famine, combine to prepare poor
mortality for the reception of its many ills, disease makes an easy
prey of its victim. When we recollect the awful effect of typhus
fever in Ireland, during the years 1740 and 1817, when the causes of
the disease were not so powerful as they now are in that unhappy
country how terrible must be the amount of human suffering, and
how great the desolation, consequent upon the present condition of
the country. With these remarks on the character of the disease,
we close our subject hoping that persons who have the opportunity
of observing this disease in our own State, will contribute to the
stock of information we already possess with regard to it.

ARTICLE XLI.

Report of the action of the Georgia Medical Society, on the Proceed,
ings of the National Medical Convention.

Savannah, Sept., 1847.
To the Editor of the Southern Med. and Surg. Journal:

Dear Sir At a meeting of the Georgia .Medical Society, held on
the 2d Sept., the enclosed Reports of the delegates of said Society to
the late National Medical Convention, held in the city of Philadel-
phia, and the Reports of the several committees appointed by said
Society to report upon the matter recommended by their delegates,
were acted upon and unanimously adopted. By resolution of the
Society, I have been instructed to forward them to you for publica-
tion in your Journal. Will you do us the honor to insert the same ?
Xcry respectful I v, your ob't serv't,

JOHNSTON B. TUFTS, M. D.,

Secretary G. M. S.

Report of the Delegates to the National Medical Con-
vention* The undersigned, Delegates from the Georgia Medical
Society to the National Medical Convention, held at Philadelphia,
in May last, have the honor herewith to submit to the Society a copy
of the minutes of that Convention, and the reports of the various com-
mittees, and also a revised edition of the minutes of the Convention
of the preceding year, held at New York.

1847.] Report of the Georgia Medical Society, <$fc. 049

The undersigned cannot help congratulating the Society on the
zeal and spirit which has caused its representation in these two Con-
ventions, for they believe that those Conventions will have a wide
spread influence on the future destinies of the Medical Profession
throughout our land.

The action ofboth Conventions was eminently conservative. All
the measures adopted were recommendatory, and will depend upon
the moral action of the Profession of the whole country. Acting
strictly 'for the good of the whole, they were entirely impartial as to
any particular school.

It is not intended to give in this report a synopsis of the pro-
ceedings of the Conventions. A reference to the minutes will shew
what these proceedings were.

But there are some subjects upon which, in order to carry out the
views of the Conventions, it is necessary that the various Medical
Societies of the Union should act.

These are specially the approbation or disapprobation of such So-
cieties, as the American Medical Association which has been crea-
ted, and the views of the Convention as to the preliminary education
of Students of Medicine, and a general code of Medical ethics.

In relation to the recommendations of the Convention as to the
requisites for graduation, it gives your delegates great pleasure to
State that the Medical department of the University of Pennsylvania,
an institution confessedly at the head of the Medical Colleges of the
Union, has already responded by announcing, that their next term
of lectures will commence on the 18th of October, and be continued
until the last Saturday in March. This example of the oldest Medical
institution of this country will no doubt prove of signal service to
the cause of Medical education.

Nor can your delegates refrain from calling the attention of the
Society to an important subject started by the Convention, which they
believe will exercise a most beneficial influence viz., a uniform sys-
tem of Registration of the births, marriages and deaths, in the several
states of the Union. As one of the undersigned (Dr. Arnold) is one of
the special committee to whom the subject is referred, he begs to call
the attention of the Society to it, as at the proper time he will invoke
aid in order to induce the Slate of Georgia to adopt such a system.

With a view then to the deliberate action of the Society on the
important matters which come within its range of power, the under-
signed would respectfully recommend the adoption of the following
resolutions :

650 Report of the Georgia Medical Society, $c. [November,

1. Resolved, That so much of the proceedings of the late Na-
tional Medical Convention as relates to the organization of an
American Medical Association, be referred to a special committee,
with instructions to report at the next regular meeting of the Society.

2. Resolved, That so much of said proceedings as relate to the
subject of preliminary education, be also referred to a special com-
mittee, with instructions to report at the next regular meeting.

3. Resolved, That so much of said proceedings as relate to a
code of Medical ethics, be referred to a special committee, with in-
structions to report at the next regular meeting.

In conclusion, the undersigned beg leave to state, that the absence
at the north of one of the delegates, (Dr. Tufts,) until the last three
weeks, has prevented a report from having been previously made to
the Society.

All of which is most respectfully submitted.

RICHARD D. ARNOLD, M. D. > n 7 .
JOHNSTON B. TUFTS, M. D. $ Uele8ales-
Savannah, August 15th, 1847.

A true extract from the minutes.

JOHNSTON B. TUFTS, M. D.,

Secretary G. M. S.

Report of the Committee upon the first Resolution re-
commended by Delegates. Your Committee have with much
pleasure and congeniality of feeling interchanged their opinions in
relation to the immense and incalculable benefits that may result
from the late organization of a National Medical Association, for the
improvement and proper regulation of the Profession in the United
States; and though littie opportunity has been afforded them of re-
viewing the proceedings of the late Convention, yet as far as they
have examined them, they approve very highly of the entire doings
of that respectable body, both as regards the subject upon which we
have been appointed to report, and other matters touching upon Medi-
cal conduct and education. All of which is respectfully submitted.
(Signed,) J. C. HABERSHAM, M. D., Ch'man. )

W. G. BULLOCK, M. D. } Committee.

W. A. KINN1LLY, M. D. )

Savannah, Sept. 2, 1847.

A true extract from the minutes.

JOHNSTON B. TUFTS, M. D.,

Secretary G. M. S.

1847.] Report of the Georgia Medical Society, <$>c. 651

Report of the Committee on the second Resolution recom-
mended by Delegates. The Committee appointed at the last
meeting of the Society, to take into consideration the report of the
Committee of the National Medical Convention on the subject of the
Preliminary Education of Students, beg leave to report, that they
have performed the duty assigned to them, to the best of their abili-
ty. That they have read attentively the report of the Committee of
the Convention, which appears to have been drawn up with care, and
proves that the subject assigned to them has received that serious and
enlightened attention which it deserves.

The Committee of the Society believe with the Committee of the
Convention, that there are many difficulties in the way of fixing the
standard of preliminary education for Medical students, as high as
would be desirable, or profitable to the student in after life ; and they
agree with the Committee of the Convention, that it is better at this
time, to fix it a little too low, than too high and to leave it to future
Conventions gradually to advance it to that point, which will enable
the student to enter upon the study of Medicine, a proficient in every
branch of preliminary knowledge, which is requisite to render him
an enlightened and accomplished physician.

The Committee of the Society therefore believe, that they can
recommend with great confidence the report of the Committee of the
Convention to the Society, for its adoption.

(Signed,) P. M. KOLLOCK. M. D.
JOHN F. POSEY, M. D.
THOS. STEVVARDSON, M. D.

Savannah, Sept. 2, 1847.

A true extract from the minutes.

JOHNSTON B. TUFTS, M. D.,

Secretary G. M. S.

Report of the Committee on the third Resolution recom-
mended by Delegates. The Committee to whom that portion of
the report of the National Medical Convention, which relates to a
code of Medical Ethics, and recommending that the Medical Profes-
sion in the United States should be governed by the same code, beg
leave to report, that they have carefully examined the same, as well
as the introduction thereto, and recommend its adoption to the Geor-
gia Medical Society.

The system of Medical Ethics, which this Society now recognizee

652 Report of the Georgia Medical Society, fyc, [November,

is entirely too vague and incomprehensible, making the duties it
imposes rather inferential than expressed. Constituted as man is,
even with the clearest perception of what may be his relative duties,
a well digested code for mutual government is essential to his well
being; without such, no association can exist harmoniously. The
intelligence of the Medical profession have long acknowledged this
truth, and we believe on all occasions, have exhibited every anxiety
to establish such rules for mutual government as would be most con-
ducive to that end. Not having a common head from which a
uniform and acceptable code of ethics could be disseminated, indi-
vidual associations have adopted such as was deemed expedient for
themselves. Much discrepancy, we lament to say, has thus arisen
so much so, that we doubt that the ethics of any two Societies could
be found to accord.

The principles that a code of Medical Ethics inculcates, and which
the experience of the profession believes necessary, we conceive,
ought to be such as would admit of general adoption. These prin-
ciples ought to be in themselves immutable, founded as they are on
that first of christian apothegms " Whatever ye would that men
should do unto you, do ye even so unto them," and as such, are
certainly worthy of general concurrence.

The code of Ethics, including the introduction submitted to us for
consideration, we believe to comprehend all that is full and adequate,
embracing within its specifications the essentials necessary to sustain
the interest and dignity of the profession. We therefore cordially
recommend the same to this Society for its adoption.

(Signed,) C. P. RICHARDSONE, M. D. <\

THOS. STEWARDSON.M.D. |

A. II. BAILEY, M. D. \ Committee.

JOHN F. POSEY, M. D.

P. M. KOLLOCK, M. D. J

Savannah, Sept. 2, 1847.

A true extract from the minutes.

JOHNSTON B. TUFTS, M. D.,

Secretary G. M. S.

1817.] Case of Glanders in the Human Subject. 653

ARTICLE XLII.

A Case of Glanders in the Human Subject, Reported by L. A.
Dugas, M. D., Professor in the Medical College of Georgia.

The disease termed Glanders or Farcy, hitherto regarded as pecu-
liar to equine animals, has been of late years ascertained to be
communicable to man, and has therefore attracted much attention,
especially in England and France. In our country the subject has
been comparatively neglected. The following case is reported rather
for the purpose of awakening the profession to this new source of
human suffering, than from any intrinsic peculiarity in its history.

Peter Walker, the subject of this notice, was an old negro man,
(about 75 years of age,) engaged in driving a dray for the last forty
years. During this time he always had charge of his own horse,
and enjoyed fine health, with the exception of '* tremor senilis," or
the "Shaking Palsy," as it is commonly called, with which he had
been afflicted for a few years. Requested to visit him on the 1st of
August last, I found that he had been suffering about a week with
pains in his limbs, which he believed to be rheumatic ; that three or
four days prior to my visit he had a severe ague, followed by a smart
fever, which still continued with little or no remission ; that he had
not had an alvine evacuation for six or seven days ; and that for the
last three days his pains seemed to be seated principally in the calf
of each leg and in the biceps flexor cubiti of each arm, all of which
regions presented a swelling of circular form, from three to five inches
in diameter, gradually extending, and exquisitely sensitive to the
touch. On examining these, I found them glossy, occupying the
skin and cellular tissue down to the muscles, which seemed to be about
an inch below the skin at these places. The cellular tissue for sev-
eral inches around the swelling was edematous, forming a pit when
pressed upon with the finger. The natural hue of the skin masked
any redness (hat may have existed. Although the patient and his
wife regarded these as "large boils," they presented no such appear-
ance and did not at first seem to suppurate, but resembled large car-
buncles. Indeed, had it not been for their number, and other circum-
stances, they might have been mistaken for such.

Never having seen a case of human glanders before, I felt at a
loss in making out the diagnosis, and prescribed cold poultices in
place of the warm, a cathartic of jalap and cream of tartar immedi-

654 Case of Glanders in the Human Subject. [November,

ately, and quinine to be taken the ensuing morning in order to modify
the fever, if it belonged to the type of our remittents.

On the 2d August I found my patient more comfortable ; his bowels
had been well emptied, and his fever was less intense ; but the local
tumefactions were about the same as before, perhaps a little larger.
Sulphate of quinine ordered again for the next morning. Diagnosis
still uncertain.

3d August. Fever still continues not modified by the quinine.
Tumors in about the same state not enlarged, yet very painful :
new ones about an inch in diameter making their appearance about
the arms and legs, but not in the course of the lymphatic trunks
no enlargement of the axillary nor inguinal glands muscular
strength, very much impaired from the first, is becoming more so.
Unable still to form any certain diagnosis, I now suspected this might
be a case of Glanders, and accordingly requested several of my pupils
to see it, and to watch lis progress. It is unnecessary to note the
symptoms from day to day. Suffice it to say that the tumefactions
gradually increased in number from the elbows to the shoulders and

to

from the dorsum of the feet to the knees, then invaded the back of the
hands, the forearms and the thighs. Neither of these, however, at-
tained the size of the original four, but varied from one to two inches
in diameter; nor did they penetrate so deeply into the tissues : the
one upon the calf of the left leg became the seat of a pustule, which
opened and continued discharging a very considerable quantity of
thin sanious matter; the one upon the left arm assumed the appear-
ance of phlegmonous erysipelas, pus being extensively diffused about
the belly of the flexor muscle. A similar state of things existed on
the anterior surface of one tibia. On the 5th August, one of these
tumors appeared on the forehead, and another near the inner canthus
of the eye, both of which rapidly met, ulcerated and discharged sani-
ous matter small white pustules occurred also upon the side of the
neck. It is worthy of remark, that nothing of the kind manifested
itself about any part of the trunk nor was there any abnormal dis-
charge from the nostrils. The patient had a slight catarrhal cough,
but was subject to it, prior to this attack. The fever continued, the
tongue became dry and of a dark brown color, the thirst was inces-
sant, the pains harrassing, and the prostration increased. Diarrhoea
supervened, the mind wandered, urine and alvine discharges passed
otF unconsciously, and finally stupor closed the scene on the 9th of
the month.

1847.] Case of Glanders in the llu.nan Subject. 655

During tho progress of the case various applications were made to
the tumefactions, without relief. As the purulent collections occur-
red after the case had attained a hopeless aspect, they were not
opened. Tho intern:-! medication was restricted to palliatives, after
the first hw days of my attendance.

Viewing the case as one of Glanders, I naturally felt a desire to
ascertain the condition of the horse in Peter's charge, and on calling
the day after the old man's death, was told by Mr. H. (on whose lot
Peter resided) that the horse had the glanders, and that he (Mr. II.)
had advised Peter not to buy him lest he might catch the disease, as
he had just been reading an account of its contagiousness in a news-
paper. Other neighbors testify that the horse "was glanclered" when
Peter bought him, which was about six months before. On examin-
ing the horse I found that he had a copious discharge from the nos-
trils, but no tumors about the jaws or neck, as is frequently, though
not always the case.

That the contagiousness of Glanders among horses is by no means
so great as has been generally supposed, has been established by ob-
servations made at the extensive Veterinary school of Alfort, in
France, only a ^ew} out of one hundred who were exposed to it, hav-
ing contracted the disease. Whilst the disease is not very readily
communicated through the atmospheric medium, such is not the case
when the matter or purulent discharge is brought in contact with the
tissues, and especially if these be denuded. This may account for
the fact that so few grooms take the disease, and that Peter nursed
his horse six months before he became affected. He probably be-
came inoculated by the contact ol" the discharge with some ahraided
portion of his surface.

The general features and termination of the above case accord
with those reported by the French and English writers. This acute
form has always terminated fatally. It may be communicated
from man toman; hence those who nurse the sick of this dreadful
disease cannot be too careful to avoid inoculation when dressing
the ulcers.

Those who may desire to invest: ibjcct will find it treated

of in Tweedie's Library of Practical Medicine, Copland's Dictionary,
The Dictionaire de Medicine, The Cyclopedia of Practical Medi-
cine, &c.

42

636 Wound of the Abdomen. November,

ARTICLE XLIII.

Penetrating and Lacerated Wound of the Abdomen cured. By
G. M. Tutt, M. D., of Columbia County, Georgia.

On the 27th of last June, I was called in great haste to see a boy
belonging to A. P. R., Esq,, of this county, who had been gored by
a cow. I arrived in three hours after the accident. The patient
was eight years old ; was sufTering excruciating pain ; and upon ex-
amination I found the horn of the animal had penetrated the abdomen
in the right iliac region, quite near the external iliac and epigastric
arteries. A considerable portion of the intestines had protruded
through the wound. They were so distended with gas that I could
not return them by taxis, and with a probe pointed bistoury I made
an incision upwards and outwards, thus enlarging the lacerated open-
ing in the abdomen. Observing no wound in the viscera, they were
now carefully restored, and the little patient soon fell asleep. Be-
fore applying the dressings, I could distinguish the arteries of this
region, and the spermatic cord entering the abdomen. The wound
was dressed with interrupted sutures, compresses and bandages
Dr. Thomas having arrived and assisted in their application. The
patient being put to bed, an injection not moving his bowels, a saline
purgative was administered, and he had several alvine evacuations by
the next morning.

June 28th. The patient had slept well. He has considerable
tenderness of the abdomen, with some tympanites: pulse 85; skin
moist. Prescribed leeches to abdomen, gruel and elm water.

29th. Has fever, pulse 100; =kin is dry and harsh. The patient
complains of pain on touching the abdomen ; the tongue is red ; has
thirst. Bled him to fainting; gave laxative ; leeches to be applied
aain diet, diluent drinks alone.

July 1st. The fever has abated; pulse is 80; skin is moist ;
tympanites and tenderness of abdomen relieved. Patient has some
appetite. Bowels are in a good state. Diet, the same.

July 4th. Found patient still improving. Dressed the wound,
which had united by the first intention. Ordered a more gener-
ous diet.

July 8th. The patient walking about with a soft leather bandage
adapted to the iliac region over the cicairix.

The weather during the treatment of this case was very warm.

1347.] The Strawberry Leaf in Chronic Dysentery. 657

ARTICLE XLIV.

The Strawberry Leaf a valuable auxiliary in the treatment of
Chronic Dy enter y. By J. C. C. Blackburn, M. D., of Barnes-
ville, Georgia.

Believing that a discovery, however eirr.ple, which has a tendency
to alleviate the sufferings of man, should be given without reserve to
the medical world, I feel disposed to present to its consideration the
claims of the Wild Strawberry. For the last three years I have been
endeavoring to analyze this plant, and to try, if possible, to arrive at
its medicinal properties. I was led to this investigation from the
mere casual fact of seeing a dog that was apparently in severe pain,
swallowing its leaves. And just here let me add, that if physicians
would more frequently lend an observing eye to the conduct of the
brute creation, when afflicted with diseases peculiar to them, they
might find remedies for diseases which though at present obtainable,
yet remain undiscovered. I have used the strawberry leaves in every
form for the cure of dysentery ; but the formula most desirable is as
follows : li. lb 1 of the Green Leaves, add to them qt. 1 of good
French Brandy, and boil to one pint. Give of the strained liquor
one table-spoonful every three hour?, until the disease in question be
relieved of its distressing symptoms. I will here add one case, the
origin of which I am totally ignorant.

Mr. B., a volunteer returned from Mexico, was taken with dysen-
tery at Matamoras last August a year ago. He was placed under
the direction of the Surgeon to the Georgia Regiment, who attended
him until he pronounced his case incurable. The patient afterwards
recovered sufficient strength to accompany the regiment to Monterey,
and thence to Vera Cruz, where he was again prostrated by this
disease. He reached home last July, with a constitution almost
broken down, and placed himself under my care. I resorted to the
use of every agent within my knowledge for the cure of his disease,
but without success. I at length determined to try the strawberry
leaves, as in the formula above-mentioned. He had not taken but
ten spoonfuls when he commenced to improve, and speedily recov-
ered. He is now entirely cured, and able to attend to the duties of
his calling. I have used the strawberry leaves in many cases since,
with the same happy result.

658 The London Lancet. [November,

PART II. REVIEWS AND EXTRACTS.

ARTICLE XLV.

The London Lancet. By the Editor, at Portsmouth, England,
August 5th, 1847.

Having been compelled through domestic affliction to leave
home, and unexpectedly detained in this place by the non-arrival
of a New York packet ship on board of which my family sailed
for Europe, I propose to employ the time by briefly noticing the
July Nos. of the above-mentioned medical periodical. The Lon-
don Lancet has long been known as one of the most useful journals
published in the world. Un er the editorial management of Mr.
Wakeley, Surgeon, Member of Parliament an 1 Corone f r a large
portion of London for years, (Middlesex.) it has acquired a reputation
second to none in Great Britain. The Lancet is now read in every
quarter of the globe an American edition has for some time been
issued in our own country. It is published every Saturday, and
in addition to its common title, embraces Journal of British and For-
eign Medical and Chemical Science, Criticism, Literature and News.
Within the few past months, Dr. Henry Bennet, favorably known by
bis writings on Diseases of the Neck of the Uterus, has been associa-
ted as junior Editor in conducting this Journal.

Each No. contains 28 pages of double column of closely printed
matter, and two volumes are thus constituted in a year.

The leading article in each of the Nos. before us is the translation,
by Dr. Goodfellow. of a course of Lectures ca the Physical Phenome-
na of Living Bodies, delivered in the University of Pisa, Italy, by
Prof. Matteucci, F. R. S. 'these lectures are of such a minute and
elaborate character as to prevent an analysis or review of them.
They are certainly distinguished by great erudition and research,
and the learned author clearly evinces a perfect familiarity with the
important subjects which have engaged his attention.

As it is not proposed to notice every article, we proceed to extract
or collate those deemed most useful and interesting to our readers.
The first we make is from an alphabetical notice of subjects connect-
ed with the treatment of 'Dyspepsia, by Robert Dick, M. D. Under
the head o^Dlet, he remarks

"It is obvious that this is a matter far too general and generic to
form the subject of a single notice.' It would itself furnish materials

1847.] Dietof the Greeks and Romans. e59

for a series of alphabetical notices as long as those we are now en-
gaged in. I propose, andei the present head, to give (as entertaining,

and not devoid of useful information) some detail- of the diet of the
Greeks and Romans, collated from materials collected by me more
than ten years ago. I mention this circumstance, because a year or
two ago, another medical gentleman of London published a work, in
which he touches to some extent, on the same subject.

"The Greeks and Romans, it is hardly necessary to say, used no
alcoholic liquor, nor yet tea, ccfTee, chocolate, or sugar. It is ex-
traordinary, also, that even butter seems to have been most uncommon
among them, Galen informing us that he had but once in his life
seen it. They were ignorant also of the greater number of our tro-
pical spices cloves, nutmegs, ginger, Jamaica and cayenne pepper,
mace, pimento, &c. They knew nothing of spinach, sago, tapioca,
arrow-root, or of the potato ; nor, among fruits, of the orange. When
we add that they were also unacquainted with tobacco, we perceive
that several articles, staple among U3, were unknown to them.

"Beef was the ordinary principal article of food with the early
Greeks and Romans. This, if not eaten raw, was hastily broiled or
roasted, and, in later times at least, strongly spiced. The flesh of the
sow and the wild boar, as being supposed most nearly to resemble
human, was considered peculiarly nourishing; Athletes, when train-
ing for the amphitheatre, consequently preferred this species of flesh.
The ancients made use of several kinds both of vegetables and animal
food which we do not employ. Thus they ate mallows, acorns, and
lupins, while radish, lettuce, and sorrel, they used more than we do.
As regards kinds of animal food not in use anions us, but employed
by them, may be enumerated, the flesh of the wild ass, young dogs,
dormice, foxes, bears, parroquc Is, lizards. The dormouse was eaten
before its winter sleep; when fat, was esteemed a great luxury, and
was served up with honey and grains of poppy. Dogs intended to
be eaten were previously castrated, with the. view at once of causing
them to grow (at, and to prevent *heir having a strong odour.

"The Romans also maintained large aviaries. The peacock was
much esteemed as an article of food both by the Greeks and Romans.
The ostrich, though forming toogh eating, was prized, but its wing
and brain were reckoned the - I ts. For one dish of ostrich

brains, 300 in number, the emperor Heliogabalus was at an expense
cqna! to 30,000/. sterling. The crane and the swan made fashiona-
ble dishes at Rome till Augustin's time ; then the stork succ<
Young cocks which had been drowned in Falernian wine, (the most
med wine of that time.) rwards macerated in it, were

reckoned a luxury: the liver of I t a paste with

milk and figs, was an invention of ul Metellus, and obtained

repute: the thrush, and ; ird were, by the anrient Romans,

the modern Italians, part in the bills of fare in

man cat inn h' and the writor can bear

testimony to the cm - kept them in

860 Diet of the Greeks and Roman*. [November,

large aviaries, and fed them with wheat in ear,- figs, and flour. The
lark and the becafigo, a small bird, still used in Italy, were anciently
much employed. They did not use frogs, though, as we have said,
they ate lizards.

'* In the earlier ages of Greece and Rome, fish were considered an
effeminate sort of food ; but at a later period, they became a principal
part of the diet of fashionable Romans, and immense expense was
lavished in procuring and maintaining them. Sometimes single
fishes were sold at a greater price than the cost of a slave. The
herring, cod, and, I rather think, the salmon, were unknown or un-
used by the ancient Romans; but the fresh-water lamprey brought
immense sums; the sturgeon was thought worthy of the tables of the
emperors and noblest Romans, and was always served up with great
pomp. The eel called murczna helena, and the Conger eel, were
greatly used; the liver of the whiting was greatly prized, and its
flesh thought next in rank after that of the sturgeon ; the turbot,
flounder, plaice, sole, and what is called the sea-sparrow, were thought
excellent dishes. Freedmen only were allowed to eat the flounder,
and it and the sole were regarded as the fishes most easy of digestion.
The mackarel and tunny were much sought after, and were eaten
with rue and assafcetida. But the roach or mullet would appear to
have been regarded as the facile princeps the ne plus ztltra of Ro-
man luxury. As they did not succeed in rearing it in their reser-
voirs, it sold at an extravagant price. Three cost about 25/. The
liver and head were esteemed the most. It was from this fish that
Apicius compounded his celebrated sause. I do not find what
was the fish for which the epicure just named made his voyage to
Africa, and am not aware if it has been ascertained.* The anchovy
was used, as it now is in Italy, pickled in vinegar. It was then con-
sidered a delicacy an opinion which any one who has eaten it in
Leghorn or Genoa, along with a flask of good wine, will not be slow
to believe.

"Pottages or soups were used but little by the Rftmans.

" Finally, as regards condiments and wine^. In general their dishes
were greatly spiced. Almost every dish was impregnated with rue,
coriander, cumin, myrtle, privet-berries, fennel, smallage, spikenard,
leaves of the laurel, cassia and of asarabacca, sumach, elder, mastic,
fenugreek, onion, leeks, cresses, rochet, the Egyptian plant called
seseli. To common salt they often added nitre and sal ammoniac,
and to their sugar confections they added pepper.

"The wines of Scio, Lisbon, Tarentum, and Falernia, were most
esteemed. They were often drunk by the Greeks and Romans, mixed
with warm water, as this was thought to develop better their flavour.
They also impregnated their wines with absinthia, roses, pennyroyal,
myrrh, rosin. They also added honey t<> wine, and had wines diluted

* I need not ir.; man who committed suicide

from a fear of wanting- means of gastronomic indulgence. When he did so,
he had still a fortune of 80,000/ , but it was much greater,

1817.] Ether in Hysteria Injury to Eye Qc 061

with barley and white of egg. To prepared wine they occasionally
added raisins or the juice of the fresh grape. They had al=oan acidi-
fied milk as a drin';. Iced and hot water for mixing with wine were
sold in shops corresponding to our ale-thops.

11 What were called voleries were extremely numerous (as we are
informed by Varro and Columella) in the vicinity of Rome. In these
were reared and fattened, thrushes, blackbirds, ortolans, quails, &c.
What is singular, oxen and hogs were fed on the excrements of the>e
birds. Each fat thrush cost about two shillings a large sum. They
were fattened on millet and on a paste formed from flour, mixed with
bruised figs; and the flavour of their flesh was raised by supplying
them with the berries of the ivy, myrtle, and lentiscus. As may be
seen in some of the bird enclosures in the Zoological Gardens, Re-
gent's park, they were supplied with water by means of a little stream
running through in a stone gutter. Although light was admitted to
these voleries, yet a prospect of the fields, &c. was carefully prevent-
ed, in order that the feathered prisoners might not be agitated by a
view of their familiar and natural haunts, but fatten in lazy content."

E (her Inhalation in Hysteria. Mr. Wilcolnson, of Lincolnshire,
relates, that having been called to a female aged 29, labouring under
hysteria for six years, v%ith great irritation of the spinal marrow,
attended at times with clonic spasms the fingers and toes perma-
nently contracted; he had recourse to the inhalation of ether. In
one minute she was composed, and in another all spasmodic action
was arrested. Sleep ensued and continued for eight hours. She
had, however, a recurrence two or three days afterwards, but which
was likewise speedily subdued by the ether.

Rupture of the Sclerotica and Iris. Mr. Wollastan was called to
see a boy 13 years old, struck on the eye by a piece of a glass bottle
shivered to pieces against a stone. The sclerotica was found to be
ruptured to the extent of \ of an inch, and the iris completely divided ;
the pupil was triangular in shape, much contracted, and vision very
indistinct ; the conjunctiva was not cut, but there was slight effusion
of blood in the anterior chamber. Treatment adopted leeches,
calomel, black draught with salts, rest in bed, and the eye covered
with a shade during the day. In a month the fissures in the sclerotica
and iris healed, the pupil was oblong in shape, and vision nearly
restored.

Nature of the Membrana Decidua. Academy of Sciences. "A
note was read by M. Costeon the nature of the decidua formed around
the ovum in the human subject. He first alludes to the hypothesis now
generally looked upon as the right one viz., that the cavity of the
uterus becomes, after impregnation, completely lined by a mem*
brana decidua. thrown out from its mucous membrane; that the
ovum, on arrivi:"; ;it :!." 0| the Fallopian tub'' into the

uterine cavity, can < . io its course by pushing this first-

662 The Membrana Decidua. [November,

formed membrane the decidua vera before it, and so inverting a
portion of it, by which it will surround itself with another tunic,
which, according to this view of its formation, is culled decidua
reflexa, the two retaining the ovum in its position, and holding be-
tween them the hydroperionic liquid. M. Coste then goes on to say,
that, several facts for a long time led him to doubt the foregoing
theory of the deciduas, but that he was disinclined to call it in ques-
tion openly, until he had made such careful investigations as to con-
vince himself of its error, and such as might lead him to the truth.
With these objects he has opened a great number of the bodies of
women who have committed suicide, and after several years' experi-
ence, he believes he has collected such decisive observations on ges.
tation in ihe human species, as to remove all doubts vfrom any sub-
ject connected with it. He announces this present paper as the first
of a series detailing the results of his researches. The present note
conveys his views respecting ihe entry of thfl impregnated ovum
into the uterus, and the formation of the decidual membranes.

"'There is never produced normally in the womb of the human
female, neither before nor during gestation, any false membrane, or
hydroperionic fluid, and, consequent!;/, the deciduous membranes, as
represented, are purely idea!.

"'The ovum freely traverses the Fallopian tubes, and penetrates
at once into the uterine cavity, and is brought into immediate con-
tact with the hypertrophied mucous membrane, depressing it at the
point where the placenta is hereafter to be developed ; and the mu-
cous membrane itself, influenced by the action the ovum sets up in
it, swells and rises as a prominent ring around it, or as a circular
fold, which at length covers over and encloses it, constituting what
has been named the decidua re flex a. As this coat, according to my
observations, is a prolongation of the uterine mucous membrane, it
has, at the first, the same structure as it. It is glandular and vascu-
lar in all its extent, like the mucous membrane. Later, however, all
these traces of organization fade and disappear, btit their existence
may be very readily recognised in uteri during the first month of
gestation. I have several specimens in my collection which leave no
doubt on this matter. We may also remark, on the most prominent
point of the reflected Iaye>r, a sort of cicatrix or umbilical depression,
which indicates the spot where the circular fold of the uterine mu-
cous membrane to envelope the ovum, was effected.

'"This then, in the human species, has no relation, except with
the mucous membrane of the uterus; and when, in cases of abortion,
or after parturition, the ovum is expelled, it is the exfoliated mucous
membrane which it carries away with it. The results which I have
just made known differ so much from the vi -rally received,

that I determined nor to expose myself to their responsibility, until
the facts had h ble. I now offer them confidently and

am persuad f no one as yet has been able to explain the pro-

blem, it has arisen from the difficulty of procuring vvembs iu an early
stage after impregnation.'

1847.] Providing a Wet Nurse $c. $c. 663

14 In conclusion, M. Coste observes, that iie is not alone in his belief
of the error of the present opinion respecting the early history of
the ovum, since Dr. Sharpey loo partakes in it ; and that the latter
has proposed two explanations, one of which may readily be recon-
ciled with his own views.

"And the seance following the one on which the preceding paper
was read, a communication was received, calling attention to the
fact that in M. Valentin's Report on the Progress of Physiology, it
was mentioned that M.Poppenheim also was opposed to the received
opmion regarding the ovum and its membranes."

Mode of providing a wet nurse on an emergency. Dr. McWiliiam,
in his report, says, the inhabitants of Bona Vista (Cape de Verde
Islands) employ a decoction of the leaves of the ialropa cure as to the
mamma?, and suction of the nipple. We saw a copious flow of milk
produced by these means, on the fifth day, in a woman who had not
nursed, and in whose breasts there had been no milk for twenty
months.

[We believe any woman within the age of chilcibearing, by
fomentations and suctions of the nipple, if persevered in, would give
milk.- Edt.]

A Physician's duty io his Brethren and Quads. "Physicians
are aware ol the great difficulties and uncertainties in their art ; they
must be sensible of frequent errors on their own parts; hew indulgent,
then, should they be towards the mistakes of others. If there is a
sight calculated to excite pity mingled with disgust, it is to see medi-
cal men judging of each other with harshness and severity ; thinking
by oppressing others they do so much to elevate themselves. Avoid,
especially, such a course as this; respect the opinion of those who
have at least as good opportunities of acquiring medical knowledge
as yourselves; cultivate their friendship; draw closer the bonds of
catholic brotherhood : so will you be spared the miseries and vexa-
tions of petty warfare, and enjoy self-respect and the respect of others.

"By these remarks, I do not wish to be understood that you are to
deal tenderly with quacks and quackery. As woe was denounced
against Scribes and Pharisees hypocrites, so must woe now be pro-
claimed against empirics. the basest of hypocrites and im posters.
Our duty to the community, a regard to the greatest good of the
greatest number, demands the exposure and denunciation of medical
imposture and deception, whatever garb they may assume, or livery
they may put on."

We give what we think a well established Case of Interstitial Uter-
ine Pregnancy.

"The Revue Medicale contains an original communication of a
ease of interstitial uterine pregnancy, terminating fatally, by Dr.
Payan, surgeon of the Hotel Dieu d'Aix. There was this point, in
addition to the rarity oi' it, interesting in the case viz., that from

684 Interstitial Uterine Pregnacy. [November,

the sudden death of the woman, without any obvious cause, a judicial
inquiry was made, and a post-mortem examination, which revealed
the true'nature of the case :

" A woman, unmarried, aged thirty-two ; strong and robust ; mother
of one child; and one used to active exercise in carrying messages,
&c, for different people of the town ; had now gone three months in
pregnancy. After having been partaking of a feast with a paramour
during the day, she felt unwell in the evening, and was seized with
violent pains in the hypogastric region, with excessive thirst and
great prostration. She retired to bed, hoping to gain ease; but this
failing, she sent for a practitioner, who applied leeches over the pubic
region. But this was without effect : her state became worse; she
grew more and more pale; her pulse became gradually feebler, and
her vision obscured. Frequent syncope, moreover, occurred, and
two hours after the onset of the attack, she expired.

"Her death being looked upon with some suspicion, three physi-
cians were commissioned to make an examination of the body. No-
thing appeared on the surface of the body. The abdomen being
opened, a large quantity of blood, mixed with the serum of the cavity,
was found in the peritoneal sac; and towards the hypogastric region,
the blood occurred in large clots, entirely covering the uterus. These
clots being removed, the uterus was ascertained to be increased in
size; but what was most remarkable, was a prominence situated at
its upper part, representing in the greater part of its extent, a diaphan-
ous wall, through which an embryo could be perceived, and which
was consequently out of its normal position. The suspicion excited
among those present was, that an attempt at procuring abortion had
been made, which had thrust the embryo from its natural situation.
With this idea in their mind, the examination was proceeded with,
by the removal of the anterior portion of the pelvis, along with the
internal and externa! organs of generation, and the bladder and rec-
tum. An incision was then made through the symphisis pubis, and
then traversing the wall of the urethra and bladder; but no traces
of injury could be found. The vagina was opened, with no other
result. The os and cervix uteri were so far dilated, or extensible, as
to admit the little finger. The neck and body of the uteius being
opened, some reddish-brown patches, of little extent, were noticed ;
but no solution of continuity. The uterus was developed to the de-
gree met with in the third month of gestation, but its cavity contained
no foetus. It was lined throughout by a kind of false membrane,
incompletely organized, in the form of a concrete matter of consider-
able thickness, as a sort of soft, mucous, grey coat; not a drop of
blood was discovered in the uterus. Connected with the uterine
cavity, near its fundus, on the left side, and in the neighborhood of
the uterine opening-of the Fallopian tubes, was another sac, formed
in the substance of the uterus. Into this accidental cavity the left
Fallopian tube seemed to open. There appeared no communication
between the true uterine cavity and this false interstitial one. The

1847.] Mode of Administering the Ether <fyc. <*v. 665

wall of the latter, by the inward pressure exeried, was very thin and
translucent, looking like a mere fold of peritoneum, although, its
structure being traced, its origin at the expense of (he uterine sub-
stance was cognizable. In this secondary cavity, the entire foetus,
*vith its placenta, was lodged. It had the usual size of one at the
third month was of the male sex, free from all lesion, and attached
by an umbilical cord to a placenta seated above and behind it. The
haemorrhage in the peritonaea] cavity was accounted for by a rupture
of the sac having taken place.

"It was endeavored to set up another view of this case, involving
some parties in guilt for attempting to bring ahout aboition. The
interpretation of appearances, by the view just alluded to. was, that a
foreign body, as a sound, had been introduced, by the aid of a^specu-
lum, between the wall of the uterus and the foetal membranes, and
pushed on to the fundus of the uterus, so as to produce there a per-
foration; that by this perforation, the womb was excited to contrac-
tion, and that such contractions drove the foetus from its cavity
through the perforation ; that what was regarded as a cyst, contain-
ing the foetus, and derivable from the uterine wall, was no other than
the ovum, with its membranes, attached to the surface of the uterus
by the clots of blood, eve. This view, it was pretended, was upheld
by some reddish spots about the orifice of the vagina, (but which were
evidently of old date,) and towards the neck of the uterus; by the
possibility of introducing the little finger through the os uteri; and
from the capacity of the womb being deemed greater than it would
be if it had contained nothing. But the last is no objection, since
the uterus is known to augment in volume in all cases of extra-uterine
foetation ; and the other objections also are groundless ; for the laxity
of the os uteri is explicable from the haemorrhage ; the spots on the
vagina were old; and those on the uterus offered no trace of abra-
sion. Lastly, the appearances met with were not explicable by this
forced hypothesis."

The mode of administering the Ether. Dr. Morton, in a letter
addressed to the editor of the Lancet, says, " I have never been satis-
fied with any apparatus for the purpose of inhalation. I have aban-
doned my old inhaler, and substituted a sponge as large as the open
hand or a little larger, and concave, to suit over the nose and mouth.
Saturated with ether, this sponge is applied to the nose and mouth,
and the patient directed to inhale as fully and freely as possible."

Death of Pari set, well known as the Secretary of the Royal
Academy of .Medicine.

