Southern Medical and Surgical Journal, 1848

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sou T II E K N

MEDICAL AND SURGICAL JOURNAL,

EDITED BY

PAUL F. EVE, M. D.,

TEOFESSOR OF SURGERY I>- THE MEDICAL COLLEGE OF GEORGIA,

AND ONE OF THE VJCE-rEESIDENTS OF THE

NATIONAL MEDICAL ASSOCIATION.

Wedical College of Georgia.

"Jc 2)rends le bien oil jc Ic trmive."

VOL. IV. 1848. NEW SERIES,

^ttqusta, ^a.

JAMES M c C A F F E R T Y

FRINTER AND PUBLISHER.

1848.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 4.] NEW SERIES JANUARY, 1848. [No. 1.

Part L original COMMUNICATIONS.

ARTICLE I.

A Chapter on Ulcerous Diseases of the Legs. By Charles T.
QuiNTARD, M. D., of Macon, Geo.

We do not hope to advance any new or original ideas,
thoughts, principles, or suggestions in this chapter, on ulcerous
diseases. We have no " new mode of treating old ulcers," but
rather what may be called an old mode of treating new ulcers.
From the time (1776) that Merk published his " De curationi-
hus ulcerum dificilium prcesertim in crurihus ohviorum,^^ we
have had " line upon line precept upon precept : here a
little and there a little ;" we have had essays, lectures, mono-
graphs, and books of all sorts, sizes and kinds, to tell us what
ulcers are, and what they are not what will cure and what
will not cure them ; and it is not, therefore, strange that the
present mode of treating ulcers should be somewhat different
from that pursued by Merk, Thomson, and. the profession of
the last century. Original ideas are often nothing more than
those which arise in the mind, from the peculiar light in which
old doctrines are viev/ed. It is well, however, now and then
to reconsider old and established truths, that they may be re-
inforced, and new ones discovered. This is just what we shall
endeavor to do ; so we warn our good readers to expect no-
thins: new.

An ulcer is a solution of continuity in any of the soft parts of
the body attended by a secretion of pus, or a discharge of some
sort. This discharge is affected, and determined and con-

Quintard, on Ulcerous Diseases of the Legs. [January,

trolled by a variety of circumstances, which may be either
local or constitutional.

Constitutional causes act most frequently in any and every
variety of ulcer. Dr. Thomson, in his Lectures on Inflamma-
tion, remarks, "that every ulcer, strictly speaking, is of a local
nature ; but there are ulcers which, though local in their ap-
pearance, are connected with, or dependent upon, diseases
which affect the general system. (Vide Lee. on Inflam., p. 427.)
Peculiar diathesis, such as the scrofulous or syphilitic, although
they may not be the exciting cause of the ulcer, have so great
an effect on its character and condition, that we may with pro-
priety speak of tlie scrofulous lilcer, the syphilitic ulcer, &c.
If a person be suffering from an ulcer on the leg, and contract
the venereal disease, it sometimes happens that the sore looses
its healthy action, and assumes the appearance of an irritable
ulcer. If a person accustomed to the use of intoxicating liquors
have a sore on his leg, its character is determined by the degree
of his indulgence. In healing an ulcer we endeavor to produce
healthy granulations, and this is done by attending in the first
place to the general health or state of the system, and after-
wards to the state of the part affected. If a vitiated state of the
constitution prevent the healthy local action, and the conse-
quent formation of healthy granulations, constitutional treat-
ment is requisite ; whereas, if the cause of the morbid action
exist in the part itself, no general treatment will suffice to re-
move it. Where there is any syphilitic taint, or scrofulous
diathesis, or varicose condition of the superficial veins, we find
it difficult to heal any ulcer ; or when the constitution has been
afiJected by the excessive use of mercury or intoxicating drinks,
neither time nor the most refined local applications, nor best
adapted remedies, will be of any use in healing the ulcer, for
the cause is not local, and they will never produce the strong,
round, small and florid granules indicative of a healthy charac-
ter. Nutrition may be defined the operation of the nutritive
faculty conducing to the substance of the animate body by
augmentation. There are many ways in which the nutritive
faculty may act. It may act generally or locally ; but a heal-
thy general action is at all times necessary to a healthy local

1848.] Quintard, on Ulcerous Diseases of the Legs,

action. Ifwesay We have an ulcer in a part whose action is
healthy, we understand it occurs in a person of good constitu-
tion, and also that the vitality of the part is sufficient to repair
the breach of continuity by inflammation, suppuration, granula*-
lion and cicatrization. Nature's process will in most cases be
sufficient to cure the disease, unaided by the surgeon, and he
oftenest shows his wisdom who watches nature's motions closest
without interfernig when there are no obstacles in the Way.
It is by imitating a natural process, that we succeed best in our
Cures ; for when we find the energies of the body iiisuflicietit to
overcome all the obstacles in the way, we have more of na-
ture's laws to guide us in assisting her. How is it, when
one of the lower animals receives a wound, the blood flows for
a time, then coagulates, protects the surface from external vio-
lence, a new skin forms, and the scab falls ofT. What better
guide can we have in directing our efforts. If we have a heal-
thy sore, why not let nature heal it ; and if it be so that no scab
Is formed, surely all we have to do is to imitate nature and form
an artificial one. Simply a little dry lint that will absorb the
moisture, and lapis calamin., or an ointment of chalk, with a
bandage applied moderately tight, will do better than any thing
else. We know that in the animal organism a change is con-
stantly taking place, and that the phenomena of life may be
kept up in substances which, introduced into the system, serve
to the increase of the mass, or to replace the matter consumed in
the "furnace of the body," which must continually be supplied.
" Every abnormal condition of supply or Waste, in all parts, or
in a single part of the body, is called disease.'* Now it is by
keeping up an equilibrium between the two forces that a nor-
mal condition of the economy is established ; but this equili-
brium is not only necessary in the general system, it must be
as perfect in every organ and part of the system ; for in a state
of health, each part is as perfect in itself, and the vital force
has as perfect control over every part as over the undivided
whole. Surgeons no doubt often prevent and hinder the for-
mation of natural dressings, having more confidence in them-
selves than in the powers of nature, " and therefore have," as
Mr. Hunter says, " introduced a practice of making sores of all

Quintard, on Ulcerous Diseases of the Legs. [January,

wounds." They may feel the necessity of obtaining a scab,
and know that it is best to imitate nature, but unwilling to trust
the slow but certain operation of its laws, they endeavor to re-
place "the matter consumed," and hence

"but skin and film the ulcerous place,

Whiles rank- corruption, mining all within,
Infects unseen."

What obstacles have we to overcome in curing ulcers on the
legs! Sir Everard Home says we have them occurring "in
parts which are too weak to carry on the actions necessary
for their recovery. In parts whose action is too violent to
form healthy granulations. In parts whose action is too indolent.
In parts which have acquired some specific action. In parts
which are prevented from healing by a varicose state of the
superficial veins of the upper part of the limb."*

Now all of these are more or less controlled by local and
constitutional causes, and it is necessary in treating any and
every ulcer to find out the cause. Mr. Spender says the ob-
stacles to be overcome are chiefly the following, viz :

1st. Varicose veins.

2d. Adventitious deposites.

3d. The form of the ulcer.

4th. The existence of constitutional disturbance or debility.f

The several circumstances mentioned by these two authors
would at first sight seem to guide and direct the surgeon in the
treatment of every variety of ulcer and so they would, were
the characters upon which the distinction is founded uniform
in their appearance and readily distinguished one from the other.

Let us for a moment consider the 2d variety of Sir Everard
Home, on ulcers in parts where powers are too weak. They
are known by the appearance of the granulations, which are
larger than those of the healthy ulcer of looser texture semi-
transparent and not dis])()sed to form skin. They are particu-
larly lia])le to be eflected by any change in the constitution or
general health, and are also aflfected by atmospheric changes.

Vide Practical Observations on the Treatment of Ulcers on the Legs, Am,
edit. Philadelphia, 1811, p. (IG.
t Vide Spender on Ulcerous Diseases of the Leg. Loudon, 18o5, p. 72.

1848,] Quintard, on Ulcerous Diseases of the Legs.

Thus, when the weather changes from dry to moist, this sort
of ulcer is apt to put on an unhealthy appearance, and is coat-
ed over with a kind of lymph " resembling melted tallow."
Hence, in treating them we are obliged to pay particular at-
tention to the constitution, in order to ward off the injurious
effects of external agents, and so to strengthen the system by
tonics, that the part affected may be the better fitted for local
applications. Frequently the granulations rise higher than the
edges of the sore, and although we may use every means at
our command to prevent this too great luxuriance, we are
sometimes baffled. Pressure by a pledget of lint and a tightly
applied bandage, will in most cases succeed ; a bandage proper-
ly adjusted, reduces them to a level with the surrounding skin,
gives firm support to the limb, and diminishes the extent of
the sore.

Nothing is easier than to distinguish an irritable ulcer from
one that is indolent. It has a physiognomy that cannot be mis-
taken. The ragged and projecting edges, the surface, the thin
ichorous discharge, and the sensibility, all designate it : but we
often see the indolent ulcer taking on these appearances from
irregularity of diet, too great indulgence, irregularity in the
various functions, or any change in the general health. To
illustrate: Bridc^et S., ac^ed 26, came under mv care with three
large ulcers on the right leg. She was accustomed to the use
of intoxicating drinks, and was very much debilitated. I or-
dered,

R. Mass PIvdror . . m-. ix. > ^.-^ . a. ., at
r, 1 t'i -^ ^ . > M. et ft. in pil. No. m.

Pulv. Rhei, . . gr. VI. ^ ^

One to be given every four hours, with a poultice of linseed
meal, on which was sprinkled tinct. opii., to be placed over the
sores. After taking the pills she had a free evacuation from
the bowels, and in twenty-four hours from the application of
the first poultice a marked improvement might be seen in the
appearance of the ulcers. I ordered sulph. quinine in doses of
2 grs. three times a day. With this she began to improve
rapidly: several sinuses which had been formed were '-^ d
open, and the parts were in all respects looking well. On the
26th day the ulcer was not larger than an inch and a half in

Qui^tard, on Ulcerous Diseases of the Legs. [January,

circumference- on the 28th day it was from six to eight inches,
with an ugly ill-conditioned appearance. I was somewhat
puzzled at this rapid change, and looked about for the cause.
I questioned her closely, thinking she had been at her old habits
of drinking,-^but no, ^hc had not tasted a drop ; her bowels
were well, and she had eaten as usual. I then enquired if she
was regular in other respects ?^f she menstruated ? She re-
plied, " O ! Doctor, I had a good show the day before yesterday,
but it stopped of a sudden, and my sore has been getting worse
ever since-^-it bleeds and pains me." This of course was a
solution of the mystery. I was fortunate enough to direct my
remedies successfully, and restore " the show," without much
difficulty, but the ulcer had resumed its old character, and it
was necessary to make some local application to remove the
sloughing parts. To do this I used nitric acid, which cleaned
it off well, and by the application of a few poultices, and balsam
Peru, obtained good and healthy granulations, so that I left off
all local remedies on the 25th day from the time it began to
deteriorate. The cause of the ulcer was a cut received in an
^' encounter matrimonial," which from a vitiated state of the
system assumed the character above described. The nature
of the ulcer had no connection with the state of the limb, but
was dependent solely upon a variation of the general system.
There was no varicose condition of the veins, nor adventitious
deposites, nor unnatural condition of the structures in the
neighboring parts. There can be no doubt " that both the
indolent and irritable description of sores originate from the
same cause, and that such cause is frecjuently a varicose state
of the veins." (Vide Spender, p. 28.)

No person who has been accustomed to treat ulcerous dis-
eases in a large hospital can have failed to notice the frequency
with which they are preceded by diseased veins, Mr. Spender
gives the following as the result of his observations, in those
eases which have fallen under his own inspection :

79 varicose, consisting of 41 simple, -27 very irritable, 11 very indolent.
^1 non-varicose, '^ ^' 15 do. 4 do. do. 2 do, (Iq,

Of the whole nunibcr, 08 females^-32 males.

Of the varicose, 59 20 "

Of the noii-varicose, 0 " J.2 *'

1848.] Quintard, on Ulcerous Diseases of the Legs,

I examined 60 male patients under my care at one time, and
out of the whole number there was but one who had not been
accustomed to drink more or less all but eight had had some
form of lues: some had been "soakers," some "drunkards,"
and a few only " moderate drinkers." But five were under 30
years of age, while the others varied from that to 80. They
were all from the low^er classes of society, if such an expression
may be allowed in this " democratic country," and some of
them were sui-generis. Such being the fact, it will naturally
be supposed their constitutions had suffered somewhat in the
rugged pathway of life. What the twin-sisters, scrofula and
syphilis had left undone, debauchery and excess had well-nigh
completed. Of the 60 cases, 37 had varicose veins, and 23 non-
varicose. The proportion of simple ulcers, &c., was about
the same as in the table given above.

It is true, varicose veins have never been thought the lead-
ing cause of ulcerous diseases of the legs ; neither Wiseman,
Benj. Bell, Mr. Baynton, Dr. Underwood, Mr. Whately, or Sir
E. Home, have attributed to diseased veins any effect in the
production of ulcers ; and Sir E. Home, who has written more
on this division of the subject than all the other writers, says,
" Ulcers occur in many patients, but more frequently in tall
people, on the inside of the leg, just above the ankle. They
have their origin from some accidental cause.*^ An ulcer, no
matter how produced, upon a limb in this state of enlarged
veins, is known to be exceedingly difficult of cure, and is very
apt to break out again after it has cicatrized. It becomes an
important point to know what connection there is between an
enlargement of the veins and ulcerous diseases, because such
knowledge must exercise a very material influence on our
application of remedies. The views of Mr. Spender on this
subject are so far novel, that he goes beyond every other wri-
ter and says, "It is not sufficient that the varicose be considered
as one kind of ulcer in common wil^li others, called, as may be,
irritable or indolent; but it should be viewed as the parent of
the others whenever it exists along with them."

Now, we think it would frequently by the parent of illegiti-
mate offspring ; for there are many cases of both the indolent

Quintard, on Ulcerous Diseases of the Legs. [January,

and irritable sore occurring in persons whose veins are en-
larged, where the prime cause has no connection with the state
of the veins, and which in their course do not, so far as we
can judge, exercise any material influence on the local disease.
The irritable ulcer may exist without any disease of the veins,
and so also may the indolent, and that varicose veins and these
two varieties of ulcers may exist at the same time, yet having
no connection, we believe, from observation and experience.
Take the following case :

j\ir. J. C, had enlarged veins on the right leg. While ex-
ercising with a straight, sharp-pointed sword, accidentally
pierced his leg, and made an incision tw^o inches long. The
wound was dressed and was healthy in every respect. He con-
tracted syphilis had primary sores and buboes. He had con-
nection with a woman two days before he received the w^ound,
but the chancres did not make their appearance till the day
following it. The evening preceding their appearance, he had
indulged pretty freely in wine. On the third day after the re-
ception of the w^ound (being the 2d after the appearance of the
chancres) I noticed dark, unhealthy spots, and an ill-conditioned
discharge about the wound, which very soon put on all the cha-
racters of a truly irritable ulcer. The remedies were at once
directed to what was considered the cause of the evil, namely,
the syphilitic disease : it was cured without much trouble, and
under favorable circumstances. At the same time I made local
applications to the sore, which so soon as the venereal influence
was removed, assumed its original character of a healthy sore,
and was healed without difficulty. If varicose veins were
" the parent " of all indolent and irritable ulcers, why did the
wound assume a healthy appearance before the chancres, &c.,
showed themselves? or, if they in all cases influence such
ulcers, why did it put on a healthy character immediately after
the venereal influence was removed ? We admit that this was
an exception, perchance, to the general rule \ but we believe
there are many such exceptions. Varicose veins weaken the
limbs, and thus indirectly i)redispose them to ulcerous diseases,
and under many circumstances, they are undoubtedly the cause
of such diseases, and as Mr. Spender says, "the parent of in-

1848.] Quintard, on Ulcerous Diseases of the Legs.

doleiit and irritable ulcers." The treatment indicated is that
which will give firm support to the limb, making equal pres-
sure on all parts, and such as will most diminish the calibre of
the dilated veins, with remedies which in their nature are most
conducive to bring about a healthy action, under the varying
disposition of the sore. The treatment of ulcers having con-
nection with varicose veins, be they indolent or irritable, ditfers
widely from that indicated when the sore exists independent
of diseased veins ; and though tight bandaging is beneficial in
nearly, if not all, indolent ulcers, its good effects are produced
directly on the ulcer, and not indirectly, as when the ulcer is
produced by a varicose condition of the superficial veins. In
an ordinary indolent ulcer, distinguished by the hard, round
and prominent edges the smooth, glossy surface, dotted here
and there with flakes of coagulating lymph : we may see how
admirably adapted is the practice introduced by Mr. Baynton,
which we shall have occasion to speak of immediately. Band-
ages in this variety of ulcer are beneficial in depressing the
prominent edges and approximating them ; the sides are drawn
more closely together, and thus the cicatrix is not so large,
nor is the sore so likely to break out after it has once cica-
trized. In the application of bandages, surgeons cannot be too
particular. If a bandage is wrinkled, or put on unevenly, it
may do considerable harm. In fact, any dressing which the
surgeon may think proper to apply, whether it be the lace
stocking of Wisemar, the adhesive plaster as used by Baynton^
or the common roller bandage, must be well applied, if he ex-
pect to derive full benefit. A bandage little over two inches
wide, will, in general, be easiest to apply, and not so likely to
wrinkle as a wider one. Bandages of flannel are in some cases
preferable, from the elastic nature of the material. In the ap-
plication of bandages we should always keep in view the indi-
cations, and we may thus the more accurately judge of the
degree of pressure required. In those cases in which the edges
are not elevated above the surface of the ulcer, the benefit
derived is in the approximation of the edges and the support
given to the limb ; but where the edges are so elevated as to
I'equire depression, the adhesive straps used, as recommended

10 Quintard, on Ulcerous Diseases of the Legs, [January,

by Mr. Baynton, effect this object with great facihty. He was
led to adopt his pecuhar mode in the appHcation of adhesive
plaster, from having frequently observed that the probability
of an ulcer continuing round, depended much on the size of the
cicatrix which remained after the cure appeared to be accom-
plished ; and from well knowing that the true skin was a much
more substantial support and defence, as well as a better cover-
ing, than the frail one which is obtained by the assistance of
art. But when he had recourse to the adhesive plaster, with a
view to lessen the probability of those ulcers breaking out
again, he little expected that an application so simple would
prove the most efficacious and most agreeable means of obtain-
ing the desired object. He gives the following description of
this method :

" The plaster should be prepared by slowly melting in an
iron ladle a sufficient quantity of litharge plaster, or diachylon,
which, if too brittle, when cold, to adhere, may be rendered
adhesive by melting half a drachm of resin with every ounce
of the plaster ; when melted, it should be stirred till it begins
to cool, and then spread thinly upon slips of smooth porous
cahco, of a convenient length and breadth, by sweeping it
quickly from the end, held by the left hand of the person who
spreads it, to the other, held firmly by another person, with
the common elastic spatula used by apothecaries ; the uneven
edges must be taken off, and the pieces cut into slips about two
inches in breadth, and of a length that will, after being passed
round the limb, leave an end of about four or five inches, The
middle of the piece so prepared is to be applied to the sound
part of the limb, opposite to the inferior part of the ulcer, so
that the lower edge of the plaster may be placed about an inch
below the lower edge of the sore, and the ends drawn over the
ulcer with as much gradual extension as the patient can well
bear ; other slips are to be secured in the same way, each
above and in contact with the other, until the whole surface of
the sore and the limb are completely covered, at least one inch
below, and two or three above the diseased part.

"The whole of the leg should then be equally defended with
a piece of soft calico, three or four times doubled, and a band-

1848.] Quintard, on Ulcerous Diseases of the Legs. 1 1

age of the same, about thr^ee inches in breadth and four or five
yards in length, or rtither as much as will be sufficient to sup-
port the limb from the toes to the knee." (Vide a Descriptive
Account of a new method of Treating Old Ulcers of the Legs,
by Thomas Baynton, 2d edit., 1799.)

Mr. Whately used very little variety of dressing, and with
some exceptions, pressure was principally relied upon as the
means of cure. Mr. W. gives a preference to fine flannel
rollers, somewhat less than four inches wide. It is no doubt
true that Mr. Baynton was as successful in the treatment of
varicose ulcers, as in that variety of indolent, having no con-
nection wath a diseased state of the veins, for his applications
were such as had a direct influence on both sorts. The great
principle involved in the treatment of indolent ulcers is to have
an equal and even pressure, so that the limb may have, as
nearly as possible, a natural condition, a firm support.

The second great remedy in the treatment of indolent ulcers
having no connection with the veins, but such as are prevented
from healing by adventitious deposites, peculiarity of situation
or condition of surrounding structure, is the formation of a
lesser ulcer to take the place of a greater one, the establishing
of an issue. We shall not attempt to discuss the various the-
ories which have been put forth as to the propriety of " drying
up" of old ulcers, but continue our attention to the effect pro-
duced by establishing a permanent discharge from the neigh-
borhood of the diseased tissues. Great care should be taken
in the placing of issues. They may be near, but not upon a
joint. Cases are recorded in which diseased action has been
increased by their introduction in the neighborhood of joints
or large venous trunks. It is a practice which has been hand-
ed dow^n to us from the old fathers. As long ago as the days
of Claudius, in whose reign the celebrated physician Colur-
jiella lived, we find it was the practice of " cattle doctors" to
^establish issues in the ears of the cow, in order to cure a dis-
temper which afflicted that animal. Columella gives the fol-
lowing description of the practice :

" Praesiens etiam remedium cognovimus radiculae quam pas-
jtores coiasiliginem vocant. Ea in Marsis montibus plurima

12 Quintard, on Ulcerous Diseases of the Legs. [January,

nascitur, omnique pecori maxime est salutaris. Sseva manu ef-
foditur aute soils ortum, sic eni n L'cta majorem vini ereditur
habere. Usus ejus traditur tulis ; senea subula pars auricula3
latissima circumscribitur ita ut manante sanguine tanquam
liters C ductus apparet orbiculus. Hoc et intrinsecus et ex
superiore parte auriculae eum factum est, media pars descripti
orbiculi cadsur subula transitur et facto foramini pra^dicta
radicula inferitur quam, cum recens plaga comprehendit ita
continet, ut elabi non possit: in eam deinde auriculam omnis
vis morbi, pestilensque virus elicitur, donee pars, qua3 subula
circumscripta est demortua excedat, et minime partis paitura
caput conservatur."*

When this practice was first adopted for the cure of ulcers,
we would not attempt to show. It was, doubtless, at a very-
early date. Experience has shown us that it is not at all times
wise to heal up ulcers which have been of such long standing
as to accustom the system to the drain made upon it. " I have
often," says Dr. Parry, " seen various thoracic affections, as
pulmonary consumption, asthma, carditis, or hydrothorax arise
from the spontaneous or artificial cure of ulcers, perpetual
blisters, or fistulas." (vide Elem. of Pathology, &c., p. 380.)
These are cases of which the surgeon must judge. If a pa-
tient fear to have a large " six by eight" ulcer healed up with-
out some diversion or outlet, the surgeon should in all cases re-
lieve the anxieties of his mind. The patient dreads to have
the "matter driven into the system" he has heard of evil

We have also discovered a small root, which the shepherds call lungwort.
It grows abundantly upon tiie Marsian mountains and is very wholesome lor
all kinds of flocks. It is dug with the left hani, before sun-rise, for being ga-
thered in this manner it is believed to possess greater virtues. The manner of
using it is this: The broadest part of the ear is circumscribed with a brazen-
pointed awl, in such a manner, that the blood flowing forth a small circle ap-
pears, drawn as it were of the letter C. When this has been done both on the
interior and exterior part of the ear, the centre of the described circle is perfor-
ated by the same instrument, and a puncture having been made the fore-named
root is introduced which when the fresh wound receives, it retains in such a
manner tlint it cannot escape: into that ear, then, the whole power of the mala-
dy and inl'cctcd virus are introduced, until that part which was circumscribed,
alonghing, falls off, and the head is preserved by tlie loss of a very small part
of it.

1848.] Qumtai'd, on Ulcerous Diseases of the Legs. 13

effects following it or perchance he has read that the " bad
humours" exist in the blood, and become separated from it and
poured out at the ulcer. But no such thing does happen the
quantity and quality of the pus or matter depend on the nature
and extent of the ulcer which secretes it. It is from pure blood
circulating in the minute vessels opening on the face of the
sore, that the discharge is furnished, and its purulent nature is
acquired after it is secreted from the capillaries. It is there-
fore improper to speak of " driving it into the system" and in
healing an old ulcer, we only restore to the system so much
blood as was required to form the pus. Now, it may be dan-
gerous to restore this quantity of blood to the circulation with-
out establishing some other drain ; for we may thereby cause
apoplexy, and a train of evil consequences which ought to be
avoided. Some would have us adopt as a safe-guard, low diet
and frequent evacuation of the intestines; but this is attended
with more uncertainty and inconvenience than the issue, and is
therefore not so desirable. It may be said, that in forming an
issue, w^e but exchange one sore for another. This is true, to
a certain extent ; but we make exchange for just so long a time
as we may desire it is far easier to cure the issue than the
ulcer. If by the issue, we can heal an ulcer which resists all
other treatment, common sense would lead us to adopt it ; we
do not have so large a secreting surface, and we thus restore
the blood to the heart, little by little. We will suppose the
cause of the ulcer to have been removed, and w^e have the effect
only to deal with. The cause may be transient, but the effect
is lasting : it is this lasting effect w^hich is to be removed ; but
in its removal, we are to beware least we establish in the sys-
tem causes for general disease, and difficulty more dangerous
in its effect than that which has just been destroyed.

In the progressive motions of nature, the state of things at
the present moment, becomes the cause of the state of the next
moment, and each motion is determined, and receives a distinct
impress from the motion which preceded it. We know how
trifling a thing will cferange the general system, and how un-
certain are most of the articles of the materia medica in their
operation on the system are we then justified in restoring to

14 Quintard, on Ulcerous Diseases of the Legs. [January,

the circulation a quantity of blood, without having the certain
means of controlling its action on the animal economy ? Do
"we not run some risk in healing up an ulcer which has been
for ten or a dozen years, with no other safeguard than an in-
junction on the patient to observe a very low diet, and perfect
regularity in evacuating the bowels? We know that patients
may feel a longing to have the ulcer removed : but poor human
nature is often too weak to resist the temptations of the table.
The surgeon, as we have said, must judge of these matters by
the peculiarities of each case. If there be no reasons why the
sore should not be healed, and it resists the application of the
adhesive plaster, the bandage, sol. nit. argent, and all the other
remedies which are of benefit in indolent ulcers, a small issue,
made by pinching up the skin, perforating it with the lancet,
and then introducing a pea, will assist nature in its efforts, and
soon enable her to do the work of reparation. Poultices, un-
less imperatively demanded, should never be used ; they weak-
en the parts, lessen the strength of the granulations, and hinder
the healing. The balsam Peru is so slightly stimulating and
so soothing, that it is a remedy often very beneficial. The
lotio nigra, and lotio flava, are both appropriate in particu-
lar cases. The pulv. sanguinaria3 ; rhei, opii ; lapis calamin.,
&c., &c., and are all to be used in those sorts of ulcers which
may be healed by simple applications. Fomentations are sel-
dom of use certainly not to the extent recommended by some
writers. A wash of creosote has the credit of being a great
" flesh producer," but it is questionable to what extent. We
must find out the cause of the ulcer in all cases, remove it, and
our efforts will meet with more success than if we went blind-
ly to work.

There is one variety of ulcer we seldom meet with, and
therefore seldom see described. We have met with but three
cases of the kind viz., the Circular Callous Ulcer in the bot-
tom of the foot. Prof Mott, in a case published in the New
York Medical and Surgical Register, in the year 1818, vol. 1,
states that, "its peculiarity consists in a remarkable horny
hardness of the thick cuticle of the bottom of the foot, and in
its being more or less of a round form," A great degree of

1848.] Q^umiai'd, on Ulcerous Diseases of the Legs. 15

insensibility may be said to form one of the characters of this
ulcer. The case recorded by Dr. Mott, presented the follow-
ing characters : The patient was admitted into the New York
hospital on the 2d of December, 1817. Three years previous-
ly he fell and bruised his knee just below the patella ; the
injury was slight, and did not interfere with the motion of the
joint, though it gave him some pain. A few days after the ac-
cident, an ulcer broke out on the outer-side of the knee y three
others followed this successively, the second making its ap-
pearance a few days after the first got well. They were all
superficial, and there was no discharge of pus from their sur-
face, but of a serous fluid ; they were all long in healing. The
last occasioned much pain, and produced a swelling of the an-
kle which remained several months, and prevented his walking.
About six months after the accident happened to the knee,
just as the last ulcer was healing, and about two years previous
to his admission into the house, he perceived that the part
immediately over the first joint of the great toe was swelled
and considerably inflamed, though it had never given him pain.
The swelling continued to increase, and at length the integu-
ments ulcerated ; the ulcer became circular, and about an inch
in diameter ; it extended to the ligaments of the joint. From
this period to the time of his admission it remained nearly sta-
tionary, seldom giving him any pain, or preventing him from
taking his usual exercise. Lotions, astringent and stimulating,
were tried, scarifications, &c. ; a circle of skin was removed
from the edge of the sore, but a few days would restore it to
its former shape and dimensions. Its cavity was several times
filled with pulv. cantharides, and kept in for a number of days ;
this gave rise to no pain, and effected no change at least nev-
er to dispose it to granulate from the bottom. At length the
following ointment was used :

ft. Acetas Cupri, . . . 3iss. > ^,
Adipis, li- I

In about six weeks this effected a cure, and on the 27th of
May he was discharged. In September following he returned,
having a precisely similar ulcer, in the same situation, succeed-
ing an attack of intermittent fever.

16 Quintard, on Ulcerous Diseases of the Legs. [January,

R. lod. Potass., . .

5ii.

Ext. Cicut, . ,

5iss.

Syr. Sarsapar., .

. 5iv.

Patrick Malone, set. 33, street musician ; strumous habit : no-
ticed "a pimple" on the cushion of the heel, which he pricked
with a pin ; the integuments ulcerated, and he was unable to
put his heel to the ground in walking ; complained of an ache-
ing in the ankle-joint ; ulcer about one and a half inch in diam-
eter and very deep. From constantly walking on his toes, the
glands along the course of the vena saphena became irritated
and very much enlarged. There w^ere about twenty of them,
extending from the ankle to the upper third of the thigh ; the
largest, about the size of a goose egg, was^ in the popliteal
space ; those nearest the groin w^ere the smallest. He stated
that a piece of " proud flesh" had grown from the centre of the
sore, which had been burned out bv a suri^eon. When he
came under my care, he was very much debilitated ; the ulcer
had existed six or eight months. Perfect rest was enjoined,
good diet, and the following mixture given internally :

M.

Tea-spoonful ter in die. Locally, the lunar caustic wajf used,
without stint. It occasioned no pain nor w^as there any ben-
efit derived from its use. Incisions were made completely
through the ulcer and the edges of the sore pared off; poultices
were then applied, which started a few feeble, pale, flabby
granulations they, however, soon gave way. The edges of
the ulcer were then scarified, and Sp. Terebinth applied, which
for a time, gave the sore a healthy appearance. Finally the
whole ulcer was exsected, and the wound healed without difli-
culty. To the enlarged glands the Tinct. and Ung. lodin. was
constantly applied. They gradually disap})eared and the pa-
tient recovered his ordinary health, so that he resumed his
usual occupation six months from the time the first application
was made. I excised the ulcer, because I thought the cause
of its indolent nature existed in the part itself. As often as
incisions were made through the tough integuments, granula-
tions woulfl spring up for a time and then be absorbed I de-
termined, therefore, to remove the whole, and obtain if possible
a healthy action, or rather give nature an opportunity to cure

1848.] BsLYis, on Medical Reform. 17

the disease for, as John Bell well observes, " it is an old but
a becoming and modest thought, that in our profession we are
but the ministers of nature."

We cannot close this article without alluding to the rapid
strides which have been made in all kinds of surgery, since
John Hunter developed the great first principle of the science,
the doctrine of adhesion. " Now it is not uncommon to find
after operations, a union of the severed parts to a considerable
extent, in twenty-four, thirty-six, or forty-eight hours." Be-
sides this, how much pain and suffering has been saved to the
unfortunates, who become the subjects of the surgeon's knife.
It is not strange that John Bell was sceptic when told that Mr.
Hunter had succeeded in inserting a human tooth into the
comb of a cock, and it was nourished and remained. Mr.
Bell totally disbelieved the facts, but upon visiting the Hun-
terian Museum at the Royal College of Surgeons, one day,
with Sir Astley Cooper, the preparations upon which he first
fixed his eye were the sections of the cock's head, upon which
the baronet good-naturedly observed, " Ah ! he does indeed
stare you in the face."* It w^as not strange that John Bell was
sceptical, for m those days, the " sympathetica! curers" were
nearer the true philosophy in the art of healing w^ounds, than
were the surgeons : the former threw the " powder of sympa-
thy" into a basin of water, kept the wound clean and cool
while the latter indulged in cruel practices, and prevented
nature in all her efforts to brine: about a cure.

ARTICLE II.

Thoughts on the Medical Convention. By John Davis, M. D.,
of Abbeville C. H., So. Ca.

Much has been, and is being said, and written, in relation to
the recommendations of the Medical Convention to debate the
standard of requirements for the attainment of a diploma to

* Vide Superstitions connected with Medicine and Surgery, by Thomas Jo-
seph Pettigrew, F. R. S., F. S. A. p. 212.

2

18 Davis, on Medical Reform. [January,

practice medicine ; and as it cannot be expected that all great
and important matters of public interest will meet with imme-
diate uniformity of action, we propose to offer a few general
remarks on the most important suggestions of that body, and
to throw out a few hints as to what we conceive to be the best
mode of effecting the objects in view.

That the standard of medical education, generally, is much
lower than could be desired, is admitted by all who reflect
correctly on the subject ; and that it is greatly in consequence
of the mode of teaching, the number of lectures delivered
in a given time, and the indifferent and loose manner of exam-
ining the candidates, for the degree of M. D., no one, we
think, can successfully deny.

To graduate, in medicine, has ever been an easy matter,
with the medical student, in this country ; and when we reflect
upon this fact, in connection with the short time in which one
is permitted to prepare for the degree the hurried, and crowd-
ed manner in which the lectures are presented to the mind, and
the almost uniform success of the applicant, for the degree, it
is quite conclusive, to our mind, that a large majority of those
who graduate are but ill-prepared to engage in the very im-
portant, and responsible business of the practice. The natural
consequence of a deficient medical education, on the part of
the young graduates of the country, is, necessarily, to lower
the standing of the profession, in public estimation, generally,
and to open the door for the ingress of quackery and imposi-
tion into our ranks.

We believe, upon reflection, that it would be almost, if not
altogether, the unanimous voice, of all candid and experi-
enced practicing physicians, who have graduated after three
or four years' application, under the present system of teacl>
ing, that the time in which one is permitted to graduate
is too short the term of lecturing too short, and the different
departments of instruction too difluse, and too much crowded,
one upon the other, to permit a large majority of medical stu-
dents to acquire a sufficient amount of knowledge to guide
them, safely, in the rules of scientific deduction, in after life,
let their preparatory education be what it may ; for no educa-

1848.] Davis, on Medical Reform, 19

tion short of a sound medical education should be taken in
exchange for the degree of M. D. If the applicant be in pos-
session of this knowledge, no matter when, where, or how he
obtained it if he complies with the requsition of the schools,
he is a fit and proper person for a diploma, and is the only
kind of a graduate likely to prove an ornament to his profess-
ion, and a safe, faithful, and judicious ministering servant to
the calls of humanity.

It is too much the case, at the present day, with a goodly
number of medical students, to merely prepare themselves
to graduate, without much regard to the matter of a prepara-
tion to practice their profession afterwards ; and it is such an
easy matter, with the assistance of a key or two to the qiJes-
tions usually asked, to pass through the ordeal of an examina-
tion, for the degree, that, after all is said, many, for the most
part, are essentially deficient, as to those qualifications neces-
sary to constitute sound practitioners ; and, in nine cases out
of ten, they ever remain no better. This is shown to be, gen-
erally, true by the large number of rejections of medical gen-
tlemen who apply for admittance as surgeons and physicians
to the army, after they have received their diplomas. Here
their medical education is thoroughly probed to the bottom,
and by medical gentlemen who are not one whit more respon-
sible for the result of their examinations than those who exam-
ine for the diploma or license.

Men may talk and w^rite about a know'Iedge of Latin, Greek,
Philosophy, the Mathematical Sciences, and a thousand other
things, as being essential to elevate the standard of medical
education, and it is all very good, so far as it goes, but if the
standard is ever raised, the work must first commence in the
medical schools, and not in the literary colleges.

Under the present system of teaching, good preparatory
qualifications are no certain guarantee, to the profession, that
the medical student will acquire a good knowledge of medi-
cine. He may be an EucUd in the Elementary Mathematical
Sciences, a Virgil in Latin, a Homer in Greek, and a Newton
in Philosophy, and yet be a mere Quack in the Science of
Medicine. Now since it is the aim of the Convention to elevate

20 Davis, on Medical Reform, [January,

the standard of professional education, how is it to be done?
and how is it to be fixed upon a firm and secure basis ? are
the questions to be settled.

The plan proposed is objectionable, in our view, or rather
it does not seem likely to effect the end aimed at, because it
mainly proceeds upon the assumption that the people, in mass,
are educated that they are intelhgent enough to be judges as
to the fitness and qualifications of professional men for the bu-
siness of their cahing, when in fact the people, generally, are
far from being educated. And any plan, or system of recom-
mendations, which falls short of aiming at, and of being so
arranged, as to effect the diffusion of a universal education
suCh an education as will make the people judges in these
matters, at least to the extent of not being imposed upon we
venture will prove utterly w^orthless.

An examination into the causes upon which the necessity for
calHng such a Convention is predicated, has brought us to this
conclusion. The cause of this necessity is evidently the facili-
ty that exists, in the medical profession, for the practice of
fraud and imposition. And what is the cause of this facility?
Evidently the ignorance of those upon whom these frauds and
impositions are practiced. Remove this ignorance, therefore,
and you at once remove the cause of this facility; and remove
this facility, and you at once elevate the standard of learning
and professional acquirements. We certainly do not mean by
any thing we have said, nor do we wish to be understood to
object to the proposition that is involved in the objects of the
Convention viz., that the practitioners of medicine should be,
generally, better educated, and that some plan should be adopt-
ed in order to bring this about. We have always felt that it
was very desirable that the most of young men should possess
more general learning than is usually the case, on entering
upon the study of the learned ])rofessions, especially that of
medicine ; but before you can bring this about, you must first
create the necessity for it. No man will give two dollars for
a thing when he can get it for one. The very same reason-
ing, in a great measure, holds in regard to education generally.
To obtain an education, requires the sacrifice of both time,

1848.] Dsivis, on Medical Reform, tti

Jabor and money, as well as the luxuries of ease and indolence.
But few men will go through all this labor, expense and time,
and deprive themselves of all those luxuries, to acquire a tho-
rough knowledge of their profession, when, at the same time,
they may accomplish their object at a much less sacrifice ; for
it is not to be denied, that nine out of ten, who engage in a
profession, especially that of medicine, do so in order to make
money ; and men generally are apt to choose that profession
which their talents, or the wishes of their friends, incline them
to think they can do best at ; so if the people will employ
them will give them money why the sooner they get at it
the better. Such men never think of elevating their calling by
elevating themselves, in knowledge, and learning, and the re-
quisite qualifications for its duties. Hence, the world is being
flooded with half made Doctors.

No better proof of this fact is needed than what is univer-
sally known, and to the disgrace of humanity it can only be
spoken, that so great are the ignorance and credulity of man-
kind, generally, in regard to diseases and medicines, that not
more than twenty years ago, not a few sensible people conclu-
ded they could practice the healing art, successfully, without
any previous preparation at all, and did, in fact, enter upon the
practice, and succeeded well, that is, obtained reputations for
skilful Doctors, and succeeded in inducing many to believe that
they knew as much, of the human system, and the nature of
disease, and remedies, as those who had spent their lives in the
study. And this is not all. The reason why this practice
does not obtain now, to the same extent as formerly, is owing
to the little light that has been forced upon the people, by the
absurd preparations of the Thompsonian or No-preparation
system, and not by any thing good or inherent in the people
themselves.

It is true, that some now engage in the profession of medi-
cine for the sake of the profession, and for the love they have
for learning and science ; but they are but few, and by no
means, at all times, the most popular. Such practice the heal-
ing art, not to make money, but to relieve suffering humanity,
but yet they make money, because they practice. Such men

22 Davis, on Medical Reform. [January,

are an ornament to their profession they are the honest in-
quirers after truth. Their range of vision is not confined within
the circumference of a dollar ; but they look out into the works
of nature as developed in both man and the universe around
him, and think themselves fortunate to be permitted to pick up
the pebbles that lie on the beach, without pretending to be in
the midst of the ocean of knowledge. And these are the men
who redeem the profession from the odium cast upon it by
quacks, and shallow-headed M. D.'s

It is said (and we think truly) that the morality of rulers takes
its character from the morality of the people they rule ; and if
the people are corrupt the rulers and law makers will be cor-
rupt also, and vice versa. The same rule holds equally good
in the professions; so the inquiry which has already been
anticipated still forces itself upon us why be other than the
people require you to be to accomplish your ends with them ?
Why put a professor out of a college, to teach a child its letters,
when one less learned, and who will do it for much less money,
will do it for you. It seems to us, therefore, clear and unan-
swerable, that until the people themselves are better educated,
go as to require in their physicians a higher standard of litera-
ry and scientific knowledge, all attempts to induce the attain-
ment of such a standard, in the profession, generally, apart
from such a requisition from the people, will prove abortive.
But as there is no probability that such a requisition loill come
from the people, unless their natures change, which is not
likely, tha question naturally presents itself what is to be
done. We will answer this question by saying, that the Medi-
cal faculty have it in their power, under even the existing
state of things, to accomplish much towards this desirable ob-
ject. They know very well, if a young man be fit to be en-
trusted with the lives of his fellow men : they may know well
enough if he be fit to practice medicine whether he know
nny thing or enough of his profession to justify thom in giving
him a diploma. Let the Faculty do their duty, here^ to hu-
manity, and the demands of their profession, irrespective of
mothers' and fathers' favorite sons, to the contrary, notwith-
standing, and reject all who are not really qualified to assume
the weighty responsibilities of their profession.

1848.] , Davis, on Medical Reforrn. ^88.

By the adoption of this course, mountebanks, who are stuck
up at every corner of the streets, in both town and city, and
many of whom are roaming over the length and breadth of the
land, hoodwinking the people, with their nostrums, for any
and every disease, would get no passports ; and if the people
be fools enough to entrust their lives and the lives of their chil-
dren to men who have not with them the recommendations of
a medical faculty, let them take the consequences.

There are many other reasons why the medical profession
is at so low an ebb, and so little respected by the mass of man-
kind ; and one is, the astonishing rage of parents to push their
sons into a profession, and especially the medical profession.
It seems to be conceded that a man must have some sense
and some learning, at least, to be even o. petty \a,wyeY; but it is
also conceded that any sense, and learning, at all short of
idiocy, is a sufficient quantum to entitle the aspirant to a seat
among the Doctors. This results from the fact that quackery
meets with less opposition in the medical, than in any other
profession. A lawyer, to practice with success, must under-
stand the principles of his profession, or he cannot succeed.
He may sometimes get an important cause on the " issue dock-
et," but if he gains it, even after that stage, it is owning to the
integrity of the court, and not to his knowledge of the princi-
ples involved. jVot so with our profession. The grave is the
Quack^s friend. Here it is too frequently the case, that the
shallowest pate gets credit for the most skill, and astonishing
to say, acquires the reputation of a successful practitioner from
no other cause than because he loses two-thirds of his patients.
Such men have the singular tact to affect learning, because they
never display any, and induce the multitude to believe them
w^ise because they are silent, or if they ever speak on subjects,
connected with the profession, they speak in a language which
neither their patients nor themselves understand. To such men
the three score and ten, the aged daughters of Eve, and, we may
add, many of the sons of Adam, of the same age, frequently
apply the adage that " a silent tongue makes a wise head" -
not knowing, or recollecting, as Shakspeare has hinted, that
even silence is not always " coimnendahle ;" since it may be

24 Davis, on Medical Reform, [January,

"foolish if we are wise, but wise if we are foolish." Such men
too often deal largely in the technicalities of their profession ;
in fact whenever it is possible for them to answer inquiries,
touching their profession, or the nature and names of disease,
or the philosophy of their treatment, by the use of Latin phrases,
are sure always to be used, and yet no proof could be more
convincing, that they are ignorant of the matters inquired of,
than by answering those inquiries in a language which those
by whom they are propounded do notimderstand. Such men,
too, may be known by their joining in to every whim and no-
tion, however incorrect, that may be entertained by the patient
himself concerning his disease, (though disgraceful to the pro-
fession,) by their lending too ready an ear to the calumnies,
that may be detailed against their successful and more scientific
rivals, and sometimes going so far as to originate those calum-
nies themselves. In short, such men study how to get practice,
not how they may deserve it.

We never knew a physician, who deserved practice, who
did not get his share ; but we have known many to get more
than their share without deserving any.

In our calculations, therefore, as to the means by which the
standard of learning, requisite for admission into the profession,
is to be debated, we must not lose sight of the materials upon
w^hich that profession is to act : we must make the materials
good, in order that the product of their manufacture may be
good also we must elevate the people before we can reasona-
bly expect that the people will prefer elevated men.

The term of pupilage should be much longer than is now
required ; the term of lecturing should also be prolonged to at
least six months instead of four ; there should not be more than
four lectures delivered per diem ; the student should be re-
quired to dissect more, and to devote more time to clinical
studies ; and the professor should require, in exchange for the
diplouia, a vastly greater amount of medical knowledge than
has hitherto been the case. No man should be allowed a per-
mit to practice, either in the way of a di})loma or a license,
without he be well ac(}uaintcd with the fundamental principles
of the profession, which can be known by a proper and tho-
rough course of examinations.

1848.] DsiYiSj on Medical Reform. 25

The effect of this would be obvious to us all. At least, a
good academical education would be so essential to the requi-
sition of the required amount of medical knowledge, that but
few, comparatively, would engage in the study of medicine
without, at least, a tolerable understanding of Philosophy, the
elementary Mathematical sciences, Lafin, Greek, (fee. If they
did, they would expect to make these departments of learning
a part of their studies (and such a thing is very practicable)
during their medical course, as is now often done in some of
the countries of Europe. This is the only plan, by which to
check fraud and imposition among us, and to elevate the stand-
ard of medical education. In fact, the influence of such a
change of requirements, in the medical schools of our country,
would, whilst it recoiled upon the literary colleges, induce a
greater proficiency in science, philosophy, and general litera-
ture, among the young gentlemen from these institutions ; for
it 16 a lamentable fact, nevertheless true, that many who pass
through the Literary colleges are mainly deficient in Philoso-
phy, History, Latin, Greek, the elementary Mathematical
sciences, &c. And so if there can be no reformation in the
medical profession, w^ithout high scientific learning, on the part
of the students of medicine, before hand, then, according to
this theory or plan, the Doctors of Medicine should spur up
the Doctors of Science to the business of manufacturing better
scholars to make medical Doctors of, and consequently, the
medical reformation, to be permanent, must first commence in
the literary, and not in the medical colleges.

As to the learning one gains from school education, it serves
only as a small capital to put him in the way of beginning
learning for himself afterwards ; and we believe every person
of sound scientific attainments, is finally his own teacher ; and
it is right that it should be so, for if it were otherwise, the rich
would buy it all and there would be none for the poor.

We wish it distinctly understood that we place a due esti-
mate upon literary qualifications, and equally admit that they
add very materially to the easy and successful acquisition of a
profound medical education. But we do not admit that even
an entire want of them, on entering upon the study of medi-

fifl Davis, 071 Medical Reform. [January,

cine, necessarily implies an inability, on the part of the medical
student, tu acquire a good practical knowledge of the profes-
sion ; for there are now numerous instances of worthy, judi-
cious and scientific practitioners, throughout the United States,,
whose education, before they entered upon the study of med-
icine, was little more than a smattering knowledge of reading,
writing, and common arithmetic, with a very imperfect know-
ledge of their own language.

What is the great object in granting diplomas, if it is not to
turn out men who understand the fundamental principles of the
healing art ? If it is known that the candidate for graduation
is radically in want of this knowledge, it is a violation, on the
part of the teachers of medicine, of the trust of a confiding
community, to grant him a permit to practice, whether he be
a graduate of a literary college or not. On the other hand, it
would be an equal violation of right, propriety and interest, to
refuse a diploma, to one who was well qualified to practice his.
profession, on the ground of his not having, previously, acquired
a certain knowledge of Philosophy, the elementary Mathemat-
ical sciences, Latin, Greek, &c. Hence we conclude that the
surest and most successful mode, to elevate the standard of
medical education, would be to be governed almost, if not en-
tirely, by the amount of medical knowledge possessed by the
candidate, when he applies for graduation, and not by what
he may have, of either literary or medical knowledge, when
he enters upon the lectures.

Since, then, it seems almost an impossibility to fix a standard
of preparatory education for the medical student, by which
the difiierent schools of the country will act in conformity, and
since a large majority of them possess at least a moderate ed-
ucation, and since experience confirms the fact, that a good
practical knowledge of the })rofession can be, and has been, in
many instances, acquired w ith an exceedingly scanty quantum
of the rudiments of learning, before hand, we would suggest
that there be no attempt made to establish a standard of pre-
paratory requisites, for the medical student; but that any, froni
the literary graduate down to the rustic ploughman, be permit-
ted to enter upon the study, if they may desire it; but, by all

1848.] Oakman, on Injury of the Brain, 27

that is just and sacred to society and to the claims of humanity,
we are opposed to the granting of a diploma, or a license^ to
any but such as really and emphatically merit it.

ARTICLE in.

Case of Fracture of the Cranium with Injury of the Brain.
By Erwin H. Oakman, M. D., of Columbia County, Ga.

The following case came under my observation when a
student of Medicine, in the office of Dr. James O. Hagood, of
Barnwell village, South Carolina.

On Monday, the 22d of July, 1844, Dr. Hagood, while riding
through the village on horseback, was requested to see
Adam, a negro, belonging to Mr. Allen, w^ho had received
an injury on the head. A small cut, about three quarters of
an inch in length, over the frontal bone, near two inches above
the left eye, was to be seen. Adam, upon being asked how he
received the wound, replied, that while carrying a quarter of
beef, he fell down, and struck his head against a fence-rail.
Dr. H., thinking the injury a slight one, directed him to be ta-
ken to his office, and request me to dress it. Removing the
hair for several inches around the cut, and drawing the edges
accurately together with adhesive straps, over which I placed
a dossil of lint, smeared w^th Turner's cerate, and over this a
bandage. The wound was not probed, as there was consid-
erable tenderness of the scalp, and no indication of serious
injury. I saw no more of Adam until the evening of the 23d,
when Dr. H. was requested to visit him, and he was repre-
sented as being quite sick : he was found complaining very
much of pain all around the wound ; the scalp was much tu-
mefied, and very tender to the touch. He distinctly said, when
questioned, that he had no pain in the head, but altogether on
the outside, passing his hand over the tumefied parts. There
were no symptoms indicating injury of the brain. He was
directed to take a dose of sulph. magnesia, and have the part
covered with a bread and milk poultice. On the morning of
the next day he expressed himself much relieved there was

28 Oakman, on Injury of the Brain. [January,

no fever, and the pain in the scalp was much easier; the poul-
tice was directed to be continued. Dr. II. called to see him
on the 25th, but he could not be found, havino: left his master's
lot the *2()th found him still complaininijf of the tumefied
scalp. The wound now presented an unhealthy appearance ;
there was no su])puration ; bloody serum was oozing from the
orifice : directed strict attention to poulticing. On the 27th,
Dr. H. and myself visited Adam, and found him standing at
the kitchen-door ; he was ordered to go to his room, which
was some twenty steps from where he was standing; he walk-
ed as if intoxicated the Doctor and I thought he was, knowing
his intemperate habits, and that he was off his master's premi-
ses the night previous, and in the neighborhood of the grog-
shops. When he got to his room and sat down, his master
asked him if he had been drinking ; he said he had. There
was some excitement about his pulse, which Dr. H. attributed
to the effects of the spirits he said he had taken. According to
Dr. H.'s directions, I took about sixteen ounces of blood from
his arm, and gave him a combination of tartar emetic and
nitrate of polassa. In the evening, found him entirely delerious,
with a strong hard pulse by request of Dr. IL, bled him
^''ad deliquium ani/ni" and gave an active purge. About three
hours after this, he was sleeping easily ; pulse much softer.
On the 28th, found him sinking rapidly: he died about 4 o'clock
in the afternoon. Dr. II. examined his head the next day at
9 o'clock. Just above the temporal ridge, and a little anterior
to the coronal suture, was an incised wound, three quarters of
an inch in length; a little anterior to this, was an extensive
fracture of the cranium, forming an opening in the scull, an
inch and a quarter in length, and three quarters of an inch in
breadth, the longest diameter, extending obliquely upwards.
A loose piece of bone covered the opening accurately, with
the exception of a fissure in the lower and outer corner, made
by the instrument which produced the injury, which penetra-
ted the brain, carrying before it, and burying in the substance
ofthebrnin, several small spiculrr of bone. The entire ante-
rior portion of the left hemisphere of the cerebrum wasacom-
plete disorganized mass, resembling turbid blood, intermingled

1848.] Oakman, on Injury of tlie Brain. 29

with small portions of brain. The whole exterior of the brain
and its membranes, showed the effects of inflammation the
blood-vessels being highly injected.

This case is very interesting to the pathologist, presenting
one of those " anomalies which we occasionally read of, but
seldom see," of so serious an injury of the brain, not resulting
in immediate death, or even ])roducing symptoms, calculated
to excite the least alarm, until they supervene, as the immedi-
ate precursors of death.

The instrument that produced the injury, was (as stated by
a witness) a large mill-saw file, with a heavy turned handle,
weighing upwards of a pound, and about eighteen inches in
length ; it was thrown a distance of ten or twelve feet, by a
white man who flew into a passion with Adam, because he let
fall a piece of beef w^hich he had employed him to carry. The
negro when struck fell to his hands and knees, immediately got
up and said he was not much hurt. Adam was bribed to con-
ceal the true cause of his injury from his master. The injury
was received the evening before I first saw him : he went to
his usual work after I dressed his wound, and continued to
walk about, until six or eight hours before his death, which took
place on the eighth day after he received the wound. He died
from the effects of inflammation of the brain, the existence of
which was not manifested until the morning of the 28th, and
then in such a doubtful manner, as to induce Dr. H. to attri-
bute the excitement in his pulse to the effects of ardent spirits,
knowing him to be an inveterate drunkard, and that he had it
in his power to procure spirits w^henever he wished it. There
was not at any time the slightest indication of compression : no
insensibility : in fact he did not take to his bed until a few
hours before his death. The history of this case is made out
from notes taken by Dr. H. after the post mortem examination,
together with my own recollection of the case.

80 Smith & Martin on Epidemic Dysentery. [January,

ARTICLE IV.

Notice of an Epidemic Dysentery. Reported by Drs. Smith
& Martin, of Atlanta, Georgia.

An epidemic has prevailed the present season, in and about
Atlanta, where our observations have been confined, of a dys-
enteric character, and when other diseases occurred they were
more or less complicated with it. Its intractability had caused
the physicians no little mortification, as many cases, despite
the most vigilant attention and energetic measures for its relief,
have terminated fatally; in its uncomplicated character we
found it obstinate, but yielding at length to proper remedies^
but when it supervened on measles, which have also been pre-
valent, it was attended by a fatality truly alarming.

The causes which usually give rise to this malady are cold
and moisture, or a cold, wet season, succeeding a hot, dry sum-
mer; but in its present advent it has reversed the order, as it
has prevailed extensively during the dry, warm fall, which has
succeeded the remarkably wet summer months. The disease
most rife in the latter summer months, particularly on the large
water courses, were of the intermittent class the cold stage
long and severe ; it yielded readily, however, to proper reme-
dies, and w'here it prevailed most extensively, we have heard
no complaint of the Dysentery. It is of its complication with
Measles, of which we wish particularly to speak through your
valuable periodical, and if we can happily elicit from some
one or more of your gifted contributors, some instruction as to
its successful treatment, we shall feel highly gratified that we
have called attention to the subject.

Our first case was a stout, hale young man, aged 20, to whom
we were called on the breaking out of the eruption. The rash
was well developed, pulse quick and soft, cough troublesome,
and fever moderate.

We prescribed a gentle purgative of Ext. Butternut and a
pectoral syrup, for the cough, and advised extreme caution in
the avoidance of exposure to cold in the progress of the dis-
ease. His convalescence was rapid, and on the fifth day he
was enabled to be out attending to ordinary business, and un-

1848.] Smith & Martin, on Epidemic Dysentery. 31

happily exposed himself to cold, by getting his feet wet, and
at night was seized with griping pains in the bowels and dis-
charges of bloody mucous. We were called on the next night,
twenty-four hours after his relapse, and prescribed Calomel
and Dover's powder, a blister over the chest, and as the irri-
tability of the stomach was considerable, a large sinapism over
the epigastrium and abdomen. He seemed better the next
morning when we left him ; but an exacerbation of febrile
symptoms and increased intestinal irritation occurred about 1 1
o'clock, A. M., the extremities became cool, and an evident
tendency to congestion of the lungs manifested itself, by the
throwing out the arms from under the bed-clothes and an in-
ability to expand them fully. Mustard baths were then re-
sorted to, and frictions and plasters to equalize the excitement.
The remedies used afforded temporary relief; but at 2 o'clock
at night, the exacerbation again occurred. The most vigorous
measures were again used, and were repeated from time to
time, as the exigency seemed to demand, until Sunday morn-
ing, about 10 o'clock, he breathed his last.

It may be proper to mention, that anodynes were given and
anodyne injections administered, and from the change in the
dejections w^e were encouraged to hope for a different issue,
as the dysenteric character of the evacuations was removed
and they became more copious and unattended by tenesmus.

At no period .of the attack did we feel justified in resorting
to the lancet, as the arterial excitement was never great nor
the fever ardent.

During the illness of the young man, three sisters were
seized with the bowel affection, and after three or four days,
the eruption of measles appeared on them. We were not
called on to prescribe for them until the eruption began to abate
and the affection of the bowels to increase. With these patients
the disease partook more of the appearance of Diarrhoea,
as the stools were larger and unmixed with bloody mucous,
but were of a serous character and generally devoid of fetor.
Anodynes were freely administered, mustard baths and plas-
ters resorted to ; anodyne injections were given repeatedly ;
blisters of cantharides applied over chest, bowels, and to the

32 Action of Medicines upon the Animal System. [January,

extremities. But all remedies proved unavailing, and they
sank, the one after the other, on the fifth and sixth days.

In all, there w^as the same congestion of the lungs, and the
relief afforded by remedies was alike temporary there was
the same periodicity in the exacerbations, and, we grieve to
record, the same fatal termination.

We have heard of many deaths from the same disease, and
presume there were the same symptoms as in the cases we
have attempted to record ; but we have never before witnessed
such fatality connected with a disease, which generally yields
to the mildest measures, and often requires no medical aid.

PART II. REVIEWS AND EXTRACTS.

ARTICLE V.

On the Action of Medicines upon the Animal System.
' By M. E. MiLLON.

M. M. Millon and Laveran have been turning their attention
of late to the investigation of the action of Medicinal Substan-
ces upon the Animal System. Their first Memoir upon the
subject was presented to the Academy of Sciences of Paris,
about three years ago, and an analysis of it may be found in the
first volume (N. S.) of this .Journal, extracted from the London
Lancet. In this they examined the effects of the double tartrate
of Potash and Soda, of Sulphate of Soda, Sulphur and Salicine,
together with the modifications which they undergo in their
passage through the system. The subject of the present Me-
moir is i\\Q Permanent Retentw?i of Aiitiwony in the Uvin<r
orfrans ; and it seems to us to be so important that we think
we cannot do the readers of this .Journal a greater favor than
by laying the whole of it before them.

Perm/incnt Retention of Antimony in the living Organs. (Presented
to the Acaflcmy of Sciences on the 22d June, 1846.) Translated
from the February No. of the Annales de Chemie et de Physique,
By John M. B. Harden, M. D., Correspondent Acad. Nat. Sci.,
Philadelphia.

In studying the passage of Antimony tln-oiigh the system when giv-
en in the form of an emetic, M. Laveran and myself have had occasion
to note its permanent retention in the difierent organs, and its gradual
ehmination after a long time. This observation leading us, as it did.

1848.] Action of Medicines upon the Animal System, 33

to attribute to the economy the faculty of retaining certain principles
foreign to the composition of the organs a longer time than had before
been suspected, made it necessary to follow it up and ascertain more
particularly the precise length of time to which it could be extended.
Legal Medicine is greatly interested in this subject and Pathology
no less so. We have every day reports of cases of Poisoning of pro-
tracted duration with equal care should we chronicle the facts which
tend to demonstrate that a very minute quantity of any metallic sub-
stance, when once introduced into the tissues remains permanently
there, and may be transmitted, as we shall see, from the female to
its young.

In order to make correct ob^rvations upon this subject, the ordin-
ary cases occurring in disease are not sufficient. We have found it
necessary, therefore, to administer the emetic to dogs. For this pur-
pose six dogs were kept up and so fed as to support a long confine-
ment. To the daily food o\ each dog were added a few grains of
tartar emetic.

The first trials with the emetic enabled us to determine, first, the
comparative value of the methods proposed for detecting the anti-
mony in the tissues ; secondly, to establish the fact of its introduction
into the different organs of the body; and thirdly, to prove its reten-
tion in these organs during a certain limited period of time, to deter-
mine which, however, a new experiment w^as necessary^ in which six
other dogs were kept up for m.any months.

In those dogs which died during the first week of the experiment
the antimony was found in the liver, the heart, the muscles, the coats
of the intestines, and the lungs. The brain, the bones and the fat,
Were entirely free from any traces of it. At the end of fifteen, twenty
and twenty-five days, the amount of the metal in each organ was found
to be the same, its quantity not being sensibly diminished. We must
add, that in these early cases of poisoning from antimony, the propor-
tion absorbed by the liver was comparatively enormoUs. 600 grammes
of different tissues in which antimony was found, furnished scarcely
as many spots as 100 grammes of the liver.

Before entering into a detail of these new experiments, however,
which appear to me sufficiently interesting to be given in full, I will
describe the method which I have employed for the purpose of detect-
ing the antimony in the tissues. _ This method consists in the employ-
ment of hydrochloric acid and the chlorate of potash. By causing
them to act successively upon the organic matters they are almo^
entirely destroyed. The antimony is precipitated Upon a very thin
lamina of tin. The two metals are then dissolved, and we introduce
the solution into Marsh's apparatus.

But to be more particular. We weigh 50 to 100 gfammes of the
tissue to be examined for example, the liver, the intestines or muscu-
lar flesh : it is cut in pieces, while fresh, and introduced into a glass
vessel containing one litre, and upon this we pour pure fuming hydro-
chloric acid to an amount equal in weight to one half of the organic

34 Action of Medicines vpon the Animal System. [January,

matter. The mixture is then placed upon a sand-bath, not hot enough,
however to cause tlie acid to boil. After digesting in tliis ^vay five
or six hours, it is then made to boil, and immediately we add to the
mixture small bits of the chlorate of potash. Filteen or sixteen gram-
mes of the chlorate is added to every 100 grannncs of the organic
matters. This addition sljould be made while agitating the mixture,
and should consume about fifteen minutes.

As soon astlie chlorate has been introduced, the fluid should be fd-
tered while boiling iiot. Upon the filter will be found a yellowish or
brown matter, resenoid, insoluble, but varying according to the nature
of the tissues. The filter with the insoluble matter is now to be
washed in a little distilled water, and into tiie filtered fluid, which is
limpid and often colorless, we place a tliin lamina of tin. If the anti-
mony is abundant, the tin will be strongly blackened; if not, it will
be barely tarnished, and will be coveretl over by some black spots.
However it may be, after keeping it in the fluid for twenty-four hours,
we remove the tin and introduce it into a small flask, and pour upon it
a quantity of hydrochloric acid sufficient to dissolve it in the cold after
a few hours. Siiould a few blackened portions remain undissolved,
we decant, and by the aid of a few drops of nitric acid the solution is
eflected, and we mix them afterwards with the dissolved mass.

The quantity of tin dissolved should not be too large, but we may
reduce as much of it as we wish by successive precipitations upon
lamina of tin having a very small surlace.*

I pass now to a consideration of the experiments upon the six dogs
which were kept up formally months after the use of the antimony.

On the 8tli day of January, these animals were put ujwn a regimen
consisting of bread and pieces of meat. Their rations were mixed
every day with a solution of tartar emetic. Each dog ought to have
received, according to the common ratio, about 4 decigrammes of the
lartarized antimony for his part each day. At the commencement of
the experiment the dogs evinced a very strong api)etite, which seem-
ed to be increased by the use of the new condiment ; but in a short
time we witnessed very opjKjsite results. Their voracity was replaced
by a marked disgust, and on the 24th of January two of the dogs re-
fused to eat. The |)roporiion of antimony was now diminished to one
lialf, but on the 2Slli-)- the use ofit was given up, the dogs did not
toucii it again in their food, and yet all of tliem showed a very marked
leanness. Thus the antimonial regimen, which lasted ten days, fur-
nished to each day about three grammes of the emetic.

After having given up the use of the antiinouial, and returned to or-

* This method is very much like that Mhich has been proposed by M. M.
Frescnius ;ind Bnbo, for the detection of any species of metallic poison, but I
hnve not been able to arrive at a similar result by the emiiloyment of the h3'dro-
cliloric acid ;ind the chlorate of potash, I have attempted many times to apply
it to the (ktcciion of arsenic, but have never been satisfied with the resulls.

t In the orip:inal the IHih is given instead of the28lh, but it appears to me to
have been so clearly an error of ihe press, that I have ventured to substitute the
28ih. J. M. B. H.

1848.] Action of Medicines upon the Animal System, 35

dinary food, four of the dogs regained their appetites, and by degrees
their former healthy condition ; but there were two wliich could not
overcome the effects of ihe metallic poison* They continued to exhibit
a complete inappctency, were reduced to the last degree of emacia*
tion, and on the tliir.l of February one of them died. Its body was
extremely emaciated; the organs generally did not exhibit any great
alteration except the liver, which was friable, and ren)arkable for its
volume. It was weighed, and compared with the total weight of the
body we found the proportion to be as one to 12 (1:12.)

As this ratio appears to me very interesting and worthy of note, I
will state at once, that in the cases of dogs in a good state of health,
we have found the following proportions between the liver and the
mass of the body. 1:32

1:40
1;24

In regard to the distribution of antimony into the tissues of this first
dog, it was general, without any apparent preference, for one or ano-
ther organ : the liver, the muscular flesh, the coats of the intestines,
the Ittngs, the brain all seemed to be equally filled with it. The
animal seemed to die from a sort of antimonial diathesis.

The second dog lived a few days longer, but died on the 10th Februa-
ry. During the few last days, he was affected with a continual ner.
VoUs tremor; the hinder legs were also affected in a singular manner,
they would all of a sudden give way, and the progress of the animal
would be instantly arrested. Yet the organs did not present any
striking alteration. The liver was friable, as in the preceding case,
and voluminous, being in the ratio of the mass of the body of 1:10.
The antimony w as in this case also found in every part, but the brain
seemed to have retained rather more than any other organ.

Our observations were now confined to the four surviving dogg
At the end of twenty days they were all restored, their appetite and
natural vivacity having returned. One of them got awaj^ and was not
again examined ; another died suddenly. A post-mortem examination
showed that his death was occasioned by the passage of a lumbricus
throu<Th the coats of the intestine into the peritoneal cavity in which it
^vas found. A search for antimony, in this case, showed a very pecu-
linr distribution of the metal. It was found in a very notable propor-
tion in the liver and in the fat, but it was particularly accumulated in
the BOXES. It is necessary to state here, that this dog died of a true
accident six weeks after having taken the antimonial, and that he had
improved already a great deal in flesh. The antimony of course had
lodged in organs where its retention was consistent with the regular
exercise of all the functions. This remark acquires a peculiar value
when we take into account the very similar distribution in the last
two dogs which were killed, one after three and a half and the other
after four months. I must declare also that the metal was in these, in
as large proportions as in those which died during the very earliest
periods of our experiments.

36 Action of Medicines upon the Animal System. [January,

In the dog which ^vas killed three months and a half after, having
ceased the use of the antimoiiial, the metal was found in the largest
quantity in tiie fat. The liver contained some of it as well as the
bones and the other tissues ; but 50 grammes of the fat furnished as
much as 500 grammes of all the other tissues put together. The ratio
of the liCer to the general mass had been restored to the normal state
of 1:27.

In the dog which for four whole months had taken none of the anti-
mony the metal was found accumulated in the bones ; the liver con-
tained also a large quantity of it: all the other tissues gave very little
traces of it. One hundred grammes of the bones yielded a quantity of
the metal sufficient to cover over with perfect metallic spots the sur-
faces of three porcelain cups with a diameter often centimetres. The
liver had attained a relative volume of 1:24.

I will conclude these observations, which so strongly attest the per-
manent retention of antimony in the living tissues, by mentioning the
case of a young bitch to whom the emetic was given during five days,
and about fifteen days before the birth of her young ones. The dog
and her young were killed immediately after birth, and the livers of
the puppies were found to contain a notable quantity of antimony.*

It is not an easy matter to know what conclusion should be deduced
from the preceding experiments. Some of them introduce new ele-
ments into certain questions connected with medical jurisprudence,
the value of whicli will be at once perceived ; others belong rather to
the domain of pathology.

Although the antimony seems to become organized, we cannot yet
affirm that it is ever fixed incur tissues : neither must we suppose^ in
advance, that the facts revealed by the administration of antimony will
also hold true with other metallic j)oisons. We must wait on experi-
ment. So to affirm that a metal detected must have come from a re-
cent ingestion, or to fix its origin and the moment of its introduction
into the economy, it is necessary to wait ; we most address ourselves
to the task and vary our experiments,

In regard to the distribution of antimony in the organs, I have been
struck with its relation to the })liysiological effects which have been
mentioned above. Has the antimony penetrated simuhaneously all
the important organs, such as the lungs, the brain, and the coats of the
intestines, the animal yields to the general poisoning, and seems to
die all over at the same time from the effects of an extreme emaciation.
Has the metal been lodged in the brain ? we find the same general
disease, but death takes place under an array of nervous symptoms
which indicate the principal scat of the poison. Lot the metal, on the
other hand, be deposited in organs of less sensibility and less general
sympathy ; such as the cellular and osseous syst(;ms, and the effects
of the poison will soon be effaced, so as to lead us to suppose that it
was entirely eliminated.

In this l;)itch the ratio of the liver to the hotly was 1:17 in the puppies^ five
in number, tlie following were the ratios:- 1:20, 1:24, 1:20, 1:17, 1:20.

1848.] Cases of Retained Placenta, 37

From this novel development in relation to poisoning by antimony,
we are naturally led to suspect similar conditions in cases of poisoning
with lead. 3Iay it not be by a kind of special localization that some
privileged constitutions escape the poisonous effects of the last metal ?
and does not the concentration of morbid symptoms upon the abdomen,
upon the nervous system, or upon the limbs, show that the lead occu-
pies corresponding regions?

This is one of the numerous methods by which may be explained
all those aOections in which tlie presence of noxious principles, foreign
to the economy while in the normal condition, is for the present sus-
pected rather than demonstrated.

The enormous development of the liver, in consequence of the ad-
ministration of the antimony, is also a fact which must, not be passed
over unnoticed. The percussion of the organs is at present practised
with so much skill that we shall not be long in ascertaining whether
the use of the antimony in man is attended likewise with the rapid
enlargement.*

Cases of Retained Placenta. By W. L. Sutton, M. D., of
Georgetown, Ky. (Boston Med. and Surg. Journ.)

Case I. Abolition Placenta retained No ill effects. On
1st September, 1822, Mrs. S. had an abortion, having menstru-
ated about the middle of May, it being the only time since the
birth of a child. The foetus was expelled, but the placenta re-
tained. The umbilical cord remained attached to the placenta
for about tw^enty-four hours, then separated. No fetor or of-
fensive discharge follow^ed. The woman recovered her health
in the usual time, no unpleasant effects appearing at any time ;
nor was any thing w^hich could have been suspected to be the
secundines, at any time observed. The woman lived many
years, and bore four children.

Case II. Abortion Placenta retained subsequent Hemoj'-
rhage and Death. Lucy, aborted on 10th May, 1840, being
three months pregnant ; the foetus expelled, but no secundines.
She seemed to improve about as well as usual after such acci-
dents, and had returned to her employer, and been engaged in
her daily w^ork, when on 15th June she was seized with a vio-
lent flooding. It was supposed she lost a gallon of blood in a
very short time, and a great deal subsequently. I saw her on

Certain raisers of Geese in Strasbourg buy sulphnret of antimony for un-
known purposes: have they been the first to find out the influence of antimonial
preparations upon the development of the liver, that rhey are so expert, produc-
ing it in geese intended for the making ot ])ies'? The retention of antimony in
the organs will be a discovers, therefore, of great importance to gastronomy.

38 Cases of Retained Placenta. [January,

the 17th. v>"hcn tb.e hemorrhage had nearly ceased, but she was
stupid ; great paleness of the mueous membrane of the mouth ;
paral3'sis of the lower limbs ; pulse rather full, but irritable.
Continued to sink until death, which took place on the 21st.
Stupor, and paralysis of the lower limbs and of the bladder,
continued till death.

Case III. Abortion ^No Sccundines found Sichseqcnt
Hemorrhage. August 15th, 1847, I was desired to visit Mrs.
C, who I found had lost a good deal of blood from the uterus ;
was doubtful as to pregnancy. Upon examining the coagula,
found a foetus apparently of about two months, which corres-
ponded with her history of her menstruation. No secundines
could be found. 17th the hemorrhage, which had nearly
ceased from the expulsion of the fcjetus, recurred very freely,
and continued for some hours, and then abated. I examined a
considerable quantity of the coagula, but could detect no pla-
centa ; but I had not an opportu.nity to examine all the coagula.
As the hemorrhage had subsided, and as nothing could be felt
at the mouth of the uterus, I felt justified in hoping all had pass-
ed. She went on very much as is common after abortions,
except that a slight discharge continued, until 3d September,
when an alarming amount of hemorrhage again took place.
Still nothing was to be found at the os uteri. The sponge, im-
pregnated with vinegar, was used, and powders of lead, ipecac,
and opiuin administered ; which seemed to arrest the flooding.
When removed, the sponge had a very offensive smell, and was
colored black, which could not be washed off. A small, but
very offensive discliarge continued about a week, for which
injections of chamomile tea, with a particle of lime infused,
were used.

' Remark.*:. These cases have caused considerable reflection
in my mind. It would seem, from what I have read upon the
subject, that the retentionof the secundines, at an early period
of pregnancy, need not give rise to any apprehension of dan-
ger. Thus, lligby (System of Midwifery, p. 359) says " Cases
of abortion have occasionally been observed, where the embryo
has escaped, but the secundines have never come away, although
the discharges, <Slc., have been watched with the greatest
attention. After a time the menses have returned, the patient
has again become pregnant, and has passed through her labor
at the full term, without any thing unusual occurring. Nothing
is intimated that unpleasant consequences ever Ibllow. It is
true, thr.t a case is mentioned in the American Journal ofMcd^-
ical Sciences, vol. iv., p. 511, in which it is said, "the lady ro-
mixined in indifl'crent henllli ior three months," when tlie secun-
dines vvere expelled. But I am not aware of any case on

1848.] Cases of Retained Placenta. 39

record in which serious and alarming symptoms have super-
vened. Is such the experience of the profession ? or have cases
been lost sight of, and considered as having done well, because
nothing more was heard of them ? Have I been less fortunate
than others ? or am I wa*ong in having attributed the hemor-
rhage which occurred in two out of three cases, which I have
seen, to the retention of the placenta ? I have always supposed
that the hemorrhage and death in case 2d was occasioned by
the retention; although the woman was thought, and considered
herself, well, and had returned to her ordinary labor. I am
every way satisfied in my ow^n mind, that the hemorrhage in
the 3d case was owing to a retention, proved sufficiently, I
think, by the ofiensiveness of the discharge, and the discoloration
of the sponge used as a tampon. Therefore it appears to me
that the condition of the woman, with retained secundines, even
at an early month, is not so safe as is supposed by many. How
is this state of things to be obviated ? Truly I do not know.
No one, I presume, would feel authorized to poke a hook into
the uterus, with no guide to direct him ; and the cavity of the
uterus is too small to admit of any manual operations. The
only alternative which I perceive is to use the ergot. This
may sometimes succeed, but I know^ it to have failed.

Case IV. Protracted Labor-- Retained Placenta Hemor-
rhage. Mrs. C, the subject of the last case, was delivered of
a large child, after a tedious labor at half-past 3 o'clock, P. M.,
October 17th, 1834. The placenta not coming readily, and
considerable hemorrhage existing, I used, for want of ergot,
acet. plumbi, ipecac, and opii, wath frictions to eibdomen,
warmth to feet, and volatiles. At 6 o'clock, nothing having
been gained, I introduced my hand, and found a partially sepa-
rated placenta, adherent to the fundus uteri, it being uncon-
tracted. By pressing moderately on the adherent portion of
the placenta, and by insinuating the points of the fingers under
the free edges, I eflfected a separation. After moving the pla-
centa about for some time, rubbing it against the walls of the
uterus, I extracted it. Hemorrhage continued free for some
time : but eventually subsided under the use of frictions and
the pills of lead, ipecac, and opii.

Remarks. This is the only case of adherent placenta which
has occurred to me in a practice of 28 years ; if we except
one which I found attached to an inverted uterus. I was guilty
of mal-practice in this case, in separating and extracting the
placenta before the uterus had properly contracted ; and there-
by exposed the woman to unnecessary hazard from hemorrhage.
It is true, that I kept my hand in the uterus some time, and em-
ployed friction on the surfoce of the uterus; but I should have
continued it until contraction took n'ace.

40 Cases of Retained Placenta. [January,

Case Y. Placenta retained hij Prefuatitre Contraction of
the Os Uteri. June 15, 1827, was desired to see Mrs. R., who
had been dehvered of her hrst cliild iitteen hours phicenta re-
tained. Upon inquiry, I learned that the placenta had been
felt at the mouth of the uterus soon after the birth of the child,
but would not come away that the umbilical cord had given
way during the efforts at extraction that a loop had been fixed
over the remaining portion. Upon examination, I found it just
so. The insertion of the cord into the placenta offered directly
at the middle ofos uteri the mouth itself very much contract-
ed. By gently dilating it, I was enabled to get two fingers up
by the side of the placenta, and fixing them in it, turn one edge
down and extract it. The WT)man declared that the pain of
this operation was equal to that of labor.

Case VI. Placenta retained hy Premature Contraction of
Os Uteri. August 2G, 1833, I saw a negro woman under the
care of Dr. D., who had been delivered of her first child three
days, the placenta retained. I found the funnel-shaped portion
at the OS uteri ; no lochial discharge, but a very offensive fetor;
slightly feverish, but no pain. A scruple of ergot was given,
which produced considerable pains, which, however, produced
no effect on the placenta. Waiting several hours, and finding
matters no better, I introduced my hand into the uterus, and
hooking my forefinger into the body of the placenta and em-
bracing it firmly with the others, I succeeded in extracting it,
Thij^ required considerable time, as the mouth and body of the
uterus were firmly contracted. Some idea of the firmness of
the contraction may be formed, when I state, that two months
elapsed before my hand had recovered entirely from the com-
})ression which it underwent whilst in the uterus. It is perhaps
proper to remark, that I was in delic^ate health at the time,
which may have prevented a more speedy abatement of these
effects.

Remarks. It has been a rule in my obstetrical practice (in-
culcjited by Prof. lIall,of the University of Maryland) as soon
as 1 have disposed of the child, to take the cord in my left hand
as a director, and run the finger of my right along it to the os
uteri; jf 1 find the fiiimel-shaped portion of the })lacenta there,
insert a finger and hook it over the q(\^^c and bring it down, and
deliver it at once. Pursuing this course, 1 have not had, per-
haps, a dozen placentae. expelled by the uterus exclusively, du-
ring my practice. From this practice I have at no time seen
any inconvenience. On the contrary, it relieves the woman
from that slate of dread and ))e]-turl:)alion, which is almost sure
to take place if the placenta is not removed in a short time after
the birth of the child. 1 do not kjiow that tliis course was ad-

1848.] Cases of Retained Placenta. 4l

missible in the last two cases; but from the statement of the
gentleman in attendance upon the first, I am induced to believe
it would have been in that case.

In case 6th, the ergot failed to do any good, although it
evidently produced a good deal of suffering. That it would
have failed, if repeatedly used, I cannot say. Dr. Dewees
speaks strongly of his confidence in its powers. To be sure,
that confidence was founded on analogy of its action in expel-
ling the secundines after abortion. Dr. Porcher, however, of
South Carolina (American Journal jMedical Sciences, v. x., p.
391), shows that it cannot always be depended on. Dr. Jack-
son, too, of Northumberland, Pa. (Medical Recorder, v. xv., p.
362), argues against not only the efficacy, but the safety of the
article in these cases. Let us look into the state of the uterus,
and consider the effects of the medicine. The os uteri was
firmly contracted ; of course it must be dilated before the pla-
centa could be expelled. Will the ergot cause that dilatation ?
I presume most men wdll say, that although it may produce
this effect, yet we cannot calculate upon it with certainty that
it will frequently fail. If it does not produce that effect, it
adds to the difficulty, by diminishing the cavity of the uterus,
and also of its mouth, in consequence of producing a general
contraction of the uterine fibres. If the intention is to intro-
duce the hand if the ergot fail, w^e ought to change our purpose,
and introduce the hand in the first instance ; because the use
of the ergot w^ill inevitably increase the difficulty of the manual
operation. If this view is correct. Dr. Dewees's advice to use
ergot first is incorrect; and I doubt not but that I had much
greater difficulty than I should otherwise have had, in conse-
quence of following his directions.

Was it necessary to introduce the whole hand ? This may
be considered doubtful. It will be recollected that no one
could tell whether the placenta would be found detached. In
feet, after my hand was introduced, I could not say with as-
surance that it was detached, it was embraced with such firm-
ness by the uterus. Again, it is doubtful whether the motions
necessary to force a finger into the placenta and extract it,
could have been effected with the hand mainly without. At
any rate, lam satisfied that the aid of the other fingers and
thumb was very serviceable in extraction.

Ought the case to have been left to nature ? This is a grave
question, which will be answered diff'erently by different per-
sons. Some, in view of the fact that the woman did as well
as ^he possibly could under any circumstances, will say that
the treatment pursued w^as the best. Others, in view of the
fact that many cases, left entirely to nature, do very well, the

42 Cases of Retained Placenta. [January,

placenta in some cases being expelled at an indefinite period,
in other cases not at all, will say that the woman was subjected
to great and unnecessary pain. That many cases of retention
have done well, is true ; that many have been followed by un-
pleasant and liUal consequences, is likewise true. It is also
true, that a wx)man is always uneasy and restless until the pla-
centa is removed. Again, it is true, that no man can say of
any case of retention, whether, if left to itself, it w^ill terminate
favorably or unfavorably. The idea seems to be that if air be
excluded from the placenta, putrefaction will not take place,
and evil will be prevented. Granting this to be true, the same
difficulty remains; no man can tell whether air will find access
or not. Neither have we any means to prevent such access.
Yet it does seem to me, that there is little probability of air
finding its way up the vagina and into the uterus. I am there-
fore inclined to suspect that putrefaction is owing to some other
cause.

In volume xxvi. of the American Jour, of Medical Sciences,
is a very valuable paper by Dr. E. Warren, of Boston, on re-
tained placenta, in which, however, he insists rather strongly
upon the powers of nature. That she will, in many instance?,
accomplish w^onders, is no less true than fortunate for mankind.
If we had any means of judging when she would show her
power, w^e should know when to trust her. Our profession is,
I think, too prone to exhibit successful cases to the world, and
keep the unfortunate ones back.* Hence we have but little
means of forming a true estimate of the number of fatal cases.
It seems to me, that Dr. W. has worded one of his sentences,
so as to make an erroneous impression, and that that impres-
sion is likely to do mischief. Speaking of Dr. Hunter's prac-
tice of leaving the placenta to nature, he says " Finally, some
unfavorable cases occurred, and the practice was changed."
This would, I think, convey the idea to most persons, that the
number of cases was small. But Dr. H. was not a man to be
turned from a course, which he considered right, by trifling
considerations. Again, I have seen it stated, that by pursuing
his course, he lost a certain number of ladies of rank in one
year. I do not now remember the number, but I do remember
that I thought it was quite enough to make him pause and con-
sider his ground.

I do not wish to convey the impression, that the ])laccnta is
to be speedily removed at all hazards. I should by no means
be willing to kill a man with o))ium, to prevent him from dying
with colic. What I advocate is, that we use all due means to

This rcllection is not applied or applicable to Dr. W., so far asl Icnow.

1848.] Cases of Retained Placenta. 43

remove the placenta with safety to the mother. What these
means are, and when they haA^e been used, wall be differently
estimated by different persons of equal respectability in the
profession. As a general rule, he who is best informed as to
the success of means used by others, and best qualified to judge
of the powers of his patient's constitution in a given case, will
^be most apt to do right.

Case Yll.^ Quick Labor Hour-glass Contraction. Mrs.
P. w^as confined August 26th, ]840. The regular attendant
being out of the place, at length I was requested to visit her.
The child had been born about two hours before my arrival.
Upon taking hold of the cord, and running my finger up it, I
encountered an hour-glass contraction. Gave seventy-five
drops of laudanum, and waited about three quarters of an hour,
wdien I found the stricture to yield readily and permit the de-
livery of the placenta.

Case YIII. Lingering Labor Hour-i^lass Contraction.
March 3d, I saw Mrs. W. in consultation with Dr. C. She had
been in labor about twelve hours. The os uteri being pretty
well dilated, and the pains trifling and unavailing, we concluded
to give ergot. After giving three portions, the pains became
more frequent, and although very short, began to produce an
effect upon the progress of labor. In about an hour she was
delivered of a dead child. The placenta not presenting itself
in due time, Dr. C. introduced his hand, and found an hour-glass
contraction. Gave half a grain of sulph. morphia, and waited
half an hour. After this interval. Dr. C. again introduced his
hand, and, with slight trouble, dilated the stricture and delivered
the placenta.

Case IX. -Lingering Labor Hour-glass Contraction..
April 28, 1845, saw^ Mrs. E. with Dr. C. She had a lingering
labor, for which it was considered necessary to give ergot.
There being some delay in the expulsion of the placenta. Dr.
C. introduced his hand and found an hour-glass contraction.
We gave half a grain of morphia, and waited half an hour,
w^hen placenta was found at the mouth of the uterus and read-
ily extracted.

Case ^.-^^Lingering Labor, with considerable Flooding at
the commencement Hour-glass Contraction. Sept. 20th, 1847,
I was called to attend Judy, a negro woman, exceedingly fleshy,
in labor with her thirteenth child. The membranes were
represented as having given way an hour and a half before
my arrival ; before and after w^hich, there had been considei'-
able hemorrhage. There w^as also some after my arrival, but
it soon ceased witliout interference. Perhaps a pint and a half
hajd been lost altogether. At this time, 5, P. M., the pains were

44 Cases of Retained Placenta, [January,

trifling and at long intervals, and were said to have been in
the same condition all day. The os uteri, however, was con-
siderably dilated, but no part of the child could be felt in the
common examination. At 10, the mouth was fully dilated, and
the head advancing in the pelvis. At 12, the head presented
at the lower strait. About this time the pains abated very
much, and scarcely made any impression on the head, that
little being lost at the end of the pain. Teas, &c., failing to
excite contractions, at 2, A. M., ergot was given, and the child
born about 3, A. M. In about half an hour, the placenta re-
maining beyond the reach of the finger, I placed my left hand
upon the abdomen, and found, in the epigastrium, a tumour about
as large as an uterus well contracted after the expulsion of the
placenta, with a hard ridge extending to the pubis. I at once
suspected an hour-glass contraction, and, upon introducing my
hand, found it so. I gave five-eighths of a grain of sulph. mor-
phia, intending to wait an hour. At the expiration of the time,
found the patient asleep ; which continuing, an hour and a half
elapsed before I undertook the delivery, when I found the pla-
centa loose, and lying at the mouth of the uterus.

Remarks. What is the cause of the hour-glass contraction ?
" Dr. Douglass, of Dublin, considers this condition as arising
from some irritation near the mouth of this organ," and "con-
cludes that whenever it does occur, it is produced by misman-
agement." This opinion, by having been repeated by a dozen
or so of the most eminent accouchers, has acquired much au-
thority ; yet it is not a particle more true now, than it was
when first uttered. If true, how did it happen that I found that
condition in the seventh case, when I sus])ected nothing, and
expected nothing but to bring away the placenta as after or-
dinary labor I How came Dr. C. to find it so in cases 8 and 9 ?
It is true that I cannot positively assert that he committed no
indiscretion upon the os uteri ; but I do know that he is cau-
tious and prudent, and therefore I am not at all disposed to
believe that he did. In the 7tli and 10th cases, if tightening
the cord and running the finger up it to ascertain the presence
or absence of the ])laccnta at the os uteri be mismanagement,
then I perpetrated it in both cases ; otherwise I did not. ]f it
was mismanagement, how are we ever to manage aright ; un-
less indeed we trust the placenta to the powers of nature,
without even attempting to ascertain what is going on?

I have heard ergot charged with producing this state. It will
be observed, that in three of the four cases detailed, it was ad-
ministered. But the cases in which this condition is most apt
to occur, are precisely those in which we are most apt to give
ergot. When, therefore, wc reflect that this contraction takes

1848.] Cases of Retained Placenta. 45

place in many cases of tedious labor, where no ergot is given ;
and, on the other hand, it is given in many cases of tedious
labor with the most beneficial results, without any untoward
effects, either immediately or subsequently, we shall pause be-
fore we lay this particular evil at its door. We can say that
this affection consists in an irregular, a spasmodic contraction
of the fibres of the uterus; but we had as well not say upon
what that spasmodic contraction depends, until we know.

Is there any particular portion of the uterus to which this
action is confined I Authors would seem to confine it to the
neck of the uterus ; at any rate, not above the commencement
of the body. In case 7th, it was but a short way above the os
uteri ; so little, indeed, that there could scarcely be said to be
a lower chamber. In case 10th, I should place it much above
the union of the body and neck. I introduced nearly the one
half of my fore-arm into the vagina ; so that at least my wrist
and hand must have been within the uterus. There was ample
room to move my hand about in the lower chamber ; and with
my fingers extended, I ascertained the existence of the strict-
ure, which appeared to extend directly across the body, em-
bracing tightly the cord and a small portion of the placenta.
Could a contraction of the lower portion of the body afford
such room in the lower chamber ? I apprehend not. I did
not introduce my hand in either the 8th or 9th case ; but from
Dr. C.'s account, I consider them as very parallel to the 10th.
He indeed is disposed to locate the stricture very close to the
fundus.

I do not know that any writer or teacher advocates the use
of opium in this affection ; and yet it is one in which we should
expect it to be beneficial. If there was a spasmodic contrac-
tion of any other muscle, opium is the very thing which would
present itself to my mind. Again, so far as my experience
goes, the parts concerned are exceedingly tender ; so much so^
that the bare examination necessary to ascertain the existence
of the contraction, inflicts much sufferinsr. What torture a wo-
man must sufter, who undergoes the dilatation of parts so ex-
cessively irritable, without a previous anodyne, tio man can
tell, even after witnessing the operation. On the other hand^
in two of the four cases, when the attempt to remove the pla-
centa was about to be made, the placenta was found lying loose
at the mouth of the uterus. Is there fear that an anodyne will
prevent the tonic contraction of the uterus? This last is much
more apt to take place when the irregular contraction is re-
moved, than during its continuance. In none of the cases w^as
there any hemorrhage either before or after the administration
of the ergot ; neither was there any bad effect whatever from

40 Ox Gall in Removing' Impacted Fceces. [January,

its use. If, then, the use of opium is safe as a means of facihta-
ting the dilatation of the stricture, or of preventincr altogether
the necessity of the operation, performing tliis operation witliout
a previous anodyne must be consideix-d downright cruelty.

Whether the placenta was attached in any one instance when
the anodyne was administered, or not, of course is not known.

Efficacy of Ox Gall in removina; impacted FcBces. By Ed-
ward Vanderpool, M. D., of New- York. (N. Y. Jour.)

I was requested to see W. J. B., aged 40 years, of full habit,
who was suffering from pain and great distress in the right
iliac region, preventing- rest and sleep, and causing constant
moaning. He had been confined to the bed a fortnight with
these symptoms, during winch time he had been treated anti*
phlogistically for peritoneal inflammation; calomel cathartics
and castor oil had been repeatedly given, producing only a very
slight faical evacuation ea(^h day ; cal. and ipecac, and cal.
^nd Dover's powder had been continued in small doses ; his
mouth had been touched for more than a week ; leeches had
been repeatedly applied, and a blister at this time was vesicating
the part. This afternoon mucus appeared with the discharge,
unaccompanied by tenesmus, skin soil and clammy, tongue pale
and moist, pulse 80 and soft, natural rotundity and softness of
the abdomen, except the right iliac region, which was preter*
naturally full. A hardness was here discoverable as of a tumor
lying deep in the abdomen, occupying the seat of the coccum
and ascending colon, which was very painful upon pressure.
Upon inquiry as to his previous health, he said that for the last
two and a half or three years he had been subject to frequent
colicky pains, for which he would every week or two take a
cathnrtic dose ofcah^mcl at night, and follow it with salts in the
morning. A small motion would be the only result, with the
invariable feeling of not being relieved. Diagnosis, distended
coccum and ascending to the transverse colon, with incipient
ulceration of the mucous membrane at this part.

ft. Fel. bov. inspissat., gr. iv. ft. in pil. No. 1.

Give two pills three times a day, and enemata of diluted
beef's gall t(Mhe amount of two quarts night and morning ;
broth and farinaceous diinks. The iirst enema extended to the
part allected and produced a quantity of scybalous Ikical mat-
ter, such as he had not been accustomed to see, with some
mucus. Some alleviation of his distressed feelings followed
this evacuation. The enema was repeated the next morning

1848.] Cure for Craiwps, 47

and cvenin^s: with the effect of an increased quantity ot'old fecal
matter and less pain afterward in the iliac region. Considera-
ble exhaustion following the morning enema, it was thought
better to omit it in future, and give two pills four times a. day
at regular intervals, and use the injection at bed time. This
course was pursued for ten or twelve days, resulting with a
voluntary faecal evacuation in the morning, which had the ap-
pearance of long impaction, and a quantity of the same in the
evening, believed by the patient to have been by him two
years. The abdominal distress abated as this old fsecal matter
passed off, and the mucus daily lessened in quantity. lie con-
valesced steadily, without any other medicine, and was soon
discharged cured.

Cure for Cramps. (In a letter to the Editor of the Edinburgh
Medical and Surgical Journal, from S. Argent Bardsley,
M. D., formerly Senior Physician to the Royal Manchester
Infirmary.)

Sir, I feel anxious to communicate, through your able and
widely-extended Journal, my discovery for the relief of a most
distressing complaint, viz., the very severe and habitual cramps
which afflict many persons in bed during sleep. Having my-
self been for many years (up to my 82d year of age) a martyr,
almost every night, to this torturing malady ; and having tried
in vain many of the " thousand and one'' remedies usually pre-
scribed for relief, I was at length led to reflect upon a fact,
w^hich had hitherto escaped my attention, viz., while sleeping
in a chair with my lower limbs, if not touching the floor, yet
so depending as to form an inclined plane v.ith the whole of
my frame, that I was, in this position, never disturbed by
cramps; and upon inquiry, I found other sufferers, from hab-
itual cramps, were under the same predicament.

These facts, in connection with some physiological consider-
ations, (not necessary here to mention.) induced me to put in
(November, 1846) practice the following plan, which, after a
trial of five months, has proved decidedly successful, by an ar-
rangement of the matresses, or by increasing the height of
the upper part of the feather bed, by removing the feathers
from the lower extremity, so as to procure the due inclination
of twelve inches. I deem it absolutely necessary to give a
caution to sufferers from cramps, that the disorder is almost
always connected with a weak or imperfect state of the diges-
tive organs ; and therefore, although tlie method now stated
for relief will allow the sufferers several luxuries hitherto for-

48 EriqHion of Measles, Variola, Scarlatina, <^c. [January,

bidden ; yet there must be Hmits placed to such indulgences, if
they expect to pass the nights entirely free from their malady.
I am desirous to add, that among several other reports of suc-
cess, two gentlemen of Manchester, within the last week, have
informed me of their cures from habitual cramps by the use of
the inclined plane.

Supposed simultaneous Eruptioji of Measles, Variola, Scarla-
tina, and Purpura. (London Lancet.)

The appearance of the eruptions of two of the exanthemata
at the same time on the same patient, has been so often observed
that it is no longer looked upon as a matter of doubt ; but the
following case, reported in the Gazette des Hopitaux of Paris,
is, if no mistake has been made, -very extraordinary, the pa-
tient being at one and the same time troubled with a whole
chapter of complaints.

The case was that of a man, aged thirty-three, working for
a wine-merchant, who entered the Hotel Dieu under M. Rostan.
Some weeks before his adinission he had -contracted a blennor-
rhagia, for which the physician he applied to gave him mercury.
While he was under this treatment, an eruption in red patches
appeared on the skin, which made rapid progress, and on ac-
count of which he entered the hospital. When M. Rostan first
saw him, the eruption Was evidently of different kinds. Some
spots, without any prominence, disappeared under the pressure
of the finger, re-appearing as soon as the pressure was remov-
ed. Among such spots some were dispersed, leaving the skin
between them of its natural color; others were larger, more
deeply coloured in patches, like scarlatina. Another kind of
rash projected slightly above the level of the epidermis, with
acute summits, giving the skin a rough, velvety aspect, conflu-
ent in character; at certain points, "^indeed, the epidermis was
raised by a liquid transparent fluid beneath. Lastly, a third
form of eruption consisted of red or violet patches, without
any prominence, but which did not disappear under the pressure
of the finger, and having the character of ecchymoses. M.
Rostan, from these symptoms, concluded that there w^as a sim-
ultaneous eruption of measles, variola, scarlatina, and purpura?
and, in support of such an opinion, quoted a case which he had
scon some years ago in a man nged seventy, who was examin-
ed by M. Cazenave, and in whom that physician recognized
four different eruptions existing simultaneously. But such in-
stances are so excessively rare.

However, this patient presents the two forms of eruption a

1848.] Eruption of Measles, Va?noIa, Scm^latina, ^-c. 49

described by Frank, viz., bare exanthemata that is, those pre-
senting no prominence above the level of the cuticle, as scarla-
tina and purpura and scabrous exanthemata, viz., those which
do project above the epidermis, as measles and variola. With
reference to the last named disease, it may be mentioned that
the patient had been vaccinated.

The man's face is swollen, his eyes almost closed ; pulse 90.
The mind is clear, he answers correctly, and there is slight
bronchitis.

As to the nature of these eruptions, M. Rostan first says,
are they due to constitutional variola 1 Nothing goes to prove
that he has had syphilis ; he says, only blennorrhagia. Are
they the consequence of mercury ? Evidently not. May they
be attributed to the copaiba he has taken for some time ? But
the eruption from copaiba is only a form of roseola, which is
here absent ; and, further, he has not taken the balsam for some
time, and since he has given it up, the eruption attending it has
disappeared. Taking all these circumstances into account,
M. Rostan is convinced that he has really to deal w4th four
eruptions in his patient ; and from the appearance of the face,
believes that the variola will be confluent. Moreover the com-
plication of the case with purpura leads him to apprehend
that the variola will be of the hsemorrhagic form, which is
known to go along with malignant small-pox, and to be one of
the dangerous varieties pointed out by the old authors.

In the preceding case, as recorded, wdth the man's skin so
imbellished with eruptions, the discrimination of the French
physician must be very nice to diagnose the rubeola from the
scarlatina. Nothing is said of the sore-throat generally mark-
ed in scarlet-fever, nor of the catarrhal symptoms, coryza, &c.,
mostly noticable in measles. The diagnosis seems to be simply
framed upon the characters of the eruption characters by no
means so clear nor so constant as to be implicitly trusted.
Therefore, without a more minute account, and better grounds
of diagnosis, we can hardly go so far as M. Rostan in believ-
ing there to be four eruptions. Further, it has been generally
observed, that where two of the exanthemata have displayed
themselves, they have not both gone on developing themselves,
but one has, as it were, given place to the other, which
has then run through its several stages in the ordinary man-
ner ; but on this point we have, in M. Rostan's case, no
information.

50 Palholo^y and Treatment of Croup. [January,

Pathology and TreatmeM of Croup in Children. By Mr.
HiRi). Reported in Lancet. (Ranking's Abstract.)

The author of this communication believes croup to be an
inflammatory disease of a specific nature, and distiniruishes it
from the purely spasmodic closure of the glottis, which, in its
commencement, it often closely resembles. He states that in
examination of fatal cases, where the patients survived the at-
tack only a few hours, and in which the inflammatory symp-
toms were the most severe, he observed only slight traces of
albuminous exudation, the mucous membrane of the trachea
and larynx presenting a red and swollen appearance, and being
covered WMth a tenacious and sanguineous frothy mucous.
When death occurred two or three days after the commence-
ment of the attack, and where the inflammatory symptoms,
although fully developed, were of a less acute character, a
pseudo-membrane, of a grayish yellow color, and about a line
in thickness, occupied either the trachea only, or the trachea,
larynx, and bronchial tubes. In some cases, a viscid muco-
purulent secretion adhered to the mucous membranes of the
air-tubes. In the air-cells and parenchyma of the lungs, a
reddish serum was frequently found; hepatization, also, w^as
occasionally observed. The croupy membrane, he stated,
may adhere throughout its entire extent to the mucous mem-
brane of the air-passages, or hang loose from a pedicle, like a
polypus, or attached in the centre, and free at one or both ex-
tremities, or it may be completely separated from the mucous
membrane by a muco-purulcnt secretion.

In the treatment of croup, Mr. Ilird stated, that during the
last four or five years he had never resorted to general blood-
letting, and that he was induced to adopt this course, from wit-
nessing the unfavorable result which generally followed its use,
both in his own practice, and in that of some of his profes-
sional friends. Croup, he considers an inflannnation of a cha-
racter bearing some analogy to erysipelas, ar to inflammation
occurring in scrofulous nidividuals, which occasions the forma-
tion of a pseudo-membrane, that will require for its removal a
certain amount of vital energy, both in the respiratory organs
and in the system generally. The inflammation of croup he
believes to be less under the influence of blood-letting than
healthy inflammation, and that wheth.er it be looked upon in
reference to the alteraticn to be expected from it on the pro-
gress of croup, or on the subsequent eflxicts of the evacuation on
the system, it will be found both unsatisfactory and dangerous.

The class of cases in wdiich he occasionally prescribes
leeches, or a cupi)ing glass to the chest, are those acute aflec-

1848.] Epidemic DyscTitery and Treatment. 51

tions in which there is not the same disposition to the formation
of a croupy membrane, and in which the larynx is affected.
The inflammation, he considers, approaches more to the cha-
racter of healthy inflammation, is more under the control of
blood-letting, and is apt to cause effusion near the glottis, which
speedily proves fatal.

In the early stage of both \^arieties of the disease i. e. both
in the ordinary tracheal disease, as well as in the more acute
afl^ection in which the larynx is affected he gives in the first
instance, an antimonial emetic, the dose varying from a quar-
ter of a grain to a grain, according to the age of the child.
After vomiting has been produced, he orders three grains of
calomel, and if necessary, repeats the dose, that the bowels
may be freely acted upon. If, by these measures, the febrile
and inflammatory symptoms are in some degree subdued, he
finds the greatest benefit from the free use of the alkalies. So
long, however, as the fever continues unabated, and the hearths
action unsubdued, he keeps up the state of nausea with a solu-
tion of the potassio-tartrate of antimony, in doses varying from
a twelfth to a quarter of a grain every half hour or hour, until a
decided check to the symptoms is produced. As a local applica-
tion to the throat, he advises a flannel bag half filled with hot
salt, as recommended by Mr. Kirby, of Dublin. The warm
bath, and a blister between the shoulders, or on the sternum,
for an hour or two, are often of great assistance. Mr. Hird
considers that the alkalies act by allaying the irritation which
produces the paroxysms of spasm, in the same manner as they
allay the cough in hooping-cough ; and that they are as valua-
ble in promoting the absorption of the albuminous exudation
thrown out in this disease, as they have been proved to be by
Sir B. Brodie, in the removal of large fatty tumours occurring
in various parts of the body. He prescribes ten or fifteen
minims of the liquor potassas every four hours, or in smaller
doses more frequently repeated. At a later period of the dis-
ease, he gives the decoction of senega, combined with ipecac-
uanha, squills, and ammonia.

Epidemic Dysentery and Treatment. By J. E. Stewart,
M. D., of Jackson, Tenn. (Missouri Med. and Surg. Jour.)

We have recently experienced two visitations of this disease
in an epidemic form ; the first commenced about the close of
the summer of 184G, and ended about the middle of October
following. The second began the first of May, 1847, and end-
ed the latter part of August. Like the destroying angel who

62 Ejiidemic Dysentery and Treatment. [January,

smote the first-born of the Egyptians, so, this malady spread
dismay and consternation throu_<z:hout the length and breadth
of this region of country. Appalling, indeed, were the ac-
counts we received from Memphis, where its victims died of!
in great numbers. Nor was it much better in Jackson. Dr.
TurnbuU (see Braithwaite's lleti'ospect. Part xv, page 111)
says : " It results from a consideration of the cases in my pos-
session t^iat venesection, caloDiel and opium, followed by
copaiba mixture and farinaceous diet, proved more successful
than any other method in the severest cases; yet it often la-
mentably failed, of which sufficient evidence will be found in
the table of unsuccessful cases." And Dr. McGrigor calls
dysentery "the scourge of armies," and the "most fatal of all
other diseases." In two years and a half tlie British army in
Spain lost no less than 4,717 men by this complaint. I might
here multiply authorities ad infinitum ; but enough has been
adduced to prove the formidable nature of dysentery. We
will, therefore, at once proceed to a consideration of the treat-
ment. I have already said that the disease under consideration
proved very fatal in j\Iem})his and its vicinity, and Jackson
and part of its vicinity : my residence is three miles and a half
east of Jackson ; and the range of my practice extends from
the extreme South to the North Fork of Forked Deer River,
and includes the Middle Fork and its tributaries, together with
the lagoons and swamps of all three inclusive : and from the
suburbs of Jackson, on the South-east, East and North many
miles into the back country ; which geogra})hical boundary in-
cludes about 1000 inhabitants, who look to me for aid, when
sick. During the prevalence of the epidemics above named, I
treated irom 50 to GO cases, which would come under the head
of the malignant form, characterized by persistent pyrexia;
severe griping and tenesmus, frequent bloody discharges, pain
in the abdomen and hypochondriac region ; nausea, and some-
times vomiting ; great thirst, much restlessness, loss of appe-
tite, &c. &c.

Casi-: 1. A. (^., ajtat. 50, was attacked on the 25th of
August, 1810. I was called to see him on the 27th, two days
after the attack, at which time he presented the following
symptoms, to wit: fever; pulse 100; weak; skin dry; tongue
dry and covered with a dark brown fur ; thirst ; pain and sore-
ness in the bowels ; ireciuent nausea and some vomiting ;
severe griping and tenesnms, with frecpient discharges of blood
and mucous. W. Mag. sul. dr. ii ; coctus cacti gr. iv, to be
])ulveiized in a mortar ; dose to be repeated every three hours;
a poultice of quercus rubor, cortex; made by boiling the bark
in water and thickening the decoction with wheat bran, to the

1848.] Epidemic Dysentery and Treatment. 55

abdomen ; to drink warm sage or balm tea ad libitum. And
at night the following pill, to wit : gum oj)ii gr. iv. Aug. 28th.
Has rested well ; pulse 90 ; tliinks he has less pain and sore-
ness ; thirst not so urgent ; discharges still bloody. Continue
treatment. Aug. 29th. Same as yesterday. Continue treat-
ment and take for diet boiled rice wi^th milk and mush, mutton
or squirrel soup.' Aug. 30th. Dismissed cured.

Case 2. J. Irvine, Esq., setat. 45, was attacked Aug. 26th,
1846; symptoms same as in the preceding case. Treatment
same. Three visits, convalescent, dismissed.

Case 3. Mrs. R., fctat. 60 or 70, constitution frail, was at-
tacked Aug. 29th, 1846. She took of her own prescription 10
grains of calomel, on the night of the attack, and on the follow-
ing morning ol. ricini. oz. i, which operated severely, and
prostrated her very much. I saw her for the first time on the
31st ; complains of great weakness, much thirst, extreme rest-
lessness, slight delirium, subsultus tendinum, abdomen sore and
tumefied ; frequent bloody discharges, tenesmus urgent ; pulse
100, weak. R. Opii, gr. iv., to be taken immediately, and fol-
lowed in four hours by mag. sul., dr. ii., coccus cacti, gr. iii.
dose to be repeated every three hours ; poultice to abdomen ;
diet and drink as in the above cases. After persisting in the
treatment for about ten days, she seemed to be reHeved ; her
discharges were natural, fever had subsided, appetite fair. She
now took a notion to try the Gibson's Well Water, which she
did, without consulting me. It immediately commenced oper-
ating on her bowels, and continued in spite of every remedy
until she fell into collapse, and died. She had no return of the
bloody discharges, nor did she complain of pain in the abdo-
men, but seemed to die from exhaustion alone. I here take
occasion to remark that this lady was the only patient I lost
during both epidemics. And I leave it to the candid judgment
of my medical brethren to say how far her own conduct was
concerned in bringing about the fatal result.

Case 4. Mrs. Hays, setat. 60, was attacked Sept. 1st, 1846.
Symptoms similar to those above detailed ; treatment same.
Three visits cure.

Case 5. Mrs. T., a3tat. 32, of delicate constitution, and ner-
vous temperament, was attacked June 2.5th, 1847. Several
young ladies had just died in town, and Mrs. T. was greatly
alarmed. I visited her, for the first time, on the 26th June,
found her weeping ; I asked the cause of her trouble, and
whether she was in pain. She said, " Oh ! doctor, I have the
flux, I do not mind dying ; but I have to leave my husband and
children." I said, " Madam, do not despond, I do not consider
you dangerous ; look up, I think I can cure you." I kept my
promise ; she recovered and is now well.

54 Epidemic Dysentery and Treatment. [January,

Case 6. Joseph, son of Mr. and Mrs. T., setat. 7, was at-
tacked, June 27th, 1847. Symptoms same ; treatment same.
Four visits cure.

Case 7. N. E., nephew of Mrs. T., an inmate of her house,
aetat. 9, was attacked June 28th. Symptoms same ; treatment
same except that the doses were of course modified so as to
suit the respective a,<i;es of the patients. Four visits cure.

Case 8, Amy, colored, the property of Mrs. T., a^tat. about
55, was attacked June 30th. Symptoms same ; treatment
same. Three visits cure.

Case 9. Mrs. Mark T., getat. 50, was attacked July 11th,
1847. He had from 25 to 30 bloody discharges in 24 hours.
I made my first visit July 13th. Symptoms same as in the
preceding cases, except more aggravated ; treatment same.
Three visits cure.

Case 10. Henry M., a^tat. 30. This gentleman had not
perfectly recovered from a severe attack of angina pectoris
when he was severely attacked with dysentery on July 17th,
1847. Had great pain in right hypochondriac region ; severe
griping and tenesmus ; high fever ; much thirst, nausea, and
inclination to vomit ; much alarmed. li. Opii., gr. iv., to be
followed in three hours by one of the following powders, which
are to be repeated every three hours. R. Mag. sul., dr. ii. ;
cochineal, gr. v. ; pill to be repeated at bed time. July 18th,
nearly the same ; persist. July 19th, better; continue treat-
ment. July 20th, convalescent.

Case 11. Mrs, M., wife of the former, aetat. 25, was attack-
ed July 19th. Symptoms same as those of her husband ; treat-
ment same. Three visits cure.

Case 12. Paralle, daughter of Mr. and Mrs. M., a3tat. 5,
was attacked July 21st. Symptoms same. R. Mag. sul., dr. ss. ;
coctus cacti, gr. i. ; dose to be repeated every three hours,
and at night tinct. opii., m. x. ; poultice to abdomen ; diet and
drink as in preceding cases. Three visits cure. Three other
cases occurred in this family, who were treated in the same
way, and all recovered.

Case 13. Mrs. Huntsman, wife of Hon. A. Huntsman, a)tat.
about 55, was attacked Aug. 7th ; with diarrhoea on the 8th
Aug., 1847, \yhich continued u}) to the 13th, when it assumed
the dysenteric form. Present symptoms: severe griping and
tenesmus; persistent fever; pulse 100, feeble; great tliirst,
extreme restlessness, soreness and pain in the abdomen and
hypochondriac region : has small disdiargos of blood and mu-
cous about every half hour. li. S.xhi sul., dr. iii., coctus cacti,
gr. v., aqua3 fontana), dr. iv., to be taken immediately, and re-
peated every four hours ; poultice to abdomen, and gr. iv. of

1848.] Intermittent treated hy Strychnine, 55

opii. to be taken at night. Aug. 14th. Better; persist. Aug.
15th. Convalescent ; continue treatment. Aug. 16th. Dis-
missed cured.

Several other cases occurred in this family; but as the symp-
toms were nearly the same, and the treatment only varied to
suit the ages of the patients, I deem it unnecessary to detail them.

Intermittent treated hy Strychnine, (Illinois and Indiana Med.
and Surg. Journal.)

Dr. Brainard of Chicago first considers some points in the
pathology of Intermittent Fever, and then remarks on the
treatment best adapted to prevent permanently the recurrence
of the disease. 1st. The first link in the chain of morbid
action consists in a derangement of the digestive functions, in-
dicated by furred tongue, loss of appetite, flatulence, deranged
action of the bowels. 2d. The languor, lassitude, &c., consid-
ered by authors as the first deviation from healthy action, is but
secondary to the imperfect assimilation. 3d. Soon after the
occurrence of the second class of symptoms there is a change
in the blood ; the fibrine being diminished in quantity. 4th.
General derangement of secretions. 5th. Various exciting cau-
ses determine a paroxysm, as exercise, cold, &c. We are to
bear in mind that debility and deranged action precede the
chills, hence the arrest of these is not the cure of the morbid
influence exciting them. Dr. B. then passes in review the va-
rious medicines that have been relied on in the treatment of In-
termittent. Quinine, he says, arrests chills, but they frequently
recur after its use, vso that increasingly larger doses are required
to produce the effect, which finally fails altogether. Sol. Arse-
nicalis usually succeeds where quinine has lost its efficacy, and
is also more permanent. Salicine is of no value in these ob-
stinate cases. Piperine is still less useful. Pruss. Ferri is
without efficacy in severe cases. The large doses of Quinine
that are required in inveterate cases, and the consequent ex-
pense, are items of moment in a new country, in which nearly
all the laboring population has been effected with Fever and
Ague; hence it became an object of importance to ascertain,
if possible, whether some cheaper and more efficacious remedy
could be found to answer the required indications. Dr. Brain-
ard's attention was directed to Strychnine, " from the manifest
analogy between its eliects and those of Quinine, from the
benefit which has been found to result from its use in chronic
diarrhoea and debility of the digestive organs, and from the
powerful tonic effect it is known to exercise over the whole

56 Monthly Periscope* [January,

system, but especially the nervous and muscular systems." The
result has been satisfactory. If not equally prompt with Qui-
nine in arresting the paroxysm, it is much more permanent.
It was given in pill or powder, l-8th of a grain thrice daily after
meals. If used in pills, they should be recenth^ made. In the
larger number of cases no sensible effect was produced, except
the sensation of improvement a few days after commencing its
use occasionally vertigo, pain in the head and nausea were
experienced. It was used in 83 cases ; benefitted permanently,
60; for two weeks, 6; for 1 w^eek, 3; over 14 it had no influ-
ence. All were old cases, in which there had been from 2 to
20 returns of the disease in the course of 12 months. Its effects
were most favorably shown w'here there was no local disease
least useful where complications of dropsy, chronic bronchi-
tis or phthisis existed. '' If the chills occur in the evening it
indicates a tendency to hectic, and the medicine is then unsuc-
cessful." In 3 of the 83 cases nausea and vertigo were present.
Sometimes unpleasant consequences ensue from heedlessness.
In one case six pills were taken at a dose, and produced severe
cramps, which, the husband mistaking for hysteria, combated
with Tinct. Assaf. The woman recovered. In consequence
of the liability to mistake the medicine for Quinine, Dr. B. com-
bines as follows: Strychnine, l-8th gr., Starch, 20 grs., and
Ipecac, grs. ij. Its bulk prevents more than one powder being
taken at a time, and should such an occurrence take place, the
Ipecac would prevent injurious consequences. He thinks he
is justified " in concluding that in a very large number of cases
of ancient agues, attended with debility and unaccompanied by
inflammation, the Strychnia is very nearly equal to the Quinia
in arresting the paroxysms, and much superior to it in remov-
ing that state of debility and derangement of the secretions,
which we have already stated to constitute the first and per-
sisting pathological state of the disease."

PART III. MONTHLY PERISCOPE.

VoJmitarjj Loss of Muscular Action. From the Christian Reflector
we extract the annexed account of the long disuse of one of the limbs
of the human body. Many similar facts are on record, illustrative of
physical endurance, and of the force of customs based on false views
of relifrious duty :

"It may seem incredible, but it is undoubtedly true, that there now
exists at the Marmaudilla Fank, in the middle oflhecity and island of
IJomhay, British India, a Imman heinn; who has inhabited a summer-
house, and held, on the palm of his left hand, a heavy flower-pot for
twenty-one years without intermission. The narrator of this circu- ,.

1848.] Monthly Periscope,

stance actually saw the hermit (for such he is called). The arm is
completely sinew bound and shrivelled, the nails of his fingers are
nine inches long, and curved like the talons of a bird. His beard
nearly reaches to the ground when standing erect.

" While sitting, the man rests his elbow on his knee, and when
walking he supports it with the other hand. His countenance indi-
cates intelligence, and he once had verj- extensive possessions. All
he now possesses is a tbw rags round the middle of his body, and a
servant who is allowed to attend to his immediate wants, the pecuniary
part of which is supplied by visiters.

" Twenty-one years ago he lost his caste by eating mutton ! an in-
dulgence in totally forbidden food, and was consequently condemned
to hold, for thirty years, a large flower pot filled with earth, in which
grows a sacred plant. To lose caste, and not be able to take it up
again, according to the superstitions of these deluded idolators, is to
incur the penalty of everlasting misery in a future state. What an
example does this poor deluded creature afibrd of perseverance, zeal,
courage and devotion, worthy even of the highest cause. If he live to
redeem his caste, most likely he will hereafter be set apart to be wor-
shipped as a god." [3IedicaI Exa?niner.

How to disiinguish Stains of Blood from other Stains, Peroz found
that blood-stains are blackened by hypochlorous acid, while most color-
ing substances are bleached by it. Brame adds, that hypochlorous
acid should be free from perchloride of mercury, as it is easily ob-
tained by Williamson's method, or by agitating fresh chlorine water
with peroxide of mercury. The same author advises removing the
stains with faintly alkaline water, and then performing the experiment
in a glass tube, 'i'he solution then appears, at a certain degree of
concentration, red by reflected light, and greenish by transmitted
light. M. Buchner states, that the presence of mercury does not ap-
pear to interfere in the least with the reaction of the acid, and that the
blood-stains instantly become brown, but not black. Chloride of lime
or chloride of soda and an addition of muriatic acid may also be em-
ployed. [Chem. Gaz.,from Leibig's Anna/en.

Promjjt and efficacious mode of curing Angina. (Translated from
Journal des Connaissances Medico-Chirurg.) Dr. Domineco Ceglie
I roposes hleedingfrom the ranine veins, and says he has been agreea-
bly surprised at rescuing patients by this means who were threatened
by impending suffocation. It may be repeated twice a day ; but all
the symptoms subside with great rapidity. A blister to the neck se-
cures the good result after the bleeding.

Decoction of Senna as a Purgative for Children. We learn from
the Bulletin General de Therapeulifjue, that to overcome the repug-
nance of children, say from 4 to 10 years of age, to taking medicine,
M. Guersant, Blache and others, have used with much success senna
Ua*-t_ made into a decoction with coflee. From a few leaves to 8 or

58 Monthly Periscope, [January,

10 grammes, according to the age, &;c., may be added to a weak de-
coction of codec mixed with miik, and the deception continued by a
piece of bread handed to the ciiild, has found to answer a very good
purpose where a purgative was indicated.

Gastric Origin of Croup. Dr. Cain enters into a lengthened dis-
cussion to prove that " inHammation of the mucous membrane of the
trachea and larynx, is sometimes caused by crudities in the stomach,"
adducing in support of his opinion in regard to croup, one case in
which an attack supervened on a quantity of indigestible food having
been taken into the stomach. He says, \)\\ Dickson of South Caroli-
na, is the only author, so far as he is aware, who has mentioned the
connection of croup with the presence of indigestible substances..
This opinion is so universally entertained by practitioners (although
no written expression may have met Dr. C.'s eye), that no extended
argument seems necessary to elucidate it. Dr. C.'s article is to be
found in the Southern Journal of Medicine and Parmacy.

[ Wood's Quarterly Retrospect.

Alum in Pertussis. Dr. Davies thus speaks of the employment of
alum in pertussis :

" After a long trial, I am disposed to attach more importance to alum
as as a remedy in hooping-cough, than to any other form of tonic or
antispasmodic. I have often been surprised at the speed with which
it arrests the severe spasmodic fits of coughing ; it seems equally ap-
plicable to all ages, and almost all conditions of the patient. I was
formerly in the habit of taking much pains to select a certain period
of the illness for its adnn'nistration, and of waiting until the cough had
existed at least three weeks, taking care that the bowels were open,
the patient free from fever, the air-passages perfectly moist, and the
disorder tVee from complication of any bruit. A continued observa-
tion of the remedy, however, has induced me to be less cautious, and
I am disposed to think that a very large amount of collateral annoyan-
ces will subside under its use. The fittest state for its administration
will be a ujoist condition of the air-[)assages, and freedom from con-
gestion, but an opposite condition would not preclude its use, should
this state not have yielded to other remedies. It generally keeps the
bowels in proper order, no aperient being required during its use.
The dose for an infant is two grains daily; and to older children, four,
five, and up to ten or twelve grains may be given, mixed with syrupus
rhfcadosand water. It is seldom disliked." [Underwood's Diseases
of Infants in Bujfalo Med. Journ.

A new Operation for Li thotonnj. (Translated from Archives Gene-
rales de Med.) M. Maisonneuve, Surgeon to the Becetre, presented
a man, aged 132 years, to tiic Academy of Medicine, upon whom he
liad operated for stone nine days ago, by a new method, called by him
reclo-perineal. This operation dilFers from that of Sanson and Vacca
for in this, the sphincter and perineum remain intact. After the

1848.] Monthly Periscope. 59

operation in tliis case, the urine retained in the rectum did not pass
an instant involuntary, but only three or four times in twenty-four
hours. This patient, examined with the greatest care, presented no
trace exteriorly of an operation. From the fourth day he commenced
to pass urine by the urethra, and now (only the ninth day since he
was operated upon) nearly tiie whole is voided in this way.

This is the operation :: The patient is placed as for the ordinary
operation of Lithotomy, and M. iMai?onneuve divides it into four pe-
riods : 1st, the surgeon introduces his left fore-fnger into the rectum,
recognizes the groove in the staffer sound previously introduced into
the bladder through the urethra, turning this f nger in forced pronation,
its nail is retained in the groove ; 2d, a pointed bistoury, having its
edge shielded by linen enveloped upon the blade, is introduced held
as a pen in the right hand, and the rectum and membranous portion of
the urethra are punctured; 3d, the surgeon now introduces the dou-
ble lithotome upon the left fore-finger still retained as before indicated,
having just withdrawn the bistoury, removing now the finger and
seizing the straff, he pushes the lithotome into the bladder, its concavity
looking upwards or forwards ; the staff or sound is now withdrawn,
and the cutting instrument, the lithotome now in the bladder is turned
round one half upon itself, so that its concavity is turned backwards ;
4th, the surgeon now introduces the fbie and middle fingers of the left
hand above the lithitome into the rectum, and separating them widely
to protect the rectum, withdraws the lithotome, m.aking a bilateral in-
cision through the prostate and the corresponding part of the rectum.
The calculus is now extracted, as in the common operation.

The author's claims for this mode of cutting for stone, greater sim-
plicity and all the advantages of the bi-lateral through the perineum
of the late M. Dupuytren.

Lipovia, Meliceris and Steatoma differential Diagnosis. Special
Treatment for each. (Translated from Journal des Connaissances
Medico-Chirurg.) M. Velpeau says writers on Surgery are far from
agreeing as to the signification of each of these expressions. Symp-
toms in common Lipoma, Meliceris and Steatoma, have this in com-
mon, they are generally small, and are gregarious. M. V. has
counted thirty-one on the head of one of the most distinguished scien-
tific Frenchmen. None of these tumors offer an alarming prognosis;
all, however, require ablation, but in a manner speci.il to each.

Symptoms peculiar to each. Lipoma is a fatty tumor formed by
adipose cells in a hypertrophied condition. It may terminate in gan-
grene, but will never be transformed into meliceris or steatoma.
Lipoma may be found any where that adipose tissue exists. It is a
fatty mass without special envelope.

Meliceris only exists either in the skin or below^ it. It is formed by
a sebacious follicle, obliterated and enlarged. I'he contents of the
tumor varies, but it contains generally a whitish or yellowish pus.
The sac may contain serum or pus.

Steatoma is always found under the skin like meliceris, and upon

60 Monthly Periscope. [January,

the head or breast. It is distinguished by a sac always separated
from the skin, and without organization.. It is in fact a sort of brittle
shell, without vessels; a true product of exudation. Tiie matter of
meliceris is soft, tliat of steatoma is concrete. Definitively, lipoma is
a soft, fatty tumor, without cyst; meliceris is a hard tumor, with a
sebaceous cyst ; steatoma, a hard globular tumor, without projections,
the product of exudation.

The treatment is the same for each of these tumors, but the opera-
tion differs one from the other.

Lipoma must be removed in totality, and not cut into pieces. The
same must be done lor iiieliceres. The steatoma is the only one that
may be split up, cut into, or emptied. Formerly this was carefully
dissected out ; all that is necessary is to split the tumor and then press
the sides together the sac or cyst will exfoliate.

Spina Bifida, cured Jby repeated punctures and tincture of Iodine to
the tumor. Dr. Evans reports, in the British American Journal of
Medical Science, a case which he cured as follows : The tumor ex-
isted at birth, and had increased since; it was fluctuating and demi-
transparent. The child's head was voluminous, and its inferior
extremities were insensible and paralized. Dr. Evans plunged eight
needles through the tumor, and covered it with lint impregnated with
tinct. Iodine. This treatment was repeated every fourth day, then a
bandage acting upon the compress wetted with the Iodine was added,
and in six months the child was cured.

On the Cutaneous Eruptions Induced hy Various Medicinal Substances.

Opium. The eruptions which in certain individuals follow the
use of the preparations of opium are always of an exanthematous na-
ture. In general they consist of red isolated patches not unlike those
of measles. This kind of eruption is rare.

The solanecB. The eruption induced by the ingestion of the prepa-
ration of this tribe of plants are also of tiie order exanthemata, and are
as uncommon as those vvliich are the effect of oj)ium. The patches
are larger and irregular, resembling scarlatina.

The oleo-resins. All the medicinal substances of this class are lia-
ble to be followed by cutaneous eruptions, but none so frequently as
tur|)entine and copaiba. The eruption very much resembles that pro-
duced by opium and belladonna, being sometimes measly, at other
times scarlatinous in its appearance. It is a rare exception to see
either vesicles, pustules, or j)aj)ules.

Cod-livet oil. This medicine sometimes gives rise to a form of
eczema, which appears generally about the fifth day from the com-
mcncr'mcnt of its use , it is, however, rarely observed.

Iodide of potassiniu. The eruptions which follow the use of this
medicine are far from unitbrm, sometimes l)eing eczematous, at otiiers
pustular, as in acne. It sometimes happens that the skin escapes the/
action of the medicine, and that the m\jcous membranes are attacked
instead ; in such cases we observe coryza and conjunctivitis, which

1848.] Monthly Periscope, 61

cease as soon as its use is suspended, but which will not yield to topi-
cal treatment as long as the medicine is persisted in.

The discrimination of the cutaneous atlections which are induced by
different medicinal substances taken internally, is of no slight practical
importance ; we have seen ignorance of these cliaracters and causes
give rise to very unpleasant mistakes. [Froiii Annuaire de Therapeu-
tique, in Provincial Journal.

Seminal Weakness cured by ligalure to the Penis. M. Fissier, of
Lyon, relates cases in the Bulletin General de Therapeutique, where
a cure was effected by applying a ribban around the penis, as the pa-
tient retires to bed. In some cases, several other means had failed
and this simple one was found successful.

Cataplasms, sedative and resolutive, against Arthritis. (Translated
from Journ. des Connaisances Med. Chir.) Prof. Trousseau is in the
habit of covering the joint afTected with a cataplasm made as follows :
Boil crumbs of bread in camphor dissolved in brandy orthe tr. of cam-
phor, sufficient to cover the whole articulation, which when prepared
cover this poultice with 8 or 10 grammes of pulv. camphor, and then
sprinkle it with a strong solution of belladonna. This is an expensive
preparation, but need not be renewed oftener than every five or six days.

Twins horn after an interval of two months between them : they live.
(Translated from Journ. des Connaissances Medico-Chirurg.) Dr.
Wilberg reports a young lady, married ten months, who after eight
months pregnancy was delivered of an infant on the 24th of March,
1846, which lived, but had not attained its full uterine development.
The accouchement was laborious ; the placenta was discharged spon-
taneously, but the mother had no nourishment for the child. She
thought she felt movements of another child, and the abdomen increas-
ed in size. The 20th of May she was again taken in labour, and gave
birth to a child more robust and heavier than the first one. Three
days after this, she was enabled to nurse both her children.

Diuretic Forjuula. White wine, half-pint; powdered squills, 4 to
8 grammes ; laudanum, 40 to 60 drops. M. Commence with a tea-
spoonful twice a day, in a tumbler of water, sweetened, and increase
to three or four. The diuresis is commonly perceived on the second
or third day. [B. Tissier, of Lyon.

New cure for Blennorrhagia, Blennorrhcea, Leucorrhceaj Cystirrhma,
and other mucous discharges. (Translated from Journ. des Connais-
sances Medico-C'hirurg.) Dr. Taddei says he has cured 163 patients
affected with mucous discharges by using the following injection re-
peated three times a day. They all bore the injections well ; and in
some obstinate cases the balsam was increased to 24 or 30 grammes-
Balsam of Copavia, . 16 grammes.

Emulsion of sweet Amonds and gum Arabic, 12 grammes.
Laurel water, 8 grammes.

62 Monthhj Periscope. Medical Intelligence. [January,

Lavement AnU-U/phoid. (Translated from the Journal des Connais-
sances Medico-Cliirurg.) Dr. De Larue.

Distilled water, . . 200 grammes.

Magnesia, .... 40 centigrammes.

Camphor, .... 50 "

AssafoBtida, ... 30 "

Cinchona red, . . 2 grammes.

Yellow of egg, No. 1.
This may be repeated two or tlirec times a day, and continued for
many days. Dr. D. thinks he has derived very valuable assistance in
the treatment of typhoid fever from the use of this lavement or injection.

MEDICAL INTELLIGENCE.

Prof. Means' hitrodudory Lcclvre. In the Medical College of Georgia, there
is delivered but one general introductory Lecture at the opening of the course.
This was delivered this session by the Professor of Chemistry and Pharmacy,
and the Class have done well in requesting a copy of it for publication. The
subject was the novel and highly interesting one of Ekctru-Physiolo^y. Intend-
ing to recur to it again, all we do at present, is to commend this able production
of its gifted author to the attentive perusal of the profession.

New Remedy for Epilepsy (Dr, Grf.enk's Letter.)

TnoMASTON, Ga., Nov. 9th, 1847.
Dear Sir: I notice some prescriptions in the last No. ofour MedicalJournal,
communicated at your solicitation, upon ilie treatment of that obstinate and ter-
rible malady Epilepsy, Having foun 1, s>ime two years ago, in an old No. of
tlie American Journal of the Medical Sciences, what was to me a new remedy,
and since had occasion-to test ils virtue in Epilepsy, I ventuie to send a brief
sketch of the article, &c. hoping it mav not prove unacceptable to you.

This communication was written by a distinguished medical gentleman of
Virginia, (Dr. Mattauer), and, as I read it in the library of my partner, while
residing in Americus, I cannot now recall to mind the date or year ol the Jour-
nal, but simply the short prescription which I took down in my note-book, as
follows :

Crusta Genu E(}uin;p, ----- one part,

Brandy, --_. f,jur parts.

Do.se Fgss to Fgiss, .'i to i times per diem ; beginning with minimum and
gradually increasing to maximum di)se. Also given in substance, by grating
the knee scab, or grinding it in a common coffee njill to powder, in doses from
2 to '20 grs., 3 to 1 times per diem.

Also, as possessing the same active properties

Parings of the hoof, - - - one part,
Brandy, ----- two parts.

Dose 5i tO'^ij (extreme do.ses.)
Dr. M. believes it to possess tlie antispasmodic power in a liigh degree, with
some sedative influence; and insists upon a due preparation of the paiienl be-
fore en)pl()yingthis article. He also directs that such scabs only be collected as
are ready to fall almo.st spontaneously.

I have u.sed this remedy in three cases of Epilepsy two of which were ma-
terially bencfitied, before 1 left the low country indeed, one of the cases exj)eri-
enced a complete susjiension of tlie paroxysms for several weeks, and was
thought, by the parents, to be cured; when, on accoimt of discontinuing Ihepre-
])aration, the fits returned.
The third case is now under treatment, being a man of middle age, in the

1848.] Medical hitelUgence, 63

legal profession, and of active business habits. He has been exempt ever since
early in the month of April last; having: suffered only occasional premonitions.
In haste, very respectfullv. yours.

ALEXANDER B. GREENE.

The natvre of Gen. Shields' Woiind. This gallant soldier has recently been
the guest of our city, and we were called upoii to dress his second wound: being
detained, we found our friend, Dr. Dugr.s, in attendance when we arrived. It
is known that Gen. Shields was wounded twice in the recent battles in Mexico,
By the discharge of a cannon at Cerro Gordo, he was shot through the body and
given over as certain to die. The General thinks it was a grape shot that
traversed his chest. The ball has evidently passed between the lungs, through
the mediastina ; entering within the right nipple and passing out near the spine
on the right side. He spate no blood, did not fall, and even gave the word of
command after being wounded. In a few moments he was in indescribable
agony, and prayed even for death, to be relieved !

None but a medical man can fully appreciate the nature of this wound, which
has no parallel on record.

Rediiction of the dislocation of the Radius atul Ulna backyards, of more than
seven months standing. In the November No. of the Dublin Gluarterly Journal
of Medical Science, may be seen the account of a case of this dislocation,
(backwards of the ulna and radius,) of four months standing, published by Sur-
geon Hughes, of Jervis-street Hospital. The patient was subjected to the usual
treatment for such accidents, and also to the inhalation of ether; but all to no
purpose the reduction not being affected.

On December 3d, a gentleman of great muscular development, having a
backward dislocation of the radius and ulna of seven months and six days dura-
tion, was subjected to etherization and the pullies, when, after one hour and
three-quarter's continuance, and efficiently aided by Drs. Dugas, Means and
Campbell, the reduction was effected. The operation was performed beforethe
Medical Class. Dr. Jarvis, the inventor of the Surgical Adjuster, has since
examined the elbow-joint, and pronounced all right.

We have, too, just reduced a backward dislocation of the head of the radius
of eleven weeks standing, by etherization and the surgical adjuster.

MEDICAL MISCELLANY.

M. Sobry (de Bruges') recommends calomel to be given to children with the
extract of liquorice roll into cylinders with the mercurial salt, and cut into
pieces representing grains.

M. Fantonnetti proposes to give quinine mixed wiih tartaric acid, equal parts,
in rheumatism. He says the disease has been thus manifestly abridged and
relieved.

The Chocra still approaches Eastern Europe.

In Flanders, twenty-two physicians have fallen victims to Typhus since the
1st January last.

According to a German Journal, the Turkish Government has just concluded
by treaty, to an English Company, the right of fishing for leeches in her waters,
for thee^onnons sum of 1--185-900 piasters.

M. Desmares proposes caustics made of the nitrate of Silver and nitrate of
Potash, in the proportion for the former of a half, a fourth or eighth. He claim*
for it an action intermediate between lunar caustic and sulphate of copper.

64

Medical Intelligence. Meteorology,

Dr. Lamarre, in a pamphlet ofeiarhty pages, and noticed in the Journal des
Connaissances MeJico-Cliir., proposes to cure consumption by a decoction and

the substance oi' s/iai/s, in hiri2:e lioses.

M. Boiiillaud presented to the Academy of Medicine of Paris an Anatomical
anomaly very rare and curious a doable aorta, terminating on each side in a
prisniiive iliac artery.

The three Faculties of Medicine in France (of Paris, Montpelier, and Stras-
bourg), have replied to the request of the Minister of public, instruction, that
they are in favor of maintaining the system of Omcours for the professorships.

There are about 2JJ tsludenis in the two Medical Colleges of Missouri 150
in the State University, and 5.) in the St. Louis University,

Dr. Miguel, tlie founder antl editor of the Bulletin de Therapeutique, died at
Nice, the !)th October, on his way to Italv, where he had been ordered by his
physicians on account of his disease. Kis Journal was one of the best publish-
ed in Paris. It is to be continued by Dr. Debout.

The Minister of Commerce of France has commissioned Drs. Beau, Mon-
neret and Contour, to proceed to the east, and report on the progress of the Cho-
lera Morbus, which is stated to be pursuing the same course it did in 1831. Its
rapid march is westward, approaching, according to the last accounts, Molda-
via, Valachia, and even Poland.

METEOROLOGICAL OBSEPvVATlONS, for November, 1847, at Augusta,
Ga. Latitude 33*^ 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

o

Sur
Thkr.

Rise.
Bar.

2, ]

TlIKR.

76

P.M. 1
Bar.

Wind.

Remarks.

~i

51

29 77-100

29 75-100

N. w.

Fair.

2

50

" 77-100;

74

" 75-lOi'

w.

Fair.

3

47

" 78-i0>)i

77

" 73-10;

w.

Fair.

4

51

'' 68-l()0l

82

" 70-10

N. E.

Fair.

5

56

" 75-100|

83

" 78-101;

N. W.

Fair.

6

55

" 78-100:

81

" 78-100

N. E.

Fair some clouds.

7

Gt

" 89-l()0!

78

" 88-100

S, E.

Fair some clouds.

8

01

" 95-100:

80

" 92-100

S.

Cloudv.

9

b8

'- 92-100,

78

" 93-100

S.

Rain 45-100 of an inch.

10

63

" 90-10!)

81

" 90-100

S.

Cloudy.

11

01

" 99-100

71

30 1-100

N. W.

Cloudv.

12

60

30 3-100

05

" 2- DO

N. E.

Cloudy.

13

00

29 97-100

78

29 90-100;

S.

Cloudy.

14

61

" 75-100

72

" 71-100

s. w.

Cloudy sprinkle breeze.

15

48

" 83-100

69

" 91-1001

N. VV.

Fair.

10

37

30 5-100,

69

30 5-100

N. W.

Fair first white frost.

17

39

" 9-10,),

74

" 8-100'

S.

Fair.

18

48

" 0-100

70

29 95-100

s. w.

Fair.

1?)

58

29 82-100'

62

" 8(;.i()o

N. W.

Fa i r sprinkle breeze.

2!)

33

30 3-100

58

30 0-iOO

N. E.

Fair ice.

21

31

" 8-100

02

" 5-100

R.

Fa i r some clouds.

22

49

"

58

29 93-100

N. E.

Cloudy.

23

60

29 70-100
" 58-10!)

09

" 73-100

S.

Cloudy.

24

01

01

" 51-100

s.

Rain 55 100 of an inch.

25

43

^' 02-100

50

" 70-100

w.

Fair flying clouds breeze.

20

32

" 90-100

40

" 95-100

w.

Cloudy.

27

20

30 11-10;),

48

30 5-100

N. W.

Fair.

28

28

" 25-100]

64

" 25-100

\v.

Fair.

29

31

" 2.-)- 100

50

" 20-100

N. E.

Fair.

30

37

" 15-100

43

" 7-100

N. E.

Cloudy.

18 Fair days. Quantity of Rain 1 inch. Wind East of S. and W. 9 days.
West of do. do. 14 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol.4.] NEW SERIES FEBRUARY, 1818. [No. 2.

Part L original COMMUNICATIONS.

ARTICLE YI.

Cases of Convulsions and other Nervous Affections, during
Pregnancy, Parturition and the Puerperal state. By
Joseph A. Eve, M. D., Professor of Obstet^rics, &c., &c., in
the Medical College of Georgia. (Continued from No. IX.,
Vol. III.)

Convulsions after Parturition.

Case XIV. A negro girl, property of Mrs. Sharpe, 21 years
of age, primipara, of small stature and feeble health, right
arm and leg deformed and smaller than the left, said to be
subject to spasms of some kind, was delivered August 28th,
1845, at 10 o'clock, P. M., of a foetus of about seven months,
apparently some time dead, after a natural and easy labour.
She was attended by my friend and former pupil, Mr., now
Dr. Martin, of Atlanta, from whose memoranda of the case
the following statement is taken.

After her delivery, she was very comfortable with the ex-
ception of a slight headache. As she appeared to be doing so
well, after waiting an hour and a half,^ Dr. Martin was about to
leave her, when she had a severe convulsion. I saw her, with
Dr. Martin, at 12 o'clock, just as she had the second convul-
sion a half hour after the first. She was bled copiously,
sinapisms were applied the whole length of her spine, 3 i.
calomel administered, and cold water poured over her head.
Convulsions continued to recur. At 3 o'clock, A. M., 29th,
three hours from the first bleeding, she was' bled again, and the
sinapisms renewed. She had been for some time insensible

5

CO Eve, On Puerperal Convulsions, ^-c. [February,

and unable to swallow. Antispasmodic and purgative enemata
were administered and retained in large quantities, but without
effect. Her breathing became stertorous, the convulsions
more frequent, the pupils dilated, and all her symptoms pro-
gressively worse. Most of the remedies ordinarily used in
such cases were, energetically and perseveringly, employed.
She expired at half-past 10 o'clock, P. M., having been coma-
tose thirteen hours, and during fourteen having had sixteen
convulsions. The right side was mainly, if not alone, affected
by the convulsions, the left being very little, if at all, moved
by them. '

Autopsie, at 8 o'clock, A. M., August 30th, by Dr. Campbell
and Mr. Martin, in presence of Drs. Dugas, Wilson, and others.

The stomach was particularly examined, as it was suspected,
from her expressions and threats some days previous, that she
had taken something with the intention of destroying the foetus
in utero : there was great congestion in this organ more,
however, in some portions than in others, and a spot of consid-
erable size very much softened.

There was nothing unusual in the appearance of the womb
and its appendages. The brain was very much congested,
with extensive softening on the left side; near the vicinity of
the arteria meningea media was observed a dark spot, one inch
in diameter, apparently the result of an old coagulum.

Case XV. Mirny, a black w^oman, belonging to T. W,
Miller, Esq., about 25 years of age, mother of several children,
without any observed premonitory symptom, was seized with
a convulsion at 9 o'clock, A. M., January 8th, 184G, nine hours
after a remarkably easy and rapid labour.

She was supposed by the servants around her to have faint-
ed ; and as she had recovered fi-oin its effects when I saw her,
twenty minutes after, I was left in doubt as to the nature of the
attack. I thought it might be attributable to her breathing
carbonic acid gas, with which the air in the room was strong-
ly impregnated from coals burning in an open oven ; in a very
short time, however, all mystery was removed by the super-
vention of another similar seizure, evidently a convulsion.
The convulsive movem.ents were neither violent nor long con-

1848.] Eve, On Puerperal Convulsions, ^c, 67

tinued, but followed by insensibility and stertor. She was
bled promptly, and removed to a room with a chimney; cold
water was applied to her head by affusion, and sinapisms to he'f
spine and extremities. She had taken a dose of oil in the morn-
ing before the attack. She soon recovered speech and intelli^
gence ; had a very slight and transient recurrence at 1 1, A. M. ;
at half-past 2, P. M., was in a very comfortable and promising
state. After so long a suspension, I thought the danger had
passed. Ffteen grains of calomel were given, and sinapisms
renewed. At 4, P. M., convulsions returned : 3i. calomel was
given her hair was removed, and cloths dipped in cold water
applied to the head, as ice could not be obtained : convulsions
recurred in rapid succession. In consultation with my friend,
Dr. Dawson of Marietta, I bled her again at 5, P. M., with
excellent effect, although the state of her pulse rendered the
propriety doubtful ; the convulsions were reduced in violence
and frequency. Cathartic enemata failed to operate, although
injected through a long gum-elastic tube introduced, very far
into the intestine as it was intended and supposed into the
colon. . At 9, P. M., four drops of croton oil were dropped into
her mouth, as she lay comatose and unable to swallow. The
sinapisms were renewed, and blisters applied to the thighs.
She had one -convulsion between midnight and morning, and
another at 7, A. M. At 8, A. M., next morning, (the 9th,) we
found her sensible and able to swallow, her pulse'^xtremely
feeble and bowels still unmoved: we gave her six drops more
of croton oil, rubbed up in sugar, which were Washed down
with water. She had taken gruel through the night. During
the forenoon, two scruple doses of calomel were administered;
enemata were repeated ; her bowels acted moderately through
the day : she spoke intelligently, and appeared to be improving
all day. At 9, P. M., prescribed a tea-spoonful of tincture of
assafoetida and two table-spoonfuls of camphor water every
two hours, while awake, with gruel and chicken water for
nourishment. During the forenoon of the 10th, which wasthe
third day she continued in the same hopeful state ; in the after-
noon she became more dull : blisters were applied to her ex-
tremities, to her neck, and to her breast, in consequence of her

68 Eve, On Puerperal Conmdsions, SfC. [February,

having complained very much of a fixed pain therein. Her
bowels were acted on, and all such means employed as her
symptoms indicated, but without any benefit the convulsions
recurred, and she became constantly w^orse, and died the after-
noon of tiie fourth day.

Autopsie, early on the next morning, by Dr. Campbell,
revealed extensive softening of the brain and great vascularity,
the pia mater moderately turgescent ; also, adhesion of the
pleura pulmonalis to the thorax on both sides, and crude tuber-
cles in abundance.

This woman, we were afterw^ards informed, had had a vio-
lent convulsion, the summer of 1839, followed by inflammation
of the brain for several days, and some time subsequently a
severe attack of pleurisy. During the last year or two, she
had frequently complained of headache, had become very
lethargic and dull, and, contrary to her former character, intol-
erably sullen and morose, all of..wtiich, as well as her last
attack,! think maybe satisfactorily accounted for by the change
that had taken place in her bmin, the ramollissement, which
was doubtless the result of pre-existing inflammation.

Case XVI. Dolly, a black woman, belonging to J. L. Cole-
man, Esq., about 30 years old, multipara, was attacked with
convulsions, March 22d, 1846, a fortnight or more after her
confinement. I understood at my visit that she had been con-
fined nine days, but subsequently I have been informed that a
fortnight or three weeks had elapsed that she had been per-
fectly well, and had voluntarily engaged in some out-door
work. She had four or five convulsions before, and one after
my arrival, from which she soon recovered her sensibility and
speech. Her pulse being full and strong, I bled her and ad-
ministered about twenty-five drops of laudanum and si. tinct.
of assafoctida, and 3i. calomel, to be followed the next morning
by castor oil or salts. Cold water was poured on her head,
and sinapized pediluvia were used, and sinapisms applied as
in other cases. She had no farther convulsion, and promptly
recovered her usual good health.

Casr XYII. Although the following case cannot be arran-
ged under any of the preceding categories, as it could not be

1848.] Eve, On Puerperal Convulsions, ^c, 69

ascertained whether the convulsions anticipated or supervened
on the labour, it is interesting from the fact that the child was
extracted alive, after the patient had had many convulsions
and appeared reduced to the last extremity, the only instance I
have known, and I believe a rare exception to the general rule.
July 25th, 1847. Called in haste to visit Mily, a servant of
Major E. B. Glascock, a delicate mulatto girl, aged 20 years,
eight or nine months advanced in her third pregnancy. At
half-past 8 o'clock, A. M., I found her almost insensible to any
impression, unable to articulate intelligibly, her pulse small and
very frequent. Nothing satisfactory could be learnt of the
history of the case, as through ignorance and stupidity the
other servants had not informed her mistress of her illness,
until the moment before I was called. Her father, who slept
in the same room, said that, at 1 o'clock she became unable to
speak ; it is therefore presumable that she had her first con-
vulsion previous to that time, but that those present were too
sleepy or too stupid to be alarmed at the sight. Whilst endea-
voring to make out the diagnosis of the case, a strong convul-
sion explained its nature. A vein was opened as soon as the
fit was oflf whilst the blood was flowing, another protracted
convulsion followed. The blood was allowed to flow until
about thirty ounces were taken. There was no external indi-
cation of labour; but on examination the ostincae was found
fully dilated, and the head low in the pelvis; the membranes-
were immediately ruptured with the hope of accelerating the,
labour, which however did not progress. Instruments were
sent for at once, but through a mistake of the servant, there
was considerable delay, and she had another convulsion.
Sinapisms were applied along the course of her spine and to
her extremities, and cold water poured over her head. She
appeared to be fast sinking immediate delivery was the
only indication, the only hope, and truly it would seem a
forlorn hope, for, before instruments could be procured,
she was to appearance in articulo mortis. Not wishing to
to mutilate the foetus, as I could have no certain evidence of
its death, inasmuch as the results of auscultation under such
circumstances could not be relied on, I determined to employ

Eve, On Puerperal Convulsions, J-c. [February,

the forceps, but hesitated for a moment, as instantaneous deliv-
ery alone could avail any thing, and the head v^ras still oblique
in the pelvis and so situated that an ear could not be felt,
whether or not to throv\^ aside that instrument and adopt the
more prompt method by perforator and crotchet, but proceed-
ing with the former, in less than ten minutes extracted a child
very nearly, if not quite, at term, and of which, to my surprise,
the cord was found to pulsate. After persevering some
time in the active employment of means to establish respira-
tion, the child breathed freely, and though feeble at first has
survived. Life appeared so nearly extinct in the mother, that
it really seemed like extracting the living from the dead. She
was delivered at half-past 8. A. M., one hour after she was first
seen. After the removal of the placenta, and the administra-
tion of a few drachms of the wine of ergot, she began slowly to
rally and became so. revived, before night, that she could drink
from a cup and reply to questions. About 11 o'clock, A. M,
she took 3 i. calomel, and in a few hours I i. sal. epsom, which
operated once or twice during the night, and freely the next
day. On the 20th, 27th and 28th, she had a very moderate
degree of fever ; her bowels were rather too free, but her con-
dition was altogether as comfortable and promising as could
bave been expected or desired. On the 29th, peritonitis was
manifested by great intumescence and tenderness of the abdo-
men : a large blister was applied over the abdomen, and 3 ss,
calomel and \ gr. sulphate of morphine given every three houra
until three doses were taken, and after a few hours a dose of
8al epsom : she also took freely diluent drinks and gruel, as
Khe had previously. 80th, her symptoms were much abated.
01st, she was still better. August 1st and 2d, she appeared to
be fully as well or better^-her fever was very light her head
had been clear ever since the first evening: the only unfavor^
able symptom was a diarrhcra, which, though restrained by
Dover's powder or morphine, had a constant tendency to
recur. August 3d. Diarrhcra became more profuse and un^
controlablo, and her vital powers a))peare{l more depressed.
Opiates and supj^orling remedies were prescribed, and every
cftort made to sustain the failing energies of licr system ; but in

1848.] , Eve, On Puerperal Convulsions^ ^-c, 71

vain. The morning of the 4th she was evidently sinking, and
expired about mid-day. Early on the morning of the 5th, a
post-mortem examination was made by Dr. Campbell, whose
notes are subjoined.

"The body not much emaciated. On opening the cranium,
the brain is found in a normal condition. Thoracic viscera
healthy, with the exception of some crude tubercles, and some
post-mortem congestion in the lungs, and a few pleuritic bands.
The liver Very dark and evincing great engorgement. Mucous
membrane of the stomach and intestines somewhat congested.
Peritoneum exhibiting marks of inflammation, throughout its
whole extent, and that investing the womb and its appendages
in a gangrenous state the broad ligaments tearing with the
most careful handhng the womb well contracted. Death in
this case was most probably owing to peritoneal inflammation.
Nothing discovered by which to account for the convulsions.
It is to be regretted, that time and opportunity are not allowed
for making a minute examination of the spinal marrow."

Peritoneal inflammation was doubtless the immediate cause
of death ; the convulsions can only be regarded as indirectly
and remotely, if at all, involved in the result, as they may have
predisposed to the former, or rendered the system less able to
bear its effects or the treatment necessary for its subduction.

Cases in which Convulsions were Threatened.
Case XVIII. Mrs. K., a lady about 20 years of age, of highly
sanguine temperament and plethoric habit, primipara, fell in la-
bour, 1 o'clock, June 21st, 1844. At 11, A. M., when the os uteri
was dilated to the size of a dollar, her pains became violent and
she complained of intense headache, with dazzling or flashes
of light. Upon the immediate copious abstraction of blood
and the application of cold water to her head by affusion, not
only did these alarming symptoms suddenly subside, but
her labour was suspended, and did not set in again until the
same hour on the 24th, making a suspension of three days,
during which time she was kept on very low diet, and each
day took a saline cathartic. When her labour was re-estab-
lished, it progressed without any recurrence of former symp-
toms, and terminated favorably in all respects.

72 Eve, On Puerperal Convulsions^ <^c, [February,

Case XIX. Mrs. B., of sanguine temp rament and very ro-
bust frame, of sedentary habits, about 40 years of age, multipara,
eight months advanced in gestation, suffered intensely from
toothache. Apprehending more danger from the continuance
of severe pain and protracted loss of sleep, than from careful
extraction, I extracted the tooth (Nov. 10th, 1845) she imme-
diately fell back in her chair and appeared about to have a
convulsion the muscles of her face and her hands were slight-
ly spasmed. Dashing cold water suddenly and freely on her
face, according to the suggestion of Marshall Hall, recalled
her from this state, and to all appearance averted an attack of
convulsions which seemed to be imminently threatened. She
was lifted into bed and directed to be kept perfectly quiet.
The next day, her pulse being full and strong, she was bled
freely. I did not see her again until December 7th, when in
labour, which was protracted and rendered more difficult and
violent, by a deviated presentation of the head, which required
to be rectified, after which the child was promptly expelled ;
but immediately on its expulsion, she began to look wildly,
talk incoherently, and twitch the rpyscles of her face, a convul-
sion to all appearance just about to come on, which, however,
was averted as before, by dashing cold water suddenly on hev
face. She spoke rationally a few minutes, complained of vio-
lent headache, and again lap^ad into a state of unconsciousness,
with evident signs of an approaching convulsion. Dashing
cold water on her face again arrested the convulsive move-
ments. From thirty to forty ounces of blood were suddenly
abstracted, without her being conscious, after which her head
was relieved, and all her threatening symptoms speedily disf
appeared.

Case XX. Mrs. S., very delicfite and nervous, about 25 years
of age, after having passed through her fifth labour in less time
and with much less suffering than ever before, immediately fell
into a state of unconsciousness, with death-like pallor of face,
and pulse almost imperceptible. She had lost very little blood,
perhaps less than is usual in parturition, certainly not enough
to have induced syncope. With one hand I grasped the uterus
through the abdominal parictes, while with the other cold vy^a^

1848.] Eve, On Puerperal Convulsions. <^c. 73

ter was suddenly dashed on her face and neck. The cold
water aroused her from tliis state with a sudden start, into
which she soon relapsed again, to be again recalled by the
same means. As soon as she could swallow, a table-spoonful
of the wine of ergot w^as given. After discontinuing the man-
ipulations, the binder w^as carefully applied with the view of
promoting uterine contraction. She gradually recovered from
this state, and had a good convalescence.

I am aware that it may be questioned whether the symptoms
in this case portended convulsions. But I confidently believe
that, if nothing had been done for this patient, she would have
died without reaction, as some have, from what is usually
styled protracted and fatal syncope, or re-action taking place
after a lapse of time would probably have been attended by
convulsions.

Case XXI. Mrs. S. J., a lady of nervous temperament and
delicate health, multipara, 35 years of age, seven months ad-
vanced in pregnancy, had had some threatenings of miscarriage,
during the fortnight previous to my first visit on the 8th April,
1847, occasioned by a severe fright. She had been bled the
day before I saw her. I prescribed a half grain sulph. morph.
and a sinapism to her back, which relieved her for the time.
The next day she complained of fulness in her head, on which
Account she was bled again. I did not see her from the 8th
until the 10th, when she complained very much of headache,
and dimness of vision amounting almost to total blindness ;
pulse ranging from 100 to 120 per minute, and weak ; nervous
system very much agitated. Further blood-letting was inad-
missible. A scruple of calomel was prescribed, to be followed
in five or six hours by a dose of salts, should it fail to operate.
Sinapisms were applied along the course of her spine and to her
extremities, repeatedly. Cold water was poured over her head
almost hourly for several days and nights, except when asleep
for a short time, and each time from fifteen to thirty minutes,
in the intervals between the affusions, cloths dipped in cold
water were applied. Sinapized pediluvia were also frequent-
ly used. She often complained of a severe pain about the
epigastric region, which was relieved by the sinapisms to her

74 Eve, On Puerperal Convulsions, <^c. [February,

back. Her blindness was always partially and temporarily
relieved by the cold affusions; vision always clearer immedi-
ately afterward. She continued in this state, extremely ill,
convulsions imminently threatened all the time, without amend-
ment, until the morning of the 16th, when she was found free
from fever, and in all respects better, except the dimness of
vision, which still continued. During the night of the IGth,
I found her in decided labor, with which it was deemed expe-
dient not to interfere in any way, lest a convulsion should be
excited. After some hours of almost painless labor, the womb
acting very feebly, she expelled a seven months- fa?tus, dead,
having perished in consequence of the feet presenting and the
second stage being unusually protracted. From her extreme
debility, nervousness and dimness of vision, convulsions were
apprehended every moment during labour, and for some time
after ; but there was not the slightest spasmodic action. She
had a recurrence of fever which lasted for some days; the af-
fection of her eyes continued for several weeks ; she remained
in a very low state a long time her convalescence was
exceedingly slow and imperfect her usual good health not
restored for many months.

Ca?e XXII. Mrs. Q., of sanguine temperament and robust,
about 30 years of age, between four and five months advanced
in her second pregnancy, was reported by those around her to
liave had a fit and to have been delirious, &c., before I saw her,
(May 18th, 1847,) in which it is possible there might have been
a mistake. I found her perfectly sensible, but .with strong in-
voluntary contractions of the muscles of her arms and legs her
pulse full and strong, 100 beats per minute, complaining of pain
in her back and abdomen. This affection was caused by a
kick on her back and a blow on her abdomen her husband,
being more potent in blows than words, had adopted this me-
thod of settling a domestic controversy and enforcing conjugal
obedience. The loss of .^xii. of blood induced syncope ; forty
drops of laudanum were given a sinapism applied over her
epigastrium and another the whole length of her spine: her
pulse fell to HO per minute and she had no return of tfie spasms.

10th, 0 o'clock, had slept none, com})lained of head-ache,

1848.] Eve, On Ptieiyeral Convulsions, ^c. 75

pulse soft, regular and 85 per minute ordered a dose of mag-
nesia. In the afternoon, although her bowels had been freely-
acted on, her pulse had become full and strong and much more
frequent, and she complained of intense headache and extreme
tenderness all over the abdomen ; she was bled to xxiv., a
sinapism applied to her spine, and i. sal. epsom given, to be
repeated in four hours, should it not operate well.

20th, I found her still complaining of headache, and very
nervous. Prescribed cold affusions to her head, to be repeated
whenever the pain returned warm sinapized pediluvia, sinap-
isms to her back and extremities, and .a gentle laxative when-
ever the state of her bowels required it. . She soon recovered
her usual health, went her full time and ffave birth to a living
child.

Anomalous Cases.
Case XXIII. Catherine, a servant of Mrs. L., of Edge-
field, district, 16 years old, about four months advanced in
her first pregnancy, w^as seized (October, 1840) with strong
involuntary contractions of her legs and arms, in irregular
paroxysms, frequently recurring, without however affecting
her mind, resembling very closely, or actually constituting
chorea. She w^as treated by sinapisms, cups, and blisters
to her back, especially the lower portion ; purgatives, opi-
ates and antispasmodics, &c. These spasmodic movements
were frequently suspended by treatment, but they continued
to recur at irregular intervals during the latter five months
of her pregnancy^ becoming so intense at last as to produce
transient loss of consciousness, on w^hich account, as well
as from the indications of her pulse, she w^as bled twice during
the last two months. She often suffered fi'om retention of
urine, requiring catheterism for its relief. Notwithstanding
she had suffered so much and so long, and the attacks had as-
sumed a more alarming character in consequence of the brain
becoming involved, which at first appeared entirely unaffected.
She had a natural and easy labour 6th March, 1847, giving
birth to a living and well developed child. This disease
recurred after labour wdth more intensity than before.

70 Eve, On Pueiyeral Convulsions^ Sf-c, [February,

March 7th. Being present when she had a very severe par-
oxysm, I availed mvself of the opportunity, while she was
insensible, and introduced three setons in her back, along the
course of the spine, by which she was very materially benefit-
ted. But 1 have been informed that she has ever since been
subject to chorea occasionally, though in a lighter degree, espe-
cially during gestation. Of her subsequent history, however,
I cannot speak particularly, as I have seen her very seldom
during the last six years.

Case XXIV. Susan Dent, a mulatto woman, multipara,
about 35 years old, of medium robustness and embonpoint,
during her eighth month of gestation, became without obvious
cause so effected that whenever she rose up herself, or was
raised up, her extremities would be convulsed, which move-
ment, however, always ceased immediately on her resuming a
horizontal position, consciousness perfect all the time.

As she was in other respects perfectly well and comfortable,
when lying down, active treatment was not deemed necessary.
She was directed to lie down ; gentle laxatives occasionally,
and sometimes sinapisms to her spine were directed. Her
pulse indicating depletion on the 16th October, she was bled.
Labour supervened on the 19th, attended with more than usual
excitement, which was promptly subdued by another abstrac-
tion of blood, after which it progressed naturally and termina-
ted favorably in all respects. Her convalescence was uninter-
rupted. I understood she had a slight return in a subsequent
pregnancy, but did not see her.

Case XXV. Mrs. O., a very delicate and nervous young
lady, while single, had become subject to a nervous affection
which, from description, was doubtless hysterical. It was
hoped it would disap])ear after marriage had her married
life been all calm and sunshine, the happy result anticipated
might have been realized ; but it was sadly overshadowed the
paroxysms became more intense and frequent, assuming a de-
cided epileptic character. As pregnancy, which occurred soon
after marriage, advanced, the fits became more and more fre-
quent, returning at intervals of six, five, four, three and finally,
of two weeks ; for some time before her confinement, she had

1848.] Antony, On Hemiplegia, T7

two convulsions every fortnight, that is, after an interval of
about thirteen days, she would have one convulsion, and ano-
ther the day after; then a suspension of the same number of
days, and so on. About eighteen days before the termination
of gestation, she had three convulsions in two days, on which
account she was bled. She had not the slightest unfavorable
symptom during labor, which was remarkably easy and in all
respects fortunate.

On the eighth day she had a fainting fit, not followed by
headache or convulsion ; her convulsions, however, gradually
returned and have assumed a very serious character, uncon-
trolled, uninfluenced by every plan of treatment to which she
has been subjected.

Remarks on Puerperal Convulsions will be furnished for a future
number.

ARTICLE vir.

Hemiplegia. Notes on the Application of Galvanism with
Sherwood's Vibrating Battery. By E. L'Roy Antony, M.D.,

of Waynesboro', Burke County, Ga.

Patrick Murphy as his name implies, a native of Ireland,
has been in the United States seven years, aet. 30, below middle
stature, well made, bilious temperament, a laborer spends his
summers at the North, his winters at the South.

The previous history, as detailed by his brother, is as fol-
lows ,: Never sick a day in his life ; formerly addicted to
drink, and has had four attacks of convulsions from the immod-
erate use of alcoholic stimuli, following which a partial par-
alysis of his forearms and hands supervened, from which he
recovered in three or four days : has not tasted a drop of spirits
since May last, at which time he took the " Pledge " in Savan-
nah, immediately preceding his passage out.

During his passage South, pr. brig Savannah, this season, he
suffered severely with sea-sickness ; remained in Savannah
eight days, the last four of which, and immediately preceding"
this c.tack, he suffered severely with intense pain in the supo

78 Antony, On Hemiplegia, [February,

rior portion of the left posterior cranial region. On Thursday,
November 25th, he arrived at the 80 Mile Station,. Central R.
lload, pursued his journey on foot, with a considerable bundle
on his head, in company with his brother, for fifteen miles, and
retired at night with less headache. He was aroused by his bro-
ther next morning {Friday) to continue their journey, when it
was found impossible for him, either to stand alone or walk,
talk, or move his right superior extremity. Much alarmed,
his brother brought him to this place, on horseback, at 9, A. M.,
for medical attentioij, at which time he presented the follow-
ing appearance: Sitting, his body slightly inclined to the
right ; right shoulder pitched forward, supporting his right
forearm with his left hand, strongly similating the sitting posi-
tion usually assumed by a patient with fracture of the right
clavicle. When asked, what was the matter ? he let fall his
right arm, which dropped pendant by his side at the same
time endeavoring anxiously to communicate by words the
particulars of his case. He commenced a rapid, unintelligible
and inarticulate jargon, resembling those peculiar gutteral
sounds emitted by dumb persons endeavoring to make them-
selves intelligible by articulation thereby evidencing lesion
at the origin of that nerve, which directs the movements of the
muscles of the tongue, and of the pharynx, especially those
necessary to the articulation of the voice, viz., the glosso-
pharyngeal, (8th pr. of the old anatomists,) which arises from
the anterior part of the corpus restiforme on the outside of the
groove which separates this body from the corpus olivare. He
was unable to stand without assistance, his right inferior ex-
tremity being as completely beyond the power of volition as
his right superior; his left leg, though materially enervated,
was not paralysed. The skin retains the faculty of sensation,
shewing that the paralysis is not complete, but the lesion is
located at the proximal termini of the motor nerves only: has
had no injury of his head that comes within his recollection, or
that of his brother, although the latter says, " his mother used
to tell him when a boy, that he got a great fall," since which
time he has been troubled with discharge from the ear. This
discharge was not suspended during the existence of his late

1848.] Antony, On Hemiplegia. 79

headache has no headache the morning after his attack. Co-
lour of his eyes Hght blue, conjunctiva injected; pupil of the
left eye perfectly normal, that of the right rather sluggish in
its movements; breathing 20; pulse 50, soft, of little volume,
intermitting every seventh beat ; appetite unimpaired ; tongue
placid and white ; deglutition easy ; bowels soluble ; kidneys
and bladder in ordinary condition ; portio-mollis of the 7th
pair and the olfactory nerves unimpaired. Intellectual facul-
ties in reasonable condition, except memory, which is some-
what at fault. .

So. much then for his past history and present condition a
sufficiently well marked case of Hemiplegia.

It suggests itself as somewhat singular, to my mind, that sa
few of the premonitory symptoms should have presented them-
selves in this case. However, I am not writing a pathological
dissertation, nor do I intend attempting any thing new as to
the pathological state of the encephalon, upon w^hich, as a
symptom, Paralysis or Hemiplegia is developed. But, having
been reared in a school which taught, twenty years ago, that
the human organism w^as nothing more nor less than an elec-
trical machine that the various functions, secretion, assimila-
tion, conception, &c., were only the results of the diversified
plays of electricity under various forms and circumstances-
that the "vis nervosa," with its hundred cognomena, was elec-
tricity, galvanism, magnetism, or any other name, but still the
same active and all-pervading agjent that the nerves were
only telegraphic wires, holding in communication the capital
and every extremity of the empire that animal life, in short,
was only a result of its affinities !

Early imbued with impressions like these, wiiich have ripen-
ed to irresistable and mature conclusions, I w^ould readily
assume, upon the supervention of a paralysis, that, either there
was a deficiency in the development of the necessary quantum
of the vis nervosa, (electricity.) or that, a sufficiency being de-
veloped, its communication between the paralyzed part and
sensorium commune had been cut off.

Under these impressions, I immediately proposed the trans-
mission of a galvanic current from Sherwood's Vibrating

80 Antony, On Hemiplegia. [February,

Battery, through the encephalon and spinal column, to the
extremities of the paralyzed members, thereby substituting the
artificial for the natural fluid ; that the organism thus tempora-
rily supported, might, speedily, by absorption or otherwise,
repair the lesion or remove the obstruction to physiological
function ; accordingly, I promised to calj again in the after-
noon and apply the battery.

Friday, Nov. 20. At 4 o'clock, P. M., applied the positive
pole to the first cervical, and in succession to the last dorsal
vertebras, the negative pole playing continually from near the
positive on the spine, the whole length of the limb to each digi-
tal extremity this I continued 10'; then applied the positive
to the left mastoid process and negative to the right this I
continued 2' ; then applied the positive over the left organs .of
conceritrativeness, approbativeness and self-esteem, the nega-
tive, simultaneously and in succession, to all of the cervical
vertebrae, accompanied with passes of that pole to the centre
of the chin and entire right side of the neck, dwelling for awhile
with the negative pole upon the anterior median line of the
neck this I continued 5' ; then applied the positive pole at
that point where the tendon of the pectoralis major is inserted
into the edge of the bicipital fossa of the os humeri, the nega-
tive between the external condyle of the humerus and the
insertion of the biceps flexor cubiti, which produced violent
flexion of the fore-arm upon the arm this I continued 10';
I then made the positive range over the dorsal spine, at the
same time making passes with the negative down the dorsum
of the arm, fore-arm, hands and fingers this I continued 10';
I then again made the positive pole range (always from above
downward) over the cervical vertebra^ and recjuested him to
protrude his tongue, which he did at tlie left oral commissure,
to the apex lingu.ie I touched the negative pole, and instanta-
neously jerking in his tongue, shouted " Fire ! fire, he Jases^
I re-applied the negative, however, to the a])ex and superior
surfaces of the tongue for 5^

I will remark, that in passing the current through the cere-
brum, it is absolutely necessary, that you so graduate the
charge that the patient can barely perceive it ; but in running it

1848.] Antony, On Hemiplegia. 81

through the brachial or crural extremities I use the whole
power of my battery.

When I completed this sitting, which occupied something
over 40 minutes, Patrick could articulate with a degree of
plainness that enabled me to understand a number of his sen-
tences ; he moved his entire right arm, lifting it up and down,
at the same time, repeatedly elevating his right foot and strik-
ing his heel against the floor, also flexing and extending the
foot ; said he was stronger and felt much better.

Saturday, 27th. Pupil of right eye as sensitive as the left ;
conjunctiva clear ; breathing 24; movements of the thorax
free and easy ; pulse 64, soft and regular ; the pulsation in the
left arm more perceptible to the touch than the right ; bowels
moved last night ; appetite still good ; deglutition still easy ;
tongue covered with a moist white coat, except the edges,
which are red and indented 1 presume from compression by
the teeth. I applied the battery as before for the space of forty
minutes ; when I concluded the operation, he spoke plainly,
sufficiently articulate to be perfectly intelligible; protruded his
tongue in a direct line and, instinctively enough, raised his
dexter hand to a horizontal, and shook his fist \ could not per-
form circumduction ; raised his foot as before, and stamped on
the floor. I then ordered him to be put to bed, which was
done. But before I left the house, he came back walking alone,
but rather indifferently, into the parlour, thanking me for the
relief he had already received.

I had neither made any other prescription, nor altered or
amended his usual diet in any particular, confidently relying
upon the allex^iative as well as curative powers of this agent.

Sunday, 28th. I visited Patrick this afternoon in company
with Major Poythress and my professional friend. Dr. Charles
W. West, who made a cursory examination of the case, and
took minutes during the application of the battary. We neither
counted his pulse nor breathing ; his countenance melancholic;
could scarcely raise his hand to his forehead, and barely stand
unsupported applied the battery as before, producing violent
contractions of the flexors, but acting indifferently upon the
extensors of the paralyzed arm, except the deltoideus, the con-

6

82 Antony, On Hemiplegia. [February,

tractions of which elevated the elbow as in abduction. Passed
the current through the tongue and entire cervical regions
antero-posteriorly; continued the application of the battery
thirty minutes ; after which his countenance became decidedly
illuminated; his articulation almost perfectly distinct; could
easily comprehend every word he uttered ; could place his
hand behind his head ; performing semi-circumduction ; stood
for the space of a half minute upon the paralyzed leg.

I would here remark, that I have not passed the fluid through
the nerves of the inferior extremity, for it evidently improved
pari passu with the improvement of the superior.

Patrick now speaks for himself, and says, that the pain in his
head, previous to his attack, was not severe ; but had some
pain, with a " falling, as if meself was thrunk."

Monday, 29th. This morning John came early, to inform
me, that his brother had arisen from his bed without assistance,
and walked into the sitting room, and appeared a great deal
better.

This afternoon visited my patient in company with my
friends. Dr. Edward J. (barter and Mr. George Mandell, to wit-
ness the effect of the galvanic fluid upon the paralyzed limbs.

The^rs^ application, on Friday, was gentle, but the second,
on Saturday, was of the full power of the machine, and the par-
alyzed members gave greater evidence of speedy and decided
improvement, than upon the first application ; accordingly, on
Sunday and Monday, I passed as vigorous a current through
the arm, as the patient could bear, producing sudden and vio-
lent contractions of the flexors, flexing the hand upon the fore-
arm, the fore-arm upon the arm, and the whole upon the anterior
parietes of the thorax.

I had desired to continue the daily application ofthe galvan-
ic fluid in this case, hoping thereby, to determine whether or
not it would fulfil the legitimate indication in the case, viz., the
sup)X)rt ofthe organism during enervation by artificial means,
until the resources of the economy should have removed the
nervous obstruction ; but his brother John, himself a laborer,
and now the only visible means of support for both, to avoid
expense and make him accessible to his personal friends, de-

1848.] Norwood, On Quinine. 83

termined to remove him immediately to one of the eleemosyna-
ries in the city of Savannah ; accordingly, with regret, I gave
Patrick a letter to the Hon. H. R. Burroughs, M. D., the present
mayor of the city, with a request that the experiment, so far
successful, if possible, might be continued.

Such has been the rapid and manifest improvement in this
case, to the time of its departure for Savannah, that the recom-
mendation to try the battery in similar cases, is no idle sug-
gestion. I have used it repeatedly, and occasionally with the
happiest results in nervous cases : in the distressing symptoms
usually accompanying prolapsus uteri, especially in patients of
relaxed leuco-phlegmatic habit, I have appealed to it with
great confidence and satisfaction.

I have made one.application of it in a case of Epilepsy, where
the attacks had become quotidian ; following the application
the patient did not have another attack under ten days. The
current in this case was passed from the cerebellum to the
coccyx, and through the lumbar and sacral regions antero-
posteriorly. The patient, however, at this time, was under the
medication of the cyanuret of iron, cold dash, and sol. ext.
belladonna.

I have used galvanism thus applied, in acute Rheumatism
and Pleuritis, with very happy results.

Fifteen years ago I witnessed its application from the com-
mon voltaic pile of zinc and copper, in a case of Traumatic
Tetanus from frost-bite, wherein the phalanges, meta-tarsal
and tarsal bones of both feet had successively sloughed away,
with complete arrest of the tonic spasm, but the patient died
hectic.

ARTICLE VIII.

Is Quinine a Sedative 1 By Wesley C. Norwood, M. D.,
of Cokesberry, So. Ca.

What is a sedative? In one sense every efficient article of
the materia medica is a sedative, or may be made subservient,
to the induction of sedation in the animal system. But if we

84 Norwood, On Quinine, [February,

wish to be clear and definite in speaking of the poAvers and
effects of any article, we must always be understood to speak
or have reference to its direct effects or impression on diseased
animal bodies. None of the minor or indirect effects of medi-
cinal agents, are intended or implied in the present article,
unless specifically mentioned. The physiological and poison-
ous effects are also not entertained. Any article that allays
pain, directly or indirectly, and remotely, is by many consid-
ered to be a sedative. Every energetic medicinal agent has
some peculiar operative power by which it controls, counter-
acts, or overcomes diseased action, or coincides and aggra-
vates. And unless the circumstances and the peculiar type,
and regularity or irregularity of the disease is noted, an un-
suitable and inappropriate article is liable to be administered.
It has ever been found useful and convenient to group or class
articles that possess something of a direct operative effect in
common notwithstanding no two articles of the class possess
the same identical powers or qualities; nor can any one of
them answer as an entire substitute for the other. Many arti-
cles that possess nothing in common, often indirectly accom-
plish what others directly effect. In Pneumonitis Caumatodes
venesection subdues pain, and induces sleep ; but these effects
are purely in virtue of its refrigerent or antiphlogistic powers^
by which it diminishes the vigor of the circulation and increas-
ed vital energies of the system. In the above disease, opium
would not be adapted or indicated ; but in Pnueumonitis Ty-
phoides opium would be the agent indicated for allaying pain
and promoting sleep. I care" not how powerful or extensive
the sedative effects of quinine may be, I have never known it
administered, in either of the above diseases, to subdue pain
and restlessness certainly two very desirable objects to the
patient and physician. In addition, the state and condition of
the system are antipodes in the above cited instances. With
such facts or evidence, I am at a loss to divine how the conclu-
sion is reached, that quinine is a sedative. I grant every man
has a right to use any term that suits him he at the same time
explaining what he intends to convey by its use.

But from experience and common consent, the various arti-

1848.] Norwood, On Quinine. 9^

cles of the materia medica have been grouped and classed, and
the leading, direct and prominent effects or powers of each
class defined. For example, we have refrigerents or antiphlo-
gistics; nervines or antispasmodics ; tonics, narcotics or seda-
tives. " Narcotics or sedatives are articles which in single
full doses directly diminish to a greater or less extent both
morbid and non-phlogistic irritability and irritation, and mor-
bid and non-phlogistic sensibility and sensation, and conse-
quently irritative mobility in any part of the system ; at the
same time more or less perfectly obviating pain, and producing
a greater or less degree of somnolency, or even sleep."

I have given the definition of sedatives or narcotics, and as
to latitude I think I will satisfy the most fastidious. I believe
opium to possess the head and front of the above definition ;
and it would be just as absurd to deny the cathartic powers of
calomel, because it does not purge when given in very minute
quantities, as to deny the sedative powers of papaver, because
other operative effects are observed when the doses adminis-
tered are extremely small. If the above definition is correct,
or whether correct or not, it designates clearly the properties
or powers of the group, and the conditions of the system they
are intended to obviate when administered in full doses. I do
not deny but that every article which belongs to the group of
sedatives or narcotics possess other subordinate powers ; but I
feel a freedom or confidence in denying to Quinine a place,
and that it does not obviate by any direct or uniform effect the
conditions of the system specified in the above definition of
sedatives. Many of the circumstances noticed are unfriendly
to its use, and should be overcome or removed before we can
administer quinine successfully. A great degree of the kind
of irritability and irritation, sensibility and sensation, spoken of
in the definition, and the restlessness and jactitation accompa-
nying are inimical, and contra-indicate to a greater or less
extent the use of quinine. And when given alone it often ag-
gravates them to such a degree as to render it absolutely
necessary to desist or discontinue its use, however much it may
be indicated by the debility of the system or the periodicity of
the disease. And as these are the prominent conditions or

86 Norwood, On Quinine. [February,

circumstances of disease relieved by sedatives and aggravated
by quinine, it surely cannot be said to have any claim to a rank
among the sedatives, or to possess the powers of sedation.
Another, and I must think forcible and valid objection to the
sedative claims of quinine, is, that it aggravates pain, if any
should exist in the above cases, or induces pain, if it did not
previously exist.

How often have all the above operations been confirmed by
the observation and experience of physicians, and the unsought
for declarations of patients ? If, as has been stated and I am
fully persuaded that it can be demonstrated at the bed-side
that quinine increases or excites pain where it does not exist,
thus robbing it of all pretension to sedation, or to the produc-
tion of sedative results. The allaying of pain is the prominent
feature relied on by those who stand forth in vindication of its
claims to operative sedative effects. In my observation and
experience, the ground of its being a sedative is predicted en-
tirely on the fact, that it mitigates or reHeves pain in cases of
pure debility unconnected with any great degree of the irrita-
bility and irritation, &c., on the one hand, and unaccompanied
by great torpor on the other. In the one set of cases, papaver is
required in conjunction with the quinine, and in the other, acrids
(not acids).

If I have succeeded in making myself understood, or of es-
tablishing what is the true powers of sedatives and the circum-
stances of the system indicating their employment, opium must
or should be placed at the head of the list of sedatives; and
that quinine is not indicated, but that it aggravates all the im-
portant conditions and circumstances which render the admin-
istration of sedatives necessary ; for example, irritability and
irritation, restlessness and jactitation, and the pain that may
accompany these circumstances of discharge, as set forth in
the definition. In regard to the position the great anti-periodic
Quinine should occupy, I know of none more suitable or pro-
no r than at the head of the list of vegetable tonics. We
t^hould bear in mind that every group or^ class of articles is
founded on the principle of relieving or obviating certain cir-
cumstances of the system. Sedatives operate by stupifying or

1848.] Norwood, On Quinine, 87

tbrpifying, and by virtue of this property overcome or relieve
the conditions stated in the definition, and they aggravate or
produce their poisonous effects when administered in opposite
states of the system. Nervines or antispasmodics differ from
sedatives in not " being followed by any dullness, torpor, ver-
tigo, somnolency, stupor, or exhaustion ; or attended by any
increase of the strength of arterial action." Surely properties
or qualities sufficiently diversified and numerous to entitle them
to being placed in a separate group or class. And notwith-
standing these numerously different operative effects, they are
indicated to relieve very nearly the same symptoms in which
sedatives are beneficially administered. But they effect these
objects principally through their direct effects on the nervous
system ; and the operative effects of sedatives are mainly man-
ifested through the medium of the circulation or sanguineous
system. Refrigerants or antiphlogistics operate by decidedly
and directly diminishing the vigor or strength of the action of
the circulating system, and lessening the vital powers gener-
ally. Venesection, antimonials and tlie neutral salts, are ex-
amples of this group, and they relieve the irritability and irri-
tation, sensibility and sensation, restlessness and jactitation, and
pain, by diminishing the increased vigor and increased or ex-
alted vital energies on which these circumstances depend.
But surely the circumstances of the system in which they are
indicated and their manner of obviating diseased action should
entitle them to a separate group. I might run through the
whole list of articles belonging to the materia medica, but I
hope the examples I have offered will serve to illustrate what
I understand by a sedative, and in some measure the propriety
of classing articles separately ; and that quinine does not fall
within the range or province of a sedative.

It is unfortunate for medical science that so much " valuable
time is wasted and learned dust raised" in observing the minor
and subordinate powers of articles, to the neglect of their direct
and prominent powers.

88 Holman, On Foreign Bodies in the Ear. [February,

ARTICLE IX,

Cases of Foreign Bodies in the Ear, From the Note Book of
J. C. Holman, M. D., of Fayetteville, Ga.
Case I. Mrs. C, of Merriwether county, brought her Httle
nurse to my office, in 1845. She was a negro girl about nine
years of age, and had gotten a small shot in her ear three days
previous to my seeing her. I used the common small syringe,
but without success. I then used a 4 syringe, and injected
warm water freely into the ear, with considerable force. On
the second effort, the shot was thrown out on the floor. Re-
lief was immediately produced, and her hearing was not im-
paired in the least.

[Might not this case have been relieved by position, and a blow
upon the opposite side of the head to the ear affected ? We recollect a
similar instance related to us the past spring by an esteemed friend
in the interior of this Siate. He had just commenced the practice of
nicdicine in a village where a patient came to consult the Doctors for
a shot in the ear. Among many suL'gestions made, ^vas the one now
proposed, offered by this young physician. But his older brethren,
simi)le as it was, absolutely relused to try it, and went on probing the
irritated and inflamed ear with scoops, forceps, &c., and with injec-
tions, &c., &c. The patient was tinally pronounced to be beyond
relief, without new instruments could be invented and made. Re-
minded of what tlic young Doctor just returned from College had pro-
posed, he concluded in this extremity of his case to go and see him:
who, inclining his head to the side of the ear containing the shot, gave it
a sudden blow, when out dropped the foreign body to the grrat sur-
prise and gratification of the distressed sufferer and with it out drop-
j)cd all the older Doctors from said village, and in dropped our young
friend to a good and lucrative practice.]

Case II. Mr. G. brought me a negro man, aged about 35,
who stated that his wife had poured melted lead in his ear
while he was asleep. He was now in great pain, and upon
examining his ear I could see the metal. I made an effort to
remove it with a small pair of forceps, but failed. I then cut
down to the foreign body, and removed it with the forceps.
On examining the metal I found it to be a piece of pewter,
which must have been put in while in a (luid state, The
patient is now well, with the exception of total deafness in
the car.

1848.] The Medical Papers of the Philos. Magazine, 89

Case III. I was called, in 1843, to see a little girl, three
years of age, who complained of pain and deafness in the left
ear. I recommended the use of warm water injections two or
three times a day, and then a few drops of sweet oil and lauda-
num, which was continued for three days. I now re-visited
my patient, and with the 4 syringe removed what is called
here ah earwig or scolopendria,, three and a half inches long.

I have on my note book some twenty cases of foreign bo-
dies in the ear such as bugs, worms, spiders, wheat, large
lumps of wax, &c., &c., which I have never failed to remove
with the 4 syringe, which I much prefer to a smaller syringe
in such cases. I do not believe there is any danger of injury
of the tympanum with a syringe of this size, with moderate
force.

[We have no doubt that failure to remove foreign bodies from the
ear is owing, in most instances, as Dr. H. suggests, to the smallness
of the syringe. We employ Civiale's 6 ^ size.]

PART IL REVIEWS AND EXTRACTS.

ARTICLE X.

Abstracts from the Medical Papers of the Nos. of the Phi-
losophical Magazine, for 1847. By John Le Conte, M.D.,
Professor of Chemistry and Natural Philosophy in the Univer-
sity of Georgia.

^' On the Ganglia and Nerves of the Virgin Uterus.'^ By Robert
Lee, M. D., F. R. S. (Read before the Royal Society, Jan. 7th,

1847.)

The author states that his recent dissections have enabled him to
verify the descriptions he gave of the ganglia and nerves of the uterus
in his papers already published in the Philosophical Transactions,
and also to detect the existence of ganglia situated in the muscular
coat of the uterus, and of plexuses of nerves accompanying all the
blood-vessels and absorbents ramifying in its walls, between the peri-
toneum and lining membrane. By examining the hearts of a foetus,
of a child of six years of age, of an adult in the sound state, a human
heart greatly hypertrophied, and the heart of an ox, he found that
there exists a striking analogy between the gangUa and nerves of the

90 The Medical Papers of the Philos. Magazine, [February,

uterus and those of the heart. He ascertained by microscopic ob-
servation that the muscular and vascular structures of the auricles
and ventricles are endowed with numerous ganglia and plexuses of
nerves, which, as far as he knows, have not yet been described, and
which enlarge simultaneously with the natural growth of the heart,
and also continue to enlarge during its morbid conditions of hypertro-
phy. The author also finds that the size of the ganglia and nerves of
the left ventricle and auricle, in the normal state, is more than double
that of the corresponding parts on the right side. (Vide. Abstract of
Proceedings of the Royal Society in the Philosophical Magazine for
February, 1847, p, 127.)

" On a Change in the Stai.e of Vision of an Eye affected with a mal-
formation.^' By Prof. J. CiiALLis, M. A.

Twenty years ago the author communicated to the Society a state-
ment of the etTects of a mal-formation in his left eye. The rays of
light coming from a luminous point, and falling on the whole surface
of the pupil, do not converge to a point at any position wuthin the eye,
but converge so as to pass through two lines at right angles to each
other, and, in the ordinary position of the head, inclined to the vertical,
as formerly described. A.s the luminous point is moved further from
or nearer to the eye, the image of the point becomes a straight line
in one or other of the positions above-mentioned. Since 1825, the
inclinations of the two focal lines to the vertical, their length, and their
sharpness do not appear to have undergone any sensible change, but
the distances at which the luminous point must be placed to bring the
focal lines respectively exactly upon tbe retina are increased, having
been formerly 3-5 and 6 inches, and being now 4*7 and 8-9 inches.
Thus while the shortsightedness of the eye is diminished, the antag-
onism remains the same. (From Abstract of Proceedings of Cam-
bridge Philosophical Society in Philosophical Magazine for May,
1847, p. 36G.)

" Researches into the Effects of certain Physical and Chemical Agents
on the Nervous System.'^ By Marshall Hall, M. D. F. R. S.

The professed object of the author, in the present paper, is "to de-
tail the results of an investigation of the phenomena and laws of pro-
duction and action of certain secondary or induced conditions of the
nervous system, which arc cHectcd by a voltaic, and probably by any
other electric current, but ])crsistcnt after the influence of that cur-
rent is withdrawn." This condition he designates by the new term

1848.] The Medical Papers of the Philos, Magazine. 91

electrogenic, as describing at once the origin and the independence of
that condition. On the present occasion he confines himself to the
subject of the electrogenic condition of the muscular nerves, postpon-
ing to future inquiries that of the incident nerves and of the spinal
marrow ; and also the modes of action of other physical and chemical
agents, such a mechanical injury, heat and cold, strychnine, and the
hydrocyanic acid.

The bones and muscles of the brachial lumbar and pelvic regions
of a frog, being isolated from all the other parts of the body, excepting
only by means of their respective brachial and lumbar nerves, which
were perfectly denuded on all sides, and raised from the glass on
which the limbs were laid, a voltaic current from a pair of the " cour-
onne de tasses " was passed downwards through the nerves, in a
direction from their origin in the spinal marrow towards their termina-
tions in the muscles. Energetic muscular movements were at first
excited ; and the current was thus continued during the space of 5,
10, or 15 minutes, and at the end of this period was withdrawn. No
sooner was the current discontinued than the muscles were affected
with spasmodic contractions, and with a tetanoid rigidity, constituting
the secondary, or what the author denominates the electrogenic condi-
tion ; an effect, which as instantly subsides on the restoration of the
voltaic current.

The author proceeds to state the precautions which must be taken
to ensure the success of experiments on this subject ; and traces the
effects of desiccation of the nerves from spontaneous evaporation, and
of the application of external moisture, on the phenomena ; and also
the modifications introduced by varying the extent of voltaic contact.
Various experiments are then described, which the author instituted
with a view to ascertain the nature of the electrogenic condition of the
nerves, and the circumstances under which it is induced; and he is
led to the conclusion that the phenomena involve some voltaic principle
which has not hitherto been fully investigated. (From Abstract of
Proceedings of the Royal Society in Philosophical Magazine for July,
1847, pp. 72, 73.)

^^ Researches on the Function of the Intercostal Muscles and on the
Respiratory Movements^ with some remarks on the Muscular Power
in Man.''' By John Hutchinson, M. R. C. S. Communicated by
Sir Benjamin Brodie, Bart., F. R. S.

The object of this paper is to demonstrate by models and dissec-
tions the action of the intercostal muscles After premising an ac-

92 The Medical Papers of the Philos, Magazine. [February,

count of the views of several eminent physiologists, and in particular
those promulgated by Haller, the author shows that they resolve them-
selves into the general opinion that the scaleni or other muscles of
the neck fix the first rib, in order to enable the two sets of intercostal
muscles to act either separately or conjointly, as inspiratory or expira-
tory muscles. He then proceeds to state the proofs tliat the intercostal
muscles possess an action whicli is independent of any other muscle,
and also independent of each other, so that any of the 12 ribs may be
elevated or depressed by them either separately or conjointly. He
demonstrates the nature of this action by means of models, producing
oblique tensions between levers representing the ribs, and allowing of
rotation on their centres of motion ; and he shows that such tension
in the direction of the external intercostal muscles, elevates both the
levers until the tension ceases, or the position of the bars by proxim-
ity obstruct each other. If the tension be exerted in a contrary di-
rection, as in the internal intercostal muscles, the bars are both de-
pressed. This movement was demonstrated by a model. It was
farther shown that two tensions decussating can, according to the
position of the fulcra, be made to act as associates or antagonists to
each other. Such motions are to be considered with reference to the
fulcra, bars with one fulcrum common to each having no such action ;
and the author accordingly draws the following conclusions :

1st. All the external intercostal muscles are true inspiratory mus-
cles, elevators of the ribs, and with this act they dilate the intercostal
spaces, thus increasing the cavity of the chest.

2. The internal intercostal muscles have a double action ; the por.
tions situated between the cartilages are associates in action with the
external layer, and act as elevators of the cartilages, while the portion
between the ribs are depressors, or antagonists of the external layer,
and arc here true expiratory muscles ; with this they decrease the
intercostal spaces.

3. These muscles can elevate or depress the ribs independently of
any other muscle, fixing the first or last rib. Any one lamella, or
series of muscles, can, as required, independently perform inspiration
or expiration at any one of the 22 intercostal spaces.

4. In insj)iralion, the Intercostal spaces increase, with a shortening
of the muscle ; and in expiration, they decrease their perpendicular
distance, with a shortening of the muscle.

5. All parallel intercostal muscles, acting with uniform force, concur
in the same eflcct, whether near the fulcrum or more di-stant from it, and
these muscles gain power with their increasing obliquity as well as
speed.

1 848.] TJie Medical Papers of the Philos, Magazine, 93

In the 3d part of the paper an account is given of the difference be-
tween the external thoracic space and the internal pulmonic space.
The respiratory movements are described in health and disease, and it
is shown that the chest is rarely enlarged at two places at one and the
same time.

In conclusion the author conceives that he has established the fol-
lowing propositions :

1 . Costal breathing may be distinguished from abdominal, by deter-
mining which part is first put in motion, and the kind of respiration
may be designated according to the name of such part.

2. Healthy costal breathing begins with the motion of the superior
rib, which is followed by that of the lower ones in succession.

3. Ordinary respiration in men is abdominal, in women, costal ;
extraordinary breathing is the same in both sexes.

4. Any of the ribs, from the r2th to the first, may carry on respir-
ation.

5. Diseased respiration is of various kinds ; the movements may be
symmetric or not symmetric, costal or abdominal ; all or none of the
ribs may move ; the abdomen may or may not move ; the chest may
dilate in all its dimensions at one and the same time ; costal and ab-
dominal breathing may alternate with one another ; costal motion
may be undulating or not ; and all these may be combined in one,
which the author terms ^'"hesitating hreathing^^ ; and lastly, the quan-
tity of air breathed is diminished when there exists pulmonary disease.
(From Abstract of Proceedings of the Royal Society, Philosophical
Magazine, hrSeipt., 1847, pp. 223,224.)

** On the Structure and Development of the Liver. ^^ By C. Haxdfielt>
Jones, M. B., Cantab. Communicated by Sir Benja^iix C. BRODiEy
Bart., F. R. S.

The author gives a detailed description of the structure of the liver
in animals belonging to various classes of the animal kingdom. He
states that in the Bryozoon, a highly organized polype, it is clearly of
the follicular type ; and that in the Asterias, the function of the liver is
probably shared between the closed appendage of the stomach and the
terminal cceca of the large ramifying prolongations of the digestive
sac contained in the several rays. Among the Annulosa, the earth-
worm presents an arrangement of the elements of the hepatic organ,
corresponding in simplicity with the general configuration of the body,
a single layer of large biliary cells being applied as a kind of coating
over the greater part of the intestinal canal. In another member of

94 The Medical Papers of the Philos. Magazine. [February,

the same class, the Leech, in which the digestive cavity is much less
simple, and presents a number of sacculi on each side, these elements
have a very different disposition ; and the secreting cells, although
some remain isolated, for the most part coalesce to form tubes, having
a succession of dilatations and constrictions, and finally uniting and
opening into the intestine. In Insects, the usual arrangement is that
of long curved filamentary tubes, which wind about the intestine;
these, in the meat-fly, are sacculated throughout the greater part of
their course, till ihey arrive quite close to the pylorus, where they
opea; near their origin they appear to consist of separate vesicles,
which become gradually fused together, but occasionally they are
seen quite separate. The basement membrane of the tubes is strong-
ly marked, and encloses a large quantity of granular matter of a yel-
lowish tinge, with secreting cells ; another portionof the liver consists
of separate cells lying in a granular blastema, which cells, in a later
stage of development, are seen to be included in vesicles or short tubes
of homogeneous membrane, often coalescing and exhibiting a more or
less manifestly plexiform arrangement ; this portion of the liver is re-
garded by Mr. Newport as really adipose tissue. The author has
termed it the Parenchymatous portion of the liver, on account of its
general appearance and mode of development, though he has not been
able to determine whether tlie tubes always originate from it. Among
the Arachnida, the follicular type of arrangement prevails ; and the
same is the case with the Crustacea, the follicles in these last being
distinctly visible to the naked eye. In MoUusca also, we find the fol-
licular arrangement universally to obtain ; yet in certain cases the
limiting membrane of the follicles cannot be shown to exist, and the
author therefore thinks that its importance is probably not great, but
that it serves chiefly to fulfil the mechanical function which its synonym
** basement^' indicates. The quantity of retained secretion in the liver
of molluscous seems clearly to imply that the bile in them is not an ex-
crementitious fluid ; it is used slowly on account of the imperfect
character of the respiration.

In passing from the Invcrtebrata to the vertebrate division of the
animal kingdom, and beginning with the class of Fishes, a great
change is immediately manifest in the form and character of the
biliary organ; it is now a gland of solid texture, to which the term
parenchymal is justly applied. Two portions may be distinguished in
it, namely, the secreting parenchyma, consisting of delicate cells, or
very often of nuclei, granular and elaborated matters in great part,

1848.] The Medical Papers of the Philos. Magazine, 95

and the excreting ducts, which, though completely obscured by the
surrounding bulky parenchyma, may yet be satisfactorily demonstrated,
and traced often to their terminal extremities in the following manner:
If a branch of the hepatic duct be taken up in the forceps, it may be
dissected out without much difficulty from the surrounding substance,
which is very soft and yields readily to gentle manipulation ; when a
trunk is in this way removed and placed under the microscope, a mul-
titude of minute ramifications are seen adhering to it; among these
not a few may be discovered, which do not appear to have suffered in-
jury ; some are occasionally seen terminating by distinctly closed
extremities ; more usually the duct becomes very minute and gradually
loses all definite structure, appearing at last like a mere tract of gran-
ular matter ; in either case there is no communication by continuity
with the surrounding parenchyma. Large, yellow corpuscles, pecu-
liar cells, and a considerable quantity of free oily matter usually ex-
isting in the liver of various fishes, seem generally to indicate a great
superiority in the amount of secretory over that of excretory action,
and to betoken clearly the feeble intensity of the aerating function.

In Reptiles, there is the same arrangement in the liver, namely, a
secreting parenchyma of cells and an apparatus of excretory ducts,
which have the same essential characters as those of fishes; but there
exists very frequently in the parenchyma remarkable dark corpuscles,
which appear to be masses of retained biliary matter, the import of
which, in the situation they occupy, is doubtless the same as that of the
similar masses existing in tishes.

In Birds, the parenchyma of the liver is remarkably free from aily
or retained biliary matters ; it often consists almost wholly of free
nuclei and granular matter, with scarcely a single perfect cell ; the
excretory ducts often greatly resemble those of reptiles, sometimes ra-
ther those of mammalia ; the essential character is, however, always
the same, namely, that they terminate without forming any important
connection with the parenchyma.

In mammalia, the parenchyma of the liver consists usually of per-
fect cells, which are arranged often in linear series of considerable
length, radiating from the axis of each lobule ; these unite at various
points with each other, so as to present a more or less decidedly plexi-
form appearance. Each lobule, as described by Mr. Hiernan, is
separated from the adjacent ones by the terminal twigs of the portal
vein, and to a greater or less extent by a ' fissure," though in most
animals the lobules are continuous with each other both above and

06 Tlie Medical Papers of the Philos. Magazine, [February,

below the fissure. The elaboration of the secreted product seems to
be most completely efr^cted in the cells adjoining the margins of the
lobules, which are often seen to contain a larger quantity of biliary
matter than those in the interior, and to be apparently in the act of
discharging it into the fissure ; the margin of the lobule then presents
an irregular surface with large globules of the secretion clustering
together all over it. The capsule of Glisson surrounding the vessels
in the portal canals gives a fibrous investment to those surfaces of the
lobules which are towards the canal; but when it has arrived in the
fissures, it forms a continuous membrane lining the surfaces of oppo-
site lobules; this membrane is often truly homogeneous, and closely
resembles the basement tissue : there appears occasionally to be a de-
licate epithelium on its free surfiice ; but this, as well as the membrane
itself, is often absent, when the margin of the lobules is in that condi-
tion which has just been described, and which may be termed active.
The minute branches of the hepatic duct as they approach their ter-
mination undergo a remarkable alteration in their structure ; they lose
their fibrous coat, which blends itself with the membranous expansions
of the capsule of Glisson ; their basement membrane becomes gradu-
ally indistinct, and at last ceases to exist, and the epithelial particles
no longer retain their individuality, but appear to be reduced to mere
nuclei, set very close together in a faintly granular basis substance.
The mode of their termination is not uniformly the same; frequently
they present distinctly closed rounded extremities, betweeen 1 and 2
thousandths of an inch in diameter ; at other times they seem to cease
gradually in the midst of the fibrous tissue, the nuclei alone being dis-
posed for some little way in such a manner as to convey the idea of a
continuation of the duct. These ducts can seldom be discerned in the
fissures, but have several times been seen in the " spaces," where
several fissures unite ; they do not form any thing like a plexus be-
tween the lobules. From the anatomical relation of the ducts to the
parenchyma, and from the circumstance that a distinct vessel convey-
ing a different kind of blood is distributed to the hepatic duct, as soon
as the liver assumes the parenchymal form, it seems probable that the
mode in which the secreted bile is conveyed out of the organ, is by its
permeating the coats of the minute ducts in obedience to an endosmotic
attraction, which takes place between the bile in which the ducts may
be said to be bathed, and the denser (perhaps mucous) fluid formed in
their interior. The large quantity of oily matter frequently existing
in a free state in the secreting parenchyma of the liver, which must be

1848.] The Medical P<ipers of the Philos. Magazine. 97

regarded as a product of secretory action, seems to suggest the idea,
that a certain quantity of the biliary secretion may be directly absorb-
ed into the blood, and in this manner conveyed away from the organs,
just as occurs in the thyroid body, suprarenal capsules, and other glands
unprovided with efferent ducts.

With respect to the development of the liver, the author considers
the opinion of Reichart to be decidedly the correct one, namely, that
its-iformation commences by a cellular growth from the germinal
membrane, independently of any protrusion of the intestinal canal.

On the morning of the fifth day, the oesophagus and stomach are
clearly discernable, the liver lying between the heart, which is in
front, and stomach, which is behind; it is manifestly a parenchymal
mass, aqd its, border is quite distinct and separate from the digestive
canal ; at this period, the vitelline duct is wide, it does not open into
the abdominal cavity, but its canal is continued into an anterior and
posterior division, which are tubes of homogeneous membrane, filled,
like the duct, with opaque oily contents; the anterior one runs for-
wards, and forms behind the liver a terminal expanded cavity, from
which then passes one offset, which, gradually dilating, opens into the
stomach ; a second, which runs in a direction upwards and backwards,
dnd forms apparently a ccecal prolongation ; and a third and fourth,
wiiich are of smaller size, arise from the anterior part of the cavity
and run to the liver,, though they cannot be seen to ramify in its sub-
stance ; at a somewhat later period, tliese ofisets waste away, except-
ing the one which is continued into the stomach, and then the mass of
the liver is completely free and unconnected with any part of the intes-
tine. As the vitelline duct contracts, the anterior and posterior pro-
longations of it become fairly continuous and form a loop of intestine,
the posterior division being evidently destined to form the cloaca and
lower part of the canal. 'J'he final development of the hepatic duct
takes place about- the ninth day by a growth proceeding from the liver
itself, and consisting of exactly similar material'; this growth extends ^
towards the lower part of the loop of duodenum, which is now distinct,
and appears to blend with the coats of the intestine ; around it, at its
lower part, the structure of the pancreas is seen to be in process of
formation. The further progress of development of the hepatic duct
will, the author thinks, require to be carefully examined, but the de-
tails he has given in this paper have satisfied him of the correclncss of
the statement that the structure of the liver is essentially parenchy-
mal.(From idem., pp. 224-227.)

98 Observations on Enlarged Tonsils, [February,

Observations on Enlarged Tonsils.. By Frank H. Hamilton,
M. D., Professor, &c. (Buffalo Medical Journal.)

1 have brief notes of 52 cases of enlarged tonsils which I
have extirpated. The notes have been made chiefly by my
students, and are not as full or systematic as I wish they were ;
yet the experience which they embody is perhaps worth re-
cording. I have made some operations in addition to these in
my note book, but in the following summary and conclusions,
I shall endeavor to confine myself to such practical inferences
as the recorded cases alone will justify.

Pathology. In all the above cases the glands have been
simply enlarged and slightly indurated, except that in six or
eight instances a few small tubercular deposites have been
found in them. I have never seen them schirrous, or affected
with any other malignant disease. Of some 50 or more pre-
served in alcohol, and in the College Museum, not the slightest
difference can be seen in their structure ; and as to size, the
largest is not more than sixteen lines in length, and eight in
breadth.

Etiologi/. Among the causes assigned by the parents and
friends, or by the patients themselves, 10 are set down as at-
tributed to scarlatina, 7 to whooping cough, 3 to croup, 18 to
hereditary predisposition, as shown in its having occurred in
tbe parents or other members of the flimily, and the balance
are unaccounted for. Many of these patients had a scrofulous
look, and some had, at the same time, enlargements of the
lymphatic glands of the neck.

Age at which the Enlargement urns first noticed. Generally
between the third or fourth and seventh year of life: from
which time they gradually increased in size until the tenth or
fifteenth year, or until they were removed.

Effects and results when left to themselves. They gradually
diminish in size after the tenth or twelfth year, and finally dis-
appear, or rather, become reduced to their normal size: so that
it is extremely rare to see enlarged tonsils after the twentieth
year. I have never seen but one after the twenty-seventh
year, and this was at the forty-second year, but the enlarge-
ment was moderate.

In the mean time, however, or, at least, during all the period
of childhood, the patient is liable to frequent attacks of acute
tonsiliiis, which alone are sometimes sufficient to permanently
impair the heahli; to a serious impediment in speech and hear-
ing, both of which I think may become permanent, but in proof
of this su))position I cannot cite any cases; it is certain, how-
ever, that it often interferes materially with the education of

1848.] Observations on Enlarged Tonsils. 99

the child. Such children are almost always dull in their stu-
dies, or timid and petulant in their manners and feelings. They
are also liable to severe attacks of croup in early life, and later
to more chronic bronchial affections.
- Local or general Therapeutic treatment. Of this 1 have but
little right to speak, since I have myself seldom resorted to any
other means than extirpation ; and I have not, because I have
seldom heard of a cure clearly traceable to these measures, but
especially because I have found the operation so simple, certain
and safe. If anything can be said in defence of therapeutic
means, I would rather leave it to those w4io have themselves
experienced their advantages.

Circumstances contra-indicatin[ an operation. The opera-
tion of excision ought not to be made when the glands are
inflamed, unless the patient is threatened with suffocation,
since the operation is then more difficult, more painful, and is
more liable to be followed by fatal inflammation, (I have seen
the operation made upon a child, ^vhose tonsils Were at the time
inflamed, terminate fatally in a few days from inflammation
extending to the larynx.) but especially because the danger
from hemorrhage is then much greater. A friend of mine, a
clergyman, applied to me to excise his tonsils, but I declined
because they were inflamed. He went next day to New York
city and called immediately upon a famous tonsil cutter, who
shaved them ofi'at once, and the w^ounds bled during three days*
The bleeding was finally arrested by the hot iron, but not until
life was almost extinct.

They ought not to be excised when no other reason can be
assicjned than that they are enlarged.

We should prefer not to make the operation, where the
patient has a hemorrhagic diathesis*

Circumstances which indicate an operation. --Ai olight to be
made w^hen from their size, the patiebt is in danger of immediate
suffocation, in whatever condition they may be. It ought to
be made, having first removed all inflammation, when they
produce deafness or impair speech, or occasion frequent attacks
of tonsilitis, or occasional attacks of laryngitis, or endanger the
developement of chronic bronchitis, or of phthsis in persons
already predisposed. Or it might be proper where, as in one
case, which will be stated hereafter, the glands w^ere affected
with an obstinate neuralgic disease.

Age at which the operation can he made^ and at ichich it is
usually 7?iade.^ThYee of my operations were made upon chil-
dren two years old, but at this acre owing to the smallness oftho
mouth, the operation is more difficult. I have made one upon
a man aged forty-two, but the large majority have been made
between the ages of four and ten years.

100 Observations on Enlarged Tonsils. [February,

Mode of operation. No one now questions the superiority
of excision to the old, tedious and terribly painful process of
ligation. The last argument upon which the ligature was sus-
tained, viz. that the knife was the most dangerous because of
the hemorrhage which might follow has long been given up :
for we know that if some little danger does actually exist from
the hemorrhage, it is much more than counterbalanced by the
danger which attends the inflammation inevitably consequent
upon the use of the ligature. I have never used the ligature
myself, but I remember to have seen it used when I was an
apprentice, and I can assure those who have never witnessed
it, that it is one of the most barbarous operations in the surgical
catalogue.

The question is now, only as to the instrument to he used in
excision. The number of instruments invented for this purpose
is very great, the majority of which have some real merit, and
will answer, for probably every man will first use that instru-
ment to which he is most accustomed, yet if I were to recom-
mend a yo?^??^' practitioner to choose, I would unhesitatingly
give preference to "Owen's" instrument. This is the instru-
ment which I have always used, and have preferred, notwith-
standing I have five or six other well made and ingenious
instruments constructed for the same purpose. In it seem to
be combined all the excellences,' with none of the faults, of other
tonsil instruments. Let me mention a few of tlie qualities which
the instrument ought to possess.

The handle should be sufficiently large to be felt in the grasp
and not too smooth^it should be set firmly on the shaft and at
a proper angle, greater than a right angle. The shaft should
be seven inches long, and three-fourths of an inch wide, so as
to separate the teeth of the patient and protect the fingers of
the operator the tonsil should be seized by forceps attached
to the instrument rather than by a pin, since, when the pin is
used the tonsil may slip off after the operation, and be swallowed,
or fall upon the rima glottidis and produce suffocation; the
forceps should be so attached upon a pivot as that the tonsil
can be drawn through the ring as much or as little as the op-
erator chooses. Those instruments whose stilets merely transfix
the tonsil without drawing it through, often fail of taking a
sufficient amount of the gland. The forceps which are moved
by the action of a spring, 1 have seen tear out it is much better
that the hand of the operator alone should control the forceps,
and especially because by the hand alone can discretion be
exercised to the amount to be removed. The teeth of the
forceps, when the- forceps are opened, should never encroach
upon the inner circle of the ring. The ring or fenestrum

1848.] Observations on Enl<irged Tonsils, 101

which is to receive the tonsil ought to be of moderate size ; if
large, it requires too much breadth at this part of the instrument.
The size which will be found adapted to nearly all, if not all
tonsils, is ten lines in breadth by twelve in length. Into this
we can always introduce the gland sufficiently far to seize it with
the forceps, and if seized, we shall never fail to be able to draw
it through as much as we choose. The edge of the knife or
guillotine must be camerated roof-shaped and not rounded,
and it must cut by "propulsion," being propelled by the thumb
of the hand which holds the instrument. Instruments that cut
by " retraction" cannot have properly shaped guillotines, nor
can such shaped guillotines be easily sharpened, and they are
objectionable also from the fact that they require one hand to
hold the instrument, while the other retracts the blade, and the
forceps must be abandoned. Besides this, it will always be
found where one hand holds the instrument and the other with-
draws the blade, that the two forces acting in opposite directions^
will not be equal, and the ring is liable to be pulled forward or
pushed backward and to slip from the gland ; but when the
thumb of the same hand w^hich grasps the handle projects the
blade, the antagonist powers are equal, and the instrument
remains steady and firm to its place.

These are a few of the principal points in the construction of
a tonsil instrument, whose value every one who operates much
will appreciate, but there are many other little details which
go to make the perfect instrument, and which require an
experienced cutler to properly supply.

If the instrument is not perfect, I would rather use a long
pair of forceps and a probe pointed bistoury, yet I object to
these generally, because the operation with the bistoury is more
difficult, and exposes the mouth and tongue to be badly cut, an
accident which can never happen with a w^ell constructed
tonsil instrument. -(Owens' instrument may be had at his cut-
ler's shop in Albany.)

The patient being seated before a strong light, the instrument
is introduced with its " back" (by the "back" I mean that
surface upon which the forceps lie, and by the " face," the
opposite surface) applied to the tongue, and its " face" directed
to the roof of the mouth : and in this way it is carried below
the tonsil, and the tonsil is made to drop into it by pressing
from below a highly practical point, which constitutes nearly
all the art of seizing the gland the " face" is then turned
obliquely upwards and outwards and pressed snugly upon the
tonsil, while the forceps is made to seize it, andby steady trac-
tion draw it through. If the gland is larsfe, the forceps should
be moved laterally and slowly. The thumb now completes the
operation by firmly thrusting the knife forv/ard.

102 Observations on Enlarged Tonsils, [February,

When, owing to the inabihty or disinclination of the patient
to control the tonp^ue, it is so thrust about that the tonsil cannot
be kept in view, the forefinger of the hand not employed in
holding the instrument may be held in the ring until the tonsil
is felt to be fairly entered, and then the same hand may be
withdrawn to seize the forceps, and the balance of the operation
will be completed as before described. So easy is it to adjust
the gland and seize it by the sense of feeling alone, that, as my
students will remember, I seldom look into the mouth during
the operation, and yet, if it is large enough to be seized at all,
I never fail to bring it out, and so far as I am myself concerned,
I haA-e come to prefer this mode of operating, yet I cannot say
that those unaccustomed to the operation would not operate
better when the gland is in sight.

Hemorrhas;e from the loound. The amount is generally
trifling, usually not more than half an ounce occasionally it is
two or three ounces. If it does not cease spontaneously in a
minute or two, a gargle of cold water will arrest it in most
cases: but if this fail, let the neck be freely exposed, and a
jieck-cloth filled with snow placed about the neck, and espe-
cially opposite the seat of the tonsil. If snow cannot be obtain-
ed, pounded ice, or even cold wet cloths will answer. This
plan I have never seen fail' of arresting the bleeding most
promptly, even where the most powerful astringents and caus-
tics had already been resorted to with no effect, or with the
effect only of increasing the hemorrhage at each application
by disturbing the partially formed coagula. In only three
cases of all the number operated upon, has the bleeding been
alarming. The two first, a girl and a boy, both a little past
the age of puberty, occurred, by a singuhir coincidence, on the
same day. I had removed about two-thirds of each gland in
both patients. One bled until partial syncope occurred, and
the olhci' was finally arrested by the snow applied to the neck,
jand short of syncope. This was my first trial of the snow
neck-cloth, and |t succeeded after a full trial of a great variety
of gargles, &c. Tiie last case was a 3'oung lady aged 15, and
of a strong hemorrhagic diathesis, of which I knew nothing
until after the operation. Nor was I informed of the bleeding,
which had only come on after she had reached home, until she
was already much exhausted. The snow neckerchief again
promptly arrested the bleeding, and it did not return.

From this accident therefore the operator has little to fear;
nor need he apprehend more danger when he cuts "off two-
thirds, or even the whole of the gland, than when he merely
shqives it or halves it. I have repeatedly, as many witnesses
can testify, removed the gland entire, and not more than one or

1848.] The Curability of Insanity. 103

two table-spoonfuls of blood have followed; while the most
alarming bleedings which have occmTed were from wounds
which left a portion of the glands in situ. No good reason
then can be assigned why the gland should not be more
fairly extirpated fhan has been usually recommended and
practised.

Other accidents. No other accidents are liable to follow a
properly made operation. The -inflammation is usually very
slight, and seldom requires any treatment. In a week or ten
days, the soreness is entirely gone.

Results. If no good reason can be assigned why the gland
should not be removed more fairly Hhan is generally recom-
mended, a sufficient reason can be assigned why it ought to be.
When the whole or two thirds of the gland is cut away, no
more trouble is experienced from this source, but when one-half
or one-third is removed, the balance does not generally disap-
pear, and not unfrequently it again enlarges. This remark
does not agree with the experience of some surgeons who have
written upon this subject, and who, believing that if one-half or
one-third is cut away the remainder will soon disappear, do
not think it necessary to remove more than half at any time.
But I have again and again seen cases in which the operation
was thus imperfectly made, return to have them re-excised.
Some of these have been my own cases, and in which I pre-
dicted at the time that the glands would be very likely to
trouble them again. In no case, however, in which two-thirds
has been removed, have the patients returned.

Neither the speech or the hearing are improved until after
the lapse of months after the operation is made. I have never
known the speech to be injured by the operation ; the appre-
hensions which some have felt upon this score do not seem to
rne to be well founded.

The Curability of Insanity ; as illustrated by the Records of the
Blooming dale Asylum for the Insane. By Pliny Earle,
M. D.-^(Annalist;)

It appears that, from the time of the opening of the Asylum,
June 16th, 1821, to December 31st, 1844, one thousand eight
hundred and forty-one insane persons were received as
patients.

The table subjoined exhibits the condition of those who had

been discharged, and the numbers still remaining: in the A
lum.

sv-

y-

104

The Curability of Insanity,

[February,

MALES.

FEMALES.

TOTAL.

Cured, ....

,

408

264

672

Much improved,

,

58

46

104

Improved, ,

,

176

142

318

Relieved, . .

,

6

1

7.

Unimproved,

,

2

1

3

Discharged bj request of friends,

mostly

unimproved, .

.

222

179

401

Eloped, condition not stated,

,

26

4

30

Died, . . .

148

79
716

227

Whole number discharged, .

1046

1762

Remain, ....

44

35

79

Whole number admitted, . . 1090 751 1841

One thousand seven hundred and sixty-two patients were
discharged, of whonn one thousand and fortj^'-six were men, and
seven .hundred and sixteen women. Of these four hundred and
eight men and two hundred and sixty-four women were cured,
making a total of six hiindred and seventy-two.

There were forty-two of the foregoing patients, twenty-
three of whom were men- and nineteen w^omen, who, after a
short residence in the Institution, were discharged as follows :--
Much improved, , , . 9

Improved, . . . . 16

Relieved, .... 1

Discharged by request of friends, 14

Eloped, 2

but, after a brief absence, were re-admitted, and finally dis
charged cured. These cases should, most unquestionably, ba
added to the cures in the foregoing table.

It is now (August, 1847) upwards of two years and a half
since the close of the period embraced by these statistics. At
that time, as will be perceived by the table, there remained in
the Institution seventy-nine patients, who were here on their
first admission. A large proportion of these were old, incura-
ble cases, which had been in the Asylum for many years.

A sufficient time has now elapsed to test the curability of the
few whose disease was of a more recent date. The subjoined
list exhibits the present condition of the seventy-nine patients
in question :

MALES.

FEMALES.

TOTAL

Discharged cured, .

4

6

10

li

much improved,

0

3

3

a

improved.

8

3

11

a

unimproved,

7

8

15

Died,

. . . .

4

3

7

Remaining;, all incurahle, ,

21

12

33

1848.] The Curability of Insanity^ 105

The results in this table should also be added to the foregoing.

It is not unfrequently the case, that a patient who is pro-
gressing towards recovery is, through the anxiety of friends,
prematurely removed, before a cure has been established.
Eighteen cases of this kind, of which thirteen were discharged
much improved, four improved, and one by the request of
friends, the condition not stated, are known to have perfectly
recovered soon after leaving. It is probable that there may
have been more.

Our object being to ascertain, as near as possible, the curabili-
ty of Insanity, it is very apparent that these cures, also, should
be included in the original list. Indeed, it is but justice to the
Institution that they should be included, inasmuch as, if they
were cured by any system of treatment, it was that which was
pursued here.

After these explanations, it appears that the cures were as
follows :

3IALES. FEMALES. TOTAL.

Discharged cured previously to Dec. 31, 1844, 408

" cured subsequently,

" not cured on first admission, but
cured on re-admission,
Known to have recovered after discharge,

Aggregate, . . 441 . 301 742

As all the foregoing cases which remain in the Institution
are believed to be incurable, and as those who were discharged
not cured have become widely scattered, and mostly lost sight'
of, it is probable that this table exhibits all, or very nearly all,
who will ever be known to have been cured. This makes the
per cent, of cures on all admissions 40*30. On the men it was
40-46, on the women 40-08.

Some authors believe that, of the insane, females are more
curable than males. In these cases, however, as will be per-
ceived, the comparative curability of the two sexes is somewhat
in favor of the men.

It would hardly be justifiable to leave the subject of cures,
without referring to a cause which has operated unfavourabl5^
upon the curability of the patients, taken as a whole, that have
been received into this Institution. When the Asylum was
first opened, fifty-two were transferred to it from the old
Asylum. A great majority of these were chronic and incurable
cases, which had been accumulating in that Asylum for many
years. This fact will become evident if illustrated by the his-
tory of those cases, subsequent to their admission into this
Institution, which is as follows :

, 408

264

672

4

6

10

23

19

43

6

12

18

106 The Curability of Insanity, [February,

MALES.

FEMALES.

TOTAL.

The whole number was, .

32

20
0

52

Discharged cured, .

4

4

" much improving,

.

1

0

1

" improved,

2

3

5

" by request of friends,

mostly

unimproved,

.

17

10

27

Eloped, condition not stated.

.

0

1

1

Died,

.

2

3

5

Remaining, Dec. 31st, 1844, .

6

3

Q

Total, ... 32 20 52

Thus it appears that only four of these cases were cured.
This is equivalent to but 7.7 per cent.

The condition of the patients who were received from the
Almshouse, in considerable numbers at a time, was very similar
to those who were brought from the old Asylum. In the
several transfers of patients which took place between the
Almshouse and this Institution, several were brought here
more than once. The whole number of first admissions was
sixty-six, of whom twenty-nine were men and thirty-seven
women. Of these, only four men and twelve women, a total
of sixteen, were cured ; and of all that were re-admitted, a re-
covery did not take place in a single case. Hence we have

MALES. FEMALES. TOTAL.

Admitted from old Asylum, . . 32 20 52

Admitted from Almshouse, . . 29 37 66

Total, . 61 57 118'

Of all these there were cured but . 8 12 20

Now, subtracting these cases from the whole number of ad-
missions, and their cures from the whole number of cures.

We have the per cent, of cures in men, . , 42.08
Do. women, . 41.64

Do. both sexes, . 41.90

Physicians to Institutions for the Insane are frequently ques-
tioned in reference to the time necessary to effect a restoration,
in cases of insanity. The following table shows the term of
residence in the Asylum of all the patients who were discharged
cured :

Less than one month,
From one to two months, ,
From two to three months,
From three to four months,

MALES.

FEMALES.

TOTAL.

45

31

76

76

37

113

66

41

107

61

41

102

29

25

54

25

20

45

29

17

46

10

12

22

8

6

14

]3

5

18

5

7

12

n

4

15

23

12

35

7

6

13

1848 J Tfie Curability of Insanity, 107

From four to five months, .
From live to six months, .
From six to seven monihs,
From seven to eight months,
From eight to nine months,
From nine to ten months,
From ten to eleven months,
From eleven to twelve months,
From one to two years.
Upwards of two years,

The whole number who were in the Asylum less than three
months each is two hundred and ninety-six. This is equiva-
lent to forty-four in every hundred that w^ere cured. The
whole number from three to six months is two hundred and
one, or thirty in every hundred. The whole number from
six to twelve months is one hundred and twenty-seven, nearly
nineteen in every hundred.

The whole number who were here upwards of one year each
is forty-eight, or seven in every hundred.

The mean or average term of residence in the Asylum was^
for the men, four months and twenty-seven days, and for the
women five months and twenty-six days.

Setting aside the thirteen cases in which the persons were
here more than two years each, the average time will be, for
men, four months and ten days, arid for women, four months
and twenty-five days.

The mean or average time of residence of both sexes in-
clusive is five months and eight days. Excluding the thirteen
cases before mentioned, it is four months and sixteen days.

Many people who take their friends to an institution of this
kind, appear to be impressed with the idea, that, if a restoration
be possible, it can be effected in a few days, as if it were an
ordinary fever. But insanity, particularly if reference be had
to those cases alone which are sufficiently prolonged to induce
their friends to remove them to an Asylum, is essentially a
chronic disease, and, even under the most skilful management,
requires a considerable time for its removal, and the establish-
ment of mental health. Were it possible always to induce the
friends and guardians of patients to leave them at the Asylum
a sufficient time, fully and satisfactorily to test their curability
by the restorative means here employed, the recoveries would
unquestionably be augmented, and that to no inconsiderable
extent. At the Retreat, near York, England, where every
patient is retained, if not cured, until all curative resources are
exhausted, it is stated by the officers of that institution, that
thirty-five per cent, of all the recoveries do not take place un-
i\\ the patiejits have been in the Asylum n)ore than a year.

108 Discovery of a New Ancesthetic Agent, <^-c. [February,

Discovery of a New Ancesthetic Agent more efficient than Sul-
phuric Ether. By J. Y. Simpson, M. D., Professor of Mid-
wifery in the University of Edinburgh, Physician-Accouch-
eur to her Majesty in Scotland, &c. (London Med. Times.)

At the first winter meeting of the Medico-ChirurgicaJ Society
of Edinburgh, held on the 10th Nov. last, I had an opportunity
of directing the attention of the members to a new agent which
I had been using for some time previoudy for the purpose of
producing insensibility to pain in surgical and obstetric practice.

This new anoesthetic agent is chloroform, chloroformyle, or
perchloride of formyle.* Its composition is expressed by the
chemical formula C^ H CI3. It can be procured by various
processes, as by making milk of lime or an aqueous solution ol
caustic alkali act upon chloral ; by distilling alcohol, pyroxilic
spirit, or acetone with chloride of lime ; by leading a stream ot
chlorine gas into a solution of caustic potass in spirit of wine, &c.
The resulting chloroform obtained by these processes is a hea-
vy, clear, transparent liquid, with a specific gravity as high as
1*480. It is not inflammable. It evaporates readily, and boils
at 141. It possesses an agreeable, fragrant, fruit-like odour,
and a saccharine, pleasant taste.

As an inhaled anaesthetic agent, it possesses, I believe, all
the advantages of sulphuric ether, without its principal disad-
vantages,

1. A greatly less quantity of chloroform than of ether is
requisite to produce tlie anaesthetic effect, usually from a hun-
dred to a hundred and twenty drops of chloroform being suffi-
cient, and with some patients much less. I have seen a strong
person rendered completely insensible by seven inspirations of
thirty drops only of the liquid.

2. Its action is much more rapid and complete, and generally
more persistent. I have almost alvv^ays seen from ten to twenty
inspirations suffice, sometimes fewer. Hence the time of the
surgeon is saved ; and that preliminary state of excitement
which pertains to all narcotizing agents being curtailed, or,
indeed, practically abolished, the patient has not thesame degree
of tendency to exhilaration and talking.

3. Most of those who know from previous experience the
sensations produced by ether inhalation, and who have subse-

* In makinfj^a variety of experiments upon the inhalation of different volatile
chemical liquids, I have, in addition to pcrchloi jde ol'lormyle, breathed chloride
of hydro-carbon, acekjne, nitrate oi* oxide ol etiiyle, benzin, the vapour otiodo-
form, &c. I may probably take another opportunity ot describing the results.
It is, perhaps, worthy of remark, that, in peribrminjj: his experiments upon in-
halation. Sir Elumphrey Davy confined his attention to the inspiration of jjase,
and does not seem to have breathed any volatile liquid.

