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SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

PAUL F. EVE, M.D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF GEORGIA,

AND ONE OF THE RECENT VICE-PRESIDENTS OF THE

NATIONAL MEDICAL ASSOCIATION.

Medical College of Georgia.
"Jeprends le bien ouje le irouve."

VOL. v. 1849. NEW SERIES,

3lugn0ta, a.

JAMES McCAFFERTY,

PRINTER AND PUBLISHER.
1849,

V

I

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 5.] KEW SERIES JANUARY, 1849. [No. 1.

PART FIRST,
riginal (Horn in xtnicatton^.

ARTICLE I.

Experimental Researches on the febrifuge properties of the
Extract of Dogwood Bark ; Cornine obtained with Cases,
ByD. C. O'Keeffe, Student of Medicine, Augusta, Ga.

Deeming it proper to premise the circumstances eliciting this
article, we take pleasure in stating that Dr. Oakman, of Colum-
bia county, Ga., presented Prof. Paul F. Eve with a specimen
of the Ext. of Cornus Florida, prepared by himself With the
view of having its remedial virtues tested. Prof. Eve thought fit
to transfer it to my preceptors, Drs. H. F. and R. Campbell, by
whom I have been kindly permitted to appropriate it as the sub-
ject of my inaugural Thesis.

It was not until the commencement of the present centurj^
that this article attracted the attention of the profession at large ;
previous to this time, it had not been much used by regular
practitioners, though a popular remedy in domestic practice,
and more particularly, among some Southern tribes of Indians.
To Dr. J. M. Walker, of Virginia, has been justly awarded the
merit of being the first to institute chemical investigations on the
constituent principles of the bark, and of promulgating to the
profession the discoveries he had made.* By more recent
writers on the subject, however, these are pronounced to have
been " very imperfect. "f

Some time subsequent to this, it was analyzed by Mr. J.
Cockburn, (Am. Journ. Pharm., vol.T, p. 114,) who found it to

* Inaug. diss., Phil. 1797. t Griffith's Medical Botany.

N. s. VOL. V. NO. I. 1

2 O'KeefCe, on the Properties of Dogwood Bark. [January,

contain other principles in addition to those discovered by Dr.
Walker. During the interim of these examinations, the an-
nouncement by Mr. G. W. Carpenter (of Philadelphia) of a
proximate alkaline principle, to which the name Cornine was
given, tended to stimulate the inquiries of other analysis ; but th6
results obtained by these were unfortunately contradictory of
Mr. C.'s assertions.

Since then, little, if any, has been advanced on the subject,
owing doubtless to an over-zeal on the part of its advocates in
attributing to it remedial properties which an enlightened ex-
perience could not sanction. At a time when the labours of
the profession were engrossed with investigating the essential
principles of the Cinchona bark, to have discovered among our
native productions a succedaneum for the expensive exotics
would have been a great desideratum. To accomplish this,
much has been extravagantly said, but has detracted in the
same ratio from the intrinsic merits of the bark. Our prede-
cessors appear to have contented themselves with the effort to
establish a complete identity between the constituent principles
of the Dogwood and Peruvian barks, the efficient virtues of the
former receiving little or no attention. The essential identity
of these barks can subserve no practical purpose; for the as-
sumption of the non-existence in the former, of any principle
analogous to the latter, does not, in the least, invalidate its
claims to anti-periodic powers. In a practical point of view,
it matters not whether their modus operandi on the animal
economy be identical; the same end is accomplished by both,
though it may be in a totally difterent manner. Each may
exert a peculiar influence over disease an influence sui gen-
eris ; but from this the conclusion is by no means warranted
that their proximate principles are analogous, or that their
power of controlling disease is the same. This peculiar anti-
periodic virtue the Cinchona bark possesses in an eminent
degree: no fact in medicine is better established. In relation
to the Dogwood bark, we are not prepared to make this broad
assertion; our remarks shall only have reference to one variety
of paroxysmal disease, viz : Intermittent and Remittent fever.

For its efficacy in the other varieties of paroxysmal disease
we cannot vouch ; such, indeed, would be premature and un-

1849.] O'KeefTe, on the Properties of Dogwood Bark. 3

founded speculation. The enthusiastic theorist may conjure
up inviting schemes of doctrine, indulge in elaborate and ingen-
ious hypotheses reveling in the creations of his fancy ; but
with the profession at the present day, facts, not speculation,
constitute the basis of investigation.

The exhibition of the Dogwood bark, by infusion and powder,
in the treatment of intermittent fever, presents no novelty; the
untutored Indian, as well as the educated physician, availed
himself of its virtues in this particular application. To the
article under these forms our remarks shall not refer, save to
animadvert upon the sensible effects set forth by all authors as
invariably resulting from its administration.

The Extract is the preparation to which we would emphati-
cally direct the attention of the profession. Of this, nothing has
been said by systematic writers on the Materia Medica, nor do
the leading periodicals of medical literature add any thing to
our information on the subject ; therefore, the conclusions rea-
sonably deduced are ^that it has never been used in any form
of disease ; that its employment in the treatment of intermittent
and remittent fever is decidedly unprecedented ; and that its
success in these affections is worthy of consideration only on
the strength of the cases hereinafter adduced, and the rigid
minuteness observed in recording the symptoms presented in
each particular case.

On reviewing the opinions of the profession concerning this
article, it strikes us that too many uncalled-for restrictions have
swayed the minds of practitioners in its adrtiinistration. It is
true, that the standard American works on the Materia Medica
abound with eulogies on its remedial properties, but these are
nullified by allegations of its tendency to "irritate the stomach
and bowels ; produce diarrhoea, griping pains, &c/* Now this
fact of itself, is sufficient to account for the utter oblivion to
which it has been consigned; and it affords a striking evidence
of the evils of that pathology which regards the gastro^intestinal
canal as i\\Q f onset origo of all febrile derangements.

With such an incompatibility staring him in the face an
irritant to a diseaped gastro-intestinal surface what practition-
er would venture the use of the Cornus Florida in a case of
intermittent or remittent fever? Of a tendencv to disorder

4 O'Keeffe, on the Properties of Dogwood Bark. [January,

the stomach and bowels, we have not seen a solitary well-
marked instance, though we have exhibitedit in unusually large
doses, and under all circumstances which would centra-indicate
the use of a remedy possessing such properties.

Let it suffice here, merely to have expressed these convic-
tions, leaving the considerations by which they are substantiated
to be adduced, when commenting upon special cases hereinaf-
ter cited.

It is curious to reflect, why an indigenous plant of such im-
portant medical properties should have fallen into disrepute in
the very infancy of its carrer. The reason of this, however, is
sufficiently obvious. It will be borne in mind, that the investi-
gations alluded to in the commencement of this article were all
instituted in a region, where, from the nature of the climate,
malarial fevers received but little or no attention, and at a time,
too, when an interpretation of its modus operandi was biassed
by the prevailing doctrine as to the pathology of fever. Why
it is that minute practical observation has not subverted these
unfounded theoretical assertions or why the master-spirits of
the profession have been governed by the ipse dixits of others,
in relation to the effects and mode of operation of this remedy,
are problems which will devolve upon the Southern practitioner
for solution. Had the various forms of periodical fever com-
posed so large a share of the Northern physician^s practice, the
far-off Quito alone yielding him the sheet-anchor of his hopes,
as it is with Southern practitioners, the opinion is unhesitating-
ly expressed that the Dogwood bark, and its preparations, would
have been among our most popular remedies.

In view, therefore, of these considerations, and the absolute
impossibility of having the curative virtues of any anti-periodic
sufficiently tested in the region alluded to, we naturally refer to
the records of M( dicine in the South, and even here, we find
our anticipations disappointed.

Bearing in mind that periodical fever is the endemic disease
of the Southern climate, and the high amount of expenditure
incurred by the unlimited use of Quinine if the success of the
treatment here pursued has been truly represented, then the
importance of substituting an indigenous agent would 1 e fully
appreciated, and its universal adoption confer incalculable
benefits.

1849.] O'Keefie, on the Properties of Dognwod Bark.

To the physician of the Southern States, then, whose great
duty is the management of paroxysmal fevers, an effort to es-
tablish an indigenous anti-periodic may not be unacceptable.
Without devoting further time to preliminaries, already extended
too far, it is proposed to pass to a brief description of the tree.

CoRNUS Florida. Common Names Dogwood ; Boxtree ;

Great flowered Cornel, &c.

A minute botanical history of this well-known tree is render-
ed unnecessary by the abundance of its growth, and the facility
of its recognition by every observer. It is, therefore, deemed
prudent to sum up, with as much brevity as practicable, the out-
lines of its botanical characters; the physical properties of the
bark, its chemical composition and therapeutical employment.
This beautiful and useful tree is found in almost every part of
the United States, especially, in swampy and moist woods, vary-
ing in height from fifteen to thirty-five feet, six to thirty-six
inches in circumference, with a rough, dark-brown bark, much
fissured. Latitude modifies its growth, being a much larger
tree in the Southern states. It flowers from February to June,
according to climate, but always with so much regularity that
some of our Southern tribes were accustomed to name the
spring from its flow^ering. From the presence of gallic acid
in it, a good writing ink may be made from it.* In the New
England states, it is well known by the name of Boxwood.

The officinal portion is the bark of the root, stem and branches;
the bark of the root is said to be preferable. In our prepara-
tions, the bark of the stem has been exclusively employed, and
has afforded results so conclusive and satisfactory, as to inspire
us with the fullest confidence of its applicability under all cir-
cumstances. However, it is not intended to question the accu-
racy of the assertion, but if time should verify its claims to
superiority, it will but furnish another argument in support of
its remedial virtues. The bark, as found in the shops, is in
pieces several inches long, half an inch or more broad, and two
or three lines thick; it is, generally, more or less rolled, some-
times with a fawn-coloured epidermis, and sometimes deprived
of it; of a reddish-gray colour, affording, when pulverized, a
Griflith,*op. cil.

6 O'Keeffe, on the Properties of Dogwood Bark. [January

grayish powder tinged with red. The bark of the root is des-
titute of epidermis. The odour is sHght, and the taste very
much Hke the Cinchona ; it is bitter, and astringent, with a little
aroma. Its astringency is, however, stronger than that of the
Peruvian bark. It appears to be more particularly related to
the cinchona oblongifolia.

Chemical Composition. Gum. resin, tannin, and gallic acid?
were the result of Dr. Walker's analysis. To these have since
been added by Mr. Cockburn, oil, fatty matter, a crystalline
substance, bitter extractive, wax, and colouring matter, lignin
and potassa, iron, lime and magnesia.* His experiments go to
prove that the extractive matter alone contains the bitter prin-
ciple, from which the crystalline substance is obtained.

As to the propriety of admitting the existence of this alkaloid
substance announced by Mr. Carpenter, the weight of authority
seems to preponderate against it. And Mr. C. has certainly
forfeited his claims to originality, (admitting its discovery,) by
withholding from the profession the process by which it was
obtained. Although the existence of this bitter principle has
long been regarded a mooted point, nay, as one unworthy the
attention of modern analysts, nevertheless, advocates are not
wanting who assure us, that they have used the Sulphate of
Cornine with as much, if not more, success, than the Sulphate
of Quinine in intermittent fevers.

The gratification of a scientific curiosity would suggest an
inquiry into the source of such contrariety of opinion, resulting
from the labours of analysts ; and a satisfactory explication is
revealed in the fact, that the investigations have been conduct-
ed under incorrect principles. That Cornine constitutes an
ingredient of the Dogwood bark, and may be obtained there-
from, it is our design to demonstrate ; but that it possesses
alkaline properties, and combines Avith acids, are fallacious in-
ferences that have too long frustrated the sanguine anticipations
of the solicitous experimenter.

It is due the kindness of Dr. Robert Campbell, to mention
his valuable services in determining upon, and conducting the
io\\o\\\w^^ process for obtaining the Cornine:

Pulverize two lbs. of the well-dried bark of the root ; separ-

Ain. Juurn. Pharm., vol. ii., p. IM.

1849.] O'Keeflfe, on the Properties of Dogwood Bark. 7

ate its tannin with sulphuric a3ther, and filter. Macerate the
separated bark in alcohol for two days, to extract its resin and
cornine. Pour ofl^ the alcohol, and precipitate the resin with
-water. Filter off the resin, and precipitate the cornine from the
liquor with a solution of sub-acetate of lead. Separate the
sub-acetate of lead from the solution by passing a current of
sulphuretted-hydrogen gas through it. Filter, and evaporate
the fluid down to the Cornine.

This substance is possessed of decided acid properties, hav-
ing a well-marked acid reaction ; it is of a dark straw colour,
very bitter and astringent.

In support of our views, we can only bring forward the au-
thority of a celebi'ated chemist of Heidleberg, (Prof Geiger,)
whose remarks we insert in full.

"^ Cornine. Mr. Carpenter declares this bitter substance ob-
tained from the bark of the root of Cornus jlorida, to be a base.

'* Prof Geiger subsequently discovered acidous properties in
this bitter substance. It is soluble in water and alcohol, and
combines with the oxides of lead and silver. This bark con-
tains a crystallizable resin."*

In continuing to designate this principle under the original
name, an erroneous signification of its properties is implied,
from an analogy between the term cornine, and those of other
alkaline bases, e. g. morphine. But, whereas, Prof Geiger,
to whom originality had given a prior right, has not deemed it
necessary to substitute a change, we have described it under
the same appellation.

Medical properties and uses. This bark is tonic, astringent,
and somewhat stimulant in its action, and from the concurrent
testimony of numerous practitioners, who have given it an ex-
tensive trial, is the best native substitute for the cinchona, and
in some cases has been found successful, where this substance
proved ineffectual in preventing the return of paroxysmal fevers.

By country practitioners it has been extensively employed

" Cornin In der als Fiebermittel empfohleneu Wurzelriude von Cottvus
Jlorida glaubte Carpenter eine Pfiauzenbase auf gefuuden-zu haben.

" Geiger fandspater, dafs sie neben einem kristallisirbaren Harze einen Bit-
terstoff enthalte, von sauren Eigensehaften, in Wasser und Alkohol loslich.mit
Bleiessig und Salpetersauren SilberoxideNiederschlagebildend." {lland-Book
of Pliarviacy^ by Geiger, 5th Edition, p. 1105,

8 O'Keefie, on the Properties of Dogwood Bark. [January,

in intermittents, and the report they give is quite satisfactory.
Prof. Barton, and Dr. Gregg, of Bristol, add their decided tes-
timony relative to its efficacy in the cure of intermittent fever.
The latter writer states, that he has exhibited it for nearly
twenty-three years, during which time he invariably found it
sufficient to arrest intermittent fever, and uniformly beneficial
as atonic in cases of debility. It has also been employed with
apparent benefit in typhoid fevers, and other complaints for
which the Peruvian tonic has been found beneficial.

A decoction of it has been found successful in the "yellow
water,'' of horses, so fatal some years ago. An agreeable bitter
is made by infusing the ripe fruit or berries in spirits. The In-
dians employed an infusion of the flowers in intermittents; and
the same has been recommended in flatulent colic. It is some-
times combined with the barks of the Liriodendron and Serpen-
taria, either in decoction or in solution.

Such were the opinions of the profession with regard to the
Dogwood bark a half century ago; and such is the amount of
knowledge to be gleaned from all that has'been written upon the
subject. We will next proceed to give the process for prepar-
ing the Extract, inspired with the hope that it will fully corres-
pond with the suggestions expressed by Drs. Wood and Bache,
in the last edition of the U. S. Dispensatory: ^' An Extract
might probably be used with advantage in intermittents in large
doses y

Take of Dogwood bark, coarsely powdered, one pound;
Alcohol, /owr pints; Water, six pints. Macerate the Dog-
wood bark with the Alcohol for five days, pour ofi' the tincture,
and express. Boil the residuum for half an hour in three pints
of the water strain the litjuor, while hot, through linen, and
express: repeat the boiling for the same length of time, with
the three remaining pints of water, strain and express as be-
fore ; then niix the decoctions, and evaporate to the consistence
of a thin syrup. Distil the alcohol from the tincture, until it
acquires the same thickness ; then mix both inspissated liquors,
and evaporate tqthe consistence proper for making pills.

Much of the remedial virtues of this Extract depends on the
mode of preparation, and the quality of the bark em])loycd.
The bark of the stem vields, proportionately, more extract than

1849.] O'Keeffe, on the Propej^ties of Dogwood. Bark. 0

that of the branches ; the size of the tree, and thickness of the
bark, also contribute to augment the amount of extract obtained.
In evaporating the decoctions to the consistence directed, the
more quickly the process is conducted, the better ; for thus, the
duration of exposure to the prejudicial influence of the atmos-
phere, is diminished. Care must be taken in distilling the alco-
hol from the tincture, that the preparation sustain no injury by
adherence to the bottom and sides of the apparatus an acci-
dent a|)t to occur, if the process be prolonged beyond the pre-
scribed limits ; should the latter take place, the distillation will
have been continued to dryness, and the extract burned. Great
caution must be observed in conducting the evaporation of both
the inspissated fluids. To prevent the prepar'ation being burn-
ed during the latter stage of the process, it will be necessary to
remove it from the fire, and complete the evaporation in an
open vessel over a slow fire, at the same time keeping it fre-
quently stirred.

The use of alcohol is indispensable for extracting thej^esin of
the bark. The boiling may be repeated until the bark is entire-
ly devoid of bitterness, which result we have noticed after the
second boiling. From ten pounds of bark we obtained fifteen
ounces of extract, yielding the proportion of an ounce and a half
to a pound. The average consumption of alcohol is a pint to
the ounjce and a half of extract.

To the adept in Pharmacy, a descent into so minute a speci-
fication of directions and precautions is inapplicable; they are
simply the facts v;hich experience has furnished us, and are
solely intended to direct subsequent experimenters, who, deem-
ing the subject worthy of their consideration, may be induced
to adopt our formula in its preparation. In the hands of other
practitioners, its success may be equivocal: if so, we have no
hesitation in attributing its failure to the absence of the necessa-
ry care in conducting the process.

Medical properties and uses. At this early period of its ex-
istence, it would be un philosophical to venture upon a delinea-
tion of the precise modus operandi of this remedy upon the
system in a pathological state. For, although its eflfects in
various morbid conditions have palpably, and repeatedly, been
manifested, and might have aflbrded data, upon which to erect

10 0'Keeffe,onthePrope7*tiesofDogttJOodBa?'k. [January,

a comely theoretical superstructure destined, perhaps, ere^
long, to be sapped by some successful revolutionist still, far be
it from our purpose, to launch out unsupported into the void
realms of hypothesis, and revel in the short lived glories of a
precocious and presumptuous speculation; but content ourselves
with confining our statements within the limits of mere fact, nor
be obnoxious to the charges emanating from the varied inter-
pretation of results, consequent upon the disparity of human
opinions. The discrepancy existing, even at this advanced stage
of its history, regarding the effects of Quinine on the animal
economy, alone might warn us of so perilous an adventure. A
general, and in spme cases, a profuse perspiration, has been the
most obvious of its sensible effects; its astringency may be set
down as well authenticated, from facts which will be presented
in their proper place ; some patients have declared that it pro-
duced " ringing in the ears," &c., but such we regard as ill-
founded, and attributable rather to the agency of a morbid
imagination.

Of its alleged tendency to irritate the intestinal canal, enough
has been said, we trust, to satisfy the most skeptical mind ; so
far from producing any unpleasant effects in the stomach, or
bowels, diarrhoeas, when occurring as complications in inter-
mittent fever, have, not unfrequently, been arrested under its
administration.

Notwithstanding our confidence of its applicability under all
circumstances, where an anti-febrile remedy is indicated, we
would not be understood as denying the existence of gastric dis-
order in evei-y case in which it has been used. Such an asser-
tion would be equivolcnt to the annihilation of a symptom the
most uniform in a febrile paroxysm, viz., vomiting; and the
candid practitioner will be free to admit the peculiar embar-
rassment presented in the treatment by this distressing accident.
The writer, anxious to ascerj:ain with precision the effects of
large doses of the extract on the system in a physiological state,
has instituted the following experiment upon himself

10, A. M. 1st dose, 30 grs. Ext. ; pulse previous to taking it, 72.

11. 2nd dose, 30 grs. ; pulse intermittent, 72-70 ; tempera-
ture of surface somewhat augmented ; general perspiration ; a
sense of fullness and slight dull pain over the frontal eminences,

1849.] O'Keeffe, on the Properties of Dofrwood Bark. 1 1

much increased on flexing tlie head forward and downward ;
uneasy feelings in the stomach and bowels.

12, M. 3d dose, 30 grs. ; pulse 76, not intermittent, but some-
what depressed ; sensation in the head uniform. On taking this
dose a sense of warmth was felt in the stomach, and radiated
over the surface of the trunk.

1, P. M. 4th dose, 30 grs. ; pulse 76, and regular ; pain in the
head augmented, and extended down the forehead to the eye-lids,
with a disposition to sleep; slight oppression in the precordia.

Eating dinner, neither mitigated nor heightened the dull head-
ache, which continued the same throughout the day : at night,
tendency to sleep much more urgent retired early, slept well
dui'ing the night, and arose in the morning free from any un-
pleasant sensations whatever.

The effects manifested in the foregoing instance by the inges-
tion of 3iL of the Ext., in solution the largest quantity ever
taken in so short a time, would appear to controvert the opinion
of its being a stimulant. Dr. Walker found the bark to aug-
ment the force and frequency of the pulse, and to increase the
temperature of the body effects which viay have been pre-
sented to this practitioner in the administration ot the bark, and
which, (as stated in our premises,) it is not our province to cor-
roborate nor refute. But, from the exhibition of the extract,
results, diametrically opposite to the former, will be found to
obtain the pulse, if previously excited, becomes soft and regu-
lar ; if natural, no material alteration is perceptible. The tem-
perature is slightly increased, invariably attended with copious,
sometimes, profuse universal perspiration, generally commenc-
ing after the second dose, and continuing several hours subse-
quent to its discontinuance.

The following cases, subjected to our own management, will
sufliciently sustain the positions assumed, in relation to the effects
and remedial powers of this Extract. A faithful history of the
most prominent symptoms observed in every case is given in
detail, particularizing those which distinctly exemplify the as-
sertions we have made. To the practitioner of this climate, a
minute relation of the ordinary characteristic symptoms of a
paroxysm of simple intermittent fever may appear futile and
uninstructive : for it need scarcely be added, that the tyro in

12 O'Keeffe, on the Properties of Dogwood Bark. [Januar}',

Medicine, and not unfrequently, the miprofessiona], in tliis ini-
mediate locality, being flimiliar with the specific, can control a
simple intermittent in as short a time, and with as much facility,
as the most experienced. Under ordinary circumstances, minu-
tiae would be unnecessary ; but when the object in view is to
establish the efficiency of a new remedy in any case whatever of
paroxysmal fever, it becomes necessary to relate accurately, the
phenomena, which taken collectively, entitle it to be ranked
among this class of diseases: otherwise the reader would be at
liberty to doubt the genuineness of such a case. And further, it
may be remarked, that few localities afford the medical practi-
tioner as ample facilities of familiarizing himself with the linea-
ments and protean types of malarial disease, as are presented in
our region ; therefore, have we thought proper to record all the
symptoms of which we were cognizant.

With a view to succinctness, the cases have been classified
according to the special points which they are" designed to
illustrate.

Case I. Sam, a negro, a^t. 2.5, steam-boat hand, of full ple-
thoric habit, previous health much impaired, being a dyspeptic;
had fever 12, M., on the 24th Sept. 1848. At 4, P. M., 25th,
had a second paroxysm, and at 8, A. M., 26th, a severe chill
succeeded by fever. First visit, 4, P. M., to-day found his
skin uniformly hot, though partially moist ; violent head-ache ;
pain in the back and limbs; pulse full, strong and frequent. He
had taken some patent pills (by his own prescription) which
had operated freely. Prescription : Ext. Cornus 4 grs. every
hour till 56 grs. are taken; sinapism to the whole length of the
spine.

1, P. M., 27th. Found him sitting up, with but little fever;
has taken the Ext. Cor.; sinapism applied ; perspired profusely
during the night says he '' thought it would never quit pouring
off him" had to exchange clothes several times; feels exhaust-
ed, and has slight pain in the back and limbs. Ext. Cor. 8 grs.
at 4, A. M., 28//i ; repeated every hour till 30 grs. are taken.

1,P. M., 28th. Prescription followed ; had an exacerbation
of all the febrile symptoms at 4, P. M. yesterday ; there was con-
siderable aggravation of the pains in the back and extremities;

1849.] O'Keefib, on the Properties of Dogwood Bark. 13

throbbing pain in the head ; tenderness of the epigastrium, with
darting pain through the stomach and vomiting. These symp-
toms continued all night ; slept none ; the pulse now is quick
and irritable ; skin warm, and bedewed with gentle perspiration
on the head and shoulders ; respiration somewhat impeded ;
tongue coated white ; complains of permanent pain in the
lower dorsal region ;- by his side is a pan containing a large
quantity of a thin, white, frothy fluid an excessive flow of
saliva, which had commenced soon after the exacerbation had
made its incursion. Ordered : Cal and Rhei. aa 15 grs. ; sinap-
ism to the spine ; 8 grs, Ext. Cor. at 8, A. M. 29th, repeated
every hour until 48 gi^s. are taken.

2, P. M., 29th. Has taken the Ext. Cor. as directed, but not
the Cal, &c. At 3, P. M., yesterday, exacerbation returned,
but its severity was very much mitigated ; great relief was ob-
tained from sinapism to the spine ; pulse weak and irritable ;
skin moderately cool very nearly natural in temperature ;
tongue coated, with a disagreeable taste in the mouth ; tender-
ness on pressure at the epigastrium, extending down the abdo-
men ; constant and copious eructation of frothy fluid. Ext.
Cor. 8 grs. every hour till 4^0 grs. are taken.

11, A. M., 30th. Has no fever; no exacerbation since last
visit ; prescription partially attended to has taken but 28 grs.
Ext. Cor. ; bowels much constipated. Calomel and Rhubarb
aa 15 grs., to be taken instanter.

4, P. M. Sent for in haste to see him : found him in a coma-
tose condition, which had supervened soon after my departure
this morning; can articulate indistinctly; from 12 to 2 o'clock
was speechless, nor could he be aroused by the loudest calls ;
skin is now universally coo' ; pulse slow and feeble ; shrinks
and groans upon the slightest pressure over the epigastric and
umbilical regions ; complains of exquisite pain in the stomach
and bowels. At 111 this morning, he took the Cal., &c., be-
came suddenly sick at the stomach, vomited freely, then sunk
into his present state. It is proper to remark, that at the time
of taking this powder, he had not had an operation in three
days owing to neglect on the part of the attendants; since
taking it, he has had two stools. Prescribed: hot mustard
pediluvium; blister-plaster over the epigastric and umbilical

14 O^Keeffe J on the Properties of Dogwood Bark. [January

Oct. 1st, 10, A. M. Blister has drawn well; pain in the
stomach relieved is much better. No medicine to-day.

Oct. 2nd. Continues to improve ; no fever.

This patient continued to improve steadily without further
medication.

Case II. A. M., white woman, set. 36, residence near the
cemetery, of delicate habit, constitution impaired. Three weeks
since, had three paroxysms of quotidian intermittent fever, for
which she had been treated by the reporter with quinine, &c.
On the arrest of the fever, menstruation commenced and lasted
three days ; a week intervened with comparatively good health,
when the menses returned more copious than ordinary for five
days. During all this time, she says she has had fever, more
or less marked, every day, owing doubtless to her menstrual de-
rangement. This brings us to the history of the disease under
consideration.

On the 14th Sept., the day on which the menses disappeared,
had a slight chill about 8, P. M. ; represents herself as having
slept none that night.

1 5th. A chill at 12, M. 7, P. M., first visit this is her
state : skin preternaturally warm and dry ; pulse feeble, fre-
quent and irritable ; tongue parched and coated brown ; pain
in the back, and extremities, particularly in the lumbar and
upper dorsal regions ; eyes icterode ; bowels torpid, having had
but one evacuation in a week ; vomiting and tenderness in the
epigastric region. Prescription : Calomel and Jalap, aa 1 5 grs. ;
sinapism to the spine ; 8 grs. Ext. Cor. at 12, M., I6th, repeat-
ed every hour till 60 grs. are taken.

16th, 4, P. M. 32 grs. Ext. taken ; Calomel and Jalap, and
sinapism, attended to as directed ; has had two stools ; feels
much better ; pulse soft and somewhat excited. Since the first
dose of the Ext., the surface has been universally covered with
perspiration the only physical effect of the medicine; pain
and weakness in the back relieved by sinapism ; vomited freely
last night describes the matter vomited to be largely mixed
with bile ; head-ache and tenderness in the right hypochondri-
um most prominent symptoms. Prescription continued a
directed.

1849.] O'Keeffe, on the Properties of Dogwood Bark, 15

17th, 1, P. M. Has taken the Ext. ; exacerbation returned
about 8 last night; was delirious ; all the symptoms of the pre-
vious paroxysm were somewhat aggravated ; vomited frequent-
ly and copiously ; thirst urgent drank cold water ad lihituin.
The pulse now is full and frequent ; skin warm and soft, being
inclined to perspire ; head-ache severe, with neuralgic pains in
the face : exquisite tenderness in the cervical and upper dorsal
spine shrinks from the slightest pressure on that region ; ten-
derness in the epigastric, with a dull, heavy sensation in the
right hypochondriac regions ; tongue dark, coated in the centre,
red at the tip and edges ; eyes suffused and yellowish ; has
vomited twice since morning ; bowels constipated. Ordered :
hot mustard pediluvium every two hours ; strong sinapisms to
the spine, and over the epigastrium ; one laxative pill to-night ;
16 grs. Cornus every hour till 80 grs. are taken.

18th, 11, A. M. Prescription strictly followed; had a miti-
gation of all the symptoms commencing about 5, P. M. yester-
day; commenced perspiring after taking the second dose of the
Ext., which continued all night ; slept tolerably well com-
plaining of slight head-ache and sick stomach. This is her
present state : pulse weak, and 90 per minute ; skin moist, and
natural in temperature ; tongue clearing off; slight pain in the
head, with great exhaustion; bowels costive. A compound
powder of Aloes 2 grs., Calomel 3 grs., and Rhubarb 10 grs. ;
4 grs. Ext. Cor. every hour till 48 grs. are taken ; diet, rice
gruel, and chicken soup.

19th. Has taken all the medicine ; has had one stool ; had a
comfortable night's rest; pulse natural; perspired freely after
taking the Ext. Cor. ; has slight pain in the head ; bowels still
constipated. Ordered : Cream of Tartar and Jalap, on alter-
nate nights, to keep the bowels regular ; diet, as before.

20th. Faund her up, and attending to her ordinary avoca-
tions. Convalescence may be dated from this period.

Case III. Mrs. T., aged 45, of delicate habit, good consti-
tution, complained of tenderness in the legs and feet on the night
of the 27th Sept. ; to this tenderness succeeded lancinating
pains, with heat, swelling and redness. 28th. Felt a general
uneasiness, with some fever ; pains in the back and shoulders ;
great restlessness, and want of sleep.

1 6 O'Keeffe, on the Proper^ties of Dogwood Bark. [January,

29th, 4, P. M. First visit : had a severe chill about 8 this
morning ; pulse full, strong and frequent : skin hot and dry ;
countenance flushed ; tongue parched, and coated white ; severe
head-ache ; pains in the back and extremities ; pain in the epi-
gastric region ; the inflamed state of the legs and feet unabated,
the slightest pressure on the legs producing the most exquisite
pain, amounting to faintness; thirst urgent. Prescribed: Calo-
mel, 15 grs., incorporated with one laxative pill ; sinapism to
the whole length of the spine ; cold water, ademesem ; 15 grs.
Ext. Cor. at 4, A. M. SOth, repeated every hour till 60 grs. are
taken; an infusion of Salts and Senna to-morrow morning.

30th, 12, M. Prescription followed : has had several copious
stools ; vomited pretty freely last night ; slept but little ; had a
mitigation of all the symptoms, commencing about 3 this morn-
ing, the pain in the legs excepted ; exacerbation returned be-
tween 8 and 9, with increased intensity ; has vomited several
times; head-ache violent, with delirium; excruciating pain in
the legs and feet ; pulse full and strong, 135; skin intensely hot
and dry ; tongue parched and coated ; pain in the back and
shoulders cannot move without distressing pain; respiration
hurried and oppressed ; great tenderness in the epigastric and
both hypochondriac regions ; vomits frequently. Ordered :
undiluted sinapisms to the spine and abdomen ; cold aflusionto
the head frequently ; cold water in large quantities, to promote
vomiting.

9, P. M. No abatement of the foregoing symptoms, vomit-
ing excepted ; has vomited but once since the application of
sinapism over the abdomen. 16 grs. Ext. Cor. at 2, A. M.,
Oct. 1st, repeated every hour till 80 grs. are taken.

Oct. 1st, 12, M. Has taken the medicine; had a remission
about 1, A. M. ; has not had a return since. The pulse now is
soft, and 98; skin warm and moist; swelling and tenderness in
the legs much relieved; slight pain in the head ; pain in the
back and stomach all disappeared ; bowels torpid. Three laxa-
tive pills ; A grs. Ext. Cor. every hour until AS grs. are taken.

2nd. Has taken all the medicine ; all febrile symptoms dis-
appeared only slight tenderness in the right leg.

From this time, Mrs. T. continued to improve steadily till
convalescence was complete.

1849>.] O'Keeffe, on the Properties of Dogwood Bark. 17

Here we have three well-marked cases of Intermittent fever,
brought to a happy termination by the Extract of Dogwood
hark. Independenlfof their applicability to illustrate the effi-
ciency of the Ext. Cor. in the treatment of paroxysmal fevers,
it is proposed to give to each a separate consideration, for the
purpose of adverting to certain adventitious complications
closely connected with the modern pathology of this disease.

Case No. 1, presents us with a dyspeptic, or perhaps, what
Prof Garvin would denominate a subject of "morbid sensibility
of the stomach.*'* To effect a cure, 162 grs. of the Extract
have been given without producing any unpleasant effect in
the intestinal canal. That the fever subsided into a local
phlegmasia gastritis, cannot be denied ; it would be absurd in
the extreme, not to admit the supervention of a complication of
sucb frequent occurrence in intermittent as well as in remit-
tent fever ; but it is presumed that no physician, (if he be not
of the physiological school,) guided by a correct pathology of
remittent fever, will attribute this gastric disorder to any other
source, than simply an accident Jable to occur, independently
of any mode of treatment. Prof Ford, speaking of the abortive
treatment of remittent fever, says,f "If after the subduction of
the fever, there remains the evidence of disease in the liver or
stomach or bowels, then this may be corrected by appropriate
remedies, more readily, more safely and effectually, than during
the fever. The writer would insist upon this subsequent treat-
ment of any remaining disease, as a necessary part of this
abortive treatment."

We likewise have additional corroboration of the impressive
inculcations of the latter writer, viz : that paroxysmal fever is
independent of the local affection, in the case before us ; the
paroxysms have been arrested by the anti-periodic treatment,
while the local affection remains to be combatted by local ap-
plications. It may be further remarked, that the first two
paroxysms were simple intermittent of the double tertian type;
that they became remittent, and passed on to convalescence, the
local affection alone remaining to be subdued by appropriate
remedies.

By this case and such others, then, are obviated two grave

* Southern Med. and Surg. Journ., vol. 2, p. 705. t Op. cit., vol. 3, p. 139.
N. S. VOL. V. NO. I. 2

18 O^Keeffe, on the Properties of Dogwood Bark. [January,

objections, found in books, to the use of the preparations of the
Dogwood bark, viz: 1st, that large quantities will produce dis-
order in the stomach and bowels; and 2dly0that in any quantity
it produces diarrhoea, griping pains, &c. An instance, perhaps,
<^ould not be found, which in a higher degree combined the
peculiarities which would predispose to these unpleasant con-
sequences, than the one under consideration ; for it is a well-
established principle, that a pre-existing morbid condition of
any organ will, generally, be increased by intermittent or re-
mittent fever ; and such precisely obtained here. The morbid
sensibility of the stomach predisposed that organ to inflamma-
tion ; its development was gradual, as evinced by the frequent
eructation of colourless fluid the morbid sensibility of the
stomach extending to the salivary glands, according to Prof
Garvin ;* and the febrile paroxysms acting as the exciting caOse.
These facts, it is hoped, will sufficiently account for the super-
vention of gastritis in the present case, and dissipate the un-
founded objections raised in conformity with doctrines long
since obsolete.

In case No. 2, we have an instance of simple intermittent
fever renewed at the third hebdomadal period by an attack of
remittent fever, and arrested by the second administration of
the Ext. of Dogwood bark. It may be seen that the disease
preserved the double tertian type throughout its course ; that
vomiting, an almost invariable symptom in remitttent fever,
occurred previously and subsequently to the exhibition of the
Extr., no modification resulting from its action ; and that after
the first dose, the obstructed cutaneous secretion has been re-
stored to the great comfort and relief of the patient.

Here a disquisition of peculiar importance piesents itself, viz.,
as to whether the Ext. of Dogwood bark exercises a prophy-
lactic influence in obviating the hebdomadal recurrence of pe-
riodic fevers. It is generally conceded that the recurrence of
the disease, under the hebdomadal form, is of more frequent
occurrence since the introduction of quinine as a therapeutic
agent; and its exclusive employment in the cure of paroxysmal
fevers, than previous to that time.

Without advocating the opinion that quinine predisposes the
* Op. c it., p. 707.

1849.] O'KeefFe, on the Properties of Dogwood Bark. 19

system to these periodic invasions, the inferences rationally de-
ducible from the general properties of the Ext. of Dogwood
bark are that with antiperiodic, it combines tonic virtues,
therefore its effects on the system are more permanent than
those of quinine, to which modern observation will not ascribe
these properties in so high a degree ; that by imparting tone to
the system, it secures a more favourable and fortified condition
of the organs for resisting the subsequent encroachments of the
morbific agent ; and consequently, may not this latter qualifica-
tion give it an important advantage over quinine, inasmuch as
it is calculated to accomplish /?er se, w'hat would require quinine,
"with a course of tonic treatment?

A few cases could be adduced in support of the position
here suggested, Which Will be adverted to en passant; but to
substantiate and mature such a proposition, would demand the
evidence of protracted experience. And should subsequent
observation add confirmation to the truth of the foregoing sug-
gestion, the profession will have attained the link which now
seems deficient in the chain of ratdical treatment of paroxysmal
fever.

Case No. 3, presents but little variation from the two pre--
ceding cases, only being complicated by anasarca, which was
a peculiarly distressing accident. The connection between the
paroxysms and the local affection is shown by the subsidence
of the latter, without any local application, on the arrest of the
former. The second administration of the Ext. Cor. prevented
a return of the exacerbation.

Case IV. F. C, a mechanic, set. 32, residence on the;
canal intemperate habits. On the 10th July, he was taken
with a chill succeeded by fever.- 12th, second paroxysm, and
on the 14th, third paroxysm. It is proper to remark, that at
this time, he was convalescing from some hepatic affection of
three weeks continuance, manifested by anicterodestateof the
skin, and slight tenderness on pressure, over the liver and stom-
ach.

16th, 7, P. M. First visit found him in the sweating stage
of a paroxysm, which came on about 12, M., to-day ; the tongue
is coated, and red ; breath offensive ; great tenderness on pres-

60 O'KeefFe, on the Properties of Dogwood Bark. [January,

sure over the epigastric, and right hypochondriac regions; also
over the dorsal vertebrae. Sinapism, to the epigastrium and
dorsal spine; Cal. 20grs., Jal. 10 grs.; S grs. Ext. Cor.atl.A.
M. 18th, repealed every hour until AQ grs. are taken.

19th, 4, P. M. Prescription followed ; had a paroxysm yes-
terday about 3, P. M. Mitigated in all the symptoms, and of
shorter duration than the preceding; has had several stools ;
tenderness over the liver relieved ; is free from fever, but there
being anorexia and much debility, has kept his bed all day.
8 grs. Ext. Cor. at 7, A. M. 20th, repeated every hour till 64 grs.
are taken.

21st. Took 64 grs. Ext. Cor. ; missed the paroxysm ; local
pains and tenderness all disappeared ; appetite and colour of
skin much improved. Convalescence was rapid, notwithstand-
ing the protracted illness.

Case V. Phil, a negro, rail-road hand, aged 29, strong con-
stitution, occupation a blacksmith, had a chill 12, M., 9th Sept.,
attended with vomiting, diarrhoea and griping pain in the bow-
els. 10th. Had the second chill about 12, M., diarrhoea and
griping pain persistent.

11th, 10, A.M. First saw him has no fever, but is mUch
exhausted; diarrhoea and pain in the bowels most prominent
symptoms. Prescribed: Cal. and Dover's powd., aa 15 grs.;
20 grs. Ext. Cor. every hour till 60 grs. are taken.

3, P. M. Paroxysm returned at 12, M. ; has taken all the
medicine ; has slight fever now ; no vomiting ; diarrhoea and
griping pain relieved the former completely checked. Infu-
sion of salts and senna to-night.

12th, 41, P. M. Has taken the salts and senna; several co-
pious stools; has no f^weY, no pain feels much better, but
weak. 12 grs. Ext. Cor. at 7, to-morrow morning, repeated
every hour till 60 grs. are taken.

13th, 4, P. M. Took the Ext. Cor., which produced slight
vertigo ; no fever convalescent.

Case VL S. L., a white girl, aged 9 years, of delicate habit :
5th Sept., had the first paroxysm ; 6th, chill at 10, A. M.
7th, 11, A. M. First visit found the pulse excited; skin

1849.] O'Keeffe, on the Properties of Dogwood Bark. 21

warm ; has had diarrhoea since she was first taken ; took a dose
of oil yesterday morning, which had operated freely antici-
pates a chill momentarily. 12 grs. Ext. Cor. every hour till
36 grs. are taken will take at 4, to-morrow morning, 8 grs,
Ext. Cor., repeated every hour till 24 grs. are taken.

8th, 11, A. M. Had taken but one dose before the invasion
of the paroxysm on yesterday, which was succeeded by fever
of short duration; has taken this morning three doses of Ext.
Cor. Same continued till two doses more are taken.

9th. Had no return of the paroxysm yesterday ; has not had
any to-day ; diarrhoea checked convalescent.
.'*.

Case VII. Mrs. B. set. 60, of delicate habit, residence lower
part Green-street, has had quotidian fever since the 21st Aug.

28th, 1, P. M. First visit was free from fever, but expect-
the return of a paroxysm about 8 this evening, which was the
usual time of access ; since the first invasion, she has had diar-
rha3a with occasional pain in the bowels, which became aggra-
vated by each successive paroxysm. Prescription: Ext. Cor.
GO grs. ; pulv. Opii. 2 grs. ; \ every hour until all are taken.

29th, 11, A.M. Directions followed: produced free perspi-
ration; bowels more regular; missed the expected paroxysm;
was slightl}^ under the influence of opium. 8 grs. Ext. Cor.
every hour till 48 grs. are taken.

30th, 10, A. M. Has taken the medicine ; no febrile symp-
tom ; pulse feeble and regular; surface cool and natural. No
medicine to-day.

31st. Continues to improve ; bowels torpid. Ordered three
laxative pills.

Sept. 1st. Convalescent.

Case VIII. G. K., set. 13, occupation in the Factory, had a
chill at 11, A. M., Sept. 11th, succeeded by fever of long dura-
tion. 12th. Chill at the same time. 7, P.M. First visit pulse
full, frequent and soft; skin moderately hot and dry; pain on
the slightest pressure over the dorsal spine and epigastric region ;
complains of slight soreness in the throat; diarrhoea with occa-
sional griping pain in the bowels; has vomited several times
to-day. Ordered two laxative pills ; a strong infusion of capsi-

22 O'Keeffe^ on the Properties of Dogwood Bark. [January,

eum and alum, as a gargle ; sinapisms to the spine and epigas-
tric region; 12 gj's. Ext. Cor. at 6, A.M. to-morrow, repeated
every hour till 48 grs. are taken.

14th, 12, M. Took the medicine yesterday ; paroxysm re-
curred at 2, P. M., of shorter duration than the preceding, and
much' mitigated; vomiting, diarrhoea and pain in the bowels
relieved ; tenderness in the throat removed ; has had several
consistent stools. 16 ^rs, Ext, Cor. every hour till 48 grs. are
taken.

15th, 4, P. M. Prescription follov^^ed ; missed the paroxysm
yesterday is up and about. No rriediGine to-dg-y.

16th. Fully convalescent,

From the third case, we have five cases of simple intermittent
fever, satisfactorily treated by the Ext. of Dogwood bark, which
establish, sine duhio, the propriety of its administration, irre^
spective of circumstances.

In the fourth case, we have a tertian intermittent cured by
the second exhibition of the Ext. Cor. The effect of 40 grs*
taken on the 18th, was to retard the period of invasion from
12, M., to 3, P. M., together with a mitigation of all the symp-
toms ; 64 grs. given in anticipation of the next accession secure-
ed its prevention. Here, there must have existed more or less
disorder of the entire intestinal canal, yet, how satisfactorily, not
only, has the fever been arrested by the Ext. Cor.-^^the assumed
** irritant" of authors but his whole system has regained tope
under its use!

The fifth case forcibly" maintains its aptitude in all cases
where the quinine is indicated, regardless of the state of the
gastro-inlestinal surface. With this patient, gastro-intestinal
disorder wap a most distressing complication, as evinced by
vomiting, pain in the bowels and diarrhoea; yet in the face of
these apparent contra-indications, the Cornus with the pro-
fession the reputed irritant to the stomach and bowels: is ad-
ministered not only with impunity, but decided advantage. It
is evident in this case, that on the first administration of the
medicine, the remaining time of the intermission was not suffi-
cient to bring the patient under its influence ; the paroxysm
returned with less severity, yet it was not without effect ; for

1849.] O^Keeffe, on the Properties of Dogwood Bark. 23

on the 12th, though no medicine was given, the paroxysm did
not recur showing its permanent influence over the system.

The repetition of a drachm on the 13th, ensured convales-
cence,-furnishing conclusive evidence of the safety of giving
two drachms of the Ext. Cor. upon an irritated stomach and
diseased bowels, and thus commending this medicine to our im-
plicit confidence, even under such circumstances.

In case No. 6, it will be seen that but one dose of the Ext.
had been taken previous to the accession of the chill on the 7th ;
40 grs. taken on the 8th, obviated the paroxysm and cured the
diarrhoea. Upon this case, more comment is unnecessary, fur-
ther than to notice the propriety of administering the medicine
to the child with as much safety as to the adult.

In the seventh case, the paroxysm is arrested by a drachm of
the Ext. two grs. of opium forming an element in the prescrip-
tion. Whether to attribute the subsidence of the diarrhoea to
the opium or Ext. Cor., the facts of the case ^alone do not war-
rant a decision. But from a careful consideration of analogous
cases in which no opiate has been employed, we feel justified in
the opinion that results equally satisfactory would have obtain-
ed under the influence of the Ext. Cor. alone. The next may
serve as an instance.

In case 8, the paroxysm is not prevented by the first prescrip-
tion ; but the time of access is retarded from 11, A. M., to 2,
P. M. ; its severity moderated, and duration curtailed ; and the
gastro-intestinal disorder rectified as promptly, safel}^ and ef-
fectually, as in the preceding case by the co-operation of an
opiate.

In the report of the five last cases, the object has been to
corroborate the assertions advanced in our premises, viz : that
the Ext. of Dogwood bark has no tendency to irritate the intes-
tinal canal ; but, on the contrary, when disordered, that the
celerity with which its healthy action is restored by the agency
of this pedicine, sanctions its unconditional apphcation in simi-
lar cases.

There is another most valuable property invariably mani-
fested by this medicine, to which we would invite especial
attention : it is its well-marked influence over that condition of
the system which determines obstruction of the cutaneous ex-

24 O'Keeffe, on the Properties of- Dogwood Bark. [January,

halation. In the foregoing cases characterized by disorder of
the mtestinal canal, the manifestations of its utility have been
so obvious as to suggest a close analogy between its modus
operandi and that of the Dover's povs^der, in controling the
morbid phenomena indicating the use of the latter remedy
combining in a certain degree the actions of both a diaphoretic
and a sedative. And further, to this sudorific agency may be
fairly ascribed the subsidence of the diarrhoea complicating the
above-detailed cases. So uniformly has this diaphoretic pro-
perty been evinced, that v^e have not hesitated to administer it
in any stage of a febrile paroxysm, thereby superinducing an
alleviation of the febrile symptoms by the early establishment
of the "sweating stage." In support of this view special cases
could be brought forward, but our limits interdict their insertion.

Case IX. J. S. set. 15, of relaxed habit, residence in Har-
risburgh. About four weeks since, he had three paroxysms of*
quotidian malignant intermittent fever the two last being at-
tended with all the symptoms characteristic of this type, viz.,
dehrium, jactitation of the arms and legs, stupor, speechlessness,
&c., &c. ; for which he had been treated by the reporter with
the ordinary remedies active depletion, general and local;
revulsion by vesication and sinapisms ; quinine, hot mustard
pediluvia, cold affusion to the head, &c. On the 0th August,
8, A. M., had a severe chill, followed by fever, which lasted till
about 4, P. M. A perfect intermission on the 7th ; and at
8, A. M., 8th, had a second chill, and fever of the same continu-
ance, but augmented in intensity.

First saw him at 7, P. M., 9th was then in usual good health,
but had many apprehensions of the expected paroxysm. Or-
dered: Blue mass, 20 grs. with one laxative pill ; 16 grs, Ext,
Cor. at 4, A.M., lOth, repeated every hour until (SO grs. are
taken; sinapism to the spine at 6, to-morrow morning.

10th, 11, A. M. Has taken the prescription; one copious
stool this morning; skin pliant and moist; pulse soft and regu-
lar; complains of nausea and slight head-ache; has no fever.
Infusion of salts and senna.

11th. Convalescent.

1849.] O'KeefFe, on the Properties of Dogwood Bark. 25

Case X. Nases, a negro, rail-road hand, aged 32, full ple-
thoric habit. Three weeks since, Imd five paroxysms of quoti-
dian intermittent, fever, treated with quinine.

7th Sept., 10^, A.M. Was taken with a chill, succeeded by
fever, which lasted all that day. An intermission on the 8th.
7, P. M., first visit expected a recurrence of the paroxysm
to-morrow morning. Ordered : Cal. and Jal. aa 15grs. ; Sgrs.
Ext. Cor. at 4, A. M., 9th, repeated ei:ery hour till 64 grs. are
taken.

9th, 5, P. M. Prescription followed ; has been freely opera-
ted on ; missed the paroxysm, and has no symptom of disease.

10th. Convalescent.

Case XI. M. C, aged 21, full Ifabit, strong constitution, oc-
cupation in the Factory. One week since, she had tertian
intermittent of five weeks duration, of which she was cured by
quinine, &c.

1, P. M., 11th Sept. Had a chill, followed by fever, and at
9, A. M., 12th, is found free from fever, but much indisposed.
Prescribed: Ca!. and Jal. aa 15 grs.; IQ grs. Ext. Cor. every
hour till 64 grs, are taken. 6, P. M. Has had several evacua-
tions; has taken but 32 grs. of tfie Ext. Cor.; no fever during
the day. S grs. Ext. Cor. at 8, A.M., 13th, repeated every
hour until 32 grs. are taken.

13th, Took the medicine; no fever. Dismissed, convalescent.

N. B. We have had an opportunity of seeing the three last
recorded cases frequently since their respective time of treat-
ment ; we can, therefore, vouch for their radical cure. Nov. 9th.

Here we have three cases of intermittent fever recurring
under the hebdomadal form after the quinine treatment, in which
this tendency is eradicated by the use of the Ext. Cor. show-
ing, at least as far as they go, the prophylactic virtue of this
article.

^L-Case 9, offers for our consideration, a tertian intermittent,
returning at the fourth hebdomadal period, after an attack of
malignant intermittent, which shows satisfactorily the efficacy
of the Ext. Cor., as well as many of the characteristics of this
affection, viz., its liability to recur at hebdomadal periods, inde-

26 O'Keeffe, on the Properties of Dogwood Bark. [Januarj^

pendent of the mode of treatment ; a progressive increase in the
intensity of each succeeding paroxysm, which, if not arrested
by medication, mig_ht have assumed the malignant type as on
the occasion alluded to, the malignant was preceded by two
paroxysms of simple intermittent. On the first administration
of the Ext. in this case, the result obtained could not have been
surpassed by the use of any anti-periodic agent.

On cases 10 and 11, we will forbear commenting; but for
further remarks upon this division of the subject, reference may
be had to our observations on case 2.*

There are some other cases which, from having no direct
relation to the special points which the preceding cases are re-
spectively designed to elucidate, could not be comprised under
any of the three divisions ^bove laid down, yet they may be
worthy of note, as justifying the claims of the Extract of Dog-
wood bark to anti-periodic power.

Case XII. Mrs. B., oet. 42, of full habit, has had quotidian
intermittent fever since 1st Sept., the time of access being va-
riable. Took, on the 6th, 20 grs. quinine ; notwithstanding the
paroxysm returned about 12, at night. At 10, A.M., 7th, the
skin is found cool and dry : puFse feeble and frequent ; head-ach^
and pain in the lumbar region; great exhaustion and restless-
ness; tongue slightly furred. Prescription: Sinapism to the
spine; 8 grs. Ext. Cor. every hour till 64 grs. are taken.

8th, 9, A. M. Has taken the medicine, missed the expected
paroxysm is much better in every particular. 10 grs. Ext.
Cor. at 8, P. M., repeated every hour till 40 grs. are taken.

9th. Has taken the medicine ; no fever since last visit
convalescent.

Case XIII. Howard, aged 23,' a steam-boat hand, occupa-
tion cook, previous health very good, has had intermittent fever
of the double-tertian type since August 27th.

First saw him 9, A. M., 1st Sept. had no fever, 4, P. M., be-
ing the usual time of access. Ordered, 8 grs. Ext. Cor. every
hour till 72 grs. are taken.

*Tn the four cases of the hebdomadal type which we have given, the immuni-
ty from subsequent attacks was ascertained by frequently visiting them from
the period of the first invasion until the present time November 5th, 1848.

1849.] O'Keeffe, on the Properties of Dogwood Bark. Sf

2nd, 10, A. M. Has no fever, missed the paroxysm yester-
day; bowels constipated. Ext. Cor., 8 grs. every hour till AS
grs. are taken; Cal. and Jal. aa 15 grs.

3rd. Has taken the prescription ; no fever convalescent.

Case XIV, A. C, aged 21, of full plethoric habit, occupa-
tion in the Factory has had tertian intermittent since 2d Sept.
Assumed the double-teitian type on the 8th.

9th, 4, P. M. First visit paroxysm came on at 10, this
morning, havino^ taken, previous to its accession, quinine pills ta
the amount of 25 grs. (by her own prescription). 'J'he skin is
now hot and dry; head-ache violent; pulse frequent and irrita-
^ ble ; exquisite pain ip the back and epigastric region. Order-
ed : Sinapisms to dorsal spine and epigastric region ; 8 grs.
Ext. Cor. at 4, A. M., to-morrow, repeated every hour till 48
grs. are taken,

10th, 12, M. Prescription followed; no fever perfect in-
termission, l^grs. Ext. Cor. at 5, to-morrow morning, repeated
every hour till 60 grs. are taken.

11th, 6, P. M, Has taken all the medicine; no symptom of
fever at any tinje of the day. Convalescent.

Case XV. Mrs. N set. 26, of strong constitution, previous
health generally good. At 10, A. M., 10th August, was taken
with a chill 6, P, M finding her thus : skin generally warm
and moist ; pulse soft and feeble; occasional sickness at the
stomach, but no vomiting ; a shooting pain through the right
breast, productive of much distress and embarrassing respira-
tion; tongue foul; head-ache; pain in the back and limbs
especially severe in the hip, knee and ankle-joints, the slightest
motion of the lower extremities being attended with great suffer-
ing. Cal. and Rhub. aa 10 grs.; 8 grs. Ext. Cor. at 4, J.. M.,
nth, repeated every hour till 48 grs. are taken.

11th, 4, P.M. Prescription attended to; two stools this
morning; paroxysm recurred at 10, A. M., not preceded by a
chill, and, as she represents, much mitigated ; head-ache, sick
stomach, and pain in the breast, persistent ; skin moist; tongue
clean at the tip and edges ; pulse 120, and feeble. Ordered, an
iofusion of salts and senna ; sinapism to the whole length of the

28 O^Keeffey on the Properties of Dogwood Bai^k. [January,

spine ; 15 grs. Ext. Cor. at 6, A. M., I2th, repeated every hour
until 60 grs. are taken.

12th, 11, A. M. Directions followed several copious stools;

skin pliant, and partially bedewed with perspiration; had slight
head-ache about 9, this morning, but was only transient ; pain
in the breast and joints relieved. No medicine to-day.

13th. Found her up and at work, without fever or any local
pain. The convalescence of Mrs. N. was pleasingly satisfactory.

Respecting these cases we will only add, that such could be
multiplied ad infinitum, from the practice of my preceptors,
Drs. Campbell ; but we trust that the views propounded in this
thesis are amply sustained by arguments fairly deduced from
the fads presented in the cases alread}^ cited.

Impressed with the importance of establishing foi;this remedy
a confidence commensurate with its value, we will further add,
that in simple intermittent fever, the paroxysm is generally ar-
rested on its first administration invariably upon the second ;
that no complicating accidents should contra-indicate its em-
ployment in a febrile paroxysm; that when it fails to preclude
an approaching paroxysm, it moderates the symptoms, and
shortens its duration ; and that in the cases of remittent fever,
treated with this medicine, the longest time of attendance was
four days, in most, less facts, which on good ground? con-
trovert the truth of that doctrine which regards quinine to be
the sine qua non under such circumstances.

Add to this the comparative immunity from expense secured
to the practitioner, by the substitution of an indigenous article,
whose abundance need not be dwelt upon, for an exotic which,
though maintaining a position unique in the catalogue of reme-
dies, has had its objections.

In conclusion, we would say those who may not be disposed
to submit the remedy to an experimental examination, can have
no right to disprove our assertions: those who may, we confi-
dently believe, will advance additional testimony in their favour.

These pages have been already extended beyond the proper
limits; yet we shall cherish the hope that words have not been
multiplied in vain, if, by our remarks, the attention of the pro-
fession be directed to a remedy consigned to an untimely obli-
vion by the exclusive doctrines of by-gone years.

1849.] Eve, on Clinical Surgery. 29

ARTICLE n.

Report of the first day^s Surgical Clinic of the present Session
in the Medical College of Georgia. By Paul F. Eve, M.D.,
Professor of Surgery.

The operations of the first day's clinic in our College, may,
in the absence of more important matter, possess sufficient
interest to be laid before the profession. It will serve to give
variety, if nothing else, to the original department of this No.
of our Journal. Four patients were introduced on the occa-
sion, and the operations, about to be described, performed be-
fore the class.

Case I. Enlarged Glands in the axilla operation com-
pleted while patient was under the influence of chloroform.
This case, the first in order, presented a collection of enlarged
lymphatic glands in the right axillary region. She is a negro
woman, aged 21, just arrived from the interior of So. Carolina,
is the mother of one child, and is now supposed to be pregnant
about the fourth month. As is too often the case with patients
of this class, little satisfactory can be elicited relative to the
cause of her present complaint. She now has a cluster of tu-
mors deeply situated in the axilla, which she says commenced
growing several months ago. They have been treated as an
abscess. They are now quite hard, moveable upon each other,
rounded in form, attached to surrounding parts by cellular
tissue, and are quite painful at times. Their removal being
determined upon, and the patient offering some objections to
etherization, an incision was made over the central mass of some
three inches in length, and several of the largest at once ex-
tracted. Finding that the chain of diseased glands extended
under the scapula, and the sufferings of the patient being great,
chloroform was administered by inhalation, and the operation
completed by removing a mass of enlarged glands, which, taken
together, was about \ pound in weight.

The diseased structure consisted of a central tumor, harder
and larger than some dozen others which were softer and of a
yellowish white color. They were distinct, of a round shape,

30 Eve, on Clinical Surgery. [January,

connected b}^ bands oT cellular tissue, were fibrous when laid
open; the largest one being evidently schirrous.
On the third day, the wound was dressed, found so near-
ly healed, and the patient doing so well, that she left for home
by easy stages.

Case II Congenital Tumor of the Hand extirpation. This
is an infant, four months old, who has a tumor of the size of a small
^gg, over the palmar surface of the fifth metacarpo-phalangeal
articulation. It is hard upon the surface, softer within, pretty
vascular, and its character confessed^ unknown. The mother
attributed it to ''longings after a brandy peach" we can, how-
ever, assure the old women it did not resemble this in any of
its physical properties. This tumor has been gradually increas-
ing since birth.

By a continuous sweep of the knife it was partially remov-
ed that is, a portion attached to the aponeurosis of the hand
still remained. There was no great hemorrhage, and the wound
was dressed for suppuration.

The part removed consisted of thickened dermoid tissue, and
of abnormal structure, made up of a congeries of whitish cords,
resembling in size, shape and color, common vermicelli.

After the third day, the wound was poulticed, and it healed
in about three weeks. There still exists a small portion of
thickened tissue at one point of the original disease, to which
pressure is being applied.

Case III. Callous Ulcer of five years standing^-^apptication
of the actual cautery .^Wmwey , a negro girl, aged 20, has now
been a year in my Surgical Infirmary. She entered for an
ulcer situated over the internal malleolus of the right foot. She
says a portion of a cotton stock Was thrust into the seat of the
disease while plowing. The ulcer has been healed on more
than one occasion, but bearing the weight of the body on the
foot invariably re-opens it. From the loss of the soft parts near
the internal ankle, the foot and -the great toe incline inwards,
so that when the foot is placed flat upon the ground, the cica-
trix of the ulcer is ruptured. No sinus is found to penetrate
the join^, and the bony structure is apparently healthy^

1849.] Eve, on Clinical Surgery. &T

This girl has been subjected to a great variety of treatment,
but none yet has proven entirely successful. At one time a
piece of skin from the jaw of a lamb was secured over the ulcer
then an anaplastic operation attempted, but with no other
favorable result, than to change the position of the ulcer to just
above the internal malleolus. The actual cautery was now ap-
plied, very little sensibility being evinced by the patient, so
callous is the diseased surface.

Case IV. Stricture of the Urethra relieved by the catheter
patient under chloroform.-. This is a negro boy, 19 years old,
who for six or eight years has labored under difficult micturi-
tion. He acknowledges no other cause for it than the fact of
his having been a dirt-eater. He denies ever having had gon-
orrhoea. The stricture is situated at the membranous portion
of the urethra, and an instrument of the smallest size cannot be
made to enter the parts. This patient was in my Infirmary
about two years ago, and so obstinate was the case then, that
he was only relieved by cutting out the contracted portion of
the urethra.

On the present occasion, he was placed under chloroform, and
although he could only pass urine by drops, a catheter of coni-
mon size entered the bladder with perfect ease. In previous
attempts the patient would writhe in pain; now no resistance
was offered on his part, and by the slightest effort, the instru-
menl passed through the stricture.

This patient is about to return home, having a metallic bougie
larger in diameter than 2^ lines, which he uses himself. The
chloroform, in his case, acted truly like enchantment.

(On the next day's cWrnc, four cataracts were operated upon,
but as a member of the class is drawing up their report, with
other cases, as a substitute for his Thesis, we shall of course
decline noticing them here.)

American Medical Association. [January,

llet)tett)0 antr jttract0.

ARTICLE III.

The Transactions of the American Medical Association. In-
stituted 1847. Vol. I. Philadelphia: Printed for the Asso-
ciation, by T. K. & P. G. Collins. 1848. pp.403. 8vo.

We proceed to redeem our promise of giving a notice of the
first volume of the Transactions of the American Medical
Association. From the several lengthy accounts already pub-
lished by us respecting the proceedings of this body, little else
remains for us to do than simply to extract what we deem useful
and interesting to those readers who are unable to obtain the
record of their transactions. All we propose then, to do now, is
to pass over the pages of this volume and transfer to our Jour-
nal the important professional facts it contains. The meeting
in Baltimore was composed as follows 4 from the U. S. Navy,
9 New Hampshire, 4 Vermont, 19 Massachusetts, 4 Rhode
Island, 15 Connecticut, 45 New- York, 8 New Jersey, 51 Penn-
sylvania, 5 Delaware, 68 Maryland, 10 District of Columbia, 14
Virginia, 3 South Carolina, 2 Georgia, 1 Louisiana, 1 Missouri,
f Kentucky, 3 Tennessee, 3 Illinois, 3 Indiana, 1 Wisconsin.
Texas, North Carolina, Mississippi, Alabama, Maine, Florida,
Arkansas, Iowa and Michigan, nme States, were not represent-
ed. Total number of delegates present, 266.

As an Appendix to the proceedings of the sessions held in
Baltimore, are the reports of the various committees appointed at
the previous meeting which was held at Philadelphia. The first
is on medical science, and prepared by Dr. W. T. Wragg, of
Charleston, S. C, who acted as Chairman, in the absence of Dr.
S. H. Dickson. It occupies 50 pages. This is certainly a
most able article, and does great credit to our young profes-
sional friend. We take the following extracts from it :

" On the Causes and Treatment of Scurvy the Journals furnish
us much valuable matter. Dr. Shapter and Dr. Lonsdale* con-
sider the absence of the potatoe* as the ''fons et origo^mali.''^
They adduce much proof from their own experience, and that
of others, in confirmation of their views. As a general rule,

Prov. Med. and Surg. Jour., and Med. Times, 1847; Edin. Mon. Journ,,1847.

1849.] Ajnerican Medical Association.

the statement may be made, that wholesome diet requires a
supply of succulent vegetables, with a portion of vegetable acid.
In the potatoe, tartaric acid exists, and to this is due its anti-
scorbutic properties.

" Dr. Bellingham* has announced similar views. ' It is clear,'
he says, 'therefore, that the cause of the present epidemic may
be traced to the absence of the potatoe from the dietary of the
poor, and it is equally clear, that a diet of bread, wMth or with-
out meat, or broth, is incapable of preserving the body in health,
and tends to develope scurvy.' Facts, he says, upset the theory
of Liebig, that as carbon, the principal constituent of fat, is
abunelant in potatoes ; whereas, the constituents of bone and
muscle are found in peas, beans, oats, barley, rye, wheat, &c.,
more plentifully ; that, therefom, these latter are more fit for a
labouring population as articles of food. 'Indeed,' he says, 'if
all we read about nitrocrenized and non-nitro^enized articles of
food were correct, the potatoe would have fallen into disrepute
long since.' Whereas 'for more than half a century, it has been
the sole food of the great majority of the peasantry of the
country (Ireland); and we believe a healthier, hardier popula-
tion w^as to be met with in {qw countries contrasting sadly
with their present altered aspect, after a diet for some months
composed of highly nitrogenized substances.'

"Dr Ritchief also considers 'deficiency of potatoes and suc-
culent vegetables as the most efficient cause.' In those forms
of the disease in which the superadded symptoms are not so
severe as to call for the undivided or the especial care of the
physician, his treatment was diet regulated on principles dedu-
cible from his views of the causes of the disease, and the use
of lemon juice or citric acid.

" Dr. CurranJ takes similar views. 'In four-fifths of his cases,
at least, the diet had been bread, with tea or coffee ; and in no
single instance could he discover that green vegetables or po-
tatoes had formed part of their dietary.' He treated the disease
with lemon juice, nitrate of potash, and vinegar.

"Dr. Christison agrees with all the other writers, that error
in diet is the cause of the disease, but considers that the indis-
pensable article is milk.

" Dr. Foltz, in his excellent report on the scurvy in the United
States squadron in the Gulf of Mexico, printed in the American
Journal, attributes the disease to the absence of vegetables ;
and refers to the change of the ration law, by which the one
day for vegetable food was taken away, as a cause of its ap-
pearance in the East India squadron. Dr. Dodd, of the Poto-

* Dub. Med. Press, 1847. t Edinburgh Monthly Journal. 1 847.

J Dublin Cluarterly Journal, 1847. Edinburgh Monthly Journal, 1847.

N. S. VOL. V. XO. I. 3

American Medical Association. \)^rm.sxY,

mac, suggests that the inferior quality of the salt used in curing
the meat was one cause. Dr. Foltz sums up the causes of the
disease in the Mexican Gulf squadron thus : 'Protracted cruis-
ing between the tropics, unwholesome and innutritions salt
provisions, vitiated atmosphere on board, resulting from imper-
fect ventilation, at times a reduction in the quantity of water;
and, in the crew of the Raritan, the despondency and disap-
pointment resulting from being kept on board ship after the
expiration of the time for which many of the crew had shipped.'
He observes, in regard to the treatment, that it consists in sup-
plying the system freely with protein, by giving freel}^ such
vegetables as most abound m it. The vegetable acids and po-
tatoes are the chief means. The basis of the potatoe being
starch, he suggests experiments with that substance. He con-
firms the experiments of Becquerel and Rodier in not having
found the blood dissolved.

" Cancer does not affect the sexes indifferently. Mr. Wilk-
inson King* gives as the result of post-nlortem examinations
made at Guy's Hospital^ the extraordinary announcement that
one-half of the females who die about the age of 44 are subjects
of cancerous formations, and of males one-eighth only.

" Diagnosis in cases of Cerebral Disease. Mr. Corfef says
that when the lesion of the brain has been sudden, the eyes are
closed, and the patient is insensible ; when slow and progressive
they are half closed, or wide open, and there is distortion of the
features, irregularity of the pupils, dullness of the countenance,
and palsy.

" Here the Committee will close their report with a contrast-
ed reference to the opinions of two authorities, high in the
estimation of their respective countrymen.

" In discussing the treatment of 'fevers and other diseases
having a definite course to run,' Ranking, in his Retrospective
Address, speaking of the contributions on the subject for the
past year, remarks: 'We may, however, acquire this one idea
from their perusal, that these cases get well but are not cured.
Nature is the agent in the benefit produced, and he is the best
physician who most clearly acknowledges her power and inter-
feres least with her operations. He is the worst who is ever
attempting to force her to bend to the potency of his drugs.'
Prof Dickson, in his beautiful introductory before his class at
the University of New York, says, on the contrary, ' Our fevers
will kill, in a large proportion of cases, if not arrested artificial-
ly ; our inflammations tend rapidly to disorganization, and our
produvia to exhaustion, among the hardy and hard-living in-
habitant of our wide spread territory, with the great majority

Med. Gazelle, 1815. t Med. Times, 1847,

1849.] American Medical Association.

of whom we shall not be able to avail ourselves of those all-
important adjuvants of a milder and less efficient system of
practice, to be found in a well-regulated regimen, judicious
nursing, and assiduous care.' "

The Report on Practi'cal Medicine next follows in order.
Dr. Joseph M. Smith, of New- York, was the chairman. This
was not read at the Association, for it^jiad not yet arrived, ow-
ing to an accident to a steam-boat on the Delaware, but Dr. S.
was permitted to make a verbal statement of its contents.
This was done in a very impressive and eloquent manner, by
the learned professor of the College of Physicians and Surgeons.
We find in it the following definition of" contdgious, infectious,
and meteor atious diseases :

*' In the observations to which the committee invite the at-
tention of the Association, epidemics are regarded as arising
from three general sources, to- wit, contagion, infection, and
meteorration ; and in accordance with this view of their etiolo-
gy, they may be divided into contagious, infectious^ and meteor-
atious, and defined as follows :

" 1. Contagious Epidemics are those distempers which arise
from poisons, generated by specific morbid actions in the human'
body, and which are communicable from th-e sick to the healthy
by mediate and immediate contact. To this division belong
scarlet fever, measles, small-pox; and a- few other diseases.,

"2. Infectious Epidemics are those diseases which originate
from the emanations or miasmata from decomposing organic
substances, including the excrementitious or effete animal mat-
ters thrown out of the body in health an-d disease.- The dis-
orde^rs referable to this class are intermittent and remittent
fevers, yellow fever, typhus, malignant puerperal fever, and
some varieties of dysentery and erysipelas.

" 3. Meteoratious Epidemics are those wide-spreading mal-
adies"' which Errise from- certain latent influences of the general
atmosphere, and which have no special relations or connections
with seasons, locahties and climates. The most notable exam-
ples of this kind are influenza and cholera.

" In respect to these three kinds of epidemic's, the following
laws are well ascertained : 1. That their prevalence is period-
ical. 2. That no two of them, belonging respectively to dif-
ferent classes, and the same is generally true of such as belong
to the same class, occur to the same extent, in the same place,
at the same time. 3. That whenever any of the diseases be-'

36 American Medical Association. [January,

longing to the several classes prevail together in the same place,
they become involved in each other in the order we have arran-
ged them, the first being modified by the second, and both of
these by the third, so that one is always predominant, and com-
pels the others to wear its livery. 4. That the same epidemic
varies in its character in diflerent years, the modifications de-
pending mostly upon the diversities of the seasons, and the
varying influences of the prevailing insensible meteoration, or
as it is called, the epidemic constitution of the atmosphere."

Of the late epidemic (typhus or typhoid fever, or ship fever)
it observes

" The condition of the German and Irish emigrants prior to
their embarkation, and during their transit of the ocean, was
in most instances conspicuously difl^erent. Whilst the former
were generally robust, and well provided on the passage with
the means of subsistence, and observant of cleanliness and ven-
tilation, the latter were in most cases enfeebled from the want
of sustenance, and on ship-board, destitute of supplies of whole-
some food, depressed in mind, clothed in filthy garments, and
crowded and confined in air rendered pestiferous by the excre-
mentitious matters eliminated from their own bodies. In con-
trasting the hygienic circumstances in which the two classes of
emigrants were placed, it is easy to account for' the greater
amount of sickness and mortality w^hich occurred in one class
than in the other. It is said, that of the admissions of emi-
grants into the hospitals and almshouse of New York, the Irish
exceeded the German in the proportion of about one to nine
or ten ; and we are told, that the Irish in British ships suffered
more than those in American.

"The amount of disease and number of deaths which occur-
red in emigrant ships, while crossing the Atlantic, are appalling
to contemplate. Many thousands perished on the voyage to
the United States and Canada. In some ships bound to New-
York, from 20 to 30 died on the passage ; and in many vessels
destined to Canada, the deaths were from 30 to upwards of 100.
From one ship, the Virginia, bound from Liverpool to Quebec,
with 470 passengers, 158 of the number were buried at sea.

" The Montreal Immigrant Committee, in their report for
1847, state, that 'in no year since the conquest has Canada
presented such fearful scenes of destitution and suflering. The
year 1847 has been unparalleled for the amount of immigration
to Canada ; near 100.000 souls have left the British isles for
these provinces the past year, over 5,000 of these died on
their passage out, 3,389 at Grosse Isle, 1,137 at Quebec, 3,862

1849.] American Medical Association. X[

at Montreal, 130 at Lachine, and 39 at St. Johns, making in all
at these several places 13,815. How many have died in other
sections in ('anada East cannot no^v be known, nor, indeed, how
many have perisiied in Canada West; but coupling all those
who have perished with those who have passed into the United
States, Canada cannot now number 50,000 souls of the 90 odd
thousand which landed upon our shores. In sketching a retro-
spect of these terrific scenes, the Montreal committee forcibly
remark "From Grosse Isle, the great charnel house for vic-
timized humanity, up to Port Sarnia along the borders of our
magnificent river, upon the shores of Lake Ontario and Erie,
and wherever the tide of immigration has extended, are to be
found the final resting places of the sons and daughters of Erin
one unbroken chain of graves, where repose fathers and
mothers, sisters and brothers, in one commingled heap, without
a tear bedewing the soil, or stone to mark the spot. Twenty
thousand and upward have gone to their graves, and the whole
appears, to one not immediately interested, 'like a tale that is
told.' "

Dr Smith advocates the identity of typhus and typhoid fever,
which we now think is abundantly established.

Accompanying this yeport is an article, published entire, from
Gurdon Buck, Jr., M. D., Surgeon to the New York Hospital,
&c., &c. It is entitled (Edematous Laryngitis, successfully
treated by scarifications #f the Glottis and Epiglottis. The
subject is also illustrated with four plates. We present our
readers one case, with the remarks preceding it, and those also
made by the author at the close of the paper :

"Within the short period of eleven months there were no
less than eight cases of this rare disease in the New York Hos-
pital, of which seven occurred between the months of Decem-
ber, 1847, and February, 1848. During this latter period the
season was remarkably rainy and wet, accompanied with very
little snow, and characterized by the prevalence of erysipelas
and typhus fever, as well as an asthenic type in other diseases,
both in and out of the hospital.

''More than a year previous to the occurrence of the first of
these cases, and without any knowledge at that time of any
similar method of cure, having been practised or proposed by
others, I was led to the conviction that scarifications of the
cedematous edges of the glottis, as well as of the epiglottis,
might be employed as an effectual means of relief in this for-
midable disease ; and when the occasion presented itself of

38 American Medical Association. [January,

carrying into effect these views, the remark was made to my
assis-tants at the hospital, and other gentlemen present, that
such had been my convictions, and that the first opportunity
had now occurred of applying them to practice.

"The well knowqi fatal character of the disease warranted
the trial of any new remedy that afforded a reasonable progpect
ofbenefit.

"In connection with this operation., the employment of the
touch was naturally regarded as of great importance as a means
of exploring the diseased parts, and thus establishing the diag
nosis beyond doubt.

*' Though the oedematous swelling of one or both edges of the
glottis is jihe cause of the dyspnoea, from the mechanical obstruc-
tion it presents to the entrance of air into the larynx, yet, as
will hereafter appear, the epiglottis almost always" participates
in the sw^elling, and being within reach of the fqre-fingers passed
into the mquth, it affords an invaluable means of diagnosis.

*' The following is the mode of performing the operation of
scarifying, as employed in the cases about to be related.

*' The patient being seated on a chair, with his head thrown
back, and supported by an assistant, he is directed to keep his
mouth as wide ppen as possible : and if there be any difficulty
jn this respect, a piece pf wood aji inch gnda quarter in width,
and half an ipch in thickpess, is to be placed pdgwise between
the molar teeth of the left side. The fore-fipger of the left hand
is then to be introduced at the right angle of the mouth, and
passed dow^n oyer the tongue till it Encounters the epiglottis.

"But little difficulty is generally experienced in carrying the
end of the finger above and behind the epiglottis so as to overlap
it and press it forwards towards the base of the tongue. In
some individuals the finger ^nay be made to overlap the epiglottis
to the extent of three-fourths of an inch.

"Thus placed, the finger serves as a sure guide to the instruv
ment to be used, ^vhich is represented accurately in the accomr
panying plate. The knife is then to be conducted with its cour
cavity directed downwards, alopg the fmger till its point reaches
the finger nail. By elevating the handle so as to depress the
blade an inch to an inch and a half farther, the cutting extreme
ity is placed in the glottis between its edggs; 'at this stage of the
operation the knife is to b.e slightly rotated to one side and the
other, giving it a cutting motion in tjie act of withdrawing it.
This may be repejated without removing th^ finijer, two or three
times on either side. The margin of the epiglottis, and the
swelling betWTcn it and the base of the tongue may be scarifi^
ed still more easily with the same instrument, or scissors cuped
flatwise may be emi)loycd for these parts, guided in the same
manner as the knife.

1849.] Ampvican Medical Associaiinv. fH

''Though a disapjre^ble sense of suffocation and choking is
caused by the operation, the patient soon recovers from it, and
submits to a repetition after a short interval. In every instance
the operation has been performed twice, and in some three
times.

"Before proceeding to the operation, it has always been ex-
plained to the patient, that the seat of his difficulty was a swell-
ing at the top of the windpipe, preventing the air from enter-
ing, and the object of the operation was to cut it and let out
fluid, and thus give him relief This explanation corresponds
60 exactly with his own sensations, which refer to the top of the
thyroid cartilage as the seat of obstruction, that he readily sub-
mits to the proposed operation, and renders all the co-opera-
tion in his power for its performance,

*'A slight hemorrhage follows the scarifications, and should
be encouraged by gargling with warm water. In one instance
the quantity of blood mixed with sputa amounted to half a wine-
glassful.

"The first case for employing the operation was the follow-
ing:

"Case I. Arthur W. Taylor, seaman, born in New York,
aged thirty-one years, was acting as nurse in Ward No. 4,
south building, New York Hospital. For two days previous
to the 13th of April, 1847, when his case was first noticed he
had suffered from painful deglutition, with elongation of the
uvula, that kept up a constant tickling sensation the fauces
also presented an inflamed appearance. The epiglottis was
seen as well as felt to be swollen. Breathing was difficult, and
attended with paroxysms of suffi:>cation.

. "A stimulating gargle had been used, and, on the morning of
the above date, the uvula had been excised with some rehef
Six leeches had been applied over the larynx, and the bites were
still bleeding at the time of the regular visit at noon. After
exploring the parts with the finger, and ascertaining the exist-
ence of swelling of the epiglottis, and also allowing my two
assistants to do the same, I scarified the aryteno-epiglottic folds
and the epiglottis, partly with scissors curved flatwise, and part-
ly with a sharp pointed curved bistoury, guarded to within one-
third of an inch of its point by a narrow strip of adhesive
plaster wound around it, and conducted to the parts upon the
fore-finger of the left hand, previously introduced at the right
angle of the mouth. Two or three repetitions were requisite,
at short intervals, to complete the operation. The patient
hawked up three or four tea-spoonsful of blood, mixed with
mucus, and expressed himself as feeling relieved. Twenty

American Medical Association. ' [J antMfy,

ounces of blood were drawn from the arnm soon after, and grain
doses of tartar emetic administered.

^ *'0n the following day (the 14th), an improvement in the res-
piration had evidently taken place.

"On the 15th, respiration was still further improved, the pulse
was 84, and soft ; patient complained of soreness of the scarrifi-
ed parts. Antimony was stopped.

"On the 17th he was much improved in all respects, pulse 68.
*'0n the 23d he was discharged cured.

*' The question of diagnosis in this disease is one of vital im-
portance, irrespective of the present operation, but in connection
with it its importance becomes very greatly enhanced. With-
out stopping to notice the distinctive symptoms which have
been generally regarded as characteristic of this disease, or
those- of other diseases that are most likely to be mistaken for
it, I beg leave to insist upon one sign which is strictly pathog-
nomonic, and does not appear to have been sufficiently appre-
ciated.

"I refer to the swelling of the epiglottis as ascertained by the
touch. The disc6very of it, according to Bayle, Die. des Scien.
Med., tome xviii., p. 507,) is due to M. Thuillier, who proposed
it in a thesis sustained before the Faculty of Medicine in Paris,
in 1815. The value of this sign will be admitted if we con-
sider how frequent the swelling of the epiglottis co-exists wnth
that of the glottis. Bayle, {lac. cit.) who dissected more than
seventeen cases of this disease, says, 'the epiglottis is rarely
intact, often it is very much swollen at its edges.' Ryland says,
{he. cit., p. 48,) 'The oedema is seldom confined to these
localities, but extends to the base and lateral edges of the
epiglottis, &c.'

" Among seventeen cases collected from different sources^
and in which the condition of the epiglottis was ascertained,
either by dissection after death, or by the touch or inspection
during life, swelling was found in fifteen. Of the eight cases
reported in this paper, the epiglottis was found swollen in seven,
and in the remaininir one there was no evidence that it was not
swollen.

"This swelling takes place either at the margin on one or
both sides of the median line, or on the lingual surface of the
epiglottis at its base, filling up one or both depressions between
it and the tongue, and obliterating the central glosso-epiglottic
fraenum.

'* It conveys to the touch the sensation of a soft pulpy body,
easily recognized and distinguished from the stifi' rigid swelling
of these parts in membranous laryngitis.

"The facility of ascertaining the condition of the epiglottis

1849.] American Medical Association.

with the end of the fore-finger, not only by placing it in contact
with its anterior surface, but by passing over its upper edi^e and
applying it upon its posterior surface, has been already noticed.

"To test this question still further, the experiment has been
repeated in at least twelve individuals, and in all with success,
though not with equal facility. In some these parts were easier
of access than in others, but in none did the experiment fail.

''In the exceptional cases where the epiglottis is not found
swollen, the edges of the glottis may be brought more within
reach by pressing up theos hyoides with one hand applied ex-
ternally over it, and acting from below upward, while the fore-
finger of the other hand is introduced as directed into the mouth.

"Should this not accomplish the object, the fore and middle
finger may be thrust far back into the pharynx, as is required for
the removal of a foreign body lodged in the throat.

"In all the five cases treated by scarifications, it will be re-
membered that the test of touch was applied, not only by myself,
but by one or more of my colleagues, or assistants, and thus
the diagnosis of the disease was established beyond doubt.

"To those who have encountered this formidable disease,
this subject will possess peculiar interest; and the remedy pro-
posed, perhaps, may be hailed by them as a valuable improve-
ment in the healing art.

*' Time and experience alone can determine this question.
To this test I desire to subject it after havirig, as I believe,
faithfully recorded and made known the results of my own ex-
perience.

"In conclusion, I desire to express my grateful acknowledge-
ments to Drs. R. K. Hofl^man and John A. Swett, my highly
esteemed colleagues at the New York Hospital, for the oppor-
tunities they kindly afforded me of applying the new treatment
upon their patients, and also to my pupil Sir. Moreau Morris,
for the accurate andbeautiiul drawings accompanying this pa-
per, and so indispensable for its illustration.

"Note. Since this paper was laid before the American
Medical Association at its recent meeting, I have had access to
Valleix's work, entitled Guide du Medecin Practicien, tome i.
p. 481, Paris, 1842, giving a detailed account of M. Lisfranc's
operation, respecting which it seemed doubtful, from the very
slight notice taken of it by early authorities, especially Cruveil-
hier, whether it had ever been performed. M. Valleix says,
'M. Lisfranc {Mem. surTAng. Lanjng. (Edem. Journ. Gen. de
Med., tome Ixxxiii., 1823,) first conceived the idea of evacuating
by means of incisions more or less numerous, the serous or sero-
purulent fluid engorging the submucous tissue of the larynx.

^ New Operation for Cure of Varicocele. [January,

This surgeon cites five cases in which this operation was fol-
lowed by an immediate change, and subsequently by a complete
cure. In a sixth case, several similar operations at variable
intervals acted only as palliatives. Extefisive lesions of the
larynx existed*, which at length caused the death of the patient.

"The following is M. Lisfranc's method of scarrifying the
larynx. ' Take a long narrow-bladed slightly curved bistoury
in a stiff handle, protected with a stripof linen to within half an
inch of the point. Let the patient open his mouth wide, and
have the jaws kept apart by means of a cork placed far back
between the molar teeth, one end of the cork being held by an
assistant. The ]3<itient being placed in front of the operator
with hi5 head supported against the breast of an assistant, pass
the ii>dex and middle finger of the left hand into the mouth till
they reach the swollen edges of the larynx, glide the bistoury
flatwise upon the finger,* holding it as you w^ould a pen. On
reaching the larynx, direct the edge forward and upward, then
after having elevated the handle depress it gradually, at the
same time pressing gently upon the point. At first, a few punc^
tures only should be made, as by the aid of pressure two or
three small incisions are sufficient. They may easily be multi^i
plied in the same way if judged necessary,

'"These scarrifications, says M. Lisfranc, produce a flow of
the infiltrated matter and sometimes a slight oozing of blood,
which effects a salutary disgorgement. The cough excited by
a few drops of serum falling into the larynx, contributes much
to diminish the swelling. The immediate beneficial results of
these scarrifications might be partially defeated, by their occa-
sioning more or less inflammation of the larynx and surrounding
parts. In such a case recourse must be had to general or local
bleeding, which would soon disperse this traumatic infiamma^
tion.'

*' It appears also, from M. Valleix's statement, that Professor
Marjolin has lacerated the oedematous edges of the larynx with
a piece of althea root, and M. Legroux with the nail of the index
finger sharpened for the purpose, and both with success,"

[ To be concluded in February No.'\

New Operation for the Radical Cvre of Varicocele. By S. D,
Gross, M. D.* Professor of Surgery* in the Medical Depart-
ment of the Univcsity of Louisville. (American .lournal of
Medical Sciences.)

The following operation for the radical cure of varicocele
I have performed eight times within the last few years. ThQ:

1849.] New Operation for Cure of Varicocele.

patients were all young men of good constitution, and they all
recovered without a single bad symptom. The cure, so far as
I have been ableto learn, promises to be permanent in every
instance.

During the operation the patient may lie down, sit in a chair,
or stand up, as may be most convenient. The scrotum, pre-
viously divested of hair, is rendered tense by grasping it behind
with the left hand. A vertical incision, scarcely an inch in
length, is made over the anterior part of the tumour, down to
the enlarged veins, which are next carfully isolated from the
accompanying duct, artery, and nerves, by a few touches with
the point of the scalpel. This constitutes the first step of the
operation. The second consists in passing a short, thick sewing-
needle a No. 1 of the milliner, underneath two or three of the
larger trunks, and winding around it a stout thread, either ellip-
tically, or in the form of the figure 8. The ligature is drawn
with great fi^mijess, so as to indent the coats of the vessels, and
ppt an immediate stop to the circulation. The operation is fin-
ished by closing the wound carefully with one or two twisted
sutures, or a few^ strips of court-plaster. The patient is now
put to bed, the scrotjam is supported with a silk handkerchief,
an4 fight diet is enjoined. At the end of twenty-four, or, at
most, thirty-six hours, the biood in the constricted veins is suffi-
cieptly coagulated to justify their division, and the removal of
the needle,. Thjs js readily effected by insinuating a narrow,
sharp-pointed bistoury underneath the vessel, with its back to-
wards the needle.

Should symptoms of inflammation arise after the operation;
or, in other words, should the parts become red, tender, and
swollen, recourse must be had to antiphlogistics, and to the ap-
plication of cold w^ater, or solutions of acetate of lead and opium.
The patient may usually sit up in five or six days, apd hi a few
more he may be permitted to walk about. The little wound
soon cicatrizes ; and the induration, caused by the coagulation
of the blood between the testis and the seat of the constriction,
gradually disappears by absorptiop. The period required for
this rarely exceeds a month.

^ The advantages of the above op^ration are, first, its perfect
simplicity and the facility with which it may be executed ;
secondly, its freedom from pain and hemorrhage ; thirdly, the
certainty with which we may avoid injury to the spermatic
artery, duct, and nerves ; fourthly, the little inconvenience or
suflfering which the patient experiences after it has been per-
form.ed ; and fifthly, the rapidity of the cure. These considera-
tions will, I think, be found sufficient to recommend this method
^Q t.he favourable notice of practitioners. Most of the opera-

4^ Cases of Pneumonia Typhoides. [January,

tions described in the books are complicated, severe, and dan-
gerous.

It occasionally happens in this affection that the scrotum is
very flabby and pendulous. When this is the case the care will
hardly be complete unless the surgeon retrenches the redundant
structures. I have been obliged to resort to this expedient only
once in my operations. A portion of scrotum, nearly of the
size of a large hand, was excised with the scalpel, and the wound
closed by the continued suture, which I consider far preferable,
under such circumstances, to the interrupted or twisted.

Louisville, Ky., July, 1848.

Cases of Pneumonia Typhoides ; with Remarks on the Use of
Acetate Plumbi, in this Affection. By Moses C. Hasbrouck,
M. D., of Rockland Co., N. Y.

To the Editor of the New York Journal of Medicine:

Dear Sir, I send you the notes of three cases of pneumonia
typhoides, or of what I am in the habit of terming "asthenic
pneumonia." They are intended to show the beneficial in-
fluence of acetate of lead, and if you deem them worthy of
publication you will oblige me by giving them a place in your
Journal.

Case I. Mr. G. S., aged 38, of sanguine temperament and
good constitution, after a day's ride, exposed to a cold and damp
atmosphere, went to bed with a severe chill, violent headache,
severe pain in the back and limbs, and soon after he became
delirous. I saw him eight hours after the attack, and found
him with a rapid and feeble pulse, constant delirium, and with
the whole surl'ace of his body and limbs bathed in perspiration.
He was also expectorating profusely a sero-mucous fluid of a
brick-dust color. His tongue was clean. His rjght side from
the spine forwards, and the scapula and axilla downwards, to
the border of the ribs, gave out minute crepitation. His bow-
els were loose.

^. G. Opii, grs. iv. '
Calomel, grs. viij..
Tar. Emetic, gr. j.
M. f in Pulv. viij., one of these to be given every third hour.

These powders with slight modifications to suit occurring
symptoms were continued until the morning of the third day,
when it became evident that unless something was ordered to
check the inordinate perspiration and expectoration, which

1849.] Cases of Pneumonia Typhoides. 4i

still continued, the patient must sink. Bronchial breathing had
taken the place of the crepitus, and the prostration was great.
Acetate of lead was now given, combined with suitable doses
of calomel and opium. In less than thirty-six hours, the perspi-
ration and expectoration were reduced to an ordinary quantity ;
the pulse was below a hundred, and the delirium gone. Crepi-
tant rale in right side returned. The gums had the blue bor-
der, and gave slight evidence of the action of calomel ; conva-
lescence was almost or quite established.

Case II. Mrs. H., aged 45, of feeble constitution, had been
frequently sick, and w^as at the time of the attack worn down
by nursing. She was taken with a chill, followed by severe
headache and neuralgia, pains of the back and limbs, and a
violent lancinating pain in the left side near the border of the
ribs extending thence to the shoulder of the same side. She
had a dry cough with trifling frothy expectoration, pulse 120
and feeble, tongue slightly coated white, and moist, skin hot and
dry. Percussion clear and a perfectly natural, vesicular mur-
mur. Two days after plueritis extended to the lungs proper;
the pain abated and a brick-dust colored expectoration appear-
ed. Uterine hemorrhage also set in, not profuse, but sufficient
to increase rapidly the debility. To check this hemorrhage,
rather than with a view to operate on the pulmonic inflamma-
tion, 'I gave acetate of lead, two grain doses, every four hours,
united with calomel and opium, which she was taking. The
next day the hemorrhage was less, but not entirely arrested,
and all the other symptoms decidedly better ; and what may
be particularly mentioned, the skin was moist. The following
day, slight effects of calomel and lead on the gums were evi-
dent ; continuing the same medicine in diminished doses, con-
valesence was established, accompanied with a very sore
mouth.

Observing the sudden effect of the lead here, and reflecting
upon it, in connection with the case of Mr. G. S., I resolved to
give it a trial in the next case which mio;ht occur, even should
there be no excessive evacuation which it might be desirable
to arrest ; solely with a view to its alterative effect upon the
capillary structure.

Case III. Mr. P. W., a young man of good constitution,
sent for me at 6 A. M., the 12th Febuary last. He was taken
the night before with a chill which lasted an hour, which was
followed by heat and pain in tiie right side, near the border of
the false ribs. He had complained of severe pain in the head
also, but -was now delirious. His pulse was 120 and feeble.

46 Cases of Pneumonia Typhoides. [January,

tongue coated with a thick yellowish coat, and moist, skin hot
and diy; he had vomited a number of times and had frequent
discharges from the bowels ; coughed frequently without ex-
pectorating. His breathing was oppressed, his countenance
contracted, eyes icterode and dull. Rale crepitans over the
right latteral region of the chest.

'^i Tar. Emetic, or. ss. ) r\ r u

o 1 u TV/r n I Once m lour hours.

Sulph. Magnesia, 3 ss. )

The next day's report was, that he had not vomitted since he
took the medicine, and his bowels had moved twice only. De-
lirium continued, pulse 110, and skin moist, slight dulness on
percussion, and tubular breathing had taken tne place of the
crepitus. Same medicine continued.

14th. All was worse, constant delirum ; the eye's had the pe-
culiar typhoid stare; coughed little, expectorated nothing;
pulse small and 130, skin dry.

^ CalomeL m\ ss. 1 t? c -u

Ti I T J r-k ' [ tiVery lour bourse

1 ulv. Ipecac, and Upii, aa gr. ss. )

16th, No amendment.

I^. Calomel, gr. j. ^

Opii, gr. i. > Every two hours.
Camphor, gr. ij. )

16th, 10 A. M. Still worse, no cough', rapid bronchial breaith-
ing of the "blowing kind," quite up to the scapula and clavicle.
I now added to the last prescription two grains of lead, evefy
two hours.

17th, 9 A. M. When I entered the foom this morning,- he
looked up, and vv^ith a natural expi'ession of countenance, and
in a perfectly rational manner, jocosely asked me whether I was
trying in how short a time I could treat a man to death. And
he was sweating profusely, with pulse down to 100, and breath-
ing comparatively easy. Cough had returned also, with a fre'e
exj)ectoration.

On the 18th the gums were slightly affected, and a rapid eoA-
valesence followed.

We are aware that the recovery of three patients from attacks
of severe inflammation during the use of acetate of lead, stated
as a simple, isolated fact, can be of but little value. But if these
cases, in their symptoms, all point to a certain pathological con-
dition, state, or stage of disease, in which the ordinary remedies
seemed to lack power to effect a favorable change, and which
change seemed to be produced by lead ; and if to this fact we*
can add a rational explanation, founded upon an analogous ope-
ration of lead in other diseases, we certainly go as far as thref^"

1849.] Scf^iita^^^s^ causes^

cstse's, tinder any circumstances, can enable us to go, in establish-
ing a principle.

Those who are familiar with the "First Principles of Medi-
cine, by Archibald BilHngs;" and, I should say, assent to his
views of the nature of inflammation that is, that the proximate
cause of inflammation is a relaxation of the capillaries, and that
sedatives, (antimony and neutral salts,) as well as alterative, are
absorbed, and thus brought in contact with these vessels, and
through an operation on their nervous tissue, cause their con-
traction will have but little difficulty in understanding the
rationale of the operation of lead in low grades of inflammatory
action. They will at once recognise, in the foregoing cases,
an extreme relaxation of capillaries, (it w^as so great in the first
two, that the fluids ran out, as it were, of their open extremities,)
and they will at once impute the sudden and remarkable change
to the well-known astringent properties of lead.

Scrofula its causes. By Dr. King. (Med. Gaz. in Braithwaite.)

The following propositions laid down by Dr. King are illus-
trated and supported by numerous facts : '

Prop. 1. The grand source of scrofula is the direct heredit-
ary principle.

2. Scrofula is also hereditary in the collateral branches when
it is latent in the direct ones.

3. When second marriages take place, if both parents are
healthy, the children will be unhealthy ; if either parent be
scrofulous, the children will be scrofulous.

4. Persons who have been scrofulous in youth may appear to
have been cured, and to have got into good health, but the con-
stitutional taint remains, and the children will be scrofulous.

5. Phthisis is a form of the scrofulous constitution, and its
most fatal form. It is the great sledge-hammer. Sydenham
had advanced so far in pathology as to call phthisis, "scrofula
in the lungs." Portal was of opinion that congenital phthisis,
" phthisic d'origine," was scrofulous. Bayle and Laennec say
the same; but less decidedly, which to our eyes appears strange.
An eminent wi'iter of the present day may be quoted as a
proof that medical men have not at present very clear ideas
upon this subject. He says scrofula is a form of cachexia i. e.
cachexia is the cause of which scrofula is the effect. It would
be more correct to say, scrofula or the scrofulous constitution,
is the cause of which cachexia is the effect. Cachexia is a form
of scrofula. Cachexia has many causes, of which a very im-
portant one is scrofula.

Scrofula its causes, [January,

6. Scrofula and phthisis co-exist in the same family. More
than half the scrofulous patients have parents or ancestors who
died of phthisis. Of 84 cases in the liospital of St. Louis, at
Paris, more than half had consumptive parents. All the pa-
tients in the hospital at St. Louis who died of the various forms
of scrofula, had tubercles in the lungs. They often recover
from the other forms of scrofula, and then die of phthisis ; and
for this reason the most experienced medical men are very cau-
tious ill their mode of curing local scrofulous affections, for fear
of metastasis to the lungs. They always endeavor to do it upon
an alterative i. e., a constitutional principle ; so that the cure
may be the effect of an improved constitution, and the improv-
ed constitution the effect of the treatment.

7. Persons who are scrofulous in youth sometimes become
strong after puberty ; but the taint remains, and the children
are scrofulous. The parents try to conceal the scrofula of their
youth, which makes it difficult for the physician to trace the
constitution of the child.

8. Persons who do not appear to be scrofulous themselves,
but whose brothers or sisters are so, have scrofulous children.
The family taint seems to pass through them to the children.

We shall now endeavor to point out certain causes which
seem to originate scrofula, or the scrofulous constitution, or
poison, independent of hereditary taint.

Cause I. The first cause is syphilis; which, in many cases^
is obvious; and m others, when the parents conceal it, it can
only be inferred. If a parent has had both syphilis and scrofula,
the poison is doubled. The eruptions, ophthalmia, ulcerations,
and caries, of the two diseases, are often very similar ; but, as
syphihs is cured by mercury, and scrofula not, the result of
treatment is a sure test of the nature of the disease. Syphilis-
is accidental, contagious, and curable. Scrofula is constitu-
tional, not contagions, and incurable, or, at least, difficult of cure.
Scrofula always existed. Syphilis did not exist in Europe till
about A. D. 1500. The disease derived from syphilitic parents
is not primary but secondary syphilis, syphilitic cachexia, or
scrofula. Spain has been overrun by this disease subsequent
to the introduction of syphilis. The antiphlogistic treatment of
syphilis, instead of the mercurial, is a cause of scrofula, because
the cure has not been radical.

Cause 2. The second originating cause of scrofula is the
excessive abuse and indulgence of the sexual instinct. One
instance will illustrate the principle: All the children of a
family had scrofulous affections : ha3moptysis, ophthalmia, pul-
monary tubercles, worms. One little girl had abscess in the
left sub-maxillary region, was of pallid complexion, with large

1849.] Scrofula its causes. 49

mouth and decayed teeth. The chief cause appeared to be the
early sexual dissipation of the father. Cases Hke this, as well
as those which are of syphilitic origin, illustrate the remarkable
and forcible expression of Job, (c. 20, v. 1 1) " his bones are full
of the sin of his youth.*' This Is one of the many ways in
which wealth may prove a curs6. Wealth is power, and the
first tendency of power is to abuse itself, in all the modifications
of which that power is susceptible.

CaUse 3. A third originating cause of scrofula is premature
indulgence of the sexual m?,imci, ^n& premature marriage. If
the offspring are to be healthy, strong, aiid vigorous, no man
ought to marry before the age of 25. The secretion of the
seminal fluid, like all other parts, is and must be subject to laws
which decide its health and vigor. The secretion should not
be too rapid or frequent, and it should also be spontaneous, i. e.,
the natural effect of a healthy orgatiism, and not of a mere
mental action or effort of imagination.

Cause 4. A foufth originatting cause of scrofula is marriage
too late in life. The debility produced by early sensuality may
be iti some measure remedied by moderation, restraint, and
time, by change of mind, thought, imagination, desire, arid in-
tellectual occupation. But the debility produced by old age
can never be remedied. The generative faculty is said to be-
gin to decline about the age of 45, which may be called its cul-
minating point. It then begins to decay slowly at first, and
more rapidly afterwards. Those who mariy late in life may
have one or two children strong, but every child is w^eaker than
the preceding ones, and the youngest are the weakest. The
old man's child has become a proverb for visible debility stamp-
ed upon its physiognomy. Many of them die* at birth. Some
are precocious in childhood, and then suddenly fade, and be-
come effete and stunted, like the withering and dropping off of
fresh fruit in autumn ; they are born out of season. The pe-
riod of weak fecundity in woman commences about forty.
After this time pregnancy is often a delusion, or there is imper-
fect conception and miscarriage, or the child perishes at birth,
or, if reared it is deli^.ate and scrofulous.

Cause 5. A fifth originating cause of scrofula is dispropor-
tionate age and unequal vigour. When! the father is youngef
than the mother, it may be a cause of scrofula.

Cause 6. A sixth originating cause of scrofula is paralysis^
epilepsy, lunacy, and other diseases of the brain.

N. S. VOL.- V. NO. I;

50 Treatment of Ganglion. [January,

On Treatment of Ganglion. By Bransby Cooper, Esq., F. R. S.
(Med. Gaz., in Braithwaite.)

[After alluding to the usual plan of giving a ganglion a sharp
blow with the back of a book, and to the fact that the walls of
the cyst are sometimes too dense to be ruptured without em-
ploying a dangerous degree of force, Mr. Cooper, says,]

I think it a better plan to pass a couching needle beneath the
skin, introducing it at some distance from the ganglion, and
after puncturing the sac in several places, to press the synovial
fluid into the cellular tissue ; pressure must be applied to the
part, and a splint then adjusted, to insure perfect quiesence of
the wrist-joint. The smaller description of ganglia which
sometimes occur on the palmar surface of the hand, at the ex-
tremity of the metacarpal bone, cannot be subjected to similar
treatment to that just detailed, but must be punctured directly ;
the small quantity of synovia they contain being expressed from
the opening.

In certain situations in the body it is extremely difficult to
form a diagnosis of bursas mucosas ; they are sometimes so hard
as to be mistaken for small exostoses ; and, by the enlargement
of the bursa, between the latissimus dorsi muscle and the in-
ferior angle of the scapula, a tumor may be formed, which might
be readily mistaken for chronic abscess, steatoma, or even
malignant disease ; but a surgeon conversant with the character
of ganglia in their natural state, would soon discover the real
cause of the swelling.

On the feet, and more particularly on the inner side of the
root of the great toe, an adventitious bursa, termed a bunion, is
very frequently formed ; it is produced by, tight and ill-made
shoes, which force the great toe into an unnatural position, out
of the line of the axis of its metatarsal bone, and under the other
toes, in such a manner that the bone of the first phalanx presses
forcibly on the capsular ligament of the joint, and induces the
inflammation and acute pain inseparable from this distortion.
Unless the deformity be remedied, the continual pressure of
the bone tends to increase the inflammatory action, and ulcer-
ation would be the ultimate result, were it not for the compen-
sating provision of nature, which leads to the formation of a
ganglion between the capsular ligament and the skin. If, how-
ever the pressure be still continued, it may induce inflammation
of the adventitious bursa, and an inflamed bunion is the conse-
quence; this so completely cripples the suflerer, and the pain is
so excessive, that surgical aid is here usually sought, although,
however, various mechanical contrivances have been proposed,
and also many diflerent kinds of plasters, the objects of all being
to remove the pressure which has been the original cause of

1849.] Enlarged Prosfate Gland.

the disease. No treatment can prove successful, unless the
great toe be restored to its natural relative position parallel W\\h
the others, and the most simple and effectual means of effecting
this, is the one adopted b}^my colleague, Mr. Key ; he recom-
mends that the stocking of the patient should be furnished with
a division or compartment, resembling the finger of a glove, to
receive the affected toe, a similar compartment being also con-
structed in the inside of the shoe ; into these the toe passes, and
is preserved in a direction parallel to that of the others ; but it
may be necessary before resorting to the use of this contrivance
to subdue the local inflammation by the application of leeches,
blisters, or evaporating lotions.

A ganglion on the dorsum of the foot or instep, sometimes
produces even a more serious form of the disease than the
bunion. It may cause contraction of the extensor tendons of
the small toes, permanently extending the latter, so that the
whole of the weight of the body falls during progression upon
the first phalanges, in which situation ganglia are found pre-
cisely similar to that just described as occurring at the point
of the great toe. If these become indurated by neglect or con-
tinual pressure, so that the effused contents cannot be let out
by puncture, the only alternative left to the surgeon is to divide
the implicated tendon or tendons, so as to relieve the permanent
extension of the phalanges, and to restore the toes to their
natural position. I have known exfoliations of the phalanx
to occur as the result of this affection, but immediately upon
the removal of the exfoliating bone, the deep ulcer which had
been produced in the sole of the foot, healed, and the patient at
once recovered.

Enlarged Prostate Gland, (Dublin Quarterly Journ.)

Dr. Mayne presented a recent specimen of diseased prostate
gland, taken from the body of a man aged 72, who lately died
of dysentery in the Hospital of the South Union. The prosta-
tic disease, under which he had laboured for a considerable
period, was attended by the ordinary symptoms, but towards
the close of the case it was marked by the occurrence of some
uncommon circumstances, which induced Dr. Mayne to lay the
specimen before the Society. This patient frequently suffered
retention of urine, occurring at intervals of three or four weeks,
easily relieved by the catheter, and again brought on by expo-
sure to cold, by any irregularity of habits, and very often by
permitting the bladder to become too much distended ;. he was
in the habit of occasionally absenting himself from the work-
house on leave, and was always observed to return suffering

52 Monthfy Periscope. [January,

from retention. In June last he had gone out, as previously,
on leave; he was absent much longer than usual, but when he
returned he was not suffering from retention. This excited
some curiosity, and being questioned, he acknowledged that,
immediately after he had gone out, he was attacked by the
complaint, and, not wishing to return so soon, he had applied
to a medical practitioner, who proceeded to relieve him by in-
troducing a catheter. This he described to have been effected
with great difficulty; that blood flowed away before the urine
began to be discharged, and that he was directed to retain the
instrument in the bladder for some days. The result was that
from that period to his death, an interval of about seven months,
he had no return of the complaint. So pleased was he with
this, that he used to contrast very unfavourably the medical
practice of the hospital with that of the surgeon, by whom he
said he had been perfectly cured at once.

Upon examination after death the prostate was found enlarged
in all its lobes ; the third lobe projected from behind forwards,
and a false passage had been effected through it, which had
become established as a new portion of the canal for the passage
of the urine, which had continued to be discharged by it.

Dr. Mayne observed that Sir B. Brodie had advised the use
of force in passing the instrument in cases of this kind. He says,
*' When your efforts to introduce the catheter have been una-
vailing, when you feel the point pressing against the tumour of
the prostate, and unable to pass over it, apply some force to the
instrument at the same time that you depress the handle. It
will generally penetrate through the prostate, enter the bladder
by an artificial opening, and relieve the patient, and, of course,
continue to reheve him, if you allow it to remain in the bladder.'

Dr. Mayne observed, that the result of the case he had laid
before the Society, whether the practice was designed or acci-
dental, confirmed (as far as one case could) the propriety of the
advice given by SirB. Brodie. January 2^, 1847.

PART III.
jHontljls $3 tri0co|)e.

Fasting for foriy-ihree Days and five Hours. The followinpf re-
markable case is furnished in a letter to the Editor, from Dr. \V. V.
M. Edmondson, da!ed East New Market, Md., Dec. 2, 1848.

" A gentleman in this vicinity John Stevens, of Luke died on the
25th of October, aged 85 years and 3 days ; having eschewed all
nourishment (except air and water) for the preceding 43 days and 5>

1840.] Monthly Periscope.

hours. His bowels were moved, for the first twenty days, once ; the
next fifteen days, twice ; the remaining eight days, three times. He
was indisposed some ten days prior to the period referred to. He was
sensible to the last, and died without a struggle. Habits industrious,
frugal, and temperate." [Boston Med. and Surg. Journal.

Unsuccessful altem'pt at Poisoning with Pounded Glass. We make
the following extract of a letter from our intelligent correspondent,
W. K. Bowling, M. D., of Adairville, in this State, dated October 15,
1848.

"Mrs. C, of this village, in her attentions to her child, about nine
months of age, after a discharge from its bowels, discovered some par-
ticles of glass adhering to its nates. Becoming alarmed she sent for
rny partner, Dr. Poor, wlio, upon his arrival, had the feces washed, and
procured more than a tea spoonful of powdered glass. He gavethe
child a dose of castor oil, and superintended in person the washing of
the discharges as long as any glass was found in them, and procured
by Aveight eighty grains .^ The glass had been irregularly powdered,
and exhibited fragments of every size from a grain of wheat to the
finest sand. The child showed not the slightest indisposition, and re-
mains perfectly well up to the present time, (five days) since the last
glass was discovered in its discharges.

" I have thought this case worthy of preservation for two reasons :
1st. Because physicians rarely have an opportunity of witnessing the
effect of pulverized glass upon the gastro-intestinal mucous membrane
of man. 2d. Because the case appears to demonstrate that this sub-
stance does not exercise any deleterious influence." [Western Jour,
of Medicine and Surgery.

Contrast of the Symptoms produced hy Prussic Acid and Opium.
Prussic Acid. Opium.

The symptoms begin immediate- The symptoms do not begin imme-
ly or they may be delayed only diately, there being an interval
a few minutes. often, fifteen, or thirty minutes.

Hence coma is speedily induced. Hence coma comes on gradually,
and is seldom delayed beyond and is seldom seen until afterthe
two minules. lapse ofa quarter of an hour.

Convulsions occasionally, Convulsions rarely.

Pupil usually dilated. Pupil most frequently contracted.

Respiration varies. Breaths slowly and almost imper-

ceptibly.

Pulse imperceptible. Pulse fulli slow, rarely frequent.

Little if any tendency to vomiting. Greater tendency to vomiting.

Terminates within an hour. Terminates within 6 or 12 hours.

[British American Med. Journal.

Nitrate of Silver in Mercurial Ptya.lism. Numerous have been
the remedies proposed in severe salivation, but none of them is so
effectual as we could wish. The nitrate of silver is now advocated as

54 Monthly Periscope. [January,

a powerful curative agent in the mercurial ptyalism, by M. Boucha-
court, in the Journal de Medicine de Lyon. He narrates a casein
which almost all the known agents had been vainly resorted to, but
upon the use of a solution oftlie nitrate of silver, rapid recovery took
place. The solution was made of the strength of one part of the salt
to sixty of water, and was applied to the mouth and tongue by means
of a staff covered with lint. Its application caused at first some pain,
particularly where there were aphthous patches, but in a few minutes
great relief was experienced, and the patient was able to sleep the re-
freshment of which he had been robbed for four nights. For the two
or three following days the lotion was applied twice daily, and about
the jourthdayall inflammation had subsided. [^London Lancet,

Case of Separation of the Stomach from the (Esophagus. By Thos.
M, Flint, Student of Medicine in the Jefl^erson Medical College.
(Communicated by Prof. Dunglison.) Prof, Dunglison ; Dear Sir,
By your request I furnish you the particulars of the case in which
softening of the stomach was found to have occurred. The attending
physician, who is a respectable graduate of this school, has given me
the following statement of facts : "The patient was a male child,
aged seven years; sick about three weeks ; symptoms of worms were
prominent one was passed ; cerebral symptoms followed, which ter-
minated in death. Coma and unconsciousness were prominent symp-
toms for ten days previous to death. When roused from this state, he
would eat a small quantity of gruel. He was treated for worms and
cerebral symptoms.

On the 4th inst., thirty-six hours after death, I opened the body in
the presence of the attending physician and a member of this class.
We carefully examined the intestines, beginning at the rectum and
tracing the tube up to the connection of the duodenum witl\ the sto-
mach, without meeting with a worm of any kind ; but noticed marked
inflammation of the small intestines. We next directed our attention
to the stomach itself, which, to our surprise, was found to be severed
from its connection with the oesophagus, and its contents, a dark-
brownish mucilaginous-like fluid, poured out into the cavity of the
abdomen to the left of the spinal column. We were not prepared to
meet with a lesion of tliis character, and could account for it only by
the action of the gastric acids producing remollissement of this organ
after death. In this opinion we were confirmed by the appearance of
the liver; for beside evident marks of acute inflammation the inferior
edge of the left lobe, which had been in contact with the gastric fluid,
was corroded and corrugated.

That you may have the opportunity of examining the case, I herewith
deliver to you the stomach and liver taken from the patient at the
post mortem. Respectfully yours, Thomas M. Flint.

Philadelphia, Nov. 7th, 1848. [Med. Examiner.

The Treatment of Onychia. Onychia forms about the root of the nail,
detaches the nail from its living connexions, but still the parts are not

1849.] Montlilij Periscope.

robbed of the power of keeping up its growth. This is a most painful
state of things ; and in the usual method of treating the complaint, a most
torturing operation is resorted to, that of cutting or tearing olFthe portion
of the nail. All this pain the patient may be saved, by first getting the
fingers as quiet as possible, by soothing measures ; when this is done,
to insinuate a shred of lint, by means of a probe, hammered flat, so as
to pass this small portion as far as it can go between the sore structure
and the surface of the nail ; and if this piece of lint be moistened with
a weak solution of nitrate of silver, the beneficial effect will be appa-
rent in twenty-four hours. The sores will heal quickly, and the pain
will be subdued. The simple lint should be kept insinuated for some
time, even after the sore is healed. The nail will grow to its usual
length, and the hollow sore will be filled up before long. [Vincent's
Surgical Ojperations, in Ranking.

Enormous Abdominal Tumor. A man died recently at Oswego,
from whose abdomen was taken, after death, a tumor which weighed
114^ pounds. The patient, a man of rather intemperate habit, re-
ceived from some cause, a strain about two years since. Soon after,
his abdomen began to increase in size, until it measured, six feet
eleven inches in circumference. It was supposed to be encysted
dropsy, but upon examination was found, we should judge by the des-
cription, to be of that variety of carcinoma, known as colloid.

[Boston Med. and Surg. Journ.

Perforation of the Skull with an Iron Bolt. Newspapers have been
circulating the story of a shocking accident which occurred at Caven-
dish, Vt., where an iron bar, one inch and a quarter in diameter, and
nearly 3 feet long, was actually driven through a nan's skull, and
passed off many rods beyond. Strange as it may appear, the facts,
as related, are true. The man is living, and walks about the house.
All the particulars of the case are preparing for publication in this
.rournal, by Dr. Harlow, the attending surgeon, who writes, under
date of Nov. 20th, "The notes of my case of injury of the head will
be ready in a few days. A sinus under the frontalis muscle is now
nearly healed." [Boston Med. and Surg. Jurnal.

Guita Percha as a Spliiit in Club Foot. Mr. Lyon mentions the
successful application of this article used as follows in the treatment of
club foot.

"After dividing the tendo-Achillis, a procedure not always required,
the limb is wrapped in a bandage of gutta percha, of the thickness of a
penny piece; softened with hot water, the bandage is applied as is
customary with the common roller. The limb being thus encased in
gutta percha while it is still soft, it is restored to its proper form, and
held for a few minutes until the bandage become perfectly hard, when
the foot is retained in the required position." [London Lancet.

Prediction of the Ancesthetic Condition during Delivery by the late

56 Monthly Periscope. [January,

Dr. Rush. "I have expressed a hope in another place, (Medical
Repository, vol. iv.), that a medicine would be discovered that would
suspend sensibility altogether, and leave irritability, or the powers of
motion, unimpaired, and thereby destroy labour-pains altogether. I
was encouraged to cherish this hope, by having known delivery to
take place, in one instance, during a paroxysm of epilepsy, and having
heard of another, during a fit of drunkenness, in a woman attended by
Dr. Church, in both of which there was neither consciousness, nor
recpllection of pain.": [Dr. Channing, of Boston,

On the Treatment of Psoriasis ^ ^c. By Dr. Ro3ibekg, Berlin.
In psoriasis inveterata. Dr. Romberg found the aqua picea, or ;iqua
picis li(|uid8s, to effect a cure when all other means failed. The aqua
picea was prepared by pouring a quart of cold water over a pound of
pitch, and leaving it to stand lor twenty-four hours in a cool place, and
a " beer-glass." (about four ounces?) of the water filtered through pa-
per, i to be taken every morning fasting, and the parts affected to be
bathed >vith it twice or th^-ee times a day. Its use may be continued
for months, the only apparent effect resulting being slight diuresis.

[This is an old English remedy, and has been used in ichthyosis.]
[British and Foreign Rev. Braiihmdte^s Retro^p.

Cholera in England.r The total number of cases of cholera alrejidy
reported from its first appearance, has now reached 1039, of which ^^^S
have proved fatal, and 331 are still under treatnient. During the last
week, the number of deaths reported in the rnetropolitan districts was
62 ; and we think, judging from the daily reports at present, that the
number this week will range about 60, although the daily returns since
Monday show a decided improvepient. On Monday the metropolitan
cases .aipounted to 18, but on Tuesday they declined to 6, ope of which
was fatal ; and on Wednesday, to 4, but three of which were fatal,
The unproved state of the weather may have ponduced to this result.
Frqn) the Provinces, the daily refurns appear without any cases re-
ported. In Edinburgh, the malady still prevails to some extent, the
new cases are scarcely ever under twenty daily; the deaths are from
five to ten daily. The official returns of the Registrar- Greneral, for
the week ending the 11th inst., only show an excess of eleven above
the average weekly returns of the preceding five years within the bills
of mortality. (The above is abridged from the latest accounts in the
English papers.) [Boston Med. arid Surg. Journ.

JjarvcE of Flies ejected from the Stomach. Mr. Editor, The two
creatures enclosed in this little box w^ere thrown from a man's stomach,
four weeks since, in the act of vomiting. The man is represented tq
be of '^ middle age," of a h?irdy, robust constitution, and in his ordit
nary health. Although not fin intemperate man, in the usual ac-
ceptation of the term, yet he occasionally drank a little spirit, and it
was "immediately after drinking a tumbler of hot gin sling," that he
was taken with nausea and vomiting, and threw up these animals, if

1849.] Monthly Periscope. 57

animals they be. They have been kept during the four weeks in a
dry pili-box made of" pasteboard, and yet one of iheni is stll alhe and
kicking. 1 have transferred them to another box, and protected them
with a lock of moist cotton to secure thtm from harm on their way to
Boston. They were presented me by Dr. Grant, of Ossipee,a member
of our Legislature now in session in this town, who will be pleased to
answer any inquiries respecting the case. If the little one should be
as active when you obtain him as he is now, I think you will consider
him, as I certainly do, a queer fish to be derived from such a source.
Very respectfully, Tiio. Chadbouk^^e.

Concord, N. H., Dec. 4th, 1648.

Immediately on the recipt of the box containing the larvae, one of
which was alive, we called on Augustus A. Gould, M. D., the distin-
guished entomologist, for his opinion in regard to them and he has
kindly sent us the tbdowing note. Ed.

Dear Sir.-^The animals you left with me are larvae of a large fly
(syrphus ?), which live in the water. They are familiary called rat-
tailed worms. The rings of the tail are constructed to push out, like
the joints of a telescope, so as to reach the surfiice of the water, and
thus accommodate themselves to different depths. Through this tube
they draw in air, and the end is protected by a circlet of hairs to pre-
vent foreign substances from entering the tube.

Respectfully, Augustus A. Gould.

Boston, Dec. 6th, 1848. [Bosfo7i Med. and Surg. Journal.

Wonderful Effects of ^^Calcarea Carlomca^' HomcRopatJ^fally used.
"A young lad, aged fifteen, extremely psoric, ha J n mained exceed-
ingly small and thin ; his }ifiibs were very slight, and his head too
large for the rest of his body. He suffered from violent headaches
when making. any mental exertion; in his childhood he had suffered
from feebleness of the limbs ; he was very timid, especially at night ;
he could not bear to be left alone in the dark. Two doses of Cakarea
at forty five day's interval, ^tier one dose of Sulphur, brought about
such a favorable change in his constitution, that, in six months, his
height, which had hitherto increased only from six to eight lines per
annum, gained ybwr inches; his limbs, the hands and feet in particu-
lar, had become large and strong, like those of a young man who
would grow to the ordinary height."

A smart boy, that, and up to chalk! Only think of it. The next
case by the same writer, is one of cyanosis in a girl seven years old,
who "presented all the appearance of abnormal permeability of the
ductus arteriosus.'' * * 'Vl globule of the 'SOth dilution of cakarea
effected a radical cure in sixzceeks, probably by restoring the abnormal
part to its ])roper state f .^ ^' Tliink of it again, Infinitely less than
the ten thousand millionth part of the duodecillionth of a grain of
chalk, will make a- boy grow four inches in six months, or close up
an open ductus arteriosus in six weeks ! ! The good book asks us in
a very positive way "who by taking thought, can add one cubit to his
stature T' Answer: We c.an't by taking thought, bm we can by
taking chalk and brimstone /

58 Monthly Periscope. [January,

Reader of ours, do not imagine that we have taken the above cases
from the renowned works of the famous Baron Munchausen, or the
true histories of Lemuel Gulliver, Esq.; they are truly quoted from
an address by the learned Dr. Croserio, before the Societe Hahneman-
nienne, in the Sept. No. of the American Journal of Homoeopathy,
published in New-York City. The same astute philosopher, in closing
his address, gives a last advice, (we should suppose he couldn't long
survive it!) "to exercise prudence in its administration," for, says
he, "this remedy (calcarea carbonica,) is one of the most energetic,
and in spite of its peculiar adaptation to infantile diseases, we should
be very circumspect in our doses, especially at that period of life and
in old age, for even at the end of six weeks it often produces very vio-
lent primitive symptoms, which might be attended with danger, if the
doses given were too strong." Further on he says, " with respect to
the duration of the action of calcarea, it is very long. When it is
very homoeopathic we may look for salutary eflects for six weeks and
longer V^

Gentle reader, if you have rickets, scrofula, lupus, neuralgia, cho-
rea, headache, cyanosis, " big head" or any other of the numerous
affections for which calcarea is homoeopathically administered, take a
globule of the 30th dilution, and if six weeks afterward, you have a
troublesome borborygmus, a twinge of the toothache, or a "crick in
the back," go and make your ^ davit that the chalk did it, and you will
contribute to that great mass of evidence upon which homoeopathy, as
a system is built. For ourselves, we can't understand how any man
in his senses can swallow and believe such nonsense. It strikes us,
that some, at least, of the converts to and advocates of, this system of
moonshine would be much benefitted by some " very homoeopathic"
article, which would produce what an old quack in Springfield declares
he can cure ^''information on the brain f [Ohio Med. Journ.