Erysipelas following Vaccination. Mr. Forgarty condemns the
practice of making numerous punctures w h< n vaccination is perform-
ed. He is now attending two eases of erysipelas from this cause, in
infants, and kni which terminated fatally. One genuine

vesicle in vaccination is as < tlieacious as a dozen there is then no
necessity for several panctui .

668 Insensibility during Operations fyc. dfc. [November,

New method of procuring insensibility under operations. M. Du-
cros has proposed to Ihe Academy of Sciences, the employment of the
electro. magnetic current. Individuals who have been subjected to
this agent remained insensible to pricking or pinching at all parts of
the body; and teeth have been extracted without their knowledge.

Ether in Surgical Operations. M. Roux has recently performed
Lithotomy in two cases, wherein the ether succeeded admirably. He
has used etherial inhalation in one hundred and forty-three casest
and never met with an accident from it.

Successor of Lisfranc at La Pitic Hospital M. Laugier, former-
ly of Hopital Beaujon.

" The Function of Generation. Nothing is better authenticated
than the fact that conception may take place during menstruation.
Professor Naegle recommends intercourse even during the menstrual
flow in cases of sterility."

"We lay it down as an axiom that no man having a conscience
would ever prescribe, order, or suggest, medicine for a sick person,
without a professional education, be he meddling friend, quack, or
chemist."

Honors conferred on Medical men. Besides Baron Flourens, in
the Chamber of Peers of France, and M. Bouillaud, in the Chamber
of Deputies, M. Malgaigne has recently been elected deputy from one
of the wards of Paris.

Inflammation and Ulceration of the Neck of the Uterus in the Vir-
gin Female. Passing over several other articles, some of much
interest, while others appertain alone to the British medical public, we
close this notice of the Lancet, by a short review of a paper by Dr.
Bennet, the junior editor. It has already been remarked that Dr.
B. baving enjoyed extraordinary opportunities as Interne for several
years in the Hospitals of Paris, has recently been engaged in publish-
ing his observations on Diseases of the Neck of the Uterus. Since his
return home to London, he has been made Obstetric Physician to the
Western General Dispensary, &c. Two years ago, he published a
Treatise on Inflammation of the Cervix Uteri; last March appeared
an Essay on Inflammation and Ulceration of the Uterine Neck in
women who have ceased to menstruate ; and the present article com-
pletes his work by a notice of the affections of this same organ in
the virgin state.

Dr. Bennet commences his paper by stating that opportunities for
investigating the cervix uteri in virgin females, as a matter of course,
have not been extensive. It has even been doubted, whether inflam-
mation of this part is frequent in them. The experience of the last
few years has, however, convinced him that not only inflammation
but ulceration of the cervix is not an uncommon occurrence in the
virgin. As physician acoucheur to one of the largest dispensaries in

1847.] Diseases of the os Uteri in the Virgin. 667

London, pood opportunities have been improved of observing the ail-
ments of young unmarried females, and thus has been ascertained in
a positive manner, that both inflammation and ulceration of the uter-
ine neck, in the virgin, are occasionally met with. No physical
examination ought ever to be thought of in the unmarried female,
without the physician is morally certain that severe disease exists in
the vagina or womb. The symptoms declaring this condition to ex-
ist, Dr. B. thus describes

"The current ideas respecting the white vaginal or the leucorrhoeal
discharges of females, those which are found in our most recent clas-
sical writers on female diseases, are, in my opinion, decidedly errone-
OUS. A white vaginal discharge is not, I believe, either the result of
general debility or iocal weakness, or solely produced by inflamma-
tion of the mucous follicles of the uterine neck, but the result of con-
gestion of the mucous membrane, lining the vagina and covering the
cervix. Thus, this white secretion is frequently, if not generally,
observed, in more or less abundance, during the entire duration of
pregnancy, when the mucous surfaces alluded to are gorged with
blood, and that in the absence of all inflammatory action. With
many females, also, it occurs throughout their entire uterine life,. a
few days before and after menstruation that is. whilst the physiolo-
gical molimen haemorrhagicum i-? present. I likewise nearly inva-
riably find it co-existing with ulcerative inflammation of the cervix
uteri, and it is then apparently secreted by the congested mucous
membrane which extends beyond the ulcerated surfaces. The liabil-
ity to these white, temporary, periodical fluxes, in a word, to simple
leucorrhoea, is certainly greater in females of lax lymphatic consti-
tution, and of weak health ; but we must also recollect that these are
precisely the females who suffer the most from disordered functional
activity generally, and in whom menstruation is the most apt to be
deranged in plus or in minus thus giving rise to the uterine conges-
tion, which I believe to precede and accompany simple leucorrhoea.

" When a leucorrhoeal discharge is merely the result of the physio-
logical congestion which accompanies menstruation, it does not last
during the entire monthly period, or if it does, for ten days, a fortnight,
or more, it is scarcely perceptible. Its existence does not either ap-
pear to me to exercise any very perceptible influence over the health
of the individual. Thousands of women, especially in towns, have *
more or less leucorrhcea. for a few days, before and after their men-
ses, during all their uterine life, without their I. _-. and
without their thinking of applying for medical relief. Lastly, when
this, the simple transient leucorrhcea alone exists, the only symptoms
present are, a sensation of pelvic and vaginal heat and fulness, and
sometimes, during the menses, the uterine and dorsal pains which
characterize dysmenorrhcea.

"When there is not merely congestion, but inflammation, and
especially if there is ulceration, then the white leucorrhoeal discharge
is not limited to the period before and alter menstruation. It is per*

G58 Diseases of the os Vleri in the Virgin. [November,

manenti because the presence of inflammatory ulceration keeps up a
continued state of congestion in the surrounding tissues. In these
cases, the 'whites' may be mixed with an abundant muco-purulent
secretion from the ulcerated or inflamed surfaces, and then the dis-
charge is yellow. But if the muco-pus is sparingly secreted, it will
often be lost in the whites, and the latter only will be perceptible.
The' nature of the discharge is, therefore, no true criterion. This is
the more true, as in limited ulcerative inflammation of the cervix, in
virgins as well as in married women, there may be very little fluid
secreted by the ulcers, either of one kind or another, and that little
may be completely absorbed by the surrounding tissues, so that no
discharge is observed. To resume : a yellow purulent discharge
indicates inflammation, and, probably, ulceration ; ^permanent white
vaginal discharge is also a very suspicious circumstance, as it proves,
not the existence of general or local weakness, but permanent uterine
congestion a condition which, generally speaking, is connected with
the inflammation and ulceration of the cervix, and which, even if it
did exist alone, would soon be followed by such disease. On the
other hand, the absence of either a permanent yellow or a white dis-
charge is no proof that inflammatory ulceration may not exist.

" In inflammatory ulceration of the cervix there are, nearly always,
local pains, and they constitute a much more valuable symptom than
the vaginal discharge. These pains are situated in the ovarian re-
gions, especially the left, and in the sacral and suspubic regions ; such
is the order of their frequency. They persist throughout the entire
interval of menstruation, although they are, generally speaking, much
the most severe during its existence. As there may be much pain
in all these regions during menstruation, independently of any local
inflammation or ulceration, it is only by what occurs during the in-
terval of the menstrual rnolimen luemorrhagicum, that we can judge
of the existence or absence of ulceration.

"The uterus is sometimes low ; being congested and voluminous, it
falls lower in the vagina than is natural, and then there is a feeling
of weight and bearing-down. As, however, the vagina is very con-
tractile in the virgin female, and gives considerable support to the
uterus, prolapsus is generally prevented taking place. This change
of position of the uterus would, indeed, seldom be observed, were it
not that the vagina sometimes gradually becomes relaxed, and loses
its tone, from the combined effects of inflammation and congestion.
Owing to this natural tonicity and contractility of the vagina in
young females, the presence of the feelings indicating partial uterine
prolapsus is therefore a very strong presumption that the patient has
been suffering from long-continued inflammatory action. In such
instances, the pessaries and other local means of support, which are
now not unfrequently blindly resorted to, are necessarily attended
with the most disastrous results, and generally aggravate the inflam-
mation to an extreme extent. One of the cases which I have to
narrate will painfully illustrate this assertion.

1347.] Diseases of the os Uleri in a Virgin. G69

"In many of the cases that I have seen of ulceration in the virgin
female, tbe most prominent symptom has been dysmenorrhoea carried
to an extreme degree. Indeed, as I have already staled, I am con-
vinced that many of the cases of extreme and obstinate dysmenor-
rhoea, which are at last considered hopeless, and merely palliated by
narcotics, will be found, on careful scrutiny, to be cases of ulcera-
tive inflammation of the uterine neck.

"Some females suffer great uterine pain during menstruation,
from the very commencement of the functions. It would seem as
if, with them, the physiological congestion which is inseparably con-
nected with menstruation, could not take place without great pain
being experienced. This may be either from the uterus being natur-
ally morbidly susceptible to the stimulation occasioned by the pre-
sence of blood, or it may be that the- monthly congestion is morbidly
great. Whatever be the explanation of this 'act, I have ascertained
by long and careful observation, that these females are peculiarly
liable to uterine inflammation, and it is principally among them that
I have found the cases of inflammation of the cervix that I have ob-
served in the virgin.

" When the cervix is inflamed and ulcerated, whether the menses
have previously been easy or difficult, they generally become painful,
sometimes agonizingly so, all the local pains above enumerated being
much exaggerated, and extreme cutaneous tenderness being often
experienced over the lower part of the abdomen, and sometimes all
over the pelvis and thighs. From what I have stated, however, it
will be evident that it is not the existence of pain during menstrua-
tion that indicates the presence of ulcerative disease, some women
always suffering pain, even in the absence of uterine inflammation,
but the presence of pain, when it did not previously exist, and its
increase when it did. In a word, to obtain any information that may
avail for the purposes of diagnosis from the examination of the men-
strual function, the previous uterine history of the patient must be
interrogated. The physiological variations which occur in menstrua-
tion, both with teference to pain, duration, periodicity, &c, are much
too great for it to be possible to establish any precise standard by which
we may judge of the state of any given patient. It is with herself,
only, when in health, that we can rationally compare her if diseased.

"In addition to the symptoms above enumerated, (the local symp-
toms of ulcerative inflammation of the cervix uteri.) there are the
general symptoms to be considered, and they will often throw great
light on the real nature of the case. It has not appeared tome hith-
erto, as I have already stated, that a mere white leucorrhceal dis-
charge that which I have described as often preceding and following
the menses, or any occasional uterine congestion reacts, to any
very great extent, on the health, although it is universally consider-
ed to do so by all writers on female diseases. Such a discharge often
exists in chlorotic, scrofulous, and phthisical females; but in them I
believe it to be merely the result of irregular, disordered menstrua-

670 Diseases of the os Uteri in a Virgin. [November,

tion, itself caused by the general cachectic condition of the individual.
In other words, I believe that iti these cases the leucorrhoea is only
one of the symptoms of a general cachectic, anaemic affection, and
not the* cause of the anaemia. In the absence of some tangible
cachexia, I may say, that I scarcely ever meet with extreme general
debility and weakness, co-existing with leucorrhcea, without rinding
on mature examination, that there is inflammation, and, generally
speaking, ulceration of the uterine neck. This is a clinical fact
which admits of easy explanation.

"When we consider attentively on what basis are founded the
opinions that are now prevalent on this subject in the profession, it
becomes difficult to reconcile them to pathological laws. Is it alto-
gether consistent with our knowledge of the diseases of mucous sur-
faces to admit, that a mere secretion from the mucous membrane of
the female genital organs can, in the course of a short time, utterly
deprave the functions of digestion and assimilation in a healthy,
young female, and reduce her to a state of extreme ansemia ? Such
is certainly not the case with other extensive mucous membrane?.
Thus, wc often see a very abundant mucous secretion from the pul-
monary surfaces, continuing for months or years, without the general
nutrition being much impaired, especially when this exudation is not
the result of inflammation, but of congestion of increased vital ac-
tivity only ; in a word, a hypersecretion. But we can, on the other
hand, easily understand that the presence of ulcerative inflammation
in an organ so intimately connected by its sympathetic nervous sys-
tem with the functions of animal life as the uterus, may, and indeed
must react, to a great degree, on the functions of assimilation and
nutrition. This, in my opinion, is the true, the real, and the hitherto
unknown, explanation of the general vital depression of the weakness
which is so frequently seen connected in the female with leucorrhoeal
discharge. It is not the discharge that reduces her vital powers to
so low an ebb, but it is the sympathetic reaction of ulcerative inflam-
mation of the uterine neck on the functions of life.

" From these considerations I may deduce the following rule : that
if, in addition to one or more of the local symptoms described, (in the
absence of any decided cachexia.) there is also very marked general
debility, it is a powerful reason for narrowly examining the nature
of the case, as its very existence is a presumption that the patient is
suffering from some deep-seated lesion of the uterus, and more espe-
cially from ulcerative inflammation of the uterine neck."

********

" A satisfactory digital examination of the uterus may be nearly
always made in a virgin, without injury to the hymen, especially
when the vagina and external genital organs have been relaxed by
long-continued congestion and inflammation. The hymen is nearly
always sufficiently dilatable to admit the index, introduced slowly
and with proper care. Generally speaking, the os and cervix are
reached with ease, the cervix not being retroverted, as it is when

1847.] Adulteration of Medicines* 671

inflamed in most married females; and when once the finger has
readied (he os, nearly all doubts may he solved. If the cervix is
free from disease, it is soft, and the os is closed ; if it is inflamed and
ulcerated, the cervix is enlarged, swollen, and the os is more or less
open and fungous. This open and soft state of the os may also exist
from mere inflammation of the cavity of the cervix."

Having ascertained the disease by a digital examination, carefully
made without injury to the hymen, the inflammatory slate may be
subdued by ordinary and well known antiphlogistic remedies, but
should ulceration unfortunately exist, then a small bivalve speculum
must be used, sparing again the hymen if possible, but rupturing or
incising it if found necessary, and mild cauterization with lunar caus-
tic had recourse to. In a future Xo. a detail of the more important
cases occurring in the practice of the author is promised.

Adulteration of Medicines. (From X. Y. Jour, of Med.)

The attention of the profession is invited to the following state-
ment from the Xew York College of Pharmacy:

Caution to Druggists. The Committee of Inspection of the
College of Pharmacy, are instructed by the Board of Trustees to
call the attention of Druggists to another dangerous fraud. A quan-
tity of a base composition, under the name of Blue Pill, is now in
market, having been lately imported by, or consigned to and sold by
Messrs. Cumming, Dodge 61 Co., of this city. It contains but little
more than one-fifth the proper proportion of mercury, according to
the examination of Prof. Reid, of this College, made at our request,
that we might have the corroborating testimony of the best analvst
in the city. His certificate of its composition, which we append,
shows an extent of methodical depravity in the manufacture, against
which honest dealers will have to oppose extreme vigilance in the
inspection of what they buy.

The article under notice is put up in rather large, white flat-cor-
ered jars, containing one pound each ; the joint covered with coarse
pink-colored muslin ; white label with nothing upon it but the British
arms and the words "Blue Pill," in rather heavy letters in blue ink.
The mass has tin foil laid over it, under the earthen cover.

From what we learn of its history, this spurious compound was
made by William Bailey, of Wolverhampton, whose manufacture
of similar Blue Pill, two years ago, was so faithfully exposed by the
late Mr. Adamson. A transcript of the correspondence on that oc-
casion may be found in the American Journal of Pharmacy, Vol. XI,
(New Series), p. 148. Mr. Adamson'* letter still remains unanswered.
GEO. D. COCGESHALL, ) Committee
JNO. II. CURR1E, } of

WM. IIEGEMAX, ^Inspection.

New-York, Aug. 9th, 1847.

43

672 Adulteration of Medicines. [November,

New-York Hospital, Aug. 6th, 1847.
Dear Sir According to the request of the Inspection committee
of the College of Pharmacy, I have made an extended investigation
into the composition of the Bine Pill furnished me, and have to re-
port the following concerning this dangerous and heartless fraud.
Its composition by analysis is :

Mercury, 7*5

Earthy Clay, . - 27-0

Prussian Blue, used in coloring 1.5

Sand in combination with the clay, .... 2*0

Soluble saccharine matters, 84*0

Insoluble organic matters, 12*0

Water, 160

100

I could not see any thing differing in the state of combination of
the mercury, from that generally found in Blue Pill.

The density of the Pi!l is about the same as the genuine. This is
accounted for by the large qtiantity of earthy matter, which, in com-
bination with the water, gives the requisite specific gravity, and
makes the deception more plausible.

The presence of so much earthy matter furnishes us with an easy
means of trying it. Place 100 grains on a clean iron plate or shovel,
and place the shovel over the fire until the pill is reduced to an ash.
The genuine gives 2 per cent., or near it ; this 29 per cent.

The per centage of mercury can be ascertained by a process pro-
posed by me, and described in the American Journal of Pharmacy
for 1841. Your's respectfully,

(Signed) " LAWRENCE REID.

Mr. Geo. D. Coggeshall, Chairman of the Committee of
Inspection of the College of Pharmacy.

Remarks. This is but a sample of the numerous impositions prac-
tised upon American physicians in the manufacture and sale of drugs.
We have again and again adverted to the frauds constantly carried
on in the manufacture ofspurious medicines, and have invited drug-
gists and others conversant with these impositions to expose them
through the medium of our pages. We have received in reply two
or three letters, which have been published in former numbers of our
Journal. We solicit still further communications on this subject.

It may not be generally understood, that the importation of drugs
and medicines into this country, is chiefly in the hands of commission
merchants, mostly foreigners, (German and French,) who are not
druggists by profession, and who know nothing of medicines, except
to buy cheaply and sell dearly. These men supply our wholesale
dealers, who, for the most part, have nothing to do with the importa-
tion of the articles in which they deal, and who are not unfrequently
imposed upon, as in the case of Blue Pill, as above stated. The

IS 47.] Adulteration of Medicines, 673

commission dealers have agents, travelling and resident, abroad, who
buy up the refuse drugs in all the principal European cities, and send
them to this country, where they generally meet with a ready sale.
Wo may mention, for example, Rhubarb, of which, we are credibly
informed, there have been but two invoices of a good article (Turkey?)
brought into this market since last December. Immense quantities,
however, have been imported, of a worthless, worm-eaten article,
called Turkey, invoiced from twopence to eight pence sterling, (from
four to sixteen cents per pound.) which, we have reason to know, has
boon ground and sold to our retail druggists for genuine Turkey
Rhubarb, worth four or five shillings a pound. The Compound Ex*
tract of Colocynth, which has been imported into this market for the
last year, does not contain a particle of Colocynth, but is made up of
an inferior sort of Aloes, with some other worthless ingredients. A
great proportion of the Compound Extracts are adulterated in like
manner. More than half of the narcotic and other extracts, as of
Belladonna, Conium, Hyoscyamus, Aconite, Rhatany, etc., are en-
tirely destitute of any active properties, as we know from our experi-
ence, and Opium is now rarely to be met with in a genuine form.
The Otto of Roses is more frequently than otherwise adulterated
with the oil of Rhodium, of which there is also an artificial com-
pound prepared for this very purpose. Our Volatile Oils are adulter-
ated more than half with sweet and other cheap oils. The Hydrar-
gyrum Ammoniatum, U. S. P., White Precipitate, of Bailey's manu-
facture, (Wolverhampton.) is now as much adulterated as the sample
of Blue Pill from the same house, analyzed by Prof. Reid. This is
an article of a chemical nature, which should, if prepared according
to the Pharmacopoeia, always be of the same quality; and yet we
have its invoice price ranging from three to six shillings sterling per
pound, according to quality. We have not ascertained whether it is
mixed with clay, like the blue pill, white lead, chalk or gypsum, but
we have no doubt that one of these will be found to constitute more
than 50 per cent, of it, whenever an analysis may be made. An
article is now imported, under the name of Colocynth Powder, which
is probably Colocynthin, mixed with some inert vegetable powder;
this varies in our Custom-House invoices, from 5 to 14 shillings ster-
ling per lb,, and is often two-thirds adulterated. The Extract of
Rhubarb, from 4 to 9 shillings sterling per pound, according to quality.
The Extract of Sarsaparilla, as now imported, is a worthless impo-
sition. Quinine is now imported in ^ulk instead of bottles. These
latter are now generally manufactured here, together with the labels,
according to the latest French patterns, usually the Pelletier stamp,
we believe is preferred. The Quinine now generally in use all over
this country, is at least one half Salacine ; this latter bein^ import-
ed very extensively for this purpose, at an expense of less than one-
third that of quinine. Some dealers, howe flour or starch
for the same purpose. We believe that it is owing to the adulteration
of this article that ach lafge doses are required, ami safely borne,

674 Adulteration of Medicines. [November,

in the malarious diseases of the South and West. We have known
practitioners in these regions occasionally get hold of a genuine arti.
cle, and they very soon found that their patients, so far from requir-
ing a drachm, or even half that quantity, found from five to fifteen
grains sufficient. The house of Teschdorf, Fischer dy Co., of Ham-
burgh, send us immense quantities of drugs of every description,
especially of Extracts, as of M Carduus Benedicius" " Chclidonium"
"Fumaria," " Gratiolus" "Lactuca Yirosa" JliUefolia" and
" Gra^tims"! Where are these articles used ? What are the medi-
cinal properties of the Extract of Grass? The only use for the
latter, we have very good reason to believe, is to mix with genuine
extracts, for the purpose of dilution. The invoice price of these
extracts varies from forty cents to $1,75 per pound.

Much of the IVilrate of Silver, so called, now on sale in our whole-
sale drug establishments, does not contain a particle of the metal ;
whether the substitution is prepared here or abroad, we do not know.
Of the Hydricdate of Potash also a large proportion is utterly worth-
less, Iodine not entering into its composition ; the article is exten-
sively imported in this shape. In order to have an article on which
they can depend, we would recommend physicians every where, to
prepare their own Hyd. of Potash, which can be readily done as
follows : Heat slightly a mixture of 100 grains of Iodine, 2 drachms
of water, 75 grains of carbonate of potash, with 30 grains of iron
filings. The mass is dried to redness. The resulting red powder is
heated with water, then filter and evaporate to dryness; 100 parts of
Iodine will thus furnish 135 parts of very white iodide of potassium,
but slightly alkaline.

Thus we could go through with the whole catalogue of medicines
in daily use by the physician. It is now well known that there are
establishments abroad for the express purpose of manufacturing
spurious drugs for the American market, and it is high time that
something was done to put a stop to it. As one important step to-
wards reform, we hope that our wholesale dealers will hereafter
import their own medicines, and not trust to a set of sharpers, who
think more of money than they do of life and health. There is no
propriety in leaving this branch of business in the hands of men
who are not competent judges of the genuineness of the articles in
which they deal. In the next place, we hope Congress will, at their
next session, pass a law, forfeiting all spurious and adulterated drugs,
and subjecting the owner or consignee to heavy penalties. We have
appraisers now connected with the Custom House, who are regularly
educated physicians and chemists, and who are fully competent to de-
tect these impositions, whenever they may be practised. At present,
although the government is fully aware of these extensive frauds, it
has no power whatever to prevent them ; its ad valorem estimation
maybe nothing, or next to nothing, as in the case of the rhubarb,
appraised v* the invoice at two pence sterling per pound; but it hag
no right to exclude the article from our markets. We need a string-

1847.] Adulteration of Medicines. 675

ent law, to prevent such practices in future. Again, physicians must
purchase their medicines in tFe crude state, and not in powder; if
they do, they will be imposed upon, nine times out of ten. They
must make their own extracts, syrups, pills and tinctures. They
must resort more frequently to the use of our indigenous medicines,
and never employ a foreign article where a domestic one will answer
the purpose. When they do purchase, they should buy only of those
wholesale dealers who import their own stock; and not take their
articles from those who are unacquainted with the characters of gen-
uine drugs. And lastly, they should deal only with those who sustain
the reputation of being honest men, and whose consciences would
not allow them to go on quietly in the daily practice of imposture
and deception, involving the lives and health of their fellow-men.
We hope the ' New York College of Pharmacy" will pursue this
subject, and expose a few more of the frauds now practised in the
manufacture and sale of medicines. And although we are not per-
sonally acquainted with the Hon. Secretary of the Treasury, R. J.
Walker, Esq., we have reason to believe that he will cheerfully co-
operate in bringing about a reform in this matter, and thus put a
check to the importation of spurious and adulterated articles, which
not only detract largely from the public revenue, but prove destruc-
tive to the lives and health of our citizens, and often fatal to the
reputation of the regular practitioner of medicine.

[Since the above was written, and in the hands of the printer, we
have received the following communication from the Xew-York
College of Pharmacy. Ed.]

Xew-York, Angust 24th, 1847.

Sir In behalf of the College of Pharmacy of the city of Xew-
Y"ork, I have the honor to submit for your consideration, and insertion
in your valuable Journal, the proceedings of the Board of Trustees,
in relation to the importation from Europe of large quamities of
sophisticated pharmaceutical and chemical preparations, which must
often prove highly injurious to those who may be subjected to their use.

The College ha;;, for many years, exerted all its influence to oppose
this system of culpable speculation, by cautioning dealers, through
the public prints, against the purchase of such articles as were proved
by careful analysis to be dangerous. This it has done cheerfully and
fearles>!v.

Thei.e efforts having proved insufficient wholly to suppress this
alarming evil, the College baa resolved to ask the co-operation of the
other Colleges of Pharmacy, and all the medical institutions and
practitioners in both branches throughout the Union, in an applica-
tion to Congress for a law, declaring that all pharmaceutical prepara-
tions and chemicals, which shall be found, upon careful examination,
to be spurious, shall bo confiscated and destroyed.

With the assurance of my perfect esteenij
I remain vour ant,

JOHN MIL!. s. Coll. of Phar. of X. Y.

To Ciias. A. Lee, M.D., Editor X. Y. Jour, of Med.

676 Case of Doubtful Sex. [November,

At a special meeting of the Board of Trustees of the College of Phar-
macy of the City of New-York, held on August 9th, 1847, convened
for ihe express purpose of taking into consideration the best meas-
ures to prevent the introduction, throughout the United States, of
sophisticated and misnamed Chemical and Pharmaceutical prepara-
tions it was unanimously

Resolced, That the officers of this institution he requested forthwith
to call the attention of the Secretary of the Treasury of the United
States to the fact, that large quantities of spurious medical prepara-
tions are being introduced daily into this country, not only to the
prejudice of the Custom-House revenue and the honest importer, but
in the sequel jeopardizing the health and lives of all those who require
medical aid, throughout the land. That the Secretary of the Treas-
ury be respectfully requested to apply the most stringent regulations
within his power, to check this alarmingly growing evil.

It was further Resolved, That the Philadelphia College of Pharma-
cy, and other Colleges of Pharmacy and of Medicine, be officially
requested to unite with us in presenting a memorial to Congress, to
devise means to suppress this most dangerous fraud, by making all
such sophisticated articles liable to forfeiture.

JOHN MILHAU, President.
OLIVER HULL, )

GEO. D. COGGESHALL, V Vice-Presidents.
WM, L. RUSHTON, >

John S.xowden, Sec.
James S. Aspixwall, Treas.

Case of Doubifut Sex. By S. H. Haeris, M. D., of Clarksville, Va.
(American Journal of the Med. Sciences.)

The existence of hermaphrodites, or those creatures which were
at one time supposed to unite in the same individual the distinctive
organs of the two sexes, is now, I believe, wholly denied by physiolo-
gists. Creatures of our race, however, have frequently been noticed,
presenting such equivocal appearances in their sexual apparatus as
to render it exceedingly doubtful as to their sexuality. A monster
of this singular character is now living in Mecklinburg county, Vir-
ginia, and is probably as remarkable a case of the kind as any re-
corded in the annals of physiology.

In describing the creature I shall use the masculine pronoun man,
more for the sake of convenience, than from any conviction of its
grammatical propriety.

Ned, a slave and house servant, wearing man's apparel, is about
eighteen years of age, and probably five feet eight or nine inches
high ; and though not corpulent, is rather robust than otherwise.
His head is large, with a coarse masculine face, wide mouth, thick

1847.] Case of Doubtful Sex. 677

lips, feminine vcice, and a chin entirely destitute of beard. His skin
is soft and delicate, with upper and lower extremities well formed
and rounded, with the exception of bis feet which resemble very much
the males of the African race. Thus far, however, his general ap-
pearance presents nothing very remarkable, or any thing calculated
to excite doubts as to his sexuality. His shining ebony shin and
rounded limb, are not uncommon with negro boys, trained up as
house servants among the luxurious livers of the South. But on
opening his vest and shirt bosom, there are presented two large and
well developed protuberant mammae, having all the external charac-
teiistics of the breast of a healthy well-formed young woman. His
neck, shoulders and chest partake likewise of this feminine character,
having the soft and voluptuous outline of the female. On examining
the external genital organs, which, by the way, are exhibited with
marked reluctance, a strange and anomalous appearance is present-
ed. The pubis is large, prominent, and covered with hair as in the
female, and but for the conspicuous projection of a dwarfish-looking
penis, about an inch long in the usual situation of that organ, the
creature would at once be pronounced a woman. This penis is na-
turally formed in every respect, and eminently endowed, as he
informed me, with virile sensibility. Immediately below it is a cleft
or fissure running back as in the female organ, to the perineum, the
sides of which are formed of thick folds of skin, resembling some-
what the scrotum, and shaded with long hair, representing tolerably
well the external labia of the female. No testicles can be found.
On separating the thighs the fissure is found to be from an inch to an
inch and a half deep, smooth at the bottom and exactly in the situa-
tion of the vagina. The cavernous portions of the penis may be dis-
tinctly felt through the walls of the cavity near the bottom. The
membrane lining it appears, in fact, to be only a continuation of the
outward skin, but is more soft and delicate; without, however, any
of the characteristics of the vaginal mucous membrane. Pressing the
finger on the bottom it yields so readily, as to induce the belief that
there is a cavity within, the outlet to which is merely closed up by the
skin or membrane stretched across the bottom of the fissure. But
the anomaly does not stop here. This singular creature has been
regularly menstruating for three or four years through the penis, at-
tended in its inception and progress, by all (he symptoms which com-
monly characterize the catamenia in young females. So well marked
are the returns of this monthly discharge by the usual disturbance of
the system, that the elder members of the family aie never at a loss
to determine when he is under its influence. As in most females in
every station in life, there is likewise at such periods a shrinking
from observation, and the constant exercise of a sleepless vigilance
in preventing exposure. The amount or character of the discharge
lias never been clearly Ascertained, but from his own imperfect ac-
count of it, and the evidences famished by his linen, it ditl'ers not
very materially either in quantity or quality from that of a young
woman.

678 On Rising too Early after Confinement. [November,

The question here naturally presents itself, to which of the sexes
does this human being belong? Id view of all the facts stated, the
conclusion, I think, is forced upon us, that the female organs pre-
dominate, or, in other words, that while the creature has only one of
the organs of the male, and that an imperfect one, he has within the
pelvis the interior genital apparatus of the female. That there is a
uterus with its appendices I feel no doubt; or whence this regular
catamenial discharge, and all those attributes, both moral and physi-
cal, which mark the presence of such an organ? But it has been
remarked that the displays in his general deportment, a decided par-
tiality for the society of young females, and it has even been noticed
that he exhibits towards them at times strong salacious propensities.
This, I think, can be easily accounted for on the supposition, that he
has been, from childhood up, taught to look upon himself as a male,
and now in imitation of others, deports himself as such to the other
sex. Whether his amorous advances to the dusky maidens around
him, has ever resulted in any practical display of virility, is unknown.
In the absence of all information on the subject, it is fair to conclude,
that no seminal discharge has, or ever will take place. Such a phe-
nomenon as a regular menstrual discharge, and the emission of
semen mnsculinum, from the same set of organs, would place the
creature in a new order of beings, with sexual endowments and facul-
ties, but a little less remarkable than those ascribed to the fabled
hermaphroditis. But whence comes this peculiar fluid 1 If furnished
by a womb, how does it make its way into the urethra? Or is it
thrown off by the bladder acting vicariously for a contiguous organ,
the natural outlet of which is occluded in the way before mentioned?
These are questions certainly of very little importance in a practical
point of view; but relating as they do to the interesting science of
physiology, are deemed not wholly unworthy the consideration of the
learned.

On Rising too Early after Confinement. By Wm. M. McPheeteks,
M. D. (St. Louis Med. and Surg. Journal.)

We have ever found it difficult to impress upon females the import-
ance and absolute necessity of remaining for a sufficient length of
time after confinement in a horizontal position, and keeping perfect-
ly quiet. Imprudence in getting up too soon, often entails upon the
unfortunate patient, months, and even years, of suffering which
might have been avoided had she listened to the advice of her physi-
cian, or to the suggestions of common sense. We are satisfied that
the practice of getting out of bed too soon after confinement, is very
general in our community, and hence it is that such a very large
proportion of our female population sutler with prolapsus and proci-
dentia uteri, as well as from other uterine affections, which subject

1847.] On Rising too Early after Confinement. 679

them to the necessity of wearing pessaries, or to the use of those
fashionable, but in our opinion very objectionable, instruments, utero-
abdominal supporters. Sometimes Ibis imprudence is attributable to
the want of proper precaution on the part oi medical advisers, but
more frequently it is owing to the folly of patients themselves. On
the third or fourth day after parturition, a patient who is "very smart/"'
feels able to sit up in bed, or in an easy chair, and in spite of all that
the physician can say, she will, in his absence, sit up tor the purpose
of changing her clothes, cr ^ret out of bed altogether, that it may be
made up, and not unfrequently walk across the floor, by way of test-
ing her strength. A moment's reflection must convince any one of
the impropriety of such conduct. The enlarged and engorged con-
dition of the womb, the great relaxation of the abdominal muscles, of
the vagina, and of the broad and round ligaments, all tend, under the
the circumstances, when the body is brought into an erect posture, to
force the uterus down into the vagina, and frequently through the
vulva. Again, on the third or fourth day after delivery, it is the
practice of most physicians to administer a dose of castor oii, or some
other mild cathartic, for the purpose of securing an operation from
the bowels, which are usually torpid up to this time. Under these
circumstances, patients, especially those who "feel smart," instead
of using a bed-pan, and evacuating their bowels in a horizontal posi-
tion, will get up out of bed, and n>c the elose stool, and thus bring
about the evils of which we have just been speaking.

These remarks are called forth by two rases which recently occur-
red in our own practice, where our patients were guilty of the impru-
dencies here spoken of. In one of the cases, in which we attended
in consultation with a medical friend, the labor was prolonged and
difficult, and it was necessary to remove the child by menus of in-
struments. It was a first confinement, and the woman had been
some fifty hours in labor before we saw her. Her strength was well
nigh exhausted, and it was with difficulty that she could be sustained
during the operation, which, however, terminated favorably, and the
patient was put to bed, with strict injunctions to keep perfectly quiet.
On visiting her on the tiiird morning after, we found that her bowels
bad been very much out of order during the night, that she had been
up several times on the close stool, and had suffered very much with
straining efforts. During our visit she complained greatly of pain,
and uneasiness in the region of the vulva, and on examination we
found the uterus highly engorged with blood, and of the size ofone's
fist, protruding entirely through the labia majora. The second case
was that of a young athletic woman, also in labor with her first child,
but she got along well. On the third day, the bowels not having
been moved, a Cu>se of castor oil was administered, and the patient,
contrary to our express directions, got out of bid when it came to
operate. The consequences were similar in kind, though not in de-
gree, to the case just mentioned.

In very many instances like imprudencies are not followed so im-

C80 Wounds and Injuries of the Abdomen. [November,

mediately by bad consequences, but it is invariably the case that
those who are guilty of such folly, are made to suffer for it, sooner
or later. Often, too, the bandage, instead of being pinned tightly
around the hips, for the purpose of supporting them, and being made
to press from below upwards, slips up, gets in a string, and acts as a
ligature around the abdomen, pressing downwards, and consequently
doing positive harm instead of good. Too much attention cannot
be paid to the suhject of bandaging. In the first instance it should
be applied and properly adjusted by the physician himself, and he
should instruct the nurse how to tighten and keep in its proper posi-
tion, and it should be worn long after the woman gets out of bed,
and until the parts have resumed their natural tone and strength.
The material, too, out of which the bandage is made, is worthy of
consideration. Of all the articles in common use, we prefer the
flannel, doubled, and of sufficient width to extend from the middle
of the hips to the umbilicus; it possesses the advantages of being
soft and somewhat elastic, and can be brought to fit the irregular
surface around which it is intended to pass.

A patient, after giving birth to a child, however easy or natural a
labor she may have had, should remain perfectly quiet on her back
for at least two or three weeks, at the end of which time, provided
every thing goes on regularly, she may be allowed to sit up cautiously
in bed, and gradually remain for a short time out of bed, in a sitting
posture; but as a general rule, they should not be permitted to rise
from their beds under three weeks and frequently not so soon. This
rule may seem a little stringent to those who have been in the habit
of getting up at farthest on the ninth day, and often walking all over
the room long before that period ; hut time would be saved by observ-
ing it, and patients would save themselves an immense amount of
sub-equent pain and unhappiness.

We are aware that our suggestions contain nothing new or original,
but the subject is one of vast importance, and which is too much
neglected it is therefore necessary to add "line upon line, and
precept upon precept." The health and comfort of the female sex
is so intimately identified' with our own happiness, that whatever
affects them materially, concerns us; and we are satisfied, that if
due attention was paid to their "proper getting up" after confine-
ment, we would not sec so many young and lovely wives suffering
with uterine affections pale and anaemic, and unable to take the
least exercise, or even to attend to their ordinary household affairs,
without the greatest pain.

Wounds and Injuries of the Abdomen. General Conclusions.
By G. J. Guthrie, F. R. S. (Ranking's Abstract.)

[Lectures on some of the more i?n port ant points in Surgery, 1847.]

1. Severe blows on the abdomen give rise to the absorption of the

muscular structures, and the formation in many instances of ventral

1347. J Wounds and Injuries of the Abdomen 681

hernia ; this may, in some measure, be prevented during the treat-
ment by quietude, by the local abstraction of blood, and by the early
use of retaining bandagi

2. Abscesses in the muscular wall of the abdomen, from whatever
cause they arise, should be opened early ; for although the peritoneum
is essentially strong by its outer surface, it is but a thin membrane,
and should be aided surgically as much as possible.

3. Severe bl< v . neral concussion, frequently give
rise to rupture of the solid viscera, such as the liver and the spleen,
causing death by hemorrhage. When the hollow viscera are ruptured,
such as the intestines or the bladder, death ensues from inflammation.

4. Incised wounds of the wall of the abdomen of any extent rarely
unite so perfectly (except, perhaps, in the linea alba) as net to give
rise to ventral protrusions of a greater or less extent.

5. As the muscular parts rarely unite in the first instance after be-
ing divided, sutures should never be introduced into these structures.

6. Muscular parts are to be brought into apposition, and so retained
principally by position, aided by a continuous suture through the in-
teguments only, together with long strips of adhesive plaster, moder-
ate compression, and sometimes

7. Sutures should never be inserted through the whole wall of the
abdomen, and their use in muscular parts, under any circumstances,
is forbidden ; unless the wound, from its very great extent, cannot be
otherwise sufficiently approximated to restrain the protrusion of the
contents of the cavity the occurrence of which case may be doubted.

8. Purgatives should be eschewed in the early part of the treatment
of penetrating wounds of the abdomen. Enemataare to be preferred.