1848.] Discovery of a New Ancesthetic Agent, <^c. 109

quently breathed the chloroform, have strongly declared the
inhalation and influence of chloroform to be far more agreea-
ble and pleasant than those of ether.

4. I believe that, considering the small quantity requisite as
compared whh ether, the use of chloroform will be less ex-
pensive than that of ether, more especially as there is every
prospect that the means of forming it may be simplified and
cheapened.

5. Its perfume is not unpleasant, but the reverse; and the
odoiir of it does not remain for any length of time attached to
the clothes of the attendant, or exhaling in a disagreeable form
from the lungs of the patient, as so generally happens with sul-
phuric ether.

6. Being required in much less quantity, it is much more
portable and transmissible than sulphuric ether.

7. No special kind of inhaler or instrument is necessary for
its exhibition. A little of the liquid diffused upon the interior
of a hollow-shaped sponge, or a pocket-handkerchief, or a piece
of linen or paper, and held over the mouth and nostrils so as to
be fully inhaled, generally suffices in about a minute or two to
produce the desired effect.

I have had an opportunity of using chloroform with perfect
success in several surgical operations (removal of tumours, of
necrosed bone, partial amputation of the great toe,) and in
tooth-drawing,* opening abscesses, for annulling the pain of
dysmenorrhcea and of neuralgia ; in two or three cases when I
was using deep and otherwise very painful galvano-puncture
for the treatment 'of ovarian dropsy ; in removing a very large
fibrous tumour from the posterior wall of the uterus by
enucleation, &c. f

I have employed it also in obstetric practice with entire
success. The lady to whom it was first exhibited during

* A young dentist, who has himself had two teeth extracted lately one under
the influence of ether, and the other under the int]uence of cloroform writes
me the following statement of the results: "About six months ago I had an up-
per molar tooth extracted whilst under the influence of eiher, by Mr. Irnlach,
The inhalation was continued for several minutes before I presented the usual
appearance of complete etherization; the tooth was extracted, and, although I
did not feel the least pain, yet I was conscious of the operation being performed,
and was quite aware when the crash took place. Some days ago I required
another molar extracted on account of loothat^he, and thi operation was again
performed by the same gentleman. T inhaled the vapour of chloroform, half a
drachm being poured upon a handkerchief for that purpose, and held to my nose
and mouth. Insensibility took place in a few seconds; but I was so completely
dead this time that I was not in the very slightest degree aware of anyihingthat
took place. The subsequent stupifying effects of chloroform went of more ra-
pidly than those of ether, and I was perfectly wll and able for my work in a few
minutes."

f 1 have now exhibited chloroform to about fifty individuals, and in not one
has the slightest bad effect oi any kind resulted.

110 Discovery of a New Ancesthetic Agent, SfC. [February,

parturition had been previously delivered in the country by
craniotomy, after a labour of three days' duration. In this, her
second confinement, pains supervened a fortnight before th6
full time. Three hours and a half after theycommenced, and
ere the dilatation of the os uteri w^as completed, I placed her
under the influence of the chloroform, by .moistening, with half
a teaspoonful of the liquid, a pocket-handkerchief rolled up in a
funnel shape, and with the broad or open end of the funnel
placed over her mouth and nostrils. In consequence of the
evaporation of the fluid, it was once more renewed in about
ten or twelve minutes. The child was expelled in about
twenty-five minutes after the inhalation was begun. The
mother subsequently remained longer soporose tha-n commonly
happens after ether. The squalling of the child did not, as'
usual, rouse her ; and some minutes elapsed after the placenta
was expelled, and after the child was removed by the nurse
into another room, before the patient awoke. She then
turned round, and observed to me that she had " enjoyed a very
comfortable sleep, and, indeed, required it, as she was so tired,*
but would now be more able for the work before her." I
evaded entering into conversation with her, believing, as I do,
that the most complete possible quietude forms one of the
principal secrets for the successful employmelit of either ether
or chloroform. In a little time she again remarked that she
was afraid her" sleep had stopped the pains." Shortly after-
wards her infant was brouglit in by the nurse from the adjoining
room, and it was a matter of no small difficulty to convince the
astonished mother that the labour was entirely over, and that
the child presented to her was really her " own living baby."

Perhaps I may be excused for adding that, since publishing
on the subject of ether inhalation in midwifery, seven or eight
months ago^ and then for the/ first time directing the attention
of the profession to its great use and importance in natural
and morbid parturition, I have employed it, with few and
rare exceptions, in every case of laboiu' that I have attend-
ed, and with the most delightful results, and I have no
doubt whatever that some years hence the practice will be
general. Obstetricians may oppose it, but I believe our pa-
tients themselves will force the use of it upon the profession. f
I have never had the pleasure of watching over a series of bet-

* In consequence of extreme anxiety at the unfortunate result of her previous
confinement, she had slept little or none for one or two nights preceding the
commencement of her present accouchment.

t I am told that the London physicians with two or three exceptions only, have
never yet employed ether inhalation in midwifery practice. Three weeks ago I
was informed in a letter j'rom Prof. Montgomery, of Dublin, that he believed
that in that city, up to that date, it had not been used in a single case of labour.

1848.] Discovery of a New Anaesthetic Agent, <^c. 111

ter and more rapid recoveries ; nor once witnessed any disa-
greeable result follow either to mother or child ; whilst I have
now seen an immense amount of maternal pain and agony
saved by its employment. And I most conscientiously believe
that the proud mission of the physician is distinctly twofold,
namely, to alleviate human suffering, as well" as to preserve
human life.

In some remarks which I published in " The Monthly Journal
of Medical Science," for Sept., p. .154, relative to the conditions
for ensuring successful etherization in surgery, I took occasion
to insist upon the three foHowing leading points:

"First, the patient ought to be left, as far as possible, in a state of
absolute quietude and freedom from mental excitement, both during
the induction of etherization, and during his recovery from it. All
talking and all questioning should be strictly prohibited. In this way
any tendency to excitement is eschewed, and the proper effect of the
ether inhalation more speedily and certainly induced. And secondly,
with the same view, the primary state of exhilaration should be entire-
ly avoided, or at least reduced to the shortest possible limit, by impreg-
nating the respired air as fully wdth the ether-vapour as the patient
can bear, and by allowing it to pass into the lungs, both by the mouth
and nostrils, so as rapidly and at once to induce its complete and
anaesthetic effect * * * g^ ygj.y common, but certainly a very
unpardonable error, being to exhibit an imperfect and exciting, in-
stead of a perfect and narcotizing, dose of the vapour. Many of the
alleged failures and misadventures are doubtless entirely attributa' le
to the neglect of this simple rule ; not the principle of etherization, but
the mode of putting it in practice being altogether to blame. But,
thirdly, whatever means or mode of etherization is adopted, the most
important of the. conditions required for procuring a satisfactory and
successful result from its employment in surgery, consists in obsti--
nately determining to avoid the commencement of the operation itself,
and never venturing to apply the knife, until the patient is under the
full influence of the ether vapour, and thoroughly and indubitably
.soporized by it."

In fulfilling all these indications, the employment of chloro-
form eviclently offers great and decided advantages in rapidity^
facilty, and efficiency over the employment of ether. When
used for surgical purposes, I would advise it to be given upon
a handkerchief, gathered up into a cup-like form, in the hand
of the exhibitor, and the open end of the cup placed over the
mouth and nostrils of the patient. For the first inspiration or
two it should be held at the distance of an inch or so from the
face ; and then more and more closely applied to it. To ensure
a full and perfect anaesthetic effect more especially when the
operation is to be severe ateaspoonful of the chloroform should
at once be placed upon the hollow of the handkerchief, and

112 Discovery of a New Anaesthetic Agent, <^c. [February,

immediately held to the face of the patient. Generally a snoring
sleep very speedily supervenes ; and when it does it is a per-
fect test of the superinduction of complete insensibility. But
many patients are quite anaesthetic without this symptom.

As an illustration of the influence of this new anaesthetic
agent, I will select and append notes of two operations perform-
ed with it on Friday last by Professor Miller the first in the
Royal Infirmary of Edinburgh, * the other in private practice.
The notes and remarks are in Mr. Miller's own words.

Case I. " A boy, four or five years old, with necrosis of one of the
bones of the forearm. Could speak nothing but Gaelic. No means,
consequently of explaining to him what he was required to do. On
holding a handkerchief, on which some chloroform had been sprinkled,
to his face, he became frightened, and wrestled to be away. He was
held gently, however, by Dr. Simpson, and obliged to inhale. After
a few inspirations he ceased to cry or move, and fell into a sound
snoring sleep. A deep incision was now made down to the diseased
bone; and, by the use of the forceps, nearly the whole of the radius,
in the state of sequestrum, was extracted. During this operation, and
the subsequent examination of the wound by the hnger, not the slight-
est evidence of the suffering of pain was given. He still slept on
soundly, and was carried back to his ward in that state. Half an hour
afterwards he was found in bed, like a child newly awakened from a
refreshing sleep, with a clear, merry eye, and placid expression of
countenance, wholly unlike what is found to obtain after ordinary
etherization. On being questioned by a Gaelic interpreter who was
found among the students, he stated that he had never felt any pain,
and that he felt none now. On being shown his wounded arm, he
looked much surprised, but neither cried nor otherwise expressed the
slightest alarm."

Case II. " A young lady wished to have a tumour (encysted) dis-
sected out from beneath the angle of the jaw. The chloroform was
used in small quantity; sj)rinklcd upon a common operation sponge.
In considerably less than a minute she was sound asleep, sitting easily
in a chair, with her eyes shut, and vvith her ordinary expression of
countenance. The tumour was extirpated, and a stitch inserted,
without any pain having been either shown or felt. Her sensation.s
throughout, as she subsequently stated, had been of the most pleasing
nature; and her manageableness during the operation was as perfect
as if she had been a wax doll or a lay figure.

" No sickness, vomiting, headach, salivation, uneasiness of chest, in
any of the cases. Once or twice a tickling cough took place in the
first breathings."

Professor Dumas, (of Paris,) Mr. Milne Edwards, Dr. Christison, Sir
Geor<^e Ballino^all, and a L'lri^'e collection of professional gentlemen and students
witnessed this operation and two others perlbrmed with similar success by Prof.
Miller and Dr. Ducan.

1848.] Conclusions respecting Hysteria. 113

The following conclusions respecting Hysteria are arrived
at by Professor C. Forget of Strasbourg. (Translated from
Gazette Medicale de Paris.)

1. Hysteria frequently attacks persons belonging to the poor and
unfortunate class of society.

2. It often atfect^s the sanguine and robust constitutions.
3i It attacks both sexes ; but very rarely the male sex.

4. Hysteria is frequently produced where there is an absence of eve-
ry material and functional lesion of the genital organs.

5. Spinal irritation as formally announced by authors as necessary
to hysteria is an error in fact.

6. It is probable, but it so not demonstrated that hysteria is quite
often associated with lesions of the uterus and especially of the
ovarium.

7. Hysteria is produced sometimes secondary to a lesion of the
blood and of several viscera; but it is often primitive and the product
of a nervous diathesis or special neuropathy ^

8. The nervous diathesis or neuropathy is an essential condition
and necessary to the manifestation of hysteria, even when this is se-
condary.

9. The determining causes of an hysterical attack is oftener moral,
or a physical cause whose seat is very variable.

10. The phenomena of hysteria are extremely diversified, and de-
rive its character rather from the disease than from any particular
symptoms.

11. Hysterical attacks are oftenest manifested by convulsive phe-
nomena, with which are fr^^quently United disturbance of intellect.

12. Hysteria often clothes itself in the livery of other affections :
this constitutes hysteria.

13. Hysteria is one of the most obstinate of diseases, and most sub-
ject to returns ; one should not confound a suspension, even for a long
time, with the radical cure of its attacks.

14. Hysteria is a real, special disease, which consists in a neuro-
pathy, the nature of which is unknown. Its name is an error, and
which should be changed.

15. The treatment of hysteria consists first, in removing complica-
tions when^they exist ; second, in the administration of means direct-
ed against the nervous state itself

16. There is no anti-hysterical remedy. The remedies for hyste-
ria are those which relieve the complications, then those to cure the
neuropathy sedatives, tonics, stimulants, antiphlogistics, according
to circumstances.

17. Hysteria being almost always the effect of an hygenical
error, it is by correcting this that we must look for securing a radical
cure.

114 Wormsfoundin the Heart, (^c.ofaDog. [February,

Worms found in the Heart and Bloodvessels of a Dog ; Symptoms
of Hydrophobia. By Dr. T. C. Osborne. (Western Jour,
of Medicine and Surgery.)

Drs. Jennings, Brown, Thorp, and myself, recently made a
postmortem examination of a dog that died of supposed
hydrophobia. The symptoms were those characterizing that
disease, and so well marked as to alarm and mislead the entire
communit)^ He was one of those much valued hounds, used
in hunting negroes ; an old dog, whose health had been good ;
fat, ordinarily remarkably peaceable ; but after his attack, the
disposition and appearance of the animal were completely
changed. He snapped at every living thing near him, assailing
dogs, or bitches, acquaintances or strangers indiscriminately ;
exhibited dread of water ; emaciation; convulsions; and death
ensued in ten or fifteen days from the time he w^as first observed
to be diseased.

Autopsy. The stomach and other abdominal organs were
healthy ; but the large bloodvessels were found filled with
worms; the heart contained of these at least one hundred.
The appearance of the worms was remarkably similar, differing
only in length. They were round, white, tapering towards
the tail, and from half an inch to four inches long, the thickness
varying from one-fourth of a line to one line. I did not note
as carefully as I ought the form of the head and mouth, and I
believe the same is true of the gentlemen who assisted me in
the examination.

Among the number of the bitten dogs was a pointer puppy,
which alone showed any symptoms of the same disease. It had
two fits, and during the second, leaped from a second story
window, and was so injured that its owner had it killed. No
dissection was made in this case.

Were the convulsions in these cases excited by worms ?
In the first case, I think there can be no question that they
were, and it is to be regretted that a sectio was not made of
the body of the second, to determine the fact whether worms
existed in it also. Was the disease hydrophobia ? I should
say it was not, from the flict that of the number of animals
bitten by the blood-hound, but a single one exhibited signs of
disease afterwards. Is it not probable that many of the cases
regarded as hydrophobic, are in reality diseases of a different
character, resulting from irritation in some part of the system ?
And may not worms occasionally be the cause of this irritation ?
The subject appears to me worthy of investigation, and repeat-
ed examinations of the bodies of these animals might lead to
valuable conclusions.

1848.] Frequency of Hei-nla in the Human Race. 115

Frequency of Hernia in the Human Race. (Teale's Practical
Treatise on Abdominal Hernia.)

By Arnaudit has been calulated that one-eighth of mankind
are the subjects of it. Mr. Turnbull, surgeon of the London
Truss Society, states, that " after the most diligent and general
inquiries throughout the kingdom, he is induced to take them,
male and female, and of all ages, upon an average of 1 to 15."
This estimate was sanctioned by Monro, supported by the
authority of Gimbernat, and was, for many years, generally
adopted by European surgeons. It is undoubtedly too high,
but other surgeons have erred in the opposite extreme. From
a return made by Dr. Vesturme, Inspector-General of the
German Legion, it appears, that of 40^460 recruits examined,
365 were rejected on account of their being effected with
hernia, nearly 1 in 111, or a little less than \ per centum ; and
of 12,835 recruits inspected in Dublin, 116 were rejected on
account of the infirmity, or 1 in 110 ; and it has been supposed
that these returns afford a tolerably correct view of the general
frequency of hernia, at least in the male population of European
states ; but the estimate is obviously too \ow, for many per-
sons afflicted with hernia, and knowing it to be a ground of
disqualification for military service, would on this account be
prevented from enlisting. A nearer approach to the truth, as
Jar as regards the male population of France of 20 to 21 years of
age, may be obtained from the records of the French conscrip-
tion. Thus, according to M. Malgaigne, of 10,241' persons
examined from 1816 to 1823, in the department of the Seine,
314 were hernial, or 1 in 32 ; and of 754,875 examined
throughout the whole of France, from 1831 to 1837, 24,221
were exempted on account of hernia^ or nearly 1 in 32.
Assuming, then, that there is 1 hernial subject in 32 males in
France of 20 to 21 years of- age, and calculating the relative
proportions of hernial subjects at different ages and in each of
the sexes, M. Malgaigne arrives at the following estimate-
namely, that there is one hernial subject in 13 of the whole
male population of France ; 1 in 50 of the whole female popula-
tion ; and 1 in 21-| of the entire population. From various
observations M. Malgaigne infers, that the relative proportions
of hernia in men and women is as 4 to L Other statements
show a great preponderance of hernia in the male sex ; but it
may be justly supposed that it is greater than really exists, since
women, from motives of delicacy, as well as from their being
less engaged in such laborious occupations as compel the her-
nial subject t3 seek relief, are less likely than men to be the
applicants at a public institution.

116 The alleged Removal of the Liver. [February,

The alleged Removal of the Liver. (From The Annalist.)

The following letter, kindly lent us for publication by a
medical friend, explains the mystery relating to this formidable
operation, a report of which has been current for some time in
the journals of our land, and which we discredited at the time.
A more melencholy instance of professional ignorance and
charlatanry, it has never been, and may it never again be, our
lot to meet with. The idea of supposing such an operation
possible without an immediately fatal result, is as absurd as
the inability to detect the true nature ,,of the extracted
mass is remarkable ; and the pitiful seeking after a spurious
notoriety, by extra-professional advertisement, has met its
just reward. We shall be much surprised if the quizzing he
gets, does not fret Doctor Thompson into a jaundice. Nor
should we wonder, if in Columbus, there were one liver less,
before long. De-/it'er us from such reputation, say we !

" I observed in the last number of the Boston Med. and Surg. Jour-
nal, a notice of a wonderful operation recently performed in this vicinity,
by Dr. Kreider, of Lancaster. The operation referred to, was perfor-
med by Dr. Robert Thompson^ of this city, assisted by Dr. K. Some
two weeks since, our public was astounded by the details of this
Waterloo' aflairy in the public newspapers. The liver was removed,
the ivhole liver, and nothing but the liver. Thus asserted the record,
and thus insisted the surgeons. Our physicians were sceptical, as
they are apt to be when modern miracles are performed ; for, though
they did not doubt the honesty or sincerity, or ability of their brothers^
they resorted to Hun^e's favorite argument against /Ae miracle, asser-
ting that the ST7.id brotheis were more likely to be mistaken, than that
the fact could be so. Thus matters went on for some days^ the pa-
tienty a female,, living without a hver, and being 'as comfortable as
could be expected.' In the mean time the news spread. From all
quarters went up ihe cry of wonder. Nearly every newspaper in the
land chronicled the strange event, and the bold Surgeon was ahnosi
clothed, by public acclamation, in the Uver-y oi HeavcUr At last the
women died, after having been a liver herself, jui^t long enough to
prove to the world, that she could live without a liver ! Taking one
of the editors of the press along^ the Surgeon proceded to verify beyond
all cavil, his diagnosis. It was a moment of intense excitement. Not
a word was spoken. Slowly, but confidently, did the little scalpel
unfold the mysteiies of that inner world to the gaze of day. The
integuments are divided and drawn' asunder a hand is thrust into the
cavity, to feel where the immense orfran, weighing twenty-nine pounds
and a-half, had so loni reposed. T/m if organ was not there, but in
its place, little dreaming of the noise it had made without, looked up,
with a quiet ' how d'ye do,' the real liver, which was removed no/ till
after the death of the patient. Thu5 eiods this new physiological,

1848.] Monthly Periscope. 117

pathological, surgical miracle. The Surgeon published a card the
next day, in which the /^er figured as an enormous oyariaTi tumour.
Sic transit gloria mundi,^^
Columbus, Ohio.

Is it certain that there was any- tumour at all ?

PART TIL MONTHLY PERISCOPE.

Structure of the Ganglia of the Spinal Nerves. By Rudolph
Wagner. (Comptes Rendus, May lOth, 1847.) The discov-ery of
the true structure of the ganglia, or at least of the ganglia of the spinal,
trifical and pneumogastric nerves is an important one for the physiology
of the nervous system. I found the same conformation first in the
torpedo, and afterwards in the ray and shark. Each elementary-
fibre which comes from the root of a cerebral or spinal nerve is pro-
longed into a ganglionary globule, (nervous corpuscle) in which a
nucleolus may be seen. From each ganglionary globule another
nervous fibre arises, which extends into the peripheric branches of the
corresponding nerves. Sometimes the medulla of the fil)re is seen
clearly to penetrate into the ganglionary globule itself; at others, more
delicate nervous fibres arise from them and the primitive fibres gradu-
ally enlarge and assume the ordinaiy appearance.

1 was astonished, continues Dr. W.,at this structure of the ganglia,
which must certainly be the same in man and the othe vertebrata.
This discovery will change our views of the physiology of the nervous
system, and the course we have pursued. But anatomy will always
be the basis of physiology. [Southern Jour. Med. andPhar,

Experiments on the Properties and Functions of the Spinal Cord
and their relation to those of the muscles. By M. Browis' Sequard.
(Comptes Rendus, May 10th, 1847.) From experiments on frogs, M.
Sequard shows that after the division of the spinal marrow, the animal
retains the power of contracting the muscles of the posterior extremi-
ties; that the strength of the contractions diminished for some time
after the division, but that it gradually increased, and at two hours
after the operation, the contractile power is twice as great as before
the operation. Twenty-four hours after, it is three times as great as
before ; it remains at this from five to twenty days, and then gradually
declines to below the natural standard. The force of the contractions
was measured by weights attached to the feet by small hooks. The
experiments were instituted to test the independent action of the spinal
cord as a generator of nervous power, as proclaimed by Marshall
Hall, and fully confirm it. Ih.

Are the movements of the Heart dependant on the Spinal Cord and
Brain? By Dr. Julius Budgr. (Gazette Med. de Paris, June 5th,
1847, from 4.rch. Fur. Physiol.) After passing in review the whole

118 Monthly Periscojie. [February,

subject, historically and experimentally, Dr. Budge arrives at the fol-
lowing conclusions :

1. Tile Medulla Oblongata is the central organ of the movements
of the heart, inasmuch as it maintains the irritability of the voluntary
muscles.

2. The Medulla Oblongata is also the central organ of the reflex
movements of the heart ; but its influence is not marked, because,

3. The movements of the heart are principally movements of irrita-
tion, and partake very little in the reflex movements of the rest of the
body.

4. The ganglia of the sympathetic nerve are not the central organs
of the movements of the heart ; they neither produce nor keep up its
rhythm, but appear to destroy the influence of the voluntary and reflex
principle.

5. The brain (of the frog) has no direct evident influence on the
movements of the heart, but a decided indirect influence. Ih,

On Bronchitis. By Dr. Thomas Laycock, Physician to the York
Dispensary, and Lecturer on the Theory and Practice of Medicine.

Sometimes there is little or no expectoration during or after an
attack of bronchitis ; but there is a most teasing cough. In such a
case an opiate is indicated, and may be safely given ; but you must
be very careful how you prescribe opiates in bronchitis. If the cough
is excited by the mucous contained in the bronchial tubes, and not by
an Irritable condition of the nerves or their lining membrane, it is
nature expelling an injurious thing. The mucous must be got rid of
somehow, and 1 do not know how it can be got out of the tubes except
by coughing. If you give an opiate, it is true that you give the natural
effort a quietus, but at the same time, you paralyze the sensory nerves.
You paralyze the nmscular fibres ; and -at last, when the mucous has
accumulated to such an extent that your patient must cough or die, he
cannot cough ! Old people are often complaining of their violent
morning cough -as soon as they awake they begin ; but it is because
mucous has accumulated in the bronchi during the night, and it is only
perceived by their mucous membrane M'hen sleep ceases the sentinels
have been dormant. But the mucous 7/m5^ be expelled, and, therefore,
the patient ?nust cough. The plan in these cases is to reduce the
blenorrhcea ; first, by taking care that the membrane is not irritated
by cold air, and then by suitable remedies. In the meanwhile preach
patience to your patient, and tell him his cough is his safeguard so
ioufT as the lungs are clogged with phlegm. Sometimes mothers go
to a druggist for " something for a cough " that their children had :
they got oxymel of squills and syrup of poppies, give a good dose to
quiet tlic babe at night, and in the morning send for the doctor-
its cough is stopped, it is "closed in the chest,'' its lips become livid,
and you have to repair the mischief done by the opiate. [Aled. Gaz.

Treacle as a local Remedy for Rheumatism, 'My, Vines stated to
the Reading Pathological Society, a case wlicrc a patient was suffering

1848.] Monthly Periscope. 119

from reheumatic pains of the legs, and had been treated by eminent
men in various ways without relief, when an old nurse recommended
the legs to be wrapped in flannel soaked in treacle for some days, which
procured him complete relief He therefore thought there was some
sedative influence in the treacle. [Prot*. Med. and Surg. Journal.

Nitrate of Stryclinia externally in Gout. M. Wendt recommends
the nitrate of strychnia, in the form of ointment, in irregular gouty
affections ; for example, in gouty aftections of the vertebral column,
which, through the filaments of the great sympathetic, attack the chest
and give rise to symptoms imitating angina pectoris. The formula
recommended is as follows: nitrate of strychnia 10 parts; axunge 8
parts: to be made into a perfectly homogeneous ointment, and applied
by friction on the sides of the spine two or three times a day. [-4m.
Jour. Med. Sciences ^ from Gazette Medicale de Paris.

Treatment of the Nocturnal Cough of Infants. M. Behrend of Ber-
lin, has successfully employed for the removal of nocturnal cough in
infancy, light purgatives ; such as manna or tincture of rhubarb ad-
ministered in the evening. The eflect is aided by the administration
of drachm-doses of solution of acetate of ammonia given at bed time.
Small doses of sulphate of quinine have also been found serviceable.
[Charleston Med. Journ. and Rev., from Gaz. Med,

Lunar Caustic for Cough. Dr. Post, in a case of distressing cough,
which came on at night and lasted several hours, used, with the happi-
est eflccts, a strong solution of Arg. Nit. applied to the fauces. No
disease could be detected in the chest, but the uvula was enlarged, and
the pharynx and fauces were somewhat redder than natural. A solu-
tion 3ij. to gj. water was applied, and with complete relief, though the
cough just before had been violent ; and the patient remained almost
free from it for the next twenty-four hours, [Annalist.

Specific of Deschamps. The following formula, recommended by
its author as a remedy for all diseases, we give to our readers. It is a
good formula, and may be found useful when prescribed with discre-
tion:

Pulverized Jalap, , .... 7 drs,
" Aniseed, . . . 1^ '^

Alcohol, 6 ozs.

Macerate four days and shake frequently during maceration.
Chopped Sarsaparilla, ... 6 ozs.
Pulverized Rhubarb, . . . Ij ''
" Aristolochia, . . 1 oz.
" China Brier, . . 1:^ oz.
Dissolve in a sufficient quantity of water to boil for two hours, then add
to the decoction, Senna leaves, chopped Sassafras, of each 3 ozs.
After having infused these two substances tor some time in the decoc-
tion, strain and express, then add, Soft Sugar 8 lbs., Honey, 16 lbs.

120 Monthly Periscope. [February,

Boil to the consistence of very thick syrup, and when cold pour into
bottles. Divide the alcoholic infusion, previously fiUered, into as many
doses as there are bottles of syrup, and mix exactly each dose with
each bottle, by moans of a spoon, in a large vessel. This is important.
Take care to shake the bottle before using the syrup. [Charleston
Med. Journ. and Rev.

Discharge of a Tooth from the Ear. By Mervin Coates, M. D. -
The following curious case happened in my practice. At the time of
its occurrence I resided in the Isle of Wight. In the summer of 1846,
being myself absent from home, a friend was called upon to attend an
old, poor man, who had suffered for some days from severe pain over
the whole of one side of the face and head, but more intensely still
about the ear. He found him feverish, in great pain, and incapable
of opening hi3 mouth ; the pinna and skin lining the external meatus
were highly inflaj-ned and, swollen. Warm fomentations, poultices,
and purgatives, were ordered. Two days afterwards I paid him a
visit : he was then in great pain, and, otherwise much in the sanie
state as I have already described, but, in addition, there was an oozing
of pus from the meatus, and almost entire closure of that passage by &.
whitish substance, which the patient conjectured to be a piece of onion,
introduced there by the recommendation of some old woman, but
which a probe detected to be bony. The patient declining to have
this removed, he was recommended to continue to foment and poultice,
That same nighta fit of sneezing forced out the piece of bone felt by
the probe, which proved to be one of the wisdom-teeth of the upper
jaw ; after that the man got well. [Lo7idon Lancet.

Treatment of Neuralgia hj Superficial Cauterization. The treat,
ment of neuralgia and of its painful symptoms has, as well as that of
many other diseases, derived some beuefit from ethereal inhalations.
It is not only to the temporary arrest of pain during insensibility that
we refer, but to the method recommended by M. Yallei^f, and which
has already in several instances been productive of the most advantage-
ous results. Thirteen cases of neuralgia, -occupying various seats,
are recorded in the Union Medicale, by M. A. Notta ; ten were
speedily cured, two were relieved only partially, and in one no benefit
was derived froni the treatment, which consisted of very superficial
cauterization with the actual cautery during ethereal insensibility.
In several instances one application was sufficient ; in others it had to
be repeated a second time. [Med. Times, Oct. 30. Med. News,

Prescrihing in Nev\spapers. Sir : Can we be surprised at the num-
ber of deaths which daily occur in children, when we see such para-
graphs as the following, in a paper largely circulated amongst the poor?

"Cure for Dvsentkry. Haifa noggin of logwood, well boiled
and strained, half agljiss of port wine, and twenty di'ops of laudanum,
have proved successful in checking dysentery in adults. For children
only fifteen drops of laudanum should be used," [Sunday Times, Oct. 3,

1848.] Monthly Periscope. 121

Such a prescription (!) will not bear any remarks, but I think it is
important to know, whether in the event of an accident from the use
of it, the editor of the paper could not be punished doubtless he is
morally guilty of a great crime in permitting its insertion.
I am, sir, your obedient servant,

4th October, 1847. M. D.

We very often see published in respectable newspapers, " sover-
eign reiriedies," which, if strictly follow^ed, would infallibly cause the
death of those who swallowed them! Any amount of ignorance w'ill
suffice for conducting the 7?ie^icaZ department of a newspaper. It is a
positive disgrace to some of our leading journals, that, before giving
circulation to paragraphs on medical subjects, the editors do not cause
them to be revised by men who understand the subject. The editors
cannot, however, be made legally responsible in the way our corres,
pondent supposes : every reader of a paper is supposed to have enough
brains to protect himself; and if he is foolish enough to follow the
quasi-medical advice published in the journal, any mischief which
follows is considered to be a proper punishment for his folly. \London
Medical Gazette, Oci., 1847. Med. Neivs,

A New Counter-irritant. By Professor Parker,

R. Croton Oil, 3ii. J

Spirits of Camphor, . . n'. V Mix.

Alcohol, . . . ( . . . ivi. S

Oath of Hippocrates. ("The philosophic physician is equal to the
gods.") To all physicians of all times. I swear by Apollo, by ^scu-
lapius, by Hygiae, by Panacea, by all the gods and goddesses whom I
here invoke as witnesses, to fulhl, according to my best capacity and
discernment, the oath which I pronounce and here subscribe.

I swear to consider my master as equal to my parents ; I will unite
my existence to his, and if he should ever require it, I will divide my
eftects with him. His sons shall be my brothers, and if they should
wish to learn the art of healing, I will instruct them without any im-
mediate salary, or any engagements for the future. Maxims, detailed
explanations, in fine, all my medical doctrines shall be transmitted by-
me to my sons, to those o-f my master, to pupils engaged by writing
and sworn according to medical law, but to none others, .

I will prescribe to the sick a proper regimen according to my abili-
ty and discernment. I will abstain irom all things unjust and injurious.
I w^ill never produce abortion. I will preserve, as a physician and a
gentleman, the utmost purity of and sanctity of morals. I will never
perform lithotomy, but leave that operation for those who make a pro-
fession of it.

Into whatever house I shall enter, going to carry 'aid to the sick,. I
will remain there a stranger to all iniquity, to ail corruption, and to
all criminal acts towards man or v.onian, bond or free. What I see
ar hear in private life, whilst in the exercise of, or even out of the

122 Medical Intelligence. [February,

exercise of my profession, and Vvhich shall not be of a nature to be
divulrrcd, I will keep holy and inviolate.

If I fullil faithfully this oath, and not violate it in any manner, may
I obtain a celebrity as a gentleman and a physician, and be glorified
by all men in all ages ; but if I transgress it and perjure myself, may
the contrary bcfal me. [Translated for the St. Louis Medical and
Surg. Journal,

MEDICAL INTELLIGENCE.

The Grippe, Cholera and Chloroform, (a new anasstlielic agent,) are the
engrossing medical subjects of Europe.

The grippe or injlicenza is there the prevailing epidemic. We hear of its ex-
istence from Spain to Scotland oi its reigning from Marseilles to Edinburgh.
In London it is reported that 1200 of the police were affected by it at one time,
and schools and academies, it is said, have had to be dismissed. The mortality
in large cities has greatly increased. A similar epidemic prevailed in Europe in
1832, and at precisely the same season of the year, which preceded the Asiatic
cholera.

The cA^^Zera still approaches western Europe. It has invaded Poland, and
has been announced in Vienna, &c. It is said to be milder than the similar
epidemic of 1833.

The announcement of a new anaesliietic agent, by Prof. Simpson of Edin-
burgh, has created quite a sensation in the medical profession of Europe.
Etherization has been far more generally employed abroad than in the United
States. It is there used extensively in the practice of Surgery and Midwifery.
The distinguished Prolessor of Obstetrics in the Scottish capital. Dr. S., has
been pursuing this subject like a true philosopher ; and having satisfied himself
and others that Cliloroforvt possesses decided advantages over ether, he has like
Jenner, presented in it an invaluable agent to the medical profession a great
boon to suffering humanity.

The failure of the French steamer to cross the Atlantic, and the long voyage
of the English one, so retarded the letter of our European correspondent that it
arrived too late lor our last No. We give place to it now, notwith?;tanding the
article under our Review and Extract department from Prof. Simpson himself.
The importance and interest of the subject seem to us todemand the space and
the allusion to the same facts.

We are now engaged experimenting with the chloroform. We believe it
will take the place of etherization. It is as yet cosily.

Lkttku III. from our EUROPEAN CO-RESPONDENT.

Paris, SOtu NovKMnKR, 1817.
Ncvi means of prndncins: JnacnsihiUty by the. InhahiUnn of tlic Tri-cJdoride of
Forniyle. This substance is called by the French chemists" the " Chlorofonne"
and is produced by the disiilh-ition of Alcohol with Hypo chloride o( Lime in a
rct(jrt. and alu r\v;irds ])assing a current of Chlorine g;is through the product,
and then re-disiillini,' it. It is not inflaniinaMe. You will sec the formula of
Soubeiran in Ihc "Gazette dcs Hopilcaux," and it is considered the best al pre-

1848.] Medical Intelligence. 123

sent known. It was first discovered by liim in 1831, and described by Leibig in
1832. Dumas, however, has the merit oC having determined its composition, in
1835. Dr. Guillor subsequently recommended it in small doses in certain kinds
ol" asthma. From the constituent pi inciples of the chloroJbrme, it is evident
that it does not difier much in its nature from the other, and experience has
now proved it to be an ancesthetic agent, more rapid, energetic and efficacious,
and undoubtedly less irritating: its use not being followed by headache, agita-
tion or pain in the chest, es sometimes happens after ether inhalations. Some
of the French pretend, "that like Jackson's discovery of the effects of ether, our
knoAvledge of the action of chloroform is due entirely to chance. They say that
my friend, Dr. Simpson of Edinburgh, making experiments on the chloroforme,
respired it himself, as did also two of his pupils, when the Doctor suddenly fell
down, and on recovering his senses, he perceived his two pupils lying on the
floor of the apartment, in a state of insensibility. In this way, they assert, was
revealed to the Professor of Midwifery (Dr. S.) the special action of this sub-
stance, and that tlien he repeated his experiments among such of his friends as
wished to be put under its influence. After some experience thus acquired, he
employed it in his private practice, and in a great variety of cases, as an inha-
led and anaesthetic agent. Professor Dumas, Dean of the Faculty of Sciences,
happened to be present at Edinburgh and v.itnessed the first public inhalations
in three patients on whom surgical operations were successfully performed, and
Dumas having immediately afterwards returned home to Paris from his visit to
Scotland, and communicated to the Parisians his opinion of what he had seen
this favorable report produced a great sensation here, particularly among the
Surgeons of the Hospitals, who lost no time in trying the effects of the chloro-
form. It is moreover not a little remarkable, that this startling intelligence
should have been conveyed to Paris by the very distinguished chemist who has
the merit of having first accurately and scientifically exposed the composition
of the chloroforme. This substance is a dense, limpid, colorless liquid, readily
evaporating and possessing an agreeable fruit like odor, and a saccharine, plea-
sant tasle, something resembling a solution of white sugar in strong whiskey.
You wil not be surprised to learn, that certain parties here, are trying to make
out something like a claim in favor of the "Grande nation," as th-ev did also
last winter, when Jackson's discovery was first known in Europe. They pub-
lish in all the Journals^ that France and a French Doctor have the honor of
priority of discovery. It may be as ^vell. to state fully this illusive pretension,
that people may be in a condition to judge exactly what it is worth, "and no
more." After the great American discovery was made known, various indivi-
duals in different countries began to experiment on the effects of the ether, as
also on. analogous substances, and among others M. Flourens, who gave the
results of his researches to the Academy, 8th March, 1847. In speaking of the
effects of the inhalation of the chloroform in a rabbit, he says, at the end of
some minutes it " was entirely etherized." " The spinal marrow was exposed,
the posterior cords were insensible; on 5 anterior cords tried successively, 2
alone preserved xhe'n viotricite~\\\e three others had lost it." To do the French
justice, however, they are free to confess that Dr. Simpson was the first to use the
chloroform in man. It appears that Simpson had never been .satisfied ^yith ether
in his obstetric practice, particularly in protracted parturition, from its disa-
greeable odor, bronchial irritation, iScc, and that he was desirous, if possible, to
find out some volatile liquid that offered the same advantages as ether without
its inconvenience. He tried, therefore, various substances which he selected
chiefly in consequence of their agreeable odor. At last Mr. Waldie advised
him to use the chloroform, which finally rewarded him richly for all his previous
disappointments. Before, however, making his discovery public, Dr. Simpson
prudently observed with attention, the anaesthetic effects of this new agent in a
great variety of cases, such as extraction of teeth, opening of abscesses, the
treatment of ovarian dropsies by galvano-puncture, also, in patients with neu-
ralgia and in painful dysmenorrhoca, and ullimatel}' during difl!icult parturition.
A dentist in Edinburgh extracted two teeth one under the influence of ether
the other after the inhalation of cliloroform. In the first case, the inhalation
was required to be kept up during several minutes, and although the patient
did not experience pain during the act of extraction, be had the consciousness

124 Medical Intelligence. [February,

of all that passed. In the second, a handkerchief on which about 2 grrmmes
of the clilorotorm was poured, having been applied to the nose and mouth, he
became compleiely infrcnsible in some seconds. Besides the slnpii'ying eflects
of the chloroiorin al'.va3-s disapjiear much more quickly than tho^e from eiher.
Dr. Simpson, who for the last six months, in the majurity of labors to Mhich he
has been called, had been in the habit of using ether inhalations, did not tail to
have recourse to his new anoesihetic agent. The first case in which he applied
it, was a patient who in a previous accouchment, and alter three days of sufler-
ing. was at last delivered by sacrificing the loclus. On her second labor, three
hours and a half after the commencement of the pains, and before the first stage
was complete. Dr. Simpson placed her under the chloroform. He rolled a hand-
kerchief in the Ibrm of a fumiel and pourel into it a half teaspoontul of the
liquid, and then applied it to the nose and mouth of the woman. In consequence
ol the evaporation he re-moistened the handkerchief in about ten minutes after-
wards. The infant was expelled twenty-six minutes from the commencement of
the inhalation. The mother -remained insensible longer than she would have
done under the action ol ether; the cries of the infant did not awaken hei, as
almost ahvays occurs, when ether is used She did not recover Irom the stupor
until some minutes after the expulsion of the placenta, and when ihe infant had
been removed into another apartment. Shortly alter this, she looked around
her and remarked, that she had enjoyed a good sleep, for which she had great
need, as she would have more strength to support her delivery. Then, soon
after, teeling no return of the pains, she expressed her lears that the sleep had
suspended the labor. Dr. S. had much difficulty to satisfy her she had been de-
livered and thai thesinfant that was presented to her was really her own. To
complete Dr. Simpson's observations, 1 avail myself of a few additional state-
ments which he has made public through the mediuu:i of an Edinburgh newspa-
per, to prove that he has letl little or noihing to be gleaned in this new field he
has the merit of having audcd to the domain of medicine. In fact, without
going so far as to assert that he has exhausted the subject of enquiry, 1 will con-
tend that at least, he has " viewed the whole ground" with an eye ol superior
intelligence and accuracy. It possesses over ether the ibllovving advantages;
1st, a much smaller quantity is required to produce the same eflecl; 2d, a more
rapid and generally a more persistent action, with less preliminary excitement
and tendency to exhilaration ; 3d, ihe inhalation is a great deal less irritating to
the chest; 4th, its perfume is pleasant and more evanescent; 5th, as a smaller
quantity is used, its application is less expensive no particular inhaler is ne-
cessary it is quite portable, and all that is required is to difluse a little of the
liquid upon a hollow-shaped sponge, or a pocket handkerchief, and apply the
same over the mouih and nostrils, so as to be fully inhaled.

About three weeks ago, Mr. J. Miller, Prof, of Surgery, and Dr. J. Duncan,
one of.the Surgeons lo the Royal Infirmary, employed the chloroform, for the
first time publicly, in the presence of Prof. Dumas of this Capital, and of a
number of medical gentlemen. 1 subjoin a brief notice of these cases:

Cask I. A boy about 5 years of age, with necrosis of the radius. Dr. Simpson
administered the chlorolbnn. Alter a fevi' inspirations the patient lell into a
profound sleep. By a deep incision and the use of forceps, nearly the whole of
the radius in a slate of snjius/naiL was removed. He was carried to bed in a
state of complete insensibility, and a long time afterwards awakened as if from
a refresliing sleep. He staled that he felt no pain during the operation.

Cask II. A soldier, who had salivary fistula consequent on exfoliation of the
jaw. An incision was made across the lower jaw the dense adhering integu-
ments were Ireely dissected the edges of the fistula were revivified and brought
together by several sutures. On the return of consciousness, the patient said
that he had felt noihing.

Cask 111. Ainpulalion of the great toe. The inhalations produced insensi-
bility inexactly half a minute.

Another case the following day occurred to Mr. Miller, in private practice.
Removal ot an incysttd tumor, below the angle of ihe jaw. The chlorofoim
was sprinkled upon a common sjionge. In less than a minute the patient was
ftound aslecj).

Pfo sickness, vomiting, headache or salivation was produced in any of the

1848.] Medical Intelligence, 125

above four cases, nor any uneasiness in Ihe chest. The quantity of chloroform
employedin the three cases operated on in the Infirmary did not exceed 15 o;ram-
mes. To have prodaced the same effects with ether, several ounces would have
been required. From 100 to 120 drops of the chloroform, poured on a sponge
or piece of paper, or handkerchief, heUl close to the nose and rnouih. for a min-
ute or so, is all that is necessary to produce its anaesthetic effects. There is one
precaution which it is proper to observe, not to apply the inhaling medicine loo
near to the patient, for M. Gerdy.ofLaCharite, scalded the face oflhe first patient
on whom he had occasion' to employ the chloroform. M. Gerdy, who has writ-
ten a very able treatise on the physiological action af ether, next used the inha-
lations of chloroform on himself, at two different limes, and again committed
the same mistake as in the patient above mentiou'cd and with the same results,
having also slightly scalded his lip and nose. He says that he has not yet fully
satisfied himself whether ether or chloroform is ihe better agent of the two. In
this respect, however, he is a little singular, as I know no one else that does not
prefer ihe chloroform. There is another point not unworthy of mention, in
which I suspect you will not coincide with me, which is, that an ether apparatus
is better and more economical th n a sponge.* In Paris, chloroform can hegot
for 18 francs an ounce. In London, the same quantity may be had for 4
shillings. It will soon be much cheaper, now that the demand has become so
great. The English journals will inform 3'ou, that the chloroform has been
successfullv employed in the London Qospitals. The24ih of Nov. was the first
day on which the chloroform was applied in Paris. At the Hotel-Dieu, both
Roux and Blandin, and also at La Charite, Velpeau, commenced their opera-*
tions by the use of the chloroform. In the preliminary attempt made by Blan^
din, the chloroform was not placed near enough to the nose and mouth, conse-
quently a couple of minutes elapsed before the mistake was observed, when
after about a minute, full insensibility was produced. The patient, a woman,
had a long and deep incision made in the upper and back part of the thigh, to
evacuate the contents of an abscess. She was so unconscious, that it was no
easy matter to convince her that the operation had been performed. Blandin^s
second patient was one of lithofomv in a female. Insensibility was effected in
about ,50 seconds. The manipulations for the fragmentation of the stone, lasted
between 3 and 4 minutes the insensibility continuing the whole of this period.
Roux's case was one of castration for sarcocele. The patient was put under the
full influence of the chloroform in a minute, and the operation was finished
without any symptoms of pain. In short, it appears quite unnecessary to mul-'
tiply examples of the admirable effects of this new agent, and it may be sufR-*^
cient to state, Amussat, Vidal, Ricord, &,c., have all last week repeatedly estab-'
lished its efficacy, and that on all hands with perhaps the exception of M. Gerdy
it is considered preferable to ether, as being more rapid, less irritating and ex--
hilerating, and not tending to excite the same amount of talking and excuse thef
word ^'havardajj^e." Some friends v/ho have inhaled the chloroform, and who
had formerly inhaled the ether, assure me, that the sensations left, after sensibil-^
ity returns, are infinitely more agreeable' than those produced by the action of
ether, and that the return to the normal state is also quicker and more free,
without leaving any feeling of nausea or confusion of thought. Ricord's firsS
patient vomited after the operation of hydrocele by injection. But this is far'
from being uncommon in this particular operation, with the other and without
it. All the inference we can legitimately deduce from the fact is, that in certain
cases the inhalation of chloroform does not prevent the action of vomitings
Velpeau tried the effects of chloroform in man laboring under traumatic tetanus,-
on the 2(5th Nov, Its action was kept up for four hours, with marked relaxation
of the rigidity and srreat diminution of the trismus. Latterly it failed to produce"
any manifest amelioration, and its use was therefore discontinued^ The case
terminated fatally.

Wednesday, 1st Dec I su.specf that I have been rather lengthy on the chloro-
form, especially as the intelligence relative to it must have reached the States-
by the last French Steamer. I had intended to have sent you something else*

* We agree it is more economical to employ au inhaler or bladder also more certaiat^
obtain the etfects. We are using one. [Eot.

126 Medical Intelligence. [February,

However, the feeling of novelty has prevailed. A fiiend is going out by the
Washington, and in all probability I will write you by that opportunity. This
omission is ot the less consequence, as really nothing out of the usual routine
h.\s occurred since I wrote you by Dr. F., of" Charleston. To be sure, there has
been no diminution of the average amount ot ordinary disease 'common
doings'* measles, chicken-pox and sraall-pox, in a mild form, are prevalent.
Trousseau innoculated the patients in his ward, to prevent them catching the
disease in the natural way. And it is surprising how very slightly they have
been effected, some having not over 15 pustules. Trousseau declares that the
vaccine matter in Paris, is not worth one cent.

What interest would it be to give you the run of surgical cases : Perhaps one
operation is worthy of being reported, as "a caution." Roux, 10 days ago, ex-
tirpated for goitre the whole of the thyroid body, in a strong, healthy, middle
aged woman. It formed an elastic, nodulated tumor of the volurane of two
fiscs. The operation lasted an hour and ten minutes, and over 30 vessels were
ligatured. The superior thyroid veins were quite as large as your fore-finger.
She survived this vivisection longer than I had contemplated, having liv^ed 36
hours. In England or in the States, such a fatality would have been noted and
publicly reprobated. Here such little matters p:\ss subs He iitlo, or are regarded as
items to swell the abstract scientific results. No doubt Roux meant well.

The Grippe is. raging in the South of France, also in some parts of Spain,
&c. Of course, as usual, it will run all over the globe. A i'ew cases have oc-
curred in Paris, but of no great severity. The Cholera is expected in the spring
to be in our midst.

Before concluding, I desire to inform you of the latest news regarding the
Chloroform. Yesterday, (Tuesday) Jobert, at St. Louis, used it in ari operation
for strangulated femoral hernia, with a sponge simply. It acted in about a
minute. Also with the same happy success in the amputation of 3 fingers, in
the case of a boy. He expressed his opinion that it w^as a better agent than
Ether. This morning, Velpeau employed it in the reduction of a dislocated
shoulder and in some minor operations. Velpeau has been unwell for a few
days, and is still in feeble health. I have not time to read over what I have
written. With kind regards, O. P. G.

Gallantry of the Medical Staff of the United States Army. Surgeon Hitchcock
acted as aid-de-camp during the battle of Buena Vista, although Medical Direc-
tor to General Taylor's division at the time. His bridle reiri w^as cut in two
and his horse wounded under him.

Surgeon Roberts, in the dreadful charge upon Molino del Rev, meeting a
company whose officers had all been cut down, took command of it, and was
killed whilst leading the men to victory. He was a Georgian, a native of Lib-
erty county.

"In the action in which Walker was killed, Surgeons Reynolds and Laner
Kave won great praise, charging as they did with the mounted force.

"Surgeon Reynolds, who, on this occasion, had volunteered to accompany
the small band of cavalrv, charged side by side wiih Capt. Walker, and con-
tinued fighting by his side in both parts of the engagement, until the latter fell
mortally wounded, and alter carrying back his body and receiving his dying
breath, again returned to the front, and there retnained until the arrival of the
reinforcements. Surgeon Reynolds captured a Mexican Lieutenant of the Ar-
tillery, and taking from him his sM'ord, delivered him over a prisoner to the
American forces; and after the termination of the battle, he resumed the duties
of his profession, and properly perlbrmedhis amputations and other operations
on the field of battle," [Newspaper.

Laner is put i'or Lamar, Dr, John T,, one of our own pupils and a native of
this citv he is the Surgeon of the I3ih Regiment.

1848.] Medical Intelligence, 127

The Protective Influence of Vardnation. Dr. T. Y. Simmons, Port Physician
and Chairman of the Board of Health of Charleston, So. Ca.^ relates in the
January No. of the Charleston Medical Journal and Review, the following re-
markable facts on the subject of vaccination : A ship arrived in distress at
quarantine on November 3d, having sailed from Havre the 9th September. She
brought over ten cabin passengers and upwards of two hundred steerage passen-
gers of all ages. Six cases, two of small-pox and four of varioloid, had occur-
red on the passage across the Atlantic. Upon examination, the crew and
passengers were all found to have been vaccinated, except the two icho had vario-
la, and three children born on the voyage. Here, then, as the Doctor remarks,
under the most favorable circumstances for the spread of the contagion of small-
pox, vaccination exerted its wonderful protective influejice.

A State Medical Associatioifin Alabama. We learn that at a Convention of
the Physicians of Alabama, held on the 1st of December in Mobile, a State
Medical Association was organized. The meeting was numerously attended.
Dr. Wooten, who has so ably contributed to our pages, was appointed to address
the first assembling of this As.'^ociation in March next.

Decoction of the Cotton Plant to promote Uterine Contraction. Dr. Blackburn,
of Barnesville, writes us that he has used a strong decoction oi the roots of the
Cotton plant, in two cases, with successful issue where ergot had failed.

Extensive Sloughing of the Gums.Dv. Calvin J. Fall, of Henry county, men-
tions in a letter the case of a negress with a morbid growth of the gums attended
with profuse hemorrhage; to such an extent was the tumefaction in both the
upper and lower jaws that it completely concealed the teeth. This diseased
structure sloughed off, and the patient recovefed.

Human Bones. To what vile purposes are we put! An English Journal (says
the Gazette Medicale de Paris of the llih Dec.) announces the arrival at Hull
of an immense quantity of human bones, collected from the battle fields of
Leipsic, Austerlitz and Waterloo, and mixed with those of horses, which are to
be- ground up and used for agricultural purposes.

Death of tJie great Priissian Surgeon Dieffeneach. We learn, with much
regret, the sudden death of this celebrated Surgeon, which occurred in Berlin on
the 11th of November last. He entered the Charite hospital of that city at
2 o'clock, P. M., in his usual good health, and I aving been introduced to two
French medical g'entlemen, was seated between them on a sofa and engaged in
describing an operation, when his head fell backwards and inclined to one side
as if he intended to whisper in the ear of one of them ceasing to speak, his true
condition wasat once detected, and remedies employed to revive him, but with-'
out avail. Up to the 15th. four days afterwards, no decomposition or alteration
of features having occurred, two medical men were still watching the corpse.

Dieffenbach was only 52 years old. He was born at Kcenigsberg, and first
studied Theology. It was only after the wars of 1814 and 15, in which he served
as a volunteer, that he studied Medicine. ^ In 1822 he visited Paris and becamer
a pupil of the ilhistrious Dupuytren. He filled the post at Berlin of the lafe

128

Medical Intelligence. Meteorology

Surgeon-General of the Prussian army, Dr. Grnefe, the associate of Baron
Larrey. He was at his death the first Surgeon of all Germany. He left a work
on Etherization, and a history of Surgery nearly completed.

Death of the celebrated Endish Svrgeon., Ltston. The commercial papers by
the last steamer from Liverpool announced the death of Mr. Liston, probably
by a return of his throat affection alluded to by our European correspondent, in
his second letter from Paris. He too has died young, at 52 3-ears<

Donation to a Medical College. A. Mr. Lyne Starling, has left by his will the
sum of thirty thousand dollars, to aid in founding and sustaining a Medical Col-
lege in the city of Columbus, Ohio. Who will imitate this exainple and re-
member Augusta, Ga. 7

METEOROLOGICAL OBSERVATIONS, for December, 18-17, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet. . -

I

Sun
Thkr.

Rise.

Bar.
30 8-100

!. 2, 1
Thkr.

43

P.M. 1

Bar. 1

Wind.

Remarks.

1

35

29 95-100

N. E.

|^^!;; J 90.100 of an inch.

2

46

29 68-100

53

" 02-100

"VV,

3

50

" 61-100

54

" 71-100

w.

Clearing off fair blow.

4

30

" 9!)- 1 00

54

" 99-100

^v.

Fair.

5

32

" 95-100 i 56

" 89-100

w.

Fair

6

29

" 90-100 ! 56

" 95-100

w.

Fair.-

1

28

30 11-100 60

30 15-100

S. E.

Fair some clouds.

8

44

30 10-100, 70

30 15-100

E.

Fair. [breeze.

. 9

54

30 7-100, 70

30 i

s.

Cloudv sprinkle last night =

10

60

29 92-100' 72

29 86- LOO

s.

Cloudy breeze.

11

61

" 87-100 68

" 90-100

s. w.

Cloudv.

12

6!)

" 94-100 70

" 94-100

s. w.

Cloudv.

13

56

" 80-1001 -65

" 65-100

s.

-Sprinkle and cloudy.

14

38

' 75-100 r 46

" 85-100

w.

Fair breeze.

15

88

" 83-100

32

" 81-100

w.

Sleet snow. ) a mere show oil
Snow, ] the ground.

16

24

" 83-100

36

" 85-100

w.

17

24

" 89-100

48

" 87-100

w.

Fair.

18

25

30 4-100

56

30 4-100

w.

Fair.

19

25

30

62

29 92-100

w.

Fair.

20

30

29 82-100

62

^' 77-100

s.

Fair.

21

36

" 81-100

A{\

" 85-100

^;-.

Fa i r breeze-^blow last night.

22

28

" 73-100

1 55

" 63-100'

Fair blow.

23

29

" 75-l00| m

" 73-100

w.

Fair.

21

38

" 66-100 62

" 60-100

s. \v.

Hazy verv dusty.

25, 45

^' 66-100 46

" 55-lOOj

s. w.

Rain, 45-100 of an inch.

26 1 28

" 97-100; 43

30 5-1001

N. W.

Fair.

27

22

'30 20-100 48

30 20-100,

E.

Fair.

28

27

30 15-100 59

30 13-10(:

E.

Fair hazy.-

29

41

30 10-100,, 64

30 7-1001

B.

Cloudy.

80

51

30 58

29 99-100

N. E.

Cloudy.

31

54

29 97-100l| 58

" 99-1001

E.

Cloudy.

16 Fair days, duantity of Rain
8 days. West of do. do. 19 days.

inch 35-100. Wind East of N. and S.

Erratum. In Dr. Greene's letter published in the last No., page 62, for read
5 in the doses of the two prescriptions.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL,

Vol. 4.] NEW SERIES MARCH, 1848. [No. I.

Part L ORIGINAL COMMUNICATIONS.

ARTICLE Xr.

Electro-Physiology. Thoughts Upon the adaptation of the
Animal Organism to the generation and maintainance of
Electro-vital Currents, SfC. By A. Means, M. D., Professor
of Chemistry arid Pharmacy in the Medical College of Geor-
gia, and of the Physical Sciences, Emory College, Ga.

The theme which has elicited the present dissertation, together
with the tenor of argument adopted in its discussion, has already,
under another form, met the public eye. But the subject having
been regarded of sufficient interest to the profession to entitle
the views there advocated to a place in the pages of the Journal,
I have consented to furnish them for publication, together with
.such additional reflections as the very limited time at my con-
trol will allow me to supply. It is due perhaps to myself, as
well as to the scientific and practical character of the organ
through which this communication is now presented, to entreat
for it an attentive and unprejudiced perusal, and to express the
hope that whether the views which it inculcates be adopted oi*
rejected, they will not, after such examination, be regarded as the
mere visionary speculations of a prurient and ambitious philoso-
phy, which constructs its airy fabrics without the supports, and
beyond the region of facts, but as the patient deductions of sober
reason, purporting, at least, to be drawn from ample experiments^
and from the known operation of recognized and established
physical laws, some of them, it is true^ at first sight, novel and
startling in their character, but nevertheless, demanding the con-
fidence of the honest and intelligent enquirer after truth.

8

130 Means, On Electro-Physiology. [March,

Our undisguised conviction of the growing and invaluable
importance of Electro-physiology to the medical philosopher as
well as the practicing physician, must be our apology for so earn-
estly inviting professional attention to the subject.

Since the body of the arguments here presented were drawn
up in their present form, it is proper to remark that the elaborate
and scientific researches of Professor Matteucci, of the Pisa
University, embodied in his " Lectures on the Physical Phe-
nomena of Living Beings," has reached me, and to which I will
occasionally take the liberty to refer. And although the view^s
of this profound ])hysiologist may not, in all their details, harmon-
ize precisely with some which are respectfully maintained in the
present article, it is unaffectedly gratifying to find the great
fundamental doctrine here defended, unequivocally announced, as
the only reasonable conclusion to be drawn from his laborious and
critical experiments upon animal nature, I allude to the gen-
eration of electric currents in the human body as the functional
result of certain portions of its organism. His language is "It
would be absurd to suppose that the chemical actions of living
beings, all of w'hich develope heat and often light, would not be
accompanied by the production of electricity.'' From his ex-
periments he says, " the existence of an electrical current in the
muscles has been well demonstrated, and its principal laws are
established." An opinion to which w^c ourselves have been re-
cently committed before an intelligent class, he fully sustains
viz., that "Galvani's assumption" (advocating the existence of
animal electricity, and generally supposed to have been disproved
by the after experiments of Volta, &c.) "was not erroneous,
since a great number of facts discovered by him are certainly
due to the electricity developed in, and proper to animals."

While it might under other circumstances constitute a sub-
ject of interesting enquiry to trace the triumphant progress of
the science of Chemistry through the last half century, and indi-
vidualize its immense contributions to our professi-on and to the
world at large, the object had in view in this essay will limit us
to the examination of a peculiar class of facts (to which allusion
has already been made in the foregoing remarks), disclosing new
and important principles which deservedly command the in-
creased attention of the philosophic workl at the present

1848.] Means, Oji ElectrO'Phijsiology. 131

momentj and destined, as we believe, to effect signal revolutions
in the psycoloEtical, as well as physiological views which have
heretofore obtained among the ranks of the learned.

To the investigations of Chemical Philosophy have been as-
signed, the laws and properties of that invisible, potential and
universal agent, whose mysterious modus existendi has hitherto
baffled the penetration of the astutest intellect, but whose illimi-
table power and ubiquitary presence are so strongly vindicated
in the roll of the thunder, the whirl of the water-spoUt, and the
corruscations of the Aurora, or in the less startling, but no less
interesting modifications of its action, detected in the violent and
spasmodic throes of the human muscle the intensity and bril-
liancy of the charcoal lights, and the vivid and instantaneous
combustion of the metals in the line of a Galvanic circle, or in
its still more recently recognized forms of Terrestrial Magnetism,
Magneto-electricity, and Electro-physiology.

To the views, then, which have forced themselves upon our
attention in examining this strange and subtle, but effective and
pervading agent, in its connexions with the animal economy
and the laws of life, we beg leave mainly to confine the investi-
gations which may follow. Nor in canvassing the topic before
us, will our limits allow, (did the reliable data at our control
justify it,) that detailed survey and elaborate argumentation
which a persistent and incorrigible scepticism may demand, and
which, the ever accumulating resources of science shall, at no
distant day, triumphantly furnish. The recent ascertainment
and novelty of many of the facts to be submitted, must, in the
present state of our knowledge, necessarily leave any theory
projected for their solution, embarrassed with unexplained dif-
ficulties which time and research can alone dissipate. It is the
province of sound philosophy ever to make a clear distinction
between facts and the j^easons of them. One fad properly
authenticated may not be rejected or challenged on the claims
of a thousand adverse theories, though the rationale of its origin
may remain unexplained for centuries. The very spirit of the
Baconian philosophy supposes the previous evidence and patient
classification of facts, from which physical laws are to bededuced,
and rational theories constructed. And ^vhen in the progress
of discovery tlie accumulation of authenticated testimony re-

132 Means, On Electro-Physiology, [March,

quires the abandonment of a supposed law, or the renunciation
of a favorite theory, candor, conscience, and science, demand
at our hands its prompt surrender. But when the field of obser-
vation is large, interesting, and comparatively unexplored, with
only a few well defined and settled points within the range of
intellectual vision, and these, in their relationships and bearings
open to enlightened conjecture, theory, cautiously adopted, is
not only admissible, but by systematizing our views, stimulating
enquiry, and directing experiments, is powerfully instrumental
in evolving truth and enlarging the boundaries of knowledge.
Such, precisely, are the conditions which surround us when
attempting to prosecute our enquiry into the subtle and recondite
causes of vital phenomena by the aid of the guiding lights which
Electricity and the cognate Sciences hold up to our view^ In
former ages this whole interesting region lay profoundly submer-
ged in the deeps of popular and professional ignorance. All was
one wide waste of waters where the Ark of speculation floated
on in its devious and doubtful course. But time has made its
steady progress : the deluge has begun to assuage, and the
pioneer dove, which had once and agan been despatched by
philosophic Enquiry, only to return on drooping wing from her
cheerless flights, has at length appeared with the olive leaf in her
beak. Summit after summit now peers above the flood, until
a hundred lofty peaks are glowing in the sunshine of science and
the Ark is seen setthng on the iVrarat of Truth. And although
the physiologist of the present age cannot yet define all the con-
nexions which subsist between these bright elevations, that lie
like sun-lit islands upon the retiring seas, yet the waters will have
soon found their lowest level, and their beautiful natural relation-
ships will be distinctly traced to the great fundamental range
of physical laws^ which sustain and characterize the whole
animal organism.

But more directly to the execution of my purpose. So uni-
form and harmonious is Nature in the maintainance and execu-
tion of her laws, that by the aid of observation and analogy, we
may generally determine with tolerable precision the habitudes,
functions, or phenonrtena of bodies, from their position, confor-
mation or structural arrangement. With such inimitable
exactitude are these laws observed that a single fossil bones,

1848.] Means, On Electro-Physiology, ISS

exhumed from its isolated bed, by the unerring physical characters
which it bore, enabled the learned and sagacious Cuvier to read
its natural history mentally to reconstruct the whole skeleton,
and to classify the original animal with the genus and species to
which it belonged. Indeed but for these invaluable indications,
our researches in Comparative Anatomy, Physiology, Pathology,
Hygiene, Mineralogy, Geology, and the kindred sciences, must be
seriously impeded if not finally aiTested. In view of this per-
vading and operative rule in physics, then, we propose briefly
to examine whether the conformation, organic structure, and
physico-chemical phenomena of the human body, seem to indicate
an adaptation, or conformity to the hnoicn laws of the electric
fluid, in its variously modified forms of action. Allow me,
however, in advance, to remark, that, at the present day, to
doubt the physical agency of light, heat, electricity and molecular
attraction, in controlUnfT the elements and determinino; the funct-
ions of organized living bodies is to overlook the palpable analo-
gies of Nature, and defy the latest and clearest conclusions of
experimental philosophy. What candid observer can fail to
recognize in the vegetable and animal economy, the presence
and activity of the same laws which govern the inorganic
kingdoms, only modified and made subordinate for the time
being, to the supremacy of the vital principle ? Light, acting
upon thejeaves of vegetables, effects the decomposition of car-
bonic acid gas and the exhalation of oxygen, after the same man-
ner that in the presence of chlorine, in inorganic bodies, it
liberates the same gas by the decomposition of water. Light is
refracted too by the lenticular structure of the human eye,
just as by a glass lens of similar curvature. Caloric is radi-
ated and absorbed by plants and animals as well as by inor-
ganic bodies. Electricity finds a ready transmission along the
hving vegetable and animal tissues, as though they were lines
of iron or copper wire, and decomposes the circulating salts of
the blood, just as it effects analogous changes in saline solutions
beyond the dominion of life ; v/hile the laws of chemical affinity
are continually active in maintaining or destroying particular
aggroupments of molecules, often different, it is true, from the
inorganic arrangements of the same elements, but dependent
solely upon their previous existence and properties for all their

134 Means, Oji Electro-Physiology. [March,

new phenomena; for, in the appropriate language of Liebig,
"all the organs together cannot generate a single element, car-
bon, nitrogen or a metallic oxide." Surely then we are author-
ized to commence the survey we have intended.

1st, then : Electricity may be generated by the friction of
solids, or of solids and fluids.

This well-known law is exemplified among solids, by rubbing
together two electrics -as, silk and glass cat's fur and sealing-
wax, &c. May not the warmth produced by brisk friction of
the hands together, depend upon the calorific energy of the
electricity thus evolved hom the non- conducting cuticle and
its immediate absorption and diffusion through the humid subcur
taneous tissues ? In advocacy of thivS view, it may be stated
that if the epidermic surface be inoist, and therefore unfavorable
to electric accumulation, heat cannot be generated, or feebly, at
best; just as the bits of wood used amongst some of the least
civilized nations for kindling their fires, must e^^hibit dry surfaces
before ignition is effected,

But, again, let a portion of Mercury be included in a thin glass
tube, a foot long, and well secured by a cork-^then shaken brisk-
ly from end to end -the cork removed, and the tube presented
to an electrometer, and it will give signs of strong electrical exr
citement. Now does not the whole sanguiferous circulation, by
a kindred process, contribute to the supply of the norman amount
o'i electricity which the animal body requires, in the constant
friction of its fluid mass against the sides of the tortuous cartir
laginous tubes through which it passes, hurried on by the pow-
erful vis a tergo of the great central muscle resisting in its
pulmonary and systemic career the superincumbent atmos*
pheric pressure of more than thirty-two thousand pounds upon
a body of ordinary dimensions, while the compressions and
concussions which are the necessary results of muscular con-
traction^ and expansions, contribute their quota to the general
stock ? The important discovery recently made in frictional
electricity, comes in opportunely to sustain the views here en-
tertained, viz,, that globules of water, and of several other fluids,
Imrried on with great velocity through tubes by the impulsive
force of steam or compressed air, evolves electricity freely. In-
deed, the most powerful arrangement hitherto known for th^

1848.] Means, On Electro-Physiology, 135

production ofqnantity is a hydro-electric machine, constructed
upon the principle above named, by Mr. Armstrong, and exhibit-
ed two or three years since at the Polytechnic Institution, in
Regent-street, London. Such was its power that even paper
and wood shavings were inflamed in the course of the spark.

2ndly. Electricity is evolved by changes in the condition of
bodies from solids to fluids, and from fluids to gases, or the con-
verse, as proved by Harris, Tamer, Lavoiser, and La Place and
others, and also by chemical combinations and decompositions, as
amply illustrated in the experiments of Pouillet on Carb. Acid
JVollaston upon the oxidation of electrical amalgam, SfC,

The elements of bodies are known to exercise certain elec-
trical relationships to each other : those which are most highly
positive, as Carbon, Hydrogen, Potassium, Sodium, &c., exhib-
iting the most vigorous affinity for those on the negative ex-
treme, as Oxygen, Sulphur, Nitrogen, Chlorine, &:c. Now
these^ are the very elements which are found to be in most active
play in the animal economy, and in the exercise of their affini-
ties might be expected to evolve electrical currents proportion-
ate to the intensity of their chemical action, and we only regret
that our limited time will not allow us to trace the various
chemical reactions incessantly going on among these elementary
"bodies in the animal organization. It is due, however, to a clear
conception of our views that specific reference should be made
to some of the w^idely prevalent and well known operations
which are constantly going on in the inorganic as well as the
organic kingdoms around us.

The results of this law, then, are seen exemplified on the most
magnificent and grand scale in those meteorological changes
which mark the varied year. The evaporation going on over
the whole liquid surface of our globe, by which water assumes
an aeriform condition, and again the condensation of vapor, thus
formed, in the higher regions of the atmosphere into fluids, and
solids, as rain and snow, or hail, all serve to liberate immense
volumes of the electric fluid. For a similar reason, the sudden
and violent changes of chemical condition produced by the molten
mineral masses and hot elastic vapors, disgorged from volcanic
craters when coming in contact with the cool and open air,
generate abundantly those vivid lightnings which have for age^j

136 Means, On Electro-PJnjsiology . [March,

past blazed around the summits of Etna and Vesuvius during
their great eruptions. JVow, recent investigations in organic
chemistry have disclosed the fact, that large quantities of this
fluid are evolved during the most silent and gentle of the vital
changes, as in the germination of seeds, and during the respira-
tion of plants through the expanded surface of their leaves and
petals. Poujllet has shown " that the surplus electricity arising
from a verdant area of 100 yards square, is sufhcient to charge
a poweiTul battery." Water is undergoing perpetual decompo-
sition in the process of vegetable nutrition, and Faraday, after
patient experiment upon the subject, has announced the opinion
that the quantity expended in separating the elements of one
si ngle grain oi i\i^i ^md, would have produced Oi strong flash of
lightning! Thus, under the higher laws of animal life and
within the pale of the human constitution, similar changes are
incessantl}' going on, attended by similar evolutions of the
electric fluid. Oxygen, entering the circulation by ])ulmonary
endosmosis, unites with the Iron of the red blood-globules, and
is borne onward as the Hydrated peroxide of the metal in so-
lution, until by a vital process it assists in eflfecting the trans-
formation of the various tissues absorbs a portion of their
carbon then becomes Carbonate of the protoxide, and after
reaching in its career a surface containing Oxygen and Hy-
drogen, undergoes another decomposition by which Carbonic
Acid is eliminated and Hydrated peroxide of Iron again formed
to reconmience the accustomed circuit. The changes of the
ingesta which occur in the animal stomach, and the auxiliary
organs of digestion and assimilation, furnish additional sources
of electro-accumulation.

According to the recently expressed views of the Professor of
Pisa, the muscular currents, whose existence has been demon-
strated, depend for their origin upon "the electric conditions
which are produced by the chemical actions of the nutrition of
the muscle" the muscular fibre being regarded as the morpho-
logical element whose transformation, eflected by the contact of
the oxygenized blood, evolves molecular currents, which arising
from a rnultitude of similar points united by a good conductor,
and conitnunicating with other points which have not under-
gone sinular nietamorphosjs, may originate general currents.

1848.] Means, On Electro-Physiology, 137

In this view, the " blood charged with oxygen and the muscular
fibre" become the elements of a pile, i. e. " the liquid and zinc.

But in the complicated organism of the human body, it is
neither philosophical, nor necessary to the maintainance of the
views which we urge, to limit the generation of electrical
currents to one class of causes alone, and we are therefore war-
ranted to admit their formation from any structural arrangement
or vital action in the system, competent to produce them. This
leads us to notice another law of our fluid.

2ndly. It is known to hegenerated directly under the domin-
ion of the vit^il principle^ and by the exclusive agency of the
living tissues, as in the Torpedo and Gymnotus ehctricus of
Surinam, and to manifest all the striking results found from
its action in the inorganic kingdom, as shocks, sparks, evolution
of heat, chemical decomposition, deflection of a galvanometer
and magnetism.

The electro-physiological phenomena exhibited by these an-
imals, have utterly exploded the opinion that the presence of
metals was indispensable to the production of voltaic electricity.
Indeed additional evidence of the fallacy of this dogma has been
found in the electrical results which have followed from the
lamellar arrangement of charcoal and plumbago ; while by com-
binations of moist masses of animal and vegetable structure, as
muscle and brain, beet root and wood, &lc., the interesting truth
has been establisjhed that, under given conditions, the organic
kingdoms possess independent electro-motive powder. ^^c

Some valuable facts here call for our attention, derived from
the recent critical and accurate experiments of Prof. Faraday,
upon the Surinam eel, and from the Report upon the Voltaic
power of the Torpedo, made to the Academy of Sciences at
Paris a few years since. First : that the membranous and col-
umnar arrangement of their electric organs generate and retain
large quantities of electricity, notwithstanding the diffused
moisture of the whole interior and adjacent surfaces, and in
defiance of the good conducting medium in which they move,
which in the case of inorganic generators, would lead to the
speedy dissipation of the current but here, as in the case of
chemical affinities acting under the authoritative supremacy of
the vital principle, we are furnished with another instance of

138 Means, On Electro-Physiology. [March,

complete and essential subordination of ordinary laws to the
modifying and controlling powers of life.

Second: In the language of the Report, "that the electricity
\vhich produces the discharge, proceeds from the last lobe of the
brain, and is transmitted ])y the nerves to the brain"- for in the
experiments, of the examining committee, the nerves, when tied,
were found, promptly to check the flow of the current, indicating,
as they say, " in the nerve a peculiar molecular disposition for
the transmission of the fluid ; an opinion which finds support in
the fact, that the uninjured nervous trunks and filaments of every
animal heretofore submitted to experiment, have furnished it an
instantaneous passage throughout the line of communication,
but when in any instance bissected or crushed, refusing to con-
vey it beyond the breach or laceration.

But again, within the present year. Prof. Liebig, in prose-
cuting his " investigation of the constituents of the animal fluids
which are found without the blood and lymphatic vessels," has
succeeded in demonstrating the existence of "free lactic and
phosphoric acid in the whole organism wherever muscle is
found"' and what is still more strangely true, but corroborative
of the views here presented, " in the animal organism, acids and
alkalis are found separated by a membrane, constituting myriads
of little galvanic circles, which, as such, must produce chemical
and electrical eflects." So that the long repud^iated doctrine of
the acidity and alkalinity of the animal fluids, taught with so
much eclat 190 years ago, by the popular Professor of the Ley-
den University, De le Boe Sylvius, however in that age, misap-
prehended and misapplied, seems not to have been entirely
chimerical.

Whether, however, this view be admitted or rejected, recent
anatomical investigations, as reported by modern microgrophers,
have disclosed the interesting fact that the construction of mus-
cular fibre is almost exactly analogous to the electrical organs of
fishes consisting of longitudinal siricB, and transverse discs
the latter being " perfectly rectilinear and the included spaces
perfectly rectangular," and in the language of Matteucci, "it is
very remarkable that with respect to the general circumstances
of the two phenomena the same laws preside over the discharge
of electrical fishes and muscular contraction."

1848.] Means, On Electro-Physiology, 1S9

4thly. Inorganic currents pass with immense velocity along
an unbroken conductor, and with greatest intensity when de-
fendedfrom lateral escape by the investment of a non-conduc-
tor, as silk or cotton thrxad, varnish, <^'C.

The nervous tissue constitutes, unquestionably, the grand o5og,
or pathway along which this etherial agent effects its instan-
taneous and invisible passage to the remotest organs of the
system, and the neuri-lemma or unctuous theca which invests
the tissue in its trunks and thousand ramifications, is as we re-
gard it, but a non-conductor, which seems designed to prevent
an undue lateral waste of the passing current, precisely as the
varnished cotton or silk wrapping secures greater certainty of
transmission along copper w^ires. And in striking resemblance
to such galvanic wires, every nervous filament is only covered
in \i% passage and left open at its cerebral and villous extremities.
More remarkable still, each filament in every fasciculus or bun-
dle of nerves issuing from the brain, has its own separate theca
or membranous coat, as if to prevent confusion iu the trans-
missiyon of the neuro-voltaic currents, and secure, unexpended,
their appropriate electro-force to the respective points of dis-
tribution. In further accordance with these views, it is an
imposing fact, that adipose matter, a bad conductor,* in the lan-
guage of Richerand, " covers and surrounds the extremities of
the^nerves, diminishing their susceptibility, which is always in
an inverse proportion to corpulency," a beautiful arrangement
and admirably adapted to guard against too rapid an escape of
this energizing fluid from the fine filiform extremities of these
delicate conductors, and to reserve it for the functional demands
of the various organs. -'In fact," adds this eminent physiolo-
gist, "it is observed that persons subject to nervous affections
constantly join an extreme leanness to an excessive sensibility,'*
' accompanied too, as our experience authorizes us to add, with
functional derangements, and general constitutional debihty
the electric waste being thus made to exceed the electric 5mjo-
plies necessary for the maintainance of hygie^nic action. Indeed
the law of insulation, or electro-retention, seems to be observed
througout the animal economy. The organs of secretion,

* And hence tallow is employed to retain amalgam upon the rubber of our
^lectj::ical machines.

140 Means, On Electro-Physiology. [March,

over which the distingushed Marshall Hall predicted that elec-
tricity would exercise an extensive influence, and which has
since been so ably and satisfactorily verified by Dr. Wilson
Phillip and others, are generally found with non-conducting
investments. The Liver is surrounded with the membranous
and lubricated linings of the abdominal cavity in front, and the
oleaginous surface of the viscera, and the hepato-gastric omen-
tum in the rear. The Kidneys are literally immersed in
adipose matter, while the Mammary glands are liberally suppli-
ed with a thick tunic of the same insulator. These may be
regarded as but interesting specimens of that electric precaution
which nature has manifested in regard to glandular structures
generally. The same defensive measures have been adopted
for the circulatory system.

As, in the calibre of the sanguiferous tubes, chemical changes
and consequent electric evolutions are perpetually going on
to supply animal heat, and for other vital purposes, it would seem
extremely appropriate that lateral radiat'.on should be prevented
by sufficient non-conductors. Now in accordance with this
anticipation, the great central organ, the Hearty always contain-
ing blood in a highly positive condition ever fresh from the
re-oxidizing region of the lungs, is encompassed by fatty and
membranous textures, while, in the language of the author al-
ready quoted, "adeps is found in great abundance in the direction
of the blood-vessels.'' Yet with all this delicate conformity to
electric law, there must occur, in its passage a diffusive expendi-
ture of the fluid, which it would seem should be compensated by
timely accessions from some adequate source.

In the construction of our Telegraphic lines, it is well known
to electricians, that the length of the ioi?'e determines the strength
of the battery. As the first is extended, the second must be
increased to allow for lateral w^aste or defective conduction, and
if the route be continued beyond a convenient distance, re-lay
batteries must be interposed at intervening })oints to re-inforce
the waning current.

Now, may not the my ^ienow?, ganglionic system, that puzzle
of all former physiology, be intended as a series of re-lay batter-
ies, stationed along the nervo^is routes, to re-supply the partial
exhaustion, and maintain the normal momentum of the electric

1848.] Means, On Electro-Physiology, 141

forces ? And to give plausibility to this suggestion, it must be
remembered that these multiplied nervous centres generally
occur in the neighborhood of the large secreting organs, and
where electro-vital accumulation seems to be most demanded.

It is interestingly true, and to some extent an entirely analo-
gous arrangement, that in the electric organs of the Torpedo,
which consist of from four to five hundred parallel prisjms, each
separated by transverse diaphrams with intervening cells,
each containinx w^ater, albumen, and chloride of sodium, the
nervous distribution is abundant and peculiar, " forming a great
number of closed circles, each of wiiich has one (nerve,) in the
cerebral lobe, and another in the wall of the cell of the organ."

Indeed, dissections of the Torpedo and Gymnitas show that
the ganglia and nerves of their electrical apparatus exceed in
extent all the rest of the nervous system put together. " The
analogies," says Matteucci, " between muscular contractions
and the discharge of the Torpedo are complete ; every thing
which destroys, augments or modifies the one, equally effects
the other." The shock w^hich it communicates is decidedly a
voluntary act, and so completely under the control of the will,
that it can at pleasure discharge either the whole or a part of
its organ.

In this class of animals w^e have, beyond question, the Tier-
vous power converted into electric force ; and why may not
the converse be true, viz., that electric force may be transform-
ed into nervous power ? The reciprocal generation of distinc-
tive phenomena, both in the in-organic and organic kingdoms,
all clearly traceable to a community of agency, and indicating
throughout the presence and control of electric currents, modifi-
ed only by the organization, the condition, or the circumstan-
ces of the bodies through which their manifestations are made,
may be regarded as settled results in science. . To illustrate :
in the inorganic universe, electricity produces chemical action,
and chemical action, in return, evolves electricity. Galvanism
(only another form of the fluid) generates magnetism, and, con-
versely, magnetism originates powerful galvanic currents.
Again, galvanism produces caloric, and caloric reciprocally
sets in motion strong thermo-electric currents, capable even in
the laboratory of producing results identical with those of gal-

142 Means, On Electro-Physiology, [March,

vanism, as shocks, sparks and magnetism. But this correlation
of physical forces, or convertibility of power, is to be found in
the vegetable kingdom also. Plants are now known, through
the activity of their vital forces, to throw off immense quanti-
ties of electricity, during the progress of healthy growth, while
electrical action, in return, has exhibited effects almost magical
in rapidly developing all the phenomena of vegetable life.
Now let us ascend to the more complicated structure of the
animal kingdom, and when it is incontestibly established that
in the case of electric Fishes nervous power is converted into
electric force, why should it be regarded either unphilosophi-
cal or improbable nay, are we not constrained to expect, that
electro-dynamic manifestations should be the result of nervous
power : or, in other words, that under the laws of animal life
they are convertible forces.

While the Tuscan profes&x)r does not consider the vis nervosa
to be identical with the electric current, he is commendably
guarded in detailing the result of his experiments. When
attempting to deflect a galvanometer by exciting irritation in
the nerve of a living animal, he says, "I must confess that
whenever the experiment was well made, I never obtained
evident and constant traces of the electric current." Again, in
endeavoring to effect the same thing by the aid of a helex, he
adds, "I never observed constant signs of the induced current
in the spiral." Upon the subject of neuro-electric currents,
therefore, we must still regard the affirmative results of the
experiments of Dr. Prevost, of Geneva, in 1838, sustained sub-
sequently by those of Prof Zantideschi and Dr. Favio, and
hereafter referred to in this article, as uninvalidated. But it
has been objected that when a nerve is ligated, the parts be-
yond the ligature upon which it is distributed, cease to feel or
act under the determination of the will, while an electric cur-
rent, sent along the same nerve, passes to its extremity and
exhibits its characteristic effects upon the contractility of the
muscular fibre, and that therefore electricity is not identical
with the ncuro-vital power. Now it does seem to us that a
fair and ingenuous admission of existing laws, and all the facts
involved, would very much weaken, if not entirely remove the
force of this objection, however honestly suggested or honor-

1848.] Means, On Electro-Physiology, 143

ably maintained. First, then, let it never be forgotten that
those physical laws which ordinarily regulate and gox^ern the
elements of inorganic matter, are at once modified, suspended
or abrogated when those elements are transferred to the do-
minion of life and made subordinate to its higher control, and
the ,very same agent which, beyond the powers of life, was
characterized by certain and unchanging indications, w4ien
marshalled within the circle of vitality, is seen under new as-
pects and often capable of higher results, while its identity
remains undoubted. Mark the pecuhar and complex combina-
tion of the simple substances, oxygen, hydrogen, carbon and ni-
trogen, in inorganic compounds, the multiplicity of the atoms
employed, and the diversity of their chemical aggroupments in
constituting such forms of matter as sugar, starch, muscle, ten-
ton, cartilage, &c., &c., and that just as soon as the vital prin-
cip/e has fled, and the unrestrained play of inorganic aflinities
commences, these compounds are suddenly resolved into their
elements, which, again, instantly re-unite under new atomic
arrangements in the formation of water, carbonic acid, ammo-
nia, &c. Witness, also, the suspension of the ordinai-y laws of
caloric in the uniformity of animal temperature, whether at the
equator or the arctic circle: under a heat of 352 Far. with
the "oven girls of Germany," or in the bleak atmosphere of
the mariner in the polar seas at 50 below 0 Far.

Now we have only to suppose that vital currents are gradu-
ated in their momentum to suit precisely the exceedingly delicate"
tissue which they are designed to traverse, viz., the pulpy or
fluid matter invested by the neuri-lemma, and that the normal
electric impulse is too feeble to pass the obstruction and put in
motion the molecules beyond, w^hile an artificial current, wi'II
pass over a breach of continuity, even in wire, to make its
circuit.* This fact seems to have modified the views of Prof,
Matteucci himself, in his examination of induced currents, and
after having ascertained that "very feeble electric discharges,"
whose presence could not be detected "either by the galvan-
ometer or any other instrument," produced contractions in

In connection witli this explanation, however, it must be recollected, that by
Prof. M's experiments on an insulated nerve, ligaied, the current "was weak-
ened and more feeble" in its manifestations beJo^ir the cord.

t44 Means, On Electro-Physiology. [March,

frogs, he tried such weak discharges from a Leyden jar upon a
galvanoscopic frog, and admits that after "a great number of
endeavours," he could discover no difference between the in-
ductive effects of such currents and those produced by the
normal muscular currents of the animal. Before closins: our
remarks upon this department of our subject, we cannot forbear
caUing attention to the very recent anatomical discovery, that
the muscular fibres are directly continuous with the tendenous
fibres in w*hich they terminate, and that the sarcolemma, or su-
perficial investment of the muscle, stops abruptly short at the
junction of the muscle with the tendon. In this arrangement,
therefore, we have ^'some reason to consider the tendon as hav-
ing the same electrical state as the interior of the muscle, so that
by establishing, by means of a good conductor, a circuit between
the tendon and the sarcolemma which covers the muscle, we
put in circulation a portion of the muscular current already
proved to exist."

5thly. The phenomena of Electricity are only manifest when .
the electric equilibrium is disturbed and then restored, by insti-
tuting a current between the positive and negative surfaces.

Now the most recent and thorough investigations in neurol-
ogy authorize us to believe in the circulation of electro-vital
currents, along this sensitive line of conductors, giving strong
indications of conformity to the above law of the inorganic
fluid. To adopt the language of a distinguished member of
the Royal Academy of Medicine in Paris, (Dr. Husson.) " the
structure and functions of the nervous system liave of late be-
come the study of physiologists, and the opinions of Reil, D.
Autenreith, and M. D. Humbolt as well as the recent works
of M. Bogros, seem to place beyond a doubt not only the exist-
ence of a nervous circulation, but also the exterior expansion
of this circulating fluid, an expansion which takes place with
such force and energy as to create a sphere of action that may
be likened to that in which we observe the action of electricity."
These views receive further support from the researches of
Prof Zantideschi and Dr. Favio, who assert the existence of
two sets of neuro-electric currents one superficial, and going
towards the cerebro-spinal axi.>, the other more deeply seated
and going from that axis to the surface. Now, should the super-

1848.] Means, On Ehctro-Physiologij. 145

ficial or returning current not be traceable by any tests now at
our control, we are fairly authorized to infer its existence from
a recently discovered fact in telegraphic electricity^viz., that it
is only necessary to make provision for the outg;oing current
along a single wire, and by allowing the extremities, each to
come in contact with the ground, though fifty miles apart the
re^wrTizTz^ current effects its invisible passage along the earth
to its point of exit^faithfully completing its electric circuit,
after having performed the task assigned it. But infallibly to
establish the existence, not only of currents, but voltaic currents
along the nervous cords, we must refer to a fact which finds
its anologue in another law of the fluid in its inorganic manifes-
tations.

6thly. A current passing under given circumstances^ at an
angle of about 90 from a soft iron bar, instantly converts it
into a magnet.

The capability of our fluid to generate magnetism istooWell
known to require illustration here. Now the interesting ex-
periments of Dr. Prevost of Geneva, as reported through M.
De la Rive to the French Academy in '38, clearly settles the
existence of such currents ; for Dr. P. " succeeded in magnet-
izing very delicate soft iron needles, by placing them near to
the nerves, and perpendicular to the direction which he suppo-
sed the e/edric cwrreTi^ took. The magnetising took place at
the moment, when, on irritating the spinal marrow, a muscular
contraction was effected in the animal."

7thly. Electricity enters and escapes from pointed conductors
with great facility.

We see an obedience to this law interestingly exemplified in
the animal phenomena of taste,' absorption, &c. To the pen of
that great physiologist. Sir Charles Bell, We are indebted for
an accurate and graphic description of these delicate processes,
given, it is true, without any apprehension of the conclusions
to which his anatomical testimony might lead. He says, "the
papillae, which are the organs of taste, are to be seen on the
point and edge of the tongue, and consist of a pretty large,
vascular soft point, which projects from an opaque, and white
sheath. If we touch one of these papilla3 with the point of a
brush" (dipped in vinegar) "and at the same time apply a mag-

9

146 Means, On Electro-Physiology. [March,

nifying glass, it is seen to stand erect, and rise conspicuously
from its sheath, and the acid taste is felt to pass backwards to
the root of the tongue." The simple rationale of this process
may be thus enunciated, viz : the acid, being a negative electric?
excites the positive electricity of the nervous villi, and attrac-
tion and erection are the natural consequences, as the applied
finger produces the extension of cotton fibres upon a charged
prime conductor. Our time forbids the further prosecution of
these interesting examinations, and we must only remark, that
Sir Charles Bell's detail of the apparatus and process of absorp-
tion, furnishes to our minds satislactory proof of the electrical
character and action of the Lacteals and Lymphatics. The
" lanuginous surface" of the intestines, the " small filaments"
which are seen by "a magnifying glass," projecting- from the
surface "like hairs," when stimulated by the negative conienis
of the bowels, and then " ei-ected" in the act of absorption all
speak plainly the electric nature of this process*

Sthly. Electricity expands fluids without chemical change,
and increases the velocity of their motion through capillary
tubes.

A fluid passing by drops from a capillary orifice, as soon as
electrified by contact with a charged conductor, flows in a fine
but rapid and continuous stream, until the communication is
broken. May not this agency heihepri?num mobile of the cir-
culation in the proper capillary tubes, forming the:anastomosing.
net-work bet wen the veins and 'arteries ? for it seems to us,
from the minuteness of their calibre and the ordinary density
of the blood, it is impossible satisfactorily to acount upon any
other received hypothesis, for the constant and speedy move-
ment of that fluid in these remote qudrtcrs.

Othly. Curved or spherical surfaces retain accumulated elee-
tricity best.

This great law of our fluid is regarded in the cylindrical form
and rounded extremities of every Prime Conductor, and the
globular knob of every Leyden jar, and yet it is strange that
no writer, with whorp we have met, seems to have recognized
a conformity to it, in -the general contour of the human body.
The undulating outline and beautiful rotundity of the human
figure, have sprung thQ imaginations of enraptured poets, an4

1848.] Means, On Electro'PhiJsiology, 147

furnished a theme for adoring lovers : rhetoricians have lec-
tured upon the purity of taste, and philosophized upon the
"curved line" as the "line of beauty;" but it seems never to
have caught the observation of poets, lovers, or rhetoricians,
that man vras shaped for the material world m which he moved
and in conformity with the great physical law which control
the elements within and around him. Our tastes are given us
by a benign Creator, to meet the circumstances of our being
and administer to the pleasures of life. But had Heaven so
constituted these tastes, the pleasing emotions which are now
excited by the gentle curve of Beauty's cheek, and the grace-
ful roundness of her sylph-like form, would hav.e been charac-
terized by equal intensity had that cheek stood out a triangle,
and that form an o^c^/z.^^.

Was not, then, the great design of bur external conformation
-to give additional security against an excessive discharge of
this vitalizing fluid? Surrounded, as we are, on every hand
and at all times by an aereal medium, often transformed by .
suspended moisture, into a rapid .absorbent of electricity a
fluid so indispensable in its control over the animal functions,
special guards seem to have been thrown around this exalted
sphere, of its action. Besides the nervous sheaths, the sangui-
ferous tubes, and the oleaginous accompaniments of both, the
exposed outposts of the system are fenced in by a general sub-
cutaneous expansion of adipose tissues itself surmounted by a
final and admirably insulating investment, in the squamous cu-
ticle^ which strictly conforms to electric laws in its curvilinear
adaptation to the whole corporeal surface, and is supplied with
a.n oily secretion, which, while, indispensable to healty exist-
ence, is nevertheless constituted a negative electric to facilitate
the accomplishment of the same grand end. Many warn!*-
blooded animals whose position in the scale of being, requires
that they should be almost constantly immersed in water, as
the whale,, seal, walrus, &c., are protected against undue elec-
trical exhaustion and consequently from an abnormal reduction
of temperature, even in the conducting medium through
which they movCj by immense masses of non-conducting unc-
tuous matter which surround the whole body to a considerable
depth under" the cutis vera. It is an interesting and relevant

148 Means, On Electro-Physiology, [March,

fact, which Chemistry has recently disclosed, that the horny
texture of the epidermis, is not only in chemical composition
nearly the same, but in non-conducting power precisely similar
to lioofs,hair, horns, nails, claws, ivool, &c., and is completely
rejiresented (where, according to our view, its insulating pre-
sence is demanded) in the corneous covering of the epithe-
lium which lines the inner surfaces of the blood and lymph ves-
sels of the intestinal canal and the passages from most glands,
as well as of the mucous membrane of the lungs. The extrem-
ities o^ ^mm^X bodies, therefore, and those parts approximating
most to points, are, in accordance with the same design, guard-
ed hy insulators. Hence the beautiful adaptation of the hoofs
and horns of quadrupeds ^the talons and heaks of birds, (kc,
to effect the high purposes of Nature.

The very instincts of mankind seem to have led them, in
many instances, to the adoption of habits conformable to the
action of this law. Nor is this remark Hmited to civihzed more
than to savage life. Artificial heat, by drying the air and the
cutaneous surface, conduces largely to electrical retention, as
well in the rude hut of the Laplander, as the costly parlor of
the American. So do the greasy skins, furs and feathers of the
Indian tribes, and eVen the rancid and offensive fish oil with
which the New-Hollander besmears his body, w^hile the enlight-
ened civilization of cis-and trans-atlantic states, effects the same
object in the non-conducting textures of the cottons, linens,
woolens and silks, with which they are clothed. The same
instinctive conformity to the inflexible habitudes of our fluid,
may be found in the sleeping arrangements of both savage and
civihzed life. For while the organic electricity of the West-
ern Indian is preserv^ed upon his buffalo and bear-skins, and
that of the wild Polynesian upon his dry grass and mats, the
Asiatic reposes electrically safe upon his muslins and silks and
hah' matresscs, and the European and American upon their
cotton stuffs, blankets and feather-beds. In accordance with
these view?, the health and longevity of our race must be ma-
terially affected by the moisture or dryness, and consequent
electrical condition of the atmosphere. Hence on the lofty
table-hinds of Mexico, 8000 feet above the level of the sea, and
amid whose pure, and dry, and transparent air, the moon is

1848.] Means, On Electro-Physiology, 149

seen as a sheet of silver, and the stars as burnished gold, em-
bossing a vault of Lapis Lazuli human life, according to the
testimony of Humbolt and Murray, is frequently extended to
the long period of " 100 years, and is still green apd vigorous,"
while according to the same testimony, down the slopes ex-
tending to the sea, " where, humid winds and frequent fogs
prevail," and where corporeal electricity is therefore rapidly
absorbed and lost, the air is almost fatal to human life. Here
we are furnished too with a satisfactory explanation of the de-
leterious consequences resulting from exposure to damp sheets
or garments, and especially in the case of invalids or enfeebled
constitutions, where the electro-generative forces are weak
and unable to compensate for the waste by absorption hence
functional derangements rapidly supervene.

Suffer us now, after having traced this parallelism of electric-
al-action between inorganic and organic, inanimate and animate
matter, briefly to refer to some facts within reach of most ob-
servers, illustrative of the control which the electric current
exerts over the excitability of the nervous tissue and the func-
tional phenomena dependent upon its action.

1st. It increases, under appropriate polar arrangements, the
peristaltic motion of the entire intestinal canal.

2nd. A galvanic hne of communication established by a con-
ducting wire and terminal plates, between two slightly excori-
ated surfaces on the human body, soon presents, under the
positive pole, active inflammation, excess of nutrition, and if
kept within conservative bounds, a rapid restoration of the
parts ; while the negative surface indicates an enfeebled vital-
ity, deficiency of nutrition, and an approach to gangrene and
mortification.

3rd. The circulatory salts of the human body may be de-
composed at the cutaneous surface, by a similar arrangement
the acid collecting at the positive pole, and the alkali at the
negative each being indicated by its peculiar characteristics.

4th. Neuralgic pains have often been relieved by the passage
of a thunder storm a phenomenon, for which a rational solu-
tion is only to be found in the fact, that the changed electrical
condition of the atmosphere had effected a disturbance in the
electrical equilibrium of the system producing, perhaps, an

150 Means, On Electro-Physiology. [March,

abnormal and irregular circulation of the neuro-electric cur-
rents, a state of things which was at once relieved, as soon as
the atmospheric balance was restored by the discharged clouds.

5th. Cases of Hemiplegia and other paralytic affections have
often found essential relief from the application of the electric
fluid in some of its forms. Under the generating power of a
large electro-magnet, and revolving armature, I have seen a
case of paralysis of the muscles of the eye, cheek, lips, &:c,
entirely relieved, after a few applications of fifteen minutes
each, which had resisted the ordinary treatment for several
months previous.

0th. Irregular and spasmodic actions in the limbs or joints,
dependent, as we suppose, upon the disturbed electro-vital cur-
rents which traverse the system, will frequently find a remedy
in the use of a similar instrument. My esteemed crolleague, in
the chair of Surgery, has kindly- furnished me with a case of
spasmodic contraction of the flexor muscles of the knee-joint,
which yielded to the first application of a moderate magneto
electric current.

7th. The beautiful and careful experiments of Broussais
show the control of the electric fluid over the processes of
absorption and deposition. He speedily generated a milky
cataract in the eye of a pig, by introducing into the crystaline
lens a fine copper wire, connected with the negative pole of an
active galvanic series, and two weeks afterwards, as speedily
removed it by reijer52?7^ the poles.

8th. Satisfactory experiments by Dr. Wilson Phillip, and
s:nce, I believe,. *' publicly tested in most of the medical schools
of Europe," have shown that Respiration and Digestion can, for
some time, be carried on after the bi-section of the Pneumo-
gastric nerve which so largely controls these functions, by
sending o, positive electric current through the pulmonary and
gastric segments.

From our acquaintance, then, with an agent so prompt and
powerful in its control over the sensibilities and functions of
the animal organism, may we not, hereafter, be able intelligibly
to trace the methodus medandi of many remedies, and the ra-
tionale of certain pathological phenomena heretofore enveloped
in perfect mystery? Does not acu-punctur'ation, formerly

1848.] Means, On Electro-Physiology, 151

employed more extensively than at present, in cases of cephal-
algia and rheumatism, owe its cm^ative efficacy to the conduct-
ing power of the inserted needles which convey silently offthe
excess of electricity collected in the part ? Again, may not
the etiology of malarious and contagious diseases, which has
long lain in profound and unapproachable obscurity, be more
satisfactorily explained by admitting the agency of electrical
affinities than. upon any other hypothesis? The human blood,
in a normal and healty condition of the system, is in ?i positive
state^ which is constantly maintained by the activity of the
generating sources within an excess generally passing off in
silence from the cuticular surface, so that out of 356 experi-
ments made by Mr. Hemmer of England, upon the " uncovered
skin," 322 indicated the presence of positive electricity. This
surplusage of the fluids upon the surface, we believe to be
indispensable to the healthful condition of the whole animal
economy, and that when, from any cause, it is diminished or
ceases, diseased action ensues. I have just received an inter-
esting communication from Mr. D. Ruggles, a blind man, of
Northampton, Massachusetts, who has for years been able to
determine upon the character of diseases from the electrical
manifestation furnished by the skin to his acute sense of touch.
"These symptoms," says Mr. R., in his letter to me, "vary in
healthy persons and in invalids ; in the former, I can feel a regu-
lar emission of what I believe to be electricity, from the pores
of the skin in any part of the body, and especially near the
wrists; in the latter, this symptom is feeble and often intermit-
tent, and in some individuals, it is not perceptible." He then
gives in detail the peculiar electrical states, exhibited in several
different diseases, as detected by sensation.

Now, by the testimony of the best authorities to which we
can have access, it may be regarded as certain, that the pesti-
lential exhalations which escape from animal putrefactions^-
vegetable decompositions, &c., &,c., and, indeed, all the ascer-
tained causes of epidemic and infectious diseases, are in an
electro-negative condition, and when the human body is sur-
rounded by a highly charged negativz atmosphere, instead of
the n-Aim-^Wy positive state of dry and pure air, the result must
be the rapid absorption and exhaustion oi\.\\Q positive corporeal

152 Means, On Ehctro-Plnjsiology, [March,

sup])lies, until the electro-vital resistance is overcome, and
functional ahherrations supervene. May we not in this way,
largel}^ account for the ennui and lassitude so commonly expe-
rienced in a damp atmosphere, where the conducting power
of the medium too rapidly carries off the organic currents, and
thus superinduces a general enervation : the barometrical
column in the mean time, indicating too little reduction in at-
mospheric pressure to fiave produced such striking effects upon
the animal sensibilities.

Once more, we believe that the true pathological distinc-
tion between the chronic and acute forms of Rheumatism, will
be found to depend upon the electro-negative condition of the
parts in the/or;;zer, and their electro-positive states in the latter
the curative applications plainly appropriate in the one, being
contra-indicQted in the other. The high inflammatory action,
arterial turgescence, florid surface, and great pain in acute ar-
ticular Rheumatism, giving evidence of an excess of the positive
fluid, which^is but increased by stimulating applications, warm
covering, ike, and attended by an aggravation of the prevail-
ing symptoms, and which can only be successfully treated by
withdi'awing a portion of blood, {electro-positive) by venesec-
tion or otherwise the application of negative-^Xecii'ics, aa
vinegar, anodyne lotions, &:c., and thin investments around the
joint : or in short, by such remedies as will discharge the
excess of the positive fluid. Whereas in the chronic form, the
absence of capillary engorgement, heat, redness, &c., and an
abatement of pain from warm covering indicate a minus con-
dition of the part, and require that the electric equilibrium
should be restored by favoring the accumulation oiihe positive
fluid, by warm poultices, flannel or silk bandages, or other
non-conductors. In accordance with their views, therefore,
in acute Rheumatism, or an electro-positive condition of the
part, allow us respectfully to suggest the use of a flexible me-
tallic bandage, or strips of tin-fojl upon linen, studded thickly
with metalic points, directed outward, which may be readily
prepared by- driving small tacksL through the bandage, and ap-
plying their heads towards the cutaneous surface ; keeping
the whole moist, in the mean while, by embrocation's of tobacco
and vinegar, or other negative electric.

1848."! Means, On Electro-Physiology, 153

Lastly: The singular phenomena attendant upon etheriza-
tion, or the use of the Trichloride of Form vie (chloriform),
which belongs to the same class of volatile fluids, for which we
have yet seen no plausible philosophical solution, may be fairly
traced, we think, to the electrical affinities at play in the pul-
monary organs and the sanguiferous channels, and directly
effecting the whole nervous tissue. Tlie views here inculcated,
it must be remembered, recognize all sensation and motion, as
dependent upon nervous energy, and the latter as only main-
tained by the presence of electric currents. .Now we have
tested by repeated experiments, that the vapor of Sulphuric
Ether, is always negative in the presence of a positively excited
body, and when freely inhaled, it passes readily by imbibition,
through the mucous lining of the air cells, into the circulating
mass of blbod, whose normally positive condition is rapidly re-
duced, until the supply is inadequate to maintain the integrity of
functional action in the sensiferous nerves, and consequent
insensibility follows. If the inhalation is continued, the motor
system of nerves next lose the necessary amount of electrical
Stimulus, and the whole muscular tissue is relaxed, and voluntary
motion suspended ; and if persevered in too long, the iiivohinta-
ry motion of the heart, arteries, &c., cease from the same cause,
and death ensues. When, however, moderately administered,
spontaneous restoration may be expected from a re-supply of the
positive fluid; furnished by the still active electro-motive re-
sources of the system.

Some experiments recently made by M. Ducros for the pur-
pose of determining the efficacy of Electricity in recovering
inferior animals from the effects of inhaled ether, and published
jn the August number of the London Lancet, greatly strengthen
our opinions as to the rationale of Letheonization. M. Ducros
states, " that the phenomena produced by the vapor af ether on
chickens and pigeons last from seven to eight minutes; but if
these birds, when thus under the influence of ether, are submitr
ted to the action of electricity by placing them on the isolating
stool, and allowing a current o{ positive electricity to pass into
them, they recover from their insensibility in about thirty
seconds. If they are placed on the electric conductor, they are
aroused "in ten seconds ; and if they are placed at the extremities

154 Gaither, On Lithotomy. [March,

of the conductors, and thus made to receive electric shocks, their
vigour is instantly restored. When submitted to the action of
the simple apparatus of Clarke, the electro-magnetic current is
equally instantaneous in effecting their restoration. The injlu-
ence of negative electricity, instead of abridging the insensi-
bility, appears to prolong i7." Comptbs Rendus and Medicaid
Gazette.

ARTICLE XII.

Notes of an Operation for Lithotomy, performed under peculiar
circumstances. By Henry Gaither, M. D., of Oxford, Ga.

Setting out at an early hour on the morning of the 3rd of
April, 1847, Professor E., accompanied by Dr. Means and
myself, of this place, and Dr. Hendrick of Covington, after a
ride of sixteen miles reached the point of our destination. Mr.-
R., the patient, was found at the residence of his father, in com-
pany with a few friends, awaiting the arrival of the Surgeon.
He is a young man of about 20 years of age, and had been
afflicted with Stone in the Bladder from early childhood. He is
of ordinary size, moderate embonpoint, and although of rather a
sallow complexion, not un-prepossessing in his appearance. He
had visited Augusta some weeks before to consult Dr. E., who,
by the use of the sound, satisfied himself as to the nature of the
disease ; but the patient preferring to undergo the operation at
home, returned thither, and underwent the usual preparatory
treatment, until the day above mentioned, which had been ex-
pressly set apart for its performance. The impression made
upon my mind, on seeing the patient that day for the first time,
was not, I must confess, at all complimentary to my capacity
for readily discerning character, either in countenance or con-
duct. For I thought I saw before me one naturally endowed
with a goodly degree of fortitude, and on this occasion nerved
to such a point of sturdy endurance that nothing could shake it
and his manly port, and dignified reserve, seemed to justify the
opinion, but the result did not verify it.

After all things had been duly arranged for the operation,
the 1 a ient placed in an appropriate posture upon the bed, the

1848.] Gaither, On Lithotomy. 155

sound introduced, &c., &c., the surgeon proceeded to his work.

The bilateral operation was performed, using a double lithotome,
similar to that of Baron Dupuytren. Time, 45 minutes : stone
small. .

The following is its analysis, by Prof. Means :

' Emory College, Oxford,
May 21st, 1847.
Dear Doctor The dimensions of the calculus taken from
Mr. R. on the 3rd ult., and submitted to me for analysis, were as
follows viz., in its gi'eatest circumference 2 inches, in its least
1 3-4, and its weight 47 grains. Its shape an irregular oblate
spheroid, with exceedingly rough tuberculated surface, exhibiting
under the microscope an investment throughout its entire ex-
tent, of extremely minute sparkling octahedral crystals of the
oxalate of lime. When sawn through at right angles to its
longest diameter it exposed a uniformly concentric structure,"
distinctly traceable, and conforming in the line of strata to a-
small cavitv in the centre of the mass, studded with crystals
similar to tKose upon its surface. The body of the stone wore
the nutmeg hue, and under microscopic examination gave
evidence of imperfect crystalization, characteristic of the mul-
berry calculus.

Yours trulv,
To Dr. Gaither," *A. MEANS.

There were several peculiaiities in this case worthy of a
passing notice. 1st. The smallness of the stone, considering the
length' of time it had been forming. 2nd. The depth of the
has fond or lower fundus of the bladder, thus shaped doubtless
by the long residence of the calculus in this yielding sac, causing
it to elude my explorations with the sound, but which availed not
against the more accustomed hand of Dr. E. Nevertheless,
after the incision was made, the stone was not so readily seized
by the forceps as usual, perhaps, partly owing to its size, but
chiefly to its location. 3rd. This case is further interesting from
the operation having been performed contrary to the will of the
patient, or rather 'after his fortitude had forsaken him ; for it
seems the touch of steel more than equalled' his anticipations,
as a stroke or two of the scalpel dissipated his courage, changed
his purpose, and reconciled him to longer companionship with
the old tormentor. But his friends thinking him incompetent,

156 Campbell, On body in Duct of Whorton. [March,

in that unbalanced state of mind, to decide so important a matter,
m'ged the surgeon to proceed, which he did : a number of the
medical brotherhood, assisted by a layman and ligature at each
leg, holding amain the patient vociferating lustily, threatening

and struggling violently he partly succeeded

in disengaging himself from his manifold encumbrances ; but
half coaxed, half coerced, he was soon again in bonds, when the

writhings and exclamations commenced anew

But while we deeply sympathized with the interesting and af-
flicted young man, we could not but feel that the whole scene
presented a rare combination of the ludicrous with the grave.
The distinguished surgeon in the mean time calm and self-
possessed amid the general commotion, proceeding secundum
artem when he could, and maintaining a " masterly inactivity"
when he should.

On the 14th of the month, (being the eleventh day after the
operation,) the urine permanently resumed its natural channel
without pressure on the perineum or any artificial aid. The
patient has now fully recovered, not having had a bad symptom
since he submitted to the knife. This leads to the 4th and last
reflection, that a skilful and expert operator may expect a
favorable issue in such cases, although subjected to unnecessary
and vexacious interruptions and delays from the violence and
insubordination of a half delirious patient.

ARTICLE XIII.

The Removal of a Foreign Body from the Duct of Wharton.
By H. F. Campbell, M. D., Demonstrator of Anatomy in the
Medical College of Georgia.

The novelty of the following case will be seen to warrant its
publication.

Of Foreign Bodies in the Duct of Wharton, so far as we know,
there is on record but one case, which is that presented by M.
Robert to the Anatomical Society of Paris, and which indeed
has been considered quite remarkable. It occurred in tlie per-
son of a shoemaker, in which case the orifice had been found to
admit a piece of hog's bristle which subsetjuently became the
nucleus of salivary calculus.

1848.] Campbell, On body in Duct of Whorton. 157

Case. Julia, a nurse, aged 14 years, while engaged at work,
with a pin in her mouth, felt pain under the tongue, and endea-
vored to remove the pin, but on feeling for it could only find the
point protruding at the side of the fraenum lingua3. Her efforts
to extract it by the point caused it entirely to disappear : be-
coming alarmed, she called for assistance. On examination,
there could not be seen the least trace of any foreign body what-
ever: she said that " the pin was under her tongue, and had
gotten into the flesh head-foremost." It gave her no pain, ex-
cept when disturbed with the fingers ; the orifice of the Whar-
tonian duct was patulous and' some saliva was flowing from it.
On applying the finger to the floor of the mouth the pin could
easily be felt near to the base of the lower jaw though from the
distance to which the head had proceeded towards the coecal
extremities of this duct, it was impossible to protrude it by ap-
plying pressure from behind, and further, from the handling to
which the parts had been subjected, the point had been pushed
out of the direction by which it entered, and having pierced the
side of the duct was resting on the alveolar process. It was
very moveable, and receded on the slightest pressure.

Failing of its removal by manipulation, the following method
was adopted : Its exact situation being ascertained, the object
together with the parts surrounding it was seized by the fore-
finger of the left hand'in the mouth and the thumb in the digas-
tric region, and pressed outward against the inner surface of the
lower jaw under the alveolar projection : a tenaculum was then
introduced from within outward through the mucous membrane^
(avoiding the situation of the gustatory nerve which near this
place crosses the duct.) so as to enclose the duct and hold the pin
fixed ; on elevating the tenaculum, the point of the pin became
prominent about three lines posterior to the orifice of the duct.
The mucous membrane and coats of the duct being cut through
with a scalpel, the pin was removed with the dressing forceps by
ihepoint which protruded through the opening of the incision.
A copious discharge of saliva followed its removal. The incision
healed rapidly, and the patient recovered without any trouble.
The pin was 1 1-4 inches in length, and of a proportionate
thickness.

158 Yi\e, On Removal of part of the Clavicle. [March,

ARTICLE XIV.

Removal of 4^ inches of the Clavicle patient fully recovered.
By Paul F. Eve, M. D./ Professor of Surgery in the Medical
College of Georgia.

Ned, a very powerful young man, belonging to Mr. H. of
Washington county, Ga., entered my Surgical Infirmary on the
21st of January, 1847.. Three years before he had received the
blow of a stick upon the top of his l^t shoulder which confined
him for six months. A fistulous opening soon after occurred
about the middle of the collar bone, from which spicules of bone
have occasionally been discharged. A portion of boiie is now
presented at this issue, which is the centre of a large tumor oc-
cupying the place of the left clavicle. So critical is the case,
that a colleague objects to an operation upon the diseased mass.
He did not consider the surgeon justified under so great danger
to life.

On the 26th, five days after the arrival of the patient, assisted
by several friends, the following operation was performed before
the* Medical Class : The sternal extremity of the clavicle was
first attempted to be dislocated, but as this was found difficult to
accomphsh on account of hemorrhage, &lq,., a long incision was-
made over the Jength of this bone, and deeply into the tumon
passing through the periosteum. A portion of the clavicle, in-
cluding its entire circumference and -measuring 4^ inches^ was
now extracted through this opening. There were also some
smaller pieces removed during the operation. Twelve or more
arteries had to be ligatured, two tents \vere placed in the wound
and the usual dressing of adhesive plaster, compress and band-
age, was applied.

No unfeivorable symptoms arose during the after treatment.
The patient was sitting up on the third day, and he left for home
in about three weeks, the wound not then however entirely
closed. He returned, by appointment, to see me a month after
this date, a small specula of bone was extracted, all discharge
ceased, and the patient soon completely recovered. There ex-
ists now no deformity, no percei)tible tumefaction, the patient
sufici's no pain, and is considered as well as he ever was is, in
fact, one of the strongest men in his county.

1848.] On Endemic Gastro-follicular Enteritis, ^c. 159

It will be perceived that the portion of the clavicle was re-
moved by what is termed the sub-periosteal. incision or opera-
tion for necrosis.

PART II. REVIEWS AND EXTRACTS.

On the Endemic Gastro-^ follicular Enteritis, or " Summer Com-
plaint'''' of children, as it prevails in the United States. By
Edward Hallowell, M. D., Fellow of the College of Phy-
sicians of Philadelphia, Member of the Academy of Natural
Sciences, &c. (iVmerican Jour, of Med. Sciences.)

Cholera Infantum, or "the summer complaint" of children,
has been considered peculiar to the United States. Billard, in
his work on the diseases of infants, alludes to its occasional
existence in Paris. In the United States it prevails to a great
extent, and the mortality from it is extreme. It occurs in all
our large cities, carrying off several thousand children annual-
ly ; it commences in the Southern States in May, and in the
Middle and Western about the beginning or middle of June,
and continues until near October, the greater number of cases
being observed in July and August. It is found chiefly in the
lanes and alleys of our large cities among the poorer classes of
society, but those in the higher ranks are by no means exempt
from its attacks. It is stated by Dr. Condie, that during a pe-
riod of fifteen years from 1825 to 1839 inclusive, 3352 infants
perished of this disease in Philadelphia, being almost' ten per
cent, of the w^hole number of infants under five years who
died during that period. In St. Louis, Missouri, during the
years 1841, 1842, and 1843, 238 children died of it. In 1823,
253 died of the same complaint in Baltimore. The average
number of deaths annually in Philadelphia is about 2(T0. The
disease is confined almost exclusively to children between four
and twenty months of age; cases, however occur as early as
the age of two months, and at as late a period as three or five
years.

Causes- of the Disease, Cholera infantum is considered to
be dependent for its production upon a heated, confined, and
impure atmosphere, acting "directly upon the skin, and indi-
rectly upon the mucous surface, at a period when the latter is
already strongly disposed to the disease from the effects of den-
tition, and from the increased devebpment and activity of the
muciparous follicles which takes place at that period." The
circumstances" of its origin, however, are involved in doubt, and
can onlv be determined bv future and more correct observation.

160 On EndermicGastro-follicular Enteritis, ^c. [March,

The exciting causes are stated by Dr. Dewees to be improprieties
in diet and clothing. He observes also, that it is very often
ag,c:ravated by worms, but such a complication has not come
under our notice.

General description of the disease. Cholera Infantum may be
divided into tliree stages, based upon its anatomical characters.
In their description we shall be guided chiefly by the. results of
our own observations.

Symptoms of the first sta^e. This usually commences with
diarrhoea, succeeded by vomiting, or with vomiting and purging ;
these symptoms are soon followed. by fever of a remittent type
with evening exacerbations ; the pulse is small, quick, and
frequent, occasionally full, and sometimes tense ; the brain ig
often affected sympathetically ; this condition is manifested by
a tendency to deHrum ; the eyes have a fierce and wild ex-
pression, and the face is flushed ; the stools in this stage vary
much in consistence ; at times they are thin and watery, but
often pasty or mush-like ; their colour differs also greatly In
the course of the day, and from one day to anotl>er ; in a num-
ber of instances they presented the appearance of chopped
^gg, upon wiiich boiling water had been poured ; occasionally
they consisted almost entirely of mucus. The period at which
the vomiting is observed varies ; it occurs usually on the se-
cond, but often as late as the fourth or fifth day; in some
instances there is no vomiting throughout the course of the
disease ; in one case it did not make its appearance until a few
days before death ; the matter vomited consisted of the con-
tents of the stomach, which were returned almost immediately
after their entrance into it ; these were more or less mixed
with mucus ; in infants at the breast the milk was returned in
a curdled state, having an acid smell ; in one instance it had
the appearance of coffee grounds ; the vomiting occurred for
the most part three or four times a day, and sometimes oftener*

Temperature of surface. The skin was occasionally moist,
more frequently dry, warmer upon the head and abdomen ;
the latter is mostly warmer than the rest of the body, and often
decidedly hot ; the temperature of the extremities is natural, or
more generally cool ; occasionally it is warm ; sometimes the
lower extremities are cool while the upper retain their usual heat.
The respiration, except in those cases complicated with other
diseases, as hooping-cough or measles, was free, the number of
respirations in the course of the minute amounting to 20, 24, 28,
29, 30, 33, 3(), 10, 44, 48, 53, 55, 50, 00, 04, 00. When over
80 the respiration was more or less interrupted. The tongue in
this stage wai? observed to be moist, but was often red at its tip
and edges, and coated at its base with a yellowish or brownish
yellow fur.

1848.] On Endemic Gastro-foUicular Enteritis, ^c. 161

The countenance in the early stage, except when the attack
was violent, was good, the eyes being bright and animated ; oc-
casionally the child would fall into a sleep from which it was
easily roused. There was usually a considerable degree of
irritability and restlessness, the little sufferer being pacified with
difficulty. The sleep was often disturbed. T^he abdomen Was
occasionally tense and tumid, and somewhat painful on pressure ;
the thirst Was often intense ; it now and then happened, however,
that drink was refused.

Anatomical characters. These consist in an undue develop-
ment of the follicles both of the stomach and intestines, or of one
of those organs without inflammation of the mucous membrane.
Children rarely die of cholera in the early stage ; opportunities,
therefore, seldom occur of observing the morbid appearances.
M. Billard, who had ample opportunities, for the study of the
diseases of children at the Hopital des Enfans Ti'ouves of Paris,
states that he had seen isolated follicles and follicular plexuses of
the intestinal tube in considerable numbers and developed without
being inflamed in twelve infants; three Were aged from- eight days
to three weeks, two aged two months, the remaining seven were
from nine "months to one year ; the symptoms of the cases he
has published correspond so closely with those of cholera infantum,
that, to use the language of Dr. Horner, it is evident had they
occurred in this country, they would have been named, and in
fact are cases, of cholera infantum. M. Billard states, that most
of these children had arrived at the period of dention, so that there
appeared to be a remarkable coincidence between the appearance
of the teeth, and that of the organic development of the follicular
apparatus of the intestines, the follicles performing an active
part in the process of digestion by furnishing the surface of these
organs with a fluid which in all probability assists in the elabora-
tion of food. Dogs, he observes, and other carnivorous animals
remarkable for their digestive powers, possess this apparatus in
a high degree of development. In a lioness which died in this
city some years ago, and of which 1 had the opportunity of making
a post-mortem examination, the isolated follicles of the intestines
Were one-fifth of an inch in dianiater.

The follicles are sometimes found to exist in great numbers
from the first period of fife, but in genera] they are not very
numerously developed, except at the period above mentioned, or
at a still more advanced age. (Billard.) Roederer and Wagler,
in their work De Morho Mucoso, in which they describe the
symptoms and anatomical characters of a gastro-follicular
enteritis that prevaile4 in Gottingen in 1760 and 1761, give very
beautiful and accurate drawings of the mucous follicles in a state
of abnormal development.

10

162 On Endemic Gastro-follicular Enteritis, ^c. [March,

The muciparous glands of the mucous membrane are, it is
known, of two kinds, the isolated and the a^minated. The iso-
lated follicles are found both in the stomacti and intestines, but
are much more abundant and less uniibrmly developed in the
former than in the latter ; the agminated follicles or glands of
Peyer occupy the free border of the intestine ; these are rarely
affected in cholera infantum. The isolated follicles are found
less abundantly in the jejunum, than m the other portions of the
small intestine. They are usually about the size of a pin's head,
and have not inaptly been compared by Dr. Horner to grains of
sand sprinkled over the surface of the intestine. They are ele-
vated above the surrounding surface of the membrane, and have
each in their centre a small grayish point. They consist simply
of a duplicature of the mucous membrane, and are readily effaced
by passing the handle of the scalpel over them with some force ;
on cutting them open they are found to contain a small quantity
of fluid. These glands receive each, according to Lieberkuhn,
Meckel, and Beclard, an artery, a vein, and a nerve. They oc-
cupy both the summit and the interstices of the valvulse conniven-
tes, and are found disseminated over every part of the intestine,
both upon its free and attached surface. (See case of Charles
Morand in Billard, Maladies, des Enfans, and of Marie Boule-
fray in the work of the same author, entitled ^' De la Membrane
Muqueuse gastro-intestinale dans Vctat sain, et dans Vetat in-
Jlammatiore, ou recherches dVinatomie patJiologique sur ses
divers aspects, sains et morhids.'^^ Paris, 1825.)

Treatment. We have thought it proper to intercalate with
our own, the opinions of older and more experienced members
of the profession, more especially those of Dr. Chapman, Prof,
of Practice in the University of Pennsylvania. His acute per-
ception o'i symptoms, appears to have impressed him more fully
than most others with the importance of depletory measures in
the treatment of this disease. Preventive means. In the be-
ginning of June examine the condition of the gums of the child,
and if swollen, lance them and send it into the countiy. A part
of the country should be chosen which is elevated, where the air
is pure and diy, and where there are no large streams nor stag-
nant water. C'hestnut Hill, in the vicinity of Philadelphia, offers
superior advantages in this respect. If it be impossible to remove
the child to the country, especially if the apartments of its dwell-
ing be not large and freely ventilated, let it be carried into the
open squares of the city, or taken frequently across the Dela-
ware in the afternoon. The sleeping apartments of children
should be large and well aired. They sliould sleep upon a mat-
trass or blanket folded upon the floor of the room or crib, and
the covering should be light ; they should be immersed in a cold

1848.] On Endemic Gastro-foUicular Enteritis, ^c, 163

bath at least once a day, or be freely sponged With cold water;
the mortality among children in Philadelphia is said to have
greatly diminished since the introduction of the Schuylkill wa-
ter ; the child should be confined to the mother's breast, care
being taken not to overload the stomach ; indeed, it often hap-
pens that the breast is given to the child w^hen it requires
only drink ; the stomach then becomes distended and vomiting
often ensues. Attention during the first year should be paid to
the diet of the mother ; she should avoid articles of a flatulent
or indigestible character. Dr. Parrish recommends as a preveri-
tive nieans, when a predisposition to cholera is suspected, the
occasional use of nutricious animal fluids ; the sucking of small
pieces of salt meat, as ham or dried beef, he observes, will some-
times be found productive of advantage; With the same vievV
of giving tone to the stomach, he recommends that aromatics, as
ginger tea, be used habitually during the summer, in those cases
in which there is strong reason to apprehend the occurrence of
cholera; This treatment may possibly be applicable under cer-
tain circumstances, as in the case recorded by him, but as a
general rule we are not disposed to recommend it. Indeed, he
himself observes, that it is applicable in all its details only to those
in whom there is every reason to apprehend that the only alter-
native is between almost certain death and the most careful
prophylactic treatment.

Treatment of the first stag6. We have seen that the first stage
c5dnsists chiefly in an abnormal development of the mucous
follicles of the stomach and intestines. This, as oberved by M.
Billard, is not, properly speaking, a triie inflammation, being
rather an intermediate stage between the normal state, and the
state of inflammation. The follicles are simply in an excited
condition, induced as there is reason to suppose, by the power-
ful influence of heat combined with malaria, acting upon the
nCrvous system. The object of treatment, therefore, is to subdue
this excited condition, and to restore the healthy state of the
skin, with which, and the mucous lining of the alimentary canal,
there is a powerful sympathy. The functions of the liver, it is
probable, are more or less impaired, but of this we have no direct
evidence. If the child be not weaned, it should be confined to
the mother's breast, care being taken to avoid overloading the
stomach, thus adding to the irritation which already exists. If
weaned, it should be confined to milk and water, rice, barl&y, gum,
or toast water. The infusion of the benne leaf (Sesamum
orientale), is also employed in this city, and is a useful remedy*
The gums should be carefully examined and lanced if swollen.
The most important point of treatment, however, is early removal
to the pure air of the country. This should be done as soon as the

164 Oji Endemic Gastro- follicular Enteritis, ^c. [March,

disease has declared itself. Dr. Georjie B. Wood, Prof, of Materia
Medica and rharniacy in the University of Pennsylvania, states,
that durin<j: the whole ])eriod of hisy)ractice, (nearly thirty years.)
but one case occurred to him, so far as fie can recollect, of a fatal
termination of this disease, when tiie child had been sent into the
country in the early stage of it. {Fract. of Med., vol. i. p. 673.)
Blisteis behind the ears have been highly recommended at this
period of the disease, and we believe the practice is attended ^vith
decided advantage. Dr. Parrish was the first to suggest them.
They should be ap])lied immediately. The advantage arising
from the early application of blisters behind the ears is confirmed
by the late Dr..Eberle, a distinguished practitioner of this city,
favourably known by his WTitings on the management of children.
He observes, " during the last seven years, I have treated but
few cases in which I have not at once applied blisters behind the
ears, and I may cofidently affirm, that since I have adopted this
})ractice, 1 have been much more successful in the management
of the disease than formerly. Their good efi^ects arise, no
doubt, from tfie counter-irritation they produce." The warm-
bath should be administered every night and morning, and the
child on coming out be gently rubbed with a piece of soft flannel ;
should there be much cutaneous sensibility, a portion of salt and
mustard may be added to it. With a view of allaying the
vomiting, various remedies have been employed. Injections of
salt and water have been recommended by Dr. Dew^ees. Lime-
water and milk, and the neutral mixture may be used for this
purpose. Dr. Chapman states, that he has found the irritability
of the stomach most eflectually allayed by lemonade in doses of
a teaspoonful, frequently repeated. It should be made pretty
sour. Great advantage may also be derived from the frequent
use of Seltzer or soda water. Dr. Parrish was jn the habit of
recomrrtending it to be put up in 3 ss phials, the contents of one of
which to be given at a draught. The soda powders may also
be employed. Chicken water was also directed with the same
view. Stimulants, as strong coffc^e, sulphuric ether, turpentine,
&c., are objectionable. Dr. Condie states, that when the irri-
tability of the stomach has been excessive, he has rarely failed
in allaying it by the administration of the acetate of lead, in
solution according to the following formular. R. Aq. pura?
Bj; acet. plumb, grs. v; acid acet. impure. ^H v; sacch. alb.
pur. 5ij^j. kSig. A teas[)oonful may be given every hour or two
until the vomiting be sus])en(led. We have been in the habit of
directing the blue mass mixed up with gum arabic, with a view
of overcoming the irritable condition of the stomach, and usually
\\\\\\ success, or small doses oiValomel, (,V c)l" a grain every two
or three hours, either alone or in combination with a very minute

1848.] On Endemic Gastro-foUicular Enteritis, ^c. 105

quantity of opium, yV' 2V' 3V' t o^h of a grain.) The blue mass
may be given as follows : h . Mass. ex hydrarg. grs. iv ;
g. acacioB pulv. ; sacch. alb., aa ss ; aq. 5 iss. M. Sig. A tea-
spoonful every three hours.

If the vomiting be obstinate, a Cayenne poultice or small blis-
ter may be applied to the epigastrium. Should the disease con-
tinue, we n^xt have recourse to small doses of calomel and
ipecacuanha in dosesTrom yV to } of a grain of the former, and
from y to I a grain of the latter, every two or three hours;
advantage may sometimes be derived from substituting a small
quantity of Dover's powders, (from j to ^ a grain,) for the
ipecacuanha. We should be extremely cautious, however, in
the use of opiates in this or indeed in any stage of cholera in-
fantum. Benefit may also be derived from the application of
a bread and milk, or mustard poultice over the whole abdomen,
or, as advised by Dr. Eberle, a poultice composed of twa or
three tj'blespoonfuls of powdered black pepper, with a few tea-
spoonfuls of Cayenne mixed up with a common poultice. Em-
brocations to the abdomen and lower extremities, with spirits of
camphor, mav also be used with advantage. Should there be
symptoms ot acidity, which may be ascertained by testing the
stools with litmus paper, a few grains of magnesia may be given,
and should the discharges continue so as greatly to debilitate
the patient, two or three grains of prepared chalk may be added
to the prescription of calomel and ipecacuanha. We cannot,
however, protest too strongly against the injudicious use of as-
tringents in this or any other stage of the disease. We once
witnessed a case in Avhich cerebral symptoms of an alarming
character supervened in consequence of a sudden arrest of the
alvine discharges by means of the chalk mixture, and the child's
life became a forfeit.

Second stas-e. The vomiting Avhich, in the commencement,
was more or less frequent, now occurs but seldom, while the
diarrhoea continues ; the stools vary much in appearance, but
are more or less bloody and painful : there is also much restless-
ness, and the child is observed to draw up its limbs at the time of
the discharge ; the predominating colour of the stools is dark-
green, looking like chopped spinnach ; the colour, however, is
occasionally lighter, but mixed with portions of a darker hue, or
with lumps of yellow more or less curdled. They are often of a
bright yellow or chrome colour, or of a dark brown or chocolate
colour, caused by the admixture of grumous blood. The appeai'-
ance of the stools varies much in the course of the day, the
change of colour probably depending upon the greater or less
quantity of bile and acid in the intestines ; the abdomen is more
or less tumid and painful on pressure ; tenderness of the abdo-

166 On Endemic Gastro-folUcular Enteritis, ^c. [March,

men, with drawing up of the Kmbs, and bloody discharges are the
most important signs in this stage of the affection; the tempera-
ture of the abdomen is usually elevated, while that of the ex-
tremities is cool ; the pulse is small and feeble, or it is frequent
and tense ; occasionally it is intermittent ; as the disease advan-
ces, the emaciation already observed progresses, the skin about
the neck and thighs hanging in folds ; the eyes become sunken
m the orbit, and each is surrounded by a dark areola ; the nose
is sharp, and the lips are shrivelled ; the feet beconie oedematous,
and the cutaneous sensibility is so much impaired that flies col-
lect upon the face wtthout causing any uneasiness ; petechise are
occasionally observed at this period ; the tongue is dry and
incrusted, and covered with aphthae, and deglutition is now
more or less painful ; the child is often observed to thrust its
fingers far back into the mouth, from dryness of the fauces ; the
appetite becomes greatly impaired, and there is almost constant
thirst. Dr. Dewees mentions the eruption of a quantity of min-
ute vesicles upon the chest, which he considers a fatal sign. Dr.
Gondie states that he has known many instances of recovery,
CA^en when the eruption has been most extensive and distinct.
A^e have observed it but in a single instance j the eruption, how-
ever, was not confined to the chest, but occurred in other parts
of the body. Dr. Chapman speaks of the appearance of pink-
eolored stools as a fatal symptom ; thi^ does not correspond with
our own observations.

Anatomical characters of the second stage. These consist
essentially in inflammation with softening of the mucous mem^
brane and ulceration of the follicles, more especially of the large
intestine. The mucous membrane of the stomach in many
cases presents its usual appearance and consistence in others it
is more or less injected and softened, the softening extending oc-,
casionally to all the coats, resembling the condition described by
Cruveilhier, as characteristic of the disease termed by him
maladie gastrn-intestinale des enfans, and by Jaeger, Gairdner,
and others, softening of the stomach.

Rilliet and Barthez in their work on the diseases of children,
notice the correspondence between the symptoms of softening
of the stomach as described by Jaeger, and those of cholera in=
fantum ; but an examination of the cases recorded in this paper
will show that this condition ofthe organ is but rarely observed.
The lining membrane of the stoinach is not unfrequcntly cover?
ed with a hiyer of whitish opaque mucus easily scraped ofl'with
the handle of the scalpel ; the mucous follicles both of the stom-
ach and intestines are more or less npjiaront ; the mucous mem-
brane of the small intestine is occasionally softened, and for the
most part pale in the greater portion of its e:5vtpnt, pontrary to

1848.] On Endemic Gastro-follicular Enteritis J ^c 167

the statements of Dewees and others, who consider the small
intestine as being the exckisive seat of the disease. In one case
the portion of intestine inflamed (the lower portion of the ileum),
presented a brick-dust colour interrupted with alternations of a
pale yellow, mottled with red in some points ; minute vessels
were seen freely inosculating with each other ; in other portions
the inosculations were less distinct, there being a uniform red-
dish tinge. In another it was of a dull red, or brick-dust colour,
minutely injected with red vessels, and in several points, espe-
cially upon the surface of the valvulae conniventes, presented a
dotted appearance ; it occupied a portion of the intestine four
inches in extent from the pylorus. In another case, (Case X.,)
the duodenum at its upper portion presented a slight shade of
pink, with a few minute arborizations, and in seve 1 other in-
stances there was a sHght degree of inflammation affecting the
duodenum at its upper extremity. There was also a slight in-
flammation of the glands of Peyer in one or two cases, but for
the most part they presented nothing remarkable. The small
intestines contained a considerable quantity of orange coloured
mucus. The large intestine was more or less inflamed and soft-
ened in almost every instance ; the inflammation existed in the
form of bands, and presented a dotted arborescent appearance ;
in one case these bands were longitudinal ; they were five or six
inches in length, and several lines in breadth ; in another case the
bands were about two inches in length, having a minutely arbori-
form appearance, and were of a deeper red than the surrounding
membrane ; the first was situat:ed one and a half inches from the
coecum, the second six inches from the first, and extended nearly
the whole circumference of the gut ; it was three inches in length
and very minutely injected, but not so much as to destroy the ar-
boriform arrangement. In most of the cases the redness was dif-
fused with occasional ramifications ; in one instance the inflam-
mation occupied the whole extent of the colon ; it was of a vivid
red throughout, and the membrane was much thickened. The
inflammation was here also for the most part diffused, or in the
form of bands occasionally presenting a ramiform appearance,
the minute versels freely inosculating with each other- From
the margin of the follicles minute vessels were seen to radiate
to the surrounding membrane, occupying the entire surface of
the intestine, showing that the inflammation commenced in the
follicles and extended subsequently to the mucous membrane.
The follicles were often found to be more or less ulcerated, the
ulcerations sometimes extending as far as the muscular coat ; the
ulcerations were more numerous and penetrated more deeply in
the rectum than in other portions of the intestine ; it was oiten
completely riddled with them ; we have not "observed the sur-

1G8 On Endemic Gastro-foUicular Enteritis, <^c. [March,

rounding membrane to be implicated to any extent ; the mucous
membrane was more or less softened in the greater number of
cases ; in one instance it was thickened ; the membrane in this
case was intensely inflamed. The coats of the intestine were
covered with a layer of mucus, sometimes so thick as to dimin-
ish considerably its calibre. It ordinarily contained a quantity
of grayish coloured faeces of the consistence of gruel. The lungs
presented nothing remarkable- but a slight engorgement posteri-
orly except in three cases, one of which was complicated with
measles, and the remaining two with hocping-cough ; in these
cases the usual appearance of lobular pneumonia were present.
In one case the patient had been attacked with pleurisy in con-
sequence of exposure to the night air ; at the autopsy a consid-
erable quantity of pus was found eflused in the cavity of the
right pleura, and the lung was more or less disorganized, The
peritoneum presented its usual healthy colour in all the cases ob-
served ; the liver was greatly enlarged in but a single instance,
contrary to the statements of most authors who affirm this to be
uniformly the case ; the gall bladder was more or less distended
with dark coloured bile staining the finger a deep yellow ; the
mesenteric glands were not enlarged ; the spleen and kidneys
presented nothing remarkable. In nearly all the cases the veins
of the pia mater were more or less distended ; the xirachnoid
was pale and moist, except in one case in which there was a
slight opacity at the base of the brain ; there was more or less
efiusion in the subarachnoid cellular tissue, for the most part
limpid ; occasionally it presented a whitish, opalescent'or citron
coloured a])})earance ; the pia mater was more or less injected,
but the injection for the most part appears to have been confined
to the larger ramifications; it was easily removed by tractiou
from the surface of the brain; the substance of the brain pre-
sented its natural appearance except in two cases, in one of
which the central, and in the other both the centraiand the cor-
tical portions were injected ; it was softened in four of the cases ;
there was little or noeifusion in the ventricles; in one instance the
lateral venti-icles ap})eared to be quite dry as if wiped with a cloth.
Treatment, We have seen that the second stage is charac-
terized chiefly by tenderness of the abdomen on pressure, draw-
ing up of the limbs, and bloody stools, symptoms which de})end
u})on inilammation of the niucous membrane, more especially of
the large intestine. The treatment, therefore, in this stage
should be antii)h!()gistic. There can be no doubt, we think, that
the mortality iVom cholera inlantum has arisen in a great degree
from not keeping its inllammatory character sufficiently in view.
We have found inilanimation of the mucous membrane of the
large intestine in every autopsy that we have made, aud evidence

1848.] On Endemic Gastro-follicular Enteritis, ^c. 169

of its existence in an advanced stage of the disease clearly dem-
onstrated in all the published cases that have come under our
observation. -

The chief object of the present essay, indeed, is to direct the
attention of the profession to the above fact, and to the impor-
tance of anti})hlogistic treatment, instead of the purgative plan
usually })ursued and with such fatal results. ' When the abdomen
is distended and painful on pressure, with a tense, frequent or
full pulse, V. s. should be resorted ib. This is occasionally re-
quired at the commencement of the first stage, when there is
much cerebral determination ; should v. s. not be sufficient to
remove the inflammatory condition, or when the state of the
pulse does not indicate it, leeches or cups are to be applied to
the abdomen ; we have not been in the habit of directing cups
in this affection, but from the great benefit which we have seen
result from their use in the lobular pneumonia of children, we
have no hesitation in recommending their employment. Moth-
ers naturally object to what they conceive to be a harsh remedy,
but by persuasion they can generally be induced to submit to it,
and the great advantage we have uniformly derived from their
employment in the last mentioned disease, we think warrants
their use in this. The amount of pain is much less than is sup-
posed, and the quantity of blood is more suddenly and effectually
abstracted than by leeches, besides which there is no risk of sub-
sequent hemorrhage. One, two, three, or four cups may be
applied to the abdomen, and be repeated should pain on pressure
or the bloody discharges continue. It should be remembered
that the reaction in children is seldom great, and that the most
intense inflammation of the mucous membrane may exist, while
the tepiperature of the skin is but little elevated ; or may be
quite cool, and the pulse feeble. Stimulants in these cases are
too often given, and may destroy the patient ; the tiaie course
is to pursue a cautious antiphlogistic treatment, supporting the
patient at the sanie time by the blandest articles of nourishment.
It has been advised to apply leeches to the anus, and this may
occasionally be done with advantage. Injections of cold water,
or iced water as the severity of the case may require, are reconi'
mended by Dr. Miller of New York, and we believe with great
propriety. The remedy, he observes, though generally advisa-
ble, appears to be best adapted to that period of the disease when
the alimentary canal has been previously well emptied of its
acrid and offensive contents. Should there be reason to suppose
the existence of such accumulations, the discharges being watery
and mixed with indigestible food, with a tumid state of the abr
domen, a grain of calomel may be given every hour or two
until the bowels are disturbed. We have observed that the

170 On Endemic Gastro-follicular Enteritis, <^c. [March,

small intestines are but little affected in this disease, and we
should think, therefore, that no objection could be made to the
use of mild laxatives for this purpose, the treatment being the
same as in dysentery. Castor oil, the oleaginous "mixture in
small doses, or the oif of butter, may also be employed. Injec-
tions of the liquor plumbi subacetat. dilut. ( 3 j to a gill of water)
are also productive of benefit, or the acetate of lead, in the pro-
portion of five grains to a gill of water, for a child of two years.
The internal remedies should be small doses of calomel and
ipecacuanha as prescribed in the first stage, or the same dose of
calomel combined with ^ to | a grain of Dover's powders every
three hours. It may often be advantageously associated with
acetate of lead, to the amount of from | to |^ of a grain, but we
believe this remedy better adapted to a more advanced period of
the disease. When there is much irritability, and the skin not
preternaturally dry, the ext. hyoscyam. may be substituted for
the Dover's powders. Emetics we consider decidedly objection-
able in every stage of cholera infantum, notwithstanding that
they have been recommended by high authority.

It will be observed that inflammation with ramollissement of
the mucous membrane of the stomach, exists in a large propor-
tion of cases, and emetics under such circumstances must be
decidedly injurious. With regard to purgatives the same objec-
tion applies. Laxatives may occasionally be proper when there
is reason to suspect the accumulation of irritating matters in the
intestine, and of them the best, as above mentioned, is calomel
either alone or in combination with a small quantity of Dover's
powders (one-quarter to one-half of a grain), and followed by a
dose of castor oil. We cannot too strongly urge upon the young
practitioner the necessity of caution in the use of opium in this
disease, or indeed in any other in which there is a determina*
tion to the head. The warm bath is a useful remedy, unless the
child be too debilitated ; he should be immersed in it up to the
neck, and cloths wrung out of cold Avater applied at the same
time to the head, in order to lessen the determination to the
brain. Should the application of cups or leeches to the abdomen
not be sufficient to remove the inflammatory symptoms, and the
pulse be feeble or the patient much exhausted, blisters may be
resorted to, but great care should be exercised in their employ^
ment lest gangrene ensue. We have seen very troublesome
consequences arise from the application of blisters to children,
and in one instance we think the child lost its life from their
imprudent use. They should never be suffered to remain more
than three hours, and after their removal, a large emollient poul-
tice should be ajiplied over the whole abdomen. Should there
be symptoms of cerebral congestion manifested by stupor, rolling

1848.] On Endemic Gastro-follicular Enteritis, <^c. 171

about of the head, or a disposition to coma, cloths wrung out of
cold water, or vinegar and water, or a mixture of equal parts of
lead water and spirits of wine should be applied to the head.
Should these symptoms continue, leeches in small numbers may
be applied to the temples or behind the mastoid processes. Coun-
ter irritation should also be made by stimulating pediluvia, or the
application of sinapisms to the extremities.

Cholera infantum not unfrequently becomes chronic, the symp-
toms being very much the same as those of ordinary diarrhoea, or
the patient may sink into a typhoid state. The remedies in this
case consist of the warm bath, to which salt, mustard, brandy or
Cayenne pepper may be added, counter irritating applications to
the abdomen, and the internal use of mild astringents. When
the diarrhoea is such as to exhaust the patient, the cretaceous
preparations may be cautiously employed^ great care being taken
not to aiTest the discharges too suddenly.

The followii>g prescription has been proposed by Dr. Parrish
for this purpose. Vr^.-. Rotassse sub-carb, 9] ; gum acacise, 5j ;
tr. opii, gtt. y j ; aq. cinnam, iiss; sacch. alb., 5j. M. A tea-
spoonful to be taken every two or three hours. Should this not
be sufficient, the following may be employed, ^ . Test, ostrear.
ppt., 3iss; gum acaciae, 3j; tr. thebaic, gtt. x ; sacch. alb., 3j;
aq. pur. vel aq. cinnam., 3 iv. M. Sig. A teaspoonful every
two hours.

Dr. Condie states that he has derived gi'eat devantage from
the use of charcoal in chronic cases of this affection, when the
discharges were of a dark colour, acrid and offensive. He em^
ploys it in combination with powdered rhubarb, ipecacuanha,
and the extract of hyoscyamus, according to the following pre-
paration, ^.-^arb. ligni, 3j a oij ; pulv. rhei, Bij; ipecac,
grs. iv agrs. xij ; ext. hyoscyam. nig. grs. xij. M. ft. chart, xii,
Sig. One to be taken every three or four hours. Lime water and
milk may also be given in these cases, also equal parts of charcoal
and magnesia.

Care ought to be taken not to continue the use of the char-
coal too long, as serious accidents are said to have arisen from
its accumulation in the bowels. The infusion of soda and hick-
ory ashes is said also to be beneficial. The syrup of rhubarb
may be given in doses of from twenty drops to a teaspoonful
every two or three hours, or the powder according to the follow-
ing formula. ^. Puly. rhei, grs. xv; pulv. ipecac, grs. v;
magnes. calcinat. grs. xx; sacch. alb. 3j; tr. opii gtt. x; ol.
anis. gtt. V or gtt. vi ;. aq. !iij. M. A teaspoonful every hour
or two (Dr. Chapman). Columbo root in po\Mler or infusion
may also be employed. (Dose from two to three grains.) The
infusion of the common togwood (hematoxylon campechianum),

173 On Endemic Gastro-follicular Enteritis, ^c, [March,

Dr. Chapman states, was much employed by Dr. Physick in this
stage of the disease. The dose is a teaspoontlil. A decoction of
the bark of the pomgranate root (imnica granatum),or of the flow-
ers, is also considered useful. The best of all these vegetable
astringents, according to Dr. Chapman, is a strong infusion of the
leaves of the dew (rubus trivialis) or of the blackberry root (rubus
villosus). The dewberry is preferable from its greater strength.
The dose is about a teaspoonful. The alum plant (Ileuchera
Americana), a common ]jlant in the neighbourhood of Philadel-
phia, has also been highly reconunended as an astringent in this
afiection. Alum, in the dose of one or of two grains with a
small quantity of opium may also be employed, or the acetate
of Ifead in combination with the same remedy. Dr. Eberle states
that in the advanced stage of this disease, he has occasionally
derived considerable benefit from the use of the tartrate of iron
according to the follovving formula. ^. Ferri tartrat. gr. xl ;
syr. zingiberis, 5ss; aq. pur. Bij. M. From twenty to forty
drops to be given to an infant four or five times daily. Dr.
Chapman advises the sulphate of iron under the same circum-
stances. 1^. Ferri sul|)hat. grs. ij ; acid sulph. gtt. x; sacch.
alb. '5j; aq. j. M. Dose a teaspoonful as often as necessary.
Dr. Meigs has writteruiavorably of a plunging tepid bath made
of the infusion of the white oak bark. American Medical Re^
carder, vol, iii. p. 507. lie states that it produced a rapid
amendment in one case in which he tried it, and a perceptible
improvement in another. When the discharges from the bow-
els are small in (juantity, thin, dark coloured, and highly offen-
sive, with fiatulency, the spirits of turpentine may be given.
Turpentine in the acute form should never be employed. It is
a " deadly remedy." The following is the formula proposed by
Dr. Condie. ^. Mucilag. g. acacise, 1 iij ; sacch. alb. 3 vj ; spt.
seth. nitros, 5 iij; spt. terebinth. 3ij; magnes. calcinat. grs. xiij;
spt. lavand. comp. ^ij. M. Sig. A teaspoonful three times a
day, or oftener when the child is over two years of age. The
junii)er oil is also consid("red an excellent palliative for this jiur-
pose. IK Ol.junip. 3ij; sulph. ether 5ss; tr. opii. gtt. xl. M.
Sig. From ten to 15 drops from three to ibur times daily. The
balsam copaiba may also be employed. The dose is from three
to five drops. Dr. Parrish states that he has frequently directed
an iniusionofbark and cinnamon in lime wjiter in the following
pro})()rtions. ^. Best bai'k coarsc^ly ])owd(M-ed, 5ss : cinnainon
3ij; lime water jijj. M. It should l)e sufiercHl to stand a little
while and then do^'anted ; a dessert sjiooniul may be taken several
times a day. With this remedy we have no exjx^rience. The
bark jacket is also occasionally em})loy(^d. Injections of bark
may likewise be given. These remedies should be employed

1848.] On Endemic Gastro-follicular Enteritis, <^c. 173

only when the symptoms are of a typhoid character, the vital
forces being insufficient to sustain the patient. When the child
is greatly exhausted, stimulating frictions to the body with
flannels wrung out of hot brandy and water, or whiskey should
be used, or if the exhaustion be extreme, it may become necessary
to resort to simulants internally, as wine whey, or a weak solution
of carbonate of ammonia. Dr. Eberle states that in these
ckcumstances he has derived great advantage from the tincture
of cinnamon in doses of from fifteea to twenty drops in some
mucilaginous fluid every four hours. When the discharges are
very frequent, attended with great exhaustion, the spiritis ammo-
niae aromaticus in combination with the chalk mixture is a
useful remedy. Dr. Hartshorne, one of the most eminent prac-
titioners of this city, recommends the use of creosote in the ad-
vanced stage of this disease. The following is a formula he
employs. ^. Creosote, gtt. j. ; test, ostrear. praeparat., 3ij.;
g. acaciae pulv., ?ss.; aq., 5vj. Dose a teaspoonful every two
hours for a child two years of age.

Tannin, we would suppose might also be advantageously em-
ployed in the chronic form of the disease when the discharges are
abundant. It is said to be less likely to irritate the stomach and
bowels than the ordinary astringents. The dose for a child of
two years is one-fourth of a grain every three hours, or of the
pure tannin one-twenty-fourth of a grain repeated as often.^

When there is an aphthous condition of the fauces. Dr. Par-
rish thinks he has found nothing do so much good as a gargle of
lime water and bark. Dr. Griffitts, he observes, in some pro-
tracted cases of cholera, was in the habit of prescribing scalded
lemonade to the child, and with a very happy effect.

Great attention must be paid to the diet. If not weaned, the
child should be confined to the breast, with the occasional use of
barley water, toast, or gum water. So long as the inflammation
is inactive, or when it has subsided or has assumed a chronic
form, articles of a more nourishing kind may be allowed,- as boiled
milk, tapioca, arrow root, or sago, or thin oatmeal gruel, or flour
boiled in milk ; the flour should be put in a rag, and then boiled
until it becomes hard, and grated. This, we believe to be a most
excellent article of diet. We knov/ a remarkable instance of
chronic dysentery in the adult, cured by small doses of calomel
and opium, and confinement to this diet when all other means
had tailed. In the chronic form of the disease when the patient
is greatly debilitated, the appetite occasionally becomes craving
for certain stimulating articles of food, which it may be right to
gratify. Dr. Parrish relates several instances of this kind in his
lectures. Dr. Wistar, he observes, used to mention the case of
a child that was brought to the parlor while the family were at

174 On Endemic Gastro-follicular Enteritis, ^-c. [March,

dinner. It was extremely weak, and seemed to be in the last
stage of the disease. It showed a strong disposition for some
ham which was on the table. The black skin covering the ham
was the part which is seemed particularly to desire* It was
gratified, and it did not discontinue sucking the piece until it had
deprived it of its nutritious juices. From this time it began to
recover, and ultimately got welL Dr. Wistar was so convinced
of the importance of the above practice that he used to tempt his
little patients with small pieces of ham. Some would eat it,
others seemed to have no desire for this kind of food. In the
latter case he did not press it upon them. Dr. Parrish states
that he often prescribed the essence of ham in these protracted
cases of cholera. He directs the juice to be bottled up to prevent
it from becoming rancid, and to be used as occasion requires.
He also relates an instance of a child under similar circumstances
that seemed very anxious to eat some butter which was on
the table ; this child was also indulged, and it continued to devour
the butter, lump after lump, until it had made way with the
whole. From this time it was allowed as much butter as it
desired, and under this plan it recovered. .

The same directions with regard to -ventilation apply to this
as to the first stage.

Third stage, Symptoms. The symptoms indicative of this
stage of the affection are an unusual disposition to drowsiness or
stupor, rolling of the head, and chewing motion of the under jaw,
succeeded by convulsive movements or rigidity, of one or more
extremities followed by paralysis. When the disease has pro*
gressed thus far, it may be considered almost, if not entirely
beyond hope.

Anatomical characters. These consist essentially, in disor-
ganization of the structure of the brain from softening of its tissue^
The softening is sometimes general, but is more often confined
either to the cortical substance, or to the central portions of the
brain and cerebellum. The softening may exist to such a de^
gree as to cause the brain readily to give way on slight pressure,
or its substance may be rendered quite diffluent so as to resem-
ble cream. These effects are the result of long continued irri-
tation ; the substance of the brain when cut into, usually presents
numerous red spots from effusion of blood. The pia mater is
more or less injected, and its veins much distended. There is
also effusion of serum in the subarachnoid tissue, and to a greatei*
or less amount in the lateral ventricles. This, however, is not
ahv.nys the case, the surface being sometimes quite dry.

Treatment. Notwithstanding the hojieless condition of the
patient, it is our duty to make use of such means as afford any,
even the slightest prospect of relief. These consist in the appli-

1848.] On Endemic Gastro-foUicular Enteritis. <^-c, 175

cation of leeches to the temples and to the mastoid processes,
with blisters to the nape of the neck. They should be dressed
with marcurial ointment. The treatment in factis the same as in
tubercular meningitis, and we think we have derived more benefit
from the use of blisters in that afFection,than from any other means.
Cloths wrung out of cold water, or of vinegar and water, should
be at the same time kept constantly applied to the temples.

Diagnosis. Cho]erdi infantum may be confounded with tu-
bercular meningitis, or dropsy of the brain. From this, it may
be distinguished by the frequency of the discharges, whereas,
in the former affection the bowels are usually torpid, and by a
proper acquaintance with the natural history of the disease.
In tubercular meningitis the premonitory symptoms are such
as indicate an affection of the brain ; it occurs for the most part
in dehcate scrofulous children. Cholera infantum commences
with looseness of the bowels. In tubercular meningitis, the
cerebral symptoms predominate in the commencement. The
child is restless and irritable, and complains of acute pain in
the head, referring it chiefly to the forehead: the pain is inter-
mittent, and is usually accompanied wnth a peculiar cry, which
has been considered by Coindet and others as pathognomonic;
the sleep is more or less disturbed, and there is frequent tossing
about of the hands ; the head is rolled from side to side, and
there is more or less moaning and grinding of the teeth ; deliri-
um is almost a constant symptom, and the countenance assumes
a peculiar characteristic appearance ; this is so marked that
even the nurses at the Children's hospital of Paris, easily recog-
nize the disease. It is only in the advanced stages, that cholera
infantum can be confounded with tubercular meningitis when
the patient relapses into a state of drowsiness or stupor; which
is a prominent symptom of the advanced stage of hydrocepha-
lus, and is often accompanied or preceded by convulsions.
Cholera infantum may be confounded with the typhoid fever of
children. To this affection it bears a close resemblance; it
may be distinguished from it, however, by the absence of gar-
gouilliment, of the numerous lenticular spots which in typhoid
fever usually make their appearance from the sixth to the
twelfth day, by the agitation and slight delirum at night; the
prominence of the spleen, the character of the fever, which is
more intense, and continues beyond the ninth day ; and the
existence of the sibilant rale, all of which are prominent, al-
though not constant symptoms in typhoid fever.*

The resemblance between the two diseases is such that it is
often impossible to distinguish them, apart. Cholera infantum

* Rillietet Barlhez, Traile cliniqe et pratique des maladies des enfans, t. ii,
p. 312,

170 Flatulence. [March,

may also be confounded with softening^ of the stomach. The
simihirity between tlie vs^yinptoms of ^^elatinous softening of the
stomach, as described by Jicger, and those of cholera infantum,
appears indeed to be striking ; the coincidence has been observed
by Rilliet and Barthez, who do not describe the latter disease
as a distinct affection occurring in Paris. The following are
the signs of gelatinous softening of the stomach, as laid down
by them in their invaluable work. If a child be taken suddenly
with obstinate vomitings which persist, with instatiable thirst,
with pain in the abdomen, with abundant diarrhtra; if at the
same time it emaciates with rapidity, whilst the gastric syn}p-
toms almost e.rchisivpli/ predominate, we may then infer a
gelatinous softening of the stomach. -(Tom. i. p. 4G7. Art.
Gastrite et Ramollisszmznt de V Estomac.)

Prognosis. The prognosis in cholera infantum mav be con-
sidered fovorable when the pulse becomes slower, when the
temperature is restored to the surface when the vomiting ceases,
and the alvine disharges become less frequent, and more natural;
an opposite opinion may be tound when the pulse continues
feeble ; the surface remains cold ; the discharges become very
frequent, resembling the washings of meat,, accompanied with
great uneasiness and jactitation, or adisposition to stupor ; should
there be rigidity and a partial loss of power of the extremeties,
the patient may be considered almost if not entirely be,yond the
.reach of art.

{The Cases are omitted.)

flatulence. By Robert Dick, M. D. (London Lancet.)

Flatulence of the stomach and bowels has two principal
sources the liquid and solid alimentary ingesta, and (as some
assert) exhalation from the mucous membrane. We must
frankly own that we have yet met with no grounds other than
conjectural for the latter view; we are aware of no facts that
prove it. True, indeed, .John Hunter anauthority not lightly
to be questioneci supposed exhalation from the mucous sur-
face to be an occasional source of gaseous distension ; still we
must repeat our opinion, tliat the alleged Aict rests on no posi-^
f/tv^ evidence; while there arc not a few strong presumptions
against it, into the consideration of which, however, it would
not be expedient to enter now. Suffice it only here to observe,
that if the rapid meteorismi or pneumatoses which arise in the
last stages of adynamic fevers, &c., seem to prove the fact of
the sudden seoetion of gases by the mucous membrane, is it
not just as likely, we would ask, that the phenomena named

1848.] Flatulence. 177

are due to the suspension of secretion and nervous action in the
stomach and bowels, and the opportunity thence afforded for
the play of the ordinary chemical affinities in the aliment or
excretions in the stomach or intestines nay, perhaps, to some
morbid secretions, the consequence of depressed or dormant
vital powers, and which actually favour the occurrence of or-
dinary chemical action in the contents of the bowels, and the
thence resulting extrication of gases I This, at least, is a more
probable supposition than the other.

On the same principle, I would account for the air eructated
in gastritis, hepatitis, &c. The vital and conservative powder
ofthe mucous membrane being in these cases greatly reduced,
while, at the same time, the temperature of the stomach is
greatly augmented, the play of 7io7i-vital chemical affinities
is favoured the stomach's own i/i//--natural secretions be-
coming the ready subject of these.

A third source of gaseous fluid in the stomach and intestines
may be named, though we consider it as of little importance
namely, the atmospheric air swallowed in the acts of
mastication and deglutition, and mechanically contained in the
articles eaten, as, for example, in the pores of bread, &c.

The gases of the stomach are principally nitrogen, oxygen,
and carbonic acid, nearly in the proportion of atmospheric air.
The gases of the intestines are those now named, and, in addi-
tion, carbonetted hydrogen, hydrogen, and occasionally sulph-
uretted hydrogen. The intestinal gases are further often load-
ed with vaporous particles ofthe foetid contents ofthe bowels.

Flatulence, as we have formerly remarked, is often due to an
inefficient action ofthe liver, and a deficiency of bile in the
intestines. Whatever promotes the hepatic secretion tends to
remove flatulence of this organic ; hence, a few drops of
colchicum wine are often effectual. Still more sure are mintite
doses of mercury. An ante-dinner and an evening pill, con-
sisting of a grain of blue pill and three of extract of rhubarb,
acts with wonderful good effect in n^iany cases of this kind, in
which, along with flatulence, there are slight constipation, yel-
low furred tongue, ill-tasted mouth, &:c. As in gastro-duo-
denitis, there is often, from the vascular tumescence of the
duodenal mucous membrane, a constriction, and sometimes
complete temporary occlusion ofthe mouth of the ductus com-
munis choledochus with, of course, interruption to the discharge
of bile ; hence, in part, the flatulent eructations, &c., which
accompany gastro-duodenitis. It is far from unlikely that the
pancreatic duct arrd secretion are often affected in a similar
way ; but for some unaccountable reason, it has not pleased
pathologists of any age to pay much attention to this unobtru-

12

178 Flatulence. [March,

sive viscus some seeming even to think that it, as well as the
spleen and supra-renal capsules, are not necessary, because not
understood.

Treatment. When the tongue is pale, when there is no
tenderness on pressure at the epigastrium, or in the right hypo-
chondrium, when there is no thirst, no dry heat of skin, and no.
quickness of pulse, flatulence requires carminatives, bitters, and
even stimulants. Thus the patient may be directed to use
freely any of the following waters : cinnamon, fennel, cassia,
pimento, peppermint, pennyroyal, mint, Cologne, lavender,
caraway, aniseed, dill, balm ; to these, some of the respective
tinctures may be added. With the carminative waters just
named, one or more of the following bitters may be given
camomile, quassia, columba, absinthium, rhubarb, to which
may be added valerian, castoreum, and camphor. As an ex-
pellent of flatus existing in the bowels, assafoetida, or oil of
turpentine, the former given by the mouth, or in injection, the
latter, in injection, are superior to all things else, excepting,
perhaps, the infusion and spirit of armoracia.

Secondly. If flatulence is accompanied with a dry and pre-
ternatural ly red tongue and fauces, with thirst, heat of skin,
tenderness of epigastrium, scanty and high-coloured urine,
heartburn, &c. in short, with symptoms of inflammatory irri-
tation of the gastro-duodenal mucous membrane, then altera-
tives are clearly indicated, or rather such substances as promote
the secretion of the mucous membrane ; these are ipecacuanha,
sulphur, potassio-tartrate of antimony, the various preparations
of mercury, magnesia, iodine, nitrate of silver. These we
would be disposed to give a trial to successively, almost in the
order in which we have named them. But a great variety of
other means may be tried, and among these the following, in
those cases in which flatulence is accompanied w^ith obvious
torpor and fulness of the liver, as well .as with gastric irritation.
The wineof colchicum, for example, may be given with a few
grains of the sulphate of potass, or if theraare acid eructations
and heartburn, with carbonate of magnesia; the infusion or
tincture of arnica may be given in the same combinations, and
so may the powder and extract of cusparia. In short, instead
of perplexing our minds with the confused subdivisions of
authors, whose classifications betray they had no clear and
scientific notions of the proper treatment of flatulence, the
simy>le point to be ascertained and kept in view is, whether
flatulence (always a mere symptom) is or is not accompanied
with inflammatory irritation, is or is not attended with stomach-
ic debility and according as we decide these queries, we adopt
the former or latter modes of treatment above enumerated.

1848.] Flatulence. 179

When the eructations are acid, the most of vegetables in
common use, except the cereal, must be abstained from. As
Dr. Prout remarks, that, in the treatment of saccharine
diabetes, he has seen the incautious use of one or two ripe
pears undo all the apparent improvement of weeks or months
of skilful medicinal and dietetic management, so it often hap-
pens in persons subject to flatulence, that a very minute and
apparently trivial indulgence induces not unfrequently the
utmost degree of uncomfortable gaseous distention, with its at-
tendant sufferings, headach, &c. This is less to be wondered
at, when it is considered that, according to Dr. Hales, the
quantity of gas extricated from an apple, in the course of its
undergoing the fermentative process, amounts to nearly 700
times its bulk.

Cases occur in both sexes of a sort of passive flatulence, so
to name it namely, meteorismus, unattended with any marked
signs of stomachic or intestinal irritation, or with much discom-
fort, excepting the frequent necessity of getting rid of the flatus.
In such cases, the flatus is usually nearly or wholly free of ill-
odour, and probably consists of nitrogen, oxygen, and perhaps
cai'bonic acid, in nearly the proportions of atmospheric air.
The treatment of these eases I have found more troublesome
than there simple nature would lead, a priori, to expect. One
or two have entirely baflled every form of treatment adopted,
and the last accounts from one patient, a clergyman in the
South of England, inform me that the annoying affection con-
tinues just as it was when he first pat himself under my care
nearly two years ago.

There can be little doubt that the occurrence of flatulence is
immensely favoured by the temperature at which many persons
swallow soups, coffee, tea, &c., and the debilitating effect which
large and systematic potations of the latter have on the functions
and secretions of the gastro-enteric mucous membrane. The
truth is, that cold, applied in drinks of low temperature, and
even in iced fluids, is not less remarkable as a stomachic tonic,
than is the external application of cold as a tonic of the sentient
and motor nerves.

In connexion with the present notice, we refer the reader to
the former notices of carminatives, condiments &c.,in preceding
numbers of The Lancet. <

180

Tahle of the Discovery of Metals,

[March,

[takex from prof, liebig's lectures.]
TABLE XI.

Names of Metals,

Gold . .

Silver .

Iron . .

Copper

Mercury

Lead .

Tin . .

Antimony

Bismuth

Zinc . .

Arsenic

Cobalt .

Platinum

Nickel .

Manganese

Tungsten

Tellurium

Molybdenu:

Uranium

Titanium .

Chromium

Columbium

Palladium

Rhodium .

Iridium .

Osmium .

Cerium .

Potassium

Sodium .

Barium .

Strontium

Calcium .

Cadmium

Lithium .

Zirconium

Aluminium

(Glucinium

Yttrium .

Tiiorium .

Magnesium

Vanadium

Latarium

Didymum

Date of
Discovery.

Tahle of the discovery of Metals.
By whom discoverd

Known to the Ancients*

Described by Basil Valentine .... 1490

Described by Agricola ........ 1530

Mentioned by Paracelsus . . . 16th century.

Brandt 1733

Wood, Assay Master, Jamaica . . . 1741

Cronstedt 1751

Gan and Sheel 1774

D'Elhuyart 1787

Muller 1782

Hielm 1782

Kalprofh 1789

Gregor 1791

Vauquelin 1797

Hatchett 1802

Wollaston 1803

Descotils and Smithson Tennant . . 1803

Smithson Tennant 1803

Hisinger and Berzelius 1804

Davy

1807

Stromeyer 1818

Arfwcdson 1818

Berzelius 1824

Wohlcr 1828

Berzelius 1829

Bussv 1829

Sefstrom 1830

Mosandcr 1839

Mosandcr 1841

1848.] , Tables of Temperature, ^c. 181

TABLE XII.

Table of ascertained Points in the range of Temperature. {Graham.)

Deg. Fahr.

Greatest artificial cold, Thilorier 135

Solid compound of alcoholic and carbonic acid melts . . . 121

Greatest artificial cold measured by Walker 91

Temperature of planetary space, Fourier . 58

Greatest natural cold observed by Ross 60

Greatest natural cold observed by Parry 55

Sulphuric ether congeals 47

Melting point of solid mercury 39

Proof spirit freezes 7

One part alcohol, three parts water, mixed, freezes . . . -|-7

Strong wine freezes -|-20

Ice melts -[-32

Medium temperature of the surface of the earth -[-50

Heat of human blood . -|-98

Wood spirit boils -[-150

Alcohol boils . ; -|-174

Water boils ~j-2i2

Tin melts -|-442

Mercury boils -|-662

Red heat, Daniell -j-980

Heat of a common fire -[-1141

Brass melts -|-18(39

Silver melts -|-2233

Cast iron melts H-3479

TABLE XIIL

Of the Boiling Points of Liquids , determined with precision . ( Graham . )

Boils.

Hydrochloric Ether 52 Fahr.

Sulphuric Ether 96

Bisulphuret of Carbon 116

Ammonia (sp. gr. 0.945) 140

Alcohol (sp. gr. 0.798) 172

Water 212

Mitric Acid (sp. gr. 1.42) 248

Crystallized Chloride of Calcium 302

Oil of Turpentine 340

Naptha 320

Phosphorus 554

Sulphuric Acid (sp.gr. 1.843) ...... 620

Whale Oil .... 630

Mercury 062

182 On the Urine in Typhoid Fever.. [March,

On the Urine in Typhoid Fever. By M. Martin-Solon.
(Bui. de I'Academie, from Medico-Chir. Review.)

M. Martin-Solon recently (Nov. 1847) read at the Academic
an interesting paper upon the condition of the urine in typhoid
fever, the principal points of which are thus summed up:
1. The urine in typhoid fever is less abundant, higher color^ed,
ajid generally more dense, than in health. 2. It is as acid as in
the normal state, and sometimes more so. 3. It is rarely
alkaline, but in consequence of its large proportion of urea, it
readily passes into the condition of alkalescence. So abundant
is the urea, that sometimes a nitrate may be at once formed by
the addition of nitric acid without any preliminary evapora-
tion, a density of from 1*030 to 1*036 indicating this condition;
4. Generally transparent, the urine is sometimes clouded with
mucus (the enceorema of the ancients), or by an excess of too
sparingly soluble salts, which give it a ^\jumenteiLx'^ appear-
ance, and which give rise to sediments, formed especially of
uric acid and the urates with coloring matter. 5. That critical
signs deduced from these appearances are not to be depended
upon. G. That in transparent urine, nitric acid sometimes
gives rise to no reaction, but in other cases produces a cloudi^
ness immediately. 7. The same thing is observed in "jument-
ous" urine, when rendered clear by filtering. 8, That this
cloud, of a peculiar tormentous aspect, formed by a bi-nitrate of
ammonia, but the nature of which is perhaps not yet entirely
known, is seen especially at the period ofthe resolution oftyphoid
fever and acute diseases, which it precedes and announces;
and according to our clinical observations (in 54 cases) pos-
sesses a critical value which deserves attention. 9. That the
bile undergoes a notable alteration during typhoid fever, which
is doubtless the cause of the appearance of hiliverdine in the
urine. 10. That the urine, sometimes becomes temporaly
albuminous during the course of acute diseases ; but that the
congestion of various organs, especially partaken of by the
kidneys, and the especial tenuity of the blood in typhoid fever,
render such temporary albuminuria far more common in this
than in other affections. 11. Temporary albuminuria is espe-
cially seen in severe cases oftyphoid, and generally gives rise to
the most unfavorable prognosis. 12. Temporary albuminuria
may sometimes become continuous, andihe kidneys then exhibit
the usual pathological characteristics of confirmed albuminuria.
13. The inspection ofthe urine throws light upon the progress
of a case of typhoid fever, and may serve as a means for the
direction of its treatment. ^ .

1848.] Periscope, 183

PART III. MONTHLY PERISCOPE.

Foreign Bodies in the Stomach. (Union Medicale.) M. Gaide
reported to the xMedico-Practical Society of Paris, the case of a young
man who had gotten a fish-bone in his throat, and who in attempting
to remove it with a fork, this latter slipped into the pharynx. Con-
suiting an officer of health, he, instead of removing the fork, advised
some sweet oil to the throat. In sliort, the patient swallowed the
fork, which still remains in his stomach. His health has not sutiered
much, he only feels slight pain each day at the period of digestion.
M. G. mentions another case in which he made a post-mortem exam-
ination of a patient who had often told him he had swallowed a fork
ten years before his death. He found, in fact, the fork in the stomach,
which was placed longitudinally to its great curvature, the four prongs
being enveloped and fixed in voluminous fleshy projections. In con-
nection with this subject, the American reader must be told that the
forks of France are made of silver and are four-pronged.

AngioJeucitis and Phkhitis. By M. Velpeau. In both cases
red streaks or lines exist, but in phlebitis beneath these are voluminous,
indurated cords. These are not present in angioleucitis, because the
vessels are small and do not become indurated. This has led me to
lay down as an aphorism ; Angioleucitis is seen, but not felt; while
phlebitis is felt rather than seen: so that the atlections might be dis-
tinguished even with closed eyes. [Gaz. des Hop., from Medico-
CJururgical. Review,

Potion against the obstinate vomitings of pregnant women. By M.
Peivat. (Journal des Connaissances Medieo-Chirurg.)
Alkaline. Acid.

Bicarbonate of Soda, 3 grammes. Citric Acid, 3 grammes.

Extract of Henbane, 20 centigrammes. Syrup, 15 grammes.

Syrup, 15 grammes. Water, 60 grammes.

Mint water, 60 grammes.

Give a spoonful of each, mixed together, every hour.

Treatment of the Aphthous Eruption (thrush) in Infants, (Bulletin
General de Therapeutique.) Aphthae is one of the most common af-
fections of suckling children. It is fortunately very trifling in the vast
majority of cases. Idiopathic, it is of little importance, but when com-
plicated with another disease, enteritis, d:c., it may become quite se-
rious.

Prof. Trousseau's mode of treatment is this: Take equal portions
of Honey of Roses and Borax, say 10 grammes of each, saturate a fine
piece of linen with the mixture, and apply to the buccal cavity five
or six times a day. This generally cures intwo to three days. When,
however, the case is obstinate, M. T. has then recourse to another
means viz.. Nitrate of Silver, 5 grammes, to Water, 30 grammes.
This is in like maancr to be applied to the whole aphthous parts. Two

184 Periscope. [March,

to three applications will generally cure the most obstinate thrush. In
tlie severest cases, the distinguished professor does not hesitate to use
the solid nitrate of silver.

The Children of Dwarfs not necessarily small.. Dr. Pidduck states
that the children of dwarfs do not necessarily partake of the diminu-
tive size of their parents. There was a well known instance of a
glover and his wife, who lived opposite the Infirmary in Edinburgh :
tiieir height djd not exceed forty inches ; their only daughter was at
least five feet high, and so robust as to be able to carry both her pa-
rents, one on each arm, at the same time. [^London Lancet.

On the Use of Ocular Douches for Ike Treatment of Purulent Opthal'
viia of Infants, Opacities of the Cornea, SfC. Qy j\l. Ciiassaignao.
M. Cliassaignac has for the last six months em})loyed irrigation of the
eye for the treatment of the ophthalmia of young infixnts witli the
greatest success ; so that wliile formerly blindness at the FoundHng
Hospital was constantly occurring from this cause, it is now seldom
so produced there. The child is laid on a table, and water allowed
to flow from a small tap through a tube over the surface of the eye
during from 5 to 15 minutes several times a day. M. Chassaignac
has discovered that in this disease a pseudo-membrane is frequently
produced, the removal of which much expedites the treatment. The
mortality of children suffering from disease of the eyes during the
last ten years was 1 in 3 ; while since this plan has been adopted, it
has been but 1 in 8. In the course of investigation, tliis means was
found applicable to several other inflammatory conditions of the eye,
and also especially for the removal of oj)acities of the cornea which
resist ordinary means. Accounts of its really remarkable success in
this last important application, have just been published by one of the
assistants at the hospital. [UUnioii Medicale, from 3Ied. Chir. Rev.

Punctures of the Scrotum in Hernia Humoralis. By M. Velpeau.
The little operation I practise almost entirely relieves the pain, and
produces no inconvenience. I gently grasp the inflamed part with
my hand, so that the thumb and index-hnger may thrust tiie fluid which
the hernia vaginalis contains towards the surface. I pass the lancet,
held like a pen, perj)endicularly into the most fluctuating portions of
the tumour, so that its point may enter the tunica vaginalis, and in
this way puncture two, three, or four times the portion lield in my
liand. Generally a little jet of fluid is discharged, and if any inflam-
mation occur, a cataplasm is applied. In almost all the cases the
pain and redness diminish at once, and the scrotum recovers its sup-
pleness. These punctures may be made at any stage of the affec-
tion. [Gaz.des Hop., from Med. Chir. Rev.

Lithotomy and Lilhotriiy. (Archives Generales de Medicine.) At
the close of a long discussion in the Academy of Medicine in Paris on
the subject o^ lithotomy and lithotrity, M. Gailliard, Surgeon-in-chief

1848.] Periscope. 185

of the Hospital of Poitiers, presented the result of 27 cases of stones
coming under liis care 23 were men, and 4 were women; 21 were
adults, and G below 16 years old. Two patients were so ill that they
could be subjected to no surgical operation. Of 25 operated upon, 16
were cut, and 11 lithotiitised, making 27 cases; 2 patients were sub-
jected first to crusiiing, which failing to relieve them they were sub-
sequently lithotomized these two were cured. LitLolriiy did not
succeed with them because in one the stone had formed around a pin,
and in the other upon a piece of catheter. Of the 25 patients 23 were
cured and 2 died. All those recovered upon whom the crushing pro-
cess was used, and two who succumbed from lithotomy, one died on
the sixth day, of suppuration of the cellular tissue of the pelvis, and
the other on the sixtieth day of bronchitis. This is certainly excel-
lent success.

Efficacy of Cotton against the pain of Orchitis. (Bulletin General
de 'Iherapeutique.) M. Fredeanelli relates, in the gazetta Toscana
delle scienze medico-fisiche, a case where all the ordinary means had
failed to relieve the pain of a swelled testicle, a layer of carded cotton
and a restricted diet, enabled the patient at once to attend to his busi-
ness.

The flexed and straight positions in Fractures of the Thighs. (Jour,
de Medicine de Lyon.) Prof. Bouisson, of Montpelier, proposes to
treat oblique fractures of the thighs by the combination of the two posi-
tions, the bent And straight. He recommends the flexed position
during the first fifteen or eighteen days, and afterwards the straight to
be permanently continued.

French and English made Instruments. The reviewer of Civiale's
work on Lithotrity in the first No. of the two English Quarterlies
combined, viz., Johnson's and Forbes' Review, (who he is, or who in-
deed is the Editor of the Journal, no one knows, for no name is ap-
pended to it,) makes the following remarks : " As some explanation
of the cause why the French makers are so much better known than
our own all over the continent, we may mention that we only paid M.
Charriere 35 francs for this instrument, (less than 30 shillings,) and
it was beautifully finished. A friend of ours paid nearly four times
this sum to an English maker of some reputation, and this very instru-
ment broke in our hands while we were experimenting with pieces of
coal on a table." This is a just tribute to that most celebrated of all
instrument makers. Monsieur Charriere of Paris, a member of the
Legion of Honor, &c., &c. We have used the workmanship of his
hands since 1830, in the various surgical operations, and have never
once been disappointed in them nor detected a single flaw.

How to remove rust from iron and steel, and how to prevent their be-
ing afl'ected by it. (Journal des Connaissances Medico-Chir.) M.
Heuslcr, druggist at Longuyon, recommends the articles to be first

180 Medical Intelligence. [March

oiled ; at the end of one or two hours remove the oil with blotting pa-
per or linen ; rub then the rusted parts with a mixture of 16 grammes
of tinct. of Savon and 8 grammes of purified Potash. Leave them ten
minutes without toiicliing them, then rub with a cork until all the rust
is removed, and wipe with a piece of cloth.

To prevent an instrument from rusting, make a mixture of 5 parts of
varnish with oil of ilax-seed, and 3 paits oil of jectified turpentine.
Rub this on them with a sponge and let it dry. Keep the articles in a
dry place and free from dust.

MEDICAL INTELLIGENCE.

Chloroform the great discovery and blessing of the age. We ventured in oui*
last No, to express a ver}^ favorable opinion respectingthe anaesthetic properties
of chloroform, and staled we were engaged in testing its virtues. We had pro-
posed not only to report in our present issue the results of our experiments, but
to give a detailed account of the facts collected on this subject during the month.
These, however, have so accuinulated, that we shall be compelled to omit many,
or simply narrate them, referring the reader lo the sources whence they are
derived.

We shall first attempt to answer the question in a plain and practical manner,
which is now so repeatedly asked, What is chloroform 1 It is a transparent, vol-
atile fluid, heavier than water; burns with difficulty ; has an agreeable odour,
and first a pungent, then a v^ry sweet taste. Its physical properties may be
compared to chloric ether. It Was discovered in 1831, by E, Soubeiran, chief
pharmacian to the hospitals of Paris. Liebeg, soon after this, described it
Flourens first experimented with it and Dumas, dean of the Faculty of Sciences
and Arts, in Paris, determined its true chemical nature and gave it its nomen-
clature. Chloroform is a compound of the following elements: Formic acid,
which was first detected in the red ant, hence the name, (from formica, an ant,)
is composed of 2 proportions of carbon, 1 proportion of hydrogen, and 3 propor-
tions of oxygen. By the chemical action of chlorine gas upon formic acid, the
oxygen of the acid is replaced by 3 proportions of the chlorine: this new pro-
duct is chloroform. It is technically called the irichloride of fflrmyl, because of
the union of three proporlio?is of chlorine gas ; and formijl, because as ihe formic acid
is decomposed, the gas unites with its supposed base or hypothetical radical, to
which the name of Ibrmyl is given. Chloroform is then composed of carbon,
hydrogen and chlorine, and these united in the proportions, represented by the
chemical signs C 2, H 1,C1 3.

It issaid, a Mr. Guthrie, of one of the New England Slates, at the suggestion
of Prof Silliman, also discovered chloroform, about 1831.

A formula for preparing chloroform may be found in our February No. At
present, chemists and druggists are engaged in searching for some cheap mode
of obtaining it. We paid Sir)0 for a pound. The high price has led to adul-
teration, chiefly with alcohol. We Ibrtunntcly possess an easy test for detecting
this. Mons. Mialhe says, if the chloroform be dropped into water, it sinks to
the bottom, and the fluid remains transparent; but if impure, the water becomes
milky.

1848.] Medical Intelligence, 187

To Prof. Simpson, of Edinburgh, is alone due the credit of applying chloro-
form as an ansesthetic means in the practice of medicine. We are free to ex-
press the opinion, that Mesmerism, or rather the investigations connected Avith
the subject, have led to the wonderful and miraculous introduction of ether and
now of chloroform, in the healing art; may we not add, oi' xha 'prcvcjiting art to
pain and suffering.

But to our own experiments, already alluded to; and to be brief, we confine
our observ'ations to cases occurring since the 1st of January, and which were
witnessed by the Class of the Medical CoUege of Georgia. They are eight in
number, in which anaesthetic means were employed.

Jan, 4th. Restoration of the Vagina, while the patient was under the ansesthetic
influence of Sulphuric ether. She had given birth to a dead child, after three
or four days labour, about seven years ago. From Vaginitis, probably, the
parts since had gradually continued to close up. A probe cannot now be intro-
duced, still there is a slillicidium of menses like fluid nearly all the time, flowing
out at a point within the fourchette. Aided by the Prof, of Obstetrics, Dr. Coe,
of DeKalb county, and several of our Students, the operation of re-opening the
vagina was commenced; but from the violent strugglings of a poM'erful woman,
we had to desist. The ether, on a sponge, was now forcibly held to her nose,
when she became insensible to the knife, which was continued cautiously work-
ing its way up to the os tincsc, only ceasing when the finger could be introduced.
We have some doubts if the operation could have been performed in this case,
without the induction of the anaestheiic condition. The patient possessed great
strength and was obstinately opposed to the use of instruments.

Jan. 5th. Amputation of the Leg, for necrosis complete insensibility was pro-
duced by the inhalation of sulphuric ether. The patient was a youth, aged 20,
(white); he had to be urged for several minutes to breathe the ether; experienced
disturbed dreams, but states he knew nothing of the operation.

Jan. 22d Aviputaiion of the Thigh, for whitc-sicclling of the knee insensibility
but for a moment from breathing the chloroform. With all our industry and
anxiety on the subject, we could only procure a very small quantity of the Tri-
chloride of formyl, and for this we were indebted to Dr. Barry, of the house of
D'Antignac & Barry. The preparation acted promptly, but before the operation
was even commenced, its efiects had passed off. Four ounces of chloric ether
were then faithfully inhaled, but failed to produce insensibility inthiscase.

Jan. 2lst. Rcvioval of a large fibrous tumor (5 lbs. 2^) f-om the Thigh total in-
sensibility by sulph. ether. This was a very aged man, the sciatic nerve was
exposed and dissected from the tumor for several inches ; the patient lay like a
subject on the table during the operation, occupying about nine minutes.

Jan. 24th. A711 put ation partial of the Foot complete anesthesia by the sulph.
etlier. This patient was 8 years old, and after overcoming his repugnance to
breathing the ether, was promptly effected by it.

Jan. 29th. Amputation partial of the foot complete, death-like insensibility
produced by chloroform. This case was that of an adult, who refused to inhale
either of the ansesthetic agents. A sponge saturated with chloroform was forci-
bly held to her noi^e and mouth, and* in a few seconds she was rendered insensi-
ble. She remained so for more than half an hour after the operation was per-
formed and the dressing applied. The chloroform was prepared by Dr. Barry.

Feb. 9th. Dislocation at the shoulder-joint neilhcv the chloroform nor ether acted

188 Medical Intelligence, [March*

satisfactorily in this case. The patient, an Irishman, had been addicted to
spirits. There were slight convulsive movements produced.

Feb. llih. Aviptdalum at t/ic s/ioulder-joint complete insensibility by chloro-
form. This was a very satisfactory case the patient had received a gun-shot
wound 48 hours previous to the amputation ; the parts injured were in a high
state of inflammation, yet he evinced no sensibility. He says he knows nothing
of the operation.

Chloric ether failed to produce anaesthesia in one of these cases it was faith-
fully tried.

Sulphuric ether succeeded in inducing this state in four of them the insen-
sibility being complete, but requiring great encouragement to induce the patients
to breathe it, and some time was lost in each instance.

The chloroform acted promptly and efliciently in all the cases to which it was
applied, giving entire satisfaction; but the insensibility was not continued long
enough in one case, on account of the limited supply of it.

We give our decided preference to chloroform, over ether.

We use a sponge or handkerchief, held to the nose and mouth, pouring upon
it from 50 to 120 drops. The article we are now using was purchased from
Mr. Risley, of the firm of Haviland, Risley & Co., and was made by Rushton
& Co., New- York.

The journals and even the news-papers of our country, are beginning to teem
with cases relating the wonder workings of chloroform. As these may be ac-
cessible to our readers, we close this notice by reference to testimony received
in its favor by the last arrivals from Europe,

In the London Lancet, for January, 1848, will be found related several cases
of didicult parturition, successfully relieved without pain to the mother, from
the inhalation of chloroform. These are by Prof, Murphy, of the University
College, London.

Holmes Coote, Esq., Demonstrator of Anatomy to St. Bartholomew's Hospi-
tal, details two cases of Lithotomy, one in a man, and another in a boy, success-
fully performed ilnder the effects of chloroform. So also may be seen in the same
Journal, accounts of operations performed under the same influence, by Tatura,
H. C. Johnson, Cossar Hawkins, Pettigrew, &c. The late Mr. Liston, Law-
rence, Phillips, Furgusson, Key, Syme, &c., have all likewise used it.

From the Bulletin General de Therapeulique Medicale et Chirurgical, pub-
lished in Paris, December, 1847, we gather the following facts in relation to the
application of Chloroform to surgical operations:

The chloroform has alF?ady been employod in a great number of different
operations. At the Hotel Dieu, Messrs, Rouxand Blandin were the first to ex-
periment with the wonderful properties of this preparation. The results of
M. Iloux conhrm those collected by Dr, Simpson of Edinburgh, He has oper-
ated for a voluminous sarcocele of the .testicle, (castration); amputated the pe-
nis; removed the whole mamma for a cancer; amputated the thigh, &c. In all
these cases the anesihajsia was obtained more promptly by the chloroform than
-with ether. From half to one minute, at most, the insensibility was complete.
ISone of these cases experienced symptoms of repugnance to inhale the gas, or
irritation of the air passages, or extraordinary hallucinations or dreams, but
av.'oke in a pleasant state. Two, however, h;\d disturbed sleep and loquacity
compared to that produced from the inhalation of ether.

1848.] Medical Intelligence, 189

M. Blandin has operated by llthotrity for stone, fistula in ano, a large abscess
in the buttock, &c. He compared the insensibility of liis patients to death itself.

Atthe St. Louis Hospital, M. Jobert. (de Lamballe) has amputated the thigh,
dilated the neck of the Avomb, operated for strangulated hernia, &c., and in every
case the insensibility was promptly produced and satisfactorily maintained
during the operation, and the awakening was very rapid.

M. Velpeau, at La Charitie, after his experiments with the chloroform in
several operations, thus expresses himself: its action is at once more prompt,
more complete, more durable, and less disturbing than that of ether.

Prof. Sedillot, of Strasbourg, also recognized the anaesthetic properties of
chlorolbrm, and declares it to be more prompt and more persistent than that of
ether.

M. Amussat and Prof. J. Cloquet, also report their operations performed un-
der the influence of the chloroform.

The following we take from the first No. of the new British and Foreign
Medico-Chirurgical Review, January, 1848:

"The information which we have obtained from various sources, enables ns
to confirm, in the fullest degree, the statements put forward in the first instance
by Dr. Simpson, M^ith regard to the advantages ot Chloroform over Ether. The
more rapid and complete production of the insensibility, the facility and freedom
from injurious effects with which this may be almost indefinitely prolonged, the
quickness with which its effects subsequently pass otf, and the almost invariable
absence of any unfavourable influence that can be fairly attributed to its use,
all concur with the ease and readiness with which it may be administered, and
with the absence of necessity for any special apparatus for the inhaling process,
to give to Chloroform a decided superiority, and, in fact, to make it as nearly
perfect as any such agent can be expected to be, the varieties and idiosyncrasies
of the human constitution being duly kept in view.

" We have reason to believe, not merely that chloroform will nniversall)'' re-
place ether, but that the majority of those practitioners, who, for various reasons,
objected to the inhalation of ether, are already yielding to the virtues of chloro-
form ; and we trust that the earnest a[ipeal which h; s been made by Dr. Simpson,
in reference to the prevention of human suftering which its use may procure
during the process of parturition, will not be without its influence on those en-
gaged in obstetric practice. Whether it should not be exhibited in an easy
natural labour, is a question which may be safely lett, we think, to the decision
of the patient; but that in ditficuli and protracted labours, of almost every de-
scription, and in nearly everv case requiring manual interference, great and
varied benefits are derivable from its use, seems to be the concurrent testimony
of all who have employed it under such circumstances. In a case recently pub-
lished by Dr. Simpson, (Lancet, Dec. 11, 1847,) a patient was kept under its
influence for thirteen hours consecutivelv, the labour being rendered tedious by
the narrowness of ihe pelvic canal, and the child being at last delivered by the
forceps. Ifany permanently injurious influence were to be dreaded I'rom the ex-
hibition of chloroform, it would surely be manifested in such a case asthis; and
yet we are assured by Dr. Simpson -\hat the child when born showed no other
want of vital power than was fully accounted for by the long-continued pressure
to which it had been subjected; and that the mother's recovery was remarkably
rapid, the child also speedily becoming perfectly well.

" We much regret to find that Dr. Simpson's philanthropic efforts for the relief
of human suffering, have been opposed on religious grounds by some well-
meaning individuals, who consider that we are not justified in doing anything to
alleviate or remove the effect of the curse pronounced upon our first progenitrix.
Of course, to be consistent, such persons should set their faces against every
kind of assistance which the skilful obstcrt^ician can afford to the suffering
mother, as well as to all the improvements -in manchinery, (fee, by which the
labour of man can be in any degree diminished, and Adam's share of the load
thus lightened."

190 Medical Intelligence, [March,

"NVe last)}' let Prof. Simpson speak himself, on the subject of his g^-eat dis-
covery :

*' Is it //ir/;/ for tlie physician to interfere with these fearful sufferings and
agonies, in oPiler to .<ave an.l sliiell his patients from the endurance of them 1
Is it proper tor him to exercise the skill of his art, so as to moderate and remove
these, ' mnximoset fere intolerabiles dolores"? Would it bey<'^ and viccL in him
to use human means to assuage the pangs and anguish attendant upon the process
of parturition in the human mother 1

"These questions, and questions like these, I have often, during the currency
of the present year, heard complacently put by medical men men, too, whose
opinions anJ actions, in other inalters and in other respects, were fully and truly
actuated by that great princi.ple of emotion which both impels us to feel sympa-
thy at the sightof sufTerinGTin any fellow-creature, and at the same lime imparts
to us delight and gratification in the c5:ercise of any power by which we can
mitigate and alleviate that suffering. Such questions, I repeat, are seriously
aslced by phvsicians ani surgeons, the professed object of whose whole science
and art is the relief of human disease and human suffering. They are ques-
tions propounded with all imaginable gravity and seriousness by individuals
who (in a mere abstract point of view) would, no doubt, strongly object to being
considered as anxious to patronize and abet the continuance of pain, or traffic
in the perpetuation of human sufferings of any kind. Nay, probably at this
date ttiere is not one in twentv, perhaps not one in a hundred, of the physicians
and surgeons of Great Britain, who have, as yet, thought seriously upon the
proprietv of annulling the tortures attendant on human parturition, or who have
acknowledged to their own minds the propriety of bestirring themselves, so as
to be able in the exercise of their profession, to secure for iheir patients an im-
munity from the throes and agonies of childbirth.

" Perhaps, as an apology for their indolence and apathv, some may be ready
to arirue, that the pain and sufffering attendmit on parturition is not dangerous
and destructive in its results, however agonizing and distressing it may be to
the patientduring its continuance. But the argument is fundamentally unsound.
All pain is, per 5", and esp^^cially wl)en in excess, destructive, and may be even
fatal in its actit)n and eff^ecls. It "exhausts" (says Mr. Travers) "the principle
of life." " It exhausts" (says Mr. Burns, of Glasgow) "both the system and the
part." " Mere pain" (observed the late Dr. Gooch) "can destroy life." And the
great pain accompanying human parturition is no exception to this general pa-
tholo'^ical law; for, in fact, the maternal mortality atteinlant upon parturition
regularlv increases in a ratio progressive with the increased duration of the wo-
man's sufferings. Tlie statistical data publisheti by Dr. Collins, in his excellent
report of the Dublin Lying-in Hospital, affords ample proot of thisas a general
principle, with re:rard to the effect of pain in protracted parturition. For, ac-
cordinLj to calculations which' I have made from Dr. Collins' data, while in the
women delivered in the Dublin Hospital, and whose suflerings were terminated
within two hours, only one in '^2^ ol the mothers died; where the labour varied
in duration from two to six hours, one in 1-15 of the mothers died; in those in
whom it continued from seven to twelve hours, one in eighty died; where it
endured Irom twelve to twenty-four hours, one in twrnty-six died; where it
lasted from twenty four to thirty-six hours, one in seventeen died ; and out ofall
those whose parturient sufferings were prolonged beyond thirty-six hours, one in
everv six perished

" Again : Some may possibly be inclined to reason, that any means by which
we could produce a state of anaesthesia, or insensibility to tlie physical pains of .
labour, must of necessity be of such a character as to add to the perils and dan-
gers of the patient. I believe this argument to be as futile and untenable as the
one that I have just noticed. Indeed, judging Irom analogy, and from what is
the fact in surgery, I believe that, as a cotinteraction to the inffuence of pain,
the state of artificial anipsthesia does not only imply a saving of human suffer-
ing, but a savin;^: also of human life. Out of above 300 cases of the larger
ami)utati()ns performed durim? the current year, upon patients etherized or in
an anirsthctic state, and which I have collaicd Irom diff'efent hospitals in Great
Britain, Ireland and France, a smaller proportion died than formerly nsed to

1848.] Medical Intelligence. 191

perish in the same hospitals under the same operations without etherization.
Thus, under amputations of the lhi<<h, Malgaij^ne found that in the hospitals of
Paris (1836- 1841,) 07 in every 100 died j in Edinburgh the mortality ol this op-
eration in the years during which the hospital reports were published, (I83t)-184'2)
was 50 in ev^ery hundred; Mr. Phillips (1844) found the average mortality 40
in 100 ; Dr. LaVrieat Glasgow (1830,) 40 in 100.* I have notes of 135 cai^es in
which this same operation has been performed during the present year in hos-
pital practice upon patients in an etherized state. Out of these 135 ca?es 33
died, or only 24 in 100. Hence, I repeat, that the condition of anaesthesia not
only actually preserves the patient in surgical practice from agony and torture,
but actually preserves him too from the chances of danger and death. And I
firmly believe, that the superinduction of anaesthesia in obstetric practice will
yet be found to diminish and remove the perils as well as the pains of labour.

"In a paper which I wrote in February last, " On the Employment of the In-
halation of Sulphuric Ether in the Practice of Midwifery," I observed, "The
question which I have been repeatedly asked is this Will we ever be 'justified'
in using the vapour of ether to assuage the pains of natural labour 1 Now, if
experience betimes goes fully to prove to us the safety with which ether may,
under proper precautions and management, be employed in the course of partu-
rition, then, looking to the facts of the case, and considering the actual amount
of pain usually endured, I believe that the question will require to be quite
changed in its character. For, instead of determining, in relation to it, whether
we shall be 'justified' in using this agent under the circumstances named, it
will become, on the other hand, necessary to determine whether, on any grounds,
moral or medical, a professional man could deem himself 'justified' in with-
holding and not using any such safe means, (as we at present presuppose this to
be,) provided he had the power, by it, of assuaging the pangs and anguish of
the last stage of natural labour, and thus counteracting what Velpeau describes
as 'those piercing cries, that agitation so lively, those excessive effoits, those in-
expressible agonies, and those pains apparently intolerable,' which accompany
the termination of natural parturition in the human mother."

"Since the latter end of January I have employed etherization, with few and
rare exceptions, in every case of labour which has been under my care, and the
resulis, as I i Iready stated in Thr Lancet, have been, indeed, most happy and
gratifying. I never had the pleasure of watching over a series of more perfect
or more rapid recoveries; nor have I once witnessed any disagreeable result to
either mother or child. I do not remember a single patient to have taken it who
has not afterwards declared hersinceie gratitude for its employment, and her
indubitable determination to have recoirse again to similar means under simi-
lar circumstances. . Most have subsequently set out like zealousmissionaries,to
persuade other friends to avail themselves of the same measure in the hour of
suffering. And a number of my most esteemed professiunal brethren in Edin-
burgh have adop'ed it with success and results equal to my own. At the same
time, I most sincerely believe that we are, all of us, called upon to employ it by
every principle of true humanity, as well as by every principle of true religion.
INledical men may oppose, for a time, the superinduction of anscstliesia in partu-
rition, but they will oppose it in vain ; for certainly our patients themselvesand
their friends will iorce the lise of it upon the profession. The whole question
is, I believe, even now, one merely of time. It is not Shall the practice come
to be generally adopted '? but When shall it be generally adopted 1 And, for
my part, I more than doubt if any man (rejeeling willingly its benefits) is really

The following tattle exhibits the actual numher of the cases of Amputation of the Thigh
referred to in the text, with their respective results :

TABLE OF MORTALITY ACCOMPANYING AMPUTATION OF THE THIGH.

Name of Reporter.
Mal;;aij?ni', Paris, .....

Ti-acock, Ef'.inl)urgh, ....
rhillijs' CollecUon of Cases,
Lawrie, Olasirow, ....

Total,
Uj-on patients in an autcsthetic state,

Cases.

Deaths.

Percent, of deaths.

201

1-26

62

in

100

43

21

60

in

100

660

263

40

m

100

184

73

40

in

100

108S

483

44

in

100

135

S3

24

in

100

192

Medical Intelligence. Meteorology.

justified, on any grounds, moral or medical, in deliberately desiring and asking
his patients to shriek and writhe in their agonies for a lew months, or a lew
years longer, in order that, by doing so, they may del'er, torso(th, to his profes-
sional apathy or pan ler to hisproiessionai caprices and prejudices."

Successor of Last o:^^ in the University College of London. Prof. Syme, of Edin-
burgh, has, we learn, been appointed to the oliice vacated by the death of Mr.
Lision. This may be a good appoiritment, but from our knowledge of the two
Surgeons, the successor is greatly inferior to the lamented deceased.

METEOROLOGICAL OBSERVATIONS, for January, 1&18, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

a:

Sur
Thf.r.

1 Rise.
Bar.

29 98-100

1 -^r

Thf.r.
! 61

P.M.
Bar.

Wind.

Remarks.

1

55

29 83-100

s.

Cloudy storm last night.

21 33

" 83-100

58

" 94-100

w.

Fair.

Fa ir some clouds in afternoon.

3

30

30

56

30 3-100

s.

4

34

29 93-100

' 60 '29 94-100

N. W.

Fair.

5

32

" 96-100

62

" 95-100

s.

Fair.

6

46

" 72-100

70

" 66-100

w.

Fair.

7

38

" 67-100

58

" 72-100

N. E.

Fair.

8

32

" 72-100

50

' 53-100

S.

jCloudy.

9

54

" 54-100:

53

" 61-100

N. W.

Fair blow storm last night.

10

25

30 7-100

44

30 15-100

N. W.

Fair blow.

11

26

" 32-100

45

" 17-100

E.

Cloudv in alternoon.

12

3t

" 10-100

53

" 6-100

N. W.

Cloudy.

13

41

" 10-fOO

47

" 7-100

N. E.

Cloudy.

14

40

" 7-100

52

30 1

N. E.

Cloudy.

15

44

30 1

GS

29 95-100

S. E.

Fair since 12 M.

16

47

29 95-100

75

" 92-100

S.

Fair some flying clouds.

17

56

'' 95-100,

62

" 97-100

S. \V.

Cloudy.

18

50

30 1

58

30 i

N. \V.

Cloudy sprinkle last night

19

40

" 15-100

50

" 17-100

N. E.

Cloudy.

20 31

" 17-100

49

" 15-100

N. E.

Cloudy.

21

31

" 4-10.)

62

29 99- 100

N. W.

Fair.

22

35

29 85-100

66

" 89-100

s. w.

Fair.

23

32

" 94-100!

{^Q

" 96-100

s. w.

Fair,

24

31

30 5-100!

67

30 12-100

E.

Fair very dusty.

25 50

^' 16-100

62

" 10-100

E.

Cloudy sprinkle.

2G 53

29 91-100

58

29 76-100

S.

Rain all day. ) 2 nights & 1 day
Fair. \ 2i inches.

27 55

" 59-100

m

" 59-100

s. w.

28 42

'' 73-100

65

" 72-10,)!

N. W.

Fair breeze.

29

47

" 74-100,

73

" 77-lOu!

W.

.^'air.

30

46

' 83-100

62

" 8 1- 1 001

s.

Cloudy sprinkle. [35-1 00.

31

52

" 73-1001

m

" 65-1001

s. w.

Cloudy sprinkle-rain at night

17 Fair days. CX

lantity of Rain S

\ inch 85-

100. Wind East of N. and S.

9d

ays. ^

^est of do

. do. 15

days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Tol. 4.] NEW SERIES APRIL, 184S. [No. 4.

Part L original COMMUNICATIONS.

ARTICLE XV.

Remarks on the Iodide of Potassium, with Cases. By John
RioRDON, M. D., of Savannah, Georgia.

The use of Iodine at this late day is extensively known, and
its respectability as a reme4ial agent is, now, duly acknowledged
by every intelligent physician.

Unlike many articles of the Materia Medica, which enjoyed
for a while the meed of unexampled praise and confidence, which
time and experience failed to substantiate, leaving them to fall
into a disrepute more ignominious by their former elevation
Iodine has attained to the highest rank in the pharmocopceia,
bidding defiance to the tesf^ which would detract from the glo-
ries it has won. It is true of this, as of all other medicines, that
its reputation may suffer in the hands of ignorance ; but our no
inc^MJJMable experience, together v/ith that of many others,
^^^fl^BBP^*^ ^^s ^^i^s extreme value in the treatment of all dis-
eases in which there is indicated a tonic, a deobstruent or an
alterative; and that marked benefit always results from its proper
administration, even though a complete cure be not efl^ected.

The existence of this substance was unsown until 1812,
when it was discovered by M. Courtois, a Soda manufacturer
of Paris. Although its discovery is dated from that period, it
w^as not known to possess any therapeutical property till eight
years after, when Dr. Coindet, of Geneva, employed it as a medi-
cine, in the treatment of Goitre,a prevaihng and obstinate disease
in that district, often baffling the skill of the medical practitioner,
and leaving the unfortunate subject at the mercy of the knife
as the only alternative.

13

194 Riordon, On Iodide of Potassium, [April,

The success of Coindet was such as to induce him to pubhsh
his experience, which furnished data for farther experiment, and
placed in the hands of Science a subject for investigation, replete
with interest to the world.

Later, the researches of M. Lugol, (whose name must ever be
associated with Iodine,) as published in his 1st, 2nd, and 3rd
*' Memoirs" on the subject, have fully established its value a? a
remedy in the whole family of scrofulous diseases. In corrobo-
ration of his views, we have ample testimony in the report of
many others who have written after him. Iodine, from its
affinity for many of the salifiable bases, and also from its misci-
bility with almost any vehicle, forms an element in the constitu-
tion of very many pharmaceutical preparations ; all which have
their individual and peculiar applications to disease ; but none so
extensively or diversely used as the one under consideration,
which alone it is our purpose, here, to notice.

The Iodide of Potassium is an anhydrous neutral salt, result-
ing from the chemical union of 1 eq. of each of its elements
Iodine and Potassium.

" Hydriodate of Potassa" is in frequent use as a synonyme,
but as this salt contains neither hydrogen nor oxygen until a
particle of water i^ added for its solution, the term embodies an
erroneous signification in its construction.

This preparation has entirely supplanted the simple substance
as an internal remedy, being pre-eminently apphcable to all cases
in which the Iodine is admissible, for reasons whiclijMd|upon
slight reflection be apparent. In those cases wher6 all iodine
course is indicated, although previous to its administration there
exists a tendency to local irritation in the gastro- intestinal sur-
face, the ingestion of simple Iodine, will not fail to determine its
development. -"^

Or in like mnnner ^ there is a general irritability pervading
the system, the apf^roflon of this irritant only enhances the dis-
position, inducing, if persisted in, nervous derangements of well-
marked characters.

Here, the Iodide of Potassium exhibits its chief excellency,
combining all the virtues with which its mother substance is
endowed ; yet so changed in its constitution by the regenerating
influence of its chemical conjunction, that where we had an

1848.] Riordon, On Iodide of Potassium. 195

irritant, a substance, mild and sedative in its effect, is presented
to us, which manifests its sanitive powers indiscriminately in all
cases.

We are aware that there are many who, from an indiscrim-
inating prejudice, or from unadvisedly deriving a rash conclusion
from their deficient experience with the remedy, may oppose the
views herein adduced ; but we will only cite them, in support
of our premises, to the many authentic cases on record, of the
ingestion of immense quantities of this salt, without producing
any irritant or other prejudicial effect : and also to the numer-
ous pathological conditions, characterized by irritability and
excitement, in which this remedy has proved remarkably suc-
cessful.

The extensive and peculiar dominion which this agent exer-
cises over both the absorbent and secretory apparatuses, elicits,
at once, our admiration and wonder. And this effect is particu-
larly obvious in a default on the part of these organs, to perform
their functions complying with what we believe to be an estab-
lished axiom, that disease heightens susceptibility to the action of
medicines.

These properties of Iodine were among the first noticed ; and
forsooth to this day, the only ones alleged to it, by some respect-
able authoritj^ Coindet first used it to reduce a hypertrophied
gland ; and since, it has been employed in every variety of
hypertrophy, whether the particles deposited in the tissues were
norra^y^r abnormal in their character.

To^ese qualities too, are we indebted for the removal from
the system, of any taints or impurities which it may have con-
tra^t^d by infection. Each system of organs constituting the
depurative apparatus is incited to redoubled energ}% disposing of
impurities in a natural manner, without the remedy having any
specific antidotal effect upon the vitiation; to which, some have
attributed its beneficial influence.

We rely so much upon the powers of this agent, that we ar^
induced to venture the expression of this novel opinion that
under its long continued use, if a supply of food commensurate
with the demands of the increased appetite (which is an invaria-
ble concomitant upon its use) be indulged in, that the body may
undergo its renewal or regeneration in half the time it does, un-

196 Riordon, On Jodide of Potassium, [April",

der ordinary circumstances. We have observed that when the
appetite was indulged, the subject soon increased in flesh and a
sallow complexion brightened into that of high health. And on
the contrary, if the demands of nature were not responded to,
and the supply of food withheld, a progressive emaciation would
soon be established through the action of the absorbents, and the
body, like the blade of Hudibras

Woald "eat itself away, for lack

Of something else to hue and hack!"

There is an objection preferred against the use of the Iodide
of Potassium, which is carried by some even to the entire exclu-
sion of the remedy. The power which it exercises over glandu-
lar enlargements has led many to the conclusion, that its influence
would be pernicious over the glandular structure in a state of
health. This bugbear notion prevails extensively in the coun-
try, where retirement and prejudice conspire to exclude the light
of truth.

We are acquainted with physicians who, not daring to use
this preparation, nor even countenancing it so far as to keep it
about their shops, w^ould send off* to a neighboring grocery, where
medicines, together with every thing else were sold, to get a few
grains of the simple Iodine. And when it was obtained they
would go through a tedious exposition oi pros and cons to the
scrofulous patient in respect to the remedy, to justify, if possible,
the use of so hazardous means.

Now, with regard to such an objection we have onl^^^say,
that we cannot conceive how the Iodide of Potassium cou^rcause
serious wasting of the glands, testicles, mammae, &:c., without
the co-operation of an absolute dietetic course, wiiich must be
detrimental to the patient in every respect.

We would invit^espccial notice to one singular and most
valuable property ^Bnced by tliis medicine. It is, its almost
niagical influence over that condition which determines certain
organs to, and insures their continuance in, a state of engorge-
ment or congestion. Whether the rationale of this action is to
be sought for in its tonic, dcobstruent or alterative virtues ; or
in its depletion of those organs by an inordinate flow of secretion,
allowing thein to regain their cf)ntractility we will not pretend
to decide. The latter explanation is invalidated in the fact, that

1848.] Riordon, On Iodide of Potassium. 197

the spleen, an organ wanting an excretory duct, is equally sub-
ject to its influence, with the liver, kidneys, lungs, &c. Without
dealing farther in hypothesis, we merely offer these opinions
which we hope to have substantiated in the following cases : ,\

Case I. Mr. G., aged 25 years, lymphatic temperament, had
laboured for about eighteen months under general debihty, result
of repeated attacks of intermittent fever. The ordinary routine
of alteratives and tonics had been put in requisition without the
least permanent benefit. On examination, find him in the fol-
lowing condition : Countenance much bloated ; respiration
short and hurried ; pulse weak, irregular and very easily exci-
ted least exercise causing great fatigue ; complains of watch-
fulness and restlessness at night ; tongue foul and tremulous ;
conjunctivae icterode ; appetite wanting ; hver inactive, with
enlargement and tenderness in both hypochondria, particular-
ly the spleen, being immense ; abdomen tumid ; micturition
scanty and sedimentous ; oedema of lower extremities and weak-
ness of knees.

Viewing the above case as essentially the result of hepatic
and splenic engorgement, upon which all the other symptoms
depended, we considered ourselves justifiable in prescribing the
Iodide of Potassium, of which the patient took grs. 5 three times
a day in a little sweetened water. In less than ten days there
was remarkable improvement, and before he had taken two
ounces of the salt his health was completely restored and his
condition and appearance so altered that one could scarcely
recogj|^e him as the cachectic, dropsical, wornout individual of
a date but a month previous.

C.4SE II. J* McC. was treated for acute gastro-enteritis by
the ordinary means viz., blisters, alteratives, &c., &c., and was
relieved of the more urgent symptoms by these remedies, though
at the end of two or three weeks, continued still the subject of
a chronic diarrhoea. At this time he was extremely emaciated ;
skin hard and dry ; countenance icterode ; pulse feeble and ra-
pid ; tongue slightly furred in middle, with reddened edges ;
appetite absent ; liver somewhat enlarged and tender ; inferior
extremities cedematous, with superficial veins varicosed left
leg much more tumefied than right, and its subcutaneous cellu-
lar, tissue thickened and indurated from ankle to knee ; also
indolent ulcer size of twenty-five cent piece on inner side.

198 Riordon, On Iodide of Potassium. [April,

Prescribed, Iodide of Potassium, grs. 5, te7'in die, with cinchon.
tinct. comp., 5 ij. On this treatment his amendment was rapid,
diarrhoea was reheved in about fourteen days ; appetite returned ;
hepatic engorgement was removed, and with it the varicosed
condition of veins and ulcer on leg ; induration in cellular tissue
of leg somewhat lessened, though not entirely removed. The
remedy was continued about two weeks longer, when patient
Appearing entirely cured medication was considered no longer
necessary.

Case III, W. H., of S. Carolina, aged 35 ^lymphatic tem.
perament ; had been for several years the subject of Dyspepsia,
evinced by indigestion, burning in epigavStrium after meals, con-
stipation, &.C., &c. had submitted to approved plans of treat-
ment for his disease without relief. On examination, amount
of general plethora ordinary, liver and spleen slightly enlarged.

Prescribed, lod. Pot., grs. 5, ter in die, with cinchon. tinct.
Gomp., 5 ss. Without other treatment he experienced marked
relief in ten days, and shortly after considered himself well ;
though having occasional returns of his symptoms, he had to
resume the treatment, interruptedly, for several months longer.

Case IV. P. S., aged 40 had been the subject of hepatic
and splenic engorgement for several months, for which he had
been mercurialized repeatedly, without other than temporary
benefit. On exainination, he is found with pulse of ordinary
frequency, though somewhat feeble ; jaundiced ; bowels irregu-
lar ; appetite wanting ; had been subject to frequent nausea for
a month previous.

Prescribed, after relieving the bowels by a cathartic, the
treatment pursued in the foregoing cases viz., lod. Pot., in
combination with the bitter tonics. At the end of six weeks
he was well, and able to resume his duty as night guard at the
R. R, Dep. without any return of disease.

Case V. J. R., aged 28, of bihous tcm))eramcnt is affected
with enlarged liver ; skin and conjunctiva jaundiced to very
high degree ; appetite deficient; vomiting daily.

Trratment. As a cathartic, prescribed grs. 20 of Calomel,
followed by Salts and Senna, afterwards 11yd. Pots., grs. 5, ter
indie, in 5 ij. comp. tinct. of Camomile and Centian. lie was
entirely relieved in a short time and able to attend to business.

1848.] Riordon, On Iodide of Potassium, 199

Case VI. J. M., aged 10, from Harrisburgh having en-
larged liver and spleen from repeated relapses of intermittent
fever ; complexion anaemic ; tongue whitish ; abdomen tumid ;
evacuations colorless and without odour; lower extremities much
swollen, and puffy.

Prescribed, grs. 3 of lod. Pot., terin die, for about three weeks,
when, being so much improved, it was thought safe to substitute
this expensive article by mur. tlnct. Ferri.

Case VII. J. D., aged 40 spleen and liver enlarged after
remittent fever ; dyspepsia, loss of appetite, &c., &c.

Prescription as in the above cases : in about twelve days ap-
petite returned, digestion became regular, and shortly after
recovery was complete.

Case VIII. D. C, aged 35: a contractor for canal work,
subject to great exposure ; during last summer was suddenly
attacked with violent conjestion of the lungs, imminently threat-
ening immediate dissolution. This was relieved by a prompt
and very copious bleeding, followed by active purgation, &c. ;
but on recovery fi'om these symptoms, there remained much
tenderness in the abdomen with enlargement in both hypochon-
driac regions. Various alteratives were applied with little or
no benefit : he was finally treated with grs. 5 of lod. Pot., ter in
die in about two weeks he was able to resume his laborious
avocation without return of symptoms.

From an attentive consideration of the above eight cases, it
will appear, that the analogy between them all obtains most
strictly, and though there is some degree of variation in their
individual characters, -their differences are plainly to be found
in the degree of intensity, rather than in any important patho-
logical characteristic : for instance, in cases first, second and
sixth, the hepatic engorgement was sufficient to cause obstruc-
tion in the large abdominal venous trunks hence, the dropsical
effusion in the peritoneal cavity and lower extremities. In case
second, engorgement being chronic, and the venous obstruction
having existed for some time, the watery effusion in the legs had
been replaced by indurated coagulable lymph. In the other five
cases, the engorgement was found to be only sufficient to de-
range the digestive functions, though not adequate to the pro-
duction of venous obstruction.

200 Riordon, On Iodide of Potassium. [April,

In the foregoing treatise it has been our object not to prove
that Iodide of Potassium will relieve chronic glandular enlarge-
ment, or remove abnormal depositions from the tissues of the
body these are propositions long established beyond mooting ;
but in the report of the above cases we have endeavored to
illustrate its applicability in sanguine engorgement of the liver,
spleen, and other viscera, of recent origin, affections ordinarily
treated unsatisfactorily by the means usually resorted to viz.,
venesection, blisters, mercurialization, &c., &c. What has
been said with regard to its faculty of increasing the activity of
the absorbent system, we think is fully corroborated in the above
cases, and w^e feel justified in the opinion that it is by this influ-
ence that we derived the favorable results which have accrued
from its application to the same.

There is one more case, which though unusual, we could
not bring in the above catalogue, but which may be worthy
of note.

Case IX. T. J. C, aged 25, of nervous temperament and of
the scrofulous diathesis, many of his family having died of
phthisis he is very delicate and of unhealthy appearance, com-
plains of restlessness, indigestion, dull pain in chest, has some
cough and expectoration. On application for treatment, he was
directed to take grs. 5 lod. Pot., ter in die. Rapid improvement
was the result.

This patient, while taking the remedy, continues apparently
in perfect health, but on discontinuing its use the symptoms
invariably return in a short time: he has been taking it nearly
a year, and has attempted several times to omit its use, but finds
its continuance actually necessary for his well being, his symp-
toms always returning upon the omission of the remedy.

Upon this case we will not comment, further than to express
the opinion that the medicine most probably is necessary to keep
up the equilibrium between the absorbent and secretory func-
tions of the systc'fn.

Of the application of the remedy to syphilitic diseases and
otherwise, we have had ample opportunity of observing cases
during the last year in the practice of Drs. Campbell, my pre-
ceptors, from whose notes we have been kindly permitted to
appropriate some of the above cases, but this particular use of

1848.] Pendleton, On Eruptive Rheumatic Fever, 201

the remedy it is not the object of this Thesis to elucidate, and I
therefore forbear further remark upon a subject already extend-
ed beyond the requirement of the Medical College of Georgia.

ARTICLE XVI.

Some account of an Eruptive Rheumatic Fever, as it prevailed
in Sparta and its vicinity, in December and January last.
By E. M. Pexdleton, of Sparta, Georgia.

The first case I saw of this disease, (Dec. 19th,) I took for a
simple case of Urticaria Febris, as the eruption was very similar,
and always attended by considerable itching. In this, however,
there is much more floridity of the skin, spreading in large
blotches, simulating Scarlatina ; but always on a close examina-
tion you will find a rash present exactly like Urticaria, which
no doubt produces the itching. I therefore regard the eruption
as a combination of Scarlatina and Urticaria. In all cases this
was not present, but in most ; and it appeared at such irregular
mtervals as to prevent any calculation as to the time it might
probably present itself. That it was essentially and mainly a
rash I have no doubt, both from the itching and general mildness
of the disease when it was well marked and kept out, as well as
its danger when repelled, always involving some of the more
vital organs.

Another pathognomonic symptom of this disease was the
extreme pain and swelling produced throughout the muscular
system. This was present in all cases, I believe, and was famil-
iarly denominated muscular rheumatism by physicians and
nurses. That this was the consequence of considerable inflam-
mation in the tissues is clear, from the fact that it frequently
resulted in effusion into the cellular texture, as well as the pain
and swelling above noticed. Whether this inflammation was
produced by cold, as in cases of epidemic influenza, or by a trans-
lation of the peculiar morbific agent of the eruption, is a question
for the curious etiologist to investigate. In some instances the
muscles of the face were so swollen as to disfigure the counten-
ance completely, quite as bad as if inflamed by the poison of a
bee, and so of other parts of the muscular system ; and the pain

202 Pendleton, On Eruptive Rheumatic Fever. [April,

and soreness were frequently so intense as to make the patient
cry out on the slightest touch.

The different stashes of the disease were irref]^ular and variant
as to time. What might be called the forming stage lasted in
some instances ten or twelve days, during which time the patient
complained of soreness in the muscles and great weakness, inert-
ness, and depression of spirits; but still not compelled to goto
bed. The next stage was more febrile, which would last but a
few days, where the case resulted favorably. During this, the
rash would make its appearance. The fever was generally of a
low form, the pulse not remarkably quick, nor full, but weak and
labored, as if the blood had to struggle with some effort through
the arteries which were doubtless compressed by the swollen
muscles. When, however, as was the case in several instances
in my practice, the disease was not so promptly subdued, the
rash being repelled upon the lungs or stomach and bowels, the
pulse would become quick and sharp, presenting all the charac-
teristics of a pneumonia or gastro-enterite : then, and only then,
did there ever appear to be any thing dangerous about the dis-
ease. The two cases which perplexed me most, was one ^vhich
resulted in a troublesome bronchitis, and another in anasarca.
Both of these were confined to bed some five or six weeks,
and up to this time (about two months from the advent of the
disease) are able to stir but little, the muscular system seeming
to have lost its tone from the force and long continuance of the
disease.

Conjoined with the above symptoms, generally, of the disease,
was a complete prostration of the muscular powers inability to
turn over in bed, or to move the lower extremities, more parti-
cularly. In two instances, which I treated, this was complete.
The upper extremities, however, were not so much involved
only in one case the extensors were contracted so as to draw the
forearm into a right angle with the arm, and this remained
throughout the whole course of the disease, gradually yielding
as it subsided. In every case which I saw, the rheumatism (so
called) was confined to the muscles : it is true, in one or two, it
seemed to be anthritic when the swelling and pain was extensive
about the ankle-joint ; but upon a close examination it was evi-
dently muscular, and the swelling was more from an accumula-

1848.] Pendleton, On Eruptive Rheumatic Fever. 203

tion of water than any thing else. In this it differs essentially
from Den2;ue.

There were generally two exacerbations of fever within the
twenty-four hours, succeeded by remissions one during the day,
at its highest about 2, P. M., and the other about midnight.
The tongue, during the first stage, had a slight yellowish fur
upon it : when, however, the disease became complicated with
visceral inflammation, it would change to a whitish fur in the
centre and bright red round the edges, or brownish, with varied
size papillas over its whole surface, according to the seat and
extent of the inflammation.

This disease has been variously denominated by the few^
physicians who have seen it, Muscular Rheumatism, Epidemic
Jnjluenza, Rheumatic Nettle-rash, Dengue, Breakbone Fever,
&c. ; but my own impression is, that neither of these names will
properly answer for it, or define its multiform and complicated
symptoms. I believe its true pathology is simply an inflamma-
tion of the muscular tissues of the system, dependent upon and
originating in a low humid atmosphere, impregnated with eflflu-
via from decaying vegetable matter. (The two families which
suffered most severely lived in situations favorable for such an
atmosphere,) And that when this inflammation was thrown out
upon the surface, it produced large circumscribed florid blotches
and a prurient rash, simulating Scarlatina and Urticaria, (an
accidental and not a necessary concomitant of the disease,) or
w^hen it fell upon some of the more vital organs, an inflamma-
tion of that organ was the consequence.

In the treatment, I regarded it important to keep a determin-
ation to the surface : hence, conjoined with gentle cathartics, I
gave stimulating diaphoretics, warm ptisans, pediluvia, hot poul-
tices to the abdomen, equable temperature of the room, &c. In
no instance did I think it prudent to bleed, but counter-irritation,
by sinapisms, blisters, &lc., I considered to be of the first im-
portance, where the bronchia, lungs, or primae viae suffered to
any extent,

I saw but eight well marked cases, one of which died after a
protracted illness of some five weeks. I was accidentally called
to this case once, in the absence of the family physician, and
have not learned the history of the case. While I regard the

204 King, On Gonorrhasa. [April,

disease as generally mild in its character, I am free to admit that
it may assume a most fearful and dangerous type, baffling the
skill of the most experienced. Dillering essentially, as it does,
from every other disease described in the books, and presenting
so singular a combination ofsymptons, 1 thought a brief survey
of it for your Journal might be acceptable, and I would be grati-
fied should it ehcit from others a similar account of the same
disease in other sections, if any other communities have suffer-
ed from it.

ARTICLE xvir.

An Essay on Gonorrhcra. By Wm. R. King, M. D., of Roswell,
Cobb county, Georgia.

[We acknowledge the reception of the above-named Essay
from Dr. King. We take the liberty of omitting the portion of
it which relates to history, symptomatology and pathology, be-
cause, although drawn up with clearness and perspicuity, it
presents no views that are not generally known to the profession.
We however cheerfully lay betbre our readers the Doctor's ob-
servations on the interesting subject of Treatment.]

The treatment may be divided into that required in the first
stages of the disease, and that proper in the second or chronic
form. There is a marked difference in the treatment of these
two stages.

In the first stage, irritating injections should not be used until
the inflammatory symptoms are subdued, by antiphlogistic treat-
ment and (emollient a})plications; nor should they be used when
the inflammation has spread beyond the ''specific distance''''
nor when the testicles are tender or inflamed nor when the dis-
charge ceasing suddenly these parts, have become sore nor
when the perinaeum is very susceptible of inflammation, and
especially if it formerly should have suppurated nor when there
is a tendency in the bladder to irritation known by the frequen-
cy of micturition. As soon as the inflammatory symptoms
abate, an injection of a solution of Nit. Argent, in strength vary-
ing from grs. ii. to xxx, })r. 3 i. once or twice per day, may be

1848.] King, On Gonorrhoea. 205

used with much benefit : also, this mixture we have used w^ith
much success. I^. Bals. Copaib.

Spts. Nit. Dulc, aa. !i.
Liqr. Potass., . . 3i.
Spts. Lavend. comp., q. s.
Mix. Acacia?, . . 5 vi.
Dose table-spoonful three times per day. The bowels should
be kept regular with saline aperients and mild laxatives.

The second or chronic form, is rather more difficult of the two
to subdue. The treatment varies considerably among practi-
tioners, some recommending one mode of treatment and some
another. The treatment which we are about to recommend is
one which we are authorized to do from observation and expe-
rience. Formerly we were in the habit of using a strong solution
of Arg. Nitrat., and it will frequently succeed per se, but cases
do occur in which we have seen it fail entirely. We generally
use the Nitrate of Silver only to premise the treatment, and then
follow it with the following injection.

Hyd. Sub. Mur., grs. x. vel. xv.
01. Lini., . . !i. M.

If the calomel and oil are well mixed, the same benefit is de-
rived from this injection as from the introduction of a bougie
smeared over with the Ung. Hydrg. We have succeeded with
the injection alone, but as a general rule it is advantageous to
begin the treatment with the Argt. Nitrate.

In a work by Andrew Duncan, M. D.,* we find a chapter
" concerning the opinion, that mercury cures the Lues Venerea
by the evacuation it produces." At the time Dr. Duncan wrote,
all forms of venereal were considered under the head of Lues.
John Bell soon after considered the question whether Gonorrhoea
and Lues Venerea originate from the same contagion, and he
was the first one who marked the difference between the two
diseases.

- Dr. Duncan, in the chapter above mentioned, argues that
priercury does not cure lues, by its causing either frequent or copi-
ous evacuations ; but that its effects upon the system aside from

Observations on the operation and use of Mercury in the Venereal Disease,
by Andrew Duncan, M. D., Fellow of the Royal Cdleg-e of Physicians, Edin-
burgh, 1772.

