y v-v Ik >y ?/r K Jt>*~ * **s 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 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 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, ' 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 lart 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 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,-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 vd 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 ' 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 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. [ 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 ", 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, 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. hi a c P o ra 3 P- p sr o & ft G S3 ft o P ft ^ ft *^ft ^ <- > ^ o'--fteftftft'-sr S <<45 w P p o o w : S : : : : o . 8 q o p q jB 2LO ft C ft 3 . cSh. 3 ^o Qu - to 9 a o GO c^ c^ to - I Sick. go I Convalescent, && Bl 8 tO- C tO U* OS to os 2 Eo go 1 Intermittent fever. 21 ** -> g* - c _ ^ | Remittent fever. h: i to j Continued fever. T _ *. *. , 1 Colic. 2 3 to to t^ too to 55 3ool Diarrhoea. n % ^ o,i9^u| Dysentery. - to tO H- tc w | Jaundice. c - to w | Piles. ?3 ft I Constipation. I Cholera Morbus. O I Bl m_I 31 si Tonsillitis. to 8 ~* J Catarrhus. Pieuritis. Pneumonia. Bror.i Syphilis I Gonorrhoea I Dyuresij 51 81 SSI to 05 ! Contusions. Sh-oSS Sht Wounds. O - rfa> cj to OJ or - cr. I Rheumatism. Otitis. I Ophthalmia. j Scorbutus. SI io?W I L1 leers i Abscesses Rubeola, etc.^c 0,5:^5' Total. Q>J w* w osj- g^^rj-'H I Returned to duty. w o S ^ 1 Sent t0 gen'i hor.p'l I Discharged "I Dead. fed 5-s. s. a II 2 to sfe o ^ *^s =*< O OS o o o r- o o p ^^ 5 IS ^ b 2? 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, 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, 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 > | 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 80 83 B2 B3 82 83 90 85 83 B8 -1 7!) 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, 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. :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, - "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! c H i p O fi . e*t < p o s _ 00 fat (^ 0 l n Go> o o B 0 3 i o GB Da c . n ' > > o G O B 10 ife Total number of 968. ~Zs> = =--- IZflt - -- r J7 0 2 SB g Tl . , J" tc * . ti i. 1 Jt o o J I- Of which Ameri- cans. <3 52 I! "7! to o 1* All other Foreign- ers and unknown. ?5 5 <1 1 ft a -? - Mexicans. H ~P CD ~ 1 8 o1 Ci to -1 Soldiers. ~ ^1 1 ck; to H- to o 9 m. Dep. and all others. x,3 m p ; ^ to Other Foreigners. 0 Xr p n 5 o L. * -' Mexicans. En E. * eo -; o Soldiers. n t% a 9 00 C,' 1 g 1 PB CO' i 0 p CO to c^ D in. Dep. and all others. c CO A 10 Other For- and unknown. 00 u to CO 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, 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 edng 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 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 !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,