[Pass his name round let it be honored now, as it certainly will
be by posterity. ^/. S, M. ^ S. J.]

Starling Medical College. Lynd Starling, Esq., of Columbus, Ohio,
has added to his donation of $30,000 to the Medical Institution bearing
his name, an additional sum of $5000. A college edifice, including a
small hospital with thirty beds, is to be commenced next spring. The
generous donor deserves to be canonized in the calender of medical
saints, for we suspect such a munificent endowment of a medical Col-
lege by a single individual, is without a precedent in this country.

[ Buffalo Medical Journal.

Fees from Clergymen. At a recent meeting of the State Medical
Society of Connecticut, a resolution was introduced by a member, to
the efiect that the present practice of prescribing gratuitously for
clergymen and their families, ought to l3e abandoned. This resolu-
tion has given rise to considerable discussion. Several communica-
tions have appeared in the Boston Med. and Surg. Journal, pro and
con, and the editor of the N. Y. Annalist enters quite heartily into the
subject.

1849.] Monthly Periscope. 59

The ground taken by those who are in favor of exacting fees from
clergymen as well as others, is, mainly, that there is no good reason
why we should not, and especially that the clerical profession do more
to upliold and extend quackery in its various forms, than any other
equal number of men.

Clergymen, it is contended, are generally no subjects for charity.
They are comfortably supporlcd, and receive, like others, their liire ;
some of them are wealthy. They are not, as a body, like them of
old; they have both "purse and scrip," and many of ihern are "cloth-
ed in purple and tine linen and fiire sumptuously every day." Their
poor parishioners who receive, perhaps, but their twelve or twenty dol-
lars per month, are compelled to pay to the uttermost farthing ; why
should not the clergyman? Again, it is said, that the clergy sustain
and extend quackery, and constantly step out of their own sphere to
meddle with that which does not directly concern them, and of which
they are profoundly ignorant. One can scarcely take up a newspaper
that he does not see the names of numbers of Reverend gentlemen,
aifixed to certificates attesting to the most ridiculous and impossible
absurdities, and recommending, in the most extravagant terms, medi-
cines, the very composition of which, they do not know, and^he na-
ture and efiects of which, they would not understand if they did.
They, moreover, are frequently intermeddling with the regular profes-
sion, recommending this man because he is a member of their partic-
ular church, and decrying that, because he belongs to another; and
they are, besides, the most active and influential advocates of hydro-
pathy, homoeopathy, eclecticism and other forms of quackery.

The above, we remark, contains the strongest part of the objections
urged against further gratuitous service. Without stating Ibrmally
the other side of the question, we shall, in as few words as possible,
give our own views on this subject. We regard it as one of some
importance, the discussion of which may do good.

We- have a high respect for the clerical profession. Their mission
is the most important that can be conceived. Compared with it all
the professions, businesses, and pursuits of life sink into absolute
nothingness. They are dignified by their calling the greatest, the
best man in the universe cannot dignify. On this account they are to be
respected ; but the very sanctity of their profession turns the eyes of all
men upon them. They are men nevertheless, and subject to like pas-
sions and infirmities with us. They are obnoxious to mistakes and
errors like us, and some of them are no better informed, even in what
relates to their own calling, than they should be. There are except-
tions to all general rules, but, taken as a whole, the clergy of the
United States are an educated, refined, and able set of men. As a
body, they are not guilty of the charges preferred against them.
Many ignorant or superficial ones (those who are varnished over with
a thin scum of universal knowledge, we mean,) there are, and these
are they, for the most part, whose names are found in the lying adver-
tisements of the newspapers. W^e will go farther. There are some
denominations very nearly or entirely iroe from the sin laid to their

so Monthly Periscope. [January,

charge. No well-educated, faithful, pious, conscientious clergyman,
who has a proper respect for his profession and himself, and we have
many such, will ever, under any circumstances, lend himself to the
propagation of error and falsehood, in the way spoken of. The vast
majority of clergymen appreciate as it deserves, the medical profession,
and are found everywhere, its considerate and consistent supportres.
The whole body should not be made to suffer for the deUnquencies of
a few. Our own. skirts are^not entirely clear. Recreant M. D's.,
who love gold better than honesty or honor, as well as Reverends, ap-
pear appended to newspaper puffs, and gaseous advertisements. We
spurn them both alike. We discriminate in the one case, why not in
the other ?

As a profession, then, we acquit the clergy of any attempt or desire
to depreciate or injure in any w^ay, the legitimate science of medicine.
So far as this charge is concerned, we would have every physician to
act for himself. W herever and whenever a clergyman is found encour-
aging, in any way, quackery in our profession, let him be marked. If
he consorts with quacks, to their tender mercies consign him ; and if
any professional services are rendered, charge to the extent of the law,
and collect the fees.

But how is it in reference to the pecuniary ability of clergymen ? In
the large cities they often receive liberal salaries, besides numerous
perquisites, but it is perfectly notorious that the great majority
throughout the country are miserably remunerated for their services.
No class of men, of equal attainments, are anything like as poorly
paid, We verily believe that, if all the salaries were averaged, the
resulting sum would not be over $500 per annum. Out of this pit-
tance, families are to be supported, and old age provided for. An equal
amount oftalent and learning devoted to almost any other pursuit, would
secure a competence, and the very fact that a young man is willing to
forego his earthly prospects, and embrace a life of self-denial, if not
of actual privation, is '' confirmation strong as holy writ," of the purity
of his motives we had almost said, of the depth of his piety. Clergy-
men are almost universally poor. Now and then one has inherited
a patrimony, or married a rich wife, but the exceptions only prove the
rule.

We think, in view of the whole subject, which we have, however,
barely glanced at, that the following is the proper course to be pursued.
When a clergymen is wealthy, or has an income, independent of his
salary he should pay his physician's as well as his grocer's bill. In all
other cases, with the exceptions mentioned before, which should be
absolute, we hope the practice of the profession will be as it has here-
tofore been, and that clergymen and their families will receive, as a
general rule, without fee, the best services we can render. [Ohio Med,
and Surg. Journal. (Well said and true. Edt. S. M. & S. Jour.)

r

The Eclectic Practitioners, or the so-called Practical Men. There
are medical men in high positions, greatly occupied with numerous
patients, who from a want of study, of intelligence, or of time, from

1849.] Monthly Periscope.

t

a natural indolence, or from being too old to master recent important
improvements, affect a supreme disdain for everytiiing that concerns
doctrine or generalization, either physiological or philosophical. They
call tliemselves practical men, and speak ironically of theorists
men of science or of the closet, such who labor most for the advance,
ment of medical science, and whose knowledge crushes and confounds
them. These so-called practical men are those who have no doctrine
and no general principles, who gather together ready made formulae
and isolated cases, without any kind of scientific discernment. The
only medicine they study is that contained in small books of prescrip-
tions, published in l8mo. or 24mo., which they carry in their pocket,
and know by heart. We have frequently had occasion to remark that
a practical man, that is, a man who Ixjasts of knowing nothing of
scientific medicine, is a medical machine inferior intellectually to a
master-mason, a locksmith, or a cabinet-maker, for these have princi-
ples and a sort of doctrine which they apply in their business. They
were appreciated in like manner by a learned individual whose author-
ity no one could doubt, and who said, " The true eclectic works
without conviction, without principle, without idea. He is continual-
ly enlarging his circle, in order to enclose within it facts of the most
contradictory nature they sacrifice in a sort to every god, and create
a kind of scientific pantheism, not less fatal to true science, than
pantheism, properly so-called, is to true religion." [Prof Cruveil-
hier^s Address to the Anatomical Society, 1845.

Headache caused hy Inflammation of the Frontal Sinuses.^ M. Mom-
bert was accidentally led to the appreciation of this cause of headache
by the observation of a friend who was attacked wi'h violent frontal
headache, which lasted the whole day and departed totvards night,
again to recur with equal severity in the morning. Several physicians
had prescribed for the patient without advantage. One morning, in
the excess of his pairf, he rubbed his forehead so violently with a
clothes-brusb that he completely took the skin off, leaving a sore,
which remained for some time. From this period the headache
entirely subsided. Instructed by the case, iM. Mombert treated a
patient laboring under similar symptoms by applying a blister over the
frontal sinuses ; the result was equally fortunate. [Fxer/e/ Jdreschrift
filr die Practisch. Hilkunde. Ranking^s Abstract,

Prescription for Whooping Cough. Dr. McMurray, in the St.
Louis Med. and Surg* Journal, for April, has found the following of
great service in the treatment of this distressing affection after healthy
secretipns of the bowels have been obtained by the use of calomel,
ipecac, and rhubarb.

R. Hydriodate Potassa, . . gr. vj.
Mucil. Acacia, .... gvij.
Syrup Senega, .... sj.

Tinct. Lobelia, ... 3j. M.

Dose, a tea-spoonful four times per day to a child two years old.

[New York Jour. ofMed^

2 Monthly Periscope. Medical Intelligence. [January,

Prescription for Nausea and Vomiting of Yellow Fever. " For the
nausea and vomiting attendant upon the disease, an ethereal tincture
of kreosote was almost invariably beneficial. By it I arrested the
black vomit itself and procured recovery. The prescription usually
employed was, Kreosote, . . . gtt. xx.

Eth. Sulph., ... gj.

Spts. Lavend. Comp., j. M.

A tea spoonful every fifteen minutes until the nausea and vomiting
ceased." [Dr. Mitchell, U. S. N., in Med. Examiner.

MEDICAL INTELLIGETNCE.

THE SOUTHERN MEDICAL AND SURGICAL JOURNAL Shall it
BE CONTINUED OR NOT 1 In entering upon the fifth of the new series of the South-
ern Medical and Surgical Journal, it will in all probability prove its last volume.
The present patronage does not support it. With every effort to discharge our
whole duty as Editor, and after every appeal on the part of the Publisher, only
three hundred ixibscribers have paid iov She Journal for the year 1848. This too
with payments demanded in advance. If this be the result of the cash system,
what would have been the result of the credit? The publisher, therefore, dis-
tinctly declares, he cannot continue the publication of the work at a positive
pecuniary loss to himself. The editor never has asked, never expected, and
has never received one cent from the subscription, for his labour in conducting
the Journal. He speaks thus plainly on the subject because the occasion de-
mands it, and experience has taught him to be candid. For the last (third) vol-
ume of the old series, one-half of the actual cost of publication had to be paid by
the editor, viz., S900.00.

In paying the subscription to the work for the first year, many have acted
upon the principle they have no further payment to make forgetting entirely
that each Vol. requires to be paid for. It will take double the present number
of subscribers, to carry on the Journal successfully and profitably. This we
have no reason to believe will be obtained, and we now announce, early in the
fifth volume, the great probability of the discontinuance of the Journal alter
the piesent year, 1849. The profession of the South and West have now these
facts before them, and they must say whether the oldest, the most prompt, and
the only monthly medical publication in this region, is to be sustained or not.

In the meantime we hope to continue our labours uninterruptedly through
the fifth volume,

Death of a child in Ulero, by Lightning the mother escaping .-^Our valuable
contributor to the Journal, Dr. J. A. Mayes, of Bradleyville, So. Ca., writes to
us, under date Dec.Gth: "Looking over the pages of the December No., I no-
ticed an account of several persons struck with lightning, the reading of which
brought to my recollection the following case. A negro woman, about 30 years
of age, in good health, and eight months advanced in pregnancy, was overtaken
by a thunder storm in the month of August. 1848. For protection against the
rain and wind, she leaned against a pine tree, but had scarcely done so, before
the tree was struck by lightning. The shoulders, front of the chest and abdomen,

1849.] Medical Intelligence. 03

were severely burned, but the brain was,. in no refpect, injured. From that time,
to her delivery, which was three weeks afterwards, she complained of beinjj very
unwell. The child was dead, and appearances indicated that it had been so
from the time the mother received ihe mh)Im' of lightning. The woman recover-
ed rapidly. This, then, is a case of a child in utero being killed by lightning,
whilst the mother escaped."

Letter from Dr. Meals on the Use of Quick-Silver.

Mariktta, Ga., Nov. 1st, 1848.
Dear Doctor A friend, who expressed much gratification after reading my
article on the uses of Crude Mercury, has just placed in my hands the October
number of the New York Annalist, in which I find an article, from the German,
confirming to a considerable extent, my views on the applicability of Cluicksilver
to diseases of the bowels. My reasons for sending it to you are first, that you
do not, I believe, exchange with this Journal,* and would most probably not see
it; secondly, that testimony thus adduced from sections so remote, might have
the effect of inducing physicians in this country to at least give the remedy a
trial; and, thirdly, from my extraordinary success in its administration, I can-
not but feel anxious that it should occupy that high position in the catalogue of
remedies, to which I think it so jusllv entitled.

Very truly, yours, &c. HENRY H. MEALS.

Metallic Quicksilver in Ileus and Obstructed Boviels. Several cases of theulili-
tv of quicksilver in Ileus have been recently published in the German Journals.
Dr. Schubert relates one of a man to whom every internal and external medicine
had been given, until the incessant vomiting obliged the abandonment of all of
the former. The constipation was most obstinate, and the abdomen much dis-
tended, but there v/ere no signs of inflammation. The patient seemed at the
last extremity, when Dr. Schubert remembering two similar cases had been so
treated with success, ordered him 4 oz. of quicksilver every half hour. His
death seemijig inevitable, only two doses were given ; but after two hours he
had stools, and soon recovered.

Dr. Lowenhardt refers to a work published by him in 1838, in which he sets
forth the advantages derivable from the substance, and in the paper before us
details additional cases in illustration. The cases now added are those of vol-
vulus, internal incarceration, spastic ileus; inflammatory ileus, after the in-
flammatory symptomsare removed; incarceration persisting after the operation
for herni 1. probably from the agglutination of the parietes of the canal by ex-
uded mucous; and especially very obstinate vomiting. All the cases he addu-
ces wei^e not cures, and he gives the postmortem examination of some, from
which it appears that the mercurv sometimes passes through an intussusception,
without removing {{.[Casper's 'Woclinschrift,^o.^, MediciiUachc Zcitung, 12
and 13.

The Ainericam. Medical Association How the first volume of its Transactions may
be obtained. By desire of the committee of arrangement, the Secretaries of the
American Medical Association request that all societies and other institutions
authorized to appoint delegates, send correct lists of those chosen to attend the
next annual meeting, to Dr. Henry J. Bowditch, Boston, on or before the 1st of
April, 1849.

We would invite attention to this request, as a compliance with it will greatly
facilitate the organization of the Association.

* We have regularly acknowledged the receipt of the Annalist on the cover of

every No. of our Journal as issued. Edt.

64

Medical Intelligence.

-Meteorology.

We take this opportunity to remind the Members of the Association of the
resolution adopted in Baltimore, direclinglhal a copy of the Transactions should
be sent to such members only as shall have paid the annual assessment for the
present year (three dollors). Those members paying to the Treasurer five dol-
lars are entitled to three copies.

Medical Societies which have been represented in the Association Avill be
furnished copies on the same terms as members (viz., three copies for five
dollars) on remitting the amount to the Treasurer.

To other persons the Transactions will be furnished at the rate of two dollars
per copy in paper covers, done up for mail, or two dollars and fifty cents in
embossed cloth, on remitting the amount direct to Messrs. Lea & Blanchard,
Philadelphia. Or orders left with booksellers will be executed by Messrs. Lea
& Blanchard.

Editors of Medical Journals will aid the objects of the Association by an-
nouQcitlg the above information in their ^d^^es. [Medical News.

Obituary. Died, irl this city, on the 18th Dec. last, Paul F. Eve, Jun., young-
est child of the editor of this Journal,
fit wasonly in oilrlastNo. that in recording the death of his son, we expressed

ourde^p sympathy for our friend, ttie editor of the American Journal of Insan-
ity Utile then thinking how soon we \Vere to experience the same heart-rending
barsavenent. "*
affliction.!

inmi^mg now soon we were lo experience me same neari-rennmg
F'or nearly three years have we been bowed down by domestic

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide 52 feet.

for November, 1848, at Augusta,
32' west Wash. Altitude above

Sun Rise.

Thkr.

43
33
32
52
51
3S
36
32
37
43
44
46
48
48
46
42
48
48
35
29
3t
30
2l
49
41
34
26
26
26
38

B^

Thkr.

29 74- 10 J,

30 7-100|

29 87- 1 00 ;
" 62- 1 00 1
'= 89-1001
" 98- 1 001

30 7- 1 00 1

29 9 7- 100 1
" 97-1001

30 6-100'
129 88-1001

" 80-1001
" 99-100!
" 88-100
" 81-100
" 81-100
" 75-10)
" 93-10'
30

29 81-100
" 93-10)
" 88-1 00|
" 53-100
" 53-100
" 61-100
" 84-100

30 3-100
" 10-100
" 5-100

29 89-100

i'rZ
57
63
54
60
60
55
60
62
61
54
51
55
50
f/J
64
72
42f
47
49
53
44
60
59
61
45
40
54
57
57

P.M.
Bat?.

Wind.

Remarks.

29 7-3-1 Ot)

N. W.

F'air blow.

" 99-100'

N. W.

Fair first frost arid ice.

30 4-100

S. E.

Flving clouds breeze. [60-100.

29 77-100

N. W.

Rain to-day & last night, 1 inch

" 67-100

N. W.

Fair--breeze.

" 92-100

N. W.

Fair.

30

N. W.

Fair breeze.

30

S. W.

Fair.

29 95-100

w.

Fair.

30

w.

Cloudy.

" 3-100

N. E.

Cloudy.

29 76-100
" 8.5-100

N. E.

Rain, 10-100.

N.

,Cloudy.

" 98-100

N. E.

Cloudy.

" 85-100

W.

iFair.

" 80- 1 00

s. w.

Cloudy.

" 76!- 100

s. w.

Fair. [the night, 5-100.

" 77-ioa

N. E.

Rain all day, 75-100 during

" 95-100

N. W.

IFair breeze.

9.5-100

s. w.

jCloudv afternoon.

" 83-100'

5f. w.

Fair-^breeze.

" 87-100

s.

Cloudy.

" 82-100

S. E.

Fair.

" 42-100

S.

Rain, 5-100.

" 61-100

s. w.

Fair breeze blow at 8, p. m.

" 91-100

N. W.

iFarr-^bfeeze.

30 7-100

W.

Cloudy.

" 7-100

S. W.

Fair.

29 95-100

s. w.

Fair.

' 84-100

s.

ICloudy.

16 Fair days, auantily of Rain 2 inches 55-100. Wind East of N. and S.
6 days. West of do. do. 20 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol 5.] NEW SERIES. FEBRUARY, 184^. [No. 2.

PART FIRST.
r i g i n a I o m m u n ic a t i o n ff .

ARTICLE IV.

Observations on Ranula; with Cases, Treatment and Cure.
By James M. Gordon, M. D., of Lawrence ville, Gwinnette
county, Ga.

Did not experience and almost daily observation teach us to
the contrary, we should not anticipate in any case of the above
nanned disease the slightest difficulty in its cure. When we
reflect with what tardiness and exceeding difficulty wounds
within the oral cavity, from the s^reat humidity, together with
other causes, are healed, we should be led to suppose that from
analogy and reasoning, a priori, that in every case a mere punc-
ture would be sufficient the continual flow of saliva through
the artificial opening thus made acting as an additional cause
to prevent re-union or cicatrization. But it is far otherwise.
Notwithstanding in perhaps a majority of cases it is sufficient,
yet in very many not so, as will be seen in the sequel of this
article.

The term Ranula, (from rana') from its supposed or imagin-
ary resemblance to a frog, or the peculiar croaking sound of the
voice in articulating, is used to denote the presence of a tumour
in the sublingual or submaxillary regions filled with saliva and
viscid mucous generally of a light straw colour. These tu-
mours not unfrequently acquire considerable size that of a
man's fist, or larger and not only partially and sometimes
wholly destroy the power of speech, but ofl!er very material
obstruction in the eflTorts of deglutition and respiration. When

>'. s. VOL. v. NO. ir, 5

C6 Gordon, on Ranula. [February,

not relieved by a counter-opening, they acquire a volume suffi-
cient to thrust the tongue backwards, and from the compression,
to waste a portion of its substance, to remove the teeth from their
sockets, &c., and finally burst' of themselves, leaving a very
troublesome ulcer. The cause of these morbid accumulations
is from either a closure or mechanical obstruction of the excre-
tory ducts of the salivary glands, or the orifices of those ducts.
The closure of these ducts may take place in the ordinary man-
ner of inflammation and adhesion of their opposite sides. The
mechanical obstructions may be either foreign bodies or the
morbid secretions of the glands themselves. By far the most
common mechanical obstruction is a deposition of calcareous
matter, which not unfrequently assumes a hard, stony nature,
and in great abundance. The duct of the parotid, from its lar-
ger size, rarely becomes closed so as to constitute ranula of
that gland. From greater diminutiveness, those of the sub-
maxillary and sublingual, are more often the seat of disease.
In cases of long standing, a kind of adventitious cyst, or sac, is
formed, which becomes thickened and more resisting in pro-
portion to the duration of the case. The afl^ection is one
producing rather a sense of restraint than of pain, except when
active inflammation is established, when it becomes acutely
painful.

Treatment, As a matter of course, the indication in the
treatment of a case will be, first, to carefully examine and re^
move any foreign body that may be present. Calcareous
deposites being the most common, and frequently in abundance,
demand especial attention.

Where the orifices of the ducts have become closed, they
should, if possible., be dilated by means of a silver probe or
bougie ; but as this is generally impracticable, an opening with
a lancet in the most prominent part of the tumour should be
made, which will not only relieve the immediate exigencies of
the case, but frequently eflect a radical cure, by a fistulous
aperture remaining, through which the saliva is discharged.
When a common puncture is found insufficient, from its dispo-
sition to close, the indication will be more certainly fulfilled by
removing a portion of the cyst, and occasionally touching the

1849.] Gordon, on Rnnula. ffl

sifles of the aperture with caustic, so as to prevent its closing.
If the latter proposition should prove unavailing,', it has been
proposed to pass a seton directly through the tumour, and suf-
fered to remain till a permanent fistulous opening is established.
Finally, after the failure of all the above enumerated modes of
treatment, it has been proposed to extirpate the sac. Biit from
the nature of the adjacent tissues and the contiguity of numer-
ous large blood-vessels, it is both a difficult and highly danger-
ous operation, and, as we believe, wholly unnecessary, and does
not at the present day receive the sanction of the profession.
The i)lan of treatment which we so successfully resorted to in
the protracted and exceedingly difficult case about to be narra-
ted, w^ould obviate, under the most adverse circumstances, the
necessity of so formidable an operation. We allude to injecting
the sac with the dihited tincture of iodine, after the manner first
proposed by Dr. Martin, for the radical cure of hydrocele, and
since, so successful in hydarthrus. This experiment we con-
sidered ourselves justified in making, after the failure of every
other known method of treatment, and as will be seen w^ith
complete success.

Case I. J. A. R., a fine healthy boy, seven years of age,^ was
attacked in October, 1843, with what his parents thought a
severe cold ; his articulation became difficult, as also his breath-
ing and swallowing. Various domestic remedies were admin-
istered in order to break the cold, when, contrary to expecta-
tion, and notwithstanding the multiplicity of remedies, the
symptoms continued to increase in severity. We were re-
quested to see him, and found a considerable tumour projecting
from beneath the tongue of the size of a walnut, or larger.
Satisfied of the nature of the tumour, we did not hesitate to at
once plunge a lancet into it. A considerable quantity of saliva
flowed out the opening never closed, and there has been no
return of the disease up to the present time.

Case IT. Ruthy, a mulatto woman, now the property of Mr
A., set. 34, of scrofulous diathesis, about three years since dis-
covered a small tumour occupying the sublingual space. It
continued to enlarge till it became of sufficient "size to occupy

68 Gordon, on Ranula. [February,

the whole space in the right side of the mouth, and formed a
large tumour under the right inferior maxillary bone, in addition
to that already formed in the sublingual region. The tongue
was thrust backwards and to the left; respiration and degluti-
tion were performed with great difficulty, and the voice nearly

entirelyslost. She was then placed under the care of Dr. ,

who had charge of the case for nearly two years, who, as he
informed us himself, had unsuccessfully exhausted every known
method of treatment, and had finally abandoned the case as
incurable, only making an opening once a week, or ten days,
for the escape of the saliva.

She was sent to our office on the 6th of April last, and pre-
sented the following appearances: K considerable tumour
occupying the sublingual, and extending from thence back-
wards to the submaxillary region and forming a prominence
below the inferior maxilla, soft and fluctuating, the size of a
duck's e^g. There also existed scrofulous ulceration of the
throat, together with enlargement of the cervical lymphatics.
An opening was made in the most prominent point of the tu-
mour opposite the second bicuspid tooth, and a large quantity
of thick, inodorous, straw-coloured fluid discharged. A gum-
elastic tent was inserted through the opening into the sac,
which, owing to the difficulty of keeping in situ from its con-
tractility, was in a few days removed, and one of oiled silk
substituted. She was directed to take, in solution, five, gradu-
ally increased to ten, grains of iodide of potassium, three times
daily, and to have the throat, externally, painted wit.h tinct.
iodine once per day. That course of treatment was faithfully
pursued for the space of two months in the mean time the
ulceration healed kindly, and the indurated lymphatics were
much improved. The tent was removed and re-inserted as
often as deemed necessary, in the hope that a permanent open-
ing would be established, but in vain, forty-eight hours at any
time being sufficient for the opening to close after the removal
of the tent.

As a dernier resort we were about acting upon a suggestion
kindly made by our esteemed friend. Prof. P. F. Eve, to insert
into an opening in the sac a common shirt-stud, with a small
hole drilled in its centre through which the saliva might escape.

1849.] Westmoreland, on Fever. 6d

and which was to be perpetually worn by the patient. It oc-
curred to us, however, before resortinir to this last expedient, to
test theefficacy of iodine injection. The cyst was filled with a
fluid composed of tincture i(3dine, one pnrt ; water, four [)arts ;
which wns retained until considerable pain was experienced,
and then discharged. Considerable inflammation followed, and
we are happy to say, a total obliteration of the cavity of the sac.
Since that time there has been no return of the disease, and
from a state of anaemia and great debility, her system has rallied,
and she is now in the enjoyment of perfect health. We deem
it not amiss to say, that notwithstanding she is a seamstress,
and valuable house-servant, she was purchased by Mr. A. at
the exceedingly low price of one hundred dollars, and that now
she would command six hundred dollars in any market where
she is known.

ARTICLE v.

On Fever. By J. G. Westmoreland, M. D., of Zebulon, Ga.

Fever, in the general acceptation of the word, is that state
characterized by heat, thirst, frequency of the pulse, &c., &c. ;
and is present in a large proportion of diseases. But " the f ever, ^'
of which this article will treat, is a radical disease, occurring in
marshy districts and other unhealthy locations. The name
fever was no doubt given to this disease, from the fact, that
heat, thirst, &c., or some one of them, constituting fever, was
always present ; and also that the symptoms of any particular
local afllection, so far as had then been discovered, were not
always present. H^nce the term idiopathic was used to dis-
tinguish this from fevers arising from acute inflammations, &c.,
which were called symptomatic. Some among pathologists,
however, contended that all fevers were symptomatic. Brous-
sais, as we might say, the father of these, believed that the
alimentary canal was the seat of local inflammation in all cases
of '*the fever;" although symptoms of that state of the organs
were far from being always present, as admitted by himself.
The idiopathisists whose recorded opinions were my text-book
in college, six or eight years ago, denied the operation of the

'W Westmoreland, on Fever, [February,

morbific poison on the mucous gastro-enteritic surface ; and, in
fact, that inflammation is set up in any organ, directly by the
miasmatic cause, but merely an irritability of the sanguiniferous
and perhaps other systems. Some of these insisted that the
capillary system is the seat of irritation, while others refer it
to other organs.

Now, it is of little importance, as I conceive, whether we call
it idiopathic, or symptomatic, so that we find out the organ pri-
marily afifected, and the nature of that affection. " The fever"
is a pecL liar fever, because it is produced by a peculiar, specific
cause, not that the symptoms, heat, thirst, &c., are different
in this f'isease from what they are in other fevers, but that they
are produced by a specific virus acting on a particular organ.
The organ or structure primarily affected by the morbific
cause, has been the subject of contention for more than two
thousand years ; and the means which have been mostly relied
on to determine this fact, (viz., post-mortem examination,) have
led to more error than any thing else. Fortunately for science
no particular organ has been found, invariably bearing the marks
of inflammation; for even these changes may be articulo-mor-
tem, or post-mortem, and calculated to deceive. That the
initial symptoms of fever are those of deranged nervous action,
has been admitted by the best pathologists for years. But dis-
sections do not invariably reveal any lesion of the nervous cen-
tres. Few, therefore, could believe they were radically diseased.
The only reasonable conclusion to which I can arrive, is, that
the organ whose functions are always first disturbed, must be
the one on which the malaria has its specific action. If the
morbific agent affected indiscriminately, whatever structure it
came in contact wuth, the lungs, blood-vessels, &c., would be
the first to give indication of disease. But every physician that
has watched the symptoms as they rise, in autumnal fevers,
knows that cerebro-spinal disturbance is exhibited, conjointly,
or the spinal alone, even before any febrile action is set up.
The nature of the primary derangement, we can learn sufficient-
ly for all practical purposes from the derangement of its func-
tions. To irritability of the capillaries, and other parts of the
circulatory system, as well as other organs of the body, is the
direct tendency of the morbid nervous action.

1849.] Westmoreland, on Fever. 71

For a complete view of the pathology of intermittent and
remittent fever, the reader is referred to Prof L. D. Ford>ex-
cellent article on that subject in the first volume of the Southern
Medical and Surgical Journal.

That intermittent fever, arising from the common cause,
may, in progress of the disease, assume a different type, from
the subject being situated so as to inhale effluvia arising from
putrid vegetable or animal substances, immediately in the
vicinity of the sick room, and of a different character from that
which induced the fever, no close observer, in the practice of
medicine, will deny. And that this exhalation which is known
to alter the character of fever, from remittent to continued or
typhoid, will, when of sufficient strength to affect a person in
health, produce fever of the latter form, is equally true. These
facts being admitted, we must conclude there is a difference in
the two forms of fever ; either from an altogether different char-
acter of the local affection in the same part, or from an extension
to a more vital organ. Then, as our only index to the primary
local disturbance, is the consecutive symptoms of deranged
functions, by the study of them alone can we learn the pathology
and treatment of fever. If, as in intermittent and remittent
fever, we find paroxysmal pains in the back, limbs, &c., with
constriction, &c., of the capillaries, we can but refer the de-
rangement to the nervous centre in proximity to, and supplying
those parts with nervous power. But if, as in typhoid fever,
we find cerebral disturbance to take the place of the paroxysmal
or periodical nature of the affection, there is good reason for
ascribing the continued character of the fever to the cerebral
derangement.

In typhoid fever, as in some other diseases whose pathology
is not very well understood, we learn a good deal by the success
or failure of remedies. For instance in spinal or remittent
fever, spinal revulsives and counter-irritants materially benefit
the patient ; while in cerebral or typhoid fever, refrigerant,
counter-irritants, &c., to the head, effect much good. Quinine,
the great remedy for fever of a spinal organ, is worse than use-
less in the continued form of fever ; for, if the medicine should
have no injurious effect, much time is lost in affording appropri-
ate remedies. It is unfortunately the case, however, that we

72 Blackburn, an Ruptured Uterus. [February,

cannot, always, distinguish the different forms in their com-
mecement. It may be said, and truly too, that typhoid fever
does not always carry with it symptoms of cerebral disturb-
ance such as delirium, &c. But, it must be recollected, that
although the mind may remain undisturbed throughout the
whole course of the disease, nevertheless the origin may be in
the brain ; for the organs of involuntary action are under the
influence of portions of the brain, whose functions may be de-
ranged, and yet the cerebrum proper, or that portion in which
resides the mental faculties, remain normal.

In the milder forms of fever (intermittent, for instance) the
brain is subject to be secondarily, or sympathetically, affected
with congestion, &c., in consequence of the deranged functions
of other organs of the body: these are removed by contracting
the primary disease. Mercury, the great alterative in fever,
seems to be applicable to any form ; but that it may prove
salutary, other appropriate remedies, according to the location
of the disease, must not be neglected. As to the nature of the
derangement produced in the brain, by the poisonous effluvia,
I would say, in conclusion, that this poison has its specific ac-
tion on the great nervous centra, deranging its functions, with-
out visibly altering its structure. A great many of the active
poisons and medicines have a specific action on certain organs
or strictures, and will eflTect no other, though in contact with
them. Some of these disorganize the part ; others as the
malaria do not.

ARTICLE Vf.

A Case of Ruptured Uterus. By J. C. C. Blackburn, M. D,,
of Knoxville, Ga.

On the 20th of November, I was summoned in great haste to

the bed-side of Mrs. W. , who was represented to be in

labor. Upon my arrival, I found her attended by an ignorant
midwife, who had, as I learned, been giving her "teas," &c., for
some hours previous to my arrival. She was the mother of
five children, and of a ijood constitution. I found the mem-
branes had given way early in her labor, and the discharge of

1849.] Eve, on Foreign Body in Pharynx and Larynx. 73

the liqitor atnn'i had been very considerable. The os uteri had
become so much dilated that the head had entered the sLi[)erior
aperture of the pelvis. During the night she was very restless,
and w^oujd turn constantly from one side of the bed to the other,
and expressed herself as fearing a latal termination of "her
labor." To relieve restlessness, 1 gave her a fe\^ drops of rinct.
opii., which suspended pain and gave her a few broken slum-
bers. As soon as the anodyne had spent its influence, her pains
returned at short intervals, and with some considerable severi-
ty. The labor made gradual progress, and I could detect no
difierence between it than a common case of tedious labor.
By the afternoon of the next day, the head had descended into
the concavity of the sacrum, and the coiidition of the soft parts,
and the tranquility of the pulse promised, as I thought, a speedy
and happy delivery. All at once the pains subsided, and she
exclaimed, ^' O Doctor, my womb is split, and I shall die !"
Her respiration became so difficult that she insisted upon being
taken up. She made a few unsuccessful efforts to get up, and
constantly insisted that she was dying. Upon applying my
hand to the abdomen, I discovered that some part of the child
had bursted through the uterus. In the mean tin)e, vomiting,
hiccuping, uterine hsemojrhage, cessation of labor-pains, &c.,
convinced me that death would soon close the agonizing scene.
Her respiration became more and more oppressed, and in a few
minutes spasms took place, and death bore her swiftly to the
spirit world.

This is the first case of ruptured uterus I have ever seen,
and pray God it may be the last. Whether it was attributable
to violence and want of skill, on the part of the attending "ttziW-
t^tje," in introducing her hand, or to the spontaneous contrac-
tions of the womb, I know not.

ARTICLE VII.

Death from a Foreign Body {apiece of hone) cutting from
the Pharynx into the Larynx. By Paul F. Eve, M. D.,
Professor of Surgery in the Medical College of Georgia.

On Saturday, 15th of June last, a coloured boy, aged nine
years, while taking beef-soup had a piece of bone to stick fast in

74 Eve, on For. Body in Pharynx and Larynx. [February,

the throat. Efforts were immediately made by the family to
dislodge it, and these were subsequenlly directed by two skill-
ful physicians of the village where the accident occurred. The
means employed consisted of emetics, the forceps, probang, &c.
These attempts having been unsuccessfully renewed the next
morning, the yttle patient was sent with his mother to me, a
distance of twenty-five miles. They arrived at my office at 4,
P. M. ; being about twenty-eight hours after the foreign body
was arrested in its passage to the stomach.

At this time, there was considerable hoarseness, besides the
difficulty of deglutition. The patient had slept some the previ-
ous night, and had also swallowed a little water since the efforts
made to relieve him. His mother said the foreign body could
be felt by the tip of the finger while the mouth was forcibly
opened at least, so she had been informed by the physicians.
There was now no cough, neither had there been at any time.
By thrusting the fore and middle fingers deep into the pharynx,
the sharp, rough, projecting edge of a piece of bone was reach-
ed, but which occasioned an instantaneous and spasmodic action
in the muscles of the part, but which excited no cough. The
forceps and other instruments were now directed against this
foreign substance, and it was supposed to have been seized more
than once; but after an hour's persevering endeavour to re-
move it, the case was abandon d for the present. It was only
while the patient was firmly held, and the mouth forcibly open-
ed, (for he was too young to be persuaded to submit quietly,) that
these attempts for its exti'action could be made.

After these latter efforts, the patient never swallowed, not
even iced water, and his respiration became more and more
embarrassed. He passed a bad night, and seemed much ex-
hausted the next morning. Indeed, it soon became apparent
that without relief he could not long survive. Drs. Newton,
H. F. and R. Campbell and Dr. Barry saw the patient at 12, M.,
and as I was engaged in carrying out our decisions viz., to
make one more attempt to extract the bone, and should that
prove, like the others, unsuccessful, then to open the pharynx
he expired. A new pair of forceps had only been directed to
the foreign body, when he breathed his last. The larynx was
now laid open, and a silver tube introduced into it encountered

1349.J American Medical Association. vl^

something foreign. Tracheotomy was next performed ami
artificial respiration attempted for half an hour. The heart
continued to act, but respiration was not re-established.

Death having thus occurred, the wind-pipe was freely ex-
posed, when a piece of bone was found projecting into the
larynx below the rima glottidis, and extending thence through
its posterier wall into the pharynx. It was the outer lamina,
thin, sharp, having jagged edges and of an oblong shape. It
measures one inch by half an inch. The irregular, serrated
edges, particularly on one side, explains the difficulty in remov-
ing this foreign substance ; and its thin, sharp extremities, the
facility with which it cut its passage from the pharynx into the
larynx. Did not the means employed produce or promote the
entrance of this foreign body into the wind-pipe? He evident-
ly died from exhaustion, the result of the treatment pursued in
the case, and the interference to respiration by the presence of
the bone in the larynx.

PART II.
Rex)tetD0 ani i' tracts. 'i(#Wt

The Transactions of the American Medical Association.

(CONXLUDED.)

The Report of the Committee on Surgery was presented to
the Association by Dr. G. W. Norris, of Philadelphia, and the
part on anaesthetic agents by Dr. Isaac Parish, of the same city.

The subj^.cts of Lithotomy and Aneurism especially claimed
the attention of the committee. The lateral operation for
stone, it is known, has most generally been resorted to in our
country. In relation to the bi-lateral method, it is said

"A few among us have resorted to it and within a few years
the profession have been favoured with valuable papers on
modifications of it by Drs. Warren and Stevens. So far as
your committee can ascertain, the first operation in our country
by this method was performed by Dr. Wm. Ashmead, of Phil-
adelphia, in 1832, nearly eight years after it was brought prom-
inently into .notice by Dupuytren at tlie Hotel Dieu of Paris,

76 American Medical Association, [February,

The case proved successful, and in that and the succeeding
years, the same gentleman operat^ upon three other patients.
Dr. Og er of'Chailesion, repeated the operation in 1835, without
any knowledge ot its having been pi-eviouslydone in this country,
and since that pf^^rioH it is known to your connmittee to have been
practiced by Dr. Stevens, Eve, the Warrens, Mussey, May,
Watson, Hoffman, Post and Pancoast"

On the subject of aneurism, five cases are referred to, w^hicii
were treated by compression. In the one of Dr. Knight, of
New Haven, manual pressure was resorted to as follow^s:

*' 'To accomplish this, a sufficient number of assistants were
procured from the members of the medical class, who che(M'fally
offered their services. They were divided into relays, two
keeping up the pressure for five or ix hours, relieving each
other every hour or half hour, and these succeeded by two
others. Sufficent pressure to arrest the pulsation in the tumour
was found to be most easily made with the thumb or fingers,
without a compress, upon the artery as it passes over the os
pubis, and the direction given to the assistants was to keep up
this amount of pressure as nearly continuously as possible.'
This treatment was commenced at 3 o'clock P. M. No pain of
consequence was produced by it for five or six hours, and then
it was not seveie, and was quieted by the eighth of a grain of
morphia once or twice repeated. About eight hours after the
pressure was applied, the temperature of the limb was diminish-
ed, and it appeared shrunken in size. Upon removing the
pressure from the artery at 11 o'clock of the following day
twenty hours from the commencement of the treatment, the
tumour was found to have diminished very little, if at all, an 1
pulsated asstrongly as before; but the tibial arteries could not
be felt. The treatment was continued. Upon examining the
parts the next morning, forty hours after the treatujent was
begun, the tumour was found to be nearly one-third less in
size, firm and unyielding on pressure, and entirely without
pulsation. All treatment was then discontinued. The femoral
artery pulsated with its usual strength in the groin, and distinct-
ly as far as its passage through the tendon of the adductor
muscles. Between this point and the tumor it could not be
felt. Several of the anastomosing aiteries, especially one upon
the inside of the limb, could be distinctly traced passing over
the knee, pulsating strongly, and enlarged in size. From that
time to the present a period of more than four months no
changi^ has taken place in the limb, excej)t that the tumour has
gradually diminished, so as now to be scarcely discoverable, and
that the leg, which was at first cold and weak, has nearly
regained its natural temperature and strength."

1849.} American Medical Association. Ti

A ligature to the aorta is thus noticed :

"That a lignture may be placed upon the aorta, there are
recorded observations to attest : that it will ever be followed
by any lasting benefit, there is every reason to doubt. Cooper's
patient having died in forty; Jannes' in three, and Murray's in
twenty-three hours after it was done. As adding, however, to
the list of cases, which show that the collateral vessels ar3
fully able to carry on vigorously the circulation after its com-
plete obliteration, a case which has been detailed by Dr. West,
in the No. of the Trans, of the Philadelphia College of Fhf/si-
cians for Febuary of the present year, is worthy of notice. The
subject of it, who was aged 32,' and died suddenly from the
rupture of an internal aneurism, was remarkably muscular and
athletic, with the superior half of his body more developed than
the lower. The interesting feature of the case, for our pur-
poses, was, that in tracing the aojia beyond the origins of the
great vessels, its cavity was found to be entirely obliterated
immediately beyond the ductus arteriosus. At the point of
obliteration, it- presented a well defined and regular contraction,
which looked as if it had been produced by a ligature thrown
around the artery. Beyond this, the vessel resumed very
nearly its natural dimensions, and so continued throucrhout its
course. It s:ave origin, in its whole length, to the usual branches ;
the upper pnir of intercostals coming off immediately below the
stricture. The internal mammary arteries, which pursued
their course along the thoracic parietes in a very tortuous
manner, were fully as large as the internal iliacs, and so were
the epigastrics ; these vessels constituting the main channels
for keef)ing up the connection of the circulation above and
below the aortic stricture."

Of the ultimate effects of*ligature to the carotid artery, the
committee close their report with the following remarks :

** Within a year or two past, attention has been, in a par-
ticular manner, directed to derangement of the cerebral func-
tions following ligature of the common carotid artery. The.se
cerebral symptoms are attributable either to cutting oil" the
direct supply of blood to the brain, or to disease consequent
upni the altered condition of the circulation in that organ.
Nearly one-fifth of the recorded cases of the operation in ques-
tion, are found to have exhibited it in a greater or less degree ;
and the fVequ^ncv of its occurrence has been singularly over-
looked by practical surgeons. Two cases have been forwarded
to the committee by Dr. Mettauer, of Virginia, in which it was
observed : in these the vessels were taken up, in one instance,

78 American Medical Association. [February,

for an anastomosing aneurism of the antrum and nasal cavities,
and in the other for the cure of a false aneurism. Both patients
had lost large quantities of blood previous to the operations. In
each case partial hemiplegia of the opposite side to the artery
which was ligatured, was noticed in a few hours, and was fol-
lowed by delirum and convulsions. In one of the instances,
death occurred on the 8th, and in the other on the 10th day.

"Autopsic examinations showed softening of the medullary
substance on the side opposite to that on which the vessel was
tied, while the hemisphere corresponding to it was healthy,
though pale and bloodless."

In the December No. of our Journal, we reported a case of
ligature to both primitive carotids, and at this time, more than
twelve years since the operation, the patient is in the enjoyment
of excellent heahh, with the full preservation of all his mental
faculties.

So much has been published in our Journal on the subject of
ancBsthetic agents, that we pass over this part of the volume
before us, and take up next the Report of the Committee on
Obstetrics. This was drawn up by Dr. Harvey Lindsly, of
Washington city, and refers chiefly to the applicability of anses-
tic means to midwifery. The conclusions are these :

"Directions for its Use. 1. The recumbent position is
decidedly the most favourable for the inhalation of chloroform,
and in obstetrical practice it should be administered in no
other.

" 2. No inhaling apparatus should be employed. A common
pocket handkerchief folded in the form of a compress, or a
sponge, applied so as to cover both the nostrils and mouth, is
the best vehicle. With these there is no danger of the exclusion
of atmospheric air, an accident to which we may be exposed
in a greater or less degree with ordinary inhalers, and they
are at the same time much less formidable in appearance, and
much more readily applied.

"3. Upon the handkerchief, or sponge, may be poured a
drachm of chloroform, if the full anaestheric effect be desired, or
one-half or one-third of this quantity, if a less decided result
only is sought for : the effect, however, to be the guide rather
than the quantity used, as very different quantities are required
in difll'rent cases.

"4. The inhalation should never be continued after th^e full
anaesthetic effect is produced, which can generally be recogniz-
ed at once by the stertorous or sonorous sleep. Nor should ift

1849.] American Medical Association. 79

ever be given after the pulse begins to fail in freqency and
force. It is advisable ti);jt the pulse should never be allowed to
fall below 60 or 05 per minute: when it reaches this point, the
sponge should be removed and atmospheric air alone be inhaled
until the pulse recovers its tone. It is also to be borne in
mind, that the depressing agency of chloroform continues to
increase for several seconds after it is withdrawn, differing, in
this respect, from ether, which does not appear to be cumulative
in its operation, for the patient never becomes more depressed,
than she is at the moment of ceasing the inhalation.

'' 5. In cases of labour where we wish our patient to derive
the full benefit (^f this agent, the ether or chloroform should be
reapplied at the accession ofeach pain a few drops (20 or 30)
being placed on the handkerchief each time for this purpose.
This may be continued with perfect safety, in all ordinary cases,
to the termination of the labour, even if it should last several
hours.

" 6. As a general rule, the inhalation should not be commenc-
ed until the labour pains are fairly established, and recur at
regular intervals, as the cloroform, if given before this period,
might interfere with their regular recurrence, and thus protract
the labour, while this result need never be apprehended if its use
is delayed to the proper time.

"The utmost caution should be observed by the practitioner
in relation to the purity of the article he employs. Its specific
gravity should not be less than 1480, the best quality being as
high as 1500. Another test is, that pure chloroform, applied
to the skin or mucous membrane, produces simple redness,
without cauterization or vesication. When mixed with a small
quantity of absolute alcohol, it acquires caustic properties.
Whenever, therefore, the chloroform used in medical practice
has caused vesication of the lips or nostril, with irritation of the
bronchial tubes, it is proof positive that it cannot be pure.

"The committee do not think it important to express an
opinion as to the comparative value of sulphuric ether and
chloroform in obstetric practice. While the latter is more
convenient, the forn)er is probably more safe, ownngtothe fact,
])erhaps, that it is not cumulative in its operation. They are
both efficient, and either may be employed at the option of the
accoucheur."

We take also the following from the same report :

"The use of Ice to promote Uterine Contractions. Dr.
Louis Mackall, a highly respectable physician of Maryland, in
a communication to the committee, states, that for several years
past he has been in the habit oiemploying pounded ice in cases

80 American Medical Association. [February,

of suspended or protracted labour. Thai when this had been
swallowed tVeelv, the pains had immediately returned, the uterus
had contracted strongly and the labour been speedily com-
pleted.

" He also communicated letters from Dr. B. Mackall, Dr.
Skinner, and Dr. M'C^ubbin of Maryland, stronjily corroborating
his statement of the efficiency of ice in promoting the contract-
ions of the uterus.

'''Dy. B. Miickall remarks, that his experience, in the use of
ice for this purpose extends through a period often or twelve
years. 'During that time' be says, 'I have had frequent op-
portunities of observing its effects, and I cag Siifely declare,
that in no single instance have I been disappointed in its action.
I have used it under a variety of circumstances and always
with the most satisfactory result. In cases where labour pains
had been suspended for twelve or twenty-four hours, they have
been renewed promptly and efficiently. In cases of inevitable
abortion, where the uterine contractions are feeble and ineffi-
cient, and where hemmorrhage is considerable, I regard it as
invaluable. In retention of the placenta from imperfect con-
traction of the uterus, and in cases of alarming hemorrhage after
delivery and expulsion of the after-birth, it is equally apphca-
ble. In short, wherever the firm contraction of the uterus is
desirable, that object will most certainly be attained by the
administration of ice.' ' In no instance have I witnessed the
slightest ill effect from its administration.'"

We pass over too the report of the committee on Education,
because its important features have already been presented to
the reader.

We make the following extracts from the able, witty and
caustic report of the committee on Medical literature, written
by Dr. Oliver Wendell Holmes:

" The general plan of the original perodical publications
which have been enumerated is very similar. The first paj't
of each number is devoted to original articles, consisting of
essays, histories of epidemics and endemics, series of cases, and
single cases, and accounts of operations. Occasionally a more
detailed and comprehensive history of somedisease is introduced
under the name of monorrraph, and not unfrequently exten-
sive statistical tables are given, bearing espf^cially upon surgical
and obstetricid practice. Then follow Rcvieirs or formal ex-
aminations of works recently published, usually analytical in
char.'jcter, and havinsr for their principal object the book rather
than the general subject of wlwch it treats. To this division

1849.] American Medical Association, 8t-

succeeds a miscellaneous and heterogeneous assemblacre of
biblioi^raphical notices; the sweepings of the critical atelier;
the rinsiniTs and heehaps of the critical banquet; a necessary
part of the editor's prospectus, but one which is least Tratitying
to minute inspection. Here the importunate friend receives
his ipected compliment, the dull dignitary is pacified with his
scanty morsel of eulogy, the Ma3cenas is paid in fair words for
his patronage ; the book which must be noticed and has not
been read, is eiribalmed in safe epithets and inurned in accom-
modating generalities. Lastly, a considerable part of the num-
ber is made up of selections, either taken promiscuously from
other journals and recently published works, or in the better
managed periodicals classified so as to present a summary of
the recent progress of science in its several departments.

" The proportion allotted to these several divisions varies very
much. Taking into consideration the usual difference of type
in the original and borrowed matter, and the very liberal ex-
tracts which the reviewers commonly make from the work
before them, it will be found that a very large part of all the
journals is made up of quotations ; and to a considerable extent
of the same quotations, whatever may be the particular journal
examined. The committee have been struck with the fact, that
the same articles have been presented over and over again to
their notice, in many different periodicals, each borrowing from
its neighbors the best papers of the last preceding number, so
that the perusal of many is not so much more laborious than
that of a single one, as would be anticipated. The ring of
editors sit in each other's laps, with perfect propriety, and great
convenience it is true, but with a wonderful saving in the arti-
cle of furniture.

"In making these remarks, it is not intended to undervalue
the great amount of intelligence and industry embodied in these
periodicals, or to make any return of ingratitude to the faithful
servants of science and humanity, who, in the midst of innu-
merable distractions, and often at an absolute sacrifice of their
material interests, are giving their time and health, and sub-
stance, to the demands of this most exacting department of
mental labour. The task of filling a vessel which had no bot-
tom, used to be thought a severe punishment enough for regions
where the art of torture was a science, but to fill a quarterly or
monthly, or weekly receptacle with the pure distillation of two
or three brains which have been tapped once, thrice, or a dozen
times a quarter for an indefinite period, is more than mortal
stamina can support. The natural inference is. that no journal
should be established which has not a pretty wide intellectual
constituency to support it, unless it wishes to live upon the

N. S. VOL. V. NO. II. 6

S2 American Medical Association. [February,

common stock without contributing a fair proportion . in its
turn.

**#* * #*#

" In the course of half a century from the establishment of the
first of the Medical Journals, their number has been gradually
rising, until at the present time, at least twenty are kno#n to
be in existence. Some principle in addition to the wants of
the reading community, must exist to account for such inor-
dinate fecundity in this particular department. This is to be
found in the homely fact, that a medical journal is a convenient
ally and advertising medium for public institutions and publish-
ing establishments, and that by the help yourself system so
generally established, it is not necessarily much harder to edit a
medical journal than to furnish the 'notes and additions' to the
work of a British author. Still, the general character of these
journals is respectable, and of several among them highly credi-
table to the state of medical science. Every year shows that
exact observation is more and more valued, and that a better
literary standard is becoming gradually established. The Com-
mittee would not discharge an important duty, if they neglected
to point out what appear to them the most obvious defects
noticeable in this important department. The first is a tendency
to speculate, and very often to dispute about the ultimate causes
of diseases, instead of thoroughly investigating their phenomena.
This is a point which has been made the subject of controversy
elsewhere. Whether the true version be 'Don't think but try'
or 'think, and try, ^ it very certainly is not 'think, instead of
trying,' or 'instead of observing.' Yet, this is the way in
which an incalculable amount of time and paper has been wasted,
by men of ingenious minds, placed in the very midst of patho-
logical occurrences which had never been properly studied in
their character of phenomena, and this it is which gives such
a gaseous and unsubstantial character to many of our magazine '
articles, that even thegreedy Abstracts and the cannibal Retros-
pects, pass them by as diet fit only for the chameleon ! Another
and sorer cause of complaint, of occasional but not frequer^t
occurrence, is to be found in the liberties allowed to anonymous
writers not so much with regard to each other, for if 'Medicus'
and 'Senex' were to succeed in reciprocal annihilation, the
loss might not be serious but with regard to their neighbours
at large and to things in general. An editor is responsible that
nothing shall be admitted into his pages, the essential character
of which is hostile and inflammatory, on the same principle
that he is bound to be courteous in his common intercourse.
Some errors of this kind are doubtless owing to want of careful
supervision on the part of the editor. That such negligence is

1849.] American Medical Association.

very general, there can be no dispute ; there is hardl^ one of
the journals whose fair features are not marked witfi tlic acne
of typographical inaccuracies and as the editors are erlucated
men, the inference is inevitable that they have not read their own
pages. Some years since, a leading American Journal remark-
ed of the report of the Massachusetts Insane Hospital, 'on page
79, is a very important typographical error the word chains
occurs twice when it should be chairs. No chains have ever
been used in the institution.' But, within a few months the
same journal allowed the following words to stand upon its
pages as Latin : ^mulierern uteres gerentum morta quopiam acuta
corripi iefhale ;' and speaks in its January number, of a disease
as being 'imminently curable.'

" The Committee have no intention of furnishing a h'st of
errata to the periodical works in question, although they have
almost involuntarily accumulated the means of so doing. The
most unpardonable are those which mangle and distort the
names of our medical authorrities * Laennec,' 'Boerhaave,'
* Bonelli,' ' Shenk,' and many more, have suffered this kind of
mutilation or martyrdom. On the other hand, some new hon-
ours have been awarded by a similar mechanism, and what is
still more remarkable, new authorities in science have been
created by the same agency. ' Baron Louis' received his title
in Boston (Nov. 3d, 1847); 'Sir John Hunter' was knighted
in New York (Jan. 1848), and Hives, the inventor of 'Hives'
Syrup,' was born a full grown therapeutist at Philadelphia
(April 1842).

" The advertising portion of the journals seems to be consid-
ered by some editors as beyond the jurisdiction of medical
ethics. It is to this opinion, or more probably to mere inadver-
tence, that the physician owes the privilege of reading before
he opens one of the prominent journals, the notice of one Dr.
Beache's Medical Works, ' for which he has received numerous
gold medals from the various crowned heads of Europe, and
diplomas from the most learned colleges in the Old World.'
(July, 1847.)"
* * * * * * # *

" It cannot be denied that the grent forte of American Medi-
cal scholarship has hitherto consisted in 'editing' the works of
British authors. The Committee are not disposed to disguise
the fact that this business has been carried on in a very cheap
and labor-saving fashion. A tacit alliance between writers
and publi'hers has infused the spirit of trade into the very heart
of our native literature. The gilt letters of the book-binder
play no inconsiderable part in the creation of our literary cele-
brities. Sometimes the additions by the 'American Editor'

84 American Medical Association. [February

have l^n real and important, oftener nominal and insignificant.
The followinor calculation of the proportion added to different
recently published works, taken at random, will show the
average amount of materials so contributed. The Editor's
proportion was, in two instances, one-fourth ; in two more one-
eighth ; in one one-ninth; in another one-tenth; in others
one-fifteenth, one-seventeenth, one-nineteenth, one-twentieth,
one-twenty-eighth, one-fifty-ninth, one-sixty-fifth, one-ninetieth,
one hundred and seventh, and, in one instance, such a sprinkling
as a single penful of ink might furnish, and leave enough to spare
for a flourishing autograph. The fairest fruits of British genius
and research are shaken into the lap of the American student,
and the great danger seems to be, that in place of the genuine
culture of our own fields, the creative energy of the country
shall manifest itself in generating a race of curculios to revel

in voracious indolence upon the products of a foreign soil !

* # % * * # * *

*'But the higher problems of medicine have been, as yet, com-
paratively imperfectly investigated. Two fatal influences have
acted not merely on medical science, but on all natural science
in this country. The first is the habit of indolence generated
by the easy acquisition of a foreign literature which seems to,
answer every necessary purpose. The second is the habit of
negligence which springs from the curious fact of a constant
parallellism, which is not identity, in most natural objects and
phenomena of the New World, with something of the older
continent. In literature this has enfeebled the relation between
words and realities ; in science it has induced the same laxity
and incoherence. The American constitution must be studied
by itself it differs from the European in outline, in proportions,
in the obvious characters of the skin and hair why should it
not differ in the susceptibilities which, awakened, become dis-
ease? The American Climate remoulds the European, and
casts a new die of humanity will it not generate causes of
disease different from those of the Old World? Over this
virgin soil a new Flora is weavinfj her long web of tapestry,
flowing from the lichens ofKatahdin to the myrtles of Cape
Sable; is there no undiscovered healing in any of its leafy and
blossoming folds? Here is the true field for the American medi-
cal intellect ; not to set English portraits of disease in American
frames; not to trust for immortality to a little more or less of
manual adroitness or questionable hardihood ; but toco-operate
with that fast-gathering band of students who, in other depart-
ments of science, arc studying what nature has done with her
American elements, and teach us what disease is here, how it is
generated, and what kindly antidotes have been sown in, the
same furrows with its fatal seeds.''

1849.] American Medical Association. 85

We close this notice of the Transactions of the IBerican
Medical Association, by a quotiitioti presented to it, on the sub-
ject of adulterated drugs; and may recu to it hereafter, espe-
cially to the report of the committee on indigenous medical
Botany.

"In none of the various branches of trade are such opportuni-
ties of fraud offered, as in that pertaining to the preparation of
medical agents. Every one, by practice or observation, may
derive sufficient information to detect imposition in the various
articles of necessity or taste, while but a very limited number
are qualified to detect frauds in medicine. Many know, or
affect to know, the modus operandi of medicines, whose general
knowledge does not in reality extend beyond the quantity
prescribed and the general external appearance of the various
preparations. Every physician cannot, (even in the extended
compass embraced in the present requirements of our medical
schools.) b}' possibility, be an analytical chemist ; and in a ma-
jority of cases, the requsitions of an extended practice and the
exigencies of a critical case, would preclude the possibility of an
analytical examination. In a practice requiring his assiduous
attention and closest scrutiny, it would be exacting too much
to expect the physician to be encumbered with a chemical
laboratory. We deem the protection affordecj^by the bill will
obviate, to a great extent, the necessity of this procedure.

There are but few of us who have not stood beside the beds
of sick friends, and watched with anxiety the professional at-
tention of the physician ; and we have staked our confidence
and our all on the curative agents administered. Alternate
hope and fear animate and depress. The agents given are
prescribed in officinal doses; but, alas! they are spurious, misnam-
ed, adulterated ; and pressing the subject no further, we leave
the imagination to complete the picture.

"No one is exempt from attacks of disease. Soon or late
all mankind need the aid of medicine. Oh ! who has not
thought, when pressed by the hand of affliction, and groaning
under the many ills that flesh is heir to, of the happy home, the
heritage of our first parents. One act of disobedience brought
death and all its concomitant evils. We have seen it in the
battle front; we hear its wail when famine and woe are near;
it commenced its persecutions at our birth, and will only end
them at our death. The All-w^ise Being has not left us without
a solace. The bruised and perturbed spirit, the healing balm
of a revealed religion blesses and restores ; for the sick and
afflicted, a no less bountiful provision is made. Every kingdom
in nature opens its bosom and stretches forth its hands to tender

^6 Constitution and Diseases of Mexicans. [February

its bei^W^s ; every plant and flower, every hill-top, every valley,
the mountain and the sea, all afford him curative agencies, chal-
lenge his interests, and awake his gratitude.

Surely, these blessings should not be frustrated ; these gifts
of kindness and comfort should not by man's invention and cu-
pidity be perverted from their primitive design. The knowledge
expended in adulterating medicine can find no apologist. Con-
nected with it, are degradation and infamy, at which we well
might startle. What opinions would we entertain of the cutler
who would prepare his instruments, either to break in the sur-
geon's hand, or with a refinement of cruelty, so construct the
knife as that its edge would turn on its first use. Destitution
and want may drive a man to seize upon that which is his
neighbour's, and we might in pity overlook the crime, or cover
it with the mantle of charity ; but the cool-blooded, deliberate,
studied, and fatal deception practised in articles designed for
the relief of suffering and disease, can admit of no palliation
can find no excuse."

Constitution and Diseases of Mexicans. By Robert Newton,
M. D., U. S. Army. (New York Journ. of Med.)

In stature the Mexicans are very inferior. The Indians are
several inches%elow what is regarded as mediocrity with us.
The inclination to degenerate in size, is remarkable in the Mexi-
can horse, jackass, and their product, the mule; and the dog is
smaller than the animal of the same species in our own country.

Both the Spanish and Indian Mexican is of a nervous tem-
perament. The body and mind are highly sympathetic with
each other. The sensibility of the nervous expansions is keen.
The remark which has been made by some of our oflicers, that
Mexicans entertain a great tolerance of pain, is, I am convinced,
erroneous. Though the Indian from his taciturnity and re-
serve makes an effort to restrain an exhibition of his sufferings,
the involuntary expressions which I have witnessed, convince
me that his feelings are very acute. Nervous complaints are
exceeding common though more especially with the white por-
tion of the community.

The Indian is distinguished for a capacious chest and a small
abdomen.

Among both sexes of the Creoles, and among the females of
the Indian race, the adipose tissue is apt to present a remarka-
ble development.

The Indian exhibits a fine instance of muscular development.
The strength he is capable of exerting is superior to that of an

1849.] Constitution and Diseases of Mexicans. 87

European laborer. His great power is particularly m|pifested
in the carrying of burdens. A large chest, small belly, and
ample muscle, constitute the conformation of men, who, without
fatigue, can march in a day twice the distance the European is
able to accomplish.

The natural intellect of the Creole is certainly good that of
the Indian very contracted. Humboldt thinks, that when the
mind of the latter is educated, it manifests a tendency " to subtil-
ize and seize the finest differences in the comparison of objects."
He at the same time ascribes to him an almost utter destitution
of imagination. Both races possess social feelings susceptible
of great refinement. Though their semi-barbarous condition
and the unprincipled character of some of their chiefs, have
stained their national history with examples of savage ferocity,
the real nature of the people is gentle and compassionate. One
of the greatest of their faults is too little independence of thought
and feeling.

The longevity of the Spanish portion of the inhabitants is not
great. It is quite rare to see a man of very advanced age.
The Indians live longer. The annual number of births in the
capital, in the mean for a term of one hundred years, was 5930,
and that of deaths, 5050; so that, apart from em migration, the
population has had very little tendency to increase.

I now proceed to the consideration of the particular diseases
as manifested among the inhabitants of this city.

Intermiltent Fever is by no means a fatal disease. The sea-
son of its greatest prevalence is that of April and May.

Remittent Fever is almost totally unknown.

Typhoid Fever is very common in all seasons, but is most so
in April and October. It has the pathognomonic characters
which were first noticed by the pathologists of Paris. In the
3d, 9th, and 14th Regiments of Infantry, since their arrival in
this city, the fever has prevailed to a very considerable extent.

I arrived here early in December, when I joined the regiment
of mounted riflemen. Previously there were a number of cases
in the regiment, and the disease had proved fatal to my zealous
and indefatigable predecessor, Assistant-Surgeon Suter. But
after him, no others in the regiment were affected until the
weather became mild.

The cases of typhoid fever which I have seen in the Mexican
hospital San Hipolito, and those which have come under my own
charge, have been marked by pyrexia ; a rose-colored lenticular
eruption ; tenderness of the bowels, and particularly in the region
of the ilio-coecal valve with a gurgling sound when pressure is
made in the latter region; looseness of the bowels; headache;
injected conjunctiva ; deafness ; more or less stupor ; a brown

88 Constitution and Diseases of Mexicans. [February,

tongue,4|,nd a collection of sordes on the gums and teeth ; with
a behef of the patient that Httle or nothing was the matter with
him. In the most severe cases, there were dehrium, subsultus
tendinum and involuntary evacuations. Some were accompa-
nied with bronchitic or pleuritic complications. The treatment
I have pursued, (and which, in the hmited number of cases that
have been under my charge, has always been successful,) has
been to shave the head and apply to it wet cloths, institute a
mucilaginous diet, purge the bowels with castor oil once, or
more frequently, (if there is much pain in the bowels and the
excretions are vitiated,) apply leeches and poultices to the belly,
and administer neutral mixture so long as there is preturnatural
heat and dryness of the skin. If the irritation of the alimentary
canal have not been great, I have sometimes given the tartrate
of antimony and potassa, with lemonade. When the pleura is
affected, I have cupped repeatedly, and endeavored to bring the
system under the influence of mercury. I have been studious
to cause in the patient's room, a constant renewal of the atmos-
phere, and during the day, have sometimes removed him to the
open air. The shirt and bed-clothes have been frequently
changed.

To the Small-pox is due the terrible reduction which the In-
dian population has experienced in some parts of this country
since the first entrance of the Spaniards. The disease appears
almost exclusively in the form of an epidemic, occurring at very
marked intervals. Its ravages were awful in 1763, and still
more so in 1779, when in the capital alone it destroyed more
than 9000 persons. " A great part of the Mexican youth were
cut down that year." In consequence chiefly of the introduc-
tion of the variolous inoculation, the epidemic of 1797 was less
destructive. The vaccine inoculation was first introduced in
1804, by Thomas Murphy, who brought the matter from the
United States. It was readily submitted toby the inhabitants,
who had previously been convinced of the value of an analo-
gous process inoculation with variolous matter. The intro-
duction of vaccination was matured by a Spanish medical
commission, which was despatched by the Government to carry
the process into Mexico and other Spanish colonies. Original
matter has been obtained from the udders of cows in Atlixco
and near Valladolid. Although the small-pox, now that its ex-
tension and violence are controlled by vaccination and rational
treatment, is divested of much of its tearfulness, in the history
of Mexico it stands pre-eminent as the instrument of death.
Terrible must have been its ravages to have given occasion to
the statement of Motolinia, that in 1520 it carried ofT one half
of the inhabitants.

1849.] Constitution and Diseases of Mexicans. 89

Yellow Fever does not appear in the capital of the republic,
but the Matlazahuatl, a disease described as resembling the for-
mer, has raged here as an epidemic in times long past. It
occurred in the years 1545, 1576, and 1736. Torquemada
estimates the mortality caused by it in the first mentioned year
at 800,000, and in 1576 at 2,000,000. It is remarkable for not
attacking whites and those in whose veins is mingled the blood
of the white man.

V Diarrha'a and Dysentery are, when taken aggregately,
charged with a greater mortality than any other disease. In-
deed, this mortality amounts to nearly one-fifth of the whole.

That form of hepatitis which results in abscess is very com-
mon these abscesses often discharge several pints of pus. It
has been found best to make a very tree external opening to the
abscess ; nor is it thought necessary to be solicitous about the
admission of air, which is not supposed to be injurious. At
least, the advantage accruing from maintaining a passage con-
stantly free for the issue of pus, more than counterbalances the
injury from the air. In this way, I learn from Dr. Galenzowsky,
more than one-half of the cases are cured.

Catarrh and Bronchitis are diseases of ordinary occurrence ;
but Phthisis Fulmonalis is very rare. Vesicular Emphysema
is frequent.

Mexicans have already been stated to be subject to nervous
affections. Among these may be specified cephalalgia, epilepsy,
neuralgia, paralysis, and chorea.

Calculus is very seldom met with in the city of Mexico. In
some other parts of the republic, it is more common.

In respect to venereal diseases, they may be stated to be one
of the greatest banes of the country. There are few males of
middle age in the city of Mexico, who have not been subjects of
this disease. Nearly all of the lower class of females, also, have
been affected. This is at once an effect and illustration of the
immorality of the population. The chancre among the Mexi-
cans is generally of the Hunterian character, and apt to be fol-
lowed by secondary symptoms. I have frequently heard our
medical officers affirm the difficulty of managing venereal affec-
tions in this place.

Dropsies are common. Hemorrhages, though the fact may
seem strange in a country where the external pressure of the
atmosphere is slight, are rare.

The inhabitants of this city are much subject to Pericarditis
and Endocarditis, and also to organic affections of the Heart.
Ossification in the vascular system, however, is said not to be
unusually frequent.

But one of the most strikingly common diseases in this place,

90 Constitution and Diseases of Mexicans. [February,

is Senile' Gangrene. Being present recently at an amputation
of the thigh performed on account of this disease, I extracted
the popliteal artery, which clearly demonstrated, in part, the
pathology of the affection. In the cardiac portion of the artery
is a coagulum of blood ; but situated in the peripheral portion,
and separated from the coagulum by a narrow section in a state
of transition, is a cord of white fibrin. It is to be supposed,
that the inner coat of the artery being inflamed caused a coagu-
lum of blood (as in the analogous case of endocarditis,) which
was succeeded by fibrin.

The poor are much affected with indolent ulcers, generally
situated in the legs. These ulcers are a frequent cause of death.

In walking the streets, one constantly meets persons with
affections of the Eye. The most common are opacity of the
cornea, fibrinous occlusion of the pupil, and inflamed and hy-
pertrophied conjunctiva. Although many cases are exhibited
for mendicant purposes, enough others are seen to convince a
stranger that the number is extraordinarily large. Inflamma-
tions of the cornea and iris, it is well known must be treated
promptly and judiciously or the sight will almost certainly be
lost by the exudation of coagulable lymph. Now there is pro-
bably no more improvident people in the world than the poor of
this city. Need we wonder then at the opacities and occlu-
sions? Besides, when we reflect that iritis is frequently pro-
duced by S3^philis, and that conjunctivitis, as well as inflamma-
tion of deeper tissues, is a result of gonorrhoeal inocculation and
of catarrhal influence, and, moreover, that syphilis, gonorrhoea,
and catarrh, are here exceedingly prevalent, we have a most
satisfactory explanation.

Considering the fact that close study is not an ordinary phe-
nomenon among Mexicans, Myopia is found in the cities of the
table-land to an extraordinary extent.

To diseases of the Skin, the constitution of the Indian seems
rather disinclined. There is, however, one horrible cutaneous
affection which is frequently encountered. This is the Ele-
phantiasis Grceca. There are three forms. The first is char-
acterized by tubercles, generally varying from a quarter to
three-quarters of an inch broad ; disposed to squareness of
shape; projecting, Fd or livid in the beginning, susceptible of
change to a bronze hue; sometimes indolent, at other times
more sensitive, and accompanied by a swelling of the subcuta-
neous cellular tissue ; preceded by spots of a variable red ;
beginning usually at the root of the nose, and extending over
the head and upper extremities, then affecting the lower, but
seldom occupying the trunk. This is called the tuberculous
form. The second, called the anaesthetic, is characterized by

1849.] Constitution and Diseases of Mexicans. 81-

want of sensibility in the extremities of the limbs, and by ab-
sorption of fhe bones. I have seen the auricular nnd annular
fingers as completely removed by absorption as by amputation
at the metacarpo-phalangeal articulation, and without any senib-
lance of a cicatrix. The third form was first dejicribed by Dr.
Lucio, physician to the San Lazaro Hospital, in this city, for
the accommodation of patients of this disease. It consists
principally in the production of red and painful discolora-
tions, which commonly terminate in ulceration. The subjects
of this form are called lazaiinos. Two or more forms sometimes
co-exist in the same individual. Dr. Lucio has discovered in
the inspection of such as die from this disease, the frequency of
certain alterations in the spleen. The first and second forms
may be regarded as incurable. The patients, after having been
affected many years without any material derangement of gen-
eral health, usually die with diarrhoea ; and in such cases the
mesentery is found to contain deposits of tubercular matter.
The San Lazaro Hospital was erected in the year 1811. In
the year 1844, it had received in all, 82 women and 123 men.
Elephantiasis affects only the poor, and particularly such as are
exposed to strong heat and humidity. All the patients in this
city come from the western side, though I am not aware of any
explanation of this fact. The subjects are from 15 to 40 years
old.

Looking for the local causes of disease, the mind immediately
recurs to the large expanse of surface in the valley of Mexico,
which is annually flooded by rains and dried during the dry
season. The portion subject to these changes is not less than
one-tenth of the w'hole valley. Here is a grand laboratory for
the production of intermittent miasmata. These, however, do
not appear to be evolved in the highest amount until the close
of the dry season, when the heat is greatest, and the superim-
posed layer of water has been evaporated.

Another cause of disease is the humidity of the atmosphere
during the wet season, when heavy rains occur every day, fre-
quently flooding the streets of the city. The perspiration of
the body not being duly evaporated, it beconles necessary that
the supply of heat should be diminished to prevent the tempera-
ture of the system rising above the normal standard. This
supply is founded in the conversion of the carbon of the system
into carbonic acid gas, and can be diminished in several differ-
ent ways. It may be effected by the deposition of carbon in
the form of fat, a process, however, which nature is frequently
indisposed to adopt. Then the supply of carbon to the system
may be curtailed by reducing the amount of food, which is the
appropriate mode of overcoming the difficulty. Nature indi-

92 Constitution and Diseases of Mexicans. [February,

cates this course by lessening the appetite in such cases. But
when the constitution is disinclined to the formation of fat, and
when the appetite is artificially stimulated as it is in Mexico by
the constant and excessive abuse of alcoholic drinks, red pepper
and garlic, then the superabundant carbon remains only to be
eliminated by the hver as an element of the bile. The excite-
ment of the liver necessary for this extraordinary labor, disposes
it to inflammation. The increased vascularity of the intestines
required for a supply of blood by the portal circle, sufficient for
the extraordinary secretion of bile, renders the intestinal canal
also predisposed to inflammation. This predisposition of the
canal is increased by the irritation attending the reception of
the unusual amount of bile and of fruits, here almost unlimited
in variety, and some of which are not very healthful. Now if
a man in the condition just described, with his system overheat-
ed and debilitated, go out doors into the rain and wet his feet
with water which has flooded the streets, the surface of the body
is too rapidly cooled, and the liver or bowels, already excited,
become almost unavoidably the seat of inflammation. We
have thus rfo difficulty in understanding why hepatitis, dysen-
tery and diarrhoea are here so frequent.

The very great difl^erence in the temperature of day and
night, and of sunshine and shade, with the thin mode of dres-
sing, is a sufficient cause for the prevalence of catarrhs and
bronchitis, as well as other interrjal inflammations. It is true
that the contiguity of the lakes has a tendency to equalize the
temperature of day and night ; but there are other causes
which render it extremely unequal. These are, the clearness
and stillness of the atmosphere; the want of trees and other
projecting bodies; and finally the rareness of the atmosphere,
which, in consequence of this rareness, has less power to
maintain an equilibrium in the heat of the body, and leaves it
more exclusively exposed to the influence of radiated caloric.
The latter agency, in connection with the thickness of the
walls of houses, renders the change of temperature very great
in passing from the sun into the house. Drafts of air, howev-
er, have for the 'same reason, less potent influences here than
in a denser atmosphere.

To the rareness of the atmosphere, also, as may be reason-
ably imagined, should be attributed the prevalence of vesicu-
lar emphysema.

1849.] Management of Still-born Children. 93

On the Mana^remenf of Still-born Children. (M'Clintock and
Hardy's Pract. Observations, from Brit. Am. Journ. of Med.
and Phys. Science.) %

The manaorement of suspended animation in new-born chil-
dren is a subject so well understood ; and the principles upon
which it should be conducted are now so clearly recognised,
as to render any lengthened observations thereon wholly un-
necessary in a work like the present. The following short de-
scription, therefore, of the practice of the Hospital in this class of
cases, (not the least important or interesting to the accoucheur,)
is purely confined to practical details especially such as relate
to the use of the stethoscope and of artificial respiration.

When a child, immediately after its birth, exhibits none of the
ordinary signs of vitality, such as respiratory efforts, or muscu-
lar contraction, the question will at once suorgest itself, does
life yet remain is there still a possibility of restoring animation?
We hesitate not to say that the most accurate information upon
this point is to be derived from the strethoscopic examination
of the heart, for we have seen very many children resuscitated
with whom the cardiac pulsations as detected by mediate auscul-
tation, had been the only proof of lingering vitality. What the
effect of such evidence should be on the physician's conduct we
need not at this moment stop to inquire ; but it would undoubted-
ly prove a source of much encouragement under circumstances
otherwise apparently hopeless, and at a time when he must be
oppressed with the consciousness that the result of his en-
deavours is awaited with the most intense anxiety and solici-
tude. We have seen many infants restored to animation in
whom respiration was for a long time suspended, yet we never
saw a single instance where the slightest symptoms of vitality
could be produced if the heart's pulsations had ceased to be
audible when the child was born. It may be asserted, without
fear of contradiction, that had the stethoscope been used, no
such accident could ever have happened as a doctor ordering
an infant to be removed as dead which afterwards recovered
without any assistance. Let it not be suppposed, from the
preceding observations, that we would recommend any inno-
vation upon the rule that resuscitations should always be at-
tempted in the absence of the signs of decomposition ; to the
excellence of this precept we give our full concurrence.

Children labouring under suspended animation at the time of
birth are found to present very different external appearances,
which, it may be supposed, are regulated by the extent and
kind of lesion the vital functions have sustained. Now we
think that, setting aside physiological considerations, and

94 Management of Still-born Children, [February,

looking solely to practice, all these cases may be conveniently
arranged in two classes, whose characteristic features are drawn
from the general condition of the infant. In the one case the
child is pale and perfectly flaccid; the eyes are closed ; there is
complete relaxation of all the muscles; great flexibility of the
joints ; and the finger can be pressed into the pharynx without
any opposition being' felt. In this form, which we are inclined
to think is, perhaps, the more dangerous of the two, the state of
the child closely approximates to syncope, as there seems to be
a failure or deficiency of the vital principle.

In the examples of the second class, the outward appearance
of the child is totally different, and would seem to be the result
of great cerebral congestion or apoplexy. The surface of the
body is apparently swelled, and of a red or livid colour, and
both these characters are most remarkable in the fnce and neck ;
the eyelids are generally apart, and the eye-balls prominent,
with more or less injection of their conjunctival membrane.
There is seldom that extreme mobility of the limbs and flaccid
state of the muscles that we see in the former class of cases.
This state of the foetus was very apt to occur where the
umbilical cord had tightly encircled the neck, or where the ex-
pulsion of the body did not take place for some time after the
head.

Should the child not begin to breathe immediately after its
birth, sprinkling the chest and face with cold water generally
proved a most efficient means of stimulating the respiratory
muscles, and exciting sensibility. This is a measure, however,
which cannot be persisted in after the first or second trial, as
it is of too depressing a nature; on this account, also, it is not
well adapted to the cases included in our first class. It was, of
course, an established rule not to sever the connection between
the foetus and placenta as long as the pulsations of the cord
continued distinct. If the child presented an apopletic ap-
pearance, some blood (3iij. or 3iv.) was allowed to flow from
the foetal end of the funis after its division. This simple mode
of depletion frequently produced the most beneficial effects,
relieving the oppressed state of the nervous system, and being
speedily followed by signs of increased sensibility. If a suffi-
cient quantity of blood could not be procured from the funis,
the application of a leech to the temple was frequently attended
with marked advantage. When the cord was long enough to
admit of it, the warm bath was sometimes employed before
cutting it. Smartly slapping the chest or buttocks is often
resorted to with advantage in mild cases where the suspension
of animation is only partial ; but it will not, we think, be found
to answer any good purpose if the infant be in a low state of

1849.] Management of Still-horn Children. 95

vitality. Ammonia applied to the nostril is an excellent restora-
tive if there be any attempts at inspiration, so that it can be
inhaled, but otherwise it is of no use. These efforts of the child
to breathe will be very much assisted by compressing the epi-
grastrium and sides of the chest with the hands, so as to empty
the lungs of the inspired air as effectually as possible. In the
first instance, and before adopting other measures, it'is of im-
portance to rid the mouth of any mucus that might hinder the
entrance of air by obstructing the glottis. For this purpose,
Gardien recommends a pledget of lint dipped in a solution of
common salt to be used. A flexible tube, with a pump attached
to it, has also been employed ; but we give the preference to
the finger over every contrivance.

Jn every instance where the process of respiration was slow
of being established, or very imperfect after two or more trials
in the above restorative measures, artificial respiration was
commenced, and continued, with intermissions, until the neces-
sity for its further employment was superseded by the natural
performance of the function, or until the gradual failure and
cessation of the heart's action showed that all attempts at
recalling the vital principle might be relinquished. We have
said " with intermissions," because it was generally thaught
advisable to suspend the process for a moment or two at inter-
vals, just to see if the failure of the supply of air to the lungs
would stimulate the child to make an effort at inspiration.
A gum-elastic male catheter, of the full size (No. 9 or 10) was
the instrument used on all occasions for inflating the lungs.
The child was placed in a horizontal posture, with the neck
considerably extended, and the head bent rather backwards ;
the catheter was passed a short way into the mouth, and the
lips and nostrils were then kept closely compressed, at the
same time that the larynx was gently pressed against the spine,
so as to favour the ingress of air into the trachea, and to pre-
vent or obstruct its transmission down the oesophagus. Alter-
nately with the insufllation of the lungs, a slight degree of
pressure was made on the epigastrium and ribs, with a view to
assist expiration. There was great difficulty with some chil-
dren in directing the current of air down the trachea, and
keeping if from distending the stomach. This was avoided by
placing a hand on the praecordial region, and altering the posi-
tion of the head and larynx. During the process of inflation,
which was repeated at short .intervals in imitation of natural
respiration, whenever the child made any attempt to breathe,
the compression was instantly removed from the mouth and
nose, in order to give every facility to the entrance of air. It
was considered a point of importance, in blowing through the

Management of Still-born Children. [February,

catheter, to do so in the manner of using the blow-pipe, nannely,
that the efforts should he made hy the mouth and soft palate,
and not by the chest ; and consequently, that the air should
come from the mouth, and not from the lungs of the operator.
This mode of inflating the lungs of still-born children is, we
conceive, open to fewer objections than any other. In the
first place, the degree of force with which the air is propelled
can be carefully regulated ; secondly, its temperature is raised
before entering the chest of the infant ; thirdly, in quality it is
little, if at all, removed from pure atmospheric air; and, lastly,
no injury can possibly be inflicted on the soft parts within the
mouth of the child. From our experience of this measure we
must speak of its utility in terms of the strongest commendation,
as we never could trace any evil effects from its employment,
whilst in very many instances we have had every reason to
believe that the child's life was preserved by its means.

The artificial respiration very constantly accelerated the
action of the heart, where this was at all pulsating at the time
of commencing the process; but we never observed that it
restored in the least degree the cardiac movements after these
had ceased to be perceptible. The recovery of the child did
not, J^y any means, follow as a consequence, of this improvement
in the heart's functions ; for, on many occasions, we have known
the pulse to double its rapidity under the employment of this
agent, but as soon as its use was suspended, the velocity of the
circulation would quickly diminish, again to become raised on
inflating the lungs ; and thus we have seen matters go on alter-
nating for two hours or upwards, and yet the great object of
our exertions not be ultimately attained.

When, however, this increased frequency of the pulse is ac-
companied by other indications of vitality, such are restoration
of the natural colour to the surface, the efforts at respiration
recurring at shorter intervals and with more strength, signs of
muscular irritability in the limbs and face, &c., we may calcu-
late, with tolerable certainty, upon a successful issue to the
case.

The artificial process was generally left off as soon as natural
respiration was at all established, or at least sufficiently so to
maintain the heart's function in that state of activity to which
it had been raised by the temporary expedient of inflating the
lungs. As resuscitation can seldom be considered complete
and satisfactory until the infant breathes naturally, or cries
aloud, it was often necessary to proceed with the employment
of restorative and invigorating remedies for some time after the
discontinuance of artificial respiration. As soon as the child
could swallow, small quantities of white-wine whey were given

1849.] Quinine in West India Fever. 97

from time to time ; or if it seemed very languid and feeble, a
small enema containing a few drops of the fetid or aromatic
spirit of ammonia was administered. But by far the mast im-
portant point in the management of tliese weakly, delicate in-
fants, or of such as are in a similar condition from having beeli
born prematurely, is to support the temperature of their bodies
by artificial means. For this purpose nothing answers so well
as cotton Wadding, being softer and warmer than flannel or any
of the materials ordinarily used in the clothing of children.

On the Employment of Quinine in West India Fever. Ely
Danl. Blair, M.D. (Lond. Lancet, and Charleston Jour.)

When quinine is taken by an adult to the extent of thirty or
forty grains, it produces certain cer^ral symptoms, the consti-
tuents of which are a ringing noise in the ears, and more of
less deafness.

This set of symptoms, where there is no idiosyncrasy, indicates
the saturation of the system by the medicine, as ptyalism does
mercury, and may be conveniently known b}^ the name of
cinchonism.

Rare instances occur in which hyper-cinchonism is ift(fuced
by a very few grains of quinine, accompanied by many nervous
symptoms, and formicatioti so severe as to proscribe the use of
the remedy. In some and this may occur in cases which had
hftheito been normal cinchonism has not been induced till
afler the administration of seventy-two grains of quinine.

Cinchonism is not peculiar to quinine: by other vegetable
febrifuges, such as salicine, angustura bark, and bebeerine,
cinchonism can be induced, but not with the same certainty as
by quinine, neither in the same uniform series of phenomena,
neither with the same harmlessness.

Cinchonism seldom lasts longer than twenty-four hotirs, ex-
cept in some cases of anaemia, in which the writer has known
it continue upwards of a week.

Quinine has been prescribed by the Writer to patients of both
sexes and all ages, and where ascertainable, almost invariably to
cinchonism, during thirteen years, and probably to the extent of
several thousand ounces of the sulphate ; and during that time he
has seen no case of danger from its effects, with tne exception
of three or four cases, of imputed abortion.

To many the muffled ears of cinchonism is not even dis-
agreeable. Cinchonism is capable of superseding and suppres-
sing that excited condition of the circulation ana animal heat
known as fever, except when depending on anaemia, as sympto-
matic of inflammation, or its effects.

K. a. VOL. V. NO. II. 7

98 Quinine in West India Fever. [February,

Quinine is purely a febrifuge ; instead of being a tonic or
stomachic, it generally induces anorexia, and a relaxed and
macerated state of the skin, some tremulousness, and in many
cases slight aphonia.

As a febrifuge, the full efficacy of quinine is seldon obtained,
unless pushed to cinchonism. Cinchonism is, therefore, the
test and criterion in practice of the full and sufficient use of
quinine. It is probable that the protective influence of quinine
against fever, seldom lasts longer than the manifestation of
cinchonism. The ordinary headache of fever doQs not contra-
indicate the use of quinine.

The power of quinine seems to be to cut off the connection
between local irritation and constitutional excitement, to disturb
and break the series of morbid elaborations set up in some
specific fevers, which ternwiate for the most part, in contamina-
tion of the blood and loss of vital cohesion of the capillaries. In
intermittent fever it is antidotal.

Quinine is of little efficacy in intermittent fever, when ex-
hibited during the paroxysm.

Quinine is of no efficacy in the last stage of continued or
remittent fever, where the vascular and thermal excitement
hav^been succeeded by organic lesion or contamination of the
blood. It should be given, as is well known, in the intermission
of intermittent fever, and in the formative, or in the first stage
of continued remittent or yellow fever.

The use of quinine against relapses of intermittent fev#r, '
whether the disease had been primary or secondary, is one of
its most valuable applications.

In using quinine against the paroxysms of intermittent fever,
hourly doses of three grains, till twelve doses be given, is the
best mode of saturating the system with the remedy. If,
however, the disease be a quotidian, with short intermission,
six-grain doses hourly, till six doses be given, will be judicious
practice.

In the other fevers were quinine is eligible, and the remedy
is prescribed during the existence of febrile excitement, the
dose, to be efficacious, must be large, and the impression on the
disease sudden and overwhelming.

An auxiliary, too, is also required in such cases : twenty-four
grains of quinine and twenty grains of calomel, in one dose, is
the most powerful resolvent of fever. One or two such doses,
with an interval of six hours, and followed by a castor oil pur-
gative, are generally sufficient ; but I have prescribed six such
doses with efficacy, and I recollect no instance of ptyalism oc-
curring when this treatment was required and adopted, and
sometimes there is but mild cinchonism. An intolerance of

1849.] Quinine in West India Fever. 9ft

quinine, or early and intense cinchonism, in such cases, is one of
the worst prognostics.

In the treatment of simple intermittent fever, or its relapsed,
calomel is rarely, if ever, prescribed by the writer. Sulphate
and carbonate of magnesia mixture, or sulphate of magnesia
and tartrate of antimony mixture, as a purgative during the
hot stage, (if needed) or fiteen drops oi solution of acetate of
morphine, with a drachm of sweet spirits of nitre, if there is
much suffering from muscular pains, headache, or emesis and
retching, will speedily relieve the paroxysm ; and followed by
quinine, in combination with purgative dos^s of rhubarb, will
fulfil all the indications for the intermission.

But when a European or North American, probably tiot long
from a cold climate, and during the prevalence of malignant
disease, is attacked by fever, anAtshows to the quick and
practised eye alarming^ indications,' no fear of the injurious after-
effects of the mercurial will have weight to withhold the resolvent
dose of calomel and quinine. In cases threatning danger to
life only need it be used, and I know of no instance wherein
the slightest untoward result has been experienced from its use.

The combination of quinine with tartar-emetic in pneumonic
and bronchitic complications of intermittent is eminentl}^ sue*
cessful. The forces which disturb the remedial power of
quinine in fever are chiefly inflammatory and congestive com-
plications, or a loaded condition of the alimentary canal. These
must be obviated by appropriate treatment, and the disease
rendered as simple or idiopathic as possible, concurrent with
the use of quinine. Thus arteriotomy may frequently be re-
quired in continued, remittent, or yellow fever ; and in intermit*
tent, with tenderness over spleen, a blister may be required, as
an auxiliary to cinchonism.

There is a form of continued, or irregular remittent fever,
occuring chiefly in children or adolescents, in which generally
no local cause can be discovered, but which is often imputed
to worms ; but give what anthelmintics you will, no worms may
be passed ; hence here they are popularly called " stu' born
Worms.'* This feVer may continue for a week or a fortnight
without any contamination of the blood or loss of vital cohesion,
and probably depsnds on intestinal irritation. Danger in these
cases chiefly arises from the supervention of some lesion, in-
duced by the long-continued and excessive heat and violent
action of the heart, or sympathetic irritation of the brain. In
these cases I use quinine, with immediate and signal efficacy,
in the following manner :

The patient is put into a bath, and the cold affusion is applied^
till the pulse becomes small, and nearly extinct, at ths wrist^

100 Quinine. [February,

and the skin cold. He then, while in the bath, gets his dose of
quinine, (two or three grains,) and is returned to bed without
being dried. The bath and the dose of quinine are continued
hourly, as long as the skin persists warm, when the houHvdose
of quinine is due. After five or six baths the skin generally be-
comes permanently cool, and then the quinine is pushed on to
cinchonism, alone, and without the bath. This mode of making
an intermission in a continued fever 1 have never found attended
with unpleasant or dangerous consequences, and it will generally
subdue the fever after every other method has been tried in
vain.

In fever of doubtful origin, and where latent inflammation is
suspected, I have frequently used a small cantharides blister
as a test : in fact, I never like to pass the blistered surface of a
patient without inspectinji^, its revelations are often so inter-
esting and important. If, instead of the usual vesication of thin
serum and cuticle, the vesication is a bladder of fibrinous coagu-
lum, or suety in consistence, inflammatory action is going on,
probably in the neighborhood of the part, and tartar-emetic, or
such-like combinations are indicated.

Relapses in intermittents have there determinate peri">ds,
the day from the last attack being generally some multiple of
seven.

The usual day of relapse among the acclimatized of this colony
is the fourteenth or twenty-eifi^hth.

After one or two relapses, the law of each individual case can
be ascertained by each patient.

The prophylactic which I have adopted with great success,
and in my own person first, many years ago, is as followes :

Two days before the anticipated relapse, three grains of
quinine, to be taken thrice daily for four days ; and after a simi-
lar relapse interval, the quinine to be again taken in the same
manner; and so on, repeated three or four times successively.
The disease is eradicated completely by thus baffling the relapse.

Quinine. By Wm. Fletcher Holmes, M. D., of Newberry,
So. Carolina. (Charleston Med. Journ. and Rev.)

There are various conflicting opinions in relation to the ac-
tion of Quinine upon the animal economy; some authors advo-
cating its sedative, and others its excitant properties ; whilst
perhaps a majority regard it as either stimulant or sedative, ac-
cording to the dose. In large doses, experience has led me to
look upon it as a sedative to the vascular, but an excitant to the
nervous system, producing a high deg'^ee of nervous erethism,,

1849.] Quinine. 101

a peculiar irritnbility of the nerves, which supply the orc^ans of
hearing and vision, anrl a vertii^inous sensation described by
patients as extremely distressing. This tendency which Quin-
ine possesses, of augmenting, and indeed originating determina-
tion to the brain, has led to its exclusion in fevers accompnnied
with cerebral congestion, or inflammation, or nervous excitabili-
ty. For some time past physicinns have been on the alerte to
discover some agent which would neutralize this peculiar pro-
perty of Quiuine without impairing its febriluge powers. The
West and South- West have exultingly proclaimed ''Eureka,"
and hold up to us morphine as the long sougfit desideratum.
But impartial observation will convince any eclectic practitioner
that any preparation of opium will enhance to an alarming ex-
tent the prevailing determination to the brain. Ever since I
took my degree, this subject has been a matter of inquiry and
experiment with me, and I have come to the decided conclusion
that Digitalis modifies the action of Quinine, in this particular,
to a more considerable extent than any other agent. I have
administered Quinine in large doses, in combination with this
medicine, to young children, whose nervous systems are very
mobile and impressible, with the happiest effects, and without
producing any of those unpleasant symptoms, commonly attri-
butable to the free exhibition of this potent febrifuge. To deli-
cate females, whose constitutional aversion to this medicine
amounted almost to idiosyncracy, it has been given with a few
drops of the tincture digitalis, with the most pleasant results.
In bih'ous remittent I do not hesitate to exhibit Quinine, as men-
tioned above, even when the exacerbation is at its height, and
the consequences are often seen in an abundant f^ow^ of the
cutaneous transpiration, a prolonged remission, and in many
instances a complete apyrexia.

I regard Quinine as possessing high antiseptic properties. In
malignant and protracted fevers, where it is desired to make a
mercurial impression upon the system, in combination with
calomel, it (Quinine) assists in the development of ptyalism, and
at the same time modifies the well known tendency of that
powerful alterative to produce ulceration of the gums, sloughing
of the cheeks, etc. In typhous and typhoid fevers, it has seem-
ed to me to correct the indisputable proclivity to putrescency
of the fluids, as indicated by petechia3, and the prompt disposi-
tion to gangrene of vesicated surfaces. In the dothen-enterite
of typhoid fever, in combinntion with calomel and the nitrat.
argent., it has been given with the happiest effects ; and in the
"congestive chills'* which have latterly sprung up into such
gloomy notoriety among us, it is the sheet-anchor of the physi-
cian's hopes, and sooth to say, it rarely fails us in the hour of

102 Nitrateof Potass in Rheumatism. [February,

trial. Upon its abundant exhibition alone must the practitioner
base his expectations of success, and its rapid and powerful ac-
tion often trrnscends our most sanguine anticipations.

The attention of the profession has hitherto been solely di-
rected to the action of Quinine as a febrifuge, overlooking what
I consider of paramount importance, viz : its special affinity for
the nervous system, and its peculiar adaptation to the relief of
neuropathic affections of long standing.

In a protracted case of neuralgic dysmenorrhoea, accompani-
ed with intense cephalalgia, which resisted cups and vesication,
in which the most powerful alteratives, such as mercury, guaiac,
iodine, and the arsenical solution had been vainly tried, I ad-
ministered Quinine combined with carb. ferri and belladonna,
with decided effect.

This may seem inconsistent with my belief in its stimulant
property, and I can account for its efficacy in this instance upon
no other grounds than its obvious analogy with the beneficial
exhibition of stimulants in the chronic phlegmasiae. In the
treatment of epilepsy, chorea, St. Viti, I am disposed to look for
important results from the use of Quinine,

JVitrate of Potass in Rheumatism. (Boston Med. & Surg. J.)

At a meeting of the Royal Medical and Chirurgical Society,
London, Nov. 14, a paper was read by W. R. Basham, M. D.,
*'0n the employment of nitrate of potass in acute rheumatism,
with suggestions for the use of saline solutions as external ap-
plications in local rheumatic inflammation." The author takes,
as the basis of his essay, the following facts : 1st, that in acute
rheumatism, as in other inflammatory diseases, the most import-
ant changes in the composition of the blood are the increased
quantity of fibrine, and the deficiency of the saline ingredients ;
2d, that where this state of the blood exists there is a special
disposition to the deposit, of fibrine, and the formation of adven-
titious tissues ; while in diseases in which the fibrine is deficient,
and the salts in excess in the blood, the blood does not coagulate,
and haemorrhages of a passive character occur; and 3d, that
although, as bis own experiments have satisfied him, saline solu-
tions have not the power of dissolving coagulated fibrine, yet
certain salts in solution, mixed with the blood at the moment of
its escape from the body, possess the property of suspending or
retarding the separation of the fibrine. He next inquires whe-
ther any therapeutic principle can be derived from these facts,
and proposes the question, wliether saline remedies, largely
employed, may not suppress the tendency to the fibrinous exu-

1849.] Nitrate of Potass in Rheumatism. 103

dation, or retard it, so as to give time for other remedies to
diminish the JDroportion of fibrine present in the blood. With
reference to tiiis question, he alludes to the observations of sev-
eral physicians on the use of nitrate of potash in acute rheuma-
tism, and details his own experience of its effects. lie i^ives
one, two, or three ounces of nitrate of potass, largely diluted
(in two quarts of water), in the twenty-four hours. In the
majority of cases no obvious effect is produced on the force of
frequency of the pulse, the digestive ftmctions, or the quantity
of urine exuded. But the urine always acquires a high specific
gravity, and nitrate of potass may be detected in it. The swel-
ling, heat and pain of the joints affected with rheumatism are
relieved in a most maiked degree, even when no other remedies
are employed at the same time. There is a certain annount of
exemption from cardiac complication; and cardiac inHamma-
tion, when present, is more amenable to remedies. In a case
which the author relates, he examined the blood of the patient
before the commencement of the saline treatment, and again
after this treatment had been continued for some days. In the
first instance it was buffed and cupped, the fibrine was in ex-
cess, and the salts were deficient. After the administration of
the nitre there was no buffy coat, the proportion of fibrine had
diminished, and that of the salts greatly increased. The author
presumes, therefore, that while the internal use of the nitrate
of potass assisted to restore the proportion of the saline consti-
tuents, the other treatment employed tended to lessen the excess
of fibrine. Some remarks of Mr. Gulliver have led the author
to investigate the effects of the external application of saline
matters to parts affected with rheumatism. His experiments
have been principally made with nitrate of potass. In chronic
rheumatism he has used the iodide of potassium, and in gout the
bibasic phosphate of soda. He applies the saline substance by
means of the spongio-piline, a portion of which, large enough
to envelop the part affected, having been moistened with water,
the salt employed is sprinkled in po\yder freely on the spongy
surface : it is then applied to the part, and secured with a roller.
In numberless instances, by this simple treatment, he has wit-
nessed the most palpable and instant relief to the local inflam-
mation. Constitutional remedies were employed at the same
time, but the relief was proved to be due to the saline applica-
tions, by the fact, that where several joints were affected, only
those were relieved to which the salt was applied. At the end
of the paper the author gives an abstract of seventy-nine cases
of acute rheumatism, showing the results of treatment, and other
particulars.

Dr. Henry Bennett had witnessed the results of a similar

%

104 Nitrate of 'Potass in Rheumatism. [February,

mode of treatment to that practised b.y Dr. Basham, in Paris, in
1837, and subsequently. In that year, M. Gendr^i had institu-
ted a series of experiments with the nitrate of potash, in acute
rheumatism. He gave it in doses varying from six to twelve
drachms^ He had seen this treatment adopted in about as many
cases as were recorded in the paper before them, and with the
same result. It was found to be a safe, powerful, and energetic
remedy. In the experiments of M. Gendrin, no other medicine
was given, not even aperients. The result of the treatment was
generally successful, but in every tenth or twelfth case it was
found necessary to resort to the old remedies, bleeding, calomel,
and opium, &c. It was noticed, also, that patients treated with
the nitrate of potash were unusually free from cardiac disease,
more so, indeed, than when any other kind of treatment was
adopted. Another noticeable circumstance connected with
this mode of treatment was, that patients recovered more ra-
pidly from the disease than when any other plan was pursued.
This was most important, particularly in Paris, where bleeding
was often resorted to, to a considerable extent, and patients
were consequently kept months, and even years, in a weakly
condition. He had never seen any injurious effects from large
doses given. This, no doubt, was owing to the large quantity
of fluid in which the medicine was dissolved. In all cases of
poisoning by this agent, recorded in works on medical jurist
prudence, the quantity of fluid used was small. The plan pur^
sued was perfectly original, and the originality was due to Dr,
Basham. In slight rheumatic cases, in which there was little
febrile action, this treatment was most beneficial, the patients
recovering in four or five days.

Dr. C. J. B. Williams inquired the number of days that it
required to give relief to the acute symptoms in rheumatic fever.

Dr. Basham said, that in only two cases had he treated the
disease by nitrate of potash alone. The acute, inflammatory
symptoms usuajly gave way on the third or fourth day ; and it
was important to state, that in no one case treated by the ni-
trate of potash had there been any relapse. This was a strong
recommendation of the value of the treatment, when we recol-
lected how common relapses were, when the other modes of
treatment were employed. In the first instance, he had given
as much as four ounces of the salt in the twenty-four hours, but
he had now reduced the quantity to one or two ounces in that
period. A great quantity of the salt escaped by the urine, the
quantity of which was not much increased, but its specific
gravity was a great deal higher, averaging between 1030 and
1040. This increase in the specific gravity he considered was
due to the potash.

1849."! The Instrument for Tracheotomy. 105

T}ie Instrument for Tracheotomy. By Marshall Hall, M.D.
(London Lancet.)

Every recollection I have of tracheotomy convinces me that
it is far more advisable to remove a circular portion of the
trachea, and to secure the integuments and muscles fron) pass-
ing over the orifice made, than to use a tube.

In one case, after the use of the tube for a few days, with much
inflammation and irritation, it was removed entirely, and the
patient breathed freely several weeks through the orifice only.

In another case, the tube excited so much inflammation as, I
believe, to prove fatal.

I would therefore propose the rejection of the silver tube.
This may be still more necessary in tetanus or hydrophobia,
should the operation ever be performed in these cases, than in
any other, on account of the augmented irritability of the spinal
system.

Reduced to this simplicity, therefore, all that is required is an
instrument for removing a circular portion of the trachea. A
steel tube with an extremely sharp ^^^^ at the lower part, to
which a piston is accurately fitted, is all that is required. All
haemorrhage having ceased, this tube must be accurately applied
to the trachea, and with a little force, and the piston is to be
drawn smartly upwards. The portion of the trachea is drawn
into the tube with a slight report.

It must be admitted, however, that such an instrument would
require to be in excellent order, and to be used with a skilful
hand. The profession are therefore indebted to Mr. Weiss,
who kindly volunteered his aid in carrying out my suggestion,
for proposing a material improvement in my instrument.

It may be known that a steel tube, with a lower cutting edge,
through which a small screw, in the form of a cork-screw, is
made to pass,* is employed for removing a minute portion of the
tympanum in certain cases of deafness. Mr. Weiss proposed
to use a little cork-screw of this kind instead of the piston, in
the instrument for tracheotomy, and such an instrument is now
before me.

The portion of trachea is seized by the screw, and the steel
tube descends with a rotary motion, and removes the portion of
trachea with the utmost facility and certainty.

A still more simple instrument could be constructed, by sub-
stituting a small tenaculum for the cork-screw. Indeed, with
the aid of a small tenaculum, the skilful surgeon would readily
remove a circular or oval portion of the trachea, by means of a
couching-needle or a very small scalpel ; or such an instrument
might be made to revolve round a fixed point. Thus, then, the

106 Turpentine Oil in Hemorrhage. [February,

profession is provided with a ready mode of performing trache-
otomy.

B.^sides the case of laryngitis, of tetanus, or of hydrophobia,
the patient in thestertor of drunkenness, of epilepsy, or of apo-
plexy, when this is extreme, dies of asphyxia. Now tiiat trache-
otomy is rendered so safe and easy, I trust such an event will
not again be permitted to occur.

There is another view of this remarkable question. I believe
no violent general convulsion could occur, if the glottis were
not closed ; in other words, if the trachea were opened. Might
not the faculties, or the life of the epileptic patient, be preserved
by tracheotomy, the orifice being preserved open ? The wound
might be healed like that of the pierced ear, and opened or
closed as the occasion required. I would propose this measure,
as a preventive, in the case of frequent severe epileptic seizure.
Over the orifice a proper guard might be worn, permitting the
ingress and egress of the air, and admitting of being closed at
will for articulation.

One gentleman has asserted that the hydrophobic patient does
not die of asphyxia. I should think he never saw, or carefully
observed and watched, a case of that most fearful of maladies,
as he is obviously unacquainted with the writings of Dr. Physick,
of Philadelphia.

I need not remind my readers of the importance of some pro-
per instrument for the performance of tracheotomy in infants
and children, in w^hom the free space over the trachea is so
limited.

On the Internal Use of Turpentine Oil in cases of Hemorrhage.
By L. Percy, M. D. (Proceeding of R. Med'. Chirurg Soc,
June 27. Gaz. Medicale and Dublin Press.)

The author, after noticing the fact that several writers
Adair, Nichol, Johnson, Warneck, Copland, Ash well, and Pe-
reira have spoken of the efficacy of the essential oil of turper^-
tine in hemorrhagic diseases, observes that this remedy seems
nevertheless to be little used by practitioners. In the case in
which he fii'st made trial of it, haematuria of two years' standing,
in an old man of eighty, was stopped in twenty-four hours by
eight drops of oil of turpentine, and did not return. He has
since used it in different cases of hemorrhage, and always with
a favorable result. The cases in which its use is indicated are
those of passive hemorrhage. It must not be employed in cases
where there is an active determination of blood, and where the
pulse is full. When the discharge of blood is the consequence

1849.] Sulphate of Quinine in Asthma. 107

of organic disease, as of disease of the uterus, or of tubercular
disease of the lungs, the action o|_the remedy is not so effica-
cious ; but the author has seen a^se of schirrus of the womb,
in which the hemorrhage was for some time stopped by this
remedy. The author has found the action of turpentine oil
very rapid, an effect being manifest in a few hours, often after
one* small dose. In order better to ascertain its power, he used
it alone, without having recourse to local astringents or cold
applications, where he could do so without fear of endangering
the life of the patient. He has used it most frequently in cases
of menorrhagia and epistaxis ; but he mentions, that it appears
to him to beparticularly applicable in the cases of hemorrhage
attending typhus. He ^noticed the fact that turpentine exerts
different actions on the body according as it is taken in larger
or small doses, being more readily absorbed in the latter case;
and he remarks, that as its beneficial- action in cases of hem-
orrhage must depend on its being absorbed, the inference would
be drawn, that the doses in which it is given in such cases ought
to be small. His experience confirms this conclusion. He
has always fouiad a dose of from eight to thirty drops sufficient.
The best vehicle for it is almond emulsion, with a little gum
Arabic. When there is pain in the abdomen, a few drops of
laudanum may be added.

Sulphate of Quinine in Asthma. By A. M. Johnson, M. D., of
Vermont, Illinois. (St. Louis Med. and Surg. Journ.)

October 20th 1843, I was called to see Mrs. R., aged 45.
I found her sitting, leaning forwards, with her knees drawn up,
her elbows on them, her head supported by her hands, laboring
for breath, her mouth open, and making such a loud wheezing
noise as to be heard at a considerable distance ; extremities
cold ; pulse feeble and irregular ; in a word, she was labouring
under all the distressing symptoms of asthma. Mr R. informed
me that she had been subject to attacks of asthma for the last
20 years, which would yield to V. S. emet. and cath. in the
course of 4 or 5 days. I recollected of somewhere reading a
treaties on the modus operandi of quinia, in which the author
suggested the propriety of its (sulph. quinine,) use in the treat-
ment of asthma. Looking upon that disease as one of the spas-
modic disorders of the excito-motory system of nerves, the
par vagum being the apparent one, and the impression it con-
veys to the medula oblongata is reflected through associated me-
ter nerves upon the bronchial muscles; and believing quinia to
be a sedative and a sudorific, I, at once administered xii grs. of

1 08 New mode of Reclaiming Drunkards. [February,

sulph. quinine. In 30 minutes, my patients remarked that she
felt faint ; we put her to be^ in two hours she awoke from a
short sleep, and observed inat she was well. Her breathing
was natural, pulse regular, and countenance normal. In 8
hours, ordered them to give oil ricini.

13th. Up to this day, she has not had a second attack.

December 29th, was called to see a boy, aged 10 years ; had
been subject to attacks of asthma from infancy; found him
with the disease firmly seated. I gave him at once v ojrs.
quinia; saw him in an hour again, not much relieved ; ordered
V grs. more ; in two hours saw him again, and was happy to
find the child entirely relieved. Was acquainted with the boy
for 2 years in which time he had not a second attack.

June 17th, 1844, 1 was called to see Mr. B., aged 28 ; found
him labouring under an asthmatic disease, to which he had been
subject for years. Gave at once xii grs. quinia: in three hours,
entirely relieved. This.patient died in September with hydro-
p?ricardium. I have treated many cases of this (asthma)
diseass, and with immediate relief. I reported my success to
my friend, Dr. Vance, of this place, who informs me that he
has used it, with the same happy effects. Drs. Christy & Allen
of Moquon, and Allen of Astoria, at my suggestion, have given
it a trial, and with a like success. I now leave the report with
this remark that I do not claim the honor of its discovery, but
presume that I was the first practitioner in the west to make
use of sulph. quinia in asthma. I leave the modus operandi of
quinia in the above disease with those who may give the above
a perusal.

New mode of Reclaiming Habitual Brandy Drinkers. By
Dr. ScHREiBER. (L'Union Medicale. London Med. Gaz.)

This plan consists in confining the person treated to one room,
and giving hini brandy in all his drink, whether water or cofl^ee,
and mixing brandy in small quantities with all his food. 139
soldiers were treated by Dr. Ritzous, at Sfockholm, under this
system. During^ the first few days, from five to seven, this new
regimen pleased the patients much. They were in a state of
continual joyous intoxication. The pulse became full and slow;
the tongue red and moist. All complained of a sense of burn-
ing in the region of the stomach. The stools were regular; the
urine red and scanty ; the skin moist. The pupils were neither
contracted nor dilated. About the end of the fifth or seventh
day, the excitement of intoxication ceased ; the patient came to
himself, but was languid and silent. The sensation of burning

1849.] New mode of Reclaiming Drunkards. 109

in the stomach became more acute, and was accompanied by
inextinguishable thirst. The tongue became yellow about the
edges; the stomach could take neither food nor drink, but they
were immediately rejected by vomiting. The greater number
gave up eating. The pulse was small, weak and trembling.
At the end of from two to four days, this state disappeared in its
turn, and the patient recommenced eating and drinking. Some
were again attacked with intoxication during six or eight days;
and when they came to their reason, they always preserved an
invincible repugnance for food and drink mingled with brandy.
In six of the men, slight delirium, which disappeared of itself,
remained after the end of the treatment.

All the persons thus treated were carefully examined by
medical men : it was considered important to direct attention to
the thoracic and abdominal organs, and to inquire if there ex-
isted no disposition to apoplexy and cerebral congestion.

The duration of the treatment varied, from six to twelve days;
for some it required twenty days, including the time required
for the treatment of the convalescence. This consisted in a
new regimen substituted for that with brandy, which had pro-
duced such an aversion that even its odour excited nausea. At
first, pure water was given in small quantities, then milk, or
gruel, and, by and by, other kinds of food were also given, but
always in small quantity.

The treatment was su5^pended in seven individuals: in two,
owing to convulsions; in three, from the vomiting of blood; in
one, from haemoptysis ; and in another, owing to a blow receiv-
ed by the patient on the head.

No other disagreeable results followed the treatment : indeed,
those submitted to it appeared to enjoy better health than they
had previously. One only was attacked b}' melancholy, and
cured by laxatives.

One man was obliged to suspend the treatment on the sixth
day, he beinor then threatened with cerebral congestion and
symptoms of irritation in the abdominal organs. He was cured
by cold applications to the head, and purgation with castor oil.
When he recovered, he had completely last his taste for brandy.

Of the whole garrison, 139 men were treated on this plan of
Schreiber 128 were completely reclaimed from drunkenness,
4 relapsed, and 7 were obliged to suspend the treatment. The
greater number were from 20 to 25 years of age. %

In this mode of treatment, strict surveillance on the part ofa
medical man is necessary. Results so satisfactory as those just
recorded cannot be always expected; relapses may take place
after apparently the most complete recovery ; but it is not less
certain that this plan of treating so widely spread and ignoble a
vice merits all the attention of the physician.

110 Tar in Cutaneous Diseases. [February,

There is another point which it may be as well to consider
in adoping this singular method of treating drunkenness, namely,
whether, if death should ensue from it, the practitioner might
not have to answer a charge of poisoning by alcohol.

Tat in Cutaneous Diseases. By Mr. Thos. Hunt, of Heme
Bay. (Medical Gazette.)

The notorious intractability of these disorders naturally ex-
cites one's attention to any remedy which has proved successful ;
accordingly, the treatment by tar, especially since the intro-
duction of capsules, has come into very general use ; and it is
unquestionable that some obstinate cases have yielded to it. I
still, however, must maintain my preference for a previous trial
of arsenic in decreasing doses, and on a full stomach, for the
following reasons :

1. As far as my experience has extended, it has, when regu-
larly and properly administered, never yet failed in any of the
diseases enumerated by your correspondent, provided the pa-
tient be free from organic disease, and temperate in his habits.
And we have yet to learn whether, in any of the cases of reputed
failure, the arsenic has been carefully administered in accord-
ance with the conditions I have specified ; and this is an all-
important yjoint; for in a majority of my own successful cases,
arsenic had failed, having previously been tried on an essentially
different plan; and in many of them tar had likewise failed.

2. Arsenic not only cures the disease, but, when continued
for a certain time after the final disappearance of the disease,
always in a great degree, and frequently entirely, destroys all
tendency to the morbid action. This is not the case with tar.
On Mr. Wetherfield's own showing, some of his patients were
only relieved for the time, and "suffered repeatedly from the
disease."

3. Although Mr. Wetherfield's patients appear to have made
no complaints to their honor be it spoken yet the odour of
tar, to say nothing of its trouble and filth, is to some persons
intolerable ; and to none can it be agreeable to reflect, that they
carry it about with them into every company. Arsenic is not
open to this objection.

4. Arsenic, besides being more certain and lasting in its ef-
^ fects, as well as less unpleasant, is as safe as tar. Of this I have

abundant proofs in the history of many thousands of cases. Nor
have I 3^et met with a patient who, from idiosyncracy, could not
bear it. I have explained in my book, that where the system
Was remarkably susceptible, and in a degree intolerant of the
remedy, the disease was so much the more amenable to its influ-

1849.] Cure for Stammering. Ill

ence, yielding speedily to such very minute doses as the patient
could bear with impunity.

Nevertheless, if I should meet with a case in which arsenic
cannot be borne in any dose, I will certainly give a trial to the
tar.

I may, perhaps, be allowed to add, however, that it is our
duty in every case, as it will prove our interest, as well as that
of the patient, to try at once the most effective remedy we have
at hand, especially if it be safe, and subjects the patient to no
annoyance.

Cure for Stammering. By Charles A. Lee, M. D. (Buffalo
Medical Journal.)

Is there any cure for stammering ? I believe there is, but not
in the Surgical Armamentaria^ nor in the materia medica pro-
per. We read that Demosthenes cured himself of stammering
by speaking with a pebble under his tongue. Mrs. Leigh, who
has had great success in curing this difficulty, has availed her-
self of this hint, and directs her patients to elevate the tongue,
raising the point towards the palate. Stammerers will tell you,
that if they allow the tongue to lie low in the mouth, they find
it much more difficult to articulate than if it is somewhat eleva-
ted. It is an excellent plan in the treatment of these cases, to
direct the patient to sing his words, and you know that persons
who stammer can sing much better than they can talk. In this
way the attention is directed more to the larynx, and its mus-
cles are brought at length under such a degree of control, that
the habit of stammering is nearly, or quite overcome. If we
could devise a method, by which the glottis could be kept per-
manently open, I doubt not, that the habit could be easily cured.
I know no better way of voluntarily keeping it open, than that
recommended by Dr. Arnott, viz: that the patient should con-
nect all his words by an intonation of the voice continued
between the different words. A still later mode of curing the
difficulty,is that suggested by Miiller, viz: of reading sentences,
in which all letters, which cannot be pronounced with a vocal
sound, viz : b, d, q, p, t, and k, are omitted, and only those con-
sonants included, which are susceptible of an accompanying
intonation of the voice; which should also be prolonged, as in#
singing. This plan, while it keeps the glottis open, combines
articulation with vocalisation. After practising in this manner
for a while, the stammerer should then proceed to the mute and
continuous consonant h, and the explosive sounds q, d, b, k, t, p.
This mode of treatment, followed up, I believe will cure most

112 Gun-cotton for Surgical Purposes. [February,

cases of stammering, however bad they may be, but then it
will require ^reat perseverance on the part of the, patient, and
patience on the part of the instructor, if there be one ; although
I see no necessity for a teacher, after the principle has been
fully explained, and understood. The patient is to study very
carefully the manner of articulating the ditTerent letters, and
then pronounce them repeatedly, slowly, and analytically. As
soon as he can master sentences from which the explosive con-
sonants have been omitted, he is to pass on to others in which
they are sparincrly introduced, and so on to ordinary language.
Confidence in himself, and in his ability to command the muscles
of articulation, is of the highest importance to the stammerer,
and this can only be acquired in the manner pointed out, viz:
overcoming obstacles by degrees, and proceeding step by step
from that which is easy and practicable, to that which is more
difficult-

Preparation of Collodion, or Solution of Gun-cotton as an Adhe-
sive Material for Surgical Purposes. (Annalist.)

M. Malgaigne has recently communicated to the French
medical journals some remarks on the preparation of gun-cotton
for surgical purposes. Several French chemists, at the sugges-
tion of M. Malgaigne, attempted to make an ethereal solution
of this compound by pursuing the process recommended by
Mr. Maynard, in the American Journal of Medical Sciences;
but they failed in procuring the cotton in a state in which it
could be dissolved by ether. It appears that these experiment-
alists had employed a mixture of nitric and sulphuric acids; but
M. Mialhe ascertained, after many trials, that the collodion, in
a state fitted for solution, was much more easily procured by
using a mixture of nitrate of potash and sulphuric acid.

For the information of our readers who may be disposed to
try this new adhesive material, we here give a description of M^
Mialhe's process for its preparation. It appears, from the re-
sults obtained by this chemist, that cotton, in its most explosive
form, is not the best fitted for making the ethereal solution.

Parts i>y weight.
Finely powdered nitrate of potash - - - 40

%. Concentrated sulphuric acid* 60

Carded cotton 2

Mix the nitre with the sulphuric acid in a porcelain vessel,

* The common commercial acid will aDswer. When very weak, a longer
immersion of the cotton is required.

1849.] Gun-cotton for Surgical Purposes. , 113

then add the cotton, and agitate the mass for three minutes by
the aid of two glass rods. Wash the cotton, without first press-
ing it, in a large quantity of wafer, and, when all acidity is
removed (indicated by litmus paper), pres^s it firmly in a cloth.
Pull it out in a loose mass, and dry it on a stove at a moderate
^heat.

^ The compound thus obtained is not pure fulminating cotton :
jt always retains a small quantity of sulphuric acid, is less infiam-
jjinable than gun-cotton, and it leaves a carbonaceous residue
Rafter explosion. It has, how^ever, in a remarkable degree, the
, property of solubility in ether, especially when mixed with a
little alcohol, and it forms therewith a very adhesive solution, to
which the name of Collodion has been applied.

Preparation of Collodion*

Patts by weight.

Prepared cotton ---- 8

Rectified sulphuric ether ------ 125

Rectified alcohol - - - . 8

Put the cotton with the ether into a well-stopped bottle, and
shake the mixture for some minutes. Then add the alcohol by
degrees, and continue to shake until the whole of the liquid ac-
quires a syrupy consistency. It may then be passed through a
cloth, the residue strongly pressed, and the liquid kept in a well-
secured bottle.

Collodion thus prepared possesses remarkable adhesive pro-
perties. A piece of linen or cotton cloth covered with it, and
made to adhere by evaporation to the palm of the hand, will
support, after a few minutes, without giving way, a weight of
from twenty to thirty pounds. Its adhesive power is so great,
that the cloth will commonly be torn before it gives Way. The
collodion cannot be regarded as a perfect solution of the cotton.
It contains, suspended and floating in it, a quantity of the vege-
table fibre which has escaped the solvent action of the ether.
The liquid portion may be separated from these fibres by a filter,
but it is doubtful whether this is an advantage. In the evapor-
''ation of the liquid, these undissolved fibres, by felting with each
'*other, appear to give a greater degree of tenacity and resist-
ance to the dried mass.

In the preparation of collodion it is indispensable to avoid the
presence of water, as this renders it less adhesive ; hence the
ether, as well as the alcohol, should be pure and rectified. Th^
parts to which the collodion is applied should be first thorough-
ly dried, and no water allowed to come in contact with them
until all the ether is evaporated.

N, s< VOL. V. NO. n. 8

114 Monthly Periscope: [February,

PART III.
iWontljlg |3cri0cope.