206 King, On Gonorrhoea. [April,

its action as a cathartic, are sufficiently obvious. Guaiac had
for a time considerable renown as an anti-syphiUtic, but as such
it has now fallen into disuse. There were other and more ac-
tive evacuants, which were known to have no such properties
as fancy had attributed to it. It was alledged that mercury
cured venereal by the evacuation it occasioned, because the
good eflects derived from its employment, were observed to be
more in proportion to the stimulant powers of the preparations
which was used, than to the quantity of mercury taken. The
data, however, here assumed, by no means leads to the conclu-
sions deduced from thence. The most stimulant preparations
of mercury, by their action on the primcB vice, are, in general,
immediately expelled from the system. When this happens they
have no influence in the cure of venereal : when they are not
thus expelled their nature is such that they most readily enter
the system.

Their superior action may be accounted for, then, without
supposing that it depends on their producing the most consider-
able evacuation. Some time ago we met an article, in the New
York Journal of Medicine, recommending very highly the use
of Hyd. Sub. Mur., xx. toxxx. gr. doses. Till the time we read
the article referred to, we had not been in the habit of using the
remedy as directed by the writer, but in a trial made^ we found
his suggestions attended with greater success than had been
anticipated by us. The calomel afiected the system, but not
deleteriously. In all cases active catharsis was produced by the
Sulph. Mag. The Hydrg. Sub. Mur. was given at night, and
followed in the morning by a dose of Sulph. Mag. To illustrate,
we will quote one of many cases.

L , aetat. 20, of good constitution, having had connection

of a suspicious nature last April, on the third day felt the first
symptoms of Gonorrhoea, and noticed his linen slightly colored
by a discharge from the lu'cthra, thin and almost colorless at
first, but which increased in quantity and thickness very mate-
rially by the end of twenty-four hours. Suspecting something

of the nature of his disease, he called upon Dr. for advice

and medicine. The Dr. gave him some mixture of Bals. Co-
paiba, Slc, the usual remedy, and advised him to use an injection
of the sol. Argent. Nit., grs. iv. to the 5 i.

1848.] Rkchcock^s Army Report. 207

The patient continued under his treatment from that time
until he fell into our hands the following October, having labor-
ed under the disease something like six months without any
beneficial effects from the treatment to which he subjected
himself

It is very important that the patient should observe a strictly
abstemious diet and well regulated state of the bowels.

Oct. 22d. Gave an injection Argent. Nit. sol., grs. xxx. to the
5 i., and at bed time administered Hyd. Sub. Mur. grs. xx., and
advised a dose of Sulph. Mag. in the morning.
,'/ Oct. 23d. Medicine has acted well : gave another injection
of the same solution at night Hyd. Sub. Mur. grs. xx., to be
followed in the morning by Sulph. Magnes.

Oct. 24th. Medicine acted finely ; the discharge some less
gave an injection.

Oct. 25th. The discharge much less, and changed in its
nature. *

Oct. 26th. Discharge almost entirely gone, and the parts feel
more natural than they have for months : inject, and at night
Hyd* Sub. Mur. ; Salts in the morning.

Oct. 27th. Had a discharge so slight in the night as scarcely
to stain his linen ; feels in fine spirits at the prospect of his recov-
ery. Inject.

Oct. 28th. Gave injection Argent. Nit. grs. x. to the ! i.
No discharge this morning.

Oct. 29th. Patient so well this morning no injection was giv-
en, but ordered him to use a gonorrhceal mixture.

Allow us to say, in conclusion, we are so much pleased with
this mode of practice, that we trust some of our professional
brethren will try it and give us the result of their labors.

ARTICLE XVIII.

Report of the Sick and Wounded in the Department of Tampico,
Mexico, under the command of Col. Wm. Gates, U. S. Army.
By C. M. Hitchcock, U. S. A., Medical Director.

We have received from our friend, Dr. H., a full and minute
report of all the sick, wounded, deaths and discharges, occur-
ring in our army at Tampico, for the months of October, No-

208

Hitchcock's Army Report.

[April,

vember and December, 1847. The diseases are arranged in
tabular form which presents only the results, without furnish-
ing other particulars ; and as our compositor has experienced
some difficulty in setting up this report in full, we propose
to give here only a synopsis of it.

The troops stationed at Tampico, are composed of Regulars
and Volunteers from Illinois and Louisiana. The medical
staff is composed of the Medical Director, Dr. Hitchcock, and
Drs. Summers, Reemes, Hamill, Whiteside, Talbot, Dashiells
and Gardner.

We notice the mortality for October, was 33 from yellow
fever, of G9 deaths; for November, 15 from the same source,
out of 33 deaths ; and for December, the deaths w^ere only 15,
and none from this fever.

a
o

>

i^

O

a;

c

.u

-zi

.

Various other diseases

making

c c

ti

c

r

QJ

R

:-

3

the amount

k a
esce
How

g

3

^
fc

C

C3

5

,2 " ^

ti a;

o

&

cn >*

Di

u,-

o

Q

Q

o

October.

300

75

450 5G

24

38

115

9

38

'

1228

November.

326

19

353

84

17

11

76

12 25

30

1053

December.

339

470

4G

2

9

47

29 19

33

11G8

-

For the month of October, 09 died, G were discharged, and
827 returned to duty. The mean strength of the Army was
1363, officers and men.

For the month of November, 33 died and 633 returned to
duty. Mean strength, 1468.

For December, 15 died, 2 were discharged, and 933 returned
to duty. Mean strength, 1549.

1848.] Twiggs, On Lithofomij. 209

ARTICLE XIX.

Lithotomy under the influence of Chloroform, hy Professor
PaulF. Eve. Reported by John D. Twiggs, M. D,, of Au-
^sta, Georgia.

With the cases ah'eady reported in the last number of this
Journal, wherein the Chloroform has been successfully employ-
ed, the following one, which I have just witnessed, may be
placed. It is probably the first case of Lithotomy performed in
the United States, under the influence of the new^ anoesthetic
agent.

My preceptor, Dr. Eve, was called on the 25th of February
last to visit a surgical case in Edgefield District, So. Ca. During
the visit, his attention . was directed to a child five years old,
laboring under symptoms of Stoue ; and so certain was he that
one existed, (although the sound had not been used,) that he
made an appointment on the 2nd of March for the operation.
Every preparation being made upon our arrival, by the family
physicians, Drs. Jennings and Tompkins, the patient was placed
on the table. While struggling, the chloroform w^as held on a
sponge to his mouth and nose, and in about a half minute he was
in a state of insensibility. The Dr. then allowed him to recover,
in order to relieve the anxiety of the family, who were very
much alarmed at the death-hke eflfects of this new preparation.
He then applied it again, introduced the staff, and instantly
detected the stone. The oloroform was then withdrawn, and
the patient in a few minutes revived and commenced fretting ;
the agent being re-applied, the efl^ect was almost instantaneous,
and, perfectly unconscious, the operation was performed. With
Dupuytren's double Lithotome Cachee the bladder was oj^en-
ed, and the stone felt ; seizing it in its 'short diameter, quite a
large calculus was removed for so young a child the common
dressing forceps of the French pocket-case were used for
its extraction. During the whole of the operation, which lasted
about four minutes, (the only delay being occasioned by the
oblong shape of the stone,) no pain was evinced by the patient,
who soon recovered consciousness when the chloroform was
removed. He was now placed in bed, but vociferated loud-
ly and insisted on getting up. He complained of no pain, but

14

210 Effects of Bloodletting on the Young Suhjcct. [April,

experienced an itching at the nose and mouth, which was no
doubt produced by the pungency of the chloroform.* We left
the patient doing well under the charge of the family physicians.

Six days afterwards (8th March), Dr. Jennings writes as fol-
lows : " Our little patient commenced urinating naturally last
Saturday evening, (second day after the operation) ; the next
day I applied adhesive strips, but he removed them ; the wound,
however, has a "healthy appearance and is uniting as fast as one
could expect. He urinates very freely, though not very often :
his penis and scrotum are somewhat swollen, but this has dimin-
ished within the last twenty-four hours : he has slight fever
during the day. His appetite is good ; bowels in a fine condi-
tion ; pulse but little accelerated; complains of some little pain
over the region of the bladder upon pressure, although he is very
playful, but as yet refuses to stand alone."

The dimensions of the stone are as follows : Length 1 1 inch-
es, short diameter \^ of an inch, greatest circumference 3f inches,
lesser 2| inches, Aveight 3 drachms. The calculus, it will be
perceived from this description, was of an oblong shape, and is
quite smooth on its surface except at a few^ points. It is supposed
to have originated four years ago, and has not yet been analysed.

PART IL REVIEWS AND EXTRACTS.

On the Effects of BJoocJl'tting on the Young Subject. By
John B". Bk( k,'M. D., Prof, of Materia Medica and Medical
Jurisprudence, in the College of Physicians and Surgeons in
New- York. (Annalist.)

There is no subject, perhaps, so deeply interesting to the
practical I'hvsician, as the Inflects of l^loodletting on the human
svstem, and the vai'ious uses to wbich it may be applied in the
management of disease. In prom|)tness and power, it exceeds
all other agents, and its capacity for doing good or harm is
proportionally great. It is resorted to, also, at every period of
life, and by some it is even prescribed. with equal, if not more
freerlom in children than in adults. It becomes, then, a question
of tbe ijrentest moment to determine, if possible, wbether the age
of the patient has any influence in modifying its effects. And
this is the subject uj)on which I propose to make a few remarks.

He had a small ulcer within the nose.

1 8<i8.] Effects of Bloodletting on the Young Subject. 2 1 1

That the youngest child can sustain the loss of blood within
certain limits, as well as the adult, is manifest from a variety of
facts. Thus children are sometimes born in a state of asphyxia
from apoplexy. On dividing the cord and letting a moderate
quantity of blood flow, respiration is established, and every
thing does well. Again, not unfrequently from not applying
the ligature sufficiently tight around the cord, or from the cord
contracting and thus loosening the ligature, haemorrhage takes
place, and yet no injurious consequences result. Besides this,
we, know that in cases of disease, the youngest children may be
bled, not merely without injury, but with advantage. When,
however, the los? of blood is carried beyond these limits,
important peculiarities are observed, showing a difference
in the effects produced in the young subject, from those in
the adult.

The first peculiarity is, that the young subject does not bear
the loss of considerable quantities of blood, so well as the adult.
I am not aware that children fall into a state of syncope from
the loss of blood more readily than adults ; but when syncope
does come on, it is very certain that they do not recover from
it so readily, and they are always in more or less danger. In
the adult, syncope from the loss of blood, unless the quantity
be very large, is a state which, as a general rule, is attended
with little or no danger, and from which the patient speedily
recovers. Hence it is that physicians are continually in the
habit of inducing it in the management of certain forms of dis-
ease, and not merely with impunity, but evident advantage.
In the young subject it is not so, and it is a state always attend-
ed with hazard. If the child recover from it, it does so very
slowly, and every now and then it sinks irretrievably under its
influence. That this is a fact, is confirmed by abundant testi-
mony, on the part of those who have taken the trouble to make
the necessary observations. ^ Dr. Marshall Hall, in speaking on
this subject, says, "In infancy, the state of syncope (from the
loss of blood) is a state of danger."* Evansoii and Maunsell
remark, " As a general rule, it is well to stop the flow of blood
when decided pallor takes place, without waiting for actual
fainting, from which children do not quickly recover."! Arm-
strong says, "Do not bleed to actual syncope in children, as
they are apt to fall into convulsions, of which they may die.
Children do not recruit from very large bleedings like adults."J
Dr. Ryan observes, "The abstraction of blood in cases of in-
fants and children until fainting occurs, is the worse practice

* Researches on the Morbid and Curative Effects of the Loss of Blood, by M
Hall,M. D., p. 87.

t On the Management of Diseases of Children, p. 107.
X Lectures, &c., by John Armstrong, M. D., p. 387.

212 Effects of Bloodletting on the Young Subject, [April,

that can be imagined, as convulsions or death may be pro-
duced."* Indeed, the general fiicts admits of no question ; and
the reason is obvious enough, if we reflect for a moment upon the
nature of the agent, and at the same time compare it with the
susceptibiHty of the subject. Carried to the point of syncope,
bloodletting is one of the most direct, speedy, and profound
sedatives that we have in our possession. In a few moments, it
reduces the subject from a state of perfect health or the high
excitement of disease, to the state of temporary death. Now
it is very evident that the capability of recovering from such a
state, must be just in proportion to the powers oithe constitu-
tion. From the very nature of its organization, therefore, it is
obvious that the system of the child cannot sustain so well as
the adult a shock so sudden and powerful as this.

,The second peculiarity attending the loss of blood in the young
subject, is, that the nervous system is more powerfully affected
than in the adult. The evidence of this is, that convulsions
and coma more frequently occur after the loss of blood in chil-
dren, than in adults. In the adult, both these occurrences
sometimes take place, more especially convulsions. Thus, for
example, puerperal haemorrhage is not unfrequently followed,
by them. I have witnessed the same thing in a gentleman of
irritable habit, who had been bled too largely from the arm.
.He had lost about a (piart of blood, when incipient syncope
came on, followed immediately by a violent convulsion. In
children, however, these occurrences are much more common ;
and the reason, no doubt, is the greater predominance, as well
as inipressibility of the nervous system. A great variety of
causes, we know, will induce convulsions in a child, and among
these exhaustion is a very common one. With regard to coma,
too, this may be brought on in children by any debilitating
cause. A striking illustration of this we see now and then in
diarrhoea, which has been continued too long. In these cases,
the brain becomes suddenly affected, and a state of stupor or
coma is induced, which not unfrequently is mistaken for Hy-
drocef)halus. The same thing occurs from the loss of too
much blood.

The third peculiariti/ is, that the j-epef if ion of bloodletting is
not so well twrne by the child as the adult. A child of good
constitution and ordinary strength, may bear a first bleeding,
perhaps quite as well as an adult. Under particular circum-
stances, too, of disease, a second may be borne very well.
Beyond this, as a general rule, it will be found, I think, that the
child cannot well sustain the loss of blood. On this point, I
believe, there is little or no diflerence of opinion among men

Manual of Midwifery, by M. Ryan, M- D.. p. 475.

1 848.] Effects of Bloodletting on the Young Subject. 213

of judgment and observation. Dr. John Clarke says, " Very
young children bear very well the loss of blood even to faint-
ing, once or twice, but they ill bear a more frequent repetition
of bleeding. Their powers sink under it, and by no art can it
be replaced."* Marshall Hall says, " In infancy, a second or
a third bloodletting is borne with difficulty."t Evanson and
Maunsell say, "Repetitions of bloodletting are not well borne
by the child."!

The fourth peculiarity is, that th& effects of local bloodlettings
especially leeching, are different upon the child, from what they
are upon the adult. In the adult, the effect of leeching is in a
great measure local, and it is not usually resorted to until after
general bloodletting is considered inadmissible. In a child, on
the contrary, it produces very much the same effect as a general
bleeding. From the greater vascularity of the skin, too, the
amount of blood lost by a leech, applied to a young subject, is
much greater than in the adult, and it is frequently much more
difficult to arrest the haemorrhage from it. The general effect,
then, of leeching, on the young subject, is much greater than
upon the adult. Hence it is that cases are so frequently occur-
ring, in which children die from leeching. Of this we have
numerous cases on record. Dr. Christison says, " I have twice
known children bleed to death in Hospital practice, the nurse
having laboured under a common prejudice among their craft,
that leech-bites cannot bleed too much." Pereira states, that
**in two cases of infants, I have seen exhaustion with insufficient
reaction, consequent on haemorrhage after a leech-bite, termin-
ate fatally. "II Ryan says, "The loss of blood from a single
leech-bite has caused the death of a child. "^

From the foregoing, then, it would seem, that although a
child may bear the loss of certain quantities of blood, perhaps
quite as well as the adult, when carried beyond this, they do
not bear it so well, nor do they bear the repeated and continued
loss of blood so well ; and under these circumstances, dangerous
and even fatal consequences are apt to ensue. In other words,
bloodletting is an agent which operates with more power, and
is attended with more danger in the child than in the adult.

If all this be so, then some conclusions may be drawn with
regard to the practical application of this agent, which to the
young practitioner at lest, may be of some importance.

1. Great caution should be exercised in bleeding children
to the point of syncope. If the state of syncope be attended

+ Commentaries on the Diseases of Children, p, 103.

t Ressearcheson the Loss of Blood, p. 87.

J On the Diseases of Childnen, p. Iu8. Dispensatory, p. 493.

II Materia Medica, Vol. II., p. 709. IT Manual of Midwifery, p. 475.

214 Effects of Bloodletting on the Young Subject. [April,

with the danger ah-eady alkided to, it is very certain that
nothing can justify us in producing it, unless it be determined
that it is essential to the management and cure of the case.
Now, that in most cases, even of decided inflammation, it is not
necessary to carry bloodletting to this extent, is very certain.
We know that it is not so in the adtilt, and it evidently cannot
be so in the child. As a general rule, therefore, it cannot be
required. By some high authorities, however, it is supposed
that under certain conditions of diseased action, the safety of
the patient depends upon the production of syncope. Thus,
for example, in croup, bleeding ad deliquium has been insisted
upon by the late Dr. Bayley of jVew-York,* Dr. Dickof Alex^
andria,f and Dr. Ferriar of Manchester. The latter especially
speaks of it, as "the essential point of the cure, without which
no M'elief can be effected. "J If in any disease the practice be
justifiable, it certainly is in this, and it cannot be denied, that
in a great number of instances, it has been resorted to with
safety. Notwithstanding this, general experience has abund^
antly established the fact, that even here it is not necessary,
and tliat all the beneficially sedative effects of the remedy may
be obtained, without going to this extent. On this point there
appears to be, at the present time, a pretty general concurrence
of opinion among enlightened practitioners, and the rule of
practice ought to be, never in any case to bleed to syncope, but
to stop as soon as paleness of the lips and cheeks comes on.
In this way, all the good of bloodletting is secured, while the
risks of syncope are avoided.

2. To determine the precise amount of blood proper to be
drawn, is a matter of much greater nicety, and involves more
serious consequences in the child, than in the adult. - In the
adult, the loss of a little more blood than is necessary, as a
general rule, is a matter of no very gi-eat consequence. In the
child, on the contrary, it may prove fatal. In the adult, too,
we have means of judging how far it ought to be carried, which
we have not in the child. Thus, for example, the pulse, which
in the adult is so valuable a guide in these cases, cannot be de*
pended upon at all in the child. It is always, therefore, a very
f^iee and difficult problem in practical medicine, how to adjust
properly in a child the amount of blood necessary to be drawn,
to the eisfUit wants of the case. Now there are only two ways
in which this can be done. The first is, by fixing upon a cer-
tain amount as suitable to dinbrent ages. Thve second is, to
judge by tlie actual effects produced at the time of taking the

* New-York Medical Repository, v^, >2, p. 331. ^^

t Hiirion's iMcd. and Phv-s. Jour.

% AJed. Uis.toi-ies jijid lU'fleciiojis^bj JqHji Fcmar. M. D., p. 371. Am. Ed,

1 848 .] Effects of Bloodletting on the Young Subject. 215

blood. With regard to the first of these modes, it is evident
that it must be a very unsatisfactory guide, if we recollect that
no two constitutions are precisely alike, and that there is every
difference in the capacity of different systems, even in the same
disease, to bear the loss of blood. Then, again, the same dis-
ease exists in different degrees of violence, and of course
requires a modification in the amount of depletion. Besides
all this, different diseases do not require and cannot tolerate
the same loss of blood. A general standard, then, founded
upon the age of the patient, is really good for nothing, except
as a mere approximation. In individual cases, it must be inap-
plicable. Hence it is, that all those standards laid down by
authors differ so much from one another, and must necessarily
do so. If blood be taken by leeches, the difficulty is still further
increased, from the circumstance that the desired quantity can
hardly ever be obtained with any degree of precision: if it is
so, it is purely by accident. That this must be so is evident,
if we recollect the variable quantities of blood drawn by the
leeches themselves, and more especially the greater differences
in the after-bleedings. It is not yet settled, I believe, exactly
how much blood a leech will draw. Christison says, "Twice
as much blood may be usually drawn by fomentations, as by
the suction of the leech. A single leech, when applied success-
fully, may thus be held to draw, from first to last, about half an
ounce of blood on an average.''^* According to Evanson and
Maunsell, " the quantity of blood obtained by a good leech,
allowed to bleed for half an hour, may be estimated at one
ounce^] Mr. Pereira says, " I believe fowr drachms to be the
maximum. On an average, I do not think we ought to estimate
it at more than a drachm and a half;^''X'\. e., the quantity taken
by the leech itself, without reference to the after-bleeding. Now
the fact is, it is impossible to specify the amount of blood draw^n,
either by the leech itself or in consequence of the subsequent
bleedings. Leeches differ in their size very greatly, and there
must, of course, be a great difference in the quantity of blood
they are capable of taking. Then, again, there is every dif-
ference in the after-bleeding, depending on the vascularity of
the skin, the part of the body to which they are applied, and
various other circumstances. From all this, it is evident how
unsafe it must be to draw blood from a child, according to any
average standard.

VV^ith regard to the second mode, that of judging of the extent
to which it should hi carried by the effects produced at the time :
in many cases this answers exceedingly well. In inflammatory

* Dispensatory, p. 492. t PrActical Treatise on Children, &c., p, 100,

X Materia Medica, vol. 3, p, 7GD,

216 Effects of Bloodletting on the Young Subject. [April,

complaints, where the full effect of the loss of blood may be
necessary, the rule can be satisfactorily applied, and the best
plan is to bleed in the erect posture, until pallor of the face
comes on, without producing actual syncope. In the adult,
according to Marshall Hall, the production of actual syncope
constitutes the criterion as to the exact amount which the case
reqiiires, as well as of the capacity of the system to bear the loss
of blood, and therefore he recommends this as the rule for the
due administration of the remedy. Now, that this will not
answer, must be obvious to every one. Every practitioner
knows that cases are continually occurring, in which actual
syncope comes on after the loss of a few ounces of blood, when
large quantities are afterwards required to be drawn. In
children, of course, the rule cannot be applicable. In them, the
loss of so much blood as to bring on only approaching syncope
might not only be unnecessary, but be attended with danger.
From all this, then, it would appear that we are not in possession
of any precise mode of determining how much blood ought in
all cases to be taken in children; and this shows the necessity
of great caution and the exercise of sound judgment, in the use
of the remedy.

3. From the uncertainty in estimating the quantity of blood
lost by leeches, and the dangers attending the loss of too much
from them in children, too great caution cannot be exercised
in their use. From the manner in which leeches are ordered
by some physicians, in the diseases of children, one would be led
to suppose that no harm could ever result from them. From
the ciise, too, w^ith w^hich they may be prescribed, and the ap-
pearance of energy which it gives to the practitioner, it is to
be feared that not unfrequently they are used without being
actually necessary, and even when necessary, they are suffered
to draw blood without sufficient regard to the quantity which
may be lost Now it should always be recollected, as already
stated, that leeches operate diilereutly on the child from what
they do on the adult. In the latter, they are in a great measure
local in their action, and may be, and generally are used, when
general bleeding is contra-indicated. In the child, on the con-
trary, they act in the same way as general bleeding. Their
gedative effects, therefore, upon the constitution of the child,
are much gieater; and if suilered to bleed beyond a certain
limit, they endajiger life. On these ac("()unls, it is more neces-^
sary to be cautious in tlie use of them in children, than in adults.
It is not my intention to go into any particulars, in relation to
the mode of conducting the process of leeching. There are a
few ))()ints, however, of a practical chanicter, connected with
this subject, which may not be unworthy of notice. - L When

1 848.] Effects of Bloodletting on the Young Subject. 217

leeches are applied to a child, the patient should always be
placed in the erect posture. The same rule indeed should be
observ^ed, in whatever way blood is drawn. If it be a fact that
leeches act like general bloodletting upon the child, the proprie-
ty of this rule must be obvious ; and it is the more necessary
to insist upon it, because it is hardly ever observed. As soon
as any paleness of the lips or face appears, the child should be
placed in the recumbent posture, and the bleeding arrested.

2. When leeches are applied to a child, the patient should never
be left until after the flow of blood i^ completely stopped.

3. Leeches should never be applied at bed-time, and suffered
to bleed during the night. In this way, the patient has, in more
cases than one, bled to death. If applied late at night, they
should be watched just as in the daytime. 4. As a general rule,
leeches should not be applied to soil parts destitute of support
from underneath, in consequense of the difficulty of making
pressure sufficient to arrest the hsemorrhage. The importance
of this was first noticed by Dr, Cheyne, who advises them to be
applied in croup, not to the neck itself, but over the clavicle,
sternum, or ribs.* 5. Leeches sometimes open into arteries,
and dangerous haemorrhage has ensued from this cause'. A
case of this kind happened, in which the temporal artery was
thus opened, and Sir Astley Cooper was obliged to divide the
artery before the haemorrhage could be arrested. f In all
cases, therefore, the progress of the bleeding should be care-
fully watched.

4 If bloodletting be so profound a sedative to children, it is
evident that it is capable of doing a vast deal of harm in cases
nnsuitedtoits use, and that it requires a very nice discrimination
(ofthe character of the case, before it can be used with safety.
This may appear very commonplace ; but, commonplace as it
js, it is to be feared that it is not sufficiently borne in mind in
actual practice. The presence of inflammation or congestion
is generally considered a condition justifying and requiring a
resort to bloodletting, and so indeed, as a general rule, it is; but
it is not so universally. Thus, for example, the inflammation
atteading scarlatina does not usually require or bear well the
loss of blood; and there can be no question that, iA this com-
plaint, many a child has been sacriffced by a resort to this rem-
edy. Then, again symptoms analogous to those produced by
inflammation or congestion result from a cause directly the oppo-
site, viz : irritation or mere exhaustion. Illustrations of this we
see frequently in affections of the head in children, convulsions,
&LQ,. In these cases, if the cause of the difficulty be mistaken and

* Pathology of the Larynx and Bronchia, by John Cheyne, M. D., p. 57,
t Johson's INIed, Chir. Rev., Vol 9., p. 71.

218 Effects of Bloodletting on the Young Subject. [April,

depletion be reported to, the result may be fatal. All this
shows that, before bloodletting is used in children, the nature
of the case should be investigated more nicely eventlian in the
adult.

5. In the use of bloodletting in the young subject, especial
regard should be had to their constitutions, as well as
their mode of living. No principle is better understood, or
ought to be so, even in adults, than that in the use of debilitating
remedies, due regard should be had to the powers ot the
system. No practice is safe which does not take into consider-
ation the relative capacity of the system to bear them ; other-
wise the remedies may be more fatal than the diseases for which
they are prescribed. Now we know that in the adult there is
every difference in this respect. In the management of the
same disease accordingly in different individuals, a very dif-
ferent course of treatment is necessary, if not in the remedies
themselves, at least in the extent to which they are carried.
In the young subject this is still more necessary. Children
whose constitutions are naturally feeble and vicious, or have
been enfeebled by debilitating causes, such as poor diet, confined
air, &c., sink very readily under the influence of depressing
remedies. In these bloodletting is badly borne, and should
never be resorted to unless absolutely necessary, and then in
moderate quantities.

6. Great caution should be exercised in the repetition of
bloodletting. After what has been already said in relation to the
effects of repeated bloodletting on the young subject, I should
not again allude to it, were it not to notice the opinions of an
eminent authority. Dr. Rush, in his "Defence of Bloodletting,"
makes the following statement : " I could mention many more
instances in which bloodletting has snatched from the grave
children under three or four months old, by being used three
to five times in the ordinary course of their acute diseases."*
That the children alluded to by Dr. Rush survived this treat-
ment 1 do not doubt; but that these repeated bleedings were
necessary,! can hardly believe. At any rate, a practice like
this, if generally adopted, would, in my humble opinion, end in
the inost disastrous results.^

In concluding this paper, I trust it may not be thought that I
am f)pposed to the use of bloodletting in the diseases of children.
The ])hvsician who dis^.ards this agent, understands but poorly
his profession or the duty which he owes his patients. The
proper use of a remedy, however, is one thing, the abuse of it
is another; and I must express the opinion, founded on no
small observation, that it is frecpiently resorted to in children

Med. Obs. and Inqs., vol. 4, p. 300.

1848.] Effects of Bloodletting on the Young Subject. 219

when it is imnecesary when necessary, it is often carried too
far and that in its general use, there is frequently an absence
of precision and care, which in many cases renders it a most
dangerous remedy. With regard to the use of bloodletting
generally in this country, there can be no doubt that the au-
thority of Dr. Rush has exerted an influence the most deleterious.
That it should have done so is not surprising. Living at a
time when medicine was yet in its infancy among us at the
head of the oldest and most influential of our medical schools
and attracting by his enthusiasm and his eloquence a large
proportion of the students of the country, his sway for a series
of years was unlimited, and his sanguinary precepts and his
stilj more sanguinary practice* were speedily diffused from
one end of the country to the other. Although sad experience
has long since exposed the fallacy, as well as danger of his
doctrines, yet many of the evil consequences of them are still
to be met with ; and not the least of these, it appears to me, is
the opportunity which they have, indirectly at least, afforded
for the prevalence of quackery. It is a part of our nature to
fly froni one extreme to another. When .an error is once ex-
posed, we are apt to go immediately to its opposite, inferring

* To justify the langurge used above, and which may be considered too strong
by some, let me make a quotation or two from Dr. Rush's celebrated " Defence of
Bloodletting;." " Bleeding should be continued with the symptoms which first
indicated it continues, should it be until four-filths of the blood contained in
the body are draun away." JMed. Obs. & Inq. vol. 4, p. 353. The amount of
blood in an adult is estimated at about 32 lbs. Four-fifths is over 24 lbs !

Again, in enumerating the advantages of bloodletting, he says: -'In/cases
where bleeding does not cure, it may be used 'with advantage as a palliative
remedy. Many diseases induce death in a /'all and highly e.xcited-state of the
system. Here opium does harm, while bleeding affbrdscertain relief. Itbefongs
to this remedy, in such cases, to save pain, to relieve convulsions, to compose
the mind, to protract the use of reason, to induce sleep, and thus to smooth the
passage out of life." Med. Obs. and Inqs. vol.4, p. j57. In other words, if I
understand him, one of the advantages ol bleeding i>, that it makes persons die
easily! This reminds me of a n)elanchDly case wliich I once witnessed. A
young gentleman, about eighteen years of age, had been suffering about three
months under organic disease of the brain. During this period he had been:
fiubjected to every kind of treatment. Bloodletting, emetics, cathartics, mer-
curials, tonics, &c., had all been used in succession, but without arresting at all
the progress ot the disease, and he had now become stone blind, was paralytic,
and reduced to the extremest state of emaciation and debility. In short he was
barely kept alive by the use of stimulants. In this state of things a iriendly
doctor happened to drop in, and expressed the opinion that the disease was in-
flammation of the brain, and that a good bleeding would relieve liim. Notwith-
standing the urgrnt remonstrances of the attending physician, that the
result would be almost iuimedjati? death, the idea took with his friends, and he
was bled by the doctor who suggested the practice. Asmight have been expected,
in about six hours he was a corpse, and the great consolation seen)ed to be that
he died so easily! Verity, on becoming acquainted with such practice, one
would be tempted to believe that the Emperor Nero must have been a very
tender-hearted man in condemning Seneca to sopleasent a mode of terminating
hisexistcnce as Vilecdingtodcaih. For the particulars see the Annals of Tacitus,
Book 15, Sect. CO.

220 The Sequels of Scarlet Fever and Measles. [April,

that what is the reverse of wrong must necessarily be right ;
and so it has been in regard to bloodletting. The public having
been made acquainted with the evils of the practice of Dr.
Rush, a prejudice, if not general, at least very extensive, has
been created aga'nst the remedy itself, and empirics, always
ready to play upon the weaknesses and prejudices of the com-
munitv, have seized upon it for the mere purposes of traffic.
Accordingly, the land is now filled with a set of men who pre-
tend to practice medicine, without resorting not merely to
bloodletting, but many of the other remedies sanctioned by
long and tried experience. And what is melancholy, but true,
they find a ready sympathy in a large portion of the com-
munity. Whether I am too severe in attributing the pop-
ular empiricism of the day to the influence of Dr. Hush, must
be left to the judgment of the profession. One thing, however,
is very certain, and which we see illustrated every day.
Whenever a person has been overtaxed with active medicine,
he is apt to discard all belief in medicine generally, and he is
then ready to fall into any absurdity. It is with medicine as
it is with religion. Superstition once thrown off, infidelity
follows, and the result in both cases is the same. Calm reflec-
tion and rational inquiry are out of the question, and boasted
independence speedily becomes the easy prey of the knave and
the empiric.

The Sequels of Scarlet Fever and Measels. By .T. A. Higgens-
TON, Esq. A paper read before the Brighton and Sussex
Medico-Chirurgical Society, August 5th, 1847. (London
Medical Gazette.)

As far back as the year 1843, 1 published in the pages of the
Gazette some pathological remarks onscarlet fever, showing
that this disease is, at a certain ])eriod of its course, an inflam-
matory one, requiring the aid of antiphl(\gistic measures. As
my experience enlarged, my views become, of course, wider,
and I was able to com])are scarlet fever with other disorders,
especially with rneasles; the conclusions of my mind upon
which, I now submit to your approval and publication in the
pages of your periodical, if you })lease.

It is nr)t generally admitted, even if it be understood, at
least I have not hitherto found it distinctly stated in medical
works, that there is an essential difference between scarlet
fever and measles exhibited in the particular mode in wliich
the poison of either disease subsides of itself, or is elhninated
from the constitution the one subsiding or settling upon the

1848.] The Sequels of Scarlet Fever and Measles. 221

liver, or being eliminated through it, and the other suhsiding
or settling upon the kidneys, or being eliminated through tjiem.
Both these diseases fall upon, the skin in their primary mani-
festations; but, in their sequels, they are respectively opposite
and different ; for in its issue, the measles attack the liver, while
the scarlet fever attacks the renal eniunctories. This is the
proposition of the case, or the problem that I wish to propound
or prove.

I apprehend that the strumous diathesis will be found predom-
inant in either predicament. But, where is struma not predomin-
ant, ifnot latent ? The manifold cares and anxieties, or, in other
words, the numerous cau>?es of vital exhaustion which subsist in
savage or civilized life, are more than sufficient to engender or
aggravate struma, the most lamentable of human ailments, and
the most lingering of incurable maladies. The first and the
la^t stages of phthisis pulmonalis; the suppuration of a single
cervical gland, and the destructive ulceration of the. synovial
membrane of the knee-joint ; the precocious intellect of strum-
ous childhood, and the premature old age of strumous man-
hood : are alike signs too well known to those before whom I
am speaking, to render it necessary or becoming in me to dwell
upon the peculiar character of health or disease which they
indicate, or to describe the fatal goal towards which they tend"
and advance with uncontrolable obstinacy, and very often with
amazing velocity.

Whatever depresses the vital forces is the cause of struma
a cause whose habitation is favored by the congenital or ac-
quired debility of the great nervous centres the cerebro-spinal
axis, w^hich, in the discharge of its several functions, betrays a
greater or less imperfection in their respective failures. In
the brain itself, tha governing organ of life, resides the origin
of all chronic, ifnot of all active maladies. Blushing, the most
common imperfection or virtue of- the strumous habit, arises
from debility of the brain, which, incapable of sustaining the
shock of mental emotion, becomes, all of a sudden, powerless
in its guard over the superficial or peripheral vessels of the
cheeks, so that their capillaries, unexpectedly and ungoverna-
bly relaxed, admit the red bloojd to flow into them and to remain
fixed there, for a time at least, in spite of every act of volition
to the contrary. This is, in principle, an explanation of acute
inflammation ; there being, perhaps, no inflammation that does
not begin in local or general debility ; the received Hunterian
dogma of excess of arterial action being an exceedingly debate-
able question. jS^ot that this alters in the slightest degree the
usual treatment, which rests upon/aci and experience, and not
at all upon the probabilities of this or that theory entertained
by pathologists either of ancient or modern date.

222 The Sequels of Scarlet Fever and Measles. [April,

But, to return to the subject of our present enquiry, namely,
that of measles and scarlet fever, both of them being a poison
eventually set free, the latter through the kidneys, and the for-
mer by the liver.

I appeal to those who have carefully attended to these two
diseases, and request them to consider whether they have not
observed diarrha?a follow upon measles, and renal affections
succeed to the scarlatina? I submit the question to practition-
ers of large experience, or, if not to those of large practice, at
least to those of still larger minds, who have well observed
what little they may have been called upon to treat. For there
is a wide difference between those who have seen a great deal
carelessly, and those who have seen much less, but, at the same
time, have studied what little they may have seen with care
and attention.

Now the three great emunctories of the frame are the lungs,
the liver, and the kidneys, by the kidneys are eliminated the
azotised or nitrogenous compounds in a fluid form, by the liv-
er the carbonaceous materials in a solid form, and by the
lungs the same carbonaceous materials in a gaseous or atrial
form namely, that of carbonic acid gas. Cruveilhier, in some
very striking experiments, has shown, that, by introducing
certain heterogeneous particles into the blood through the veins,
one or other of these three great emunctories becomes deran-
ged according to the kind of poison or obstruction that has been
introduced. The first effect of these deleterious substances is
on the veins themselves, that is to say, provided that these sub-
stances are arrested in their course before reaching the arterial
branches or ramifications of the circulating tree, producing pus
in the veins phlebitis, in fact, gangrene and death. But if
these heterogeneous particles pass forwards from the veins into
the arteries, their ultimate effects fall upon the more vital or-
gans far removed from the seat of the original mischief, giving
rise to abscesses in the muscles, the joints, the eye, the liver,
softening of the various tissues, inflammations in distant organs,
depositions of pus, blood, lymph, and serous effusions. And
what is very singular is, that Gaspard agrees with Cruveilheir
in asserting that, in its course along the current of the circula-
tion, the poison finds great difficulty in its transmission from
the arterial to the venous capillaries ; while Cruveilheir re-
marks that, in successfiil cases, the poison, when dilute or in
small quantity, is eliminated hy intestinal or urinary excretion^
but that when large or concentrated it kills. Tiedemann and
Magendie have, indeed, put the question almost entirely at rest
by their experiments, which demonstrate that the liver and
the lungs are the two great emunctories of the frame; and it

1848.] The Sequels of Scarlet Fever and Measles. 223

is owing, perhaps, to this, says Dr. Ferguson, who has written
very ably on this point of pathology, and from whose work on
Puerperal Diseases the foregoing observations are chiefly bor-
rowed it is owing, perhaps, to this, that they (tlie lungs and
the liver) are, of all the organs of the body, the seats of the
greatest number of maladies. Surgeons know well enough the
fever that follows upon amputation when the veins have been
injured, or have become the focus of suppurative inflammation
a fever which is well known to them in its source as it is in its
almost invariably fatal issue. Arid the accoucheur knows far
better than I am able to describe to him, the formidable symp-
toms of puerperal peritonitis, its rapid progress, and its lament-
able catastrophe a catastrophe originating, as Cruveilhier has
so picturesquely portrayed, in a pathological condition both of
the womb in particular and of the constitution in general, pre-
cisely similar to that following upon the amputation of a limb,
or the introduction of a morbific poison into the veins ; deranged
excretions, pus, &e., together with inflammation of the veins
(phlebitis), disturbed circulation, typhus fever, delirium, purulent
infiltrations, and death. In fact, the patient dies of poison. It
is probable that some of the symptoms of the hectic infesting
the last stages of phthisis pulmonalis may be attributable to the
absorption of pus from the lungs, and that the co'liquative
diarrha3a which precedes the end may arise from the purulent
matter continually welling up from the ulcerated lung, and
as freqently swallowed as spat out by the patient; for the pus
thus swallowed carries with it the germs of struma, and infects
the intestinal glands with it; besides which, diarrhoea is, as is
generally known, one of the. modes by which pus is evacuated
from the system.

I have been led to introduce these remarks in order to show
that it is not a private opinion of my own, but that it is the con-
viction of some of the most approved pathologists in Europe,
that the mass of circulating blood may be poisoned, and that
the poison thus circulating is eliminated from the blood through
the channel of one or other of the three great emunctories of the
frame.

[i] Thus, it will be found that, after the measles have passed
by, and the eruption has effloresced and disappeared in the usual
way, there supervenes a stage chara<iterised by gastro-hepatic
symptoms, eruptions at the angles of the mouth, or sore eyes,
(lipitudo, or chronic conjunctivitis of a scrofulous aspect). The
liver is either directly or indirectly brought to a halt ; there is
black or pale, and eventually exceedingly yellow, bile. The
countenance becomes flushed and excited, the sleep disturbed,
the appetite diminished or lost, and the pulse and the heart's

224 The Sequels of Scarlet Fever and Measles, [April,

action accelerated. It may be there is bilious vomiting or
diarrhoea, in which what is popularly called ''an overflow of
hik,-^ shows itself. On the loss of appetite quickly follows
failure of the strength, and with the hurry of the pulse is associa-
ted fever. Now, if the poison of measles be not (as I apprehend
it ought to be) eliminated through the liver, or if the liver remain
torpid and inactive even under the exhibition of its ordinary
medical stimulants or reagents, it will follow that the fever runs
into the type of what is usually known as infantile remittent
fever, that is to say, a fever with irregular intermissions, chiefly
affecting the muco-hepatic surfaces, and continuing from one to
six or eight weeks. During his anxious interval, there will be
observed obstinate derangement of the entire alimentary canal^
a very white tongue, costive or relaxed bowels, thirst, absolute
loss of appetite, debility, delirium, emaciation, and death; or,
on the contrary, instead of death, recovery from the lowest
and most alarming stage of attenuation and decline The most
favorable crisis is vomiting-^the vomiting of yellow or green
bilious matters, or diarrhoea, sudden and unexpected, by which
the alimentary canal is discharged of its morbid contents, or the
liver is emulged of its overloaded or poisonous congestion. But
if this diarrhoea or vomiting do not take place, the fever pro-
ceeds, and may, after having lasted a certain number of days
or weeks, subside by leaving the little sufferer as thin as a ghost
and as pale as the waning moon. When the mother holds her
darling in her lap, scarcely discernible in point of color from
the sheet that envelopes its wasted limbs, she may begin to hope
that the sharpness of death has passed, and that her offspring
will be restored to life as well as to its wonted hue and noisy
animation and strength.

[ii.] But the reverse of all this is the case in the sequels of
scarlet-fever. Of the many cases that I have been unhappy
enough to witness, I nev^r saw one in which, when the kidneys
had been decidedly affected, a perfect restoration to the former
state of health was ever accomplished. They have all declined.
The passing hopes of to-day have been blighted by the postive
relapse of to-morrow; and though, m some instances, several
years have ensued, yet the event has been always the same,
and the starting-point of the illness has never lailed to termin-
ate in protracted hopes, disappointinent, and death.

When we consider that the kidneys, the great emunctories
of those deleterious elements which, if retained within the round
of the circulating blood, act as a specific poisoixon the brain,
are the organs pi'imarily and chiefly affected, there can be no
hesitation in declaring, that, if their natural or normal tone be
not restored at once, death must, sooner or later, be the inevitable

1848.] The Sequels of Scarlet Fever and Measles. 225

result. This is the simple fact. The inflammation of scarlet
fever is, by one of the hitherto unexplained operations in
disease, translated from the skin to the kidneys, which, when
thus attacked, are, no longer able to excrete the nitrogenous
compounds from the blood, and, consequently, become the
immediate instrument for interrupting and putting a stop to the
functions of the arterial and cerebro-spinal systems together;
for, if these nitrogenous or azotised materials be not excerned,
but are retained and sent back on the brain, they operate as a
direct poison, depress the vital forces, and eventually disable
and annihilate the whole process of life. The truth is, when,
upon discovering that after scarlet fever the urine contains no
lithic acid, nor any of the lithates (the lateritious deposit of
health), but that, on the contrary, it betrays the presence of the
phosphates, or albumen, or blood (hgematuria), we may be sure
that the kidneys are in such a case already the seat of the
diseased poison, virus, or action, that there is danger either
immediate or remote, and that the final debility or disease of
the patient may be predicted with the greatest certainty. I have
not yet seen a confirmed case ofthis description ever recovered
from. There is something so extremely delicate in the renal
tissue, and, at the same time, something so essential to life in its
perfect capacity, that any intermediate stage between its
primitive perfection and its ultimate disorganisation is, in its
various proportions, phases, and degrees, equally detrimental
or destructive to the animal economy.

The result of renal disorder in consequence of scarlet fever,
is profound debility, a debility which, as it generally happens
at an early or a premature age, it is very mournful to witness.
At its commencement there is doubtless a stage of inflammation
which can be met and successfully treated by the ordinary
antiphlogistic remedies ; only this stage is very short ; and, if it
be not foreseen in its onset, if its transit be not perceived, or if its
existence have not been recognised, then its after treatment
is nugatory, at least only palliative. It is during the inflam-
matory stage that the brain is troubled "With meningitis a kind
of inflammation by no means uncommon in connection with
primary or secondary disorders of the kidney. At the first,
while the urine is high-colored, scanty, and of a high specific
gravity, the proper treatment will consist in calomel, salines,
antimony, venesection, cupping, or leeches; but afterwards,
when the acute stage, short as it is, has passed away, nothing
will be beneficial, except the warmer purgatives, good food,
the mineral acids, and removal to a more invigorating air.
Recovery will, in a certain degree, reward the adoption of
these measures, but perfect recovery never. The die has been

15

226 Obstetrical Memoranda. [April,

cast: the lot of life is determined, and nothing remains but a
broken constitution, scarcely worth thehavinjr.

The end of these cases is permanent debihty. I have seen
it at all ages at 12, at 15, and at 45. One of the sadest results
is, that, as the brain declines in power, stimulants are pro-
portionally more and more requisite; for the sinuses of the
encephalon are, from their anatomical construction, incapable
of contraction, and, consequently, cannot accommodate them-
selves to the diminished stream of blood. Now, as the heart
declines in power, the jet of arterial blood thrown up into the
brain is depressed, the same strean) does not continue to
reach the great nervous centres, energy declines, and, with
the loss of cerebral energy, decWues pari passu the tonic func-
tions of the spinal cord and the kidneys. Thus, power is lost,
and with the loss of power in general is also lost the particular
energy to excern the lithates those poisonous elements of the
circulating mass of blood : in short, all is lost, except under the
pressure of ardent spirits and the highest therapeutic tonics,
which can, however, be sustained only for a limited length of
time. The glands of the neck inflame, indurate, and run into
suppuration : the pus is discharged, ulceration ensues, and
sometimes lays bare an extensive surface : the hmbs become
oedematous, the cellular or areolar tissue mortifies over those
points of bone unavoidably pressed upon by the bedding, the
entire skin becomes white, dry and furfuraceous, and anasarca
is formed. The progress is soon told. The phosphatic diathe-
sis is established. In protracted cases, renal calculi are formed
and passed, life is prolonged, but the patient is cut off from the.
fellowship of life, and death calls him to his account by means
of dropsy, paralysis, or coma.

Obstetrical Memoranda. Partial occlusion of the Os Uteri
during labour, treated successfully by Incision. Ri<ridify of
the Os Uteri treated by Injections of Belladonna. By A. H.
Cenas, M. D. (New Orleans Med. and Surg. .Journal.)

Rigidity of the os and neck of the uterus during the course oi
labour, is by no means a rare occurrence, and ofiers sometimes
no inconsiderable obstacle to its safe accomplishnjent. But it
is not, generally speaking, a dangerous complication, and is in a
groat majority of cases easily overcome by a] i^ropriatc general
or local means. There is, however a source of rigidity some-
times n)ot with, more serious in its character and exercising a
more important and sometimes Ihtal influence upon the progress
of labour ; 1 mean rigidity with more or less complete occlusion

1848.] Obstetrical Memoranda. 227

of the OS uteri. This raro condition may be congenital, but it
is more often the result of previous disease of the parts, occurring
as a consequence of protracted or instrumental labour and
when met with must be boldly treated by free incisions other-
wise exhaustion, laceration, or extensive and fatal sloughinfi; may
take place, either before or after the labour is accompHshed.
In the course of my obstetrical practice,. I have met with but
one such case and in which I pursued the bold practice above
alluded to with the most satisfactory results.

The patient was a young woman of about 25 years of age,
who had been the subject of instrumental delivery in her first
labour, the result of which was inflammation and sloughing to a
serious extent I found her advanced to about the fourth month
of her second pregnancy, and suflTering under active uterine
contraction, with considerable haemorrhage. Examination per
vaginam detected a preternatural hardness of the whole neck,
and the os uteri which was dilated to about the size of a dime
piece, conveyed to the finger the sensation of a firm structure
the uterine contraction having not the slightest effect upon it.
As her pulse was firm, and skin hot and dry, I bled her " ad dili-
quium,'^ and kept up the impression with nauseating doses of
tart, emetic for nearly six hours, without ^ffect. The pains,
however, increased in violence, and an arm of the foetus was
actually cut off by the sharp and firm edge of the os uteri and
expelled ; fearing the worst from such powerful and unavailing
contractions, I determined to incise freely the strictured os uteri,
which, with the assistance of my friend. Dr. Le Monnier, I ef-
fectually accomplished, and had the satisfaction of seeing the
balance of the foetus expelled in a short time afterwards. My
patient suffered very little from the operation, and soon recov-
ered her usual health.

Simple rigidity, as I said above, does not often resist general
means, such as venesection, when the patient admits of it, or
nauseating doses of tart, emetic, either with or without opium.
But sometimes even these means fail, and then we have a pre-
cious recourse in belladonna, which in my own opinion and expe-
rience dilates the os uteri as rapidly and eflfectually as it docs
the pupil of the eye.

Case 1. I was called to Mrs. G., aged about 19 years, in
labor with her first child : she had been suffering already nearly
twelve hours, and the os uteri thick, hard and dry, was dilated
scarcely more than the size of a half dollar piece pulse being
full and skin dry, she was bled to fainting, and the impression
kept up with tart, emetic. But discovering little or no effect
after the lapse of six hours, though the skin had become cool and
relaxed, I applied belladonna freely, and in little more than one
hour the labor was over.

228 Obstetrical Memoranda. [April,

Case 2. Was also a primipara, and the patient, aged about
20 years, had been in labor about fourteen hours before I was
sent for. I found the contractions active, and the os uteri about
the size of a quarter dollar, thick and hard, though the head was
low down in the pelvis. As general means seemed here indica-
ted also, I bled usque ad deliquium and gave solution of tart,
emetic, without effect. for nearly four hours. A liberal applica-
tion oi belladonna, as in the above case, terminated the labor in
less than one hour after its use.

Case 3. Was a premature labor, seventh month of gestation,
and was brought on by a fall. The patient had been in active
labor under the charge of a midwife before I was sent foi'. I
found the os uteri dry, hard and diffused, and open to the extent
of about half a dollar. Tart, emetic used as in the other cases,
producing no effect ; I resorted to belladonna, and as pains seem-
ed flagging, gave ergot under the combined influence of which
the case was terminated in little more than a hour.

Case 4. Was also a premature labor patient a primipara
and term of pregnancy about sixth month. Uterine action
"w^as brought on by a fall, and the contractions had been pretty
active for several hours before I was called. On examination,
found the commoii dryness and heat, the head descending rapidly
in the pelvis, covered by the hard and rigid neck, and the os uteri
felt so small and wiry, that I feared incisions would be necessary.

The bleeding and tart, emetic to nausea and the effects kept
up for some time, seemed to produce some influence upon the
parts but after a few hours, finding no further benefit resulting,
I applied the belladonna, which in this case seemed to act more
readily than in any previous one in which I had used it, for the
labor was terminated in little less than one hour after its appli-
cation showing its rapid influence not only upon the os uteri,
but also upon the soft parts below, viz., the perineum and os
externum.

Tlie foregoing' cases are only a few of many similar ones oc-
curring-in my practice- They are not given as novelties, for
the same results obtain every day where the belladonna is effi-
ciently used. But as the profession is by no means agreed upon
the obstetric value of this agent, and as some high authorities
have even pronounced against it, I am disposed to think that its
mode of apj)ficati<ni has ;i good deal to do with its efficiency, for
we know that the usual method of applying it is either in extract
or ointment of the extract, carried on the end of the finger to*
the parts to be acted upon. But this plan is uncertain, and for
this reason, that the medicine is wijied from the finger during its
passage through the vagina, and little or none of it reaches its
destination hence, in my opinion, the frequent failures and

1848.] Typhus Fever. 2*29

disappointments complnined of. Now, in order to obviate this
inconvenience and secure a direct contact of the article, I have
been in the hab^t for seme time back of employing it by injec-
tion, either in the form of a watery solution of the extract, or as
an ointment sufficiently fluid to answer the same purpose. The
instrument used should be an ordinarv vagina syringe. Employ-
ed in this way I am pretty sure that very few disappointments
wou'.d result.

In relation to the above method of applying belladonna by the
OS uteri, viz., by injection, I would remark that I was under the
impression, until iately,.that it was peculiar to myself But I
have within a short time had occasion to learn that Professor
Eve, of Georgia, has recommended preciselvthe same practice.
Although I find myself shorn of the merits of originality in this
matter, yet I am highly pleased in having the testimony of such
exceilent authority in behalf of its value.

[Our friend; Professor J. A. Eve, desires us to say that Professor Cenas
has given him more credit than is justly due to him that in an extemporane-
ous lecture h may have advised a solution of the extract of Belladonna, in
preference to the ointment in rigidity of the os uteri, and some gentleman in
attendance may have spoken of it afterward, but candour and justice prompt
him to declare that Professor Cenas is fairly entitled to the claim of originality,
being the first to employ it in practice, and publish the result j and that whilst
grateful lo Prof. Cenas for his kindness, and admiring his magnanimity, he
takes pleasure in correcting the mistake, by which he had done himself injustice.]

The Cause^ Prevention and Treatment of Typhus Fever. By
I. PiDDucK, M. D. (Lancet.)

The cause of typhus fever is the exhalation of a specific poison
from the bodies of the sick, by which persons in health become
infected with the disease, as in cases of small-pox, measles,
scarlet fever, &c.

This poison maybe destroyed by a temperature of 212deg.,
whether by boiling in water or by hot air; it may also be diluted
by washing and ventilation, so as to be rendered* inert.

The prevention of typhus fever consists

1 . In separating the healthy, particularly the young, from the
sick.

2. In removing curtains and carpets from the room, and
clothes from the person of the sick.

3. In boiling linen and cotton garments, blankets, and rugs in
water, before they are washed, and in baking woolen cloth gar-
ments, which cannot be boiled, put into a sack, in an oven.

4. In washing the bodies of the sick, and the floors of rooms,
with soap and water, and the walls and ceilings with lime, .

230 Typhus Fever, [April,

5. In lighting fires in fireplaces, and setting open windows
and doors.

6. In keeping provisions away from the apartment of the sick.
But as this poison exerts a much more malignant and fatal

effect upon persons whose health is impaired by exposure to
malarious influence, it is of great importance that putrid effluvia
from drains, dunghills or privies, should be carefully obviated.

The drains from houses should be covered in, cesspools and
necessaries should be emptied, stagnant ponds should be run off*,
and every cottage in the country should be provided with a
bricked cistern, covered with a wooden flap-lid, for the recep-
tion of all solid and liquid manure, which should be emptied and
carried out on the land, as soon as it is full.

If these precautions are taken, there is no need for chloride of
lime or any other disinfecting agents, which only correct putrid
effluvia ; they have no power to destroy the poison. They are
worse than useless when they lead to a false security, and occa-
sion the neglect of these more efficient means. In like manner,
drinking to excess, especially ardent spirits, eating unwholesome
food, such as bad potatoes,decaying vegetables, half-rotten fruit,
musty or sour meal, unsound meat, stale fish, and drinking
stagnant water, should be carefully avoided. Great attention
should be paid to personal and domestic cleanliness. The house
should be kept dry, warm, and well ventilated.

The treatment of typhus fever. This is better left to the
medical practitioner in the locality, who is best able to judge as
to the remedies most suitable for individual cases.

The following are the principles which guide the practice in
the typhus fever of London :

1. To remove all ofl?ending matters from the stomach and
bowels, an emetic of salt water or ipecacuanha is administered,
then a grain or two of calomel, and fifteen grains of rhubarb, fol-
lowed by castor oil if necessary.

2. After the operation of the emetic and purgative, the patient
is washed all over with soap and water, and put into a clean
warm bed, with a fire in the room, and the window open.

3. Five grains of the chlorate of potass in a wine-glassful of
camphor-mixture is ordered every six hours. The chlorate of
potass seems to aid the vital energies in expelling the poison,
evinced in the improved colour of the skin, and altered state of
the secretions.

The diet consists of bread and milk, or gruel, seasoned with
salt instead of sugar, light broth, and f es'i, well-boiled vegetables;
whey, sngo tea, or lime-blossom tea, ;;n I oat-meal toast-water.

The body linen and flajmel vest are changed daily, and the
sheets once a week; The dirty linen, cotton antl flannel, are put
at once into cold water, and boiled before they are washed.

1848.] Nitrate of Silver in Diarrhasa and Dysentery, 231

From this statement, it is evident that the cure of typhus fever
ccn no more be eflected by medical treatment than the cure of
small-pox, measles, or scarlet feverr The disease, once set in,
must run its course. It terminates naturally on or about the
fifteenth day. The object of medical treatment, therefore, is to
avert its fatal tendency ; or, in other words, to conduct the pa-
tient in safety through its different stages. If the disease do not
admit of cure, much may be done toward its prevention. 1. By-
separating the healthy from the sick. 2. By destroying or di-
luting the poison. 3. >By avoiding all those causes which impair
the health, and weaken the powers of resistance,-

On the Internal Use of Nitrate of Silver in Obstinate Diarrhoea
and Dysentery. By Thomas Aikin, Esq. (Dublin Medical
Press.)

The author of this communication remarks, that the topical
application of the nitrate of silver to inflamed or ulcerated mu-
cous surfaces is confessedly a most efficient mode of treating
such cases. The knowledge of this fact may have induced
physicians to employ the same remedy internally against disease
invading the mucous surface of the hollow viscera. Accord-
ingly we find that ample testimony is afforded to the efficacy of
the nitrate of silver in certain morbid conditions of the mucous
coat of the stomach; but no English writer, Copland excepted,
(Dictionary of Medicine,) sanctions its employment as a thera-
peutic agent in morbid conditions of the mucous surface of the
intestinal tube. The author's object in the present communi-
cation is to adduce such testimony in favor of its sanative power
in these affections as may stimulate further inquiry into the
action of this salt in certain obstinate forms of diarrhoea and
dysentery, which occasionally resist the action of the most
esteemed remedies wielded in the ablest manner.

Boudin (Gazette Med. No. 51, 1836), physician to the Military
' Hospital at Marseilles, treated fifty cases of typhoid fever (dothin-
enteritis), in most of which severe diarrhoea was the most promi-
-nent feature, with the nitrate of silver thus: When the lower
portion of the intestinal tract was presumed to be the seat of ulcer-
ation, enemata, containing from one to three grains, dissolved in
distilled water, were administered. In most cases one enema
sufficed, the symptoms undergoing speedy amelioration. In
other cases the remedy was given by the mouth, in half-grain
doses every half hour, [?] formed into pills with gum tragacanth,
i or starch, until from two to four grains were thus taken. In some
^instances these two modes of treatment were combined: the

233 Nitrate of Silver in Diarrhasa and Dysentery. [April,

results were that only two of the fifty cases succumbed. Ex-
amination showed " many ulcers" on the mucous membrane in
a case of inci])ient cicatrization ''en voie de cicatrisation*'
There was evidence of the solutiv^n administered per rectum
having passed the ileo-ca?cal valve, and producing eflects on
the lower portion of the ileum precisely similar to those resulting
from its action on the surface of the colon.

Kalt confirms Boudjn's statement, having treated twenty-two
cases of dothinenteritis with the nitrate of silver. Of these one
died. lie gave it in mixture (grs. ij. to vj. in decoct, salep.
oz. vj.) ; a table-spoonful of which was taken every half hour,
or hour, according to circumstances.

Hirsch of Konigsberg (Hufeland's Journal) found the nitrate
of silver to succeed in obstinate cases of diarrhoea on the fail-
ure of ordinary remedies. It. proved specially useful in the
diarrhoea of newly-vv-eaped infants. In "the 'advanced stage
of such cases, when emaciation was extreme, the dejections
being frequent, fetid, and consisting of a variously coloured,
sometimes greenish, or bloody mucus, aud wanting altogether
the fecal character. When aphthous ulceration pervaded the
mouth, and when prostration was extreme, the action of the
nitj'ate was brilliant." He gave it to children thus ;
^. Argent nitrat. crystall. gr. i.
Aquas destill, . , , l'}].

Gum mimosae, . . . Bij.

Sacch. albi, ... 3ij, Misce. Ft. mist,

A tea-spoonful of this mixture was given every two hours,
and an enema, containing a quarter grain of the salt, with mu-
cilage and a little opium, was administered. The good effects
of this treatment were occasionally visible in a few hours,
somtimes not until the second day. He pronounces it a speci-
fic in the diarrhoea of infants, He found it almost equally effica-
cious in severe forms of diarrhoea and dysentery occuring in
adults. He ndministercd it to the latter in pills, in doses varying
from one-twelfth to one-twentieth of a grainevery twohours. For
this purpose he recommends liquorice powder as preferable to
the vegetable extracts which allect its decomposition. He also
gave enemata, containing half a gain or a grain, with mucilage
and opium.

Canstatt also extols the nitrate of silver as prescribed by
Hirsch in the diarrha'a a)>hu'tatnruin.

Since the author became nctjaintcil Vvith llirsch's observations,
opportunity presented for testing ihe powers of the nitrate of silver
in a severe case of dianha^a occurring in a child of a year old,
Vomiting and purging; set in, and continued with almost unabated
intensity for five days. The stomach at length retained fluids

ri

1848.] Epidemic Dysentery. 233

in small quantities, but the purging continued. Chalk mixture,
kino, opium, and acetate of lead were tried, and all, with the
exception of the last, seemed to increase the irritation. The
dejections were frequently greenish, sometinies bloody, and ver}"
fetid. On the sixth day prostration was very great; there was a
tendency to stupor, and quantities of greenish mucus were voided.
Under these circumstances he gave the mixture as prescribed by
Hirsch. The first dose seemed to increase the discharges ;
however, in about six hours, the character of the dejections
were improved, they became feculent, and every symptom under-
went a corresponding improvement.

Should the foregoing observations induce practitioners in
this country to subject the action of the nitrate of silver in
diseases of the mucous surface of the intestines to a more extensive
trial, they may arrive at results confirmatory of those already
obtained by the authorities which the author has quoted, and
thereby extend tl>e application of an agent of great therapeutic
energy to forms of disease occasionallv so intractable as tobaflfle
the powers of ordinaiy remedies.

[The advantage of the nitrate of silver in the diarrhoea of in-
fants, of which we have had considerable experience, is also
acknowledged by Bouchart (flannel Pratique des Nouveau-nes)
and by Trousseau. We have given it frequently, and with
much benefit also, in the '"irritable" bowels of the adult. We
generally prefer to exhibit it in solution, more especially in
children, since, if given in pill or powder, we have no guarantee
that it will not, by suddenly dissolving, exert all its effects, which,
in that case, may be too powerful, upon a circumscribed portion
of the mucous membrane. This is a point which is not suf-
ficently attended to in pi*escribing the nitrate of silver for gastro-
dynia, and sufficiently accounts for the diversity of opinion res-
pec ting its benefit in tliis complaint. It may be readily conceived
that it makes all the difference whether half a grain of solid
nitrate of silver lies in a corner of the stomach and dissolves, or
whether originally in solution its action is distributed throughout
the entire irritable mucous membrane. Ranking.']

Epidemic Dysentery. By James Bryax, M. D., Lecturer on
Surgery, late Professor of Surgery and MedicalJurisprudence
in the Academy of Medicine, Vermont. Also formerly Phy-
sician and Surgeon to the Philadelphia Dispensary, etc. (S[.
Y. Journ. of Medicine.)

The winter of 1846-7 in Philadelphia was certainly "sicca et
aquilonia," dry and cold, particularly the latter part* of it, and
acute inflammations were of course common during the greater

234 Epidemic Dysentery. [April,

part of the winter. The spring was "pluviosum" or wet, and
was also cold and late ; and so Tar does not correspond with the
descrij)tion of the father of medicine. A larcce amount of rain
fell during the months of March, April and May, wdth what is
generally understood as a "raw atmosphere." Not until June
did the thermometer rise sufficiently to make it comfortable
without good fires in our houses.

The latter part of June, however, became suddenly warm ;
and in the beginning of July, the heat became intense, alterna-
ting with heavy showers of rain. From the middle of July to
about the 10th of August, the weather was most oppressive, and
remarkable for the suddenness with which, on several occasions,
the thermometer fell in a few hours at one time to the extent of
forty degrees between the evening and the following morning.
The change was most uncomfortable. On one day the heated
air appeared as if issuing from a furnace, and the next morning
winter clothing was necessary. The cold continued for three
or four days, gradually giving w^ay, until the thermometer rose
again to the point (more than one hundred) to which it had risen
before. Large numbers of children and old persons died sud-
denly during this time.

The Dysentery commenced in May, and has continued to the
present time, 20th of August. The last case I was called to,
was a lady about eight months gone in gestation ; the disease is
yielding very rapidly to the calomel, ipecacuanha and opium
treatment, with starch and laudanum injections.

The severest cases occurred about the middle of July, and the
mildest are those seen now.

The following cases are presented as examples of the disease
and its treatment, as observed by myself. As usual, in the lan-
guage of Dr. Rush, the epidemic influence has induced most
other diseases "to wear its livery." Perhaps the most serious
attendant and follower of the disease was engorgements of the
brain and inflammation of its membranes. This was particu-
larly the case about the middle of July, when the heat was great-
est and most oppressive. The mortality among children, at that
time, was much greater than has been usual at the same season
of the year ; many of them dying of diseases of the brain and
its membranes.

In many instances, in adults, the disease (Dysenterv) was ac-
companied with general jaundice, and sallowness of the skin.
The attack was often sudden, during a meal, or in the midst of
conversation, or after drinking water; the latter would be in-
stantly expelled from the stomach, and the vomiting and nausea
would continue long after the discharges per anum had com-
menced. Almost every one suffered from a feeling of nausea, a

1848.] Epidemic Dysentery. 235

disposition to costiveness, or a diarrha3a ; generally the latter
following on the heels of the constipation. A diarrhoea com-
menced, changed to a Dysentery in a few hours. The symptoms
could not be attributed altogether to the heat of the weather, or
the use of unripe fruit ; (the latter, we believe very unjustly,
stands as the scape-goat for all bowel affections during the sum-
mer months :) because they commenced long before the ther-
mometer had attained a high range, and two whole months before
the fruits of the season appeared in our markets.

I had not an opportunity of making many post-obit examina-
tions. In one case, which occurred in the practice of three of
our most eminent practitioners, I found pretty extensive ulcer-
ations in small spots over the Jower part of the colon and through-
out the rectum; they were not, however, deep; the mucous
membrane seems alone to have suffered, appearing as if nibbled
by some insect. It was also softened and thickened.

General bleeding, as far as my experience and that of a num-
ber of my medical friends extended, was not found necessary.
Leeches and blisters, particularly th*e latter, produced very hi^p-
py efiects. In some cases the starch and laudanum clysters,
with the exhibition of calomel and opium pe/^orem, met the indi-
cations, and were successful. In most of my cases I found the
" Hope's Mixture," or a modification of it, entirely successful.
The use in the early stages of mass, hydrarg. in three grain pills
at night, in conjunction with the acid treatment, was found very
efiectual in checking the bilious vomiting and nausea, as well as
changing the bitter taste in the mouth. Small quantities of ice,
allow^ed to melt in the mouth, were the best means of relieving'
the thirst, which, in most cases, was very urgent. I did not find
the combinations of ipecacuanha, opium and calomel, so suc-
cessful this season as formerly in dysenteric affections.

The disease was confined to no age, color, or condition in life.
My own observation, however, induced me to believe that the
black did not suffer as much as the white portion of our popu-
lation.

Case l.-^On the 15th of June, I was called to visit Miss A
aged 9 years, with a severe Dysentery, the sixth day of the
disease. I commenced the treatment with the use of the acetate
of lead and opium, with starch and laudanum clysters. This
proving ineffectual, I tried the hydrargyrum cum creta et opii,
in conjunction with mucilaginous and opiate injections. On the
tenth day, I commenced, on the recommendation of my friend.
Dr. S. G. Morton, who consulted with me in the case, the use of
^ the following, mixture :

I^. Acid nitric, gtt. iv.

Aquce cam ph., f I iv.
Tinct. opii, gttt. Ix. M.

236 Epidejnic Dysentery. [April

Take a tea-spoonful every hour, and use the starch and mor-
phia injections. This treatment, with the use of a mild nutritious
and unirritating diet, was continued up to the fourteenth day,
when the sym})toms had so far abated, that she was directed to
use a mild cold infusion of Prunus Virginianus bark. The con-
valescence was slow but regular; and in about three weeks, with
the use of the above infusion, and two or three other tonics, she
was able to go out of the city to the country.

The following case, though not strictly indigenous to our city,
is given as exhibiting, in an aggravated form, the symptoms of
the disease as imported from Mexico, where it is known to have
been very prevalent and fatal among the men of our army.

Case 2. On the 19th of July, I was requested to see Capt.
G. D., who has suffered with chronic Dysentery, more or less,
during the last four months. He has just returned from New
Orleans, between which place and Vera Cruz, Tampico, ]\Ieta-
moras, and other Southern ports, he has been engaged in his pro-
fession for the last ten months. On leaving this city, ten months
ago, he was a fine, healthy, 'robust man. He is now very much
emaciated ; sallow, and scarcely able to walk or stand upon his
feet. He has from twenty to thirty stools per diem, consisting
of blood, mucus, and pus. Has very little appetite, continual and
urgent thirst, with great tenderness of the abdomen, particularly
in the epigastric region, continued jactitation and insomnia.
The pulse is quick, small and frequent. Suffers very much from
nausea and unpleasant tastes in his mouth and throat, with oc-
casional vomiting of bilious and other matters, especially after
drinking water, or other fluids. Is a perfectly temperate man.

I commenced the treatment by prescribing the following :
^. Acid nitric, gtt. iv.
Aqua3 camph,, f ! iv.
Aquae morph., f 5 ss. M,

Take a tea-spoonful every two hours, and to take in the even-
ing one three-grain pill of mass, hydrarg.

20th. Eleven o'clock, A. M. No stool to-day up to thia
time. The number of passages during the night much dimin-
ished. This freedom I'rom stools, lie says, has not occurred
before, since the commencement of the disease ; feels generally
better.

21st. Number of stools increased, and pain returned both at
stool and in the intervals. To take a clyster of thin flour starch
with a teaspoonful of the licjuor mor})hia, and re})eat during tho
day.

22d. Passed a bad night. Vomited several times ; the stools
have increased very much in frequency, the pain is greater with
great debility to take the Ibllowing :

1848.] Epidemic Dysentery. 237

I^. Spts. nit. dulc, f 5ss.
Aquae purse, f 5iij.
Acid nitric, gtt. iij.
Liquor morph., f I ss.
Sacch. alb., 3i,
M. To take two tea-spoonfuls every two hours, alternating
with the following :

^. Protochlorid. hydrarg., gr. vj\
Pulv. opii., gr. iij.
M. dividend, in chartul., No, xii., taking one every two hours,
Emplast. cantharid., 5 by 5 inches, applied to the hypogastric
region, to remain six hours. Small lumps of ice to be allowed
to dissolve in the mouth as a drink, diet boiled milk well salted.

Ditto, 5 o'clock, P. M. Blister smarts very much, is very red
and discharges freely. Patient lies upon his back ; stools but
two, since 9 o'clock this morning. To apply bread and water
poultice to blister, and to take at 9 o'clock this evening two tea-
spoonfuls of the liquor morphicP, with the view of producing
sleep.

23d. 9 o'clock, A. M. Has had but two passages since 5
o'clock yesterday; tongue more furred, particularly in the cen-
tre, The blistered surface discharges freely. The pain in dif-
ferent parts of the abdomen is much less, but the blister is very
sore and painful. Continue medicines, and to take some weak
mutton soup, with a small quantity of rice in it.

Ditto, 5 o'clock, P. M. Only three stools during the day ; no
pain, no blood in the discharges. Patient remains on his back,
on account of the blister. Continue medicines and diet ; the
soup agrees well with the stomach. Had a refreshing sleep from
10 to 12 o'clock ; this, with one hour's sleep obtained last night,
is the first he has had for a long time.

24th. One stool during last night ; taken a pint of boiled milk
this morning. One stool this morning ; slept very well last night,
without morphia. The blister healing slowly. No pain.

25th. No stools last night, but one this morning, and that
nearly natural and without pain or blood. Slept well, has taken
*' tea and toast " for breakfast, is able to sit up and shave himself.
Continue acid mixture.

26th. Appears convalescent : to take camomile tea, and
continue acid mixture in half the former doses. The patient
continued to improve, the appetite increased, and the digestive
organs became strong and healthy.

Case 3. On the 28th of July"^ I was called to visit Mr. T., a
young man 25 years of age, a house-painter. Had suffered
during the last five days with occasional pains in the abdomen ;
with nausea and diarrhoea, the discharges tinged with blood. He

238 Epidemic Dysentery, [April,

had taken some medicine once or twice, with partial relief.
This afternoon he was seized with intense pain in the bowels
and excessive vomiting. Several painful anal discharges mixed
wdth blood. When I saw him, I found him tossing about on his
bed in great pain. Every now and then vomiting freely, cold
skin and sweat ; small pulse, thirst, with pain in the head, and
generally tlu'ough the bones. The tongue was covered with a
thick fur, dark in the centre. I directed a pediluvium of warm
water and mustard, a large sinapism to the abdomen, and twenty
grains of calomel to be administered in molasses. The dose
to be repeated at the end of three hours. The thirst to be al-
layed by pieces of ice allowed to melt on the tongue. Cold
applications to the head.

29th. The brother called early this morning, and informed
me that my patient had had no vomiting after the first dose of
calomel, the latter appearing to act as an anodnie. Had passed
a comfortable night, slept well, and, in fact, was met in the street
this morning considering himself well. I directed him to take a
dose of oleum ricini. The cure was complete. Two other
cases in the same house, on the sajne occasion, were treated in
this way with like results.

Case 4. I w^as requested to visit a patient in West Philadel-
phia, Mr. D., a strong laboring man, who had had Dysentery for
five days. On the first day he sent to Mr. B., a popular drug
vender, for " medicine for the Dysentery." Some astringent
mixtures were sent, the use of which checked, in tlu'eedays, the
discharges; left the tongue furred, the pulse quick, the skin dry,
the stomach irritable, and a continual hiccough, which was very
distressing to the patient, and alarming to his friends. The
hiccough had existed two days when I was called, accompanied
with great difiiculty in swallowing fluids, I prescribed twenty
grains of calomel, to be repeated at the end of three hours.
Meeting my friend. Dr. S. Jackson, of Northumberland, I men-
tioned the case to him, and he concurred with me in thinking
the case somewhat dangerous, and recommended, if the ]irescrip-
tion already made did not relieve the patient in twenty-four
hours, the use of blue pill to salivation.

2d day. The hiccough was moderated for a short time by
the calomel, it having induced great sickness of stomach, and
pretty free vomiting of bilious matter, which relieved the pa-
tient considerably for a short time. The second dose did the
same thing to a less extent. Still, however, the hiccough con-
tinned. 1 directed a three-grain p 11 of blue mass to be taken
every two hours, and a tea-sjioonful of J loffman's Anodyne
every three hours ; to take mutton soup and boiled milk well
salted as a diet.

1848.] Action of Medicines. 239

3d day. The hiccough has nenrly subsided, each dose of the
anodyne reheves it ; the bowels have been moved once, the
appetite has improved, the stomach retains both soup and milk.

4th day. The hiccough ceased at twelve o'clock Inst night ;
two passages per anum without pain or blood ; strength im-
proving, general condition much better; continue pills. This
patient gradually recovered, but not until the gums were
*' touched." The convalescence was slow, but sure.

In this case, I considered that the stomach and liver had
become, to a certain extent, paralyzed ; very much as in the
case of the confirmed drunkard, or in the latter stages of typhoid
fever; and therefore prescribed the calomel in large doses, with
the view of rousing them from their torpid condition. The
use of the blue mass was of course designed to keep up the
impression and continue the action ; the favorable termination
of the disease would seem to justify this view of the case.

September 1st. In conversation with my medical acquaint-
ances, and b}^ my own practice, I find the bowel diseases above
described have generally given place, at this early day, to
autumnal levers, generally of a bilious type. This is the case
in the city proper, and more especially in the suburbs, and
along the water-courses. The banks of the Schuylkill are lined
with cases of bilious fevers, some of them very severe. The
weather is close and sultry, with almost daily thunder showers,
followed by a hot sun, which fills the air with terrene vapors
impregnated with the gases thrown oflffrom dead and decaying
vegetable matter.

Action of Medicines. By Professor Blake. (Ibid.)

Professor Blake of the St. Louis University, has published a
valuable paper in the November No. of the St. Louis Medical
and Surgical Journal, on the subject of the Action of Medicines,
containing the results of numerous experiments, made during the
last few years. The principal objects which Dr. B. has aimed
to ascertain are, " whether medicines act by being taken into
the circulation, or whether they produce their effects by impres-
sions made on the nerves of the part to which they are applied,
which impressions are capable of 'strongly modifying the func-
tions of the nervous centres, and by this means re-acting on the
whole system ?" Another question which he has attempted to
solve, is, whether " when a substance is absorbed into the blood,
do the re-actions it gives rise to, depend on the chemical pro-
perties of the substance used? or in other words, are the reac-
tions between the elements of the blood and tissues and inorganic

240 Action of Medicine. [April,

compounds, governed by the snme laws when takino: place in
livin^x aninnils, as they are when these sanie elements are mixed
together out of the hotiy. and no longer forming a part ot" the
living organism ?" With respect to the first point, viz., the
absorption of medicines into the blood, before acting upon the
system, after stating the opposite views entertained by physi-
ologists on this subject. Prof. B. states, that a carefully con-
ducted series of experiments has convinced him, that an
appreciable interval of time always elapses between the appli-
cation of a poison to a mucous surface, and the appearance of
the first symptoms of its action, the interval varying in diflferent
animals. For example: half a drachm of anhydrous hydrocy-
anic acid, applied to the tongue of a large dog, produced no
eflfect until eleven seconds had elapsed ; the respiration then
became affected, and the animal was dead in thirty seconds
from the time the poison was introduced. When the animal
"Was made to respire through a tube introduced into the trachea,
a longer interval elapsed between the application of the poison
to the mouth, and the appearance of the first symptoms of its
action, owing, in the opinion of Dr. B., to the poison having a
longer distance to go before reaching the brain ; " for,'' he ob-
serves, " owing to the great volatility of the thing, hydrocyanic
acid, it is instantly converted into a vapor on coming into con-
tact with so warm a surface as the mouth ; it thus becomes
inhaled into the lungs, and is there absorbed by the mucous
surfaces, and reaches the brain through the pulmonary veins,
the left cavities of the heart, the aorta and carotids ; whereas,
when it is prevented from entering directly into the lungs, it
has, in addition to the above course, to pass down the jugular
vein, into the right side of the heart, and through the })ulmonary
artery."

The dfl^erence in the two cases amounted, however, to only
five or six seconds. The uniformity of this result would seem
to establish very conclusively the correctness of the explanation
above given.

In experiments with the alcoholic extract of Conia obtained
from the seeds, Dr. B. f )und, on injecting a small quantity in
solution into the femoral vein of a dog. that fifteen seconds
elapsed before the slightest symptoms of its action manifested
itself The animal then became convulsed, and died in 30
seconds after the administration of the poison. This exp3riment
was repeated four times, and in no instance did any symptoms
appear in less tlian 15 seconds.

Having procured some Woorari poison from Sir B. Brodie,
Dr. Ji. injected five grains of it, dissolved in water, into the
jugular vein of a dog; no symptoms of the action of the poison

1848.] Action of Medicines. 241

showed themselves until 20 seconds had elapsed, and the animal
died in 45 seconds.

Strychnine was also extensively used by Dr. B. in his exp-^ri-
ments ; five grains in solution being injected into the jugular
vein of a dog, spasms were first observed about twelve seconds
after the poison was introduced, and the animal died in a minute
and a half The results of all the experiments on this subj ct
justify the inference, that an interval always elapses between
the application of a poison to any part of the body and the
appearance of the first symptoms of its action ; and therefore,
that there is no reason to believe that poisons ever act by a
direct impression produced in the nerves of the part to which
they are applied.

As the rapidity of the circulation d'ffers considerably in
diflferent classes of animals, Dr. B. remarks, that "it is evident
that, if a poison acts by being carried to the nervous centres
through the medium of the circulating fluid, it must reach the
brain most rapidly in those animals in which the circulation is
quickest.' He accordingly made experiments on the horse,
dog, rabbit, fowl, and goose, using, for the most part, Woorari
or Strychnine.

On the horse, six grains of Strychnine, injected into the
jugular vein, produced the first symptoms of its action by slight
twitchings of the muscles of the thorax, in sixteen .seconds; in
seventeen seconds the animal fell like a mass of marble, every
muscle being in a state of the greatest rigidity ; the animal died
in tetanic spasms/owr minutes after the infection of the poison.
When strong doses of concentrated hydrocyanic acid were
poured on the tongue of the horse, no symptoms were per-
ceived until after an interval of from twelve to seventeen
seconds. It will be observed, that the time required for these
poisons to act, when introduced into the veins, or applied to the
mouth of the dog, was from eleven to twelve seconds, an inter-
val of four or five seconds less than the time required to produce
any eflfect upon the horse. In the foivl, the interval was still
shorter; a grain and a Imlf of strydmine, introduced into the
jugular vem, producing convulsions in six and a half seconds,
and in eight seconds causing the death of the amimal.

In the rahJnt the interval was only four seconds and a half,
the animal dying in seven seconds ; the hydrocyanic acid was
found, in some instances, to act in less than four seconds, when
poured on the tongue. These experiments on different animals
were often repeated by Dr. B., and always with the same
results. It is thus proved, that in different animals the interval
varies that elapses between the time when a poison is applied
to the tissues or mixed with the blood, and the appearance of

16

242 Bibliographical. [April,

the first symptoms of its action it being sixteen seconds in the
horse, and four and a half seconds in the rabbit. If poisons
acted by an impression on the nerves of the part to which they
are applied, they should act with equal rapidity on all animals,
Avhicl) is not the fact. The conclusions arrived at by Prof. B.
are the following.

I. That an aj)preciable interval always elapses between the
administration of a poison and the appearance of any symp-
toms of its action.

II. That this interval varies in different animals, being shorter
or longer, according to the size of the animal and the rapidity
of its circulation.

III. That the nearer the point at which the poison is intro-
duced into the system is to the brain, the more rapidly are its
effects manifested.

By another series of well-devised and skilfully-executed ex-
periments. Prof. B. has shown that the time recjuired for the
blood to complete the whole round of the circulation in the
horse, is about twenty seconds; in the <fo,ir, from ten to twelve
seconds; in the fowl, six seconds ; in the rabbit, four and a half
seconds ; thus furnishing a most striking agreement between
the numbers furnished by the two series of experiments an
agreement so close as to render it impossible not to admit an
intimate connection between the action of poisons, and the cir-
culation of the blood; the periods of time, in fact, being coin-
cident.

The paper of Prof. Blake is an extremely valuable one, and
we hope he will favor the- profession w'ith the results of farther
investigations connected with this important subject.

BIBLIOGRAPHICAL.

1. Lectures on the phijsical phenomena of living beings. By Carlo
Mattkucci, Professor in the University of Pisa. (Translated under
the superintendence of Jonathan Pekeira, M. D., F. R. "S.)

This is the title of. a new and interesting publication, just issued
from the press of Lea & Blanchard, Philadelphia.

The Lectures here eniljodied, were written and delivered by their
distinguished author under a special appointment from the Government
of Tuscany, made in the year 1844, and havT already, previous to their
appearance in an English garb, un(leri;one two editions in Italy and
one in Prance, They evidence throughout, a profound knowledge of
the anatomical structure of the human body, and its physiological, as
well as pathological phenomena. His extensive acquaintance with

1848.] Bibliographical. 243

the science of Comparative Anatomy, comes in largely to his aid in
the prosecution of some of his most important researches, and it is but
due to the learned author to say, that where he has not originated or
discovered, he has at least confirmed, some of the most valuable and
novel facts now known to be connected with the laws of organic life.
Without designing to undervalue his contributions to the subjects of
Capillarity, Endosmose, Digestion, Nutrition, &;c., I refer especially
to the establishment of the doctrine of electro-vital currents in animal
bodies, and the certain development of //g/i^ as well as heat^ as the
result of functional action. In short, however his views and researches
may lead him to differ in some points with many other eminent phy-
siologists of the day, upon the great questions which he has so ably
canvassed, we believe that his judicious, ingenious, and laboriously
conducted experiments, directed, successfully by a penetrating and
observant mind, richly stored with scientific knowledge, should rank
him with Liebig, Chaptal, and Mulder, while his easy, unostentatious
and perspicuous style, will ever recommend his writings.

A. M.

2. The Practice of Medicine : A Treatise on Special Pathology and
Therapeutics. By Robley Dunglison, M. D., &c., &c. 3d Edi-
tion, in 2 vols. Philadelphia : Lea & Blanchard, 1848.

It is with pleasure that we call the attention of our readers to a new
edition of Prof. Dunglison's valuable work upon the Practice of Medi-
cine. The author is certainly the most industrious compiler in our
country, and deserves much credit for his efibrts to promulgate the
views of writers whose works would other\vise be little known amongst
us. The work before us is one of the most elaborate treatises of the
kind we have. The author " trusts that the present edition will be
regarded as an adequate exponent of the existing condition of know-
ledge on the important departments of wdiich it treats." We regret
that the learned author has not availed himself of many valuable |)rac-
tical suggestions contained in the pages of the old and new series of the
Southern Medical and Surgical Journal, especially those in relation to
the pathology and treatment of Remittent fevers. Rheumatism, Colica
Pictonum, Purulent Ophthalmia of infants, &c., &;c. The error is too
common in our country of heralding exotic views often valueless, to the
neglect of important contributions of indigenous origin. A fewyears
since, Drs. Cammann and Clarke, of New York, announced in one of
the medical periodicals of that city, the discovery of a new method of
exploring the chest, which consisted in the auscultation by means of a

2'41 Bibliographical. [April,

solid stethoscope of the sounds produced by percussion. This is certain-
ly one of the most valuable improvements in the art of diagnosis made
since the days of Laennec ; yet it is not even hinted at by Professor
Dunglison in his chapter devoted to the "physical examination of the
chest." D.

3. Remarks on the Superinduciion of Ancvsthcsia in natural and mor-
hid Parturition : with cases il/ustratice of the use and effects of
Chloroform in Obstetric practice. By J. Y. Simpson, M. D., F.R.S.,
<kc., &:c. With an Appendix. Boston : 1848.

The pamphlet before us is a reprint of an article read by Professor
Simpson to the Medico-Chirurgical Society of Edinburgh at their meet-
ing on the 1st Dec, 1847. It contains not only arguments, but also
facts, in favor of the use of anaesthetic means in surgical operations
and obstetric practice.

" Malgaigne (1842) showed that under amputations of the thigh, in
the hospitals of Paris, 62 in every 100 died; in Edinburgh, the mor-
tality from this operation, in the only years during which the hospital
reports were published (1839-42) was 50 in every 100; Mr. Phillips
of London (1844) fonnd the average mortality 40 in 100 ; Dr. Lawrie
at Glasgow (1839) found it also in the hospitals of that city to be 40 ia
100. I have notes of 135 cases in wiiich this same operation has
been performed in hospital practice on patients in an etherized state,
out of these 135 cases 33 died, or only 24 in 100."

Prof. S., after urging the advantages of chloroform over sulphuric
ether, adduces 12 cases of natural and morbid parturition in which he
administered it with the mostdecidid advantage. The appendix con-
tains letters from Drs. J. C. Warren, W. Channing, A. R. Thompson,
C. T. Jackson, M. Wyman, J. M. Warren, &c., all of whom give a
decided preference to chloroform over ether, in surgical and obstetric
practice, and recommend the article prepared by Wm. B. Little & Co.,
of Boston. D.

4. The History, Diagnosis and Treatment of the Fevers of the United
States. By IvMsua Bartlktt, M. D., Professor of the Theory and
Practice of Pljysic in the Medical department of Transylvania Uni-
versity, &c., &c. Philadelphia: Lea iS*: Blanchard. 1847. pp 547.

It is truly refreshing, in this age of book-making, when, for the pur-
pose of acqu'ring the title of "author," men care but little whether
what they j)ublish be new or not, to have placed in our hands a pro-
duction intrinsically original. The work of Prof. Bartlett is not only
his own, but is decidedly the most valuable treatise on Fevers with

1848.] Bibliographical. 245

which we are acquainted. As its title indicates, it contains the " His.
tory, Diagnosis and Treatment of the Fevers of the United States,"
comprehending Typhoid, Typhus, Periodical and Yellow fevers. The
work is remarkably systematic, ^nd written in a clear, perspicuous
and easy style. It is eminently calculated to be useful to the profession
and cannot fail to secure to its able author an European reputation, as
well as to reflect credit upon the medical literature of our country. D.

5. A Si/stc7n of Surgery, by J. M. Chelius, Doctor in Medicine and
Surgery, and Professor of Surgery, <S:c., &c. Translated from the
German, and accompanied with additional notes and observations,
by John F. South, late Professor of Surgery to the Royal College
of Surgeons of England, and one of the Surgeons to St. Thomas's
Hospital. In three volumes pp. 640, 586 and 942. Philadel-
phia: Lea & Blanchard. 1847.

These volumes, issued from the American press under the super-
vision of Dr. G. W. Norris, have been lying upon our table for the
past four or five months. We have had occasion very frequently to
refer to the work during the course of Lectures on Surgery, just com-
pleted in our Medical College. At one time we contemplated a review .
of it for this Journal ; hence the delay of this notice. The matter of
the author, Dr. Chelius, has however, been before the profession for
several years, and the notes, &c., of the translator. Dr. South, are
chiefly made up of extracts from John Hunter's works. Sir Astley Coop-
er's, &:c., d:c., so that we thought it would be best simply to give
our opinion respecting this system of Surgery.

We have here in these 2168 pages, including an analytical index
of 171 pages, another immense work on Surgery, only equalled in
matter by Townsend's, JMott's, Velpeau's. With -these two systems
of Surgery, the first embracing G'^rman and English, and the latter
French and American, surely no student need be at a loss for any
thing in this department of the medical profession. The work before
us is well gotten up by the publishers: Dr. Xorris has only referred
to American Surgical literature ; and it may be considered as com-
plete as any system of Surgery can well be.

6. A Practical Treatise on the Causes^ Symptoms and Treatment of
Spermatorrhea : by M. Lallemaxd, formerly Professor of Clinical
Surgery, at the University of Montpelier, <Scc. Translated and
edited by W. J. McDougall, member of the Royal College of Sur-
geons of England, d:c., vkc. p. 320. Philadelphia : Lea 6l B.anch-
ard. 1848.

We are indebted to the Publishers, as we are for the preceding

240 Bibliographical. Periscope. [April,

works, for a copy of tliis translation of Prof. Lallemand's on Sperma-
torrhoea, of which it may be said no one has yet attempted to improve.
It is, we believe, not only tJie best, but the only complete publication
on the subject.

7. The American Journal of Science and Arts. Conducted by the
Professors Sillimans and James T. Dana. New Haven, Con-
necticut,

Silliman's Journal is now known and acknowledged over the world
to be one of the most scientific and best conducted publications of the
day. It has long been our desire to do what we could to extend the
usefulness of this periodical, of which every 4merican may be proud.
Our attention has just been called to tlie March No., lying on our
table, which we find peculiarly rich in scientific matter and intelli-
gence. We call upon every friend of Science and Arts of our
country, to sustain, by his subscription and contributions, this truly
American Journal,

PART III. MONTHLY PERISCOPE.

Diagnosis of Scurvy and Purpura. In an elaborate article which
the present prevalence of scurvy has given rise to, the author, Dr.
Curran, makes the following distinctions between that disease and
purpura ;

scunvv. purpura.

Most frequent aftt r 18 years of age. Most frequent between 5 and IS years of ag.

Chirllj alfects males Ffinalcs.

Uums more or less sore end spongy. Gums l)lei'd sometimes, are rarely sore, and

m-viM- spongy.

Ecchymoses more frequent than petechia. PoUcliiajJike Sj.oti frequent, eccbymosM

ran-r

ghades of eruption nfost various. Al first always dark colored.

Lower extremities almost exclusively affect- All paits nearly equally,

ed.

Muscular indtirations nearly always. Never,

H.xmaturia scarcely ever. Not infrequent.

Bloody stools very rare. Fr'(|iuMit.

True haemoptysis never. Occasionally,

Neuralgic puius and pains in the spots Inva- Never,

rial.le.

Jlrtusions in joints frequent. Never,

Contraction of flexor muscles frequent. Never,

La^ts for months, if not interfered with. Rarely lasts more than a few dayt,

Fri-quently fatal if not checked. Scarcely ever fatal.

Alwa\ s in connection with eriors in diet. None such discoverahle.

Aff"Cl's large numbers of Individuals at the Sj'Oradic j epidemics extremely rare.

same time.

SjH edily cured by lemon juice and fresh Cured by i)urgation and turpentine,

vegetables.

[Duhlin Quarter/ 1/ Journal.

Dr. Hchcrden's Treatment of Dijsrnfnrj/. Dr. Ayres, after quoting
the elegant Latin of the " Comm(!ntaries," in which the use of saline
aperients in dysentery is strongly urged, remarks :

1848.] Periscope. 247

I have been in the habit of giving saline purgatives for the last seven
or eight years, and, as I can safely affirm, without a single unfavora-
ble or untoward result. To aduils I have usually given a drachm of
sulphate of magnesia, combined with a grain of ipecucuanha, in some
simple aromatic water, every six hours; to children about half the
quantity ; and to infants a still smaller dose. I have observed that so
soon as natural fecal dejections are produced, the bloody mucosities
cease to be discharged, the tenesmus disappears, and the patient is
cured. In by far the majority of cases the bowels have been proper-
ly relieved within twenty-four or thirty-six hours ; but in a few cases
of a more severe character the bowels have been more obstinate, and
the saline purgatives have not produced their proper effect until after
the lapse of three days. I have also, occasionally, observed the con-
tinuance of tenesmus after the proper action of the bowels; but this
has been easily relieved by an opiate. The addition of small doses of
ipecacuanha 1 have imagined to be beneficial, from the known efficacy
of this substance in several intestinal diseases; but I should place my
chief reliance on the saline purgative. In practice I direct the patient
to continue the medicine until fecal motions have made their appar-
ance, and then either to take the medicine less frequently, or altogether
omit it, as, without this precaution, severe diarrhoea might be induced.
Where this plan of treatment has been adopted, I have not seen a single
case in which the disease became chronic. [^Medical Times.

Skoda's Treatment of Pneumonia. Dr, George W. Balfour, in a
paper read before the Medico-Chirurgical Society of Edinburgh, and
pubhshed inthe Edinburgh Med. and Surg. Journ., (Oct., 1847,) gives
'the following account of the treatment for pneumonia pursued by Dr.
Skoda in the General Hospital, Vienna.

" On entering on his duties, Dr. Skoda treated this disease according to the
most approved ])rinciples. He drew blood from the system ; Jeeched and blis-
tered Iree'ly ; giving at one lime tartar-emetic in various doses at another
employing mercury equally freely. Becoming, however, skeptical as to the
amount of benefit derived from such heroic treatment, he gradually left it off;
and now nauseants and mercurials are equally unknown. Leeches, cupping-
gla.sses, and blisters are never employed, and general bleeding only where the
fever rims high, and the dyspnoe i is great, previous to hepatization. After this
has occurred, he regards the abstraction of blood as injurious, diminishing the
chance ofa speedy and complete absorption of the exudation. If dyspnoea or
cyanosis be occasioned by a secretion of tough mucus, an emetic is given. His
general treatment consists in giving a scruple of !.r/rac/wwo'rawmw,e.r^. Glycyr-
rhizcB, or some other equally innocuous extract ; from teri to twenty grailisof
nitre, or latterly aquarter ofa grain of corrosive sublimate, by way of attempting
to reduce the plasticity ot the blood. These remedies are dissolved in from six
to eight ounces of water, and given often warm, in the course of the day. From
six to eight grains of Dover's powder are occasionally employed, or a grain or
two of opium is given, according to the amount of pain and irritation present.
Many patients are treated wholly without opium. All have a thick warm cloth
(umschlag) l?id over the chesf. The temperature of the wards is about 60 F.
summer and winter; and though well aired during the tbimer season, they are
close and ill-vendlated during the latter. The diet is in conformity with the
habits of the people, anu not more rigid than in other hospitals."

This method of treatment has been pursued. Dr. Balfour states, for
three years, and the results have been most satisfactory. \^Am. Jour.

248 Periscope. [April,

Treatment of Corijza. M. Deschamps slates that he succeeds in sus-
pending a common cold, if taken at tlie onset by injecting into the
nostnU a weak solution of the extract of opium. Tiie liquid may be
eitiier thown up with a syringe, or alternatt ly snuffed up each nostril,
the other being closed with the linger. [Journ. de. Chirurgie.

Treatment of Acute Rheumatism. In recent cases Romberg's prac-
tice is to bleed in the first instance ; to keep the painful limbs at an
equable temj)crature by enveloping them in wadding, and to exhibit
ten minims of the tincture ofcolchicum seeds every two hours, com-
bined with two scruples of the sulphate of magnesia. The remedy
found most ethcacious in sliortening-tlie duration of an acute attack was
the bichloride of mercury. To adults it was given in the dose of l-Slh
to 1-Olh of a grain three times a day. Counter-irritants were at the
same time applied. [Romberg^s Clinical Observations, Brit, and
For. Med. Review.

Influence of Periods of the Day on Births. Dr. Casper has ascer-
tained

1st. That the greatest number of births occur between nine o'clock
in the evening and six in the morning ; while the smallest number
occur between nine in the morning and six in the evening.

2d. The pains of labour conmience most frequently between twelve
at night and three in the morning, but frequently between six and nine
in the morning.

3d. The intiuence of night is more marked with respect to the com-
mencement of labour than with respect to con)j>lete delivery.

4th. Among those births in which the pains commenced by day, the
greater number were male children, and vice versa.

5th. On an average the delivery was more protracted when the
pains commenced by day than by night.

Cth. The preponderance of nocturnal over diurnal births is more
striking in respect to children born dead than to those born alive.

[British and Foreign Med. Review.

Treatment of Chronic TJpitudo. By Isaac Hays, M. D., Surgeon
to Wills Hospital. Ophthalmia tarsi is generally a manageble dis-
ease, but occasionally cases are met with in which the atlection, in
consequence of neglect or bad management, has persisted for years,
the lids have become pully, their lining membrane thickened and
villous, causing more or less eversion (cclropimn), their edges raw
and sometimes ulcerated, the ciliie irregular and scanty, or entirely
lost; with plK)toj)h()l)ia, lachrymation, tVc. 'J\vo such cases came
under our cliarge during our recent service at Wills Hospital, and as
thry had resisted the usual remedies, 1 was inchieed to try the alter-
nate application of tincture of iodinr*, and the solid sulphate of copper,
at intervals of three days. The external surface of the lids was
painted with the former ; and three days afterwards the latter was
freely applied over the thickened conjunctiva. Under this treatment

1848.] Perucope. %A^

both cases,' one of them of 12 or 14 years continuance, have recovered,
and \vc are induced to communicate the circumstance in hopes that
this course may prove equally useful in the hands of others. [^Ameri,-
can Journal of Med. Sciences.

Rapid Mode of Producing Vesication. Apply six drops of a mixture
of one drachm of liq. ammonise tbrtissimus, and. two drachms of olive
oil, to the woollen side of .Markwick's spongio-piline, (patent lint,)
and press this gently against the skin. In the course often minutes
a perfect blister is formed. [Pharm. Journ.

Nitrate of Silver, in the f>rm of Compound Powder, in Chronic
Discharges from the Ear. The difficulty of applying nitrate of silver
in the soiid tbrm, or in the form of solution, to the tube of the eiternal
ear, led M. Bonnafont, a considerable time since, to contrive a po^^der,
which, in cases of chronic discharges from the organ, might be blown
in. His formula directs equal parts of fused nitrate silver, talc of
Venice, and lycopodium powder, thoroughly pulverized. He affirms,
that with certain precautions as to the previous cleansing of the meatus
from purulent matter, and the like, this treatment is of the greatest
service. [Bulletin de Therapeutique, and Gazette Medicale de Paris^
from N. y. Journal.]

Physometra Tympanitis. (From Meigs' " Females and their Dis-
eases.' ) Dr. Brown was a famous physician, who lived at Port 'i o-
bacco, in Maryland, many years ago. He was one of three brothers,
all of whom obtained considerable eminence in medicine in their own
Districts and States. He was the Dr. Brown w ho was called in con-
sultation with Dr. Dick and Dr. Crajk, at the last illness of General
Washington. My master, Dr. Thomas "Hanson Marshall Fendal, of
Georgia, was his pupil, and he told me, thirty-eight years ago, that
this was one of Dr. Brown's formulas. Dr. F. used it in almost all
severe cases of tympanitic disorder, and I have used it ever since,
and ever shall.

Take one ounce of manna,

One drachm of anise seed,
Eight ounces of boiling water.

Mix them, and let the mixture rest for half an hour, then strain the
liquor.

To the strained liquor add three drachms or four drachms of Car-
bonate of Magnesia, so as to make a perfect mixture.

A wine-glassful may be given for the dose, to be repeated every
two hours, or three hours, until it operates.

To make Leeches take. Dr. Rennes recommends a piece of linen
wetted with pure wine ; the leeches then placed in the linen are ap-
plied to the parts to be topically bled. They are said to take hold
immediately and draw vigorously. ]Journ. des Connaissances,

250

Medical Intelligence.

[April,

MEDICAL INTELLIGENCE.

Medical College of Georgia Graduates for Session 1847-8. Accompanying
the last No. ol" our Journal, was a Catalogue ofihe Students for the last Course
of Lectures in the Medical College of Georgia. Through inadvertence, the
Dame of Mr. B. S. Simmon.s, of Georgia, was omitted; making the whole num-
ber 151, instead of 150. At the close of the course, the Degree was conferred
upon the following approved candidates:

RKSIDRNCE. TIIR.SIS.

Georgia, Gastritis.

NAME.

J. H. Walton,
G. G. Mathews,
J. A. Ethi idge,
J. H. Oliver,
A. G. Hulsey,
E.M. Feint,
Thofiias J. Hester,
W. Capers Bowie,
Andrew Young,
H. C. Hines,
J. E. Ellison,
Henry Rossignol,
H. A. Bignon,
A. C. Hart,
Juriah Harris, Jaa'r.,
R. T. Stell,
O. J.Seitle,

E. W. Perry,
J D. Twiggs,
Lewe Sessions,
T. A. Ward,
T. C. H. Wilson,
H. E. Hurst,
J. P. Clopion,
Cicero Gib.son,
Robert Montgomery
D. F. Bovvers,
R. L.Warren,
Enoch Mulkey,
T. D S. Ryan,
S. G. N. Ferguson,

F. E Fitten
William Lindsey,
W. P. Parker,
T. E. Massingale,
R. A. Trippe,
John Clardy,
J. A. Williams,
W. tl. C Prior,
J. R. Johnson,
J. L. Harris,
J. H. Walker,
D. B. O'Sullivan,
D. A. Rich,
J. N. Simmons,
C. C. H. Mathews,
M.J.liolan,

G. B. Knight,
W. R. Ncal,
John Riordon,
J. W.Yarhorongh,
Lafayette Riley,

" GonorrlKra.

" Bloodletting.

" Acute Hepatitis.

" Typhoid Fever.

So. Carolina, Oil of Turj)entine.

" Rhus Toxfcodendrum.

Georgia, Plireniiis.

" Pneumonia.

" Foetal Circulation.

" Medical Reform.

" Gonorrhoea and Chancres.

" Sulphate Cluinine.

" Intermittent Fever.

On the Blood.

" Bloodletting.

So. Carolina, Intermittent Fever.

Georgia, Pneumonia.

" Effects of Tobacco.

" Gonorrhoea.

" Prolaj)su8 Uteri.

" Mercurials in Fever.

Alabama, Fevers.

Georgia, Medical Profession.

" Diseases of the Liver.

Tennessee, Iodide of Potassium.

So. CaroUna, Dyspepsia.

Georgia, Congestive Fever.

" Phlegmasia Dolens.

" Uterine Hemorrhage.

" Diarrho-a.

Alabama, Menoirhagia.

Georgia, Purpura Hemorrhagica.

" Obstructed Labour, 6t.c.

" Conge.'^tive Fever.

" Menstruation.

So. Carolina, Laryngitis Membranacea.

Georgia, Remitting Fever.

" Cliiinine.

Alabama, Intermittent Fever.

" Intermiiienl Fever.

Georgia, Inllammaiion.

" Science of Medicine.

" Drastic Cathartics in Paroxysmal Fever.

' Iodine.

Bloodletting.

^' Medicinal Combination.

" Erysipelas. '

" Organic Medicine.

" Iodide of Pota.ssium.

*' Gonorrhoea.

" Intermittent Fever.

1848.] Medical Intelligence. 351

Of which number, 42 were from Georgia,
5 from Souih Carolina,
4 irom Alabama,
1 from Tennessee.

Total, 5-2 Graduates.
Prof, Garvin, on the part of the Faculty, delivered a very excellent and ap-
propriate Addiess to the Graduating Class, and Dr. Fittex, of their number, in
his response, did honor to himself and his associates by whom he had been se-
lected lor the occasion.

Chloroform applied to Midwifery, as icell as Surgery, in Augusta, Ga. With
much pleasure, we give place to the loUowing letter, with the sentiments of
which we pretty well accord. Differences of opinion and practice too, must be
expected in a country like our own, where medicine may be exercised without
restriction. Where neither the law nor people acknowledge science in the
healing art, the introduction of any new potent agent as a remedial means
must be attended with disastrous results in its indiscriminate application to dis-
eases. The discoverer of chloroform to produce insensibility, Prof. Simpson,
of Edinburgh, expressly staled that as it contained no oxygen, a closed inhaler
should never be employed. A handkerchief or sponge was recommended in its
administration to patients; so that the atmosphere might have access to the nose
and mouth during respiration. An air-tight inhaler was recently employed by a
dentist in Cincinnatti, to produce insensibility in a lady whose tooth was about
to be extracted; and the news-papers of the day are widely circulating the report
of her death. Had carbonic acid gas been used, instead of chloroibrm, the
same unpleasant result could not have been more effectually secured. Chloro-
form, like every agent of the materia medica, requires discrimination in its
application.

Since the report in our last No. (and we here correct an omission in it, viz:
on page 188, l3th line, between the words "cases" and "to", please insert vriih
one exception,) we have resorted to chloroform ization in a lew cases. Besides
the one published under the original department of this No., it has been employ-
ed in a case of Hare-lip, Episioraphy,* Strabismus, &;c. In the case of Lithot-
omy, the rectum was freely evacuated after the state of insensibility was pro-
duced, although the bowels were stated to be empty. In the Hare-lip, for fear of
strangulation by the blood entering the larynx, the anaesthetic condition was de-
signedly only partial. In the Episioraphy, we found the operation could not be
performed while the woman was under the influence of the chloroform. The
rectum, by its involuntary contraction, would occasion the inferior posterior
surface of the vagina to bulge up, which when removed by the finger, the
uterus would descend, Chloroformization had to be abandoned, and the opera-
tion performed without its aid. In the operation for Strabismus, a hook was
used to draw the eye outwards, to expose the tendon of the internal rectus mus-
cle. This was in our own son, aged 13 years.

Letter from Professor J, A. Evk to the Editor, on the use of Chloroform in
Obstetric Practice.

March 15th, 1845.
Dear Doctor Before taking leave of our last Class, I expressed to them my
thorough conviction of the safety and utility of the Chloroform in Obstetric

Epieion, the labia pudeadi, and raphe, suture.

253 Medical Intelligence, [April,

Practice; as these have certainly been satisfactorily demonstrated by Professor
Simpson, to whom the gratitude of the gentler sex and the medical profession is
due for having introduced it into obstetrics. And its safely and utility deter-
mine the propriety; for it is absurd toobject to its use as an attempt to counter-
vail ilie Divine decree which said to our lirst mother "in sorrow thou shall bring
forth." The argument would be equally good against all obstetric assistance,
and indeed of equal force against any prolession or calling in life, by which
any descendant of Adam may "eat bread," otherwise than "in ihe sweat of his
brow." li is certainly much more consonant with sound reason and irue reli-
gion, to regard all the discoveries and improvements in Science and Ait as the
blessings of God, given to soften the severity of the primeval curse, and melior-
ate man's fallen state, without respect to person or sex.

But whilst the safety of Chloroform, in properly selected cases, has been
demonstrated, it is unreasonable to suppose that an agrnt, so powerful in its
action on the nervous system as entirely to suspend sensibility, can be alto-
getlier devoid of danger, in some cases, and no caution requisite in its admin-
istration.

My opinion is, that it .should only be administered in labours of unusoal
severity, or wherein some capital obstetric operation is required, and never,
unless the system is free Irom disease, especially from those of the head, or even
a predisposition thereto. That it should rarely, if ever, be given before the ter-
mination of the first stage; that the patient should not be kept under its influence
more than one or two continuous hours, but be allowed to wake up, and after a
short interval be put to sleep again, as often as may be considered necessary.

On the 4th instant, I administered the chlorolorm to a lady whose former
labours had been very painful and protracted: at a quarter past 10 o'clock, P.M.,
soon alter the second stage had commenced she began to inhale itsimply poured
on a handkerchief, as a piece of sponge could not be procured. She soon fell
asleep, but the uterine contractions continued with equal force and more efTect.
My first remark was, that the coniraction.-* were more efiicient in advancing
the labour, though farther apart, but on timing the intervals by a watch, it was
fouhd that they were only apparently long, from the intense anxiety with
which I waited for the uterus to act, and that sometimes the interval was not
more than two or tlirec minutes. Her pulse became slower. Her respiration
was sometimes audible, but never stertorous; during most of the time siie slept
and breathed as sweetly and softly as an infant. She would occasionally wake
up partially, and eagerly grasp and press the handkerchief to her nose to deepen
the effect. She continued under the influence of the chloroform an hour and a
quarter, unconscious of pain until alter the expulsion of' the head, when she
awoke and earnestly entreated for more, but the supply was exhausted. She
declared that if she had had more, the whole birth would have been accomplish-
ed without her knowledge; but even as it was. she said she did not suffer near
as much, as she oiherwise would have done, from the last pain or two required
to terminate the delivery, in con.sequence of having had so long a respite from
pain.

- 1 confidently believe, had she not taken the chloroform,her labour would have
continued some hours longer, as on former occasions, when her children were
much smaller than in this instance; the child weighed eleven pounds.

The agency of chloroform in accelerating labour is most probably attributa-
ble, in a great degree, if not principally, to its effect in rendering the patient
silent and motionless, when no power being expended in exclamation and mo-
tion, all the energies of the system are concentrated on the uterus.

This lady compared the sensation excited in her head, by chloroform, to the
sound often thousand hammers, but it was not at all painful or even uni)lea.sant.
She expres.sed herself in the highest degree deliglited with its efl'ccts, and
thanked EJeavcn that she had had resolution enough to take it that hereafter
she would not be afraid to use it forany purpose.

Not the slightest injury was sustained, eiiher bv mother or offspring.

Since the above was written, there has been published inllie Medical Exam-
iner a letter Irom Professor Meigs to Profes.sor Simpson, in which Ihe former
gentleman objects to chlorolorm, in obstetric practice 1st, because he regards
the pain in parturition as physiological, and thinks it ought not to be suppressed,

1848.] Medical Intelligence. 253

and 2dly, because, in the employment of instruments, he considers it necessary
tokn(jw how much the patient sutlers to avoid doing harm.

The first olijection appears to me rather more specious than solid, for admit-
tinsr the pain to be physiological, I can perceive no good reason why ii should
not be relieved, if susceptible of relief, without interference with the process or
injury to the paiient. But it is a difficult question to determine how much pain
is strictly physiological, or essential to parturition, and how much is the result
of the unnatural and injurious habits and customs of civilized life; for we
know that in the savage state and among those whose manner of living is more
natural and conducive to the healthy performance of all the physical lunctions,
there is comparatively very little pain or danger; and even in the most refined
society, instances are not very uncommon of almo>t painless labour.

In what are styled easy labours, or whenever the suffering is not intense,
anaesthesia is scarcely necessary, even if there were no danger at all. But pain,
when inordinate, is itself a great source of danger, as it may destroy lil'e direct-
ly, or indirectly, by inducing convulsions or other fatal affections; it should
certainly therefore be at least abated, whether physiological or pathological.
If (here were no dangers to be apprehended from pain, it is in itself a greaievil,
and its relief an object of vast importance, one of the happiest achievements and
highest triumphs of meuicine. Surgical statistics declare a diminished martali-
ty, iindrr the use of anaesthetic agents, and I think it highly probable there will
hereafter be the same result in obstetrics.

Professor Meis:s' second objection does not appear to me much more valid
than the first. The degree of pain actually felt is not always in proportion to
the injury sustained, and the expression is a still more fallible criterion.
Some complain excessively when suffering comparatively very little, whilst
others make very little complaint, however intense their sufferings may be.
Nothing can compensate to the accoucheur fur a want of the most minute and
accurate knowledge of the maternal structures and the position and relations to
them of the foetal head. He should always operate by art and not by force,
graduating the power emploj-ed by his knowledge of what may be applied and
borne with safety, and not by the resistance to be overcome: he should always
know that he is using no destructive violence, inflicting no injury, whether the
patient be sensible of it or not. It would certainly be a very uncertain and un-
safe reliance, to depend on the patient to inform us whether we are applying
and using instruments properly. One great source of embarrassment and dan-
ger in operative midwifery is the difhculty often encountered, of controlling the
voluntary movementsof the patient, which is entirely obviated by the anaesthetic
influence of the chloroform. It is in instrumental deliveries, and during the
performance of other important obstetric operations, that I consider its adminis-
tration peculiarly appropriate and advantageous.

With sincere regard, your friend,

J. A. EVE.

The first meeting of the Medical Association of Alaiama^ We have received the
following intelligence respecting the first regular meeting of the Medical Asso-
ciation of Alabama: It was held on the 8ih and 9th of March, at Selma Dr.
R. Lee Fearne, was elected President for the ensuing year; Drs. S. D. Holt and
B. R. Hogan, Vice Presidents; Dr. J. Marion Sims, Recording Secretary; and
Dr. H. V. Wooten, Corresponding Secretary. Committees were appointed to
investigate the diseases, &c., which may occur during the year in the different
sections of the State, and report fully on the subject at the next annual session,
which will be held in Welumpka on the first Tuesday of March, 1849. The
following Delegates were elected to the National Medical Association: Wm.
B. Johnson, P. H. Lewis, A. Lopez, B. R Hogan, H. V. Wooten, D. H. Byth-
erwood, J. E. Prestridge, B. A. Blakey, Ed. Gantt, F. A. Bates. Dr. A, G. Ma-
bry was appointed to deliver the next annual address.

The meetiog, we learn, was a full one, and the very best spirit pervaded ita

254 Medical Intelligence. [April,

members. The adJress ofour dlslinguished contributor, Dr. Woolen, will be
published in pamphlet form.

M:dical Convention nf Snuih Carolina. We Icfarn from the March No. of the
Charleston Medical Journal, that a Convention has recently been held in that
city of the Physicians of South Carolina. It resulted in the formation of the
South Carolina Medical Association, with the following named ofTicers:
Dr. Moultrie, President; Dis. Branch and Ready, Vice-Presidents; Dr. Cain,
Recording Secretary; Dr. Johnson, Corresponding Secretary; Dr. Robertson,
Treasurer; and Dr. Gaillard, Orator for 1819.

To the Editor of Ike Southern Medical and Surgical Journal .'

At a regular meeting of the Georgia Medical Society held on the 2d instant,
the following gentlemen were elected officers for the present year: President,
Richard D. Arnold, M. D. ; Vice-President, P. M. KoIiocU-, M. D.; Secretary,
Treasmer and Librarian, Johnston B. Tufts, M. D.

Very respectfully, your obedient servant,

JOHNSTON B. TUFTS, M. D., Sec'y G. M.S.
Savannah, March 3d, 1848.

Epidemic Pneumonia. Dr. Jones writes to us from Irwinton, Ga., dated Feb.
1818: "I am now very busily engaged in treatitig an Epidemic Pneumonia
which is prevailing extensively .in this and the counties west of this place.
There is something particularly interesting in the history of the disease, but it is
impossible for me to give it to you now. It is confined entirely to the districts
and water courses where intermittent fever is most prevalent during autumn.

"The attack is sudden and violent, with great prostration of strength; rapid,
feeble, and irregular pulse; the peculiar rusty sputa appear in a few hours.
It will not bear well general depletion large doses ot quinine give almost cer-
tain relief."

Permanent recovery from Deafness, by the inhalation of Ether. We have the
fact from good authority, that a lady in Macon, Ga., while subjected to etheriza-
tion for the extraction of a tooth, suddenly recovered her hearing. This occurred
some months ago, and the perception of sounds remains perfect.

Epidemic Measles: Fvom all sections of our State, and from .several of the ad-
joining ones, we learn the prevalence of the Measles. Its character in this
city thus far, is mild.

H"aJtk of Augusta, G^nrrria. During the sixteen Sessions of Lectures in the
Medical College of Georgia, embracing four months of each year and about
125^ Students, there has occurred but one death.

Ano^ljcr fact on the same subject, is, that we have four persons, three white
and one colored, residing in the same family, each over 80 years old. They are
from the French West India Isles.

MF.nirAL MISCELLANY.
M. TIc'not, surgeon in chief and professor of the Military Hospital of Instruc-
tion at Metz, France, has performed successfully the disarticulation at the coxo-

1848.] Medical Intelligence. 255

femoral joint. The patient was under the influence of the ether; aged 26 years ;
disease, a voluminous exostosis: method, anterior and posterior flaps ; lime, 5
minutes and 30 seconds, including the ligatures to the arteries of the anterior
flap.

M. Liston died on the 9th of Dec, of an aneurism of the aorta near the in-
nominata. It had opened into the trachea.

The celebrated chemist. Baron Berzelius, has for two months past, Nov, and
Dec., been laboring under paralysis of the inferior extremities. His intellect
remains perCect and his Secretary writes every day, while he dictates. He also
carries on his chemical experiments.

M. Bouillaxid, having declined the Presidency of the Academy of Medicine
in Paris, M. Royer Collard was elected in his place. M. Velpeau, vice-Presi-
dent, and M. Melier the annual Secretary,

It is proposed in Germany, to levy a tax on all dogs, as a prophylactic means
against hydrophobia. How many worthless curs exist in the United States,
each one of whom, besides consuming what might support a hog, may possibly
be the means of propagating a most terrible and incurable disease. We counted
in our city the other day, eleven dogs following one black boy.

There are no less than 36 missionary Physicians now engaged in the work of
civilizing and converting the heathen world. Of this number, a large majority
are from the United Stales.

OBITUARY NOTICES.
At a meeting of the Faculty, Alumni, and Students of the Medical College of

Georgia, held on the 20th March, 1848, the following Preamble and Resolu-
tions were unanimously adopted :

Having by Divine dispensation been bereft of our friend and associate,
Dr. David A. Rich one whose life was not only blameless, but who united to
talent of high order, an abiding love of virtue, an amiable disposition and
amenity of manners, which never failed to secure the respect and admiration
of all who knew him Therefore,

Resolved^ That we deplore the death of our lamented friend and associate,
who has been cut off in the vigor of life, and in the midst of bright prospects of
a useful and honorable career.

Resolved, That as a mark of resjject to the memory of the deceased, we will
wear the usual badge of mourning for thirty days.

Resolved, That a copy of these resolutions be forwarded to the relations of our
departed friend, as an expression &f profound sympathy in their sore bereave-
ment.

Resolved, That these proceedings be published in the city papers, and in the
Southern Medical and Surgical Journal.

G. M. NEWTON, Chairman.

J. N. Simmons, Secretary.

Deathof Dr. Hardrn of Georgia. With deep regret it becomes our painful
duty to record the death of Dr. Harden,of Liberty county, Ga. It was never our
good fortune to meet him in life; but for years past we have been associated
with his name in the medical periodicals of the day. He was a graduate of the
Pennsylvania University; had contributed largely to our medical journals: he
^ died of dyspeptic symptoms near Tallahassee, Florida, on the 16th February,

256

Medical Intelligence. Meteorology.

1848, at the early age of 33. In a precedinj? No. of this Journal, voj. 2, p. 590,
Ave look occasion to express our opinion of Dr. Hardcn's contributions to the
meclic.nl literature of our country. His articles in the Southern Medical and
Surj^ical Journal, and in the American Journal of Medical Sciences, had se-
cured to him a well earned reputation as a writer. Hisresenrches onlsopathia,
or the Parallelism of Diseases, were alone suHicient to stamp him an indefati-
gable student and a man of decided talent. No one in this State has done more
for medicine. Under many disadvantages he toiled on undismayed by disease
or death itself, and with the christian's hope he sank into an early grave. We
mourn the loss of one of the most active and interesting collaborators in the
death of Dr. John Macpherson Berrien Harden ^^society, one of its most useful
and benevolent members science, a true friend and ardent cultivator and our
profession, a must devoted and kind-hearted brother.

Deaths in Philadelphia. Dr. Hbwson, for many yenrs one of the Surgeons to
the Pennsylvania Hospital, and long engaged in extensive practice in Philadel-
phia, has just died at an advanced age.

Dr. Jacob Randoi-pu, the son-in-law of the late Dr. Physick, one of the Sur-
geons to the Pennsylvania Hospital, Lecturer on Clinical Surgery in the Uni-
versity of Pennsylvania, we learn by the pa])ershas also suddenly deceased.

MliirEOROLOGICAL OBSERVATIONS, for February, 1848, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

Sun Rise.

TllF.R.

3.S
44
40
54
39
29
20
32
2S
33
46
3(;
30
32
55
50
50
52
40
50
50
0
55
51
41
3S
39
30
40

AR.

I 2, P

29 83-100
" 72-10.1
" 05-100
" 45-100
" 4.5-100
" 02-100
" 82-100
" 07-100

30 2-100'

29 94-100
" 84-100'
" 93-100

30 14-100
30 2-100
29 91-100

' 85-100
' 70-10.)
' 80 1 0 |
' 81-100
' 02-100
' 00-100
' OVIOO
' 80-100
' 74-100
' 89-100
' 9M00
' 93-100
' 85-100
' 03-100

50
01
54
60
44
40
50
55
53
55
60
53
50
60
59
61
68
52
55
60
(iO
60
62
47
41
42
60
64
73

M.
Bar,

Wind.

29 80-100
" 62-l00|i

" 62-uyo'

" 4.5-lOOJ
51-100
72-1001
87-100

6i-ioo:

30 2-100!

29 88-100;
83-l()()!
95-100

30 12-100
29 90-100

' 88-100
' 81-100
' 70-lOi)
' 80-1110
' 72-100
' 01-100
' 72-1110;
' 57-100
' 81-100
' 77-100
' 90-100
' 98-100
' 87-100
' 83-lOv)
' 03-100

s.
w,
w.
w.
w.

N. W.
N. W.

E.
S. W.

N.
S.

s.
s. \v.
s. w.
s. w.

K.
8 W.

s.
s.

N. W.
N.
N.
N. K.
N.
W,
W.

Rem

ARKS.

Cloud V afternoon.

Ch)udy breeze.

Fair blow.

Fair blow.

Fair.

Fair blovi'.

Fair.

Cloudy.

Cloud}' sprinkle.

85-100.

Fair smce

Fair

Fair.

[Rain,

[Rain,

Cloud)

JRain drizzly.

(Cloudy.

Cloudv hcavv

Kain,' )

Kail), >

Cloudv rain, )

2 inches.

2 o'clock.

[4.5-100.
rain at 12 M.

2 inches and
65-100.

Rain.)
Rain, \

Cloudy sprinkle.
('lc)U(iy.
I"\iir breeze.
Fair breeze.

10 Fair days, auantity of Rain 6 inches 30-100.
3 days. West of do. do. 15 days.

Wind East ofN. and S.

SOUTHERN

MEDICAL AND SURGICAL

JOUR N A L .

Vol. 4.] NEW SERIES MAY, 1848. [No. .

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE XX.

Observations on Malarial Fever. By J. A. Mayes, M. D.,

of South Carolina.

When we reflect upon the organization of man, and observe
the play of the vital forces, as displayed in the functional activity
of organs, producing assimilation, secretion and excretion ; when
we observe the muscular development, indicative of strength ;
and the nervous system rendering the man capable of perceiv-
ing the impressions of external agents ; we are naturally led to
make an inquiry into those causes which maintain this action
when once established. In this investigation, the speculative
mind of man has been long diligently engaged, and the important
facts which have been elicited by this scrutinizing inquiry, have
served as the basis upon which to build the theory of disease.
To the medical philosopher, the study of man in the healthy
state is all important : unless he knows what it is that constitutes
health, he can never have a correct idea of disease. Health is
a term which admits of no exphcit definition- it is only a word
expressive of the aggregate condition of organs ; disease is a
term expressive of the same, and none can have correct ideas
of the latter without a full understanding of the former. Thus
we account for the thousand theories of disease which have had
their day, and thus we account for the rejection of hundreds,
which in times past have been regarded by their advocates as
the only safe theory by which to be guided in medical practice.
The Science of Physiology being still progressive, manv theo-
ries which are now the reigning favorites, will become supplant-

17

258 Mayes, On Malarial Fever, [May,

ed by others, which will be based upon the future discoveries
of physiologists. But, because this is so, need we now fold our
arms and do nothing? The advancement of the medical sciences
should not be left to physiologists alone ; but it becomes us who
are more intimately connected with medical practice, to make
the best use of the light which has been already given us. Per-
fection is not yet to be attained in Medicine ; but he, who does
not exert himself to establish that practice, which he believes
to be in accordance with the present state of physiological
science, does not discharge his duty to his profession or to his
country.

All agents, innocuous or morbific, can act upon the human
system only through the intervention of a perceptive medium ;
and as this perceptive faculty is universally assigned by physi-
ologists to the nervous system, we must look upon that system
as being primarily disordered in every form of disease. That
the intervention of this perceptive medium is absolutely neces-
sary, is a po'nt, which might be assumed as a known fact, and
passed over without argument, since none could safely deny its
truth ; but as upon this point hangs the theory which I shall ad-
vocate in this article, it will require more than a passing notice.
Perception is a fundamental requisite of existence; the divine
spark of hfe itself cannot animate our bodies without the inter-
vention of this principle, for without perception of its presence,
could animation result ? The food which we receive into our
stomach would not answer the purpose intended ; nor the
medicine we take in sickness, nor the cooling draught to allay
our thirst, unless that organ perceived its presence. Without
perception, the ideas of light, colors, beauty or deformity, could
never have entered our minds ; the sense of taste could never
exist ; in short, without perception, nothing could have been
created, for chaos itself perceived the power of the Almighty,
and the ultimate elements of the organic and inorganic creations
hastened to dispose themselves at his command.

It being universally admitted that the nervous system is the
medium through which the impressions of all external agents
are perceived, it is unnecessary to dwelt longer upon this point,
and therefore the important subject of Irritation will be at once
taken up. Any attempt to give a concise and explicit definition

1848.] Mayes, On Malarial Fever. 259

of the term Irritation would likely end in nothing satisfactory,
since the constitutional disturbances produced by different irri-
tants vary a great deal; antimonials, alcoholic drinks, and
narcotics, produce a series of symptoms peculiar to each, and it
is this difference in the constitutional effects of different irritants
that produces variety in diseases. The disturbances produced
in the system, by any irritant, will be in proportion to the force
of the impression : a moderate light gives us pleasure, but the
glare of the mid-day sun gives us pain, and even deprives us of
sight ; the sound of sweet music is enchanting, but the filing of
a mill-saw is extremely unpleasant. All agents capable of
making an impression upon the system, or any part of the nerv-
ous system, are irritants, strictly speaking, though that term is
usually applied to morbific agents. Sight, hearing, taste and
touch, are all instances of irritation, though not mrorbific ; the
agents producing these various sensations are all irritants, their
impressions being recognized by that perceptive faculty with
which the nervous system is endowed. The peculiar effect of
these irritants on the nervous tissue itself, the particular changes
which- it undergoes in order to convey distinct ideas to the
mind, are utterly incomprehensible. And this is the case with
those more potent irritants those capable of producing serious
constitutional disturbances. We can readily detect the exist-
ence of irritation, but we cannot define its intimate nature.
The agent makes its impressions, the nervous tissue perceives
that impression, irritation is themanifestationof that impression
and the constitutional effects are the result of the irritation.

As a general rule, the effects of each individual irritant are so
well marked, that it is not likely the cause of the disturbance
will be mistaken. The fevers of malarial origin have some fixed
characters which serve to distinguish them from all other fevers,
though agreeing in many points with others produced by differ-
ent causes those fixed characters (to be more explicitly men-
tioned afterwards) serve to rank them as a distinct class of
diseases. The disorders produced by cold and atmospheric
vicissitudes have also certain characteristics, by which they can
be readily recognized. The peculiar effect of cold upon the
nervous tissue and the consequences, will of course receive no
consideration here, but the class of ^diseases are mentioned as

260 Mayes, On Malarial Fever. [May,

afTording corroboration of the remark made above. So in the
exanthemata, venereal poison, and those diseases supposed to be
propagated by hereditary transmission; in all of these there is
little risk of mistaking the cause.

Again, all those substances taken into the body for its nour-
ishment all those agents which produce the different sensations
of touch, smell, &c., and all the appliances made for our com-
fort, being made perceptible through the intervention of the
nervous system, we are led to the conclusion that the nervous
system is the avenue to health as well as to disease, and that
Health is but the perception of those impressions that are inno-
cuous, whilst disease is the perception of those that are hurtful.
There being, in the present state of our knowledge, no other
mode to account for the phenomena of health than by supposing
the integrity of the nervous system to be unimpaired, it would
be unphilosophical to suppose that the phenomena of disease
could depend upon any thing else than upon disorder of the
same system. We all know the vital importance of a due sup-
ply of the nervous current to any organ, and if that nervous cur-
rent be disordered in any way, can we expect any other result
than an irregular action of that organ. Look at the liver that
pet of practitioners how could its functions be interrupted in
any manner other than a disturbance of its nervous supply the
lungs or any other organ. Thus a true theory of disease, to be
secure, must be based upon the theory of health, and we are
compelled to arrive at the conclusion that irritation is as neces-
sary to health as it is to disease ; and that the difference in the
two conditions is caused b}- the difference in the impressions of
the irritants. This view would lead us to expect a revolution
in medical practice ; but this revolution cannot be fully accom-
plished until the doctrine of nervous irritation can be successfully
applied to all classes of disease ; that this is already being ac-
complished, is known by all who keep pace with the progress
of the science.

Some irritants produce direct constitutional debility other,
indirect debility. The heat of a Southern climate relaxes the
system and exhausts the vital energies, producing indirect de-
bility, and with this loss of tone the mobility of the nervous
system is excessively increased. Under these circumstances, a

1848.[ Mayes, On Malarial Fever, 261

person exposed to malaria will readily contract fever. The
fever is the evidence of the increased mobility of the nervous
system, and as this increased excitability is owing to the loss of
tone, any treatment other than a soothing and tonic course would
be improper.

The particular irritant, the effects of which I propose to dis-
cuss, is Malaria. Notwithstanding so much has been written
on this subject, the origin of malaria is still involved in obscurity,
and as my own observations have led to no discovery of the
manner or cause of its generation, I shall pass over this part of
the subject very hastily.

The influence of malaria does not appear to be felt at any
considerable distance from its source. I have known families to
remove but a short distance, three quarters of a mile, from a
swamp, abounding in a highly concentrated malaria, who es-
caped the agues through the whole season, whilst those who still
remained on the- swamp suffered severely from its attacks.
Living in a malarial country, my attention has, of course, been
often directed to this question, and my opinion is, that under
favorable circumstances as to position and growth of trees, the
influence of malaria would be felt only a very short distance
from its source. I have strong faith in the healthiness of the
pine lands, and provided I could get a forest of pines a quarter
of a mile in breadth between the sources of malaria and the fami-
ly residence, I would have but little fear of the ague.

The particular portion of the nervous system upon which
malaria makes its impressions is a question which has been dis-
cussed by some ; but as I am under the impression that this is a
matter of but little practical value I will not attempt its discus-
sion. Dr. Ford has located the seat of irritation in the spinal
marrow, but I think the centre is not more affected than the
periphery ; in short, I am disposed to regard the entire nervous
system as affected by it : the constitutional disturbances in
many cases being very general the various organs of the body
being more or less disordered. With malaria, as with all other
irritants, the effect of the impression is in proportion to its force.
We have in the same season, fevers of every grade of severity ;
and in the same family at the same time, fevers of all the differ-
ent types. Occasionally the force of the irritant seems spent

262 Mayes, On Malarial Fever. [May,

upon one organ at other times, all suffer more or less, and in a
great many cases, no constitutional disturbances of any import-
ance ensue.

The amount of constitutional disturbance resulting from the
impressions made by malaria upon the nervous system, varies
much ; difference of type indicating, in a great measure, the
difference in the force of the impressions. Thus, in the remit-
tent type, we observe the greatest amount of disordered action
in the various organs, and in the quartan ague, the least the
intermediate types presenting a degree of severity intermediate
between those two extremes. In cases, where all the organs
are implicated, and the poison is supposed to be more diffused,
we seldom meet with any symptoms indicative of great danger ;
but, on the other hand, where the forces of the poison is concen-
trated upon one organ, as the brain, lungs, stomach or liver, the
patient is in danger of dying from congestion or inflammation.

Inflammation and congestion have both been regarded by
many as symptoms indicative of a variety of fever proceeding
from some other cause than malaria ; but observation has serv-
ed, in a great measure, to correct this erroneous opinion. The
term congestion has not been in use very many years as a mark
of distinction between those malignant forms which were once
regarded as purely inflammatory. Local inflammations do now
and then occur in the course of treatment, but it is a matter of
doubt, whether the inflammation proceeds from the treatment,
or whether it is a consequence of irritation of the organ by the
poison which originally caused the fever. The fact that the
intermittent types are seldom or never complicated by local
inflammations, would give authority to the latter conclusion ;
but it is a lamentable fact that it does undoubtedly proceed, in
many cases, from medical treatment. Irritability of the stom-
ach can be easily changed to inflammation: so can duodenitis,
enteritis and colonitis, be produced by the improper treatment
for irritability of those portions of the intestines. Duodenitis
is particularly liable to be produced in this way, as it is upon
this portion of the intestine that calomel exerts its chief influ-
ence; and when we consider the frequency with which patients
are dosed by this mineral, we need not be surprised to find a
slight tenderness of the epigastrium under pressure, change in a

1848.] Mayes, On Malarial Fever. 263

few days to exquisite pain. Strange to say, this tenderness of
the epigastrium is regarded by many as an indication for the use
of large doses of calomel, and this indication is regarded as still
more urgent if the irritation of the duodenum and stomach is
sufficient to cause vomiting.

The Remittent fever has been emphatically styled the Bilious
fever, and is that form of fever which has been heretofore re-
garded as the disease which calls loudly for calomel in its treat-
ment; but before we adopt this opinion and practice, it is wise
to inquire how far it is right. The symptoms of constitutional
disturbance which usher in an attack of remittent fever cannot
be distinguished, by the closest observers, from those which
precede the intermittent. In both cases, we have the languor
and sense of weariness, the general and the local pains, the dis-
ordered state of the bowels, want of appetite ; and these general
symptoms continue in both cases about an equal length of time.
The chill, at length, supervenes, and in either case, it may be
very light or it may be a protracted ague ; the fever rises imme-
diately on the subsidence of the chill ; the general and local
pains which produce so much suffering during the chill, now
leave almost entirely, and a new order of symptoms arise ; the
head aches and the eye is intolerant of much light ; the stomach
becomes irritable and vomiting of almost every thing taken into
that organ ensues ; the thirst is great, and if much drink is taken
the vomiting is sure to be increased. Bilious matter is now
thrown up, indicating that the contents of the duodenum have
been forced backwards into the stomach : this series of symp-
toms will continue for several hours, and then, with the decline
of the fever, they all disappear. Until the decline of the fever,
no one can tell whether it will be a remittent or intermittent ;
or if the fever is determined to be an intermittent by the com-
plete apyrexia, who can determine the type before the next
paroxysm ensues ? Thus, the symptoms being the same in both
forms of fever until the declension of the paroxysm, we have
'the best of reasons for concluding that the two forms of fever,
remittent and intermittent, are produced by the same cause;
and that the essential difference between the two viz., in one
a complete apyrexia between paroxysms, and in the other a re-
-mission of all the symptoms is caused by the difference in the

264 Mayes, On Malarial Fever. [May,

force of the impressions made upon the system by the morbific
agent ; and, as before stated, the constitutional disturbances in
the remittent form of fever, must necessarily be greater for that
reason, than in the intermittent. These disturbances are mani-
fested in the deianged condition of the organs, and as the liver
must of course participate in this general disturbance, and as
this participation is made more manifest by its accidental loca-
tion, and its peculiar secretion oftener seen during the fever, than
in health, it was supposed that its disordered action was the
cause of the fever. This opinion being promulgated by the
physicians of former days, the notion is now prevalent among
the more illiterate that the bile is a most virulent poison, and
consequently whenever they vomit bile in any form of disease
it is an evidence that it is a disordered secretion from the liver,
not knowing th.at the liver normally secretes bile, and that its
presence in the matters ejected from the stomach is owing
merely to the inverted peristaltic action. Bile is always present
in the upper portions of the intestines in considerable quanti-
ties ; and this quantity is well known to be increased by the
pressure made upon the liver by the muscles concerned in vom-
iting. This being so, can we not now account for the quantities
of bile we often see discharged by vomiting? The more we
vomit the more bile will be discharged ; the quantity then is not
to be taken into consideration at all, except as an evidence of
the fact that in consequence of extreme irritability of the stom-
ach, there has been a great deal of vomiting.

Again, the discharges from the bowels are watched with the
greatest solicitude, and if a purgative has been administered, all
the bile in the upper portions of the intestine which escaped
ejection by vomiting, will most likely be found in the discharges
per anum. This circumstance, instead of being thus rationally
accounted for, is looked upon as a strong confirmation of a dis-
ordered liver. Calomel is now administered, and as this mineral
irritates the duodenum very much, this irritation extends along
the bile-ducts to the liver ; for the duodenum is that portion of
the intestine into which the liver discharges its secretion. The
consecjuence of this irritation is an increased flow of bile ; and
as this bile will now be darkened, becoming greenish or darker
colored, in consequence of the action of the gases of the intes-

1848.] Mayes, On Malarial Fever. 265

tines upon the calomel, it is now looked upon as a certain fact
that the liver is disordered. Dose after dose of calomel is given,
and as by each dose the liver becomes still more irritable, pain
in the side is complained of by the patient; and if any doubts
of a disordered liver had ever existed in the mind of the practi-
tioner, it is now wholly dispelled; for what could cause that
pain, if the liver was not diseased ? At this point I will now
agree that there is a diseased liver; I will admit that the organ
has been goaded too far, and I will fear that chronic disease has
been entailed by the practitioner upon his patient. This view
of the practice by those who believe in this origin of fever is in
the main correct, though the case above may be a little too
strongly drawn, as the fever does undoubtedly yield in a great
many cases before any severe injury has been done to the con-
stitution; but how many have suftered with a lingering disease
of the liver, who date the origin of their ailment many years
back, when they suffered an attack of remittent fever. Calomel,
under that theoiy of fever, is the sheet-anchor of practice ; and
when we considei" the extensive prevalence of this theory, and
the poisonous nature of the remedy, we can no longer be at a
loss to answer the question, why do we find so few men above
the age of fifty, who are hale and strong ? Without an excep-
tion, those who have been often subjected in early life to the
practice based upon this theory, are weak, infirm old men at the
age of sixty. Hale, hearty, robust men, of seventy-five, are
found only among those who have taken but little medicine.
This reflection leads us to believe that there is something radi-
cally wrong in medical practice, that it is not consonant with
the laws of nature ; and we believe strongly that it is this very
theory which we have been combatting, that has caused the
mischief. The constitutional effects of calomel cannot with
propriety be considered here ; but our aim is to show that remit-
tent and all other types of malarial fever can be treated more
safely and more successfully without it than with it.

All the symptoms which occur during the paroxysm of fever
are dependant upon nervous irritation ; and so soon as this irrita-
tion can be overcome, the fever itself will yield, no matter
whether it be remittent or intermittent whether it be compli-
cated by congestion or inflammation ;. for congestion is but a

2G6 Mayes, On Malarial Fever, [May,

symptom of excessive irritation, and inflammation is but the
result of irritation too loni^ neglected. Cases complicated with
congestion require an energetic administration of remedies,
wholly inadmissible in simple cases ; and inflammation requires
its proper treatment, in addition to that peculiarly appropriate
to the malarial disease, which it complicates. It is a matter of
little imj)ortance where the congestion may be, the most ener-
getic treatment is required, and yet that treatment must be the
exhibition of the simplest means; no mineral compound will
avail here ; mercurials are wholly inadmissible, and we must
look to the vegetable and animal creation for the means to com-
bat this formidal)le symptom. Inflammation requires the use of
all those means long since firmlv established as the best treat-
ment, but we cannot com])at it successfully without reference
to its cause. Remove that, and we do more than half towards
the removal of the local disease. Nature requires but a little
help from us ; give her that, and she will accomplish the balance.

The irritation produced by malaria in the nervous system is
of a peculiar kind : its intimate nature we know nothing about,
but with the constitutional disturbances resulting from it, we are
all familiar ; and as the idea has been advanced in the forego-
ing pages that our treatment, to be in consonance with the laws
of nature, should be directed against the cause of those disturb-
ances, and not against the derangements themselves, it is proper
that the treatment should now receive a share of attention.

As we know nothing of the intimate nature of the peculiar
irritation produced by malaria, reasoning alone would never
lead us to its correct treatment. Experience is to be our only
guide, but we could lianlly want a better guide in practice,
than experience, especially when its results are in entire con-
formity with the theory established by Reason. To treat
malarial fever, so as to prevent any serious constitutional dis-
turbance, would require the means used to be eminently abor-
tive ; they must be such as would crush the disease by striking
at its cause. Those means must necessarily have some specific
action on the nervous system, as our theory looks to that sys-
tem as being ])rimarily aflected.

Opium, being a substance exercising an important influence
over the nervous system, was early used as a remedial agent in

1848.] Mayes, On Malarial Fever. 267

intermittent; and its beneficial effects have been such as to
cause many to repose unhmited confidence in its powers. A
North- Western writer has said that he would never feel the
want of means to combat intermittents, so long as he had a
plenty of opium; and the practice is now almost universal to
combine opium or some of its preparations with those means
principally relied on for arresting the periodical paroxysms of
intermittents. I have myself derived considerable advantage
from its use ; but I prefer not to use it indiscriminately in all
cases: its beneficial effects appearing to be more strongly
marked in cases of irritability of the stomach ; or in those
cases in which the disease appears to be making progress in
spite of the ordinary treatment. In such cases, the paroxysms
become more alarming at each return, and it is then that
opium in decisive doses 3 to 5 grs. will exert its favorable
action. In remittents, administered during the remission, it is
equally as effectual as it is in intermittents.

Camphor and Ether often do a great deal of good and are
admissible in cases where opium would be found to disagree
from constitutional idiosyncracies. Combined with Quinine,
we can place more confidence in a favorable result, than we
could expect from Quinine alone. In many cases, no other
remedy will be necessary than a combination of Camphor,
Ether and Laudanum, in full doses, to be administered just be-
fore the time of an expected paroxysm.

The Sulphate of Quinine is, however, better entitled to our
confidence than any other remedy; and when we consider the
certainty of its arresting an expected paroxysm, and its admis-
sibility in all cases, and in all stages of the disease; whether in
the paroxysm or during the apyrexia, its effects being the same,
we are forced to the conclusion, that it is a specific for the
fevers of malarial origin. Its action is spent entirely upon the
nervous system; on this point all are agreed, but what is the
intimate nature of that impression, none have been so fortunate
as to discover. We know not the intimate nature of the irrita-
tion produced by malaria, neither do we know the nature of
that produced by its great counter-irritant, Quinine.

The application of Quinine to the treatment of intermittents
has been very well understood since its discovery in 1820 ;

268 Mayes, On Malarial Fever, [May,

but ev( n n')\v, there are hundreds in the ranks of the profession
\vho know nothing of its highly })eneficial effecis in Remittents.
That false notion, which traced Remittent fever to the disorders
of the liver, is now being abandoned, and as a necessary con-
sequence, a treatment directed against its true cause has been
adopted, with results truly astonishing to those who looked upon
the bile as the evidence of the origin of the fever. Quinine
may be administered freely during the remission and with thje
assurance of perfect safety ; no matter how indistinct the re-
mission. Under this practice those fevers which were a few
years ago looked upon as fatal in a high degree, as being but a
little removed in point of danger from the yellow fever of New
Orleans or Vera Cruz, and which required the utmost skill of
the practitioner to treat successfully, are now as much under
our control, and are attended with as little danger, as the
intermittent type. This improvement in medical practice
has given rise to the remark, that diseases have changed, that
bilious fever has been supplanted by other fevers of a less dan-
gerous character. This remark is particularly apt to be made
in the neighborht)od of those physicians who understand the
application of quinine to the treatment of malarial fevers.
And it is not strange that this remark should be made by the
unprofessional, when we reflect upon the fact, that now, a man
seized with remittent fever is up and about his business, in less
than half the time it took the old routine practitioners to get
the fever arrested. The practice has greatly changed, and not
the diseases; new theories have, it is true, given new names
to old diseases, but that has been the only change except the
improved practice founded upon those theories.

It is true, that the name Bilious fever should be forgotten,
and those physicians, who, like myself, do not believe in its
existence, should make it a point never to use the expression.

Purgatives are generally very useful in all forms of malarial
fever. By unloading the bowels, we remove all matters that
may act as irritants to the intestines ; but the principal use of the
purgative is to favour the action of the quinine ; and for this
purpose, some of the vegetable cathartics in common use, will
be found amply suflicient. A compound of rhubarb, aloes and
Castile soap, is an old formula, but not the less excellent on that

1848.] Mayes, On Malarial Fever, 269

account. I think highly also of jalap, and the podophyllum
peltatum senna and the neutral salts. Any one of these com-
binations, or any other formula of simple vegetable purgatives,
will answer all the useful purposes we could expect from ca-
thartics.

However easy it may be to arrest the paroxysms of an at-
tack of malarial fever, it is generally admitted to be a matter
of ?ome difficulty to arrest the disease permanently. In this
region, there is a great tendency to relapses, and no treatment
which I have hitherto adopted for the prevention of relapses
has been completely successful ; many cases resisting all treat-
ment, and even continue to this time. The intervals between
the relapses has been generally 14 or 21 days; the greatest
number being disposed to return every 14th day. Those who
are partial to the use of calomel attribute relapses to the ab-
sence of this article in my prescriptions ; but this reflection is
entirely unwarrantable. I have used calomel in a great many
cases the past season, for the expressed purpose of determin-
ing its powers in this respect ; and the result has been opposed
tathe use of the remedy. I have even produced severe saliva-
tion ; yet the relapses occurred as regularly as before, but with
this disadvantage, the general health between the attacks was
not so good as before the mercury was used. Nor do I trust
to cases occurring in my own practice for the condemnation
of the mercurial practice ; but I could cite cases occurring in
the practice of one of the neighboring physicians, who is known
to be devoted to the . calomel practice ; and I would further
make the assertion, without fear of contradiction, that what I
state to be my own experience, would be found to be the ex-
perience of every Southern physician. My observations will
however be directed to this point during the next autumnal
season, and should my views on this subject undergo any
change, I will, as a lover of truth, immediately acknowledge
my error.

I have lately seen the result of some trials made with Strych-
nine at the North- West, but I have not had an opportunity of
testing the value of the practice. I can readily believe that it
is a valuable remedy.

I have never used arsenic for the purpose of preventing re-

270 Connell, On Ascites. [May,

lapses, except in one case, and in that the result was most
satisfactory; the principal reason for not using it more, being
the invincible objection of patients to its use. I would, how-
ever, prefer to discard all mineral medicines from my practice;
but in the present state of medical Botany, minerals are still to
be regarded as substances fit for medicine.

In the preceding remarks, nothing like a systematic disserta-
tion upon the causes, pathology and treatment of fever has
been attempted. The medical journals teeming with essays
on the subject, the necessity for dwelling upon all the points
connected with the subject, was not so urgent : it was my object
simply to give expression of my belief and practice, and to
contribute a little towards establishing that doctrine and prac-
tice which I believed to be in accordance with the present
state of Physiological Science.

ARTICLE XXI.

Ascites, folloived hy Suppuration after Tapping patient re-
covered. A Case reported by A. Connell, M. D., of Mount
Zion, Hancock county, Georgia.

I propose giving a brief history of a case of Ascites, which
occurred in my practice, and which, if you think worthy of a
place in your Journal, is at your service.

In the spring of 1841, I was requested to see Peggy, a negro
woman, aged 50, belonging to Mr. P , who had b(^en la-
boring under dropsy of the abdomen, for twelve or fifteen
years. The collection of water at the time I saw her was
very great, and I thought it advisable to tap, before putting
her under any course of treatment. March 7th I tapped
her, and drew off between six and seven gallons of wa-
ter. The character of the fluid presented nothing peculiar in
its appearence. The patient soon recovered from the opera-
tion ; and I flatttered myself, at one time, she would be per-
manently relieved by it and the subsetjuent- treatment ; though
after the lapse of two or three years, the fluid began to accu-
mulate slowly, until March 5th, 1817, at which time she was
suddenly seized with a violent pain in the right hypochon-

1848.] Connell, On Ascites, 271

driac region, which soon extended over the whole abdomen.
I was requested to see her March 7th, and to bring with me
an instrument for tapping. I found the abdomen enormously
distended, and exceedingly tender over its whole surface so
much so, that she could not bear the weight of her clothing, or
the slightest pressure of the hand. I was at a loss to know
whether the pain was produced from peritoneal inflammation,
or whether it arose simply from tension. I, however, resolved
on tapping again, and risking the consequences, as it was the
only means that promised even temporary relief I accord-
ingly introduced the trocar, and to my astonishment, nothing
but ^"purulent matter was discharged. The pain in the abdo-
men ceased, after taking away between a half and a full gallon
of this matter, except that of the right hypochondriac region
where the pain had first commenced, which satisfied me, that
this pain was produced from tension, and not from peritoneal
inflammation, as I had apprehended was the case. I withdrew
the canula, after taking away about two and a half gallons of
pus, without any change in its appearance.

I applied difl^erent tests to this matter, all of which proved it
to be pure pus. I sent a specimen of it to Dr. J. A. Eve, of
Augusta, who, assisted by Dr. Dugas, examined it carefully,
and they also pronounced it to be ^'' pure purulent matter.^"*

The patient soon recovered sufficiently to walk about the
room, and professed to be much relieved by the operation.
She was sufl^ered to take nothing but mild laxatives, and a light
but nutritious diet, for about three weeks, at which time I
again tapped her, taking away four gallons of pus, of the same
kind as the first, making in all six and a half gallons. She was
then put under an alterative course of mercury, combined with
diuretics. Under this course of treatment she rapidly recov-
ered, and was soon able to resume her usual occupations in the
family. In some two or three months, after the last operation,
she walked a distance of three miles and back on the same day,
without inconvenience.

I submit this case without comment, as it is the only one of
the kind I have ever met with, and a post-mortem examination
can alone reveal its true character.

272 Hammond, On Gun-shot Wound. [May,

ARTICLE XXII.

Interesting Case of Gun-shot Wound. By A. Lewis Ham-
mond, M. D., of Augusta, Georgia.

We frequently meet with gun-shot wounds, now-a-day, in
private practice, full of interest. The one before us is such in
several points of view. Mr. H., a civil officer of Augusta,
about 40 years old, of good constitution, well rhade, and in per-
fect health, was fired upon on the night of the 4th of March,
and feeling himself badly wounded, attempted to reach his
home. He walked a short distance, called for help and fell.
He was assisted home by the city-guard. I saw him soon after
this, and found him lying upon his face and in great agony.
A ball had entered directly in the median line of the body,
below the middle of the sternum, and had made but one open-
ing. He, however, complained when pressure was made in
the course of the sixth and seventh ribs, thus indicating the pro-
bable passage of the btdl in this direction. Dr. L. D. Ford, the
Mayor of the city, saw the patient about an hour after he was
shot. A tumour was now perceptible, forming below the
lower and outer margin of the great pectoral muscle, and below
the axilla of the right side. His pulse was extremely feeble;
the extremities were cold ; and some blood had been expec-
torated. Hot bricks were directed to his hands and feet, and
we gave the patient some brandy and water. At 4, P. M., five
hours after the wound was received, there was some reaction.

March 5th. Dr. P. F. Eve saw the patient, and suggested a
consultation with other gentlemen, which was held at 9, A. M.;
Drs. Dugas and Newton being also present. The attempt to
ligate the intercostal artery, supposed to be wounded, was dis-
cussed, but on account of the extent of injury to the right lung,
the operation was deferred for the present. The tumour below
the axilla still conlinucd to augment, as indeed it did for 24 or
more hours after the patient was shot, and acquired a size in
the cellular tissue, under the skin, ca])able of holding a quart or
more of fluid. Bui the effiision of blood and air into the chest
als(j incie:is(ul, until the right side of the thorax was nearly
filled, and the vesicular rcs])iiati(m arrested. The system, too,
had now fully reacted, and it was determined to watch the

1848.] Eve, On Unsuccessful Cases. 273

operations of nature in the case. Opiates, elixir vitriol, cold
drinks, and per-fect quietude, v^^ere enjoined in the treatment.

On the Gth, the patient appeared somewhat better ; the hem-
orrhage had ceased as far as \h( symptoms would indicate, and
he had had some refreshing sleep. The urine had to be drawn
off by a catheter. During the day a change began to be mani-
fested in difficult respiration, intense pain about the right lung,
vomitings, rapid increase of pulse from 120 to 175, and becom-
ing feeble and tremulous. His cough also increased ; he spat
up some blood, and had continued mucous rattle. These un-
pleasant symptoms resulted in death on the 8th, being the fourth
day after the reception of the wound.

Autopsy, seventeen hours after death, enabled us to make
the following report to the Jury of Inquest.

Augusta, March 9th, 1848.

In examining the body of Mr. H. this morning^ between 9 and
10 o'clock, in the City of Augusta, Richmond County, Georgia,
we trace the ball through the skin, directly in the median line
of his chest, and 2\ inches above the lower line of the breast-
bone or sternum, through which it also passed, thence it was
traced through the inferior or lower lobe of the right lung, and
out of the cavity of the chest through the seventh rib, which it
fractured near its lower edge, dividing the intercostal artery.
The ball we found under the skin and below the right arm-pit.
We moreover found the cellular tissue, about the wound, espe-
cially, at the point where the ball lodged, distended with blood
and air, as also the right cavity of the chest. The wounded
lung was likewise infiltrated with blood. The opposite side of
the chest contained serum. The ball was larger than the largest
sized buck-shot, it is compressed, as if forced into or out of the
pistol, constituting what is called a slug. In our opinion, this
wound produced the death of Mr. H. Paul F. Eve.

A. Lewis Hammond.

ARTICLE XXIII.

Vw-successful Cases in Surgenj. By Paul F. Eve, M. D.,

Professor of Surgery in the Medical College of Georgia.

A Medical Journal is wantin: which shall communicate only cases thai have
ended unlavorably. It would be ol'more service than a numtier of others.

Von Dr. F. Paidi, of Leipsic.

The prospectus of a Medical Journal designed to become the
record of unsuccessful cases, would, we apprehend, meet with

18

274 Eve, On Unsuccessful Cases. [^lay,

but little encouragement. The novelty of such a proposition
might indeed attract attention, but few could be induced to con-
tinue their support, by subscription, andstill fewer by contribu-
tion to a periodical, in which only their unfavorable results in
the practice of medicine and surgery were to be found. Still
there is a moral irnplied in the above suggestion, and we re-
quire to be often reminded of the obligation to discharge our
whole duty. With every disposition to be honest and candid,
yet because success is so flattering, we often fall short in re-
porting the whole truth. Designing to do what is right, still
we omit the disagreeable part of our duty. IIow true is it
that unsuccessful cases are never or seldom published. As
journalists, we complain of the indolence of those who might
with a little effort, add something valuable to the stores of
knowledge, for the public good, and have repeatedly urged prac-
titioners of medicine to be more industrious and faithful in
writing for the medical periodicals of the day ; but by what
appeal, we should like to know, could they be induced to send
us their unfavorable results ?

That our profession may exert its full influence, a. change in
this respect is demanded. It is only from a collection of all the
facts bearing on a given subject in medicine, that correct j^rin-
ciples in reference to it can be derived. We want the general
and not the particular cases of a surgeon or physician his
whole practice, and not the successful instances alone. The
examples of my worthy preceptors, Drs. Gibson and Horner,
of Philndelpliia, should be more generally imitated on this sub-
ject. We want more of their independence in recording and
publishing too, unfavorable cases. In medicine, give us the
whole truth.

It is true, that the position of the medical profession to soci-
ety is such and there exists so great a disi)osition, on the part of
the public, to arraign and censure its members for true or al-
leged errors, that some apology might be ofliired, at least in the
United States, for the reluctance manifested to publish unfortu-
nate instances occurring in practice. But this is not the only
reascn, and were it, we Avonld be willing to encounter it.
Who is the faultless man ? Who has not erred in the practice
of medicine and surgery ? We exercise a fearfully respon-

1848.] Eve, On Vn- successful Cases. 275

sible calling, and our whole concern is to dischdiYge faith fulli/
our duty, the consequences belong to God. The community
know this fact, that we are not and cannot be held accountable
for the results of a single dose of medicine, or any operation
whatever, when prescribed or performed according to the ac-
knowledged principles and practice of the profession. We
have yet to learn that any one will suffer by an honest exposi-
tion of the truth. We have published successful cases ; it is
proper that we give the same notoriety to those that have ter-
minated unsuccessfully.

The foregoing ren;iarks seem appropriate to the object of this
article. It is proposed to present the profession a brief narra-
tion of cases in surgery, occurring in, our practice, which have
had an unfavorable issue. Those of a striking character, ex-
citing much interest at the time, are here given. While the
catalogue may not be complete, all are included of any note
during a practice of twenty years. We have endeavored to be
candid and honest in these confessions.

Case I. Amputation of the Penis for Cancer ; death in a
few hours afterwards. In 1837, I amputated the penis of an
Irishman in our city hospital. He was near 50 years of age ;
had had phymosis, and the glans was now the seat of a large
cancerous ulcer. Hemorrhage being prevented by pressure,
made by Dr. Newton, in addition to a tape tied around the pe-
nis, near its base, about one-half of this organ was removed by
a single sweep of the knife. Ligatures to the bleeding vessels,
and the usual dressing were applied, and a dose of laudanum
administered.

Finding my patient doing well in the afternoon visit, at his
request, an orange was sent him. About 11 o'clock at night,
I was sent for; the messenger reporting him to have a sudden
and violent attack of colic, produced by his eating not only the
orange, but its rind. Before I reached the hospital, he was
dead. A mustard plaster had been applied, and more laudanum
with peppermint given to him. He had swallowed the entire
rind of the orange, and was attacked soon alter with what the
keeper of the Institution thought was cramp colic. There had
been no hemorrhage from the stump, neither had the sufferino-s
of the patient been very great.

276 Eve, On Unsuccessful Cases. [May,

In 'Taylor on Poisons/ just published, on page 23, it is stated
that there was great reason to believe that a child, aged seven
years, had died from the effects of a quantity of orange peel with
which it had gorged the stomach.

We have known the case of a child, in w^hich death resulted
from eating the rind of an orange. (Page 133, 5th edition
Wood & Bache's Dispensatory.

I think death in this case, must be clearly attributed to the
effects of the orange peel, and not to the operation performed.
Dying, as this patient did, in about twelve hours after it, it could
not have been from the exhaustion of the amputation, (nervous
or sanguine,) as the ficts prove, nor of course from inflam-
mation, because sufficient time had not elapsed for it to have
been established. A post-mortem examination could not be
obtained.

Case II. Comminuted Fracture of the Patella application
of the immovable apparatus mortification amputation of the
thigh recovers/ of patient. This case produced great excite-
ment at the time it occurred, or rather when agitated by a
conflict with the law. It is the one, for which a suit of mala-
praxis was commenced against me in our Superior Court
damages laid at $10,000 but which the plaintiff's attorney
abandoned soon after my testimony was partially presented at
the trial.

On the evening of the HUh of May, 1841, I was called to see
Mr. B., in conjunction with my cousin, Dr. J. A.Eve. While
driving a horse in a buggy, he had been kicked on the knee, and
had fallen to the ground. The leg had therefore been flexed
upon the thigh subsequent to the accident, which occurred about
a mile out of the city, and an hour or two before we saw the
patient. A transverse fracture of the patella was read ly de-
tected : as the patient was Voung and in good health, the
immovable apparatus was proposed as the most certain mean
of securing union in the broken bono. This was accordingly
a[)f)lipdat once, embracing the foot, leg and thigh. The usual
number of daily visits were made, a dose or two of morphine
and some opening medicines administci'ed, and on the 22d, six
days after the accident, a roller bandage was applied over the

1848.] Eve, On Unsuccessful Cases. 277

whole apparatus, to keep it in close contact with the limb, as it
had become a little loose by drying and the shrinking in the soft
parts. The next day the patient complained of pain, for the first
time, in the knee-joint, and the whole dressing was removed.
The limb was found cool and pale, owing probably to the com-
pression, but chiefly to the position of it, it having been kept
constantly elevated at an angle of about 45 degrees. The knee
and the parts below soon after this began to swell, and Drs.
Hook and Dugas were added to the medical council. The
unfavorable symptoms continuing to increase, amputation of the
thigh was performed on the 26th, ten days after the accident.
The patient had a good recovery from this operation.

In examining the knee-joint, it was found filled with dax'k
grumous blood, a portion of the cartilage of the internal condyle
of the OS femoris was chipped off, and the patella fractured into
a number of fragments. The portion of the adductor magnus
muscle which passes down to be inserted into the internal con-
dyle of the thigh bone, was moreover in a sphacelated condition.

On June 13th, I was called to attend to an infant in the
father's family of this patient, which was so ill that it died. As
late as August, I was employed to adapt an artificial leg to the
stump, and it was not until the next winter that the suit was
brought against me.

A statement of the case, with interrogatories, were sent to
eminent surgeons of Boston, New- York, Philadelphia, Charles-
ton, the interior of this State, &c., and by the aid thus obtained,
through the efficiency of my attorneys, Messrs. Gumming and
Jenkins, I was prepared for ti'ial on the day appointed in June,
1842. My thanks are due to Dr. G. W, Norris, of Philadelphia,
for putting at my disposition Seu tin's work on the Im.
Apparatus, just then arrived in this country; and I cannot re-
frain from inserting here the noble reply of Prof Geddings, of
Charleston, when the question was propounded to him, what is
the result of such accidents as the one I was called upon to
treat ''death of the patient, either from mortification or teta-
nus." This controversy but the more fully convinced me that
I belons^ed to an honorable profession, and was the associate of
high-minded, dignified and liberal gentlemen. I have yet to
learn that a want of success in every case is any disgrace, or

278 Eve, On Unsuccessful Cases. [May,

that this trial ever injured nie. My private class, the next
winter after it, paid all my expenses, amounting to $700. I
have fi'eely forgiven all who may have ever wished to slander
or wrong me, and I can now allude to the circumstance witlwut
an unpleasant emotion.

Case III. Failure to Ligate the Femoral Artery for false
Aneurism death in about sixty hours afterwards. The 27th
of April, 1841, I was called in consultation with three practi-
tioners of this city to a case, the history of which is as follows :
Master M., aged 12 to 14 years, had some six weeks previously
slipped on a slated roof of one of our largest houses, and fell into
the gutter containing broken window glass. The family physi-
cian could detect no foreign body, in a small wound found to exist
below the anterior inferior spinous process of the left ileum.
A tumor, however, gradually formed in this region, and which
continued to develope and bled so freely at times, that in
the end four physicians were called to the case. On the day I
made the first visit, the patient had lost a considerable quantity
of blood, and was found in nearly an exsanguinous condition.
Believing a false aneurism existed in the upper part of the
thigh, under the fascia lata, an opening near the wound which
had been previously made was enlarged, and a piece of glass^
about two inches long and narrowing from half an inch to a
sharp point, was extracted from the centre of a large bloody
tumor. The clots were now turned out of the sac, and as is
usual in such cases, no arterial opening into it could be detect-
ed. The patient was so exhausted, that no pulsation could be
felt in either of the inferior extremities. It being deemed pru-
dent and proper, I attem})tcd to ligate the femoral artery at the
crural arch. Having made the usual incisions, &c., and reject-
ing what was first sui)posed to be the artery, (for there was no
pulsation whatever to direct us,) the ligature was tied around
what all agi-eed was it.

In urinating, a few hours after this operation, tiie hemorrhage
was reproduced from the anourismal sac. This occurred, too,
when his bnwe!s were evacuated. The patient never rallied
from the time 1 ^aw him, and expired in about sixty hours after
this period. A i)06t-mortcm examiiiiition of this case was per-

1S48.] Eve, On Unsuccessful Cases. 279

mitted, revealed an immense aneurismal sac, in the upper an-
terior part of the thigh, extending into the pelvis near the ante-
rior in.'erior spinous process of the ileum. This explained
how the action of the bladder and rectum reproduced the
hemorrhage. As regards the operation, the femoral artery was
not tied; the ligature embraced onlv a portion of a tendon. In
justice to myself, I called the attention of the professional gen-
tlemen present to the facts, that I had cut upon a non-pulsating
artery, and by laying down a director, exhibited how far it had
been displaced (about an inch) by the aneurism from its natural
position. The external circumflex artery was the one injured,
I think by the piece of glass. We were not prepared to inject it,
and could not otherwise ascertain the wounded vessel.

Case IV. Trephining the Antrum Highmoinanum death
within ffty hours. The 12th of April, 1844, I operated for en-
largement of the right superior maxillary bone. The source of
the disease was quite obscure. The patient, a young lady aged
18 years, had an indistinct recollection of receiving a blow, by
a fall, upon the cheek, while going to school, very early in life.
The tumor was supposed to have originated in the antrum, and
had now acquired considerable size. The eye was distorted
by it, the cheek projected, the nostrils were closed, and the
paiatine process of the upper-jaw of the right side much de-
pressed.

An operation being decided upon, the membrane of the mouth
was so detached as to expose the anterior surface of the supe*
rior maxilla, and while the lips were drawn to the right side, the
crown of a trephine of common size was applied to the bone.
Its action was gradually continued until it had attained the
depth of one and a half inches. The enlargement proved to be
osseous, and the operation for its total removal was for the pre-
sent abandoned. The diagnosis of four physicians, that it was of
a polyix)us nature, was erroneous. A small strip of linen was
placed in the opening made by the circular saw, and the patient
retired to bed. The operation was well borne, there was no un-
usual hemorrhage nor unpleasant circumstance attendinor jt, ex-
cept the error of diagnosis, which was not communicated to her,
but was afterwards to her par^ents. The patient was seated dur-

280 Eve, On Vn-siicccssful Cases. [May,

ing the time in a laige arm-chair. She took |- gr. moq)hine when
she hiid down. The next day our i)atient was up in a chair by
an open window, as the weather was pleasantly warm, engaged
in a sprightly conversation wiih her friends. She retired early
to bed this night without a complaint or unpleasant symptom.
About 11 o'clock, having occasion to -spit, and find;ng the basin
had been removed from the chair, near the head of the bed,
upon the floor, without disturbing her mother, Avho was sleeping
with her, she reached out of bed, with her head down, and took
up the basin from the floor. A discharge of blood from the
mouth, and pain referred to the seat operated upon, roused the
family, and I was sent for. The bleeding had ceased when I
arrived, having not amounted to more than a table-spoonful,
probably not so much ; the lint was removed from the wound,
and the mouth freely washed with warm water. Having thus
quieted the alarm about the hemorrhage, a tea-spoonful of lauda-
num was administered to relieve pain and induce sleep, and at
12 I left the patient sleeping quite naturally..

Between 5 and 6 o'clock the next morning, I was summoned
in haste by the report that my patient was dying. Her mother
stated that she had slept as usual up to day-light, when, to her
great surprise, she did not answer w^hen s})oken to. The patient
was now c^^matose, unconscious, insensible ; had slightly
stertorous breathing, dilated pupils, the pulse was frequent and
feeble, the eye-lids closed, the countenance flushed and the skin
warm and moist. These symptoms continued in spite of the
assiduous and energetic treatment, consisting of cold to the head,
sinapisms over the extremities and body, stimulating enemata,
directed by four physicians. The patient expired about 12
M., fifty houis after the operation. No post-mortem examina-
tion .was allowed.

What was the cause of death in this case, so u-^expected until
a few hours before its actual occurrence ? Was it the result of
the position of the head in reaching the spit-basin, inducing
inflammation or apoplectic condition of the brain? or am I
flat ering myself in the willingness to accept this cx})lanation
o! it ? Had the laudanum, one L'a-spoonful only in quantity,
any thing to do in inducing the melancholy result? This was
of course the satisfactory cause of death which ihe public seized

1848.] Eve, On Unsuccessful Cases, 281

upon to censure the Doctors. But the symptoms were not those
ol" narcotic poison, and yet it is proper to state, that it was said
a sister of the deceased had died irom an ordinary opiate dose.

This patient could not be roused at any time ; there was no
vomiting ; the lower-jaw did not drop ; the sphincters were not
relaxed; there were no convulsions. . Taylor says, the smallest
fatal dose of the tincture of opium in an adult, which is record-
ed, is two drachms.

Admitting, as we do, that an over-dose of opium produces a
condition of the brain resembling apoplexy, and tliat this affec-
tion is rare in early life, yet being fully satisfied that one tea-
spoonful of laudanum and } of a grain of morphine was all tl^is
patient took during the period she lived after the operation, a
space of fifty hours, her death cannot be attributed to narcotism.
She died, in my op.'nion, from a congested state of the brain,
brought about by the pi'oximity of the wound to that organ, and
the unfortunate pendant position of the head, just before her
unfavorable symptoms commenced. It might have been better
practice to have given the laudanum in an enema. If in error,
I should be pleased to be corrected by my professional brethren.

Case V. Failure of an Anaplastic Operation for Cancerous
Mainma return of the disease, and death of the patient, Feb-
ruary 21st, 1846, I performed an extensive dissection for a
cancerous breast of a man, and attempted to cover the surface
exposed by healthy integuments transposed from the neighbor-
ing parts. The patient was about 50 years old, and had ob-
served a tumor, very early m life, occupying the right mamma,
which, during the lew past years, had ulcerated and greatly
increased in size, and now presented the evident signs of can-
cerous degeneration. In consultation with my friends, it was
determined to remove the whole of the diseased structure, and
to supply its place by a flap dissected from the left hypochon-
driac region. The operation was performed before the Class of
our College; the surface denuded was found to measure 22
inches in length by 9 in its lesser diameter. The base of the
reflected flap was 2| inches, and situated near the opposite nip-
ple. The number of sutures employed to retain it in its new
position was very great, and these were moreover sustained by

282 Eve, O/i Unsuccessful Cases. [May,

aihesive strips, compress and bandafre. The integuments of
the denuded hypochondriac region were made to a]iproximate
as nearly as i)ossihle by adiiesive plasters. On the 23d, two days
after the operation, the wound was dressed. An unpleasant
odor, faint at first, but increasing as the dressings were remov-
ed, prepared us for the unpleasant reality of a detachment of the
entire cuticle of the flap. On the 25th, the sutures were all ex-
tracted, and tile base of the raised and transposed integuments
cut off, as only about half an inch of its entire circumference
had adhered to the surrounding parts.

Twenty days after the operation, new tubercles began to ap-
pear on the parts from which the disease had been removed.
In vain were these attempted to be repressed by local and con-
stitutional means. The actual cautery seemed for a time to
exercise the most controlling influence over the cancer, but it
finally prevailed over all remedies suggested, and my patient
returned home to die the next fall.

Case VI. Ancient Dislocation of the Fore-arjn backwards
reduction, hut fracture of the olecranon. This case is alluded
to in one of the recent numbers of this Journal, and the impres-
sion made at the time that it w^as completely successful. We
haste to correct the error the dislocation was reduced, but at
the expense, we now believe, of the olecranon ])rocess.

Our patient. Mr. G , is a fine specimen of a man, aged 27,
height six feet two inches, weight 200 pounds. By a fall, the
left fore-arm was dit^located backwards, seven months and six
days before the attempt was made to reduce the displaced
bones. He was subjected to the influence of ether and the
])ullies, and at the end of one hour and three quarters, the fore-
arm was bent about at a right angle to the arm. (Jreat force was
used, and a distinct crackling noise heard near the elbow-joint,
at the time the })arts yielded. One pint of ether was consumed,
and when the patient recovered from under its influence, he
thought the time in which we had been engaged in the opera-
tion to have been about fifteen minutes.

Our yiatient suffered but little irom the terrible pulling, &c.,
to whicli he had been subjected; was out on the fifth day after
the operation, and lelt for home on tlic ninth day, with in.struc-

1848.] Eve, On Unsuccessful Cases. 283

tions how to use the member, and requested to report liimself
in two or three months. I saw him again in March; he had
not recovered the use of the arm to the extent expected, and
upon examination of it, I found the ulna f of an inch shorter
than the opposite one. Still the patient is satisfied with the
result of the operation, for while he has not the full use of the
limb, he can yet dress and feed himself By actual measure-
ment and comparison of the two ulnas, I have little doubt but
that the olecranon process of the dislocated limb is broken off.
This, too, is the opinion of others who have seen the case.

Case VII. Removal of a fibrous Tumor of the Thigh,
weighing 5 Ihs. 2 o% death on the fourth day after the opera-
tion,AhowX the middle of January last, I was consulted in
reference to a large tumor in the posterior region of the thigh
of an aged iVfrican. It extended from about the trochanters
into the popliteal space, and projected very considerably poste-
riorly. Being bound down by the fascia lata, it gave an indis-
tinct sensation of fluctuation, particularly in the inferior portion
of it. The patient was very aged, probably near 90 years old,
and could give a very imperfect account of his disease. He
first said it dated back only a month, and this connected with
the palpation of it, induced the deceptive diagnosis of its being
a femoral abscess. As this was the opinion of those who had
examined it, I made an explorative puncture before the Medical
Class on the 19th of January, Only blood issued from it; the
open'ng was enlarged and the finger now detected its fibrous
character. On the 21st, two days afterwards, the diseased
mass was dissected out and found intimately attached to the
sciatic nerve. After the integuments and fascia lata were laid
open over the length of the tumor, it was raised up, and this
large nerve, flattened by the pressure to more than double its
usual width, was found involved in it. By careful dissection,
the sciatic was avoided ; the edges of the wound were then
maintained in position by plasters, compress and the uniting
bandage. The patient was rendered insensible, during the
whole operation, by etherization.

The tumor weighed five pounds and two ounces. It was
fibrous in its nature, much harder in its upper portion than the

384 Femalei and their Diseases. [May,

lower. By ^ dose or two of morphine, the patient passed a
comfortab'e ni^ht, and was in good spudts the next day. On
the afternoon of the 2d, finding him rest'ess, the wound was
dressed. There was no union taking phice, but bloody serum
was being freely discharged. The patient would lie in bed in
no other position but upon his back, and of course sustained the
weight of the thigh somewhat upon the wound. On the third
day he began to decline, and died on the 25th, being the fourth
day after the operation. A post-mortem examination revealed
not only inflammation, but affusion of blood in the spinal cord,
where the sciatic nerve was given off on the left side.

In concluding this article, I hope the impression has not been
produced from itsp^^rusal, that I have been uniformly success-
ful in all my other operations. This is far from being its ob-
ject. Those only of a striking character have been narrated.
Many are the minor faults in surgery which have been com-
mitted.

PART II. REVIEWS AND EXTRACTS.

ARTICLE XXIV.

Females and their Diseases ; a series of Letters to his Class. By
Charles D. iMeigs, iM, D., Professor of Midwifery and the Dis-
eases of Women and Chiidren, in the Jctforson iMedical College at
Philadelphia, &c., &c: Philadelphia: Lea & Blanchard. 1848.

This valuable work was received two months since; but a notice
was deferred w:ith a hope of being able to lay before our readers a
review with extracts; but incessant engagement has prevented us
from devoting to it the time and attention due to its merits.

This book consists of a series of familiar letters addressed to the
members of his class.

If Professor Meigs had written for reputation or sought the fame of
authorship rather than the benefit of his readers, it would perhaps have
been better for liim to have composed a systematic treatise on the
diseases of females, such as Dcwces', Ciiurciiiil's, Colomhat's, &:c. ;
or on some of the most important Diseases peculiar to the sex, on the
plan of the works of Clarke, Hamilton, Blundell, Ashwell, d:c., &:c. ;
but it is very doubtful whether he would have so well subserved the

1848.] Females and their Diseases. 385

interests of those for whom he professes to write young graduates
just commencing the practice of tlieir profession.

The style of this work is very irregular: sometimes it is elegant
and occasionally ornate ; sometimes rather turgid, but now and
then the author descends to trite, undignified expressions, which
appear out of place and not in keeping with the rest. He sometimes
details conversations which, though pleasant enough and doubtless
well suited to the occasion on which they were spoken, might have
been left out of these letters without materially lessening their value,
and certainly without detracting from his reputation as an author.

Our author advises young physicians to be plain and unpretending
in their intercourse with their patients to use simple language and
intelligible terms, thereby to bring medicine down to the comprehen-
sion and understanding of the people, in all which we most heartily
concur. We believe this is the true policy of physicians, the most
certain and effectual method to elevate medicine and put down
empiricism. It is the ignorance of the people in relation to medi-
cine that subjects them to the imposition of empirics. Empiricism
shrinks from the illuminations of science, and, like the foul phos-
phoric light, the product of corruption and rottennes, only shines in
darkness.

The following beautitljl extracts, from pages 25 and 27, shew how
properly our author appreciates the importance of plainness of speech,
and how well he understands in what true dignity consists :

"I say, then, it is our stupidity and remissness that work evil to the
people, and redound to ouv own hurt also ; for there is no person,
endowed with a good share of common sense, to whom you could not
address, through that common sense, a reasonable and plain statement
of the facts of his case, the probabilities as to its course, duration, and
end ; with an enumeration of the safest, most convenient, and certain
processes for its cure. Imagine such a person, well-informed, and
you have the idea of a patient the most docile, the most exact in thera-
peutic and hygienic obedience ; the most conliding in your skill, and
the most grateful for your intervention in his behalf. Would that all
our brethren in this land might adopt views like these. With their
united force of intellect, of character, of beneficence, and of social
station, it would be but a short time e'er the diminished head of char-
latanism, under whatever disguise, would be found only to lift itself
among the most ignorant and abject portions of the population, instead
of riding, as it does to-day, with chariots and with horsemen, a shame
to the intelligence of the age, and a perpetual eye-sore to the lover of
truth and contetrmer of every species of imposture. Let us explain
ourselves then to the people."

286 Females and their Diseases. [May,

" Dignity is you, not physic, nor the practice thereof. Did you
never liear that

" ' Worth makes tlie man, the warn of it the fellow,
And all the rest is leather and prunella V

"I have seen cliiTnitiod shoemakers, carters, butchers, and even a
very diirnified tailor, and I have known philosophers and very learned
men witiiout diirnity. Believe me, there is true dignity in great vir-
tue, great information, and great power to diffuse, apply, and make
that information useful to our fellow men. Such is the dignity you
shall strive to attain.

'* If I could give you the best piece of advice in my power, I think
I should give you this advice ; namely, in all your dealings with man-
kind as physicians, and in all your life-doings, strive, iirst, to increase
the boundaries of your knowledge ; and, second, strive to make that
knowledge as vulgar, as popular as possible."

It is to be regretted that he often violates his own admirable pre-
cepts, not only by using the hardest and strangest words ever intro-
duced into our language, but in making quotations from various
languages, Ancient and Modern, with which, it is well known, a large
portion of young graduates as well as old physicians are not familiar.

Although we regret minor imperfections and blemishes that might
have been so easily avoided, we are not offended with a few spots,
where there is so much to admire and approve.

Notwithstanding the great irregularity of style, these letters are
always entertaining and generally instructive, bearing upon them the
impress of a kind heart, and good head, well stored with learning and
enjoying an extensive experience. These letters arc highly j)ractical ;
the author appears to bring his reader to the bedside of the patient,
and there examines the case and prescribes for the disease. Every
young physician may read them with profit, and, judging by ourselves,
we believe some not very young might be much worse emp'oyed.

On the appearance of Prof. Meigs' translation of Colombat's work
on Diseases of Females in Europe, much surprise was expressed that
he should have undergone the labour of translating such a book, when
by his notes appended to it, he had j)roven himself capal)le of writing
one much better: how far the same judges may consider their favor-
able opinion realized, by the work under consideration, \ve cannot
say ; but we candidly believe, though of much humbler pretension,
this is |)ractically a much more valuable book than Colomhat's; and
it is only to be regretted that the time and labour expended on the
translation of the latter had not been employed in rendering his own
more perfect.

1848.] Females and their Diseases. 287

The following lines (pige 17) express the motives the author had
in writing these letters, and declare the necessity of lengthening the
usual four months' term, which must be acknowledged by all who, in
that short space of time, are required to deliver lectures on Obstetrics
and the Diseases of Women and Infants.

" Gentlemen When I took leave of you, at the close of the session
of our Lectures on the last of February, I engaged to address to you a
series of letters, in which I should endeavor to lay before you my
views upon some of the. disorders of females; and you may remem-
ber, I on that occasion, requested each one of you to consider these
letters as addressed to himself. I felt that I had not fully discharged
the obligations of my professorship as relates to disquisitions upon the
sexual maladies; and explained to you that the time allowed for a
course of lectures, a period of only four months, is too short to permit
any one fully to describe the many diseases to which females are
liable.

" I had taken advantage, it is true, of every open occasion to describe
the phenomena and treatment of the disorders and accidents of the
various structures which it was my province to demonstrate. Still
there was much incumbent on me to say, which the shortness of
your sojourn here would not allow me leisure to say."

Much good sense and truth are embodied in the ensuing sentences
from pages 18 and 19.

"The relations between the sexes are of so delicate a character, that
the duties of a medical practitoner are necessarily more difficult when
he comes to take charge of a patient laboring under any one of the
great host of female complaints, than where he is called upon to treat
the more general disorders, such as fevers, inflammations, the exanthe-
mata, &c. So great, indeed, is the embarrassment arising, from
fastidiousness on the part eiiher of the female herself, or of 'he practi-
tioner, or both, that, I am persuaded, much of the ill success of treat-
ment may be justly traced thereto.

'* It is to be confessed that a very general opinion exists, as to the
difficulty of effectually curing many of the diseases of women; and it
is ns mortifying as it is true, that we see the cases of these disorders
going the whole round of the profession, in any village, town, or city,
and falling, at last, into the hands of the quack ; either ending in some
surprising cure, or leading the victim, by gradual lapses of health and
strength, down to the grave, the last refuge of the incurable, or rather
the uncured : I say uncured, for it is a very clear and well known
truth, that many of these cases are, in their beginning, of lighter trifling
importance cases in which the constitution takes no part in affections
of tissues or organs, which, when slightly modified by disease, may
long continue to be so without provoking any disturbance as to the
harmony of the other great organs: this for example, in the organs,
of the circulation, nutrition, respiration, and innervation. Yet, by

288 Females and their Diseases. [^^ay,

neglecting such affections in their rise, on the one hand, or by impru-
denily treating them by violent and disturbing ther .peutical or hygien-
ical methods on the other, the whole constitulion at length comes into
sympathy with the deranged member of it ; and the health, the
usefulness, and so, the happiness or lil'e of the mismanaged and
misinformed female, are sacriuced.'*

With reference to professional character, he says, (p. 21 and 28)

"The mind and lieart of the practitioner ought to be the shrine of
truth and probity ; his mind sliould not deceive itself, and liis heart
should not suffer itself to be deceived and misled, by any earthly
temptation, from the narrow and rugged way of duty and conscien-
tiousness."

*' In order fully to discliarge the duties of tliis great mission, is it not
indispensable that you should prepare yourselves tor its offices by
suitable preparation of the mind and person ? Of the mind, by arming
it with knowledge and wisdom, with prudence and patience, with
firmness to encounter all vexation and responsibility, with charity and
liberality, and with all that armature of the soul which alone can ren-
der m^n wortliy to be called c\tv9cpoi, for none are so but those whose
condition has raised them above the grossncss and scnsuaiity of the
corporeal nature, rendering the body the servant and the minister, not
the tyrant of the soul and the heart, that ought to "sit lightly on
Reason's throne ;" not as crushing, but adorning the intellect with
noble sentiments.

"it is difficult to say how a man, in forming his manners, should
proceed. Indeed, there is, probably, no art so great to form the man-
ners as that which teaches us to keep the temper and the desires of the
soul within the just bounds within which it is contained among all
true followers of the Christ. To be a true and accomplished gentle-
man, one should " do justly, love mercy, and walk hun^bly before
God." Any person, under sucli guidance, cannot fail to have man-
ners acceptable in all forms and ranks of society, where business may
present him."

He ought to have given the English for e\cvOcpoi, or to have trans-
lated it, for the benefit of his readers, as some never knew Greek, and
others have forgotten it : it signifiesyVec, (mc7i being understood.)

Descriptive of the peculiar or distinctive characteristics of woman,
the following sentences (from pages 41, 42, 44, and 45) are very fine.

" Do you think tliat a woman, who cnn produce a race and modify
the whole fahric of society, could have developed, in the tender soil of
her intellect^ the strong idea of a Hamlet, or a iVlncbeth ? ('ou'.d her
voice, like tlie acccmts of Hortensius, or Tiilly, or Chatham's, or
Burke's, command the bent ear of listening senates, or move like a
tornado the agitated masses of a people tossed in the tempest of its
own vehemence ; and then, like a gentle west wind, soothe and calm

1848.] Females and their Diseases, 289

them down again by the influences of its reasoning and prayerful
suasion ?

" ' Ille regit dictis animos, et pectora mulcet.' jEneid, I.

" Such is not woman^s province, nature, power, or mission. She
reigns in the heart; her seat and throne are by the iiearthstone. The
household altar is her place of worship and service. The Forum is
too angry for her. 'J'he Curia is too grave and high, and the Commitia
too boisterous and rude. -Home is her place, except when, like the
star of day, she deigns to issue forth to the world, to exhibit her beauty
and her grace, and to scatter her smiles upon all that are worthy to
receive so rich a boon and then she goes back to her home, like as
the sun sinks in the west, and the memory of her presence is like the
sun-light that lingers long behmd a bright departed day."

" Whata beautiful picture is that engraving of the "Intemperate!"
which you see everywhere in the print shops .? What touching, what
immortal fidelity is depicted by the artist in the face of that woman !
A face beautiful in its expression of resignation, and of pride in her
own faithfulness and truthfulness, as she bears on her bosom the young-
est child, while she leads a sick boy by the hand, and is clutched by
a timid older girl, all of them barefooted, houseless, hopeless, homeless,
for they leave behind in the distance, the pretty cottage where they
were born, to pursue, along a rugged way, the uncertain, drunken
footsteps of the husband and the father, who leads them miserable far
away, deserting tlie homestead she had brought as her dower, in that
blessed morn when in the village church she gave herself away for
him. Now here is her reward ! But she will cling to him until the
death of the drunkard shall have broken the bond ; and after that, go
weep on his discreditable grave, and forgive him too. Such pictures
are from life. There are thousands of such.

"The female is naturally prone to be religious. Hers is a pious
mind. Her confiding nature leads her more readily than men to ac-
cept the proffered grace of the Gospel. Ifanundevout astronomer
is mad, what shall we say of an irreligious woman ? See how the
temples of the Christian worship are filled with women. They flock
thither with their young children, and endeavor to implant in their souls
the seeds of virtue and piety, to be reared in that pure soil and by their
watchful nurture, into plants that shall blossom like the immortal
amaranth among the stars. See then what and how great the influence
that women exert on the morals of society, of whole nations, of the
whole world : wherever there is a true civilization, woman reigns in
society. It is not untd she comes to sit beside him, in view of ail the
people, that man ceases to be barbarous ; or semi-barbarous, and
<jruel, and ignorant.

The following contains much of fine sentiment (page 52.)

"I do not believe in a physician who knows only calomel and rhu-
barb. I would have you fill your souls with knowledge ; I would
have you bathe in it as in an ocean. Were I young again, and could

ID

290 Females and their Diseases, [May

I appreciate as I now in some degree begin to do, the beauties of learn-
ing, I could not cast away, as 1 have done, a half century of time, but
I would grow j)ale by the reflection of the midnight lamp, and 1 would
never be satiated until my soul were satisfied with the fulness of
knowledge. For what are we in the general but erring and curious
inquirers ? and, does not the most higldy cultivated intelligence to be
found among men, leave them at last, even the most gifted among them,
blind, groping, feeble worms of the dust ? What should be our motto
and our cry, from the lowness of the human nature in which we lie
groveling ? Excelsior ! Excelsior /"

Prof. Meigs' remarks on displacements of the uterus are excellent.
We know no treatise on the subject with which we are more pleased,
or to which we can refer for more judicious views of the nature and
manacjement of these distressing affections.

We are gratified to find his opinions, in most respects, coincide with
our own. Our limits will only allow us to subjoin a few sentences.
(Pages 173, 4 and 5.)

" Those females, however, who labor under prolapsion from the
mere- descent of the vagina, arising from its relaxation or loss of
tonicity, can be cured by the pessary. I take it for granted, that
every living tissue has an inherent tendency to contract, and when
that tendency is not carried out into execution, it is because something
resists, antagonizes, prevents it from obeying its law. To support,
then, a vagina at its normal elevation within the pelvis, is to take
away the resisting antagonizing preventing cause, and to allow it,
with time, to recover its normal density and solidity.

" I mean not to say that this is always the sole thing needful to the
cure ; but I do suppose that it is in many instances theonly chirurgicaior
medical processdemanrled, since thefreedom from pain or inconvenience
that follows tlie timely application ofa proper pessary sets the woman
free from the bonds of her symptoms, and enables her to take advan-
tage of the restorative power of diet, air, exercise, bathing, traveling,
and other hygienic methods, the wise and prudent employment of
which may be expected to repair the mischief of debility and relaxation
not as to tiie vagina alone, but as to every part and parcel of her living
system.

"Where the woman's general health, liowever, is broken, and her
great alimentary, resj)iratory and circulatory functions overthrown, we
should gather by carefid inquiry and observation the indications of
treatment, and pursue thf m to a subd notion of the special evil or evils.
A woman may have bad health from deranged action ofthe chylopoietie
or'-'-ans, requiring the exhibition of blue pill, taraxacum, alkalies, nitro-
muriatic acid, eccoprotics, or even purgatives. She may have
neuralgic or neuropathic affections spiinging from a vice in the
h;ematosic tissues, from exaijgerated vital sensibility ofthe heart, Asc.
In all these varieties of complaints, wjiose name is legion, let the espe-
cial sin be found out and eradicated.

1848.] Females and their Diseases, 291

"The bitter tonics, bark, wine; the chaljbeates ; a trained health ;
the exact indication of the diet as to quality and quantity; the amount
of wine, malt liquor, &c. : these are the problems you are to solve,
and Upon their correct solution depends the question whether you are
to have the great satisfaction of seeifig your patient restored to health ;
or whether she, by a dawdling, indeterminate course of counsel and pre-
scription, is to be left to drag out the weary years of btokeii health,
lapsing from one evil to another, until, under the first serious attack
of disease, she falls the victim of what is truly denominated a broken
constitution. Who broke that constitution? The disease, by its vio-
lence, or the Doctor, by his want of foresight, 2:eal, and intelligence?

"The pessary, then, is to be regarded as the sUspensofy, as the
splint, as the bandage and, in truth, as happens in many other cases
in surgery, these are the only indications. But, as in surgery, you
would not, perhaps, treat an orchitis solely by the suspensory, but
would make certain prescriptions, with a view to abate constitutional
or local derangements of the circulation, the absorption, or the inner-
vations of a part, so in the management of the prolapsions, you might
not rest content with the curative power of the pessary alone, but pro-
vide the other juvantia of which I have already made mention.

" How long shall a woman wear the pessary ? An important ques-
tion, that cannot be solved but upon experiment. Several months
will in general be required in any case, because the fastidious delica-
cy of a female will always prevent her from disclosing to you her dis-
tress in its early stages, and you know that chronical disorders are
more difficult of cure than recent or acute ones. Hence I repeat that
the cases that may come under your care, are very likely to prove
tedious and protracted. They wiil be mostly chronical.

" It will be a part of your duty to keep up a strict surveillance of the
patient under treatment. It will be a duty to receive her report from
time to time as to the operation of the instrument. You may become
convinced that a larger or a smaller one is indicated ; and always,
where you can believe that a reduction of the diameter of the instru-
ment is admissible, that ought to be done, on account of the less incon-
ven'ence to be suffered by the tissues under a less degree of distention
and pressure. I esteem it a very great fault on the part of the medical
man, to adjust a pessary, for a female, and to send her away without very
plenary instructions as to the conduct of the subsequent stepsof the cure.
Women sometimes have wholly forgotten them, and allowed them to
remain for a series of years, until the instruments having become spoiled
by age, or the action of the acids of the parts, have rusted, opened, and
admitted into their cavities the most shocking collection of putrid hu-
mors. I have removed several such for persons, who had neglected
themselves for years, and thus become exposed to the danger of putrid
infection from materials kept in a state of decomposition in the interior
of their bodies."

Eighteen pages are occupied by a conversation with Miss Helen
Blanque, which, though very sensible and pleasant, might very ad-

292 Females and their Diseases. [May,

vantageously liavc been condensed into six, or less. We append the
first sentence or two as a sample. (Page 145.)

"I was requested on the day of , 184-, to visit Miss

Helen Blanque, at No. Ciiestnut-street, and when I called at 11
o'clock in the morning, I found her reposing in a \u\uv'\onsfaiiteuil of
the richest crewel work, arrayed in a beautiful negligee, with her
slij)pered feet resting on a low ottoman. The apartment was richly
furnished with mirrors, and chandeliers, and candelal)ras, and carved
sofa^, with chairs of every form and hue. A fresh bouquet stood upon
the little table near her, by a half a dozen volumes, some of which
were opened and lying on their faces, as if taken up and laid down in
disgust; her hair was in curls, but carelessly; and the tout ensemble
of the young lady was expressive of languor and indifference, if not of
pain or distress. As she was an old acquaintance, I could speak to
her very familiarly, and sol began the following conversation :

" 'Good morning, my dear Helen, I hope you are not very sick;
and indeed I must think you are not, if I may judge by your fair face
and bright eyes. What can you possibly want with a Doctor ? Don't
you know it is a very dangerous thing to meddle with people who go
al.)out the world with their pockets full of lancets, blue pills and
iodine?'

" ' Oh dear me, doctor, I am very ill indeed ! and I desired to know
if you could do anything that might (Miable me to get rid of the pain
and weakness I have endured so long?'

"'How long?' ^

" ' Why at h.'ast two years and a half I have been absolutely broken
down with distress. I can't stand up nor kneel at church without
misery ; 1 faint at Baiiey & Kitchen's or at Levy's counter ; the opera
kills me, I cannot dance, much less wahz ; and if I am to live this
way, I declare my o|)inion is fixed that life is no boon.'

" ' Tilly vally, child! there is little the matter with you. You are
not half as ill as you think for, as I shall soon show you.' "

'J'his would sound admirably well in a novel or love tale, but in all
our philosoj)hy we never dreamed of finding any thing like it "in a
grave medical book;" we must remember, however, that our author
writes for young gentlemen we may have lost some of our romance,
or our appetite for reading never being indulged to satiety, may the
bett(M- relish plain and substantial fare, and not require to be excited
by dainties.

On the subject of uterine tumours and enlargements, we had antici-
pated marc ; his remarks are calculated to discourage persevering
end(>avor?; to effect their removal or reduction, whereas we have
known, by long continued treatnient, very considerable enlargements
entirely disappear or become reduced in size. Our author's remarks
on their nature aiid formation are most excellent, but for their treat-

1848.] Females and their Diseases. 293

ment we would refer our readers to the works of Dr. Ashwc.l and
Mr. Lever.

His remarks on cancer are very judicious. The following may
serve as a-sample. (Page 280.)

"In the progress of this half erosion or maceration, and half phage-
denic ulceration of the parts, the motiier cell makes its beginning ; and
once begun, the parts once inoculated with this new and wild, uncon-
strained, uncontrolled form of life, the destruction goes on with rai)idi-
ty ; nothing stays, notliing arrests it^ and the sole resource of our art
consists in the exhibition of opium in someone of its forms, ibr the
subduction of the distress.

" The principal matter, however, is to make a correct diagnosis.
There is danger of an incorrect one in this, that if you come to the
clear conviction that the case is one of veritable carcinoma or cancer,
you will be paralyzed by that conviction ; and, like every body else,
will settle down in the conclusion that nothing is to be done beyond the
administration of those palliatives, which, though they cannot cure,
yet can console and comfort the patient.

^' I have certainly met, in the course of thirty years, with several
cases of diseased uterus, which I had the greatest reason to suppose
cancerous, but which yielded to persevering treatment, and ended in
the perfect recovery of health.

"Far be from me tlie intention to proclaim that I have been more
fortunate than my brethren, and that 1 have cured cancer of the womb.
My desire is to say that I was mistaken in my diagnosis, and that I
treated a curable and not an incurable nialady. I am of the opinion
that everybody holds on the subject of this terrible evil viz., that it is
one of the opprohria medicorum, and that it cannot be cured. No, not
even by the excision of the part atlected. I speak of the true cancer."

After treating of organic diseases of the uterus and its appendages,
our author discusses at full length the physiology of menstruation and
its disorders, the signs and diseases of pregnancy, and then takes up
the subject of abortion ; after which he treats of the lying-in state,
and some of the principal diseases consequent on it, as puerperal fever,
phlegmasia dolens, 6:;c., all of which are treated of in a manner credit-
able to the author. If required to state with what part of this work
we are most pleased, we would say with his letters on Puerperal fever
and Phlegmasia Dolens.

It has not been our design to give an analysis of this work, but sim-
ply to make some remarks upon it, and extracts from it, which we
hope may furnish our readers with a correct view of it, and recommend
it to their favorable consideration; for \ve desire to do justice to them
as well as to the author. It is certainly a unique j)roduction,
in many respects obnoxious to criticism; if subjected to the crucible,

294 Medical Practitione?'* sand Students Library. [May,

there would unquestionfjbly be a fair proportion of caput mor-
tuum ; but it must be admitted that, even when not instructive, it is
always interesting, and unquestionably does contain a great deal of
truly scientific as well as valuable practical matter, on account of
which we believe few will ever regret its purchase or perusal.

J. A. E.

BIBLIOGRAPHICAL,

The Medical Practitioners and Students Library. Published by
Lindsay & Biakiston, Philudjelphia,

The first number of this publication has been received, containing
a new work entitled, " Elements of the Principles and Practice of
Midwifery. By David H. Tucker, M. D., Professor of the Principles
and Practice of Medicine, and formerly of Obstetrics, and the Diseases
of Women and Chil4fen, in the Franl^lin ]\f edical College of Phila-
delphia with num6rous Illustrations."

The two first sentences of the author's preface set forth plaiiiiy and
ftilly his design and the extent of his claims.

^' In undertaking the preparation of a concise and practical treatise
upon Obstetrics, \yc at first proposed to translate either the work of
Cazeaux or Jacquemier ; but it was found impossible to comprise within
the prescribed limits of this work, either of these expellent treatises.
The mutilation of these works did not accord with our taste, nor did
we think such a plan could be adopted without doing injustice to the
character of the works to which we have alluded. For ^i)ese reasons,
and for these reasons only, vye have undertaken the compilation of a
treatise upon Midwifery, without tiie slightest claims to originality,
but based upon the valuable materials derived from the numerous
^orks, both American, English and French, which have been published
>yithin the last few years.

" In the execution of this work, we have drawn freely and unre-
servedly from the best writings within our reach. In the text, we
have generally given the names of those whose opinions have been
quoted; but lest this, our intention, may occasionally have been neg-
}e/3ted, we ta)<e this opportunity of acknowledging our oblijgations to
those authors from whouj the materials are drawn."

The autlior has accomplished well all he has proposed his task is
well done, find he is entitled to the thanks of the profession ; for he has
read for then) extensively and brought together from various sources
and condeiiMod into a small cojnp!>ss all that la good and new in Mid-
wifery. The improvements and discoveries in this dcpjirtn^ent Are ftH
posted up to the present date, in the most concise style.

1848.] Theory and Practice of Midwifery, 295

So many systems of Midwifery have been published within a few
years, that on first hearing of this book, we thought it would at least
be superfluous, but on seeing it our opinion has been changed.

It consists of four hundred and two pages ; very few books, in the
same space, contain as much valuable matter. It will certainly be a
desirable acquisition to all physicians, as well as medical students,
who may not have an extensive library or time to read many books.

J. A. E.

" On the Theory and Practice of Midwifery. By Fleetwood
Churcuill, M. D., M. R. I A. ; with Notes and additions, by
Robert M. Hustox, M. D., Professor of Materia Medica and Gen-
eral Therapeutics, and formerly of Obstetrics and the Diseases of
Women and Children, in the Jefferson Medical College of Philadel-
phia ; President of the Philadelphia Medical Society, &;c., &c.
Third American edition, revised and improved by the author, with
one hundred and twenty-eight Illustrations."

The third An^erican edition has just issueci from the press of Messrs,
Lea (^ BJanchard, Philadelphia.

This excellent book is so well known to the profession in the United
3tates, and we have so recently, on the appearance of the second
American edition, spoken of it in such commendatory terms, that
nothing fjrther need be added at present.

This edition is not increased in size, but if improved, as we trust it
is, all the better; for improvement without augmentation is far prefer-
able to augmentation without improvement, which too often occurs in
ne>y editions.

We will let the author and editor speak for themselves in their pre-
faces,

^Preface to the Third American Edition, hy The Author. I have
been requested by the American publishers to revise this edition of
my book, and to make such additions as the progress of science may
have rendered necessary.

" This I have done so far as time permitted ; and though I confess
that the work is far from being as complete as I could wish, yet I see
no reason to modify or change the principles therein inculcated. An
extended experience will of course, in all such cases, involve the inser-
tion of new matter ; and, owing to the industry of my friend Dr. Huston,
I feel satisfied that few facts of importance have been omitted*

" I owe a large debt of gratitude to my kind American friends,
which I gladly take this opportunity of jicknowledging, and also to the
profession in America for the flattering reception they have given to
my volumes. No reward could be more highly valued by me, nor
could any thing make me more anxious, by labor and study, to make

296 Elements of Gen. Pathology. ^^The Human Brain. [May,

my works as perfect as possible, than the knowledge that their useful-
ness may extend to another hemisphere.
f' Dublin, November, 1847."

^' Note hyilic Editor. The complete revision of the present edition
by the author, has rendered any material additions by the editor un-
necessary ; especially as so short a time has elapsed since he had the
opportunity of embodying whatever seemed to him important to be
&ddcd to the text. The author's additions are numerous, and on ahnost
every subject; but being scattered tiiroughout the work, they can be
appreciated only by a careful perusal of its pages. The notes of the
editor, which are retained at the instance of the author, with slight
alterations, remain as in the former editionr

''Philadelphia, February, 1848."

The demand for another edition, in so short a time, is the strongest
evidence of the value of the work and the high estimation in which it
is held by the profession, j. a. e.

Elements of General Pathology. By Alfred Stjlle, M. D., die.
Philadelphia: Lindsay & Blakiston, 1848 pp. 483.

The work before us is a very creditable production, and will cer-
tainly be useful to students, for whom it is specig-lly designed, It
embraces ^Etiology, Pathogenisis, Nosology, Diagnosis, ProgiiosiB,
Semeiology and General Morbid Anatomy, all of which topics are
lucidly though succinctly treated. We are happy to see the younger
members of the profession devoting their leisure hours to the publica.
tion of elementary works; for their labor whilst it is advantageous to
themselves must be equally so to students, whose wants they can better
appreciate than those who have lived long enough to forget the diffi,
cukies under which they had to struggle during their pupilage.
Dr. Stille's work constitutes the second number of a series to be
issued by the enterprising publishers. P.

The Ihiman Brain : its Structure, Physiology and Diseases with a
description cf tlie Tyyical forms of the Jyraiii in the Animal Kingdom,
\\y Sa31L'ki, {Solly, V. U.S., SiC. V\\m\ the '2d London edition,
with 118 wood Engravings. Philadelphia: Lea & Blanchard,
1848 PI). 49G.

We return our thanks to the Publisliers for this very neat and inter-
esting work. It is one that was much needed in our country, and will
be perused with nmch satisfaction, by all wlio may desire to "bring up"
their knowhidge of this most interesting portion of the liuman fabric.
Tin; htudy of the nervous system lias made such advances of late years
that it becomes necessary, liom time to time, to embody the now facts

1848.] Poisons, 297

and opinions in a form suited to the general practitioner. M'ho cannot
be expected to "post up" for himself. This work has been faithfully-
done by the author. D.

Poisons. (American Medical Almanac.)

The following table contains the poisons that are most commonly
used either for self-destruction or for murderous purposes, with
the attendant symptoms and the necessary ti'eatment.

Arsenic." Arsenious Acid. Fowler s Solution. King^s Yel-
low. Sheeles Green.

Symptoms. Metallic, austere taste in the mouth, violent
burning pains in the region of the stomach, constriction of the
pharynx and oesophagus, violent retching and vomiting and
tenderness of the epigastrium, the matter vomited greenish or
yellowish, often streaked with blood, severe gripings, purgings,
and tenesmus, the stools being deep green or black, and horribly
offensive; sometimes excoriations of the anus; the urine scanty,
red, and often bloody ; the pulse small, frequent and often inter-
mitting ; difficult respiration and cold sweats ; countenance
collapsed, eyes red and sparkling, delirium, death.

Treatment. If vomitiug does not already exist an emetic of
sulph. zinc may be exhibited and its effects promoted by muci-
laginous drinks. If sulph. zinc is not at hand, an emetic of
rnustard may be given. The best antidote is hydrated peroxide
of iron, in doses of a tablespoonful or more every five minutes ; if
the patient cannot swallow, it should be introduced by means of
a stomach pump : if this antidote be not at hand, let the common
red oxide mixed with water be used as a substitute. If the poison
have been taken in the form of Fowler's Solution, copious
draughts of lime water may be given. Counter irritants and
opium may be used to relieve the pain and spasm. Bloodletting
should not be employed, unless to allay the subsequent inflam-
mation, or after the stomach has been thoroughly evacuated.

Acids. Sulphuric Acid.

Sijrnptoms. Sour, styptic taste in the mouth, burning pain in
the throat, gullet and stomach, increased by swallowing, nausea,
vomiting, and horrible foetor of the breath ; matter vomited
tinged both by arterial and venous blood, and effervesces if mix^
ed with carbonate of lime ; difficult respiration, croupy cough,
gmall, contracted and feeble pulse,

Treatment,-^r-D\\\xiQ /argely with milk mixed with the car-
bonate of potassa, lime, or magnesia. In the absence of these,
with soap suds, infusions of wood ashes, white of eggs, milk, or
oil. Water should not be allowed, in consequence of the heat
generated upon its mixture with sulphuric acids.

298 Pohons, [May,

Nitric Acid. Aqua Fortis.

Symptoms. -Much the same as those of sulphuric acid. If
the acid be strong and the dose large, almost immediate death
follows; if it be weak, the patient may linger for a considerable
time, vomiting at intervals, shreds of membranes which have
an almost iiisupporting foetor ; obstinate constipation; yellow
spots upon the skin where the acid has fallen.

Treatment. Carbonate of magnesia or lime, in water, or any
bland fluid ; then evacuate the stomach by large draughts of de-
mulcent fluid and treat the secondary symptoms on general
principles.

Oxalic Acid. Salt of Lemons.

Si/7npto?ns. -^Burning pain in the stomach, nausea and severe
but inetfectual efforts to vomit, great dilatation of pupils, vertigo,
convulsions, death.

Trcatmeiit,- Give large quantities of chalk, whiting, or mag-
nesia or its carbonate, made into a cream with water and freely
exhibited. In the absence of these antidotes, administer copious
draughts of warm water, at the same time promoting vomiting
by tickling the throat. Avoid the alkalies, potash and soda or
their carbonates, since the salts which they form wdth oxalic
acid are as poisonous as the acid itself

Muriatic Acid. HydroMoric Acid.

Symptoms. Same as Sulphuric acid. It is said byOrfila, that
when muriatic acid is the y)oison taken, thick white fume of a
sharp penetrating odor, similar to that exhaled by the ^cid issues
from the mouth.

Treatment. Same as sulphuric acid,

Mercurials. Corrosive Sublimate,

Symptoms. Acrid, metallic, astrigent taste, sensation of
fulness and burning in the throat, burning pain in the stomach and
intestines ; nausea, vomiting and purging, often of bloody matter ;
pulse small, quick and hard ; frequent faintings, great prostration,
sometimes coma, convulsions and death,

Treatment.- Large quantities of albunien in some form ox
other, as white of egg, for instance, must be freely administered ;
if this cannot be had, wheat flour beaten up with soap suds
may be used. Bleeding is requisite if the pulse be quick and
Iiard ; inflammatory symptoms to be treated on general princjr
pies.

White Mercury. White Precipitate.

Si/mptoms and Treatment same as corrosive sublimate.

TuRBiTii Mineral. Sulphate Binoxide of Mercury,

Symptojjis and Treatment same as corrosive sublimate.

Other Mineral Irritants. Tartar Emetic.

Symptoms. Nausea and severe vomiting, hiccough, burning

1848.] Poisons, 299

pain in the pit of the stomach, griping and purging, sense of
tightness in the throat, small, frequent, and hard pulse, difficult
respiration, vertigo, great prostration, insensibility, death.

Treatment. If vomiting have not occurred, it should be pro-
duced by copious draughts of warm water, and tickling the
fauces with a feather. Dilute freely with a tepid infusion of
galls, Peruvian bark, oak bark, or green tea, to form an insoluble
tannate. Powdered yellow bark may be used until the infusion
is prepared. Opium is highly useful in allaying the pain and
excessive evacuation.

Sulphate of Iro?^. Green Vitriol. Copperas.

Symptoms. Griping pains in the stomach and abdomen,
constant vomiting and purging, violent pain in the throat,
coldness of skin and feebleness of pulse.

Treatment, Carbonate of soda or magnesia given freely is
the best antidote. Evacuating the stomach by means of emetics
of sulph, of ?inc, and inflanan^atory symptoms treated on general
principles.

Chloride OF Tin. Spirits of Tin, Dyerh Spirits.

Symptoms. The same as those from other irritant poisons,
and a peculiar tanned appearance of the villous coat of the
stomach.

Treatment. ^-MWk acts as an antidote to this poison and
should be drunk copiously. Vomiting should then be excited.

Sub-acetate of Lead. Sugar of Lead.

Symptoms. A burning, pricking sensation in the throat, with
dryness and thirst, irritation of the alimentary canal, spasms,
vomiting, and often colic ; rigidity of the abdominal muscles,
cramp, obstinate constipation, urine diminished, saliva increased.
When the case is protracted, paralysis of the upper extremities.

Treatjnent. This consist in the free exhibition of solution of
the-alkahne sulphates, either soda or nr)agnesia, Phosphate of
soda is also an antidote, Carbonates should be avoided, as
carbonate of lead is poisonous. Jf vomiting do not exist, emetics
of sulph. zinc should be given. In the chronic form, or cojica
pictonum, purgatives, and anodynes are resorted to.

Carbonate of Potash. Pearl ash. Salt of Tartar. .

Symptoms, Those common to other irritant poisons. The
matter vomited effervesces with acids.

Treatment, :r-The patient should be made to swallow from
time to time, draughts of vinegar and water, lemon juice, or other
vegetable acids. The fixed oils are also good antidotes, such as
the castor, linseed, olive, and almond; they form a soap by
uniting with the alcali and thus destroy its caustic effects.

Nitrate of Silver. Lunar Caustic.

Symptoms, -^NesiYly the sanie as those produced by corrosive

300 Poisons. t^^y*

sublimate; the pain and burning in the stomach, however, are
more severe.

Treatment. A strong solution of chloride of sodium or com-
mon salt, is the best antidote ; it forms an innocuous chloride of
silver ; then evacuate the stomach by an emetic and treat the
inflammatoroy symptoms on general principles.

Verdigris. Sub-acetate of Copper.

Symptoms. Very similar to those produced by arsenic ;
vomiting of a green coloured liquid, and diarrhoea are the
most prominent symptoms ; coppery eructations, and taste m
the mouth.

Treatment. The efforts to vomit should be promoted by the
free exhibition of warm water, milk, or any mucilaginous drink ;
the chemical antidote for the preparation of the copperis albumen,
if not at hand, wheaten flour and w^ater, or milk. Vinegar
should not be given ; iron filings mixed with water may be given
with good effect ; very strong coffee with plenty of sugar, also
acts as an antidote by decomposing the salt of copper.

Sulphate of Copper. Blue Vitriol.

Symptoms. Violent vomiting of matter remarkable for
being of a blue or green colour, sometimes containing broken
crystals of the blue vitrol ; pain in the abdomen and diarrhoea.

Treatment. Same as for sub-acetate of copper.

Sulphate of Zinc. White Vitriol. .

Symptoms. Violent vomiting, astringent taste in the mouth,
a sensation of choking, burning pain in the stomach and lower
belly, quickened pulse, paleness and shrinking of the features
and coldness of the extremities. Death rarely follows, owing to
the prompt emetic action of the poison.

Treatment. Assist the vomiting by copious draughts of warm
water; carbonate of soda in solution, to decompose the sulph. of
zinc. Let the patient drink freely of milk, or albumen, which
partially decomposes the poison, and renders it more inert.

Nitrate of Potassa. Nitre. Saltpetre, Sometimes taken
in mistake for Glaubers' salts.

Symptons. Nausea, vomiting and excessive purging, ac-
companied by bloody stools, and excruciating pain in the bowels;
sensation of intense heat in the stomach, dyspnoea, cold ex-
tremities, sync()))e, convulsions, death.

Treatment. Empty the stomach as ra])i(lly as possible, either
by emetics or the stomach pump ; then let the patient drink free-
ly of milk, flaxseed tea, or other bland mucilaginous drinks.

Nitrate OF Bismuth. Pearl powder.

Symptoms. Similar to those produced by corrosive subli-
mate, general inflammation of the whole alimentary canal,
vomiting, sensation of great heat in the chest, and difliculty of
breathing.

1848.] Poisons. 301

Treatment. Large draughts of milk, which is coagulated by
the poison thus entangling it and enabling it to be expelled from
the stomach ; to be followed by emetics. Inflammation to be
treated on general principles.

Phosphorus.

Symptoms. Violent pain in the stomach, with a hot garlicky
taste in the mouth, vomiting, diarrhoea, great excitement of the
arterial and nervous system, convulsions and death.

Treatment. Lariie draughts of water, or any mucilaginous
fluid, so as to envelope the phosphorus and impede the combus-
tion. An emetic to be promptly administered; magnesia may
be mixed with the fluid to neutralize the phosphorous and phos-
phoric acids which may be formed. Oily and fatty substances
should be avoided.

V^EGETABLE IRRITANTS. HeLEEBORE. CoMUM Or HeMLOCK.

Belladonna or Nightshade. Datura stramonium or Thorn
APPLE. Aconite or Monkshood.

Symptoms. The symptoms of these poisons resemble each
other so much, that they mav be classified under the same head ;
stupor, numbness, heaviness in the head, nausea, sometimes vom-
iting, at others the stomach and bowels are so paralyzed, that
vomiting can scarcely be produced by the most powerful emetics;
a sort of intoxication, pupils dilated, sometimes delirium, redness^
and tumefaction of the face, convulsions and death. The same
results follow when these substances are appli^ to wounds.

Treatment. Empty the stomach as rapidly as possible, by
emetics of tartarized antimony, sulphate of zinc or sulphate of
copper. Evacuate the bowels by active purgatives and in-
jections, and follow these by large doses of vinegar and water
and other vegetable acids. After the vomitinof, strong cofl^ee
proves very efficacious in removing the insensibility. If coma or
apoplexy be present, after the evacuation of the stomach, treat
it by blood-letting, and revellents.

Savine. Oil of Samne,

Symptoms. All those of high excitement, with very acute
pain in the ston>ach and bowels: nausea, vomiting, excessive
purging and convulsions, and abortion in pregnant women.

Treatment. Evacuate the stomach by copious dilutions with
mucilaginous fluids, and keep down inflammatory symptoms by
the lancet and antiphlogistics.

Ergot. Secale Cornutum. Spurred Rye.

Symptoms. In large doses, nausea and vomiting, dryness of
the throat, great thirst, uneasiness or actual pain in the abdomen,
occasionally alvine evacuations, w^eisjht and pain in the head,
giddiness, stupor and dilatation of the pupils, diminished fre-
quency and fulness of the pulse, paleness and lividity of the

302 Poisons. [May,

face, and when its use is long continued, gangrene. It is fre-
quently given in poisonous doses to produce abortion.

Treatment. First evacuate the poison from the alimentary
canal, by the use of emetics or purgatives. (Chloride water has
been recommended to decompose the ergotin, or active princi-
ple ; in the absence of this, nitro-hydrochloric acid properly
diluted might be exhibited. Subsequent treatment on general
princi})les.

Castor oil seed.

Symptoms. Vomiting, purging, and griping, of great violence,
burning pain in the stomach and bowels, tenderness on pres-
sure, hiccough, faintness, and small, feeble pulse.

Treatment.. Evacuate the stomach by an emetic, and treat
the inflammatory symptoms by diluents, anodynes, and anti-
phlogi.^tics generally.

Oeiu's^^ and its preparations. Laudanum. Paregoric. God-
freifs Cordial. Dalhy^s Carminative. McMunn^s Elixir,
Morphia and its salts.

Symptoms. Drowsiness and stupor, followed by delirum,
pallid countenance, sighing, deep and stertorous breathing, cold
sweats, coma and death.

Treatment. The stomach pump should be used as soon as
possible when the liquid poisons or powdered opium have been
taken ; when not at hand, give from one to two scruples sulph.
zinc, or five to tifteen grs. sulph. copper; if these cannot be
readily had, a teaspoonful of powdered mustard, or a table-
spoonful of common salt, dissolved in a tumbler of water.
Emesis should be promoted by tickling the fauces with a feather.
In using the stomach pump, it is better to inject astrigent infu-
sions, as the infusions of galls, which has the effect of neutraliz-
ing the morphia. After the stomach has been evacuated, the
cold dash is an effective means of rousing the patient ; the
subsequent narcotic effect may be obviated, by the administra-
tion of the vegetable acids, hot strong coffee, brandy or ammonia.
The patient should also be kept in motion and on no account
allowed to sleep. Cupping to the temples is sometimes useful,
as well as the warm bath where the drowsiness is very great.
As a last resort, artificial respiration is sometimes useful in
averting the fatal termination.

Camphor.

Symptoms. Great excitement of the brain and nervous
system, vertigo, great anxiety, insensibility, vomiting, small
pulse, difficult res})iration, cold sweats, and convulsions.

Treatment. If solid camphor has been used, an emetic should
be administered, and wine and opium exhibited at short inter-
vals until the symptoms abate.

1848.] Poisons. 303

Hydrocyanic ACID. Prus sic acid. Essential oil of almonds.
Laurel water.

Symptoms. Nausea, giddiness, debility, vertigo, and loss of
sight, weight and pain in the head, eructations having the flavor
of the acid, dyspnoea, small vibrating pulse, spasms, dilated pupil,
convulsions and death.

Treatment. There are four principal agents to be relied on in
the treatment of poisoning by this acid ; viz.: Chlorine, am-
monia, cold affusion, and artificial respiration. Chlorine water
may be given in doses oi t 5ij. in f 5J. of water, or 30 or 40
drops of the solution of chloride of soda in a little water; the
patient should at the same time inhale air impregnanted with
chlorine gas. Ammonia \b also an antidote, but it should not
be employed in a very concentrated form ; it may be administer-
ed either by inhalation or in substance. Cold affusion being
always at hand, may be applied immediately; a stream of cold
w^ater should be poured from a height upon the head and spine
for some minutes; cold water may also be dashed upon the
head and face. Artificial respiration should never be omitted.
This can be easily effected, by making powerful pressure with
both hands on the anterior surface of the chest, the diaphragm
being at the same time pushed upward by an assistant, inspira-
tion being effected by the mere removal of the pressure and the
consequent resiliency of the ribs.

Carbonic acid Gas. Fumes of burning charcoal.

Symptoms. Same as those of apoplexy, or narcotic poison-
ing; great drowsiness, difficulty of respiration, and suffocation ;
features swelled and face bluish, as in cases of strangulation.

Treatment. Remove the patient at once into the open air,
elevate the head, and pour cold water upon it, bleed either by
cups to the head, or by opening a vein, apply friction to the
thorax, and revellents to the feet. If these means fail, then make
use of artificial respiration. Administer stimulants cautiously,
as soon as the patient can swallow.

Alcohol. Brandy, Wine, Spirits, ^c.

Symptoms. Those of narcotic poisons ; insensibility with
apoplexy or paralysis. Countenance swollen and of a dark red
-colour, and stertorous respiration. The poison can often be
detected by the smell.

Treatment. If the patient can swallow, administer an emetic
of sulphate of zinc or tartar emetic; if not, evacuate the stom-
ach, by means of the stomach pump and apply cold affusions
to the head, which should be elevated ; if these means fail,
blood-letting should be resorted to, either by cups, or by opening
a vein, and generally, the jugular, should be selected. Arti-
ficial respiration is necessary in some instances.

304 Experiments on the Capillaries of the Lungs. [May,

Experiments to prove that the Capillaries of the Lungs do not
Anastomns!'. By G. P. Camman, M. D. (New- York Jour-
nal of Medicine.)

As it is still a question among anatomists,* whether the Pul-
monary Capillaries do or do not Anastomose, the following
experiments may not be without their value.

Experiment 1. We injected water colored with gamboge
into a branch of the pulmonary artery going to a section of
lung, and found that a define 1 portion became moderately dis-
tended with the fluid ; the water then commenced flowing from
the accompanying bronchus and vein. The latter being secured
by ligature, we continued to force in the injection, until this
portion of lung became very tense. The injection continued
confinad to the sam3 original extent of lung; the surrounding
parts remained perfectly flaccid, and not a drop of the fluid
escaped from any of the bronchi or veins.

Exper. 2. A similar injection was forced into a branch of
the pulmonary vein. The fluid flowed only from the accom-
panying bronchus and artery. (The injection entered with
such facility as to show that its course was not interrupted by
any valves.)

Exper. 3. We moderately inflated a section of lung through
a bronchial tube and secured it bv ligature. The accompanvins]j
pulmonary artery was then injected, and it was found that the
injection extended exactly as far as the inflated portion of lung,
following closely the indentations so marked at the boundaries
of the bronchial ramifications; the sur-rounding parts remaining
flaccid.

Exper. 4. We substituted the vein for the artery with
similar results.

Having, to our entire satisfaction, repeated the above experi-
ments a number of times, we i)roceeded i'rom the laiger arteries
and veins to the more minute; gradually approaching the
periphery or free border of the lung, and at each advance neces-
sarily including a smaller section. We found in these experi-
ments, as in the former, that the injection of colored water
remained confined to the ramifications of the artery or vein
und-U' examination, and did not interfere with the neighboring
branches. We thus pursued the arteries and veins until they
became so minute that it was impossible to insert the finest
tube. In other words, we approached so near the terminal
branches as to inject only a lobule or a part of a lobule.

To confirm the preceding experiments, and place the mat-
ter beyond doubt, wc had recourse to another series.

* Reisseissen, Marshall Hall, and others.

1848.] Experiments on the Capillaries of the Lungs. 305

Exper, 5. We injected a moderately-sized pulmonary artery
with a strong solution of tartaric acid, and continued to fill the
vessel, until from the accompanying bronchus and vein there
streamed out a fluid which, when tested with bicarbonate of
soda, proved to be the acid.

Exper. G. Having previously secured by ligature the ac-
companying bronchus and vein, we injected a branch of the
pulmonary artery with the acid solution, until the portion of
lung to which it was distributed became distended and tense.
We then, in a similar manner, injected an adjoining branch of
the artery with a strong solution of the bicarbonate of soda, and
applied force almost sufficient to rupture the tissue. The two
solutions were apparently in close contact, yet not the least
chemical action ensued, although w^e kept the vessels thus dis-
tended until we were apprehensive that the chemicals acting
through the tissues might lead into error. Neither in this nor
in the former experiment did any liquid come from the neigh-
boring vessels.

Exper. 7 When the two solutions were injected successively
into the artery and vein accompanying the same bronchus, the
lung was rent in every direction by the disengaged carbonic
acid.

Exper. 8. We pursued our investigations from the larger
branches of the pulmonary vessels to the more minute, and car-
ried them down as far as practicable.

If anastomosis of the capillaries had existed, the effervescence
from the soda and acid would have burst the pulmonary tissues
as in experiment 7.

As the preparations from the above experiments were of a
perishable nature, we injected sections of lung with mucilage of
gum Arabic colored with indigo, and then suspended them
in alcohol. The injection passed only to the lobule or lobules
to which the vessel was distributed. We possess many of
these preparations, in which portions of lung have been injected,
the intermediate spaces being entirely free. The surrounding
lung remained perfectly flaccid and free from discoloration, even
when a degree of force was employed sufficient to rupture the
capillaries and form collections of injections either in the sub-
stance of the tissue or beneath the pleura. A distinguished
pathologist observed this, on submitting sections of the lung to
a powerful microscope. So perfectly distinct were the lines of
demarcation between the injected and uninjected portion of
lung, that we could readily dissect the one from the other,
without causing the least escape of fluid. These preparations
strikingly illustrate the perfect fidelity with which the experi-
ments had been performed.

20

30G ExpcrirnciUs on the Capillaries of the Lungs. [May,

In performing these experiments, certain precautions were
necessary to ensure success. 1. While cutting offthe piece of
hing for experiment, care was taken not to draw down the
edges, lest the vessels to be injected should be on the apex of a
cone, as the terminations of some of the lateral vessels might
thus be above the incision. 2. The piece of lung was so held
that the colored water flowing- from the accompanying
bronchus and vein could not run into the neighboring vessels.
3. The surface of the cut lung was wiped so dry that any
oozing of fluid could be detected. 4. The injection was passed
in very slowly, in order that none of the capillaries or tissues
might be ruptured. The liquid was entered rather faster than
it flowed from the accompanying vessels. 5. The bronchus
and vein were not closed too soon, lest the air, which was, in
some cases, forced before the injection, might rupture the
capillaries. 6. On approaching as near as possible the periphery
of the lung, and after inserting the tube, by compressing with
spring-forceps some of the branches of the vessels under
examination, a very small portion of a lobule could be injected.
7. In the small lobes of the lungs of the sheep, where the vein
runs superficially for an inch or two,it afforded great satisfaction
to observe the colored injection as it returned by the vein, and
which continued to flow for some time before it escaped from
the accompanying bronchus, proving that it must have passed
through the capillaries ; and if there had been any communica-
tion with the neighboring capillaries, they w^ould have become
distended.- 8. The warmest w^eather of summer was found
to be the best season for making experiments and preparations.
At this time of the year the lungs retain their elasticity, wMiereas
they become dry and do not freely accommodate themselves
to the injection after being hardened by a reduction of tempera-
ture and then subjected to artificial heat.

We have thus ascertained that there is no anastomosis of the
capillaries of one branch of an artery or vein, however minute,
with the capillaries of any other branch in the pulmonary
circulation; or in other words, that the capillaries of each
minute branch of an artery or vein are pcriectly isolated and
indopendant of any other capillaries for a collateral supply of
blood. We hold it, then as proved, that there is no anastomosis
between the capillaries of one lobule with that of another, nor,
as far as analogy will warrant, between the capillaries of one
minute or terminal artery with those of another. If any ad-
ditional confirmation were required it might be furnished by
an examination of the })reparations, when it could be seen that
the interstitial cellular membrane, even of the most minute
lobules, remains |)erfectly free from any discoloration from the
injection.