9. The omentum, when protruded, is to be returned, by enlarging
the wound, through its aponeurotic parts if necessary, but not through
the peritoneum, in preference to allowing it to remain protruded, or
to be cut cfT.

10. A punctured intestine requires no immediate treatment. An
intestine, when incised to an extent exceeeding the third part of an
inch, should be sown up by the continuous suture in the manner re-
commended in pages 26 and 27.

11. The position of the patient should be inclined towards the
wounded side, to allow of the omentum, or intestine, being closely
applied to the cut edges of the peritoneum. Absolute rest, without
the slightest motion, should be observed. Food and drink should be
restricted when not entirely forbidden.

12. If the belly swells, and the propriety of allowing extravasated
sed matters to be evacuated seems to be manifest, the continu-
ous suture or stitches should be cut across to a certain extent, for the
purpose of giving this relief.

13. If the punctured or incised wound is small, and the extravasa-
tion or effusion within the ca\ i to be gnat, the wound should
be carefully enlarged, and the offending matter evacuated.

1 !. A wound should not be closed until it has ceased to bleed, or

682 Effects of Blisters on the Young Subject. [November,

until the bleeding vessel has been secured, if it be possible to do it.
When it is not possible so to do, the wound should be closed and the
result awaited.

15. A gunshot wound penetrating the cavity can never unite, and
must suppurate. If a wounded intestine can be seen or felt, its torn
edges may be cut off, and the clean surfaces united by suture. If the
wound can neither be seen nor felt, it will be sufficient for the moment
to provide for the free discharge of any extra vasated or effused mat-
ters which may require removal.

16. A dilatation or enlargement of a wound in the abdomen should
never take place, unless in connection with something within the
cavity rendering it necessary.

17. When balls lodge in the bones of the pelvis, they should be
carefully sought for and removed, if it can be done with propriety and
safety.

18. in a wound of the bladder, an elastic gum catheter should be
kept in it, until the wound is presumed to be healed ; unless its pre-
sence should prove injurious from excess of irritation, not removed by
allowing the urine to pass through it by drops, as it is brought into
the bladder.

19. In all cases in which a catheter cannot be introduced, in con-
sequence of the back part of the urethra or the neck of the bladder
being injured, an opening for the discharge of the urine should be
made in the perineum.

20. The treatment of all these injuries must be eminently antiphlo-
gistic, principally depending on general and local blood-letting, abso-
lute rest, the greatest possible abstinence from food, and in some
cases from drink, the frequent administration of enemata, and the
early exhibition of mercury and opium, in the different ways usually
recommended, with reference to the part injured.

On the Effects of Blisters on the Young Subject. By Dr. J. B. Beck.

(New-York Journal of Medicine.)

The mode of conducting the process of blistering in a young
subject is a matter of greater nicety, and should call for the utmost
care on the part of the practitioner. As one of the principal causes
of gangrene, is the leaving the blister on too long, this is a point which
should be specially attended to. To many this may appear a small
matter, but it is really one of great moment, and in relation to which
I am sorry to say that the directions given in many of our practical
works are so discordant, as to be very poor, if any, guides to the
young practitioner. By way of illustration, I will quote a few of
them. Dr. Armstrong says, "from twelve to fifteen hours is gener-
ally sufficient for the application of the blister in adults, and halfthat
period in children." Dr. Williams says, that " to avoid gangrene in
children, it is advisable never to allow the blister to remain on more
than six hours/*' Dr. Dcwces states that "in children, the blister is

1847.] On Ike Varieties of Headache. 683

frequently found to have performed its duty in eight hours, and very
often in six. It should therefore always be examined at these peri-
ods, and dressed, if sufficiently drawn ; if not, it should be suffered to
remain until this take place. Evanson and MaunseU say, "in no
instance is the Mister to be left on more than a few hours (from two
to four) not longer, in fact, than until the skin is reddened, when
vesication will follow ; but this result should not he waited for, as at-
tendants always will do. unless the most express directions to the
contrary be given." Xeligan directs that "as a general rule, in
infants and young children, blisters should only be left on until red-
ness of the surface is produced, when the application of a warm
poultice to the part will cause vesication." Ballard and Garrod re-
mark, that in children a blister should not he allowed to remain on
longer than to produce redness of the surface ;" and they add, "in
very young infants, it has appeared to us doubtful whether even red-
ness should be permitted to occur before its removal." The foregoing
is a sample of the discrepancy of opinion in relation to a most im-
portant point of practice, and one confessedly too, not unfrequently
involving the life of the young subject, as advanced by authors of the
highest respectability, and who may be supposed to exert a wide
influence in guiding the practice of young beginners in our pro-
fession. The fact is, and this perhaps may account somewhat for the
difference of opinion just noticed, that no positive rule can he laid
down in relation to the precise time that a blister should he left on a
young child. From the original differences in the sensibility of the
skin in children, the period must necessarily vary, and the only safe
general rule, is to be governed by the actual effect produced. For
this purpose the blistering plr.yfer should be raised at suitable inter-
vals and the state of the skin observed. And the safe plan is, ac-
cording to the directions of some of the authors quoted above, to
remove the blister as soon as the surface appears uniformly red, and
then to apply a soft poultice. In most cases this will be followed by
suitable vesication, while any injurious consequences will be averted.

On the Varieties of Headache. By Dr. Wright -(Med. Times,
from Ranking's Abstract.)

The various circumstances under which headache may arise as a
prominent symptom, arc thus briefly explained by Dr. Wright in a
series of clinical lectures.

To give you a general notion of them, as we are yet dealing in
generalities suppose a patient comes to you complaining of head-
ache. This is a very generic sort of term, and may involve a great
variety of specialities, some serious, and others simple. One patient,
we will say, is in his teens, or not far out of them, yet he looks older
by many yenrs than he ought to do. His face is blanched and
parchment-like, cheeks sunken, eyes hollow, lustreless, and watery,

684 Onihe Varieties of Headache. [November,

and they never look fairly at you ; the man is timid, nervous, shuns
society, and has no inclination for active pursuits ; he is subject to
giddiness and forgetful n ess, and has almost constantly a dull, heavy
pain at the back of his head, perhaps extending down the spine, with
a sense of weight and dragging of his le^s. Here you have a nervous
system enfeebled and shaken from causes you will easily learn if you
pointedly inquire after the personal habits of the sufferer. Another
complains of oppressive pain chiefly over his eyes, scarcely ever
leaving him, but distressingly aggravated at different periods of the
day. It is probable that these periods are subsequent to meal times,
and that then the headache is attended also with drowsiness. The
man is dyspeptic. He will tell you that his bowels are confined, and
that he is troubled with wind. Look at his tongue, and you will see
that it is furred with, most likely, a brownish patch in the centre.
Percuss the right hypoehondrium, and you may find a greater extent
of dullness, or more tenderness, than natural. The condition of the
great viscus here is wrong. Liver, stomach and bowels, are the
sources of that frontal headache. Another patient has pain in the
forehead, but it is acute and lancinating, and not persistent. Its
periods of accession and departure are pretty regular. Ask the pre-
cise spot of the pain, and you will have indicated the exit of the supra-
orbital nerve of either side, probably the left. Here you have a case
of tic douloureux, which may have no obvious exciting cause, or may
result from exposure to cold, from dyspepsia, from pregnancy, from
uterine disease or disorder, &c. Another complains of aching all
over his head, considerabl}' increased by heat or cold, as the case may
be. On further inquiry, you learn that the pain is chiefly superficial,
and that to rub the patient's hair in different directions, sharply, is to
agonize it. Here you have rheumatism of the cranial integuments.
Look cautiously after this case. You may suddenly have a pain of
a different kind, and deeper seated, ushered in by screaming and
shouting, followed by restlessness and delirium, with a glaring and
dejected eye the meninges of the brain will be suffering from metas-
tatic rheumatism in its most active form. It was gout, thus trans-
ferred, that destroyed the valuable life of Dr. Ingleby, your late Pro-
fessor of Midwifery. Another has acute pain darting through his
temples and ears, especially when he gets warm in bed ; at the same
time, he has what he well describes as ' gnawing pains' in his shin-
bones ; his nose is tender, and the roof of it painful ; he has, or has
had, sore throat, and there are copper-colored patches about his body.
This headache has its foundation in syphilis; mind your treatment,
or the more delicate bones of the head and face may be sacrificed.

A delicate female complains of heavy throbbing pain over the
middle, or at the back of the head. She has had it several months,
more or less, and is liable to periodical exacerbations. The uterus has
likely something to do with this pain. It may be a case of simple
amenorrhcea; it may denote the climacteric period of female life; it
may depend upon pregnancy or the uterus may be undergoing some

1347.] Treatment of Acute Articular Rheumatism. 586

morbid change. This organ, however, may not be at fault ; habitual
constipation, which females are often in the habit of neglecting; may

be the cause of the suffering, or it may be occasionally by hemor-
rhoides.

Such, and so many, nay, many more, are the varieties of pains in
the head, having different causes, and requiring different forms of
treatment.

[Dr. Wright has described with great clearness several varieties
of headache. We have often met with the following not mentioned
by him : An individual rises in the morning with a headache, with
which he may or may not have gone to bed. At dinner or supper
the evening before he partook of some indigestible article of food
which, passing the stomach, is producing irritation in the bowels.
In this region green corn is often the cause of such trouble. The
remedy is obvious, and consists in a laxative to remove the offending
body. A Seidlitz powder or a little Blue-lick water, taken before
breakfast operates promptly and affords complete relief.

We have met with still another variety of headache, which generally
attended influenza in 1843, and is often associated with catarrh.
This is a headache confined to a small space over the eye, in the
region of the frontal sinuses, and is not unfrequently periodical in
its character. Such headache is sometimes purely nervous, and
will yield to an opiate. In the epidemic referred to, this pain in the
forehead was the m;st distressing symptom in a majority of cases,
and its subsidence under a teaspoonful or two of paregoric often
surprised as much as it delighted the patient. It was found neces-
sary to repeat the opiate two or three days at the recurrence of the
headache. Western Journal of Med. and Surgery.']

Treatment of Acute Articular Rheumatism hy cold applications to
the effected joints, with opium and quinine at night. By W. S.
W. Ruschenberoer, M. D., Surgeon U. S. Navy. (From Am.
Journ. Med. Sciences.)

Extract from a paper, accompanying Surgeon Ruschenberger's
quarterly report of diseases and injuries, at the Naval Hospital, New
York. Communicated by Thomas Harris, M. D., Chief Bureau of
Medicine and Surgery, U. S. Navy.

"In a case of acute rheumatism, complicated with nodes on the
shins and syphilis, an ineffectual attempt to obtain the specific effects
of mercury had been made in the commencement of the case.
When in health, the patient weighed 220 pounds. He had been
confined to bed for four months, and when admitted was unable to
bend the knee, wrist, elbow, or finger-joints, without great pain.
Cold water dressings were kept constantly applied to the painful
joints, half diet was allowed, and he took at bed time, every night,
two pills, composed of four grains of opium, and four grains of &ul

6 SO Diagnosis of Mer curial Sore. [November,

phate of quinine. On the tenth day of treatment he left his bed.
His weight was 136 pounds. At the expiration of twenty days the
pain had disappeared ; the quinine and opium were discontinued.
There still remained thickening and stiffness ahout the joints. For
this condition phosphoric acid in syrup of primus virginiana was pre-
scribed, as follows : R. Sol. acid phosphoric 5ij; syrup pruni virg.
q. 3.; ft. gviij. M. cap. gss in aq. font, giv, q. q. 4ta hora. Under
this treatment the functions of the joints were perfectly restored,
and the patient gained twenty pounds in weight in thirty days, and
the nodes disappeared.

11 While taking the quinine and opium the bowels, which had been
previously constipated, were regularly moved once in twenty-four
hours; but under the use of phosphoric acid, it was found necessary
to occasionally prescribe castor oil, and an anodyne at night.

"I have been in the habit of treating acute rheumatism, upwards
of two years, by cold applications to the hot and swollen joints, and
administering at night from three to six grains of opium, with an
equal quantity of sulphate of quinine, regulating the quantity by
condition of the pupil alone. With a dilated pupil, I found patients
to bear the largest dose without inconvenience, and I have not yet
met a single case in which pain was not completely removed in from
twenty four to thirty-six hours, provided the attacks were recent, or
of not more than a week's duration. Large doses of opium, espe-
cially in combination with sulphate of quinine, do not tend to con-
stipate, but rather to relax the bowels. After the pain is removed
by the opium, I then resort to the use of the iodide of potassium, in
medium doses, say from five increased gradually to ten grains, three
or four times a day.

"Passed Assistant Surgeon, S. Holmes, who witnessed the results
of this practice in my hands, made trial of it on the coast of Africa,
and as he informed me, with entire satisfaction."

Diagnosis of Mercurial Sore. (From Ibid.)

Dr. Porter, in a valuable course of lectures on syphilis, published
in the Dublin Medical Press, gives the following as the characteristics
of the mercurial in contradistinction to the venereal sore :

1. Mercurial sores are not necessarily circular or oval in shape,
neither are their edges regularly defined ; on the contrary, they vary
in these particulars, and assume different forms as they spread ; their
edges are often quite ragged, loose, and undermined, and their bor-
ders are often marked with a thin, transparent cuticle, like that of a
newly-formed cicatrix, extending quite around them, and giving them
a silvery-white appearance.

2. The bases of mercurial sores are not hard, neither are their
surfaces covered with the tenacious adherent lymph so characteristic
of venereal; on the contrary, the. surface of the mercurial ulcer

1847. J Therapeutic Action of Nitrate of Silver. 687

may present every variety of shape and appearance, sloughy at one
spot, deeply excavated and rapidly ulcerating at another, with ex-
uberant granulations at a third, and exhibiting a tendency to heal at
a fourth.

3. But the most striking characteristic of the mercurial ulcer is,
its tendency to spread, and the manner in which it enlarges itself.
Venereal sores, when not affected by phagedena, increase slowly,
and having reached a given size, remain so; the mercurial generally
spread quickly, and there seems to be no limit to the size they may
possibly attain. I have seen an ulcer as large as my hand in each
groin of the same individual. Mercurial sores, too, are easily dis-
tinguished from the venereal, when they assume an herpetic charac-
ter, and heal in one part whilst they are spreading in another, which
the latter never do ; this latter diagnostic is often extremely valuable
in ulcers of the throat and on the penis, where any extensive loss of
parts may be most sensibly felt during the life of the patient. The
mercurial ulceration, too, often attacks the cicatrix of a recently
healed chancre, and a fresh sore is thus formed a circumstance that
does not happen to the true venereal sore, except by some accidental
injury, or the application of a new infection.

PART III. MONTHLY PERISCOPE.

The therapeutic Action of Nitrate of Silver. Dr. Florian Heller
determined to examine experimentally the different opinions en-
tertained by authors regarding the therapeutic action of nitrate of
silver, whether employed externally or internally. The good effects
of this agent when used locally in the pathological changes of the
mucous membranes of the eye, of the organs of generation, and as
a caustic, are now pretty well known and acknowledged by all.
This salt coagulates the albumen and cellular tissue, decomposes
also the chloride of soda and the phosphates found in all the secre-
tions, and the result is an insoluble chloride and phosphate of silver.
The frequent application of this agent upon the epithelium cells
which cover the mucous membranes, while it occasions a rapid and
abundant separation of these cells, is followed by a rapid and abun-
dant reproduction of them. But the explanation of the internal
action of the nitrate is not so easy. Dr. F. H. carefully examined
the blood, the urine and the faeces of patients who took this salt in
large doses during several months ; as well also its direct action upon
the gastric juice. Seven epileptic patients took from 3 to 12 grains
daily of nitrate of silver during three full months, making thus 2|-
ounces that each one swallowed; and this without any influence
over the disease or direct action on the system, not even the brown
coloration of the skin. No change was made upon the blood neither
in the urine. The flccal matter contained the whole silver that had
been administered. Mixed with the gastric juice, the nitrate was

11

6S8 Cod-liver Oil in Struma. Treatment of Insanity. [November,

decomposed and precipitated by the chlorides of potash, soda and
lime, which this secretion normally contains. Not an atom penetra-
ted the blood, and the coloration of the skin noticed by some authors
after the use of this salt, Dr. Heller believes to be a mere coinci-
dence. [Translated from the Archives Generates de Med.

Cod-Liver Oil in Struma. Having mentioned the use of cod-liver
oil in the strumous diathesis, I avail myself of this opportunity of
corroborating the testimony of those (and, among the rest, of Dr.
Bennett) who have extolled the use of this medicine in strumous dis-
eases in general. I have seen it do what I never saw any other
remedy effect, i. e., reduce to the natural size amygdalae that were
enlarged from the period of extreme youth. A most remarkable in-
stance was that of a young lady, aged about 19, whose amygdala;
were as large as small walnuts, and which I treated without effect for
two years, both by iodine internally, and nitrate of silver locally. A
three months' course of cod-liver oil left no trace of the disease be-
hind. Under the influence of this oil, the enlargement of the cervical
glands in young persons of a scrofulous habit frequently disappears,
and the tendency to the formation of phthisis and the recurrence of
strumous haemoptysis is occasionally overcome. In persons of a con-
sumptive tendency I consider this as a valuable addition to our
remdies.

Having mentioned the spitting of blood that so frequently forms
the first obvious symptom of consumption, a remarkable case is
brought to my memory which I saw along with Dr. Stokes and Mr.
Corr. It was that of a young man, a partner in an extensive manu-
factory in this city, who was attacked on his birth-day with a spitting
of blood. The disease did not recur until his next birth-clay, and thus
he was attacked for several successive birth-days. The last haemop-
tysis ushered in the usual train of symptoms attending on galloping
consumption. The recurrence of the symptoms on his birth-day
evidently arose, not from any real periodicity in the disease, but from
nervous and vascular excitement produced by apprehension. [Dr.
Graves, in Dublin Quarterly Journ. of Med. Science.

Treatment of the acute forms of Insanity, particularly Mania, by
the prolonged use of irrigation and baths. M. Brierre de Boismont,
being a candidate for a vacant place in the section of Therapeutics,
communicated to the Academy of Medicine of Paris, a work having
the above title. He observes that heretofore the greatest number of
mania were cases cured from the second to the fourth month, some
not until the fifth to the twelfth. By his mode of treatment they
are generally cured in a weel". Of 72 cases, 35 of which were acute
mania, 33 were cured; 10 of furious mania, 6 cured ; II of delirium
tremens, all were cured; 10 of monomania, all cured; and of 6
chronic intermittent mania with acute symptoms, all resisted the
treatment. They were under treatment from 1 to 15 days. Each

1847.] Int. Fever. Croton OH. Urticaria. Variola. $c. <>89

patient took about six baths. The essential plan of treatment was a
batl) of ordinary temperature which was allowed gradually to cool
while the patient remained in it ten, twelve or even fifteen hours, re-
ceiving upon his head at the same time a cold stream of water, fall-
ing the height ofo or 4 feet. [Trans, from the Arch. Gen. cle Med,

Treatment of Intermittent Fever by Sulphuric Ether. (Gazette
Medicale. Trans.) Dr. Challeton has almost constantly succeeded
in curing intermittent fever in the neighborhood of Gannat, by giving
a half tea-spoonful of sulphuric ether in sweetened water, either at
the moment of the chill or in the intervals of four hours during the
day preceding the attack. Several other practitioners have confirm-
ed the results thus obtained by Dr. C.

Efficacy of the topical employment of Croton Oil as a palliative
means in pulmonary tuberculization. (Gaz. des Hopitaux. Trans.)
AI. Rayer has obtained good effects from copious frictions made with
the Croton oil on patients a prey to the formation of pulmonary tu-
bercles. He commonly has applied 24 drops to the anterior surface
of the chest, and recommends the patient to rub them freely with the
palm of the hand.

Tincture of Iodine in obstinate Intermittent Fever. Dr. Seguin,
of Albany, in a short paper in the Journal des Connaissances Medi-
caids Pratiques, December, 1846, states that he has found the tincture
of iodine, a very valuable and effectual remedy in cases of intermit-
tent fever, which have resisted quinine and other antiperiodics. It
is is not equally effectual, he says, in recent cases. He gives it in
doses of 30 drops in a little sweetened water, in three doses during
the paroxysm, and gradually increases the dose to 40, 50 and even
60 drops. [American Journ. of P harm.

Pathology of Urticaria. Dr. Douglas M'Lagan has surmised,
from the result of a chemical examination of the urine in one case,
that urticaria depends upon the non-elimination of urea fromfthe sys-
tem. In the case in question the proportion of urea was diminished
by one half, the total quantity of urine being at the same time not
increased. Under the impression that as in rheumatism, in which
an analogous condition exists, colchicum is known to be useful, it
was exhibited in the above case, and with the best results, as the next
examination proved the urea to have been increased nearly threefold.
At the same lime the cutaneous irritation entirely subsided. [Edin-
burgh Monthly Journal.

Variola, Vaccinia. Varioloid and Varicella. Dr. Koesch, the au-
thor of an essay published under the above title, concludes:

1. That cow-pock is nothing more than small pox, transmitted to
the cow by contact.

690 Ascites. Salivation. Psoriasis Inveterata. [November,

2. That persons who have been effectually vaccinated may, in
some rare instances, contract dangerous small- pox.

3. That small-pox after vaccination is, in the great majority of
cases, of trifling severity.

4. That the rarity and mildness of small-pox are in proportion to
the recency of the vaccination.

5. That small-pox seldom appears after the age of thirty, but is not
always less severe when it does so.

6. That the majority of the vaccinated are entirely exempt from
small- pox, even though exposed to contagion.

7. The identity of variola and varioloid is demonstrated by their
phenomena, development, and by the results of contagion or inocu-
lation.

9. That varicella is in nowise connected with variola, but is a per-
fectly distinct disease.

9. That vaccination is the only mode of exterminating small-pox.
[Medicinische Corresp. Blatt., and Prov. Med. Journ.

The Urine in Ascites. In ascites, dependent on lesion of the liver,
the urine is always more or less deeply colored, whilst in renal ascites,
(Bright's disease or otherwise.) the urine is white and colorless
(Rayer.) This characteristic condition of urine in ascites was per-
fectly known to the Arabian physicians. [Monthly Journal of Med.
Science.

Chlorate of Potass in Salivation. Mr. Alison states, that having
bad many opportunities of observing the beneficial effects of the in-
ternal use of the chlorate of potassa, (KO, CIO.,) in the various forms
of pure anaemia, in which the intolerance of mercury is notorious, he
was led to believe that as these closely resemhle in many particulars
the state of system produced by the full action of mercury, the medi-
cine might be equally beneficial in the latter, and that the result of
numerous trials exceeded his expectations. He warns us, however,
that certain precautions are necessary in the use of the chlorate, as
if it be given in injudiciously large doses, or for too long a time, it is
apt to give rise to inflammatory symptoms. He thinks that it and
mercury are antagonistic in their action. [Med. Gazette.

Psoriasis Inveterata. Dr. Romberg found the aqua picis liquidae to
effect a cure when all other means failed. The aqua was prepared
by pouring a quart of cold water over a pound of pitch, and leaving
it to stand for twenty-four hours in a cool place ; and a beer-glass of
the water, filtered through paper, is to be taken every morning fasting,
and the parts affected to be bathed with it twice or three times a day.
Its use may be continued for months, the only apparent effects re-
sulting being slight diuresis. Six cases are related in proof of the
great efficacy of this remedy. [Medical Neics.

1847.] Navus. -Fissures of the Anus. Albuminous Urine. 691

Cure of Ncbvus. Dieffenbach says, in flat naevi, up to the size of
a crown-piece, lint, steeped in pure liquor plumbi, is to be fastened
over the part with a bandage, and wetted by fresh applications of the
lead without frequent removal. After days or weeks, the swelling
becomes whiter, flatter, and firmer; soon afterwards, little, firm,
white spots form on the surface, and the cure is certain. By means
of a solution of alum and compression, neevi, so large that extirpation
would have been impossible, have also been cured. It may be ne-
cessary to keep the remedy constantly applied for six months.

[Medical News.

Treatment of Fissures of the Anus, by M. Diday M. Diday re-
commends the patient to apply to the anus, night and morning, with
the end of the finger, a portion of ointment, about the size of a cherry-
stone, composed as follows :

R. Axungiae, - - 15 grammes,

Tannin, - - 1 gramme;
increasing the proportion of tannin gradually to three grammes or
more, according to its effect on the sensibility of the part. To apply
it efficiently the patient should push his finger as far as possible with-
out forcing the sphincter, and there leave the ointment, where fis-
sures are situated higher, a solution of tannin may be injected into
the rectum with a small syringe. The quantity of liquid introduced
should be as small as possible, in order that it may be retained for
some time. In both cases the patient should experience some degree
of heat, and smarting continues for some time after the application.

[Annuaire de Therapeut Ranking's Abstract.

Albuminous Urine produced by the use of Cantharides. M. Bouil-
laud read to the French Academy of Sciences, June 8th, a note on
the production of albuminous urine by the use of cantharides. Hav-
ing had numerous cases under his care where albumen was detected
in the urine including true cases of Blight's disease, he determined
to make some new researches concerning the different conditions or
circumstances under which albumen may occur in the renal secre-
tion. For a long time he had noticed it in those cases where there
was undoubtedly serious disorganization of the kidneys, or Bright's
disease; but besides confirming his previous knowledge in this mat-
ter, his recent researches had brought to light one source of albumen
in the urine which had escaped others, and that source existed in the
action of cantharides. In many individuals, in whom there was no
renal disease, he had large blisters placed on the skin, in those places
where they had been previously cupped. In a man who had moder-
ate pleuritic effusion, but whose urine contained previously no albu-
men, after he had been cupped, a blister was placed over the cut part.
The urine passed after this, was put by, and on the next morning it
was treated with nitric acid, when it became turbid and white, and
altogether assumed the aspect and consistence of weak emulsion.

092 Prevention of Abortion. Bronzing Confectionary. [November,

The action of the cantharides on the kidneys, in this case, was evinced
by the frequent desire to make water, the pain and agitation attend-
ing it ; all which, as in other cases observed, passed off in twenty-four
or thirty-six hours afterwards. This was the first case in which the
experiment was tried ; it was repeated in many others, all confirming
the results above obtained. The action of the blisters in the way
spoken of, was greater when applied to the skin after cupping, than
when this was entire a feet to be anticipated dpriori. This curious
form of albuminuria disappears at the end of two or three days, and
is followed by no dropsy, as is the case where there is organic disease
of the kidney.

In England, this action of cantharides in producing albumen in the
urine, as well as in causing the exudation of blood, has been previous-
ly noticed. The investigations of the French physician, however,
are confirmatory. [Lancet.

Prevention of Abortion. In the number of the Dublin Quarterly
Journal tl>r May last, Dr. Griffin advances, in one of his medical
problems," the question whether, when miscarriage or premature la-
bour takes place, at fixed periods, from the influence of an acquired
habit, the "nodical movements may not be prevented by such rem-
edies as prevent the return of epileptic fits or agues? In an answer
to this query, he relates the case of a lady who had miscarried sever-
al times at ibe third month, and came under his care in her sixth
pregnancy. Dr. Grifnn could not detect any obvious cause of her
former abortions, and as all other moans had been tried, it occurred
to him to try a course of some metallic tonic, given on the same
principle as in i She therefore took two grains and a half of

oxide of zinc, with extract of \i^\)s, three times a day, followed by
valerian, aromatic spirits of ammonia, and decoction of snake root.
She was advised, instead of lying upon the sofa, to take the air as
much as possible. Under this treatment she passed the usual period
of miscarriage to her great joy. Happening, however, to meet soon
after with causes of mental excite, experienced the premon-

itory symptoms of abortion to which she had been accustomed ; but
by taking a grain of opium every hour till the pain ceased, the acci-
dent was warded off, and she was soon able to resume the zinc. She
went her full time. A second and still more striking case is narrated.

[Amer. Journ. tf Med. Sciences.

Bronzing of Confectioner,;. According to the Police Regula-
tions of Paris, confectioners are allowed to use only gold and silver,
as metallic ornaments to confectionary. Copper, bronze, and all the
alloys of copper and zinc are prohibited. Some confectioners have,
however, employed sham gold ; an alloy formed of zinc and copper.
A large quantity of confectionary thus ornamented, has been recent-
ly seized at Bordeaux, and an action has been commenced against
the confectioner who supplied th^ articles. He produced some of the

1847.] Pectoral Syrup. Epsom Salts. New Purgative. 693

powder, which he said he procured of a druggist, who sold it to him
as a mixture of talc and oxide of gold. The application of nitric
acid and ammonia, however, soon proved that the gold was a copper
alloy. Jour, de Chimie. Nitric acid is perhaps the best test, as
some of these alloys very closely resemble red gold in colour. The
copper alloy is immediately dissolved by the acid, forming a green
coloured solution; gold remains unaffected. These copper alloys are
much used in England for ornamenting gingerbread, and Scheele's
green and chrornate of lead are also employed for the purpose of co-
louring sugar plums. De minimis non curat lex. The English law
thinks any interference with this mode of selling poisons, an invasion
of the liberty of the subject ! [London Med. Gaz., and Idem.

Pectoral Syrup. (Gazette Medicale. Trans.) Dr. Maroncelli
recommends the following syrup to facilitate expectoration and calm
the coughing, without the objection and inconvenience of containing
any opiate preparation :

Take o( Balsam of Tolu, 60 grammes. Agitate for two hours in

boiling water 3000 grammes, pour it then upon the

dry leaves of Digitalis, > .
if R Ti i i 16 grammes.

' " Belladonna, ^ b

Ipecacuanha, bruised, 4 grammes.

Let it macerate for 12 hours, filter and add white sugar, 6000 gram-
mes. Heat moderately to dissolution of the sugar, and then clarify
with the white of an egg in 125 grammes of water. Dose: two to
four teaspoonsful occasionally during the night.

To remove the Bitterness of Epsom Salts. (Journal des Conn.
Med-Chir. Trans.) M. Combe says that 10 centigrammes of tan-
nin in the water necessary to dissolve 30 grammes of Sulphate of
Magnesia, will destroy its bitterness. The taste of the tannin may
be removed by 10 grammes of roasted and pulverised coffee the
whole taken in a little broth.

A pleasant Substitute for Epsom Salts as a Purgative. M. Garot
recommends the following formula for the preparation of tasteless
purgative salts (citrate of magnesia) :

Carbonate of Magnesia .... 15 parts

Citric acid 21 to 22 "

Aromatic Syrup .... 00 *'

Water - 300 "

The citric acid is separately dissolved and added to the carbonate
of magnesia diffused in water.

As thus prepare.! it is not effervescing; but it is easily rendered so
by adding only half the quantity of acid, and reserving the addition
of the other half, until the dose is taken. The above proportions in
grains would constitute a dose.

Dr. Pereira long since suggested the use of citrate of mngncsia in

/ b /

694 Syrup of Wild Cherry Bark. c. $c. [November,

nearly similar proportions. He found that one scruple of crystallized
citric acid saturated about fourteen grains of light or heavv carbon-
ate of magnesia. [Loud. Med. Gaz.

Syrup of Wild Cherry Bark. Take 4 ounces of the powdered
bark and macerate in 12 ounces of water for 43 hours remove the
fluid by displacement and add 24 ounces of sugar. Apply no heat,
for that would dissipate the hydrocyanic acid, and the syrup would
ferment.

Acid Nitrate of Mercury. Dr. Xeligan gives the following as the
formula for the preparation of this new and useful application:
Take of pure mercury, 100 parts; commercial nitric acid, (density
about 1380.) 200 parts : dissolve the mercury in the acid with the aid
of heat, and evaporate the solution until it is reduced to 225 parts.

[St. Louis Med. and Surg. Journal.

Mode of Administering Aperients to Children. Phosphate of soda
may be used conveniently as a condiment in soup in the place of
common salt. Children may be unconsciously beguiled into the
taking of the medicine in this way, and it will be found an excellent
purgative. [Med. Tunes and Med. Xcics.

Carminatives and Tonics. Cullen's opinion was that coriander-
seeds correct better than any other carminative the griping effects of
senna. Cascarilia, says Dr. Dick, is an excellent aromatic tonic,
which agrees with most Btomachs. It may be either given by itself,
or else conjoined to stronger tonics or purgatives. Thus it corrects
the cold and griping tendency of senna and neutral salts. In a course
of tonics we may often advantageously commence with cascarilia,
and go on to gentian and quinine. [Ibid. and Idem.

On the removal of Stains on Linen made by the Nitrate of Silver
by W. B. Herapatii, M. D., London. Medical practitioners
in the habit of using the nitrate of silver extensively, as a remedial
agent, must have frequently heard loud complaints of their patient's
linen having been indelibly stained and spoilt, by some accident hav-
ing occurred during its use ; and in many cases, patients have refused
tc employ these preparations, in consequence of the extensive des-
truction of linen which they occasion. I have therefore very little
doubt that the following observations will prove most acceptable to
my brother practitioners.

These dark stains consist of very finely divided metallic silver in
intimate union with the fibres of the cloth. Had they been oxide of
silver, any diluted acid would have dissolved them; but nitric acid
alone produces any effect upon them, which of course cannot be em-
ployed on account of its powerfully destructive effects upon the linen
fabric. Iodine immediately converts them into iodide of silver, which

1847.] Medical College of Geo. Diseases about the os Uteri. 695

is instantly dissolved by a solution of hypo-sulphate of soda, and the
cloth remains as white as when issued from the bleaching-house, and
as firm and durable as ever.

The best mode of employing this substance is to strain the spotted
linen over a basin of hot water, and then to let fall upon each spot,
previously moistened with water, a few drops of tincture of iodine,
and instantly to pour sufficient solution of the hypo-sulphate of soda
to dissolve the iodide produced, and then immerse the spot in the wa-
ter beneath, to wash out and cleanse the tissue, at once, from the stain
and chemical re-agents employed. The tincture of iodine of London
Pharmacopoeia strength is the one I employ; and one drachm of
crystallized hypo-sulphate of soda, dissolved in two ounces of water,
will make an excellent bleaching liquid.

A patient may thus be very readiiy taught the manner of removing
an unpleasantness frequently attending the use of a most valuable
remedy. [Lancet.

MEDICAL INTELLIGENCE.

Medical College of Georgia. Prof. Means is to deliver the Introductory to
the next Course of Lectures in this Institution. This will take place on Mon-
day, November the 8th, at 12, M.

Amidst the many changes which have occurred during this year among the
professors of the Medical Colleges of the United States, our own has remained
free from resignation : all the members of its Faculty have been preserved
by a kind Providence, and are now ready to enter upon their duties.

Considerable additions have been made to the Chemical apparatus.

Oca European Correspondent. During our recent visit to Paris, we were
fortunate enough to make the acquaintance, and secure, we trust, the friendship
of a gentleman, now resident of that city, who for sixteen years had been con-
connected with the anatomical chair in one of the most flourishing schools of
medicine in Great Britain. Below, we present the reader with his first letter,
which will no doubt be read with much interest. Our correspondent preferred
to remain unknown, hence the assumed initials to his communication this we
regret, as it is our wish to give full credit to every one from whom we may de-
rive valuable information.

Diseases about the Os Uteri Clergyman's sore throat, <$*c.

Paris, 13th Sept., 1847.
My Dear Sir, The morning after you left Paris, I met Dr. Gibson, of Penn-
sylvania; and between the Professor and Mr. T., of Savannah, I have not had
a moment's leisure to write a letter. T. and his son have departed this fore-
noon for Liverpool, and Dr. G. goes on Saturday, to sail by the Steamer of the
4th Oct. Mr. Al. is well I am in possession oi the August number of your
Journal, which he kindly gave me. Among other places! visited with Dr. G.,
were the, l/rurcvne* and the Necker Hospitals. In the former we saw many caaejp

* This institution is destined for the exclusive reception of public prostitute! of Paris, la-
Louring under the sy,hilitio disease. [F.dt.

696 Diseases about the os Uteri, Sore Throat, 6fC. [November,

of catarrh of the uterus, where the solid nitrate of .silver was introduced for
about half a minute into the os uteri. In superficial ulcerations of the os uteri
the acid nitrate of mercury is employed taking great care that none of the liquid
touches the vagina, and for this purpose, a quantity of water is instantly after-
wards introduced through the speculum. This practice is repeated every 8 or
10 days, during the progress of the treatment, with almost daily applications
of large quantities of the powder of alum, introduced with a brush through the
speculum. With these means of cure, are combined baths of a moderate tem-
perature, for one or two hours at a time, and frequent injections of cold water.
In Uteralgia, 3 drachms of the Belladonna to 1 lb. of water in decoction, as an
injection 3 times every day, or the decoction of the heads of Poppies, combined
with counter irritants to the skin. Trousseau is fond of using a pill of the Ex.
of Belladonna and a small quantity of Gallic Acid, which he desires the pa-
tient to insert high up the vagina, and moistened with saliva or any other bland
fluid. Bleeding is never now, I believe, had recourse to, excepting in very pe-
culiar circumstances, for simple enlargement of the neck or body of the womb,
unless in acute cases depending on painful menstruation, with evident inflam-
mation. In several of the patients that had been treated with the Alum, the
vagina was actually lined with a membranous looking layer which required to
be detached before reapplying the alum. In this connection, permit me to add
that I have seen following a menstrual period, more than usually painful the
mucous membrane itself of the uterus entirely discharged. This is a " fixed"
fact, admitting of no doubt, and induces me to mention, that last fall I assisted
at two dissections here, along with Prof. Coste of the College of France, where
it was clearly and unequivocally demonstrated that in normal impregnation
the veritable mucous lining of the uterus constitutes the meinbrana decidua.
All this was known before, however. The opinion is here, as in London, be-
coming almost universal, that leeches should not be applied to the neck of this
organ; and among other reasons, for this important one, that the bites often
cause ulcerations; and nothing you know is more difficult or troublesome to
cure permanently In uterine catarrh, where the discharge is copious, a pleget
covered with equal parts of lard andalum is introduced into and retained in the
canal. Velpeau introduces the solution of the Acid Nitrate of Mercury into the
neck of the uterus, and it s-eems a very powerful agent for destroying granula-
tions and the thin walls of the follicles, from which last, in many cases, nearly
all the discharge proceeds, particularly in finer aibns. Ricord throws a strong
solution of the Nitrate of Silver into the neck of the organ taking care that the
instrument only half fills the os uteri, and also, that the quantity applied will
not more than half occupy the cavity, and this, for fear of any of the liquid pass-
ing by the tubes into the abdominal cavity; although he deems this accident next
to, if not absolutely impossible in the living subject. Jobert, of St. Louis Hospi-
tal, is in the habit of applying the hot iron in simple enlargement of the neck,
without ulcerations; sometimes 20 or 30 times, at intervals of a fortnight or
three weeks; and in this way, at length, a large portion of one or both of the
lips, is destroyed without, however, as far as I have been able to ascertain, per-
manently removing this inveterate affection. The truth is, the enlargement is
very rarely confined to the neck alone. As the vaginal portion of the organ is
alwavs entirely insensible, and apparently unprovided with nerves, no pain is
experienced during the application of the hot iron, which seldom fails to afford
temporary relief. Notwithstanding the profuse discharge, that often comes
from the uterus, innumerable dissections have satisfied me that ulcerations in-
ternally rarely or never exi^t, unless complicated with malignant disease.
Thickening, turgescence, and in particular, a granular condition of the cervical
portion, chieflv with enlargement of the lacunce, are the appearances met with
after death, which on frequently, I should say, never happens, from this com-
plaint of itself. We saw several patients with vaginitis who were treated by the
pleget covered with the Nitrate of Silver and lard, in the proportion of 3 grains
of the former to an . of the latter, and suffered to remain for 10 or 20 minutes,
or withdrawn only when the pain becomes acute.