Function of the Skin. Mr. Wilson, in his work on Diseases of the
Skin, (says the Charleston Medical Journal and Review,) after de-
scribing the structure and arrangement of the sudoriparous glands,
makes the following curious remarks :

" Taken separately, the little perspiratory tube is calculated to
awaken in the mind very little idea of the importance of the system to
which it belongs, but when the vast number of similar organs compos-
ing this system are considered, for it includes the sebiparous organs,
which are also agents in perspiration, we are led to form some notion,
however imperfect, of their probable influence on the health and com-
fort of the individual. I use the words imperfect notion, advisedly, for
the reality surpasses imagination and almost belief. To arrive at
something like an estimate of the value of the perspiratory system, in
relation to the rest of the organism, I counted the perspiratory pores
on the palm of the hand, and found 3528 in a square inch ; now each
of these pores being the aperture of a little tube of about a quarter of
an inch long it follows that in a square inch of skin, on the palm of the
hand, there exists a length of tube equal to 282 inches, or 73^ feet.
On the pulps of the fingers, where the ridges of the sensitive layer of
the true skin are somewhat finer than in the palm of the hand, the
number of pores on the square inch a little exceeds that of the palm,
and on the heel, where the ridges are coarser, the number of pores on
the square inch was 2268, and the length of the tube 567 inches or 47
feet. To obtain an estimate of the length of the tube of the perspira-
tory system of the whole surface of the body, I think that 2800 might
betaken as a fair average of the number of pores in the square inch,
and 700 consequently of the number of inches in length. Now the
number of square inches of surface in a man of ordinary height and
bulk, is 2500; the number of pores, therefore, 7,000,000, and the num-
ber of inches of perspiratory tube 1,750,000, that is, 145,833 feet, or
48,600 yards, or nearly 28 miles."

A Case of Superfcetaiion and Mixed Birth. By Tiios. B. Taylor,
M. D., of Princeton, Miss. The following remarkable case ofsuper-
foetation and mixed birth occurred in this neighborhood a few months
since ; and as there are but few cases of a similar character on record,
and as this differs in some of its features from any other, I have con-
cluded to report it, provided you may deem it worthy of a place in your
yfournal.

Clarrissa, a negress, the property of Mr. A. Knox, aged about 35
years, in May last, was delivered of twins; one a mulatto, and the
other a negro child. She had been married to a negro man on the
plantation, of delicate constitution, for many years, and had had several
children by him. Iler menstrual discharge had occurred for several

1849.] Monthly Periscope. 115

months previous to her pregnancy, at about the lull of the moon. She
felt herself pregnant by her customary signs, about the middle of the
month ; and, to confirm her suspicions, at the next period, it did not
appear. About three weeks from the time she first felt she had con-
ceived, and one week after her menses had failed to appear, she had
sexual intercourse once with a white man. She slept with her husband
every night had connection with him the night before she had inter-
course with the white man, but not on the same night. At their birth
the mulatto child bore marks of being at least three weeks younger
than the negro ; thus sustaining the woman in her suppositions, as to
the time between her tvvo conceptions. This woman is a faithful
servant, and I have every reason to believe she told the truth in relating
the circumstances of her case to me. \^New Orleans Med. and Surg.
Journal.

Can a Reptile live in the Stomach ? 'To the Editor of the Boston
Medical and Surgical Journal. JJear Sir, Permit me to make the
inquiry, through you, whether it is possible for a reptile to live in the
human stomach? and if so, how long? Could it not only live hut
grow to some size there ?

The reasons for making this inquiry, are the following : Mrs. W.,
who has usually enjoyed excellent health, has, during the summer past,
been unable to attend to her ordinary business. Her appetite has been
capricious. She has complained of a disagreeable sensation at the pit
of the stomach, sometimes amounting to pain, and frequently attended
With nausea, These symptoms increased in severity until, abou a fort-
night since, she ejected a live snake from her stomach. It was seven
inches in length, and of the common green species. It lived two days in
a bottle of water, and then died. 1 have it now preserved in spirits.
Mrs, VV. thinks she remembers having swallowed some object in a
glass of spring Water which she drank in the dark, in May or June-
She has now recovered her usual health. Yours, &c.

Hallowell, Me., Nov. 1, 1 848. M. C Richardsox, M. D.

Neuralgia of the Teeth. By Doct. R. A. Chambers, of Mifflin co.,
Penn. This troublesome disease, which is ge7Z6;ra% characterised by
periodical pams, shooting with the utmost violence along the branches
0^ the fifth pair of nerves distributed to the affected jaw, I have suc-
ceeded in arresting and entirely curing in two cases. Both patients
had been troubled for years, and suffered much from the intenseness
of pain which attacked them at stated periods, and continued for several
hours, after which there was not the slightest symptom for some three
or four days, when it would make its appearance with the same dis-
tressing effects. Various applications, as well as internal remedies,
had been resorted to, but all to no purpose, as little or no benefit had
resulted from their use. The poles of an electro-magnetic apparatus
Were ordered to be applied to the jaw, tracing as near as possible the
distribution of the nerves. This was done ; and after /2^,'o applications
in the one case, and three in the other, I had the pleasure of witnessing

IIG Monthly Periscope, [February,

a cure, as no returning symptoms have made their appearance during
the several months which have now elapsed.-^[iV. Y. Annalist,

Poisoning by an infusion of Poison Oak. Mr. Wilkes, a student of
medicine from Tennessee, curious to test the truth of the statement of
some writers on materia medica, that the Rhus toxicotendron only pro-
duces its poisonous effects when applied to the skin, tried, a few weeks
since, the experiment of drinking a strong decoction of the plant. He
boiled the vine, with its leaves, and drank about a gill of the fluid,
taking care, while preparing it, not to let the vine come in contact with
his person. It was taken after supper, and next morning he found his
face much swollen. The swelling continued to increase until his
eyes were completely closed. He resorted at once to a wash com-
posed of perchloride of mercury, gr. j. ; sal. ammoniac, grs. ij. ; water,
5ij., which he had prepared in the event of his being poisoned. In
about thirty-six hours the swelling and inflammation had disappeared.
He slept nearly the whole time his eyes were closed, showing thenar-
cotic action of the article. [Western Joum. of Med. and Surg.

Blisters to Thigh in Vomiting. The treatment recommended by
the author in this disease, is rational and practical. There is one
remedy which we have found useful, to which he does not allude.
We have used it in cases where the vomiting was incessant, every
thing being rejected the moment it reached the stomach, the dejections
frequent, copious and watery, and the thirst most distressingly urgent,
and where every thing had failed to relieve, or even to mitigate the
severity of the symptoms. Under such circumstances we have found
small blisters applied to the inside of the thighs, give almost immedi-
ate relief to the nausea, retchings vomiting and thirst, and afford time
and opportunity for the administration of remedies. Applied on the
inside of the thighs, they have produced a decided mitigation of the
symptoms as soon as vesication commenced, whereas when applied to
the epigastrium, they have in such cases little or no effect. [Charleston
Medical Journal.

Leeches. ^The following simple method lor preserving leeches and
making them suck vigorously a second time, is recommended by Dr.
Christison. " It has been stated that they may be rendered in a few
days as active and useful as ever, by dissolving a little white sugar in the
water (in which they are kept,) and renewing this solution twice at
intervals of twelve hours, and twice afterwards at intervals of a day.
I have tried this plan and found that the same leeches drew blood three
tiiTies at intervals of three days, with scarcely any diminution of
activity, and with scarce a death among them." p. 540. This of
course^ does not dispense with the necessity for stripping them. [Ihld,

Operation for Hare-lip. M. Guersent, who has had extensive op-
portunities of judging of the most favorable period for operating in
hare-lip, gives the preference to the period recommended by Dui>oi9>

1849.] n Monthly Periscope. 117

during the first fortnight after birth. He advises against undertaking
the operation when the child is about a year oM, or during the process
of dentition. It may again be performed with much greater hope of
success when the child has attained the age of five or six years.
i)ietlenbach luiterly gave a similar preference to the early operation.

[Gaz. des Hop., in Month, Journ.

Amputation at the Hip-joint. M. Guersent operated, on the 28th
December, 1847, for a cancerous affection of the femur by disarticu-
lation at the hip-joint. The child, aged 5, was very much reduced.
He was put under the influence of chloroform insensibility was
complete in two minutes. The operation lasted only two minutes.
When the ligature was being placed on the vessels the child became
pale, a little foam came from the mouth, the eyes were turned up, and
the pulse at the wrist dissappearcd. This state of syncope was dissi-
pated by means of active ventilation, and the introduction of a few
spoonfuls of wine into the stomach and the child began to cr)^, much
to the relief of the surgeon. Twenty-two days after the operation
the child was as well as possible. [Journ. de Med. et de CJier., in
Prov. Med. and Surg, Journ.

Ergot as a Remedy for SperinatorrlKKa. In a recent lecture on
excessive and involuntary seminal emissions, Prof VV. Parker stated
that he had used the Ergot in combination with the Tinct. f'erri.
Murias, with very marked benefit. [Annalist.

New Mode of preparing Sections of Skin so as to show the Glands,
M. Flourens communicated, July 12, to the Academy of Sciences, the
following extract of a letter from M. Retzius : " I have the honor to
present to you two fine sections of the skin from the Axilla, in which
can be distinctly seen the superficial sebaceous glands, and the more
deeply seated sudorifirous glands. The skin is rendered diaphanous
by maceration in sulphuric ether. In this way, we can see the beau,
tiful glands either with the naked eye or with the magnifier. [Compte
rendu, in AnnaUst.

Novel Effects of Hydropathy. A friend at our elbow suggests that
the notion of drugs working out through the skin after long remora in
the, system, was deduced in this vicinity from the case of the Rev.

J , once a respectable minister but who abandoned hitnsulftodrink

and opium eating. He was induced, by some of the cold water sages,
to try the cflect of their panacea. When he was under a full head of
the sweating and steaming process, sure enough, the pent up vapors
gave forth a most unsavory odor of laudanum ! With their usual
cautious generalization, and the modest self-reliance which always
marks the inductive philosopher, the old women of both sexes who
watched the phenomena, at once held up their hands in amazement at
the miraculous fact more wonderful than the liquefiiction of the blood
of St. Januarius that the long locked up poison was compelled to

118 Monthly Periscope, [February,

desert its victim ! Poor J ! the reform was of short duration. The

Lunatic Hospital at Worcester soon received him, and the amusing
explanation came out, that a small vial of the precious tincture, which
he had concealed about his person to comfort him in passing through
Jordan -for his dread of the element had long been perfectly hydro-
phobic rhad been accidentally fractured, and its perfume thus shed
abroad !

" You may break, you may ruin the vase if you will,
But the scent of the roses will han": round it still."

[Buffalo Medical Journal.

Springs of South Carolina. Still more singular Mere the circum-
stances related to me respecting the Woodboo Springs ; many years
ago a similar "break*' or sink having occurred in the canal it was
repaired by driving piles into it and filling the interstices with fascines
made of rice straw, (then grown extensively in the inland swamps of
this neighborhood) covering these with rammed clay an# planking over
the whole. The worki however, having been carelessly performed,
did not last long, the piles, fascines and other material used in the
repair suddenly disappeared and were followed by the waters of that
entire section of the canal. ^ Two months afterwards, to the surprise
of those who witnessed it, the fascines of rice straw came up with the
bubbling waters of Woodboo Springs at a distance of two miles below.

[Cliarleston Medical Journal.

The Ervalenta Quackery exposed. In the PharmaceuticalJournal,
March, 1845, the nature of a secret remedy for constipation, called
Ervalenta, and Melasse de la Cochin China, was exposed. The first,
(the ervalenta,) we explained, was the meal of the lentil, called
Ervum Lens, sold at three times its ordinary prince ; and the second
(the melasse de la Cochin China), was common treacle, sold at five
times the usual charge for it; and the smallest quantity of these two
sold, cost twenty-eight shillings.

<' The speculation has, we presume, proved a lucrative one, for it
has given rise to an imitation in the form of a preparation called ' Reva-
lenta Arabica, a nutritive and eminently curative fecula, derived from
an African plant.' It is prepared like gruel, by mixing two ounces of
it with a pint and a half, or a quart of water, boiling over a slow fire,
and stirring well till it has boiled for fifteen minutes. Honey, or the
best raw sugar, and salt to taste, are then added, and it is ready for
use. If this does not act sufficiently on the bowels, two or three spoon-
fuls of 'our prepared melasse' are to be substituted for the raw
sugar.

" The word ' Revalenta ' is obviously borrowed from ' Ervalenta '
by the transposition of the letters of the first syllable.

"The word ^Ervalenta' is derived, as we before explained, from
the ^ Ervum Lens,^ the botanical name of the lentil.

"The lentil is culivated in Egypt, as well as in various parts of
Europe, and therefore the proprietor of the revalenta is so far correct
when he says it is an 'African plant.'

1849.]' ** Monthly Periscope^, 119

' On subjecting the meal called revalenta to a microscopic examina-
tion, we tind that, like ervalenta^ it is prepared from the lentil. The
character of the starch-grain readily distinguishes it."

The expccted-to-be omnicient medical man has here the history of
this queer-named composition. The facts speak for themselves much
more truthfully than the silly certilicates which are putted in such
abundance on the subject, from the pens of dyspeptic parsons, constipat-
ed lawyers, 6lc. [Lancet.

Cure for Hiccups. Travelling some time since, by railroad from
Columbus to Baltimore, I took my seat immediately in front of a gen-
tleman who was suffering under a paroxysm of hiccup, to a degree that
1 had never before witnessed. In a few minutes a person appeared
from the end of the car, and took a seat beside him, when he said,
"Sir, can you tell me what is good for the hiccups? I have been
afflicted in the way you see me since yesterday noon, and have had
no rest, or relief from a physician to whom I applied for assistance ;
I am worn out with suffering." To whom the person replied, " Sir,
I will cure it in less than two minutes by your watch ; have confidence,
for I am sure I can do it. Hold up, high, above your head, two fingers
of your hand ; lean back in your seat, opening your mouth and throat,
so as to give ^rea passage to your lungs ; breathe very long and softly,
and look very steadily at your fingers." In less than the time specifi-
ed the cure was performed, one hiccup only occuring during the
trial. The patient could not express his gratitude, while the practi-
tioner only exacted from him as a fee, the promise that he would
extend the knowledge which he had imparted, as freely as he had
received it, assuring him that he would never be dissappointed in the
result.

We were all struck with the fact, and many of us considered that
the stranger was sent by the appointment of that Power, often designat-
ed as a particular Providence. Since then I have often had occasion
to practice upon patients in the same disorder, and never without the
most signal success. {^Newspaper.

Persistence of the Urachus in an Adult. Dr. Robert Cabell has
brought before the Medical Society of New York the details ofa case
of persistence of the urachus in a mulatto girl, fifteen years of age, and
enjoying good health. The umbilicus was depressed, and presented,
in the centre, a small aperture, through which the girl could make her
urine pass while lying down. Dr. Cabell introduced a thin gum-
elastic catheter into that orifice, and succeeded in conveying'the in-
strument into the bladder, after having introduced it for six or seven
inches. On the catheter being withdrawn, a jot of urine followed.
The canal of the urethra is, however, perfectly free, and the patient
is nowise inconvenienced by this abnormal conformation. [^Lancet.

The Use of Iron as a Prophylactic against Cholera. To the Editor
of The Lancet. Sir, I wish to suggest to those exposed to the in-
fluence of cholera, the internal use of iron as a prophylactic.

120 Medical Intelligence, [February,

I conjecture that when the blood is well impregnated with iron, it
is rendered less prone to undergo the nM)rbid change in which many
epidemic diseases primarily consist. The experience of an individual
is sufficient to put this conjecture to the test ; and as regards cholera,
I have not even that experience to off^er. During the prevalence of
Irish fever, I believe I did obtain a little negative evidence in support
of mj opinion, but not nearly sufficient to establish it.

^ Taken in the form of pill along with solid food, iron scarcely ever
disagrees, provided neither fever nor active inflammation be present.
A-ny one disposed to try it against the contagion for such I believe
it of cholera, will find a grain or two of the sulphate, made into a pill,
with extract of gentian, to be taken during, or immediately after, each
of the principal meals, a convenient method.

Your obedient servant, M. D.

Here^s Hood^s Illustration of Hydropathy. '^ It has been our good
fortune, since reading Claridge on hydropathy, to see a sick drake
avail himself of the ^ water cure,' at the dispensary in Saint James'
Park. First, in wading in, he took a 'Fuse bad,' then took a 'Sitz
bad,' and then turning his curly tail up in the air, he took a 'Kopf
bad,' Lastly, he ra^e almost upright on his latter end, and made
such a flapping with his wings, that we really expected he was going
to shout 'Priesnit^ for ever.' But no such thing. He only said,
' (juaek ! quack !j quack !!!' ''

MEDICAL INTELLIGENCE,

(fer TO THE PHYSICIANS OF GEORGIA. The Faculty of

the Medical College of Georgia, suggest to the Medical profession of
the State, the propriety of organizing an association. Since the in-
stitution of the National or American Medical Association, our sister
States, Alabama and South Carolina, have taken action on tlie subject.
It is therefore proposed to call a convention of the Physicians of Geor-
gia, to be held in the City of Augusta, on Tuesday the 20th of Feb-
ruary next, then to adopt such measures for the improvement and
benefit of the Profession as they may deem proper.

The Georgia Rail Road has promptly reduced its fare to one half,
for all members of the profession coming to the Convention, and it i
presumed that the other rail roads will do the sam^.

Edijors favorable to the above object will please insert this notice.

J)r, Gordon^ s Letter respecting the continuance of thi^ Journal,

Lawrenceville, Ga., Jan. 8th, 1849.
To the Editor of the Southern Medical and Surgical Journal :

Dkar Doctor It is with unfeigned regret that I have discovered
by the last (January) No. of the Southern Medical and Surgical Jour-
nal, that it is languishing for the want of patronage. In all candour,

1849.] ' Medical Intelligence. 121

and with a truly praiseworthy frankness, you have given publicity to
these (acts, and now throw the final destiny of the oldest and one of
the best monthly medical periodicals of the South and West upon the
teader nflercies of the medical profession. The all-important question
is propounded *' Shall it be continued or not?" Now sir, in
addition to this important query, I would ask, if there is one solitary
individual composing the long list of Alumni or friends of the Medical
College of Georgia who will not cheerfully enlist all his energies and
influence in sustaining the character and honor of his Alma Mater, or
State Medical Institution. Or rather, will not the profession of the
South and West unite, and, as with one voice, proclaim that it can and
will be sustained. So far as our knowledge at present extends, we
know of no Journal published in the United States containing so much
interesting matter at so low a price. This fact alone should be suffi-
cient to insure its success.

But a more important consideration why it should be continued, is,
that it is a ^<?;/i^ journal, the only convenient medium through which
we can freely interchange our views upon professional subjects, and
aid each other in the high and holy objects of doing good.

We cannot but indulge in the gloomy forebodings, that if the present

crisis is suffered to pass unimproved, from this time henceforward may

^ dated the downfall of Southern Medical Literature. That if its

joldest and ablest exponent is suffered, for the want of support, to be

numbered "with the things that were,'' those of more recent origin

will aliost necessarily follow in the train, and truly, like a star, we fear,

" It will sink to rise no more."

In conclusion, \ would make this proposition to my professional

brethren of Georgia and the adjoining States, and more especially to the

Alumni of the Medical College of Georgia that each individual use

his utmost exertions to procure at least two new subscribers, and as

many more as practicable.

Since the reception of the last No. I have been enabled to obtain
two subscribers who have not hitherto favored it with their support,
and I promise further to obtain two more. But just let the Alumni
(to say nothing of the exertion of other friends) unite and carry out our
proposition, and the work is done. Not only will the subscription de-
fray the expenses of publication, but also remunerate you, Mr. Editor,
for your arduous duties in conducting the Editorial department, for
veriiy " the laborer is worthy of his hire."

Truly yours, &c. Jas. M. Gordon.

The Asiatic Cfiolera. This dread disease has recommenced its
'ravages on our Continent at two quite distant points, first at New York
City, and still more recently at New Orleans. We are enabled in
this No. to present the reader with a full account of its appearance,
progress, and we hope decline and departure from the vicinity of the
former place ; hoping in our next issue, to be |)ermitted to announce
the like favour as regards the valley of the Mississippi.

The report which follows, is prepared by Dr. Alexander B. Whi-

122 Medical Intelligence. [February,

TING, Health Officer at the Quarantine establishment of New York,
by order of the Mayor and Medical counsel.

On the second of December, the packet ship New York arrived at (Quaran-
tine with a number of persons sick, having lost seven during the last week ol her
voyage, with a disease that has since proved to be Asiatic Cholera. The New
York left Havre on the ninth of November, with three hundred and thirty-one
steerage passengers, twent3'-one cabin, and thirty-three crew; a total of three
hundred and eighty-five. All continued well until the tv.'enty-fifih, Saturday,
when one of the steerage passengers, a German, aged twenty-nine, in robust
health, was attacked with vomiting and purging, accompanied by cramps of the
miuscles of the upper and lower extremities. The Captain supposed it to be
cholera morbus, and prescribed judiciously for the symptoms, but they continu-
ed until the third day, when death occurred.

The next case was on the2r)th, Sunday, when an old man, aged sixty-two, in fee-
ble health, was attacked with vomiting and purging, with coldness of the whole
body, and violent cramps and spasms. He died on tlie second day after the at-
tack. Monday and Tuesday, 27th and 28th, two cases occurred. A girl, aged
five years, died in two hours, and a boy also, aged five, died in four and a half
hours alter their first attack, both perfectly well previously. Wednesday, 28th,
a man, aged forty, was attacked ai 8 o'clock. A. M., and died at 3, P. M., of the
same day. On Thursday, two children sickened and died, alter six and eight
hours illness.

The ship came to anchor at (Quarantine on Friday night, and from that time
until Sunday noon, when the passengers were landed, twelve new cases occurred.

Since the arrival of the ship at (Quarantine, eighteen cases have occurred,
making, with the twelve taken from the ship, thirty cases, of which number
twenty have died. The whole number, from the first case at sea, has been thir-
ty-seven, of which twenty-seven have proved fatal.

The disease was considered by Cajtain Lines as dholera morbus, and treated
by him as such, with calomel and ipecacuanha, opiates, warm drinks and mus-
tard, and heat externally. Vomiting and pmging, cold clammy skin, cramps
and spasms were observed by him in several of the cases, but not the peculiar
character of the evacuations.

In the cases that have occurred here, Diarrhoea has preceded in only a few,
or about one-third. A majority were attacked in the morning, between the
hours of two and eight.

Most of them have presented all or most of the following symptoms: Vom-
iting and purging of thin discharges, sometimes at first, lisfht brown, but gener-
ally from the first, of a white or yellowish white or pearl color, with white
flocculi, forming a thicker whitish sediment on standing a short time. They
are well described as rice water evacuations. In some cases a half gallon has
been vomited, but generally in smaller quantities, A child, six years old, vom-
ited fully this quantity at once, had no other evacuation, and afierwards recov-
ered.

The vomiting is usually accompanied by great uneasiness and pain, parti-
cularly at the epigastrium. In some cases vomiting has existed without purging,
and vice versa. In several cases neither vomiting nor purging, but the stomach
and bowels were found filled after death with the same fluid. One or more large
worms, the Lunibrici, have been discharged, either by vomiting or the bowels,
in a large majority of ihe cases. This fact has been before remarked.

The tongue and breath are icy cold; sometimes the tongue is clean, but
generally slightly coated. The voice becomes weak and husky, and with a
great effort the patient speaks in a thick whisper.

The skin assumes a dark livid color, becomes cold and clammy, and when
pinched up, remains so for a short time.

The countenance wears a haggard, sunken look, the eye is dull and heavy,
although the pupil is somewhat dilated.

The extremities are shrivelled, the fingers and toes, and nails, resembling
those that have been long in the waier, and of a purple hue.

All the cases have been affected wiih cramps and spasms of the extremities
and abdomen, in some slight, but generally a very painful symptom.

1849.]

Medical Intelligence,

J 23

The pulse, from the inception of the real attack, becomes small and frequent,
from 110 to NO, according to the progress oi the disease, and in the slageof col-
laits*^ entirely lost at the wrist for hour?.

The breathing labored and hurried, and in the cases where the spasms were
severe, occasionally suspended mbmentaril\'.

In some of the cases all these symptoms were present, while in others only a
few of them existed. The number or apparent violence of the symptoms form
no criterion for the prognosis. Fatal results followed in a number ol cases in a
f^w hours, where the dejections were slight, and spasms and other violent symp-
toms were absent. Death seqms to ensue I'rom the oppression ot the vital organs,
and the nervous system, by some giant poison. The wretched exjiression of
countenance, the icy tongue and breath, the sunken eye, reveal this most strongly.

In this disease there has been but one stage that'of collapse although every
pains have been taken to detect the first deviations from health, directions given
to all to communicate them at once, and persons employed to inspect them con-
stantly, and a physician to pass among them at all hours of the night and day.
The first intimations are the extreme symptoms, delying the most prompt and
decided remedies.

The appearances after death are those that have been usually observed after
death from cholera. A shrunk and shrivelled livid exterior, a gorged and con-
gested condition of the internal organs The meninges and substance of the
brain, and all its vessels, usually red, either from actual congestion, or the re-
tention of the cnior of the blood while the serum is drained off. The lungs, liver,
spletn, heart, intestines and kidneys, present the same deepened color. 1 have
observed no alterations of structure or softening.

The bladder is contracted to an extremely small size. I should have observed
that there is an entire suppression of urine in most of the cases.

In several cases that I have examined, the entire mucous lining of the bron-
chial tubes has been much injected.

That this is Asiatic Cholera, cannot be doubted. From the commencement of
the disease to the present time, thirty-seven cases have occurred, twenty-seven of
which have died in an average period of ten hours. The average duration of
the di.sease in the children that have died, has been four hours.

A new feature h; s appeared in the history of this disease, in the fact that six
persons have been afl^ected in a similar.way, who had been but for two days ex-
posed to contact or proximity to these people.

Nothing like cholera existed at this place at the time of the arrival of the ship
New York. When her passengers were remove i to tlie public stores they were
occupied by about seventy persons, who had just recovered from other diseases.
One of these, a man just recovering from a fractured patella, assisted in the re-
moval of the patients. This was on Sunday; on the Wednesday following, he
wasattacked with violent symptoms of cholera, and died the same day. A wo-
man who had been a nurse, v^iihout having any communication with these peo-
ple, but occupying another room in the same building, was attacked, and died
the same day. Avith all the symptoms of cholera. A man who had been dis-
charged arid gone to the city of New York on Monday, and had remained a little
over a (lay in this same enclosure, was returned ft om the city as a case of cholera,
and died also on Wednesday. On perceiving this communication of the disease
to the convalescents,! immediately sent them away and distributed them through
the other hospitals, since which three others have been attacked, two of whom
have died, but none other than those at first exposed at the public stores, have been
affected. These had all been inmates of the hospital for weeks, were ready to
be discharged, and had but a limited exposure for forty-eight hours to the influ-
ences of the disease.

At the time the first cases occurred, November 25th, the ship was in N, lat.
42, long. Gl. about 140 miles S, S, W, from Sable Island. On the 23d and
24th, the two days preceding the appearance of the cholera, the wind was N. N.
W, On the 25th it changed to the southward, withsqualls and rain. In the
morning the barometer was at oO inches, and fell during the dav to 21U inches ;
thermometer G0 Fahr. Sundav and Mundav, 2()th and 27ih. wind westerly, and
Ircsh ; Tuesday, 28lh, moderate' from N. W. ;' barometer :iO, thermometer 42.

I have given these particulars of the wind and weather in conuection with the

124 Medical Intelligence, [Febiiiary,

dates of the first appearance of the disease that all aid may be given to our at-
tempts to account for its origin. Here its actual manifestations commenced.
Did it originate in a casual but unusual mingling of certain elements or condi-
tion of the elements, or from contact with an advanced wing ofthe grand cholera
army, or from the development of seeds latent and waiting for peculiar culture'?
Here we are met by interesting and peculiar facts.

All the persons who have been attacked, from the first case on board ship, to
the last, excepting the inmates ot the hospital, have been from among two hun-
dred and seventy Germans who have been living in Havre and its environs,
where there has not been a single case of cholera.. These persons were origin-
ally from Germany, mechanics, and flourishing, until by the triumph of liberty
and equality, the native French artisans have succeeded in inducing the public
to withdraw their patronage, and the municipal authorities to proscribe them.

The consuls of their native countries have come forward and provided for
their emigration to America. The question arises, is there not some difference
between these and the other passengers that must enable us to account for the fact 7

The only one that may be adduced, is the depressing influence of grief at be-
ing driven from their homes and flourishing trades; but this is not apparent ia
their a()pearance or manner. The}' enjoyed promiscuously with the other pas-
sengers, the best accommodations, and I am assured by Capt. Lines, that their
fare was the same with the other passengers.

I have examined their provisions on board ship, casks of bacon, rice, flour,
beans, buiscuit and potatoes, unheaded and exhibited to me, as it has been dealt
to them, and I am sure that more wholesome or sweeter provisions could not be
provided.

They are all healthy and robust have not been exposed to the cholera at home,
and have since leaving their port of departure, shared equally with the exempt,
the comforts and privations of a sea voyage, variations of wind and weather,
have breathed the same air, and fed on the same food.

When I speak of treatment, s.i\& mention twenty deaths out of thirty cases, I can
evidently not be expected to produce a successful plan of treatment.

I will mention the general plan, however, as in some cases it has been suc-
cessful, and in others failed from the fact that the disease presented its first and
final stage simultaneously. On admission, the patient is enveloped in warm
blankets, next the skin, and warm mustard applied largely to the stomach and
bowels and extremities. Hot bricks, bottles of water, or bags of sand applied to
various parts of the body, and a stream of hot air conveyed from a hot air appa-
ratus under the bed clothes. With this is combined as much friction with hot
tincture of capsicum as can be carried on under the clothes without exposure of
the body to the air. This is done in all cases, and is an efficient method of re-
storing warmth to the surface, if practicable.

Various internal means of treatment have been tried. In a number of cases.
Dr. Joseph Brown's practice of administering mustard emetics, has been adopted,
but without the blood-letting. Only two cases that were treated in the first stage
of the disease in this way, were benefited, reaction occurring after the emetic,
followed immediately by a scruple doseof calomel, combined with Dover's pow-
der. Unless reaction is effected by the emetic, the prostration and irritation of
stomach produced by it can only serve to enhance the disease.

In eight other cases, the large doses of calomel, capsicum and camphor, as
administered in the practice of Dr. Cartwright, of Mississippi, and suggested to
me by S. M. Fox, Ksq., were carefully tried, combined with the rubbing in of hot
tincture of capsicum. But the results did not encourage the continuation ofthe
treatment.

Chloroform has been administered in a number of cases, carefully and re-
peatedly, and at first gave some hope that it would prove a successful remedy,
but no other permanent good has resulted from its use but to relieve the spasms
and cramps. For this purpose I have used it in all cases moderately, and if not
a cure for all the symptoms, it is an invaluable remedy in subduing one ofthe
most painful symptoms of the disease. ,

Hot wine whey and mustard whey have been administered, in combination
with other means, particularly in the latter stages of extreme prostration.

The saline mixture has also received a careful trial in a number of cases from

1849.] Medical Intelligence, 125

the commencement of the disease, and although hopefully watched for beneficial
results, laid aside as worse than inefficient. If administered in a condition of
the system when it might be absorbed, advantage may be derived from it, other-
wise it can but increase the irritability of the stomach, the thirst and prostra-
tion, and aggravate the disease.

Sugar of lead and opium have been administered in large and small doses,
but soon abandoned as impotent.

The treatment that has proved of most service has been calomel in scruple
doses, combined with opium and camphor, followed at two or three hours inter-
vals, by smaller doses of calomel, until reaction is indicated by some action of
the liver. This plan, combiffed with the faithful application of external heat,
Slc., I am satisfied has proved of most advantage in the cases that have come
under my notice. Every case in which the slightest bilious evacuation has been
procured, has commenced to recover from that moment, and although of itself,
unable to effect the reaction necessary for its own peculiar action. Calomel
will doubtless always prove the most potent auxiliary in the catalogue of reme-
dies for cholera.

No one specific can ever control a disease whose nature is made up of so
many complications, an obstinate exsanguination and paralysis of the surface
with a fearful congestion of all the internal vital organs, and a derangement of
the nervous system, indicated by convulsions of every portion ol the body.

December 19th. Since the above was submitted, I have had further opportu-
nity to observe the character and treatment of the cholera, existing at the Marine
Hospital. Since the 11th December, to date, there have occurred thirty-three
new cases. All but three ol' these have been from the same class of Germans
from Havre, as the other cases. One, and the only one that has occurred among
the French passengers of the New York, was a Frenchman from Paris, a fatal
case.

Two others were old inmates of the hospital of Irish nativity. They were just
recovering from typhus fever, and located in a hospital most distant from ihe
cholera hospital. One was attacked on the lOtb, the other on the 11 ih of Decem-
ber, with all the symptoms of the disease, proving fatal on the third day in the
first case. The other is convalescing. No intercourse between these patients
and the cholera cases can be detected, neither of ihe convalescents that were at
first returned from the public stores, and were afterwards attacked, had visited
their wards, and their physicians in attendance had been but little among the
cholera patients.

The whole number of cases, thus far, at Cluarantine, has been sixty-three. Of
these, twenty-nine have died. A large proportion have been children under
fourteen years, twenty, or about one-third ot the whole number having been of
this class.

Most of them passed through the first attack of the disease, and died from sub-
sequent congestion or effusion in the brain.

Of the thirty-three cases that have happened since my report of the 11th, lam
glad to state that only nine have been fatal. And as there appears to be no dif-
ference in the severity of the symptoms at the outset of the disease, I cannot bnt
attribute the diminished fatality to a more happy plan of treatment.

From the reisults of the first thirty cases, and post-mortem revelations, I became
convinced that the stimulating plan was not the treatment for (his cholera, and
abandoned at first the mustard, then Ihecapsicum, ammonia, brandy, wine whey,
etc., and relied on calomel in large doses, with opium, Dover's powder, and
camphor.

With regard to camphor, even though it has been always landed, and by some
as the specific in cholera, I entertain suspicions of its utility.

The treatment I have now adopted, and adhere to, from its decided agency in
controlling the symptoms and inducing early reaction, is the exhibition of mod-
erate doses of calomel, with morphine, at short intervals. Five grains of calo-
mel, with a quarter of a grain ofsulph. morphia, is at first given to an adnltj in
a half of an hour, or one hour, a scruple dose of calomel is exhibited, and is usu-
ally retained; afterward, a pill of cal. grs. v., sulph. morphine, gr, |, is given
each hour, two hours or three hours, as the eflfect may indicate. This is obserr-
ed in the subsidence of the pain and spasms, the diminished quantity and fre-
quency of the evacuations, the return of warmth, and restoration of the pulse.

126 Medical Intelligence. [February,

This treatment is continued until some indications of bilious action appear;
the first is usually a change of color and consistence, from the light, thin, rice
water, to a greenish, and then brown or brownish yellow color. The evacua-
tions IVom the stomach and bowels will frequently continue green, or of the color
of sulphate of copper, for hours, but I have not known a single case to relapse
where this effect had once been produced.

I was led to substitute rhe morphine for opium, from its being less liable to
disturb the stomach or to produce narcosis, an effect to be deprecated in this stage
of congestion, except it result naturally from the obviation of pain and excite-
ment. ^

. In children, however, under six or seven years, I have used Dover's powder
in preference to morphine, as being more manageable in regard to the dose. A
very simple remedy, but one that I have used in children with happy effects, has
been the tea of the spearmint, givim hot in the first stages, and afterwards cold,
in a small quantity, a large spoonful occasionally.

The most valuable external means is the stream of hot vapor of alcohol, pour-
ed over the patient by a very simple apparatus at the foot of the bed. This is a
large alcohol lamp placed under a sheet-iron cylinder, with a pipe running from
it. The lamp is placed on the floor, and the tube with an elbow, and termina-
ting in a large funnel to elevate the clothes, is inserted under the bed-clothes.

This and hot mustard applications are the only external means that I rely on.
They are potent, and can be continued without the fatigue or exposure of the
patient, a paramount desideratum, as there is plenty of both to contend with as
the inevitable effects of the disease.

We also append the following report from the Sanatory Committee
of the Board of Health of the city of New York:

"The undersigned, having been appointed by the Sanatory Committee of the
Board of Health to prepare a communication to the public, in relation to the
Epidemic Cholera with which this city is at present threatened, respectfully

report:

That, as yet, the disease is entirely limited to the Cluarantine, and the hope is
cherished that under the protection of a kind Providence, this city may be pre-
served from its ravages. It is evident, however, that the cause of the disease is
hovering in the atmosphere about us, and it therefore becomes a duty to adopt
in season all such precautionary measures as may tend, if possible, to mitigate
its evils, should it unfortunately assail us. Under this impression, they beg
leave to make the following suggestions:

As the whole history of the cholera shows that its diffusion is promoted by all
those causes which have a tendency to render the air impure, the first and most
important concern relates to the cleanliness of the City. To accomplish this,
the undersigned are satisfied that the Board of Health have taken such measures,
and will continue to do so, as they trust will be efficient. The Board of Health,
however, it is evident, cannot do everything, and the Committee would respectful-
ly call upon their fellow citizens to co-operate with them in every possible way
in their power. Sources of filth and impurity may exist without ilie knowledge
of the public authorities, and every citizen should feel the necessity of keeping
a watchful supervision over his own premises, and when individual efforts are
inadequate, to call upon the Board for aid and assistance.

Believing that much may be done in the way of prevention, if not cure, of the
disease, in case it should unfortunately attack us, the undersigned would offer
a few suggestions of a "general nature, founded on experience, leaving the appli-
cation of them to the good sense and discretion of the community at large.

In the first place, they would advise particular attention to clothing. From
the nature of the complaint, it is evident that much depends upon keeping the
body warm, and protecting it from sudden exposures to cold and moisture.
Flannel next the skin should be a universal article of apparel, and they would
respectfully suggest to those charitable associations which are in the habit of
supplying the poor with clothing, to make this an object of special attention. At
this season of the year, too, the supply of fuel to the poor should be liberal.

1849.] Medical Intelligence. t^^

In the second place, the diet should be pariicularly attendul to. The under-
signed would not recommend any sudden orf^reat chanp:e in the ordinary modes
of livinjj, where those modes a re temperate, and have been found to a^ree Such
changes, they .believe, would do moreWiarm than good. From ile peculiar
nature of the disease, however, it is well known that certain kinds of lood are
injurious, and, without going into particulars, they would merely state that all
such articles as have a tendency to relax the bowels, ought to be avoiiled. All
crude and raw vegatables, as well as violent purgative medicines, are calculated
to do mischief. Excesses, either in ealingor drinking, cannot be too religiously
abstained from.

In the third place, attention to personal cleanliness, by the frequent use of the
tepid bath, is particularly recommended.

In the fourth place, the preservation of a calm and composed state of mind is
all important, and may do more than is generally supposed in preventing the
onset of this disease. It is the result of experience th^t all epidemics are
aggravated more or less by mental disturbance, whether in the shape of active
panic or low despondency. To the cholera this is particularly applicable.
While our citizens, therefore, use every prudential and precautionary measure,
let them keep up a good heart and dispel all fear.

In the fifth place, with regard to the treatment of cholera, it may be observed
that as a general rule, the disease does not attack so suddenly as to preclude the
possibility of calling in timely medical assistance. A relaxed .state of the bowels
for a longer or shorter period, gives notice of its approach. In all cases, there-
fore, when any disorder of this kind exists, common prudence will suggest the
necessity of resorting to medical aid. If this be done in season, the disease
may generally be promptly arrested. When professional aid cannot be imme-
diately obtained, and where simple relaxation of the bowels exists, fifteen or
twenty drops of laudanum may betaken; to be repeated in one or two hours,
according to circumstances. For young persons and children, the dose must be
reduced according to the age at the age say of ten years, five drops at the age of
two or three years, two or three drops.

Where the symptoms are more sevete, and the patient is cold, in addition to
the laudanum, he should be put immediately to bed, between blankets, and every
appliance in the .shape of bottles of hot water, bags of hot salt, or sand, frictions,
&c., &c., &c., be diligently resorted to, A strong mustard poultice, too, should
be applied over the region of the stomach, to remain on till it produces smarting
of the skin. In addition to this, a little brandy and water should be given, with
the view of restoring warmth. As in this city no difficulty in obtaining the
speedy assistance of a physician can exist, any directions in relation to the after
treatment are deemed unnecessary.

JOHN B. BECK, M. D., Chairman.
RICHARD L. MORRIS, M. D.
JOSEPH M. SMITH, M. D.

New York, Decembers, 1848.

Tribute of Respect to a member of the present Medical Class.

Medical Collkge, Augusta, Ga., Jan. IGth, 1849.

The Faculty and Students of the Medical College of Georgia, having just been
called to lament the sudden and unexpected death of Mr. James Antony, son
of Dr. Milton Antony, (foimerly of this city,) and one of the matriculated mem-
bers of the present class, unanimou.sly

Resolved, That while they unaflTectedly mourn the premature departure of this
estimable young man, they cannot but as sincerely regret the severe mental
discipline, and the uncompromising devotion to study, which they believe have
cost him his life. Gifted with a fine mind, and a stirring ambition, he had set
his mark high lor distinction in his profession, encouraged, no doubt, by the
grateful memory of his honored father's worth. Forgetful of the claims of
Nature, the morning star often found him absorbed in his studies, with his

128

Meteorological Observations.

[February,

couch unpressed, until disease supervened, and he fell an early victim to its
violent ravages, a melencholy, but instructive lesson to the living, that, in order
to lay the foundation for long and extensive usefulness in the profession, the
claims of the body, as well as of the mind, cannot be, with impunity, neglected.
But high minded, amiable, and hopeful as he was, our young friend is /r^^, and
with heartfelt earnestness, we can only exclaim, ** peace to his departed spirit."

Resolved, also, That his bereaved relatives have our kindest sympathies, and
that a copy of these resolutions be forwarded to his eldest brother, and through
him to the other surviving members of the family, with our united condolence
in their affliction.

Resolved, furthermore, That as a mark of respect for the memory of the de-
ceased, we wear era Re upon the left arm for 30 days.

The foregoing resolutions, passed unanimously, were directed to be published
in the city papers, and in the forthcoming number of the Southern Medical and
Surgical Journal.

PAUL F. EVE, Chairman.

METEOROLOGICAL OBSERVATIONS, for December, 1848, at Augusta,
Ga. Latitude 33 27' northLongitude 4 32' west Wash, Altitude above
tide, 52 feet.

i

Sun
Ther.

Rise,
Bar.

2,1

TER.

', M.
Bar.

Wind.

Remarks.

1

41

29 75-100

64

29 85-100

S. E.

Cloudy rain at 7^ p.m. 25-100.

2

46

" 71-100

58

" 82-100

N. W.

Fair.

3

32

30

60

30 4-100

8.

Fair.

4

39

" 6-100

63

" 6-100

S.

Cloudy,

5

44

" 10-100

74

10-100

S.

Fair.

6

47

' 6-100

74

30

S.

Fair some flying clorads.

7

GO

29 94-100

64

29 88-100

8.

Drizzly rain.

8

56

" 92-100

77

" 94-100

S.

Fair.

9

50

" 97-100

74

" 94-l0(y

s.

Fair some clouds.

10

63

82-100

76

73-100

s.

Cloudy rain at Sf.M. 10-100.

11

59

73-100,

67

" 68-100

w.

Cloudy.

12

50

" 69-100

54

" 70-100

E.

Cloudy rain, 80-100.

13

46

" 86-100

46

" 90-100

7*. W.

Cloudy.

14

43

" 91-100

46

'' 85-100

N. E.

Rain, 20-100.

15

48

" 73-100

67

" 77-100

N. W.

Fair after 12 M.

16

^54

" 82- 1 on

58

" 73-100

S.

Rain, 45-100.

17

60

" 83-100

66

" 85-100

w.

Cloudy sprinMe.

18

61

" 90-10

71

" 90-100

s, W.

Cloudy rain last night, 10-100.

19

64

" 95-100

79

98-100

s. w.

Fair blow.

20

54

30

77

30

g. W.

Fair breeze.

21

55

29 90-100

80

29 83-100

S. W.

Fafr breeze.

22

58

" 84-100

76

" 78-100

9. W.

Fair blow flying clouds.

23

54

30

58

30 8-100

E.

Cloxjcfy.

24

50

" 3-ion

58

29 98-100

S. E.

Cloudy sprinkle.

25, 57

29 87-100

73

" 82-100
30 18-100

S.

Cloudy rain afternoon, 5-100.

26 44

30 6-100

61

N. E.

Fai r some clouds breeze.

27 42

" 6-100

42

29 94-100

N.W.

Rainy.

28

38

29 96-100

61

' 94-100

E.

Cloudy,

29

50

" 66-100

52

" 48-100

N.W.

Rainy, 50-100.

30

46

" 56-100

58

" 77-100

N-

Fair, with flying cloudsv

31

40

30

57

30

N. E.

Cloudy.

Thermometer 70 at 10 o'clock, A. M.
12 Fair days. (Quantity of Rain 2 inches 45-100.
8 days. West of do, do. 12 days.

Wind East o-f N.aBd 3.

Hk

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. .] NEW SERIES MARCH, 1849. [No. 2.

PART FIRST,
rijinal (Hommunications.

ARTICLE VIII.

The past History and present Condition of the Science pf
Chemistry, By Alexander Means, M. D., Professor of
Chemistry and Pharmacy, in the Medical College of Georgia.

The investigation of no department of physics has, within the
last half century, been prosecuted with so much ardor, or con-
tributed so many important and astonishing results to the
general fund of human knowledge, or advanced so rapidly the
progress of civih'zation, as the science to whose history we
devote the present aiticle. Its grand discoveries have already
incalculably increased the stores of medical philosophy, and its
fruitful resources promise yet larger accessions for time to come.

A science, therefore, whose pervading laws and invaluable
disclosures seem to effect every co-ordinate branch of the pro-
fession, may well, in the present day, challenge the attention of
physicians; and a brief review of its past progress and present
condition, may not, it is hoped, be unacceptable to the medical
public. And yet it is a subject of sincere regret, that up to the
middle of the last century, the reliable resources within the
author's reach and upon which he is allowed to draw for his
historical details, are so extremely meagre and unsatisfactory.

The extent and value of the claims of Chemistry upon public
attention, were once either unknown or utterly misapprehended.
A few striking but mysterious phenomena in the natural world,
dependent upon agencies then entirely inexplicable, caught the

N. S. VOL. V. NO. iir. 9

130 Means, on Chemistry. [March,

public 63-6 and sprung the enquiries of many enthusiastic, but
aspiring minds.

In a speculative and superstitious age, when there were few
land-marks to science, and when vague conjecture supplied the
place of facts, it is not a matter of surprise that the chimerical
pretensions of Astrology and Alchymy should for a time reign
in the ascendant, and even claim the dignified appellation of
"Philosophy." Yet, to a student of the I9th century, it seems
passing strange that the extravagant dogmas of the one, should
have commanded public confidence for perhaps five thousand
years, while the technical jargon of the other was bandied from
the lips of the learned for at least eighteen hundred.

Chemistry, then, unlike most of the sister sciences, is traced
back to a period when its deluded and moon-struck cultivators
wasted their lives in cells and caverns, secluded from the sweets
of society and the light of heaven, in the prosecution of their
occult processes, in the vain and futile attempt to discover the
Grand Catholicon, which should heal all diseases, avert death,
and confer a terrestrial immortality: the Philosopher'* s Stone,
which should confer countless wealth, by enabling them to
transmute all the baser metals into gold or silver: and the
Alcahest, or universal menstruum, whose solvent powers were
supposed to be irresistible.

If we are to credit Suidas, a Greek lexicographer, who lived
in the latter part of the 9th century, "Chemistry {x^\^^^) is the
art of making gold." He also reports that many books written
upon this subject, existed in Egypt in the reign of the Emperor
Dioclesian, 284 years before the commencement of the Christian
era : and that such were the apprehensions of that monarch,
that the wealth to be procured by this mysterious act might
encourage a spirit of rebellion against the Roman power, that
he ordered them all to be collected and burnt. According to
the same ancient -authority, the famous Argonautic expedition,
so much celebrated in former ages by poets and historians, in
which Jason and his followers, 1263 B. C, by a hazardous and
eventful voyage through the Mgd^n Propontis and Eeuxine seas
from Greece to Colchis, effected the redemption of the Golden
Fleece, from the guilty monarch iEetes, is but an allegorical
representation of an enterprize, undertaken for the purpose of

1849.] Means, on Chemistry. 131

procuring a book bound in sheep skin, which taught the art of
making gold.

The alchymists, however, claim a high antiquity for the dis-
covery of their art, and refer its origin to Hermes Trismegis-
tius, who is regarded as identical with Canaan the grand-son of
Noah, through Ham, and who is fabled to have left the secrets
of the art engraven upon some Egyptian pillars. The earliest
accredited historian, however, Herodotus, who travelled exten-
sively through Egypt, Italy and all Greece, and who wrote 445
B. C, makes no allusion to such pillars.

Albertus Magnus, it is true, a learned writer, whose works
appeared about the commencement of the 13th century, says
that " the method of making the Philosopher's Stone was en-
graven by Hermes, upon an emerald tablet, which was buried in
his tomb, and taken up again by order of Alexander the Great,"
and the public were afterwards edified by a publication of this
hypothetical deposit in the Bihliotheca Chemica of Manget, an
eminent Geneva physician who flourished about 1675.

Without dwelling longer upon the vague and unsatisfactory
annals of this age of extravagance, or attempting more accu-
rately to define the period which gave origin to the dogmas of
Alchymy, they may be certainly pronounced to have obtained
universally by the 10th century, and for five or six hundred
years afterwards Chemistry may be regarded as identical with
this fabulous science, and its range of action confined to the art
of making the Philosopher's Stone.

Overawed by a solemn parade of learning and the imposing
mysteries of the art, it is not surprising that an ignorant and
credulous populace should soon attribute to the alembic and
crucible of the chemist, strange and transforming powers, ca-
pable not only of the wonderful metallic transmutation at first
proposed, but of producing remedies of specific and sovereign
virtues for the cure of all diseases and the removal of all in-
firmities, so that the sick bed should no longer hold its victim,
and even old age and decrepitude should undergo complete
rejuveniscence and flourish again in the perpetuated vigor of
youth.

Chemical medicines, prepared by unknown processes, began
at length to be pursued for public use. When this practice first

132 Iffeanis, on Chemistry. [March,

commenced, the records within our reach will not enable us to
say, or how many empirical panderers to the morbid palates of
the superstitious, might have spread their useless or their haz-
ardous nostrums, before talents and learning lent their aids to
these investigations, we know not. The first individual of
elevated character, however, who is known to have draughted
upon our science in the preparation of medicines, is Basil Val-
entine, a Benedictine Monk of the town of Erfurt in Germany,
who made his appearance, if we may determine from the con-
flicting reports of biographers, about the middle of the 15th
century. He seems to have been a man of original and inves-
tigating mind, and less infatuated by the alchymistical mum-
meries of the day than most of his contemporaries. To him
we are indebted for the discovery of Antimony, In strolling
abroad, on a certain occasion, he is said to have met wirh some
of the crude metal (the sulphuret,) which attracted his atten-
tion. In order to try its properties, he fed it to some swine,
which seemed rapidly to fatten under its administration. He
next covertly tried its action upon his "brethren of the cloister,"
to whom it proved, in every instance, fatal. Hence, its pre-
sent English appellation from 'Avti, (against) Movap^oc:, (a monk) ;
and ihe French, Antimoine,

The torturings of this article by acids, alkalis and fire, led to
an acquaintance with many of its properties, and hence the
origin of his famous work, Currus triumphalis antimonii,
Here allow us dic^ressively to remark, how different the esti-
mates placed upon the same articles of the materia medica in
different ages and by different physicians. Antimony furnish-
es a striking exemplification of this remark for it has at one
time been extolled by medical men ^as a panacea, and at ano-
ther decried as a poison." And in the 17th century, we are
assured that the French Parliament, led by the Faculty of
Paris, first proscribed and then restored both the antimonial
medicines and those who employed them.

About the close of the 15th century, a bold, erratic mind
arose from the literary canton of Zurich, in Switzerland, which,
for more than one hundred years, controlled popular opinion
upon the subject of medicine and surgery and their tributary
sciences. Born in the age of the Zuinglian reformation, and

1849.] Means, on Chemistry, 133

for 38 years contemporaneous with the great Swiss Reformer,
he was neither his inferior in intellect nor enterprise, although
he selected a different field in wh ch to display his prodigious
activity of character. The complex and pompous praenomen,
however, of the great Basle professor Aureolus Philippus
Theophrastus Bombastus de Hohenheim Paracelsus, differs not
more from the brevity of ordinary names, than his arrogant
pretensions and cumbrous formulae, from the modesty of merit
and the simplicity of truth. Characterized however by re-
markable shrewdness of observation, great egotism,.and strong
superstitions, and urged on b}^ a fervent temperament, a fear-
less spirit, and a towering ambition, he could not but make, by
the very force of his genius, a powerful impression upon the
age in which he lived. Vague and incoherent as were his own
views of the origin and cure of disease, he was unsparing in his
invectives and vulgar sarcasms against his Galenic contempo-
raries. His boasted recipes appear to have been mostly but a
ridiculous medley of inert and often disgusting articles, de-
pendent alone upon one or two medicinal agents for all their
therapeutical results. '* Dried toads, frogs, serpents, mummies,
scarabaei, the dung of pigeons, and of dogs, and even still more
disgusting preparations figure among the most efficacious of
his remedies," while opium and mercury, correctly employed
under the direction of his inventive talent and irrepressible zeal,
seem mainly to have won his professional reputation. Believ-
ing, though he did, with his great German predecessor, that
salt, sulphur, and mercury constituted the elements of all sub-
stances, he nevertheless cultivated chemistry and mineralogy
with commendable energy, and perhaps shows to more ad-
vantage in these departments of science, than in all the rest
embraced in his elaborate philosophical treatises. The works
of this fearless pioneer of medicine are to be found in the well
selected library of the Medical College of Georgia.

The Aristotelian Philosophy, which for more than three cen-
turies before the Christian era had controlled the opinions and
misguided the researches of the philosophic world, now had to
yield before the intellectual power and learned labors of the
immortal author of the Novum Organum, and Lord Bacon,
viscount of St. Albans, piquantly pronounced by Pope, as

131 Means, on Chemistry. [March,

"the wisest, brightest, meanest of mankind," has won the envia-
ble distinction of having aboUshed the false method of investi-
gating nature, which contented itself with first adopting favorite
postulates in science, and then gleaning pertinent facts to sup-
pprt them, either overlooking or rejecting, in the mean time,
all counter testimony, and by substituting in its stead the
inductive system the only true and safe mode of scientific
research, which marks patiently and impartially the character-
istics of physical phenomena, and then, from the uniformity of
observed results, determines upon the existence of general
laws. Mind, thus liberated from the thraldom of erroneous
opinions, began to interrogate Nature for facts upon which to
form correct theories. The old dogmas of Basil V^alentineand
Paracelsus, soon fell under the ban of t!ie Baconian Philosophy,
and Sir Robert Boyle, son of Richard Boyle, Earl of Cork,
about the year 1650, is believed to have been \\\q first original
experimenter in Chemistry, and the first to signify his dissent
from the doctrines of his predecessors. The valuable labors of
this great and pious man opened the way for other adventurers,
and, in connexion with those of Robert Ilooke, and Sir Isaac
Newton, about the year 1666, may be said to have given the
exterminating blow to the existence of Alchemy in the British
dominions.

The spirit of free inquiry soon resulted in invaluable contri-
bution to the experimental sciences, and among them, Chemistry
could not fail to secure a share of public attention. Chemical
medicines became in high repute, and physiology itself was de-
pendent upon the play of chemical affinities for the explanation
of all its functional phenomena. From the latter part of the
17th century, therefore, till the middle of the 18th, the Chemical
Physicians occupied their zenith of prosperity. In this cata-
logue must be ranked the learned scholar and active experi-
menter, John Baptist Van Helmont, born at Brussels, and for
eighteen years contemporaneous with Boyle. A sworn enemy
to the Galenists and Peripatetics, he devoted the energies of his
gifted mind to the correction or modification of the views of
Paracelsus, bringing to his aid the results of many valuable
chemical discoveries, and acquiring a reputation for his many
wonderful cures, which subjected him to an arraignment before

1849.] Means, on Chemistry . 135

the Inquisition upon- the charge of Magic. Honorably dis-
charged from this arrest, he retired to Holland to free himself
from the curse of such superstitious intolerance. Under his
prompt and powerful treatment, recovery or death were hasty
issues either the disease or the patient being obliged to yield
within two or three days.

It is to De le Boe Sylvius, however, a native of Hanau, in
Germany, and professor of medicine in Leyden, we are to look
for the first attempt to explain the laws of animal physiology
by the application of chtmical principles. This eloquent and
popular lecturer was elevated to the chair of the university of
which he constituted so distinguished an ornament, in the year
1658, where he attracted crowds of pupils to witness his demon-
strations of Harvey's discovery of the circulation of the blood
as well as to imbibe his chemical doctrines. It is true, that the
prevailing opinions of this great teacher were characterized by
many extravagancies and error, unsparingly challenged by sub-
sequent physiologists as downright absurdities, and yet it is
interesting to remark that his vague notions of the active agency
of acids and alkales in the human body, in the production of
hygienic or diseased action, have been rendered much less
chimerical, than they were once regarded, by the wonderful dis-
coveries of the 19th century. That galvanic currents are being
constantly generated throughout the animal organism and are
widely diffused through the whole of the muscular, cellular and
nervous structures dependent for their origin upon chemical
changes going on among the elements of the blood, by the pro-
cess of nutrition, the metamorphosis of the tissues, &c., has, by
the ablest experimentalists of the age, as Dumas, Lagaree,
Doune, Zantideshi, Matteucci, and others, been satisfactorily
demonstrated, and that the irregularity, diminution, or excess of
these chemico-electric currents, is profoundly concerned in the
production of many pathological conditions of the human body,
we think equally clear. Again, the prevalent condition of the
secretion of the human stomach is acid, and that of the liver
known to be alkaline, and by a beautiful and ingenious ar-
rangement of the Professor of Pisa, consisting of a simple wire
with terminal plates, these two important organs were thrown
into the line of a galvanic circle, and a current instantly detect-

136 Means, on Chemistry, [March,

ed which deflected a cralvanometer 20. The celebrated Liebig
has more recently still, furnished further evidence of structural
arrangement for chemical reaction, productive of electro- vital
currents. He has found that the complicated cylindrical cells
of the muscular texture, detected by the microscopic observa-
tions of Raspail and others, are saturated with a fluid containing
free lactic acid and some "tribasic phosphate of soda, with ex-
cess of acid," which by interstitial communication and chemical
reaction with the alkaline elements of the blood, serum, chyle
and lymph, every where diffused through their mass, must
necessarily generate galvanic currents. While, therefore, the
lights of science have exposed the incongruous absurdities which
marked the pathology of Sylvius, and his chemical cotempora-
ries, still some physiological agencies which he seems but dimly
to have discovered, have since been more distinctly traced and
recognized.

How true is it that bold and original minds leap to grand and
important conclusions from deductions drawn from a few lead-
ing facts, the relationships and ultimate bearings of which the
dull plodding powers of ordinary minds cannot perceive or
comprehend, and therefore, reject. And it is not until a host
of correlative and sustaining facts has accumulated in the slow
progress of ages, that the philosophic world is forced back upon
the great truth, which genius in advance of its age, had long
before announced. Such was the fate of the grand astronomi-
cal system first discovered by the intellectual acumen and
profound learning of the great Prussian Astronomer, who, after
twenty years intense labor, was constrained to renounce the
deferents, cycles and epicycles of the prevalent Pythagorean
Philosophy, and recognized the doctrin.e of planetary revolu-
tions around a solar centre. -And yet, alas! from the ignor-
ance of the age, the simple and correct views of Copernicus,
were destined to be rejected and superseded by the errors
of Tycho Brahe, which reigned for 160 years, until the illustri-
ous Newton again reinstated the authority of truth, and the
enlightened world now every where submits to its claims.

About this period, also, the reveries of the Mathematical
Physician had reached their acme of notoriety, and the advo-
cates of this crude theory attempted to sustain their views in

1849.] Means, on Chemistry. 137

opposition to those of the chemical school until about the year
1725, when both the contending sects seem to have sank into
merited neglect, and arrested popular attention no longer.
Chemistry, however, which had contributed too much to the list
of the materia medica not to be regarded as a valuable adjunct
to the medical profession, was nevertheless not understood in
its loftiest pretensions, but by popular consent was degraded to
the offices of mere pharmacy and regarded as synonymous with
it. For more than fifteen years, (viz. from 1730 to 1746,) even
in Great Britain, the chemist was limited in the application of
his art solely to the articles of the pharmacopoeia. Here, how-
ever, a brighter light begins to dawn upon the hemisphere of
science. A powerful mind, radiant with genius and glowing
with thought, appears upon the horizon, ('aledonia may well
boast of her distinsruished son, and enrol upon the same scroll
with her Hunters, her Monros and Leslies the name of
William Cullen, while her two celebrated universities will
long cherish the recollection of .his eloquent lectures, and for
successive ages continue to feel the effects of the stirring im-
pulse which he gave to the subject of Philosophical Chemistry
throughout the British isles.

His early predilections for this science, which he cultivated
with such enviable success while a public lecturer in Glasgow,
were, in 1751, abandoned for that of medicine, to which he was
probably influenced by the appointment, under the crown, of
King's Professor of Medicine, and to which his lofty powers
and varied attainments admirably fitted him.

He left not this interesting field, however, until he had exci-
ted a spirit of liberal enquiry in the philosophic mind. With
almost prophetic vision he looked forward to the future tri-
umphs of Chemistry predicted its glorious career, and pro-
claimed and eflected its enfranchisement from the Lilliputian
domain to which pharmaceutists had confined it. In the midst
of the crowded classes who hung, delighted, upon his lips, and
gathered wisdom from his "thoughts that breathed and words
that burned," was one mind of kindred stamp to his own. His
lectures formed the taste and fired the genius of Joseph Black,
who was born of English parentage, at Bordeaux, in France,
but educated at Belfast and Glasgow, where he took the degree

M8 Means, on Chemistry. [March,

of M. D. in 1754. This memorable philosopher was destined
to become the successor of Dr. Cullen in both universities. Dr.
Black seems to have been characterized by quick perceptions,
patient industry, and fine powers of analysis, and to have de-
voted himself with untiring assiduity to chemical pursuits, a
strong predilection for which induced him to resign the profes-
sorship of Anatomy in the Glasgow University to which his
superior abilities had at an early age elevated him.

To the science and penetration of this great man, we trace
the origin of Pneumatic Chemistry. Until the age of the
illustrious Florentine philosopher, the existence of any material
body in the universe, of less specific gravity than sulphuric
ether, was not even suspected. The learned and sagacious
Galileo, however, detected and proved the gravity of the atmos-
phere, which was afterwards more fully demonstrated by Tor-
ricelli and Paschal. Still Nature preserved the secrets of her
world of gases for more than one hundred years longer, and no
other aeriform body was known, until a gleeful group of idle
children, surrounding a brewer's vat, and ever and anon extin-
guishing their little straw tapers in the bursting bubbles which
escaped from the fermenting mass, caught the quick eye of the
Glasgow professor as he strolled along the street. By ordinary
minds this little incident would have passed, as it had done per-
haps for centuries before, either entirely unobserved or without
exciting a moment's reflection. Not so with Dr. Black. With
him, Thought was ever enthroned and Observation on the look-
out to detect and solve the interesting phenomena of the natural
world. His examination, in this instance, made in. the year
1757, resulted in the discovery oi Carbonic acid gas, called by
him, in his inaugural dissertation, Fixed Air, and which he ascer-
tained was combined with common limestone and magnesia,
and evolvable from these bases by the application of heat and
acids. He found that it was also liberated in the process of
respiration and fermentation, and constituted one of the products
of combustion. His discovery of the doctrine oi Latent Heat
also, was not among the least of his contributions to chemical
science. Following in the wake of their distinguished leader,
the two celebrated pupils of Dr. Black, viz., Drs. Irvine and
Crawford, prosecuted with ardor and success the examination

1849.] Means, on Chemistry. 139

of the laws of caloric, as operatinir both in the animate and
inanimate universe. The well-known theory of animal heat,
as taught by the latter, at one time largely commanded the
confidence of the scientific world. Dr. C. supposed that the
carbonic acid gas thrown off in the breath, was generated in
the lungs by the union of the oxygen of the air with the carbon
of the blood, and that the combination was attended with the
disengagement of heat: that tfie capacity o{ arterial, compa-
red with venous blood, was as 1030 to 892, leaving the difier-
cnce between the two (138) to be given out as sensible heat
along thj track of the sanguiferous circuhition. Physiological
facts, however, under the eye of such able experimenters as
Davy and Williams, Leibeg, Matteucci and others, have long
since disproved the correctness of these views, and authorized
the adoption of others, less embarrassed with difficulties and
based u})on a more luminous exhibition of organic laws.

After the discovery of Carbonic Acid, pneumatic chemistry
made rapid advances. In 1766, Hon. Henry Cavendish of
England an able chemist, mathematician, and astronomer
discovered the great levity and inflammability of Hydrogen
gas. In 1772, Nitrogen was added to the list of gases by Dr.
Daniel Rutherford, a physician and philosopher of Edinburgh,
and afterwards professor of Botany and keeper of the botanic
garden.

The existence and properties of Oxygen, the most important,
perhaps, of all the gases, were discovered by Dr. Joseph Priestly
a dissenting English Divine, of great literary attainments,
whose contributions to electricity, optics and other departments
of chemical science, have been highly valuable. Unfortunately
for Dr, Priestly, the brightness of his philosophical reputation
has been largely shaded by the heterodoxy of his theological
views, and the boldness and heat with which they were pressed
upon popular attention. After the destruction of his house,
manuscripts, library and apparatus, by the violence of an infu-
riated mob, he determined to seek a more quiet retreat in
America, to which he removed in 1794. Here his Socinian
views were openly and controversially maintained with warmth
and pertinacity. He died in 1804, but not until he had witness-
ed the entire explosion oi the Stahlian theory of Phlogiston,

140 Mayes, ov Malainal Fevers. [Ma"ch,

to the defence and propagation of which, his great talents had
been long enthusiastically committed. This dogma of Becker
and Stahl, which lay like an incubus upon the progress of
chemical research for more than fifty years, required not only
the demonstrations of science, but the force of genius and the
reiteration of truth, for ten long years before the philosophic
mind could be disenthralled from its paralyzing spell. It was
reserved for the able and indefatigable Lavoiser to achieve
this victory in science and to open the way for a free and satis-
factory explanation of the phenomena of combustion and other
chemical changes. .^, i ^

(to be COWTIKUED.) ]t<M|^

ARTICLE IX.

Remarks on the true value of Mercury in the Treatment of
Malarial Fevers. By J. A. Mayes, M. D., of So. Carolina.

Innovations upon established doctrines and theories in Medi-
cine, are necessarily received with extreme caution ; and, this
is more particularly the case, when, the theories attacked have
been regarded as true and indisputable, for a length of time,
sufficient to throw the weight of antiquity in their favour. The
difficulties of a successful innovation also increase in magni-
tude, if the partizans of the former theories, claim a share of
success equal to those of the latter. It is very plain, then, that
numerical tables setting forth equality of success under both
systems, cannot be made use of by either party, as an argument
in favor of their respective theories. Other considerations
must be thrown into the scale; and as the only considerations,
which could affect the relative value of two distinct theories,
claiming equal success, must refer principally to time and
to ultimate consequences^ the argument must be confined to
those topics entirely ; and, therefore, it behooves the party who
attempts the innovation, to show that all the advantages which
could be gained by those circumstances, are on the side of the
Practice proposed as a substitute for the old.

The profession have long been taught to look upon mercury
as the most certain means of cure, for fevers of malarial origin ;

1848] Mayes, on Malarial Fevers. 141

and, previous to the discovery of Quinine in 1820, there was
no reason to doubt the correctness of the Practice; as the pro-
fession had no other remedy at their command, upon which
they could phice reliance in the treatment of the then formida-
ble Remittent fevers. They had, it is true, the Peruvian bark,
from which the Quinine is prepared, but reason and experience
both teach us, that the bark, if substance, could never be safely
administered in those conditions of the disease, in which the
Quinine is found to exert its most salutary influences. They
had, then, no other resource but mercury, and if in the free use
of this mineral, mischief was sometimes done, no blame can be
attached to them ; their motto was, that it was better to live
with the general health impaired, than to die; a motto, to which,
all of the present day subscribe.

These cogent reasons, which once existed for the free use of
mercury in Malarial fevers, have been set aside by recent dis-
coveries, and we are now in possession of remedies, the use of
which, is followed by speedy convalescence and little risk of
permanent injury to the general health. But, as this is not ad-
mitted by all, it becomes us to enter more minutely into the
consideration of the subject.

The pathology of Malarial fevers, must necessarily receive
but little notice here. Sufficient for our present purpose will
it be, to refer to the able articles of Prof. Ford, in the Southern
Medical and Surgical Journal, for an exposition of the subject,
and to the article of Prof Dugas, in the same, on the application
of Quinine to the treatment of Remittent fever.

The efficacy of the treatment, recommended by both these
writers, has never been disputed, so far as it relates to the jugu-
lation of the disease : their opponents admitting that their course
of Practice will certainly arrest the fever very suddenly, but
assert that it does not so completely eradicate the disease as
that recommended by the standard authorities on the subject.
This objection must certainly arise from an oversight, as Dr.
Ford expressly declares "if, after the subduction of the fever
(by Quinine) there remains the evidence of disease in the liver
or stomach or bowels, then, this may be corrected by appro-
priate remedies, more readily, more safely and efTectually than
during the fever." To make good the objection, therefore, it

fS IVfayes, on Malarial Fevers. [March,

will devolve upon their opponents to show, that the administra-
tion of mercury after the subduction of the fever, is not attend-
ed with favorable results, or that the absence of fever is not a
favorable condition for its employment.

As all admit the powers of Quinine in arresting very sudden-
, \y the paroxysms of fever, if would be useless to bring up an
array of evidence bearing upon that point. That the sudden
stop|>age of the fever must not be considered as the evidence of
cure is a point upon which we would lay some stress. With-
out appropriate after treatment, relapses are very apt to occur;
and in consequence of the neglecting of this important matter
by the patients themselves, who generally feel too well to he
taking medicine^ the principal value of the treatment is lost, and
the system of practice unjustly censured as defective; which
defect, if critically examined, will be found to consist in the
proscription of all exhausting and debilitating remedies, leaving
the patient so little weakened, that, without the exercise of
considerable authority by the practitioner, the patient is left
uncnred, though apparently cured.

The intention of the mercurial treatment was the same as
that for which many now prescribe the Quinine, viz., the sub-
duction of the fever. The time necessary for this, was, in the
most favourable cases, about ten days, but it frequently did not
arrest the fever in that time, and the final termination of the
case was always uncertain. The principal object of the prac-
titioner being, in most cases, the production of salivation as soon
as possible, the convalescence was necessarily tedious; if not
from the salivation itself, certainly so in consequence of the
debilitating nature of the treatment, of which, mercury was
always the leading article.

The ultimate consequences of this treatment are worthy of
our most serious consideration. Mercury is not an innocent
medicine, but

"a mortal mineral; which, being took,
Should by the minute feed on life, and, ling'ring,
By inches waste you."

Slowly and surely undermining the powers of life, it converts
the robust man into an invalid fur life, and in the tender years
of infancy lays the foundation of permanent ill health, insuring
premature old age, and imbecility of mind.

1849.] Mayes, on Malarial Fevers. 143

That an impairment of the vital powers, to a greatet* or less
degree, is the usual consequence of a decided mercurial impres-
sion, is evident from the following considerations : The vital
powers resist the encroachments of all agents that are, in them-
selves, calculated to lessen the duration of life ; in other words,
there is a vis-conservatrix, an instinct which prompts to the
expulsion .of all substances, thart are not subservient to the pur-
poses of nutrition ; and, as medicines do not, in any direct
manner, subserve those purposes, their administration is always
followed by the increased activity of some organ in procuring
their elimination. Thus, taking advantage of this fact, we ad-
minister medicines in different diseases, with a view to their in-
creasing the action of some particular organ, and, in this indi-
rect manner, do they answer useful purposes in the treatment
of diseases ; there being none, or few, which act specifically.
The prolonged excitement of any organ results in a state of
actual debility; just as much so, as long continued and excessive
manual labour would debilitate the system generally. A familiar
illustration of this may be found in Dyspepsia, brought on by
overloading the stomach ; the organ, at last, becoming torpid,
and requiring the most active stimulation to arouse it ; which
stimulation, in the end, results in a form of the disease more un-
manageable than the first. The vital powers will resist suc-
cessfully the encroachments of medicinal substances for a while,
as one or two cathartic doses does not materially injure the
tone of the bowels, neither will one or two days use of diuretics
injure that of the kidneys. Frequent repetition of these sub-
stances, will, however, bring on a condition of those organs,
which will demand their further use; and is not this condition
an evidence that they are debilitated ?

In the same manner, one or two doses of mercury will do
little or no harm; the vital powers will, however, yield to its
prolonged use, and as the remedy is one which is believed to
exert its action in stimulating the glandular system generally,
the consequence of that prolonged stimulation, must be an im-
pairment of their functional activity to a greater or less degree.
Whatever conclusions we reach concerning the ultimate results
of the prolonged use of any class of medicines, we are bound to
admit the correctness of them when applied to other classes-.

AV inIS^

ayes, on Malarial Fevers. [March,

bearing in mind, at the same time, the specific diflferences in
their modus operandi.

We are perfectly familiar with the fact, that a person, once
subjected to the mercurial influence, is very readily affected by
it afterwards, although it may have been a very difficult mat-
ter to produce the constitutional impression at first. With
every salivation after the first, we find our patients more suscept-
ible of its impression ; and the remark is constantly made, and
with much truth, that a person after being salivated, suffers
much more readily from the vicissitudes of atmospheric tem-
perature. As the action of mercury is spent upon the system
generally, whilst most other medicines are confined in their
action to single organs, w^e arrive at the conclusion, that it will
impair the general health more than other medicines. Quinine,
and the narcotics" generally, are not confined in their action to
single organs, but affect the whole nervous system ; what pre-
cise amount of injury they are capable of doing cannot be
ascertained ; but their action, if long continued, would certainly
result in disastrous consequences. The specific action of Qui-
nine cannot be continued many days with safety, but this is
never necessary, except in extreme cases ; all the assistance it
is capable of rendering, being obtained in one or two days vig-
orous employment. If this was the case with mercury, one of
the principal objections to it would fall to the ground ; but
experience teaches u^, that many days use of the mineral are
requisite to procure the desired effect, i. e., the subduction of
the fever; and, as with the subduction of the fever its consti-
tutional impression becomes apparent in most cases, we come
to the point which constitutes the essential difference between
mercury and Quinine, as remedies for fever; the one arresting
the fever with only a slight perturbation of the nervous system,
the other with a derangement of the general system, which, by
the confession of all, often becomes permanent.

But the intention of employing mercury was not alone to
subdue the fever. If that were the sole object, the argument
might now be closed, as all are prepared to admit that the fever
may be arrested in a much shorter space of time by Quinine.
The advocates of mercury contend that its use is necessary for
the correction of the vitiated secretions, particularly that of the

1849.] Mayes, on Malarial Fevers. , 145

liver ; and here we make issue with them again, not denying the
powers of mercury in modifying the hepatic secretion, but
maintaining that this control over the secreting system can only
be acquired during the existence of the fever, at the risk of
permanent injury to the general health. To establish our point,
we only deem it necessary to refer once more to the writings
of Professors Ford and Dugas, where it has already been ably
discussed, and the position rendered impregnable, that the
vitiated state of the hepatic secretion, is the result of the fever
and not the cause of it. The course of treatment, then, dictated
by a prudent regard for the welfare of our patients, would cer-
tainly consist in the employment of those means which would
arrest the fever in the shortest space of time ; and we would
also be morally bound to reject all remedies which would not
contribute directly to that result. If this can be accomplished
immediately by any known remedy, we should prescribe it, and
await its effect, before we turn our attention to those disorders
of the general system, which have been induced by the fever ;
the treatment of which would, then, be attended with no diffi-
culty.

If merdurials are useless during the existence of the fever,
the same cannot be maintained successfully with respect to the
after treatment. Nothing is more usual after the subsidence of
fever, to find the patient with a dry, coated tongue ; bitter, dis-
agreeable taste ; bowels costive ; urine highly tinged with
bilious matter; whites of the eyes/ and the skin generally,,
tinged with a yellowish hue. Again, we often find want of
appetite; indisposition to the least exercise ; much thirst, par-
ticularly at night ; restlessness at night ; rather quick pulse ;
blisters on the lips, and much depression of spirits. Also, in
the cases of children, irregular appetite and a disposition to
dropsical effusions. For the relief of these symptoms, we have
no more effectual remedy thnn mercury; the best preparntion
of which is the blue pill. The remedy being used at this stnge,
the practitioner runs no risk of giving too much ; and conse-
quently, the patient will enjoy all the advantages which cou'd
be derived from mercury, without the chnnces of hnvins: his
general health impaired by a salivation, either accidental or
designed.

N. s. VOL. v. NO. ur. 10

! i
I I
ill

li

VI

146

Eve, case of Lithotomy.

[March,

That the mercury will "improve the secretions" as cer-
tainly at this period of the treatment, as before, is a proposition,
which, we presume, will never be gravely disputed, as all are
^agreed upon the principle that an excited state of the circulato-
ry system, is an unfavourable state for medicines to take their
proper effect ; and consequently, in the absence of the fever,
mercury will display better effects than during the paroxysms,
without the danger of being accumulated.

In conclusion, the writer would say, that the subject dis-
cussed in the foregoing pages, is one of much practical import-
ance : that he feels his inability to present the argument in such
a manner as would command attention; and that he hopes
some one of the South, more gifted than himself, would success-
fully accomplish that which he has humbly essayed to com-
mence.

ARTICLE X.

Lithotomy 117 Calculi, weighing A\ ounces, successfully re-
moved. By Paul F. Eve, M. D., Professor of Surgery in the
Medical College of Georgia.

A brief notice of the following case, against the writer's ex-
pressed wish, was made in one of our newspapers. It is propo-
sed to record it now, where, if it possesses sufficient interest, it
legitimately belongs.

In the severe September gale of 1824, Mr. O'Bannon, then a
lad of 18 years, was engaged at work upon a house, which was
blown down. In the fall, he was struck upon the back by a
piece of timber, and from the injury then received he dates his
difficulty in urinating. During the twenty-four years he has
been a sufferer, Mr. O'B. has fully tested the prescriptions of
the unprofessional of several States, and he has travelled far
and near in search of relief He even became a sailor on the
ocean ; but all to no purpose, his disease continued to harrass
him day and night.

For the past two years his difficulty to urinate became so
rreat, that to discharge it at all, he had to assume the horizontal

1849.1 Eve, case of LithoLomy. ^ 147

position, and then with the fingers introduced into the rectum,
he pushed up the bladder. A large quantity of matter, he says,
is also evacuated by the penis. When \)Q sits upon the edge of
a chair he experiences a sensation as of crushing (crepitation)
a ball of snow in the perineum.

In December he entered the charitable Institution under our
Faculty, and a catheter was for the first time attempted to be
introduced. This came at once in contact with a calculous
mass in the perineum, where a tumor was found, projecting to
the right of the raphe running back fiom the scrotum.

Operation. On the 6th of last month (January) the follow-
ing operation was performed in the presence of the Medical
Class of our College Chloroform was administered by Dr.
Means. After the patient was placed in the usual position for
lithotomy, an incision, about three inches in length, was made
over the tumor situated in the perineum, as for the lateral oper-
ation, except that it was upon the right instead of the left side.
About 56 calculi were removed through this opening, and it
was hoped the operation was completed; but upon introducing
a female catheter through the wound into the bladder, a second
collection of stones was readily detected in this receptacle. A
grooved sound was now passed through the urethra and the
double lithotome conducted by it into the bladder ; the former
was withdrawn and the bi-lateral section completed, by draw-
ing the latter instrument out somewhat in the line of the external
incision made in the skin. With the lithotomy forceps repeat-
edly introduced, by conducting it upon the finger, 61 stones
were extracted from the bladder. Through the opening in
the perineum a quantity of pus was discharged. During
the operation, the rectum protruded in a large mass so as to
interfere with lowering the handle of the forceps, to seize the
calculi in the bladder. The patient also had violent and invol-
untary contractions of the abdominal muscles, and during the
latter stage of the operation the chloroform was discontinued.
It lasted one hour. He was so reduced by his long sufiering, a
period of twenty-four years and four months, that after the
operation I took him like a child in my arms and carried him
up a Alight of stairs to his room.

The following is the analysis of the calculus, kindly made by
Professor Means, and addressed to me :

l4'8 . Eve, case of Lithotomy. [March

" The urinary calculus, taken from the bladder of Mr. O'Ban-
non, has been subjected, at your request, to a chemical analysis,
and merits at my hands the following description, viz :

External form. The particular calculus under considera-
tion, is but a fair specimen, both in its physical properties and
chemical constituents, to every other of the entire number re-
moved from the perineum and cystic cavity of your recent
patient, and which, by your courtesy, I was privileged to exam-
ine, both during, and after the extraordinary operation. Being
a solid, bounded by four oblique planes, it presents the tetrahedral
shape distinctly: its solid angles and lateral edges, instead of
being legularly truncated, and replaced by tangent planes, ex-
hibit gently rounded surfaces, which gradually blend with the
respective faces, and are evidently the result of constant attri-
tion, kept up for many years.

Physical characteristics. The exterior furnishes a beauti-
fully smooth, and even polished surface. The structure is
laminated with admirable parallelism the respective tunics
conforming to the external figure of the stone, and easily sepa-
rable by the nail ih^ fracture, uneven, and ihe powder, harsh
and gravelly under the touch.

The predominant color is a greyish white, which is frequently
substituted, however, in the more deeply seated laminae, by a
pale-brown tint. Its specific gravity, \s 1.02.

Chemical constititents. I had anticipated the uric acid cal-
culus, but the use of the blow-pipe flame, and the application of
appropriate acid and alkaline tests, soon revealed the presence
of Phosphate of Lime, almost pure. This form of urinary con-
cretion has been pronounced by Silliman, Gardner and others,
as very rare. It is peculiar, however, to the prostate gland, in
the neighborhood of which the calculi, in your recent operation,
were found to be en-rbedded, and which probably controlled the
chemical affinities that subsequently deposited so large a mass
in the fundus of the bladder. Its chemical elements are 3 atoms
of Phosphoric Acid, 8 of Lime, and 1 of basic water, as ex-
pressed in the following formula: 8 CaO, HO-I-SPO^.

The Fusible Calculus (Phosphate of Ammonia and Magne-
sia) has, in one or two instances, reported in the Philosophical
Transactions, for 1809, been found in such quantity as nearly
to fill the cavity of the bladder, but so large a mass of Bone-
earth calculi, is surely a still more rare occurrence.

The whole number extracted was 117, of which the largest
weighed 3 ij. and 38 fjrs. ; the two next in size, each 78 grs,, and
the smallest 1 gr. furnishing an aggregate weight of 5 ivss."

As usual with me, no dressing was applied to the wound, but
the patient was -requested to keep his knees together and to

1849.] Yi\Q, case of Lithotomy, 149

remain perfecily quiet. lie took 40 drops of laodanum the
night after the operation, and his diet was restricted to cold
lemonade flaxseed tea. He also omitted the medicines upon
which he had been placed, viz., Peruvian bark and sulph. iron,
with volatile alkali occasionally.

January 7th. Had passed a pretty good night. Some urine
had even been already voided by the natural passage, notwith-
standing the opening in the perineum. He has bathed himself
in warm water ; has now no fever, is quite cheerful, smokes his
pipe, and has taken some soup, table tea, and an orange.

Jan. 8th. Is doing well. Has had a good night the best, he
says, for years past. Uses a bed-pan to prevent soiling the
clothes. Has sat up a little by the fire.

He has continued gradually to improve, notwithstanding the
unfavorable state of the weather. No other application to the
wound than castile soap and warm water, several times daily.

On the 10th, four days after the operation, he changed his
room. He experienced the next day some uneasiness in urina-
ting, and had for a day or two slight diarrhoea.

On the 17th, the eleventh day since the operation, he was out
in the yard walking about. By pressing the edges of the wound
together he could now pass nearly all the urine through the
urethra.

On the 24th of January, i. e., the 18th day after he was dis-
embarrassed of his numerous calculi, Mr. O'Bannon returned
home, a distance of 22 miles. The wound had nearly healed.
He is to use, as a tonic, small doses of sulphs. quinine and iron.

A month after the operation, a special messenger reports
him entirely well-
In noticing the peculiarities of this case, we remark 1st, the
cause an injury to the spinal column, probably by partial
paralysis of the bladder favoring a pervertion of the function
of this organ.

2d. The nature of the calculus phosp^hate of lime or bone-
earth. This is, I believe, peculiar to disease of the bladder
itself. Any calculus may have a coating of phosphate of lime,
but when composed throughout of this combination, the evi-
dence is strong, if not conclusive, that it originated in the
bladder. -' if^'' "

150 Asiatic Cholera in New Orleans. [March,

3d. The long existence of the disease without its character
being detected.

4th. Tlie size and shape of the calculi. They appeared both
in the perineum and bladder to have been regularly impacted,
one against the other. Occasionally two, but generally one
only was seized by the forceps in their extraction.

5th. The membranous portion of the urethra preserved its
integrity, while the bulbous was ruptured by the stones. The
two deposites, the one in the perineum and the other in the
bladder, were about two inches apart.

6th. The calculi must have all had a common origin there
being no difference in their shape, color or composition. Those
in the bladder were, however, a little larger than those taken
from the perineum. I agree with Prof. Means in the opinion,
that they probably originated in the prostate gland, observing
the laws of crystalization in their subsequent aggrandizement
in the bladder and perineum.

7th. The remarkable fact that Mr. O'Bannon preserved his
virile powers. His wife has borne several children, and is now
actually seven months pregnant.

8th, The speedy recovery, in certainly, what must be con-
sidered, quite unfavorable circumstances.

PART II.
Eex)utD0 anir S-ttracts.

The Asiatic Cholera in New Orleans.

We take the following from the Picayune, published in ad-
vance of the Medical Journal, the January No. of which has
not yet reached us it is from the pen of one of the original
founders of this Medical Periodical the Ne\v Orleans Medical
and Surgical Journal.

To the Editor of the New Orleans Med. and Surg. Journal :

Dear Sir According to your request, I shall offer you some
brief memoranda of the epidemic cholera which has recently
scourged our city. We have passed through a long-dreaded
and most dangerous crisis ; and now that "the action" is over,

1849.] Asiatic Cholera in New Orleans. 151

and the dust and smoke of the "battle-field" (if you will allow
the metaphor) are cleared away, it is both meet and proper for
us to review the scene, take account of the "killed and wound-
ed," and endeavor to learn from the result some lesson of wis-
dom and usefulness. Nor do 1 deem my military metaphor
altogether inappropriate to the present time. True, our city
is shrouded in mourning and sadness, yet many have escaped
the peril of death ; and as we have recently commemorated our
r.lmost miraculous deliverance from from the arms of the inva-
der in days of yore, let us not be unmindful or ungrateful for
our recent deliverance from an impending danger scarcely less
terrific. We have encountered an unseen and dreadful foe
one whose progress was marked by the victims strewn along
his course. Yet even his ravages were not unmixed with
mercy. Here and there a victim was overwhelmed,*" as by
an avalanche, and there was no help for him ; but for the most
part, fair and timely warning was given, and those who attend-
ed to the dictates of wisdom and prudence found but little diffi-
culty in escaping the impending danger. Amidst the general
alarm and distress that pervaded the community, the duties and
responsibilities which devolved upon the respectable portion of
the medical profession were of the most serious and important
nature : they were met and performed with a firmness and
fidelity worthy of a passing notice. Without regarding the
unjust and illiberal imputations that were cast upon the profes-
sion, it is not to be denied that the physicians of New Orleans
have boldly stood their ground, shared the common danger and
done all in their power, as well to instruct their fellow-citizens
how to keep well as to rescue them when ill. What better evi-
dence need I adduce to substantiate this assertion, than the fact
that although nearly every body felt more or less the epidemic
influence, there were comparatively but few bad cases and very
few deaths amongst the better classes of people such as usual-
ly apply to respectable and educated physicians for medical
aid? The reason is obvious : these people applied for medical
aid in good season they obtained the best advice and remedies,
and were promptly cured ; whilst others were either deluded
into false security, by relying upon some worthless but well-
puffed nostrum, or through ignorance and temerity neglected
all remedies until the disease had advanced beyond the curable
stage. This was the penalty of ignorance and folly and a
severe one, too. Without farther preliminaries, let us note
some of the more prominent facts connected with the rise, pro-
gress and results of the epidemic.

The commencement of the late epidemic may be dated from
the 11th of December, when the ship "Swanton" arrived at

162 Asiatic Cholera in New Orleans. [March,

this port, thirty-nine days from Havre, with 280 steerage pas-
sengers, consisting of German and French immiorants chiefly
German. Now, whether it be a mere coincidence that epidemic
cholera broke out in this city just at the time when a vessel
arrived having some cases of cholera on board, or that said
vessel brought the infection, which rapidly spread through the
whole community, is an exceedingly debatable question. But
let me go on with a statement of such facts and circumstances
as I have, before I attempt to debate it. The whole subject is
replete w'th interest. Every thing connected with it is new to
me, and I will endeavor to make the most rational induction in
my power, h-sviug no preconceived theory to substantiate.

For several weeks previous to the arrival of the ''Swanton"
the weather had been changeable' for the most part very warm,
though' th^re had been several white frosts. Yellow fever had
almost disappeared, and there was but little sickness prevail-
ing; though amongst the existing diseases were observed some
remarkable cases of stomach and bowel complaints. On the
5th of December I attended a gentleman on Customhouse-street,
who labored under vomiting, pain and spasms in the bowels,
and prostration to such a degree that, if epidemic cholera had
been supposed to be here, no person would have hesitated to
pronounce him a case. He had no rice water evacuations, but
his bowels were rather costive, and he vomited bile; butnjany
such cases have been seen since the epidemic was declared.
He recovered after two or three days' illness, and has not been
again sick.

Some days previous to this, three or four negroes were at-
tacked with cholera morbus on the same night and at the same
house, in Gravier-street. They were promptly treated, and all
soon recovered. Similar cases were observed in the practice
of a number of physicians in diflferent parts of the city, all going
to show, as it appears to me. that the epidemic influence of cho-
lera was gradually being matured and developed in our midst.

I have recently learned some other facts, which are worthy
of notice in connection with the commencement of this epidem-
ic. The ship ^'Guttenburg," from Hamburg, with some 250
steerage passengers, after a passage of fifty-five days, arrived at
New Orleans on the 6th of December. Cholera was prevailing
at Hamburg when this ship left, and six or seven deaths from it
occurred on board before she got out of the Elbe. As soon as
the vessel got out to sea, the disease subsided completely, and
no more cases occurred during the whole voyage. As there
were no cases of cholera on board when she arrived here, it
attracted no attention, although she came from an infected port;
but I am informed by one of the visiting physicians of the

1849.] ' Asiatic Cholera in New Orleans. 1-68

Charity Hospital, that soon after the ep'demic broke out here,
a man died in one of his wards, who stated that he had recently
arrived from Germany on board a vessel which had lost several
passengers by cholera. What became of the other passengers
of the "Guttenburg" I know not.

In addition to this I should not omit the following fact, ob-
tained from the records of the Mayor's office and the newspa-
pers of the day, viz: The bark "Callao," fi-om Bremen, having
152 German emigrants on board, after a passage of forty-eight
days, arrived at New Orleans on the 8th of December, was
anchored off Slaughter House Point, on the opposite side of the
river. The Secretary of the Board of Health was sent to
examine her on the 11th of December, and reported that:
** During the voyage eighteen of the immigrants died, some of
whom died wlih pur gin s[ and vomiting, and others with violent
attacks of diarrhoea. The last death occurred on the 30th of
JMovember. At present no cases of sickness on hoard, and those
who left the vessel since its arrival are well. N. B. It is re-
ported in the log-book that the first case that died perished from
cholera. This is merely the opinion of those on board, and is
not entitled to much weight."

The Callao remained over on the opposite side of the river
until about the 4th of January, when she was brought over on
this side to be loaded.

The ship S wanton left Havre on the 2d or 3d of November.
There was no cholera at Havre when she left, nor have we heard
of any since. There was none in any part of France, but the
epidemic had reached Germany, and some of the passengers on
board the Swanton were German emigrants. Whether they
came from an infected district or not, we are not informed.
The vessel was out twenty-six days before a death occurred,
the first being from consumption on the 28th November. We
learn that sixteen or seventeen deaths occurred during the pas-
sage, most of them from bowel complaints, supposed to be
dysentery. The Swanton reached New Orleans on the 11th
of December, and took position at the wharf in the upper part
of the Second Municipality. On the morning of the 12th a
woman was carried from the ship to the Charity Hospital, and
found to be in a complete state of collapse. She was reported
to have been attacked the night previous with violent vomit-
ing, purging and cramps.

The intelligent house surgeon, Dr. Wedderstrandt, as well
as a number of other physicians w^ho saw this case, at once re-
cognized it as Asiatic cholera, and the Board of Health was
notified of the fact. The woman died at 6. P. M. The Secre-
tary of the Board, Dr. Hester, was immediately despatched for

1 54 ' Asiatic Cholera in New Orleans. [March,

the purpose of examining the condition of the vessel and passen-
gers. He reported the facts above stated, and in addition, that
" he found two old women laboring under bowel complaints, and
two children suffering from debility the ship in a fair condi-
tion as regards cleanliness passengers generally look well."

On the morning of the 13th, a man who came over on the
same vessel, was brought to the Charity Hospital and found to
be in a complete state of collapse. He was cold and pulseless,
but his intellect was perfectly clear, and he gave the following
account of himself; He said he had a slight diarrhoea on the
morning of the 11th, but he walked about the city and ate an
appli. On the 12th he left the ship and went to a boarding-
house near the Poydras market still had slight diarrhoea, but
ate no fruit this day. After going to bed, was attacked with
severe vomiting, purging and cramps took no medicine and
was reduced to a state of collapse when he entered the hospi-
tal. He died about 6 P. M. The books of the hospital show
three other cases of cholera admitted on this day, all of which
terminated fatally. They were from different parts of the city,
and not passengers of the Swanton. On the same day I observ-
ed two women in the hospital from the same ship. They had
only slight diarrhoea, and were promptly relieved. The two
fatal cases were seen by a number of physicians, most of whom
felt no hesitation in prOnoucing them Asiatic Cholera, though a
different opinion was expressed by some. The rumor soon
spread throughout the city and created great consternation.

On the evening- of the same day (13th December) that the
second case was taken to the Charity Hospital, a man who has
resided here for many years, and who does business not far
from the St. Charles Hotel, came into my office with strong
symptons of cholera. He had not been near the ship Swanton,
nor seen any of the passengers. I prescribed for him, and on
visiting him at his room, half an hour afterwards, I found him
extremely ill, with severe pain in his bowels, copious watery
purging, skin bathed in cold sweat, great thirst and general
prostration. His condition was so alarming and he derived so
little relief from large and repeated doses of opium, calomel,
camphor and capsicum, assisted by sinapisms, stimulating fric-
tions. &c., that I determined to resort to the inhalation of chlo-
roform. By this means he was made perfectly easy in about
two minutes, and remained so until the other medicines he had
taken had time to act. He got through the night pretty well,
and recovered in a few days from a dangerous illness.

On the r4th December, the Bo'ard of health held a special
meeting, and issued a card which appeared in the newspapers
the following morning, assuring the public that there was no

1840.] Asiatic Cholera in New Orleans. 155

foundation for the t*umor that Asiatic cholera had made its ap-
pearance in the city. This statement was seconded by flour-
ishing editorials in several of the newspapers of" the day.

On the 15th December there were eight cases of cholera
admitted into the Charity Hospital, and I heard of cases in the
private practice of a number of physicians.

In a letter from a learned physician of this city to a distin-
guished firofessorin Paris, which was published in the Commer-
cial Times of the 23d inst., the author mentions three fatal cases
of cholera that occurred on Customhouse, Bienville and Chartres
streets on the 15th. He goes on to say: " It is well enoufih to
remark here, that these three primary victims of cholera in New
Orleans were all cooks, going every morning, very early, to
the principal market in the city, situated on the bank of the
river, a cable's length from the infected vessel." In the latter
part of this statement, the worthy author must have made a
mistake, for the President of the Board of Health was inform-
ed by it^ccretary, who was sent to examine the Swanton, that
he founcWier in the upper end of the Second Municipality,
which is nearly a mile from the aforesaid principal market, fre-
quented by the unfortunate cooks. So these cases must have
originated in a different way.

On the 16th December there were eleven cases of cholera
admitted into the hospital, and the disease was evidently rapid-
ly increasing in private practice.

On this day I was called to see Dr. J. B. Morgan, of Jackson,
Miss., who was attacked the night previous, without having
committed any other indiscretion than eating some fish and
oysters at dinner. When I arrived at his room, I met Dr. Far-
rell, who had seen him before, and had good reason to be pro-
voked at the difficulty he found in convmcing Dr. Morgan of
the danger he was in, and the importanceof prompt and vigor-
ous treatment. Dr. M. had already passed about thirty liquid
evacuations, then had cramps in his legs, and in fact was on the
verge of collapse. Dr. M. being an old friend and neighbor of
mine, I joined my entreaties to the arguments of Dr. F., and we
did all we could to convince him of the importance of vigorous
treatment, but all to no purjx)se. He insisted that he was not
dangerously ill I hat he had been- similarly affected many a
time before, and that if he were not disturbed he would soon
be well. The sequel soon verified our worst apprehensions.
He was incorrigibly obstinate, dallied too long with a danger-
ous disease, and was lost.

The panic now prevailed throughout the city, and vast num-
bers of people fled in every direction ; yet some of the leading
newspapers and a few physicians hooted at the idea that the

15d Asiatic Cholera in New Orleans. [March,

disease was Asiatic cholera, and the Board of Health still kept
uloot". From this time the disense increased so rapidly that on
the 22d December, ten days from the time when the first case
was admifted into the hos[)ital, the number of deaths by cholera
in that institution amounted to twenty-two, and in the whole
city to forty-five. But let me not encroach upon your pro-
vince, Mr. Editor. Being Secretary to the Board of Health,
you will of course supply your journal with all the mortuary
statistics that may be interesting: to the profession. I may be
permitted to state in this connection, however, that the Board
of health published on the morning of the 23d Dv?ceml)er that
Asatic cholera was "epidemic" in the city, the numl)er of
deaths from it the day previous having been forty-five; and
they announced the cessation of the epidemic, on the 6th of
January, when the deaths amounted to tliirty-eight.

The epidemic raged most severely from the 22d to the 30th
of December, having reached its zenith about the28th, on which
day the deaths by cholera were n nety-two. Fron^the 16th
to the 22d the weather was oppressively warm, the tMrmome-
ter rising as high as 84. From the 22d it was cool, wet, and
gloomy, till the night of the 30th, when there fell a white frost.
On the morning of the 1st January there was another white
frost, and from that time the disease declined steadily.

The epidemic influence appeared to be felt by almost every
person in the city, whether native or foreigners, acclimated or
unacclimated. Thousands complained of an extraordinary un-
easiness in the stomach and bowels, but in a vast majority of
instances it was easily relieved, and but few bad cases occur-
red amongst those who were piudent and paid proper attention
to the premonitory symptoms. The lower classes of people
have evidently suffered most, which may be attributed to ig-
norance or neglect. The mortality at the Charity Hospital
has been very great ; yet no one can be surprised at it who
visited that institution during the epidemic and witnessed the
condition in which the patients were when admitted. Cholera
is an insidious disease that generally steals upon its victims,
seldom declaring itself openly until it has them completely
within its fatal grasp. I have not a doubt that seven-tenths of
the peo|)le who have recently perished of it in this city might
have been saved, if they had procured proper medical aid at
the onset of the disease. I presume there is hardly a physician
in the city who has not been called to persons reduced to the
most dangerous condition by relying too implcitl}' and too long
upon some of the various "specifics" advertised in our news-
papers and lauded by the editors. Yet sotne may have been
saved by these very nostrums ; for there be many in this good-

1849.] Asiatic Cholera in New Orleans. 167

ly Commonwealth who have such an antipathy to pRysic, that
they will not take it under any circumsiances, unless they see
its assumed virtues blazoned before the public by the effulgent
illumination of fictitious puffs and certificates. They have a
decided penchant for the marvellous, the mysterous, and the
unknown. They scorn reason and common sense, and have
contempt for honest simplicity in scientific researches. Like
the followers of the veiled prophet of Khorasson, they
" Woald be dupes and victims and they are.'^

But let me not weary your patience with matters of this sort.
The people are free astents, and have the ricrht to take what
medicine they like. If they prefer artful humbu^gery to honest
unpretending science, why let them have it to their heart's con-
tent.

The mortality from cholera at its late visitation, compares
most favorably with that of 1832, when it first scourged our
city. The number of deaths by cholera from the r2th Decem-
ber, 1848, to the 20th January, 1849, as appears from the reports
of the Board of Health, amounts to near 1400, five hundred and
ninety-six of which occurred at the Charity Hospital. We
learn from an interesting Memoir on the Cholera of 1832, ad-
dressed to the Academy of Medicine of Paris, by Dr. M. Hal-
phen, a French practitioner of this city at that time, that the
disease made its appearance about the 25th of October, in the
midst of an epidemic of yellow fever; that in a few days it
raged sevefely. and that in the short space of twenty days it
killed about 0000 people. Dr. Halphen says, that the mortality
amounted on some days as high as 500 a day. He estimates
the full population of the city then at 50,000, and as cholera
broke out during the prevalence of yellow i^v^v, ere yet the
absent citizens had returned and before the customary visiters
dared to come in, he does not think the population at that time
exceeded 35,000 ; thus showing the frightful loss of about one^
sixth of the people in about twenty days. When we read over
these sad details, we may well congratulate ourselves upon our
happy deliverance from the late pestilence. True, we have
lost about 1400 people, amongst them a few valua:ble citizens;
but what would have been our fate if so malignant a disease as
that of 1832 had broken out in December last, when afl our own
people were at home, and the city was full of strangers? In
1832, the living could not afford decent burial to the dead. Dr.
Halphen states, (hat on some days upwards of one hundred
corpses were accumulated at the cemeteries, waiting for inter-
ment. Large trenches were dug, into which cart loads of
uncoffined bodies. were heaped indiscritninately ; and in the
dead of night, a great number of bodies, with bricks and stones

158 Asiatic Cholera in New Orleans. [March,

tied to the feet, were stealthily thrown into the river. The
same ratio of mortality at the present time would demand about
twenty thousand victims. Let us turn from the appalling cal-
culation, and thank God that we have been so mercifully spared.

As in 1832, the epidemic has declined to a stage of compara-
tive security, but the disease has not entirely disappeared.
There is as little cholera in New Orleans at the present time,
in proportion to the population, as in any other part of the
Lower Mississippi Valley. Whether the epidemic will be re-
kindled, at the approach of the ensuing summer, remains to be
seen. If the miserable condition of the city, as regards clean-
liness, will have any influence upon the event, we may certainly
expect it. New Orleans must ever continue to be a prey to
the most fatal diseases that prevail, until something efficient is
done to improve its sanatory condition.

The manner in which the cholera has spread frorn this city,
in every direction, forms a problem as curious and difficult as
that of its first appearance. Almost every vessel that left the
city, a few days after the disease commenced, soon had cases
aboard, and on some of the steamboats going up the river there
were twenty or thirty cases and many deaths. Thus, persons
having the disease, and dying of it, were carried to all the land-
ings, towns and cities up the river as high as Cincinnati. In
many of these places it spread to a limited extent among the
inhabitants; in others it did not. We have as yet heard of no
place up the river where the disease has prevailed as an epidem-
ic. We learn that cholera is spreading among the plantations
along the river, and also in the interior of Louisiana. To some
of these the infection appeared to be directly carried; at others
it began without any communication with an infected district.
The most remarkable mortality that we have heard of, out of
the city of New Orleans, occurred in the 8th Infantry, a body of
450 soldiers which arrived here from Jefferson Barracks on the
1st of December, and were stationed at the Barracks^ about
four miles below New Orleans. There they remained till the
r2th, when they embarked for Port Lavaca, in Texas^ on board
the steamships Telegraph and New Orleans. These ships
reached T^)rt Lavaca on the 1 5th, but the men did not land till
the 20th December. On the night of the 21st, according to a
correspondent of one of our newspapers, the right wing of the
regiment, under the command of Brevet Major Gates, moved
twelve miles into the country ; the left wing, under command
of Major Morrison, remaining in Lavaca. During the night
the weather changed, from sultry heat to a cold, rainy norther,
and by daylight four soldiers of those left in the town were
dead with cholera, and many laboring under the disease. On

1848.] Asiatic Cholera in New Orleans, 159

the following day an express came back from Major Gates,
with the intelligence that his men were falling raj)i(lly with the
same disease. The disease raged with such severity that in the
brief space of three or four days 115 men, or about one-tourth
of the command, perished. Yet, strange as it may appear, the
correspondent informs us that "no cases occurred among the
citizens." Now these soldiers must have imbibed the morbific
cause somewhere, which lay dormant in their systems, like a
powerful enemy in ambush, until a fit opportunity was offered
for action by the sudden and malign influence of a Texan north-
er. Then it sprung upon its unsuspecting victims, made
dreadful havoc, and in a few days vanished.

We are informed that cholera has prevailed to a considera-
ble extent at Houston, Texas, whilst Galveston on the sea-board,
has escaped, although situated on the line of travel from New
Orleans to Houston.

Soon after the epidemic commenced in this city, a trader on
Esplanade street took his negroes (about sixty in number)
across the lake and located them in the pine woods, where he
hoped they would be perfectly secure. They were all well
when they left the city, excepting one case, which terminated
fatally on the day of their arrival over there, and continued well
for nearly three weeks after reaching their point of destination.
The cholera then broke out among them and killed a consider-
able number in a very short time.

At the Charity Hospital, probably as many as fifty cases have
occurred among the nurses, servants, and persons who had been
admitted for other complaints.

After reviewing the few recent facts which I have just stated,
what shall we say about the contagiousness or transportability
of cholera ? Numberless striking facts recorded in the history
of cholera would seem to prove beyond cavil that it may be
transported from place to place, through the medium of persons
afl^ected. On the other hand, the numerous instances in which
the disease failed to be propagated through this medium and the
utter futility of rigid quarantine regulations and sanatory cor-
dons in arresting its march, would seem to authorize a different
opinion. Amidst these contending difficulties, if the reader can
arrive at a satisfactory conclusion, I can only say he is more
fortunate than myself Speaking of quarantine, perhaps we
niay hear before long that the city of Natchez, on the river
above us, has been protected from cholera by her quarantine.
I have been informed that there were some fatal cases of chol-
era in that pjace. Moreover, I have good authoritv for saying
that the quarantine regulations of Natchez are altogether worth-
less, except to the officers charged with their enforcement.

160 Asiatic Cholera in New Orleans. [March,

I ou^ht not to close this communication without saying some-
thincr about the general character of the disease, and the treat-
ment pursued by the physicians of New Orleans. As to the
character of the epidemic, I think I may safely say that it has
not been very malignant. In most instances the attack was
insidious and mild generally commencing with a looseness of
the bowels, attended with more or less griping, and often accom-
panied by nausea and vomiting. The latter symptoms almost
invariably attended those patients who had committed impru-
dence in eating. Without descending into minutiae, I may say
thnt the disease nlmost invariably commenced with some unusual
disturbance of the digestive organs. When this disturbance
commanded the attention it deserved, it was generally most
easily remedied by the simplest means; but if neglected, it
seldom failed to lead on to the most disastrous consequences.
This, then, is the curable sta^e of cholera, and almost the only
stage in which it can be cured; for if it be permitted to run on
till the patient becomes cold and pulseless, ninety-nine in a hun-
dred will inevitably die. By powerful means, reaction may
often be established ; but the danger is not yet passed a great
majority still die of the consecutive fever. Say what you will
about creating panic and spreading alarm amongst the people,
I feel no hesitation in asserting that when epidemic cholera is
prevailing, every person who has any unusual diarrhcea, had
better believe he is a case and act accordingly. If this simple
rule were universally adopted, cholera would soon be rendered
comparatively harmless. Thus, according to Dr. Watson, one
of the ablest English authors, the disease was arrested in Lon-
don by the establishment oi '' Diarrhoea Dispensaries,^'' where
the poor were supplied gratuitously with proper rcTnedies.
Thousands applied, who would otherwise have waited to^e^ ill
before goinirto a hospital to be treated. Who can deny that it
would be well \ofris;hten the people, if need be, into this degree
of precaution ? Without it yon may rest assured there is no
safety.

I deem it unnecessary to enter into a minute detail of the
symptoms that characterize cholera, as they are familiar to
most persons, whether belonging to the medical profession or
not. It may not be amiss, however, to mention a few of the
most remarkable ones that attended the late epidemic. Many
bad cases were marked by an obstinate vomiting of bile, which
continued until death. The vomiting would conthiue.for days,
and incredible quantities would be thrown up. In these cases
the diarrha?a was generally moderate and sometimes absent.
The worst cases were those in which the rice water discharges
were profuse, as well from the stomach as the bowels. In these,
there was no appearance of bile whatever.^

1849.] Asiatic Cholera in New Orleans. 161

A few cases were seen at the Charity Hospital which termi-
nated in black vomit.

When collapse supervened early in the attack, before the
system was too much exhausted by copious rice-water evac-
uations, it was less difficult to brinii: about reaction, and there
was better hope of ultimate success. So far as I know, the
only cases of recovery that took place after decided collapse,
were of this kind.

Where reaction from a state of collapse was slow and difficult,
a sort of typhus fever supervened, which lasted for some days,
and generally terminated fatally with affection of the brain.
The intellect was generally clear and undisturbed to the last ex-
cepting those who died of the consecutive fever. It is marvel-
lous and astounding to witness the mental clearness and com-
posure of some persons dying with cholera! Whilst the atten-
dant relatives and friends are agonized with grief at the sudden
and awful calamity, the poor victim is often seen supernatural-
ly calm and uttering words of consolation with the expiring
breath.

The treatment of cholera admits of much variation. Educa-
ted physicians every where concur in the indications to be
fulfilled or what is wanted to be done ; but amidst the multipli-
city of remedies at their command, of course each one resorts
to such as he thinks are best adapted to the circumstances of
the case. Doubtless the same object may be accomplished by
a variety of means, if it can be accomplished at all ; and in our
choice of remedies we must be guided by observation and expe-
rience. In the treatment of what are called the premonitory
symptoms, the first indication is to check the diarrhoea as soon
as possible, keeping an eye at the same time to the important
secretions of the liver, kidneys and skin. For this purpose,
physicians very generally resort to opium and its preparations,
combmed with stimulants and aromatics or opium with some
mercurial, ox with quinine. According to the urgency of the
symptoms a good prescription maybe made of laudanum or
paregoric and brandy or laudanum, spirits of camphor and
tincture of assafcptida or laudanum, essence of peppermint
and compound spirits of lavender or calomel, opium and capsi-
cum or camphor or equal parts of paregoric and tincture of
catechu. The following is a recipe which I found to answer
very well, viz: l^. Sulph. Quinin, drm. i. ; Tinct Opii., drs.
iss. ; Tinct. Capsici Comp., drs. iii. ; Mucilag. Acaica with Aqua
Cinnamon, f oz. iv. M. Give a table-spoonful and repeat after
every two loose stools.

Although opium is so often found in the prescriptions above,
I should mention that some physicians disapprove of it, and sel-

N. S. VOL. V. NO. iir. 11

162 Asiatic Cholera in New Orleans. [March,

dom prescribe it in cholera, except bj^ enema. These gentle-
men place their chief reliance upon calomel, combined with
camphor, capsicum and the like. As to the sulphate of quinine,
it appears to be serviceable in almost every kind of disease that
occurs in this region. It possesses remarkable intrinsic vir-
tues, and may be used as an adjuvant to many other remedies.

In the treatment of the violent or acute stage of cholera,
when there is vomiting, purging and cramps, we resort to ano-
dynes, antispasmodics, stimulants, calomel, &c., internally,
aided by sinapisms, stimulating frictions, &c., externally.

The treatment of the stage of collapse is altogether desperate.
As before stated, a vast majority of patients die after getting
into this condition ; and it is no wonder, for the system is then
completely drained of its vital fluid. An excesssive haemor-
rhage from a divided artery would not produce a greater pros-
tration than is brought about by the copious serous evacuations
of cholera; for all the fluid discharged is abstracted from the
blood. Various remedies are used in this stage, such as sinap-
isms, blisters, the hot and the cold bath, the hot air bath, calo-
mel, carbonate of ammonia, &c., &c. The most .remarkable
recovery from collapse that I witnessed was eff'ected by very
large doses of calomel, washed down with table-spoon doses of
laudanum, aided by sinapisms and frictions with spirits of tur-
pentine and sweet oil. This was a lady who was rescued from
the very jaws of death. She was afterwards pretty badly sali-
vated, but recovered without serious injury.

Two other physicians attended her with me. In the case of
Dr. Morgan, mentioned before, I witnessed the astonishing
power of cold water in bringing about reaction from a hopeless
state of collapse. Warmth was restored, the pulse returned at
the wrist, and life was prolonged two or three days ; but still it
failed, for the injury sustained was irreparable. The cold bath
was administered in this instance at the suggestion of my
friends, Dr. Richardson, of Vicksburg, and Dr. Gustine, late of
Natchez, who said they had derived great benefit from it in the
cholera of 1833. Being favorably impressed with the power
which the remedy displayed in the case of Dr. M., I resorted to
it in two other cases of collapse in private practice. It produced
reaction, but they both died for want of vital power to sustain it.

I must apologise for the length to which this communication
has unexpectedly been drawn. I have not gone into the minu-
tiae of the theory and practice, or the pathology of cholera. It
is to he hoped that our medical journal will be enriched by some
valunblo papers on these subjects, especially the pathology of
the disease, which has been laboriously investigated by some of
our most respectable physicians.

1849.] Injiuence of Quackery on Health, Morals, 6fC. 163

Before closing, I will offer a remark or two on the course to
be pursued by persons exposed to the epidemic influence of
cholera :

1. Let them avoid imprudent excesses of all kinds.

2. Let them not make too sudden and great a change in their
established habits.

3. Most persons should avoid fish and oysters ; also, acid
fruits and vegetables, with the exception of rice, potatoes, and
beans.

4. When feeling weak and slightly indisposed, let them take
a little good brandy or wine.

5. Let them pay prompt attention to the first and slightest
premonitory symptoms. Their family physician, or sorne re-
spectable regular physician will give them the best advice they
can obtain, as it is their interest as well as their duty to pre-
serve the lives of their employers.

6. When some simple remedy does not quickly arrest the
disease, they should send for their physician : they will be apt
to do this sooner or later, and it is but right that he should have
a fair chance to save them, a his reputation is involved in the
result.

By attending to these simple directions, many may escape the
impending danger ; whilst, by neglecting them, thousands will
fall into untimely graves. Very respectfully,

New Orleans, January, 1849. E. D. FENNER.

Injiuence of Quackery on Health, Morals, <^c. (Boston Medi-
cal and Surgical Journal.)

Remarks of Mr. Sanborn, of Hanover, in the N. H. Legisla-
ture, upon the Bill incorporating the New Hampshire Medical
Botanic Society.

The most scientific physicians of the age admit that, in past
ages, too much medicine has generally been administered to
the sick. Excessive medication has been a fault of many prac-
titioners of the healing art ; and why ? Simply because a large
proportion of the diseases for which physicians are called upon
to prescribe, are imaginary, and the patients really need no
medicine. All physicians and metaphysicians agree on this
point, that the imagination has an important agency both in
the production and cure of diseases. The mind and body are
so intimately associated that they mutually affect each other.
Moreover, many real diseases are merely functional and not
organic in their nature. They belong rather to the movement

164 Influence of Quackery on Health, Morals, 6fC. [March,

of the vital machinery than to its separate organs. For in-
stance, a clock or watch may be perfect, in all its wheels, and
yet fail to make the time accurately, because it is not well
regulated. So the human system may be sound and entire,
in all its parts, and yet its heahhy functions may be so deranged
as to render the patient really '///. Now what does such a
man need? Simply the advice of a competent physician, who
may prescribe, perhaps, a change of diet, a change of place, new
objects of attention, increased exercise, or some inert and harm-
less medicine to satisfy the demands of the patient. The ex-
istence of this great class of mere]y J 2inction a I and frequently
imaginary diseases, gives the homceopathist his wonderful
success. Being called, in many cases, where the patient needs
no medicine, he administers an infinitesimal quantity, just to
satisfy the demands of the sick, that "something should be
done," and the man speedily recovers. Did any sane man
ever persuade himself that the efficacy of a medicine is increas-
ed precisely as its quantity is diminished? and that the small-
er the dose, the more potent its influence ? If the doctrines of
the founder of homoeopathy be t^'ue, an ounce of opium would
convert Lake Superior into excellent paregoric, and the world
might be supplied with soporific mixtures already shaken and
fit for use, as long as time shall last. But Hahnemann was a
deceiver and an impostor. His own language to a friend
was ''*! give medicines but very seldom, although I always
prescribed small powders 1 I do this for the sake of keeping up
in the patient's mind the firm belief that each powder contains
a particular dose of some medicine! Most patients will get
well by adopting a simple mode of living, and by placing a
boundless confidence in their medical attendants.'' It is, no
doubt, well for the patient to confide in the skill of his physician,
and it is sometimes well to humor the patient's desire for a
prescription, though no medicine be needed. In such cases,
the most eminent physicians frequently administers some in-
nocent substance, as a bread pill, or a little gum Arabic water,
which usually proves successful.

Besides the imaginary diseases above alluded to, another
large class arises from slight indigestion, or from occasional
intemperance in food or drink. A man abuses his system by
excessive eating, or by improper or innutritions food. He suffers
from nausea, faintness and depression of spirits. At night he
is troubled by bad dreams or incubus. Anothc, perhaps, has
been too closely confined to a sedentary life, has inhaled bad
air, and feels languid and feeble, experiencing what an old lady
once denominated "a sense of all-gone-ness." What do such
patients need ? The first should/c^.^^ ; the second should "take

1849.] Influence of Quackery on Health, Morals, ^-c. 105

up his bed and walk" But while they are suffering from a
voluntary transgression of the laws of health, the advertisement
of some nostrum vender meets their eye. It matters little
what the medicine may be, it is adapted to cure any and every
specific disease. Their symptoms are exactly described ;
thousands have already been cured, and respectable men certify
to the efficacy of the offered remedy. They, too, are persuaded
to try it. They take into the stomach, already enfeebled and
needing rest a stimulant, perhaps an active poison, which
operates as a local irritant. The patient immediately feels
better, and the next day is ready to certifs' to the wonderful
efficacy of the new remedy, and perhaps on the day following
he finds it necessary to resort to it ''yet airain.''' The mirac-
ulous cure can be easily accounted for. The operation of the
stimulant or local irritant is simply this. It has pleased the
Creator to lay up in the store-house of the human constitution
avast amount of strength and animal spirits, which remain
latent while the system is in healthy and undisturbed action,
but are develn]3ed by certain exciting agents and causes. This
dormant energy may be waked to aotion either through the
agency of strong passions and mental excitement, or by medical
agents operating mechanically upon the delicate lining mem-
brane of the internal organs. Alcohol and all the diffusive
stimulants operate, in this wa^^ upon the animal system. As
most of the nostrums of the day contain alcohol, or some other
poison or irritant resembling it in its effects, we may very
properly illustrate the operation of patent medicines, by the
well-known effects of alcohol. Alcohol, likeother active poisons,
is indigestible; and, of course, innutritions. No part of the
system can assimilate it. When taken into the mouth its
tendency is to corrugate its lining surface and produce a burning
sensation in the organs of taste. It produces the same effect
upon the stomach. It is taken up by the absorbents, and
mingling with the blood, it moves in a fiery current through
the arteries and veins, visiting, in its course, the heart, the lungs,
and the brain. Of course, the nervous system is greatly
excited, and there is an increase of nervous energy, and con-
sequently an increase of strength and animal spirits. The latent
powers of the system are roused, and the machinery of life
moves with an increased and unnatural velocity. This eflect
continues till the offensive fluid, being rejected at every portal
of life within, is thrown oflTrom the system by'the emunctories
and pores of the skin. Herein it operates as a deceiver. The
wary man, or- the sick man, drinks and feels refreshed. He
is, as he believes, both brighter and stronger; while, in fact, he
has only drawn, in advance upon that nervous energy, which

166 Influence of Quackery on Health, Morals, ^c. [March,

is treasured up to meet the demands of the system in cases of
emergency. Any of the violent passions would, when in action,
produce the same result. Let a neighbor approach the toper
just as he is about to raise the cup to his lips, and spurn him
with the foot or buffet him with the fist, without provocation,
and will not the insult make the w^ary man forget his fatigue ?
Will it not incre'ase his strength as much as though he had
swallowed the potation. No doubt it would ; and the excite-
ment resulting from the exercise of any strong passion would
produce the same result, whether it be love or fear, jealousy or
hate. But in the human constitution, as in physics, action and
re-action are equal and in contrary directions. The unnatural
excitement, from whatever cause produced, whether by alcohol,
vegetable elixirs or passion, is followed by unnatural depression
and consequent physical exhaustion. A man, by using artificial
stimulants, may do the work of two days in one, and he will
live two days in one ; and this is the reason why drunkards do
not live out half their days. The same is true of those who
swallow large quantities of patent medicines, which usually
contain some active poison. They operate as a stimulant or
local iritant upon the already jaded stomach, destroy its healthy
action, and produce a chronic and incurable disease.

But it may be asked, if this be the ordinary effect of frequent
medication by popular nostrums, why are so many cures an-
nounced ? The answer is obvious. The sick recover in spite
of the medicine, but would recover much sooner without it.
Many of these boasted cures are only lucky coincidences.
Post hoc, ergo propter hoc, is the great stumbling block of
ignorant men. One event follows another in the order of time,
the inference is that the consequent was the effect of the ante-
cedent. Patrick called on his physician for a prescription for
his wife. He was ordered to apply a blister to the chest. Pat
having no chest in the house, applied the blister to the lid of
an old trunk, and the wife happened to recover, and was ready
to certify to the efficacy of the application. A few years ago,
there lived in Vermont a medical prophet, who healed the
diseases of patients at a distance, provided they sent him a
minute account of their symptoms, with the inquired fee. A
lady residing in the county of Cheshire, in this State, who had
for a long time been in ill health, had faith in the prophet.
She besought a neighbor who was about to visit the residence
of the prophet, to carry a letter detailing the symptoms of her
disease. She inquired diliirently the time when he would arrive
at the place, that she might know whether her disease was
affected by the power of the ])rophet. At the supposed time
of his arrival, she beojan to amend ; the next dav she walked

1849.] Influence of Qjaackery on Health, Morals, cj-c. 167

abroad, extended her walk the day follovvinc^, and when the
neighbor returned, was iTiuch improved in health. On iiujuiry,
she ascertained that the faithless neighbor had never seen the
prophet, and her unopened letter and money were returned.
The history of charlatanry is lull of such facts. It is no doul)t
true, that more thnn half the cases of illness that occur, would
terminate successfully if no physician were called and no me-
dicine were taken. These cases furnish the certificates of im-
postors.

The cure of the scrofula by the royal touch, the weapon
ointment and sympathetic powder, in popular use about 200
years ago, furnish testimony in point. For many generations,
it was customary for the kings of England to lay their hands
upon persons afflicted with the " king's evil " (so called), and
hang a piece of gold around the neck of each patient. The
profligate Charles II. is said to have touched nearly 100,000
patients of this description, all of whom were essentially benefit-
ed, except in cases of deficient faith. It will not be denied
that the peculiar mental state of patients, in such cases, may
have modified real disease, and perhaps, in some instances,
removed it ; still, the virtue resided in the patient, not in the
King. The unguentum armariiim, or weapon ointment, which
was so popular for a time in healing wounds, was applied to
the weapon and not to the wound. A similar use was made
of the sympathetic powders, for the relief of pain. A hand-
kerchief or some article of apparel belonging to the sick was
moistened with a solution of the powder, and the patient was
relieved. Thousands were ready to testify to the eflicacy of
each of these absurd curative processes. So when Perkins's
metallic tractors were in vogue, about 40 years ago, it is said
that a million and a half of radical cures were announced as
resulting from the use of these harmless pieces of metal. They
were soon discarded by the public when it was ascertained
that equally wonderful results were produced by tractors of
Jead or wood, with nails, pieces of bone, slate pencil and tobacco
pipe. Then men forebore to pay five guineas for a couple of
ounces of brass and iron ! Surely the poet has well said :

"The world is generally averse
To all the truth it sees and hears,
But swallows nonsense and a lie
With greediness and gluttony."
* * * *

" Surely the pleasure is as great
Of being cheated as to cheat."