1848.] Experiments on the Capillaries of the Lungs. 807

If We allow the structure of the pulmonary blood-vessels to
be as it is generally supposed, and the anastomosis of iheir ca"
pillaries to be as intimate as Dr. Marshall Hall and others
describe, we would expect that almost every case of profuse
haemoptysis from pulmonary apoplexy, congestion, or any other
cause, must necessarily prove fatal,* from the continual action
of the lungs pumping, as it were, the blood from the vessels so
easily supplied by the very numerous and freely-communicating
capillaries, and from the difficulties which would thus be pre-
sented to the formation of coagula. Now, we know, on the
Contrary, that immediate danger is comparatively slight, not^
Withstanding, as stated by Bichat, and verified by others, that
the lungs, especially when inflamed, are more frequently than
any other organs, flooded with an immense quantity of blood.
Bichat well says, "Yoyez le poumon d'un peripneumonique ;
en le fendant Vous dirie^ au premier coup d'oeil, que ce sont les
solides qui y sont augmentes, il a souvent comme I'aspect du
foie dans la masse pesante qu'il represente; mais mettez-le
macerer, bientot tout s'echappera en fluides. Or, examinez
comparativement la peau, I'estomac, le foie, les reins, etc.,
devenus le siege d'une inflammation aigue qui a fait succomber
le sujet; ils ne presentent rien d'approchant de ce surcroit
^norme de fluid dont le poumon inflamme dans as substance est
surcharge. Again ; what prevents the occurrence of exhaust*
ing hemorrhage when there are abscesses and excavations in
the lungs, surrounded by perfectly healthy structure, without
even the intervention of false membrane ? According to
Baillie, this is "principally the case when the abscesses
are small and placed at a considerable distance from each
other." Yet, even then, we Would suppose that the blood
would be continually forced out into the cavity by the action
of the lungs, while the free communication of the capillaries
would furnish an ample supply. The preceding remarks are
also applicable to an excavation from pulmonary gangrene ;
for, as Andral says, "the parietes of this cavity are, in general,
not lined by any false membrane ; the pulmonary parenchyma
which surrounds it is in some cases perfectly healthy."

In the pathological conditions of the lungs there are appear-
ances which are very peculiar, viz. ; the abrupt and perfectly-
defined margin that frequently exists between the healthy and
diseased parts. These singular boundaries, as if marked out
with a pencil, are found in no other organ, except^ perhaps, in
the brain. In inflammation, or as the effects of inflammation, in
other organs, the surrounding tissue is involved ; and as we

* We would certainly anticipate such a result, when it is remembered with
^hat facility the injections entered the bronchi.

308 Experiments on the Capillaries of the Lungs. [May,

recede from the point of most active disease, the remote parts
are less affected, but there are no lines of demarcation ; indeed,
we can scarcely pronounce where a healthy condition com-
mences, whereas, in very many of the diseases of the lungs,
the separation between the morbid and healthy parts is perfect-
ly defined, as has been remarked by every pathologist. Ad-
dison says, that, " especially in certan atonic forms of pneumonia,
these changes are confined to individual lobules, more or less
remote from each other, the common cellular membrane forms
a distinct boundary to the inflammation." Grisolle speaks of
isolated lobules being the seat of pneumonia; and Andral
alludes continually to this disease as being circumscribed.
With respect to pulmonary apoplexy, Laennec observes, that
" it is always very exactly circumscribed, the induration being
as considerable at the point of termination as in the centre.
The pulmonary tissue around is quite sound and crepitous.^
Andral makes the same remark. He also, in his Clin. Med.,
has very interesting observations and facts upon the lobular
nature of tubercles, but they are too long to be transcribed.

The experiments of Dr. Marshall Hall on the batrachia, will
not apply to \varm-blooded animals. In Roget's Animal and
Vegetable Physiology, it is beautifully shown how, as we ascend
from the lower order in the scale of beings to the most perfect-
ly organized, the pulmonary structure materially varies, so
that analogy will not hold good between the different orders
of beings. He observes, that in the frog a limited portion only
of the blood thrown out from the heart goes to the lungs, so that
any inconvenience from intimate communication of the capil-
laries is prevented; and proceeds to show the perfect and
well-developed structure of the lungs of the mammalia. He
states, also, that the tor])id and cold-blooded reptiles are separa-
ted from the mammalia by a very wide interval ; for though
the former respire air, that air influences but a part of the blood,
as the pulmonary is only a branch of the general circulation.

It is allowed by the best anatomists and ))hysiologists, that
the cay)illarics are differently arranged in each organ, being so
modiffed as to accommodate themselves to the tissues through
which they ramify. Bichat considers it certain that their dis-
tributation and formation differ in the tendons, aponeuroses,
muscles, etc.

li' we admit that there is no anastomosis between the capillaries
of the lungs, we can satisfactorily explain many points in the
j)hysiol()gy and pathology of the pulmonary organs. 1. We can
easily perceive how, in pulmonary hemorrhage, the arterioles
or capillaries, having no collateral su])i)ly of blood to instantly
rusli in and kee[) them distended, readily contract, and allow the

1848.] Experiments on the Capillaries of the Lungs. 309

formation of coagula, which effectively prevent excessive loss of
blood. 2. We can explain why, in small abscesses where there
is not a false membrane between the parietes and healthy struct-
ure, there is not a continual flow of blood into the cavity, for
as the capillaries discharge themselves they shrink; although in
large cavities where, from extent of surface, and exhausting
hemorrhage might occur, nature provides a false membrane.
3. We can read understandingly the facts recorded by Ba3^1e,
Laennec, Andral, Barth, and indeed by all correct and skilful
pathologists. We understand why pulmonary inflammation,
congestion, apoplexy, gangrene, etc.., are so exactly circumscri-
bed and defined; and why in inflammation we do not, as in other
tissues, always observe a gradation in the degree of engorgement,
as we recede from the centre of disease. We find the cor-
rectness of Andral, when he describes inflammation as attack-
ing isolated points of the pulmonary tissue ; and when he speaks
of even vesicular pneumonia, of which Grisolle observes, that
' Billiet and Barthez seem to show that this lesion, described by
Andral, is only vesicular bronchitis, in which a portion only of
the pulmonary vesicles are inflamed and distended with puriform
fluid.' We see reasons for Andral's statement, that " even in
those parts where the hepatization seems most perfect, it rarely
happens that some small bronchial tube may not be found still
permeable to air ; and we sometimes find, that when the lobe of
a lung which appeared uniformly hepatized throughout, is dried
and carefully examined, w^e can discover some capillary tubes
and air-cells which, instead of having their calibre diminished,
are very considerably dilated, and are at the same time free from
any appearance of congestion." 4. We can understand when
we turn to physical signs, why the crepitous rale is so frequently
accompanied by the respiratory murmur. We also ascertain
why crepitous rale without respiratory murmur, shows very
considerable engorgement ; and when respiratory murmur is
present, much of the lung is still healthy. We likewise advance
a step towai'ds an explanation of lobular pneumonia in children,
. and account for the frequent relapse and only apparent con-
,.valescence in pulmonary inflammation, from small lobules and
, vesicles remaining in a condition of active disease, after all phys-
_ ical and rational signs of functional derangement have disap-
. peared. Finally, we comprehend the cause of the following
phenomena observed by Stokes. " I have frequently seen," says
he, " all the signs of solidification subside within two days, and .
have even observed great modifications in the course of a few
hours, **** On this subject more extensive observation is
wanting."

We have thus demonstrated how, by being composed of an

310 Monthly Periscope. [Mav,

aggregate of isolated portions, the lungs are protected from the
extension of disease ; and how, but for this safeguard of nature,
organs so essential to existence would be more liable to per-
manent injury, when a portion of their tissue is inculpable of
performing its functions..

PART III. MONTHLY PERISCOPE.

Homogeneousness of Man and Woman. Dt, Matthieu, of Paris, has
recently published a work on the Diseases of Females, in a notice of
ivhich in the Gazette Medicale, we observe the following tahlp taken,
it ig ^a^d, from the oral lectures of Prof. Serres.

WOMAN.

Ovarium.

Fimbriated e^trpmity of tljp fallq-
pian Tube.

Fallopian Tube.

Uterus.

Uterine neck.

Utero-vaginal Glands,

Corpus Cavernosum.

Labium majorum.
[And what astonishes us is the omission of comparison of the Penia
to the Clitoris, or of adaptation of the Penis to the Vagina, and this top
i^y a Frenchman.] Edt.

MAN.

A.

Testis.

A.

B.

Epididimis.

B.

C.

Vas Deferens.

C.

D.

Vesicula Seminalisj

D.

E.

Prostate Gland.

E.

F.

Cowper's Glands.

F.

G.

Corpus Cavernosum.

G.

H.

Scrotum.

H.

Prof. Barton's opinion of the Virginia Spri7igs. ^^Thc late distin-
guished naturalist and eminent physician, Doctor Benjamin Smith
Barton, Professor of Botany, Materia Medica and Practice of Mpdicine
ju the University qf Pennsylvania, informed us, that he visited, in q,n
Impaired state qi' health, the Warm Springs of Virginia, soon after
jthey had begun to attra,ct notoriety for their medicinal properties; that
during his residence there his health greatly improved, and when, on
^he eve of departure to return hon>e, the proprietors reqiiested of him,
^s he had derived so much bcncfjt froni a visit to their establishment,
^ certificate qfhis personal experience of the efficacy of the waters;
J.he doctor replied, '< that he had no objection to give a certificate to the
effect, that riding over their romantic country breathing their pure
mountain air^eating their fine venison drinkingthejr choice wines
enjoying the delightful society of their visitors, with a relaxation from
{irduous professional pursuits and studies, had restored him to a sta^e
of health, such as ho had not previously enjoyed for several years ;
but as to the cfilcioncy of tlie medicinal properties of the mineral watery
pf the establishment, he had nothing to testify in relation to his own
personal experience in the use of them, as ho. had neither drunk of tiien)
por bathed in tlioni." [Si. IfOitis Med. apd Surg. Jourfial.

1848.] Monthly Periscope, 311

~0n the Internal Use of Nitrate of Silver in Cholera. By Mr.
Richard Southee, Cambridge. The nitrate of silver being much
more frequently prescribed than heretofore, it may not be uninteresting
to some of your numerous readers to learn that the discolorization of
the skin is not of that frequent occurrence generally supposed ; in
fact, large and repeated doses may be given without producing such
effect. In the year 1831, when the cholera raged to a frightful extent
at the port of St. Petersburgh, I ordered it in grain doses in every case
of collapse, and frequently repeated the same quantity every quarter
of an hour, without in one instance discoloring the skin. This remedy
was mentioned as being very successful, in the report of the Govern-
ment Commissioners, Drs. Russell and Barry, at the time ; and I
know of no medicine capable of producing reaction with so much
certainty, though this sometimes was sudden and violent, requiring the
immediate use of the lancet; and in several cases the inordinate
excitement was difficult to suppress, but no discolorization followed.
[^London Medical Times.

External Use of Nitrate of Silver in Conjunctivitis^ by John S.
Cameron, M. D. Dr. Hocken, of London, presented to the profession,
some time since, through the Lancet, an article upon strumous con-
junctivitis, and a method of cure with nitrate of silver, applied to the
outside of the lids. As I had seen a o^ood deal of the sufferinoj attendant
upon the usual application of this remedy, and its doubtful efficacy, this
new plan struck me as, on one account at least, preferable to the old.
I therefore determined to try it, and have done so, in a variety of cases,
not merely of struma, but of acute and chronic inflammation from
other causes, even in cases of granular lids, and always with astonish-
ing success. I cannot recall a single instance where more benefit has
not followed, than I had been accustomed to expect from the old
method. In some cases the intolerance of light, scalding tears, pain,
and injection of the conjunctiva have been removed by one application,
and the eye almost perfectly restored in twenty-four hours after ; and
this without the production of the least pain. It is no small advantage
of this mode of using nitrate of silver, that no harm can result to the
eye by its injudicious use, as may follow the introduction of the caustic
into the eye, either in the solid or fluid state.

The manner of using it is to draw a clean stick of pure caustic,
previously moistened, once or twice over the fids, keeping them, in the
meantime, a little tense ; and repeating this, if necessary, in a few
days. [iY. Y. Annalist.

[We have been pleased with this use of it.] Edt,

Treatment of Porrigo larcalis hy Iodide of Sulphur. (Journal des
Connaissances Medico-Chir.) Dr. Escolar relies chiefly upon Iodide
of Sulphur, employed internally and externally, in this very trouble-
some aftection. The ointment he uses is composed of Lard 32
grammes, Iodide of Sulphur 2 grammes, and Essence of Roses 6
drops; at the same time the liltle patient takes every day about 1 gr.

312 Monthly Periscope. [May,

of the Iodide of Sulphur internally, and a saline purgative each week.
Milk for diet, moderate exercise, and extreme cleanliness, he recom-
mends to aid this treatment. By the end of the month the cure is
generally affected.

Hydrocephalus cured hy Blistering the head. In the February No.
of the Journal des Connaissances MedicoTChirurgicales is a case of
hydrocej)halus cured by Dr. Salgues. The patient was 5 years old,
of good constitution, and had had impetigo for two years. This was
suddenly cured by a quack ointment. There occurred from this date
the manifest symptoms of hydrocephalus, and by measurement the
head was over 59 centimetres. Dr. S. now gave him 8 grs of calo-
mel every fifth day, and a tisan of mucilage with nitre. The head was
shaved and covered with a very large blister, which was renewed every
eighth day. In six weeks there was a considerable change for the bet-
ter, and at the end of three months the head measured only 51 centime-
tres there being no longer any pathological phenomenon in this case.

Suction of the finger of the accoucheur while the infant was in the
womb. (Journal des Connaissances Medico-Chirurg.) Dr. Hosser,
Physician at Saint Omer, was called the lltli of August, at 6 o'clock,
A. M., to Mad. Foucault, aged 44, of good constitution, and now in
labour for the tenth time. The pains had commenced two hours be-
fore his arrival, and the membranes were ruptured. The moutii of
the womb was soft, dilatable, and opened about an inch in diameter,
A presentation of the face, fronting the left iliac fossa was recognized.
The mouth of the infant was opposite the centre of opening of the
uterus, the finger entered it easily, and he very distinctly felt a pretty
strong suction. The labour pains had then ceased. He renewed this
experiment several times, and always found the finger was sucked with
some vigor. He allowed nature to manage tlie case the position of
the presentation was soon changed, and at a little after 11 o'clock his
patient was delivered of a remarkable fine child, which though as-
phyxied at first was soon recovered.

The actual Cautery to the Spine for Lcucorrlicea. Dr. Mitchell, in
the Dublin Medical Press, recommends a most energetic treatment in
that most obstinate of ailcctions uterine Leucorrhtra. He heats the
actual cautery in a spirit lamp just sufficient for it to act revulsively,
and not to destroy the parts touclied by it. He ajiplies the heated iron
to tiic lumbar region to four jxiints on each side of the spinal column,
and then upon four of the spinal processes of the vertebrae making
thus twelve places. He has employed this means in seventy cases,
most of them were cured by a single application, but where granula-
tions existed about the neck of tlic \\'omb, these were touched by
nitrate of silver.

Retention of Urine reJiei:ed without having recourse to the Catheter.
(Bulletin General de Therapeuti(|uc.) Dr. V'unden Broeck says that

1848.] Medical Intelligence. 313

large cupping-glasses applied to the superior or internal parts of the
thighs will, nine times in twelve, relieve retention of urine dependant
upon cerebral affection.

Hemorrhage from the Tonsils arrested hy the local application of Ice.
(Bulletin General de Therapeutique.) The hemorrhage produced by
excision of a portion of the tonsils is often troublesome, if not even dan-
gerous. The actual cautery has been resorted to in some cases. M,
Chassaignac had to do with one where the operation had been per-
formed eight days before, and the bleeding had not yet ceased. Ice to
the neck, in drink, alum, and various other styptics had been tried in
vain. A piece of lint wetted with lime-juice arrested it for a short
time. A lump of ice w^as now seized w^ith a pair of Museux's forceps
(long forceps with double hooks at the extremities) and held perma-
nently upon the point where the hemorrhage escaped, when it ceased
completely.

[We presume pieces of ice were held upon the spot, since one lump
could not he permanently.] Edt.

Enlarged Parotid cured hy Tincture of Iodine. J. Morrison has
treated successfully, he says, (see Lancet, Jan. 8th,) many cases of
enlarged parotid with tincture of iodine. He paints the tumor with
the tincture, and also gives it internally in doses of ten minims, night
and morning, in cold\vater. [Am. Journ. of Med. Sci.

MEDICAL INTELLIGENCE.

TVie American Medical Association. This Body will have assembled in Balti-
more by the time this No. of our Journal is distributed. "We early offered to
publish any notice in relation to the business of the Association, but have to
state the fact that not until after our last issue, did any information reach us as
to the number of delegates which each College, Society, &c., was entitled to
send; it is now too late for us to do so, since the meeting takes place the first
Tuesday in May. (We have published a notice in the newspapers.)

We don't expect to get any credit for it, still the fact may be stated, that the
Medical College of Georgia was organized in 1832, upon a six months course
of Lectures. For the live following sessions the lectures commenced the middle
of October of each 3'ear, and terminated the middle of April following. Find-
ing our classes did not increase in number, in 1835, our Faculty addressed a
circular to every Medical College in the United States, proposing the six months
course, &c., &e. In compliment to the oldest Institution, the University of
Pennsylvania, the time of meeting and the number of delegates to be appointed
were left to her decision ; but her Faculty refused to take any action on the sub-
ject, and we were reluctantly compelled to adopt the four months course. Now
the University of Pennsylvania is claiming priority of movement, and calling
upon the profession to sustain her in the effort to establish the six months
course. When any other College will prove this effort to have been made as
early as 1832, and that it was faithfully tried for five consecutive years, the

314 Medical Intelligence. [Mny,

Medical College of Georgia \vill yield all her claims to priority of action on
the subject.

We hope /ire months will be the length of the course of Lectures adopted by
the American Medical Association. No College has yet proposed six months,
and in the South we have no hesitation to say it cannot be carried into effect.
We hope some one in the Association will have the candour to admit the object
of the preliminary lectures in October of certain Schools of Medicine. We are
advocates for the course continuing during the months of November, Decem-
ber, January, February and March, and at four lectures a day.

Two members of our Faculty (Drs. J. A. and P. F. Eve,) will, it is ex
pected, represent the Medical College of Georgia at Baltimore.

Collodion a subslituU for Adhesive Plaster. We have again the gratification
of announcing to the fac professional brethren who read our Journal, a new
therapeutical preparation in Surgery, It is called Collodion, from kolla, glue ;
and eidos resembling. It is a solution of gun cotton in sulphuric ether. Ap-
plied to wounds, &.C., the ether evaporates, and a layer of cotton is deposited
upon the surface retaining the opposite edges in contact, protecting the parts
under it, &c, A drop or two of Collodion in the hand, closing this until it dries,
will at once convince any one of its importance" to Surgery. Its retentive pow-
ers are very great, and it becomes so adherent to the skin, that it is quite difficult
to remove it. It is of course insoluble in water.

We have used it in some half a dozen cases, and feel prepared to acknowledge
ita very valuable substitute in many cases for adhesive plaster.

It is introduced to the profession by Dr. S. M. Bigelow, in the Boston Medical
and Surgical Journal. A Mr. Maynard, of Boston, has . also set up a claim to
its discovery. To Dr. Barry, apothecary, of this city, we ^re indebted for our
supply.

OUR EUROPEAN CORRESPONDENT Letter III.
By the arrival of the last Steamer, we have received the following letter from
our correspondent at Paris an attack of rheumatism had interrupted his writing.

SUEGICAL REPORT OF THE FRENCH REVOLUTION CI.ASSJFICATION
OF GUN-SHOT WOUNDS, &C.

PARIS, (FuANCE,) March 2d, 1848.
GazetU dcs Hopilmix, La Charlie M. Vclpcau; Wonnds from fire-arms; Chs^
slficationt Qwesiion of imviediate or secondarij avipiUalion.-r Among the general
questions relating togun-shot wounds, one of the most important is without coii-
tradiction, that which treats of ihc necessity ol amputations in casesof this kind.
The wounds that one observes in war, ought to be divided into two great classes:
sword and bayonet wounds (armes blanches) and gun-shot wounds proper. The
first difler little from those we see in ordinary practice. Of these we will say
nothing. The second, on the contrary, present peculiarities. They can be ar-
ranged into two categories wounds of limbs and wounds of visceral cavities;
these last (otlier thinp:s being equal) arc more serious than the first. Let us oc-
cupy ourselves first with wounds of the limbs. Here we establish two classes:
wounds produced by a ball, which hns penetrated the limb from side to side; and
wounds produced from a ball which has only entered the limb. These latter are
less serious in general than the first. In short, whatever be ihe course that the
ball has followed, generally the wound involves but one tissue the cutaneous
sub-cellular; the vessels and nerves having escaped. The wounds which per-
forate tin* limbs from .'>ide to side, can be in their turn subdivided, into simple

1848.] Medical Intelligence ^ 315

and complicated. They are simple when the vessels, the nerves and bones have
not been injured ; and complicated in the opposite condition. And here we shall
subdivide this latter class, according as there is an injury of the vessels, of the
nerves, or even of the bones. Wounds of the nerves expose the patient, it is
true, to partial paralysis, that of the vessels, to hemorrhage more or less consid-
erable, and may require ligatures. These accidents are very serious; but frac-
tures by a ball are still more so. In fact, the severity of these latter case^, pro-
ceed from suppuration in the bed of the fracture from the contusion of the soft
parts by the Iragm'ents ; but these fractures taking place most frequently by indi-
rect causes, there is no contusion of the bones, while in the cases of which we
&re at present speaking, there is contusion and mortification ot all the tissues.
The necessary suppuration here ought to take place in all the thickness of the
limb, comprising the bone which is necessarily rendered carious and necrosed.
If there is a wound of a limb, which has two bones, and if only one bon'e is
involved, it is less dangerous than a similar wound of the portion of the limb
.constituted by a single bone; for in the first case, the sound bone serves to sup-
port the other. Besides, the position of the wound influences our prognosis;
thus, the middle part is less dangerous than near an articulation. It may hap-
pen that the bone is penetratedby the ball, without its continuity being destroyed.
M. Velpeau saw three cases of this kind, in 1830. Or the destruction of the
bone may be confined to its border, so as to form a gutter near or less deep.
Other things being equal, wounds of the lower limbs are more dangerous than
those of the upper extremities. Fractures of the thigh are more dangerous than
those of the leg, It is not the same in regard to the upper extremity j fracture
of the armand forearm are of equal severity. Of all kinds of fractures, the most
dangerous are those of the thigh, for these are almost always comminuted, and
numerous splinters pass into the soft parts. In short, this region is constituted
by a single bone of a tissue very conTpact, and much disposed to break into
fragments and surrounded with numerous and powerful muscles, with much
cellular tissue, large vessels and nerves. There is suppuration the pus infil-
trates itself, burrows upwards and downwards, and one understands then the
danger of this kind of fracture.

Of immvudiate and secondary Amputations. These observations permit us
now to discuss the question relative to the necessity of amputation. Is it better
to amputate on the field, limbs that leave but little hope that they can be pre-
served, or is it better to wait some time, and to operate only when amputation
has become absolutely necessary? In other words, this is the question of imme-
diate or secondary amputation,' the subject of the discussions of the Academy of
Surgery, and of the memoirs of Faure and Boucher. Boucher said that if am-
putation was judged necessary, it ought to be performed iminedi^tely ; Faure
rnaintained on the contrary, that it was better to wait, seeking to preserve the
limb, and not amputating but at the last extremity. These two surgeons, besides,
have very well noted, that in these wounds there are several periods for the
operation. In the first, which lasts from some hours to two days, there is an ex-
(citation, a general shock, physical and moral, to which succeeds a certain state
of stupor; after an operation, we do not observe fever, and there is more chance
of success according to Boucher. The second period, the period of inflamma-
tion, arriving the 12th or 16th day, isanalogousto that Tvhich we admit for burns.
(Here M. Velpeau endeavors to establish a strong resemblance between gun-shot
wounds and certain burns.) In the two cases, there is developed a work of sep-
aration, having for its end to detatch and expel from the tract of the ball, the
mortified tissue. This period has several phases: first, one observes inflamma-
tory accidents, which last two or three days; a foetid, blackish discharge pro-
ceeds fronj. the wound ; then true pus is formed, and we enter into the period of that
of suppuratii^a. Meanwhile, we can say, in the first place, that amputation in
the inflammatory period is performed in unfavorable conditions, this is generally
admitted, and with reason, for inflammation already existing, does not disappear
under the influence of the operation, but is increased by the surgeon. Velpeau
is here of the opinion of Faure, if we do not amputate in the first period, it is
better to wait until the third. But it is very difficult to decide positively ihi.
question. First, one can scarcely determine '=in advance" whether there will
)je a possibility or not to preserve the limb : there are chances for or agaipst jt,

31G Medical Intelligence. [May,

but the results, in a certain number of cases, weaken the prognosis. Faure
says, that in amputating tardily, we preserve all the limbs that we would have
improperly removed: Bouciier replied, that by this method, we saved much
fewer of the wounded. Thus, take 100 wounded, if you amputate all immedi-
ately, 5-ou-cure 90, for example; if, on the contrary, you amputate only second-
arily, you will preserve the limbs of 25 wounded but, of the other 75, there
will die 25. The figuies are j)urely suppositions; but something analogous ex-
ists, and suffices to shew the complexity of the question, and lo explain the lon^
discussions of the Academy ol Surgeons, on this subject. For iractures of the
femur, all military surgeons, Larrey, Percy, Ribcs, are unanimous and agreed .
on the necessity of immediate amputation.' Notwithstanding, in 1830, some of
the surgeons of Paris rnon-military) did not submit in an absolute manner to
this rule, and they souglit to preserve the limbs. At this period, M. Velpeau,
among 12 or 15 i)atients, preserved the limb twice, and had to practice ibur or
five times secondary amputation. How do we know, that if all of them had
been subjected to immediate amputation, eight or ten would not have survived "?
Absolutely, one does not lose more patients, among those whp submit to second-
ary amputation, than among others that undergo immediate amputation. But
this is not the point of view in which the question ought to be considered. The
matter to be determined, is to ascertain whether the patients that had not suller-
ed amputation, and who sunk before the arrival of the epoch of the secondary
operation, might not have survived if they had been amputated immediately.
This is the great question to decide. But there are cases where amputation is
formally indicated. Seven or eight of our patients are in this position. Several
have refused to be operated on, and now it cannot be done. It is necessary to
wait till the third period.

Complications of Guii-shot vwunds Gangrene, divisions, etiology; diagTiosis^-^
Hemorrhage. As complications ofwounds" by fire-arms, we ought to note stupor,
agitation, hemorrhage, and gangrene. We'have already, twice observed this
last condition. One can distinguish in gun-shot wounds, two kinds of gangrene
one may be called direct, the other indirect. The first takesplace necessarily
it is that which we observe on the level of the wound itseli. Gangrene de-
pends, generally, on three orders of causes : wounds of vessels, of nerves, and
contusion of the soft parts. Injury of arteries alone is not a sufficient cause of
gangrene; but if the vein, or the principal veins, are involved, there is a great
probability that mortification of tlie limb will ensue. Thus, in tlie operation of
ligature, take care not to tie the veins along with the artery. After the ligature
of the artery, the blood continues to circulate by the collateral branches, but it is
necessary that it returns to the heart, and this can only take place through the
veins: but these conversely to the arteries, go on reuniting instead of dividing:
the collaterals become fewer in number from below upwards, andthe ciirulation
cannot be continued by their means. If the^wound exists in a limb, where there
are several important arteries, in the tliigh, for example, and that but one of
them only is injured with its corresponding vein, it is not entirely of the same
importance, for there are several orders of veins: thesaphena, with its anastho-
moKCs, the accompanying vein of the profundafemoris, might supply the princi-
pal vein. The division of the nerves may also lead to gangrene, but this does
not occur where there are several important nerves in the member, as in the
arm, for instance. There the division of the median or radial, or of any other,
docs not cause mortification of the arm; but this might take place if they were
all divided. The injury to other tissues may give rise to gangrene, but only in
the case where the injuries are considerable. The injury of the skin alone, or of
one or several muscles, the tracture even of a bone with sjilinters, is not in gen-
eral followed by indirect gangrene; but it will he quite otherwise, if several of
these are involved at the same time, and especially if also the vessels are wound-
ed. The diagnosis of declared gangrene is not dilhcult, but it would be import-
ant to foresee its beginning, which is not eany, for that depends generally on the
nature of the wound, and it will be necessary always to iletermine it exactly.
If the ball has caused great damage, this can be easily ascertained, if on the
contrary, there is injury of the vessels, of the nerves, of the bones, it is often dif-
ficult to ascertain the state of the parts. Wlien there is paralysis, one may be
guided by the anatomical knowledge, and thus determine the nerve or nerves

1848.] Medical Intelligence. 317

wounded. When there is arterial hemorrhage, we ought also to find out what
artery is wounded, but here a certain difficulty presents itself: first, it is neco
sary to learn if the hemorrhage is arterial or venous, and this is often very diffi-
cult. Such is the case of one of our own patients. M. Velpeau is satisfied that
there is not here injury of a large vessel, for the pulse is preserved and the hem-
orrhage has not returned; but this is not conclusive, the artery may be oblitera-
ted, and the circulation re-established by the collaterals.

Gazette dcs Hopitaux^ Wth March M Vdpcau on Gangrene; prognosis ^ treat-
ment, Is it necessary to amputate immediately, or wait the limitation 1 The
-prognosis of the gangrene comprehends two elements : the danger of gangrene
in regard to the member, and its danger in relation to the life of the patient.
The gangrene that supervenes in consequence of wounds by fire-arms^ is more
dangerous than that arising from ordinary wounds; but there is a kind of gan-
grene still more formidable, viz., that which is spontaneous. It is necessary that
the mind be well penetrated with the distinction of gangrene into spontaneous
and accidental. The spontaneous gangrene is the more dangerous ; first because
it is connected with a general cause, a bad constitution ; also, because it depends
generally on an organic lesion of the vessels; such as arterites, chalky degen-
eration, or tuberculation of the arteries; Against this kind of gangrene we can
do nothing. Accidental gangrene, although it rnay be very dangerous, is not as
much so as the spontaneous; for if it also takes its source in the alterations of
the soft parts, the vessels, nerves, &c., we may hope at least that this traumatic
injury will not extend itself, and that the mortification will remain limited. In
the accidental gangrene, there are still varieties as to degree of dangers. Thus
it is evident that its seat and.its extent will modify the prognosis. The gangrene
of the toes, is less dangerous than that of the legs, &c. We have already said
that gangrene from fire-arms, is more alarming than that from ordinary wounds,
and that among the cases of the first category, those where the wound has been
produced by the discharge of an howitzer, is the most dangerous, because these
projectiles can scarcely injure exclusively the vessels or the nerves, and that all
the tissues participate in general with the disorder; in short, one of the causes
which contribute to render serious the prognosis in gangrene by fire-arms, is the
general infection which may show itself, and influence unfavorably the economy.
In the midst of all this, there is a prognosis which scarcely varies it is that
which regards the fate of the limb itself, the gangrenous part is ultimately lost.
We arrive, meanwhile, at the question of treatment a question which governs
the others What is it necessary to do ? Ought the mortified parts be amputated,
or will it be better to leave them to fall of themselves 7 Formerly, surgeons pre-
ferred to leave to nature the care of detatching the dead parts, rather than to
practice amputation. Now, this opinion is generally abandoned first, because
having atour disposal the ligature, torsion, &c., one no longer fears hemorrhage
in amputations. In short, because in following the ancient method, the bone
makes a considerable projection, and we obtain a stump very deformed, giving
place to great inconvenience. Meanwhile, this question presents itself: Ought
we to amputate during the pi ogress of gangrene, or is it better to wail until its
progress be arrested ; in other words, to wait for its limitation 1 In favor of this
lastopinion, several arguments have been produced: first, gangrene is a cause
of gangrene; that is to say, that it propagates itself; there exists a sort of mole-
cular alteration of the parts, so that the gangrene shows itself, in spite of ampu-
tation. Further, it happens often that the vascular injury, the arterial oblitera-
tion extends itself more or less above the apparent gangrene so, that in operating
on parts extremely sound, we operate, in short, below the obliteration, and so
that the gangrene may appear in the stump. In the third place, it is said that
in wounds by fire-arms, there exists a commotion, a shock, a state of stupor, a
sort of poisoning; so that before such a general state, we cannot know where the
gangrene will stop, and amputation, in fact, will serve only to hasten death.
There is in all this something of truth, but it is necessary to return to the divis-
ion established at the commencement of this lesson. In spontaneous gangrene,
in gangrene following organic injuries of an artery, it is better to wait the limi-
tation, but in the gangrene from external injury, from bruises, &c., M. Velpeau
thinks that it is better to hasten the operation, and precisely for one of the reasons
used in support of the opposite opinion, for gangrene is the cause of gangrene

318 Medical Intelligence. [May,

and the best means to protect the best of the limb from this dahgetous tendency,
js to remove the mortified part. Besides, a gati^rerioUs member is still more
than the wound itself a formidable bed of general infection. In short, there isa
kind of reaction against the tendency to mortification of neighboring parts,
Which concurs also to weaken the patient. It is a distinction rriade by Larrey.

Comparison of the Trcalment of Chui-shot wounds at HolehDicu, La Charite and
Val-de- Grace. The patients wounded during the three days, recovered badly; a
larger proportion than usual have died: this might be expected, as the wounded
were all inhabitants of Paris and mostly ill-fed and ill-lodged. Velpeau's pa-
tients have done w^orsi of all the beds in La Charite are greatly crowded and
not a particle of Iresh air is ever admitted by any accident; he makes great use
of heavy flax-seed poultices, with great quantities of lint enveloping the whoie
limb, and if fracture of a bone happens to exist, then, in addition to all this, we
have splints, lots more of lint and bandages. Blandin, at the Hotel-Dieu, has
been a shade more fortunate than Velpeau. Roux's cases have generally done
very -well all three had each an amputation at the shoulder-joint Roux's pa-
tient, quite a young man, alone survives. Fortunately, the number of wounded
altogether is not considerable, for the total amount in all the hospitals, on the
25th of February, was no more than 428; there were more than 500 at Hotel-Dieu
alone in 1830, Jobert applied to the wounds cold poultices, frequently renewed,
in some cases where inflammatory action was high, he applied ice. When
inflammatory action began to manifest itself the cold poultices were replaced
by tepid ones containing a little laudanum. The fractured cases, as usual with
him, were treated by simple and permanent extension. On the" l5th March, I
went across to Val-de-Grace and saw the patients they had been treated by
bleeding, leeching, purgatives and low diet, in the first instance, while at the
same time lint was laid over the wounded part, and on this a current of iced
water was directed the limbs were placed in an eas}-; posture on cushions im-

f)ervious to water. This treatment was continued while the inflammatory stage
asted afterwards light dressing and bandaging were employed. The patients
have recovered it is admitted on all hands, much better at this military hospital
than at any other of the hospitals in Faris: the situation is high and surrounded
with gardens and a large open space the wards arc large, high in the roofs, and
well ventilated the number of beds is proportionably small; and to these cir-
cumstances perhaps more than to the mode of treatment, the more rapid recovery
of the patients is attributable, Velpeau declares that the iced-water treatment
has not been found to answer well elsewhere. Several of the patients at Val-de-
Grace had a ball lodged in the chest, others in the thigh, &c., and were doing
well. The only serious case, w^as that of a young man whose elbow joint had
been shattered, the ends of the bones had been removed, and the wound had aft
Unhealthy, flabby appearance the young man was much exhausted.

Paracentesis Thoracis in Pleurisy. I -vVitilessed an operation of Paracentesis
Thoracis. The patient had been laboring under an attack of pleurisy of the
left side, for nearly two- months considerable efl^usion had occurred and the
heart was displaced towards the right side. The opei-ator used a small, flat tro-
Char; the skin was drawn u])wards, and the instrument entered obliquely for
more than an inch, previously to perforating the intercostal space between the
8th and 9th ribs and in the posterior region of the thorax ; a large basin full of
serum, mixed with a few flakes of lymph, was withdrawn. The heart speedily
returned to its normal position, and a distinct " bruit de froitcment" was per-
ceived in the anterior region of the left side of the chest. This operation is
oflen performed in Paris, sometimes as early as the 12th or 15lhday of the pleu-
l-jsy, and Indeed whenever the presence of a considerable quantity of liquid is
detected. Unless the amount of fluid is very great, the patients seem to obtaih
immediate relief and recover rapidly. Many valuable lives might be saved,
\vere this simple operation more frequently performed. Tsot long ago, a similar
operation was successfully performed at Val-de-Grace, on a soldier 33 years of
age, who had had chronic pleurisy of two years duration; he was two month.'?
and a half under treatment, without any beneficial result; the puncture was
made in the Gth intercostal space ; immediately the eanula gave issue to a sero-
purulent, greenish fluid, sensibly alkaline charged with albumen^ enclosing a

1848.] Medical Intelligence. 319

great quantity of pus globules. The use of gold-beater's leaf, to surround the
canula, ought never to be neglected, as it permits of the escape of fluid, and hin-
ders the entrance of air. A month alter the operation, the patient was completely
restored to health. M. Louis says, that when pleurisy is simple, and not com-
plicated with pulmonary tubercles, it terminates always happily, and that there-
fore it is useless to puncture. But to this many exceptions exist, where the
effusion persists in spite of the most active tieatment.

Yours, O. P. G.

New AncEsthetic Agenls.^We observe thatM. Pogiale, Professor of Chemistry
at Val-de-Grace, in Paris, has announced to the Academy of Sciences, that he
has found the inhalation of the vapour of aldehyde promptly followed by the
most complete insensibility. He says its action is more prompt and energetic
than either ether or chloroform. It is more economical than chloroform. It is
prepared by distilling a mixture of sulphuric acid, water, alcohol and peroxide
of manganese, and rectifying the condensed fluid with chloride ot lime. Alde-
hyde thus prepared at the temperature of 82? Fahrenheit, contains only a
small portion of alcohol and formic ether.

A German chemist also proposes the vapour of Sulphate of Carbon.

MISCELLANEOUS MEDICAL ITEMS.

It has just been decided by the School of Pharmacy of Paris, to have placed
upon its walls, the portrait of Nicholas Courtois, the discoverer of Iodine, in 1811,
He is said to have lived and died in obscurity. It is thus with the world. The
man who will nobly and liberally give to society an important invention or dis-
covery will too often be neglected and suffer in absolute penury, while the quack,
from his worthless nostrum, may indulge every luxury.

Velpeau has lately expressed in the Academy of Sciences, his decided opinion
in favor of chloroform over ether.

Prof Berard, of Paris, is publishing his Lectures on Physiology, and the im*
pression is made that he designs retiring to private life.

Philip Boyer, son of the old veteran. Baron Boyer, has lately had the eighth
successful amputation of the thigh a success tinprecedented for Paris.

Gutta Perka, known to Europe since 1843. is being now used for various
surgical purposes, as in the treatment of fractures, in the construction of bougies,
pessaries, &c. It is the lactescent juice of a tree found in Singapore. At the
temperature of 50 Farenheit, it is as hard as wood, but becoming soft as wax-
below the temperature of boiling water. It is insoluble in water, but is dissolv-
ed by chloroform.

Prof. Berard, Dean of the Faculty of Montpellier, was recently dismissed
from his office for his liberal principles, by the Ministry of Louis Philippe.
But they in their turn being deposed by the people of Paris for their illiberal
actions, the old Dean has been reinstated by the new government of France.

Prof. Orfila, Dean of the Faculty of Paris, has been dismissed from his office,
and Prof. Bouillaud appointed in his place.

Stromeyer has succeeded Dieffenbach at Berlin.

There are 454 Students of Medicine in the school at Constantinople.

In Russia, Physicians alone can resort to ansesthetic means. No dentist or
midwife is permitted to use chloroform or ether, except in the presence of and
under the authority of a regular educated doctor.

The Society of Medicine of Strasbourg has decided upon the proposition of
Prof. Sedillot to raise a subscription to be presented to Dr. Jackson of Boston,
the inventor, say they, of the application of ether as an anoesthctic agent.

M- Jobert (de Lamballe) is editing a work entitled Summary of Surgery, by
.T. Lisfranc. Our readers will recollect that the great Surgeon Lisfranc died
last year in Paris, with the regret that his work on Surgery vvas not completed.

320

Medical Intelligence. Meteorology.

Dr. Lesserre, captain in the 3d Legion of the National Guards of Paris, and
dangerously^ wounded by a musket ball through his thigh, has been promoted to
the rank of colonel, as a recompense lor his devotion to the French Republic.

Among the candidates for representatives to the Convention to organize the
Republic of France, we see the names of five physicians, among them are Roslan
and Sandras, In the address of Prof. Rostaii, he says, the convictions of my
whole life have been that a Republic was the only government proper for
France that it is the one under wdiich the greatest number will receive the
greatest good that he owes nothing to any government or monarch that the
little he possesses in this world was obtained by his own individual pfibrts; hav-
ing secured his professorship in the school of Medicine of Paris by concour, &c.

The number of wounded during the late French revolution received into the
civil and military hospitals of Paris, amounted to 521.

METEOROLOGICAL OBSERVATIONS, for March, 1848, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

CJ

Sun Rise.

2, P. M.

Wind.

Remarks.

1

Ther.

tJAR.

TlIEU.

JiAR.

1

4G

29 82-100

53

29 87-100

E.

Cloudy.

2

48

" 85-100

03

" 85-100

S. E.

Fair afternoon.

3

41

" 83-100

01

" 85-100

w.

iCloudy sprinkle.

4

40

30 4-100

58

30 0-100

N.

Fair.

5

43

29 92-100

50

30 1-100

N.

|Cloud)' blow.

6

28

30 15-100

50

30 17-100

S.

Fair.

7

30

30 G-lOO

04

30 3-100

S.

Cloudy.

8

42

29 88-100

m

29 73-100

s.

Cloudy.

9

5G

" 55-100

57

" 47-100

s.

Rain, 90-100 of an inch.

10

41

" 53-100

57

" 00-100

w.

Fair high wind.

11

36

" 45-100

GO

" 90-100

s. w.

Fair.

12

40

30

05

" 97-100

s.

Fair.

13

51

29 92-100

05

" 92-100

N. W.

Fair high M'ind.

14

34

30 1

48

" 95-100

N. W.

,Fair thick ice.

15

32

29 8G-100

54

" 80-100

N.W.

Fair high wind.

IG

30

30 11-100

54

30 3-100

N. E.

Fair.

17

32

29 88-100

06

29 08-100

S. W.

JFair high wind.

18

54

" GO- 100

00

" 00-100

S. W.

.Cloudy high wind.

19

5G

" 75-100

74

" 77-100

s.

Cloudy high wind.

20

58

" 79-100

09

" 80-100

s.

Cloudy sprinkle. [p.m,-55-100

21

G2

" 82-100

79

" 75-100

s. w.

Cloudy high wind storm at G,

22

59

" 08-100

04

" 04-100

s. w.

[Cloudy.

23

50

" 08-100

75

" 80-100

w.

Fair.

21

50

" 99-100

72

" 98-100

E.

Fair,

25

52

30

71

" 98-100

S. E.

Fair.

20

54

29 87-100

78

" 83-100

S. W.

Fair some clouds.

27

58

" G9-li)()

81

" 02-100

s. w.

Fair.

28

GO

" 71-100

78

" 74-100

s. w.

Fair rain during night25-100.

29

02

" 85-100

71

" 90-100

s. w.

Cloudy.

30 GO

" 90-100

08

" 90-100

N. E.

Cloudy sprinkle.

31 G2

" 94-100

81

" 87-100

1 s.

Cloudy rain last night 5-100,

17 Fair days, auantity of Rain 1 inches 75-100, Wind East of N. and S.
C days. West of do. do, 15 days,

Equino.x of the 22d, G, a, m. Wind S, E. ^just stopped raining,

9, A.M, Ther. ()2, Bar. 09-100. Wind S.
12. M, " GO, " 07-100, " S-.W.
G.p.M. ' 07, " 03-100. " S.W.

Being a very cloudy but calm day. There was a storm from the N. W. last
evening at C, v. m.

SOUTNEftN

MEDICAL AND.SURGICAL

J 0 tJ R N A L I

Vol. 4.] NEW SERIES. JUNE, 1848. [No. 6.

Part L original C0MMUNiCATI0N8,- '

ARTICLE XXV.

Cases of Erysipelas. By Charles T. Qun'JTARi), M. Dr, '
of Madon, Georgia.

This disease, so long and yet so little known, has been vari-
ously described and designated. It has been called "the Rosfe,"
from its color " St; Anthony's Fire," because to him pfayers
were offered to cure inflarrimations. Bollaridus gives an ac-
count of the miracles wrought by the intercession of St. Anth6'ny
in curing the "ignis racer," when it was raging in many parts
of Europe in the eleventh century ; and in those days, too, less
reliable remedies than prayers to the Saint were adopted, for
Blochwick me'ntio'ns an amulet against Erysipelas-^^ Elder on
which the sufi never shine'd. If the' piece betwixt f he kiio't^ be
hung about the pa,tient's neck, it is much commended some cut
it in little pieces, and sew it in a knot in a piece of a man's shirt,
which seems superstitious."

The disease has been designated by the following names
viz: the Girdle; Shirigles; in Switzerland, the Violet; in Eng-
land, the Rose ; by Galen and Celsus, Phygethlon. But names
are unimportaftt, save only as they desigriate, ti^uly and clearly,
objects and things. It is the true pathology of the disease \vith
which we have to deal ; for, as Dr. Reid has justly remafied,-
" there is no greater impediment to the ad-^anCem'ent of know-
ledge than the anibiguity of words." We propose to consider
that form of inflammation of the skin, either alone or combined
with that of the subjacent cellular tissue ; generally, though not
always accompanied with vesicular eruption, the local affection

21

329 Quinlard, o;i Erysipelas. [June,

being attended by symptomatic fever, and which, in common
parlance, is called Erysipelas. (Vide Cyc. Prac. Med.) We
turn to the ponderous tomes of Dr. Good, and he tells us that
Erysipelas is an idiopathic fever producing ery thematic efflores-
cence. Here is a manifest difTerence in the definition. The
disease is an inflammatory one, characterized by a deep red
color of the parts, with pain and swelling, and more or less con-
stitutional disturbance. It may attack any part of the body,
although the face, head, and lower extremities are the parts on
which it oftenest occurs. The part affected is of a clear, shining
red color. There is no throbbing, but a burning heat and
tingling rather than acute pain. In those cases in which the
skin alone is affected the swelling is not very perceptible, but
may be felt by passing the finger across the line of inflammation.
The redness disappears by pressing the finger on the part, but
instantly returns on its removal. The inflammatory action
progresses with considerable rapidity in the parts surrounding,
and it seems, literally to *'draw" the ''adjoining" structure and
shows how appropriate is the term Erysipelas (epCw e^ <Xaf.)
A day or so previous to the appearance of any local morbid
action, there is slight malaise, succeeded by shivering, disagree-
able sensations about the region of the heart. These symptoms
are more or less prominent, according to the degree of local
inflammation which is to succeed them. There are however
exceptions to this rule, as will be shown in two of the cases quo-
ted in this sketch. Before the inflammation in the skin is devel-
oped, there is loss of appetite ; pains, more or less violent, in the
head; dejection and debility, and sometimes nausea and vomit-
ing. The disease is sometimes ushered in by severe chills, and
a high degree of vascular reaction. Mr. Lawrence informs us
that Erysipelas is seldom confined to the skin ; the cellular struc-
ture soon becoming involved, effusion taking place, and a soft
swelling being caused by it. The stinging itching, which is felt
at first, is followed by a severe, sharp, smarting and burning
sensation; the tongue is moist and covered with a white fur
which varies with the disease ; the pulse is rapid and frequent,
or it may be only accelerated; the skin is dry and parched,
considerable thirst, and generally a constipated condition of the
bowels.

1848.] Quintard, on Erysipelas. 823

*'The inflammation usually continues for eight or ten days;
and for the same time, the fever and symptoms attending it also
continue."*

Although the general symptoms commohty follow the progress
of the local erysipelatous affection, both increasing and declin-
ing together, yet in their respective grades of violence there is
often no direct proportion between them.f

Simple Erysipelas is by no means a formidable disease, but
one that will readily yield to almost any treatment ; but even
when it occurs in its simplest form it should be closely watched,
for it is liable to sudden turns : when it attacks the head and
face, it is far more dangerous than when it occurs on the trunk ^
in the latter, than in the extremities ; for when the head is the
seat of the disease, we have to dread a metastasis to the brain
and meninges when the thorax, we fear lest the lungs and
pleura may be seized on, (fee. A number of cases are recorded
in which the seat of the inflammatory action has been changed
from one part of the body to another. Bartholinus relates an
instance of Erysipelas leaving the feet, whereupon an affection
of the head, with fatal lethargy, ensued. Storck records two
cases. (Vide also Lond. .Med. and Phys. Journ., May, 1829.)
This change of place, is most fatal w^here it attacks the brain ;
in adults it is followed by coma, delirium and apoplexy in chil-'
dren, by hydrocephalus, &C/

Erysipelas has been divided, by Desault, into phlegmonoii^y
bilious, and local, (Chir* Journ., vol. 2) by Pearson, into phleg--
monous, oedematous, and gangrenous, (Prin. of Surg. cap. 10.) -
by Bursevious, into idiopathic, syfnptomatic, and accidental,
(Inst. Med. Prac, t. 2, and c- 2, 8vo.) -by Mr. Lawrence, into
erythema, simple, oedematous, aiid phlegmonous, (Med* Chir*
Trans., voL 14) by Dr. Good, into local, and erratic, (Study
of Med., vol. 3, p. 72.) A number of sub-divisions have been
made as by Rogerson, erysipelas phlegmonoides has been
termed compound erysipelas ; but these are unimportant, and
do very little toward assisting us to a clear knowledge of the
disease.

The causes of Erysipelas are various. It has beeu attributed

* CuUen's Practice of Physic, vol. 1, p. 228.
t Vide Eberle's Practice, vol. 1, p. 44b.

3^4 Quintard, on Erysipelas. [June,

to cold, intemperance, suppressed perspiration, heat, blisters,
issues, seatons, caustics, or other acrid matters applied to the
skin to wounds, punctures, bruises; "mechanical or chemical
irritation of wounds, ulcers, or other local diseases, will cause it."
It follows the indiscriminate use of sutures. It has occurred in
consequence of repelled gout, (Stoll. Rat. Med., vol. v., p. 436)
suppressed m'enstniaiion, (Alberti's Jurisprud. Med. iii. 796.)
Richter tells us that he has known it occur in individuals after
a violent fit of anger. Erysipelas occurs sometimes in the
course of fevers, apparently from a critical effort of the system
to reliev-e itself from some internal irritation. (Eberle's Prac,
vol i., p. 453.) Some constitutions seem to be" predisposed to
fhe disease in some' it appears hereditary in some it returns
periodically^ Dr. Eberle states the case of a gentleman who
was affected for thirty years with an extensive superficial ulcer-
ation on one of his legs. Whenever the ulcer became dry,
which generally occurred several times during the year, either
an erysipelatous inflammation occurred on the face or fore-
arms, or he was seized with a violent fit of asthma.

'The cutis and dermoid structure in general appears to be
the true seat of this disease. When the inflammation is very
active, and extends to the cellular structure, it assumes some of
the characters of common phlegmonous inflammation, but it is
always readily distinguished from them. This disease presents
itself on the scalp, and sometimes in a frightful form "the cel-
lular structure may be completely destroyed by it, so as to be
removed in large pieces ; it is said to resemble bundles of tow."
(MS. Lects. of Prof. \^ Mott.) In the Diet, des Sciences
Med., t. 13, it is contended that the seat of erysipelas is the very
surface of the cutis its most vascular and nervous part ; and
though this is ix> doubt often the case, we are compelled to
acknowledge that the researches of Mr. Lawrence, and many
other notable writers, have confirmed our own observation, and
that the inflammation does extend to the subjacent cellular
membrane. The affection of the cellular membrane in this
disease, cannot well be confounded with simpfe phlegmonous
inflammation.

The distinction between the simple cutaneous erysipelas, and
diffuse inflammation of the cellukr tissue, is wide enough and

1848.] Quintard, on Erysipelas. 3:25

clear enough to prevent much confusion in practice; but cases
will occur in which the one runs into the other, and there are
numerous intermediate forms, some of which approximate more
closely to the cutaneous erysipelas, and some to the cellular
inflammation. The broad line of demarkation between the two
affections is this : that in erysipelas, the inflammation begins
in the skin and affects the cellular tissue consecutively while
in inflammation of the cellular tissue, that is first involved, and
afterwards "the skin. (Travers on Constitutional Irritation,
Med. Chir. Rev., 1835, p. 317.) In that form of the disease in
which the subjacent cellular structure is involved, and serous
effusion takes place, it is recognized by an accompanying cede*
ma, and it is this form that so frequently terminates in suppu-
ration from the violence of the action or the loss of tone of the .
absorbent system. The matter is of a thin consistence, secreted
by the same vessels which have loaded the cells with serum
under a continuance of the inflammatory action "an action
incapable of the higher stage of adhesive deposition.^'

^' The cellular texture dies, and with the eflused fluid under-
goes that state of decomposition to which the expressive term
^pourriture'' is applied by the French.

" So many opinions have been given by medical writers on the
^contagious nature of this disease, that we are left considerably
in the dark ; which opinion is built on the surest foundation we
scarcely know physicians are neither decided nor unanimous.
Erysipelas prevails sometimes as an epidemic : so do catarrh,
sore throat, bowel complaint, and many other diseases, but no
one would say that these depend upon a specific poison floating
in the air, because they are accoujited for by variations in the
economy excited by consecutive causes. Catarrh, diarrhoea,
&c., prevail at <iei tain seasons of the year ; they are dependant
upon ba^'ometrical and thermometrical changes of the atmos-
phere, and why should it not be so with erysipelas; we see it
following nearly the same law^t is generally most prevalent
in variable seasons, or in extreme seasons, but particularly the
former: we look for it in spring and autumn at the breaking
up of a frost^n very hot summers during the prevalence of
cold winds : we find it usually concur with other affections, the
consequence of such causes with catarrh, with sore throats,

320 Quintard, on Erysipelas, [June,

with bowel complaints." (On the Effects of Morbid Poisons,
Med. Chir. Rev., 183T, p. 365.)

It seems probable that there is some kind of infection about
this disease, for cases iiave occurred in our practice in which
no other mode of accounting for its invasion has presented
itself; and if we turn to books for information on this point, "we
are told by some, "that the facts in support of it are so many,
and so irrefragable, that no doubt can be reasonably entertain-
ed of its truth,"' while others scout at the very idea. We would
not say, however, that in those cases which have caused a doubt
in our mind with regard to the infectious nature of erysipelas,
there has not been some latent constitutional cause predisposing
them to the attack ; for we do believe that this is a disease
which peculiarly requires for its development predisposition on
the part of the individual, and yet we cannot, with Macintosh,
^'deny altogether the idiopathic nature of erysipelas." Dr.
Williams, in quoting from Mr. Travers' work on Constitutional
Irritation, says that in the navy the contagious nature of the
fiisease, and consequently its communication by fomites, is so
generally admitted, that it has become a debated question,
whether its ravages are best limited by swabbing the decks in
the general manner, or by dry-rubbing them. His reviewer,
in the Med. Chir. Rev., thus adverts to these remarks: "Dr.
Williams has alluded to the doubt that prevails respecting the
superiority of dry-rubbing over swabbing on board ship, during
the prevalence of erysipelas, or as a preventive of it. But he
has not ventured to tell us how dry-rubbing, which has won the
/day, should destroy infectious matter better than washing.
The fact is, that swabbing has been denounced, because it was
believed that the cold and wet gave rise to the complaint, not
because it was not calculated to destroy fomites." This is
i^irer le diahle par la queue, with a vengeance.

Cases have pccurred in our practice, in which the disease
has been transmitted from the patient to the nurse. We say
transmitted, because it is a convenient term, not because it has
J3een i)roven that the disease can be conveyed from person to
person; but in a case like the following, one's ideas are very
like to settle upon something. Mr. F. had erysipelas beginning
on the right ear, whi^sh for a long time bore no other character^

1848.] Quintard, on Erysipelas. 327

than those of simple erysipelas. On the seventh day, more
than ordinary swelling was noticed, and a free incision was
made some pus and a small quantity of blood was discharged ;
the application of sulph. ferri was persevered in, and the pa-
tient did remarkably well. The inflammatory action was
distributed over a large surface. Mr. T.'s servant had broken
a bottle the morning the incision was made, and was slightly
cut by a piece of the glass he held the cloths when the pus
and blood was discharging ; some of it got on his wounded
hand, which was unprotected by any covering. The second
day after he was attacked by erysipelas, commencing in the
hand, which extended well up the fore-arm. Nitrate of silver
did not stop the progress of the disease, but it finally yielded to
the sulph. of iron. In the treatment of erysipelas, a great
variety of articles have been strongly recommended articles
differing in their nature and mode of action. The antiphlogistic
ourse has its advocates, as well as the bark and wine ; but
from the obscurity of the pathology of the disease, nothing has
heretofore been applied which in the least degree insured sue?
cess. The truth is, that a disease occurring in constitutions so
widely different, requires a corresponding variety of treat-
ment what suits one will not suit another. Locally, all sorts
of farinaceous substances have been applied ; meal, flour and
magnesia, have been used on the principle of the Kenrick treat-
ment. Dr. Mott uses yeast : '* I have used hogsheads and hogs-
head in the form of yeast poultices," (Mott's MS. Surgical
Lects.) Warm lead-water has been much recommended, and
particularly when combined with opium : it certainly has a
soothing effect, and is as agreeable as any other remedy. The
application of argent, nitrat., as introduced by Mr. Higginbo-
tham, has enjoyed more celebrity than most local applications,
and is yet very much in vogue. Mr. H. applied it in solution
over the whole inflamed surfaee, and his custom is to use a
strong or weak solution at the ushering in of the local inflamma-
tion. He also advises that the parts should be circumscribed
with the solid caustic. Some pass the solid caustic all over the
inflamed surface. It will sometimes beget or institute a new
action, and stop the progress of the disease. Another mode,
which may be properly called an ''American mode," and which

328 Quintard, 07i Eryf^^elas. [June,

is foujid quite, if not more generally applicable, than the appli-
cation of the nitrate of silver on the extremities, is the use of
blisters. This prQ,ctice Of'iginated during the revolutionary
war, and was introduced by a surgeon in the U. S. army. Dr.
Physick adopted it, with considerable success.

Dr. Cox has brought for"v^argl the use of the tinct. iodine,
and in some caseg with hg.ppy effect. We have seen no cases
in which it has been used, but learn from a medical fri.end that
it has succeeded in two of his own cases.

Dr. McDowel has j-ecommended the upg. mercurial ; but
it is now entirely given up, for it has been found ifiefficacious
in consequence, probably, of its greasy nature.

Mr. Lawrence practised incisions, after it had been adopted
by Mr. Hutchins. In the Med. Chir. Rev., he recommends
them as local depletories : they are sometimes of great benefit.
Jf we rernomber rightly. Dr. Mott seldom practised this mode
of tji'eatment, unless in parts where thpx'e is considerable c.ellu-
lar structure. Care should be used in making incisions, lest so
much bleeding take place in the poultipes, as to reader th^n;
U}Ox^ hurtful than advantageous.

Sir Wfn. Dobson's practice is to rpake a number of punctures
in the part affected, and repeat a number of times, during twen^
ty-four hours.

Lastly, we n^ust mention what is probably worth more thaji
most of the others as a local application, Velpeau's remedy r
^uJph. of irof^.

These, we believe, constitute the prominent articles which
h/^vp bee;:^ fe.commepded as local applications. The argent.
nitrat. ha^ not succeeded so well in our practice as "\ye anticipa-
ted from reading Higginbotham. We have used it in solution
over the whole inflamed surface, and surrounded the diseased
part with tjbe solid caustic, and yet, the inflammatory action has
\X}. no way been modified, nor stayed i^i its progress. Cases,
ho,wevjer, do frequently occ,ur, in which it will put a termination
to the disease, \yithout much delay, and we therefore surround
the diseas.ed part with it, for it can do no harm, and may prove
beneficial. JQf blisters, we can speak very favorably, particular-
ly where the extremities wjer.e affected, so as to enable us to pass
a strip of the plaster completely around the limb. The chlo.

1848.] Quintard, on E?ysipelas. 320

sodae, in cases of simple or erratic erysipelas, applied pretty
strongs will raise blisters over the surface, and often check the
disease at once, and as a wash, after incisions have been made,
we have found it to succeed in cleansing the sloughing parts,
destroying the fetor and removing the discharge. In that form
of erysipelas where the head is affected, and we have coma and
delirium, relief "'will be afforded by the semicupium"' sinapisms
to the feet, mustard pediluvia, and blisters ad nuchae. The gen-
eral treatment of erysipelas is indicated by the type of the fever
occompanying it. If the disease assume the typhoid character,
recourse must be had to those remedies which will support the
strength of the system, and which are found beneficial in typhus,
such as, wine, Peruvian bark, quinine, and other remedies of an
invigorating kind. In the outset of the disease, emetics are ad-
vised, followed by a brisk purgative. Where the febrile action
is very high, or when the fever is well marked synocha, we
are obliged to resort to means calculated to diminish inflam-
niation.

The following cases have occurred in the practice of my co-
partner, Dr. Richard ^J^cGoldrick and myself, and will serve to
illustrate some of the modes of practice which have been recom-
mended from time to time, and the manner in which the disease
ppgress.es.

Ga3e I. Was called to s,ee Mr. D., who had been confined
to his house five or six days by general malaise, shooting pains,
B, sense of chilliness and debility, and who stated that he had
swallowed a fish-bone that was hurting him at the angle of his
jaw, and in the throat, which was slightly swollen. No foreign
substance was in his throat, but the mucous membrane was
inflamed. He complained of pain in the head ; pulse full,
frequent and quick; tongue furred, presenting a dirty ash color-
ied appearance; bowels constipated. Mr. D. was of a full,
plethoric habit, accustomed to high but temperate living. Hp
was bled 5 xx., the solid caustic was applied to the inflammation
in the throat, and a strong solution of the same over the whole
seat of inflammatory action ; a brisk cathartic of hyd. sub. mur.
and pulv. rhei was administered.

2d day. The inflammation had extended all over the scalp^

330 Quintard, on Erysipelas. [June,

which was much tumefied ; considerable difficulty in swallow-
ing; the temporal and carotid arteries pulsating with unusual
force ; much heat about the head. Ordered, emplast. vesic.
around the throat, sixty leeches to temples and back of the
ears, and a saline cathartic at night, puly. Dover, grs. xii. ;
continue the wash.

3d day. Inflammation had increased ; eyes closed, and the
whole head swollen enormously; tongue swollen, but not so
great difliculty in swallowing; pulse full, round and bounding.
Had his head shaved ; bled ^xvj.; twenty leeches applied to
temples, and gave seidlitz powders. The wash of arg. nit. was
changed for that of acet, plumb, et opii. at night, pulv. Dover.

4th day. Passed a restless night ; signs of suppuration about
the scalp. Hyd. sub. mur. and pulv. antimonialis ordered in
the morning. Evening Inflammation about the throat sub-
sided. 01. ricini, ! i.

5th day. Patient delirious, head very hot, fluctuation about
the scalp. Free incisions were made through all the tissues of
the scalp, on both sides, extending low down behind the ears ;
some pus escaped apply hot poultices, leeches to the temples,
and a saline cathartic given. Evening pulv. Doveri., grs. xv.

6th day. Patient not improved ; still delirious ; the whole
cellular tissue of the scalp felt perfectly loose ; fluctuation felt
in nearly every part. Three incisions were made on the front
part of the head, from which large quantities of pus escaped
tongue dry, and considerable restlessness. Continue the poul-
tices, and ordered iced lemonade for drink. Emplast. vesic. ad
nuchae Dover at night,

7th day. Passed a comfortable night j the ears enormously
distended and the integuments about the temples swollen and
doughy. An incision was made over each temple on the right
side the temporal artery was accidentally cut, but very little
blood was lost. Forty leeches back of ears and neck; discharge
copious and very eflusive. Pulv. antimonialis given during thp
day, in small doses. Continue the poultices.

8th day. Mr. D. rather more comfortable ; pulse full, but not
so quick ; bowels sufficiently free ; tongue foul, and breath
offensive a quantity of matter had formed just below the ear
near the angle of the jaw, on both sides. Free incisions were

1848.] Quintard, on Erysipelas. 831

made, and large quantities of pus escaped. Continue poultices
to head ; discharge as yesterday. Drink lemonade.

9th day. Patient better ; delirium has ceased : complained of
tenderness and uneasiness about the bowels. Rhei and magne-
sia as cathartic ; wash of sol. chlo, sodse, in place of poultices.

10th day. Slight delirium ; tongue coated ; pulse full and fre-
quent. Ordered full dose of hydrg. sub. mur. Incisions were
made along the inner edge of the sterno cleido, and the head
kept constantly wet wdth sol. chlo. sodse.

11th day. Bowels not moved by the calomel, tongue improv-
ed, still delirious ordered an enema.

i2th day. Much improved, tongue moist, pulse soft con-
tinue the wash to head.

13th day. Complains of pain in the head blisters to the back
x)f the neck, extending well down between the shoulders ; hot
foot bath at night, and pulv. Dover.

14th day. Much better in every respect ordered :
^. lod. potass., ... f i.
Syr. sarsap., . ' . . 5 xii.
Table-spoonful morning and evening ; bowels were regulated
by the use of Congress water. He continued to improve up to
the 2Qth day; but patient very much debilitated. Put him on
the use of lod. quinine ; allowed him weak porter sangre. No
important change was made in the treatment up to the 30th
day, w^hen patient was considered convalescent, but advised
the continuation of hyd. potass, and syr. sarsap.

Case II. Patrick M., aged 42, perfectly prostrated and broken
down by debauchery, fell, in .a fit of intoxication, and struck his
right knee against a stick of timber. For several days the knee
was swollen and painful. On the sixth day after his fall we were
called in, and found him with great febrile excitement ; pulse full
and jerking, skin hot and dry, and tongue coated and brown.
Erysipelas had two da} s before our visit attacked his knee, and
was spreading both above and below : his leg and thigh were
bathed in cold water, and a solution of nitrate of silver, one
drachm to the ounce, applied over the parts affected ; his bow-
els, which had been constipated, were acted on by a dose of
ol. ricini, and four pills of hyos. and camph. given at night. In
the morning delirium tremens was developed. He was rest-

332 Quintard, on Erysipelas. [June,

! . - - . -^

less, watching, and saw all the goblins that ever haunted a man's
imagination ; complained that some one was constantly " filing
at his leg with a dull saw." We were obliged to have three men
in constant attendance to restrain him. The solution of nitrate
of silver was changed to yeast poultices. Two grains of opium
failed to procure sleep. This was the eighth day from the time
ofhisflill.

On the ninth day, four deep incisions were made in the thigh,
and three in the leg, from those in the thigh, immense quanti-
ties of pus escaped; half a grain of sulph. morph. was adminis-
tered, and the poultices kept constantly applied. About three
hours after taking the morphine he fell into a profound sleep,
and slept till twelve o'clock at night.

11th day. Pulse soft; skin dry, tjut not very hot; bowels not
moved since taking the oil ; tongue dry. Continue the poultices,
and give, every three hours, sulph. quinine, grs. ii. : a glass of
porter at noon and another at night, with nutritious diet.

12th day. The inflammatory action almost subsided ; the dis-
charge of matter from the inoisions abundant could pass the
probe in all directions. Ordered an injection, and poultices of
bark and charcoal continue the porter,

13th day. Pulse small; an exhausted expression about the
countenance ; bowels moved by the injection the day before.
Continue the poultices, quinine and porter.

14th day. No improvement continue remedies. Pus pour^
ipg out from the incisions. At the instance of a professional
friepd we injected a solution of argent, nit. into the sinuses
formed by the burrowing in and breaking down of the tissues.

15th dd^j. No materijil change ; patient very weak and ex-
hausted; pulse small apd feeble. The morning of the 18th day
he died while being raised in bed by his attendants,

This case presented several points of interest, and in watchr
ing its progress, we were constantly impressed with thedelicar
cy of the machine we had to deal with : the slightest error
would cause the chords of life to vibrate and quiver while
constant attention to the harmony of the various parts, alone
gave us cause for hope. In a person like this one, whose con-
stitution has been broken down by debauchery and excess, we
do not look for the vis medicatrix natunc, for it is never found

18*48.] Quintard, on Erysipelas. 383

in those bodies in which nature is burned out by the fire of
intemperance. If there be a vis medicatrix, how fearfully do
those err who destroy it, by " looking upon the wine when it is
red in the cup."

Case III. Dr. McK., aged 36 ; good constitution was at-
tacked, on the 5th March, with pain at the angle of the jaw,
preceded by rigors and vascular excitement : health previously
to this date very good. He complained of very severe shoot-
ing pains in the head ; bowels were constipated ; tongue coated;
pulse full and round, but compressible, with some soreness of
the scalp behind the ear of the right side. An emetic was at
once administered, and followed by a mercurial cathartic-

2d day. Erysipelas of the head was fully developed the
whole ear and the surrounding integuments were involved -all
the symptoms of a severe attack were present. The parts were
marked off with caustic, a wai'm wash of acet. plumb, et pulv.
opii. was kept constantly applied, a full dose of sial|)h. rnag. was
administered.

3d day. Inflammation not at all affected hj the line of caus-
tic, which it had passed over, and involved the palpebrse of the
right eye; complained of some soreness of throat, which re-
moved by the application of caustic. Salts ajCted well keep
on with the wash, and pulv. Doveri at night/

4th day. No improvement bleeding from' the ear ; parf^
immensely swollen, and the inflammatory action in no w^y sub-
dued ; pain in head Very* severe. Ordered another mercurirf
cathartic, pedilutia of hot mustard water, aiid hop poultices to
the scalp. From this d^iXe the cfase gradually trec'ame more
serious, assuming all the characters of erysipelas of the head and'
face, which can never be mistaikeii not forgotten, until the tenth
day, when fluctuation was discovered immediately over the'
occiput. A free incision vras made through all the tissues of
the scalp, from which escaped pus mingled with blood. A se-
cond incision wa;s made on the twelfth day, above the right eaf,
on the parietal bone, from which a similar discharge took place'.-
Poultices were kept constantly applied, and the discharge wa^
free. The disease had extended completely round the head,'
and the left ear was at this time as much swollen as was the
tight at the beginning of the attack; fluctuatipawas discovered

331 Quintard, on Erysipelas. [June,

behind the ear, and a free incision made on the fifteenth day
over the mastoid process, from which about half a pint of pus
was discharged.

18th day. Over the cheek of the right side, from which the
inflammation had subsided abotit a week, there was spread an
efflorescence, partaking more of the character of Good's erratic
erysipelas, than of a phlegmonic form which had occupied it
previously. To this, cloths wet with a solution of chlo. sodae
were applied, which blistered the surface and removed the in-
flammation without difficulty.

19th day. Free discharge of pus was kept up, poultices appli-
ed, and the following ordered

^* lod. potass., 4 . . I'l.

Syr. sarzae., . . . !xii. M.
Tea-spoonful, ter in die. For five days, or from the 19th to the
24th, the case seemed progressing favorably, and so the general
health was improved. His appetite, which had been impaired,
was restored ; bowels were regular, and he slept well at night.
He had used the following pill:

^. lod. quin., . . gr. xii.-
Ext. sarsap., . q. s. M.
et div. mass in pil. equal. No. xii., one ter in die,

But at this time the incision over the parietal bone of the
right side had closed. On the 25th day we were called, and
found the scalp much tumefied, and the face on the right side
considerably puffed up ; complained of great pain. An incision
was made larger than the first a small artery was cut which
was allowed to bleed 'till about a pint had escaped, when it was
stopped by pressure. From this time no more trouble was ex-
perienced. In the treatment of this case it was impossible to
follow any given course, of treatment ; indications were met
with their appropriate remedies. Mercurials were given till
the system was influenced, and the "odor of sanctity" Was dis-
covered in the breath, but not pushed to such an extent as to
"lay the patient down/'

Case IV. In the case of a child of Mr. II., when the disease
attacked the head and face, and the child was completely blind
for three or four days, the sulph. of iron was applied to the scalp,
leeches to the temples, and lead and opium wash over the eyes*
The child recovered in ten davs.

1848.1 Quintard, on Erysipelas. 335

' ' - ' ' -

Case V. Mrs. D., aged 55 years, widow of Dr. D., a rela-
tive of the child, and living in the same house, whose constitution
was impaired, and who had frequently suffered from attacks of
erysipelas, was seized with a very severe chill the day after our
first visit to the child. On the 18th of February, erysipelas
began on the point of the nose, and spread from thence all over
the head ; tongue dry and dark, breath foetid, bowels costive,
pulse full and frequent. Mrs. D. had been suffering from a
cough for some days previous to the attack. At the invasion of
the disease there was considerable nausea ; nothing was retain-
ed on the stomach. An emplast. vesic. was applied over the
epigastric region, and Congress water ordered ; lead and opium
was applied over the seat of the- local inflammation.

2d day. Eyes closed, and the disease increasing. Calomel
and Dover powder was given, to be followed by a dose of castor
oil and turpentine in about eight hours continue the wash.

3d day. Medicine operated well. Leeches were applied to
the temples, and a hot mustard foot bath ordered continue
wash to head.

4th day. Cough very troublesome, great oppression, slight
expectoration, and breath very oflensive ; delirium ; bowels not
moved since the action of the oil. A blister was applied to the
chest, an enema of oil and turpentine administered, and expec-
torant mixture given to allay the cough pulv. Dover at night.

5th day. Patient had rested well during the night, and a slight
improvement was perceptible continue the wash; blister ad
nuchse.

6th day. The sulph. ferri was substituted for the head, and
opium wash. She continued to improve ; swelling subsided,
eyes were open, pulse natural, cough relieved, and every indi-
cation of a speedy recovery was present until the 11th day,
when a casual visit was made. No swelling was any where
about the head: she complained of pain in the head, and on a
, close examination a circumscribed redness Was perceptible on
the tip of the nose, where the disease first originated. Satisfied
that the disease was about to return, the friends were advised
of her danger. Pediluvia and an injection of soap and water
ordered. Returned in six hours ; found the eyes involved, and
patient cottiplained of severe pain in the head leeches order-

^^^ Quiiitard, on Erysipelas. [June,

ed to the temples. She became comatTose about four hours after
our second visit, and died at 8 o'clock the following morning.
A post-mortem could not be obtained.

Case W. L. W., aetat 22 ^good, vigorous constitution
was exposed in a storm at night in travelling on horseback. For
two days complained of general debility; a fulness of the head,
nausea, and feverishiless. When we first saw him he presented
the following appearances: Tongue moist, and covered with
white fur; pulse full, frequent, and quick; on the point of the
nose the skin was inflamed, bright, shining and red, and slightly
elevated above the surrounding parts. The efflorescence grad-
ually increased spread upward, until the eyes were closed by
the swelling of the palpebras ; bowels constipated; not a great
degree of arterial excitement. This case progressed well : there
was slight biliary disturbance. The treatment consisted in
small doses of calomel, followed by ol. ricini, venesection, and
the application of the lead and opium wash. The eighth or
liitith day after the attack, he walked oiit. In these simple cases
the skin is not left in that morbid condition w^hich sometimes
results from the phlegmonic form, whete it jjlts on pressure,
and which is distinguished from anasarca by a roughened and
thick cuticle". When this Condition of things results from an
invasion of the' disease, a second attack follows at some future
period. " When this happens, the patient will be' subject to
returns of the malady foi' the rest of his life." ^(Calle's Lect.-
Oh Surgery.)

Case VIL N. W. T^., aged 53, of excellent constitution, felJ,
and struck his shin-bone against the limb of a fallen tree. He took
no notice of a slight scratch which was present ;'T^ent about his
ordinary occupations for two days after, without nuich incon-
venience. At this time he had a Very severe rigor, followed by
g^reat feverishness, thirst, nausesi, headache*, &c., with pain ifi!
the right leg, which was the one injured ; pulse accelerated ;
tongue dry. In three days, the" inflammation, of a well defined
erysipelatous character, had nearly reiiched the kriee. Mercu-
rial cathartic was given, and the limb encircled just fcelow the
knee with a narrow strip of blister plaster. This was also done
^bove the ancle-joint. Ordinary remedies were resorted to,
and the case recovered without trouble. From the violence of
ihc symptoms we had expected a severe attack.

1848.] Green, on Ligature of the Primitive Carotid, 337

Article xxvi.

Ligature of the Primitive Carotid. By James M. Green, M.D.,

of Macon, Georgia.

In the Medico-Chirurgical Review for 1842, Mr. Branaby
Cooper, of London, published a case of ligature of the common
carotid, accompanied by some observations in which he advo-
cated an improved method of performing this capital operation
in surgery.

Mr. Cooper recommends that the surgeon should not make
his external incision, so near the edge of the sterno-cleido
mastoid muscle, as is directed by authors, and that he should
cut directly down upon the trunk of the artery, and not upon
the internal jugular, or the line of division between these two
vessels.

Operating surgeons, in their reports, dwell upon the incon-
venience and danger produced by the swelling and turgidity
of the internal jugular, during the operation for carotid aneur-
ism, and it is well known that this important vessel has been
punctured in more than one instance ; adding a grave compli-
cation to a dangerous operation.

By cutting down more to the inner side of the jugulo-carotid
sheath than has been directed by the surgical authorities, these
difficulties are avoided, a considerable mass of undisturbed
cellular substance is left, which binds down the internal jugular
in its proper place, and prevents it from swelling up and over-
lying the artery, thus seriously interfering with the success and
safety of the operation.

Believing that Mr. Cooper's method is a real improvement in
the manual of the operation, I am induced to communicate the
particulars of a case in which a somewhat similar plan was
pursued by myself, in the year 1841. If valuable in no other
way, it may be in a statistical point of view.

In November, 1841, I was requested by Dr. Thos. F. Green,
then physician to the Georgia Penitentiary, to operate on James
Deas, a convict in that institution, for aneurism of the right
carotid artery. Deas gave the following history of the tumour.
About eighteen months previously, he first observed a small

22 '

338 Green, 07i Ligature of the Primitive Carotid. [June,

swelling on the upper part of the right side of the neck, imme-
diately after a severe strain \vhile planing some hard wood.
This was at first supposed to be an enlarged gland; it increased
in size very slowly until the month of May, '41, since which it
had rapidly augmented to the size of a hen's egg ; pulsating
violently, very sensitive, and producing much pain; confusion,
fulness, &c,, in the right side of his head. When I first saw
him it was a good deal larger than a common sized hen's e^g,
pulsated very strongly, and was quite red, and tender to the
touch. It was situated just below the ramus and posterior part
of the right lower jaw. The peculiar whizzing noise, said by
the surgical writers to be so peculiar to aneurismal tumours,
was very indistinct almost imperceptible ; nor could we hear
the fluid rushing into the sac again, after obliterating the calibre
of the artery, by pressing it firmly against the vertebras. Nei-
ther could the sac be entirely emptied by stopping the flow of
blood into it ; it. still retained about a third of its volume, but
this we attributed to a little surrounding oedema and a few
enlarged glands, and perhaps some coagula in the aneurism
itself Always after handling the tumour, the pain, fulness and
confusion in the right side of his head was very much increased.
For two weeks preceding the application of the ligature,
Deas was subjected to a very rigid diet, and took blue pill and
salvine cathartics several times, which treatment produced some
diminution in the size of the swelling, and a marked abatement
in its redness and sensitiveness, as well as the unpleasant feel-
ings in the head. As this improvement, however, was not so
great as to suggest a hope of cure by the method of Valsalva, it
was determined to apply the ligature.

December 14th. Proceeded to perform the operation, assist-
ed by Dr. Benj. A. White and Dr. Thos. F. Green. After
placing the patient irf the recumbent posture and inclining his
head to the left, as usual, the operation was commenced, by
making an incision two inches in length through the skin and
cellular substance, in the sulcus, between the edges of the sterno-
mastoid and sterno-hyoid muscles. The dissection was then
continued through the superficial and <leep-seated fascia, down
to the left side of the sheath directly upon the artery. Finding
some inconvenience from the smallness of the external wound

1848.] GreeUy on Ligature of the Primitive Cai'olid. 839

and the profundity of the artery, it became necessary to increase
the length of the external incision about three-quarters of an
inch upwards. Making now a small opening in the sheath, just
over the centre of the artery, at the lower edge of the omo-
hyoid muscle, with the point of the scalpel, the ligature was
without much difficulty passed under the artery, by means of
Gibson's aneurism canula, which was carefully insinuated
through the opening in the sheath, and then round the artery
from without, inwards. We now compressed the artery be-
tw^een the finger and the canula, to observe its effect on the
aneurism, and then carefully excluding the pneumo-gastric
nerve, the ligature (a strong silk one) was drawn tight, and se-
cured by three knots. Not more than three ounces of blood
was lost, and no vessel but the carotid required a ligature. The
patient was allowed to rest a few minutes, when the edges of the
wound were drawn together by two points of suture, and cov-
ered with lint, which the attendants were directed to keep con-
stantly moistened with fresh cold water.

During, and for some time after the opel'ation, the patient
complained of intense tooth-ache in two of his right lower mo-
lars, which might have had some connection with an accidental
pinch that the descendens noni received from the dissecting
forceps. . ( ?-> Edt.)

In consequence of making a very small openings and that on
the inner side of the sheath, no trouble was experienced from
the bulging and turgidity of the internal jugular indeed it was
not seen or perceived during the operation.

Subsequently to the application of the ligature, a very obsCiire
pulsation was observed in the tumour; whether from the im-
pulse communicated by the impetuous beating of the artery
below the ligature, or from the recurrent circulation, we were
unable to decide.

At our evening visit, we found that Deas had a good deal o^
head-ache, and complained of considerable pain in swallovvincy ;
the tooth-ache was gone. Closed the wound with strips of ad-
hesive plaster.

15th. At our morning visit, Deas had a good deal of head-
ache; he said he had vomited freely during the night. His
head^ face and neck, flushed ; had slight nausea, furred tongue,

340 Barr, on Spinal Irritation, [June,

and some epigastric tenderness. The temporal and other arte-
ries on the left side of the face and head were very much
developed, and the conjunctival vessels of the right eye a good
deal congested. The artery below the ligature was still pulsa-
ting strongly. Pulse 70, not much excited. Directed a dose of
sulph. magnes., and cloths dipped in cold water to his forehead.
In the evening he was better in all respects the medicine had
moved him three times. Ordered, a dose of blue pill at bed time.

16th. Found Deas quite comfortable his head-ache, flushed
face, (fee, have passed oft', and he has some appetite. The
pulsation in the tumour and neck had disappeared, and his medi-
cine had acted twice.

The wound united in its whole length, and the sutures were
consequently removed. From this time forward Deas went on
to recovery, without an unpleasant symptom; the tumour rapid-
ly diminished to a small hard lump; the head-ache, cerebral
confusion, &c., soon disappeared ; the ligature separated on the
18th day.

He presented himself to me some months afterwards, in
Macon, well in all respects, save a small lump in the position of
the original tumour, though without pulsation or other incon-
venience.

[We cannot but express a doubt if an aneurism existed in
this case.] Edt.

ARTICLE XXVII.

Case of Spinal Irritation. By W. F. Barr, M. D., of Green-
ville, Tennessee.

May, 1847. Mrs. , about two years since, (before her

marriage,) was thrown from a horse into a pond, during men-
struation. As would be expected, the menses were suppressed ;
after which they returned at irregular periods, and were attended
with great pain. Since then she married. A few months after
marriage, it was supposed, she had an abortion. For the last
twelve months she has been subject to hemicrania. During the
last year, she had an attack which continued for three months;
since which time she gave birth to a child-^labour occurring
seven months after conception. The child was four months

1848.] Ban, on Spinal Irritation. ^i\

old, when she had a return of hemicrania. For the first time, I
was now called to see her. The attack continued five or six
weeks.

Treatment. Purgatives, blister to the back of the neck, and
ext. stramonium and belladonna in combination. During con-
valescence, carb. ferri. precip. Under this treatment she
recovered.

In about a month or six weeks the disease returned. Upon
examination^ found the cervical vertebrae very tender. I now
cupped upon the back of the neck, which gave almost immediate
relief. In two or three days cupped again. After the scarifi-
cations got well, I found no tenderness of the cervical vertebrae,
and the patient remarked she was in the enjoyment of better
health than she had been in twelvemonths'!

In a short time, she was attacked with continued fever. Af-
ter this was checked, the o/(i disease (hemicrania) returned with
all its violence. Upon examination, I found the cervical,
several of the dorsal and lumbar vertebrae, very tender ; the
tongU3 somewhat red, and slightly coated with fur upon the
posterior portion ; no pain or uneasy sensations of any kind, in
any part of the system but the head. Suspecting that the
affection of the head might, in part, depend upon a diseased
condition of the uterus, I made strict inquiries to ascertain its
condition. The patient said she felt no pain, soreness, heavi-
ness, weight, or dragging sensations about the uterus or vagina;
no discharge from the vagina; no pain or uneasiness in discharge
of urine or faeces. Having none of the symptoms, commonly
attendant upon affections of the uterus, I thought it unnecessary
to make an examination per vaginam.

Believing that the affection of the head depended upon spinal
irritation, (having found no other part of the system affected,)
I directed my remedies to the alleviation of pain, and the reduc-
tion of the irritation of the spinal marrow.

Prescription. Cupped upon the cervical and dorsal verte-
brae; ext. belladonna and stramonium in combination, until
vertigo was produced: after which, gave carb. ferri precip.

In a few days, for the first time during the attack, she com-
plained of pain in the lumbar region, hips and knees. Found
the lumbar vertebrae very tender upon which I cupped : since

342 Johnson, on Passage of Half-Dollar, ^-c, [June,

then, she has not complained of these pains. But a short time
afterwards, the patient complained of slight pain and soreness
near the anterior superior spinous process of the ilium. Found
lumbar vertebrae yet tender. Circumstances of a peculiar nature,
induced me at this stage of the disease, to make an examination
per vaginam. There was no pain or tenderness felt in the
vagina upon the introduction of the finger ; the vagina of natur-
al temperature, the uterus being in its proper place; no tume-
faction or tenderness of the os uteri, and all the parts found to
be in a healthy condition. Cupping upon the lumbar vertebras
removed the pain and soreness near the anterior superior spinous
process of the ilium. She now became convalescent. During
her convalescence, this patient ate a supper which caused such
violent vomiting as to produce great prostration, and sub-acute
inflammation of the stomach.

Prescription. Light diet, emolient injections, and a balsamic
mixture, according to a formula in Eberle's Practice " Chronic
Gastritis.''

May 4th. Convalescent again,

July. Patient, having been visiting among her relatives for
several weeks, began to feel debilitated and unw^ell. She applied
to a physician in a neighboring town, where she was on a visit.
He gave her pills composed of aloes, ipecac, and ext. hyoscy-
amus. These produced a diarrhoea, which could not be stopped,
and in a few davs she died.

ARTICLE XXVIII,

Passage of a Half-Dollar through the Alimentary Canal.
By N. B. Johnson, M. D., of Griflin, Georgia,

Mr. T. L. N -, of Salem, Ga., aged 21 years, while spend-

intr a few days in our town, accidentally swallowed a half-dollar
on the 18th of March. He had already taken about half an
ounce of antimonial w^ine before I saw him, and complained only
of slight soreness in the oesophagus. After filling his stomach
with solid ingesta, to entang/e, if possible, the foreign body, I
gave him an emetic; and this was again repeated during the
day, but without dislodging, by vomiting, the half-dollar. I de-

1848.] Holliday's Ca^e of Self -Castration. 343

sisted after this from active treatment, and my patient resumed
his ordinary diet. On the 24th, being the seventh day since it
was swallowed, he passed the foreign body per anum. He ex-
perienced no pain or inconvenience from its presence or passage
through the alimentary canal, except the slight soreness about
the oesophagus already mentioned.

The coin was an eagle half-dollar of the U. S. stamp, date
1826, and measured seventeen hues in diameter. When dis-
charged, it was coated all over with a glutinous deposit which
had rounded off its edges, changing its form from flat to an
ovoidal shape. When this was removed, its color was quite
black. Was it right to give the emetics? Would it have been
prudent to administer cathartics ?

[We answer, that this was one of those cases where the very
best practice was ^oc?o7io^/iZ7zo-. Nature being fully competent
to relieve it, no interference was required. There was no indi-
cation, (except to remove the foreign body, which could not be
prudently done) no alarming symptom had occurred, and all
the physician was called upon to do, was simply to watch the
ease, as our friend, Dr. J., finally adopted. An important duty
often arising in the business of a doctor, is to convince his pa-
tient, that the very best plan of treatment, in some instances,. is
to do nothing.] Edt.

ARTICLE XXIX,

A Case of Self -Castration. By John S. Holliday, M. D.,
of Fayetteville, Georgia,

Mr. B , aged about 30, passed through this place about

two years ago, on his way to one of the lower counties of this
State. Two miles from this village, he stepped aside from the
road, and with a dull pocket-knife castrated himself, removing
both testicles with a part of the scrotum. The hemorrhage Was
very great. He put the testicles in his pocket, and reaching a
house in the neighborhood, desired to lie down by the fire.
The bleeding on the floor attracting the notice of those around
him, he informed them what he had done. Dr. Blalock and
myself were called to see him, and found the hemorrhage had
ceased by sliglit compression. The usual treatment, consistin^^

3H Pneumonia treated hy Tartar Emetic. [June,

of astringents, (Sec, was pursued in the case, and our patient had
a rapid recovery. This act has cured him of his mental de-
ranijement, and he now repents most sincerely committinc: it.
I have frequently seen Mr. B. since his recovery, and report
him now to be fleshy and doing well. He has a wife, but I do
not know tliat he lives with her.

PART II. REVIEWS AND EXTRACTS,

The Result of Cases of Pneumonia treated chiefly hy Tartar
Emetic {Antimonii et Potasses Tartras). By J. F. Peebles,
M. D., Petersburg, Va. (American Journal of the Medical
Sciences.)

In all the systematic works, we find the tartar emetic admin-
istered with a view to the attainment of its sedative effects on
the circulation recommended in the treatment of inflammatory
diseases, especially those of the pulmonary organs. Rasori first
propounded its claim as a contra-stimulant, but it seems that to
Laennec is due its extensive employment in the treatment of
pneumonia, These authors, and most subsequent writers, speak
of its administration in almost incredible (quantities, given within
an exceedingly short space of time. Rasori, for instance, has
given many drachms within twenty-four hours, and several
ounces during the course of a disease, and Laennec has con-
firmed, to a certain extent, his statements, since he gave with
impunity from one to two scruples, and even a drachm and a
half within twenty-four hours.

No allusion is made by these, or most other writers, to any
injurious effects arising from its use; nor is any caution express-
ed in relation to its employment, under the circumstances calling
for its administration. Since there exists, therefore, such
weighty testimony in behalf of its innocuous character, the
writer feels some hesitation in attributing the unfortunate ter-
mination of the cases he is about to relate, and the peculiar
symptoms which supervened upon their progress, to the efl'ects
of the drug ; yet the uniformity \\\ the character of these latter,
under a state of things pretty ntarly similar, certainly is sufficient
to excite attention. These cases, we may add, v,'ere carefully
noted at the time of their occurrence, not with the view,
however, of observing the effects of the tartarized antimony, but
simply for the purpose of obtaining general facts relating to the
history and treatment of this important class of affections.

1848.] Pneumonia treated by Tartar Emetic.

Case I. Louis, a robust young negro man, was seized, after
complaining several days of slight indisposition, with a severe
rigor during the n"ght. I saw him Nov. 3d, 1844, on the second
day following the chill. I found him lying on his back, labour-
ing under dyspnoea and great prostration; his countenance
was anxious and shrunken ; his skin was rather cold and harsh ;
his pulse was very feeble, and 110 beats per minute ; he com-
plained of dull pain in the phest, coughed frequently, and ex-
pectorated freely tenacious viscid mucus of a dirty tinge, oc-
casionally variegated with a pinkish hue.

The right liuig was dull, throughout, on percussion, whilst
under the ear the crepitation of pneumonia was detected in the
upper portion of the left, and found to exist, generally, in the
right lung, in many places completely obscuring the vesicular
murmur. Diagnosing it as a case of double pneumonia, and
taking into consideration the general condition of the man, and
the delay which had occurred in calling aid to the case, although
the disease had not yet passed beyond its first stage, my
prognosis was unfavourable. Sinapisms were applied to the
extremities, and he was freely cupped on the chest. Deeming
venesection inadmissible, and believing that urgent necessity
existed fur the speedy relief of the lungs, I determined on the
use of the tartarized antimony as recommended by Laennec.
Beginning immediatel}^ the man was ordered to have one grain
of the drug every second hour, dissolved in water, to which was
added infusion semen lini sufficient to make the dose four
ounces. He tolerated the medicine from the first; it produced
neither vomiting nor purging ; and at my evening visit, I found
his condition somewhat ameliorated ; his pulse was fuller and
less frequent ; his skin was warmer and slightly moist ; he
still, however, maintained his position on the back^ and was
much troubled by cough. Continued the medicine, and ordered
10 grains pulv. ipecac, et opii, at bed-time.

Nov. 4th, Condition same as the previous evening. He
passed a restless night from his cough. No nausea ; had not
vomited since I last saw him, but had had two copious, but
consistent evacuations from the bowels. The stools were
unaccompanied by pain, and they consisted of dark vitiated
secretions. No thirst; his tongue moist and covered with a
creamy coat. There was increased dullness on percussion,
and the stethoscopic signs indicated a further consolidation of
the left lung Sputa more viscid and tenacious, having a
fibrous appearance, with gi'eat elasticity, and of a dark hue; his
pulse quick and compressible. Ordered cups between
shoulders, and increased antimony to two grains every second
hour.

346 Pneumonia treated hy Tartar Emetic. [June,

5th. No change. Still a perfect tolerance of medicine
without any evacuation, save a slight perspiration. Continued
treatment, stopping medicine, however, whenever he fell
asleep.

6th. But little change; treatment continued.

"Tth. Evidently better: respiration more free, strength in-
creased, cough less troublesome, expectoration easy, and the
sputa less tenacious ; has now become thick, creamy, and is
occasionally unmixed with blood. Although the medicine has
been steadily continued, he wants to eat. The state of the lungs
correspondingly improved; chest more resonant, and there is
less obscuration of the vesicular murmur by the crepitation.
Diminish dose of antimony to one grain every third hour.
Farinaceous diet.

8th. Patient 'had four evacuations from the bowels during
the night, and did not rest well. Still, however, improved.
Desires food ; cough much less troublesome ; can lay on either
side, and easily gets in and out of bed without help. Continued
same diet, and directed 5 drops tr, opii in each dose of me-
dicine.

9th. Still improving. The laudanum had restrained his
bowels, and he slept well during night. On the 10th, all me-
dicine was discontinued. The symptoms generally had sub-
sided, and he could walk about the room. After visiting him
several days as a security against errors in diet and exposure,
I left Louis, satisfied that his recovery was secure.

24th. Exactly ten days since I had paid him my last visit, I
met Louis in the street, returning from his work. ' Perceiving,
from his appearance, that he had not improved as I had expected,
and struck by the pallid, ashy hue of the skin, I stopped him.
My attention was at once arrested by a collection of pinkish-
coloured mucus around each nostril. He told me that his nose
had bled just as it did then for several days, but he persisted that
he had quite recovered. I found his pulse very small and
frequent, his skin shrunk and cool, his tongue very pale and
clean ; and upon examining more closely, I detected several
ecchymosed spots on the mucous membrane of the mouth, one
as large as a five cent piece, existing over the buccal membrane
on the right side. Becoming, at once, anxious about the case,
I ordered the man to be confined to the house, and directed for him
a hot foot-bath, quinia, a nourishing but unirritating diet, and
the free use of lemonade.

27th. Summoned early to see Louis. The hemorrhage,
which, though slight, had nev^er ceased entirely from his nose,
had increased greatly during the night, and I found him suffering
from profuse epistaxis. lie still made no complaint of})ain or sick-

1848.] Pneumonia treated hy Tartar Emetic, 347

ness. The hemorrhage was purely passive ; there was no heat or
vascular excitement about the head ; the blood seemed to flow
steadily in sluggish streams from both nostrils. Its arrest was ex-
ceedingly difficult ; indeed, I found it impossible to prevent a slight
oozing, wliich continued. There was no fever, and his appetite
was excellent. ' Ordered him to drink freely of cool acidulated
drinks, to maintain the sitting posture and as night came on,
substituted for tiie former treatment, acetas plumb, et. opium
in full doses, at short intervals. His condition hourly was be-
coming^ more critical.

28th. Patient allowed his nose to bleed all night, or nearly
so, without calling for aid. He had now become too weak to
support himself erect and he was propped up to elevate his head.
His nostrils were carefully injected with solutions of alum,
sulphate of copper and with creasote, but without success; I
then securely plugged them up from behind. He still maintain-
ed his cheerfulness, and ate heartily.

29th. Blood oozing from his nose all night. As he lay with
his head turned aside, from the base of either nostril a small
stream would form and tickle slowly over the cheek sufficient
to wet a small handkerchief in a couple of hours. The blood
had become thin and nearly colourless. In the course of the
day, his urine became bloody, which was speedily followed by
stools of the same character. He rapidly became so perfectly
anemic, that the very slight pressure occasioned by a bandage
which passed under his nose to be tied over the head, for the pur-
pose of fixing the external plugs wuthin the nostrils, was sufficient
to create complete oedema in the face and forehead above it, the
raised and pellucid appearance of the skin giving the counten-
ance a singular aspect. He soon became unmanageable, and
progressively sank, the bloody discharges continuing; and
during a slight convulsion, he expired on the next day.

No post-mortem could be made.

The scorbutic symptoms in this case were attributed, at the
time of their occurrence, to the treatment the man had received.
Soon after I ceased my visit, he was made to sleep in a crowded
apartment, and to mess with the other negroes, on a diet con-
sisting of salt pork, fish and beans.

Case IL December 10th, 1845. Visited Caroline, a well-
grown negro girl, aged 17. After suftering with a severe catarrh
for several days, upon exposure on a raw damp afternoon, she
was seized with a chill which lasted her nearly all night. I
found her labouring under a threatening attack of acute bron-
chitis, extensively involving the lining membrane of both lungs.
The symptoms were urgent ; there was great distress in respi-
ration ; a disposition to sit up in bed : her countenance was

348 Pneiunonia treated by Tartar Emetic. [June,

anxious, her lips livid, and she was slightly delirious. She had
lonc^ fits of coughing at short intervals, and she brought up at
the end of each, considerable quantities of frothy mucus, freely
streaked with blood. She had taken a full dose of calomel the
previous night, which had been followed by castor oil that morn-
ing, and the bowels had been freely evacuated.

V. S. ad deliq. animi, to be followed as soon as reaction was
established, by cups to the chest. ^. Antimonii et potassse
tart. gr. vi. : p. g. acacine 3 iv. ; aquae font. I vss. ; syrup, aurant.
iss. ; one table-spoonful of this mixture every hour. The se-
cond dose of the medtcine vomited her freely ; afterwards toler-
ance became fully established. The symptoms continued so
urgent that V. S. was again employed" in the evening, and the
medicine ordered to be continued all night.

11th. Rested badly, and is but little, if any, better. Cough is
extremely troublesome, and the respiration so much oppressed
that she is scarcely able to converse. Pulse less frequent, tongue
somewhat moister. Same treatment continued, in addition to
which the chest was blistered extensively. As evening ap-
proached, signs of amendment appeared ; the respiration be-
came better, cough less troublesome, and not so harsh and
ringing, and there was a free expectoration of sputa, which was
much less frothy, though plentifully streaked with blood. Some
perspiration on the skin. No other evacuation from the tartar*
ized antimony, which was continued.

12th. Kested well. Symptoms all improved. Bowels twice
moved during the night, without pain, however. Cough still
troublesome and expectoration free. Sputa less tenacious, more
opaque and thick, occasionally of a purulent tinge. Medicine
continued. From this time the girl's improvement was pro-
gressive, and I left her on the eighth day of her attack ^vee from
cough, and although she was considerably emaciated, there was
every prospect of uninterrupted recovery. By accurate com-
putation, she had taken during her attack 36 grs. antim. et potass,
tart., and nothing else besides the single dose of calomel in its
onset, and some light laxative medicine.

26th. Summoned at daylight to see Caroline, who was repre-
sented to be bleeding dangerously from the nose. I leai'ned
that some four or five days after I had left her, she had passed,
during a cold, rainy afternoon, several hours in an open porch,
which imprudence had been followed by. a relapse of the bron-
chial inflammation: and, that the family had given her two vials
more of the medicine as ordered before, and according to the
same prescription, which had controlled the symptoms. It
seems soon aiter her relapse, epistaxis came on, occurring at
first during severe fits of coughing; and of winch she had had

1848.] Pneumonia treated by Tartar Emetic. 349

repeated attacks every day, without, however, being sufficient
to excite apprehension. The bleeding had continued all night,
and T found her pulseless, faint, restless, and altogether unman-
ageable. The blood streamed from both nostrils, or gushed
from her mouth, when any pressure was made on the nose.
Though an intelligent girl, her extreme restlessness would not
allow her to adopt the necessarv means to insure relief. Her
nostrils were unsuccessful! v plugged, and every other measure
to arrest the hemorrhage, failed she died late that day..

Case III. Eaton, a young negro man, remarkable for his
previous good health, was seen Nov. 7th, 1846. He was labor-
ing under pleuritis of the right side, and complete pneumonic
engorgement of the corresponding lung. He had been seized
the night before I saw him, and was then suffering with pain in
the side, high fever, cough, with viscid expectoration tinged
with blood.

V. S. in the sitting posture to approaching syncope, followed
immediately by a full dose of calomel and opium. By evening,
I found his bowels had been twice moved by the calomel. He
complains less of his side, but his cough was very troublesome,
and the arterial reaction was still high. Ordered him to be
freely cupped on the chest and side, and to take a table-spoonful
of the following mixture every second hour. I^. Pulv.g. acaciae
ss. ; aquae font, iviiss.; antim. et potass, tartras. gr. vi. ; syr-
up, aurant. !ss. M.

Nov. 8th. Had borne the medicine well ; bowels had been
twice opened, the evacuations being dark and consistent ; his
cough was harrassing, and the pain in the side was worse than
on the night before. Repeated cupping, and continued the
mixture. In the evening, it was found necessary to employ
venesection again, which was followed by the following pill,
in addition to the mixture, which w^as continued as before.
^. Protochlorid. hydr. gr. v.; pulv. opii. gr. j. ; syr. simplex
q. s. M. ft. pilul.

9th. Had slept, and expressed himself better; pain in the
side less. Some increase of dyspnoea, besides which, no change in
symptoms. Upon examination, unequivocal traces of effusion
w^ere found to exist in the right pleural sac; and there w^ere
also signs which created a suspicion that the lung had passed
into a state of hepatization. There was less arterial actio.n;
his tongue was coated, and there was considerable thirst.
Discontinued mixture, and blistered chest, ordering, instead
of the former, the following pill to be taken every fourth hour:
l^. Protochlorid. hydr. gr. iij ; pulv. opii gr. ss ; antim. et
potass, tartras, gr. iss. M. ft. pilul. In the evening his ^qwgt'
rose, and not deeming it expedient to renew the venesection to

350 Pneumonia treated by Tartar Emetic. [June,

subdue it ordered resumption of the mixture, a tablespoonful
every four hours, dividinii; the time equally between each
dose ofj^ills. From this time little chan2;e was made in the
treatment of the case. lie bore the medicines well, genera]ly
having his bowels opened by purgative enema. On the tenth day
of his illness, the gums became tender, and the pills were dis-
continued. This was followed by a gradual amelioration of
the symptoms. The mixture, however, was continued, although
at longer intervals, until the thirteenth day of attack

20th. Examined chest; patient sitting up, with good ap-
petite, and a clean tongue. Pleuritic effusion gone; respiration
returned in nearly every part of the lung. Coughs only oc-
casonally, and expectorates only round masses, thick and pus-
coloured. Is very thin and weak ; ordered quinia in small doses,
and chicken soup.

22d. Siting up, looks very feeble ; his skin dry, husky, and
apparently tightly drawn over the face; does not complain ;
appetite good. I expressed surprise that he was not more
improved, when an attendant informed me that his bowels
were too free. He had had four copious evacuations from
them within the preceding twenty-four hours. These dischar-
ges, which had been reserved for inspection, had a putrid,
and exceedingly offensive odour. They had the consistence of
tar, were full and copious, and were of a reddish-brown colour.
Ordered vegetable astrigents, quinia in "small doses, frequently
repeated, and a nourishing, but unirritating diet.

24th. Unable to sit up. The discharges had continued from
the bowels, having one about every fifth or sixth hour. They
were unaccompanied, howevei', by the slightest pain. His bow-
els ap);)eared constantly as if they were completely empty, the
abdomen being so flat that the spine was easily felt, and there
w^as not the slightest tenderness on pressure. Appetite good
no thirst the tongue, which had been previously clean, began
to show a long, dirty fur down its centre. The evacuations
still consistent as before, and jnore offensive. Their colour had
now become more florid, and upon a closer inspection, this was
found to be due to myriads of minute dots of blood intimately
blended with fecal matter.

25th. Sinking. Evacuations more highly colored with blood,
putrid odour, and more frequent. Whilst standing by the bed-
side, following an effort to clear the throat, he spat up about a
tea-spoonful of florid, liquid blood, which produced an immedi-
ate change in his voice, inducing the impression that the hemor-
rhage came from the larynx. I inspected his mouth and found
nothing amiss in it or the throat all traces of the ptyalism,
which had been slight, had disappeared. He continued to spit

1848.] Pneumonia treuted by Tartar Emetic. 351

up blood in this way, at short intervals, until his death, which
occurred next day. Pressing engagements prevented my ma-
king a post-mortem examination.

Case IV.-^Dec. 29th, 1846. Visited Mr. J. R., mechanic,
aged about 27 ; robust, but of rather intemperate habits. It
w^as the day following his attack, and I found him laboring under
pleuro-pneumonia. The progress and treatment of this case
were so similar to the one just preceding it, that I deem it un-
necessary to give its details. The patient was bled twice early
in the attack ; he had similar doses of the antimonial solution,
alternated in the same way by the mercurial pill, which latter
was administered with a view to its specific action on the sys-
tem. Tenderness of the gums came on the eighth day of the
attack, when the pill was discontinued, but the antimony was
given until the eleventh day.

At this time the symptoms had all declined in the most satis-
factory manner ; save a trace of effusion, still existing in the
pleural sac, the lung appeared completely relieved. The sali-
vation had not progressed after the withdrawal of the pill, and
his appetite was good, tongue clean. There w^as no error in
diet which could be detected ; yet on the evening of the twelfth
day of his attack, I detected the peculiar putrid odour which
had existed in those of the former case, in an evacuation from
the bowels which the patient had during my visit.

Upon inspection I found a complete coincidence also in the
colour and consistence of the excretion. This relaxation of the
bowels had existed during the day, and the patient was evidently
not so well. No blood could be detected in the excretion,
although its colour was florid. This however, appeared next
day, when he had several passages, which consisted entirely of
grumous blood, yet the putrid offensive odour still existed.

On this day, the thirteenth of his illness, he was visited by Dr.
B. H. May in consulting with me. The doctor agreed with me,
that the pneumonic symptoms had disappeared, and that the
lung had resumed its function.

At his suggestion the following prescription was adopted :
l^. Hydr. c. creta, pulv. ipec. et opii, aa gr. iij. ; acet. plumbi
^r. ij ; tannic, puree gr. j ; a powder to be taken every third hour.
Farinaceous diet. This prescription w^as sedulously continued
for four days, when the bloody stools gradually subsided, and
w^ere followed by dark, bilious evacuations. This man recover-
ed, although several months elapsed before his health was fully
restored.

Case V. Jan. 21st, 1847. Called to see Dred, a young, but
delicate negro man, who had but recently recovered from pro-
tracted intermittent fever. He had been seized on the previous

852 Pneumonia treated by Tartar Emetic, [June,

evening with chilliness, and I found him laboring under pneu-
monic engorgement of the right lung, accompanied by cough
and bloody expectoration: dull pain in the chest. His pulse
was frequent and very compressible, and there was great mus-
cular prostration.

He had got. the previous night, a dose of calomel and Dover's
powder, which had been followed by castor oil that morning,
and his bowels had been freely evacuated. Conceiving that
his condition precluded the employment of venesection, I had
him freely cupped over the engorged lung, and ordered him {
gr. of tartar emetic in a wine-glassful of sweetened mucilage
every second hour. The symptoms seeming to yield under it,
no change was made in this prescription for three days, when
I was summoned to see Dred in anticipation of my regular
visit. I found a total and remarkable (considering the short
time which had elapsed since my visit the day before) change
in all his symptoms.

The pneumonic symptoms had all vanished ; the lung was
resonant, and the cough and expectoration had ceased ; and he
was now labouring under acute gastritis. Purging had super-
vened in the course of the previous night, and he continued to
have thin watery evacuations. He complained of burning and
pain at the epigastrium, had a constant thirst, and his tongue,
which had been pieviously coated, was now dry and perfectly
clean, and so devoid of its proper coating as to present the
appearance of raw meat. TlVe purging had produced great
prostration. iJnder appropriate treatment from the gastro-
enterite, viz., leeching the epigastrium, mucilaginous drinks,
with hydr. c. cret., and Dovers pDwder to stay the purging,
this man progressively recovered, without ever once manifesting
any return of the pneumonic symptoms.

Remarks. It will be perceived that I have only adopted the
exclusive use of the tartarized antimony in the treatment of
pneumonic affections, under particular circumstances, namely,
1st, in cases where general blood-letting was altogether inadmis-
sible ; 2dly, where its further employment, from the advanced
progress of the disease, was deemed (f doubtful propriety, and
yet where some measure was required to keep down arterial
action; and,3dly,in those cases, whether blood-letting was admis-
sible or not in which the symptoms were too urgent to await
the slower and more sure process of mercurialization, which I
prefer and usually adopt. I find, in looking over my sketches,
that in the above cases, more of the antimony was given than
was used in the treatment of any other case of the disease which
I have noted. It is true I have generally employed the remedy

1848.] Pneumonia treated hy Tartar Emetic, 353

in conjunction with other means, in nearly every case of severe
pneumonia ; but in all others, save the ones reported, I have
abandoned it early, either because it disagreed with the patient,
or from a conviction that its continuance would not be useful
after the advancement of the morbid condition of the lung into
hepatization, and that, if it has been employed later, it was in
smaller doses and at longer intervals. It will be perceived,
moreover, that its operation in the cases quite satisfactorily
confirm the existence of the power which has been ascribed to
the drug, to control pneumonic inflammation.

The first case, particularly, illustrates, in a striking manner,
its prompt and efficient action in resolving a grave case of the
disease. We believe, indeed, that no one witnessing its opera-
tion when administered after the plan of Laennec, provided the
patient bore the medicine well, could remain unconvinced of
its efficacy and great power in cutting short an attack of the
disease.

We consider, therefore, that the only questions left open for
discussion, are the safety and general applicabiHty of the reme-
dy. Whilst it may be conceded that it will speedily resolve an
inflamed lung, an equal interest should certainly be felt in the
consequences resulting to the system from its operation to pro-
duce this effect. In other words, though it may speedily cure
the original disease, may not its effects on the constitution be
such as to seriously protract and retard convalescence, if not to
lay the foundation, as the above cases would seem to show, of
an altogether new and equally fatal malady? This is a ques-
tion of great interest. As just remarked, it is certainly an
efficient and powerful agent, prompt and satisfactory in its
action; hence the establishment of the several points respecting
the character of the cases adapted to its power, the best man-
ner of exhibition, so as to insure its good, and, at the same time,
to guard against its bad effects, how far it should be carried,
and the particular regimen best suiting, constitutes a great
desideratum, which, as we are loth to abandon the remedy, we
should rejoice to see supplied. In none of the books which we
have consulted, is any allusion made to its action in retarding
convalescence after it has acted happily in removing the origin-
al attack, nor do we find recorded any account of such accidents
following its employment as those which, we have shown, befell
our patients, whose original attacks were promptly arrested by
its operation. Prof. Wood, in his recent work on the practice,
speaks less favorably of this plan of treating pulmonary inflam-
mations exclusively, than any modern author whose works are
at hand. He has seen a fatal result hastened by its employ-
ment, and cautions against its use where there is gastric irrita-

23

354 Pneumonia treated by Tartar Emetic. [June,

tion. In the six cases mentioned by Laennec, which died out
of forty patients treated by his cousin, A. Laennec, of Nantes,
three, it is asserted, died in consequence of errors in regimen
during convalescence. No account is given of the symptoms
or the conditions which these errors induced, and it is unfortu-
nate, since we are deprived of the benefits which might have
arisen from a comparison with the effects which we have des-
cribed as following its employment under somewhat similar
circumstances. The great change in the character and action
of the remedy, which clearly exists when administered after
the plan directed in pneumonia, is an exceedingly curious fact.
Ordinarily, we know, that but a single grain will produce pow-
erful effects upon the system, but then administered grain after
grain, may be hourly given without sensible action. When we
consider, therefore, its ordinary powerful operation, it is not
unreasonable to suppose that the exhibition of such quantities
of the drug, making every allowance for the supposed antagon-
ism to its effects which the disordered state of the organism is
said to create, may produce a constitutional effect which might
last long after the disease, for which it was administered, was
eradicated. The solution of this problem is intimately blended
with that of the modus operandi of the antimony under these
circumstances. If we knew how the remedy acted to produce
its good effects in inflammation, we could then judge with some
certainty whether this action was likely to be afterwards perni-
cious to the system.

None of the theories extant throw satisfactory light upon this
point ; indeed, no two writers seem to explain it in the same
way. In ascribing the tolerance of the remedy to the exist-
ence of an inflammatory diathesis at the time of its administra-
tion, Rasori, we conceive, overlooked an important fact, in not
taking into consideration the interruption to the harmonious
action oi the nervous sj^stem, which must be created by so
grave a state as acute inflammation in a vital organ, especially
the lungs. We know that severe local disease does subvert the
action of many remedies; under certain states, large quantities
of opium, alcohol, &c., may be administered without producing
their characteristic effects. In proportion, generally, to the
destruction of the sympathy of the nervous system, or to the
impairment of the general sensibility, do remedies cease to pro-
duce their usual efforts.

As it regards its modus operandi in curing inflammation, the
most varied and opposite conclusion also prevail. Those au-
thors which are most enthusiastic in its favor, contend that it
does most good when it excites no evacuation. That it can
operate favorably under these circumstances, is amply proved

1848.] Pneumonia treated by Tartar Emetic. 855

by its action in the cases above reported. Dr. A.- T. Thomp-
son, in an article in tiie London Lancet^ for August, 1846,
advances the hypothesis that tartarized antimony cures pneu-
monia, by acting topically on the gastro-enteric mucous mem-
brane, through a sub-acute inflammation which it establishes in
that tissue. He says that tolerance after the first dose is estab-
lished, because this topical action afterwards prevents the
absorption of the remedy into the blood. Its operation in our
Case 5th, would seem to favor this conclusion, but then, in Cases
1st and 2d, in which more of the drug was employed, with
equally good efl^ect upon the disease, we see no trace whatever
of any gastro-enteritic irritation. . The hypothesis obviously
falls short of explaining the phenomenon. Indeed what is fatal
to the conclusion is the fact, that gastro-enteritic inflammation
frequently co-exists with pneumonia, and so far from being re-
garded as salutary, as this view would hold out, it is always
looked upon by the practitioner as a serious, and frequently
fatal complication. There can be no doubt that the remedy
operates more generally upon the organism, than this view, or
most views which have been taken of its action, w^ould seem to
favor. The obscurity which rests over the subject, cannot, it
seems, in the present state of our knowledge of the action of
remedies upon the system, be penetrated. If it is conceded that
the protracted use of lafge doses of the drug tends to the pro-
duction of a state of the system allied to scurvy, or purpura
hemorrhagica, as the result of some of the above cases would
really seem to show, a conjecture relative to its methodus me-
dendi might be hazarded, which certainly, we conceive, has
plausit)rlity for its recommendation. The essential nature of
these diseases, scorbutus particularly, it is held by pathologists,
consists in an alteration of the blood; which alteration, it is as-
serted by Dr. Laycock, of York, in a late article in \\iq Medical
Gazette, is due to a deficiency of its fibrin and plastic elements.
Now, in inducing this resultupon the circulating fluid, the tar-
tarized antimony would operate in such a manner as directly to
tend to the destruction of inflammation, since it thereby would
remove what every one knows constitutes the chief element of
this morbid process. But our object is not to advance an hy-
pothesis ; it is simply to record the facts as they were presented
to us, leaving their explanation or application to those better
qualified than ourselves. And, if we succeed in attracting the
attention of such, and through that means, cause more light to
be thrown upon the important points involved in the considera-
tion of the subject, we shall conceive ourselves amply repaid for
the trouble which we have been at in the preparation of this
article.

356 Strychnia in hitermittent Fever. [June,

Cases and Observations on the use of Strychnia, in Intermittent
Fevers. By J. E. McGirk, A. M":, M. D., Chicago. (Illinois
and Indiana Med. and Surg. Journ.)

There is perhaps no practitioner, who has resided for any
length of time in those districts where intermittent fevers pre-
vail, but has met with cases of agues, more commonly old and
sometimes even recent agues, in which his best directed efforts
were powerless to restore deranged secretion or perverted nu-
trition. He has been compelled to see the sallow and emaciated
being, perhaps a near and dear friend, wearing daily away, until
.the hollow cough and the sunken and lustreless eye have shown
too plainly that the days of the victim were few for this world.
Having met with such in my practice in the Junita district, of
Pennsylvania, it was with no small degree of satisfaction that I
first learned from Professor Brainard, the advantages he has
derived from the use of Strychnia incases of this nature, in the
Chicago Hospital, under his direction. I witnessed the saluta-
ry effects of its use and resolved to try it if an opportunity
offered. The following case, in which I have tried it, will show
for itself. I would merely premise that the crystals of Strych-
nia were used.

Mrs. F., set. 28, a laborer's wife, whose health previously
to her attack of ague had been good, -and w^hose habits were
regular, placed herself under my care on the 15th of June last.
She states that she has had the ague for several months, thinks
since October of last year, at intervals, and she used Sapping-
ton's pills, which mostly arrested it, for a few days, but they
afforded her no permanent relief. She has now the ague every
second day ; the shake occurring about 10 o'clock, A. M." Her
tongue is coated white ; skin harsh and dry ; head-ache and
general lassitude ; bowels irregular ; great thirst and occa-
sional vomiting; spleen enlarged ; breathing oppressed ; much
emaciated, and without any appetite. On percussing, the chest
sounds clear; auscultating, the breathing is found distinct over
the whole chest. She is nursing a child four months old.

I ordered her quinine, ten grains, with one-sixth of a grain of
sulphate of morphia, to be taken night and morning for four days.

16th. She feels much better. Her shake to-day was much
lighter than usual, but the quinine lies heavy upon the stomach
and was to-day rejected. The spleen is much reduced in size.
I may here state that M. M. Vafleix and Gouraud, think that
quinine has no effect upon the volume of the spleen in ague,
(London Lancet, vol. vi., p. 397,) while M. Piorry contends
that it has. Whether it was the remedy that reduced the size
of the spleen, in this case, I will not say ; but that it was reduced

1848.] Strychnia in Intermitieut Fever, 357

and that no other remedy was exhibited but that ordered, I un-
hesitatingly assert, and my opinion is with those who believe
in its efficacy, in this respect. As the stomach did not bear the
quinine well, I for the first time ordered the strychnia, in the
manner recommended by Professor Brainard, namely, one-
eighth of a grain, three times, daily a dose to be given after
each meal. He says, (Journal, vol. ii., p. 118,) "that when it
is mixed directly with the contents of the stomach, it is less
likely to produce unpleasant effects."

20th. Feels better than she has done since her first attack.
The shake has left her, as also, the head-ache; tongue clean;
bowels regular; able to sit up again, and appetite better.
Strychnia to be continued until she takes two grains more.

I saw her on the 20th of October, up to which time she had
continued well and without a relapse.

[Dr. McGirr gives six other cases, which, being similar, we
omit, but add the author's remarks.] Edt.

Remarks. -^l believe that Strychnia will take its rank as an
adjuvant to quinine, in the treatment of fevers ; and, that, while
the latter will be used, as now, to break up the paroxysms, the
former will then take its place to perpetuate the cure, restoring
the perverted nutrition or deranged secretion, the cause or
consequence, as the case may be, of disease. I am satisfied that
the Strychnia is, by no means, as dangerous a remedy as is gen-
erally supposed. Case three, took six and two-third grains, in
twenty-three days. Case five, took eleven and one-eighth
grains in forty-one days; and. Case seven, took eight and one-
fourth grains^in twenty-seven days. In all the cases the effects
of the remedy were closely watched in order to observe the
least symptom that might contra-indicate its use. It produced
slight tetanic spasms in case one, and also slight vomiting when
first given. In two cases the patients complained of vertigo.
These were the only effects observed, and they were not con-
sidered sufficient to require the Strychnia to be discontinued.
It was always given in powder mixed with starch.

Quere ? As both the cases, three and five, in which anaemia
was present, in so marked a degree, were salivated profusely,
during their treatment, might not this condition of anaemia have
been caused Or, at least, aggravated by the free and indiscrim-
inate use of mercury ? We know that mercury will combine
with the pepsin, thereby impairing, for a time, digestion ; and
if a fresh portion of mercury be still added to neutralize each
new portion of pepsin eliminated, we can easily see that it
would be very easy to perpetuate its destructive effects upon
digestion, and more particularly so, since the pathological ten-

358 Alkaline Tj-eatment of Dysentery. [June,

dency of the disease itself is so strong in that direction. If such
be the case, miuht not many physicians do better than to indis-
criminately administer mercury in these fevers ?

Some Cases illustrative of the Alkaline Treatment of Dysentery .
By D. Kelly, L. A., Mullingar. (Dublin Journal.)

Acute Dysentery ; Alkaline Treatment; Cure. February
11th, 1847.- William Reeves, aged 28, was suddenly seized,
at 2, A. M., with violent tormina, tenesmus, and purging, which
was preceded for a few days by diarrhoea, but to which he paid
no attention.

When first seen, at 9, a. m., he was laboring under constant
retchings ; the ejections whitish ropy mucus ; violent purging,
dejections frequent, bloody, serous and colliquative, flowing
from him, but not unconsciously, each motion being preceded by
a feeling of sinking, and most excrutiating pain in the region of
the colon ; constant thirst, cold tongue and extremities ; extreme
prostration ; dorsal decubitus ; no cramps ; intellect unimpair-
ed; gargouillement in right iliac region. A starch enema, with
one drachm of tincture of opium, was administered ; turpentine
stupes applied to the lower part of the abdomen ; thirty minims
tincture of opium given in a draught ; and jars of hot water ap-
plied to the upper and lower extremities.

1, P.M. The lavement came away almost immediately, ac-
companied by a copious sero-sanguineous motion, mixed with
coagula, five of which he has had since the morning visit. Ten
minims of liquor potassse and five of tincture of opium, were
given every second hour; to continue the turpentine stupes;
barley or rice water for drink ; and a spoonful of brandy and
water every hour.

8, p. M. Has been comparatively easy since the commence-
ment of the alkaline treatment ; had but two motions since last
visit ; tormina and tenesmus so considerably abated that he has
scarcely remarked their occurrence.

There being some abdominal fulness, with just perceptible
tympanites, I gave, at bed-time, one grain of opium, one grain
hippo, ten grains hyd. c. creta, and ten of dried soda.

12th. Passed rather a favorable night ; about 5, a. m., had
two brownish, biHous-looking feculent motions, extremely fetid,
and, prescnlinir scarcely any trace of the dysenteric character.
To continue tlie medicine, increasing the interval to four hours,
and have two or tin-ce spoonfuls of rice jelly every hour.

13th. Had a very good night, slej)! quietly, and awoke re-
freshed ; no gargouillement or soreness on pressure ; bowels

1848.] Alkaline Treatment of Dysenteiy. 359

opened but once since morning ; dejections more consistent and
natural ; pulse full and soft ; omit medicine, and continue rice
regimen.

14th. Convalescing rapidly, and sitting up.

16th. Convalescent.

The feature of most importance in this case was the almost
magical effect of the alkali in allaying the tormina, tenesmus, and
purging, the tincture of opium appearing to exert no influence
whatever over the disease till combined with the liquor potassae ;
the patient remarking, when I visited him in the evening, that
-the last medicine produced a feeling of ease and rest from pain
quite cheering to him.

Acute Dt/sentert/ of a fortnights duration; Dysuria, (Ede-
ma, and tendency to general Anasarca, ; Alkaline Treatment ;
Cure. February 28. Being called suddenly to see a carpenter
named Patrick Oulaghan, aged about 70, who, I was told, had
fallen down in a fit, and was dying, I found on my first visit that
he had been laboring under dysentery of a fortnight's duration,
and that, having got up for a motion, he had fallen through de-
bility. He then presented the following symptoms: appearance
dusky and collapsed; tongue cold; eyes drawn in, shining, and
surrounded by leaden-coloured areolae ; voice low and whisper-
ing; pulse almost imperceptible; intense thirst; extremities
cold and cEdematous ; dysuria ; tormina, tenesmus, and almost
incessant purging ; dejections scanty, muco-sanguineous, with
glairy, yellow deposit, as if the process for the production of
plastic lymph had been arrested through debility, and agelatino-
albuminous secretion, colored by cholesterine, was the result ;
iliac gurgle, and soreness on pressure ; abdomen slightly col-
lapsed. Ten minims of liquor potassae and five of tinct. of
opium were given every second hour ; a mustard poultice ap-
plied to the abdomen three times a day ; rice regimen and
brandy and water. Slight improvement in the evening.

March 2d. Much improved to-day ; had but four pinkish,
flocculent, fibrinous evacuations, with just perceptible yellowish
tinge, since yesterday ; strength much improved ; oedema on
the increase ; dysuria less. Continue the medicine, but with
four hours' intervals.

5th. Had ten or twelve muco-feculent motions, with scybala,
tormina, and tenesmus, during the night, in consequence of
having regaled himself with sweet cake and tea in the evening.
A draught of castor oil and tincture of rhubarb given ; other
medicines continued.

8th. Convalescing most favorably ; had but two feculent,
brownish, consistent motions during the day ; oedema of feet

300 Alkaline Treatment of Dysentery. [June,

and legs still continues, with anasarcous tendency. Omit medi-
cines ; four ounces of broiled meat for dinner, and a glass of
porter twice a day.

12th. Anasarca and oedema gradually disappearing under
influence of good nourishment.

20th. Convalescent ; oedema and anasarca have disappeared ;
and, on the whole, he appears much,stouter and in better con-
dition than he had been for years before.

In this case, also, the alkaline treatment was most satisfacto-
ry, checking almost at once the purging, tormina, and tenesmus,
which it appeared to keep in complete subjection, till reinduced
by an error in regimen, which, in its turn, promptly yielded to
an aperient and a continuance of the alkaline treatment.

Viewing dysentery under the phase of increased acidity in
the whole tract of the alimentary canal, which, to a certain ex-
tent, is proved by the fact of the dejections at once developing
an exalted acid reaction on the application of the litmus test,
and being originally led into this train of thought from observ-
ing the highly acid state of the motions in the bowel complaints
of children, analogy prompted me to adopt a treatment calcula-
ted to counteract and neutralize, if possible, that peculiar ten-
dency, by exhibiting, in combination with alkalies, a regimen
which should be as free as possible from acescence.

Scybala, which are considered by most authors as one of the
pathognomonic symptoms of the disease, I certainly never saw
passed, that their presence could not be clearly traced to errors
in diet. Considering them, therefore, as an accidental and not
a constant symptom, and supposing their presence to be invaria-
bly dependent on errors in diet, it follows as a corollary to that
hypothesis, that in the choice of solids all substances having a
tendency to leave too great a residuum in the bowels should be
avoided.

In pursuance of these views, rice-jelly, prepared by boiling
equal quantities of rice and fowl, or beef, into a jelly, removing
the meat, and flavoring with salt, pepper, or any spice, accord-
ing to the taste of the individual, should form the solid dysenteric
regimen.

With reference to fluids, the drinks should be of as inascessant
a character as possible, viz., rice water, barley water, thin
arrow root, toast and water, or plain water, with brandy or
whiskey and water for a stimulant, when such is required.

Beer, wine, ale, or any fluid containing much sugEfr, in conse-
quence of their great tendency to ascescence, are, therefore,
contra-indicated ; and milk, so universally used in these diseases,
is, 1 think, even more objectionable still, for directly it is receiv-
ed into the stomach it is at once converted into a highly acid

1848.] Typhus Fever. 361

whey, and tough indigestible curd, the first increasing the
hypercatharsis ah'eady in existence, and the latter, by accumu-
lating in scybala, producing the most excruciating tormina and
tenesmus for their expulsion.

In conclusion, I wish it to be distinctly understood that I do
not pretend to assert that the alkaline treatment will prove
effectual in every case of dysentery ; my only object in putting
forward the above cases being merely to draw the attention of
the profession to the subject, now that the disease is again likely
to become rife, that so they may give it a fair trial, and thus
impartially judge for themselves.

The Cause, Prevention, and Treatment of the Tyhphus Fever.
By I. PiDDUcK, M. D. (Lancet.)

The cause of typhus fever h the exhalation of a specific poison
from the bodies of the sick, by which persons in health become
infected with the disease, as in case of small-pox, measeles,
scarlet fever, &:c.

This posion may be destroyed by a temperature of 212 deg.,
whether by boiling in water or by hot air ; it may also be diluted
by washing and ventilation, so as to be rendered inert.

The prevention of typhus fever consists

1. In separating the healthy, particularly the young, from the
sicL

2. In removing curtains and carpets from the room, and
clothes from the persons of the sick.

3. In boiling linen and cotten garments, blankets and rugs
in water, before they are washed, and in baking woollen cloth
garments, which cannot be boiled, put into a sack, in an
oven.

4. In washing the bodies of the sick, and the floors of rooms,
with soap and water, and the walls and ceilings with lime.

5. In lighting fires in fire-places, and setting open windows
and doors.

6. In keeping provisions away from the apartment of the
sick..

But as this poison exerts a much more malignant and fatal
effect upon persons whose health is impaired by exposure to
malarious influence, it is of great importance that putrid effluvia
from drains, dunghills, or privies should be carefully obviated.

The drains from houses should be covered in, cesspools and
necessaries should be emptied, stagnant ponds should be run
off, and every cottage in the country should be provided with"
a bricked cistern, covered with a wooden flaplid, for the re-

362 Typhus Fever. [June,

ceptioTi of all solid and liquid manure, which should be emptied
and carried out on the land, as soon as it is full.

If these precautions are taken, there is no need for chloride
of lime or any other disinfecting agents, which only correct
putrid effluvia ; they have no power to destroy poison. They
are worse than useless when they lead to a false security and
occasion the neglect of these more efficient means. In like
manner, drinking to excess, especially ardent spirits, eating
unwholesome food, such as bad potatoes, decaying vegetables,
half-rotten fruit, musty or sour meal, unsound meat, stale fish,
and drinking stagnant water, should be carefully avoided.
Great attention should be paid to personal and domestic clean-
liness. The house should be kept drv, warm, and well venti-
lated.

The treatment of typhus fever. This is better left to the
medical practitioner in the locality, who is best able to judge as
to the remedies most suitable for individual cases.

The following are the principles which guide the practice in
the typhus fever of London :

1. To remove all offending matters from the stomach and
bowels, an emetic of salt water or ipecacuanha is administered ;
then a grain or two of calomel, and fifteen grains of rhubarb,
followed by castor oil if necessary.

2. After the operation of the emetic and purgative, the patient
is washed all over with soap and water and put into a clean
warm bed, with a fire in the room, and the window open.

3. Five grains of the chlorate of potass in a wineglassfull of
camphor-mixture is ordered every six hours. The chlorate
of potass seems to aid the vital energies in expelHng the poison,
evinced in the improved colour of the skin, and altered state of
the secretions.

The diet consist of bread and milk, or gruel, seasoned with
salt instead of sugar, light broth, and fresh, well-boiled vegeta-
bles ; whey, sago-tea, or lime-blossom tea, and oatmeal toast-
water.

The body linen and flannel vest are changed daily, and the
sheets once a week ; the dirty linen, cotton, and ilannel are
put at once into cold water, and boiled before they arc washed.

From this statement, it is evident that the cure of typhus fever
can no more be effected by medical treatment than the cure
of small-pox, measles, or scarlet fever. The disease, once set
in, must run its course- It terminates, naturally, on or about
the filteenth day. The object of medical treatnient, therefore,
is to avert its fatal tendency; or, in other words, to conduct
the patient in safety through its different stages. If the disease
do not admit of cure, much may be done toward its prevention.

1848.] Remarkable Case of Constipation. 363

1. By separating the healthy from the sick. 2. By destroying
or diluting the poison. 3. By avoiding all those causes which
impair the health and weaken the powers of resistance.

Remarkahle Case of Constipation.
To the Editor of the Boston Medical and Surgical Journal;

Sir, Wliile in Western New York, last summer, I saw a
remarkable case, in the person of a young lady, who has had but
three foecal discharges in nine years; and thinking the state-
ments in full might be interesting, if not useful, to the medical
profession, I now communicate them.

The patient's name is Ellen R. Allis, daughter of Joel Allis.
She lives about three miles from the centre of Batavia. When
about 12 years of age, she attended a singing school, and being
ensnared in a trap made of a rope by some boys, was thrown
down, and her spine injured. She became quite sick, w^ent to
her bed, and there has remained up to the present time, perfect-
ly bed-ridden. She is now 21 years old. She lays in her bed,
her body being in an angle of forty-five degrees with her ex-
tremities ; nor can she be removed from that position without
producing intense pain, and much dyspnoea.

From her waist down, there has been no increase in size since
her first injury ; but above the umbilical region, she has grown
hke other girls. She is w^onderfully intellectual for one thus
circumstanced, and has shown a remarkable skill in the forma-
tion of different curiosities.

As you would naturally conclude, she has but little physical
strength. Her heart beats like an infant's ; her respiration is
peculiar, and so slight is the effort, that it is "hardly distinguished
by a careful observer.

Two days previous, and about three days after, the move-
ments of her bowels referred to, she was perfectly insensible,
and in a comatose state. About a tea-cupful of a thin viscid
discharge come from her at each time.

* There has been an attempt on the part of physicians in the
region of Batavia to remove this difhculty, (whether it be a
partial stricture of some portion of the intestines, or a want of
action in them, is.unknown,) but in vain.

Her diet is very light, consisting mostly of white sugar and
tea, and occasionally a thin broth.

As you will understand, she has had but three stools in nine
years. Oliver, in his Physiology, makes mention of some per-
sons having no discharge in one year ; but no instance like the
above have I ever found recorded. Yours, respectfully,

Millhury, Mass.^ April 13, 1848. Ch.^rles A. Greene.

30 4 Treatment of Prolapsus Ani. [June,

New ajid successful method of treating Prolapsus Ani. By

Dr. Hake.

The method consists in returning the bowel or hemorrhoidal
tumors with great care after the daily motion ; in assisting its
return by means of soap lather ; in applying a coil of moist
sponge firmly upon the anus, and, while retaining it there with
one hand, bringing the nates together by means of a broad strip
of adhesive plaster, as on approximating the edges of a wound.

This method Dr. Hake has now tested in several cases; it
has never failed of success.

[The following is extracted from a letter from a patient who
first put the plan to trial, and by whose ingenuity it was first
conceived :]

"Take a piece of sponge four or five inches long, an inch and a
half wide, and half an inch thick, the more elastic the better; roll this,
in a damp, but not wet state, pretty tightly, so that the roll, if relaxed,
would be ready to spring back into its full length, and it would then
make a roll of some little substance, round, but still soft, and. its
length, when thus rolled, will of course be an inch and a half. Apply
it, then, lengthwise, to the anus, so that it may be pressed about the
centre of it, quite home and firmly to the part. Taking care that it
may remain so, stretch a length of adhesive plaster, about 14 inches
long, and three and a half wide, more or less, straight across the
nates, rather low down, and contrive so that while the plaster adheres
on one side, you press the other side closer to its opposite, before you
fix the length finally where it is to remain. Then sit down, at first
gently upon it, and it will become very firm and fast, so long as the
plaster is good. These two pressures constantly going on, do the
work without any inconvenience worth speaking of; I mean the roll
of sponge always striving to unwrap itself, and the cross-band of adhe-
sive plaster always keeping it from doing so by holding the nates sufl[i-
ciently close together. I'he working is pertect with a little use and
management. I never put this on until 1 am going about, or to take
exercise, whether walking, riding, or driving. In the evening I take
off* the plaster, but leave the sponge in its place, where it has got by that
time so firmly fixed by gradually spreading and swelling, that there
is no danger that anything short of great exertion will loosen it, and it
is of course more comtbrtable to do without the plaster when it is not
wanted. The sponge should be washed in cold water every time it is
taken off', and in cold weather the plaster should just cross the fire be-
fore it is put on; in moderately warm weather it will adhere of itself,
especially if it is sit upon for half a minute. The same plaster is bet-
ter the second day than even the first, and will do even the third,
where economy is an object. Wash the parts where the plaster goes,
every morning or oftcner, with water, or water and vinegar, and the
skin will never suffer. If the plaster leaves something sticky behind
it, when it is taken ofl^, rub it with a very little spirit of wine, and the
towel will remove it.

1848.] Datura Stramonium an Emmenagogue. 365

"If there be an irritation about the anus or the gut that comes
down, wash it with vinegar and water, and the relief will be wonder-
ful, and that part of the evil soon cured. This wash cannot be too
much praised for this purpose, for piles, and the like." [Lond. Med.
Gaz. British American Journ. of Med. and Phys. Seience.

Datura Stramonium an Emmenagogue. By B. F. Jones, M.D.,
of St. Louis County, Missouri. (Western Journal.)

Mrs. K. aet. 31, in the spring of 1837, had a violent attack of
congestive fever, for which she was salivated. I was called to
see her October 1st, 1841, four years after the attack of fever,
for the first time, to prescribe for a suppressed menstruation,
which she informed me, had existed for four years. She had
been in the hands of numerous physicians, who had rung the
changes on all the emmenagogues, remedies local and constitu-
tional, known to the books, or the tradition of the "mothers."
Her general health was miserable, and a thousand and one
nervous phenomena, inseparably associated with a protracted
suspension of uterine secretion, made existence a burden. I
gave her four of the following pills :
^. Prot. chlo. hydg.

P. rhei opt. aa. gr. xxiv.

Gm. Gamboge, gr. viij.

Acacia mucilaginis, q. s. ut fiant pil. ponder. gi\ v.
After the operation of the pills, I put heron the tinct. semen,
stramonii, prepared by the following recipe :
^. Semen stramonii uncias iv.

Alcoholis diluti octantem unum.

Degere per dies decem, et per chartam cola.
I directed her to take twenty drops, three times a day, for the
first day, adding a drop to the dose each day, and to continue
it, either until it produces dizziness, vertigo, or the catamenia.
In ten days after I first saw^ her, I was summoned to her again,
and learned that the day previous she had commenced evacu-
ating blood from the bowels, in small quantities and at irregular
intervals. I gave it as my opinion that this was a vicarious
evacuation, and the harbinger of a regular catamenia ^^er rz5
naturales; and directed her to suspend the medicine for two
weeks, and then resume it again in the same dose last taken,
(xxx. gtt., ter dicj) to be increased as before directed, and to
report to me in two weeks thereafter. At the expiration of the
twowTeks from the resumption of the medicine, she reported a
regular and plentiful catamenia. From this time she was per-
fectly regular, until she became pregnant, and in due course of
time was delivered of a healthy child. She entirely regained
her health, and has subsequently borne two other children.

3G6 - Quinine in Acute Rheumatism. [June,

Quinine in Acute Rheumatism. (Lancet.)

Most of our readers nre probably aware that among other
remedies for rheumatic fever, sulphate of quinine has been re-
commended ; a mode of treatment contrasting strongly with that
by profuse bleeding, or that by mercury, and yet, one, it w^ould
appear, very successful. The quinine plan of treatment is fol-
lowed by M. Trousseau, of the Hopital Necker. The following
is from a clinical lecture :

In a case recently in that hospital, one of rheumatic fever,
with effusion into the knee-joint, but without any cardiac affec-
tion, sulphate of quinine was administered, unpreceded by any
other treatment. In four days a marked amelioration took
place ; from fifteen to thirty grains of the medicine being taken
per day. In a few days more the patient was able to walk ; all
effusion and fever had disappeared. Here, then, was a rapid
cure of rheumatic fever : however, that disease mostly lasts for
two or three weeks. When it proceeds in its usual manner it
may be combated in the same way as intermittent fever. If
the quinine be suspended as soon as an evident benefit is pro-
duced, there is a danger of relapse, just as when that medicine
has arrested an ague fit. The quinine must therefore be given
every two, three, or four days, and continued after the pains
have ceased. We must enter into the belief that rheumatism is
not a local affection, and that an individual is not cured when
the pains are stopped. Whilst the patient sweats, whilst his
appetite does not return, and there is something wrong in his
pulse, the rheumatic diathesis must be treated. When we em-
ploy blood-letting, we do not treat the rheumatism ; we are only
occupied with the diathesis by virtue of which the solids and
liquids take on the rheumatic affection. When we make use of
quinia, we act upon the entire economy, on that particular con-
dition of it known as the diathesis, whence come the pains and
other phenomena presented by the joints. The diathesis may
persist for two or three years after all manifestation of the dis-
ease has ceased, and we are obliged to act against this diathesis
as we do in the case of the syphilitic or scrofulous. Such a
persistence, or latency, is also seen in the marsh miasm, where
a person having once been in an infected locality, may, at an
interval of years, get an attack of ague, although in a district
quite free from the visitations of that malady. Thus we see
that a patient may be cured of all the outward symptoms of a
disease, and yet the germs of that disease lurk, as it were, within
him, ready to be developed, and to manifest themselves, when-
ever, from a concurrence of circumstances, they are kindled to
a new life. So also, as in ague, the germs of a disease may be

1848.] Compound Dislocation of the Knee-joint. 367

imbibed into the system, and lie hidden for a lon;^ period ; but
yet retain their power of beincr developed into evident disease.
Such is also seen in the eruptive fevers, and we may suppose
the same thing possible in other diseases.

Case of Compound Dislocation of the Knee-joint. By O. H.
CosTiLL, M.D., of Frankford, Penn. (Med. Examiner.)

. On the 5th of November last, I was called to see E. B., a boy
aged 1 1 years, said to have his leg broken ; the accident had
occurred rather more than an hour previous to my seeing him.
I found him lying on a settee, in great suffering. Upon ripping
up the left leg of his pantaloons, I found the head of the tibia,
completely exposed, having been thrust entirely through the
soft parts covering the joint, posteriorly and a little outwards.
As nearly as could be ascertained, the accident occurred in the
following manner. The boy suspended himself from the back
part of a wagon which was passing through the street ; in the
act of extending his legs beneath the wagon, the left one was
caught between the spokes of the wheel, which, by its rotation,
brought the anterior part of the limb in contact with the wagon ;
the boy still clinging (through fright) to his first position, the
force thus applied, as the bone did not break, drove the head of
it backwards, and produced the displacement stated above.

By making extension and at the same time flexing the leg,
while the body was firmly held, I reduced the luxation without
difficulty, though some hemorrhage attended. The laceration
was severe; the whole of the posterior part of the joint was
exposed, and the popliteal artery distinctly visible. I brought
the integuments together by adhesive strips and stitches, and
removed with the scissors some shreds of tendon which hung
from the wound. A compress and roller were then lightly ap-
plied, and the limb was supported in a slightly flexed position by
a splint on the inside, extending from the foot nearly to the
groin ; a pillow was placed under the knee. The patient was
directed to take a tea-spoonful of paregoric, to be repeated
during the night, if necessary, to procure rest. It was 7 o'clock,
P. M., when the dressing was finished. The pulse and skin
were natural, and the boy expressed himself as feeling much
more comfortable than before the limb was dressed ; neverthe-
less I thought it right to apprise his parents of the dangerous
nature of the accident. The next morning at six o'clock I saw
him again; he had complained much during the night, but had
some sleep, and was as well as if the case had been one of ordin-
ary fracture. The dressings were saturated by discharge from

368 Bibliographical, [June,

the wound. In the evening Dr. Taylor saw the patient with
me ; at this time there was some fever, the pulse, however, did
not exceed 100; we directed an infusion of senna, and the ano-
dyne to be repeated. Nov. 7th. He is much more comfortable
this morning ; no unfavorable symptom has occurred. On the
fifth day, for the first time, the dressings were removed. Sup-
puration had partially commenced. A poultice of bread and
milk was applied, secured, by a many-tailed bandage. The
splint was continued, and the limb rested on a pillow. In this
way the dressings were renewed daily, with but little variation;
free suppuration and some sloughing occurred, but the wound
healed in six weeks, and in two weeks more the boy could walk
with slight assistance. He is now perfectly well, except that
the joint admits of but little motion, although not entirely anchy-
losed.

BIBLIOGRAPHICAL.

1. Practical Observations on certain Diseases of the Chest, and on the
Principles of Auscultation. By Peyton Blakistox, M. D., F. R.
S., dec, &c. p. 348. Philadelphia: Lea & Blanchard. 1848.

We are indebted to the publishers of the American edition, for a
copy of this work. Not having had time to examine it carefully, we
are compelled to rely upon the opinion of others for an estimate of its
value. In the Dublin Journal we notice a very favorable review of
it. It is considered one of the best works of several recently publish-
ed on the subject of auscultation.

2. Manuals of the Blood and Urine. By J. W. Griffith, M. D,,
F. L. S,, &c., G. Owen Rees, M. D., F. R. S., &c., and Alfred
Markwick, M. D., &c. pp. 183, 165, 113. In one vol. 12mo.
Philadelphia: Lea & Blanchard* 1848.

These three little works, although originally issued in London in
separate volumes, have with propriety been united into one by the
American publishers. They are designed " to assist the practitioner
or student in medicine in discovering the deviations from health, and
their nature in the blood and the various secretions of the body. An
outline of the mode of analyzing the different products, sufficient for
practical purposes, is also subjoined, so as to make it a complete
practical manual." We commend this volume to our friends who
would keep pace with the rapid advancement in microscopical
anatomy.

1848.] Bibliographical 869

3. On Disorders of the Cerehral Circulation ; and on the connection
between Affections of the Brain and Diseases of the Heart. By
George Burrows, M. D., &c., 6lc. With colored plates p. 216.
Philadelphia : Lea & Blanchard.

As the substance of this volume has been before the profession
some few years, all we have to do on this occasion, is^ to acknowledge
our thanks to the enterprising publishers for this edition of a standard
work in medicine.

4. Materia Medica and Therapeutics. By Martin Paine, A, M.,
M. D., Professor of the Institute of Medicine and Materia Medica
in the University of New York, &c., &c. p. 411, 12mo. New
York : Samuel S. and William Wood. 1848.

This syllabus of Dr. Paine's Lectures has been kindly sent us by
the publishers ; but we have neither time nor disposition at present to
enter upon a minute examination of the volume. We have no doubt
the objects of the profound author are fully carried out in the work, and
it must prove of great assistance to a student attending his lectures.

5. Elements of Natural Philosophy; being an exp^rimeiital introduc
Hon to the study of the Physical Sciences, By Golding Bird, M.D.^
&c., &c.,&;c. With 372 illustrations^p. 402, 12mo. Philadel-
phia : Lea & Blanchard. 1848.

The American publishers have taken their edition from the revised
and enlarged third London. Now that no one disparages the import-
ance of physical sciences to the educated physician, the student of
medicine cartnot too much appreciate works like the one before us.
A thorough knowledge of physics is absolutely essential to the practi-
tioner of the healing art. The contents of Bird's Elements of natural
philosophy should be familiar to every one Who expects to study medi-
cine.

6. On Poisons in relation to Medical Jurisprudence and Medicine.
By Alfred S. Taylor, F. R. S., Lecturer on Medical Jurispru-
dence and Chemistry in Guy's Hospital, &c., edited by R. Egles-
field Griffith, M. D., &;c. Philadelphia : Lea & Blanchard.
1 vol. 8vo., pp. 687.

The frequerlcy of poisonings, both accidental and criminal, renders it
an indispensable necessity that the physician should make himself
familiar with the signs by which the various species of poisoning may
be' recognised^ and also with the processes by which poisons may be
detected. Some years since the subject was involved in much uncei'-
fainty, but of late toxicology has made rapid advances, and the ends o^
justice are rarely defeated when the case is subjected to the investiga-

24

370 Monthly Periscope. [June,

tions of those who are familiar with the science. Among the works
which have been written upon this subject, we do not hesitate to give
the preference to the elaborate work of Mr. Taylor. It contains all
the improvements and discoveries which the last few years have
brought forth, and is enriched with numerous cases, many of which
have not been before reported, and which impart great interest and
value to the work. It should be in the hands of every jurist and phjsi-
cian. G.

Part til monthly periscope.

Ice in Dysentery. Our experience in this epidemic, says the West-
ern Journal of Medicine and Surgery, has been most emphatically in
favor of ice, which has been allowed to our patients in every instance
where it was desired. We have lately noticed in the journals a re-
commendation of ice in the treatment of dysentery. In the Transyl-
vania Journal (vol, ix., p. 240), we reported some cases of that disease,
in which ice and effervescing draughts produced the happiest effects,
and, ever since, our practice has been to gratify the cravino-s of our
patients for ice and iced drinks, in all forms of gastric and intestinal
disease. During excessively hot weather, we have repeatedly wit-
nessed the most pleasing results from this practice, both in children
and adults. Called to a patient troubled w-ith sick stomach, before
giving any medicine, our invariable rule has been to prescribe ice,
until the gastric symptoms were relieved ; and not a case has yet come
under our notice in which it has failed to afford marked and almost
immediate relief.

Thus premised, a few doses of calomel have been found sufficient,
in most instances, to relieve the complaint. Quinine, of course, is
prescribed when the case exhibits a periodic character.

Fistula in Ano, Dr. Van Camp has communicated to the Society
of Medicine of Anvers a method of curing fistula in ano, without opera-
tion, by means of injections of iodine. A workman, aged twenty-four,
had had an enormous abscess at the anus, which became fistulous,
its inner opening being very high up in the gut. Wishing to avoid
operating in the case, a solution of nitrate of silver was tried as an
injection, but it failed to do any service, and then recourse w-as had
to an injection of equal parts of tincture of iodine and water, which was
thrown into the fistulous cavity twice a day for five days. The first
injections were attended with severe pain, and when the inflammation
produced by it was considered sufficient, the proceedings were suspend-
ed for three days; they were then renewed, as a little faecal matter
was discharged from the wound, but the cavity had diminished to an
inch in height, and by the sixteenth day the cure was complete. Jour,
de Med. and New- York Journal of Med.

1848.] Monthly Periscope, 8TI

A good subsiituie for the Stomach Pump. (Bulletin General de
Therapeutique.) M. Honore Gay has proposed to evacuate the stom-
ach by the following mechanical means, which no doubt will bef gener-
ally acknowledged a valuable substitute for the stomach pump, too
often found out of order when required to be used. He uftites two
CEsophagean catheters by a glass tube in the middle, one of (hem,
previously oiled, is then passed into the stomach, and by means of a
funnel adapted to the exterior extremity of the other, the fluid is
poured in ; theii lowering that portion of the tube out of the mouthj
the catheters are Cdnverted to a siphon.

The advantages of this instrument are, according to M. Gay, its low
price, beirlg always ready, of easy transportation, great simplicity, and
celerity of action. [We may add another important one, the impossi-
bility of injury to the stomach, the mucous coat of which it is well
known, has been drawn by the force of the stomach pump into the eyes
of the cesophagean catheter. We should be pleased to see this instrii-
meiit made in our couniry, and bespeak one for ourselves. ^Edt.]

Hemorrhage from the Tonsils arrested hy Pressure. (Gazette Med.
de Paris.) M. Hatin had operated with Fahnestock's instrument
Upon both tonsils of a woman aged 30 years. Two hours afterwards
he Was called in haste to the patient, and found a frightful hemorrhage
had occurred from the wound made upon the left side. Several of thei
ordinary means failing to arrest the bleeding, M. Hatin procured a
forceps with long \eg^. Upon the extremity of one of these he applied
a piece of spunk wetted with alum water. This he now placed upon
the bleeding tonsil, while the extremity of the other branch or leg of
the forceps, protected by linen, was supported outside of the mouth
upon the angle of the inferior jaw-bone. The hemorrhage now ceased.
The forceps was secured to the head-dress of the patient for three days.
The spunk remained on the tonsil for another day, and wa then de*
tached spontaneously.

Treatment of Scahies hy Olive Oil.-M. Grifli, of Sardinia, has
treated scabies with great success by the simple application of olive
and other fixed oils. The method consists of covering the affected
parts with the oil,- slightly heated to favor its absorption, three times a
day. The itching completely subsides in three days, the eruption
dries up and desquamates, the redness and swelling disappear, and
the patient is generally cured in twelve days. The application should
be continued a feW days to ensure success. The almond, linseed, nut,
and othef oils, and even simple lard, will produce the same effect.

[Nc2v- York Jour, of Med 4

On Cod Liver Oil in Sti'uma, hy Dr. Graves. Dr. G. corroborateiS
the testimony of those (and, amongst the rest, of Dr. Bennett,) who
have extolled the use of this medicine in strumous diseases in generaL
He has seen it do what he never saw any other remedy effect, i.e.,
reduce to the nautral size amygdalae that were enlarged from the

212 Monthly Periscope. [June,

period of extreme youth. A most remarkable instance was that of a
young lady, aged about nineteen, whose amygdalae were as large as
small walnuts^ and which were treated witliout 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 behind. 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 haemop-
tysis, is occasionally overcome. In persons of a consumptive tendency,
be considers this a valuable addition to our remedies. [^Idern.

The Actual Cautery in Neuralgia. M. Notta adduces thirteen cases
in illustration of the value of this form of counter-irritation. Of these
two were instances of intercostal neuralgia, ten of sciatica, one of facial
neuralgia. Half the patients were robust, the remainder debilitated and
impo-verished. All were well-marked instances of neuralgia, that is
to say, there were points painful on pressure^ and darting pains along
the course of the nerves; these pains were severe, and sleep was more
or less disturbed in all the patients. Of the patients labouring under
sciatica, six were quite unable to walk, and four only had received any
benefit from previous treatment. In all these cases the cauterization
was conducted as follows: The patient being placed in a favourable
position, was rendered insensible by aetherization, and the affected part
was crossed two, three, or more times, with a thin iron, heated to
whiteness, after which it was covered by compresses, dipped in cold
water. The cautery produced brownish lines, which the day after
became dry and crisp, and eventually disquamated. The subsequent
pain was inconsiderable.

In respect to the effects of the cauterization,^ it may be stated that
the most remarkable was the notable relief of the neuralgic pain. In
five or six hours the limb could be moved with facility, and the follow-
ing night was tranquil ; in the course of twenty-four or forty-eight
hours the darting pains disappeared. Of the thirteen patients, in
whom it was tried, ten were perfectly cured, two were much relieved,
and in or>e only was there no improvement. [Brit. Am. Jour, of Med,

Use of Ice in Exhausting Disease. Some interesting cases are quo-
ted in a recent number of the Revue Medico-Chirurgicale, from a
French journal, in which ice taken internally seemed to be of great
service in reviving powers fast sinking. The writer employs it in
very various diseased conditions, providing tliese manifest the signs of
intense debility. The re-action it induces may prove curative in some
casesy while in others, in which this is impossible, a marked tempora-
ry amelioration of the patient's state occurs. In the cases in question
there is great atony and extenuation, and an extreme aversion to any
food whatever, with or without a development of heat. A number of
morbid states and organic lesions, having no other points in common,
may induce this condition. Iced water does not succeed anything like
60 well as the administration of the ice in little lumps, which by re-

1848.] Monthly PeHscope. a73

quiring time for their solution, ensure its gradual introduction. These
impart great tone to the system, and revive the inclination for food in
a remarkable manner. [^Revue Med. Chir. Idem.

Acetate of Lead in Tympanites Dr. Badeley, mentions a case of
temporary intestinal obstruction with excessive lymphatic distention,
in which the best effects followed the exhibition, of the acetate of lead.
Purgatives had failed to procure an evacuation. Vomiting supervened,
with hiccough, and the coils of distended bowels could be felt through
the abdomen. Feeling convinced that the symptoms depended upon
a loss of tone in the muscular fibres of the alimentary canal, alum
was ordered, with turpentine injections, and having failed, three grains
of aceate of lead, with one-sixth of a grain of morphia, were given
every four hours. This was soon followed by the expulsion of large
quantities of gas, and copious dejections. The hiccough and vomiting
declined, and the man was soon convalescent. [London Lancet.

Bite of a ^^ Copper Head'' successfully treated with indigo. Dr.
Edward P. K\ncr details the foUowinsf cases which occurred in N. Y.
city. The ordinary treatment of cauterizing, local bleeding, diffusible
stimuli, ligature, etc., having failed, the Dr. resorted to indigo, having
heard it recommended. [ Western Lancet.

''I applied it in solution freely to the wound, and exhibited it inter-
nally in ^ drachm doses every two hours. The inflammation and
pain rapidly subsided ; so much so that I resolved on removing the
bandage higher up on the limb, to the centre and upper portion of the
arm, where it remained until the following day. The arm still con-
tinued to swell to some extent towards the last ligature, but exhibited
none of that lividity nor spotted appearance which characterized the
lower portion. The man recovered, and I attribute his recovery en-
tirely to the remedial efficacy of the Indigo." [N. Y. Annalist.

Treatment of Cancer. M. Rivaille read a paper on the use of caus-
tics for the treatment of cancer. In a general manner Dr. Rivaille
states that caustics were preferable to the removal of these tumors
with the knife. Concentrated nitric acid had yielded him in his
practice most advantageous results. Poured over a pledget of lint,
it constituted with the latter a semi-solid cake, which moulded itself to
the shape of subjacent parts, and effectually prevented hemorrhage.
It was particularly in fungous tumours disposed to this accident that
M. Rivaille had found nitric acid useful as a local application. M.
Rivaille also in many instances employed alum for the purpose of ar-
resting the progress of hospital gangrene. [Missouri Med. and Surg.
Journal.

Peculiarity of Mercurial Salivation It has been recently observ-
ed, that mercurial preparations produce salivation only in those
persons who are provided with teeth. In illustration of this, a case
has lately come under the notice of M . Berard, in which a wom.an,

3'7J Monthly Periscope. {June,

having been submitted for some time to mercurial frictions, at length
became salivated ; but it was remarked that the increased flow of
salvia was only manifested in the neighborhood of two stumps of teeth
^vitli which her jaw was supi)lied. \^Ann. dc Med. de Flandrc. Idem.

Easy means to recognize, in certain cases, the Sensibility of the
Retina. (Bulletin General de Therapeutique.) M. Serres d'Alais
proposes compression of the eye with the point of the little finger upon
its side. If a luminous point be produced and perceived in an opposite
direction to the part pressed upon, then the sensibility of the retina is
preserved. This diagnostic mark rnay be of service in operating for
artificial pupil, &g,.

Means of detecting Carhonatc of Potash in Iodide of Potassium. -^-^
On account of the great use made of iodide of potassium, and its con-
sequent high price, it is a drug much aduherated, and, among other
things, very frequently so by carbonate of potash. The presence of
the latter salt is, however, detected b^^ a very simple process. Seve-
ral grains of the suspected iodide are triturated in a mortar with an
^qual quantity of hycjrochlorate of ammonia (sal ammoniac); if the
iodide of potassium contain the smallest portion of the carbonate of
potash, the mixture immediately exJiales a very evident odour of am-
Woniacal gas, [^London Lancet.

Detection of Tarturic Acid in Citric Acid. This adulteration ip
readily detected by a very simple process. Into a small quantity of
lime-water is poured, drop by drop, a nearly saturated aqueous solu-
tion of the suspected citric acid, If the solution remains perfectly
transparent, it is a proof that the acid examined is pure, and does not
contain any tartaric acid ; if, oii the contrary, a precipitate forms, we
are assured that the citric has been sophisticated by the tartaric acid.
The precipitate consists of the almost insoluble tartrate of lime, but
citric acid forms with lime, a salt, soluble in a considerable quantity
of water. [Ibid.

Ulcers of the Leg. ^The fifth article treats of "Ulcers of the
Leg ;" and we give the Author fall credit for the mode of treatment
which he proposed in 1829 for the relief of indolent or callous ulcers.
" This was to apply a large blister over the sore and neighbouring
swelled part of the limb," We liave repeatedly witnessed the
valuable and permanent advantages derived from this method of treat-
ing these troublesome and obstinate ulcers. [Dublin Journal.

The While of Zinc substituted for the White of Lead in the Arts.
(Journal des Connaissances ]\ted, Chirurg.) l\I. Lcclaire, painter of
houses, and occupied from infancy in his calling, has been engaged in
searching for some material for piiint wliich would be inoxious to
workmen. His experiments have proven that the white of zinc may
be substituted lor the white of lead, and its employment in the arts will

1848.] MonMy Periscope. 375

not in the least compromise the health of those using it. M. Velpeau
admitted the great advantage this discovery would be to the world.

Remedy for Costiveness. To the Editor, &:c. Dear Sir, I
write you this not to inform your readers, if they do not already know
it, of a simple and easy method of overcoming costiveness. It is a
matter of no small importance to be able to relieve nearly one half of the
world of an evil fraught with so much suffering, and that, too, in a most
easy and natural way. It corrects, most happily, acidity and flatulence
of the stomach, and relieves, very much, most of the symptoms attendant
on this disease. The only thing to be used to accomplish this, is
boiled wheat. It should be taken as a diet in the same way that
boiled rice is eatpn, with either sugar, molasses or milk, as it best
suits the patient. It is quite agreeable to the palate, and patients do
not easily get tired of it. Your most ob't serv't, Joii>' Clough.

[^Boston Medical and Surgical Journal*

Remedy for Toothache. A mixture of two parts of the liquid am-
monia of commerce with one of simple tincture, is recommended as a
remedy for toothache, so often uncontrollable. A piece of lint is dip-
ped into this mixture, and then introduced into the carious tooth, when
the nerve.is immeditely cauterized, dTid the pain stopped. It is stated to
be eminently successful, and in some cases is supposed to act by
neutralizing an acid product in the decaying parts. [London Lancet.

Prescription for Chilblain. (Journ. des Connais. Medico-Chir.)
M. Series of Carcassonne, recommends Black Balsam of Peru, 32
grs. to Camphor 8 grs. Dissolve the camphor in the balsam, and
keep it well slopped for use, At night let the patient warm the parts
frost-bitten, and rub in this preparation with the palm of the hand, and
then cover it with a piece of linen. Two or three days will be suffi-
cient to cure chilblains not ulcerated, and only a few more^ at most,
for those that are in a state of suppuration.

Diuretic Prescription. (Gazette IMedicale de Paris.) M. Teissier
of the Hotel Dieu of Lyons, recommends the following diuretic mix-
ture, the efficacy of which he has tested. R. White Wine ^ pint ;
powdered Squills 4 to 8 grammes ; Laudanum 60 drops. Commence
with a tea-spoonful twice a day one before breakfast, and the second
three hours after dinner, giving each in a cup of some sweetened tea.
After some days the dose may be increased to three or four tea-
spoonfuls.

Prescription for Sore Nipples. (Gazette Medicale de Paris.)
M. Jose Leon has used the following liniment as a prophylactic means
against chaps of the nipples in pregnant women. R. Tannate ofLead
4 grammes ; Simple Cerate 30 grammes; Oil of Roses 2 drops. Let
the nipples be washed in warm water, and this liniment applied once
a day during the month preceding the delivery of the patient.

3'7n Medical Intelligence. [June,

Belladonna Ointment in Vomitings of Pregnancy. Whenever in a
woman, pregnant for tlie first time or many times, vomitings super-
vene during the course of gestation, frictions should be made upon the
hypogastrium with a mixture of belhvdonna, and the vomitings will
cease. [ Western Journ. of Med. and Surg,

MEDICAL INTELLIGENCE,

The first Annual Session of the American Medical Association,

On the first Tuesday (2d day) in May, the Nalional Medical Association
assembled in Baltimore, to hold its annual meeting. This body is composed of
regular members already admitted, "two delegates from the Faculty of each
Medical College; one delegate from every ten regular resident members of
Medical Societies, and one for every additional fraction of more than half of
this number ; two delegates from every chartered or municipal hospital con-
taining a hundred inmates or more, and one delegate from every permanently
organized Medical institution of good standing," The Conventions of Physi-
cians held in New York city, ISAG, and in Philadelphia, 1847, were only pre-
paratory to the organization of the present society, now known as the National
Medical Association.

At 11 o'clock, on the day appointed, the delegates having had their names
registered, the venerable President, Dr. Chapman, opened the session in the
Universalist Church by a short and appropriate address. There were about
200 members present, representing twenty States and the District of Columbia j
by the close of the meeting the whole number amounted to 25G. The University
of New York, the 'Transylvania University, thelUouisiana Medical College,
the Medical College of South Carolina, the Memphis Medical College the
States of North Carolina, Alabama, Mississippi, Arkansas, Louisiana and
Texas, had, we believe, no delegates present. The whole South had but a feeblo
representation. There were not .more than 80 in all. From the States south of
Virginia and Kentucky, but three of eight sent delegates, and they numbered
less than 10, viz: 3 from South Carolina, 2 or 3 from Tennessee, and 2 from
Georgia.

The first day was pretty much consumed in the election of ofticers viz; a
President, four Vice-Presidents, two Secretaries and a Treasurer. Upon the
first ballot but three of the eight were elected. The election was then commit-
ted to a body composed of a delegate selected by the delegation of each Stale.
Their report was unanimously agreed to the next morning, and accordingly Dr.
A. H. Stevens, of New York, was declared President; Drs. John C. Warren,
Samuel Jackson, Paul F, Eve, and U. M. Awl, Vice-Presidents; Drs. Alfred
Stille and H. J. Bowdilch, Seeretaries, and Dr. Isaac Hays, Treasurer.

An unpleasan-t discussion arose during the first da}', from the introduction of a
proposition to have the daily sessions of the Association opened with prayer. So
great was the opposition to this reasonable and appropriate custom of most de-
liberate bodies of our country, that we regret to say the motion was laid upon the
table; and at the afternoon session a resolution was adopted to tlie eflect that
in this action, the Association disclaimed any want of respect for devolipnal ejfr

1848.] Medical Intelligence. 377

ercises on such occasions, but it must be rcg:arded in the light of a concession
to those members who have scruples of conscience on the subject. We can
view this act on the part of the National Medical Association in no other way
than as disgraceful to the profession, disrespectful to religion, and irreverent to
God. The admission that there were scruples of conscience among gentlemen
associated in the same benevolent calling, and now assembled together for the
first time for the same great object the good of Medicine and yet who refused
to invoke the common blessings of a common Protector and Father around the
same altar, is deplorable indeed.

It might be unprofitable at this time to enter into a detail of the various pro-
ceedings of the Association, as they will be officially reported hereafter. The
committees on the various departments of the profession, appointed at the previ-
ous Convention, made very able reports, and these were referred to the board of
publication, so that our readers may thus secure the valuable matter they con-
taiji.

Medical Education. On the subject of Medical Education, we remarked an
unanimous opinion among the profession, out of the Faculties of the Colleges,
jn regard to lengthening the term of lectures; and even with the professors, few
were found oppo.sed to it. At a caucus of the delegates from the Medical
Schools, held on the evening of the first day's meeting of the Association, we
Jielieve nine-tenths voted for five months. Besides prolonging the course of
Lectures, by way of improving the present mode of instruction, ihe attention of
the Association was directed to recommending weekly or daily examinations,
recapitulatory of previous Lectures, lo substitute clinical reports of cases for a
Thesis on the part of a graduate for the degree, and to secure the faithful attend-
ance of Students to the close of the term. These were recommended in addition
tp what the previous Convention held in Philadelphia had already advised.

Medical Literature. The report on Medical Literature was read by Dr. O.
W. Holmes, and as any one who. may have seen an introductory lecture of his
recently published, might have inferred, great injustice has been done the South
3,nd West, in this paper, purporting to be national. In it he says

" 'Rivalry in medical institutions must always exist, but, this business of un-
derbidding and under-feeding, this farming out of medical students, like town
paupers, to the lowest contractor, must eventually be arrested. If the law can-
not do it by the necessary discrimination, organized public opinion can and will
do it. And the time mu.st come when those institutions which cannot by any
possibility afford practical instruction in the most important branches of the
profession will cease to be recognised as capable of giving a full title to public
confidence. It is but the addition of three or four letters to those which desig-
nate the medical graduate, and the Doctor Medicince Pennsyhanicnsis or Har-
vardiensis is as well known as the Parisian graduate by the title which he never
fails to claim, and the equality which now confounds the most important dil-
lerences is at ojice overthrown and abolished!' "

We have, comparatively speaking, no Parisian graduates among us, and we
^eny that a Diploma from Pennsylvania or Harvard confers any distinction
whatever upon its possessor. On the contrary, a graduate of the Medical Col-
lege of Georgia requires no additional examination for license to practice in
this State; but an applicant, especially from one of the New Engliind Medical
Colleges, {Harvard included,) is subjected to a rigid scrutiny. And, why 7

378 Medical Intelligence. [June,

Because of their imperfect organization, several of these schools having, until
recently, but four or five professors.

And again, " 'There are many peculiarities iathe medical character of this
section of the country. Our position in New England, a little out of the broad
current, our distinct origin, our hereditary habits, manifest their influence in
the shades of professional as well as political character. We may expect to
find the New Englander as cool, as shrewd, as practical in medicine as in
business. But liis peculiarities are best displayed in the medical teacher and
the medical public. The first is singularly calm, simple and didactic, as coin-
pared with many of his distant brethren; the second cautious, sedate, respectful
to a degree which the fiery children of the south would call tame and submissive.
When the annual flowering of ."Introductory Lectures " takes place, it may be
seen that the colors are generally higher as the distance from equator is less,
and that the gayestdisplay is from those that have had the advantage of the last
ra3's of the setting sun ; the eflHorescence of scientific enthusiasm on the banks
of the Mississippi or Missouri. Whether it^be the coldness of Northern winds
or the sterility of Eastern soil, there is less leaving out in proportion to the yield,
and that of a less glaring aspect in our sober nurseries of knowledge tlian in
those of our Southern and Western friends. Our danger is in the direction
oi sensible dtil/iess, and theirs in that of glitteriog wordiness."*

Our author also speaks of " miserable apologies for medical schools," of
"inferior schools located in wrong places," ol "unemployed young men becom-
ing teachers," alluding particularly to the South and West, but entirely overlooks
the fact of the existence of Medical Colleges at Castlelon, Woodstock, Hanover,
Bowdoiu, Berkshire, Pittsfield, and even his own favored Harvard all small
New England villages. Dr. Homes, himself, once lectured on Anatomy in a
place of about 1500 inhabitants, viz. Hanover.

That part of the report referring to the Medical Periodicals of our country,
commences with a narration of the articles in the late New England Medical
and Surgical Journal, and then a notice of a Journal which was published in
New York, but also defunct years ago; it enters minutely, not only into every
original communicationjof the American Journal of Medical Sciencesof Phila-
delphia, of the past, as well as those of the two Nos. of this year, but even gives
an extended list of contributors, not forgetting, of course, the name of the re-
porter himself; a hasty glance is now taken of the Southern and Western Jour-
nals, and the report winds up with the present doings of the Boston JNIedical and
Surgical Journal. Some three or four pages are devoted to this periodical, the
only one issued in all the New England States, and which is published weekly;
and in as many more are dismissed all the vioyithlics and bi-vi oyitklics of Charlea-
ton. New Orleans, Memphis, Lexington, Louisville, St. Louis, Chicago, Cincin-
nati and Augusta. The name of one of the most vigorous writers in medicine
of our whole country, and one who has repeatedly and recently too, contributed
to our medical literature, is not even alluded to in the report; but then he re-
sides in Natchez, Mississippi. Some of the Journals actually in existence are
not so much as even noticed. As regards our own, the Association was inform-
ed that Dr. Ford recommends quinine in Intermittent fever, (without one word
as to the doctrine he so much insists upon, viz., to jugulate the cliill,) that Dr.
Dugas had written on the Liver, and Dr. Cunningham, of Tennessee, had pub-
lished an article on the climate, diseases, &c., of the eastern portion of that
State.

Now this injustice to our section of the United States is the more flagrant
when it is known that the reporter. Dr. Homes, had access to aU the Medical

1848.] Medical Intelligence. 379

Periodicals of our country. At the office of the Boston Medical and Surgical
Journal, he could at any time have examined their contents, as he did no doubt
there count their number, which he correctly stated to be about twenty.

The reporter, moreover, passed a severe criticism upon the literary character
of our Journals, deservingly it may be, but made no allusion to the laborious,
self-denial and discouraging duties of an editor. (See Article on last page.)

We believe the report was faiihlul in condemning the soidhantdiUihois, who,*^
adding a few lines to a foreign Book, forthwith have their names guilded on the I
back', and entered conspicuously on the title page as co-editor of the work. J
There is, however, one omission in it, and to it we would now call the attention

of both Dr. H. and that of our reader this is the new mode of making Books

from Books^ and occasionally too, of manufacturing an Introductory Lecture.
It maybe that if we of the South and West contribute less to the Medical Liter-
aXure of our country^ that little is " more original.

In referring to this subject, we beg leave to say that we do it with no ill or
sectional feeling whatever. Medical literature, like the republic of letters,
.should know no Potomac recognize no Alleghany. If wrong be done any one,
v/e cheerfully offer our pages to correct the impression produced, and may
thus serve the authors of the publications about to be noticed.

The first is an Introductory Lecture by Prof. Mutter, delivered in the Jeffer-
.son Medical College of Philadelphia, Nov. 1st, 1847. We quote from page 16.

"To medical men too, is Botany greatly indebted. That wondrous giant in
intellect, whose name stands at the head of the list of those who first brought
^'orderout of chaos," in the science of Botany, was, atthe time he pubishedhis
most valuable works on Botany, professor of medicine at Upsal. The name of
Linneus is familiar to you all, for who that has entered the threshhold of medi-
cine has failed to encounter it at every turn 7 Malpighi, the anatomist, Dutro-
chet, Jusseiu^ Gmelin, Willdenoir, Hasselqvist, Pereira, Wood, Griffith, and Carson,
physicians, have nobly striven in this department, and a host of others might
te "cited, as able collaborators in the same field.

In the more fixed and certain sciences, loo, physicians have been pre-eminent-
ly distinguished. The most wonderful truths, proven to be such in the science
OH astro 7107711/ , were first promulgated by a physician, the magnijiceni Copernicus.
The inventor of the analytical and differential calculus, was the kind physician
Bernouilli. In chemistry physicians have been the chief laborers. "Behold,"
observes an eloquent writer, " that group of children gathered together around
the fermenting vat of a brewery, upon one of the populous streets of Glasgow,
amusing themselves by lighting their temporary tapers of shavings and straws,
and shouting with delight on observing how, as by magic, those lights are extin-
guished the .-instant they are projected beyond the edge of the vat. Tliousands
are the passers by, each stopping for a moment to regard them, for who that is
toiling, care-worn, along the path of lile, will not stop a moment to catch the
exhiliration ol the merriment of childhood, and pass on. But here comes the
philosopher, the man who has been disciplined in the school of the natural scien-
ces; his open ear catches their shouts- he joins himself to the group, and enters
into their sports. The observation of that fact, sets his powerful mind at work,
and on the spot he draws a conclusion pregnant with the richest benefits to sci-.
ence, viz., that the air arising from the fermenting materials is difierent from
common atmospheric air. A new direction is given to his studies, and shortly
he appears belbre the world, the discoverer oi carbonic acid gas. And who was
this philosopher'? Dr. Black, the physician I

The works of Stahl, of Foucroy, of Barthoktt, of Marcet, of Wallaston, of
ThoTnson,oi Rogers, and of our own Dr. Bache, proclaim in trumpet tones, the
indebtedness of chemistry to the practising physician."

We now ask the 480 pupils to wham this was addressed, the many who may
have subsequently read it, if the impression was produced that the author has

380 Medical InteUigence. [June,

derived, literally, word for word, his entire reference to Chemistry, from one
of the Professors of the Medical College of Georgia? The signs of quotation
may have been accidentally omitted after the M'ord j)hysicia7i, but special care
ought to have been exercised in correcting the proof-sheets, since the author
belongs to a school just accused in the South-weslern Medical Advocate of a
great horror to inverted commas. If Dr. Miilter intended to associate Dr. Ford,
of Augusta, Georgia, with the philosophers above mentioned why not name
him as well as his "own Dr. Bache,"

"VVe now dismiss this report on NatioTwl Medical Literature, which with
greater propriety might be called the Boston and Philadelpliia Medical Litera-
ture, by another quotation which w-e take from a review oi Prof. Wood's Trea-
tise on the Practice of Medicine, in the last No. of the New Orleans Medical
and Surgical Journal. The reviewer, w'hom we recognize by the initials to be
a very distinguished physician and writerof Alabama, after passing the highest
commendations upon this work, goes on to observe

" Much is given as the result of the author's own observation and experience,
and in the application even of the labors of others to his use, there is a thorough
revision, a perfect and yet concise elaboration, and appropriateness of selection
and nice adaptation of parts, evincive of a degree of labor and care, far beyond
that ordinarily bestowed on works of a similar character. In this respect.'how
favorably does it contrast with some that have recently preceded it, which, instead
of giving the views and experience of the (soi disant) authors, to any uselul ex^
tent, are almost entirely composed of verbatim extracts from standard works of
the day, and from the various medical periodicals, strung together until a suffi-
cient mass has been accumulated to form a book, the only original part of
which is perhaps the title page, on w^hich appears conspicuous the name of one
as author, whose share in the production has been confined principally to an
industrious use of ti)e editorial scissors, and a careful correction of the prnof-?,heets.
Perhaps in most instances, in such productions as we have allusion to', it will
be found that the sources from whence the materials have been obtained, may
be acknowledged by quotation marks, or by appending the names of the authors
borrowed from, to the parts respectively for which each has been laid under
contribution; but to this even, there are exceptions, and it must be noted with
regret, that the gatherers of the mingled heterogeneous masses to which we have
alluded now and then so far forget the rights of others, as to copy from their la-
bors, page after page, without acknowledgment in any shape whatever. That
the unwary reader, too, may be deluded into the belief, that there is at least
some originality in the production for which he has expended liis money, and
on which he may waste his time, the device is now and then adopted, of modifj'-
ing slightly the phraseology of some oi ihe borrowed, paragraphs, by the substitu-
tion of one wora occasionally for anollier, or slightly varying tlie arrangement
of the sentences. That our imagination is not at fault in regard to thi.'; matter,
should any reader ask, "can sucli things be 7" we would relcr to a work, fihe
first edition of which was published in Pliiladelphia in 1812, and which has
passed through a second edition since,) entitled, "The Practice of Medicine,
or a Treatise on Special Pathology and Therapeutics," as an example, liable in
no slight degree to the objections to which we have made allusion. In regard
to the first objection which we have urged, a general glance only is necessary
to shew to what extent this production is a mere hasty and un-elaborated gather-
ing from other works. For an instance of the second objection, to wit. the ap-
propriation without any acknowiedgement whatever of ihe labors of others, we
would refer the reader to the diagnosis of Iritis, on page 417 of the second vol-
ume, and to the symptoms of the same disease by Dr. Taylor, in the second
volume of Twedie's Library at Medicine, page 408, from whence the spoliation
is made. For exainj)lcs of the oriniiud material entering into the composition
of the book, manur;icturc(.l as we have already observed, by a transposition of
Bentences wiiich others have written, and the occasional substitution of one
word for another, we need not search f open the book and let chance determine

1848.]

Medical Intelligence.

381

the page, as we will now do, and lo! they are present. Accident has opened
before us the article on "Purulent inflammation of the conjunctiva," and we
will turn lo the corresponding part of Twedie's Library of Medicine, headed
"Purulent Opthalmia."

Fiom " the Praciire of Medicine, or a
Treatise on Special Pathology and T/te-
rapeutics." First Edition publis/ied in
1842.

"Purulent opthalmia occurs under
three forms, the two first, however, are
in reality the same disease; and the
third is merely produced by a specific
cause ;^^rs/, the purulent opthalmia
of the adult; secondly, that of the new
born child; and thirdly, the gonor-
rhcBal."

From Twedie's Library of Medicine,
First American Edition, published in
1840.

"Purulent opthalmia occurs under
three different forms, which are yet
essentially the same disease ; the two
distinguished only by circumstances
arising out of the age of the patient,
the last (gonorrhocal opthalmia) pre-
senting some peculiarities, which are
perhaps referable to the specific nature
of the cause.^'

Speaking of the Purulent Opthalmia of the adult,

In Twedie's Library of Medicine we
find:

" The pain varies in degree accord-
ing to the textures which are involved;
if the conjunctiva alone suffers it is in-
considerable, but when the deeper and
firmer tissues are attached it becomes
almost insupportable. It is felt chiefly
in the neighborhood of the orbit, and is
of an aching pulsative character, sub-
ject to remissions and exacerbations of
variable duration." * * *

" With local suffering of such sereri'
ty, we find some degree of constitution-
al sympathy in the form of fever, and
the general health is at times much im-
paired by the prolonged irritation.

A characteristic of the disease is its
tendency to relapse. * * * Rupture
of the cornea, which sometimes occurs
during a paroxysm of pain, at variable
periods from the commencement of the
disease, may afford a temporary relief
to suffering, but this is not always the
case, as sometimes it does not put a
termination, to the disease, and scarcely
even checks its progress. If resolution
takes place the inflammation may issue
in the production of various morbid
conditions of the eye and its appenda-
ges, as vascular thickening of the palpe-
bral conjunctiva with enlargement of
the mucous papillae, commonly called
''granular conjunctiva," opacity, ul-
ceration, sloughing or staphyloma of
the cornea, or prolapse of the iris."

Turning over a page or two we come to Strumous Inflammation of the Con-
junctiva, from which in the appropriate colums we will place a short paragraph
from each book.

The author of " the Practice of
Medicine," &c., observes: .

"Whilst the inflammation is con-
fined to the conjunctiva, the pain may
not be great; but as soon as it in-
volves the deeper seated parts, which
do not readily admit of distension, it is
at times excessive, generally it is felt
chiefly in the orbit, and is of an aching
pulsative character, subject to occa-
sional exacerbations."

"Under such severe irritation the
constitution sympathizes greatly, and
there is often "much fever; if the dis-
ease, too, persists for any length of
time, the health often suffers. It is
very liable to relapse, and even if
resolution takes place the inflamma-
tion may give occasion to various
morbid conditions of the eye and its
appendages as vascular thickening
of the conjunctive lining the eye lids,
with enlargment of its follicles, com-
monly called granular cortjunctiva,
opacit}^ sloughing, staphyloma of the
cornea or prolapse of the iris, or sup-
puration and collapse of the eyeball.

Rupture of the cornea sometimes
takes place during the violence of the
pain. Thismay occur at an uncertain
period from the commencement and
afford some relief; but at other times
it does not even seem to check the pro-
gress of the disease."

S83

Medical Intelligence.

[June,

From "the Practice of Medicine."
&c.

" The dejjree of pain is not often
great whilst the eyes are shaded from
the light, but should the inflammatory
phenomena be considerable it -Is fre-
quently urgent especially during the
night. The secretion from the eyes in
passing over the cheeks gi.ves occasion
to redness of the integuments, and the
nostrils are often greatly irritated."

From Twedie's Library of Medi-
cine.

"The degree of pain is generally
moderate while the eyes are shaded
from the light. When the inflammato-
ry symptoms are active it is considera-
ble, especially during the night. The
secretion from the eyes is evidently of
an acrid nature, from the irritation it
occasions in the nostrils and upoa the
integuments of the face."

We turn to the next subject, ^Inflammation of the Cornea, for our next ex-
tracts.

From " the Practice of Medicine,"

"The disease generally commences
slowly, and insiduously, and the cornea
loses its natural brilliancy, and be-
comes dull, shaggy, the surface ap-
pearing as if covered with fine dust, or
resembl ing glass that has been breathed
upon. * * * *

The fine vessels of the conjunctiva
and sclerotica, which is the principal
seat of vascularity, being arranged in
radii round the cornea and presenting
a carmine hue."

From Twedic's Library of Medicine.

* "It generally commences
slowly and insidiously, the cornea loses
its brilliancy, and becomes dull and
hazy, its surface appearing as if cover-
ed with fine du3t, or resembling glass
that has been breathed upon. * * *

The fine vessels ot the conjunctiva
and sclerotica become injected with red
blood; those of the latter membrane,
which is the principal seat of increased
vascular action, are arranged in radii
round the cornea, and present a car-
mine hue."

But why should we weary the reader by multiplying such examples here,
when a simple glance through the volumes will serve to show most incontesti-
bly, that there is scarcely a single chapter in the entire work, in which specimens
of what appear at least to be the most gross and flagrant plagiarism, such as we
have presented, may not be found. "There is, it really would seem, in this whole-
sale, but varied method of appropriating far ones own especial profit, the pro-
ductions of other men's brains, a something, for which it is diflicult to account.
Isitin consequence of an 'Auri ***** fames'?' Most certainly," authors
of books of the stamp of which w^e are speaking, cannot delude themselves into
the belief that they are conferring a benefit on the members of the profession, by
giving them, under a new name, a crude and undigested mass, collected from
this source and that, the diflerent parts of which have already apjTeared before
them in a less questionable shape," and served the purpo5cs intended, in their
proper position and connections; nor yet do we thinlc it probable that they can
so far deceive themselves as to believe for a moment that they are acquiring, irw
Ihe way of reputation and character, by such means, anything which the good
and wise would not look upon as in<^st unenviable. There is in a course like
this, it does seem, we repeal, a double deviation from thatsiricland rigid regard
for the rights ol others, by which some at least would desire to be guided, in
their intercourse with the world, first, in the seizing upon that which properly
belongs to another, and using it to one's own profit, and consequently more or
less to his detriment; and second, in inducing, by the fascination of anew
name lo the purchase of that which may already be possessed in its original
shape and place. Does not the law recognize, as an oflence against it, the ob-
taining of money under "false pretences V And can there be a stronger ex-
emplification than is here presented? We have glanced at the matter here for
illustration in a pecuniary view, but it might be placed in other lights.

From the purpose of obviating charges of a similar character hereaft'^r, we
would with all due deference suggest to the aiuhor of "the Practice of Medi-
cine, or a Treaties on General Pathology and Therapeutics," a slight modifica-
tion in the title page, of any future editions of the work, which might with pro-
priety read thus;

1848.] Medical Intelligence. 383

" Extracts fron Tioedie's Library of Medicine, and other Standard Authorities,
selected and arranged by Roblcy Dunglison, M. D., tf-c,"

But perhaps we have been over hasty, and have made an inconsiderate use of
the word "plagiarism," when all might, be explained on the score of mere coin-
cidence; ana, as an instance in point now occurs to our mind, where an author
satifactorily exculpated himself from a similar insinuation on something like
the grounds we have named, it is but justice toProfesssor Dunglison, in the fear
that we have done him Avrong to mention it, that he may have the benefit of the
precedent. We allude to the case oi Mr. Puff, author of a tragedy called 'Hhe
Spanish Armada.''^ The reader will please remember that Messrs. Sneer and
Dangle are witnessing, with Mr. Puff, in front of the curtain, at the first re-
hearsal of his p]a3r.

"Enter (on the stage) a Beefeater."

Beefeater. ' Perdition catch my sonl, but I do love thee."

Sneer. Have'ntI heard that line before 1

Puff. No I fancy not where pray ?

Dangle. Yes, I "think there is something like it in Othello.

Puff. Gad; now )^ou put me in mind on'it, I believe there is, but that's of
no consequence all that can be said is, that two people happened to hit on the same
thousht aiid Shakspcare made useof it first thai^s all."

We know not whether it should be looked upon as a fortunate circumstance, or
a subject of regret, that in so many instances othei writers hit upon the thoughts
of the author of "The Practice of Medicine," &c., and made use of them first.
In one point of view, at least the circumstance may be looked upon rather un-
pleasant, or, would be so to most men, since it may lay him under the impu-
tation of plagarism ; but most fortunate for him at least, (having an eye to lucre,)
if not for his readers, if so it is, that previous publication, (as some perhaps may
think to be the case.) alone could have incited him to the efforts of authorship,
and that otherwise all that he has accomplished would have remained latent, still
retaining its fluidity within the reservoir of ink from whence the ideas flow.

W. M. B."

Thanks of the Provisional Government of France to the Medical Profession of
Paris. The following circular has been addressed to the Physicians and Sur-
geons of the Hospital of Paris:

Citizen Theirry has been authorized by the Provisional Government to return
its thanks to the Physicians, Surgeons, and Apothecaries of the hospitals, for
their valuable services rendered to the wounded during the revolution. The
gratitude of the French Republic cannot better be expressed than in the promise
of multiplying therapeutic means, of reforming all abuses, and of giV'ing to the
medical profession every consideration which it merits.

Paris, 27th, February, 1848.

Lengthening the Course of Lectures in. the Medical College of Georgia. We
are gratified to say, that the next Course of Lectures in the Medical College of ,
Georgia will continue fiv'e months embracing November. December, Janua-
ry, February and March. The recommendations of the National, Medical
Association will no doubt be complied with as far as practicable by this Insli- ,'
tutioD. - /

' . /

Neic Frigorific Mixture. M. Jourdan, apothecary at St. Marie-du-Mont,
France, proposes Hydrochloric Acid 1 part, Sulphate of Zinc reduced to powder
Ipart. A thermometer at 55 plunged into this mixture fell instantly to about
18'. [Jour, de Chimie Medic.

384

Medical Intellige nee. Meteorology .

Reicard of the Editor of a Medical Journal From inquiries made at the Na-
tional Medical Association, we venture the assertion that not one of the twenty-
Medical Journals of our country is adequately sustained not one paying its
editor S500 a year. The main income from his labor consists in the books sent
him for review or notice, and in the reception of the exchange Journals. We
entered upon the publication of ihe Southern Medical and Surgical Journal
without the hope of fee or reward, and this we can assure our readers has been
fully realized. All we desired was that the subscription would pay the printer.
We again reiterate the fact, that the publisher takes the subscription list for his
pay. The subscribers at present number 4G2-=-viz., 307 in Georgia, 67 in South
Carolina, 52 in Alabama, 9 in Mississippi, 3 in North Carolina, 4 in Tennessee,
5 in Louisiana, 10 in Florida, 1 in Massachusetts, 1 in Connecticut, 1 in Arkan-
sas, and 2 in Texas; besides our exchanges and some eight or ten honorary sub-
scribers. The Jourual can alone be sustained by payments made in advance,
but nevertheless there is now due more than two thousand dollars. To obviate
pecuniary embarrassment, this condition of its publication {payment inadvancc),
will hereafter be adhered to with all new subscribers, and those who do not
receive their Nos. will at once divine the cause.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north^Longitude 4''
tide 152 feet.

for April, 1848, at Augusta,
32' west Wash. Altitude above

J
"a,

<

Sur
Ther.

\ Rise.
Bar.

29 84-100

%
Ther.

P.M.
Bar.

Wind,

Remarks.

1

62

70

29 88-100

w.

Cloudy.

2

50

30 13-100

70

30 15-100

N. E.

Fair blow.

3

48

30 24-100

68

30 19-100

E.

Fair.

4

52

30 19-100

67

30 11-100

S. Ev

Cloudy.

5

52

30 7-100

74

30

S.

Fair.

6

61

29 85-100

70

29 82-100

s. tv.

Cloudy sprink.--rain at night.

7

55

" 80-100

50

" 78-100

N. E.

Rain, 2 inches and 25-100.

8

51

" 65-100

52

" 62-100

N. E.

Rain. 1 inch and 10-100.

9

49

" 69-100

54

" 65-100

N.

CloudySprinkle.

10

46

" 80-100

75

" 85-100

N. W.

Fair.

11

46

" 91-100

82

" 92-100

s. w.

Fair.

12

51

" 90-100

85

" 79-100

s. w.

Fair.

13

63

" 70-100

74

" 62-100

w.

Cloudy.

14

66

" 62-100

69

" 63-100

w.

Cloudy. ^midnight 25-lOa

15

49

" 74-100

70

" 65-100

E.

Fair thund. at light., a rain at

16

49

" 8.5-100

m

" 88-100

N.

Fair blow.

17

46

" 97-10(1

74

" 96-100

S. W.

Fair.

18

53

" 90-10

71

" 80-100

s. w.

Cloudy blow.

19

47

" 88-100

61

" 91-100

w.

Fair blow.

20

43

30 8-100

65

30 7-100

w.

Fair.

21

40

30 5-10(i

64

30

S. E.

Cloudy frosty morning.

22

54

29 96-100

61

29 88-100

S. E,

Rain. \ -- .^^
Rain, to 12 M.J ^''^""

23

55

" 75-100

66

" 73-100

E.

24

51

" 64-101)

81

" 61-100

W.

Fair.

25

56

" 67-100

80

" 66-100

w.

Fair sprinkle at 3, p. m.

20

58

" 75-100

80

" 7.5-100

s.

Fair some clouds.

27

60

89-100

60

" 95-100

N.

Cloudy- rain at night 35-100'.

28

56

" 97-100

65

30 1

E.

Cloudy.

29

60

" 9S-100

70

29 91-100

S. W.

Cloudy. [45-100.

30

60

" 90-100

75

" 89-100

S. E.

Cloudy rain before daylight^

14 Fair days. Quantity of Rain 5 inches 15-100.
11 days. West of do. do. 14 days.

Wind East of N. and S.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 4.] NEW SERIES JULY, 1848. [No. 7.

Part L ORIGINAL COMMUNICATIONS.

ARTICLE XXX.

Thoughts on the Modus Operandi and Therapeutic Properties
of Quinine. By James C. Harris, M* D., of Wetumpka,
Alabama.

Believing that any thing in the least calculated to settle ex-
isting differences as regards the operation of a medicine so
extensively used as Quinine is, in the treatment of Southern
diseases, v^^ould be acceptable to the profession, has induced us
to offer the following reflections, in support of the opinion that
it is a stimulant and anti-periodic, and that it possesses these
properties in an eminent degree, together with the power of
neutralizing the malarial poison, or enabling the system to do
so, or both, and that if it ever manifests very clearly any other
action, it is either owing to idiosyncrasy, ot to its having been
given in unnecessary, if not dangerously large doses.

For the purpose of illustrating and sustaining these positions,
we cannot but consider it a useless waste of time to inflict upon
our readers a detailed account of the different varieties of the
Cinchona bark, or the different quantities and diseases in which
it has been administered, believing it necessary for our present
purposes, merely to intimate further than what may be gathered
from the following pages that two of its elementary principles,
Carbon and Nitrogen, during the round of the circulation in
the lungs, under the vital forces, can, on strict chemico-physio-
logical principles, be shown directly assisting in increasing the
animal temperature and sensibiHty.

25

386 Harris, on Quinine. [July,

As regards the term sedative, Dr. Charles Caldwell observes,*
"that when medical writers shall have learned, to deal more in
matter, and less in mere words, unsanctioned by reason, we feel
persuaded that the term sedative will be erased from the
nomenclature of the Materia Medica. If the term, in common
accceptation, possess any meaning at all, a sedative is that
which, diminishing or removing existing impression, diminishes
or suspends existing action if the impression be not removed,
it is a law of nature that the action will continue. But how
can a substance or agent remove from living matter an impres-
sion already in existence, or suspend or alter action already
going forward, otherwise than by substituting an impression
and mode of action of its own ? Such a process is impossible.
A stimulant impression inducing action is a reality: it must,
when applied to living matter, act, and if it act, it must make
an impression. This very action and impression, therefore,
pronounce it to be a sedative only in name, not in fact ; to be
capable of acting and impressing, it must be a stimulant, im-
pression being another name for stimulating action. But," con-
tinues the same writer, "to attribute to reputed sedatives the
power of altering vital action in any other way than by means
of impression, would be to assert an effect without a cause. In
the strict sense of the term, a sedative is only known in the
language of the schools."

Again, in speaking of the nitrogenized vegetable remedies,
(of which quinine is one,) Prof. Leibig remarks,! ** that when
introduced into the system they augment the energy of the
vital activity of one or more organs they also excite morbid
phenomena in the healthy body; and that all of them produce
a marked effect in a comparatively small dose, and that many
are poisonous when administered in larger quantity."

To the mind of almost any unprejudiced person, opinions so
clearly expressed as are those just quoted, ought to be sufficient
to establish the action of any particular medicine, or class of
remedies. Still, to others more testimony may be necessary;
and which, if we are not greatly mistaken, may be found in a
well written article on the Poisonous properties of the Sulphate

Caldwell's Cullen, pp. 103-4. t Organic Chemistry, p. 54.

1848.] Harris, on Quinine. 887

of Quinine, by Wm. O. Baldwin, M. D., of Montgomery, Ala.
In this paper, originally published in the American Journal of
the Medical Sciences, for April, 1847; we are of the opinion that
Dr. Baldwin has performed for science an acceptable service;
and although many of his conclusions are based on results
flowing from the inordinate administration of the remedy to
dogs and puppies, they are, nevertheless, from the known
similarity of its effects on man and animals, (established by
himself and other experimenters,) entitled to no inconsiderable
weight, and are, as given by Dr. Baldwin, as follows : " Rest-
lessness generally preceded all other symptoms, as was indicated
by the animal changing its position often, 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 medi-
cine was taken by the stomach ; then came on muscular agita-
tion or tremulous movements of the body and extremities, with
a constant motion of the head ^in attempting to walk, the dog
would totter from side to side, and fall, or if he maintained his
feet, would walk in a direction different from the one 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 com-
pletely paralyzed. This state was accompanied with more or
less excitement of the vascular system the pulse increasing in
frequency, and varying Ifrom 110 to 160, and in one instance
even as high as 240 per minute great oppression of the breath-
ing was present, and sometimes frothing at the mouth. The
pupils of the eyes were invariably dilated, and generally to an
enormous extent, leaving but a small ring of the iris perceptible,
and vision, as well as could be judged, was entirely lost. Con-
vulsions was 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 medi-
cine failed to produce this result, furious delirium was present
in one case, as was manifested 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

Harris, on Quinine. [J^b'

after the poison had been taken, and in a few- instances the sub-
ject seemed as if stunned by some sudden and powerful blow,
or violent fit of apoplexy."

The post-mortem appearances, as given by Dr. Baldwin,
were equally uniform with the symptoms before death, and
consisted in a "dark fluid and defibrinated 'condition of the
blood, and 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 also more or less vascular, and in one
instance, a semi-fluid coagulum of blood was found in the upper
half of the thaeca vertibralis ; this was probably owing to the
subject being very young, and the convulsions being much more
violent and frequent than in any other instance."

Had we have been required to detail a series of symptoms,
and post-mortem appearances, resulting from the inordinate
administration of some undeniable stimulant, we must confess
that we should have been somewhat puzzled to have arranged
a series, that would have placed the matter in a much clearer
light. But on this subject we will let Dr. Baldwin speak for
himself, who continues '* evidences too palpable to be denied,
and gathered from experience with it as a remedy, prove to me
that it is occasionally a stimulant. These experiments go far
in confirmation of that fact, at least upon the healthy economy,
and without attempting to offer any explanation for the apparent
conflict of the two statements, I will simply repeat that I have
seen it on the contrary, have, on innumerable occasions a most
decided and unmistakeable contra- stimulant effect."" Now, with
what gentlemen have seen on other occasions, we, at present,
will have nothing to do ; but by what particular process of
reasoning, with the facts before him, (in any thing less than
dangerously large doses,) Dr. Baldwin could have arrived at
such a conclusion, we are entirely at a loss to determine, espe-
cially when we recollect that he had previously declared that
the remedy had been detected in the urine, and that it entered
and mixed with the circulating masses of the body, and through
this means, when given in quantities suflicient to destroy life,

1848.] Harris, on Quinine. 389

exerted a direct influence on the nervous system oian eminent-
ly excitant character (nature). Neither do we beHeve, and
indeed, were it necessary, think we could very easily show,
that its good effects in his cases of Menengitis, where lie also
informs us that the attending^ circumstances w^ere of such a
character as to contra-indicate the use of the lancet, and other
depletory means were derived from other than the contra-
stimulant effect of the remedy.

Upon this subject we were both taught, that it was not credi-
ble that an agent of any description, would radically change its
own nature, and be at all times, all things, unto all men ; then
if this be true and to the correctness of which we are not
sensible that any exception exists we are driven to account
for the apparent difference of action of this remedy on other
principles than that of its sedative properties. To illustrate :
we receive a gentle charge of Electricity, and are momentarily
excited continue, and gradually increase the charge, and w^e
remain excited ; but suddenly increase it to the strength of the
terrible thunder-bolt, and we are instantaneously destroyed.
Now will any one contend that all these different effects are
the result of a change in the nature of the agent ; we think
not, the evidence is too palpable. Again : were we so disposed,
we would show that similar results, by increasing the quantity,
might be obtained from the administration of brandy, or any
other alcoholic drink.

But were any thing more necessary, than what has been al-
ready advanced, to establish the stimulating properties of the
remedy, or could we really esteem it necessary to bring forward
more proof on a subject so perfectly plain, and defensible, we
know perhaps of no other, in which these properties, together
with its anti-periodic virtues, are more clearly shown, than in
the power it possesses of warding off and preventing the return
of the cold stage of an intermittent, and in which the **'smallness
and weakness of the pulse the paleness and coldness of the ex-
treme parts, with the shrinking of the whole body, sufficiently
show that the action of the heart and larger arteries, for the
time, are greatly weakened."

~T ^ -"

t Cullen's descriiption of an ague. -

390 Harris, on Quinine. [July,

In fact, its therapeutic powers are more wonderfully display-
ed in preventing and relieving any undue sanguineous accumu-
lations that may occur during the persistance of any grade of
autumnal fever provided the accumulation be of a periodic
character, and the result of an existing weakened action of the
heart, or perverted nervous action, than in almost any other
diseased condition of the sj'stem.

In view of what has been already advanced, together with an
examination of the experiments and observations made with this
article by Mellier, Duval, Berandi, and others, we think it may
be clearly inferred that in a large majority of instances, in both
animals and man, many, if not all of its most prominent effects in
doses varying from 5 to 100 grains, are nothing more than such
as would naturally flow from the administration of many other
stimulants, and that whenever it fails to give manifestations of
this character, in untoward symptoms, and prostration, it is
owing to idiosyncrasy, or causes unnecessary here to be men-
tioned.

We also learn, from the same sources, that, as a general rule,
larger quantities may be given to man, without producing its
toxicological effects, than to animals; also, that it appears to
increase vascular activity much more powerfully and with
greater certainty in dogs, than in man : when swallowed by
the former, it seems almost invariably to vomit, which fact is in
direct opposition to our experience with it in man hundreds
taking from 12 to 18 grains daily, for several days in succes-
sion, without ever experiencing or complaining of the slightest
nausea.

Then, if the position be correct, that the action of quinine on
man, in small, medium and large doses, is to a considerable ex-
tent stimulant and anti-periodic, can it, we ask, on any thing
like rational principles, or with any reasonable prospect of bene-
ficial results, be given at all, in stages of excitement, unless very
clearly marked with paroxysmal remissions? We think not.
On this subject, we find ourselves sustained by the able editors
of the Southern Journal of Medicine and Pharmacy,* Messrs.
Gaillard &l De Saussure. These gentlemen, once believers in

November No. 1847.

1848.] Harris, on Quinine: 391

the necessity and perfect safety of 20 and 40 grain doses, to be
given between the paroxysms, have been induced, from some
experience worth while with the remedy, to modify the prac-
tice. They now employ much smaller doses, and always give
these during the greatest remission.

On this subject, we will here, once for all, remark, that it has
only been, in remittent fever, and after the patient had been for
several days under what we esteemed efficient, well directed
treatment, and where the remissions were clearly marked, with
an evident tendency to a solution, that we have ever derived
any very decided benefit from the remedy, and then but seldom.
Although we have, under such circumstances, but seldom suc-
ceeded in cutting short the febrile stage, we have never observ-
ed, in any thing like safe doses, its administration change the
character of the disease, or produce any other efiect than an
aggravation of all, or a greater portion of the symptoms. That
larger doses, under such circumstances, do aggravate all the
symptoms, and might possibly change the character of the dis-
ease, substituting in its stead its toxicological effects, we are not
disposed, or at present prepared, to deny ; neither are we per-
mitted to doubt that the action of the remedy is sometimes
materially modified by idiosyncracy also, by the particular
type of the disease, and season of the year ; but so far as regards
that great want of uniformity of action, we would be induced
to beUeve from the articles of different writers in our medical
periodicals, our experience has not furnished us any very well
grounded reason to complain, either as regards constitutional
peculiarity, or size of dose, with from 4 to 6 grains of an un-
adulterated ar^ic/e, repeated everyone or two hours, until 18 or
20 grains has been given, during the period of apyrexia, has,
almost invariably, in our hands, given its stimulant and anti-
periodic properties, sufficiently strong to ward off, in our au-
tumnal febrile affections, the approach of the cold stage of an
ordinary intermittent; that larger doses (10 grains, repeated
, every hour, until two or three are given) are sometimes given,
and frequently administered with safety and advantage in the
malignant intermittents of Southern latitudes, we are not dis-
posed to doubt with us it has, and still continues to be a
favorite practice, and one that we think the success of which

393 Harris, on Q,uinine. U^^'i

will withstand the severest scrutiny. No one, we apprehend,
will pretend to deny, that during the febrile stage of a large
majority of our autumnal fevers, there are evident remissions
and exacerbations', then, if quinine, as a general rule, has been
given by some in these stages with anything like its vaunted
good effects, it must have been owing to its anti-periodic and
not to its contra-stimulant qualities. We wish to be under-
stood, in the above expression, as meaning to say, that in this
character of cases, we do not think it impossible that its anti-
peinodic properties might not be displayed in such a manner as
to destroy the periodicity of the disease, and the patient suffer
no material inconvenience from its stimulating effects ; but as
yet the practice rests on too insufficient evidence to justify its
general adoption. We might here, with some propriety, urge
many other reasons against this plan of practice in the continued
type of fever one we will mention, and only one, and by no
means the least inconsiderable is the desire they beget on the
part of their advocates for the exclusive and foo indiscriminate
employment of the remedy, to the neglect of other, safer, and,
we believe, better plans of practice even granting that febrile
action can in this way be suspended, breathing the same atmos^
phere, and surrounded by the same remote causes that first
produced the disease; and the vis medicatrix naturcB being
unable to remove existing internal derangements. As soon as
the remedy ceases to act, what else but a recurrence could be
expected. We think that an organization in health that would
be unable to resist successfully deleterious impressions, would
be but badly prepared to do so, when greatly debilitated by
previous disease ; and laboring under functional derangements
of eo grave a character as we know exist in fever, and which
much experience has satisfied us are not to be removed, either
alone, or by the combined action of the powers of the system,
and this remedy we are almost certain that we have seen
more pale faces, ocdematous limbs, and dropsical effusions, the
result of this exclusive plan of tieating fever, than from nearly
all other causes combined. The question here very naturally
arises, if large doses, as is contended for by some, possess the
power of depressing the action of the heart and arteries^ from
what quantities are these effects to be expected ; arc we to look

1848.] Harris, on Quinine. 893

for them in 20 grain doses ? We answer, No ! this quantity
has been tried, and found to produce very unpleasant effects
such as raising the pulse from 78 to 105 beats in the minute,
pain in the head, and hot, dry skin. Then are they to be found
in 70 or 90 grain portions, or divided, and run up in the course
of eight or ten hours. To these quantities, again we answer in
the negative. Doses of these sizes, and under these modes of
administration, have been shown by the observations of Bald-
win and Briquet, to have produced most alarming symptoms,
and even death. Lastly : are we then, for the purpose of pro-
ducing, in the opinion of its advocates, this desirable condition,
to administer it in the doses of Dr. Bazire ? We hope not.

Refusing, then, to our opponents, all that they may desire to
claim in this particular for their harmless and powerful remedy,
by denying that there is, or probably ever will be, an ascertain-
ed dose, and mode of administration, from which contra-stimu-
lant effects may, as a general, ever be expected to follow, without
serious risk of producing some one, or all of its toxicological
eflTects, and for which, when they do make their appearance, in
the shape of intolerable pain in the head, dimness of vision,
heat and burning in the precordial region, with restlessness,
heat of surface, and greatly accelerated pulse we would advise
the immediate suspension'of the medicine, cold affusions to the
head and surface, with morphine, as the remedies in our hands
that have proved most serviceable.

Having compressed and finished our remarks, in as small a
compass as it was possible for us to do, and remain intelligible,
we leave the further consideration of the subject, for those who
seem to experience so little difficulty in relieving the system of
''bile* with remedies that do not evacuate in any sensible
manner,"

See New Orleans Medical Journal, May No. 1847. page 753.

394 iMeals, on Crude Mercury. [,^^J^y,

ARTICLE XXXI.

An Essay on the applicability of Crude Mercury to Ileus, and
its kindred affections, with Cases. By Henry H. Meals,
M. D., of Marietta, Georgia.

Notwithstanding this remedy has been occasionally used by
physicians for several centuries past, and at one time enjoyed
much popularity with the practitioners of England, it seems
now to have been almost entirely excluded from the list of
curative agents. If the author of this essay, by a simple narra-
tive of the cases in which he has successfully used Quicksilver
some of them too presenting very alarming features can induce
the profession to employ this remedy, in a class of diseases al-
ways grave and frequently fatal, his object will have been fully
accomplished.

Case I. June 16th, 1840. A girl, set. 8, had been attacked
with Remittent bilious fever six days previously : she was
treated, by the overseer of the plantation, with the usual reme-
dies, without benefit, up to date, w^hen I was called to see her.
The case presented the following symptoms : Head preterna-
naturally warm ; extremities cold ; considerable stupor; when
roused, complained of pain, upon pressure, about the umbilical
region ; pulse, small, feeble and frequent, running 120 per min-
ute; bowels constipated, no evacuation from them since the
first day of attack. Ordered fly blisters applied to the nape of
the neck, and on the legs; to be given internally, croton oil,
gtt. i. every two hours during the night.

17th. Blisters drew well; less stupor; pulse sHghtly im-
proved ; no evacuation, although croton oil gtt. x. had been
administered ; abdominal pain increased. Continue croton oil
internally, and had rubbed over the epigastric region gtt. vj;
hot poultices, etc. applied over the region of pain.

18th. No particular change ordered crude mercury 5i.
every two hours, until Ifej. was administered, or the bow^els
evacuated. Owing to an unusual number of engagements, I
was obliged to leave the administration of the mercury to the
overseer, and did not see the patient again until late on the
evening of the 19th inst. At this visit, I found her unobservant

1848.] , Meals, on Crude Mercury. 395

of surrounding objects, except when roused, when she still
complained of pain in the abdomen ; muscular prostration very-
great ; pulse, small, feeble and frequent. The overseer had
declined giving the mercury, thinking, as he declared, that she
must die. I gave immediately crude mercury !iss., which op-
erated in less than half an hour, producing, one hour thereafter,
a decided improvement in all the symptoms. Ordered at 9 p. m.
calomel grs. xv., to be followed in the morning, should it not
produce two or three free evacuations, by castor oil.

20th. Calomel operated well; stupor relieved; pulse 100;
pain in the abdomen absent, though there was some tenderness
upon pressure; appetite voracious. Ordered, sulphate quinine
grs. ij. every two hours during the day, gruel and chicken soup
occasionally ; calomel to be repeated at 9 p. m.

21st. Two bilious and consistent evacuations from the bow-
els ; muscular strength greatly increased ; pulse 90 ; appetite
good. Continue quinine during that and the following day.

23d. Patient convalescent.

Case II. August 20th. A gentleman, aBt. 35, convalescent
from a violent attack of congestive fever, in' which he was se-
verely salivated, and from which he had not wholly recovered,
consulted me, after two days free indulgence of his appetite,
for constipated bowels, attended by slight febrile symptoms.
Ordered, castor oil 5 i. at bed time, and hot mustard foot-bath.

21st., 9, a. m. No evacuation from the bowels; pulse 90;
slight pain, upon pressure, in the lower part of the bowels. Or-
dered, castor oil 5 ij. to be given immediately, enemata, contain-
ing castor oil, every hour. 9, p. m., no evacuations ; occasional
vomiting ; great restlessness ; pulse 95. Ordered, croton oil gtt.
ij. alternated with opium gr. i. every hour; enema comp. gruel
water 1 pint and comp. ext. colocynth Diss., to be repeated
twice during the night should no passage follow its previous
employment.

22d., 9, a. m. No evacuation from the bowels ; pain violent,
pulse 110 ; vomiting frequent ; great restlessness ; patient much
excited by forebodings of approaching death. Ordered, castor
oil !iss. "and spts. turpentine 3iss.; enemata to be repeated
every hour during the day. 9, p. m., no evacuation ; pulse
small, frequent and feeble ; great restlessness ; pain in the ab-

306 Meals, on Crude Mercury, [July,

domen greatly increased ; stercoraceous vomiting. Ordered,
sulph. morphine gr. ss. (in pill) every two hours, until quiet was
produced, or grs. iij. were administered ; blisters (flies) over the
region of pain ; attempted to pass a stomach tube through the
anus into tl^e bowels, with the intention oi'throwing, through the
tube, enemata into the bowel ; after passing the tube about 10
inches, I was forced to desist, from meeting with an unyielding
obstacle the enemata were however throwa up to this point.

23d., 9, a. m. No evacuation ; slept a little during the night ;
took morphine grs. iiss. ; pain greatly increased; extremely
restless; vomiting frequent ; pulse 130; blister drew well. -
Ordered, crude mercury 5iss. every hour until lb iss, had been
given : enemata continued. 9, p. m., no particular change in
the symptoms : took crude mercury tfe iss. Ordered morphine
gr. ss. every two hours until quiet or sleep was produced ; took
during the night grs. ij.

24th., 10, a. m. Bowels evacuated a few minutes previously,
in which evacuation the mercury was apparent : four passages
followed during the day, producing much improvement in the
symptoms.

25th. Slept well without opiates ; pulse 100 ; muscular pros-
tration great ; some appetite. Ordered, salicine grs. ij. every two
hours during the day ; arrow root, occasionally. Discharged
convalescent five days afterwards.

Case III. A grocer, of rather robust appearance, though
addicted to alcoholic drinks, was suddenly attacked, on the af-
ternoon of the 18th March, with the following symptoms:
Irritability of the stomach; occasional vomiting; cramp of the
abdomen and muscles of the limbs ; coldness of the extremities;
pulse, hard and strong ; tongue, loaded and rather dark ; skin,
dark-yellow ; bowels, constipated ; no evacuation during the
two preceding days. Ordered, venesection 5xvi,, calomel xx.,
opium grs. ij., to be repeated every two hours, if restlessness
and pain continue, during the night ; fomentations, over the
region of pain, of cloths squeezed out of hot vinegar and wa-
ter; sinapisms to the extremities; enema with castor oil sij.

loth, morning. Pain much increased; no evacuation; rest-
lessness increased; swelling of the abdomen, somewhat tymp-
anitic; slept a little; pulse hard and frequent; vomiting fre-

1848.] Mesih, on Crude Mercury. 397

quent. Ordered, venesection dxx., castor oil 5i., turpentine
3iss., enema with comp. ext. colocynlh 9ij., to be repeated
every two hours during the day; blister (flies) over the region
of pain. 9, p. m., no particular change : blister not drawing.
Ordered, opium grs. iiss. every two hours during the night ;
enemata continued.

20th, 9 a. m. Slept very little ; no evacuation ; muscular
prostration very great ; pulse small and frequent, 130; blister
had drawn well- Ordered, croton oil gtt. iij. every two hours,
and enemata during the day, composed of gruel water, sal. epsom
et sennae, etc. 9, p m., no improvement ; sterCoraceous vom-
iting; unable to retain either water or medicine in the stomach
10 minutes. Ordered, crude mercury 5iss. every hour until
fei. was taken, opium grs. iij. at 10 o'clock, to be repeated three
times during the night.

21st., 9, a. m. No evacuation; an aggravation of all the
S3^mptoms. Deeming it unwise to administer medicine by the
mouth, as they were immediately rejected by the stomach, I
continued only enemata, composed of comp. ext. colocynth, sal.
epsom, sennae, etc., during the day. 9, p. m., no evacuation ;
vomiting and restlessness continued. Ordered, enemata with
laudanum during the night.

22d., 9, a. m. Had an evacuation about 5, a. m. ; after
which, he slept well until a few minutes before my visit, when
he had another large and very offensive passage; pain relieved,
though abdomen very sore, unable to bear pressure ; pulse soft,
105; muscular prostration great ; some appetite. Ordered, ar-
row-root occasionally during the day ; at 9 p. m. calomel grs. x.
23d., 9, a.m. Slept well; calomel operated thre&> times;
less abdominal soreness. Ordered, ext. gentian grs. v. every
three hours, arrow-root, soup, etc.

24th., 9, a. m. Ordered, the ext. gentian to be continued for
a few days, and his bowels kept in a soluble condition by ene-
mata, if necessary, and suspended my visits.

Case IV. A lady, set. 38, was attacked, fifteen days previ-
ous to my visiting her, with the bilious fever, which though
violent at first, seemed to be gradually yielding to the judicious
treatment of her family physician. Seven days before I saw
her, her bowels became constipated, though previously they

398 Meals, on Crude Mercury, [J^'y

were easily acted upon by ordinary cathartics. The physician
in attendance, a gentleman of considerable experience and skill,
had used during the period of constipation a great number of
the ordinary cathartics, together with croton oil, freely; varied
purgative enemata, cold and warm water, infusion of tobacco,
etc., without success.

Sept. 12th. I was called in consultation: she presented the
following symptoms: countenance, anxious and expressive of
much apprehension ; extremities cold ; pulse, small and frequent ;
pain in lower part of abdomen great ; abdomen swollen and
tender ; vomiting whatever was taken into the stomach, and
occasionally bilious matter. We gave her crude mercury 5 i.
every hour until fcij. were given.

13th., 10, a. m. No improvement. Ordered, enemata du-
ring the day. 10, p. m., mercury passed with considerable
feculant matter. Case speedily recovered under the treatment
of the family physician.

Although I have used successfully crude mercury, in fifteen
cases, I deem it unnecessary to extend the limits of this essay,
by narrating them ; particularly as they present no differences
from the cases detailed, other than those which would neces-
sarily result from age, sex, condition and idiosyncrasy. Of the
eleven not narrated, seven were similar to cases 1 and 4 ; two
similar to case 3 ; and two similar to case 2. It will be appa-
rent, upon an examination of the symptoms of the foregoing
cases, that in the 1st and 4th, constipation was probably owing
to a loss of muscular power in a portion of the intestinal canal ;
in one, case 2, there was some mechanical obstruction, probably
intussusceptio ; and in one, case 3, there was primarily bilious
colic, which subsequently terminated in ileus. I am induced to
advise an adherence to the doses and intervals, which I observed
in the administration of crude mercury, because I have not, in
the few experiments made upon dogs, found it to operate much
more speedily when given in Ibss. doses, and in some condition
of the bowels, in ileus, hopeless injury might be done by throw-
ing into them larger quantities, at once, of a metal of such
gravity. It will be observed that the mean time of passing
through the alimentary canal, in the cases detailed, except case
1, which is sui-generis, is fifteen hours ; although I have known

1848.] Girardey, on Lithotomy. 390

it vary from ten to thirty hours. It is not needful to my pur-
pose, at present, to discuss the hypothesis offered by Dr. Aber-
crombie, and approved by others, that the distended part of the
bowel is the real seat of disease, but rather to draw the follow-
ing practical deductions from my experience in the employment
of crude mercury :

1st. It is a, harmless remedy, given in proper doses.

2d. It is a potent, though tardy, remedy ; requiring fifteen to
twenty hours to operate.

3d. Its passage through the canal is principally accomplished
by distension, aided, perhaps, through a portion of it, by its
own gravity.

ARTICLE XXXII.

Another Operation of Lithotomy, under the influence of Chlo-
roform, by Prof. Paul F. Eve. (Reported by Edward
Girardey, Student of Medicine, Augusta, Ga.)

On the 26th of May last, I had the pleasure of witnessing my
preceptor, Dr. Eve, perform the operation of Lithotomy, under
somewhat peculiar circumstances.

The patient is the son of Capt. P., of South Carolina, aged 5^
years. He was a seven months child, and at birth was so
feeble that little expectation was entertained that he would
survive. For months the child could be held in the palm of the
mother's hand, who, during gestation, had been extremely ill
with fever. From early infancy, difficult urination occurred.
The various domestic remedies used on such occasions having
been exhausted in the case, a physician suggested the probabili-
ty of urinary calculus.

It is proper to remark that the patient, from its very feeble
existence at birth, and long continued suffering from the pre-
sence of stone in the bladder, was only partially developed, both
physically and intellectually. He still has chorea. Indeed, ta
some extent, he may be considered deaf and dumb : with great
difficulty can he be made to comprehend ordinary conversation,
or what is passing around him.

400 N tic method of performing Cheiloplasty. [July,

Dr. Eve having detected a calculus, by a sound introduced
on the 25th, preparations were made for the operation the next
day. The patient was also subjected to the inhalation of chlo-
roform, and it acted very kindly upon him. At 10 o'clock on
the day appointed, the bi-lateral operation was performed with
Dupuytren's instrument. The stone was reached with the fin-
ger in about half a minute, but some time was consumed before
it could be secured in the forceps. It proved to be a mulberry
calculus, of an ovoidal shape, and weighed 2 drachms 4grs.

For more than an hour after the operation the little patient
could alone be quieted by chloroform. During its performance,
he evinced no sensibility, and the gratification of the parents at
this result, seemed to know no bounds.

The patient was up in a few days, not only in the room, but
out of doors. No effort was made to close the wound until the
ninth day when the urine, which had passed previously both
through the incised parts and urethra, resumed its natural
channeL

PART II. REVIEWS AND EXTRACTS.

ARTICLE XXXIII.

Nen) method of peiforming Cheiloplasty. By Dr. C. Sedillot,
Professor at Strasbourg. (Translated for this Journal by
Henry Rossignol, M. D., of Augusta, Ga.)

The anaplastic operation Is most frequently employed for the resto-
ration of lips, thau for any other purpose, and it is seldom crowned
with more success than in such cases. The elasticity of the integu-
ments of this region permits us to obtain flaps sufficient to restore the
apparently irreparable loss of substance, by suitably varying the ex-
tent and direction of the incisions and detachments.

Taliacotius has left us a description of his method, which is to
form flaps from the fore-arm, or arm, and it would, certainly, not be
very difficult to make the same use of the skin of the hand, when pro-
tracted contact with the chin would neither be very painful to the
patient, nor very difficult for the operator to maintain ; nevertheless,
the Italian method has been justly abandoned on account of its rela-
tive inferiority, and has been replaced by the more sure and efficacious
methods of the Indians and French.

1848.] Ntw method of performing Cheiloplasty, 401

Delpech, Dupuytren, M. M. Lallcmand, DiefTenbach, and Textor,
have had recourse to the Indian method, and generally witli but little
success. The integuments of the cervical region, dissected to a great
extent, to replace the whole of the inferior lip, which operation was
rendered necessary on account of the destruction which existed, be-
came gangrenous in the majority of instances ; and when this accident
does not occur, the flap, incessantly drawn down towards its pedicle
by the double efl!et of its weight and contractility, abandons by de-
grees the level of the teeth, applies itself to the denuded part of the
maxilla, and does not even serve to retain the saliva.

The French method, Avhich would, as I have remarked in my Trea-
tise on Operative Medicine, be more properly demonstrated the method
ofCelsus, or the ancient method, is in all cases much to be preferred,
whether the integuments of the neck be dissected to cover the chin
and reform the lip, as did Chopart, M. M. Roux, (of Saint- Maximin,)
Morgan, Serre, (of Montpelier,) etc., or whether the integuments of
the cheeks be separated on either side and made to approach the medi-
an line, to be united by a few sutures.

These methods are of easy execution when only a part of the lip
has been destroyed. The examples of success are innumerable, and
there is a great advantage in using the cheeks to reform the lip, inas-
much as the flaps are lined With a mucous membrane. Success fol-
lows also where the whole of the lip has been destroyed; but if the
disease, after having been healed several times by caustic or the bis-
toury, has returned, and not only the lip, but a part of the cheeks, have
become affected and ulcerated, the French method offers but little
success.

The elasticity of the skin, however considerable it may be, is nev-
ertheless limited^ and when the sutures are too tightly drawn, the
integuments inflame, tear loose, and do not unite, the loss of substance
is not repaired, and a deformity, more or less hideous, still persists.

It is in vain to try secondary incisions, the operation fails completely,
and aggravates the condition of the patients, or yields lamentable re-
sults*

The conditions necessary for success in anaplastic operations are :

1st. To have flaps susceptible of repairing the loss of substance,
and of being placed in contact, and retained so, without impeding the
circulationf and without danger of gangrene. Thus, and only thus,
the deformity is not paliated for the moment only, but it disappears for-
ever, because the flaps remain perfect and cicatrization goes on rapidly
and regularly.

26

402 New method of performing Cheiloplasiy. [July,

2d. It is necessary that the anaplastic flaps be sufficiently support-
ed in the position given them, and for this it is indispensable that their
pedicle be not on the side opposed to the free and unresisting edges
desired to be restored, such as the edges of the lips or of the eye-lids.

It is, indeed, beyond doubt and experience confirms it daily, that the
integuments serving anaplastic purposes tend incessantly to retract in
proportion to the remoteness from their attachment or pedicle, where
they are less supported, and it appears to us incontestible, notwith-
standing all assertions to the contrary, that a quadrilateral flap length-
ened from above downwards, detached from the cheek to which it
adheres by its inferior extremity only, and turned up of a piece on the
inferior eye-lid which it is to reform, will infallibly drag the latter
down, on account of the absence of all resistance capable of supporting
the slow and constant retraction just mentioned. It is the same when
the integuments are detached from beneath the chin and simply
brought up to replace the inferior lip. The flap thus formed will de-
scend gradually towards its point of origin, that is, from above down-
wards, not being at all supported in a contrary direction, since the
superior border is to remain free and without adherence, to reconsti-
tute the free border of the lip. Hence the important rule in anaplastic
operations, of placing the fixed points of the flaps in an opposite direc-
tion to that in which their own weight would tend to draw them. Thus
for the inferior lip, the origin or pedicle of the flap should be situated
above, or at least on a level with the free border of the organ. An
important peculiarity which has been neglected pretty often even by
surgeons who believed that they had made considerable progress in
this branch of our art.

3d. A third rule, particularly applicable to Cheiloplasty, seems
worthy to be set forth. It is essential, as Delpech and M. Diefienbach
so well understood, and as M. Serre (of Montpelier) so clearly demon-
strated, that the new lip should be lined with a mucous membrane.
All bleeding surfaces, placed in front of the dental arch, will adhere
to the wound made in front of the maxilla if not suiHciently supported,
and will cause all hopes of obtaining a free and moveable lip to vanish.
Delpech tried to double the flap upon itself, so as to form thus a mucous
membrane by. transformation, and this idea seems to us quite ingen-
ious, and one from which all the advantage has not been derived that
might be expected.

Professor Serre (of Montpelier) has insisted upon preserving the
mucous membrane in all cases whenever it is healthy. It is an advice
which no one will think of overlooking, and it is not presumable that

1848.] New method of performing Cheiloplasty . 403

a surgeon, with a little experience or instruction, would ever be dis-
posed to sacrifice, without motive and against all reason, such ftn
important membrane. There fore< if the mucous membrane has been
destroyed, we must try to replace it by the skin,- as advised by Delpech,
and success seems certain, if we can prevent mortification of the flap,
and give the pedicle or point of origin a higher level than its free bor-
der, which condi|ions may be easily attained by my new method. If,
on the other hand, the mucous membrane exist, care should be taken
to make use of it.

It has sometimes happened, and an example rriay be seen in the
work ofM. Serre (of Montpelier), that a large portion of the skin of
either cheek has been detached, and united on the median line in front
ofthe mucous membrane. The success of this method is easily under-
stood, and we are far from denying it; but we will remark, that in all
cases in which the integuments are thus applied upon moving tissues,
these will fold and pucker at the junction ofthe flaps, interposing them-
selves between their edges, and thus be a great obstacle to union and
final cicatrization* This truth may be verified in all cases where
Vicious cicatrices are excised. If care is not taken to remcTve the sub-
jacent fatty tissue it will pout out between the edges of the wourtd,
because it is forcibly drawn in this directioft by the approximation of
said edges.