We had a lonsrconversation with Trousseau, re^r.nrdinghis experience of the
efficacy of the Nitrate of Silver in diseases of the larynx, especially of the parti-

1847.] Convuhions in Infant s. 697

cular kind so frequent among clergymen in the T He said that

the membrane of the lips of the glottis, was often involved in consequence of a
particular species of inflammation of the throat and pharynx, just in the same
manner, as the membrane of the uterus is seized through extension along the
yagin, &e He applies the solution of the Nitrate ot Sliver to the back part of
the pharynx with a camel's hair pencil, of about the thickness of the little hnger
at the same time depressing the tongue with a long spatula: often, also, he
touches the parts affected with a small piece of sponge, soaked with the solution,
the sponge being fixed to a long rod of whalebone, very much bent at the end to
which the sponge is secured In less severe states, he prefers the Sulph. oi Zinc
or Copper. He also, occasionally uses the Nil ilver in the solid form;

indeed the same remark is applicable not only to the mucous membrane of the
throat, but to all those surfaces that are open'or exposed. Many practitioners
believe, that they insert the solid nitrate of silver into the cavity oi the larynx it-
self, down to the true vocal cord.-. But, it is not so. for although a strong tube
can be passed into the trachea without creating much uneasiness, especially if
the operation of passing be performed suddenly and with force, it is truly a very
different thing in relation to Hot-ids. This is abundantly evident, and when
inflammation and swelling co-exist the operation is utterly impracticable. For-
tunately the ulceration is extremely slight, should it happen to be present; for
if not connected with constitution: . r tubercular consumption, chronic

laryngitis is most usually unattended with ulcerations or vegetations.

The mail, by England, closing this evening, I shall therefore as far as time
permits, give you extracts from the Joui concluding by assuring you

that before long you will again hear from me. it is to be hoped, with something
nioreinterestingih.au this s]

Hopitai des Enfants. M. Guersant, the father. (From L'Union Medicale of

Tuesday, 3lst August, f

Convulsions in Infants. This disease has for cause, simple lesion of "inner-
vation cerebrate" without ai tic alteration idiopathic convulsions;
or it depends on an organic lesion of the nei symptomatic con-
vulsions; or it is the i with or effect of diseased organs more or less
distant sympathetic convulsion-. The idiopathic convulsions, attack infants
in a sudden manner and apparently when enjoying perfect health, acquire
speedil. of violence, once, without leav-
ing any other functional trouble, but a lecbk i lasts but a short time:
in other words, in the interval of the fits, the infants have neither fever nor head-
ache, no disturbance of ideas, nor of the exercise ot sense, no change in the
secretions, or in the heat of the skin, and no derangement o: digestion or of nu-
trition. The convulsions arise under the influence of a lively stimulation of
the nervous centres, return at intervals more or less distant, "and yield either
spontaneously, or in consequence of appropriate means. Convulsions
tonwlic, of a modification more < i - ound of the cerebral centi
announced, in general, by pain of the head, more or less acute, exaltation ol sea-
sibility, perversion of intelligence, and often even a little lever. At the moment
of the attack, we discover agitation, incoherence of speech and distressing cries,
heat of head, vomiting and violent cephalalgia. &c These convulsions, are
prolonged during some hours or day^, Avith i . dining which time the
spasms lose their violence, without the patients' recovering the complete exercise
of their cerebral functions; and when they have di ihey leave behind
them a marked prostration of intelligence of sensibility, and of mobility.
pathetic convulsioi s tantly connected with perturbation, either apparent
or concealed, of some function essential to lift or, at least, with a morbid
alteration of some - import;.!!.. these orgaj
stomach holds the first ran:;. - numerous extra-
ordinary examples hi in the stomach many
days, and-excite convulsions which continued until these substan<
expelled. Thus, in a c . almost without intermission
during nine days: i of white wine forced into the mouth produced
vomiti. number of gooseberries, some of

698 Convulsions in Infants. Epilepsy. [November,

them entire. On which, the convulsive movements almost immediately ceased.
The preceding characters commonly suffice to distinguish, in children," the par-
ticular kind of convulsions. Yet there are not a tew occasional exceptions.
The chain of symptoms, is often nearly the same in the various species. And
although the idiopathic and sympathetic fits are generally of short duration, and
not usually followed by any important derangement in the cerebral functions,
these convulsions may, if prolonged with frequent returns. occasion adisorder as
serious and persistent, as those caused by organic disease. It is in the careful
study of the consecutive accidents, and not in the form of convulsions or even in
their extent, that we can draw the elements of our diagnosis. Generally speak-
ing, the danger of convulsions, as in exact relation with the nature of the exciting
cause. The least dangerous are the idiopathic. Nevertheless, repeated attacks
may terminate, when the patient is very young, in idiotism, or in death ; and
that too, without our being able to discover on dissection, in the nervous cen-
tres, any appreciable lesion. At the moment of a convulsive attack, it is difficult
to pursue any rational mode of treatment, because the diagnosis is rarely fixed.
We are influenced by the general condition of the patient, &c. If the means at
first employed succeed, we continue them, if not, we try new remedies: antiphlo-
gistic, revulsive, purgative, compression of the carotids, antispasmodics, cold
irrigations on the head, and unfortunately without success. Bleeding, general
and local, according to the gravity of the'symptoms, have been much relied on.
Leeches are most commonly employed, and they are put behind the ears, and
when the patient is irritable to the ancles, when the flow of blood should be en-
couraged during one or two hours, according to the effect produced. Compres-
sion of the carotids, so highly recommended by M. Trousseau, apply principally
to convulsions of the congestive form, and confined solely to one side of the body.
We practice this compression on the carotids of the side opposite to the one that
is convulsed, with the thumb, fore and middle fingers, united; and with these
placed parallel to the axis of the artery, and the palm of the hand directed out-
wards, so as not to compress the larynx or trachea. This compression, in some
cases, appears to arrest for a very short time, the access of the fits. As however
its action is instantaneous, if it does not after a few minutes avail, it should be
abandoned. Revulsives to the skin, or intestines, are almost always employed.
Cataplasms of the flour of mustard, to the lower limbs, are much in vogue.
Some use a sponge with boiling water, which they move quickly along the infe-
rior extremities others apply blisters or ammonia. We also administer calomel
with jalap internal, or perhaps rather purgative enemata. Refrigerants appli-
ed to the head have almost constantly a good effect. The most incontestible
advantages are derived from cold effusions; and also continued irrigations di-
rected in preference on the fontanel in the case of infants. These irrigations
create, sometimes, a depression so alarming that it is necessary to suspend them,
or the patient may perish under the jet of water. In certain cases the convul-
sions are accompanied with a general chill, which contra-indicates the use of
cold effusions. Among antispasmodics, we place in the first ox. of zinc alone
or combined with musk, ether, valerian or assafcetida. It is when the disease
has not yielded to the preceding means of cure, and when the convulsions do not
depend on congestion, that we are authorized to have recourse to antispasmodics.
Of all these last enumerated remedies the ox. of zinc is the most successful.
Guersant gives it in progressive doses up to 120 centigrammes during each day,
divided into 9 or 10 powders mixed with sugar. Sometimes he unites the musk
with the zinc.

I subjoin a communication on Epilepsy, but first take leave to state, that anew
and valuable means of diagnosis has been quite recently established, between
this disease and puerperal convulsions, in which last, albumen can always be
detected in the urine, so at least M. Cazeau stated in his lecture the other day.
(Medical Gazette, 1 1th Sept., 1847. Academy of Sciences, 6th Sept.) M. Plou-
viez, of Lille, has presented a treatise on Epilepsy, which he regards as a
permanent aberration of the manner of the sensibility (" du mode de scnsibilile")
of the brain, the existence of which is manifested by a tendency to convulsive
attacks. He thinks that by proper treatment, one may often succeed in destroy-
ing this condition, especially when it has for a cause, strong moral emotions,

1847.] Leeches, Diseases of the Skin. 699

fright, for instance. 1st. Agents whose effects modify the cerebral system. His
formula is Watery Extract of Belladonna, 2 grammes; Digitalis in powder, 3
gram. ; Indigo, 10 gram. ; Mucilage, q. s. ft. 50 pills. Three or four days before
an attack, commence with one pill if it appears to have no effect, give another
at noon, and even a third during the evening. The dose is augmented gradual-
ly until there is produced slight intoxication and somnolency. The medicine is
intermitted for two or three days, after the period of the attack has passed, to re-
cur to it again at the approach of another access. M. P. continues in this way
lor a )'ear or more. One ought never to be discouraged when a slight ameliora-
tion has once ensued. He maintains that by perseverance, we will sooner or
later triumph over the disease, and that success depends on the degree of intel-
ligence used in applying this mode of treatment. 2d. Cold baths and the " botte
Junod."* The cold baths are to betaken at a temperature of 75 degrees for three
or four minutes, then they are lowered insensibly, even to freezing, accordingio
the susceptibility of the patients. To be careful to avoid violent shocks. In
going out of the bath, the patient is covered with blankets, to excite perspiration
for several hours. Xot to excite acute pain, he still employs the "botte Junod,"
and uses it for 25 or 30 minutes. These three means are not administered
simultaneously, sometimes he gives pills with the cold baths, sometimes with the
boot of Junod," and always three or four days before an attack. 3d. Auxiliary
means bleeding, leeches and revulsives. These last not always necessary, ex-
cepting in certain cases.

Leeches. (From Union Medicale, 31st August, 1847.) Since 1843, leeches
have been submitted to the process of stripping or disgorgement at the Hotel-
Dieu. and each year the administration has realized a considerable profit ; it
amounted, in 1846, to 27,874 francs. In the first year, for axample, 28,000 leeches
made 52,000 bites. Although no inconvenience or complaint has arisen from
the use of disgorged leeches, all those applied to the patients in St. Louis, the
Lourcine and the Midi, (venereal hospitals,) are, for obvious reasons, excluded.
Within a few hours after the leeches have acted, they are placed, a dozen at a
time in watercontaining 1G parts in the 100 sea salt, "from which they are soon
withdrawn and plunged into water, " which feels very warm to the hand." The
leeches are then pressed slightly between the fingers, when they void without
effort all the blood they had taken. After which, they are put into earthen pots,
containing fresh water, renewed every 24 hours. In about eight or ten days
more, they are again fit for being reapplied and so on for the third or fourth
time. If they are fatigued or not in good condition they are conveyed into small
ponds constructed at the Hotel-Dieu. These tanks are lined with Roman ce-
ment, and filled with water, which is renewed as often as the slightest alkaline
trace is perceived. One small basin is sufficient for 50,000 leeches. The bottom
is covered with fullers earth, in which are planted several aquatic plants. A
gentle, but constant current of water passes through the basin. When they de-
sire to catch the animals the water is agitated; those that are vigorous come to
the surface, the others remain in the fullers earth. The whole expense incurred
is a mere trifle.

Iodide of Sulphur in Diseases of the Skin, (from the same Journal,) formerly^
used by M. Biett, as an external application for the cure of Porrigo, and tuber-
culous affections of skin, has recently been highly recommended by M. Escolar,
of the general hospital of Madrid. In children he commences with 2 centigram-
mes and a half, and in adults with 1 decigramme. The dose maybe increased
in the former to 15 centigrammes, and in the latter to 3 decigrammes. In sup-
port of his opinions, M. Escolar reports nine cases of different diseases of the
skin, which were all cured by the Iodide of Sulphur, after having resistei all
other remedies. He says, in his work, having never seen bad effects from the
employment of this medicine, one ought not to hesitate to give it, particularly in
herpetic affections.

* Botte Junod. By this term is meant a kind of boot so arranged as to exhaust the atmos-
pheric pressure within it a powerful revulsive means from the head. Junod is the name
of the inventor. Edt.

'00 Gangrene of the Lung. Ophlhdlmy. Epilepsy, [November,

Gangrene of the Dung without constant fectidity of the Breath. By M. Leuret,
Physician-chief of'Bicetre. (From Gazette Medicate, 4th Sept., 1847.) Gan-
grene of the lung, although a rare disease, is most usually seen in the insane.
M. Guistan, in a memoir published in 1836, states that he had then seen thirteen
cases. Those that have occurred at Bicetre, hare all proved fatal, having been
combined with paralysis, gangrene^ the back, &c. The existence of the gan-
grene would not hare been discovered before death, if the patient had not hap-
pened to cough at the time of the visit. "I conversed," says M. L. "with this
patient; he coughed, when suddenly I perceived an excessively foetid odour. I
searched around, and in the bed, to discover its source the' patient coughed
again, when I ascertained the fetor proceeded from the effects of the cough.. On
its censing, the gangrenous odour disappeared. M. Marcel and I percussed
the chest, which arforded no abnormal sound. No rale could be perceived on
auscultation. Idonot know that an analogous fact has been noted by authors,
for in the observations published on gangrene of the lungs, the fcetor of "the breath
is given as a constant symptom, whereas, in this patient, it only existed during
the period of the coughing." Although M. L. visited him every morning for
twenty-eight days previously to death, and M. Maicel returned to visit him once
or twice during the day, no gangrenous expectoration could be detected, and the
gangrenous breath teds only Ived. The right lung presented in the

posterior part of the interior lobe, a cavity capable of containing a large egg.
The cavity was irregular, of a greenish black color, and emitted a strong gan-
grenous odour. (I Gin Sept., 1847.)

From the Constitution^ of 5th September, 1847. M. Chassaignac has lately
presented a memoir to the Academy of Sciences, on the Nature and the Treat-
ment of Puruh nt i ) in which he endeavors to prove : 1st. That purulent
oohihalmy of new-born infants is in many, if not in all instances, a diphteritic
ophthalnry, false membrane. 2d. The diphteritic membrane is consistent, and
adheres strongly to the conjunctiva, and cannot be detached in a complete man-
ner, neither by washing, nor by rubbing with any soft substance; whereas, by
seizin? it with a forceps it can be removed entirely in one piece. 3d. The ab-
straction of this membrane hastens in a striking way the cure ofophthalmy of
Bew-born infants. 4th. The frequent use of injections and washes of the eye,
and the internal surface of the eye-lids, leads to a rapid cure of this ophthalmy,
i. e., " rlcs douches practised lrom a certain height." M. Flourens thinks, from
researches he has made on mucous membranes, that those above alluded to, are
not accidental false membranes, but the epidermal lining of the eye-lids.

This opinion ol M. Flourens is much more plausible than correct, for how
can we explain there-appearance, in a few hours, of these membranes, moreor
less extensively, often fifteen or twenty times during the second stage of the dis-
ease, and this too, after they have been most carefully removed. It now occurs
to me. that I omitted to mention that water irrigations are in great repute, at this
time. hero. Not content with applying them in all cases of acute vaginitis and
conjunctivitis, many also have recourse to them in chronic and scrofulous dis-
eases of the eye and eye-lids. A constant stream is directed on the parts, for,
from fifteen minutes to half an hour, morning and evening. Sometimes, in
vaginitis, oftener and for a longer period. An instrument called an Irrigator is
used, which consists of a cylinder, piston and an injecting tube, moved by ma-
chinery. O. P." G.

The Treatment of Epilepsy, by Professors Rostan, Velpeau, Williams, &c.
By reference to the Letter of the Editor, in the last No. of this Journal, it will be
seen, that he had not at its date received communications from the above named
gentlemen, on the subject upon which they had been consulted. He now briefly

1st. Take for drink the infusion of the flowers of the peach tree, or the leaves
of the laurel.
2d. Take three times a week a bath with the infusion of the linden tree, or of

1847.] Epilepsy. Adulteration of Medicines. 701

the leaves of the laurel, and ol the temperature of 98, while cold water is pour-
ed upon the head the patient remaining in it four or five hours.

3d. Id the interval between the baths, the patient will occasionally be plsced
standing in a foot-bath at the temperature of 104, and water at 78 be poured
upon the head.

4th. Take of the powdered root of belladonna, one grain each day for the first
week, and increase one gr. each week, watching carefully the effects of this ar-
ticle upon the system diminishing, augmenting or suspending it, according to
its action.

5th. Let the patient be purged at least once a week.

(Signed,) Rostan.

Paris, 14th August. Velpeatj.

M. Leuret, physician in chief to the Eicetre Hospital, was also consulted.
He agreed with the treatment just related, and laid great stress upon exercise
to fatigue, and also recommended to arrest the premonitory symptoms of attack,
a large dose of opium and musk.

Prof. Williams' letter is as follows :

London, Holies St., Aug. 25, 1847.

The chief indication in the treatment of these cases is obviously to endeavor
as much as possible to equalize and strengthen the circulation, whilst all causes
of occasional embarrassment or excitement are carefully avoided or counter-
acted. The treatment of each individual case will require a very careful exam-
ination into the state of all the functions, and the application of fitting measures
to correct any that may be in disorder. The functions which I have found most
frequently erring (even when not mentioned by the patient) are those ol the
heart and kidneys. Palpitation often precedes the attack without being obvious
to the patient; and to prevent this 1 havelound hydrocyanic acid or digitalis, in
doses gradually increased, very serviceable remedies; and they may be com-
bined with tonics or otherwise, according to the condition of the system. An
unhealthy state of urine, manifested by either scantiness or albuminous impreg-
nation, I have discovered in several cases, and have corrected by a large blister to
the loins, followed by a free and lon^ continued use of the expressed juice of
Taraxacum (or Extract prepared without heat) together with bi carbonate of
potash or other diuretic salt. In addition to these means, others calculated to
improve the general health and tone of the circulation much open air regular
moderate exercise, careful diet. &c. should not be overlooked.

The prognosis is extremely varied and cannot be stated without a very minute
knowledge and some experience of the case. I have known many cases recover
partially some entirely : in others no improvement took place, but ultimately
gradual lapse into altered structure of the encephalon. A lady, the mother of
one case now under my care, was subject to occasional fits from puberty until
her second confinement, which happened about 14 years ago, since which she
has had none. Her daughter has also had several since puberty, but she has
had only one in the last 12 months, during which she has 3 times a day taken
gr. iss. Zinci Sulphat. wither, xij. Ext. b lor. Taraxaci (prepared without heat.)

The above are the best hints which I can ofler, without the advantage of see-
ing the patient; and remain, Yours, faithfully,

C. J. B. Williams.

Adulteration ef Medicines. We call the attention of practitioners of the healing
art, to the disclosures made known, and to the remarks which follow them, in
the article with the above title, selected from the New-York Journal of Medi-
cine. In confirmation of what is therein published, we state that of 4 3 of
AssafuBtida, carefully weighed by one of our students, ihere was deposited on the
filtering paper over i and 3vi. of sand, after the tincture was made from it.
While Turkey rhubarb is invoiced at 4 cents per pound, we know the same

702

Meteoroligical Observations. Errata.

article here costs us five dollars. Is it not time that some action should be taken
on the all-important subject of the genuineness of our remedial agents 1 Surely
life and health are too precious to be thus trifled with; and Medicine as a sci-
ence is difficult enough for most men, without adding the monstrous evil of using
impure medicines in its practice.

We commend the movement of the College of Pharmacy of the city of New-
York on this subject, and hope aciion will be taken upon it by all our Colleges
and Medical Societies. Let the piofession be united, and we feel persuaded that
Government will be induced to check the importation of adulterated chemical
and pharmaceutical preparations.

METEOROLOGICAL OBSERVATIONS, for September, 1847, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

QQ

Sur
Ther.

l Rise.
Bar.

4, ]
Ther.

P.M.
Bar.

Wind.

Remarks.

~1

C>6

29 87-100

80

29 85-100'

s.

Fair.

2

68

" 85-100

76

" 85-lOOj

S. E.

Cloudy.

3

69

" 86-10:)

73

" 84-100

S. E.

Rain, 95-100 of an inch.

4

67

84-100

74

" 82-100!

S. E.

Rain, 1 8-100 of an inch.

5

70

" 84-100

84

" 83-100,

S.

Fair.

6

71

" 83-100

88

" 79-100'

N. W.

Fair.

7

68

" 81-100

78

" 80-lOOj

B. W.

Fair rain at 1 p. ml

8

69

" 83-100

81

" 78-100

E.

Rain.

9

67

<: 84-100

87

" 82-100

S. E.

Rain. 83-100 of an inch.

10

64

" 84-100;

70

" 84-100

N.

Cloudy.

11

62

" 85-100

67

" 82-100

X. W.

Cloudy.

12

63

" 78-100

76

" 81-100

X. E.

Fair.

13

62

" 78-100

80

" 75-100

S.

Fair.

14

63

" 86-100

78

" 84-100

E.

Fair.

15

61

" 93-iOOi

79

" 87-100

N. E.

Fair.

lb

60

" 89-100!

77

" 87-100

It

Fair.

17

63

<' 85-1001

73

" 79-100

X. E.

Fair.

18

63

" 74-1001

75

" 64-100

N. W.

Fair.

19

61

" 72-100

76

" 68-100

s. w.

Fair.

20

60

" 64-100:

78

64-100

X. w.

Fair.

21

61

" 78-100

88

" 78-100

s. w.

Fair.

22

62

;c 84-1001

77

" 87-100

S. E.

Cloudy. [30-100 of an

inch.

23

66

" 82-100:

77

" 75-100

S. E.

Cloudy sprinkle rain at night

21

67

" 68-100

78

" 65-100

w.

Fair some flying clouds.

25

59

;< 71-100

82

" 67-1 or |

w.

Fair.

20

59

" 70-100

82

" 74-10

w.

Fair some clouds.

27

58

" 72-100'

86

" 68-100

s. w.

Fair.

28

64

b4-l00

88

60-100

w.

Fair.

20

60

" 72-100'

74

" 74-100

N. W.

Fair.

30

48

" 76-100;

76

" 76-100

W.

Fair.

22 Fair days. Quantity of Rain 3 inches and 16-100. Wind East of N. and
S. 11 days. West of do. 14 days.

Errata. Page 640, line 14, for reviewing, read viewing; page 644, line 7, for
irritatory, read initiatory; page 645, line 4, insert from between the words "em-
anates and small-pox."

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol, 3,] NEW SERIES. DECEMBER, 1847. [No. 12.

PART I. ORIGINAL COMMUNICATIONS.

ARTICLE XLVI.

Contributions to Practical Midwifery, with Cases occurring in
Obstetrical Practice. By Jajies M. Gordon, M. D., of Law-
renceville, Georgia.

The function of reproduction, has justly been considered, by all
civilized nations, as the most important, attached to the animal
economy* It is, then, not at all wonderful, that a very respectable
portion of the talents, engaged in the profession of Medicine, should
have been enlisted, from the earliest existence of the healing art, in
guarding against the evils attendant upon pregnancy relieving the
suffering, and averting the dangers of parturition. However diver-
sified the character, and changes of constitution, to which the
human female is susceptible, the instances are rare, where during
pregnancy, the general health is not impaired ; and many cases are
productive of extreme anguish and suffering, and attended by the
most fearful consequences, and even death itself. Fortunately for
mankind, the function of parturition is, in a vast majority of cases,
naturally and safely performed, and require but little interference on
the part of the obstetrician. But cases do occasionally occur, calcu-
lated to strike the stoutest hearts with terror, and demand timely and
efficient aid. The object of the present communication, is to detail
a few of those anomalous cases, which are of such imminent danger
to the patient ; and render the most prompt and appropriate treat-
ment, indispensably necessary.

Puerperal Convulsion;. There is perhaps no question connect-
ed with obstetric art, that has been subject to a greater contrariety
of opinions, than the one under consideration ; and strange to say,

45

704 Contributions to Practical Midwifery, fyc. [December,

among the most distinguished accoucheurs of the day, it yet remains
a subject for controversy. All are, however, agreed, as to its being
a subject of vital importance, both to the medical profession and to
the public. The supervention of convulsions, is undoubtedly the
most formidable accident that can possibly happen to the parturient
female.

To review the opinions of the various obstetrical authors, as regards
the pathology of puerperal convulsions, would perhaps be an unne-
cessary consumption of time, as doubtless most of the readers of the
Journal are familiar with them. In regard to the treatment, it is
sufficient to say, that however formidable the disease may be, it ia
commonly successfully treated, when that treatment is based, as we
believe upon its most enlightened pathology.

The recent valuable discoveries of Dr. Marshall Hall, in relation to
the physiology of the nervous system, has, in this, as well as many
other diseases, been as the dawning of a new era, in the history of
Medical Science. And to Dr. Robert Lee, the medical profession
owes a debt of gratitude, that should be commensurate with its exist-
ence, for his indefatigable skill and industry, m the discovery and
demonstration of the nervous system of the uterus. The brilliant
discoveries of these distinguished physiologists and co-laborers in
Medical Science, we would hail as the harbingers of valuable patho-
logical reform, succeeded by more satisfactory practical results gen-
erally, but more especially in the treatment of puerperal diseases.

Females of whatever age, peculiarities of constitution, idiosyncracy
or temperament, are universally liable to convulsions, either during:
first, or subsequent pregnancies.

In our very limited observations and experience, we have found
that those most obnoxious to attacks, were individuals of delicate
constitutions, and predominant nervous temperament, and in first
pregnancies. It is known that there is more irritability of the sys-
tern, during the first than any subsequent pregnancy. Every case
that has come under our immediate notice (of which we have met
with four in the past four years) have been of prima para.

Causes. If in this division of our subject, we adopt the general
method of classification, into predisposing and exciting causes, it
will be barely necessary to advert to the principles laid down in a
foregoing part of this article. It has already been observed, that
co- existent with a first pregnancy, there is always a highly excitable
state of the uervous system. This excitability obtains in subsequent

1847.] Contributions to Practical Midwifery, 4*c. 705

pregnancies but in a diminished degree. The reasons for this state
of excitability, are obvious and easy of comprehension. From the
period of conception, important functional changes take place. There
is a total suppression of the catamenial function, the most important
secretory act, incident to the preservation of female health. In lieu
of the abolishment of this absolutely necessary function, a new sys-
tem is established a new being is created. Where once there exist-
ed but one system, simple and easily sustained, there now exists two
distinct systems, of more complication, different, and to Some extent
antagonistical in character; one of which is undergoing continual
change, from growth and development. The manner in which these
various changes produce this nervous irritability, in the present ex-
tent of our knowledge, we are unable to explain. The remote or
predisposing causes of puerperal convulsions, may be comprehended
in few words: That pregnancy exists, or the presence of the foetus
in utero.

Exciting Causes. The principle exciting causes we believe to be,
in addition to the peculiar condition of the uterus itself, from the
highly excited state of its nerves, and the transmission of this excite-
ment, to the spinal marrow ; other sources of irritation, acting through
the excitor nerves, on the spinal marrow, such as the presence of
crude and indigestible food ; constipation, or a morbid state of the
bowels ; vesical irritation, produced by over-distention of the bladder,
and perhaps depraved quality of the urine; excessive grief, or men-
tal anxiety ; sudden shocks; great muscular exertion ; hemorrhage,
&c. all acting upon the spinal marrow and its excito-motory sys'*
tern of nerves.

Pathology. From the premises previously laid down, it will be
readily perceived that it is to the spinal division, of the nervous sys-
tern, that we most anxiously look, for a solution of the mysteries, that
have heretofore surrounded the pathology of this intricate subject.
It is on the spinal marrow alone, that all the actions in parturition,
whether healthy or morbid, essentially depend. We include in the
term spinal marrow, all that portion of the spinal cord which does not
preside over the functions of volition and sensation, including the
spinal marrow proper, together with the corpora quadrigemina and
medulla oblongata. Physiological experiments upon inferior ani-
mals, have satisfactorily demonstrated the fact, that irritation of the
Spinal marrow will produce convulsions. It has also, in like manner,
been proven, that no amount of irritation of the brain, or cerebullum,

706 Contributions to Practical Midwifery^ Ape. [December,

is adequate to the production of those effects. Irritation of the brain,
with the finest instruments, and by the most subtle chemical agents,
produce no motions, either voluntary or unvoluntary, though the
slightest volition moves the whole body; but on the contrary, irrita-
tion of the spinal marrow, by the point of a needle, or a drop of acid,
excites the most intense spasmodic actions. In consequence of these
established facts, we have been irresistibly forced to abandon the
most commonly received opinion, in regard to the pathology of con-
vulsions, in the puerperal state, i. e., that they are the legitimate
result, of either primary or secondary cerebral congestion. That this
pathological view of the subject is erroneous, requires but thorough
investigation to be established beyond the possibility of doubt.
First from direct experiments of Drs. Hall, Magendie, and others,
we have seen that cerebral irritation will not produce convulsive ac-
tion. This fact alone should settle the question. Secondly If
simple vascular pressure upon the brain, causes convulsions, we should
have them occurring much more frequently, during the second stage
of labour, than at any other time. But we presume this will not be
borne out as a fact by general experience. Patients frequently fall
into convulsions before labour has actually commenced ; and at all
events in a greater proportion of cases, before the arrival of its second
stage. During the second stage of labour, and especially in the last
expulsive efforts, the uterine, together with the general spasmodic
muscular contractions, cause to be poured into the system, an addi-
tional quantity of blood from the veins and arteries, which is driven
upon the cerebral organs; and if simple cerebral vascular pressure
caused convulsions, it would be precisely at this period we should
most frequently witness their development.

So far from this being true, every experienced practitioner knows
that not uncommonly they are first exhibited after the completion of
the third stage of labour.

Now we would not have the hardihood to assert, that during the
second stage of labour, it is impossible for convulsions to appear,
simultaneously, with sanguineous or serous effusion, or during the
existence of vascular congestion of the brain. But on the contrary,
we aver that some one of these morbid states are almost invariably
co-existent with convulsions, but they are the effects and not the cause
of the disease.

For the sake of argument alone, we will for a moment suppose,
that cerebral congestion or effusion may be the primary cause of con'

1847.] Contributions to Practical Midwifery, c. 707

vulsions ; then, and if that supposition was an established pathological
fact, it would be to the spinal marrow, finally, that we should be com-
pelled to direct our attention for a satisfactory explanation of its
pathology. We cannot conceive it possible, for there to exist any
considerable degree of pressure upon the brain, without producing
corresponding counter-pressure upon the medulla oblongata, which
we have seen is a sufficient cause for an attack of convulsions. The
most rational presumption is, that after the onset, the consequent
cerebral oppression by the counter-pressure upon the medulla ob-
longata, tends, in a considerable degree, to a continuance of the mala-
dy. It is also a well verified fact in the paroxysms, that there is
6pasmodic closure of the glottis, and thus venous congestion of the
brain, and medulla oblongata, is produced by the interruption of the
free return of blood from the head. As certainly as effect follows
cause, do we have the effusions so uniformly observed in 'postmortem
examinations, and described by almost all authors, as the immediate
and exciting cause of the disease. Some authors believe the princi-
ple cause, of this cerebral oppression, upon which they suppose the
disease to depend, is produced by the pressure of the gravid uterus
upon the abdominal aorta. It will however be observed, that at the
same time it presses with equal, if not superior force, upon the inferior
Tena cava, thereby removing the pressure of the blood, from the
inferior extremities, and thus obviating, rather than assisting, in the
production of cerebral congestion. The most obvious and rational
causes, in our opinion, are in addition to tbe increased quantity of
blood, both arterial and venous, that is thrown into the system, in
consequence of the compression of the arterial and venous trunks,
by the irregular spasmodic muscular contractions, and its natural
tendency to flow to the brain, the rigidity of the muscles of the
neck, and the closure of the glottis, by spasm, in the convulsive par-
oxysms retarding or preventing the return of blood from the head.
In this way, we believe it is not only possible for convulsions to be
established nay, we are certain, that they are frequently continued
by the operation of these causes. The brain, by the emotion, the
result of congestion, becomes an excitor of the spinal marrow, through
the medulla oblongata, and it is only in this way, that the brain ex-
ercises any power or control over spinal actions.

Convulsions are most frequently brought on, by the changes neces-
sary to take place in the uterine system, antecedent and preparatory
to the commencement of labour ; or, prior to this, the mere presence

708 Contributions to Practical Midwifery, <fyc. [December,

of the foetus in utero may give rise to them. It has also been stated
upon good authority, that the presence of a deadfostus is much more
likely to produce convulsions than a living one, as it is a much strong,
erexcitor of the reflex actions. When once they have been estab-
lished, comparatively slight causes are sufficient to effect a return of
the most aggravated symptoms such as the pressure of the bag of
waters upon the os tines, and os externum, or after their discharge,
of the fcetal head upon the same parts. The introduction of the
hand, as in turning, or even the mere act of making a vaginal ex-
amination, is sufficient to bring on a convulsion. Intestinal irritation,
particularly of the rectum, as in cases of worms, or a collection of
hardened scybalce, or the excessive action of cathartic medicines,
particularly alcetic preparations, are prolific sources of convulsions,
in the highly excitable state of the nervous system, incident to pregT
nancy, labour, or the puerperal state. Other less common causes of
irritation we omit to mention, as it would extend this article much
beyond its designed limits; and in the conclusion of this division of
our subject, by way of recapitulation, it will only be necessary to say,
in a few brief words, what has already been repeated in substance ;
that labour is a function of the cxcito-motory system, and the true
puerperal convulsion can only occur, when the cerebral organ of this
system, the spinal marrow, has been acted on by an important class
of its incident nerves, in a very excited condition. The result of this
action, or irritation, (as it is more properly termed,) is produced, as
we have seen, in one of two given methods: either by direct action
upon the spjnal marrow, or indirect irritation, communicated to it
through its incident excitor nerves. That this is the true pathology
of this frightful and dangerous disease, we entertain the most honest
convictions. They are the same adopted early after the outset of our
professional career, and daily experience in professional toil, only
tend to confirm us in the correctness of the position.

Treatment. In a plethoric subject, with fulness of the vascular
system, we employ blood-letting, carried to a sufficient extent to pro-
tect the brain from the injury it might otherwise sustain from conges-
tion, and the dangerous results of effusion, during the convulsions;
and ajsq to produce a decided sedative effect upon the spinal marrow.
For this purpose, the blood should be rapidly drawn, in a bold stream,
from a large orifice, so as to make a very decided sedative impression
upon the neryous system, at the onset of the attack. By this means
jthe brain will be amply protected from congestion and effusion, and

1847.] Contributions to Practical Midwifery, $c. 709

the medulla oblongata defended from the perilous effects of mechani-
cal counter-pressure an object of great importance, and one that
should demand especial consideration.

This remedy, however valuable in itself, is susceptible of being
greatly abused, either by excess, or its employment in cases, where
it should have been scrupulously avoided. For we arc clearly of
opinion, even from our very limited observation, that but compara-
tively few cases depend upon plethora, or vascular fulness, but on
some irritation independent of either of those pathological conditions.
In those subjects, characterized by the nervous temperament, and
delicacy of constitution, and where the local irritation is situated in
the uterus, stomach, or rectum, blood-letting to any considerable
extent, cannot otherwise than prove highly detrimental, as, instead
of exerting a sedative influence upon the spinal marrow, it actually
becomes a stimulant to that organ. Blood-letting, in its action upon
the spinal marrow, is greatly modified by the condition of the circu-
lation. When the system is in a state of great vascular fulness, it
exerts a decided sedative influence over spinal action. On the con-
trary, in a state of anaemia, it becomes a positively spinal stimulant.
It is only when from the violence of the convulsions, the brain is in
imminent danger of permanent injury, that its employment is to be
tolerated in weakly nervous females, or an anaemic condition of the
system.

After appropriate blood-letting, the next important indication is
to procure free alvine evacuations, if the least suspicion exists, that
there is contained in the alimentary canal, any foreign matter that
may become a source of irritation. For this purpose, a combination
of calomel and croton oil, is perhaps the most valuable remedy.
The smallness of the dose, when compared with its certainty of effect,
and great activity, together with the comparative ease with which
it can be administered, renders it particularly applicable. As the
patient is frequently in a state of insensibility, ten grains of calomel,
and one drop of croton oil, may be placed on the tongue, and with
the saliva it finds a ready entrance into the stomach. The dose
should be repeated, if necessary, and assisted by stimulating enemata,
till full and free evacuations are produced.

Cold applications to the head, in the form of douche, by cold wa-
ter poured from a height, from the mouth of a pitcher, in a continu-
ous stream, upon a central point of the cranium, and continued a
sufficient length of time to make a serious impression upon the ner-

710 Contributions to Practical Midwifery, <fyc. [December,

vous system, will be found to be productive of great benefit. First,
by promoting a free return of bloo'd from the brain, and thereby as.
sisting in. the prevention of congestion, and effusion and its fearful
consequences. Secondly, by allaying nervous excitability, upon
which the continuance of the paroxysms depend.

The impression of cold should be kept up, by the application of a
bladder of pounded ice to the head, or if the season is such that it
cannot be procured, then napkins frequently wrung out of the coldest
water, may be substituted.

It is also recommended by very high authority, that during the
convulsive seizure, cold water be freely dashed in the face, in order
to excite inspiration, by producing a dilatation of the glottis. Dr,
Denman records an interesting case, in which a convulsion came
on at the accession of every labour-pain, in which he was successful
in warding off the attacks, till the termination of labour, by simply
sprinkling the face with cold water with a bunch of feathers, on the
return of each pain. If, however, it should not prevent the return
of the convulsions, it is reasonable to believe that it may be of benefit
in occasionally relaxing the glottis, and causing inspiration, which
has the effect to diminish the quantity of venous blood in the system,
thereby removing a considerable amount of vascular pressure from
the nervous centres. Not having used the remedy, we cannot speal^
of it as from experience, advised.

Revulsives to the spine, will be found of the utmost importance, to
relieve the nervous excitability produced by an irritable state of the
uterus, and transmitted to the spinal marrow by its nerves. Dr.
Robert Lee, has shown that the uterus is more abundantly supplied
with nerves, than any other abdominal organs* His dissections
prove, that the uterine nerves are derived, principally, from the third
and fourth sacral nerves, and hypogastric ganglia. They also show
a continuity of nervous fibres, to a newly discovered ganglia of the
uterus, vagina, and ureters. The branches of the recently discov-
ered ganglia unite, in various directions, with the inferior mesentery
plexus, to give off the hsemorrhoidal and spermatic nerves, which,
descending from the broad ligaments, are distributed upon the uterus.
The frequent occurrence of small ganglia, in the course of the newly
discovered nerves, and their accompaniment by injected blood-
vessels, such as are peculiar to, or at least closely analagous to those
that attend the course of ganglionic nerves, leave no doubt of their
being to some extent a ganglionic system. Without digressing from

1847.] Contributions to Practical Midwifery, $c. 711

the subject, to engage in the discussion of the physiology of the ner-
vous ganglia, we would but observe, that the frequent occurrence of
these various ganglia, in the distribution of the uterine nerves, form-
ing so many distinct centres for the radiation of nervous influence,
whether normal or abnormal, and modifying the symptoms of puer-
peral diseases, explain these phenomena.