The truth is no man is proof against deception ; and when the
body is weakened by disease, real or imaginary, the mind suffers
from sympathy ; and under such circumstances, the most

168 Influence of Quackery on Health, Morals, ^c. [March,

intelligent are easily duped by pretenders and quacks. Their
medicines always promise more than any medicine, however
good, could be expected to perform. It is safe to assert that
there is not an advertised nostrum, in the market, which does
not hold out false hopes to the sick. Every such advertisement
is an imposition upon the public, whether it come from physi-
cians regular, irregular or defective ; and in the grammar of
medicine, the latter class is very numerous. If one tithe of
what the vegetable doctors assert were true, we might attain
unto what the progentors of our race would have secured by
partaking of the fruit of the tree of life. We might "live
lorever." If the pompous assertions of the makers of cosmetics,
washes for the face, and beautifying lotions, were true, we
might have ladies beautiful as the houris, with the assurence of
perpetual juvenescence. In a word, we might bid defiance to
the darts of death, and the vegetable doctor might stand over
the prostrate king of terrors, and exclaim, in triumph, " Oh
death, where is thy sting?" and then turn to his patient, and in
the language of Oriental -adulation, exclaim, oh patient, " live
forever"!

It is pretended that nobody is deceived by the professions of
quacks. Every day's experience contradicts this assertion.
The rich and the poor, the wise and the simple, are all occa-
sionally deluded by these cheating, lying impostors. The hu-
man mind is so constituted, that we must confide in others. We
are made to trust each other ; to believe the solemn declarations
of our fellows. Without this mutual confidence, society could
not exist : hence the abuse of it becomes the more odious.
None are so credulous as the sick. They listen readily to the
advice and suggestion of others. Fearing the ravages of disease,
they eagerly lay hold of any hope, however delusive, which
empirics may hold out to them. The extensive sale of vegeta-
ble medicines proves this. A few years ago, when Morison's
vegetable life pills were so popular in this country, a suit was
commenced in a court in Massachusetts, by Morison and
Moat, against John K. Palmer, for selling a spurious article.
It appeared there in evidence, that the proprietors had been so
successful in England, as to be able to estalish the "British
College of Health," at an expense of 8250,000, from which
agents were sent into all the principal cities in Europe and
America. The demand for thes pills became so great, in this
country, that the sale amounted to $250,000 in a single year ;
and the seller of the spurious pills had disposed of 100,000 boxes,
before he was arrested by the patentee. It appeared, further-
more, that this "British ('ollege of Health," with its high sound-
ing name, had neither charter, professors, nor students ; but

1849.] Infiuetu:eof Quackery on Health, Morals, ^c. 169

consisted of an immense building in the suburbs of London,
with appropriate a})paratus for the manufacture of " H yjizeian
pills"; and that the proprietor was neither surizeon, physician
nor man of science, but an arch quack. What has become of
this vaunted remedy, in the brief space of ten years I Gone,
like thousands of its pedecessors, to the shades of Erebus and
old Night !

The fact that new nostrums remain popular only for a brief
period, proves that their healing virtues, like the diseases they
profess to cure, are imaginary. Each remedy has its brief
day of glory, and is succeeded by a rival candidate for tiie
popular applause. Each new invention has a two-fold office.
It comes to bury the dead and herald a new race. Every
fresh adventurer denounces all rivals as deceivers and impostors.
These makers and venders of nostrums abuse each other like
pickpockets. They wage upon every fellow quack an inter-
necine w^ar. Ever member of the fraternity is an Ishmaelite
to every other. On all sides it is war to the knife, and the
knife to the hilt. The dead lie prostrate on many a hard-fought
field; but it is [he patients who die, not the quacks! But are
we not bound to believe what these impostors say of each
other? Who should know the iricks of the trade better than
they ? If we can trust their promises, we certainly are bound
to credit their assertions concerning the fraternity. They warn
us, "as we value health,^' to shun all prescriptions of quacks
except their own ; and this is done by every inventor of a new
medicine. Look at the flaming jidvertisements of the rival
Drs. Townsend, which stare us in the face from every paper
printed in Concord, together with a beautiful wood cut, repre-
senting old Dr. Jacob Townsend himself. These rivals mutu-
ally vilify each other, if they speak the truth of each other,
no greater villains walk the earth, "un whipped of justice.*'
They both offer for sale a syrup of sarsaparilla The old doc-
tor says he has paid 8200,000 within the last eight years for
advertising; and whence came this immense sum ? We cannot
suppose that any man would devote more than a" tithe of his
income to advertising; therefore the doctor must have been
doing an excellent business in the sarsaparilla line, for eight
years. Indeed, Messrs. Allison & Gault, of this town, certify
that they alone have sold over 4000 bottles of that article within
the past year.

At the present day there is a great fondness for vegetable
medicines. Anything having the prefix of vegetable to it, goes
down with the multitude. Notwithstanding everybody knows
that no new vegatable has been discovered, and no new proper-
ties have been detected in vegetables before known ; still they

170 Influence of Quackery on Health, Morals, ^c. [March,

confide in the assertions of cheats and knaves that the com-
monest herbs may be made sovereign remedies for " all the
ills that flesh is heir to." It is equally well known that a ma-
jority of all the medicines in the pharmacopoeia of the regular
faculty, are of vegetable origin ; and, that the most deadly
poisons, such as destroy life almost at a blow, like a thunder-
bolt, are from the vegetable kingdom ; still we are told that all
vegetable remedies are safe, while mercury is the great bugbear
of the many. But it has been proved, in courts of justice,
where quacks have been arraigned for manslaughter, that pills,
professing to be purel}^ vegetable, have produced salivation in
the patient. There are, perhaps, a score of infallible remedies
for consumption ; and, there can scarcely be a doubt that the
only ingredient in them all, which serves to allay the irritation
of a chronic cough, is opium! This for a time quiets the con-
sumptive patient, and deceives him with the hope of recovery ;
but by frequent use of it, the strength is exhausted, and the
system sinks under the repeated assults of empiricism.

But of all the gross and palpable impositions upon the public
credulity, the pretence that the Indians understand the healing
virtues of roots and herbs is the most absurd and monstrous.
Civilized and. christian men having recourse to savages to learn
science ! It is, however, a notorious fact that Indian " medicine
men," as they are called, are the greatest impostors living.
They surpass their civilized imitators. They "out-Herod
Herod" in knavery. The whole system of practice among
the Indians has always consisted in fraud and pretence.
Catlin, who spent years among our North American Indians,
constantly atfirms this. They know literally nothing of the pow-
, er of simples. They employ over the sick, charms, spells and
incantations, and make use of amulets and consecrated medicine
bags as curative agents Yet our scientific botanists go to
these ignorant, besotted dupes of superstition, to learn medical
science ! Sometimes a veritable Indian doctor appears among
us, with more brass than copper in his face. He makes his
prescription with great gravity and solemnity. He cuts his
herbs and gathers his roots under the influence of certain as-
tronomical signs 1 These signs, by the way, are but a relic of
old astrology, as ancient as the Pharaohs, and have no more
significancy ibr us than the worship of Isis. But our doctor
regards the "stellar influence" in gathering his herbs. He
strips the bark upward for an emetic, and downward for a
cathartic. He steeps the whole in river water taken up in a
peculiar way. I once heard of an instance where the whole
process failed because the patient dipped the water up stream
instead of down ! " Because vou see," said the learned doctor,

1849.] Influence of Quackery on Healthy Morals, ^-c. 171

"if the water be dipped up stream, it goes agin natur;.if
down stream, it helps nalur"" ! Such are Indian doctors. Ab
uno discs omnes.

Last, but not least, I mention the inventions of Thomsonians.
To this class belong the petitioners. According to the
system of farmer Thomson they practise medicine. This
system every where discourages study, and encourages empiri-
cisms. Like Dogberry in the play, they not only hold that
"reading and writing comes by nature," but medical science
comes by inspiration, or accident. The founder of this system
gained his knowledge entirely by experiment and chance. By
accident he discovered the emetic properties of lobelia. He
first administered it as a medicine to his own children for
measles. On the rehearsal of this fact, one of his eulogists ex-
claims: "Hark! attention the universe! Momentous event!
To his own child, when greatly debilitated, did Samuel Thomson
administer, in November, in the year 1802, several portions of
lobulia inflata as an emetic. Propitious moment, well worthy
o^f being celebrated, could the exact time be ascertained, through-
out all ages to come"! The philosophy of this great man was
truly simple! He says ''the component parts of all animal
bodies are earth and water. These are the solids ; fire and
air are the fluids. Death and life are cold and heat." This is
all very natural, very artless, and clear as mud ! But it is as
difficult to see the bottom of a puddle as of the ocean ; hence,
by a figure of speech, we may denominate this bold theory,
profound. Medical practice is gi'eatly simplified by his new
hypothesis of disease. "Disease," says he, "is a unit, having
one common and general cause, ar.d requiring one general
remed}^ for its removal." Hence steam and lobelia were ap-
plied by him and his followers in all conceivable cases. But if
human diseases require but one remedy, this new philosopher
found that human credulity would tolerate some twenty or
thirty difi:erent preparations of it, and the individual who heads
the petition now before this House, has invented nearly as
many more purely vegetable remedies ! How complicated this
unit of disease and remedy becomes, as we move onward, by
the power of steam ! This is the great motive power of all mod-
ern enterprise. Our ships are propelled by steam ; our machine-
ry is driven by steam ; we travel by steam : and any man who
chooses may take his long and last journey to "that undiscover-
ed country from whose bourne no traveller returns," by steam.

I have said that the Thomsonian practice discourages scien-
tific study. This appears in the writings of all its advocates.
In the "Thomsonian Manual," printed at Boston, No. 8, page
121, it is written " Dr. Thomson has always opposed the idea

172 Influence of Ouachery on Health, Morals, (^c. [March,

which some entertain, that a college education is necessary for
a practitioner, or to advance the glorious system of which he
is the founder." The writer admits that medical institutions
may be useful, but still maintains that they are not necessary ;
for he adds, " that it requires a long and laborious study of the
anatomy and physiology of man, or a profound knowledge of
botany, in order to make a successful Thomsonian practitioner,
the career of Thomson and many others proves the contrary.'*
lie goes on to assert that the requisition of study for a year or
two in some college or infirmary creates "a dangerous mon-
opoly," and tends to clothe the new theory in mystery. Dr.
O. r. Warren, the first individual named in this act of incor-
poration, in his " Vegetable Expositor," No 1, page 19, speak-
ing of botanic practice, says "The shop of the chemist, with
its thousand of technical instruments, and the paraphernalia of
the druggist, are not necessaiy to its existence. Nature is its
laboratory. Nature, his chemist, furnishes, in every clime,
the cure for every incidental disease, in some simple vegetable ;
and every child of nature understands the disease and remedy.
It is only within the pale of civilization that these vegetable
remedies have been unknown." He adopts, it seems, the notion
of Indian skill ; nay more, he says, page 1 of the same pamphlet,
that Samuel Thomson "learned from the beast the physic of
the field." The only useful lesson taught by the beasts is to
shun vegetable poisons. They never crop these vile weeds,
except by mistake. The object of this system is to multiply
nostrums, and sell them to eniich the inventors. These medi-
cines have already become a heavy burden to the community.
They need no legislative encouragement, but rather require
prohibitory enactments. They have become as numerous as
the frogs of Egypt. They are found in our marts of business,
in our shops, and in our streets. They are carried by pelders
from house to house. They come up into our chambers, and
our kneading troughs, and our beds! The makers of them
amass princely fortunes and live in palaces. The buyers of
them, for the most part, lose their purchase money and their
health. It is by no means contended that all these nostrums
are uniformly injurious to .health. Some of them may be
useful, if properly applied.' But as they are used indiscriminate-
ly by all classes of persons and for all Sorts of diseases, they are
undoubtedly productive of infinite mischief Such of them as
are invented by illiterate pretenders to medical knowledge, can-
not be safely used by any person. Many of the Thomsonian
practitioners boast of their ignorance and glory in their shame.
They openly abuse learning and its advocates; yet they prate
about nature's laws. They pretend "to assist nature" in the

1849.] Collodion in Diseases of the Skin. 173

cure of diseases. How can they assist nature, unless they
know how nature acts ? They are quite as Hkely to contravene
the laws of nature as to co-operate with her, unless they have
thoroughly studied physiology and anatomy. These sciences
they discard. Botany alone they study and that empirically,
and thus ''assist nature.'^ If nature could utter her voice, she
would, no doubt, exclaim in the language of the Patriarch of
Uz, "miserable comforters are ye all."

Observations on Collodion in Treatment of Diseases of the Skin.
By Erasmus Wilson, Esq., F. R. S. (Lond. Lancet.)

It is now about four months since a solution of gun-cotton in
sulphuric ether (collodion) was placed in my hands by Messrs.
Bell of Oxford-street, and since I first proceeded to employ it in
the treatment of cutaneous diseases. I was at that time much
interested in the medical progress of a young lady (the daugh-
ter of a physician in the west of England) who had been suffer-
ing for many years with scrofulous ulceration of the skin in
various parts of the body. She had been under my care for
several months, and the sores were much improved, but they
were nevertheless very far from being healed. The diseased
skin had the appearance of being worm-eaten, its hollows were
filled with pus, which burrowed under the surface, and it was
moreover thickened and congested. By the constitutional
treatment which I had pursued, I had, to a considerable degree,
corrected the pyogenic tendency of her system; but I felt the
want of a local remedy that would serve as an impermeable
covering to the surface in fact, take the place of the lost epi-
dermis, and act the part of an artificial scarf-skin. I had tried
vulcanized caoutchouc spread with adhesive plaster, gutta per-
cha, nitrate of silver, astringent solutions, ointments, and pres-
sure by bandage, in vain the remedy was not as yet found. I
was revolving this difficulty in my mind when the collodion
was put in my hand. The bearer of the little bottle may re-
member my exclamation, that "that was exactly the thing I
wanted."

On the next visit of my patient, I removed the dressings from
the sores, and pencilled them over y^ith the new agent, which
covered the surface with a powerfully adhesive film, of about
the thickness of gold-beaters' skin, and effectually represented
the lust scarf-skin. A piece of dry, soft linen was the only ad-
ditional covering required, and she left me, much delighted at
the abandonment of the local applications and bandages. This
young lady has since continued to apply the collodion herself,

1^ Collodion in Diseases of the Skin. [March,

night and morning, until the present time, when the sores are
nearly well, and the congestion and scrofulous thickening of the
skin almost gone.

From careful observation of the effects of the collodion in
this case, I found it to possess four important properties viz :

First. That of a mild stimulant.

Second. That of an efficient substitute for the natural scarf-
skin.

Third. That of a mechanical compress.

Fourtlj. That of an adhesive glue, from which quality it de-
rives its name.

First. As a mild stimulant, it is fitted to exert a local altera-
tive action on the congested capillaries of a chronic ulceration
and give activity to the healing process.

Second. In its character of a substitute for the absent scarf-
skin, it is transparent, pliant and more or less impermeable,
according to the thickness of the layer that may seem to be
required.

Third. Its most remarkable property, as it seems to me, is
the contraction which occurs during the dessication of the collo-
dion, and which produces a local pressure of considerable power
on the surface to which it is applied. Thus, in the case above
related, the congestion of the thickened skin was relieved by
the varnish-like film of collodion spread upon its surface, by
means of a camel-hair brush, as completely as if a nicely ad-
justed bandage had been placed over it. In another instance, I
found a film of collodion entirely remove a purple congestion
(resulting from imperfect circulation) from the tip of the nose,
in a lady who had long suffered from the annoyance. In a third
case, in which the fingers of an elderly lady were congested
and blue, and the congestion was attended by pain and throb-
bing, like that which accompanies chilblains, the collodion pro-
duced so much contraction as to render their tips white and
bloodless, and I was obliged to discontinue the application in
consequence.

Fourthly. The glue-like property of the collodion is evinced
in its adhesion of cut surfaces, a property which is much in-
creased by the contraction above mentioned. When employed
with the purpose of keeping together the edges of an incision,
a piece of cambric or thin linen rag should be dipped in the
solution, and placed ajong the line of incision, after the cut
edfjes have been adjusted and carefully dried, perfect dryness
of the skin being a necessary condition to the adhesion of the
solution. From the rapidity with which the solution dries, and
its perfect adhesive powers, collodion is likely to occupy an im-
portant place in surgical practice.

1849.] Collodion in Diseases of the Skin. 175

The diseases of the skin in which I have hitherto used the
collodion with advantage are, chronic erythenna of the face :
intertrigo ; chapped nipples and chapped hands; herpes labinlis,
preputialis, and herpes zoster ; lichen agrius ; lupus non exedens
and exedens ; acne vulgaris ; and several affections of the sebi-
parous organs. In chronic erythema of the face, its contracting
power was most usefully evinced, as it was also in lupus non
exedens, and acne.

In a troublesome case of chapped hands and fingers, resulting
from chronic lichen agrius, the collodion acted not merely as a
protective covering, but also promoted the. healing of the cracks
more quickly than the remedies I have been in the habit of em-
ploying. In chapped nipples, it was even more efficient in its
protective and curative action, and seemed, in the two instances
in which I used it, to work a charm upon the painful skin.
The gaping cracks were instantly drawn together and almost
obliterated by the contracting power of the remedy, and were
effectually shielded from the influence of moisture and'the pres-
sure of the gums of the infant, and all this, in consequence of the
rapid evaporation of the ether, in an instant of time. In another
point of view the remedy is invaluable as an application to
chapped nipples namely, as being in nowise injurious to the
infant, from offering nothing which can be removed by the lips
during the act of sucking, and in this particular, therefore, pos-
sessing a vast superiority over the various forms of ointments,
astringent lotions, &c.

In four instances, it immediately put a stop to herpes labialis,
and in a very severe attack, it showed itself to be a powerful
and useful remedy. Small superficial ulcerations of the corona
glandis and prepuce, caused by excoriation, were cured by a
single application, and in a gentleman very susceptible of exco-
riation, it acted admirably as a prophylactic. From the success
of the latter trial I am inclined to think that it might be usefully
employed as a prophylactic, in case of exposure to syphilitic
contagion.

When properly applied, the collodion enters all the crevices
of the lines of motion of |Jie skin, and adheres so firmly as to
require several washings for its removal. As it is usually pre-
pared, it has the consistence of syrup, and in this state is best
suited for those cases in which its adhesive properties are prin-
cipally needed. Where, however, it is intended to be applied
to the surface of an ulcer or abrasion, or to chaps of the skin, I
find it convenient to dilute it with ether, and render it almost
as limpid as water.

In pursuing this subjett, I have made trial of a solution of
gutta percha in chloroform, and also in benzole, but these solu-

176 Directions for Prevention of Cholera. [March,

tions are very inferior to the collodion, for the purposes above
named. Their adhesive powers are weaker than the collodion,
and the layer which they form when painted on the skin, is apt

to rise at the edges, and rub off.

Extract from a Clinical Lecture on Cholera. By Prof. Har-
rison, of Cincinnati, 0. (Western Lancet)

DIRECTIONS FOR THE PREVENTION OF CHOLERA.

. I. Purity of Air.

a. All impurities of a personal and domestic nature to be
removed ^yqq admission of fresh air, with entire perflation of
atmosphere.

h. Humidity to be removed by fires dry scrubbing to be
used in domestic cleansing, in place of water cleansing.

c. Crowding of persons within apartments to be avoided,
especially during sleeping hours.

d. Avoid the use of every article that would impregnate the
atmosphere with vapors of any kind-^tobacco, tar and even
chlorine vapors, by deteriorating the vitalizing action of the
atmosphere, are injurious.

II. Diet and Drink. 0

a. No sudden innovation, or change, to be made in the plan
of living.

h. Acid fruits and vegetables to be avoided.

c. Excess in eating to be shunned.

d. Poor diet, and impure water to be avoided.

e. Tea and coffee may be used by those accustomed to their
use. Vinous or spirituous drinks to be avoided by those un-
habituated to them, and employed moderately by those who
have contracted the habit of their daily use.

/. Meat suppers to be avoided ; but plain dressed meats may
be eaten at dinner. Beef, mutton, fowls, and bacon may be
safely eaten once a day ; pork should not be taken.

g. Rich deserts of every kind, vs#th ice cream, to be avoid-
ed; lso very cold drinks and acid liquors.

h. Cucumbers, melons, and corn are improper ; rice well
boiled, and Irish potatoes are best ; bread a few hours out of
the oven, is better than when very fresh.

III. Dress, and Protection of the Surface,
a. Wet and insufficient clothing to be avoided. Flannel
next the skin is partly protective, especially when a flannel, or
woolen belt is worn around the abdomen.

1849.] Directions for Prevention of ChoUra. 177

h. Extremes of heat and cold to be shunned.
c. The bedding and clothing should be daily exposed in cold
weather to the fire, and in summer to the sun.

IV. Exercise.
a. Fatigue is to be avoided.

h. Moderate exercise, when not exposed to a damp air or hot
sun, is best.

-W State of the Mind *

a. A calm, cheerful condition of mind is to be maintained.

1). Fear, above afl other emotions, i'g the most injurious ; an

attack of cholera is frequently determined by the depressing

agency of a strong presentiment of a seizure; or by an urgent

personal appropriation of its peculiar phenomena.

c. Scrupulously abstain from that "idle commenting of the
brain," which leads timid and excitable persons to a perpefaal
recurrence of thought upon this, to them harrowing theme.

d. Although plaosible grounds may be offered to prove that
cholera is, on rare occasions, contagious, yet ample observation
has demonstrated, and diversified experience attested, that no
real contagious property appertains to the mode of its propa-
gation. All the terrors of a dark and superstitious faith in its
contagiousness, should be quieted under a calm assurance that
there is no choleric poison given out by those afflicted with the
disease, but that its mode of propagation is altogether atmos-
pheric that it spreads in virtue of a peculiar vitiation of the
entire air we inhale, and not by distinct lines of personal con-
tamination.

e. Every thing calculated to depress, or in any Way deterior-
ate the physical or moral energies, will act prejudicially.

Treatment in the Precursive Stage.
First. Employ the following tonic mixture, three times a day,,
in tea-spoonful dose^, mixed with a wine-glass of cold watci*.
^. Sulph. Quinine, Bij.
Ether Sulphuric, 5ss.
Spts. Camphor, iss. Mix.
Second. Carefully watch the state of the stomach arjd hoWeh.
If sickness of the stomach comes on, and especially if looseness
of the bowels, then no time is to be lost in applying for medical
advice. But if there be no opportunity of immediately consult-
ing a judicious physician, and the diarrhoea be slight, the fol-
lowing prescription may be usefully taken and this, with a
strict regulation of the diet, and avoidance of fatigue, will prove
available for an arrest of this symptom of the precursory period
of the complaint.

N. s. VOL. V. NO. in. 12^

178 Directions for Prevention of Cholera. [March,

1^. Tinct. opii, 3ij.
Ess. ppt., 3j.
Ess. cinnamon, 3j.
Chloroform, 9ij.
Syrup tolu., l\]. Mix.
A tea-spoonful every two hours till the diarrhoea is checked.
Or six or eight drops of laudanum with thirty drops of the spts.
of camphor, in a little water, will perhaps answer.

Shftuld the diarrhoea prove obstinate, and especially should
there be an absence of bile in the evacuations, then the formula
given below is to be used.

Treatment in the Invasive Stage, or when the Premonitory
Symptoms are present.

First. Nausea, or vomiting; or diarrhoea, particularly of a
thin rice-water material, or cramps, denote, when either, and
especially when more than one is experienced, that the choler-
ine, or commencement of the cholera, is upon the patient.

Second. If plethora exists, blood-letting has proved eminently
serviceable.

Third. Take of the following pilk every two hours till the
diarrhoea is checked.

3^. Sugar of lead, Bj.
Opium, gr. vi.
Cayenne pepper, 9j.
Camphor, Bss.

Calomel, 9j. Mix. Divide into six pilk.
Fourth. If the patfent has lately partaken of any article of
diet, then give a table-spoonful of powdered mustard and the
same quantity of common salt, in a tumbler of warm water.

Fifth. Apply a large warm mush poultice all over the abdo-
men, and spread over the poultice, before its applicatiouy a thick
layer of strong powdered mustard.

Sixth. If the patient grows worse, then employ the following:
1^. G. Camphor, ij.
Cayenne pepper, I ss.
Pow. mustard, j.
Spts. turpentine, !vj. Mix.
To be rubbed over the entire surface of the body.
And the following : ^. Ether sulphuric, j.
Spts. camphor, 5ij.
Spts. ammonia, I ss.
Brandy, xij. Mix.
A table-spoonful, witli an equal quantity of cold water every
hour.

This last mixture is to be used after symptoms of collapse set

] 84t).] Qilin ine in Puerperal Fa err. 1 V.)

in, and, in conjunction with its exhibition, strong mercurial
ointment mixed with camphor and cayenne pepper, are to be
apph'ed to the surface. Additional to these means, injections of
ten grains of stigar of lead, dissolved in an ounce of starch or
gum water, With a tea-spoonful of laudanum, should be admin-
istered every half hour.

Quinine as a Prophylactic of Puerperal jPeue?\ (Lancet.)

The idea that quinine is preservative against puerperal fevef
was started by M. Alphonse Leroy, of Rouen, in 1793. M.
Leudet put it to the test in an epidemic which occurred in 1843,
and lasted for three months, administering it before the accus-
tomed period of the first appearance o( the makdy. For this
purpose he employed the quinine in 15 grain (one gramme)
doses,- and in the few cases it was then tried in no fever follow-
ed. He repeated his experiments in two other epidemics,
occurring in the years 1845 and 1846, when he found that those
submitted to this medicine did not contract the fever. To give
the statistics: Of 83 Women who entered the Hotel Dieu de
Rouen, between September, 1843, and January, 1844, 74 took
no medicine, and 21 of them were seized with puerperal fever^
whilst the remaining nine were dosed with the quinine, and
escaped contagion. Again : between July 8th and August 9th,
1845, 2G deliveries occurred : 11 women were sobmilted to no
medication, and eight of them were attacked with the epidemic
fever; of the 15 others trefrted with sulphate of quinine, one
only caught the disease* Lastly, between the 9th of March
and the 21st of April, 1846, 36 Women were delivered: of the
10 who took no quinine, 11 were attacked : of the 16 submitted
to its action, only one was seized with fever.

The following is the manner in which M. Leudet employs
the quinine: As soon as the newly delivered woman has a
little recovered the shock of the child-birth viz., in about four
hours after delivery, 15 grains of the medicine are given in the
course of the 24 hours, in three portions. The same quantity
is prescribed the next day, but on the third day it is diminished
to ten grains, and the same dose is persevered in until the usual
})eriod of the accession of the fever has passed by, up to about
the sixth day. The occurrence of milk fever is not always an
indication to stay the quinine, for in very many cases that fe-
brile disturbance is very slight.

The plan of using quinine as a prophylactic has been subse-
quently adopted in Paris, by M. Cazeaux, who could, from his
experience, however, make no report of its efficacy. Never-
theless, any remedy holding out such a promise, in so fearful a

180 Alkalies in the Treatment of Rheumatism. [March,

disease, should not be thrown aside until after a careful and
repeated trial. On the other hand, hygienic measures must be
looked upon as by far the best safeguards, both against the de-
velopment and the propagation of puerperal fever.

On the utility of Alkalies in the Treatment of Rheumatism. By
J. I. FuRNivALL, M. D., Hollov^ray, (Ibid.)

SoKie remarks on the treatment of rheumatism by alkalies
have been recently published in The Lancet. I have now for
nearly twenty years, been in the habit of treating rheumatism
by means of nlkalieSy (the liquor potassse, the carbonate, bicar-
bonate of potass or sodas ;) and as cases have multiplied in my
practice during that long period, I have become more and more
satisfied of their effrcacy in preventing the supervention of
heart disease ; while as to their value in curing rheumatism, I
beg to refer to reports published about a year ago, by Dr. Wright
of Birmingham.

I have seldom used them alone in severe and threatening
cases, though Dr. Wright has done so with great success ; but
considering that the inflammation and pyrexia were the effects
or concomitants of the peculiar state of the blood in rheumatic
ievew to remove which state alkalies are recommended, I have
combined with the alkalies various other remedies colchicum,
to remove pain and lower excitement, nryercury sometimes, &c.

The results of my clinical observations have been these,^

First. That no case of supervening heart disease has ever
occurred in my practice since I have administered alkalies in
rheumatic cases; nor will they, in my opinion, if the concomit-
ant inflammation and fever have at the same time been properly
attended to.

Secondly. That many cases of rheumatic fever are on record
which have been energetically treated by medical men of e-mi-
nence, but without the use of alkalies, in w^hich heart disease
has ensued, and proved fatal.

Thirdly. That mercriry and colchicum, separate or combin-
exJ,. and either or both pushed to their utmost extent, will not
secure the patient irom heart disease, without the addition of
alkalies.

Now, seeing that heart disease is a dreadful affliction, (in the
poor man orerpoweringly so,) seeing that its supervention is
not merely coiifined to acute cases of rheumatic fever, and that
it may arise in all cases of rheumatism, even in those seemingly
^flight forms of chronic pains; and seeing that alkalies may
easily be combined with other remedies in the treatment of
rheumatism, I would again press on my medical brethren the
necessity of prescribing alkalies in all cases of rheumatism.

1849.] Acetate of Lead in Vomitini^. Treat, of Catarrh. 181

Acetate of Lead in Vomiting. Communicated in a letter to
Prof. Lawson. By J. G. CiiiNN, M. D., of Lexington, Mo.
(Western Lancet.)

Dear Sir: Although the treatment of the case I will pre-
sently detail, may not be new to most of the readers of your
valuable periodical, yet if you think it of sufficient importance,
you are at liberty to make it public.

Some time in September last, I was called on to visit a lady
of this place, pregnant with her second child, and was informed
she had been more or less sick at the stomach, with occasional
vomiting for above eight weeks, the supposed time of impreg-
nation being about two weeks previous to sickness. As she
had been in a similar situation with her first child, a great many
remedies had been tried in vain, which had formerly given re-
lief Two days previous to my visit the vomiting had been
incessant. I resorted to all the usual remedies, such as blood-
letting, cupping, sinapisms and blisters to the stomach and inside
of the thighs, and after removing the cuticle, applied tinct. opii,
morphia, bruised mint, &c. ; emetics, the various effervescing,
alkaline and absorbent preparations, anodynes in liberal doses,
creosote, bitters, irritating injections, &c. ; notwithstanding
which the vomiting continued for six days and nights, not more
than two hours intermission at any time, and generally but
thirty minutes no food or drink was retained, and the patient
was supported with nourishing enema. It at length occurred
to nae that the matter ejected, was a morbid secretion from the
stomach, and as the acetate of lead was a valuable remedy in
various hemorrhages, &:c., it might be of service in this case.
I accordingly took 12 grains of the acetate of lead and one
grain of morphine, and divided in four portions, with directions
to give one every two hours, and had the satisfaction to find
my patient eflfectUcilly relieved, and snatched as it were from
the very jaws of death ; and although an abortion took place
about one month afterwards, yet there was but a slight nausea
at any time after the second dose of the medicine.

A New Treatment of Catarrh. By Johx A. Lockwood, M.D ,
Surgeon U. S. Navy. (Amer. Journ. of Med. Sci.)

For nearly a year I have pursued a plan of treatment in
catarrh, which, in numerous instances, unfailingly relieved its
initial symptoms almost immediately. It is adapted to its earli-
e.st stages, w^hen the mucous lining of the nasal cavities is dry,
tumid and red, accompanied with a feeling of heat, fulness, and
itching of the part.

The remedy consists in the application of a solution of nitrate

183 ' Monthly Periscope. [March,

of silver to the Schneiderian membrane. It is best applied
with a caiDel's hair pencil. The strength of the solution should
not be less than eight grains of the salt to one ounce of the dis-
tilled water, I ordinarily apply a solution somewhat stronger
ten grains to the ounce.

The application is not painful, nor even disagreeable. Its
immediate effect is to excite a copious serous effusion, which
continues for some minutes. After this the nostrils are freed
from the previous impediment to the passage of the breath
through them, when the sensation of relief becomes at once
manifest. With the subsidence of the local swelling, the gen-
eral heaviness and malaise disappear. For some minutes, the
inhalation of cold air communicates to the mucous lining of the
nose a feeling of rawness. This, however, is of short duration,
^fter which, unless the inflammation has extended beyond the
Schneiderian membrane, the cure is complete.

To accomplish a radical cure, the solution should be applied
at the very commencement of the attack. When the inflam-
mation has extended to the pharynx, &c., it is no longer
practicable to subject all the parts afiected to a treatment which
is imainly local. I have, however, applied the remedy in many
cases where the disease had made several days' progress.
Then, although no expectations were entertained of removing
;any symptoms of bronchia] irritation which might have super-
vened, the relief to the head was always satisfactory, by the
liberty it afforded to the passage of air through the nostrils.

M. Deschamps, in the Gazette des Hopitaux for October
1847, recommends snuffing up the nostrils every two hours
a solution of opium in w^ater, as an effectual cure for coryza.
This method I have not tried. Before reading an account of it, I
had for several months employed the solution ofnitrate of silver
with such happy results, that I was indisposed to seek for any
better plan. The insufflation of ardent spirits will often check
an incipient catarrh, but the remedy is unpleasant and painfuL

'

PART III.
.JHonttjlg |)eri0cope.

Ergot of Rye a Remadyfor Excessive Dilatation of the Pupil from
Belladonna. M. Comperat has announced a plan by which he has
succeeded in removing dilatation of the pupil produced by belladonna
in a patient of his, in whom the iris was scarcely visible, so complete
had been the action of a small close of balladonna applied externally.
For some days the excessive dilatation resisted the employment of

1849.] Monthly Periscope. 16S

various collyria. He prescribed powdered ergot of rye, taken like
snufF. 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 fix3m the other causes. [Lon. Med. Gaz.

Means of Applying Heatto Cholera Patients. Dr. William Robert-
son states that at the Cholera Hospital in Surgeon Square, Edinburgh,
he has found the following means more efficacous for restoring warmth
to cholera patients than the methods usually adopted for that purpose.
" A sheet wrung out of warm water is applied, as hot as the patient
can be-ar it, over his whole body, including and closely em'bracing the
limbs, and leaving no part of the person but the head uncovered.
Over the sheet several blankets are tightly wrapped, or ' packed,'
after the fashion of the hydropaths, but without the slightest respect
for their pathology, or wish to imitate what they can with justice
claim as their exclusive practice. Between the folds of the blankets,
vessels full of warm water are disposed at intervals. The patient is
then placed in a position which enables him to vomit over the side of
the bed, and is supplied with toast and water, hot or cold, ad libitum.
The remedy is an ancient one, often revived in modern times, and is
to be regarded merely as a simple and powerful hot-bath. Whether
it.acts by restoring the healthy functions of the skin, by preventing
evaporation, or by conveying fluids into a system from which they
have been previously drained away, may possibly admit of question.
It certainly seems to me, when applied in the case of children suffer-
ing from the collapse of cholera, to be a most valuable and rapid mode
of restoring the natural temperature. I have seen reaction establish-
ed in a bad case within two hours after the application of the sheet. It
is, however, generally necessary to continue the use of the remedy for
six or eight hours. This practice seems less applicable to adults ; the
extreme restlessness, jactitation, eflbits to vomit and to procure drink,
usually observed in such patients, render it quite impossible to con-
tinue the application of the sheet for more than a few minutes at a
time, without more constant nursing than the utmost vigilance on the
part of the medical attendants can, 'inag hospital, ensure. Strong
patients commonly succeed, ere long, in disengaging their arms, and
throwing the bed-cloths off the upper part of the trunk, thereby expos-
ing an extensive moist surface to evaporation, and totally defeating
the object which we seek by the use of the sheet to attain." [Mo7ith.
Journ,

Antidote to Strychnia. Dr. Isaac Pidduck states {Lancet, Nov.
1848) that camphor is an effectual antidote to strychnia. The fourth
of a grain of strychnia (instead of the sixteenth, which had been pre-
scribed for neuralgic pains) as taken by a weakly man. His muscles
were convulsed with tetanic spasms. Five grains of camphor were
dissolved in almond emulson, and almost immediately after taking
this dose the spasms ceased. [^American Journ. Med. Sci.

184 Monthly Periscope. [March,

Mode of rendering Sulphate of Quinine Tasteless. Dr. John Hardin,
of Greensburg, Ky., informs us that he has been in the habit, for some
time, past, of administering sulphate of quinine in an infusion of slippe-
ry elm, and finds it the most eligible methed he has ever tried. It is
easy to invest the powder completely in the thick mucilage, and thus
deprive it of taste, which is an important point where the patient is a
child. Western Journal of Med. and Surg.

St. Thomas^ s Hospital. Mr. Grainger on Cholera. The announce-
ment that Mr. Grainger would deliver a discourse on cholera, attracted
^ crowded assembly of medical and non-medical hearers to the great
hall of this -hospital on Wednesday, Jan. 3d. Mr. Grainger sketched
a very animated parallel between fever and cholera, and endeavored
to show that hotfi these aflections are epidemic, but not contagious,
maintaining that if they were Communicable from man to man, their
progress could not possibly be arrested. He remarked that the poor
SLt Hamburgh suffered five times more in parts surrounded by stagnant
ditches than the same classes in healthy localities of the town ; that
in the same city, hardly one-tenth of the applications for relief,
dyring the reign of the epidemic, came from those parts which
had been rebuilt, after the destructive fire, on more improved sanitary
principles ; that in Coatbridge (Scotland), a place surrounded by
filthy ditches, forty cases a day occurred in a population of 10,000;
and so much as 140 per diem were reported in Glasgow, where filth and
overcrowding are extreme. The disease is essentially an affection
of the blood ; all the well-known phenomena are only secondary to the
original poisoning of the vital fluid, and the discharges are an effort of
Nature to get rid of the noxious substance introduced into the system.
The secretion of bile is not arrested, the gall-bladder is ever found
full ; but it seems that something arrests the reflex action which impels
the biliary fluid into the ducts. The surest sign of the disease is the
suppression of the renal secretion, and the kidney takes the morbid
characteristics of Bright^s disease. Mr. Grainger concluded his ex-
cellent address by pointing out how lamentably ignorant most classes
of society are regarding sanitary questions ; the Irish at Glasgowfancy
the medical men want to poison and get rid of them; numbers of parochi-
al boards contend that houses can do very well without certain conven-
iences; and so many as one hundred families live in a limited row of
buildings at Glasgow, who, with a very wealthy man as a landlord,
have but one water-closet for them all ! [London Lancet.

New mode of Dilating Strictures of the Urethra, M. Amussat, in a
case of stricture which resisted all treatments, and beyond which or-
dinary instruments could not be passed, finally succeeded in intro-
ducing a very fine bougie of half a millimeter, (the millimeter is equal
to 1-26 of an inch English.) and, using this as a conductor, on the
following days introduced alongside of this successively several others,
to the number of six. Between these the urine passed. They were
left in for several days, being occasionally withdrawn and re-intro

1849.] Monthly Periscope. 185

duced in a bunch, passing as easily as a single bougie of the same
size would. The stricture was now readily dilated with ordinary
instruments and the cure rapidly effecled. I'he advantage of this
method is, that when once we can introduce an instrumtnt, however
small, there is no liability to failure in introducing the bougie a second
time if once withdrawn, or in attempting to pass a larger one. What-
ever is gained is maintained, and the first intioduced serves as a guide
to other instruments* of the same size. The dilatation can thus be
readily accomplished, and the urine passing between the small bougie
they can be retained several days without inconvenience. [Jeuni. de
Med, ei de Chir., from Prov. Med. Journ.

A Remedy for Dyspepsia. For three years I suffered from dyspep-
sia in an aggiavated form, baffling every kind of medical treatment;
it was suggested to me by an mtel"ent physician, practising ho-
moepathically, to take smail doses of tincture of nux vomica. 1 had
not to take it long, before its beneficial effect was apparent ; and from
that time (three years ago) to the present, 1 have never suffered from
dyspepsia. Having, been a sufferer fVom it, I can sympathize with a
fellow sufferer, and feel it a duty to tell him of the remedy that has cured
me and many others, to my own knowledge. \_A London Surgeon.

Application of live Subcutaneous section to the treatment of Lipoma.
M. Bonnet treats fatty tumours upon the above plan with success
He first introduces a sharp-pointed tenotomy knife under the tumour,
and then with a probe-pointed bistoury divides the tumour upwards
towards the skin, so as to reduce it to several lobules ; he then squeezes
the tumour so as to extravasate the fatty matter, and leaves it
to be removed by absorption. This operation is repeated several
times, according in the size of the tumour. No injurious effects have
fodowed in the cases which he reports, but the results have been so
favorable that he is induced to prefer the operation to the methods
in general use. [Pro. Med. and Surg. Journ., from Bulletin de The-
rapeutique.

Reduction of Incarcerated Hernia. By M. Amussat- The method
adopted by M. A.^ which has olten succeeded in causing reduction of
incarcerated hernia, when other measures had failed, is the following:
A board being first placed under the pelvis, in order to give a solid
fulcrum to the efforts of the surgeon, both hands are applied to the
tuimour, exercising ;a moderate degree of pressure upon it; this pres-
sure is gradually increased, by the super-position of the hands of the
assistants over those ofthe operator. Thus the efforts can be uninter-
ruptedly continued for a considerable length of time without fatigue
to the surgeon, and often with the most satisfactory results. London
Med. Times from Revue Med.

Calomel as a local application in Chancre. This is a favorite treat-
ment in the hospital, iti all obstinate chancres and buboes which will

186 Monthly Periscojye. [March,

not heal after being opened. The powder is sprinkled freely over the
surface, which is then dressed with lint wet with dilute solution of
chloride of soda. I have repeatedly noted the most striking results
from it, where the black, wash had. entirely failed. [^Anier. Journal.

On Photuria, or Luminous Urine. Cases, however rare, have been
cited, in which the urine, as it passed from the urethra, had a lumin-
ous appearance. The phenomenon lias not been explained, therefore
the following case, with the observations of M. Fallot, will be read
with interest :

A man, aged sixty, had for many years, at intervals, passed lumin-
ous urine; the luminous appearance was most distinct as the fluid
dashed on the ground, but a few sparks were seen in the stream as it
passed from the urethra. Examination discovered nothing particular
in the fluid, which varied iiPits constituents according to circum-
stances.

M. Fallot thinks that these cases would be found to be more com-
mon if attention were directed to them, but that as the aflTection is not
accompanied by any notable derangement of health, it passes unob-
served. In the case referred to, the patient had never alluded to the
circumstance until he was questioned concerning it, in consequence
of its being accidentally witnessed by M. Fallot. [^Prov. Med. and
Surg. Jour., from Rev. Med. Chirurg.

Application of Laudanum in Orchitis. It is well known that the
pain which attends the acute stage of orchitis and blennorrhagic epi-
didymitis is most intense. M. Voillemier employs the following
treatment, which relieves those pains when most intense, in a few
hours. He envelops the inflamed testicle in a compress dipped in
pure laudanum, and covers it with oiled silk. In three or four hours
the organ is narcotized ; the pains cease and the inflammation always
rapidly abates. [Gaz. des Hopiteaux. American J ourn. Med, Sci.

On the Use of Stomachics in Dyspepsia. Your heavy feeder's safe-
ty lies in his dyspepsia: cure this and you kill your patient. The man
who takes five times too much nourishment into his stomach, w^ould
die at once, if the digestive system would convert it into five times too
much blood. He that habitually overfeeds, suffers from a dyspepsia,
which prevents more blood than is necessary being elaborated, and is
much more frequently the cause of a deficient supply. A certain
quack medicine once obtained an extensive reputation for the cure of
gout. The Duke of Portland, whom it had benefitted, bought the
recipe for two thousand guineas, and made it public. Hence, it was
long known as the Portland powder. All who suffered from gout or
dyspepsia, fortified their stomachs for the pleasures of the table with
this medicine, and agreed that they never felt better or enjoyed them-
selves more. Sombody, however, at length discovered that no one
lived long, after being cured by the Portland powder. All died in the
course of two or three years, of apoplexy, or an attack of acute inflam.

I84d.} Montkly Periscope, 187

mation. The tonic action of tlie bitter ingredients of this medicine
had enabled tiie digestive system to elaborate a larger supply of blood
than was necessary, and the brittle vessels of the brain were burst by
the distension to which they were subjected, whilst a predisposition'to
acute inilammation arose from a redundance of organizable material.

[Prov. Med. and Surg. Joum,

Local AncBsthesia. M. Jules Roux recommends the application of
liquid chloroform to the surface of a wound left after an operation,
while the patient is still in a state of general anaesthesia, with the view
of benumbing the cut extremities of the nerves. The local insensi-
bility is maintained, according to M Roux.. for forty-eight hours (?)
and the patient is thus exempted from pain, both during and after the
operation.

A case of hydrocele is described, in which M. Roux injected four
drachms of chloroform into the sac. Two drachms were allowed to re-
main. The case ran the ordinary course, a cure being obtained in
fourteen days. Gaz. des Hop.

[A few days ago we applied liquid chloroform to an ulcer on the leg
of a female, which required cauterization with the nitrate of silver.
She appeared to suffer little pain from tl^ chloroform, and certainly
very much less than usual from the cacltic. She refused to inhale
the drug. ]^ Monthly Rctros.

Chloroformin the Treatment of Ophthalmia. M. Uytterhoeven has
enTj:>loyed chloroform successfully in various forms of ophthalmia. In
a patient at the Hopital St. John, Brussels, he soothed by this means
neuralgic pains resulting from injury of the eye. He has also found
chloroform very useful in photophobia of scrofulous ophthalmia. M.
U. prescribes it as acollyrium, in the dose of eight drops in an ounce
of distilled water.

MM. Rusch and Cunier have administered it in the dose of 8 to 16
drops in a mucilaginoiis portion of 60 grammes; to be taken in tea-
spoonful doses in the 24 hours. The benefit obtained fron:: it in eight
cases of chronic scrofulous ophthalmia, and in one of neuralgia of the
eye, was very remarkable. [/oMmoZ des Connais. Medico -Chirurg.
Amer. Joum. of Med. Sciences.

Minute Injections. Dr. Hershfield, who has become celebrated in
Paris for the perfection of his minute injections, adopts the following
method : The subject being placed first in a bath for some hours, the
following mixture is injected : For the arteries : oil, one litre ; Ver-
million, one and a half lbs. For the veins: linseed oil, two litres ;
white lead, 1 lb. ; indigo, q. s. The addition of two tablespoonfuls of
soft Venetian turpentine, renders the mixture as penetrating as pos-
sible. [Neic-York Journal of Medicine.

188 Medical Intdligence. [March,

MEDICAL INTELLIGENCE.

The State Medical Convention. After Uie notice issued by the Faculty of the
Medical College of Georgia, and published in our last No., for the Physicians
of the State to assemble in Aiigur>ta on the 20th of February, to organize a Medi-
cal Association, the Georgia Medical Society (ofSavalinah) made a suggestion
for the meeting to be held in Macon on the 20ih'of March. This was soon fol-
lowed by an article in one of the newspapers of Savannah, stating the change
of place and time of the proposed Convention of the Physicians of the Stale.

The Facuhy, desirous of unanimity on the subject, accordingly issued a cir-
cular and addressed it to all the Georgia subscribers of the Journal, stating their
cheerful acquiescence in the suggestions ol the Medical Society of Savannah.
The meeting, therefore, of the Physicians of the Slate, is called for the 20^/i of this
7iio?ith, (March,) in the city of Macon.

The Georgia Rail-road, the Stale Rail-road, and the Macon and Western
Rail-road companies, have each reduced the fare one half to all attending the
contemplated Convention of Physicians at Macon. From the Central Rail-road
Company we have received no reply from the Physicians of Savannah who
were requested to make application but doubt not the same arrangement has
been or will be made. It is understood that the signature of the President of
the Association will secure a free return passage.

As our name has been assoirited with the efibrt to get up this Convention
of the profession of the State, and as we shall in all probability be prevented
attending the meeting, we throw out the following hasty suggestions to those
who may be present on the interesting and important occasion:

The notice is addressed to the Physicians of the State of Georgia. In the or-
ganization of the meeting, each county should be called alphabetically and the
representatives thus registered. We presume all regular practitioners in good
standing, having a diploma or not, are included in the call. Bui every one,
even if he has a diploma, and we care not from what College, who is at present
engaged in the practice of any exclusive or special system of medicine, ought to
be excluded. 01 this, however, the meeting will be fully competent to determine.

There should be a registration of all the regular Physicians of Georgia.

Action should be taken at this meeting on the proceedings oi the National
Medical Association.

Our indigenous medical Botany ought to be investigated.

The general and rapidly increasing p-esciiptiojis by Apothecaries and Drug-
gists ought, if })ossible, to be checked or prohibited,*

A legislative enactment prohibiting the sale or use of any nostrum, which has
not the composition fully and accurately described accompanying it, deserves
the consideration of the Physicians of the Stale.

The subjects of Medical education, the lengthening the course of instruction
in our Medical Colleges, the support of a Medical Journal, &c., &:c., will of
course claim a considerable time of this body of the proiession.

The call of the Convention in Macon during the progress of the course of
Lectures, will of course prevent \ht Faculty of our College attending as a body,
or all of us, as individuals: still a delegation will be sent to the meeting.

* We were called this very day to a lady poisoned by an over-dose of morphine, prescribed
in a cough misLtuic by a druggist.

1849.]

Medical Intelligence. 189

Dr. J. A. Eve's Introductory Lecture on Medical Education. We have refrain-
ed, from obvious reasons, from expressing our own opinion respecting this
Introductory. We may, however, with every propriety, give place to those ol
others; especially, that our own physicians, about to meet in Convention, may
know what is thought abroad of the actions respecting this all-imporiani sub-
ject Medical Education takgn long ago, and now confirmed by lengthening
the present course, in the Medical College of Georgia.

From ike Annalist, of New York.

Introductory Lecuures, Medical Education, die Since our last issue we
have received a very interesting Introductory Lecture on the subject of Medical
Education from Prof Eve of Georgia, and another on "The Importf^nce of
Professional Studies," by Prof Grant of Memphis. The latter is a well written
and sound appeal, to the class before whom it was read, in favor of devoting
their whole time and talents, iinremiuingly to their prolession. And the fact,
that excellence can only be attained by the most assiduous labor, is set forth and
illustrated in a manner that could not f;iil to inspire a higher ambition, and a
nobler purpose in the minds of his hearers. The lecture of Prof Eve, is devo-
ted to the much discussed and ever interesting topic of Medical Educati-on and
Reform. He warmly espouses the cause ot improvement, and congratulates
his class on their good fortune in enjoying a prolonged lecture term ; and in
consequence, of greater lacilities for the acqtiisition of medical knowledge.
The Trustees and Faculty of the Georgia Medical College have ever been among'
the foremost advocates of a more elevated standard of medical attainments.
They adopted a six months course at the outset^ their career; and lor several
years strenuously endeavored to induce other schools to adopt the same, but
failing in this, they were reluctantly compelled to fall back on the short terms
so universally adopted by others. On the subject of the length of lecture terms,
however. Prof E. has the following very ju.'^t remark : "The five months course
is merely an approximation to the proper term. Lectures shmUd be continued
through the greater part of ike year; at least as long in medical, as in literary
colleges. The elementary branches should occupy the first, and the practical
branches the latter half of the collegiate course this would allow the student
to attend on hospital practice to some profit." This is taking the right position;
and if the professor had added to this continuance of the college term, a further
subdivision of labor, by attaching to each school 12 or 14 professors, instead ol'
six or seven; and so arranging their courses that the pupil need take, in any
one season, only so many tickets as he was prepared fully to pnjfit by, and the
remainder the next season, and so on, he would have come up to what we think
a Medical College should be. By such a subdivision of labor in the art of
teaching, connected with the proposed extension of term, every part of the ex-
tensive field of Medical Science could he fairly and thoroughly presented, in
such order that first class students would not be under the necessity of listening
to lectures on Surgery before studying Anatomy, or on Theory and Practice
before Materia Mediea, as is now frequently the case in our best schools.
Again, by narrowing the field ol each Professor's labor more perlection and
exactness would be attained by all, and a far greater amount of professional
talent concentrated in each school.

But no such reform can or will take place, so long as the degree of M. D.
conferred by the colleges, is universally recognised as a full admission into Ihe
profession. And for proof of this, we want no better evidence than is furnished
in this sante lecture of Prolessor Eve. Why was it that the Georgia College
could not sustain itself with a six months term while all other schools practised
but four?

It ceriainlj^ was not because six months did not ftirnfsh greater facilities for
the same amount of money, than four months; but it was plainly because stu-
dents could graduate in a shorter time elsewhere. And the graduation con-
stitutes with very many, at least, the ruling motive. If we sliould establish
two literary college;-, in the same place, possessing equal merits in all respects,
except one gave a term of six months for one hundred dollars, and the other
only four for the same sum, docs any one doubt which would command the

wo Medical Intelligence. [March,

largest class 7 Certainly not, because the object of the literary student is to
obtain knowledge. But abundant experience has demonstrated, "that the M. D.
so far interferes with this, the only legiii-mate object of th*". student in choosing
a college, that it often holds a predominating influence ; and hence the question,
where can I gain the greatest amount of sound medical knowledge, is lost in the
more influential query, where can I graduate the most cerlainlij and in the
shorkst time 7 ^

Again we have the authority of this lecture, corroborated by Prof. Yandell.of
Louisville, and Prof. Moultrie, of Charleston, staling that a medical college,
recently established in Philadelphia, has taken up, and in a few weeks, confer-
red degrees on students, only just previously rejected by other schools. And we
know of a notorious homoeopath, who holds and flourishes a diploma, from one
of our old established medical colleges, and yet he has never attended one whole
course of lectures in any college during his life. Nor is this all; for we have
more than once known students apply to certain medical colleges for admission
as candidates for graduation, before ihey hadstudied the required length of time,
or were of the required age, or Aviih a previous understanding that they should
have their degree at the end of thterm, without reference to the quality ofiheir
examination; and on beins: refused, a very few weeks have shown their names
on the matriculating books as candidates for graduation in other schools. Now
we repeat what we have before asserted, (and been roundly abused lor doing it
too,) that a connection which is constantly leading to such corruption and abuse,
and which effectually prevents any medical college in the country, from resting
its patronage entirely upon its merits as a .school of medical learning, 75 radi-
cally wrons in principle, and owjhL to be abolished. And unti^ human nature
is thoroughly regenerated, the^union of the teaching and gradoating power in
the same hands, will constantly retard, if not effectually thwart the wisest meas-
ures for improvement that can be devised. But more anon.

Frovi the Western Journal of Medicine and Surgery ^ of Louisville , Ky.
The lecture of Dr. Eve treats of a variety of subjects, the most prominent of
which is Medical education. He reviews, somewhat in detail, the various re-
commendations of the Medical convention in regard to preliminary education,
the extension of the lecture term, &c . and expresses a hearty concurrence in all
the suggestions which look to the elevation of the profession. The tone of the
lecture is frank, earnest, and manly. Its author does not hesitate to speak of
abuses wherever he findsthem; but while inveijjhing against them*with a gen-
erous indignation, he never loses sight of the charities of the christian, nor of
the language that befits the refined physician.
* * *,* *

But bad as this is, it is not the worst aspect of the case, A sorer evil is ad-
verted to by Prof Eve, in his introductory lecture, as having grown out of the
scramble for students. He says-^

"In Philadelphia there are five medical colleges, which causes a competition
and contention for pupils derogatory to the profession. In vain do other colleges
reject unqualified candidates, When they have only to go to Philadelphia, to
be certain of a diploma in a few months, however limited their qualifications.
These fact.'? are too notorious to require scruple or delicacy in advertingto them.

"While in Philadelphia, we were informed, that a student who had been re-
jected by the University obtained a diploma, a fortnight after in that city. In no
other city does the same corruption, do the same enormous abuses exist. It is
certainly more iticumbent on the physicians of Philadelphia than all others to
be active and energetic in the work of reformation."

A similar statement was made to us, by gentlemen in Baltimore and Phila-
delphia last spring, and the character of the authors leaves no room to doubt its
truth. Here then, at the emporium of medical .science in America, in the city
of Rush, Wistar, and Physick, is an institution, chartered by the commonwealth,
in which the rejected candidates of other medical schools, after a few weeks'
study, are invested with all the honors of the doctorate. The fact ought to be
proclaimed abroad, that physicians when they send their sons and pupils to
Philadelphia may know what cautions to give them. By a letter just received

1849.] Medical Intelligence. 191

from a physician of Mississippi who is passing the winter in Philadelphia, we

are glad to see that students are fully apprised of the standing ot this institution.
"Tbey look upon it," he says, "with perfect contempt. Two of the professors

lelt it after deliverinor their introductories, and ' lectures on three different

branches himself. He cannot ^et respectable physicians of the city to join him."
Dr. Burden, and Dr. Thomas D. Mitchell, resigned their chairs in this school
at the close of the last summer session.

From the same gentleman, we learn that the Franklin Medical College has
closed doors, and that the building has been sold to the Catholics for a hospital.
** ******

Professor Joseph A. Eve states in his Introductory Lecture, that the Medical
College of Georgia, at its organization, adopted six months as the length of their
lecture term, but that after persevering five years "with liitle encouragement
and patronage," the professors finally came down to the short sessions of other
schools. " Alter the adoption of the four monlh's^erm," he remarks, " the classes
increased rapidly."

We lake great pleasure in quoting this piece of medical history, not only as
an act of justice to a highly respectable institution, but as illustrative of that
progress in the profession signs of which are visible all around us. A number
of schools have adopted a lengthened term, and they experience no diminution
in the size of their classes. A few years have wrought a signal change in pro-
fessional opinion, and the schools are conforming to that enlightened judgment.
In all the schools the sessions, in a few years, will be extended; and dissections
and clinical instruction will be insisted upon, as pre-requisites to graduation.
It gratifies us to learn that the Medical College of Georgia is prosperous. With
a gifted faculty, alive to the true glory of their profession, ready to second every
movement tending to its advancement, high-toned and manly, it deserves to
prosper.

From the Western Lancet, of Cincinali, O.

Professor Eve adverts to the present state of the profession, and while he
laments the defectiveness of medical education in our country, expressly
declares that he has no sympathy with those who deplore the degeneracy of our
colleges, and sigh for the palmy days of old. On the contrary, he believes that
the profession is far in advance of its former condition, and our colleges far
superior to those of an earlier period.

These sentiments fully accord wifh our own, so qft repeated ; and we are
gratified to find one .<?o candid and manly as Dr. Eve to stand forth, and maintain
a position so just and liberal. The profession of medicine, we admit, needs
further improveaient, and it is improving quite as rapidly as any of the natural
sciences. And no impartial observer can for a moment believe that it has not
improved upon its former condition. What, then, do we need ^ Reform ? No (
for that implies that we are now radically wrong, and that some other system or
teaching is demanded. We need, then" perseverance, the correction of some
abuses, but no radical changes.

Dr. Eve is a .strong advocate for the extension of the Tectnre term in colleges.
We a?ree with him in that opinion. And we may ask, why is it not universally
adopted 1 Because there is no concert of action; the recommendation of the
National Association has been disregarded by some schools, from interested
motives; and others, surrounded by such, feel it difficult to act alone. We
hope to see the time when this evil may be corrected.

The author also adverts to the evils arising from legislative enactments
legalizing empiricism, and multiplying colleges to an injurious extent. And
he expresses the opinion that Pennsylvania and New England have especially
sufferedby the multiplicity of schools. "In Philadelphia," he continues, "there
are five medical colleges, which causes a competition and contention for pupils,
derogatory to the profession. In vain do other colleges reject unqualified can-
didates, when they have only to hasten to Philadelphia, certain of a diploma in
a few months, however limited their qnalifications." And it is further stated,
that while in Philadelphia the author, was informed that a student who had
been rejected in the University, obtained a diploma in a fortnight after, in thai
city.

192

Meteorolos;ical Observations.

We of Cincinnati have ^ifood cause to feel the justness of the above remarks.
The legislature of Ohio, has seen proper to charter two empirical or botanical
schools, thereby placing them, so far as legal rights are concerned, on an
equality with the regular colleges ot the country. These schools take good
care to thurst themselves forward, and take every alvantange of popular preju-
dice and ignorance to sustain their deceptive systems. But they are schools of
medicine; they confer degrees; they claim even superiority in science, and
attempt to break down all distinctions between regular and empirical schools.
And the legislature the guardians of the pe(;ple (God save the mark!) have
done all in their power to elevate andgive currency to ignorance and deception,
and thereby to impair the usefulness of true science.

The m-idtip/ icity oi' schooh, to which Dr. Eve alludes, is felt not only in Penn-
sylvania and New England, but likewise throughout the West. This increase
of schools cau.ses, as coriectiv observed, "a competition and contention for
pupils derogatory to the prol'es^ion." Cya-pcning with nil of its attendant evils,
together with credits, personal favors, limited qualifications required, and many
additional evils, will as certainly spring from this system as miasm from bogs
and marshes.

Finally, Dr. Eve has written a well-timed, sensible and interesting lecture,
which is alike creditable to himself and the school to which he is attached.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feel.

for January, 1849, at Augusta,
32' west Wa.sh. Altitude above

<

Sun
Thrr.

Rise.
Bar.

1 2' ^
Ther.

67

P,M.
Bar.

Wind.

RExMARKS.

"1

38

20 9.'>-100

29 92-100

N. E.

n^air cloudy afternoon.

2

41

" 80-10

68

"84-100

N. E.

Fair.

3

44

" 86-100

43

" 80-100

E.

Cloudy drizzle a little.

4

38

" 72-100

52

" 07- 100

N. W.

Very cloudy morning.

5

32

' 90-100

48

" 93-100

W

Fair blow cloudy afternoon.

6

28

" 97-100

51

30

w.

Pair.

7

30

30

37

29 97-100,

E. & S.

Cloudy sleet in afternoon.

8

36

29 92-100

39

" 84-100'

N. E.

lain, 55-100.

9

41

" 52-10)

41

" 62-100

N W.

Drizzly breeze.

10

30

" 98-100

43

30 4-100

N.W.

Fair breeze.

11

25

30 23-100

44

" 25-100

N.

Fair breeze.

12

23

" 37-100

48

" 37-l()0|

E.

Fair.

13

37

" 30-100

53

" 20-100

S.

Cloudy drizzle.

14

52

" 5-100

70

" 4-100

a.

Cloudy.

15

62

" 3-100

1 70

29 95-100,

s.

Cloudy blow.

16

57

" 22-10!)

62

30 3-100

g. E.

Cloudy drizzle.

17

56

29 95-100

74

29 90-100'

s. w.

Cloudy blow.

18

54

30 4- 100

51

30 10-100

N. E.

Cloudy drizzle.

19

36

" 40-100

47

" 42-100

N. E.

Cloudy.

20

33

" 37-100

36

" 30-100

N.

Cloudy drizzle.

21

43

" 15-10

71

^' 7-100

W.

Cloudy blow sprinkle.

22

46

" 9-10!)

62

" 12-100

N.W.

Fair.

33

33

" l-2-10(

m

" 13-100

S.

Fair.

24

^

" 12-10

68

" 12-100

S.

Fair.

25 42:

^' 10-10

69

" 7-100

S,

Cloudv afternoon blow.

26 5(7

29 87-100

58

29 83-100

s.

Rain, 35-100.

27 46

*' 92-10;)

in

30

N. E.

Fair.

28

39

30 14- 10)

60

" 14-100

N. W.

Fair afternoon.

29

44

11-100

72

" 4-100'

w.

air with flying clouds.

30

50

30

77

29 93-100

s. w.

Fair.

31

57

29 91-100

78

" 93-100

SI w.

Cloudy afternoon.

10 Fair davs. auantity of Rain 90-100 of
S. 9 days. West ol do. do. 12 days.

an inch. Wind East of N. and

%*t*f

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. L] fflW SEtaS.-APWL, 1849. [No. 4.

PART PiRSr.

ARTICLE Xit

Malforrriation of the Genito-Vrinary Appctrdius. By L. Ai
DuGA^) M. D., Professor of Physiology and Pathologidal
Anatomy in the Medical College of Georgia.

Having just had an opportunity to eiamine the malformatiotl
existing in the person of Joseph Hayden, a native of Rhode
Island, about 21 years of age, we think that it may not be
\vithout interest to present to the profession a description of
its peculiarities. .The seat of the' malformation is principally
in the genito-urinary apparaftis, but this gives rise to modifica-
tions in the parts contiguous* The first feature that strikes the
eye is a red, angry looking sui^face, of nearly circular form and
about three inches iii diameter, just above the usual place of
the symphisis pubis. This surface protrudes considerably be-
yond the general level of the abdomen when the individual
stands up, but when he assumes the horizontal position the
protrusion gradually diminishes and finally subsides entirely*
Indeed, after having been in bed all night, atid before arising,-
the surface rather ptesents a depression. The protrusion is
therefore occasioned by the pressure of the abdominal viscera
and constitutes a species of heriila. Upon examining the red
surface it is found to be a mucous membrane which seCretes
healthy mucus, and which terminates abruptly at its circum-
fererice, where it is united with the skin of the abdomen.' '"At
the lower portion of this mucous membrane may be seen, about

N. S.- VOL. v. NO. IV. 1.1

194 Dugas, on Malformation. [April,

an inch apart, the orifices of two tubes which make their way
obliquely through it, and from which urine is continually drip-
ping. These are the orifices of the ureters, and the red surface
is the mucous membrane of the posterior portion of the urinsft-y
bladder.

But this red surface is elongated inferiorly so as to reach the
region of the symphisis pubis, at which place we find continuous
with it an imperfect glans-penis, about midway between which
and the orifices of the ureters are found two other orifices from
which the seminal fluid issues wh'enever the venereal orgasm is
excited. These latter orifices are, therefore, those which or-
dinarily convey the semen from the seminal vessicles into the
iHTethra. There is no urethra here however ; the posterior
portion of the bladder and" of its prostatic region being all that
is left, and their mucous membrane constituting a part of the
external surface of the body, the secretions from the ureters as
well as from the seminal and prostatic ducts are enabled to
reach the surface without their usual conduit, the urethra:
hence it is that the glans-penis is found attached to the remains
of the neck of the bladder and that its- superior aspect presents
a groove or fissure covered with mucous membrane, in lieu of
the urethra. The glans looks as though it had been cleft upon
the median line from its corona down to the urethra. The
prepuce would seem also to have shared the same fate, for it is
bilobed as well as the glans, as far down as the level of the
urethra its frenum being perfect. The corpora cavernosa
are of course entirely wanting, but the spongy texture of the
glans still remaining, this is susceptible- of erection under vene-
real excitement.

The testicles are in the scrotum, but this is much less capa-
cious and pendulous than usual, the testicles being located just
below the external inguinal ring. A slight inguinal hernia
shows itself on the right side. The hair which should occupy
the mous veneris is here found upon the sides of the mucous
sui'face just described.

There is no umbilicus perceptible and this case oflfers us a
specimen of some of those erroneously referred to in support
offhe doctrine that the foetus maybe nourished without the
direct communication with the mother afforded by an umbilical

1849.] Dugas, on Malformation. life

cord. The disappearance of the umbilical cicatrix is, however,
(in these cases at least) not conclusive evidence of the non-
existence of the unnbilical cord at a former period. In anoma-
lies like the one before us the umbilical cord has existed, but its
attachment was so near the upper margin of the exposed mu-
cous membrane of the bladder, that the cicatrix resulting from
its fall is continually subjected to the distension occasioned by
the pressure of the abdominal contents and the consequent
herniary protrusion of the mucous membrane. The umbilical
cicatrix has been here effaced by long traction and seems
blended with the imperfect cicatrix which results from the
union of the mucous with the cutaneous surface. It must be
remembered that the abdominal walls are here replaced by
those of the posterior portion of the urinary bladder. The
intestines are therefore at this place retained by a wall much
thinner than that formed by the abdominal muscles; hence the
herniary protrusion, which by its continual traction tends to
increase still farther this attenuation, especially at the umbili-
cus where the wall does not appear to be thicker than common
writing paper.*

We have thus far described only the external peculiarities of
this case ; but the malformation extends to the bones of the
pelvis. The pubic bones do not form a symphisis, but are
separated from each other from 2 to 2i inches. The whole
pelvis is broader than usual in the male and much resembles
that of a woman. The thighs are far apart, and the want of
firmness or of fixedness in the pelvis renders walking awkward
and tiresome.

The general aspect of Mr. H. may be thought by some rather
effeminate ; yet it is not more so than that of most men of fair
complexion, light hair, and rather scanty beard. His voice is
as masculine as that of most men indeed there is nothinor in

* The Museum of the Medical College of Georgia contains a remarkably fine
specimen of this malformation, sent to the Faculty by the late Dr. Foster of
Warren county. Being a full grown male fcEtus, in which the umbilical cord
has not dropped off, as the chiM did not live after birth, it may be seen that the
cord is inserted just at the upper margin of the mucoussurface,\vhere we would
naturally look for it, and where it is almost uniformly found in ectroversions
of the bladder. Besides these, we had an opportunity to seenvo others livino-, in
Paris one an adult male, and the other a female about 25 vears of age. In
these four instances the umbilicus was similarly located.

196 Dugas, on Malformation. [April,

his general appearance that would indicate any malformation,
save his gait, the freedom of which is impaired both by the de-
fect of the pelvis and the efbrt made to prevent the painful
friction of the exposed muccus membrane against the clothing.

The anomaly we have just noticed was first satisfactorily
described by Chaussier, ivho termed it alternately Ectroversion
and Ectrophy of the urinary bladder. It has also been called
Inversion, Prolapsus and Hernia of the bladder. It is evident,
however, that these terms convey but an imperfect idea of the
true state of things. Indeed, the complexity of the malforma-
tion is such that no single appellative can comprehend all its
features. It is therefore now most generally treated pf under
the head of Ectrove sion of the bladder, as this is not only the
most striking peculiarity, but also the probable cause, or ante-
cedent at least, of all the others.

Two theories have been proposed for the purpose of explain-
ing the manner in which these anomalies afe produced Whilst
Chaussier and others beheved that the bladder after haiving been
formed protruded through the unclosed walls of the abdomen,
and, adh ri ig to the sides of the fissure, suffered a loss of its
anterior portion by laceration, absorption or otherwise, M.
Isidore Geoffroy Saint-Hilaire,* invokes the aid of analogy and
of the well established laws of evolution, and very satisfactorily
demonstrates that we have here nothing more than an arrest
of evolution. The very interesting and we may add beautiful
researches of M. Serres upon Transcendental Anatomy throw
a flood of light upon this subject. They teach us that in the
process of evolution all the symetrical portions of the body are
originally distinct or separated from each other by a space or
fissure upon the median line ; that the symetrical portions situ-
ated upon this line unite more or less early in different localities ;
and that all the abnormal fissures that we find persisting after
the full evolution of the body are clearly attributable to an arrest
in the process by which the union should have been completed.
Such is the explanation of fissures of the lip, palate, abdominal
Walls, penis, clitoris, scrotum, pubes, &c., &c. If the process
of union had not been arrested in these cases the fissures would
certainly not remain.

Histoire des Anomalies, tome 1, p. 386,

1849.] Dugas, on Malformation. 197

Now in the case before us there has been an arrest of evolu-
tion in the parietes of the abdomen, the pubes, the bladder, the
urethra, the penis, the inguinal canal and the testicles. The
persistence of the abdominal fissure at the time of the formation
of the bladder permitted the anterior margin of each half of this
to adhere to the corresponding sides of the fissure, whilst it did
not prevent the union of the two posterior margins of the blad-
der. We accordingly find the posterior portion of this sac
presenting a normal condition and perforated by the ureters.
It must be remarked, however, that the bladder, after having
been thus far developed, has ceased to grow ; it is much smaller
than it should be in an adult, and the ureters open much nearer
the prostate gland than they do in the fully evolved organ.
There has been here an evident arrest of evolution, and this
arrest has extended very naturally to those parts the existence
of which is but a consequence of a fully formed or closed blad-
der, viz., the urethra and penis. The secretions from the kid-
neys, testicles and prostate being poured out upon the exposed
surface, there could be no use whatever for an urethra nor for a
penis. The corpus spongiosum, it is true, does exist, because
it is formed earlier than the corpora cavernosa and almost
simultaneously with the bladder, but we find that here, as in the
bladder, an arrest of evolution occurred just after the posterior
edges of the lateral halves had united, and that the anterior
edges have never grown together. The cleft then is continu-
ous from the anterior portion of the bladder down to the ex-
tremity of the glans penis.

Whether in the case of Mr. Hayden the spermatic vesicles
exist, or not, could not be ascertained. They have been found
wanting in some of the cases subjected to post-mortem inspec-
tion,* and this is in accordance with the general principles of
arrests of evolution, inasmuch as these vesicles do not exist at
all in many animals, and are formed comparatively late in man.

The very extensive researches of Mr. I. GeofTroy Saint-
Hilaire, have enabled him to verify the deductions of reason
in relation to the order and frequency of anomalies in the vari-
ous parts of the animal structure. He accordingly establishes
the general rule that anomalies are most frequent in the organs
* Diet, des Sciences Medicales, tome 14, p. 346.

198 Dugas, on Malformation. [April,

last formed, and that this is especiallylhe case in relation to the
several parts of a common apparatus. (Loc. cit., Tome 1, p. 440
et seq., and Tome 3, p. 390 et seq.)

In the osseous system, the bones last ossified are ihe most
often affected with an arrest of evolution. The nerves sufier
this arrest -much less frequently than does the spinal marrow,
and this less often than the brain, which is the last portion of the
nervous system evolved. The heart, which is formed long
after the aorta, is more frequently imperfect and even in this
organ the septum-au-riculum, which is the last portion perfected,
is also most commonly the seat of an arrest of evolution, by
wh'ch the foramen ovale remaias pervious.

We should add to the principles just ajinounced another
which may bs regarded as complementary viz., that whenever
the first formed organ or portion of an apparatus suffers ail
arrest of evolution, those which would have been fornaed sub-
sequently are usually found wanting. The impetus of forma-
tion, if we may use the expression, having been arrested in the
formation or evoloition of the first part of an apparatus, it is lost
to all the remainder. (Loc. cit., T. 3, p. 391.)

It will be perceived that with the aid of these general laws all
the anomalies existing m the case of Mr. H. are very easily
accounted for. We have seen that the arrest of evolution in
the bladder was but a consequence of the persistence of the
abdominal fissure. In the formation and evolution of the urin-
ary apparatus the kidneys are first formed, then the ureters,
the bladder, and lastly the urethra. In Mr. H.'s ease, the ai'rest
occurred only after the formation of the kidneys, the ureters
and the bladder to a certain extent. But the bladder having
remained only partially evolved, the urethra has as a conse-
quence remained in a similar state. Yet although the urinary
and generative apparatuses are, strictly speaking, distinct in
their functions, certain portions of each have an intimate ana-
tamical relation. Ilcnce it is that anatomical lesions of the one
will not unfrequeotly occasion modifications of the other, espe-
cially in the male sut)ject. in Mr. H.'s case the testicles have
been fully evolved, but they have not assumed the positioii they
would have occupied had all things progressed normally. They
are not hanging loosely in a capacious and pendulous scrotum,

1849.] Dugas, on Malformation. 190

but are found just below the external inguinal ring, and in a
contracted scrotum. Whether this is owing to an arrest in the
evolation of the sjrotum or in that of the spermatic cord, is not
certain. It is probal)]^, however, that the defective evolution
of the latter has occasioned that of the former. In many cases
the testicles remain permanently within the abdomen, and in
all such the scrotum is found to have suffered a corresponding
arrest of evolution. That the generative as well as the urinary
^apparatus has, in the case before us, suffered an arrest of evolu-
tioti is evident. In the order of their evolution the testicles are
first formed, then the seminal vessicles, the prostate gland, and
Jastly the corpora cavernosa. In the case of Mr. H. the testi-
cles are fully formed, but not fully evolved- We say not fully
evolved, because, if so, they ought to be in the place assigned
them in the normal adult. This arrest of evolution, although
slight with regard to the portion of the apparatus usually first
formed, must be moie manifest in those of subsequent forma-
tion. The spermatic ducts or vasa deferentia, may terminate
abruptly upon the raucous surface, or they may first give rise
to the formation of the vesiculae seminales, which themselves
imay be more or less perfectly developed, and lead to a similaa*
state of things in the prostate gland. It is probable that, inas-
'.much as the prostate is evvidently partially developed in Mr. H.,
the seminal vesicles are likewise more or less so. The effects
of the arrest being, ^however, more and more marked as we
^ome to the last foi^med portions of the generative apparatus,
we are prepared -to findihat.it lias entirely prevented even the
formation* of the corpora eaivernosa.

This malformation, although exceedingly interesting to those
who are fond of the study ofnature's works, whether normal or
otherwise, is to Mr. H. a very serious grievance. He is affect-
ed not only with impoteacy, but with an inability to retain his
urine. This, by continually dripping and flowing over the glans
penis, the scrotum and the thighs, keeps these surfaces more or
less excoriated and painful. He has observed that whene^^er
his digestive functions are impaired the acrimony of the wrine

The terms formatio7i and development or evoluiion are not synonymous. An
organ may be formed without being ever evolved. The heart, the 'brain, &c.,
^re formed long before their full development or evolution.

200 DugBS, on Malformation, % [April,

]g very much increased sometimes to such a degree as to de-
nude almost the entire surface upon which it passes. Moreover,
he finds it very difficult to prevent his garments and bed from
being more or Jess impregnated with urine, the odour of which
is a source of great annoyance both to himself and to those who
approach him, Besides the inconveniences consequent upon
the incontinence of urine, the patient suffers from the friction of
his clothes against the mucous membrane, and, whether stand-
ing or reclining, is compelled to protect this surface. This he
4oes by a very badly contrived apparatus, consisting of a con-
Gave metallic pad, fixed to a belt and placed over the mucous
surface, and to which is attached one end of a folded napkin
which passes dow^ over the perineum and is fastened by its
pther extremity to the posterior part of the belt. It is a matter
of no Httle surprise, that one reared in the *'land of inventions"
has not been provided with something more appropriate to
comfort as well as to cleanliness. By substituting for the napkin
a bag of India rubber fabric, or even of oiled silk, containing a
sponge, this would absorb tb^ urine, which could from tmie to
time be expressed and the sponge replaced. By renewing the
gponge occasionally, or cleansing it well, all unpleasantness of
odour would be efiectually avoided.

But the patient suffers considerable inconvenience, and we
might add danger from the forcible protrusion of the mucous
membrane by the abdominal contents. The walls of the blad*
der are well known to be very thin when compared with those
of the abdominal parietes and are in this case, as has been
already observed, almost as thin as writing paper at the umbili-
eal cicatrix, Whenever he takes much exercise, or is affected
with cough, the tension causes much irritation and pain in the
bladder, which are increased by muscular efforts, Indeed he
is constantly in danger of rupture, which might prove fatal,
In view of this state of things the question naturally presents
itself is there no relief to be expected from mechanics nor
from surgery? As this protrusion is really herniary, the appli
cation of a truss might be proposed, Bnt it is evident that the
j)ad could not be endured by the mucous surface to which it
would have to be applied. The irritation would soon become
intolerable, whatever might be the nature of the pad or of the

1849.] ' Dugas, on Malformation, 201

interposed medium. We know of no mechanism by which the
protrusion may be prevented.

Surgery we think promises more nay, entire relief, so far at
least as relates to the protrusion. We have stated, that after
being in bed during the night the position of the mucous sur-
face is reversed ; that in lieu of a protrusion we find a depression.
In the case of the child referred to as being in our museum, and
similarly affected, the body is suspend^^d by the knees to the
upper part of the bottle in which it is immersed in alcohol. In
this position the weight of the abdominal contents is entirely
removed from the bladder, and this, so tar from protruding,
recedes into the abdomen so as to present a pouch. In this
case it would certainly be very easy to bring the lateral bor-
ders of the pouch together, to denude them just beyond the
mucous membrane, and to maintain them in apposition with
pins or sutures until adhesion would be effected. In short, by
an operation similar to that for hare-lip, the skin upon each side
of the mucous surface might be made to adhere. In this event
the mucous surface would be folded upon itself, and would con-
stitute a sac more or less complete. The effect of such an
operation, if successful, would be to conceal the mucous sur-
face from view, to strengthen this portion of the abdominal
walls, and, if necessary to permit the application of a truss.
The urine would continue to flow as fiist as secreted, but if
caught in a sponge, as suggested, it would be attended with
comparatively little inconvenience.

In the case of Mr. H. the operation would not be so easy as
it might have been in the child alluded to. Yet upon a careful
examination of the parts we found that the integuments on each
side of the abdominal fissure were much more yielding than
might be supposed, and that by gradual traction they could be
brought entirely over the mucous surface so as to be secured
in apposition. The operation could certainly be neither very
painful nor in anywise dangerous.

Having fully explained our views to Mr. H., and offered to
make the attempt to relieve him, he consented, and promised
to return to Augusta after a short visit to a neighboring city.
Should his fears not deter him from doing so, we will lay the
,,,.., .,u ipfore the profession.

202 Harriss, on Saliva. % [April,

ARTICLE Xir.

Notes upon the Properties of Saliva and its use in Digestion-,
taken from the Lectures of M. Bernard, and contained in a let-
ter from J URIAH Harriss, M. D., of Georgia, now in Paris.

It is not my object now to mention those properties of saliva
which are so well know^a a^nd generally recognized, but merely
to give a short sketch oi some recent experiments and their
results, by M. Bernard. I shaH find it necessary, however, in
order to give clearly his views, to mention some of the estab-
lished properties of this fluid. First, then, it is generally admit-
ted that saliva is alkaUne. The mucus of the mouth, as all
other mucous secretions, is add when exposed .to air. This has
led some to believe thai the saliva is acid. It is true that the
the saliva when taken from the mouih is sometimes acid, but
this is the msult of a great quantity of mucus being mixed with
it. If a person whose saliva seems to be acid will smoke, he
will soon expectorate the mucous -secretion, and then his saliva
will be alkaline. Among the great variety of substances which
we eat, saliva acts alone upon starch. It acts neither upon
albumen, fibrin nor oils, nor indeed upon any other substance of
which our food may he composed. If saliva he allowed to re-
main in contact with starch for a short time, the starch will be
transformed into dextrine; if allowed to remain longer, it will
be changed into sugar ; and if -^ill longer, it will be transformed
into lactic acid, as it is generally believed. If saliva be taken
from the mouth and placed into a gkss vessel it will distinctly
separate into three strata. The first will be the mucous secre-
tion which floats upon the top, the aext the clear saliva, and the
last the epithelium from the mucous membrane of the mouth,
which is deposited at the bottom of the vessel M. Bernard has
discovered and demonstrated in his lectures, that although the
anatomical construction of the salivary glands is apparently the
same, yet the fluids secreted from them are diflferent and theij*
office somewhat unlike. He has shown that the fluid secreted
by the parotid is clear and limpid, whereas that secreted by the
sub-maxillary is glutinous. The sub-lingual secretes the same
kind of fluid as the parotid, and the orbital (formed in the dog)
secretes the same as the sub-maxillary. These facts, so im-

18^ii).] * Ilarriss, on Saliva. 203

portant io understand well the office of this fluid, he demonstra-
ted by taking the fluid separately from each gland. Thus, to
prove that the parotid secreted a clear limpid fluid, he cut (upon
a dog) down to the duct ofsteno, ligated it, and then made an
opening into it upon the portion of the duct nearest the gland.
He formed a fistula. To show that the sub-maxillary and orbi-
tal glands secreted a different fluid, he performed the same
operation upon their respective ducts. As acids are well known
excitants of the glands, he placed in the mouth of the dog some
acid ; this caused the saliva to flow freely, when he caught it
in separate vessel-sas it ran from each gland. Thus he had the
saliva from each gland pure and unmixed. He proved first that
the fluid from each gland was alkaline, and that when they were
mixed they were yet alkaline. He next showed that the saliva
from the parotid and sub-lingual was clear and limpid, whilst
that from the sub-maxillary and orbital was glutinous. He
showed also that if you triturated either of the glands in a
little warm water you would have the same kind of fluid as that
which the gland naturfilly secreted that the parotid and sub-
lingual would produce a clear fluid, and the sub-maxillary and
orbital a glutinous.

The discovery that saliva would transform starch into sugar
was made by M. Zench, a German, and since then the error
has continued to prevail. M. Bernard has most conclusively
shown that saliva does not possess this property; that it cannot
of itself produce this .effect; but that it derives it from the mu-
cus. Jle demonstrated it thus: He took :the saliva, pure as
it ran from each gland, by the means just mendojaed, and mixed
them in separate vessels with starch. In neither of these ves-
sels was sugar to be found. He then mixed the Scdiva coming
from each gland in a o^essel in which he also placed starch, nor
^et was there the least manifestation of the presence of sugar.
This proves, beyond a doubt, that the property does jiot exist
either in the saliva from any one gland, nor in them all com-
bined. If, however, the saliva be taken from the jnouth and
placed in a vessel with anaidon, the sugar will be readily pro-
duced showing that it derives the property from this cavity.
What then gives it the property to produce the change? It
evidently derives it from the mucus which becomes intimately

204 Harriss, on Saliva. [April,

mixed with it in the mouth. This is proven from the fact that
the mucous secretion from any mucous membrane will produce
the same change even that from the rectum : and farther, a
mucous membrane placed in a solution of starch, will produce,
as a result of its action, sugar, and finally lactic acid. M. Ber-
nard stated that any fluid from the economy will bring about
the same result, even the serum of dropsy ; but he added, one
must not suppose from this fact that they would assist in
digestion. He however stated that he once saw a case in
which the saliva from the glands did apparently produce this
effect before it had entered the mouth. This was a man who
was wounded in the late revolution. The ball entered one
cheek, passed through the mouth, and made its exit through the
other cheek, opposite its place of entrance; it cut the duct of
steno in its passage, and a fistula was of course the result. This
is the only case among the four or five which he has seen that
seemed to contradict his theory. He found, however, upon a
minute examination of the case, that there existed a communis
cation between the fistula and the cavity of the mouth, through
which communication the mucus from the mouth became
mixed with the saliva. This apparent difficulty was thus satis-
factorily explained.

Ptyaline is one of the principal components of saliva. It is
insoluble in alcohol. If alcohol be placed in a vessel which
contains saliva, ptyaline will be deposited in the bottom. It is
this which gives to saliva its viscidity. It is found in the sub-
stance of the glands, and may be obtained from them by mas-
cerating them in a little warm water.

The test of the presence of amidon is tincture of iodine, which
turns a mixture of it blue. It was by this test that M. Bernard
proved that there was no sugar produced, and that the starch
was unchanged when placed in contact with saliva taken from
the glands before it had entered the mouth. When dextrine is
present, the same test gives a rose color, whereas with sugar
no color is produced. When sugar of the second kind is placed
in a warm solution of potash, a blue color is manifested. I
mean the grape sugar, for it is the only kind found in the animal
economy. Sugar of the first kind, or cane sugar, boiled with
an acid, is transformed into sugar of the second kind, after

1R49.] Harriss, on Saliva. 205

whichno farther alteration takes place. Cane sugar is changed
into grape sugar in the stomach, and is then digested. Grape su-
gar is constantly formed in the liver. If you kill an animal, and
a short time after analyze the blood of the hepatic vessels, sugar
will be found in it it is formed in the liver, and regurgitates
into these vessels after death. If you kill the animal and take
the blood from these vessels immediately, no sugar will proba-
bly be found : this i.i owing to the fact that time is not allowed
for the regurgitation. The test which M. Bernard uses to
prove the presence or absence of sugar in saliva or other fluids
is tartrate of copper and potash. If it be present, the solution
is turned blue by this test. M. Bernard, after showing that
saliva taken from the mouth (or rather the mucous) wonld turn
starch into sugar, gave a dog a solution of it- to drink, into the
stomach of which he had placed a canula. The canula was
placed in the stomach in the following manner : An incision
Was made upon the left side, just below the ensiform cartilage,
in the direction of the fibres of the rectus muscle of that side
the fibres of this muscle assisted m the retention of the instru-
ment. After cutting through the walls of the abdomen, and
coming upon the stomach, he drew a portion of this through
the orifice, and passed a threaded needle through the Walls of
the stomach ; he then cut a hole in the stomach near the string,
placed his canula in this orifice and secured it with the string.
The other end was passed through the external opening, which
was closely sewed up around the canula. The canula was of
course closed, so that no gastric juice could escape, except
when desired. A silver canula was used, because (he gastric
fluid does not act upon it. About two hours after giving the
dog this mixture of starch, he collected it in a vessel through
the canula, and no sugar could be discovered by the test before
mentioned, but the starch was unaltered. This seems a con-
tradiction to his statement, that the saliva vrould turn starch
into sugar. The contradiction is however only apparent, for
it can be easily accounted for. Why then was not the sugar
produced ? The solution was taken into the mouth, and imme-
diately swallowed, so that the saliva had not sufficient time to
act upon the starch in the mouth, and it did not carry a suffi-
cient quantity into the stomach to produce it there; and be-

206 Harriss, on Saliva. [April,

sides, the gastric juice, being acid, does not allow the action to
take place in the stomach. This is not a peculiar property of
this juice, for any acid will prevent the action.

M. Bernard thinks that saliva performs little or no office in
digestion its action being mechanical, and little or not at all
chemical. When an animal is masticating food, the greater or
less flow of saliva in the mouth is not occasioned by its chemi-
cal composition, but by its mechanical properties. If you give
an animal a hard or dry substance to eat the flow of this fluid
will be very great ; but if }^ou give him a soft or moist article of
food, the flow will be much less. To illustrate this point, M.
Bernard performed his experiments. upon a horse, as they were
more satisfactorily done upon this animal than any other. He
fotmd that the horse swallowed naturally four boluses per min-
ute, but when he cut the duct of the parotid gland, mastication
and deglutition were retarded, and the animal swallowed with
nnuch more difficulty and less frequently. In this state the horse
could swallow but one bolus per minute, if the substance was
dry, and but two if it was moist. This proves that saliva does
assist a great deal in mastication and deglutition, from its mere
mechanical properties. His process of getting the saliva from
the horse, was to cut the oesophagus, and to give the animal a
bolus of bran, which, when he swallowed, made its exit through
the opening in this conduit. The saliva is then obtained by
compressing the bolus. The glands which secrete limpid saliva
are for mastication, as they mingle rapidly with the food ; but
those which secrete glutinous fluid are to assist in deglutition.
Saliva is much more active when there is salivation or any
inflammation of the mucous membrane, because there is more
mucous mingled with it. Saliva, in transforming starch into
sugar, gives off a gas ; hence, if the gastric juice is not suffi-
ciently active to prevent the action in the stomach, digestion
will be more or less retarded, and the stomach filled with gas.
This is probably a frequent cause of dyspepsia. If you cut the
pneumogastric nerve, the food can no longer enter the stomach,
but will be arrested in the oesophagus, just where it passes
through the diaphragm. This is caused by a constriction of
the muscular fibres at this point. This experiment was made
upon a rabbit. Both the pneuniogastric nerves were cut, after

1849.] Oakman, on Therapeutic Action of Quinine, 207

which the animal eat bread as though nothing had transpired.
Wheat bread was given to it in order to distinguish it from the
food which it might have had in its stomach previously. After
the animal had eaten he attempted to vomit. These efforts
were caused by the a3sophagus being filled, and some of the
food getting into the larynx and producing a little suffocation,
which induced him to attempt to rid himself of the source of
annoyance. This phenomenon of vomiting always occurs in
this experiment. M. Bernard has made this experiment upon
dogs and other animals, and always with the same result.

Extract from another letter from Dr. Juriah Harriss.
I will give you the outlines of a case I saw at La Charite,
under the charge of M. Velpeau. It was one of Popliteal An-
eurism, which he attempted to cure by Galvanism, He passed
the fluid through it by means of metallic pins, which were stuck
through the tumour, The next day this was not cured as some
thought it would be, by coagulating the blood, but the whole
leg was much swollen and the knee very tender to the touch.
He applied poultices, to reduce the swelling, but without suc-
cess. About five days after the use of galvanism he tied the
femoral artery at the middle of the thigh, the second day after
which gangrene took place, and extended to the knee the
third day he amputated the limb, and upon the fourth, gangrene
commenced in the stump, and the man died the night of the
fourth day. The gangrene is not attributed to the galvanic
fluid, but to there not being a sufficient number of anastomosing
branches to keep up the circulation in the leg, for the man was
55 years of age.

ARTICLE XIII.

On the Therapeutic Action of Quinine. By Erwin H. Oak-
man, M. D., of Columbia county, Ga.

In the February No. of this Journal, I observed an article on
Quinine, (taken from the Charleston Medical Journal and Re-
vieiv) by Dr Holmes, of Newberry, So. Carolina, in which he
states that his " experience has led him to look upon large doses
of quinine, as n. sedative to the vascular ystcm; also possessing

208 Odkmdin, on Therapeutic Action of Quinine, [April,

a tendency to augment and originate a determination to the
brain ;^\ this, he says, "has led to its exclusion m fevers accom-
panied with cerebral congestion/' Now if quinine is an
arterial sedative, it is the Very-remedy indicated in fevers ac-
companied with congestion of the brain ; for, together with its
*' sedative action upon the circulation,'^ it is the most powerful
febrifuge We possess, having a peculiar and mysterious property
of equalizing the circulation a property, I believe, admitted by
nearly every physician, who has had much experience with the
article* If this arterial sedative, as Dr. H. calls it, in the same
dose, acts as a sedative to the circulation, and at the same time
'* originates and augments a determination to the brain,'* it pos-
sesses a po\Ver possessed by no other niedicine in the materia
tnedica, and will at once destroy our theory as to the "modus
operandi " of this class of medicines.

I think Dr. Holmes makes too sweeping an assertion, when
he says that "quinine has been excluded in fevers accompanied
with Cerebral congestion." The great mass of physicians of
the South and South-West use quinine in our autumnal fevers,
whether accompanied Vv4th congestion of the brain or not
having learned from experience that it is one of the most potent
remedies they possess for removing this serious complication.
Dr* H. Could not have read Dr. Lavender's able article on
congestive feVer, published a few months ago, in the American
Journal of Medical Sciences, or he would not have made so
bold an assertion. If quinine was excluded from every case of
fever, accompanied with congestion of the brain, or nervous
excitability, we would have very little use for this inestimable
febrifuge, in our autumnal fevers.

Again, Dr. H. says, "the South and South-west have exulting-
ly exclaiihned * Eureka,' and hold up io us morphine as the long
sought dcsidei'atum" to prevent quinine from "originating and
augmenting a determination to the brain.'* I think here Dr. H.
is mistaken ; the physicians South and South-west, I presume,
combine morphine with quinine, to prevent its unpleasant effects
upon the optic and auditory nerves, and not to prevent conges-
tion of the brain ; the merest Tyro in medicine would not think
of giving morphine, to prevent congestion of the brain.

Dr. Holmes passes quite an encomium upon the power of

f.

1849.] Oakman, 07i Therajje^itic Action of Quinine. 209

Digitalis, in preventing the unpleasant effects of quinine. I
have never used digitalis in combination with quinine in fevers,
but am inclined to look upon it as a doubtful remedy. Dr.
Pereira, in speaking of its effects in fever, says "it cannot be
regarded, in the most remote way, as a curative means; on the
other hand, it is sometimes hurtful. Thus, not unfrequently,
it fails to reduce the circulation ; nay, occasionally, it has the
reverse effect, accelerates the pulse, while it ino^edses the cere-
bral disorder, and \ie\:h^\ii irritates the stomach. Sulph. Ether
(a cerebral stimulanf) has greater power in preventing the
unpleasant nervous disorder, produced by large doses of quin-
ine, than any medicine with which I am acquainted. If D^r.
H.'s theory W;as correct, its effects vC^ould be just the reverse.
I first used sulph. ether in combination with quinine, having
heard the venerable Dr. Chapman, of Philadelphia, speak of it',
as the best remedy he kne\v of, to relieve the tightness about
the chest, and roaring in the head, complained of by persons
under the influence of quinine.

Dr. Holmes m'entions quinine as the "sheet anchor of the
physician's hopes, in congestive cmlls." Dr. H. here seems to
have forgotten the view^ he took of the physiological effects o^
quinme in the beginning of hts nari'ation. In most of the caseS^
of "congestive chill" (a veif inappropriate name', for all chills
are Congestive) which I have witnessed, the brain was the or-
gan most frequently congested.

I do not think that quiniri'e should be classed either as an
arterial sedative, or stimulaM. The great diversity of opinion
upon this subject, among physicians', is enough to convince' any-
one, that it does not possess either power to any great ext^ht.-
I look upon quinine as at'r antidote (o malaria, and hence its
virtue in all diseases having a malai^ious origin. Malaria, act-
ing as it does, upon persons of various idiosyncrasies, does not
al\\^ays exhibit the same phenomena: in on6, the" pulse may be
dep'i'-fessed below the natural standard in another, accelerated ;
the latter is the most frequent effect. Now in either case, if
Quinine be administered, the pulse is brought to \h natural fre-
quency, the poison in the system being neutralized. This
poison, I conceive, acts upon the nei^vous system, especially the
eerebro-spinal, and quinine, its antidote, acts upon the same fleld.

>r. S. VOL. v. NO. IV. 11

210 Dr. YandeiVs Medical Notes of Europe, [April,

PART II.

Ret)tetDS anJ attracts.

filBLIOGRAPHICAL NOTICES.

1

I. Notes on Medical Matters and Medical Men in London
and Paris. By David W. Yandell, M. D. Louisville, Ky.
1848.

From Professor L. P. Yandelf, we have been presented with
a copy of the above work, forming quite a neat volume, and
containing the notes of his highly gifted son, made during his
two years sojourn in Europe. We learn from the St. Louis
Medical and Surgical Journal, that even at the early age often
years, this youthful author gave evidence of great promise and
Worth ; and his recent letters (several Written before the age of
o'' mar hood and expressly to relieve the editorial burdens of a
father) now compose a volume of nearly 350 pages. May such
a son long live to lighten the labors of his worthy sire, and
prove aii ornranent, as he assuredly will, to the profession of his
choice!

Our estimate of this book, we propose to exhibit, by transfer-
ring from it to our pages, such information as we think may
interest our readers; and this we shall do, without any formal
review of its contents.

We first present the preface of the author.

Preface. It was not with any expectation of making a book, that
I commenced my ISotes on Medical Matters and Medical Men m
Europe, which, for more than two years, have occupied so much
space in the Western Journal of Medicink and Surgery. The
letters were written to one of the Editors, and, at first, without any
object beyond his personal gratification. They were deemed by him
worthy of publication, and forthwith I was enrolled "Foreign Cor-
respondent" of the Journal. In the midst of engrossing studies,
which left me but little leisure, I was induced to continue the corres-
pondence, not more by the evidence afforded me that my contributions
wore well received, than by the assurance of the working Editor,
that they lightened his onerous labors. The correspondence, com-
menced and continued m this spirit, has, at length, grown into a
volume. As the successive numbers were passing through the press,
a few extra sheets were obligingly set apart for the author by the
publishers, and these make the volume now presented to the reader.
With this explanation, no apology will be necessary for the style in
'vVhioh it appears.

1849.] Students of London. Stricture of Urethra. 211

Medical Students in London. The students attending the hospitals
and lectures in London have none of the affability so characteristic, of
young men in our country ; neither are they so fine in appearance aa
those you are accustomed to see. They are earnest, assiduous stu-
dents, but distant and indifferent; crowding around their teachers,
'eager to hear, careless whether standing in your way or not, and
looking all the time most ludicrously frigid. Students of the same
small class will often be found wholly unkiwwn to each other. There
are those I have seen who have followed Mr. Liston and other
teachers through the hospitals for three or four years, and expect to
take their degrees soon, without ever having exchanged salutations
with them. I know a class consisting of five students dissecting for"
Mr. Liston, who n>oet every morning, and have dined together, on
an average, twice a week for two months, who, nevertheless, profess
no acquaintance. 1 inquired of one of them, a day or two ago, the
name of a gentleman, pointing to one of his class-mates. "Well, I
declare I don't know," was his reply. But they are students, in
Iruth. You may walk into the library room of the University College
and find twenty or thirty young men poring over their books, fron>
which they are taking notes, not or>e of whom will raise his head to
see who you are. You ask the librarian for the book you wish to
consult ; it is handed to you immediately, and you take your seat at one
of the tables without your next neighbor's turning his eyes to see
whether you are an acquaintance or a stranger.

Dr. Quain on Strictures of the Urethr a. -^Inhls clrnical lecture, somef
days since. Dr. Quain insisted that there is no such thing as purely
spasmodic stricture of the urethra^ In cases of stricture, after using
fomentations to the loWer part of the abdomen, and perineum, a warm
bath, tartar emetic, a saline purgative and opium, he recommends
the introduction of a soft catheter, mstead of the one commonly employ-
ed. He is in the habit of using an instrument of this description
both in hospitals and his private practice, and he prefers a large
catheter, which he has sometimes been successful in introducing after
surgeons had failed to pass a small instrument, lie can give no di-
rections as to the manner of introducing the catheter, dexterity in
this, as in nearly all the operations in surgery, depending upon prac-
tice. He advises students to carry a catheter in their pockets, and to
take every opportunity to introduce it into the dead subject. Hold the
instrument loosely, are his directions, and rather sutler it to pass by
its own gravity than use any force to carry it forward. He spoke of
two cases of retention of urine, one occurring in a young man in con-
sequence of stricture} the other in the person of a man eighty years
of age, produced by enlarged prostate, which after existing for some-
time, brought on paralysis of the bladder. In the young man the
bladder could be felt above the pubis, round and well defined ; in the
man advanced in life this roundness w-as absent, and the outlines of the
distended organ were not well defined. The urine in paralysis of
the bladder is muddy, and, under the miscroscope, purulent. He in-

212 Hunterian Museum. -^Test for Alt ohoL ^c. [April,

jects the bladder in such cases with warm water to Wash it out, and
gradually reduces the temperature of the water until it is cold, which
acts favorably in restoring the contractility of that viscus.

The Hiinierian Museum. -^The Hunterian collection contained, in
all, ten thousand five hundred and sixty-three specimens. Of these
963 pertained to osteology, 1345 to natural history, 1215 were fossils,
617 dry preparations, and 3745 preparations in spirits; constituting
the physiological department. The pathological department contained
of preparations in spirits 1084 specimens, dry preparations 625,
monsters and congenital malformations 218, calculi and concretions
636, microscopic preparations of normal and abnormal structures
217. The members of the College have added 12,347 specimens to
the museum; of which, in the physological department, 2119 are
osteological, 240 are dry preparations, 1998 are in spirits, 427 relate
to natural history, and 1200 are fossils ; and', in the pathological
department, the preparations in spirits are 2142, the dry preparations
1385, the monsters and congenital malformations 187, calculi- and
Concretions 884, and the microscopic specimens 1791.

Th-e museum, through the liberality of its proprietors, is open four
days in the week, instead of two, and under special circumstances
visitors are often admitted on the other two. The library consisting,
of works on all branches of medicine as well as the collateral sciences,
embracing a great number of most costly books relating to natural
history, amounts to 20 000 volumes ; it is kept complete by the regu-
lar addition of new works, and affords every facility for study, being
open from 10 o'clock until 4 daily. The books have cost the College
about 10,000, and the annual expense of the library is about 600.
The average weekly number of visitors is one hundred and twenty.
The Council, some years ago, instituted studentships, three in number,
with salaries of 100 per annum, which are held for three years.
The appointments are bestowed as the rewards of merit, the test being
a strict examination.

Test for water in alcohol. In no countiy are physicians more in-
terested in knowing whether tiie alcohol they use is frde from water
than in the United States. There are various methods known to
almost every one for ascertaining this, but there seems to me none so
simple, and few, I am inclined to think, v/hich succeed so well as that
of M. Casoria, published in the J-ournal of Medical Chemistry. It is
based upon the property possessed by the common hydrated sulphate of
copper of losing its color when it becomes dry, and regaining it when
again brought in contact with wati^r. Thus, if we place a piece of
anhydrous sulphate of copper in a vessel containing the alcohol which
it is wished to test, in a short time it becomes blue if the alcohol be
mixed with water, whereas if it is absolute the salt will remain
white.

Th6 action of Strychnine on the Bladder. M. Trouc-seau, in his

I

1849,] Action qf Strychnine on the BIadde7\ ^18

Traite de Thcrapeutique, speaking of strychnine, says : '< We have not
seen any secretion rendered more active by the nux vomica if it be
not the urine, and here not only is the secretion more abundant, but
the excretion is both more frequent and more energetic, to such a
degree that some patients are obliged to urinate every hour." Trous*
seau is one of the iew writers on medicine who have indicated this
predilection, so to speak, of strychnine for the urinary apparatus,
Several cases have occurred recently in the Wards of M, Vigla, at
the Hotel Dieu, which, while they tend to confirm this opinion, sug^
gest some reflections of the highest practical importance.

The subject of the first case was a man aged forty years, who had
been taken five months before, without any known cause, with lassi*
tude and feebleness in the legs, which phenomena gradually became
more intense, and ended by constituting a true paralysis of the inferi.
or extremities. He was admitted into the war(J, where he was treated
at -first by revulsions upon the digestive tube, then by strychnine,
M. Vigla is a.ccustomed to commence with strychnine in the dose of
one-fifth of a grain per diem, givei? in a gum julep of fo.ur ounces. He
prefers this mode of administering it 6oth to the endernnic method and
the form of piMs. He has rem.arked that the effextg of the medijcine
are more rapid and complete whe it has been dissolved before reach?
ing the stomacji, sii;ice this organ thus effects ithe absorption much
more promptly than when bol,h its soJutiQU and Q\)^Q}y}ion are require4
at the same time.

The first e^ect produced in this case -was ?, more abundant sCiGre,-
tion of urine, then frequent desi^*e to micturate^ during which act there
was slight scalding; subsequerhtly there were twitchings and piaoh.
ings in the legs, and a very marked return of m.obiH:ty, so that the
patient was able to walk wiihout UjUcii difficulty. ^\ie augmented
activity of the bladder, the more remarkable as there existed at the
time the patient entered the hospital ;a<commencing paralysis of this
organ, continued oniy for a few days, and has diminished in the ^'atio
with which the strychnic pheflonjena haye ^amfe^ted themselves i^
the muscles of the exitremitie^. ^

The second case relates to a man who has bee sick for e^x months.
The affection co^nmenced by constipation, dfficulty in defecation,
sliaggishness of fthe bladder, pains in the ba^k and leg?, the latter
growing so weak thai on his entry^ about foti-r months ago, he wa^
totally unable to walk. 'I'-he treatment that he had unde,ygone before
/JOming to the hospital consisted in venese^ion,. hip baths, ptisarie of
cherrystones, wine of cinchona and gentian. When e-^:amined for
the first time, he had almost complete retentioii of urine resulting
fi'om distension of the mu^ciijar fibres o^ the Madder^ which were
deprived of their elasticity. jBeliadanna was first pre^cnbcd, then
strychnine in the same dose and manner as in the case j-ust related.
Here, equally as in the preceding example, the first symptoms produc-
ed were manifested in the bladder frequent disposition to urinate,
accompained by scalding during micturition ; convulsive twitchings
^n the muscles cf the legs and thighs. At this period (April) tho

214 Action of Strychnine on the Bladder, [April,

strength has increased, and the patient has commenced walking with
considerable iacility, although he still throws one of his legs slightly
to one side.

The last case is that of a man, who in September last, was attacked
with a myelitis, which became chronic. He entered the hospital on
the 20th of February, at which time it was wholly impossible for him
to move his legs. He was put upon strychnine, and, as in the two
others, he experienced tremblings and twitchings in the legs, and even
pretty severe pains ; a little increase of activity in the secretion as
well as excretion of urine. A varioloid, so light that it did not even
suppurate, supervened, and the strychnine was obliged to be suspend,
ed. But, singular to relate, under the influence of the varioloid, at
the end of seven ,or eight days, the psiralysis seemed to be modified,
and now the subject, lying upon his bed, can move his foot from the
horizontal plane which it has occupied, and lift it to some height.
The retention of urine has ceased, and there is no longer any difficulty
in its expulsion.

Before proceeding to give some other instances of an analogous
character, I may submit, that should ulterior and more extensive ex-
periments with strychnine demonstrate that it has an almost specific
action upon tlie muscular fibres of the bladder, we may hope to derive
very great advantages from its employment in certain paralyses of
this organ, whether they be idiopathic, the result of some mechanical
cause, in which case strychnine is the principal element of the treat-
ment; or symptomatic of some other afiection, when it would consti-
tute a useful adjuvant to stimulate the inert viscus, while appropriate
means were being directed again^st the causes of the affection.

M. Mauricet has published in the Archives de Medicine (te. xiii,
page 403) a shc^'t history relating to this subject, M'hich, being unusu-
ally striking, I translate entire: The two sons of Mr. R., he says,
the one 13, the other 14 years of age, both of lymphatic constitution,
had labored since their birth under nocturnal incontinence of urine.
I prescribed the alcoholic extr. of nux vomica in doses of^ gr. morning
^nd evening. Three days elapsed ; the incontinence had disappear-
ed and was not again seen during the use of the remedy. At the end
of iilteen days, the nux vomica was discontinued ; relapse. Consult-
ed again. I made the same prescription ; the incontinence again dis-
appeared. The treatment was interrupted; another relapse. Finally,
having taken the extract for the third time, and having continued its
use during a month, the two patients were completely cured of their
disngreeable alfection.

M, Mauricet, after observing concerning these facts that they re-
quire to be substantiated by new experiments, adds "Nevertheless,
in considering that the incontinence of urine has always disappeared
under the influence of strychnia, and that it manifested itself anew at
the cessation of the remedy, have we not ground for believing that the
nux vomica contrihutod powerfully to the cure'/"

One more case, and I dismiss the subject : M. Trousseau employ-
ed strichnine with the most perfect success in a woman who, in con-

1849] Cancer of the Breast, 21-5

sequence of a fall from a considerable height, had been jRrst paraplegic,
and afterwards morely affected with a paralysis of the bladder. The
latter aflection yielded most piomptiy to the strichnine.

Cancer of the Breast. Vklpeau. A peasant about fifty years old has
returned to our service for a cancer of the breast. I say returned, for
she had presented herself to us when the tumor was circumscribed, its
limits clearly definable, its mobility evident in a word, when it offer-
ed conditions favorable to the operation. But the tumor was the seat
of no pain ; the patient could not comprehend how a tumor which gave
her no trouble was a fit subject for the knife, and, refusing the only
efficacious renaedy that wg could propose, returned to the country.
Today she asks for what at that time she could not be prevailed upon
to accept ; today the tumour is ulcerated, adherent, and extends per-
haps to the ribs. This is a trouble that you \v\\\ often meet with in
practice. You will see the operation rejected at the moment when it
is opportune, and solicited at a later period, when the progress of the
diseases has rendered it almost impossible, or at best ofdoubtful success.
And this is particularly the case when the cancer causes no pain,
especially as women find physicians who give them counsel more in
accordance with their taste in altogether discountenancing the opera-
tion or in postponing its application. This order of physicians may
he subdivided into numerous genera. The first are charlatans, whose
only end is to inspire the patients with a false security, the consequence
of which it is needless to allude to. There are others, and these may
perhaps be conscientious, who believe in the medical cure of cancer,
at least in certain cases; these essay internal medication before re-
sorting, if it should become necessary, to the removal of the tumor.
It is not true that medicine ever made the smallest cancer disappear,
and these pretended cures arise from an error in diagnosis. In good
practice, he alone attacks cancer by internal remedies who is assured
that the nature of the disease is not malignant. And should he have
to deal with confirmed cancer, he is in a dangerous path ; he loses
precious time in dissipating or diminishing the engorgement of the
tissues which surround the tumor, while he exercises not the slightest
influence on the final result. This method, then, possesses not a sin-
gle advantage, while it has many attendant evils.

In the first place, that cancer is often primitively a local affection I
have not the slightest doubt, although this is a point which, as you
know, has been warmly contested. In temporizing, then, or leaving
the disease to become general, the cancerous cellule, if it really exist,
is transported first into the circulation, afterwards into the other or-
gans, and infection is the result. Granting, even, that the cancerous
principle pre-existed in the economy, and that the tumor is but a
manifestation of it, in removing this tumor, if you do not destroy the
principle, you at least destroy one of its effects, without increasing in
any degree the activity of the cancerous diathesis.

On the other hand, as a wound the operation offers no danger if it
be made in time, a little while after the appearance of the morbid pro.

216 Cancer of the Breast, [April,

duct when, for example, its volume does not exceed that of a filbert.
In this case you relieve the patient by a small incision scarcely follow-
ed by reaction. I should advise you, and this is my practice, to
operate as soon as the cancerous character is evident. To wait till
the tumor ulcerates and extends, or even until the ganglia become af-
fected, is to compromise the life of the patient as w^ell as the character
of surgery. When the ganglia ^re only engorged, the result is alrea-
dy uncertain, and if you would op.erate under such circumstances now,
you will not do it when you become old. Young practitioners attri-
bute this to the coldness of age, and, full of confidence in the powers of
the art the duties of which they are just entering upon, they mistake
for timidity what is but the fruit of experience. And after a first and
even a second failure, they still repeat their efforts; but finally cor-
recting themselves, they in their turn become old, and no more subject
their patients to useless torture.

Jn the case which occupies us, the tumor is ulcerated, adherent,
comprehending perhaps the ribs, and the ganglia in the axilja are
enlarged. This lymphatic engorgment, which is nearly always can-
cerous, would deter me from any operation if the patient, seeing but
too cleanly the fate that awaits her, had not persuaded me by her re-
peated and anxious entreaties to give her, uncertain as it is, the sole
chance that remans. The condition of the part, and especially its
size and depth, forbids removal by the bistoury; caustics are scarcely
of easier applications, but they disturb the economy less, occasion no
fever, and although more painful, are less alarming to the patient.
To what caustic should we give the preference to the paste of chlor-
ide of zinc, or that of Vienna, or that of frere Come? The latter
possesses a particular danger belonging to the poisonous nature of
arsenic, which constitutes its base ; and although these dangers have
been exaggerated, still they are not the less real, as there are instances
to prove. And here the size of the absorbing surface augments it in
a fearful degree. Besides, this paste produces great pain and high
inflammation. That of Vienna produces a sanguineous discharge
which fuses it, and its action is too superficial. That of the chloride
of zinc attacks only fungous tissues or those deprived of their epi-
dermis ; you may hold it a year in your hand without feeling it, but
the moment you remove the epidermis by a blister, it will take effect
and burn you violently a property as true as it is strange. It would
be necessary here to denude a part of the tumor, and this initial step
i$ very embarassing ; and let me add that this paste causes cruel
suffering during the whole time of its application.

The Mack caustic, composed of sulphuric acid and saffron, without
any precise formula, but so as to form a homogeneous paste, appears
to me to possess incontestable superiority over all the others. It
destroys every surface with which it comes in contact ; it occasions
no sanguineous discharge even when the skin is ulcerated and fun-
gous ; it occasions very little paiji ; the tissues attacked become dry,
and suppuration arrives only with the eliminatory inflammation at the
end of fifteen days ; and during this time, without any dressing, with-

184^] Fissures of the Anus, 217

out any care, the patient may forget his eschar. Added to all the rest,
the retraction of the eschar limits the extent of the cicatrix. It is true
that its application is somewhat difficult ; it adheres more to the spatu-
la than to the tissues. As it burns all, the diachylon cannot circum-
scribe it; it is not well applied except on a horizontal surface, and it
is, moreover, liable to become fused. But these defects, which I am
far from endeavoring to conceal, by no means counterbalance its good
qualities, and I repeat that the black caustic is, in my opinion, prefera-
ble to all the others. I proceed to attack successively the various
points of the tumor by partial applications.

Fissure of the Anus ; Subcutaneous Tenotomy. We are, aware of
few local alfeclions in which a longer catalooue of remedies has been
proposed, than the one which forms the caption of this article. The
very often intolerable pain which attends it, accompanied not unfre-
quently by spasm of the anus, demands active means to soothe the
one and overcome the other. The employment of the history is not
rarely reouired, though there are many cases for the relief of which
all that is necessary, is the application of emollient and anodyne
fomentations, or at most, cauterization with the nitrate of silver.

Dupuytren, it is reported, employed with considerable success a
mixture of the folloiving ingredients :

Extract of belladonna, 3ij.
Honey water, . . fij.
Adipis, .... ij.
carried yito the anus by means of a wicfc or tent. By gradually
augmcDtiaig the volume >of the tent, the resistance of the sphincter is
over<jonie. It appears desirable to make the tent as large as possible,
lor, although it causes very considerable pain at first, this soon ceases.

Cold water applied fo the part, and decoctions of various substances
have beeji much vaunted, but the three remedies whi.ch have been
most insisted on within late years, are cauterization whh lapis -inf ema-
ils and nitrate of silver, dilatation, ad section of the sphincter.

Boyer, the first to propose incision .of the sphincter, regarded this
operation as invariably successful, though Roux, Beclard, and Rich-
erand have all cited cases in which it has failed in their hands.

Dilatation has also had, and has still, its advocates among others,
Dubois, who declares that it constantly succeeds, and Beclard, Marjo-
lin, Copeland, (Sz:c.

Withoiit consuming further time in this way, I will say that the
subcutaneous section of the muscle, as proposed by M. Blandin, ap-
pears to nie to possess incontestable advantages over all other methods
that I have ever seen used, and I have seen almost all used that the art
possesses.

M. Blandin divides the operation into four stages:

1st. Puncture of the skin.

2d- Introduction of the finger into the rectjLim,^nd tension of the
skin on both sides of the anus.

3d. Pushing the tenotome between the mucous membraoe and the
muscle.

218 Fissures of the Anns. [Apri

4th. Division of the muscle.

The puncture of the skin is so simple that it is unnecessary to speak
of it, save in relation to its seat, which is a matter of some importance.
Practiced too near the anus, it renders the section of all the muscular
fibres somewhat difficult, and exposes, while dividing them, to enlarge-
ment of the cutaneous opening; then, if the patient is obliged to go to
stool before the cicatrization is perfect, the contact of the fecal matter
with the wound will irritate it and determine an inflammatory action,
which may even pass, in some circumstances, rare it is true, to the
phlegmonous state.

If the puncture is practised at too great a distance from the anus,
some difficult}' will be experienced in cutting the most internal
fibres of the sphincter, which, I need not remark, it is always essential
to divide completely. The proper distance at which to make the
puncture of the skin is from five to seven lines from the anal open-

If it be complained that I have given too much space to this portion
of the subject, my reply is, that in subcutaneous sections of muscles
the persistence of the integrity of a few very fine fibres may almost
completely mar the results of the operation. Some years ago, when
strabotomy was, if we may use the expression, the fashionable t)pera-
tion, it often happened that the complete section of the muscle, with
the exception of one or two fleshy fibrils, produces no change in the
direction of the ocular globe and it became necessary, by aid of a blunt
crotchet to find those fibres which had escaped, in order to effect a cure.

That which obtained in the muscular fibres of the eye occurs equally
in the section of the sphincter of the anus. It has happened to
Blandin himself, and notwithstanding the care that this able operator
invariably takes he has been more than once obliged to resort to a
second section, in order to relieve a contraction which a first attempt
had failed to overcome.

In connection with this subject, the following case which occurred
in Blandin's wards may prove interesting:

A young girl entered the service of M. Blandin a short time since,
having an anal fissure accompanied by all the characteristic phenome^
na, spasmodic constriction, lively pain, etc. The operation was per-
formed by the subcutaneous method ; the recovery was rapid., equally
as regards the fissure and the muscular constriction. Notwithstanding
there still remained something a little pain, a little constriction. The
finger introduced into the anus passed, however, with sufficient
facility, and M. Blandin thought that with time and the aid of
opiates the girl would be cured. But, convinced that some of the
fibres of the sphincter had escaped, he determined to perform the
operation anew, as being a more simple and rapid means, and more
certain of effecting a complete and definite cure.

What remains to be said of the operation is but brief.

The introductin* of the finger into the rectum is of real importance,
since its internal face serves as a c;uide to the instrument inserted be-
neath the mucous membrane. This introducton may sometimes pre-

1849.] Gun-Shot Wounds. tj-c. 219

vent the destruction of the mucous membrane, which would certainly
be farmoreeasy without this introduction. Tiie remaining steps of'the
operation do not dilfer from those of ordinary tenotomy. At the mo-
ment when the instrument divides the muscle the well known hrvit
de craquenent, characteristic of the section of a tense muscle, is heard.
When t^3 operation is terminated, by the muscular section being
complete, contraction ceases, and the finger introduced into the rectum
manifestly feels a depression, if it may be so expressed, of greater or
less length and extent, formed by the interval which separates the two
extremities of the divided sphincter. The dressing consists simply in
the application of compresses, wrung out of cold water, to the little
wound, which cicatrizes in forty-eight or seventy-two hours. Five or
six days suffice to reunite the two extremities of the muscle.

Gun-Shot Wounds.. The chief surgeon ofVal de Grace, M. Baudens,
during a short series of lectures which he delivered just after the Rev.
olution of February, on gun-shot wounds, gave in a very few words
the basis of his treatment of these accidents, which, from all accounts,
was eminently successful in Algeria.

It isemboditd in six precepts, which run thus :

1st. Of a compound wound make on the spot a simple one, by ex-
tracting the fragments of bone.

2d. Combat by cold water, and if need be by ice, the excess of the
local traumatic reaction.

3d. Keep the intiammatkxi local, and thus prevent it from gaining
the important viscera.^

4th. If the thoracic member has a comminuted fracture, extract
the fragments, make suitable resect ioijs, and reserve amputation as a
last resource.

5th. If the feinuiT is fractured with fragments, amputate immedi-
ately ; if the tibia or the fibula alone is fractured, endeavor to preserve
the extremity, afier having removed the fragments, and reserve ampu-
tation ; if the fracture involve Ijoth bones^ as a general rule, amputate
immediately.

6th. Isolate, at whatever cost, the patients whose wound suppurate,
in order to prevent the much to be dreaded miasnaatic infection. In
the absence ofchainabers, put the wounded under tents ; in the absence
of tents, place them in the open air, Under hastily-erected sheds.

We give the next letter, the last of the series entire. We had
marked it for republication when issued in the Western Medi-
cal and Surgical Journal. We believe it contains true and
valuable information for all desirous of visiting the European
Medical Institutions.

" What are you going to London for ?" I once heard a young grad-
uate in medicine asked, who had just had a passport filled for Great
Britain. His reply w.aS; '^' for the hospital advantages and anatomical

220 Cojnparlsonof London and Paris for Students. [April,

facilities." I had passed a summer in that vast city only two years
befbie, in search of medical knowledge, and felt the injustice my
young professional brother would be doing hiiriself in sojourning there
any Itngth of time, but in the hurry and bustle attendant upon disem-
barking from a long voyage, although I wished to make myself known
to him and point out the error under which he was laboring, the op-
portunity for doing so did not present itself.

What, in reality are the hospital advantages of London? Great,
very great. In comparison with those of Paris? Small, very small.
And as for anatomical facilities, there is not a medical school, in any
village in the United States, howeyer small, whi;h does not afford
subjects for dissection cheaper a-nd in greater abundance than either
King's College, or University College, or any other College in Lon-
don.

I^remember very well, that in the summer of 1846, wl^en following
the lamented I^iston through the ^vardsof the University College Hos-
pital, 1 thought what an .ample opportunity was alforded ixje for acqui-
ring medical knowledge! At that tiipiie I fancied that he who saw
most would learn most. It was not long, however, before I began to
experience that there was something wanting that there were too
many students about the, beds of the patients; tii,at I sa>y disease, but
could i^either feel or hear disease ; in a word, that my opportunities
carried me to a ceilain point and there stopped. Not content with
what I saw in Uii^yersity College hospital ajone, I followed Key, in
Guy's Hospital, Fergusson in King's College Hospital, Jyawrence in
St. Bartholomew's, and other surgeons in o her hospitals; but still
the same obje^ctions were present to me. \ bethought me, of the dis-
secting roorn, and througli the kindjiess of Mr. Listen eyery facility
was atibrded me free of ^charge, which, was effected by my dissecting
in his private room. 7 hose studen-ts, however, who were dissecting
at that time were payiiig, if I rp;iiember aright, a guinea for an arm,
no shillings for a leg, and from tour to five guineas for ai? entire sub-
ject. For what they were paying for a smgle lower eiitremity in
London, they might have dissected in Paris, from the first of November
to the middle of Aprils, and ip Florence for two sessions of five months
each, and had their knives regularly sharpened into the bargain.