The same phenomena occur in the riiode of Cheiloplasty^ which 1
notice. The flaps draw with them the tissues with which they afe
lined, and the preserved mucous membrane becomes folded, and swell-
ing out towards the point of union, becomes an obstacle to the speedy
formation oi a cicatrix. It would therefore be manifestly more ad-
vantageous to apply free flaps upon the undisturbed mucous membraine,
which would unite without either tension, fofce or violence, and which
would have sufficient amplitude to extend oVer and preserve all the
mucous membrane, instead of tending to fold it upon itself.

The follo^ving case will enable us to judge more easily ofthe valu8
of these precepts, and will render the advantages of my new mode
more clear:

Cancerous Ulcer ofthe whole of the inferior lip and of a portion ofthe
chin and cheeks ; ablation and Cheiloplasty by a new method of
Pfofessof Sedillot. (Indian method by double flapsf.) Cd9e drawn
up by M. Schelsbach, house-siirgeon.

Case. Velon (John Nicholas), born at Devillez, near Epina!,
farmer, aged 46 years, admitted to the Surgical Clinique of Strasbourg
as a paying patient, on the l2th April, 1847. This man, of a strong

404 New method of performing Cheiloplasty. [July,

constitution and sanguine temperament, is exempt from hereditary dis-
eases, does not smoke, and had always enjoyed excellent health, when
about twenty-one months since, he perceived, without known cause,
in the middle of the free border of the inferior lip, a transparent vesicle,
which ruptured and formed an ulcer.

At first, this slight lesion was not at all painful, and did not alarm
the patient, who felt only a slight itching about the part; but at the
end of five months the ulcer enlarged and became the seat of sharp
and lancinating pains ; the saliva escaped involuntarily from the
mouth, because of the loss of substance already sustained, and Velon
placed himself in the hands of barbers and shepherds who promised to
cure him.

The principal treatment consisted in applications of caustics, which
were repeated more then thirty times during the first year. There
was at first an eflbrt at cicatrization ; but the ulcer very soon re-opened
and made new progress. In vain did the patient invoke the assistance
of a physician and take alteratives, the disease became worse each
day, and Velon determed to put himself under the care of Prof. Sediliot.
The patient, on his admission at the Clinique, has his face injected.
All the free border of the inferior lip from one commissure to the
other, a small portion of the cheeks, and the projection of the chin, had
been destroyed by the ulcer. Two scars about the size of a dime,
produced by the last cauterizations, exist at the angles of the mouth.
The mucous membrane is nearly untouched throughout, and only a
little excoriated on the border of the lip. This membrane is turned
outwards. The teeth, covered with tartar, remain uncovered, and the
saliva drips continually and involuntarily on the clothes of the patient.
The tissues surrounding the ulcer are slightly swelled; but are not
painful. The sub-maxillary glands are not engorged. The patient
feels a heaviness of the head, vertigo, buzzing of the ears, and puffs of
heat in the face. His sleep is agi'ated. Nothing abnormal in the
respiratory and digestive functions ; there is a slight tendency to con-
stipation.

M. Sediliot having made a microscopical examination of some of
the particles of the ulcerated surface, did not recognize the distinctive
characteristics of cancer, and pronounced it a cancerord affection.

The treatment consisted for the first few days of general blood-
letting, cathartics, narcotic, emollient fomentations and vegetable
regimen.

Atler this, a few cauterizations were tried with nitrate of mercury
(azotate acide de marcure), solidified paste of Vienna (pit de Vienne

1848.] New method of performing Cheiloplasty. 405

solidifiee), and the arsenical paste of Rousselot (pate arsenicale de
Rousselot), but without advantage.

The wound made in venesection having inflamed, and the com-
mencement of a suppurating phlebitis being perceived, 15 leeches,
poultices, arm baths, embrocations of lard, slight laxatives and absti-
nence caused the disease to disaippear.

May 6. The condition of the patient being good, and the ulcer
continuing to enlarge, M. Sedillot decided upon the removal of it, and
to supply the loss of the lip by a new mode of anaplasty.

After having etherized the patient sufficiently to allow him to oper-
ate before he awoke, M. Sedillot circumscribed the ulcer by two ver-
tical incisions, having their points of departure at a short distance
from, and above the commissures, and united them by a transverse
incision passing over the projection of the chin.

The flap thus made was dissected away, and the mucous membrane
preserved. A large quadrilateral wound remained, produced by the
ablation of diseased tissues.

M. Sedillot then proceeded to the reparation of the lip.

An incision, commenced at the height of the border of the lip, about
a finger's breadth on the outside of the loss of substance, descended
vertically to the left upon a portion of the cheek, then upon the maxil-
la, and then extended two centimetres in the supra-hyoidean region.

A second incision commenced lower down, and more internally,
from the angle of the first wound, resulting from the ablation of the
ulcer, was also extended vertically and united to the lower end of the
preceding by a transe verse section.

The cutaneous flap thus formed was immeniately detached from be-
low upwards.

The same process was repeated on the right side, and M. Sedillot
thus obtained two lateral flaps, which he raised and turned mwards
towards each other, taking care that they might meet on the median
line.

M. Sedillot having ascertained that the loss of substance could be
regularly filled by the process, first united, with pins, the two vertical
borders of the wound, produced by the removal of the flaps. They
were now united to each other on the median line, then to the chin
inferiorly, and to the preserved portion of the mucous membrane supe-
riorly. All these last sutures were made by whip-stitch, .with an
ordinary needle. and very fine thread.

The dental arch was by this means entirely recovered and the sali-
va retained.

406 New method of performing Cheiloplasty. [July,

The dressing consisted of a little bag, filled with ice, placed in con-
tact with the wounds, and retained by a common chin bandage.

A kind of bib, made of oiled-silk, whose inferior border was folded
upon itself in the form of a gutter, and inclined towards a vessel, pre-
served the cloths and bed of the patient from moisture.

Velon, Oil returning to consciousness, appeared much surprised to
find that he had bee^ operated upon ; but on looking at himself in a
glass, he wept, alleging that the roots of the disease had not been taken
away, and that not only th lip, hut the greater part of the integuments
of the cheeks and cervical region ought to have been removed.

M. Sediilot, who had until now, appeared to adopt the ideas of the
patient concerning these pretended roots, caused long filaments to be
separated from atendo-Achillis which he presented to Velon, assuring
him that they had been drawn from the wound during his sleep. The
patien^t was thus appeased and regained confidence. Cephalalgia
during a few hours after the operation ; pretty abundant hemorrhage
below the left flap ; quiet night, sleep. The next day no headache;
physipgnonny calm; skin moist; puise 74; no thirst; no appetite.
The left flap seems a little raised by clots of blood, and is slightly
etretched and reddish.

May 9. The right flap is entirely united, but the left adiieres but
little ; it suppurates, and has at its free extremity a point of mortifica-
tiQn a few miliimitres in extent. The pus is gently pressed from
yncjer the flap, and the parts fomented with aromatic wiue.

May 11. The threads of the sutures are cut, and many of them
drawn out, as wejl as the pins ; the use of ice is discontinued, and the
suppurating flap supported by bands of adhesive plaster.

May 12, 13, 14, 15. Excellent health. The mortified extremity
of the left flap taken ofi', and secondary union by the first intention
(reunion in^mediate secoiidaire) is tried, but in vain, notwithstanding
the great laxity of the flaps, Tliese, although perfectly alive and tho
seat of an active circulation, have lost all sensibility, and may be
transfixed by a pin without giving the least pain,

May 16, IT, 18, 19, 20, 21. Tiie pins witli which the secondary
union by the first intention (r6union immediate secondaire) was tried,
iiavc torn the tissues without producing adhesion, a transverse double-
headed roller bandage is not more successful, and the extremities of
the flaps uniting by their inferior border ojily, have left a slight dcr
pression between them superiorly.

May 20. The cicatrization is complete, and on tiie 28th the patient
left the hospital. The depression was scarcely perceptible. The two

1848.] New method of performing Cheilop last y. 407

lips meet very well. The alveolo-labial gutter being re-established,
prevents the involuntary flow of saliva. The preserved mucous
membrane, lined the internal face and superior border ef the new lip,
the commissures remaining only a little puckered. M. Sedillot pro-
posed to remedy this by the ablation of a few of the folds; but as the
patient was satisfied with the cure thus far, and as he was very anx-
ious to return home, M. Sedillot did not insist upon the advantages of
a more perfect restoration, which nature would naturally accomplish.

This prognosis of M. Sedillot was rapidly realized. The patient
returned to Strasbourg in July and at the end of August. The cica-
trix had remained perfect, and the new lip as well as the commissures
had become more supple, thiner and consequently more regular. The
teeth were entirely hidden, and notwithstanding the cicatrices, one
would with difficulty have suspected the nature and gravity of the
operation he had undergone.

The Indian method of double flaps, of which the description has just
been given, and whose results may have been appreciated, appears to
oflTer the most favorable conditions of success in a great number of
anaplastic reparations.

1st. The flaps have a great degree of vitality, because of their
shortness, the width of their base, and the feeble degree of lortion of
the pedicle.

2d. We may thus undertake to restore by anaplasty, either the
whole of the lip, the face, or any other part, with greatly increased
chaqCies of success, since the principal danger, which consists in the
mortification of the flaps, is avoided with almost entire certainty.

3d. The tissues employed in forming the new lip are not submitted
to any traction, and it is easy to give them sufficient amplitude to pre.
vent all future unpleasant retraction,

4th. The new lip being supported near the eornniissures by the
pedicles of the two flaps which constitute it, and which are continu*
ous with the cheeks, is drawn up in the direction of its free border,
a very great advantage to which sufficient attention had not until now
been paid. Suppose the base of the flap was below the border of the
lip, this would infallibly be drawn down, and would eventually leave
the dental arch exposed, g,s has been observed in the primitive me-
thods, or those modified by Chopart.

5th. The perfect vitality of the flaps augmented by the width of
their base, in the case where the reparation is considerable, would
permit us to realize successfully the ingenious idea of Delpech, and to
double the skin upon itself to replace the mucous membrane. This

4U6 Treatment of Fever by Cold Water. [July,

result would be obtained, however, spontaneously by the simple pre-
caution of notching from above downwards, on a level with the labial
conimi:j.'?urc, the free border of the flap destined to represent tlie con-
tour of the lip ; the latter would turn inwards by the cicatrization.

6th. The loss of substance produced by the dissection and turning
up of the flaps is inclined to unite readily by the first intention, in the
cervical region w^here the integuments, besides their extreme laxity,
rest upon compressible planes, this does not exist upon the maxilla
whose osseous formation is fixed and immovable.

7th. Another advantage is, that the subjacent mucous membrane is
not puckered in the case where this membrane might be preserved;
this is a favorable condition of the Indian mode, and we will add the
perfect integrity of the flaps which being taken from a region more or
lessdistant from the seatof afl'ection, lessens the probability of a return
of the primitive disease.

Our method appears to us to be much superior to the French in
similar cases to the one we have mentioned, and believe it may re-
ceive numerous and injpprtapt applications.

On the Treatment of Fever by Cold Water. By William
Gill, M.D., Physician to the Nottingham Dispensatory, &c.

(Ilanking's Abstract.)

Before entering more immediately on the object of this paper,
the author describes concisely the general features of the pre-
valent fever. In most cases the immediate cause of the attack
was traceable to sleeping in crowded lodging-houses, the usual
abode of fever in large cities; the proximate causes, doubtless,
were over-fatigue, and insufficient and unwholesome food.
The term " hunger pestilence" has been aptly applied to the
disease. A true ty})hoi4 gastro-enterite was present in many of
the patients, closely resemblini? what so frequently is observed
in the Parisian hospitals. Whether the essentiality of the
fever existed in the condition of the muco-alimentary membrane
or not, it was not the author's intcntiori to discuss. This,
however, he remarked, that 50 soon as the signs ofgastro-
alimentary irritation were subdued, the siii^ns of general fever
subsided. Some two or three cases, which ho read, corroborate
this of)servatibn. In the generality of patients under his care,
not only was the gastro-alimentaiy membrane affected, but
also the muco-pulmonary, fts evidenced by cough, shortness of
respiration, and frcqently universal sonorous rales, aftecting the

1848.] Treatment of Fever by Cold Water. 409

whole of the chest. In most of the Irisli sick, the skin was
spotted with petechia?, of different sizes and colors, chiefly de-
veloped on the abdomen and chest. This was not remarked
amoncrst the Enf^lish cases. Tliere w^as no discharfre of blood
from the inner membranes. CEdema of the lower extremities
occurring early in the disease was generally a fatal symptom,
thoufjh we had two cases of recovery in boys, who were
universally anasarcous from the commencement. The distur-
bance of the sensorium was marked by low muttering delirium,
sometimes wandering about the bedroom, constant picking at
the bed-clothes, and subsultus tendinum. Some w^re affected
with a heavy, comatose, and stupid state, from which they
were wqth difficulty aroused, and when aroused, with difficulty
were made to understand questions ; they relapsed immediately
into the same lethargic condition when left to themselves.
This comatose condition often continued till convalescence
was established, and in some even later. It seemed a perfect
prostration of all mental energy, and was only relieved as the
bodily powers regained their tone. In no one case did active
delirium occur. The secretions from the bowels were thin,
frequent, black, and offensive, and often attended with severe
griping, but ud bloody discharges. The function of the blad-
der in one or two individuals was suspended and it was neces-
sary twice daily to use the catheter. The usual period of the
termination of the fever seemed to be from the eighteenth to
the twenty-first day, at which time the patients were left in a
state of the greatest prostration. When the case terminated
fatally, an unrousable, unconscious coma closed the scene.
The usual symptoms of fever were generally present, as the
hot dry skin, black tongue, urgent thirst, pulse varying from 90
to 130, insomnia, and pains in head, back, and limbs, &c.
After this brief description of the general features of the disease,
he proceeds to the treatment.

He remarks that he is well aware that a great prejudice ex-
ists in the profession against the treatment to be advocated,
partly because it is opposed to preconceived opinions, and chief-
ly from the unprofessional manner in which it has been ushered
into notice. Feeling certain, however that h.e was adressing a
body of gentlemen willing to receive truth for the sake of itself,
he with perfect confidence, detailed a treatment of fever as yet
untaught in the schools, and generally unrecognized by the pro-
fession.

Dr. Currie, of Liverpool, was the first scientific English phy-
sician, who enlisted cold water as an external remedial agent in
the treatment of fevers. Successful as the practice was ujider
his direction, it has bee.n little followed ip later times. It is

410 Treatwent of Fever by Cold Water. [July,

only within the last few vears that the prejudice which existed
against the internal and external use of water has begun to
subside. "Perhaps," observes the author, "the prominence of
the sanatary questions, and the many evils proved to arise from
the want of a due supply of pure water, has had much to do in
removing this groundless prejudice, and may have produced an
undue reaction in its favour, causing it to be considered not only
as necessary to a healthy condition, but as a curative agent of
universal efficacy. Hence, perhaps, the public mind has been
somewhat prepared to receive the hydropathic theory with
much more favour than its intrinsic merits demand. An
universal remedy w-ill ever find many advocates, and in a nu-
merous profession like ours, there are ever men to be found who,
from selfish motives,^ will pander to this diseased taste of the
public mind. We, as an association, must ever protest agamst
such exclusive theories as prevail in our days, beinj]: in our
opinion unscientific, opposed to experience, and calculated to
lead to incorrect views respecting; the power of many known
and valued medicinal agents. In making this protest against
any exclusive theory for the cure of diseases, we must not
rush into the opposite extreme, and, from disbelief of their
universal efficacy, deny their particular efficacy, when the
touch-stone of experience speaks to the contrary."

The plan the author has adopted for the cure of fever, has
been a modification of Dr. Currie's. Instead of pouring buck-
ets of cold water over the body, he has it enveloped in a wetted
sheet, an instrument more effective than Currie's in reducing
the temperature of the body, and producing a warm and com-
fortable perspiration, which did not uniformly follow his plan.
The fear of evil consequences from this treatment is ground-
less. He gives no opinion as to its utility, except in cases of
fever. Here, however, he states that he can speak wMth con-
fidence. When the skin is burning hot, and the mouth and
tongue parched, the application of a sheet wrung out of cold
water, and applied closely to the whole surface of the body, and
evaporation prevented by the application of three or four
blankets placed over it, produces a most grateful feeling of
refreshment, which is soon followed by a more or less warm
perspiration. In young people, this perspiration breaks out in
from five to ten minutes after its api)lication ; in middle-aged
people the period is longer. Many uncomfortable sensations
are soon relieved by its use; such as the muscular pains in the
back, thighs and legs, and the sense of aching and weariness;
the thirst often becomes less, and even the dry tongue sympa-
thises with the relaxing influence induced on the cutaneous
surface. He has seen the low moaning delirium subside whilst

1848.] Treatment of Fever hy Cold Water. 411

under its use ; and some patients, who have not slept before,
doze, especially if the hair has previously been cut short, and a
flannel nightcap, wetted with vinegar and water, been applied
to the head.

The simple plan he has followed has been this : On a flock-
bed he has placed from three to five blankets, superimposed
over these, a sheet wrung out of cold water, on which the pa-
tient, stripped, is placed, with legs outstretched, and arms to the
side ; the sheet is then drawn tightly around, up to the neck,
and inclosing the feet ; first, one blanket, then another, and so
on to the w^hole number, are tightly drawn over the sheet, so
as to have the whole body well arid closely packed. In this state,
the patient lies from a quarter of an hour to one or two hours,
according to the object in view, and the effect produced. Some
get tired at the end of half an hour, some can continue for one
or tw^o hours, and feel very comfortahle. As soon as a gentle
perspiration commences, a wineglassful of water is given
frequently. At the commencement of this treatment, in a case
of fever, he has generaly ordered its use for one hour; after
that time the w^et things are removed, and the sick person is
placed in a bed, well wrapped in three blankets, and allowed to
perspire for three hours ; afterwards, the blankets are to be
carefully removed, one at a time, so as to allow the perspira-
tion to subside gradually, and the patient is then placed in bed,
between the sheets.

During the whole of this period, small quantities of water
should be given. In the summer, during this process, a free
ventilation may be allowed in the chamber, in winter it is neces-
sary to have a good fire, and to have one blanket well warmed,
to apply around the body, so soon as removed from the wet
sheet.

Several cases of incipient fever have lost all traces of disease
after the first application. If the fever be not reduced, the
next day the same plan must be repeated, keeping the patient
in the wetted sheet from half an hour to one hour, according to
the intensity of the symptoms, and in the blankets from one to
two hours. This may be repeated every day till indications of
a cool skin arise, then it must be immediately discontinued.

During some period of this treatment the temperature of the
atmosphere being very high, (75^ to 78 in shade,) the author
has not found it advisable to keep the patient as long as two
hours sweating in the blankets ; from half an hour to one hour
w^as sufficient. A longer period caused the pulse to be accel-
erated instead of lowered, which latter is the usual effect of the
treatment. In very hot weather, when a free perspiration has
been induced at the Gommencernent of the fever, he has adopted

41'i Treatment of Fever hy Culd Water, [J^l/

the following: ])]an. To wra]) the sick person for half an hour
in the wet slieet, covered lightly with one blanket; to be then
washed all over with a towel wetted with te])id water, then rub-
bed dry. and placed in bed between the sheets. He has not
found it necessary to make useof tliis treatment more than five
times to the same individual ; generally, after the third or fourth
application, the skin becomes cooler, and the other signs of
fever gradually subside. When the skin becomes cool, and the
tongue less dry. he has instantly discontinued all water remedies,
and given bark, wine and broths, and it was surprising how
soon convalescence and strength became established. During
the whole course of the fever, milk and water, or weak broths,
were allowed ad libitum. In one person, twice in the course
of the same day, owing to the intensity of the fever, it was
found necessary to repeat the wet sheet, using it the second
time for only half the period of the first ; comfortable night
ensued.

Without doubt, this is a most effective mode of quicJdi/ re^
ducing the temperature of the body; an equilibrium is soon
established between the cold of the water and the heat of the
body, and the patient becomes bathed in a natural vapor-bath,
as maybe felt by placing the hand under the bedclothes. Where
the fever runs high, and the delirium is violent, the wet sheet
may be safely applied for short periods, (two minutes,) several
times in the course of the day. This will be found a more
effectual mode of reducing the cerebral excitement, than any
other means with which we are acquainted. This refrigerating
plan, used for ten minutes, during an evening exacerbation, will
often produce a few hours' refreshing sleep.

The author confesses that he had, at first, great doubts as to
the safety of this treatment, where the mucous membranes of
the bronchi and gastro-alimentary passages were complicated.
Very soon his fears on this head were dissipated by the con-
vincing evidence of experience; in fact, these ])roved the cases
in which the decided benefit of the treatment was most marked.
The quick and embarrassed respiration, dry cough, and sonor-
ous rales, subsided quickly after one or two applications of the
wet sheet; the cough became looser, the rales moister, and ex-
pectoration was established.

The same happy change also occurred where the gastro-
alimentary membranes were disordered. Generally, the first
wet sheet puts a stop to the diarrhoea, and soon alterwards, pain
and swelling disappeared. A confined state of the bowels was
frequentlv the efl'cct of the wet sheet: and it was found necessa-
ry, in several of the patients, to resort to small doses of castor
oil. In three or four cases, the symptoms of gastric and ab-

1848.] Source and Injiuence of Malaria. 413

dominal irritation or inflammation were so violent as to have
justified the employment of leeches, calomel, and opium ; and,
indeed, we know that depletion by leeches is the usual treatment
followed in the Parisian hospitals, and yet by the simple means
mentioned, in three days every bad symptom had vanished. A
great saving is made to the patient's strength, when we can dis-
pense with the abstraction of blood.

On the Source and Influence of Malaria in the South-west.
By Dr. A. G. Lavvtox, of Marshall, Missouri.* (New York
Journal of Medicine.)

What I conceive to be the most prolific source of malaria is,
animal matter in minute fragments, mingled with vegetable mat-
ter in a process of slow decay. Where wash- water is being
constantly thrown out, around houses, in by and shady places,
amongst rubbish, where old bones and vegetable matter are left
to rot by slow degrees, it cannot fail, after a long time, to give
rise to, or produce a pestilential effluvia, especially in very dry
seasons; for it is generally the case that wash- water contains
more or less animal matter, and that, too, of a kind favorable
for the ajeneration of miasmatic exhalations.

It will be found generally the case, that the sickly season
does not commence until the thermometer falls a little from its
extreme point, and the sky assumes that peculiar veiled ap-
pearance that it has in the latter part of the summer, and the
autumnal months, or in very dry times. The fore part of the
season is the healthiest part of the year, for the heavy rains and
storms of the spring have swept all noxious matter from the air,
and left it rightly and equally tempered. It generally happens,
that as the drought increases the dews lessen, until the healthful
moisture of the air is gone. Now, at this time, the intensity of
the sun's rays is on the wane, for this occurs in the latter part
of summer and fall, and the hottest days of the year are in the last
of June and the fore part of July, and the most sickly time is in
September, and sometimes in October.

When the dews begin to lessen a little, the sky assumes a
dark or red appearance, and the sun's rays are a little blunted,
as though its rays were in some way obstructed ; until now the
evaporation from the earth's surface is not very poisonous, but
now the evaporation from all the high lands, and drier part of
the country, is very tx'ifling, and daily lessens; and now the
drought increases. At this time the water is mostly gone from

* Tn 3d vol. we published an article from Dr, L., taken also from the New
York Journal. Mississippi was put for Mi&souT\.'-{Edt. S. M. ^ S. Jour.

414 Source and Injluence of Malaria. [July,

the earth's surfiice ; the ground parched by drought ; the atmos-
phere ah-eady deprived of all healthy sources, whereby it might
be supplied with moisture, at the very time when there is the
greatest necessity for it ; and this lack of humidity in the air
must be supplied from some source, and this vacancy is soon
filled up by an increased and rapid evaporation, from the half
dried swamps, stagnant pools, sinks, gutters, sewers, and from
the banks and bottoms of streams, where the water has fallen
and left the mud exposed; from these sources the moisture of
the air is still maintained, and the atmosphere is still humid.

But now the equilibrium of the air is partially destroyed, it
being over-dry in some places, and excessively humid in others ;
for this humidity is not like the humidity which comes from
clouds and storms of rain, which in itself is harmless, but it is a
humidity formed of noxious vapors, constantly springing from
decomposing matter ; which, being either chemically united or
mechanically mixed with some elementary principle evolved
from decomposing matter, is thereby rendered much heavier
than humidity from other sources, and becomes incapable of
rising very high in' the air, unless it is forced up by some fixed
current ofwdnd; and thus it happens that, under these circum-
stances, the atmosphere becomes unequally tempered. And
now the moisture of the earth is so far exhausted on all the up-
lands, that it cannot afford much material for evaporation, and
this process is of necessity limited to a small surface, that is,
from swamps, marshes, ponds, streams, etc., from which places
evaporation is very much increased, and the vapors rise in
denser volumes, bringing up the poisonous exhalations from
these places, where Vegetation, flies and reptiles, have fallen
and rotted for ages ; where the matter, after being long steeped,
is every year dried down, in the latter part of which process
there is formed, and evolved from this mass, by the action or
re-action of decomposing elements on themselves, a something
which we call malaria, long knoWnbyits effect, being followed
by a certain train of diseases peculiar to themselves, and known
to be produced by no other morbific effect.

Now, under these circumstances, should the wind be low,
which is generally the case, sometimes a dead calm prevails, or
the wind sets lightly from an eastern direction, blowing with a
current just strong enough to move the poisonous vapor from
its resting place, and spread it over the country; and should this
state of things exist long, and progress to an intense degree, a
sickly time must inevitably follow; and when this state of things
does progress to an intense degree, it is generally brought to
bear most severely on the community in the autumnal months,
increasing as the cold season approaches, or until some violent

1848.] Source a7id Injluence of Malaria. 415

storm or frost occurs; when the reverse of this happens, the
sickness of the season is very much modified, assuming less of
an epidemic character. r

I am convinced, from experiments and observations, that
w^ood is capable of generating an immense amount of this
poison; decomposition of the ligneous fibre is slow, and where
it is long exposed to wet and dry, as in marshes, pools, and
about houses, for many years, I believe it Avill produce a pesti-
lential effluvia. If pools of water, standing in the blue clay on
these prairies, have nothing of the wood kind in them, the wea-
ther being very dry and hot, so the water does not move in or
out of these pools, in two or three months the water becomes
perfectly sweet and clear, and if it is not agitated from the bot-
tom, it may be drunk or used with impunity ; but if these pools
contain logs, chips, brush, leaves, or wood of any kind, that is,
old and in a decaying state, then the water never becomes either
sweet or clear, but assumes a dark color, and the drier the wea-
ther, the blacker it gets, when it becomes an active and certain
poison, producing on the human constitution sudden and alarm-
ing effects, accompanied with excessive vomiting and purging,
extreme prostration and death. And how much sickness there
is produced by drinking water impregnated with this poison, is
difficult to say, as water holds it in solution in every degree,
from the minutest quantity, which would require years to affect
the constitution, up to a degree of concentration sufficient to
destroy life in a few hours.

The Indians suffer less from these causes than the whites, and
the reason is obvious ; they seldom live long in a place, con-
stantly moving from one place to another, and often burn their
tents, and erect new ones, and a fire is kept constantly burn-
ing in the centre of the tent, around which they sleep ; they do
not live long enough in a place for the accumulation of filth to
become an effectual source of disease.

Although these countries, as a general thing, are not subject
to extreme atmospheric vicissitudes, yet it sometimes happens
that we have inflammatory diseases in the cold half of the year,
as inflammation of the lungs, pleura, and the like; and although
they occur at a season of the year when the air is free from all
noxious exhalations, yet they generally assume that grade and
type which is common to malarial fevers, and they generally
fall most intensely on those living nearest the focus of miasmal
emanations ; hence I count them as malarial ; and taking this
view of the subject, I have long since concluded to bleed less
and give quinine more, and with this treatment I have been
much more fortunate than when I used the lancet.

But antimony is our main reliance in these cases. Tart.

416 Abdominal Tktmor mistaken for Pregnancy. [July,

antimony, judiciously administered, will seldom disappoint the
physician's expectations. As soon as the pulse falls, and the
expectoration becomes a little modified, I add quinine to the
antimonial powders; and when the antimony is no longer indi-
cated, I continue the quinine, combined with ipecac, and
sometimes Dover's powder. (My Dover's powder is made
with the nitrate of potassa in placo of the sulphate.)

I have only one thing more to add at this time, and that is,
with respect to the use of quinine, combined as described in
my former paper. (South. Med. and Surg. Journ.,vol. 3, p. 159.)
Make a powder of quinine, camphor and pulvis Doveri, then the
powder will contain quinine, nitre, opium, ipecac, and camphor;
now, if you increase the ipecacuanha a little, you will have a
better powder for winter fevers, for ipecac increases the eflect
of quinine very much, especially in fevers that verge towards
the continued type. I look upon opium and camphor as import-
ant additions to quinine, unless contra-indicated, and we seldom
meet with a case where nitre is not admissible. ' In treating
fevers, there are many indications to be fulfilled, some of which
quinine alone would not effectually meet/ Quinine sometimes
operates too locally, and the addition of camphor gives it a
more general searching eflect ; and if the effect should not be
increased, I believe it is more effectual by be^'ng more particu-
larly directed to certain indications to be.fulfilled, which is just
what we should be led to expect from a priori reasoning ; and
in addition to all this, it sometimes becomes necessary to add a
more potent and diffusible stimulant, as brandy.

Ahdominal Tumor mistaken for Pregnancy. By John Chal-
LicE, Esq. '(London Lancet.)

[The following case is one of great practical value, and dis-
plays forcibly the great difficulty which surrounds the diagnosis
of pregnancy. It would, perhaps be difficult to meet with an
instance affording stronger circumstantial evidence. of that con-
dition.]

Mr. Challice received an urgent message to visit a 5^oung
lady, said to be laboring under cholera, but from hints received
from the maid-servant he was induced to suspect the possibility
of pregnancy.

When he arrived he saw a yoimg female in bed, lying on her
ri.G^ht side, with her face buried in the pillow, and the knees
drawn up towards the abdomen. She seemed to be in pain,
but was sullen, and refused to answer any questions. The

1848.] Ahdojuinal Tumor 7Jiistaken for Pregnancy. 417

mother stated that she had been vomiting, and complaining of
pains in the loins, with a constant desire to pass water, and that
for the last five or six months she had observed a change in her
daughter the appetite capricious, temper irritable, and on
several occasions she had been surprised in tears ; notwith-
standing, she denied being ill, and continued to perform her
domestic duties. These facts seemed confirmatory of the ser-
vant's suspicions, and with almost a conviction in his mind of
the condition of the girl, the author placed his hand upon the
abdomen; it was tense and sw^ollen, and a movement like that
of a living foetus was distinctly felt; he then listened and de-
tected a loud and quick pulsation.

The presence of these symptoms induced him to pronounce
the patient pregnant. No suspicion had entered the mother's
mind ; she was an only dauorhter, and bore' an excellent charac-
ter. However, she did not deny the fact, but after a distressing
burst of grief, and a pitiable appeal for forgiveness, she con-
fessed that her cousin had had connection with her once, and
only once, about six months before, a few days previous to his
departure from England. Being unwilling to aggravate her
sufferings by what appeared unnecessary enquiries, or disturb
the patient by further and more careful examination, consider-
ing the case quite decisive, Mr. ChalHce contented himself with
prescribing some simple remedy for relieving the sickness and
pain. The next day there was a great improvement in the
condition of the patient ; the fear of discovery no longer agita-
ted her, and she had been forgiven. Up to this period she had
so contrived to compress her figure, that no increase in her
bulk was perceptible wiien dressed, although her size was quite
that of the six months of gestation when undressed. Nov7 that
this cruel mental and physical restraint no longer tormented
her, she suffered less from pain and sickness, became less sullen,
and more communicative.

It appears that the connection took place after prolonged
resistance, just previous to the usual period of menstruation ;
that up to that time there had never been the least irregularity
of this function during the three years she had menstruated.

She was greatly alarmed at the absence of the accustomed
appearances at the usual time, and did not feel well in health,
although she had no marked symptoms ; a general sense of un-
easiness, with pains in the loins, and an occasional slight feeling
of sickness and loss of appetite w^ere felt. When the next pe-
riod came round, she was pleased at finding herself " unwell,"
but only to about half the usual extent; menstruation had con-
tinued regularly up to the time Mr. Challice saw her ; on each
occasion, however, more and more scantily. The abdomen

27

418 Abdominal Tuinonnistaken for Pregnancy. [July,

had gone on gradually increasing in bulk, and about five months
after the connection the patient was conscious of a movement
and pulsation in the abdomen, and believed herself pregnant.
The breasts were small, and marked with an indistinct areola ;
around the eyes and mouth there were dark circles, and her
mother said she had fallen away in flesh. Previous to this un-
fortunate occurrence, the patient not only enjoyed good health,
but was remarkable for strength, endurance, and activity, in-
clined to embonpoint^ full of life and spirits, and in her nine-
teenth 5'ear.

During the next month or six weeks Mr. Challice saw the
patient occasionally. She complained of no urgent symptom,
walked out now and then, had a good appetite and digestion,
with sometimes slight irritability of tiie bladder, and irregularity
of the bowels. The gradual increase in size still went on, and
the mother (who now slept with the daughter) said that the
movement of the child continued. The patient complained of
its violence when in bed, and began to suffer from lumbar pains
and constant irritation of the labia, which was much increas-
ed when she drank beer, wine, or spirits. And so the case
went on.

When the ninth calendar month had nearly expired since the
connection, Mr. Challice became much interested in the case,
thinking it one in which the period of gestation could be ac-
curately ascertained.

On the evening of the expiration of the ninth month tlie
author received the expected message, with an urgent request
to hasten, as very strong labor had come on. When he ar-
rived the patient was standing at the foot of the bed, grasping
the bedpost, and evidently suffering from pain, although not of
a violent character. There was an interval of about ten
minutes in the pains, during which she walked about the room,
having a very anxious and haggard look.

After a good deal of persuasion she consented to an examina-
tion jyer vaginam, which seemed to cause excessive pain, as she
screamed violently, and exclaimed that she was being murder-
ed. At the time, the author thought the patient hysterical, but
was much surprised at the narrow constricted condition of the
vagina, and the presence of the hymen nearly perfect; the
agony, however, produced by the examination seemed so in-
tolerable that the patient, by a sudden and violent effort, threw
herself from him, declaring that he should torment her no more.

Finding that the pains were weak and ineffectual, and at
longer intervals, and feeling assured, from the condition of
the parts, that immediate labor was not at hand, the athorgave
twenty minims of opium, and left, directing a full dose of castor

1818.] Abdominal Tumor mislaktn for Pregnancy. 419

oil to be given in a few hours. During the night she slept well ;
the oil acted freely in the morning; and the next day passed over
without pain or any inconvenience, the patient having a good
appetite, and being better in spirits. About eleven o'clock at
night the pains returned with increased violence, and he found
her straining and bearing down at the bedpost. An old experi-
enced nurse declared " that the pains were quite strong enough,
with assistance, to bring the child into the world." The mother
states, that during the night she had placed her hand on her
daughter's stomach, and felt the child move vigorously.

In -the intervals of pain the patient walked about the room,
and was cheerful, except expressing what seemed to be an un-
reasonable horror at any examination. The pains commenced
in the abdomen, and then extended round to the loins, came on
regularly every ten minutes, and were marked' with all the cha-
racteristics of labor in first stage.

The extreme excitement and dread which the patient evinced
when the necessity for an -examination was impressed upon
her induced the author to waive it, although he was anxious to
ascertain the real condition of affairs. It would be useless to
detail the diurnal symptoms ; suffice it that a week passed over,
and matters remained apparently without alteration either one
way or the other. I may here state that menstruation did not
take place at this period. Doubts now began to rise in the au-
thor's mind about the nature of the case ; and, when nine calen-
dar months from the departure of her cousin had expired he
became very anxious about it. It was at this stage that Dr.
Lever was consulted. After a careful and thorough external
and internal examination, this gentleman, justly famous for his
skill and tact in diagnosis, having the history ofthe case before
him, came to the conclusion that it was " extra uterine impreg-
nation." At that time her physical condition was as follows:
Countenance pale, an anxious expression ; eyes rather sunken;
nose pinched; breasts somewhat flaccid; abdomen the size of
mature pregnancy, if not larger ; bowels sometimes costive for
a day or two, at other tim.es the reverse ; urine most frequently
pale and copious, but on some occasions thick, scanty, and high-
colored. Over the entire abdominal region a distinct pulsation
could be heard and felt: but owing to the extreme excitability
of the patient it was almost impossible to ascertain whether or
not it was synchronous with the pulse. Palliative measures
were adopted, and the case, now become one of painful interest,
w^as closely watched. During the next fortnight no perceptible
alteration occurred, except that the pulsation in the tumor be-
came less distinct, and the abdomen more tense. Dr. Ferguson
now visited the patient, and pronounced the abdominal pulsation

420 Abdominal Tumor mistaken for Pregnane J/. [July,

to be synchronous with the heart's action, and doubted whether
impreirnation had taken place at all. On his recommendation
the author punctured the abdomen with a fine " trochar," and
drew off about five pints of thick grumous and offensive matter.
Great relief followed the operation, only, however, temporary;
for in the course of a short time I he abdomen became as tense
as before, and all the patient's sufferings returned. The interest,
in a further detail of the symptoms of this case, here ceases,
no doubt now being entertained of its character. After a se-
cond and third tapping, the poor girl gradually got weaker and
weaker, her only comfort the oblivion produced by anodynes ;
and on the 15th of February she died.

The day following, assisted by Mr. Druitt, a post-mortem
examination was made. The upper portion of the body was
extremely emaciated, but owing to slight oedema of the lower
extremities, this appearance was not general. Abdomen greatly
distended, and marked by enlarged veins ; it measured in cir-
cumference fifty-eight inches. About a gallon of fluid was
drawn off by the trochar, previous to making a free incision,
after which nearly a pailful of brain- iike matter rolled out.
This had been contained in a cyst, which extended from the
pubis to the ensiform cartilage, and from the left to the right
hypochondrium ; in some parts the walls of the sac were more
than an inch thick, and of a fibro-cartilaginous consistence ; the
anterior portion adhered firmly to the abdominal parieties, the
upper being formed by the inferior surface of the liver ; that
organ was bathed with the contents of the sac, and became
inoculated, several small cysts, filled with medullary sarcoma,
having formed in its substance. There were, also, many isolated
cysts, varying from the size of a hazel nut to that of a pigeon's
egg, formed in the walls of the cyst; these had no connection
with each other, or communication with the general cavity.
The uterus was found embedded in the lower portion or base of
the cyst ; no trace of the ovaries could be met with ; the blad-
der was small, but not affected by disease.

The peculiar interest of this case arises from the close re-
semblance to the symptoms of impregnation ; the development
of a malignant disease seeming, in a great measure, to be influ-
enced by the feelings or instinct of the patient. The author
asks, would the girl have died had no connection taken place?
How far did the mental and physical excitement act upon the
origin or the progress of the disease ? Or was it completely
independent and its course inevitable?

[It is not improbable that the ovarian excitement, connected
with the act of copulation, was the starting point of the disease,]

1848.] Treatment of Typhus or Ship l^ever. 421

Treatment of Tijphus or Ship Fever. (New Jersey Med. Rep.)

Extract from a "Summary of, and Observations upon the medi-
cal practice of the New York Hospital, in the m.onths of
July, August, and September, 1847. By John H. Griscom,
M. D., attending physician."

"The treatment of this Hisease was based upon the idea of its
proximate cause being mainly a vitiated, deficient and innutri-
tious condition of the blood. I say maui/// because I have no
particular theory as to the real nature of the disease, whether
produced by a specific poison entering the system from without,
as is maintained by some, or by a partial decomposition of the
blood by others, or by a disorganization of the solids by a third
party, etc. The most important point in my estimation to be
considered, being its treatment, I have been disposed to look
chiefly at its remote causes, and to endeavor to ascertain from
a contemplation of them, what is required to overcome their
effects.

*'The remote causes are two in number: 1st, an insufRciency
of food, and 2d, the inhalation of a vitiated air. The first of
these must necessarily produce an exhausted neutrative con-
dition of the blood; that fluid, under a protracted privation
of nutriment, will not only be diminished in quantity, but its
red globules, it is reasonable to suppose, will become deficient
in "number and in those properties which are believed necessary
to the health of the organism. Both these consequences are
aggravated and increased by the second cause;, for in the at-
mosphere of the steerage of a passenger ship, crowded to the
utmost limit of the law, there must necessarily, one may easily
believe, be not only a deficiency of oxygen, but an actual pre-
sence of other gases, whose chemical action upon the blood
cannot'but be deleterious, depriving it still further of its healthy
properties.

"I may be told that this brief view of the causes and char-
acter of ship fever is insufficient to account for the febrile symp-
toms^ that there is nothing in starvation, or want of oxygen,
or the presence of deleterious gases, to produce/ei^er. If any one.
who should raise this objection to the insufficiency of my posi-
tion will tell us what fever is, I might then be able to discover a
connection between it and the causes I have named. Until the
specific nature of fever is demonstrated, it is in vain to argue
about the nature of its causes, or to endeavor to trace the modus
operandi of the influences which are supposed to produce it.
But if we are to understand by fever, the frequent pulse, hot
skin, thirst, etc., etc., then I answer, that ship fev^er, as it has
been presented to us this year, is in very many instances, not a

423 Treatment of Typhus or Ship Fever. [July,

fever at all. Repeatedly have we seen patients brought from
on ship board without a single symptom of fever ; with pulse
below the natural standard, skin moist and cool, fauces not dry,
no thirst, and yet the body covered with petechise, the eye con-
gested, the senses benumbed, and most of the other symptoms
o(the ii/phiis condition.

"Confining our attention to this simple view of the causes of
ship fever, we find little cl?e to do than to counteract their
effects. The means for this are clearly indicated, and may be
classed under three general heads.

" 1st. To maintain the continuity of the body, and sustain its
nervous energy, by stimuli, until we are enabled,

" 2d. To improve the quantity and character of the blood by
appropriate nourishment ; and

" 3d. To oxygenize the blood thoroughly by pure air.

^' For the first indication, after giving a warm bath, (an inva-
riable rule .where it could be borne,) the most powerful and
direct stimulants w'ere found necessary. Brandy and carbon*
ate of ammonia constitute the main reliance ; and during my
attendance I have been astonished to observe what enormous
quantities of these remedies will be borne in this disease. As
an instance, I may mention the case of a girl about 15 years of
age, who took about 5 pints of brandy every day for 5 days,
and for two weeks longer from 2 to 3 pints daily. At the same
time she was taking 10 grains of carb: ammonia every 15 min-
utes, amounting to two ounces in twenty-four hours, besides
soups and other nutriments. And all this without the least
manifestation of excitenient, or injury to the stomach or bowels,
such was the intensity of the disease. She was under this
treatment nearly three weeks, before any very decided symp-
toms of improvement were manifested; unfortunately, before
time elapsed to observe the ultimate result in this case, and just
as she was beginning to feel the good efifects of the treatment,
the patient had to be discharged ' relieved,' being removed from
the hospital by her parents. Many other cases might be cited,
in which it was necessary to continue, night and day, to ply
these remedies unceasingly ; a very short respite was frequently
sufficient to put the patient back decidedly, and a vast number
of the cures were undoubtedly due to the faithfulness with which
these means were applied. Where the circulation was unu-
sually languid, or tiie extremities were cold, sinapisms andarti^
ficial warmth were very valuable.

"To answer the second indication, the patients were fed at
fre(]ucnt intervals with nutritious sou])s, arrow-root, or gruel,
with wine or brandy, milk punch, egg-nog, beef, chickens, etc.

*' Upon the tiiird indication, pure air, I may remark, that on

1848.] Treatment of Typhus or Ship Fever, 423

several occasions the necessity for it was strongly marked.
The pressure for admission several times became so urgent,
that the bounds of prudence were quite overstepped, as was in-
dicated by the fact that in certain of the wards which were
most crowded, and contained the worst cases, the recoveries
became more protracted, and the relapses more frequent. It
became necessary to close two of the wards in the north build-
ing, and to have them thoroughly cleansed and purified. After
this operation, and upon confining the number of patients in
them to a reasonable limit, a decided improvement w^as mani-
fested in the rapidity of recoveries, and convalescence. The
position of a patient's bed in a ward, was observed to have an
influence over his treatment. In the corners of the rooms, the
patients got along more slowly than in the central parts, or
near the doors or windows ; and I frequently found that when
a patient had been lying for several days, in a part of a ward
most distant from the windows, and w^as not doing well, a re-
moval of his bed right under a window would, in 24 hours, pro-
duce a decided change in the symptoms for the better.

" Although this was the general course of treatment, it was
frequently varied to suit the condition of the patient. Occa-
sionally a case would present a degree t>f excitement, with hot
and dry skin and thirst, which called for the spiritus mendereri,
ice in the mouth and to the head, and the mildest diet ; some-
times gastric irritation with nausea would demand a mild emetic,
such as an infusion of eupat: perfol. If the pain and heat in
the head w^ere marked, dry cups to the temples, or forehead,
or blisters behind the ears, and application of ice, would gener-
ally be found sufficient. Pneumonic symptoms with cough
frequently complicated the case ; when these occurred, Stoke's
expectorant, with dry cups, or vesication of the chest, formed
the principal addition to the other treatment.

*' Sometimes there would occur such a combination of general
prostration and external heat and dryness, as to indicate a com-
bined stimulant and febrifuge treatment; such, for example as
the administration of carb. ammon. or a half ounce of brandy,
alternately every hour or two hours, with a half ounce of spirit
Minder., and so frequent and sudden were the changes, in many
instances, from one condition to the other, an almost constant
watching was necessary to withhold the one or the other, and
again resume it. In fact, the varieties and shades of symptoms
were almost infinite, and called for an endless variation in the
means of relief To enumerate them would take more time
and space than could be reasonably asked. There were many
cases, however, for which no other treatment was necessary
than good diet and cold water. Cleanliness, pure air, and food,

424 Employment of Iodide of Potassium. [July,

appeared all-sufficient for the removal of the disease, even in
the well-marked cases, not a particle of medicine being admin-
istered to them." '

On the Accidents ivhich may result from the Employment of the
Iodide of Potassium, and the best means of their Prevention.
By M. RoDET, Surgeon de Tllospice de I'Antiquaille de Lyon.
(Medico-Chirurg. Review.)

In the Review department of our last Number (p. 129), we
have adverted to a paper by M. Cullerier, upon tlie ill effects
occasionally resulting from the use of iodine ; and M. Rodet's
essay will be found to contain some very useful observatious
upon the causes and prevention of another class of these. Ad-
mi tting the high claims of the medicine to attention, he sets out
with protesting against the great abuse that has been made of it
in French practice. The article is thrown into certain proposi-
tions, which it will be best to state in the author's own words :

"Proposition 1. In the physiological cojidition, the iodide of
potassium exerts its action on certain special organs ; and
when this becomes pathogenetic, its effect is exerted upon one
of these organs, or upon any organ which is already suffering,
and is liable to an habitual irritation or ffuxion.''

All practitioners who have much employed this medicine in
large doses, must have observed the excitement it imparts to
certain organs or tissues, giving rise to increased appetite, a
deeper colour of the mucous membranes, diuresis, &lc. ; and
that in some cases this goes on to the production of irritation or
inflammation, haying certain special characters, and constituting
forms of gastralgia, exanthemata, coryza, bronchitis, or nephrir
tis, and a peculiar condition of the brain termed iodic intoxica-
tion. M. Ricord maintains that on the mere suspension of the
medicine, all these symptoms soon disappear. Other practir
tioners have not been so fortunate, but have found themselves
obliged to combat intense inffammation by active procedures.
It is true that in such patients there frequently exists a peculiar
predisposition.

"2. The iodide would rarely, if ever, produce serious ill ef-
fects, if it were only given in cases which evidently call for its
employment." Tliis is the general result of the author's ob-
servation, and in \^hich he places the more confidence iVom its
agreement with sound reasoning. When the cases have been
projjcrly selected, so far from its producing any ill eflfects, it has
been borne even in enormous doses by the weakest and most
irritable stomachs, and has exerted a powerful influence in re?

1848.] Employment of Iodide of Potasaium. 4*25

establishing that regularity of the various functions which con-
stitutes health. Practitioners, seeing the really surprising cures
it operates under these circumstances, have hastily generalized
its application, by prescribing it in all the stages of syphilis,
and in the most opposite diseases, and then are surprised at the
disappointment v*hich ensues. Convinced of its innocuousness,
and awaiting the surprising effects they have led themselves to
expect, they allow the mischief it produces to increase more
and more, until .at last the patient's relief becomes a matter of
great difficulty. It is no panacea, and its really remarkable
specific effects are only to be expected in certain rare cases,
which have been carefully discriminated.

" 3. The iodide, as a general rule, is ill borne in cases in which
the employment of mercury is indicated ; so that, in place of
being asuccedaneum to this drug, it is only complementary to
it."' The author well observes that, in spite of all that has been
said against it, and the prejudices of the public, sometimes fos-
tered by those of the prolession, mercury i^ our most certain
antidote against the venereal disease, and much mischief has
resulted from the indiscriminate substitution of iodine for it.
iMercury often fails, from the ineffectual mode in which it is
administered; and the iodide then resorted to is given without
hesitation in the most enormous doses. Experience has, how-
ever, confirmed the truth of M. Ricord's observation, that mer-
cury is inefficacious in proportion to the long-standing of the
disease, w^hile in the very same degree is iodine useful ; but
another fact which has not been remarked upon is, that the
more powerful the agency of iodine against the morbid symp-
toms it is employed to relieve, the less capable it is of producing
the iodic accideiits ; and, on the contrary, these are easily in-
duced, just in proportion as it is powerless against the diseased
conditions. Mercury suffices for the early stages of the vene-
real disease, and iod.ne for the latest, while for the medium
ones a combination often best succeeds ; but if the order be
inverted, a train of accidents arise: mercurial, if the mercury
has been too long'persisted in ; iodic, if the iodine has been pre-
maturely employed. So much do these accidents resemble
each other, that until recently they were all referred to the ac-
tion of mercury ; but the author has never seen either drug give
rise to them, when the caution now recommended has been
observed.

*'4. The iodine acts so much the more favorably, if the pa-
tient have not been already treated by other measures. The
f^ct of one or two mercurial courses having been recently under-
gone, should make us fear the production of iodic accidents,
especially such as relate to the brain." A niost mischievous

426 Employment of Iodide of Potassium. [July,

error has been the admission of the claims of the iodide of potas-
sium as an antidote of the mercurial cachexia. This has arisen
from confounding syphilitic cachexia with mercurial cachexia,
and from attributing to the influence of mercury the exostoses,
caries, necroses, and large ulcerations, which are, in fact, but
the consequences of an advanced stage of the disease. In proof
of the truth of this observation the author remarks that, (1) he
has never seen iodine produce any mischief when employed
against old syphilis in patients who had never undergone mer-
curial treatment ; (2) the same remark holds good when the
mercury had been employed at a very early period to combat
the primary phenomena of the disease ; (3) on the other hand,
he has seen this medicine give rise to the most serious lesions
when used shortly after the employment of mercury. Several
cases observed by the author, or communicated by his friends,
are cited in proof of this. The question then presents itself, as
to how far the mercury may have been influential in inducing
the accidents in question. It is somewhat difficult of solution,
and may be best answered by examining the different catego-
ries of the cases. (1.) For the mercury, employed for the re-
lief of secondary symptoms, the iodide was, after a longer or
shorter period, substituted. Here the accidents may depend
upon the absence of an indication for the use of iodine, an ex-
cited condition of the various organs produced by the mercury
predisposing them to become easily irritated, or upon the com-
bination of the mercury yet remaining in the tissues conferring
on the iodine more active and irritating power. (2.) The pa-
tient was submitted to one or more mercurializations, more or
less complete, for secondary symptoms, and iodine then employ^
ed for the treatment of a relapse. The same explanations may
be adduced as in the former case ; but it may be remarked, in
reference to the latter portion of these, that although the opinion
that mercury may remain accumulated in certain tissues for an
indefinite period is evidently incorrect, yet it is certain that it
may continue to influence the economy for some time after its
use has been discontinued; and although the period required
for the removal of this from the system cannot be determined,
and is probably variable, yet the shorter the time which elapses
between the discontinuance of the one drug and the commence-
ment of the other, the greater is the danger of any ill effects
resulting from their combination. (3.) The mercury was em-
ployed for the relief of tertiary symptoms, and iodine had re-
course to after its failure. As here the iodine was indicated,
the ill eflfects following its use must have chiefly arisen from
some such combination adverted to. In some cases they seem
to have depended upon the new irritation of the iodine having

1848.] Employment of Iodide of Potassium. 427

checked some habitual secretion. "The cerebral symptoms re-
sulting from the simple action of iodine differ from those which
are produced by the combination of it with mercury. In the
first case, as M. Baumes has already remarked, the patient
complains of an uneasiness, giddiness, and heaviness of the head,
rather than of a true headache. There is also a diminished
power of hearing, sight, and recollection, and a difficulty or
uncertainty in walking, accompanied often with diminished sen-
sation and warmth in the legs. There is almost always consti-
pation, but I have never seen any difficulty in passing water.
In a word, the symptoms indicate rather an oppression of the
brain than an inflammation of that organ. In the other case,
the same symptoms exist, but there are likewise pain and con-
gestion of the head, seeming to threaten a true inflammation of
the brain."

Means of prevention. The precepts of the' attainment of this
end naturally flow from the consideration already bestowed
upon the causes of the accidents in question. 1. The iodide
should never be administered except in cases which rigorously
call for its employment. This seems like the mere stating a
truism ; but the abuse of this medicine has been so great as
scarcely to render it superfluous. It is sufficient for a dubious
case to present itself, and the history of the patient, to exhibit
the fact of syphilis having once existed, for a vitiation of the
blood to be assumed, and this medicine at once given ; and that
in cases in which, were mercury the drug in question, much
greater circumspection w^ould be employed in prescribing it.
It is the erroneous opinion of the inoftensiveness of the iodide,
which has led to the great abuse made of it. In other cases,
where syphilis is out of the question, it has been ordered be-
cause reputed to possess certain chemical properties, and
because other means have failed. If this is no more successful,
the dose is increased wath a rashness observed with regard to
no other remedy. Frequently it gives rise to irritation of the
throat, which, mistaken for syphilis, leads to a still further abuse
of the means that has caused it. The cases recorded in the
journals of such wonderful cures in such opposite diseases, which
are often but errors in diagnosis, have given the medicine a
celebrity it does not deserve. With the exception of syphilis,
the iodide can only be said to be advantageous in scrofulous
diseases, and in glandular and other engorgements. In syphilis,
when discriminately employed, it is truly an heroic remedy ;
but M. Rodet recommends us, (1) never to employ it for pri-
mary symptoms, unless to fulfil some accessary indication ;" (2)
never to employ it for secondary symptoms ; (3) never at first
to employ it for the mere symptoms of transition, and to asso^

42S Employ jnent of Iodide of Potassium. [July,

ciate it with mercury only when this proves slow and uncer-
tain in its operation ; (4) always to employ it alone in tertiary
aflections at first, and afterwards, if it prove not efficacious
enough, to associate mercury with it rather than give it in ex-
cessive doses.

2. Iodine must he employed with the more circumspection in
proportion to the greater amount of mercury the patient may
have tak^n, and as the epoch at which this has been taken is more
recent. To prevent the mischief already pointed out, we should
never give iodine, when mercury is still indicated and may be
employed without fear ; as it saturates the system, and induces
consequent accidents. If mercury has already been taken at a
recent epoch in large quantities, and it is feared to have re-
course to it again, the chloride of gold, not the iodide of potas-
sium, is the eligible substitute. In general, the patients are
cured by its agency ; and if its effects are not sufficiently favor-
able, we can discontinue it at the end of five or six weeks, and
then have recourse to the iodine alone or conjoined with mer-
cury ; the system having had time to rid itself of the overdose
of the mercury, and recover from the condition of excitement
this may have produced. As might be expected, the gold gives
rise to no accident, producing no injurious chemical reaction
with the mercury or iodine. If the first mercurial treatment
has taken place somewhat remotely, then may the new symp-
toms be treated either by mercury or iodine, according as they
are secondary or tertiary, or in those of transition by the two
combined ; but in the use of iodine after mercury we should
always proceed with much circumspection, and that in propor^
tion to the shortness of the interval.

3. Whenever the disease for which iodine is given is compli-
cated with inflammatory action of any organ, or by any other
affection not directly dependent upon it. we should remove such
coniplication before employing iodine. It must be acknowledg-
ed that frequently great difficulty exists, in distinguishing whe^
ther a given morbid condition or an organ arises from, or is
independent of, the constitutional disease. Acute affections, as
inflanmiations, cannot give rise to doubt. Their removal must
be accomplished before commencing the special treatment.
Sometimes, some habitual discharge is suppressed, such as
sweating from the feet, cpistaxis, hemorrhoids, &c. When this
gives rise to the irritation or inffammation of some organ, the
course to be pursued is obvious; but when there is only a feeK
ing of general uneasiness, an abnormal condition of the system
whif-h rofjuires only a slight cnuse to localize itself in some par-
ticular p;irt, the adniinistration of iodine may easily play the
part of such occasional cause. Before having recourse to it,

1848.] Burnett* s Disinfecting Fuid. 429

therefore, we should endeavour to restore the deranged equilib-
rium by reproducinfr the fluxion.

4. The action of the iodine should he carefully watched ; it
should never be ^iven in larger doses than strict necessity re-
quires, and should be suspended as soon as it seems to excite any
deletejnous effect upon the system. Even in small doses it pro-
duces very injurious effects in certain idiosyncrasies; while in
others, after having long tolerated it, the system suddenly re-
fuses to bear it. "But such intolerance is of far more frequent
occurrence, when it is given in too large doses, or continued too
long. The desire of producing prompt effects, and such as may
surprise the patient, has sometimes led to its being given from
the first in large doses. But the physician should always know
how to resist desires of this sort, and have nothing in vijw but
the true interest of the patient confided to his care. The dose
required varies surprisingly amid apparently identical condi-
tions, according to the idiosyncrasy of the patient; but we should
always commence with small ones, and only reach the large doses
sometimes required gradually, and when we have assured our-
selves of their necessfty and of our patient's power of tolerating
them. As a general rule, M. Rodet commences w^ith five or
six grains, augments the dose only weekly, doses not exceed
from two scruples to a drachm daily, or prolong the treatment
beyond two months. Cases in which larger doses and their
long continuance are required are exceptional, for w^hich no
rules can be laid down, their management depending upon the
tact and skill of the practitioner. Gazette Medicale, 1847,
Nos. 46, 47, 48.

We have seldom perused a paper with more satisfaction than
the above, replete as it is with sound principle and much-needed
caution. Perhaps in the whole range of the materia medica,
there is not a drug that has been more rashly and preposterous-
ly prescribed than the one in question.

BurnetCs Disinfecting Fluid, (London Lancet.)

The chloride of zinc in solution, it appears from a parlia-
mentary document which has just been issued, has been em-
ployed extensively as a disinfectant in dissecting rooms, the
wards- of hospitals, and in the royal navy, and, according to the
reports which we have seen, has been eminently successful in
effecting the objects for which it is designed.* The medical
officers at Chelsea Hospital state that it has been used in that
Hospital in the close-stools of patients affected with dysentery,
in the water-closets and cesspools, and ^Iso in the wards, when

430 Burnett's Disinfecting Fluid. [July

the air was tainted by purulent expectoration or discharge from
sores, with the effect of immediately removing the disagreeable
odors. It has also been used in the surgery with good effect,
in removing the smell of putrefying animal substances, and the
odor of dead bodies under inspection; when employed as a
dressing to ulcers, it removes the disagreeable smell of purulent
matter, and, in the proportion of one part of the clear solution
to eighteen of water, it preserves subjects of natural history
from putrefaction, and in a fit state of anatomical inspection,
after more than a year has elapsed. A similar testimony in
favor of the solution of the chloride, is borne by the Assistant
Surgeon of the Marine Hospital at Woolwich, who adds, "the
great advantage which the chloride of zinc possesses over other
agents employed for a like purpose, is, that it removes the dis-
agreeable eflluvium, without leaving one little less offensive in
its room, and may therefore be made use of wherever this effect
is required in private as well as public buildings, in the sick
bed-chamber no less than in the crowded ward. The method
adopted, at this Hospital, is to supply each of the wards with a
bottle of the diluted solution, which the nurses have directions
to use whenever occasion may require, besides sprinkling it over
the floors before the morning and evening visits are made."

Its utility in the dissecting-room is confirmed by the state-
ments made by Mr. Bowman, Dr. Sharpey, Mr. Partridge, Dr.
Murray and Dr. V. Pettigrew, who concur in asserting, that
in a proper degree of dilution its success is complete, and that
it appears to preserve the color and texture of the parts very
admirably. It has, further, the very important advantage of
not acting on the steel instruments employed, being in this re-
spect equal to alcohol. Dr. Methven especially mentions an
instance in which the solution corrected advancing putrescence,
and enabled him to dissect during July. He believes, further,
it will be the means of saving many valuable lives, which are
annually lost by wounds received in the course ofdissection, as,
while dissecting this putrid body, he cut himself several times,
and once received a punctured wound, without any bad conse-
quences arising. Mr. M'Bain, of the '' Mastiff," adds his tes-
timony "to the rapid and perfect eftects of the chloride of zinc
solution upon animal matter in a state of putrefciction. Having
frequent opportunities of dissecting or examining large fish, &c.
cast on shore, whilst undergoing decomposition, the task has
been occasionally any thing but agreeable, for want of a con-
venient power to destroy the putrefactive process. The chloride
in these cases acts like magic ; and as a great practical agent
over one of the most important conditions of animal and vege-
table matter viz., putrefaction, it stands unrivalled." Its in-

1848.] Burnett's Disinfecting Fluid. 431

fluence on board ship, in annihilating the offensive smell of
bilge-water, and in sweetening between decks, is shown by the
united evidence of captains, surgeons, and masters in the royal
navy. Among other vessels it was used on board the "Victoria
and Albert," royal yacht, to remove a more than ordinary
stench of bilge-water, and other offensive odors, with most
complete success. The surgeon states that she has remained
comparatively sweet ever since, and when a bilge-water smell
is occasionally perceptible, a sli-ght application of the fluid re-
moves it. The solution has also been used for very disgusting
privies, &c., effluvia from which it quickly neutralizes.

Mr. Henderson, the Surgeon to the Dockyard at Portsmouth,
has employed the fluid in a severe case of open cancer, the
foetorfrom which was intolerable to the patient and attendants ;
this it destroyed so long as the dressings were kept moist there-
with. Professor Quain has used it, he says, in the treatment of
sloughing tumors with beneficial results, and he has no doubt it
will supplant the chlorides of lime and soda altogether in the
removal of foetid odor. Mr. Gibson, Surgeon of the ' Euridice,"
employed it in a case of angry ulcer, in the proportion of one
part to four of water. An eschar was the result, the separation
of which left the ulcer in a healthy condition.

Several naval and other medical men have employed it as a
disinfectant in hospitals, and on board ship, the general result
being a marked diminution in the rate of mortality. Dr. Lind-
say, Dr. Cronin, and Dr. Connor, of Cork, all bear testimony to
its beneficial effects. Mr. Verling, Surgeon of the "Venge-
ance," thus speaks :

*' Having used the chloride of zinc rather extensively on board
Her Majesty's ship ' Vengeance,' w^hilst employed in the con-
veyance of troops, I think proper to report to you the result
thereof. We carried the first battalion of the forty-second regi-
ment, consisting of about 700 men, women and children, from
Malta to Bermuda. Measles had prevailed epidemically in the
regiment previous to their embarkation, but w^e received none
on board laboring under the disease ; yet, after being ten days
at sea, several cases occurred simultaneously among the sol-
diers, and, on the 1st April, having been then a month at sea,
the disease appeared among our own people, ten cases occurring
on that day, and from that day to the 15th of the month, when
we arrived at Bermuda, fresh cases were of almost daily occur-
rence, either among our own people or the troops. On getting
rid of the troops, which we did at Bermuda, my attention was
of course specially directed to every means whereby the con-
tagion could be destroyed. Cleanliness and ventilation were
duly attended to, and every part of the ship where the sick had

4S2 Nitrate of Silvsr in Diarrhoea and Dysentery. [July,

been, after beino; clenned and aired, was sponged well over with
the solution of chloride of z'nc several times. Than the result,
nothing could be better; the disease totally ceased, no fresh
case occurrinir after. On our passage from Halifax, with the
sixtieth regiment on board, the weather was so bad, and the
ship working so much, that it was quite impossible to open any
of the lower deck ports, on which deck the whole of the peo-
ple lived, troops as well as our own people, for eight days ; the
air throughout the deck was exceedingly vitiated with every
rnixture of noxious smell, but the free use of the chloride of
zinc tended, in a most surprising manner, to do away with the
bad smell ; so much so, that the surgeon of the regiment came
to me to get some to use in the part of the ship were the ladies
of the officers \vere. The effect of the chloride of zinc is most
obvious in correcting all bnd and offensive effluvia ; and from
the sudden and surprising manner in which the measles disap-
peared after its use, it is not, I think, too much to say, that it
must have been very instrumental in decomposing the miasm,
or state of atmosphere in the ship, which tended to the gener-
ation of the disease."

From all these statements, then, it is clear that the solution
of the chloride of zinc is a powerful agent in neutralizing noxious
gases, and in arresting the progress of decomposition. Sir
W. Burnett has therefore rendered, by its discovery, a great
benefit to suffering humanity. On board ship, its influence in
removing the offensive odors from bilge-water can hardly be
too highly estimated, while its action in sweetening the wards
of hospitals, and destroying noxious and infectious effluvia,
seems to be equally evident.

On the Internal Use of Nitrate of Silver in Obstinate Diarrhma
and Dysentery. By Thomas Aikin, Esq. (Gazette Medi-
cale. Ranking's Abstract.)

The author of this communication remarks, that the topical
application of the nitrate of silver to inflamed or ulccraled mu-
cous surfaces is confessedly a most efficient mode of treating
such cases. 'I'he knowledge of this fact may have induced
physicians to employ the same remedy internally against disease
invading the mucous surface of the hollow viscera. Accord-
ingly, we find that ample testimony is afforded to the efficacy
of the nitrate of silver in certain morbid conditions of the mu-
cous coat of the stomach: but no Ihiglish writer, Copeland
excepted, (Dictionary of Medicine,) sanctions its employment
as a therapeutic agent in morbid conditions of the mucous sur-

1848.] Nitrate of Siloer in Diarrhtta and Dysentery. 433

face of the intestinal tube. The author's object in the present
communication is to adduce such testimony in favor of its san-
ative power in these affections as may stimulate further inquiry
into the action of this salt in certain obstinate forms of diarrhoea
and dysentery, which occasionally resist the action of the most
esteemed remedies wielded in the ablest manner.

- Boudin (Gazette Med. No. 51, 1836,) physician to the Mili-
tary Hospital at Marseilles, treated fifty cases of typhoid fever
(dothinenteritis,) in most of which severe diarrhoea Was the
most prominent feature, with the nitrate of silver thus: When
the lower portion of the intestinal tract was presumed to be
the seat of ulceration, enemata, containing from 'one to three
grains, dissolved in distilled water, were administered. In most
cases one enema sufficed, the symptoms undergoing speedy
amelioration. In other cases the" remedy was given by the
mouth, in half-grain doses every half hour, [?] formed into pills
with gum tragacanth, or starch, until from two to four grains
were thus taken. In some instances these two modes of treat-
ment were combined ; the results were that only two of the fifty
cases su(5cumbed. Examination showed " many ulcers'^ on the'
mucous membrane in a case of incipient cicatrization -'envoie
de cicatrisation.^^ There was evidence of the solution admin-
istered per reetumi having passed the ileo-Csecal valve, and pro-
ducing effects on the lower portion of the ileum precisely similar
to those resulting from its action on the surface of the colofi.

Kalt confirms Boudin's statement, having treated twenty -twa
cases of dothinenteritis with the nitrate of silver. Of these'
one died. He gave it in mixture (grs. ij. to vj. in decoct, salep.
oz. vj.) a tablespoonful of which was taken every half hour, of
hour, according to circumstances.

Hirsch of Konigsberg (Hufeland's Journal) found the tiitfaitef
of silver to" succeed in obstinate cases of diarrhoea on the failure
of ordinary remedies. It proved specially useful in the diar-
rhoea of nevidy weaned infants. In " the advanced sta^e of
such cases, when emaciation vi^as extreme, the dejections being
frequent, fetid, and consisting of a variously colored, sometimes
greenish, or bloody mucus, and wanting altogether the fecal
character. When apthous ulceration pervaded the mouth, and
when prostration was extreme, the action of the nitrate v^^as
brilliant.^' He gave it to children thus :
^ Argent nitrat. crystall. gr. \.
Aqua destill. ij;

Gum mimosae^ 9ij,

Bacch. albi, 3ij. Misce. Ft. mist.

A teaspoonful of this mixture was given every two hours,
and an enema, containing a quarter grain of the salt, with mu-

28

434 Nitrate of Silver in Diarrhoea and Dysentery. [July,

cila^e and a little opium, was administered. The good effects
oi this treatment were occasionally visible in a few hours,
sometimes not until the second day. He pronounces it a spe-
cific in the diarrhoea of infants. He found it almost equally
efficacious in severe forms of diarrhoea and dysentery occurring
in adults. He administered it to the latter in pills, in doses va-
rying from one-twelfth to one-twentieth of a grain every two
hours. For this purpose he recommends liquorice powders as
preferable to the vegetable extracts which effect its decomposi-
tion. He also gave enemata, containing half a grain or a grain,
wi h mucilage and opium.

Canstatt also extols the nitrate o^ silver as prescribed by
Hirsch in the diarrhoea ablactatio.

Since the author became acquainted with Hirsch's observa-
tions, opportunity presented for testing the powers of the nitrate
of silver in a severe case of diarrhoea occurring in a child of a
year old. Vomiting and purging set in, and continued with
almost unabated intensity for five days. The stomach at length
retained fluids in small quantities, but the purging continued.
Chalk mixture, kino, opium, and acetate of lead were tried, and
all, with the exception of the last, seemed to increase the irri-
tation. The dejections were frequent, greenish, sometimes
bloody, and very fetid. On the sixth day prostration was very
great; there was a tendency to stupor, and quantities of green-
ish mucus were voided. Under these circumstances he gave
the mixture as prescribed by Hirsch. The first dose seemed
to increase the discharges; however, in about six hours, the
character of the dejections were improved, they became fecu-
lent, and every symptom underwent a corresponding improve-
ment.

Should the foregoing observations induce practitioners in this
country to subject the action of the nitrate of silver in diseases
of the mucous surface of the intestines to a more extensive trial,
tliey may arrive at results confirmatory of those already obtain-
ed by the authorities which the author has quoted, and thereby
extend the application of an agent ofgreat therapeutic energy to
forms of disease occasionally so intractable as to baffle the pow-
ers of ordinary remedies.

[The advantage of the nitrate of silver in the diarrhoea of
infants, of which we have had considerable experience, is also
acknowledged by Bouchart (Manuel Partiquedes Nouveaunes)
and by Trosseau. We have given it frequently, and with much
benefit also, in the "irritable" bowels of the adult. We gener-
ally prefer to exhibit it in solution, more especially in children,
since, if given in pill or powder, we have no guarantee that it
will not, by suddenly dissolving, exert all its effects, which, in

1848.] Monthly Pcriscoj)c. 435

that case, may be too powerful, upon a circumscribed portion
of the mucous membrane. This is a point which is not suffi-
ciently attended to in prescribing the nitrate of silver for gastro-
dynia, and sufficiently accounts for the diversity of opinion
respecting its benefit in this complaint. It may be readily con-
ceived that it makes all the difference whether half a grain of
solid nitrate of silver lies in the corner of the stomach and dis-
solves, or whether originally in solution its action is distributed
throughout the entire irritable mucous membrane.]

PART III. MONTHLY PERISCOPE.

Remedies for Incontinence for Urine. 1. Benzoic acid has been
employed with success against this complaint; it is given in doses
of twelve grains daily, half in the morning and half in the evening, and
the dose may even be doubled. M. de Fraene, of Brussels, records a
successful case in a girl between 13 and 14 years of age, who was
attacked with nocturnal incontinence, after recovering from a second
attack of acute rheumatism. The complaint was neglected for several
months ; there was no pain in the part, the appetite was good, and
the bowels regular, but the face was pale. Various remedies were
employed without success, after which, two drachms of benzoic acid
were made into forty pills, four of which were taken night and mor-
ning, and the complaint was completely cured.

2. A woman, aged about forty years, was received into the Hotel-
Dieu, under M. Guerard, to be treated for incontinence of urine and
pulmonary emphysema. The first infirmity appeared to depend upon
a phlogosis of the neck of the bladder. The urine passed involuntari-
ly both night and day. The asthma was treated with acetate of
ammonia. The emphysema was much amehorated, the respiration
became more easy, and the asthmatic attacks after a few days ceased.
The incontinence of urine, however, continued, for which enemata
were ordered, containing four grains of camphor dissolved in yolk of
ogg, and mixed in a little water, so that it might be retained in the
rectum. This treatment alone sufficed to remove the incontinence for
some time. In a few weeks however, it returned, and was once more
removed in the same manner. At present the enemata are continued
as a prophylactic, the cure seems to be permanant. [Prov. Med. and
Surg. Jour.

Influence of the Weather Upon Health. Dr. Casper, professor in
the University of Berlin, in his essay on this subject, gives the follow,
ing practical conclusion: In Berlin, while the month of January is
least, December is the most, favorable to health. Tlie greatest num-
ber of deaths occur in spring, and the smallest number in summer.'
Extremes of temperature are dangerous to life. A high barometrical
pressure tends to increase, while a low pressure tends to decrease,

435 Monthly Periscope. U^^h'>

the rate of mortality. The influence of atmospheric pressure on hu-
man life varies in different seasons. No condition of t lie air is so
dangerous to life as dry cold. On the contrary, humid cold has the
greatest tendency to support life. Of all seasons of the year, the
winter gives rise to the greatest number of cases of inflammatory
diseases, whilst the spring is most fatal to them, especially to cases of
pneumonia. Cold winters, warm springs, summers, and autumns,
increase the danger and fatality attendant on inflammation attacking
the brain and respiratory organs, and vice versa. The maximum
mortality from phthisis occurs in spring, and after this season in winter.
The minimum mortality in autumn and winter. Variations in the
state of the atmosphere appear to exert but little influence upon the
relative number of deaths from phthisis. Nervous fever is most fre-
quent and fatal in autumn least frequent and fatal in spring. The
influence of weather and season varies with the different periods of
life^ This influence is most marked in the ages of infancy and
puberty, but it is least marked in the first septennial period of exis-
tence. From the twentieth year upwards, the winter is the most
dangerous and the summer the most favorable season to life and
health: and the older the individual the more striking is this differ-
ence. [3Ied. Times.

Case of Anchylosis of the second aud third Molar Teeth at a right
Angle. By VV. Grhishaw, F R. C. S., Dentist. The accompanying
illustration exhibits a molar tooth which I extracted from the upper
jaw of a lady about sixty years of age, who applied to me about two
months ago, in order to have it removed. Upon attempting to bring it
away I experienced a great deal of difficulty, so much so, that I felt
persuaded that there was something very unusual connected with it.
During the effort at extraction, the emire maxillary bone appeared to
shake under the forceps. However, by proceeding with the operation
in a very cautious manner, I gradually succeeded in removing the
tooth. Upon examining it, I found that it had been anchylosed at the
roots with another tooth, the dens sapientia? of the left side, which
joined it at a right angle, and created the difficulty attendant on its
removal. In the course of my experience I have not met with an
exactly similar specimen, nor have 1 read any description of such an
occurrence in books on dental surgery, although I have frequently seen
teeth joined together at their sides ; it is not very uncommon to meet
with primary teeth thus unted. [Dublin Journal.

On the Discovery of a new Fluidfor preserving the Colour of pathogical
and anatomical Preparations. By M. H. Stapleton, M.D., F. R.
C. S.j M. R. I. A., Surgeon to Jervis-street Hospital.
Sir, I beg leave to make known to the profession, through the
pages of your Journal the discovery of a solution, which I have
employed during the last six years, for preserving pathological spe-
cimens. It possesses the important advantages of causing such pre-
parations to retain their colour perfectly unchanged, and it dose not

1848.] Medical Intelligence, 437

harden the substance immersed in it. These two results are well
instanced in several preparations in Jervis-street Hospital, in par-
ticular preparations of the brain, showing apoplectic clot ; apo.
plexy of the lung, and the recent appearances in stricture of the
urethra.

The process I adopt is simply as follows : In a quart of a saturated
solution of alum in water I dissolved half a drachm of nitre ; in this
fluid I immerse the recent preparation, which soon becomes decolouriz-
ed, but the colour gradually returns within a few days, the period,
however, varying in different preparatons. When the colour is thus
completely restored, I put up the preparation in a filtered solution of
alum. The specimens are open for inspection.

I remain your's, &;c. &c., M. H. Stapleton.

To the Editor of the Dublin auarterly Journal, I6th Jan., 1848.

Means of detecting Blood spilt on Clothes. Sulphuric acid dissolves
the ligneous tissue of clothing without affecting the fibrin of the blood.
Prof. Piria observes, that in these experiments, the fibrin forms a net-
work so as to distinguish cloth upon which blood has been spilt.

[Journal de Chimin.

MEDICAL INTELLIGENCE.

TTie American Medical Associalion additional items of its proceedings,^-''We
obtain the following particulars of the proceedings of the National Medical As-
sociation, assembled at Baltimore, from the Medical Nev/s and Library. They
were prepared for that Journal and may be considered official, since the editor
js chairman of the publishing committee. In addition to what has already been
published, our readers have now a general yievv of what was done at the first
annual meeting of the profession,

Resolved, 1st. That the assessment for the present year be three dollars.

2J. That voluntary contributions be invited.

3(1. That a copy of the printed proceedings be furnished to such members only of the ajso-
Ciation as shall have paid the assessment for the year.

4th. That those members ol the association who shall pay five dollars, instead of the
assessment of three dollars, shall be entitled to three copies of the proceedings.

5th. That the committee on Publication be authorized to make such arrangements for the
sale of the transactions of the association as they may deem expedient, and to present copies
to such public libraries, editors ofmedicaljournals, Sic , as they may consider proper.

Resolved, That a committee of one from each State be appointed to report to this associa-
Ition at its session of tomorrow njorning, the names of gentlemen to com|)Ose the various
standing committees for the present year, and that said committee be instructed to present
the names of such members only as are in actual attendance.

Dr. Wynn presented a communication from the medical department of the National Insti-
tute on the subject of hygiene, and olfercd a resolution that the communication be referred
tp a seli'cl committee of tivf^, which was adopted, and the following committee was appoiijt-
led : Drs. J. Wynn, J. M. Thoma-;, O. W Holmes, Isaac Parrish,andG. L Corbiu.

The committte ap[)ointed to nomiuate the standing committees, reported the followirjg
pominations, which were ailopti-d.

C <mmittee of Anang>7nents.\ics Jacob Bigelow, E. Hale, Z. B. Adams, ' Dalton, Johi;

Ware, (). VV Holmes, N. J. Bowditrh, of Boston

Cifiiimillee on Medical Scitnccs.Dra. L. I*. Yandejl, Ky. ; Smith, Ohio j White, do. ; E,
S. Carr, Vt. ; S. J.ickson, IVnn. , Upshur, Va. ; Harris, Te'nn.

Committee on Practical Medicine. Drs. Cond'm. Penn.; Gerhard, do. ; Clymer, do.; Joha
Ware, Boston ; G Tyler, D C; Fitiiian. N. J. ; Kreider, O.

Commi'.tte on Sui^erij Drs. N. K. Smith, Md. ; Askew, Del. ; Baxley,Md. ; Knight, Conn, ;
Pancoast, F'cnn. ; McGnire, Va. ; Shipman, Ind

Committee on Obstetrics. Dm. VVelUord, Va.; Peebles, do.; N.Young, D.C.; Z B.Adaips,
Mass. ; G. II. Gilman, N. Y. ; J A. Eve, G,i. ; House, 111.

Committee on Medical Literature. Drs. J. P. Harrison, Ohio ; Breeze, do. ; Edwards, (11.;
;.atta, lud,; Holmes, .Mass. ; Stewart, Md. ; Thomas, D.C

438 Medical Intdligence. [July?

Committee on Medical Education. Bts. F. C. Stewart, N, Y.j John Watson, do ; J. M.
Smith, do. ; A. L. Pierson, Mass. ; Pennington, N J. ; Gaillard, S. C ; Meeker, Ind.
Committee on Publicatiuns.Drs. I. Haj s, Ponn. ; Stille, do.; Condie, do ; Bowditch,
Mass. ; Uunbar, Md. ; Bdrkei,Conn. ; Jump, Del.

The committee also recommended the city of Boston for the next meeting of the associa
tjon. The report was acce|ptd, and the nominations confirmed.

Dr. Wellford presented and read a rcjjort from the standing committee on Medit al Educa-
tion, accomjianied with a sciies of resolutions, which were umended and adopted as follows :

1. Resolved, That this associatjon considers defective and erroneous every system ol meili-
cal instruction which does not rest on the basis of practical demonstration, and clinical
teaching, and tliat it is therefore the duty of the medical schools to resort to every honorable
means to obtain access for their students' to ihe wards of a well regulated hospital.

2- Resolved, thertfoie, Tiiat this association earne.-tly and respectfiiUv appeal to the trus-
tees of Hospitals to 0(>en tlioir wards for the purposes of clinical iusiru'ction, satisfied that
they will thereby more elliciently aid the cause of humanity, and more perfecll)" accomplish
the bcne\olent intentions of the founders of the charity.

3. Resolved, That the practice of ap])ointiiig ])\\\ sici&ns and surgeons to the charge of an
hospital on political, or other grounds tiian those of jirofessional and moral worth, is incon
sistent with the welfare of its inmates, and of consequence, inhumane and unjust, subveisivo
of the objects of its founders, and incompatible with a conscientious appreciation of tlie high
responsibilities devolved on the appointing power.

4. Resolved, That this committee reiterate, and strongly recommend to the associa'ion, a
practical observance of the resolutions appended to the report of the committees on jjrelimin-
ary education, and on the requisites for gradua'ion, submitted to the medical conventiou,
which assem)led in Philad. Iphia, in May, 1S47.

5. Resolved, That the faculties of the different schools be requested and advised to institute
daily or weekly examinations, reca])itulatory of the pievious lecture or lectures, and take
such measures as may enable them to ascertain the regular attendance of the students upon
the lectures up to the close of the term.

6. Resolved, That this association recommend to the faculty of each medical school to con-
duct the final examination of candidates for di])loma, in presence of some oIKcial ])crson or
persons properly qualified to recognize the attainments of the candidate, but who has no
pecuniary interest in the institution or in the number of its pupils.

7- Resolved, That it be also recommended, that, in view of the usual inaugural Thesis, or iu
piddition thereto, each candidate for the diploma be required to present to the faculty, at or
Jjefore the time of final examinalion, a report drawn up by himself and from his personal ob-
servation, of not fewer than ^jue cases of disease, and upon which he shall be duly examined.

8. Resolved, That ihe faculty of each medical school be requested, annually, and as early
as possible, to furnish the chairman of the committee on education with a statement of the
number of pupils and of graduates jn their resjiective schools, together with such other in-
formation as may expedite the labours of the committee, and enable it to discharge the duties
assigned by t!ic constitution under which it acts.

Dr Hays asked jjcrmission to enquire whether it was the sense of the association in refer-
ring the minutes, reports of the standing rommittes, with the accompanying documents and
other paj)ers to the committee on publications, that these should be i)ublished entire or that
the committee should have discretionary powers ? when on motion it was resolved that dis-
Cretionary powers be vested in the committee.

On motion of Dr. J. L. Atlee, a resolution was adopted, earnestly recommending to the
physicians of those States in which State Medical Societies do not exist, to take measures to
organize State Societies before the next meeting of the American Medical Association.

The corrmittee to whom was referred the communication of the Medical Department of
the National Institute, on the subject of hygiene, rejjorted, recommending the api)ointment
of a committee on hygiene, to consist of twelve members, to be ap[iointd liy the president,
with ]>ower to fill vacancies. The following constitute this committee :.,-Drs. James Wynn,
Bait.; Charles P. Cage, Concord, N. H.; J M. Thomas, Washington, D. C; Isaac Paiiish,
Philnd ; P. C. Gaillard, Charleston; L.Y. Vandell, Lnuisville ; J. P. Harrison, Cincinnati ;
A- Smith, Petersboro', N. H ; J. Curtis, Louisville; E H. Barton, N. O.; J. H. Griscom,
N. v.; 'I rirner, N. O.

Rtsolved, That in order to prevent the Lass of lime to the Association, the committee of ar-
rangement be requested to sit on the day before the annual meeting, and that all members
uho arrive on that day be desired to i>resent their credentials without delay.

On motion of Dr. G L. Corbin, a comniittee of twelve was ordered to represent the associ-
ntion at tiie meeting of the British Association, and of the Prov. Med. and Surg. Association,
nnl the following were appointed : Dr. Geo. B. Wood, of Philada ; Jacob Bigelow, of Boston,
and H H. McGuirc. of Winchester, Va

On motion of Dr Zulick, the mmibcrs of the association were reqtiestcd to transmit to the
chairman of the appropriate standing committees, the histories of any important cases, which
they may meet with in practice.

We have hut a sin:le rommenl fo make on Ihcse iTPoliition.!; it f.s in refer-
ence to Ihe jnsiire or propriely of'lhat one instriiclinp: ihe Committee, composed
o( one drlc!T;alc from each State, (o prcf'< nl llir )u/)!i(S of svch vicvihcrs avhi as ircre
in artual attendance. Thi.*!, ofcoiir^c, eKchideci The many excellent and worthy
members of ihc Association, wlio may have been absent from unavoidable cir-
cumf-tances, from participating in the prcparal ions for the next annual meeting.

1848.] Medical Intelligence. 439

T'o the Editor of the Southern Medical and Surgical Journal :

Dear Sir, I perceive ihat you have transferred to the pages of your valuable
Journal of the 1st of June, certain strictures upon Diinglison's Practice of
Medicine, originally published in the New Orleans Medical and Surg. Journal.
I have carefully compared the parallel columns intended to establish the serious
allegation of plagiarism preferred against the learned professor, and I must con-
fess that Ido not find the charge sustained. The candid readercannot fail to per-
ceive thai the language of the extracts is not identical! in both, and that if the
ideas seem to correspond, such must always be the case when different authors
have to treat a subject, admitting very little scope for the play of imagination.
The symptoms of a well understood disease must always be alike, and it
ought not to be considered strange that different writers will enumerate the
same, and often in nearly identical language. Common charity should there-
fore lead us to attribute such correspondences of expression rather to the nature
of the subject and to coincidence than to premeditated imitation. If this be
plagiarism, there will be found very few authors exempt from it vyhen describ-
ingvvell known things or facts. You would find instances of it in every page
on anatomy and symptomatology, on chemistry, physics, &c. We have ail
sins enough for which we should be held accountable, without having to bear
the brunt of those we have not committed, and this js especially the case with
Prof Dunglison, whose extraordinary propensity for book-making has so often
led him to the labor-saving use of scissors. One of the most striking illustra-
tions of this may be found in the autljor's Hu^an Physiology, a considerable
portion of which is a translation verbatim et literatum of Adelon's " Physiologie
de I'homme." The fact here mentioned attractel my attention long since, and
would have been then publicly n,otice,d had i not preferred leaving the ungrate-
ful office to others who might have more taste for denunciation. Nor would
I even now do violen.ce to my feelings, were it not for the desire to relieve the
author from the charge of plagiarism where it cannot be clearly demonstrated,
and to place him upon the grounds he has chosen for himself, Let us see the
relation which the Human Physiology bears to the work of Adeionj and to do
this ihs respective works may be compared at almost any chapter, I open at
random the second volume of Dunglison's work, Jst edition, published in 183^,
and at page 25 find the section on " The absorptiori of Lymph." The same sub-
ject is treated by Adelon, in the 3d vol. of his secopd edition, published in 1823.
The following parallels speak for themselves;

'^ The lymphatics consist of twoplanes "Ilsmarchent sur deux plans, I'un
. ihc one superjicial, the olher deep-seat- svpcrficiel, qui rampe sous la peau ou
ed. Tlie former creeps under the outer sous la membrane qui enveloppe I'or-
covering of the organ, or of the skin, gane, et qui accompagne les veines
and accompanies the subcutaneous superficielles et sous-cutatvees; I'autre
veins. The latt*^r is seated more deeply profoixd, quj est situe plus profondement
in the interstices ofthe muscles, or eyen dans les interstices des muscles, ou dans
in the tissue of parts^ and accompanies letissuemcmedes parlies, etqui accom-
the nerves and great vessels. These pagne les arteres. Pes anastomoses ex-
planes anastomose with each other, istent entre ccs deux plans. Cette dis-
This arrangement occurs not only in position ne se remarque pas seulemcnt
the limbs, but in the irunk, and in ev- dans les membres; elle a lien dans
ery viscus. In thetrunk, the superficial chaque visccre, et dans le ironc lui-
plane is seated beneath the skin; and meme, ou Ton voit le plan superficiel
the deep-seated between the muscles des vaisseaux lymphatiquesau-dessous
and the serous membrane that lines the dj2 la peau, et le plan profond entre les
splanchnic cavities." chairs et la membrane sereuse quilap'

isse les cavites splanchniquea/'

440

Medical Intelligence.

[July,

"The lymphatics have been asserted
to be more numerous than the veins;
by some, indeed, the proportion has been
estimated at fourteen superficial lymph-
atics to one superficial vein ; whence it
has been deduced, that the capacity of
the lymphatic system is 'greater than
that of the venous. This must, of
course, be mere matter of conjecture."

'It has been a matter of some inter-
est to determine whether the lymphatic
vessels have not other communications
with the venous system tlian by the two
trunks just described ; or, whether, soon
after their origin, they do not open into
Ihe neighboring veins; an opinion,
which lias been enunciated by many of
those who believe in the doctrine of ab-
sorption by the lymphatics exclusively,
in order to explain why absorbed mat-
ters are found in the veins. Many of
Ihe older, as Aveil as more modern,
anotomists have proiessed a similar
opinion.

" ViEussENs affirmed, that, by means
of injections, lymphatic vessels were
distinctly seen to originate from the
minute arteries, and to terminate in the
small veins. Sir William Bltzard as-
serts that he twice observed lymphatics
terminating directly in the iliac veins.
]R.i}iE,s, by injecting the supra-hepatic
veins, saw the substance of the injec-
tion enter the superficial lymphatics of
the liver. Alard considers the lymph-
atic and venous systems to communi:-
cate at their origins. Vino. Foiimann,
that the lymphatic vessels communi-
cate directly with the veins, not only in
the capillaries, but in the interior of the
lymphatic glands. Lautii, of Slrasr
bourg, who went to Heidelberg to
learn from Foumann his plan o( inject-
ing, announced the same facts in
1824.

"By this anatomical arrangement,
Ladtii explains how an injection, sent
jrito the arteries, reaches the lymphat-
ics, without being effused into the cel-
lular tissue; the injection passing from
the arteries into the veins, and thence,
by a retrograde route, into the lymphat-
ics, Bkclard believed, that this com-
munication exists at least in the interi-
or of the lymphatic glands; and he
supported his opinion by the fact, that
in birds, in wliich these gland.s are
vaiiLing, and are replaced by plexuses,
the lymphatic vessels in these plexu.ses
are distinctly seen to open into th^
veins. Lastiy, in 182.5. Rkoolo Lu'pi,
of Florence, in his lUuslrazioni Fizio-

"Les lymphatiques sont, dit-on, plus
nombreux que les veines; on dit qu'il
y a quatorzc lymphatiques superficiels
pour une veine; d'oxil'on etablitquela
capacite du systcme lymphatique est
superieure a ce)le du .systeme veineux.
Mais, d'abord, il est impossible de pre-
ciser la capacite de chacun de ces sys-
temes."

" Une importante question est cells
de savior si les vaisseaux lymphatiques
n'ont pas, dans le systcme veineux,
d'autre abouchement que par les deux
troncs que nous venons de decrire; ou
si, au contraire. ces vaisseaux, chemin
faisant, et des leur origine, s'ouvrent
dans les veinesqui lesavoisinent. Nous
avons annonce que beaucoup de secta-
teurs de I'absorption exclusive par les
lymphatiques, afin depouvoirexpliquer
pourquoi les maticres absorbees se re-
trouvent dans les veines, avaient emis
cetle derniere opinion; et, en effet, beau-
coup d'anatomistes anciens et modernes
la professent. Viensscns, par ex em pie,
dit avoir reconnu, a Paide d'injections,
que des vaisseaux lymphatiques naisr
sent des parois des dernieres arterioles
et vontaboutiraux parois des dernieres
yeinules. BUzard assure avoir vu
deux fbis une terminaison directe de
lymphatiques dans les veines iljagues.
M. Rihcs, en injectant les veines sus-
hepatiques, a vu la matiere de I'injec-
tion penetrer dans les vaisseaux lymph-
atiques superficiels du foie. M. 4l^ard
qui, dans I'ouvrage que nous avons
cite plus haut,nie I'absorption veineuse,
fait de la communication des systemes
lymphatique et veineux a leur origine
la ba.sc de tqute sa theorie. En 1820, un
anaiomistede Heidelberg. M. FohmaTn
a avance que les vaisseaux lymphatir
quescommuniquaientdirectementavec
les veines, non-.seulement dans leurs
premiers plexus, dans leurs plexus ca-
pillaires, mais encore dans I'interieur
des ganglions lyinphatiques. II a 6t^
suivi en cela par M. Lanth de Stras-
bourg, qui etait alle en Allemagne ap-
prendre de 31. Fokman son procede
d'injcction, et qui a annonce les m^mes
fails dans sa dissertation a I'^cole de
Strasbourg en 1824: par cctte disposi-
tion nMritomi(juc, M. Lavlh explique
comment une injection poussee dans
Icsarleresarrive dansles lymphatiques,
sans s'clre epanchee dans le tissue celr
lulaire; I'injcction a passe des arteres
aux veines, et de celles-ci par voie ret.
rograde aux lymphatiques. Beclard
pensait que cettc communication exist-

1848.]

Medical Intelligence.

441

logiche e Palkologice del Sistema Livfati-
co-chilifero, has made these communi-
cations the express subject of his work.
According to him, the most numerous
exist between the lymphatic vessels of
the abdomen and the vena cava inferior
and all its branches. So numerous are
they, that every vein, according to him,
receives a lymphatic vessel, and the
sum of all those vessels would be suffi-
cient to form several thoracic ducts.
Opposite the second and third lun)bar
vertebrae, these lymphatic vessels are
manifestly divided into two orders;
some ascending, and emptying Ihem-
selves into the thoracic duct; others
descending and opening into the renal
vessels and pelves of the kidneys.

"Lippi admits the same arrange-
ment, as regards the chyliferous vesf^els ;
and he adopts it to explain the prompti-
tude with which drinks are evacuated
by the urine."

" Subseqent researches do not seem
to have confirmed the statements of
Lippi. G. Rossi, indeed, in Omodei's
Annals for January, 1826, maintains,
that the vessels, which Lippi had taken
for lymphatics, were veins. Ttie ques-
tion is still sid) lite."

"Chaussier includes, in the lymphatic
system, certain organs, whose uses in
the economy are not manifest, the
thymus gland, the thyroid gland, the
supra-renal capsules, and perhaps the
spleen. These he considers as varie-
ties of the same species, under the name
gUmdiform ganglions."

ait au moins dans I'interieur des gang-
lions, et il appuyait son opinion sur ce
ce que dans les oiseaux, oii les gangli-
ons manquent et sont remplaces par des
plexus, on voit disiinciement dans ces
plexus les vaisseaux lymphatiques
s'ouvrir dans les veines. Enfin, en 1825,
M. Lippi de Florence a public sur I'a-
natomie des vaisseaux chyliferes et
lymphatiques, un travail dans leqnel
celle communication est encore plus
completement annoncee; il ne s'agit
plus en efiet d'anastomoses, rares, a
I'aide de vaisseaux capillaires, et cach-
ees dans I'inlerieur des ganglions, ma is
de communications etablies par lemoy-
en de gros vaisseaux. Selon M. Lippi,
il existe les com.munications les plus
nombreusesentre les vaisseaux lymph-
atiques de I'abdomen et la veine-cave
inlerieureet toutesses branches, veines
lombaires, spermatiques, sacree moy-
enne, veine azygos, etc.; ces commu-
nications sont a tel point multipliees,
que toute veine le^oit un vaisseau
lymphatique, et que la somme de tous
ces vaisseaux lymphatiques formerait
plusieurs canauxthoraciques. Au ni-
veau des deuxieme et troiseme vertebres
lombaires, ces vaisseaux lymphatiques
se partagentmanifestementen deuxor-
dres, les uns ascendants, qui vontabou-
tir au canal thoracique, les autres de-
scendants, qui vont s'ouvrir dans les
veines renales et dans les bassinets des
reins. Nous avons deja dit que M.
Lippi admettait sur tous ces points des
.dispositions semblables dans les vais-
seaux chyliferes, etqu'il s'en etaitservi
pour expliquer la promptitude avec la-
quelle les boissons sont evacuees par
I'urine."

" Les recherches qu'on a faites depuis
la publication du travail de cet anato-
miste n'ont pas confirme les faits qu'il
avait annonces; M.Rossi a soutenu
que les vaisseaux que M. Lippi avait
pris pour des lymphatiques n'etaientau
contraire que des veines; la question
reste encore en Jitige parmi les anato-
mistes."

" M. Chaussier considere comme ap"
partenant aux ganglions lymphatiques,
un certain nombre d organes dont les
usages dans Teconomic ne sont pas en-
core bien conn us, telsque le thymus, la
tliyroidc, les capsules surrenales, et
peut-ctre la rate; il en fait une section
$. part, sous le noni de gatiglions gland-
iformcs."

442

Medical Intelligence.

[July,

" The thymns gland is a body, con-
sisting of distinct lobes, situated at the
upper and anterior part of the thorax,
behind the sternum. It belongs more
particularly to loetal existence, and will
be investigated hereafter.

" The tiuiroid gland is, also, a lobular
organ, situated at the anterior part of
the neck, beneath tlie skin and some
subcutaneous muscles, and resting upon
the anterior and inferior part of the
larynx, and the first rings of the trachea.
It is formed of lobes, which subdivide
into lobules and ^ranula; has a red
and .sometimes a yellow colour; and
presents, internally, vesicles, filled with
a fluid, which is viscid and colourless
or yellowish. It has no excretory duct;
and, consequently, it is difficult to dis-
cover its use. It is larger in the foetus
than in the adult; and has, therefore,
been supposed to be, in .some way, in-
servient to foetal existence. It contin-
ues, however, through life, receives
large arteries, as well as a number of
nerves and lymphatics, and hence, it
has been supposed, fills some important
office through the whole of existence.
This, however, is all conjecture."

"Lastly, the snpra-renal or atraiUia'
ry capsules or glands, are small bodies
in the abdomen, without the peritone-
um, and above each kidney. The arte-
ries, distributed to them, are large; and
the glands themselves are larger in the
fioetus than in the adult. They, like-
wise, remain during life. These bodies
consist of small sacs, with thick, paren-
chymatous parietes; are lobular and
granular ; the internal cavity being fill-
ed with a viscid fluid, which is reddish
in the foetus, yellow in childhood, and
brown in old age."

'^ Lymph may be procured in two
ways, either by opening a lymphatic
vessel, and collecting the fluid, that
issues from it, but this is an uncertain
method, or by making an animal fast
for four or five days, and then obtaining
the fluid from the thoracic duct. This
has been considered pure lymph,"

" Le thymus est un corps forme de
cinq a six lobes distincts, situe dans le
thorax, a sa panic superieure et anter-
ieure, derriere le sternum, et qui, ap-
partenant plus pariiculicrement au pre-
mier age de la vie, sera decrita I'article
du fanus. La thyroidc est un organe,
lobulaire aussi, situe a la partie anle-
rieure du col, au-dessous de la peau et
de quelques muscles sous-cutanes, ap-
puye sur la partie anierieure et inferi-
eure du larynx etles premiers anneaux
de la trachee-aricre. Forme de lobes
qui se subdivisent successivement en
lobules et en grains, cet organe a une
couleur tantot rouge, tantol jaune, et
presente interieurement des vesicules
remplies d'un fluide qui est visqueux
et incolore ou jaunatre. On a dit qu'il
servait a secreter le mucusbronehique;
mais jamais on n'a pu lui trouver un
canal excreieur. Comme il est plus
volumineux dans le Jbcius que dans
I'adulte, on peut le croiree destine plus
particulierement a quelques fonctions
nutritives relatives a cet age; cependant
sa persistance j usque dans I'extreme
vieillesse, le volume enorme des arteres
qui lui arrivent, ainsi que le nombre
des nerfs et vaisseaux lymphatiques
qui le penelrent, ne permettent pas de
douter qu'il ne remplisse aussi, dans
tout le cours de la vie, quelque office
important, mais inconnu."

"Nous en dirons autant des capsvks
surrenales, petils corps places dans Tab-
domen, horsdu peritoine, au-dessus de
chaque rein dont iis embrassent I'ex-
tremite superieure; les arteres qui y
aboutissent out aussi plus de volume
chez le loetus que chez I'adulte; mais
comme ces organes persistent pendant
toute la vie, on ne peut les croire inu-
tiles. lis consistent endepetitespoches
a parois parenchymateuses epaisses,
dont le tissu est aussi lobulaire, gran-
ule, et dont la caviie interieure est
pleine d'un fluide visqueux, qui est
rougeatre dans le foetus, jaune dans
I'enfance, et brun dans la vieillesse."

"D'abord, il est deux manicres de
.-'en procurer: ou bien Ton ouvre plus-
icurs vaisseaux lymphatiques par une
sorte de lymphee, comme S(r7n7ncring
I'a fait une foisau pied,et Ton recueille
le fluide (jui en sort; ou bien, Ton fait
jeuncr quatre a cinq jours un animal,
ct quand on presume qu'il ne se fait
plus de chyle par suite de I'abslinence,
on tue I'animal, et on recueille le fluide
qui est dans le canal thoracique, et
qu'on suppose devoir itre alors de la
lymphe piue."

1848.]

Medical Intelligence.

443

"The fluid, thus obtained, is of a
rosy, slightly opaline tint, of a marked
spermatic smell, and saline taste. At
times, it is of a decidedly yellowish co-
lour; and, at others, of a madder red;
circumstances, which may have given
occasion to erroneous inferences, in
experiments, made on the absorption of
colouring matters. Its specific gravity
is, to that of distilled water, as 1022.28
to 1000.00, Its colour is affirmed to be
more rosy, in proportion to the length
of time the animal has fasted. When
examined by the microscope, it exhibits
globules like those ot the chyle ; and,
like the chyle, bears considerable analo-
gy, in its chymical composition, to the
biood. When left at rest, it separates
into two portions; the one, a liquid,
nearly like the .serum of the blood; and
the other a coagulum orclot of adeeper
rosy hue; in which a multitude of red-
dish filaments appear, disposed in an
aborescent manner; and, in appear-
ance, very analogous to the vessels,
which are distributed in the tissue of
the organs."

"Mr. Brande collected the lymph
from the thoracic duct of an animal,
which had been kept without food for
twenty-four hours. He Ibund its chief
constituent to be water; besides which,
it contained muriate of soda and albu-
men ; the latter being in such minute
quantity, that it coagulated only by the
action of gah^an ism. The lymph of a
dog yielded to Chevreul, w^ater, 926.4;
fibrine, 4.2; albumen, 61.0; muriate of
soda, 6.1; carbonateof soda, 1.8; phos-
phate of lime, phosphate of magnesia,
and carbonate of lime, 0.5."

"It is impossible to estimate the
quantity of lymph contained in the bo-
dy. It would seem, however, that not-
withstanding the great capacity of the
lymphatic vessels, there is, under ordin-
ary circumstances, but little fluid cir-
culating in them. Frequently, when
examined, they have appeared empty,
or pervaded by a mere thread of lymph.
Magendie endeavored to obtain the
whole of the lymph from a dog of large
stature. He could collect but an ounce
and a half; and it appeared to him,
that the quantity increased, whenever
ihe animal was kept fasting."

" Voici les propridtes physique qu'elle
presenter c'est une liqueur diaphane,
incolore, peu odorante el peu sapide
selon les uns; qui, selon les autres, a
une couleur rosee, legcrement opaline,
une odeur de sperme loriprononce, une
saveur salee ; qui est legerement vis-
queuse, essentiellement albumineuse,
et dont la pesanteur specifique est su-
pericure a celle de I'eau dislillee; le
rapport de I'une a I'autre est comme
1022,28, a 1000,00. Sa couleur, dit-on,
est d'autant plus ro&ee. que I'anim; 1
sur lequel on I'a prise a plus jeiine.
Examinee au microscope, elle offre les
memes globules que ceux qui compo-
sent le sang, sinon qu'ils sont plus pe-
tils, et non revetus de I'envelopi'e colo-
rante Dans sa composition chimique,
elle a beaucoup de ressemblance avec
le sang. Abandonnee a elle-meme,
elle se partage comme lui en deux par-
ties: 1 une liquide, qui est un serum
a peu pres semblable a celui du sang;
2 une solide, qui est un caillot d'un
rose plus lonce, forme de filaments rou-
geatres, ressemblant a des arborisations
vasculaires, et compossee aussi comme
le caillot du sang."

" M. Brande, qui le premier a fait
I'analyse de la lymphe, dit qu'elle est de
I'eau tenant en dissolution un peu d'al-
bumine, de chlorure de .'^odium, et un
peu de sonde. Dans 1000 parties de
lymphe retiiee d'un animal ajeun, M.
Chevreul a trouve: eau, 926,4; fibrine,
004,2; albumine, 061,0; muriate de
soude, 0(;6,1 ; carbonate desoude 001,8;
phosphate de chaux, de magnesie, et
carbonate de chaux, 000.5."

"Gluant a la quantite de la lymphe,
il n'est guere possible de I'evaluer.
Comment pouvoir recueillir toute celle
qui remplit le systeme lymphatique 1
Peut-etre cette quantite est-elle moins
considerable qu'on ne I'a suppose d'ap-
res la grande capacite du systeme lym-
phatique et le grand nombre devaisse-
aux dece systeme 1 En etfet,beaucoup
de ces vaisscaux paraissent etre vides
le plus souvent, ou n'ctre parcourus
que par un mince filet de lymphe. Une
expierience particuliere de M. Mo gen die
porte aussi ale croire. Ce phy.^iologiste
cherchant a recueillir toute la lymphe
d'un chien de Jorte tailie, n'en a guere
obetnu qu'une once et demie; il lui a
paru que cette quantite augmentait
toutes les fois qu'on soumettait I'animal
a I'absiinence."

444

Medical Intelligence.

[July,

" At one period, the lymph was con-
sidered to be simply the watery portion
of the blood; and the lymphatic vessels
were reganied as the mere continuation
of the ultimate arterial ramifications.
It was adirined, that the blood on reach-
ing: the final arterial branches, separa-
ted into two parts; the red and thicker
portion returning to the heart by the
veins; and the white, serous portion
passing by the lymphatics. The rea-
sons for this belief were, the great re-
semblance between the lymph and
serum of the blood; and the facility
with which an injection passes, in the
dead body, from the arterial, into the
lymphatic capillary vessels. Magen-
DiE has revived the ancient doctrine;
and, of consequence, no longer consid-
ers the lymphatics to form part of the
absorbent system ; but to belong to the
circulatory apparatus,"

" This system consists of myriads of
vessels, called vems, which commence
in the very textures of the body, by what
are called capillary vessels; and from
thence pass to the great central organ
of the circulation the heart.

"The origin of the veins, like that of
all capillary vessels, is imperceptible.
By some, they are regarded as continu-
ous with the capillary arteries; Mal-
PiGHi and Leuwknhoek state this as the
result of their microscopic observations
on living animals; and it has been in-
ferred. Irom the facility with which an
injection passes from the arteries into
the veins. According to others, cells
exist between the arterial and the ven-
ous capillaries, in which the former
deposit their fluid and M'hence the latter
obtain it. Oihers, again, substitute a
spongy tissue for the cells.

"A question has also been asked,
whether the veins terminate by open
mouths; or whether there mav not be
more delicate vessels, communicating
with their radicles, similar to the ex-
halants, which are presumed toe.xist at
the extremities of the arteries, and are
the agents of exhalation.

"All tiiis is, however, conjectural."

"Avant la decouverte du systeme
lymphaiique, les Anciens regardaient
la lymphe comme n'eiant que la sero-
sii6" du sang. II en fut de mcme
encore dans les premiers temps de la
decouverte de ce systeme, lorsqu'on
disait que les vaisseaux lymphatiqnes
n'etaieni que la continuation des der-
nieres arterioles. On etablissait que
le sang, arrive aux dernieres rami-
fications des arteres, se partageait en
deux parties; une rouge, phis con-
sistante, qui etait rapporlee par les
vcines; et une blanche, sereuse, qui
etait repportee par les lymphatiqnes.
Lespreiivessur lesquellesonse fondait
etaient la resemblance apparente qui
existe entre la lymphe et la serosite du
sang, et la facilite avec laquelle une
injection cadaverique passe des dern-
ieres arterioles dans les premiers radi-
cules des lymphatiqnes. Dans cette
maniere de voir, qui est encore celle de
M.Mage7idie,(ii\\ niel'absorption lym-
phatique, I'histoire de la lymphe ne
devrait pas se rapporter a la fonction
des absorptions, mais a celle de la cir-
culation."

"Use compose, chez Thorame, de
vaisseaux nombreux, appeles veinet^
qui, commencant dans I'intimite de
toutes les parties du corps.dansce qu'on
appelle les sj/ste/nS capiUmres,se portent
depuis ces lieux divers ou se lont les
absorptions internes, jusqu' a I'organe
central de la circulation, le cqcur.''

" Leur criginc dans la profondcur dos
parties nous echappe. Selon les uns,
les veines sont continues aux ramifica-
tions dernieres des arteres; MaJpii^hi,
Lcuwenhocck, par exemple, croient I't
avoir remarque dans leurs observations
microscopiques sur les animaux viv-
ants. On I'a ditaussi d'apres la facili::
te avec laquelle une injection passe
d'une artcre dans une veine, facilite
qui est plus grande iciqu'cn tout autre
vaisseau. Selon d'autres, aucontrairc
il y a, outre les arterioles dernieres ct
les premieres vcinules, des cellules, nri
parenchyme sp()ngieux,dansle(inel les
premieres deposent des sues et ou les
dernieres en pompent d'autres. Le
doule ici tient al'impossibilite ou not^S
.sommcs de penetrer la texture des.sys-
temer capillaircs, comme nous I'avons
deja dil a Tarticle des lymphatiques, et
comme nous le dirons encore a celui
de la circulation. Les veines coinmen?
cent-elles, comme les lymphatiqnes,
par des radicules beants aux diverse*
surfaces 7 Ou ont-clles a leur originp

1848.]

Medical Intelligence.

445

"When the veins become visible,
they appear as an infinite number of
tubes, extremely small, and communi-
cating very I'reely with each other; so
as to form a very fine net-work. These
vessels gradually become larger and
less numerous, but still preserve their
reticular arrangement; until, ultimate-
ly, all the veins of the body empty them-
selves into the heart, by three trunks."

"In their course towards the heart,
particularly in the extremities, the veins
are divided into two planes j-^one sub-
cutaneous or superficial; the other deep-
seated, and accompanying the deep-
seated arteries. Numerous anastomoses
occur between these, especially when
the veins become small, or are more
distant from the heart."

"Leaving the organ, we find them
situated between the laminae of the dura
mater; when they take the name of
sinuses. In the spermatic cord, they are
extremely tortuous, anastomose repeat-
edly, and t'onn [he corpus pampiniforme ;
around the vagina, they constitute the
corpus retiforme; in the uterus, the uter-
ine sinuses, &,c."

" The veins have three coats in super-
position. The outer coat is cellular,
dense, and very difficult to rupture.
The middle coat has been termed the
proper ynembrane of the veins. The gen-
erality of anatomists describe it as com-
posed of longitudinal fibres, vrhich are
more distinct in the vena cava inferior
than in the vena cava superior; in the
superficial veins than in the deep-seat-
ed: and in the branches than in the
trunks."

"The difficulty of arriving at any
exrct conclusion, regarding the relative
capacities of the two systems, is forci-
bly indicated by the fact, that whilst
BoRELLi conceived the preponderance in
favour of the veins to be as four to one ;

des vaisseaux pins delies, charges
d'etfectner I'absorption, de meme que
les arteres en auraient, a leur terminai-
son, charges d'effectuer I'exhalation
nutritive 1 Encore une fois, tout cela
ne pent etre presente que comme con-
jecture."

"A partirde cetteorigine, lesveines,
quand elles commenceni a ^tre visibles,
se presentent sons forme de cananx
tres tenus, communiquant tons les uns
dans les autres, et constitnant nn reseau
ires delie Elles cheminent de la en
formant successivement des ramns-
cules, des rameaux, des branches, des
troncs. en un mot, descanaux de plus
en plus gros et de moins en moins
nombreux, et en se dirigeant du cote
du coeur, dans I'oreileette droite duquel
elles finissent par aboutir par trois
troncs."

" Dans le long trajet qu'elles ont a
parcourir, elles afiectent deux plans:
\\r\prof(md, qui estcontigu eaux arteres
et se distribue comme elles; et un 52^.-
perficicl, qui se dessine sous la pean, et
sous I'enveloppe de chaque organe : de
tres Ireqnentes anastomoses les unis-
sent. Ces anastomoses s'etendent des
veines superficielles aux veines pro-
fondes."

"Du reste, ces Veines oftrentpresque
foutes des particularites dans chaque
partie du corps; par exemple, au cer-
veau, elles aboulissent toutesaux sinus
de la dure-mere j au cordon spermati-
que, elles, sunt tres flexueuses, anasto-
moses tres frequemment enire elles, et
forment ce que nous verrons y etre ap-
pele le corps pampiniforme ; autour du
vagin, elles forment le corps retiforme ;
dans I'uterus, les sinus uterins, etc."

" Enfin, les veines sontcomposees de
trois membranes superposees les unes
aux autres et uniesenire elles par de la
cellulosire. 1 La membrane exteri-
eure est celluleuse. et n'est gucre qu'une
condensation du tissu cellulaire envi-
ronnant, de ce tissu jete dans I'inter-
valle des parties pour en remplir les
vides. 2 Au-dessous est la membrane
propre des veines, qui adhere beaucoup
a la premiere."

" Mais on ne peut evaluer en chiffres
de combien I'un surpasse I'autre. Bor-
elii dit que le systeme veineux a qnatre
fois plus de capacite que le systeme ar-^
teriel, et est a ce systeme comme de
quatre a. un; Sawt^^Jj^^dit commeneuf a

410

Medical Intelligence.

LJuly,

Sauvages estimated it at nine to four;
Hai.i.er at sixteen to nine; and Kr-iLat
Iweniv-five to nine."

"All the veins, that return from the
digestive organs, situated in the abdo-
men, unite into a large trunk, called the
vena porta. This, instead of passing
into a larger vein, into the vena cava,
for example, proceeds to the liver, and
families, like an artery, in its substance.
From the liver, other veins, called
supra-hrpatic, arise, which empty them-
selves into the vena cava; and which
correspond to the branches of the hepatic
artery as well as to those of the vena
portoB. The portal system is concerned
only with the veins of the digestive or-
gans situated in the abdomen; as, the
the spleen, pancreas, stomach, intestines
and omenta. The veins of all the other
abdominal organs, of the kidney, su-
pra-renal capsules, &c., are not connect-
ed with it."

" Its smell is faint and peculiar ; by
some compared to a fragrant garlic odour,
but it IS sui generis ; its taste is slightly
saline and also peculiar. It is viscid to the
touch ; coagulable, and its temperature
has been estimated at 96 Fahrenheit."

" When blood is examined with a mi-
croscope of high magnifying powers, it
appears to be composed of numerous, min-
ute, red particles or globules, suspended
in the serum. These red particles have
a difFerent shape and dimension, accord-
ing to the nature of the animal."

" When blood is drawn from a vessel
and left to itself, it exhales, so long as it
is warm, a vapour consisting of water and
animal matter, of a nature not known."

" After a time the blood coagulates,
giving off", at the samp time, a quantity of
c.'irbonic acid gas. This disengagement
is not evident, when tho blood is suff"ercd
to remain exposed to the air, except by
the apertures or canals formed by its pns-
KOge through the riot; but it can be col-
lected by placing the blood under the
receiver of an air pump, and exhausting
(he air."

quatre c*est-a-dire qu'il a plus dii dou-
ble de capacite ; Ilallcr corame seize a
neuf, ce qui est un pen moins dii dou-
ble; KeU comme vingt-cinq a cinq, ce
qui est les quatre cinquiemes."

"Toutes les veines qui reviennent
des organcs digestifs situes dans I'ab-
domen se reunnisent en un gros tronc
qu'on appelle veine-parte ; celle-ci, en-
suite, an lieu de se rendre a une veine
plus grosse a la veine cave inferieure,
par exemple, va se raraificr a la mani-
ere d'nne arleredans le tissu du foie;
et de ce foie naissent alors d'autres
veines appelees sns-hepafiqves qui se
rendent a la veine cave inferieure, mais
qui proviennent autant des arteres du
foie que des rameaux de laveine-porte.
Cette exception bien remarquable, et
sur I'utilite de laqiiellc on a fail mille
conjectures, ne porie que sur les veines
des organes digestifs situes dans I'ab-
domen, la rate, le pancreas Tesioraac,
I'intestin, les epiploons; hs veines de
lous les autres organes de I'abdomen,
des reins, de la vessie, des capsules
surrenales, des organes genitaux, des
parois abdominales, y sont etrangeres.'

" D'une odeur fragrante d'ail ou fade,
sm gc7}cr/ 5,6' une saveur legerement salee
d'une chaleur egale a cclle du corps hu-
main, visqueux au toucher, coagulable,
et d'une pesanteur specifique superieure
a celle de I'eau distille."

" C'est surtout a I'etude de ce fluide
qu'a ete applique le microscope : le sang
examine avcc ect instrument a paru
compose d'un vehicule sereux, dans lequel
sont en suspension de petits globules
rouges, sur la forme desquels les observa-
tcurs ne sont pas d'accord, et dont le vol-
ume d'aillcurs n'cst pasle mcme dans les
animaux."

" Ce fluide extra it des vaisseaux qui le
conticnncnt, et abandonue a lui-mcme
d'abord exhale, pendant tout le temps
qu'il conserve sa chalpur,une vapeur
formee d'eau et d'une matiere aniraale
putrescible."

" Ensuite il se coagule en degagean*
une grande quantite de gaze acide car-
bonique. Ce degagement n'est mani-
feste q\iand le sang est laisso a I'air libre,
que paries canaux qui en resultent dans
I'interieur du coagulum ; mais on en re-
cueille lo produit en pla^ant le sang sous
le recipient d'une machine pneumatique,
oil Ton a f<ntle vide.''

1848.] Medical Intelligence. 417

See 2d Vol. Dunglison's Human Physiolog\', pp. 25, 26, 27, 28, 29, 30, 33, 37,
39, 40, 45. See also, Adelon's " Physiologie, de L'Homme," pp. 71, 73, 74, 75,
76, 80, 81, 83, 100, 101, 102, 103, 104, 105, 106, 107, 109, 110, 124, 125, 126.

Other parallels may be found by comp .ring Dunglison, vol. 2d, pp. 46, 47,
57, and vol. 1st, at pp. 461, 463, 465, 467, 468, with Adelon, vol. 3, p. 117 and
vol. 2, pp, 394, 397, 401, 409, 410.

These comparisons \vill,perhaps, explain the wonderful facility with which the
author manufactures books, for it appears that he not only quotes the views of
Adelon, but continually appropriates his quotations. A reputation for medical
lore is thus acquired with but little trouble. Prof. D. must certainly put a very
low estimate upon the erudition of his readers. The medical profession of the
United States have a right to feel indignant at a practice which the learned
gen'ibman woulJ certainly never have ventured in his own country.

X. Y. Z.

Amputation under Chloroform. Dr. E. C. Jones, of Madison, Ga., writes us
under date May 22d, that he had amputated the leg of a negro man, aged 45,
while the patient was under the influence of chloroform. The operation was per-
formed in the presence of the medical gentlemen of the place, and the aneesthetic
effects of the preparation were of quite a satisfactory character.

The Bill prohibiting the importation of adulterated Drugs, has passed Congress.
The medical profession of the United States are chiefly indebted to the Apothecaries
of New-York, and to Dr. Edwards, member of Congress from Ohio, for the passage
of a bill imposing heavy penalties upon the importation into this countrj' of spurious
chemical and pharmaceutical preparations for the Materia Medica.

Honourable Fees. We were recently c lied into consultation with the Profes-
sor of Obstetrics, &c., in the Medical College of Georgia, to attend a lady in
puerperal convulsions. When the case terminated, a Bank check, signed by
the husband, who is a member of our Bar, with the amount left blank, was sent
to each of us.

Another. We learn that a Surgeon in Savannah, having operated success-
fully on the son of a lady in that city, had, besides his usual fee, a splendid
case of surgical instrumsnts presented to him by the grateful mother. These
are truly green spots in the arid professional path, and we have to regret they
are so far apart.

To remove Writing Ink. Writing Ink, says the Pharmaceutical Journal,
can be removed by a solution of muriat. ac. and chlor. sod., and made tore-
appear by a solution of ferro-cy an ide of potassium. [Annalist.

Isopathia something rich in Medicine. From the prolific brains of the Ger-
mans, we have again another theory of medicine it is this: the disease of an
organ is to be cured by taking as physic the analogous organ of some healthy
animal; thus inflammation, or a deficiency either, of the brain is cured by eating
asses' brain, or the brain of an ape disease of the liver by swallowing goose's
liver, &c., &c. Here is \\ie similia similUnts ZT^di the curantur with a vengeance.
Alas! what a rich consolation for the droopingspiritsof HomoBopathists, &c., &c.

448

Medical Inltlligencf. Meteorology.

MEDICAL MISCELLANY.
Ages of some of the Parisslmi Professors. ^eWeX^n QQ^ Rostan 58, Piorry 52,
Blandin 50. Cloqiiei.58, Velpean 53, Diibois53, Trosseau47, Dumas4S Gerdy
51, Bouillaud 52, Royer Collard, 46, Berard 50.

M. Laugier has been the successful candidate in Paris for the place of the lato
Prof. A. Berard, Clinical Surgery in the School of Medicine.

lyiirti/ Doctors oiihc 900 representatives to the National Convention of France
have been elected. Profs. Trosseau and Gerdy are among the number.

A woman at Hertford, in England, aged 64, has recently been delivered of a child.
She had had eleven children, the last at 55 years old. The case seems to be well
authenticated.

In 1847, 12,927,643 pounds of tea, and 150,332,992 pounds of coffee were con-
sumed in the United States.

The name of the Hospital of Louis Philippe of Paris, has been changed to that
of Hospital of the Republic.

Dr. Angelo Dubini states in the Bulletin General de Therapeutique for April, that
chloroform will preser\'e subjects. He even says the form, flexibility, volume and
color will be retained by it.

METEOROLOGICAL OBSERVATIONS, lor May, 1848, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 152 feet.

>-

Sun

s

Ther.

1

60

2

60

3

58

4

59

5

66

6

64

7

65

8

66

9

66

10

61

11

54

12

49

13

56

14

55

15

58

16

60

17

60

18

59

19

64

20

64

21

63

oo

63

23

66 1

at

63

25

66

26

68

27

68

28

69

29

68

30

68

3I|

67

Rise,
Bar.

11 3,
Ther.

P.M.
Bar.

29 90-100

71-I00|i

59-100;|

64-100;t

73-100:

80-100|i

75-100'

64-100,1

62-100

61-100

59-100

60-100

82-100

86-100

90-100

94-100

87-l0()l

83-10'

87-100|

79-100,

67-lOoi

61-100

62-100

66-100

72-100

77-100

76-100

80-100

67-100

59-100

60-100

66
80
78
80
81
88
88
80
82
74
66
63
72
82
84
78
82
82
70
76
82
86
86
86
82
76
76
69
83
84
82

Wind.

29 87-1001
" 55-100,
" 67-100
" 65-100
" 79-100
" 85-100
" 66-100
" 56-100
" 65-100
" 52-100,
" 55-1001
'' 70-100
" 85-100
" 86-100,
" 92-100|
" 92-100
" 84-100
" 84-100
" 87-1001
" 70-1001!
^' 61-100
" 59-100
" 59-100
" 63-100,
" 75-100
" 68.IOO1
" 79-100
" 80-100
" 63-100
" 55-l00|
" 63-100;

N. W.

s. w,

S. .

S.

S. W.

S. W.

N. W.

W,

w.
w.
w.

N. W.

w.
w.

E.

s.

S. E.
S. E.

E.
S, E.

s, w.
s. w.
s. w.

s.

s.

s.

E,
N. E.
E.
S.
E,

Remarks.

Rain last night 77^-100.
Cloudy.
Fair.

Scudding clouds.
Flying clouds.
Pair.
Fair.

Fair fl ving clouds dry gale.
Cloudy-^breeze. [25-100.

Thunder storm at 1, p.m. rain
Cloudy blow-^shower 5-100.
Fair flying clouds gale.
Fair breeze.
Fair blow at IJ, p.m.
Fair to !2M. thun. shower.
Fair breeze.
Fair some clouds.
Fair some clouds.
Cloud)' thun. shower 7^-10*0.
Cloudy ;pr inkle.
Cloudy.

Fair some flying clouds.
Rain 25-100.
Cloudy rain 30-100,
Cloudy thunder.
Rain thunder, &c. GO- 1 00.
jCioudy sprinkle and blow.
Rain storm, I inch 40-FOO.
Fair at 3, p.m. rain in morn'g.
Cloudy rain last night 20-100.
'Fair.

13 Fair days. Quantity of Rain 3 inches 90-100. Wind East of N. and a
10 days. West of do. do. 15 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 4.] NEW SERIES. AUGUST, 1848. [No. 8.

Part I. ORIGINAL COMMUNICAf IONS.

ARTICLE XXXIV.

Remarks on Labor, ohstructed by Tumors, with Cases. By
Washington P. Parker, of Villa Riga, Georgia.

In this paper, I shall not attempt to give any thing like a
regular essay upon this difficult, yet interesting subject, but
briefly notice some of the most important tumors, with which
-ve may expect to meet in practice, illustrated by two cases.

The obstruction, it need scarcely be said, is truly mechanical,
and leads to the development of formidable symptoms, and
delay in the second stage. But in this class of obstructions
there is imminently more danger, both to the mother and the
offspring, than in cases of simple powerless labor, for in the
latter there may be indulged a hope, that the uterus may be
aroused to action, without the assistance of art, but those me-
chanical obstructions generally indicate the necessity for their
removal, or interference in some way, involving the process,
with more or less danger. Nevertheless it is frequently justifi-
Me to Wait, where the symptoms in the case will justify the
detention, with the hope that nature will pi'-ovide the remedy,
either by displacing or rupturing the fumor, and thus for the
time being, at least, remove the impediment.

These obstacles do not at all interfere with the first stage of
labor ; for however large and unyielding be the tumor, the'
mouth of the womb continues to dilate with as much uniformi-
ty as ever, except in cases where the uterus itself be involved
in the disease.

29

450 Parker, on Obstructed Labor, [August,

The immediate danger is in direct proportion to the resist-
ance and the violent action of the uterus and abdominal mus-
cles, for if the resistance and action both be great, there will be
great danger of the parietes of the uterus being lacerated, and
thus producing fatal consequences ; besides this, the powerful
action of these organs and the great pain produced thereby,
(to say nothing of the fatal accident above alluded to,) hasten
exhaustion, and thus the vital forces escape, pain by pain, as the
electric spark reduces the prime conductor.

These tumors may be of various sizes and characters, as well
as various in their relations and consistence. First, then, of
their size, which may vary from the size of a hen's-egg to the
full size of the pelvis, of even larger, sometimes extending up
into the abdomen, displacing in its evolution both pelvic and
abdominal viscera. They may be fibrous, cartilaginous, fleshy,
adipose, cellular, steatomatous, sarcomatous, schirrous, or may
be variously modified may be malignant, or non-malignant .
may be sensible, or insensible highly vascular, or otherwise
acute or chronic, idiopathic or sympathetic.

The position, and relations, may vary also : they may exist
within the uterus, or vagina, upon the fundus uteri, its parietes,
cervix, os tincae, or upon any part of the vagina ; as also, with-
out this canal, either anteriorly, posteriorly, or laterally, within
the bony 'pelvis, occupying the vesico-vaginal septum, or the
recto-vaginal seyjtum, or even within the rectum ; in short, they
may occasionally be found to occupy almost any of the soft
parts within the pelvis.

As to consistency, they may be either solid or fluid, (Edemat-
ous or fluctuating, elastic or pulpy, with various modifications.

For practical purposes, it may be well to make two classes
of tumors, in reference to their location, as obstacles in parturi-
tion. First, then, of those that are within the uterus and vagina,
which may be pediculated, or diffused in their attachments.
Those having pedicles, necks, or footstalks, are attached to the
inner or mucous surface of the uterus or vagina, by a small
point, or stem, having one or more roots, the most frequent
variety of which is, perhaps, the polypus, with a narrow neck,
and small attachment, becoming larger and wider, as the dis-
tance increases from its attachment, as the pear, or without

i

1848.] Parker, on Obstructed Labor. 451

unifornhilty of shape, being subject to many modificatiotis from
pressure of the surrounding parts. These are rarely sensible
to pain, and varies in their sti'ucture, some ate fibrous, some
glandular, and others are cellular ; all of which, however, are
subject to many modifications in the process of their evolution
and development.

There may also 6xist adipose, steatomatous, sarcomatous, and
* Schirrous tumors, in these parts, ofsuflicient size and density to
Interfere in the process of labor, having large attachments,
involving a Considerable portion of the uterus, or vagina, in the
disease. These may exist singly, or in an agglomerated mass,-
of small tumors, each with its distinct capsule.

The cauliflower excrescence, which is a highly vasculat
turhor of somewhat a firm structure. Covered with a fine mem-
branous coat that secretes a large quantity of watery fluid, and
tvhich attains a large size, may be found sometimes occupying
these parts. It bleeds easily, and no'l unfrequently is so modifi-
ed as to feel like the placenta, and might, under som.d circum-
stances, be mistaken for placenta-prsevia.

The next class of tumors that 1 shall notice, are those that
e^ist in the soft paf is of the pelvis, external to the uterus and
tagina. There may exist abscesses in varigus localities of thfe
pelvis, prolapsed bladder, impacted tectum, hernial tilinors,
diseased ovarici, etc. As it is kno\tn that muscular and cellular
tisstie are each obnojcious to abscesses, in any part of the body,
we need not be surprised to meet with them in the peltis occa-
sionally. They may be hard and very painful, at soft and
fluctuating.

During labor, the bladder sometimes folds down before the
tit?fus, becomes filled with urine,- and by this means, developes
a tnmor, of sufficient capacity to impinge upon the passages of
the outlet, and obstruct labor. The state of these parts, the
sufferings of the patient, and* the nature of the obstruction, will
be materially aggravated sliotild there exist in the bladder, at
stone, or the development of cystitis.

The rectum may become impacted with Concretes excrement,
or scybala, and may be so much enlarged, as nearly, or entire-
ly, to fill up the pelvis, and forbid the exit of the child, at the
same time materially aggravating the sufferings of the patient,
by inducing false pains, violent tenesmus, etc.

452 Parker, on Obstructed Labor. [August,

On the 30th of July, 1846, 1 was callen in haste to Mrs. F ,

in her first labor; the first stage was completed ; the pains were
violent and her sufferings intense. Upon examination, I found
the vaginal canal much impinged upon, by a large tumor lying
against its posterior wall, opposing the egress of the fcetal head.
It appeared hard and unyielding, as well as uneven to the touch.
I introduced the finger into the rectum, and found its contents
to be hard balls of excrementitious matter, rough, and gritty to^
the touch, as if it were fragments of stone. I forthwith substituted
a scoop for my finger, and removed them one by one, until I
succeded in reducing the entire mass, much to the comfort of
the patient, as labor now went on to a safe completion in a
short time. She was about 18 years of age, of nervous tempera-
ment, had been in labor some fifteen hours, and her strength was
fast failing, from the violent action of the uterus and abdominal
muscles, and the combined pain of labor, tenesmus, etc. 1 did
not consider it safe to wait for the action of a cathartic, or to
depend upon the action of an enema, under all the circumstan-
ces, as they would probably have failed in this instance to fulfill
the indication in time, if at all.

The most important, however^ of these tumors, are those that
result from diseased ovaria. These organs are subject to in-
flammation, enlargement, induration, and to deposition of fluid
or solid matter, as also to a species of conception, as evinced
by being sometimes found to contain in their substance, bones,
teeth, hair, nails, etc., being no doubt the residuum of arrested
foetal developtnent.

The dropsical ovaf ia may consist in one large cell, or cyst,
or in many smaller ones, agglomerated in one large mass.

Whilst speaking of obstructed labor, from dropsical tumors
of the ovaria, it may not be amiss to relate a case which came
under my observation, which I supposed to have been one of
ovarian dropsy.

On the 20th day of August, 1846, called to visit Mrs. M :

I arrived about 1 o'clock, A. M., found her in labor at full
time; she represented herself to have been in labor about six
days. She was of full habit, short and close form, of bilious
temperament, aged about 35 years, the nrother of several chil-
dren.

1848.] Parker, on Obstructed Labor. 453

Several midwives had been in attendance, since the com-
mencement of labor, all of whom had ^mistaken the tumor for
the gravid uterus, with its mouth occluded, and no doubt v^^ith
this view, had each made repeated efforts to pierce it with the
finger, hoping to burst the membrane that they had supposed to
exist, and thus make free the outlet.

Proceeding to investigate the case, I found the abdomen very
large, and jutting over considerably in front of the symphysis
pubis, and upon the introduction of my finger per vagina m,
found the pelvis filled, with what I at first supposed was the
impregnated uterus, though, to my surprise, I could not detect
the OS tincse, nor could I find an opening up the vagina, in any
direction, save in one next the symphisis pubis, and this was
much pressed upon by the tumors in the pelvis. At this time
her pulse was full and strong, skin moist, tongue clean, and
bowels free.

I discontinued for a short time the prosecution of the exam-
ination, that she might have some rest, and at the same time to
see if nature would not assist in the diagnosis. After she had
rested for some time, I bled her from the arm, until the pulse
w^as affected in some degree ; and after waiting awhile, I again
prosecuted the vaginal and abdominal examination. I found
the gravid uterus, with the head of the child, over in front of
the symphysis pubes, entirely without the pelvis. With my
left hand upon the pendent abdomen, using as uniform and
steady pressure as I could with that hand, whilst steadily insinu-
ating the index finger of the right hand into the flattened aper-
ture above spoken of, behind the pubis and the bladder, which
contained but very little, if any, urine. By this mean, I at
length, with great difficulty, succeeded in touching the posterior
lip of the mouth of the uterus, which appeared to be considera-
bly dilated. I tried, in vain, to hook my finger into the dilated
posterior lip, with the hope of assisting the efforts of the left
hand, in bringing the uterus into position, and thus to crowd
or push back the tumor into the abdomen, to facilitate the
labor.

The tumor occupied the recto-vaginal septum, and gave very
little evidence of fluctuation. I endeavored to make the tumor
ascend, by pressure upon it, applied in various ways; manipu-

4fii| Parker, on Obstructed Labor. [August,

lating both the tumor and abdomen, each separately and con-
jointly, all without any ^effect. I next thought of puncturing
the tumor, as probably the most available method ; the evidence,
however, of fluctuation was so small as to make the propriety
^t least doubtful. I therefore suggested to her husband, the
necessity for the operation, should no favorable change take
place, for which I would wait as long as the circumstances of
the case would admit, and that I preferred consultation with
spme physician, if possible. It was some sixteen or seventeen
rjriiles to send, q^nd it was sunrise before the messenger was dis-
patched. I then gave her an opiate, with a view of retarding
the operation, as well as to procure her rest and comfort.

I waited at the house during the forenoon, occasionally makr
ipg e3j:aminations. during which time no marked change took
place, save that the opiate had, in some degree, its desired effect ;
and the mouth of the womb seemed to be more dilated, and the
pains became gradually more frequent and stronger. About
J o'clock, P. M., she became more restless, seemed to have
sojne fever, was thirsty, and very impatient. At 2 o'clock her
symptoms were aggravated ; no remarkable change in the
tumor or the parts. At half-past 2, she began to grow very
v^eak, with most intense suffering, with symptoms of rapidly
approaching exhaustion. The os uteri seemed to be fully dila-
ted. I could not tell exactly at what time this process w^as
completed, for I had thought that this had taken place early in
the morning ; of this, however, it was difficult, if not impossible,
to determine, with any thing like accuracy. At this time the
gravid uterus seemed more hard, and pointed, in front of the
symphysis pubis, and pressed so hard against the recti, and
pyramidal muscles, at each pain, as to create ^ fear, that very
soon the uterus must give way, and thus produce sudden and
irreparable mischief. There was at least a probability that the
child would sufler, or that the mother, from excessive pain, and
protracted distress, with its progressive accumulation, would

very ^oo"^ succumb.

It was just at thistime, and near 3 o'clock, P. M., when Dr,
Davis came, ^nd after making a speedy examination of the
patient, he concurred with me, in the diagnosis and the plan of
treatment.

1848.] Parker, on Obstructed Labor.

I was prepared for the operation, before Dr. Davis had arriv-
ed, as I had expected to be compelled to go on with it, without
consultation, and bear the responsibility alone, or see my pa-
tient die. The instruments were two in number, the straight
Bistoury, (of Professor P. F. I'iVe's pocket case,) guarded with
a strip of linen, to within an inch and a quarter of its point, and
a large silver female Catheter.

The patient being placed upon the lap of Her husband, and
then exposed, the knife was introduced into the vagina, as high
up as was convenient, the naked point was suddenly plunged
into, and through the posterior wall of the vagina, some three
or four inches above the fourchette ; then withdrawn, and the
catheter introduced into the puncture, through which flowed
the contents of the tumor, until some twelve or thirteen pints
had escaped ; after w^hich the gravid uterus was lifted over the
OS pubis into the pelvis, and in a few more minutes the labor
was completed, in safety, both to mother and infant.

The fluid extracted from this tumor was thiner than honey,
yellowish, with brown and -dark-colored shreds, and flocculi.
The odor was not offensive. Some six or seven days after the
delivery, I visited the patient, and found her sitting up, sewing
or knitting ; said she felt as well as ever she did the same length
of time after delivery, with the exception that she felt some
uneasiness, or inconvenience, when she sat down to evacuate
the rectum, or bladder, and supposed, from her feelings, that
some part of the tumor yet remained. I made an examination
while she was standing erect, and whilst she squatted down.
I found no appearance of this tumor, but that the uterus was
very low down in the pelvis. This was easily rectified, though
she could not be persuaded to keep, for a few days, the recum-
bent posture.

It has been some eighteen months since, nor do I know of
any return of the tumor, or any other unpleasant symptom.

[This is the Inaugural Thesis of Dr. Parker, submitted to the
Trustees and Faculty of the Medical College of Georgia, for the
Pegree of M. D., March, 1848.]

4jW New Views on the Physiology of Digestion. [August,

ARTICLE XXXV,

New Views on the Physiology of Digestion, contained in a
letter from our European Correspondent.

The gastric juice has two actions one chemical, the other
physiologic^,!. Thus iron taken into the stomach decomposes
the water of the gastric juice, the oxygen oxidises the iron,
hydrogen is disengaged, and lactate of iron is formed. The
gastric fluid (the specific gravity of which never varies) pos-
sesses the singular property of dissolving all azotised substances.
The gastric juice is transparent, with a slight lemon tinge. Ix
is a little acidulated, and contains 99 parts ip the 100 of water ;
this lOOdth part consists of phosphate of lime, chloride of hme
and ampaonia, a small part of mucus, and a particular organic
matter. The acidity of the gastric juice is caused by the prcr
sence of lactic p-cid in small proportions, and sometimes also
to the existence of a feeble quantity of phosphoric acid- Chlo-
ric acid, also, has been obtained, but as the result of a bad and
djeceptive process. However, it signifies little what particular
acid, whether acetic or sulphuric, predominates in the stoniach,
for the gastric juice is little, if at all, troubled by their presence.
The organic matter, the pepsine, is the only principle that is
essential to the solvent action of the gastric juice. As is well
known, it can be precipitated by the aid of leiad and sulphuretted
hydrogen. But the best way to obtain it is to precipitate it by
the action of alcohol, to filter tbe solution, and to dry the pre-
cipitate ; then to re-dissolve it in distilled water, and by adding
acid, the gastric juice is reproduced. If the gastric juice is
boiled, the organic matter is destroyed; and as this matter is a
kind of ferment, the gastric juice does nqt act unless its temper-
ature is elevated to a certain point. Below 40 it has no effect,
and to produce its full power, it must be raised to the heat of
the stomach, that is to from 98 to 100^. The first efl'ect of the
gastric, juice on fibrifie, is the imbibition of mojsture by the
fibrine i. e. hydration, by vyhich the fibrine is increased in
volume; it afterwards gradually loses its transparejicy, and is
at length reduced to a whitish powder, that is ultimately disr
solved. This last transformation of the fibrine is a special
action of the gastric juice, and can be produced by no other acid

1848.] New Views on the Physiology of Digestion. 457

or fluid. It is not to be forgotten, that the constant movements
of the stomach itself, and the regularity of the temperature with-
in this organ, are powerful agents in facilitating digestion.

Albumen is not coagulated in the stomach by the gastric juice.
There takes place merely a mixture of the fluid albumen with
the gastric juice, and not anything resembling a dissolution.
Coagulated albumen does not present the same extensive sur-
face to be acted on as the long threads of fibrine, but when
equal portions of each are acted on at the same, the difierence
in their dissolubility is inconsiderable. Still it must be admitted
that the molecules of the albumen are denser than those of
fibrine, and therefore offer greater resistance.

Milk is immediately coagulated by the gastric juice. By
mixing milk with gastric juice, even out off* the stomach, this
speedy coagulation is seen. The coagulation -is not produced
by the acid of the gastric juice, but by the pepsine. Caseine,
obtained from milk, is an azotized substance. The first action
of the gastric juice on caseine, is to separate from it the globules
of fat which it always contains. Fat and oils are not dissolved,
but swim on the surface of the gastric juice. Caseine, on the
contrary, when swallowed in milk, is instantly coagulated and
precipitated. The coagulation of caseine is well seen in infants.
After the complete dissolution of azotised substances by the
gastric juice, the compound fluid thus formed, may be kept for
any length of time exposed to the air, in a glass or dish, without
undergoing any further visible change. Indeed, the substances
acted on by the gastric juice appear to 'be unalterable. This
is called the antiseptic property of the gastric juice,

In performing experiments on the gastric juice, an opening
is made into the stomach of a dog, for instance, by cutting into
it through the parietes of the abdomen; a silver ring provided
with a suitable plug made of cork is used, by which a fistulous
opening is maintained. In this way, we can withdraw from,
or introduce into, the stomach, such matters as we desire, and
by removing the plug we can see all that is going on within this
organ. By giving the dog some substance of difficult digestion,
such as the boiled gullet of a sheep, two or three hours after*
wards a considerable quantity of gastric juice, mixed with
mucus, is obtained. We separate some fibrine from bullock's

458 New Views on the Physiology of Digestion. [August,

blood, and put it into a glass tube, with a little gastric juice ; on
exposing the tube for a few hours to gentle heat the fibrine is
entirely dissolved. The same quantity of fibrine, placed in
another tube, containing a solution of muriatic acid, remains
almost unchanged. By introducing a small square of solid albu-
men into one of these tubes,- and treating it exactly in the same
way as above, with gastric juice, after a short time the angles
become transparent, and are afterwards entirely dissolved,
shewing that the portions which are of least thickness are first
acted on. In the same manner, operated on, caseine forms a
kind ofemulsionof a whitish color in the gastric juice, and con-
tinues solid until exposed to heat, when, if agitated briskly, it
entirely dissolves. Hematine, the coloring matter of the blood,
is acted on by the gastric juice. The blood globules first become
swollen and of a dark color. The same blood never again
becomes red, after having been exposed to the action of the
gastric juice, as we perceive in the leech, &c. Gelatine dis-
solved in the gastric juice, loses forever its power of coagulation.

Mucus. It is remarkable, that when there exists a mixture
of mucus and gastric juice, putrefaction of the mucus is not
thereby prevented. Mucus is to be regarded as an indigestible
substance, being, in this respect, exactly similar to hair, cuticle
feathers and claws. These last, when swallowed by rapacious
birds, are, after some time, vomited. Gluten is, like fibrine,
insoluble in water. Vegetable fibrine contained in flour is solu-
ble in water so, also, is starch, the other principle contained in
flour. Legumine, found in vegetables, is the " caseine vegeta-
ble." All the azotized substances of animal or vegetable origin,
above mentioned, are by the action of the gastric juice, at length
reduced or assimilated to the same uniform matter.

In milk, we have caseine, fat and sugar. The fat is not dis-
solved in the stomach, and this seems extraordinary when it is
remembered that bones are. We shall by-and-by discover
what becomes of the fat. The gelatine of the bones is dissolved
by the gastric juice, and the phosphate of lime is precipitated.
The portion of a bone undissolved, remains hard, unchanged in
color, and presents more or less of a cellular or reticulated ap-
pearance. Starch or fecule oflers globules of different dimen-
sions, enveloped in a membrane, which by hydration is ruptured,

1848.] New Views on the Fhyslulogy of Digestion. 459

when the dissolution of the starch takes place. The gastric
juice has no action on starch, or on farinaceous or leguminous
substances. The changes produced on starch, when swallow-
ed, are 1st, into dextrine, 2d, sugar, and 3d, lactic acid.
Common sugar, or chrystalized, introduced into the gastric
juice, is dissolved and changed in its composition into sugar
" de resin,"* in other words, molasses; this last, however, is not
dissolved. Gum, is like sugar unacted on by the gastric juice ;
and the same remark applies to resinous matter. Osniasome
is a singular exception to other azotized substances, in not being
acted on by the gastric juice. It is the extract of animal mat-
ter contained in "bouillon."t Starch, when in solution in
water, is detected by iodine, forming a blue precipitate so
dextrine has a violet precipitate. When this dexterine is
changed into sugar, the iodine produces no change of color.

The best of all tests for sugar is the double tart, of copper
and potash. A very good formula for this compound salt, is to
take 30 grammes of the carb. of potash, boiled in 100 grammes
of distilled water, and add 50 grammes of tart, of potash. Then,
dissolve 3.0 grammes of sulph. of copper in 100 of water. The
two solutions are mixed and filtered. By mixing a little of this
solution with one containing sugar, and raising it to the boiling
point, a red precipitate of copper is formed. This occurs only,
however, after a small quantity of sulph. acid has been added,
by which the sugar is converted from the chrystallized to the
resinous sugar. A small quantity of the *' sugar de resin," mo-
lassesnow chrystallized sugar, should be put into a small glass
tube. On first exposing the tube to a boiling heat, a very minute
quantity of tart, of copper should then be added, when, as
the boiling is continued, the fluid becomes successively, yel-
low, brown, reddish, and deposites the oxide of copper. On
treating in precisely the same way a solution of common or
chrystallized sugar, no change is observed in its color, and the
sugar is not decomposed. Starch, stearine, &c., give no pre-
cipitate when tested in the same manner. This method is
particularly suitable for detecting the presence of sugar in the
diabetic urine, for when heat is applied, after the addition of
the tart, of copper, the red precipitate appears. The moderate
of grapes. Ed. t broth. Ed.

460 New Views on the Physiology of Digestion. [August,

use of sugar before a meal, increases apparently the quantity
of gastric juice. The mucous membrane becomes red and
turgid, as soon as food enters the stomach ; the mucus is separa-
ted from the inner membrane of the ] yloric portion, which
pours out the gastric juice. If the irritation produced in the
stomach, by any thing introduced into it, amounts to pain, im-
mediately the secretion of the gastric juice is arrested, but the
inner membrane of the stomach does not cease to be red and
turgid. All acids diminish greatly the formation of the gastric
juice : slightly alkaline, on the contrary, favor this secretion.

To produce good effects on the secretion, the quantity of
alkaline matter swallowed requires to be small. In inflamma-
tion of the stomach, the secretion of the gastric juice is suspend^
ed, and when the tongue is white and loaded, the stomach
invariably participates in the same state. Acidity powerfully
promotes the action of the gastric juice, and by mixing alkali
with it, its solvent agency is destroyed. But if we abstract the
alkali, the influence of the gastric juice is restored, proving that
the alkali only masks its action. It has, however, been already
stated, that the feeble action of the minute quantity of organic
matter (pepsine) is quite essential to this fluid. By boiling the
gastric juice, as has been above noticed, we destroy the organic
matter ; the acid remains, and yet the solvent power is des-
troyed. If we take a portion of the mucous membrane of the
pyloric end of the stomach, and macerate it in tepid water, the
water becomes acid, and a kind of strong gastric juice is ob-
tained, which, however, does not keep over four or five days,
when it becomes putrid, owing to the large quantity of organic
matter it contains. An additional quantity of acid requires to
be added to the liquid to preserve it. A portion of the mucous
membrane of the stomach is completely dissolved, on being ex^
posed for some time to the influence of moderate heat in acid.
The organic matter is also dissolved ; for it is not, as has been
asserted, indissoluble. On filtering this fluid, it may be preserv-
ed for an indefinite period t)f time, and is concentrated gastrio
juice.

Saliva. When we put the saliva in contact with starch, this
last i^ converted into sugar, whereas the gastric juice has no
action on starch. And these experiments have been very often

1 848.] New Views on the Physiology of Digestion. 4G 1

repeated. There exists in the saliva a ferment, which acts in
digestion as a solvent of non-azotised matter ; yet, although the
compound fluid, which forms the saliva, converts starch into
sugar, the pure fluid obtained from the parotid duct has no ac-
tion whatever on starch. The mixed fluid or saliva, secreted
by all the glands of the mouth and throat and mucous mem-
brane, invariably acts on starch. The organic matter of
ferment is not found in the six large salivary glands. The fluid
secreted by the sub-maxiliaries, is more viscid, denser, and more
tenacious and adherent, than the fluid of the parotids. Azotised
matter becomes putrid, when kept for some tin>e in the saliva,
which, as has been already remarked, converts starch into sugar,
which last again is changed in the stomach into lactic acid. Sali-
va is alkaline when secreted, but if the mouth and tongue are dry
or foul, the mucus is often acid. When, however, the saliva is
pure, it is always alkaline. The pancreatic fluid has errone-
ously been assumed to be similar in its properties and mode of
action to that of the saliva. This question has, however, been
conclusively settled within these few weeks by my friend, Dr.
Bernard, assistant to Magendie, who has ] roved that the pan-
creatic fluid acts on the three kinds of aliments, viz., fat, adipose
substance, and oils, dissolving these in the duodenum with
astonishing rapidity. As this is a new and important fact, hith-
erto unknown, and never suspected, it will be better to give
the details in this connection, with some more than usual ex-
tension, so that you may have the pleasure of first publishing
them in your valuable Journal It will be first of all necessary
to conclude with one or two other topics, including a few ob-
servations on the bile. As the gastric juic3 is secreted only by
the pyloric portion of the stomach, if the yellow prussiate of
potash, in solution, is injected into the jugular vein during the
period of digestion, you will discover this substance in the gas-
tric juice, but in no other secretion, not even in the saliva.
All the facts and experiments are in opposition to the opinion,
that the gastric juice is secreted by the small glands of the
pyloric end of the stomach. The lactate of iron immediately
converts the gastric juice into a blue color, in those cases where
the prussiate of potash has been previously injected into the
veins. What is not a little singular, however, these two sub-

462 New V^iews on the Physiology of Digestion. [August,

stances do not combine in the circulation itself, even when they
have been injected into the veins of the same animal the one
into the one jugular, and the other into the opposite. The union
ap]>ears to take place on the surface of the mucous membrane
and only at the pyloric end of the stomach, and not in the small
glands as had been supposed. The solution of the prussiate of
potash should .never be stronger than 1 part to 5 of water,
otherwise the animal will be destroyed. With the lactate of
iron it is otherwise , the strongest solution is not toxic or hurtful.
Bile. Azotised substances or fat are not changed by the ac-
tion of the bile, hence it has been regarded by some simply as an
excretion ; 62 experiments prove, that the interception of its
flow into the intestines, by directing its flow through a fistulous
op-ening externally, invariably proves fatal. Adhesion is effect-
ed first between the parietes of the abdomen and the gall blad-
der; through this point an opening is made into the gall bladder
so as to conduct the bile externally and then the common
biliary duct is tied. This last is very apt to be entirely or
partially re-established, by ulceration and adhesion forming a
new Canal. All the azotised substances are changed by the
bi!einto a uniform matter, in this respect the bile resembles the
"ix)le^' of the gastric juice which also converts different injesta
into a homogeneous substance. There is no doubt that the bile
has an important influence in digestion that it is essential and
indispensable in this function. It has been said that bile is a sort
of soap, but this is in3Xact. To believe that the bile has a con-
stant reaction is also erroneous, for it varies like the urine and
other fluids. The fundamental principles of the bile are suffi-
ciently well determined ; it contains a salt of soda united to'
cholic acid, forming a cholate of soda. All the other acids
found by Bsrzelius and Teideman are the products of this com-
position. Besides, there is a coloring matter, a kind of resin.
Thus composed, it exercises an action on the aliments, that
have been d'ssolved in the stomach. The bile poured out on
the chyme forms a kind of precipitation that adheres to thei
villosities of the mucous membrane. Platner (of Heidelberg)
has ascertained the action of th^ bile. We have already stated
that the chyme affords a precipitate with the bile, but if gas-
tric juic^ is added, or mixed with the bile, then there is no pre-

1848.] New Views oil the Physiology of Digestion. 463

cipitate formed. If, however, alimentary substances are dis-
solved in the juice, in that case an abundant precipitate talces
place a precipitate of all the matters the gastric juice con-
tained. The action of the gastric juice on the aliments forms
the lactates of albumen, fibrine, &c. If we put these substances
in contact with the bile, we have a kind of decomposition :
By the play of double electric affinity the Choleic acid of the
Choleate of Soda unites with the fibrine of the Lactate of
Fibrine, and forms Choleate of Fibrine ; and the Lactate acid
of the Lactate of Fibrine unites with the Soda of the Choleate
of Soda, and forms Lactate of Soda.

Choleate of Fibrine is insoluble. The action of nitric acid
makes manifest the coloring matter of the bile. To detect the
presence of cholic acid, it is necessary to act with sulphuric
acid and sugar. These agents give a violet color with cholic
acid. In this manner Platner has found cholic acid in the pre-
cipitate, but no coloring matter. This coloring matter is
largely found in the excrements, Part of the organic matter
taken up by alcohol from the faeces consists of the choleate of
soda, the characteristic matter of the bile. (Carp. p. 504.)
Besides the bile performs another function, which will be ex-
plained, when the pancreatic juice has been considered. By
adding nitric acid to a fluid containing bile it becomes troubled,
by adding more acid it becomes changed into green, then blue,
and by a further addition, it is converted into red. The nitric
acid, however, must not be pure, but should contain nitrous
acid. By adding sugar to a solution of bile, and then using
sulph. acid, we have the action of the bilic acid shown by a
violet color. The nitric acid again acts solely on the coloring
matter. Ithasbeenebove explained, that the lactate of fibrine
and albumen formed by the gastric juice, combines with the
bilic acid and unites with the fibrine and albumen, whereas the
lactic acid combines with the soda of the bile and forms the
choleate of soda. In this Ivay a double decomposition occurs.
When you give an animal azotised substances to eat, exclusive-
ly, the small intestines always contain acid in excess. The
action of the bile occurs in the second stage of digestion, and has
reference to the preparation of the chyle, by rendering com-
plete the digestion of azotised substances and by converting

404 New Views on the Physiology of Digestion. [August,

them into an uuiform albuminous matter. The pancreatic
juice is poured into the intestines in two ways, that is to say,
generally by two canals, the larger opening into the common
biliary duct, as this last comes in contact with the sub-mucous
cellular tissue of the duodeneum. In this way it may be said
that the pancreatic duct and the common biliary open into the
intestine close to each other, but that they are covered by
a small fold of the mucous membrane so as, strictly speaking, to
terminate by one common orifice. There takes place therefore
a mixture of the pancreatic juice with the bile. Second, ano-
ther canal of the head of the pancreas exists, which in the
gi'eat majority of instances is isolated and opens a little lower
than the former and mUch larger one. These two canals are
not unfrequently, if not always, united together by a short canal
nearly about an inch from their e'xtremities. This short canal
of union is Very variable in size, and sometimes it is not trace-
able. In the dog, the two canails largely communicate : the
upper is the smaller one, and opens along with the Common
biliary, the other is much larger and terminates in the boWel
lower down. In the cat, the pancreatic and common biliary
terminate together. In the rabbit, the pancreatic duct opens
into the duodenum 35 centimetres below the common biliary.
In the sheep, the pancreatic duct opens into the common
biliary at some little distance from the intestine, and the two
alkaline canals communicate with one that is acid, so rapid is
the change in the two fluids. For th^ mixture of the bile and
the pancreatic fluid, both alkaline, is, notwithstanding, acid, and
invariably gives an acid rieaction, Teideman atid (Jmelin have
ascertained that the saliva has the po<ver to change starch into
sugar. Bronchardat proved that the pancreatic juice had the
same property ; but this is not a special quality. The serum of
the blood, and fluid withdrawn in ascites, mucus, &c., and often
the bile have the same property a property common to or-
ganized fluids. The pancreatic jdice is a fluid transparent,
limpid, tenacious, thready and constantly alkaline. This last
fact is important. The pancreatic juice flov^s during the period
of digestion only. Bernard describes a plan of making pancre-
atic fistulae, that had been first employed by Magendie. The
appearance of the pancreas varied, according as the animal has

1848.] New Views on the Physiology of Digestion. 405

been previously fasting, or otherwise. When the stomach is
empty, the pancreas is of a remarkably shining whiteness,
while during the time of digestion it is much swollen, of a deep
red color, and its blood-vessels, especially the veins,- distended
with blood. It is necessary that it be in this state of excitation
or activity, when we desire to see the flow of the pancreatic
fluid of viscous pearly drops. A small bag of elastic-gum,
well compressed to expel all the air, is attached to a silver tube
of suitable size, which is introduced into the lower and larger
duct of a dog, and secured by ligature. In the space of twenty-
four hours we can collect in this manner, about 50 grammes.
During the first three or four hours, the juice flows rapidly,
even to the extent of 25 or 80 grammes, and it is to be noted
that the elastic gum-bag does not receive all the quantity secre-
ted, for there is a certain proportion that reflows by the upper
canal into the duodenum. As soon as the juice is collected,
and examined, it is found to have a specific gravity greater than
that of water, and to be ropy, gluey, constantly alkaline, and
having a saltish savor, similar to that of the blood. It has also
the property to coagulate by heat, or by the addition of nitric
acid. Numerous experiments prove, that it does not exercise any
action on azotised substances, but on those containing starch.
M. Bernard has quite recently discovered another most im-
portant use of this juice, that is, its action on fatty matter
an action that takes place at all temperatures, and with all sorts
of adipose substances. For instance, writh oil, a minute quanti-
ty, only one part of the juice to ten of the oil, suffices for the
immediate emulsion of all the oil. No vestige of the oil remains,
but it has undergone a kind of solidification, and when examined
with the microscope, there is an appearance of minute crystal-
lization, where the two fluids are in contact. Pure fat disap^
pears rapidly in the pancreatic juice, and if this union is assisted
by moderate heat, it is almost immediate ; nothing of the fat is
visible, except fine globules, resembling those of milk. All
adipose substances suffer the same transformation, the fat of
sheep, suet, one of the most solid of all the varieties, is quickly
dissolved. We can distinctly see this action out off* the body,
it being a physical action in short a complete emulsion of
fatty matter. One might suppose that this is a species of sapo-

30

466 Neil) Views on the Physiology of Digestion. [August,

nification. It is not so. The action is entirely due to the
organic matter contained in the pancreatic fluid. If it be ren-
dered shghtly acid, it still preserves its properties, which could
not be the case if the combination resulted in a saponification.
As, then, this action depends on an organic principle, if it be
destroyed by heat, the juice no longer dissolves fat. This ac-
tion is almost analogous to that of ft^g and almonds, that form
emulsions with fatty substances. If the pancreaticjuiceiskept
for three or four days, certain alterations occur, and although it
preserves its property of changing fecule into sugar, it loses that
of forming emulsions with fatty matters. In this, it differs
notably from the gastric juice, which remains for a very long
while unchanged. From what has been above stated, it will
be abundantly evident, that fatty and oily substances, which
pass into the duodenum, are there emulsioned, and prepared to
be absorbed. What happens when fat is fermented or decom-
posed in any way? The fat is nothing else than a sort of salt.
Palm oil, for example, is composedof a fatty acid and glycerine.
The pancreatic fluid produces exactly the same decomposition
on all fatty substances. The emulsion, that arises from the
mixture of the pancreatic juice with fat, becomas acid, and af-
fords a very intense acid reaction. The decomposition of
oil gives, thus, an oleic acid and glycerine. Butter butyric
acid, manifests itself by its odor. Fat cebacic acid and glycer-
ine. The secretion from the pancreas is the sole fluid in the
economy that possesses this property there is no other that
has it to any degree. The bile has not this action, as has been
erroneously assumed by some. The pancreas, then, is an organ
essential to digestion, that is to say, to the absorption of fatty
matters, which are taken up by the lacteals in a half dissolved
condition. Indeed, the opacity of the serum arises from their
absorption. The existence of milky chyle is impossible, with-
out the pancreatic juice, and the true lacteals are never seen
above the entrance of the pancreatic duct into the duodenum.
Lymphatics exist in the stomach, and great intestine ; but no
lacteals have ever been detected in the one or in the other. In
the dog, some have attributed the action belonging properly to
the pancreatic juice, to the influence of the bile, but in taking
precautions to prevent the arrival of the bile, into the intestine,

1848.] New Viev:s on the Physiology of Digestion, 467

*- - ' ' - *

the fat has been dissolved. In the rabbit, there is only one
canal, and it does not unite with the common biliary duct, but
opens into the intestine 35 centimetres below the entrance of
the bile. We therefore can see in rabbits that fatty matters are
not changed, until they have been submitted to the influence of
the pancreatic fluid, and also, that the bile entering higher up,
has no action on them, unless they are in a rancid state. On
tying in the dog, the two ducts of the pancreas, we have chyle*
resembling lymph, and the fatty substances swallowed are ren-
dered unchanged. Brodie has studied this question. He tied
the common biliary duct in young cats, and found that the fatty
matters were not altered. Magendie repeated the same experi-
ments, and found the contrary. This difference probably arose
from Brodie having ligatured the common biliary duct, near the
duodenum, so as to include the canal of the pancreas ; whereas,
Magendie secured the duct at some distance from the duode-
num, and left the pancreatic canal free. If a larger quantity of
fatty matter is given than the pancreatic juice can dissolve, it is
found in the excrements. Although the bile has no action on
recent or fresh fat, it acts on such as has become acid. That
bile removes spots of grease, is a fact, that was called to the
support of those who maintained the saponification of the fat by
the bile, but the truth is, it is necessary to wait some time, till
the grease has become decomposed, and the acid fat placed at
liberty. The bile acts on the acid fat, whether butyric or oleoric,
and the acid unites with the soda of the bile, and liberates the
choleic acid. It is probable that the fatty matters are not all
changed into fatty acid ; and as acids are generally hurtful or
poisonous, if all the fat were transformed into the acid of fat,
this would be injurious to the intestine. The mixture of the
pancreatic fluid with the bile forms the intestinal juice. When
these two fluids first are mixed, we discover that the bile, instead
of remaining alkaline, becomes instantly acid, and also that the
coloring matter of the bile is precipitated at the same time.
This, then, affords a remarkable example, of the mixture of two
alkaline fluids producing one that is acid. This intestinal juice
has a special property, for it is a fluid that can even azotise
substances, and in short allows none soluble to escape it. The
fluids secreted in the intestine do not appear to be essentially

4iS8 New Vietos on the Physiology of Digestion. [Augusi,

concerned in digestion. As we easily make a gastric juice, so
also we can produce an artificial pancreatic fluid, by breaking
down and bruising tlie tissue of the pancreas in a small quantity
of water, and then adding a little alkali. The pancreas of
chicken answers very well. It is necessary, however, to re-
move the gland from the animal immediately after death. The
pancreatic fluid changes with extraordinary rapidity, and this
is one of its principal phenomena. Animals w^hose pancreas
has been removed or in whom the canal has been tied, are soon
much emaciated.

It may be proper here to recall to recollection the three
kinds of aliments. The azotized matters, although dissolved in
the gastric juice, and forming a homogenous solution, have not
entirely lost all their characters before they combine with the
bile until that moment they are simply azotized substances
dissolved in the gastric juice ; but when once they have united
with the bile, they lose completely their distinctive properties.
If we mix the gastric juice and bile, no precipitation takes place,
but the gastric containing digested '^viands" is mixed with the
bile, and an abundant precipitate is immediately formed. Plat-
ner first showed that the precipitate w^as a choleate of aliment-
ary matter, while at the same time a lactate of soda is formed,
thus : 1st. Thfe Lactic acid of the chyme unites with the
soda of the Bile and forms Lactate of Soda, whilst the Fibrineof
the chyme uniting with the Cholealide of the Bile forms a Cho-
leate of Fibrine. 2d. The Glycerine and Acid fat form an
emulsion. 3d. Sugar.

Before the precipitate (the choleate of fibrine) is absorbed, it
is necessary that it be previously dissolved, and the intestinal
juice "uses up" this precipitate,. a discovery that we owe to
Platner. The intestinal juice has the property of digesting
azotised matter equally as well as does the gastric juice. This
fact is beyond all doubt. The gastric juice is composed of two
elements, one acid, the other organic. In certain animals, the
organs that secrete these are separate. In birds, the gastric
juice acts only as ascidulated water, as in the intestines the
aliments undergo the action of the intestinal juice, and where
the true digestion occurs. It is the same in the Horse there
is no stomachal digestion, and as they subsist on vegetable sab*

1848.] New Views on the Physiology of Digestion. 46^

stances, the gluten has no need of the gastric juice to dissolve
it. It is in the intestines alone that they require the agency of
a fluid, enjoying the properties of the gastric juice. Speaking
generally, it is in the duodenum that digestion is performed, and
it is there that the chyle commences. In the carnivorous ani-
mals the gastric juice has the power of dissolving alimentary
matter, but the gastric juice of the horse, of rabbit and of
birds, has not this property. It has been erroneously supposed
that the gastric juice has nearly the same properties in the dif-
ferent classes of animals. When you give a dog, for instance,
azotised substances exclusively to eat, the small intestines con-
tain acid in excess. As the gastric juice is secreted under the
influence of the nervous and vascular system, whatever trou-
bles the one or the other, diminishes this fluid, which results
from a species of decomposition of the blood. The mucous
membrane of the stomach has a peculiar afiinity for acids, and
by putting a solution of the acetate of soda into a glass, and
covering it with the mucous membrane of the stomach, the acid
combines with the mucous membrane, and the soda remains,
on the inside of the membrane. If we inject into the veins two
solutions, one of the yellow prussiate of potash, and the other of
the lactate of iron, these agents do not combine in the blood,
but in that portion of the mucous membrane of the stomach,
where the blood is transformed into the gastric juice. It affords
a precipitate of Prussian blue; none of this, however, is seen in
the small follicular glands, but in the vellosities, demonstrating
that the gastric is a perparation from the mucous membrane
itself alone. As to the action of this fluid on drinks, it has no
action on alcohol, except in large quantities, when it precipitates
the organic matter. In very small quantities, if not often re-
peated, it increases the secretion. The gastric juice discolors
wine. It acts only on the coloring matter of the wine which
it precipitates, and thus if a large quantity of wine is much
colored, it will be hurtful to digestion. M. Gosse alledged that
vegetables are sooner digested than animal flood ; this mistake
is easily explained, as the vegetables pass quickly out oflf the
stomach into the duodenum, whereas animal food remains till
it is digested. Fish, chicken and veal, are easily digested.
Boiled beef, on the contrary, is of very difficult digestion. Per-

470 RtherisoWy on Chlorofurmdui'ing Labor. [August,

haps, the gastric juice prepares leguminous and farinaceous,
and even fatty matter, for being dissolved in the duodenum. It
is apparent that these matters are more or less swollen, hydrated,
and triturated in the stomach. There is only one kind of chyle
with, or w^ithout, the milky white color, and by giving different
kinds of aliments to animals, we can, at pleasure, produce the
one kind or the other. Is the chyle absorbed before it reaches
the great intestines? or is there absorption in the stomach?
Magendie has proved, that the stomach will rapidly ; but this
does not take place during the period of digestion, the turgid
and highly congested, almost inflamed state of the membrane,
prevents this. No doubt, quantities are absorbed bv the veins
in great quantities before digestion begins,

Paris, May 25th, 1848. O. P. G.

[ To be conti7iud.]

ARTICLE XXXVI.

Successful Employment of Chloroform during Labor. By
J. J. RouERTsoN, INI, D., of Washington, Georgia.

The follov^^ing case, bearing additional testimony to the ap-
plicability of chloroform in obstetrical practice, may not prove
altogether uninteresting to the readers of the " Southern Medi-
cal and Surgical Journal."

Mrs. R., aged 27, of nervous temperament, was taken with
slight labor pains about 2 o'clock, A. M., on the 2d of June,
which slightly increased until about 6 o'clock, when she had the
first severe pain ; two others followed before she was placed
in bed. On examination, the os* uteri was found well dilated,
and the presentation natural, I proceeded, at once, to admin-
ister the chloroform in the usual way, on a handkerchief, and
in less than two minutes she gave evidence of being under jti
influence commenced laughing, clapping her hands, and ex-
pressing herself as " perfectly happy." I carefully watched its
effects, and whenever its influence seemed to be subsiding, I
would again administer it. Labor progressed uninterruptedly,
and terminated in about two and a half hours from the first
inhalation, during which I administered the chloroform four

1848.] Rohertson, on Chlor of or fn during Labor. 471

times. The last time I exhibited it in a larger quantity than
had been before ventured upon, which produced complete stupor
for some minutes. It was during this period that labor was
completed, and it was nearly half an hour after the birth of the
child that she became conscious of the fact ; she also states, that
from the first inhalation to the termination of labor she felt not
the slightest sensation of pain. The quantity of chloroform
used in this case was about | ^ .

At my request, my friend, Dr. John H. Pope, a skillful and
experienced accoucheur, was in attendance, and more particu-
larly watched its effects upon the uterine contractions. He
states that the expulsive efforts of that organ were, in no way,
interrupted, but, on the contrary, were regular and vigorous
throughout ; and from the relaxation of the soft parts, produced
by the chloroform, we are led to believe that labor terminated
much sooner than it otherwise would have done.

I have attended Mrs. R. in her previous confinements, and
although there was no deviation from natural labor in any
instance, yet, the severe pain which resulted from the contrac-
tions of the uterus, always produced an unusual degree of pros-
tration which generally continued for several days, and on one
occasion was quite alarming, what is usually termed the
" nervous shock," amounting to almost fatal syncope. In the
present instance she has experienced nothing whatever of this
prostration, or of any other unpleasant sequel to labor, and I
have never witnessed a more rapid and favorable recovery.

In none of her previous confinements did she have hemor-
rhage; nor was there any Extraordinary effort on her part to
which I could attribute this unusual prostration ; I therefore
concluded it must have been the legitimate result of severe
pain, which view seems to be justified by the fact that in the
present instance no such unpleasant consequence has been de-
veloped. Although some, in high authority, " are accustomed
to look upon the' sensation of pain, in labor, as a physiological
relative of the power or force," and as " a most desirable, salu-
tary and conservative manifestation of life-force," yet, I think
the numerous cases of entire exemption from pain during labor
produced by anaesthetic agents while the power or force of
uterine contraction is unimpaired, are sufficient arguments

472 Eve, on Chin-shot Wound. [August,

against this opinion; and admitting that pain, under these cir-
cumstances, is physiological, yet, are not its effects on the gen-
eral system the same as though it were pathological ? The
case of Mrs, R., I think, fully illustrates the fact that pain alone, in
labor, may produce great exhaustion of the nervous system, for
I can trace the unfavorable results before alluded to, in her pre-
vious confinements, to no other rational cause ; and her entire
exemption from them on this occasion seems to confirm the
correctness of this opinion.

Mrs. R/s previous health had not been good: she had slight
pulmonary hemorrhage about two years ago, and, although I
cannot detect any tuberculous deposite in the lungs, she has
been quite feeble since that time. The inhalation of chloroform
did not excite the least cough, nor was there any appreciable
alteration either in the respiration or circulation. I did not
suffer her to inhale it to its full eflJects until just before the ter-
mination of labor, as anaesthesia seemed to be complete before
it was carried to the extent of torpor. Although complete
insensibility is desirable in surgical operations, as there is then no
embarrassment to the operator on account of the motion or re-
sistance of the patient, yet, in obstetrical practice it seems to
be unnecessary,

Mrs. R. was suffering from severe nervous headache when
taken in labor ; this was evidently removed by the chloroform,
and she has had no return of it. Both mother and child are
doing well.

In addition to the above case, I have also administered the
chloroform in three cases of surgical operations within a month
past, and once to extract a tooth, I have taken notes of these
cases, and may report them for a future No. of the "Journal/'

ARTICLE XXXVII,

Gun-shot Wound hall opening the graviduterus death in
twenty hours. By Paul F. Eve, M. D,, Professor of Surgery
in the Medical College of Georgia,

At 1 o'clock, A. M., March 20th, 1838, I was called up to
see Charlotte, a negro girl aged 19 years, said to have been ac-

1848.] Eve, on Oun-shot Wound, 473

cidentally shot. On arriving, I found Dr. R. in attendance,
and learned that our patient had just received a pistol ball at
the distance of about six paces. She was engaged with a large
dancing party when interrupted by the accident. She was
standing near the fireplace at the time ; the ball entered just
above the anterior superior spinous process of the ileum, and
penetrated transversely the hypogastric region. The probe
and finger could follow in its tract, without, however, ascertain-
ing where it had lodged or whether it had opened the abdomen.
There was no external hemorrhage nor intestinal protrusion.
Besides the shock to the general system, there were no special
symptoms beyond the ordinary appearance of a gun-shot wound.
Upon inquiry, we learned that Charlotte was about the fourth
month of utero-gestation.

At 4 o'clock a loop of the bowels protruded through the ex-
ternal wound, which was immediately returned by taxis, and
then retained by compress and bandage. Our patient now
exhibited symptoms of prostration, which continued to increase,
notwithstanding the means employed to counteract them, and
she died at 8, P. M. twenty hours after she was shot.

Early the next morning, 21st March, in presence of the
Medical Class, the abdomen was laid open by a crucial incision.
About half a gallon of clotted blood was removed from the pel-
vis, and a small fcetus with its secundines. The ball was
found to have penetrated the abdominal parietes, passing
through two or three convolutions of the small intestines, with-
out producing any escape of their contents ; it then made quite
gL large, gagged opening into the uterus, at its anterior superior
portion of the fundus, and striking the left iliac fossa, dropped
into the cavity of the pelvis. Its range was transversely across
the hypogastrium, and from above downwards.

4T4 On Chemistry of Pathology and Therapeutics. [August,

PART II. REVIEWS AND EXTRACTS.

Lectures on the Chemistry of Pathology and Therapeutics ;
showing the application of the Science of Chemistry to the
Discovery, Treatment and Cure of Disease. Delivered by
Alfred B. Garrod, M. D., London, Assistant Physician to
University College Hospital; Lecturer on Materia Medica
and Therapeutics, etc. (Lancet.)

Introductory remarks to the Course; subjects little understood by the Medical
Profession; advantages of the application of Chemistry in studying the various
branches of Medicine; to Anatomy and Physiology ; explanation of composi-
tion of Muscle; of the Blood; of the Phenomena of Respiration; of Animal
heat; cause of the different temperature of Animals; mode by which the same
temperature is sustained in an animal; to Materia Medica; new remedies
obtained; useless ones rejected ; active principles separated; method of com-
bination taught; to Pathology; use in the Diagnosis of disease; Albuminous
Urine; Scarlatina; Dropsy.

Gentlemen, It is my intention, in the course of lectures
which I am about to deliver, to bring under your consideration
a subject which I think all will allow to be of the greatest im-
portance to the medical practitioner viz., the application of
chemistry to pathology and therapeutics. At the same time
it is one which perhaps is less understood by the majority of
the profession than any branch of medical science, the cause
of which is easily explained; for so few years have elapsed
since the doctrines of Cullen, or solid pathology, had so strong
a hold on the minds of medical men, and the extravagancies
of some of the ancient chemical ideas as to the nature of disease
had but so recently been disproved, that the very name of
chemistry in connexion with medicine was shunned. But at
the present time this is far from being the case ; organic
chemistry having recently made such immense strides, its
power of elucidating the structure and functions of the animal
body has become so evident, that it is the opinion of many,
that through the proper application of this science to the study
of medicine, we must hope to become more intimately acquaint-
ed with the real nature of disease, and the therapeutic action of
remedies. I shall not attempt, in the present lecture, to bring
before you the various hypotheses of the ancients as to the
cause and nature of diseases, some ascribing all of them to
affections of the solids, others to alterations in the fluids of the
body, for such a history belongs rather to an introduction to a
course on the princi]:)les and practice of medicine ; I shall only
state my opinion, that any doctrine of disease which takes
cognizance of the changes either in the solids or fluids exclu-
sively, must necessarily be itnpei'fect and erroneous, for the
animal body is composed both of liquids and solids, which, in

1848.] On Chemistry of Pathology and IVierapeittics. 475

truth, are little more than different physical conditions of the
same substances, the blood bcinir, in reality, a liquid flesh.

I must assume, in the following lectures, that my hearers
possess a certaiii amount of chemical knowledge ; that they
understand the doctrine of equivalent proportions, the general
properties of the more important elementary bodies, and their
simpie combinations ; that they also have some slight acquaint-
ance with organic chemistry ; but at the same time, it will be my
endeavour to make these lectures intelligible to those who have
not had time or opportunity to make themselves conversant
with the present advanced state of chemistry, by simplifying the
subject, and avoiding, as far as possible, all complicated formu-
lae and unnecessary detail of analysis.

I shall devote a short time, previous to speaking in detail of
the subjects which will engage our attention, to the considera-
tion of the importance of this study, and show how very imper-
fect our knowledge must be, both of the healthy and diseased
condition of the body, if we do not call in the aid of chemistry
to elucidate its phenomena.

Importance of Chemistry to Anatomy and Physiology. In
these sciences chemistry is of great importance. Let us take,
for example, a piece of muscle. Anatomy teaches us that it
can be divided into fasciculi and fibres: with the aid of the
microscope we can further demonstrate that these fibres contain
an immense number of fibrillae, enclosed within a sheath; that
each of the fibrillae is composed of a single row of elongated
cells, measuring not nore than from 2 o 1- o o to 3 ol^ 0 0 Ji^ch in diam-
eter. Physiology teaches us the properties of this tissue, its power
of contractility under the influence of stimuli ; also, that certain
electrical phenomena are produced by such contractions.

When, however, chemistry is brought in to aid our investi-
gations, our knowledge of muscular tissue and its functions
becomes much more extended. We shall find that the base
of the tissue consists of fibrin, which is also contained in the
blood, and that within these minute cells composing the ulti-
mate fibrillas, is a fluid having peculiar properties compared
with the blood, and containing, dissolved in it, substances
which result from the disintegration of the tissue itself. We
shall find the inclosed fluid strongly acid, whilst that surounding
it is alkaline and probably this difference is in some way con-
nected with the physiological properties which distinguish this
tissue; but this subject will be fully considered in a future
lecture. As with muscular, so with the other solids of the
animal body ; our acquaintance with them must be very
imperfect if we are ignorant of their composition. If in the study
of the solid portions of the body chemistry greatly aids our

476 0 Chemistry of Pathology and Therapeutics, [August,

inquiries, how much more is its importance manifests in our
investigations of the animal fluids! in fact, ahiiost all our know-
ledge cnicerniiig them is derived from that science. As an
example : the blood from physical examination, is shown to
consist of globules, suspended in a clear fluid, and ^fter being
drawn from the body it separates into two parts, called clot
and serum. Without a chemical examination, little more can
"be mada out concerning it ; but when so analized, we find that
the results obtained are of the greatest interest and importance.
Chemistry teaches us the composition of the globules ; that
they contain a colouring substance, ha3matosine, which is
peculiar to them, and whxh has a large amount of iron in its
composition; it also show us, that in the blood all the proximate
principles exist which are essential for the formation of the
difl^erent parts of the frame. We find the food for the muscu-
lar system, for the skin, mucous and serous membranes ; in it
also we can demonstrate the existence of the calcarous salts
which are employed by the osseous system, and here also are
discovered fatty and other matters, used either as food for
respiration and the production of animal heat, or for deposition
in different parts of the body ; and besides these, the blood can
be shown to contain a small amount of matters which result
from the disintegration constantly going on in the system, and
which again enter this fluid previous to being thrown out by
the various excreting organs.

Again, if we examine some of the principal functions of the
body for example, that of respiration, and the production of
animal heat, what an immense amount of information do we
derive from chemistry! Without its aid we should only know
that a cerla-n amount of air is constantly being taken in, and
again expelled from the body by means of the respiratory ap-
paratus ; and as it enters at the temperature of the atmosphere,
and is thrown out at that of the body, it would naturally be
supposed to be a means of depriving the body of heat ; but
chemistry teaches, first, the composition of the atmosphere or
inspired air, and shows us that which is thrown out differs con-
siderably from that which was taken in that, in fact, a part of
the oxygen has been absorbed, and its place nearly supplied by
the carbonic acid evolved: and it also shows us that the ulti-
mate efliect of respiration is not unlike the phenomena of ordi-
nary combustion, most of the carbon and hydrogen contained in
the body bein<j: tln'own out in the f >rm of carbonic acid and
water: a small part, however, being eliminated with the nitro-
gen by the kidneys, as urea, uric acid, &:c.

U we examine the respiratory function, or that which cor-
responds to it, in the vegatable iiingdom, we find the reverse

I

1848.] On Chemistry of Pathology and Therapeutics. 477

of the process I have just described ; here carbonic acid is
absorbed, and oxygen given off, hence, as animals are the
contaminators, so are vegetables the purifiers, of the atmos-
phere; and it will be seen as we proceed, that the functions
of the animal and vegetable kingdoms a])pear to be in antago-
nism to each other. From what I have just said, with regard
to the formation of carbonic acid and water in the body, we^
can at once explain the production of animal heat. We know
that when carbon and hydrogen, or a compound containing
them, is burnt, heat is produced, and it signifies not whether
this combustion is slow or rapid ; this holds good in the body ;
the amount of heat given off by an animal in a given time ap-
pearing to be the same as that produced in ordinary combustion,
when measured by the amount of oxygen consumed. Until
within the last few years it was thought that other sources of
animal heat existed in the body than that arising from the
oxidation of the carbon and hydrogen; but more recent inves-
tigations are opposed to this view. This subject, however w
shall discuss fully at some future time.

Our knowledge of the mode by which animal heat is produced
enables us easily to explain many phenomena. Thus it shows
why in young children the temperature, should be greater than
in adults, also why in birds it should be higher than in mam-
malia, for we always find the amount of respiration corresponds
to an increase of temperature ; this also explains why in amphi-
bia and fishes the temperature should belittle above that of the
medium b}' which they are surrounded, their respiratory process,
compared with that of the so-called warm-blooded animals
being so vei*y imperfect in the first class, owing to the con-
nexion between the right and left cavities of the heart, and
consequent imperfect oxidation of the blood; in the second,
from the oxygen consumed in respiration being obtained only
from that dissolved in water. The temperature of man,
whether living near the equator or in very cold climates, has
been found to be nearly, if not exactly, the same; the cause of
this equality appears to arise from the increased clothing in
cold climates, and from the power of assimilating large quanti-
ties of food consisting of matters destined to be consumed in
the respiratory process. As an illustration, I may mention the
warm fur clothing of the Greenlanders, and their use of train-
oil as an article of diet; in hot climates, the excess of heat ap-
f)ears to be carried off by the conversion of a large amount ^of
iquid into a gaseous form, which takes place from an increased
action of the cutaneous surface. If deprived of the element
necessary for the respiratory process, the temperature of the
body sinks, and we must all be familiar with the coldness felt

478 On Chemistry of Pathology and Therapeutics. [August,

in huiifrer, and know how much the power of sustainincr cold is
increased from the use of small quantities of alcoholic fluids,
which soon enter the circulation, and are consumed in respi-
ration.

The process of digestion is also capable of being explained
by chemistry; we shall find that new substances are hot formed
during the act, but those taken are only dissolved, and reduced
to a condition in which they are capable of being absorbed; this
solvent power depending on the gastric juice, a fluid which is
always strongly acid in its re-action, and containing a certain
organic principle called pepsin, a kind of ferment, which, in
conjunction with the acid, at the temperature of the stomach
is enabled to render albumen, fibrin, casein, starch, &c., solu-
ble, so that they can be taken up by the chyliferous vessels or
lacteals. This process we are able to imitate, by preparintr an
artificial digestive fluid ; we can thus cause the solutions of
these substances to take place out of the body, in vessels kept
at the temperature 100 Fahrenheit. The ivQQ acid contained
in the gastric fluid has been proved to be lactic acid, and this
acid is a constant product of the decomposition of muscular
tissue, and therefore always formed from the action of this sys-
tem ; this is probably the reason why exercise developes an
appetite and increases the digestive powers; also why those
who endure much labour require a large amount of (flesh or
inuscle-forming) food. These few examples of the application
of chemistry to physiology will, I think, be sufficient to con-
vince you of its great importance in the study of this branch of
your profession.

To Materia Medico. The advantages that materia medica
has derived from chemistr}^ are manifold.

First. It has given us many medicines unknown in ancient
times.

Secondly. It has taught us to reject many inert substances
which were formerly used in medicine.

Thirdly. It has taught us to separate the active principle?;
from many medicines, which are often better suited for admin-
istration than the substances themselves; and,

Lastly. It has taught us the method of combining medicines
in such a manner, that their efl^ects may not be neutralized.

First. Amongst the ancients, remedies were chiefly derived
from the vegetable and animal kingdoms, the medicines they
p*)ssessed from the mineral kingdom being but a few in number,
and chiefly used in the state in which they are naturally found ;
but since the advancement of chemistry, and its application to
materia medica, many of our most active and useful medicines
are derived by its processes from the mineral kingdom. Of

1848.] On Chemistry of Pathology and Therapeutics. 479

these I may mention the various preparations of mercury, anti-
mony, lead, silver, iron, zinc, arsenic, (fee. ; also the various
acids, as nitric, sulphuric, phosphoric ; and the alkalies and
earths, as potash, soda, lime, magnesia, barytes, together with
their various combinations with acids, forming the numerous
class of saline medicines. Amongst other useful remedies
brought to light by meansof chemistry, we may mention iodine
and bromine the first derived chiefly from the ashes of plants
belonging to the algae family, called kelp, and in smaller quan-
tities from some minerals and mineral waters ; traces a/so being
found in burnt sponge probably explains the use of this sub-
stance as a medicine. The latter (bromine) is very analogous
to iodine in its chemical properties and medicinal action ; it is
chiefly derived from the mother liquor of sea water, called bit-
tern, from which common salt, or chloride of sodium, has been
separated by chrystalization.

From the organic kingdom also many remedies are derived
by the aid of chemistry : for example, alcohol, naphtha, or wood-
spirit, creosote, the various ethers ; also hydrocyanic or prussic
acid. With regard to the latter substance, chemistry enables
us to explain a peculiar phenomenon which takes place when it
is formed from the bitter almond. You may perhaps know,
that the sweet or bland oil of almonds can be obtained either
from the sweet or bitter fruits. For commercial purposes it is
chiefly derived from the latter, by the process of expression,
and a dry substance, called the marc, is left having no odour.
Prussic acid, then, does not exist ready formed in bitter almonds,
but is derived from it by the decomposition of a substance con-
tained in it ; and the only difference between the sweet and
bitter almond appears to be, that the latter contains a neutral
organic principle, called amygdaline, which when separated
from the marc by the action of alcohol, is obtained in the form
of a crystalline substance, soluble in water the solution being
devoid of smell, and capable of remaining for a long time with-
out decomposition ; but when another substance is added,
which is also contained in the sweet and bitter almond called
emulsin, a substance similar in composition to the white of an
egg, and which occasions, in a great measure, the white ap-
pearance in the almond emulsion, this acts on the amygdaline
as a ferment, and occasions its decomposition, breaking it up
into several compounds, amongst which we find the essential oil
of bitter almonds, and also hydrocyanic or prussic acid.

A boiling temperature has been found to destroy the catalytic
power of the emulsion or albuminous ferment.

A similar decomposition also explains the formation of the
acrid oil of mustard, when v/ater is added to the flour or pow-
dered seeds.

480 On Chemistry of Pathology and Therapeutics. [August,

Chemistry als enables us to obtain a very useful remedy in
gallic acid a substance derived chiefly from the decomposition
of tannin, which latter body is contained in many natural orders
of plants. Gallic acid has been extensively used in medicine,
and found of great service in various forms of haemorrhage, not
acting so powerfully as tannic acid on the mucous membranes
with which it comes in contact, but enlering the circulation, and
producing its efl'ects on the remote parts of the system.

Secondly. Chemistry has been of no little service to materia
medica, by diminishing the number of substances formerly con-
tained in its list. Thus we learn from old writers on the sub-
ject, that it was the custom to administer pearls. Oriental bezoars,
(concretions found in the intestines of some species of goats,)
and various other parts or products of animals. Important
medicinal effects were ascribed to them ; for in Pomet's History
of Drugs, (published in 1725,) the use of the bezoar is thus des-
cribed : " It is a preservative from pestilential air, and a remedy
for the small-pox, and other contagious diseases ; it is reckoned
also proper against vertigoes, epilepsies, palpitation of the heart,
jaundice, colic, dysentery, gravel, to procure labour-pa'ns, and
against poisons. Dose, from four grains to twelve." And when
describing the action of pearls, he states: "All pearl is esteemed
cordial, proper against infection, to recruit and restore lost spir-
its; but their chief virtue is to destroy and kill the acifls, as
other alkalies do, and, likewise to correct the acrimony of the
stomach. Pearl is likewise good against a canine appetite, a
flux of the belly, the haemorrhage, &c. The dose, from six or
ten grains to a drachm."

In this last quotation we find many virtues ascribed to the
pearl to which it has no claim. There is likewise noticed its
antacid power, which it possesses in common with all substan-
ces containing carbonate of lime. In our present list of materia
medica, but more especiallN'in the older ones, many substances
are found, the medicinal properties of which depend on the same
active principle. From the knowledge of this fact which chem-
istry has afforded us, we are enabled, with confidence, to reject
many, retaining only one or two of the most important of them.
This remark applies especially to those plants in which tannic
acid is the active agent. The same may be said of the gentian
tribe, all the individuals of which contain a similar bitter prin-
ciple. -J

Thirdly. Chemistry has enabled us to extract the active I
principles which are contained in many medicinal substances,*
and to exhibit them in separate and more advantageous forms;,
also to free them from noxious principles with which they are
sometimes combined in a natural state. One of the best exanv

1848.] On Chemistry of Pathology and Therapeutics. 481

pies of this fact is seen in quina and cinchona, which are con-
tained in the different species of cinchona, or Peruvian barks.
In the natural state, these are united with great quantities of
useless matter, such as woody fibre, &c. ; and frequently when
large doses of this mfedicine were required, the stomach rejected
it ; but now, by the administration of quina in small quantities,
such as a few grains, the same remedial effect can be produced
on the system without disturbing the digestive organs. Another
example is seen in morphia, an alkali contained in and procured
from opium, in which it is combined with many other substan-
ces; and it is found that morphia can frequently be given in
cases ^'hen opium itself would produce unpleasant effects.
Many other examples might be given such as the extraction
of salicine from the willow-bark ; strychnia and brucia from
the nux vomica and allied, plants; aconitina from the monks-
hood, or aconitum Napellus, &c. From the animal kingdom
also an active principle is obtained, called cantharidine.

Lastly. Without the knowledge of chemistry we should be
liable to combine many medicinal substances in such a manner
as to destroy their efficacy. As a familiar example, we will
take two stringent substances acetate of lead and dilute sul-
phuric acid; when given separately, the value of each is un-
doubted ; but combined, their effects would be destroyed. Now,
although this appears a palpable instance of the administration
of incompatible substances, yet not unfrequently such a com-
biriation is prescribed, the lead being given in the form of pill,
the acid in a fluid state. When, however, acetate of lead and
sulphate of zinc afe prescribed in the formation of a lotion, the
combination may not be incompatible in a medicinal point of
view ; for although in this instance, also, the insoluble and inert
sulphate of lead is formed, we have produced, at the same time,
acetate of zinc, which remains in solution, and it is the active
ingredient in the lotion; but in the administration of remedies
we must not always suppose, that because two bodies are chemi-
cally, that they are medicinally incompatible with each other ;
in fact, we should find some of our most valuable forms unable
to bear such a chemical scrutiny. Thus, nothing is more com-
mon than prescribing with opium a vegetable astringent con-
taining tannic acid. In this case a tannate of morphia is formed,
which, although insoluble in water, is capable of being acted
on by the fluidsof the stomach, producing the desired beneficial
effects.

To Pathology. -If the application of chemistry aids our re-
searches into the structure and functions of the body in the
healthy condition, we shall find that, in the diseased state, its
assistance is equally valuable ; for no doubt every morbid con-

31

482 On Chernistry of Pathology and Therapeutics. [August,

dition is accompanied by a change in composition, although as
yet our powers of analysis cannot always detect it : hence the
great value of chemistry as an instrument for diacrnosis. As a
simple example, we may select one or two morbid conditions of
the urine. In health we find that this fluid throws down no
deposit when heated wilh a few drops of nitric acid; but in
certain diseased conditions, such is not the case the urine con-
taining albumen in solution. Now, the knowledge of the exist-
ence of this body in the urine is frequently of the utmost im-
portance ; for, wnth very few exceptions, such a condition
implies some morbid state of the kidneys, either from deposition
within its structure or from intense congestion ; and not only
will these organs be affected, but, from the imperfect perform-
ance of their function, matters which ought to be thrown out
are retained in the blood, and give rise to various secondary
morbid phenomena. A good practical illustration is seen in
the sequelae of scarlatina. In many cases of this disease, at a
variable time from the disappearance of the eruption, different
parts of the body become oedematous; frequently this is first
noticed in the face, and soon, if the case is left to itself, we have
the production of scarlatina dropsy. A few years since the
cause of this was unknown, some ascribing it to an excited
condition of the vascular system, others to the effect of the pre-
ceding inflammation of the cutis, &c. ; but we now know that
it is owing to an affection of the kidneys, which can be recog-
nized by the chemical- examination of the urine. It is found to
contain albumen, and with it sometimes the coloring matter of
the blood the cause being, an intense congested condition of
these organs, probably produced by the action of the same poi-
son which affects the skin and throat in this disease. It is found,
also, that the severity of the aflfection of the skin bears no rela-
tion to that of the kidneys, and hence the approach of this
secondary disease is more apt to be overlooked. On examining
the blood in these cases, we also obtain much useful informa-
tion ; for in it we find a larpe amount of urea and other matters
which the kidneys should have eliminated, and the presence of
which has given rise to the dropsy, from an attempt to free tho|
blood from these deleterious matters by a vicarious action off i
the skin and serous surfaces. If the disease be treated in the
early stage by depletion and counter-irritation over the regions
of the affected organs, and the free action of the skin and bowels
promoted by saline diaphoretics and hydragogue purgatives, it
is by no means an intractable malady, and the function of the
kidneys is usually perfectly restored ; but if neglected or impro-
perly treated, the patient either sinks in the early stages, or the
kidneys become permanently injured.

1848.] Hereditary Predisposition. 483

Hereditary Predisposition. By T. L. Ogier, M. D., of Charles-
ton, So. Ca. (Charleston Med. Journ. and Rev.)

By Hereditary Predisposition, we mean a congenital peculiar-
ity in the structure or form of one or more organs of an indivi-
dual, derived from his parent rendering him peculiarly liable
to certain diseases. The frequent transmission of external
form and features, from parents to children, is a fact well known,
and has come under the observation of every one; and this re-
semblance of the offspring to the parent, not confining itself to
the external form, exists often in many important internal or-
gans, and not unfrequently in the entire organic structure. If,
then, an individual be affected with a disease arising from some
organic defect or peculiarity, the offspringof that individual in-
heriting the same organic structure will be liable to the same
organic disease ; and thus are diseases perpetuated from genera-
tion to generation ; and it is in this way that in our domestic
animals, we have constant varieties springing into existence.
Pritchard relates an instance of a new breed of sheep, arising
from a lamb having been born with exceedingly short legs. " He
was carefully preserved and bred from, and many of his lambs
inherited his deformity these were selected and bred together,
until an entire new breed of sheep was produced, called the
otter breed, from their having all very short legs, with the or-
dinary long bodies of common sheep. They are considered
valuable, on account of their deformity not allowing them to
get over fences, and enabling them to be more easily kept."
The frequent occurrence of these varieties in animals, affecting
the bones, color of the skin, the length and texture of the hair,
&c., has caused some naturalists to consider the different races
of man to have been produced in like manner.

The disease arising most commonly from hereditary predis-
position, are scrofula, consumption, gout, insanity, asthma, an-
gina pectoris, epilepsy, apoplexy, amaurosis and cancer. These
by many authors are called hereditary diseases ; but as this
term is not exactly correct as applied to them, it would be as
well here to draw a distinction between hereditary disease and
hereditary predisposition. There are cases in which the dis-
ease seems to have been transmitted directly from the parent to
the ffEtus, as in an instance related by Dr. Hey, of a child hav-
ing been born with syphilis, whose mother had never been dis-
eased in the genital organs, but had contracted the disease in
the nipples during a previous confinement, by an infected nurse
drawing them the disease had never been eradictaed from the
system of the mother, and when the second child was born it
was found diseased. Dr. Jos. Brown, also relates his having

484 Hereditary Predisposition, [August,

found tubercles in the lungs of still born infants, whose parents
were consumptive. These then are cases where the disease
may be called hereditary where the embryo may be supposed
to have received a morbific principle, or the seeds of disease
with the principle of life, or commencement of its existence.
The child here, if born alive, has the disease already developed.
In hereditary predisposition, the child is born healthy, and fre-
quently is not affected by disease until a late period of its life.
Scrofula generally appears early in life ; consumption about
puberty ; gout after puberty ; amaurosis and cancer, especially
in females, later in life, generally about or soon after the cessa-
tion of the menses.

We sometimes see an individual inheriting the constitutional
tendency to disease of the parent, pass through life without
ever being affected, and yet beget children who die of the old
disease of the grand parent. Thus in scrofula and consump-
tion, we often see the disease pass over one generation and re-
appear in the next. It seems necessary therefore, in many
cases, that there should be some exciting cause to develop the
disease to which a predisposition already exists, which cause
would probably produce no affect upon an individual in whom
there was not a like predisposition. Certain changes in the
system causing excitement in organs remote from those predis-
posed to disease, sometimes prevent its development. Beer
mentions a family in which the females, even to the third
generation, became completely and incurably amaurotic ; but
several of the sisters became pregnant and bore children; and
all of these escaped. The constant irritation or excitement of
the uterus, acting as a counter-irritation to the affection in the
retina, seems here to have been the cause of exemption.

Although many cases of hereditary predisposition require
some exciting cause to produce disease, there are instances
when the predisposition exists in organs whose mere develop-
ment, in common with other parts of the body, necessarily pro-
duce disease. As in individuals with malformation of the ribs
and sternum, when puberty approaches, and the organs, par-
ticularly those of the chest expand; the lungs and heart are
pressed upon by the surrounding hard walls, their development
is impeded, and disease necessarily results. Another instance
of this kind, which we not unfrequently meet with, is phymosis
from congenital malformation of the prepuce. The opening in
the foreskin is extremely small, but still large enough to allow
the urine free passage during the early part of life but later,
as puberty advances and the glans penis is' developed, and the
secretions become mo e abundant, the preputial orifice is too
small to allow them free passage, and becomes irritated, and if

1848.] Hereditary Predisposition. 485

not soon relieved, a violent inflammation of the whole penis is
the result, which is only to be cured by dilating the opening in
the prepuce, or by circumcision. We have seen as severe cases
of phymosis arising from this cause as from gonorrhoea or
syphilis.

It is supposed by some naturalists, that only congenital varie-
ties or peculiarities of structure are transmissable, and therefore,
that no individual can inherit an infirmity or tendency to dis-
ease, whose parent or grand parent w^as not horn with the same
infirmity.

Dr Pritchard has laid it down as a law of nature, that con-
nate varieties of structure are apt to appear in the progeny ; but
changes produced by external causes, terminate with the indi-
vidual, and have no influence on his descendants. This is no
doubt correct as applied to the majority of cases, but there are
many exceptions to it in the transmission of tendency to dis*
eases ; we see scrofula and consumption often produced in in-
habitants of warm, residing in cold climates, from external
causes alone, and Brown and Wall, assert that children born of
such parents are very liable to die of the same diseases, or as
much so as when the diseases, of the parent is inherited.

Combe thinks that the ofl^springis influenced by the state of
the parents at the time when existence is commenced in the
embryon, that it is not necessary that there should be any or-
ganic derangement to afl^ect the off*spring, but that a mere tem-
porary excitement of certain organs, of the brain, for example,
of the parent, at the time when^he child is begotten, will pro-
duce corresponding results in the brain of the child and it is
owing to this fact, he maintains, that children of the same pa-
rents vary so much in intellectual powers ; children born early
in life, he thinks, have less intelligence and more physical
strength, than children of the same parents born at a later period,
because in men, the animal faculties are most active early in
life, and the intellectual, later. If it was clearly established
that the first children were the least intelligent, this would cer-
tainly be an ingenious way of accounting for it, but this cannot,
w^e think be proved, on the contrary, we often see children be-
gotten by fathers in their young days, excelling intellectually,
children of the same father born at a much later period of his
life.

We do not believe that a mere temporary excitement of an
organ in the parent, will be transmitted to the oflispring ; but it
is very possible that when this excitement of an organ is con-
tinued until its structure is altered, as in accidental consumption,
scrofula, or insanity, that the peculiarity may be transmitted,
and thus a disease originating entirely from external causes, be

488 Hereditary Predisposition. [August,

continued to successive generations by hereditary predisposition.
A very interesting question connected with this subject, is the
following : Does the olTspring derive its character morally and
physically from the father or mother, or equally from both ?
From many facts observed among animals, it appears to us that
the peculiarities of the father, more frequently than those of
the mother, are shown in the progeny. In the mule for instance,
we have the head, long ears, and general appearance of the ass
strongly marked, the size only being like the mare, whilst the
bardeau or offspring of the stallion and ass, is said to resemble
most the horse and has short ears. Black rams are said almost
certainly to beget black lambs, and are therefore, not generally
allowed to exist in flocks of sheep.

A still more remarkable insance of the peculiarities of the
male being transmitted to the offspring, is the following : A far-
mer in the west of Pennsylvania, fond of trying experiments
for the improvement of liis cattle, thought his breed of cows
would be very much improved by crossing them with the
buffalo. He accordingly procured a buffalo bull, and had his
best and largest cows covered by him, they conceived, became
pregnant and went the usual length of time, but when parturi-
tion came on they all died in labor in consequence of the large
heads of the buffalo's calves being unable to pass through the
pelvis of the cows. The cross breed was afterwards obtained
by putting the common bull to the buffalo cow ; but the pro-
geny have resembled the common cow more than the buf-
falo.

According to the present generally received notions of con-
ception and generation, that the ovum and all the parts going
to produce the foetus are furnished by the females, and that the
male semen acts only as a stimulus or vivifying principle to
this ready formed matter ; how is it that the offspring ever re-
sembles the father ? Yet this is not only true in the instances
above mentioned, but the male has been known not only to pro-
duce his likeness in his own progeny, but to influence children
not yet conceived, and to he begotten by another father. Huit re-
lates the following well authenticated experiment made in the
zoologrcal garden of London. A common mare was put to a
quagga, conceived, and had a colt striped like the father and
otherwise resembling him ; she was then taken away and put
to a common stallion ; conception again took place, and in
due time a colt was born, but this colt was also striped like the
quagga, her first husband.

It is also stated that if a young pointer slt be lined, and has
pups for the first time by a poodle dog, and the next season be
put to a thorough bred pointer like herself, some of the pups

1848.] Hereditary Predisposition. 487

from this latter union, will have long hair and resemble the
1 oodle who was the father of" her first litter.

These curious facts in generation cannot, we think, be satis-
factorily explained by any of the present theories of genera-
tion.

Although the offspring most generally resembles the father,
yet it often bears a strong likeness to the mother, and almost
always resembles her in some of its parts, therefore, to produce
a perfect animal, Huit thinks that the mare should be as care-
fully selected as the stallion, in which case, the colt never fails
to be good ; and Combe in his chapter on hereditary qualities
says, " I am not acquainted with a single instance in which the
moral and intellectual organs predominated in si^e in both fa-
ther and mother, in which all the children born of them, did
not partake of a moral and intellectual character, differing
slightly in degrees of excellence, one from another, but all pre-
senting a decided predominance of the human over the animal
faculties. U we have then, a peculiar development in both
father and mother, the offspring will almost certainly inherit
the pecuharity. If the peculiarity exist only in the father, it is
still very apt to inherit it, but if it be only in the mother, it may
be transmitted to the offspring, but with no very great cer-
tainty." The great French General, Napoleon, seems to have
resulted from a union of this kind, where both parents had par-
ticular qualities equally developed. Sir Walter Scott says, "The
father of Napoleon possessed a handsome person, a talent for
eloquence, and a vivacity of intellect, which he transmitted to
his son. It was in the midst of civil discord, fights and skir-
mishes, that Charles Bonapart, married Letitia Ramollini, one
,of the most beautiful women of the Island, and possessed of a
great deal of firmness of character. She partook of all the
dangers of her husband during the years of civil war, and is
said to have accompanied him on horseback on some military
expeditions during her pregnancy with the future ICmperor."

The mother has perhaps more influence in forming the fu-
ture character of the child than the father ; for the offspring
may inherit certain traits of character from him, yet it is taught
both by precept and example early in life, almost exclusively
by the mother, and the inherited qualities are exercised and
developed or allowed to lie dormant, according to the condition
of the qualities in the maternal teacher. Hence it is, that we see
pious and well educated females, mothers of a large proportion
of distinguished men. Washington, according to his biogra-
phers, is an example of the effect of female education; an ex-
cellent and cultivated woman herself, Mrs. Washingtion, is said
to have devoted herself to the cultivation of that high moral

488 Diseases of the Cervix Uteri: [August,

character which marked all the actions of her distinguished
son. Lafayette was also left entirely to the care of his mother,
his father, a distinguished colonel in the French Army, having
been killed at the head of his regiment in Germany, before the
future hero was born.

For the improvement of mankind, therefore, it is undoubtedly
of the greatest importance, that females should be well educated,
that their good qualities may be transmitted to their (>tispring,
or when this does not happen, that they may by their teaching,
correct many evil propensities inherited from the father in
either case the progeny would be improved.

As I'egards the practical application of our knowledge of he-
reditary predisposition, we think it may be usefully applied
to many cases of disease, which come under our treatment.
Some of these diseases we know, require an exciting cause to
develop them, and knowing these causes, w^e have it in our
power frequently to avoid or correct them. To the scrofu-
lous, for instance, we would prescribe a mild climate, warm
clothing and nutritious and invigorating diet. To the gouty,
rigid temperance, regular exercise, &^c., and so on in many other
diseases, depending upon exciting causes, and even in some of
those cases which become developed without the aid of any
external cause, we may remedy the defect in early life, and thus
prevent future disease, as in malformation of the prepuce by a
simple incision, and in the deformity of the ribs and sternum,
called pigeon breast, by mechanical pressure.

Diseases of the Cervix Uteri. By B. Fordyce Barker, M. D.,

of Connecticut. *

[We have been favored by the Secretary (Dr. Russel) of the Con-
necticut Medical Society, with the proceedings, &c., and the annual
address delivered before that body in May, 1848. The dissertator
was Dr. Barker, and the subject, "Some forms of non-malignant dis-
ease of the Cervix Uteri." We have read the article with considerable
interest, and regret we can only give space for the conclusion of it.]

"I will submit to you an abstract of the more important
symptoms attending thirty-three cases which have come under
my care, as I should exhaust your patience, were I to give a
detailed report of each. All were or had been married.
Twenty-one had borne children, and of the remaining twelve,
seven had aborted ; one, four times, three twice, and three once
each. A constant leucorrheal disaharge was a symptom in

1848.] Diseases of the Cervix Uteri. 489

every case. This discharge was in some white, in others yel-
low, and in five it was frequently sanguinolent, particularly
after connection. Dysmenoi'rhea (I restrict the term to those
cases where the pain continues severe through the whole cata-
menial period) existed in nine cases. In all, the first day of the
menstrual discharge was attended with a good deal of pain.
Menstruation was profuse in thirteen, scanty in three, irregular
as to its appearance and sometimes profuse and sometimes
scanty in five. The " bearing down" symptoms were the most
prominent in thirteen, eight of whom had worn abdominal sup-
porters, four had worn pessaries, the other was accustomed to
wear a belt of her own construction, which she thought reliev-
ed her. Two patients had no suspicion that they were subjects
of uterine disease, but sought medical advice on account of
some pulmonary symptoms, which alarmed them extremely.
These however entirely disappeared when the disease of the
cervix was cured. I think the above analysis embraces all the
important general symptoms, except those which may be re-
garded as purely nervous. These were so numerous, and pre-
sented such a variety of characters, that it would be impossible
either to analyze or to classify them.

I will ask your indulgence while I give a somewhat detailed
report of three cases, which I think offer some points of pecu-
liar interest.

Sept. 6, 1846, I was called in great haste to see Mrs. ,

who was represented to be in a dying state. I found her in a
violent hysterical paroxysm, really alarming to her friends, as
they never had seen her in such a state before. She was of a
ilorid complexion, very full plethoric habit, and had always
been in perfect health, the bystanders stated. But on visiting
her the next day, I learned the following history. Up to the
time of her marriage, which was five years before, she never
had had an ill day to the best of her recollection. Five weeks
after she was married, she w^as attacked with what her physi-
cian called "inflammation of the bowels." Soon after her re-
covery, she first observed a leucorrheal discharge. It was
sometimes white, sometimes yellowish, and at other times
greenish; but she "did not think there had been a single day
that she had been free from it, except when she was unwell."
She had aborted three times; the last time (in Jan., 1845), she
was obliged to call in medical aid " after she got all through,"
on account of the flowing, which was very excessive. Since
that time menstruation had been growing more and more pain-
ful. She could not recollect that she had suffered during the
catamenial discharge previous to the last abortion. Coition
had been painful and disagreeable to her since she had " inflam-

490 Diseases of the Cermx Uteri. [August,

mation of the bowels." More than a year ago it became so
extremely painful and intolerable, that she " had been compelled
to live like a nun ever since." These were her exact words.
The menses had been diminishing in quantity for the last six
months. The two periods previous to my being sent for, had
continued but two days each, which she had been obliged to pass
upon her bed on account of the severity of the dysmenorrhea!
pains, and a most distressing vertigo. She was perfectly willing
to submit to any treatment which would ofier a prospect of cure,
on account of the unhappy coldness existing between her hus-
band and herself, which she described as amounting to absolute
hatred on his part, which was breaking her heart, but which
had been most studiously concealed from their most intimate
friends, as the}^ erroneously supposed. At this time her skin
was hot and dry, pulse quick and hard, pain in the head, back,
and along the thighs. No satisfactory information could be ob-
tained by the touch, on account of the extreme tenderness of
the cervix uteri, except that it was very low down in the pelvis
and much enlarged. I therefore directed her to remain in bed,
and to take the following medicine, viz : I^. Pulv. Rad. Colchic.
3i. ; Pulv. Gum Camphor, Bii. ; Ext. Hyoscyamus, 9i. M.
Div. in chart No. 10. S. One every fifth hour. If there was
no movement of the bowels, she was to take, on the next day,
^. Sulph. Magnes., ii. ; Tart. Antimonii et Potassae, gr. i. ;
Succi Limonis, Aq. Puree, aa 1\\. M. Sep. 10. The general
appearance of the patient had very much improved. The
mixture had operated freely, both as an emetic and cathar-
tic. I did not attempt to examine by touch, but introduced the
speculum, with some pain, for the purpose of applying leeches
to the cervix. There was an abundance of muco-purulent
secretion in the upper part of the vagina, on removing which
with a dossil of lint, a part of the anterior lip was seen, of a
deep red color, but no ulceration was visible. Eight leeches
were applied. She was directed to inject into the vagina, four
or five times a day, a warm decoction of poppy leaves, and a
pint of cold water into the rectum every morning.

Sept. 18. The patient so much better, that I was able to get
a good examination. The cervix is low down, enlarged, offer-
ing to the finger very distinctly, the velvety sensation around
the orifice, and well marked lobulated indurations. By the
speculum, the orifice was about a half inch in length, somewhat
patulous, from which I wiped nearly a tea-spoonful of a muco-
purulent secretion, when an ulceration was distinctly seen,
occupying both lips. The ulcerated surface was of a bright red
color, and did not bleed. Cauterized with the acid nitrate of
mercury. In the evening, ten hours after the cauterization,

1848.] Diseases of the Cervix Uteri. 491

she had a second hysterical paroxysm, more violent than the
first. The succeeding two days her symptoms were all aggra-
vated ; but after that she improved so much, that it was with
difficulty she could be persuaded to remain in bed. Weak
injections of sulph, zinc and alum, were substituted for the de-
coction of poppy, she continuing the cold water enema every
morning.

Sept. 26. The cauterization was repeated, the immediate
effects of which were much less severe than before. The
menses appeared on the 30th, nearly a week earlier than she
anticipated, lasting three days, but attended with a good deal of
pain. Cauterized again Oct. 8th. On the 15th the induration
was entirely gone, and the ulcerated surface completely healed,
but as purulent matter was seen issuing from the orifice, I intro-
duced nearly an inch into the cervix, the solid nitrate of silver,
and again on the 20th. The menses appeared on the 24th, con-
tinuing for five days, and without pain, except just before their
appearance. I then permitted her to resume her ordinary hab-
its. Nov. 12th. On examination with the speculum, and by the
touch, no appearance of disease was discovered. The patient
described herself as being perfectly well, and it was sufficiently
evident that connubial harmony was restored. Dec. 15th. A
speculum examination was made, as the patient had some symp-
toms which led her to fear that the disease was returning. An
irregular erosion with some increased redness was visible on
the anterior lip; the solid nitrate of silver was applied, a tem-
perance lecture was given to the husband, and the patient has
had no occasion for medical aid since, except on one occasion,
when the squalling of a fine baby was deemed delicious music
by at least three persons, the parents and the accoucheur.

Case II. The patient in this case was forty-two years of
age, the mother of eight children, the youngest eight years old,
since the birth of which she had never been pregnant. She
was very pale, extremely emaciated, and years before, she had
worn out the patience of every regular practitioner in the vicin-
ity, since which she had tried every itinerant quack, and every
patent medicine that she could hear of I shall not attempt to
give a history of the case as it was related to me, as it was the
most tedious that I was ever compelled to hear, she seeming to
fear all the time, that I should not attach sufficient importance
to every ache and ail she had suffered since her childhood.
Among other complaints, according to her opinion, she had
" two consumptions," "the liver complaint," "the gravel awful-
ly," and " falling of the womb." She asserted, that for many
years, she had had a constant leucorrheal discharge, but that
she had been "flowing" every day for the last five months,

492 Diseases of the Cervix Uteri, [August,

which statement was confirmed by her husband's sister, who
was present. The discharge had never been fetid. On a digi-
tal examination, the ulcerated surface was distinctly felt, the
anterior lip seeming shorter than the posterior, indurated and
volum'nous. The touch was 720/ painful, and the uterus was
perfectly movable On introducing the speculum, it was half
filled with a bloody, sanioiis discharge, on removing which, a
fungous ulceration was distinctly visible, completely filling the
field of the speculum. On varying the direction of the specu-
lum, so as to bring into view the other parts of the cervix, about
one-third only of the posterior lip was found free from ulcera-
tion. The diagnosis was extremely doubtful in my mind,
whether it was a corroding ulcer, an ulcerated cancer, or an
inflammatory ulceration.

It was impossible for me to decide satisfactorily whether the
increased size of the cervix was due to engorgement or to mor-
bid deposition in the part. But the uterus was movable, and
the discharge had never been fetid, two facts opposed to the
idea of carcinomatous ulceration, and the fungous granulations
appeared too large for corroding ulcer. ( "n suggesting, with a
good deal of h sitation, that there was a bare possibility that
some benefit might accrue from cauterizing with a hot iron, to
my utter astonishment, she at once insisted it should be done,
evidently from a morbid desire for sympathy on account of be-
ing the subject of such a terrific operation. Not to weary you
with a minute detail of the case, I will say in general terms that
the cervix was cauterized with the hot iron three times, and with
the nitrate of silver twice, the intervals between each cauteri-
zation varying from eight days to three weeks, and that a per-
fect cure was the result. It js now more than a year since she
has had any uterine discharge, either sanguineous or leucor-
rheal, and her general health is now excellent. A little of the
old spirit, however, remain-:, as the last time I saw her, some
two months since, she was very much afraid that her flesh was
bloat and her color hectic.

Case III. I shall relate in very brief terms this case, solely
for the purpose of showing how easy it is to be mistaken, and
of enforcing the importance of caution in prognosis. The pa-
tient was pale, feeble and emaciated from a menorrhagia of
three years standing. It had been several times arrested for a
short period, only to recur again with increased violence. She
was the mother of three children, the youngest six years old,
since the birth of which she had never conceived. The slight^
est exertion, as going up stairs or riding in an easy carriage,
would frequently bring on a sudden and profuse discharge of
blood. I will do myself the justice to say, that in the onset I

I

1848.] Diseases of the Cervix Uteri. 493

suspected a polypus, but on making a mos* careful examination,
I found nothing to confirm my suspicion. The cervix was
moderately tender to the toucfi, the orifice open, admitting the
ungueal portion of the finger, with apparently a very superficial
induration of the anterior lip. The vaginal portion of the cer-
vix seemed to me full two inches in length, but not enlarged to
any considerable extent. From the result of this examination
and a full history of the case, I was induced to urge upon my
patient a specular examination, which she with some reluctance
consented to. On discovering a superficial ulceration of some
extent, involving both lips of the cervix, I was stupid enough
to promise a very speedy cure. The ulceration was soon cured
but not so the uterine hemorrhage. This continued, although
not the slightest disease of the cervix could be discovered by
repeated and careful examination, both by the touch and with
the speculum.' Every known remedy was resorted to, with
but very little benefit, until at last I lost all confidence in myself,
and plainly told my patient so. She became subject to repeat-
ed attacks of hemorrhage from the nose, and her general health
was fast breaking up. Thus the case went on, for nearly four
months, when in October last, I read an article by Dr. Bennet,
in the London Lancet for August, 1847, on ulceration of the
cervix uteri, accompanying uterine polypi. Another specular
examination was made, separating the lips of the cervix with
the speculum forceps, so that a portion of the cavity of the cer-
vix was distinctly visible, but nothing^ could be detected indica-
ting the existence of a polypus. On attempting to examine
with a probe, so much hemorrhage came on that I was obliged
to desist from farther exploration. She was so much exhausted
by this examination Hiat she kept her bed for a week, and three
weeks were allowed to pass before she was again subjected to
another examination. At this time a sponge tent was introdu-
ced into the cervix, and retained in its place by filling the vagina
with old linen, and this was allow^ed to remain, she keeping her
bed for two days. The last day she suffered from pains which
she described as being exactly like labor pa'ns, only more se-
vere than she had ever experienced. On removing the tampon
and sponge, a profuse discharge of blooH took place, obliging
me to wait nearly two hours before I judged it proper to pro-
ceed farther. On introducing the speculum, and separating the
lips of the cervix, the cavity of which was a good deal dilated by
the sponge, the cause of all her trouble was apparent, although
imperfectly so from the constant oozing of blood. With a good
deal of difficulty I succeeded in twisting and pulling off with
the forceps, the polypus which I now exhibit to you. Symp-
toms of acute metritis, requiring active treatment for a few

49 1 On Certain Forms of Headache. [August,

days, came on directly after the operation, followed again by
ulceration of the cervix, which yielded readily to cauterization
with the nitrate of silver. Her restoration to health was slow
but complete.

It was my intention to have added a few observations on some
of the functional disorders which occur so frequently, as symp-
toms of the diseases which we have been considering, but I
have already taxed your patience too severely. Allow me in
conclusion, to state my conviction that a large majority of the
cases of prolapsus, dysmenorrhea, menorrhagia, and leucorrhea,
which the medical man is called upon to treat, arises from or-
ganic disease of the cervix uteri. Dr. William C. Roberts, in
by far the very best paper I have read on the subject of leucor-
rhea, (New York Journal of Medicine, for May and July, 1845,)
demonstrates, most satisfactorily to my mind, that this is the
true pathology of leucorrhea, and I have no doubt that future
investigations will establish the fact, that the other affections
referred to above, are rarely idiopathic diseases.

On Certain Forms of Headache. (Amer. Journ. of Med. Sci.)

Dr. P. Murphy, in a paper on this subject read before the
South London Medical Society, (Nov. 25th, 1847,) after allud-
ing to the frequent occurrence of headache, stated that his
intention was to confine himself to the consideration of those
varieties originating from disease of bone, or its periosteal cov-
ering; from disease of fibrous structures, or rheumatism; from
afl^ections of the occipital nerves, or fromideficiency of excess
of blood within the cranium.

Periostitis of the cranium is scarcely met with unless after a
mercurial course, the constitution being almost always scrofu-
lous, and is generally found to invade either the coronal or
parietal bones, which the author attributed to their less protect-
ed situation. The diagnosis of this form of headache, although
not difficult, has been at times erroneous. The pain is severe,
and confined to one or more spaces of the above-mentioned
bones ; is increased by warmth at night, by stimulating drinks,
by exposure to cold and pressure ; and a raised surface can be
detected by the finger at the spot in pain: and, on inquiry, it
will be found that more than one course of mercury has been
undergone. It occurs chiefly in men below forty years of age,
and in the degraded class of females. The treatment should
consist in the application of the Empl. c. Hydr., spread on thick
leather, to the part, which both protects it from the cold, and

1848.] On Certain Forms of Headache. 495

removes the effusion of lymph. The exhibition of the iodide of
potassium, combined with morphia and tinct. digitahs, is highly
useful.

Another form of headache, the rheumatic or fibrous, not very
common, is located in the tendon of the occipito-frontalis, the
temporal aponeurosis, and tendinous insertions of muscles at the
back of the head : it is usually preceded by rheumatism of other
parts, and is increased by muscular movements. Warm cov-
erings, when they can be applied, usually relieve it; also sinap-
isms; and, if the pain is very severe, leeches and cupping, and
a few doses of calomel with opium, seldom fail to give relief.
Gout may also attack the same parts, but may be diagnosed by
our previous acquaintance with the habits of the patient. In
both cases the pain is intermitting, changes its locality, is felt
to be external, and the health is not affected.

The next form belongs to the class of spinal irritation, is very
frequent, and met with exclusively in females during the men-
strual periods, and attacks mostly the left side of the head ; the
pain is intermittent, shooting, and lancinating; may be fixed for
days, and is most severe at the temple (when it is termed clavus
hystericus), and next at the parietal protuberance and occiput :
it proceeds from the sub-occipital nerve, and, if the exit of the
nerve is pressed upon, pain more or less severe is complained
of, extending along the whole course or at certain sites only of
the nerve as at the temple, nape of neck, parietal protuber-
ance, &c. : it is usually increased during the menstrual period,
and is generally a complaint of unmarried females between the
twenty-third and thirty-fifth years of life, and is indubitably a
form of hysteria. The menses are usually profuse or diflicult,
the bladder irritable, and there are ill-defined painful sensations
about the pelvis ; other forms of neuralgia often co-exist. The
irritation of the sub-occipital nerve must be traced to the ova-
ries, being only present where these exist, and while capable
of fulfilling the function of menstruation ; and our treatment
must be primarily directed to remove any congestion or irrita-
tion of these peculiar organs, and secondarily to lessen the pain
of the nerves. The author advises the daily use of hip-baths
or sea-bathing, where possible ; attention to prevent accumula-
tions in the rectum ; abstinence from stimulants ; mental em-
ployment ; inf. valerian c. digitalis, with pills of assafcetida ;
occasionally general or only local bleeding; and, when these
fail, a gentle mercurial action, the cold bath being during the
time omitted. As local means he recommends belladonna
plasters, veratrine ointment, sinapisms, or blistering. Where,
however, the patient is exhausted by leucorrhoea or profuse
menstruation, with symptoms of chronic inflammation of the

496 On Certain Forms of Headache, [August,

womb or ovai'ies, the treatment becomes more doubtful ; but
the author prefers the trial of a tonic treatment, and advises
the exhibition of the valerianate of zinc and quinine, as espe-
cially efficacious, and the sulphate of iron in infusion of valerian
when there are evidences of confirmed chlorosis. This head-
ache may be termed the nervous headache : it also assumes
another form, which may be termed the cutaneous headache,
and is the hemicrania of our forefathers : it seems to be located
in the integuments of one half usually the left side of the
head, which is so exquisitely sensible as scarcely to bear the
least touch of the finger, and the pain never passes the mesial
line.

Another form of headache is that arising from deficiency of
blood within the cranium, and coming on after hemorrhages,
exhausting discharges, or any other debilitating causes: the
best examples occur in chlorosis. It is increased by the erect,
diminished by the recumbent posture ; is not a very painful
form, but is often attended with impaired vision : its cause may
be traced to diminished muscular power of the heart, which
palpitates on slight exertion : there is also dyspnoea^ pale face,
and other symptoms of a feeble circulation, with a sinking pain
at the epigastrium, and craving appetite. If the true cause of
of this headache is mistaken, and depletion used, paralysis has
been known to supervene, but if the debility be remored, the
muscular power of the heart is easily increased ; and the most
useful remedies are, steel by itself or combined with cjuina, full
diet, and the recumbent posture.

The last form of headache alluded to by the author arises
from excess of blood, and may exist as a passive or congested,
or as an active or inflammatory state. The former, arising
from the various known causes of congestion, is diagnosed by
the constant heavy pain at the anterior part of the head, in-
creased by the recumbent posture, sense of chilliness, slow,
feeble pulse, tendency to vomiting, and pain in the lumbar re-
gion, caused by congestion of the spinal cord. It is a dangerous
form of headache, and has hi the depressing diseases proved in
a few hours fatal, but in other cases has lasted weeks without
much mischief The treatment should be to induce reaction as
soon as possible by the warm-bath or an emetic. The author
deprecated the usual attempts to arrest vomiting during the in-
vasion of fevers. If the headache persists, with hot skin,
leeches to the inner nares will be found of talue ; applied to
the temple, they debilitate without relieving this pain of head,
and they are altogether inadmissible when this coexists with
typhus or scarlatina. Blisters may also be applied, and diaph-
oresis produced by the usual means ; cold applications to the

1848.] On Certain Forms of Headache. 497

head, the author considered useless, and even likely to increase
congestion. Care was also requisite that mere congestion should
not by the use of stimuH be forced into inflammation, which is
the next stage if resolution or fatal termination does liot take
place. The author regarded idiopathic phrenitis as a most rate
disease, and hydrocephalus acutus as congestion not inflamma-
tion. Phrenitis Was Well marked by the tensive pain increased
on stooping, by the bright eye, hot skin, nausea, and vomiting,
tendency to delirium, and occasional twitching of the muscles
of the face ; the most active antiphlogistic measures should be
used.

There were other forms of headache easy of diagnosis, but
of these the author Would only mention the constant pain of
head in children, with emaciation and want of sleep, and which
diagnosed tubercles of the brain. In the headache of pregnant
females referred to the centre of the head, and attended with a
remarkably slow pulse, and in which, if bleeding is neglected,
convulsions, abortion, and too often death, are apt to supervene ;
and lastly, the pain of the head occurring after a night^s de-
bauch, the cause of which, whether in the stomach or affected
organ, the author considered not to have been sufficiently in-
vestigated.

The President inquired of the author his means of judging
in cases of headache whether the treatment should be depletory
or stimulating, as in his own practice he had at times found it
extremely difficult to decide, and was often obliged to try, as
it were, a tentative treatment.