But to return more immediately to our subject. Every practitioner
is aware of the promptness with which a sinapism to the sacrum
arrests labour-pains, and from a natural course of reasoning, we should
expect spinal revulsives to produce a like salutary effect in puerperal
convulsions. The spinal irritation being in the two cases identical,,
differing only in degree of severity. Experience, the most unerring
of all teachers, has proved the correctness of these deductions. Cases
of puerperal convulsions, have been cured by the use of revulsives to
the spine alone, after other modes of treatment had been unsuccess-
fully exhausted.*

In the conclusion of these observations on the treatment, it be-
comes necessary to mention a remedy of more doubtful effect, and
one that has been most unceremoniously condemned on the one
hand, and its value as highly estimated on the other. We allude to
the administration of opium. Whatever may have been the opinion
of others, as to its merits, or demerits, we most unhesitatingly declare
it to bo the most effectual therapeutical remedy, in the treatment of
this disease. The discrepancy of opinion, among the profession, in
regard to its value, must have arisen from one of two causes. First,
from improper regard to the previous reduction of vascular fulness.
Secondly, the small quantity of the article given. Opium is adapted
to the exercise of either a stimulant or sedative effect on the nervous
system. The effect being modified as to whether it is given in mini-
mum or maximum doses, or in a plethoric or anaemic condition of
the system. In fulness of the circulation, it is a stimulant to the
spinal marrow, while in ana?mical cases, or after sufficient vascular
depletion, it acts as a decided sedative to that organ. The same is
true of its effects, as given in large or small doses : if even in a state
of anaemia it be used in small doses, it becomes a spinal stimulant
whereas, if administered in full and effective doses, the effects are
those of a sedative. If opium be administered in moderate doses, or
in a full state of the circulation, previous to appropriate blood-letting,
an aggravation of all the symptoms may be reasonably expected ;

* See London Lancet, vol. 2dj for 1844.

712 Contributions to Practical Midwifery, fyc. [December,

but if prescribed in full and efficient doses, subsequently to active
vascular depletion, and other appropriate auxiliary treatment, it is
capable of exerting most salutary and happy effects. It is indeed the
heroic remedy the sheet-anchor of our hopes, in many cases of this
much dreaded disease.

The beneficial effects of this potent remedy may be greatly en-
hanced, by a combination with some of the more valuable articles of
the class of antispasmodics assafcetida we believe to be the best.
Since the discovery of the refiex functions of the nervous system, anti-
spasmodics are much less used than formerly. The treatment more
generally being directed to the removal of irritation from the various
excitor surfaces, so much reliance is not placed on the relief of
spasm, by the different classes of nervine medicines. But in cases
where the causes are unknown, or involved in mystery and obscurity,
they are of important benefit. In puerperal convulsions, where the
exciting cause is to be found in the existence and presence of the
foetus in utero, and delivery, the only effectual permanent remedy,
Assafcetida may be given in combination with opium, with great
advantage. To some extent this assists the latter article in diminish-
ing the excitable state of the spinal marrow and its nerves, and thus
acting the part of a sedative of the reflex function. We have com-
monly used them agreeably to the following formula :
Tinct. Opii., .... 60 minims.
" Assafcet., . . . 5ii.
to be taken every two hours, till the convulsions cease. It ma)' re-
quire, in the most obstinate cases, what might otherwise be consid-
ered, a very extravagant quantity of those articles. In one case wc
gave to the amount of ten grains of opium, and two scruples of assa-
fcetida, before the convulsions were finally arrested. But the judi-
cious accoucheur will not so much regard the quantity as the effect
of his remedies, when positively indicated. And when the indica-
tions in the treatment of puerperal convulsions are fulfilled in obedi-
ence to the foregoing principles, we can most confidently assure the
profession, that they will rarely be disappointed in realizing the most
happy practical results.

There is an important question, however, to be considered, in re-
lation to the free use of opium pending labour. Does the administra-
tion of full doses retard, or otherwise modify, the regular progress of
labour ? On this question, there exists great discrepancy of opinion.
By some writers it is contended that it retards, and by others that it

1847.] Contributions to Practical Midwifery, <$rc. 713

accelerates labour. The true physiological effects will be ascertain^
ed to be, that in puerperal convulsions, it actually and indirectly
hastens labour, by arresting the convulsions, (which interfere with
the regular parturient efforts of the uterus,) and allowing its unin-
terrupted progression ; independent of this effect, opium exercises no
control over parturition.

Case I. Mrs. B , aged 25, of nervous bilious temperament,

in the eighth month of utero-gestation with her first child, was
attacked June 13th, 1343, with spasmodic twitching of the muscles
of the whole body, which gradually increased in severity for twenty-
four hours, when we were requested to visit her. Found the parox-
ysms recurring about once every half hour ; her general health bad
indeed there existed a decided state of anseraia. She complains of
pain in the lumbar and sacral regions, accompanied with severe
head-ache. Prescription. A cathartic, and a blister applied to the
lower portion of the spinal column Tinct. Opii. 40 minims ; Tinct.
Ass. 3i. ; to be taken and repeated pro re nata. Directed to remain
quietly in bed, and free from noise and confusion. The improvement
was gradual and perfect, and she was delivered at the regular period
of a living and healthy foetus.

Case II. Mrs. O , in her first pregnancy, 20 years of age, of

middle stature, and nervous bilious temperament, was suddenly seiz-
ed with convulsions on February 19th, 1341. We saw her soon after-
wards, and learned from her husband, that she had arrived at or near
the full period of gestation. She had previously been in delicate health.
Complains of severe pains in the loins and head, and also says that her
bowels are constipated. Prescribed venesection to 20 oz., and a
cathartic composed of 10 grains of Calomel, and one drop of Croton
Oil. The purgative acted freely in two hours, and the convulsions
continued. As her face was very much flushed, a vein was again
opened, and the blood suffered to flow again to the extent of 20 oz.
Labour had not commenced. Notwithstanding the copious blood-
letting, and active purgation, the convulsions continued, and evident-
ly increased in violence. We then gave her Tinct. Opii. 60 drops;
Tinct. Assafcet. 5ii. ; which exerted a most happy effect. Tho
Convulsions ceased, and she fell into a sound sleep, which was only
interrupted, after the expiration of an hour, by occasional moanings,
and other evidences of pain, which we suspected to be true parturient
pains, as they recurred at regular periods. The truth of the suspicion

714 Contributions to Practical Midwifery, <%c. [December,

was verified by a vaginal examination, and the os tincae found dilated
to the size of a dollar. The presentation was natural, and the labour
proceeded regularly, and without the slightest interruption, for six
hours; but during the last expulsive effort, and just as the fcetalhead
was emerging, she fell into a most violent convulsion, which con-
tinued for near half an hour. She was entirely unconscious of the
birth of the child, (a living one, and rather above the ordinary size,)
and remained in coma for an hour.

The placenta had not yet been detached, and as there was consid-
erable haemorrhage, the first opportunity of only a partial rally of the
system, was anxiously sought to remove it. The introduction of the
hand, for that purpose, brought on another convulsion, equally as
severe as the former, but not of so long continuance. Free vesica-
tion was produced upon the sacrum, by means of Granville's counter-
irritating lotion, and as soon as deglutition could be performed, she
was ordered Tinct. Opii. 60 minims; Tinct. Assafcet. 3ii. ; after
which there was no return of the convulsions, and she rapidly recov-
ered without an unfavorable symptom.

Case III. Mrs. Mc , aged 14, of nervous sanguine tempera-
ment, in the eighth month of her first pregnancy, was attacked with
convulsions. She was of small stature, and delicate conformation,
and had previously been in wretched health. At the time of her
attack, she appeared in a state of great debility, and there was gen-
eral anasarca of the whole body. On our visit, we found that she had
just recovered from the fourth paroxysm. Labour had not commen-
ced. Ordered an enema, and as her face was considerably flushed,
and she complained of severe head-ache, a vein was opened, and
10 oz. blood drawn ; sinapism to the sacrum, and cold douche to the
head. The bowels having been sufficiently evacuated by the enema,
a purgative was omitted, and she was given Tinct. Opii. 60 drops;
Tinct. Assafcet. 3ii. ; after which, there was no return of the con-
vulsions for three hours, and we left her apparently quite comfortable,
with strict injunctions to be immediately sent for, if they returned.

Eight hours after leaving her, we were again summoned in great
haste, and were informed that the convulsions had returned with re-
doubled violence. On our arrival, we ascertained that she had suf-
fered three paroxysms, and was then in the fourth, a most violent
convulsion ; indeed she now (at 7 o'clock, P. M.) seemed to be in
articulo mortis.

1847.] Contributions to Practical Midwifery, <$-c. 715

Discovering, however, some abatement in the symptoms, we deter-
mined to persevere in our efforts for her relief. The countenance
was very much flushed, and there existed great turgidrty of the cer-
vical and cerebral vessels. Venesection to 12 oz., and Granville's
counter-irritant applied to the sacral region, so as to produce free
vesication. Continue cold applications to the head.

Deglutition being impracticable, we administered, per annum,
Tinct. Opii. 5iii. ; Tinct. Assafcet. gss. ; which was almost immedi-
ately returned, and repeated, as we considered it the only reasonable
hope for success. Notwithstanding the activity of the treatment, the
convulsions continued, without intermission, for seven successive
hours, until 2 o'clock, A. 31., when, to our great gratification, evident
signs of improvement were manifested. So soon as deglutition be-
come practicable, we gave her 1 gr. Sulph. Morphia, which effectu-
ally controlled all convulsive action, and she fell into a profound
sleep, which lasted four hours.

At 6 o'clock, A. 31., from the writhing, and other indications of
pain, we suspected the commencement of parturient action. The
correctness of the supposition was verified, by a manual examination :
it was ascertained that the stage of dilatation had commenced. It
was also at the same time discovered, that the labia were enormously
distended, by serous accumulation, which was immediately relieved,
by free puncturation with a lancet.

Although she was wholly unconscious of passing events, and ex-
hibited satisfactory evidence of being fully under the influence of
opium, yet the labour progressed regularly, and at 6 o'clock, P. M.,
(just twelve hours after the commencement,) she was delivered na-
turally of a very small dead foetus, and from the cuticular disquam-
mation, and insipient putrefaction, we inferred that for several days
life had been extinct.

After delivery, she remained in a state of coma for twenty-four
hours and partial mania for the four subsequent days which gradu-
ally subsided under the use of mild laxatives, with low diet, and con-
finement to a darkened apartment, free from noise and confusion.
Her recovery was perfect, and as rapid as could have been anticipated,
considering the great exhaustion of strength, and of the vital powers.

Case IV. Dec. 6th, 184G. Mrs. B , 20 years of age, of

nervous bilious temperament, in the eighth month of her first preg-
nancy, was attacked with convulsions, of violent character, whicb

716 Contributions to Practical Midwifery, fyc. [December,

returned at intervals of one or two hours : each renewal of the attack
being more severe than the former. We were requested to visit her,
but considerable time had elapsed since the attack, as she lived at the
distance of eighteen miles. She had previously been in the enjoy-
ment of excellent health, and was of a full habit. When we arrived,
she was comatose, and was informed by a midwife in attendance,
that she had had frequent convulsions during the afternoon and night.
She was immediately bled to 30,oz. ; and 10 grains of Calomel, and
one drop of Croton Oil, placed on the tongue, which in the space of
two hours, by the assistance of stimulating enemata, brought away
large quantities of dark bilious evacuations. It was also ascertained,
that she had not passed any urine for twelve hours. The introduc-
tion of a catheter, was followed by the discharge of about twenty
ounces of high-colored urine, of exceedingly strong odour. The con-
vulsions continuing to recur, a vein was again opened, and 20 oz. of
blood withdrawn; a blister was immediately drawn, upon the sacral
region, by means of Granville's counter-irritant; and as she had
vomited several times, it was thought best to omit the use of assafce-
tida, lest it might again produce nausea and vomiting, and to use
opium in its most concentrated form. She was therefore given one
grain of Sulphate of Morphine, which was effectual ; and she fell into
a deep sleep, which continued five hours, and from which she was
aroused by pains of a parturient character. It was ascertained that
labour had commenced, and the first stage slowly advancing. So
soon as consciousness was restored, she was questioned as to when
she last felt the foetal movements; to which inquiry she replied, she
had not been sensible of its motion in two or three days. The labour
advanced slowly, but favorably, to the completion of the first stage ;
and also through the second, to the engagement of the head in the
inferior strait, when it suddenly became arrested, and symptoms of
an alarming nature presented themselves. The patient's strength
appeared entirely exhausted a death-like pallor of countenance,
cold extremities, pulseless at the wrist, were the alarming symptoms
now developed : nothing appeared certain but death.

At this critical moment, no time was to be lost immediate delive-
ry seemed the only hope. The forceps, which were at hand, were
applied ; and the delivery readily effected. The foetus was of com-
mon size, and in an advanced stage of putrefaction.

After the completion of the delivery, the most active exertions were
required to produce a reaction, to avert dangers that threatened cer^

1847.] Malignancy. 717

tain destruction. The most active diffusible stimulants were freely
administered, and assisted in their operation by sinapisms, and artifi-
cial heat, by bottles of warm water placed to the feet, and around the
body, in bed. The remedies were eventually successful, although
for an hour she appeared as one dead.

Her recovery was tedious, and for a considerable time imperfect.
She had occasional returns of convulsions, for a fortnight subsequent
to delivery, but which were uniformly promptly arrested, by a com-
bination of opium with assafcetida.

In addition to all the other difficulties, she suffered immensely from
phlegmasia dolens, which, at different periods, attacked each of the
lower extremities, and received the necessary attention. Her re-
covery, although tedious, has been perfect, and we are happy to say
that she is now in the enjoyment of excellent health.

Remarks. In a very brief manner, we have disposed of this im-
portant subject, and are aware of the many imperfections in our
remarks upon it; but we would indulge the hope that physicians of
more eminence and talents, with enlarged experience, may be induced
to take hold of, and thoroughly investigate, the subject of spinal physi-
ology, and its relations to pathology, and to practice generally ; but
especially in the treatment of puerperal diseases. In every depart-
ment, diligent inquiries should be instituted, in the investigation of
the derangements and diseases of the spinal system, in order that a
successful method of treatment may be adopted. We cannot but
indulge the hope, and belief, that the time is not far distant, when
the treatment of spinal nervous diseases, based upon the knowledge
of Dr. Hall's valuable discoveries of their physiology, will lead to
most gratifying and successful results in practice.

We cannot but regard these discoveries, as the most valuable ac-
quisitions to the medical profession, in modern times, and worthy to
be ranked with the discovery of the Circulation, the Vaccine Virus,
and the Stethoscope.

ARTICLE XL VII.

Malignancy. By Wesley C. Norwood, M. D., of Cokesberry, S. C.

In a former communication, I noticed the want of precision, and
the inappropriatencss in the various terms used to express the above
condition of disease. I hope I offered sufficient reasons, to show

718 Malignancy. [December,

that they did not denote, with any clearnesss, the great variety and
forms of disease with which malignancy was associated. Nervous,
was one of the terms alluded to, as improper ; and cited as an exam-
ple, the great mildness of catarrhus epidemicus, of certain periods,
on the. one hand ; and typhus carcerum on the other. The former,
is often very extensive in its range, and as non-malignant as it is
widely prevalent. The latter is always malignant. That typhus
putridus did not define or characterize it, as it embraces two species
or varieties : Patudus proper, and Synochus, which differ as widely
as the poles, in their degree or violence. I stated more fully, my ob-
jections to congestion it being an incident, and perhaps never a
primary affection. I further stated, that I considered congestion a
remedial process, induced by the vis medicatrix naturae, or instinct*
Also, that if the blood were to remain in the capillaries, and superfi-
cial vessels, in syncope, there would, in all probability, be no cases of
recovery ; that in purely malignant cases, the condition of the brain,
and nervous system, not being changed, where there was suffusion,
engorgement, or congestion of the superficial vessels, death would
invariably result. In support of this assertion, I alluded to the spotted
fever of the north typhus syncopalis. Typhus syncopalis, is not
a synonime for typhus putridus. Typhus gravior and spotted fever,
are not convertible terms : they have both been called spotted fever.
Typhus syncopalis, is a well marked and perfectly defined nervous
fever, and associated perhaps with passive inflammation of the brain.
There is a mottled appearance that occasionally accompanies typhus
gravior, which has given rise to the name spotted fever; but with
as little correctness, as black or red tongue, as prefixed to many va-
rieties of fever of the present day. In a previous communication, on
page 399, typhus gravior, was put down instead of typhus synco-
palis, in parenthesis. The mottled appearance, when in excess*
indicates genuine malignancy. I also gave a great number of the
apparent symptoms of malignancy, and stated, that death was the
invariable result of some of them, when they singly appeared, and
it followed from their plurality, in other instances. Again: that
symptoms which belonged to, and were characteristic of the noso-
logical place and relation of the disease, were malignant, when they
appeared out of their regular order, in any considerable number, of
were marked by unusual severity. That frequently a single symp-
tom, of the last stage of disease, indicated extreme malignancy, when
it appeared with severity, in the incipient or forming stage. I gave

1547.] Malignancy. 719

an example in the case. His disease was ushered in, with mild or
pleasant, but striking delirium. No other symptom of severity ap-
peared, either in the nervous sanguineous, or secernent and absorbent
systems. That malignancy consisted in exhaustion of the energies of
the vital functions, and of symptoms not peculiar to the disease.
That malignant diseases were never protracted, by ordinary treat-
ment, but were brought by such treatment to a suddenly fatal issue;
while obstinate and severe diseases may be, and frequently are, pro-
tracted, by injudicious treatment. That malignant cases were not
palliated, and would not bear reducing agents or antiphlogistic*, but
that obstinate and severe cases might. In cases of periodicity, I did
not believe that quinine and bleeding were indicated in any case, at
the same time, in the stage of reaction or exhaustion. That a great
many of the cases in which venesection was practiced, were cases of
lethargy, coma, insensibility and convulsions, accompanied with
torpor of the brain, and nervous system; and unaccompanied by ex-
haustion, the peculiar and striking feature, in all cases of malignancy.
And something was given in the way of example or illustration,
where a large quantity of blood was taken, and the little impression
made at the time on the disease, and the freedom of the system from
present shock, or immediate injury from sue!) excessive draining and
waste of the vital fluid. I also gave a few case? illustrative of the
success of an opposite system of treatment (.Medical Student);
also, my disbelief of inflammation supervening in important organs,
and observing the periodical course of the disease. That many of the
reputed cases of inflammation, were believed to be nothing more
nor less than extreme irritability, frequently accompanied with neu-
ralgic pains ; and that the peculiar tenderness of the muscles of the
epigastric, and other regions, on pressure, was purely nervous. In
colic, we often find the muscles of the abdomen exquisitely tender on
pressure, where the sanguineous function was regular and undisturb-
ed, during the whole course, or paroxysm, and often an entire subsi-
dence of the pain. The fact i, in regard to colic, 1 believe it to he a
purely neuralgic affection ; and that there is no such thing as bilious
colic. That the disordered state of the biliary secretions, is the effect
of the treatment, instead of being the cause of the disease ; and the
fever, if any should follow, is merely irritative and symptomatic.
That in colic, as in other . there is torpor in one set of i

and irritabiliiy in another ; but torpor more commonly predominates.
Even colica rachialgia, I believe to be neuralgic, in a greater or less

40

720 Malignancy, [December,

degree : else/whence the nervous tremors paresis or semi-paralysis.
The name itself is indicative of such conclusion.

I further stated, that the general condition of the system was not
altered by the supervention of any local affection. If it were cauma-
toid, the local could not be atonoid : if it were atonoid, the local could
not be caumatoid. I spoke something in regard to indications. As
I expect to treat of indications, in a separate article, I shall omit say-
ing any thing on that head at present. All the assertions and illus-
trations that have been made, are in reference to the apparent
symptoms of genuine malignancy. I have witnessed every- one of
them in pneumonitis typhoides, which was the disease I selected to
give examples from. I have seen them frequently in other diseases*
I alluded to two symptoms of malignancy in cholera infantum, that
are not embraced in the above declaration.

The following remarks are made in reference to diseases that are
insidiously malignant or where the symptoms of malignancy are
not apparent; and for which cases we have no language to express
our ideas, or, to use a nautical phrase, in which there is not "breeze
enough to steer by/' We are frequently called to cases, in which
there are no symptoms of urgency, no particular derangement of the
functions of the brain and nervous system: the sanguineous but
slightly affected ; the pulse, being morbidly natural or slow ; the
biliary and intestinal secretions indicated but few symptoms of mor-
bid action; no unusual appearance of the tongue; no foulness or
collection of sordes on the teeth : where emetics and cathartics oper-
ate kindly ; where stimulants, tonics, and narcotics, produce none oC
their deliterious effects; and when the medicines administered, are
not followed by harsh or drastic effects. But still the symptoms do
not yield, but grow worse, so gradually and imperceptibly, that we
cannot say the patient is any worse, unless we compare the symp-
toms, not of one day, with another, but by a space of two or three
days -in which the by-standers do not consider the patient in any
danger; and if you attempt to enforce it, they treat it with the ut-
most incredulity, and when he dies, will be astonished, and attribute
his death to negligence on the part of the nurse, or to mal-practice
and ignorance of the physician. This sort of cases will suddenly
and without any assignable cause, grow worse on the seventh, ninth,
fourteenth, or twentieth day, and many of the symptoms of apparent
malignancy will supervene or the symptoms common, and properly
belonging to the disease, will be unusually increased, or materially

1947.] lignancy. TCI

aggravated, and death follows in from twelve to thirty-six hours.
Although at the outset, there are no symptoms which clearly mark
and indicate such issue, still to the practised and observing, there is
something in the general appearance of the patient, that denotes dan-
ger, or a " hidden ambush," and is a source of much uneasiness to
the physician in attendance. These are the cases in which the
ignorant, the careless, and unobserving physicians forever blunder
in which they promise certain, if not a speedy return to health : and
their patients are always reputed to die in some unheard of and re-
markable manner. I hold, and maintain, that there is something in
these cases, which a skilful and closely observing physician will de-
tecta "tout ensemble" to the other cases of malignancy where
the symptoms are striking and apparent: that if type, pulse, stage,
crisis and diathesis, are thoroughly studied, and properly understood,
and the peculiarity of the endemic or epidemic, particularly observ-
ed, and the general : y and irregularity which it observes, in
its rise, progress and decline, noted, there will be little or no danger
of error in diagnosis, or prognosis, however much the physician may
be unable successfully to treat the disease. These are the cases and
circumstances in which the skilful and observing have the advantage
over the ignorant, unskilful, and unobserving practitioner.

The standing and popularity of a physician, depend as much ofl
correctness of prognosis, as of diagnosis. To discover this sort of
cases, requires close observation and study ; but when properly un-
derstood, the prognosis and diagnosis, the indications and treatment
will be unincumbered by error and disappointment.

Mr. W. was more or less dyspeptic; he had one or two chills;
whether they were followed by much fever, or frequency of the pulse,
I do not now recollect. I was called in council. There was not a
single symptom of urgency cr severity, with the exception of occa-
sional and irregular paroxysms, of ep;nastric sinking or uneasiness*
and a frequent gaping, or rather gasping. With these two except
tions, (and the first of them was not by any means excessive, and
took place most frequently during the night,) every symptom was
unusually mild. The pulse was perfectly regular, as to frequency,
and not exceeding seventy-two beats in the minute, moderately full,
but soft ; the tongue was moist, and very slightlj covered with a
light white mucous, or slimy fur or coat ; the thirst moderate ; a "-en-
eral freedom from pain; the surface perhaps rather cool; the skin
soft, and not hot and dry; very little torpor, or irritability of the

722 Malignancy. [December,

alimentary canal, or saltaticious viscera; the least possible derange-
ment in the excretions from the bladder, bowels, or skin ; no de-
rangement in the sensorial functions. Had no more chills ; was
cheerful, calm, and free from restlessness, unless when laboring under
the above sinking spells, at which times the pulse would frequently
increase, from ten to fifteen beats, but would soon resume its seventy
or seventy-two pulsations. There was no irritability of temper, or
peevishness, during the whole course, which sometimes accompany
diseases that prove fatal: still there was something undefinable,
indicating clearly, that all was not well. His disease continued near
three weeks. In this case, I consider that the semi-servae ganglion,
or great sympathetic nerve, was the part on which the burden of the
disease was expended. Whether it was a paresis, or semi-paralysis,
or an inflammation of this system, I cannot say ; but shorty (that is,
from twelve to thirty-six hours) before the fatal issue, the pulse be-
came unusually small and frequent, and the tongue dry. In this
sort of cases I have always observed this rapidly increased frequency
of the pulse, within a short period, or from twelve to thirty-six hours
before the fatal issue : also, that these cases are usually protracted ;
and as certainly as they are protracted, they terminate in death.
Now the question for solution is this : Can inflammation exist in this
nerve, or its various branches, ganglions, or plexus, without mani-
festing itself for a considerable time, in the system generally ? Can
paresis, or semi-paralysis, exist for a length of time in mask, or latent,
and its effects undeveloped on the system generally? I think they
may, and do exist. For this system, or organ, appears to have an
independent function, or office, to perform, and is not influenced by
external agents, as other portions of the nervous system, and is per-
haps independent of impressions from the external world, at least to
a very considerable degree. I believe it to be the principal seat of
disease, in all cases that are insidiously malignant. I will make a
statement or two, and leave it with the medical profession to judge
for themselves, and each individual can take hold of which ever horn
of the dilemma suits him best.

When this system (the sympathetic nerve) is affected with paresis
or semi-paralysis, does it induce, in its final result, coma, torpor,
lethargy, or convulsions? or, does it excite in the system, all the
symptoms peculiar to extreme irritability and susceptibility ? If it is
affected with inflammation, does it excite torpor, coma, and convul-
sions ; or does it excite in the system, symptoms or events, that

1847.] Malignancy. 723

would indicate the presence of inflammation in some organ of im-
portance to the system ?

Mr. Mc. was attacked very similarly to Mr. W. He had none
of the symptoms of subsidentia, or sinking, but had more or less pain
in the head, which was paroxysmal and irregular, and gaped or gasp-
ed frequently : the pulse was more full and strong ; he was free from
dyspeptic symptoms : the pulse was natural, as to frequency; the
bowels were rather inclined to torpor ; the mind clear, and free from
delirium. About twenty-four hours before death, he became coma-
tose, insensible, and severely convulsed, and was not confined con-
stantly to bed, till the last mentioned symptoms made their appear-
ance. The duration of the disease was about three weeks.

I have pointed out but few of the symptoms in the last mentioned
case ; and they were generally such as did not exist in the first men-
tioned case. Above, the two cases are given : one was accompanied
with slight and irregular paroxysms of epigastric sinking, and free-
dom from pain, accompanied with more or less gaping or gasping,
during the whole period. The heat of the skin, and frequency of the
pulse, were greatly increased, about thirty-six hours before death.
The other was accompanied with pain in the head, paroxysmal, but
very irregular, but no epigastric sinking more gaping, yawning, or
gasping; the pulse a little more full and strong; and died comatose,
insensible, and convulsed the latter symptoms not appearing till
about twenty-four hours before death.

Which of these cases was affected with inflammation, and which
with paresis or semi-paralysis of the great sympathetic nerve? or
did either, or neither of these affections exist? If not, what was
the condition ? I do not think that pain generally accompanies dis-
ordered states of the great sympathetic for that must be the organ
principally affected, and that produces that peculiar feeling and sink-
ing sensation iri the epigastric region ; and I have no doubt, but that
it is the affection of this nerve that occasions that indescribable an-
guish and sinking in yellow fever. I think I have discovered, that
there was more pain, during the disease, when the patients died
lethargic, insensible, and convulsed, than when they died in an oppo-
site condition; and that the epigastric sinking was less. I saw the
first case but three times, and that after the chills had ceased. The
last case I had in attendance from the outset.

In the treatment of diseases, with apparent symptoms of malig-
nancy, or with the regular symptoms of disease, appearing out of their

724 Malignancy. [December,

regular course, or order of appearance, the remedies most suitable
and proper are, stimulants, tonics, acids, and narcotics, epispactics
and rubefacients, and the least possible purging, or emesis, that will
answer. To be a little more particular : In the cases of torpor,
accompanied with exhaustion, emetics of sulphate of zinc and ipecac,
sulphate of copper and ipecac, or sanguinaria instead of the ipecac,
Mustard is an excellent emetic in such cases: it operates speedily,
excites but little nausea, and arouses the stomach it is truly and
properly an acid emetic.

Stimulants and aqids should be given at the same time, in combin-
ation with the emetics. If there is much exhaustion, rubefacients
and epispastics should be freely used. Very little, if any, of the pre.
parations of papaver, is indicated in these cases. Stimulants, acids
and tonics, in regular and uniform doses, at short intervals, accom-
panied with epispastics and rubefacients, to equalize the heat of the
surface, and relieve any local symptoms, and arouse the system. In
case of irritability, and exhaustion, stimulants, tonics, and narcotics,
are the principal remedies. Stimulants are not required in such
quantities as in cases of torpor ; neither acids nor blisters are indi-
cated in these cases of irritability : they may be necessary to meet
some local affection but if papaver is not given freely during their
application ; and deeming the irritation they excite, will far overbal-
ance any good derived from their effects on the local affection, The
various preparations of papaver are highly useful, and cannot be dis;
pensed with in these irritable cases. When the patients are severely
sick, tonics frequently disagree, and stimulants, and narcotics, and
often narcotics alone, are indicated. This is the general treatment
for cases of torpor, with exhaustion, and it ratability, with exhaustion,

There is a set of cases, not so urgent nor severe, which will re-
quire such emetics as I have alluded to, and moderate purging with
calomel, before entering on the administration of acids, tonics and
Stimulants epispastics and rubefacients. These are cases of torpor,
with moderate exhaustion. The irritable cases with moderate exhaus-
tion, will require moderate purging with calomel, in combination
with papaver, before entering on the stimulant, and tonic, and nar-
cotic course. I believe the above general plan, will meet all the
general principles of treatment. The incidental circumstances
must be met according to the nature and urgency of the incident, bp
it of what nature it may.

In regard to the insidiously malignant cases, I much doubt whether

1847.] Injury of the Medulla Spinalis. 725

any course or system of treatment is followed with success ; for I
am unprepared to say, what effect any article of the materia medica
will have on the great sympathetic system. It appears to be an or-
gan neither of sensation nor motion, in the common acceptation ;
yet it appears to influence the actions of the heart, and the organs of
nutrition and digestion or in other words, it appears to be the great
instinctive agent of the system : perhaps the organ, or instrument,
through which the vis-medicatrix naturae operates, or in which it is
seated, as the brain is the organ or seat of intellect. But whether its
actions can be changed whether it can be increased or diminished,
by the usual agents, which excite motion and sensation, and over-
come diseased action and pathological states and conditions of the
system, by producing a different pathological condition, or exciting
a new set of actions, I feel no warrant in saying. I am rather in-
clined to the belief, that we cannot correct, with any of the agents
known, any pathological conditions of that system. Nevertheless,
it may be through this very system that all the remedial agents oper-
ate, and bring about a state of the system, incompatible with any
pathological condition excited by the agents producing disease. As
this system is connected throughout with the nervous system, parti-
cularly in all the organs essential to the preservation and reproduction
of the human species, it may be that we should attribute all the suc-
cess in the treatment of disease, to remedial agents operating on this
system primarily, and changing the actions of the other organs
secondarily. As far as I know, at present, I shall leave this subject
forever ; but not without a hope, that I may have excited some one
competent to the task, to take it up, and make all clear and intelligi-
ble, that is now dark and not understood.

ARTICLE XLVIII.

Injury of the Medulla Spinalis Death : Autopsy. By J. A.
Mayes, M. D., of Sumter District, South Carolina.

Lafayette, a negro man, aged about 25, of good constitution, and
in the enjoyment of excellent health, sustained a severe injury by
falling from a tree on the night of the 10th of September. He had
been hunting around his master's cornfields for racoons, and had
discovered one in the top of a tree some 25 or 30 feet high. The
usual mode of taking the^e animals, practised by the negroes on

726 Injury of the Medulla Spinalis. [December,

Black River, is to climb the tree and shake them out, having full
confidence that their trusty dogs below will not allow them to escape.
This, Lafayette essayed to do, but when about 15 feet above the
ground, he made some false step, which resulted in his being pre-
cipitated headlong to the ground. His companions state that he was
speechless for nearly half an hour, and as soon as the power of ex-
pression returned, he complained of pain in his neck and, between
his shoulders. He was, however, incapable of voluntary motion, as
respects the lower extremities, but could move his head a little
more freely to either side, than either backwards or forwards. He
could also raise his elbows, but his hands and fingers were motion-
less.

I visited Lafayette about an hour and a half after the accident, and
found him in the following condition : His mental faculties in no
respect disordered, memory of what had passed perfectly distinct,
and gave mc the foregoing account himself, differing from that re-
ceived from h is companions only in minuteness of detail; stating
that he did not fall directly upon his head, but that the back of his
neck and head struck the ground first : complains of pain in the
neck, and that only when he was moved ; feels no pain when suffered
to be still ; incapable of any voluntary motion, except the slight
movements of his head and elbows before mentioned; surface of the
entire body rather cool; pulse full, but slow, 54 to the minute-^-
neither dislocations nor fractures could be detected, but some serious
injury of the cervical vertebrae and spinal marrow was considered as
absolutely certain, though the nature of the injury could not be cor-
rectly ascertained.

Being called upon to direct the treatment of this interesting case,
I directed counter-irritants to the spine, believing that the only hope
of a successful termination consisted in relieving the spinal marrow
of the dangers of high inflammatory action, although it was very
questionable whether its integrity was preserved. As this latter con-
dition could not be ascertained, I could do no better than to take it
for granted, that the spinal marrow had received no lesion, which
would, of itself, cause death, but that loss of life might be the result
if high inflammatory action should supervene. Counter-irritation,
by means of blisters from the occiput to the sacrum, seemed to be
preferable to any other treatment; blisters also were applied to the
extremities, and not till then did I discover that he was entirely in-
' sensible to pain in the lower limbs although the blisters drew well,

1847.] Injury of the Medulla Spinalis. 727

he never felt them. After reaction was somewhat established, the
pulse being 75 to the minute, full but soft, I bled him from the arm
about 10 ounces, and administered 5 i. of castor oil. This was on
the day after the accident occurred. The oil did not operate, how-
ever, until a second dose of like quantity was administered. The
muscles concerned in the expulsion of urine seemed to have been
completely paralyzed ; the catheter was therefore used twice daily.
The secretion of urine was very abundant, and had the appearance
and smell of healthy urine until the 8th day after the injury; at
which time it became tinged with blood and very foetid, the quantity
also was considerably increased; this state of the urine continued
till the 10th day, when it became rather thick with mucus lobe
drawn off by the catheter : he died a few hours after I first observed
this state of the urine. His bowels were rather torpid the whole
time, but could be moved by large doses of castor oil. that being the
only purgative medicine administered. His breathing was very full
and easy the whole time. The pulse remained at 75 until the 8th
day when it rose to 90, soft, but with less volume the 9th day it
was 110, very feeble and for many hours beibre death it was exceed-
ingly quick, but too indistinct to be accurately counted. He had no
appetite, but seldom refused nourishment when brought to him.
From the 8th day he belched a great deal of fluid from his stomach,
and this belching bad increased so much on the 10th day, that it was
almost an incessant flow, He had hiccup occasionally on the day
of his death. His intellect remained unclouded and frequently spoke
of approaching death with calmness. On the night of the 20th
Sept., just 10 days after the injury was received, he was relieved of
his sufferings, by death ; no do.j'jt a welcome relief.

In reference to the treatment of this case, I should have but little
to say, but as some may in such cases, prefer cupping to blistering
the spine, it is proper that I should give my reason for preferring the
latter. Cupping relieves by local abstraction of blood, and does not
exert any influence upon the system generally, whereas, a blister
relieves by local depletion and at the same time exercises an import-
ant stimulating influence over the whole animal economy ; a matter
of great moment in a case like the present. If my views on this
point are incorrect, I hope some one will take the trouble to correct
them ; as my object in reporting this case, is not to attempt to enlight-
en the Profession, but simply to announce the fact that I am in want
of information, good practical information, on the treatment of
injuries of the Spinal Marrow.

728 Adherent Placenta. [December,

Autopsy 7 hours after death. The autopsy in this case did not
embrace a particular examination of all the organs, as the lungs,
kidneys and brain exhibited no evidences of injury during life.
Want of time compelled me to make the examination as short as pos-
sible. The cervical vertebroe were exposed and found to be injured
in two placed The atlas and dentata were entirely separated ; the
atlas remaining firmly fixed in its position. The spinal marrow did
not appear injured at all at this point. This fracture (as it may well
be called a fracture) was complete, the separation being entire. The
fifth and sixth vertebra3 were also partially separated, and at this
point there was manifest injury of the medulla. As soon as the
muscular coverings of the bones were cut through, the marrow
gushed out, similar to the escape of purulent matter from an abscess,
when opened with a lancet. The medulla spinalis, at this point was
evidently in a state of decomposition. How more injury had hap-
pened to the medulla at this point, where the bones were still adhering
in front, than at the other, where the separation was entire, appears
to me inexplicable.

The internal organs were very cursorily examined. Evidences of
peritoneal inflammation were plainly to be seen, though its existence
was not suspected during life. The bladder was nearly black and
had formed strong adhesions to the surrounding viscera on all sides;
distended with urine The stomach was also distended with fluid.

The result of this examination was a conviction that in consequence
of the injury of the medulla spinalis, no treatment would have done
any good ; death would have been the ultimate result. The peri-
toneal inflammation, no doubt, hastened its approach.

ARTICLE XLIX.

Case of Adherent Placenta with Hour-glass Contraction, Reported
by Drs. Martin & Smith, of Atlanta, Ga.

Obstetricians are divided in opinion relative to the adherence of
the placental mass in hour-glass contractions of the uterus. Very
respectable authorities* contend that it is extremely rare, othersf of
equal standing, that it generally exists. We are not prepared to
decide the point, but from our limited experience, are inclined to the
latter opinion.

+ Ramsbotham. Dewees. t Douglass.

1847. J Adherent Placenta. 729

We were called on the night of the 24th September last, to a Mrs.
D., who had given birth to a fine child before we saw her, and in
whom the placenta was retained. Some hours had elapsed since the
labor before we reached her. External examination found the
womb high up in the right hypogastrium, contracted firmly, large,
and of irregular globular form. Upon careful examination per va-
ginam, we found it utterly impracticable to effect the removal of the
after-birth without the introduction of the hand; upon introducing
it, a difficulty presented itself about midway the uterus, the mouth
of the womb was sufficiently dilatable to enable us to reach about
halfway to the fundus, but at this point the stricture in the organ
prevented further progress. The careful insinuation of one finger
after another enabled us at length to overcome the contraction and
feel the adherent mass.

We proceeded cautiously to detatch it with the index finger, until
after a tedious effort we were enabled to withdraw it entire from the
womb ; there was happily no alarming hemorrhage. The structure
of the placenta was peculiar, being in some of its adherent portions
almost as hard as a schirrous gland, very much resembling a diseased
jnamma.