Knowing that clinical lectures were oi inestimable value, I looked
about me f r good teachers, determined to attend their courses with
the utmost assiduity. Stanley amused me exceedingly the first two
or three days by his pompous, inflated florid style, but \ soon grew
weary and ceased attending his clinicy, jFergusson possessed even
less talent for lecturing than Stanley, and although the matter of his
lectures was pre-eminently sound, practical and valuable, hjs nianner
of communicating it was so unpleasant that my patience was soon
exhausted. J. C. B. Williams, although by no moans a le.cturer pf
ths first order, was still infiuitf ly superior to either of those just named,
and always succeeded in imparting much that was useful, notwith-
standing his manner was offensively testy and ill-humored. Quain
could almost be said to have been a pleasant lecturer, though he was

1840.] Comparison of London and Paris for Students, 221

somewhat wanting in a very essential element of a speaker, anlma*
lion. Without extending to greater length the list of clinical tcnehcrs,
it may be said of the London faculty, that it would be a dithculttask
to find among so many men of extensive acquirements and reputation,
60 few who were interesting and attractive instructors. The power of
imparting knowledge orally, so far as my observation extends, is pos-
sessed by a very small number of Englishmen.

Every medical school in London has in connection with it a hospital,
access to which is obtained by paying, save in a few instances, a hos-
pital fee, varying in amount in diti'erent hospitals.

A-dmission to the University College Hospital costs four dollars ; to
the London Hospital, ten dollars; to King's College Hospital, two
dollars; and to Middlesex Hospital, five dollars.

The offices of dresser, house-surgeon and clinical clerk, in smrie
hospitals, are obtained by purchase ; in others they are awardefrto
merit. In Guy's Hospital a dressership costs two hundred and fifty
dollars per annum ; in the London Hospital it commands one hundred
and fifty dollars, as is also the case in the Middlesex Hospital.

Attendance upon both the medical and surgical practice of Univer-
sity College Hospital costs one hundred and hfty dollars ; upon either
one alone seventy-five dollars per annum.

One cannot become an attendant upon the meetings of any of the
scientific societies unless he pay the admission fee, varying in different
institutions, but in all cases being of some moment to the student who
wishes to take advantage of all the various means of improvement by
which he is surrounded. How differently things are conducted on
the other side of the channel !

In the first place the most abundant anatomical material is obtained
at the Ecole Pratique or Clamart, during six months, for six dollars
for less than half the cost of a subject in London. And this, if one is
not a Candidate for a diploma from the EcoU de Medicine, is the sole
outlay for medical knowledge. Should the diploma be made an ob-
ject, the sum that the h(!)Use.surgeon annually pays at Guy's will
meet all the costs and give him thirty dollars to spare. In other
words, the attendance upon one single course of lectures in any one
of the schools and any one of the hospitals, in London, will cost more
than attendance during four years u|X)n the lectures of eighteen pro-
fessors and twelve hospitals in Paris. In Paris a' hospital fee is un-
known, and the house-surgeoncy and clinical cferkship, instead of
costing ^heir occupants one or two hundred dollars, are sources of
almost tha:t much revenue, yielding to each, eighty dollars and their
lodgings, tlie first year, and a hundred dollafs and their lodgings' dtlr-
ing the second and third years.

In London, although each school has its hospital, tlie number of
students in attendance on them is too great to allow of that close ex-
amination and continued investigation of cases, which is necessary to
give clinical instruction the highest value of which it is susceptible.
In Paris the case is different. The numbey of students at the Ecole
de Medicine is, say one thousand. These are divided among ten'

222 Facilities of Pains for Students. [April,

hospitals, and the hundred thus allotted to each are ajrain subdivided
and scattered over the buildinii, some in Uie surgical, and others in
the medical wards some following Velpeau, others Gerdy, and others
again Bouillaud.

Let us take La Charlie, for instance, and observe how instruction
is dispensed there. The patientsare distributed through sixteen wards,
and are committed to the care ofeight physicians and surgeons. The
wards are open to students from 7 o'clock, A. M. till 10, A M., three
hours, during which lime the visits and lectures are made, and opera-
tions and autopsies performed. Now, Velpeau, attractive as he is,
seldom has with him more than twenty or thirty students during his
visit; as soon as he adjourns to the amphitheatre, which he always
does at a regular hour, the number is greatly augmented by acces-
sioj^from the other wards, and even from other hospitals. But during
tfllBour of his stay in the wards he racely has more students than I
first stated, and because he has so many his visits are less profitable
to students than those of his neighbor, Gerdy, for the very obvious
reason that the few who accompany Gerdy have a much better op-
portunity for making a thorough examination of the cases. Bouillaud,
although, as I have said before, one of the first clinical lecturers in
the world, does not generally succeed *in assembling more than ten or
fifteen students, and consequently every one of them has an opportu-
nity of examining the many interesting cases in which his wards so
constantly abound.

French medical students well understand, as I suppose do all medi.
cal students who have seen hospital practice, that beyond a certain^
and that quite a limited number, seeing becomes a thing quite impos-
sible; and unless the student himself can vSee, hear and feci the pa-
tients, it is quite clear that he will walk the wards of the hospital for
many a long day before he can become a diagnostician or practitioner.^
Merely breathing the atmosphere of hospitals is far from being ade-
quate to rendering students competent physicians. A man, for ex-
aniple, can never learn diseases of the chest unless he auscult, and
this he cannot do in a hospital if there be a large number of students.
He can never ediicate his linger, so as to make it an intelligent servant
in vaginal examinations, unh ss he has opportunities to use it. Ho
may grow grey in loooking at Hugier and Paul Dubois practice
the toucher, and be none the wiser for it It is indispensable, if he
wou'd become a physician, that he auscult, and percuss, and touch
for himself. These are things that cannot be done by proxy, and the
superiority of French hopitals over all others, consists in the facilities
which they afford for these examinations in propria perso?ia. In a
single morning one may see a dozen cases of disease of the uteri, in
Jobert's wards, and may auscult half this number of lungs in Bouil-
laud's wards, at least three tiaics a week.

The industrious student in Paris may see in one morning the cases
in boih a medical and surgical ward, hear a clinical lecture, witness
any operations that are to be performed, and be present at the post--
mortem examinations. And if he be strong, and fle^t of limb, he may

1849.1 Facilities of Paris for Students. 223'

follow Roiix- thrc ucrh his wards at the Hotel Bieu, Jobert through his
at St. Louis, and hear Velpeau lecture at La CkariLe. No hospital,
or library, or apoiliecary's fet/is necessary to all this. The matricu-
lation ticket of the school of medicine, or a diploma from any other
medical school, secures a card of admission to those hospitals; and in
the absence of a diploma, a simple declaration of the fact of your be-
ing a foreign studeiit or physician is sufficient, the ticket system having
been introduced so ely with the view of preventing improper persons
from entering the hospitals, and even this obtains in only a few of
them.

As I have already intimated, situations in the hospitals are neither
bought nor given away ; they are the reward of merit, free alike to
the young and old, the rich and poor, to be obtained in but one way
by concours which, with all the objections that may he urged ag^gat
it, is, in my opinion, the best, and in truth, the onlv decisive te^PP
merit.

Relative to that most important subject, anatomical facilities, one
could not wish them greater than they are in Paris. There are two
immense establishments set apart for dissec ions, the Ecole Pratiqm,
and Clamart ; the one within a few steps of the school of medicine,
and used during the winter session ; the other distant a mile or more,
the most convenient, largest, and best appointed buiUiing of the kind
in the world, and open both winter and summer. The demonstrator-
ships and assistant demonstratorships are the reward of merit, confer-
red by concours. At the Ecole Pratique ihere are five or six rooms,
each furnished whh a demonstrator, and each containing eight or ten
tables for subjects ; and about as many rooms, containinu four or five
times the number of tables, at Clamart. The classes are composed of
four or five members; the cost of the dissecting ticket is thirty francs
a session ; the number of subjects furnished is amply sufficient ; the
demonstrators are always at their posts, and are necessarily compe-
tent. Two courses on operative surgery are given annually : one in
the amphitheatre of the Ecole Pratique, during the winter, the other
at Clamart, during the summpr. Besides these, which are embraced
in the curriculum of the school of medicine, private courses can at all
times be obtained from the ditferent demonstrators, who also take,
although contrary to the edict of the dean of the faculty, private
classes on anatomy. Since I have alluded to the subj-^ct of private
teaching I may remark, that the various interims and clinical clerks
are but so many private instructors, whose services are to be obtain-
ed at the rate of five or six dollars a month, and it is by embracing the
opportunities which these men afford that the student will learn most.
Some years ago private clinical instruction in the hospitals was sanc-
tioned by the administration, but being carried by the intcriius to too
great an extent, the patients made such loud complaint that it became
necessary to prohibit it. A physician, who was interne during the
existence of the law permitting it, told me, that so great was the love of
money or the love of teaching, he could not say which, a short time
Ijefore the law was repealed, the internes spent almost the entire day

"5^4 Facilities of Paris for Students. [April,

in the wards, examining and re-examining the patients, very often
rousing them from sleep before it was fairly light to begin the work of
investigating their diseases, and, not satisfied with prosecuting it
through the day, pursued it often by candle-light far into the night.
Patients, at length, grew impatient and refused to submit to such tor-
ture; the law was abrogated, and under the present system private
clinical teaching is conducted suh rosa. But the laws of a hundred
faculties and administrations would, be little heeded by the internes,
when pecuniary reward was in question. Human nature can too sel-
dom withstand the temptation of money, and French nature is not proof
against it. Form a class of four, or even two, and offer an interne five
dollars per month each, and the doors of the hospital turn noiselessly
on their hinges, and the faces of the nurses wear a smile of welcome ;
tkftjiirector never intrudes, the patients are your own, to be examined
crt^ur leisure, apd the interne at your side to assist, direct and instruct
you.

Orfila, strict, stern and severe as he was, never succeeded in sup-
pressing private courses on anatomy and surgery at either Ciamart
or the Ecole Pratique, though he often swore he would make cadavres
both of those who attem-pted to give and those who received them.
They were given in spite of his watchfulness and in defiance of his
threats, and would have been given had there been a score of deans
all 6qual to Orfila. They are given now under Bouillaud's adminis-
tfaition, and will continue to be given till there are no students willing
to pay five dollars a month for a course on the former, and ten dollars
for a complete course on the latter subject.

Paris abounds in private teachers. Private instruction can be ob-
tained on any subject. Magendie's assistant delivers lectures on
Physiology; Blandin"s assistant on Operative Surgery; Paul Dubois'
assistant on the Toucher ; the keeper of Dupuytren's Museum on Pa-
thological Anatomy. The price of these ticket.s varies from six to ten
dollars. Then there are Sichel's, and Desmarre's, and Tavignot's
clinics on diseases of the eye, a clinic on diseases of the ear, etc., et6.

Another advantage that cannot be too highly estimated arises out of
the circumstance that there are ih Paris hospitals devoted exclusively
to a certain class of diseases; a:s the Du Midi hospital io venereal
diseases, St. Louis, a lai'ge portion of it, at leajst, to diseases of the
skin, and other hospitals to other diseases.

Without extending my present ai^d last letter* to greater length, the
advantages atlbrded by Paris may be briefly said to consist in the
number, size, and wise and liberal administration of her hospitals, the
abundance of anatomical material, the number of private clinics and
private courses, the talent of her' public and private teachers, the
cheapness of instruction in all its branches, the number and reputation
of her scientific bodies and associations, and tlie system of concours,
which, while it secures the highest qualifications, is impartial in its
operation, affecting alike the rich and the poor, the befriended and the
friendless.

Jn bringing to a close this series of letters, extendinir now through'

1849.J Harrison s Anatomy. 225

more than two years, and over six volumes of the Journal, I trust I may
be indulged in a few words personal to myself. The corresspondence
was commenced without any definite plan, and without tlie slightest
expectation that it would swell to such an extent, the chief motive
which commenced it and has kept it up, having been a desire to lighten
the editorial labors of one to whom I owe all that a son can owe a fa-
ther; and if I have accomplished nothing else by my letters, it is a
source of unfailing satisfaction to me to know, that I have at least been
successful in this. The reader who has had experience in literary
matters will not need to be told, that the preparatioo once a month for
the press of a long letter, amid the labors of a medical student in Paris,
is no small tax upon one's time and energies. But through all the
toil and weariness of it I have been cheered at every stage by the as-
surance, that my communications were well received. The favor,
indeed, with which thoy have met, far exceeds anything that I Hbld
have expected or hoped. With an expression, then, of my thanks to
the readers of the Journal for their indulgence, and to my brethren
who through the press have spoken so approvingly of my letters, I
here brinij the correspondence to a close.
Louisville, Ky., Oct. 29th, 1848.

The reader will recollect we have frequently before drawn
fronn this same source, Dr. Yandell's letters, as issued from the
press; during the past two years.

Anatomy : a Text-Book of Practical Anatomy. By
Robert Harrison, M. D., M. R. J. A., Fellow of the Royal Col-
lege of Surgeons of Ireland and of England, &c., &c. With addi-
tions by an American Physician with numerous illustrations.
New York: S. S. & VV. Wood. 1848. Pp. 720 large 8vo.

We acknowledge with pleasure the receipt of this excellent work.
The numerous additions it has gained in passing through the hands
of its able reviser. Dr. Robert Watts, jr., which enhance its value,
and the manner of its execution, does justice to the well established
reputation of its publishers. Its title page reads, "A Text Book of
Practical Anatomy ;" but in the present enlarged and improved con-
dition of the work, it might well be denominated, ^^ The Library o?
Practical Anatomy," for it indeed contains all that the student can
possibly require, in the prosecution of his studies. To sum up : we
cannot better signify our approbation and commendation, than by
stating the fact, that it is our old, much esteemed favorite, the Dublin
Dissector of Robert Harrison, enlarged and improved, to adopt it to
the wants of the American student, and these wants it most amply
supplies. H. F. C.

N. S. VOL. V. NO. w. 15

22G Bihliogi^apJiical. [April,

3. An Illustrated System of Human Anatomy special, general, and
microscopic. Samuel George Morton, M. D., Pennsylvania and
Edinburgh, member of the Medical Society of Philadelphia, New
York, Boston, Edinburgh, and Stockholm; author of Crania Ameri-
cana, Crania Egyptiaca, &c. With 391 Engravings on wood.
Philadelphia: Gregg, Elliot & Co. 1849. pp. 642 royal octavo.

Here we have presented to us the most magnificent work on Anato-
my ever published in this countr}?-. It is dedicated to Students of
Medicine by the distinguished author, and we have no hesitation in
saying, that is the Anatomy for them. Besides the clear, concise and
correct description of the human system here so faithfully delineated,
the whole subject is admirably illustrated with well executed eiigra-
vinijll. But what renders this book so valuable is the important addi-
tion which it contains on microscopical ^iUdXomy . This is what gives
it a superiority over all others. We cannot too highly recommend
this work to all studying Medical Science the production of one of
the most laborious and worthy members of the profession.

4. Clinical Midwifery. Comprising the history of 54b cases of difficulty
preternatural and complicated Labour loith Commentaries. By
Robert Lke, M. D., F. R. S., &c., &c., &c. First American
from the second London edition. Philadelphia ; Lea &; Blanchard.
1849. pp.238.

This, it will be perceived, is one of those reprints from English
Medical Literature, to which the profession in this country is so much
indebted. We thank the ever-industrious Publishers for remembering
us in their distribution of copies.

5. The Half Yearly Abstract of the Medical Sciences: leing a prac-
tical and analytical digest of the contents of the principal British
and Continental Medical works published during the preceding six
months, SfC, SfC, SfC. Edited by W. H. Ranking, M. D., Can-
tab, &c assisted by Drs. Guy, Day, Ancell and Kirkes. No. 8.
July to December, 1848. Philadelphia: Lindsay &l Blakiston.
pp.271.

This is another re-publication, for which we are mdebted to its pub-
lishers in this country for a copy. We have already expressed our
favorable opinion of this retrospect of Medical Science, and our fre-
quent reference to its pages for matter under the head of extracts, is
the best evidence of our estimate of its value.

1849.] Efficacy of certain Medicines in Dysentery. 227

On the comparativ?. Efficacy of certain Medicines in Dysentery^
und other Intestinal Fluxes of Hot Climates. By Dr. Papil-
LAUD, Brazil. (Charleston Medical Journal.)

The treatment of dysentery has varied in different epidemics,
and inflammation, once considered a cause, is only one form,
alteration of secretion another; in the most decidedly inflam-
matory form, the purely antiphlogistic treatment is seldom
suflicient, and often useless. In diarrhoea the indication for
sanguine emission is still less frequent and even if it did exist,
the physician is never called in, until the time for them has
passed by. In Dr. Papillaud's private practice in France and
in the hospitals of Paris, laudanum and starch injections, diet,
and the extract of rhatany were usually sufficient, but he fdund
since he practised in South America, that the former were
insufficient, and that astringents usually aggravated the disease.
In the province in which he lived, intestinal fluxes were very
common, dysentery endemic and often epidemic towards the end
of the summer. He experimented with castor oil, ipecacuanha,
calomel, sul ph. of soda; ofthe vegetable astringents, he tried rha-
tany and simarouba ; of the mineral astrinsrents, lime, acetate of
lead, alum, and nitrate of silver ; of narcotics, extract of opium
and sulphate of morphia; from the result of these experiments, he
determined to abide by sulp'iate of soda and opium, the eflJects
ofthe other medicines being variable and uncertain. Castor
oil does not sufficiently modify the intestinal secretions. Ipecacu-
anha is used not as an emetic, but as an antidysenteric. Intro-
duced by the rectum, and causing neither vomiting nor purging,
it is just as efficacious as when introduced into the stomach.
Dr. Papillaud thinks its virtues have been overrated. The
preparation and dose are not a matter of indifference. He
prefers the infusion ofthe root, seven to thirty grains to four
ounces of water, a table-spoonful every hour, as less provocative
of vomiting than the powder. Calomel he rejects as uncertain,
sometimespurging,sometimesbeinginert. The English practice
of calomel and castor oil is very unsuccessful. The combi-
nation with ipecacuanha, in equal proportions in pills, is more
efficacious. Sulphate of soda, he thinks, deserves the praise
it received from Bretonneauand Trousseau, acting energetically
and most rajiidly. One or two drachms, dissolved in a small
quantity of vehicle, and given in divided doses, usually arrest
a dysentery in twelve, twenty four, or forty-eight hours at the
longest. Any acute dysentery which is not suppressed in this
time by it, calls for the closer attention ofthe physician, either
as presenting complications, or being of extreme gravity. No
state of the pulse or tongue, counter-indicate its use in small.

228 Efficacy of certain Medicines in Dysentery. [April,

moderate, or large doses. In twelve or twenty-four hours the
bloody stools are replaced by natural ones, the number is dimin-
ished to three or four, and the tenesmus dissappears. In other
intestinal fluxes it is equally efficacious. In only one very
sev^ere, advanced case, it increased the diarrhoea; in three, it
was without efl^ect. Rhatany and simarouba deceived his
expectations. In the greater number of cases an amendment
took place after the first twenty- four hours, but dissappeared
the next day.

Mineral astringents he condemns altogether. They caused
violent ])ain in the stomach and bowels, increased the fever,
and were of no benefit. A syrup of lime was only successful
in some chronic diarrhoeas without general symptoms.

Opium he considers equal to sulphate of soda, and together
they formed one of the most efficacious combinations. He
preferred the extract of opium, one grain in three to four ounces
of vehicle, given in divided doses, and increased by a grain
each day, if necessary ; if the disease resists four grains, one
grain of the sulphate of morphia was substituted, and progres-
sively increased in the same ratio.

The sulphate of soda and opium were united, both because
separately they were so efficacious, and further, because the
sulphate of soda, not acting as a purgative, but as a general and
local modifier, the action was prolonged by its union with
opium, which prevented or retarded its expulsion by the action
of the intestines.

Two-thirds of the patients treated by sulphate of soda and
opium were cured in twenty-four hours. The maximum dura-
tion of treatment was five days, the minimum twelve hours, the
average two days. Opium alone gave fewer rapid cures, but the
maximum and mean remained the same. Ipecacuanha alone
or with calomel gave an average of five days and a maximum
of eight. The deaths were as one in ten ; with the former
method as one in twenty. With astringents the treatment was
inefficacious in half the cases one forth died ; the duration of
the treatment was from five to thirty days. General bleeding
was indicated once in every twenty-five cases local once in
every fifteen.

These observations were collected in a province of Brazil,
in twenty-nine degrees south latitude, therefore in an extra-
tropical, warm region, and if we compare the results there
with what occurs in France, we may conclude that the medical
power of astringents in the class of diseases decreases in direct
proportion to their acuteness and severity, and also in direct
proportion to the elevation of temperature of the regions where
they prevail.

1849.] Asiatic Cholera. 2*29

The summary of his remarks is contained in the following
conclusions:

1. Opium and sulphateofsodaare the TemQd\e^,par excclknce,
in the great majority of intestinal fluxes, acute or chronic,
sporadic or epidemic.

2. Either one of these, or both combined, suppress dysentery,
without any danger.

3. Ipecacuanha, so much used in these diseases, is not a
reliable remedy. When it did cure, it was owincr neither to an
emetic nor purgative property ; it was most efficacious when
tolerated ; its introduction by enema was useful.

4. Calomel alone was more faithless still ; added to ipecacu-
anha it promoted its toleration and regulated its action.

5. Vegetable astringents were seldom useful, and often
hurtful. In the few cases where they are indicated they should
be comiiined with opiates.

6. Mineral astringents were still less valuable, and more in-
jurious than vegetable astringents.

7. The indications for local bleeding were very rare ; that
for general bleeding occurred only as an exception.

Prophylactic Indications to he observed against the Asiatic
Cholera. (New Orleans Med. and Surg. Journ.)

At the time when Asiatic Cholera seems on the point of
reaching us, we deem it our duty to make known to our readers
an interesting report on the prophylactic indications to be ob-
served against this terrible malady, a report of which the Belgi-
an Academy of Medicine is now discussing the results. This
report suggests painful reflections. In efl^ect, while around us,
in Germany, in England, in Belgium, everywhere, the public
mind is pre-occupied with the coming of the Scourge, the French
Government alone seems content to remain quiet and inactive.
The following is the summary of the results of the report.

1 . Tg improve the sanitory condition. 1st, in the is^norance
which 'Cxi^s of the virtual or efficient cause of epidemic Cholera
Morbus, to endeavor to combat efl^ectually the auxiliary or pre-
disposing causes, which singularly favor its invasion, and influ-
ence so powerfully its propagation, its malignity, its treatment
and its termination.

2. To observe carefully the preservation of the public health ;
to seek by all disposable means to destroy, to correct or at least
to diminish the causes of insalubrity, by placing the poor and
laborious classes in physical conditions similar to those in which
indejiendent persons are generally found.

230 Asiatic Cholera. [April,

3. To provide for the healthfulness of cities and of the coun-
try, as well as for the improvement of the condition of the
indigent and for their education.

4. To direct Magistrates to neglect nothing for the removal
of whatever may favor the development of the disease.

5. To take care to preserve the greatest cleanliness in inhab-
ited places, in dw^ellings, and of person and clothing.

6. In the imminence of the disease to have the streets, lanes,
crossings, public places, markets, &lc., in cities and towns, and
villages, swept frequently, not only during the day, but even at
night also, and never to suffer dirt, filth, sweepings, excrement,
animal and vegetable matter, in a state of putrefaction, to re-
main there.

7. To facilitate the flowingoff of rain water, slops, &c., fall-
ing on the surface of the ground, and to permit no where near
habitations, the formation of muddy and putrid pools.

8. To cleanse the sewers, ditches, ponds, canals, flat ponds,
dung heaps, &c., during the winter or at the commencement of
spring.

9. To arrange the perimeter of marshes, ditches, and ponds,
and even of rivers with a gentle current, whose beds are partly
exposed during the summer, so that their waters may be con-
stantly elevated and may keep the banks submerged unless
circumstances may not permit them to be cleansed or desicca-
ted before the appearance of the epidemic.

10. If the disease makes its appearance in any particular
locality, to defer or to forbid the cleansing or desiccation of the
surrounding stagnant water, unless imperious necessity com-
pels a different course; to prevent at that time even fishing in
the lakes and ponds when it cannot be done without first draw-
ing off the water, and exposing the putrescible mud of their
bottoms.

11. To cause the inspection and cleansing of wells, cisterns^
fountains, pumps, and watering places.

12. Public and private privies, when it may be requisite,
should be examined and emptied; and those of them should be
closed up whose flagrant insalubrity is irremediable for the
want of a regular drain, or other means suitable to insure their
innocence.

13. To exercise a special and constant superintendence over
all public institutions, where large masses of people are assem-
bled together, such as Theatres, Barracks, Prisons, Hospitals,
Schools, Colleges, Universities, as well as w^orkshops, and fac-
tories, in order to maintain in them the most perfect salubrity,
particularly those which are reputed to be insalubrious, likely
to compromise the public health by being badly kept, and by

1840.] Asidlic Cholera. 31

the noxious vapors which they diffuse, regarding private rights,
however, as lar as possible.

14. To pursue the same course towards slaughter houses,
hutclieries cemeteries, luiriber yards, warehouses, shops, cellars,
granaries, stables, stalls, furnished rooms, houses occui)ied by
pour families, ragmen, gut-spinners, cattle-merchants, persons
who raise hogs, chickens, rabbits, &c., places in which the air
is often, impure, contaminated, and imperfectly renewed.

15. To sprinkle chlorides frequently in necessaries and w^a-
ter closets, in kitchen sinks, in the sewers of slop water, in places
where large numbers of persons assemble, in butcheries, slaugh-
ter houses, fish markets, in dead chambers, &c., in short, where
ever noxious emanations are formed.

16. In situations other than those enumerated, (15) the best
and the princijml remedy is a free circulation and renewal of
pure air.

17. The habitations of the poor should always be ke])t clean,
and rendered healthy ; they should guard against the crowding
of lodgers, and where it exists, it should be speedily obviated.

IN. At the ap[)roach of the disease, to disperse a part of the
population which is crowded in narrow and unhealthy habita-
tions, by procuring for them spacious lodgings, well aired and
ventilated, until the danger is past.

19. Houses which have been recently invaded by the over-
flowing of rivers should not be inhabited until after they have
been perfectly dried and purified throughout.

20. To furnish necessary supplies, and to secure subsistence.

21. To cause to be inspected, and approved by experts, the
condition of articles of food offered for sale, in all places what-
soever, to prohibit by severe penalties all those which are of
doubtful or bad quality, as well as those which have marks of
alteration or adulterations. Unripe fruits, vegetables, the flesh
of swine, salted, smoked or dried meats,* pickled fish, melons,
cucumbers, &c., demand above all especial attention on the part
of thesanitory police.

22. To recommend temperance and sobriety, and the ob-
servance of a nourishing regimen, not exclusively vegetable,
but composed of animal and vegetable substances.

23. To remind the municipal authorities of the principal du-
ties prescribed by law with regard to food and drinks.

24. To warn the people, by every possible means of publicity,

Viandcxfaisandees are the words of the orif^inal which I have translated
dried vieals. They mean meal.s which have been kept until they linve acquired
a taste of venison ; or as an American would say, until tiiey have become taint-
ed, and would no lonj^er require the practiced iiose of an inspector to condemu
them as articles ot food.

232 Asiatic Cholera. [April,

that an improper regimen and acts of intemperance frequently
provoke the development of the ej)idemic cholera, and that the
use of indigestible food, excess in eating and drinking, the abuse
of aJcohohc liquors, drunkenness, incontinence, the use of ices
and sherbets, the imbibing of very cold draughts, are also so
many causes likely to produce the disease.

25. To persuade the people to abstain from the use of any
remedy w hatever, preservative or curative, without the advice
and consent of a physician.

To make every preparation in advance for medical treatment.

26. Not to establish on the continental frontiers either cordons
of health, or pest houses, or quar^mtines, for the purpose of pre-
venting the invasion of the cholera, experience having shown
that these means are more productive of inconvenience than of
benefit.

27. Nevertheless if there should be in any of our maritime
ports vessels on board of which there are cases of sickness or
deaths from the disease, such vessels should not be permitted to
have free intercourse with the inhabitants, but should be treated
as evidently suspicious, and subjected to a quarantine of twelve
days at least.

28. To increase the means of public relief afforded to the
indigent sick, and to secure to the poor the means of subsist-
ence ; to procure fur them clothing, fuel, blankets, and to dis-
tribute aniong them frequently fresh straw for their beds.

29. To establish in every community sanitory commissions
for the purpose of observing every thing which concerns the
public health. These commissions composed of the burgomas-
ter, of notable inhal)itants, of j)hysicians and apothecaries, shall
give advice as to the changes and anieliorations of which the
localitii'S confided to their superintendance may be susceptible,
in order to anest the progress of the Cholera, and to aid those
who may be attacked with the disease.

30. In each division, district or section of cities to establish
besides sub-commissions of health, whose business it shall be to
examine the streets, public places, markets, public and private
institutions, houses, &c., to investigate the causes of insalubrity
and to make tlieni known, in order to point out the danger to
the inhal)!tants, persuading them to reinedy these causes as much
as p()ssil)le, under the direction of the authorities. To these
commissions might be granted all the powers which may be
thought useful for the improvement of the condition of the poor
and of the public health: they should correspond with the cen-
tral sanitory commissions and the authorities of the community

1849.] Asiatic Cholera. 233

to which they belonfj, and should be composed of the curate or
vicar of the parish, of three notables, the head of the poor es-
tahil^hment, or a member of the Society of Benevolencte, of a
physician, a surgeon and an apotfiecary.

31. To fxiisuade the heads of tiie poor, the members of be-
nevolent Societies, the ecclesiastics of the parishes, and all
charitable persons who have influence with the wretched and
less enlightened portion of the population, to visit indigent fam-
ilies in order to make them feel that a want of cleanliness, hu-
miditv, crowding, want of air, of ventilation, and ot solai light
in iheir habitations and of suitable clothing, intemperance, pro-
longed exposure to the incleniency of the weather, excesses of
every kind, especially drunkenness, favor the development of
the disease and aggravate its effects. They should endeavor
to prevent many patients from lying together, or being con-
fined in a locality too small, or containing other individuals in
good health.

32. To increase the number of physicians of the poor or of
charity, so that all the sick without distinction may be visited
and relieved without delay.

33. In each division of populous cities and in all the commu-
nit es, to establish, under the direction of the Sanitory Commis-
sion,/)ffices of reliel, to which shall be attached two physicians
at ita>t, so that they may relieve each other when occasion
may require, and that there may be always one in waiting, day
and night, ready to give advice and attention to such as may
present themselves for that purpose.

34 These offices of relief should be provided :
1st. With a covered litter furnished with a matrass, with
blankets and every thing necessary for the transportation of the
sick ; 2.,d, with a medicine chest ; 3rd, with utensils indispen-
s-cbh tor the use and administration of the first remedies.

35. As the disease, from the time it has entered a house is
not only formidable to those whom it has attacked, but threat-
ens also the inmates who may be in good health, one of the
principal means to he employed for the protection of the latter,
is to cause them to remove, by procuring ior them salubrious
dwellings, lemote from the foci of infection.

36. When the sick belong to the indigent class they should
be prevailed on by persuasion to sufler themselves to be trans-
ported immediately to some of the hospitals destined for Chol-
era patients.

38.* It is indispensible that temporary Hospitals, well or-
ganized, should be established, combining every thing requisite

I suppose 37 is omitted as not applicable. I give the numbers as I find them.

231 Asiatic Chokra. [April,

for the treatment and cure of the sick, and the preservative of
other ind viduals.

39. These asylums, opened by public benevolence to afflict-
ed humanity, should not only receive gratuitously all the indi-
gent who may be attacked with the disease, of whatever coun-
try they may be, but moreover every person who may demand
to be admitted on paying so much for every day that he may
remain.

40. These temporary hospitals should be furnished with what-
ever is indispensible for the medical service, and should have
their directois, tfieir physicians, their resident students, apoth-
ecaries and stewards.

41. In each city or community there should be at least on6
of these hospitals for every one hundred thousand inhabitants.

42. They should be on dry ground, in the most elevated or
exposed situations, well ventilated, remote from the evaporation
of rivers, ponds, marshes, sewers and ditches, and in cities near
the districts inhabited by the poor, upon whom particularly the
scourge exerts its ravages.

43. It would be better to increase these temporary hospitals
than to diminish their number by giving each of them too great
extent ; the air of these large hospitals, the wards of which con-
tain many sick, is the chief obstacle to their cure.

44. In cholera hospitals three divisions should be established :
one for those who are suspected of having the disease, another
for confirmed cases, and the third for convalescents.

45. If these temporary hospitals do not adnni of the divi-
sions just mentioned, houses of refuge or of health should be
established near them, for those who are suspected of having
the disease, and houses destined for the reception of convales-
cents.

4(5. To enjoin upon the Commissaries of the police and other
officers to keep a Register of every event relating to the public
health, which they should communicate daily to the Sanitory
Commission of the place.

47. To request the proprietors and principal tenants of
liouses, hotel and innkeepers, lodgers, and all those who keep
furnished apartments, to make known with as little delay as
possible, to the nearest office of relief, all that relates to the
Cholera.

48. When a sick person is in a condition to receive imme-
diately the necessary relief, the director of the office should
send him a physician without delay. After the administration
<^)f the first remedies, he should be removed to the nearest tem-
j)orary hospital, if the patient oj- his fi'iends consent.

4i). To cause to be w\ashed, bleached or disinfected, the litter,

1849 ] Calomel in BlUary Secretion. 23i

linen and clothinf]^ which have beon used by Cholera patients,
before pcitnitting ihcin to be used by healthy persons.

f)0. The bodies of those who have died of the chsease nfler
having t)een sprinkled with chloride of lime, should be removed
as soon as the death has been clearly nscertained, so that tliey
may be immediately transported in carriages well covered, to
the place destined for their interment.

51. The bodies should be interred in the ordinary cemeteries,
or In some place set apart for that purpose, remote from habita-
tions, never in chuix'hes, or chapels, or gardens, or private
houses, and should be buried in ditches of a meter and a half in
depth, without waiting, as the custom is, until other bodies have
arrived.

52. To prohibit the exposure of the bodies ofCholera patients
in the churches, where they might greatly prejudice the health
of those who assist at the religious ceremonies.

53- To transport bodies to the cemetery during the night,
before the rising or after the setting of the sun, without noise,
without the ringing of bells, and without religious pai'ade, from
whach it would also be well to abstain in going to administer
the sacraments to the sick.

54. During the continuance of the epidemic the sounding of
the agony or of the funeral knell should be forbidden; at the
same time, as numerous assemblages are much to be feared,
ihey should also be avoided.

55. In short, to persuade the public, particularly the common
;people, to call physicians to tlfeir assistance, as soon as the first
symptoms of the disease manifest themselves. M.

Does Calomel realhj Expel the Biliary Secretion? By Dr.
Mich E A. (London Lancet.)

Dr. Michea has published, in U Union Medicale, a very in-
teresting paper on the above question. The author's object
was to ascertain, by chemical analysis, whether the green co-
lour which purgative doses of the chloride of niei-cury give to
the alvine dejections (besides rendering the latter more copious
and less dense) is really owing to a superabundant secretion of
bile. Opinions, says Dr. Michea, are not agreed on this point
either in France, Germany, or England. INIr. Higgins (who
published his paper in L'Uriion Medicale) and M. Mialhe con-
sider that calomel really excites the biliary secretion. M ]\L
Trousseau and Pidoux, authors of an esteemed work on materia
medica, express their doubts on the point. Actual expeiiments
have been made bv Dr. Franz Simon. Dr. Goldincf Bird, and

5J36 Calomel in Biliary Secretion. [April,

M. Siebert. The first of these inquirers found, after large doses
of calon)el, a great quantity of bile and billiverdine ; the second
discovered only a few traces with a hydrocephalic child taking
mercury, and the third maintains that the alvine dejections fol-
lowing the use of this metal present no trace whatsoever of
bile. The green stools resulting from the use of the Carlsl)a(l
and Marienbad waters are, on the other hand, denied by jVL
Kerstin, of Freiberg, to contain any trace of bile, and that
physician thinks the colour to be due to green sulphuret of
iron, by the reduction, in the stomach and intestines, ofthesut-
phate of- soda contained in mineral waters, into a sulphure-t,
which subsequently combines with the iron likewise to be found
in these waters. This theory is founded upon the fact, that
hydrochloric acid removes the green colour of the faeces, and
evolves a large amount of sulphuretted hydrogen. Dr. Gold-
ing Bird and Professor Schonk-in are of opinion that the green
colour given to alvine dejections by calomel is due, not to an
excess of bile, but to an alteration ol the haematosine. Startled
by these dissimilar statements. Dr. Michea began a series of
chemical analyses upon 1, the spontaneous alvine dejections
of healthy men; 2, the same substance, of a more or less green
colour, from men affected with gastro-intestinal inflammation ;
3, the same, resulting from various doses of calomel ; and 4^
evacuations produced by neutral salts and resinous purgatives.
The author prefers for his tests, the strong nitric acid of Dumas
to the sulphuric acid and syrup of Pettenkoffer. The sponta-
neous alvine dej.^ctions of six healthy individuals, four adults
and three childien, were examined ; their fiUered solution re-
mained unaltered by nitric acid. The evacuations of three pa-
tients affected with gastro-intestinal derangement were exam-
ined, and much bile was found in one case only. When the
vomiting had subsided, the bile disappeared from the dejections.
Calomel given to eight persons, five men and three women, in
doses varying from twelve to fifteen grains, produced green
stools in four patients only. These being analyzed, it was found
that they contained a superabundance of bile, and that, with
nitric acid, two principles of that secretion might be made
manifest, viz., bilverdine and albumen. The evacuations of
two of these subjects gave, not a pure green by nitric acid, as
this reagent will generally produce on biliverdine, but a dirty
olive, (on this Dr. Michea grounds his belief, that he found bile,
and not biliverdine alone;) this olive colour, however, assumed
the same successive shades of purple, red, and yellow, which
biliverdine will yield. In the two other instances, the nitric
acid gave a drab or yellowish-red colour, almost without any
subsequent shades. The author puts the question, whether this

1849] Calomel in Biliary Secretion. 237

mi^ht not have been the bilifulvine of Mulder. The evacua-
tions of five persons who took neutral salts and resinous purg-
atives were never green, and exhibited no albumen on the ad-
dition of either by nitric acid or heat, whereas the albumen,
as shown by a plentiful precipitate, was abundant with the four
patients using calomel. This albumen was, according to Dr.
Michea, furnished by the bile. These experiments would, then,
tend to elucidate the practice, First of English physicians,
who regard calomel as a specific in liver affections; secondly,
of Dr Schonlein, in typhus, who looks for green evacuations
by fifteen-grain doses of the chloride of mercury; and thirdly,
of Russian practitioners, who consider calomel the most efficient
agent against cho'era. Modern organic chemists look upon
bile as partly of an excrementitial nature, and that the liver as
well as the lungs removes from venous blood substances which
have become unfit for assimilation, (the resin and fat to be found
in the bile containing much carbon and hydrogen.) The more
plentiful, therefore, the seci'etion of bile, the purer the blood.
Thus it becomes clear how calomel may act beneficially in
miasmatic contaminations, in typhus and cholera. We sub-
join Dr. Michea's conclusions:

1. Calomel acts in a special and direct manner on the liver :
this salt occasions alvine evacuations of a peculiar colour, due
to an excess of actual bile, as shown by the action of nitric
acid, which points to the presence of its colouring matter (bili-
verdine) by change of colouration, and of its albumen by pre-
cipitating the latter.

2. This influence of calomel upon the biliary secretion is
not constant. It varies according to certain conditions and
circumstances

3. The green evacuations produced by calomel are more
frequent with men than women. (This the author supposes to
be owing to the greater quantity of alkaline chlorides gener-
ated in the stomachs of men, which chlorides, according to
Mialhe, would contribute to transform the chloride of mercury
into a bichloride.)

4. These evacuations have a peculiar consistence viz., a
viscous liquidity, somewhat like oil, or white of eggs beaten up
together.

5. In some affections of the intestinal canal, an excess of
bile, to be detected by reagents, may be found in the evacuations.

6. Spontaneous alvine evacuations in healthy people are
quite ^v^e^ from an excess of bile.

7. Neutral salts and resinous purgatives exercise no direct
or special inffuence on the liver The alvine dejections which
they produce contain no excess of bile, remaining unaltered by
nitric acid or heat.

238 On the Sound of Circulation. [April,

On the Sound of Circulation. By G. G. White, Esq., of New-
port, U. S. (Ibid.)

An interesting; article which appeared in a recent number of
the Lancet, from the pen of James Yearsley, Esq., revealing a
new remedy for deafness, induces me to communicate to your
columns a discovery which I made, some time ago, of the
sound of circulation, the result of which affords, I think,
an explanation of the causes of numerous cases of defective
hearing.

B}^ inserting the ends of the fingers within the ears, or by
covering them with the hands, or any other part of the person,
we detect a rumbling sound ; this sound proceeds from circula-
tion throughout the system, and is conducted to the hearing
through the fingers or the part applied. If another person
places his hands over our ears, we hear the circulation cours-
ing through his body. Other noises are excluded, and the
sound of circulation is carried with full force to the tympanum.
If a lifeless body is applied there, no sound is produced ; so that
it may be determined by a reference to the organ of hearing
when the blood ceases to flow, and life becomes extinct. By
holding any conductinor, though lifeless, object to the ear, we
may get the sound slightly, but it will proceed from the hand
or from the living body which supports it there. This may be
simply tested. By turning the head upon one side and standing
a cork within the ear, no rumbling will be heard, except, per-
haps, a very faint one, produced by its contact with the portion
of the orifice where there is a vein, from which it is conducted;
but by applying the fingers to the cork, and pinching it, the sound
is increased to an extent which will leave no doubt as to its
source.

In most cases of deafness, the patients complain of an inces-
sant buzzing or rumbling. Now it is evident that all sound
must come to the ear, as sight does to the eye, externally ; and
if the orifice of the ear be not rightly formed if it be a little
sprung, or swells, or projects into its own channel, it must convey
this rumblinf]^ sound, in the same manner as will the finders or
any other part of the person ; and it must, according to the
extent of the deformity or projection, shut out other sounds and
communicate its own. The same rumbling is sometimes pro-
duced in gaping; oftener, however, when the gaping organs
act with the mouth closed ; also, to a slight extent in swallow-
ing. The action projects a portion of the sides of the orifice
of the ear into its own funnel, which conducts the sound. I
can, at any time, produce the buzzing in my own person, by a
contraction of muscles in the region of the car. mis-sha])ing

1H49.] Chloroform in Cholera. i>31)

thereby its channel to the drum. It will be readily understood
that wax may produce, in some measure, the same rnrnhlin;^,
by its contact with the orifice, or a part of its linini;, from
which it may communicate the sound ofcirculation, at the same
time closinf^ the channel to other sounds.

If this theory of deafness and of rumbling, from defective
construction of orifice, be true, (and I have no doubt it is,)
could not a shaping frame be made to remedy it? Is there no
way of correcting the form of the channel to the tympanum?

A Case of Cholera in which Chloroform was successfully given
internally. By R. S. Strother, M. D., of Bardstovvn, Ky.
(Western Journ. of Med. and Surgery.)

On a recent trip to New Orleans, I had an opportunity of
tryino: chloroform in cholera. The vessel on which I returned
had fifteen or eighteen cases of the disease on board, of which
seven terminated fatally. In the spasmodic stage large doses
of opium, morphia and musk were used, but without saving a
solitary case.

The next case that offered itself was that of a negro man,
who w^as seized with profuse diarrhoea. This was checked by
opiates, and for thirty-six hours he took no medicine. At the
expiration of this time I was called in haste to see him. The
diarrhea had returned ; he was vomiting incessantly, and his
cramps were violent, affecting the muscles of his arms, legs,
and abdomen. He was in great agony, and apparently in a
hopeless condition. 1 at once gave him a hundred drops of
chloroform in a little sweetened water, the effect of which was
to arrest the vomiting ; he vomited but once after taking it, and
in fifteen minutes every symptom of the disease had disappear-
ed. His rapidly declining pulse returned, his extremities grew
warm, and he remained in a half-intoxicated state, pei'fectly
free from pain, and with pleasant sensations, for six hours,
which interval I seized for the administration of other appro-
priate remedies. I left the patient convalescent, and apparently
out of danger.

The other cases by being taken in time, were cured by the
usual remedies. Had they advanced to the stage in which I
found this man, I should have given chloroform, for the purpose
of suspending the disease and gaining time. As an antispas-
modic, it is unquestionably the most efficient article known to
the physician, and, I am persuaded, not more dangerous than
the preparations of opium.

240

Cholera. Dislocation of the Pelvis.

[April,

Is the Cholera Contagious? Extract from an article on this
subject in the Annalist.

To mnke this subject of contagion more clear, let me in con-
clusion place in juxtaposition the well known and acknowledged
characteristics of contagious diseases and cholera.

1st. All diseases indisputably 1st. The cholera exhibits no
contaijious, have a regular period such period; individuals being of-

of incubation or interval between
the time of exposure and the ac-
cession of the disease.

2d. Owing to the first charac-
teristic, contagious diseases al-
ways spread slowly at first, and
are easily traceable from the sick
tother attendants and others more
or less directly in contact with
them.

3d. In all contagious diseases,
an approximation to the bodies or
clothing of the sick, is essential to
the communication of the poison.

4th. The most contagious dis-
eases known, may be limited in
extent by rigid quarantine and
non-intercourse regulations.

5th. Contagious diseases are
propagated as readily in the coun-
try as in the city, in mountains as
in valleys, in the housetop as in
the basement, and during the ex-
treme cold of winter as well as
heat of summer.

Now, I would ask in all seriousness, by what rule of logic,
or what principle of scientific induction, two diseases, whose
prominent characteristics stand in such marked contrast with
each other, can be ranked together in the same category ? Cer-
tainly in no other way than by reasoning on the most loose and
vague generalities.-

ten attacked within a few hours
after entering the pestilential dis-
trict.

2d. Cholera often appears in
several parts of a city suddenly,
and so nearly simultaneous, that
no connection whatever can be
traced from one to adother. So
true is this that the epidemic is of-
ten at its height in five or six days
from its commencement.

3d. In cholera seasons no such
approximation is necessary, the
most secluded individuals being
often attacked, while those in daily
and hourly contact with the dead
and dying are unaffected.

4th. Cholera has uniformly set
at naught all cordons sanitaire,
even though enforced by the rigor-
ous arm of despotic power.

5th. The cholera chiefly con-
fines itself to the lowest, dampest
and dirtiest situations, very sel-
dom ascends mountains, or pre-
vails in rural districts ; and never
spreads during the extreme cold of
winter.

Dislocation of the Pelvis. (Prov. Med. and Surg. .Tourn., and
Ranking's Abstract.)

In the sixth volume of the 'Abstract,' p. 77, an article is in-
troduced on "Separation of the Sacro-Iliac Symphysis, by M.

1849.] Cholera in Nashville. 241

Kluyskens ; the following notice "On Dislocation of tlie Pelvis"
has subsequently appeared in several of the journals :

M. Murville, in a memoir presented to the French Academy
of Medicine, on luxations of the pelvic bones, relates the two
following very remarkable examples of this accident. The
first was the case of an officer, who fell from a second-floor
window, and lighted on the tubera ischii. The sacrum was
displaced downwards by the weight of the body. On exami-
nation, the crests of the ilia were found to be almost touching
the false ribs; the os coccygis, much shattered, projected con-
siderably below. The patient complained of js^reat pain in the
sacro-iliac symphysis, with paralysis of the bladder and rectum,
small pulse, and other signs of colIa])se. He was restored some-
what by stimulants, and when reaction was fully established,
he was treated antiphlogistically, the displaced bones being
maintained as motionless as possible. No attempt at reduction
was considered advisable. This treatment was marvellously
successful ; not only did the patient survive, but the paralysis
diminished, and in ten days the patient was able to walk with
difficulty.

The second case is unique. An officer, during a review, was
run away with, the horse, at the same time, plunging violently ;
in one of the plunges he was thrown considerably from his
saddle, upon which he descended again with such force as to
lacerate the left side of the pelvic arch, without injuring the
skin. A second plunge of the animal added to the mischief,
completely rupturing the ligaments of the symphysis pubis.
When examined, a large inguiual hernia was discovered on the
left side, and in the perineum a tumour projected as larire as the
fist, which could be pushed upwards into the pelvis. The sym-
physis pubis was separated to an extent which allowed the hand
to be insinuated between the ossa pubis. The hernia was re-
duced, and the bones kept in apposition by bandages, and in
three months the patient w'asable to walk. M. Murville, upon
this case, founded some remarks upon the feasibility of the
operation of division of the symphysis in labour. In a discus-
sion which ensued, M. Malgaigne doubted that it was a case of
simple dislocation, thinking it probable that there w^as also
fracture.

Cholera in Nashville relation to Limestone. (Western Jour,
of Medicine and Surgery.)

We have just received a letter from Dr. H. B. Walton, of

Nashville, givinof some interesting particulars in relation to \\.i
appearance of cholera in that city. He slates that the pestilence

.\. S. VOL. v. NO. IV. IG

242 Cholera in Nashville. [April,

firt appeared there about two months since, and that the aver-
age mortality from it had been about two a day. " The weather
for the greater part of the time has been warm and wet. But,"
he adds, "the point to which I wish particularly to call your
attention is the predilection of the disease for a certain quarter
of the city. It has prevailed almost exclusively about a parti-
cular locality. At first, this appeared inexplicable ; but since
reading the remarks of Dr. Jackson on the connection between
cholera and limestone regions, I have supposed that the cause
was revealed. A large portion of the city of Nashville is sup-
plied with water from the Cumberland ; citizens in other parts
use water from springs and wells which, of course, is largely
impregnated with carbonate of lime. It is to the latter, with
scarcely an exception, that cholera has been confined. Two
cases presented themselves which, at first, I supposed, were ex-
ceptions to the rule. One was a lady, who resided in that por-
tion of the city where hydrant water is used ; the other was a
negro man living in the same quarter ; but, on inquiry, I learned
that the former used water from a spring in the cellar of her
dwelling, and that the latter had been laboring in the vicinity
of a spring from which he obtained all the water that he drank.

"A large majority of ihe more aggravated cases have occur-
red in a small neighborhood, in the vicinity of a spring more
highly charged with lime than any other in the city. Whether
it IS to the use of this water, or to some other cause, that the
disease has prevailed in this locality while the city has been ex-
empt from it, is a question not to be determined without farther
observation. But the fact is instructive, and, as bearing upon
the local origin of cholera, I have deemed it worthy of being
recorded."

It may be interesting to remark, in reference to the sugges-
tion of Dr. Walton, that cholera infantum has prevailed with
much less severity in Nashville since the introduction of hy-
drant water, as we were assured by physicians there some years
ago. Nevertheless, we are not prepared to give our assent to
the doctrine that cholera is produced by drinking limestone
water. That it manifested a preference for limestone districts,
in its former visit to our country, we had occasion to remark
two years since, when speaking of the bearing of geology upon
disease ; but it does not follow that the water had any connec-
tion with it. We attempted to show that it was particularly
in regions where the older, or blue limestone is the surface rock,
that the pestilence w^as most fatal. But this is not more soluble
than the other limestones. The water at Louisville is as highly
charged with the grey limestone, as the water at Lexington is
with the blue. In Louisville, the epidemic at its height carried

1849.] Monthly Periscope. 243

off seven a day, in a population of 20,000; in Lexington, in a
population of 5,000, sixty persons died in one day. At New
Orleans, where there is no limestone, the disease was excessive-
ly destructive. At Cincinnati, Maysville, Lexington, and Ver-'
sailles, all on the blue limestone, its mortality was great. At
IVashville, again, at Murfreesborough, Shelbyville, and Pulaski,
it appeared in a malignant form, and they are all upon this rock.
A few miles south of the latter places, the formation changes,
and the epidemic was heard of no where beyond them. These
facts are curious. They seem to show a relation between cho-
lera and our geological formations ; but they do not reveal the
cause of the pestilence.

PART IIL
iEtlontljIg JiJeriscopt

Presence of Sugar in the Liver. MM. Bernard and Barreswill
have demonstrated the presence of a notable quantity of sugar in the
liver both of man and animals. By fermentation they obtained alco-
hol from this sugar, a sample of which M. Pelouze exhibited to the
Academy. Hitherto no means had been ascertained of obtaining
from the liver other than a kind of molasses charged with salts, the
sugar of which was uncrystalized. Repeated experiments have ena-
bled MM. Bernard and Barreswill to establish the fact that the sugar,
which exists in considerable proportion in the tissue of the liver, is not
found in a normal state in any other organ, and that consequently the
liver is, on this account, chemically distinguishable from all the other
organs of the animal economy. They have satisfied themselves that
the liver always contains the same large proportion of sugar, even in
animals completely deprived of food containing either sugar or starch,
and kept for a long time exclusively on animal diet. They conclude
thr.t the existence of sugar in the liver is a physiological fact complete-
ly independent of the kind of food taken. [^London Med. Gazette.

New Method of Detecting the Presence of Sugar in the Blood. If a
small quantity ofdiabetic serum is placed in a glass tube, with an equal
quantity of a solution of tartrate of copper, and liquor potasste, which last
isof a blue colour, and the mixture be cautiously boiled for a few min-
utes, the presence of sugar is detected by the conversion of the blue
into a brick-red colour, with, at the same time, a precipitation of the
oxide of copper. [Proi?. Med. and Surg. Journal^ from Annales de
Tkerapeutique.

Creasote in Mercurial Salivation, By E. W. Faulcon, M. D., of
Warren county, N. C. "Two days ago, while lookiiig over the last
edition of * Watson's Practice of Physic,' on the subject of ' Mercury

244 Monthly Periscope. [April,

in Inflammation,' I recalled to memory a case that came under my
observation six years ago, wliile I resided in another section of this
State. It was one of severe salivation from the use of this mineral in
remittent bilious fever.

"I suggested to the attending physician of the patient the following
gargle: creasote 3ss., sage lea one pint. To be used every hour
during that day, and its etfects accurately noted. In thirty minutes
after its first ai)plicalion, he felt a sharp tingling sensation along the
angles of both jaws, and a slight convulsive motion in the muscles of
the lower jaw. Shortly after the appearance of this last sensation,
there was a marked relaxation of all the muscles of the face, and he
expressed himself as feeling better (locally) than he had done for many
days. In the evening there was a very great decline of the salivary
discharge, and a great improvement in the appearance of the mucous
membrane of the mouth and palatine region, which, prior to its appli-
cation, wore that aspect so indicative of a near approach to sloughing.
29th. Improving ; discontinue creasote, but add to the strength of the
sage tea. 30th. So much improved as to require no further local
treatment. Directed that the bowels be kept soluble by the use of
mush and milk as diet, and occasiona'lly aperient doses of the phos-
phate of soda. In a few days thereafter, he was 'dismissed cured,'
or in other words, to receive no more visits from his physician."

[ Wood's Retrospect.

Nitrate of Potass in Rheumatism. Prof. C. R. Gilman reports the
following facts :

Case 1. A. B., a female, aged 48, had been under treatment for
upw^ards of six months; has taken vin. sem. colchici, Tr, acteae
racemosae, and various other remedies, without marked effect. The
nitrate was given in 3ss. doses twice a day for two days, then 5i. was
given, and the patient began to improve ; the dose was continued near-
ly three weeks, when she was discharged cured.

Case 2. C. D., a girl, aged 19, has suffered for months from sub-
acute rheumatism. The remedies given to No. 1 were faithfully
tried, and also Hyd. Potass, with Extr. Hyosciami. The nitrate was
used in 3i. doses, and produced similar results as in No. 1.

" Case 3. E. F., a man, aged 40, admitted witii sub-acute rheu-
matism ; treated with colchicum, guaiac, &lc. The nitrate was given
in two drachm doses. He was entirely relieved when he had taken
but two ounces." {^Annalist.

Polydipsia cured hy CampJwr. By M. Rayer. The following case
is curious, if not instructive. A healthy woman of 35 was awakened
in the night by an earnest desire to drink. Having done so copiously,
she was soon jigain awakened by a repetition of tlie desire to urinate
and drink. This went on until tiie patient came to drink six pails of
wat(raday, without quenching her thirst, and to urinate in the same
proportion She liad iieadaehe, loss of apj)elite, dyspepsia, and ema-
ciation. The specific gravity of the urine, not greater than that of

1849.] Monthly Periscope, 245

distilled water, oxcludcd all idea of diabetes. She was | uton the use
of" camphor in pills, and allowed light aliment. In a few days the
thirst sensibly diminished, a;ul in a lew weeks she was cured. On
leaving olflier pills some time afterwards, the symptoms threatened to
return. [^Annalcs de Tlicrap., from Wood's Retrospect.

Consumption cured hij Digitalis. By D. K. Fauri:. [This heading
will attract great attention and inspire not a little interest. Its very
rarity gives interest to what follows :]

Many physicians have recommended Tinct. of Digitalis as a means
of curing phthisis, and assert their success. ]M. F. claims two for
himself. The dose was first 20 drops a day, adding 10 drops every day,
until in one case 200, in another 240 drops were taken. In one it was
given 28 days, in the other 30, and was discontinued because of the
cessation of the morbid phenomena. Both patients, on coinmencing
the treatment, were confined to bed : the second had cavernous rale,
continuous fever, with exacerbations, night sweats, etc. They were
well fed, and the tincture caused no inconvenience. One case had
lasted four years, and the other six months. It is not said whether
there is any return of the disease, and the cases are at least encour-
aging.

Baylc recommended the Tinct. of Digitalis on the authority of
Maginnis, who spoke of it in 1799. His success was astonishing, al-
though B. says his memoir bears the evidence of authenticity and goal
faith. Many of the details are ample, and B. advises a trial of the
remedy. [Bulletin de Therap., from Ibid.

Whooping-cough Prescription. By Dr. Heinricii.

Tobacco leaves, 4 grammes. (1 drachm 15 grains.)
Angelica root, 12 "
Liquorice " 15 "

Boiling water, 250 "
Dose a tea-spoonful every hour to young children ; for adults a
table-spoonful. The severity of the paroxysms is much abated in
two or three days. [Russ'n Journ., from Ibid.

Delirium of Fever, Tartar Emetic and Opium in. The practice re-
commended by Dr Graves, of treating the cerebral excitement of lever
by tartar emetic and opium, is highly approved of by Mr. Todd, in an
interesting communication on the state of the brain in fever. [Lancet.

Naphtha. This is another of the many vaunted remedies for chole-
ra, and is said to have been given with great effect in the Russian
army. The dose is from ten to twenty drops. The dose was seldom
rc([uired to be repeated. [Banking's Abstract.

Case of Neuralgia. Local Anccsthesia. Dr. Hays stated, that he
had employed the chloroform to produce local anjrsthesia with appa-
rently the most happy eflects, in a case of neuralgia, occurring in a

246 Monthly Periscope. [April,

gentleman fifty years of age, who had been for a long time a sufferer
from neuralgia of the foot, in which all the remedies that had been
previously employed failed to produce relief. Dr. H. was called to
this patient about eight days since, and found him in intense pain,
which had deprived him of sleep the whole of the preceding night.
Dr. H. directed the affected parts to be enveloped with a pledget of
lint or a few folds of muslin wet with chloroform, and the whole to be
covered with a portion of oiled silk to prevent evaporation ; on the
next morning he found him entirely free from pain, which has not
since returned. Whether the relief experienced in this case is to be
ascribed to the local anapsthesia produced by the chloroform, or is to be
considered as a mere coincidence. Dr. H. does not pretend to decide.

\^New York Journ. of Med,

On the Treatment of Scahics. By G. Cokfk, Esq. Mr. Corfe
states that he rigorously pursues the following plan with a patient
affected with itch :

We provide him with old soiled linen and a worn out sheet ; and
each morning and evening he is ordered to make a good lather of
yellow soap in his hands, and thus dip them wet into a basin of sifted
or fine sand, and assjduously rub every part of the body on which the
slightest trace of a vesicle exists. Having performed this ablution
until the skin tingles smartly, he wipes himself dry, and then rubs the
common ung. sulphuris firmly into the itchy parts. He is then envel-
oped in the winding sheet, and has a pair of old gloves on his hands,
and he is left till night, when the same operation is pursued, and re-
peated daily until the fourth day, when he is ordered to indulge (and a
great indulgence it is) in a warm bath, where he again lathers his
body in plain soap and water, puts on fresh linen, and is provided with
clean sheets, and the cure is fiom thence invariably effected. The
vesicle of course is broken by the friction of the sand and soap ; the
acarus is exposed, and this ectozoon receives his death-blow by the
inunction of the sulphur, which is oftentimes not accomplished by the
mere application of sulphur ointment alone. The use of sand-soap
balls is more elegant, though not more efficacious. [Med. Times.

Treatment of Lupus. \n the "Revue Mid. Chirurgical," M. Erne.
ry publishes the results of his experience in this disease. He has
found that no treatment, whether internal or external, possesses the
efficacy of cod-liver oil in large doses. The quantity of this medicine
exhibited by M. Emery will doubtless astonish our readers. It is in
doses from sixteen to thirty-two ounces daily that it should be used.
With every deference to the learned physician of the Hopital St.
Louis, we must say that few patients will be al)le to keep on their
stomachs such exaggerated quantities of a particularly nauseous medi-
cine, and that, even if they succeeded in not rejecting it, it is question-
able if anything like that amount can possibly be absorbed, oily sub-
stances being generally changed within the stomach into insoluble
adipocerons compounds. M. Emery states, however, that, having had

1849. J Monthly Feriscope. 247

occasion to treat seventy-two cases of confirmed lupus, twenty-eight
were completely cured by a persevering use of this medicine. [Med.
Time's.

New Adhesive Mixture. Dr. Sanborn of Andover, Mass., has made
a new adhesive preparation that is likely to prove a prominent rival
to the collodion. Gutta percha is dissolved in chloroform, having
about the consistency of melted glue. It is applied with a brush, and
meets the decided approval of competent judges. The inventor says
that he communicated the discovery of the properties of this combina-
tion to one of the Boston papers more than a year ago. The men-
struum does not evaporate quite so rapidly as ether, consequently the
gutta percha adhesive fluid is rather more economical than the collo-
dion, which rapidly disappears, after removing the cork. [Boston Med.
and SurS' Journal.

Compression of Ike Carotids in Hcemorrhage after Tonsillotomy. By
M. Gensoul, of Lyons. In a casein which death was imminent, M.
G. made pressure on both corotids, and particularly on the side whence
the blood chiefly issued. The flow ceased. The compression being
kept up for half an hour, the bleeding did not recur. Since then, he
has always successfully adopted this plan, whenever the haemorrhage
seemed too free, after removing the tonsils. It is applicable to all
troublesome haemorrhages about the face and mouth, epistaxis, and
neuralgia of the face. [Rev. Med. Chir., from Wood^s Retrospect.

Lotion for Burns. By M. Thorel.

Chlorhydric acid, at 20 50 grammes, 750 grs.
Powder of sulph. sod. 65 " 975 "

Keep the burned part as much as possible in this liquid, or use it
often as a lotion. It is adapted only to burns of the 1st and 2d degrees :
causes the inflammation to cease immediately, and prevents the for-
mation of phlyctenae, or interrupts their development. [Jour, des Con.,
from Ihid.

Anthrax treated hy Vienna Paste. By M. Jobert. When the
patient dreads the knife, M. T. applies on the tumor a long track of
Vienna caustic, comprising all the length of its vertical diameter.
The caustic is left on for 15m. Pain ceases almost immediately, and
the abnormal sensibility diminishes, so that the part may be handled in
all parts without suffering on the part of the patient. The patient
sleeps tranquilly all the following night. In about nine days the
eschar falls and leaves a healthy sore, which soon heals. Bulletin de
Therap., from Ihid.

Subcataneous Puncture in Hygroma. By M. Blandin. The rad-
ical cure of these bursal swellings is seriously difficult; simple punc-
ture often fails, for the sac is oftenest multiocular, or may contain
coagula, or albuminous bodies. To inject it, it must be opened large.
ly, and excision is dangerous.

248 Monthly Periscope, [April,

The following case illustrates M. B.'s practice: A man had an
hygroma in front of the patella, the size of a small egg. M. B. slid
in a tenotome to the distance of three finger breadths, entered the cyst
and split it from side to side in different directions. He then compress-
ed it with a compress and bandage. It did not recur. The compres-
sion must be sustained until the entire absorptionof the contents of the
tumor. [Jour, des Conn., from Ibid.

Local Application of Chloroform in Lumbago. By M. IMoreau.
Three cases of this disease are detailed in which immediate and per-
manent relief was obtained b}^ the application to the loins of a piece of
lint on which some chloroform had been poured. Oiled silk ought to
be laid above the lint, to prevent the evaporation of the chloroform.
In a few minutes the patient complains of a burning heat in the part,
which becomes red, and occasionally vesicles are formed ; at the same
time the rheumatic pain disappears. The author thinks that the cure
cannot be attributed solely to the counter-irritation, as in one of the
cases recorded sinapisms had been previously employed without suc-
cess. He supposes the chloroform to reach by imbibition the cutane-
ous and supeificiai muscular nerves, on which it exerts its anaesthetic
power. [V Union Medicak, from Ibid.

On the Action of Proto- Sulphate of Iron in the Treatment of Chancre,
Gonorrhoea, ^c. The whole class of caustic agents, when applied to
the Hunterian chancre, (though the potassa fusa cum calce be used,
till the ulcer be "punched out," as recommended by M. Ricord,)form
an eschar with pus still secreting; in fact the morbid cells have not
been destroyed. The alkaloids and hydro-carbons are equally ineffi-
cacious.

If a chancre be perfectly freed from its eschar and the enclosed pus,
at the b(jt{om of the excavation may be observed minute white points
or germs, secreting, slowly, the morbid virus. If, now, the proto-
sulphale of iron, minutely pulverized, be dropped into this excavation,
the parts will instantly assume a charred apjjearance, the metal is ab-
sorbed into the tissue, the morbid cells or germs will instantly cease
to secrete pus, the cleared cavity will shortly granulate, and a smooth
surface, without induration, will be the result of the use of the proto-
sulphate of iron. The chancre is destroyed,

it is known to chemists that the proto-sulphate of iron absorbs large
volumes of oxygen and nitrous oxide gases.

The proto-sulpliateof iron, I have observed to be the most powerful
agent for arrestirig decomposition in animal and vegetable substances.
Inflammation and decomposition in the living tissue is likewise arrested
by it.

In gonorrhoea, we have now an agent arresting the morbid cellular
action in the salts which should be used in solution super-saturated.

In leucorrhfpa, and in simple ulcers, the morbid action is arrested
or peroxidized l)y this metallic salt.

Large doses of this salt have been exhibited in obstinate diarrhoea,
with i{reat benefit.

1849.] Monthly Periscope, 249

The action of this salt will produce a great chaiige in superseding
mercury in the treatment ot diseases of specitic origin. ]^Mtd. Exam.

Ergot in Retention of Urine. M. Allier read a comnnunication on
the use of ergot in retention of urine. According to him 1st, ergot
restored contractility to a bladder which had been paralysed by over-
distension; 2d, it has succeeded when other remedies have failed;
3d, it has been equally succesfsful in paralysis of the bladder following
apoplexy ; 4th, it does not exert any beneficial influence over hemi-
plegic limbs ; 5th, it is useless in retention of urine from enlarged
prostate; 6th, the medicine must be given in repeated small doses;
but it may amount to a diachn> and a half per diem.

[A case illustrative of the good efiects of the ergot in retention of
urine is related by Dr. Jeffreys, of Liverpool (now of Shrewsbury), in
the 'Provincial Journal,' foi- 1844, p. 44. Dr. Ross, of Cambusmore,
in the county of Sutherland, reports a similar case ; see ' London and
Edinburgh Monthly Journal,' for January, 1844, and 'Provincial
Medical Journal,' vol. vii., p. 378. See also Johnson's iVledico-Chir-
urgical Review,' for July and October, 1839.] Frov. Med. and
Surg. Journ,, from Rajiking^s Abstract.

Liquor Potassce in Strangury Dr. INfulock states that, in three
cases of strangury from blistering with cantharides, he found speedy
relit f from liquor potassae, in thirty-drop doses every hour. He was
led to the use of this preparation from its known efiects in relieving
irritation of the bladder in other cases. He thinks it may prove an
antidote for cantharides taken internally, and suggests that a trial
should be made when an occasion offers. [Duhlin Quarterly Jour.

Collodion for Carious Teeth. A piece of fine cotton, thoroughly
soaked in the transparent fluid, and then inserted into the hollow of the
tooth, previously cleansed and dried, has been Ibllowed by complete
relief to the toothache, and has maintained its position for several
weeks. [Amer. Jour. Med. Sciences.

Compliment to Professor Wood, in Ranking^ s Abstract. Among the
newly published works which have reached us fornotice in the pre-
sent Report, we would make particular mention of a 'Treatise on the
Practice of Medicine,' 2 vol. 8vo., by Professor Wood, of Philadel-
phia, as a production of no ordinary merit. It may be safcly stated
to be, for comprehensiveness and careful digest of matter, second
only to the herculean labours of Dr. Copland, and has the advantage,
not always perceptible in similar works, of being brought up strictly to
the knowledge ofthe day. It must not, however, be looked upon solely
as a compilation, for although, as must of necessity be the case, it is a
digest ofthe opinions ofthe most reputable authorities, it is also enrich-
ed by the record ofthe actual experience of a physician whose oppor-
tunitics of observation have extended over a period of thirty years, and
who enjoys the reputation of being one ofthe most skilful and scientific
practitioners of our sister country, [RanJcing^s Abstract,

250

Medical Intelligence.

[April,

MEDICAL INTELLIGENCE.

The Graduates of the MEorcAL College of Georgia Session 1848-9.

The Degree of Doctor of Medicine was conferred on the gentlemen named
below on the 20ih of March. The graduates were addressed by Prof. Le Conte,
M. D., of Franklin College, in a most eloquent and appropriate Lecture, which
we propose to publish in our next No,

Attending the course just closed were one hundred and thirty- three students,
of whom 100 were from Georgia, 18 from South Carolina, 12 from Alabama,
I from Texas, 1 from Virginia, and 1 from New York.

The Faculty reported the following gentlemen as having complied with all
the requisitions of the College, and undergone satisfactory examinations, viz:

S. L. RiciiAKDsoN, Alabama.
L. B. IVIcCoN.x, Georgia.
W. C. Ware, South Carolina.
J. F. Groves, Georgia.
D. C. O'Keeffe South Carolina.
A. M. Cox, South Carolina.
James McMichael, Georgia.
R. F. Seay, Georgia.
VValdi-:mar Moody, Georgia.
J. A. G. Reeves, Georgia.
W. M. Pitts, Alal)ama.
J. F. Dickinson, Georgia.
Jasper Brovvnk, South Carolina.
J. C. Lanier, South Carolina.
Peterfield Tri.nt, Virginia.
G. W. Dardex, Georgia.
S. C. Tatom, Georgia.
G. W. Mitchell, South Carolina.

G. W. Holmes, Georgia.

J. F. Alexander, Georgia,

G. W. Fort, Georgia.

H. R. PiERi e, Georgia.

J. L W ATKINS, \labama.

J C. Calhoun, Georgia.

E. C. Jones, Georgia.

W. H. Montague, South Carolina.

W. B. Joii.NSON, Georgia.

0. H. Paull, Georgia.

A. D. Shewmake, Georgia.

B. F. Hall, Georgia.
T. C. Glover, Georgia.

R. H. Etmeridge, Georgia.

C. C. Thomas, Georgia.
Edward Girardey, Georgia.
G. A. Williams, Alabama.
J. M. Bunch, Georgia.

The Meeting of the Profession in Convention, at Macon. We give place, with
much pleasure, to the following communication on this subject rejoicing too
to learn from other sources, that a more harmonious and profitable meeting for
our time-honored profession, has never been held any where:

Macon, March 22d, 1849.

Dear Sir, I have the honor to notify j'ou of the official action of the late
meeting of the Medical Convention and Society, held in this city. In pursu-
ance of the call emanating from the Medical College of Georgia, and concurred
in by the Georgia Medical Society of Savannah and Macon, the Convention
assembled at 10 o'clock, on the morning of the 20th. About eighty Delegates
were present.

For the purpose of preliminary organization, Dr. Tiios. Hoxey, of Colum-
bus, was called to the Chair, and Dr. L. W. Burney, of Monroe county, requested
to act as Secretary.

On motion, a committee of one from each County represented was appointed
by the Chair, to select permanent officers for the Convention.

The Committee reported the following names: For President, Dr. Lewis D.
Ford, of Augusta; for 1st Vice-President, Dr. R.D. Arnold, of Savannah ; for
2d Vice-President, Dr. Thomas R. Lamar, of Macon ; for Secretary, Dr. James
M. Greek, of Macon ; for Assistant Secretary, Dr. C. T.CIuintard, of Macon.

1849.] Medical Intelligence. 251

The Convention being thus organised, on motion, the President designated
the following gentlemen a Ccunniitlec to dralt a Constitution and By-Laws:
Drs. R. D.Arnold, J. M. Green, Thos. Hoxey, Chas, West, Hugh J. Ogilby, R.
d. Dickinson, James M. Gordon.

After some di.scu.ssion and modification, the Constitution and B3'-Laws were
unanimously adopted. The Convention then resolved itself into " The Medical
Society of the Stale of Georgia."

The first business in order being the election of officers, a ballot was ordered,
and the following gentlemen wefe declared duly elected; President, Dr. Lewis
D.Ford; 1st Vice-President, Dr. R. D. Arnold; 2d Vice-President, Dr. Thos.
R. Lamar; Corresponding Secretary, Dr. James M. Green; Recording Secreta-
ry, Dr. C. T. Uuintard,

The Society then proceeded to ballot for Delegates to the "American Medical
Association." On counting the votes, it appeared that ihe following gentlemen
were elected, viz; Drs. Thos, Hoxey, T. F. Green, H. S. Ogilby, E. L. Strohecker,
Robert Campbell, I. E. Dupree, W. B. Stevens.

The following Committee was appointed to memorialize the Legislature, on
the necessity of instituting a regular registration of marriages, births and deaths:
Drs. Arnold, Strohecker, Ogilby, Geo. A. Winn, G. F.Cooper.

A Resolution was introduced and adopted, that a Committee of one from each
congressional district, of which the President of the Society shall be chairman,
be appointed to address the Profession at large on the expediency of forming
auxiliary societies, and other matters. The President appointed the following:
Drs. L. D, Ford, Thos. Stewardson, Chas. West, E. F. Knott, W. P. Beasiey,
Wm. N. King, W. L. Jones, Asbury Kingman.

The following named gentlemen were appointed a Committee to make proper
arrangements for the next annual meeting of the Society; Drs. J. B. Wiley,
Jos. LeConte, Chas. Thompson, J. C. Gilbert, C. B.Nottingham all of Macon.

A Resolution was passed, that the next annual meeting of the Society take
place in the City of Macon, on the 2d Tuesday in April, 1850.

The Convention adjourned at 1 o'clock, P. M., on the 21st.

The Recording Secretary will, at his earliest opportunity, furnish you with a
copy of the proceedings of the Convention and Society.

Very respectfully, JAMES M. GREEN, M. D.,

Cor. Sec'y Med. Soc. of Ga.

To Paul F. Eve, M. D., Sc

Editor of S/i. Med. <f Surg. Journal.

A Suit for Mal-Practice (Furnished by a trwdi^al friend unconnected loilh the
parties.) The following is a report of the suit of Sidney Lanier vs. Dr. Chas.
Thompsov, for alledged mal-practice in the treatment of an injury of the fore-
arm, near the wrist-joint, whereby great deformity and loss of motion have
ensued. The amount of damage claimed was $10,000, The jury relumed a
verdict for the plaintiff, with one dollar damage. The case was tried before
Judge Floyd, at the January term of the Superior Court of Bibb County, 1849.

Sterlincr Lanier, aw orn. Called defendant to attend his son; went with him
to and saw him take charge of son; cannot .state the exact time, but thinks it
was in Januarv, 1847. Defendant said the arm was fractured. Thinks defen-
dant pursued the usual course. The accident happened in the country; plain-
tiff's arm had bandages on when he returned ; defendant look them off and pro-

252 Medical Intelligence. [April

cured an apparatus* from Mrs. Wood. Thinks it was about two or three hours
atier the accident that defendant saw the case; can't state the exact time.

(Cross examined.) Thinks the accident occurred in January, but cannot
Slate the exact time. Plaintiff went to ride after dinner, and returned before
night. When phiintifl' returned, his arm had splints on: plaintift' stated that
Mr. Basset had put them on : don't know that ihey were well placed ; don't
know anatomy. The arm was not much swollen then : it swelled afterwards.
Instrument shown looks like that used by defendant, but not exactly like it it
appears a little smaller, but of the same kind. Thinks defendant did not dress
the arm the first night, but is not positive; thinks he put on splints the next day.
The arm was painful to the touch. Don't knOw how long defendant attended
the case; don't know that another physician was called. The arm looked pret-
ty well when the splint was taken ofit did not take particular notice it appear-
ed a little crooked, but thouglu it would become straight. Thinks he was pre-
sent at second dressing; don't know how long defendant was attending the case;
when attending, he was kind and attentive; cannot say whether bandages were-^
loosened or not by plaintif!'. "^

(Reexamined.) Don't remember particularly whether the arm was much
swollen or not at the first dressing. The arm is permanently deformed, itsuse-
I'ulness is destroyed plaintiff does not use it as he does the other,

Mr. Obear.swovu. Saw plaintiff soon after he had been injured; assisted A
him from buggy to his room. Saw most of the proceedings during the treat- l|
ment. Plaintiff had splints on his arm; defendant took them off and put on
others, of pasteboard. The arm was swollen. Defendant said he would set it
in two or three day.s inflammation would subside by that time ; was not pre-
sent when the arm was .set. Defendant's treatment was not interfered in by
others: thinks the bandages were not removed they were once clipped near
the fingers, which were much swollen. Plaintiff has lost the use of his arm
he uses the other instead.

(Cross examined.) Was not with plaintiff all the time, but a great deal of
the time; generally staid until 11 or 12, P. M. Boards at Lanier's yet. Does
not think plaintiff loosened the bandages would have known if he had done
so might have done so and tightened them again. The arm appeared straight.
Don't remember the exact time when the accident happened. Instrumentshown
appears like that used by defendant; did n't see it taken off; plaintiff' wore it
four or six weeks Saw the arm the day following that on which the instru-
ment was removed: there appeared to be a little rising on it then; bandages
were clipped by defendant's orders. After instrument was taken off, defendant
applied two splints, one on the fore and the other on the back part of the arm:
defendant was very attentive.

R. Basscif, sworn. Plaintiff was taken into witness' house about the 20th of
January, 1847. Said he had been thrown from a horse. His arm was badly
hurt hi> wrist was dislocated witness tried to pull it back. Lives one mile
and a half from town.

(Cross examined.) Wasn't fractured, as he knows of, but was dislocated;
witness reduced it; his brother helped; has set bones before; wasn't hard to
get back : plaintifi's arm was very painful and swelled fast: did not see plain-
tiff fall. One hour and a half after accident Mr. Brown took plaintiff home.
Plaintiff did not object to witnes.s' course: witness thought he put it about right. 1

Dr. JFi%, sworn. Is a practising physician and surgeon; has once exam- |
ined plaintiff's arm ; considers it permanently deformed. Knows nothing of
the case; thinks the result might have been diflerent had [Here he was inter-
rupted by defendant's counsel, who objected to answers given as he was about
to answer.]

(Cross examined, by Defendant.) Is aware of the great difficulty of discrim-
inating the nature of injuries to joints; considers it necessary to be called im- 1
mediately; a surgeon should attend a fractured arm four or six weeks; the |
muscles tend to displace the bones: it is difficult to keep the fractured bone in *
place ; there is danger of sloughing from light bandages.

Whenever the term apparatus, splint, or instrument, is used, the article referred to is
Rot's Calciit
t This was the last time that the defendant saw the arm, until shown in Court.

1849.] Medical Intelligence. 253

[The Defendant here proposed to apply the same apparatus to the arnn of any-
one present, and to dress it in the snme manner as that in which he had dress-
ed the arm of Plaintiff, and to ask the witness whether or not the application
were proper To which Plaintiff's counsel objected, and the Court adrniiitdihe
objection on tfie jjround that no professional witnesses were present when plain-
tifi's arm was dressed by defendant, and consequently none were compeieni to
state positively as to the precise manner.]

(Examination resumed.) Witness thinks the instrument used was well adapt-
ed to the purpose: has not used it. Where there is not much swelling:, there is
difficulty in diagnosticating^. Three, six, or twelve months are required for
these injuries to heal. Thinks plaintiff's ulna was dislocated and radius frac-
tured. There are eig-ht bones of the wrist. The ulna is seldom dislocated;
when fracture and dislocation concur, the difficulty of treatment is increased.
Surgeons do not generally see such cases until an hour or two after the injury
has been received; two hours might increase the difficulty of diagnosis. The
proper treatment is to place the fractured ends in apposition and endeavor to
retain them there.

Dr. J. M. Green, sworn. Has examined plaintiff's arm; considers it perma-
nently deformed; thinks the result would have been better had it been well
treated, and had the patient submitted. Witness would have reduced the frac-
tureand applied means to keep it reduced immediately thinks if such course had
been adopted, the present deformity would not have ensued ; when such course
is not adopted, loss of power and motion is the consequence ; plaintiff has almost
entirely lost the use of his arm ; he is disqualified in a measure from using it.

(Cross examined.) Has had many cases of fractured radius; don't remem-
ber exactly how many; has not had cases of dislocation of the ulna ; thinks
plaintiff's ulna is dislocated. When the ralius has been fractured, thinks the
patient should not use his arm in less than two months. The bones of the
wrist are seldom injured except by direct force; there use is to break the force
of an injury; they are seldom injured. There are two kinds of fracture, ob-
lique and transverse; fracture of the radius is generally oblique; such fractures
require care on thfi part of the patient as well as surgeon ; thinks the fractured
ends might be kept from slipping past each other; splint shown is as good as
any a good cure might be made with it; strong union would take place in
four or six weeks; patients would do wrong to take off splints in that lime ; in
a majority of cases there is some deformity, as a rule, still the bone retains its
position. Thinks such cases might be treated successfully; thinks Professor
Parker of New York an able surgeon considers Cooper and Miller good au-
thorities.

Mrs. Lanier, sworn. Is mother of plaintiff; was with him during his illness ;
defendant's directions to him were strictly followed. Plaintiff was confined
about three months. When splint was removed it was by defendant's orders;
plaintiff could not then turn his arm over; thinks the arm was never set; don't
know that defendant set it; when defendant first saw the arm. he said he would
set it in two or three days. Defendant saw the plaintiff immediately after his
return home; never was set except by Basselt.

(Cro.ss examined.) The arm was very painful, but not much swollen. Saw
defendant apply paste-board and splints ; the bandage was not cut during the
night, except a little at the fingers. Did not hear defendant say that there would
be defoimiiy. Defendant was kind and attentive to the case; was present when
splints were taken off do not remember defendant's remarks; thought defend-
ant was doing right; don't know whether arm was .straight when defendant
first .saw it; don't know how long defendant attended the case; the accident
happened in the latter part of January, 1847. No other physician took charge
of son; Dr Strohecker once looked at it; don't know that plaintiff refu.sed to
answer defendant's interrogatories.

The pro.secution was here closed, and the following defence was made:

Dr. S/rohec/ier, SM'orn. Is familiar with injuries of the wrist has found
much difficulty in treating them : when there is much swelling the diagnosis is
obscure and difficult; in fractures, the action of the muscles tends to draw the
broken fragments past each other. Saw plaintiff's arm on or before Feb. iSth,*

' This was twenty-eight day.s or less after the injury had been rcceivecl.

254 Medical Intelligence. [April,

1847 the entry is made on that day; was asked to see plaintiff before then, but
refused because defendant was attending^. When witness saw plaintiff's arm,
the splints and straps were loose and doing no good; has never used the instru-
ment shown; it would be easy to slacken the straps around it; thinks plaintiffs
arm is fractured and dislocated: in such cases the physician should not quit his
patient in \e^s than two months if he docs so, the muscles cause deformity,
callus is soft and rnay be compressed; muscular contraction causes a difficulty
in setting the bone, and keeping it reduced in cases of fractured radius; thinks
"plaintiff's arm was obliquely if'ractured; mistakes in diagnosis of injuries of
the wrist do occur; did not dress plaintiff's arm but once ; don't know that any
one else did; when witness took the case, plaintiff's father said defendant had
been discharged.

(Cross examined.) The arm was not properly bandaged when witness saw
it; witness would not apply apparatus immediately, if much tumefaction exist-
ed he would wait a iew days. Plaintiff's arm was past remedy when witness
saw it; knows nothing of defendant's treatment of the case from result^ thinks
it might have been different; splint shown, was not on when witness saw it.

Dr. Benson^ sworn. Does not think injuries of the wrist very difficult to diag-
nosticate, unless there be much tumefaction ; cannot say that good surgeons
frequently mistake fractures for sprains, even where there is much tumefaction
good surgeons wait until the tumefaction subsides before they forma diagno-
sis. Fractures of the radius, near the wrist, are extremely difficult to treat
they generally result in some deformity; the instrument shown would answer
in cases where only one of the bones of the fore-arm was fractured, but would
be inapplicable to cases in which both bones were fractured. Have once ex-
amined plaintiff's arm. [ Witness declined givingtestimony without farther ex-
amination, which he institutes.] Considers the case to have been one of simple
fracture of the lower portion of the radius; states that there is nut a dislocation
of the ulna; considers the natural relation oi the ulna to the radius to have
been changed by the action of the muscles opon the lower fragment of the frac-
tured radius: there is no fixed time at ^vhich fractured bones uniie^ sometimes
months and even years elapse before bony union takes place, and in somie cases
it does not take place at all; aye, health, constitution and many other circum-
stances, m'^dify the formation of callus; plaintiff's constitution appears good;
thinks a fractured bone in him would unite without much difficulty j don'iknow
any thin*: about defendant's treatment of plainiiif''s case; cannot say that the
fracture had not been reduced it might have been reduced and afterward the
action of the muscles have produced the present deformity; a surgeon should
not abandon his patient until bony union has taken place, without reference to
the lime necessary to that result: patients always try to use a fractured limb
before they should do so, and the surgeon's attention is as necessary at the time
the callus is becoming firm, as in the first treatment of the case ; fractures are
not irremediable so long as the callus remains soJt; does Dot distinguish betweea
primiiive and definitive callus, considers these but different names for the same
substance, terms without practical value.

(Cross examined.) Cannot say the result would have been different, had pro-
per treatment been adopted by the surgeon and submitted 60 by the patient, for
sometimes circumstances contraindicate the use of splints or other apparatus,
and deformity would be preferable to the consequences which mighs ensue from
their use.

(Re-examined.) Knows Prof Parker of New-York, personally and by rep-
utation ; would be sorry to find Dr. P's opinion in collision with hisown con-
siders him almo.st as high authority as any surgeon in the United States.

Mr. Armstrongs sworn. Has seen plaintiff use deformed arm in managing
his horse.

Mr. Bloom, sworn. Knows that the said horse is extremely diflicult to man-
age he once ran away with witness.

Although the answers of Prof Parker and of Dr. Wells, of New-York, were
not permitted to be introduced in evidence, on account of some legal objections,
it is but justice to the defendant, whose professional reputation has been staked
upon this trial, to give them. It is also but justice to the plaintiff, and to the

1849.] Medical Intelligence. 255

community who maybe interested in this suit, that they should be reported; for
without such report, the defendant's friends mi^ht imagine them lobe of greater
importance than they really are; and with their report, the plainttft''s friends
can say that the whole defence, equitable and legal, is before the public,

WiLLARD Parker, personally appeared before ns, on this the sjxfh day of
January, 1819, and being duly sworn, testifies that he is Professor of Surgery in
the University of ihe State of New- York, and that he has been a practitioner of
medicine and surgery 19 years. He also further testifies, that I'ractures of the
lowerextremity of the fore-arm are common ; and wh-^n the surgeon has the full
co-operalion ot the patient, his treatment, however skilful, will be followed al-
most certainly with more or less of deformity and impairment of motion. The
radius is most frequently broken, and the solution is either just above the joint
or through it. These fractures are usually produced by falls upon the pa!m of
the hand. It is always difficult to make out the precise nature of the accident,
especially if the surgeon do not see the case before swelling occurs.

In the treatment, every practical surgeon, hov;ever skilful, knows he cannot
prevent all deformity, and that the patient has cause to congratulate himself if
he recover the use of the joint in from six months to a year.

1st. The Pronator Radii Cluadratus, by its action, destroys the natural paral-
lelism of the bones of the fore-arm, and the six flexors and extensors of the
hand and the flexors and extensoi s of the fingers, force the fractured ends by each
other.

2nd. When the joint is complicated, inflammation must ensue, and as a con-
sequence, the natural motion of the joint must be impaired for a long time, if
not permanently.

In every actual jracture at the wrist or near it, there will be, in my opinion,
some deformitv. W. Parker, M. D.

Isaac E. Taylor, M D., [l.s.]
A. B. Robeson, M. D., [l.s.]

Thos. Wells, personally appeared before us, on this the sixth day of Janti-
ary, 1849, and being duly sworn, testifies that he is a resident ofthe city of New
York, and that he has been a practitioner of medicine and surgery thirty years;
that he has treated many fractures of the lower pan of the fore-arm.

He also further testifies, that in cases of fracture ofthe lower extremity ofthe
radius, there is always more or less obscurity in the diagnosis, in determining
the exact nature of the injury, and this difficulty increases as the injury ap-
proaches the radio-carpal articulation, and in proportion to the degree of swell-
ing of the parts, at the moment the surgeon is called to take charge of the case
and it may very properly be said that the difficulty oi LreaXmenl is increased in
proportion to the difficulty of diagnosis in the case. '

All writers on Surgery agree that fractures of the radius near the wrist, are
among the most difficult to manage; to avoid either deformity or imperfect pro-
nation or supination of the hand, or impeded action of the fingers ; and too fre-
quently all these evils are found to exist in the same case, after the most skilful
management. To ensure a satisfactory result in this species of fracture, the
case must be taken in charge early, before any considerable degree of efl^usion
or swelling supervenes; the patient must be entirely submissive to the surgeon,
following riiridly his directions in regard to the dressings and position of the
arm, and they must be followed up for a period, varying from six to ten weeks
of careful treatment, before the patient should be allowed to take his own course.
After all, no matter what the case mav have been, it is often a very long time-
in some cases several years before the free and easy aciion of the parts impli-
cated is regained, even in cases where success is finally complete. But in a
large proportion of such cases, the patient is doomed ever after to submit to
more or less deformity, or impeded action of the parts. To guard against the
latter, should rather be the main object of the surgeon, even at the expense of a
good deal of deformitv. Thos. Wells, M. D.

Isaac E. Taylor, M. D. [l s.]
A. B. Robeson, M. D. [l.s.]

256

Medical Intelligence.-

-Meteorology.

[April,

OBITUARY NOTICE OF A MEDICAL STUDENT

At a meeting oltlie Faculiy and Students of the Medical College of Georgia,
held March 8th, 18l'J, thelollovving preamble and resolutions were unanimous-
ly adopted:

Being suddenly called to lament the death of Mr. D. W. Jacobs, one of the
matriculated members of the present class a candidate forlhe degree of Doctor
of Medicine, and feeling (for the second time during the present session) this
dispensation of Divine Providence in the death of our friend and companion
wiiose estimable character had won for him our highest esteem

Be it tlierefore^ Resolved, That we deeply deplore the death of this our friend
and associate who has been thus suddenly stricken down in the morning of life,
and just as he was about commencing his career of hope and usefulness in an
honorable profession.

Resolved, Asa mark of respect for the dead, we will wear the usual badge of
mourning for thirty days.

Resolved, That a copy of these resolutions be forwarded to the parents of the
deceased as a manifestation of our unaffected sympathy and condolence in this
their severe bereavement.

Resolved, That these proceedings be published in the city p:\pers, th Ham-
burg Journal, the Greenville Mountaineer, and the Southern Medical and
Surgical Journal. P. TRENT,

T.B.LAMAR, > Ccmmittee,

A. D. SHEWMAKE,

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet.

for February, 1849, at Augusta,
32' west Wash. Altitude above

n

Sun

Ther.

1

54

2

56

3

58

4

57

5

61

6

32

7

36

8

36

9

49

10

35

11

46

12

44

13

32

14

32

15

43

IG

32

17

23

18

27

19

17

20

26

21

39

22

44

23

49

24

42

25

50

26

36

27

46

28

47

Bar.

29 97-
" 90-
" 93-
" 93-
' 47-
" 94-
" 98-

30 11-
29 80-

" 9;)-

" 70-
" 41-
" 91-
30

29 85-
" 71-
" 69-
" 84-

30 28-
29-
22-
20-
15-
16-
73-
76-
82-

5-

29

30

100

io;)|

100
100
100
100
100
100
100
100
100
100
100

100
100
100
100
100
100
100
lOi)
100
100
100
100

lo;)

100

Ther.
64

P.M.
Bar.

29 94-100

1 78

" 85-100

70

" 94-100

64

" 86-100

56

" 67-100

57

" 88-100

53

30 6-100

48

30 3-100

62

29 80-100

58

" 89-100

G6

" 64-100

56

" 48-100

56

" 94-100

62

30 2-100

48

29 82-100

46

" 6C)- 100

48

" 68-100

32

" 97-100

44

30 30-100

54

" 20-100

64

" 22-100

65

" 18-10(1

72

" 10-100

58

" 7-100

68

29 70-100

56

" 75-100

58

" 87-100

1 56

30 10-100

Wind.

N. W.

s. w.
w.

N. W.

w.
w.

N. W.

s. w.

N. W,

S. E.

s. w.

w.
s. w.

w.

N. W.
N. W.
N. W.

W.
N. W.

s. w.
s. w.
s. w,

N. E.
E. & S.
N. W.
N. W.

N. E.
N. E.

Remarks.

9 Fair days, duantity of Rain 90-100 of an inch.
S. 4 days. West of do. do. 23 days.

Fair afternoon rain at 6, *.B!v

Fair blow, with clouds.

Fair cloudy morning.

Cloudy.

Fair afternoon rain 15-100.-

Fair breeze.

Fair.

Cloudy.

Fair afternoon.

Cloudy rain at night 10-10^

'Fair cloudy afternoon. flOO.

Fair blow rain last night 65-

Fair.

Fair.

Cloudy.

Fair breeze.

P'air breeze.

Fa ir drizzle snow

Fair.

Cloudy afternoon.

Cloudy.

Cloudy.

Fair.

Fair afternoon.

Fair heavy blow spr'kle last

Cloudy afternoon blow.

Cloudy blow gale last night.

Cloudy dry gale continues.

Wind East of N. and

["Sv A.M.

storra at

f night.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. .] NEW SERIES MAY, 1849. [No. 5.

PART FIRST,
rigtnal (Homniunications.

ARTICLE XIY.

** The Philosophy of Medicine ;" an Address, delivered before
the Graduates of the Medical College of Georgia, on the 20th
of March, 1849. By Joh\ LeCoxte, M. D , Professor of
Natural Philosophy and Chemistry, in Franklin College,
University of Georgia.

Gentlemen, Graduates :

It is recorded of the immortal Newton that, whilst contem-
plating the simplicity and harmony of the laws by which the
universe is governed, as manifested in the relations which his
gigantic mind developed between the distant and apparently
unconnected masses of the planetary system, his thoughts
glanced towards the organized creation ; and reflecting that
the wonderful structure and arrangement which they exhibit,
present in no less a degree the indications of the order and
perfection which can result from Omnipotence alone, he re-
marked, " I cannot doubt that the structure of animals is gov-
erned by principles of similar uniformity." {'^Idemque did
possit de uniformitate illd, quce est in corporihus animalium.")
More than one hundred and fifty years have elapsed since this
opinion of the greatest of men was promulgated. During this
period, what immeasurable advances have been made in all the
sciences! Astronomy has approximated perfection ; in every
department of the mechanical art the scale and scope of pro-
gress are as vast, as its character and attributes are substantial

N. !?. VOL. V. NO. v. 17

258 Le Conte, on the Philosophy of Medicine. [May,

and solid ; tlie laws of electricity and magnetic i)henomena
have been unfolded : chemistry has opened new fields of inves-
tigation and established new laws; and even the complex
phenomena of meteorology have been partially disentangled.
But while all this activity is dis[)layed in connection with the
advancement of the sciences which appertain to inanimate ob-
jects, does the spirit of the age withhold its influence from the
science of life? Has the labor of its cultivators been barren
and unproductive? Have they untblded none of the laws of
organization? In short, has that science, to the pursuit of
which we are devoted, stood still, while its kindred of the great
family of knowledge have advanced with gigantic strides?
Shall we conclude that because charlatanical devices spring
up, and continue to attract the heedless multitude by their cun-
ning delusions, that the professors of legitimate science have
been idle? Assuredly not. There is, in truth, no branch of
knowledge which, in the conviction of those who are capable of
judging, has of late years made advances more rapid and more
solid than medicine. In acquaintance with the intinriate phe-
nomena of diseased processes and products, we, of the present
day, have vastly outstripped our immediate predecessors ; in
the facility with which we recognize the existence, and in the
accuracy with which we define the characters, of maladies
during life, we are incomparably their superiors; in the great
object of our art, that of mitigating the sufferings and control-
ling the ravages of disease, our capabilities have notoriously
become increased and invigorated. But, above all, we have
the more substantial proof that our slow^ and steady labor tells,
in the grand tiuth, that the mean duration of human existence
is on tlie increase.

But while we thus bear testimony to the great and important
progress which the science of medicine has made, yet, it must
be admitted by every candid inquirer, that all the zeal and
industry of its cultivators have failed to establish on a solid and
enduring foundation, any grand and comprehensive law of the
animal economy, such as must have been contemplated by
Newton in the extract which was given at the commencement
of this address. Many subordinate principles of the science of
organization have been based on a secure foundation ; and

1849.] he Conie, on the Philosophy of Medicine. 259

many more, which were at first doubtful, are daily receiving
fresh confirmation ; but they have been unsuccessful in unfold-
ing laws of the hifrhest decree of generality, such as have re-
warded the labors of the students of physical science. Are we
to infer from this fact, that the Creator of the universe, who
has manifested the severest and most refined geometry in the
construction of inanimate nature, has' abandoned all law and
rule in the construction of organized beings? Was Newton
mistaken when he prophetically announced that, similar uni-
formity must characterize the structure of animated nature?
Certainly not. In the ever-varying conditions of the animated
world, a very superficial glance will display to us a certain
degree of regularity and derangement; and the more attentively
we investigate the relations which its changes present, the more
stable and definitt^ is the assurance we obtain, that they are all
harmonized and controlled by fixed laws, which are but simpli-
fied expressions of those conditions of action which the Creator
has imposed upon organized no less than upon inorganic matter.

Impressed with these ideas, I have thought, that the causes
which have impeded the advancement of the science of life, and
the consequent improvement of the art of medicine, together
with those which may have conduced to its recent progress,
would form an appropriate topic for to-day's consideration. It
is well to premise, that the negative and positive sources of
advancement are too numerous to allow of more than a cursory
notice of some of the more prominent ones.

As vital phenomena have excited the attention of all classes
of men, from the earliest ages of the w^orld, and have probably
formed the most ancient and universal theme of conversation
and speculation, both with the learned and unlearned, we
should naturally expect, that medicine ought to be one among
the most advanced of the sciences; because, for thousands of
years, it has been the object of the labors of so many intelligences.
Unfortunately it is notso; and the reasons are sufliciently obvious
to the reflecting mind. When we consider tfie peculiarly intri-
cate conditions connected with every physiological problem
the large advances that must be made in many capital portions
of knowledge, before one successful step can be made in this,
we readily perceive, that a thousand complicated inquiries besei

260 Le Conte, on the Philosophy of Medicine. [May,

the investigator at the very threshold of physiology, stimulating
him to ardent investigation, and inspiring him with wholesome
caution. Indeed, the complication of the processes carried on
in the organized kingdom, the widely-extended circle of their
agency, and the ever- varying results of their compound influ-
ences, appear to have been almost too much for the mind to
comprehend as a whole; and the powers of reason have been
bewildered in the inextricable labyrinth of causes and effects
of actions and reactions. This is no fault of its cultivators, who
have comprised in their list the highest and most varied talents
and industry, but of the inherent complexity of the subject, and
the infinite multitude of causes which are concerned in the
production of every, even the simplest, vital phenomenon.

But there are other reasons why medicine cannot possibly
advance at a pace equal to that of the other branches of science.
It is true, a vast number of observations have been made on
the phenomena of life ; but they are, at the same time, observa-
lions in the most restricted sense of that word. We observe
the phenomenon presented to us, but cannot modify and vary it
at pleasure; we cannot reproduce it at will. In a word we
cannot have recourse to experiment. We are hence compell-
ed to register facts; and, as Sir William Herschel has very well
observed, we resemble a man who hears now and then a few
fragments of a long history related at distant intervals by a prosy
and unmethodical narrator. In recalling to mind what has
gone before, he may occasionally connect past with present
events; but a host of circumstances omitted, or forgotten, and
the want of connection, prevent his obtaining possession of the
entire story. Were we allowed to interrupt the narrator, and
ask him to explain the apparent contradictions, or to clear up
any doubts on obscure points, then might we hope to arrive at
a general view. The questions that we would address to na-
ture are the very experiments of which we are depi ived in the
science of organization. The obstacles which interpose them-
selves to the prosecution of this science, result more from that
difficulty in the ascertainment of facts and the observation of
phenomena, which is occasioned by the peculiar conditions of
living beings, than from any incapability on the part of these
facts and phenomena to be comprehended within laws as stable

1849.] LeConte, on the Philosophij of Medicine, 261

and as definite as those of the purely physical sciences. Thus,
although the structure of the human body has been carefully
and minutely examined by so many thousands of Anatomists,
how many points are still uncertain, and how much still re-
mains to be discovered ! The difficulties which beset the path
of the physiological inquirer are still more appalling. The
complexity of the combinations in which vital phenomena pre-
sent themselves is such, as to baffle all attempts at analysis,
while their dependence upon one another is so intimate, as al-
most entirely to preclude their separate examination. "Were
we able to ascerlain the changes which take place in the inte-
rior of the living body, with the same ease that the astronomer
watches the motions of a planet, or the chemist observes the
formation of a precipitate, the very multiplicity of these chan-
ges, and the variety of conditions under which they occur,
would be of essential service in the determination of their laws,
instead of being, as at present, sources of doubt and embarrass-
ment. The chemist, when desirous of establishing to w^hich of
the ingredients in a given mixture a particular effect is due,
places each separate!/ in the conditions required to produce
the result : but the physiologist finds that the attempt to insu-
late any one organ, and to reduce the changes performed by
it to definite experimental investigation, necessarily destroys,
or considerably-alters, those very conditions under w^hich alone
its functions can be normally performed. Take away an im-
portant and essential part of a living being, and it ceases to exist
as such ; it no longer exhibits even a trace of those properties
which it is our object to examine; and its elements remain
subject only to the common laws of matter. We cannot, like
the fabled Prometheus of old, breathe into the lifeless clay the
animating fire ; we cannot, by a judicious and skilful arrange-
ment of those elements, combine them into new and artificial
forms so as to produce new and unexpected phenomena."
(Carpenter's Gen. et Camp. Physiol, 2d ed., p. 3.)

Moreover, all the phenomena of life are, at present, almost
wholly removed from the logic of quantity. Now, so far as
the logic of quantity is applicable, so far are we certain of our
conclusions, as certain at least as we are of our own existence.
But when this logic cannot be applied, our conclusions are no

262 Le Conte, on the Philosophy of Medicine. [May,

longer such as must be no longer follow from our prernises as
necessary consequences ; but are only, for the most p.art, such
as may be ; that is to say, have no more than that degree of
probability which arises from the evidence we have of the
truth of the phenomena or events, forming our premises. In all
knowledge depending on mere observation, v.hat we know is
grounded on our own ob>^ervation and experience, or on that of
others. What we ourselves observe, we too often observe very
imperfectly ; or do not understand, when observed. But phe-
nomena or events, the knowledge of which we are obliged to
receive at second hand, on the testimony of others, and which
may have been observed through the distorted medium of
ignorance or of prejudice, may even have been wilfully misrep-
resented of these we have a still less assurance. If the phe-
nomenon or event be of frequent occurrence, or if its nature be
such, that it is capable of being brought under our own obser-
vation ; in order to remove our uncertainty, we endeavor to
observe it ourselves. Such is the method we pursue in ob-
taining all that knowledge which is the result of mere observa-
tion. The different events succeed one another, but we know
not wherefore ; w^e see not their mutual connection. We be-
lieve that one phenomenon will, probably, follow another;
because the one has generally followed the other, or because of
some other probability ; but we cannot discover that necessary
connection between the two phenomena, which so irresistibly
leads us to determinate conclusions, where we can apply the
laws of quantity. {Prout. in Bridgewater Treatise.)

In medicine, the objects to be examined are, beyond com-
parison, infinitely more variable and complex than in any
department of physical science. And as the complicated phe-
nomena of health and disease are made up of elements which
allow of no exact measurement, the description must necessarily
be clothed in the imperfect and inexact language of the senses.
The imperfections of medicine as a science are consequently
inherent in the subject itself.

The physician, unlike the mathematician, is not the creator
of his own science; uiil ke the astronomer, he has no simple
relations of matter to deal with ; he cannot, like the chemist,
make any two things which he examines or uses identical ; the

1849.] LeConte, on the Fldlosophy of Medicine. 203

objects of his study are more variable than the winds and tiroes,
and the materials with which he works infinitely more difBcult
to adapt to their uses than the matter which the mechanic or
the engineer presses into his service. In all his preliminary
studies (with the exception of inorganic chemistry), in all his
original inquiries, in all his practical applications, he encounters
the varying effects and complicated phenomena of life. The
liuman frame unites within itself all that is most wonderful in
contrivance and most elaborate in workmanship. Its structure
as much surpasses the most skilful work of man's hands, as its
functions do the play of his most ingenious mechanism, and its
products the results of his most refined chemistry. That which
he knows bears no proportion to that of which he is entirely
ignorant; what he sees, he sees but darkly ; much of what he
does, he does but guessingly. He seeks for causes, but they
elude his search; they bafi^e him at every turn; he strives, as
it were, to seize them by fcrce, but the violence which he uses
de'eats itself, and the tortured body dies that it may preserve
the seciet of its life. " Such, and so inscrutable is the body in
health; disease surrounds it with new mysteries.'"' (Vide. Brit,
and For. Med. Rev., July, 1841.)

The aspect of living nature is everywhere characterized by
boundless variety, by inscrutable complexity, by perpetual mu-
tation. Our attention is solicited to a vast multiplicity of objects,
curious and intricate in their mechanism, exhibiting peculiar
movements, actuated by new and unknown powers, and gifted
with high and refined endowments. In place of the simnle
combinations of elements, all organic structures, even the most
minute, present exceedingly complicated arrangements, and a
prolonged succession of phenomena, so varied and so anomalous,
as to be utterly irreducible to the known laws which govern
inanimate matter. How are we to find law and order in such
diveisified combinations? How are these anomalies to be ex-
plained ? Must we say that nature is capricious ? Assuredly
not ; for these anomalies are due to the action of the verv causes
which give rise to the other phenomena. An isolated observer,
however much he may be supposed to be endowed with perse-
verance and sagacity, could not possibly arrive at a plausible
explanation. Overwhelmed by the multiplicity of objects, and

264 Le Conte, on the Philosophy of Medicine. [May,

lost amidst the complication of phenomena, he soon becomes
dismayed by the magnitude and arduous nature of the investi-
gation. He is ready to ask, shall we ever comprehend the
nature of th-e subtile and pervading principle, by the agency of
which all the wonderful phenomena of life are produced, and
which, combining into one harmonious system so many hetero-
geneous and jarring elements has led to the formation of this
exquisite frame, this elaborate machine, this miraculous assem-
blage of faculties? Perhaps, w-e are still far from the time
when we shall be able to penetrate the dense veil which nature
has thrown over the interior machinery of life, and discover the
long-sought clew to the mazes of this perplexing labyrinth. It
may even be said to be problematical whether this time will
ever come. But though the complete solution of the problem
may remain unattainable, its partial solution may still be anti-
cipated ; indeed, the effort to understand the phenomena of the
universe is still the highest, as it is the eternal goal of all scientific
investigation. Whatever difficulties may have hitherto opposed
the development of the science of medicine, it has unquestiona-
bly made very notable progress since the end of the last centu-
ry ; and it now advances with a slow and steady pace. Future
ages will erect the edifice, of which we have laid the founda-
tions ; and we may already say, that the general plan is simple,
and that its apparent complexity arises from the close connec-
tion of the parts with each other, a connection so intimate,
that it is difficult to circumscribe the limits of the phenomena.
The more deeply we penetrate into the mysteries of nature, the
more harmony do we detect ; the more do we perceive the con-
nection of phenomena, which, severally and superficially regard-
ed, seemed long to resist every attempt at co-ordination and
arrangement ; the more do we see simplicity, order and beauty.

With these reflections, permit me to pass on to the considera-
tion of the causes which have conduced to the recent advance-
ment of medical science, and its kindred departments.

1. One of the most efficient causes of the recent improvement
in medical science seems to me to be the virtual abandonment
o^ q\\ exclusive systems. Since the period when men, shrinking
from the toil of severe observation and induction, yielded to
the easy pleasure of fabricating a priori doctrines of disease,

1849.] LeConte, on the Philosophy of Medicine. 265

systems upon sj'stems have followed each other in endless suc-
cession, interchange and admixture. Could such systems ad-
vance true knowledge ? The answer becomes easy, when the
manner in which they were conceived, is for a moment consid-
ered. A few facts are observed, it might be one, it might be
two, or, with the more sober of the founders of systems, a some-
what greater number; these facts may have been observed
carefully and accurately, as far as the state of general acquire-
ment, existing at the period, permitted. But all the accuracy
lathe world could not increase their number they remained
but one, or two, or at best a very few. ?\ow, in the characters
and relations of this fact or these facts, a quick apprehension
fancied it caught some ruling principle : the principle thus pre-
sumed to be discovered, was forthwith generalized, and made
the basis of a theory, whereto all the phenomena of disease
were to be referred. Disref^ardinfr the first principles of just
reasoning, these men, ambitious of scanning i>s at ure's mysteries
without moving from their easy chairs, succeeded too often in
persuading the multitude that they had in their theory, laid bare
the secret engine whereby the phenomena of disease were
worked. The general hypothesis was thus established with
the pretensions and w^eight of demonstrated truth. Meanwhile
facts went on accumulating, some supporting (either really or
apparently), others as distinctly opposing, its provisions. All
opposing facts, were, in the first enthusiasm for the new doc-
trine, set aside. But facts of this conflicting order still went
on, they were noticed in so many quarters, their learning and
importance were uiged by so many persons, that an impression
at length arose as to the possible fallacy of the doctrine ; symp-
toms of declining veneration for their doctrinal idol might, by
a shrewd spirit, be traced in the multitude. At such a conjunc-
ture there was ever a new theorist, a new dealer in first prin-
ciples, to be found ; seizing the propitious moment, he started
the doctrine to which his reveries had led him, and had the joy
to see it raised to the just-vacated pedestal. Such has been the
course of things from time immemorial, from one false system
to another, men have wandered in a state of perpetual transi-
tion. The unsatisfactoriness of all such attempts, and the
necessary consequence of this, a constant alteration and sue-

266 Le Conte, on the Philosophy of Medicine. [^l^y.

cession of inappropriate hypotheses, were indications of the
progress which was going on towards a more genuine form of
the science.

But the emptiness of all systems founded upon a priori rea-
soning, might be inferred from ceridim primci facie pecuharities,
which characterize them all. While the phenomena of nature
and the laws governins: them have been, and will ever continue,
immutable, these systems invariably bear the stamp of certain
coniinued and changeable circumstances. In many of them
may distinctly be found the impress of the marvel-worship and
superstition of the dark ages, in which they were conceived;
in others, the temporary impulse given to some one of the collat-
eral sciences may be traced ; in others, the peculiar social
circumstances, amid which individuals have been placed, have
had a striking influence upon the theories they have originated.
In all the finite, the temporary, the unstable qualities of even
the brightest of man's conceptions, as compared with the infin-
ite, the enduring, the stable attributes of nature and her laws,
stand forth in impressive contrast. It would be easy to show
that every system in medicine may, in respect of its origin, be
placed in one or other of these categories ; but I need not pause
to illustrate this point, as your studies must have afforded nu-
merous examples of the correctness of the opinion.

Rejoice, then, gentlemen, you who start upon the career of
medicine, that the day of exclusive systems has, practically
speaking, passed by, at least among the most intelligent mem-
bers of the profession. Rejoice, that we are neither Pneumat-
ists, nor Archa^ists, nor Animists, nor Vitalists, nor disciples of
the Jatro-chemical or Jatro-mathematical creeds, norBrunoni-
ans, nor Solidists, nor Humoralists, nor Broussaisians, nor Ra-
sorians. Rejoice that, instead of all this, our boast is to be
simple observers of Nature, who seek by patient and close
investigation to ascertain the facts of our science. The history
of all sciences warrants the assertion, that all myths concerning
imponderable matters and special vital forces inherent in organ-
ized beings, only render views of nature perplexed and indis-
tinct. Reason, boldly and with increasing success, now seeks
to break down the ancient forms, by means of which, as with
mechanical contrivances and symbols, man has still been wont

1849.] LeConte, on the Philosophy of Medicine. 2G7

to strive to obtain mastery over rebellious nature. Let -us,
therefore, hail the abandcnment of exclusive systems in medi-
cine, as a f ropitious omen. Even the most perfect of the
physical sciences, anatomy, had to pass through a similar cycle
of unsatisfactory tiypoihjses, before any great positive discov-
eries were fixed and perpetuated in conspicuous and lasting
truths. Well has it b^en s:iid, by a talented writer of the pre-
sent day, that it is *'a condition of our race, that we must ever
wade through error in our advance towards truth; and it may
even be said, that in many cases we exhaust every variety of
error before we attain the desired goal. But truths reached
by such a course are always most highly to be valued ; and
when, in addition to this, they may have been exposed to every
variety of attack, which splendid talents quickened into energy
by the keen perception of personal interests can suggest; when
they have revived undying from the gloom of unmerited neg-
lect; when the anathema of spiritual, and the arm of secular
power have been found as important in suppressing, as their
arguments were in refuting, them tlien they are indeed irre-
sistible. Thus tried, and thus triumphant, in the fiercest war-
fare of intellectual strife, even the temporary interests and
furious passions which urged on the contest have contributed
in no small measure to establish their value, and thus to render
th se truths the permanent heritage of our race. Viewed in
this light, the [ ropagation of error, although it may be unfavor-
able or fatal to the temporary interests of an individual, can
never be long injurious to the cause of truth. It may, at a par-
ticular time, retard its progress for a while, but it repays the
transitory injury by a benefit as permanent as the duration of
the truth to which it is opposed." (Vide. Babbage's Ninth
Bridgewater Treatise, p; 28.)

2. In the second place, the vigorous and healthy tone of re-
cent n^pdical progress, may be traced to the declining venera-
tion for what have been termed ''authorities^' in medicine. It
follows, as a natural consequence of the intellectual, and even
physical, inequality of men, that some individuals become dis-
tinguished for superiority of scientific attainments. To the
decision of such men, on points of science, respect is most un-
questionably due. But daily experience as unquestionably

270 Le Conte, on the Philosophy of Medicine. [May,

sion, than in the exnmple just ffiven. Fortunntely, the remedy
for both of the evils we have ghinced at, is sufficiently obvious:
neither the '' author ili/,^^ nor the unti-ied man, are to be taken
at their words. Tiiey are, in each instance, to be asked for
their y.)roofs, they must describe any alleged appearance in
such a manner as to furnish evidenceof their own accuracy
their descriptions must place the reader, as fiir as is possible, in
the position of the observer, and put him in possession of
grounds for foi'ming an independent opinion.

3. In the third place, the progress of sound medical knowledge
has arisen from the adoption of greater caution in the applica-
tion of conclusions founded upon analogy. No one can dispute
the great value of analogy as an instrument of reason; some of
the most obscure points in physiology have been elucidated by
labors of Naturalists, in the fertile field of comparative physi-
ology. Thus, Dr. Edwards was enabled to arrive at many
important conclusions with respect to the influence of exte:nal
agents on the phenomena of life, by subjecting reptiles to treat-
ment which would have been fatal to animals of a higher order.
Yet such reasoning must be cautiously applied ; for, in truth,
there is scarcely any proposition, be it ever so absurd, that may
not be quasi- proved by analogical ar^^ument. By reasoning
thus conducted it may be shown, for instance, that the circula-
tion of the blood in man is carried on independently of any of
the motor forces, commonly recognized as accomplishing that
function. For, first, in monsters deficient in brain and spinal
marrow, the circulation goes forward ; consequently, the ner-
vous centres are without influence on the phenomenon. Se-
condly, in animals without a heart, there is, nevertheless, a very
excellent vascular circulation: therefore the heart is useless in
the maintainance of the function. Thirdl3^ experiments on
mammiferous animals show that, under certain circumstances,
the circulation is sustained by the simple action of a heart,
without aid from the arteries, capillaries, or veins, or*from
muscular pressure, or from the suction exercised by the right
auricle, or by the chest; therefore the arteries, capillaries, and
veins, may be dispensed with in carrying on the circulation.
Hence, to resume, reasoning of this kind would lead to the ab-
surd conclusion, that the continuation of the blood's movement

1849.] LeConiCy on the Philosophy of Medicine, 271

depends neither on the heart, arteries, or veins, nor on nervous
influence, nor on aspiration exercised by the thorax or right
cavities of the heart.

Other sciences haVe, like our ow^n, felt the baneful influence
of this method of establishing conclusions. Vohaire cuttingly
ridicules the pretensions of this class of rcasoners. In one of
his satirical tales, Micromegas, an innaginary inhabitant of Siri-
us, is supposed to make a voyage of discovery through the solar
system in company with a denizen of Saturn : they philosophize
as they go. Approaching the planet Mars, Micromegas and
his companion plainly descried two moons acting as satellites
to that body, moons which have certainly escaped the ken of
terrestrial astronomers. *'I know perfectly well," continues
the author of the tale, '"that Father Castel" (an astronomer of
the time) "will write, and write sufficiently pleasantly, too,
against the existence of these two moons ; but J appeal against
his decision to logicians, who reason from analogy. These
excellent philosophers are perfectly aware how difficult it.would
be for mars a planet so far removed from the sun to get on
with less than two q^ these satellites." (^'Micromegas et
THistoiredes Croisades.'^ Lond. 1752.)

But because the indiscreet use of analogy is positively detri-
mental to the advance of science, it by no means follows, that
the use of analogical argument is to be discarded. But it is to
be employed cautiously, and solely as a means of suggesting,
and pointing to, questions deserving of investigation by the only
sound method that of direct observation. With these limita-
tions, analogy is an invaluable guide to the physician as well as
the naturalist.

4. Another source of recent improvement in medicine is,
an increasing tendency in the minds of men, at the present day,
to ascertain the intimate nature of the phenomena of diseases,
and the /aw;s governing their origin and progress; instead of
speculating on the Jinal causes of diseased actions. To ascer-
tain the laws which govern the phenomena of disease is the
goal of rational and legitimate pathological investigation. We
are aware that it has been said, that the knowledge of these
laws is of little value ; that unless their causes are fathomed,
no greater advance is in reality made than when they were

272 Le Conte, on the Philosophy of Medicine. [May,

unknown ; that no practical inferences, no enlarged notions of
the nature of disease follow from their estabhshment. No
greater fallacy could be imagined. What if it can be ascer-
tained by observation repeatedly undertaken and cautiously
conducted, that a given disease arises under a certain combina-
tion of circumstances ; that it affects the system generally in
an assignable way, before it exercises its influence on particular
parts ; that it affects certain of these parts and none others,
in a certain sequence, and in none others ; endures for a cer-
tain length of time, which may, with slight oscillations, be pre-
dicted ; if it be ascertained in the same way that a fixed pro-
portion of persons attacked with this malady will die, and that
the age, sex, habits of life, assign beforehand to any given indi-
vidual, with a great share of certainty, his place in one or other
of the two classes, of those to die, or those to live: if all
this can be done by the well-devised search after Laws (and it
has been done in respect of several diseases,) will it continue
to be. affirmed that the practical utility of their discovery is
limited that they do not vastly widen the field of true ac-
quaintance with disease?

But there are certain men who deem that their mental en-
dowments are of too high a stamp to be wasted on the patient
toil of observation, and the induction of laws from its results.
Let such men survey the field beyond their own. Let them
look to the history of other sciences, and see- how the illustrious
among their followers thought of the investigation of Laws.
Let them regard the vast intellect of Newton, disdaining all
petty scholastic disputations regarding causes; and observe
him devoting all his energy to establishing the conditions of the
great Law he had discovered. Let them remember that, "all
the human mind has produced the brightest in genius, or the
most continuous in application has been lavished on the de-
tails of the law of gravity." (Babbage. Ninth Bridgewater
Treatise.) And the great philosophers, who follow now in the
path of that immortal genius are they engaged in the struggle
to detect final causes ? No ; they feel that many of the discov-
eries of the present day point to a yet more general law than
that of gravity, and expend all their wisdom in the effort to
hasten its establishment. Let the medical inquirer, discontent-

1849.] he Conic, 071 the Fhilusophtj of Medicine. 278

ed with the search after laws, because it affords not span com-
mensurate with his powers, ponder upon all this, and if vanity
has not placed him beyond the reach of humiliation, he must
shrink abashed from the contemplation of his tiny efforts to
unveil the mystery of causes.*

5. So far we have spoken of the advance of Medical Science,
as the result of the surrender of systems and methods of rea-
soning stamped, as it appears to us, with error. Herein lie
what may be termed the indirect sources of progress. The
direct cause is none other than the more general adoption of
close OBSERVATION and induction in clinical and pathological
research. Through the earnest application of these great in-
struments of progress in all sciences, all recent solid advance-
ment in medicine has been effected. It has of late been under-
stood in medical science, as it has long been understood in other
sciences of observation, that: "To begin with self-evident
principles, to advance by timorous and sure steps, to review
frequently our conclusions, and examine accurately all their
consequences though by these means we shall make both a
slow and a short progress in our systems are the only methods
by which we can ever hope to reach truth, and attain a proper
stability and certainty in our determinations." {Humes Es-
says Academical and Sceptical Philosophy. Part I.)

6. Lastly : It is to the growing habit of counting facts to
the use of what has been termed the numerical method that
must be traced in great measure, the accuracy . of existing
knowledge in pathology. We are aware that this is not an

(Note.) These remarks refer exclusively to pathological investigations, and
not to physiological and anatomical researches. Indeed, final causes are in-
volved in our fundamental conception of organization : the parts have a. pur-
pose, as well as a law ; we can trace a determinate end, as well as laws of
causation. The application of this principle, has, in the hands of Cuvier
and others, contributed largely to the advancement of physiology, zoology,
and comparative anatomy. But, when it is attempted to be applied to dis-
eased processes, interminable error and confusion must arise. Can any one
assign a purpose to any given diseased action 1 Has any organ di function other
than a normal and healthy one 7 It appears to me, that physicians have not
kept this fundamental distinction between ph)'siology and pathology in view,
with sufficient clearness and steadiness. Hence, the vast number of crude hypo-
theses and vague conjectures, which have been framed to account for ihe
objects and ends of various diseased processes.