Dr. Murphy thought we should not often be led astray if at-
tention was paid to certain points. If a patient complained of
the pain of head coming on and increasing after getting up iii
the mornings or assuming the erect position, and relieved on fe^
suming the horizontal ; if troubled with dimness of sight, faint-
iiess, perspirations, palpitations on exertion, cramps of legs, de-
pression of spirits, frightful dreams, &c., he concluded a tonic
treatment would be useful; headache from congestion is, more-
over, a rare disease. In answer to Mr. Wright, his usual prac-
tice in clavus hystericus was to commence with tonics, which
Usually effected a cure. Still in some cases he resorted to cup-
ping at the back of the neck with the greatest benefit, after the
former plati had failed. In cases of young females where signs
of congestion about the womb existed, leeches to the groins
were often useful.

Dr. Silvester agreed in the value of Dr. Murphy^s diagnostic;
symptoms, and alluded to the existence of the venous bruit,
which, when present, always indicated an ansmial Condition of
system, and contraindicated depletion, but is benefitted by a

32

498 Bibliographical. [August,

tonic plan ; as a general rule, he thought it wiser not to deplete
in headache. He did not agree with the author that the pain
of syphilitic headache occurred generally at the front or most
exposed portions of bone; he thought it was more general
about the muscular insertions at the back of the neck, and in
parts well covered with muscles ; there appeared to be an elec-
tric attraction in the poison for certain parts of bones.

BIBLIOGRAPHICAL.

Ohsiefric Tahles : Comprising graphic Illustrations, with Descriptions
and practical Remarks ; exhibiting on Dissected Plates many im-
portant subjects in Midwifery. By G. Spratt, Surgeon-Accouch-
eur. (Re-published.) Philadelphia: Thomas, Cowperthwait& Co.

These are certainly most ingenious and admirably executed plates :
every part, every process and every operation, in obstetrics, suscepti-
ble of pictorial illustration, is handsomely demonstrated. Many of the
plates are so arranged that, by raising up or turning down successive
layers, each one exhibits several figures, representing different periods
of a process, or stages in an operation.

Every thing that can be is accomplished in these plates. More per-
haps is attempted than is practicable and much for which verbal descrip-
lion might very well suffice ; but they can not fail to afford valuable
assistance to the student, in the acquisition of knowledge, and to prove,
occasionally to the practitioner, a useful remembrancer, reminding
him, at a glance, of much that he might have forgotten and which
would require considerable reading to recover. j. a. e.

On the Causes and Treatment of Abortion and Sterility : being the
result of an extended practical inquiry into the physiological and

;. morbid conditions of the Uterus^ with reference especially to leucor-
rhcBal affections and the diseases of Menstruation. By James
Whitehead, F. R. C. S., Surgeon, <k,c. (Re-published.) Phila-
delphia : Lea & Blanchard, 1848.

This is, in our opinion, the most scientific and able treatise on Abor-
tion and Sterility, that has ever issued from the press. Besides these
highly important subjects, it treats incidentally, but most satisfactorily,
of many of the principal and most frequent diseases peculiar to fe-
males.

It is certainly saying a great deal, but we sincerely believe not too
much, to say that it ranks with Dr. Bennett's Practical Treatise on
Inflammation, Ulceration and Induration of the neck of the Uterus,

]848.] Monthly Periscope.

and, like that invaluable work, throws much light on that previously
too much neglected subject, uterine pathology.

It may be emphatically styled a book of facts, of facts obtained
from careful observation in actual practice, worth a thousand volumes
of fine theories, fabricated in the closet, or elaborate systems made, by
snips of the scissors from numerous authors, independent of all help
from clinic experience.

It would be a pleasant task, if time permitted, to analize this work
and exhibit its merits more fully to our readers ; but we hope this brief
notice will suffice to commend it to their favorable consideration,
which we do with the most unhesitating confidence, assured that they
can not fail to accord with us in our high estimation of its claims.

J. A. B

PART III. MONTHLY PERISCOPE.

Health cf Americans covipared to Englishmen. 'There is too much
reason for apprehending that Americans err greatly in their estimate
of the -healthfulness of this country. It has been calculated that
while the average age of tlie whole living population of the U. States
is 22 years and 2 months, that of all living in England and Wales is
26 years and 7 months. It has also been shown, that while but about
56 per cent, of the population of the United States survive the age
of 15, and 4 per cent, only that of 60, nearly 64 per cent, of the
population of England survive the former, and more than 7 per cent,
the latter age. These statistical results and common observation mu-
tually confirm one another. European travelers in this country
wonder that so few old persons are to be met with, and Americans
abroad are surprised at seeing so many persons advanced in life, en-
gaging still in active pursuits, and retaining the cheerfulness and
vigor of middle age. -^[Transactions Phil. Col. Physicians.

On the Chemical Composition of various Tumours. 'The following
analysis have been recently made by Von Bibra r

1 2 3 4 5 e

Water 84-82 80-83 82-20 70-0 81-09 84-89

Solid residue ..... 15-18 19-17 17-80 30-0 18-91 15-11
Proteine substances . . 4-83 3*70 5-00 16-99 14-29 1-97
Soluble, albumen, and

a little haematine
Extractive matters . / 2.44 1-63 1-06 0-57 3-02 &.07

Glutine 5-47 5-90 7-32 3-78 .... 7-24

Fat ......... . 0-36 5-47 0-44 8-66 1-60 0-62

(1) was a fibroid tumour ; (2) a scirrhous tumour ; (3) an encepha-
loid tumour; (4) and (5) encysted tumours; and (6) the contents of
a tumour lying between the pulmonary and costal pleura.

2-08 2-47 3-98 traces . 0-21

500 Monthly Periscope. [August,

The salts left on incineration consisted chiefly of chloride of sodium,
sulphate and phosphate of j^oda, and phosphate of lime, in very vary,
ing proportions. [Medico-Chirurg. Revietc.

Dysentery caused by Insects. Rolander, a student in Entomology,
while he resided in the house of the illustrious Swede, Linne, was
attacked by the disease in question, which quickly gave way to the
Usual remedies. Eight days after it returned again, and was as before
soon removed. A third time, at the end of the same period, he was
seized with it. All the while he had been living like the rest of the
family, who had nevertheless escaped. This of course occasioned no
little enquiry into the cause of what had happened. Linne, aware
that Bartholorious had attributed the dysentery to insects which he
professed to have seen, recommended it to his pupil to examine his
faeces. Rolander following this advice, discovered in them innumera-
ble animalcules, which upon a close examination proved to be mites.
It was next a question how he alone came to be singled out by them;
and thus he accounts for it. It was his habit not to drink at his meals,
but in the night growing thirsty, he often sipped some liquid out of a
vessel made out of juniper-wood, inspecting this very narrowly, he
observed in the chinks between the ribs a white lime, which when
viewed under a lens, he found to consist of innumerable mites, pre-
cisely the same with those that he had voided. Various experiments
were tried with them, and a preparation of Rhubarb was found to des-
troy them most efTectually. He afterwards discovered them in vessels
containing acids, and often under the bung of casks. In the instance
here recorded the dysentery, or diarrhoga, was evidently produced by
a species of mite, which Linne hence called Acarus Dysenterice ; but
it would be going too far, I apprehend, to assert that they are invaria-
bly the cause of that disease. \Kerhy and Spencers Entomology.

Noi5el effects of the Sub -Borate of Soda. By John C. Hubbard,
M. D., of Ashtabula, O. If an Aqueous Sol. of 3iss. Sub-Borate
Soda is taken at bed-time per anum and retained, the individual re-
ceiving it will in a few hours be found laboring under a high degree of
venereal excitement. The pulse will be more resisting and the skin
hotter than it is in a normal state ; there will be a slight ringing in
the ears, a sense of heat, and fulness in the loins. If the subj^xt is
an aduk male, erection of the penis, an emission of the semen (partly
insensible) follows. These conditians will commonly pass off* by
morning. When double the quantity of Sub. Bor. Soda above men-
tioned is taken in the same manner, the excitement of the genital or-
gans will be intense, the pulse full and hard, loud ringing in the ears,
a sense of fulness, heat, and soon after, absolute pain in i\^ cerebel-
lum.* Accompanying these symptoms are pain and heat in the lumbar
division of the spine, frequent involuntary discharges of semen, from
three to five during a night. With the exception of the emissions, the
detailed effects of the last experiment will be exhibited for the foUow-

Where the phrenologists locate their organ of amativeness.

1848.] Monthly Periscope. 601

ing day. These facts prove that the borate of soda can stimulate the
sexual arrangement to the last degree, and kindle up an action in the
arterial system in a measure independent of venereal orgasm, because
it continues many hours after the latter sensations subside. Richter,
Hufeland. Kopp, and others commend its emmenagogue powers. The
last authority says, it is well adapted to cases of obstructed menstrua,
tion attended by general plethora and febrile habit of body. How
can it be so ? Do not its emmenagogue powers grow out of the local
excitement it gets up ? We have used it several times with prompt
success in cases of suppression that defied other remedies. It was
preceded by preparatory treatment and given in xv gr. doses every
eight hours. [N. Y. Annalist.

Living Skeleton. Dr. Sweet had lately received a call from the
living skeleton, who came to him for professional advice. He was
said to be 32 years of age and weighed 39 pounds He was about the
size of a boy of 12 and when viewed jfrom behind had much the ap-
pearance of a boy of that age. His parents were healthy, but he
"was emaciated when born. He had worked on a farm doing light
work and could lift a weight of 80 lbs. His spine was straight, chest
well formed, joints large. His voice was that of a child, and there was
no appearance of puberty. His mind, too, resembled that of a child.
His face had the look of an old man of 60 or 70. The abdomen waa
somewhat protuberant, and the superficial veins remarkably distinct.
His appetite had been prodigious, he eating heariy food in enormous
quantities ; sometimes he would vomit after eating, and would then
fall too again. The bowels were generally regular. During the past
month he had suffered from feebleness, dry cough, and rapid pulse.
There were aphthous sores in the mouth, and he had diarrhoea.

[N. Y. Annalist.

Use of Castor Oil in Mucous Membrane Cases. By Dr. Thomson,
Burton-on-Trent. [Dr. Thomson believes there are but few cases of
diarrhoea occurring in infants under a year old but what may be cured
by castor oil, even when ulceration has taken place : as shown by a
predominance of blood in the evacuations tenesmus, abdomen tumid
and painful, mouth dry and aphthous, &;c., &c. He gives the castor
oil with yolk of egg, and according to circumstances does or does not
add a gentle opiate. He recommends, however, as accessory, the
warm bath, liniments to the abdomen, and occasionally a mild mercu-
rial dose. He observes:]

No mercurial so quickly changes the character of the evacuation as
the emulsion, which only requires to be steadily persevered in. The
following is the form in which I generally prescribe it for infants ;
For an infant of from two to four months old :

ft. 01. ricini, 1 drachm 1^ drachms;

Vitelli ovi semis., Aq. aneth, foeniculi, 1 ounce.'
Ft. emuls., coch. parv. bis die.

To the above, from two to six drops of laudanum may be added, or

502 Monthly Periscope. [August,

not ; but, of course, this as well as the size and frequency of the dose,
must vary with the case. The mixture is generally taken readily,
and even liked. The same preparation is equally useful in that form
of intestinal affection which is met with in children of from one to nine
years of age. idenlical with the infantile t^pe cited above, but present-
ing slightly varied symptoms, such as the tendency of the evacuations
to become watery, brown, black, and very offensive ; the picking of the
lips, nose, &c. In a case of this nature which lately came under my
care, the patient, a boy aged three years, lay almost insensible and
somnolent. The evacuations, resembling black dirty water, and very
offensive, were passed eight or ten times in the twelve hours. Other
symptoms of sub-acute inflammation of the mucous membrane also
present. After the first dose of simple emulsion, there was no motion
for thirty-six hours, all the other symptoms becoming ameliorated.
The medicinal action of the oil is certainly much modified by its union
with the yolk of egg, for the same dose which would act well as an
aperient alone, when thus conibined, will scarcely act at all. ["i^e-
trospeci" frpm the Monthly Journal of Med. Science.

Differential Diagnosis of Pneumonia and Pleuritis. The following
points chiefly deserve attention. 1. The resonance of the voice is
clearly perceived in pneumonic, but never in pleuritic exudations ;
chiefly in the former when the voice is neither high nor feeble. 2. In
pleuritic exudations, percussion can distinctly limit the healthy and
diseased regions, whereas, in pneumonic, the dullness on percussion
vanishes only by degrees. 3. On account of some cells still retain-
ing air, even amidst the infiltrated lung, the tone of percussion is not
so perfectly dull in pneumonic exudations as in pleuritic ; forthe same
reason the rcsistence of the chest is less in the former. 4. Whenever
the dull tone is perceived only at the angle of the scapula, and not
likewise on the anterior surface of the chest, the exudation is necessa.
rily of pneumonic origin. 5. Enlargement of the thoracic walls
never occurs, as a consequence of pneumonic exudation ; on the con-
trary, as a consequence of pleuritic exudation, it constantly occurs in
children, and very frequently in adults. Pleuritic exudation, when on
the left side, may be easily mistaken for an enlarged spleen ; but in
such cases, it should be borne in mind that the surface of the pleuritic
exudation has a tendency to cross the ribs ; whereas the tumour of the
spleen invariably extends in the direction of the ribs, [Clinical Notes
taken in the Hospital of Prague.

Pneumonia, cured hy nature. I have repeatedly seen pneumonia
(one of the most fatal of all internal inflammations) and pleurisy ter.
minate favorably without any active treatment, their existence having
been overlooked until their course was nearly run. Surely these and
similar facts should teach us a little more caution in assigning so large
a part to ourselves, and so small a part to nature, of the credit that is
attached to the favorable termination even of cases of severe inflam.
matory diseases. (Drt Taybr,) Lancet,

1848. J MontJily Periscope, 503

Condition of the Gums in Phthisis. By Dr. Fredekicq. The au-
thor's attention was first called to this subject in 1844, when he observed
aline of a red brick colour near the free edge of the otherwise normal
gums of a phthisical patient. The line was very narrow, and ran
parallel with the edge of the gums, but only opposite the incisors and
canine teeth. Since that period, he has examined the gums in numer-
ous subjects of phthisis, and has always found this red line more or less
distinctly visible, although sometimes only opposite the inferior median
incisors. The researches of the author do not enable him to say
whether this sign manifests itself as one of the earliest symptoms of
phthisis, nor to declare absolutely that it is seen in no other disease,
although he has never yet met with it in such. [American Journal.

Solution of Sulphate of Iron in Prolapsus Ani. Mr. Vincent states
that he has of late had great advantage in employing a solution of
sulphate of iron, one grain to the ounce, in prolapsed bowels, and that
an operation may often be dispensed wi.th, and the patient cured merely
by the use of this remedy. Very lately he has had two cases of the
worst sort, one of twenty years' standing, with great protrusion and
abundance of bleeding piles, which in three weeks was completely
cured. The other came from one of the institutions which offers great
pretensions in the treatment of these cases. The patient was very bad,
having both internal and external piles, and the bowel descended
largely and most readily ; he was completely relieved in about a
month. Other cases of a slighter kind have been set to rights in a
week. The patient should be kept in bed, so that the bowel may be
as much as possible in repose, and after it is cleansed out, a small
quantity of the injection should be daily thrown up, and retained.
Balsams are also well adapted to the disease. [Olservations on Surg,
Practice, from British Am. Journ. of Med. and Phys. Science.

New Method of Applying Ligatures to Tumours. Professor Fergus-
eon and Mr. Walne have both described this method. It consists in
passing a double ligature through the base of the tumour and then di-
viding it ; a needle with the eye at the point is then threaded with one
tail of the ligature, and passed also through the base of the tumour at
right angles to the double thread; this tail is withdrawn from the needle,
and the eye threaded with the other tail of the double ligature; the
needle is then drawn backwards, bringing with it the second ligature,
which then passes at right angles to the original double ligature, and
through the same channel as the first tail. The end of the ligatures
having been left long enough for tying, there are now two ligatures,
forming two figures of 8, each embracing two opposite segments of the
tumour, and the surgeon has only to tie the ends of each ligature once,
in order to command the base of the tumour. [Medical Gazette.

Treatment of NcBvus. Dr. Cordier, in a paper addressed to the
Academy of Sciences, states, that in order to destroy or modify nsevi
materni, he introduces white lead under the skin by means of needle.

501 Montltly Ptrhcopt. [August,

This operation is soon followed by a little inflammation, phlyctenae,
and slight eschars. When the latter fall, the coloring matter em-
ployed, (the white lead,) \vhich is very analogous to the color of the
parts around, takes the place of the naevus, and remains indelibly.
(We suspect that this is rather far-fetched, and would hardly bear the
test of practice,) [Lancet.

Treatment of Traumatic Erysipelas. By M. B^andin. M. Macquet
has recently furnisned an account of M. Blandin's views, according to
which inflammation of the lymphatic vessels is the means by which a
mere local atfection becomes more generalised. The red lines de-
noting this, and an enlargement of the glands in the vicinity, may even
precede any erysipelatous appearance around the wound. This is
the element of the disease to be attacked ; and as soon as M, Blandin
recognizes a painful enlargement of the glands, he orders twenty-five
leeches to them, repeating these two, three, or even four times, if ne,
cessary, to subdue it. Poultices are afterwards applied. Since he ha;s
had recourse to this method, most of the threatened attacks of erysipe-
las have been cut short.-^[L' t/w^Vw Medicale^ from Brit, and Foreign
Medico-Chir. Review.

The Application of Ice in Traumatic Lesions.-^M, Baudens, senior
surgeon of the Military Hospital Valde-Grace, has long been in the
habit of applying ice, either with or without salt, in the treatment of
every description of traumatic lesion, for the purpose of keeping down
the abnormal temperature which, in these, is so much higher and so
niuch more persistent than would be supposed by those who had not
ejfamined into the subject. Not only is the cure expedited, but the
.patient's suflerings are much alleviated, while no ill consequence has
resulted. The patient's feelings are taken as the guide, indicating
when the pathological caloric has become exhausted ; and wet com
presses are then gradually substituted. Not only is the ice employed
at the commencement of the affection, but throughout its course, even
while the wound is in a state of free suppuration. [(ra?. des Hop.r-^Ib,

Diagnosis of Incomplete Fracture. M. Debron, relating a case of
fissured fracture of the lower end of the femur, vrhich was undetected
during life, observes that while the obscurity of these cases, owing to
the abscnceof crepitus and all the usual symptoms, renders detection
difficult, it is very important for the patient that this should be effected ;
else he is not placed under restrictions in the movements of his limb,
which are essential to his well-doing, inasmuch as incaution in this
respect has led to the development of inflammation, which has termina-
ted in death, or the loss of the limb, Severe pain at the seat of frac?
ture, distinguishable from the more diffused, less fixed, and lesp intense
pain of tiie accompanying contusion, is one of the best signs. If the
indication furnished i)y this is overlooked or inappreciable, and the
limb is not secured, another sign manifests itself, viz., erysipelas arising
at the very seatof fracture ^ thus developing itself after the inflammation

1848.] Monthly Periscope, 506

depending on the contusion has subsided. This erysipelas is accom-
panied, too, by an oedematous or pasty feeling of the part. The delay
(perhaps several days) in the appearance of this form of erysipelas,
arises from the inflammation first occurring among the soft parts
around the bone, and spreading from within outwards, (inversely to
what it usually does,) it being, in fact, but a symptom of the suppura-
tion which is going on between the bone atid tTie muscles. Archives
Generales. Ibid,

Proteine as a Medical Agent. E. VV. Tusson states (Med. Times,
April 22, 1848,) that he has prescribed proteine extt-nsively with very
beneficial results as a medical agent, and one calculated to produce a
favorable termination in most cases of caries; also in some cases of
scrofula, extensive ulcers, debility, diseases of the gums and teeth, rick-
ets, undue lactation, and insufficient secretion of milk. In infancy,
where debility exists, and where the functions are not duly carried on,
and in some affections of the spine, five grains, once or twice daily, will
be sufficient for a child, and ten or twelve grains for an adult. He
orders it to be taken as a powder, dry, or upon bread and butter.

lAm. Journ, of Med, Science,

New Article for Pessary. We take the following extract from a
review in the Western Lancet. Buffalo Med. Journ.

" Many articles may be used as pessaries besides those named by
the author. One of the latest we have seen, is an egg-shell prepared
by making a small hole in each extremity of the egg, and blowing out
its contents. It is light and smooth, and when well placed with the
point looking towards the pubis, answers all the purposes of an 'instru-
ment of two inches,' Care must be taken to use the shell, not the
egg. Inattention to this point has given rise to painful and living re-
sults. In one case an egg was introduced into the vagina, and at the
end of the usual period of incubation, the patient felt such pointed suf-
fering, that she was induced to remove her 'uterine splint,' when lo!
and behold ! there was the bill of a living chick. The practitioner
had overlooked the fact that some places, are the best places in the
world for hatching."

Mode of taking Castor Oil. [The following method of taking this
aperient medicine is recommended by Dr. Wansborough, of Chelsea.]

Wet the inside of a wine-glass, and the edge particularly. To a tea-
spoonful or two of brandy, add five or six drops of lemon-juice, and half
an ounce, or a little more, of cold water ; upon this, in the centre of
the fluid, pour the requisite quantity of oil ; desire the patient to open
wide the mouth, and throw it down the throat. The flavor of spirit and
acid remain on the tongue, and the oil is not tasted. Should the patient
be of a nervous temperament, the practitioner must perform the act,
which, simple as it may seem, requires a certain degree of adroitness
and tact, to pass the fluid at once into the pharynx, avoiding the glottis,
or it will not effectually answer the intended purpose. [Med. Times.

500 Medical Intelligence. [August,

MEDICAL INTELLIGENCE.

Medical College of Georgia. We respectfully call the attention of the profes-
sion to the Circular of this Institution, accompanying this No. of the Journal.
Besides the annual announcement, catalogue of the last class, &c., there will be
found a full list of all the graduates of the College from its foundation. It
will be seen that ihey amount to 369 during the sixteen years of its existence.
The profession can now tell who our graduates are.- We would specially invite
our friends and alumni to the new feature in the annual advertisement, viz., that
provision has been made by the Faculty during the lecture term, for all patients
in indigent circumstances requiring surgical operations. Negroes, too, will be
boarded and nursed at any time during the year, free of expense to the owner,
at the Surgical Infirmary the only charge being for attendance and medicines.

Our thanks are due to the Editors of ihe Buffalo Medical Journal, Boston
Medical and Surgical Journal. Charleston Medical Journal, Missouri Medical
and Surgical Journal and the North-Westcrn Medical and Surgical Journal,
for their candid admission, that to the Medical College of Georgia is due
priority of^ SiClion in Medical Reform and improvement.

Dr. Oliver Wendell Holmes' Letter respecting National Medical Literature.
Since our last No. was issued, a letter from Dr. Holmes, the Chairman and
Reporter on National Medical Literature to the Association held at Baltimore,
has been received. He says the Editor of the Boston Medical and Surgical
Journal had directed his attention to our remarks on his report, contained in the
June No. of this Journal; and in looking over them he determined, without any
irritated or unkindly feeling, to address us a letter pointing out a number of
errors into which we had fallen, and leaving it entirely to our sense of justice to
take such notice of it as we pleased. We replied to Dr. H that it was our de-
sign to lake such notice of his communication in the next No. of the Southern
Medical and Surgical Journal, as we hoped would prove satisfactory to him.
His disclaiming to do injustice to the South in the report on Medical literature,
was sufficient evidence of the absence of design or intention on his part our
object being truth and justice, we hoped to be considered incapable of willingly-
wronging any man.

We proceed now to redeem our promise, and expect to exhibit to the satisfac-
tion ot all, that we had cause to complain of the injustice done the South and
West in the report on National Medical Lirerature. We propose to deal with
all fairness and candour in this notice.

Dr. Holmes' object is explained in the following extract from his letter:

"I remark, first, that I endeavored to divest myself of any illiberal or sectional
feeling as far as might be; for all of us have our unavoidable prejudices in favor
of our own home and its immediate vicinity. In order to be as fair as I could I
made every effort to obtain all the important works, especially the Journalspub-
lished in all parts of the country. There was not one of them that I took up
without an honest wish to find something in it worthy of approbation. I had
not a single enemy, to my knowledge, and I wrote with a single impulse to say
the truth, or what I thouglit was the truth, without making a single enemy if I
could help it. But observe this one point the only medical journals of which
1 could obtain files, or even tolerably complete sets, for the year, were those pub-
lished in the Middle or Eastern States. Of many of the Southern and Weslern
Journals I could find hut a few numbers, and ol some not a single one. Besides,
in quoting and praising the American Journal of Medical Sciences, I did not
feel that I was favoring any one State or section ; for its contributors have always

1848.] Medical Intelligence. 507

been scattered (n-er the whole country, from Maine to Florida, and I think your
own name was made tamiliar to me in its columns,

"I will go farther than this: So much was I impressed with the great supe-
riority ola Journal which has contributors from every State in the Union, that
I felt bound to use the language of eulogy with regard to it; and as a conse-
quence, to takeoff the appearance of partiality. I was really anxious to find
articles of interest in the other Journals those of the South and Westlorin-
stance, which I could conscientious) v praise. I confess one thing, which I can
hardly be blamed for, that, as a Northern man, and living in a region wholly
free from malaria, I should not, and probably did not, appreciate fully such of
the medical literature of the region where malarious fevers forms one of its chief
staples."

We ask, now, any candid mind, if this admission (and for which we thank
the Doctor) is not sufficient of itself to sustain the complaint which we made
against the report. Here is the confession of one appointed to make a report
on our Xalional Medical literature, who proclaims little or no interest on the
subject oi malarious fetters, because he resides in a region wholly free from that
morbific influence. If any thing has been contributed to medical literature
from the South and West, we presume it has some connection with malaria.

Dr. H. now makes the following numerical objections to our remarks on his
report :

" \. 'We have, comparatively speaking, no Parisian graduates among us.'
f did not say we had. The meaning is plain enough ; the Parisian graduate
writes his title D. M. P,, which distinguishes him from the graduates of other
schools, sortie of which certainly hai'e not all the advantages of that of Paris.

" 2. ' We deny tliat a Diploma from Pennsylvania or Harvard^ confers any
distinction whatever upon its possessor.' I did not say it does so. But will
you not own the truth of what I do assert, that if the Pennsylvania, or Harvard
(or Georgia) Medical College added its initial as the Paris school does to iis
title, it would draw a line between these schools and such others as may be in-
ferior 7 And are there noi some which are inferior in advantages to those I
mentioned?

"3. I do not speak of 'miserable apologies for medical schools' I quote a
letter in a foot-note where this expression is usel and as I quote it as another
man's statement, you were bound to give it in the same way. I should not have
written in just such language as my correspondent used.

"4. ' located in wrong places.' I never used the word located in my life. It is
rarely employed by correct writers, I believe, at any rate it has a vulgar sound
to my ears and I reject it."

To the 3d and 4th objections, we remark, that distrusting our own judgem^ii:
respecting the Introductory Lecture of Prof. Holmes, at Harvard University,
we adopted the notice of it by Prof Austin Flint, of Buffalo, New- York, and
Editor of the Medical Journal published in that city. Dr. F. is a native of Mas-
sachusetts, a former colleague of Dr. H., a graduate of Harvard, and styles
himself \he friend of Dr. Holmes. Could we therefore, have been more fair or
honorable to him, than relinquishing our own opinion as regards his prejudices
against the West and South, we presented those expressed by a native of his
own State, by a graduate too of his own school of medicine, by his friend and
former associate"? Now, here is what Dr. Flint says, in his review of the In-
troductory referred to;

* * "The lecture, as a literary effort, takes precedence of all which we
have received; but, as regards matter and tone, we must say, it seems to our
prosaic apprehension to be open to criticism. *

'' If a feeling resulting from ' the institution o^ inferior medical schools situated
in v/rong places,' &c., originated the ' great national project' of the Convention,
it is truly surprising that the proceedings of the Convention do not contain even

^08 Medical Intelligence, [August,

an allusion to the subject. Strangre that no action was had upon it, and that no
member of the convention even proposed it as a matter for deliberation ! *

" Dr. H. says : ' In this University there was a full complement of instructors.'
Would it not have been more strictly correct to say there is a full complement,
lor, if we mistake not, the number recommended by theConvention, viz.. seven,
did not exist at the lime the first Convention was held. * It was recom-
mended by the Convention that dissections be rendered obligatory upon pupils
before graduation, yet we find by the reply to the interrogatory whether at that
school the student is required to dissect, that it is voluntary with the student.
Some other Institutions had already adopted this improvement.

" Our readers have not failed to observe from the tenor of a note annexed to
the extract preceding the last, that Dr. Holmes entertains a very low opinion of
Western Schools, His ideas of Western and SouUwrn teachers may be gathered
from the extract which will follow. His remarks upon multiplied schools, and
' inferior medical schools located in wrong places,' ' unemployed j-'oung men be-
coming teachers for a moderate compensation,' &c., seems to have reference
especially to the West and South. We cannot let this pass without a remark or
two, althongh our western and southern brethren are abundantly able to defend
themselves, and perhaps will not thank us for volunteering any comments on
this attack, for so we must term it. Our remarks will be rather apologetic for
the writer than otherwise. We have some little practical acquaintance with
* Boston notions.' One of these notions is, that Bo.sion is the ne plus ultra ot all
places, another is, that it is the sine qua nan. We should be sorry to seem ob-
noxious to the accusation of being wanting in respect for the metropolis of our
native state. The accusation would be groundless. We delight to honor it as
the seat of learning, science and refinement ; but it does not absorb all the talent,
acquirement, and intellectual resources of the country.

"The author of the address before us, in the remarks to which we
have directed the reader's attention, only expresses a common sec<t>?m/ sentiment,
We do him the justice to believe that he supposes his remarks to be such palpa-
ble truisms, that no oflJence can possibly be taken, for, we presume he would
Bot knowingly violate the rules of' courtesy and good-breeding, to say nothing of
medical ethics. That he honestly thinks the medical institutions of the distant
West are ' miserable apologies for medical schools' we have no doubt, and, fur-
thermore, it is to his mind so obvious that it must be so, as to require no reserve
in uttering the opinion. He could not probably be induced to speak disparagingly
of the schools which are, comparatively, in his neighborhorhood, viz., at Pitts-
field, Woodstock, Castleton, Hanover, Bowdoin, all located in small villages.
These are in New England, -and cannot be charged with being 'Inferior schools
wiongly located,' the chairs filled with 'unemployed young men,' &c. New
England needs them all. But in the 'great states of the distant we.st' ^nA South,
what are the schools referred to] They are as follows: One at Chicago, Illi-
nois, a town now larger than was Boston when the Boston Medical School was
instituted ; one at La Porte, in the greatstate of Indiana ; two at St. Louis, a city
larger than was Boston twenty years ago; one at Cincinnati, cfne at Columbus,
and one at Cleveland, these from the great state of Ohio ; two in Kentucky, one
at Lexington, the other at Ijouisville; one in Tennessee; one in Louisiana, at
New Orleans; one at Charleston, South Carolina, and one at Augusta, Georgia.
These are the Medical Institutions of the distant West and South. We beg the
reader to cast his eye upon the map of the United States, and compare the terri.
lory over which these schools are scattered, with the area of new England with
its seven Medical Colleges, (five of which are in villages,) and more in contem-
plation!" **%

* "It would seem that the Lecturer feels bound, at all hazards, to pro-
duce on that occasion a specimen of fine writing, and, hence, attempting the
most difficult species of composition, an ornate, fiowery style, as might be ex-
pected the production in some instances would become better the college sopho-
more, than the incumbent of a professorial chair. Our Boston friend would
pcrhavs say this criticism applies to Western and Southern Lecturers more es-
pecially, but, if we do not err, it is not neces.sary to go out of Philadelpliia,
New York, or even New England for illustrations."

1848.] Medical Intelligence. 509

The reader will at once perceive, that while it was no offence for Dr. Flint
thus to write and publish concerning this introductory lecture of Dr. H., it be-
comes a serious charge of injustice to adopt and repeal them in our Journal.

But, says Dr. H., ^peaking ofthe word located, which he never used in his life,)

" Perhaps this sounds captious, but you must permit me to say that it is essen-
tial in every criticism to be punctilious in quoting to quote correctly. May I
ask if you employ a proofreader, (in connection with this matter ofaccuracyl)
Here lies your Journal before me, and without turning a leaf, I see the following
names misspelt; Bartholett for Berthol/et, (1 Edt.) Jusseiu for Jussieu, Foucroy
for P^ourcroy, Wallaston for Wollaston. If these are Dr. Mutter's errors, they are
so gross they should have been corrected or commented upon at least. And
let me leave a long interval my own name, spelt correctly at the beginning of
your article, is twice printed as Dr. Homes on these same two pages.

"I enclose this half page in brackets, as less essential to my purpose than
some of the other remarks I have to make."

Ahhough this may be less essential to the author of the letter, it may Hot prove
so to us. Surely this is small business for a Professor. We answer, however,
for his satisfaction, that we have no regular proof-reader; our Journal is not
worth one. All the editor can do amidst his many pressing and onerous engage-
ments, is to find time to look over once the matter as issued from the press.
With every care, errors will occur in the Journal. We do not aspire to the
office of a critic ; but we are happy to inform Dr. Holmes, that the ^7-05^ inac-
curacies pointed out by him, are due to Dr. Miitter, all of them, save one an
a for an 0. We now ask, with what consistency or propriety he censures us for
not correcting, or at least commenting, upon these ^ross errors of Dr. Miitter,
when, as chairman and reporter to the Association, he was specially charged
with the examination of our national medical literature"? He overlooks these
inaccuracies which he calls gross, when published last November in Philadel-
phia, but readily detects them when copied into theMedical Journal at Augusta,
Ga., and this too, after his commission on our medical literature had expired.

We have always conceived it to be a very unpleasant duty to criticise the
writings of others; Dr. H.'s letter has been committed to our honour, and there-
fore, however obnoxious it may be to the very faults of which we are accused
by him, the reader is spared the notice of them.

5. What authority had we to say he alluded to the South as well as the West
in his Introductory Lecture 1 We refer him to hi* friend, Dr. Flint's opinions,
which we only adopted.

6. He denies alluding to his own name in the teport, but says it was another
Dr. Holmes. Our apology is, that when (his name was enumerated at the close
of a long list of contributors to the American Journal of Medical Sciences, there
was a long pause, and then a laugh by the members of the Association this is
what induced us to believe he was referred to by the name mentioned. We take
pleasure to correct this mistake.

7. He says he is confident he did allude to Dr. Saraucl A. Carttrright, of
Natchez, in a part of the Report notread. We regret his valuable contributions
to literature have not been better appreciated by Dr. Holmes. Perhaps his recent
article on Camp Diseases is better estimated by our volunteers and regulars
who have been serving in Mexico.

8. Dr. Holmes writes us he noticed all the Journals of our country that he
could find or hear of He made every possible efllbrt to procure them, used
every means in his power to discharge his duty in this respeet. Without any

616 Medical Intelligence. [August,

research on our part we think we can point out one or two omissions. The
New Jersey Medical Reporter was only named to say it had ceased to be issued,
which is a mistake; and only one of the two Journals was noticed which are re-
gularly published at St. Louis. If in error we beg pardoB, But Dr. Holmes
does not deny that some three or four pages of his report are devoted to the Bos-
ton Medical and Surgical Journal, which is published vcchly ; and in as many
more are dismissed all the monthlies and bi-montJdicsoi Charleston, New Orleans,
Memphis, Lexington, Louisville, Sr. Louis, Chicago, Cincinnati and Augusta.

9 and 10. He could not get access to all the medical periodicals of our coun-
try, and could not therefore have examined them. At the office of the Boston
Medical and Surgical Journal, they are not preserved, if even received. Hav-
ing received letters from Montreal, New- York, Philadelphia, Chicago, &c., re-
specting mutilated or missingNos. of our own Journal, we were simple enough
to suppose that even the medical periodicals of the South and West might be
obtained in the capital of New England. We here cheerfully withdraw the
word Jlagrant injustice, as applied to Dr. H., since it was expressed upon the
assumption, he had seen or could have seen all the Journals of our country.

11, Dr. Holmes thinks he made ample and elaborate eulogy of the Editors of
the Medical Journals of our country, as a set-ofTto the criticisms he felt bound
to submit upon their failings. The volume of the proceedings of the National
Medical Association is promised to be ready by August, when read, all can de-
cide whether the .severe criticisms inflicted upon these poor Editors in the report,
{whose original communications are so few and valueless that compared to
furniture in their offices, ihey are compelled to be seated in each others laps, &<.,)
is not enough to make one iorget the lean praises subsequently bestowed upon
them. For our own part, we confess it was the deliberate thrusting us aside of
the Frenchman, with the ejaculation of his unmeaning pardonnez moL

In conclusion, he says, "I plead wholly innocent of any anti-national or anti-
sectional feeling; I own a less perfect acquaintance with the medical literature
of distant parts of the country than with that of the region where I have always
lived and the great central cities of New York and Philadelphia; but thi-sraust
of course have been expected and allowed for by those who appointed me."

We have not charged him with wilfully doing injustice to the South and
West, but of neglecting, through prejudice, our rights and interests on the sub-
ject upon which he was called upon to report at the meeting of the National
Medical Association, and this much we think he has admitted. We know him
to be a man of decided and brilliant talent, a wit and a poet of no mean preten--
sions. We doubt not this little difference between us will make us better
acquainted with each other and better friends; we may have been hasty in con-
demning his report as sectional in character, but have already pronounced it a
very able one. And we are not alone in the.se opinions, for in the June No. of the
Western Journal of Medicine and Surgery, Dr. Yandell, one of its Editors, and
who is also Chairman of the Committee on Medical Sciences for this year, says,
respecting it, he only heard part of the Report on National Medical Literature,
and is therefore unable " to speak of it as a whole, but so much of it as we heard
appeared to us just, able and judicious. Some o( {he slridurcs of \he writer were
severe, but, we thought not unmerited. Many of the members thought that he
evinced a disposition to sneer at our ined.ical literature, and was partial in his re-
trospect and comments. He was charged with showing an ovcnoeening regard

1848.] Medical Intelligence. 511

for the Journals jnMished near Boston^ and orerlooking the merits of others more
remote"

Since the above was written, the North-Western Medical and Surgical Journal
for June and July, has been received, and Dr. Holmes' Lecture is noticed as it is
by Dr. Flint and ourself, viz., as applied to both South and West, and doing
them injustice.

We have received a communication from Professor Dunglison in relation to
the critique which appeared in our May number. The letter is a private one,
but contains a defence of himself, which we feel is due to him to give the pro-
fession. Edts. New Orleans Med. and Surg. Journal.

Philadelphia, June 2, 1 848.

Dear Sir : In the Preface to that work* you will find 1 remarked, that " the
improvements and modifications incessantly taking place in the departments of
pathology and Therapeutics render it advisable from time to time to incorporate
them, so as to furnish those to whom the different general treatises, monographs
and periodicals are not accessible, with the means of appreciating their existing
condition."

In the fulfilment of this object, I laid every essay of value under contribution,
and, so far as my ability permitted, endeavored to render the work a consistent
whole, to which the reader might refer with satisfaction to learn the existing
condition of the branch of science on which it treated. Where facts or histories
of disease were concerned, I regarded them as common property, unless when
the descriptions which was rarely the case were entirely original; and in ail
cases I have striven to do justice to the labors of observers, who have in any
way enlarged, or seemed to me to have enlarged, the boundaries of science.
Especially have I considered this important where opinions were stated, which
belonged apparently or really to the individual. Accordingly, in the first edition
of the "Practice," I placed in a parenthesis, after a description that could, in
any manner, be esteemed to belong lo any one, his name; and, in the part of
the work '^ on Diseases of the Eye" which has been selected by the reviewer for
especial comment, this was done repeatedly, and in cases where the name of
Dr. Taylor ought scarcely, perhap?, to have been added alone.

When the second edition of the work was called for, the plan of parenthetic
insertions was objected to by my publishers, and it was regarded by the reader
as destroying the continuity of the sentences. It was, therefore, abandoned;
but SI ill, as you will find, the " Library of Medicine" was especially referred to,
and the name of Dr. Taylor repeatedly introduced, wherever I deemed it advis-
able, and so often that the idea of concealment on my part must be out of all
question.

In the number of the Journal to which I have referred, passages are taken
from my "Practice," and from Dr. Taylor's articles in the "Library of Medi-
cine," and sentences detached from the rest, are placed in such juxtaposition
and so animadverted on, as to lead to the inference, that extensive passages have
been adopted without acknowledgement; and a special reference is made to the
diagnosis of Iritis, as having been taken without acknowledgement from Dr.
Taylor.

The main object I have in view, in this communication, is to show you that
the pas.sages in question are not original with Dr. Taylor, and have been regard-
ed t^y Am so completely as common property, that although ihey and several
others have been adopted by him with little or no verbal variation from his
predecessors and contemporaries, he has not considered it necessary to refer to
authorities. If you will take the trouble to examine the chapter on Iritis in
Mackenzie, and certain, paragraphs on the same subject in Lawrence, you will
find them almost identical wiih those in the "Library of Medicine."

Many of the paragraphs on the "Purulent Ophthalmia of Infants" are
scarcely changed from those in Lawrence, whilst the article on "Corneitis"
differs hardly at all from Mackenzie. All these works, with the best of France,

The Practice of Medicine.

513

Meteorological Observations.

Germany, S:c., were before me; and it was difficult, if not impossible, to say to
whom to' give the priority for the analogous and identical passages; but, cer-
tainly, the "Library of Medicine" was not entitled to it.

I wo\]ld draw your attention, also, to the divisions of purulent ophthalmia, by
Dr. Taylor, ciied' by the reviewer, which are taken, almost verbatim, from Law-
rence, to whom, indeed, he refers; and you will find, that a similar division is
adopted, on like principles, by Dr. Watson and most modern writers. I do not,
indeed, know of a single systematic work that has appeared of late, which does
not contain pas-^^ages against which the same objections might bemade as against
mine. Descriptions of natural history, and, as a part, ol the natural history of
disease, have never been regarded as belonging to individuals; nor, so far as I
kno\<^, has it ever been esteemed improper to use them. It is otherwise as re-
gards thoughts and opinions,

Resignation of Professors Cooper and St/me in University College, London.
"When the nomination of Mr. Syme, of Edinburgh, was made as the successor
of the late Mr. Liston, we ventured to predict it would not be satisfactory. Mr.
Samuel Cooper,/ the veteran surgeon, author of the Surgical Dictionary, &c.,
has resigned his office in the University, and Mr. Syrae has followed his exam-
ple and gone back to Edinburgh.

It is said Mr. Li.ston left but little property.

METEOROLOGICAL OBSERVATIONS,

for June, 1848, at Augusta.

Ga. Latitude 33

27' north Longitude 4 32' west Wash. Altitude above

tide 152 feet.

5

Sur
Ther.

1 Rise.
Bar.

29 72-100

3,]

TtTER,

80

P.M.
Bar.

Wind.

1 Remarks,

1

66

29 77-100

E.

Fair flying clouds.

2

60

" 82-100

75

" 83-100

E.

.Cloudy.

3

64

" 81^100

78

" 76-100

S.

iCloudy.

4

66

" 71-100

80

" 63-100

S.

jCloudy sprinkle.

5

66

" 62-100

89

" 62-100

s.

Fair thunder at 9, p.m.

6

67

" 67-100

85

" 73-100

w.

Fair.

7

63

" 81-100

82

" 80-100

w.

iCloudy.

8

58

" 84-100

84

" 81-100

N.

Fair. [rain 5-100.

9

66

" 77-100

86

" 69-100

s.

IFair thunder in afternaoD

10

70

" 68-100

78

" 65-100

s. w.

'Showery, 55-100.

11

68

" 75-100

7G

" 77-100

s.

Cloudy rain at night 85-100.

12

68

" 79-100

76

" 81-100

N.

Cloudy.

13

66

" 81-100

82

" 80-100

w.

Cloudy, foggy morning.

U

69

" 83-100

83

" 85-100

w.

Fair.

15

62

" 87-100

84

" 89-100

s.

.Fair some clouds.

16

68

" 88-100

85

" 88-100

s.

Cloudy. [35-100.

17

70

" 84-100

86

" 73-100

s.

Fair breeze rain at 5, p.m.,

18

68

" 77-10

82

" 78-100

8. W.

Cloudy rain at5, P.M., 65-100.

19

68

" 83-100

82

" 79-100

s. w.

Rain, e~ .fx
Rain! ^*^-

20

67

" 88-100

84

" 88-100

W.

21

68

" 74^100

88

' 70-100

s. w.

Fair.

22

69

" 74-100

88

" 76-100

s. w.

Fair.

23

71

" 86-100

84

" 84-100

8. W.

Showery, 40-100.

24

70

" 85-100

89

" 82-100

W.

Fair breeze.

25 71

" 87-100'

86

" 87-100

N. E.

Fair some clouds.

26 69

" 88-100

86

" 89-100

8. E.

Fair.

27 66

" 90-100'

86

" 89-100

S. E.

Fair.

28| 67

" 88-100

86

" 83-100

8. E.

Fair.

29 70

" 80-100

84

" 77-100

S. E.

Fair a light shower treezc.

30 71

" 77-100

77

" 73-100

S. E.

Showery.

16 Fair days. Quantity of Rain 3 inches 35-100.
8 days. West of do. do. 12 days.

Wind East of N. and S^

SEVENTEENTH

AINUAL AMOIJICEIEIT-

bT THE

i5

MEDICAL COLLEGE

6t

GEORGIA.

AUGUSTA, GA.

t>RtNTED BY JAS. McCAI^ERXt.
184 8.

ANNUAL ANNOUNCEMENT, &c.

The Trustees of this Institution are much gratified to have
it in their power to announce to the Medical Profession, that
their Faculty have resjlved to comply with the recommenda-
tions made by the Medical Convention and reiterated by the
Medical Association. They have accordingly extended the
course of Lectures from four to five months, to be commenced
on the first Monday in November next. In thus adding to
their labors, the Faculty have been actuated by the desire to
demonstrate to the Profession that the prosperity of their school
will rather prove an incentive to increased exertions, than to
retrograde indolence. The age in which we live is emphatically
one of progress and one in which therefore no institution should
be deemed worthy of patronage which can remain satisfied
with the statu quo. The large and respectable bodies above
named, have loudly sounded the note of reformation; this has
been re-echoed by the profession throughout our land ; and shall
it not be heeded by those upon whom devolves the responsible
office of teaching? The Trustees of the Medical College of
Georgia confidently appeal to the Profession, to sustain the in-
stitution which was first to adopt a six months course of Lec-
tures, first to call a national convention for purposes of reforma-
tion ; and which now boldly comes up to the recommendations
of the Medical Association. It is true that it was not sustained
in its effort in 1832 to continue the term six months, and it is
equally true that it did not succeed in the attempt to assemble
a convention in 1836. This Institution at that time stood alone
in its cry of reformation. The Profession at large has since,
however, awakened to the subiect, and spoken in language that
cannot be misunderstood. The time has come when to be
luke-warm in the matter must be suicidal. Professors must re-
double their zeal, and by so doing inspire pu]iils with that indus-
try and desire for knowledge which characterize the ai::;e, and
without which none should expect to succeed in the discharge
of an honorable and responsible vocation. The issue is now
fairly made between those who desire to do their whole duty to
society, and those who wonld rather remain behind than incur
the risk of diminishing their emoluments by a change which is
acknowledged on all hands to be necessary to substantial acquire-
ments. The Trustees believe that their Faculty incur no such

risk, that the Profession will be with them unanimously in this
section of the country, and that their onward career of pros-
perity will suffjr no check.

In addition to the courses heretofore delivered, there will be
one upon MeHical Jurisprudence, speci;illy. The Faculty will
endeavor to make their instruction as demonstrative as practi-
cable, and, in order to bring before the Class as many surgical
cases as possible, the friends and alumni of this Institution are
invited to send to the faculty, during the course of Lectures,
persons in indigent circumstances who may require surgical
operations, provisions being made for their accommodation
wh 1st under treatment.

The college building is" undergoing such renovation as may
be necessary to add to its convenience and comfort. The
Anatomical room will be much enlarged and so modified as to
make the demonstrations plainly visible to the whole Class.
Ample opportunities for the prosecution of practical Anatomy
Will be secured.

The City Hospital, being under the direction of the Faculty,
is accessible to the class daily, and clinical lectures are there de-
livered regularly at least twice a week. The Infirmary of the
Pro essor of Surgery is likewise open to the class. In short,
the Faculty will lose no opportunity to bring cases of interest
before the students, in order to familiarize them with disease.

The Course of Lectures will be delivered as follows:
By Prof. G. M. Newton, M. D.,

Upon Anatomy, General and Descriptive.
By Prof L. A. Dugas, M. D.,

Upon Physiology and Pathological Anatomy.
By Prof Alexand*er Means, M. D.,

Upon Chemistry and Pharmacy.
By Prof I. P. Garvin, M. D.,

Upon Therapeutics, Materia Medica and Medical Jurisprudence.
By Prof L. D. Ford, M. D.,

Upon the Institutes and Practice of Medicine.
By Prof Jos. A. Eve, M. D.,

Upon Obstetrics and the Diseases of Women and Infants,
By Prof Paul F. Eve, M. D.,

Upon the Principles and Practice of Surgery.

Demonstrator of Anatomy H. F. Campbell, M . D.
Assistant do. do. RnBERT Campbell, M. D.

The Fees for the entire course. Hospital ticket included, are
$115. Matriculation ticket, to be taken only the first course at-
tended here. 85. Ticket for Practical Anatomy, obligatory upon
candidatesfor graduation who have not taken one before,$10.

Board may be obtained at from $13 to $17 per month, every
thing included.

5Si^IE I? E'lBWS^IilSS

Hon. CHARLES J. JENKINS, President,
Rev, WM. T. BRANTLY, Vice-President,
L. A. DUGAS, M. P., Sec'ry and Treasurer,

John Bones, Esq.

Richard Banks, M. D.

Alex'r Cunningham, M. D.

Alonzo Church, D. D., Pres'dt Univ. of Georgia,

J. L. Dagg, D. D:, Pres't Mercer Uijiversitj^,

T. H.Dawson, M. D. -

Rev. C. S, DoD,

JospPH A, Eve, M. D,

Paul R Eve, M. D,

L. D. Fopp,' M D.

I. P. Garvin, M, D.

James Harper, Esq.

D. Hook, M. D.
T. HoxEY, M. D,

E. E. Jones, M. D.
Alex'r Means, M. D.
Hon. A. J. Miller,

G. M. Newton, M. D.

g, K. Talmadge, D. D., Pres'dt Oglethorpe University,

C. W. West, M- P.

JJon. J. W. Wilde, Judge Court Com, Pleas,

OF THE

JflEDICAIi COIiLEC^E OF GEORGIA.

Adkins, Dan'l F.
Adkins, Wm. L.
Alfriend, Wm. L,
Alfriend, E. W,
Allen, Jas. P.
Anderson, A. F.
Anderson, L. G.
Antony, Edw. LeE*
Antony, Milton,
Ardis, Christopher W,
Archer, R. A.
Austin, Robert
Avary, J. C.
Baker, J. L.
Barton, J. F.
jBarton, Willoughby
Bailey, David F.
Bartow, John T.
Barry, Edw'd J.
Belt, L. C.
Belt, R. B.
Bexiey, A. R.
Bedel, Joseph
Bignon, H. A,
Bowen, Isaac
Borders, John McD,
Bowers, J. M.
Bowers, B. F.
Bothwell, W. C.
Both well, D. J.
Bowdre, Thos. E,
Bowie, W. C,
Bolai), M. J.
Bolton, G. W.
Brooks, T. J.
Brewster, B. D.
Brewster, S. H.
Brantley, F. M.
Brunson, S. T.
Brown, E. A.'D.

Burton, p. T.
Burt, Wm. M.
Bussey, N. J.
Byrd, John G.
Carswell, E. R.
Casey H. F. R.
Camak, Jas.
Campbell, H. F.
Campbell, Robert, Jr.
Carlton, J. B. '
Caver, S. R.
Cade, G. M.
Gary, H. H.
Carter, J. W.
Clarke, S. B.
Claybrooks, W. E.
Clark, J. W.
Clardy, Wm.
Clardy, John
Clopton, J. P.
Cook, Horatio R.
Colley, F. S.
Cooper, J. D,
Couch, J. M.
Cobb, J. C.
Cody, J, M.
Collier, H. G,
Cochran, W. L,
Cousins, W. E. M,
Colquitt, J. M.
Crawford, W. W, B.
Crawford, J. L,
Creighton, A. J.
Cullens, Aug. A,
Culver, E. V.
Cumming, Wm. H.
Davis, W. H.
Davis, T. C.
Darling T. J.
Dannelly, F. O.

G

Day, David
Dunsby, D. McA..
Da in all, J as. M.
David'Oii, Paul
Dearing, W. E.
Diliard, J. H.
Dixon, Roger K.
Dill, Chas. B.
Dieken, B. B.
Douglas, Tihnan
Dozior, T. a.
Dorsey, T. A.
Dunham. Tlios. K.
Duncan, T. W.
Dunn, W. G.
Earle, J. W.
Earle, P. H.
Ellington, W. H.
Elliott, W. M.
Ellison, J. E.
Etheridge, J. A.
Evans, B. C. H.
Eve, Edw'd A.
Pant, E. M.
Felton, W. H.
Ferguson, S. G. N.
Fittcn F. E.
Fokes, J. M.-
Forbes, Joseph
Floyd, Lark in
Fleming, N. R.
Fryer, R. H.
Garrett, Thos. S.
Gantt, John
Galphin,J. M.
Galluchat, Joseph
Gardner, Jos. M.
George, Franklin
Gilbert, Wm.
Gilbert, J. B.
Gilder, G. P.
Gibbs, Jasper
Giltenan, A. A.
Gillespie, James
Gibert, J. T.
Gibson, Cicero
Gordon.. T. B.
Gordon, J. M.
Gross, B. W.

Griffin, Jno. D.
Graves, Thos.
Greene, Alex. B.
Grimes, Thos. W.
Gunn, J. M.
GuUett, J. M. T.
Hammond, C. C.
Hart, F. T.
Hartridge, Theodore
Harlow, J. A.
Hammond, A. L.
Hagood, iVl. G.
Harriss, Juriah, Jr.
Harris, J. L,
Hart, A. C.
Hewell, J. W.
Hester, T. J.
Heard, W.N.
Hill, James
Hibler, E. S.
Hitchcock, S. C.
Hilihouse, J. P.
Hines, H. C.
Houston, J. L,
Holland, J. L.
Holland. Calvin L.
Holland, A. J.
Holliday, J.S.
Hoxey, Jno. J. B.
Howard, Jno. G.
Howard, Charter C.'
Hook, E. B.
Holt, J. VV.
Hubbard, Geo. A.
Hubert, R. W.
Hulsey, A. G.
Hurst, H. E.
Irby, J. J.

Jackson, H. F. M. S.
Jackson, A. H.
Jennings, J. H.
Johnston, S. B.
Johnson, N. B.
Johnson, W. J,
Johnson, J. R.
Johnson, Absalom
Jones, H. F. A.
Jones, Taliaferro
Jones, Albert W.

Key, R. S.

Keith, Tarlton F.
Kilpatrick, And'w R.
Knox, John
Knight, G. B.
Lark, John
Lamar, Jno. T.
Leak, W. S.
Leak, W. W.
Lewis, J. L.
Little, William
Linch, Ransom
Lindsay, Wm.
Long, H.R.J.
Long, J. D.
Lovett, Rob't W.
Lowe, Jessee
Maddox, Jackson
Magruder, T. J.
Martin, Martin H.
Mann, J. A.
Martin, F. J.
Mathews, Wm. L.
Mathews, G. G.
Matthews, C. C. H.
Massingale T. E.
Mackie, J. D.
Massey, P. B.
Martin, W. A.
Mayson, C. N.
Martin, Alex.
McLester, James
McLester, John
McLester, Leonidas
McCoy, A. W.
McTyre, John
McCleskey, Green L.
McCarty, Sherod
McKee, A. A.
McCullers Jas. C.
McNair, J.D.
Merriwether, Nicholas
M. als, H. fl.
Mitchell, G.
Milligan, J. A. S.
Minis, W. W.
Mitchell. Wm. J.
Mi.ner, W. A*
Miller, Bright

Mitchell, B. J. J.
Morrison, Roderick
Morgan, J. M.
Montgomery, Robert
Moore, O. 6.
Musgrove, Wm. C.
Murray, E. W.
Murph, Jas. M.
Murray, James H.
Mulkey, Enoch
Nash, J. M.
Neal, W.R.
Neeson, Horace
Nesbitt H. O'K.
Noble, J . A.
O'Farrel John
Ogilvie, P. S. S.
Olive, Y. B.
Olive, Richard
Oliver, J. A.
Oliver, J. H.
O'Leary, Pearse
O'Sullivan D.B.
Parks, R. M
Park, C. M.
Palmer, J. T.
Parker, Robert
Parker, W. P.
Pattison, T. H.
Peterson, Bartholomew
Perry, W. H.
Peters, M. W.
Pearson, B. H.
Perry, E. W.
Perritt, T. A.
Phinizy, T. B.
Polhill, J. G.
Pope, John H.
Porter, J. L.
Powell, Green B.
Price, J. R.
Prior, W. H. C.
Pugesly, S. A.
Ralls, J. P.
Ramsay, H. A.
Rambo, John
Reid, J. A.
Richardson, E. H.
Riley, Lafayette

^u^

Riordon, John
Rich. D. A.
Robert, Wm. H,
Roberts, E. A.
Robertson, Jos. J.
Rogers, L. D.
Rossignol, Henry
Rutherford, H. W.
Ryan, T. D. L.
Sanders, Simon H#
Sadler, C. W.
Schley, Jas. M.
Settle, O. J.
Sessions, Lewe
Sessions, A. M. R^
Shands, A. C.
Shannon, Joseph
Shaw, H. A.
Shaw, W. B.
Sheppard, P. M.
Sims, Jno. T.
Sims, J. C.
Simmons, J. N.
Simmons, J. A.
Smvth, Geo. E.
Smith, C. M.
Spencer, Alex'r
Spalding, A. M.
Sparks, H. B.
Spruill, A. B.
Stewart, Theophilas
Strickland, A. G.
Strawn, J. W.
Starr, E. F.
Stell, R. M.
Stell, R. T.
StronsT, B. R.
Stribling, E. A.
Taylor, Joseph
Taylor, Geo. F.
Taylor, Wm. S.
Tate, H. G.
Thompson, B. L.
Thompson, E.N.
Thomas, F. A.
Toole, Jonathan
Todd, J. W.

Trippe, R. A.
Trezevant, G. W. C.
Trammel, W. M.
Trammell, P, T.
Turner, H. F. P.
Tutt, Wm. H.
Twiggs, J. D.
Verdel, D. B.
Walthall, J. E.
Walker, F. J.
Walker, V. H.
Walker, J. E.
Wakefield, T. A.
Wakefield, F. B.
Walton, Bryan
Walton, Oliver
Walton, J. H.
Walton, Simeon
Ward, Thos. A.
Warren, R. L.
Weaver, D. A.
West, Chas. W.
West, G. W.
Westmoreland, Harrison
Westmoreland, J. G.
Whale, J. G. W.
White, Boling A.
Wilson, J. S.
Wilson, A. A.
Wilhight, C. F.
Wightman, J. S
Williams, J. A.
Williams, D. M.
Williams, Z. C.
Williams, Wm. M.
Willis, P. A.
Wilson, T. C. H.
Wilkinson, A. M,
Wofibrd, Benjamin
Wooten, J. H.
Wooten, H. V.
Wynn, A. W.
Wynn, J. A. C.
Yarbrough, J. W*
Young, Andrew
Zachry, W. T.

Total,

360.

OF THE

CLASS FOR 1847-8,

A. P. Allday,
H. D. Aderhold,
George F. Barnes,
W. C. Bowie,
Jasper Browne,
Samuel Boyd,

J. E. Baker,
M. J. Bolan,
H. A. Bignon,

B. F. Bowers,
J. M. Bunch,
J. C. Calhoun,
A. M. Cox,
A. N. Clardy,
J. M Cosper,

R. Campbell, Jn,M.D.
J. J. Coates,
Flournoy Carter,
L. L. Clark,
M. M. Carter,
P. G. Cobb,
Carey Carter,
John Clardy,
J. P. Clopton,
J. T. Dickinson,
W. S. Douglass,
M W. Dobbins,
G. W. Darden,
J. A. Et he ridge,
J. E. Ellison,
E.M.Fant,
S. G. N. Ferguson,
F. E. Fitten,
Cicero Gibson,
Howard Garvin,
Edward Girardey,
T.C. Glover,
J. L. Harris,
H. E. Hurst,
A. G. Hulsey,

Georgia,

So Ca.,
Georgia,
So. Ca.,

Georgia,

((

So. Ca.,
Georgia,

So. Ca>,
Georgia,
Alabama,
, Georgia,
So. Ca.,
Georgia,

Alabama,
Georgia,
So. Ca.,
Georgia,

it
(
i<

Chemistry^

iBt Course in Med. Col. of Ga.

1st Course in Med. CoK of Ga.
1st Course in Med. Col. of Ga.
1st Course in Med. Col. of Ga,

Graduate Med. Col. of Ga.
1st Course in Med. Col. of Ga*

Chemistry*

1st Course in Med. Col. of Gra,

Tst Course in Med, Col. of Ga.

" 1st Course in Med. Col. of Ga.

* Isi Course in Charleston.

So. Ca., 1st Course in Med. Col. of Ga.

Georgia, 1st Course in Med. Col. ol Ga.

Alabama, 1st Course in Med. Col of Ga.

Georgia, 1st Course in Med. Col. of Ga.

" Chemistry.

Alabama, 1st Course in Leiington, Ky.

1st Course in Jefferson Col., Phils,

Georgia, 1st Course in Med. Col. of Ga.
2

la

John Hunt,

Georgia,

H.C. Hines,

((

Juriah Harriss, Jr.,

((

W. T. Hollingsworth

((

J

B. F. Hall,

a

J. A. Huddleston,

.

E. H. HoUiday,

((

A. C. Hart,

((

A. C. Hanson,

u

T. J. Hester,

So. Ca ,

L. B. Hemphill,

Mississippi

J. R. Johnson,

Alabama,

William Jones,

Georgia,

D. W. Jacobs,

So. Ca.,

E. C. Jones,

Georgia,

W. B. Jones,

it

Josiah Johnson,

No. Ca.,

J. J. Kent,

Georgia,

Will-iam Kerr,

((

G. B. Knight,

u

Lewis Kennon,

i(

D. C. Keller, M. D.,

So. Ca.;

A. C. Lovett,

Georgia,

J. M. Lott,

ii

J. C. Lanier,

So. Ca.,

T. B. Ligon,

Georgia,

G. W. Lynes,

Alabama,

J. C. Longstreet,

Georgia,

William Lindsey,

((

W. C Matthews,

Alabama,

T. J. Maddox,

Georgia,

H. B. McLendon,

u ^

A C Mathews,

((

G. W. Mitchell,

So. Ca.,

Sidney McWhorter,

Georgia,

J. H. Mackie,

a

C C. H. Matthews,

iC

W. S. Milligan,

(4.

J. H. McEntire,

u

John McWhorter,

u

Robert Montgomer}-',

Tennessee,

T. F. Mitchell, M. D.

Mississippi,

Waldemar Moody,

Georgia,

F. T. McLester,

Alabama,

Enoch Mulkey,

Georgia,

T. E. Massingale,

((

G. G. Mathews,

u

W. R. Neal,

((

A. G. Naglc, Jr.

So. Ca.,

1st Course in Med. Col. of Ga.
1st Course in Med. Col. of Ga.

1st Course in Med. Col. of Ga.

1st Course in Med. Col. of Ga.

1st Course in Med. Col. of Ga.

1st Course in Lexington, Ky.

Chemistry.

1st Course in Med. Col. of Ga.

Chemistry.

1st Course in Med. Col. of Ga.

Grad. of Philadelphia Med. Col.

1st Course in Med. Col. of Ga.

Chemistry.

1st Course in Med. Col. of Ga.

Chemistry.

1st Course in Louisville, Ky.

Graduate of Louisiana Med. Col.

1st Course in Med. Col. of Ga.
1st Course in Med. Col. of Ga,
1st Course in Med. Col. of Ga.
1st Course in Med. Col. of Ga.
1st Course in Med. Col. of Ga.

11

J. H. Oliver,

Georgia, *

1st Course in Med. Col. of Ga.

John O'Connor,

((

D. B. O'Sullivan,

((

1st Course in Med. Col. of Ga.

D. C. O'Keefe,

So. Ca.,

A. N. Perkins,

Georgia,

J. H. Phinizy,

((

Chemistry,

A. M. Pitts,

Alabama,

H. R. Pierce,

Georgia,

Charles Phinizy,

ii

Chemistry.

OmarH. Paull,

ii

W. H. C Prior,

it

1st Course in Med. Col. of Ga.

E. W. Perry,

a

1st Course in Med. Col. of Ga.

W. P. Parker,

(

1st Course in Med. Col. of Ga.

W. M. Pitts,

Alabama,

, B. R. Rives,

Georgia,

Lafayette Riley,

((

1st Course in Med. Col. of ^a.

J. A. G. Reeves,

i(

Henry Rossignol,

Georgia,

1st Course in Med. Col. of Ga.

R. L. Rockett,

Alabama,

S. L. Richardson,

ii

D. A. Rich,

Georgia,

1st Course in Med Col. of Ga.

John Riordon,

((

1st Course in Med. Col. of Ga.

T. D. S. Ryan,

((

1st Course in Med. Col. of Ga.

R. F. Seay,

a

L. A. Sale,

a

W. B. Sikes,

((

W. B. Samuel,

So. Ca.,

1st Course in Med. Col. of Ga.

J. A. Strahan,

Georgia,

C. W. Smith,

A. H. Saffold,

ii

B. S. Simrpons,

ii

Chemistry,

- J. N. Simmons,

((

1st Course in Med. Col. of Ga.

0. J. Settle,

So. Ca.,

1st Course in Med. Col. of Ga.

Lewe Sessions,

Georgia,

1st Course in Med. Col. of Ga.

Freeman Schley,

a

Chemistry.

^ A. D. Shewmake,
^- R. T. Stell,

it

C(

1st Course in Med. Col. of Gsu

. J. B.Shelton,

a

Chemistry.

Peterfield Trent,

Virginia.

John D. Twiggs,

Georgia,

1st Course in Med. Col, of Ga.

S. Z. Tatom,

((

i C. C. Thomas,

a

1 R. A. Trippe,

n

1st Course in Med. Col. of Ga.

1 Henry A. Urquhart,

a

John Usher,
J. W. Veazey,

ii

Chemistry,

ii

\- J.P.Taylor,

a

1 JohnL. Watkins,

Alabama,

1 G- A. Williams,

((

12

W. C. Ware,

So. Ca.,

*

John E. Walker,

Georgia,

1st Course in Jefferson Col , Phila.

J. H. Walton,

((

1st Course in University of Pa,

C. T. Williams,

((

J. E. Wofford,

So. Ca.,

T.C. H. Wilson,

Georgia,

1st Course Col.Phys.& Surg., N.Y,

T. A. Ward,

(i

1st Course in Med Col of Ga. *

R. L. Warren,

1st Course in New Orleans,

J. A. Williams,

ti

1st Course in Charleston,

T. L. Waterman,

i(

W. R. Youngblood,

Alabama,

J. W. Yarbrough,

Georgia,

1st Course in Med. Col. of Ga.

Andrew Young,

ii

1st Course in Med. Col. of Ga.

RECAPITULATION.

Fronr-Georgia,

112

" South Carolina,

18

*< Alabama,

16

" Mississippi,

2

^ Tennessee,

1

" North Carolina,

1

" Virginia,

1

Total, 15)

GEO.

M. NEWTON, M. D.,

Dean of Faculty.

*l

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 4.] NEW SERIES. SEPTEMBER, 1848. [No. I

Part L ORIGINAL COMMUNICATIONS.

ARTICLE XXXVIII.

Coichicum ; its therapeutic action. By Wesley C. Norwooi^,
M. D., of Cokesberry, Abbeville District, So. Ca.

The reader vi^ill perceive that I have headed my article
Ctilchicum. Although thus headed, 'Cathartics will be treated
of in general and Coichicum in partidular. We have various
species or varieties of cathartics, and each variety or kind is
adapted to the removal of certain conditions of the "diseased
animal system. A portion of these articles have scarcely any
effect in obviating confirmed pathological conditions: never-
theless they are grouped or classed in reference to the quality
01* kind of operation they excite in or from the alimentary canal
and collectitious viscera. Cathartics have been divided into
four species or varieties, which are presumed to include all the
important divisions of this class of medical agents. (Doubtful,
if what I state in the sequel is true.)

The first division or species, Eccoprotics : they gently move
and quicken very slightly the peristaltic action, and hasten in
a limited degree the discharge of fecal matter, thereby obviating
moderate costiveness or torpor of the bowels ; but are inert and
inefficient articles in chaijging the conditions on which striking-
ly diseased and pathological actions depend manna or honey
will serve as an example.

The second species, Copragogue Cathartics, very obviously

increase and hasten the discharge of fecal matter from the

intestinal canal, producing little or no change in the quality or

kind of operations, but merely purge the alvine canal of its con-

* 33 *

514 Norwood, on Colchicum. [September,

tents. Castor oil will serve as a suitable and proper example.
This species also has little orno effect in changing or obviating
and modifying to any extent confirmed pathological conditions
or states of the animal system. They do not alter, counteract,
or overcome morbid action of any kind, and have no immediate
or remote agency in subduing, removing, or curing diseased
action. Strictly speaking, they do not operate as curative
agents, but are used merely to empty the bowels of fecal mat-
ter to hasten or assist the operations of other cathartics, or to
remove accumulations that may be injurious from quality or
bulk.

Cholagogue Cathartics is the third species. Their powers
and operative effects are principally expended on the liver,
spleen, &c. By them, pathological conditions are overcome,
new modes of action are excited, disease is controlled, the
secretions undergo manifest change and the excretions are much
altered. This species or division acts principally as counter-
agents, and subdue disease or the states of the system on which
disease depend, more by virtue of a moderate and general
change wrought by them on the secretions and excretions, than
by anv actual reduction they may excite in the vital energies
or functions. The articles of this species certainly possess a
two-fold operation, action or effect a cathartic and deobstru-
ent or a reducing and counteracting effect. The latter is the
chief and mostly to be desired effect or operation. It is a highly
important species or division of medicinal agents; they are
used mainly for the purpose of obviating derangements of the
biliary and organs of a kindred nature. The diseases peculiar
to these organs are operated on, benefited, cured or removed,
by virtue of the operative effects oi this sort of articles. In-
flammations, acute, sub-acute and chronic, are changed and
overcome, when unaccompanied by any great degree of entony
and irritability on the one hand, or atony and torpor on the
other. If these peculiar conditions exist, they should be re-
moved, that the proper and beneficial effects may be realized.
The various preparations of mercury belong to this division,
and it would be an idle waste of time if I were to attempt to
point out the various and multiplied forms of disease to which
they are peculiarly and exclusively adapted.

]848.] Norwood, on Colchicum. 515

The fourth species or division, is Hydragogue Cathartics:
they operate generally as reducing agents or antiphlogistics.
The articles belonging to this species or division, so far as their
operative effects have been manifested, examined and under-
stood, may with propriety be said to possess two powers of ac-
tion by which they control disease ; one of these properties or
powers merely exhausts or reduces the vigour of the system or
vital energies, by operating on the exhalents and depriving the
system of that great diluent of the blood, water or serum, and
do not counteract and change diseased action in any other way
than by lessening the quantity of the circulating fluids.

Elaterium is a striking example of the peculiar effects of the
reducing properties or powers of a portion of the articles of this
species* I have discovered no other medicinal effect belonging
to it than a mere agent of reduction. It is useful in removing
collections of water, thereby giving other articles an opportuni-
ty to correct the conditions on which dropsical affusions depend.
Sulphate of soda, sulphate of magnesia, and sulphate of potash,
operate after the same manner as elaterium, so far as their pur-
gative powers depend or are concerned; or, in other words,
they lessen the tone and vigour of the system by producing
copious watery evacuations. But these last named articles pos-
sess another power, by which they overcome and change morbid
action accompanied with entony, or exalted vital energy, which
is a purely refrigerant power, and by virtue of this property of
quality, (refrigerant,) they allay the restlessness and jactitation,
heat and dryness of the skin in the case in which they are indi-
cated. Both of the powers, strictly speaking, and with proprie-
ty, may be styled reducing, from the circumstance of their
overcoming disease accompanied with entony or exalted action.
But the mode or manner by which these two effects of control-
ling disease is manifested should certainly be distinguished and
separated. In the one case, the entony or exalted vital energy
is overcome by the reduction of the quantity of the vital fluids
in the heart and arteries : thus giving the system an opportunity
to rally and recover itself. In the other case, the condition on
which the increased strength of the heart and arteries depend, is
changed, altered, counteracted, modified and overcome, inde-
pendent of any discharge. Which of these properties, powers,

^16 IS OTWoody on Colchi cum. [September,

or operative effects, is the most efficient in the cure of disease,
is not fully settled one portion of authority relying on the one,
and the other, or opposing authority, on the other.

But to illustrate what I understand and mean to convey by a
refrigerant effect or operation, in contra-distinction from the
purgative or reducing effects alluded to above, I will do so
by tartar emetic and its properties or powers.

We know that this article powerfully exhausts by its active
emetic operation, and much more so if it excites catharsis in
addition. Exalted action is reduced by virtue of the liquids dis-
charged by emesis, and much further if catharsis follows. We
have it on the highest authority, that the more of this article
that can be given at repeated intervals, short of producing
nausea and vomiting, the more effectually it subdues and over-
comes morbid action. This action, or the effects produced by
'administering tartar emetic, in small doses and at short inter-
vals, so as not to reach the point at which nausea and emesis
are exerted, is what I understand by a refrigerant. The emesis
and catharsis that follow, or ensue, from the administration of
this article in full doses, reduce by evacuation instead of refrig-
eration, and I think it clearly and manifestly marks out the
difference between the various effects of this article. The above
will, I trust, serve imperfectly to convey my meaning.

In using cathartics in the cure of disease, we should bear in
mind, or examine minutely into, the diseased condition of the
system, and ascertain the kind of cathartic that is indicated to
remove the condition we are attempting to obviate. Castor
oil would be worse than useless as a cathartic if calomel was
truly indicated. The same may be said of rhubarb if neutral
salts were called for, and so on. In the administration of
cathartics, as curative agents, we should look to their immedi-
ate and remote effects to the shock or impression we wish to
make. Whether it would be proper to storm the citadel or
take it by siege; or, in other words, whether we shall attempt
to break up the disease by powerful and active purging with
cathartics that rapidly exhaust and reduce, or by slow and mod-
erate purging, and with articles that rather counteract than
reduce. It is altogether important to be able to select the arti-
cle indicated, and equally necessary to administer it in portions
to meet the force of disease.

1848.] Norwood, on Colchicum. 517

There is anotlier species or division of cathartics which should
be added, however silent the books may be on the subject ; or
it may be that the species to which I allude is pointed out by
authors that I have not examined. Be this as it may, if the
species-is spoken of or treated by any author, I hope the learned
Editor of the Journal will cite the author or authors. It is
Chylogogue cathartics. If I am not greatly mistaken, Col-
chicum acts as specifically and generally on the chylifacient
system, or the chyliferous vessels, as mercury on the liver, and
that its operations are as purely chylogogue in appearance as
the operation of calomel are cholagogue. It is considered to
be hydragogue by some; but I am fully persuaded in my own
mind that it does not produce hydragogue operations, and that it
only possesses one property in common with that species, and
that is its exhausting or reducing power. I believe it to be
sound philosophy and correct reasoning, that where the appear-
ances of the operations are different, the effects on the system
different, and the diseases to which an article or articles are
indicated are different, that they should not be arranged under
the same species or division of remedies. I have used colchi-
cum extensively, and in every variety of dose, and in various
combination; but I never saw it produce a watery stool in my
life. It has, under my observation; invariably produced whitish,
frothy operations they foam and froth, and resemble very much
in appearance lime and w^ater stirred together, and look as
though they were in a state of fermentation. I am fully con-
vinced, from an extensive use and closely observing its effects,
that colchicum is one of the most efficient agents of the Materia
Medica in subduing disease ; and that it is as safe as it is ener-
getic.

I believe a great many of our most valuable articles have
fallen into disuse and unmerited neglect, from the bunglingly
careless manner in which they are prepared and administered.
I have found no one article of so much value in the cur6 of
Rheumatism and Gout ; many cases of Dysmenorrhcea have
yielded to its use ; a great many pains, non-descript, (if I may
be allowed the expression,) have readily given way under its
influence.

Mr. W. was troubled v*ith pain in the region oi the spleen

518 Norwood, 071 Cokhicum. [September,

and kidneys, weakness in the lumbar region, with occasional
attacks of haematuria ? had been treated for affections of the
spleen and kidneys; was afterwards treated successfully with
Golchicum alone.

M. J, had pain midway between the anterior superior -spinous
process of the ileum and navel ; could cover the spot with his
finger. Had been treated for liver disease ; had taken a great
deal of blue mass, with various other remedies. Colchicum,
alone administered, relieved or cured him.

If I am right in my views, as to its operating more particularly
on the organs of chylifaction, and that the nervous energy of
the brain and spinal marrow and healthy sanguinification, are
so entirely dependent on the normal performance of this system,
in the economy of nutrition, growth and development, of every
kind, it must follow, as a legitimate consequence, that this arti-
cle, operating on this portion of the system, does change, over-
come and cure, or greatly modify, nervous diseases and nervo-
febrile diseases. A strong proof in confirmation of its peculiar
action on the portion of the animal system assigned it in this
article, its, that in many cases little or no effect is produced, or
relief obtained, until the peculiar operations or discharges from
the bowels occur, which are evidence or tests that the portion of
the system on which it specifically operates, has been reached.

Mr. C. is another instance of the powerful effects of the arti-
cle. He is frequently attacked with violent pain in the knee
and heel, sometimes with, and at others without, febrile affec-
tion. I have treated him successfully with colchicum, when
free from, or when accompanied with violent febrile affection
or symptoms ; and I must be permitted to state here, that his
was the first case which called my particular attention to the
peculiarity of the discharges occasioned by this article. He
being easily alarmed, immediately sent for me to relieve his
fears, as to what might be the effects of these peculiar whitish
and frothy operations. This was in the year '30. The urgent
symptoms were all relieved when 1 reached him; and as I
knew not, nor had witnessed no such discharges before, I attribu^
ted them to the article he was taking, Since that time, I have
given my attention to its cflTects.

Mr. J. C. is subject to attacks of pHin in the heel and great

1848.] Norwood, on Colchicum. 519

toe, which are accompanied at times with febrile symptoms,
and at others there is no general effects or disorder of the sys-
tem. Treated successfully with colchicum. This is the second
case that called my attention to the peculiarity of the discharges.
He had taken it freely, so much so that it produced emesis and
catharsis. He became alarmed at the peculiarity of the dis-
charges I was again sent for; when I arrived, the emesis and
catharsis had ceased, and every vestige of pain was gone.

It is a valuable remedy in Pneumonitis, where it attacks
gouty or arthritic patients. It is cathartic, and more or less
emetic; in addition, it possesses considerable nervine powers.
Although set down as a diuretic and hydragogue cathartic, I do
not believe that it possesses any properties why it should be
dubbed with these titles. But others that have used it more
successfully, extensively and accurately, than I have, may have
discovered these to be its peculiar and specific operative effects.
I admit that it exhausts considerably, if pressed so as to operate
drastically or excessively; but I hold even this to be evidence,
more or less, in point of its operating on the chylifacient and
chyliferous systems. If it produced large watery evacuations,
we could account for its reducing powers. But writers speak
of its being much more exhausting than most hydragogues. I
think the following the true, or, at least, reasonable explanation.
By discharging chyle, and inverting the action of the chylifer-
ous vessels, we can readily understand how it would weaken
and exhaust, by directly operating and diverting this animalized
and highly nutrient fluid from entering the circulation and
withdrawing the very pabulum vitas from the brain and nervous
system. I believe it possesses great deobstruent powers, and
in that respect may be classed with calomel, conium, nitrate of
silver and iodine ; because, like many of these articles, it re-
moves disease without producing any discharge by emesis,
diuresis, diaphoresis or catharsis.

The above remarks were written, to point out in some meas-
ure the various kinds of discharges excited by the different
species of cathartics, and a portion of their general effects ; but
more particularly to call the attention of physicians to the
powers of colchicum, and the kind of cathartic I believe it to
be, and some of the diseases I have used it in with effect.

KO Norwoocl, m CQlchiq^im. [Sepiembqi;,

We often hear of wonders being performed, by some men^
with articles, and their proving inert or detrimental in the hands
of others. This conflicting testimony can only be reconciled
by the preparation, application, and conditions of the system
being better understood, and more cautiously applied in the
hands of the succeesful than by those who fail; and it certainly
should impress every man with the necessity of understanding
the powers of articles he uses, and the portion of the system they
peculiarly operate on, and that they are particularly adapted
to the then existing states or conditions when administered.
The Practice of Medicine being an art, can never be transmit-
ted or handed down from one to another, and its perfection
must ever depend on the study, industry and judgment, of the
iftdividuals themselves, Colchicum is considered to be a
diuretic by many, but on what grounds or principles I am at a
loss to conceive. If its powers over the chylifacient and chylif-
erous organs were borne in mind, and the disorders of the renal
secretions arising or having their origin from derangements of
that highly important system, occasioning great variations in
the secretions, we would not be so liable to attribute for prima-
ry effects, those that are truly indirect and secondary. It would
be well also to bear in mind, that deficiency of action or torpor
in one portion of the system, is liable to be followed by increas-
ed irritability and secretion in other or distant organs ^when a
corrective or counter agent, or allayer of morbid nervous irri-
tability is administered, we can readily comprehend and under^
stand the indirect effects of remedial agents. And how readily
and susceptible organs are, that have been torpid and lain
dormant for any length of time. When an organ h^is suffered
from excessive cold, it can bear a much less quantity of heat
and so in regard to the kidneys when they have become torpid
or secrete unhealthy urine, in consequence of derangement in
the chylopoietic viscera. They, by restoring this derangement,
will take on an undue activity and remove accumulations that
no pure and direct diuretics could ever effect. When dropsical
affusions depend on biliary disorganization or functional biliary
derangement, calomel or iodine, by correcting and bringing
about a healthy action of the liver and its peculiar functions^
indirectly excites the kidneys, and cures or obviates the morbid

1848.] Norwood, on Cokhicum. 521

state or condition on wliich the dropsical effusion was depend-
ent. In virtue of this remote or ultimate effect, it is often and
again said and claimed to be diuretic, when, in truth, it has no
claims to be classed under the head or division of diuretics.

In conclusion, Colchicum is a chylogogue cathartic : it cures
diseases, dependent on and connected with derangement of the
chylifacient and chyliierous organs or vessels. Gout is often
the consequence of excessive eating and drinking. These kind
of excesses derange and weaken the chylifacient and chylifer-
ous organs. Colchicum corrects the effects of these excesses ;
consequently colchicum is a suitable and proper remedy for
gout, and is peculiarly adapted to the removal of painfully un-
pleasant symptoms. Rheumatism is often dependent on disor-
dered chylification. Colchicum corrects or counteracts this
imperfect and impurely formed chyle consequently it is indi-
cated, and often signally removes arthritic derangements.
Dysmenorrhoea often has its origin in an abnormal condition
of the chyliferous and chylopoietic organs. Colchicum arrests
or counteracts these morbid conditions, and is often indicated
as the proper remedial agent in such cases. Dropsy often has
its origin in the unhealthy performance of the chylopoietic vis-
cera. Colchicum is the article indicated to remove the condi-
tion and erratic accumulations from the unhea'thy action of this
portion of the animal system. Pneumonitis often attacks arthri-
tic subjects : these cases are invariably and tediously protract-
ed, unless colchicum is administered. Many nervous and
nervo-febrile diseases are dependent upon or are kept up and
influenced by impure chylification. Colchicum possesses con-
siderable nervine powers, (not narcotic,) in addition to its
cathartic properties, Colchicum, consequently, relieves many
painful conditions of the nerves or nervous system. Chloro-
sis is often and strikingly dependent on the unhealthy per-
formance of chylification, and the torpor and inactivity of
this system is usually manifested in deficiency of action, not
only in the nervous and sanguineous systems, but throughout
the whole ganglionic system, the great regulator of nutrition and
healthful organic development. Colchicum forms the basis of
treatment in all such cases.

I use an alcoholic tincture, six ounces of the seed or root

522 Norwood, on Colchicum. [September,

to the pint. I usually commence with twenty drops, and
increase the dose from three to ten drops daily, till it purges
or produces purely colchicum evacuations, which may be
known by their foaminf and frothing and whitish appear-
ance. I then omit the article for a day or two; beginning
again with the minimum dose, and proceeding as above, till
purging is induced, or the symptoms relieved. If much pain
accompanies th3 disease, I use papaver, in some form or other,
in combination. Many cases of paralysis are dependent on
chylopoietic derangement for their origin, and are often treated
successfully with colchicum. The menstrual secretion is fre-
quently deficient and accompanied w^ith barrenness. I have
succeeded in removing both these difficulties by colchicum.

Physicians who have directed their attention to the wonder-
ful influence exercised over the nervous energy of the brain and
spinal marrow by the chylifacient organs, and the healthful dis-
charge of that whole system, will readily understand and appre-
ciate the value of any article that powerfully operates on, and
corrects, its abnormal actions. Healthy sanguinification and
nervous influence of the brain and spinal cord or marrow, be-
ing dependent on this system for their nutritive and sustaining
qualities, it should always receive a close and scrutinizing in-
vestigation, lest the many diseases that are often called protean
in their seat and origin should be overlooked.

The active principle of colchicum is supposed to be veratrine.
I do not believe that it possesses a single particle of veratrine.
They both excite emesis and catharsis ; but whether veratrine
produces chylous operations in appearance, and whether they
foam and froth, or appear to be in a state of fermentation, I am
not able to say; but I will determine this point the first oppor-
tunity. Veratrine excites a peculiar and not unpleasant burn-
ing or glow on the surface, which. colchicum does not, and is one
of the tests of the system being under its influence.

Veratrum viride is said to possess powers in common with
colchicum and veratrum album or sabadilla: it possesses neither
veratrine ,nor colchicia ; it is considerably emetic and narcotic ;
it never purges ; it often excites a peculiar kind of delirium,
occasions considerable nausea, and an unusual degree of pale-
ness and coldness of the surface, and constantly and obviously

1848.] Norwood, on Gokhicum. 523

lessens the frequency of the pulse, so much so, that a pulse of
one hundred and thirty in the minute may be reduced to eighty,
forty, and even thirty pulsations in the minute, in the course of
thirty-six; twenty-four, or even twelve hours, and kept thus
reduced in frequency without difficulty or inconvenience ; and
a peculiarity in the nature and kind of reduction is, that the
pulse beats full and distinct, and is not accompanied with fee-
bleness, indistinctness, or irregularity. It is an invaluable
remedy in the treatment of pneumonitis typhoides nervosus
and putridus, and pneumonitis typhoides notha (et dysenteria),
and pneumonitis sub-putridus or synochus.

I think the various differences above specified, are sufficient
to show that the active principle of the above articles is not the
same. If I were allowed an opinion, I would designate the ac-
tive principle of colchicum, *' colchicine," the active principle
of veratrum viride, '^ viridine," The other article is appropri-
ately appHed.

To sum up the matter cathartics are divided into four spe-
cies, or varieties, or divisions, from the kind of operation they
excite, I believe these embrace the whole laid down by au-
thors. 1st. Eccoprotics ; 2d. Copragogues; 3d. Cholagogues;
4th. Hydragogues.; and if I am not mistaken as to the effect, or
if no author has spoken previously, I must claim the discovery
of a fifth species Chylogogue, from the appearance of the
operation. I know cathartics are divided and sub-divided,
perhaps farther and into more numerous divisions or species ;
but these divisions have no reference to the quality or the
operation, but to other influences exerted over the system, as
for example, refrigerant or antiphlogistic, stimulant, tonic, dras-
tic, <Slc., &c. The narcotic powers attributed to colchicum
are founded on its purely nervine effects ; and any person, by
referring to a previous article, can see the distinctive marks or
effects between a narcotic and nervine, and can judge whether
the distinctive marks are genuine and real, or exist only in ima-
gination.

524 Green, On Aneurism. [September,

ARTICLE XXXIX.

Observations on the Diagnosis of Aneurism. By James M.
Green, M. D., of Macon, Georgia.

[Soon after the distritjution of the June No. of the Journal, we
received a letter from Dr Green, the author of the following commu-
nication, respectfully asking, explanations of the two brief additions
made to his article on Ligature of the Primitive Carotid Artery, pub-
lished in that No. The reader, by reference to it, will find that the
first is a sin. pie interrogatory, having allusion to a pinch with the for-
ceps of the ncrvus descendens noni, producing intense toothache in
two lower molares ; and the second, at the close of the article, is an
expression of a doubt as to the existence of an aneurism in the case.
In reply, we stated, that in addition to our other engagements, we
had to serve as a grand juror the day the above letter arrived, still we
complied with the request of giving an immediate answer. Our views
were therefore hastily written ; we meant no offence whatever by the
doubt expressed did not condemn the practice pursued in the case.
Editors of Journals corrected and commented upon communications
sent them. (See April No, American Journal Medical Sciences, page
355, where Dr. Hays, the Editor, attributes the favorable termination,
in a case of traumatic Tetanus, to the removal of a splinter from the
wound, and not to the treatment pursued by the writer of the article.)
This has been our custom; and Dr. G. was invited, if he felt aggrieved,
to sustain his opinions, we reserving the privilege to make a few com-
ments should it be necessary. In the following communication, it will
be seen that its author has abandoned the first point, viz., the question
in relation to the effect of the descending portion of the ninth pair of
nerves, and has, with good taste and judgment, extended his remarks
to the general subject of diagnosis of Aneurism. Editor.]

"A tumour progressively on the increase, at first compressible, diminishing
under pressure, pulsating violenily, and throughout its whole extent, at the
margins as well as in the centre, the pulsation ceasing and the swelling subsid-
ing in whole, or in [)art, (according to the size, duration and quantity of solid
matter, the layers of lymph and coagulum it contains,) when pressure is made
on its proximal side, is undoubtedly aueurismal." (Liston's Pract. Surgery.)

In the Southern Medical and Surgical Journal, for June
last, I communicated the narrative of a case of Aneurism, in
which it became necessary to apply a ligature to the primitive
Carotid.

The respected Editor of this Journal having cast a doubt
upon the correctness of the diagnosis, and consequently upon
the propriety of the practice pursued, it is perhaps due to the
other fjentlomcn who were connected with the case, as well as
to myself, that I should present some observations upon aneuris^

1848.] Green, on Aneurism. 525

mal tumours, going to prove that our diagnosis was correct, and
the operation necessary and proper. In doing this, not very
difficult task it is hoped, I shall invoke as far as possible the
authority of Sir Astley Cooper, Samuel Cooper, Hodgson,
Mott, McClellan, Liston, Porter, and Dupuytren, and shall be
content, if it can be shewn that I have been right, or have
erred, in company with these and other illustrious names in
Surgery.

[The proposition of Dr. Green, if we understand the subject cor-
rectly, is this, he invokes the aid of the above-mentioned authors,
illustrious names it is true in Surgery, to prove that he is right in pro-
nouncing a tumor of the neck an aneurism of the carotid artery, which
commenced eighteen months previously, ''by a small swelling oti the
upper part of the right side of the neck, immediately after a severe
strain while planing some hard wood. This was at first supposed to be
an enlarged ^/fifrifZ; it increased in size very slowly until May, 1841,
(a given period Erf^.) then rapidly augmented to the size of a hen's
Ggg'i pulsating vloleuily, very sensitive, and producing much pain ;
confusion, fullness, &c., in the right side of his head. When I first
saw him it was a good deal larger than a common sized hen's eggj
pulsated very strongly, and wa'S quite red, and tender to the touch. It
was situated just below the ramus and posterior part of the right lower
jaw. (Must then have been near the bifurcation of the primitive caro-
tid artery. Edt.) The peculiar whizzing noise, said by surgical
writers to be so peculiar to aneurlsmal tumors, was very indistinct
almost imperceptible ; nor could we hear the fluid rushing into the sac
again, after obliterating the calibre of the artery, by pressing jt firmly
against the vertebrae. Neither could the sac be entirely emptied by
stopping the flow of blood into it; it still retained about a third of its
volume, but this we attribute to a little surroun(Mng oedema and a few
enlarged glands, and perhaps some coagula in the aneurism itself.
Always after handling the tumor, the pain, fulness and confusion, in
the right side of his head, were very much increased." Moreover,
medicinal treatment of two weeks duration produced some diminution
in the size of the swelling. Ought not the tumor to have been then
more prominent from the reduction of the "surrounding oedema," if an
aneurism existed ? There was a very obscure pulsation in the tumor
subsequently to the application of the ligature, but two days afterwards,
it had ceased both in the tumor and neck The wound united, the
ligature separated on the eighteenth day, the tumor rapidly diminished
to a small hard lump, and the patient recovered without an unpleasant
symptom. Some months afterwards he presented himself to his sur.
geon, well in all respects, save a small lump in the position of the ori^
ginal tumor. No change had therefore occurred in the aneurismal
tumor in some months after the artery had been ligated. A small
hard lump existed in the neck when the ligature came away, and

526 Green, on Aneurism. [September,

a small lump still occupied the position of the original tumor some
months afterwards. In relation to the few enlarged glands^ (one of
which was at first supposed to be the tumor pronounced aneurismal,)
we are left entirely in the dark. What was their character, their po-
sition, as regards the aneurism, their subsequent history, the condition
of the patient now, &c., the author has entirely omitted.

We have thus employed his own language, his own description ;
and now for the evidence, that an aneurism of the carotid existed in
this case. If the subject has been fairly presented, we are prepared
for the witnesses ; nor do we propose to adduce other testimony, but
simply to correct and complete it where we find important omissions
to occur. Edt.]

It must be either a very right thing, or a very AVrong thing,
to apply a ligature to the primitive carotid ; a very right thing
to do so for a progressive aneurism ; a very wrong thing to
ligate this great arterial trunk for an abscess, an enlarged
gland, or an encysted tumour.

There is little that is new to be said on this subject, and in
taking a short review of the prominent features of aneurismal
diagnosis, I shall whenever it can be appropriately done, use
the exact language of any of tbe distinguished authorities
above named.

The diversities in the origin, progress and termination of
aneurismal tumours are so infinitely various that no one will
contend for an exact parallelism in their general history, or in
the symptoms at any period of their growth. So also, with the
sympathetic disturbances excited by them. This must neces-
sarily be the case li'om the variety which exists in their origin
and in the causes (solid bodies, fasciae, &c.) which favor or
resist their development in different directions and positions.
The mode in which they originate from the artery, whether by
a narrow neck, or from the whole calibre of the vessel, must
exercise a material influence on their development. The ge-
neral health, and the vigor or debility of the heart, are also im-
portant elements in the rateof progress, of aneurismal tumours.
There is perhaps as great a variety in their duration as in any
thing connected with them, some requiring only a few weeks
for their greatest development, while others extend over a pe-
riod of several years, and one instance is on record, of an anetn*-
ism which lasted for thirty years. It is also well known that
they are often stationary for long periods, and then taking a

1848.] Green, on Aneurism. 527

new point of departure, progress rapidly to their termination.
Another circumstance which must have a marked bearing upon
the diagnosis and history of aneurisms, is the more or less rapid
deposition, of laminated coagula upon the sides of the sac, the
force and vigor of the pulsations ; the aneurismal thrill and
whiss are doubtless greatly influenced by the same cause. This
must also affect the duration of the pulsation and the extent of
the subsidence when the tumour is compressed ortthe artery
obliterated.

We learn from Mr. Hodgson, that, "one of the circumstances
which in the most early stage, generally attends the formation of
aneurism, is the establishment of that process which is the basis
of its future cure." Again: "The opinion that these layers of
coagula are not met with in small dilatations of arteries, but are
found in large expansions of them, is (he says) contradicted by
numerous careful observations." (Cooper s Surg. Diet.)

[Dr. Green is mistaken in this second quotation by referring again
to Cooper, he will find it due to Scarpa and not to Hodgson, and who,
speaking of dilated arteries, was actually alluding to a specimen be-
fore him of Jive by six inches in extent, which, unlike an aneurism^
contained no coagula whatever. Edt.]

In some instances, however, this process seems to go on very
slowly, as must have been in the very interesting case reported
by Mr. Kerr, where the softness and pulsation, to a considera-
ble extent, continued for thirty years. A few rare cases have
also been recorded of large aneurisms that were entirely free
from lamellated coagula, probably from a constitutional absence
of coagulating power in the blood.

It follows then, from what has preceded, that an aneurism
could not be expected to lose all its volume upon obliterating
the arterial canal leading to it, except at its very commence-
ment.

Diagnosis. Perhaps the two great features of the diagnosis
of aneurismal tumours, are, pulsation, and change of volume,
from compressing the artery upon the proximal or distal side of
the swelling.

1st. Pulsation. This indication, when well developed, is
relied upon by surgical authorities as one of the most unmis-
takable features of aneurism. It is of course synchronous

528 ^ Green, on Aneurism. [September,

with the arterial pulsation, and has a marked and peculiar char-
acter. '* They (the pulsations) are eccentric the tumour not
b ing raised en masse, but dilated at every systole of the heart."
{Cycl Pract. Med. and Surg) Dr. Mott considers the swell
and general growth of the pulsation as the chief diagnostic
mark of aneurism. (Motfs Velpeau) The expansion of an
aneurismal sac is equal in every part and every direction, and
the pulsatll)n can he felt as correctly at the base or at the side,
as at the summit. (Porter on Aneur.) "Pressure upon the
proximal side of the tumour, weakens or destroys the pulsation
according to its degree, the swelling becoming more soft and
flaccid, but pressure on the vessel bevond the tumour, renders
the aneurism more tense and augments its pulsations." -{Boyer,
quotedin Cyc. Porter, in Cyc. ofAnat. and Phys.) In regard
to the changes that time produces in this indication, Mr. Porter
remarks, that "the pulsation is said to become moie faint in
proportion to the growth of the tumour, and this, though gen-
erally true, is not so universally, for this symptom will present-
ly be found to be influenced by a number oi circumstances,
such as the blood within the sac being fluid or coagulated, the
situation and depth of the tumour and the coverings of fasciae
it may possess." It is well also to recollect, in this connection,
that occasionally medullary or other tumours of a fungous na-
ture, exhibit a pulsatile character.

2d. Change of volume, from pressure upon the artery from
which the aneurism originates. This from the nature of things,
must be the most certain and unfailing of all the symptoms of
this afl^ection, for it may be very safely asserted, from all that
is known of the subject, that none other but an aneurismal tu-
mour can exhibit a real difference in size from this cause.

Although it is well established by the investigations of Hodg-
son and others, in regard to the deposition of laminated coagu-
la, &c., that an aneurism even when of moderate size cannot be
entirely removed by pressure upon its proximal side, yet that
they do become remarkably diminished, (and in some rare cases
whe-e the blood js fluid, entirely disappear,) is a fact universally
admitted. Pressure upon the distal side of the tumour, where
it can be applied, of course increases its volume, tenseness and
throbbing.

1848.] Green, on Aneurism. 529

Although the diagnosis of external aneurism, when within a
certain size, is generally an easy matter, yet, on some occasions
it has been difficult to distinguish them from other tumours
situated over the tracks of large arteries, having a pulsating
motion synchronous with the action of the heart, " They can
however be usually distinguished from aneurisms by their hard-
ness, mobility, and cessation of pulsation when pushed to one
side or elevated." ''If also pressure be made- upon the artery
above or below the tumour, vo alteration occurs in the appear-'
ance of the swelling unless it be aneurismal. Moreover aneur-
isms can usually be diminished by regular compression of the
tumour and artery, but regain their dimensions immediately
upon its removal. This diminution may be effected to some
extent even in old aneurisms hut not in the case of ordinary
tumours^ ^{Cyc.of Prac. Med. and Surg.)

Mr. Porter draws the following distinction between an abscess
seated over a large vessel and a true aneurismal tumour : *' An
abscess receives only an undulatory thrill from an artery, per-
ceptible in the line of the vessel, but fading away and becoming
indistinct in the remoter parts of the tumour/'

Having now taken a very brief glance at som6 of the main
features of the subject, I shall reserve the consideration of some
others until we come to the discussion of the specific objections
advanced by the editor of the Journal, to the diagnosis.

A remark may here be made upon the comparative size of
carotid aneurisms. One of these tumours as large as a hen^s
egg, situated on the side of the neck, constitutes a swelling of
no inconsiderable size, and would occupy at least half the length
of an ordinary neck, supposing its top to be on a level with the
OS hyoides. Were it twice as long as this, it would extend
nearly to the clavicle and render necessary the ligature of the
carotid near to its origin, or the innominata itself, if it were
considered desirable to ligate a healthy porti<5n of the artery.
Of this any one can convince himself who will take the trouble
to apply an egg to this region and imagine it to be placed under
the skin.

[We think we have removed tumors from the neck, (two even the
past winter before the medical class,) much larger than an egg, which
could only be detected in certain positions of the head. One too

33

530 Green, on Aneurism, [September,

weighing nearly half a pound, the weight of about half a dozen eggs,
dissected from the tonsil and surrounding parts, may be found in the
2d vol. ofMott's Velpeau's Surgery, taken from the Southern Medical
and Surgical Journal. This we can assure Dr. Green was not a very
prominent tumor of the neck. The carotid artery, it must be recol-
lected, is deeply situated in this region. The aneurism of this artery,
for which Dr. Post of New York operated in 1813, measured in length
6^ inches, breadth 4, height or projection from neck more than 2, and
in circumference sixteen and a half inches ; still the artery was suc-
cessfully ligated to the proximal side of the aneurismal tumor, even at
this early period of surgical experience in these affections.

In Lecture xxiii., on Aneurism, by W. H. Porter, Esq., (one of the
authors relied upon by Dr. Green,) published in the Dublin Medical
Press, is recorded a case operated upon by himself, wherein the an-
eurism of the carotid extended from about three quarters of an inch
above the clavicle to the mastoid process, was bounded posteriorly by
the trapezius muscle, and anteriorly it pushed the larynx considerably
to the right side. From the thyroid cartilage across the tumor to the
spinous process of the 4th cervical vertebra it measured 92- inches,
between the same points on the opposite side only 5|. The ligature
was not only applied in this case to the cardiac side of the tumor, but
Mr. Porter expressly states, that " altogether there was much less
difficulty in the operation than might be anticipated."

We are constrained, therefore, to differ entirely from the views en-
tertained by Dr. G., in reference to a hen's egg placed under the skin,
i. e. in the carotid region, constituting a swelling of no inconsiderable
size. Besides all this, the tumor he described as an aneurism, must
have been Z>OL'e the level of the os hyoides "it was situated just be-
low the ramus and posteriorpart of the right lower jaw." Edt.]

I will now proceed to consider the subject with more parti-
cular reference to the case at issue.

It must be evident, from all that has preceded, that an aneur-
ism in the carotid region could only have been mistaken for
one or other of the following tunriours : Abscess, Enlarged
Glands, Encysted Tumour, Sarcomatous Tumour,, Medul-
lary Tumour. To this list might be added Maunoir's Hydro-
cele suR cou., which not infrequently occurs in this region,
and which from its generally elliptical, rounded and distinct
outline and its elasticity, might well be confounded with aneur-
ism by a careless observer. I have met with most of these
tumours again and again, but never found any very great diffi-
culty in distinguishing them from aneurism.

[Dr. Green then has been more fortunate than most surgeons in this
respect. He is not only right with the illustrious authorities he quotes,

1848.] Green, on Aneurism. 531

but does not err in the diagnosis of tumors of the neck like some of
them have "he " has met with mast of these tumors again and again,
but never found any very great difficulty in distinguishing them." In
1831, Dupuytren made an exploratory puncture in a tumor of the
neck, the character of which he could not determine. He took it for
an abscess, but it proved to be aneurism of the left carotid artery. In
Mott's Velpeau's Surgery are recorded two cases of ligature to the
carotid, when the aneurisms were subsequently found after death to
have existed in the aorta. Mr. Benj. Phillips, of London, says, "I
know at least eighteen cases where an aneurism has been mistaken
for an abscess, and in several cases treated acccordingly." Of thirty-
eight cases operated upon for supposed carotid aneurism, collected
and published last year by Dr. Norris of Philadelphia, mfour the
tumors were found out subsequently not to be such. In seven of the
thirty-eight cases, errors of diagnosis were made. In one (occurring
to the celebrated Lisfranc) the tumor on dissection proved to be a
fungus haematodes ; in another, it was carcinomatous ; in a third, the
tumor surrounded the artery ; in a fourth, the patient looked upon as
cured, the disease was found to be a glandular swelling ; in a fifth, an
abscess was incised, and the patient died from hemorrhage, notwith-
standing the ligature to the carotid; in a sixth, Mr. iz5^on opened
a scrofulous abscess, aneurism followed, then ligation of artery, but
unfortunately this patient died too; and in the seventh, the aneurism
was situated in the vertebral artery. A case is reported in the Dic-
tionnaire des Sciences Medicales, where a tumor in the neck, submit-
ted to the diagnosis of celebrated surgeons in America, Paris and
London, was pronounced to be aneurism of the carotid artery. "It
was afterwards ascertained by M. Boyer, that no such disease existed
but simply, an extensive enlargement of the glands of the neck.'^
Dupuytren mentions a case of aneurism of the aorta forming a tumor
behind the sternum, which being mistaken for an abscess, was punctu-
red and the patient died. Mr. Porter states the fact in one of bis lec-
tures, that in an urgent case he punctured the trachea with a trocar for
what he thought was spasms of the glottis. His patient died three days
afterwards of an aneurism of the aorta. He says the idea of an aneur-
ism never crossed his mind. Sam'l Cooper remarks, "there is no part
of the body where the diagnosis of aneurisms is more liable to mistake
than in the neck. There the disease is particularly apt to be confound-
ed with tumors of another nature. We have already cited examples
in which aneurisms of the arch of the aorta so resembled those of the
carotid as to have deceived the surgeon who was consulted. The
swelling of the lymphatic glands, or of the cellular substance which
surrounds the carotid, the enlargement of the thyroid gland, and es-
pecially abscesses, may resemble an aneurism by the pulsations com-
municated to them by the neighboring artery." In Liston's Lectures,
by Dr. Mutter, we read, " you must be quite sure that the disease you
are. treating is an aneurism. You must not mistake a solid tumor, or,
indeed, a tumor of any kind pressing on a vessel, for an aneurismal
tumor." From these facts, in connection, be it remarked, with aneur-

532 Green, on Aneurism. [September,

isms of the carotid artery alone, and hastily collected, we would sup-
pose that error in diagnosis of cervical tumors w^as not an impossible
event. Edt.]

There is, it is believed, nothing in the records of surgery to
justify the assertion that either of the above mentioned tumours
will instantly lose two thirds of its volume upon obliterating the
calibre of a large arterial trunk (by pressure or the ligature)
running over, under, or near it. No one, it is presumed, v^^ill
advance such an opinion.

[It is not stated in Dr. G.'s case, that the tumor lost instantly two-
thirds of its volume upon obliterating the artery. Edt.]

It follows, then, as a matter of inevitable necessity, that as no
other one, could have presented this indication, the tumour in
question could have been nothing else hut an aneurism. And
thus we arrive at the diagnosis by exclusion.

[Did Dr. Green never see or feel a tumor in the neck recede by
pressure or diminish by treatment of two weeks duration ? Edt.]

Having been, at my own request, politely favored by Dr. Eve
with his reasons for doubting the correctness of the diagnosis,
and liberally invited to discuss them in the pages of the Jour-
nal, I shall proceed to do so seriatim^ The first objection is as
follows :

*' The cause of the aneurism (a severe strain while planing
some hard wood) is not sufficient to produce the disease." {Dr.
Eve's letter.) In answer to this it may be observed that it was
the patient's own statement, and altogether unworthy of confi-
dence. [Then why mention it no other cause was assigned
by the author. Edt.'] Probably the most authoritative opinion
on this point is, that all aneurisms except those produced by
external violence traumatic lesions, &c., arise from disease of
the coats of the artery itself. It is true that Richerand and
Pelletan maintained that popliteal aneurisms were caused by
violent extensions of the leg, and the former brought forward
some experiments upon the dead body in support of this opin-
ion. But this explanation was conclusively refuted by the
arguments and experimental researches of Samuel Cooper,
Hunter, Home, Hodgson and Scarpa. {Cooper'' s Surg. Diet,)

1848.] Green, on Aneurism. 538

Dr. Hodge, in an able resume of all the knowledge on the sub-
ject, remarks that, " spontaneous aneurisms depend on an
original diseased condition of the artery." "There is always a
morbid condition of the arterial tunics as an essential predis-
posing cause, the dilatation often occurring without any external
influence." '* Under another division, it will be shown that no
tumour forms unless prior disease existed in the artery." " An-
eurisms never form in healthy arteries." The general conclu-
sion drawn from the facts detailed that aneurisms by dilatation
of one or all the arterial tissues, never occur in healthy arteries,
is confirmed by dissection, showing, in perhaps every instance
of dilatation, a preternatural softness or brittleness of the inter-
nal coats at least." (Cyc. of Pract. Med. and Surg.) This
predisposing cause of aneurism was believed, b}" Hodgson,
Guthrie, Begin and Breschet, to be chronic inflammation.

*'It often happens that a patient complains of the crooking of
the fingers, or the numbness of the foot, unmindful of the tumour
'under the clavicle or in the popliteal space." *' These consid-
erations lead us to the belief, that previous to the occurrence of
spontaneous- aneurism, the artery has undergone some change
predisposing to it." (Porter, in Cyc. ofAnat. and Phys.) This
change is believed by Mr. Porter to be unhealthy inflammation.

[Where is the proof that this cause was operating in the case un-
der consideration ? Edt.]

2d. " Aneurism of the carotid is very rare in this State
enlarged glands, tumours of the neck, ^c, very common. You
say there were a few enlarged glands^ thus showing a disease
of that system the glandular and it was at first supposed to
he an enlarged gland. ''^ {Dr. Eve's letter.)

In regard to the rarity of aneurism in this State, there is no
doubt of it. It is so every where. Velpeau, in the last edition
of his " Operative Surgery," was only able to collect forty-three
instances in which the carotid was tied for aneurism. {Motfs
Velpeau)

Dr. Mott, in his immense practice extending over a period of
forty years, has applied a ligature to the primitive carotid only
twenty-three times, and but a small proportion of these opera-
tions were for aneurism. {Motfs Velpeau.) Mr. Liston ob-
serves that, " Spontaneous aneurism at the angle of the jaw, is

534 Green, on Aneurism, [Septembeir,

not an every day occurrence, and few cases are recorded."
(Pract. Su7'g.) They are met with, however, occasionally, in
Georgia ; I have recorded one, and a medical friend in Mil-
ledgeville informs me that he has seen two cases. Had I time
or opportunity to consult the profession more extensively, other
instances, there is little doubt, might be discovered. Aortic
aneurisms are not at all unfrequent,

[Dr. Green is here certainly mistaken. Aneurisms of the Aorta
are not common in Georgia. Can he point to a single case verified by
loost-moriem appearances ? We are aware that aortic aneurisms are
sometimes suspected to exist, but the history of them in this region of
country is yet to be written. Still less frequent are carotid aneurisms
in this State. We have the candor to admit, one of our colleagues
thinks there is a case in this city. But Dr. Green's medical friend in
MiUedgevilLe, has met with just as many cases as did Dr. Hodgson,
the celebrated pathologist of London, and one upon -whom our author
justly places a high estimate. During his indefatigable researches
on diseases of the arteries and veins, carried on too for years in one of
the most important hospitals in tlie world, and" in the city of London,
the very centre of civilization, he could only enumerate two cases of
aneurism of the carotid artery out of 63 he had collected. In the table
by Lisfranc of 179 cases of aneurisms in general, only 17 were an-
eurisms of the carotid. Indeed, so rare is this disease of the arteries
in our country, that Dr. Green can boast of performing a cure never
attempted by our own great Dr, Physick. In the statistics already
referred to by Dr. Norris, one of the Surgeons of the Pennsylvania
Hospital, we learn the carotid has been tied 149 times in 24 the oper-
ation was for true aneurism. The full particulars of only two cases
occurring in America are given, one by Dr. Post, of New York, the
other by Pr. Warren, of Boston. Dr, Green's may be the third in
the United States, ^o far as we know. Of course, we allude to the ap-
plication of tlie ligature for spontaneous, true or mixed aneurism of the
carotid the artery itself has been twice ligatured at Augusta.- Edt,]

The "few enlarged glands" above alluded to, were absorb-
ents, swelled and inflamed from the irritation of the tumour, and
jt is highly probable that no aneurism can exist in a glandular
region like the neck, groin or ham, without producing some
irritation and enlargement of the surrounding absorbents.

It was the patient not either of hi^i physicians who at first
supposed it was an enlarged gland, or "kernel," {Vide the case
in the June No.)

[This is not so stated in the narrative of the case ; nor can we agree
with the author, in the opinion, " it is highly probable that no aneur-

1848.] Green, on Aneurism. 535

ism can exist in a glandular region like the neck, &c., without pro-
ducing some irritation and enlargement of the surrounding absorb-
ents." We have consulted the authorities he refers to, and find not
one agreeing with him on this subject. Dr. Hodge, on the contrary,
entirely differs from him. He speaks of the condition of the tissues
or organs connected with or dependent on the diseased artery, and no-
tices the muscles, ligaments, bones, joints, nerves, cellular membrane
and skin, fasciae and blood-vessels, and si}^s of the absorbents, they are
in many instances, like the arteries and veins, closed by the pressure,
or more frequently completely obliterated. It is denied that " enlarged
glands, absorbents swelled and inflamed," result from the irritation of
aneurismal tumors. Edt.]

3d. The symptoms are not satisfactory. The peculiar thrill
or whizzing sound ought to have been heard in a case of only
eighteen months standing.^"* {Dr. Eves letter.)

The expression used in the narrative was " very indistinct
almost imperceptible," conveying the idea that the bruit or
whizzing sound was not entirely absent, though it is not pre-
tended to correct the diagnosis in this respect at this late date.
As well as is now recollected, the stethescope was not used, but
the naked ear applied. The absence, however, of this sound
cannot be allowed to vitiate the diagnosis, as it is not insisted
upon as a necessary element in the diagnosis of aneurism by
any of the great masters in Surgery. It is only said to be gen-
erally present. This indication, from a variety of causes
thickness of laminated coagula, density of surrounding tissue,
and different conditions of the arterial orifice, &:c., must be very
variable. It is also often heard in tumours, not aneurismal.
" The whizzing sound (bruit de soufflet) generally heard in aneur-
isms is not pathognomonic, for the fungoid or other tumour
situated over an artery may produce it, and it may be created
by artificial pressure." {Porter.) Velpeau and Mott place
little dependence upon stethescopic indications in this disease.

[The Doctor here dwells upon the non-importance of one of the
symptoms of aneurism, viz., the whizzing sound absent in his case.
We wrote, the symptoms are not satisfactory, and particularized only
one, which we contend is important, and is so considered by surgeons.
But where are the peculiar thrills felt in tumors aneurismal ; where
the complaint that the patient experienced something beating, thump-
ing, alive in the tumor ; the rushing in of the blood when the sac was
temporarily emptied ; the- entirely emptying the sac of an ordinary
size ; what was the condition of the pharynx ; where the almost pa-

536 Green, on Aneurism. [September*

thognomonic symptom, found in Motl's Velpeau's Surgery, and first
noticed by M. Gendrin of Paris, viz. the peculiar tremor of the tumor
between each diastole, produced by the sinking under the hand or
contraction in the artery? How satisfactorily account for the few
enlarged glands, the red, tender, and very sensitive tumor ; the pain
increased by handling, &;c. ? These are included in the objection,
the symptoms in the case are not satisfactory, and not simply the ab-
sence of the bruit desoullletf Edt.]

4th. " The tumour, if aneurismal, should have been obliterated
by pressure to the proximal side of the tumour especially as it
was only of the size of a hen's egg. (Dr. Eve's letter.)

If the observations of Hodgson, Samuel Cooper and Porter,
previously quoted and referred to, respecting the early deposi-
tion of laminated coagula, are true, it follows that the tumour
could not be obliterated completely by pressure on its proximal
side, and consequently deprives this objection of all force. The
following extract from an article by Dr. Hodge, it is believed,
embodies the authoritative and almost universally received
opinion upon this point.

'* In the very early stages, the blood is sometimes, though
rarely, entirely fluid, especially where it passes readily into and
from the artery, and where the circulation has been active. la
such cases pressure can obliterate the swelling. In a short
time, however, the blood will be found partially coagulated at
first in soft clots, but very soon in laminae on the circumference
of the swelling, while fluid blood occupies the centre. Pressure
now diminishes, but does not obliterate the tumour.'* {Cyc. of
Pract. Med. and Surg.)

[Dr. Hodge is at present Professor of Obstetrics and Diseases of
Women and Children in the University of Pennsylvania, and though
he once lectured on the Principles of Surgery in a summer school in
Philadelphia, would no doubt be surprised to hear himself quoted as
embodying the authoritative opinions of the profession on a surgical
question. But we apprehend Dr. Green did not read the entire arti-
cle he refers to, for Dr. Hodge also writes, "in the early stage a
pulsating tumor, of a hemispherical or elliptical form, is observed over
the course of a large artery. It is indolent, soft, and circumscribed ;
the skin retaining its natural color and properties, without heat, pam or
other inflammatory symptoms." Again : " Pressure on the aneurism
diminishes or totn/li/ ob/ilerates the tumor,'" (Bayer.) Also, the liga-
tion is "fuilowed by absorption of the coagula, and by condensation
and obliteration of the sac and artery."

1848.] Green, on Aneurism. 537

Listen says, the tumor is at first compressible, and completely dis-
appears on tirm pressure being applied, either directly tp the sac, or to
the artery above, the sac being thereby emptied of its contents, or pre-
vented from being filled. * * * The obliteration of the sac proceeds,
in some cases, very rapidly ; it assumes a harder feel, decreases, and
disappears.

Prof. Porter lectures to his class in Dublin, "the blood, if the case
proceeds favorably, is afterwards absorbed, and the sac, in process of
time, is converted into a solid piece of ligamentous substance, similar
to that into which the arterial trunk has degenerated."

And in Samuel Cooper's Surgical Dictionary, we read, the " sac
becomes filled with coagulum, and gradual obliteration of the aneuris-
mal swelling is the result, * * * the lamellated agd coagulated
blood in the sac is by degrees absorbed ; and at length the tumor dwin-
dles away, or is quietly reduced to one, the size of which is so inconsid-
erable as to create no inconvenience."

It follows, then, from these extracts, that Dr. Green must rely upon
some other authority than what he refers us to Samuel Cooper, Por-
ter, Hodge, Listen, &c., equally declare in our favor, that his aneuris-
mal tumor could have been obliterated by pressure or ligature to the
carotid. Eut.]

A remark in regard to the size of the tumour has been made.
The aneurism was statec^to be "a good deal larger than a hen's

5th. '* But I rest my doubt as to the existence of an aneurism
in this case^ especially upon the fact, that the operation did not
remove the tumour. An aneurism of the carotid, size of a hen's
egg, most certainly would have been obliterated by ligature to
the artery. No lump ought to have existed some months after-
wards in the position of the original tumour. {Dr. Eve's letter.)

On the contrary, it can be shown that the usual process of
cure is a more or less gradual subsidence of the aneurismal
swelling after the operation.

[Just so. Who has said to the contrary? The subsidence of the
aneurismal tumor after the application of a ligature to an artery is
gradual, but when the operation is successful, the obliteration of it is
completed. To remove the swelling, as well as to arrest the pulsations,
and thus prevent the danger of hemorrhage, is the plain indication in
the cure of this affection. Edt,]

In some instances this subsidence occupies long periods. In
proof of which I quote some cases from that well known work,
"Cooper's Surgical Dictionary." "In June, 1805, Sir Astley
Cooper operated, in Guy's Hospital, on a man aged 50, who had

^38 Green, on Aneurism. [vSeptember,

a carotid aneurism, attended with pain on one side of the head,
throbbing in the brain, hoarseness, giddiness, &c." ' The tu-
mour was at last quite absorbed, though a pulsation existed in
it until the beginning of September. " The swelUng at the
time of the operation, was as large as a pullet's egg, and situa-
ted on the left side, about the acute angle made by the bifurca-
tion of the common carotid, just under the angle of the jaw.
The patient was cured and returned to his occupation." Here
is a case, from the highest authority, resembling in its symptoms
very much the one I have reported, in which the pulsation con-
tinued for over three months after the operation, and the
tumour itself probably much longer.

[We are compelled here to notice some remarkable omissions' in the
history of this case. Sir Astley Cooper says, in the very work re-
ferred to by Dr. Green, " in a little more than nine weeks, the wound
was quite healed and the patient recovered" besides using; the ex-
pression , " the tumor was at last quite absorbed.'''' In his xv. Lecture,
subject Aueurism, referring to this very case, it is stated, " the tumor
totally disappeared^ In Chelius' Surgery, vol. ii., p. 512, it is said
of this same case, (for it was the first one successfully operated on for
true carotid aneurism,) the tumor was ^ completely obliterated, that
when the patient died thirteen years after the application of the liga-
ture, with all the acknowledged skill of Sir A. Cooper in injecting
vessels and dissecting them, he could not determine the precise situa-
tion of the formerly existing aneurism. He supposed it must have
been in the internal carotid artery. We must presume then that
even in this case, selected as a comparison to his own by Dr. G., the
ligature did obliterate the tumor. No lump remained in its original
situation. Edt.]

In a case by Mr. Vincent, pulsation continued two days, and
the tumour was diminishing until the eighteenth day. After
this inflammation and abscess took place, and the patient died.
The case is valuable, however, as showing the gradual diudi not
sudden diminution of aneurism after operation. (Cooper'' s Surg.
Diet. Art. Aneur.)

[In the authority quoted by Dr. G., we read "the pulsation in the
tumor did not entirely cease, at first, when the artery was tied, but it
did so in two days afterwards; and the swelling was ropzVZ/j/ diminish-
ing."Edt.]

I quote the following from Mr. Porter : ;" A man was operated
on by Mr. Colles, for popliteal aneurism, on the 22d January,

1848.] Green, on Aneurism. 530

1831. The ligature came away on the seventeenth day ; the
tumour diminished ; in shoft, every thing went on well, and the
patient left the hospital perfectly cured." " He remained heal-
thy until his death from fever in March, 1835, and such an
opportunity for pathological investigation was not neglected.
The tumour, which had been originally of the size of a turkey's
egg, was found to have diminished to little more than the size
of a walnut ; externally it felt hard and as if completely solidifi- .
ed. On being cut into, however, neither artery or sac was
obliterated." In this instance the tumour was not obhterated
in over four years after the operation.

(With regret, we must again notice omissions in reporting this ease,
1st, Mr. Porter says, "so far as the aneurism was concerned, he re-
mained healthy." 2d, "It seemed as if the current of blood throfugh
the sac had never been interrupted" the ligature failed to cut off the
circulation Chrough it. Was this the condition of the aneurism in Dr.
Green's case ? But Mr. Porter also furnishes other evidence in our
favor, that aneurismal tumors become obliterated when the blood cir-
culating in them is arrested. He says, in 1831, having failed to ligate
the arteria innominata from the diseased condition of the vessel, the
patient nevertheless recovered perfectly. " The aneurismal tumor dis-
appeared entirely.''^ In another case of popliteal aneurism, where he
applied a bandage to the entire limb from the toes upwards, he says,
''on my visit the next day, the aneurism was goneJ^ In Dr. Mott's
case the carotid was ligated to the distal side of an aneurism at the
bifurcation of the innominata, and he states that the ligature came
away " oil the twenty-sixth day after the operation, the tumor above
the sternum aud pulsation having entirely disappeared On dissec-
tion, no tumor appeared externally," though a large one existed in the
thorax. Dupuytren ligated the axillary artery for an immense aneur-
ism involving the origin of the right subclavian and carotid ; the pa-
tient dying on the ninth day after the operation " on examination
there were but few traces of the tumor." In the celebrated case of
Mrs. Denmark, operated upon by Mr. Wardrop of London, the aneur-
ism, size of a turkey-egg, at the bifurcation of the innominata, " not a
vestige of the aneurismal tumor remained.^^ (Costello's Cyclopoedia
of Practical Surgery.) Edt.]

To these cases, I will add one from the lectures of that most
brilliant genius and admirable surgeon, George McClellan, now
unfortunately no more. This surgeon tied the carotid of an
elderly gentleman, one morning, for an aneurism of the size of
a walnut under the angle of the jaw : although pulsation stopped,
the tumour became much harder, and (Dr. McC. supposed)

540 Green, on Aneurism, [September,

pressed with such force upon the internal jugular that apoplexy
took place, and the patient died abAu four o'clock in the even-
ing. This case is of value as sho vising that even small aneur-
isms do not always subside immediately after the application of
the ligature.

Dupuytren has reported an instance of axillary aneurism,
where the inspissated contents of the sac were discharged by
suppuration three years after the deligation of the subclavian.

[Here the Doctor is again unfortunate in the selection and com-
parison of this case with his. He has only alluded to it this is
its history, taken from Dupiiytren's Lecons Clinique vol. iv., p. 524.

"C , aged 37, joiner by occupation, entered the Hotel Dieu 27th

February, 1819, to be treated tor false consecutive aneurism of the left
axillary artery. When made a prisoner in Spain in 1811, he was
knocked down by the blow of a sword received upon the left shoulder.
Much hemorrhage then occurred, but by simple dressings the wound
healed without further bleedings. Two months after being wounded,
C. detected a small tumor in the arm-pit, otiering pulsations, but with-
out change of color in the skin. Two years afterwards this swelling
was as large as a fowl's egg, and its pulsations were stronger. From
the fatigue of returning now to France on foot, a distance of 300 leagues,
the tumor acquired the size of an irfanVs head at birth, (flere follow
a minute description of the symptoms of the case, and the operation ot'
tying the sub-clavian artery above the clavicle.) On the eleventh
day the ligature came away, and by the thirtieth, the wound was cica-
trised. The tumor sensibly diminished every day, but becoming soft
and threatening to suppurate, Dupuytren covered it with resolutive
compresses. The seventy-eighth day after the operation, the tumor
was reduced to one-fifth of its original volume, no pus having formed.
At the end of some months C. left the hospital to resume his former
business, and for three years continued well. At this period, from ex-
cessive work, he was attacked with infiaminaiion and tumefaction m
the axilla. He again sought relief at the Hotel Dieu on the i4th July,
1822. In the arm-pit was a tumor as large as the (ist; the skin was
now red and thin ; and i's summit of a violet color as it threatened to
burst. This tumor offered no pulsation ; the patient had had chills,
fever, want of appetite, &-c. Dupuytren declared it had no relation
with the circulation, and the matter it contained was not under the
influence of the heart. He wished to open the tumor by an incision,
but the patient preferred to wait, and it was poulticed. At the end of
fifteen days it opened spontaneously, and discharged a great quantity
o{ pus mixed with matter resembling grapes in consistence and color.
This was evidendy formed from the old blood without the circulation,
and altered by the work of suppuration. By proper treatirient this
patient left the jiospital 22d October, 1822, a second time perfectly
cured, having no kind of tumor or swelling in the axilla." Surely
there is quite a contrast between this case and the one narrated by

\

1848.] Green, on Aneurism. 541

Dr. Green. He must admit at least an error of diagnosis in this
instance. Edt.]

I might go on and quote other cases, but enough has been
said, to show that it is neither new nor unusual for an aneurism
**a good deal larger than a hen's e^g^ i^ot be instantly dispers-
ed by the application of the ligature, and leave no vestige be-
hind some months afterwards.

[The reader will decide, if a single case has been exhibited to prove
the latter clause of this sentence. Edt.]

Having previously reached the diagnosis by exclusion, and
I will now endeavor to arrive at it by the positive method, and
will give my reasons for still believing Deas' disease was an
aneurismal tumour.

1st. Because, "it was progressively on the increase."

2d. Because, "it was compressible, diminishing under pres-
sure."

3d. Because, " it pulsated violently, and throughout its whole
extent, at the margins as well as in the centre." [Not so stated
in the narration of the case. EdtJ]

4th. Because, the pulsation ceased and the swelling subsided
two-thirds of its volume when pressure was made on its proxi-
mal side.

5th. Because, the size and pulsation of the tumour were in-
stantly restored upon removing the pressure. [Not so stated
in your Article. EdtJ]

6th. Because, the last two indications were more completely
evidenced, when the artery was compressed between the finger
and canula, during the operation. [Not so stated in your Arti-
cle.Ec?^.]

7th. Because, of the immediate beneficial results of the opera-
tion, in producing a subsidence of the tumour and pulsation,
and in relieving the pain, confusion, and other cerebral disturb-
ances. [This is at direct variance with the effects of the opera-
tion, as recorded in the June No. Edt.']

8th. Because, it was going through the usual and regular
course of cure after operation, and "some months afterwards,
he was well in all respects, save a small lump in the position of
the original tumour."

542 Green, on Aneurism. [September,

9th. Because, Dr. Benj. A. White,' of Milledgeville, a gentle-
man of consummate abiHties and extended surgical experience
for twenty-five or thirty years past, united with Dr. T. F. Green
and myself, in carefully and deliberately canvassing every point
in the diagnosis, and in coming to the conclusion that the dis-
ease could be nothing else but an aneurism.

Having now arrived at the conclusion, and occupied more
space than was at first intended, it only remains, to tender my
acknowledgments to the editor of the Journal for this opportu-
nity of placing myself rectus in curia before the readers of his
periodical.

('

[As we have given to Dr. Green every advantage, and introduced no
new evidence, but attempted to explain and complete his own, we are now
done with the discussion of this subject. The proof-sheets will be sent
him, that errors may be corrected in any thing we have said or done,
and this too in the present No. under the head of Medical Intelligence.
We regret sincerely if we have unintentionally wounded his feelings
in the slightest degree nothing was farther from our object. We
would not injure his professional reputation, fair and honorable as we
^ have heard it to be, but on the contrary, he has our best wishes for a
long and prosperous career of usefulness in life. But errors often
occur in medicine and surgery. None of us are above committing
mistakes in the exercise of the most difficult of all professions. We
had not even accused the author of making one, but only expressed a
doubt as regards his diagnosis in a case. Mr. Wardrop, celebrated
for his operations on aneurisms, is said to have lost a patient, who pre-
sented a tumor disconnected with the carotid, and a ligature around
the tendon of the omo-hyoid muscle as it crosses the artery. And but
a few months ago, it having been determined in consultation by distin-
guished surgeons in Paris, that a patient laboured under a carcinoma-
tous disease, the spermatic cord was first divided, and the scrotum laid
open, when lo and behold! a sound testicle existed at the bottom of a
hydrocele. The operation was arrested, a second consultation held,
when it was decided to complete it, and for once the doctors could
assure the patient his cancer would not return. The case of the late
Mr. Lision is also one strikingly in point. The most distinguished
pathologists failed to detect his disease aneurism of the aorta.

Nor would we insinuate that Dr. Green intentionally misquoted from
authors the differences between us here may be justly attributed to
different editions of the same work. Edt.]

1848.] Wilson, on Enlarged Prostate Gland. 543

ARTICLE XL.

Enlarged Prostate Gland Puncture of the Bladder^ success-
fully. Reported by Jno. S. Wilson, M. D., of Marengo
County, Alabama.

Believing that the following case will not be entirely uninter-
esting to the profession, I report it from memory ; but still, I
hope with sufficient accuracy, to present all its interesting
features, while the tedious minuteness of detail, generally so
irksome in reported cases, will be avoided.

In Oct. 1845, I was requested by my father. Dr. C. H. Wil-
son, of Crawfordville, Ga., to visit with him, J. A., laboring
under retention of urine. The patient was about 70 years of
age, intemperate in his habits, of a cold, phlegmatic tempera-
ment possessing remarkable powers of endurance, but little
excitability, having passed through a long life of intemperance,
with but slight impairment of constitution. He presented the
following symptoms: Pulse somewhat accelerated, moderately
full and intermittent, (my father remarked that he had observed
this to be a frequent phenomenon with old persons, generally,)
his skin was pleasant abdomen much swollen and tense
the bladder much distended could be plainly felt, mounting above
th'C pubis, and extending near to the umbilicus ^anxious ex-
pression of countenance, and tenesmus. On examination per
rectum, the prostate gland was found much enlarged. My
father informed me, that this patient was afflicted with a chronic
enlargement of the prostate, w^hich was frequently so much ex-
acerbated by a "frolic" as to produce total retention ; but that
he had always been able to relieve it, by the use of opiates, warm
bath, and other ordinary anti-phlogistic means : all of which
had been tried in the present attack, without avail. It was
now late in the evening an attempt had been made to intro-
duce the catheter in the morning, without success the symp-
toms were becoming truly alarming, and the danger from rupture
or gangrene seemed to be imminent. I^. V. S. to faintness.
After the bleeding' another attempt was made to introduce the
instrument, with no better success than before. Every variety
of catheter in common use was tried the common silver one

544 Wilson, on Enlarged Prostate Gland. [September,

and the gum-elnstic, with and without a stilet. In addition to
these, resort was had to a number of bougies, of various sizes
and various materials, such as wax, composition, metal, &c.
The finger was introduced into the rectum, and the manipula-
tions with the instruments, and the position of the patient were
varied, in every manner that ingenuity could suggest, or that
offered the slightest prospect of success, but all proved abortive.
^. Morph. Sulph. gr. 1 pro renata ; 01. Ricin. and tepid bath
at bed-time.

It was decided that he should be left with these prescriptions
for the night, and if the attempt next morning to introduce the
catheter should prove unsuccessful, the bladder must be punc-
tured as a last resort.

MorniufT, Great distention of abdomen ; skm hot and dry ;
pulse quick, corderl and intermittent; jactitation and anxiety
of countenance increased. l^. Continue Morphine and apply
leeches to the perineum. The day being cho] and cloudy, the
leeches would not draw. Another attempt was made, to gain
a passage to the bladder, with no better success. An operation
was now imperatively demanded, and every moment's delay
compromitted the life of the patient.

Dr. Wilson having an aversion to the puncture above the
pubis, caused by the unfortunate termination of a case in which
he had previously operated, and being fully convinced of the
greater safety of the operation through the rectum, selected
that point. But he had no instrument suitable for the purpose,
and fatal consequences might ensue before one could be pro-
cured from Augusta (64 miles). Under these circumstances, it
became necessary to provide an ex tempore instrument, consist-
ing of a long curved trocar, with a triangular point, sheathed
in a leaden canula, mounted with a circular tin guard, and per-
forated with holes, for the insertion of tapes. A pretty rough
instrument, by-the-by, but nevertheless, it answered the purpose
for which it \^as designed admirably, the greatest inconvenience
being its too great length, which rendered it somewhat difficult
to retain it in situ, but this was readily obviated by filling the
interspace between the guard and anus with cotton.

The operation gave but little pain, notwithstanding the rough-
ness of the instrument, and a large quantity of water was passed

1848.] Long, on Glossitis in an Infant. 545

much to his relief. After a few days, the canula became dis-
placed, by the action of the bowel, and he continued to pass
his urine for a length. of time per rectum, without any ill effects-
The prostatic inflammation gradually subsided, the natural
channel was re-established, the artificial opening closed, and he
found himself entirely in statu quo.

ARTICLE XLI.

Case of Acute Glossitis in an Infant nine months old^ success-
fully treated. By John A. Long, M, D., of McMinn County,
East Tennessee.

On the 11th February, 1847, 1 vi^s called to an infant, aged
nine months, who was laboring under inflammation of the
tongue. The mother informed me the child had had scarlatina,
but, as she expressed itj had gotten Well again. It now had the
thrush, or aphthous eruption of the mouth, and the tongue be-
came swollen, which latter symptom increased until I saw it on
the morning of the 11th. It now presented the following
symptoms : High fever; countenance flushed; pulse, quick,
small, and much accelerated, (164) ; tongue, enormously swol-
len, so much so as to fill the entire cavity of the mouth, and
protruded to a considerable distance out of it ; had slept none,
nor taken the breast for thirty-six hours ; fretted incessantly,
and respired with the greatest difliculty ; a quantity of viscid
saliva was secreted and adhered to the surface of the tongue;
this organ was hard to the touch, the swelling being nearly
entirely confined to its left side. The tongue protruded from
the mouth in a lateral direction, presenting a curved shape.
From the rigidity of the organ, I concluded that pus had not
yet formed in any part ; or if so, it must be deeply seated, as
there was not the least sign of fluctuation. I at once deter-
mined on a free incision into the tongue with a common thumb
lancet. This opening, to my surprise and great satisfaction,
gave exit to from 1|- to 2 oz. pure pus, with a quantity of dark
blood and pus in a state of mixture. Almost immediately re-
lief was thus afforded to the poor little sufferer. It soon fell

35

546 Cramps of Writers. [September,

asleep ; the organ retracted into the mouth, and in about five
hours it took the breast freely : has convalesced rapidly, and is
now entirely recovered.

PART II.~REVIEWS AND EXTRACTS.

ARTICLE XLII.

Cramps of Writers. By Dr. S. Sandras. (Translated by
Henry Rossignol, M. D., of Augusta, Ga.)

Our colleague, M. Lenfant, of Marans, desired us to enlighten him
on the treatment of this disease. We are happy that one of the most
competent practitioners of Paris has been pleased to charge himself
with this. Our readers will remember, without doubt, that this
is not the first time we have spoken of this disease. It has been al-
ready mentioned sev#al times in this journal.

Case hy Dr. Lenfant. M. D., employed in a banking establish-
ment, aged 35 years, of a nervoso-lymphatic temperament, of a deli-
cate constitution, born of healthy parents, having had no tendency to
cutaneous or venereal disease ; his father, however, has suffered for
more than a year, from neuralgia of the face, and he himself complains
of irregular pain and bad digestion. M. D. suffers from a nervous
affection which prevents him from writing.

The seat of the disease is in the right fore-arm. He feels no pain
whatever, but only a sensation of continued lassitude, resembling that
which would result from fatigueing exercfses in one not accustomed to
them, such as fencing, riding, &c.

This feeling of uneasiness is less sensible during the day than at
night ; it does not prevent sleep, but it causes a sensation as if the
fore-arm was then very much swellej3.

In the act of writing, the movements of the hand, obeying no
longer the will, want- precision ; the patient, nevertheless, uses his
hand with steadiness in any other case : thus, he will carry a tumbler
full of water without spilling any, or he will thread the finest needle
without difficulty or resting the hand ; but when he wishes to write, it
is different: the hand is sometimes pushed along, sometimes stopped
in its movements, and then agitated by nervous jerks, which prevent
him from writing readily. For the writing to be legible, it is neces-
sary that the letters be made very slowly, the only means by which
he can overcome the spasmodic force which compels the hand to form
imperfect letters.

1848.] Cramps of Wj iters. 547

The fingers, which at first hold the pen with sufficient force, soon
exercise scarcely enough to hold it at all ; the thumb, in relaxing,
crosses and mounts up the index finger by slipping along the pen,
which is thus imperfectly controlled.

The patient at first did not pay attention to this affection, but felt at
times a sensation of lassitude in the muscles of the hand, which grad-
ually increased up to the bend of the arm, when the sensation of fatigue
and numbness ceased entirely.

Such are, as far as we can describe them, the irregularities and
nervous phenomena which characterize the disease, against which the
following therapeutical means, which I have repeatedly tried, have
failed: Neglin's pills internally; baths of brandy, cold water, sea
water, sulphate of potassa and mustard, frictions with balm of Fiora-
venti, and other stimulant and sedative liniments. Compression was
also tried ; cauteries and setons but with little effect, as acknowledged
by M. Cazeneave; and as these means are very repugnant to the pa-
tient, we have abandoned the use of them until more fully enlightened.

I have examined with attention the details of this interesting case
noted by our honorable colleague. The history of this case resembles
in its principal features others which I have met.

In all no material lesion could be discovered about the brachial
plexus, the origins of the nerves going to it, nor along their
course from the bend of the arm ; neither could any persistent lesion
be discovered in the neighboring parts ; similar symptoms, however,
were remarked. Numbness of the fore-arm, commencing at the
hand; loss of voluntary motion in these parts, especially when their
movements should be quick, precise and adroitly performed ; a feeling
of pain or numbness more or less painful, accompanied, sometimes,
with a heaviness of the limb, very fatigueing, and contraction of the
fingers.

This state which I have seen followed by a little loss of sensation,
seemed to me, susceptible of different treatment, according to the dif-
ference of constitution.

The symptoms above given seem to resemble partial chorea, when
they occur in subjects affected with nervous or chlorotic diseases. I
have prescribed the internal use of proto-carbonate of iron, frequent
warm baths with the addition very often of sulphur and soap, and
habitual frictions, morning and night over all the benumbed parts, with
simple salve, containing y^j part of strychnine.

In plethoric and sanguine subjects, frequent applications of leeches
towards the superior border of the numbness, frequent use of flax-seed

548 Congestive Fever. [September,

poultices, warm and emollient baths prolonged to two or three hours,
rest of the muscles during the active treatment, and at the same time
a proper regimen, seemed to me to answer best.

In similar cases to the one just reported, a few applications of leech-
es to the superior and outer part of the fore-arm and posterior inferior
part of the arm, frequent emollient baths to the fore-arm, frictions
with salve containing strychnine, seemed to be the most proper treat-
ment.

I should add, in such cases, I believe it useful to try, as a general
means, the proto-carbonate of iron whenever chlorosis is suspected ;
three to five centigrammes of belladonna, taken at night, when the
sensibility is too acute, and when the numbness amounts to pain, espe-
cially during the night ; baths containing a bottle of rum, if the gener-
al feebleness is too great ; and lastly aromatic frictions along the
spine, particularly over the points of origin of the nerves going to the
affected parts.

I have seen similar treatment terminate favorably, very soon, when
the patient was at the same time put upon hygienic regimen suited to
the rest of the treatment.

This does not succeed in all cases, however, and I have been com-
pelled to recur to repeated applications of blisters on different parts of
the fore-arm and on the posterior part of the arm. These blisters, re-
peated often, instead of allowing them to remain on long, seemed to
have produced excellent effects in almost all cases. A' few slight
electric currents through the affected part, with or without acupunc-
turation, seemed to relieve the patient for the moment. 1 have never
used setons or cauteries ; what I have seen of them in a number of
nervous affections, not satisfying me of their utility in such cases.

After the information given by our esteemed colleague, I would sub-
mit the patient to a third mode of treatment, which lends its means to
the indications of the two first. 4

My personal experience leads me to expect a happy result, since I
cannot discover any important symptom of the commencement of a
progressive paralysis. [Journal des Con. Med. Chir,

Congestive Fever. Dr. Lewis, of Mobile, in his Medical His-
tory of Alabama, published in the New Orleans Medical and
Surgical Journal, says:

** The successful treatment of congestive fever demands the
most prompt and energetic application of positive remedies la
medecine expectante is here out of the question, and the indica-

1848.] Congestive Fever. 549

tions stand forth clearly and boldly; (he heavily oppressed ner-
vous and vascular systems, the cold and shrunken surface, the
engorgement of internal organs, the general prostration of the
vital powers, all appeal strongly to you for prompt relief.

"To equalize the circulation and -call back the vital heat to
the surface, is the first indication, and with this viev^ revulsives
are applied extensively over the external surface, strong cata-
plasms of mustard are applied to the abdomen and extremities,
and the more extensively the better ; in addition to such appli-
cations, with which too many practitioners are satisfied, we
would beg leave to impress upon the reader the importance of
dry cups along the whole course of the spine, to be followed
immediately by one of the above stimulating cataplasms. The
reaction following this plan has been so prompt and decisive in
many instances, as to force upon us the conviction that in the
spinal column is to be found the pathological centre of all the
mischief. In plethoric subjects, determinations take place to
the abdominal or thoracic viscera, demanding also the free use
of cups.

*'In the summers of 1835 and '36, when it was not unusual
for the patients to remain several days in a cold adynamic con-
dition, (the disease constituting but a single paroxysm,) we were
driven to the use of long continued frictions ; a copious kettle of
decoction of capsicum and mustard in brandy, (or rather tincture,)
was prepared and a servant stationed at each extremity was
directed to keep up rapid frictions with the liquid heated almost
to the boiling point. In this way a partial reaction was pro-
duced and kept up until the internal remedies had time to come
to the rescue and stave off the fatal co//a/?5e.

"Calomel, opium, quinine, and piperine are the favorite reme-
dies for internal administration ; they are used singly or variously
combined, according to the condition of the patient and peculiar
notion of practitioners. If vomiting and purging, either separa-
tely or together exist, calomel and opium (5 grains to 1) may
be given every hour until quiet is restored ; enemata of starch
and laudanum are also used with happy effects. Many prac-
titioners, who are ordinarily opposed to complication of remedies,
prescribe in urgent cases something like the following formula;
Calomel grs. v., opium gr. |, piperine gr. i., and quinine grs.
iii., ever hour or two some one of these ingredients may be
left out where from its specific effect it is thought inapplicable.
After a few doses the calomel and opium are withdrawn, and
the quinine increased in quantity and continued for a longer or
shorter time, according to the duration and circumstances of
the case.

*' Quinine is not given in congestive fever as a stimulant to

SU Strangulated Inguinal Hernia, [September,

promote reaction. On the contrary, it is a popular and well-
founded impression that when given in adynamic diseases in
large doses-, its effect is decidedly sedative and consequently
prejudicial in this stage of the disease. It is therefore given in
combination with stimulants, as opium, capsicum, brandy, am-
monia, &c., in order that it may have time to exert its peculiar
anti-periodic effect. During the state of extreme depression,
many gentlemen give opium and brandy to the exclusion of
every other remedial agent. Some give as much as 100 drops
of laudanum every hour until a change in the symptoms is pro-
duced. We have never given it in this way, but are assured
by gentlemen of experience and judgment that it soon arrests
the pernicious tendency of the disorder, and places the system
in a condition to be easily and happilv influenced by external
and internal stimulants, and thus enable them to guard against
another paroxysm,"

Case of Strangulated Inguinal Hernia, reduced on the New
Method recommended by Dr. Andrew Buchann, Professor
of Institutes of Medicine in the University of Glasgow. By
Archibald Wallis Mackie, Cupar, Fife. (London Lancet.)

G. M., aged seveteen years, railway labourer, of a stout habit
of body, and enjoying previous good health, whilst employed
lifting some heavy railway sleepers on Friday last, felt something
to give way at the lower part of his abdomen. The patient
was unable to walk, and was carried to a neighboring house,
where he remained till next day, when he was conveyed to his
father's residence, a distance of eleven miles. I was called to
visit him on Sunday morning, and on examination found a
tumor the size of a hen's egg, situated in the right iliac region,
the general characters of which led me to conclude that it was
a case of strangulated oblique inguinal hernia. The patient
had not had his bowels opened since the morning of the acci-
dent. I ordered him an enema, and, after waiting till it was
expelled, I applied the taxis, but unsuccessfully ; I then had
recourse to the usual remedies adopted in such cases, but
without any affect. I bethought me of the plan recommended
by the talented Professor of Physiolgy in the Glasgow Univer-
sity, and I was glad to see my effort crowned with success.
The mode is very simple. I placed my patient on his back,
flexing the tliighs on the pelvis, and putting the muscles of the
abdomen in as relaxed a condition as possible. I then desired
the patient to empty his lungs of as much air as possible, and
having an assistant at hand, who immediately held his nose and

1848.] Typhoid Fever, Intertnittents and Phthisis. 551

mouth to prevent inspiration, I applied gentle pressure over the
tumour in the proper direction, and, as it were, drawn up into
its natural cavity.

The rationale seems to me to be, when the lungs are empti-
ed of air, the diaphragm is, as it were, sucked up to fill the di-
minished thoracic cavity ; it (diaphragm) exerts a tractile power
over the floating viscera of the abdomen, and draws the pro-
truded intestine upwards naturally assisting, if not altogether
accomplishing the reduction of the hernia.

Such is the mode, I conceive, in which the reduction is accom-
pHshed ; and I have no doubt that in addition to the mechanical
influence, the temporary suspension of the breathing must have
a powerful sedative effect, and consequently a relaxing influ-
ence, on any part morbidly constricted. Before operating I
would always give this plan a fair and impartial trial, and I am
confident, if practitioners would adopt this method, they would
have the satisfaction of relieving their patients, and thus avert-
ing the dangers of a painful and often fatal operation.

On the Antagonism between Typhoid Fevers, Intermittents, and
Phthisis. By M. Boudix. (From New York Journal of
Medicine.)

The following summary of M. Boudin's conclusions on this
subject are given in a recent number of the British and Foreign
Review. The facts are simple, and the sources from whence
they are obtained sufficiently accurate to justify a reliance on
the statements.

1. Those localities in which the producing cause of endemic
intermittents thoroughly modify the constitution of man, are
remarkable for the infrequency of pulmonary phthisis and
typhoid fever. 2. The localities in which pulmonary phthisis
and typhoid fever are particularly prevalent, are remarkable
for the infrequency and mildness of intermittent fevers con-
tracted on the spot. 3. The drying up of a marsh, or its con-
version into a lake, diminishes or prevents intermittent fevers,
but seems to dispose the organism to a new series of diseases,
in which pulmonary phthisis and (according to the climate)
typhoid fever are particularly prominent. 4. After a residence
in a thoroughly marshy locality, an individual enjoys an immu-
nity from typhoid fever, the degree and duration of which is in
direct proportion, first, to the length of the previous residence ;
second, to the intensity of the fevers proper to the locality, con-
sidered under the two-fold relations of form and type ; third, or,
in other \vords, that a residence in a country of remittent and
continued fevers, such as certain points of the coast of Algeria,

552 External use of Chloroform. [September,

and the centre of the marshy part of Brasse, is more, pro-
phylactic against the disease referred to, than, for example, a
residence near the marshy embouchure of the Bievre, at Paris.

5. The conditions of latitude and longitude, and of height (above
the sea) which limit the manifestation of marsh fevers, equally
limit the curative or prophylactic influence of the marsh miasm.

6. Lasth^ certain conditions of race, and possibly of sex, di'
minish the susceptibility of the system to the cause of marsh
fevers, and in equal degree diminish the therapeutic influence
of that cause.

The subject of which M. Boudin treats has considerable prac-
tical value in the distribution of troops, and in the hygeine of
those predisposed to consumption*

External use of Chloroform.
To the Editor of the Boston Medical and Surgical Journal.

Sir, If the following notice meet your approbation, and you
should deem it worthy of a place in the pages of your valuable
Journal, you are at liberty to make it public.

The discovery of chloroform, and its secondary effects upon
the human system, so far as they have been ascertained, has
manifestly awakened, on the part of the profession in this
country, and in Europe, most ardent and laudable efforts to
become acquainted with the fullest extent of its potency, and
the whole rationale of its action, both as an anaesthetic and
therapeutical agent, 1 take it for granted, therefore, that
making known to the medical public any novel symptoms the
effects of this most wonderful substance which may fall under
the observation of those using it, will tend, in a measure, to
accomplish the object desired- ,

On the 15th of March last, while at the house of a patient of
mine, Mr. P., a hale, robust young man, came in to see me, for
the purpose of liaving me "examine his leg," in which he mani-
fested great lameness when attempting locomotion, and in
which he had suffered "severe and incessant pain for the last
forty-eight hour^." About the centre of the gastrocnemius
muscle, superficially, of the left leg, was the region to which
he referred the seat of pain. He could attribute the difficulty
to no known cause.

Upon examining the limb I was unable to discover any indi-
cations of disease, but concluding the affection to be of a rheu-
matic nature, I resolved to try the virtue of chloroform externally
having seen a notice of it^ favorable results under similar
circumstances. Accordingly, I at first applied about half a
drachm with some degree of friction on the part, and continued

1848.] Death from Fracture of the Vertebrce. 553

the use of it thus, a few minutes, with short intervals after each
appHcation, watching narrowly for any visible affect it might
produce. He at length complained of nausea, and spoke of ex-
periencing a strange sensation, a peculiar ''combination of
coldness and numbness," in the part, and subsequently exten-
ding over the whole system. I observed his countenance
had become pale, he was stupid, the pulse was retarded in its
action and augmented in volume ; in short, there were present
all those phenomena usually resulting from ordinary inhala-
tion of the article. He was placed upon a bed. Having lain
there a short time, he arose and walked about the room with
perfect ease. He said he was entirely free from pain, and thus
he has remained up to the pesent time. E. E.

N, Andover, May 16, 1848.

Sudden Death From I^racture of the Vertebra.
To the Editor of the Boston Medical and Surgical Journal.

Sir, The sudden death of a lad aged 14 years, who fell in
attempting to get from a pew into the aisle of a meeting-house,
near my residence, brought to mind the case which occurred
to Mr. Abernethy, at St. Bartholomew's Hospital, some years
past. This lad, who fell here, son of Mr. Tracy, struck on the
angle of the socket of the left eye. The contusion was slight
in external appearance ; but death was instantaneous, he show-
ing no sign of life after the fall, but one single gasp !

The case which occured at St. Bartholomew's was related in
the London Metropolitan, and never, that I know of, has ap-
peared in any medical journal. The relater says : " A drunken
coal-heaver fell from a waggon, going up Ludgate Hill. He
was covered with mud, and appeared to be hurt. I and two
others laid him upon a shutter, and took him to St. Bartholomew's
Hospital. He was stripped, and the surgeon examined him,
but no injury could be discovered ; still he could not rise up in
bed. Mr. Abernethy happened to come in shortly afterwards,
when the case was shown to him, but he could make nothing of
it. ' Let him,' said that great surgeon, ' be washed thoroughly
clean, and send for a barber and have that beard taken off,
which appears to be of a month's gi^owth.' About an hour
after this, as I was relating to the surgeon how^ he fell from the
waggon, a message was brought that the man had instantaneous-
ly, while he was undergoing the operation of shaving, given up
the ghost. We all immediately repaired to the spot, where lay
the man, half shaven and quite dead. The barbar said he
appeared to be well, and was talking to him one instant, and
the next was a dead man. ' I had hold of him,' said he, ' by
the nose, and did but turn his head very gently to use the razor,
when he, without breathing or a sigh, went off.'

554 On Food for Children. [September,

"Abernethy turned to the young students, and told them
this was a case for study, saying, * there was a cause for the
man's death ; and tliat the foUowins: morning he would open
the body and find it out.' ' But,' added he, ' think of the case,
and before I make the examination, tell me in the morning, each
of you, your opinion, what it is that has so suddenly deprived
him of his life." One of the students said, 'I think a vertebral
bone is fractured, and that as the barber turned his head to
shave him, a splinter penetrated the spinal cord.' ' You have
it,' cried Abernethy, ' turn him over, and w^e will see.' They
immediately cut down the back, and discovered a small piece
of fractured bone, not bigfjer than half a pin, which had pen-
etrated the spine ; then taking the corpse by the nose, they
observed, as they turned the head one way, the splinter came
out, and as they turned it the contrary, it entered the vital
cord. The problem of his defith was at once solved, and
I learnt how little it took to stop the great machine of life in
man.^'*

Thus far the relation of this case, to wdiich I may add, in con-
clusion, the following:

Remarks. The reason that Mr. Abernethy could make noth-
ing of the case, when he first saw the man alive, after the ac-
cident, may have been that fractures of the cervical vertebrae
may so disable a patient, that he, like the coal-heaver in
this case, could not rise up in bed. The tact and talent of Mr.
Abernethy's student, in pointing out the cause of the instant
death of the man, when the barber turned his head, by taking
hold of his nose to shave him, has ever, when I have thought
of this case, struck me with admiration. The case appears not
to have been related by a medical man ; hence the vertebra
which was fractured is not designated. But w^e should at once
infer that it could be no other than one of the cervical. And
this was probably the cause of the instant death of the son of
Mr. Tracy. Yours, dear sir, very truly,

Lebanon, Ct., May, 1848. Joseph Comstock, M. D.

P. S. There is a case related in which a negro man fractured
the fourth and fifth cervical vertebrae, who lived thirty-three
hours; but never secreted any urine after the accident. The
catheter was frequently introduced, and not a drop drawn.
\

On Food for Children. (American Journ. of Med. Sciences.)

Dr. Thompson, in his "Researches on the Food of Animals"
after some remarks on the relative quantities of nutritive matter,
in various articles of diet, makes the following judicious obser-
vations on the appropriate food for children :

1848.] On Food for Children.

"Milk, in some form or other, is the true food of children, and
the use of arrow-root, or any members of the starch class, where
the relation of the nutritive to the calorifiant matter is 1 to 26,
instead of being as 1 to 2, by an animal placed in the circum-
stances of a human infant, is opposed to the principles unfolded
in the preceding table. In making this statement, I find that
there are certain misapprehensions into which medical men are
apt to be led at the first view of the subject. To render it
clearer, let us recall to mind what the arrow-root class of diet
consists of. Arrow-root and tapioca are prepared by washing
the roots of certain plants until all the matter soluble in water is
removed. Now, as albumen is soluble in water, this form of
nutritive matter must in a great measure be washed away ;
under this aspect we might view the original root before it was
subject to the washing process, to approximate in its composi-
tion to that of flour. If the latter substances were washed by
repeated additions of water, the nitrogenous or nutritive ingre-
dients would be separated from the starchy or calorifiant ele-
ments, being partly soluble in water, and partly mechanically
removed. Arrow-root may therefore be considered as flour
deprived as much as possible of its nutritive matter. When
we administer arrow-root to a child it is equivalent to washing
all the nutritive matter out of bread, flour, or oatmeal, and sup-
plying it with starch; or it is the same thing approximately as
if we gave it starch ; and this is in fact what is done, when chil-
dren are fed upon what is sold in the shops under the title of
" Farinaceous Food," empirical preparations of which no one
can understand the composition without analysis. Of the bad
effects produced in children by the use of these most exception-
able mixtures, I have had abundant opportunities of forming an
opinion, and I am inclined to infer that many of the irregulari-
ties of the bowels, the production of wind, &c.,in children, are
often attributable to the use of such unnatural species of food.
It should be remembered that all starchy food deprived of nutri-
tive matter is of artificial production, and scarcely if ever, exists
in nature in an isolated form. The administration of the arrow-
root class is therefore only admissible when a sufficient amount
of nutritive matter has previously been introduced into the
digestive organs, or when it is inadvisable to supply nutrition to
the system, as in pases of inflammatory action. In such cases
the animal heat must be kept up, and for this purpose, calorifiant
food alone is necessary. This treatment is equivalent to re-
moving blood from the svstem, since the wasting of the fibrinous
tissues goes on, while an adequate reparation is not sustained
by the introduction of nutritive food. A certain amount of
muscular sustentation is still, however, effected by the arrow-

556 Effects of Tobacco, Tea and Coffee. [September,

root diet; since according to the preceding tables, it contains
about one-third as much nutritive matter as some wheat flours.
The extensive use of oatmeal, which is attended with such
wholesome consequences among the children of all ranks in
Scotland, is, however, an important fact, deserving serious con-
sideration, and it appears to me, is strongly corroborative of the
principles which I have endeavored to lay down.

Injurious effects of Tobacco, Tea and Coffee. Clinic of Prof.
Parker. (x\nnaiist.)

A man aged 35 years, has been troubled with palpitation of
the heart two years ; temperate habits, drinks tea and coffee,
and chews tobacco ; bowels slightly costive ; tongue somewhat
furred ; pulse nearly natural ; some dyspeptic uneasiness in the
gastric region. The palpitations were greatly increased by
mental or physical excitement, or exercise. A careful exami-
nation could detect none of the physical signs of organic disease
of the heart. This case, said Dr. Parker, is very interesting to
the student and young practitioner, as it finely illustrates a large
class of similar ailments, in which a correct diagnosis is of the
greatest consequence in reference to the treatment.

There we have such a tr^in of ordinary symptoms, embracing
long continued palpitations, and these uniformly increased by
mental excitement or physical exercise, that, without the aid of
auscultation and percussion, it would be impossible to deny the
existence of true organic disease of the heart. But if Hyper-
trophy existed, there ought to be increased fulness of the left
side ; the apex of the heart ought to be found on a line outside
of the nipple, or more than three inches and a half from the
centre of the sternum ; the hand, when placed over the heart,
ought to receive the impression of being distinctly lifted up by
the heart's pulsation; and there would be dulness on percus-
sion, and absence of the respiratory murmur over a larger space
than natural. Again, if the semilunar valves were diseased,
application of the ear over the junction of the cartilage of the
third rib with the sternium, should elicit the abnormal sounds
belonging to that disease ; or if the mitral valves are affected,
placing the ear over the apex of the heart should elicit a similar
result. There, however, we have none of these results ; and
hence, we may conclude with much certainty, that all the car-
diac disturbance is purely functional depending on derange-
ment of the digestive organs, and this again depending on
the free use of Tobacco, Tea, and Coffee, and too much confine-
ment within doors. What, then, are the indications of treat-
ment ? 8hall we give physic in such a case? Will physic

1848.] Poisoning by Arsenic cured by Magnesia. 557

cure bad habits? Not a bit of it. Let the patient, simply,
throw away his Tobacco, his Tea, and his Coffee; adopt a
plain and wholesome diet, and take regular exercise in the
open air, and he will soon be well ; in a word, remove the
causes of derangement, and the effects will cease. Dr. Parker
here alluded to the fact, that much less medicine is now given
by well educated physicians than formerly ; and to the erro-
neous supposition that this was owing to the influence of some
modern theories. Nothing, he said, could be further from the
truth ; on the contrary, it is owing entirely to the increase in
our knowledge of disease, and especially to our more precise
and certain means of diagnosis. For it may be laid down as a
genera] rule, that the more certain and accurate is our knowl-
edge of the nature, extent, and existing stage of disease, the
more perfectly shall we adapt our remedies to the precise objects
to be accomplished, and, consequently, the less will be required.
While so long as our ideas of the nature, extent, and location
of disease, are confused and uncertain, so long shall we be prone
to increase the quantity and variety of our remedies, with the
hope that some one of the number will hit the disease. And
lucky will he be, who, under such circumstances, does not hit
the patient instead of the disease.

Poisoning by Arsenic Succesfully Treated with Calcined
Magnesia. By Emory Bissel, M. D., of Norwalk, Conn.
(American Journal.)

Peter Gal pin, a labourer, aged 27, a powerful and robust
young man, of intemperate habits, attempted suicide on the
evening of the 4th of march last, by taking arsenic. As is often
the fact, he was prompted to the deed by those horrors and
remorse of conscience which so often succeed a debauch.
The quantity taken, as nearly as could be determined, was not
far from a scruple. When I was first apprised of the fact, two
hours had elapsed from the time it was taken. I hastened the
messenger who came for me as quickly back as possible, with
some thirty grains of sulphate of zinc in two doses with
directions to administer it as soon as he could reach home, on
horseback distance about one mile to give the second parcel
in ten minutes, if needful. I followed as expeditiously as I
could ; when 1 arrived he had vomited freely twice, but with-
out any relief. The family had given him copious draughts
of a weak infusion of tobacco, which produced no other effect
than to increase his sufferings, which at this time were extreme ;
so much so, that he begged me to kill him at once, if I could not
end his pain in any other way. His pulse was one hundred and

658 Poisoning by Arsenic cured by Magnesia. [September,

thirty per minute, small ^nd wiry. He complained of great con-
striction and dryness of the fauces, but chiefly of a most ago-
nizinG: pain and burning in the stomach; it seeming, as he ex-
pressed it, "as if it were filled with burning coals." As nearly
three hours had now elapsed, since the poison entered the
stomach, I considered that any further effort to evacuate it would
be futile, and that if life was saved at all, it must be by the
antidotal power of some medicinal agent. Having had nay
attention directed to the experiments of Prof. Peter, of Tran-
sylvania University, and the case of Lepage, published in the
January and April numbers of this Journal, in 1847, 1 determin-
ed to give the calcined magnesia a fair trial, and accordingly
put it up in drachm doses, to be given every hour mixed in
milk and water. During the hour which I remained with him,
his symptoms were rapidly becoming more unfavourable.
The pulse was one hundred and fifty per minute, the constric-
tion and dryness of the fauces extreme, the whole surface be-
dewed with perspiration, the pain and burning sensation in the
stomach seemed augmented to the highest possible degree,
whilst the right hand was entirely paralyzed; in short, every-
thing betokened a speedy dissolution. I left him at 10 o'clock,
in charge of the mistress of the family, whom 1 knew to be
an intelligent and faithful nurse. On visiting him the next
morning, instead of finding him dead, as I much feared, I was
most happily surprised to find him very quietly dozing in an
easy chair. I learned from the lady, who had been unremit-
ting in her care of him during the whole night, that in a very
few minutes (not more than five or ten), after taking the first
dose of magnesia, he said he felt much relieved, and belbre the
time came for the second dose, he had fallen into a doze. She
stated that each successive dose had produced the most surpri-
sing and marked mitigation of every symptom, and that long
before morning he was entirely freed from suffering, and had,
on the whole, passed a quiet and comfortable night. The
bowels had moved freely and easily twice during the time.
He complained of nothing save a general weakness, and a sort
offaintness at the pit of the stomach. The right hand had
recovered its power, and the pulse had fallen to eighty-five per
minute. Directed to continue the magnesia, through, the day,
once in four hours, and to give light nourishment. On the
sixth I made my third and last visit, as the young man seemed
to require nothing but nursing, and a little time, for the reco-
very of his strength. I have since learned, that in a very few
days he resumed his labour upon the farm, and felt no incon-
venience from what he had taken, except a muscular weakness
of the lower extremities, which was not very great. The case.

1848.] On Etherization. 559

in some of its aspects, much resembles that of Lepage, especially
in the prompt and efficacious effects of the remedy, and the
speedy recovery which followed. Should future cases yield
results as gratifying as these two, we may, indeed congratulate
the profession in the possession of a sovereign and prompt anti-
dote, always at hand and easily administered, to the dreadful
poison by which such numbers of our race have found a terrific
and agonizing death.

On Etherization. By Prof. Lindsly, of Washington, D. C.
(Medical Examiner.)

[This so well accords with our own views and experience, (not in
midwifery, but surgery,) that we with pleasure give place to it. Edt.]

Having observed, in several papers, notices of the Report
which I presented at the late meeting of the American Medical
Association in behalf of the Committee on Obstetrics, that are
erroneous in various respects, I beg leave through your valua-
ble journal to offer a few remarks on etherization, in which
some of these errors will be corrected.

It has always been very remote from my intention, to take
an ultra or partizan stand in favor of etherization in midwifery.
I believe, in the very great majority of cases, no interference
with the natural progress of labour is necessary or justifiable,
but I also believe that there are cases where it is proper for the
practitioner to resort to a remedy, which is confessedly efficient
in relieving pain, and which I have no doubt is, with due cau-
tion, entirely safe. And I regret to see physicians of high
standing in the community, not only condemn without trial,
but take the lead in denouncing, means, of which they are ex-
perinientally ignorant, thus reversing the sound advice of Hunter
to Jenner " Do not think, but try," for these gentlemen say
by their actions, " we will think (and condemn), but we will
not try."

Those who object to the trial of chloroform in midwifery as
unsafe, seem to forget that it is possible to make a trial of it
without producing ihefull anaesthetic effect. I contend, and I
know it by personal observation, that an effect very fiir short
of complete anaesthesia, will give very great relief, by allaying
pain, and especially by soothing that nervous excitability, which
is so distressing to many parturient women. The inhalation of
ten or twenty drops of chloroform will often accomplish this,
and I do not believe a patient can be found who could not inhale
this quantity with perfect safety, especially if the handkerchief
or sponge be occasionally removed (for a moment) from the

560 Case of Prolohged Gestation. [September,

mouth or nostrils, so that atmospheric air alone may be inspired.
There can be no doubt, that chloroform, like all other narcotics,
can be given in doses that are unquestionably safe, and that
these smaller doses may be of great benefit, without giving en-
tire relief, just as Dpium or any other anodyne may soothe pain,
without wholly removing it. Complete insensibility cannot be
produced by opium, without giving it in dangerous quantities,
and yet no one pretends for a moment that this is any reason,
why it should not be employed in quantities that are safe, for the
purpose of affording ^rt?'^za/ relief. If we should admit, there-
fore, for the sake of argument, that chloroform cannot be safely
given so as to produce complete anesthesia, there still remains
the same reason for prescribing it, as leads us to the use of other
narcotics, viz., that it can be given with perfect safety, so as to
relieve pain, without causing insensibility. Its safety (given in
this way) and efficiency being admitted, it unquestionably pos-
sesses three most important advantages over opium : it produ-
ces its effect almost instantaneously ; it does not retard, but
rather hastens the progress of the labour ; and it causes no
ulterior bad results.

The important practical doctrine which I wish to inculcate
is this : that sufficient evidence has now been adduced in favor
of etherization in midwifery practice it having been employed
in probably two thousand cases without a single fatal result to
render it the duty of the profession to give it farther trial, to ex-
periment with it, cautiously and judiciously, in order to see if
w^e cannot finally arrive at general laws and principles, which
will enable us to administer it without danger or apprehension.

Case of Prolonged Gestation^ in which the date of Conception
was accurately ascertained. By R. H. McIlvain, M. D., of
Charlotte, N. C. (Amer. Journ. of Med. Sciences.)

The following case of gestation, prolonged to probably 296,
certainly to 293 days, occurred under the personal observation
of the writer. The parties are of unexceptionable character,
and the statement of the husband that no intercourse was had
after the night of the 4th of July, may be implicitly reh'ed on.

Mrs. , whose character is above suspicion, was visited

on the evening of .July 1st, 1847, by her husband, whose busi-
ness had compelled him to reside for more than a year before in
a distant state. The husband remained till the morning of the
6th of July, and then departed, and did not return for more than
nine months. On the nights of the 1st, 2d, 3d, and 4th of July,
there was sexual intercourse between the parties, but none on
the night of the 5th, or after. Shortly after Mrs. con-

1848.] Bihliogi-aphical 561

sidered herself pregnant, and on the 23d of April, 1848, was
delivered after an easy labour of a fine healthy female child,
weighing nine pounds.

Supposing impregnation to have occurred on the night of the
first, as a consequence of the first coition, -the duration of the
pregnancy must have been 296 days, but if we suppose the last
copulation to be the one from which the pregnancy resulted,
the period of gestation was 293 days.

This case is interesting, inasmuch as it furnishes conclusive
evidence, that gestation may be prolonged to thirteen, if not
sixteen, days beyond the usual period.

The large size of the child being a full pound and a half above
the average weight of female children, is a circumstailce in fa-
vor of its having been carried beyond the usual period.

The mother has borne three children previously, none of
which weighed ovet eight pounds.

BIBLIOGRAPHICAL.

1. Principles arid Practice of Surgery. By the late Geo. M'Clel-
LAN, M. D. Edited by his son John H. B. M'Clellan, M. D.
Pp. 432, 8vo. Philadelphia : Gregg, Elliot & Co. 1848.

We have had this volume for some two or three months upon our
table, and have taken notes for a somewhat lengthy review of it; but
really our time is so occupied, and the Journal so filled with other
matter, that we are compelled to substitute our opinion for the pf-oof of
the high estimate we place upon the work.

The character and standing of the late Dr. M'Clellan as a Surgeon
arid Professor of Surgery, in Philadelphia, must be familiar to our
readers. His early conneclion with the Jefferson Medical College,
and subsequently with the Pennsylvania Medical College; his many
bold and successful operations ; his extensive practice in surgery; his
study and preparation for the very work before us ; and his very sud-
den and deeply deplored death in the midst of his labors imd Useful-
ness, are likewise known to all. His son has undertaken to edit his
father's manuscript notes, and a volume of 432 pages is the result aft
present, with the promise of further details in a future publication.

From a careful perusal of these principles and practice of SUrgery
by Dr M'Clellan, we give them ouf unqualified commendation. A
better work, one containing more worth to its size and pretensions, has
not been published. Incomplete though it be, still the reader will find
the subjects it treats of containing the latest intelligence, and presented
in an able and judicious manner.

35

563 Bibliographical. [September,

2. Principles of Medicine : comprising Pathology and Therapeutics^
and a brief general view of Etiology, Nosology, Semeiology, Diagno-
sis, Prognosis, and Hygienics. By Charles J. B. Williams, M. D.,
F. R. S., Professor of Principles and Practice of Medicine, and of
Clinical Medicine, &ic.. University College, London, &c., &:c., &c.
Edited, with additions, by Merkditii Clymer, M. D., late Prof, of
the Principles and Practice of Medicine, &c., in the Franklin Medi-
cal College, &c., &Ci Third American from the second and en-
larged London edition. 8vo., pp. 440. Philadelphia : Lea and
Blanchard. 1848.

We have here again the pleasure to notice a most valuable work
sent us by the great American Medical Publishers. The title of the
volume, the editions through which it is passing both in Europe and
America, and above all the name of Prof Williams, its author, are
all we need give in its recommendation.

3. On Bandaging, and other Opera ions of Minor Surgery. By F.
W. Sargent, M. D. 12mo., pp. 379. Philadelphia : Lea and

Blanchard. 1848.

The object of this little work, says the author, has been, to present
to the younger surgeon and to the student, information relative to the
art of bandaging, and to some other points of importance in the prac-
tice of Surgery. Judging from a hasty glance over these pages, the
volume we hope will fulfil the design of the writer, aided as it is by
these same plates, called now into requisition for the thousandth time.

4. The Young Stethoscopist; or, the Student^ s aid to Auscultation. By
Henry J. Bowditcii, M. D., one of the Physicians of Massachu-
setts General Hospital. Second Edition, 12mo., pp. 303. New
York: Samuel S. and Wm. Wood. 1848.

This is pronounced to be, by all the notices we have seen respecting
it, a most excellent work on the subject of which it treats. It is dedi-
cated to Students of Medicine, but probably it might benefit those too,
whom age would seem entitles them to practice only.

5. A Dispensatory and Therapeutical Remembrancer ; comprising the
entire lists of Materia Medica, Preparations and Compounds, ^c,
Sf'C , as authorized by the London, Edinburgh and Dublin Royal Col-
leges of Physicians, S^c, S^-c. By John Maynf:, M. D., L. R. C. S.,
Edinburgh. Revised, with the addition of the Formula) of the Uni-
ted States Pharmacopoeia, &C. By R. Eglesfeld Griifitii, M. D.,
<Si:c. 12mo., pp. 329. Philadelphia: Lea and Blanchard. 1848.

Here is an excellent compendium of all known in the various Dis-
pensatories, and the very thing needed by the general practitioner o.

1848.] Monthli/ Periscope. 5i3

Medicine. If accurate, and we have no reason to believe it otherwise,
it njus? proVe a very serviceable and useful little book to the professbn.

6( The Obstetrical Reniemhrancer ; of, Denman^s ApJwrisms on Na-
tural and Difficult Parturition, SfC, SfC. Augmented by Michael
Ryan, M. D., first American, from the ninth London edition ; with
additions by Thomas F. Cock, M. D.,- visiting Physician of the
New York Lying-in Asylum. 18mo., pp. 258* New York : Sam'l
S. and Wm. Wood. 1848.

7.- Memoranda on Anatomy, Surge fy and Physiotogy ^forming a
pocket companion for the young Surgeon, or for Students preparing
for examinations . By Mark iVoble Bowkr, Surgeon. Corrected
and enlarged by an Amarican Physician. 18mo., pp. 325. New
York : Samuel S. and Wm. Wood. 1848.

8. Ophthalmic Memoranda respecting those Diseases of the Eye which
are more frequently met with in Practice. By John Foote, Fellow
of the Royal College of Surgeons in London, &c., &;c. 18mo.,
pfp. 131. New York : Samuel S. and Wm. Wood. 1848.

The well known Publishers have done us the kindness to send a
copy of the above little works, which we have thought proper to class
together, as they are similar in character and have a common object.
Memoranda like these will no doubt aid the student, and often present
valuable hints to the practitioner. It is the first of these little volumes,
which a Western paper noticing, called the " Obsolete Remembrance,^'
exhibiting ihws prima facim evidence of its ignorance o( professional
technicalities.

PART TIL MONTHLY PERISCOPE.

On the Independent Contractility of Muscular Fibre. By Dr. E.
Harless A new set of experiments performed on this subject, upon
animals rendered completely insensible by ethereal inhalation, con-
firms' the opinion that the irritability of muscle is a property inherent
in the tissue itself, and not in any way derived from the nervous sys-
tem. Dr. Harless found that even when the nervous system had been
rendered, by the action of ether, utterly incapable of conveying a
galvanic stimulus, applied ether to the nervous centres or the nerve-
trunks, the same stimulus applied directly to the muscles, would im-
mediately throw them into powerful contraction. Muller''s Archiii.
1847. No. 2.

These results are in harmony with those obtained by Dr. Madden
some years since, and communicated to the British association at its
meeting in Edinburgh, on the agency of narcotics in destroying the

564 Monthly Periscope. [September,

power of nervous conduction, without diminishing muscular contractil-
ity in an equal degree. We hope that they will tend to convince
Professor Miiller and other German physiologists, of the untenability
of the doctrines they have upheld as to the dependence of muscular
contractility upon nervous agency. [Medico-Cliirurg. Review.

On the Causes operating in determining the proportions af the Sexes
at Birth. Dr. Emerson has shown from statistical data that whatever
influences tend to maintain a high state of physical health and energy,
leads to an increase in the proportion of male births, while all agen-
cies, moral or physical, which reduce the powers of organic life, di-
minish such preponderance* This is fully illustrated by the influence
of the Asiatic cholera, which in Philadelphia and Paris, reduced the
ordinary male excess from 6 or 7 per cent, to 1 per cent. The com-
mercial embarrassments of 1836 in Philadelphia, caused a very per-
ceptible disninution in the preponderance of male births for the years
1837-8. [^Medical News and Lihaary.

Influence of the Imagination. In the Boston Medical Journal is the
following good story: "In the early part of my practice," says the
author, " I was called into a neighboring town to visit a patient. It
being about the middle of the day, the old gentleman of the house in-
vited me to stop and dine. While at dinner, he says : *I don't know
as you like my dinner ?' * Why, yes,' said I, 'I do; I like it very
well. It is very good.' 'I guess,' said he^ 'you don't know what
you are eating?' ' Why, yes,' said I, *I do. It is same new corned
beef.' *Ah! said the old gentleman, ' it is horse beef.' I replied, *I
don't believe it.' 'It is,' said he, 'I declare it is some of my old mare.'
I was not much acquainted with him at that time. I looked at him
supposing him to be joking, but could not see a muscle of the face to
alter or change. I had just taken another piece on my plate, and a
mouthful of the second slice in my mouth, and in fact it was horse
meat, sure enough ; I could taste it as plainly as my olfactory nerves
would discover the scent of an old horse. The more I chewed it, the
more disagreeable it tasted. I continued picking and tasting a little
sauce, which I could swallow ; but the meat, as the negro said, was
no go. I at last gave a swallow, as I do with a dose of physic. I
thought that I should have thrown the whole contents of my stomach
up at table. I afterwards tasted a little sauce, but took care not to
put any more meat in my mouth, and kept time with the family. Clad
was I when dinner was over. It being cold weather, the old gentle-
man went to smoking and telling stories. \t last he says, *I won't
leave you in the dark about your dinner. I told you we had horse
meat for dinner, and so it was. I told you it was some of my old
mare, and so it was, for I swept her away for a steer, and that was
some of the beef.' I have ever since been glad that the genteman
put the joke upon me, for I never should otherwise have known how
far imagination would have carried me." As a pendant, take the fol-
lowing from a contemporary not recollected : A gentlemen travelling

1848.] Monthly Periscope. 565

in Europe discovered a man sitting in a state of most woful despair,
and apparently in the last agonies, by the side of one of the mountain
lakes of Switzerland. With great anxiety he inquired the cause of his
suffering. '^ O !" said the man, " I was very hot and thirsty, and took
a large draught of the clear water of the lake, and then sat down on
this stone and consulted my guide-book (this guide-book was written
in French, of which language he was ignorant). To my astonish-
ment," he said, " I found there, that the water of this lake is very
poisonous ! O! I am a gone man I feel it running all over me. I

have only a few minutes to live ! Remember me to ." " Let me

see the guide-book," said the gentleman. Turning to the passage he
found : " L^eau du lac est bieii j)oissonneuse,^^^\.\xe water of the lake
abounds in fish. " Is that the meaning of it?" "Certainly." ''I
never was better," said the dying man, and immediately leaping up,
his imaginary pain left him. "What would have become of you,"
said the gentlemen, " if I had not met you 1" "I should have died of
an imperfect knowledge of the French language." [^Annalist,

Tears in Children. M. Trousseau states as a general rule, that
when the infant sheds tears it is not dangerously ill ; and, on the con^
trary, the absence of weeping indicates a severe disease. He regards
this to be so true las to deserve to be considered as an aphorism. He
does not deny, however, that there may be exceptions. \^Gaz,des,
Hop., and Revue Med. Chir.

Blood in Scurvy. Having devoted considerable space to this dis.
ease in our last Report, it is not our intention to do otherwise than
allude briefly to communications upon the same subject, which have
subsequently appeared.

In an important communication by Dr. Garrod,* the author endeav-
ors to show, and with much appearance of truth, that the proximate
cause of scurvy is a deficiency in the salts of potash contained in the
blood. He has further determined, that, in all the dietaries of scorbu.
tic patients, potash has been deficient ; and, conversely, that in those
aliments which are fftund to be beneficial in the disease, that salt exists
in large quantities. As a practical fact, elicited by his researches, he
states that scorbutic patients may be restored by the simple addition of
potash to their diet, without other aheration. This communication is
made in a philosophical spirit, and merits the attention of the political
economist no less than of the physician.

A report on scurvy, as it appeared on board an American vessel of
war, has been furnis|?ed by Dr. FoltZjf a surgeon in the United States
navy. It contains neither facts nor deductions which offer any features
of novelty, but both of which serve to confirm the opinion expressed
in our former Report, of the important part played in the causation of
the disease, by the deprivation of fresh vegetables combined with ex-

Monthly Journal of the Medical Sciences, Jan., I84S.
tAtnerican Journal of the Medical Sciences, Jan,, I&IS.

566 Monthly PeHscope. [September,

tra labour and deficient ventilation. The author particularly insists
upon the value of the potato as an antiscorbutic, thus agreeing with
several writers mentbned in our last volume. [Rajikhig's Abstract.

New Diagnostic Sig7i in Enqjhysema of the Lvngs Mr. Corfe has
the following remarks as part of his papers on scmeiotics :

But an observation ought here to be made of a fact which will help
to a decision on the nature of the disease before the ear is placed on
the chest of such a patient. It is this : that if there is emphysema to
any extent, and it has reached the upper lobes for emphysema usu-
ally begins in the lower lobes, and spreads upwards each act of
coughing produces "hernia of the lung," so to speak, in that trian-
gular space which is formed by the clavicles, sterno-cleido, and
omohyoidei muscles. At this point, and at this point only of the thorax,
we know that the pleura is wholly unprotected by muscle ; and, as the
lungs are jerked up by each distressing effort of hard coughing, the
emphysematous lung and pleura are forced up into this triangular
space, and may be seen as one distinct tumour.

This appearance alone has often enabled me to form my diagnosis
of a pair of emphysematous lungs before I had even applied my ear to
the chest. [Medical Times.

On the Treatment of Chronic Gastralgia. By M.Valleix. [Chron-
ic gastralgia, says M. Valleix, most frequently arises after acute
jdiseases, from our keeping the patient too long upon low diet.]

In the treatment of chronic gastralgia, M. Valleix has derived the
greatest benefit from the employment o^ small doses of acetate of mor-
phia. The medicine is not a new one in this disease ; but M. Valleix.
has advantageously modified the usual mode of its administration.
Thus, instead of giving it before, he prescribes it immediately after a
meal; and in this way he has relieved cases which had resisted all
other treatment. A very well marked one of this description is de-
tailed. M. Valleix orders one grain of the acetate in thirty drachms
of distilled water, and nine drachms of syrup, and directs a tea-spoonful
to be taken immediately after each meal. Under the use of these
small doses, the bowels, so far from becoming constipated, are better
regulated. [Revue Medico-Chirurgicale, from the Bulletin de Thera-
peutique. Brit, and Foreign Med. Chirurg. Rev.

Use of Vinegar in Rheumatism. By J. C. Atkinson, Esq., West-
minster. [Mr. Atkinson says that common vinegar has been success-
fully used by him in various forms of arthritic^ rheumatic, and even
neuralgic maladies. Fie remarks.]

I was first led to employ this auxiliary comestible, if I may so term
it, in cases where the alkaline treatment with colchicum had totally
failed. Persons whose digestive organs were deficient in the assimi-
lating process, arising from imperfect secretions, and producing foul-
ness of breath and foetid eructations, were much benefited by the
administration of vinegar. Constant pains in the epigastric region

1848.] Monthly Periscope. 5G7

t

after eating or drinking, no matter what, although ordinarily digestible,
are likewise symptoms which indicate its adoption. One characteristic
of its successful use is when all cloudiness of urine disappears. I may
furthel' observe, that it is rarely in the young that this remedy is re-
quired ; those of middle age, whose constitutions have been injured by
dissipation, will find great advantages from the use of the vinegar
remedy after the colchico-alkali treatment has been proved of no utility.
The distilled vinegar, or dilute pyro-ligneous or pyro-acetic acid, may
be administered in the following manner : Acetic acid, one drachm ;
tincture of jalap, twenty minims ; tincture of orange-peel, one drachm ;
camphor mixture, sufficient for a draught, to be taken twice or thrice
a day. The quantity of vinegar may be diminished or increased ac-
cording to the feelings of the patient and the effect produced.

[Braithwaite's Retrospect.

Hornet's Nest, an Antispasmodic. Dr. T. T. Lockwood, of this
city, at a late meeting of the Buffalo Medical Association, stated, that,
when practising in the country, he had frequently prescribed horneVs
nest, as an antispasmodic, and that particularly in whooping cough, he
had found it to exert more influence in controlling the paroxysms and
shortening the duration of the affection, than any other remedy he had
ever tried. We suggest the employment of this article, especially to
our brethren in the country, where the article can be readily procured,
in order that its therapeutical value may be more fully tested. Will
some of our classical friends invent a classical name by which to
distinguish it. in season for its formal induction into the Materia
Medica 1 [Buffalo Medical Journal.

New method of Dilating Strictures of the TJrethra. By M. Amus-
SAT. The treatment of strictures of the urethra, simple and easy
enough in ordinary cases, sometimes present very great difficulties,
often insuimountable, if we have not at our disposition different modes,
which unhappily are not found in general treaties on Surgery.

When the obstacles which render micturation either impossible or
very difficult have been surmounted, by using a very small elastic
bougie, about a half millimetre in diameter: it is left in the canal; it
serves as a conductor to the urine which runs off with more ease ; the
next day, or the day after, instead of withdrawing it to substitute a
larger one, another bougie of the same size is introduced along the
side of the first, and others are successively introduced, which are al-
lowed to remain, and which forms a fasciculus composed of five or six
bougies through which the patient can urinate. And as the bougies
are not in immediate contact, they overcome the obstacles much better
than a single one whose volume would be equal to all the small bougies
united; they are also more easily borne by the patient, because they
are very flexible, and also because the urine can pass with more liberty
through the intervals between them. After using this means, the or-
dinary mode of dilatation is adopted, with elastic or metalic bougies,
whose size is gradually increased ; and in case the obstacles resist the

568 Monthly Periscope. Med. Intelligence. [September,

dilatation, I use either mechanical dilatation with a particular instru-
ment which I will describe hereafter, or scarification or cauteriza-
tion. [Translated by Dr. Rossignol, trom Joum. dcs Con. Med. Chir.

VAdansonia Digilala, a siibsUtule for Quinine. M. Duchassaing
announces to the Academy, that owing to the exorbitant price of sulphate
of quinine, he has been led to the discovery of another remedy against
intermittent fevers, called miasmatic. He employed the bark of the
Adansonia digitala. He is satisfied of the efficacy of this remedy from
numerous experiments. It is not costly ; is of an agreeable savor ; does
not act upon the nervous system ; and is propitious to the functions of di-
gestion, on account of its mucillaginous principle. He has succeeded in
several cases, where the sulphate of quinine had no effect. One ounce
of this bark put into a litre of water and boiled down to a third, sufilces,
most frequently, to cure these murderous fevers. [Translated by Dr.
Rossignol, from Journal des Con. Med. Chirurg.

Bitter Ferruginous PilU. By Lucien Piest.

Aloes, ...... 3i.

Quinine, ..... gr. xv.

S^ulphate of Iron, ... gr. x.
Extract of Mint, ... q. s.
Make six pills. Give one every three hours.

MISDICAL INTELLIGENCE.

^^ Amcricc^n Medical Asssociatipn meeting of Professors of ike Medical Colleges.
We feel the great and important question of medical reformation, so far as public instruc-
tion is concern^id, is about to be decided by the Profession at large. In a few months the
classes of our different Medical Colleges vill have assembled, and their statistics will ex-
l^ibit the fact, whether a change in It-ngthcning the courge of Lectures was degired or not.
It is now known that several of t)ie Faculties of these Institutions have added one month to
the regular course of instruction, others have not. The annual announcements, &c., of the
Medical Colleges, are before the whole medical public of this country, and it repains for
each preceptor of students to do l)is duty in tljis matter. We ^vould make no distinction,
but leave tjie subject where it properly belongs, to the jirivaiq ranks of the profesgjon. In
t))e mean time, we copy the procepdings in reference to it of the Professors assembled at Bal:
timore, which of course will not be puMisljed in the volume, now nearly ready, of the doings
pf the last afinual meeting of the American Medical Assqciation. It is taken from the West-
ern Journal of Medicine a)id Suigery, apd is prepared by Prof. Yandell, of Louisville.

We continue our a.ccount of what occurred at the late r^ieeting of the Arnefir
can Medical Association.

prof. Paul F. Eve, olGeorfjia, on the first day of the meeting, proposed that
pie professors' in the various Mpdicai Schools present, should meet'that evening,
for the purpose pf interchanging: views respecting medical education in the
United Slates. A meeting was according:] y held at (he Iccture-roum of Dr.
Dunbar, at which the following schools were rcprescntpd : the Boston Medical
College. Medical Institution of Yale College, College of Physicians apd Spr-
peons of New York, University of Pennsylvania, Jefierson 'lyiedipal College,
Franklin Medical College, Pennsylvania Medical Coljege, Pjijladclphia Col-
lege of Medicine, Huffalo MedicafColle^e, University pf Maryland, Washing-
ton University of Baltimore, Columbian College, Washington, D.C, University
of Virginia, Medical College of Georgia, Medical College of Ohio, Starljpg

1848.] Medical Intelligence. 569

Medical College, Indiana Medical College, and the University of Louisville.
Professor Warren, ot Boston, was requested to take the chair, when an inlonnal
discussion ensued upon a resolution offered by Prolessor Eve to the effect, that
the lecture-term of the inedicab schools ought to be extended to five months.

Professor Harrisun,of Cincinnati, was not prepared to vole lur this resolution.
The question whether it was expedient to lengthen the term had not been decided
by the Faculty of the Medical College of Ohio, and he was, therefore, without
instructions from his colleagues.

Professor Ware, of Boston, did not deem the extension expedient, and in'this
view he was sustained by his colleague, Professor Holmes, who addressed the
meeting in a few pointed remarks, strongly expressive ol his disapprobation oi
the measure. He did not believe that any "thing would be gained lo students by
requiring them to attend more protracted courses of lectures. The change re-
quired is in the mode of instruction, which is radically imperfect, if not demon-
strative.

Professor Jackson, of Philadelphia, was in favor of the resolution. If the
operation of the measure should be to diminish the number of students and physi-
cians in the United Stales, he thought it would be well. The proportion of
physicians to the population, in this country, is 1 to 3(.)0 or 400, whereas in Eu-
jrope it is 1 to 1,500, or 1 to 3,000 or 4,000. What the public is interested in, is
not an increase in the number, but an improvement in the quality of our prac-^
titioners. The community wants highly educated men medical philosophers
men capable of solving the higher problems of medical science. It is very pos-
sible to be good practitioners, and yet not be highly educated. Most diseases
are managed successfully without much medicine, and if the physician be a man
of tact he may succeed well v;ith moderate attainments. The schools of this
country turn out as good practitioners as any in the world, but still they are not
physicians of the highest grade. Our graduates must still go abroad to fit them-
selves for the higher questioris of medicine. In our short courses we are una-
ble to do it, nor shall we be able to do it when the courses are extended to five
months. It is well fof our profession that the dogmatic style of teaching is pass-
ing away, and the demonsti aiive iaking its place. But a difficulty lies in llie way
of a thorough change there must be hospitals for demonstrative teaching, and
unfortunately there are but few of these in this country in which clinical in-
struction can be made available to tl|e student. In Philadelphia, he said, they
experienced this evil to a great extent. The people have inadequate conceptions
pf physic, and do not properly secor^d the efforts of physicians to advance the
profession. They conceive that the only business of the physician is to find out
remedies for diseases, and hence they give no countenance to human dissections,
and do nothing to promote the study of clinical medicine. The pt-ople our
municipal authorities must first f^nd us hospitals, and then we can make our
teachings demonstrative.

Professor Hamilton, of Buffalo, advocated the resolution. The school in
which he was a teacher had already made the extension proposed.

Professor Bond, of Washington University, at Bajiimore, thought that those
who had spoken had failed to make a correct diagnosis, and consequently to
suggest the true remedy for the evils under which the profession i.s suffering.
The prof Session, he said, is becoming more and more debased^s coming down
to its pristine condition "barber surgery."' As confirnnatory pf his opinion, he
related the following incident: A graduate of one of the Atlantic schools, a
practitioner in Baltimore, insisted jn a consultation, that his patient, a female,
was affected with an enlargement of the prostate gland. " I think you must be
mistaken," remarked the consulting physician. "No sir, I cannot be," replied
the young Hippocrates. " But, sir," was the copclusive answer of his senior,
' a woman has no prostate gland."

Dr. Bond went on to say, that students too generally entered fhe schools wilhr
out the necessary qualifications for study, and were confused during the whole
time of their attendance. They could not profit by the lectures, for the reason
that their preliminary educatjon was s,o imperfect. The conse(|uence is, that
the profession is sinking everywhere. Physicians are not looked upon as educa-
ted men. The evil lies in the fact that there are too many students, and too
many medical schools. The multiplication of medical schools is at the bottom
pf the Kqiisc^ief, and here the reforni must begin.

570 Medical Intelligence. [September,

Professor Harrison rose again and remarked, that to his mind there was clear
evidence that our profession is advancing. He could not speak so confidently
concerning the East, but, in the West, he was sure it was making progress, and
his belief was that it was going forward in all partsof our country. Hedidnot
share with Dr. Bond in his despondenc}', but indulged high hopes for the future.

Professor Huston, of Philadelphia, stated that he was not prepared to recom-
mend an extension of the term. The Faculty of the Jefferson Medical College
had not deciiied in favor of the change.

We stated, on behalf of the University of Louisville, that that Institution had
already declared in favor of the principle of the resohuion by adding two weeks
to the session, and that in 1849 the term would be extended to five months.

The vote was decidedly in favor of the resolution of Dr. Eve, and when the
question came before the Association, two days alter, the result, as we staled in
our last number, was the same ; so that there is reason to believe the sessions in
all schools will so(3n be extended. The extension will impose additional labor
upon teachers, and additional expense upon students, but the sacrifice will be
cheerfully incurred if it can be made to appear that good therefrom will result
to the profession. Our conviction is clear that the step is in the right direction
and we do not doubt that the wisdom of it will soon be apparent to all.

When this subject was brought up in the Association by the report of the
Committee on Medical Education, Professor Bond availed himself of the occa-
sion to repeat the derogatory remarks concerning the profession which he had
made at the meeting a few evenings before. His speech, which was heard by
the members with evident signs of impatience, broughc out Prof. Jackson in a
very liappy reply. Prof. J. spoke warmly of the improvement which medicine
had undergone since he was himself a student. In a word, he administered a
rebuke to those who had spoken of it as retrograding, which nearly every on?
lelt to be just, and his remarks elicited hearty applause.

It was proposed by the committee just referred to, that students should be ex-
amined at the close of their first course of lectures, and, if found to have made
proficiency, receive a certificate to that effect from the professors, but after a good
deal of debate, the proposition was rejected. It was conceded to be most desira-
ble that some mode should be adopted for securing the attention of students in
the first year of their pupilage, but an examination of such a number as attend
many of the schools was admitted to be impracticable under the present system.
If the practice were universal for students to aUend three courses of lectures,
then they might bedivided into classes, and examined successively, at the close
of each course, on the different branches of medicine. In this way their faithful
application would be encouraged, and they would know from year to year what
progress they were making. It may be that such a system will be adopted in
time, but at present we presume none of our schools are prepared to insist
upon three courses as a pre-requisite to graduation.

In lieu of the Theses now demanded of students of medicine, or as a part of
them, it was proposed by the Committee on Medical Education, that students
should be required to report a number of cases of disease which had passed un-
der their own observation. The resolution advisatory of this change wasadopted.

Another resolution ofleied by this committee was to theefiect, that the Associ-
ation would support those schools which respected its recommendations. This
was rejected upon the ground that there was something in it resembling a threat.
It was deemed best to leave the schools entirely free to adopt or reject the sug-
gestions.

A resolution was adopted to appoint delegates to the British Association,
Several distinguished Americans understood to be in Europe, among whom
t^'^ere Professor Wood and Professor Horner, of Philadelphia, were appointed.

Some interesting statements were made by Professor Jackson and other mem-
bers, in regard to a pastrnbjia resulting in the laboring people of cities, from the
excessive use of cofiee and want of nutricious food. Prof. Jackson remarked
that within a year or two he had met with more than twenty cases which had
their origin in this cause. It was not uncommon for laboring men in Philadel-
phia to make their breakfast, dinner and supper, Ujion bread and coffee, without
any animal food, and it was uniformly in such subjects that he had met with
gastralgia. Milliners carry the abuse of cofiee to a still greater length, drink-

1848.]

Medical Intelligence. 571

ing it not only at breakfast, dinner and supper, but resorlin? to its stimnlating-
effectis between meals. The subject will be brought up at the next meeting by
the Committee on Hygiene.

We have already alluded to the singular discordance of opinion, among the
members of the Association, with regard to the value and salety ofanae.-thetic
agents in the practice of surgery and obstetrics. Dr. Lindslt-y recommentieci
them warmly in his report on" Midwilery, Dr. Hodge, on "ibe oiher htnd,
while he would leave to surgeons the question of their propriety in thai hranch
of tlis art, dues not consider that they are admissible in obstetrics. S^jnie p&in
in labor, he supposes, is natural and healthful, and if excessive, it is lor the ac-
coucheur to ascertain and remove the cause. To give chloroform or ether in
such cases, with a view to rendering the woman insensible, is no Deuer practice
than administering opium to a patient suffering under colic from irritating
matter in his bowels. Congestion of the brain is a consequence of etherization,
and it is well known th^at in many parturient females a dangerous tendency ex-
ists to this condition of the cerebral circulation. For these reasons, Dr. Hodge
agrees with his analogue. Dr. Meigs, of the Jefferson Meiical College, in de-
clining to employ aneesthetics in obstetrical practice.

Dr. Parrishand Dr. Xorris, members of the Committee on Surgery, were not
agreed as to the value of these agents. The estimate placed upon them by the
.former gentleman is much higher than that of the latter. In this connexion \\
is proper lo remark-, that no surgeon in our country, perhai's, has looked moie
industriously into the history of etiierization, orexamined its statistics with
greater care, than Dr. Parrish, and the mass of testimony , adduced by him in if*
favor is such, v/e judge, vhat scepticism will hardlybeable'togainsay or resist.

Dr. Warren remari^ed, that having heard of the cases of death from chloro-
form, three of which were authenticated, he was at one time inclined to return
to the use of sulphuric ether, but beinre doing so, since this agent was not wholly
unobjectionable, he determined to experiment with some other substances. One
of those of which he made trial was chloric ether, which he had found, in his
experience with it thus far, eminently .satisfactory. Up to the first of May he
had administered it in from thirty to fifty cases, and in all with the desired ef-
fect. He did not pretend to say that this was a sufficient experience with the
agent, but as far as it went it was encouraging. The chloric ether is not so
sudden or so concentrated in its action a^s chlorolorm, and therefore more under
the control of the operator, at the sametime that it does not require lobe given in
as large quantities as sulphuric ether and is otlierwif^e more eligible than this
agent. Two weeks before the meeting of the Association he had employed it in
the case of a woman, who submitted to an extirpation of a cancerous tumor
from the antrum. The patient felt nothing during the operation; the incision
was closed by means of the ethereal solution of gun-cotton, and only a line was
left upon her face. Previous to this operation, he had given it to a patient about
to submit to lithotripsy. The calculus, consisting ol oxalate of lime, and which
was as large as a robin's ^g^, was broken down and removed, without pain, at
a single sitting.

The city in which etherization has found most favor, in this country, is Bos-
ton, the one in which the practice originated ; that in wliich it has met with most
opposition is Philadelphia. In New York", the profession is much divided op
the question, as it is also in Baltimore. In both citie^i it has met with decided
opposition, but has also warm advocates. We spent some profitable and pleas-
ant hours with the medical gentlemen of Buffalo, on ourway home, and learned
from them that the practice had not become popular in that city. Dr. Eve, of
Augu.sia, Georgia, is an advocate for it; and Dr. Parrish enumerated in his re-
port many of the most eminent practitioners in the country who had declared in
its favor.

The sentiments of the members were not more accordant respecting the rela-
tive merits of the various anaesthetics employed, some prelerring chloroform,
some sulphuric ether, and at lea.st one inclining to a third agent. On the score
of safety, it would appear .that the ethers claim a superiority over chloroform,
no well authenticated case of death from their inhalation having yet been an-
nounced; at the sametime chloroform is .so proqipt, and, generally, so pleasant
in its effects, is required in so small a quantity, and is so agreeable to inhale.

673 Medical Intelligence, [September,

that it will be apt to maintain its ground with patients and ihe profession, anless
the disasters from its use should become more frequent than they have been..

Here we must close our notice of the ^sociation until we are in possession of
its printed proceedings. We look forward with pleasure to the appearance of
this volume, which we feel assured will be creditable to the profession of our
country. We shall then return lo the subject and supply the deficiencies of our
present report.

[To what indignity and insult is the profession of Medicine to he next subjected ? Truly
we live in an enlightened and anti-janatical age. tor.]

Trial of a Physician for Assault and Battery in delivering a patient. A trial of
a novel character has lately taken place in New Hampshire, in which a respect-
able physician was the delisndant. Trials of medical men for 77ial-practicc have
not been very uncommon, and have afforded opportunities for unprincipled in-
dividuals to attempt to obtain money from those who had used their time and
best skill for the relief of the arflicted. The case alluded to is a new mode of
harassing the profession ; and, it would seem, with not exactly the same object
in view as criminal punishment, instead of pecuniary damages, was the penal-
ty anticipated. The complaint was made by L. C. Delaware and his wife, of
South-Hampton, N. H., against Dr. J. B. Gale, of Salisbury Mills, Mass. .the
charge against the latter being for an assault and battery upon Mrs. D. in
March, 1847, upon the occasion of her confinement with her first child. It would
seem that this worthy couple, since the alleged assault more than a year ago,
have, through the means of certain books which have been freely circulated re-
specting the impropriety of employing male accoucheurs in midwifery cases, or
by some other means, become fully convinced of thp alleged gross indelicacy of
such a practice, and for the purpose of showing their abhorrence of it, and to
prevent as far as possible its repetition, the present complaint was made. How
far they were justified, by the circumstances of the case, in adopting such a
course, the evidence given on the trial will show. The following is the testi-
mony of Mrs. D. herself, while that of Mrs. Woodman, an intelligent woman
who was present, did not differ much from it.

" Dr J. B. Gale, on the morninac of the 5th of March, 1S17, called to see me, agreeably to
my request, which was conveyed to him by my husband. I was sick at that time, and ex-
pected to be delivered of a child. Dr. Gale came into my room about 5 o'clock and staid till
9, when I was delivered of a child, my first born My motner and Mrs Woodman were in
the room when the doctor came, and remained there until thechild was liorn. He had been
in the room about fifteen minutes, when he came to where I was lying upon the lu'd, and aU
ter remarking ' Sister, yon are doing well don't be scared ' he commenced making an
assault Ujion me by placing his han.l upon my person. 1 had labor pains occasionally, and
at intervals of a quarter and a half hour, he renewed his assaults, liy placing his hand upon
my person At these different tim<'S, I told the doctor to let me alone, and to go away, but
be did not. I also asked for my husband : but the doctor rei)lied, ' Umph I you do not need
j-our liusband.' The doctor did not ask my consent to make an examination. I think he
increased my pains at each examination he made. I lay upon my lelt side the doctor camo
uj) and made his examinations until my child was born, wliich was at & o'clock.

" On the cross examination, the evidence of Mrs. D did not vary materiallj from that of
the examination in chief and was as follows : While lying upon the bed, my person was
not exposed, to my knowh^dge ; the doctor remained at my side five or ten minutes at a timi- j
he assisted at the hirtli of the child. I did not think it was right V a' rbedoctnr should handle
tne and told my husl)an<l so. This affair happened sixteen months since, and the reason I
had not complained of the doctor before, was l)ecause I wantid time t think of it ! The 4oc
tor visited me twice afterwards, and promised to call again, but did not."

Several physicians were called for the defence, who testified that the conduct
of Dr. G., as stated by these witnesses, was not different from the usual practice
on such occasions. Alter the address of the counsel for the government. Justice
Currier, before whom the case was tried, briefly reviewed the evidence, and after
remarking that there appeared to be no cau.se for the complaint, that Dr. Gale,
in doing his duty, had committed no offence whatever, ordered him to be dis-
charged.

The friends of tl)is species of reform will see that this mode of conducting it is
not likelv to succeed, and we may then^fore hardly expect a repetition of the
Sitiempt. lBoston Medical and Surgical Journal.

1848.] Medical Intelligence. 573

Surgery at a Dhcount. The followingcase came before one of the city magis-
trates a few days since. The son of a man whose income is, say $25,000 a year,
received a wound about three-fourths of an inch long on the upper lip. The
wound extended obliquely upwards and backwards from the free border of the
lip, which was entirely divided for the space of a quarter of an inch. A young
physician brought the edges together by means of the twisted suture, and adhe-
sion took place immediately. The reparation is almost periect, scarcely a mark
being leit in the line of the wound. After the lapse of a proper time, a bill of
ten dollars wdifi sent to the boy's father; payment was refused, and suit was
brought to enforce payment. One of the editors of this Journal swore (and does
yet for that matter) that the service was well worth ten dollars; another physi-
cian swore ihat it was worth just three dollars; and a student of medicine (!)
swore that it was worth just three dollars. The doctors' testimony being as li^
to 1, the court decided that the cure of accidental harelip is worth just three dol-
lars! The plaintiff, not satisfied with the judgment, took an appeal. He says
he wants the value of such a piece of surgery fixed and settled indubitably;
wants it placed on record, so that in future there may be no litigation. We shall
give notice of the result. [ Western Journal of Medicine and Surgery.

United States Naval Medical ^^a/ The Naval Register of the United States,
for.the year 1848, presents a catalogue of 68 Surgeons, 40 Passed Assistant Sur-
geons, and 37 Assistant Surgeons^making the small complement of only 145
for the whole naval service of this great Republic. Without this official infor-
mation, we should have supposed that several hundreds were in commission, as
a matter of necessity, considering the number of government vessels, and their
Various positions, at home and abroad. With these statistical tables before us,
it really appears as though the number was too small to supply the various land
stations, as well as the floating marine.

The pay of Naval Surgeons is as follows: For the first five years after date
of commission, waiting orders, SI ,000 per annum; in navy yards and receiving
Vessels, SL250; at sea service, $1,333 33; Surgeon of the Fleet, $1,500. For
the second five years, when waiting orders, $1,200; in navy yards and receiving
vessels, $1,500; sea service, $1,600; Surgeon of a Fleet, $1,800. For the third
five years, waiting orders, $1,400; in navy yards, receiving vessels, &c., $1,750;
sea service, $1,866 66 ; Surgeon of the Fleet, $2,100. For the fourth five years,
waiting orders, $1,600; in navy yards, receiving vessels, &c., $2,000; sea ser-
vice, $2,133 33; Surgeon of a Fleet, $2,400. For twenty years and upwards,
after date of commission, waitin: orders, $1,800; in navy yards, receiving ves-
sels, &c., $2,250; sea service, $2,400; and if Surgeon of a Fleet, $2,700. The
pay of a Passed Assistant Surgeon, wailing orders, per annum, is $850; in
navy yards and receiving vessels, $1,150; and at sea, $1,200. That of Assist-
ant Surgeons, the lowest grade ol medical officers in the navy, is, when waiting
orders, $650; in navv yards and receiving vessels, $950; and at sea service, the
same. Dr. Jonathan Cowdery, the senior Surgeon, received his commission,
January 1st, 1800; and the next, in official age, is Dr. Wm. Tuck, commission-
ed May 15, 1800. Dr. Phineas J. Horwitz, of Maryland, appears, by this regis-
ter, to have been the last appointment, Nov. 8th, IMI. [Boston M. and S. Journ.

Medical College Circulars. This is emphatically the month of Medical Cir-
culars, announcing the approach of another season of Lectures, and setting forth
in terms more or less glowing, according fo the modesty or metal of the parties,
.the respective advantages of our numerous institutions. The plan of inordinate
puffing which originated with one of the rivals of the old University in the city
of brotherly love, has proved so successful that it has been liberally adopted not
only in the commercial emporium, but also in many other places. Whilst char-
latanism in practice is generally reprobated by the piofession, we see no reason
why it should be tolerated in " Annual Announcements."

We are gratified to seethe moral influence which the Medical Co^r/ention has

574 Medical Intelligence. [September,

exerted throughout the land. No circular that we have seen has remained silent
on the subject of reform, and although ail the Institutions have not come up to
the recommendations of the Convention, some have done so fully, and many
others partially. It is plainly to be seen that whilst the necessity of lengthening
the Course of Lectures is generally admitted, the selfish apprehension of dimin-
ished classes has been antagonistic to the dictates of conscience in too many
instances. Hence the novel device of "Preliminary," "Supplementary," "In-
troductory," and "Additional" courses, by which it is attempted to satisfy both
the Convention who advise dilons course, and the indolent \Vho wish a Diploma
with the least possHile outlay of time and money. Is it not supremely ridiculous
(to say the least of it) to announce an increase in the length of the course because
the Lime hcrehforc aUoxvcd was loo short, and then to add, that candidates for Grad-
uation will only be required to attend four fifths or five-sixths of said course"?
The n-hole course must be either necessary or not. If not so, it ought to be cur-
failed whereas, if it be at all necessary, we would like to know why it is less so
to the candidate than to others. He who is about to enter upon the practice of his
profession should certainly be required to attend a fvU course and not a partial
tme\ and if it be conceded that a full course of lectures cannot be delivered in
four months, wliy apply the terms Preliminary or Supplementary, instead of
announcing at oTice, and honestly, that the course has been extended to five or
id six months! The device is too shaTlow not to be detected at the first glance,
and cannot fail to be reprobated by all lovers of truth and candour.

As a Southerner w cannot pass without comment the second paragraph in
(he "annual anriouncement of the Jefferson Medical College," because it is evi-
dently a renewal of ihe attempt made in the same and other quarters to under-
value local advantages which we feel that we, in common with our Southern
and South-western brethren, uridoubtedly possess in the study and treatment of
malarious diseases. The passage is as follows:

" The idea that a Student of Mndicine must be taught his profesion in the very locality in
which he is destined to practice it, is now geni'rally, as itonj^ht to be universally, abandon-
ed. It must t)e almitli'd that the tr('at principles of the Science are the same every where,
und that the Student ou>;ht for his own sake, [for the sake of the JeHerson Medical Col-
lege i Edt.] to seek for information wherever it can be best and Most readily obtained."

We deny that the " idea " alluded to is " generally abandoned." Such may be
the case at the North, but it is certainly not so at the South. Whilst we readily
admit "that the great principles of the Science are the same every where," v^e
do not think that any Southern practitioner will "admit" that a physician Who
has never seen our marshy districts, our malignant intermittent, remittetit,
congestive and yellow fevers, rior our negro peculiarities, can be very well pre-
pared to practice in our latitude, and still less to teach others to do so. The
"great principles of the Science are the same every where," but their applica-
tions are as various as the races of man and the ditferences of climate. Would
any one "admit" that the symptoms and treatment of the Plague can be taught
as well in Philadelphia or in Georgia as in Cairol The " idea" would be pre-
posterous. Let Southern practitioners look into the numerous works upon the
Practice of Medicine published in Europe or at the North, and he will at once
perceive that they contain but little oJ value in the management of our fevers.

We will close these remarks with the candid confession of a gentleman who
stands deservedly -high in his own State as a man of erudition, and one eminent-
ly qualified as a teacher. " I confess one thing, which 1 can hardly be blamed

1848.]

Medical Intelligence. 575

for, that, as a Northern man, and living in a region wholly free from malaria, I
should not, and probably did not appreciate fully, such of the medical literature
of the region where malarious fevers forms one of its chief staples." Such is the
language of Prof Oliver Wendell Holmes, of the Harvard University.

Advantage of Rail-Roads and the Telegraph to the Profession. We recently
made the journey ot 542 miles, performed an operation, (remaining 12 hours
-with the patient,) lost comparatively no sleep, and were absent from home only
51 hours two days and three hours. The arrangements were made by the
telegraph, and the travelling done by rail-way. '

MISCELLA^^EOUS MEDICAL ITEMS.

We learn from the Gazette Medicale de Paris the following peculiarities in reference to the
wounded during the insurrection of June in that capital: the insurgents had recourse to
very various materials to charge their guns. Balls were cast with projecting copper points,
some actually contained arsenic; type metal, typo themselves, shot of various sizes, &.c.,
were emjiloyed. Another circumstance was the direction in which wounds were received.
The immense majority were made from windows, &c.,and of course the wounds were oblique.
Sometimes this proved favorable to the patient, by the ball glancing, but when they entered,
from the very circumstance of their obliquity, they were more difficult to extract and their
tracks were longer and more tortuous.

At LaCharite there were 120 wounded ; at Val-de-Grace 190 ; Hotel Dieu 400, besides a
great number who died immediately after arriving there ; 90 at the Maison de Sante of Du-
bois ; 78 at the College Clinic ; 63 at St. Lazare ; and 500 at St. Louis. Double this number
for private houses.

A large dose of Lunar CaiisHc. A young man laboring under gonorrhoea, swallowed by
mistake his preparation for injection, consisting of Distilled water 30 grammes, Lunar tJaus-
tic in crystals 1 gramme. A prompt emetic and a strong solution of common table salt re-
lieved him.

Horse Flesh During the month of January, 1849, 147 horses were killed at Berlin, fur-
nishing thus 60,943 pounds of meat for public consumption. In one year, 244,625 pounds, the
weight of 522 horses, were consumed in that city.

The Asiatic Cholera. It will be perceived by our last European intelligence, that this fear-
ful scourge has re-commenced, with fatal avnges, in Miiscow and St Petersburgh.

In the National' Assembly of Prussia are 10 Physicians ; in that of Piedmont, there are 7,

We find in the Buffalo Medical Journal the following report of a certain case, agreeable to
a municipal regulation of the city of New York, requiring all physicians to give in writing
a statement, for registration, of the cause of death of patient :

" This woman was died because she did die, and she was die of vickness, and she could
not live. (Signed,) Dr. Vanderhiden."

The excision of the head of the femur has just been performed for the first time, on an adult
in England, by Mr. Henry Smith.

A French agent in Itussia writes, that to preserve the potato, they first deprive it of its
covering, or skin, and then dry it.

Rooms are now ventilated by leaving a small opening (2 by 4 inches) in the upper part,
corresponding to the chimney. This may be hid by any kind of ornamental work, or a pic-
ture placed oliliqtiely to the wall.

On the 23d of June, M. Jobert, in making his morning visit to the Hospital St. Louis, was
forced to cross the barricades in the Faubourg du Temple. Recognized by one of the insur
gents whom he had treated for a wound received in the revolution of 24th February, he was
publicly escorted by a gtiard of hono'- to the hospital.

The ntimber of the insane have greatly increased iu Europe since the commencement of
the recent political disturbances.

The two celebrated instrument makers of Paris, M. M. Liter an4Charriere, have invented
an instrument for seizing the thumb to facilitate its reduction in dislocation. M.Blandin has
been the first to use it, and with success.

576

Medical Intelligence. Meteorology.

A Student of Medicine in China has been the means of abolishing the censorship of the
Press in that country. Wishin'gto obtain the Degree of Doctor of Medicine from the Faculty
ol Pekiii, Mantchon, considered by his associates as a young man of great talents and prom-
ise, wrote a tliesis^in which the censois thought he rellected on the emperor of the celestial
Emjiire, and they condemned him to receive 100 lashes. Learning this decree, the students
of the city to the number of more than 5000 assembled, disarmed the soldiers, and presented
themselves before the Emperor himself ; who, comprehending the nature of the supposed
offence, revoked the decre^nd established thereby the liberty of the Press.

The Ladies of LivcrpooPhave sent lint and linen to the wounded in Paris.

The editor of the Boston Medical and Surgical Journal has heretofore been considered the
leading wit of the professional editorial corps of tht- United States ; but he now has a formi-
dable rival in Dr. Roberts, of the New York Annalist. At (he close of the rej>ortof the case,
(already noticed in this Journal,) where a lady is sail to have worn an egg for a pessary, her
physician forgetting that some places are as good as others for latching, and the cause of her
acute pain having been detected to be tht' bill of a chicken in the vagina the Annalist
gravely wonders if her husband was henpecked! This we can't answer, but presume he
ran the risk of catching thepip, especially if his wife were like the cacfrii Ladi/ of Georgia
noticed by that Lditor irt his April No., whose very cackle could be heard more than half
a mile !

METEOROLOGICAL OBSERVATIONS, for July, 1848, at Augusta, .
Ga. Latitude 33 37' north Longitude 4 32' west Wash. Altitude above
tide 152 feel. .*

Sui]
Ther.

Rise.
Bar.

1 3, ]
.Ther.

P.M.
Bar.

Wind.

Remarks.

1

70

29 73-100

; 74

29 70-100

w.

Showery, 60-100.

2

70

" 65-100

i 89

" 56-100

w.

iCloudy.

3

72

" 55-100

i 89

" 60-100

w.

'Fair breeze.

4

71

" 74-100

j 90

" 80-100

N. W.

Fair breeze. [3, p.m.

6

68

'' 82-100

91

" 75-100

N. W.

Fai r breeze thunder storm at

G

72

" 66-100

91

" 57-100

W

Cloudv breeze.

7

76

" 50-100

76

" 48-100

W.

Rain, "25-100.

8

70

" 59-100

80

" 70-100

N. E.

Cloudv foggy morning.

9

70

" 82-100

83

'' 85-100

N. E.

Fair rain at'4, p.m. 90-100.

10

69

" 88-100

85

" 88-100,

S.

Fair foggy morning.

11

70

" 90-100

1 88

" 72-100

w.

Fair.

12

68

" 90-100

' 90

" 90-100

s.

Fair.

13

73

" 87-100

89

" 85-100

s.

Fair thunder in afternoon.

14

72

" 83-100

90

" 79-100'

s. w.

Fair.

15

74

" 77-100

80

" 68-100;

s w.

Rain, 25 100.

16

72

" GO-lOO"

82

" 56-i00l

S. E.

Rain, 10-100.

17

70

" 70-100

84

" 75-l00;

N. E.

Fair.

18

66

" 85-10

80

" 92-100

S. E.

Fair breeze.

19

67

" 94-100

70

" 95-100

S. E.

Rain, 25-100. [6, p.m.

20

66

" 91-100

84

" 84-100

S.

Pair some clouds sprinkle at

21

66

" 85-100

84

' 77-100

8.

Cl'dy-brecze-rain, lin. 30-100.

22

69

" 81-100

84

" 80.100*

S.

Cloiidy breeze rain, 25-100.

23

69

" 86-100

82

" 86-100

S. W,

Cloudy thunder sprinkle.

24

70

" 87-100

87

" 85-100

S. w.

Pair some clouds. [p.m.

25

70

" 90-100

89

" 88-100

s. w.

Fair some clouds blow at 8^

26

70

" 8H-100

83

" 88-100

s. w.

Cloudy rain last night, 10 100.

37

71

" 85-10!)

88

" 83-100

N.W.

Fair-^some clouds, [aft'noon.

28

72

" 85-100

93

" 84-100

w.

Fair- some clouds thunder in

29

72

" 83-100

91

" 73-100

8. W.

Fair, do. do.

30

72

" 77-100

90

" 70-100

w.

iFair, do. do.

31

73

" 68-100

1 88

" 63-100

w

iRain, 50-100.

18 Fair days. Quajitity of Rain 4 inches 50-100.
6 days. West of do. do. 19 days.

Wind East ofN. and S.

SOUTHERN"

MEDICAL AND SURGICAL

JOURNAL.

Vol. 4.] NEW SERIESOCTOBER, 1848. [No. 10.

Part I. ORIGINAL COMMUNICATIONS.

ARTICLE XLIII.

The Infancy of Physic. By C. T. Quintard, M. D., of

^ Macon, Bibb Co., Georgia.

It is a pleasing and profitable pastime the tracing out the
history of the early Fathers of Medicine to examine the dif-
ferent opinions they held concerning the causas rerum, to study
the grand theories they reared, and to watch them as they
gradually crumbled away under the influence of new systems;
to see young physic in its swaddling bands, and to mark the
time when first it donned the breeches, and finally stood forth
clothed in glittering vestments. If more attention were paid
to historical writings if deeper researches were made into the
principles and practices of the earlier physicians, there would
be far fewer claims of originality urged than are presented to us
now. Why quackery itself is at a loss, for it can scarce find a
single straw to tickle the credulity of men, which has not been
plied ages ago. The "Fairy "of Paracelsus is reproduced and
poured down the throats of barren women, under the new ap-
pellation of "Lucina Cordial." The "admirable secrets" of
Albertus Magnus are held by cancer doctors and curers of
fistula. The "natural magic" of Baptista Porta was revised
by Ha,hnemann, and is now practised by homoeopaths all over
the world. The "Demones" of Cornelius Agrippa are under-
stood by that class of quacks who by stroking cure all diseases.
The " Elixir of Life" of Van Helmont, is pumped into the stom-
achs and dashed over bodiesof old women by the disciples of
Priessnitz. Spiders, snake skins, old rags, charms of all sorts,

37

578 Quintard, on the Infancy of Physic. [October,

and talismans of every variety, are used now as of old, only the
genius of quackery have changed the names they received at
their baptism, ages gone by. So is it in physic proper : new
names are given to old things, and doctors fight for priority
about some simple operation the division of a tendon, or a mus-
cle perchance, which has been practised by the worthies of old,
but not considered of sufficient importance to record in connec-
tion with the sublime reasonings they have left us on abstract
and abstruse subjects, such as "Motion," "Passion," "Human
Nature," &c. Now and then, some new light some modern
genius, astonishes the sober-minded ones of the profession, by
the discovery of a new remedy, which is at last found to be
adulterated blue pill, or something quite as innocent. In fact,
old remedies have become new, and we are almost obliged to
study, not remedies themselves, but their adulteration. The
history of medicines is now absolutely indispensable, and woe
be to that tyro who attempts to give physic, knowing it only
by name.

Although the history of medical men is not of such peculiar
importance as to demand a thorough investigation by all who
practice physic, it is nevertheless pleasant, while examining the
weapons of the profession, to learn something concerning those
who first wielded them and the manner in which they were used.
With this view, and to while away a leisure hour, we brush the
dust from off' the page of antiquity, and shall give a hasty sketch
of the lives of one or two able commentators who flourished af-
ter 'Hhat Prince of Physicians," Hippocrates, and on whom the
mantle of good old Galen fell. M. Renard, in his late work,
"Histoire de la Medecine depuis Son Origine jusqu' au xix.
Siecle," has made three great chronological divisions, viz : the
age of Foundation, the age of Transition, and the age of Reno-
vation. These are sub-divided as follows : The first age
comprises the Primitive Period, terminating with the fall of
Troy, B. C. 1184; the Sacred or Mystic Period, terminating
with the dispersion of the Pythagorian Society, B. C. 500; the
Philosophical Period, terminating at the Foundation of the Alex-
andrian Library, B.C. 320 ; the Anatomical Period, terminating
at the death of Galen, A. D. 200. The second age comprises
the following periods: The Greek Period, terminating at the

1848.] Quintard, on the Infancy of Physic. 579

Destruction of the Alexandrian Library, A. D. 640 ; the Arabic
Period, terminating at the Revival of Literature in Europe,
A. D. 1400. The third age comprises the Erudite Period, com-
prehending the 15th and 16th centuries, and the Reformatory
Period, comprehending the 17th and 18th centuries. Accord-
ing to Plato, Medicine is of five kinds viz:

Pharmaceutical cureth diseases by application of medicine,
Chirurgick by incision or cauterizing.
Di^TETicK by diet.
NosoGNOMONicK disccms diseases.
BoETHETicK removcth diseases.

The diagnostic school to which Aristotle and Plato belonged,
exercised a powerful influence on Medicine, and although the
latter philosopher did leave the path by which most good would
have accrued to knowledge, inasmuch as he neglected observa-
tion and speculated on the final causes of matter, motion, and
primary elements, yet, at the foundation of the Alexandrian
school, we find Galen professing the same doctrines taught at
the school of Cos several centuries before. The abstract ideas,
the metaphysical researches, and the acute reasonings of Plato,
seem to have swayed the philosophy of medicine, as well as
that of other branches of knowledge, till Galen's time ; and we
can almost hear him exclaim, as he bends admiringly over the
page of Plato "Thou reasonest well." Galen then belonged
to the Dogmatic school, and demonstrated the mode of treating
diseases which had in the first instance been pointed out by
Hippocrates. He had all those powers of mind, which were
necessary to the elucidation of great principles obscurely laid
dowB, and yet from his desire to exhibit his superiority to the
Fathers of Medicine, he frequently is prolix and sophistical.
He had a liberal education, and was a man of fine subtle parts,
and much learning. After his travels in the East, he returned
to Pergamus, from whence he went to Rome, A. D. 163. Here
he met with such violent opposition from the Faculty, for pre-
tending to know more than they or, what they did not know
that he was obliged to leave in the course of four or five years,
when he again wended his way to Pergamus. From this retreat
he was soon called by the Emperor Marcus Aurelius, and he

580 Quintard, on the Infancy of Physic. [October,

continued to reside in Rome till his death. At Rome, physi-
cians were divided into sects. The Methodists were numerous,
as were also the Dogmatists. They were, however, divided
among themselves; and though Galen joined none of them, he
at once saw the superiority of the doctrinesof Hippocrates, and
adhered to them. He did not, however, pursue tjiat rational
and judicious method of investigation, nor as carefully observe
and follow nature as did Hippocrates ; nor did he reason as
accurately and justly, from those observations in his own theo-
ry of disease but the Peripatetic Philosophy, as subtilised by
Aristotle, previously introduced into Rome, was embraced by
him, and he endeavored to engraft all the fine distinctions, con-
cerning elements, temperaments, occult and cardinal quaHties,
and the no less subtle divisions of the humors of the body, on
his own Theory of Physic*

Finding it difficult to explain all the phenomena connected
with the causes and production of disease, by the mystified logic
his own fancy had taught him, he was obliged to neglect all
principles of evidence, and to find out some way by which he
could demonstrate the operations of nature agreeably to the
imaginary divisions of the elements, temperaments and humors
of the body. He did not stop to enquire whether these truly
existed ; but taking it for granted, he indulges in all the fine
spun reasoning necessary to support his supposititious data. His
was a colossal intellect, or it would have tottered and fallen
from the height its own daring had attained. Serpent-like, his
genius crept into the narrowest paths of knowledge, and again
it soared on high and gazed undazzled into the sun of wisdom.
There is a peculiar pleasure in contemplating the irresistable
power of a mind such as was Galen's. We see it breaking
away from its earthly tenement gliding through immensity
drawing nourishment alike from the vast and the minute from
other spheres and other systems from " the years beyond the
flood," and feeding upon the ages of futurity.. Galen wrote over
five hundred books in Physic, and a great number in Philoso-
phy and the other Sciences. Numerous as those extant are,
we have but a small part ; for many of his works were burnt in
Rome, when his house was consumed. The oldest and most

Vide Ililiai's Med. Knowl.. p. 97. Lond., 1741.