We learned from the woman, upon enquiry, that three months
previously she had received a severe blow on the abdomen, from a
fall, which doubtless caused the morbid adhesion of the after-birth.
No formidable symptoms supervened in the case, and, with the ex-
ception of phlebitis of the left thigh and leg, she is doing well.

The operation of detatching an after-birth where the adhesion is,
as it was in this case, extensive and firm, is not the work of a moment.
We were engaged a considerable time in effecting it, causing with
our utmost care much suffering to the patient. A ruder hand
would no doubt have accomplished it sooner, but we were satisfied
with the result.

We submit the case, for no novelty that marks it, but as another
instance of the utility of our glorious profession without its aid in
this case, as in numberless others, death would have been the inevi-
table results.

Not less applicable are the words of Armstrong, relative to a kin
<dred branch, Surgery

" For want of timely care

Millions have died oi' medicable wounds."

730 A Treatise on the Practice of Medicine, [December,

PART II. REVIEWS AND EXTRACTS.

ARTICLE XLX.

A Treatise on the Practice of Medicine. By Geo. B. Wood, M. D.,
Professor of Materia Medica and Pharmacy in the University of
Pennsylvania, &c, &c. Grigg, Elliot & Co. 1847.

Here is another of this so prolific class of books in American
Medical Literature, exceeding all its predecessors, in size, at least,
numbering 1638 pages. Being of those who have a decided objec-
tion to this kind of works believing that the true science of Medi-
cine can never be taught by these compendiums that their effect
on the great mass of the profession is injurious, by discouraging
thorough study, making superficial practitioners; and considering
how the American press has recently been flooded by works of this
kind, we turned with eagerness to the preface, to see what possible
apology could be offered to the profession, for the appearance of ano-
ther. It there appears " that he has written in obedience to impulses,
which he could not well resist" o'ermastered by the high behests of
facts and opinions, the result of his long experience and investiga-
tion. "The present work claims to be something more than a mere
compilation." And yet, as if struck with the absurdity of the claim
of originality, in a work devoted to an account of each one of the long
catalogue of diseases, said claim is most materially modified by the
candid declaration, that he has 'gathered from every attainable
source, the knowledge which he might deem important." Thus is it
an omnium gatherum, like all the rest of the same class.

It is very evident that the author has, with great industry, collected,
considered, and "re-arranged his materials" that he has actuallly
written out the whole of this voluminous book that he has not gain-
ed the honors and emoluments of authorship, by handing another's
book to the publisher, to reprint, with here and there a note of his
own; nor has he made translations of foreign works, either by his
own or others' hands, and published with his own name to the title
page. It must, we say, have cost a great amount of labor; and look-
ing at this vast heterogeneous mass as the result, the reflection is
forced upon the mind how unfortunate that so much time and labor
should have been expended, to so little profit ! so little profit and
advantage to the science of Medicine, we mean that the energy of
the author should have been frittered away, amidst such a variety of
subjects: what a pity, that the patience and perseverance, which lasted

1847. j A Treatise on the Practice of Medicine. 731

through the fearful drudgery of compiling and re-arranging sixteen or
seventeen hundred pages, had not been devoted to original, independ-
ent observations and reasonings upon a few subjects ; for under such
an application of the powers, of this professor in the oldest college
in the country, wiih his access to the public hospitals and his large
private practice, the same time would have brought forth more than?
one monograph, which would have carried his name, with honor, to
posterity. It requires but little sagacity to foresee, that this work
of labor will, in a few years, be supplanted by some other of the same
kind, aided into notice by the very accidental causes, which, no doubt,
will give popularity to this, when it will bear the same relation to the
reigning favorite, that "Thomas' Practice, or Dewees', or Dunglin-
son's Practice," now bears to "Wood's Practice of Medicine."

But such works will be published, as long as the profession de-
mands them ; and our abhorrence of the class shall not prevent us
doing jusl ice to the merits of this one.

The style is simple, free from any attempts at flourish a good, sen-
sible, didactic style such a style, as we might anticipate would be
forced upon the man, who probably did his equal share of drudging
out and compiling that invaluable work the U. S. Dispensatory.
The author treating of grave subjects, diseases and their remedies,
very judiciously abstains from the bombast and flummery, which
disfigure the pages of some of his fellow-laborers in the same field.

The work is divided into two parts the first treating of general
Pathology the second of special Pathology and Therapeutics, the
first part, under the head of Constituent forms of disease, Etiology,
Symptomatology and General Therapeutics, constitutes a very liberal
treatise upon General Pathology, occupying upwards of 200 pages
an appendage valuable to many a practitioner, whose library consists
of a few treatises on the Practice of Medicine. The second part*
comprising the great body of the work, treats of individual diseases
which are arranged in three classes, viz., General diseases, Constitu-
tional diseases and Local diseases. The author uses this classifica-
tion, merely for convenience, very wisely, claiming for it no other
merit.

The class of general diseases embraces, together with others, the
Exanthematous fevers. The second class embraces but two diseases,
Rheumatism and Gout. Those of the third class are thrown into six
sections Diseases of the Digestive, Absorbent, Respiratory, Circu-
latory, Secretory and Nervous systems.

732 A Treatise on the Practice of Medicine. [December,

On looking aver the section of diseases of Digestive organs, we
get the impression, that each one has been very carefully considered,
and their varieties specified, so as to guide the young physician, as
clearly as he can be guided by any book ; and that the practice re-
commended is as free from objections as the practice of any physi-
cian would be when subjected to the criticism of the profession.

The diseases of the Respiratory system are preceded by a full de.
velopement of the various methods of physical exploration of the
Chest. It is however, to be regretted that the author had not more
fully developed the method of stethoscopic percussion. It is barely
mentioned, in the article Auscultation, in the first part of the Work,
in terms calculated to show forth the diligence of the author, but
Certainly not to render it intelligible to, or available by the reader.

We notice, with satisfaction, full details, in the section on Urinary
diseases, for testing the physical and chemical characters of the
urine and the application of the results to the purpose of diagnosis
and treatment*

It is impossible to comment upon each of the many diseases freak
ed of, and we shall only offer a few general remarks, which have-
been suggested on the reading of it. We remark an unusually full
and faithful description of the external character or symptoms of
disease, and a patient pains-taking to present all their varying com-
binations. The practice recommended may be characterized as ju-
dicious and safe, yet not temporizing; it manifests no undue prejudice
against the active agents of the Materia Medica, but a just cautiori
in their use it is entirely free from the reproach of rashness. The
author's pathology of particular diseases, however, is generally vague
and unsatisfactory* This general charge, we will not prefer, without
specification. Of Hysteria, under the head of Nature of the disease,'
he says: " The nature of the complaint seems to be a morbidly ex-
cessive irritability or excitability of the whole nervous system, which
causes it to be thrown into disorder, by causes insufficient materially
to disturb its action in health." What adevelopement of the nature
of Hysteria ! consisting as it does of a repetition of the fact,- in a
purely hypothetical form, that slight causes produce the characteristic
disorders of Hysteria. And in the latter clause under this head, he
speaks of " the hysterical condition of the nervous system" as produ-
cing uterine and intestinal disorders.

Of the nature of Chorea, after declaring that "we know little or"
nothing more than that it is a functional disease of the brain," to

1847.] A Treatise on the Practice of Medicine. 733

suggests this lucid exposition : "It is probably a perversion of that
function of the brain, through which the will acts, rendering it par-
tially subservient to other powers than the legitimate one."

Of Epilepsy, it is written, "The disease probably consists in a
morbid excitability of the brain and each paroxysm in a morbid ex-
citement or irritation."

Here is a sentence occurring under the head of Nature of Deliri-*
um Tremens : "There is little doubt that, could we look into the in-
terior operations of the brain, in delirium tremens, we should see the
springs of the organ every where relaxed, its machinery moving
languidly and feebly; and the streams of its influence sent forth
scantily to their several destinations. The vacuum thus created in
all parts of the system gives rise to disturbances, not unlike those
arising from repletion of the same influence; just as the wind and
the storm, in the exterior world, follow as well the diminution of the
sun's influence as its increase."

Now this sort of pompous emptiness may answer very well to deal
out to the non-professional, to satisfy pressing importunity for infor-
mation as to the nature of disease ; but in a work for the profession,
it is certainly out of place. We will not be so unjust as to reproach
Professor Wood with ignorance of the true pathology of these ob-
scure nervous diseases that reproach belongs to the science of med-
icine ; but in attempting to pass off such unintelligible jargon of
words and phrases, in a magisterial manner, as illustrating their pa-
thology, he is obnoxious to the reproach of violating the wholesome
rules of a sound medical philosophy and falls short of the severe
requisitions, which it makes upon those speaking from high places.

But look at his pathology of some other diseases, of which the
profession claims to know something of Rheumatism, for example :
"All that we know of the real nature of the disease is that it is pe*
culiar, and that it owes this peculiarity, not to the character of the
cause, but to some unexplained condition of the system, called the
rheumatic predisposition or diathesis." Surely this is a dark kind of
knowledge! How much more valuable to know, that there exists
disease in the spinal chord or its appendages, as a uniform concomi-
tant, which upon fair principles, explains many of the phenomena of
the disease, though not all. This knowledge points out a treatment,
which mitigates the horrors of the disease and materially shortens its
duration ; whereas when called into the arena to contend with an
unexplained condition of the system, in this uncertain light, our well-

734 A Treatise on the Practice of Medicine, [December,

meant blows may as likely hurt the patient as his enemy. We can-
not, for a moment, suppose the author to be ignorant of the pathology
of Rheumatism, alluded to; he has shown himself too diligent a
searcher of the records of medicine, to have overlooked it. He
evidently undervalues it; whilst he parades into notice, the supposi-
tion of an undefined peccant humour, and Dr. Prout's opinion that
this peccant humour is the lactic acid, merely to condem them, he
appears to have neglected this pathology as too low for. his criticism
he treats it with silent contempt not a word of reference, in the
treatment, to topical applications to the spinal column. Thus it ever
fares with those who indulge themselves in the vain philosophy of
words and occult causes ; they come, at last, to prefer darkness rather
than light.

Of Intermittent fever, he has no pathology, of any kind to offer.
As to the nature of Remittent fever, he has no opinion ; his strongest
bias seems to be to that of the dependence of the disease upon "bile
in the blood" at least, there is a strong interrogational squinting in
that direction. The Profession in this Southern climate, where Re-
mittent fever is the great endemic, look with great interest, fb the
articles on Miasmatic fever, in these Practices; they will be griev-
ously disappointed at finding nothing definite on its pathology, in this
one. They will not be satisfied with being told that "Miasmatic
fever differs from other forms of fever, in consequence of something
peculiar in the operation of its cause," more especially, when it is
immediately added, "what this peculiarity is cannot be certainly
determined, in the present state of our knowledge !"

We cannot close this article, without a remark or two upon the
treatment of Remittent fever. The author takes up seriatim, each
one of the measures of the old routine practice bleeding, emetics,
cathartics, diaphoretics, and the affusion of cold water; and we cheer-
fully acknowledge that his directions for their use, are admirable.
It is then added, "In mild cases of remittent fever, few other reme-
dies will be required besides those above detailed. When the remis.
sions are very distinct, and approach the character of intermissions,
the cure may often be greatly hastened by the use of quinia, as will
be stated more fully in a subsequent page. Rut violent and threat-
ening cases demand additional treatment."

We would fail in attempting to express our astonishment at finding
that the additional treatment demanded by violent and threatening
cases, consists in the use of Calomel ; for then follows a high enconium

1S47.] A Treatise on the Practice of Medicine, 735

on the curative powers of this medicine, and minute directions for
administering it. True, he says M it is not necessary to give mercu-
ry in all cases of bilious fever, the great majority will do well with-
out it." But mark the conditions, upon which it is to be given.
"But, when the disease is violent from the outset, and does not soon
show a disposition to yield to the remedies employed, or when it as-
sumes a dangerous aspect in its course, there will always be a proprie-
ty in administering it in reference to its constitutional effects. "
Thus we find, coming from one of the chairs of the University of
Pennsylvania, the recommendation to treat bilious fever, by mercury
pushed to salivation. Fortunately for the present generation of pa-
tients with bilious fever, in this region, this practice has been fully
tried, in former times, and condemned and abandoned years ago.
How much to be regretted it i, that the author did not announce, that
the Profession, in the Southern country, at least, did indeed, find it
unnecessary to resort to Calomel, in "the great majority" of cases,
having discovered, or rather, revived and extended the use of a spe-
cific, which in that proportion of cases, strangulate the disease in its
very incipiency a treatment, which has disarmed this hitherto
formidable disease of all its terrors. But of the use of this specific
let the author himself speak. "Sulphate of Quinine is another all-
important remedy, in certain cases of bilious fever. It has before
been stated, that in ordinary cases, it will often shorten the duration
of the disease, if given in the remission, after this has become very
decided, so as almost to amount to an intermission. Should no signs
of cerebral or gastric inflammation be present, and the activity of the
circulation have subsided or been subdued, this medicine may be
ventured upon, whenever the remission has the character above-
mentioned."

" But there are circumstances, in bilious remittent fever, which
render quiniaof the utmost value. When a paroxysm of great viru-
lence has occurred, from which the patient has been saved only by
the most strenuous exertions, and there is every reason to fear that
a similar one will prove fatal, recourse should be had to the su
of quinia, in (he remission, however imperfect or short it may be.
When the fever has hitherto shown little or no tendency to remit, and
the grade of violence is such that fatal results appear imminent,
should the slightest remission show itself, and the symptoms not be
those of cerebral inflammation or strong determination, the quinia
should be poured in without stint. The more nearly a case approach-

47

736 On the Semeiology of the Tongue, [December,

es to the above extremes, the stronger is the indication for the use of
the anti-periodic medicine." What then, we ask, is to become of the
vast host of intermediate cases, between these two extremes? Shall
we stand by and withhold the anti-periodic remedy, until they ap-
proach the extreme of malignity, and then use it in desperation?
And what is to be done, for those malignant cases, which the author
excepts from the benefit of this remedy, viz: those showing "the
symptoms of cerebral inflammation, or strong determination?" Are
such to be abandoned to their fate ? Has the author yet to learn, that
his excepted cases are those, which, under the treatment of Southern
physicians, illustrate most strikingly, the triumphs of this heroic
medicine?

In conclusion, we repeat the opinion that the history of the external
characters of diseases is very full that with indefatigable industry,
the author has generally given the latest knowledge, and that this
work will compare very favorably, with the best of the class.

F.

On the Semeiology of the Tongue. By Samuel Weight, M. D., of
Birmingham. (Clinical Lectures in Medical Times.)

Whilst some are disposed, in a prodigality of prejudice, to look up-
on the tongue as pathognomonic of nearly all the "ills that flesh is
heir to," others make comparatively light of it, and consider its testi-
mony as little trustworthy. To be amongst the best judges on the
subject, is to belong to neither of those parties. Asa rule, the tongue
is a very faithful indication of the condition of the alimentary organs ;
but its evidences are not unexceptionable. A furred tongue, for in-
stance, is a common indication of dyspepsia, but it is not a constant
one. We sometimes meet with irritable nervous subjects, whose
tongues are habitually furred, yet without any signs or symptoms
whatever of gastric derangement. Others again, will have clean
tongues, and of natural redness, whilst they are suffering from severe
stomach disorder. Various circumstances exert a remarkable influ-
ence upon this organ. Some people, otherwise healthy, get a furred
clammy tongue, if their stomachs are empty a little longer than usual.
Others have their tongues always furred when their stomachs are
full ; the coating continues only during digestion, and passes off as
this function ceases. Mental and moral emotions affect the condi-
tion of the tongue in a singular manner; perhaps it never becomes
morbid without the nervous function, in its higher offices, being some-
what implicated. This would explain why a furred tongue is so
rarely met with in the inferior animals. It may happen, and I think
not unlikely, that in dyspepsia, the disorder the brain suffers, sympa-
thetically with the stomach, has as much share as this organ itself

1847.] On the Semeiology of the Tongue. 737

in giving the tongue its characteristic coating. Certain it is, as I
have said, that the feelings of the mind will, in a very few minutes,
render a clean tongue a foul one. This is a subject which I have
been induced curiously to inquire into for some years past, and I have
seldom met with an exception to what I have just observed. Among
the profoundly studious, amongst those terrified by sudden apprehen-
sions, or shocked by the sudden advent of ill news ; among the hypo-
chondriacal, hysterical, gloomy, and desponding, you will find many
examples of the mind's influence, in this particular, upon the body.
A patient of mine, living near this town, will well illustrate what I
say. He is a man of remarkably good constitution, and moulded like
a miniature Hercules. Moreover, he has no incumbrances ; an ex-
cellent mercantile business, that takes up little of his time, is partial
employment for him, leaving him many leisure hours in every day
that he has some difficulty in disposing of. These he chiefly occu-
pies in fancying himself the victim of all possible kinds of aliments.
There is no disease in the nosology too much for his imagination.
Of course, these things are all imaginary, and tiresome enough to
listen to, when your judgment and sense of justice tell you that it is
not a case for "physic and a physician." You will anticipate my
saying that this gentleman is possessed of a most unfortunate nervous
sensibility, which chiefly manifests itself in an ideal pathology ,ali re-
flected upon his own person. The peculiarity in point, however,
which I chiefly wish to speak of, refers to his tongue. I had never
seen him with this organ quite clean (although I have not once attend-
ed him for dyspepsia), yet the readiness with which it acquires a fur
is very remarkable. Many times have I examined his tongue, and
found it comparatively what it ought to be, before hearing a recital
of his imaginary maladies; and after this, in some quarter or half
an hour's detail, that same tongue has put on an aspect almost like
that of flannel. lam at this time attending with >$r. Carter, a pa-
tient, one amongst the pitiable many who have seen better days. I
shall take occasion hereafter to give you his case in due detail, but
for the present, I may observe that his tongue has the peculiarity
characteristic of the one just spoken of. I should premise, however,
that there is a fancied trouble in the one instance, and a matter-of-fact
one in the other. Four days ago. in calling upon the gentleman I
am now alluding to, one of the first things I did was to look at his
tongue. I found it as usual, very pale, flabby and moist, but without
any coating. After having made other necessary inquiries, I was in-
formed by my patient that his heart, which has long been disturbed
by mental emotion, the other night beat with unusual vehemence and
irregularity. On my asking if he could account for it, he told me
that he had just then received the distressing intelligence that an
uncle, from whom he expected a competency, had not left him a shil-
ling! This pitiable tale, told with much earnestness and visible
feeling, occupied little more than twenty minutes; at the end ofthat
time I again looked at his tongue, and found it coated with a thick
white fur !

738 On the Use of Opium in Inflammation. [December,

I mention these things, thus generally, to you, not only as items
in pathology with which you ought to be made familiar, but also as
suggestive ofadiscreet rule of practice, viz., to let the examination
of a patient's tongue be one of your first duties at his bedside. My
own experience, perhaps not inconsiderable on this point, enables
me to say that in nine cases out often, and more especially among
females, the tongue will be found, on first entering the room, in a
very different state to what it is after half an hour's questioning and
manipulation.

On the Use of Opium in Inflammation. By W. H. Ranking, M. D.,

(Half- Yearly Abstract.)

The legitimate sphere of action of opium, in the treatment of in-
flammatory diseases, is, we conceive, a point upon which our notions
have arrived at tolerable precision. Under whatever modifications of
individual circumstances attending such diseases the beneficial action
of opium is observed, one well-marked morbid condition has, accord-
ing to my observation, existed in every case, and that is an excitement
of the nervous system, altogether disproportionate to the exaggera-
tion of vascular action. This excitement is not shown in the exist-
ence of spontaneous pain alone, as we know that that symptom may
be insignificant, or altogether absent, in instances of the most exten-
sive and destructive inflammation ; neither is it shown mainly by
increased sensibility to local impressions. The excitement to which
I allude, exhibits itself in disorders of the sensory and motor func-
tions of the nervous system chiefly, and consists in watchfulness, or
transient delirium, irregular respiration, and especially in restlessness
and jactitation. In this condition of things, whatever be the violence
of the local inflammation, or whatever organ be affected, (excepting
the brain in some instances,) opium is imperatively called for. In
other words, whenever, during the existence of inflammation, symp-
toms indicative of a Joss of balance between the nervous and vascular
systems exhibit themselves, sedative medicines are demanded in
doses proportionate to the nervous preponderance.

This want of balance declares itself, I believe, chiefly under two
conditions 1st, the existence of inflammation in a constitution na-
turally exciiable, or in which the general powers have been reduced
by the disease itself, by treatment, or by contingent circumstances
relating to food, air, &c; and, 2d, in inflammation of organs or tis-
sues, the implication of which, induces a state of things more or less
opproaching to that condition which, for want of a better term, we
are in the habit of calling shock. In illustration of the first division,
we may mention inflammation occurring in the hysterical constitu-
tion. In these cases, the phenomena which depend upon irritation
of the nervous centres, take so decided a lead in the symptomatology
of the case, that until they are controlled by opium, or some, under
certain circumstances, more appropriate sedative, the inflammatory

1347.] On the Use of Opium in Inflammation. 739

symptoms proper do not display themselves with their characteristic
features. Again, inflammation may attack an ill-fed or previously
debilitated individual ; or the inflammation may have been too active-
ly combatted by blood-letting, mercury, &c., without reference to the
deficient resiliency of constitution, which, in children, more particu-
larly, may lurk behind an appearance ostensibly robust. In these
cases there may exist from the first, or there comes on assuredly at
no distant period, a condition in which opium becomes necessary to
save life, to prevent, in fact, in the latter case, the anomaly of the
patient M dying cured,"

Under the second class of cases in which opium becomes a neces-
sary part of the treatment, or is even mainly to be relied on, is inflam-
mation of an organ or tissue largely supplied with ganglionic nerves,
and in which, for this reason, the nervous system requires a large
share of attention in the treatment of the case. Such is peritonitis or
enteritis, either idiopathic or secondary : such are, also, one form of
delirium tremens, diffuse cellular inflammation, and more particularly,
phlebitis, the inner membrane of veins having the closest analogy to
serous membrane in many respects, but especially in its large supply
of organic nerves. In all these inflammations, the usual battery of
antiphlogistics is worse than useless, unless combined with the liberal
exhibition of opium.

The symptoms either existing ah initio, cr, as is more commonly
the case, coming on in the course of the disease, which indicate the
necessity for opium, can only become familiar to the practitioner by
clinical observation ; but as tar as written descriptions can be relied
upon, it may be stated, that the broad expression of this condition
consists in a failure in the power or regularity of the pulse, pallor of
the countenance, moist skin, (but not in all cases,) tendency to inco-
herence, with restlessness, sleeplessness, and, in an aggravated form,
jactitation. This is the broad outline, so to speak, of the state refer-
red to, but it declares itself in minor degrees, with which experience
alone can render us familiar, and the appreciation of which is in it-
self sufficient, in many cases, to make the difference between a suc-
cessful and an unsuccessful practitioner ; for to persevere in anti-
phlogistic treatment, or to withhold opium, when these indications
offer themselves, is to destroy the patient.

In the exhibition of opium when these symptoms show themselves
in inflammation,! know of no drawback. no contra-indication which
should weigh for one moment against its paramount necessity. Re
the skin sweating or dry, the tongue moist or dry, the bowels consti-
pated or not, opium must be given. The constipated bowels, which
are regarded by some as inducing the necessity for hesitation in the
use of the medicine. I look upon as of the least importance in the
generality of inflammations ; in some, as in enteritis, a quit
state of the bowels is even needful ; and were it not so, the probabili-
ty is, that if the case has been properly managed at first, such a
clearance will have been effected as will render any risk from accu-
mulation comparatively small.

740 Treatment of Chronic Cystitis, [December,

Treatment of Chronic Cystitis by Injections of a Solution of Nitrate
of Silver. (American Journal of the Med. Sciences,)

Dr. Robert L. MacDonnel, in an interesting paper in the British
American Journal of Medical and Physical Science, (Sept. 1847,)
extols, in strong terms, the efficacy of injections of nitrate of silver,
in chronic inflammation of the bladder, a disease which has proved
very refractory to other remedies, and which entails on those who
labour under it, the most exquisite suffering. In proof of the value
of the remedy, he relates four cases, one of which is the following :

44 A gentleman consulted me last February, under the following
circumstances. He had suffered for some months from inflammation
of the bladder, marked by frequent desire to pass water, accompa-
nied by heat and scalding, violent straining, pain in the region of
the bladder, above the pubis and in the perineum, and a constant
feeling of heat and weight in the lower portion of the abdomen.
These symptoms gradually increased in severity. The urine be-
came at first bloody, and afterwards purulent, and the desire to void
it became so urgent, that it had to be yielded to at least every fifteen
minutes; the discharge of the fluid being followed by pain and scald-
ing at the neck of the bladder, and along the course of the urethra.
His general health became impaired : and his sleep being so fre-
quently disturbed, a haggard and anxious expression of countenance,
and extreme irritability of the system, were soon established.

44 When he first consulted me, fully one-half of the fluid passed
from the bladder was pure pus; and after repose, a deposit of blood-
globules was found to intervene between this and the supernatant
urine the latter being highly alkaline, foetid , and albuminous. Ex-
amined microscopically, it exhibited some scales of nucleated epithe-
lium, a large deposit of triple phosphate in prismatic crystals, pus,
and blood-globules. There was no pain in the loins or along the
ureters. He had a stricture of long standing, about one inch from
the orifice of the urethra. In addition to the above characters, the
urine was frequently mixed with tenacious masses of lymph, varying
in length from half an inch to an inch,* and entangling a quantity of
earthy matter ; they frequently obstructed the passage of the urine
through the stricture, and required to be broken up and squeezed
through by the pressure of the patient's fingers.

44 Having dilated the stricture, so as to allow a large-sized catheter
(No. 11, Weiss) to pass, I determined to treat the disease by injec-
tions of nitrate of silver; and accordingly, on the 17th of February
1 injected into the bladder, a lotion composed of eight grains of lunar
caustic, two drachms of tincture of hyoscyamus, and four ounces of
distilled water.

* C'est encore dans les cas de suppuration, qu'on trouve des productions
pseudo-tnembraneuses dont parlent les auteurs. C'est l'expulsion de ces fausses
membranes par l!urethre qui a fait repeter a taut de medicins que la tunique
muquese de la vc^sie pouvait etre entierement detachee et expulsee par por-
tions avec les urines. Ferrus, Diet, de Med., Art. Cvsfi'e.

1847.] Treatment of Chronic Cystitis. 741

"The injection caused hardly any inconvenience, except that of
inducing a strong desire to empty the bladder, which was prevented
by compressing the penis, until the fluid had been in the bladder for
about one minute, when it was allowed to escape. The next day,
the patient stated that he was somewhat better, but the quantity of
pus and blood was not, however, much diminished, and the flakes of
lymph were more numerous and larger than before. Although he
continued improving, yet, as the amendment was not as rapid as I
anticipated, injection of the viscus was again resorted to on the 5th
of March. On this occasion, the quantity of caustic was increased
to sixteen grains in the four ounces of distilled water, and the hyos-
cyamus was omitted. A decided improvement immediately follow-
ed ; the frequency of making water was greatly diminished ; instead
of requiring to be voided every fifteen minutes, the bladder could re-
tain its contents for more than two hours at a time, and the quantity
of pus had greatly decreased. An injection, of the same strength,
was again employed on the 28th of March, and with happy results.
The urine could now be retained for three or four hours ; was passed
without pain or scalding; was clear and transparent, and, to the
naked eye, free from pus ; but, when examined microscopically, a
deposit of pus-globules and some epithelial scales were perceptible.
On the 18th of April, I repeated the injection, and since then ho has
been completely free from any symptoms of his troublesome disease ;
he has resumed his former mode of life and pursuits, and has been
subject to various changes of temperature whilst travelling, without
experiencing the least return of his former symptoms."

The method of injecting the bladder which Dr. MacDonnell has
found most efficient is the following:

" The patient being placed either in the erect position or on a sofa,
a gum elastic catheter, about the size of No. 9 or 10 (Weiss), is in-
troduced, and water at the temperature of 98 Fahr., is injected
through this into the bladder, by means of a caoutchouc bag, or, what
I prefer, a syringe, with a "three-way valve," by which the fluid can
be drawn back from the cavity if necessary. After the bladder has
been completely cleansed of any foetid urine and mucus which may
be contained in it, the solution of the caustic, being heated to the
same degree, is to be introduced in a similar manner, and allowed to
remain there for about one minute, care being taken, by compressing
the urethra, to prevent its being forcibly ejected by the violent strain-
ing that is certain to be induced. The quantity of water or solution
should never exceed four ounces, for though the bladder in its heal-
thy state is capable of containing nearly a pint and a half of urine,
without being over-distended, yet as the quantity it is capable of re-
taining in severe chronic inflammation, seldom exceeds a few table-
spoonfuls, the bladder accommodates itself to its diminished contents,
and gradually becomes smaller, and consequently, a large injection
would act injuriously in two ways by over-distending the organ, or
by pasting up into the ureters. In fact, we iind it unnecessary tu use

742 Ycsieo-Yaginal Fistula. [December,

a larger quantity cf the solution than I have mentioned, for it requires
some add: roduce even that amount without resorting to

force. The patient is then ordered a warm bath, and should the
urine become bloody or mixed with shreddy concretions, he should
use fr : mentations and anodynes. But these symptoms sel-

dom last for more than a fe<v hours, and our patient should always
be informed t: nsequences are likely to be the immediate

effects of the operation.

My patients have not suffered from retention of urine, which it
appea s the use of the solid nitrate in the practice

.ve they had any inconvenience which was not
readily by an opiate.

"The a^ which I consider the solution of nitrate of silver

possesses over tl in a solid form are, first, that we can

employ it of various strengths, from one to f< sea strong-

er if necessary. Seconf i ?.in that the application comes

in contact with the entire diseased surface. e are also

ied that it does not act more violently on one part than on ano-
ther. Fourthly, it is more read:' ed by an inexperienced
operator; and, above all, it cannot possibly be attended with any
risk, from the apprehension of which it is not easy to divest thenv.nd,
::sing trie parte caustique of LaUemand, and together with the
above ad* . I has this also to recommend it, that it will be
found at least equally success!

A Case of Vesica- Vaginal Fistula remedied by Caustic. By Elan
\V. Bjlbbis, M. I ood. Cape Girardeau county, Mo.

(Western Journ. of Medicine and Surgery.)

Mr-. C. a married lady, a^ed 30 years, presented herself to me
early in February last, laboring under the unfortunate, painful, and
_- infirmity of vesico- vaginal fistula, Her garments were
constantly wet ; the vaginal cavity, labia and thighs bathed with
urine, in an erysipelatous condition, and exquisitely tender. The
complaint had existed for five years, and occurred seven or eight
davs after a tedious first labor, and vio! -re manipulations of

her midwife. In addition to the soreness caused by the irritation of
the urine, she suffered violent pain in the bladder, which often pre-
vented sleep whole n he sometimes passed urine the natural
way for a day or two at a time, but always with great pain, and if,
during her mo: : ods, the urine is discharged through the
urethra it is mixed with the catamenia fluid, just as it is when the
urine passes through the fistula and vagina.

The parts being too sore to attempt any exploration, recumbency,
aperients, fomentation, and tepid lotions were enjoined. In a few
davs. her condition being much improved, the finger was introduced
into the vagina, the walls of which felt hard and irregular, presenting
to the finger the sensation of cicatrices. No o> tineas or neck of

1847.] Vesico-Vaginal Fistula. 743

#the womb could be felt. The vaginal speculum was now carefully
inserted into the vagina, which terminated in a round sac-like cavity
without anything like the neck of a wound projecting into it. In-
stead of an os tincae, a small opening was found large enough to
admit a silver probe which entered the uterus; about three quarters
of an inch from this aperture, in the anterior wall of the vagina,
was found an oblique fistulous opening into the bladder (five lines in
extent), through which the urine could be seen flowing. The bladder
was then sounded, and I soon convinced myself of the existence of a
calculus. The patient was informed that the only relief that could
be afforded was by extracting the stone, and that there was barely a
hope that the fistula might be healed, and thereby relief obtained
from the troublesome and disgusting incontinence. She replied that
she would willingly submit to any operation rather than remain in
her miserable condition.

On the second day after the examination, a long delicate pair of
forceps was introduced through the meatus urinarius, with a bistoury
at hand to make the proper incision if found to be necessary for the
extraction of the stone. By gently and gradually opening the chaps
of the forceps, the urethra was sufficiently dilated in about twelve
minutes, (with very little pain), to enable me to take hold of the
stone. In endeavoring to get a firm grasp, this was crushed to pieces,
which I considered a fortunate occurrence; the fragments were re-
moved with the furccps and syringe, at a sitting of a few minutes
each day for five days, when no more could be Jound. Some of the
particles pissed through the fistula and were washed out of the va-
gina with a syringe. I weighed four drachms and six grains of
gravel saved, and there was fully as much lost. No unpleasant
symptom occurred, and she was permitted to walk about, expressing
great gratification on account of freedom from pain.

The incontinence was still annoying, and on the sixth day after
the removal of the last of the gravel, the speculum was again intro-
duced, and a piece of solid lunar caustic made fast by a thread in
the same forceps used for extracting the stone, was carried up through
the speculum, into the vesico-vaginal opening, and rubbed on the
edges and angle of the wound, until they were completely cauterized.
A tube was firmly fixed in the bladder to conduct the urine into a
vessel placed below, and emollient injections daily used. On the
third day there was tenderness and pain in the pelvic region, fever
and bilious vomiting. The catheter was removed, and by the use of
the lancet, an emetic, and fomentations, those symptoms were re-
lieved. The catheter was then replaced and not removed until the
eighth day, when to my great satisfaction it was found that she could
retain the urine and pass it per vias naturales.

Thus has a cure been obtained of a loathsome malady, which at a
time still not very remote was supposed to be beyond the resources of
art.

I saw Mrs C, yesterday, and she informed me that she had men-

744 Purulent Infection. [December,

struated three times since the operation without difficulty or pain,
but that the menstrual fluid passes from the bladder mingled with the
urine, showing, I think, the existence of utero-vesical fistula. Fears
are entertained that particles of the menstrual fluid retained in the
bladder may form the nucleus of another stone. The woman, how-
ever, is contented and happy.

Purulent Infection. (Med. Chirurg. Review-)

M. Sedillot believes that authors have too generally regarded this
affection as constantly fatal in consequence of their only taking into
consideration extreme cases. He establishes a distinction between
purulent infection and metastatic abscesses. As long as the disease
is confined to the former condition, it may be cured ; if there are ab-
scesses only of small size, or few in number, all hope is not extinct;
dea'th only being inevitable when these are very numerous or large,
or open into the pleura, the articulations, &c. The effects vary much,
also, not only according to the quantity of pus mingled with the
blood, but also according to its qualities the pus from a phlegmon
producing much less deleterious effect than asanious pus. Wounds
of the perineum, in which there is a mixture of pus and urine, pro-
duce, even when the suppuration is not very abundant, fatal effects
in a very brief space of time. It may be replied to the state-
ment that the less advanced cases of purulent affection recov-
er, that such were not examples of the disease at all ; but M.
Sedillot believes the pathological changes induced in man and
animals from this cause are the same, and numerous experiments
upon these last have proved to him 1. That a small quantity of pus
injected into the veins only produces slight effects. 2. If the injec-
tion be repeated for several successive days, thirst, shivering, &c,
are produced ; but the animal continues to live if they are then dis-
continued so that we must kill it in order to observe the pathologi-
cal alterations at this period, such as patches in the lungs, emphysema,
&c. 3. If a new portion of pus be daily injected, death takes place,
always producing the same changes.

The lungs are the organs in which pus is found to be most fre-
quently deposited in this affection ; then follow the pleurae, the joints,
the liver, and the muscles. Although veins are constantly found
leading from the source of pus, in a great number of cases no trace
of phlebitis is visible. After amputations, in deep-seated phlegmons,
in chronic suppuration, caries, &c, it is always by means of the
divided or eroded veins that a direct communication between the
purulent centre and the circulation is established, and the mixture of
pus with blood which this gives rise to is one of the best ascertained
phenomena of the disease. The constant obliteration of the veins by
coagula, even in the cases in which they are inflamed, is contrary to
the statement of most authors, an exceptional occurrence. The co-
agulum, when it exists, docs not adhere to the walls of the vein, but

1847.] Cold Water in Burns. 745

floats in the pus. having an elongated, fusiform shape. If it is inter-
rupted from place to place, the blood remains fluid in the intervals,
having lost its red colour, and become converted into a sanies by ad-
mixture with pus.

Recognizing different stages of this affection, and its curability in
some of these, M. Sediliot enumerates the following indications of
treatment: 1. Combating the inflammatory symptoms, if intense,
by bleeding, especially local. 2> Modifying the surface secreting the
pus, in the case of a wound. This is to be done by stimulant lotions
or baths, or injections of aromatic wine. In this way the vitality of
the tissues becomes modified, and the pus changed in qualities, or its
secretion arretted. 3. Furnishing ample exit for pus by prompt in-
cisions if necessary. 4. The frequent renewal of dressings. 5. The
use of the actual cautery. This is often very efficacious. 6. If puru-
lent ifection seems threatened after attempting union by the first
intention, the commencing cicatrix is to be broken, and the edges of
the solution of continuity irritated. 7. A revulsive action of the
secretory organs is to be maintained, especially by the use of purga-
tives. 8. Cold fluids should be drank in abundance, to maintain the
venous system in a state of repletion, and diminish its absorbing
powers as much as possible. 9. Counter-irritants should be applied
in the vicinity of any organs suffering from derangement of function.
10. Tonics are not indicated until the febrile action has declined,
and true prostration set in. 11. In the case of symptoms of infec-
tion occurrring in a carious limb, amputation offers the best resource
if its performance be not too long delayed.

Cold Water in cases of Severe Burns.. By Dr. Kustex. (London
Med. Gaz., from Caspar's Wochenschrift and Am. Journ.

A case of very extensive burning, treated most successfully by the
prolonged application of cold water, has been recorded by Dr. Ktisten,
the particulars of which seem to indicate the great advantage which
may probably be derived from this mode of treatment in most cases
of severe burns. Dr. Kusten was first led to set a high value on
the use of cold water in such cases, by observing the good effects
which resulted from it, in the case of his own child, nine months old,
which was severely scalded about the neck, chest, and abdomen, by
the upsetting of a tea-kettle containing boiling water. The appli-
cation of cold water was commenced immediately after the child's
dress was removed : very abundant vesicative power had already
taken place in the form of numerous large and small blisters. For
six hours, without intermission, the application of cold wet cloths
was continued : the cloths being replaced by others as quickly as
they became warm. At the end of this time, the smaller vesicles
had quite disappeared, and the places occupied by the larger ones
were indicated by more or less intensely reddened spots. The child
meanwhile had fallen asleep, and it slept soundly the whole night,

746 Cold Water in Burns. [December,

(the accident having occurred about six o'clock in the evening).
On the following morning the only trace of the burn consisted of a
dry shrivelled appearance of the cuticle on one small spot; and this
peeled off in a day or two.