N. s. VOL. V. NO. v. 18

274 LeConte, on the Philosophy of Medicine. [May,

universally-admitted position ; there are persons who oppose
the application of figures in the settlement of questions of all
kinds connected with pathology, etiology .and therapeutics, on
the ground that morbid conditions are too complex and too
varying in character to admit of being represented by num-
bers: others hold the contrary opinion. The modes of pro-
cedure of the two parties may thus be sketched. An author,
belonging to the one, simply states that he has treated a given
malady in a certain manner with such general effects, as induce
him either to recommmend that a similar Hne of conduct should
be uniformly pursued in its management ; or to dissuade others
from following his example. The writer, who has faith in the
application of figures, tells his readers how many cases he has
treated in how many instances he has relieved in how many
instances he has cured, and in how many instances death has
occurred. The natural reflection upon the former mode of
proceeding is, that for the accuracy of his verdict we must trust
blindly and implicitly to the author; and the nature of that
verdict will depend, probably, more on the character of the
man, than of the facts which are presented. It is perfectly
clear, that the same result will be differently viewed by him,
according as he is of sanguine or desponding temper, vain or
modest, cautious or rash in his judgments ; according as he is
ready to accept slight evidence or requires full demonstration.
He may fancy that he always does good ; or that he frequently
does good;, or that he (which is rare) seldom does good; or
that he (which is still rarer) never does good ; and what fair
grounds are there, whereon his readers may either question his
accuracy or gainsay his determinations ? On the other hand,
according to the second mode of proceeding, the temper and
character of the observer have no influence on the general
result. Figures have nothing to do with temperament ; the
numbers 1, 10, 100, 1000, have but one meaning for all mankind.
Does not the superiority of conclusions obtained upon the lat-
ter, to those set forth upon the former, plan, as guides to prac-
tice, appear clear and self-evident ? In point of fact, no man
can form a correct estimate even of his own success in the
treatment of any disease, unless by counting the instances of
his failure and the contrary. Moreover, how else can the ex-

1849.] LeContc, on the Philosophy of Medicine. 275

perience of one observer be added to that of another ; how
else can the experiences, acqmred at different periods and in
different countries, be made to take part in one general result ?
The valuable results which have already been attained, through
the cultivation of the general statistics of disease, as it affects
large populations, warrant the highest anticipations in relation
to the assistance which medicine will eventually receive from
this source. Of what problems, regarding the health of man,
may we not anticipate the solution, when the diseases of vari-
ous climes, properly registered, may be compared with each
other! With what certainty shall we be enabled to establish,
not only the influence of civilization generally on disease, but
even of particular modes and forms of social progress ! In the
history of the more demonstrative sciences, it will be found
that it is the introduction and use of accurate numerical mea-
sures, that forms the prelud3 to the epoch of rapid advancement.
The theory of gravitation in astronomy, that of definite pro-
portions in chemistry, and that of luminiferous undulations in
optics, are all numerical theories, susceptible of mathematical
expression.

From these several considerations, I think we may safely
affirm, that modern medical science is based on a secure foun-
dation, and that it will ultimately attain to a degree of exact-
ness which will be sufficiently satisfactory to the mind. We
have just entered upon the inductive epoch in medicine. This
is the period for collecting facts, for multiplying observations,
for establishing the basis of wider and higher generalizations.
Nor is there any observer, however unpretending, who may
not add to the stock of ascertained facts ; so varied and inex-
haustible are the stores of nature. The humblest contributors
may rest assured, that they are imperceptibly raising an endu-
ring structure of scientific truth.

Unfortunately, by the side of this scientific system, another
is seen growing a system of unproven, and, in part, entirely
mistaken empirical knowledge. Embracing but few particu-
lars, this kind of empiricism is the more presuming, because of
its utter ignorance of the facts by which it is assailed. Shut
up within itself, it is unchanging in its axioms, and arrogant,
like every thing else that is restricted ; whilst enlightened sci-

276 Le Conte, on the Philosophy of Medicine. [May,

ence, inquiring, and therefore doubting, goes on separating the
firmly estabHshed irom the merely probable, and perfects itself
daily through the extension and correction of its views. In-
stead of investigating the medium point about which, despite
the apparent unfettered aspect of nature, all phenomena oscil-
late within narrow limits, it only takes cognizance of the
exceptions to the law ; it is ever disposed to presume the train
of natural sequence interrupted, and to overlook in the present
all analogy with the past. Such a system opposes every thing
like those comprehensive views which raise our conceptions of
the dignity and grandeur of nature, by the discovery of uni-
versal laws, laws that reign in the most delicate textures that
meet us on earth, no less than in the Archipelagos of thickly-
clustered nebulae which we see scattered through the awful
depths of space.

The general prevalence of this empiricism may be traced to
the present imperfect state of the science of hfe. The notion
of life, and of vital forces, is still too obscure to be steadily held.
We cannot connect it distinctly with severe inductions from
facts. In the language of a distinguished historian of science ;
" We can trace the motions of the animal fluids, as Kepler
traced the motions of the planets ; but w^hen we seek to render
a reason for these motions, like him, we recur to terms of a
wide and profound, but mysterious import; to virtues, influ-
ences, undefined powers. Yet we are not on this account to
despair. The very instance to which I am referring shows us
how rich is the promise of the future. "Why," says Cuvier,
"may not natural history one day have its Newton ?" {Ossein.
Foss. Introd) The idea of the vital forces may gradually be-
come so clear and definite as to be available in science ; and
future generations may include, in their physiology, proposi-
tions elevated as far above the circulation of the blood, as the
doctrine of universal gravitation goes beyond the explanation
of the heavenly motions by epicycles." (Vide. WhewelVs Hist.
of Inductive Sciences, vol. 3, p. 404, 405.)

And of all this, gentlemen, what is the object and what the
end? None other than the discovery of truth, and the applica-
tion of this truth to the relief of human suffering. Such are the
aims of him who enters, in the right spirit, upon the study of

1849.] LeConte, on the Philosophy of Medicine. 211

medical science. And can there be a nobler combination than
that which practice opens to your view, the intellect keenly
laboring for the benefit of your fellow-men, and the affections
deeply sympathizing in the results of the labor? And ought it
not to be a high privilege to belong to a profession, of which
such is the exalted mission? Is it not vividly inspiring,
ought it not, in itself, to suffice to cheer you on amid toil, amid
neglect, amid ingratitude, amid worldly struggles, to remember
that, by taking a position in its ranks, you have acquired the
power to think, to feel, to act, for the accomplishment of things
so great, that you have insured for yourselves the enjoyment
of pleasures so pure ? But if admission into this profession
confer such privileges, and supply such foundation for the nobler
orders of happiness, a return is looked for on the part of him
who enters it. Of that profession he is required to bear himself
as a worthy and high-minded member; and to maintain its
dignity and elevate its position, as far as his individual charac-
ter, conduct, and acquirements can conduce to that end.

And let me be permitted to close this address with words of
calm though bright encouragement. Let me turn to those
among you, who may feel diffident of your capabilities who
are disposed to recoil from the task before you, disheartened
by the modest apprehension of intellectual deficiency, and say,
that the "race is not to the swift, nor the battle to the strong."
It is to him who spares no toil ; who shrinks at no sacrifice of
ease and momentary enjoyment ; w^ho feels elevated by the
grandeur of the end he aims at, and by his very energy spurns
away difficulties, which otherwise must have thw^arted and over-
come him. Upon you, on the other hand, who form a higher
and prouder estimate of your capabilities, who have wnthin you
the consciousness of power, I would impress the necessity of
assuminor and maintaining]^ an iron and unbendinn^ will to work
that power to its full ; I would bid you accept the augury of
success your own bosoms have delivered, and let your lives be
one unfaltering eflx)rt to fulfil the prophecy.

278 Eve's Report of Surgical Operations. [M.ay,

ARTICLE XV.

Report of Operations performed under Ancesthetic Agents.
By Paul F. Eve, M. D., Professor of Surgery in the Medi-
cal College of Georgia.

Ill December, 1847, I received from Prof. McKenzie, then
residing in Paris, now on a visit to this country, the first intel-
ligence of the new compound known as chloroform, proposed
by Prof. Simpson of Edinburgh, as a new anaesthetic agent in
Midwifery and Surgery. In common with others of the day,
I was then engaged in testing the value of the means suggested
to produce insensibility in patients subjected to operations a
proposition hitherto viewed by the profession quite chimerical.
A keen edge to the cutting instrument, dexterity in the surgeon,
and some suffering on the part of the patient, were the essen-
tial conditions of even good surgery at the present day. That
the knife gave a little pain has ever been an admitted fact, and
many an one has been doomed to measure its full extent without
our power to do much to mitigate the distress of the sufferer.

Who then exercising the benevolent profession of medicine,
possessing, as every one should, a kind sympathizing spirit, can
remain unaffected by the fact now well established, that the
state of insensibility can be safely induced during the perform-
ance of the most painful operations in midwifery and surgery?
What surgeon, accoucheur or general practitioner, does not re-
joice that the healing art is now disarmed of much of its terror,
and of the real aggravation of human suffering by our own
proceedings ? The alleviation of physical pain and distress is
now instantaneous, direct and complete, by the employment of
means happily within the reach of every one. Nor is this all.
If pain be the initiatory step to inflammation, and the preven-
tion of one arrests the other, then we may begin to estimate the
value and importance of these new ana}sthetic agents.

The use of the inhalation of sulphuric and chloric ethers, and
of chloroform, in midwifery and surgery, was regularly brought
before the la^?t meeting of the American Medical Association.
Members of that body were not only ready, but some were
i[n\\e anxious to discuss the general subject. It was thought,

1849.] Eve's Report of Surgical Operations.

279

however, judicious to delay definite conclusions respecting the
applicability of these agents in practice, until more extensive
and enlightened experience had been obtained regarding them.
Willing to contribute my observations to the general fund,
limited and imperfect as they are, it is proposed to furnish a
statistical table presenting the result of Operations performed
under Ancesthetic Agents.

O -- 3 O O

o o c o o

'J z; ;5 h o

a, J

1 1

s 1

O O O O -w o
O O O O O O

oooozo

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o o o

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k< >-

if

'3 J

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il

O
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:<5 caci,

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00 00
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00 m m

D^ii lis

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g

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o o> eo P3 o 'O

* C< (N C< !' *

-^ o "O t o

I give the date, supposing this might be the first operation under Chlorofornx
in our country.

280

Eve s Report of Sugical Operations.

[May,

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p

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Embraced in the above report are fifty-eight cases in which
chloroform was alone used ; of tlie whole number, sixty four,
there w^ere three deaths one on fourth day after the operation,
one on the eleventh, and the third about six weeks after it all
supposed to have occurred entirely independent of the induc-
tion of anaesthesia. Before the class the past winter, of forty-
three operations, this agent was employed eighteen times. I
also removed, in the presence of the students, a large fibrous
tumour from the thigh of a mule, the animal being fully in the
state of chloroformisation. I have also administered chloro-
form in some cases of midwifery ; occasionally, too, even in the

1849.] Kves Report oj tSurgical Operatiuns. 281

extraction of teeth in some instances producing only a partial
state of insensibility, in all exercising great caution, especially
AVith this agent. Altogether, I may have seen the anaesthetic
condition induced in about one hundred cases, during the ])ast
twelve months, and in only two of this number was there any
unpleasant symptoms too profound an impression by the cu-
mulative etfects of chloroform ; at least, it was greater than
"was expected in these instances ; but in each, as is now be-
lieved, independent of its proper administration.

I believe, in some cases, the local ana3sthetic effect of chloro-
form may answer the purpose for minor operations. I have
not ventured to use these agents in cataracts, or in affections
near the brain.

From the facts above stated, I can subscribe the following
opinions, taken from the Monthly Journ. of Med. Sciences :

" Chloroform in Surgical Practice. At a meeting of the
Medico-Chirurgical Society of Edinburgh, Dr. Simpson asked
Professor Miller and Dr. Duncan to state the extent to which
they used chloroform in their public and private suigical prac-
tice.

" Professor Miller observed, that in the hospital and else-
where the surgeons of Edinburgh have used chloroform in all
their operations, with the exception, perhaps, of any such with-
in the cavity of the mouth as were expected to be attended
with much hemorrhage. And he could speak of its perfect
success, and perfect certainty, and perfect safety, in the most
unequivocal terms. There had been no misadventures, no
failures, and now no fears of those spasms and other prelimina-
ry symptoms to which Dr. Simpson had alltided. In saying all
this, he believed he was simply stating the opinion and experi-
ence of all his surgical brethren here ; and that no one amongst
them would deem himself justified, morally or professionally,
in now cutting and operating upon a patient in a waking and
sensitive state. Every professional principle, nay, the common
principles of humanity, forbade it, seeing that surgery was
now happily possessed of sure and safe means by which it
could avoid the necessity of such cruelty. Those were strong
opinions, strongly expressed, but, in answer to Dr. Simpson's
question, it was impossible for him to say less.

'* Dr. Duncan stated that he sincerely coincided in every
part of the statement made by Professor Miller, and that, in
in his hospital and in his private practice, he constantly, like
his other surgical brethren, used chloroform in all his opera-

282 BihUographical [May,

tions, and even when making any painful examinations for the
purpose of diagnosis. There was only one case in which he
had found a ditficulty in its appHcation, viz: when operating
for internal hemorrhoids, the patient not, ot course, having the
capability of protruding the bowel when anaesthetic.

"Professor Miller stated that, in operating for internal hemor-
rhoids, he had latterly been in the habit of making the patient
first protrude the bowel ; he then fixed the hemorrhoid with a
vulsellum, chloroformed the patient, and afterwards terminated
the operation.*'

PART II.

BIBLIOGRAPHICAL NOTICES.

1. On the Cryptogamous origin of Malarious and Epidemic Fevers,
By J. K. Mitchell, A.M., M. D., Professor of Practical Medicine
in the Jefferson Medical College of Philadelphia. Philad. Lea &
Blanchard. 1849. 12mo., pp. 137.

The little volume whose title page is given above is decidedly one
of the most interesting and important productions of the day. It is
interesting because of the handsome garb in which the gifted author
has clothed naked facts, and important from the impulse it cannot fail
to give to researches of a novel character in relation to a subject
which has a direct bearing upon a very extensive class of diseases and
which has been hitherto involved in the most perplexing obscurity.
No study has engrossed more time and talent, from the dawn of Medi-
cal Science up to our own times, than that of the causation of fevers ;
and yet there is perhaps none in which so little real advance has been
made. This is so true, that many of the ablest pathologists of the
day have abandoned it in despair, preferring to direct their energies
upon the more promising inquiry after remedial means. If the work
of Prof. Mitchell accomplished nothing more than to rid medical litera-
ture of such unmeaning words as malaria, marsh miasmata, atmos-
pheric poison, 6ic., much would be gained. It does more however;
it opens to us anew field of observation, and one which, if properly
tilled, must necessarily yield an abundant return.

The work before us consists principally of facts in relation to the
})roduction and influence upon the animal economy of fungi, which,
after being carefully collated, f)rni the l)nsis of an exceedingly ingen-

1849.J BibliugrajjhicuL 283

ious and plausible theory. We cannot at present give a more satisfac-
tory and condensed view of the work than may be derived from the
caption of the six Lectures of which it consists.

" Lectuke I. Theories of Malaria. The Vcgeto-animal Tlieo-
ry. The Atmospheric Theory. The Sulphur-product Theory of
Daniel. Theory of HofVman. Gaseous Theories. Miscellaneous
Theories. Theory of Dr. Robert Jackson. Theory of Dr. Fergu-
son. The Animalcular Theory.

''Lecture IL Habitudes of the Fungi. Traces, among xVuthors,
of the Fungous Theory. Rapid growth of the Fungi. Their Poison-
ous Properties increase as the Latitude decreases. They are found
chiefly in Autumn.

" Lecture IIL The Fungi are active almost exclusively at
Night. Fungiferous power of Epidemic Periods and Seasons.
Sudor Anglicanus. The Milzbrand. The Milk-sickness of the
Western Country.

"Lecture IV. Poisonous Quality of the Fungi. They produce
Fevers. They produce Fevers which Remit or Intermit. They
produce Fevers with Gangrene. Fungi cause the Potato Rot. The
Fungi in the Atmosphere. Fungi cause many Cutaneous Diseases.
They also cause Aptha?, a disease of the Mucous Membrane. They
are found in the Stomach, in the Bowels, in the Peritoneal Cavity, are
associated with Indigestion, appear in Typhoid Fever, in the Bladder,
on the Pleura, in Chole-ra, and in Diabetic Urine. The Fungi cause
many diseases of Insects and Reptiles, as the Muscardine of the Silk-
worm, &c. They seem, according to Scripture, to produce Scalls
and Leprosy. They are found after death in Pigeons, Fowls, and
other winged animals.

" Lecture V. The Fungous Theory explains the cause of the Post-
ponement oftheEflects of a Malarious Infection, and accounts for the
nice Limitation of Malaria, for the Eflects of Dried Air, of Danip Sheets,
of Fomites. Yellow Fever. Cholera. The Plague. Localization
of Peculiar Diseases. Quarantines- Pestilential Premonitions.

"Lecture VI. Hygienic Inconsistencies of Seasons and Places,
explained. The Maremma of Italy. Volcanic Eruptions aflect the
Health of the following, and not of the current year. Fairy Rings.
Liebig's Theory of the Cause and Non-recurrence of Diseases,
refuted. A new explanation of these, offered. Why the first Cases
of an Bipidemic are most Fatal. Why Barren Plains are sometimes
Sickly. Recapitulation."

W^e add the author's Recapitulation of the most important elements
of his argument.

o

"I began, by showing that all the usually received opinions on this
subject, are liable to insuperable objections, except that whicli refers
to the causation by organic life, and especially by animalcules, as
held by Columella, Kircher, Linnaeus, Mojon, and Henry Holland.

" While I was impressed, for the reasons .so ably stated by Holland,

284 BihhograpliicaL [May,

with the greater probability of the organic theory, I prefer, for reasons
stated by myself, the fungous, to the animalcular hypothesis.

" My preference is founded on the vast number, extraordinary vari-
ety, minuteness, diffusion and climatic peculiarities of the fungi.

" The spores of these plants are not only numerous, minute, and
indefinitely diffused, but they are so like to animal cells, as to have
the power of penetrating into, and germinating upon, the most interior
tissues of the human body.

'' Introduced into the body through the stomach, or by the skin or
lungs, cryptogamous poisons were shown to produce diseases of a
febrile character, intermittent, remittent and continued ; which were
most successfully treated by wine and bark.

" Many cutaneous diseases, such asfavus and mentagra, are proved
to be dependent upon cryptogamous vegetations ; and even the disease
of the mucous membrane, termed aphthae, arises from the presence of
minute fungi.

" As microscopic investigations become more minute, we discover
protophytes in diseases, where, until our own time, their existence
was not even suspected, as in the discharges of some kinds of dysen-
tery, and in the sarcina of pyrosis. We are therefore entitled to be-
lieve that discovery will be, on this subject, progressive.

"The detection of the origin of the muscardine of the silk worm,
and a great many analogous diseases of insects, fishes and reptiles,
and the demonstration of the cryptogamism of these maladies, their
contagious character in one species of animals, their transfer to many
other species, nay even to vegetables themselves, all concur to render
less improbable the agency of fungi in the causation of diseases of a
febrile character.

" A curious citation was subsequently made, of the fungiferous
condition during epidemics and epizootics. These moulds, red, white,
yellow, gray, or even black, stained garments, utensils and pavements,
made the fogs fetid, and caused disagreeable odors and spots, even in
the recesses of closets and the interior of trunks and desks.

*' These moulds existed, even when the hygrometric state did not
give to the air any unusual moisture for their sustentation and propa-
gation. Their germs seemed to have, as have epidemics, an inher-
ent power of exten^iion.

" The singular prevalence of malarious diseases in the autumn, is
best explained by supposing them to be produced by the fungi, which
grow most commonly al the same season. The season of greatest
photophytic activity, is, in every country, the period of the greatest
malarious disturbance. The sickly season is, in the rains in Africa,
in the very dry season in Majorca and Sardinia, in the rainy season
of the insular West Indies, and in the dry season of Demerara and
Surinam. Even when tlie vegetation is peculiarly controlled, as in
Egypt by the Nile, and the cryptogami are thus thrown into the sea-
son of winter and spring, that season becomes, contrary to rule, the
j)estilential part of the year.

"Marshes arc a safe residence by day, whilst they are often liigldy
dan<Tcrous bv ni^dit. In iho m^st dondlv localities of our southoni

1849.] Bibliographical. 285

country, and of Africa, the sportsman may tread the mazes of a swamp

safely by day, although at every step, he extricates vast quantities of
the gases, which lie entangled in mud and vegetable mould. This
point, so readily explained by reference to the acknowledged noctur-
nal growtii and power of the fungi, is a complete stumbling-block to
the miasmatists.

"The cryptogamous theory well explains the obstruction to the
progress of malaria oflered by a road, a wall, a screen of trees, a veil
or a gauze curtain.

"It also accounts for the nice localization of an ague, or yellow fe-
ver, or cholera, and the want of power in steady winds to convey
malarious diseases into the heart of a city, from the adjacent country.

" It explains also well, the security afforded by artificially drying
the air of malarious places, the exemption of cooks and smiths from
the sweating sickness, the cause of the danger from mouldy sheets,
and of the sternutation from old books and papers.

" On no other theory can we so well account, if account at all, for
the phenomena of milzbrand and milk-sickness, the introduction of
yellow fever into northern ports, and the wonderful irregularities of
the progress of cholera.

" The cryptogamous theory will well explain the peculiar domesti-
cation of different diseases in different regions, which have a similar
climate ; the plague of Egypt, the yellow fever of the Antilles, and
the cholera of India. It accounts, too, for their occasional expansion
into unaccustomed places, and their retreat back to their original
haunts.

" Our hypothesis will also enable us to tell, why malarious sick-
ness is disproportionate to the character of the seasons ; why it infests
some tropical countries and spares others ; why the dry Maremma
abounds with fevers, while the wet shores of Brazil and Australia
actually luxuriate in healthfulness. The prolonged incubative period,
the frequent relapses of intermittents, and the latency of the malarious
poisons tor months, can only be well explained by adopting the theory
of a fungous causation.

" Finally, it explains the cause of the non-recurrence of very po-
tent.maladies, better than the chemical theory of Liebig ; and shows
why the earliest cases of an epidemic are commonly the most fatal."

It will be seen that we have not exaggerated the merit of Prof. M's
work, and that it deserves the attentive perusal of every medical phi-
losopher. \)Mp%^

2. Manual of Plujsiohgy. By William Senhouse Kirkes, M. D.,
assisted by James Paget, Lecturer on General Anatomy and
Physiology at St. Bartholomew's Hospital. With 118 illustrations
on wood. Philadelphia : Lea &; Blanchard. 1849.

This is a very neat duodecimo of 552 pages, and remarkably well
adapted to beginners in the study of medicine. It is more erudite

286 Bibliographical. [^^''^7;

than manuals generally, but not too much so, and is fully up to the
modern state of our knowledge. Indeed Physiology, under the influ-
ence of the researches now being made in organic chemistry and
M'ith the microscope, is progressing at such a pace that it has to be
re-written at short intervals in order that the student may know its
true position. The work before us will doubtless be extensively used
as a text book in our country. D.

3. A Practical Treatise on the Domestic Management and most im-
portant diseases of advanced life ; with an Appendix containing a
series of cases illustrative of a new and successful mode of treating
Lumbago and other forms of chronic Rheumatism, Sciatica and other
neuralgic affections, and certain forms of Paralysis. By George
E. Day, M. D., Fellow of the Royal College of Physicians, and
Physician to the Western General Dispensary. 8o. pp. 226.
Philadelphia : Lea & Blanchard. 1849.

Although the diseases of old age, like those of infancy and child-
hood, present important peculiarities, it is a little remarkable that they
have not attracted the same attention. The press is continually issu-
ing new volumes upon the affections of early life, whereas the one
before us is the only monograph devoted to advanced age that has
appeared in the English language during the present century. It will
therefore fill a void in our medical libraries that must have been seri-
ously felt by the practitioner. The work of Dr. Day bears the impress
of research and experience, and is gotten up in good style. Its ap-
pendix contains an account of the use of the heated iron hammer or
button which has of late been recommended very highly by Continent-
al as well as by English authorities of distinction, especially in the
treatment of neuralgic affections. We have no doubt that this work
will be consulted with advantage by practitioners, both old and young.

D.

4. Obstetrics : The Science and the Art. By Charles D. Meigs,
M. D., Professor of Midwifery and the Diseases of Women and
Children, in the Jefferson Medical College of Philadelphia, &;c., fec.
With 121 illustrations. Philadelphia: Lea & Blanchard. 1849.

In every department of Medicine, and especially in that of obstetrics,
during the last few years, systems on systems have appeared in con-
stant succession ; there has been a superabundance of such works ;
physicians have become wearied of seeing the announcement of new
systems, which of all publications are, generally, least valuable to the
l)rofossion and least calculated to secure permanent reputation for their
authors ; they arc ephemeral in their nature, shining for a day and

1840.] Bibliographical. 287

then passing away to be succeeded and superceded by new aspirants
after popular favour, laying claims or making pretensions to greater
perfection, professing to post the whole subject up to the latest date,
to include all the recent discoveries in science and improvements in
practice.

Such publications must be but republications to a considerable
extent; they must necessarily consist principally of compilations and
collations from previous authors ; the language may be different, but
however varied the phraseology, the matter must be the same, for all
facts in nature and truths in science must be forever immutable.
The most valuable publications are monographs or treatises which
give the opinions, or detail the practice and experience of their au-
thors on particular subjects. Such are Collins' Practical Treatise
on Midwifery Hamilton's Practical Observations on various subjects
relating to Midwifery Lever's Essay on Organic Diseases of the
Uterus Bonnet's Practical Treatise on Inflammation, Ulceration
and Induration of the Neck of the Uterus, &c. Whitehead on Abor-
tion and Sterility and Lee's Clinical Midwifery, a very small but
most valuable work recently republished in our country, noticed in
the last number of this Journal.

It is to be regretted that Professor Meigs has employed his excel-
lent talents so unprofitably, and expended his energies in translating
the works of others and composing a general system, w^hen he might
have done so much more good and gained for himself so much more
lasting fame, by concentrating his attention on some particular de-
partment, or on one or more individual subjects. We hope, if his valu-
able life should be longer spared and his health restored, that hereafter
he will only tell us what he has seen and done himself, and give us his
own observations and reflections, leaving others who have more time
and less to do, and who may be ambitious to shine, by reflected light,
to translate and edit the works of others or to compile systems.

But we bid the present work of Prof. Meigs a more hearty welcome
than we would an entirely new system, appearing as it does in place
of a third edition of his Philadelphia Practice, hvhich was published
more than ten years ago, and of which a third edition was demanded.

It is highly creditable to Professor Meigs, thus to re-write, remodel,
extend and improve his former work, when his advanced age demand-
ed rest, and his long continued arduous labors in the cause of human-
ity so richly entitled him to it, especially too as there could be no
doubt but that a third edition, without revision or amendment, would
liave commanded a ready sale.

288 Bibliographical. [May,

Time will not allow us to make a critical analysis of this work.
In substantial merit, it will compare well with any of the systematic
treatises on midwifery which have appeared within the last ten or
twenty years: it is a very complete and comprehensive system, com-
prising every thing valuable and interesting in obstetrics, both old
and new. The author gives his own opinions and views with firmness,
but always acts with the utmost fairness towards those who differ
from him.

We have long regarded Dr. Meigs as one of the soundest and ablest
obstetric practitioners in the United States. The present work possess-
es much true merit : the matter is generally excellent, we take pleasure
in recommending it as a valuable help, not only to students, to whom
it is particularly addressed, but to those engaged in practice ; it is,
however, to be regretted, that in style he too often deviates from that
simplicity and chasteness, which should characterize all scientific
and especially medical works. It is sometimes turgid, inclining
to magniloquence and savouring a little of pedantry, abounding in
quotations from ancient and foreign languages. The author, in
the abundance of his learning, appearing to forget that those to whom
it is particularly addressed, medical students, rarely, if ever, possess
the same extensive scientific and literary acquirements that he him-
self does. These defects of style are particularly to be regretted,
inasmuch as, from his deserved popularity, they are calculated to exer-
cise an unfortunate influence over the taste of young physicians and
students, who, like other young persons, are disposed to imitate those
whom they respect and admire.

It has been often remarked, that elderly gentlemen are averse to
adopt or admit the value of new discoveries or improvements in prac-
tice, and to regard them as useless or injurious innovations on the
good old beaten paths. Professor Meigs is perhaps less obnoxious to
this charge in general, than almost any person of his age far from
this, he seems disposed to float upon the very foremost wave of im-
provement, or by spreading every sail and bending every oar, to out-
ride the waves, or, as tiiough he would after ascending the loftiest
pinnacle, boldly take still a higher step ; but he appears to entertain
an undue prejudice against chloroform indeed, if we did not know
him to abound in the milk of human kindness, and to be most em-
phatically and truly the female's friend, we would consider him de-
ficient in sympathy for the fair sex. For our own part, although on
the dark side of forty, the age opposed to innovation, we hailed with
delight a discovery which promised to meliorate woman's hard fate.

1849.] The Heart-Clot. 289

and soften the severity of the primeval curse ; notwithstanding our
difference on this subject, we do not, however, believe our respected
friend possesses less gallantry or charity than ourselves. As our opin-
ions respecting chloroform are already known to the readers of this
Journal, having been expressed a year ago in a letter to the Editor,
in which we replied to some of Dr. Meigs' objections, it would be
superfluous to repeat them now, we will only add that subsequent ex-
perience has confirmed our opinion and strengthened our confidence ;
still we say let it always be used with caution and not in ordinary
cases, but only when intense suffering demands relief.

In the employment of instruments, the author inclines more to
French than British obstetrics. No one would contend more strenuous-
ly than ourselves, that the forceps should always be preferred to the
crotchet, as long as there is any doubt of the death of the foetus, until
they had been fairly tried, or after mature consideration rejected as in-
adequate, or their application deemed impracticable. But we verily be-
lieve, on the continent of Europe and in the United States, more
mothers are injured and children destroyed by the unnecessary em-
ployment of embryospastic than embryotomic instruments, inasmuch
as, in practice, there is a constant disposition to resort to the former
sooner than necessary, or when not required, and so great a repug-
nance and abhorrence to the latter, that they are deferred to the last
extremity, often too long. As a gentle counterpoise to some of Dr.
Meigs' views on this subject, which in the main are excellent, we
would advise the student and young practitioner to read attentively, at
the same time, his friend Dr. Robert Lee's Clinical Midwifery.

There are some other points in which we can not fully coincide
with the author, but where we find so much to approve, we will de-
cline further criticism, preferring that others should read and judge
for themselves, hoping they may derive the same pleasure and profit
that we have from the perusal. J. A. E.

The Heart-Clot. {From Philad. Med. Examiner.)

To the Editors of the Examiner:

Gentlemen : I beg leave, through the columns of your useful
periodical, to present the statement of certain opinions I have
long entertained, relative to points in pathogeny connected with
the occurrence of endo-cardial coagula ; and I do so, because I
consider them deserving of serious consideration by the practi-
tioner.

N. S. VOL. v. NO. v. 19

290 The Heart-Clot. [May,

These opinions are connected with certain points of practice
or treatment that are, in many cases, indispensably necessary
for the safety of the sick ; and my sole desire in offering the
communication, is fomided on the hope that it may tend to pre-
vent some disastrous events, which the want of a little reflection
might allow.

I believe it is a fact, not to be controverted, that in an animal
slowly bled to death, the first portions of blood extravasated,
coagulate less readily than the last portions. If this doctrine
is true, it follows that the coagulability of the blood left in the
vessels after great hemorrhages is augmented : I have had se-
veral occasions to find that it is dangerously augmented.

To take one of the most ordinary cases of hemorrhage I
mean that occurring after labour, or in abortions we have an
instance in which, even after the arrest of the bleeding, the
patient is exposed to mishap from the coagulability of the blood
remaining in the vessels. Loss of blood produces a tendency
to fainting, or lipothymia ; during an attack of fainting, the
motions of the heart are enfeebled, the diastole slow torpid,
for the blood moves languidly in both the vense cavse, pours
itself out in a slow current into the auricle, which it sluggishly
distends, and sometimes is then instantly converted into a solid
clot. If a clot be formed in the right auricle, it will also be
formed in the iter ad ventriculum dextrum filling up the cone
of the tri-cuspid valve ; and the nucleus of it will cause the
coagulum at length to occupy the cavity of the right ventricle,
and extend itself to a greater or less distance along the tractus
of the pulmonary artery. If the whole pulmonic side of the
heart should be perfectly occupied in this way, the death of the
individual would be instantaneous ; and I doubt not, that many
of the examples of sudden death, after delivery in hemorrhagic
labours, are produced by the formation of cardio-morphous
coagula which form in the instant of a state of fainting, or li-
pothymia. It is understood, that the young Princess Charlotte,
whose death at Clermont cast a mournful gloom over the whole
British Empire, died within fifteen minutes after the birth of
the princess, and that there was no very considerable hemor-
rhage^ no laceration, nor other incident that might fitly explain
the suddenness of her decease. Many women are known to
perish in this manner. I have been the eye-witness of instances
of the kind. I have also seen a very great number of persons,
who appeared to me to be in danger of perisjiing in the same
way, but who escaped a fate so deplorable. I am aware also
of instances in which women, after considerable hemorrhagic
losses, have been esteemed by their physicians to be what is
called doing well, during a space of from one to seven days,

1849.] The Heart- Clot. 291

but who afterwards becoming instantly extremely ill, have
perished without remedy in from two to twenty days thereafter.
If a surgeon, desirous to reduce a luxated humerus, should
attempt to do so, he might find the resistance of the muscular
contraction so great as to prevent his success, and he would
therefore probably resolve to take away the resistance of the
muscular contraction, by bleeding his patient ad ddiquiurn.
The surgeon knows that the deliquium would take effect upon
the loss of a much smaller quantity of blood if the patient
should be placed upon his feet in a standing posture, than if he
were to recline upon his bed in a low recumbency. He would
bleed the man while in an erect position. This ordinary prac-
tice is conformable with the dictates of experience in all cases
of fainting, for it is well known that an individual will faint
more readily in a vertical than in a horizontal position ; and the
first idea that is obvious to any medical man in a case of faint-
ing is this that he shall cause the patient to be laid with the
head very low, taking away for the time even the pillow. I
have on many occasions, besides taking away the pillow, found
myself under the necessity of elevating the foot of the bed by
placing books or blocks under the lower bed-posts in order to
favour the determination of blood to the encephalon ; for I con-
ceive that in all cases of fainting the brain has become oligsemic.

I may assert the opinion here, that fainting is oligaemia of the
encephalon, and that a hypersemia of the encephalic bulbs is the
very converse of and absolutely incompatible with the state of
swooning. To raise up a woman who has within the few days
past lost a considerable quantity of blood is almost inevitably
to bring on deliquium. Kow, if the idea be just that hemor-
rhage renders the remaining blood more coagulable, then it
follows, that to take the woman out of bed, or to let her sit up
in bed, is to expose her to the hazard of forming a coagulum in
the right auricle, which, by extension of the nucleus, may fill
the ventricle, occupying the aperture of the tricuspid, and pass
several inches upwards in the course of the pulmonary artery
and its branches. Monthly nurses, and tlie ordinary attendants
of the sick know nothing of these things, and they hesitate not,
oft-times, to exhort or to permit the anaemical accouchee to rise
and sit for a few moments for purposes that might be answered
without quitting the horizontal position.

A lady was taken in labour in the afternoon. She sat in her
arm-chair all night without sleeping: at five o'clock in the
morning she placed herself upon the bed and the child was born
in half an hour. The placenta was spontaneously and perfectly
extruded, nothing being left in the womb: it was her filth labour.
Within an hour she had hemorrhage the vagina and uterus

292 The Heart-Clot. [May,

contained large coagula which were turned out by the physi-
cian, whereupon the hemorrhage ceased : she may have lost
altogether some thirty ounces of blood. He remained near
her for several hours. At mid-day, throughout the afternoon,
and during the following night, she appeared to be perfectly
well. At half-past nine the following morning the physician
made his visit ; she was without pain or the least indisposition,
nor had she any symptoms, save those that appertain to the con-
dition of a healthy accouchee. Her pulse was about 75 beats
per minute ; the respiration, temperature, and hue, satisfactory
to the medical attendant; her complacency, physical and moral,
was absolute.

The physician left her at 10 o'clock in the morning. Being
summoned again, he reached her apartment at 1, P. M., and
found her in a state, which led him to suppose that she might be
near dying. The pulse was 164 per minute, very feeble and
thread-like; the hands" were cold, and the respiration was per-
formed apparently by the strongest effort of her will only. The
respiratory acts were performed with great violence, and with-
out rythm. Auscultation of the heart disclosed a feeble impulse,
with great irregularity of the systolic action. She had lost no
more blood beyond the ordinary lochial discharge; the vagina
which was examined contained no coagulum.

When I came into the apartment at 3 o'clock, P. M., she
supposed herself to be in a dying state, and asked me if I thought
she would live half an hour. It is difficult to conceive of a
spectacle of more extreme physical distress than that presented
by this dying lady. Every respiratory act wa attended with
violent pain referred to a place near the lower extremity of the
sternum, as in angina pectoris. Palpation of the abdomen and
questions relative thereto, showed nothing abnormal there.
Upon retiring for consultation, I expressed to my medical bro-
ther the opinion that the pulmonary heart was filled with a
coagulum or false polypus ; the prognostic, therefore, was ne-
cessarily fatal.

She had been left at 10 o'clock in the morning with a pulse
at 75, and in the course of the forenoon she had been taken up
from her recumbent position, and allowed to sit upon the close-
stool for the purpose of evacuating the bladder of urine, imme-
diately after which she was ill, and the physician sent for.

I made this diagnostic upon these grounds, viz : I said, there
is no pathogenical principle that I know of that can explain the
change of her pulse from 75 to 164, in so short a time, save that
of a mechanical obstruction formed by a clot or tampon filling
up the cavities of the heart. It is clear that there is no scar-
latina, no variola, no fever of any kind no attack of Asiatic

1819.] The Heart- Clot. 293

cholera nor other malady, that is capable of makinsf so soon,
so great a change in the action of the heart as is here observed.
The patient had hemorrhage yesterday, which has increased
the coagulabihty of her blood ; she was taken out of her recum-
bent position and placed upright in bed, whereupon she became
suddenly ill in consequence of the coagulation of blood in her
auricle, and there is no power that is able to remove this tam-
pon from the cavity of her heart ; it will destroy her as effec-
tually as would a musket ball deposited in the ventricle.

The respiration in this case was carried on, at the time of
my arrival, solely by the force of the voluntary power. There
seemed to be no rythmical respiration whatever ; when she
ceased to breathe by her volition, her respiration appeared to
be suspended altogether. As might be expected, these volun-
tary aspirations were not rythmical, but interrupted, uncertain,
having long intervals. The blood that came up from the infe-
rior cava and down from the upper cava, must have passed
with great difficulty between the superficies of the clot, and the
paries of the heart. It must have moved in small quantities
only through the tricuspid, and when distending the pulmona-
ry ventricle, that ventricle could contain but a small portion of
fluid blood, being mainly occupied by the coagulum. A simi-
lar difficulty existed as to the afflux of the blood along the pul-
monary artery, which w^as tamponed at the time with a cylin-
drical clot extending several inches along the vessel and its
principal branches. Under these circumstances, the quantity
of carboniferous blood entering the lungs by the pulmonary ar-
tery, for aeration, could be a small quantity only ; hence the
violent almost spasmodic protracted effiDrts to aspire the air of
the atmosphere; efforts which, however great, must measurably
fail of the purpose of abolishing the direful sense of pulmonary
oppression, or respiratory distress, or to use a more concise
term, asphyxiation. The quantity of blood in the lungs was
too small to receive the endow^ment of oxygen which is re-
quisite to preserve any individual from a feeling of suffocation ;
and however thorough might have been the aeration of the small
quantity that was there, however brilliant and florid may have
been its arterial hue after being breathed upon, the quantity of
oxygen imparted to it must necessarily be sufficient so to act
upon the nervous mass, the neurine, as to hinder the conscious
principle from perceiving the sense of asphyxiation. With a
heart situated in this manner with the utter impossibility of
thoroughly oxygenating the sanguine mass, the innervation
gradually fails a failure which is manifested in the decadence
and ultimate overthrowof the various functions. All the func-
tions are but the expressions of the biotic force that is sent

294 The Heart-Clot. [May,

down by the encephalic bulbs and spinal cord to the distal
points of the nerve-fibrils in the organs. Every acinus of a
gland is alive solely by the nervous force which comes into it
by the fibril that connects it with the nervous mass, to obey
whose mandate is to live, while to fail of receiving it is com-
mand to die ; the same is true of every part and particle of the
histological constitution.

As the encephalic bulbs certainly cease to irradiate the or-
gans when they themselves cease to receive through the oxy-
geniferous streams injected into them by the carotids and
vertebrals, the supplies of oxygen which alone enable them to
evolve the life force, the nerve force, the lehenskraft^ the biotic
force it follows, that the organs die in the same ratio as those
bulbs fail and perish.

One is not surprised, therefore, upon observing that a person
in good health, like this unfortunate lady, the right side of whose
heart becomes suddenly, instantaneously tamponed by a coagu-
lum, should fall a victim, and that speedily, not to the presence of
the clot alone, but to disease developed in other parts, whose life
is overthrown in consequence of the obstruction of the prime
organ of the circulation. Only a few hours could pass with a
large coagulum in the heart, before the pericardium would begin
to be filled with serum, or the embarrassments in the pulmona-
ry circulation seek in vain for relief, by pouring out a vast ef-
fusion of water into the cavities of the pleura ; or the innerva-
tive force being withdrawn from the viscera contained within
the abdomen, whose venous blood is prevented from flowing of!
through the pulmonary artery, there is set in motion in the
peritoneal sac, a tide of effusion filling it up in the course of a
few hours.

In all such cases as those of which I am speaking, the escape
of the blood from the venous side of the sanguine circle is
retarded, with the effect of producing enormous engorgements
of all those venous branches, which usually and readily allow
their products to run off through the ascending and descending
cava3. Let the reader perpend for a moment the condition of
that portion of the vascular system which receives the aortic
injections by the cff'liac and the superior Xp inferior mesenteric
arteries ; let him reflect that the whole of this torrent, which is
entirely expended upon the chylopoietic and alimentary or-
gans, is first collected by the capillary radicles of the portal
vein, then distributed again among the capillary termini of the
hepatic porta, whence it is a second time collected to flow off
by tlie hepatic veins. Now, if the auricle and ventricle are
tamponed by an endocardial coagulum, this whole torrent is in-
evitably arresterl, and the cavities become immediately en-

1819.] The Jfmrt-Clot. 295

gorged by the continued injections from the aorta, leaving no
grounds of astonishment as to sudden or fatal derangement of
the healthy states of the tissues that are developed by it.

The time required for extinguishing the life of the sufferer is
a variable time; one relative to the magnitude and extent of
the coagulation. I can imagine that in the case of the Princess
Charlotte, already alluded to, a coagulum was formed which
filled the heart so completely, as to put an end to its action
within fifteen minutes after the birth of the princess. My pa-
tient above'mentioned, lived forty-eight hours after the occur-
rence of the accident, during which time she suffered the most
inexpressible respiratory distress. She filled her pericardium
with serum, while her peritoneal cavity became also the subject
of a great effusion. Upon examining the heart twenty-four
hours after her decease, one might feel surprised that her life
could be so long protracted, since the auricle, tricuspid, and
ventricle were completely tamponed with a clot which was not
an enthanasial clot, but consisted apparently of a firm, whitish-
yellow mass of fibrine, out of which every particle of haemato-
globulin had been washed aw^ay, or expressed. An entha-
nasial clot is, in my opinion, necessarily a red one ; a pre-
enthanasial one ought to be white.

A patient in this city was delivered early in the morning.
Soon after the birth of the child and the delivery of the placenta,
the physician descended to the breakfast room, having given
strict charge that the patient should preserve the recumbent
position, and be kept quiet. While at his breakfast, cries from
the top of the stairway called him, for " God's sake," to hasten
to the assistance of the patient. In a moment he was at her
bed-side, where he found her already dead, having fallen back-
wards across the bed with her legs hanging over its side. He
was told thart she had said to her nurse, " I wish to get up,"
" The Doctor says, madam, you must not get up, if you please."
"But I must get up, I will get up." She threw her feet out of
the bed, and rose up sitting upon its edge ; her head reeled to
and fro, and she fell back and expired. No examination was
made of the dead body, but I ask the reader to explain the cause
of this sudden death, otherwise than by the rationale that her
heart ceased to beat because it became instantly filled with an ,
immovable clot.

Man cannot die, save by the cessation of activity in the brain,
or in the heart, or in the lungs ; he lives within this triangle, and
can only escape at one of its angles. He must die by the
brain, or by the heart, or by the lungs. It is to the last degree
improbable that this woman perished solely because her brain
ceased to evolve ; but if it did not instantly cease to evolve, it

29 The Heart- Clot. [May,

must have continued to be the cause of motion everywhere.
If the heart, as I suppose, became instantly filled with congealed
blood, so that it could no longer receive nor discharge any por-
tion of that fluid, the nervous mass would cease to live as soon
as it should have consumed all the oxygen contained within its
capillary vessels at the moment of the arrest of the cardiac circu-
lation. The patient died by the heart.

A lady was confined in a natural labour, giving birth to a
healthy child, at term. She lost a considerable quantity of blood
at the time of the extrusion of the placenta, which-left her fee-
ble and pale. Her physician directed her to be kept quiet.
She had a good day, and following night. At the morning vis-
it the physician found her comfortable, and her condition was
satisfactory to him. Soon after he left her apartment she was
seized with violent alarming illness, whereupon he was recall-
ed, and was again present after the lapse of about an hour.
Her pulse was extremely frequent, feeble, and small ; it contin-
ued frequent until the moment of her death, which took place
about the nineteenth or twentieth day. On the eighteenth day,
I think, I saw the lady, and formed the opinion that she was
perishing on account of a false polypus, clot, or tampon in the
heart, established there by the imprudent early uprising after a
hemorrhage. After her death a great quantity of water was
found in the cavity of the right pleura, while a firm white coa-
gulum, entirely destitute of corpuscles, w^as detected in the right
auricle, filling up very much the cone of the tricuspid, while the
ventricular end of it seemed to be torn or threshed to pieces
by the cordae tendineffi, which during so many days, had been
vainly occupied in the endeavour to demolish it. The filling
up of the pleura with serum was a natural consequence of the
condition of the respiratory organs, quite as much so, but not
at all more so,- than w^as the filling up of the pojitoneum and
pericardium in the former case, consequences of the arrest of
the circulation in the cava and its branches.

Towards the end of the year 1848, a primapara gave birth
to her first child. She was tall, very slender, and delicate ; the
placenta was not removed ; she lost a good deal of blood. Be-
tween forty and fifty hours after the birth of the child, upon
being called to her succor, I removed the placenta from the
cervix uteri in which it was grasped and detained. I removed
it with the index finger of my right hand. The stench of it
was noisome to the last degree. The putrid odour of it re-
mained upon my hand for twenty-four hours, notwithstanding
every effort to remove it. The patient was pale, and her
pulse somewhat frequent, presenting the usual characteristics
of the anffimical pulse. On the following day she was com-

1849.] The Ileart'Clot. 2i)7

forUible ; tiie inilk was secreted, tlie lochia healthy, and she was
doing well, though still very pale. On the sevenili day, she was
placed in a chair before the fire, sitting up : she immediately
felt sick, was put to bed, and I bein^ called into see her, told
her friends that she had formed a fatal coagulum in the heart.
She lived about forty-eight hours after the accident ; J did not
examine her body. I leave the reader to judi^e whether my
diagnostic was or was not probably correct. She had a pulse
upwards of 100 the impulse of the heart-feeble the respira-
tion disturbed frequent.

On a great many occasions since I have been a practitioner
of medicine, I have been called to see patients, who, after
hemorrhagic labours, have disobeyed my injunctions as to
horizontal rest, and who being prematurely lifted upright in
bed, had fainted. I have not a doubt that among those of these
persons in whom I found the heart fluttering, irregular and fee-
ble in its action on my arrival, incipient coagulation existed.
I have thought as I entered the room of a patient, that her
auricular blood had begun to thicken, but was driven out from
the auricle before its thorough coagulation, in consequence of
the startling efiects of a dash of cold water upon the face, or of
clapping the hands, or snatching the pillow from under the head
and shoulders, a.llowing the head to fall so as to favour tlie re-
storation of its vascular tension or even hypereemia, and there-
by re-establishing the perfect and powerful extrication of its in-
nervative force. The re-excitation of the innervative force of
the brain would probably soon enable a heart so situated to dis-
charge itself of the inchoate coagulum.

It is not needful that I should draw out this paper to any
great length ; nor that I should discuss the reasons why so
many autopsies present the evidences of the endo-cardial clot
of which I have spoken, without having excited in the mind of
the attendant practitioner, the suspicion of its presence before
the death of the patient. It appears to me, to be enough for the
present occasion, to propound the question Can a patient with
a white clot in the auricle and ventricle recover? If such a clot
be a small one, the pulmonary circulation, although checked, is not
necessarily suspended, but the nucleus of such a clot, like the nu-
cleus of an urinary calculus, tends constantly to increase in size,
and hence a small coagulum, which strangely disturbs the action
of the heart, may consist with a considerable protraction of the
struggle against its fatal power over the circulation. The
gradual augmentation of the volume of the clot, and its exten-
sion into the pulmonary artery and its branches must in every
case lead to an inevitable dissolution. I iiave not the least con-
fidence in the power of alkaline medicines to dissolve such

298 The Heart-Clot. [May,

coagula, nor do J admit tliat the dull white endo-cardial co-
agulum so often discovered is the result of a state of endo-
carditis ; but I rather attribute its occurrence to a temporary
stasis or near approximation to stasis during a state of fainting
in an exhausted patient. Its occurrence after hemorrhagic
labours, or upon the almost total suspension of the circulation
at the cessation of an attack of puerperal eclampsia ought not
to excite surprise. If a coagulum should fill the auricle and the
tricuspid valve completely and at once, the death would be
almost instantaneous and the clot would be found red. If the
process of its formation should be long protracted it would be
dull white.

I did not design in this paper, to speak at all of the entha-
nasial coagulum ; it is perhaps quite normal that some portions
of the blood last reaching the heart, at the moment of death,
should congeal there.

In regard to the diagnosis of cases in which the endo-cardial
coagulum becomes suddenly constituted, as in the examples of
which I have spoken, it appears to me that the medical observer,
in order to make it, must resort to a method wiiich is only to be
fitly characterized as transcendental diagnosis. It is true that
the feeble impulse and almost complete suspension of the sounds
of the heart, might serve as quasi physical diagnosis of however
little value.

By transcendental diagnosis I mean one made by a process
of the mind, fitter to be called sentiment or conviction, than a
regular ratiocinative progress.

To enter an apartment one has quitted only half an hour be-
fore, and to find a patient hopelessly ill with signs of imminent
death, yet who had no serious symptoms of illness before to
find her making desperate voluntary efl^orts to breathe, without
any signs of laryngeal or phrenic or pulmonic inflammation or
accident to see the face pale and ghastly to observe her
conscious sense of impending asphyxiation from loss of oxygen
without the leaden or iodic hue of a general cyanosis These
are the grounds of a diagnosis which may be called transcen-
dental, one in which the consciousness of the physician informs
him that a mechanical obstruction wnthin the heart exists, and
that such an obstruction alone can give rise to the phenomena.

In all the lingering or sudden progressions of the accidental
disorders Fupervening in endo-cardial coagulum, no purely
cyanotic manifestations have met my observation.
" Writers on cyanosis mostly refer the cyanotic symptoms to
the backing of the carboniferous blood of the veins into the ca-
pillaries. You, Messrs. Editors, are aware that I have main-
tained the opinion that cyanosis is, in its essence, not blueness

1849.] Effects of Winds on the Human Cunstitutiun. 2U9

of the surface, but a state of the nervous mass produced by the
absence of oxygen in the brain-capillaries.

The writers, and among them, perliaps in chief, Professor
Rokitansky in his Pathologischen Anatomie, contend that
cyanosis depends most commonly upon constriction of the
orifices of the great vessels of the heart, preventing the venous
blood from escaping from the cava? by the routes of the heart.
Now, I aver that, no obstructions existing in the vessels of the
heart can be more complete than that depending upon a large
endo-cardial clot, or tam|)on ; and yet I venture to say that under
circumstances of such kind the victim perishes without mani-
festing the peculiar Hvor or cyanotic tinge which characterizes
the forms of the malady, that are connected with open foramen
ovale and imperfect action of Botalli's valve. It is my clear
conviction, that as long as the respiration can be carried on in
endo-cardial clot, the blood, however small in quantity that
reaches the lung passing along the superficies of the clot, is
highly charged with oxygen. While, therefore, oxygeniferous
blood continues to reach the brain, the patient, though conscious
of the want of oxygen in due quantity, is in a state different
from that of one who injects only carboniferous or venous
blood into the neurine of the encephalon.

My intention was to speak only of the white clot, the false
polypus, to show the probability of its being formed under cir-
cumstances of deliquium, in the oligaemia that follows uterine
hemorrhage ; and thereupon show how dutiful a thing it is on
the part of the attendant physician, to issue the clearest and
most precise orders as to the guidance of the hemorrhagic ac-
couchee. I believe that a w^oman who has lost a very great
quantity of blood, and who is prematurely taken out of her re-
cumbent decubitus, and placed upright upon the close-stool ;
whether in bed or not, incurs a most dangerous risk of a mis-
erable and premature death, from the sudden formation of a
heart-clot.

I am, gentlemen, your ob't servant,

Cjiarles D. Meigs.

On the Effects of different Winds on the Human Constitution.
By J. C. Atkinson, Esq., M. R. C. S., &c., of Westminster.
(London Lancet.)

My attention has been for many years turned towards ex-
tending the knowledge we already have of the iniluencc of the
winds in this country on health and disease. The subject
seems to have been hitherto considered either as destitute of

300 Effects of Winds on the Human Constitution. [May,

much interest, or as nor presenting any point of practical utili-
ty, for I cannot find myself indebted to any particular author
who has been the pioneer or forerunner in any investigations
on this matter.

It will be, perhaps, proper in a preliminary way to observe,
that our views in this country, of the operation of the winds,
are mostly domestic and proverbial. Who does not intuitively
repeat to himself the well-known couplet

" When the wind is in the east,
It's neither good for man nor beast ;"

and when he feels the sometimes keen influence of a dry
breeze ? What schoolboy does not recollect the story of a very
rheumatic pedagogue, who alwa3^s felt ill when the wind blew
from that quarter? The mischievous boys, well knowing his
infirmities, and his general severity of manner to them in the
schoolroom at such times

"Full well the boding tremblers learnt to trace
The day's disasters from the morning face"

determined to fix by a nail the vane of the weather-cock, which,
being opposite his bed-room window, he was in the morning
always in the habit of consulting, and this had the effect of mak-
ing him poor fellow ! remain in bed for one whole month.

With respect to the east wind " being neither good for man
nor beast" there is no absolute truth in the common saying,
which is purely an Eastern couplet, and hot applicable to this
country. The latter instance rather shows the power of the
imagination over the body, than its real action.

There are various winds, however, possessing peculiar and
distinct qualities. In southern Europe the sirocco, or south-
east wind, is extremely insalubrious. It sometimes blows for
several days together, to the great detriment of the whole veg-
etable and animal creation. The medium heat of this wind is
calculated at 112 Fahr. It is fatal to vegetation, and destruc-
tive to mankind, and especially to strangers. It suspends the
power of digestion ; so that those who venture to eat a heavy
supper while this wind prevails are commonly found dead in
their beds the next morning, of what is called an indigestion.
In Palermo, for instance, where its effects are strongly marked,
the inhabitants doctors included shut their doors and win-
dows, to exclude the air or wind. No one whose necessities
do not compel him to quit the house, is to be seen while
this tremendous wind continues to blow, and the streets and
avenues of the city appear to be nearly deserted. Immediate-
ly on the prevalence of the tramontane, or north wind, which
in a short time restores the exhausted powers of animal and
vegetable life, Nature assumes her former appearance.

1849.] Effects of Winds on the Human Constitution. 301

There is another equally pernicious wind, and of an extra-
ordinary blasting character, which is occasionally felt in the
Falkland Islands. Happily its duration is short, continuing to
blow only twenty-four hours. It cuts the herbage down ; the
leaves of the trees are parched up ; fowls are seized with cramps ;
men are opppressed with an interrupted perspiration, weight on
the chest, and sore-throat. It has always been supposed that
some mephitic vapour is generated during the prevalence of
the above winds, and which produce all the bad effects above
noticed in man and animals.

Before I proceed any further regarding the various winds
and their operations, destructive or otherwise, it is necessar}^ to
consider what winds are. The motions of the atmosphere are
subjected to the same laws as those of denser fluids. If we re-
move a portion of the water in a large reservoir, we see the
surrounding water flow in to restore the equilibrium if a por-
tion, being rarefied by heat, or condensed by cold, ascends or
descends, a counter-current in another part is the necessary and
visible result. It is thus in the atmosphere. The eminent
chemical philosopher, Dr. Priestly, ascertained that the atmos-
pheric air is, in reality, a compound, and may be artificially
produced by the union of oxygen and nitrogen gases. I admit
that an atmosphere may be produced in this manner, but I de-
ny that this is the constitution of the air as it is. The electrical
powers have not been observed ; for without them (the com-
ponents oxygen and nitrogen possessing different specific grav-
ities) hov/ can the mixture remain without disturbance and de-
rangement? The atmosphere, in chemical character, is pro-
nounced to be the same in valley as it is at the highest elevation
or latitude man has reached. Again, the difference between
air of one country and that of another, has never been noticed
as regards any of the components viz., oxygen and nitrogen,
and yet we find great differences as regards their operations on
living structures and beings. To what can we attribute the
variable influences of different winds, if not to something yet
undiscovered something which has wholly escaped observa-
tion ? The emission of latent heat, as well as solar heat and
electricity, gives rise to those changes distinct altogether from
the chemical nature of the atmosphere.

The difference of the weight of the atmosphere which our
bodies sustain at one time more than at another, is very consid-
erable. On the increase of the natural weight the weather is
bad, and people feel listless and inactive ; but, on the contrary,
when there is a diminution of the weight, the weather is com-
monly fine, and we feel ourselves what we call braced, and
more alert and active. Hence it is no wonder that persons

302 Hydropathy and its Evils. [Mav,

suffer very much in heat from changes m the atmosphere, es-
pecially when they take place very suddenly. Thus we all
know, that when the variations of the barometer and thermome-
ter are sudden and great, illness will inevitably prevail ; and
during some years this is more observed than in others.
Slow changes are never followed by any epidemic disorders :
the human body being naturally endowed with the power of
accommodating itself to his kind of change, no injurious conse-
quences ensue.

I will, in a future number, enter into the particular charac-
ter of other kinds of winds, and their good and bad effects, ad-
verting fully to the winds generally prevailing in this climate,
and their various influences on health and disease ; and I will
likewise point out, from my own experience of the uses of va-
rious philosophical apparatus, how far they are to be depended
upon in conveying accurate information.

Hydropathy and its Evils Report of a Case. By C. B. Gar-
rett, Esq., Surgeon, Thames Ditton. (Ibid.)

Five children, of a respectable family in my neighborhood,
were attacked last month with scarlatina ; all progressed well
till Friday, Nov. 3rd, when one, a boy, through incautious ex-
posure to wet and cold, was seized with inflammation, of the
meninges. I saw him shortly after its commencement, in the
evening, and adopted the proper therapeutic measures. The
pain and screams of the boy increased during the night, and at
the suggestion of an alarmed relative, who had been under this
treatment, the hydropathic doctor was sent for early on the
morning of the 4th. Wet sheets, towels, and bandages were
lavishly applied ; cold water lavements, cold water for food, and
(toujours perdrix I) nothing but cold water for food, drink, or
raiment.

On my arrival I met this gentleman : " Sir," said 1, " how do
you expect your treatment to. act?" " Derivatively," replied he ;
" cold water promotes absorption, attracts the morbid action to
the skin, and instantly relieves the brain. The wet rollers round
the loins act powerfully on the kidneys, and the lavements clear
out the bowels. Taking nothing but cold water starves out
the disease. Sir," continued he, " smash your bottles ; you will
adopt hydropathy in a week, and a splendid water-cure practice
you will make." " I wish you could get rid of a toothach for
me," said I, experiencing a twinge at that moment. " Sit with
your feet wrapped in cloths of cold water for half an hour, and
I will guarantee that you lose your toothach."

To proceed : my visits now ceasing to be professional, I con-

1849.] Fathological Changes in Mucous Injlamrnation. 303

tinned them occasionally, out of curiosity. On the evening of
the 4th, pain most acute ; epileptic attacks frecjuent ; ])ulse fee-
ble, &c. On the 5th, pains diminished ; pupils dilated ; pulse
slow and feeble ; coma, insensibility, and great prostration of
strength. The treatment went on till the morning of the 10th
when, on the visit of the learned hydropathist, he shook his head
and pronounced the boy in articulo mortis, put on his hat, and
left the house.

My attendance was again requested. I found the little pa-
tient in a positive pond of water and wet clothes, bed and all
soaked. He w^as perfectly unconscious of all around him,
moaning and crying " Ma ! ma ! ma !" unconscious of his moth-
er's presence ; the symptoms, previously enumerated being, if
possible, aggravated. The excretions were passed involuntari-
ly, and he had not even swallowed water for twenty-eight
hours ! pulse almost imperceptible, and in every respect all but
dead. A dry bed, dry clothes, warm milk-and-water, tonics,
&c., soon^revived him ; a genial warmth pervaded the system,
the pupils regained their natural calibre, consciousness return-
ed, and with it a serenity and happiness of countenance, which
too plainly evidenced the advantage of the change, and his
lucky escape from this amphibious incarceration. On the 11th,
he conversed cheerfully with those around him, took pleasure
in his toys, and ate with much gout a mutton-chop for his din-
ner. He is now quite recovered.

This, Sir, is a part of the tale only, for the other four child-
ren were all hydropathed. Two had congestion of the brain,
and the other two anasarca. The two former recovered, but
one of the latter (urine becoming albuminous, bilious vomiting
and purging) speedily died. The above circumstances I have
related to you with the most perfect sense of candour and impar-
tiality, entertaining as I do a deep respect for the opinions of
others, however erroneous : and I must say, that my hydropa-
thic friend acted throughout with much courtesy and unobtru-
siveness, and appeared to attend the case reluctantly, and as
though pressed against his inclination.

On the Pathological Changes in Mucous Infiammations. By
RuD. ViRCHow. (Amer. Journ. of Med. Sci.)

All inflammations are to be considered as alterations of the
nutritive process, by which the plasma of the blood is thown
out of the vessels in increased quantity. In inflammations of
mucous membranes, their anatomical relations cause the exu-
dation of this plasma upon a free surface. The plasma itself

304 Pathological Changes in Mucous Inflammation. [May,

may be unchanged in constitution, or its fibrine may be in-
creased in quantity. Ditierences in the constitution of the
plasma determine differences in the result ; and thus are estab-
lished three leading forms of mucous inflammation ;

1. The Catarrhal Form. In this the quantity of the blood-
plasma is increased, and thrown out on the free surface. The
cells (of epithelium) are formed in greater quantity than normal ;
but they do not reach their normal development, being replaced
constantly by an increased succession of new ones. The richer
the plasma, the more rapid is the self-dev^elopment. In the so
called chronic catarrh, there are frequently found in the fluid
cells quite perfectly developed, of the aspect of the ordinary
epithelium. In acute cases the cells do not reach this stage
of development ; they do not take on the epithelial forms char-
acteristic of the part, but are thrown oflJ'as round, more or less
spherical, mostly single-nucleated cells (mucous corpuscles). In
the very acute, particularly the blennorrhagic forms of inflam-
mation, almost all the cells are found in the earliesi stages of
development, smaller, more delicate, and containing often three
to five nuclei ; in short, possessing all the characters of the or-
dinary pus cell. All these forms may be considered as differ-
ent grades of the epithelium cell ; or, if the name epithelium be
dropped, as cells developed on the surface of a mucous mem-
brane, and whose only diff^erence is their different degree of de-
velopment.

2. The Croupous Form In this the plasma is not only in-
creased, but is also altered in constitution, containing a large
amount of fibrine, and coagulating more or less completely.
The coaguluni lies free on the surface of the membrane. This
form is most frequent in the respiratory mucous membrane.
The false membrane is either softened, friable (as in tracheal
croup), and contains many cells ; or it is of a more firm and
fibrinous character (as in bronchial croup and exudation into
the air-vessels, or true pneumonia), and contains the products
of rupture of the capillary vessels, red and colourless blood cor-
puscles. In pneumonia the stage of hepatization, where the
air-cells are filled with firm coagulated exudation, is generally
succeeded by that of purulent infiltration, in which cells in every
grade of development are formed in great abundance. In the
first stages these cells have various dem-ees of resemblance to
pus or epithelium ; in the stage of resolution of the pneumonia,
we find the air-cells full of granular cell and masses, or a fine-
ly granular emulsion, which are to be considered as the retro-
grade steps of the newly formed cells.

3. The Diphtheritic Form. In this the exudation consists
of nearly dry coagulated amorphous fibrine, and is infiltrated

1849.] Treatimmt of Worms iiL Cliihlrrn. 305

into the tissues composinf^ the superficial layer of the mucous
membrane, or ratlier of the submucous cellular tissue ; for when
it projects from the free surflice, it is jrenerally covered hv the
epithelial layer. Where organization proceeds in this kind of
exudation, it is generally very imperfect ; more commonly it is
entirely absent, and a superficial slough is formed. Hence this
form has been rightly considered as allied to a gangrenous form
of inflammation ; it is, in truth, closely allied to hospital gan-
grene. Archiv. fur Pathologische Anatomie, &c. Band. I.
Heft 2.

[We shall take another opportunity of adverting to these
opinions, as well as to other views enunciated in this able
journal. In the meantime, we may state that we agree in many
of the author's conclusions, although difiering from him in some
points ; as, for instance, in regard to the constitution of the blood
plasma, which we believe to be least altered where the fibrine
is in greatest quantity, as in the croupous and diptheritic forms;
and mo.9^ altered where, as in the catarrhal forms, the inflamma-
tory phenomena are but a slight alteration of the ordinary
secreting process. We believe that the membrane, in its
healthy state, possesses a power of selecting from the blood
plasma a new product mucus ; that in disease the nature of
this product is changed, and assimilated more and more to the
plasma of the blood; in other words, that while the vessels ac-
quirean increased power of pouring out the elements of the
blood plasma, the power of the membrane to alter and select
from these elements is diminished. [Monthly Journal and
Retrospect of Medical Sciences.

On the Treatment of Worms in Children. By Dr. C. West.
(Medical Gazette, in Braithwaite.)

[The symptoms said to indicate the presence of worms, are
most of them, Dr. West remarks, of small value ; and nothing
short of seeing the worms can be regarded as affording con-
clusive evidence of their existence. When, however, the
symptoms usually entunerated continue with varying severity
for several weeks together, w^e have reasonal)le ground for sus-
pecting the presence of worms, and as Dr. West observes :]

.Fortunately the treatment which the general symptoms would
lead us to adopt will be in a great measure such as, if worms
exist, will prove most efficacious in producing their expulsion.
The capricious appetite will induce us to regulate the diet with
care ; the disordered and generally constipated state of the
bowels will lead to the employment of alteratives, and to the
occasional administration o^ brisk cathartics ; while the absence

N. J^. vol.. V. NO. V. 20

30G Treatment of Worms in Children. L^^^ay,

of febrile symptoms will probably seem to warrant the employ-
ment of some of the preparations of iron. These remedies
will in many instances not have been continued long before the
appearance of worms in the motions encourages us to persevere
in the same treatment. The combination of ferruginous pre-
parations with active purgatives, is a plan especially effective
in cases where the lumbricoid entozoa are present, and is
likewise of much service in getting rid of the ascarides which
inhabit the rectum, and in preventing their production. The
latter worms, however, need to be assailed in their habitation ;
and, from the circumstance of their living in the lower end of
the rectum, this is a sufficiently easy task. Enemata of lime-
water usually answer the purpose of destroying them ; but,
should they fail, the addition of some two drachms of the
muriated tincture of iron to the clyster is tolerably sure to make
it effective. In young children these ascarides sometimes not
merely occasion much itching and distressing irritation about
the anus, but even produce a troublesome diarrhoea, attended
with considerable tenesmus. Under such circumstances, the
lime-water injection should be administered daily for two or
three days together; while, at the same time, small doses of the
castor oil mixture every six or eight hours will soothe the
irritation of the bowels. In female children these ascarides
sometimes creep up the vulva, and not merely cause much
irritation there, but sometimes excite a leucorrhoeal discharge,
which ceases on the expulsion of the worms.

The alarming symptoms of cerebral disturbance which have
sometimes been produced by worms in the intestinal canal,
have resulted more frequently from the presence of the round
worm than of other varieties of these entozoa. This, however,
is not always the case ; and in the only instance that has come
under my observation, in which the occurrence of convulsions
seemed clearly traceable to the presence of worms in the
intestines, the small thread-worms were the cause of the
symptoms. Apart from the knowledge which we have in
many of these cases, that the child had previously been afflicted
with worms, there is nothing in the symptoms which could
enable us at once to distinguish between convulsions from this
cause and those which result from some other source of irrita-
tion of the nervous system. In most instances, however, the
child has passed worms frequently before the cerebral symp-
toms made their appearance, and not improbably was under
treatment for the destruction of these parasites at the time
when the nervous symptoms supervened. Even though this
be not the case, the constipated state of the bowels which is
almost sure to have preceded the occurrence of the convulsions,

1849.] Gun-shut Wound. 307

indicates the employment of active purgatives remedies which
in most instances remove together these symptoms and their
cause, although convulsions apparently induced by the presence
of worms have sometimes had a fatal termination.

The taenia is, as was stated, much less common in childhood
than after puberty ; and in the few cases in which I have met
with it during early life, I have been reluctant to try that heroic
remedy, turpentine and castor oil, which is so serviceable in
procuring the expulsion of tape worms in the adult. I have
been accustomed to employ the decoction of the bark of the
pomegranate root in ij. doses three times a day to a child of
seven years old, interrupting its administration twice in the
week, in order to give a purgative of scammony and calomel.
Under this plan, pursued for several weeks together, large
quantities of the worm have been voided, and the children
have appeared entirely freed from this very troublesome
parasite. I have not yet made trial of the administration of a
dose of the decoction or powder of the pomegranate bark every
hour for four or five successive hours, as recommended by Mr.
Breton,* who brought the remedy into notice in this country.
I purpose, liowever, making a trial of this method on the next
occasion that may offer, since the effects of the remedy, when
thus administered, appear to be surer, as well as more speedy,
than when it is given at long intervals.

Gun-Shot Wound Ball in the Hip Thirteen Months. By G.
Kimball, M. D., Prof of Surgery in the Berkshire Medical
Institution, Mass. (Boston Med. and Surg. Jour.)

George Church, a soldier of the Massachusetts Regiment
during the late campaign in Mexico, was shot down in the
battle of Molino del Key, on the 28th of September, 1847. He
was taken into Hospital the evening of the same day, and fell
under the charge of one of the chief surgeons, Dr. Satterlee.
It was found, upon examination, that a wound had been
received in the hip that a musket ball had entered just ante-
rior to the great trochanter, and made its way, apparently
upwards and forward, towards the anterior superior spinous
process of the ileum. Attempts were immediately made to
extract it, but they were unsuccessful. The wound healed
very slowly, and it was not till nearly the .end of five months
that he was able to leave the hospital. He then returned home
to Massachusetts, and gradually became so far restored as to
be able to engage moderately in the common duties of farm-

McLlico-Chiiurgical Transactions, vol. xi., p. 301.

308 Gun-shot Wound. [May,

ing. In the course of a few months a/ter this, some 10 months
from the date of the wound, he was seized with a violent
paroxysm of epilepsy. Three weeks after, he was seized with
another, still more violent ; and thus they continued returning
at intervals of every two or three weeks, till the latter part
of October, 1848, when, at the suggestion of Dr. Guiteau, of
Lee, his attending physician, he came to Pittsfield for the
benefit of a surgical consultation. The result of this consulta-
tion, was an unanimous conclusion that the epilepsy had been
induced by the wound in the hip that a ball or some other
foreign body, lodged there at the time the wound was received,
was implicating some important nerve and an operation, with
the view of its dislodgment, afforded the most reasonable
chance of relief. This operation, however, was not pressed
with much earnestness. The efforts of the army surgeon, to
the same end, had proved abortive in the first instance; and
the present circumstances of the case, certainly gave no very
flattering assurance that a second attempt would be more suc-
cessful. However, the proposition was readily embraced by
the patient, and the operation accordingly performed on the
28th of October.

A fistulous opening, sufficient to admit a common-sized
probe, indicated the original course of the wound, to the extent
of some three inches, and in a direction as before stated, to-
wards the anterior superior spinous process of the ileum. As
a most critical examination of the part, had hitherto afforded
no idea of even the probable location of the ball, it was
thought best to endeavor to reach it by tracing, if possible, this
fistula through its entire course. A grooved probe was accord-
ingly introduced, and pushed forward till it came in contact
with the surface of the ileum. Upon this, a straight bistoury
was introduced to the same extent, and the fistula, thus far,
laid freely open. Its further continuation and direction were
now detected, though with difficulty, from its course having
been so entirely changed. A long probe being introduced into
this new branch of the fistula, it was made to pass some 8
inches backwards and downwards, making its way along the
surface of the bone, just under the crest of the ileum, till it
reached the ischiatic notch, when it fell directly upon the ball,
which was situated, it would seem, very near to, if not in con-
tact with the sciatic nerve. An attemipt was now made to
bring into service, the ball forceps, but the length, the narrow-
ness and unyielding callous walls of the fistula, rendered them
quite useless. It seemed necessary, therefore, to lay open this
passage still further, and it was accordingly done to the extent
of some 5 inches. Again the forceps were introduced, the ball

1849.] Monthly Periscope. 309

readily laid hoW of, and a good deal of force applied ; still it re-
fused to yield. ' A bistoury was now passed into the bottom of
the fistula, and the callous tissue immediately embracing the
ball, carefully divided at several points, so that upon a third
application of the forceps, it was brought away with compara-
tively little force.

This operation, undertaken with a good deal of reluctjince,
and, in view of the circumstances of the case, with serious
misgivings as to its success, has been most satisfactory and
gratifying in its results. From the day it was performed to the
present time, there has been no return of epilepsy; and the
patient's liealth, which has previously been most seriously im-
paired, has now become so far restored as to make it safe to
pronounce him perfectly well.

PART III.
ill 0 u 1 1) 1 2 P i: r i 0 c 0 p e

Extraction of a glass gohlet from the Rectum. Case reported by
W. S. W. RuscHENBERGER, M. D., U. S. Navj, Fleet Surgeon for
the East India Squadron. While recently on a visit to Canton, I de-
rived the history of the following case from the notes and verbal
explanations of the Rev. Peter Parker, M. D., Chief of the " Ophthal-
mic Hospital," &., under whose notice it fell. The case seems to
be so unusual, that I avail myself of Dr. Parker's consent, and sub-
mit it for publication. The first case affords us a glance at the
debauchery practiced by a portion of the Chinese population about
Canton.

On the records of the hospital, the case numbers 23,930. Glass
goblet extracted from the Rectum. In the evening of the 1st inarch,
1848, a young man, very respectable in appearance, solicited Dr.
Parker's aid tor his father, whom he had brought to the hospital.
With many expressions, indicative of his sense of shame and morti-
fication, he related that Loo, his father, then sixty years of age, had
spent the preceding night in one of the " flower boats," or floating
brothels on the river, with a prostitute. Under the insane excitement
or intoxication produced by the combined influence of drinking
spirituous liquors, and smoking opium, the lecherous suflerer, in mis-
chievous frolic, forced a glass goblet, of the form and size indicated in
the accompaning diagram, into the vagina of the companion of his
sports. In the course of the night, Loo fell into a state of uncon-
sciousness, when the woman sought her revenge. She carefully
insinuated the base of the goblet within his anus, and then placing the
end of her opium-pipe a cylinder about an inch in diameter, and a
foot and a half in length at the bottom of the goblet on the inside,
suddenly pushed it into the rectum, entirely above the sphincter.

310 Monthly Periscope. [May,

Twenty-four hours had elapsed since its introducti^jn. An angle of
about a half inch of the rolled lip of the glass had been broken out by
efforts made by friends to remove it.

Such \\'is the report of the case when brought to the hospital for
relief.

On examination, the glass was found firmly fixed in its position ; it
was very difficult to pass the extremity of the finger beyond its lip,
betwixt its outside and the rectum. In Dr. Parker's opinion, it was
impossible to extract it entire; and, therefore, though anticipating
difficulty and danger in the operation, he determined to break it down.
By means of forceps, such as used by obstetricians in breaking up
the foetal cranium, commencing on the side nearest the pubis, he broke
up the goblet and extracted it piece by piece, carefully guarding the
parts by folds of cotton cloth as he proceeded, and removing the small
sharp fragments which fell, with a teaspoon. After the bowl, or bell
portion was removed, the most difTicult part of the operation remained
to be performed, for the hemorrhage was free, and the base of the
goblet, with the sharp points of the sessile stem, resulting from the
fracture, was high up in the rectum, and firmly embraced in a
transverse position. Assisted by the bearing-down of the patient,
the edge of the base was reached by the point of a finger, and with
difficulty turned edgewise, guarding against fractured points by
pledgets ; then, by pressing the smooth side, or bottom of the glass
against the rectum, it was at last extracted. Remaining fragments
were sought for, and the intestine thoroughly washed out. To arrest
the hemorrhage, which was considerable, strong solutions of sulphate
of copper, and of alum, were injected, and temporarily confined in the
rectum, by pressing a sponge against the anus. For a time the
bleeding ceased ; but during the night, several ounces of coagulated
blood were evacuated ; afterwards, there was no more hemorrhage.

The operation occupied an hour and a half. An opiate was ad-
ministered, and the patient placed in bed. The general treatment
consisted in rest, laxatives, and light diet ; the rectum was occasion-
ally injected with tepid water, and solutions of nitrate of silver.

On the fourteenth day the case was discharged, cured.*

[American J ourn. of the Med. Sciences.

Quinine in Cholera. Dr. Little says, (London Med. Gaz., Dec.
15th, 1848,) from all he has witnessed of malignant cholera, he is im-
pressed with the belief that, it is more nearly allied to febres than to
any other nosological class, and, consequently, he considers, that
quinine administered })efore the supervention of decided collapse in
the large doses recjuired to arrest malignant intermittents, say in doses
of half a drachm and upwards, deserves a trial. [Ibid.

Employment of Nux Vomica in the Diarrhcca of Exhaustion. Dr.
Nevins mentioned, at the meeting of the Liverpool Medical and

This patient should liave been made insensible, nnd the tumbler turned by
means of the hand introduced into the rectum. [/vV. 6\ M. (f- .S. Jovrn.

1849.] Munthly Pcriscupe. 311

Pathological Society, the benefit derived from the employment of nux
vomica in the treatment of the diarrlioea from exhau.stion, chiefly ob-
served in pauper patients, and especially children. In these cases he
had repeatedly found no benefit irom astringents and ordinary tonics,
but the i)atients had rapidly improved under the use of the l()llowing
prescription : 'Vlcoholic extract of nux vomica (not ofiicinal, but ])re-
parcd by most wholesale druggists), gr. ss ; rhubarb, gr. ss; sacchara-
ted carbonate of Iron, gr. j ; blue pill, gr. ss; opium, gr. ^, made
into a pill, and taken three times daily. In many cases he omitted the
opium. altogether.

He attributed the benefit to the influence of the nux vomica, which
by stimulating the nervous energy of the bowels, enabled the lactcals
to absorb the nutriment from the food, and the large intestines to re-
tain the faeces ; whilst, at the same time, the iron acted as a permanent
tonic ; and the very small doses of rhubarb and blue pill improved the
character of the secretions, without acting as an aperient. Improve-
ment was generally perceptible in a ^aw days, and he seldom had
occasion to continue the prescription more than a fortnight.

Mr. Taylor, of the Liverpool workhouse, confirmed this account
from his experience of many cases in the same class of patients in
whom he had tried it, on Dr. Nevin's recommendation. [London
Medical Gazette.

Lemon Juice in Rheumatic Gout. Dr. Owen Rees narrates the
case of a girl, aged 18, suffering from rheumatic gout in all her joints,
who was treated successfully by lemon juice, in the dose of half an
ounce three times a day. In his remarks on the case, he states that
he has in many other cases seen marked and rapid relief from the
same plan! He first had recourse to lemon juice from a belief that
vegetable acids, from the large quantity of oxygen they contain, con-
tribute to effect the transformation of the tissues generally, and
moreover, from the idea that the supercitrate contained in the juice,
by its transformation contributed to the alkalinity of the blood.

[Medical Gazette,

Nutritive Properties of Bran. M. Millon has communicated to
the Academy of Sciences the result of some interesting investigations
of his concerning the ligneous matter of wheat, whence it would ap-
pear that bran is a very nutritive substance. Though bran doubtless
contains from five to six per cent, more ligneous substance than flour,
it presents more nitrogenous matter, twice as much fatty matter, and
moreover two distinct aromatic principles, one of which possesses the
fragrance of honey; and these are both wanting in flour. Thus, by
sifting this wheat impoverished in nitrogenous matter, fat, fecula,
aromatic, and sapid principles, in order to free it from a small propor-
tion of ligneous substance. M. Millon, therefore, thinks that bran
and meal ought to be ground over again and mixed with the pure flour,
and he has found, by repeated experiments, that this mixture yields
a superior kind of bread, and free from the inconveniences of that

312

Monthly Periscope.

[May,

bread which, in some countries, and particularly in Belgium, is made
with coarse meal. [Lancet.

Distinction between Syi)liiliiic and Scrofulous Affections of Bone*
By M. RicoRD.

Syphilitic Affections of Bone.

1. Very rare with young people.

2. Syphilitic precedents.

3. Compact texture of bones at-
tacked.

4. Superficial part of the bone.

5. Little tendency to hyperosto-
sis.

6. The pains which precede the
development of the affection in-
crease, and become very intense,
until they decrease again, and
entirely disappear in the latter
periods of the disease.

7. A tendency to circumscrip-
tion.

8. Exostosis.

9. Tendency to ossification and
eburnation, but very little suppu-
ration.

10. A chain of syphilitic symp-
toms, either concomitant or ante-
cedent.

11. Rapid cure under appropri-
ate treatment.

Scrofulous Affections of Bone.

1. Very frequent in youth.

2. Scrofulous precedents.

3. Spongy or cancellated texture
of bones attacked.

4. Deep parts of the bone.

5. Much tendency to hyperosto.
sis.

6. The tumefaction precedes the
pain, but the latter soon increases,
and becomes more and more in-
tense as the disease advances.

7. A tendency to diffusion.

8. Hyperostosis.

9. Tendency to softening, to sup-
puration, caries, and necrosis, and
not to ossification.

10. A chain of scrofulous symp-
toms widely differing from those
of syphilis, either concomitant, or
antecedent.

1 1 . Very difficult cure, often in-
complete, and sometimes impossi-
ble.

Syphilis may, however, be superadded to scrofula ; we must then,
in combating any lesion, endeavor to find out to which of the two
diatheses it is mostly owing, and select our therapeutic means accord-
ingly. [Ibid.

Collodion in Burns. Dr. Payne, dentist, Montreal, appears to have
suggested the use of collodion in burns,* and Dr. Crawford, of the
same city, employed it in the case of a young gentleman who met
with a severe burn of the face and hands. The burn thus treated
was covered with a thin glazing, or varnish, which completely ex-
cluded the air. The pain almost instantly subsided, and if the exclu-
sion ofairbethc chief desideratum in such cases, this remarkable
fluid will more conveniently and effectually produce it than any other
remedy. Its utility in burns has been confirmed by other practition-
ers. [Ranking\s Abstract.

* The British American Journal, Aug. 1818.

1849.] Monthly Periscope. 31^

Anaslhesia from the local AppUcatlon of Chloroform. Mr. Iliggin-
son communicated to the Liverpool Medical and Pathol oirical Society,
the case of a lady, aged 25 years, in labour with her lirst child : the
perineum had long been on the stretch by the head, wliich was
tumefied by the pressure : the pain was great with each uterine
contraction, but was referred entirely to the perineum, no pain being
apparently felt from the uterine contraction itself.

About half a drachm of chloroform was poured ujx)n a handkerchief
in the ordinary manner, but instead of being applied to the mouth, it
was held in almost immediate contact with the perineum. The pain
immediately ceased, though the uterine contractions continued in full
force ; and the lirst intimation the patient had of the progress of the
labour, was hearing the child cry. Her mind was not at all affected,
nor was intellectual consciousness in any degree diminished.

He had observed the same thing, though in a less degree, when the
chloroform had been applied to the sacrum in another case.

He had also applied this agent to the os uteri of a patient suffering
from very severe dysmenorrhoea, by means .of a sponge placed in a
curved glass speculum, which was introduced into the vagina. The
pain almost immediately abated, and on its return, after some hours,
the patient re-applied it hei^elf with similiar benefit.

Dr. Watson mentioned some cases confirmatory of its good effects
when locally applied. He had painted it over a swelled testicle, with
speedy relief to tlie pain, and had applied it along the course of the
spine with a similar result in a case of acute spinal tenderness, which
Iiad not been relieved by other treatment." He had also applied it to
the surface of a large mammary abscess prior to opening it, which was
afterwards done without suffering to the patient ; and also to the vulva
of a woman before cauterizing the orifice of the urethra. It had re-
lieved the cramp and collapse in a case of English cholera, when laid
upon the epigastrium, and had abated the pain almost immediately
Avhen painted round the edge of a surface to which potassa fusa had
been applied for the purpose of forming an issue. \Lond. Med. Gaz.

A new mode of removing Ncpvi. J. C.Christophers describes (iwi-
don Med. Gaz., Dec. 1848) a method of applying a simple ligature to
strangulate and remove na^vi, which, he says, he has employed in six
cases, and in all with perfect success, and without any untoward acci-
dent occurring. His method is as follows:

1st stage. Take a piece of strong silk, well waxed, about half a
yard long, and dip the moiety of it in ink to dye it, the more readily to
distinguish the ends after it is divided ; thread a needle with the same,
leaving the ends equal, and pass it under the centre of the part to be
removed. This done, cut the ligature in the middle, leaving the
needle attached to the inferior or black half of the ligature ; take the
same and pass it through the skin, immediately below the part to be
strangulated. Thread the needle with the superior or white half of
tlie ligature, and pass it through the skin in an opposite direction to
the black ligature, immediately above the part to be strangulated.
Ivemovc the needle.

314 Monthly Periscope. [May,

2d stage. Tie tightly the two ends of the black loop that includes
the inferior half of the nsevus. Tie in the same manner the two ends
of the white loop that includes the superior half of the naevus. The
four ends remaining, two black and two white, are now to be tied
nlternately and tightly, the one to the other, and the operation is com-
pleted. The whole mass to be removed is by this means completely
and entirely enclosed in a double circle, both from within and without,
and is most effectually and permanently strangulated. The pain, he
says, of this operation is trifling. [^Amer. Journ. of Med. Sci.

Lateral Transjixture of the Chest hy a Scythe Blade, followed hy
complete recovery. By E. Q. Sewell, M. D. The subject of this
extraordinary case was a youth 18 years of age, who had been mow-
ing, and had taken the scythe oft' the handle, and was carrying it home
to have it sharpened. Whilst walking, he happened to step on a log,
"when his foot slipped, and he fell on the scythe blade, the point of
which entered under the right axilla, between the third and fourth
ribs, passed horizontally through the chest, and came out through the
corresponding ribs of the opposite side, making a small opening. The
wound on the right side was about two and a half to three inches long,
that on the left, about one inch. The poor lad lay still, until his bro-
ther, who was with him, with admirable presence of mind, drew the
scythe slowly out, observing with much caution as he did so, the cur-
vature of the blade. The effusion of blood was not excessive, and the
patient walked home with his brQj;her's assistance. There was, it is
said, no spitting of blood. The patient entirely recovered. [British
American Journal, and Ihid.

On the external use of Iodine in Croup. Dr. Willige speaks of
having had remarkable success in the treatment of urgent cases of
croup by the external application of iodine to the larynx and trachea.
He recommends that tincture of iodine should be smeared with a fea-
ther over the front part of the neck, corresponding to the larynx and
trachea and their immediate neighborhood ; and that this should be
repeated several times, witli intervals of about four hours, until red-
ness and irritation of the skin is induced. In most cases this is fol-
lowed by subsidence of the distress of breathing, of the spasms of the
glottis, and of the other bad symptoms. He mentions the particulars
of three cases in which, by this means, he succeeded in averting im-
pending death. [London Med. Gaz., from Schmidt's Jahrhucher,

The advantages of Chloride of Gold as a Caustic. By M. Cn avan-
NES. MM. Recamier and Legrand signalized the advantages of the
chloride of gold as a caustic many years ago and our author confirms
their statements from observations made chiefly in the treatment of
lupus and syphilitic tubercles and ulcers. M. Chavannes maintains
that llio chloride of gold destroys hvss than the other caustics, and^
when the crust separates, cicatrization is found in a forward state of
advancement. Tlie cicatrix which remains after the use of this chlor-

1649.] Munthly Fcriscope. 315

ide, is said to be less marked than when other caustics are employed.
It is prepared thus: gold leaf one part, hydrochloric acid three parts,
nitric acid one part. [Montlily lictros,, from Gaz. Mtd. de Farts.

Fracture of the Fenis. A young man, native of Canton, applied to
Dr. Parker Ibr relief. He had been married about eight months. On
the nuptial night, he met with insurmountable ditliculty in his attempt
to establish sexual intercourse with his bride, and in an eflbrt, on that
occasion, sustained a severe, and most probably, irreparable injury,
which caused great pain. Since that night, erection of the penis is
limited to about half an inch of its root, the extremity of the organ,
with its glans, hanging flaccid.

On examination, a well-defined, transverse space, through the cor-
pora cavernosa, about a half inch from the pubis, the site of fracture,
was found to separate the j)enis into two parts.

No attempt was made to remedy this serious misfortune. '[^Ameri-
can Journ. of Med. Science.

Rupture of the Femoral Artery. Dr. S. Parkman exhibited the
artery, torn at the point of its passage through the adductor magnus
tendon ; a cart loaded with coal had passed over the lower third of the
thigh ; there was no external wound or abrasion of the skin ; but the
sudden ecchymosis, and the cessation of pulsation below the knee ren-
dered the nature of the accident perfectly clear. The integuments
w^re rendered very tense by the eflusion of blood through the whole
thigh. The limb was amputated above the injury. Besides the arte-
ry, the gracilis, sartorius and semi-tendinosus muscles were com-
pletely ruptured, and the eflusion of blood very considerable. The
bone was injured. [Ihid.

On the action of Froio-suTphate of Iron in the treatment of CJiancre,
Gonorrhoea, ^c. The whole class of caustic agents, when applied to
the Huntcrian chancre, (though the potassafusa cum calce be used,
till the ulcer be " punched out," as recommended by M. Ricord,) form
an eschar with pus still secreting ; in fact, the morbid cells have not
been destroyed. The alkaloids and hydro-carbons are equally inefTi-
cacious.

If a chancre be perfectly freed from its eschar and the enclosed pus,
at the bottom of the excavation may be observed minute white points
or germs, secreting, slowly, the morbid virus. If, now, the proto-
sulphate of iron, minutely pulverized, be dropped into this excavation,
the parts will instantly assume a charred appearance, the metal is
absorbed into the tissue, the morbid cells or germs will instantly cease
to secrete pus, the cleared cavity will shortly granulate, and a smooth
surface, without induration, will be the result of the 'use of the proto-
sulphate of iron. Tlie chancre is destroyed.

It is known to chemists, that the proto-sulphatc of iron absorbs
large volumes of oxygen and nitrous oxide gases.

The proto-sulphate of iron. I have observed to be the most power-

316 Monthly Periscope. [May,

ful agent for arresting decomposition in animal and vegetable sub-
stances. Inflannnation and decomposition in tlie living tissue is like-
wise arrested by it.

In gonorrhoea, we have now an agent arresting the morbid cellular
action in the salts which should be used in solution super- saturated.

In leucorrhoea, and in simple ulcers, the morbid action is arrested
or peroxidized by this metallic salt.

Large doses ot" this salt have been exhibited in obstinate diarrhoea,
with great benefit.

The action of this salt will produce a great change in superseding
mercury in the treatment of diseases of specific origin. [Med. Exam,

Tetanus. Dr. Wilson is on these grounds inclined to refer the
disease to augmented excitability of the true spinal system, of a purely
functional character, and makes known in the following propositions,
wuth which the memoir concludes.

1st. That tetanus depends on irritation, direct or indirect, of the
excito-motory system, by which it becomes surcharged with motor
influence, and that inflammation in or about the cord, or any appreciable
lesion, is not an essential condition of tlie development of the disease.

2d. That while we have ample evidence, physiological and practi-
cal, that opium is ill calculated to fulfil the indication in tetanus,
namely, to diminish the excitability of the true spinal cord, until our
views become improved, and the knowledge of our anti-tetanic agent
ceases to be a desideratum, we are not justified in altogether
discarding the use of the drug.

3d. That our grand object in the treatment of tetanus should be to
support the patient's strength, with a view to compensate the vital
powers for their great exhaustion, consequent upon the expenditure of
force in the violent muscular contractions.

4th. That as the removal of the exciting cause, once that the first
evidence of irritation propagated to the spinal cord becomes manifest,
does not, in the least degree, check the progress of tetanus, or abate
the violence of its symptoms, all operations in traumatic cases are
not only unnecessary but injurious. [Buhlin Quar. Jl. of Med. Sci.

Collodion and Ashesiosfor Toothache. Mr. Robinson, a distinguish-
ed dentist of London, says that he has frequently applied collodion
in severe cases of toothache arising from exposure of the nerve. The
method he adopts, is to make the patient first wash out his mouth in
warm water, in wliich a few grains of bicarbonate ofsoda has been dis-
solved. He then removes from the cavity any foreign substance likely
to cause irritation. After drying the cavity, he drops from a point, the
collodion, to which has been added a few grains of morphia; after which,
he fills the cavity with asbestos, and saturates with collodion. Lastly,
over tliis he places a pledget of bibulous paper. In a few seconds the
whole becomes solidified and forms an excellent non-conductor of heat
and cold to the exposed nerve. Hy occasionally renewing this, he has
been enabled toclll'Ct a more durable stopping than with gold. [Med.
Times.

1849. J Medical lutclUgcncc. IHH

MEDICAL INTELLIGENCE.

A Disserlafion mi the Practice of Medicine. Containiv!^ an nccmiut of Uic causes,
symploms, and Ircabncnt of Diseases: and adapted to the use of Phi/siciaiis and
FaviUies. By Tomlinson Four, M. D, pp. 710. Milleclgeville, CJa. Printed
at the Federal Union OIGce. I&ID.

It was our pleasing duty to herald in advance the forthcoming of the work,
the title of which is given above. From the proof-sheets confided to us by the
author, we selected the article on the sources of bilious Remittent Fever, which
we were gratified to see le-published, or noticed, in several of the Medical Jour-
nals of our country. Time has not permitted us to review the book of Dr. Fort:
that, we are promised, will be done by another and abler pen; all that
remains for us, in this second notice of it, is to say that it meets our highest
expectations.

The work is dedicated to the Physicians of the State of Georgia, as the author
states, as a grateful acknowledgment of the kindness, respect and confidence,
which he has experienced at the hands of every one of them, with whom he had
the honor of becoming acquainted; and to show that he had a great reliance in
their ready acquiescence in this attempt, to give to the science of Medicine, a
wider range in the mental operations of the age.

The typographical execution of this volume is peculiarly accurate ; the bind-
ing is very neat and good ; and it is altogether well gotten up, for a State where
very few books are published. From the title page it will be perceived that the
work is not strictly a scientific one, or one designed alone tor physicians, but
that its range is far wider, being adapted to families and the general reader.
We learn there is every prospect of the author reaping a rich return for the la-
bor bestowed upon ^is book.

Proceedings of the Stale Medical Convention^ held in Macon, March, 1849; and
Comtitution of tlve Medical Society of the State of Georgia. Macon : Printed
by S. Rose &Co. 1849.

We have been furnished a very neat pamphlet of 39 pages containing the
above proceedings. To the action of the Physicians assembled at Macon last
March, is appended, the Introduction as also the code of Medical Ethics adopted
by the American Medical Association. This we consider very wise on the
part of the publishing committee, and doubt not the dissemination of this excel-
lent manuel of the duties of Physicians to their Patients and of the obligations
of Patients to their Physicians, v.'ill do much good at this period of medical
improvement. It ought to be known and faithfully carried out by every mem-
ber of the healing art.

In the proceedings of the Medical Society of Georgia, and not published in
our last No., we notice a resolution adopted by it respecting this Journal. It is
as follows: 'Resolved, That we have the utmost confidence in the integrity and
faithful ability with which the Southern Medical and Surgical Journal is con-
ducted, and most cheerfully recommend it to the patronage of the medical pro-
fession.' We return our sincere thanks to all those who kindly voted for it, and
express the hope to sec the Journal, in other and abler hands, become the medi-
um of professional intercourse and medical intelligence in this and the adjoining
States.

318 Medical Intelligence. [May,

Opinions of the Medical Press, on ike subject of the discontinuance of this Journal.
The editorial courtesy with which we have always been treated, with scarce
an exception, ever since we assumed the management of this publication, has
placed us under great and repeated obligations. But the very kind and flatter-
ing manner in which the announcement of our withdrawal from the duties of
Editor has been noticed in some of our exchanges, has called forth our warmest
sympathies and heart-felt gratitude.

We are happy to state that Mr, McCafTerty, the publisher of the Journal, is
not only willing, but anxious to continue the work, upon the same terms as
heretofore issued ; but the editor, from severe domestic affliction, still continuing
unabated and without now a hope of relief; from heavily increasing professional
labour, &x:., still considers it his duty to retire after the completion of the pre-
sent Volume, at the close of the year. Arrangements will be made for carry-
ing on this Journal,

"We copy the following from the Buffalo Medical Journal :
* * * " The able editor of the Southern Medical and Surgical Journal,
Professor Paul F, Eve, has given notice that the Journal will be discontinued
after the present year, owing to want of adequate patronage. He states that
the privilege of laboring for his readers during the past year,* has required
from his own pocket an outlay of S^OO, and he very reasonably concludes that
tlie luxury of serving the medical public on these terms is loo expensive to be
longer indulged. That a periodical of such merit as the Southern Medical and
Surgical Journal should require more than the gratuitous services of the editor
to secure ample support, is a stigma upon our southern brethren which we sin-
cerely hope they will not consent to bear. We anticipate that the effect of the
notice referred to, will be to secure a list q{ paying subscribers, that will not only
justify the continuance of the work, but furnish a complimentary testimonial
to the value of the editor's past labors."

" We cordially adopt these sentiments. We hope and believe better things
of the phy.^icians of the South, than that they will suffer a journal so faithfully
edited as that of which Professor Eve has had charge, to fail for want of pecu-
niary support." [ Western Journal of Medici7ic and Surgery.

" So-iUhcrn Medical and Surgical Journal. This excellent periodical, we learn
from the last number, will probably be discontinued, after the close of the pre-
sent volume, lor want of adequate support. It has been conducted, under the
auspices of Prof. Eve, with great ability, and untiring industry, and we call
upon the profession of the South to rally to its support," [A'c?/; Orleans Medi-
cal aiul Surg. Journal.

" Southern Medical and Surgical Journal. We learned vvilh much regret and
no little surprise, that this Journal, which is certainly an honor to the south, is
likely to die for want of patronage. The able Editor informs us that its publi-
cation for the last year, aside from his editorial labors, was attended by an
expense of S900, to himself. With all due respect to our southern brethren, we
do say that this is a shame. We feel almost a personal interest in the matter,
for if we cherish one desire more than another, it is to see our profession eleva-
ted and improved. We know that well conducted Medical Journals are an
important, nay an indispensable means, to this end, and we hope to see them
established and sustained wherever there is room for them. Foreign and dis-
tant Journals are important, but every physician ought in duty bound, to support
first with his patronage and so far as he can, his pen, those published near his
own locality. We sincerely hope that the Editor's plain statement of facts will
be so effectual, that his Journal will hcrealter add as much to his purse as it
already has to his reputation. With that we are sure he would have abundant
cause t.o be satisfied. "[OA/Vj Medical a?id Surg. Jmunnl.

^(Corrcclion.) The last volume of the fyrmcr series. Ed. S- M. ^- S. Jwrn.

1849.] Medical Inldligencc. 319

MEDICAL MISCELLANY.

Essays on Infant Thcro'pmlir^. Prof. John B. Beck, of New York, has had
his valuable papers recently published in the medical journals throughout our
country, issued in pamphlet form, entitled, "Essays on Infant Therapeutics,"
&c., and has had the kindness to send us a copy.

Dr. Cross' P-rcscription for Clwlcra. Gum Opium, gr. \ ; Cayenne Pepper,
gr. ii.; Calomel, gr. iv. Made into pill. Give one every two hours, (varying
according to circumstances.)

To rcviovc Stains of Silver. Dr. Parsons, of Bristol, England, proposes to re-
move stains of nitrate of silver by a solution of corrosive sublimate in muriate
(hydrochlorate) of ammonia.

Iodide of Potash in Paraplci^ia. Dr. Sandras, in the Bulletin General de
Therapeutic, recommends the use of Iodide of Potash in certain ca.scs of Para-
plegia.

Dean of the FaciiUy of Paris. Prof, Berard has suceeeeed the deposition of
Prof. Bouillaud. The "former Dean, the celebrated Orfila, was displaced from
office because he had appropriated money designed for another object; and
Bouillaud was made to resign becau.se of his bitter hostility to his predecessor.
Berard, is Professor of Physiology, and is one of the most eloquent, talented and
amiable of the Faculty.

Sugar Anti-aphrodisiac. M. Provencal, in the Bulletin General de Thera-
peutic, says, experience has proven to me that sugar in po-und doses arrests the
venereal ardor more effectually than camphor.

Modi of adnmiistering Cod-liver Oil. Chew orange peel both before and after
swallowing the do.se.

FaiJiting during t/ic Inhalation of Chloroform. Prof. Laugier operated at La
Petie upon a student of Pharmacy for Ffstula \\\ Ano. Chloroform was em-
ployed. Insensibility promptly occurred, and the operation terminated without
ihe'patient manifesting pain. All at once the young man exhibited a profound
syncope. For four minutr.s he was without pulse and respiration. He was taken
to the open air" and artificial respiration attempted. Every one around him was
in the greatest anxiety. Happily this state of iainting passed off, and the pa-
tient speedily recovered.

Thco Nev) Anesthetic Agents. Dr. Nunneley. of Leeds, England, announces
in the Med. Times, a new agent, having all the good properties of chloroform
without any of its danger. This is the Chloride of olefantgas^ Holland oil, or
the oil of Holland Chemists. Prof. Simpson also states thatrw/i tar nophta is
an anaesthetic agent as powerful as chlorol'orm, and a great deal cheaper. The
effect is as rapid and complete, but not so agreeable in odor. It probably owes
its anaesthetic property to benzole.

The Wealth of Quacks. It is said that the united fortunes of the five principal
quack-doctors of London is over 5,000,000 of dollars.

Tiro voices at the same time in the same individual. Dr. Pcttigrew, Professor of
Physiology at St. George's Hospital, exhibited a Mr. Richmond wlio possesses
the marvellous faculty of producing at the same time two different .sounds, dis-
tinct and perfectly harmonious. The acute voice is of a nature soil and melo-
dious. Mr. R. emitted a base note accompanied with a tremolo.

An Epidemic Voluntary Mutilation. Two regiments in Africa, one French,
the other belonging to the Foreign legion, lately presented the .sad elfccts of the
power of iinit at ion. A soldier shot himself through the wrist in 20 days thir-
teen others exhibited the same mutilation. The colonel of the regiment imme-
diately determined to break up his encampment, and marched to the (luarlers of
another regiment distant 21 to 2-1 miles. What was his astonishment on ar-
riving there to learn that eight cases of the very .same n)Utilation had just
occurred there. It is asserted that there had been no recent communication

320

Medical InteUigence. Meteorolugij.

March of Improvement change of the figures inarking time. It is proposed by
a writer in the London Lancet to continue the figiires of watches and clocks
from 12 to 24. In telegraph despatches, in noting cases, &c., he argues, it will
be economy in time, be more accurate, &c. For instance, 16 o'clock would
indicate by that figure alone what we now have to express by 4, P. M.; then the
confounding of A. M. with P. M. would be entirely avoided. He says, too, the
additional figures can be arranged on watches and clocks now in use.

The Author (f Etherization Dr. Jaclsmi. The French Academy of Sciences
have awarded to Dr. Jackson, of Boston, the acknowledged discovorer of etheri-
zation, Chevalier of the National o'-der of the Legion of Honor.

Another Test for Chloroform. This is Albumen. The white of e^^ will be
coagulated by the alcohol which chloroform may contain. A single drop may
thus be analysed.

METEOROLOGIC.
Ga, Latitude Sa''
tide, 152 feet.

A.L OBSERVATIONS,

27' north Longitude 4

for March, 1849, at Augusta,
32' west Wash. Altitude above

5

Sur
Ther.

1 Rise.
Bar.

Ther.

P.M.
Bar.

Wind.

Remarks.

I

4G

30 10-100

30 3-100

N. E.

Fair afternoon.

2

42

29 94-100

69

29 90-100

S. W.

Cloudy.

3

50

" 84-100

70

" 81-100

S. E.

Cloudy.

4

46

30 2-100

46

30 4-100

N. E.

Cloudy.

5

41

" 10-100

48

" 10-100

N. E.

Cloudy.

6

46

'' 10-100

64

" 7-100

N. E.

Fair after 3, p.m.

7

47

29 95-100

i:^^^

29 86-100

W.

Rainy sprinkle.

8

44

" 93-100

70

" 95-100

N. W.

Fair foggy morning.

9

52

" 76-100

65

".65-100

S.

Cloudy sprinkle.

10

48

" 65-100'

84

" 60-100

W.

Pair some clouds breeze.

n

56

" 56-100;

84

" 51-100

S. W.

Cloudy blow.

12

56

" 62-100'

82

" 66-100

s, w.

Cloudy breeze.

13

59

" 77-100:

86

" 78-100

s, w.

Fair.

14

65

" 80-100

80

" 80-100

s, w.

Cloudy rain at 4, p.m., 45-100.*

15

60

" 82-100:

80

" 85-100

w.

Cl'y storm9 P.M., r. 1 in. 15-100

16

60

" 78-100:

68

" 82-100

s. w.

Cloudy sprinkle.

17

55

" 85-100;

78

" 78-100

s. w.

Cloudy sprinkle.

18

62

" 72-100;

78

" 73-100

s. w.

Flying clouds.

19

52

30 3-100

70

30

s.

Fair breeze.
Cloudy blow.

20

51

29 87-100{

70

29 70-100

s.

21

m

" 5(i-100

79

" 95-100

s.

Do. storm rain 10-100

22

44

" 80-100,

68

" 99-100

E.

Fair.

93

43

30 . 5-100

68

30 10-100

S. E.

Cloudy.

24

56

" 4-100

73

29 98-100

S, E,

Cloudy.

25

56

29 79-l00|

60

" 71-100

S, E.

Rain, 30-100.

26

47

" 80-100

58 .

" 80-100

N. W.

Fair blow.

27

36

" 84-100

58

" 75-100

N. W.

Fair blow.

28

41

" 61-100

68

" 61-100

N.W.

Fair blow.

29

45

" 83-100

72

" 83-100

W.

Fair.

30

50

" 88-100

77

" 90-100

S. W.

Fair.

31

54

" 78-100

72

" 84-100

S.

Cloudy.

9 Fair days, auantity of Rain 2 inches. Wind East of N. and S. 9 days.

West of do. do. 17 (lays.
The first rain since I2th February. ,

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Yol. 5.] NEW SERIES. ME, 1849. [No. 6.

PART FIRST.
(H) r i 3 ill a I (E o mm it n i c a t i o n s .

ARTICLE XVI.

A Clinical Lecture upon Syphilis, delivered at the Augusta
Hospital. By L. A. Dugas, M. D., Professor in the Medical
College of Georgia, and one of the attending Physicians to
said Hospital.*

The term Syphilis is variously applied in Continental Europe
and in the United States ; for whilst in the former countries it in-
cludes Gonorrhoea, this is with us generally regarded as a distinct
affection^^4t Europeans have of late endeavored to distinguish
between simple urethritis and those cases in which this disease is
complicated with internal chancres, insisting that whereas the
simple form is not followed by constitutional symptoms, these
may be manifested if a chancre have existed within the urethra.
But how are we to ascertain the existence or non-existence of the
ulcer if it occur beyond the visible surface ? Are we to resort,
as has been suggested, to inoculation in every case presented to
us, before we can be able to prescribe judiciously ? We pre-
sume that few practitioners and still fewer patients in our coun-
try would feel disposed to adopt the test. American physicians
have therefore wisely come to the conclusion to regard all cases
of Gonorrhoea as purely local, and to treat them accordingly ;
leaving all subsequent manifestations to be treated upon their

This Lecture was delivered in December last, extemporaneously, and with-
out the expectation of being called upon to reduce it to writing. Having been
requested to do so by some of the class, its substance is now furnished as nearly
as the circumstances would permit. A similar request was made in relation
fn one or two other clinical lectures which may hereafter appear in this Journal.
\, s. yoi,. V. NO VI. 21

322 Dugas, on Syphilis. [June,

own merits. And will it be said that our procedure is more
often followed by constitutional symptoms than that pursued
beyond the Atlantic ? Such is not the fact, for we are told
that their occurrence in Europe is tiot uncommon ; yet they
are certainly of extremely rare occurrence in our country under
such circumstances. There must therefore be either a differ-
ence in the disease in Europe and in the "United States, or the
sequelae must be occasioned by the treatment instituted. Per-
haps what we have to say upon chancres may throw some light
upon this question.

The very great importance attached to the existence of
chancres naturally suggests the query : what is a chancre? Is
it something easily detected or recognized ? Is it a form of dis-
ease presenting such definite characters that it can always be
distinguished from others ? In short are there any pathogno-
monic signs by which a specific chancre can be distinguished
from a simple ulcer? You will look to your books in vain for
any guide to certain diagnosis and your experience will confirm
the difficulty. It is true that Hunter and others refer to eleva-
ted and indurated edges as characteristic of the specific or
syphihtic chancre ; but every practitioner of experience knows
the fallacy of such views. We are told by some' tl^at its ob-
stinacy or resistance to ordinary means will reveal its specific
nature ; but are we to wait for this to make up our diagnosis
and our treatment? And why should an obstinate ulcer upon
the penis indicate a specific inoculation any more than an ob-
stinate ulcer any where else ? If any of these peculiarities be
worth anything we ought never to find constitutional syphilis
occurring after the existence of ulcers of the penis which did
not present them. Yet such is not the fact, as will be abund-
antly testified by practitioners of experience. We certainly
meet with as many cases of secondary or constitutional syphihs
after the occurrence of chancres or ulcers which readily yield-
ed to treatment and which presented neither elevated nor
indurated edges, as we do after the manifestation of these pe-
culiarities.

1 insist therefore that we cannot distinguish a specific from a
simple chancre by occular inspection. Shall we decide the
(jucstion by referring to the history of the case furnished by the

1849.] Dugas, 071 Syphilis. 323

patient by ascertaining whether or not he has been exposed
to inoculation, and whether or not the female herself had chan-
cres? The difficulty of getting at the truth here is as great as
it is in reference to the value of the physical signs. Some pa-
tients feel a reluctance to acknowledge the illicit intercourse
and may mislead you. The great majority will be unable to
testify with any certainty to the condition of the female. We
are still upon terra incognita; and yet we are called upon to
prescribe. Let us drop the term chancre since it means some-
thing that cannot be defined, or, in other words, nothing. Let
us retain that of ulcer, and our procedure will be simplified.
Inasmuch as we know that the ulcer may or may not have re-
sulted from the inoculation of a morbific principle, and that if
this principle have been thus introduced it may be attended
with constitutional symptoms, and, moreover, that we have no
means by which we can determine the true cause of the ulcer,
prudence dictates that we prescribe such a course of treatment
as will not only heal the ulcer but also most effectually avert the
constitutional developments consequent upon inoculation. We
must proceed as though we had the certainty that the patient
had been inoculated with the syphilitic virus.

What then is the best treatment to secure this end ? or do we
know of any upon which we may rely with certainty, or even,
I might add, with probability of success ? We meet here with
difficulties no less than those we have encountered in relation
to diagnosis. There are three methods in general use for se-
curing the patient against constitutional symptoms. These are
the specific or mercurial, the abortive or cauterizing, and the
rational or antiphlogistic. Let us consider briefly the merits
of these methods.

The specific, antidotal, or mercurial treatment of syphilis,
has been so long and so generally adopted as the most effica-
cious by the profession, that any attempt on my part to dis-
credit it might well be regarded as presumptuous, had this not
already been done by abler pathologists as well as by those
better situated for making observations upon a large scale and
for bringing to the support of their deductions the valuable aid of
statistics. It is to Desruelles we owe the first serious and, in
my opinion, successful eflbrt to show that tnercurv is not enti-

324 Dugas, 071 iSyphilis. [June,

tied to the supremacy it had so long enjoyed. His position, as
military surgeon, enabled him not only to treat a very large num-
ber of cases, but also to observe the effects of his treatment for
years in succession, and to keep correct statistics. The result
of his extensive researches prove conclusively in the first place,
that the primary symptoms of syphilis may be as effectually, if
not more so, treated by ordinary antiphlogistics as by mercuri-
als ; and in the second place, that the secondary or constitutional
symptoms occur as seldom, if not more so, after the former than
the latter treatment. Nor have these conclusions been con-
fined to Desruelles; they have been confirm.ed repeatedly since
the publication of his work, by others both in public and private
practice, and to these I unhesitatingly add the humble weight of
my own testimony. The most strenuous advocates of the
mercurial treatment will not presume to assert that this may
be regarded as always successful in the prevention of secondary
symptoms. Ask any practitioner of experience if he will in-
sure a patient affected with chancre against constitutional
symptoms after the mercurial treatment, however well admin-
istered, and he will tell you No ! certainly not ! His predi-
lections may lead him to regard it as the surest guaranty ; but
his experience will never allow him to view it as a certain one.
Such is the partiality in our country to the use of Mercury in
almost every disease, that I may safely affirm that we scarcely
ever meet a case of secondary syphilis in which this agent had
not been more or less freely used during the existence of the
primary symptoms. Indeed we continually see such a state of
things in individuals who have gone through the most thorough
and repeated mercurialization. One of the very few cases of
secondary syphilis I have had to follow my treatment of the
primary symptoms, was one in which I yielded to the importu-
nities of my patient, and mercurialized him to ptyalism three
times, and followed this by the free use of the tea and syrup of
Sarsaparilla for six weeks. He had only one small chancre,
v/hich was cured up in a few days. His apprehensions were
such, however, that he insisted uj)on the thorough ''preserva-
tive^^ treatment just stated. h\ about four months after this,
he was covered with syphilitic blotches and sore throat, which
proved more obstinate than any similar case I ever treated.

1849.] Dugas, on Syphilis. 825

I know that it will be urged that inasmuch as secondary
symptoms are (in this latitude at least) rare in comparison with
the great number of cases of primary syphilis, this result should
be attributed to the mercurial treatment so generally instituted.
This argument would undoubtedly possess great force were it
not equally certain that the secondary symptoms will occur
quite as rarely (I think more so) after any other treatment.
The demonstration of the fact that secondary syphilis rarely
follows the treatment of chancres by mercury is not conclusive
evidence of the value of the mercurial medication. It must be
also demonstrated that secondary syphilis occurs more rarely
after the use of this agent than without it. This I believe can-
not be done. It certainly does not accord with the experiencG
of Desruelles nor with that of many others, myself included.

The examination of the value of the specific method of treat-
ment having led me to estimate also that of the antiphlogistic,
it is unnecessary to say any thing more in relation to this at
present. Let us therefore pass to the consideration of the abor
tive or cauterizing method.

It is alleged by many that if a chancre be well cauterized
with Nitrate of Silver, or any other agent of the kind, very
soon after its occurrence, say on the first, second, or even third
day, that the virus will be destroyed and that the system will
consequently escape infection and the liability to secondary
syphilis. I will not deny the fact that the secondary symptoms
will be rarely manifested after such treatment. Such we have
acknowledged to be the result of the other methods. But I
cannot give my assent to the inference^ that this should be at-
tributed to the destruction of the virus. This would unques-
tionably be at variance with all we know in relation to the
laws of absorption or imbibition, as well as with the analogy
oftered by the inoculation of any other morbific or pernicious
substance.

The syphilitic virus having been applied to the delicate sur-
face of the glans penis, or of the prepuce, is absorbed, or, to use
a more intelligible term now adopted by physiologists, is itn-
hibed more or less promptly. It is not supposed that it could
remain upon such a surface for any length of time without
penetrating it, as it would any other porous substance paper

326 Dugas, on ISyphUlis. [June,

for instance. The cuticle, which in other parts of the surface
of the body offers some resistance to imbibition, can exercise
but Httle here. The fact that the vesicle and subsequent chan-
cre will occur only a number of days after the application of
the virus, is no evidence that this was not very soon imbibed,
for we know that even after inserting the vaccine or the small-
pox virus beneath the cuticle and into the thickness of the skin,
the vesicle or pustule will show itself only after the lapse of
several days. Does the virus then remain in the locality in
which it has been imbibed until the formation of the ulcer?
We have no reason to believe this, but on the contrary many
to disprove it. Such an occurrence would be in direct oppo-
sition to physiology as well as to pathology. The very same
laws of imbibition by which the virus would be carried through
the surface would carry it still further and into the circulation.
The tissues beneath are as porous as those at the surface, and
are moreover bathed in the natural fluids which would dilute
the virus and at the same time take it along with them into
the circulating vessels, particularly the veins. The very dilu-
tion just noticed may account for the fact that the virus at first
produces a visible lesion only at the point of its application.
It is out of the question to suppose that any liquid can be thus
retained within a given locality of the soft tissues for any
length of time. It will always be imbibed and carried into the
circulation. You may satisfy yourselves upon this point by
inserting into the tissues any liquid substance whose effects are
promptly recognized morphia, strychnia, arsenic, corrosive
sublimate, for example Will it be said that in these instances
the manifestation is prompt because the absorption has been
so ; and that it is tardy in syphilis, vaccine, small-pox, &c., be-
cause of a corresponding tardiness of absorption ? There are
agents which do not induce any manifestation of their absorp-
tion or presence in the system until the lapse of a number of
days or even weeks, and the time which thus intervenes be-
tween the admission of the morbific principle into the system
and the manifestation of disease, constitutes what has been
termed the period of incubation. This varies exceedingly, and
probably in accordance with the predispositions of the patient
to disease. As a general rule, the period of incubation after

1849.] Dugas, on Si/jjhllis. 327

inoculation of the vaccine or of the small-pox virus is about
three days. Yet it is not uncommon to find it extended to a
week or two after exposure to the contagion of variola without
inoculation. I have known a case of small-pox in which there
was every reason to believe that the patient had not been ex-
j)osed to its contagion for three weeks previous to its occur-
rence. The virus must have been then absorbed by the respi-
ratory organs and remained dormant or "in incubation" for
this long period. It is generally believed that the hydrophobic
virus remains thus latent for forty days, and even longer, yet
no one would imagine that it had remained thus long in the
locality in which it had been inserted.

Perhaps the strongest argument, however, may be found in
the experiments upon the influence of cauterization on the con-
stitutional eflxicts of the inoculation of the variolous virus.
Would any one expect to arrest these by cauterizing the pus-
tule after it had been developed ? Assuredly not. The cau-
terization at this stage would not even modify the disease. If
analogy be worth any thing here, we should not expect to arrest
rior even to modify the constitutional manifestations of syphilis
/by theapplication of caustic to the inoculated region after the
^p?omotio5^3f the vesicle or ulcer; and the caustic could not
be used before their formation because they furnish us the first
evidence we can have of thei|^ inoculation.

Whilst the cauterizing plan is not a more certain preventive
of secondary symptoms than either the mercurial or the anti-
phlogistic, it is liable to an objection that does not attach to the
mercurial and still less to the antiphlogistic : it provokes the
formation of Buboes. A bubo is an inflammatory enlargement
of one or more of the inguinal glands, and may be induced by
a simple as well as by a specific ulcer upon the pemT and we
have no means by which we may distinguish a bubo produced
by the former from one produced by the latter cause. Every one
knows that buboes not unfrequently follow injuries or ulcers
about the toes, feet or legs. In like manner do w^e find similar
enlargements of the axillary glands in aflfections, whether acci-
dental or otherwise, of the upper extremities and mamma.
Now it cannot be supposed that in all these cases the inflam-
mation of the gland is occasioned by a morbific agent carried

328 Duga?, on Syphilis. [June,

to it by the lymphatics. Buboes are sometimes occasioned by
wearing tight boots when the toes are affected with corns,
although there may be no ulceration whatever. The fact that
they may follow accidental injuries, simple ulcers, or mere
abrasions of the penis, would rather lead us to regard them as a
mere extension, by continuity of tissue, of the inflammation
along the lymphatic and up to the gland it penetrates. Be this
as it may, it is quite certain that, in general, the danger of the
formation of the bubo will be in a direct ratio with the inten-
sity and persistence of the affection of the penis. We there-
fore find that the surest method to prevent buboes is that which
will most readily subdue the inflammatory action of the ulcer,
and heal it. It cannot be denied that the Nitrate of Silver will
often accomplish these ends remarkably well ; but I think it by
no means so uniformly successful as the antiphlogistic treat-
ment properly so called. In many instances the caustic will
aggravate instead of allaying the inflammation, and thus occasion
a bubo, which would not have occurred under another treat- J
ment. It is much to be regretted that so few practitioners take :
the trouble to keep statistics, for these would often reveal the
..fallacy of our estimate of remedial measures. In relation to
the treatment of chancres, I feel assured that a rmj&lt'^^rg^^
proportion of buboes will be found to follow the use of caustic,
calomel, styptic washes, and othj^r irritating applications, than
that of the simple antiphlogistics. In my practice, I never ex-
pect buboes if they do not already exist when the case is pre-
sented to me and, when they do already exist, I can almost
invariably ascertain that irritating applications have been made,
or that the chancres were aggravated by gross neglect of
cleanlines and of the rational means of relief.
c.^ Havjbig^ thus far endeavored to show you that the rational
or antiphlogistic treatment of ulcers of the penis, or chancres,
is to be preferred to either of the other methods, as more
prompt and less apt to be followed by buboes and constitution-
al or secondary symi)toms ; I have likewise affirmed, however,
that we know of no method which, having been diligently re-
sorted to, offers a certain guaranty against the supervention of
secondary syphilis. Methinks I hear the query : "does our art
then avail nothing?" I repeat; it may accomplish much, but

184 J).] Dugas, o/i Syphilis. \V>\}

it is not infallible. Whence then the delusion of those who
consider mercury a specific in syphilis? I think you will find
its origin in the assumption that most chancres result from
syphilitic inoculation, and that this inoculation will necessarily
be followed by constitutional syphilis unless an antidotal treat-
ment be instituted. Now the fact is that the majority of chan-
cres are not produced by syphilitic inoculation. They are
frequently occasioned by uncleanness, the sub-preputial secre-
tions becomini^ rancid and corrosive, by irritation and even
laceration during the act of coition, by the friction of coarse
clothing, &c. Sometimes they occur spontaneously, or with-
out appreciable cause. Some of the most obstinate chancres I
have ever seen originated in this way. I recollect at present
a case in which one half of the glans-penis sloughed away,
despite every effort to save it and yet the patient had not co-
habited for four months previous to the invasion of the chancre.
The assertion of the patient may be doubted by some; but I
am fully satisfied of his entire veracity, and know that he
would not have deceived me. He certainly had no interest in
doing so.

The assumption that syphilitic inoculation will necessarily
be followed by constitutional symptoms, if not properly treated,
reminds me of an anecdote I have heard or seen somewhere in
relation to the influence of certain nostrums in preventing the
bad effects of bites from venomous reptiles. It is related that
an individual alleging to have discovered an infallible antidote
to the bite of the viper, applied to the Parisian Royal Academy
of Medicine to have his remedy tested, whereupon a commit-
^tee was appointed, at the head of which was Majendie. The
efficacy of the antidote was to be determined by causing a
number of dogs to be bitten by a viper, and immediately ap-
plying the lotion to the wound thus inflicted the inventor
declaring in advance that they would escape uninjured. All
arrangements being made, the dogs were bitten and the lotion
was about to be applied, when the wily physiologist insisted
upon seeing first what effects would ensue without the lotion.
The dogs suffered but little, and not one died ! The experi-
ments were of course carried no further. Perhaps the memory
of each of vou will recall instances in which the bites of ven-

330 Dugas, Oil SjjphUis. [June,

omous serpents Um- not been fatal. It is indeed rarely so unless
the virus be deposited in a vein, so that it may reach the heart
and nervous centres suddenly, or more rapidly than it can be
eliminated by the emunctories, and its effects be overcome by
the energies of the system.