1848.] Quintard, on the Infancy of Physic. 581

complete edition of his writings, in Greek only, is the Aldine,
1525 folio ; which was followed by the Greek edition of Basle,
1538 folio; and the Gracco-Latin one in 13 folio volumes, by
Ren. Chartier, with the works of Hippocrates added Paris,
.1679; in 1819, Doctor Kuhn, in Leipsic, undertook a new
edition in Greek and Latin;* and lastly, we have another edi-
tion, by one of our talented Philadelphia physicians.

Cotemporary with Galen was Caelius Aurelianus, of Sicca, a
city of Numidia, in Africa. His translation of the works of
Soranus, of Ephesus, on Acute and Chronic Diseases, gives an
exposition of the doplrines of the Methodists. The works of
Soranus, who was the most eminent among the Methodists,
written in the Greek, are lost, and but for the translation of
Caelius, we would not now have so clear a knowledge of the
doctrines taught by this numerous sect. From his pen, also,
we principally gain our knowledge of those distinguished physi-
cians who belonged to the sect of w^hich he was so distinguished
an ornament, as Diodes Caristus, Praxagoras of Cos, Sera-
pion of Alexandria, Asclepiades, Themison, &c.

Although the Methodists objected to all enquiry as to the
causes of diseases, and paid very little attention to the parts of
the body affected, they were nevertheless pretty accurate in
their diagnosis. They did not compare symptoms, nor trace
them to any particular seat in the structures of the body; nor
did they enquire what were the uses of the different structures;
nor pay particular regard to the forms of morbid action, as
modified by variety of tissue, but referred all diseases either to
" adstriction or contraction," *' relaxation," or both combined.
The result of such a theory was a practice correspondingly
improper. Thus Caelius tells us,t that he gave purges in all
diseases, and ordered bleeding and purging at any stage of the
disease, w^ithout any rule or attention to indications: it is there-
fore no wonder that the practice was as unsuccessful as the
poet Juvenal represents, when he says

** Cluot Themison negros autumno acciderit uno."

Vomiting, bleeding, fomentations, anointing, and various

kinds of exercise, were prescribed by this sect. They were

* Encyclop. Americana, vol. v., p. 351.
t CaeliusAurel. de Morb. Acult. et Chron.

582 Quintard, on the Infancy of Physic. [October,

particularly careful to have free ventilation. In treating in-
flammatory diseases, they cooled the sick room with green
branches, or by sprinkling the floors with water. Their pa-
tients virere not allowed to taste either solid or liquid food for
three days. Caelius Aurelianus is the first wh mentions bleed-
ing by leeches,* and gives a description of making Diacodium,
from the juice of, or by making a decoction of poppy-heads and
honey. He is also said to have been the founder of the Metho-
dist sect.f But this is improbable, for Asclepiades was the first
who presented a systematic mode of viewing science, and his
system was founded upon the philosophy of Epicurus. The
Methodists met with small share of favor from Galen, who
demonstrated their sophisms, showed the folly of their theories,
and ridiculed the professors. So simple was the system they
taught, that Thessalus boasted he could teach the whole science
in six months an opinion adopted by some moderns, notwith-
standing the necessity of a knowledge of anatomy, chemistry,
and the sciences collateral to medicine. Ours, however, is a
peculiar age an age in which the ingenuity of man is exhaust-
ed to furnish nutrim'ent for its labor-saving, utilitarian spirit ;
an age in which mind is as subject to mechanical power as the
machine which at every turn, turns out a button-mole, or a
nutmeg ; an age in which men know without learning in
which mind has become a sort of spiritual steam-engine, which
whistles, and whirls, and snorts, and roars ** through the fair
fields of science, untrammeled and free," and it may be that
knowledge is acquired now with so much greater facility than
in the days of Thessalus, that notwithstanding the number of
branches now taught, a man may, like Strepsiades, in the clouds
of Aristophanes, "hang his cloak upon the Arts and Sciences,"
and let education "soak in from the outside." We hasten on
to give a sketch of several Greek physicians, and enquire what
they did to advance the medical art.

First in the list is Oribasius, of Pergamus. . Oribasius was a
pupil of Zeno, the Cyprian. He did not, however, complete his
studies with this philosopher, but left Sardis and went to Alex-
andria, in Egypt, where he became a distinguished professor,

Caelius Aurel., Ibid. Acutor. L, 3, C.3, in Cap. de Cephalea.
t Idem, et Celsus in Praufat., p. 15.

1848.] Quintard, on the Infancy of Physic. 583

about 150 years after the death of Galen. Fifteen, of all the
books he wrote at the request of the Emperor Julien, are now
remaining.

From his great admiration of the theories of Galen, and from
the fact of his adopting so completely Galen's views, and com-
piling his writings, he was called Galen's ape. Though his
Theory of Physic is precisely that of Galen, we find some things
in his works mentioned by no other authors : so, too, in his
Anatomical researches. He was the first to describe the sali-
vary glands,* and is the first who mentions the mode of bleeding
by scarification. f He employed this practice in his own case
while suflTering from an attack of the Plague. On the second
day of his attack, he scarified his thighs and took away two
pounds of blood. This method he also practised in suppression
of the menses, headache, giddiness, dyspnoea, &c. He also des-
cribes a peculiar kind of madness which he calls Auxav ^pwria. J
This was, in all probability, more frequent in those days than
now. The same disease is mentioned by ^Etius, Paulus, Actu-
arius, and others, and is probably synonymous with the demo-
niac of the scriptures. It has also been described by some more
modern authors.^ Another practice introduced by Oribasius,
was that of giving nutritious clysters. This practice was adopt-
ed, and is described by Avicenna, who lived several centuries
after Oribasius. Oribasius was a man of genius, and had he
adhered to the mode of reasoning adopted by Hippocrates,
rather than that of Galen, he would have left a more valuable
legacy. He had suflUcient acuteness to perceive the errors of
Galen, and has, in some trifling instances, explained them. He
was captivated by the assumed independence of Galen, and
seems to have followed him as much for the qualities of the
man, as those of the physician.

Amida, a city of Mesopotamia, gave birth to the next physi-
cian of note, whose works have came down to us. ^tius lived
in the latter end of the fifth century, about A. D. 480. ^tius
was a clearer writer than Oribasius, and treats of more diseases ;
but his works on Surgery are much inferior to those who had
preceded him. His description of the operation of castration,

* Oribas. Oper., Lib. 24, cap. 8. + Oribas. Oper., coll. 7, 20,

: St. Mark, eh. 5, v. 3. St. Luke, ch. 8, v. 27. Dr. Friend's Hist, of Phys*.

584 Quintard, on the Infancy of Physic. [October,

is better than that of any previous writer; but this operation
was so frequently practised, long before his time, in making
Eunuchs, that he had probably more observation to guide him.
He is the first to describe issues made with a- cautery, to drain
off bad humors.* The remedy was frequently worse than the
disease; for the cautery was applied in so many and in such
places, as to become a greater evil than the disease for which
they were applied. The first that we learn of the application
of issues, not of cautery, is their use by cattle doctors.f Ac-
cording to Dr. Friend, ^tius first gave an account of the
Dracunculi. Plutarch, however, quotes Agartharchides on this
subject, long before iEtius. Plutarch calls them ^paxovlia j^axpa.
The Arabians call it medineusis, or medena vena vena, be-
cause they doubted its being a living animal, and medineusis,
from the frequency of its appearance at Medina. Avicenna
treats it among abscesses. Le Clerc mistakes them for the
bovina affectio ; but iEtius separates, and Albucasis distin-
guishes them with great care. Some suppose that he takes his
description from Leonidas, of Alexandria, who had probably
seen it in Egypt; but he himself probably met with it in Persia,
where it is, in some parts, as frequent as in Arabia. He has
given the best account of Egyptian Pharmacy, and has col-
lected a great number of receipts, as well as some of the most
famous nostrums of those days : from him we learn the com-
forting fact that quacks and their nostrums were as numerous
then as in our days. The priesthood had, as early as A. D. 366,
been forbidden by the council of Laodicea, to study or practice
enchantment, mathematics, astrology, or the binding of the soul
by amulets, for the monks had converted the purposes of medi-
cine to the most improper uses, and so great had become the
evil of charms, amulets and relics, that the Lateran council,
under the pontificate of Calistus II., forbade the attendance of
the priests at the bed-side of the sick, otherwise than as the
ministers of religion. ^Etius tells us of one Danous, who sold
aCollyrium, at Constantinople, for 120 Numismata ; and Nicos-
tratus sold his "Isotheos," (colic drops,) for two talents. J

^Etius Tetrabib, Lib. 2, cap. 2, 28.

B., South. Med, and Surg. Journ., Jan. '48.
, Ivor, :{75 if of gold, 4500 .

1848.] Quintard, on the Infancy of Physic. 585

Quackery in those luxurious days was quite as popular as now,
and men were as willing to pay for being tickled into a belief,
that the real "Elixir of Life" had been fonnd. " It is painful,"
says a writer in the London Med. Gaz., "to witness, at the pre-
sent day, the patronage and confidence and that by parties,
who, from their position, ought to be leaders in the enlighten-
ment of society bestowed upon the professors of homoeopathy,
hydropathy, and animal^ magnetism ; whilst men profoundly
acquainted with the structure and diseases of the human frame,
are left to struggle on unnoticed." One of the most amusing
cases, in which the properties of the remedial agent were pro-
bably well adapted to the pathological condition of the patient,
we clipped from an Ohio paper not long sincej and as it will
show how enlightened are some who live in the 19th century,
we copy it for the benefit of those w^ho are " Death on Fits.'
*' Our friend, John Barber, of Clark Co., 111., says, I saw last
summer a boy that had had fits, which was a curiosity to me.
His parents say the boy was cured by sleeping with a hound
puppy. The father of the boy told me that the dog was not
deformed when young, but that now he is deformed the worst
kind ; his feet turned up, and his legs very much bowed." How
important is it that we should "seize upon truth, wherever
found."

Isopathy, then, is not so recent a discovery as the talented
Editor of the N. Y. Annalist supposes; for this is a case in
point. Our friend. Dr. Roberts, " suggests as an idea wholly
original, that morbid organs would more strictly, and perhaps,
successfully carry out X\\q similia similibus curantur principle:
thus hepatized lung, for pneumonia ; cirrhosed liver, for cir-
rhosis, &c." We recommend some of our Northern pathists
to use the deformed puppies of the canine species, to cure those
puppies of the human species, who are " sent into this breath-
ing world scarce half made up."

But to return. JEtius was about the first physician who
embraced Christianity. He had great faith in the cure of dis-
eases by miracle. He collected whatever was worthy of note
in the writings of his predecessors. This he did "by cutting
out portions of prior writings, and placing his scraps under cer-
tain chapters."

586 Quinlard, on the Infancy of Physic. [October,

Not long after iEtius, lived Alexander Trallianus, a native of
Tralles, a city of Lydia, near Ionia, where the Greek tongue
was spoken more pure than in most other parts of Greece. He
was a man of nice honor, sound learning, much practice, and
enjoyed a brilliant reputation. He travelled from place to place,
in search of knowledge, and vigorously prosecuted his research-
es in science. He enquired into and reasoned closely concern-
ing the causes of disease, and like Hjppocrates and Aretaeus,
of Cappadox, deduced a rational mode of curing them. His
manner of writing is clear ; his style concise, and his language
pure. His method of treating diseases is his own. He was a
great admirer of Galen, but was not so much influenced by the
Peripatetic philosophy as either Galen or Oribasius. In the
books he has left, he as accurately describes diseases and their
symptoms, as do Hippocrates and Aretaeus enquires into their
causes, and as judiciously describes the indications as they.
From his close observation and acute reasoning, he was able to
distinguish those diseases whose characters and symptoms are
similar.* He neither formed any hypotheses of his own, nor
admitted those of Galen. His manner of observing is like that
of Hippocrates, while his reasoning is peculiarly his own. He
plainly asserts his views, and tells us why he differs from his
predecessors. The hypothetical theory of Galen, as well as his
method, are condemned by Afexander.f

Though he explains his mode of treatment, he gives his read-
ers cautions concerning what should be avoided, "which, if all
other writers had as exactly followed, might have been of as
much use to us, as many of their positive precepts." In ple-
thora, he advises bleeding and frictions, to prevent evil conse-
quences ; and though Hippocrates and Aretaeus had advised
the same practice before him, we find Oribasius and iEtius were
afraid of the practice : so that Alexander has the honor of re-
viving the practice defending it, with sound logic and judi-
cious observations. Previous to him, phrensy had been attri-
buted to a morbid condition of the diaphragm; but he shows

Alex. Trail, de Calcul. et Morb. Chlo., Lib. 9, cap. 4. Et de Pleurit. et
Plepalit,, Lib. f), cap. 1, &c.

t Alex. Trail., Op. Lib. G. cap. 1 ; Lib. 12, cap. 1, G, 7, 8. Dr. Friend's Hist,
of Phys.

1848.] Quintard, on the Infancy of Physic. 587

that it belongs to the brain, and recomhnends bleeding in the
arm and forehead. He also mentions a tubercle in the lung,
which causes dyspnoea, without fever or expectoration.

In fevers, he advises bleeding and cool drinks. He describes
the taenia, and records the case of a woman who voided one
twelve cubits or six yards long. In his epistle to The<jdorus,
he describes the ascarides, and the mode of removing them.
No other writer so strongly insists on bleeding in a fit of the
stone, which is a very judicious practice, especially if there be
suppression of the urine at the same time.* He mentions many
other things in his practice which are worthy oi note ; and he
may be looked on as one of the most practical men of his time,
and one who did more to advance the medical art than any of
the ancients befoa-e him, except Hippocrates himself.

About the end of the sixth and beginning of the seventh cen-
tury, lived Paulus iEgineta. After pursuing his studies in
Greek, he visited Alexandria, in Egypt, which was then the
most celebrated school in the woi'ld. The Peripatetic philoso-
phy and theory of Galen were his favorites. He became cele-
brated as an Obstetrician, and was the first to write on woman
and her diseases. His fourth book is on the subject of cutane-
ous diseases, ulcers, &c. He begins with Elephantia, and is
clear and concise in his description of Pterygion vel onychia
maligna. He also distinguishes Lepra from Psoriasis, and re-
commends us not to interfere with the eruptions of infancy,
except in their decline. He has numerous rules concerning
regimen and the milk of the nurse. f He has treated of the
diseases of old age, in his first book ; his fifth book treats of
poisonous animals' and insects ; his sixth, is upon surgery, and
is fuller than any work preceding it on surgical operations.
He suggested a number of new operations, and improve-
ments on old, and is very exact in his descriptions. In
lithotomy, he orders the incision to be made obliquely, as was
practiced in more modern times by Mr. Raw, of Amsterdam,
Cheselden and Heister. He distinguished hernia inguinalis
from hernia scrotalis, and both from bubo, very exactly. He
has marked the diflference between the various kinds of hernia,

Hist.ofPhys., vol. 1, pp. 9-120.

t Pauli ^ginetae Opus de re Medica, Lib. I, p. 7. Parisiis, 1533.

588 Quintard, on the Infancy of Physic. [October,

as well as the operations then in vogue for their cure. He tells
us an aneurism is a tumor which rises from arterial blood ex-
travasated describes the various kinds of aneurisms, the dila-
tations of the arterial coat, &c. In 1805, Sir A. Cooper tied
the common carotid, advised two ligatures, and recommended
that the artery should be divided in the interspace. This form-
ed a memorable era in the annals of British surgery ; but Paulus
describes the operation, and after having applied the. ligatures,
he orders the vessels divided, and expressly says, we ought to
tie the artery not only above, but below the aperture.

Paulus invented a scarificator with three blades, and frequent-
ly used cupping, and mentions the use of the hook or crotchet,
in obstetrical practice. Although he gives directions concern-
ing the delivery of a child, and the treatment of the lying-m
woman, we have no evidence that he himself paid very much
attention to the practice of midwifery.

We are surprised, in examining these historical records of
the earlier Fathers, to find how great a degree of perfection
had been attained. Paulus lived about a thousand years after
Hippocrates. Surgery had then almost grown old; but when
we consider the astonishing improvements made in other
branches of science in anatomy; in aknowledgeof the struc-
ture and uses of the various parts of the body ; in the circula-
tion; in the uses of the bile; in chemistry, and in the whole
economy of nature, we are obliged to admit that the moderns
liave not advanced as rapidly as might have been expected.
The ancients were obliged to progress in a dim, hazy and ob-
scure atmosphere, while we are surrounded by the full tide of
light which comes irom research and experiment.- M. Renouard
has left unwritten the history of the 19th century. Who shall
write it ? All the strange systems all the odd theories, of the
present day, to be fully described and explained, will form a
rich treat to those who will feed on us when we are turned to
^' many a thousand grains that issue out of dust." Not only will
the history of the 19th century require a minute detail of sys-
tems, but this '^ age of elevation'''' will be peculiar in another
way. The mode of "making doctors'' the facility, and the
care the cheapness of the commodity, &:c., are all conspiring
to ff)rce upon the nation a swarm, about as beneficial in their

1848.] Robertson, 071 Chloroform in Parturition. 580

action on the body politic, as the thousand and one quack reme-
dies which are floating down the stream of time. In fact, as our'
friend, Dr. Rives suggests, the time is fast approaching when
we shall see suspended from many a dilapidated mansion
"Cheap Doctoring done here !"

ARTICLE XLIV.

Successful Employment of Chloroform in Parturition. By
J. J. Robertson, M. D., of Washington, Geo.

In the August No. of this Journal, I reported a case of labor
terminating favorably while under the influence of chloroform.
It affords me no little satisfaction to be able to present another
case, having the same happy issue.

The subject of this case is the mother of eleven children ;
with a temperament exceedingly nervous and excitable : her
health, for many years past, has been quite delicate and preca-
rious. I was informed, on the evening of the 21st of July last,
that my services would probably be required before morning,
and by request of her husband I repaired to their residence.
I was not called into her chamber until 1 1 o'clock, P. M., when
she informed me that she had experienced slight pains during
the day, which were now increasing, both in frequency and
vigor. I found, however, they were produced by the contrac-
tion of the circular fibres of the womb, and were not at all
expulsive in their character. She had previously decided on
using chloroform; and at my request, my friend, Dr. James H.
Pope, was sent for to be in attendance with me. At 12 o'clock,
the uterine contractions became more effectual, and the pain
attending them quite severe. Upon exannmsLhon per vaginam,
the OS uteri was found somewhat dilated sufficiently so to as- '
certain the presentation to be natural. After waiting for half
an hour, I found that the dilatation of that portion of the organ
was but slightly increased, although it was in a dilatable condi-
tion. She was now having some pains, and was suffering from
palpitation of the heart, and very considerable dyspnoea; in
addition to which distressing symptoms, there was spasm of the
extremities, and her general appearance strongly betokened
convulsions.

590 Robertson, on Chloroform in Parturition. [October,

I, at once, administered a full dose of chloroform, in the usual
way, which took effect in an incredibly short space of time.
The spasm immediately ceased, the respiration became calm
and natural, and the heart gradually resumed its normal action.
The dilatation of the os uteri was speedfly effected, labor pro-
gressed favorably, and terminated at 2 o'clock, A. M., without
her being conscious of the fact. She was first apprised of the
event by the cries of the infant, some fifteen minutes after its
expulsion.

The effects of the chloroform having subsided, after-pains
came on, as usual. I administered it again, which arrested them
temporarily , they however returned, but were not so severe as
to require the administration of remedies for their relief.

Upon visiting her the next day, I found her doing remarkably
well. She informed me that when^he first inhaled the chloro-
form, she felt the difficulty of breathing subsiding : she soon,
however, lost all consciousness, and did not feel the slightest
pain, from the first inhalation, until after the termination of
labor. After the first administration, I did not use the chloro-
form in sufficient quantities to produce sopor for more than a
few seconds, until just before the expulsion of the child ; I then
administered rather more of it, upon which she fell asleep, and
remained in that condition for some time after the termination
of labor. When first aroused, she remarked that she felt as
though she had been asleep for two or three nights.

The chloroform was used, in this case, at almost every con-
traction of the uterus, but in very small quantities. It was not
followed by the exhilarating effects described in the case before
reported ; the patient was calm throughout, and notwithstanding
each contraction of the uterus was attended by the correspond-
ing effort, as in ordinary cases of labor, she made no complaint
of pain, and assures me she felt none whatever.

Mrs. , has usuall suffered much in her confinements, and

her recovery has been .lieretofore slow and protracted, owing to
the shock given to the nervous system, and complete prostra-
tion by pain. On this occasion she has experienced nothing of
that character, neither has she had so favorable a recovery since
the birth of her first child. It may be well to mention that the
child was of the usual size, and is doing quite as well as the
mother.

1848.] Robertson, on Chloroform in Parturition, 591

The administration of chloroform, in the face of such an array
of apparently formidable symptoms as presented themselves in
this case, may be objected to by some ; but having been the phy-
sician of Mrs. for several years past, I was w^ell aware of

her peculiarities of constitution, and felt assured that the palpi-
tation of the heart was not attributable to any organic disease
of that organ, but simply to a functional derangement. I had
previously known her to suffer with dyspnoea and convulsions,
during gestation, and viewing them, in this instance, as hysteri-
cal in their nature, I regarded chloroform as peculiarly applica-
ble, as, I felt sure it would not only exempt her from pain during
labor, but also arrest those unpleasant symptoms, which it most
effectually did.

I am fully convinced, that labor will terminate sooner under
the influence of chloroform, than otherwise; for, while it does
not, in any way, interrupt the force of uterine contraction, (ex-
cept for a few minutes after its first exhibition,) it most effectu-
ally overcomes all rigidity of the soft parts, and thereby removes
resistance to the efforts of the uterus from this source.

While my limited experience in the use of chloroform in sur-
gical, as well as obstetrical cases, is entirely satisfactory, and
while I cannot but indulge the hope that it may become in
general use, yet I would not prescribe it in all cases of natural
labor, for the simple reason that unpleasant consequences have
grown out of its use. In all the cases, however, which I have
examined, where unfavorable results have taken place, I think
the bad effects may be clearly traced to one of these causes
viz : an impure article of chloroform, an improper mode of ad-
ministering it, or, there was some organic disease which would *
have enabled the skilful physician to have predicted the conse-
quences, and warned him to refrain from its administration.
I am fully persuaded, that, to a healthy individual, not too ple-
thoric, chloroform, if pure, and properly administered, is not
only safe, but effectual in the accomplishment of all its most
sanguine advocates claim for it.

Oliver, on Friapism. ^jr/t " i [October,

ARTICLE XLV.

An Obstinate Case of Priapism. By James H. Oliver, M. D.,
of Burke County, Georgia.

I was summoned, on the 30th of June, to see H , a negro,

18 years of age. I found him with some fever, tongue coated
with a white fur, and his penis in a state of complete erection
every tissue apparently upon the stretch : he complained of
severe pain just posterior to the corona glandis, and a sensation
of great distension in the part. Inquiring more fully into the
case, I learned that his virile organ had been in this condition
ever since the morning before. He said he was awakened in
the morning by a voluptuous dream and found his penis in a
state of priapism. Whether any emission of semen took place
or not during this dream, I could not ascertain. Thinking the

erection would soon subside, H went into the field and

ploughed that day.

Treatment. I resorted to venesection ad deliquium animi.
I then had cold water poured from a height of three feet upon
the pubes, &c.; which however, had no beneficial effect save
that of lessening the pain. A solution of tartarized antimony
was prescribed and continued until from its nauseating effects
syncope was produced. I expected that when fainting was
produced, the erection would subside ; but I was signally dis-
appointed.

July 1st. I found my patient in the same condition as when
I left. Prescription: camphor, 5 grs., opium, 1-6 gr.,to be giv-
en every two hours, with the warm bath. Retention of urine
also existed, but was relieved by the gum-elastic catheter.

July 2d. Still in the same condition. Attempted to bleed him
in one of the large veins of the penis, but failed, owing to the
great distention of the parts. I then cupped him in the perine-
um and on the pubis, from which he appeared to be benefitted.

July 3rd. No change. Prescription : camphor poultice to
the perineum, with the solution of tartar emetic internally.

July 5th. Still no change. Leeches would have been appli-
ed , but they could not be obtained. I examined his spinal co-
lumn, and finding him tender on pressure on the 4th lumbar

1848.] Campbell, on Anatomical Peculiarity. 593

vertebrae, cups were there applied. Thinking the erection
was kept up by some irritation at the neck of the bladder or in ,
the Urethra, I prescribed tartar emetic in unction upon the pu-
bis, with balsam copaiba internally, (there was considerable
ardof urine.)

July 6th. Treatment continued. No improvement.

July 7th. I found some amelioration of the symptoms. Pre--
scripflbn : the balsam as before, with a blister io the tender
vertebrae. Thinking that I had not giten the camphor and
opium a fair trial, I Was determined to resort to it again in larger
doses and to continue it for some time* Prescription: camphor
20 gts., opium 1-4 gr. this to be given three times a day.

July 9th. I found H -=- gradually improving: hig penk
had diminished some in size ; prescription, the same.

July 11th. Found H still improving' his penis had dj--
tninished considerable in size, though it is tery hard and resist-
ing on pressure. Cold affusions to his head were ordered, still
continuing the balsam.

July l7th. 1 found his penis about its natural size, though
still hard and inflexible. He complains of pain and giddine^
in his head. Cupped the back of his neck and apph'ed a Mis-
ter. Absorption has now taken place and the effusion into the
penis has been somewhat removed, though not entirely so, eten
Up to this date. Throughout the treatment his l^oWels' Were
kept soluble.

ARTICLli XLVI.

Andtomicat Peculiarity : observed by Kob't CAM'PBEtL, M.t).,-
Assistant Demonstrator in the Medical College of Ga.

Not finding it recorded tn any anatomical Work We have
examined, we deem the following coincidence Worthy of notice J

The direction of the canals for the passage of the nutritious

Vessels into the long-bones of the extremities varies in theeree^

position of the body, thus -

Humeri, ) ^, t , ,
T.biiE, Obhquely down-

Fibulee, ' ^^'"'''

17 V Wards,

remora. )

38

694 Obsercaiions on Congestive Fever. [October,

Now when the limbs assume a position corresponding with that
of the fostus in utero (admitting the head to be up) viz: the
fore-arms flexed upon the arms, the arms upon the chest, the
thighs upon the abdomen and the legs upon the thighs, the canals
will all be found to pursue a course directly downwards.

The entrances to these canals are generally situated about
the centre of the bone, or at the junction of the upper and
middle thirds of the shaft. The location may vary sightly,
but their direction is always the same ; to ascertam which, we
have examined all the bones within our reach.

Perhaps this may prove to students a useful formula, for im-
pressing upon the memory the situation and direction of these
canals.

PART II. REVIEWS AND EXTRACTS.

Thoughts and Observations on Congestive Fever. By Charles
E. Lavender, M. D., of Selma, Alabama. (American
Journal of Medical Sciences.)

In the following remarks, it is my purpose to be brief and
practical ; to avoid, as far as possible, theoretical disquisition,
and to confine myself mainly, to such facts as have come under
my own observation. By congestive fever is understood that
form of autumnal disease, wherein the vital force is depressed,
by the influence of miasmatic poison, below the y)oint of suc-
cessful reaction. In consequence of this depression of vital
force, the heart is unable to give due circulation to the blood,
which consequently becomes congested in the internal organs,
and large venous trunks. If the vital energies do not fail in
the onset, each succeeding paroxysm adds to this venous con-
gestion, while the struggles of the heart grow fainter and
fainter, till they cease altogether, unless, aided by the vigrorous
reaction of a powerful constitution, or by the use ofcflective*
remedies, it is aroused to an effort of such power and con-
tinuance, as to resist, and finally to overcome, the downward
tendency.

This nomenclature maybe significant enough, yet it is by no
means free from objection. It sometimes happens that the
patient dies in the first paroxysm, without any febris at all.
At other times, there is a chill or cold stage followed by a state
of comparative repose, but little or no reaction, to be succeeded

1848.] Observations on Congestive Fever. 6ft5

by another and fatal cold stage. Venous congestion also doubt-
less exists in other forms of fever. This congestion, however,
so far from being the seat, or proximate causes of the disease
in qXiestion, is but an effect of the action of the poison upon the
brain and nervous centres. A similar pathological condition
may be superinduced by concussion, or other injury done to the
brain. It is but a symptom of congestive fever. And could we with
equal clearness see the workings of the cerebro-spinal and
nervous systems, the motions and uses of their fluids, the degree
of their intensity, the momentum w^ith which they circulate,
and the obstructions which they encounter, we could then
advance another, and more satisfactory step in the investigation
of this, as well as other forms of disease. These more obscure,
yet vastly more important, vital and pathological phenomena
have unfortunately, been overlooked by many able pathologists,
in their researches on the liver and venous congestion. Too
much importance has doubtl_ess been attached to the circulation
of the blood, to the neglect of the nervous functions. The
symptom has been elaborately investigated, while the cause has
received comparatively little attention.

A case that has assumed, and for some paroxysms maintain-
ed, the character of remittent or intermittent, may suddenly
put on a congestive type. An attack, which at first assumed a
congestive form, may, after a successful effort at reaction, wear
the face of remittent or intermittent, of a mild character.

Many cases in their onset and progress, wear the livery of all
three of these types ; and might, at different stages, be set down
under each of these heads. And sometimes, it would be
no easy matter to decide upon the class to which a case properly
belongs.

These facts clearly prove congestive fever to be, not a
disease sui generis^ but a form or modification, and that, too,
the most violent and alarming, of the efl^ects of miasmatic
poison. It should be remembered, however, that congestive
cases bear no fixed relative proportion to the number of au-
tumnal fevers. It often happens, that a season passes by with
but few well-marked cases of congestive fever, although
l^ilious remittent and intermittent fevers prevail extensively.
Such was the case, according to my observation, in the years
1832 and '34, in the valley of the Alabama river. At other
times, the number of cases may be comparatively small, but the
fever of a decidedly congestive type. Such was the case in
the years 1835 and. '36, when congestive fever first invaded
this valley as an endemic. The years '40 and '41 were similarly
marked: the former, which was extremely w^et, being ver>'
sickly, with but few malignant cases ; the latter, which was not

flW Observations on Congestive Fever. [October,

so wet. but very hot, not so sickly, but with many more fatal
cases. Since that time, no year has passed without conirestive
fever. It never appears early m the season ; rarely before the
first of August. The hotter and dryer, the earlier. It con-
tinues till after frost.

These facts would indicate that there is some constitutional
peculiarity in this miasmatic poison, or in the electric state of
the atmosphere, caused perhaps by long-continued and ex-
cessive heat, which gives type and character to the prevailing
fevers of the season.

In its premonitories and its access, congestive fever presents
but little to distinguish it from an ordinary attack of intermit-
tent. There are more languor, more restlessness, and more
debilit3\ It is rarely the case that it makes its attack without
a day or two of the ordinary premonitories of autumnal fever.
It then approaches in the form of a chill. The patient is restless,
and very much oppressed ; skin pale and shriveled ; extremities
cold ; features contracted ; lips purple ; tongue pointed, and of
a leaden hue, or pale, cold and clammy ; pulse feeble, quick,
frequent, irregular, aftd intermitting; tendons corded : occasional
rigors, and sometimes shaking chills, though the patient rarely
complains of coldness. There is no acute pain, but a dull heavy
aching in the head, back and limbs. Usually there is great thirst,
with nausea and vomiting, but these symptoms are not always
present. In place of febrile reaction, the surface grows colder,
and is bedewed with a cold unnatural perspiration. There is an
indescribable sense of restlessness and op|)ression, the patient
remaining but a few seconds in any one position ; on rising to
his feet, he becomes giddy, staggers, and perhaps falls. He
writhes under tormenting heat, calls for ice, desires to be fan-
ned constantly, and to have cold Avater sprinkled on his face
and breast, while his skin is as cold as the marble wet with the
morning dew. In some cases, howevei', there is much morbid
heat alDiout the head and chest. A copious sweat suddenly
breaks out and as suddenly disappears ; skin becomes motley and
bluish, its sensibility impaired, impress of fingers remains some
seconds after pressure is removed ; sometimes ecchymosis in de-
pendent parts; respiration irregular, with frequent sighing ; greaf
anxiety, countenance haggard ; eyes suffused ; a Avatery purging
is sometimes a dangerous symptom, and hiccough a trouhlesome
attendant. There is usually a most distressingsense of sinking
down, and, to the patient himself, a most alarming incubus, or
feeling of suffocation : he lies still, it maybe for a minute, without
breath'njT.then gasps for breath, makes short and hurried respira-
tion ; cries out that he shall die for want of breath; rises, advances
hurriedly to the window, st^iegers, thro^vs himself on another

1848.] Observatians on Congestive Fever. 597

bed, or falls on the floor ; the pulse has ceased to flutter at the
wrist ; a moment's unusual anguish, a gasp or two for breath,
the heart ceases to beat, and death closes the scene in six or
eight hours from the access, the sufierer retaining his senses to
the last. At other times, death approaches under cover of a
deep comatose sleep, of several hours' duration. Sometimes,
though rarely, the paroxysm closes in convulsions.

The fatal moment is sometimes delayed a few hours by the
free use of diffusible stimulants, in which case the patient
usually dies comatose. At other times, partial reaction takes
place ; the skin becomes warm or even hot ; extremities re-
maining cold; pulse may again be counted ; from 150 it falls to
120 ; it may be the patient sleeps for some hours, or dozes on
in painful and interrupted slumbers, to be followed the next
twenty-four hours by another paroxysm, terminating in fatal
<iollapse.

It must not be supposed that all cases of congestive fever
are alike malignant, or marked by the same alarming symp-
toms and fatal results. Perfect reaction may terminate the
first paroxysm in rapid convalescence. Partial reaction may take
place; the next paroxysm may be less violent, and of shorter
duration ; this may be followed by reaction still more complete,
and so on, till perfect innervation is restored, all the congested
blood in the system put in motion, all the organs disengorged,
with equalization of temperature, and of nervous energy ; or
the disease may run into well-marked remittent or intermittent.
But most commonly, under proper treatment, complete reaction
follows the first paroxysm ; morbid action is then broken up,
congestion removed, innervation restored, and the patient
recov^ers rapidly.

There is scarcely an important organ which may not, during
the progress of the disease, become the seat of local congestion.
The spleen may become engorged to such an extent in a ^ew
hours, as to be found double its natural size. The same, to a
less extent, may be said of the fiver. Congestion of the lungs
is an alarming occurrence, which doubtless always exists, to
a greater or less extent, in this form of fever. The great op-
jDression, laborious breathing, heaving of the chest, and sense
of suffocation and sinking down, denote such a state. But of
all the local congestions that attend upon this form of disease,
that of the brain is most alarming, least manageable, and most
fatal. It is marked by deep coma, low muttering delirium,
rolHng of the head on the piilow, a drawing of the head back-
wards, dilatation of pupils, optic illusions ; and if partial reaction
takes place, raging delirium may come on.

Unfortunately for young practitioners at tlie South, their

508 Observations on Congestive Fever. [October,

knowledge of this formidable disease is chiefly drawn from the
well studied lectures of professors who never met with it in
practice, or from the ponderous volumes of writers on general
therapeutics, to whom congestive fever is a matter of history.
The most unwelcome, and perhaps the most useful, lesson that
such a practitioner ever learns, is taught him by the first well-
n^arked cases of this type with which he meets.

That the character of the disease in question, as it makes
its appearance in this latitude, may be properly apprehended,
I introduce a few cases from my note book, which terminated
fatally, without treatment.

Case I. B. D., octat. 16, good health and temperament; experi-
enced a light chill 3d Sept. '41 ; little reaction ; copious perspiration ;
restless, and very much oppressed.

4th. Somewhat languid, but no particular complaint.

5th. Cold stage at 8 A. M.; shivering at intervals, alternating
with flushes of heat, for two hours ; extremely restless and oppressed ;
could not be confined in bed ; would rise, stagger, and sometimes
fall ; surface very cold, but complained of much heat. At 12 o'clock,
without febrile reaction; profuse perspiration; at first warm about
the head and chest, but soon becoming cold and icy ; confusion of
intellect; optic illusions; twitching of tendons. In less than an
hour, watery purging ; low delirium. When I saw him at 3 P. M,,
he was dying convulsed.

Case II. P. D., octat. 14, brother to the above; a sprightly boy,
of good temperament, was attacked on the 7th Sept., two days after
the death of his brother ; some chilliness, followed by deep sleep and
copious sweat, hut little, if any, fever ; restless night.

8th. Walked about the farm ; insisted he was well; took no me-
dicine.

9th, Rose early, dressed, and went out. Came in at seven, with
a chill; threw himself on the floor, and went to sleep. In an hour,
was sweating profusely; in another was cold, and could not be
waked. At 9, his mother became alarmed and sent for me. When
I arrived at 12, the boy had been dead one hour. Although the
surface was cold and clammy when he died, two hours afterwards it
waii dry and of natural warmth. Even the extremities, tips of the
nose and ears were warm, and the countenance natural in ap-
pearance.

Case III.^ Mr. K, a labouring man, aged 38, 24th of July '41,
felt some indisposition, restleness, with sense of impending danger;
some rigors, with hot flushes, but no fever.

25th. Somewhat indisjx)sed, but rode four miles to mill, and
returned in tlie afternoon. Passed a very uncomfortable night,
tossing in bed, and labouring for breath; at times rising and going
to the door; surface cold, but corpplainingof internal heat.

20th. Felt somewhat bettor in the morning; but soon the distress,
ing symptoms returned, with increased force. Some shuddering at

1848.] ObservoHons on Congestive Fever. 599

first ; soon became cold, but would not be covered ; nor remain long
in bed; on rising, would reel, with sense of falling forward ; com-
plained of great heat, and went from bed to bed, in search of a
cooler place; drank often of cold water, no relief; occasional emesis;
cold sweat. When I saw him at 2 P. M., the whole surface was of
that peculiar icy coldness, painful to the touch, and damp with clammy
sweat; skin pale and shriveled ; features shrunken and cadaverous ;
countenance unatural, and marked with deep distress; pulse gone
from the wrist ; heart fluttering rapidly, but feebly ; tongue pointed,
pale, and cold ; breathing laboured, interrupted, and greatly oppress-
ed; breath cold; complained of "burning up;" that he should "die
for want of breath ;" would not remain half a minute in one position,
nor suffer the lightest covering; rose rapidly from bed, staggered to
the door, and returned as hastily to bed; spoke rationally; no ap-
pearance of delirium. Took quin., camph., ammon., &c. ; no per-
ceptible effect. About 3, rose hastily; said he should die if he did
not get fresh air; lay down on the floor, remained quietly on his side
for a few seconds, perhaps without breathing ; turned on his back,
exclaimed "I'm gone," and breathed no more.

Cases like these, terminating fatally on the third day, or in the first
well-marked paroxysm, ofi;en occur, during a season in which "con-
gestive chills" prevail.

Treatmtnt. In order to arrest a disease like this, tending
with such fearful rapidity to a fatal termination, the most
prompt, vigorous, and well-directed treatment is necessary.
In this, above all other diseases of a general character, time is
of the most vital importance. One hour's indecision may
prove fatal. With the first three or four hours after the case
becomes alarming, all may be lost. x\nd yet, when properly
treated, there is no disease to which the physician, who loves
his profession, can point with prouder satisfaction.

Blood-letting, which is always a most hazardous operation in
this form of disease, if resorted to at all, should be accompani-
ed by the most powerful internal and external stimulants.
Brandy, quinine, camphor internally, sinapisms to the spine and
epigastrium, and hot applications to the extremities, while a
small orifice is made, as I prefer, in the external jugular vein.
As the blood runs slowly, the fingers should be placed upon
the pulse, and its changes carefully noted. If it waver, become
more feeble, frequent or intermitting, the vein should be instantly
closed. If the pulse increase in force or volume, and not in
frequency, the bleedins: being serviceable, may be carried to
considerable extent. Even then it is more safe to bleed very
moderately, and to repeat in an hour or two, if thought ad-
visable, than to make a large bleedinfr at once. For it will
sometimes happen that the pulse maintains its force and volume
through the'bperation, and even for some time afterwards, and
then suddenly sinks, perhaps to rise no more.

600 Observations on Congestive Fever. [October,

In ca&e second^ two hours after death, I found the jugulars
very much distended, one of which was opened, and a pint of
black blood discharged. This blood was evidently regurgitat-
ed, and was with ditliculty restrained by means of an adhesive
strip, the urgency of my engagements at the time, })re vent-
ing a more extended observation. On the following day, oc-
curred

Case IV. H. S., cetat. 18, after a day or two of the usual premon-
itories, at 10 A. M., Sept. 10th, 1841, became cold, restless, op-
pressed, with occasional rigors; could not be confined to his room;
lay a few minutes in one bed, and then hurrricd to another, Ex-
jtremities cold to the body, but some morbid heat about the head and
chest. Was put into the warm bath, fainted, and was with some
difficulty restored. Saw him at 6 P. M. Pulse barely perceptible at
the wrist, 150, deep seated, thready and intermitting- skin very
jcold, but much complaint of heat, and sense of suffocation ; frequent'
sighing, and interrupted respiration ; remains but a minute in one
position, and will not be covered ; some watery purging ; countenance
pale, shriveled, and anxious ; eyes suffused and watery ; intellect
good. Ordered, immediately, brandy, camph. and laud., with fric-
tions of dry mustard. Was preparing sinapisms, when the attendants
cried out " lie is dead." On approaciiing the bed, found him moi.
tionless and pulseless; breathing had ceased, and no motion could be
fclt over the region of the heart; jugulars much distended. With
the case of the day before fresh in my mind, I instantly opened a
jugular vein, which bled freely. In about one minute alter the blood
began to ffow, the patient breathed, and the pulsations of the heart
were again manifest. Sinapisms, lotions, frictions. Brandy and
water, almost thickened with quinine and camphor, thrown into the
gtomach. In ten minutes he breathed freely, and swallowed with-
out difficulty. In twenty minutes, he spoke rationally and took
readily whatever was offered to him ; pulse could be counted at the
wrist, 150. For some hours he rested well, and hopes were entertain-
ed of successful reaction. lie sunk eight hours after the bleeds

Cas]b V. Sancho, a coloured man, a;tat. 35, taken on the 4th
Sept. '42, without any premonitory symptoms, and soon sunk into
collapse. Saw him at 10 P. M, 8 hours after access. Insensible;
low muttering delirium, and rolling on the floor, but now quiet; eyes
fixed; pulse a mere flutter; breathing laborious and rattling; sup-
posed to be dying,

The brain appearing to be the seat of congestion, he having been
insensible from the access, opened at temporal artery ; bled imper-
fectly; opened a jugular ; bled freely, at intervals, for an hour or
two, with marked improvement of symptoms about fjxx ; rubbed
all over with spts. capsicum and mustard ; cold dash to head,
sinapisms to feet ; stim. enemata; spts,, (hud,, cam[)h., liberally, In
the course of 12 hours, one drach. calomel had ostablished free secre--

1848.] Ohserv(Uion$ m Cong^jstive jE^aper. 00 \

tion from the liver and bowels ; reaction took place ; a common remit-
tent followed, which yielded to ordinary remedies.

Although a few cases like the above, have induced me
favorably to regard bleeding from the jugular vein, in desperate
cases of congestive fever, or in which congestion of th^ brain
exists, yet am I compelled to regard the use of the lancet, in
this malignant form of miasmatic disease, as a most hazarcfbus
and often fatal practice.

During the progress of reaction from a congestive chill, in-
flammation of the stomach, liver, or other important organ,
sometimes makes its appearance, accompanied by fever of
high excitement, as a sequela of the engorgement of these
organs. Such cases may require topical, and if the inflammato-
ry symptoms run high, general blood-letting. But while the
distinctive symptoms of congestion remain, while there are
great restlessness and oppression, quick, intermitting or com-
pressible pulse, laborious breathing, especially if there is no
congestion of the brain the lancet should not, for a moment,
be thought of. Even where the symptoms have, in a measure,
given way, and reaction been partially established; when the
heat becomes equalized, oppression alleviated, pulse full, and
slightly resisting even then, a small bleeding may, and a large
one will, almost inevitably, bring on a rapid and fatal col-
lapse.

There is yet another condition that deserves marked atten-
tion, because it is so likely to betray the young practitioner
into the use of the lancet. It is when a congestive attack has
yielded to the influence of quinine ; reaction appears to be com-
plete, natural temperature is restored to the surface, pulse be-
comes full and flowing, with a peculiar swell under the finger,
and slight sensation of resistance. At the same time there is
a feeling of restlessness and apprehension ; dull headache, with
fullness of superficial veins. The patient complains of oppres-
sion, and often requests to be bled. Open a vein, and the blood
flows freely, looks dark and thick. When eight or twelve
ounces have^ been drawn, the bleeding suddenly stops, the
venous fullness has left the surface, which becomes pale and
shrunken ; the pulse quick and thread-like ; an indescribable
sense of sinking comes over the patient ; he cannot be con-
trolled, but tosses in bed, or rises to his feet and falls. In a
few hours death closes the scene. At other times you may
bleed freely, in such cases as the above, with relief to the head,
and no perceptible ill eflects for one or two hours after the
bleeding, and when you begin to congratulate yourself upon
your success, the patient becomes faint, nausea and vomiting
fjliow, and a few hours may close the scene.

002 Observations on Congestive Fever. [October,

In this latitude, fevers of any kind do not bear the lancet
well. Congestive fever does not make its appearance till the
system is greatly weakened by long-continued and excessive
heat. When it has made its attack, the vital force is very
much exhausted, and the patient is fast falling into collapse.
In such a case as this, I would earnestly say to my young pro-
festional brethren Beware of the lancet ! Be assured, without
proving by sad experience, that the lancet, instead of being
''the anchor of hope" is, emphatically, the sickle of death in
congestive fever.

Emetics are decidedly hurtful in congestive fever, unless it
be to unload the stomach at the onset, and this nature rarely
leaves for the physician to do. When necessary, mustard, or
ipecacuanha in an infusion of capsicum, is to be preferred. In
most cases, irritability of stomach is a most troublesome ^
symptom, which emetics tend to excite and to aggravate, rather
than to allay. Nothing, perhaps, except the lancet, is more
effectual in driving i^ito hopeless collapse a case of congestive
fever, than an emetic, and especially an antimonial one.

Cathartics of a drastic or hydragogue character, are scarce-
ly less objectionable than emetics. The very worst con-
sequences may always be expected from their use. Collapse,
fatal, if not speedily remedied, is often the consequence of an
active cathartic. This tact, and .the treatment necessary to
insure reaction, may be more clearly illustrated by an ex-
ample.

Case VI. Mr. L., planter, ret. 40, bad chills, followed by somo
fever; with dull headache, inability to walk without reeling, and
sense of falling forward. Before the third paroxysm, took a dose of
jalap and crem. tart., which operated copiously. In a few hours,
chill came on ; no reaction ; purging still continued. Sj)ent a restless
night.

Sept. I9tl), 1842. Saw him at 9 A. M., day after the cathartic.
Catharsis still continued ; surface cold and damp as marble in the
morning dew, yet complaining of intolerable heat : pulseless at wrist;
great anxiety ; cannot rest a minute in any position ; will not sutler
tbe lightest covering; great thirst drinks and rejTccts ; delirious,
pulling at the bed, and catching at the air; will not allow himself
rubbed; tears olf all applications; capillaries congested; surface
purple.

Gave at once 40 drops of laudanum, 10 grs. sulph. quin., 2 grs. g.
camph. in brandy and water. Cold affusions. Repeated the quin.
and camph. in one hour, afterwards, every two hours. Catharsis and
emesis ceased ; skin .soon became warm, and resumed its proper
colour; puKse returned to the wrist. In six hours, he was restored
to his proper .senses, and a calm sleep followed. He was kept fully
under the influence of the quinine, about 2 grs. per hour, for forty-

1848.] Observations on Congestive Fever. G03

eight hours, when a mild laxative of rhubarb and magnesia completed
the treatment. No chill or fever foJovved.

And yet, cathrtics of a proper character are valuable in con-
gestive fever, and in some cases indispensible. If the patient,
after the first paroxysm, be put promptly under the influence
of quinine, and so continued for iorty-eight hours, or until the
time for a second paroxysm has been passed in safety, a
mild cathartic or two will complete the cure. But when two
or three paroxysms have elapsed when the viscera become
engorged with blood,, secretions vitiated or suppressed, tongue
furred in these cases, more active cathartics are necessary.
Everything, however, depends upon the character of the ca-
thartic, and the manner of its operation. While a dose of
active medicine, causing free watery purging, would, if uncon-
trolfed, be attended with dangerous, if not fatal consequences,
that remedy which acts upon the liver in the production of
dark, consistent bilious opeiations, is full of hope. In the
fulfilment of this important indication, nothing is so much to be
relied upon as a mercurial. Let this secretion be established
by the use of calomel, or blue mass, and milder means, as rhu-
barb and magnesia, may be substituted.

Quinine is fully proved by experience to be ihe great remedy,
in all cases of marked periodicity, and emphatically so in con-
gestive chills. At what time it should be administered, is no
longer a question. No time should be wasted in useless efforts
to prepare the system for its reception. The patient should be
put promptly under its influence, and continued under it until
all fear of a congestive chill has passed. What quantity should
be given is not now so important a question as it was once
held to be. The effect is a vastly more important consideration
than the amount of the remedy necessary to secure that ellect.
Five grains will do as much in one case, as twenty in another.
In the same case, five grains will aflx^ct as much at one time, as
twenty grains at another time. Miasm is a poison that acts by
depressing the vital force; but as a given amount of miasm
will not produce the same degree of prostration in all persons
who are subjected to its influence, so will not the same dose of
quinine be attended with similar results in all cases. The
quantity must be proportioned to the susceptibility of the ner-
vous centres to be acted upon, the aptitude of the vital tele-
graph to convey the impression, and the venous and nervous
congestion to be overcome.

When a well-marked case of congestive fever, or one of a
doubtful character, presents itself, five, ten, or, if it be an urgent
case, twenty grains of quinine ought to be administered at
once, and repeated very hour or two, till its characteristic

C04 Ohsei'vations on Congestive Fever. [October,

effects are manifest. This being clone, the pulse becomes more
firm, and somewhat flowing, with a peculiar swell, regular,
and twenty or thirty beats in the minute less frequent; the
tongue becomes moist, and less pointed; skin dry and warm,
or, if there has been morbid heat, the surface becomes pre-
ternaturally cool, the intolerable inward heat and oppression
greatly mitigated, headache and restlessness in a measure re-
moved ; patient becomes calm, and perhaps sleeps. When
the system comes fully under the influence of the remedy, its
peculiar action on the brain is made known by a sense oi" full-
ness and ringing, or roaring, in the ears. This state of things
being superinduced, two or three grains per hour, or four grains
every four hours, will be suflicient, in most cases, to guard the
patient against another paroxysm. An hour or two, however,
before the chill is anticipated, a larger dose should be adminis-
tered. Much care ought to be taken that the eflects of the
remedy be not sulfered to expire, till all fear of a chill has passed.
If general reaction be established, breathing free, circulation
vigorous, sensorium undisturbed, little danger need be appre-
hended, for the case is safely under the control of the remedy.
If the hour at which the previous chill occurred, be safely
passed the following day, there is strong hope that no other
paroxysm will follow. And if the same hour be passed the
third day, in safety, that ho]je becomes confirmed. A mild ca-
thartic, and a few more grains of (piinine, will comi>]ete the cure.

It sometimes happens that quinine causes an almost uncon-
trollable irritability of the stomach, and at other times, a very
disagreeable fullness of the brain, and ringing in the ears,
seeming to spend its force upon the brain, without influencing
the circulation. In the former case, I usually add \ gr. of
morphium, and in the latter, a giain or two of ipecac. In cases
where quinine seemed inadmissible, 1 have substituted, with
happy consequences, a combination of camphor and opium,
with a small portion of ipecac, in brandy, if the stomach will
bear 'it. I seldom risk the case w^ith a single remedy, but
prefer the following combination: IK S. quinin. grs. iv ; g.
camph. grs. ij ; pulv. ipecac, gr. ss ; g. opi. gr. \, to be taken
every two hours ; varying the proportions, of course, to suit
the case.

When taken in large doses, by a person in health, quinine
increases the frequency of the pulse eight or ten beats in the
minute, augments its volume, and gives to it a peculiar and
somewhat resisting swell, not readily mistaken by one accus-
tomed to it. Give one or two grains to a man in open fever,
and you add to the excitement, and sometimes bring on head-
acheand slight delirium, as I have seen. Give ten grains iu

1848.} Observations on Congestive Fever. 605

such case, and you allay febrile excitement, have a full, flowing,
quinine pulse, cool, moist skin, sensorium clear, and no
complaint of heat or thirst. This is one of the great peculiari-
ties of this medicine. Give ten or twenty grains to a patient
in congestive chill, or in that stage when a feeble effort, is being
made at reaction, and in an hour or two the pulse will be found
lessened in frequency twenty or more beats in the minute, but
much increased in force and volume; with abatement of all
the urgent symptoms. The good effects of a single dose will
sometimes be felt for twenty-four hours, or longer; and in
some cases, no repetition of the remedy will be found necessa-
ry. Instances similar to the following abound in my note-book.

Case VII. Dr. H., aet. 35, full habit, good temperament, had
been for some days labouring under remittent fever, which had
assumed a congestive character. A crisis was approaching about 6
P. M. Had been taking calomel 20 grs., s. quin. 5 grs., g. camph.
2 grs., every two hours through the day, with no sensible effect;
sinking hourly. Pvlet his attending physician, who had been with
him all day. and who was so fully convinced that the patient must die,
that he would not return with me.

Found him, at 6 P. M., covered with a cold, clammy sweat ; ex-
tremities cold to the. body ; some morbid boat about the chest ; pulse
a mere flutter, not to be counted; skin purple; impression of the
finger remains a minute or more; great restlessness; oppressed and
laborious breathing ; tongue furred, leaden colour, pointed and
clammy; intellect somewhat wandering. Mixed 20 grs. quin. in
half a tumbler of brandy and water. On being raised from his
pillow, made a hasty and rather convulsive effort to swallow, spilled
one-half, rejected what he had swallowed, and fell back, exhausted.
Having in my hand another portion of twenty grains, put it into the
tumbler, which still held some grains of the first, and gave it all, with
some difficulty, in cold water.

In twenty minutes, the circulation was under the influence of the
quinme, and the pulse, in a few hours, became distinct. For thirty-
six hours, the peculiar effects of quinine, a swelling pulse, with
tingling in the ears, continued, although not another grain was given.
One hour after the quinine, the patient swallowed 100 grs. cal.,
which dose was repeated in three hours. Before morning, black bile
was discharged freely, and the ursjent symptoms gave way. Some
days of fever, of a remittent type, followed, which yielded to the usual
treatment.

I am by no means persuaded that quinine is a harmless
agent, and may be given, in almost any quantity, without
producing hurtful consequences. When pushed too far,
painful fullness of the brain, alarming sounds, and ringing in
the ears, deafness, slight deliriuin, twitching of tendons and
hiccough, will be some of the consequences. Caution must,

6W Ohsei-vations on Congestive Fever. [October,

therefore, be exercised, not to push this valuable remedy too
far. Overwork ihe brain, and the vital powers may become
exhausted by too long-continued and excessive action. In this
way, I have no doubt, frequently repeated heroic doses of
quinine exhaust the vital powers, cause indirect debility, and
thus hasten that very collapse which quinine, judiciously ad-
nnnistered, is so well calculated to avert.

In like manner, brandy, and other stimulants, though val-
uable in supporting the vital force, and preventing collapse, or
in arousing the system from that state, and for such purposes,
may be given in large quantities; yet may they be pushed too
far, or be continued too long; and thereby aid in producing that
condition which they were intended to prevent. They are
useful, and may be given liberally, while they act in harmony
with the system, quiet the' stomach, soothe the brain, and in-
vigorate the circulation. But if they cause nausea, pain in the
stomach, headache or symptoms oi' intoxication, they should
be used more cautiously, or be discontinued altogether. A
patient who may have* borne a pint of brandy in twelve hours
before reaction, may not bear an ounce afterwards. The
same observation is applicable to quinine. Although twenty
grains of the sulphate may have been taken, with the most
ilecided benefit, in a case of collapse, or in a case of conirestive
chill threatening collapse, yet, when reaction has been establish-
ed, one grain may be sufficient, and even that not always re-
quired, and sometimes hurtful.

Cahmel, as has been observed, is often useful, and sometimes
indispensable. If, by the timely exhibition of quinine, conges-
tion be broken up, and reaction fully restored at an early stage
oi^ tlie attack, little further treatment will be needed. But
when reaction is incomplete, with vitiated or suspended secre-
tions, calomel should be given, so as to act upon the secreting
organs, and chiefly upon the liver. Let this action be made
known by the appearance of dark vitiated bile; let it be con- -
tinued by moderate doses of calomel, or rhubarb and blue mass,
till the secretions becomes he;ilthv, and the patient is safe.
]^et the vital force be sustained bv the use of quinine, and if
there be not congestion of the brain when the bile begins to
flow, the danger is passed. At least, I never saw a case that
did not, under such circumstances, recover. The dose of
calomel is to be decided by the necessities of the case. In a
majority of cases. 10 grs. every two or three hours will be
sullicient. ^. Calomel grs. x; quin. grs. v; ipecac, gr- j ;
morph. gr. j; pil. hydrag. q. s. Ft. pil. sum. quart, hs.

In many cases, quinine cannot, for a moment, be retained on
the stomach. Roll it in blue mass, and the difficulty is some-

1848.] Observations on Congestive Fever. G07

times obviated. Administer largely per enema. Draw a
blister speedily, and dress it with quinine. The system may
be brought under its influence, and the patient saved.

But quinine, like all othe*' remedies, will sometimes fail us.
Twenty, forty, or one hundred grains may have been taken.
Its action on the brain may be apparent. Strange sounds
distract the ears. The patient may imagine himself in a thun-
der-storm, with lightenings flashing in his closed eyes, and burn-
ing in his brain, and still be sinking all the time. The remedy,
pushed too far, is doing mischief Failing to counteract the
disease, it has attacked the vital organs, and is prostrating still
further the vital force. A grain of morphine will not give a
moment's rest. Diffusible stimuli only add fuel to the flame
that burns within, and are immediately rejected. Rubefacients
have been used till the skin is sore; and the capillary vessels
congested till the surface is purple. The patient rolls from
side to side, and throws his limbs in every direction ; calls for ice
or cold water, which is rejected as soon as swallowed ; calls
upon the attendants to fan him, and to- sprinkle water on his
face, to save him from dying. What, under these alarming
circumstances, is to be done ? I know of nothing better and
the emergency has often presented itself to me, in all its fearful
realities I know of nothing better than large doses of calomel,
repeated every two hours till a decided impression is made ;
accompanied, at the same time, with the cold dash, or cold
affusions. The case, as supposed, though alarming, is not
altogether hopeless. A large dose of calomel, when swallowed,
Avill be retained. These doses do not, in such cases, purge
actively. So soon as their influence is felt upon the system,
the patient becomes more quiet, complains less of heat; while
the surface becomes warmer, heat more generally difl^used,
pulse stronger and less frequent. Free hepatic secretion is
concomitant with, or soon follows, this state of things. Much
smaller doses, or milder means, may be sufficient to keep up
this action. Let this be done, and with ordinary prudence, the
patient will recover.

Ptyalism I do not regard with favour. Salivation will not
arrest a congestive chill, as I have experienced in my own
case.

Rubefacients, sinapisms, lotions, spts. turpentine, should be
promptly and perseveringly applied to spine, epigastrium and
extremities. If the patient will sufler no applications, rub him
well with dry mustard, or spirits and capiscum, or spts. turpen-
tine. If he will lie on hfs back, apply a sinapism, or flannel
roller wet with spts. turpentine, the full length of the spine.
The following case may serve, among other purposes, to show
the value of persevering in the use of external means.

608 Observations on Congestive Fever. [October,

Cask VIII. L). S., a?t. 8, cold stage, P. M. 8th Sept., 1841, fol-
lowed by hii!;h excitoim-nt, .whicli soon, and suddenly, ceased, and he
became coid and pulsieless. Stiniulanls were resorted to.

9th. Saw him at '2 A. .M., for thejirst time. Pulse thread-like
and irregular, 1130 to 140; tongue dry, pointed, leaden hue, red
edges; delirium; muttering; distress; skin cold and clammy; some
morbid heat in the head; great thirst; rejects everything that is
swallowed; remains but a few seconds in one position. On moving
from side to back, or vice vers&,, breathes six or eight times, hurried,
half-inspirations ; ceases to breathe from eight to twelve seconds,
then draws a large inspiration, mutters, or calls out incoherently,
and changes position, ft. Statim. cal. grs. xx.; quin. grs. ij ; g.
camph. gr. j. Sinapisms, frictions.-*-Calomel grs. v ; quin. gr. j ;
camph gr. ss ; carb ammon. gr. ss ; 2 hs.

4 P. M. Worse. Pulse 'fluttering, and too indistinct to be counted;
sub. tend., singult., picking at the bedclothes, apparently moribund.
Gave morph. gr. i in brandy. Rub him all over with hot medicated
spirits, and spts. turpentine, and apply mustard poultices to extrem-
ities and epiga^strium. R. Cal. grs. XX ; ipecac, gr. j ; morph. gr.
I ; mass, hydrarg q. s. JPt. pil. sum quart, hs. Camph. quin , C.
amnion., aa gr. i ; sum. uterq. hora. Cold dash, and cold applications
to head. Warm bath, fainted ; restored with difficulty.

10th. 8 A. M. Has not rested five minutes through the night. No
improvement in any of the symptoms; low delirium, mutters, and
occasionally cries out. Cadaverous look and smell. Sponge him all
over with the medicated spts., and envelop him bodily in a strong
mustard poultice. Continue treatment. 6 P. M. Sleeping. Several
discharges of black bile ; feet warm, but hands and arms cold, though
not so dam]); pulse 130, regular; tongue moist; respiration 30,
regular. Slept one hour; the first rest for as mtich as live minutes,
for 48 hours, ft. Compound cal. pil. every -I hs., and comp. quin.
pil. every two hs. Continue poultice.

11th. 8 A. M. Rested. Slept 2 hours; warm; pulse 120, regular,
more soft and full; tongue moist and furred; slight ptyalism. Four
free discharges of black bile. ft. Pil. rhei., chicken water, rice
water. 12th. Much better. Dark bilious matter copious. Continue
treat. 13th. Convalescent.

Anodynes are peculiarly serviceable in fliis form of fever.
Opiates are best ; and no article of this class can give more
satisfaction than the salts of morphium. In easing pain, in quiet-
ing intolerable restlessness and anxiety, in mitigating bodily
and mental anc^uish, in superinducing temporary forgetfulness
of suffering and danirer, in soothing nervous irritability, in allay-
ing spasm, and thereby removing impediments to reaction, and
thus promoting secretion, morphium has no rival, and may just-
ly be called "the divine remedy." A compound of ipecac, gr.
j, s. morph. gr. J-, given with calomel, promotes its action; with
quinine, it is peculiarly useful in obviating, or in mitigating the

1848.] Observations on Congestive Fever. G09

unpleasant effects of that remedy on the brain and nervous sys-
tem. There are but few cases of congestive fever v^hich are
hot, at some period of their progress, largely benefitted by the
use of morphine. Where continued irritability of stomach ex^
ists, it may be introduced by enema, or Used endermically.-
Care should be taken that an over-dose be not administered, in
this tvay, as I have seen one grain, applied to a recently blister-^
ed surface, cause decidedly narcotic effects.

Cool acidulated drinks, ice water, lumps of ice, juice of acid
and sub-acid fruits, as lemons, oranges, pomegranates and
grapes, are veiy useful in aillaying thirst ar^d mitigating inter-
nal heat.

The Cold Dash, or cold ba:th, as a remedy in this fever, yet
remains to be noticed. In miasmatic fevers of high excitement^
especially where there is much determination to the head, there?
can be but little doubt of the good effects of the cold bath. But m
fevers of a congestive type, where the extremities are cold, it^'
propriety becomes more questionable. In these cases, I make
the feelings of the patient my criterion. If I find morbid heat
about the head and chest---if cool drinks are grateful to the stom-
ach, and cold applications cause a pleasaftt sensation, I use the
cold bath or cold effusions freely. But wbere they cause, as
they sometimes do, a disagreeable chilly feeling, I contiifme hot
applications and frictions.

Having decided upon the use of the cold bath, if the patient
is able to sit up, he is placed over a large vessel, with his feet
in Water as hot as he can well bear it, and cold water poured
freely over his body, till he complains of feeling cool. If not
able to sit up, he is placed on a mattress, or on thick blankets,-
warm applications are made to his feet, and cold water poured!
freely and steadily over his body for five minutes or m'ofe.-
Nothing can be more refreshing. On being replaced in dry
sheets, he rests more quietly, and sometimes sleeps ; perhaps ai
healthful glow appears on the surface, and his condition is favor-
able for the action of medicine. In obstinate cases, to secure
the good effects of the cold bath, it must be frequently repeated;
or the patient may be for some time enveloped in sheets wrung
out of cold water.

Case IX. Mary J., get. 14, bilious-nervous temperament, aftef
some days of languor and oppression, with some chilliness, ^^'as at-
tacked on the 7th Aug., '47 ; cold, but complained of great heat. Dark
green matter by catharsis, yellow by emesis. Was raised i'n bed,
fainted, and continued extremely faint, and much oppressed irt bTeath--
ing, with nausea.

5 o'clock P. M. Pulse thread-like, one hundred and eighty to the
minute, at times not to be felt at the wrist ; tongue clammy, leaden

39

610 Observations on Congestive Fever. [October,

centre, pale edges; skin cold and damp; complains of heat; frequent
rolling of head and tossini^ of limbs ; dullness of seeing and hearing ;
intellect dull. R. Statim, s. quin. grs. v ; s. morph, gr. \ ; g. camph.
gr. j ; frictions, sinapisms. R. Quin. grs. iv; camph. gr. j, every
hour cal. grs. iv ; ipecac, gr. j ; morph. gr. \, every 4 hours.

8th A. M. Passed a restless night. Pulse 1(30, otherwise as before ;
no action on bowels; nausea subsided; tongue dry; skin soft and
natural; pupils dilated; dullness of senses and restlessness as before ;
respiration oppressed and irregular 4 to 6 half inspirations, and then
a full one, at which the patient opens her eyes wide, and changes posi-
tion. R. Quin. grs. v; camph. gr. i, every two hours. Caloniel
and camph. as before. Sinapisms, frictions.

P. M. No marked alteration. Continue treatment.

Eccht/mosis in all the dependent surface, from head to foot. Back,
thighs, &c., of dark blue ground, with black splotches covering near
half the surface. Frictions, spts. turpentine, and ess. oils.

9th. Passed a restless night. Slight delirium. No abatement or
alteration worth noting. Continue treatment. P. M. Considerable
excitement. Pulse of more force, but irregular, 144 ; breathing much
oppressed. Skin dry and very hot so much so as to be painful to the
touch. Tongue and fauces dry, much thirst ; no action on bowels ;
cannot rest two minutes in one position. Cold applications grateful.
Cold bath, by placing the patient in sheets that had been dipped in
cold spring water, and covering well with blankets; hot applications
to the feet; considerable shock. At first, respiration short and inter-
rupted; in ten minutes, patient became composed ; in fifteen minutes,
slept calmly; respiration regular and free, 22 ; pulse more distinct
and regular, 120. Repeated afiusions. Slept 30 niinutes. Remain-
ed in bath 90 minutes. Complained of feeling cool; surface still
warm. Wiped with warm towels, and put in dry sheets. Felt more
comfortable, and rested better. R. Cal. gr. x, spts. nitre. One
hour after the bathing, perspiration general and warm. Rested tol-
erably well through the night.

10th. Pulse 120, full and regular; tongue moist; senses normal;
some bilious stools 5 through the day. R. Quin. grs. iv, every 4
hours. Rhubarb and magnesia in small doses.

11th. Slept two hours at a time through the night. Three stools of
bilious character ; pulse 95, full and regular; skin warm and moist;
tongue nearly clean ; ecchymosis red, absorption going on. R. Quin.
grs. iv, every 6 hours ; magncs. nocte.

12th. Convalescent; ecchymosis disappearing; soreness in the
limbs, and along the large muscles ; secretions free and nearly normal.
Convalescence rapid. No ptyalism.

The cold dash in cases of collapse, and in congestive fever
falling into that state, is a bolder practice. Jn such cases, it ap-
pears to act revulsively, through the capillary nerves, on the
brain and ganglionic system, arousing them to renewed action,
as in case of catalepsy. Be this as it may, 1 have often had

1848.] Tirne of the Action of Foison. OH

recourse to its use, and have in no instance had cause to regret
the practice. It aids powerfully in arousing capillary circula-
tion, in equalizing heat, in quenching the fire that burns within,
and restoring warmth to the surface. I offer a case by way of
illustration.

Case X. Esther, a colored wontan, aged 35r ; chill 7th Aug., ^40 ;
little or no reaction ; great restlessness ; copious sweat. As most of
the family were down with fever, and not enough well to wait on the
sick, no further note was taken of this woman, till I found her, on the
9th, collapsed, cold, clammy, pulseless, delirious, rolling on the floor ;
tongue pale and pointed; respiration hurried and laborious. Gave,
with some difficulty, twenty grains of quinine.- Had her laid on
boards, and ten gallons of cold spring water poured over her in about
five minutes, then rolled in dry blankets. In half an hour, there were
decided symptoms of reaction. In four hours, the quinine and cold
dash were repeated ; in four hours more, warmth was restored to the
surface; pulse 108; resting well. R. Quin. grs. iv ; camph. gr.j;
ipecac, gr. ss, m. sum. 2 hs. Kept the patient under the influence
of the quinine for 48 hours, when a small dose of rhubarb and magne-
sia completed the treatment. No return of chill of fever.

Whether or not the cold dash in such cases as the above, un-
aided and alone, would bring afcout successful reaction, must be
decided by a bolder practitioner than I am, while I hold in my
hand such a remedy as quinine. I have found nothing more
efl^ectual in arousing the circulation in cases of collapse ; for
which purpose it may be again and again repeated. Especially
is the colcl dash serviceable in cases attended with great irrita-
bility of stomach, or where quinine determines too powerfully
to the brain, or where there is much morbid heat about the
head and chest. In such cases it acts more promptly, and per-
haps more vigorously, than hot applications. Nor are they at
all incompatible with each other. Nor is the cold dash incom-
patible with the vigorous use of calomel. On the contrary, it
promoted the action of that remedy, by bringing the system to
a proper secreting point, and by sustaining the vital force,- till
the calomel has time to act. It was my intention to introduce
some cases illustrative of the foregoing remarks, but my essay
has already reached the limit which I had prescribed to' it.

Time of the Action of Poisons taken internalJi/. (British ancf
Foreign Medico-Chirurgical Review.)

The time required for the action of poisons taken into the
stomach, however, is subject to very considerable variation ;
the difference being dependent on the rate of absorption, whicb
is modified by the state of the stomach at the time, that medi-

612

Time of the Action of Poisons. [October,

cines as well as poisons act most quickly and certainly, when
taken upon an empty stomach, has lonir been known ; and there
have been cases in which the action ol' large doses of powerful
poisons has been remarkably retarded, apparently from the re-
verse condition of that viscus. Much light has been thrown
upon this question by the observations made not long since by
Mr. Erichsen, in a case of extroversion of the bladder, which
enabled him to collect the urinary secretion directly as it pass-
ed from the kidneys. His first set of experiments was on the
ferrocyanide of potassium, which, being swallowed in solution,
v^as immediately looked for in the urine, and was detected in
periods varying, as shown in the subjoined table, from one min-
ute to thirty-nine minutes. It will be seen, by an inspection of
the table, that the earliest appearance of the salt was always
when the stomach was empty, and the latest when it was full.

EXPERIMENTS WITH FERROCYANIDE OF POTASSIUM.

Nature of last Meal.

No. of Ex-

Quantity

periment.

taken.

1

20 r rains

2

40 -

3

40 "

4

40 "

5

20 "

6

30 "

7

40 "

8

40 "

9

40 "

10

40 "

When first ap-

When last

peared in urine.

menl taken.
2 hours

12 minutes

2

4 "

6J -

U "

2 -

Hi "

1

11 "

16

24 min.

2i "

4i hours

14

1 hour

27

2 min.

39 "

2 "

Meat, potatoes and bread
Bread and butler, and coffee
Mutton, bread and butter, and tea
Potatoes

Bread and butter, and tea

Plum-pie

Bread and butter, and tea

Bread and butler, and tea

Mutton, bread, and potatoes

A second set of experiments was made with vegetable sub-
stances, of such a character as to pass unchanged into the urine,
and capable of being distinctly recognized there. It will be
seen from the subjoined table that these substances were, on the
whole, much longer in making their appearance in the urine
than was the ferrocyanide of potassium ; but none of the ex-
periments upon them exhibit either the shortest or the longest
periods, as the observation was in no case made immediately
after a meal or after a long fast.

EXPERIMENTS WITH VEGETABLE SUBSTANCES.

No. of Ex-

jieriment.

Substance taken.

Whenftrst
ai)|.'ar('d
in urine.

When last
meal taken.

Nature of last Meal.

11

Infusion of galls

36 min.

2i hours

Bread, meat, and potatoes

12

Ditto

33 "

li "

Bread and butter, and coffee

13

Ditto

30 '

!j "

Bread and butler, and tea

14

Infusion of rhubarb

22 "

2! '

Potatoes and dripping

15

" madder

16 "

3i "

Bread and dripping

16

" uva ursi

35 "

1} "

Bread and butter, and tea

17

Tincture of rhubarb

31 "

2i "

Liver and bacon, and bread

18

Derorl, of lop: wood

19 "

41 "

Bread and butter, and tea

1 848.] Time of the Action of Poisons. G 1 3

It is probable that the state of fuhiess or emptiness of the
sanguiferous system would have a considerable influence over
the rate of absorption, as well from the alimentary canal, as
from any other part of the body. There cannot now be any
doubt that the blood-vessels, rather than the lacteals, are the
channel by which soluble salts, &c., are chiefly taken up from
the walls of the alimentary canal ; the same will be the case
when poisons, &c., are introduced into a wound. When solu-
tions of soluble salts, however, are applied to the skin, they seem
to enter the lymphatics more readily than the blood-vessels ; as
might be anticipated from the vast amount of the former dis-
tributed through its substance, and from the thinness of their
walls. On the other hand, the absorption of poisons in the state
of gas or vapour, through the medium of the lungs, will obvi-
ously be effected by the vast surface of capillary blood-vessels
spread out upon the lining of the air-cells ; and we find, as might
be expected, that volatile substances are more rapidly and ef-
fectually introduced into the circulation in this manner, than in
any other. We have a remarkable example of this, in the nox-
ious effects of even a very minute quantity of arsenic, when it
is inhaled in combination W\t\\ hydrogen. Very frequently, too,
the operation of these substances is modified in a remarkable
manner by this method of exhibition ; thus, ether and chloro-
form, taken into the stomach in a liquid state, do not produce
by any means the same results as when respired in the state of
vapour. These differences are probably to be explained by
reference to the well-known fact, that the chemical operation of
many substances is considerably modified according to the fine-
ness of their state of division. We are not aware that any pre-
cise observations have been made, tending to show adiflference
in the rate of absorption through the lungs, according as the
vascular system is turgid or the contrary ; but there are many
.indications that a deficiency in the fluids of the body greatly
favors absorption of watery vapour from the atmosphere; and
the generally admitted fact, that an exhausted or debilitated
state of the system acts strongly as a predisposing cause in favor-
ing the operation of poisonous miasmata, whilst a state of vigor-
ous health, rather tending to plethora, is equally opposed to
their agency, is probably referable, in part at least, to the same
category. It is a circumstance of much importance, that the
influence of poisonous gases is exerted as well through the skin
as through the lungs ; thus, Mr. Donovan states, that a rabbit,
whose body was enclosed in an atmosphere of sulphuretted
hydrogen gas, but which was allowed to breathe freely in the
atmosphere, perished in ten minutes.

614 Death ill the Pot ; or Adulteration of Food, ^c. [October,

Death in the Pot ; or the Adulteration of Food, 6fC. By John
Mitchell, M. C. S., of London. (From Ibid.)

The f(>lIowing are enumerated by Mr. Mitchell, as the pur-
poses of these adulterations :

"*' 1. To mako the substance more saleable by improving its appear-
ance, by the addition of some body either innocuous or otherwise.

" 2. To depreciate its quality, by adding to it some substance which
will diminish its reed without altering itfe apparent strength or general
appearance. This is generally a very deadly fraud,

"3. To depreciate its quality by the addition of some simple sub
stance, as water, or if it be a solid body, as plaster of Paris, sand, &;c."

As an illustration of the first may be noticed the adulteration
of bread with alum, carbonate of ammonia, carbonate of mag-
nesia, the sulphates of copper and zinc, &c. ; all of which are
employed to improve the appearance of the article, especially
when it is made from inferior flour. Prom the statements of
the author, it would appear that the London bakers' bread al-
most invariably contains alum, in quantities varying from 34|
grains to 116 grains in the 4lb. loaf. As an example ol the
>second, may be cited the adulteration of porter by cocculus
indicus, quassia, &c., which seems to be still carried on to an
immense extent, in spite of very stringent enactments to the
contrary, and the instantaneous conversion of new beer into old,
by the addition of sulphuric acid. And the third is familiar to
us in the watering of our milk, the sanding of our sugar, <fec.,&c.

Besides intentional falsification, our food is subject to receive
contamination from accidental or unintentional causes ; espe-
cially through means of the vessels employed in cooking it.
The first section of Mr, Mitchell's work is, therefore, very pro-
perly devoted to this branch of the subject ; and he then treats
of the impurities to which water is liable. Flour, bread, milk,
beer, cider, wines, spirits, cotlee, tea, chocolate, sugar, honey,,
lozenges, &c., cheese, vinegar, ])ickles, anchovy sauce and paste,
catsup, ojive oil, pepper, n)ustard, and soap (which, although not
an article of food, is placed on the same footing with the pre^
ceding as an article ofdomestic consumption), are then succes-
sively passed under review; the principal adulterations in each
being specified, and an account being given of the chemical
niei'.ns available for their detection. Much useful information
is contained under these heads; but'M'c think that the work is
very capable o\' improvement. Several of the chemical pro-
cesses are insufficient for their purpose ; others are needlessly
complex ; and a great degil of troublesome analysis might, in
many iufet^ances, l)e saved by the sitnple appeal to microscopic
evidence, eK])ecially in tjie case of substances in })owder, Thus

1848.]^ The Value of Human Excreta, 615

flour may, by its means, be detected in milk, sugar, mustard, &c.;
potato-meal in flour, bread, tapioca, sugar, &c. ; factitious in
real pepper, red lead in cayenne pepper, &c. The following is
a curious and not* unimportant fact, showing an unexpected
source from which contaminations may be derived, and of inter-
est also in a physiological point of view.

" M. Coulier, inspector of police, having purchased some bread, sub-
mitted it to chemical analysis, and, to his astonishment and horror,
found that it contained traces of mercury. At first he thought he was
deceived, made a second and a third analysis, and with the same re-
sult. M. Coulier, on this, made the strictest inquiries at the baker's,
and found that one of the workmen employed was laboring under a
frightful disease, requiring the exhibition of mercury ; and the mercu-
ry existing in the bread had proceeded from the arms of the man in
question. Although the author has never met with bread thus con.
laminated, it is very probable indeed that much of the same kind is
distributed from the same cause in London."

[We doubt this being the source of mercury in this case. Edt.]

We add the following, as a matter of more practical import-
ance :

" The author has also examined buns and other pastry obtained
from various shops in the metropolis, and in many of them, mora espe
cially, he has found alum, plaster of Paris, chalk, and sand, in very
large proportions, far greater than in bread, in one bun alone, the
author found as much as three grains of alum and ten grains of chalk."

Such adulterations are, of course, the more to be deprecated
on account of the deleterious effects which they may produce
upon children, who are the chief consumers of such articles.

We have little doubt that a far greater amount of disease
than is generally suspected, arises from contaminations of food
and of water;, and our readers will render good service to the
public, if they will apply their chemical knowledge to the detec-
tion of these, under the guidance aflforded them by Mr. Mitchell.

The Value of Human Excreta. (From Ibid.)

Of the immense economic value of the preservation of human
excreta, when we are sending whole fleets in search of those of
birds, which consist of precisely the same materials in a less
advantageous form, no thoughtful man can entertain a reason-
able doubt. Various estimates are given by Mr. Ellerman from
different sources, which place this matter in a strong litrht. The
lowest estimate, that of Mr. Smith, late of Deanston, well
known as the distinguished agriculturalist, rates the average
annual value of the excreta of each individual as l ; so that,

010 New Mode of Treating Deafness. [October,

taking the whole population of Great Britain as 28 milHons, we
are positii^ely throwing away Qx^xy year that which is equiva-
lent to iu'cnty-eigJit millions sterling. The actual saleable va-
lue in Belgium of the excreta is 37 shillintrs for each individual ;
and at this rate we may be said to be annually depositing the
worth of fifty-one millions sterling in the ocean that washes our
shores. It seems to us that there is an essential fallacy in all
such estimates of the actual money loss or gain, involved in the
difference between perfect and irTiperfect sanitary arrange^
ments; since it does not by any means follow, that because a
certain quantity of manure W'ould at present fetch from 20 to
37 shillings, the same quantity multiplied twenty-eight millions
of times woujd have a value twenty-eight million times as great,
But the immense importance of preserving human excreta, and
of applying them to the production of food, is perhaps better
understood from the ascertained results of their employment in
agriculture. According to Dr. Lyon Playfair, a pound of urine
^s capable of increasing the production of grain by an equal
weight ; go that, even allowing for some exaggeration in this
estimate, the human urine at present wasted in this country
would serve to produce more than all the grain required for the
consumption of its entire population, besides affording, through
its fertilizing influence on lands at present im})erfectly tilled or
not tilled at all, a source of employment to our superabundant
population- We cannot too strongly urge an alteration of our
present system, by the introduction of some general system
for the profitable application of sewage-manure, which shall be
encouraged if not enforced bv the legislature, as one of the
most important measures of public economy, and as likely to
conduce more, if fully and effectually adopted, to the support of
our national prosperity, than any other, affecting its material
elenients alone, to which public attention has yet been directed,

New Mode of Treating JJeafness. (Boston M. and S. Jour.)

[The following is a brief extract from several papers which
have appeared recently in the London Lancet, written by
.lames Yearsjey, Esq., Surgeon to the Metropolitan Ear
Institution. The Editor of the Lancet has seen the remedy
ap[)ljed, with con^plete success, in cases of apparently incurable
deafness.]

Jn 1841, a gentleman came from New York to consult me
under llu^ following circumstances : He had been deaf from
an early age, and on examination, I found great disorganization
of the dium of each ear. On my remarking this to him, he
replied, "How is it, then, that, by the most simple means, I

1848.] New Mode of Treating Deafness. G17

can produce on the left side a degree of hearingquite sufficient
for all ordinary purposes ; in fact, so satisfied am I with the
improved hearing which I can myself produce, thnt I only
desire your assistanc-e on belialfof the other ear." Struck by
his remark, I again made a careful examination of each ear,
and observing their respective conditions, I begged him to
show me what he did to that ear, which I should unhesitatingly
have pronounced beyond the reach of remedial art. I was at
once initiated into the mystery, which consisted of the insertion
of a spill of paper, previously moistened at its extremity with
saliva, which he introduced to the bottom of the meatus, the
effect of which, he said, was " to open the ear to a- great in-
crease of hearing." This improvement would sometimes con-
tinue an hour, a day, or even a week, without requiring a
repetition of the manipulation. Such an interesting fact could
not fail to excite my attention, and it naturally occurred to me
to try so simple a method in other cases. I did so in several
which appeared to me to be identical with that of my patient,
but I invariably failed. I was on the point of abandoning the
idea that the remedy could ever be made available in practice,
and of considering either that my Amjcrican patient's case was
unlike all others,, or that it depended on some idiosyncrasy,
when it happened that a young lady came under my care, by
the recommendation of Mr. Squibb, Surgeon of Orchard street.
She was the daughter of wealthy parents, whose anxiety for
her relief was so great as to induce them to bring her to me
long after I had discouraged their visits, and openly expressed
my inabiliy to relieve her. She had become deaf at a very
early age, after scarlatina, which had produced disorganization
of the drum of each ear, and the deafness was extreme. Un-
willing, however, to abandon hope, her friends continued to
bring her to me, in order, as they said, that "nothing might be
left untried." With liiLtle expectation of success, after so
many previous failures, I was induced to apply the new
rjemedy, with some modifications upon my previous experi-
ments. Instead of adopting my American patient's plan, it
occurred to mie to try the effect of a small pellet of moistened
cotton wool, gently inserted and applied at the bottom of the
meatus, so as to come in contact with the small portion of
membrane which still remained. The result was astonishingly
successful. On the evening of a day, in which she had risen
from her bed with the sad reflection that she must be forever
debarred from social converse and enjoyment, she joined the
family dinner party, and heard the conversation which Avas
going on around her with a facility that appeared to all present
^uite miraculous. Day after day the remedy was applied with

G18 Ectrotic Treatment of Small-Pox. [October,

the same marked success, and eventually she learned the art of
applyinix it herself, and thus became independent of me. It
was observed that, until the wool could be brought in contact
with a particular spot at the bottom of the meatus, the hearing
was not at all benefited, on the contrary, was prejudiced; but
the moment it was properly adjusted on that particular spot,
the hearing was restored. Subsequent experience, in a vast
number of cases, confirms this remarkakle fact. It is not
merely necessary to insert moistened cotton wool to the bottom
of the meatus. Such a manipulation would in most cases add
to the deafness. It is essential to find the spot on which to
place the wool, and so adjust it as to produce the best degree of
hearing of which the case may happen to be susceptible. This
of course differs according to the variety and extent of the
disorganization.

Ectrotic Treatment of Small-pox. By James H. Johnson, M. D.
(St. Louis Med. and Surg. Journal.)

"It was my fortune, some three years since, to be associated
with Dr. A. T. Crow, in attendance on small-pox patients in
the pest-house of the city of Galena. During the period of the
prevalence of the disease, we tried many experiments, especially
with the Liquor Hydrariryri, Solution of Nitrate of Silver, and
Labarraque's Chloride of Soda. In four cases, treated at
various periods during the existence of the disease, each pa-
tient separately submitted to the above remedies. The first,
with Tr. Iodine ; the second, Sol. Nit. Argenti ; the third,
Liq. Hyd. Bichloride; and the fourth, Lab. Chloride Soda.
All of the above patients I have repeatedly examined since re-
covery, and find the patient who was under the Chlorine
Medication, the least pitted ; the Iodine patient second; Nit.
Argenti, third ; and the Liq. Hyd. Bichloride, fourth. Each
subject of trial presented all the appearances of distinct small-
pox. However, it is proper to remarkd here, that the external
applications were used daily over the entire body, at an early
stage of the eruption, and were continued until the period of
desquamation. The last and fifth experiment was some months
subsequence to the above. the patient laboring under semi-
confluent variola: that is to say, on the extremities, trunk, (fee,
the pustules were distinct, but the head, face, and neck, pre-
sented the confluent aspect. The general treatment was the
ordinary indications of cure the Ectrotic applications as fol-
lows: the head, face, neck, and the left arm, were bathed from
five to eight times a day with the Lab. Chloride Soda, from

1848.] Digitalis in Infantile Cachexia. 619

the eruptive period nntil desquamation, censed. The distinct
pustules, on each extremity, were perforated and filled, those
on the right leg with Tr. Iodine, on the left leg with Liq.
Hyd. Bichloride, the right arm and chest with the Sol. Nit.
Argenti. On the extremities, every large pustule was per-
forated, and the remedial agents applied, with a common pen,
on three occasions during the maturative period. Some four
months after the recovery of the patient, he was submitted to
a careful examination, and a very material difference was ob-
servable in regard to the size and depth of the pits. The head,
face, neck, and left arm were but little marked (Lab. Chloride
Soda) ; the right inferior extremity, second in order (Tr.
Iodine) ; right arm and chest, third in order (Sol. Nit. Argenti) ;
lei\ leg, fourth in order (Liq. Hyd. Bichloride). The result
of the experiments would seem to indicate that Chlorine, in
this form, displays the most active preventive powers; Iodine,
the second; Nit. Argenti, the third; and Hyd. Bichloride, the
least. When we take into consideration the exposure of the
face to the light, with its local confluency, and then, under the
circumstances, compare the beneficial effects of the Chlorine
with the other remedies, we must necessarily, award to the
former the first rank, as a remedial agent, and to the Iodine,
the second, in regard to its specific action."

Digitalis in Infantile Cachexia. By Dr. Winder, of Mon-
treal, L. C. (British American Journal.

"The remedy to which I allude is digitalis, and its beneficial
influence in cases of emaciation in children, conjoined with
irritation of the circulation, I am disposed to attribute to the.
principle, that while the lymphatic organization requires ex-
citation, the arterial impulse demands restraint. We must
stimulate the one, and depress the other. Whatever may be
the mode of explaining the action of digitalis in the case sup-
posed, I am certain of the fact, that under its use, the quick,
inflammatory, irritable pulse, assumes gradually a slow, equable
character, the lymphatic torpor is overcome, the swelled abdo-
men subsides, and the child, from having been drowsy and
feeble, becomes lively, and comparatively strong.

The following are the formulae in which I have ordinarily
prescribed digitalis for the state of disease, or constitutional
disturbance before mentioned :

1. R Potassae nitratis 3j. Vini antimon. 3j. ; Tinct. digitalis
gutt. xvj.; Syrup, simp.; Aquas purae aa ^j. ; Misce, 3j. ter quo-
tidifi.

C20 Efficacy of Calomel [October,

2. ft PotsscE nitratis 3j. ; Tinct. scilloe 5j ; Finct. digitalis giitt.
xvj. ; Syrup, simp. ; Aqua3 puraB aa j. ; Misce, Dosis 3j. ter quo-
tidie.

The liver in these disorders is almost constantly affected,
and doses of mercurials are frequently called for. Of these
there is none more sure and efficacious, than the hydrarg.
cum creta. Two <?rains of this every night, or every second
night, for a child of two years old, and a drop, or two drops, of
the tincture of digitalis, three times a day, gradually increased
to three or four, will, in general, be found sufficient to produce
a marked good effect in the condition of the patient. When
an aperient is required, the following will be found of ser-
vice :

R Tinct. rhei gutt. xx., Potassae tartratis 3 ss, Aquae anethi ss,
Misce Fiat haustus, mane sumendus; or the powder called by the late
Sir William Fordyce, his "Pulvis Antihecticus et Antirachiticus
Infantum," famed, as he says, " for curing, as if by miracle, the
hectic fever and swelled bellies of children." R Sal. polychrest.
gr. X. Pulv. rad. rhubarb, gran, iij., iv., v., vj., vel vij.; Misce pro
una dosi, omni mane sumend. per 14 dies, vel donee cesserit Febris
Hectica, aut tumor abdominis.

It may be occasionally combined with opium, as in this
formula:

R Digitalis pulv. gr. ij., Calomel, Opii pulv. aa gr. j., Misce et
divide in chart, viij. quarum j. node manoque dand. ; or the medicine
may be given without the calomel, occasional doses of the hydrarg.
cum creta being substituted for it, and an aperient exhibited according
to circumstances.

The use of opium, in young children, requires extreme
caution."

Efficacy of Small and Repeated Do:ies of Cahinel. By Prof.
Trousseau. (Wood's Retrospect.)

Prof T. has been much in the, habit, for some time past, of
administering in acute diseases, as rheumatic fever, puerperal
peritonitis, iritis, &c., minute doses of calomel, and with com-
plete success. He takes one grain of c. and one drachm of sugar,
and divides it into twenty-four powders, one of which is taken
every hour. The same treatment is continued two, three, or
more days, or until the gums are touched. This usually occurs
in 48 hours, and sometimes even in 24 hours, oi* after the ad-
ministration of only one grain of calomel. It is rarely necessa-
ry to continue the powders during the third day.

The advantages of this method are 1. The system is

1848.] The Alphabet of Auscultation. 621

brought under the influence of mercury as rapidly and as cer-
tainly as by any other mode of administering the drug. 2.
The mercurial action never proceeds further than is intended,
and the serious consequences of excessive saHvation are entirely
avoided.

In the treatment of puerperal peritonitis, M. Velpeau for-
merly used large doses of calomel and rubbed in mercurial
ointment very freely, but unpleasant effects often followed
this practice. But of late Prof. T. has adopted the plan of
small and repeated doses, and he is convinced that he thus obtains
all the good, and completely avoids the evil effects of the
remedy.

In chronic diseases the same doses may be giv^en at longer
intervals : tenderness oi the gums vs^ill not probably appear
before the fifth or eight day.

This method of giving calomel originated with Dr. Law of
Dublin, who proposed it a few years since, but it did not at the
time appear to receive much notice. The modus operandi of
this method appears, according to Mialhe, to consist in the
fact that calomel in the stomach undergoes a slow change
before absorption by coming in contact with an alkaline solu-
tion, as that of common salt, which thus partially changes it
into a bi-chloride and metallic mercury. Hence as only small
portions oT calomel can be thus converted, it is immaterial,
so far as absorption is concerned, whether one grain or one
drachm is administered, as in either case the quantity of bi-
chloride formed is the same. According to this view, the ex-
hibition of common salt with the calomel ought to increase its
activity in a marked degree, and perhaps the cases of so-called
idiosyncrasy, w^here a small quantity of chloride has given rise
to severe salivation, may find in this circumstance a rational
explanation.

The Alphabet of Auscultation. (Ranking's Abstract.)

Mr. Corfe gives the following succinct epitome of the princi-
pal stethoscopic indications in pulmonary disease. These are:

Two dry sounds. Rhoncus ; sibilus.

Two moist sounds. Small crepitation; large ditto.

Three vocal sounds, Bronchophony; cegophony; pectorilo-
quy. Thus:

1. Two dry sounds. Rhonchus, or snoring, heard in the lar-
ger bronchi, is produced by an intumescence or oedema of the
mucous membrane of the bronchi, on which phlegm impinges.
This sound occurs especially at the bi'urcation of the bronchi,
where the membrane is bevelled off, and is called by the French

622 The Alphabet of Auscultation. [October

physiologists the "eperons," or spurs of the bronchi. When
the iinizers are spread out, the reflected skin from the base of
one finger to that of the others represents a magnified form of
this reflection of the bronchial mucous membrane. The sound
denotes the existence of bronchitis. The pathological change
abov described, is well exhibited, in other respects, in conjunc-
tivis, when eflxision exists beneath this membrane.

Sihilus, wheezing, whistling, or cooing. Produced by the
same cause as above described, with the exception that \i ori-
ginates in the smaller bronchi, so that the grave sounds of a
bassoon, and the shrill sounds of a piccola, or the air drawn
through the semi-closed lips well moistened with saliva, and
through the larynx as in snoring, afford a. tolerably accurate
representation of these two bronchial sounds.

2. Two moist sounds. Small crepitation is the invariable
symptom of the first stage of pneumonia, and is produced by the
inspired columns of air passing; through a series of inflamed pul-
monary cells, which are partially clogged with sero-sanguinolent
secretion. The act of rubbing the hair between the fingers
gives sotYie notion of this important diagnostic symptom. I
need scarcely say that emphysema from fractured ribs and
wounded lung will cause this sound also; but, as I do not wish
to confuse the student by describing those morbid changes pro-
duced by traumatic causes, I shall omit any further notice of
them now.

Large crepitation is similar to the breaking of large soap-
bubbles, and is heard over the lower lobes behind, in cases of
advanced or chronic bronchitis, the third stage of pneumonia,
and in emphysema with (rdema pnlmonum.

3. Three vocal sounds. Bronchophony, or increased reso-
nance of the voice, is produced by a solid portion of lung acting
as a better conductor of sounds than a vesicular or healthy
portion: so that the voice of the patient rings under the ear of
the auscultator. This solidification is either the result of
pneumonia, or of a mass of aggregated tubercles in the upper
lobes. In the latter case, it is heard under the clavicles; in
the former, it is usually detected over the lower lobes behind.

(Egophony, or bleating of the goat. A sound peculiar only
to the presence of a small portion of eflxised lymph between
the surfaces of the costal and pulmonary pleura, the result of
pleuritis. It is not heard when the effusion is copious, but it
is again heard when the eff'usion is in the course of absorption.
Hence it is an unfavourable auscultatory sign in the early, and
a good one in the latter stages of pleuritis. This sound should
be listened for over the lower lobes behind ; the ordinary seat
o{ the early occurrence of pleuritis.

1848.] Treatment of Hemorrhage. 623

Pectoriloquy is the effect of the intonation of the voice pass-
ing up the stethoscope, as thousrh it came from within the chest
rather than from the mouth of the patient. Its production
is the unequivocal evidence of a cavity in the suhstance
of the lungs, which cavity is usually in the upper lobes,
and therefore this vocal sound is to be sought for under the
clavicles. If you place the stethoscope over the wings of the
thyroid cartilage, and make the person talk, you have a fair
specimen of this vocal sound in the above diseased change.

The Treatment of Hemorrhage. By J. P. Vincent. (Observa-
tions on some of the Parts of Surgical Practice, 1847; p. 217.
From Ranking's Abstract.)

The most important step in managing all cases of bleeding
is that the surgeon should be most careful to keep the bleeding
vessel free from all coagulum. The smallest arteries will go
on bleeding if they are covered with a clot, and many consid-
erable hemorrhages will stop if the bleeding points are quite
clear from all blood ; even rather large arteries will sometimes
permanently cease to bleed, if kept uncovered and exposed to
the air. This fact I have seen. It is known that if a divided arte-
ry be in contact with a layer of fibrine, it has a strong affinity
and aptitude to shoot into it; and it is possible that a clot of co-
agulum has a modified effect of this sort upon the orifice of an
artery, so as to keep it from contracting and closing. It is,
however, certain that a coaffulum over a bleeding artery
keeps up hemorrhage. It is by this means that all styptics
have generally failed, while, for the most part, they have only
done what bare exposure will generally effect; if the blood be
carefully removed, and the styptic be applied, it has the credit
of supporting its character, but generally, if the blood be re-
moved and kept from forming a coagulum, the vessels will
cease bleeding as the effect of the mere exposure of the part.
The doctrine explaining the use of plugs of coagulum about an
artery to restrain its bleeding, was never to me very convinc-
ing. I know, practically, that arteries of a considerable size, such
as those about the hand, of the size even of the radial, will cease
to bleed if left quite exposed, and kept freed from a coagulum
taking place about them ; so, when a socket of the tooth bleeds,
if it be kept quite clear of coagulum, and the oil of turpentine
be applied, it will succeed in quickly arresting the bleeding.,
I have every reason to feel assured, from what I have tried in
these cases, that the bleeding may be stopped in epistaxis upon
these principles, by which the patient may be saved from the

624 Cancer of the Uterus simulated by a Sponge. [October,

annoyance of what is called plugging. The plan of the pro-
ceeding that I have adopted is to keep the parts which are
bleeding freed from coagulum, and this should be done in this
case by syringing the nostrils, so as to wash the blood out.
Now. if a styptic be used, such as the sulphate of zinc, it coagu-
lates the blood as it issues from the vessels, and so far stops the
bleeding ; but there is a process going on, by which this clot is
loosened from its adhesion, and perhaps on the second day, the
bleeding is renewed. This will happen repeatedly ; so that
these cases have ended by being plugged. But what I contend
for is, that if the syringing be carried on until the bleeding
ceases, it will not only stop, but not recur. It is generally con-
sidered of importance that the water used in cases of bleeding
should be cold, but from what I have observed, arteries will
contract under the use of warm water, which has abetter effect
in clearing away the clots, and keeping the parts clean from the
blood. I have already alluded to the influence of a coagulum
in keeping up bleeding, when- speaking of the necessity of
squeezing out the coagulum in a pile when it is opened.

[The novelty of Mr. Vincent^s views will strike every reader;
we must confess, that were they from a less experienced sur-
geon, .we should hesitate in extracting them. The application
of cold, in particular, has been admitted universally as a means
of arresting hemorrhage; plugging and promoting the forma-
tion of a coagulum has also been very generally taught and
practised. Malgaigne, we observe, treats of hemorrhage as
capillar}', venous, and arterial. (Operative Surgery.) In the
first, he recommends the removal of clots, exposure to air, and
the application of cold; in venous hemorrhage, compression of
the part, so that a clot may form; and he gives sixteen plans re-
sorted to by surgeons for the arrest of hemorrhage from the
open mouths of arteries. H. A.]

Cancer of the Uterus simulated h/ the Irritation of a Piece of
Sponge. (Dublin Medical Press.)

Dr. Mitchell relates the following instructive case. Mrs. P.,
a^t. 26, a delicate anaemic woman, married two years ; com-
menced menstruating afsixteen, and has been regular up to the
last year and a half When four months married, she had an
abortion, and amongst other means employed to arrest the
flooding, the vagina was plugged. She continued for a long
time in a very precarious state, and has never been well since.
She now (January 16, 1846) complains of great pain at the
lower part of the abdomen, with constant pruritus of the vulvae
but v/hat distresses her n:iost is the constant discharge of a dirty

1848.] A Method of Catheterism, <$^c. G25

sanious fluid from the vagina, varying in quantity at times, but
always increased during tlie menstrual period, the fetor being at
all times unbearable. She has consulted several medical men,
some of whom have pronounced it cancer. She is much ema-
ciated, and in very low spirits, having tried a variety of remedies
without benefit. The speculum has been used, and applica-
tions made to the part. On examining with the finger, the
mouth of the uterus could not be detected at all, but a soft
fleshy mass, occupying its place, and projecting over the cervix
and into the vagina, quite insensible to the touch, could be felt*
On introducing the speculum, a dark-colored fimbriated body
was brought into view. The end of an uterine sound was ap-
plied to it for the purpose of tracing its attachments, during
which examination a small piece was detached. This piece
was put under water, and found to consist of a minute portion
of sponge, with a quantity of what appeared to be lacerated
muscular fibre.

The after part of the treatment was very simple. Portion
after portion of the mass was detached without much trouble,
the whole being in a completely decomposed state, and only
held together by the granulations from the uterus, w^hich were
Very long and tender. The separation was attended with a
small loss of blood. The pieces, when put together, weighed
five drachms and a half The vagina was syringed out fre-
quently with warm water, and the surface to which the sponge
had been applied touched three times with nitrate of silver, at
an interval of four days between each application. At the end
of a month the os uteri w^as quite normal, with the exception of
a slight induration and puckering of the lips. The menstrual
function has been naturally performed, and she is gaining
strength and flesh. This lady continued to improve, proved
pregnant in March, 1846, and was safely delivered at the full
period.

On a Method of Cathetensm in Disease of the Prostate or
Injury of the Urethra. By Dr. M. C. Bernard, Dundrum
Dispensary. (From Ibid.)

It is well known to every practical surgeon the distress which
patients laboring under disease of the prostate gland constantly
suflfer from retention of urine. This retention, which is for the
most part caused by mechanical obstruction, (the walls of the
urethra being either closed together by the swollen prostate, on
the one hand, or the third lobe overlapping in a valvular man-
ner, the entrance of the urinary passage on the other,) may
often be easily removed by a manoeuvre first suggested by Mr.

40

62f> On a Method of Cathctvrism. [October,

Hey, and now well known to every surgeon viz., by with-
drawing the stilet when the instrument has passed the mem-
branous portion of the uretlna, whereby the top of the catheter
is tilted into the bladder. Leeches to the perineum, the hipbath,
and anodyne enemata, are also useful auxiharies to allay the in-
flammation and irritation which generally attend on these cases.
There is not, perhaps, a gland in the body more susceptible
to changes in volume from atmospheric influences than the dis-
eased prostate. If a patient who is afflicted with this complaint
gets even an ordinary cold, he is sure to suffer from an aggra-
vation of all his symptoms. The prostate gland, already in a
state of hypertrophy, becomes inflamed and congested ', some-
times a permanent varicose state of the gland may supervene.
In this altered state of the parts, the walls of the urethra are
so closely brought in contact, that the patient, with all his
efforts caniTot pass one drop of urine ; often, in his vain efforts
to micturate, the overloaded vessels of the distended prostate
will give way, and haemorrhage to a considerable extent may
take place either in the urethra or bladder. Under cnxum-
stances of this description, there is often considerable difficulty
in passing an instrument into the bladder, and when the surgeon
succeeds in introducing the ordinary gum-elastic catheter, he
may find to his disappointment, after withdrawing the stilet,
that not one drop of urine will pass : in fact, the instrument
becomes choked with coagulated blood. Exactly the same
thing may occur after you have succeeded in passing an instru-
ment into the bladder, either in rupture of the urethra from
accident, or where a false passage has been made by a forcible
attempt to introduce a catheter.

[Dr. Bernard relates the case of an old man who laboured
under retention of urine from diseased prostate, in which, when
the symptoms had been aggravated by cold, the catheter (full
sized gum) could with difficulty be passed; and when it was
introduced into the bladder no urine escaped, the tube being
blocked up with coagulated blood. Not having a syringe at
hand to clear the tube of coagula. Dr. B. tried the following
expedient. He says, ]

I took a gum-elastic catheter of large calibre, without its
stilet, and introduced into it (in the same manner you would
put your finger into a glove) another catheter armed with its
stilet, and of sufficient size to fill completely the larger one. I
passed this double catheter with the greatest freedom into the
bladder, and had the hap[)iness to find upon withdrawing the
smaller one, that the urine flowed in a full stream, at the same
time giving my patient immediate relief from his protracted
bufterm!::.

1848.] Aeir Operation for Varicocele. G2'

New Operation for Varicoce!e.^^{hondon Lancets)

M. Velpeau, in a clinical lecture, gives an account of the plan
of opetating tor varicocele, by torsion, as devised by M. Rey-
naud, and modified and practised by M. Vidal de Cassis.

In the operation for varicocele, it is the object, not only to
obliterate the veins of the spermatic cord, but also to raise the
affected testicle, which, as is well known, sinks to a louver level
than the other; for by so doing: the danger of relapse is lessen-
ed. M. Vidal proposes to accomplish this end, along with the
obliteration of the veins, by the plan he advocates. Although
it is difficult to describe an operation in words, we shall endeav-
our Id give a succinct description of the one in question. Two
portions of silver wire, one double the thickness of the other,
are thi^eaded severally through a lancet-shaped needle: the
operator then isolates, with his fingers, the vas deferens from
the valricose spermatic veins, pushing the foTm'er backwards,
whilst he draws the Veins forward in a fold of skin. The lar-
ger needle, with the' thicker wire, is now passed through the
skin, between the vas deferens behind and the varicose veins in
front. This being done, the wire is slightly bent, so as to give
it a concavity, looking forwards. The veins are then released
from the grasp of the fingers, and a fold of skin pinched up fromi
over those vessels through which the second needle, with the
finer wire, is passed, and thus the wire occupies a position an-
terior to that of the veins. The needles are introduced and
escape through the same openings, which, hence, are but two
in number, and consequently, the operation may be regarded
as subcutaneous; and from their position, the wires embrace
the dilated veins between them. All this having been accom-
plished, the wires are cut so as to leave about an inch project-
itrg from each of the orifices made; and then, a very gentle
movement of rotation and tortion is exerted on the greater
wire. Now, it is easily seen that, in proportion as this torsion
is made, the loop of wire in which the veins are engaged con-
tracts in its dimensions, and so exerts a compression on the'
veins, and soon, these vessels, at first, onfy so compressed, be-
come rolled around the thicker wire, like a rope" round a roller,
while the vas deferens remains intact behind. The more turns
made, the higher is the testicle drawn up to^Tards the abdomen,'
and thus the ascent of that organ is effected. The loose skin of
the scrotum seems, also, to be a little rolled up, following the
movemetit exerted on the spermatic veitis by the torsion of the
wires. A little circular pad is lastly placed on the skin between
the two punctures which give passage to the wires ; the end^
of the wires are bent back over this pad, and twisted togethe?'
by pincers-

628 Bibliographical [October,

Since this plan was devised, M. Vidal has operated on hun-
dreds of cases of varicocele, and has never met with any acci-
dent, nor has had any failures or relapses. If such brilliant
success has attended such practice, it is indeed worthy of the
consideration of surgeons generally, and certainly deserving of
trial. It is a very simple process, but very mechanical, and
rather coarse in appearance; but on this account it should by
no means be neglected, for as much may be said of many surgi-
cal manoeuvres.

BIBLIOGRAPHICAL.

1 . Medical Chemistry for the use of Students and the Profession ;
being a Manual of the Science, with its application to Toxicology,
Physiology, Therapeutics, Hygiene, SfC. By U. P. Gardner, M. D.,
formerly Professor of Chemistry in the Philadelphia College, &c.,
&c. Large l2mo., pp. 396. Philadelphia: Lead: Blanchard. 1848.

The promised notice, or review, of this work has not come to hand.
We have hastily glanced over its pages, and find it divided into five
Parts. 1st, is on the Chemical Forces, II. The simple bodies of
greatest importance. III. Organic Chemistry. IV. Animal Chem-
istry. V. Treats of the Metals. We do not feel prepared to say
whether this book will accomplish all the author designs, or if it will
be accepted as a text-book for Students by the Professors of our numer-
ous Colleges. We are, however, of the opinion that it is an excellent
Manual of Chemistry, and deserves to be extensively patronized by
the members of the profession.

2. The Half. Yearly Abstract of the Medical Sciences, SfC, SfC. Edited
by W. H. Ranking, M D., &c. Assisted by Drs. Guy. Day,
Anccll and Kirkes. No. 7. January to June, 1848. 8vo., pp. 358.
Philadelphia : Lindsay &l Blakiston.

The American publishers of this well known periodical have kindly
sent us the above No., which we find well stored with the latest medi.
cal intelligence. About one half of it is taken up with carefully pre-
pared reports on Practical Medicine, Surgery, Obstetrics with Diseases
of Women and (Jhildrcn, Forensic Medicine, Toxicology, and Psycho-
logical Medicine. This No. ably sustains the high character of this
Medical Periodical.

3. The British and Foreign Medico-Chirurgical Review, or Quarterly

Journal of Practical Medicine and Surgery. No. III., July, 1848,
pp. 284. New York : Re-published by Richard and Geo. S. Wood.

It may not be known to our readers that there are two rival Houses,

1848.] Monthly Periscope. 629

one in Philadelphia, the other in New York, engaged in re-publishing
this British Medical Quarterly. It was formerly furnished at $5 to
subscribers, but the price is now reduced to Three Dollars. In
addition, the Messrs. Wood present to each subscriber, paying in
advance, a small Quarterly Retrospect of American and Foreign
Practical Medicine and Surgery, of 64 pages, double columns; or this
latter is afforded alone at $1 per annum, in advance.

Of the character or worth of this Foreign re-publication, nothing
need be advanced by us it is known to all medical men. Wood's
Retrospect is a useful little periodical.

PART III. MONTHLY PERISCOPE.

Will insoluable substances introduced into the intestinal canal enter
the circulation ? By M. Mialhe. ( Translated for this Journal.)

M. Mialhe has established in his tbrmer publications, that the liquid
state is indispensable to the general action of medicinec- and poisons,
and that in the same class of bodies, every thing being equal, the most
soluable are the most active. But the recent experiments of Prof.
Osterlin seem to establish that insoluable substances can pass from
the intestinal canal into the circulation.

This, if true, overturns entirely the theory which admits the solua-
ble state to be indispensable to absorption. M. Mialhe has repeated
the experiments of the German physician, and from these experiments
there remained the most positive proofs that charcoal introduced into
the digestive canal could not pass into the circulation.

M. Mialhe concludes;

1st. That it is impossible for insoluable substances to pass into the
circulation.

2d. That internal medicaments, to have a general action upon the
organism, should be soluable, or capable of becoming so by the chemi-
cal reaction produced in the organs.

3d. That soluable substances alone are susceptible of undergoing
the phenomenon of absorption, and that the old axiom corpora non
agunt nisi sint soluta, is a truth not less established in physiology than
in general chemistry. [Gazette Med. de Paris.

Parturition without Pain. By an old Army Physician of Jefferson
Barracks. I sometime since saw stated in one of our '* Medical Jour-
nals," a case of "Parturition" without pain; and as a similar case

once occurred to me, I will relate it. Mrs. J , wife of Lieut. J ,

aged 23, of a light frame,, fair complexion, but of feeble constitution
though in good general health, had arrived at the termination of her
gestation with her first child, without the slightest disturbance of her
health in any manner and was standing in her kitchen making cake,
when "she felt," as she said, "something give way, and water run-

680 Monthly Periscope, [October,

n^ng down her legs," and as this somewhat alarmed her, she immedi-
ately went up to her chamber, apd sent for a kind )ady, her next
neighbor, who hurried in and at onoe sent for me. Luckily, I was
just passing tjie door. I found her on the bed, and immediately placed
heron her left side, and proceeded to examine her, when I at once re-
ceived the child ! "Oh!" said she, "I have dirtied in bed." This
caused much laughter in the lady and myself to think that our patient
could not distinguish between a motion by stool and the bringing fbrtb
a child. The placenta came in Ove minutes after, in the same way,
without the slightest color, save that produced by severing the cord,
"When all was over, I asked her why she thought she had passed a
stool in bed. She replied, " she felt only the same bearing down as
when she went to stool, and not the slightest pain, nor when the ' pla-
pcnta came away." She had neither after-pain nor hemorrhage, aptJ
soon got up well. [S/. Louis Med. ajid Surg. Journ.

Case of Super-Fmtation a mare bringing forth at one birth a colt
and a mule. Extract of a letter from Albert N. Read, M. D., ad,
dressed to the editor, dated Andover, Ashtabula county, Ohio, January
4th, 1847.

" Permit me to mention to you one of nature's freaks in generation,
whi,ch occurred in an adjoining township the past summer. A mare
at one birth brought forth a well formed coU and a mule. She was
put to the Horse some two or three weeks after having received the
Jackass. Both the colt and the mule are doing well. I am aware
that the fact of imprepjnation by diflbrent males, is not new to physiolo-
gists, but the great difference in time, in this instance, I thought was
Wprth mentioning." [Medical Examiner,

Diagnosis between Syphilitic and Scrofulous Affections of Bone. :
fliis is laid down as follows by Ricoid :

Syphiltic Affections of Bone. Scrofulous Affections of Bone.

1. Very r^re with young subjects. 1,. Very frequent in youth.

2. Sypiiilitic antecedents, 2. Scrofulous antecedents.

3. Compact textures of tlie bone 8, Spongy tissues of bone attackr

attacked. ed.

4. Superlicial layers attacked. 4. Deeper layers attacked.

5. Little tendency to hyperostosis. 5. Much tendency to hyperostosis.
jG. The pains which precede the G. The tumefaction precedes the

development of the aflcction pain, but the latter soon in-

jncrease and become very creases, and becomes more

intense, until they decrease intense as the disease pro.-

again. cecds.

7. A tendency t^ circumscription. 7. A tendency to diffusion.

8. Exostosis, 8. Hyperostosis.

9. Ossification, eburnation, but 9. 'J'endency to softening, suppu-

scldom suppuration. ration, caries, and necrosis.

10. Rapid cure under appropriate 10, Difficult cure, and sometimes

trentment. impossible.

[London Lancet.

1848.]

Monthly Periscope.

631

On the Action of Diuretics. By Prof. Krahmeh, of Halle. From
a series of experiments, the results of which are recorded in the Ibl-
lowing table, Professor Krahmer seems to have established, beyond
all doubt, that the ordinary so-called diuretics are totally devoid of
any physiological action.

Tabular view of the average daily amount of the urine and its constiiu-,
ents [expressed in grammes.)

Solid Combustible
Urine, residue, portion. Ashes, Urea. Uric Acid,

^t?ons''(loV^^..''.^'^^^^^^^^^ ^^^^'^ ^^^^ ^^^^ ^^'^^ ^^-^^ ^'^^

Do. of those when no diu-# cnoA r ^^ m onrr or OA iar4 nor

retic was taken (62)...} 2084-^ 7401 39 G5 3524 19 G4 036

D.0, alter the use of dis- ) .^on n -n -n oa ra

tilled water (1) ] ^^^^'^ '^'^ ^^'^^

^ret!cf(]S).'!''.'/..'^.'"| 1871-2 7177 3793 3383
Pulv. bacc. j unip.*(4) '.!*... 17591 6588 2932 36-56

Terebinth (4) 1277-2 60-37 34-52 25-85

Pulv. rad. scill. (6) 17604 6996 32 38 37-58 15 82

Pulv.fol. digitalis (11).... 21031 76 16 3934 36-82 19-71 0-23

Pulv. rad rhei (6) , 18994 73 56 4185 31-71 19 46 0-35

Resin, guaiac. (5) gll4 0 75 39 42-77 32-62 22-74 0 29

Tinct.sem. colchici(5).... 17565 71-99 42 26 2973 22-84 0-69

Referring to Becquerel's tables as a standard of comparison, we find the cor-,
responding figures 1319-8 36-8 27 6 9-6 16.5 0.5

which are most of them considerably lower than the above numbers of Krahmer,
TliCisubject evidently requires further investigation. [Jour /-iir. ;?m/jL C/iemie^
Bd, ,xli., pp. 1-7. From Med-Chir. Rev.

Paralysis of the Tongue from Passion. The following case is re-
lated in the Medicinische Zeitung. A man, aged 59, of delicate
constitution, and choleric temperament, while engaged in a
dispute, suddenly lost the power of his speech, his intellectual faculties,
however, remaining. He was unable* from this time to move his
tongue freely, or to Utter and articulate sounds. Respiration, the
heart's action, the digestive and urinary functions, were normal. No
symptoms of congestion of the brain were to be observed. His phy-
sician had recourse to electricity, which was continued daily for
from five to ten minutes. In the course of five days the faculty of
speech was restored, [Journal of Psychological Medicine.

An easy means of rendering the Ulnar Artery accessible to the finger
or even to the eye. By M. Malgaigne. The means suggested by
M. Malgaigne, the efficacy of which the reader may at once test upon
his own person, will be found of great utility, when circumstances
prevent our feeling the pulse at the radial artery, or when it is desired
to take up the ulnar. He thus describes it :

" I have several times had occasion to place a ligature around tho
ulnar artery for lesions of this vessel ; and when the cellular tissue is
gorged with effused blood, and it is necessary to seek it at a considera,
ble depth, I do not hesitate to term it a very difficult operation. Per-
haps the means I am about to state will assist in removing the principal
difficulty, which especially depends upon the depth of the artery. U

Monthly Periscope. [October,

the fingers and hand are turned forcibly backwards upon the dorsal
aspect of the forearm, tiie relations of the ulnar artery become surpris-
ingly changed. The deep-seated muscles upon which it lies are forci-
bly raised, and cause a sensible projection under the skin. The tendon
of the flexor carpi ulnaris, on the contrary, retreats inwards and back-
wards; so that the artery, which, in the natural position of parts, is
partly concealed by it, is now forced to a much more anterior plane,
and lies four or live millimetres on the inner edge of the tendon. In
many subjects it becomes more superficial than the radial, and it may
be seen raising the skin at ea,ch pulsation.

*^ In traumatLG lesions of the vessel, the same position brings the
wounded extremity of the vessel towards the surface, and enables us
to seize it ; and in any case, when we wish to pass a ligature around
the vessel, there will be no longer occasion to denude and draw away
the tendon of the flexor." [Rev. Medico-Chirurg,, from British and
Foreign Med, Chirurg, Rev.

Muriate of Opium.^^\)r. Nichol recommends this as the best pre-
parationof opium, never inducing headache. It is made as follows;
Take of the best powdered opium, gj.
Muriatic acid, gj.
Distilled water, xx. Mix.
Bhake this mixture very frequently every day, during fourteen days,
then strain and filter. The dose is from twenty to tbrty drops. ac
cording to circumstances. Many of my medical friends have tried
this preparation, and they highly approve of it.- [Ranking^s Abstract,

Opcrationfor Internal Hemorrhoids. Professor Riberi, of Turin,*
fiei;zes the base of the tumour, however high it may be placed, with a
curved, pointed hook, or tenaculum, and draws it downw^ards ; he then
passes a second curved tenaculum through the base, at right angles
to (he first ; the convexity of the curve of the instruments being direct,
ed upwards, and their }X)ints outwards from the anus. The two instru.
ments are held hy an assistant, a ligature passed behind them, and the
tumour strangulated, after which the instruments are gently withdrawn.
One extremity of the ligature is cut short, and the tumour returned
into the rectum without puncturing it, A feeling of numbness is felt
by the patient after the operation, to be alleviated by an injection of
coid water. The ligatures seperate about the third or fourth day, and
the cure is complete from the twelfth to the twentieth. The operation
has been uniformly succetisful in M. Riberi's hands. [Rank's. Ahst,

Treatment of Whitlow. By Dr. Barnes. Whitlow maybe remov.
ed, in the early stages, and in the later stages may be much relieved,
by applying potassa fusa. Slightly moisten the end of a stick of this
caustic, and rub it over the surface of the diseased and adjacent parts
for a few seconds, until the patient complains of much pain. If this

Giornale dell' Academia Medico-Cliirurgica di Torino.

1848.] Monthly Periscope. 033

pain or burning sensation lasts for a few n)inute.s, the applicaiioii has
been sufficient; if it subsides more quickly, re-apply the caustic lor a
short time. Be very caretul not to destroy tlie skin. [RetroapecL

Colour of the Vagina in Pregnancy. By Dr. Albert. Dr.
Albert states that of all the signs of pregnancy hitherto known, that
derivable from the observation of the dark red colour of the vagina is
the best, seen as it is by the aid of a speculum at so early a period
of pregnancy, and proceeding progressively with the development of the
uterus. He has tested its utility in about 30 cases, and has besides
examined, with the same success, a great number of animals at various
periods of gestation. [Zeitschriftfur Geburtskunde, from Review.

Treatment of Fissures of the Anus. M. Miday recommends 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, compos-
ed as follows: Axungiae 15 grammes, tannin 1 gramme, increasing
the portion of tannin gradually to three grammes or more, according
to its effect on the sensibility of the part. 'Jo apply it efficiently, the
patient should push his finger as far as possible without forcing the
sphincter, and there leave the ointment.

Where fissures 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 re-
tained for some time. In both cases the patient should experience
some degree of heat, and smarting continues for some time alter the
application. [Medical Times.

On the Prevention of Habitual Miscarriage. By Dr. Griffin.
Dy. Griffin, physician to the county of Limerick Intirmary, recom-
mends to the notice of the profession the use of tonics and antispas-
modics when there is an habitual tendency to abortion or miscarriage.
In three cases, which he treated successfully, he employed the follow-
ing remedies two grains and a half of oxide of zinc, with two grains
of extract of hop, three times a day; and, after each pill, two table-
spoonfuls of a mixture of valerian, aromatic spirits of ammonia, and
infusion of snake-root. He recommends also a box of pills to be kept
by the patient, containing a grain of opium in each, to be taken whep
pain comes on, and to repeat the dose every hour till relief is obtain-
e^.-^llbid.

Hydrocele cured by Compression. (Translated for this Journal.)
M. Rossi relates the complete cure of a case of hydrocele by com-
pression, which had been previously treated by punctures. He
effected the cure by exercising compression upon the tunica vaginalis
by means of a thin plate of lead. He applied it on each side of the
scrotum, taking precaution to leave the spermatic cord and testicles
free. By this means an inflammation was established which produced
adhesions of the walls and consequently a radical cure.

6184 Monthly Periscope. [October,

By this means the chances of success are much less, than by the
process of injection; but it has the advantage of being entirely inno-
cent. [Gazette Med. de Paris.

Disinfection. Pound the well dried raw bean of coffee, and strew
it over a moderately heated iron plate till the powder assumes a
dark browu tint ; it will then remove almost any noxious effluvium.

[M. Weber, from Braithwaite,

The Electrical Cloth :^a mode of employing Electricity by simple
Friction. -'The following plan is recommended for the preparation of
electrical cloth. Five parts (by measure) ofmonohydrated sulphuric
acid are to be mixed with three parts of monohydrated nitric acid.
The cloth, either cotton or linen, is well saturated in this liquid (one
part of cloth requiring fifteen parts of liquid by weight), and allowed
to digest for an hour. The loosely adhering acid is then squeezed
out of it, and il is thoroughly washed in water. In order to deprive
it of any sulphuric acid, it is soaked in weak ammonia, and again
washed. It is afterwards plunged in water slightly acidulated with
nitric acid. This neutralizes any ammonia which may be left, and
at the same time increases the electrical and combustible properties
of the cloth. It is with this species ofpyroxyline that M. Meynier has
produced by friction large quantities of electricity; and some practi-
tioners have used it with great benefit, in the form of local application
and frictions, in various disorders of the nervous system, [Med. Gaz^

Substitute for Granville's Lotion. The following is the formula :^.
R. Strongest preparation of Aq. Anmionia, 4 oz;s.
Spts. Rosemary, 2 drs.
*' Camphor, I dr.
Saturate a piece of cotton or lint and apply immediately with the hand
pressed on it, until slight vesication is produced. [South West. Med.
Advocate.

Inferior Animals subject to Intermittent Fev>er. (Translated for this
Journal.) M. Dupuy has advanced the opinion, that lower animals,
sheep in particular, are subject, like man, to intermittent fevers, when
they have been exposed to marsh effluvia, and that they have in these
cases, enlarged spleens more or less altered, [Gaz. Med. de Paris.

Statistical Researches of Chorea.. Dr. Easelmann, after collecting
reports of cases from ditfereiit authors, and adding to them his own,
finds that females are much more prone to chorea than males, in the
proportion of 73 to 27 in 100 cases. Up to the age of 11, of 33 pa-
tients, 22 were girls, 1 1 boys ; from 1 1 to 15 years of age, of 45 cases,
34 were females, and but 1 1 in males ; about fifteen years old, or 22
patients, 17 were women, and only 5 men.

Thus, wliilst the proportion of males remains the same before and
after thengeoflo, the pro{)ortion of females increases remarkably

1848.] Monthly Periscope. 635

from the JOth to the 16th years; a fact which leads to the conviction
that the period of puberty exercises a great influence on the develop-
ment of the disease.

Respecting the causes of chorea, fright is the most common. Thus
in 100 cases, 31 were referable to this cause. Next in the category,
rheumatism appears to be a not uncommon cause, eight cases in 100
being traced to it. In 42 instances, the exciting cause could not be
arrived at.

The interval elapsing between the operation of the exciting cause
and the onset of the morbid phenomena was not noted in 74 cases, in
8, the chorea manifested itself immediately ; in 13, after a week, and
in 5, after two weeks or more.

Of the success of remedies used, purgatives alone, or combined with
diet, were successful in 6 cases, and of benefit in another ; 2 cures are
referred to rhubarb administed in port wine ; arsenic was employed
in 7 cases, in two with success; iron in 29, effecting a cure in 19,
SLud benefiting in two cases ; zinc, in the form of sulphate chiefly, ef-
fected a cure in 45, .and improved the state of tw^o others. Quinine,
gentian, chamomile, andnux vomica were tried in nine instances, and
cured in three. Antiphlogistics were used with three patients, curing
two and relieving a third. Electricity has proved of great service in
old and rebellious cases, chiefly in young women in whom the chorea
had an hysterical character, and in children, where the disease was not
dependent on irritation ; nine cases of cure out of 15 are attributed to
this agent, but in five of those nine case oxide of zinc and carbonate of
iron were conjoined in the treatment, Aflusion has also succeeded,
but not to such an extent as electricity.

In fmej of the lOT) ^cases, 80 were cured, seven nearly cured, ten re-
lieved more or less, and three died. Tliis duration of treatment was
for three weeks in 24 cases, from three to six weeks in 40, from six to
eight ^veeks in 23 cases, and from two to three months in 13 other
instances. ^London Lancet.

Nus; Yomica as a Purgative. Mr. Boult, of Bath, suggests in the
Provincial Journal, the addition of a small portion of the extract of nux
vomica, as a remarkable powerful adjuvant to purgatives. He says

"I ascertained that an aperient scarcely sufficient by itself to pro-
duce a single evacuation, when combined whh this extract, caused
active purgation. The dose must be varied according to the patient's
idiosyncracy, but, generally speaking, a pill, containing three quarters
of a grain of Barbadoes aloes, three quarters of a grain of the extract
of rhubarb, and half a grain of the extract of nux vomica, {Pharmaco-
peia Edin^nsis,) if taken at bed time, will produce one, or perhaps two
full evacuations the following morning. The addition of a single graiu
of calomel to this pill will cause two or three bilious motions. [^Ihid,

Neip method of extracting jmre Gold from Alloys and from Ores,
By C. T. Jackson, U, S. G. S. The following method of obtaining
pure u^ctallic gold in the form of a spopgy m/iss has been practised by

636 Monthly Periscope. [October,

me for several years, and no account of the process lias, to my know-
ledge, heretofore been published. It is very useful to the chemist and
to the manufacturer, and is more economical than any other method
that I am acquainted with.

After separating the gold from silver by means of a mixture of nitric
and chlorohydric acids as is usually done, the solution containing gold
and copper is to be evaporated to small bulk and the excess of nitric
acid is tiius driven off'.

A little oxalic acid is now added and then a solution of carbonate of
potash sufficient to take up nearly all the gold in the state of aurite of
potash is gradually added. A large quantity of chrystallized oxalic
acid is then added so as to be in great excess, and the whole is to be
quickly boiled. All the gold is immediately precipitated in the form
of a beautiful yellow sponge which is absolutely pure metallic gold.
All the copper is taken up by the excess of oxalic acid and may be
washed out.

Boil the sponge in pure water so long as any trace of acidity re-
mains, and the gold is then to be removed from the capsule and dried
on fihering paper. It may be pressed into rolls, bars or thin sheets,
by pressing it moderately in paper. I have made several useful appli-
cations of the gold sponge thus prepared, and had a tooth plugged
with it in October, 1846, to which purpose it is well adapted. \^Aiii.
Jouin. Science and Arts.

HomcEOpathy. A highly respectable gentleman, who holds a re-
sponsible station, in a neighboring State, (Ky.,) informed a professional
friend of ours, called to attend him in a recent illness, that, some year
and a half since, he had a strong predilection for t^omusopathy. He
became sick, and sent for a practitioner of the Ilahnemannic order.
He told him at once that all that ailed him, was the quinine that the doc-
tors had previously given him, and launched into a tirade of abuse of
Allopathy. "1 will give you, said he, an antidote to the quinine, and you
will soon be well." Some powders were given. Not getting better,
after a few days, the patient began to complain. "To-morrow I will
change the medicine," said the honest disciple ; "have patience and
you will soon be well." On the next day, some drops were given.
They tasted rather bitter, and on testing them, both the powders and
the drops were found to contain considerable quantities of Quinine, not
of the twentieth potency, but good, regular, common sense doses. The

patient was immediately cured of Ilonuijopathy, and there is no

danger of a relapse. [Ohio Med. and Surg.Joum.

Account of a Bosjesman^ or Bushman. Dr. Brigham of the Lunatic
Asylum at (jtica, N. Y., in a recent tour to the South and Southwest,
thus described an individual he met with at Washington City:

" We saw at Washington many persons distinguished for their great
abilities and mental attainments, but we were perhaps most interested
by a single s})ecimen from the very lowest, in these respects, in the
scale of human beings. We allude to a young Bosjcsman or Bush-

1848.] Medical Intelligence. 637

man, in the care of Isaac Chase, Esq., United States Consul at Cape
Town, Africa. The Bosjesmans are considered a branch of the Hot-
tentot race, and are indisputably in the lowest state of degradation that
human beings have ever been seen. 'Without houses or even huts,^
says Pritchard, ' living in caves and holes in the earth, these naked and
half starved savages wander through forests in small companies or
separate families, hardly supporting their comfortless existence, by
collecting wild roots, by a toilsome search for the eggs of ants, and by
devouring whenever they can catch them, lizards, and the most loathe-
some insects. It is no matter of surprise, that those writers, who
search for approximations between mankind and the inferior orders of
the creation, fix upon the Bushmen as their favorite theme.'

"This specimen was but 18 years old, and 3 feet 11 inches high,
and had been with Mr. Chase four years. Those belonging to his
race, seldom attain a height over 4 feet 4 inches. This one looks like
a boy of 10, understands what is said to him, and speaks tolerably well,
but seems to have few ideas, and no reflection, constantly moving like
a monkey. He is very fond of play, but very obstinate, and cannot be
made to do any kind of service but a few minutes at a time. His skin
is of light copper color, eyes black and far apart, flat nose and high
cheek bones. His head is small as a whole, but very small anteriorly,
and large posteriorly, and the hair on his head is in patches or clusters
of curls, leaving much of the head naked. Mr. C. says he has not, nor
those of his race, any religious notions. He seems fond of Mr. C. and
is obedient to him, but it is like that of a dog to his master. He sup-
poses Mr. C. has all power, and can do anything, even restore him to
life, if drowned, &c. On looking at him, and observing his manners,
and trying to arrest his attention and converse with him, we were
strongly impressed with his resemblance to the Orang Outang, and did
not wonder that he should be regarded by some as the connecting link
between that animal and man." [American Journal of Insanity,

MEDICAL INTELLIGENCE.

Neglect of the Medical Corps of our Army and Navtj. Why have there been
no promotions in the Medical profession connected with our Army and Navy
in the recent campaigns in Mexico 1 We have looked in vain for the first sur-
geon's name, over the long list of promotions among the regular and volunteer
troops. There have been created some 500 brevet-commissions during the last
two years indeed,scarcely an officer of our army, it matters not in what capacity
he has served, so he was not in the medical staff, who has not been promoted.
We read of most onerous duties faithfully performed daring the whole war, of
gallant services during engagements with the enemy, of several, many sad
deaths occurring among the surgeons of the Army and Navy, but not of a
single promotion. It is thus ever with the medical profession ; whether in civil
or military life, we must toil on, toil ever labor, day and night, before, during
and after a battle and do this without distinction or reward. The soldier
who performs one daring deed, is rapidly advanced and adequately requited ;
but the surgeon, equally self-sacrificing, who renders duties far more arduous,

incu.n;ut AnLcui^tiucc. ^_\^y^\.\ju^i ,

is seldom noticed never promoted. We are familiar with the heroes of every
battle fought in Mexico, but, with the occasional or general commendation at
the close of an officer's report, we find no further notice of that highly respecta-
ble corps of medical men, who have rendered most efficient service to their
country, and who have saved many a valuable lile. Again we ask the proper
authorities, why have there been no promotions among the Surgeons of oar
army and navy 1 Have they alone failed in their duty; if not, why are they
alone neglected 1

The Ohio Medical and Surgical Journal. We have just received the first No.
of this new medical periodical, issued at Columbus, Ohio, and edited by John
Biitterfield, M. D., Professor of the Practice of Medicine in the Starling Medi-
cal College. It is to be published every other month, each No. to contain 96
pages, at S2.00 per annum, in advance.

We have looked ov^er the pages of this new candidate for professional patron-
age, and mustsay we have been well pleased with its spirit and execution. It
is gotten up in very neat style ; its communications are excellent; and its editor
has at once made the impression of a talented, learned and laborious man.
W^ shall no doubt, often refer to its pages with advantage to ourself and read-
ers. A cordial greeting is extended to this Journal, and our best wishes for an
hotiorable career in gathering the many important professional facts, otherwise
lost to medical science.

Dr. Cfrccn^s Letter concerning our comnvcnta on his article on the Diagnosis of
Ancurism.-^A% intimated in our closing remarks on Dr. James M, Green's
communication in the September No., the proof-sheets were sent h*fm to have
corrected any errors he should detect in our comments upon it; and he was re-
quested fc have prepared by a given time, what he might deem striclly within
the pfovlnce of a critic limited to the correption of mistakes, mistatemeftts, &c.
This was necessary in order that the whole subject could be embraced in the
saine No. of the Journal. After delaying the press more than three days for his
express aecommodation, he sent us a manuscript of about twelve pages of thirty-
five lihCs e'ach. Besides the utter impossibility of then publishing this lengthy
communication, we considered it an unreasonable demand upon the pages of
our periodical. Dr. G. had written twice upon the subject and we only once,
and then .;tated we were done with it We had, moreover, introduced no new
mailer, afid gave him the privilege to correct our errors and thus conclade the
di.sf ilssion.

Desirou.^ of avoiding a controversy, and determined that this Journal should
not be made the medium of it, we proposed to Dr. Green that we would ptrblish
without word or comment, whatever three professional friends might agree up-
on in relation to our different views about an anciirismal tumor or w* ti'olild
distribute, under cover of the Journal, whatever hti might think proper to publish
on the subject. He has rejected both these propositions, and having withdra\X>n
his last communication to us, is, we understand, about to appeal to the profes-
sion. If we have done Dr. Green, his friends or his cause, the least injustice,
we do not know how more fair or honorable wo. could have been thjfn in' the
propositions we have made to him. If truth and justice have been denied hini
by us, surely he rnighl have trusted his own friends in Macon. In reference to
his contemplated appeal to the profession, we have only one remark to make,

1848.] Medical Intelligence. 639

that is, our professional brother may feel assured we shall not return evil for
evil, nor railing for railing, but contrariwise.

Notwithstanding the withdrawal of the last communication by Dr. Green, we
extract the following facts contained in it, bearing legitimately upon the subject
under discussions

His patient, Deas, went to the West soon after the operation, and he cannot
now tell what is the present condition of the tumor upon which he operated,
never having heard from him. 0

Dr. Green has verified by post-mortem examination one case of aneurism of
the aorta, and has still the preparation.

Dr. White, of Milledgeville,has met with two cases of aneurism of the caro-
tid artery one occurred in a negro woman of Dr. Fort, who, assisted by Dr.
W., operated successfully; the other, also in a negro woman, from Jones Co.,
who declining an operation, died quite suddenly.

In corroboration that it was the patient who supposed the aneurism was an
enlarged gland, and not his physician, it is stated in the narration of the case,
"Deas gave the following history of the tumour." This we had overlooked,
and were justly amenable to criticism for it.

Dr. Green moreover denies that he made any remarkable omissions in stating
his cases, but says he has given them lull, fair and appropriate, and, with one
exception, strongly to the point he says, too, his quotations are not mis-quota-
tions. We were charitable enough to attribute the differences between us, in
reference to quotations, &c., to different editions of the same author. In sus-
taining our position, to which Dr. Green has forced us, we have endeavored to
exercise every disposition to treat him with all possible respect and kindness,
in the discussion. We passed over his using a private letter, in no way prepa-
red lor publication, and making it the basis of his article on the diagnosis of
Aneurism he was not criticised, for taking an incomplete sentence (in Samuel
Cooper's Surgical Dictionary) from Hodgson, on page 91, and coupling it with
another incomplete one on page 97, from Scarpa, and attributing them to the
same author; the more glaring the error, as Hodgson was speaking of aneur-
isms, and Scarpa of dilatation of arteries. This mistake was only pointed out.
The reader, if he will take the trouble, will by comparing the quotations, decide
upon the question here involved between us. We; have in every instance referred
to the last edition, and in the authority of Prof. Porter, of Dublin, we have
preferred his Lectures published in the Medical Press, to his article on Aneurism
in the Chycopedia oi' Anat. and Phys. In every other instance, we believe,
Dr. Green and ourself quote from the same book. In completing the history of
a case, however, we obtained information from every available source.

When the reader will have perused the appeal to the profession, he can de-
cide if we have acted wisely in excluding it from the Journal.

The opinion of the ^^ Annalist" of Dr. Holvies' report, <^c., on National Medical
Literatare. "In the Southern Med. and Surg. Jour, for Aug., is a very gentle-
manly rencontre between Dr. Holmes, of Boston, the able critic of American
Period. Literature, and Dr. P. F. Eve, of Augusta, Ga. It is the reply to a per-
sonal letter of Dr. H. to Dr. E. Dr. H. tells him that " of Southern and Western
Journals he could find but a few numbers, and of some, fiot a single one." He
was not, therelore, very well qualified to express an opinion respecting the peri-
odical literature of this section of the Union : and he honestly confesses, that
being in a region wholly free from malaria, he should not and probably did not

640

Medical Intelligence. Meteor o logy.

appreciate fully such of it as relates to the subject. Dr. E. very naturally con-
siilers th;it this indifference impairs materially the force and value of Dr. H.'s
criticisinson this portion of our National Med. Literature, Dr. E. as naturally
complains tliat he should bech;irged with injustice in repeating in his journal,
a criticism on an Introductory of Dr. H.'s, which it was no offence for Dr. Flint
to write and publish. Dr. E., in the letter, is censured for not correcting, or
commenting on .some typographical errors made by Dr. Mutter, which the said
E thinks should have been taken notice of in Dr. H.'s report. Dr. E. avers that
Dr. H. devoted 3 or 4 of its pages to the Boston Jl., which is published vrchly,
and in as many more dismisses all the montlUics and bl-vcotUhiies of Charleston,
New Orleans, Memphis, Lexington, &c., &c., &c., &c. Dr. E. thinks that Dr.
H. has admitted that, through prejudice, Southern and 'Western rights and in-
terests on the subject on which be was called upon to report at the meeting of
the Nat. Med Con v., were neglected. On the whole, we think Dr. E.'scase is a
very good one: and that in a future report of the kind, a rather more extensive
acquaintance with the subject will be desirable, on the part of the reporter."

METEOROLOGICAL OBSERVATIONS, for August, 1848, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' wet Wash, Altitude above
tide 152 feel.

Ther.

64
64
67
72
72
70
70
68
6i)
70
70
69
68
70
69
70
70
71
72
68
63
66
70
70
70
68
64

70
70

Sun Rise.
Bar.

29 7.5-100

" 87-100

" 92-100

" 82-100

= 85-100

" 83-100

" 8.5-100

" 90-100

" 91-100

" 85-100

" 78-100

" 81-100

" 81-1001

" 81-1001

" 81-100

" 82-100

" 77-100

" 70-10'

" 68-100

" 60-100

" 58-100

" 84-100

" 84-l00|

" 83-100

" 90-100

" 93-100

" 94-100

" 82-100

" 67-100

" 61-100

" 65-100

3, RM.

Wind.

Ther.

tSAR.

83

29 85-100

N. w.

83

" 90-100

w.

84

" 93-100

s.

88

' 89-100

8.

88

" 80-100

S.

84

" 81-100

S.

84

" 88-100

E.

85

" 91-100

N.

87

*' 86-100

8. E.

84

" 81-100

S. E.

86

" 78-100

N.W.

90

" 79-100

E.

78

" 77-100

N. E.

80

" 77-100

N. E.

74

" 82-100

N. E.

83

" 79-100

E

84

" 73-100

N.W.

88

" 67-100

W

86

" 67-100

w.

86

" 49- 1(H)

s.

85

=' 68-100

N.W.

82

" 83-100

E.

81

" 81-100

S.

74

" 86-100

s.

76

" 92-100

s.

76

" 95-100

s.

81

" 92-100

N. E. '

84

" 75-100

E.

88

" 60-100

E.

88

" 61-100

N.W.

92

" 64-100

8.

Remarks.

-a splendid day breeze.

15-100.

Fair-
Fair.
Fair.

Fair some cloud.s. [at night.
Cloudy blowat5 P.M. sprink.
Cloudy thunder.
Cloudy sprinkle breeze.
Cloudy breeze.
Fair morning.
Rain at 4 p.m., 20-100.
Cloudy.

Fair shower at 5 a.m.
llain, 30-100.
Cloudy sprinkle,
ainyday, 40-100.
(Cloudy sprinkle at 8 p.m.
Cloudy rain at 6i p.m., 20-100.
Fair breeze.
Cloudy sprinkle.
Cloudy sprinkle dry gale.
Fair- blow.
Fair.

Rain, 15-100 showery.
Rain, 80-100.
Rain, 25-iOO.

Rain, 1 inch 75-100. [breeze.
Fair morning some clouds
Fair. [noon, 10-100.

Fair moning shower in after-
Fair.
Fair.

14 Fair days, auantity of Rain 4 inches 30-100. Wind East of N. and 9.

12 days. West of do. do. 8 day.s.

Errata. On page 577, seventh line from bottom, read revived iov XQ^ioti'
Page 579, twelfth line from top, read dogmatic for diagnostic.

SOUTHERN

MEDICAL AND SURGICAL

. JOURNAL.

M. i.] NEW SERIES. NOVEMBER, 1848. [No. 11.

i

Part L ORIGINAL COMMUNICATIONS.

ARTICLE XLVII.

nitious Remitting Fever its sources. By Tomlinson Fort,
M. D., of Milledgeville, Georgia.

The frequent occurrence, wide extent, and formidable
character of this disease, justify an accurate account of its
causes, and treatment. I have said that the varieties of fever
which arise from malaria, whether it be a real or imaginary
cause, cannot be accurately defined. Yet I have divided the
subject, and have no doubt, shall be able to treat of it^ more
perspicuously and more usefully by so doing. By far the
most important of these divisions is bilious fever, under which
name I propose to treat of all malarious fevers having remis-
sions and exacerbations. This class will include, the autumnal,
bilious remittent, pernicious intermittent, congestive, and I
know not how many more Varieties of fever which hate been
described by authors.

Intermittent fever is excluded from this class, because of
its mild character, and long duration, but there will occur cases
which it will not be easy to assign to one of these classes rather
than the other. Arising ffom the same cause, they run insen-
sibly into each other, so that there can be no perfect discrim*
ination.

History of Bilious Pever in Milledgeville and its neighbor-
hood. In a state of nature this was a rich, variegated country^
covered with majestic forests and tall waving grass. The low
lands on the sides of the streams, were covered with heavy

41

642 Fort, on Bilious Remitting Fever. [November,

cane brakes, or unbroken beds of reeds. Such was Milledge-
ville and the contiguous country till about the year 1807, when
it became, the residence of the white man. In this state of
primitive grandeur and unequalled beauty, this country was
decidedly healthy. I was here soon after the Indian inhabi-
tants had left it. I witnessed its rapid settlement the des-
truction of its forests the extermination of its canebrakes, its
reeds and its grass and the laying bare of its bosom to the
sun.

Bilious fever appeared as suddenly, as the face of nature had
been changed by the hand of man. For eighteen years it was
a formidable epidemic, during the summer and fall seasons.
The mortality was greatest where the lands were most fertile.
Milledgeville, located on a spot of great fertility, was perhaps
the greatest sufferer. No tables of mortality, were kept, but I
cannot be mistaken in placing the deaths from bilious fever
alone, as high as five per cent, of its whole population, each
year from 1808 to 1812 or 13. This mortality happening in
d few months, gave to the disease the terror of a pestilence.
Forty years have now elapsed, and great has been the change
in the face of this country. It has been reduced in many places
almost to sterility. Its gullied hills and deeply sanded bottoms
have become dry. The bilious fever has almost ceased its
annual visit. The annual deaths in Milledgeville from this
cause, which I have said were at one time as many as five in
the hundred of its population, have gradually diminished, so
that within the last five years they have not exceeded one in
two thousand. The facts which have attended this great
change cannot be uninteresting.

Causes. If there were no summer, there would be no bilious
fever. But to what degree the thermometer shall rise, or how
long continue, at any degree of heat to produce this disease,
is not ascertained. The process is, I think, not sudden. I
have seen in the month of June, the river overflow its banks
and subside under the greatest heat of summer. No fever
appeared for five or six weeks, but its onset was then sudden
and violent, and it only subsided on the coming of frost* No
example is given of the appearance of this disease in winter.

1848.] Fort, 071 Bilious Remitting Fever. 643

except in persons who had contracted it beforehand ; nor is it
agreed, what length of time the infection may remain in the
system.

So far as it regards climate, it appears that summer heat,
and moisture must combine to produce bilious fever before
absolute dryness or thorough wet, it equally disappears- I
have seen biHous fever appear in July, disappear in the driest
and hottest weather of August, and re-appear on the coming
of rainy weather in the next months. These observations are
not new. In the East, it has been remarked that the over-
flowing of the Delta of the Ganges and Indus, is the signal of
returning health to their inhabitants.

Malaria. An Italian physician has the credit of having sug-
gested as the cause of bilious fever, an effluviunr or emanation
from decaying vegetable matter in marshes. Chemistry has
never detected this malaria, and many are disposed to doubt
its existence. The circumstances connecting the existence of
bilious fever with the state of adjacent lands or marshes have
been investigated with great care, and the belief that the cause
of the disease is to be found in the state of these places, is
general. I am free to confess, that the facts I have witnessed
go far in my mind, to corroborate this doctrine. At the same
time I desire to say that I see no proof that the production of
this malaria, or miasm is a mere chemical process. We know
enough to satisfy us, that there are in nature, besides gravity,
other powerful agents which totally elude our research. The
cause of small pox, which emanates from a diseased person,
and, at some distance, produces the same disease in one which
was well, has defied chemical detection as much as the ma-
laria of marshes. Whether it is a fluid or aeriform matter, or
an influence extending itself on principles yet unsuspected, is
entirely unknow^n.

What I wish to enforce is, that so far as the cause of bilious
fever is concerned, we know enough of it, to protect ourselves
from its power in almost any country : and that he who can
place this knowledge in the custody of those to whom it will
be most useful, will render an important service to mankind.
To aid however slightly, in this great object, I shall without

644 Fort, on Bilious Remitting Fever. [November,

much comment, mention the principal facts I have witnessed,
which carry in their mere statement, important information.

Locality. The people of the south almost universally be-
lieve, that bilious fever arises from the influence of humid
places. Mill ponds are universally regarded as nuisances,
and many have been legally abated, on the ground of their
causing fever. The valleys of rivers, and smaller streams, lie
under the same distrust. Ponds of water, especially lime
sinks, are perhaps the most distrusted. A vast experience
and enormous loss of life, have given strength to these opin-
ions. They are in the main, well founded. But there are
many places which seem to be harmless, in spite of the exis-
tence of these causes, and it is of some importance to know
why it is so why one pond should produce disease and an-
other not. A pond whose"" water is always of the same ele-
vation and covers the same ground, will not produce fever.
One surrounded by alluvian sands, and having for its bottom a
white or light blue clay, though its soil for a foot or more be
of half decayed aquatic plants, may dry up in the heat of
summer and yet produce no fever. I have witnessed many
examples of this; in the country stretching across a few miles
below the falls' of our rivers, where the long leaved pine covers
the surrounding country. In this same region, mill ponds are
equally innocent. If their streams are short and do not arise
in the granite hills, and they are not too near the river, they
may rise or fall, be full or empty, and the surrounding inhabi-
tants will be unaffected. The sides of these streams running
through this country, present in rare instances a mild re-
mittent.

Milledgeville and its neighborhood, which from the scene of
my observations, afford the greatest variety of soil and situa-
tion. The town lies on a primitive foundation, with soil of
rich clay loam, subject to wash into deep gullies when the sur-
face is once broken. The country around, and especially
along the streams which enter the river near this place, is
hilly and has the same predominant feature of a soil formed on
tenacious clay. Low^er down, the face of the country sud-
denly changes. The margin of the ocean was once here, and
the rolled gravel, and accumulated sand, form soil for the lof*

1848. J Fort, on Bilious Remitting Fever

ty pine forests which extend to the seaboard. A close obser-
vation shows that the change for a few miles is* only on the
surface, and that on penetrating the earth only a few feet, the
rock is still in its original position. It is no longer granite, but
changes to gneiss, mica slate, and clay slate, in a few miles.
Through such lands the streams are crooked, and the hills ab-
rupt ; but no country is better drained, better watered or more
healthy. I know many places where the inhabitants have for
half.a century, lived totally exempt from bilious fever, even in
its mildest form.

Far different has been the experience of those who settled
the richer lands, founded on clay and presenting a more in-
viting aspect. The rich loam was no sooner broken, than fe-
ver made its appearance. It was more violent along the sides
of the streams, and w^orst where the valleys of those streams
were wide, and too wet for the growth of crops without drain-
ing. The cane which grew thick on these lands, was suddenly
destro5^ed and the soft mud laid bare to the sun. These pla-
ces were regarded as the chief source of the malaria, which
annually produced such alarming effects. But the fevers of
those years, did not always seem to depend on contiguous
marshes, rivers or mill ponds. The newly broken soil in fhe
clay lands, seemed in some instances, to produce the same ef-
fect. The gray sandy lands when remote from marshes, were
most healthy, and as I have remarked in some cases entirely
exempt from this disease.

The inhabitants of Milledgeville suffered their full share,
of the ills of a bad location in anew country. Situated on the
Southwest bank of the Oconee River, on a soil very fertile,
and formed chiefly of clay, it could not well escape the evils
of a sudden settlement and clearing of the land. The sloping
banks of the river, the water of w4iich rises nearly thirty feet
in the highest freshets, would, when rendered bare of its origin-
al rich vegetation, be a great source of the causes of disease
of which we have been treating. It is certain that at the time
the population of about two thousand, was cutting down the
forest, erecting houses, plowing new fields and allowing; their
cattle and horses to destroy the reeds and grass whith were
the natural covering of the land, they suffered the annual in-
vasion of bilious fever in its worst form.

C46 Fort, on Bilious Remitting Fever. [Xovember,

Districts of country. From the earliest times, the term
sickly country, has been applied to places subject to the various
forms of bilious fever. Dr. Watson in his summary of the
opinions of enlightened travelers of the present day, says that
the inhabitants of such countries are represented as being
" puny, sallow and sickly ; feeble in body and spiritless in mind;
having yellov/ faces, swelled bellies, and wasted limbs; subject
to dropsies and fluxes ; phlegmatic, melancholy and short lived."
This picture is drawn from the most unhealthy regions, but it
must be acknowledged, we have many places whose inhabit-
ants exhibit too many of the symptoms described. Every one
will acknowledge the importance of avoiding evils so appalling.

Sicily was considered by the Greeks an unhealthy country,
and one of their writers adds, that the m.ost sickly parts, were
those in which the wells w'ere shallowest. This remark holds
true within the compass of my observation, with but few ex-
ceptions. The islands of our coast which are composed of sea
sand, and have on them only the water which falls in rain, are
healthy, though the wells are very shallow. But there are
exceptions, to the healthfulness of the islands of our sea coast.
Those of South Carolina are considered very unhealthy. The
cause of this, has not been well ascertained. I have no doubt
that a stratum of marl or clay, will be found, at a greater or less
depth, below the surface, of these sickly islands. This is the
common cause of the unhealthiness of similar localities.

The formation of peat is hindered in southern latitudes by
the extremes of heat and drought. It never occurs in places
sometimes overflown and at other times dry. The presence of
peaty earth proves the absence of putrefaction. The great
Dismal Swamp, at the south of the Chesapeake Bay, has been
often referred to, as the most extensive and healthy region of
peat in the south. I know thousands of acres of similar lands
located in our sandy pine woods, which have proven equally
innocent. But I have witnessed the clearing of some of the
lands, around the streams furnishing xh^^epeat mosses ; and the
consequent frequent overflow of them by muddy water and
sand, and finally a change in the people of thi^ neighborhood
from health to sickness.

But we will return to the general fact, that very shallow

1848.] Fort, on Bilious Remitting Fever. 617

wells indicate a very sickly country. To this I know no excep-
tion, except such as have been mentioned. The sea coast of
the Carolinas and Georgia, give extensive exemplifications.
The soil of this whole region is sandy, but is, I believe, univer-
sally underlaid by a stratum of alluvial clay, sufficiently com-
pact to hold water. In many places this clay is exposed,
furnishing the rice lands of this extensive district.

Leaving the sea coast and penetrating the country thirty or
forty miles, the sand hills rise, the wells get deeper, and the
people have another and higher grade of health. This region
is, in Georgia, fifty miles or more in breadth, and is an exceed-
ingly healthy country. It is unfortunately unproductive, and
thinly inhabited, and will so remain, till skill in cultivating this
interesting section shall develop its capacity to sustain a dense
population.

Ascending the streams, we next meet with that remarkable
region, called, in Georgia, the rotten limestone. From the sea-
coast of New York, it extends, gradually winding and rising in
elevation above the sea, till in Georgia it has become nearly two
hundred feet above the tide, increasing in breadth and eleva-
tion as it progresses south and west. This whole region,
extending to Mexico, is considered unhealthy. Many parts of
it have high hills and deep wells, and are healthier than other
places in the same region, but there is no warrant for the enjoy-
ment of health and extension of life in such a region.

The composition and structure of this extensive, fertile and
sickly region, is such, that the streams through it are very level,
their vallies subject to overflow, and in many places lime sinks,
developing large streams of water under ground, running to
some larger neighboring stream. The surface of the country
is sandy, and in some places, elevated into hills; but a substra-
tum of clay or marl at various depths from the surface, detains
the rain water which flows perpetually from the sides or bot-
toms of the hills. The water of these springs is offensive to the
taste, and in some places, has the smell of stale animal matter.
This putrid smell is probably derived from the beds of marine
shells through which this clear water has passed. The whole
arrangement and composition of the earth in this region favors
dampness, and produces the sickliness so generally feared.

648 Fort, on Bilious Remitting Fever. [November,

. Proceeding up the rivers we next come to a range of elevated
and well drained pine w^oods, free from marl, though abounding
in porcelain clay. This clay, in greater or less purity, is seen
in the banks of streams, the bottoms of ponds, or on the tops of
hills. It seems to be a transition from the granitic to the rotten
limestone region ; and is as healthy as any part of the country.
It extends. from Augusta to Milledgeville, and onward as far as
I have examined, and is from five to ten miles in width. This
region is comparatively poor, but under all circumstances more
free from bilious fever, than the country above or below it.
Mill ponds, or natural ponds, in the elevated plains, are harm-
less, under any degree of damp or drought. This region is
thinly inhabited, by a population who live, from generation to
generation, without experiencing bilious or intermittent fevers.

We next come to the great primitive formation east of the
Alleghanies. It is a granite region, though infinitely diversified
in appearance. The country is rolling and well drained, and
"when cleared and brought into tillage by the planter, very
healthy. This country, 'extending from the tops of the moun-
tains to the last granite falls in the rivers, is the strength and
the pride of the South. From Virginia to Georgia it covers
^bout one half cJf the country east of the mountains, and is pro-
bably not excelled, in cHmate and situation, by any part of the
earth. It has no limestone, but clay, and all the elements of
granite combined in a thousand ways, ensure a fair amount of
fertility. But these elements and their vegetable products, give
rise under certain circumstances to bilious fever. Mill ponds,
badly drained valleys, oozy and damp hill sides, and probably
many ill drained but cultivated fields, prove fruitful sources of
disease. In all this region there is great difierence in the
healthfulness of neighboring places ; but it will generally hold
good, that places well* drained and sufiiciently removed from
ponds or similar nuisances, will be healthy.

But experience has shown that a residence near our great
streams or wide overflowing bottoms, in our primitive region,
is unhealthy. In this region mill ponds are fearful nuisances,
These causes are worst where the country has been but lately
brought into cultivation. They diminish as the country grows
older. The overflowing of river lands, and their subsequent

1848.] Fort, on Bilious Remitting Fever. 649

drying in hot weather, has been regarded as the most certain
cause of bihous fever. I have again and again witnessed fever
which I thought arose from this cause. But the rocky bed of
a rapid river, being laid bare by extraordinary drought, has
been found as capable of producing fever as the muddiest
swamp. It is not then in proportion to the quantity of mud.
The slimy rocks of dried up rivers, have appeared to produce
diseases as violent and as fatal, as any produced by swamps of
any kind. As a general rule, it may be said, that places are
unhealthy in proportion to their contiguity to extensive deposits
from streams which become dry in the heat of summer.

2. Elevation Distance. Admitting that the sloping banks
and fertile bottoms of streams, and the margins of ponds, are
in summer, productive of the cause of bilious fever, it becomes
an important question, in choosing a residence, to know the
safest locality. I have pointed ouf the circumstances productive
of fever, and those free from the danger, and it is now my pur-
pose to say something of the distance, and elevation, which
may be relied on as a protection. Three miles has been assum-
ed as the nearest safe distance from a spot producing malaria.
My own experience places the line of safety far within this
limit, but having seen the range of bilious fever near the same
river, vary in different years in proportion to the severity of
the disease of the season, I conclude that the danger is more
extended, when the product of the cause is greater or more
powerful. I have compared it with the emanations of putrid
effluvia from decaying animal substances they become weaker
in proportion to distance. I have never seen bilious fever, as
much as two miles from the place which I considered as ori-
ginating its cause. And I believe there are few places which
ever produce it at so great a distance as a mile and a half. It
has been said that the cause of this disease, moves with the w^ind,
and continues near the surface of the earth that an upper
story is safer than a lower story of the same house. This does
not correspond with my observations. The room or building
nearest the nuisance, will probably be first attacked ; but I have
never seen the residents of an upper story, less afTected than
those who resided or slept below. Nor can I confirm the opin-
ion of some men of high standing, that this miasm cannot cross

iteW Fort, on Bilious Remitting Fever. [November,

a pond or river. The Oconee river, in the alluvial country
below Milledgeviile, runs in several places at the base of high
bluffs, extending back to a great distance in a well drained and
healthy country. These bluffs are considered a more danger-
ous residence, than the rich bottoms on the opposite side, where
the only apparent cause of the miasm is to be found.

To what elevation the cause of fever may rise, is a question
yet unsettled ; and I have witnessed no facts directly bearing
on this point. Between creeks or rivers, there must be a point
of greatest elevation; and this point is apt to be at a medium
distance between them. This elevation above the river, within
a few miles of this place, is from one to four hundred feet. On
each side of Fishing Creek, which empties into the Oconee
immediately below Milledgeviile, there arisehillsof this height,
overlooking its valley from each side. I have many times, in a
tour of professional labor, made a circuit of twenty miles upon
one side, and down on the other of this stream. It was at
several points easy to behold the valley, from one to three miles
from hill to hill, spread out like a map for several miles. On
the top of the hills, on which there run public high ways, there
was not, nor ever has originated, a bilious or intermittent fever.
No wind from the valley, although so near, has ever spread the
pestilence so far. It has been interesting to notice the exact-
ness of the limit which seemed to be assigned the disease. I
have several times noticed two settlements, one hundred yards
apart the most distant would escape altogether, while that
which was only one hundred yards nearer, suffered the disease
in almost every member of the family. .

It has been said, that villages are more subject to the visits of
agues, than cities I will add that a single residence in the
country, is more subject than either. If the decomposition of
vegetable matter, by warmth and moisture, especially in com-
bination with a clay soil, is the cause, these facts will appear as
matter of course. The suburbs only of a great city can be much
exposed, and a village can have but little protection every
house is near the suburbs on one side or the other.

I have said that intervening water affords no protection
against malaria; and I think that intervening houses are equal-
ly insufficient to arrest its progress. Intervening hills are en-

1848.] Fort, on Bilious Remitting Fever. 051

titled to more confidence. It has long been observed in the
United States, that the summit of the nearest hill to a river
valley, is the most sickly residence which can be chosen. Any
part of the valley has been justly thought more healthy. In
1813-14, I attended a family located on one of these picturesque
hill tops, elevated perhaps one hundred feet above, and distant
about half a mile from the river. The family, with scarcely an
exception, had every year a violent, attack of bilious feyer,
and two or three died from it. I advised a removal over the
hill; but the gentleman, whose possessions did not extend far,
could only accomplish it by moving lower down w^here the hilt
was narrower. He in this way secured a hill between him and
the river valley, but gained little in distance, and was on a
place at least fifty feet lower than that he had left. His new
residence proved entirely exempt from bilious fever, and is still
inhabited and healthy.

Mist, or fog, has been thought to cause, or to serve as a means
of transporting the cause of fever. I believe this idea is ex-
ploded amongst those whose opinions would entitle them to
much respect. But the fog, which can be seen, gives the most
perfect development of the places in a valley which will be most
subject to this disease. When it rises from a river in a calm
morning, it may be seen to spread equally over the valley,
arising in an equal cloud to the tops of the hills. The slightest
movement of the air will drive it all over the hill, but it will not
pass over in its thickness, but like smoke, pass in a thin stream
over the hill. Admitting that this fog fills the air containing the
malaria, is it not obvious that the brow of the hill is the part
most exposed to its influence ? For at this point it all passes near
the earth's surface, and in my opinion affords a good exemplifica-
tion of the reason, the hill top is the most unhealthy location.

3. Heat a7id cold, wet and dry. Heat and moisture are es-
sential ingredients in the cause of fever. It has been said that
bilious or intermittent fever, will never occur unless the ther-
mometer, in the shade, will show sixty-five degrees of heat, in
the day time. My observations on this head, are not experi-
mental. I feel authorized to say, that 1 have never seen the
disease occur, unless the heat had previously been at least ten
degrees above sixty-five ; and that with the heat, and all other

652 Fort, on Bilious Remitting Fever. [November,

causes favoring its production, a considerable time is necessary
to produce it. In years which produce the most violent dis-
ease, I have observed tiie mildest cases earlier in the season.
When every year produced a fatal epidemic fever in Milledge-
ville, the middle of June commonly presented numerous cases;
since 1826, the date of their first appearance has gradually
receded, till they are hardly seen before the month of August.
The heat of our summers is always sufficient to produce the
disease, when other causes concur.

Moisture seems to be the true point at which the process,
whatever it is, goes on. Inundations and drenching rains sus-
pend or destroy it. This I have witnessed, in so many instan-
ces, and under such various circumstances, that 1 think there
can be scarcely a doubt of its truth. When in July, 1810, the
month of June presented many cases of fever, drenching rains
and a freshet in the river, suspended them for a month or more ;
but the dry season which followed, was attended with many
fatal cases. It was remarkable that year thafthe disease, when
it re-appeared, seemed to come suddenly, and in its greatest
violence. A family of some forty persons, black and white,
resided near the river, ^we miles below Milledgeville. The
Indian corn, at the freshet about the middle of June, was in
bloom ; and when the water subsided, fell down and decayed
with great stench. A second planting was made, and during its
tillage, and till it was in silk and tassel, the laborers and the
family were in good health. In September, two or three of this
family were attacked. On the morning of the third day, these
cases appeared alarming, and a messenger was dispatched for
medical aid. The messenger was struck down on the road, and
a second was dispatched, who passed the first, but did not reach
his journey's end, till he also was compelled to descend from his
horse, and rest under the friendly shade of a tree. A traveller
passing the road, saw the two messengers, and brought the intel-
ligence to me. I immediately went to this scene of distress.
I'here were only three persons out of the whole of this family,
able to render any aid to the sick, I considered myself fortu-
nate, that from vigorous measures in removing the whole of these
))eople to a healthy location; and procuring for them such aid
as they absolutely required, I was able to say only two died
of their diseases.

1848.] Fort, on Bilious Remitting Fevef. 653

I have seen it stated that the extreme of drought, was as apt
to produce this disease, as any thing else. This never occurs,
except in the immediate neighborhood of ponds, or rivers, or
other places, which are at other times covered or saturated with
water. While the violent endemic, a few years past, was deso-
lating the city of Augusta, an eccentric man was sowing turnips
in the bed of the river, on land on which the sun had never be-
fore shone within the memory of man. The English army
when in Spain, pitched their tents near some pools of water, in
the bed of a river which was nearly dried up. They found in
the malaria, a more dreadful enemy than the French. In every
instance in which I have investigated this subject, I have found
cause to believe, that a state of mosture, and not of wetness or
dryness, was necessary to give rise to bilious fever. The effect
is greatest, when all circumstances conspire to favor the most
rapid putrefaction. But I am not prepared to say, that putre-
faction is the cause. I have never seen the disease arise from
the decay of anirAal matter, however offensive.

4. Decaying substances. Animal substances or animalised
matters, such as are found in privies, stables, and yards, have
never, within my observation, produced bilious fever. The
scavenger may remove from cities, the cause of dysentery,
cholera morbus, and possibly typhus fever ; but he is compara-
tively useless, in removing the cause of bilious fever. Let the
suspected place be dried or submerged in water, and what hu-
man art can do is accomplished.

It does not now occur to me that I have ever Seen it stated,
that the putrefaction of the flesh of animals has produced bil-
ious fever, in any of its forms or varieties. I have stated that
the decay of the litter of stables, or other similar matter is equal-
ly harmless. The testimony is different in regard to vegetable
matters. Grains, fruits, vegetables, and roots, gathered for
consumption, but suffered to dec^y, have in thousands of in-
stances been thought to produce this fever. The danger is
greatest when the decay is most rapid. I once met an alarm-
ing fever, on a place which I supposed from its location, would
be exempt from the malady. On making search, I found near
by, four or five bushels of potatoes in the last stage of putre-
faction. In 1840, 1 was in the city of New York, in the month

654 Fort, 071 Bilious Remitting Fever, [November,

of August. Passing near one of the slips on the East river, I
observed in the transparent water, a large quantity of potatoes,
not less than one hundred bushels. They had undoubtedly
become too unsound for sale, and been thrown overboard, in
such a situation as to be exposed to the air and the sun at low
tide. When I saw them, they were covered in water, but the
escape of gas from them, equalled the most active fermentation.
Apprehending ill from this state of things, I continued to notice
the newspapers, and soon after observed that a fever had bro-
ken out near the spot I have been describing. In the year
1810, I was in the city of Baltimore in the month of July.
Passing near Fell's point, I observed a new wharf erected,
which was being filled up with shavings and mud, raised by a
machine from the bottom of the basin near the wharf This
compost was raised several feet above the tide. A fatal bilious,
or as it was called in the newspapers, yellow fever, soon arose
near this spot, and spread consternation through the city.

But it is comparatively seldom, that biliftus fever can be
traced to causes thus obvious. The decay of vegetables, grains,
seeds, or fruits, gathered by men, seldom cause bilious fever.
Trees also decay and fall in any number; and when other
causes do not occur, no fever will arise. When large trees
are cut around near the root, and die after having put forth
their leaves, the sap sometimes descends, forming a kind of
jelly, which decays with great stench. I have once remained
during the summer months, very near hundreds of pines in this
state. Not the slightest sickness occurred to myself, or any
one of the numerous family, equally exposed.

5. Is putrefaction tke' cause of fever? I have said that fever
dose not arise as soon as putrefaction commences, but after a
considerable time has elapsed. I have never been able to de-
tect the cause of fever, by the presence of any unpleasent smell
in the atmosphere. The gases, discharged by putrefaction,
have long disappeared before fever occurs. Nothing could ex-
cel the calm, serene beauty of the heavens, and the refreshing
cool and sweet atmosphere, which 1 have ofthen breathed in
Millcdgeville, in the month of October, when the watch light in
every house, and the anxious face of almost every one I met.
announced tlie ])rescncc of an awful pestilence. The senses^

1848.] Fort, on Bilious Remitting Fever, 655

give no intimation of the presence of this fatal pest. A friend
of mine who resided in Savannah in 1820, when fever was a
pestilence there, has made to me the same remark. When
the cool nights of autumn came on, the citizens who had re-
mained during the season, began to suffer less, and the cause
of disease seemed to be giving way ; but woe to him, who
from healthier places, ventured to expose himself to this de-
ceitful scourge, at such a time. A single night in a place thus
circumstanced, has been fatal to many. There is no safety,
till the thermometer has been below the freezing point. Frost
must have killed the vegetation and blackened the land. How
long this undiscovered substance, the cause of fever, may remain
in the place it has originated, under a state of the atmosphere
too cool to produce it, cannot be told. It disappears suddenly
before frost, and with equal suddenness, leaves a land over-
flown with w^ater. But if the atmosphere becomes cool, but
' without frost, there is reason to believe that many weeks will
elapse before ther-e will be safety for the visitor of these infect-
ed places,

6. Water. I think there is no where, a civiHzed people, who
drink so little, besides the water of their wells and springs, as
the citizens of the Southern States. With our ancestors, the
excitement of wine and distilled liquors, was a fashion ; and
while it heightened the zest of their social intercourse, it pro-
duced ills not to be contemplated without dismay. This fash-
ion has now become a matter of history it has passed away:
It has given way to a climate unsuited to intemperance, and
cannot be again revived. This I am sensible will be disbe-
lieved by many who think that the reform in regard to tem-
perance, has been brought about by moral causes. These it
is true, are the noblest foundations of temperance, but our
case would be bad, if these alone could save us from this de-
grading vice.

I love the Southern Atlantic States. I look upon them as
the chosen seat, of the highest physical and mental develop-
ments of man. I therefore have seen, with unspeakable satis-
faction, the steady progress of the cause of temperance, for the
last thirty years. The people of this region are physically in-
capable of using ardent spirits, as a beverage. Nor are they

656 Forf, Oft Bilious Remitting Fever. [November,

fnuch more capable of u^ing fermented liquors of any kind.
If the fountains of their hills flowed with porter and wine, a few
persons might become sots ; but neither wine nor porter, would
become the common beverage of the country. Intoxication is,
with many of these people, a fearful temporary insanity. They
can no more sink down in quiet stupefaction, from strong
drink, like the Russian, than they can eat ten pounds of whale
blubber at a meal, like the Greenlander. The Southern men
who become occasionally intoxicated, commit more acts of out-
rage and violence, than a. thousand times their number of so-
ber men. The number who give way to this vice is small ;
but the crimes they commit are so fearful and frequent, that
persons at a distance regard the country as a scene of anarchy
and bloodshed. Rejoicing that these scenes are becoming less
frequent, and having full confidence that persons born and
raised in this climate, have irresistable tendencies towards
temperance in drink, I return to the consideration of the ef-
fect of the water drank by these people, on their health.

Water which falls in rain on the earth, is in a tolerable state
of purity ; but by the time it finds its way into springs and
wells, it becomes more or less mineralized. In the primitive
region, which lies above the great falls of the river at Colum-
bus, Milledgeville, and Augusta, the water is sufficiently pure
for drink. That which is most disagreeable to the taste may
still be drank with safety. But as we get into the rotten lime-
stone, the scene changes. The first pine hills, resting on mica
slate and other primitive rocks, yield water in the highest de-
gree pure and salubrious. Immediately below, the water is to
be regarded with distrust. That which is found in wells, be-
ing in fact, rain water, which has passed through an alluvium
of clay and sand, is not unwholesome. But the springs from
deeper veins, are less to be depended on. Many of these, aris-
ing in whitish clay, yield water of a whitish or milky appear-
ance. In other cases the w^ater is perfectly transparent, and as
the limestone region sets in, the water becomes decidedly
clear. The extensive region to which I now have reference,
stretches across the country, from ten to fifty miles below Mil-
ledgeville. Many parts of it are free from bilious fever, and inf
some, the health of the inhabitants seems to be good. But I

1848.] Fort, on Bilious Remitting Fever. G57

can hardly be deceived, in the opinion, that they are far more
subject to diseases of the hver, spleen and intestines, than those
persons, who reside higher up the country. This difference,
I attribute to the water they drink. This conclusion has not
been hastily adopted. I have often visited this region, and
have met the pale face, the tumid spleen, torpid liver, and
disordered bowels, as far and wide as the springs and wells
afforded the evidences of bad water I have referred to. Not
so of bilious ibver. This does not extend far beyond the val-
ley or hills, combining the circumstances above described.

How to avoid Bilious Fever. The cause of bilious fever,
may in many instances, be avoided, and health and life
preserved, by persons who live near it. This cause is met
in the open air, on the road, in the field, or in the woods, and
even in houses, located too near the place it is produced in.
The means of avoiding it, will vary with the circumstances
under which individuals are placed. Experience has shown,
that those most exposed to the open air at night, are soonest
and worst affected. To sleep in the open air when the malaria
is present, is the worst sort of exposure. To visit infected
places at night, is dangerous ; but I have never known a
case of fever, brought on by visiting an unhealthy place in
the day time, and retiring before night. Great advantage
would be derived from entering and closing the house, and
remaining thus secluded till the next day. Striking exam-
ples of this, are related by authors ; but I never found it prac-
ticable to induce people to conform to this rule. A single
night spent in an infected atmosphere, will produce the disease,
in as violent a form as a longer time. Persons in towns, or on
plantations, should recollect, that the cause of this fever arises
in the nearest marsh, or some such place. Every foot they
can retire from it, is an advantage. The width of a street, I
have often found, a matter of consequence. My residence, in
Milledgeviile, was chosen with the light of experience on this
subject. My family, averaging more than a dozen persons,
have for twenty years, entirely, escaped. Not even the mild-
est intermittent has happened amongst them. Every year of
the time, has presented this disease, of some grade, within a

42

658 Rossignol's Statistics of Mortality. [November,

quarter of a mile. One year, it was formidable, in every house
south of me; and in the nearest, within forty yards, several
violent cases, one of which proved fatal, occurred. The first
object, then, is to keep at a proper distance. A mile and a
half, is probably sufficient. There are few spots in this coun-
try, in which a healthy residence, within this distance, may
not be found. Very soon after the settlement of Milledgeville
several families found safety in country residences, judiciously
chosen, from two to four miles distant. These citizens main-
tained daily intercourse with the town, when it was most un-
healthy ; and returned to it in the winter, and there never oc-
curred a single instance of fever, chargeable to these daily
visits. Persons who travel in summer, should bear in mind,
the danger of a single night's 'exposure to unwholesome air.
The journey should be so arranged, that night may not over-
take the traveller at unhealthy places. The mariner has with-
in his reach the same means of escape. He may go on shore
in the day time, in safety, and in equal security, traverse ev-
ery sea and visit every clime; but woe to him, if the tempta-
tions of sea-port towns, or sickly shores, allure him to remain on
land at night. Thousands have perished from this cause. This
danger has been pointed out by medical men, and is now gen-
erally understood. A rigid rule of staying on board, and at
night, and keeping at a safe distance from land, is the means
of preserving the health and the lives of thousands every
year.

ARTICLE XLVIII.

Statistics of the Mortality in Augusta, Georgia, from 1839 to
1848. Arranged by Henry Rossignol, M. D.

The materials for the following tables have been derived
from the Books of the City Sexton, which it is to be regretted
have not always been kept in such a manner as to be of much
practical utility. Similar statistics for former years having
been published in this Journal, (see vols. 1 and 3 of old series,)
it may be interesting to have them continued from time to
time, if for no other end than to exhibit the relative salubrity

1848.]

Rossignol's Statistics of Mortality,

659

of the city at different times. The writer feels that this object
will be attained inasmuch as the records are correct so far as
relates to numbers, however defective they may be in reference
to ages and to the immediate causes of death.

The census is that taken by order of the State, and, although
not as detailed as would be desirable, is the best that could be
procured.

Table No. 1.
Census of Augusta, taken by order of the State. May, 1845.

Whites.

8948

Free colored.

440

Slaves.

3114

Deaf.lDumb.

2 1

Lunatic,

7

I White males, hC'
tween 6 and 16

436

Female whites, be.
tween 6 and 15

439

Table No. 2.
Deaths in each year, from 1839 to 1848.

Year.

Whites.

Blacks.

Total.

1839

320

unknown.

1840

98

109

207

1841

63

95

158

1842

72

81

153

1843

81

120

201

1844

97

85

182

1845

68

87

155

1846

71

91

162

1847

59

87

146

Table No. 2. In preparing this table, the still-born are in-
cluded, although not in accordance with usage. It is unfortunate
that the number of blacks who died in 1839 cannot be ascer-
tained, owing to the confusion occasioned by the epidemic which
ravaged the city during that year. It is notorious, however,
that the black population suffered comparatively little mortality
from the yellow, fever of that year, and that its fatality among
the colored was in a direct ratio with the proportion of Cauca-
sian blood in their veins.

660

Rossignors Statistics of Mortality. [November,

Table No. 3.
Deaths in each month durinsi' nine years 1839 to 1848-
horns included.

-still'

-d

X,

cr

CO

C3 1

o

O

^

s

i

S

S

<

lb3l

Jan.

Feb.

March

April,

May,

June,

July,

Aug.

Sept.

Oct.

Nov.

9
5
13
10
12
11
13
37
137
49
18

Dec.

f)

320

1840

Jan.

8

12

20

Feb.

15

1

22

March

8

8

April,

9

8

17

May,

/

10

17

June,

5

5

10

July,

8

r.

14

Aug.

10

II

21

Sept.

10

9

19

Oct.

10

17

27

Nov.

9

/

If)

Dec.

7

9

16

207

1841

Jan.

4

b

10

Feb.

5

10

15

March

4

9

13

April,

5

5

10

Mav,

6

10

16

June,

8

3

11

Julv,

9

7

16

Aug.

4

7

11

Sept.

c>

5

11

Oct.

4

17

21

Nov.

5

1%

12

Dec.

3

9

12

158

1842

1843

1844

Month.

V.

7

.X

CO
9

13
16

o

1.^
1845

c
o

5

i

Jan.

Jan.

4

<)

10"

Feb.

2

4

6

Feb.

6

10

16

March

3

5

8

March

5

12

April,

9

6

15

April,

8

8

16

May,

3

5

8

May,

7

5

12

June,

7

6

13

June,

8

9

17

July,

8

()

14

Julv,

7

5

12

Aug.

9

7

16

Aug.

3

5

8

Sept.

7

8

15

Sept.

7

8

15

Oct.

7

11

18

Oct.

6

9

15

Nov.

6

7

13

Nov.

2

5

7

Dec.

4

7

11

153

Dec.

5

10

15

Jan.

11

5

16

1846

Jan.

2

10

12

Feb.

3

4

7

.

Feb.

2

4

6

March

4

8

12

March

7

5

12

April,

8

6

14

April,

3

4

7

May,

2

11

13

May,

/

4

11

June,

7

6

13

June,

3

8

11

July,

14

12

26

July,

10

8

18

Aug.

8

15

23

Aug.

7

9

16

Sept.

6

19

25

Sept.

9

14

23

Oct.

7

12

19

Oct.

14

9

23

Nov.

5

11

16

Nov.

6

9

15

Dec.

6

11

17

201

Dec.

1

7

8

Jan.

8

11

19

1847

Jan.

3

4

Feb.

4

8

12

Feb.

1

7

a

March

9

6

15

March

6

9

15

April,

17

8

25

April.

2

3

5

May,

1!

7

18

May,'

7

7

June,

12

6

18

June,

4

3

7

July,

11

6

17

July,

o

10

12

Aug.

3

7

10

Aug.

13

II

24

Sept.

6

11

17

Sept.

8

10

18

Oct.

8 8

16

Oct.

10

11

21

Nov.

5 3

8

Nov.

7

9

16

Dec.

3

4

7

182

Dec.

3

3

6

155

162

146

Table No. 4.
Number of deaths in each month, during a period of eight years,
(from 1840 to 1848,) with averaores deduced from the column
of Whites, from that of Blacks, and from the total.

"Whites.

Blacks.

Total.

January,

47

63

110

February,

38

54

92

March,

38

57

95

April,

61

48

109

White

Black-

Total

average.

average.

average.

5-87

7-87

13-75

4-75

675

1150

475

712

11-87

7-62

6-00

18-62

1848.]

Rossignol's Statistics of Mortality.

6G1

Whites.

Blacks.

Total

May,

43

59.

102

June,

54

46

100

July,

69

60

129

August,

57

72

129

September,

59

84

143

October,

66

94

160

November,

45

58

103

December,

32 .

60

92

White

Black

Total

average.

average.

average.

5-37

7-37

1275

6-75

5-75

12-50

8-62

7-50

1612

7-12

9-00

16-12

7-37

10-50

17-87

8-25

11-75

2000

5-62

7-25

12-87

400

7-50

11-50

Table No. 5.

Average number of Dsaths per annum, amonf^ the Whites and

Blacks, at different ages. (1846 and 1847.)

WHITES.

BLACKS.

Under 5 years,

25-00

Under 5 years,

36-00

From 5 to 10 years,

350

From 5 to 10 years,

300

" 10 to 20

I

450

" 10 to 20 '*

5-50

*' 20 to 30

i

7-50

" 20 to 30 *'

8-00

" 30 to 40

(

9-00

*' 30 to 40 "

550

" 40 to 50

(

5-00

*' 40 to 50 '*

5-00

" 50 to 60

(

500

*' 50 to 60 *'

350

* 60 to 70

i

2-50

" 60 to 70 "

800

" 70 to 80 ''

2.50

" 70 to 80 '*

8-50

Over 80 years,

0-50

Over 80 years,

6-00

Table No. 5.

-The

sexton'

5 records did not contain

, with

sufficient accuracy, the ages of those who died previous to 1846,
to allow correct tables to be made out for that period. We
are therefore constrained to furnish tables for only,two years.
The apparent longevity of the blacks is evidently the result of
ignorance of their real age, and of their well-known propensity
to exaggerate it.

Table No. 6.
Ages of those who died in 1846 and 1847.

WHITES.

Under
5 years.

From
CtolO

10 to 20

20 to 30

30 to 40

40 to 50

7
10

50 to 60

60 to 70

4

1

70 to 80

4

1

Over

80

1

TotaL

1846

1847

23

27

5
2

7

3
6

11

4
15

9
9

5
5

71

59

50

9

18

10

5

5

1

130

blacks.

1846"

1847

40

2

3

7

6

5

2

9

8 9

32

72

4
6

8

9

5

5
10

5

7

7
16

9 3
17 12

11

16

11

91

_86_

178

cm

Rossignol's Statistics of Mortality. [November,

S2

D3

r
o

C5'>0

Ci-ooaoov^* w

Sundries.

tU tcic^

Diarrhoea.

^ H-

Klieumalism.

^

^_

Mortificaiion.

CJ

^ ^ H- "- >

Brain tever.

^_

^ coto to

Croup.

w *-

Dysentery.

CO

H-

Cholera Inlantum.

ty h-

H- w ^ ^

Affection? ol lunj^s.

iOCD

coto to c;^ w>*>. -

Teething.

Cholera Morbus.

^J Oi

ODOtO.*^C>-'CO>^r!>^l

Fever.

*>. c;^

OC Ci 0 ^ ^ ^ -I u^ *^

1 iStill-born.

^ Oi

cr. to -J to ^

1 Pneumonia.

^

f-

Afiections ol'liver.

bO

- h- ^

1 Tetanus.

I-*

to CO -: CO -1

1 Intemperance.

<^ to

> toco rfi. CO -

Fits, Spasuis and Cramps.

to

W 1-

1 Pertussis.

toc^

rfi.W>fi^-> 4i.C0 C5

1 Inflammation ot bowels.

H- - >-

1 Erysipelas.

to

^ tOCi

1 Cholic.

o w

to "-to

, Palsy.

^ to

^to -H-- -

1 Woru)s.

*- to

CO (0 N- CJl H-

1 Dropsy. j

^

u to

1 Measles. |

- .

1- to 1- K- to

1 Pleurisy. |

^^

CO

1 Typhus lever. {

to-

to to CO

1 Child-bed. 1

to

CO >- H- K* 1-

1 Apoplexy. j

^

to

1 Dropsy ol'brain. j

^ t^ ,_

1 Inflauimation ol' brain. j

-1 (O

- to COCTi

1 Old age. 1

tOH-

- H-

1 Dyspepsia.

C' CO

1 Scarlet lever.

>U CO

rfi. 00 'O C^ 0 -> c-^ 0 to

1 Consumption. ]

*>.

t tOOCOCO*.COrf.

1 Casualties. 1

to

0

1 Yellow lever.

*-o

10 a: en Ti 0 00 -1 ci 'O

Diseases unknown.

ss

S5-'S-'g2si

Diseases stated.

5S'd^

fi^i^.^.^^s^i

Whole No. of deaths.

^

:^

^
S

Table No. 7. It will be observed that the diseases of the

((

24,

<(

31,

((

34,

<<

45,

iC

27,

((

28,

u

27,

1848.J Eve, on Amputation at Shoulder -joint. 603

blacks are stated only for two years. This is all that could be
gleaned from the sexton's book. The names of the diseases
are such as have been recorded. It was deemed better to fur-
nish them in this manner than to undertake any regular classi-
fication or change of nomenclature. Indeed very little reliance
can be placed upon this table, inasmuch as for several years
the sexton rarely derived his information from those who were
alone qualified to make it correct.

Table No. 8.
Relative Proportion of the Sexes of those who Died.

In 1840, died (Whites) Males 64, Females 29, Sex unknown 5

37, " 24, " 2

" 40, " 31. " 1

" 45,

51, " 45, " 1

41,

43,

32,

48, " 43,

49, " 38.

ARTICLE XLIX.

Successful Amputation at the Shoulder-joint, for Gun-shot
Wound patient under Chloroform. By Paul F. Eve, M.D.,
Prof, of Surgery in the Medical College of Georgia.

On the nth of February, 1848, I removed the arm at the
shoulder-joint of a black boy, who had about 48 hours previ-
ous been accidentally shot. The discharge from the gun
was received at a distance of only a few feet; it was loaded
with squirrel shot, and tow was used for the wadding. This
occurred in a neighboring county, and the patient was sent to
Augusta by the rail-road. Dr. Beggs, who saw him soon after
the gun-shot wound was made, removed the tow, with some of
the shot, and restrained the hemorrhage, represented to have
been considerable. The wound presented an irregular ovoidal
opening, of an inch to an inch and a half in diameter, upon the

In 1841,

((

((

In 1842,

u

a

In 1843,

i(

it

In 1844,

a

a

In 1845,

a

ti

In 1846,

u

a

In 1847,

a

te

In 1846,

" (

Blac

In 1847,

((

604 Eve, on Amputation at Shoulder-joint. [November.

upper outer surface of the left arm, about an inch below the
acramion process of the scapula, and the shot, after cutting the
OS humeri nearly in two, passed in the direction of the shoulder-
joint and subclavian artery. His pulse when I first saw him,
was over 100; his fingers of the injured side he said were
benummed, and he complained of pain in the region of the
wound. The arteries of the left upper extremity pulsated dis-
tinctly ; the age of the patient was 11 ; his general health good.
His bowels had been moved with salts, and 50 drops of lauda-
num had also been given to procure ease and sleep.
. Amputation at the shoulder-joint having been decided upon
in consultation, assisted by Dr. Dugas, who by pressure upon
the subclavian artery efiectually controlled the circulation, and
Dr. Means, who administered the chloroform, in the pre-
sence of the class in attendance at our college, the heel of the
amputating knife was applied upon the anterior edge of the
acromion, and by a continuous sweep around the head of the
OS humeri, two flaps, one anteriorly and the other posteriorly,
were made, and the operation completed by ligating four or
five arteries. In carrying the elbow forward, to throw the
hearl of the bone backwards so that the knife might the more
easily pass through the joint, the humerus was fractured, so
near was its complete division by the shot, which must have
entered en masse. The time consumed in the amputation, was
thus increased by this fracture, but the longest estimate of
those present was 22 seconds.

The insensibility produced by the chloroform was extremely
satisfactory ; the operation having been performed and the
dressing applied without the knowledge of the patient. He
was sitting up on the fourth, and left the surgical infirmary on
the seventh day.

With the exception of some delay from the shortness of the
flaps, owing to the destruction of the deltoid muscle by the
wound, the discharge of a few shot from it, and some fever
created or rather aggravated by worms, he had a good recov-
ery, and is now a hearty, well boy.

1848.] Medical Ethics, 665

PART II. REVIEWS AND EXTRACTS.

Medical Ethics.

[We present the following extracts to our readers, taken
from the Biitish and Foreign Medico-Chirurgical Review
being a notice in that Journal on the subject oi Medical Ethics.
For high tone morality, the exponent of the true dignity and
duty of the medical profession, for enlarged benevolence, we
have found nothing equal to them. Edt.]

The long interval of almost uninterrupted peace and tran-
quillity wh.ch Europe has enjoyed, and which is now disturbed
not so much by international quarrels as by intestine com-
motion, has left the minds of men at liberty from the engrossing
thoughts and efforts which war demands ; and the result has
shown itself, and we trust in spite of a temporary check, will
continue to show itself, in the advance of all the arts and
sciences. The sciences of morals and of mental philosophy
have received their share of consideration ; and consequently
we find metaphysical theology, religious doctrines, formulae and
ceremonies, and ecclesiastical government and d^scipl'ne, oc-
cupying the thoughts of a large and influential portion of the
community. The medical profession is not exempt from the
general movement; and, while we have to note with pleasure
amounting to delight the wondrous progress that the medical
sciences have made during the last thirty years, we cannot shut
our eyes to the i'act that the moral or ethical relations of the
profession have not been neglected. Of recent years each
European language has afforded at least one contribution to
medical deontology and medical ethics; and if in our own
country, the formal the.ory has attracted little attention, the
practice of the great body of the profession has been in full ac-
cordance with its soundest teachings. No class of men not
even the clerical order has exerted itself more disinterestedly
and benevolently for the welfare of mankind; at home and
abroad, we find the severest toil, the most dangerous duties,
undergone with a cheerfulness and alacrity which can only result
from a deep inherent sense of the claims of suffering humanity
upon medical skill ; and besides those whose official duties c^rry
them to the remotest parts of that empire on which the sun never
sets, numerous individual members of our body have been en-
listed into the service of Christian missions, and Asia, from the
coasts of Syria to the rivers of China, has felt the presence of
practitioners, who carry succour for the souls of men in their
right hand, and in their left help for their ailing bodies.

ceo Medical Ethics [Novembei

The little tract entitled * Claims of the Missionary Enterprise
on the ?Iet]ical Profession,' by Dr. INIacfi^owan, an American "
medical missionary at Ningpo, contains facts and arguments of
interest to every practitioner who looks beyond this earth, and
the pains and sorrows he has to alleviate; nay, of deep and
surpassng interest, because if truly Christian, he must see that
the medical missionary is therein more closely assimilated to
the founder of his holy religion than any other. " Ot" the phy-
sician it is the high and honorable boast that with him science
is merely the necessary means to an important end that all his
knowledge is eminent!}^ practical, and its great purpose benevo-
lent. It is his province to assuage human sut^ering in all its
varieties and aggravations, and in imitation of the Saviour, 'to
heal all manner of diseases.' " When, however, he passes the
boundaries of European civilization (and we, of course, include
the civilized states of the New^ World within them), his labours
become far more valuable and far more effective. In highly
civilized nations medical science has interpenetrated the social
condition of the people; and much of the prophylactic and
practical knowledge of the profession is in daily application
without the assistance of individual practitioners. The abound-
ing numbers, too, ofskilltul hands and well-stored heads, lead
to a lower estimate of the value of a skilled practitioner. He
is no longer considered as "more than armies to the country's
weal." But if we turn our eyes to half-civilized nations or to
barbarous tribes, and mark the treatment of the sick and the
ravages of disease amongst them, the glory of the medical pro-
fession its power to save from misery and death stands
forth in brilliant clearness. "Behold Dr. Grant," says Dr.
Macgowan, "armed only with his needle for the removal of
cataract, forcing mountain passes, and, amidst ferocious war-
riois, winning his way to their homes and their hearts.. On
account of his professional skill he was enabled to traverse in
f;af'ety regions heretofore untrodden by civilized man, and in
whose defiles an army would perish in effecting an entrance."
The destruction fi'om epidemical diseases is frightfully appalling,
especially from smallpox; and the sad traces of syphilis ap-
parent amongst distant tribes, since they have become familia-
rized with Europeans, show that medical aid to the sufferers is
called for alike as an act of moral duty and of Christian love.
The treatment of the sick in many countries is truly cruel,
either from ignorance, superstition, or apathy. Brahmin priest
chokes the sick Hindoo with mud from the Ganges, and the
weak, the aged, and the dying are left exposed on its banks to
the glare of a burning sun, or are held up in the river and its
sacred water poured down their throats until they expire.

1848.] Medical Ethics. GC

Immense nun)bers of blind, we are told by Dr. Macc^owan, are
seen in the streets of Chinese cities, and their blindness is fre-
quently the result of a simple ophthalmia, easily cured by suita-
ble remedies. Dr. Bradley, who is stationed at Baijkok, in
Siam, states that the relatives and friends of many who were
literally all corruption, ' helpless and hopeless," brought them
to his door and then forsook them. His abode was almost con-
stantly the scene of the uroanino-, the dying, and the dead.

Medical missionaries have not gone ibrth from Europe and
the United States as missionaries of medical art and science
exclusively, or even principally, but rather with the intent of
rendering medical science and art subservient to the propaga-
tion of Christianity. Dr. Macgowan enumerates five American
missionary Societies, five British, and one French, as sending
out thirty-five medical missionaries ; and this list we happen to
know is imperfect, as both the Church of England and the Wes-
leyan body have professional men thus engaged. They are to
be found in Africa, India, China, Syria, and the Islands of the
Pacific. The ot)ject of the persons by whom Dr. Macgowan's
address has been reprinted and circulated the Edinburgh
Medical Missionary Society is to stir up the members of the
medical profession in Great Britain to consider their own duties
and responsibilities in connexion with the great object of Chris-
tian missions to the Heathen; and, in fact, to raise up a new
order of missionaries, who shall combine, as of old, in their own
persons the sacred functions of teaching religious truth and
curing bodily infirmities. The Scotch editor of Dr. Macgow-
an's address, in a note attached thereto, does not hesitate to call
upon " practitioners of some experience," and "not very young
men," to go forth and give their personal services ; and addu-
ces circumstances and considerations fitted and intended to
warn us, that some or even many amongst us may one day be
constrained personally, to consider aiid answer the question,
'* Am I fitted, and if fitted, am I willing and ready to obey the
call of my Divine Master to become a fellow-helper to the truth,
in devoting my professional skill and personal exertions to the
promotion of the spread of the Gospel?"

****** The physician's proper
study is MAN in every possible relation. He has to study man
as a spiritual being, and as a mere animal ; as a moral creature,
and as a piece of vital machinery; as in the "image of God,"
and as an unreasoning brute. In considering him as a spiritual
and moral being, the physician, in common with the philoso-
pher, trenches upon theology and moral philosophy, and is
bound to study all questions thence arising in connexion with
the structure, functions, and disorders of the brain and nervous

668 Medical Ethics. [November,

system. It cannot be matter of surprise that with such a wide
sco}>e of inquiry, and a scope which it is imperative that the
physicinn should occupy, the physician has come to conclusious
not always in accordance with the principles of dogmatic the-
ology, or of the popular code of morals ; that he has been lenient
in his judgments, slow to punish, ready to plead human infirmity
in excuse for crime, thrown the shield of professional opinion
over the thief and murderer; io(>kednot for uniformity of faith
and practice, pleaded for toleration, has been latitudinarian in
his principles, and, in short, has been pronounced a simpleton,
a fool, a protector of felons, a heretic, a materialist, an irreli-
gious person, an atheist. An irreproachable life, and gratitude
for services rendered in the hour of need, may have often
shielded the })ractitioner from persecution by the religious zea-
lot, but oftener his discretion and caution have stood him in
better stead. Feeling the impossibility of convincing, he has
kept a watchful silence, or given a verbal assent to dogmas and
doctrines which he could not comprehend, or which he suspect-
ed to be groundless.

From the earliest periods of Christianity a second advent of
Christ has been expected, and therewith a more perfect condi-
tion of morals. For such a great and glorious event, the daily
and hourly prayers of Christendom are offered up in the words
tfiught by Christ himself "Thy kingdom come, Thy will be
done on earth as it is in Heaven." How such events will be
brought about, we are not taught; but if we seek for informa-
tion in experience, and judge the future by the past, they will
arise with fundamental changes in existing forms and ceremo-
nies, and with a clearer and^niore perfect manifestation of God's
infinite wisdom and goodness. Science, and especialFy the
science of human nature, may be expected to have a large share
in the agencies that will effect this. * * * * If an unde-
vout astronomer be mad, how much more mad the educated
and instructed but undevout practitioner, to whom God's handi-
work is revealed, and the operations of infinite wisdom laid
open in the living creation, and especially in man, the image
of God?
* ######*

"Whatever man may do, so long as he does it for himself, as a
finite being, by himself, and through his own counsel it is vain and
will sink to nothing. Only when a foreign power takes possession of
him, and urges him forward, and lives with hitn, in room of his own
en'M'^ry, does true and real existence first take up its abode in his life.
This tbreign power is ever the power of God. To look up to it for
counsel implicitly to follow its guidance, is the only true wisdom

1848.] Medical Ethics. 669

in every employment of human life, and therefore most of all in the
highest occupa'ion of which man can partake the vocation of the
triie Scholar." (p. 192.)

Shall we be presumptuous if we recommend these views to
our professional brethren ? or if we say to the enlightened, the
thoughtful, the serious, this if you be true scholars is your
vocation ? We know not a higher morality than this, or more
noble principles than these: they are full of Truth.

In his third Lecture, Fichte treats of the progressive scholar,
and in particular of genius and industry. He points out the
nature and bearing of the two qualities, and the characteristics
of those in whom they are deficient. Whenever a man, after
having availed himself of existing means of mental improve-
ment, remains inactive, satisfied with his acquirements, and
proud of his powers, then he has neither the "Idea" nor " Gen-
ius," but only a vain ostentatious disposition, which assumes
a singu'lar and fantastic costume in order to attract attention.
Fichte thus compares this man of Dutch metal with one of
sterling ingot. ^

" Such a disposition shows itself at once, in self gratulatory
contemplation of its own parts and endowments, dwelling on these in
complacent indolence, commonly accompanied by contemptuous dis-
paragement of the personal qualities and gifts of others ; while, on the
contrary, he. who is restlessly urged on by the Idea, has no time to
think of his own person ; lost with all his powers in the object he h%3
in view, he never \!^eighs his own capacities of grasping it against
those of others. Genius, where it is present, sees its ohjeift only,
never sees itself; as the sound eye fixes itself upon something beyond it,
but never looks round upon its own brightness. In such a one (one
who contemplates his own brightness) the Idea does certainly not
abide.. What is it then, that animates him that moves him to those
eager and active exertions which we behold ? Is it intense pride and
self-conceit, and the desperate purpose, in spite of Nature, to assume
a character which does not belong to him ? these animate, impel, and
spur him on, and stand to him in the room of genius." (p. 150.)

Such is Fichte's description of that man in whom study and
science have worked but imperfectly; parrallels we fear are to
be found too numerously amongst the members of the medical
profession, although most assuredly not exclusively there.

* ******#

" Whatever thou doest, do it with integrity ; if thou studiest, let it
guide thy studies ; and then, as to whether thou shalt prosper in what
thou doest, leave that to God ; thou hast most surely left it to him when
thou goest to work with true and honest purpose ; with the attaiment
of that integrity thou wilt also attain unbroken peace, inward cheer-
fulness, and an unstained conscience ; and in so far thou wilt assuredly
prosper." (p. 156.)

670 Medical Ethics. [November,

But, while tlie practitioner is tolerent even to latitudina-
rianism, nnd allows to every man that freedom of opinion that
he claims for himself as the sacred gift of God, anti as the
emanation of the s^odlikeness of human nature, he pities these
aherrations in religious principles and practices whicli throw
ridicule on sacred things, and give an air of folly or knavery,
or both, to religious professors. To fiim there is no essential
difference between the acetism of the fanatical Hindoo and the
self-inflicted penances of the fanatical Christian. The sainted
hermit, dwelling on the top of a pillar, differs in nothing Irom
the sainted faquir, swinging from a pole, w^ith a hook in his
back. The tinsel tawdry of imagery is to him equally removed
from the true^spiritualism of human nature, whether visible in
the islands and shores of the South or North Pacific, or in the
peninsula of Italy or India. In the vagabond life of the faquir
or friar, he sees only a modification of that appetite for restless
movement and objectless action, which impels the professional
mendicant to endure cold and hunger and the restraint of the
lock-up, rather than the toils of honest industry. The delirious
ecstasies of pious women he often knows to be none other than
anomalous forms of hysteria, founded partly on fraud, partly on
vanity, partly on insanity. The convulsive seizures and cries
of multitudes in popular assemblies, induced in excitable persons
by impassioned apostrophes or terrible denunciations, are not
lb his experienced eves the solemn manifestations of the Holy
Spirit of God, such as he loves to recognise m the pages of in-
spiratior^ but only the unmeaning and neurotic phenomena of
an excited brain and nervous system. He hesitates to accuse
the suflferers of hypocrisy or blasphemy ; he denies that they
are inspired by God. He pities their weakness ; he maintains
the truth.

It may be asked, to what extent should the medical practi-
tioner interfere to propagate the religion he professes. We
already find Christian medical missionaries abroad in the earth,
and we are led to think that more will be influenced to go.
Upon this point we think the free-will and conscience of the
individual must decide. What we concede to the Christian,
we catmot deny justly to the Hindoo. The liberty that we
demand for the Protestant cannot be refused to the Jesuit.
The only condition we have to demand is, that the mission be
done honorably. But if the medical practitioner seeks, through
the weakness and folly of his patients, to insinuate his creed and
propagate his religious tenets, he is criminal : such conduct is
only tolerable in the bigoted and crafty ecclesiastic, if in him.
Many good and well-meaning people would have the practi-
tioner to hold up the terrors of death before the eyes of his

1848.] Medical Ethics. 671

confiding patient, and extort from his fears and enfeebled m^'nd,
what his sound and perfect judgment refused to concede. They
would have the physician to preach a sermon at the bedside,
and the apothecary to pray. It is reasonable and a duty to
warn a patient of his approaching end, or of his danger, and to
hint that an attention to the duties of religion is incumbent upon
him, and a good thing. This may be so done that the chance
of recovery, slight although it may be, shall not be entirely de-
stroyed, and that the life which the practitioner has intrusted
to him to save be not extinguished. Where the practitioner
is in attendance on a co-religionist, a closer bond exists, and he
may with propriety engage with his patient in those spiritual
exercises* to which, during health, they have been both alike
accustomed ; but still he must remember that the care of the
body is his chief concern, the care of the soul is the duty of
another ; with him he may co-operate, but his place should not
be usurped. Frequently the sectarian practitioner is the least
learned and skilful ; for the time that he devotes to his religious
exercises and public services is necessarily taken from that
which ought to be devoted to his studies. A high spirituality
is by no means inconsistent with professional eminence ; but a
minute and slavish adherence to forms, or a usurpation of cleri-
cal duties, always is. It is, we think, certain that the path of
duty lies to the professional man, in the exercise of his profes-
sion with Godlikeness, and with integrity and love. He is the^
revealed hand of Providence to suffering man; the earthly
means whereby God softens the weight of the prim;?! curse.
To do this with singleness of purpose, should be his first and
greatest duty ; for it comprises love to\Vards both God and man,
and is the vocation to which God has called him.

The punishment and reformation of criminals will ultimately
come within the pale of medical science. Many a wretched
man has been hung and quartered, burnt at the stake, broken
on the wheel, or racked with merciless cruelty, simply because
he had had chronic cerebral inflammation ; and man}" a poor,
uneducated creature, abandoned by society to his own way,
trained up, from no fault of his own, but from the neglect of his
fellow-men, in the practice of every vice, is forced, when com-
paratively innocent, to consort with hardened mockers at every
thing good and virtuous ; and then, when the necessary results
have followed, and he has injured society, society turns upon
him in the sacred name of justice, and with its dread forma-
lities, inflicts, not punishment, but revenge ; seeks not to amend
and reclaim, but to injure and annoy. Yet sound philosophy
and genuine Chrstianity must and ought to, and we believe
will, plead against such blind vengeance and unmeaning, useless

672 Medical Ethics. [November,

cruelty; and will appeal to medical science for the means and
the mole whereby mercy and justice may be linked together.
If a criminal cannot be reclaimed, he may be restrained. At
present, the antagonism between the ermine on the bench and
the rags at the bar, is too unnatural to be right ; the dignity
of human nature is outraged not more in the culprit than in the
judge.

The relief of the sick poor is a duty which has ever been
diligently performed by the conscientious practitioner; and, so
long as society leaves the poor partially or wholly uncared for
in this respect, that duty ought still to be performed. But it
should be performed to fulfil a duty, rather than to flisplay an
active benevolence; from an active principle of humanity, ra-
ther than to gain applause. Indiscriminately gratuitous relief
of the sick poor is like indiscriminate almsgiving ; sickness, like
hunger, is not accidental, but the common lot of man; and they
differ only in this, that the one occurs regularly and at short
and certain intervals, the other is of uncertain recurrence.
It is a necessity for which the individual, or society for him, is
bound to provide, and not a class of educated men. Relief of
poverty from the public purse, as a social right, is one of the
characteristics of modern civilization; and this principle should
be further extended, to include relief of sickness. Kindness,
tenderness, and gentleness should, however, ever accompany
the administration of this public relief The poor man, bowed
down by_disease, has a large claim upon the sympathy of the
practitioner ; and perhaps the greater, now that a number of
sects prevail. Formerly, when the priest of the parish was the
special guardian of the poor, the poor man had in him an influ-
ential advocate, and one intimately acquainted with his neces-
sities. Now it is the union surgeon or dispensary physician
who is brought exclusively into this intimate relationship, and
it is he who has to fight the battle of poverty against the proud
man's contumely and the greedy man's avarice.

Although the relief of the sick poor is seldom withheld, it is
to be lamented that theofiicers of public charities often dimin-
ish the value of their services by a want of punctuality in their
attendance. Few consider how wearisome it is to the sick
man to wait; how valuable is the poor man's time, how much
loss and suffering is inflicted, when the medical oflicer either
comes late to his duties, or neglects them altogether.

7r TT tT^ Vr 7P tT* tF V

There can be no doubt but that medical science is to be a
mighty moral agent for centuries to come, and that its applica-
tion to social and political economy promises the most brilliant

1848.] Medical Ethics. G73

results. The arrest and extinction of epidemics is one of these ;
another is the highest salubrity attainable by architectural ar-
rangements and domestic sewerage. These and the like must
await the evolution and development of medical science itself;
but the minor points referred to above are within the power and
judgment of the individual practitioner. He is a social reform-
er in the highest sense of the word. Everywhere he comes in
contact with misery and vice, with degraded habits and inju-
rious customs, with the numerous families of the poor, and the
sterile pampered homes of the rich. To all he can give advice
with benefit, and in every sphere of labour diffuse a knowl-
edge of ^hygiene. If there be a " disgrace to the family,"
it may be within his power to show that it is a species of
eccentricity, bordering on insanity, which guides the culprit's
action ; and it is education and moral culture that will reclaim
him, not punishment. The matrimonial alliances of those
families that give him their confidence, may be rendered safer
and happier by his skill and knowledge as to the detection and
demonstration of hereditary diseases. If a family become
inconveniently numerous, from the indolence of the mother, he
can show that, in many instances at least, the natural check is
prolonged lactation and a diligent attention to maternalduties.
And thus the enlightened and conscientious practitioner can

act with the multifarious relations of hygiene.

* * * * # # * *

Whether a mere profession of religion, and the restraint of
the ecclesiastical police which such profession involves, can
check aberrations from the true principles of medical ethics,
would appear from the preceding and similar instances to be
somewhat doubtful. The heart of man "is deceitful above all
things ;" and, while the religious professor flatters himself that
he is doing his full Christian duty, by a strict attention to the
forms and ordinances of the church, the spirit and essence of
Christianity is wanting, and he forgets its fundamental principle
of conduct, the law of Divine Wisdom and Love, *' Do unto
others as ye would that men should do unto you." This only
can be the foundation alike of medical ethics and medical
etiquette. Much, no doubt, is to be gained by a natural suavity
of demeanour and humility of feeling, by gentlemanly training
and associations, and by a fear of the results consequent upon a
breach of etiquette or ethical manners ; but the only true and uni-
versally safe principle is that principle just announced. And we
would commend the comment of St. Paul on this new law of
love, revealed by Christ, to be found in his letter to the Christians
of Corinth, as the best code of medical etiquette, and as compris-
ing all that is necessary for soothing or preventing those bick-

43

674 Medical Ethics. [November,

erings, jealousies, rivalries, and deadly enmities, felt and too
much indulged by some professional men. " Love," St. Paul
says, "is forbearing, obliging; love is not envious; love is not
arrogant, is not proud, is not rude or selfish, or irritable or slan-
derous. It has pleasure in truth, and not in falsehood. It is
content with all, confides m all, trusts to all, bears with all.
Tiie highest rank, the greatest skill, the profoundest learning
are, without this, nothing ; the greatest performances and ac-
complishments in literature and science without it are vain as
the jingling cymbal." Such are the sentiments, freely transla-
ted as to form, but correctly translated as to the spirit, of the
inspired philosopher and martyr of early Christianity. How
much, from time to time, has there been occasion to regret that
these sentiments have not influenced the feelings of many even
distinguished philosophers and practitioners in the course ot
their intercourse, whether personal or literary !

We have brought to the test of these principles the rules of
the Manchester Medico-Ethical Association. This institution
was founded to frame a code of etiquette for the guidance of
its members, to decide upon all questions of usage or courtesy
in conducting medical practice; to support the respectability
and maintain the interests of the profession; to promote fair
and honorable practice ; to correspond with bodies or indi-
viduals in other parts of the kingdom on any matter touching
professional interests; and, by its moral influence and the ex-
ercise of a judicious supervision, to prevent abuses in the pro-
fession.

The following are the bye-laws which regulate the disquali-
fication for membership :

" Any practitioner who may act in opposition to the principles in-
volved in the six succeeding laws, shall not be eligible to the mem-
bership of this association ; and if already a member, he shall, on in-
fringing the same, be liable to expulsion.

'1. No member shall practise, professedly and exclusively, homce-
opatliy, hydropathy, or mesmerism.

"2. No member shall, by advertisement, circular, or placard,
solicit private practice.

"3. No member shall be the proprietor of, or in any way derive
advantage from the sale of, any patent or proprietary medicine.

"4. No member shall give testimonials in favour of any patent or
proprietary medicine, or in any way recommend their public use.

" 5. No member, who may keep an open shop, shall sell patent
medicines, perfumery, or other articles than pharmaceutical drugs and
preparations.

" 6. No member shall enter into compact with a druggist to pre-
Bcribo gratuitously, and at the same time share in the profits arising
from the sale of the medicines."

1848.] A Case of Tuphlo-enteritis, <^c. 675

Looking at these by-laws, with reference to meidical ethics,
the first consideration which strikes us is the total absence of
any fundamental principles of medical morals or etiquette, the
exclusively trade character of the laws, and their inadequacy to
the purpose aimed at. If a member may not be permitted to
practise any one of the three leading varieties of the day exclu-
sively, there is nothing on the face of the laws to prevent him
practising them conjointly. If a member may not solicit private
practice by advertisement, circular, or placard, he may fee a
reporter to publish a speech or a puff, or he may advertise a
professional publication in the newspapers, get a paragraph in-
serted in the same as to the successful use of chloroform, or
permit a friend to admire in print a singularly skilful operation.
The three laws as to the ownership, recommendation, and sale
of patent medicines are of questionable wisdom. The demand
for remedies having specific objects, and according to approved
formulae, is one that is universal ; it is felt in the profession as
well as out of it. The authorized Pharmacopoeia is a proof of
the one; the "antibilious pills," " antiscorbutic drops," "family
pills," and the thousand nostra of the quacks, are the proofs of
the other. The demand then being certain, why leave the sale
of these specific conapound remedies exclusively to the ignorant
pretender ? Why not let the by-law run that the practitioner
shall not patent, recommend, or sell any remedy, the composi-
tion of which is not known to the Society and approved by
them?

A Case of Tuphlo-enteritis, or Inflammation and Perforation
of the Ccecum, from the lodgment of a hone, pointing exter-
nally. By J. W. RoHRER, M. D., of St. Louis, Mo. (St.
Louis Med. and Surg. Journ.)

On the 5th of October, 1847, about 2 o*clock, A. M., I was
called to see Christian Lauter, residing about two miles from
the citv, who, as the messenger stated, was laboring under a
most (fistressing disease of the bowels. Mr. Lauter is appar-
ently a man of regular habits, and certainly of a vigorous con-
stitution, aged 40 years.

On my arrival, about 2 o'clock, I found the patient in extreme
agony lying on his back with his knees drawn up, nausea and
vomiting of bilious matter pulse rather small and wiry, respi-
ration frequent, pain continuous and of a twisting character.
The pain was referred particularly to the right illiac fossa,
lancing towards the thigh. I ascertained that the case was
considered colic, by those around him, and Jbat stimulants and

ffWJ A Case of Tuphlo-enteritis, ^-c. [November,

cordials at hand had been freely administered, previous to my
arrival, which exasperated the symptoms.

The bow^els had not been moved for 48 hours. A disconnect-
ed history of a course of treatment by another physician, for
disturbance of the bow^els, immediately preceding this attack,
deterred me from using the lancet, which might otherwise have
been indicated. A large dose of opium was accordingly ad-
ministered, and repeated in an hour. A moderate dose of cal-
omel was also given. Mustard at hand, was applied externally
over the abdomen, and frictions of the same to the cold and
contracted extremities. The second dose of opium was follow-
ed by excessive and offensive evacuations. Administer g. opii.
and ordered

:^. Ilydrg. Prot. chlor.

Ext. Hyoscyam. aa gr. xxiv.
Pulv. opii " vi.

M. ft. Pills No. xii.
S One after each evacuation.

The above prescription was found adequate to. control the
bowels, and the patient was left comparatively calm and easy,
extremities warm, skin moist and improving. Evening. Found
the patient still calm, the bowels completely controlled. On
examination, however, I discovered a slight tumefaction in the
region of the csccum, and extreme tenderness on pressure.
Ordered a blister over the tender point.

October 0th. Strong symptoms of peritonitis: Fever, pulse
hard and frequent, respiration thoracic, extreme tenderness and
pressure, and rapidly increasing distension of the abdomen, the
patient 13'ing upon his back with his knees drawn up as on the
previous morning, the bowels still disposed to be open. Ordered
venesection ad deliquium animi, blisters from ileum to ileum,
calomel and large doses of opium.

Evening. Pretty much the same. Distention of the abdo-
men still increasing. Ordered stimulating dressings for the
vesicated surface, and the apj)lication of warm spirit of turpen-
tine with flannel to the abdomen above the blisters. Mercury
by inunction, the calomel and opium continued

October 7th. Has had one evacuation in the last twelve
hours. The pain and tumefaction in the right iliac increasing
abdomen tense as a drum, strangury. Ordered demulcent
drinks, and the former ])rescriptions continued.

October 8th. Had eight or ten distressing and offensive evac-
uations during the night, tympanitis subsiding a little, pain in the
ilh'ac persistent, distinct chill, the specific clfects of the mercury
evident. Ordered barley water, a little chicken broth and

1848.] A Case of TupldO'enteritis, 4'C. t>77

I^. Quinia sulph. gr. vi.
Ext. hyoscyam. " xii.
Pulv. opii " iv.

M. ft. Pills No. xii
S One every three hours.

October 9th. The patient improving. Prescription con-
tinued. Allowed a little wine, and soothing dressings to the
extensive blisters.

October 10th. The pain and tumefaction in the groin in-
creasing. Great improvement in every other respect. Diet
more liberal.

October 14th. The bow^els rather lax. Ordered opium to
be given occasionally.

October 23d. Tumefaction more evident, as the tension of
the abdomen subsides, and presents itself under the form of a
large and painful tumour, threatning suppuration. Ordered
emollient poultices and supporting diet. Quinine continued.

October 30th. The patient's sufferings being insupport-
able, and fluctuation of the abscess distinct, C. J. Carpenter,
M. D., was consulted as to the propriety of opening the abcess,
which he performed with great satisfaction, and relief to the
patient. More than half a pint of pus was discharged in a jet,
with a large amount of gas, so foetid that the presence of fecal
matter was at first suspected. On examination, however, no
feces could be detected.

The induration of the parietes now subsided slowly. After
a few days, the patient was able to walk about, but a small
opening and slight discharges continued until the latter part of
February, 1848, when it healed up.

On the 7th of March, Mr. Lauter called on me to open a
small abcess, which, as he states, commenced forming immedi-
ately after the original opening healed. After removing a
strip of adhesive plaster, I found a small opening about half an
inch below the original, directly over the caecum, and on close
examination, discovered a small bone projecting, pointing
directly outward, which was removed and found to measure
one and three-eights of an inch in length, and about a line in
diameter. It is somewhat flat, and roughened on the edges.

The opening is now healed, a little induration, but no ten-
derness perceptible,

Mr. Lauter has resumed his employment, and declares him-
self as well as ever. He and his wife states that they remember
distinctly of his having swallowed a small bone of a chicken in
September, 1846, which caused him much uneasiness at the time.

f8 Poisoning by Bite of a Rattlesnake. [November,

On the Treatment of Poisoning hy the Bite of a Rattlesnake.
By JosiAii Trowbridge, M. D. (Buffalo Med. Jour.)

Sir: In your Journal for the month of July, I notice an ac-
count of the symptoms of, and ti'catment for the l)ite of a rat-
tlesnake, in the case of the lamented Dr. Wainright, of New
York, taken from the Annalist. I am not disposed to make
any strictures on the treatment in that case. The bite of a
rattlesnake is of rare occurrence in the Northen States of late
years, as they have been nearly, if not entirely, exterminated
from the settled portions of the country. I will simply relate
what has ocurred in my ow^n practice.

I came to Buffalo to reside in 1811, and at that time the
rattlesnake was common in many localities in the vicinity. I
think some six or eight cases have fallen under my care. I
distinctly recollect four of them. I recollect also, the piomi-
nent symptoms in two of the cases. The first occurred in
1812.* A boy of about twelve years of age was bitten on the
side of one foot, near the small toe. Being absent from the
village, I did not see him until two or three hours after the
accident. The limb was then badly swollen to the body, the
skin was discolored and mottled, and, if I recollect aright, of a
green and yellow color. The pain was severe, and the pulse
accelerated. I immediately directed the administration ofOlive
Oil, both externally and internally ; Internally, by the admin-
istration of In every half hour, and externally, constantly,
with friction. Under this treatment the swelling subsided, the
pain was assuaged, and the boy recovered.

The other was a man of fifty years of age, of intemperate
habits. He kept two large rattlesnakes in a box. At about
10 o'clock, P. M., being somew-hat intoxicated, he removed the
snakes from the box to the floor, and began playing with them.
At length one of them struck him between the thumb and fore^-
finger. My office being in the vicinity, a" student of mine was
requested to attend. He applied salt and vinegar to the hand,
and administered aqua ammonia) intetnally, without relief. At
half-past 11 or 12 P. M., I was called. At this time the hand
and arm were badly swollen to the elbow, and the pain severe.
I directed the administration of the Oil as in the former case.
I requested the student to remain with him, and to see that the
remedy was faithfully apj)lied until the threatening symptpms
subsided. The next morning, at 7 or 8 o'clock, I met the pa-
tient upon the side-walk, free from any ill effect from the poison.
All the other cases were treated in the same way, and all re-
covered.

I am aware that numerous trials and long experience are

1848.] Poisoning by Bite of a Rattlesnake. 67*.)

required to establish the character and value of any remedy,
and I have not great confidence in antidotes, and less in spe-
cifics. In looking back into some of the old medical periodicals,
I find that Sweet Oil, as an antidote to the poison of the rattle-
snake, is not a new remedy. In Vol. 2(1, No. 2, Article 4th, of
the Medical Repository, published in 1805, there is an article
republished from the Charleston (South Carolina) City Gazette,
a part of which I quote. " In great cities, particularly in Lon-
don, a number of persons procure their livelihood by catching
vipers. They are employed by Chemists and Apothecaries,
&;c. I remember some years before leaving England to have
read in the Philosophical Transactions of the Royal Society in
London, a curious circumstance relative to one of these viper
catchers. A member of the Society had received, causually,
information that a man engaged in this business was frequently
bitten, and that he cured himself with Olive Oil. After consid-
erable inquiry the viper catcher was found, and the questions
asked, whether he did cure himself with the Oil, and whether
he was willing to gratify a number of gentlemen by an exhibi-
tion of the fact ? The man answered affirmatively to both
questions. Accordingly a most numerpus meeting of the Royal
Society was convened, composed of a considerable- number of
the nobility, &c. The viper catcher attended, accompanied by
his wife, with a large viper, and laying his arm naked to the
shoulder, suffered the irritated reptile to strike, which it did
forcibly. His wife permitted the poison to operate till her
husband's head, face and tongue were greatly swelled, his arm
and face also very black, and his senses much affected, when
she applied the oil, by pouring a small quantity down, and
bathing the part bitten. The man gradually, and soon recov-
ered. This circumstance being strongly .impressed upon my
mind, and knowing that the poison of an English viper is con-
sidered, in that country, the most subtle in nature, determined
me to try its antidotal power in the bite of the rattlesnake, the
first opportunity which should offer, on my retirement from
Charleston to the back Country, now Pendleton county. I
was also particularly impelled to make the trial from a con-
sideration of the newness and wildness of the country, and the
number of my famiiv, beside which, there were hardly, a dozen
more in the countrv. This was in the year 178G. In about a
month after my arrival, a person in full speed came to my
camp, and most urgently begged to know if I could assist a
man who had just been bitten by a large rattlesnake. Although
I lamented the misfortune, I rejoiced at the opportunity it offer-
ed to ascertain fully the property of Olive Oil as an antidote
to this deadly poison. Accordingly I put a vial of oil in my

680 Poisoning by Bite of a Rattlesnake, [November,

pocket, mid mounted the messenger's horse. When I arrived
at the unfortunate man's cabin, he struck me as the most
frightful object I had ever beheld. Ilis hands and face were
prodigiously swelled, the latter black, his tongue proportionably
enlarged and out of his mouth, his eyes as if shooting from their
sockets, his senses gone, and every appearance of immediate
suflbcnlion. He iuid been struck on the side of the foot, about
the middle, in the hollow. Immediately, but with great diffi-
culty, I got down two table-spoonfulls of oil. Its etiects were
almost instantaneous, and astonishingly powerful, in counteract-
ing the })()ison, as appeared by the strong, though (juick con-
vulsions that followed. (How is it ascertained the convulsions
were the effects of the remedy and not of the poison ? Edt.
South. M. and S. Jour.) In about thirty minutes it operated
strongly, both emetically and cathartically, after which the
swelling of the head and face, ^zc, gradually abated, and the
tongue began to assume its place. In about two hours, he was
so far recovered as to be able to articulate, and from that time
recovered fast. The oil inwardly taken, and applied to the foot
and leg, both exceedingly swelled, did not exceed seven or
eight s})oonfulls.

The number of cases 'of a like nature, in the course of twelve
years, has been considerable, in all of which Olive Oil has
proved itself to be peculiarly adapted, and fully adequate to the
worst of cases, if timely ap|)lied."'

I find another case recorded in the eighth volume of the
Medical .Journal of Medical Sciences, page 3})7, communicated
by Dr. Horner, which terminated fatally. It appears that
B iiss. of Olive Oil was administered in two doses, at a long in-
terval between, and the last dose when the man was in articulo
mortis. The principal reliance in this case seems to have been
upon cupping, external irritants, acjua ammoniye, &c. I do
not think that this case makes either for, or against the use of
Olive Oil. I copy from the Boston Medical and Surgical
Journal of .January 5th, 1848, from an article comnmnicated
by Dr. Stephen W. Williams, of Deerfield, Massachusetts, the
following additional testimony in favor of the use of Olive Oil.
"The use of Olive Oil niay be strongly recommended for the bite
of the rattlesnake. My grandlather. Dr. 'pios. Williams, for-
merly a very distinguished physician in this town, once restored
a [)atient bitten by a rattlesnake, ap|)arcntly in the last stage of
life, by the external and internal administration of Olive Oil.
Mr. .1. Miller, of Pendleton, South Carolina, observes, that
Olive Oil, taken internally in the quantity of a few spoonfulls,
aud applied to the bitten part, has j)roved itself fully adequate
to the worst cases if timely administered."

1848.] Report of a Curious Surgical Case, 081

It seems to me that the results m the cases here related,
furnish abundant testimony in favor of an early and diligent
use of this remedy. Thnt there may be cases which will be
fatal under any circumstances, and in spite of the Olive Oil, or
any other remedy, is probable, but if it succeeds in a lart^e
majority, it is sufficient to w^arrant its use, and a reasonable
reliance upon its powers as an antidote to the poison.

[And- yet after all what great virtue can there be in Sweet
Oil ? Ammonia does possess very evident properties, and may
be an antidote to the virus of the rattlesnake ; but upon Olive
Oil alone we should be loath to trust a case. Edt. South. Med,
and Surg. Jour.)

Report of a Curious Surgical Case. By John G. Kyle, M. D.,
of Cedarville, Ohio. (Western Lancet.)

In the spring of 1846, 1 was called to see Moore, a boy,

aged two years ; had been a very strong, healthy and fleshy
child now weak much emaciated and suffering great pain in
the bowels ; face pale, extremities cold, no appetite, secretions
nearly natural, abdomen very tender on pressure, wuth a swell-
ing or ridge semilunar in shape, commencing on the left and
terminating on the right side of the abdomen, and running so
nearly to divide the umbilical from the right and left iliac re-
gions about 14 lines in width, and one or two in height, skin
slightly reddened, with the appearance of pointing at the ex-
tremity of the swelling on the right side, as if some foreign
body was trying to make its way out, being as yet, however,
rather uncertain what direction it should take, in order to reach
its intended destination.

The history of the case w^as, that, fourteen days previous to
that time, the boy was badly choaked by something, which
after some considerable difficulty he swallowed. After which
his parents noticed nothing peculiar for two or three days,
when he became fretful and peevish, lost his appetite, and had
pain in his bowels. The parents thinking their child had cohc
gave anodynes, cathartics, and almost every thing else, But
finding him growing worse and sinking rapidly, brought him
to the village, where I then resided, Roundhead, Ohio, for ad-
vice. Being called on, I found the boy in the condition already
described. The history of the case, with the then present
symptoms, led me at once to conclude that the boy had swal-
lowed some solid indigestible substance, and it having become
entangled in some fold of intestine, had passed through its coats

682 Formulary of the Hopital du Midi. [November,

and was now pointing to the surface, and that an operation
would be necessary to relieve the boy. The parents were,
however, rather doubtful about the success of an operation, and
asked until the next morning to deliberate on the matter, to
which I readily assented.