The case, however, in which the beneficial effects of this mode of
treatment were especially illustrated, occurred in a brandy distiller,
who, in consequence of the bursting of a still, was extensively scald-
ed over the body by the boiling and blazing spirit. The man's head,
at the time of the accident, was fortunately covered by a thick cloth
cap, and escaped injury; but the upper part of the body, being de-
fended only by a shirt, suffered severely. When seen by Dr. Ktisten,
about an hour after the accident, the patient was almost unconscious :
he lay moaning, and constantly ejaculating "Fire?" After washing
off, by means of a watering-pot, the layers of scraped potatoes which
had been spread over the burned surface, it was found that over the
whole body, down to the lower part of the thighs, there was scarcely
a spot which was not more or less injured. The slightest degree of
injury was manifested by vesication ; but over the neck, chest, arms,
and abdomen, the skin in places was quite destroyed. Dr. Kusten
immediately covered the entire burnt surface with linen ; and for
an hour this was kept constantly cold and wet, by pouring cold water
over it from a watering-pot. After pausing for live or six minutes,
the application of cold water was renewed, and continued for another
hour, at the end of which lime the man had recovered from his state
of partial unconsciousness. He was then left, with directions that
the application of the cold water should be continued as before.
When seen about six hours afterwards, the patient was in a promising
condition: his face was slightly flushed ; eyes open ; pulse 100. He
complains of a sense of general burning, which was relieved by
drinking, and by the repeated application of cold water to the burnt
surface. This application was continued until the patient complain-
ed of being cold. On examining the injured part the following day,
the places which were previously occupied by the vesications, were
indicated only by intense redness; the other part had much the same
appearance as before : portions of the destroyed skin came off on re-
moving the dressing. The injured parts were then dressed with
cloths dipped in vinegar, and kept constantly wet by sprinkling cold
water on them. The patient had some sleep during the night, and
on the following day the reddened portions of skin had resumed al-
most their natural colour : commencing granulations were observed
along the margins, and within the spaces of the surfaces, where the
skin had been destroyed. The pulse was 90, the thirst less intense,
and the tongue less dry than on the preceding day. For nine more
days the same treatment was continued, and with the happiest results,
for at the end of this time the wounds were almost healed.

In the treatment of such severe wounds by this mode, the dressing
must, of course, be changed at least once in the twenty-four hours.

Dr. Kiisten mentions one or two other instances, in which the

1847.] Inflammation of the Spleen, c. 747

healing of bums, of various degrees of severity, was effected most
rapidly and satisfactorily by this continued application of cold water.

Case of Inflammation of the Spleen, terminating in Suppuration.
By J. Daniel Holly, M. D., of Lowndesborough, Ala. (New
York Journ. of -Medicine.)

April 10, 1847. I was requested by Mr. C. to visit his son, aged
15 years, who had, previous to this attack, labored under intermittent
fever. I found him laboring under excruciating pain in the left
hypochondrium, extending as far as the clavicle or shoulder, increased
on pressure, with sensation of cold, and partial rigor, considerable
nausea, dry cough, more than ordinary symptoms of pyrexia, great
weight and fulness in the left hypochondrium, involving the upper
portion of the lumbar space, with pain on respiration, slight hBemate-
masis, with accelerated pulse, tumor extending from the origin ofthe
cartilages ofthe ribs on the left side to the mesial line in one direc-
tion, descending to the ileum, (crest), occupying the upper portion
ofthe lumbar space.

Treatment. I had recourse to venesection, both local and general,
cups applied to the left hypochondrium and lumbar space, with par-
tial abatement of the foregoing symptoms. As the indication, at this
juncture, for applying a blister was decided, vesication was resorted
to, over the whole space occupied by the tumor, followed by the ordi-
nary purgatives. The blister drew well, and the purgative had the
desired effect, the pain and fever being diminished. On the follow-
ing day I exhibited the following mixture of Twining :* R. Pulv.
Jalap, Rhei, Columbae, Zingerberis, Bitart. potassae. aa 3iss., Ferri
sulphas, grs. x., Senna) tincture, 5 ij., Aquae menthae sativae, 5 v.

Alternating with this mixture, after an interval of five days, I pre-
scribed for him pills of Sulphas ferri, x., Aloes soctari, 3iss., Sulphas
quinae.

April 22, the above were discontinued ; the patient now complains
of a dull heavy pain, with a peculiar burning sensation in the region
of the spleen ; striking as far as the spine and clavicle ; attended with
a fulness and throbbing, and an increase ofthe tumor. f Shivering
came on at intervals, terminating in slight perspiration over the most
oedematous portion. I applied warm fomentations of hops, contain-
ed in a small woolen bag, wrung out in warm water, followed with a
poultice of linseed meal, copiously sprinkled over with mustard, with-
out any perceivable change in the character of the enlargement.
The patient is much debilitated, the pulse is frequent, unequal, small,
and sharp, with flushing ofthe face; the skin cold and clammy, with

* Stokes' Lectures, American edition, vol.1., p. 562.

t "In unyielding text; Mr. Li.-ton. (Elements of Surgery, American

edition,) "the increase of swelling by the formation of purulent matter, is often
attended by an aggravation of the symptoms, and with an increase of danger to
the structure allcctcd.1'

748 On the Local Treatment of Amenorrhea. [December,

perspiration towards evening ; the ammoniacal plaster was then ap-
plied without any apparent benefit, towards the evacuation of the pus
externally. Caustic, (the potassa fusa,) was then had recourse to.
I used it in the solid form well pointed, not in paste, as is sometimes
used. This application had the most happy and desired effect. On
the following day the purulent fluid found an outlet externally, (im-
mediately over the splenic region,) and large quantities of a dark
puriform discharge came away through the opening; it was then
dressed with common meal poultice. The patient at this time is
much emaciated, from large quantities of pus being added to the cir-
culation, producing hectic kver, accompanied with diarrhoea. He
was put under the use of nourishing food, wine, tonics, etc., which
were used sparingly for a short time, and afterwards gradually in-
creased. The diarrhoea was stopped with opium, astringents, and
absorbents. For the inordinate perspiration 1 used the Acidum sul-
phuricum aromaticum, with the happiest effect. A tent was then
introduced through the opening in the abdominal wall, in order to
keep up the discharge from the spleen.

April 29. Discharge has stopped ; patient takes exercise in open
air; appetite good ; food exhibited sparingly ; the left hyppochondri-
um is much excavated as it were, from the large quantities of pus
evacuated from the spleen.

On the Local Treatment of Amenorrhcea. By A. Legrand.
(Month. Journ. Med. Sci.,from Gaz. Med. de Paris.)

The author commences this short memoir with a deserved compli-
ment to the practitioner, whoever he was, who first thought of the
application of nitrate of silver in the treatment of affections of the
mucous membranes, characterized by a diminution of their vitality,
a relaxation of their texture, an increase and vitiation of their secre-
tion ; for, he says this idea has been the happy foundation of many
safe uses and unexpected benefits of this remedy. He refers in par-
ticular to its unexampled success in virulent ophthalmia, whether
sporadic or epidemic, and in urethral discharges, and remarking on
the varieties in the strength of the applications employed by different
authorities, he condemns the excessive quantities recommended by
some, as a practice eminently disturbative. Noticing the easy transi-
tion from the use of nitrate of silver in the urethra to the use of it in
the vagina, he remarks on the anatomical causes of the less efficacy
of the form of solution in the latter case, as having led first to the di-
rect cauterization of the canal, either general or partial, by the aid
of the speculum, with the nitrate in the solid state; secondly, to the
use of rolls of lint, bougies, and the like, smeared with an ointment of
nitrate of silver.

To the use of the nitrate in the solid state he objects, on the ground
of its severity and other inconveniences, and rejecting the supposed
advantage of the tampon for keeping apart the inflamed opposite

1847.] Influence of Quinine on the Spleen in Ague, 749

surfaces of the canal, he objects to it, besides, as a foreign body, the
presence of which must irritate. Our author's method in opposition
to these, is the simple application of an ointment of the nitrate,
which may penetrate between the rugae of the canal. This ointment
is composed of one part of nitrate oi silver, dissolved in twenty-five
parts of water, and then thoroughly mixed with seventy-five parts of
cerate. From two to three grammes (from thirty to forty-five grains)
of this cerate are put into a muslin-bag, open enough in texture to
permit the cerate to pass through under a slight pressure. The fore-
finger is inserted into this bag up to the first phalanx, the bag being
fastened around it, and the finger so armed is introduced into the
vagina, and is carried over its whole extent, so that every sinuosity
of the canal and of the vulva may be freely anointed with the con-
tents of the bag. Our author occasionally employs the ointment of
somewhat greater strength. He finds it of the greatest service in
various affections of the vagina of an inflammatory character, ac-
companied with discharges, care being first taken to remove as far as
possible those determinate causes with which the affection may be
connected. Other remedies may be applied to the vagina by the
same method thus, Dr. Legrand has used successfully by this me-
thod an ointment containing tannin in relaxation of the vagina.

Influence of Quinine on the Volume of the Spleen in Ague.
(Lancet.)

M. Valleix, physician of the Hotel Dieu, has directed his attention
to the action of the sulphate of quinine on the volume of the spleen
in intermittent fever. He has done so to test the accuracy of a
statement made by M. Piorry, that the disappearance of the paroxysm
coincides with the diminution of the volume of the spleen ; that this
organ sensibly diminishes in thirty or forty seconds after the admin-
istration of a full dose of quinine, in solution, and acidulated; that
the diminution goes on very rapidly if the quinine be continued in a
sufficiently large dose. M. Gouraud having examined into this
matter, however, states that he has not found the spleen thus dimin-
ish, but that, in consequence ofan accumulation of gas in the stom-
ach, from the ingestion of the quinine, the left hypochondrium is
rendered sonorous, and the dulness over the spleen becomes masked.
These opposite statements M. Valleix has kept in view in making
some fresh observations. He narrates a case, and its course ; quite
a simple case of ague, occurring in a young and robust man, who had
never suffered before. It was a recent case, and there were no evi-
dences of organic disease in any organ ; the spleen had undergone
very considerable enlargement, being readily perceived through the
abdominal wall, and therefore its size could be estimated with the
the greatest precision. The sulphate of quinine, although given in a
very strong dose of thirty grains, and acidulated, so as to render the
salt a bisulphatc, did not act, as represented by M. Piorry, on the vol-

750 On the Use of Starch Bandages, [December,

urae of the spleen, neither at the end of forty seconds, nor of twenty
minutes, nor even of twenty- four hours. The medicine also had no
such power when given in still greater quantity, but divided, during
the day, into several dcses, and continued on succeeding days. But
after the application of cupping-glasses and leeches over the splenic
region, the volume of the spleen, on the contrary, diminished rapidly,
although the dose of quinine was abated. Lastly, notwithstanding
the persistence of the splenic engorgement, the fever was cut short,
and there was no trace of a recurrent paroxysm.

Another equally uncomplicated case occurred to M. Valleix, and
the same method being tried, was attended by the same results. It
must, however, be mentioned, that three days after the first dose of
quinine, a slight diminution of the spleen was noticeable; but this
little decrease, which perhaps, too, was partly owing to a bottle of
eau de Vichy which the patient took, was lost sight of when com-
pared with the rapid diminution which followed two days afterwards,
when cupping-glasses were applied over the spleen, and which con-
tinued to go on. In this case, also, as in the preceding, although the
enlarged spleen remained, the fever was removed.

The third case differed from the two preceding, in that it was of
older date ; but there was no essential difference in the effects of the
treatment. The spleen remained unaffected in size during the first
day, when quinine alone was given ; but quickly decreased after lo-
cal bleeding, although the dose of quinine was lessened. The fever
was removed before the engorgement of the spleen had subsided.

Thus these observations contradict the assertions of M. Piorry,
both as to the coincidence of the disappearance of the fever and the
decrease of the spleen, and as to the immediate and prolonged influ-
ence of quinine in diminishing the splenic congestion. M. Valleix
also confirms the observation of M. Gouraud as to the formation of
gas in the stomach upon the quinine being swallowed, augmenting
the resonance over the left hypochondrium, and so hiding the dulness
over the solid spleen beneath to a slight extent ; not so much so,
however, but that palpation and percussion will readily detect the
engorged organ.

On the Use of Starch Bandages. By Dr. Rognetta. (Annales
de Tberapeutique Med et Chirurg., and Amer. Journ.)

The starched apparatus has now been employed for a sufficient
length of time, at the clinic of La Charite, in the treatment of frac-
tures, to enable us to form a definite and mature opinion ofits value.
We are the more willing to weigh its value, because on this point
there is much diversity of opinion among the surgeons of Paris, and
because we have before us many facts capable of affording us the
grounds of a decisive judgment on this subject. First, it is to be re-
marked, that in the Parisian Hospitals the starched apparatus has
been adopted into general use by two surgeons only, namely, Vel-

1847.] On the Use of Starch Bandages.

peau and Blandin. But yet this apparatus has been everywhere
tried. At first it was applied indiscriminately to fractures of the
extremities, of all kinds. Velpeau himself, in his first memoir, ex-
tolled it, without any exception. In the sequel, nevertheless, unsat-
isfactory results were noticed in oblique fractures of the shaft of the
femur, and Blandin was the first to give up this method in fractures
of that kind ; and Velpeau finally did the same. At the Hotel Dieu
we have seen in fact such fractures treated by this apparatus, present,
some an enormous riding of the fractured extremities of the bone,
others an entire failure of reunion, owing to the starched bandage
forming, as it dried, an arch projecting from the limb, while, as soon
as the limb itself lost its former swelling, there was no longer a
co-aptation by the apparatus ; the muscles contracted without impedi-
ment, and dragged the disunited parts so as to ride more and more on
each other. Velpeau has doubtless been led, by cases like those
described, to abandon his first opinion ; and his doing so is creditable
to his love of truth. Indeed, the cases which we have seen so treated
at La Charite\ though cured, were not remarkable for freedom from
deformity. Thus such fractures must be left to the old treatment of
Scultetus, with the addition of continued extension, for which pur-
pose a starched bandage suffices. Though objectionable at the com-
mencement, yet we must add that, towards the end of the treatment
of oblique fractures of the thigh, when the patient begins to walk about
on crutches, the starch apparatus answers admirably. What we have
said, applies also to fractures of the body of the humerus. But as
regards fractures of the neck, and of the condyles of the humerus, as
well as of the condyles of the femur, the starched apparatus, if applied
after the swelling has gone down, is of the greatest utility. Velpeau
and Blandin apply the starched apparatus to all other fractures, name-
ly, to fractures of the leg, of the forearm, and of the clavicle. For
the forearm this apparatus possesses very great and obvious advanta-
ges. But we confess we cannot see its superiority over the common
apparatus in fractures of the leg. The state of the limb cannot be
ascertained till it is too late to remedy the riding of the bones, if that
shall have taken place. Thus the starched bandage, though it may
be regarded as an important acquisition to surgery, owing to the
many applications of which it is susceptible, in various departments
of practice, is far from having displaced the treatment handed down
to us by Scultetus. It is proper to add, that Velpeau uses but a weak
solution of starch, so that his bandages are not very stiff. The starch
is first worked up with spirit, and then water is added, to bring it to
the consistence of syrup. The bandages, after being dipped in the
solution, are squeezed as much as possible, and the whole dries in a
few hours if the limb be placed on a pillow covered with a large sheet
of paper.

48

754 Bibliographical. [December,

BIBLIOGRAPHICAL NOTICES.

1. Principles of Human Physiolgy, with their chief applications to
Pathology, Hygiene and Forensic Medicine. By Wm. B. Car-
penter, M. D., F. R. S., &c, &c, 3d American, from the last
London Edition with Notes and additions by M. Clymer, M. D.,
&c, &c, with 317 wood-cuts and other illustrations. Philadel-
phia;: Lea & Blanchard, 1847. 8vo., pp. 752.

We take pleasure in calling the attention of the Profession to a
new edition of the above valuable work. The productions of the
able author are now too well known to require any eulogy at our
hands. They justly hold the first rank in Physiology, and should be
read by all who wish to keep pace with the rapid advances of the
study of animal organism, and of the Human in particular. The en-
terprising publishers deserve much credit for the very handsome
manner m which they have gotten up the book.

2. Outlines of the Veins and Lymphatics ; with short descriptions.
Designed for the vse of Medical Students. By John Neill, M. D.r
&c, &c. Philadelphia: E. Barrington and G. D. Haswell. 1847*

In the language of the author's preface, "this little volume is in-
tended to accompany two of a similar kind, which have already been
published, on the Arteries and Nerves." The work is concise and
well adapted to the use of Medical Students in the beginning of their
studies,

3. Lectures on Subjects Connected with Clinical Medicine. By
P. M. Latham, M. D., F. R. S., Physician to St. Bartholomew's
Hospital, 2d Edhion. Philadelphia: Barrington & Haswell.
1847, pp. 158.

Under the above modest title, Dr. Latham has presented the Prcr-
fession a very useful little work upon Semiology, or the Doctrine of
Symptoms, embracing all that is important to the general practition-
er in relation to Auscultation. Such works cannot be too much
multiplied in our country, where diagnosis is so generally neglected,
especially in diseases of the chest. Its passage to a second edition
evinces its appreciation. It should bo in the hands of all Students of
Medicine.

4. Lectures on the Principles and Practice of Physic : Delivered at
King's College, London, by Thomas Watson, M. D., dec, &c.
Third American from the last London edition. Revised with Ad-
ditions bv D. Francis Condid, M. D., dec, &c. Philadelphia ;
Lea & Blanchard, 1847. pp. 1040.

We have received from the publishers, this very elegant, voIuhhd-

1847.] Bibliographical Typhoid Fever. 755

ous and useful volume. It will be perceived that this is a new edition
of a practice of medicine, which has been before the profession since
1843 one too, which has been so well received as to require several
editions to supply the numerous demands for it. This work merits
the liberal patronage which it receives in our country.

5. Illustrations of Medical Botany : consisting of coloured figures
of the Plants affording the important articles to the Malaria Medica.
And descriptive Letter Press by Joseph Carsox, M. D., Prof, of
Materia Medica in the Philadelphia College of Pharmacy, &c, &c.
Philadelphia: Robert P. Smith, 1847.

We have been furnished a specimen No. of this magnificent work
in folio. It contains three splendid engravings of plants, on stone,
and the printing of the letter press is of superior style. We take
pleasure in calling the attention of the profession to this publication,
and soliciting for it a liberal encouragement to the author, well known
as he is for his contributions to the Materia Medica.

PART III. MONTHLY PERISCOPE,

Treatment of Typhoid or enfero-mysenteric Fever, by Ethiops
mineral or the black sulphuret of mercury. By Prof. Series. -(Trans-
lated from Archives Generales de Med.) The Professor commences
by remarking that all exanthematic fevers, as the typhoid fever, are
composed of two distinct elements: 1st, the exanthema which con-
stitutes the foundation ; and 2d, the group of phenomena which the
presence of this exanthema develops in the organism called fever, and
which constitutes the form of these diseases. If the exanthema is
discreet or of little intensity, the fever is light ; if, on the contrary,
it is confluent, the fever is very intense. M. Serres establishing thus
the analogy between variola and typhoid fever, has thought that as
the former was aborted in the eruption of its pustules by mercurial
preparations, (as covering the face wiih the plaster of Vigo cum mer-
curio,) so the latter might yield to the same potent agency. Mis
treatment consists in the internal and external administration of mer-
cury. His formula is, internally, Black-sulphufet of Mercury (Ethiops
mineral), 1 gramme; powdered gum Tragacant, 50 centigrammes J
simple Syrup q. s. for four pills Dose 4 or 6 pills every second day.
Also, externally, mercurial ointment, in frictions, over the abdomen,
8 or 10 grammes repeated every morning. This treatment may be
continued eight or ten days before salhation is developed, when the
frictions must be discontinued and the dose internally diminished one
half. M. S. says in two or three days the action of this treatment is
quite evident; the fever diminishes, the typhoid symptoms disappear,
and the patients soon convalesce. He seldom uses more than 2 to 3
grammes of the Ethiops mineral.

756 Neuralgia. Gout and Rheumatism. Cataract. [December,

Neuralgia Tic Doloureux. The following case, which occurred
in the practice of R. II. Alkanett, M. D., &c, is important and in-
teresting, inasmuch as it throws light upon at least one occasional
cause of an acutely painful and obstinate affection, so frequently per-
plexing to the routine practitioner, who relies for its removal on the
reckless administration of inordinate doses of the most powerful and
highly deleterious narcotics. "A gentleman called on me a fortnight
ago, suffering from a severe tic of the trifacial nerve, which branches
up on the cheek and forehead, and the paroxysms observed like an
irregular periodicity. His appetite was good, and the functions of
the stomach were apparently uninjured ; the liver secreted a due
quantity of bile ; the bowels acted with regularity ; and nothing could
be detected, after the most minute search, to account for the agoni-
zing pain in the peripheral expansions of the sentient nerve. As is
my custom, I placed him under a preliminary course of active purga-
tives, and the pain in the face, and indeed all the symptoms, were
aggravated to a considerable extent. Disregarding this temporary
manifestation, I urged upon him the necessity of continuing the
aperients until the full effect should be produced: and this morning
he informed me that, in the middle of the night, he had a most copi-
ous evacuation ; undetected scybalae, in large quantities, had been
ejected from the bowels : he immediately experienced an inexpressible
feeling of relief, and the facial tic has totally disappeared. [Lancet.

Pyro-acetic spirit in Gout and Rheumatism. By Dr. John
Hastings. "For upwards of twelve months," says Dr. Hastings,
"I have employed Pyro- Acetic Spirit in the treatment of gout, acute
and chronic rheumatism, and my treatment has been attended with a
success quite extraordinary, far exceeding the results usually obtained
by colchicum, &c. I have not yet seen a case of goat, or acute
rheumatism, which has not rapidly disappeared under its use, at the
same time that it brings about a very improved condition of the
general health. Chronic rheumatism requires a more lengthened
treatment for its removal ; indeed, it has less power over this affection:
than the two preceding." [Ibid.

Operation for Cataract under the Influence of Mercury M.
Travignot addressed a note to the Academy, stating that he looked
upon mercurial salivation as a means of preventing many of the evils
of inflammation after the operation for cataract. He seems to have
imbibed this notion from the general observation of the influence of
mercury in acute inflammation of the iris and cornea, and from con-
sidering that such a condition of those parts of the eye is what is to
be feared after operating. He has put this idea to the test, having
operated on three patients, who were just beginning to be affected by
mercury, and in whom, too, there were some complications. He
effected a perfect cure in from three to five weeks, having had no ills
resulting from inflammation. The mercury is continued two- or

1847.] Casarian Section. Beef. tea Fate of the Physician. 757

three days after operating, combined with extract of opium, so that
the salivation induced may be most severe, just at the time when the
ordinary precursors of iritis, or of corneitis, make their appearance
that is, about the third or sixth day after the operation. [Ij

Caisarian Section. The statistics of the Cesarean operation at
present yield the following results: It has been performed in 378
cases, of which trust-worthy accounts have been given. In 145 of
these cases the women recovered ; in 233 they died ; or the recoveries
were in the proportion of 33 per cent, or as one in 20 cases. The
fate of 318 children is mentioned, of whom 219 were saved, 99 were
lost, or the child survived in 68 per cent., or rather in more than 2
cases out of 3. [Dr. West's Report on Midwifery, from Retrospect.

Beef tea. When one pound of lean beef, free of fat, and separated
from the bones, in the finely chopped state in which it is used for beef
sausages or mince-meat, is uniformly mired with its own weight of
cold water, slowly heated to boiling, and the liquid, after boiling
briskly for a minute or two, is strained through a towel from the
coagulated albumen, and the fibrine, now becoming hard and horny,
we obtain an equal weight of the most aromatic soup, of .such strength
as cannot be obtained, even by boiling for hours, from piece of fle>h.
When mixed with salt, and the other usual by which soup

is usually seasoned, and tinged somewhat darker by means of roasted
onions or burnt sugar, it forms the wry beat soup which can in any
way be prepared from one pound of flesh. Liebig, from Boston Med.
and Surg. Journal.

The fate of the Physician. We extract the following from the
columnsofour I contemporary, the iVetfl York Annalist:

u Another Physician, Dr. I). 1). Hall, died yesterday this is the
fourth." New Orleans paper.

Such are the brief, cold terms in which the public are told that
Medicine is offering up victim after victim, on the altar of profes-
sional duty.

Where are now the Hydropathy Homeopaths, Root Doctors, and
the whole legion of quacks .' They are silent they have probably
fled to seek in someplace of safety for dupes and victim*. And
where are now the flippant ll it the uncertainty of m

science the M Dorter*' quarrel*" t the Doctors' bills" Mtb D c
tors' rapacity ?*' Silent all ! no \oice is heard to breathe a word of
reproach or ridicule. Nol no! the talk i iciani

are labouring, dying." f Medicine and m

men. In the hour of su fieri eg, <r ol dan
with eager seal and rewarded with garrulous gratitude : but :

hour pass, and the danger, ai suffer*

ing, ami he V/boM toil Dlfl adlho

public turn from their long-lued pb) >e tho i

758 Sothern Med. and Surg. Journal. --Surgeon Lision, [December,

which he has so dearly earned, to the ignorance, the impudence of
the nostrum-vender, or the new system-man.

And what is our duty when thus treated ? Go onward! Lookup,
ward ! Go onward ! the path of duty is before you. Look upward !
the reward is on high.

MEDICAL INTELLIGENCE.

The Southern Medical and Surgical Journal. This No. completes the 3d
Volume of the new series of this monthly Periodical; and by the first of Janu-
ary next the 4th Volume will have been commenced. We have so recently
expressed our views and intentions (see July No.) respecting the work assigned
us, and the character of the Journal is now so well known, that in terminating
one and beginning a new volume, little need be said. During the past six
months, for the first time since its establishment, all the original matter has been
supplied in advance. This we think angurs well for its reputation. From it
we take courage and are determined still to labor faithfully in the discbarge of our
arduous duties. We often feel our insufficiency for conducting this publication
and know full well that without the kind and efficient co-operation of its con-
tributors and friends, it could not be sustained. With all our sacrifices, indusr
try, and anxiety to render the Journal useful, there are many faults for which
to claim the considerate indulgence of the reader. The imperfections will, we
hope, be passed over, and by practice, its character for the future may be
improved. While striving all in our power to make the work acceptable and
useful to our professional brethren, we trust they will still continue to aid us by
their contributions to its pages. Communications on medical subjects, essays,
reports of cases, reviews of works, synopses of journals, &c, &c., will be thank-
fully received.

The editor returns his sincere thanks to all those who have thus far kindly
assisted him in carrying on the Journal. His public acknowledgements are due
too, to the publishers of Medical works, who have generously supplied him, and
also to editors of Medical journals, for a very liberal exchange.

For terms, &c, see the Publisher's Prospectus for Vol. IV. An increased
patronage is respectfully solicited in his behalf,

OUR EUROPEAN CORRESPONDENT. LETTER II.

Late alarming state of Surgeon Listen's Health. By the steamer Washington
we have received another letter from our esteemed friend of Paris. We also
give place to an interesting case kindly reported for the Journal, by a young
English gentleman pursuing his studies in the French capitol, whose acquaint-
ance we made during our late visit there. Further contributions from the same
source are generously promised. Our correspondent too, says he will himselt
do the best he can for us.

The celebrated English Surgeon, Liston, we are informed, suddenly lost
his voice about the first September. A few days afterwards he felt something
give way in his throat, and in a few minutes ejected from his mouth, without

1847.] Aneurismal Tumour of the Left Arm. 759

cough, about thirty ounces of fluid blood. There was no return of the hemor-
rhage. Drs. Forbes. Watson, Walshe, and Stokes, (of Dublin.) all declare his
lungs to be sound. Our correspondent thinks an abscess had formed near the
vocal cords of the larynx. We are happy to add, Mr. L. is again in full vigor-
ous health.

Hopital de La Charlie, Paris, Oct. 18th, 1847.

Aneurismal Tumour of the left arm, Sebastian, aged 22, a
shoemaker, living No. 55 Rue Cherche Midi, entered the hospital.
Constitution good, temperament sanguino-lvmphalic, has generally
lived in comfortable quarters and been well fed, has never committed
any excess: since 8 years of age, has been accustomed to Epistaxis
nearly every week, but has had no other hemorrhage ; has never had
syphilis, or any other serious affection, and has never been bled. In
the month of March, 1843, without any appreciable cause, he felt a
slight pain in the anterior part of the left elbow. Fifteen days after
the appearance of this pain, just in the place where the tumour now
exists, he felt a little swelling about the size of a pea, moveable, hard,
not disappearing on pressure; and very slightly painful. This tu-
mour grew gradually, and at the end of the year had acquired the
volume of a small walnut: in the mean time it had become softer,
but at no period had it been the seat of pulsation the pain always
remaining as at the commencement. The tumour gradually grew to
its present size.

Present slate. At the anterior part of the elbow we perceive a
tumour of a hemispherical form, a little flattened, limited externally
by the tendon of the biceps muscle, stopping internally about one-
third of an inch outside of the summit of the epitrochlea; it rises
about two inches and a half above the humero-cubital articulation
it descends a little below this articulation. Its outward projection
is about one inch ; its circumference is irregular; its diameters are
from three to four inches. In some points its circumference is easi.
ly limited in others it is difficult to limit. It appears subaponeuro.
tic; the skin is normal and non-adherent. The tumour is slightly
moveable, but holds fast to the subajacent parts. It is firm, slightly
resistant, of unequal density, and fluctuating in its centre.

In examining the tumour with the fingers, there is no expansion,
pulsation, or fremissement appreciable to the touch, and the stetho-
scope reveals nothing but the distant shock of the artery. The
elbow enjoys all its movements without pain; the arm and forearm
are completely healthy. The arteries of the affected member appear
healthy, and exactly similar to those of the limb on the opposite side.
General health good.

Three or four days after the entry of the patient, M. Velpeau
made an explorative puncture into the centre of the tumour, and
through the canula. Drop by drop came three table-spoonfuls of
blood, which was red, and which quickly coagulated. The following
days Velpeau thought he perceived an expansion of the tumour,

700 Aneurismal Tumour of the Left Arm. [December,

which seemed to diminish on pressure of the humeral artery? and
appeared to increase when the pressure ceased. The tumour was
then by firm and constant compression, continued for several days
without intermission, reduced to one-fourth of its volume. After-
wards, when the artery was compressed, the tumour rested placid,
but on removing this pressure the tumour resumed its original size.

Fifteen days of compression with the bandage produced no satis-
factory or permanent result. After this time Velpeau tied the hu-
meral artery, but no change took place in the tumour, and the same
evening the pulse appeared in the radial artery. Permanent com-
pression was then made for one month, without effect. On the 16th
September, Velpeau traversed the tumour with eight needles, which
rested three weeks and determined a good deal of inflammation and
suppuration along the track of the needles.

October 12th. Needles withdrawn, and the tumour appearsin its
original condition.

[Note. I mentioned this case in my letter from Paris seepage
637 Aneurism. Edt.]

You will remember having examined the above case, when you
were at La Charite ; and 1 dare sny you will also recollect it had been
seen by the most experienced and noted Hospital Surgeons of Paris,
all of whom, after careful examination, had differed widely in their
diagnosis. One supposed it to be a malignant tumour, another to
be an enlarged bursa communicating with the articulation of the
elbow-joint, &o. It was not till M. Velpeau found that it diminished
or rather almost entirely disappeared on pressure, and afterseeing
that nothing but a quantity of arterial-looking blood flowed through
the canula, that this the most learned and sagacious of French Sur-
geons, concluded that the tumour was formed by an aneurism. Any
doubt, that he still retained, was removed, as soon as he ascertained
that the canula could be moved freely in all directions within the
walls of the sac.

Before proceeding to ligature the humeral artery about the middle
of the upper arm, he stated that the tying of the artery in this situa-
tion, sometimes failed to cure the disease. lie also alluded to the
difficulties that might be caused by the chance of encountering a
high division of the brachial. From the strong pulsation immedi-
ately above the tumour, he thought the distribution was in this patient
normal. Notwithstanding these consideialions, and after a full and
careful review of all the circumstances of this very anomalous case,
he stated, that he had decided indeed deemed it his bounden duty,
to prefer this mode of procedure, to the other alternative : that of
laying open the sac and ligaturing the vessel both above and below
it. This last kind of operation, he mentioned was much more cer-
tain, but likewise more difficult for the operator, and infinitely more
painful and dangerous for the patient. And lastly, that it could bo
had recourse to ultimately, in the event of non-success after simple
ligature above the tumour. I will keep you informed of its further

1847.] Consecutive Strabisynus. 761

progress, and trust that in the mean while, you will be less perplexed
relative to its true nature than I confess myself to be.

Monday, 18th Sept. There has not been any thing doing in the
hospitals of late, except what you will see reported in the Gaz. des
Hopitaux. Jobert has had two successful cases of vesico- vaginal
fustula. Generally the operation is tedious and irksome, sometimes
lasting for fully an hour. Jobert deserves much credit for his im-
proved methods of treatment, and operating in these difficult cases.
We are daily, however, seeing operations done in the various hos-
pitals, in what would be deemed in England and the States, a care-
less, rude, and improper manner. The treatment of incised wounds
has long been, and, with rare exceptions, still is, a theme of constant
reprobation. Let us take, for example, the last operation, of conse-
quence, an amputation of the leg. To arrest the bleeding instead
of the common dissecting forceps, a tenaculum was employed, by
which the divided vessels were secured and a great deal more.
They don't stick at including a nerve here, if it comes in the way.
Then, the ligatures were large and thick enough for the aorta of a
horse. The flaps were retained by common pins, not over sharp
at the points. The whole stump was finally enveloped with an enor-
mous quantity of adhesive plaster, large lumps of agaric, and the
usual superabundance of lint. They have no idea of trying to heal
stumps by the use of light water dressings, whereby the parts are
kept cool and excessive inflammatory action is often prevented.

Guerin, at the Xecker, has about thirty times operated with happy
results in cases of consecutive strabismus. The manipulations are
nearly all sub-conjuntival. He brings forward the cut and retracted
extremity of the divided muscle, and '-engrafts il" of new, by fixing
the tendon with a ligature, to the schlerotic coat and, exactly in
such a place, as afterwards to secure the parallelism of the organ.
The ligature is retained in the wound for from five to six davs. In
fourteen cases Guerin run the thread right through the ball of the
eye of course perforating the retina, vitrious humor, &c, and that
too, he asserts, without any ill consequences, excepting in two cases.
In one of these last, he told me, "I passed the thread too much for-
ward, too near the iris, and violent iritis was induced." I have
carefully examined one case in which he operated five weeks ago.
The patient, a powerful young man, had been treated for covergent
strabismus of both eyes, by section of the recti interni, about a year
ago. In consequence, as almost always happens, his sight, instead
of being improved, was made worse the eyes were turned quite
outwards, with diplopia and great aberration of vision ; nor could ho
even direct his ringer to an object placed immediately in front ol him.
He is cured the parallelism of the axis of vision is perfect, and he
can direct his eyes equally well in all directions.

There is at this time (18th September.) in the service of
M. Vidal, at the Midi Hospital, a case of complete transposition
of the thoracic and abdominal viscera. The patient (Oct. 22)

763 Transposition of the Viscera. M. Civiale. [December,

entered with cirsocele of both sides, for which he has been cured by
ligature with " enroulement." His constitution is vigorous ; he is
powerfully made, and has always enjoyed excellent health. The
heart's action is easily perceived on the right side of the chest. M.
Mailliot, who is here considered, next to Piorry, the most adroit and
skilful in auscultation, and in the use of the stethoscope, has recent-
ly "explored him," with almost typographical minuteness, so that the
outline of the various internal organs is "limited," or traced in the
skin, by dark lines made with the nitrate of silver: that is, the situa-
tion of the liver is indicated in the left hypochondriac region, and the
stomach and spleen in the right. The strange appearance these black
lines present, reminds one forcibly of the coarse ugly maps of North
America that were engraved over 150 years ago, presenting a strik-
ing contrast to the magnificent map of Georgia recently published.

The Academy has been, since you left, engaged almost exclusively
in an unprofitable discussion on the comparative merits of lithotomy
and lithotrity. Civiale pretends that he cures 98 in the 100. But
he admits, that they must all be cases carefully selected hy himself,
after he has examined them with particular attention, at different
times during a period of one or two months, in many instances.
Then, all those who die immediately after his operations are not to
be counted, nor any of those who sink in consequence of the means
used in exploration, nor any of those who succumb from the consecu-
tive accidents arising therefrom. A pretty liberal deduction, indeed,
but not more than is absolutely required.

At the sitting of the Academy of the 28th ult., having been very
sore pressed, he was forced to admit the want of correctness of his
tables, "that certain facts should not figure in his statistics, and that
others were omitted." During the last six weeks he has been doing
nothing worth reporting. He has not had one operation of lithotrity
at his hospital, although he examined several patients, and, to very
little purpose. At this time, he is uncommonly nice and particular
in the selection of cases. In one, there is stricture ; in a second,
enlarged prostrate; in a third, thickened irritable bladder ; and, in
a fourth, fungous tumour, but unfortunately, with a very wide base of
attachment, contra-indicating, therefore, all means of extraction.
He saM, at his clinic the other day, that the pain, inflammation, and
contraction of the bladder, following lithotrity, is never caused by the
fragmentation of the calculus, but by the injudicious and prolonged
efforts that too generally precede or accompany this process. In
short, he attempted to swell out his little speciality, into something
of gigantic dimensions, of mighty complexity, and extraordinary
practical difficulty, by repeating a string of plausible mystifications,
that may, perhaps, have caught some of lhe most verdant of his
young auditors. He was not content, with glorifying and renowning
himself; for, after having boasted for nearly an hour, under the in-
fluence, no doubt, of a delicate regard to the interests of truth, he told
us, that Roux had four times, and Velpcau three times, performed

1847.] Ether in Labour. 763

lithotomy in patients in whom no stone existed. As the excuse for re-
verting to this last statement, he proceeded to propound, that indura-
tion of the neck of the bladder is often mistaken for a calculus that
in doubtful cases sounding is insufficient and rubbing (frottement)
deceptive that the bladder should be explored when full, and when
empty, to ascertain the size, and the condition of the parts that his
lithotriteur with two branches is the only proper instrument fitted for
perfect exploration that by opening and shutting it in the bladder a
large field is exposed, and that by the " va et vicnt" (forward and back-
ward movement) of the instrument, he can not only always discover
the precise volume and form of the stone, but also of fungous tumours
jn the different parts of the bladder. Last Saturday he succeeded
in removing several small prostatic calculi.

Dr. Smith, of Bartholomew's Hospital, was over here two weeks
ago, and succeeded in getting authority to try the use of Ether at the
Jlopital of the Faculty in four cases of labour. Smith has published
on this subject in the Lancet, and informed me that, far from ever
having any bad effects, it soothes the pains, and produces singular
relaxation of the perineum. He has prolonged the employment of
ether for two hours and a half in difficult cases, and in one, particu-
larly, for three hours and a quarter. Of course the ether is given
jevery time the pains come on, and its use intermitted during the
interval of remission.

1st Case (at cliniquc de Faculle). Succeeded pretty well ; the la-
bour was long, but the pains were steady, and of ordinary power,
though not so frequent. Rather more sanguineous discharge, per-
haps, than usual after separation of the placenta. 2d Case. A pre-
sentation of the head and right arm. This patient had had five
previous accouchements; the infants all died immediately after birth,
The same fatality occurred to this infant. 3d Case. Malformation
of the upper straight of the pelvis. Long forceps were used : the
child lived. Alter expulsion of the child, considerable hemorrhage.
4th Case. A phthisical patient. Did well during the labour; ex-
cessive hemorrhage after separation of the placenta. Cold applica-
tions were applied to the vulva, with frictions over the uterine region,
and tight compression.