That the human economy, in common with that of all organ-
ized beings, possesses an inherent power of self-preservation, is
too evident to require any argument to establish the fact at
present. The plant, as well as animal, will by its ow^n powders
heal the w^ound inflicted upon it, and eliminate noxious sub-
stances introduced into the system. Give a man Arsenic,
Iodine, or any deleterious substance that may be readily de-
tected in the urine or other secretions, and if the quantity be
administered gradually so as not to be fatal, you will find it
rapidly thrown off by the emunctories. So it is with all mor-
bific agents, to a greater or less degree. Let ten individuals
be exposed to the contagion of small-pox they will all inhale
the same infected atmosphere yet some will take the disease
and others escape it. Inoculate a given number of children
with the vaccine virus, and some will not take it, although the
operation be repeated. The history of all epidemics shows
that, although all equally breathe the cause of disease, many do
so with impunity. In these cases the morbific agent is elimina-
ted and its effects neutralized by the energies of the system.
Those whose conservative or protective energies are least
developed, will suffer most. In other words, the readiness with
which the system thus protects itself against the inroads of dis-
ease, is in a direct ratio with the stamina of the individual.
Certain causes of disease are more potent than others, and^
therefore less often effectually resisted. It is more rare to
escape the contagion of variola than that of rubeola. But the
same cause is also more effectually resisted by some than by
other individuals, and even by the same individual, more at
one time than at another. This conservative power has been
called the vis medicairix naturcn, and has, as such, been alter-
ternately extolled and villi ficd. The power does exist, and it
is of great importance that il be properly estimated neither
blindly trusting to it, nor rashly thrusting it aside or overlook-
ing it.

lalU.J Dugas, <nL Si/jt/iili::. 331

In order philosophically to test the value or eUlcacy of any
given treatment for the prevejition of secondary syphilis the
first step should be to ascertain in how many cases the second-
ary symptoms would follow the primary, if these were allowed
to run their own course or be treated as merely local aficctions.
These observations, carefully made, would furnish us the only
correct data upon which to establish a comparison. I am not
aware that any extensive series of, observations have been made
in which no treatment was instituted ; but I have already stated
that they have been made on a very large scale in reference to
the value of the local treatment alone, and that the result was
decidedly favorable to this method. Desruelles found that the
secondary symptoms were decidedly more frequent after the
mercurial than after the local treatment. And these experi-
ments were made in a latitude in which the secondary symp-
toms occur more frequently and with much greater violence
than they do in our Southern country. Having closely attend-
ed the Hospitals of our Northern cities for two and those of
Paris for three years, I may safely aver that during a practice
of nearly twenty years in Georgia I have never seen a case of
constitutional syphilis to be compared in virulency and obsti-
nacy with a large number of those almost continually to be
found in those hospitals.

That warm are less favorable than cold climates to the de-
velopment of constitutional syphilis has been long since observ-
ed ; but whether this circumstance should be attributed to
temperature rather than to some peculiarity in the constitution
of the inhabitants of the South, may well be questioned. In
our Northern cities as well as in London and Paris, the preva-
lence of the scrofulous or strumous habit is infinitely greater
than it is in Georgia and the neighboring States. Whilst
Phthisis Pulmonalis, one of the worst manifestations of this
diathesis, is exceedingly common in those latitudes, it is of com-
paratively rare occurrence in our favored region, especially
among natives of the South. Now the scrofulous diathesis is
most strikingly characterized by a radical deficiency of the
conservative power or vis medicatrix natura?, so that its sub-
jects are peculiarly pr^e to diseases of almost exery kind, and,
when attacked, recover with great difllculty. This habit I hold

332 Dugas, on Syphilis. [June,

to be, of all others, that in which syphilis is most apt to prove
inveterate. Who has not observed the difficulty with which
even simple gonorrhoea is removed in such constitutions? Nay,
it not unfrequently baffles all our remedial efforts, and has final-
ly to be left to " wear itself out." And if a scrofulous individual
be inoculated with the syphilitic virus, not only will the chan-
cres and buboes be difficult to cure, but the patient will, in all
probability, be subsequently- affected with secondary and ter-
tiary symptoms. The conservative powers of the system will
not be able to throw off the morbific agent before it have con-
taminated every tissue ; and this deteriorating influence being
added to the inherent defect of the constitution, will sometimes
favor the development more or less simultaneously of both
scrofula and syphilis. The two diseases become mixed up to-
gether, if I may be allowed the expression, so that it is often
difficut to determine which of the two we should treat. In
looking at the plates of works illustrating syphilis and scrofula
as distinct diseases, we are at once forcibly struck with the
very great similarity of the cutaneous affections and ulcerative
destructions represented in both. In Northern hospitals the
difficulty of correct diagnosis is frequently encountered, and
the physician is obliged to resort to the history of the case in
order to determine whether it should be called scrofula or
syphilis.

I believe that I have now pointed out why it is that all who
are inoculated do not have constitutional symptoms, and also
why it is that these occur more frequently in Northern than in
Southern latitudes. Let us now endeavor to see why it is that
the development of constitutional symptoms is not prevented,
but rather favored by the use of mercurials. If it be true that
the non-occurrence of the secondary symptoms depends upon
the ability of the system to resist the deteriorating influence of
the poison and to throw it off, and that this ability is especially
impotent in persons of a scrofulous habit, it follows as a logical
deduction that we should do nothing that ma}^ impair the ener-
gies of the system, and especially nothing that would aggravate
the scrofulous diathesis. Does not mercurialization impair the
energies of the system ? Look nt thof e who work mercurial
mines or who are exposed to the influence of mercurial emana-

1849.] Dugas, on ISyphUis. 333

tions in the prosecution of certain pursuits ; look at those who
are continually resorting to them for every slight indisposition ;
look at the protracted convalescence of those who have been
saturated with it in the treatment of acute or chronic diseases,
and see the barometrical sensitiveness of their tissues. Every
thing indicates in these individuals rather an impairment than
an invigoration of the energies of the system. Again : does
not mercurialization aggravate the scrofulous diathesis ? The
affirmative is generally admitted. No one would think of mer-
curializing a patient threatened with Phthisis Pulmonalis or any
other form of scrofula. Our inference would therefore be ad-
verse to the use of mercury as a preventive of constitutional
syphilis, even though we were fertified in our position by ex-
perience.

Having given you my reasons for the course I pursue in the
management of syphilis, I will now proceed to the details of
treatment as briefly as possible. The primitive symptoms,
being local, are treated as such. To chancres I apply a lotion
consisting of a drachm of French chloride of soda and 8 oz. of
water. I say French chloride, because that prepared in our
country is usually very inferior, either from the careless man-
ner in which it is put up, or from some original defect in its
preparation. In order to preserve it good, both air and light
should be excluded. The very weak mixture I use is usually
strong enough ; if stronger it will occasion smarting and prove
highly irritating. It should however be made as strong as it
can be applied without producing any^ sense of smarting. The
ulcer having been gently washed by pouring the mixture upon
it, (not by friction,) a bit of patent lint or of soft old linen should
be saturated with it and kept applied by being interposed be-
tween the prepuce and glans penis. This little precaution is
very important, for if the surfaces of the prepuce and glans be
not thus separated, the ulcer will heal with great difficulty.
The prepuce will of course be drawn over the glans so as to
retain the lint. The lint should be wetted three or four times
a day, without removing it, and renewed night and morning.
If this plan be adopted early, most chancres will be healed in a
few days. In cases of Phymosis, however, as the lint cannot
be thus interposed, we have to resort to a small syringe for the

334 Dugas, on Syphilis. [June,

purpose of throwing up the lotion three or four times a day. A
cold flaxseed or slippery elm poultice may then be applied to the
penis three times a day with much advantage. If Paraphymo-
sis exist, the prepuce ought to be drawn down as early as pos-
sible, and this may always be done by compressing the glans
between the end of the thumb and fingers of one hand at the
same time that with those of the other hand we draw down the
prepuce. Some time and patience may be required, but with
perseverance you can always succeed without resorting to the
knife. I have never been obliged to make an incision in such
cases. The patient should remain as quiet as possible, and take
a dose of salts, and avoid stin^uj^i^ng food and beverages.

If the chancres have assumed an indolent character, it may
become necessary to use a styptic or astringent lotion. 20 grs.
of sulphate of copper in 8 oz. water will often act remarkably
well ; so will a decoction of red oak bark or of blackberry roots,
if not made too strong. Calomel applied to the ulcer at this
stage is also very good, but more apt to induce buboes than
either of the other remedies mentioned. I therefore very rare-
ly use it.

When the ulcers evince a disposition to slough the styptics or
astringents may be made a little stronger, but care must be had
not to increase the inflammation if the sloughing be occasioned
by it rather than by a bad constitution. In these cases it will
generally be found advantageous to invigorate the general
health by the use of Porter or Beer, the Iodides, Sarsaparilla,
and a generous diet.

The treatment of Buboes is very simple. It should be such
as would be naturally suggested without the influence of pre-
conceived theories. Regarding them as a mere extension of
inflammation from the ulcer along the lymphatics, we may ex-
pect generally to see them subside with the improvement of
the chancres. When such a result may be anticipated, I sim-
ply apply to them a plaster made with three parts of white
diachylon and one of adhesive plaster melted together and
spread upon sheep skin. To rub them with mercurial or any
other ointment can only add to their inflammation and therefore
promote suppuration. Whether the plaster has any intrinsic
merit, is queslionablc. It certainly has that of preventing the

1819.] Dugas, on Syphilis. 335

use of worse means. Cases are sometimes, however, presented
to us where suppuration seems imminent. We should then
resort to leeches and cold poultices or saturnine lotions, and
strictly enjoin upon the patient to remain in bed. If suppura-
tion does supervene, treat it as you would any other abscess
open it and apply mild poultices.

We now come to the treatment of the secondary symptoms.
These are most frequently cutaneous blotches about the fore-
head or over other portions of the surface, excrescences about
the anus and vulvsi, warts upon the scrotum, sore-throat, with
or without ulceration, &c. The constitution is evidently af-
fected and there is an inflammatory diathesis which reveals
itself as just stated. The antiphlogistic treatment is clearly
indicated ; but in what shall this consist? There can be no
doubt that if the patient will confine himself to the bed, be mod-
erately depleted, and eat as little as possible, he will in many
instances be ultimately reheved. Unfortunately, however, this
plan of treatment can very rarely be resorted to elsewhere than
in hospitals. In private practice our patients expect to be
treated whilst attending to their usual avocations and in such a
manner as to escape suspicion on the part of their friends.
Under such circumstances I know of no better remedy than
mercury, administered either in the form of proto-iodide, of blue
pill, or of a solution of corrosive sublimate, until the gums be
slightly touched two or three times. The patient should in the
mean time avoid animal food and live as abstemiously as the
nature of his pursuits will permit.

You may be surprised that I now recommend mercurials, af-
ter having said so much against +te efficacy in the preventive
treatment. You might with equal propriety find it strange
that we do not bleed to prevent Pneumonia when it is preva-
lent because we use the lancet after its development. Although
depletion is useful in pneumonia when once formed, it strongly
predisposes to it before that. The convalescent and those en-
feebled by any cause are certainly those most liable to suflTer
during a prevalence of the atmospheric causes of pneumonia or
of any other inflammatory disease because the powers of re-
sistance in the system are then lessened. That mercury admin-
istered so as to aflect the whole system is an antiphlogistic of

^.

Campbell, on !Schirrus of Pancreas. [June,

considerable power is abundantly established by its use in the
treatment of almost every variety of phlegmasia, w^hether acute
or chronic. It is also thought by many to exert an influence
sui generis, or in other words to set up an action of its own by
which that of the disease is combatted. This is, however, not
so easily understood nor so certain as its depressing or anti-
phlogistic effect. In general I prefer the proto-iodide of mer-
cury to either of its other combinations, because we have here
the antiplilogistic and the anti-scrofulous remedies happily
blended. Haifa grain given morning and night in pill will be
found in the great majority of cases to act remarkably well, and
is not so apt as mercury alone to aggravate the strumous dispo-
sition which so often obtains in secondary syphilis.

The appellation of tei'tiary syphilis has been by Ricord given
to those forms of the disease in which the osseous and cartila-
ginous structures are principally affected, because these are
usually the sequelae of the primary or local, and of the secondary
or cutaneous and mucous symptoms. They evince a stronger
scrofulous taint than the secondary symptoms, and we accord-
ingly find that they require remedies more directly corrective
of this. The Profession is now almost unanimously opposed to
the use of mercurials and in favor of that of the Iodide of Potas-
sium in tertiary syphilis. This remedy in conjunction with or
followed by sarsaparilla, arsenic, nitric acid, and other perma-
nent tonics, will generally be found to control the disease at this
stage, especially if persevered in sufficiently long. , ,

a jj /f , w>^ y^ 'H-

ARTICLE XVII.

Autopsical Observations Scirrhous Degeneration of the Pan-
creas with Rupture of the Stomach. By Henry F. Campbell,
M. D., Demonstrator of Anatomy in the Medical College of
Georgia.

When we consider the great importance of post-mortem ex-
aminations to the forming of correct conclusions with regard to
the phenomena of disease, and the facility with which they are
made, we are forcibly struck with the comparative infrequehcy
of these investigations. Although well impressed with the ad-
vantages of autopsical observations, admitting their value, and

18-49.] CsLinpheWy on Schirrus oJ\t*ancrtas. 337

urging with seeming ardour, their utility and practicability, still
it is a melancholy fact that this only correct mode of studying
the physical changes wrought by disease is most deplorably
neglected by physicians in many sections of our country, and
from the most inert negligence, lesions escape observation and
record, which would assist in the elucidation of many of the
mysterious phases of disease.

The Profession long ago fully awake to the importance of
these investigations, has by prudent and judicious management,
succeeded in bringing the popular mind to a proper tolerance,
and now examinations are assented to with readiness, that once
were made only with the greatest difficulty, from the abhorrent
prejudices of the patient's friends.

In the dissecting room also we have frequent opportunities
of observing many rare and interesting lesions in the subjects
destined for dissection, and though from their varied character,
and in many cases, want of history, their value is much im-
paired and classification rendered impracticable, still, as notes
of record, we are induced to report them, hoping that their ac-
curacy, at least, may give them that importance with which our
unpretending interpretation fails to invest them.

There is perhaps no place where a better opportunity is
afforded for pathological study than the dissecting room, and
though at first recent students may fail to detect the pathologi-
cal changes on account of their inexperience in healthy tissues,
still from the abundant facilities for comparison here extended,
one will soon acquire, with a little attention, sufficient skill to
appreciate at least the more ordinary variations from the nor-
mal Histology.

Case I. Scirrhus of the Pancreas, <^c. The subject of the
following autopsy was a negro woman, aged about 72 years.
On external examination the body is found extremely emacia-
ted. A tumor is apparent in the abdomen, extending from the
inner portion of the right hypochondriac, across the epigastric
and somewhat into the left hypochondriac region, and project-
ing anteriorly so as to resemble in size and shape the head of
a small foetus.

The abdomen being opened by a crucial incision in the epi-

N. F. VOL. v. NO. VI. 22

338 Ca,mphe\\, oji Schirrus of Pancreas. [June,

gastric region, the viscera are found in the following condition :
Stomach very much contracted, measuring from cardiac to
pyloric orifice but about G inches, and transversely but 2^ to3i
inches. At its cardiac orifice the coats appear of nearly nor-
mal integrity, though even here the mucous membrane is much
congested. At the greater extremity, or cul de sac, there is
much thickening in the coats of this organ, especially the fibrous,
the cells of which appear to be filled with indurated coagulable
lymph, and towards the pyloric end, its tissue is much softened,
tearing under traction with the fingers. On the posterior wall,
near the pylorus is observed a rupture communicating with a
cavity in the rear of the stomach, and surrounded by the rag-
ged and disorganized coats of this viscus. In the cavity of the
stomach is found about a gill of dirty looking grumous pus,
w^hich is its only contents.

The duodenum is very much indurated and thickened, ex-
cept where it encircled the head of the pancreas, in which
place the induration had given place to softening as in the ad-
jacent portion of the stomach ; by the tumefaction, the opening
of the ductus communis choledochus is permanently closed.
This viscus, together with the rest of the small intestine and
also the large intestine, is much contracted and attenuated.

The Pancreas. On the removal of the stomach the pancreas
is found enlarged to many times its normal dimensions. The
structure throughout its whole extent is much altered except
at its left extremity, and even here there seems to be an inor-
dmate development of the normal glandular granules, which
are much darker than natural. Approaching the right ex-
tremity, there is found much purulent infiltration, with a total
metamorphosis of its tissue, this extremity constituting the
large tumor above referred to. On the anterior surface of this
tumor is found the ruptured entrance to a cavity containing a
quantity of unhealthy purulent fluid with many shreds of nor-
mal tissue and communicating anteriorly with the rupture in
the stomach above described. The matter here is not contained
in a sac as in ordinary abscess, but the containing cavity seems
to be the result of a solution of the glandular tissue, in this
situation, rather than by the regular formation o^ pus, there
being many imperfectly dissolved particles floating in the fluid.

1849.] C'dm\)hc\\, on Schiri'iis of Pancreas, 339

The Wursungian duct is seen only in the left extremity, and
here its structure is much altered, its coats thickened and cali-
bre obliterated.

The lymphatic and mesenteric glands are much enlarged,
some of the latter attaining the size of a nutmeg; indeed the
whole lymphatic system in this region is much involved in the
disease.

The Liver somewhat below the natural size, of darker hue
than normal, and in structure so dense that it was with much
difficulty that the finger could be made to enter it.

Tlie Gall Bladder very much distended, containing about
five ounces of bile, very dark and thick, which had distended
the cystic duct, and the ductus communis choledochus as far
as its entrance into the duodenum, which, as before mentioned,
is entirely occluded by the tumefaction and induration of this
intestine.

Spleen normal in color and structure, though somewhat
diminutive.

The Kidneys and pelvic viscera unexplored.

History. Through the kindness of Prof. Joseph A. Eve,
we are fortunately enabled to supply a few historical notes in
the above somewhat rare, and interesting case.

For about two months previous to her death the patient had
complained of pain in the epigastrium, with occasional nausea
and loss of appetite : she was very much emaciated and the
pulse feeble. The tumor was not observed till two weeks sub-
sequently, at which time it resembled in size and shape a large
orange. As it continued to increase the pain and nausea be-
came more distressing, and vomiting quite frequent, till finally
she was unable to retain even the blandest ingesta. Emacia-
tion increased to actual marasmus ; the pulse, before feeble,
became extinct, and her completely exhausted condition told
plainly that the finale was near at hand. On the night of her
death, her attendants assert that while assisting her in chang-
ing her position, they distinctly heard " a noise resembling the
bursting of something inside," and on replacing her in bed she
immediately expired.

310 CsimpheWj on Schirous of Pancreas. [June,

Remarks. In the consideration of the foregoing case there
is much of interest, both to the pathologist and practitioner.
The httle Hability of the pancreas to disease, of any kind, had
for a long time led pathologists to the opinion that it was
scarcely ever affected, insomuch th^f M. Andral, in his Treatise,
devotes but a few lines to this organ, and is content with ob-
serving "that it is exceedingly rare to find it altered * * * *
that it is sometimes compressed by scirrhous or tuberculous
masses formed around or within it ; but in general we may
assert, that the pancreas is one of those organs in which altera-
tion of structure is least common, and that it is only by hypo-
thesis that it has been made to play an important part in certain
gastric affections." And Dr. Marshall Hall expresses the same
opinion, when he asserts, that to this day, the diseases of the
pancreas are of as little moment in a therapeutical point of
view, as they are rare in their occurrence. M. Cruveilhier, in
his extensive collection, reports but a single case of scirrhous
pancreas, but refers to one other reported by another author.
Prof. Gross also adverts to the great infrequency of pancreatic
disorders, but admits their occasional occurrence in the form
of simple inflammation, which sometimes causes induration,
which may degenerate into scirrhus. In M. Velpeau's cele-
brated case, the scirrhous deposit in the pancreas was only the
result of a carcinomatous cachexia, wherein all the tissues of
the organism were similarly affected: Here "the common
cellular membrane, the muscles, bones, the lungs and heart, the
tissue between the costal pleura and ribs, the stomach, duode-
num and small intestines, the pancreas, kidneys, liver, vena
cava, and coats of the gall bladder, the peritoneum, dura mater
and the thyroid gland were all, in various degrees, affected
with the disease," which consequently was not idiopathic in
the pancreas.

Dr. Bigsby is quoted in the Library of Practical Medicine
(3d vol., pp. 194-5,) to have enumerated twenty-eight cases
of carcinoma of the pancreas recorded by different authors,
which he conceives to have been idiopathic, and in eight of
these, which were of long standing, carcinomatous disease did
not extend beyond the pancreas. In one instance death took
place from sudden hemorrhage, and a large, deep ulcerated cav-

1849.] C&mi)hG\]y on Schirrus of Fancreas. 341

ill/ was found in the cephalomatous head of the pancrtas com'
municatlng hy a wide opening with the duodenum.* In two
cases, no vestige of any form of scirrhus remained, the gland
being altogether in a state of cancerous ulceration.

But above all, in illustration of the infrequency of carcino-
matous disease of the pancreas, we would refer to the only
correct and reliable data upon which to base an assertion, in
regard to any point, in the history of this truly mysterious dis-
ease, viz., the statistical reports of those whose opportunities
and assiduous researches have entitled them to our confidence
and respect. In the Philadelphia Medical Examiner, is a me-
moir on the relative frequency of cancer, presented by Dr.
Tanohou to the French Academy of Sciences : " The frequency
of diseases, says Dr. T., is in direct ratio to the susceptibility
of the organs affected by them. When this does not occur, it
is to be attributed to some accidental circumstance. Cancer
does not escape this general law. But what has not yet been
investigated, are the order and nature of the causes of thisdis**
ease. Imagining that the effects of civilization might play no
small part in the production of this affection, Dr. T. consulted
with the assistance of the Prefect of the Seine, Count Ramber-.
teau, the Civil Register of that department." His statistics
are deduced from the examination of these registers during the
period of eleven years, from 1830 to 1840 inclusive, and it ap-
pears that in this lapse of time, there died in Paris and in the
districts of Sceaux and St. Dennis, 9118 persons of cancerous
affections occurring in all the various organs of the body. But
two cases, out of this immense number, are noted as carcinoma
of the pancreas. -J

In concluding our remarks on this subject, we would suggest
that diseases of the pancreas are perhaps more common than
is generally believed, and that the paucity of reported cases

The close analogy between this case (the account of which we had not seen
till after our report was completed) and the foregoing is very remarkable, they
differ only in two points, both important viz., the variety of carcinoma, and
the point at which the rupture occurs, the one being encephaloid, while we are
induced to consider ours Scirrhus the one opening into the duodenum, the
other into the stomach.

t We would here call attention to the excellent paper of Dr. LeConte, on lh
Slaiislicsof Cancer, published in the 2nd volume of this Journal.

342 Eve, on Deaths from Sulphuric Ether. [June,

may arise from the fact that this organ is often overlooked in
post-mortem examinations, on account of its obscure position,
together with its usual immunity fiom disease, and that it may
thus be often in a pathological condition and yet escape obser-
vation.

ARTICLE XVIII.

Deaths from Inhalation of Sulphuric Ether. By Paul F. Eve,
M. D., Prof, of Surgery in the Med. College of Georgia.

Case I. Mr. J., a member of the class in our College the
past winter, and a candidate for the degree in medicine, inhaled
sulphuric ether during the evening of the 3d of last March.
The article was obtained from a Druggist of good reputation,
in quantity 2 ounces, and the motive for using it, was its exhil-
erating effects, which he had experienced before. It was in-
haled from a pocket-handkerchief, renewing or applying it three
times, and about one ounce was supposed to have been con-
sumed. The time of inhaling it was reported to be considera-
ble, and a companion of Mr. J. removed the handkerchief
suddenly while he was still breathing it. He became then fu-
riously excited, and it required several persons to control him.
He w^as forced upon a bed, where he soon fell asleep. A few
moments afterwards, another student of medicine, not liking
his breathing, which he reported to be sonorous, awakened
him, when he again became much excited ; indeed, so much
so, that cold water was dashed over him. He now retired to
bed, and nothing special was noticed until the next morning.
He awoke perfectly rational, but complained of great pain in
the forehead. This continuing unabated, I was sent for to see
him at 2, P. M., on the 4th. Magnesia and salts in purgative
doses, cold applications to the head, mustard-])laster to the
neck and warm pedekivia w^ere prescribed; with the expres-
sion of the hope that these means would give entiie relief. 1
was again sent for at 8, P, M., and also at 8, A. M., of the 5ti),
(the next day,) but did not see the patient until 11 o'clock,
three hours after ; he had been visited, and prescribed for in
the meantime by Drs. Carter and Dugas Dr. Ford was subse-
quently added to the consultation. Symptoms of meningitis,

1849.] iSlerility Revieduiblehij Mfdianical Treatment. 343

&LC., persisted in spite of all treatment pursued, and our i)atient
died on the morning of the 7th.

Case II. For this I am indebted to a friend : During a re-
cent visit to Huntsville, Alabama, among the several excellent
professional brethren I met with there, was Dr. John Y. Bassett,
who, among other advantages, had visited Europe. At my re-
quest, he kindly furnished the particulars of a case o^ tetanus
to which he was called on the 15th of August, 1847. In the
progress of it, Dr. Fearn, whose reputation is well known
throughout our country, and who has twice been elected to a
professorship in our Medical Colleges, was called into consulta-
tion. He proposed the actual cautery and the inhalation of
sulphuric ether. Dr. B. says, at this time the patient's "pulse
was good and there were no signs of immediate extinction of
life. I heated my cautery, and sent for a Dentist wdio was in
the habit of administering the ether. I gave a watch to the
owner of the negro affected with lock-jaw, and requested him
to speak at every (j^uarter of a minute. In one minute, the pa-
tient was under its influence ; in a quarter more he was dead
beyond all my efforts to produce artificial respiration or restore
life." All present thought he died from inhaling the ether.

Of course these cases should by no meaits be used as objec-
tions to the judicious employment of etherization. They are
only adduced as proofs to the position, that ether as well as
chloroform may produce death.

PART II.
RctJicius anb (Extracts.

On some of the Causes of Sterility Remediable by Mechanical
Treatment. By G. T. Gream, Esq., Surgeon-Accoucheur
to the Queen Charlotte's Lying-in Hospital, etc., etc. (Lon-
don Lancet.)

Sterility in the married female is found to depend upon con-
stitutional as well as upon local causes ; but the states of the
general system occurring after marriage, which may give rise
to it, are those of plethora, and the contrary slate of anaemia.
The treament proper for the one and the other of these con-

344 Sterility Remediable by Mechanical Treatment. [June,

ditions, by restoring the health, will generally, at the same time,
render the uterine system fit for conception.

But it is the management of the local and mechanical im-
pediments to conception to which I desire more particularly to
call attention ; those which are to be found at the orifice of
the vagina, and that which exists at the mouth of the uterus.

It not unfrequently happens that virginity is prolonged after
marriage, owing to over-excitement in the husband in conse-
quence of his age, or other circumstances. By advice judi-
ciously given, the former difficulty is always very readily
overcome ; but where there is incomplete physical power in
the husband, it often becomes necessary to adopt a plan of
treatment tow^ards the wife.

I was called to see a lady, whom I found lying insensible
on a sofa. I v/as told that she had frequently fainted, and that
she was usually very hysterical ; but that her friends had
become alarmed in this instance by her prolonged insensibility.
I took means to restore her, and v/nen I called to see her on
the following day, I learned that she had been married four
months ; that the first menstrual period after her marriage
had been passed over without the appearance of discharge ;
that she had been m.ore or less nauseated* upon taking food ;
that she had become thin, and that she was thought by herself
and her friends to be pregnant ; and it vvas supposed that
this v/as confirmed by the appearance of several slight and
sudden discharges^of blood from the uterus, which w^ere at-
tributed to threatened abortion ; by the enlargement of her
abdomen, (evidently from fiatulence,) and a sense of fulness
within the pelvis, and of tenderness in tile groins and in the
mamma}.

The history of the case caused me at once to make further
inquiries of the husband, and he fairly told me, that although
he was led into the belief that his wdfe might be pregnant,
owing to the assertions of her friends, yet tliat now, after I had
expressed a doubt about the matter, lie felt sure that he had
not been possessed of physical power enough at the time of
connexion, to complete sexual intercourse. Upon examina-
tion of the wife, I found an unbroken hymen, but there was no
great rigidity of the vaginal orifice, and it was evident that her
health was impaired owing to the frequent attempts at, and the
non-completion of connexion.

And this is not at all a singular state of things. I have known
every symptom of pregnacy to supervene upon marriage, even
to the suppression of the menstrual discharge, and the presence
of moisture in the breasts ; and in some such cases I have found
an unbroken hymen, and the absence of conception.

1849.] Sterilitij Remediable by Mechanical Treatment. 345

On the day following the exannination of this patient, I
introduced into the vagina a large-sized metallic rectum
bougie, causing a good deal of pain, and some loss of blood, and
on the two following days a still larger one. A few days after-
wards the husband called upon me, and said that the treatment
had been quite successful. I did not see this patient again
until some weeks had elapsed. I then found her stout and
healthy, and having all the genuine symptoms of pregnancy.
A little more than forty weeks from the period of the introduc-
tion of the bougies, she gave birth to a child. I learnt
afterwards that the impediment to complete intercourse having
been removed, no more want of power had been felt by the
husband, which was owing, no doubt, to the warmth and
lubrication of the vagina.

When the husband is advanced in years, and is newly mar-
ried to a young wife, pregnancy may i3e deferred, owing to the
absence of the physical prowess in him necessary for penetra-
tion. We have evidence that neither is the hymen, when
present, a proof of non-impregnation, nor that physical power
in the man is absolutely necessary, in order that pregnancy
may ensue, in the fact that the hymen has not unfrequently
been found entire at the time of labour; and in two instances
which I could recoid, this membrane was perfect up to the
period of delivery, in the wives of persons very much older
than themselves, and who, from feebleness, were unable to use
the force necessary for penetration, although they possessed the
power of impregnation.

The presence of the hymen, under these circumstances, con-
sidered in a medift)-legal point of view, would be strong
evidence in favour of legitimacy, if the parentage of the child
was doubted that child having been the ofispring of the
young wife of an aged husband.

I was consulted by the mother of a young lady who had
married a husi)and very much her senior, on account of some
suspicions which she entertained, that the impaired health of her
daughter was owing to imperfect sexual connexion. 1 desired
her to make some necessary inquiries, and it became manifest
that the physical powers of the husband had been too feeble to
allow of his having effected intercourse with his wife. I
suggested that the wife should sit over the steam of hot water,
that she should apply an unctuous application externally to
herself, and that her mother should explain to her that the
contrary to resistance should be offered to connexion. Im-
mediately after these recommendations had been carried into
effect, signs of pregnancy manifested themselves, which have
been confirmed by subsequent events. The patient's health is

346 Stej'ility Remediable by Mechanical Treatment. [June,

restored, and as she is progressing* most favourably in her
pregnancy, there is but little doubt of her giving birth here-
after to a strong and healthy child.

I have selected this case for publication, in order to show
how simple are the steps necessary very often, in such cases,
for the relief of bodily suffering and mental anxiety; and yet,
without advice, these precautions would probably never have
been taken. I had proposed to dilate the vagina of this patient
had not the means I recommended been found to succeed.

It will sometimes happen, that owing to excessive rigidity at
the orifice of the vagina, there is an impediment to impregnation,
although in the man there is no unhealthy condition. I have
known virginity to exist after marriage, for periods varying from
weeks to months, and even years ; and I have been consulted
by men who have honestly told me that they have frequently
had connexion with women, before marriage, and had found no
impediment to its perfect completion, but that, although they
had been married a long time, they, felt certain that something
was wrong, but they could not say what it was. In such cases
I have found in the wife an unbroken hymen, or so complete a
state of contraction and rigidity of the vagina, as to prevent the
possibility of its dilatation by the ordinary and natural means.

In the not uncommon cases of unbroken hymen, without
any great rigidity, the simple introduction of moderate-sized
bougies will in almost all cases be followed by conception.

The following case is interesting as affording an example of
a very prolonged virginity after marriage, and of the great
benefit that may result in such cases, both morally and bodily,
from medical treatment.

A gentlemen called upon me to tell me of what, he said, was
a most extraordinary case, and to consult me with regard to it.
He said that he had been married for more than ten years, but
that he had never yet had proper intercourse with his wife,
although there was no want of power, either physical or as
regarded secretion. He stated, that at first his wife's resist-
ance, through fear, and the excessive pain she appeared to
suffer if a near approach was made to her, had deterred him
from using force to any extent ; that his emissions had always
occurred externally ; and that from having become habituated
to this mode, and his wife being perfectly apathetic concerning
it, as well as having no strong feeling of attachment for her, he
had felt no wish to take steps to remedy the local evil that
existed ; but that she had become desirous of bearing a child,
and that on her account, and not his own, he had been induced
to consult me.

I appointed to sec the wife, and from her I obtained a con-

1849.] Sterility Remediable by Mechanical Treatment. 'Ml

firmation of lier husband^ history. She lold me she iiad
married very young; tluit she liad not been mnde aware
previously of what she was to undergo; tliat she resisted
llirough fear, and that until within the last year she liad never
experienced the slightest sexual feeling, but that now she felt
differently ; that she was anxious to become a mother : but her
great desire was to do away witii the estrangement tliat she
believed the existing state of circumstances caused between
herself and her husband. Upon examination, I found the
orifice of the vagina so rigid, that it required very firm pressure
to introduce my finger, and its introduction seemed to cause
excessive suffering. It thus became cvjdent that no natural
means could have caused penetration.

On the following day 1 introduced an elastic bougie a little
larger than my finger, and for four days afterwards I introduced
bougies of gradually increased size, the last that was employed
being two inches in diameter. Their introduction caused
extreme sufTerinir, and some quantity of blood was lost. I then
desired that for some nights a large sponge tent should be intro-
duced, and kept within the vagina, and removed in the morning,
and five days afterwards I was able to introduce the largest
metallic bougie with comparative ease, and with no pain what-
ever. I now for the first time learned that the husband was
obliged to be absent from home, and as the patient herself was
going into the country, I recommended the continuance of the
use of the sponge tent during each night until the husband's
return.

I have since received a letter from this gentleman, informing
me that there is no longer any difficulty ; that in all particulars
a great improvement has been made, and I have but little doubt
I shall ultimately learn that pregnancy has supervened upon
this altered condition; and I am led to think tliis because the
state of the uterus was particularly healthy, and seemed per-
fectly fitted for conception. Here, then, is an instance in wliich
domestic peace has been re-established, and supposed physical
incapacity effectually and altogether removed.

I have selected these cases from my note-book, as being
indicative of the effect of treatment to a marked degree.
There are others whose general character is the same, but
occurring under vaiied circumstances, and I fiave known a
few instances in which actual incapadky on the man's part had
rendered treatment of no avail ; but these are only rare cases,
and I am led to believe that there are but very few, whether
the incapacity depends upon the woman, or whether upon the
man, which may not, by proper treatment, be eventually cured.

It i.^i now mv desire to notice tfie causes of sterilit\" arisinsj

348 Sterility Remediahls by Meckanical Treatment. [June,

from an impediment at the uterine orifice. This impediment
will depend upon unnatural constriction of the cervix, which is
found in sucli cases to have no depression in its centre ; its
sftrface is smooth throughout, and upon viewing it through the
speculum, the only indication of the position of the os uteri
will be a vascular state of that part of the cervix immediatelv
surrounding it. This condition maybe met with in the individual
of full habit, as well as in the anaemic, languid woman, whose
person is but little developed, but in either case there will
usually be much suffering from dysmenorrhoea.

There is also a state giving rise both to sterility and
dysmenorrhoea, not discoverable by ordinary examination ; it
depends upon a constriction of the internal extremity of the
cervix uteri, while the external opening remains freely dilated.
This may be detected by the introduction of a small bougie, or
of any instrument of that form, and it is not necessary to have
recourse to inventions and probes for the uterus, of uterine
sounds, or other such things, which after their construction, are
usually found to be of less use than instrwments not made for
the purpose.

The free dilatation of the os uteri is in such cases the object to
be gained, and perhaps no treatment is attended with greater
success, for in the majority of instances it is followed by im-
pregnation.

Should there be tenderness either in the uterus or its neigh-
bouring parts, it should be relieved previousl}^ to the attempt at
dilatation ; and sometimes even the abstraction of blood from
the loins is necessary, or from the cervix uteri, by leeches, in
order to relieve the inflammation consequent upon repeated
excitement and irritation not followed b}- pregnancy. These
symptoms are seldom present in any but woman of full habit,
and may generally be removed by the use of warm hip-baths,
of laxatives, and a separate bed: but usually, in these cases,
there is not that loss of general health that supervene? upon the
non-consummation of marriage, as before described.

At first it is diflicult to introduce a bougie of even a small
size into the os uteri, under these circumstances, but after it
has once been introduced, it can readily be followed by one
somewhat larger, and perhaps a third, of still greater size. On
the following day, or in some cases after a longer interval,
a considerably larger bcWigie may be passed, and then a dilator
may be introduced. I have employed lor many years an in-
strument made upon the same principle as the female urethra-
dilator, with two blades, but without the wooden appendages
that are attached to that instrument, so that when the blades
are closed a simple round steel staff is formed. The point of

1849. J Sterility Remediable by Mechanical Treatment. 349

this is inserted into the os*uteri, and the dilatation effected by-
turning the handle until considerable resistance is ollercd to the
further separation of the blades, or until the patient complains
oi sickness, I repeat this daily, unless much pain follows the
process, and until the os uteri remains open, and is about the
size of a goose-quill,

In order to facilitate the introduction of the dilator, the
patient should lie on her left side, as in labour. I have in some
instances succeeded more readily in dilating the os uteri
by applying the dilator through the speculum, and I think there
are sometimes advantages in using this instrument.

The following cases are illustrative of the immediate benefits
derived from the dilatation of the os uteri :

A lady, twenty-five years of age, who had been married two
years, of delicate appearance, but making no complaint, except
of the pain she suffered ^t the periods of her menstrual dis-
charge, applied to me in consequence of the absence of
pregnancy. It was of much importance that she should have
children, in reference to property to w^hich they would succeed.

I prescribed some tonic remedies ; and as, from circum-
stances, she would be separated from her husband for three or
four weeks, she went to Brighton during this time. Upon her
return there was a marked improvement in her appearance,
but she still suffered from dysmenorrhoea, which she had
never ceased to do at each monthly period. About six months
after this she again consulted me, as I had requested her to do
if pregnancy did not supervene ; and upon examination of the
cervix uteri, I found it small, and without any perceptible
opening. T dilated it gradually until it had attained a fair size,
and I especially remarked that there was a distinct increase of
bulk in the uterus between the time of the first introduction of
the bougie and the full dilatation of the orifice. It became
developed, but not inflamed ; for no tenderness whatever
succeeded any of the introductions of the dilator, which was
used for six successive days, during which time the patient
lived separately from her husband.

I have generally begun to dilate the os uteri about a day or
two after the cessation of a menstrual period ; but in this in-
stance circumstances prevented my doing so, and it was not
until the middle of the third week from the last period that I
commenced the treatment, which was succeeded by painless
menstruation. This was immediately followed by pregnancy.
Abortion, however, unfortunately occurred at the fourth month ;
but this patient subsequently gave birth to a child at the full
period of gestation.

1 was consulted by a patient who was anxious to bear

350 Sterility Remediable by Mechanical Treatment. [June,

children. She was thirty-two years of age, robust and healthy,
with the exception of constant pain in the back after taking
exercise, and of the regular occurrence of painful menstruation.
There was considerable tenderness when pressure was made
upon the cervix uteri, which did not yield to the less active
remedies ; she therefore lost about ten ounces of blood by
cupping, and, after the symptoms were relieved, I dilated the os
uteri, being obliged to wait once for two days, in order that
some supervening pain, accompanied by sickness, might sub-
side. This patient had for a long time afterwards no recur-
rence of dyshamorrhoea, but pregnancy did not follow the
dilatation, and after a little less than twelve months had passed,
I again saw her on account of some threatening of pain at the
two last menstrual periods. Finding the os uteri closed nearly
as before, I at once proceeded to dilate it. This patient sud-
denly gave birth to a child within a* year from the adoption
of the treatment.

The following case proves that other advantages are
derived from dilatation of the os uteri :

A patient come to consult me, accompanied by her mother,
from whom I learned that she was much distressed at not
bearing children, which she attributed to her impaired health.
She was twenty-nine years of age, had been married eight
years, and although she was a fully-developed woman, she was
not anaemic. Her pulse was small and weak, and her extre-
mities usually cold ; she was generally out of health. She had
not menstruated for nearly two years and a half, and when she
had done so, great pain always accompanied it. I prescribed
steel and other remedies with great advantage as regarded the
general system, but with none as far as menstruation was con-
cerned, nor was there the slightest indication of its approach.
I therefore examined the uterus, and found it small in size ; the
cervix gave but little indication to the finger of the position of
the OS uteri. I introduced a small bougie, and subsequently
followed the same course, in order to dilate the os uteri, that I
have described in the other cases. There was some bleeding
at the time of the last dilatation, and there was sickness on the
following day, but the uterine secretion returned from this time,
at first irregularly, but eventually at intervals of three weeks,
small in quantity, but without pain. I learned from the
husband of this patient that connexion had previously always
been attended by excessive pain high up in the vagina ; this
had entirely ceased, and as the health had improved, there rs
every reason to anticipate a successful result in this case as
regards pregnancy.

1 have other cases on record in wliich freedom from

1849.] Sterility Remediable by Mechanical Treatment. 351

d^menorrhoea was obtained by a dilatation of the os uteri, al-
though pregnancy did not always supervene ; but I am in no
way intending to recommend the adoption of the treatment,
simply to relieve this complaint. I should shrink from sug-
gesting the propriety (under any circumstances, except those
of most rare occurrence) of destroying the hymen of unmarried
women, by the introduction of an instrument into the vagina
a custom I fear two much adopted just now by a few practi-
tioners, with the view of treating ulcers in the cervix uteri.
An ulcer may be readily formed by caustic, but caustic will
not remove that which does not exist.

I examined with the speculum (being induced to do so by
the special circumstances of the case) the uterus of a patient
who suffered extremely from dysmcnorrhoea. The os uteri was
small, but not quite closed, and the part of the cervix sur-
rounding it was vascular. I thought it better to use the
dilator, w^hich I did twice ; and within a week the vascularity
had disappeared, and pregnancy subsequently ensued. This
patient had been married three years, but had never been
pregnant ; she had been under treatment, however, for weeks,
if not months, up to the time of my seeing her for supposed
ulceration of the cervix uteri.

The practice of dilating the os uteri in cases of sterility, has
been adopted for many years it is practised by all whose at-
tention is particularly directed to such circumstances. Some
few authors have written upon the subject, but owing to the
absence of publication concerning it, the practice had been
thought to be exclusively confined to one or two individuals.

I am aware that a system has been adopted not, however,
in London, except in a few experimental cases, of incising the
cervix uteri ; but as 1 have become cognisant of the formation
of cicatrices after such treatment, and of permanent alteration
in the shape of the uterus, causing, in my judgment, an impedi-
ment to conception for ever afterwards ; and as I have also
heard of the occurrence of alarming haemorrhage at the time
of making the incisions requiring plugs to be introduced into
the vagina, I have not been induced to notice this practice
farther than to observe that it has been proposed and even
hazarded but that it has not been adopted by those best able
to judge of its safety and efficacy.

Sponge tents have also been introduced into the cervix uteri
for the purpose of dilatation, and in some instances they might
succeed ; but the use of the dilator appears to me to be both
safe and more certain. I have therefore preferred it to any
other mode.

The supposed cases of ante-flexion, and retro-flexion, &ic.,

352 Cauterization in Surgical Operations. [June,

as causes of sterility, hardly require notice, so rarely do tlmjr,
if ever, occur; nor would "the practice of introducing instru-
ments into the uterus, and causing them to be retained there,
call for any comment, if it were not right to warn those who
may be inclined to try experiments, against the harm that may
arise from such introduction. The cases are not uncommon in
which much mischief has been done by these instruments;
and those who have been able to retain them during a twelve
hours' journey to the metropolis have been, in most instances,
too glad to have them removed immediately upon their arrival ;
and fortunate if they have not been obliged, as has occured, to
undergo treatment in order to remedy the ill-consequences
produced.

Cauterization as a Remedy for Accidents resulting from Sur^
gical Operations. By M. Bonnet, of Lyons. (Condensed
from the Bulletin General de Therapeutique, Feb. 1848.)
Ranking's Abstract.

Among the " accidents" or consequences of surgical opera-
Irons, as amputations or the ablation of tumours, which render
extensive incisions of the skin necessary, erysipelas proceed-
ing from the edges of the solution of continuity, step by step,
over a large portion of the cutis, phlebitis and purulent
absorption, abcesses in the viscera, humid gangrene and the
putrefactive fermentation of substances contained in cavities
imprudently opened are not infrequently observed. Nothing
in practical surgery is of deeper interest, or more imperiously
demands a new investigation, since it may be stated with con-
fidence that art is deficient in resources to counteract the
greater part of these complications. Numerous facts have
demonstrated to me the powers of cauterization.. Practised
either with nitrate of silver, potassa, chloride of zinc, or even
the hot iron, according to circumstances, it arrests the progress
of erysipelas, phlebitis, and humid gangrene, especially when it
is applied with energy, and at the period when these lesions
are still accessible to its direct action.

Struck with the results, and comparing its harmlessness with
the lesions, so frequently mortal, from incision, ligature, or
excision of varices, I considered that cauterization should be
substituted as much as possible for all .the operations which
relate to varices. I developed this general principle in a
memoir published in 1843, and I considered cauterization
especially as a method prophylactic and curative of phlebitis
and purulent absorption. The cauterization of hemorrhoids
complicated with prolapse of the rectum, in the form of a ring

J 849.] CaalcrizaiioiL in SurgUal Operations. iii)3

projecting externally, was also considered in this memoir. To
these results I could add new facts of another order, as the
treatment of four cases of varicocele, in which the destruction
of the veins by caustic resulted in complete cure without any
risk ; but I merely mention them as indicating the generality
of the law, and I pass on to the special object of this memoir,
that is to say, the study of cauterization as a means of coun-
teracting the accidents above mentioned.

1. Phlebitis. For the purpose of demonstrating the utility
of cauterization in inflammation of the veins, I cited, in my
memoir of 1843, two orders of facts the one relative to phle-
bitis the consequence of anatomical punctures ; the other, to
phlebitis the consequence of bleeding. Of phlebitis from ana-
tomical punctures, which I had then treated with the hot iron,
the cases were four in number. They were all complicated
with inflammation of the superficial absorbent vessels. There
was enormous swelling of the forearm and arm in three cases,
and of the leg and thigh in the fourth. I have only once since
this period had occasion to apply the actual cautery to an ana-
tomical puncture, acting as the point of departure of similar
lesions. In this, deep cauterization of the wound carried along
the course of the diseased vessels w^as followed by the same
result as in the former cases. In the memoirs of 1843, there
was but one case of phlebitis, the consequence of bleeding,
treated by the actual cautery. The cellular tissue of the whole
arm was in this case the seat of suppuration and gangrene.
This tissue was cauterized deeply into the seat of the superficial
veins. ' Le Bulletin de Therapeutique' contains an analogous
case, in which the actual cautery arrested a violent phlebitis,
the consequence of bleeding in the arm.

When the inflammation is confined to a few centimetres
round the punctured vein, and not attended with any sign
threatening gangrene, we may content ourselves with less pow-
erful caustics, and such as are more easily applied. We may
use Vienna caustic, or caustic potassa. In a case of very pain-
ful inflammation of the foot, developed from a puncture of a
vein in the foot, in bleeding, six days previously, the chloride-
of-zinc paste introduced into the large opening occasioned by
the bleeding, and allowed to remain for eight hours, produced
an eschar fifteen millimetres in diameter, and completely limit-
ed the progress of the inflammation.

Purulent resorption. It w^ould be the triumph of therapeu-
tics to cure this disease, so constantly mortal, and so frequently
the result of the larger operations. Aware of the power of the
actual cauteiy to check phlebitis I naturally tried it in cases of
purulent absorption. The results were not very favourable;

\. p. VOL. v. \n. VI. 23

354 Cauterization in Surgical Operations. [June,

and it is easy to understand that its efficacy must be limited,
especially when the absorption follows amputation. In fact,
phlebitis, which precedes and generally involves as a conse-
quence purulent resorption, occupies the veins which accom-
pany the arteries, or those which make an integral part of the
medullary tissue of the bone. We can only reach the large
extremities at the surface of the wound, and it is impossible to
cauterize them in their course. When unquestionable symp-
toms of purulent resorption manifest themselves, pus has
already formed in the interior of the viscera, as the liver and
lungs, and death is an inevitable consequence.

In spite of these unfavorably conditions, deep cauterization
of the wound is the only means which offers any chance of
success. In five patients, whose cases are given in the memoir
of 1843, three died as quickly as if the cautery had not been
applied ; a fourth lived three months, the wound resulting from
an amputation having been deeply cauterized with chloride-of-
zinc paste. He escaped the results of that dreadful disease,
from which he would have perished in less than a week. The
fifth case, which w^as cured, resulted from the ablation of a
tumour from the side of the tendo Achillis.

M. Cauviere, of Mareilles, has employed the actual cautery
in three cases of purulent resorption ; in one of which it was
completely successful. Since cauterization is the only method
which has produced any satisfactory result, I advise its employ-
ment, especially at the commencement of the affection, at the
period when the swelling and pain in the neighbourhood of the
wound indicate that resorption is imminent. It may be done
with the actual cauter}^ or with the chloride-of-zinc paste,
which should be left in the wound from twelve to twenty
hours.

In a communication to the Academy of Sciences, the 13th
of September, 1847, M. Gouyon advised dressing with a solu-
tion of three grammes of nitrate of silver in thirty grammes of
water. He does not give cases in support of his practice ; but
the very superficial cauterization thus obtained is probably not
so useful as the deep cauterizations which I employ, even
these being frequently insufficient to localize the disease.

Traumatic erysipelas. This kind of erysipelas must not be
confounded with erysipelas from an external cause independant
of an injury, from which it differs in its nature, symptoms,
course, gravity and treatment. No relation can be established
between simple erysipelas and inflammation of the lymphatic
vessels; but frequently, from the commencement of traumatic
erysipelas the skin is observed to be streaked with red lines
following the direction of the lymphatics, and which subse-

1849.] Cauterization in Surgical Operations. 355

quently uniting, give birth to well-marked erysipelas. In
spontaneous erysipelas, the diseased part is insensibly blended
with the healthy part, and it generally stops where it was
originally developed ; in traumatic erysipelas, on the contrary,
a red elevation, a line of demarcation, separates the erysipela-
tous from the sound skin, and the evil, at first confined to the
site of the wound, encroaches gradually, and frequently to a
great extent, upon the healthy part. While spontaneous
erysipelas is frequently accompanied with only simple oedema,
of the cellular tissue, mortification of this tissue is as frequent
a consequence of traumatic erysipelas; and this is inevitable
when traumatic erysipelas attacks the skin of the penis or
scrotum. Simple erysipelas is frequently unattended with any
danger: the prognosis in traumatic erysipelas is, on the con-
trary, always unfavorable. Its appearance when the wound
is deep, leads us to apprehend the development of purulent
absorption ; it is attended with delirium when it occurs on the
hairy scalp ; and frequently, without either of these complica-
tions, it proves fatal.

The treatment of traumatic erysipelas, compared with that
which is proper for the simple variety, is not less different.
While emetics and divers local applications, as vinegar and
water, mercurial ointment, &c., appear to produce the most
marked results in the latter, which gets well in a few days
under the influence of such treatment, or simply by the ex-
pectant plan, the former pursues its course in spite of internal
remedies or the local applications usually resorted to. A
special mode of treatment can alone arrest its progress. The
object of such treatment must be to destroy as much as pos-
sible the putrid principles which may be absorbed from the
surface of the wound, and to limit the erysipelas to the part
which it has already invaded.

Cauterization is the only means by which w^e can obtain this
double result, at the same time that it is the only remedy
possessed of any efiicacy against phlebitis and purulent ab-
sorption ; it is the only useful remedy in traumatic erysipelas,
which has so close a relation to those afl^ections in its courses
and intensity. It may be done with concentrated solution of
nitrate of silver, or caustic potassa, applied to the surface of the
wound and the affected skin, as employed by Mr. Higginbottom,
and subsequently by M. Fanchou. We may use an ointment
of nitrate of silver, as recommended by M. Jobert containing
four, eight, or twelve grammes of the nitrate to thirty-two of
water, according to the intensity of the disease. These means
will suffice in slight cases ; but there is a better chance of suc-
ceeding by cauterizing the wound deeply, which is (he point ot

356 Methods of Treating Asiatic Cholera. [June,

departure of the erysipelas. When difficulties present them-
selves from the extent and depth of the wound, and the surface
occupied by the erysipelas, the deep cauterization may be ad-
vantageously combined with superficial cauterization of the
skin. In the cases in which the traumatic erysipelas makes
rapid progress, and neither the nitrate-of-silver solution nor
deep cauterization of the wound puts a stop to it, the actual
cautery should be resorted to. Larrey recites two very
remarkable cases of success obtained by the cautery applied in
numerous spots over the erysipelatous surface, and insists on
the advantages of this treatment. I have had to regret not
having adopted this bold practice under many analogous cir-
cumstances.

[The principles advocated in this paper are illustrated by
the following cases :]

1. Laceration of the skin of the fore-arm ; traumatic erysip-
elas ; cauterization with nitrate of silver ; rapid cure.

2. Traumatic erysipelas of the hairy scalp, succeeding to
the opening of an abscess; cauterization of the whole internal
surface of the abscess; almost immediate cure of the erysipelas.

3. Extirpation of a scirrhous tumour of the breast, and of
numerous glands in the axilla ; traumatic erysipelas ; cauter-
ization of the bottom of the wound, and employment of nitrate
of silver ointment; cure.

4. Section of the sphincter in a fissure of the anus ; traumat-
ic erysipelas; useless cauterization of the wound with chloride
of zinc, and of the erysipelas with nitrate of silver; actual
cautery ; gangrene of the scrotum ; cauterization of this part
with chloride of zinc ; alarming complications ; cure.

Synopsis of the Methods of Treating Asiatic Cholera, recom-
mended by recent Writers. (Ibid.)

1. Dr. Graves: No faith in mercury. A scruple of acetate of
lead with one grain of opium, divided into twelve pills; one to
be given every half hour till the discharges diminish. Clinical
Lectures, 2d Ed. vol. i, p. 419.

2. Dr. Wood, Philadelphia ; Calomel and opium, in small,
repeated doses ; acetate of lead, kino ; cold water to drink ;
external warmth ; diffusible stimulants. Treatise on the Prac-
tice of Medicine, vol. i.

i\. Dr. Parkes : First stage, blood-letting sometimes ; acetate
of lead, two to three grains, with a quarter of a grain of opium,
every half hour for two or three hours ; external warmth
useless ; large doses of calomel injurious ; mustard poultices to

1849.] Methods uf Treating Asiatic Cholera. 357

epigastrium; cold drinks ; diffusible stimuli. J n co//ay7.9<?, blood-
letting sometimes relieves. No treatment to be relied upon.
Researches on Ah^ide Cholera.

4. Dr. Milroy : External warmth ; saline emetics, as salt,
one table-spoonful in a tumble of water ; turpentine stupe ;
salt or turpentine enemata ; calomel when the vomiting has
abated. Pamphlet on Quarantine^ 1847.

5. Mr. Bell: Bloodletting, if seen in three or four hours from
invasion ; quinse disulph. grs. xij ; .ferri sulphat. grs. ix ; aquas
Oiss. Dose not stated. Medical Gazette, Jan. 1848.

6. Dr. Black : Small bleeding in stout subjects ; calomel and
croton oil repeated three times; then calomel with capsicum;
enemata of warm water. Prov. Med. and Sur. Journal, Jan.
26, 1848.

7. Dr. King : Cold water ad libitum ; large doses of
calomel.

8. Dr. Turnhull: Capsicum embrocations. Lancet, Jan,
29, 1848.

9. Dr. Arthur Wilson: Warm mustard emetic; venesection
where possible ; neutral non-aperient alkaline salts ; inhalation
of oxygen. Lancet, Nov. 4, 1848.

10. Dr. Ayres: Two grains of calomel and two drops of
laudanum everv ten minutes, as long as collapse lasts. Lancet^
Oct. 7, 1848.

11. Dr. Henriques : Quinine in large doses, in all stages;
stimulant embrocations ; injections of decoction of bark.

12. Mr. Allen : Large doses of calomel at the commence-
ment; bleeding occasionally; mustard poultices to the spine and
abdomen ; enemata of hot salt and water. Lancet, Oct. 21,
1848.

13. Dr. M'Cann: Mustard emetic; brandy and laudanum,
and calomel and opium; stimulant embrocations. Lancet
Oct. 21.

14. Mr. Hird: Mustard emetics, followed by acetate of
lead and opium ; stimulating apothems. Lancet, Oct. 21.

15. Mr. Jenkins: Strychnia, gr. j. ; conservative of roses
sufficient to form eighteen pills ; one every quarter of an hour.

10. Mr. Beaman: Salt emetics; external warmth; then
carbonate of soda in effervescence with lemon juice ; external
warmth. Lancet, Sept. 2.

17. Mr. Hancorn : Emetics ; diffusible stimulants, as am-
monia, capsicum ; hyd. c. creta ; tinct, ferri sesquichloridi in
concentrated form after every motion ; sulphuric acid embroca-
tions ; hot-air bath. Lancet, Sept. 9, 1848.

18. Dr. Radcliffe Hall: Five grains of tartar emetic in half
a pint of camphor mixture; an ounce every two hours, till
tolerance i.s effected.

359 Treatment of Diarrhoea of Infancy. [June,

19. Mr. Brady: In premonitory stage, ol. ricin. 3iij. chlo-
roform, gt. vj. tinct. opii, gt. xx. ; aquas menthae, I iss. ; f. haust.
If reaction ensues, external warmth, sinapisms, and following
draught and pill, repeated according to circumstances.

P> Chloroform, gt. viij,

Sp. vin. gall., 3iij,

Aquae, iij, f. Haust.
>} Fellis bovini, gr. iv,

Hyd. chlor. gr. iij. f. Pil.
Chloroform embrocations to the spine. Med. Times, Oct. 14.

20. Dr. Shearman: Bloodletting, followed by transfusion of
blood; respiration of oxygen and atmospheric air; tartar-
emetic-treatment. Medical Gazette, Oct. 14.

21. Dr. Patterson : Rathkeale; Five grains of calomel, with
thirty drops of laudanum, every four hours ; then an enema,
consisting of sulphate of copper, sulphate of zinc, and alum, a
scruple of each in two ounces of water ; a wine-glassful thrown
up every few minutes till retained ; after retention for half an
hour, a large warm water injection. Dublin Medical Press,
Sept. 20.

22. Dr. Cowan: Thinks well of bleeding in robust persons :
stimulating emetics; calomel and opium ; effervescing salines
ad libitum ; external warmth. Prov. Med. and Surg. Journal^
Nov. 1, 1848.

23. Sir James Murray : A wineglassful of his fluid of cam-
phor every ten minutes, with a few drops of laudanum, inflating
the lungs with electrified air ; galvanic discharges through the
respiratory and spinal nerves. Lancet, Nov. 4, 1848.

24. Mr. Marsden : Calomel and ginger : with powders of
common salt, 5ij, carbonate of soda, 9j, oxymuriate of potassa,
gr. vij, every quarter of an hour till reaction ensues ; hot salt
baths; warm saline emetics. Lancet, Nov. 4, 1848.

25. Dr. Willemin and M. Moreau : Cannabine, the active
principle of Indian hemp. The preparation a tincture of the
strength of one grain to ten drops of alcohol ; dose, ten to
fifteen drops. Lancet, Nov. 4, 1848.

26. Dr. Hill: Place the patient in a warm bed; give in-
ternal stimulants ; friction with warm flannels ; external heat ;
chloroform inhalations repeated at intervals. Lancet, Nov. 4,
1848.

Treatment of the Diarrhoea of Infancy. By Dr. West.
(Medical Gazette.)

In his treatment of the intestinal affections of infancy. Dr.
Weft shows great powers of discrimination and therapeutical

1849.] Trtattntnt of Diarrho'a of Infancy. 359

application. In the simple form he relies greatly on a well-
regulate I diet ; but if th? evacuations are abundant, but facal
and unattended with tenesmus, he gives to a child a year old a
mixture containing

IJ^ Magnes. sulphatis, 3j ;
Tinct. rhaei, 3ij ;
Aquas carui, 5 vij :
Dose a teaspoonful every six hours.
In the diarrhoea of teething, he lances the gums where
gingival tumefaction is very decided, but otherwise thinks the
operation a needless infliction. In this form, instead of the
saline mixture, he employs small doses of ipecacuanha combined
with an alkali, from which he has derived great benefit. Three
or four drops of liq. potassse, and the same of vin. ipecac, are
given in a little mucilage every four hours ; and at the same
time a powder of one grain of Dover's powder and one of hyd.
c. creta is given at night. The warm bath is also an useful
adjuvant.

Where astringents are required, he gives the preference to
extract of logwood in combination with tincture of catechu,
which is a valuable tonic as well as astringent. If the motions
are slimy, he continues the night powder. If there is much
acidity, a little soda is added to the astringent mixture.

In inflammatory diarrhoea Dr. West seldom considers depleto-
ry measures to be called for, but if leeches are used, he advises
great caution to prevent unnecessary loss of blood. In these
cases, if there is no great irritability of stomach, he thinks
highly of small doses of castor-oil and laudanum, as below.
^ 01. ricini, 3j ;
Pulv. acac, 9j ;
Syrup, simp., 3j ;
Tinct. opii, gi. iv ;
Aquae" aurant. flor., 3 vij.
A teaspoonful every four hours.
Tenesmus is treated by laudanum and mucilage enema,
Speaking of the still more severe forms of diarrhoea, the author's
remarks are as follows.

" There are some cases in which, after the disease has pas-
sed its acute stage, it still retains much of its dysenteric
character ; the bowels not merely acting with undue frequency,
but the evacuations containing mucus, pus, or blood, and their
expulsion being attended with very considerable tenesmus.
The strength in such chronic cases is very greatly reduced,
and emaciation goes on to a greater degree than in almost
any other aftection, with the exception of phthisis and mesen-
teric disease ; while the bowels are excited to almost immediate

Gastrotomy in Obstructed LEsophagua. [June,

Miction by even the simplest food. The treatment of these
cases is attended with considerable difTicuity ; recovery, when
it does take place (and it is consolatory to know that it often
does, even from a condition apparently desperate,) is brought
about very slowly, and each remedy emplyed seems speedily to
become ineffectual. Throughout their course two objects are
to be borne in mind: one being to check the diarrhoea; the
other to support the child's strength during the time required
for nature to effect the cicatrization of the ulcerated mucous
membrane, and to restore it to a state of health. The utility of
mercurial preparations has appeared to me to be almost exclu-
sively confined to the early stage of dysentery, and to cease
when the disease has passed into the chronic form. On the
other hand, astringents may now be employed with the most
marked benefit, and, when one fails anotlier may be substituted,
for it. In cases where the stomach has been very irritable, so
that almost everything taken has been speedily rejected, I have
sometimes employed the gallic acid in combination with
laudanum, and have seen much benefit follow from its use. At
other times I have given the acetate of lead likewise with
opium a combination which, notwithstanding that decompo-
sition takes place, yet retains its eflicacy when given in the
form of mixture. The sulphate of iron combined with opium
is another highly useful remedy in these cases, and appears to
have this advantage over the sulphate of zinc, which has
likewise been used in similiar cases, that it does not excite the
same irritability of the stomach.

Our remedies are not to be confined to those administered
by the mouth ; for much may be done towards relieving the
symptoms and curing the disease by suitable enemata. In
some cases of unmanageable diarrhoea, M. Trousseau employs
an enema of nitrate of silver in the proportion of a grain to an
ounce of distilled water, with very good efiect. I have never
employed it, but have sometimes used the gallic acid as an
enema, though not sufficiently often to be assured of its
efficacy."

[The author concludes with directions as to diet, in which he
advises weak animal broths in preference to farinaceous articles.]

Gastt'otomy in Cases of Obstructed Oesophagus, By Professor j|
Sedillot. (Condensed in various European and American '
Journals, from the Gazette Med. de Paris, Jan. 1817.)

Ranking's Abstract.

The operation here proposed consists in incisingthe abdominal
pnrietes oppor^ite the anterior wall of the stomach, making an

18-19. J iidstroUtiiiy in Ohst/uclrd (J'Jsojj/tagus. UGl

opening into tlie latter, and conneclinn; the edges of this opening
with the external wound, so as to iorm an artilicial fistula, by
which sustenance niay be administered in cases wiieie ineme-
diable obstruction of the nntural passage exists. Such cases, if
left alone, are quite desperate, their only possible termination
being death by famine ; and Sedillot, therefore holds that it is
justifiable to interfere by any means which offer a chance of
safety. That the operation which he proposes is not im-
practicable is proved by various cases (such as that of the
celebrated Alexis St. Martin) in which a stomachal fistula oc-
curred, as a consequence of accidental wounds : and also by the
experiments of Blondlot on animals, in one of which he kept
a dog in health two years, nourishing him by means of an ar-
tificial fistula of the kind described, Experiments of this
description have also been performed by Sedillot himself with
a successful result. With these facts before him, he argues
that, although gastrotomy ought not to be proposed where there
is a probability of life being continued for sonie time without
interference, yet in those in which death is evidently imminent,
and where there is no other resource, the surgeon ought not to
hesitate about giving his patient the chance of a prolonged ex-
istence, and freedom from suffering.

If this be admitted, it is evidently of great importance to
keep in view those circumstances under which obstruction of
the a^sophagus might render such an operation necessary. The
author, therefore, enters into an elaborate review of all those
lesions of the oesophagus which lead to permanent constric-
tion of the natural passage. He gathers from pathological
writers a great variety of cases, which he arranges under
fifteen heads, viz :

1. Congenital absence of part of tlie oesophagus.

2. Stricture in consequence of tumours in the neighbour-

hood of the oesophagus.

3. Tumours formed between the tunics.

4. Hernia of the mucous membrane.

5. Polypi.

6. Stricture by atrophy of the tube, without appreciable

lesion of its walls.

7. Atresia, from cicatrices, with loss of substance.

8. Fibrous stricture.

9. Fibrous degeneration of the muscular coat.

10. Cartilaginous stricture.

11. Osseous transformation.

12. Complete obliteration.

13. Cancerous stricture.

3G2 Gastrotomy in Ohstructed CEsophagus. [June,

14. Impermeable stricture of the cardia.

15. Fatal oesophageal stricture without known cause.

The cases to which the operation is applicaJDle, as above
enumerated, appear to be referable to two divisions ; the first
being those cases in which the operation is performed without
hope of modifying thereby the original diseased condition, and
merely to prevent death by hunger ; second, comprising cases
in which the original condition is susceptible of modification,
and where the establishment of a new passage to the stomach
either assists the cure, or prevents the further progress of the
disease. In this respect the proposed operation has a cloSe
analogy in its mode of application to the more familiar one of
tracheotomy.

The principal cases to which gastrotomy is applicable, ac-
cording to Sedillot, with the double purpose above mentioned,
are those comprised in ihe fourth, seventh, and thirteenth
sections of his arrangement. In the fourth series, in which
the mucous membrane is thrust through the other tunics, so as
to form diverticula, he holds that the constant passage of the
food distending these abnormal pouches is certain to keep up
the morbid lesion, and, even by dilating the pouches still fur-
ther to hasten the ultimate obliteration of the normal passage ;
whereas, if the operation of gastrotomy be performed, there is
a probability that the pouch may, in time, contract and obliter-
ate itself. In the seventh series, comprising all the wounds
and inflammatory lesions of the oesophagus, in which there is
hope that the judicious employment of catheterism might
ultimately restore the tube to its function, Sedillot holds that
gastrotomy will often permit us to continue this treatment
when otherwise the death of the patient, by inanition, would
have frustrated our efforts ; and he believes that, in such cases,
the chances of cure will often be greatly increased by the com-
plete rest which is obtained in the intervals of treatment for
the diseased portion. Finally, in the truly cancerous lesions,
where the diagnosis can be ascertained with any degree of
certainty, he conceives repose of the part to be of the first
consequence, as both catheterism and the passage of food
through the cancerous part tend very much to the rapid pro-
gress and fatal issue of the disease ; and he thinks, therefore,
that gastrotomy may possibly be found to be applicable to
cancerous cases at an earlier period than that at which death
by inanition is imminent.

It is necessary to state that the operation has never yet been
performed by Sedillot, although he so strongly advocates its
performance.

1841).] NtctinsUtj of Kxcisiun in (Janet i of the Lijj.

luy.i

On the NecFssity of Excision in Cancer of the Lip. By
Cfiarles Fluder, Esq. (Condensed from a letter in the
Medical Gazette, May 26, 1848.) Ibid.

The object is to direct attention to a most impoitant fact,
already pei-haps known to many, but not duly acted on the
certain fatality of cancer of the lip, if left to its own course, or if
treated in any other way than by excision ; and the necessity
of, and more especially the almost certain cure consequent on,
that measure.

In the course of rather more than twenty years of practice,
it has been my lot to observe very many of these cases ; on the
one hand proving what I fear cannot be said of scirrhus at
other parts of the body, the real utility of excision ; and, on the
other hand, as clearly demonstrating the certain melancholy
fatality consequent on reposing on other treatment, to the ex-
clusion of the only real remedy, the knife.

The disease begins with some little wart or fissure, or
abrasion, and it most commonly occurs on the lower lip. Be-
fore very long ulceration is perceivable, and induration, and the
progress is much like scirrhus at other parts. One or two
cases will be sufficient in illustration.

A few years ago a medical practitioner was on a visit to a
gentlemen in this country, on whose lip he one day accidental-
ly observed a very small appearance of the sort above
mentioned. He was told it had been there many weeks, and
had not changed much in appearance, either for better or
worse, notwithstanding various applications had been used.
He advised excision, but others recommended the trial of
various escharotics for several months ; and beyond this, I
believe even still more delay occurred. At last, after an in-
terval I imagine of nearly a year from the time that excision
was first advised, the disorder becoming more formidable, it
was decided in consultation that the time for an operation
had passed, and the poor gentleman died a lingering and mis-
erable death.

About seven or eight years ago a labouring man, resident in
this neighbourhood, showed me a small ulcer in his lip, which
he attributed to the adhesion of a tobacco pipe, while smoking.
The ulcer had been there two or three months, and there was
some hardness around it. He had applied leaves and ointment
to it, without benefit, and lunar caustic had been used. I ad-
vised him to let me cut it out, but he declined. I met this man
some six or seven months afterwards, when iie again showed
me his lip. The disease had increased, having become a hard
tumour, about the size of a nutmecr, with an ulcerated surface.

364 Necessity of Excision in Cancer of the Lip. [June,

On this occasion I urged very strenuously the necessity of
excision. He was unable to muster sufficient courage, and I
again lost sight of him for several months. He then came a
third time. I examined the poor man again; but the disease
had extended too deeply. The submaxillary and sublingual
glands were contaminated; the tongue itself was assuming a
morbid appearance, and it was decided, by others as w^ell as by
myself, that an operation could be of no avail. This poor
creature perished in the most horrible manner ; not, however,
until the deadly parasite had gnawed its way through the mouth
to the pharynx and oesophagus.

On the other hand, I have around me many cases (and I
know of many more) in which the operation has been per-
formed ten, fifteen, and eighteen years ago ; and though in all
of these the operation was only had recourse to when there
was no mistake as to the malignity of the disease, in none has
it returned.

Whether the disease in question be or be not true scirrhus,
is not a point for me to determine. One thing to me is certain,
that there is a disease of common occurrence in the lip, watery
or ulcerative, with induration, trifling at first in its appearance,
insidious in its progress, but fearful fatal in its result; which,
if treated by excision, rarely, perhaps never, returns if other-
wise, leads invariably to a painful death.

The operation is sufficiently simple. A triangle of lip must
be taken out, the base of which triangle is formed by the sur-
face of the lip, with the tumour or ulcer on it. The incisions
are best made with a bistoury, extending beyond the indura-
tion on each side of it, so that the apex of the triangle may be
thoroughly clear of induration. A semicircular incision has
been recommended around the induration, but this is not so
good as the triangular operation. The w^ound is much longer,
healing by granulation, and leaves a worse lip ; indeed, it is as-
tonishing how very little deformity or inconvenience arises
after the triangular operation, two or three small sutures, strap-
ping, and a light bandage being all that is required in the way
of dressing.

An ulcer or wart, or tumour of the lip, of suspicious, ap-
pearance, may be treated by caustic or escharotics for a short
time ; but if the disease gives evidence of increase instead of
diminution, it is unjustifiable to delay excision until the adjacent
textures are implicated, because of this exceedingly important
fact that what is malignant here, unlike malignant disease of
other parts of the body, is at an early period entirely under the
control of the knife. In short, that scirrhus at this part is
capable not of extirpation only, but of extermination.

1849. J Remarks on Lupulin as an Anaphrodisiac. 305

Remarks on Lupulin as an Anaphrodisiac. By Wm. Byrd
Page, M. D., Consulting Surgeon to the Philadelphia Hos-
pital, Blockley. (Medical Examiner.)

In offering to the medical profession the application of a
means of relief for any affection, the practitioner does nothing
more than a self-imposed duty requires.

Actuated only by such a motive, I propose the administra-
tion of Lupulin as an anaphrodisiac, a use to which, I believe,
the article has never before been applied as a therapeutic agent.

The hop has long held a prominent position in the materia
medica as a tonic, and as a narcotic and calmant, in many dis-
ordered conditions of the nervous system. Its different pre-
parations have been administered internally, and applied
externally, in affections calling for the exhibition of medicines
for the production of sleep, the relief of pain, and for quieting
unusual nervous excitement, when the more powerful and
usually more certain medicines of the same class, have been
deemed inadvisable from some peculiar circumstances.

The principle virtues of the hop are believed to reside in
Lupulin, which is described as occurring as a secretion in the
form of granules, on the under surface of the scales or strobiles
of the Humulus lupulus.

Lupulin was first described, and its properties made known,
by Dr. A. W. Ives, of New York, though some notice had been
previously taken of it. According to the U. S. Dispensatory,
" it is obtained, separate, by rubbing or threshing and sifting
the strobiles, of which it constitutes from one-tenth to one-
sixth by weight. It is in the state of a yellowish powder,
mixed with minute partibicles of the scales, from which it can-
not be entirely freed when procured by a mechanical process.
It has the peculiar flavour of hops, and appeared to MM.
Lebaillif, and Raspail, when examined by the microscope, to
consist of globules filled with a yellow matter, resembling in
this respect the pollen of vegetables. It is inflammable, and
when moderately heated becomes somewhat adhesive."

It is kept by most apothecaries, and can be procured in a few
moments by the above simple process.

More than two years since I introduced Lupulin to a limited
extent into the Philadelphia Hospital, (Blockley,) as a remedy
to prevent nocturnal erections in difterent forms of acute
venereal disease, and have subsequently used it sufficiently ol'ten
in my practice, to justify its presentation to the medical pro-
fession as a very good article for the purpose, one of great
efficacy, and entirely free from many of the objections to the
preparations of camphor, opium, dulcamara, stramonium, &c.,
which have hitherto been principally relied on.

366 Remarks on Lupulin as an Anaphrodisiac. [June,

One of the most painful and troublesome attendants upon go-
norrhoea, is chord ee, brought on by nocturnal erections, the
occurrence of which has been completely prevented by the
administration of Lupulin at bed time.

In acute gonorrhoea, it not only prevents erections and con-
sequently chordee at night, but it also seems to exercise a very
soothing effect on the inflamed urethra, and to facilitate the
operation of medicines for the cure of the disease.

Relief from the troublesome pain in the perineum in chronic
gonorrhoea, and during the treatment of stricture w^ith the
bougie, has been obtained by the administration of Lupuliu
alone.

In the treatment of chancres on the penis, the process of
healing is often interfered with, and the efforts of nature and
the surgeon placed somewhat at defiance by the occurrence of
erections, when the patient is warm in bed, which distend
the parts and lacerate the edges of a weak or imperfectly
formed cicatrix. In this disease the Lupulin has been used with
the desired effect.

I have also used it after the operation for phymosis, with the
effect of preventing the occurrence of erections during the pro-
cess of the cicatrization of the incision. Its use may doubtless
be adopted with the same intention after any other operation
on the penis.

The Lupulin has been administered for nocturnal seminal
emissions, and although it does not claim a curative power in
this distressing affection, it will prevent their occurrence so
long as the patient is freely under its influence, and will give
the practitioner an opportunity to prosecute any treatment
which he may adopt, with an increased prospect of success,
from the interruption to the habit of the disease, and from the
prevention of erections when topical applications are made to
the urethra. I cauterized the prostatic and membranous por-
tions of the urethra, with Lallemand's instrument, for a gentle-
man labouring under this disease, and gave Lupulin to prevent
erections, which often harass the patient after this simple
operation, with complete success.

My own experience in the use of the remedy has been
corroborated by that of other practitioners, who have given it
at my suggestion. Dr. F. G. Smith administered it to a patient
suffering fromspermatorrh(ca, and prevented the recurrence of
the emissions so long as the eflect of the remedy was kept up.
He has also given it to a gentleman under his care with chancre.
Dr. Edward Hartshorne reports to me a case which establishes
its efllcacy beyond a doubt, in suppressing the venereal appetite.
A healthy negio )nan conflncd in the Eastern Penitenti^ny,

1849. J Method of Operating for Congetiilal l*/ii//nosis. 'H')l

practised onanism to such an extent, as to bring on an attack of
insanity. The mania was relievegl by active treatment, and
the usual means were applied for the suppression of what
seemed his ruling passion, without effect. He became con-
scious of his unfortunate condition, and of its cause, and con-
fessed that he })assed his time when not watched, in this self-
debasing, and health-destroying amusement. He entreated
the Dr. to give him something "to take his courage down."
Lupulin was administered to him in two grain doses, several
times in the twenty four-hours, and he now states that " it is
all gone," and that he is no longer troubled with his hitherto
unconquerable desire.

The dose of Lupulin is from 5 to 10 grains, to be repeated as
occasion requires. The latter dose rarely requires a repetition
during the night. It may be given in powder or in pill. It
produces no headache, does not constipate, or give rise to
nervousness or any other unpleasant consequence.

An improved Method of operating for Congenital Phymosis.
By W. CoLLERs, F. R. C. S., Surgeon to Steven's Hospital.
(Dubhn Journal.)

On examination, in cases of congenital phymosis, we in general
find the prepuce, especially in persons after the age of puberty,
very much elongated, much more than sufficient to cover
the glans penis ; the skin forming the outer fold of the prepuce
seems loose and natural until within about a quarter of an inch
from its termination, where it is reflected back to cover the
glans. Here there is a contraction, sometimes to such an
extent as to present an orifice scarcely larger than that of
the urethra itself.

The operations proposed to remedy this defect, and allow
the exposure of the glans penis, may be divided into two
kinds: 1st, the entire removal of the double fold of skin or
prepuce, i. e., circumcision ; or 2nd, the simple incision of the
prepuce in the line of the penis, over the surface of the glans.

The objections to the circumcision are:

That the surgeon, anxious to remove sufficient integument
at one incision, draws forward the skin as much as possible,
hoping thus to include the folds of the prepuce within his
fingers, not considering that a considerable portion of the inner
fold must remain covering the glans ; and then, when he
amputates this portion of the integument, the outer skin recedes,
sometimes halfway up the penis, and a considerable portion of
the inner fold remains still covering the glans. He has gen-

368 Method of Operating for Coagenilal Fhymosis. [June,

erally removed too much of the outer, and too little of the
inner fold. Thus to compjete the operation will' be a tedious
and painful process, but to circumcise the prepuce by any
other method will be much more tedious and painful.

Another objection to complete circumcision is (as I have
seen), that the wound, on healing contracts so considerably as
to cause great pain in any subsequent erection ; besides this,
the patient is annoyed by the constant appearance of a drop of
clear, ropy mucus at the orifice of the urethra, caused by
the irritation of the exposed glans, extending to the urethra,
and causing this increased secretion from it; and this symptom
will continue long after all other inconveniences have disap-
peared. If we circumcise merely this narrow band of the fold
of the prepuce, it in healing will contract so as to leave the pa-
tient as bad, if not in a worse condition than before the opera-
tion.

The second plan of operation is by making an incision per-
pendicular to the orifice, introducing a bistoury beneath and
slitting up the prepuce, on some one surface of the glans, either
above or below This will leave one or two very inconvenient
flaps of skin on one or both sides of the glans, and may cause
curvature of the penis, in erection, from a hardened cicatrix.

The only proposal combining the advantages of the two
operations, is, as far as I can recollect, the plan of M. Ricord ;
but this is a tedious and painful operation, and I believe, seldom
performed.

I have been in the habit, for some time, of removing the de-
formity by a simple and very effectual operation. 1 seize the
edge of the prepuce, at its fold forming this narrow band, in the
left hand, and holding the scalpel in the right, and at right angles
with the penis, I remove a circular portion of skin, about a
quarter of an inch wide. The outer fold of skin, being loose, is
then drawn back on the penis, leaving the glans covered by the
inner and tighter fold. I then divide this layer about halfway
back, more or less, slitting it up exactly in the centre, by pas-
sing a sharp-pointed bistoury under it. We have now the
outer fold of skin loose, with a large circular orifice; the inner,
or more contracted portion, presenting also an orifice, but
larger by double the perpendicular incision, which forms two
angular flaps.

I then turn these flaps outwards, and by a suture attach each
angle to the edge of the external skin, at about a quarter of its
circumference from the fraenum ; a slight suture at the frsnum
completes the operation. I then draw all forward so as to
cover the glans.

Jn two or three days I remove the sutures, and generally

1H49.J Caiiij)huratcd ChluroJ'u///i Lini//itn(. IlttO

find the wound healed, leaving a covering for the glans, differ-
ing in no respect from the natural and perfect prepuce; and in
some cases it would be difficult to know that any operation
had been performed, or that any had been required, on this
part.

Camphorated Chloroform Lininent. (New Jersey Medical
Reporter and Transactions.)

A communication from the London Lancet, published in the
Eclectic department of our last number, gives a formula for
preparing a mixture of Chloroform and Camphor, held in
solution by the yolk of an egg; thus procuring a very elegant
preparation by which a larger dose of camphor can be ad-
ministered, than by any other known method. We have tried
this remedy in several instances, and have found it to afford
relief in an obstinate case of flatulent colic, and in several cases
of Dysmenorrhoea. In the latter complaint we believe it to be
a valuable remedial agent : and we refer to the fact of the pow-
erful solvent properties of chloroform, to introduce to the notice
of our readers, a liniment that has been prepared by Wm. B.
Price, an enterprising druggist of this city, where olive oil is
used as the vehicleof the compound of camphor and chloroform,
instead of the ^gg, as mentioned in the communication referred
to. The officinal Linimentum Camphorae of the U. S. Dis-
pensatory contains half an ounce of camphor to two fluid
ounces of olive oil, but it has been ascertained by the gentle-
man referred to, that by the aid of chloroform a much larger
quantity of camphor may be held in solution, thus increasing
greatly the strength of the compound. As three drachms of
camphor are perfectly soluble in one fluid drachm of chloro-
form it is clear that the strength of the officinal liniment may
be greatly increased by the use of the latter solvent. The
present formula gives us half an ounce of camphor to two fluid
ounces of oil ; by dissolving the camphor in chloroform, it may
be increased in weight to one ounce and a half, and will be
held in solution by the same quantity of oil, with the addition of
two fluid drachms of chloroform, to give an anesthetic property
to the liniment. We have used this liniment in a few cases of
local pain from neur;algia and rheumatism with good effect.
Our patients speak of it as a soothing and pleasant remedy ; '
it is worth a trial.

N. S. VOL. V. NO. VI. 24

370

Monthly Periscope.

[June,

PART III.

Comparative advantages of Litliotomy and Lithotrity. M. Guersant,
in one of his late clinical Lectures, on the surgical diseases of chil-
dren, gives the following very interesting table of the comparative
advantages and disadvantages of the operation of lithotomy and lithot-
rity :

ADVATS'TAGES.

Lithotomy. Lithotrity.

1. Promptness of operation. 1. No wound.

2. Always accomplished at one 2. No hemorrhage.

8. Not necessary to confine the

patient to bed.
4. No fear of consecutive infiam-

mation.

sittmg.
8. Complete extraction of the cal-
culi.

4. No fear of allowing any to re-
main.

5. Applicability of the operation to
all ages and to all calculi.

According to this table we find the advantages about equal ; it is
not the same, however, as to the inconveniences.

INCON\^ENIENCES.

1. Pain.

2. Danger of hemorrhage.

3. Wounding the rectum.

4. Also of the ejaculatory canals.

5. Fear of consecutive inflamma-
tion.

6. Difliculty of extraction in cer-
tain cases.

7. Visico-perineal fistulas.

1 . Many sittings and longer than
in cutting.

2. Pain as in cutting.

3. Fruitless sittings which does
not occur in cutting.

4. Pinching of the bladder.

5. Consecutive inflammation.

6. Eno;a2;inoj of small calculi in
the membranous portion of the
urethra.

7. Sometimes a consecutive oper-
ation.

8. Fear of leaving fragments in
the sacs that may exist in the
bladder..

9. Fistula.

10. Unfavourable conditions in
which patients are left after the
operation, and that at some fu-
ture tkne it becomes necessary
to cut.

11. The employ of lithotrity, im-
possible when the calculus is of
great size or encysted.

12. Breaking of the instrunient.

18iy.J Munlhhj Periscope. 371

After comparing these circumstances, we deduce the following
conclusions which tally in every respect with our experience :
1st. Cutting should be the method generally adopted in children.
2d. Lithotrity sliould be employed only in cases where the calculus
can be crushed in a single sittin^r.

In support of these two propositions, the following figures are cited:

Of 42 individuals cut, 34 recovered, 8 died ; 4 from the operation,
and 4 from intercurrent diseases. Of 21 individuals in whom litliot-
rity had been employed, 18 boys and 3 girls, 12 recovered and 6 died;
2 from the operation, 4 from intercurrent diseases; 3 were after-
wards cut.

Thus of the 42 subjects cut for stone, 4 died from the operation;
and of the 21 operated on by lithotrity, 2 died from the operation.

[ Western Journ. of Med. and Surg,

Gastrodynia. If arising from acidity, of course antacids must be
given, carbonate of potash first; and, this failing, carbonate of mag-
nesia. If the symptoms indicate a sub inflammatory congestion of
the gastric mucous membrane, give neutral salts with the infusion of
senna, if the patient is young and plethoric ; if, however, he is past
the middle age, and of gouty or rheumatic diathesis, do not give neu-
tral salts, but give extract of rhubarb and blue pill, with or without
extract of colchicum, followed by an infusion of senna and rhubarb,
with tincture of cardamons. If the disorder arises from ingurgita-
tion of bile, begin with an emetic, and then give taraxacum, to which
sulphate of magnesia may be added, if the stools are pale and ineffi-
cient. If the cause is flatulence, give a mixture containing four or
six drachms of sp. ammon. co. and tinct. assafoet. with six or eight
ounces of inf. sennae co. If interruption of the menses or suppressed
hemorrhoids lead to the gastric pain, leeches to the anus or groins,
hot pediluvia, and moderate purging, are the proper remedies. And
if the gastrodynia appears to be simply neuralgic, without appreciable
cause, some of the various sedatives, narcotics and tonics, mineral
and vegetable, must be used, according to the temperament, age and sex
of the patient. (Dr. R. Dick, p. 114.) Braithioaite^s Retrospect.

Creosote a Remedy for Facial Neuralgia. In the Dublin Medical
Press, Surgeon Kelly reports a violent case of fiicial neuralgia, cured
by the following formula : R^Creosoti, gtt. iij ; Macae panis, q. s. ut.
fit. pil. iij ; dose one pill every three hours, in six hours alter the
pills were taken, the paroxysms ceased, which was very violent before
the pills were given. A purgative draught was afterwards adminis-
tered, and the patient had no return of the neuralgia. [New Orleans
Medical Jour.

DiarrJuBa. The presence or absence of bile in the stools, deter-
mines a very important point in the treatment. If the evacuations
are bilious, opium is not only borne, but needed : if there is a deficien-
cy of bile, opium will be injurious.

372 Montldij Feriscojje. [June,

Chronic. In chronic diarrhoea with whitish stools and general re-
laxation of the system, strychnine is an admirable remedy, rendering
the stools consistent, faeculent, and bilious. (Dr. J. F. Duncan, p. 117.)

Give one-twelfth of a grain of muriate of barytes, and one-fourth
of a grain of muriate of morphia, made into a pill, thrice a day.
(Dr. A. Walsh, p. 119.)

Almost all cases of chronic diarrhoea, except the diarrhoea of
phthisis or that caused by ulceration, maybe cured by persesquinitrate
of iron. The ordinary dose is from fifteen to thirty drops of a solu-
tion prepared according to the formula at p. 121 of this volume, thrice
a day ; but in some cases, we may begin with five drops, and gradu-
ally increase the quantity. (Dr. Graves, Dr. Neligan, Mr. W. Kerr,
p/n9.)-^[Ihid.

Dysentery. Injections containing two grains of nitrate of silver in
an ounce and a half of thin mucilage, and a few drops of laudanum,
are very valuable, conjoined with other treatment, in the early stages
of the dysentery, before ulceration has taken place. (Mr. W. Gar-
like, p. 123.)

Chronic. Decoction of logwood with laudanum, is the best astrin-
gent that can be given. Where there are profuse discharges without
pain, enemata of sulphate of alum with laudanum, produce a very
good effect. (Dr. D. Donovan, p. 124.) [Ibid.

Aphtha. After every time of feeding, take care to remove from
the mouth all remains of the food, by wiping it carefully with a piece
of soft rag dipped in warm water. In very mild cases this will be
sufficient to effect a cure, especially if a solution of borax 3i. or 3ss.
in i. of water, is applied after every time the mouth is thus cleansed.
If this is not sufficient, let a solution of nitrate of silver, five grains to
the ounce, be applied twice a day, in addition to the use* of the borax.
(Dr. C. West, p. lll.)[IMd.

Fissure of Anus. Depends on spasms of the sphincter, and is to
be treated by introducing one finger after another into the rectum,
until the whole hand is introduced, and drawing the closed fist back
through the anus. (M. Maisonneuve, p. 195.) [Ihid.

Keep the mouth clean. The editor of the Dental Recorder says that
" when the mouth is in a healthy condition, the best specifics for pre-
serving it so are the '^scruhhiiig hrush and soap and sand. ^^ The
scrubber should be a well made French tooth brush, with bristles ofa
medium degree of coarseness, set in a firm, compact manner, and
having all the corners of the ivory carefully rounded, so that the mem-
brane of the mouth may not be wounded by a slip while using. The
soap should be of the best quality of Castile, and well seasoned, and it
should be combined with sand of different kinds, according to the con-
dition of the teeth. If the enamel be rough on its surface, requiring
polishing, finely pulverized pumice' should be used, mixed with orris,

1849.] Monthly Periscope. 373

or any pleasant vegetable powder which will serve to dilute it and pre-
vent it from cutting the cnannel too much; whilo if the suriace of the
teeth has that beautiful natural polish which is often seen, or if it has
acquired an artificial one, the mildest kind of polishing powder will be
all that is required, sucii as chalk, and, with many persons, the brush
and water, thoroughly used, will be all that is necessary to preserve
the teeth from the slightest stain.

If all would thoroughly cleanse their mouths in this way, at least
once in twenty-four hours, there would be but little use for tooth
washes, and perfect cleanliness would be found to impart a more de-
ligiitful freshness to the breath than all the perfumes of the East."

l^Oliio Med. and Surg. Journal,

Fat Children. In Wayne Co., Indiana, are a couple of children
who are quite a curiosity from their size. They both belong to the
same family. The elder, a boy, weighed 120 pounds at 4 years, 9
months, and the younger, a girl, 56 pounds, at one year. The West
is a great country. [Ibid.

Triumph of Vital Statistics. Mr. Finlaison calculated from the
events of preceding years, what ought to be the number of deaths
which the Registrar General would be called on to record in the first
j'earofhis operations. The result was 355.968. The observed fact
was 355.956 error 12. [London AtheiUBum.

Preservation of Sweet Spirits of JSiire. By Kloue. When Spi>.
itus jtheris JSltrosi has become acid it is generally rectified from
calcined magnesia ; but this does not prevent its again becoming acid
in a few weeks. Klour states that if neutral tartrate of potash be
substituted for magnesia the spirits does not again acquire acidity.
According to his experience Spiritus ^theris Nitrosi rectified in this
way can be preserved for months without giving a trace of acidity.

[Buckner's Repertorium,

A New Method, of Writing upon Glass. M. Simonin, of Nancy,
has suggested an easymethod of engraving divisions, letters and unal-
terable characters upon glass, for the use of chemists and apothecaries.
It is as follows: Spread with a soft brush a coating of engraver's
varnish upon the bottles or tubes you would use ; when dry, trace
your letters with a pointed instrument, so as to remove the varnish ;
over these places spread a moderate thick coat of sofl paste, made ex-
temporaneously with powdered fluor spar and strong sulphuric acid.
Afler several hours of contact, wash it, and the glass will be sufficient-
ly corroded. For the formation of indellible marks for labeling pur-
poses, the action may be rendered more energetic by covering the
paste over with a piece of lead.

I have tried the above givea method with the most satisfactory re-
sult. I would recommend, however, a coating of wax instead of var-
nish, as tending better to preserve the glass from being acted upon,
except in the parts exposed.

374 Monthly Periscope. [June,

The action of the paste during the space of eight hours, produced
well defined linos, as strongly marked as though done with a file ; five
minutes time gave a very perceptible impression. [^Amer. Journal
of Pharmacy,

The Intention of Hiccup. In the convulsive movement of hiccup,
the diaphragm is depressed ; the larynx is. raised ; and the glottis is
closed. What would be the effects of these conditions ? The de-
pression of the diaphragm would tend to expand the cavity of the
chest ; but the glottis being closed, no air can enter the lungs. The
two ends of the oesophagus are, however, still open, and if the hiccup
be strong enough, air will enter the oesophagus at both ends. If a
person will make a prolonged voluntary effort of the conditions which
occur in hiccup, he will find a portion of air sucked, as it were, into
the oesophagus, from the pharynx. Now, spasmodic hiccup is a re-
flex movement, excited, in general, by gaseous irritation of the stom-
ach ; under these conditions the hiccup will suck the air of the stomach
into the lower extremity of the oesophagus. This, then, is the inten-
tion of hiccup to pump off the air of the stomach. The movement of
the hiccup sucks the gaseous contents of the stomach into the lower
extremity of the oesophagus, and an inverted action of the oesophagus,
propels them upwards and discharges them at the pharynx. [Prov.
Med, and Surg. Journ.

Tolerance of Opium. Mr. Godfrey, (of Bristol.) narrated two ca-
ses at present under his care, illustrative of the large doses of opium
that can be borne v/ithout narcotism. In one, the lady swallowed
frequently forty grains of opium within the day ; in the other, the
patient, who for years had been subject to violent neurotic attacks, of-
ten took within the day sixty grains of the acetate of morphia.

Mr. Norman, some years ago, had a gentlemen who suffered from
senile gangrene, from which he recovered ; he then took opium, and
subsequently took a wineglassful of laudanum regularly fwice a-day.
He obtained from Apothecaries Hall twenty drachms of opium, which,
after cutting up, he macerated for above a month in a quart of bran-
dy; of this tincture he took two glasses a-day, without any further
sensible effect than to exhilerate his spirits. While tnking this, on
two occasions constipation came on, with imminent risk to his life.
After the second attack, he at once left off all his opium, and lived four
or five years afterwards, dying eventually of disease of the brain.

Dr. Blackmore had known four hundred grains taken in one day,
whhout narcotism being produced. [Ibid.

Vegetable Remedies. Remarks of Mr. Sanborn, in the N. H.
Legislature, upon the Bill incorporating the New Hampshire Medical
and Botanic Society. {Boston Med. Sf Surg. Jour.

At the present day there is a great fondness for vegetable med-
icines. Any thing having the prefix of vegetable to it, goes down
with the multitudes. Notwithstanding every body knows that no

1849.] Monthly PtrUcopc. 37 i

new vegetable has been discovered, and no new properties have been
detected in vegetables before known ; still tli^y confide in the asser-
tions of cheats and knaves that the coninioncst herbs may be made
sovereign remedies for " all the ills that flesh is hoir to." It is
equally well known that a majority of all the medicines in the
pharmacopoGia of the regular faculty, are of vegetable origin ; and,
that the most deadly poisons, such as destroy life almost at a blow,
like a thunderbolt, are from the vegetable kingdom; still we are told
that all vegetable remedies are safe, while mercury is the great
bugbear of the many. But it has been proved, in courts of justice,
where quacks have been arraigned for manslaughter, that pills pro-
fessing to be purely vegetable have produced salivation in the patient.
There are, perhaps, a score of infallible remedies, for consumption ;
and, there can scarcely be a doubt that the only ingredient in them
all, which serves to lay the irritation of a chronic cough, is opium!
This for a time quiets the consumpative patient, and deceives him
with the hope of recovery ; but by frequent use of it, the strength is
exhausted, and the system sinks under the repeated assaults of em.
piricism.

Remuneration of Medical Men in England, for attendance on the
poor. The following is a summary of orders, visits, and medicines
supplied to patients in the Halifax district of 990 acres, with a popula.
tion of 19,881. Visits 541, mixtures dispensed 1029, pills 3157,
powders 663, lotions 36, liniments 45, boxes of ointment 36, plasters
79; remuneration for this duty and supplying the above, two shillings
per case, or 20 ! [Lancet.

Another Death from Chloroform. The Glasgow Herald states that
recently a young gentleman returned from Australia to visit his rela-
tives in the neighborhood ofGovan, but before leaving the colony he
met with a slight accident in the foot, which being, perhaps, neglect-
ed during the passage home, caused the great toe-nail to grow into the
flesh. To remove the pain and inconvenience, the gentleman resolv-
ed to submit to an operation, which a respectaVjle surgeon in Govan
was employed to perform on Tuesday last. Preparatory to doing so,
the surgeon resolved to make use of chloroform ; but the patient,
after inhaling the gas, almost instantly expired. An investigation of
the affair is in progress. Lond. Med. Gaz.

Test for Chloroform. In order to test the purity of chloroform,
Dr. Letheby recommends that it should be washed with three or four
times its bulk of water, the water being carefully decanted after each
operation ; four or five times its bulk of quicklime are then introduced
into a retort, and carefully distilled in a water or steam-bath. The
chloroform thus obtained will be fine, and should exhibit the following
properties: 1st, it should be perfectly free from opacity; 2d, its spe-
cific gravity should be near 1.496 ; 3d, it should neither redden nor
bleach litmus paper ; 4th, it should not become opaque when dropped

376 Medical Intelligence. [June,

into water ; 5th, it should not be whitened with solution of nitrate of
silver ; 6th, it should not coagulate white of egg. The last two are
regarded as important and easy tests. [London Lancet.

Test of the purity of Cod-Liver Oil. Mr. Hockin mixes, on a porce-
lain slab, four parts of cod-liver oil and one of strong sulphuric acid;
when, if it be genuine, a rich violet hue is produced, which in a few
moments passes gradually into a dirty-brown color. This remarkable
characteristic, he observes, is not possessed by any other oil, either
animal or vegetable.

We have already alluded to the effects of this remedy in lupus,
(See p. 77.) We may state that we have continued to exhibit it in
phthisis, with results quite unattainable with any other medicine.-^ [i J.

A case in which a glass Pessary Iroke williin the body. On en
quiry, I found that the pessary had broken, that while standing at the
window, doing nothing ; she heard a noise, and that any effort since
had caused pain. On examination I found it broken indeed, into a
great number of pieces ; parts of the periphery were in situ, and all
the parts were at the upper part of the vagina. I found I had an
unenviable task before me the extraction of these sharp angular and
pointed piec&s of glass from the vagina. I had some doubt as to the
feasibility of the operation, and some apprehension for the result.
After two hours and a.half of most diligent and most careful manipu-
lations, I succeeded in extracting every vestige of the glass. The
number of pieces extracted were fifty, of all shapes and angles, -^-^
Boston Med. ^ Surg. Journal,

MEDICAL INTELLIGENCE.

An Indigenous Deohstruent and Alterative Compound,

[We give place, with much pleasure, to the following letter re.
marking that our opposition to the introduction of new remedies, as
stated, had reference to remedies of douitful character. The agents
of this new compound are certainly not of this class.

We also state that our friend Dr. Mayes, says, a practitioner of his
neighborhood has used this medicine in a case of cachexia Africana,
The morbid appetite for dirt-eating soon disappeared, and the patient
enjoyed a state of health, which he had never before experienced.]

Bradleysville, Sumter Dist., So. Ca. >
April 28th, 1849. I
Dr, Paul F, Eve :

Dear Sir Although in the December No. of the Journal, for 1847,
you distinctly annnounced your opposition to the introduction of new
articles into the materia medica, being more desirous, as you say, to

1849.] Medical InLtUigence. 877

investigate more fully the properties of those now admitted and ac-
knowledged ; yet, it is hoped, that this opj)osition dots not reach so
fur as to prevent your giving a trial to thosti new articles, which nmy
be brought to your notice by your friends.

I am one of those who feel a deep interest in the investigation of
our Indigenous Medical Botany; not oidy to determine the number
and names of our medical plants, but to ascertain the best modes of
preparation lor medical purposes; by which tlieir properties may be
secured most fully, and the practitioner, consequently, not liable either
to underrate or overvalua them as remedial agents. To this latter
point, my attention has been strongly directed for some time, and -I
may occasionally bring to your notice the results of my observations.

My present purpose is to bring to the notice of the Profession a
compound which 1 believe to possess deobstruent and alterative pro-
perties in a high degree. It has succeeded so well in my hands, and
also in the hands of a neighboring practitioner, as a valuable adjuvant
to Quinine, Iodine, Mercury, or the alkalies, in the treatment of
chronic diseases, that I am induced to believe it much superior to
Sarsaparilla ; and, as it is composed of the roots of indigenous plants,
it certainly possesses some claim to a trial.

The roots used in its preparation are those of the Styllingia Sylvati-
ca (Queen's Delight), the Ptcrocanlon Pycnostachyum (Black Root),
and the bark of the root of the Laurus Sassafras.

As the Black Root is not recognized by any of the works on the
materia medica as a medical plant, it will be necessary to give it a
separate notice* In Elliott's Sketch of the Botany of South Carolina
and Georgia, page 324, vol. 2, the plant is very fully and accurately
described under the name above given, with references to Michaux,
Pursh and Nuttall under the name Conyza Pycnostachya, and to
Walter as the Guaphalium Undulatum. In a medical note, he ob-
serves: "The root under the popular denomination of Black Root, is
much used in some parts of the country as an alterative and as a
cleanser of old ulcers." Upon inquiry among the midwives and
other old women skilled in herbs and roots, I ascertained that the
plant in question was very highly esteemed as a remedy in menstrual
irregularities and other diseases brought on by exposure to the influ-
ence oi cold. Their mode of using it is to pour boiling water upon
the bruised roots, and cover the vessel closely until cool enough for
use. The dose is about two fluid ounces every two or three hours in
recent cases, until it acts upon the bowels or skin; then not so often.
Their intention was alwafsto produce free sweating, it being seldom
given as a cathartic. In chronic cases, a tea-cupful of the infusion
was taken two or three times a day. My own experience with the
root confirmed, to some extent, their opinion of its efficacy as an altera-
tive, and as the root was abundant, it very soon superceded Sarsaparilla
altogether as an adjuvant to the more powerful minerals in the treat-
ment of most diseases of long standing.

Its combination with Stylingia and Sassafras was the next mode of
administration, and the only preparation of it which I now prescribe ;

378 Medical Intelligence. [June,

the effect of the combination being such as to leave me but little to
desire.

As you might probably induce one of your intelligent apothecaries
to prepare a small quantity for experiment, I will give you my mode
of preparation.

Fresh roots of Stylingia Sylvatica, - - 6 pounds.
" " " Pterocaulon Pycnostachyum, 6 pounds.
" Bark of Root of Laurus Sassafras, 1 pound.
N. B. If dried roots are used, one half the above weights.

The roots are to be cut fine, and put into a distilling apparatus, and
water, sufficient to cover them, poured on. The distillation is then
commenced, and so long as the water comes over, very milky, it is to
be preserved. When it comes over clear, or nearly so, it must be re-
jected until half the remaining quantity has been displaced ; the other
half to remain in the still. (The quantity of water first poured on to
be noted, and the quantity rejected to be noted also.)

Pure alcohol is then to be poured on (the quantity noted) until the
roots are again covered. The displacement of the alcohol is suffered
to go on until there remains in the still only sufficient to replace the
water which had been rejected. The process is now stopped, and the
alcohol which has been displaced will be sufficiently pure for most
purposes.

When cool, strain through a cloth, and to this product add the oily
fluid first obtained. When well mixed, bottle and keep well corked.
The quantity of extract obtained is usually 6 or 7 pints.

For administration, I prepare it as follows : Of the extract, one
ounce ; syrup, three ounces. Dose, a tea-spoonful three our four
times a day. The proportions of the extract and syrup, are, however,
often varied to suit particular cases. It does most good when slight
nausea, for a few minutes, follows its exhibition.

To this syrup, may be added Iodide of Potassium, Corrosive Sub-
limate, Quinine, or the alkalies to suitcases.

I will only particularize one application of it, which can hardly fail
to excite attention. It has, in my hands, in combination with Quinine,
proven to be the only preventative of the relapses of malarial fevers,
which I have yet used; and its eflects in permanently curing the dis-
ease have been so very striking that I regard it as the long sought
desideratum.

To four ounces of the syrup prepared as above, add forty grains or
a drachm of Sulphate of Quinine. Of this, a tea-spoonful three times
a day for a fortnight. In old cases, I usuarty direct 5 grs. Blue Mass
every third night ; but in recent cases, this addition is not often ne-
cessary.

As a test, I have tried the quinine without the syrup, but the results
were always unsatisf^ictory. Its usual effect, when given after an
attack of malarial fever, is to produce bilious evacuations from the
bowels, restrains the usual morbid appetite, and clears the skin of the
jaundiced hue. Yours, with the greatest respect,

J. A. Mayes, M. D.

184i.]

Medical Inttlligeuce. 379

' Right of Physicians to charge as Witnesses in Courts.

Editors op the Medical Examiner :

Will you spare me a corner in your valuable Journal, to make known the
final seillemeiit, recently, of a case involving the Je^ral riiihis of physicians lo
charge lor professional services rendered the Cominonvcalth as witnes>cs in
criminal cases'? The establishment of this claim is a matter of interest and
importance to the profession. About nine years since. Dr. J. M, Wallace and
myself examined, at the instance of the Coroner, the body of a child who had
died, as was alleged, from the eiiects of poison administered by a servant in the
family. The chemical analysis of the contents of the prinice viae was conduct-
ed at the expense ot much time, labour, and material, by Dr. R. E. Rogers, then
living in Philadelphia, and upon the tiialwewere all examined as medical
witnesses, to prove the existence of the poison. Proper bills tor the service, ex-
clusive of ordinary witness-money, were rendered at the time to the prosecuting
officer ol the Court, and by him cndoised to the County Commissioners for set-
tlement. Payment, however, was refused, not from any indisposition, it was
said, to compensate us for the services, but simply from a supposed w^ant of
proper legal authority to do so. The claim, consequently, was pushed no fur-
ther until a late decision of the Supreme Court, in a similiar case, had settled
ihe point, that professional service rendered at the instance of a proper legal
officer, was entitled to special compensation by the County. In conlormity with
this decision, an appropriation was lately madeibr the settlement of our bills.

Hitherto, medical men have been subjected to much labour and vexation in
medico-legal cases, without receiving any pecuniary compensation, the legal
tribunals, like the public generally, expecting that physicians would of course
always be willing in such cases to render their professional services gratuitously.

For the future, however, it should be unilerstood that the law vivst pay when
it needs a medical opinion in order to promote the ends of justice, and every
one will see at once the indispensable necessity of such testimony in trials for
murder charged to have been committed by means ol poison. It is high time,
we conceive, that the profession had taken a firm stand in defence of its just
claims to remuneration, not only by courts of justice, but in other quarters also,
vhere its charities are so liberally appealed to, more especially, too, as its mem-
bers are liable to be mulcted in heavy damages upon charges ot neglect merely;
and we trust, therefore, that a reform in this, as well as in other matters, will
not be definitely postponed.

Yours, &c., Francis West.

Philada., April 6, 1849.

[We endorse the above with all our hearts, more especially as we too have
been sufferers in. circumstances nearly similar. It is indeed high time that the
medical profession were looking after their own interests in these matters, and
in every instance where professional opinions and valuable time are demanded
for the purpose of justice, that they should insist upon proper remuneration for
their services. Medical witnesses are not only called upon to render time and
learning to further the ends of justice, but are obliged often to submit to the im-
pertinent badgering and cross-examinations of counsel, very frequently more
for their own amusement and the display of their little smattering of medical
knowledge, than for any positive advantage that may accrue to the case under
trial. We hope, therefore, now that the precedent is established, that no medical
witness will fail lo claim and sue for proper remuneration for services rendered.
Eds.]

We too have suffered indeed, who of the profession has not been grossly
imposed upon on this subject? Edt, S, M. & S. J.

380 Medical Intelligence. [June,

THE AMERICAN MEDICAL ASSOCIATION.

Boston, Tuesday, May J, 1849.

The American Medical Association met this morning: at the Lowell Insti-
tute, at 11 o'clock.

Dr. Warren, in behalf of the Massachusetts Medical Society, briefly address-
ed the delegates.

Dr. A. H. Stephens, of New York, President of the Association, then deliv-
ered an address to the members.

A list ot delegates present, was then read by the Secretary. They numbered
about 250.

A committee was then appointed, consisting of one member from each State,
to nominate officers for the ensuing year.

AFTERNOON SESSION.

The Association met at 3^ o'clock.

The Nominating Committee appointed in the morning, reported the names
of the following gentlemen as officers of the Association for the ensuing year :

For President Dr. John C. Warren, of Massachusetts.

For Vice-Presidents Dr. J. P. Harrison, of Ohio; Dr. H. H. Maguire, of
Va.; Dr. A. Flint, of N. Y.; Dr. R. S. Stewart, of Md.

For Secretaries Dr. A. Siille, of Pa.; Dr. tl. I. Bowditch, of Mass.

For Treasurer Dr. Isaac Hays, of Pa.

These gentlemen were then unanimously elected to the respective offices
above named.

A Committee was appointed to wait on the President elect and inform him of
his election.

They soon after returned accompanied by Dr. Warren, who took the chair,
after returning thanks for the honor conferred upon him, and addressing a few
sensible and pertinent remarks to the delegates.

The reading of the reports of the Standing Committees was then commenced.

The first report read was from the Committee oq Practical Medicine, of
which Dr. Condie, of Pa., is Chairman. The reading of this report occupied
all the afternoon, and was not finished when the hour for adjournment arrived.
It was then voted to suspend the further reading of the report, and refer it to the
Committee on Publication.

Wednesday, May 2d.
morning session.

The Association met at 10, A. M., pursuant to adjournment Dr. John C.
Warren, of Boston, in the chair. The first business of the session was the read-
ing of the minutes of the Association.

Dr. Bowditch, Chairman of the Committee, reported a list of delegates to the
Association, from Avhich it appeared that w\)\vaiTA&o{ four hundred members are
now present in the city, representing twenty-two States.

On motion, Dr. J. P. Jewett, of Lowell, was elected a permanent member of
the Association by a unanimous vote. This motion involved a brief discussion
as to the true interpretation of the article in the constitution which refers to
permanent membership.

Reports from Standing Committees were called for. A motion was made
that the reading of reports, in full, be dispensed with, and that the Chairman of
a Committee be permitted to read such portions as he deemed to be more imme-
diately interesting to the Convention. Upon this motion considerable discussion
arose. It was contended on the one hand that it was disrespectful to a commit-
tee, who had carefully elaborated papers in behalfof the Convention, not to hear
them; also, that, referring reports to the Committee on Publication, the Con-
vention gave their sanction to documents, doctrines, and principles which they
miglit not be willing, on revising their opinion, to approbate. On the other
hand, it was contended that the objects for which the Convention assembled,
would be entirely lost, by reading in lull, every report that the committees had
prepared ; that even one or two lengthy reports would consume all the time of

1W4'JJ Medical Intelligence. 381

the sessions ; that it was not necessaril)' disrespectful to a committee to dispense
with the reading oi a report, because, such a course is in accordance with the
practice of parliamentary bodies; that the 'association did not necessarily be-
come responsible for the doctrines of a report, but that, though they appeared in
the volumes of the transactions of the society, yet they stood there as reports
only, and the committees alone were responsible for them. The motion was
finally withdrawn, when

Dr. >'aihan R. Smith, of Maryland, Chairman of the Committee on Surgery,
read a lengthy and elaborate report on that .subject. A large portion of the report
was devoted to a consideration of the great improvements in Surgery which the
discovery and introduction of anaesthetic agents had enabled them to adopt. In
reference to chloroform, the report says it is the most powerful agent of the kind
known, and that care should be taken in administering it to the patient. It has
been administered to millions of subjects, and we have but fifteen cases of au-
thenticated deaths supervening from its use. Alarm, therefore, on the subject
is needless. Much more cause is there for alarm, much more reason to appre-
hend a fatal termination in taking an ordinary rail-road journey, than in in-
haling chloroform, at the handsof a judicious and careful practitioner.

It is inadmissible, the report says, to proceed with a surgical operation in
dangerous cases, without the use of chloroform, because safety and immunity
from pain are secured. It should not be used where there is a disease of the
heart ; and in inhalation care should be taken that atmospheric air be mixed
with the chloroform. Inhalation should stop the moment that insensibility is
attained. Prof. Simpson has published his opinion that one hundred lives have
been preserved by the use of chloroform where one has been lost by it. He fur-
ther says, that the mortality where chloroform is used, is much less than in
similar cases where it is dispensed with.

In careful hands chloroform is an invaluable agent. The author of the re-
port has administered it thirty-four times to one patient, a young woman, to the
extent of complete insensibility, without any unpleasant results. Prof. Mott, of
New York, has performed operations which he would not have attempted with-
out the aid of chloroform. Other important matters were introduced, which we
forbear alluding to. The reading occupied one hour, and was received with
the most lively tokens of approbation. It was referred to the Committee on
Publication.

Dr. Chandler R. Oilman, of the College of Physicians and Surgeons of New
York, read a report from the Committee on Obstetrics. This report, like that
on Surgery, is largely filled with remarks on the wonderful advantages which
Obstetric practice has gained through the introduction of anaestherical agents;
and it is very cordial in its notice ot Dr. Channing. who, the report says -'has
made a most invaluable contribution to the literature of Obsieirices in the pub-
lication of his work, " Etherizalion in Child Birth." Etherization has now
been used in thousands of cases, and in no one instance has the slightest injury
resulted to the mother. These results may well be considered wonderful, but
particularly so in cases of instrumental labor.

In order to present the question of anaesthesia in child-birth before the Asso-
ciation in entire fairness, the Committee have incorporated into their report the
principal objections which those who oppose the use of such agents have urged
against them. They, however, give it as their deliberate opinion that the
chances of a patient's recovery is greatly increased by etherization, and they
say that anaesthetics may not only be given in all cases of labor, but, they say,
they may not rightfully be withheld. The report was accepted and referred to
the Committee on Publications.

At half past 1 o'clock, the Association adjourned, to meet at 3|, P. M.

AFTERNOON SESSION.

Meeting called to order by the Piesident, Dr. John C. Warren. The first bu-
siness in order was the report of the Committee on Medical Literature, which
was read by Dr. John P. Harrison, of the Medico-Chirurgical Society of Cin-
cinnati. The gentleman remarked, in the outset, that he should probably claim
the attention of the Association one hour. The field alloitect to the conimittee,
he remarked, was ''wide and fertile, but they had endeavored to explore the field

382 Medical Intelligence. [June,

with the care and patience which its importance demands." In considering the
subject, the Committee had regarded the division which the Association had
marked out for them, to v.it:

rirst The general character of medical periodical literature in the United
States.

Second A consideration of the most important and prominent articles that
are thus brought to our notice.

Third Original or native American medical publications.

Fourth. Medical compilations and compends of American writers.

Fifth American reprints of Foreign periodical medical works.

Sixth All snch measures as may be deemed advisable for encouraging and
maintaining a medical literature of our own.

The report stated that there are twenty original or native medical publications,
and four foreign periodicals. Of these, five are quarterlies; six are published
bi-monthly, six monthly, one three times a year the transactions of the Phila-
delphia Society; and one weekl)^ the Boston Medical and Surgical Journal.

The report was very ably drawn up, and presented in a clear and impartial
manner, the present condition of medical litcature in the United States. It ap-
pears that many important contributions had been made to this department of
medicine, and thattlie most eminent practitioners in the country have exercised
their talents in enriching the pages of medical periodicals. And woman, too,
has contributed the riches of her mind and cultivation to enlarging the bounda-
ries ot medical knowledge. "Elizabeth Blackwell, M. D., a graduate of
Geneva College, Ohio, does high CT&Axi io hex alma mater mher inaugural thesis
on Ship Fever."

The report very feelingly alluded to the medical biography of the past year.
The biographies of D. O. Partridge and Dr. Enoch Hale are briefly, but beauti-
fully sketched in the pages of the Boston Medical and Surgical Journal. Other
eminent ph3'^sicians who have died within the last year were appropriately
mentioned.

On the subject of Empiricism, the report was very strong and determined.
It was regarded as a giant evil, and called upon the eminent in the profession
to come forward boldly to the work of ridding "the public from the deplorable
woes arising from their use. " We are told, that truth is great and must pre-
vail, but truth should not be deserted by her friends, and they ought not to look
on calmly, and see her trodden under foot by her enemies."

The largest medical library in the country is that of the Philadelphia hospital.
It was commenced in 1762, by the donation of a book from a Mr. Fothergill, of
London, who shortly afterwards made another donation of books, six cases of
anatomical specimens, and a skeleton and foetus. The library now contains
upwards oi ten thousand voluvies. There are other libraries in Universities and
Colleges, containing, some, seven thousand, three thousand, and two thousand
volumes. The catalogue of medical works in the library of Harvard College
numbers one thousand seven hundred and si.xty-nine volumes; that of the
medical department of Harvard University, in Boston, twelve hundred volumes.
The libraries of some of the most eminent Boston physicians contain upwards
of five thousand volumes. The report was very length}-', occupying in its read-
ing one hour and forty-five minutes. It was accepted and referred to the Com-
mittee of Publication.

On motion of the Chairman of the Committee, it was Resolved, That a Com-
mittee of three be appointed by the President of the Association to report upon
the recommendations contained in the document just read. The following gen-
tlemen were appointed on this committee: Dr. Harrison, of Ohio; Prof. Horner,
of Philadelphia, and Dr. Hays, of Philadelphia.

On motion of Dr. Wood, it was

Resolved, That the subject of an international cop5'--right law be referred to
the Committee just raised, with instructions to report to the Association.

Dr. Wood, in urging his motion, remarked that it was essential to the medical
literature of the country, that an international copy-right law be established.
He claimed it for our writers, who now receive no encouragement. They must
produce a better book, a great deal better book than the English writer can pro-
fince, or they cannot find a bookseller who will pay them for their work. He

181U.J Medical Intdligtncc. 383

claimed it too on the ground of justice to English writers, who were despoiled
of the labor of their heads and hands by the cupidity of our booksellers.

Dr. F. Campboll Stewart, ot New YorU', chairman of the cuniuiiitcc on medi-
cal education, being absent the report was read by Dr. M. L. Taft, of the New
York Academy of Medicine. This report, like others that proceeded it, was
very lengthy; and, though the reader omilied large portions of il, he occupied
upwards of one hour. Like the others, loo, it was elaborately drawn up and
indicated much learning and labor on the part ol its author. The report con-
cluded with a long scries of resolutions, and recommended a committee of
seven to take the matters contemplated in the resolutions under consideration.

Dr. John Ware, from the Medical department of Harvard College, presented
a paper, as part of the report of the Committee on Education, from a Commit-
tee of the Faculty who were appointed to take into consideratwn some of there-
commendations of the Medical Association with regard to Medical lectures,
particularly in reference to extending courses of lecturers beyond the establish-
ed period of four months. The purport of the paper was that the Faculty were
constrained to differ from the views of the Association with regard to the prime
importance of lectures, and also that in their view no profitable object could be
gained by extending the term of lectures beyond a period of four months.
Lectures are a subordinate and subsidiary part of a medical education. The
great object in view from them is to learn the student how to study for himself.
The paper did not undervalue the import:ince of medical lectures far from it.
Information was communicated through these sources which would not be ac-
quired any other way, but it was desirable thai they should take their proper
place in the education of students. It regarded the establishment of private
Medical Schools in our cities as of very great importance.

The report was accepted and its further considerntion made the order of the
day for half-past three o'clock, P. M.

The nominating committee made further reports as follows. For committee
on Forensic Medicine, Dr. Stephens, of N. Y., chairman Drs. Bell, Earle,
Rockwell, Robert Walts, Bond and Knight, On Indigenous Botany and Materia
Medica, Dr. Ives of Ct., chairman, and Drs, Corbin, Frost, Davis, Lenoir,
Cochrane and Hanson, Committee on Hygiene, Dr. Smith, of N. Y, chairman,
Drs. Gardner, Jarvis. Cook of Va., Holmes, Emerson, Symonds and Ives,

The Nominating Committee, reported that Cincinnati be the appointed City
for the next annual meeting of the Association.

This report was unanimously adopted, and the following named gentlemen
were constituted a Committee of Arrangements: Drs. Drake, Dodge, Judkins,
Wood, Riley, Lawson, Richards and Strader. of Cincinnati.

The following committees have been appointed, who are to report on the vari-
ous subjects submitted to them at the next Annual Convocation :

On Medical Science Drs. John Ware, Chairman; Jacob Bigelow, and J. B.
S. Jackson, of Boston ; A. B. Malcolm, Iowa; James Moultrie, S. C. ; G. Em-
erson, Penn.; David King, R, I.

On Practical Medicine J^rs. J, K, Mitchell, Chairman; La Roche, and F.
West, of Penn.; Jones. Lou.; R, D. Arnold, Geo,; Smith, Indiana,

On Surgery X)vs. R. D. Mussey, Chairman ; and W, M. Auld, of Ohio ; A.
B. Shipman, Indiana; Usher Parsons, R. I.; L. A. Dugas, Ga. ; Samuel
Jackson, Boston ; J. R. Wood, N. York.

On, Obstetrics Dv T. G. Prioleau, Chairman, S. C; L. D, Ford, Geo ; R.
Lebby, S. C, ; Barlett, N. Y. ; Aiken, Del. ; Evans, 111 ; Isacc Lincoln, Me.

On Medical Education Drs. Joseph Robv, Chairman ; T. A. Rolserts, and
R. S. Stewart, of Maryland; R. W, Silvester Va. ; F. A. Ramsey, Tenn.; G.
Sumner, Ct. ; W. H. Rockwell, Vermont.

On Medical Literature Drf^. Alf, Stille, Chairman ; F, Y. Smith, and T. H
Yardley, of Penn.; P. C. Gaillard, S. C. ; A. T. Morris, Ala.; Fithian, N. J.;.
Johnson, Me.

On Publication Drs, Isaac Hays, Chairman ; and A. Stille, of Penn ; H. J.
Bowditch, Boston,; D. F. Condie, Penn.; B. F. Barker, Ct, ; Isaac Wood, N.
Y. ; Pitiman, N, C.

On Forensic Medicine Drs A. H, Stevens, New-York, Chairman ; L. V.
Bell, Mass., W. H. Rockwell, Vermont; Robert Watts, New-York; R. S,
Steuart, Maryland; J. Knight, Conn.; Pliny Earle, New York.