When the morning came, Mr. Moore called and requested
me to call and operate on his son, as he believed he would die
soon, unless immediately relieved.

The symptoms more aggravated than yesterday I, in the
presence of Dr. A. De Long, L. M. White, Esq., and several-
other gentlemen, proceeded to operate in the following man-
ner : The boy being secured, I made an incision ten lines
long about equidistant from the umbilicus and ant. sup. spinous
process of the right ilium cutting carefully through the integu-
ments and abdominal muscles, a foreign body could now be felt
under the peritoneum, which I j)unctured with a sharp pointed
bistoury, and brought to view a brown corn straw, which I
seized with a small pair of forceps and drew out, applied sim-
ple dressings, the wound healed by the first intention, and the
boy regained his health in a short time. The corn straw was
forked near the middle, measured thirty-three lines in length,
one in diameter, and at the fork nearly three lines across. It
had evidently been swallowed by the boy fifteen days previous
to the operation.

The novelty of the operation, the causes which led to it, and
the happy result of the same, are the only apologies the writer
has for thus making this case known to his professional brethren.

Formulary of the Hopital du Midi {Venereal Hospital of Paris) .
By M. llicoiiD. (London Lancet.)

NON-VIRULENT DISEASES.

L Injection for Balano-posthitis. Make three injections a
day between the glansand prepuce with the following fluid:
Distilled water, three ounces; nitrate of silver, two scruples.

2. Abortive Treatment of Bh'unorrfi a f!:ia. Make one injec-
tion only with the following liquid : Distilled water, one ounce;
nitrate of silver, fifteen grains. And take every day, in three
doses, the following powder : Cubebs, one ounce ; alum, thirty
grains.

3. Injection for Blennorrha;:ria, when the period for Abortive
Treatment is passed. INIake three injections daily with the fol-
lowinu: liquid : Hose water, six ounces and a half; sulphate of
zinc, and acetate of lead, of each fifteen grains.

4. Internal Treatment of Blennorrhasria. Take one table-

1 848.] Formulary of the Hopiial du Midi. C83

spoonful of the following emulsion three times a day : Copaiba,
syrup of tolu, and syrup of poppies, of each, one ounce; pep-
permint water, two ounces ; gum arabic, a sufficient quantity ;
orange flower water, two drachms.

5. Acute stage of Bknnorrhag^ft. Twenty leeches to the
perinasum; bath after the leeches; refreshing drinks; rest in
bed; low diet; suspensory bandage. Take one of the follow-
ing pills four times a day: Expressed and inspissated juice of
lettuce, (lactuca sativa,) and camphor, of each, forty-five grains;
make twenty pills.

6. Gleet. Make every day three injections with the follow-
ing liquid : Rose water, and Roussillon wine, of each, six
ounces ; alum and tannin, of each, ten grains.

7. Subacute Epididymitis. Rub the testis twice a day with
the following ointment : Stronger mercurial ointment, and ex-
tract of Belladonna, equal parts^of each ; a poultice to the part
after the ointment, and rest.

8. Acute Epididymitis. Fifteen leeches to the perinseum,
and the same number in the groin corresponding to the affected
epididymitis; bath after the leeches ; barley-water for common
drink ; low diet, rest, and poultice.

9. Chronic Epididymitis.- -^PPty Vigo's plaster to the testis,
and wear a suspensory bandage. (Simple plaster, yellow wax,
pitch, ammoniacumj bdellium, olibanum, mercury, turpentine,
liquid styrax, and volatile oil of lavender, are the component
parts of Vigor's plaster. (Rep oj^ter of Lectures.)

VIRULENT DISEASES. PRIMARY SYMPTOMS.

CHANCRES.

10. Abortive Treatment of Chancre. Within the first five
days of the contagion, destroy the chancre with potassa fusa
cum calce (pate de Vienne.)

1 1 . Regular non-indurated C//7? ere. Frequent dressing with
the aromatic wine,* extreme cleanliness, occasional light cau-
terization with the nitrate of silver. Rest, demulcent drinks ;
when there is inflammation, antiphlogistics, purgatives, and
emollient applications. (N. B. No mei'cury.)

12. Phagedcenic Chancre. ^Complete cauterization with the
nitrate of silver, the liquid nitrate of mercury, the potassa cum
calce, or the hot iron, according to circumstances. Afterwards

Aromatic wine, (Parisian codex.) Aronnatic species, (viz., the dried tops
of the sage, balm, thyme, wild thyine, marjoram, hyssop, peppermint, worm-
wood,) two parts; vulnerary spirit, (viz., alcoholic distillation of anthyllis,
vulneraria, origanum, gnaph; lium dioicum, arbiUns uva iirsi, and several
others, known under the name of vulnerary flowers, and largely exported
through Europe hy the Swiss for popular purposes,) one part; red wine, six-
teen parts. Macerate for a few days, then filter.

084 Formulary of the Hopital du Midi. [November,

lotions with aromatic wine, three ounces ; extract of opium,
three grains ; or, aromatic wine, eight ounces ; tannin, thirty
grains; or, distilled water, three ounces ; tartrate of iron and
potash, four drachms ; or, in the scrofulous diathesis, distilled
water, three ounces; tincture of iodine, one drachm; or, sul-
phur ointments, and sulphurous baths. Internally: tartrate of
iron and potash, one ounce ; distilled water, eight ounces. One
ounce three times a day.

13. Indurated Chancre. Three dressings a day, with the
following ointment : Calomel, one drachm ; axunge, one ounce. ,
(N. B. Mercury is used internally for the indurated chancre :
as to the mode of administration, see secondary syphilis. No. 21,
as the metal is given in the same manner in both cases.)

BUBOES.

14. Acute non-Specific Adenitis, vel Inflamed Bubo. Twen-
ty leeches on the tumour, emollient cataplasms, barley-water
as ordinary drink, rest, broths. If fluctuation be detected, let
out the purulent matter by a free incision.

15. Abortive Treatment of the Bubo Consecutive, by Absorp-
tion of the Virus, to the non-Indurated Chancre. Deep cauter-
ization of ten minutes' duration, with the potassa fusa cum calce,
and await the fall of the eschar. (N. B. Analogous to the early
destruction of chancre.)

16. Bubo Consecutive to the non-Indurated Chancre, which
inevitably Suppurates. Use antiphlogistics according to cir-
cumstances, and then free the purulent matter by cauterization
with potassa fusa ; gradually destroy afterwards, by the use of
caustics, the glandular mass which lies at the bottom of the
open bubo. To the poultices used after cauterization may be
added an ointment, of equal parts of extract of belladonna and
mercurial ointment.

17. Ilorse-shoe Bubo and Gangrene. Horse-shoe and Pha-
gedenic ulcers in the groin, resulting from a suppurating bubo,
require the dressings mentioned in No, 12. Gangrene: Chlo-
ride of lime, one ounce ; distilled water, three ounces. This
lotion is to be used several times a day. Or, powdered char-
coal, powdered Peruvian bark, equal parts of each, to be thick-
ly applied to the sore.

PREPUTIAL COMPLICATIONS.

18. Phimosis. Inject between the glans and prepuce the
aromatic wine with opium, as mentioned in No. 12, and use
emollient and sedative applications ; if gangrene be imminent,
operate.

19. Paraphimosis. Keep the organ raised, and surround it
with cold compresses. Blanddiet,refreshingdrinks; endeavour

1848.] Formulary of the Hdpital du Midi, 685

to reduce or free the constriction by an incision, according to
circumstances. After the strangulation is relieved, use emol-
lient and antiseptic applications combined with opium.

SCROFULOUS COMPLICATIONS.

20. Order every day the following emulsion in three equal
doses : Iodine, three grains ; oil of sweet almonds, one ounce;
gum arable, a sufficiency ; almond emulsion, three ounces.

SECONDARY SYPHILIS.

21. Order every day three tumblers of decoction of saponaria
leaves, and put into each tumbler one table-spoonful of sirop
de cuisinier, (N.B. Sirop de cuisinier: sarsaparilla, borage
and white rose leaves, senna, aniseed, honey, and sugar ;) and
take every day one of the following pills : Proto-iodide of
mercury, inspissated juice of lactuca sativa, of each fortv-five
grains ; extract of opium, fifteen grains ; extract of hemlock,
one drachm and a half Mix, and make sixty pills.

22. Slight Stomatitis. To gargle three times a day with
the following liquid : Decoction of lactuca sativa, five ounces ;
honey, one ounce and a half; alum, one drachm and a half

23. Mercurial Stomatitis. To gargle three times a day
with the following liquid : Decoction of lactuca sativa, five
ounces ; honey, four drachms ; hydrochloric acid, fifteen drops.

24. Salivation. Order every day one drachm of flowers of
sulphur, incorporated with honey. As a common beverage, the
nitric acid lemonade. Gargle three times a day with decoc-
tion of lactuca sativa, five ounces ; honey, four drachms ; hy-
drochloric acid, fifteen drops.

25. Mucous Patches in the Mouth. Gargle three times a
day with decoction of hemlock, six ounces and a half; bichloride
of mercury, three grains.

26. Mucous Tubercles around the Anus^ (Condylomata.)
Put twenty leeches to the perinseum. Take every evening a
small enema of a decoction of poppyheads, cold, and mixed with
twenty drops of laudanum. As an habitual beverage, take lin-
seed tea, sweetened with sugar and almond emulsion.

27. Vegetations. Put twice a day on the vegetations the
following powders : Powdered Savine, oxide of iron, calcined
alum, of each one drachm.

TERTIARY SYPHILIS.

28. Order one tumbler of decoction of saponaria three times
a day. In each tumblerful put a table-spoonful of the following
syrup: Syrup of sarsaparilla, one pint; iodide of potassium,
one ounce.

686 Treatment of Phthisis Puhnonalis. [November,

Treatment of Phthisis Pvlmonalis hy Cod Litter Oil. By Dr.
Hughes Bennett. (Monthly Journal and Retrospect.)

The effect of the oil in many cases of phthisis is very strik-
ing, and is well seen in hospital and dispensary practice. In-
dividuals presenting emaciation, profuse sweats, constant
cough and expectoration, as most prominent symptoms, with a
degree of weakness that prevents their standing alone, after a
few week's use of it are enabled to get up with ease and walk
about, with a visible improvement in their general health, and
an increased amount of flesh. The physical signs of tlie disease
may continue unaffected for some time; but if the treatment be
continued, the moist gurgling rales are exchanged for dry
blowing sounds, which become more and more persistent,
pectoriloquy is merged into bronchophony, the respiration is
easier, and a check is evidently given to the ulcerative pro-
cess, and the formation of purulent matter in the air-passages.
In this state, patients often feel themselves so well that they
insist on leaving the hospital, or give up their attendance on
the dispensary. Dr. Bennett has frequently found it impossible
to prevail on such persons to continue the treatment, and the
consequence is, that, again returning to their often unhealthy
employment and bad diet, and exposed to the other causes
favourable to the production of the disease,.the distressing sympt-
oms again recur. Several cases, with one or more caverns in
the lungs, have in this manner returned to the Infirmary from
four to seven or eight times during the last six years, and on
each occasion have gone out in their own opinion perfectly
cured.

Notwithstanding the difficulties which have presented them-
selves in bringing about a complete cure of the disease. Dr.
Bennett has succeeded, in several cases, in ascertaining that
caverns have completely healed up, every symptom and phy-
sical sign indicating their presence having disappeared, and
only slight dullness on percussion, and increased vocal resonance
remaining as a proof of the puckering and induration of the
pulmonary parenchyma attendant on the cicatrix. He gives
two unequivocal cases where this occurred, and alludes to
others which he purposes publishing at some future time.

Most cases of phthisis puhnonalis, especially in the advanced
stage, are affected with more or less dyspepsia, which renders
the stomach irritable, causes total loss of appetite, and is often
the cause that prevents nourishment from being taken. In
many instances there is no difficulty in employing the oil under
these circumstances, but in others it cannot be retained on the
stomach. It will tlien be necessary to calm the irritability of

1848. J Premonitory Symptoms of Salivation. 687

the organ, and the best remedy for this purpose, according to
Dr. B.'s experience, is naptha. It is to the power this sub-
stance possesses of checking vomiting, and thereby allowing
nourishment to be retained, that he attributes the advantages
which have attended its use in the practice of Dr. J. Hastings,
and others. The diet should always be nutritive, without
being stimulating; and counter-irritation to the chest is an ex-
cellent auxiliary. This treatment should be perseveringly
persisted in ; whilst, to prevent fresh exudations of tubercular
matter, an equable temperature is of the highest importance.
To equable temperature must be ascribed the advantages of
favoured localities for phthisis, and with proper precautions it
can be very well maintained in this climate.

Oji a Premonitory Symptom of Salivation, By John Tomes,
Esq., Dentist to the Middlesex Hospital. (Med. Times.)

In salivation produced by mercury, the effect is first discerni-
ble upon the gums. Some hours previous to the coming of the
metallic taste, and to the foetor of the breath, and also to the
soreness and discomfort which mark the influence of mercury
on the system, the gums show indications that these conditions
are about to appear in fact, that the patient will in a few hours
be salivated. The state of gum I am about to describe is, in
fact, a premonitory sign of ptyalism, for should it appear, and
the mercury be immediately discontinued, yet salivation will
come on. The sign is this: the adherent portion of the mu-
cous membrane of the gums assumes an opaque white colour,
contrasting strongly with the non-adherent portion, which pre-
serves its natural hue or becomes more red. The free edge of
the gums is moveable, but that part which lies over the edge
of the alveoli is firmly tied down to the periosteum ; and as
the edges of the alveoli present a festooned line, so the whitened
mucous membrane presents in a corresponding festooned line.
Again, where the mucous membrane is loosely reflected from
the gum to the cheek, the natural colour is preserved. The
whiteness of gum is produced by an increased secretion of
epithelium, which from being thicker and more opaque renders
the colour given by the vessels to the subjacent tissue less ap-
parent.

The surface of the mucous membrane when deprived of epi-
thelium is studded over with innumerable small conical eleva-
tions or papillae. The thickened epithelium is readily rubbed
off the tops of the papillae, while it retains its full thickness in
the hollows between them; thence, if closely inspected, the

G88 On Glycerine. [November,

gums will not be seen to present a uniform white hue, but a
mottled aspect : and this because the epithelium is thin over
the ])apillae and thick between them, and therefore more colour
will show through at one part than at another. With the in-
creased thickness there is a decrease of tenacity between the
scales that form the epithelium, for the surface may be much
more readily rubbed off than when in its natural state.

This curious and useful premonitory sign of coming ptyalism
was, I believe, first noticed, and its value pointed out, by Mr.
Corfe ; at all events, he first of all diew my attention to the
fact, anH I am not aware that it has been described by any au-
thor. Since, however, Mr. Corfe mentioned the result of his
observations as to the constancy of the sign, I have verified for
myself its presence in all cases of salivation that have come
under my notice, and from these I have written the foregoing
account.

If you would make use of this indication in your practice, it
will be necessary that you should carefully note the state of
the gums at the time the mercurial treatment is commenced,
for it is quite possible that other agents may produce a similar
state of gum, and that such may exist previous to the exhibi-
tion of mercury.

On Glycerine. By J. Startin, Esq., Surgeon to the London
Cutaneous Institution. (Ibid.)

The nature and use of glycerine,* the sweet principle of oils,
which may now be had of any first-rate druggists, are thus
stated by Mr. Startin :

When perfectly pure and anhydrous, glycerine is a nearly
colourless liquid, of a sweet taste and syrupy consistence; it
has a faint but not disagreeable odour, and possesses a great
affinity for water, with which it readily combines; it also easi-
ly unites with oils, and dissolves many gums and resinous sub-
stances; it will neither crystallyize nor ferment like a sugar,
nor will it eva])orate beyond a certain point, but is destroyed
by ebullition.

The antiseptic and uncloying properties of glycerine first
led me to attempt its use for medical purposes, as I believed,
by the means of such properties, lotions, poultices, baths, &c.,
might be rendered peculiarly emollient and soothing. When
preternatural dryness, roughness, or harshness of the skin was
present, and particularly in those cases where the hair or scalp
was involved, as in instances of dandriff or pytiriasis of these
parts, my expectations were more than realized by reducing my
conjectures to practice ; and I found that by the addition of

1848.] The Sore Throat. 089

one-fourth to one-eighth, or even one-sixteenth of glycerine to
any lotion, poultice, or external application, all the indications
I have mentioned were fulfilled, and that such application never
became perfectly hard and dry, whilst it soothed and tranquil-
lized the diseased part, by attracting moisture from the air and
thus keeping up a constant -evaporation from the surface ; its
antiseptic properties also, in a great degree, prevented the un-
pleasant odour of vitiated secretions or discharges, whilst its
undrying nature did not permit the formation of hard scabs or
incrustations, which it is known very often interfere with the
healing process, and occasion much pain on their removal. I
have had little experience in the use of glycerine internally,
but it is a mild stimulant, antiseptic and demulcent, and might
be employed to sweeten many articles of food or drinks for
those invalids whose disordered digestive organs would forbid
the use of sugar. Pills made with the addition of a few drops
of glycerine never become dry, and syrups and extracts by its
means are kept from evaporation to dryness, as also from fer-
mentation, and the formation of cryptogamous vegetation, or
mouldiness, and many other such uses for this agent will not
fail to suggest themselves ; I shall briefly enumerate some
diseases of the skin in which I have employed glycerine w'ith
most benefit and success; these are pityriasis or dandriff* (par-
ticularly that form of the disease which I have termed P. con-
genita,) lepra, psoriasis, lichen (in its dry advanced stage,)
impetigo inveterata, and prurigo. I have found glycerine also
a useful addition to lotions in the incrusted forms of lupus, or
herpes excedens, and to various syphilitic or strumous eruptions,
which have a tendency to produce foetid discharges and hard
crusts, for w^hich reason it has proved of service in the scabbing
stage of small-pox. As a wash for the hair and for chapped
hands, face, or nipples, combined with a little rose-water and
a few grains of borax (the glycerine being in the proportion of
one-sixteenth.) this remedy furnishes, perhaps, one of the most
elegant and efficacious preparations which has been introduc-
ed. It may also be combined with soaps which it renders
peculiarly softening and efficient, particularly to individuals
who have a dry or hard skin.

The Sore Throat Tonsillitis et Thacheitis, Croup.

[For about two months past, an epidemic tendency to sore
throat has been observed in our community. It commences
like common catarrh, then inflammation and ulceration, but we
believe most frequently an exudation covers the Tonsils; and

44

690 The Sore Throat. [November,

so far as we have heard, in nearly every case where croup su-
pervened, death has occurred. It mostly attacks children.

We have not reliable Information at present, but it is intima-
ted, that the same atmospheric disposition is prevailing pretty
extensively throughout the South. Will some friend prepare a
description of the disease for the Journal? In the mean time
we publish the following Articles, the first taken from the Sum-
mary of the Transactions of the Col. of Fhys. of Philadelphia:]

. M. Guersant jr. in a paper in the Gazette des Hopitaux, Nos.
48 and 52, presents some very interesting remarks on the treat-
ment of croup. To constitute this disease, he acknowledges,
with the best modern authorities, that the presence of a mem-
braniform exudation in the larynx is essential. The disease,
he remarks, may commence at the tonsils, in the bronchi, or
suddenly in the larynx itself In the first case there is more
or less redness of the pharynx with swelling of the tonsils, and,
what is of great importance, these latter are covered with little
white patches, which sometimes extend as far as the velum or
uvula.

The medical means for the treatment of croup are accord-
ing to M. Guersant very limited. Depletion, once so freely
employed, under the supposition that the disease was a simple
inflammation, is very rarely, he conceives, of any utility, and is
often injurious. Emetics have proved far more useful as
adjuvants, by favouring the detatchment and expulsion of the
false membranes but alone are not to be relied upon. Mer-
curials, especially when used early, have, he believes, often ex-
erted excellent afi^ects upon the disease they are beneficial
only in cases where the dyspnoea is not very urgent, or the
patient much enfeebled used alone they have seldom effect-
ed a cure. Hence M. G. conceives that it is upon surgical
treatment we must in the generality of cases chiefly rely. Under
the head of surgical treatment he includes the application of
caustics to the pharynx, and the operation of tracheotomy. As
a local application he prefers the nitrate of silver. Weak so-
lutions of this article are sufficient at the earliest stage of the
disease, when there is little else than the pseudo-membranous
deposits upon the pharynx. In some instances these cannot
be detected in an examination of the fauces, being deposited,
from the first, solely in the larynx, but such cases are rare.
Occasionally the deposits arc not detected in the pharynx ui
consequence of the first stage of the disease being already
passed.

In the early period of croup the symptoms are but little ur-

1848.] The Sore Throat. 091

gent ; and a physician who is not accustomed to treat children,
often neglects to examine the throat. M. Guersant makes it an
invariable rule, to make such examination whenever a child
manifests any febrile reaction ; and in this manner he has fre-
quently been enabled to detect the approaching disease, the
presence of which would not, otherwise, have been suspected.
At first, and while the tonsils are covered with the plastic ex-
udation, the symptoms, as already remarked, are not severe
but this is, nevertheless, a precious moment for the surgeon ;
he may now frequently arrest a disease, which, if allowed to
go on, is usually fatal.

While employing the solid caustic, the child should be held
by a strong assistant, the (opgue must be depressed by a broad
instrument, as. a very large spatula, or the handle of a large
spoon, or what M. G. prefers, a large wooden tongue depres-
sor. For fear of accidents the caustic should project only very
slightly from its case. Many practitioners prefer the caustic
in solution, and in the earlest stages of the disease a weak so-
lution applied three times a day will suffice, but in serious
cases the solution must be very strong 1 part to 3 or 4 of
water and need, then, be used only once a day. It may be
applied by means of a sponge fixed to the end of a piece of
whale-bone by sealing wax. To prevent the extension of the
false membrane, the caustic should be applied beyond its mar-
gin as well as upon it. The application frequently dissipates
the exudation from the tonsils, and yet it may extend to the
epiglottis. The caustic is still our best remedy. A larger
sponge is now required, which must be fixed upon a strong
whalebone, bent at an obtuse angle. The operator places
himself on one side, and, introducing the sponge directly to the
base of the tongue, executes some semi-rotary movements.
Sometimes the epiglottis is raised, and the fragments of false
membrane are deta'ched from its inferior surface, which may
be known by the paroxysm of dyspnoea this gives rise to. The
caustic, in these cases, requires to be repeated three or four
times in the twenty-four hours.

When, notwithstanding the full and persevering use of the
caustic, the disease is not arrested, tracheotomy is our only
resource. M. Guersant, has, next to M. Trousseau, performed
this operation more frequently than any one else, and he speaks
unhesitatingly as to its propriety, and believes that numerous
failures arise from its being too long deferred. Cases have been
known to recover, after the operation, notwithstanding the
false membrane had penetrated even into the larger bronchi.
The vital point which cannot tolerate the presence of the
slightest amount of the pseudo-membranous exudation is the

ITO The Sore Throat. [November,

Cord(F vocales. In performing tracheotomy M. G. usually
employs a straight history, and has several small sponges mount-
ed on whalebone and a curved ring forceps at hand. If the
false membrane does not reach into the trachea we have only
to maintain the aperture patent, while, when it extends lower
down, its removal may be attempted by means of the bent for-
ceps. To maintain the wound open, the canula of M. Trous-
seau is an admirable instrument. It consists of a double canula,
so that when obstruction occurs, the inner one may be changed
without disturbing the outer one. M. M. Trousseau, and
Bretonneau, prior to introducing the canula, pass small sj^onges,
moistened with a solution of nitrate of silver, into the trachea,
but M. G. doubts, the propriety of ^ny such interference, unless
false membranes are obviously present. The canula may
usually be removed at the end of from eight to twelve days,
but sometimes requires to be retained for twenty or thirty.

The air of the chamber should not be kept too dry and hot.
To render it sufficiently humid it is a good practice to evapor-
ate some emollient decoctions in the room several times a day.
It is difficult to maintain an equable temperature about the
child ; for a long period M. G. has experienced the utility of
wrapping around the neck, without tightening it, a light woolen
comforter, having its meshes very widely knitted. By this
contrivance, the air, before it reaches the trachea, becomes
sufficiently warmed. When the canula becomes obstructed,
the inner canula should be removed and cleaned, instead of
thrusting sponges into it, which may increase instead of remov-
ing the obstruction. When it is deemed proper to cleanse out
the trachea, only the most delicate whalebones must be em-
ployed. When indurated concretions form, both canula? should
be removed, and the patient encouraged to ex}>el them by
coughing. M. G. has never removed the canula before the
tenth day, but M. Trousseau has done so on the third or fourth.
IJe advises us not to remove it suddenly, but, at first, for one,
and then for several hours daily.

The croup is so grave and so constantly mortal a disease,
that we should have recourse to tracheotomy before it reaches
its last stage. M. Trousseau at first recommended its perfor-
mance as late as possible^ but found it almost always unsuc-
cessful ; but now, having met with numerous instances of suc-
cess, he recommends its performance as early as possible as
soon, in fact, as no other chance of success remains. Of 136
children operated upon, M. T. has saved the lives of 32. M.
G, has met w'ith 4 successful cases in 30 operations a success,
he conceives, sufficiently great for us to lay it down as a law
that we should perform the operation rather than allow the in-
fant inevitablv to die.

1848.] The Sore Throat. 093

Dr. Latour relates, in the Gazette Med. de Paris, of August,
1847, a case of croup in a child of four years old cured by the
local application of a solution of nitrate of silver to the larynx.
The symptoms under which the patient laboured were sore
throat, accompanied with a hoarse cough, fever, anxiety, and
other severe symptoms; the uvula and right tonsil being cover-
ed with very adherent false membranes. The solid nitrate of
silver was immediately applied to all the affected parts within
reach, followed by an emetic, by which some fragments of false
membrane were brought away. Next day the false membrane
had not covered the left tonsil, but appeared to have extended
downwards, and- the larynx seemed to be involved in the dis-
ease, as there was a suppressed hissing cough, and loss of voice.
Dr. L. determined to employ a solution of nitrate of silver, seven
to eight grains to the ounce. A strong ball of lint being satura-
ted in the solution, this was conveyed to the opening of the
larynx by means of a long curved pair of forceps, and then the
solution was squeezed out by compressing the ball between the
blades. The solution was, in this manner, applied every eight
hours, for four days, with complete success ; the voice was first
restored, and then convalescence w^as soon fully established.

Dr. Chas. Ware also records, in the Boston Med. and Surg.
Journ. for December, 1847, a case of membranous croup, suc-
cessfully treated by the application to the larynx, by means of
a piece of sponge attached to a whalebone, of a solution of nitrate
of silver, (sixty grains to the ounce of w^ater.) The disease in
this case was evidently limited to the trachea, if not to the
larynx, and in this respect was peculiarly favorable for this
treatment.

Dr. W. N. Blakeman likewise relates, in the N. Y. Med. and
Surg. Reporter, two cases of croup treated successfully with a
solution of nitrate of silver. In tlie first case, which occurred
in a child two years of age, after the most active treatment had
been perseveringly employed, for about eighteen hours, without
avail, the symptoms of suffocation becoming alarming. Dr. Blake-
man commenced the application to the larynx of a solution of
nitrate of silver, a drachm to an ounce of water.

The application was somewhat difficult, and the dyspnoea very
great ; a quantity of thick, tenaceous substance was brought
away by the sponge, and a large quantity by the vomiting
which followed. At the end of ten minutes a second applica-
tion was made ; a larger quantity of membraniform matter was
brought away by the sponge and vomiting. The breathing
now became less laborious, the crowing sound less sharp, and
the child more quiet. After about five hours from the last ap-
plication of the solution, a third was made ; a thick, tenaceous

004 Croup, or Laryngitis Memhranacea. [November,

matter, of a yellow colour, was brought away upon the sponge
and by vomiting. After the vomiting, the cliild fell asleep; on
the next morning a slight hoarseness alone remained, which
required no further treatment.

In the second case, which occurred in a child six years old,
the application of the solution of the nitrate of silver was resort-
ed to at the very commencement of the attack. Two applica-
tions were made, each being followed by vomiting, and the dis-
charge of a (juantity of tough mucus; and at the end of seven
hours the child was well, with the exception of a slight hoarse-
ness.

Croup, or Laryn iritis Memhranacea, treated by the Use of
Argenti Nitras.(New York Journal of Medicine.) The
topical application of nitrate of silver to the glottis and larynx
in this affection, has already acquired something of a pro-
fessional notoriety. Within a few months past eight cases
have been reported in the different Medical Journals and trans-
actions of Societies, and two have been related to us, the au-
thenticity of which we can vouch for in all of which recovery
has taken place. It is no more than justice, however, to state,
that in some of these cases the use of the nitrate was not alone
depended upon. Antiphlogistic treatment in four cases, con-
sisting of the use of repeated doses of calomel, and the occasion-
al exhibition of antimony, in some form, sufficient to produce
nausea was, during some period of the affection, resorted to.
The recovery of ten cases of genuine croup (as they all claimed
to have been) under one plan of treatment, is a new feature in
the therapeutics of this disease, and should at once claim the
attention of the profession.

It appears from a review of the history of these cases that the
disease was confined to the tonsils, glottis and larynx. In all
cases when the inflammation is confined to these parts, we
deem the treatment not only feasible but juslifiable from the
first. But in cases where by extension the trachea, bronchia
and lungs are implicated, like the o])eration for tracheotomy,
but little if any good can result from its use. Believing as we
do that the pathology of this afl^ection consists in inflammation,
primarily seated about the epiglottis or in the larynx tracheitis
and bronchitis being secondary complications, our readers will
readily recognise the propriety of early resorting to the treat-
ment, which the success of these cases warratits us in recom-
mendinjjrto their consideration. These therapeutic indications
are still further confirmed by the recognition of the general law
enunciated by Ilasse, in his Anatomical Description of the Dis-
eases of the Organs of Circulation and Respiration, viz., *'Exu-

1848.] Monthly Periscope. C95

datory inflammation, appears in the respiratory passages, to
spread invariably from above downwards, never in the opposite
direction. Faihng to resort to it early and thus not to recog-
nize the light thrown upon the treatment of this almost univer-
sally fatal malady, by the recent investigations in pathology, we
have not the least doubt that the treatment of membranous
laryngitis, or croup, by a strong solution of the nitrate of silver
will fail in success as frequently as tracheotomy did in the
hands.of M. Amusat, Blandin, Roux and Baudelocque. The
judicious physician will readily see the propriety of conjoining
appropriate antiphlogistic treatment, which must be adapted to
the exigencies of individual cases in order to secure, we appre-
hend, the greatest possible success.*

PART TIL MONTHLY PERISCOPE.

On the Effects of Chloroform We greatly regret having to place
before our readers another case, in which the poisonous effects of
chloroform have produced a fatal result. We cannot conceive that,
by any ingenuity whatever, this result can be otherwise explained in
the present instance ; and it appears to us that a most serious liability
is now thrown on all those, who encourage the use of chloroform as a
means of escaping the pain of operations not tl^mselves attended with
even a remote danger to life. We still remain of the opinion ex-
pressed in our last Number, that in severe operations the probable
benefit is far greater than the probable risk ; but no one is justified,
as it seems to us, in running such a risk for a mere avoidance of the
pain of the extraction of a tooth. We have reason to know that, in
the practice of a dentist who has most largely employed it, and whose
success is much quoted as an argument in favor of its exhibition for
this purpose, troublesome and long-continued disorders of the nervous
system have followed its use in several instances. [Brit, and Foreign
Med. Chirurg. Review.

Prof Williams^ Theory of the local effects of Inflammation, Dr.
Williams' summary of the "local elements of inflammation.

" determination of blood towards the affected part.

" Obstruction of the vessels most affected ; by a tonic enlargement
of the capillaries; by production and adhesion of white corpuscles in
the vessels.

" Distension of arteries and capillaries before the obstruction, caus-
ing increased effusion of serum, lymph, pus, &c.

Great care should be observed in selecting a pure article of the nitrate of
silver the crystals are to be preferred. In the cases reported, the strength of
the solution varied, according to the age of the patient, from forty to sixty grains
to the ounce ol water. The sponge should be soft, conical and securely attach-
ed to the whalebone, which may be made of the desired curve by placing it in
hot water for a few moments and then holding it in the fingers, for a short time,
beat according to the shape wished until it becomes set.

Monthly Periscope. [November,

" Emptiness of veins beyond the obstruction, causing increased ab-
sorption ; hence softening, &c.

" Impeded or arrested circulation at the obstruction, causing a re-
duction or abolition of vital properties ; hence the death of the part,
and its removal by ulceration and suppuration, or its decomposition
by gangrene.

''Increased circulation of blood around the obstruction, causing ex-
altation of vital propenies ; hence spasm, pain, sympathetic irritations,
increased secretion, &c." [Ibid.

Difference between Chlorosis and Anamia, Messrs. Becquerel Sf
Rodier. ( These de Concours.) " In ana3mia considerable but varia-
ble increase of the proportion of the blood, notable reduction of the
cypher of the globules ; preservation of the proportion of the al-
bumen, serum, and extractive matters; slight elevation of the cypher
of the fibrine ; slight increase of the sum of fatty matters ; no change
in the proportion of the chlorides and solubles. In chlorosis, the water
is equally augmented , but in less proportion ; the globules are dimin-
ished in quantity, but in a more variable proportion. Some exper-
iments authorize the idea that this diminution is not even constant.
The proportional cypher of the albumen and that of the tibrine are a
little elevated, as in anaemia. The fatty matters and salts are in
normal proportions. Ancemia, on the diminution of the proportion of
the globules of the blood, recognises always as a cause of origin an
evident cause, palpably, sensibly discoverable. Such are abundant
haemorrhages or fluxes of some kind, long debilitating maladies. The
degree which it presents is, in general, in relation to the intensity and
duration of the action of the producing cause. It may be produced
at will. The causes of chlorosis are not those of anaemia. We do not
know any" one position incontestable, and have only notions on some
influences which may favor its development, but not to produce it di-
rectly." [Gaz. Med., from Wood's Retrospect.

On the Counteraction of the ill effects of Mercury by Dulcamara.
M. Bretonneau, from long observation, has convinced himself that the
too prolonged use of mercury gives rise to symptoms, besides those due
to its peculiar action on the nervous system, quite analogous to those
of secondary syphilis. He has also been led to form a very high opin-
ion of the power which the solanum dulcamara possesses as a preven-
tive or as a curative of these. He lays great stress, however, upon
its mode of administration. Two drachms (prepared as decoction)
are to be given daily for the first week, four for the second week ; and
so on, adding weekly two drachms until ten are attained, which brings
the patient to the sixth week, at which time the dose is to be gradually
diminished, until the two drachms are again attained, when the medi-
cine is to be discontinued. [Rev. Med. Chir., from Med. Chir. Rev.

Treatment of Colica Pictonum. By J. H. Johnson, M. D., of St.
Louis Hotel for Invalids. In the first place, counteract by all possible

1848.] Monthly Periscope. 097

means the intestinal spasm; this is best done by large doses of proto.
chl. hyd. and opium, say from 30 to 50 grs. of the Ibrmer combined
with from 2 to 5 grs. of the latter, to be repeated at least once in three
hours. In some cases opium may be given much oftener, as no
idiosyncrasy ever occurs in cases of colica pictonum. In two hours
after the last dose of calomel and opium, give from 2 to 4 oz. of ol.
ricini combined* with from 4 to 5 gtt. of ol. tiglii. Generally, in a
few minutes, a copious and free evacuation will take place ; if not,
then commence injections, not a pint, or a quart, nor a gallon, but
enough to distend the bowels. It sometimes may require a large
quantity of fluid but continue ; the object is, or should be distension
nature then will perform her function. Many eminent practition-
ers prescribe injections for the purpose of softening the intestinal fsecal
matter, and for increasing the peristaltic motion of the bowels. The
true principle in colica pictonum is to distend, and consequently to
remove the intestinal spasm. [St. Louis Med, and Surg. Jour,

Tartrate of Iron and Potassium in Syphilis. M. Ricord strongly
recommends the use of Tartrate of Iron and Potassium for the cure of
primary phagedcenic syphilitic sores.

He advises much larger doses than are usually given, generally
commencing with three drachms per day, given in divided doses ; and
gradually increasing it until the quantity reaches six drachms daily.
He says that the good effects of the medicine will often be apparent
in three or four days after commencing its use. But its administration
should be continued until cicatrization is complete. He also recom-
mends a solution of the same substance as a local application.

[Annalist.

New Mode of Reducing Dislocations of the Humerus. Mr. Morgan
describes as follows, in the Provnicial Journal, a mode for effecting the
above object, which he states to be found convenient and useful in the
practice of the Bristol Infirmary. [London Lancet.

" Without any preliminary treatment, the patient is seated sideways
on a firm chair, with his arm hanging over the back, which is well
padded ; one end of a double or reel-towel is passed through the other
end, so as to form a noose, which is applied to the arm just above the
elbow. The loose, depending part of the towel forms a stirrup, into
which the surgeon places his foot, and gradually brings his whole
weight to bear on the towel, as an extending power. One or two
assistants are useful to press back the acromion, and keep the patient
firmly in his seat. The reduction is effected almost immediately ;
and if due precaution is observed in properly padding the chair, and
the arm where the towel is applied, little or no pain is felt, nor any
subsequent inconvenience from the pressure."

A new haemostatic means Epistaxis In the Annales of the Society
of Medicine of Gand, we learn from the August No. of the Bulletin
General de Therapcutique, that Dr. Meulewaeter has found sweet

698 Monthly Periscope. Medical Intelligence. [November,

milk snuffed into the nostrils to promptly arrest epistaxis. It is said any
practitioner can satisfy himself" on the first occasion which may oiler,
of the etlicacv of this new rcniedv. '

Tincture of Iodine in Ophthahnia. Dr. Landran, of Lyons, has
obtained good results from the useoftinct. iodine in the internal ophth-
almia, accompanied with effusion of purulent matter into the ant.
chamber. He orders the eye to be bathed three times a day, with a
collyrium composed of 12 drops of tr. iod. in oz. 2^ aq. dist. In five
cases of acute oph., with iritis, and purulent effusion into the ant.
chamber, this collyrium, used after antiphlogistic treatment, caused
rapid absorption. [//. de Med. de Lyons.

Medicinal Employment of Gutta Percha' Giitta Percha bting very
soluble in sulphuret of carbon, and the latter not losing any of its great
volatility by the combination, M. Uytterhoeven, head surgeon of St.
John's Hospital, in Brussels, is in the habit of spreading the mixture
in its liquid state over parts which he is anxious to preserve from the
action of air and water. Recently, an abscess resulting from caries
of the ribs, after being emptied, was covered by a coat of this fluid, a
small patch of court-plaster having previously been placed on the
puncture. In this manner the inflammation of the parieties of the
cyst was prevented, and the latter was emptied as often as accumula-
tion of matter required. The same surgeon has employed the material
prepared in the manner mentioned above, to prevent the entrance of
air into an articulation laid open by a wound. There is no doubt that
chloroform might advantageously replace the sulphuret of carbon.

\^Lancet.

Iodide of Potassium, a Cure for Nurses' Sore Mouth. Dr. H. D.
Holt states (New York Journ. of Med., May, 1848), that every case
he has treated of this disease ''has yielded within forty-eight hours to
the use of iodide of potash in gr. v. doses three times a day." [Amer.
Journ. of Med. Sciences.

MEDICAL INTELLIGENCE.

A Work on Medicine by Dr. Tomijnson Fort, of Milled gcv ilk, Georgia.
Within the last few weeks, we have learned with much gratification, that Dr.
Fort, of this State, was engaged in preparing a large octavo volume on the
Practice of Medicine. In heralding this notice to the profession, we state the
additional fact, that the author has kindly confided to us, nearly one half of the
contemplated work indeed, committed to us over 300 pages, to take such notice
of them as we might think proper. We have accordingly selected the entire
Article on the sources of Bilious Remittent Fever, and made it the leading one
for the present No. of our Journal.

Intending to recur again to this new and praiseworthy enterprise of our pro-
fessional Father in Medicine, we close our remarks here, by informing the

1848.] Medical Intelligence. 099

reader at a distance, that Dr. F. has represented this State in Congress, and has
for forty years, occupied, in our opinion, the most prominent position of any
man in the medical prolession of Georgia.

Th change of Editors in the New York Medical Journals. The able Editor,
Dr. Charles A. Lee, of the New York Journal of Medicine, has been compelled,
from other more important engagements, to resign his post, and has been suc-
ceeded by Dr. W. D. Purple, of New York city.

The highly industrious Editor, Dr. W. C. Roberts, has also retired from the
Annalist, and Dr. N. S. Davis, late of Binghampton, now of New York city,
has assumed its editorial management.

We cannot let the occasion pass without expressing our deep regret at the
retiring of these professional brothers from the editorial corps. We.know we
have lost two of its most able and valued members, who really seemed the very
best qualified for the work they had undertaken. They carry with them into
retirement our kindest feelings, and sincere wishes for a long, prosperous and
honorable life.

We welcome their successors to the arduous duties before them, and hope to
live in perfect harmony with both, whose interests we shall be happy to pro-
mote to the extent of our feeble abilities.

The Medical Examiner, on '^sectional Medicine." That which we have long
expected has eome nt last. The ungenerous spirit with which the Medical Ex-
aminer, published in Philadelphia, has treated every thing medical, not of that
city, or every one who does not pronounce the name of the Jefferson Medical
College with all possible deference, there was no reason to believe we were al-
wa)'s to escape. The illiberal attacks upon the New Orleans Medical and Sur-
gical Journal, the South-Western Medical Advocate, the New-York Medical
Intelligencer, the New-York Medical and Surgical Reporter, the Annalist, &c.,
&c., &c., have long since admonished us to bide our time. The fact of our
having been the pupil of one of the colleagues of its Editor, may be assigned as
his apology for our escape until nov/.

The re-publication from the New-Orleans Med. & Surg. Jour, of the striking
similarity ot Twedie's Library of Medicine and Dr. Dunglison's Practice of
Medicine; (we promptly published, too. Dr. D's defence, such as it was, address-
ed to the Editors of that Journal,) the admission into our Journal of another ar-
ticle, accusing Dr. Dunglison of appropriating Adelon's Physiology, without
acknowledging the translation of it-, the accusation of another Professor in the
Jefferson Medical College, using' a portion of Dr. Ford's lecture without proper
credit; and the notice in our September No. of Medical College Circulars, have
proven too much, it may be, presented too many facts, for the Editor of the Med-
ical Examiner, and hence the occasion for one of his learned essays on "section-
al melicine," to be found in his last (Oct.) No.

We did not write the notice of the ('ollege circulars. Knowing so well the
temper and acerbity of the Medical Examiner, and desirous of avoiding even
the appearance of giving offence, we would not have used the words complain-
ed of in brackets. Exceptions had been taken to the Jefferson College circular,
but a call into the country prevented our preparing the notice. At our request,
thi was done by a friend who preferred to remain unknown. Believing it a

708 Medical Intelligence. [November,

merited rebuke to a self-laudatory College, -whose annual announcements have
generally given offence believing, too, the exposition in the parenthesis to be
the true one. we voluntarily assumed the responsibility ofthe article and affixed
to it the ' Edt.'

In noticing the illiberal feeling and garbled statements of the Editor ot the
Medical Examiner, we hope to avoid all personality, and in what we have to
say, shall not forget he too belongs to the medical profession. In applying to us
the term "Southern champion," "our Southern polemic," &c., he has the satis-
faction to know they have failed to produce any effect. We are engaged in an
honorable calling, and shall endeavor on all occasions and on every subject
connected with it, to preserve self-respect and a proper regard for the honor
and dignity of the medical profession. We are of the opinion, too, that the
question about our cheeks burning, when the words complained of erroneously
supposed to have been written by us, comes with bad grace from one, who never
lets an occasion pass wnthout attempting to injure the character and reputation
of rival medical schools. What has been the course he has pursued, in noticing
medical college circulars ? In announcing the organization of the Medical
College of Memphis, we read in the Medical Examiner, Feb. 1S46 "New Med-
ical ScooiiLs. A medical University (!) for teaching how to steam and give
Lobelia and Nuviber Six, has recently been chartered by the State of Alabama,
and a new medical school at Memphis, by the State of Tennessee." May it not
be asked, if there were any iinglings in the cheeks when this disgraceful associa-
tion of a steam and lobelia establishment with a highly respectable medical
institution, was made by him in one and the same sentence'? But this blow
aimed at that College, failed of its purpose, and in spite of his opposition to it,
we are gratified in announcing the fact, that the success of the Memphis Medi-
cal College has already excelled the renowned Jefferson Medical College of
Philadelphia.

Again: Sept., 1845, in announcing the reception ofthe annual circulars of
Transylvania University, Lexington, Ky.; Richmond, Va.; Pennsylvania Col-
lege, Philadelphia (one ofthe rivals to Jefferson Medical College); University
of New-York; Willoughby Medical College; Laporte University, Indiana; he
sa5'^s, "In the midst of so much competition, it is gratifying to find in several of
these publications the assurances of unexampled success. Each finds occasion
for exultation one in the numerous diseases, and scarcely less numerous deaths,
which so bountifully supply its clinics and dissecting room, z?i conscqiicnce of be-
ing siliuited in a large city ; another from the healthfulness and freedom from
exposure to the temptations and vices of a large city, because it is a country
school; a third felicitates itself on the presumed benefit ofthe Faculty being sclf-
lumiinat^d and self-governed, and a fourth finds advantages in the peculiar itistUu-
iions which surround it, and the opportunity afforded for learning sectional med-
icine, and perpetuating sectional feelings, Slc., &c. In all, we discover no lack
ofthe natural yearnings after success, whatever deficiency there maybe evinced
in some of the dignity which makes success honorable." The italics are all the
editor's, and we leave the reader to make his own comments upon this article.

Tiie -circular of Rush Medical College, at Chicago, is thus noticed: "Addi-
tions to the means of illustration in the department of Chemistry are mentioned,
and among the apparatus, a fine microscope f^ The point and italics are used by
the editor. But here again, he failed to injure the rising reputation of this infant
medical institution: its last ckus numbered 1-12.

1848.] Modical Intelligence. 701

We take but one more notice of the manner in which medical college circu-
lars are reviewed in the Examiner. It is of the annual announcement of the
Medical Department of the University of New York the dreaded rival of the
Jefferson Medical College. In the November No., for 1846, it is said:

" We have rarely met with a circular from a medical school so little in ac-
cordance with our notions of good taste and good feeling as this, nor have we
seen one that drew so largely upon the credulity of its readers. Not to go too
muh into particulars, we shall refer to only two or three examples.

" The title page is ornamented with a neat wood-engraving of a very fine
building appropriated to the Academical department of the University, which,
besides being along way from that in which the Medical Lectures are given, is
as unlike it as it is unlike any other building in the city as unlike it Sl^ a gran-
ite fronted buUdijis v'ith the lov-er story fdlcd with shops, is unlike the handsome
marble building figured in this publication.

"The language employed throughout this Announcement, it seems to us, is
eminently hyperbolical. One object appears to run through all its pages, and
in every paragraph that of impressing the reader with the belief that the
Medical Department of the University of New York is the great school of the
country! Nay, the schools of Europe, as well as those of America, are brought
into invidious comparison. In this, however, 'the Faculty would notarrogale
to themselves superior talents or learning'! What then 1 'A few years since,
and New York was known only as the Commercial Emporium; her fame in
Medicine had not travelled beyond the confines of her own state ; and her Med-
ical classes were insignificant in numbers, composed mostly of students residing
in the vicinity of the city.' What then has made the Avonderful change so com-
placently dwelt upon, if not the 'superior talents and learning' of the Faculty
by whom this Announcement is issued? The city was there the people, the
hospitals, the dispensaries, a well organized medical school every thing except
the ' Medical Department of the University of New York'!

"The ridiculous fustian about 'building up a national school worthy of tlie
country and tlie age^ is truly laughable. Why should a school in the city of New
York be national any more than in Philadelphia, Cincinnati, New Orleans,
Boston or Baltimore, and why the school in the Stuyvesant Institute in Broad-
way, any iore than that in Crosbj'-street ? Such extravagant pretensions,
bombast and self-laudation, are little calculated to gain the esteem and secure
the confidence of the thinking public, and least of all, the medical public."

In closing this notice, the Editor remarks, "a liberal and frank policy is al-
ways the best in the end." Moral. ^In his July No. for 1848, after stating that
the University of New York, and Boston school, still adhere to the old system of
four months, he announces the fact that in the Jefferson Medical College the
lectures would commence on the 16th of October, thus adding three weeks to
the usual term, and concludes the paragraph by stating, " Similar arrange-
ments likewise exist at the University of Pennsylvania, in which the regular
lectures will commence on the same day as in the Jefferson College." But not
the least intimation is given when they terminate. " Similar arrangements like-
wise exist at the University of Pennsylvania,''^ and the inference is irresistibly, that
the lecture term must be the same in both Institutions, Will it be believed that
the writer of this very sentence, knew at the time he Avrote it that in the old
school, (the University of Pennsylvania.) the lectures would continue an entire
month (March) longer than in his College ? Who now should exhibit the
blushes of shame and confusion of face ! Behold the liberal and frank policy of
the Dean of Jefferson Medical College and Editor of the Medical Examiner.

In the very last catalogue of the Jefferson Medical College, may be found the
names of about a dozen gentlemen who matriculated in the University the same
session i. e., atknded the lectures of both, schools at the same tivie. The University

702 Medical Intelligence. [November,

says every name on her catalogue is authorized, but the Jeiferson Med. College
can not and does not vouch the same. No Institution of our country can attract
students like this one, and for making up a large class it possesses wonderfQl
and unrivalled facilities -/^jf^miT ^^"^'t '-remote Burmah'' wider contribution
"causing representatives from Ireland, France, and from all quarters, tojlock to this
Institution /" And then to entice, oh no, that is done in New York, invite is the
word, to her halls, take the following, found in the November No. of the Medical
Examiner for 1845. When the season of the year is considered, its disinterested-
ness will be at once apparent. " The Reports oi the Board of Health, as well as
the observation of the most extensive practitioners of medicine, show the present
to be an extraordinary healthy season of Philadelphia. We hear of small-pox in
some of the neighboring cities, but in this place we know of no contagious, epidemic^
or other diseases of a serious character nothing more than the ordinar}^ occur-
rences, such as cold, accidents, &. The season has been mild, and the autumn,
thus far, more exempt from storms and foul wcatficr than we have almost ever
experienced." The italics here are ours. Is the Editor of the Med. Examiner
and Dean of the Faculty of Jeflerson Med. College satisfied on this subject, or
does he desire further information as to the manner how classes are made up
and counted there 1 It will give us no pleasure to do so, but if he insists, he can
be accommodated.

It is moreover announced in this same Institution, that " to lecture may be
regarded as synonymous with to read," and " every one, who attends but two
lectures a day will not learn more of these particular subjects than others who
are engaged with six." Such are some of the absurd doctrines put forth in order
to oppose the present educational movements at improvement by the profession.
It is known too, full well, that not two, but the average of four lectures daily are
proposed. But besides six lectures a day in winter, their circular of 1846 stated
that 1028 cases in the College Dispensary, 1044 in the Pennsylvania Hospital,
152 in Will's Hospital, 5.57G in the Philadelphia Dispensary, &c., had been of-
fered to her students making thus over 70 cases daily for investigation and
prescription. Six lectures, besides dissection, study, &c., and 70 cases each
day, is going it prdty strong for even a Philadelphia Lawyer, and reminds us of
the professor who lectured aimuaUi/ four months in four different and widely
separated medical schools.

And now as to tj;ie challenge given us for discussion in the Examiner. The
Editor has neither defined his position nor attacked ours. In his four printed
pages he has talked at. random, without point, employs contradictory arguments,
avoids facts, and garbles our statements.

Our propositions are tliese : There are peculiar diseases to every locality of
the globe where a disease prevails, there it can be best investigated there are
peculiar disea-ses in the South and West, some among our Negroes, (see Dr.
Drake's letter on this subject,) which ought to be best known, and consequently
better taught at the South and West, than any where else. We have never de-
nied that malarious diseases were unknown to the profession at the North, but
as these diseases do exist here, modified by various circumstances, and seeing
them is worth something, we prefer the medical education at the South for
Southern practitioners of medicine as we would, under like circumstances,
prefer a Northern physician, were we .sick at the North.

The idea then that a medical student can best be taught his profession in the

1848. J Medical Intelligence. 703

very locality in which he is destined to practice, ought not to be, is not, andtievcr
will be abandoned.

We presume these propositions will be received without comment least of
all from the Editor of the Medical Examinpr. If not, out of his own mouth he
can be condemned, for hear him "The editors (Southern Med. and Surg.
Journal) are well known as able teachers and writers, and long conversant with
the diseases of the South, and loc hope for the sake of the profession in all parts of the
comitry,but more especially in the interesting region where they reside, that their pre-
sent attempt will be successful." One of the present Professors of Jefferson
Medical College went to Canada to study Cholera. Who for a moment sup-
poses that Philadelphia, with all her advantages, possesses any thing special for
studying the Plague, Cachexia Africana, the Cholera, Small-pox, Intermit-
tent fever, Yellow fever, and many other affections that might be enumerated'?

We have given the voluntary opinion of Prof. Holmes, of Boston, in refer-
ence to our malarious diseases ; we present now those of another professor of
the same name, formerly in the U. S. Army, but now of St. Louis. It is taken
from the American Journal of the Med. Sciences of Philadelphia, published in
1846. Dr. R. S. Holmes says, " on my arrival in Florida, knoicing nothing of
Southern diseases from practice, and being stationed alone at a distant and un-
healthy post, I learned the rules by experience alone, guided by which I have
successfully administered quinine. I practiced on Northern precepts, annoying
the patient without arresting the disease, by a continued succession of two grain
pills; occasionally at long intervals checking the disease, by these means, but
much more frequently vexed for weeks by continued sickness of the soldier. I
rose finally to ten grains, and continued to give this quantity at once; I more
frequently succeeded by this practice, but not yet to my satisfaction." * *
Finally, he remarks, "I increased my minimum dose, for intermittent fever, to
fifteen grains given at once." What now will be the surprise of the reader to
learn, after all that Dr. Dunglison is said to have written on the subject of large
doses of quinine; of his claims to having first thus recommended its use in this
country; after the denial of the Editor of the Examiner that the South has any
title whatever to the introduction of this article in its present mode of adminis-
tration in paroxysmal diseases; after his violent attacks upon every Journal)
lecture, &c., containing the least allusion to peculiar Southern diseases and
practices, or ''sectional medicine," as that term pleases him best, and the occup)'-
ing of four pages in his October No. to prove every thing in Medicine belongs
to, or is known in Philadelphia we again ask, what must be the re^ider's as-
tonishment to be told that the author of the quotation just made is a graduate of
Jefferson Medical College and a native of Pennsylvania! The name of Prof R.
S. Holmes, M. D., may be seen in the catalogue of its graduating class for 1838,
with Pa. for his State. Can a more overwhelming refutation be made on any
subject 7 And yet thisdoctrine of peculiar diseases to peculiar locations, the Edi-
tor of the Medical Examiner calls '' degrading, ^^ considers-it absurd, unscientific,
unprofessional. He has actually attributed the unfavorable state of the medical
profession in this section of our country to the acquirement of medical education
in the South and West, instead of the North. He admits some of us graduated
at Northern schools, and therefore learn something; but when we return home,
he denies we have any thing more to do than apply our " Nortliern pi-ecepts to
Southern diseases.'^ Our observations and experience are utterly worthless ; to
observe for ourselves, is to advocate " sectional medicine."

704

Medi cal Intelligence. Meteorology.

The extern of our "sectional medicine" is this: we believe that up to 1840
it may be even to the present date that Philadelphia has done more for the
medical science of our country, than all other cities of the United States put to-
gether; that the University of Pennsylvania has done more for the medical pro-
fession, than all other Colleges put together; that the house now known as Lea
& Blanchard has done more for medical literature, than all other publishers put
together. Will the sectional spirit (for Jefferson Med. College is not included)
of the Editor of the Examiner allow him to go as far?

Lest the inference may be made to our prejudice, we publicly state that up to
this time, we have never said, written or done any thing to bias a student against
the Jefferson Medical College. We have entertained the highest respect for her
Faculty, deplore the present position they have assumed, are now compelled to
condemn the spirit of their Dean, and desire no interruption to the personal
friendship of several of its members.

Prof W. M.BoLTNG, of Montgomery, Ala. From the New Orleans Med. and
Surg. Journal, we learn that Dr. Boling has accepted the appointment to the
Chair of Materia Medica and Therapeutics in the Memphris Medical College.
We do not know how a better selection could have been made, and wish Dr. B.
every success in his new office and location.

METEOROLOGICAL OBSERVATIONS, for September, 1848, at Augusta,
Ga. Latitude 33^27' north Longitude 4 32' west Wash. Altitude above
tide 52 feet.

6.

Sun
Ther.

I Rise.
Bar.

Thf.r.

P.M.

Bar.
29 72-100

Wind.

1 Remarks.

1

69

29 71-100

92

N. W.

,Fair.

2

70

" 83-100

93

" 83-100

N.W.

iFair.

3

70

" 81-100

93

" 86-100

S. W.

'Fair.

4

69

" 89-100

89

" 88-100

S. E.

|Fair.

5

68

" 83-100

90

" 70-100

S. Vf.

Fair light ghower in afternoon.

6

67

" 82-100

82

" 79-100

s. w.

Cloudy storm at 8 p.m., 1 inch.

7

66

" 87-100

66

" 89-100

N. E.

Cloudy drizzle breeze.

8

60

" 87-100

75

" 85-100

N.

Fair breeze rain last night,

9

54

" 80-100

78

" 78-100

W.^

Fair. [10-100.

10

56

" 82-100

81

" 84-100

s. w.

Fair.

11

58

" 89-100

82

" 91-100

s.

;Fair.

12

63

" 90-100

85

" 90-100

8, W.

iFair breeze.

13

64

" 87-100

84

" 87-100

E.

;Cloudy.

14

b8

" 89-100

83

" 86-100

W.

'Fair some flying clouds.

15

65

" 87-100

87

" 65-100

s. w.

iFair some clouds.

IG

68

" 61-100
" 64-100

82

" 59-100

s. w.

jCloudy light shower at 4 a.m.

17

61

79

" 60-100

s. w.

; Fair breeze.

18

55

" 76-lOn

80

" 80-100

s.

Fair.

10

56

" 83,-100

82

" 83-100

s.

Fair breeze.

20

59

" 76-100

84

" 70-100

8. W.

Somewhat cloudy.

21

65

" 66-100

78

' 64-100

s. w.

Cloudy calm day.

22

55

" 83-100

72

" 85-100

N.

Fair ^blow fiom 4 a.m., all day.

23

51

" 87-100

68

" 87-100

E.

iCloudv blow continues.

S4

52

" 84-100

75

" 80-100

S. E.

pioudy.

25

58

" 71-100'

74

" 62-100

N. E.

iCloudy blow.

20

61

" 59-100

82

" 61-100

N.

;Fair dry gale.

27

58

" 72-100

76

" 69-100

N.

Fair breeze.

28

56

" 64-100

76

" .58-100

N.W.

Fair.

2!)

48

" 58-100

78

" 52-100

S. W.

Fair blow. [45-100.

30

52

" 51-100'

81

" 44-100

S.

Fair rain storm at 6 p.m., 2 in.

21 Fair days, auantity of Rain 3 inches 55-100. Wind East of N. and S.
G days. West of do. do. 16 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 4.] NEW SERIES. DECEMBER, 1848. [No. 12.

Part I. original COMMUNICATIONS.

ARTICLE L.

Operations on the Jaws, with the Results of Fourteen Cases,
By Paul F. Eve. M. D., Professor of Surgery in the Medical
College of Georgia.

Case I. Fibrous Tumor attached to Superior Maxillary
Bone, with Polypus of the Nose Ligature to both Primitive
Carotids, removal of Tumor Recovery of Patient. In July,
1835, I ligated the left carotid artery, removed a polypus from
the left nostril, and dissected from the cheek of the same side,
a fibrous tumor which was found attached to the outer surface
of the left superior maxillary bone. This foreign growth had
an osseous attachment, and was about the size of a guinea
e.^g. The patient was a youth aged 18 years. His parents
inhabited a sickly district of South Carolina, and had recently
lost five children ; this their last one was of a cachectic habit.
The polypus returned the next winter, and was removed a
second time. In 1836, the patient visited New York to con-
sult Dr. Mott, who ligated the right carotid. He is now a man
of family, managing a large tproperty. I saw him a few days
ago, and the only evidence remaining of disease about him, was
a slight fulness in the left cheek. Twelve years have now
elapsed, and he has experienced no unpleasant effects from the'
ligature to both primitive carotid arteries.

Case II. Removal of nearly the whole Right Superior Maxil-
lary Bone for Pohjpus of the Antrum Recovery of the Pa-
tient. May, 1836, Mr. J. S., aged 21, was operated upon the

45

706 Eve, on Operations on the Jaws. [December,

third time for a large fibrous polypus of the right antrum high-
morianum. In two previous attempts the foreign growth had
been attacked in the nostril, the antrum was opened, and the
soft palate slit up, but without succeeding in its entire removal.
In the third operation, a flap was made by two incisions through
the cheek and lip, this reflected over the eye, the maxillary
bone of the right side thus exposed was separated between its
first and second incisor teeth, then the nasal process of the
same bone divided transversely, after which the alveolar pro-
cesses with six teeth (the wisdom tooth not being developed)
was gradually detached. The palatine process of the superior
maxilla, and the palatine plate of the palate bone were also re-
moved, and as the fibrous tumor could not yet be pulled away,
even by great force, it was separated by curved scissors from
the basilar processes of the occipital" and sphenoidal bones, and
also from the internal plate of the pterygoid process. The^
mass removed weighed three ounces three and a half drachms.
Three sutures were applied to the palate and five to the face in
dressing the wound. The latter united, but the former did not.
The patient entirely recovered : I have seen him several times
since the operation, and believe he is still living in One of the
upper counties of this State. (For further particulars, see
Southern Medical and Surgical Journal, vol. i, first series, p. 78)

Case III. Removal of 4^ inches of the Inferior MaxAllary
Bone^ including one of its angles, for Osteo-Sarcoma the dis-
ease returned and destroyed life in about 8 months after the
Operation. May 31st, 1838, I operated upon a negro woman,
aged 25, for a tumor involving nearly the whole left half of the
lower jaw-bone. She had had one child; the catamenia j\'ere
now suppressed ; for years she Jiad been complaining from
what was called jaw-ache ; and the molar and bicuspid teeth
of the diseased side had been extracted. While preparing the
y)atient for it, the operation was hastened from impending suf-
focation. An incision was made perpendicularly from the left
angle of the lips to the thyroid gland, and from this point another
one -extended to the lobe of the ear of the same side. Extract-
ing the canine tooth of this side, the inferior maxilla was divid-
ed with a saw, and then by careful dissection, this portion of the

1848.] Eve, on Operations on the Jaws. 707

bone was drawn outwards so as to apply the saw at its neck,
leaving its condyle in tiie articulation. It measured 4 inches
and f in length ; the diseased mass presented a large fungous
growth containing numerous irregularly shaped spiculae and
laminae of bone.

Three ligatures and some eight or ten sutures with the ordi-
nary dressings were applied, and the patient returned home on
the fortieth day after the operation. She, however, did not
recover; the disease reappeared in the right sub-maxillary
gland, then invaded all the tissues, and destioyed life in about
eight months. (For further particulars, see Southern Med.
and Surg. Journal, 1st series, vol. ii, p. 720.)

Case IV. Operation for Separating the Jaws Success only
Partial. Early in 1840, I made an attempt to re-open the
mouth for the son of Mr. S., aged five years. He had had
gangraenopsis, which had resulted not only in destruction of the
soft parts but ankylosis of the lower jaw. There was also
great deformity of the mouth. After free division of the zygo-
matic muscles and other soft parts, the right commissure of the
lip was depressed, and the separation of the lower jaw increas-
ed by the lever power. The patient, who was from the coun-
try, was committed to his parents, with instructions how to
treat the case. I frequently see him, now become quite a lad,
and regret to add the deformity has only partially been re-
medied.

Case V. Fungus Hcematodes involving the Jaws Opera'
tion Death of the Patient in a few months after it. In x\u-
gust, 1840, I made an incision into a tumor situated under the
right masseter muscle and about the size of a common egg.
The patient was the Rev. Mr. D., of South Carolina, aged
about 40 years. The cause of his disease was quite obscure,.
When the opening was made, the fingers soon turned out a
considerable quantity of brain-like matter, mixed with blood,
and the caronoid process of the right side of the inferior max-
illa down to the angle of the bone was found entirely de-
nuded of its periosteum. The operation was now abandoned.
An immense bloody tumor was rapidly developed on the side

708 Eve, 071 Operations on the Jaws. [December,

of the face, involving all the tissues, bleeding spontaneously,
and death alone relieved the sufferer in about eight nrionths from
the operation.

Case VI. Removal of Portion of the Inferior Maxillary
Bone for Epulis Recovery of Patient. On the 7th of Sept-
ember, 1840, I operated upon Mrs. H. in Madison, Geo., for
epulis of the lower jaw. Exposing the bone by an incision
from the left angle of the mouth through the cheek to the ex-
tent of an inch and a half, the diseased mass was isolated by
two perpendicular applications of the saw, and it was then
chipped off with the chisel and mallet. This patient fully re-
covered.

Case VII. Removal of nearly the Whole Right Superior
Maxillary Bone for Fungus Ha^matodes of the Antrum, SfC.
Return of the Disease and Death of the Patient in a few
months. The 6th of February, 1842, I performed before the
medical class of our college a similar operation to the one des-
cribed in case 2. The patient was a negro man, aged 45 years.
The disease was removed as far as could be traced, and was
pronounced fungus haematodes or soft cancer. The patient
so, far recovered that he returned home in about a month, but
his affection was rapidly reproduced, and he died ia two or three
months after the operation.

Case VIII. Operation for Separating the Jaws Success
only Partial. In 1843, I operated upon Dr. G. then a student
of medicine, for deformity of the mouth and closure of the infe-
rior jaw, said to be the effects of cancrum oris, or of profuse sali-
vation. The operation and its results were similar to case 4.

Case IX. Trephining the Antrum Jlighmoriannm Death
of Patient within fifty hours after the Operation. This case
was a young lady, who for years had a tumor developing in
her right cheek. Considering it the result of polypus of the
antVurn, the anterior surfiico of this cavity having been exposed,
a trephine was applied and made to penetrate one inch and a
half the tumor, however, proved to be osseous. This was on

1848.] Eve, on Operations on the Jaws. 709

the 12th of April, 1844. The operation was now abandoned;
and the patient to our surprise, apparently doing well, died on
the third day from symptoms of congestion, &c., of the brain.
(For further particulars of this case, see Southern Med. and
Surg. Journal, vol. iv, new series, p. 279.)

*
Case X. Removal of a Portion of both the Superior MaxiU

larij Bones for Epulis Recovery of Patient. Mrs. H. of South
Carolina had been laboring for some years und^r a fungus
growth from the ajveolar processes of the upper jaw. It pro-
ceeded from carious teeth, some of which had been plugged
and others had artificials inserted upon their stumps or roots.
The tumor now extended to both of the superior maxillary
bones. The diseased mass had once been removed by exci-
sion. On the 5th of July, 1845, I divided the gums both an-
teriorly and posteriorly to the foramen incissivum ; then by
extracting the first molar of one side and the canine tooth of the
other, with saw, (fee, the included portion of the bone was
removed. The patient had a considerable hemorrhage during
the evening after the operation ; having been called into the
country, another physician kindly arrested it by.creasote. Mrs.
H. left for home a week after the operation, and had a good
recovery. A small tubercle subsequently presented itself, but
was promptly repressed by caustic, and I believe she is still
quite well.

Case XI. Removal of a Portion of the Inferior Maxillary
Bone for Osteo-Sarcoma Recovery of Patient. Juno, a negro
woman, aged 30 years, had carious teeth, and by the extraction
of a molar tooth of the left side of the inferior maxilla, a portion
of the alveolar was removed with it. She' has continued to
suffer pain in the jaw for some years past; and has had all the
teeth of this side extracted. Eighteen months ago, a tumor
began to be devoloped at the seat of pain, which was laid open
by a physician. On the 14th of Octob^r,*1845, thinking it a case
of epulis, the whole of the diseased mass was cut away, and as
it began to be reproduced, I applied the actual cautery on si^ dif-
ferent occasions. The knife in removing the tumor had its
edge fractured by coming in contact with spicula? of bone which

710 Eve, 071 Operations on the Jaws, [December,

it contained. On the 16tli of November same year, I divided
the cheek fron:i the left commissure of the mouth to near the
angle of the lower jaw of the same side. This exposed the
whole disease of the bone which when denuded was removed
with the saw. The artery of the bone was found obliterated ;
a mere strip of its base remained undivided by the saw.

This patient *had a good recovery ; was presented to the
class on the 23d, seven days after the operation, apparently
cured ; and returned home on the 25th. I saw Juno a year
after the operation, and fo.und her not only healthy and sound,
but the mother of another infant.

Case XII. Removal of Portion of the Inferior Maxillary
Bone for Osteo- Sarcoma Recovery of Patient. June 5th,
1S46, I operated upon Mrs. D., in Decatur, Ga., for disease of
the lower jaw-bone. It had been of some years standing, and
involved the whole circumference of the bone. It was about
the size of a turkey egg, its center occupying the position of the
right stomach tooth, and included the base of this bone. A plug
of the inferior maxilla, about one inch and a half of its whole
circmference was removed and contained thin s|)iculaD and
lamina) of osseous structure. This patient had a good recovery,
and continues well at present.

Case XIIL Operation to Separate the Jaw s-^ Failure. In
1846, Mrs. W., of South Carolina, applied to have her mouth
re-opened, and a large circular opening closed in her left cheek.
The deformity was attributed to profuse salivation. Slitting the
left commissure of the mouth, a lever was applied upon the
lower jaw, but no force exercised could start the bone at its
articulation. The portion of the alveolar holding the inferior
incisor teeth upon which the lever was applied was even frac-
tured. The incision of the soft parts was then extended to the
coronoid process, and the saw applied to it, but again without
success in separating the jaw. A ledge of bone, or a coalescing
of the coronoid process to the malar bone seemed to have been
produced or to have occured in this case. Closing the opening
in the cheek. Dr. Mott's instrument for separating the jaws
was furnished the patient and after a few days she returned

1848.] Eve, on Operations on the Jaws. 711

home. I have since learned that she has not been much ben-
efited by the operation.

Case XIV. Removal of Portion of Inferior Maxillary
Bone Closure of opening- in the Cheek Recovery of Patient.
On the 16th of last June, I was consuUed by Mr. B., of a neigh-
boring county, for a considerable deformity of his mouth. He
was about 45 years old, and while laboring under Typhoid
Pneumonia during the past winter, had been profusely salivated.
He now presented an opening in the left cheek of about | of an
inch diameter, from which the saliva dribbled, and he could not
separate the jaws. A small hard band of cicatrix formed the
left commie sure of his mouth.

On the 20th of this month, the angle of the mouth was laid
open, the cheeks freely separated from the jaws, the cicatrix-
like border of the flaps were pared away, two pieces of the
inferior maxilla, found partially detached, were removed, the
wound was then closed by four sutures and covered with col-
lodion. Two teeth had previous to this operation been extract-
ed, which, with the three now removed with their alveolar
processes, represent the portion lost of the bony structure,
besides which there were large sloughs from th6 soft parts.
Finding the union in the wound not satisfactory on the third
day, chloroform was administered for the first time to the pa-
tient, and sutures reapplied. Notwithstanding every care, a
small opening again occurred in the cheek, which was attribu-
ted to the hollow produced from the great loss of substance in
the destructive process of the disease. By persevering applica-
tions of lunar caustic, adhesive strips, &c., this was finally
closed, at the end of about a month, the patient returned home
in a satisfactory state, and so far as I know still continues well.

Since the above was set up in type, Mr. B. has called upon
me, exhibiting a firm cicatrix in the cheek, and a good state of
health. His object was to obtain, if possible, a wider separa-
tion of the jaws. By the use of the knife, a finger could be
passed between the cheek and the remaining portions of the
jaws, and also between the incisor teeth. With instruction
how to gradually increase the separation of the dental arches,
he is about to return home again. He expresses himself well
pleased with the success of the operations.

712 Harris, on Chloroform. [December,

In four of the above cases the operation was limited to the
superior maxillary bone, in five others to the inferior maxilla,
and in the five remaining it included both of the jaw-bones.
In one, death occurred within three days after the operation,
and in three others the patients only partially recovered from
the disease not one dying from the effects of the operative
procedure in itself -

ARTICLE LI.

Remarks on the administration of Chloroform in the Hospitals
of Paris : Contained in a letter from J url\h Harris, M. D.,
dated Paris, 1th Sept, 1848.

Chloroform is now administered in all important surgical
cases in the Hospitals of Paris. I have not seen since my ar-
rival here, a single important surgical operation performed
unless the patient was first placed under the influence of this
agent. It is given with readiness and even with impunity to
children. At the Children's Hospital (Hopital des Enfants) it
is invariably given when operations are to be performed. In
adult persoqp it is not confined to capital operations, but is fre-
quently administered in opening abscesses and other minor
operations. As often as I have seen it administered, I have
never witnessed any injurious effect resulting from it. The
only instance in which I have seen it produce any unusual t^eci
was in a young woman, to whom it was given for the opera-
tion of fistula in ano. Even in this case the effects were not
dangerous, but merely produced some hysterical symptoms.
The patient rolled from one side of the bed to the other, throw-
ing her arms violently in every direction, with screams. So
violent were her muscular exertions, that four or five students
found it difficult to hold her so that the operation could be
performed. The operation was however soon completed, by
M. Velpeau, and the patient recovered in a few minutes, with
no knowledge that the operation had been performed. I do
not think that these sym})toms would have been produced
even in her case, had it not been for the state of mind in which
he was at the time. She was placed upon the operating table,

1848.] Harris, on Chloroform. 713

being much embarrassed and agitated, and her person exposed
before the chiss five or ten minutes prior to the adniir)istr<Mtion
of the chloroform. With this state of things, and the shock of
modesty, (for she wept bitterly,) it is not surprising that these
nervous symptoms should have been produced by the chloro-
form. Having seen chloroform so often administered without
any alarming symptoms, I cannot believe that it is attended
with danger when prudently given. I am aware that it is con-
sidered by the profession as a dangerous agent, and very justly,
for a mfeans so potent cannot be harmless. But this is no ar-
gument against its prudent use. As well might it be urged
that arsenic should be stricken from the list of remedies be-
cause it is poisonous or opium, because it will produce death
when given in too great quantity. Indeed, according to this
reasoning, many of our most valuable remedial agents would
be thrown aside. I am also aware that several deaths has been
attributed to chloroform, which took place under its administra-
tion. But I think that this cannot be fairly proven to be owing to
the action of this agent. Might not the patients have died
even though chloroform had not been administered ? Many
cases are recorded of patients dying under the knife, even of
the most eminent surgeons, without having taken chloroform.
A case was but the other day reported of a patient in London,
to whom chloroform had been given, and who died under the
use of the knife. Another, just after, of a little girl, upon whom
was performed an operation too trifling to administer chloro-
form ; yet no sooner had the surgeon made his first incision
than the patient expired. Now might not the former have
died as did the latter, without the use of chloroform, or might
not the latter have died as did the former, even though this
agent had been used ; for no one pretends that it will directly
prevent death. I believe that it will enable some to undergo
an operation, who, without it, could not withstand the shock.
This agent is administered in England even more than in France.
Does it appear in these two countries that more patients die
from the effects of operations now, than before chloroform
was discovered ? The statistics of Mr. Simpson, of Edinburgh,
show quite a contrary result, and the opinions of many distin-
guished surgeons of England corroborate Mr. Simpson's report.

714 Harris, on Chloroform, [December,

The effects upon various subjects are somewhat different :
some sleep as quietly during the operation as though they were
taking their natural rest: others speak incoherently, and others
groan as though they felt sensibly the operation. These effects
are of course owing to peculiarity of constitution. Some sur-
geons have complained much that they cannot produce the
desired effects, viz., insensibility and sleep. This I think is
either owing to the impurity of the article used, or to the fact
that a sufficiency has not been given. Patients often make
great resistance and violent struggles just at the time tliat they
are getting under the effects of the chloroform. These symp-
toms often frighten the surgeon, and he ceases to give the chlo-
roform, when but a little more would quiet the patient.

There are several modes of administering it adopted here.
Some surgeons use an instrument perforated with holes, which
may be graduated so as to admit more or less air, as the case
may require : others (and this is the most general plan) use
simply a sponge, upon which the chloroform is poured and ap-
plied to the mouth whilst the nose is held by the hand.

M. Mercier, in cases where chloroform produces death from
too large a quantity being given, has offered to the Academic
de Medicine of Paris a very satisfactory theory of its modus
operandi. He thinks that " deaths from chloroform are owing
to a viscosity of the blood, preventing its free circulation in the
capillaries of the lungs, or to a paralysis of the heart resulting
from general collapse, or from the two combined." I think
that it probably results from the paralysis of the heart. He
adds, "the less blood the nervous system receives, the less it
will react upon the other organs, and particularly upon the
heart." If it be true that the heart does not receive sufficient
nervous influence to cause it to perform its function of propel-
ling the blood through the vessels, of course the patient must
die. M. M's. endeavours then, is to keep the blood in the brain
and upper portion of the body, so as to enable it to react upon
the heart and other organs. This object may be attained, he
says, "by placing the patient in the horizontal position, and also
by pressing upon the axillary and crural arteries, and, if possible,
upon the abdominal aorta, when we see the patient's life is
endangered.

1848.] Harris, on Chloroform. 715

M. Blatin reported to the Society, that he "thinks death to
be caused by mucus in the mouth, which is confined by closing
the lips, and is drawn into the air passages." He therefore thinks
that " the patient should take the chloroform in the sitting pos-
ture, with the head bent forwards." This is not only unsatis-
factory, but impracticable, for the patient cannot retain the
sitting posture when he loses his muscular power. Chloroform
has been found remarkably useful in the reduction of dislocations,
not only by annulling the pain, but by relaxing the muscles.
This is a very desirable object to be attained in such cases. By
using chloroform, you destroy pain and effectually relax the
muscles, thereby rendering the reduction easy. I have seen it
used in but one case as yet. M. Velpeau used it in a disloca-
tion of the Radius and Ulnar backwards, and easily effected the
reduction in the usual way. He has employed it in other cases,
and is well satisfied with the results.

Chloroform is never used here in Midwifery cases. M. Du-
bois, v^ho is at the head of the profession in this branch, opposes
its use. When chloroform was first thought to be beneficial in
such cases, he administered it in one instance, and the result
having proved unfavorable, he has never since made use of the
article. I do not know why this operation failed as I have
never seen a report of the case. I think, however, that M.
Dubois acts very unphilosophically in ceasing its use, even
though it acted prejudicially in one instance. Professor Simp-
son, and others, have reported very numerous cases in which
it has been administered with the greatest advantage. The re-
ports have swollen the list to such an extent as to justify any
man in at least giving it a fair trial.

The effects of chloroform, so far as I have observed them,
are these: Sensibility is gradually diminished until it entirely
ceases. This may be tested by a pinch, or by the prick of a
pin. All power over the voluntary muscles is lost, so that if
you raise the patient's arm or leg, it immediately falls the
eyes become set and lose their natural brightness. I have seen
the pupils dilated, though this is not a constant symptom. The
eyelids become heavy and remain more or less closed. The
patient is then fully under its influence.

716 Warren, on the Effects of Lightning, [December,

ARTICLE LIT.

Account of several persons struck hy Lightnings andtheineans
adopted to resuscitate them. By R. L. Warren, M. D., of
Florence, Georgia.

On the 3rd day of September, 1848, in the town of F ,

there were five ladies and one negress ^^ struck with lightning."
These persons had attended church in the village, and were on
their return home in the evening, when there arose a tremend-
ous thunder-cloud which induced them to go into the house of
one of the citizens ibr protection from the rain. The lightning
was intensely vivid. These females, from a great fear of ^^ be-
ing struck,'^ had scarcely huddled together on a bed in a room,
near which stood a very tall oak tree, before it received the
electric charge. Accompanying it was an explosion which
resulted in completely prostrating the entire crowd.

1 was immediately summoned to the spot. I immediately
ordered large quantities of cold water to be thrown on their
heads and in their iaces, and, as soon as it could be procured,
the vapour of a?n?noniated alcohol to be applied to the nostrils,
which remedies had the happy effect of producing immediate
resuscitation. I did not order cold water to be sprinkled on
the ffice, but rather that '' pails-fuir'' should be thrown on the
face and entire person in short, the cold douche was prescribed.
It appears that sprinkling had proven ineffectual previous to
my arrival, which circumstance induced me to try the remedy
in a more wholesale manner. All the patients the next morn-
ing were fully recovered from the shock, and were laboring
under very little excitement, not more than might have been
expected from the contusions produced by the pieces of timber
that were shattered off from the walls of the house, and the
incised wounds produced from the broken fragments of a large
mirror that was suspended against the wall. (I might have
mentioned, that a large dog which laid on a large root of the
tree under the house with a block and chain fastened to him
was killed.) After the patients were resuscitated, tinct. opii.
was administered in anodyne doses to allay excitement and
irritability. Some of the patients were actually burned by the

1 848.] Composition of the Animal Fluids, ^c. 717

electric explosion. Whenever the fluid came in contact with
a bad conductor a severely burnt spot was left; for instance,
where the clothes were moistened by perspiration, and came
in contact with the body, a burnt abrasion was left. One of
the young ladies, who had a gold locket about her neck, was
severely burned on her breast by its being dissolved. The
negress had opened the window, and was standing facing the
tree, perhaps not more than four feet from it she was resusci-
tated with much more difficulty than any of the others; her
shoulders, arms, fore-arms, sides, thighs and legs, were very
nearly denuded.

All the patients, after reviving, complained of severe pain in
the stomach ; it was of a spadmodic nature, and was relieved
by the anodyne treatment above mentioned.

The tree and the house were very much injured by the elec-
tricity.

PART II. REVIEWS AND EXTRACTS.

Composition of the Animal Fluids in Health, and the alterations
of Disease. By Alfred B. Garrod, of London. (London
Lancet.)

A few years since it would have been necessary for me, at
the commencement of a discussion on the fluids of the animal
body, to have given you an accout of the various opinions
which have been held from time to time as to the cause of dis-
ease to have spoken of the views of the solidists, who ascribe
every change to the alterations of the solids, and of the humour-
alists. who look for all explanations in the condition of fluid
portions; but, at the present time, I think that such an account
would be unnecessary, as it would occupy your time and direct
your attention to a subject which might be more advantageous-
ly studied afterwards at your leisure. For such information I
cannot do better than refer you to a course of lectures on the
blood, delivered by Mr. Ancell, which were published in The
Lancet, vols. i. and ii., 1831)-40, and where you will find this
subject well treated. Those who are conversant with the
amount of knowledge that we now possess on this subject must
see that any such exclusive views as were formerly held must
be erroneous ; for there cannot be a doubt that each portion f
the animal frame is equally essential, and that disease can arise

718 Composition of the Animal Fluids, SfC. [December,

from changes afTectinfr either solids or fluids, and that when one
portion is diseased, the other becomes frequently secondarily
affected. The distinction also between the animal solids and
fluids is more apparent than real. Let us take, for example, a
portion of muscle; in it, not more than twenty-five per cent, of
solid matter is contained, and the blood in health has as much
as tw^enty per cent. ; aijain, the muscle is found to consist, ulti-
mately, of an aggregation of very minute cells; and I have
shown you that these cells possess a power of metamorphosis,
and are capable of disinteirrating proteine compounds into krea-
tine, lactic acids, &c. When blood is minutely examined it
also presents to view" aseries of corpuscles, suspended in a
clear liquid ; these corpuscles are in reality cells, and we have
every reason to suppose that they also have a power, the exer-
cise of which is of the (greatest importance in the animal econo-
my. The animal fluid's may be divided into four classes 1st.
The blood. 2nd. Fluids, destined to supply nutriment to the
blood, as the chyle. 3rd. Secretions, destined to fulfil import-
ant offices in the system, as the gastric juice, saliva, the true
bile, &c., or to nourish the young of the animals, as milk. 4th.
Those destined simply for excretion, as of no further use, as the
urine, the colouring matter of bile, &c. Some of these viz.,
the blood, lymph, and chyle not only contain organic but or-
ganized substances in their composition, that is, bodies possessed
of structure, which no doubt are capable of effecting changes in
matter in contact with them; the other fluids simply contain
organic matter in a state of solution.

Blood. If any one portion of the body might be considered
of paramount importance, this would undoubtedly be the blood.
In the Old Testament this fluid is spoken of as constituting the
life of the flesh, or the life of the animal, which well expresses
this importance ; for through its means all the changes attend-
ing the phenomena of life are accomplished, through its agency
the different portions of the animal become nourished, and it is
in itself the centre of the most important changes. Hence the
value of a careful study of its composition and properties. As
the blood receives all the crude nourishment introduced into the
system previous to its becoming a part of the solid frame work,
and prepares such for its destination ; as it is also the receiver
of all eflete matters, the products of metamorphosis, which have
been formed in the tissues, we shall find among its constituents
matters which are readv to be prepared and made fit for nutri-
tion, bodies already so prepared ; also the active agent, oxygen,,
by whose power all the changes in ihc animal body are effected,
^d without the presence of which life is incapable of being for
a moment sustained. Lastly, there exist in the blood the effete

I

1848.] Compositionof the Animal Fluids, ^c. 719

matters about to be excreted ; in health these are found in very
small quantities, owing to the activity of those depurating or-
gans whose office it is to free the blood from such as soon as
they are received into it.

As the knowledge of the chemistry of healthy blood is essen-
tial for the right understanding of physiology, so a knowledge of
the alterations which take place in the blood in disease is equally
important for the purpose of comprehending pathology; and it
will be seen that this fluid will often be the first to give indica-
tions of any morbid phenomena taking place in the system.
Should nourishment be insufficient, improper, or not rightly
digested and absorbed, the blood is early atiected, and altered
in composition ; should morbid changes be taking place in any
part, the normal constituents of this fluid become altered in
quantity and quality : should the excreting organs become im-
peded in their functions, the matters so retained are found in the
blood, where they give rise to secondary aflfections : and lastly,
should the absorption of the oxygen into the system be impeded,
its deficiency is soon made manifest in the condition of the blood.

I shall first give you a short description of the physical pro-
perties of this fluid in man and in the lower animals ; then speak
fully of its chemical constitution, and of the various methods
used in analyzing it, and in detecting its morbid conditions ; of
the variations arising from age, sex, temperament ; and lastly, of
the alterations which occur in diseased states of the body.

Physical Characters of Blood. When circulating in the
vessels, or when fresh drawn from them, the blood of the higher
animals presents the appearance of an intensely red fluid, more
florid in arterial than venous blood, of a somewhat thick and
viscid consistence, and, on close examination, a glittering ap-
pearance is observed, arising from the reflection from an
immense number of small surfaces. The specific gravity of the
blood in mammalia varies from 1041 to 1082; in the human
subject, from 1050 to 1058; it is rather less in women than in
men ; its odour is peculiar, differing in different animals and in
the two sexes ; it has a saltish taste, and an alkaline reaction,
which is best observed in the serum; the temperature of the
blood also varies in different animals, and indifferent vessels, in
the aorta of the ox, 103 Fah. ; in the hog, 99.5 Fah. ; arterial
blood is stated to be 1.8 Fah. higher than venous.

Microscopic Examination. Satisfactorily to obseiwe the
microscopic structure of the blood, a magnifying power of
about 400 diameters is required, which is best obtained from an
acrpmatic object-glass of about one-eighth or one-tenth inch
focus, and a thin layer of the fluid should be used. Blood is
then found to consist of a clear and almost- colourless liquid.

720 Composition of the Animal Fluids, ^c. [December,

with a great number of rounded bodies, called corpuscles, float-
ing in it. If human blood is employed, these corpuscles are
found to have tJie form of circular discs, similar in shape to a
piece of coin, but with a dcjiression in the centre, so as to ren-
der them biconcave, which is best seen as they roll over in the
fluid; their diameter varies from ^^jVtt to 32V0? ^^^ the thick-
ness is from about one-fourth to one-fifth of their diameter. In
most mammalia, the red globules are similar in shape to those
of the human subject ; but an exception exists in the camel
tribe, where they are oval. In birds they are oval, somewhat
pointed at their extremities, and biconvex; in reptiles they are
oval, and double convex: in the cartilaginous fishes they have
a structure similar to those in reptiles, but in the osseous they
are more circular, and sometimes concave ; in the invertebrata
they are very irregular in shape. In the diflierent classes of
animals there is considerable difference in the size of the blood
corpuscle ; it has been found to be largest in the proteus and
siren, where the long diameter is ^\-^\.\\ of an inch; smallest in.
the goat, 6 TrVoth ; and in the musk deer, yaioo^^'- (Gulliver.
Although the size of the red corpuscle is by no means propor-
tioned to that of the animal, yet Mr. Gulliver has observed that
in species of the same order there is a close connection. This
is well seen in the ruminant tribe.

In reptiles the red corpuscles consist of a central nucleus,
surrounded by a thin envelope, and between these a red matter
is observed; the same structure can be seen in many other of
the lower animals, but in man and mammalia, although Hewson
and Muller have described the existence of a central nucleus,
most observers have failed to discover it.

Besides the red corpuscles w^hich we have just described,
there exists a few colourless ones, which have been called the
pale corpuscle or lymph globule ; these, in the human subject,
are larger, about o iVo inch, but in reptiles smaller than the red
particles. When water is added to the blood, endosmosis takes
place, the corpuscle is distended and the colouring matter dis-
solved. The clear fluid in which the globules float is called the
plasma, or liquor sans^uinis.

Cocifrnlation of Blood. We have thus seen that the living
blood when moving the vessels, and shortly after been drawn
from them, consists of the tw^o parts which we have just de-
scribed. In the blood of man and mammalia, these cannot
easily be separated, on account of the minute size of the cor-
puscles allowing them to pass through the finest filter, but if
frogs' blood be employed, the two portions can be readily col-
lected, the globules remaining on the filter, and the clear liquor
sanguinis passing'through.

1848.] Composition of the Animal Fluids, 4^. 721

Within a few minutes after being drawn, a change takes
place in the blood, an exhalation is emitted, a film appears upon
the surface, commencing at the circumference, and very short-
ly the whole becomes a gelatinous mass. In from fifteen to
twenty minutes a shrinking of the mass takes place from the
sides of the vessel, and a clear fluid exudes; this continues for
some hours, and the blood is thus resolved into two parts, the
one called the clot, the other the serum. If this change had
been observed in the thin strata, under the microscope, the red
globules would have been seen to arrange themselves in rou-
leaux, forming meshes, and after a short time stretching across
the spaces formed by these rouleaux, very fine fibres may be
seen, which appear to be attached to the corpuscles, often
giving the appearance of net-work to the space. The pheno-
mena we have just described may be thus explained.

The liquor sanguinis contains within it a small amount of a
substance, called fibrine, \^ich possesses the property of spon-
taneous coagulability when drawn from the vessels, and during
its solidification, consisting, as this does, in the formation of the
numberless minute fibres seen under the miscroscope, entangles
within its meshes the red corpuscles thus forming the clot.
The clot then contains the red corpuscles plus the fibrine; the
serum, the liquor sanguinis minus the fibrine. If, in the exper-
iment with frogs' blood, we allow the liquor sanguinis, which
has passed through the filter, to remain a few minutes, it also
coagulates, forming a clot and serum. The former, however,
is in this case colourless, consisting only of the fibrine, the red
corpuscles having remained on the filler. There are certain
circumstances which have a powerful influence over the
phenomena of coagulation. Among the retarding causes we
may mention, depression of temperature, which, if continued
very long, and under 38 Fahr., altogether prevents it ; contact
with living parts also retards it. This is seen in frozen animals,
or blood enclosed in vessels between ligatures, or when ex-
travasated and in the bodies of leeches. It has been stated,
that in animals killed by lightning, or by injuries to the brain
and spine the blood is slow in coagulating. The same is also the
case in the blood drawn from animals in a highly excited state.
Certain substances added to the blood also lessen or prevent
its coagulating property. This is the case with bile, urine,
solution of opium, alkalies and their carbonates.

All accelerating agents, raising the temperature from 110^
to 120 Fahr. favours the coagulation of the blood; but 140"^
Fahr. prevents it. Addition of serum or water in small quan-
tities, exposure to air, and a fainting state of body, also operate

46 .

722 Compositionof the Animal Fluids, <^c. [December,

in hastening this change. At our next meeting we shall pro-
ceed to the chemistry of the blood.

Cheniistry of the Blood.
At the conclusion of my last lecture,- I was speaking of the
physical properties of the blood, its appearance urfder the mi-
croscope, and also of the peculiar change which it undergoes
after it has been drawn from the vessels. I mentioned, also,
that certain circumstances influenced this phenomena, either
accelerating, retarding, or preventing it altogether. We shall
now 'proceed to the examination of its chemical composition,
which we shall find to be exceedingly complex so much so,
indeed, that it is almost hopeless, at the present time, to attempt
its perfect analysis. I shall first give you a list of the various
proximate constituents of this fluid ; then the mode of separat-
ing thepe principles and their properties, when such have not
already been described in the preceding lectures ; afterwards,
the various modes used to analyze Ifce blood.

If we take a portion of blood, and submit it to the action of a
water bath, and then to a higher temperature, in a chloride of
calcium bath, so as to drive off" all the water, we have left a dry
mass, which on incineration, leaves about four and a half per
cent, of ash, and the organic matter, according to Playfair and
Boeckmann, has a composition which corresponds to the for-
mula C4 8 H39 Ng Oj 5 a formula containing three atoms of
hydrogen and one atom of oxygen more than that given by
Liebig for the composition of protein; so that, from ultimate
analysis, we learn only that the organic portion of the blood is
closely allied to the protein class of compounds. By employing,
however, other modes of investigation, we shall be enabled to
subdivide this portion into many principles, each of which pos-
sesses properties peculiar to itself. We shall find in the blood,
in health, the following substances, some existing in large,
others in very minute proportion.

Constituents of Healthy Blood.
Water : Oxygen ^

Carbonic acid > dissolved in the fluid.
Nitrogen )

Fibrin : Globulin
Hsematine
Hsemaphasin (?)
Albumen : TSeroline

Cholesterine
7-, , Cerebrate
^^^^ i Phosphuretted oil

Margaric acid ^

^Oleic acid, &c.

1848.] Composition of the Animal Fluids, <^c. 723

{Phosphates of soda, hme, magnesia, and iron
Sulphate of potash,
(chlorides of sodium and potassium
Sihca, &c.

Undetermined matters, with traces of urea, uric acid, &c.

These different proximate constituents we shall describe
separately.

Fibrin. To obtain this substance from blood we should stir
that fluid, when first drawn, with a bunch of twigs or wires ;
by this means the fibrin is collected in the form of tough, elastic
fibrous threads which surround and adhere to the twigs or
wires. From these it can be easily removed without loss ; it
should then be washed in water, to separate any globules which
may adhere, and afterwards dried at a temperature a littb
.above 212^^ Fahr. The only precaution requisite in this opera-
tion is to stir the blood properly, not too quickly, or the fibrin
will be finely divided, and \v(ill not adhere; or too slowly, so as
to allow coagulation to commence, and partial clots to be for-
med. Another mode of obtaining the fibrin from blood, used
by Berzelius, is to take a portion of clot, and after having finely
divided it, and put it upon a filter, to submit it to the action of
cold water until it becomes colourless. The clot consists of
fibrin and globules; the latter, by the action of the water, are
dissolved, and pass through the filter, leaving the fibrin, which
may be detached from the paper and dried. Or we may allow
the blood to flow into a bottle, having within it some strips of
lead ; if it is then gently shaken, the fibrin is collected around
the lead and can be afterwards separated, washed and dried.

Before estimating the weight of the fibrin, it will be necessa-
ry to submit it to the action of boiling alcohol or ether ; to
remove the fat which always accompanies it, after it ceases to
yield anything to these menstrua, it should be again dried, and
then carefully weighed. Had you to estimate the amount of
fibrin contained in blood from the appearance of the clot, you
would, in all probability, form a very erroneous idea of the
quantity ; for in healthy blood the clot is very large, occupying
nearly the whole vessel a^d possessing considerable firmness,
this firmness being entirely due to the fibrin. After collecting
it, however, then purifying and weighinjr it, we find its actual
amount to be very small, 1000 parts of healthy human blood
containing only about 2.2 parts of fibrin. I have described in
a former lecture the properties of this body, and stated that it
was a protein principle, and might be distinguished from others
in the same class by its spontaneous coagukibility, and its
property when coagulated, of swelling up in acetic acid, and
decomposing the peroxide of hydrogen. It has been asserted

724 Composition of the Animal Fluids, ^c. [December,

by Denis, and the statement confirmed by Scherer and Nasse,
that the fibrin fi'om venous blood diflers irom arterial fibrin in
dissolving slov^Hy when heated in a solution of nitrate of potash ;
after exposure to air it loses this property, and fihrin from the
buffv coat dose not possess it. In disease, the amount of this
proximate element of the blood is subject to great alterations ;
sometimes we shall see that it becomes greatly increased, at
others, greatly diminished in quantity. In the first case it usual-
ly gives considerable firmness to the clot, and a buffy coat, or
upper stratum free from globules ; in the latter the blood pre-
sents a very loose clot, and an appearance to which the term
''dissolved state" is given. The size of the clot depends much
on the amount of red corpuscles present.

Red Corpuscles or Globules. to estimate this portion of the
blood is a subject of great dfficulty, and indeed, all the modes
at present employed are liable to considerahle objections. In
the blood of the frog, proteus, siren, and other lower animals,
their size is such as enables us to use a filter for the purpose of
separating them from the liquor sanguinis; but in man and
other mammalia this cannot be done without our previously
adding some other fluid to the blood ; we have therefore often
to estimate their amount by other means. Berzelius has shown,
that if we add sulphate of soda to freshly-drawn blood, coagula-
tion is prevented, and the globules, afer a time, subside, and
form a layer at the bottom of the vessel. After decanting the
supernatant fluid, these globules may be collected on a filter,
and used for examination; or we may use the clot, which has
been well dried with blotting-paper. This, however, contains
the fibrin also. If we act on the globules by means of alcohol,
acidulated with sulphuric acid, w^e separate them into two sub-
stances, one of which dissolves, and communicates a blood-red co-
lour to the alcohol ; the other, being insoluble, remains as a grey-
ish-white precipitate. The first is called haematosin or haematin ;
the latter, globulin, united in this case with sulphuric acid.

Hcpjnatosin or Hcematin, The acidulated alcohol has the
power of holding this substance in solution. To obtain it
pure we should add caustic ammonit to the alcoholic solution,
till it smells strongly of that body; then allaw it to stand for
some time, when the sulphate of amirionia which is thus formed
being insoluble in alcoliol, will be gradually deposited. The
fluid separated from the deposit is then allowed to evaporate,
when the ha^matosin is precipitated in the form of a brownish-
black powder. After being washed with water to dissolve any
trace of sulphate of ammonia, and then with hot alcohol, in
which it is insoluble, it may be considered pure, and possesses
the following properties : It is insoluble in water, either cold

1848.] Composition of the Animal Fluids^ 4^. 735

or hot ; also in ether, in acids or alkalies, or pure alcohol; but
it has the peculiarity of dissolving in the last-named menstruum,
either when acidulated with sulphuric acid, or when rendered
alkaline by means of ammonia-^a property which distin-
guishes it from other bodies. Formerly it was suppposed that
it assumed two physical conditions, the soluble and the coagulat-
ed form ; but this idea was owing to its not being separated
from other matters viz., albumen or globulin, to its association
with which the power of coagulation was due. The solution
of haematosin is of a dark-red colour, similar to that of venous
blood, which is retained even when exposed to the air, so that
it does not change colour in the same manner as the blood-
globules when so exposed. Pure haematosin has been examin-
ed and found to yield close approximations to the following per
centage of elements:

Carbon 65.84

Hydrogen ....... 5.37

Nitrogen 10.40

Oxygen .11.75

Iron 6.64

which corresponds to the formula C^^ H^o ^s^a ~l" ^^'
This was found to hold good when this matter was obtained
either from arterial or venous blood, or from that of different
animals. You will observe, on looking at the composition of
this substance, that it differs from all other organic bodies in
containing iron; this metal appears to be united directly with
the other elements that is, it is not in the state of oxide of iron
united to an orcjanic principle. The amount of this element is
stated by Mulder to be invariable ; others, probably from using
impure hsematin, have found slight differences. As iron is pe-
culiar to haematosin, it was naturally supposed that the colour
of this principle was due to its presence ; but such does not ap-
pear to be the case, as I shall now show ; for if we mix haematosin
with strong sulphuric acid, leave the mixture for some time,
and then add water, hydrogen gas will be given off, and the
solution will contain sulphate of iron. Afterwards, having well
washed the residue, if we treat it with alcohol acidulated with
sulphuric acid, we obtain a solution of a red coloring matter,
which, however, is entirely free from iron, and has a composi-
tion expressed by the formula C^^ H22 N3 Og that is, of
haematosin minus the atom of iron. If dried blood had been
used in place of the pure colouring matter, we |hould have ob-
tained in the acidulated alcoholic solution a compound of haema-
tosin free from iron, but united with sulpho-proteic acid and
water, represented by the formula Cg^ H5.^ Ng O^g S03=l
atom of haematia free from iron C^^ H33 N, Og-j-l atom of

726 Compositionof the Animal Fluids, ^c. [December,

sulpho-proteic acid C^ ^ H3 ^ N^ 0,2 SO3-I-4 atoms of water
H4 O4. We thus see that although iron is always present in
the colouring matter of blood, yet that the colouring evidently
is independent of the presence of that element. By using
chlorine instead of sulphuric acid we also separate the iron, but
at the same time the colour is destroyed, and a wMiite substance
remains, having a composition represented by C^^ H22 N3
Og-|-6 CI O3, or one atom of haematin free ifrom iron united
with six atoms of chlorous acid ; the iron is found in the solu-
tion in the state of a chloride of that metal.

If we burn pure haematin, it puffs up, gives off an animal
odour, and forms a carbonaceous mass, which afterwards is
consumed, and the iron left in the state of a peroxide of which
9.49 per cent, is obtained. Mulder supposes that the iron ex-
ists in haematin in a state very similar to that of sulphur in
cystine.

Globulin. Our knowledge of this substance is still very im-
perfect ; in many respects it resembles the other protein bodies,
but it has properties peculiar to itself. It is soluble in water,
coagulates when heated in the same way as albumen, but from
this substance it differs in being rendered insoluble by saline
solutions in which albumen dissolves. The compound which
globulin forms with sulphuric acid is soluble in boiling alcohol
of sp. gr. .935, whereas the sulphate of albumen is insoluble
in that menstruum. Simon considers globulin to be a modifi-
cation of casein ; in some respects it is like fibrin, for it swells
in acids, and afterwards dissolves in them. It is usually obtain-
ed of a greyish-white colour, and, on incineration, an ash is left
which is rich in peroxide of iron. To prepare it, we have only
to take the residue which is left, when strong alcohol, acidulated
with sulphuric acid, acts on the red coi-puscles. Mulder repre-
sented its composition by the formula 15Pr.-|-S.

We have now seen that the matter composing the red corpus-
cles can be separated into at least two portions, ha^matosin and
globulin, but Simon describes a third body which he has called
Hama])}iin ; it is associated with the ha^matosin, and can be
separated from it by warm alcohol, in which it is soluble, and
which it colours dark brown. This body has as yet been very
imperfectly investigated, and in the opinion of many, is only a
product of the decomposition of the red colouring matter ; the
ash which it leaves on incineration contains no iron.

We can obtoin the principal ingredients of the globules, or
the mixture 01 haMuatosin and globulin, by draining a clot of
blood, cut into thin slices, upon bibulous pa))er, for the purpose
of removing the scrum, and then treating tliis matter with cold
water; by this agent the ha?matin and globulin are dissolved,

1848.] Composition of the Animal Fluids J 4^c. 727

and the solution possesses a blood red colour. If evaporated at
a low temperature, under 122 F., it can be dried without losing
its solubility, but if the temperature is raised above 180 F.,
these substances are coagulated and precipitated together.
The solution of blood globules in many respects resembles in
its re-action that of albumen; probably in the corpuscles these
matters may be chemically united, and, if so, may be called
hsemato-globulin. The agents used in the analysis separating
it into the two we have just spoken of

To estimate the amount of these bodies separately or com-
bined, many methods have been employed. Berzelius takes the
clot from a weighed portion of blood, and dries it by placing it
in thin slices between weighed filters, absorbing the moisture
by means of bibulous paper above and below, which is frequent-
ly renewed ; after all sensible moisture is removed, the dried
substance and filters are to be further dried in vacuo over sul-
phuric acid, and then weighed. By deducting the weight of
the filters, and also of the fibrin which would be contained in
that amount of blood, and which must be separately determin-
ed, the amount of red corpuscles is ascertained ; or the dried
clot may afterwards be washed till colourless, and the weight
of the dried fibrin so obtained deducted.

Figuier finds the amount of the red corpuscles by mixing
blood which has been defibrinated by stirring with twice its
volume of a watery solution of sulphate of soda, of specific
gravity, 1.130, and throwing the whole on a weighed filter pre-
viously moistened with the same solution. The globules will
then remain, and may be first washed with a little of the solu-
tion, and afterwards the filter immersed in boiling water, which
coagulates the heemato-globulin, and dissolves out the sulphate
of soda ; the filter and globules must afterwards be perfectly
dried and weighed.

Andral and Gavarret determine the amount of globules by
taking the clot from a known quantity of blood, drying it per-
fectly, and finding how much it loses by evaporation. The
water thus lost is considered to be derived from serum remain-
ing in the clot, and the red globules are estimated by subtracting
from the dried clot the weight of the fibrin previously deter-
mined, and also a quantity equal to that which, united to the
amount of water given off, would constitute serum; this must
be separately determined, by evaporating to dryness a weighed
portion of that fluid.

Becquerel and Rodier estimate the red globules in a manner
very similar to the last ; they first find the per centage of solids
in the serum, which is easily affected by thoroughly drving a
weighed quantity. They then find the amount of solids in a

788 Composition of the Animal Fluids^ ^-c. [December,

portion of defibrinated blood, and consequently the amount of
water, which they assume, in the same way as Andral and
Gavarret, to exist in the form of serum, by subtracting the
amount of solids which, united to the water given off by the
defibrinated blood, would form serum, from the matter left on
evaporation of such blood, the amount of corpuscles is obtained.

I shall shortly give you some examples of this mode of deter-
mining the red corpuscles.

Simon estimates the amount of hasmatin and globulin sepa-
rately, by the methods I have shown for obtaining these sub-
stances, his process depending on the property possessed by
weak alcohol of dissolving globulin and haematin from albumen,
and of acidulated alcohol afterwards causing the separation of
the haematin. Of the advantages and disadvantages of these
different methods, and of the comparative results obtained from
them, 1 shall defer speaking till I describe to you the mode of
analyzing blood, for the pui'pose of estimating its most important
constituents for clinical purposes.

The amount of globules contained in healthy blood is stated
rather differently by different observers. Andral and Gavarret
consider that they constitute 126 parts in 1000 parts of blood;
Simon gives the amount of ha?matin and globulin at about 112
parts in the 1000 ; Becquerel and Rodier place them as high as
141 parts; Nasse, at 116; Lecanu, at 132 parts in the 1000.

The amount is very liable to become greatly altered in dis-
ease. The haematin contained in the globules is estimated by
Berzelius at 5.5 per cent. Simon also considers, that in health
the globules contain about five or six per cent. Most observers
do not separate the two principles in their analysis. All the
estimate of the red particles which have hitherto been made,
have as yet been defective. Andral and Gavarret, and Bec-
querel and Rodier, consider all the water in the blood to exist
as serum, which is certainly a gratuitous assumption, for as the
blood globules consist of cells whose walls have probably a
decomposing and separating power, there can be little doubt
that the contents of the interior are very diflerent from serum.
As yet this subject has not been studied, and the examination is
beset with difficulties ; still, it is probable that much light might
be thrown upon the action and use of the blood-corpuscles by a
close investigation. When the globules are estimated, by col-
lecting them on a filter, after the addition of a saline solution,
we are unable to say what change has taken j)lace in their com-
position; probably exosmosis has ensued, and a portion of the
solid contents of the cells has escaped.

Before completing the chemistry of the blood-corpuscle there
is one subject to which I must advert the difference of colour

1848.] Compositionof the Animal Fluids, ^c. 729

which the blood exhibits in different vessels, and the change
which venous blood undergoes when exposed to air, or to
certain re-agents. It has been usually considered that the
colouring matter contained in venous and arterial blood
differed in its nature ; that in arterial blood has. been suppos-
ed to contain more oxygen, that in venous blood an excess
of carbon, in its composition. These suppositions arose from
several circumstances ; venous blood becoming bright-red
when mixed with oxygen; when this takes place in its passage
through the lungs, oxygen is absorbed and carbonic acid given
off. But it can be shown that neither is oxygen .essential for
the production of the bright-red colour, nor is carbonic acid
required to darken it; for when we add a solution of a neutral
salt, as of sulphate of soda, nitrate of potash, (kc, to dark venous
blood, the colour is immediately changed to a bright-red, in the
same manner as when exposed to the influence of oxygen.
Again, when bright-red blood is diluted with about twice its
bulk of water, it becomes dark-red, and when so darkened the
action of oxygen is no longer capable of brightening it, but the
addition of some milk, finely-divided gypsum, or other substan-
ces which reflect white light, will again cause the colour to be-
come bright-red.

Liebig, who entertains the first view, considers that in the
colouring matter of venous blood the iron exists in the state of
carbonate of the peroxide: but in that of arterial blood as a
peroxide. He thinks also that by this means the oxygen is ab-
sorbed in the lungs, and afterwards given out in the course of
the circulation ; if such were the case, we should be able to
abstract the iron from the haematosin by means of dilute acids.
Liebig states that weak acids do remove. iron from blood ; but
Mulder denies that they do so from haematosin, which, after
being so treated, still yields 9.49 per cent, of oxide of iron, the
amount contained in the colouring matter before being acted
upon. He allows that iron can be so obtained from dried blood,
but considers that it exists in other parts of the fluids besides
the globules, and that in an oxidized state, v/hich would enable
it to be thus dissolved. When pure serum is burnt, iron can
be discovered in the ash.

IVHilder considers that the different colour of the two kinds
of blood is due to a mechanical, rather than a chemical cause.
I have stated that in the human subject the form of the red
corpuscle is similar to a piece of coin, but slightly depressed in
the centre ; or that it is a bi-concave disc. Now, in dark blood,
Mulder thinks they become less depressed, or even bi-convex ;
and when in such a state, do not reflect so powerfully, and
hence the colour is darker ; the addition o{ a dense solution

730 Subacute and Chronic Rheumatism. [December,

brightens the blood, by causing exosmosis from the globule, and
the resumption of the bi-concave form. Water acts in the op-
posite manner, by first distending and afterwards destroying the
corpuscles; and hence the bright colour can no longer be re-
stored but by the addition of some bright reflecting surfaces, as
those contained in milk, gypsum, &c. Carbonic acid, passed
through bright blood, is said to change the form of the globules,
and make them bi-convex.

Portions of clot also undergo changes in colour when sub-
jected to various influences. Treated with solution of sulphates
of soda or potash, iodide of potassium or chloride of sodium,
they become brightened ; but \vhen subjected to the action of a
solution of potash, soda, ammonia, lime, baryta, &c., or to an
acid, as carbonic, oxalic, sulphuric, phosphoric, hydrochloric,
acetic, &c., they again darken, these changes appearing to
depend on the mechanical alteration produced by such re-
agents, altering the reflective power of the red particles.

To explain the action which Mulder supposes oxygen pos-
sesses in inducing this change, it is necessary to remember what
I stated in a former lecture with regard to the efl^ect of oxygen
on the albuminous compounds. I then told you that oxygenized
protein bodies could be produced, called the bin arid ter-oxides
of protein. Now, Mulder thinks that the action of oxygen on
the blood disc (a protein body) is to convert its surface into
Jhin bin-oxide ; and that the thin layer thus deposited is the
cause of the white reflection which gives the bright colour to
arterial blood; but that during the passage through the capilla-
ry sy.stem this is consumed, and the globule then retains only
its thin, transparent envelope. Bin-oxide of protein also pos-
sesses a contractile power, which would give a tendency to the
discs to become more bi-concave. This is seen in the cupped
surface of inflamed blood where this oxide exists in large quan-
tities.

On Suhacute and Chronic Rheumatism. By Dr. S. Wright,
of Birmingham. (Med. Times, from Braithwaite's Ret.)

[Subacute, which is the variety of rheumatism most ,com-
monly met with in practice, is not necessarily a sequela of the
acute form. Dr. Wright observes that]

Acute rheumatism, perse, is not a dangerous affection, except
in so far as heroic treatment and metastasis may make it so.
The former I advise you to guard against; the latter always to
be prepared for. Avoid doing too much, whilst the ailment
confines itself to superficial parts ; do enough, and do not delay
it, when secondary inflammation seizes any de^^p seated organ.

1848,] Subacute and Ch7'onic Rheumatism. 731

But as I have said, there is no dan2:er so long as the limbs only
areaflected; the ailment may be tedious and painful, but it will
be little else ; good management w ill lessen both the duration
and the degree of the attack.

In the majority of cases acute rheumatism wears itself out,
so to speak. In ninety-nine of every hundred cases of subacute
rheumatism that you meet with you will find that the ailment
exists pe?' se, and has not had acute rheumatism for its precursor.
Subacute rheun^atism chiefly seizes upon muscular parts, such
as the shoulder, loins, and liips ; or parts wftll supplied with
ligaments, as the knee, ankle, and wrist. It is more liable than
acute rheumatism to atfect muscles solely ; and is less liable
than this to metastasis to internal organs. In its transference
from superficial to deep-seated parts, it rarely shows an increase
of activity, at least of an inflammatory nature.

Subacute rheumatism is not a sequela of the acute form, as
I have 'said; it differs from this in the absence, or the great
mildness, of the sympathetic fever, and in the local aflfection not
furnisWng distinctive evidences of inflammation. The parts
are swollen, stifle, and painiul, but they are not redder than na-
tural ; there is rarely an increase, and often a diminution of
heat. This, in an artificial form, generally increases the pain,
and hence the ailment has sometimes been denominated " cold
rheumatism," to distinguish it from the other, which was called
'*hot."

In subacute rheumatism there is more or less acidification,
but not to the extent observable in the acute variety ; but the
gastric and hepatic disorder is often much more manifest in the
former than in the latter: this, again, is seldom, the other often,
hereditary; this never becomes chronic, and generally leaves
the patient as he gets older ; the other is always prone to recur-
rence, to ehronicity, and to aggravation in old age. There is
an obvious patliological relation between acute and subacute
rheumatism ; but still there are items which point out their dis-
tinctness, the chief of which is, that they do not run into one
another. The treatment of subacute rheumatism is not a mat-
ter of difficulty, except in so far as the task is often a tedious
one. The indications to be fulfiled are both general and local.
The former chiefly consist in improving the alimentary func-
tion, correcting the secretions, and imparting tone to the system ;
the latter in soothing or strengthening, as the ca,se may be, the
suffering parts. Let me recal to you some of the examples you
have seen.

Mary Ann Hackett, aged fifty-six, was admitted into the hos-
pital on the 5th of November last. She was the subject of
. rheumatism in a subacute and severe form, which was of about

32 Subacute and Chronic Rheumatism. [December,

five weeks' duration. She had often suffered from it before.
The affected parts were chiefly the shoulders, back, and knees.
Her tongue was coated with a yellowisli-white fur ; appetite
bad; bowels costive; urine scanty, and depositing a copious
red sedifiient ; saliva acid. She was ordered to put her feet,
every night, into hot soda and water, and to take the following :

^. Inf. gentianae comp., 5 viij.; soda? bicarb., potassae bicarb.,
aa. 9ij. ; sp. eth. nit., 3iij. Misce fiat mist, cujus cap. coch.
magna duo terdie. Cap. omni nocte. pil. rhei c. gr. v.

Under this iovm of treatment she immediately began to im-
prove, and continued to do so, without one untoward symptom,
until she was quite well. In this state she left the hospital in
nine days after her admission.

[Another woman with lumbago was ordered the same medi-
cine, with the substitution of calumba for gentian on account of
irritability of the stomach, and the addition of a compound soap
pill every night; and the soda fomentations were applied to the
back. She spsedily recovered. Again, a man with subacute
rheumatism in his knees of two months' standing, lithic acid
urine, and acid saliva and perspiration, was ordered to have an
alkaline bath at bed time, and,the following medicine :]

^. Inf. buchu, 5 viij. ; liq. potassae, 3ij. ; tinct. hyoscyami,
3ij. M. ft. mist, cujus capiat, coch. ampla duo ter indies. Cap.
pil. rhei c. gr. v. omni nocte, hora somni.

With this treatment, he steadily improved until the 27th, when
we found that he was suffering from synovitis in the left knee.
In every other resyjcct he w^as much better. I had not seen
him the day previously, but learned that, on the night preceding
this, his knee had become uncovered whilst he was asleep, and
exposed to a draught from a window near which he lay. The
knee was largely swollen, immovable, and very painful, and
there were evidences of fluid in the joint. A blister, six inches
by five, vi^as ordered to be applied to the knee; the mixture to
be continued; and the following pills were substituted for the
compound rhubarb :

J^. Pil. coloc. c, pil. sapon. c. opio, aa. 3ss. ; pil. hydrarg.,
gr. X. Misce in massam, dividendam in pilusas xij. quarum
capiat ij. on)ni nocte.

[The synovitis was not subdued for a fortnight ; and then for
the swelling, tension, and weakness that remained the following
medicines were prescribed :]

^. Inf. buchu., 5 viij.; liq. potassa?, 3j.; hydriod. potossae,
3ss.; sp. eth. nit., 3iij. M. ft. mist. cap. coch. ampla duo ter die.

I^. Pil. rhei. c, 9ij. ; tinct. hyoscy., 9j. Misce et divide in
pil. xij. quarum cap. ij. omni nocte.

The kuee was ordered to be well rubbed night and morning,
with this liniment :

1848.] Subacute and Chronic Rheumatism. 733

IJ^. Liniment, sapon. connp., !ij.; tinct. lyttae, tinct. opii.
aa. 5ss. ; potassae hydroid., 3jss.

[Under this treatment he speedily got well. "Chronic rheu-
matism is nothing more than a persistent form of subacute,"
showing little tendency to a crisis, and rarely altogether disap-
pearing. The vitality of the affected parts becomes diminished ;
they are thicker, colder, and less moveable than natural. The
most intractable kind of chronic rheumatism is met with in
those who have the rheumatic diathesis, or who are scrofulous
or cachectic ; those who have been much exposed to cold and
privation, or have suffered from extensive bleeding and mercu-
rialization.]

' The treatment of chronic rheumatism is both local and gen-
eral, and mainly consists in imparting tone and energy to the
system and the suffering parts; correcting any undue acidity;
mitigating pain by narcotic remedies ; and effecting the absorp-
tion of any materials that may be foreign to the joints, or unfa-
vorable to their motion.

[As an illustration of the treatment of chronic rheumatism,
Dr. Wright relates the case of a man named Edward Neile,
thirty-one years of age.]

He had served for nine years as a private in the Dragoon
Guards. He had enjoyed good health up to thirteen months
prior to the date of his admission, when he was. thrown by a
young restive horse, and his back considerably bruised by the
fall. This happened at Exeter, and in the regimental hospital
of that place his injury was treated and considerably relieved.
When convalescent, he caught a violent cold, and the pain in
his back returned with great severity, additionally to which he
had severe pains in his shoulders, hips, and knees. He was
again treated in the hospital during the period of four months,
but with little benefit. His joints, he informed me, were large-
ly swollen, hot, and excessively painful, and the pain in his
back was so severe that he could not support himselfin the up-
right position. At the end of four months, the regiment came
to Birmingham, and he was in the barrack hospital here, under
a fresh surgeon, for upwards of three months, but \Vith little or
*no improvement. Subsequently the regiment went to Chat-
ham, and he was three months in the general hospital there ;
but, making no progress, he was dismissed as incurable, and on
leaving the regiment, came to Birmingham to see some friends.
When he had been here about two months, he was persuaded
to come into Queen's Hospital.

When we first saw him, he had a very sunken, careworn
look. His appearance was that of a man almost double his age.
Face thin and sallow ; limbs considerably wasted, except the

734 Subacute and Chronic Rheumatism. [December,

elbow and knee-joints, which were larger than natural, and
somewhat tender on pressure. His legs he could not straight-
en, and said that he had not done so for more than a year ;
neither could he straighten his back, and the effort of attempt-
ing this caused him so much pain that the sweat actually ran
down his face. The poor fellow, in fact, was seemingly crip-
pled; he walked with the greatest difficulty, and could not
conveniently hobble more than a dozen paces at a time. His
pains during the night were so severe that he disturbed the
other patients with his groans; and the nurse told us that he
often cried bitterl}^ when these pains were upon him. His
tongue was pale and turred ; appetite very bad; saliva acid;
urine depositing a copious red sediment : bowels costive. He
was ordered an alkaline bath at bedtime, to be repeated every
third night, and the following medicines:

l^. Infusi diosmse crcnatce, .^ viij.: liq. potassae, j.; hydriod.
potassae, 3ss.; tinct. hyoscy., 3ij. M. IL mist, cujus cap. coch.
larg. duo ter die.

IJ^. Pil. coloc. c, pil. sapon. c, opio, aa. 3ss. misceet divide
in xij. quarum cap. ij. omni nocte.

In two or three days from the date of this treatment he began
to feel better and walk better. He expressed a hope that his
leading wish would be gratified to be reinstated in the army.
In a week his improvement was so decided that 1 felt inclined
to change the opinion I had at first formed, that at best his treat-
ment could be only palliative. When a fortnight had elapsed,
we found him going through the different processes of drill,
much to the amusement of the other patients. He then told
us that, with the exception of pain in his hack, he felt as well
as he had ever done in his life. He could straighten his knees
and walk well ; his appetite and general health were much bet-
ter ; he had scarcely any pains by night or day ; his knees and
elbows were less swollen ; tongue clean ; urine natural ; bowels
open. He was ordered to continue his medicine, to discontinue
his baths, and to have applied to his loins an opium plaster,
twelve inches by eight.

This was all the treatment the man had, until he had been in
the hospital five weeks, when he caught cold one day, and had
a slight attack of diarrhoea, but he had no return of his rheuma-
tism. He used to show us his muscular capabilities, in testi-
mony, not only of his improvement, but of his fitness to return
to his ambitious position in the dragoons. He was in the hos-
pital two months, and left it, to all intents and purposes, well.
As T have before said, this was one of the worst cases of the
kind I ever met with ; and certainly its recovery suprised me,
as it did the poor fellow' who had often been told that he would

1848.] Aural Surgery. 735

never regain the use of his Hmbs. The alkaline baths did him
much service ; but I am inclined to attach the chief importance
to the hydriodate of potass*; this is of vast service in cases of
this kind, and the more especially if you combine it with liquor
potassce. You may make any tonic infusion the vehicle, but
I have a liking for buchu (perhaps because I am accustomed
to it), for in addition to tonic properties, it also possesses those
of a diuretic and diaphoretic.

In all these cases I advise you to push the alkaline treatment,
both locally and' generally : the hydriodate of potass is of vast
service ; buchu is a good vehicle, but you may give any other
if you like; with old people cascarilla or cusparia is excellent
and the addition of ammonia is often valuable. Tincture of
Iodine to the joints, or hydriodate of potass ointment, compos-
ed of a drachm of the salt to an ounce of cerate, is a good
remedy, when there is enlargment of the proper structure, or
nodosity. Alkaline fomentations generally do great good; and
an opium plaster, where applicable, or tincture of aconite, is
valuable in subduing pain. In old people, remember, your plan
must be chiefly sustaining and palliative.

Aural Surgery. By Henry Axcell, Esq., M. R. C. S.
(Ranking's Abstract.)

In the" Archives Generales,'"' an account is given of some
important statistical researches of diseases of the ear by Dr.
Kramer of Berlin, the materials having been drawn from the
most attentive examination of 2000 cases. The results are
recorded in a journal, which comprises the name, age, and place
of residence of the patient, the date of the attack, the causes of
the disease, the existence or absence of tinnitus aurium, and
other symptoms, the auditory power of each ear, the treatment
pursued by the patient before applying, and that prescribed by
the author, the duration of the disease, audits consequences.
The results are arranged in 19 tables, and the 2000 cases con-
sist of the following :

Diseases of the auricle 5 or ^i^

" external auditory canal . . . 281 or -i

membrane of the tympanum . . 442 or \\

li

middle ear 198 or J^

Nervous Deafness 1028 or i

Dumb Deafness 46 or jV

2000

786 Aural Surgery, [December,

1st. Diseases of the Auricle.

Hypertrophy and induration 8

Erysipelas . . 1

Abscess , 1

5

2d. Diseases of the External Auditory Canal.

Accumulations of wax from erythematous inflammation of

the lining mpmbrane 213

Catarrhal inflammation 51

Phlegmonous inflammation 9

Periostitis with caries 8

281

3d. Diseases of the Memhrane of the Tympanum,

Acute inflammation , . 45

Chronic inflammation . 397

442
4th. Diseases of the Middle Ear.

Catarrhal inflammation of the mucous membrane with ac-
cumulation of mucus . . 164

Inflammation, with contraction of the Eustachian tube 28

Obliterationof the Eustachian tube 2

Inflammation, with abscess ofthe cavity of the tympanum 4

198

The catarrhal, phlefrmonous, and periosteal inflammations of
the auditorv canal were attended with runnincj from the ear,
but these constituted only one-seventh of the cases ofrunnmg.
Of 510 cases of discharire, aboat six-sevenths depended upon
inflammation of the membrane of the tympanum. Nearly
one-fourth of all the cases of deafness met with are caused by
inflammation ofthe membrane ofthe tymj)anum, or its conse-
quences, and in general the auditory canal does not participate
in this inflammation. The great frequency of catarrhal in-
flammation of the middle ear depends upon its proximity to
the nasal fossae and throat, v^^hich are so frequently the seat of
catarrhal inflammation; for instance, a slight deafness is fre-
quently observed in an ordinary coryza, which usually disap-
pears with the catarrh, and is then most probably dependent
upon the orffice ofthe Eustachian tube being afl^ected, and
rarely the cavity ofthe tympanum.

When one ear is afliected with a discharge, the practitioner
should never fail to examine with attention the auditory power
and the organic condition of both ears, for a discharge may be
too thick or in too sm'all a quantity to make its way externally^

1848.] Aural Surgery. 737

and the patient's statement should never be trusted, for he fre-
quently believes that the hearing is perfectly good, when on
investigation it is found to be only a little less imperfect on one
side than on the other. Of the 2000 cases, 103D were cases
affecting both ears, and 361 only single affections. Dr. Kramer
observed, in all the cases of phlegmonous inflammation of the
meatus externus, one side only was affected, and that catarrhal
and periosteal inflammation was much more frequently single
than double. Ofthe cases of nervous deafness, 984 were double,
and 44 single, or twenty-two to one.

Acute inflammation of the membrane of the tympanum rarely
passes into a chronic state, as may be inferred from the extreme
relative frequency of the latter. Mr. Wilde, of Dublin, who has
paid great attention to the subject, states, on the contrary, that the
appearances of chronic inflammation of the drum are to be found
as the sequeloG of all the other forms of inflammation, just as
chronic succeeds to acute ophthalmia. As respects the com-
plications of diseases of the ears in the same individual. Dr.
Kramer found 38 cases only, where, one ear being affected,
there was moreMhan one disease, and 6% cases where both ears
being affected, there was more than one disease. The most
remarkable complications were, 1. Accumulation of Wax in
the auditory canal on one side, and nervous deafness on the
other (5 cases). 2. Chronic inflammation of the membrane of
the tympanum on one side, and accumulation of mucus in the
middle ear (10 cases) ; or nervous deafness (18 cases) in the
other. Also, united in the same ear, 1. Accumulation of w^ax
in the auditory canal, and of mucus in the middle ear. 2. Ac-
cumulation of wax, with nervous deafness. In general, how-
ever, in nervous deafness, the secretion of wax, as well as the
mucous secretion of the middle ear, are decidedly diminished.
3. Catarrhal inflammation of the auditory canal, and a certain
degree of inflammation of the membrana tympani, without any
tendency in this inflammation to terminate in suppuration, ulcer-
ation, or any other change of texture.

In 305 cases of chronic inflammation of the membrane of the
tympanum, with perforation, internal otitis occurred only six
times; when perforation did not occur, an accumulation of
mucus in the internal ear never presented itself In this inflam-
mation the reappearance of wax should be considered a good
sign, as it indicates the cessation of the chronic inSammation.

Inflammation of the mucous membrane of the tympanum
neither extends to the tympanum itself nor to the labyrinth ;
as soon as the mucous is evacuated the hearing is restored. Dr.
Kramer was certain that in 164 cases of this nature the mem-
brana tympani remained perfectly healthy.

47

"788 Aural Surgery. ' [December,

For the purpose of diagnosis in diseases of the external
auditory canal and of the membrana tympani, it is necessary to
employ the speculum auris. Two thirds of the diseases of the
ears have their seat beyond the field of observ^ation, and in those
of the middle or internal ear, catheterism of the Eustachian
tube is of the greatest moment ; it is here that the tactus eru-
ditus and a fine sense of hearing constitutes the superiority of
the experienced practitioner. By the ear especially he may
appreciate the nature of the brmit which the air produces in
penetrating into the cavity of the tympanum. The ear cannot
furnish indications so certainly as the sight, but this is no
reason for rejecting its assistance, and Dr. Kramer concludes
that it is impossible to treat these affections properly without
the aid both of the speculum and of the catheter ; catheterism
being performed in various ways.

Dr. Kramer considers the ticking of a watch the best term
of comparison of the power of hearing in different diseases of
the ear. A good ear will perceive this at a distance of 30 feet.
Individuals who do not hear a- watch tick when applied directly
to the ear, cannot hear what a person sa)4> when speaking
loudly and very close to the ear. The sense of hearing is a
little better when the watch is heard by direct contact ; but it
is only when the' patient can hear the tick at a distance of
several inches, and especially several feet, that he can follow
up a conversation. It is worthy of remark, that the suscepti-
bility in the ear to perceive the human voice is not always in
relation with the susceptability to perceive the tick of a w^atch ;
it may be more or less susceptible as respects the one or other
of these sounds.

The general result of an examination of the power of hearing
in 3639 cases of diseased ears is, that in all diseases of the ex-
ternal auditory canal, of the membrane of the tympanum, and
of the middle and external ear, deafness may proceed to a great
extent ; but it is especialy in affections of the internal ear that
it is most frequent and most complete.

In chronic inflammation of the ji:icmbrana tympani, the gen-
eral limit of the auditory power is from one to three feet (one
foot in half the cases and three feet in one-si^th of the cases).
With organic alteration's of the membrane, to all appearance
analogous, the deafness may vary to a very great extent ; and
reciprocally,*vith great differences in the state of the membrane
we may find divers degrees of deafness. This kind of con-
trariety is very frer[uent where a perforation of the tympanum
exists, and is explained by the impracticability of recognising
the changes, independent of the perforation, which may have
been produced in the parts inclosed in the cavity of the tym-
panum. .

1848.] Aural Surgenj. 739

Whenever in this case the patient cannot hear the watch, or
hear^ it only at a very short distance, there is but Httle hope
of re-establishing the hearing, although the inflammation be
suspended; the prognostic is a little more favourable when the
auditory power extends to several inches.

When the membrane was perforated in this affection, which
occurred in 217 patients and in 305 ears, deafness was com-
plete in 50 cases, the power of hearing extended to one inch in
80, to one foot in 113, to three feet in 50, more than three in 9,
and to a considerable distance in 3. In 180 patients and 359
ears, where perforation had not taken place, deafness was com-
plete in 42 cases ; hearing extended to an inch in 88, to one foot
in 148, to three feet in 51, to more than three feet in 19, and in-
determinate in 11. Complete deafness was proportionally more
frequent as the perforation was oi small dimensions, but hearing
was much more frequently preserved intact when there was
no perforation, so that little advantage could result from per-
forating the membrane of the tympanum. If, however, it should
be deemed expedient in any cases to resort to this operation,
the opening should be made rather large, since the hearing
suffers much less, from a large than from a small opening; but
it is important to remark that if very large (the size of a lentil),
the auditory power which remains does not extend so far as
where the opening is smaller. The hearing was not complete-
ly preserved in any case of perforation, although in the most
favourable cases, the patient could sustain a conversation with
ease, so that a superficial observer might imagine that a partial
des#uction of the membrane is consistent with perfection of
hearing.

In 676 ears affected with chronic inflammation of the tym-
panum, scarcely one in three was so afiected independent of
polypus or perforation : in more than two-thirds, the membrane
was perforated or covered with polypous vegetation ; the two
affections being united in 37 cases. Six-sevenths of the dis-
charges from the ears depended upon chronic inflammation,
with perforation or polypi. .

Tinnitus aurium existed in 117 out of 305 cases of perfora-
tion. In the 2000 cases it was observable in 1267 ; there was no
trace of it in the deaf and dumb. In accumulation of wax in
the meatus, acute inflammation of the membrane of the tym-
panum, and nervous deafpess, it existed in three out of four
cases ; in catarrhal inflammation of the meatus, in phlegmonous*
inflammation of the same, internal otitis, and accumulation of
mucus in the tympanum, it was as frequently absent as pre-
sent ; in chronic inflammation of the membrane of the tympan-
um,'it w^as absent in two cases out of three.

740 Au?'al Surgery. [December,

Kramer's researches have led him to the conclusion, that
tinnitus aurium is valueless as a symptom, it is rarely met with
without some affection of the auditory power; but all its varie-
ties accompany indiscriminately all the diseases of the ear, and
every variety of disease may run through its whole course
without presenting a trace of it, and without any obvious rea-
son for its presence or its absence. Mr. Wilde, however,
thinks it more than probable that a knowledge of the peculiari-
ties of this symptom may yet be found to assist in the diagnosis
of particular forms of deafness.

Of all the diseases of the ear, according to Kramer, three only
can be regarded as having an acute character, viz. erysipelas
of the auricle, acute inflammation of the membrane of the tym-
panum, and phlegmonous inflammation of the lining membrane
of the auditory canal.

Caries of the auditory canal occurs before ten years of age,
and is generally dependent upon the scrofulous diathesis; acute
inflammation of the membrane of the tympanum occurs from
20 to 40 years of age, and is independent of diathesis ; and
chronic inflammation of the same membrane is always connect-
ed with the scrofulous diathesis; two-thirds of the cases occur-
red between the ages of one and ten years, and chiefly during
the first two years, as a sequel to exanthema, and were chronic
from the beginning.

Nervous deafness generally comes on very insidiously, being
most frequently developed from 20 to 30 years of age, after the
application of cold, or moral aflections. It rarely occurs before
10 or after 60 years of age. It first affects one ear and ni^kes
slow progress, not attacking the other until the lapse of a con-
siderable period.

Among the 2000 patients treated by Kramer, more than four-
fifths had always enjoyed good health, the disease being purely
local, and local treatment alone was employed. In the remain-
ing fifth there were complications, the most frequent being
general nervous debility, coinciding almost exclusively with
nervous deafness, and never with inflammation of tlie mucous
membrane of the middle ear.

Inflammation of the mucous membrane of the tympanum is
frequently connected with scrofula and catarrh ; the catarrhal
affection may exist with nervous deafness, but this is rare.

Nothing is more diflicult than to determine the causes of dis-
eases of the ear ; their origin is frequently unperceived, since
there is rarely pain and deafness ; a running or tinnitus aurium
alone excites attention, although the affection may have com-
menced long previously. Of the 2000 cases, in 1109 the causes
were totally unknown. Cold appeared to be the most common

1848.] Aural Surgery. 741

cause of acute inflammation of the membrane of the tympan-
um, and of phlegmonous inflammation of the external auditory
canal ; also a common cause of that inflammation which produces
an accumulation of mucus in the middle ear and of the erythe-
matous inflammation, which occasions an accumulation of wax
in the meatus, and of inflammation of the glands of this latter
canal. Nervous dealness and chronic inflammation of the mem-
brane of the tympanum also frequently have their origin in
cold.

Exanthems, especially scarlet fever, and other diseases of the
skin, frequently occasion chronic inflammation of the mem-
brane of the tympanum. Nervous and gastric fevers frequent-
ly occasion the same disease, and also nervous deafness ; in
two cases, gastric fever produced accumulation of mucus in the
middle ear. Blows on the ear produced, in 3 cases, glandular
inflammation of the canal; in 12, chronic inflammation of the
membrane of the tympanum ; and in 24, nervous deafness.
This deafness may occur instantaneously in consequence of a
physicial lesion of the head or spine. Nervous deafness is
frequently a consequence of violent chagrin, intense toothache,
abundant hemorrhage, or the concussion caused by a very
violent noise ; it also appears to occur, under some hereditary
influence, in one case in six.

Small-pox is the disease which destroys, most frequently,
and to the greatest extent, the membrane of tbe tympanum,
from chronic inflammation, but confined to one side ; measles
more frequently leads to perforation on both sides, and scar-
latina and cold, although still very powerful causes, have less
disastrous results.

Relative to curability, Kramer arranges diseases of the ear
into four groups 1st, diseases certainly curable; 2d, diseases
in which a cure is probable ; 3d, diseases susceptible of ameli-
oration only ; 4th, incurable diseases.

1st. Among diseases certainly curable, whatever be their
duration, degree, and the negligence with which they may have
been treated, are placed erysipelas of the auricle, furuncles, ac-
cumulations of wax, catarrhal and phlegmonous inflammation
of the auditory canal, acute inflammations of the membrane of
the tympanum, and catarrh, w'ith accumulation of mucus in the
middle ear. The tegumentous erysipelas of the membrane,
which leads to accumulation of wax and of epidermic layers,
readily subsides, and when the passage is cleared of the foreign
bodies, the patient is immediately relieved. Catarrh and in-
flammation of the skin and glands give w^ay to saturnine injec-
tions, revulsives, and purgatives. When complicated with
dartrous and scrofulous affections, general treatment is requir-

742 Aural Surgery. [December,

ed, and months may be necessary to effect a cure. Phlegmon-
ous inflammation, if not arrested with leeches, passes rapidly to '
suppuration ; as soon as the abscess is opened, all the symptoms
disappear, although the swelling may remain for some time,
and occasion inconvenience. Acute inflammation of the mem-
brane of the tympanum generally subsidcvS in a few days, by
leeching, revulsives, and injections. Inflammation of the middle
ear, with accumulation of mucus, terminates in a cure by aid of
those measures intended to expel the mucus and restore the
membrane to its healthy secretijig power, particularly by the
use of the catheter and the air douche. In recent cases it is
sufficient to blow through the catheter; when, however, the
mucus has become viscid, only a temporary relief is obtained
by this means. Dr. Kramer then employs the air douche, and
he remarks, that the cold air gives tone to the membrane ; the
local means, when there is a particular diathesis, and in parti-
cular scrofula, general treatment and an appropriate regimen
must be added.

2d. Among the diseases, the cure of which is probable, are
arranged- eczema of the auricle, periostitis with caries of the
external auditory canal, chronic inflammation of the membrane
of the tympanum, retraction of the Eustachian tube, nervous
deafness. The chronic inflammation of the membrane of the
the tympanum is frequently connected with a general dyscrasy,
and the chances of cure depend upon our power of action upon
the constitution, and upon the extent of organic mischief to the
membrane. The membrane being considerably thickened, oi*
perforated to a considei;able extent, cannot be restored to its
normal structure. Polypous vegetation may, in general, be re-
moved, unless large, flat, and sessile ; but since the membrane
is at the same time hypertrophied and perforated, their removal
can have but little effect. Dr. Kramer adds, if we consider
that in half the cases of chronic inflammation this membrane is
perforated, and in a cjuarter of the cases there are polypous ex-
crescences, we may regard as successful treatment the cure of
yVth of the cases ; and the amelioration, more or less, of |{ths,
that is to say, by lessening the suppuration and improving the
hearing; in y\ths there being no improvement.

Contraction of the Eustachian tube presents fewer chances
of successful treatment than chronic inflammation of the mem-
brane of the tympanum ; in both cases the want of success
arises chiefly from the prominency of the organic changes.
Similar causes oppose the cure of nervous deafness, whenever
the vitality of the quditory nerves has greatly suffered. In
fact, these nerves have not only a dimmished susceptibility to
sonorous impressions, but also a morbid susceptibility to im-

1848.] Foreign Bodies in the Rectum. 7^3

pressions of all kinds, which augments with the progress of the
disease ; hence- the difficulty, and even the impossibility, of
findmg appropriate remedies, capable of acting upon the audi-
tory nerves without injuring them. In 271 cases the patients
could not tolerate any treatment, although they appeared to be
in the most favourable state, as respects age and the degree of
deafness. In 703 cases, hearing was improved, or the tinnitus
aurium was diminished or suspended, in various degrees, by
treatment. In 54 cases -only, a complete cure was obtained.
In the treatment. Dr. Kramer always has recourse to stimula-
ting vapours, especially of distilled water, assafoetida, musk, and
bitter almonds ; he rarely employs any general treatment, and
he has remarked that it rarely happens that any improvement
is produced in nervous deafness by general remedies, although
they may sometimes be useful before having recourse to local
treatment, in order to re-establish the general health, if deteri-
orated. *

3d. Among the diseases susceptible of amelioration only, the
author places internal otitis, a disease the resolution of which
may occur in rare cases, but which, in most cases, entails, inde-
pendent of the desfruction of the organ, real danger to life.

4th. The incurable diseases are only the obliteration of the
Eustachian tube and deaf-dumbness.

Finally, Dr. Kramer is satisfied that an electro-magnetic cur-
rent is a powerful stimulant of the organs of hearing, principally
when directed from the inferior orifice of the Eustachian tube,
towards the external auditory canal of the same side. This
stimulant action manifests itself by. convulsive titillation, and
pains in the ear, with a temporary augmentation of the power
of hearing, which is generally not of long duration ; and also by
the augmentation, at the time, or shortly after the operation, of
the tinnitus aurium. It requires great prudence in, its employ-
ment, and must be abandoned if the tinnitus aurium increases
in a marked degree, without a favourable change in the power
of hearing. Electro-magnetism is useful to verify the existence
of nervous deafness.

Foreign Bodies in the Rectum. By T. M. Harris, M. D., of
Harrisville, Va. (Western Jcurn. of Medicine.)

The novel and remarkable character of the following case
constitutes my apology for communicating it to the profession.

On the 19th of May, 1846, 1 was summoned to attend a young
Dutchman in this neighborhood, and received the following
history of his case:

744 Foreign Bodies in the Rectum. [December,

He had been suffering from an attack of piles, and having
been informed that the disease could be cured by introducing '
the neck of a well-greased bottle containing some hot spirits of
turpentine, he undertook to prove the remedy. But unfortu-
nately, using nothing larger tlian a half-pint flask, and having,
as I suppose, a more than ordinary capacious outlet to the ali-
mentary canal, the flask slipped in, and the" sphincter closed
upon it.

Here is a dilemma -a man with a half-pint flask in his rec-
tum seeks relief ; and what is to be done? Notwithstanding
the case borders a little upon the ludicrous, it became, to me, a
subject of most serious and anxious concern. At length, how-
ever, I resolved upon a plan, and accordingly went to a blackr
smith and had a pair of forceps made somewhat after the fiishion
of the obstetrical instrument, with blades about seven inches
long, by about three fourths of an inch wide, and handles eight
or ten inches long. These being prepared, and the blades well
greased, I introduced a blade at a time so as to enclose the bot-
tle, locked the instrument, and commenced my efforts at extrac-
tion. But the blunt end, or bottom of the bottle, presenting, I
soon satisfied myself that it would be no'easy task to effect its
removal. At length, by the force of my eflTorts, I smashed the
flask in fragments. Having no further use for my forceps, I
laid them aside and set myself carefullv to work, removing it, a
piece at a time, with my fingers. This I completely accomplish-
ed, after laboring faithfully for about three hours. I then washed
the rectum by throwing up large quantities of warm water ;
ordered a dose of sulph. magnesia, and in three days had the
satisfaction of seeing my patient about his employment.

On the 29th of January, 1847, I was called to see the same
patient, and informed that a similar mishap had befallen him,
the body now introduced being a beet. I made an examina-
tion, and could trace with the finger the large end of a beet of
such dimensions as to cause the utmost astonishment ; and to
increase the difficulties of the case, it had been retained more
than 48 hours, the patient having entertained the intention of
dying like a hero, without disclosing his condition ; from which
determination, however, the intensity of his sufferings forced
him to depart.

There was now a good deal of tumefaction and tenderness
about the anus ; and very great tenderness of the abdomen gen-
erally vomiting had set in. I again introduced my forceps,
but with great difficulty, on account of the tumefaction and
soreness of the parts, and soon found that I could not make the
necessary extractive efforts without havino-my forceps slip off':
the patient was also exceedingly irritable, and could not endure

1848.] On Chinoidine. 745

the necessary force. I now took my forceps to the smith, kad
the width of the blades reduced one-fourth, and the i)oints turn-
ed in so as to form a hook, obtained two or three assistants, and
returned to the novel operation.

Having premised a free bleeding and the hot bath, so as to
obtain a good degree of relaxation, I administered 35 drops of
the tinct. of opium, and having placed my y>atient on his knees
and strapped him down tightly over some chairs, I again intro-
duced my forceps, and quickly succeeded in bringing away a
beet nearly seven inches in length, and in its largest diameter
about three and a half inches.

It had evidently been selected by my patient on account of
its size, in order that it might be impossible for it to be taken
in ; and feeling thus secure, he had introduced the small end,
and pressed down upon it with his whole weight.

I now administered injections, and laxative doses, and restrict-
ed my patient to a low diet for two or three days, when he again
resumed his employment.

On Chinoidine. " By J. S. Unzicker, M. D., of Cincinnati.
(Western Lancet.)

Chinoidine has been for several years past extensively used
in Germany, but up to this time has not been generally known
in this country.

It is a resinous substance, and was first discovered and sepa-
rated from the mother liquor of sulph. quinine, by Sertuerner, a
chemist. There are two kinds in commerce, the pure and im-
pure. The genuine is hard, and has a smooth, glossy break, like
the hepatic aloes, which it resembles incolor. It is transported
in oblong f^at lumps weighing about one pound each, wrapped
in wax paper; will dissolve perfectly in dilute sulphuric acid,
alcohol and ether, forming a clear tincture of a brown color.

It is insokible in cold, but scantily soluble in warm water,
imparting to the latter a strongly bitter taste.

The adulterated comes in jars, and is soft ; will only partly
dissolve in alcohol and ether, not forming a clear tincture like
the other.

Chinoidine has been analyzed by a number of chemists, but
as yet no satisfactory results obtained. It contains, according
to Liebig, identically the same composition as quinine, but dif-
fers only in form, one being crystalline, the other not, and there-
fore he terms it the amorphous quinine. Chemical investiga-
tions, as far as they have extended, have thrown an interesting
iight upon the testimonies borne to the efficacy of chinoidine

746 Epidemic Dysentery. [December,

inithe treatment of intermittent fevers; and there is no doubt in
my mind, that the amorphous, if prescribed in its pure state, hke
the crystalline quinia, will produce the snme effect on the animal
organisnr, only that the effects of the former are more lasting.

I have used chinoidine for the last three years more exten-
sively than quinine, and on an average with better success,
especially in cases oflong standing.

In a number of obstinate cases of long standing, that came
herefrom the Wabash country, quinine w^as first given without
any effect. I then gave the chinoidine, which not only checked
the paroxysms, but no relapse follow^ed afterwards.

From the experience which I had during the above time with
this remedy, I think the return of the fever was one-third les^
than when I used the quinine. It is particularly suited in cases
where the digestive organs are not much debilitated. My mode
of giving it is thus: ^. Chinoidine, gr. xij. ; rad. ipecac, gr.j. ;
morph. acet., gr. i. Mix, and make into six pills, to be given
in two doses, two hours previous to the chills. Some German
physicians prefer to give the chinoidine in combination with
cremor tartar and cloves, in the form of pills.

This I found would hgTVe the same effect as that of many
grairis of quinine with the same combination. After the chills
w^ere stopped, I would then give a tea-spoonful of the tincture
(3j. to !j. of alcohol), from two to three times daily, in some
claret wine, for several days afterw^ards.

It has been said by some, that the effects of chinoidine de-
pended on the quantity of chinine and cinchonine it contained.
This is an error ; for suppose it did contain some chinine and
cinchonine, how much could then be in twelve grains of
chinoidine? Surely not half a grain of each! and would they
have produced the effect above described ? Certainly not.
Many, as well as myself, have labored under this mistake, until
they have learned to distinguish between the pure and impure
article, for if it is pure the results will be alike.

Chinoidine will undoubtedly, in time, become the great reme-
dy of practitioners in the West; for when w^e consider the high
price of quinine, ^3 per ounce, and chinoidine at 40 cents per
ounce, and besides a more effectual remedy than the former, no
doubt is left of its adoption into general use.

Epidemic Dysentery.

To the Editor of the Boston Medical and Surgical Journal:

Sill, Having learned, from your Journal and other sources,
that dysentery is prevailing somewhat extensively at the North,
and is uncommonly fatal, I iiave thought a concise description

1848.] Epidemic Dysentenj. 747

of the symptoms and treatment, in different parts of this county,
might be useful to the profession, and accordingly oifer the fol-
lowing imperfect skeK:h, hoping others will give us some ac-
count of its appearance in other sections.

As far as my observation extends, it is confined to those
sittiations where daily changes from heat to cold are greatest
viz., to valleys, where reflection from surrounding hills produces
high temperature during the day, and evaporation from ponds
and streams a low^ one at night. The thermometer in such lo-
cations shows a change of rarely less thah seventeen degrees,
and often twenty-eight and thirty, in twenty-four hours. I have
not seen a sinole case exempt from the above influence ; and
^ not one traceable to errors in diet, or the common causes of
bowel complaints. The disease has been very fatal in some
neighborhoods; of some 25 or 30 attacked in one, 16 died.
Of the treatment in those cases, I know^ but little ; they were
all children mider 14 years of age.

The first I saw of the disease was April 3d, when two per-
sons were attacked the same day ; and in those and all subse-
quent cases, a striking characteristic of the disease was, its un-
^delding obstinacy, ordinary doses "lof medicine effecting noth-
ing, and even twenty-five or thirty grains of opium in twenty-
four hours procuring little rest or sleep. There was, from
April 3d, an interval of precisely three months ; but, from July
3d to the present time, I have had daily opportunity of studying
the character, treatment, &c., of the disease. We have, usually,
abundance of disease to treat in this section, through July and
August, classed under the general head of boicel complaints ;
and side by side with the epidemic, have been cholera morbus,
diarrhoea and dysentery, arising from teething, worms, unripe
fruit, &c., and all yielding to ordinary remedies. But no one,
yvho had seen a single case of the disease in question, could
mistake the sunken, anxious expression of countenance, the
severe tenesmus, jerkins pulse, and general violence and obsti-
nancy of the disease, for any of these. ^

It was usually ushered in by more or less chill, followed by a
moderate grade of fever ; tongue coated with white fur ; pulse not
full, but hard and frequent, with a peculiar jerking movement ^
the discharges frequent, of blood or bloody mucus, with dreadful
griping pain in the bowels, and steady pain in the loins. No pain
in the head ; no vomiting ; skin dry and rough ; urine scanty, and
high colored. The disease seemed to exert its whole force on the
rectum and colon; usually extending to the descending colon
only, though sometimes reaching through the whole colon to
the caecum.

There was not the least particle of bile tinging the dischar-

r48 Gonorrhoial Ophthctknia. [December,

ges ; hence I inferred a want of action in the liver. To excite
the action of the Hver, and thereby reheve the venous congestion
of the diseased parts, I gave blue mass and conium say blue
mass four grains and conium two grains every three hours,
until bilious discharges appeared; then, at longer intervals,
regulating the dose so as to keep up a steady action of the liver,
and following the mercury with castor oil as a laxative. With
the above, I used opium in different forms, with ipecac, and
acetate of lead say for an adult, ipecac, and opium, agrs. ij.;
acet. lead, grs. iv.; or, what I preferred, acet. morphia instead of
opium. As the bloody evacuations lessened, with a free iiow
of bile, I changed the lead for kino or tannin, at first giving both
together say tannin and ipecac, aa gr. j.; sugar of lead, grs.
ij.; acetate morphia, gr. |, every three or four hours. If the
tongue became dry, the astringents were lessened, or omitted,
and blue mass ordered, with laxatives of oil.

When occasional bloody evacuations appeared, after the
height of the disease was passed, balsam copaiba in small doses
was very useful. Injections were used, but were found to be of
doubtful efficacy, and in some cases were decidedly injurious,
the inflamed surface be-^riifg no direct application. The fol-
lowing I found decidedly useful. Dilute vinegar, Oj.; s. lead, 3 ij.;
tr. opium, j. Flannels, wet in this, to be applied to the bow-
els. Narcotism was carefully avoided in children, though mer-
cury and lead were given freely ; one main point in the treat-
ment being, io procure a free and steady action in the liver, not
one fatal case occurring where that was obtained. The first
flow of bile was in each case dark and granular, like coflfee
grounds, and very offensive ; but always aflfording more or less
relief. As diet, I used the various mucilages, with as much ice
as patients chose to eat.

Convalescence was slow, and very tedious to patients, whose
appetites were craving forbidden fruit. The duration of the
disease would average about nine days.

Thougji the above treatment may seem an ahise of potent
remedies, yet they were never carried beyond the point of relief;
and not the fii'st sign of salivation has followed the continued
*use of blue pill in this disease, . M. D.

Clinton Co., N. Y,, October, 1848.

Gonorrhccal Ophthalmia. (Dublin Journ. Med. Science.)

In his lecture upon syphilitic diseases, lately published in the
Lancet, M. Ricord recommends the application of the solid
nitrate of silver to the aflected surface, so as to produce a white
film, but not to destroy the tissues ; after which he advise.? the

1848.] Pustular Ophthalmia. 749

thorough irrigation of the part, in order to wash off any por-
tion of the salt which may adhere. JBy this means, he s^ys
the secretion is momentarily suspended, but when the crust
formed by the caustic falls off, the pus re-appears, though it is
then lighter in color and turns sero-sanguineous. "So long"
he says, "aslitttle white streaks, the result of cauterization,
remain visible, and so long as the secretion is not again puru-
lent, you may judge that the influence of the nitrate is contin-
uing; but when the streaks have disappeared, and the secretion
re-assumes its primary character, you may infer that the effects
of your cauterization are over, and you may then repeat it ;
indeed it can safely be used three times a day." He thinks that
mei'curial friction in the early stage of the disease rather tends
to increase than diminish it. When chemosis ensues, he advises
its immediate incision ; at the same time he thinks that the cau-
terization should precede the incision. It is in the early stage
of this symptom, and when it is merely the result of oedema,
that he thinks the most benefit can be derived from it, but
"when the chemosis has reached the phegmonous state it can
no longer be excised, you must then have recourse to scarifica-
tions, but their effects are very inferior to those of excision.
In the interval between the cauterization with the solid nitrate
of silver, I inject into the eye, three or four times a day a weak
solution of the salt." M. Ricord also depletes largely, both gen-
erally and locally. While v/e agree in the general rules laid
down for the treatment of this disease by the distinguished au-
thor whom we have just quoted, we confess our dread of rub-
bing the coats of the eye three or four times a day with the
solid nitrate of silver. Upon the subject of the treatment of
urethral discharge during the continuance of the ocular affec-
tion, M. Ricord's observations are worthy of attention. The
urethral discharge, he says, no doubt, diminishes, but never al-
together ceases, when the eye is engaged. He objects to taking
pus from another individual in order to reproduce the urethral
discharge, because, as he justly says, there may be latent chan-
chres in the urethra which yielc^the pus, and then an additional
misery might be entailed. When the ocular disease has been
communicated from the urethral discharge of the same person, '
he uses copaiba " in order to control the urethritis, as in so do-
ing I remove the chance of relapse as regards the eye."'

Case of Pustular Ophthalmia. By H. Richie, M.D., Chicago, III.
(Western Lancet.)

My daughter, aged about 13 years, was attacked about eight
weeks ago, with pustular ophthalmia, which resisted all the or-

750 Quinine in Intermittent Fever. [December,

dinary modes of treatment, such as astringent collyria, aperients,
strict diet, counter-irritation in the shape of a blister behind the
ears, mercury, Dr. Dudley's favorite treatment of puking and
purging. The eyes being very much inflamed, the left particu-
larly, the conjunctiva a mass of enlarged blood-vessels, the upper
and lower lids swollen, and the lashes matted together. At the
junction of the adnata with the cornea one continued pustule
extended around the cornea, advancing about a line upon it.
Purulent matter was constantly discharged fj'om the eye. No
intolerance of light. The system otherwise normal, tongue
clean, no scrofulous taint. I ordered Hyd. potassae, xxv grs. ;
Iodine, v grs. ; water, 1 oz. Dose, 10 to 12 drops three times
a day in a spoonful of Carpenters fluid ext. sarsaparilla. Cerat.
simplex 1 oz. ; red precip., finely powdered, 3 grs.; Kreosote,
4 drops.

The inside of the lids to be anointed every night with a piece
about the size of a pin's* head. Blue pill, v grs. every night.
At the time I am now writing, which is just one week from the
time she commenced this course, I am enabled to pronounce the
eyes well. The inflammation has entirely disappeared ; there
is a slight pustule, not more than a line in diameter, still in each
eye, but gradually diminishing.

None of these latter remedies are suggested by standard au-
thors on diseases' of the eyes. I found them in some of the
Medicaf Journals of the day.

Quinine in Intermittent Fever. (Gaz. Medicale de Paris, from
Monthly Journal and Retrospect.)

M. Bouchardat conceives that intermittent fevers may be
usefully arranged under four forms or varieties, according to
the intensity of the disease, and the corresponding effect of
quinine on its course and duration. The first form includes
those obstinate cases which require large'doses (15 to 30 grains)
of quinine for their temporary cure, but in which, in spite of tl:M3
methodical use of the remedy, <the fever continues to recur for
years. This variety is found in Italy, North of Africa, &c., and
is contracted, according to Bouchardat, by. a lengthened resi-
dence in the neighborhood of marshes, the \yater of which con-
tains sulpho-salts in solution. To the second form belong those
cases which "require, but may be eflectually cured by large
doses (15 to 25 grains) of quinine. An intermittent of this kind
prevails at Tours, and has been well described by M. Breton-
neau, who observes that small doses are here insuflicient. They
habituate the patient to the action of quinine, irritate the stom-
ach, and render it diflicult to obtain the full action of large

1848.] Kreosote in Erysipelas. 754

doses. The third form comprises those mild cases in which
small doses (1 to 5 grains) are sufficient, not only to arrest the
fever, but also to prevent its return. Lastly, he includes in a
fourth form, the numerous cases in which change of residence,
or admission into hospital, is sufficient to remove the disease.

[This classification of intermittents is certainly of considera-
ble practical value, and serves to establish the principle, that the
dissimilarity of action of the same remedy may indicate differ-
ences in diseases apparently identical occurring in distatit parts
of the globe. The cases of intermittent fever observed in Paris
and Vienna, belong to the third and fourth forms of M. Bouch-
ardat. Thus, the practice of Skoda, of Vienna, which consists
in giving three doses of quinine of two grains each, at intervals
of one hour previous to the usual period of accession of the
paroxysm, rarely fails to effect a cure in two or three days. On
the second or third day he sometimes increases the third dose
to four or six grains. The form of intermittent is, however, so
mild, that we have repeatedly seen cases in other wards of the
same hospital recover without any treatment whatever. On
the other hand, the experience of physicians in Italy, Africa,
and some parts of North America, has -shown that small doses
of quinine are quite inefficient in the treatment of the intermit-
tent fever prevalent in these parts of the world.]

Kreosote in Erysipelas. By P. Fahnestock, M. D., of Pitts-
burgh. (American Journ. of Med. Science.)

Allow me to state that, during a practice of many years, I
have been in the habit of using kreosote in erysipelas of the
face, (as well as on all other parts of the body,) in both its sim-
ple and phlegmonous forms, confinincr my local treatment to this
article alone. And such has been the success ofthis treatment,
that I have as yet to wellness a case which has not yielded to it.

In every case of local erysipelas I immediately apply the
purest kreosote with a camel's hair brush over the whole of the
affected surface, extending it some distance beyond the inflam-
ed part, and at the same time administering a dose of chlor.
hydrarg., followed by a sufficient portion of jalap to insure free
catharsis. This, in the majority of cases, is all I find necessary.
But when the- mucous membrane of the mouth dnd fauces is
also affected, I pencil those parts with a strong: solution of the
nit. argent., say from 3ss. to 3i. to ^ i. of distilled water.

In the phlegmonous form it will be found necessary to repeat-
the application more frequently than in the simple, with the
addition of a bread and w^ater poultice, applied nearly cold and

752 Recovery of Speech by Gahano-puncture. [December,

well sprinkled with water strongly impregnated with the kre-
osote, or a cloth, kept constantly wet with the solution, especial
ly for the face.

The kreosote when applied, should cause the parts to become
white immediately. If this does not occur, it is not pure. Thus
you will perceive that success depends upon having the best
quality of oil. It is worthy of remark that the skin does not
become in the least marked by the application, no matter how
often it is applied.

I was first induced to make a trial of this remedy, bv a remark
made by Dupuytren in a small pamphlet which fell into my
hands, in which he supposed it might be a good remedy in this
disease.

The result of an extensive and exclusive use of this article in
erysipelas, has induced me to place the most implicit confidence
in it; and all I ask of the profession is a fair trial for it, confi-
dent that whoever once tries it, will abandon all other articles
in its favor.

Case of a Woman who, by the means of Gahano-puncture, re-
covered her speech after havins; lost it for twenty-three years,
(M. Camino. Gaz. Med. de Paris.)

In 1813, a married woman, Rosa Ponti, then aged 47, was
affected with a loss of sensation and movement, inconsequence
of a great fright. Recovering by little and little, she regained
the use of her legs, but did not recover that of her arms and
head, which remained paralysed from that time. From that
moment she could not articulate a single word ; she stammered
sometimes, but without being able to pronounce even a mono-
syllable. The tongue, which remained immovable between the
teeth, a|)peared also to be atrophied.

On the 21st of May, 1830, a metallic needle was introduced
into the neck, directing its point towards the occipital branch of
the first cervical- nerve ; then it was brought into connection
with the zinc pole of a voltaic pile; and holding the tongue,
elevated and stretched out on a sheet of the same metal, the
circle was closed by presenting to that organ the knob of a
brass director. The patient showed, by quickly drawing her-
self away, that she had felt the shock. The experiment was
repeated, anil the efTect was more marked than before. She
gained immediately the power of lilting her tongue. At the
end of three other shocks the patient exclaimed "Oh, Dieu!"
and could answer some questions in an intelligent manner,
although with some difficulty. She also became able to move
her tongue from side to side.

1848.] Hypertrophy of the Follicles of the Pharynx. 753

The next day, after some shocks given in the same manner,
M. Camino commenced to vary the points of contact, and to
give the electricity different directions. The patient shovi^ed
more and more sensibility, and the faculty of articulation fol-
lowed the gradual return of the movement of the tongue.

Two days of repose employed in exercisinir the organ sensi-
bly rendered the faculty of pronouncing and articulating sounds
easier and more accurate. In a short time she was able to
speak as before, and acquitted herself so well, and with so much
ardor, that she seemed, says the author, to wish to make up as
quickly as possible for the time lost in inaction and silence.

Every three or four days she came back to receive four or
five shocks from the pile, not being able, as she says, to bear
more.

On the 10th of June, she complained, without obvious cause,
of pain in the head and a g-eneral feeling of weight, an ailment
which was dissipated by bleeding.

After some more sittings, not only was her speech recovered,
but also the activity of the other paralysed parts, which became
quite fit to exercise their functions.

Hypertrophy of the Follicles of the Pharynx. (London Lancet.)

Concerning this pathological condition of the pharynx, M.
Chomel has instituted a careful inquiry, and accords to it the
name oi follicular angina of the pharynx. This affection con-
sists in an abnormal development or hypertrophy of the follicles
of the pharynx, of the pillars of the fauces, and of the uvula.
It may exist at any age, but is more frequent between 15 and
30. It is much more frequent in men than in woman, in the
proportion of 17 to 5. Accompanying this lesion, M Chomel
noticed a peculiar structural condition of the mouth and nose,
the nasal fossae being constricted, as also the anterior and
posterior nares, and the upper lip short, exposing the teeth ; a
condition necessarily associated with breathing through the
mouth open, and which may be a cause of the enlarged follicles,
by its rendering secretion more active in them. This affection
often coincides with ancient herpetic eruptions, and many pa-
tients are troubled with acne. Singers are subject to it, together
with a thickning and redness of the mucous membrane.

In most cases, the disease advances slowly; when arrived
at a certain stage it causes great inconvenience. It frequently
commences with a slight cough, without expectoration, and is
generally unattended to. When the secretion becomes abun-
dant, then it becomes troublesome. The affection is marked by

48

754 Hypertrophy of the Follicles of the Pharynx. [December,

a feeling of constriction in the fauces ; the patient exerts
himself to expel masses of mucus, which, are found over the
enterance of the air passages ; he desires to drink a little water,
to allay the uneasiness or pain, which it will effect for a few
moments. In slight cases, on depressing the tongue with a
spoon, from two to ten little red points, of the size of a millet-
seed and round, may be seen disseminated over the reddened
mucous membrane. In a more advanced stage, these round
points become discoid, or ovoid and glistening ; and in the most
intense degree, we see the diseased parts projecting in the form
of pillars, or projecting columns, from the sides ; and lastly,
these transverse folds may so entirely occupy the pharyngeal
mucous membrane as to leave but a few small isolated patches
of it in a normal state. The alteration of the follicles, however,
is not always in relation with the intensity of the symptoms;
for the latter depends much on the susceptibility or irritability
of the patient.

It is not uncommon to see the follices covered over by a
thick, adhesive mucus, which must be removed before their
condition is brought into view. The progress of this affection
is essentially chronic; it will often spontaneously disappear;
at other times will yield to very simple treatment ; but some-
times also is very refractory, resisting all modes of cure. Speak-
ing and singing aggravate the malady.

The cough attending it is guttural ; it does not come from
the chest, nor do the pellets of mucus, which are expelled in
small quantities. The latter are small globular masses, of the
size of a small pea, very adhesive, and semi-transparent ; in the
morning they are sometimes strewed w^ith minute greyish-
black points, consisting of inhaled carbon. The voice is gener-
ally somewhat altered ; and as a similar change occurs in
phthisis, some alarm may be created ; but then the absence of
the peculiar features of the latter disease will remove all^is-
quietude on that score. The voice becomes soon worn out,
and reading or speaking aloud soon involves the necessity of
ceasing. Sometimes, owing to a ])iece of tenacious mucus, the
patient is obliged to wait before he can articulate the smallest
word. Singers perceive they have lost one or two notes, that
the clearness of their voice is lost, as also its sweetness of tone.

The diagnosis presents no difficulty, unless the susceptibility
of the patient be so great as to preclude examination, or ren-
der it very difficult, when care must be taken not to confound
this condition of the follicles with the common normal hyper-
trophy of the mucus membrane and follicles, which is often
present in advocates and singers, and which demands no treat-
ment.

1848.] Bibliographical 755

Cauterization is the most effectual and ready mode of treat-
ment, but it is sometimes difficult to limit. Nitrate of silver, or
dilute nitric acid on a sponge, may be used for the purpose.
Caustics, however, should not housed in the first instance;
gargles of borax and alum should be previously tried, and will,
in most cases relieve, if not permanently cure. The sulphurous
waters of the Pyrenees and of Enghien, particularly the latter,
have often proved useful one or two glasses being used in a
morning gargling, and then gradually swallowed. In summer,
douches to the neck may be used as adjuncts. Reading aloud
must be avoided, as also much taking, and the diet must be re-
gulated. Acrid and irritating aliments must be refused, and
care should be taken to masticate thoroughly parts of hard sub-
stances, as crust, which may mechanically irritate the pharynx.

BIBLIOGRAPHICAL.

1. A Dispensatory, or Commentary on the Pharmaccepias of Great
Britain (and the United States); comprising the natural history,
descriptions, chemistry, pharmacy, actions, uses, and doses of the
articles of the Materia Medica. By Robert Christison, M. D.,
V. P. R. S. E., President of the Royal Col. of Edinburg, Prof, of
Materia Medica, &c., &c. Second edition, revised and improved,
with a supplement, containing the most important new remedies.
With copious additions, and 21.S illustrations. By R. Eglesfield
Griffith, M. D , Author of Medical Botany, &c., &;c. pp. 1008.
Philadelphia: Lea & Blanchard. 1848.

Dr. Griffith has in our opinion laid the profession under obligation,
by preparing an American edition of Dr. Christison's Dispensatory.
The work will no doubt prove a formidable rival to the very useful
Dispensatory of Drs. Wood and Bache. It is pronounced to be as
perfect as such an undertaking can well be. We have only to add,
it is issued in the publishers usual excellent style, and to recommend
it to the profession generally.

2. A Practical Treatise on the Diseases of Children. By J. Forsyth
Meigs, M. D., Lecturer on Diseases of Children, &c. pp. 575.
Philadelphia : Lindsay & Blakiston, 1848.

This is No. III. of tfie Medical Practitioner's and Student's Libra-
ry ; an undertaking commenced, as is known, by certain junior gentle-
men of the profession in Philadelphia. The No. before us will bear
a favorable comparison with those already issued by this association,
excellent as they were, and is exceedingly creditable to the zeal and
industry of our young professional brother, the son of Prof. Meigs.

756 Bibliographical. [December,

3. A System of Human Anatomy, general and special. By Erasmus
Wilson, M. D., Lecturer on Anatomy, London. Fourth American
from the last London edition. Edited by Paul B. Goddard, M. D.,
Prof, of Anatomy and Histology in the Franklin Medical (College of
Philadelphia. With 251 illustrations by Gilbert, pp. 576. Phil-
adelphia: Lea & Blanchard. 1848.

The publishers have sent us this new edition of Dr. Wilson's Anato-
my. It is one of the Text-books recommended by the Professor of
the subject on which it treats in the Medical College of Georgia. It
therefore receives our highest commendation.

4. Lectures on Yellow Fever : its Causes, Pathology and Treatment.
By John Hastings, M. D., U. S. Navy. pp. 69. Philadelphia :
Lindsay & Blakiston. 1848.

It appears that Dr. Hastings, while on service in a national vessel
in the Gulf of Mexico, had a good opportunity of observing the yellow
fever ; on his return to Philadelphia, he delivered lectures on the sub-
ject, which at the request of a committee, "representing the whole
audience," have been published. We are much gratified at this in-
stance, of a member of the profession in the public service, giving his
experience on an interesting subject, and hope his example will be
imitated by others, for the public good.

5. An Inquiry into the Degree of Certainty in Medicine ; and into the
nature and extent of its power over Disease. By Elisha Bartlett,
M. D., Prof, of Theory and Practice of Medicine, in Transylvania
Univ., (kc, 6ic. pp. 84. Philadelphia : Lea & Blanchard. 1848.

In this inquiry, Dr. Bartlett reads Dr. Forbes a severe lesson on
his late publications. We think this little work called for by the ex-
igencies of the times, and commend Dr. B. for the spirit and axcellent
manner with which it has been executed.

6. Medical Lexicon. A Dictionary of Medical Science; containing
a concise explanation of the various subjects and terms; with the
French and other synonymes; notices of climate, and of celebrated
mineral waters ; formulae for various officinal and empirical prepa-
rations, &c. By RoBLEY DiJN(JLisoN, M. D., Prof, of the Institutes
of Medicine, &c , in Jcftbrson Med. Collcire, Phihidelphia. Seventh
edition. Carefully revised and greatly enlarged, pp. 912, double
column. Lea & Blanchard. 1848.

Some years ago, we purchased one of the earliest editions of this
Dictionary, and became so dissatisfied with the disappointments met
in searching for medical definitions, in it, that we gladly deposited it
in the College library. The edition of 1846 was, however, so greatly

1848.] Bibliographical 757

improved, that Dunglison's Dictionary has been our constant reference.
The present, seventh edition, is said to contain between six and seven
thousand new terms, not found in any previous one. We have exam-
ined it, of course only cursorily taken, for instance, the word Glycerin,
(not found in Christison's Dispensatory,) and have obtained a satisfac-
tory explanation of it; and so of other terms.

This is just such a work as the untiring industry and accurate re-
search of Prof. D. would make us expect him to excel in, we have no
hesitation to pronounce it the very best Medical Dictionary now extant.

7. The Principles and Fractice of Modem Surgery. By Robert
Druitt, Fellow of the Royal College of Surgeons. A new Amer-
ican, from the last and improved London edition. Edited by F. VV.
Sargent, M. D., Author of Minor Surgery, &c. Illustrated with
193 wood engravings, pp.576. Philadelphia: Lea&Blanchard.
1848.

The first American edition of Druitt's Modern Surgery was edited
by Dr. Flint, of Louisville, Ky. A second one having been demand-
ed, and Dr. F., from his distance from the place of publication, having
declined. Dr. Sargent was invited to prepare the present edition.

We have already expressed a favorable opinion of the excellency of
Druitt's Manual of Surgery ; and notwithstanding the efforts made to
disparage its worth, in comparison with other recent works on Surgery,
the charge that the author holds no high surgical appointment, that he
obtained his information somewhat surreptitiously, &c., we shall still
recommend it to our students. Dr. Sargent has added to its value.

8. An Analytical Compendium of the various branches of Medical
Science for the use and examination of Students. By John Neill,
M. D., Demonstrator of Anatomy in the University of Pennsylvania,
Lecturer, &c., and Francis Gurney Smith, M. D., Lecturer on
Physiology, &c., &c. Anatomy, pp. 180. Physiology, pp. 133.
Surgery, pp. 122. Obstetrics, pp. 133. Materia Medica and
Therapeutics, pp. 115. Chemistry, pp. 93. Practice of Medicine,
pp.150. Philadelphia: Lea & Blanchard. 1848.

This, it will be perceived, is a collection of manuals on the several
departments of Medical Science usually taught in our Medical Col-
leges. From the character of the gentlemen engaged in preparing this
Compendium, we have no hesitation in recommending it to students.

9. The Nature and Treatment of Deafness and Diseases of the Ear;
and the Treatment of the Deaf and Dumb. By W3r. Dufton, M. K.
C. S. pp.120. Philadelphia: Lea &;Blanchard. 1848.

We thank the Publishers for a copy of this little manual on diseases

758 Bibliographical. Monthly Periscope. [December,

of the Ear, a cursory examination of which has induced a favorable
opinion of its value.

10. The Transactions of the American Medical Association instituted
1847. Vol. 1, pp. 403.

We have received our copy too late for notice in this number. An
extended notice of it is proposed for our next issue. In the mean time,
we advise all who can to obtain a copy of this truly x\merican iMedical
Publication being the first volume of the Transactions of the Na-
tional Medical Association.

PART III. MONTHLY PERISCOPE.

Ozone a cause of Epide?nic Diseases. Professor Schonbcin, says
the Journal de Chimie Medicale for July, places ozone among me-
teorological morbific agents. This substance, the smell of which is
so penetrating, and the oxydating powers of which are so great, acts,
according to Dr. Schonbein, as an irritant of the respiratory, mucus
membrane. He ascertained the presence of ozone, in a free state, in
the atmosphere, particularly in the winter, when the snow covers the
ground, and in the summer in stormy weather ; and he considers.itas
one of the principal causes of catarrhal epidemics. Several epidemics
prevailing at Basle, have been closely \\ atched by the professor, and
he has ever observed their rise and decline to be in a direct ratio with
the quantity of ozone in the atmosphere. Cholera is now confidently
stated to depend on vhe greater or lesser amount of electricity in the
atmosphere; infiuenza shares the same explanation. On the hands
of Dr. Schonbein, these seem to be the times for bold hypothesis; we
venture to say, that ozone is not done with, and that its influence will
by and by be proved to generate many other diseases. [Londo7i
Lancet.

Usque ad Nauseam New method of curing Drunkenness. Dr.
Landblaed, of Gotheberg, in Sweden, and Dr. Ketzius, in Stockholm,
have just reported a number of cases of habitual drunkenness cured
by the method advised by Schrieber. The latter consists in placing
the patient in confinement, surrounded with every comlbrt, liis food
mixed with diluted l)ran(ly, and the same liquor, with twice the quan-
tity of water, as an habitual beverage. He generally likes the fare
very well at first, remaining constantly half intoxicated, and sleeping
a <rrcat deal. In a few days, however, he acquires a great distaste
for the brandy ; but the system is continued until he refuses his food
altof^etber, unable to bear even the smell of the once cherished liquor.
Dr. Landl)la(>d treated thirty-five soldiers in this manner, and succeed-
ed so well, that only three of them resumed habits of drinking within
a year after their discharge. Dr. Retzius experimented on a larger
scale, and treated 1:39 soldiers of the guards according to Schriber's

1848.] Monthly Periscope, 759

system, of whom 128 were completely cured, and four only had a re-
lapse within one year of the treatment. The ages of the men varied
from twenty to twenty-five. This system is not without some danger
and inconvenience, and should be applied in all cases under the super-
intendance of a medical man. How would it answer for gin-drink-
ers llUid,

Quinine as a Prophylactic in Puerperal Fever. M. Leudet cites
several cases which occurred during the prevalence of three different
epidemics at Rouen, in which quinine, given in doses of five grains
three times a day, and commenced with a few hours after delivery,
seemed to exert a protective agency. On the third day, this quantity
was diminished, and the drug left off about the sixth day. In those
epidemics in which the disease commences very speedily after delive-
ry, the quinine should be administered as soon as labour begins.
[L' Union Med., from Br. and For. Med. Chir. Rev.

Nourishment for Infants. A very pleasant, nourishing, and harm-
less substitute may be formed in fresh new milk or cream diluted with
rennet whey, in the proportion of one part of the former, to two parts
of the latter. This, sweetened with loaf sugar, forms the diet which
we universally recommend, where there is any need for an artificial
supply ; and it is submitted to the Association as well worthy their
consideration. [New Jersey Med. Rep.

Emulsion of Castor Oil. The following formula is published in the
Journal de Chimie Medicale, under the signature of A. Manne, Phar-
macien, Paris.

' Having frequently, to make emulsions of castor oil, either by pre-
scriprion of physicians, or at the demand of my customers, making
them in fact four or five times a day, I found myself in a position to
make researches relative to the best means of administering this med-
icine. * * * I have employed gum Arabic in ditTerent proportions,
but have obtained emulsions either too thick or imperfectly made.
The yolk of egg has offered me an excellent emulsion, but one yolk
is required for every ounce and a half of oil. Is it not possible that
the yolk of egg injures the purgative effects of the oil by its nutritive
properties ? does it not render the purgative heavier and less suppor-
table by the stomach ? These doubtful points led me to doubt the utili-
ty of yolk of egg, and to make other attempts at finding a means
of making a homogeneous, emulsion, aggreeable to the sight and more
supportable by fhe stomach. To accomplish this, I have had recourse
to gum tragacanth, and the following formula has given the most satis-
factory results. R. Castor oil, 11 drachms; Powdered tragacanth,
half dr.; White sugar, 75 grains; Water, 2^ fluid ounces; Syrup of
orange flowers, 6 fluid drs. Mix and make an emulsion as follows :
Triturate the tragacanth with the sugar, then add the syrup and ag-
itate rapidly in a mortar until the mucilage begins to thicken a little,
then add the oil and continue to triturate until the mixture is homoge-

760 Monthly Periscope. [December,

ncous, and add the \vator little by little during the trituration. In this
manner 1 have obtained an emulsion of castor oil wiiicii leaves nothing
to desire, and which will remain eight or ten days without an atom
of oil separating." \_Boston Medical and SurgicalJournal.

Ergot of Bye a remedy for excessive Bilatalion of the jmpil from
BeHadonna. M. Comperat has announced a plan by which he has
succeeded in removing dihitation of the pupil produced by belladonna
in a petient of his, in whom the iris was scarcely visible, so complete
had been tlie action of a small dose of belladonna applied externally.
For some days the excessive dilatation resisted the employment of va-
rious collyria. He prescribed powdered ergot of rye, taken like snutF.
The dilatation disappeared in a few seconds it soon returned, the
same remedy was again employed, and it did not' reappear. He
thought that ergot might be thus used in cases in which dilated pupil
arises from other causes. [London Med. Gaz.

Opening of the Banine Veins in Angina. M. Ceglie has derived
much advantage from -this mode of bleeding in diseases of the throat.
He explains the success by reference to the anatomical distribution
of the blood vessels. He has seen it alibrd great relief in the acute
stages of inflammatory croup, the symptoms of oppression, the agita-
tion, suflbcative cough, &:c., ceasing almost instantaneously.

To perform the operation, the tongue is drawn forward, and after
puncturing the veins, the mouth is frequently gargled with warm water.
The bleeding may be repeated three or four times in 24 hours.

[Gazetta Toscanna delle Scienza MepicofsechCf and Prov. Jour.

Examination of the Throat in Infants. A mode adopted by the eel-
ebrated Golis seems too often neglected. While jilaying wilii the
infant, he j)assed his little linger between its jaws as far as the base of
the tongue ; the child immediately made an etlbrt as if to vomit, du-
ring which, having previously assumed a pro|)er position, lie took the
opportunity of making the inspection. \^Rev. Med. Chir.^ from Med-
ico-Chirurg. Rev.

Minute Injections. Dr. Hershfield, who has become celebrated in
Paris, for the perfection of his minute injections, adopts the follovying
method : The subject being placed first in a bath for some hours, the
following mixture is injected : For the arteries^ oil one litre, vermil-
ion one and a half lbs. For the veins, linseed oil two litres, white
lead one lb., indigo q. s. The addition of two tablespoonfuls of soft
Venetian turpentine, renders the mixture as penetrating as possible.

[Medical News,

Remedy for the Toothache. Mr. James Boatson, in the Med. Times,
rccomniends a solution of Gum Co|)al in Chloroform as a remedy for
pain in decayed teeth, 'i'he cavity should be cleaned out, and a bit
of cotton, moistened in the solution, introduced into it. ''TheChlo.

1848.]

Monthly Periscope.

761

roform removes the pain and the Gum Copal resists the action of the
saliva. It is worthy of trial. [Annalist.

Hydrophobia. We see by a communication in the Philadelphia
Ledger, that Dr. T. N. Haller, of York, Pa., has reported a case of
well marked Hydrophobia, occurring in a boy 12 years old, who was
bitten by a rabid dog six months previously. He was treated with
acetate of lead and Dover's powder, two grains of each every four
hours, with success. The remedies were continued until he had taken
80 grains of each. [^Ihid.

Chloroform in Mania-a-potu. Dr. G. Lane Corbin, of Virginia,
writes to us that he has used chloroform successfully in two cases of
mania-a-potu, after the various preparations of opium had failed to
procure sleep. [Medical News.

EFFECTS OF TEMPERATURE. (ChrlstisOU & Griffith.

Deg

Greatest artificial cold produced by the evaporation of a
mixture of solid carbonic acid and ether, in vacuo,
by Faraday ....

Strongest nitric acid freezes -

Sulphuric ether congeals - - -

Mercury freezes . - -

Proof spirit and brandy freeze

Oil of turpentine freezes - . -

Strong wines freeze - - - -

Vinegar freezes ' -

Milk freezes - - - -

Olive oil freezes ....

Mediiim temperature of the surtace of the globe

Medium temperature of England

Oil of aniseed freezes

Lard melts

Heat of human blood

Phosphorous melts

Spermacelti melts

Tallow melts (Thomson)

(Nicholson)

Beeswax melts

Sulphur fuses (Fownes)

Camphor fuses

Lead fuses

Red heat (Daniell) -

Heat of common fire (Daniell)

Iron fuses

Deg.

from

below ;

160
55
47
39

7

above zero.

16

20

28

30

36

50

52

64

90 to 97

98

99

112

92

127

142

226

303

594

980

1140

3479

On Examination of the Uterus by the Rectum. M. Chomel urges
that the exploration of the uterus by the rectum in cases of its malver-

762 Monthly Periscope. [December,

sation, is by far too much neglected ; although information so derived,
both as respects the position and diseases of the organ, is oftentimes
quite conclusive. In exploring in this way, however, it must be re-
membered that on the posterior surface of the uterus in tlie retrovorted
state, a kind of furrow, separating the cervix from the body of the
organ, is perceived, and that, in almost all women, pressure here ex-
cites intense pain, which many surgeons have mistaken for an indica-
tion of inflammatory action, of which it is no sign whatever. [Gaz.
dcs Hdp., from Medico-Chir. Review.

On the Ethereal Solution of Gun Cotlon or Collodion. By Edward
Pakrish and VV. W. D. LivERMore. The following observations are
the result of a series of experiments in making the solution which
have several times disappointed us: as far as they go, 'they are freely
offered for the benefit of others who may be disposed to attempt it.

1st. Ordinary commercial gun cotton is not soluble in ether.

2nd. The best tbrmula that we have tried for the preparation of this
solution, is as follows :

Take of Nitric acid, sp. gr. 1,452,

Sulphuric acidj (Commercial) each, 1 fluid ounce,
Cleansed and bleached cotton, ' 2 drachms.
Thoroughly saturate the cotton with the acids, and macerate for twelve
hours. Then wash the cotton, dry it rapidly by artificial heat, in the
shade, and dissolve it in

Sulphuric ether, one and a half pints.

3d. Gun cotton as thus prepared, will lose its solubility entirely, by
being kept a few days, or particularly by being exposed to the sun's
rays.

4th. The gun cotton, prepared as above, is entirely soluble in the
oflicinal sulphuric ether, though not in the hydrate ether or lethcon.

5tli. As many groundless ohjections to the solution are due to its be-
ing carelessly or improperly applied, care should be taken to saturate
the Aibric used in making the plaster with the liquid, and allow it to
dry while in close contact with the skin, and where a permanent plaster
is required, it is well to apply it over the exterior surface with a hrush.
When thus applied, apiece of muslin one inch in breadth, and applied
over a surface of an inch and a half in length, will sustain a weight of
ten pounds, its adhesion not being affected by moisture or temperature.

[Anier. Joum. Pharmacy.

On the Use of Solution of Caustic Potash in relieving Strangury.
By R. Mulock, M, D In three cases of strangury, caused by blis-
tering with cantharides, I found the solution of caustic potash a perfect
remedy. Two of the cases were head affections, where opium was
inadmissible. Thirty drops, given in half a wine-glass of water every
hour, gave relief before tlie third dose was exhibitcnl. What led me to
the use of this pre[)aration was its known afli^cts in relieving irritation
of the bladder in other cases, nnd ;ilso its efficacy in relieving the
stings of wasps or bees when applied to the skin. I considered that it

1848.] Monthly Periscope. 763

might also relieve the acrid principle of the cantharides. Indeed from
its effects, it would probably be a remedy for an overdose of that med-
icine, if given in proper time. In looking over the ^various works on
irritative poisons, 1 tind no antidote to the poison of cantharides, and
mention this now that further trial may be made of its effects in giving
relief. [Duh. Jour. Med. Sci.

Remedies for Corns. Dr. John Travis, of Tennessee, requests us,
in a late communication, to call the attention of practitioners to the
efficacy of red wafers as a remedy for corns. He states that he has
found them to effect a cure when applied for a length of time. Another
medical friend in Tennessee informs us that he has succeeded in re-
moving these troublesome and painful excrescences from the toes by
the application,' duly persevered in, of the common adhesive plaster.
The remedies are simple, and from the- authority on which they come
to us we would recommend a trial of them. [West. Jour, of Med.
and Surg.

On a mode of producing rapid Vesication. By G. F. Schacht, Esq.
[This is a new application of Mr. Markwick's Impermeable Piline.]
A liniment was prepared according to the following formula : R. Liq.
ammon. fortiss. 5j ; ol. olivae, 5ij. M. Six dropsof this liniment were
applied to the woollen side of the piline, placed upon the skin, and gently
pressed with a handkerchief. In ten minutes a perfect blister was pro-
duced, the size of a crown-piece. The piline is not in the least injured
by such an experiment, and after being washed, may be used again,
for the same or for other purposes.

Pathology of the Blood in Inebriates. A Mr. Thompson, of South
Berwick, Maine, aged 35 years, for a long time had been the subject
of intemperate habits, being daily accustomed to the use of alcoholic
drinks ; for five days previous to the examination of the blood, he had
been in a beastly state of intoxication; and it was found upon inquiry
that he had drank in that time two gallons of" West India Rum." At
the expiration of the fifth day he called upon Dr. J. C. Hanson, and
complained of the usual symptoms of drunkenness. Dr. H. immedi-
ately, for experiment sake, drew blood from the arm ; it was found
destitute in a measure of its watery elements. On applying a lighted
taper to it, it began to burn whh a flame similar to alcohol. Dr. Jew-
ett, and several respectable citizens of South Berwick, were eye wit-
nesses to the experiment. Dr. Pray, of Boston, wbo reports the case,
appends the following remarks : It is well known to the medical
profession, that hquids, and even mineral and vegetable substances,
taken into the stomach, are shortly found in different parts of the sys-
tem. Madder, for instance, when internally administered, imparts a
like color to the milk, and urine, and to the* bones of animals, without
materially affecting the healthy action of any tissue, or sensibly de-
ranging the constituent parts of the solids or fluids, unless too long
persevered in. But there are very few known cases in which so much

7C4 Monthly Periscope. [December,

alcohol has been absorbed into the system, as^to change the chemical
qualities of the blood, or so modify it, that its watery proportions should
give place to the fluid which has been immoderately indulged in. The
case, which we have briefly narrated, plainly shows that such may be
the fact. [^Boslon Med. and Surg. Journ.

Detection of Human Skin by the Microscope. At a recent meeting
of the Microscopical Society of London, Mr. John Quekett, the micro-
scopic demonstrator to the Royal College of Surgeons, read a very
interesting paper on the importance of the microscope in the determina-
tion of minute structures of a doubtful nature. The author stated that
his object in bringing this communication before the Society, was to
point out how minute portions of skin, which had been exposed to the
air for centuries, could be recognised as human. There existed in this
country certain traditions, that persons who had committed sacrilege
were flayed, and their skins nailed to the doors of the churches they
had robbed, as a terror to the sacrilegists ; and three portions of such
skin had been forwarded to the author, for examination, by Albert Ray,
Esq., the Secretary of the Archaeological Society. The first was
taken from one of the doors of Vvorcester Qathedral, where now only
portions remain underneath the ornamental clamps and hinges. The
second specimen was taken from the church-door of Hadstock, in
Essex, where it had been protected, for many cenutries, by an iron-
grating; this portion of skin was said to have been that of a Danish
pirate, and is supposed to be nearly 900 years old. The third speci-
men was taken from the church-door of Copford, also in Essex. On
all the specimens Mr. Quekett succeeded in finding two or three hairs,
which the microscope clearly proved to be human. Thus this valua-
ble instrument is able to confirm a tradition, and prove the former
prevalence of a practice which had been doubted by many archajolo-
gists. [Lou. Med. Gaz.

On Puncturing the Memhranes to produce A horiion. By T. Salter,
Esq., Poole. Mr. Salter recommends an instrument invented by his
son for the purpose of puncturing the membranes in the early months
of pregnancy. He says,

It consisted of a flexible gum male catheter, but of suflicient firmness
to preserve its straight form, even when opposed to a moderately ex-
isting body, having a perforation at its extreme point, just large enough
to allow a common wire stilet to pass through.

The patient, lying on her left side, and near the edge of the bed, the
catheter was introduced into the vagina with the right hand, and pushed
forwards upon the anterior surface of the fore-finger of the left, and in
this manner it readily entered the os uteri, and passed tlirough the
cervix; withdrawing the finger from the vagina and os uteri, tiie in-
strument was pressed forward until it met with steady resistance. The
stilnt wiis then introfluced nnd passed on, making its exit at the open-
ing prepared f()r it, when it was immediately found to have perforated
the membranes.

1848.] Monthly Periscope. 765

Renewed pressure being then made upon the catheter itself, that also
entered the cavity of the amnion, and on withdrawing the stilet the
liquor amnii flowed in a full and continuous stream, as urine is ob-
served to do from a catheter introduced into a distended urinary blad-
der. The fluid collected amounted to about a pint and a half.
Nothing could have been more successful than the use of this simple
instrument, and I would venture to recommend its employment to my
professional brethren, as equally adapted for the purpose for which it
was had recourse to, as the ingenious cutting instrument contrived
and recommended by Dr. Ramsbotham, which I did not happen to
possess, and the use of w^hich, in unskilful hands, might not be alto-
gether unattended with danger, and be especially hazardous in cases
where the cervix and os uteri are undeveloped, as in the present
instance. [^Prov. Med. and Surg. Journ.

Arsenic in Furunculus and Acne. Dr. Schweich has prescribed
arsenic with great success, in various cases of furunculus that have
come under his care for some time past, and has found the cure very
durable, and the use of the medicine, during which the ordinary diet
may be continued, attended with no inconvenience. He begins with
4 drops of Fowler's solutidH forenoon and afternoon, until a drachm has
been taken, and then gives 5 drops until the second, and 6 drops until
the third is attained, and so on. Acne simplex, in which the knotty
pustular appearance of the eruption gives it the character of miniature
furuncle, and which is often so obstinate, and, when attacking the
face of young people, so annoying, yields as readily to the arsenic.
The injurious effects of aperients in these affections leads to the sup-
position that the source of the dyscrasis is a specific irritation of the
alimentary canal, which is only augmented by the stimulus of purga-
tives, especially the saline. [Casper^ s Wochenschrift, from Medico-
Chirurg. Review,

Treatment of Burns hy Ammonia. M. Guerard recommends in
burns the application of caustic hartshorn; the application of cloths
steeped in ammonia immediately relieves the pain, and must be con-
tinued for one hour after the accident. When the burn has produced
any destruction of the skin, ammonia should not be used; but in the
erythematous form, or when phlyctcnae are present, it is of the great-
est advantage. Annates de Therapeuiique. Med. Times.

Whooping Cough. Dr. McMurray, in the St. Louis Med. and Surg.
Journal, for April, has found the following of great service in the treat-
ment of this distressing aflection, after healthy secretions of the bowels
have been obtained by the use of calomel, ipecac, and rhubarb,
li. Hydriodate Potassa, . . . gr. vj.

Mucil. Acacia, vij.

Syrup Senega, j.

Tinct. Lobelia, .... 5j.

M. Dose, a tea-spoonful four times per day to a child two years old.

[New York Journ. of Med.

76G Monthly Periscope. [December,

Use of Chloroform in Midwifery. Dr. Edward W. Murphy, of
University College, London, has recently published a pamplilet enti-
tled " Chloroform in the Practice of Midwifery," from which we extract
the following conclusions :

"1st. It does not interfere with the action of the uterus, unless it be
given in very large doses, which is never necessary.

" 2d. It causes a great relaxation in the passages and perinaeum ;
the mucous secretion from the vagina is also increased.

" 3d. It subdues the nervous irritation caused by severe pain, and
restores nervous energy.

"4th. It secures the patient perfect repose for some hours after her
delivery. These three last effects consequently render an operation
must easier to perform, and the recovery of the patient afterwards much
more favourable.

" 5th. The order of its effects on the vital functions seems to be
loss of sensation partial loss of voluntary motion loss of conscious-
ness complete loss of voluntary motion stertorous respiration loss
of involuntary motion cessation of the action of the uterus of rcs-
.piration of the action of the heart.

" 6th. Its injurious effects, when an ordinary dose is given, seem to
depend on constitutional peculiarities, or on improper management.
Much excitement about the patient may render her violent. Catalepsy
has occurred in some ; clonic contractions in others. Some patients
are slow in recovering from the effect of a large dose ; they remain
giddy during the day, and sometimes faint when they stand upright."

[New York Journ. of Medicine.

Another Victim of Quackery. In one of the Western Med. Journals,
Dr. Meeker, of Laporte, Indiana, details a case of cancer or scirrhus
tumour in the breast ; to which a" cancer doctor " first applied a blis-
ter and removed tlie cuticle, and then a plaster spread over with a fine
white powder. The plaster occasioned great pain, but was continued
on the breast eleven hours. After it had been on only two hours, the
patient began to feel a metallic taste in the mouth, nausea, griping
pains m the stomach and bowels ; and soon after vomiting with spas-
modic action of the muscles. These symptoms continued until the
plaster was removed, when a dose of laudanum was given, and a physi-
cian sent for. He came in a ^aw hours, and found the patient as
follows, viz: "Pulse 12G, violent spasms, constriction of the muscles
of the pharynx, burning sensation in the oesophagus, nausea and vo-
miting, cold extremities," &c. She lingered until the seventh day,
and died, notwithstanding the most judicious and faithful attention.
Dr. Meeker was called in consultation, and finding the " cancer doc-
tor" in the house, induced him to state the composition of tiie powder;
which was corrosive suhlimote^ in quantity near 100 grains. He
alledged that " he iiad applied it to a great number of cancers, but
never knew it to produce such an effect before."

After the fatal result, the old quack explained it all, by saying " that
the roots of the cancer reached the heart, and that the medicine, in fol-

1848.] Medical Items. 767

lowing them out, produced death." Some, however, not seeming
satisfied with this explanation, he secured his own safety Ly decamping
with twenty dollars, which he received, in part pay, for the murder.
The rapidity with which the poison was absorbed in this case is worthy
of notice. [Annalist.

MEDICAL ITEMS.

Gutta Percha for Tooth-ache. We suggest the solution of Gutta Percha in
Chloroform for odontalgia or tooth-ache. Let the tooih be thoroughly wiped
out, and the solution dropped into the carious cavity.

Powder against Flatulency. Senna leaves, 26 decigrammes; Mint and Cori-
ander seed, each 15 grammes. Mix. Mak'e a powder. Dose, a small tea-
spoonful three times a day. Dr. Heim.

Amputation. After the insurrection of June last in Paris, M. Roux perform-
ed 11 primary amputations, 6 died; 4 secondary, 3 died. M. Baudens had 14
"primary amputations, 11 were cured; of G secondary, all died.

Effects of Compound Dislocation of Ankle-joint. Prof. Syme states that of 13
cases of compound dislocation of the ankle, received in the Royal Infirmary of
Edinburgh, and not subjected to amputation, only 2 recovered.

Influence of Statistics on Quakcnj. Dr. Cartwright, in his recent statistical
inquiries made on the influenc of empiricism on the public mortality of Natchez
for the last sixteen years, has clearly and lairly demonstrated, "that the pre-
valence of quackery has been more fatal, nearly two to one, than the prevalence
of yellow fever, cholera, measles, whooping-cough, smallpox and all other dis-
eases put together," New York Journal of Medicine.

University of Louisiana Medical Department. The Legislature of Louisiana
have appropriated S30;000to this University a large portion of this sum is to
be expended in completing the medical department. We thank Louisiana for
honouring our profession, and are confident it will lose nothing by this gen-
erous gift.

Giittn Percha for Artificial Palate. A correspondent of the monthly Journal
of Medical Science, (England,) recommends this article for all deficiencies
about the palate he has used it with entire success.

Solution of Gutta Pcixha in Chloroform. 1 ounce of Chloroform to 1 drachm
of Gutta Percha.

Successor^ to Air. Liston. Mr. Arnott has receive^l the appointment of Pro-
fessor in the University of London, since Mr. Syme has retired from it to
Edinburgh.

So great is the distress in Paris, we learn that Chomel was without a single
patient to visit during one whole day, and Marjolin does not receive 20 francs
a day.

Remuneration of learned men in England. The salary of the porter of the
House of Commons is 74 pounds sterling more than the royal astronmoer and
chief librarian of the British museum; and the porter of the Admiralty receives
the same amount as the third aid of the Royal astronomy.

768

Medical Items. Meteorology. [December.

We copy the following obituary notice from the American Journal of In-
sanity:

Died, at the New York State Lunatic Asylum, August IGth, John Spencer
Brigham, aged 12 years, only son of the Editor of this Journal.
' Thou ha.sl first
Begun the travel of Eternity;
I gaze amid the stars.
And think that thou art there,
Unfettered as the thought
'That follows thee.
We deeply sympathize with our brother under his heavy bereavement, and
invoke that consolation which the world cannot give him.

Death of Professor Carpenter of Ncic Orleans. We learn with deep regret the
death of Dr. Wm Carpenter, Professor of Materia Medica and Therapeutics in
the Medical Department of the University of Louisiana. He died at New Or-
leans on the 4th October, aged 38 years.

Death of Dr. Charles A. Luzcjihcrg, of New Orleans. We are informed by the
Medical journal ot'that place, that t)r. Luzenberg died at Cincinnati on the
16ih of July last. For many years he was a prominent surgeon, and owned a
large private hospital in New Orleans.

Death of Bcrzelius the Chemist. The celebrated Berzelius, of Sweden, whose
ill-health we noticed a few months ago, died at Stockholm on the 7th of August.
He was 69 years old his disease an affection of the spine.

METEOROLOGICAL OBSERVATIONS, lor October, 1848, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide 52 feel.

b

Sun Rise. f

3, P.

8

Thf.r.

Bar.

Thkr.

I

(JO

29 50-100

77

2

2

58

" 71-1001

70

3

40

" 94-100

70

4

51

" 97-100

78

5

54

" 93-100

80

6

60

" 94-100

78

7

59

" 98-100

77

62

" 95-100

79

9

62

" 9t-100i

74

10

64

" 86-100:

66

n

60

" 81-100

73

12

58

" 85-100

68

13

56

" 61-100'

58

14

51

" 73-100

70

I.')

50

" 78-100

78

If)

53

" 77-100,

75

17

61

" 65-100

74

18

43

" 77-10 !

63

19

48

" 72-100

54

20

44

" 73-100

59 .

21

40

" 81-100

6(i

22

42

" 80-100

72

23

48

" 83-100

67

24

57

" 77-100

08

2.')

58

" 85-100

72

20

60

" 71-100

72

27

47

" 71-100

72

28

47

" 6;- 100

72

29

6')

" 49-100,

78

30

49

" .^)7-100

76

31

56

" 61-100

66

M.

Bar.

29 51-100

" 81-100

" 94-1001

" 98-1001

" 90-1001

" 94-i00!

" 96-100

" 89-l00:

" 94-1001

" 8I-100:

" 83-100:

" 76-100

" 53-100

" 73-100

" 80-100

" 7Li00|

" 62.100!

" 75-100

" 58.100

" 79-100

" 71-100

" 82.100

" 82.100

" 74-100!

" 82.100

" 6:1.100

" 74-100

" 52-100

" 49-100

" 60-100

" 68-100

Wind.

s. w,
s, w.

N.
N. NV.
N. E,
S. E.

E.
N. E.

N.
N.
N.
N.
N.

N. W
8. W
S. W
8. W
W.

N. W.
S. W.

s. w.

8.

s.

N. W.

N. W.

s. w.

s.

8. W.
S. Vf.

w.

ReM;IRKS.

Cloudy. [35-100.

Fair breeze rain last night,

Fair.

Fair.

Fair.

Fair strong breeze i fly'g cl'ds.

Thick fly'g clouds il stiff breeze.

Cloudy breeze.

Cloudy breeze.

Rainy day, 15100.

Fair cloudy after 3, p. m.

Cloudy. [80-100.

Rain storm from 3, a. m., rain,

Fair breeze.

Fair foggy morning.

Cloudy.

Cloudy blow at 8, p.m.

Fair.

(lain, 10-100.

Fair.

Pair breeze.

Fair.

Cloudy.

Rainy" all day, but light.

Pair.

Pair rain at 3, a.m., 5-100.

Fair.

Pair strong breeze.

Fair .strong breeze.

Fair.

Fair.

19 Fair days. Uuantity of Rain
9 days. West of do. do. i7days.

1 inch 45-100. \Vind East ofN. and

/^r

INDEX TO VOL. IV.

9

OF CONTRIBUTORS.

Antony, E. L'Roy, M. D. On Hemi-
plegia 7"

Barr, W. F., M. D. Case of Spinal
Irritation 340

Campbell, Henry F., M. D. Remov-
al of a foreign body from the duct
of Wharton '. 156

Campbell, Robert, M.D. Anatomi-
cal Peculiarity 593

Connell, A., M. "D. Ascites, follow-
ed by Suppuration after Tapping. . 270

Davis,'john, M. D. Thoughi.s on the
Medical Convention 17

Eve, Joseph A., M.D. Cases of Con-
vulsions, &.C., during Pregnancy. . G5

Eve, Joseph A., M. D. On the use of
Chloroform in Midwiferv 251

Eve, Paul F., M. I ). On Chloroform
and operations under its influence, 18G

Eve, Paul F., M. D. Gun-shot
Wound ball opening the gravid
uterus, 472

Eve, Paul F., M. D. Meteorological
Observations at the end of each No.

Eve, Paul F., M. D. Operations on
the Jaws, with the results of four-
teen cases, 705

Eve, Paul F., M. D. Removal of 4^
inches of the Clavicle 158

Eve, Paul F., M. D. Report of the
first Annual Session ot the Ameri-
can Medical A.ssociaiion 370

Eve, Paul F., M. D. Reply to Dr.
Holmes' letter on National Medi-
cal Literature, 506

Eve, Paul F., M.D. Reply to Dr.
Green's Observations on Diagnosis
of Aneurism, 524

Eve, Paul F., M. D. Reply to the
Medical Examiner on Sectional
Medicine, 099

Eve, Paul F., M. D. Successful Am-
putation at ihe Shoulder-joint, 663

Eve, Paul F., M. D. t-'/i-successful
cases in Surgery, 273

Fort, Tomlin.son, M. D. Bilious Re-
mitting Fever its sources, 641

Gaiiher, Henry, M. D. Notes of an
Operation for Lithotomy, 154

Girardey, Edw'd. Report of an Op-
eration for Lithotomy, under the
influence of Chloroform, by Prof.
Eve, 399

Green, Alex. B. New Remedy for
Epilepsy, 62

Green, James M., M. D. Ligature
of the Primitive Carotid, 337

Green, James M., M. D. On the
Difignosis of Aneurism, 524

HainiTiond, A. Lewis, M. D. Inier-
e^ling ca.e of Gun-shot Wound. . 272

Harris, Jas. C, M D. On Gluinine, 3b5

Harris, Juriah, M.D. Administra-
tion of Clilorotbrm in the Ho.^piials
of Paris, 712

Hitchcock, C. M , M. D., U.S A. Re-
pot t ot the sick and wounded in tlie
department of Tampico. Mexico.. 207

Holliday, John S., M. D. Case of
Self-Cai^tration 343

Holman, J. C, M. D. Cases of For-
eign Bodies in the Ear, 88

Johnson, N. B., M. D. Passage of a
Hall-Dollar through the Alimenia-
rv Ciinjil, 342

King, Wm. R., M. D. On Gonor-
rlioea, 204

Le Conte, John, M. D. Abstracts
from the Medical papers of the
Philosophical xM;.gazine,for 1S47, 89

Long, John A., M. D. Case of Acute
Glos.-itisin an infant 9 months old, 545

Mayes, J. A., M. D. Observations
on Malarial Fever, 257

Meals, Henry H , M. D. On appii-
cabilitv of Crude Mercury to Ileus, 394

Means, A., M.D. On Electro-Phys-
iology, 129

Norwood, Wesley C, M. D. Col-
chicum: its therapeutic action... 513

Norwood, Wesley C, M.D. IsClui-
nine a Sedative 1 83

Oakman, Erwin H., M. D. Case of
Fracture ot the Cranium with In-
jury of the Brain, 27

Oliver, James H., M. D. Obstinate
case of Priapism, 592

O. P. G. European Correspondent
Letter III., 122

O. P. G. European Corre.;pondent
Letter IV., 313

O. P. G. European Correspondent
New Views on Digestion, 455

Parker, Washington P., M. D. On
Labor, obstructed by Tumors, with
cases 449

Pendleton, E. M., M. D. On Erup-
tic Rheumatic Fever, 201

auintard, Charles T., M.D. Ca.ses
of Erysipelas, 321

IV

INDHX.

auiotard, larles T., M. D. On Ul- i

^ cerous dk^ses of the Icar^ 11

auiniarJ, Charles T., M. D. The

Infancy of Pliysic, 577

Riordon, John, M. I). On ihc Iodide

of PoUii.siiini, with cases, 103

Robertson, J. J., M. D. Chltiroluim

in Pariiuition, 589

Robertson, J. J., M. D. Chlorolonn

during Labor, 470

Rossi -drnol, Henry, M. D. Cramps

of Writers translated from Dr. S.

Sandras, 546

Rossignol, Henry, M. D. Statistics

of Mortality in Augusta, Ga., from

l83i>tolS4S, ^. G58

Rossignol, Henry, M. D, New me-

thod of performing Cheilopiasty

translated from Dr. C. Scdillot,. . . 400
Smith & Martin, Drs. Epidemic

Dysentery, 30

TwIVjzs, John D., M. D. Lithotomy,

under the influence of Chlorolbrm, 209
Wairen,R. L., M.D. Resuscitation

of persons struck by Ligliining, . . . 7l6
"Wil.-on, John S., M. D. Enlarged

Prostate Gland puncture of the

Bladder, 543

X. Y. Z. Notice of Medical College

Circulars, 573

X. V. Z. On the similarity of Prof.

Dunglison's and Prof. Adelon's

work on Phvsiolouv, 439

INDEX or
Page.

Abortion, Whitehead on 4i*S

Ab()rtit)n, puncturing membranes for 7G1
Action of Medicine upon tlie animal

system 32

Adv-anlageofrail-roadsand telegiaph

to the profession 575

Alimentary canal, will insoluble sub-
stances enter the circulation thro' it, 621)
Alimentary canal, passage of a half-
dollar through 312

American Journal oi'Science & Arts, ^Ki

Amputation under chloroform, 447

Amputation at Shouldei-joinl under

chloroform, OiVA

Anatomical Peculiarity, 593

Anossihesia in Paris, . ' 122

vAna'sihetic agents, new 319

V Anaesthetic agent more efficient ilian

sulphuric ether, 108

Anchylosis of the second and third

molar teeth, 43(5

Aneurism, diagnosis of 524

Angina, prompt and eflicacious mode

of curing 57

Angina, opening ranine veins in., . 7(50

Angioleucitis and Phlebitis, 183

Antimony in the living organs, reten-

' tion of 32

Antispasmodic, Hornet's nest 5(57

Anus, fissures of, treatment of G33

Aphthous eruption, treatment of 183

Arsenic, poisoning by, cured by mag-
nesia 557

Artery, ulna, made evident G31

Ascites followed by suppuration after

tapping 270

Arthritis, cataplasms against (5l

Augusta, Ga., health of 254

Aural Surgery, 735

Auscultation, alphabet of 022

Bartlett, on fevers of the U. States.. 244
Bartlctt, Dr. on certainty in Medicine 75G

ARTICLES.

Page.
Bird's Elements of Nat. Philo.sophy, . 3H9

Births, proportion of sexes at 5G4

Kiiths, periods of the day 24H

Blakiston on Diseases of the Chest, . . 3G8
Blennorrhagia, BlennorrliOBa, Leu-

corrha\T, Cystirrho'a, &c 61

' Blistering or vesication, rapid mode. 703
1 Bloodletting, ell'ccts of, on the young

I subject 210

Blood spilt on clothes, means of de-

j tecting 437

; Blood, composition ol 7l7

i Blood in inebriates, 763

I Blood stains, how to distinguish 57

I Boling, Prof, appointment 704

Bones, human 127

Bones, sypliilitic and scrofulous 030

Bosjesman or Bushman, account of. . 636

Bowditch's Young Stethoscopist 562

Bower's Memoranda on Anatomy,

Suigery and Physiology, 563

Bronchitis, 118

Burrows on Disorders of the Cerebral

circulation, 369

Burns, treated by ammonia 765

Cachexia, infantile, digitalis in 619

Calomel, efficacy of small and repeat-
ed doses of 620

Cancer, treatment of 373

337

343

501

505

759

; Carotid, ligature

j Castration, case of

I Castor oil, use of

i Castor oil, mode ol' taking

Castor oil, emulsion of

Citric acid, Tartaric acid in, detec-
tion of 374

Chelius' System of Surgery, 245

Cheilonlasty, new method of perform-

ing....... 400

Chemistry applied to pathology and

therapeutics 474

Chiniodine, 743

INDKX.

Children, tears in 5(55

Children, food lor 551

Chilbhiin, prescrijHion fur 375

- Chloroform in ihe Hospitals of Paris, 712

'-'Chloroform, elJecls of 695

Chlorosis and An[emia,dilierence be-
tween 60i)

-Chloroform, external use of 552

*Tjhlorolorm during labor, -170

-^Chloroform applied to midwifery, at

Augusta, 251

' Chloroform, operations under its in-
fluence 187

^Chloroform the great discovery and

blessing of the age, 180

Cholera, internal use of Nit. silver in 311

Chorea, statistical reseaiches of. Ooi

Christison's Dispensatory, 735

Churchill's Midwilery, 295

<;iavicle, removal of 4j inches 158

Coclf's Ryan's Obstetrical Remem-
brancer 503 j

Cotiee, disinfection by 634

Colica Pictonum, treatment of 696

Collodion, or Gun-colton, 762

Collodion a substitute lor adhesive

plaster, 3M

Colchicum : its therapeutic action, . . 513
Conjunctivitis, nitrate silver external

use of 311

Constipation, case of 363

Convulsions and other nervous artec-
tions, during pregnancy, parturi-
tion and the puerperal state, 65

Cooper, Prof, resignation 5l2

Copper head, bite of. treated with In-
digo, 373

Corns, remedies for 763

Coryza, treatment of 248

Costiveness, remedy for 375 j

Cough, lunar caustic for 119

Cough, whooping 755

Cramps of writers, 546

Cramps, cure for 47

Croup, pathology and treatment of. . 50

Croup, gasii ic origin of 58

Croup, 089, 044

Cutaneous Eruptions, induced by va-
rious medicinal substances, 00

Deafness, cured by gal va no-puncture, 752
Deafness cured by inhalation of ether, 254
Deafness, new method of treating. . . 015
Death in the Pot; or adulteration of

food, 614

DeschaiTip's specific Ii9

DiarrhcBaand Dysentery, internal use

of nitrate silver in 231, 432

Dieffenbach, death of 127

Digitala, adoensonia, substitute for

quinine 508

Digestion, physiology of, new views, 450
Disea.ses, epidemic, ozone, cause of. . 758
Dislocation of Humerus, new mode

of reducing 697

Diseases, exhau.sting, ice in 37'i

Dislocation of the Radius and Ulna,

reduction of 03

Disinfection, 634

Disinfecting fluid, Burnett's 429

Dislocation compound of the knee-
joint, 367

Di-scharge of a tooth from the ear, . . . 120

Diuretics, action of 631

Diuretic prescription, 375

Drunkenness, new method of curing, 758

Druiii's Modern Surgery, 757

Drugs, adulterated, prohibition to im-
portation 447

Duftou, on Deafness and Diseases of

the Ear, 757

Dunglison's, Dr. Medical Lexicon . .

Dunglison's, Dr. Letter 511

Dungli.son's Practice of Medicine,. . 243
Dwarfs, children of, not necessarily

small 184

Dysentery, epidemic, 1848 74r

Dysentery caused by in.secls, 500

Dysentery, ice in 370

Dysentery, alkaline treatment of 358

Dysentery, treatment of, by Heberden 2-lt)

Dysentery, epidemic 233

Dysentery, epidemic, treatment 51

Dy.sentery, epidemic, notice of 30

Ear, foreign bodies in 88

Ear, chronic discharges from 249

Editors of New York, change of 699

Electro-physiology, 129

Electrical 'cloth, 634

Emmenagogiie, datura stramonium, 365
Emphysema, nev.' diagnostic sign. . . 560

Epilep.sy, new remedy for 62

Epistaxis, 697

Ergot of rye for dilated pupil 760

Eruption of measles, variola, scarla-
tina, and puipiua, 48

Erysipelas, cases of 321

Erysipelas, Kreosote in 751

Erysipela.^, iraumaiic, ireatnientol. . 504

Etherization, 559

Eye, stale of vision 90

Excreta, human, value ol 615

Fees, honorable 447

Females and their diseases, 2h4

Fevers, history, diagnosis and treat-
ment of 244

Fevers, malarial, observation.? on . . . 257

Fevers, ti-atment of, by cold water.. 408

Fever, congestive 54^

Fevers, tyj.hoid, intermitienis, and

phthisis' 551

Fever, congestive, thoughts and ob-

servat ions on 594

Fever, intermittent, inferior animals

sul)ject to 634

Fever, bilious remitting, its sources, 641

VI

INDEX.

Fever, typhoid, urine in 182

Fever, tvphns, cause, prevention and

treatment 229, 331

Fever, intermittent, treated by strych-
nia .' 35G

Fever, intermittent, quinine in 750

Fever, puerperal, quinine a proph)''-

lactic 750

Fissures of anus, treatment of r)33

Fistula in ano 370

Flatulence, 1 7(5

Foote's Ophthalmic Memoranda,,.. 5G3
Formulary of Venereal Hospital of

Paris, 6H2

Formula, diuretic Gl

Fort, Dr. work on Medicine G98

Fractures of the thighs, flexed and

straight po.>itions 1 05

Fracture, incomplete diagnosis of. . . 504
Fracture of the verlebrffi, death froiTi 552
Furunculus, arsenic in 7G5

Gardner's Medical Chemistry, G28

Gastro-entcritis, epidemic 15!)

Gastralgia, chronic, treatment of 5GG

Gestation, prolonged 500

Glossitis, acute, in an infant 545

Glycerine, 6SS

Gold from alloys, &c., new method

of extracting G35

Gonorrhoea, essay on 204

Gout, strychnia externally in 119

Graduates in the Medical College of

Georgia, 1848 '. . . . 250

Granville's lotion, substitute for ()34

Greene's Dr. letter, notice of G38

Gums, extensive sloughing 127

Gun-shot wound, case of 272

Gun-shot wounds in Paris, 314

Gun-shot wound ball entering the

uter us 472

Gutta Percha, medicinal employ-

ment of G08

Harden, Dr. John Macplierson Ber-
rien, his death 255

Hastings, Dr. on yellow fever 75G

Health of Americans coi)ii)arcd to

Eni,Mishmen, 409

Headache, certain forms of 404

Health, intiucnccofthe weather upon 435
Heart, its movement dependent on

the spinal cord and brain 117

Hemiplegia apj)lication of galvan-
ism with Sherwood's vibrating bat-
tery 77

Hemorrhage, treatment of G23

Hemorrhoids, internal, operation for G32
Hernia in the human race, frequen-
cy of 115

Hernia humoralis, puncture of scro-
tum in , 184

Hereditary predisposition, 483

Hernia, inguinal, strangulated, new

method of treating 550

Hewson, Dr. his death 25G

Hippocrates, oath of 121

Holmes' report, Annalist's opinion of G39

Homoeopathy, 63G

Homogeneoiisness of man & woman, 3I0

Hydrophobia 7GI

Hydrocele cured by compression .. . G33
Hvdroce])halus cured by blistering

the head, 3l2

Hysteria, 113

Ileus and kindred afi'ections, crude

mercury in 304

Imagination, influence of 5G4

Inflammation, local efiecis of G95

Infants, nocturnal cough, treatment of 119

Infants, nourishment for *59

Infants, examination of throat 7G0

Injections, minute 7G0

Injury of the brain with fracture of

cranium, 27

Ink, writing, to remove 447

Insanity, curability of 103

Instruments, French and English,. . 185
Intermittent, treated with strychnine, 55
Iodide of potassium, carbonate of pot-
ash in, means ot detecting 374

Iodide of Potassium, accidents from

employment of 424

Isopathia, 447

Irritant, counter, a new one 121

Jaws, operations upon, results of four-
teen cases 705

Labor, obstructed by luniors, 449

Lallemand on spermatorrhoea, 245

Lavement, anti-typlioid G2

Leeches, how to ap))ly them 249

Lesions, traumatic, application of ice in 504
Lcucorrhoea, actual cautery to the spine

for .' 312

Lightning, resuscitation from 716

Lipoma melicerisand stcatoma, differ-
ential diagnosis 59

Lipitudo, chronic, treatment of 248

Lislon, death of 128

Liston, his successor 192

Lithotomy and Lithotrity 184

Lithotomy, notes of, under peculiar cir-
cumstances 154

Lithotomy, a new ojjeration for 58

Lithotomy, under the influence of chlo-
roform, 209,319

Liver, structure and development of... 93

Liver, alleged removal of. 116

Lungs, capillaries of 304

Malaria, source and influence of in the

South and West 413

Manuals of the blood and urino, 368

Maniaapotu, chloroform in 761

INDEX.

Vll

Mattetici's lectures on the phenomena

of living beinnrs, 242

Mayue's Dispeusiitory, 562

MClellan's Principles and Practice of

Surgery, 561

Means' introductory lecture, notice of 62

Measles, epidemic 254

Med. Miscellany, 63,254,319, 448, 575, 767
Medical Staff U. S. army, gallantry of 126
Medical Association in Alabama... 127, 253

Medicines, action of 239

Medical College, donation to 128

Medical Convention ofS. Carolina 254

Medical Association, American, report

of 313,376

Medical Convention, thoughts on 17

Medical College of Georgia, lengthen-
ing the course 383

Medical College of Georgia, annoucc-

ment, &c. of 506

Medical Journal, rev/ard of editor of... 384
Medical literature, national, letter on,

by Dr. Holmes 506

Medical Staff'United States navy, 573

Medical College circulars, 573

Medical ethics, 665

Medical intelligence, 698

Medical As^jociation, American, addi-
tional items 437

Medical Association, Amer., meeting

of the Professors at 568

Medical corps of our army and navy,

neglect of 637

Medicine, sectional, Med. Examiner on 699
Medical Association, American, 1st

vol. of transactions 758

Meigs, Dr. on diseases of children 755

Mercurial salivation, peculiarity of 373

Mercury counteracted by dulcamara, 696

Metals, discovery of 180

Midwifery, chloroform in 766

Miscarriage, habitual, prevention of... 633

Mortality of Augusta, Ga 658

Muscles, intercostal , 91

Muscular fibre, independent contrac-

tihty of 566

Muscular action, voluntary loss of. 56

Naevus, treatmentof. 503

Neill's and Smith's Analytical Com-
pendium, 757

Nerves, spinal, structure of. 117

Nervous system, efiects of agents upon 90
Neuralgia by superficial cauterization,

treatment of. 1 20

Neuralgia, actual cautery in 372

New counter irritant, 121

Nipples, sore, prescription for 375

Nitrate silver, internal use of, in diar-
rhoea, &c 231

Nurse's sore mouth, iodide of potassium

a cure for 698

Nux vomica as a purgative, 635

Obstetrical memoranda, 226

Obstetric plates, Spratt's 498

Ohio Medical and Surgical Journal 638

Ophthalmia, tincture of iodine in 698

Ophthalmia, purulent, douches in 184

Ophthalmia, gonorrhoeal 748

Ophthalmia, pustular 749

Opium, muriate of. 632

Orchitis, efBcacy of cotton in 185

Ox gall in removing impacted faeces. ... 46

Parotid gland, enlarged, cured by tinc-
ture iodine 313

Parturition, chloroform in 589

Partmition without pain, 629

Pertussis, alum in 58

Pessary, new article for 505

Pharynx, hypertrophy of its follicles... 753

Phthisis, condition of the gums in 503

Phthisis pulmonalis, treatment of by

cod-liver oil 686

Physic, infancy of. 577

Physiology, electro 129

Physiology, comparison of Prof. Dun-

glison's with Prof. Adelon's work... 439

Pills, bitter ferruginous 568

Placenta, retained, cases of. 37

Pneumonia, treatment of, by Skoda... 247
Pneumonia, Cases of, treated by tartar

emetic 344

Pneumonia and pleuritis, differential

diagnosis of 502

Pneumonia cured by nature, 502

Pneumonia, epidemic 2.54

Poisons, 297

Poisons, action of. 611

Poisoning by bite of rattle-snake, 678

Porrigo larvalis, by iodide sulphur,

treatmentof. 311

Preparations, anatomical and patholo-
gical, fluid for preserving 436

Pregnancy, color of vagina iu 633

Prescribing in newspapers 120

Priap'sm, obstinate case of. 592

Prolapsas aui, treatmentof. 364

Prolaj)sus ani, splution of sulph. iron in 503

Proteine as a medical agent, 505

Prostate, disease, catheterism 625

Prostate gland, enlarged 543

Quackery, another victim 766

Quinine, modus operandi and therapeu-
tic properties of. 385

Quinine is it a sedative? 83

Randolph, Dr. Jacob, his death 256

Ranking's half-yearly Abstract, 628

Rectum, foreign bodies in 743

Retina, sensibility of, easy means to re-
cognize 374

Vlll

INDKX.

Review, British and Forci<;^n Modico-

ChirurfT G28

Rlicumatism, acute, quinine in 30(5

IJhouniatisin, use of vinofnir in 506

Rheuinatisin, treacle as a local remedy 118

Rheumatic fever, eruptive 201

Rheumatism, subacute and chronic... 730

Rich, Dr. David A., his death 256

Rust, how to prevent 185

Salivation, premonitory' symptom of... 697

Salivation, mercurial, peculiarity 373

Sargent, on bandaginjr, &c 502

Scarlet fever and measles, sequels of... 220

Scabies, treatme)it of by olive oil 371

Scurvy and purpura, diagnosis of 246

Scurvy, Wood in 565

Seminal weakness cured by ligature

applied to the penis, 61

Senna, decoction of, as a purgative for

children 57

Shieldfe, Gen., nature of his wound 63
Sick and wounded of Tampico, report

of 207

Simpson, on anaesthesia 244

Skeleton, living 501

Skin, human, by microscope 764

Smull-pox, electric, treatment of 618

Sollv, on the Human Brain 296

Sore throat 689

Spina Bifida, cnred by punctures and

tincture iodine to the tumor, 60

Spinal cord, experiments on the proper-
ties and functions of 117

Spinal irritation, case of 340

Springs, Virginia, opinion of 310

gtille's General Pathology 296

Stomach pump, sul),stitute for 371

Stomach, foreign bodies in 183

Strangury, caustic potash in 762

Struma, cod-liver oil in 371

Suction of fui'^er of accoucheur in-
fant in the womb 312

Supcr-I'dtation, rase of. 630

Surgery, unsuccessful cases in 273

Sttrgery at a discount 573

Siirgical case, report of, curious 681

Syme, Prof. re8ignatifn 512

Syphilis, tartrate of iron and potass, in 697

Taylor, on Poisons, 369

Teinix-rature, effects of 761

'I'hanks of Provisional (iov. of Franco

lo the Medical profession, 383

'J'ohaccn, tea inul coffee, cflects of 556
Tongue, paralysis of, from passion 63 1

Tonsils, hemorrhage from, relieved by
ice '.

Tonsils, hemorrhage from, arrested by
pressure

Tonsils, enlarged, observations on

Toothache, remedy for

T<>othachp, remedy for

Traumatic lesions, ice in

Trial of a physician f)r assault, &c., in
delivering a patient,

Tucker's Midwifery,

Tumors, chemical compoyition of

Tumors, new method of applying liga-
tures to

Tumor, abdominal, mistaken for preg-
nancy

Tuphlo-enleriti.s, case of

Twins, l)orn after an iziterv'al (if two
I months between them both live

Tympanitis, physometra

! Typhus or ship fever, treatment of

I Tympanitis, acetate of lead in

i

Ulcerous diseases of the legs,

Ulcers of the leg,

Ulnar artery, means of rendering ac-
cessible, &c

Urethra, new method of dilating stric-
tures of

Urethra, injury of, catheterism in

Urine, retention of, relieved without the
catheter

Urine, incontinence of, remedies for...

Uterus, cancer of, simulated

Uterus, nerves of

Uterine contraction by the cotton plant,

Uteri, cervix, disea.ses of

Uterus, examination by rectum

Vaccination, protective influence

Vagina in pregnancy, color of

Variocele, new operation for

Vesication, rapid mode of producing...

Virginia springs, o])inion f>f

Vomitings of j)regnant women, potion in
Vomitings of pregnancy, belladonna

ointment in

! Wharton's duct, foreign !Sf>dics in

Whitlow, treatment of

White of zinc substitute for white of

lead in the arts,

Williams' Principles of Medicine,

Wilson's Anatomy,

Worms in the heart and blood-vessels

of a dog,

313

371
98
375
760
504

573
294
499

503

416
675

61
249
421
373

1
374

631

567
625

312
435
624

89

488
761

127
6.T3
027
249
310
183

376
156
632

374
562
756

114