Dubois intends soon, to give the Ether quite a " big trial," as it is
only by a large induction, carefully made, that proper deductions
can be drawn. Meanwhile, the experiment is being made on a large
scale in England, and in one or two places in France, and Belgium.
In the Gazette Medicale de Paris of 9th October, is a long and elabor-
ate communication by Dr. Jules Itoux, of Toulon. He is of opinion,
that in laborious labours the pain should be deadened by etherization ;
that the abdominal muscles in etheric intoxication continue to con-
tract, while those of the perenium are relaxed; that no ill conse-
quences arise to the mother or child, especially in what relates to
hemorrhage, after parturition, or the secretion of the milk; and,
na]ly3 he add*, with some reserve, '*that it appears to him, after

764 Tertiary Symptoms of Syphilis. [December,

difficult parturition, as after surgical operations, one observes less
inflammatory reaction, and that the utero-genital organs are sooner
restored to their normal condition.''

In the Medical Gazette of the 2d October, M. Roux publishes some
cases wherein he had employed Ether and as usual with Frenchmen,
he does not know what has been done in England; for he says that
science docs not possess up to this day an observation of a double
accouchement effected by art, when the woman was in an etheric
state. He then cites at great length the particulars of a successful
case of twins, where ether was used by him. The first child was de-
livered with the forceps; the second was extracted by the feet, as well
as a large placenta, and both without pain to the mother. There was
absence of strong contraction of the womb immediately after delivery ,
which was resumed, however, after a few minutes. The second case
is one of presentation of the arm and shoulder, wherein he turned
with extreme ease, and without the mother being conscious that any
thing had been done to her. After delivery, the uterus contracted
violently, he adds, " with happy consequences to the mother and
child." o. r. g.

Hopital du Midi, Paris, Oct. 16th, 1847.
Interesting Case of Tertiary Symptoms of Syphilis.

A man named A , aired 26 years, a baker, of a sanguine tem-
perament and good constitution, was admitted into the Hopital du
Midi, on the 24th of September, 1347. into one of Ricord's wards.
No. 3, bed Xo. 22. This man wa> affected by blcnnorrhagia about
seven years ago. which disappeared in three weeks without any treat-
ment. It was followed by no constitutional accident. A year subse-
quently chancres appeared on the prepuce these ulcerations cica-
trized in a few weeks, but the subjacent tissues were indurated four
weeks after cicatrization was completed. The inguinal glands were
slightlv engorged, but did not suppurate. The posterior cervical
glands were also engorged from the patient's account. At the same
time the hair began to fall off, and the hairy scalp became covered
with impetigenous incrustations. There was also supraorbital cepha-
lalgia, and palmar psoriasis in both hands. These symptoms excited
the attention of the patient, and by the advice of a physician, he sub-
mitted himself to a mercurial treatment. Two months after this the
above symptoms disappeared. From that time the throat was con-
stantly the seat of irritations and ulcerations, which disappeared and
re-appeared at different periods.

Two years ago these symptoms became more intense; numerous
and separate ulcerations invaded the isthmus of the throat, and in the
tongue were a number of very hard points, some of which ulcerated.
The patient was treated with the Iodide of Potassium ; at the end of
eight months, all had completely disappeared. It is now six months,
and no primitive accidents have supervened. The symptoms in the

1847.] Tertiary Symptoms of Syphilis. 765

throat re-appeared. M. Ricord treated them by the syrup of Cusi-
nier, and the cure was effected in one and a half months. About five
weeks since dull pains, increasing by the heat of the bed, invaded the
right arm. Fifteen days after the accession of these pains, the
movements of the arm began to become difficult, extension was in-
complete. These symptoms increased to the present moment, when
extension of the arm could only be effected to the extent of two-
thirds. The pains then ceased. At the time the patient presented
himself to us, the fore-arm was flexed on the arm at an angle of one
hundred and forty decrees (French). No force was sufficient to
straighten the arm. Now the patient no longer experiences any
pain ; the biceps is strongly contracted. On a level with the tendon
of the biceps is felt a considerable thickness, which announcesacom-
mencement of plastic degeneration. In fact, no other symptoms are
present which could be assigned to syphilis. From the history of
the case, from the existence of muscular contraction, the first degree
of plastic degeneration of the muscles and plastic degeneration of the
aponeurosis of the tendon of the biceps, II. Ricord administered the
Iodide of Potassium, (his treatment par excellence in tertiary acci-
dents or symptoms).

25th September. Ptisans of hops, syrup of Gentian, three gram-
mes of the Iodide of Potassium, per day. Straps of Sparadrap of
Vigo cum mercurio were firmly applied around the arm.

4th October. The angle which before the treatment was only 140
degrees, at this time measures ISO degrees; the movements of the
arm become more free, slight bronchitis, mobility of the fingers
restored.

6th October. Complete extension of the arm, 19") deg. (French),
movements entirely free, contractions have disappeared, and the
slight thickening of the biceps tendon hardly perceptihle.

M. Ricord, on account of some symptoms which manifested them-
selves in the thorax, discontinued the Iodide of Potassium.

We have often had occasion to notice the plastic degeneration of
muscles. In the first stage of the disease the muscular tissue seems
to coagulate and contract. In this instance, it is not a tonic retrac-
tion, but an entirely passive shortening which exists. After the re-
traction begins, there appears a plastic degeneration : so long as the
alteration is not mure advanced, it yields very readily to treatment,
without leaving any deformity. Bat if this morbid process be per-
mitted to proceed to organization, cither atrophy by erosion, fibrous
transformation, or rather a cartihgenous and osseous transformation,
is the result. This latter consequence is always a permanent short-
ening of the afiected muscle. The>e degenerations almost always)
invade the flexor muscles of the limbs. Before us we have an exam-
ple on the tibialis anticus, which is one of the flexors of the foot on
the leg. This aileetion is not generally painful, and the attention of
the patient is only called to it by the inability of movement. Since
Mr. Ricord has called the attention of pathologists to this kind of

766 British and Foreign Medical Review. [December,

degeneration, Mr. Bouisson, of Monfpelier, has published a work
in which he gives several cases of this nature. Mr. Ricord has also
observed a curious case of plastic degeneration of the fibres of the
heart. In this instance, the person having died, a post-mortem exam-
ination revealed the existence of plastic nuclei in the parietes of the
heart.

All the tissues of the human body may participate in this altera-
tion the liver, the heart, the lungs, the brain, and the symptoms
occasioned by it most generally are not different from those function*
al symptoms which exist in affections of these organs. We have at
this moment a patient whose syphilitic history would be too tedious
to narrate. About a month ago, he was seized with weakness of
complete paralysis of the whole of the left side of the body, at the
same time he has on the surface of the skin nuclei or fibrous degen-
erationson cicatrices produced by Rupia. Since the appearance of
these symptoms of hemiplegia, his intelligence and memory have
almost completely disappeared, and he fell into a state of coma, re-;
fusing to eat, passing the contents of the bowels in bed, <kc. in a
word, conducting himself like a paralytic, deprived of all his mental
faculties. The left testicle was also the seat of plastic degeneration;
We have every reason to believe that the same alteration existed at
the base of the right hemisphere of the brain, and therefore resumed
the use of the Iodide of Potassium, which had been discontinued some
time before. At the present time, for about a month the Iodide of
Potass, was carried to four grammes per diem. His intelligence and
muscular power were restored; the appetite and the instinct of pre-
servation, which had disappeared, returned.

We hope to be able to account for all these symptoms. The plastic
nuclei may become organized in the cerebral substance as in other
parts; and during the first period of their formation, the resolution
of them may be accomplished, but if they are suffered to become or-
ganized, we can do no more than check their further development >
then they terminate either in fibrous or cartilagenous or osseous or-
ganization, and act as foreign bodies in the cerebral mass. They1
are of a violet colour, and leave cicatrices in the cerebral substance,
resembling traces of small apoplectic cysts.

The study of these tertiary syphilitic alterations have perhaps been
too much neglected, and the contractions, fibrous nuclei, and other
abnormal productions which we find in the tissues of the body, with-
out often being able to explain their cause, are generally the result
of syphilis. (Signed,) Robert Melchior,

Principal Interne of M. Ricord.

Discontinuance of the British and Foreign Medical Review , or Dr. Forbes1 Jour-
nal.By the last No. (Oct.) of this periodical, we learn the ^confirmation of
what had been before intimated, that its publication ceases; its editor retires,,
and hereafter the work is to be incorporated with the Medico-Chirurgical Review,
so Ion? known as Johnson's Journal. It is thus seen that the rivalry between

1847.] Prickly Ash. Death of Dr, Washington. 767

lhese two London medical quarterlies is at an end, and shaking hands to-
gether the two are henceforth to be blended into one. The British and Foreign
Medico-Chirnrgical Review, or Quarterly Journal of Practical Medicine,
is the title of the new periodical, which is to appear the first of January,
1848.

Dr. Forbes has conducted his Journal for twelve years, and considering that it
was wholly original, made up of reviews and notices of medical works, his labor
was immense. How he discharged his onerous duties, seems wonderful; and
yet he has found time to make a decided impression in the medical world by
his own voluminous writings. He has done much good as a medical reformer,
and conducted with ability an excellent Journal. The editor's purse is too often
as empty as the poet's, and we regret in the present instance to say, that the re-
ceipts exhibit a deficit of some thousand dollars in the twelve years' publication
of this work.

The Prickly Ash as a remedial agent. Opposed as we are to the introduction
of new articles of doubtful character into our already over-abundant Materia
Medica, being much more desirous of ascertaining fully and satisfactory the
virtues of those now admitted and acknowledged, we yet give place to the fol-
lowing extract of a letter from an intelligent physician of Washington, in this
State :

"You wish to know my views in regard to the Prickly Ash, as a remedial agent.
I have scarcely used it enough to predicate an opinion as to its real meiitsj
though I am satisfied from the trials I have made with it in chronic rheumatism
and secondary syphilis, that there is no article more deserving the attention of
the profession than the one under consideration."

Our friend, Dr. Barry, druggist, of this city, is now preparing a syrup from
the extract of this article.

Death of Dr. James A. Washington, of New York. During the present year,
death has been busy in the professional ranks. Many a brother has fallen with-
in the past twelve months; some in the tented field, others on or near the bois-
terous ocean, others again engaged in civil practice. Of all, and we say they
are many, who have been called from theii labours on earth, none stood fairer,
higher, more honorable than did Dr. James A. Washington. It was our good
fortune to make his acquaintance in Philadelphia, twenty years ago, where he
had arrived from North Carolina, his native State, to study Medicine. We have'
subsequently watched his career through the Pennsylvania Hospital, been asso-
ciated again with him in Paris, followed his return home to New York, and
witnessed his rapid promotion to professional usefulness and renown in that
great city. Dr. Washington was at one time elected a Professor, we think, of
Clinical Medicine, in the New York University, but never entered upon his pro-*
fessorial duties. He re-visited Europe last year, and was a passenger on the
Great Western during the dreadful storm she encountered in September. Anti-
cipating a happy meeting on our own return from Europe, the summons at his*
door, on Broadway, New York, announced the unwelcome intelligence of his
sudden death. He died of ulceration of the ccecum, produced by foeeal accu-
mulation.

By the suavity of his manner, dignity of character, his modesty, his honesty,

7G9

Candidates for Professorship Meteorology.

his professional acquirement, his Christian virtues, no man promised more use-
fulness than did this friend a worthy descendant of the Washington family.

Candidates for the Professorship vacated by the death of A. Bcrard. "We learn
from the Gazette Modicaie de Paris, that Messrs. Laugier, Jobert, Robert,
Miction, -Vidal (de Cassis), Malgaigne, Chassaignac, Gosselin, Marchal, Hu-
guier, Ricord and Alquie, have already been inscribed as candidates. We have
here a formidable array of talent and acquirement in the Medical Profession--
several names well and favorably known even in this distant quarter of the world.
The contest for the vacant Chair promises to be one of the most interesting ever
held in Paris. It is for external pathology.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide 152 feet.

for October, 1847, at Augusta*
33' west Wash. Altitude above

0

o

Sur
Ther.

i Rise.
Bar.

2, ]
Thf.r.

P. M.
Bar.

Wind.

Remarks.

1

50

29 77-100

81

29 7.3-100

w.

Fair.

2

55

" 77-100

81

" 75-100

w.

Fair.

3

56

" 79-100

81

" 81-100,

N.

Fair morning, some clouds*

4

58

" 89-100

75

" 85-100

N. W.

Fair a few clouds.

r.

53

" 87-100

70

" 76-100

S. W.

Fair.

6

58

(JO- 1 00

82

< 55-100

S. W.

Fair cloudy afternoon,

7

62

" 58-100

so

" 53-100

s. w.

Cloudy rain at night 20-100,

8

56

" 52-100

71

" 50-100

N. W.

Fair breeze,

9

50

<: 61-100

74

" 67-100

w.

Fair.

10

49

" 71-100

79

" 73-100

s. w. 1

Fair.

11

52

" 71-100

81

" 75-100

w.

Fair.

12

51

" 74-100

81

" 68-100

s. \v.

Fair some clouds.

13

64

" 48-100

68

" 48-100

w.

Cloudy sprinkle.

1 1

44

" 64-100

64

" 68-100

N. W.

Fair.

15
16

40
40

" 83-100
" 95-100

66

6$

" 87-100
" 90-100

N. E.
H. E.

j{J J slight frost-very dry*

17

50

' 92-100

71

" 90-100

N. E.

Fair.

18

48

" 92-100

76

" 88-100

N. E.

Fair.

1!)

49

" 86-100

78

" 82-100

N. W.

Fair.

20

52

" 86-100;

80

82-100

B.

Fair.

21

59

" 96-100'

71

" 80-100

N.

Fair cloudy this morning.

02

55

M 94-100!

78

" 88-100

S.

Fair some clouds.

S3

63

85-100

81

" 78-100

s.

Fair some clouds.

34

G5

" 80-1 00;

80

" 70-100

s.

iFair mist this morn. breeze1.

25

53

:< 70-100,

71

" 73-100

w.

Cloud v rain last night 35-100*

26

53

" 95-100

63

" 99-100!

N. E.

Fair breeze.

27

48

30 10-100

63

30 10-100

N.

Fair.

28

42

" 25-100

57

" 25-100

N.

Fair breeze.

29

38

" 25-100

59

" 20-100

N. E.

Fair light frost still dry.

30

42

" 15-100

68

" 7-100

N. W.

Fair.

31

42

* 5-100

69

1

N. E.

Fair.

28 Fair days. Quantity of Rain 55-100 of
S. 8 days. West of do. 16 days.

an inch. Wind East of N. and

Errata. Page 708, line 21, for cerebral read central; page 711, line 9, insert
false before labour-pains.

INDEX TO VOL. III.

OF CONTRIBUTORS *

449

602

Barr,W. F.,M. D. On irritation of
the spinal marrow, and ganglia of
the sympathetic nerve, 82

Barr, \V. F., M. D. On propriety ot
large doses of calomel in Dysen-
tery and Cholera Morbus, 10

Barton, E H., M. D. Surgeon IT. S.
Army Mortality at Vera Cruz, 571

Beal, L. B., M. D. Case of gun-shot
wound, 202

Blackburn, J. C. C, M. D. The
Strawberry leaf, a valuable auxil-
iary in the treatment of chronic
dysentery 657

Branch, Franklin, M. D. Case of
Cauliflower excrescence of the os
tincae, cured 275

Campbell, H.F,M.D. Practical ob-
servations on Cutaneous diseases,

Campbell, 4. F., M. D. Treatment
of ftooping-cough with the Iodide
of Potassium,

Colley, Francis S., M. D. An Es-
say on Turning, 193

Cunningham, Sam'l B., M.D. Lo-
cality, climate and diseases of
East Tennessee, 385

Davis, John, M. D. Cases cured by
blistering the spine, *. 270

Davis, John, M. D. Treatment of
Pneumonia, 328

Dugas, L. A., M. D. Address to the
Class of the Med. College of Ga., 64

Dugas, L. A., M. D. A case of Glan-
ders in the human subject, 653

Dugas, L. A., M. D. On the use of
GLuinine in Intermittent and Re-
mittent fevers, 1

Eve, Jos. A., M. D. Cases of Con-
vulsions and other nervous affec-
tions during pregnancy, parturi-
tion and the perpeural state, 513

Eve, Jos. A., M. D. Pregnancy
and Parturition with cancer of
the uterus, 198

Eve, Paul P., M. D. Amputation
of the fore-arm, 2iU

Eve, Paul F.,M.D. Case of mechan-
ical obstruction in the bowels, ... 13

Eve, Paul F.,M D. Letter lioin Parifl t'.liti

Eve, Paul F., M.D. Remarks on
Dr. Hitchcock's Report -107

Eve, Paul F., M. D. Review ol
American Journ. Med. Sciences, 407

Eve, Paul F., M. D. Review of
Jones' Ophthalmic Medicine and
Surgery, 335

Eve, Paul F. M. D. Review of the
London Lancet, 658

Ford, Lewis D., M. D. On Inter-
mittent Fever, 129

Ford, Lewis D., M. D. Review of
Dr. Wood's Practice, 730

Gaither, Henry, M.D. Colic reliev-
ed by balsam copaiva, 462

Garvin, I. P., M. D. Purpura He-
morrhagica, 526

Garvin. 1. P., M. D. Remarks on
Medical Reform, 532

Gordon. James M., M.D. Contri-
butions to Practical Midwifery,
with cases occurring in obstetri-
cal practice, 703

Harden, John M. B.,M. D. Notes
on the medicine of Moses, 257

Harden, John M. B., M.D. Of Mer-
curv and its compounds, 575

Harden, John M. B., M.D. Trans-
lation of Dumas' researches on
the blood 16

Hitchcock, 'C.M., M. D., U.S.A.
Report on the sick and wounded
of the 2d Division of the U. States
Army in Mexico 406

Kolloek, P. M., M. D. Case of
Traumatic Tetanus, cured by
Strvchnine,; 597

Kolloek. P. M.. M. D. Resection of
a portion of the upper maxillary
bone, 437

LeConte, John, M. D. On Sulphu-
ric Ktlier, 253

Leconte, John, M. D. Review of
Dowlcr on the Natural History of
the Alligator 89

Little, Robert Edmonds, M.D. Ob-
servations on various diseases,.. 141

Letttera from our Paris Corres-
pondent, (i!).-,. 76a

Martin and Smith, Drs. Case of
Adherent Placenta, with Hour-
glass contraction, 728

Mayes, J. A., M. D. Application
ol creosote to the treatment of
Diarrhoea and Dyseniiv, 147

Mayes, .1. A., M. D. Injury of the
medulla spinalis death: autopsy, 725

Means, A., M. D. Alcohol, .' C5

IV

INDEX.

Means. A., M. D. Sulphuric Ether, 255

Melcnoir, Robert Dr. Report of
case in Paris tertiary syphilis, . . 766

Norwood, Wesley C, M. D. Ma-
lignancy, 336

Norwood, Wesley O, M. D. Ma-
lignancy, . 717

Oakman, Erw-m H., M. D. Exper-
iments on Rabbits with opium and
its preparations 334

Pearson, 43. H., M. D. Notice of a
highly malignant disease, 332

Pendleton, E. M., M. D. Case of
Rupture oftheFibro-cartil age and
ligaments between tbe 3d and 4th
cervical vertebrae with paralysis

of all the depending portions of the
body, 410

Pendleton. E. M., M.D. Poisonous
properties of Sulphate of Quinine 605

auintard, Chas. T., M. D. Febris
Typhoides, 465

GLuintard, Chas. T., M.D. Random
thoughts on Febris Typhoides, . . 639

Tutt, G. M., M.D. Penetrating and
lacerated wound of the abdomen
cured, 656

Twiggs, John D. Case of Tape-
Worm, 413

Wooten, H. V., M. D. Cases and
Comments 321

INDEX OF
T e

Abdomen, penetrating and lacera-
ted wound of, cured 656

Abdomen, wounds arid injuries of. 680

Abortiun, prevention of 6J2

Adulterations of various substances

used in medicine and the arts 53

Alcohol

Alcohol, means of ascertaining its

ARTICLES.

purity 635

Alkaline remedies, on the abuse of, 366
Alligator, on the natural history of 89

Alnus serrulata. remarks on 630

Amenorrhea, local treatment of. . . 748

rage

Asphyxia Neonatorum 312

Asthma and hooping-cough,ether in 370

Baker, Dr. Abner, (a monomaniac)

I lie and trial of 248

Bandages, starch, use of 750

65 Bed-sores prevented 25 L

i Beef-tea 757

Berard, Augustus, obituary of 192

Bichloride of Mercury combined

with Tartar Emetic 188

Bile 54

Bi-Penis, case of 439

American .lourn. Medical Scienees 467 Blisters, effects of on young subjects 682

Amputation of the lore-arm 204

Anatomy, handbook of human 319

Anatomy, pathological of the hu-
man body 349

Anatomy, system of human 350

Aneurism at the elbow, &c 637-759

Aneurism by compression 3j7

Aneurism, " observations on and

treatment 623

Aneurism, operation for 62

Annalist, notice of 447

Anus, fissures of 691

Aperients, mode of administering to

Blistering with camphorat.ointment 629

Blood, researches upon the 16

Bones, inflammation of, treated 185

Bone, resection of the upper maxil-
lary 457

Bones, new method of excising, &e. 566

Boslock, obituary of 192

Botany, Medical 755

Bowel's, fatal case of mechanical ob-
struction in . . 13

Bowel complaints,Iodinelinimentin 183
Brain, concussion of, treated 176

Bright's diseases treated, 251

children T.. 694 Bromide of Potassium substitute for

Arsenic, poisoning by, successfully the Iodide 374

treated 498 Bronchitis, chronic, treated by

Arteries, effect of injecting various

substances into 563

Arteries, application of ligatures to 481
Arteries, statistics of mortality con-
sequent on tying the carotid and

innominata

Arteries, Prof. Porta on deligation of
Asafoetida, its use in obstetrics. . . .

Ascarides, treatment of

Ascarides of the rectum, treated

Ascites, the urine in

Ascites

505
63
631
250
250
690
123

Ascites, iodide of starch for 441

Ascites, remarkable case of 372

Asiatic Cholera in Persia 187

Ash, prickly 767

strychnine 426

Broussais, C, death of 638

Buffalo University 573

Bullet, of Med. Science discontinued 191

Burns, blisters.&c, prescriptions for 64

Burns, cold water in 745

Burns, treatment of 628

Cachexia treated 173

Coesarian section child lives 511

Caesarian section, statistics 757

Cajeput oil as a remedial agent. . . 633
Calculus, large 319

Calculi salivary, mistake respecting 213

Camphor, case of poisoning by 370

Camphorated Blistering Ointment. 629

INDEX.

Cancer, opium dressing for 123

Cancer of the stomach 40

Cancer, relapse of 122

Candidates for professorship in Paris 768

Carminatives and Tonics 694

Cases and Comments 321

Castor oil emulsion 3l7

Castor oil, method of disguising the

taste of 187

Cataract, removal of by aspiration 373
Cataract under the influence of mer-
cury 756

Cauliflower excrescence of the os

tincae cured 275

Chemistry, notice of works on 52

Cherry bark syrup 694

Chest, fallacies attending physical

diagnosis in diseases of 235-414

Chloride of Sodium, therapeutical

action of 58

Chlorosis, diagnosis and treatment

of 56-59

Chorea, nux vomica in 57

Cicatrices of the variolous pustule

prevented 188

Clinical medicine, lectures on 182

Colic relieved by balsam Copaiva . . 463
Colites acute, treated by injection of

nitrate of silver 507

Conception, extra uterine 637

Confectionary, bronzing of 692

Confinement,on rising tooearly after 678
Congestive fever, practical remarks 355

Congestive lever 485

Convalescence from acute diseases,

management of 364

Convulsions during Pregnancy and

Parturition 513

Convulsions in infants 697

Cornea, observations on the curabil-
ity of opacities of the 214

Correspondents, our European. .695-758
Corrosive sublimate, incompatibles

with 186

Coryza, prescriptions for 446

Cotton, mode of detecting the pre-
sence of in linen 636

Cretinism of large cities 564

Croup, treatment of 495

Croup, observations on 35

Cupping, employmant of gun cot-
ton in 187 !

Cutaneous diseases, practical obser-
vations on 449

Cystitis, treatment by nitrate of sil-
ver injection 710

Death by Strychnine

Death, new sign of 63

Death, to distinguish apparent from

real 370

Debility and loss of appetite treated 446
Deglutition excited by dashing cold

water on the face 248

Delivery, premature excited 635

Detecting cotton in linen 636

Diabetes, treatment of 315

Diagnosis, necessity for accuracy in 55
Diagnosis, a point of between Rub-
eola and Scarlatina 56

Diarrhcea,employment of bismuth in 251
Diarrhoea and Dysentery, treatment

of by creosote 147

Diarrhoea and dysentery treated with
preparations of the walnut tree. . 59

Diarrhoea, hydrate of lime in 60

Diet of the Ancients 658

Digestion in 1846 54

Diseases of the army of invasion . . . 293

Diseases, &c. of East Tennesse 385

Diseases, observations on various.. 141
Diseases, camp, some remarks on,

in Southern climates 151

Drastic potion 184

Drinking intoxicating liquors, re-
sults of , 313

Dropsy, prescription for 60

Dysentery and cholera morbus, pro-
priety of large doses of calomel in 10

Dysentery Syrup 59

Dyspepsia and Diet 658

Ear, extraction of a piece of pewter

from the 127

Editor's notice and remarks 446

Electricity, influence of on the hu-
man system 625

Emetics," effects of on young subjects 50
Encyclopedia Americana, notice of 182

Epilepsy, treatment, &c 698, 700, 636

Epsom salts, to remove bitterness of 693
Epsom salts, a substitute for as a

purgative 693

Epistaxis, treatment of by insuffla-
tions of alum 251

Erysipelas following vaccination . . 665
Erysipelas, treatment of by camphor

in ether 444

Erysipelas, Ung. Potass-jc in 186

Ether, inhalation of in obstetric

practice 519

Ether preparations, physiological

action ol 606

Ether, substitute for to produce in-
sensibility 510

Ether vapor of in asthma and hoop-
ing eough 370

Ether, fatal effects of inhalation of 374
Ether, sulphuric inhalation of, pro-
duces insensibility 226

Ether, sulphuric inhalation of in

surgical operations 252

Ether, in;i!c oi 'administering 665

Ether in surgical operations... 666-637
Etherization .effects of on respiration 696

Extra-uterine conception 637

Eye, treatise on diseases oi 350

Fat, formation of in the animal body 219
Febris Typhoides, random thoughts

on ....' 669-465

>1 the spleen 499

VI

INDEX.

Fever,statistics of cases of miasmatic 241 1
Fevers, Intermittent and Remittent,

treatment with quinine 1

Fever, typhoid, Ethiop's mineral in 755
Fracture, compound case of bad .... 174

Ganglions, treatment of 316

Gastrotumy, remarks on 108

Generation, the function of 666

Genitals in children, epidemic dis-
ease of 127

Georgia Medical So., report of the 048

Gestation, disputed period of 502

Glanders in the human subject, a

case of 053

Globular body found in the stomach

of an ox 318

Gonorrhea, treatment and prescrip-
tions for 01, 310, 511

Graduates of the Medical College

of Georgia 318

Gun Cotton, mode of preparing.. 250

Haemostatic. Ergoiine as a 121

Haemostatic property ol'SecaleCor-

n utum 509

Hail storm of May, 1847 384

Hare, Prof, resignation of 573

Headache, varieties of 083

Heart, use ol digitalis in diseases of 438

Heart, movement of, &c 502

Hemorrhage from leech bites ar-
rested 02

Hemorrhage from the nose 445

Hemorrhoids, Tinct. of Iodine to. . 123

Hiccough protracted, relieved 028

Homeopathy 119, 190

Honors conferred on medical men GG0
Hooping cough, alkalies in 59

Hooping cough, treatment ot I 44J 314

Hydriodate of arsenic and mercury, 371
Hydriodate of Potassa, on the use of 306
Hydrocele, comparison oftr. iodine

and vinous injection in 184

Hvdrocephalus successfully treat-
ed 309,505

Hydropathy, or the cold water cure 45
Hydrophobia, the Marchand reme-
dy lor 188

Hysteria, inhalation of ether in 001

Hysteria, pathology and treatment of 250
Hysterical, nervous and sleepless
cases 440

Inhalation, fatal effects of 374

Insane in France, number of 120

Insanity, hereditary transmission of 620
Insanity, treatment of acute forms of 088
Insensibility, new method of produ-
cing 660

Intermittent fever, strychnine in . . . 505
Intermittent fever, Tinct. of Iodine

in obstinate cases 121, 089

Intermittent fever, forms, treat-
ment, &c 129

Intermittent fever, on the types of. . 57

Intermittent fever treated with sul-
phuric ether 689

Iodine, internal administration of . . >

Iodide of Iron, on the syrup of 632

Iodide of Mercurial Chloride, pre-
paration of 568

Iodine, proper diet in conjunction

with 369

Irritation of the Spinal Marrow and
Ganglia of the sympathetic nerve 82

Joints, diseases of and treatment . . . 624
Journal, British and Foreign Review 766
Journal, South. Med. and Surg . . 190, 758

Labour, ether in 763

Lactation, case of protracted 441

Lactation, protracted 3i7

La Lancette Canadienne 3b3

Lamar, Dr. appointed assistant sur-
geon U. S. A 191

Larynx, diseases of 696

Leeches 699

Leeches,method of makingthem bite 126

Lisfranc, death of 448

L ston's illness 758

London Lancet, review of 658

Lung, gangrene of 700

Malaria and malarial diseases 159

Malignancy 396, 717

Malignant disease, case of 332

Mania, for violent, with deficient

urinary secretion 446

Materia Medica aud Therapeutics,

notice of a work on 247

Medical association, standing com-
mittees of 570

Medical reform in Canada 572

Medical College of Georgia 095

Medical Botany 623

Medical Ethics 537

Medical Intelligence 512

Medical Miscellany 447, 512

Medical Reform, new plan of 301

Medical topography of Texas 293

Medical Institutions in U. S 319

Medical Sciences, abstract of 181

Medical school, another (the 5th) in

Philadelphia 191

Medicated milk 182

?viedicine, clinical 753

Medicines, adulteration of 671, 701

Medicine of Moses 257

Medulla Spinalis, injury to death 725

Membrana decidua, nature of 661

Mercury and its compounds 575

Mercury, nitrate acid of 694

Mercury, effects of on young subjects 218
Mercurial preparations, use and

abuse of 437

Meteorological observations, by P.

F. Eve, at the end of each No.
Midwifery, contributions with cases 703
Midwifery, use of Ether vapor in

die practice of 251

INDEX.

Vil

Mi 'wiferv, statistics of 186 >

Milk a purgative 319 :

Mortality in Vera Cruz 571 i

Mortality in New Orleans 573

Mortality in Prisons 573

us membranes, castor oil in

diseases of 183

Ncevi, cure of 415, GDI

National Medical Convention, pro-
ceeding of 320, 532

Do. do. code of medical ethics of 537

Do. do. organization of 374

Do. do. notice of 101

Nature, mystery of, explained 120

Nerves, on accidents from puncture 434
Nervous diseases, on diagnosis of. . 351 '

Neuralgia, belladonna in 371

Neuralgia, coffee a remedy for 412

Neuralgia, extract of tobacco in. . . 121
Neuralgia, en dermic application of

belladonna in 371

Neuralgia, purgatives in 750

New- York, University of 573 j

Nitrate of silver,therapeutic action of 087

Nitric acid, poisoning from 500

Notice of Volume ill 64

Obituary notices 192, 334, 574

Oil of common fish instead of oleum

jecoris aselli 442

Opium, cold water in over-doses of 433

Opium and its preparations 334

Opium, use of in inflammation 738

Opthalmic medicine and surgery. . 335
Opthalmy, purulent, nature of and

treatment 700

Opthalmy .solution of common salt in 123

Orchitis, treatment of 42

Osteo-sarcomo, excision of the infe-
rior maxillary bone for 1G5

Pain in the side in thoracic inflam-
mation 316

Paralysis, electro-magnetic currents

in 177

Paraphimosis,new mode of reducing 445

Pariset, death of 06b

Parturition, lectures on natural and

difficult 3ii

Pectoral syrup 093

Pharmacopoeia preserver's 53

Philosophy of animated existence . . 351
Phimosis, ingenious operation for 445

Phthisis, cod-liver oil in 249

Physic, principle and practice of. . 754
Physician's duty to his brethren and

quacks G03

Physician's fate 757

Physiology, principles of human . . 7oi
Placenta, adherent with hour-glass

contraction 739

Placenta, structure and functions of 501
Placenta, on extraction of before the

child 373

Plague and quarantine 115

Pneumonia, treatment of 169, 328

Pneumonia, physical sign of 506

Poisoning from nitric acid 500

Poisoning from swallowing percus-
sion caps 443

Poisons, law of Prussia respecting

sale of 512

Practice of Medicine by Dr. Wood,

review of 730

Pregnancy, case of interstitial uter-
ine 663

Pregnancy, exhibition of assafcetida

during 373

Pregnancy and parturition with can-
cer ot the uterus 198

Prisons, mortality in 573

Prize essay of the Louisiana Medi-

co-Chirurgical Society 3>3

Pruritus ani et vulvce. treatment of 249

Psoriasis In veterata 690

Pulmonary tuberculization, topical

use of croton oil in 689

Pulse, on the frequency of, &c 503

Purpura hemorrhagica 526

Purulent infection 744

GLninia, arseniate of 443

Gluinine, sulphate, poisonous prop-
erties of 605

Gluinine, influenceof coffee on. .441, 63

Gluinine, on use of 367

Gluinine, sulph., cause of blindness 313
Gluinine, sulph.. action onthe spleen 248

Gluinine, use of in Florida 167

Gluinine, mode of using 184

Gluinine, topical application of . . . . 47

Rabbit, opium not poison to the 126, 331
Rattle snake, cure for the bite of. . . 61
Rectum, vast fecal accumulation in 172

Rectum, prolapsus of. treated 185

Remarks on the surgeon's report of

the U.S. A 407

Remittent lever, J re a ted 60

Rep irt of action of Georgia Medical

Society on the Convention 648

Report, medical and surgical, from

the army of Mexico 277

Report of the sick and wounded of

2d division of U. S. A 406

Report, partial, of the battle of Buena

Virta 319

Rheumatism, chronic, prescription

for 314

Rheumatism, acute articular, treat-
ment of 636

Rheumatism and gouf, pyro-acetie

spirit '. 7."),">

Rib, a triplet 192

Ribs, fractured, new method of treat-
ing 436

Rupture of the sclerotica and iris. . 661

Salivation, chlorate of potassa in . . 690
Salivation, mercurial, new remedy
tor i&T

VI11

I?sDKX.

Scammony, action of 51 1

Sclerotica and iris, rupture of 661

Scrofula, conclusions in 61

Scrofula, nature, causes, treatment 3l2

Sea-sickness, remedy for 57

Sea-sickness, nature u treatment of 617
Secale cornutum, hemostatic prop-
erty of 509

Sex, cases of doubtful 504, 1 18, 676

Skin, diseases of, treated 699

Skin, diseases, local treatment 63

Sinn, on the therapeutical employ-
ment of certain medicines in dis-
eases of 224

Skin, efficacy of creosote on papular

affections of 184

Skin, topical treatment of certain

diseases of 63

Skull, strength of the human 183

Smell, sense of destroyed and how.. 440
Solution of hydriodate of arsenic

and mercury 371

Sore, mercurial, diagnosis of 666

Sphincter ani, subcutaneous divis-
ion of 316

Spinal irritation, observations on. . 260
Spleen, influence of quinine on its

volume 719

Spleen, inflammation and suppura-
tion of 747

Spine, cases cured by blistering the 270
Stains on linen from nitrate of sil-
ver, removed 694

Statistics of Medical Institutions in

U. S. for 1846-7 383

Sterescope 187

Stomach, irritability of treated 314

Strabismus, consecutive 761

Stramonium seed, effects of one 4 13

Strawberry leaf in chronic dysentery 657

Struma, cod-liver oil in 688

Surgery, operative, by Velpeau... 311

Surgical cases at Monterey 285

Surgical operations after inhalation

of ether 29

Swelling, white, treatment of 62

Syphilis infantum 180

Syphilis, constitutional, treatment in

infants 444

Syphilis, constitutional, prescription

for 511

Syphilis, primary, treatment of 428

Syphilis within the os uteri 317

Syphilitic eruptions of the skin, pre-
scription for 511

Syphilis, tertiary symptoms 761

Tape worm, case of 413

Teeth, short rules for preserving the 188
Tennessee, East, locality, climate,

and diseases of 385

Tetanus, traumatic, history of 7 cas-
es successfully treated 22, 97

Thompson, John, M.D.. obituary of 192
Tongue, semiology of the 7" 6

1 Toothache, permanent relief of . . . . 125
Tracheotomy, air into the veins. . . 509

Trismus Nascentium 127

Tumors, new mode of diagnosing.. 372
Tumors, instrument for diagnosis of 568

Turning, an essay on 193

Typhoid ti'ver at Geneva in 1846-7 431
Typhoides febris, account of. ..465, 639

Ulcers, treatment of by firing 506

i Ulcers, cancerous, treatment with

clorate of potass 508

i Urethra, extraction of a pin from.. 373
Urethra, chronic discharges from . . 125
j Urethra, process for finding after

amputation of the penis 185

i Urinary changes, diagnosis of 206

j Urinary diseases, treatment of 238

| Urinary bladder, case of inverted . . 48
Urine, albuminous, caused by use

use of cantharides 691

Urine, means of preventing its cor-
roding action on the skin 635

Urine, incontinence, treatment of.. 185

Urticaria, pathology of 689

Uteri os, diseases of 695

Uterus, inflammation, ulceration,

and induration of the neck of 310

Uterus, inflammation, &c. of the

neck of in a virgin 666

Uterus, flexions and engorgement of 124

Vagina. bifid 446

Vagina, double, two cases of 1 70

Vagina, occlusion of 123

Vagina, bloody vesicle ol the 305

Variola, vaccinia, varioloid, &c. .. 689
Veins and lymphatics, outlines of. . 753

Vera Cruz, mortality of 571

Vermifuge syrup 318

Vertebrae, rupture of fibro-cartilage

and ligaments 410

Vesico-vaginal fistula, treated by

caustic '. 742

Virginia springs 624

Viscera, transposition of 762

Vision, case of uncommon acute-

ness of 121

Vomitings, nervous, of pregnant wo-
men 124

Vomiting of castor oil injected into

the rectum 55

Vomiting, obstinate, during preg-
nancy, treatment 507

Vulva, follicular, disease of 372

Washington, Dr. death of 767

AVer nurse, mode of providing in an

emergency 663

Womb engorged, treatment of 317

Wound, case of gun-shot 202

Wounds, new method for the union

of 627

Wound, penetrating and lacerated,

of the abdomen 656

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