384

Meteorology. Errata.

On, Botany and Materia Medica Drs. Eli Ives, Conn , Chairman ; G. L.
Cobrin, Va.;' H. R. Frost, So. Ca. ; W. H. Davis, Md. ; N. S. Davis, C. B.
Coventry, N. Y.; J. P. Harrison, Ohio.

On Hi/geia Drs. J. M. Smith, N. Y., Chairman; Yartner, N, Y.; E. Jarvis,
Dorchester, Mass.; A. T. M. Cook, Va.,; Holmes, Mo.; G. Emerson, Penn. ;
Simonds, Lou.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet.

for April, 1849, at Augusta,
32' west Wash. Altitude above

<

Sur
Ther.

Rise.

Bar.'
29 76-100

2,1
Ther.

P.M.
Bar.

Wind.

Remarks.

1

54

74

29 76-100

N.W.

Fair blow.

2

49

" 95-100

70

30

E.

Fair breeze.

3

41

30

59

30

S. E.

jFair, do.

4

53

29 90-100

66

29 80-100

S.

Showery.

5

61

" 77-100

79

" 81-100

W,

Fair breeze.

6

54

" 97-100

86

30

S. E.

Fair.

7

66

30 7-100

82

" 9-100

S. E.

Cloudy.

8

61

" 9-100

88

29 97-100

s. w.

Fair morning.

9

62

29 87-100

88

'' 86-100

s. w.

Fair.

10

61

" 77-100

82

" 77-100

s. w.

Cloudy breeze.

11

56

" 83-100

80

" 89-100

N. W.

Fair.

12

57

- 97-100

78

30

E.

Fair hazy.

18

59

30

80

29 87-100

S. W.

Fair morning. [night.

14

64

29 74-100

80

" 68-100

E,

Cloudy morning dry gale at

15

50

" 70-100

40

" 72-100

N. E.

Gale heavy snow storm at 12j

16

31

" 75-100

62

" 74-100

S. W.

Fair ice and frost. [M.

17

36

" 74-100

70

" 61-100

s. w.

Hazy blow frosty morning.

18

58

" 44-100

66

" 51-100

N.W.

Fair heavy gale of dust.

19

37

" 62-100

64

67-100

w.

Fair blow ice and frost.

20

38

" 70-100

66

" 77-100

w.

Fair breeze ice and frost.

21

47

" 93-100
" 97-100

68

" 98-100

s. w.

Fair breeze.

22

42

76

" 96-100

s, w.

Fair do.

23

50

" 95-100

81

" 92-100

s.

Fair do.

24

57

" 90-100

82

" 84-100

s.

Cloudy.

25

62

" 84-100

76

" 84-100

s.

Cloudy breeze.

26

61

" 89-100

76

" 90-100

s.

ICloudy- rain 1 inch 20-100.

27

64

" 89-100

82

" 88-100

N. E.

jCloudy sprinkle.

28

62

" 84-100

88

" 73-100

N.W.

Cloudy sprinkle.

29

62

" 70-100

83

" 66-100

N.W.

Cloudy sprinkle.

30

66

" 86-100

82

" 86-100

S. E.

Fair afternoon.

14 Fair days, auantity of Rain 1 inch 20-100.
9 days. West of do. do. 16 days.

Wind East of N. and S.

(J(^ As the absence of the author of our first article prevented its revision by him, the
reader is requested to correct the following

KRRATA :
Page 321, 4th line of 1st paragraph, period instead of comma after "affection."
" 324, 2d line from the bottom, read "and had sore throat."
" 325, 12th " " " read inference, instead of "inferences."

" 327,16th " " " read ^/le, instead of "their."

*' 3-27, 18th " " " read formation, instead of "promotion."

" 328,9th " " " read J /lai'c, instead of "Having."

" 330, 1st line from the top, read have, instead of "has."
" 330, 6th line from the bottom, read more so at, instead of "more at."
" 335,11th " " " read (AetV f^tcacy, instead of "its efficacy."

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. .] NEW SERIES. JULY, 1819. [No. 7.

PART "FIRST.
r i g i n a I Communications.

ARTICLE XYIII.

Observations on the Pathology and Treatment of the Cholera^
as witnessed in the Hospitals of Paris during the recent
Epidemic. By Juriaii Harriss, M. D., of Georgia.

Since the invasion of Paris by the epidemic of Cholera, I
have been anxiously hoping that the discovery of some new
lesion might indicate a more successful treatment than has
heretofore been adopted, or that a successful treatment might
be accidentally found among the various plans which would
be tried. I have waited in vain. The physicians of the hos-
pitals have been engaged day after day in making post-mortem
examinations to find out a lesion which would explain satisfac-
torily the course and action of this mysterious and scourging
malady, arid lead to rational means of cure. Their attempts
have been unsuccessful. Treatment after treatment has been
adopted, until nearly every agent of the materia medica has
been tried. Success has attended none of them, at least to the
extent that it was desired and hoped.

I shall not give a description of the symptoms and phenome-
na of this disease, but will confine myself to its pathology and
treatment as witnessed in the hospitals. I will say but a few
words upon the causes. It does seem strange to hear physi-
cians even complaining and lamenting that the profession does
not know more of the causes of this disease. I really think
that we know as much of the cause of Cholera as we do of

N, 8. VOL. V. NO. vir, C")

386 Harriss, on Cholera. ['^uly,

any other disease. I believe that a specific poison operates
upon the economy and produces Cholera, just as another
specific poison will produce intermittent fever. Do we know
any thing more about the causes of variola and scarlatina ?
I think not. We only know that a certain specific cause will
produce variola, and another scarlatina; but w^hy they produce
these diseases alone, and not another, we know no more than
a Natural Philosopher does what gravity is or why it produces
certain and invariable effects. As he recognizes gravity by
its phenomena, so we recognize Cholera by its phenomena.
This is all that we know of any disease.

Before entering into the pathology of Cholera, it will proba-
bly prove interesting to give a statistic of the number of cases
and deaths in the hospitals. The first case which occurred in
the hospitals was upon the 27th of January. A few cases con-
tinued to occur from this time to the 18th of March, only
eighteen having made their appearance during this interval.
From this date it increased, and continued to do so until the
19th of April : since then it has been decreasing.

I extract the following table from the '' Union Medical,"^
which gives the number of cases and deaths in most of the
hospitals to the present time.

NO. CASES. DEATHS.

Hotel Dieu, - - - 366 193

LaCharite, - - - 263 152

LaPitie, - - - 252 128

La Salperiere, - - 835 600

Hopital St. Louis, - - 202 107

Baujon, - - 121 79

desEnfans, - 20 12

Necker, - - 52 31

Ste. Marguerite, - 37 19

St. Antoine, - 48 23

des CHniques, - 25 20

Bon Secours, - 47 25

du Val-dc-Grace, - 209 53

du gros-caillou, - 253 90

It will be seen from this table that the Salpetriere has been
most dreadfully scourged by the epidemic. This hospital is
situated upon the out-skirts of the city upon on of the Boule-
vards ; it is a ho.<>:pital for women whose constitutions are bra-

1849.] Ilarriss, on Cho/rra. 3H7

ken down by disease or age. The epidemic did not confine
itself to the infirm women, but attacked many of the nurses and
'* internes" of the hospital, a portion of whom have succumbed.
The Cholera has been so violent there that the hospital has
been partially evacuated. Since this the number of cases has
much diminished, doubtless because there were a less number
exposed to the disease. A thing a little strange, is that the hos-
pital for the infirm men, though situated in a very densely popu-
lated portion of the city, has been exempted from the malady.
Patients have been daily brought from its immediate vicinity
into other hospitals, and its inmates have been allowed to walk
into the city during the day.

It is needless to say that the lesions attending Cholera are
varying and inconstant : it is hence very difhcult to account for
the rapid and distinctive course of the malady. In uncompli-
cated cases, the brain and spinal cord preserve their natural
colour and consistence ; but nearly all the other organs, such
as the lungs, liver, spleen and kidneys, are found frequently
congested or ecchymosed. The lungs are more frequently
congested than the other organs. This is the only abnormal
condition of these organs that I have seen, and it was by no
means constant. The most evident traces which this disease
leaves upon the dead body are to be found in the alimentary
canal. The stomach and intestines are found to contain more
or less of the rice-water fluid, similar to that passed by vomit-
ing and stools ; they are sometimes so distended by it that,
when punctured, a jet is thrown out by the elasticity of their
coats. The color of the mucous coat of the intestinal canal is
variable ; I have seen it the whole length of the canal very
pale at other times, and more generally, it was more or less
injected with blood. Generally this coat of the intestines is
pale until you reach the ileum, when it becomes colored from a
rose to a deep dark red. The glands of Peyer are frequently
hypertrophied, sometimes pale and at others more or less red.
Bruner's glands are more rarely enlarged : in the ileum (rarely
above it) are frequently found small granulations ; thoy are
more frequent and numerous near and ujion the ileo-6oDcal
valve ; they but rffrely extend into the caecum. These granu-
lations are small, semi transparent, contain a whitish fluid, and

388 Harriss, on Cholera. [}^^)\

are frequently, though not always umbilicated ; they disappear
when pricked with a pin some have stated that they were
constant, but they certainly are not, for I have seen many cases
in which they were absent. The large intestines are general-
ly more or less injected : these lesions are not constant, nor do
they occur in any regular order. The intestines may be pale
or <iongested, with or without hypertrophy of Peyer's glands,
and with or without the granulations. I have seen two cases
in which there was hypertrophy with ulceration of Peyer's
glands; but the ulcerations I accounted for by the complication
of typhoid fever: one had typhoid fever in the hospital before
the attack of the Cholera ; the other was brought into the hos-
pital with the Cholera, so that it is impossible to say positively
whether or not the patient was affected with typhoid previous-
ly. This, however, is probable.

The most interesting portion of the pathology is to be found
in the fluids of the body, the recent analysis of which has de-
monstrated some very curious alterations. There seems to be
some difference of opinion as to the composition of the fluid
evacuated by stools and vomiting ; this fluid gives an alkaline
reaction, and contains the epithelium of the mucous membrane
of the intestinal canal with a few pus globules ; these matters
are deposited at the bottom of a vessel when left quiet for a
short time. The point of dispute is, whether there is or not
albumen contained in these evacuations. There is high author-
ity upon both sides of the question. M. Andral (and his opin-
ion is aflirmed by M. Mi al he) states that it contains no albumen
whatever; they say it contains ^^ alhuminose,^^ or the final pro-
duction of albuminous food by digestion. M. Andral asserts
that it contains no portion of the components of the blood, but
is simply a sudden and abundant secretion of mucus which is
altered in its character. The distinctive character between
albumen and " albuminose," is that the former is coagulated by
heat or nitric acid, and the latter is not. They could obtain no
precipitate by either of these agents. MM. Levy and Masse-
lot aflirm on the contrary, that it may or may not contain albu-
men, they assert that they have frequently obtained a precip-
itate and coagulation by nitric acid and heat,* though sometimes
none could bo obtained, M. Mialhe savs that the albuminose

1849.] Harriss, on Chulera. 389

is produced from the albumen and fibrinof the blood and living
tissues. These two substances of the blood undergo a trans-
formation analogous to that which results from the digestion of
these matters in the stomach by the pepsine of the gastric juice,
and the muscles undergo the same metamorphosis by a kind of
intersticial absorption. This matter, instead of nourishing the
patient, is thrown off' from the economy: it is first formed from
the blood, and secondly from the muscles. He thus accounts
for the rapid emaciation of the patient. This drain upon the
blood, for the albumen, fibrin, serum, &c., renders it so thick
and viscid that it stagnates in the capillaries, and hence the
cyanosis and coldness of the limbs. M. Masselot stated that
the albumen at the commencement of an attack is wanting or
but little, and augments as the disease advances. In cases
where there existed but little or no albumen in the evacuations
before death, there is frequently a good deal found in the fluid
contained in the intestines after death. This latter fact seems
a little extraordinary. This fluid contains a considerable quan-
tity of urea. As the[secretion of urine is stopped, the intestines
take on the function of the kidneys to illiminate the urea from
the economy.

The bladder is generally found to be congested, contracted,
and contains but little urine. The urine has a specific gravity
of 1.014, contains but little urea, and gives an acid reaction.
This fluid also deposites albumen by nitric acid or heat. This
fact was discovered and reported to the Academic de Medicine
by M. Levy of the Val-de-grace. M. Rostan had also proved
its existence. I have seen the latter test its presence frequent-
ly since. So abundant is the albumen that one might easily
imagine the patient to have Bright's disease, M. Rostan states
that its quantity in the urine is in a direct ratio to the intensi-
ty of the disease that it diminishes or increases in proportion
as the disease diminishes or increases. He also says that it is
so constant, that were he doubtful about the existence of
Cholera in any case, and there was albumen in the urine, he
would pronounce it unhesitatingly to be Cholera. If this be
strictly true, it will be a valuable diagnostic and prognostic sign.

No new alteration has been found either in the bile or blood :
the latter is deprived of its albumen, fibrin, serum and most of

390 rianiss. on Cholera. L'^'-'b'?

its salts ; owing to this drain it becomes thick, viscid, black,
and loses its affinity for oxygen.

Every variety of treatment has been tried, and all have been
attended with the same unsuccess no one, has appeared much
superior to the others, nor has obtained any very satisfactory
results. I will mention some of the treatments which have
been adopted during the epidemic. The Stachys Anatolica
was among the first which was tried it was given in infusion,
as a drink ; at the hospital of St. Louis it was administered to
several patients w^ith success. M. Cruveilhier, of La Charite,
and M. Barth, of La Salpetriere administered it, but no benefi-
cial effects were produced, and all to v/hom it was given died.
This medication was therefore soon rejected as being unpleas-
ant to take and ineffectual.

Chloride of Sodium has been administered with some success
by M. Oulmont, an interne at La Charite : he gave it in large
doses by the mouth and by the rectum. This was repeated at
St. Louis with success. M. Oulmont did not follow entirely the
plan recommended by Stephens, from whom he doubtless got
the idea. Stephens gave this salt in combination with the
Bi-carbonate of Soda and Chlorate of Potash. M. Oulmont
gave the Chloride of Sodium uncombined. The success with
which he first met gave grounds to hope that it would prove a.
valuable agent ; but results from a longer trial proved that it
could not be surely relied upon. In some cases it certainly
acted favorably it soon stopped the vomiting and diarrhoea,
animated the heart's action and promoted the secretion of urine.
He still has great confidence in this agent. It certainly seems
more rational to me to administer all the salts which Stephens
recommends. The only reason for adopting this treatment, as
I conceive, is to supply the blood with the salts which have
been drained from it through the intestinal canal. If this is so,
why administer one and not the other ?

The Nitrate of Silver has also been administered. M. Barth
gave it in injection and succeeded in stopping the diarrhcea ;
the cessation was, however, but temporary ; the flux soon re-
turned with its former abundance. He has ceased its use.
This agent has been more extensively given by the mouth.
]\IM. Girouard and Greslon reported five or six cases of sue-

1849.] lliiniss, on Cholera. 391

cess. Dose, 4 frrs. to 4 or 5 ounces of water ; a table-spoonful
every hour. The reaction })roduced by this agent is not vio-
lent, and therefore not attended with much danger. The facts
are not sulliciently multiplied to allow us to draw a conclusion
either favorable or otherwise, of this treatment. This agent
has been a long time since recommended in epidemic dysente-
ries, but has never obtained a great reputation for its efficacy.
M. Trousseau recommends it in some dysenteries of children.
Chloroform has been administered internally with some degree
of success ; 31. Yernois reported ten cases, nearly all of whom
recovered. Many others have been reported since given in
doses of 10 or 20 drops with 10 or 12 drops of Laudanum, in
some convenient drink, it is said to calm, without any doubt,
the cramps and stop the vomiting. It has also been tried by
inhalation its effects were favorable, but temporary; the dis-
ease soon returned with its former violence and destroyed the
life of the patients. Purgatives, emetics, and emeto-cathartics
have all been recommended and tried in their turn. Galvanism
has also been tried, though not to a great extent. Homoeopathy
has had a much fairer tiial : six or eight patients were treated
by this plan at the hospital of St. Louis, but one of whom re-
covered. M. Guillot gave six patients from his ward at Salpe-
triere to a homoeopathist to treat, but unfortunately for the
doctrine of Hannemann, as w^ell as for the patients, all sunk
under the disease without even a temporary relief from the all-
powerful medication.

Dry air-baths and the internal administration of stimulants
has proven to be the best of all known treatments. This has
been adopted at Yal-de-grace and Hotel Dieu, where it will be
seen from the table that the best success has been obtained. It
is true, that the patients of the Val-de-grace are soldiers, and
consequently men better fed and clothed than those brought
into the civil hospitals. It is doubtless owing to this circum-
stance that the number of cures are greater there than at the
Hotel Dieu, where the treatment has been identical. But this
alone will not account for the greater success at Hotel Dieu
than at the other civil hospitals, for it is as badly situated as
any fiospital in Paris. I have observed a circumstance which
was also observed in the last epidemic of Cholera, viz., the ap-

392 Harriss, on Cholera. [July,

pearance of a great number of odd diseases. There were a
great number of neuralgias and rheumatisms, particularly of
the muscles, accompanied with eruptions upon the skin unlike
any of the ordinary diseases of this surface some resembled
rubeola and scarlatina, but did not take frankly the ordinary
characters of these diseases ; they would sometimes appear
upon patients who had never had Cholera, at other times they
would appear upon those convalescent from this disease. In
patients affected with bronchitis, pneumonia or typhoid fever,
who weie attacked with Cholera, the first would disappear until
the latter was cured, and then reappear and run its ordinary
course. The most important complication that I have seen
with the Cholera was of cerebro-spinal meningitis; this disease
is generally consecutive of the Cholera, for it occurred in most
cases whilst the patients were in a state of convalescence. I
have seen but three cases of this kind though many have oc-
curred ; these manifested all the symptoms of meningitis, and
died in a state of coma. The brain, as revealed by autopsy,
was congested its whole substance infiltrated with serous fluid.
This was also found in considerable quantity between its con-
volutions and in the ventricles, particularly the lateral:

The circumstance that the Venereal hospital here has been
entirely exempt from the Cholera, and that some affirm that
they have not seen a single syphilitic patient attacked with the
epidemic, has led to the suggestion that probably syphilis is a
specific against it. If there is any truth in this, the question
would arise whether the specific against the Cholera was
syphilis or mercury, which is administered in greater or less
quantity in such cases?

Now that the epidemic is declining, nearly every variety of
treatment seems to succeed to some extent. Though the
treatments are exactly the same now as at the commence-
ment of the Cholera, the success of each seems much greater ;
this I think is not owing to the efficacy of the plans adopted,
but to the mild character which the epidemic has taken in its
decline.

Paris, 1st May, 1840.

1849.] Veuditiion, on SlaliUk:/ of Diseases. 398

ARTICLE XIX.

Statistics of Diseases in Hancock Counti/. By E. M. Pendle-
ton, M. D., of Sparta, Georgia.

For the past several years I have kept a book of all the cases
occurring in my practice, from which I have condensed several
statistical tables, which I propose to present to the readers of
the Southern Medical and Southern Journal in consecutive
numbers, with such remarks and inferences as may present
themselves to my mind. It is now an established principle, I
believe, that statistical information is more valuable than almost
any other in determining the great principles of Medicine,
whether those principles relate to the etiology of disease
or the therapeutical effects of remedies. Hence it has almost
become to be an adage that one fact is worth a thousand
theories.

I am particularly influenced to bring forward these tables,
by the fact, that no such effort has ever been made, in my
knowledge, by any private practitioner, and that the country,
especially, has never been represented even by Sexton's Re-
ports, much less by any definite tables indicating the'character
and mortality of diseases. I have only to regret that the
smallness of my tables will not in all instances indicate the ex-
act ratio of disease, but I hope at some future day to present a
mass of information on this subject, that will at once edify and
move to the production of similar results, some of my medical
brethren who perhaps have better opportunities for eliciting
facts of this character.

I have made such classifications of disease as appeared to
my mind to be the most natural, without any reference to the
nosological distinctions of authors. In the main, however, my
tables correspond with the generally received opinions
where they differ essentially I will endeavor to explain so as
to relieve the subject from all ambiguity.

My first table embraces 1613 cases, and is intended to
indicate the susceptibilities of different organs and functions
to disease at different periods of the year. The table, how-
ever, will speak for itself

394

Peiidleturi, on Statistics of Diseases.

[July,

General classes of

DISEASE.

XJ

^

ra

'5
1-^

fcC

<!

1

o
15

c3

Q

5
o
H

425
224

89

104

37

21

70

38

204

41

188

87

82

53

I613I

Digestive

19
16
9
4
0
3
5
3
12
2
6
5
3
5

17

^2

7
G
2
4
4
G
11
2
3

,^

3

22
14
10
8
3
3
8
5

17
1
3
3
7
7

45

24
4
6
G

2
8
4
18
2
4
3
8
5

43

15
9

11
5
2
G
2

IG
2
5
3
5
2

40
8
8

14
4
1
4
3

23
G
3
1
7
2

123

50

22
8

14
2
1
4
5

16
5

19
0
7
G

159

37
9

10

10
5
1
4
3

28
8

34
5
6
5

165

68

14
7

11
2
2
8
3

16
3

52
2
5

199

49
31
6
6
5
1
3

.1

2
46
6
8
3

186

21

17

5

8
1
0
8

.?

3
9
2
5
3

95

14

24
6

8
2
1
8

1

4
3
9
5

107

9,G 3

Respiratory

13 0

Brain and Nerves. . .
Osseous

5.5

G 5

Urinary

9, 3

Visual

1 3

Cutaneous

4 3

Articular

9, 4

Peculiar to women..
Abscess

12.6
2 5

Periodic fevers

Continued fevers....
Injuries

11.7
2.3
5 1

All others

3 3

Aggregate

92

111

111

139

126

100

All the diseases of the osseous system in the above table be-
long to caries of the teeth, with the exception of two cases of
necrosis of the tibia. Those marked cutaneous, embrace
eruptive fevers, which should have found a distinct class; but
within the few past years, neither scarlatina or rubeola have
occurred epidemically in this section until the present spring,
which is not embraced in these tables. I therefore conclued to
embrace all cutaneous affections under one general designation.
Under the term Abscess, I embrace furunculus, ulcers, and ab-
scess proper. Parturition is classed with diseases peculiar to
women. Periodic fevers include the remittent, intermittent
and congestive ; continued fevers, the simple inflammatory,
common continued and typhoid.

The following facts are inferable from the above table :
That January is the healthiest month in the year, and Novem-
ber the next ; that September and October are the sickliest.
That there are three climaxes of disease during the year the
greatest in September, the next in April, and the least in De-
cember. Thus, from June to September there is a rapid
increase of disease, and from September to Noveniber a rapid
declension. From January to April there is a gradual increase,
and from April to June a gradual decrease. And so there is
an increase in December over November, and a decrease in
January again, forming the smaller climax in December. The
increase of disca'^e in the autumnal months is accounted for on

ia4U.J rcnJletuii, un SluliaUca uj Diaeaacs. '6\ib

the i)rinciple of malaria, formed from heat, moisture and vege-
table putrefaction. Why April should be so much ahead of
February and March is not so clear. By reference to the
table, however, we find that the increase depends mainly on
diseases of the digestive system ; hence, we infer that April is
a sicklier month than the others on account of the introduction
of unripe fruits and early vegetables, which have a relaxing
effect upon the digestive organs, and produce cholera morbus
and gastric fevers, especially among children. And we sup-
pose that December, being the first month of winter, is produc-
tive of more diseases of the respiratory system (as the table
indicates) on the principle of alternation of temperature, from
the mild bracing weather of November to the cold chilling
winds of winter.

We further learn from the above table, that about one-fourth
of all our diseases effect the digestive organs, one-eighth the
respiratory, and nearly another eighth are peculiar to women.
Periodic fevers come in next, constituting about one-ninth.
These four classes, embracing considerably more than one-half
of all the diseases in our table. It is proper to remark, in refer-
ence to diseases of the teeth, that we cannot form a fair estimate
of their relative proportion with the other classes owing to the
fact that we have had a good portion of the time embraced, a
resident dentist in our village, who has appropriated a consid-
erable portion of this practice.

With regard to the effect of season on the particular classes
of disease, it would seem that September presents the maximum
of digestive cases, and December the minimum. October the
maximum of the respiratory, and June the minimum. Of peri-
odic fevers, September is in the ascendant, and February and
March the lowest. Of diseases peculiar to women, Auirust
stands the highest against February, and November the lowest.
The remainder of the classes do not present such marked differ-
ences, but the modifications of season will appear more manifest
in my next table, which will present the cold and warm months
in aggregation and opposition to each other.

39G Cooper, on Gun-shut Wound. July,

1^ ARTICLE XX.

Case of Extensive Gun-shot Wound Recovery. By George
F. Cooper, M. D., of Perry, Houston County, Geo.

Nancy, a servant woman, aet. 40 years, received on the 30th
of January of the present year a wound, by the accidental dis-
charge of a shot-gun, charged with the largest size shot. She
was sitting within twelve feel of the young man who had the
gun, (a son of the owner of the slave,) and must have received
the principal part of the load her face must have been turned
obliquely to the left of the young man, as the shot entered
about the middle line of the face and passing out just anterior
to the ear. The wound extended vertically from the internal
canthus of the right eye, down through the upper lip ; the soft
parts included between a line drawn from immediately below
the internal canthus to the tragus, and another drawn from the
right angle of the mouth back to the angle of the inferior max-
illa, were entirely destroyed, with the exception of the duct of
steno, which was entire, lying loosely down upon the inferior
jaw, totally divested of all its attachments, back as far as the
extent of the wound. It could be easily raised to its normal
position and was found to be of proper length ; it of course
came away with the detachment of other sloughs, and the sa-
liva escapes now at an orifice within the oval cavity. The
right naris was entirely destroyed back into the pharynx, the
left opened half of its course anteriorly ; the right half of the
hard palate was also destroyed ; the whole of the masseter
muscle carried away, and the end of the temporal was cleanly
detached from its point of insertion into the cornoid process.
The whole body of the sup. maxilla was mutilated and the
quarter portion driven away, separated from its fellow along
the palatine process, including the right palate bone which was
also separated from its opposing fellow, and rested upon the
tongue, to the great annoyance of the patient. The orbitar
plate of the sup. maxilla was fractured into several pieces,
causing the eye to fall much below its proper level. The injury
in this region extended back to the bottom of the orbit. The
alveolar processes of the left sup. maxilln, including that of the

18 49.] CoopeTy on Gun-shot Wound. 387

incisors, were also fractured. The malar bone was distinct
from all its angles held in place, however, by the skin which
partly covered it. The inferior maxilla was fractured just
anterior to its angle. The point of the coronoid process was
shot away the body of this bone contiguous to its angle was
denuded of its soft parts.

With this array of facts, one could readily imagine what re-
mains to be said of the constitutional condition of our patient ;
especially when we consider the importance and vascularity
of the parts involved, and its contiguity to the brain.

The second degree of concussion was present for some hours,
but consciousness slowh^ returned ; the nervous and vascular
systems still remaining in an extreme lethargic condition ; pulse
eight hours after the reception of the injury were about 45
beats per minute and very feeble ; the extremities were cool,
&c. The amount of immediate hemorrhage will explain in
part her prostration it being probably more than is usually
consequent upon w^ounds of this character. It was however
of short duration, which circumstance, perhaps, was fortunate
for her. On the morning of the 31st, her improvement was
scarcely perceptible; the temperature of her body was rather
more equable than the evening before. She now complains of
considerable headache. I removed all the spiculae of bone;
cold water dressing was applied, and ordered to be kept up ; a
simple roller over the vertex and under the jaws, to support
the inferior maxilla, and a compress over the seat of fracture,
constituted the treatment. Apprehending if irritation should
be at all violent, a recurrence of hemorrhage and almost inev-
itable inflammation of the brain from contiguity, (for be it re-
membered the wound extended to the bottom of the orbit almost
in contact with the base of the brain,) I at no time ordered
the administration of any stimuli to accelerate reaction.

Feb. 1st. But little improvement, vital phenomena scarcely
more active than the day before, which I regarded as decidedly
favorable, for reasons stated above. I now entertained some
fears of secondary hemorrhage upon the detatchment of
sloughs : treatment continued.

Feb. 2d. Reaction exceedingly tardy ; no furlhpr unfavor
able indications ; same treatment continued.

398 Wooten, on Death from Laudanum. [July,

Feb. 3d. Sloughs beginning to separate; suppuration in its
incipiency ; no recurrence of hemorrhage. Ordered, warm
water dressing, and as a topical application, a dilution of La~
harraques Solution, for the correction of the fcetor and its
slightly stimulating effect; meal-gruel, chicken-water and wine
whey, allowed for nourishment ; an enema ordered in the af-
ternoon.

Feb. 4th. "Wound now granulating finely ; every indication
of terminating happily : treatment, same.

I did not, after this, in consequence of the distance, see her
regularly; but obtained intelligence from her as often as was
necessary. She gradually convalesced, and had entirely re-
covered when I last saw her, March, 19th, she was still ema-
ciated, yet enabled to walk about the house the right eye,
as before stated, which had fallen below its level, had been ele-
vated to its proper height vision, however, was very imperfect
and the pupil preternaturally dilated.

The wound, in cicatrizing, had drawn the face somewhat to
the right, and the great destruction of the soft parts was re-
paired to a considerable extent, leaving, however, a large open-
ing in the cheek, which permits a protrusion of the tongue at
every eifort to speak, rendering articulation exceedingly indis-
tinct. The lower jaw had united, to my surprise.

I am induced to make this report, from the extent of the
wound, the importance of the parts involved in it, and the
power of the vis medicatrix natures in bringing about a recov-
ery.

ARTICLE XXI.

Death from a Drop of Laudanum. By. H. V. Wooten, M. D.,
of Lowndesboro', Alabama.

A fine, healthy, female child, in the 5th day of its age, suf-
fered from "griping," as its mother supposed, for which she
administered to it one drop of laudanum. Thirty minutes after-
wards, its breathing becoming slow and stertorous, I was sent
for; but being absent, another physician saw it, who found n

1819.1 Wooten, on Death froin Laiulaaum. 300

impossible to get tlie child to swallow any thing. External ex-
citants, &c., were resorted to, and three hours after the lauda-
num was taken I saw it. Its pupils were dilated and insensible
to light, breathing very laborious, each inspiration giving a
loud struggling sound, great lividity of complexion, &c. It
would draw four inspirations, at the rate of sixteen per minute,
and theh cease to inhale about thirty seconds, when the four
inspirations would again be drawn. On the fourth inspiration,
a general spasm of the extremities would seize it. Its pulse
during the last two inspirations were about fifty to the minute,
during the spasm and suspension of breathing it would run up
to about 100, become very weak, and finally cease at the wrists
about six seconds before the breathing was resumed.

This condition continued without material variation until
the sixth hour, when on bathing it in hot water and brandy,
followed by the application of plasters of cayenne to the feet
and hands, it breathed, continuously, but with great difficulty,
at the rate of 30 inspirations to the minute, for 20 minutes,
and its pulse during all this time ranged from 90 to 100. Its
pupils contracted a little, and the lividity of complexion disap-
peared to a considerable extent. Hopes were now entertained
that it had passed the crisis, and would recover ; but spasms
again seized it, from which it fell into a collapse, from which
nothing that we could do would raise it. After this it would
draw only three inspirations at the rate of twelve to the min-
ute, when spasms would occur, and the suspensions of breath-
ing become longer. At the 10th hour, it drew but two inspira-
tions together about twelve seconds apart, and then suspend
for nearly a minute. For three hours, I thought during every
suspension of breathing, that it was dead, as its pulse would
cease at the wrists before breathing was resumed ; but it con-
tinued to labor for breath in this way until the end of the Uth
hour, when it died.

The laudanum was dropped from an ounce vial, in which
there was but about ten drops. It had been stopped with a
piece of twisted paper, and hanging up about a year : all the
inner surface of the lower part of the vial was encrusted with
opium, and the remaining laudanum was heavily charged
with this deposit resulting from cvnporation. Every means

400 Cullender, on Hysteria. J>-ily,

of keeping the child alive which our ingenuity could suggest,
were diligently applied, and with apparent effect, but not
success.

This case is one which rarely occurs, and I report it mainly
on that account ; yet it is not otherwise destitute of interest.
The stomach pump was not used, because I had no tube of
suitable size, and besides, I was satisfied that it was too late to
resort to measures of that kind when I saw it.

Singular Case of Hysteria. By George D. Cullender, M. D.,
of Pelham, Tennessee.

Mrs. H , aged 22 years, received some injury of the

knee-joint; the pain was most excruciating for several hours;
when it ceased, she immediately began to laugh and cry alter-
nately. At this time I saw her, and considered it a well marked
case of Hysteria. I administered an antispasmodic. As there
was no pain in the joint, I ordered the limb to be kept quiet.
In about twelve hours afterwards I was again sent for in haste.
When I arrived I found her convulsed. I learned that the pain
in the joint and the hysterical symptoms alternated ; so long as
the joint was painful she was free from convulsions. They
now increased to a fearful degree. Opium was given without
benefit. It now occurred to me, that if I could keep up the
pain in the joint the convulsion might cease. I immediately
applied equal quantities of spts. ammonia and spts. turpentine
to the joint, with smart friction ; this produced some pain, and
moderated the convulsions. I then applied a blister to the
joint the convulsions ceased entirely. The blistered surface
was dressed with stimulating ointment, and a mild cathartic
exhibited, followed by a dose of morphia. Next day she ap-
peared almost well ; the irritation was, however, kept up for
several days, when all pain ceased in the joint, &c., and she
Was as well as usual.

1849.] Bibliographical Notices. 401

^^== ~ ' ' , , ' '' I t

PART IL

BIBLIOGRAPHICAL NOTICES.

1 . Practical Pharmacy : the arrangements, aj)paratus, and maniputa-'
iions of the Pharmaceutical Shop an^ Laboratory. By Francis
MoHK, Ph. D., Assessor Pliarmaciic ofthe Ivoyal Prussian College
of Medicine, Coblentz ; and Theophilus Redwood, Professor of
Chemistry and Pharmacy to the Pliarmaceutical Society of Great
Britain. Edited, with extensive additions, by Wm. Proctor, Jr.,
Prof, of Pharm. in the Philadelphia College of Pharmacy. Illus-
trated by 500 engravings on wood.- 8vo. Pages 576. Philadel-
phia: Lea &; Blanchard. 1849.

It seems to us this work is calculated to do much good. It has long
been a desideratum to our practitioners of medicine, especially those
of them removed from the facilities of pharmaceutical manipulations
of large cities, to have some work of reference in preparing their
therapeutic agents. Combining, as this one does, the mode of admin--
istering the materia medica of Germany, Great Britain and our own
country, it must certainly contain very superior results. The illus-
trations, &c., arc executed in the usual excellent style of the well
known publishers, to whom we are indebted for a copy.

2. Anaesthesia, or the Employment of Chloroform and Ether in Surge-
ry, 31idicifery, Sfc. By J. Y. Simpson, M. D., F. R.S. E., Prof.

of Midwifery in the University of Edinburgh, &c. 8vo. pp. 248*
Philadelphia: Lindsay & Blakiston. 1849.

We have in this volume the history of the most important and
useful discovery of the present age. All wishing to be fully ac-
quainted with the subject of which it treats, would do well to possessr
this book.

3. A Practical Compendium of Midwifery ; being the Course of LeC"
tures on Midwifery, and on the Diseases of Wornen and Infants,
delivered at St. Bartholomew'' s Hospital, by the late Robert Gooch,
M. D. Prepared for publication by George Skinner, Member of
the Royal College of Surgeons, London. Fourth American edition*
8vo. pp. 339. Philadelphia: Edmund Barrington and George D.
Haswell. 1849.

We have here, in a permanent form, the lectures of one of the most
celebrated accoucheurs of Great Britain, on a most interesting and
deeply important department of Medicine. Their value may be esti-
mated by tiie fact that this is the fourth American edition.

N. ?. VOL. V. NO, VII. 26

402 Bibliographical Notices. U^^y,

4. The Maternal Management of Children in Health and Disease,
By Thomas Bull, M. D., Member of the Royal College of Physi-
cians, &c. From the third London edition. 12mo. pp. 406.
Philadelphia : Lindsay & Blakiston. 1849.

We find this to be an excellent manual for mothers ; written, as the
author states, at the request of a missionary, it will do great good
in the nursery in the absence of a physician.

5. An Introduction to Practical Chemistry, including Analysis. By
John E. Bowman, Demonstrator of Chemistry in King's College,
London. 12mo. pp. 303. Philad : Lea & Blanchard. 1849.

Works on Chemistry surely abound of late. This little one only
aspires to teach the very elements of this delightful science. Fpom
a cursory examination of it, this seems to be well done.

6. Lectures on the Venereal and other Diseases arising from sexual
intercourse; delivered in the summer of 1847, at the Hopitaldu
Midi, Paris, by M. Ricord. Reported and translated by Victor
DeMeric, M. D., &c. 12mo. pp. 296. Philadelphia : Edmund
Barrington and Geo. D. Haswell. 1849.

These lectures, some of which we had the pleasure to listen to when
delivered in the garden of the great Venereal Hospital in Paris, were
originally published in the London Lancet. We have had frequent
occasion already to enrich our pages by abstracting from this source.
The name of the author is now forever identified with the subject which
he has so graphically described, and to the treatment of which he is
devoting his life. Born in America a citizen of France since an
adult, Ricord is not unfrequently consulted in Great Britain to deter-
mine doubtful cases of sexual diseases. No man has a more world-
wide reputation for venereal affections.

7. A Manual of Auscultation and Percussion ; by M. Barth, Agrege
to the Faculty of Medicine of Paris, &c., and M. Henry Roger,
Physician to the Bureau Central of the Parisian Hospital, &c., &c.
Translated, with additions, by Francis G. Smith, M. D., Lecturer
on Physiology in Philadelphia Association for Medical Instruction,
&c. Second edition. 12mo. pp. 167. Philadelphia : Lindsay &
Blackiston. 1849.

This is one of the best of the many works published on the
subjects of Auscultation and Percussion. It is a second edition of
what we have previously recommended to the favorable notice of our
readers.

1 849.] Auloplasly in treatment of Vcsicu- Vai^inal Fistulce. 403

AntopInstJ/ applied to the treatmnnt of Vesico-Vaginal fistulcp..
By M. JoRKRT, (De Lamballe.) Surgeon to llie 8t. Louis
Hospital. (Translated ibr this Journal, by Henry Rossignol,
M. 1)., of Augusta, Ga.)

Yesico-vaginal fistula3 were, for many ages, considered as
entirely beyond the reach of surgery, and so firmly was this
believed, that even within the past few years some of the most
celebrated surgeons denied the curability of them, without
even giving themselves the trouble of examining the living
proofs to the contrary which were placed before them. This
scepticism was unjust and badly founded. Since cures have
been so often effected by M. Jobert, a doubt can no longer be
. entertained upon the subject. Alread}^ have the readers of this
Journal had presented to them several cases which occurred in
the Hospital St. TiOuis. My intention is not to add new facts,
I wish only to call attention to certain peculiarities in the mode
of operating. But first, let us glance at the ancient and modern
authors.

J. L. Petit is the first who occupied himself with Vesico-
vaginal fistulse, and interesting as his reports are in several
respects, all are silent on the subject of cure ; one only con-
tains any thing worthy of notice. This was the case of a
woman, who, affected with a vesico-vaginal fistula, consulted
several practitioners, among whom was the illustrious surgeon.
After a minute examination, one of them proposed the suture
as a curative means. J. L. Petit objected to it, on account of
the difficulty of putting it in practice. His opinion prevailed,
and the patient was advised to use, as a palliative means, a
peculiar instrument, a kind of urinal, which J. L. Petit called
heWs hole.

Desault did more than J. L. Petit he pointed out a curative
means his method, the simplest of all, without being the most
rational, consisted in fulfilling two principal indications; 1st, in
bringing the two lips of the fistula together; 2cl, in preventing
the urine from passing through the abnormal opening. The
first indication was fulfilled by introducing a tampon into the
vagina, and the socond by fixing a catheter in the bladder.
Notwithstanding the respect which we have for the word of
Desault, and notwithstanding the reports in the Treatise on
diseases of the urinary passages by Chopart, we doubt whether
a vesico-vaginal fistula was ever radically cured by this means.
At least, the numerous cases which we have collected for sev-
eral years, will scarcely permit us to admit it. The surgeons
who came after Desault do not adopt his method ; they employ
cauterization either with nitrate of silver, caustic potass, or the
^'"fual oautrry. The cauterization was most frequpntly appli-

404 Autoplasty in treatment of Vesica- Vaginal FistiilcB. [Jul v,

ed to the lips of the fistula. M. Leroy d'Etioles, wishing to
change the form of the fistula and to draw the edges together,
proposed to apply the caustic on the outside of the fistula, and
gave to this method the name of radial cauterization. All
these methods are insuflicient in the majority of cases, for the
reason that all vesico-vaginal fistulas are accompanied by a
loss of substance more or less great. They do, nevertheless,
aflford some amelioration, but unfortunately, it is but for a very
short while, and the cause is easily explained. The caustic
causes a local inflammation of the edges of the fistula or a tu-
mefaction which may place the lips in contact ; but very soon
the eschar falls off*, the tumefaction subsides, and the urine re-
commences to pass through the vagina more freely, because
the falling off of the eschar has only augmented the fistulous
opening. This difficulty was perfectly understood by M. Lal-
lemand, who, after having cauterized the edges of the lips of
the fistula, imagined that he could keep them in contact by
means of a pair of hook-forceps. This is a complicated instru-
ment, difficult of management, by the aid of which the posterior
lip is seized with a pair of hooks and drawn in front, whilst the
anterior lip is pushed backward by means of a plate placed in
front of the pubis. There is besides, fastened to this instru-
ment, a tube which remains fixed in the bladder and gives issue
to the urine. M. Lallemand's method was, undoubtedly, an
improvement, and in 1825, he published, in the Archives of
Medicine, a memoir in which the radical cure of a lady is men-
tioned, by means of the hook-forceps. However, the instrument
of the professor of Montpellier could not be born without pain
and could only be applied to transverse fistula3.

M. Laugier modified it so that it could be applied to all
fistulas.

Notwithstanding the success of M. Lallemand, cauterization
was partially abandoned and replaced by the. simple suture.
M. Roux advised the twisted suture. The majority of surgeons
use the interrupted suture. However, whatever kind of suture
is employed, it is first necessary to trim the edges of the fistula,
and though this might be done by means of caustic, practition-
ers generally prefer the knife.

The trimming of the edges presents great difficulties, depend-
ing upon the depth at which the parts are situated. In order
to avoid this inconvenience, Sanson detached the neck of the
bladder on two sides; this done, he introduced a finger mto the
bladder ; the borders of the fistula were then easily brought to
the vulva and the suture easily effected. We think this exposes
the patient to an incontinence of urine. Sanson's operation
was unsuccessful, and M. Vidal (of Cassis) despaired of ever

1 849.] Auto^ilasty in treatment of Vesica- Vdgimil Fistulw. 405

succeeding by a direct mode and suggested the indirect method
or that of infibulation. l^efore discussing tfiis new method,
we will wait until a well authenticated case has established its
use. We will only remark, that, since time immemorial, the
operation of infibulation has been practised among several na-
tions of the East, to secure the chastity of the females.

The operation of Professor Sanson was, without doubt, well
performed; but an important point had escaped him it was
not only necessary to put the lips of the fistula in contact, but
it was also necessary to repair the loss of substance. It was
this autoplastic principle, this therapeutic indication, which has
been lately perceived by several modern surgeons, and so ad-
mirably fulfilled by M. Jobert.

The method of M. Gerdy, which consisted in dissecting
away the mucous membrane on each side of the fistula and in
maintaining the two lips thus formed, in contact by means of
the twisted suture, only succeeded partially. M. Velpeau's
was not as successful. It consisted in forming a flap on the
posterior part of the vagina, sufficient for the obliteration of
the fistula. This is not the case with the operation of M. Jobert,
since by this method fifteen or twenty patients have already
been radically cured. It is this method which we will describe
in detail : we will first say a few words of an autoplastic oper-
ation, to which the surgeon to the St. Louis Hospital gave the
name of elytroplasty.

This operation, difficult in its performance, and little certain
in its result, consists in taking a flap from one of the buttocks
or greater labia and placing it in the fistulous opening, the edges
being previously trimmed. M. Jobert was successful in sever-
al instances by this method, but it must be confessed he failed
much oftener. With this he w^as not satisfied, but continued
his researches until he discovered the autoplastic operation
which we are about to describe. Though minute in its details,
it is important to know them all and to omit none. Several
instruments are required, which we will describe.

1st. A univalve speculum lever, which serves to depress the
posterior portion of the vagina.

2d. A lever with an elbow bend, used for elevating the ure-
thra and anterior part of the vagina.

3d. Two levers for separating the sides of the vagina. This
instrument can be replaced by the fingers of the assistants.

4th. One or more of Museux's forceps, with which to seize
the neck of the uterus, as we will see hereafter. M. Jobert
has lately invented a pair of forceps which grasps the neck of
the uterus at the insertion of the vagina. These forceps do
not tear the tissue, like those of Museux. They are so jix-

40G Aiitoplasty in treabnent of Vesica- Vaginal FistulcB. [July,

ranged as to remain fixed upon the neek of the uterus when it
is taken.

5th. A pair of curved forceps, with which one of tlrehps of
the fistula is seized and brought forward, so that the edge can
be more easily trimmed.

6th. Forceps with very fine teeth, or with teeth which fit in
between each other, similar to those used by M. Jobert in the
operation for strabismus.

7th. A common needle-holder of M. Roux, used for holding
the curved needles.

8th. A straight needle fixed in a solid handle. M. Jobert
has abandoned this instrument.

9th. It is sometimes difficult to introduce the needles through
the vagina. In these cases, M. Jobert uses a canula which con-
tains a moveable needle; with this the thread is carried up to
the urethra ; the thread is then passed from the bladder to the
vagina.

10th. Besides these instruments, it is necessary to have scis-
sors, bistouries, female catheters, ordinary forceps, curved need-
les with fiat thread and fixed to the needle-holder, a tampon of
agaric, a gum-elastic catheter.

The operation is performed as follows:

1st, The patient is placed upon her back, the buttocks near
the edge of the bed, the legs flexed upon the thighs and these
upon the abdomen. The patient is held by several assistants.
The univalve speculum is then introduced and the posterior
part of the vagina depressed, whilst the greater and lesser lips
are separated by the fingers of several assistants. The neck
of the uterus is seized with a pair of forceps and brought to the
vulva, and maintained there during the operation. This dis-
displacement of the neck of the uterus draws downwards and
forwards the anterior part of the vagina where the fistula is
situated, thus rendering it more accessible to the knife.

2d. By means of a half circular incision, the anterior portion
of the vagina is detached from its connection with the neck of
the uterus ; the two edges of this w^ound separate immediately
and leave a V)leeding surface of about an inch in extent. The
vagina slips forward spontaneously, and the lips of the fistula
come in contact. The loss of substance is, by this simple in-
cision, entirely replaced.

3d. The edges of the fistula are trimmed offby means of the
forceps and scissors, or bistoury. The edges should be trimmed
with great caution and in a circular direction of about a centi-
metre in extent. The mucous membrane alone should be re-
moved. These two precautions are indispensable : the first, to
place two bleeding surfnces in contact; the second, to avoid
increasing the loss of substance.

1849.] Domestic Medicines. 407

4th. The sutures are now applied, varying in number accord-
ing to the size of the fistula. M. Jobert prefers the interrupted
suture- Sometimes the needle pierces both lips of the fistula
at the same time, and nt others, on the contrary, each lip is
pierced separately. The thread should always be flat, and
composed of three strings and well waxed. The sutures should
not be more than a centimetre apart.

5th. The threads are drawn tolerably tight, and one end left
long enough to be seized, when it becomes necessary to remove
them.

Gth. Sometimes, after the sutures are applied, and notwith-
standing the separtion of the vagina from its insertion, there
still exists some degree of drawing about the fistula ; this is
remedied by a few superficial incisions in front or on the sides
of the fistuia.

7th. In order to avoid the dripping of blood, a tampon of
agaric is introduced into the vagina ; this is removed some days
after, sometimes on the next day.

8th. A gum-elastic catheter is fixed in the bladder and the
patient put to bed, lying upon her back, and the legs and thighs
elevated by means of cushions. The catheter is fastened to a
bandage which passes around the body. It should be watched
and kept open so as to allow the urine to pass.

This important operation, devised by M. Jobert, in 1845, has
already, in his hands, furnished a great number of cures.

A. Roze, M. D.
[From Bui. Gen, de Therapeutique.

Domestic Medicines. By J. F Skinner, M. D., of Browning-
ton, Vt. (Boston Medical & Surgical Journal.)

The careful consideration of the public is requested to the
following exposition of facts, in connection with the sale of
medicine as the business is now carried on throughout the
country. That gross and injurious fraud and deception are
constantly practised upon the community by the various
nostrum venders of the day, is plainly visible on the face of
their own publications, which are thrown, broad cast, into
every family, containing the most inconsistent and extravagant
statements and recommendations that the ingenuity of man
can possibly devise. Each one claims the discovery of some
new and wonder-working composition, derived from the
vegetable kingdom ; possessing the strange property of curing
all and every kind of disease, of whatever organ, or from
whatever cause excited. For illustration, by one class we

408 Domestic Medicines. [July,

are told that all diseases arise from impurity of the blood, and
that their pills are the only article in the world possessing the
power of purifying that vital fluid ; of course they are the only
safe remedy for all possible kinds and forms of disease. A
moment's reflection will satisfy any attentive mind, that the
doctrine here advanced is utterly false. Instead of impurity of
the blood being the cause of all diseases, it can never be the
cause, but is always the consequence of disease, either func-
tional or organic, afl^ecting some one or more of the various
organs concerned in secreting or circulating that important
fluid; for while all such organs maintain perfectly healthy
action, the blood can no more become impure, than a good per-
fect distillery, operating on the proper material, could fail to
produce a good article of any of the various oils procured by
distillation. The doctrine, then, which is here taught, and
w^hieh forms the basis on which such pills are palmed off upon
the public, is utterly and entirely false. The community are
taught to believe an error in principle, which leads to error
and consequently injury in practice.

By another class we are told that their plasters are rare
compounds, possessing the singular property of acting as a
stimulating and strengthening plaster when w^anted for that
purpose, and still strangely mild, soothing and all-healing,
when applied to the raw and tender surface of a large burn or
seald, or to the surface of the most irritable ulcer ; of course
they are called all-healing, and directed to be used in all pos-
sible cases. V/hat person of common sense and observation
can believe this ? Does not the simple fact that they are sufli-
ciently active and stimulating to render them of any value for
the purpose of a stimulating and strengthening plaster, afford
conclusive proof that they cannot be used with impunity in
burns, scalds, wounds and irritable sores, which positively re-
quire the most mild, soothing and healing applications.

Another class tell us that all diseases arise from suppressed
perspiration, and that there all-healing ointments, when applied
to the surface of the body, will open the pores and thus eradi-
cate all kinds of disease. Who can believe that a small box of
almost inert ointment, applied to the surface of the body, will
at once be a sovereign remedy for inflammations of the brain,
lungs, bowels, and all the various forms of disease produced by
all the various causes which operate on the human system ?

So wide, varied and extensive is the range of quackery, that
in considering its follies and impositions, one hardly knows
where to begin or where to end. A few only of the multitude
can be here even hinted at. Homoeopathic, hydropathic,
electro-magnetic, botanic, mesmeric and Indian, all come in for

1849.] Domestic Medicines. 409

a share, each claiming infallibility, and discarding every princi-
ple of philosophy and chemistry known by scientific men to
have been for ages well established and incontrovertible.
Look at the doctrine laid down by the founders of homceo-
pathy. The danger to the community from this form of
quackery is rather negative, than positive the neglect to do
wiiat may be needed, rather than doing a positive injury, as
any medicine administered in infinitesimal doses can neither do
good nor hurt. What sane man can possible make himself
believe that the smaller the dose of any given medicine, the
more powerful will be the effect the niore it is diluted, the
stronger it becomes? On this principle, should a lady mix a
teaspoonfal of salaeratus with a whole barrel of flour, instead of
a small mass for a batch of biscuit, the w^hole would become at
once a strong and concentrated alkali. Who does not know
that if he takes thirty drops of laudanum, he will feel the effects
of the opium ? but who would expect to feel as much from
taking only one drop? And still more strange would it be
that any effect could be felt from one millionth part of a drop.
Such is homoeopathy, as far as the proportion and administra-
tion of medicine is concerned. Believe it who can ?

Hydropathy is of a still more recent date ? or rather the re-
vival of an old and long since exploded system, and will proba-
bly never extensively afl^ect the community, as the expense of
attending a hydropathic infirmary is too great to be met by per-
sons in ordinary circumstances; most persons, likewise, who
are sick enough to need medicine, are too sick to go to a dis-
tance, and there are but few who relish the packing in sheets
dipt in cold water, well enough to follow it long.

Since scientific physicians have discovered that there are
certain cases of loss of nervous power, causing palsy, which
may be essentially improved by the application of electro-
magnetism, there has sprung up a new race of doctors, calling
themselves electro-magnetic. Wc now find their signs out,
and their flaming handbills posted up in almost every village,
and medicine neatly bottled up, claiming to be highly charged
with galvanism ; so that the sick, by swallowing lightning by
the spoonful, can find at once a safe and speedy cure for all
their ills. The idea of administering galvanism by magnetiz-
ing medicines and sending them about the country, is so gross-
ly absurd, that I should not have deemed it necessary even to
allude to this order of quacks, had I not recently seen upon
signs in several of our cities, in flamming lettei's of gold,
^'Electro-magneiic Doctor." On inquiry, I learnt that they,
too, had found their dupes.

The botanic class is bv far the most extensive, and em-

4 JO Domestic Medicines. [^^ly

braces almost the entire range of nostrum venders. All these
do what they can to impress the public mind with the belief
that all medicines are unsafe unless derived from the vegetable
kingdom, and that what they please to call apothecary medi-
cines should never be used. Now who does not know that
the most powerful and suddenly fatal of all poisons are vegeta-
ble in their origin. Many more deaths occur yearly from
poisoning with vegetable, than with mineral poisons. It is
also well known that a large part of all the medicines used by
the regular physicians is vegetable. The only hope of this
class of quacks, is from keeping the fears of the credulous con-
stantly excited in regard to apothecary medicines. Thus you
will find every pill box, and every phial, carefully matked pure-
ly vegetable as much as to say, all is safe. iPor my part I
can see but little difference between being poisoned with
arsenic, and strychnine the former a mineral, the latter a
vegetable product. The truth is, that good, safe, and valuable
medicines, are derived from the mineral, vegetable and animal
kingdoms. But all medicines, from whatever source derived,
should be used only in such cases and for such diseases as they
are found to be well adapted to cure.

Mesmerism has had its brief day of glory, and departed. It
burst upon the world, like a flaming meteor, in. the cities and in
the country ; hosts of lecturers were seen, with their high-
sounding pretensions; the sick in multitudes attended ; the
clairvoyant was sent to explore the inner organs of the invalid,
and reveal the remedy. But in a few brief years, the glowing
light of mesmerism has passed away, and left its advocates and
those it had deceived in utter darkness and dismay.

But the most strange of all is the unaccountable charm
which the name of Indian possesses over the minds of many,
even in a civilized and christian community. Does the
civilized world go to the rude, uncultivated and ignorant
savage to learn the arts, the sciences of law,or divinity? Would
you go there to procure a man to manage your farm, your
mechanic's shop, your factory, to build your rail roads, or to
teach you philosophy, astronomy, anatomy, physiology or
chemistry ? If not, why go there for help and advice when the
human system, that most delicate and complicated of machinery,
is out of order ? Can it be possible that a race of beings so
grossly ignorant as to be excluded from participation in every
other kind of business amongs't civilized men, should be wise
in the healing art ! The fact is well known that the Indians
know but little in regard to the powers or virtues of even the
most simple vegetables, and but little if anything of the nature
and cause of disease. Their medicine-nien, as thev are called,

1849.] Domestic Mt'i/iciNrs. 411

use but little medicine of any kind. Their only resort is to
chaims, spells and incantations, arnulc^ts, and consecrated medi-
cine bags. Such snpersitions are their chief velinnce. Yet
men in our own civihzed country will Ln'avcly tell us that they
have been lor months or years amongst the Indians, and have
there learned medical science. How many kinds of Indian
vegetable })ills have been thrown out before the public, with
flaming show bills, rendered attractive by pictures of the rude
man ot the forest, in Indian costume, with the recently-gather-
ed herbs in his hand. Such pills claim to be pure Indian
medicine, such as the red man of the forest uses, and most of
them claim to be a safe and infallible cure for all the ills that
flesh is heir to. Most surely if Indian doctors and Indian
medicine venders know anything of the business they are in,
they owe it to their association with civilized society, and not
to the Indian race.

The foregoing are some oi^ the facts which are plainly visi-
ble on the lace of the medicine traffic, as it now stands before
the public. What can be more evident, than that the man
who recommends a given medicine for the cure of diseases,
directly opposite in their nature and causes, is either grossly
ignorant of the properties of medicines and of their effect on
the human system, or else that he designs to deceive. One
or the other must of necessity be true. That many of the
medicines before the public are prepared by men wholly unac-
({uainted with medical science, is abundantly evident, from the
fact that many of them are persons claiming the venerable title
of Rev., many are persons who palm themselves off upon the
public under the assumed title of Dr., when it is well known
that they have never devoted a single moment to the study of
medicine in any of its numerous branches. To suppose that
such persons are qualified to prepare and prescribe medicine
judiciously, is to suppose that any other men in the community,
of similar occupation and education, can do the same. For the
past twenty-six years my time and energy have been almost
exclusively devoted to the study and practice of medicine in all
its various departments. For years past I have witnessed,
with feelings of regret, the evils thrown upon society by the in-
judicious and often unnecessary use of patent medicines ; the
sick man oi'ten taking an article in no way adapted to his
necessities, and the well one often taking it to keep himself so.

The question may be here raised, to whom does all this
wrong become chargeable ? The first and foremost in the
wrong in this case are certainly the men who deceive by false
doctrine, or by pretensions above what simple facts will
warrant. TheMeceived, when no influence is used to prevent

412 Domestic Medicines. [Jul v.

them from being deceived, by presenting the truth to the mind,
are certainly not to be blamed. I would here ask, has the
medical profession done its duty to the public in this matter ?
When error and fraud have been posted up in every village
in the land, and physicians have witnessed their wither-
ering influence in the many cases which have fallen under their
observation, what effort have they made to correct public senti-
ment, and to spread out light and truth before the mind ? It
is true that here and there a worthy member of the profession
has ably addressed his brethren, and forcibly exposed the
w rong and evils of quackery, through the medical journals ; and
the theme of quackery has formed the thread of discourse in
many of the introductory lectures delivered in our medical
schools. But what effect can all this have on the mass of public
mind who never attend medical lectures or read medical jour-
nals ? My belief is, that truth is powerful and will prevail. Let
the truth in regard to medical science be faithfully and per-
severingly spread out before the public, and thrown into every
family, to go side by side wdth the vaunting and truthless pub-
lications of those who are evidently ignorant or intend to
deceive, and I am willing to risk the decision of the question to
the judgment of an enlightened and virtuous community.

It ever has been the case that the public will have some form
or other of domestic medicines, to w^hich they can resort,
without in every case calling a physician. Now unless
physicians themselves prepare such medicines, in a good and
convenient form for administration, accompanied with suitable
directions, we cannot think it strange that the multitude should
seize upon such as are offered, especially as they are recom-
mended and urged upon them by almost every merchant with
whom they deal. The facts are, that the influence of the press,
and the influence and interest of the men of trade, are all
enlisted in favor of quackery. Now the question is, shall the
physicians of the country stand silently by, and see the gume
of deception played off, and quietly surrender the whole field to
the occupancy of quackery ; or shall they themselves engage
in that most difficult and laborious part of professional labor,
and prepare and furnish to the public good and efficient
medicines, honestly and faithfully recommended, with plain di-
rections for their proper use ? This course suggests itself to
my mind as the only one which at the present time can be
successfully adopted to combat medical error and delusion. I
hope yet to see the time when the various boasted nostrums
which now crowd the shelves of all our apothecaries and
stores, will give place to medicines prepared by men of science
and medical experience, and directed to be tised each in its

1849, J Gun-shot Wound of the Chest. 413

proper place and order. When this shall be done, then shall I
believe that physicians have faithfully and honorably discharged
to the public the high and responsible duties of their station as
conservators of the public health.

EXTRAORDINARY GUN-SHOT WOUNDS.

[Our friend, Dr. Cooper, has furnished for the original de-
partment of this No. one interesting case on this subject;
we add three others, calculated to claim the attention of the
reader.]

Case of Gun-shot Wound of the Chest. By A. M. Blanton,
M. D., of Frankfort, Kentucky. (American Journ. of the
Medical Sciences.)

Ed. Cahill, aet. about 40, a large muscular man of 180 pounds
weight, private in Capt. Turpin's Company, 2d Regt. Kentucky
Infantry, was wounded on the 23d February, 1847, at the bat-
tle of Buena Vista, in the left breast, under the middle point of
the clavicle, by a large shot his companions say grape-shot,
as they were too far distant for musketry to take effect, and as
they noticed the discharge of a Mexican cannon simultaneously
with his falling.

The ball entered between the second and third ribs, cutting
the inferior edge of the former and the superior of the latter,
passed through the lungs, again through the ribs, ranging hori-
zontally, and lodged, as there is every reason to believe, under
the scapula.

He was borne off the field in a collapsed condition, blood and
air rushing copiously from the dreadful wound, and w^as placed
against a wall in an upright position, it being discovered that
he was threatened with suffocation when his body was at all
inclined horizontally.

lie was carried to Saltillo the same night, and placed in the
cathedral, used as a temporary hospital, where 1 found him on
the 2Gth in the position above named ; breathing short and dif-
ficult; unable to pronounce three words without pausing;
having a constant troublesome cough with bloody expectora-
tion ; not much pain about the wound, which discharges in
twenty-four hours from a pint to a quart of blood and bloody
serum ; air also was rushing through the orifice at each act of
respiration. His skin Avas cool and moist; pulse 100 and
weak; countenance blanched and anxious. When he was
struck his left arm was elevated so that the relative position of
the great pectoral muscle with the hole between the ribs was

414 Gun-shot Wound of the Chest. , \}^^\

altered when the arm was permitted to fall, and the opening
into the chest was valvular. By raising the arm to a level with
the clavicle, the wounds in the muscle and between the ribs
were made to correspond, and presented an opening into the
chest one inch in diameter. L attempted to probe the wound,
but every time the instrument was inserted he would faint and
compel me to desist ; pieces of torn lung were forced through
the opening by the efibrts of coughing and by the discharges
of blood.

He had been kept as quiet as possible since the injury was
received, had eaten scarcely any thing, and taken no medicine
save a laxative and opiate.

A large piece of lint was kept over the wound, and below
were placed large cloths to receive the discharges. He was
put on a mattrass, one half of which was placed upright against
a wall: a half cup of tea and a small piece of stale bread were
allowed three times a day, and he was kept nauseated six hours
in twenty-four by powders of ipecac, and calomel ; and each
night took \ gr. of morphia to enable him to sleep.

March 1st. Has been doing very well; inclination to feve^*
has been checked by extreme abstinence and nauseants. But
little pure blood expectorated or thrown out of the wound,
which is almost free of its slough, and disposed to suppurate.

4th. Can hear the air escaping through the wound at ten
paces, when he coughs ; discharge is sero-purulent and of offen-
sive odour, amounting to at least a pint in twenty-four hours.
Has pleurisy, which is disappearing under the use of almost
complete starvation, nauseants, mercury and opiates ; the last
named always necessary to procure sleep. He also takes every
other day a dose of castor oil. Pulse is 100 and weak ; surface
pale and cool. The wound externally is clean ; attempted to
examine it with a probe, but he fainted as before, not from pain,
but from a peculiar tickling sensation, as he expressed it.

I had the arm elevated, and picked away several speculse of
bone from the ribs, and then exposing the chest to a very strong
light, saw entirely through the cavity a. rib posteriorly white and
denuded. He complains of a dull, heavy and constant pain un-
der the scapula and about the shoulder.

25th. Nothing of much interest has occurred ; has had pleu-
ritis several times, which was relieved directly by the before-
mentioned remedies, and as many times after a little exertion
has coughed up several mouth fuls of blood. The wound has
contracted to the size of a dime; discharges about 5 ij. daily
and permits the escape of air, with a whistling sound. He can
sloep with his body depressed to an angle of thirty degrees.

Apr']] 10th. Discharge nearly ceased ; wound round and a

18.J0.] Gun-shot Wound of t/ie Chest. 415

quarter of an inch in diameter; air escapes when he coughs ;
still restricted to a very spare diet ; for two weeks has taken
no medicine, except several laxatives and opiates ; walks seve-
ral hundred yards during the day.

May 1st. Has been allowed for ten days, a liberal diet;
wound closed ; a very little air escaped several days since.
Still complained of pain in the shoulder and weakness of the
corresponding arm ; has fattened ; can lie down ; appetite and
digestion good ; goes through the city, walking several miles
a day ; when he takes severe exercise, has some difficulty of
breathing. Discharged from the hospital.

In June, Cahill came to the United States, a hearty, robust
looking man, of one hundred and eighty pounds weight, and 1
had not heard any particulars about him since, until in July,
when I was told he had died, and that an examination had been
made on his body. Feeling a great interest in his case, a friend
was requested to furnish me a description of the appearances
his body presented, and in a few days sent the following letter:

*' Winchester, Kij., Aug. 16th, 1848.

"Dear Sir I am sorry that I am not able to give you a
more minute history of Cahill's case.

"I saw him only once during his last illness, and only a few
times since his return from Mexico.

" When he first came home he was as healthy and robust a
looking man as I ever saw ; he weighed at that time (June,
1847), I have no doubt, two hundred pounds ; but Dr. Duncan,
his physician told me that he had frequent attacks of ha3mopty-
sis ; and that he started frequently out of his sleep, saying that
he felt as if he was suffocating.

*' He was taken sick about three weeks before his death, with
every symptom of inflammation of the stomach .... he
had a feeling of weakness, as he expressed it, in his breast.

" He has been living since his return at a tavern in the capa-
city of a bar-keeper, and I have been told that he was quite
intemperate.

" On opening the chest it was discovered that the left lung
was completely atrophied, not being larger than your hand, and
ofa dark livid color, and there were dense organized bands
crossing the cavity in various directions, which had to be cut
before the ball could be tbund.

" When discovered it was between the spinal column and
end of the fifth rib, which was detached from the back-bone
and fractured an inch from its extremity ; the fractured por-
tion was forced out of its place so as to form a resting? place
between the adjninin^j: ribs and spine for tho ball. Thf^ ball

416 Gun-shot Wound of the Head. [July,

was made of a metal resembling the metal of which bells are
made, and weighed four ounces and five grs. ; there was with
the ball a brass button, weighing nearly two drachms, both of
which were almost covered with a thick membrane, and also
within the same sac there was a considerable quantity of exfo-
liated bone; those portions of the back-bone and ribs which
were near the ball were entirely denuded.

" The pericardium was entirely agglutinated to the heart, the
right side of which was somewhat atrophied. The right lung
had morbid attachments between the pleura pulmonalis and
costalis, and also to the diaphragm ; it was of a lighter color
and softer than natural.
"A. M. Blanton, M. D., } Very respectfully,

Frankfort, Ky, \ A. S. ALLEN, M. D.''

Remarkable Case of Recovery from a. Gun-Shot Wound of the
Head. By David Rice, M. D. (Boston Medical and Sur-
gical Journal.)

Henry W. Richardson, aged 14, son of Francis Richardson,
of Leverett, on the 28th of Sept. last, received a severe gun-
shot wound in his head. A considerable portion of the sub-
stance of the brain was traversed by the ball, but the boy has
now quite recovered. I deem the case of sufficient impoi'tance
to be reported, being in my opinion a rare and interesting
one. The circumstances connected with, and leading to, the
accident, are as follows:

George, an elder brother, was in the house loading a rifle,
preparatory to firing at a target, at some distance through an
open window. Henry was at the barn unloading a cart, and
not being aware of danger, ran to the house, in a foot- path
leading directly by the window from which George was about
to fire his rifle. He passed by it just as the piece was dis-
charged, the ball entering his head when within two feet of the
muzzle. He fell lifeless, and was supposed to be quite dead
for nearly an hour. He was carried into the house and laid
upon a bed. I saw him for the first time in the evening, about
four hours after the accident. I found him comatose, extreme-
ly pallid, the whole surface of his body and extremities cold
and clammy, pulse hardly perceptible, and the breathing
discernible only by close observation. I found that the ball
had passed directly through his liead, as considerable portions
of brain were hanging both at the entrance and exit of the
shot. I proceeded to shave the hair from around the external
wounds, and to apply a temporary dressing, supposing that the

1819] Gun-shot Wound of the Head. 417

lad would probably die before morning; but on visiting him
again at sunrise, I ibund, much to my surprise, that he was
still alive, and that the powers of life had considerably rallied.
I removed the dressinij^s, examined the wounds more accurate-
ly and removed several comminuted frni^ments of bone, with
shreds of membrane and brain, that hung from the injured
parts in view.

He remained entirely unconscious for six days after the in-
jury. The left side of the body was completely paralyzed
up to this time. On the seventh day, the swelling of the scalp
having subsided, I ascertained, on examination, that the skull
was considerably fractured and broken up, at the place of exit
of the ball. I made a crucial incision through the scalp at this
place, dissected up the corners, and removed, with an instru-
ment, several i)ieces of bone that had been partially broken off
from the skull by the force of the shot, and were making some
pressure upon the brain.

From this time the boy evidently began to amend. His
bowels were easily moved by cathartics ; whereas before, there
had been but little action, and it was with difficulty that a
stool could be procured. His pulse and breathing assumed a
more favorable aspect, and gradually became natural. He had
an evident relish for food, and began to talk. The paralyzed
portion of his body, from this time, rapidly regained its normal
action. In four weeks from the accident the wounds had com-
pletely healed, and the boy could walk about the house, and
converse with his friends, although there was as yet but little
strength in the left side of his body.

The only dressing applied, through the whole course of
treatment was simple strips of linen, secured over the wound
with adhesive plaster. These were changed as often as they
became loosened. The head was wet freely with brandy and
water, and a solution of sugar of lead. The bowels were
kept open with castor oil and a decoction of senna. The diet
consisted entirely of fluids for the first fortnight ; after that, he
was allowed more nutritious food.

The anatomical facts as to the boundaries of the injury are
as follows. The ball (sixty -seven weighing one pound) enter-
ed the head in the right temple, about one inch above in front
of the ear, passing through the lower part of the frontal suture,
a little above its junction with the sphenoid bone, and passed
out at the back part of the head, through the lambdoidal suture
of the same side, a few lines below its apex. The distance from
one wound to the other was about five inches and five eights-.

These measurements show that the ball must have traversed
nearly or quite five inches of the substance of the brain. The

N. F. VOL. V. NO. VII. 27

416 Gun-shot Wound of the Head. U'-^'^'j

was made of a metal resembling the metal of which bells are
made, and weighed four ounces and five grs. ; there was with
the ball a brass button, weighing nearly two drachms, both of
which were almost covered with a thick membrane, and also
within the same sac there was a considerable quantity of exfo-
liated bone ; those portions of the back-bone and ribs which
were near the ball were entirely denuded.

" The pericardium was entirely agglutinated to the heart, the
right side of which was somewhat atrophied. The right lung
had morbid attachments between the pleura pulmonalis and
costalis, and also to the diaphragm ; it was of a lighter color
and softer than natural.
** A. M. Blanton, M. D., ) Very respectfully,

Franhfort, Ky. \ A. S. ALLEN, M. D.'*

Remarkable Case of Recovery from a. Gun-Shot Wound of the
Head. By David Rice, M. D. (Boston Medical andSur-
gical Journal.)

Henry W. Richardson, aged 14, son of Francis Richardson,
of Leverett, on the 28th of Sept. last, received a severe gun-
shot wound in his head. A considerable portion of the sub-
stance of the brain was traversed by the ball, but the boy has
now quite recovered. I deem the case of sufficient impoi'tance
to be reported, being in my opinion a rare and interesting
one. The circumstances connected with, and leading to, the
accident, are as follows:

George, an elder brother, was in the house loading a rifle,
preparatory to firing at a target, at some distance through an
open window. Henry was at the barn unloading a cart, and
not being aware of danger, ran to the house, in a foot- path
leading directly by the window from which George was about
to fire his rifle. He passed by it just as the piece was dis-
charged, the ball entering his head when within two feet of the
muzzle. He fell lifeless, and was supposed to be quite dead
for nearly an hour. He was carried into the house and laid
upon a bed. I saw him for the first time in the evening, about
four hours after the accident. I found him comatose, extreme-
ly pallid, the whole surface of his body and extremities cold
and clammy, pulse hardly perceptible, and the breathing
discernible only by close observation. I found that the ball
had passed directly through his head, as considerable portions
of brain were hanging both at the entrance and exit of the
shot. I proceeded to shave the hair from around the external
wounds, and to apply a temporary dressing, supposing that the

1849.] Gun-shot Wound of tht Head. 417

lad would probably die before morning; but on visiting him
again at sunrise, I found, nnuch to my surprise, that he was
still alive, and that the powers of life had considerably rallied.
I removed the dressings, examined the wounds more accurate-
ly and removed several comminuted fragments of bone, with
shreds of membrane and brain, that hung from the injured
parts in view.

He remained entirely unconscious for six days after the in-
jury. The left side of the body was completely paralyzed
up to this time. On the seventh day, the swelling of the scalp
having subsided, I ascertained, on examination, that the skull
was considerably fractured and broken up, at the place of exit
of the ball. I made a crucial incision through the scalp at this
place, dissected up the corners, and removed, with an instru-
ment, several pieces of bone that had been partially broken off
from the skull by the force of the shot, and were making some
pressure upon the brain.

From this time the boy evidently began to amend. His
bowels were easily moved by cathartics ; whereas before, there
had been but little action, and it was with difficulty that a
stool could be procured. His pulse and breathing assumed a
more favorable aspect, and gradually became natural. He had
an evident relish for food, and began to talk. The paralyzed
portion of his body, from this time, rapidly regained its normal
action. In four weeks from the accident the wounds had com-
pletely healed, and the boy could walk about the house, and
converse with his friends, although there was as yet but little
strength in the left side of his body.

The only dressing applied, through the whole course of
treatment was simple strips of linen, secured over the wound
with adhesive plaster. These were changed as often as they
became loosened. The head was wet freely with brandy and
water, and a solution of sugar of lead. The bowels were
kept open with castoi oil and a decoction of senna. The diet
consisted entirely of fluids for the first fortnight ; after that, he
was allowed more nutritious food.

The anatomical facts as to the boundaries of the injury are
as follows. The ball (sixty -seven weighing one pound) enter-
ed the head in the right temple, about one inch above in front
of the ear, passing through the lower part of the frontal suture,
a little above its junction with the sphenoid bone, and passed
out at the back part of the head, through the lambdoidal suture
of the same side, a few lines below its apex. The distance from
one wound to the other was about five inches and five eights..

These measurements show that the ball must have traversed
nearly or quite five inches of the substance of the brain. The

N, p. VOL. V. NO. vii. 27

418 Gun-shut \\ oujid narrow escape. [J^W.

boy is at the present time quite well, although he has some
peculiarities that he did not have before the injury. He has a
slight stoop in his shoulders, goes with his head down, and is
more inclined to mirthfulness.
Leverett, Mass., May 1st, 1849.

Gun-shot Wound narrow escape, (Ohio Med. and Surg. Jl.)

Dr. William Lindsay, of Donnelsville, has- sent us an account
of a case of gun-shot wound that occurred in his practice some
years since. On the 27th of Nov., 1844, he was called to see
the young man who was the subject of the accident, a son of
Mr. Jacob Snider. While blowing into a rifle which he firmly
believed was not loaded, he had the temerity to place his foot
or great toe upon the hammer of the lock, and springing it, the
piece exploded. He immediately fell, as though dead, but soon
recovered the use of his faculties and limbs. On examination,
it was found that the two front incisors of the upper jaw were
gone, and that the ball entering there, had passed upwards,
almost exactly in the median line, that is to say, the ball enter-
ed the socket of the right incisor, with a slight inclination to the
left, perforated the septum and, entering the frontal sinus, made
its appearance under the skin and periosteum, about three-
fourths of an inch above the superciliary ridge, and a few lines
on the left of the median line. The skull was fractured by the
outward passage of the ball, but the brain did not seem to be
at all affected. There was some hemorrhage from the mouth
and nose, and an oozing of blood from the inner canthus of the
left eye. One tooth was discovered and removed from the
wound some days after the accident, the other was not found.
Small spiculas of bone came from the wound at intervals, and
some six weeks after the accident. Dr. Lindsay removed a por-
tion of dead bone from high up in the left nostril. The ball was,
of course, removed, and with it the " patch," and the wound
properly dressed. No untoward symptoms occurred, and the
young man speedily recovered.

The only remarkable circumstance about this case is, the
very fortunate direction and lodgment of the ball. Had the
young man's head been in almost any other possible position,
he must have been instantly killed. As it was, the ball kept
so near the median line as to avoid all important vessels, nerves
and organs. It probably did not enter the cavity of the brain
at all, else there would have been more disturbance of the
cerebral functions. The young man had a most fortunate
cscapp.

i

1849. J Remedksfor Cholera. 419

Rejnedies for Cholera. By VI . T. Gaiudner. (Monthly
Journal Medical Sciences.)

The first and most controverted of cholera remedies io
which we shall allude, is venesection. In reference to this, the
evidence is of the most varied character. It has been em-
ployed with alleged benefit in all stages of the disease, and not
less in this country than in India. The most satisfactory ac-
counts are of its use in the early stage, before the collapse has
occurred ; and here it seems to be often most effectual in re-
lieving the feeling of tightness and oppression about the
stomach and region of the diaphragm, which are frequently
most distressing to the patient. As to the effect on the mor-
tality, it is difficult to form an opinion. It is usually only in
the early stage that blood can be procured in quantity, and this
is precisely the stage not only when mistakes of diagnosis are
most apt to occur, but in which the disease is most manageable
under any form of treatment. Notwithstanding this circum-
stance, the mortality where blood-letting formed a considerable
part of the treatment, is rarely much less in any of Mr. Ross*
tables than 50 per cent, and sometimes more ; few of these re-
sults, however, relate to blood-letting alone. Dr. Robertson,
whose observations on this subject in our present number are
well worthy of attention, thinks that he has in several instances
prevented the collapse by this measure ; and the favorable re-
sult of his cases presents the greatest encouragement to the
practice. He employs it, however, only in the early stage.

Stimulants, especially alcoholic liquors, have been lauded in
cholera, no less than blood-letting ; but there appear to be now
grave reasons for doubting their efficacy, and even, we think, of
rejecting them in a great measure in the treatment of this dis-
ease. Not onl)^ are they in many cases most disagreeable to
the patient, whose perpetual thirst they do nothing to relieve ;
but it seems to be most probable that they are not absorbed,
and that their action is therefore purely local. It is important
also to observe, that the evidence against them in Mr. Ross's
tables is most unequivocal, and that, both alone and in combina-
tion with other kinds of practice, they seem invariably to have
deteriorated the results wherever they were used. There is
not an instance in these tables of a mortality under 50 per 'cent,
where stimulants have formed part of the treatment. That by
stimulants alone, gives in the aggregate 58.8 per cent.

Opium has a very large amount of individual testimony in
its favor, and is indeed apparently so directly indicated by the
diarrhoea, that we cannot wonder at its having been extensively
u.sed. In conjunction with acetate of lead, it forms the cele-

420 Remedies for Cholera. [July,

brated pill of Dr. Graves, which has had a most extensive repu-
tation in the cholera both of this country and India. There
seems no reason to doubt, that, in the premonitory diarrhoea,
this remedy has the power, ascribed to it ; but, in the confirm-
ed disease, Mr. Ross's tables show that it has not diminished
the aggregate mortality below 50 per cent. Those who con-
tinue to employ it should certainly do so in the fluid form, in
order not to oppose any unnecessary obstacle to its absorption.
In the stage of reaction, or where there is a tendency to coma,
as is often the case in this country, there is every reason to
reject opium as probably injurious.

Mercurt/, in the form of calomel, and usually in combination
with opium, has been widely recommended in India. In this
country it has been used to a large extent, but without remarka-
ble success, according to the returns, excepting in the hands of
Dr. Ayre of Leeds, and Dr. Peacock, in whose cases the mor-
tality was as low as 31 per cent., and who both used it without
stimulants. Whether this success is due to the calomel, or to
the simplicity of the treatment in other respects, is, we think,
very doubtful, considering the negative results of mercury in
other hands, and combined v/ith other modes of treatment. If,
however, mercury be employed, we think that the method re-
commended in our Medical News, by Dr. Fleming, deserves
attention; that of administering it in the fluid form of corrosive
sublimate. Absorption is known to take place with great
difficulty in cholera ; and it is difficult therefore, to conceive a
worse form for conveying mercury into the system than that
of calomel.

Tartar Emetic is strongly recommended by Dr. Billing,* on
the ground that cholera is a fever, and must be treated by seda-
tives and fever medicines. He considers the collapse of
cholera to be similiar to the cold stage of ague, and strongly
reprobates stimulants in every form. He allows cold water
to be liberally given, and even pushes his theory of the disease,
so far as to administer quinine from the begining. The tartar
emetic is given in small doses. Dry friction is the only ex-
ternal application. In Droitwich Lunatic Asylum, where
tartar emetic was the staple of the treatment, there were only
four deaths in twenty one cases ; but this number is too small
to afford anything more than a presumption in favor of the
remedy. We attach, however, more importance to Dr. Billing's
testimony than to his theory, and consider this method as wor-
thy of further trial.

Injection of the neins was first introduced by Dr. Mcintosh,

On the Treatment of Asiatic Cholera. Bv Archibald Billing, M.D., &c.
London, 1848. P. J. 7.

i

1849.] Remedies for Cholera. 421

of Edinburgh ; it has been so frequently tried in cholera, and
so frequently found wanting, that notwithstanding its extraor-
dinary effects in the first instance, we should hesitate to recom-
mend it in any case which presented a hope of recovery
under any other treatment. Nevertheless, the high mortality
ascribed to it in Mr. Ross's tables (85.7 per cent.) is evidently
to be ascribed to the trials of it having mostly been made upon
moribund cases, in which alone it is by many practitioners
thought justifiable. We refer our readers to Dr. Robertson's
remarks on this subject, in our December Number, as well as
in the present one. Nevertheless, we think that, if this treat-
ment is to have any chance of success, it must be by being
tried earlier in the disease, and repeated as often as the collapse
recurs.

Emetics and strong Purgatives (such as croton oil) hJive
each had their supporters ; neither from theory nor experience
can we gather much satisfactory testimony in their favor.

Chloroform Inhalation has been used in thirty-seven cases
in Peckham-house Asvlum, all of which presented characteris-
tic symptoms. (See ^Med. Gazette^ Nov. 24, 1848, p. 903.)
The number of cases is too small to enable us to form a de-
cided opinion upon the practice, more especially as the details
of symptoms and treatment are not given. In the mean time,
the results are superior to most of the methods in Mr. Ross's
tables, but inferior to the tartar emetic practice ia Droitwich
Asylum, before referred to, and very decidedly inferior to the
results of upwards of 700 cases treated by cold water and
saline medicines inte*'nally. In the Edinburg Hospital, chloro-
form was found to relieve the cramps while the patient was
under its action ; but with respect to the restoration of tem-
perature, and amendment of the symptoms of collapse, it was
believed to exert a negative, if indeed not an unfavorable influ-
ence.

With regard to several other remedies which have been
faithfully tried in Edinburgh, we must again refer to Dr.
Robertson's paper.

On the whole, we think it is clear enough that the specific
for cholera remains yet to be discovered; and that none of tha
more vaunted cholera remedies present evidence in their favor
so strong as to command an exclusive attention. On the other
hand, it is much to be feared that the routine heroic practice
of many practitioners, both in this country and in India, has
aggravated to no small extent the mortality of this tremendous
disease. This is especially the case, as we have already point-
ed out, with regard to stimulants.

On reviewing the evidence deduced from large numbers, we

422 Remedies for Cholera. \)^^y,

find that there are two modes of treatment which present so
marked an advantage in respect of mortaiity, as to arrest our
attention very forcibly. The treatment by common salt, with
cold water given in abundance internally, produced in 607
cases (in various hands) a mortality of 20 per cent ; and in
Greville Street Hospital, 107 cases treated by a saline mixture
with copious draughts of cold water, gave a mortality of only
14 per cent.; the lowest which has yet been recorded from a
similar number of unselected cases. Nearest to these stands
the treatment by ice, alone, given by the mouth ; a continental
practice, of which the results are 30 per cent, mortality. It is
a remarkable fact, as pointed out by Mr. Ross, that in all these
the administration of cold water by the mouth plays a promi-
nent part ; and v/hen we consider the success which this remedy
alcPne appears to have had in the hands of many practitioners
(especially Dr. Shute of Gloucester.) it is impossible not to
think favorably of it in cholera. Dr. Shute states, " that under
this system the state of collapse is prolonged to two, three or
five days; and others have remarked, that, during the reaction,
a paroxysm of raging delirium is apt to take place. It is not,
therefore, an inoperative remedy." Add to this, that it is most
grateful to the patient, whose burning thirst seems always to
point to this as the most appropriate resource for his relief. If
it be the case also, as seems every way probable, that the water
so administered is either absorbed into the blood to replace the
fluid lost, or tends to prevent the less of fluid from the blood by
the intestines, we can have no dimculty in understanding its
beneficial effects. .

We are most firmly persuaded, that cholera, like all other
diseases dependent on a specific poison, has a spontaneous
tendency to cure after the virus has exhausted itself; and that
the treatment will be most securely and successfully accom-
plished by discarding, in the majority of cases, heroic reme-
dies; by following out the indications afforded by the feelings
and desires of the patient ; and, as Cullen said of fever, by
attending to thof;e conditions and means calculated to "obviate
the tendency to death." Now, all that v/e yet know of the
pathology of this disease tends to ascribe the fatal result in
the collapse to a slov/ asphyxia, induced by the imperfect
fluidity of the blood. In proof of this assertion, we would
refer to pathological facts (see our review on this subject in
February, 1848,) as well as to the wonderful, though too
transitory, effect of the injection into the veins. We would
therefore endeavor by every means to supply fluid to the blood
through the intestines, the skin, the lungs, or at least to prevent,
in as far as possible, the fluids of the body from being thrown
fl^bv these channels.

1849.] Remedits for Cholera. 423

This might be'accomplished 1st, by supplying cold water
in abundance by the mouth, as already mentioned, and as
dictated by the thirst of the patient ; 2d, by the use of baths of
regulated temperature, at least at the beginning of the treat-
ment; 3d, by maintaining the body of the patient throughout the
treatment in contact with fluid media, or at least with fluid
vapor, by means of soaked cloths placed around him, and
covered by a sufficiency of blankets ; 4th, by surcharging the air
of the apartment with vapor, particularly when the external air
is dry and frosty.*

The third of these indications was put in force by Dr.
Robertson, by means of the hot wet sheets, surrounded by
several dry blankets, very soon after the commencement of
treatment in the cholera Hospital ; and the advantages of \i
over the use of heated air, as in the first cases in the Infirmary,
was soon apparent. The mortality under the latter practice^
indeed, was so considerable as to cause it at once to be re-
nounced in the Cholera Hospital. It was found, how'ever, to
have some disadvantages in the case of adults, from the disa-
greeable sensations sometimes caused by it, which gave rise to
restlessness and strugglincr, and consequent exposure to the air.
We are disposed to ascribe these effects in part to its having
been used very warm, and exclusively with the view of pro-
ducing reaction by artificial heat, and think that many of these
inconveniences would vanish if the temperature were studious-
ly regulated by the feelings of the patient.

The regulation of temperature, is a most important means
in the treatment of cholera. The extremes both of heat and
eold appear to be ill borne. The momentary shock of the cold
affusion (followed by warm wrappings) has indeed been useful
in rousing patients from deep collapse ; but nothing has shown
its continued application to be beneficial. On the other hand,
the exhausting influence of excessive heat, externally applied,
has been noticed b}' many writers. The supervention of
reaction appears to us to depend much more upon the reception
of fluid into the blood than upon the application of external
heat ; and "we have seen it take place, and follow its usual
course, where no external heat has been applied. Should the
relation of the reaction to the fluidity of the blood be estab-
lished, it will appear still further how paramount is the indica-

* We are happy to find a corroboration of these views, as to the importance of
fluids in the trearmentol' cholera in an able pamphlet by Dr. Buchanan, of Glas-
gow, which deserves especial notice as one of the few recent contributions to the
pathology and general history of the disease, bearing the traces of independent
ibought and observation, without being the mere exposition of a hypolnesis.
See Ohervntinns on Maligno.ni Cholera, (^'C. By Andrew Buchanan, M. D.
Professor of the Institutes of Medicine in the University of Glasgow.

424 Prevention of Cholera. [July,

tion of treatment by fluids, to which we have alluded. Mean-
time a moderate amount of heat, such as is agreeable to the
patient, appears to us to have most evidence in its favor in the
treatment of the collapse.

The relief of the spasms is the next important indication of
treatment during the collapse. In relation to this symptom,
further trials of chloroform appear to be requisite, unless it shall
be found to affect unfavorably the progress of the case. The
use of frictions to the aftected parts, and of stimulation of the
skin by liniments, or by mustard cataplasms, is universally ad-
mitted to be useful

Finally, in the management of the reaction the most impor-
tant indication appears to be the restoration of the urine, and
of its normal constituents, especially the urea and uric acid,
"which are often deficient, and appear by their deficiency to
lead to coma. An excellent suggestion of Dr. Robertson's in
these cases is the administration oi colchicitin ; and we believe,
this has been carried out by him in a few instances with good
effect ; though, of course, nothing can be yet said decidedly on
this remedy.

Prevention of C holer a,'^{hQiicet.)

Poor Law Commissioners. The following are the sugges-
tions made by the gentlemen appointed by the Poor Law
Commissioners to inquire into the condition of the metropolitan
poor-houses, with respect to cholera.

1. We would urge the necessity in all cases of cholera^ of
an instant recourse to medical aid, and also under every form
and variety of indisposition ; for during the prevalence of this
epidemic, all disorders are found to merge in the dominant dis-
ease.

2. Let immediate relief be sought under disorder of the bow-
els especially, however slight. The invasion of cholera may
thus be readily and at once prevented.

3. Let every impurity, animal and vegetable, be quickly
removed to a distance from the habitations ; such as slaughter-
houses, pig-sties, cess-pools, necessaries, and all other domestic
nuisances,

4. Let all uncovered drains be carefully and frequently
cleansed.

5. Let the grounds in and around the habitations be drained,
so as effectually to carry off moisture of every kind.

6. Let all the partitions be removed from within and with-
out habitations, which unnecessarily impede ventillation.

1849.] Prevention of Cholera. 425

7. Let every room be daily thrown open for the admission
of fresh air; and this should be done about noon, when the
atmosphere is most likely to be dry.

8. Let dry scrubbing be used in domestic cleansing, in place
of water-cleansing.

9. Let excessive fatigue and exposure to damp and cold,
especially during the night, be avoided.

10. Let the use of cold drinks and acid liquors, especially
under fatigue, be avoided, or when the body is heated.

IL Let the use of cold acid fruits and vegetables be avoided.

12. Let excess in the use of ardent and fermented liquors,
and tobacco, be avoided.

13. Let a poor diet, or the use of impure water in cooking
or for drink, be avoided.

14. Let the wearing of wet and insufficient clothing be
avoided.

15. Let a flannel or woollen belt be worn around the belly.

N. B. This has been found serviceable in checking the ten-
dency to bowel complaint, so common during the prevalence
of cholera. The disease has, in this country, been always
found to commence with a looseness in the bowels, and in this
stage, is very tractable. It should, however, be noticed that
the looseness is frequently unattended by pain or uneasiness,
and fatal delay has often occurred from the notion that cholera
must be attended with cramps. In the earlier stage here re-
ferred to, there is often no griping or cramp, and it is at this
period that the disease can be most easily arrested.

16. Let personal cleanliness be carefully observed.

17. Let every cause tending to depress the moral and physi-
cal energies be carefully avoided; let exposure to heat and cold
be avoided.

18. Let crowding of persons within houses and apartments
be avoided.

19. Let sleeping in low or damp rooms be avoided.

20. Let fires be kept up during the night in sleeping or ad-
joining apartments, the night being the period of most danger
from attack, especially under exposure to cold or damp.

21. Let all bedding and clothing be daily exposed during
winter and spring to the fire, and in summer to the heat of the
sun.

22. Let the dead be buried in places remote from the habita-
tion of the living.

By the timely adoption of simple means such as these, cholera
or any other epidemic will be made to lose its venom ; so true
is it that *' internal sanitary arrangements, and not quarantine
and sanitary lines, are the safe-guards of nations."

420 Caio/nd in tha Trtatrntnt of Chulfva. [J^^y,

Caloviel in the T?^eatmsni of CJiokra. By John Allan, Esq.,
Epsom, Eng. (Prov, Med. and Surg. Journ.)

Having witnessed, with extreme pain, the ill success attend-
ing the treatment of this fell disease on its visit to England in
1832, I have been most anxious, since its threatened return, to
gain practical information relating to it, from such of my pro-
fessional iViends as had enjoyed extensive opportunities of ob-
serving and treating it. Among these, Mr. Robert Stedman,
of Greatbookham, Surrey, has kindly furnished a narrative
of his experience, which is most interesting ; since the treat-
ment which he adopted, first in his own person, and afterwards
in a large number of cases, was attended with unfailing, and,
inasmuch as he did not lose a single patient, I may say, une-
qualled success. With Mr. Stedman's permission, I submit to
the profession the substance of his narrative.

Mr. Stedman arrived off Calcutta in the early part of Octo-
ber, 1817, a few weeks after the cholera first broke out at Jes-
sore. The ship, on board of which he was the appointed sur-
geon, was eleven days kedging up the Hoogly river, and as
each day's progress lessened the distance to the capital, so it
increased the horrors of the spectacle presented by the numer-
ous dead bodies floating, up and down, with the flux and reflux
of the tides. Mr. Stedman was the first person in the ship
who was attacked by the cholera, probably, as was strongly
impressed on his mind at the time, because, as a professional
man, he took more interest, than any other individual on board,
in noticing the numbers, forms, colors, &c., of the dead bodies,
and, particularly looking on, when any native was performing
his duty, as police, in moving such of them as happened to get
entangled, when the ship was at anchor, at the bows, by the ca-
ble, or otherwise. The Bengal papers of that period stated,
that between two and three thousand dead were cast into the
river in a w^eek. Hence Mr. Stedman's exposure to a suflicient
force of putrefying animal effluvia to account for his being the
fiist individual in the ship seized by the disease.

His plan of treatment was smiple and bold, but most une-
quivocally successful, since he lost not one of the crew, amount-
ing to forty-eight, all of whom, with only one single exception,
had the disease, whilst other ships in the river lost many of
their men. A Bristol ship, moored about two cable lengths
higher up the stream, lost thirteen of her crew the first fort-
night after her arrival.

Mr. Stedman's sheet anchor and sole reliance was calomel.
Having commenced dosing himself, and having repeated it to
a successful issue, he followed the same plan in all the other

1849.] Calortu'l in the Treatintnt of Chohra. 427

cases as they occurred. He was, as it were, knocked down
by the first seizure, and instantly rendered unable to go to the
medicine chest. He requested the chief officer to go and
weigh twenty grains of" calomel for hiu). He replied that he
would bring the calomel and the scales, but that he was not
going to giv^e such a dose as that. By the time lie returned
into the cabin, Mr. Stedman had incessant' vomiting, but no
power. He begged the officer to weigh twenty grains, and
then to slip it off the scale upon his tongue. This done, the
vomiting ceased for a short time, but not the cramps in the ab-
domen or limbs. On the recurrence of the retching, Mr. Sted-
man again, in less than ten minutes, requested to have twenty
grains more. This checked all further vomiting, and, in one
hour afterwards, still having spasmodic pains and drawings of
the abdominal muscles, with heavings to vomit, he asked for
twenty grains more. This, the first officer rei'used to have
any thing to do w^ith, but the second officer and others standing
around over-ruled the objection, and a third dose of twenty
grains was given. Shortly aftei- this, Mr. Stedman was so far
relieved as to be able to sit upi'ight in the chair, and then they
made him sip brandy and water. This warmed his stomach,
and brought on re-action of .the heart, and, although very fee-
ble, with frequent cold sweats for several days, he might be said
to have been well next day, as he was abJe to walk about, and
attend to his duty.

The second case occurred on the third day after Mr. Sted-
man's attack; and very rapidly all on board, with the single
exception already mentioned, of the chief officer, (who entirely
escaped.) were seized. The captain, who had gone ashore, and
remained there the whole time, also escaped.

To some of the men Mr. Stedman found it necessary to give
to the extent of five doses, and, to one individual, six doses, of
twenty grains each. Jn two instances he began with half-
drachm doses. In all the cases this simple plan proved success-
ful. The only adjuncts were brandy and water, and as soon
as the appetite could take it, solid food well spiced. What
seems still more remarkable, when one considers the habits and
mode of living of the natives, is, that the same treatment proved
equally successful ^ith them. The native boat called ''The
Dingy,'"' employed to convey messages, persons, &c., to and
from the shore to the ship, frequently brought alongside, friends
or relations of the boatmen, for the doctor's advice and medi-
cines. To these Mr. Stedman gave his never-failing powders.
Some of them he saw no more of, nor could he ascertain that
any one of them died. On the contrary, the boatmen contin-
ued to bring more patients, or begged for powders for those

428 Diagnosis of Diseases of the Ear. [July

who were too ill to be brought to the ship. To show his thank-
fulness and gratitude for the benefits conferred on his friends,
the boat-master brought to Mr. Stedman, as a present, a string
of beads, such as he said, were worn only by Brahmins of high
caste.

Dr. ScHMALZE, of Dresden, on the Diagnosis of Diseases of the
Ear. (Medico-Ghirurg. Review.)

Let us now pass to the consideration of an instrument, which
our author proposes to employ as';a diagnostic means in certain
diseases of the ear. We allude to the tuning-fork. Dr.
Ernst Heinrich Weber had recorded the following experiment.
He stopped up one ear with his little finger, and brought into
contact with the hard portion of the head of the same side the
handle of a tuning-fork, which had previously been set in
vibration ; he then brought the tuning-fork into contact with
the head on the opposite side on the side where the ear re-
mained free. He observed that he heard much more distinctly
on the side of the stopped-up ear, than on that of the ear which
remained free. Reflecting upon this experiment, Dr. Schmalze
was led to adopt the following propositions, which he afterw^ard
confirmed by repeated experiment.

" When both ears are healthy and open, the vibrating
tuning-fork is heard equally well on both sides. But when
the meatus of one side is stopped up by the little finger or other
object, the tuning-fork is always heard much more distinctly
by the stopped-up ear, so that it appears to many persons that
they hear only with that ear. When the meatus of one ear is
morbidly closed, as by accumulated membranes and inspissated
wax, the tuning-fork is heard by this ear, provided the integri-
ty of the auditory nerve be uninjured, more distinctly than by
the other. If the other ear be stopped up also, then the tuning-
fork is heard equally on both sides. The same relation also
obtains, when in a healthy condition of the nerve the eustachian
tube or the tympanum of one ear is closed, as by effused blood
depositions of catarrhal or rheumatic matter, whether the
meatus be closed or not. Certain cases thfit have come before
me, in which, notwithstanding that the meatus, the eustachian
tube, and the tympanum were free from obstruction, the
tuning-fork was heard more strongly upon the diseased side,
and in which I obtained a complete cure by the use of resolvent
remedies, render it, in my opinion, not improbable that even
single portions of the labyrinth, as for example, the vestibule,
may become occluded by collections of lymph, by effused

1849.1 Early Operation for Hare-lip. 429

blood, (fee, the nerve (at the commencement) not participating
in the disease. On the other hand, when the auditory nerve
of one ear is affected, the vibrating tuning-fork is always heard
less distinctly by the diseased ear than by the sound ear ; and
the occlusion of the sound or unsound ear makes, in this respect,
not the slightest difference. These observations I have en-
deavored to utilise for practical purposes in the following
manner : the tuning-fork appears to me to be particularly ap-
propriate to the examination of the hearing, when only one
ear suffers, or at least the one more than the other. Thus,
when the patient hears the vibration of the tuning-fork through
the diseased or more diseased ear much more strongly than
through the sound or less diseased ear, we may conclude that
obstruction of the meatus, tympanum, or labyrinth, or of
several of these parts at once, is the cause of the disease.
Although mere obstruction of the meatus may, as a rule, be
easily confirmed by investigation with the speculum, yet this is
not always possible, and in such cases the tuning-fork becomes
a convenient auxiliary. But if in the cases specified we find
the meatus free from obstruction, or the patient after the re-
moval of the obstruction hear little or no better ; and the
results obtained by the tuning-fork remain unchanged, then we
may conclude that the obstruction is seated beyond the
membrana tympani, in the tympanum or labyrinth. Finally,
if the patient hears the vibration of the tuning-fork less dis-
tinctly on the diseased or more diseased ear than on the other,
be this latter obstructed or not, we may, with tolerable securi-
ty predicate disease of the auditory nerve itself.

On Operating early for Hare-lip, (Ibid.)

Dr. J. Mason Warren has recently published a paper confirm-
atory of a recommendation he had formerly given, that infants
should undergo this operation at as early an age as possible, he
having frequently resorted to it 24 hours after birth, and with
better success than in older children. This arises from the less
resistance offered by the child, and the great rapidity of the
healing process at that age, enabling it to suckle almost as soon
as if nothing abnormal had been present.

In double hare-lip, complicated with fissure of the bones and
a projecting tubercle, he operates on .one side first, and allows
that to heal ; for if both sides be operated on at once, the tissues
are too much stretched, and suppuration occurs. If one side
has united, and a month be allowed to elapse before the second
operation, the protuberant intermaxillary bono will be found to

430 Early Operation for Hare-lip. [July

have become more or less drawn into its place. Sutures are
very preferable to needles, however wide the separation may-
be; for they can be more easily introduced, cause less irrita-
tion, and can be removed in from 48 to 72 hours without
disturbing the tender adhesions. They allow the part to be
inspected and any excess of inflammation to be kept down by
wet compresses ; so that after their removal, the line of adhe-
sion is often free from redness, and after a short time is hardly
perceptible. The suture-needles are most conveniently passed
when straif^ht, and sometimes by seizing them firmly with a
forceps. American Journ. 'Med. Sciences, No. xxx, pp. 337-8.

Dr. Anselon states that along experience has convinced him
that the practice of immediate operation, put into force by M.
Bonfils of Nancy, is the best; the child then sleeping much,
wanting little nourishment, possessing only an impertect sen-
sibility, and offering less resistance. The longer the operation
is delayed, the less perfect is the adaptation obtainable, for the
two segments are never developed exactly alike. The imper-
fect sensibility of the child is so far from favoring, as stated,
the occurrence of convulsions, that these are of far more fre-
quent occurrence in older children. The child may easily be
nourished for the first three or four days with a tea-spoon, and
after then it will suck with ease and safety. Much disappoint-
ment in this operation results from neglecting to divide the
adhesions of the lip to the gum, without whicli exact coaptation
cannot take place. After the operation, constant surveillance
ofthe child by two attendants during 72 hours, is requisite.
Each of these, in turn, constantly maintains the parts in exact
apposition, by gentle pressure of finger and thumb, for in this
way alone can the consequences ofthe movements ofthe face
be guarded against. VJJnion MeclicaJe, No. 76.

M. Guersant observes that there are three periods at which
this operation may be performed with different chances of suc-
cess. The best chance is offered when it is performed within
the first fifteen days. Later, we succeed less often, owing to
the indocility ofthe child ; its crying, eating, &c., preventing
also accurate union. Later still, when the child has reached
from 10 to 15 years, we may reason with him, and again oper-
ate with more success. Gazette des Hopitaux.^o. 75.

In addition to the above, we may observe that M. Paul Dubois
likewise, some time since expressed a strong opinion in the
Academic in favor of operating, in simple cases, upon very
young infants. He uses very fine insect pins, and as those
usually found in the shops are too long, and bend before the tis-
sues, thus increasing the pain and duration of the operation,
they sfiould be shortened before passing. After 21 hours,, the

184C.] The Obstetric Air-tractor. 431

first threads are to be replaced by others less tightly drawn,
such change being repeated daily, and much diminishing the
inconvenience produced by the pins. The upper pin may be
removed after the 72d hour, and the lower one from the 80th
to the 96th, according to the solidity of the union, which should
then be found complete. The children are suckled as usual
after the operation, which M. Dubois regards as important for
their welfare, and preventive of cries and struggles. He has
never met with hemorrhage after the operation, and he believes
the best security against this, is the bringing the pared surfaces
into accurate contact, and the avoiding making incisions into
any other part than the lip itself The detaching from the gum
the portion of the lip W'hich is nearest to the upper angle ofthe
wound, for the purpose of rendering approximation easier, is
in his opinion unnecessary, as the naturally yielding character
of the part allow^s of this being effected.

The Obstetric Air-tractor. By J. Y. Simpson, M. D. (Lond.
Med. Gaz., from Proceedings, Edinburgh Obstetric Society.)

We make the following extract from a communication for-
warded to us by Dr. Simpson, in reference to his ingenious
invention of the Obstetric Air-tractor :

If we could fix upon the exposed portion of the foetal scalp,
the suctorial disc of a limpet or cuttle-fish with the usual force
with which they adhei'e to the sea rocks, to w'hich they are
attached, we should have in many cases a power sufficient to
enable us to apply by them the necessary amount of extractive
force. The discs of the limpet and of the cuttle-fish attach
themselves firmly to the surfaces to which they adhere, by
being formed so as to act upon the principle of the common
sucker used by the schoolboy to lift stones, &:c. viz., by re-
moving or rarefying as far as possible, the air placed between
the attaching and attached body, and thus taking advantage of
the great power exercised by pressure ofthe atmosphere upon
the surface of solids. This pressure is, as is well known to
all, equal to nearly fifteen pounds upon the square inch when
the subjacent vacuum is perfect; or, in other words, it would
require a force equal to fifteen pounds of every square inch
attached, to effect the separation of surfaces thus united. The
limpet and cuttle fish have the surface ofthe acetabula or discs
with which they fix themselves so strongly upon the rocks, be-
dewed with a thick mucous secretion ; after placing the surface
of the disc upon the part to which they are to attach them-
Felves, they, by a muscular movement, raise the centre of the

432 The Obstetric Air-tractor. [July,

disc so as to produce a more or less perfect vacuum ; and the
cuttle-fish has a central body in the middle of each disc, which
it draws up and uses for this purpose, exactly on the principle
of the piston of a syringe.

Such an arrangemeat and apparatus may be imitated by art;
and, when rendered more perfect and complete, may perhaps
give us a simpler, and safer obsteric power for some cases than
even the forceps. In one protracted case which Dr. Simpson
described, he had lately made use of this power to extract the
child. When applied, the head was still high up in the pelvic
cavity, and the instrument easily afforded such a hold of the
head as to allow it to be slowly dragged forwards and extract-
ed. During this extraction, the instrument required to be
reapplied once or twice. Dr. Duncan and Mr. Dickson
were present at the delivery.

The instrument used in this case was very rude and imper-
fect. It consisted of a common metallic vaginal speculum,
fitted with a piston, and with the edge of the trumpet shaped
concave disc at its outer or broader end covered with leather.
This broader and leathered end was coated with lard, and ap-
plied to the head of the child ; and then an exhausting eflfect
was produced by moving the piston forwards. The apparatus
would admit of much improvement and simplification, as by the
mouth of it being made expansible, and capable of altering in
shape, instead of metallic and fixed; by the inner edge of it
beins^ coated, as in atmospheric railways, by a thin layer or
cushion of air enclosed in caoutchouc ; by the exhausting ap-
paratus being valved and more perfect, &c. &c.* But if the
Air-tractor could not be made both simple and satisfactory in
its application, it would not replace the forceps, and more ex-
perience would be required to decide whether it had any title
to do so.

If the instrument, when properly constructed, should be
found to succeed, it would be still niore advantageous in re-
placing the long, than in replacing the short forceps. In the
case in which it was used, the head was of the height in which
long forceps are usually required. If a suctorial tractor should
answer in some long forceps cases, and enable us to drag with
sufficient force upon the exposed portion of the scalp, it would

* Since the preceding abstract was drawn up, I have made a great variety
of experiments, with the view of ascertaining the best form of disc or mouth-
piece and exhauster. I find that a syringe and piston, valved like the common
breast-pump, so as to make a perfect vacuum, and having a disc attached to it
formed of a double cup, the outer cup of caoutchouc, and overlapping consid-
erably the edges of an inner and smaller cup of metal or gutta-percha, makes
an Air-tractor possessed apparently of the necessary applicabiHty, and requisite
adhesive and extractive power. J. Y. S.

1849.] The Obstetric Air-tractor. 433

save the danger dreaded by many, of wounding the uterus by
introducing and working the blades of so long an instrument as
the long forceps high up in the neck and cavity of the uterus
itself.

Presentations of the breech sometimes require instrumental
assistance. The hook passed over the flexure of the thigh is
dangerous, and very apt to injure. The forceps, as recom-
mended in these presentations by some authorities, are often
inapplicable and inefficient. Perhaps the Air-tractor may
afford us a new and sufficient instrumental force for the man-
agement of some of these cases. Its use would be simpler and
safer than any of the other methods proposed.

Dr. Simpson further observed, that he was not aware that
any one had applied practically this obsteric means, before it
was employed in the case detailed to the Society. But the
idea of using such a power had been long ago proposed by a
gentlemen, for whose works and talents they all entertained the
utmost respect Dr. Arnott, of London. In his admirable
work on Physics, (p. 636) Dr. Arnott alludes to the subject in
the following words : " The forceps (says he) to be well and
safely used, requires address, which even the naturally dexte-
rous man cannot possess without a degree of continued
practical familiarity with it ; and, except in large towns, a man
must be unfortunate in his practice who often requires it ;
hence the really small number of persons who use it well. A
tractor of three inches in diameter would act upon any body,
to lift or draw it, with a force of about a hundred pounds much
more, therefore, than is ever required or allowable in obsteric
practice. In lifting a stone, the tractor does not act as if it
were glued or nailed to the stone, but merely bears or takes off
the atmospheric pressure from one part, and allows the pres-
sure on the opposite side, not then counterbalanced, to push
the stone in the direction of the tractor ; so when placed upon
the child's head, it would not pull by the skin, in the manner of
a very strong adhesive plaster applied there, as uninformed
persons would be apt to suppose ; but by taking off a certain
atmospheric pressure on the other side or behind to urge the
head forward on its way. Of course the pressure in such a
case would not operate on the head directly, but through the
intervening parietes and contents of the abdomen. It would
be preferable to have a gentle and diffused action of the tractor
over a large space, rather than an intense action on a small
space ; and, therefore, a tractor for the purpose now contem-
plated should not be very small, and should have a little air
underneath it in a slight depression or cavity at its centre.
The forceps must be more effective than the tractor for recti--

N. s. VOL. V. NO. vir. 28

434 Coffee in Infantile Cholera. [Juljr^

fying malposition of the head, and diminishing its transverse
diameter ; but the tractor will answer both these purposes in a
greater degree than might at first be expected."

In conclusion, Dr. Simpson stated that he had now used the
Air-tractor which he had constructed in several cases of
labour, and with results answering his best expectations. But
it doubtless^ admitted of much further improvement in con-
struction, in mode of application, in working and other details.

Beneficial Effects of Coffee in Infantile C/io/era. (London
Med. Gaz., from Henle's Zeitschrift.)

Dr. Pickford states, that from the great importance which
now attaches to the treatment of cholera, he feels it to be in-
cumbent upon him to impart to others the experience which
recent opportunities have afforded him of the effects of coffee in
the cholera of infants.

In the case of an infant at the breast, to which he was called
late, to whom the usual remedies had been administered unavail-
ingly for four days, the exhibition of coffee was attended with
complete success. The incessant vomiting and purging had
produced extreme emaciation; the abdomen was distended;
the pulse was frequent and small ; there w^as great restlessness,
and sleeping with the eyes half opened ; convulsive motions of
the eyes when awake. Carbonate of ammonia, with nourish-
ing diet, and external stimulants, having been fruitlessly exhib-
ited, Dr. Pickford determined to have recourse to coffee, which
he knew to have been recommended as a stimulating tonic, by
Dr. Dewees. He began with a small dose, a scruple, infused
in two ounces of water, with one ounce of syrup, giving a large
spoonful every hour. The effect was surprising; the vomiting
was arrested; the evacuations became more consistent, im-
proved in colour, and less frequent. The amendment progress-
ed so rapidly, that by the tenth day the child w^as discharged
as cured.

The eilects were equally good in a little girl, fourteen weeks
old, in whom the vomiting was not so severe, but the diarrhoea
was quite as copious. In this case, also, the coffee was given,
after other means had been tried, and the patient greatly re-
duced.

Dr. Pickford has since used this remedy in nine children of
different ages, from four weeks to two years and a half. The
doses have varied from half a scruple to two scruples daily. He
has, also, administered it to children labouring under premonito-
ry symptoms, especially where the evacuations have been very
light-coloured. In some cases a single dose of calomel haa

preceded its employment. The effect was always favorable,
except in one case to which he was called too late, when the
child was already sinking.

He has not had any occasion to try the value of coffee in the
diarrhoea of adults, having found calomel and opium of sufficient
efficacy.

The benefit of coffee, especially in bilious diarrhcea, has been
extolled by Lauzow and Chultze (Richter's Arzneimittellehre,
vol. 1.) West, in 1813, found a combination of coffee and
opium very useful in the epidemic of that year. Coffee has
long been employed by the common people as a remedy (in
Germany, we suppose,) 'after excessive indulgence in spirit
drinking. It is known to have the property of promoting
digestion, and the action of the bowels.

The purgative action of burnt coffee, is attributed by Dn
Pickford to its tonic exciting properties. Like some other
substances, in small doses it is capable of restraining diarrhoea,
while in large doses it acts as a cathartic. The physiological
explanation of this opposite effect of the same remedy is proba-
bly to be found in the condition of the motor nerves, which,
being weakened, are by its moderate stimulus restored to their
normal state of excitement, and thereby diarrhoea depending
on their paralysis is cured. In this way, also, is explained its
aperient action in larger doses on adults, by its over-stimula-
ting these nerves, and so promoting increased movement of tho
intestines.

A Successful Mode of Treating Fevers. -(Boston Medical and
Surgical Journal.)

Notwithstanding the great improvement in the practice of
medicine, from the days of Hippocrates to the present time,
above forty years experience has convinced me that but* few
physicians have employed the best or most proper method of
treatment in epidemic and contagious diseases; particularly
fevers, termed remittent, continued, inflammatory, typhus, scar-
let, and such like ail of which I believe stand in the same associ-
ation, and are the effect of actual poison, which being present in
the system often bids defiance to the lancet, emetics, cathartics,
or sudorifics, and the unhappy patient frequently falls a victim
to its deadly grasp. But the best means that I have found, for
rescuing the patient from the impending danger, is to disarm
the enemy of his deadly weapon. For this purpose, for nearly
twenty years, I have employed the oil of olives and alkali ;
these being the greatest antidote with which I am acquainted.
The following is my usual manner of treating such disorders.

436 Monthly Periscope. [J^^y.

I sometimes, though but seldom, bleed, but generally cleanse
the stomach by the use of few grains of ipecac, or some other
mild emetic. I then direct the patient to be rubbed all over
with the oil daily during the fever, using about two ounces at
each time. I also direct the patient to take a tablespoonful
of a week solution of alkali, mixed with a little saltpetre, once
every two, three or four hours, quieting the system by employ-
ing a few grains of Dover's powder occasionally, and drink
freely a decoction of Virginia snake root and valerian, and as
much cold water as the patient wants. For regulating the
bowels, I generally employ the olive oil, castar oil or rhubarb,
but mostly of the former, a tablespoonful of which may be taken
every day at the commencement of the external application.
If the bowels are much filled with morbid matter, I sometimes
add a few grains of calomel to the rhei, avoiding drastic purges,
as they not only irritate the system, but are often succeeded
by diarrhoea, which is sometimes difficult to restain. I regard
quietness, both of body and mind, of the utmost importance.

An Old Practitioner.

[The writer of the above has given his name to the Editor,
and is, as he professes to be, an old practitioner. As such, he
is entitled, to record the results of his practice. We think
there is reason to believe, however, that the successful results
in his cases were more owing to the mere harmlessness of his
treatment, than to any remedial efficacy exerted by it,]

PART III.
illontljlg |3ri0cop

A New Physiological Fact. (Revue Medico-Chirurg. de Paris.)
M. Magendie announced to the Academy of Sciences on the 2d April,
that M. Bernard had detected that if a pointed instrument was made
to prick the fourth ventricle, a little above the origin of the eighth pair
of nerves, the urine of the animal wounded, which was before troubled,
alcaline and deprived of saccharine matter, became abundant, clear,
acid and holding in solution a great quantity of sugar like that of the
diabetic. An hour and a half to two hours would be sufficient to pro-
duce these changes. The blood also contains much saccharine matter.

The experiment was repeated upon 16 rabbits, and exhibits a sin-
gular influence of the nervous system upon nutrition.

Removing a piece of Pipe-stem from the Bladder. We see in the
Bulletin General de Therapeutique, the case of a man who in a
drunken frolic attempted to sound himself with the stem of a common

pipe. This broke off, and a piece more than two inches in length
passed into the bladder. He came to LaCharite Hospital, where thai
skillful surgeon, Velpeau, removed it by an instrument like Civiale's
Lithotritor with three blades.

New mode of curing Stricture of the Urethra. Dr. Brainard, Prof,
of Surgery in the Rush Medical College, relates a case in the North
Western Journal of Medicine, in which he performed a novel opera-
tion for stricture of the Urethra. The retention of urine was almost
complete, and finding it impossible to pass a catheter, &c., the blad-
der was punctured above the pubis. A canula was here retained
for two months, when the thought occurred to the surgeon to pass a
catheter through this supra-pubic opening in the bladder and thence
forwards through the neck of this organ into the urethra, where it was
seized, drawn forward and placed m situ as ordinary. At the end
of three or four days, this instrument was removed, and a fresh one
passed per urethram into the bladder.

The novelty is passing the catheter from behind forwards, whicii
mode, could it be adapted to cases in general, would be of immense
importance to surgeon and patient.

Collodion in Chilblains. In chilblains I have used it with the most
decided success. In one case the patient had her feet for some time
exposed to severe cold, which produced an erythematous inflammation
of several of the small toes. They were swollen, red, tender, and
itching. I completely enveloped them in a thick coating of collodion,
and the contraction which took place on its drying produced so much
compression of the vessels, that the toes were as pallid as frozen ones.
The pain and itching were immediately relieved, and in twenty-four
hours these members were nearly well., I have cured pernio of the
heel, also, with this article, but I do not believe it a panacea for all
cases of chilblain, even in its erythematous stage. [Dr. C. Green, in
Buffalo Medical Journal.

Belladonna in the Nocturnal Incontinence of Urine in Children.
M. Trousseau narrates the case of a girl, five years old, who, since
her third year had been the victim of this obstinate complaint. I^o
effort was neglected on the part of the parents to remove the habit ;
but all the means adopted some of them sufficiently severe were
without effect. A pill, containing one centigramme of the powder-
ed root and half a centigramme of the extract of belladonna, was
ordered to be taken every night at bed-time. During the first week
two nights were passed without accidents ; and from that time, with
two or three exceptions, the complaint entirely disappeared. The
treatment was resumed from time to time for nearly a year. This is
only one of several cases occurring, as well in his own practice as in
that of M. Bretonneau, in which Prof. Trousseau has observed mark-
ed benefit from the use of this drug. [VUnion Med., Oct- 14, 1848.

In a more recent number, Oct. 21, of the same Journal, Dr. Bache,

438 Monthly Periscope. [July

Physician to the Hospital des Enfans, records two very obstinate cases
of nocturnal incontinence of urine, occurring in individuals, one fifteen
and the other eighteen yearsof age, where mercurial and sulphureous
baths, refrigerant and astringent applications, tonic and ferruginous
medicines, tannin, ergot of rye, nux vomica, and all other means had
failed. Ultimately belladonna was exhibited with complete success.

[Monihhj Retrospect, Dec. 1848.

Phlebotomy in Ancient Times. In the early ages some of the Ab-
beys had a bleeding house called Phlelotomaria, in which they had
four general quarterly bleedings ; and in the order of St Victor, the
l^rethren had five bleedings per annum. Haifa century ago, bleed-
ing was generally in fashion spring o-ndfall ; and surgeons were then
never seen without a box of lancets and a red fillet. A fashionable
phlebotomizing surgeon has been known to receive aboyp a thousand
guineas a year for this operation alone. [Med. News,

New Method of Treating Urethral Pains following Gonorrhoea.
]\i. Vidal (de Cassis) haying frequently remarked that these pains
were relieved by pressing the penis with the fingers, has been led to
try compression for their treatment, and has found it useful, affording
A perfect cure in many cases, and a marked alleviation in others.
The operative procedure, says M. Vidal, is so simple that it is scarce^
\y necessary to mention it. "The surgeon takes a long strip of
diachylon plaster, one centimetre (two-fifths of an inch) in breadth,
and rolls it around the penis in the same manner as a common band-
age, beginning at the glans ; or, still better, he may apply it more
accurately by using a number of small strips of plaster, each of which
shall only be sufficient to encircle the orgjin once, and the tw^o ex-
tremities of each strip should be made to cross upon the urethra, for
\\\c purpose of insuring the firmness of the dressing. The principal
point to be attended to is the degree of compression, which ought to be
as firm as possible, without interfering with micturition, which would
of course, necessitate the removal of the dressings. The compression
should be continued for a considerable period after the cessation of the
pains, to prevent their return." M, Vidal cites two cases, from
amongst great numbers which he has treated, in favor of thjs mode of
practice. [Month. Retrospect, from VUnion Medicale.

Therapeutic effect of Oleum Jecoris Aselli and Prunus Virginiana^

Phthisis Treated Recovery. \u Sept. 1848, Mr. F. F. of B -,

palled on me for medical advice. He was twenty-two years of age
-had been afllictcd with a severe cough for thee months had
laryngitis and every diagnostic symptom of phthisis in the right lung.
I prescribed for him 01. Jecoris Aselli, three table spoonfuls a day,
and comp. tine, opii 3ii., witii a strong decoction of Prunus Virginiana.
Being fond of the oil, he took the full amount, and, the latter part of
|lhe time, six ounces of it a day. He rode on horseback every day.
The larynx was touched daily for two weeks with a solution of nit.

1849.1 Monthly Periscope. 43U

arg. 40 grains to the ounce of aqua distillata. In six weeks he had
gained twelve pounds of flesh, and was free from all his phthisical
symptoms. He has had no return of them since. Whether this was
one of those cases which would have come under the denomination of
Laennec's Spontaneous Cures, or like the late Dr. Parish's case in
Philadelphia, where puckerivgs or fistulous CQi\\i\es will be found in
the lung upon post mortem dissection, I will not determine. That it
was a case of Phthisis, 1 have not the least doubt. I would merely
suggest, that a comUnaiion of these two agents, the cod fish liver oil
and the wild cherry bark, may be more efficient than we have here-
tofore supposed, and may be worthy of a trial in all cases. [Charles-
ion Medical Journal and Review.

Fissures of the Nipples. M. Jose Leon advises all pregnant women
who have reason to fear chapped nipples, to use during the month
preceding delivery, once a day, the following liniment, the breast3
being previously washed with tepid water : R. Tannate of lead,
grammes iv. ; Simple cerate, grammes xxx, ; Oil of roses, drops ij.
The bosom should be immediately covered with a compress of soft
linen. [American Journal, from Gaz. des Hop,

Prolapsus of the Umbilical Cord. By Dr. Rigby. Is either pro-
duced by two great distention of the uterus from liquor amnii, or from
the lower portions of the uterus not contracting sufficiently about the
child.

Preserve the membranes unruptured as long as possible ; so long as
this is the case the cord is in little danger.

If the passages be well dilated, and the pains active, you may venture
to deliver with the forceps ; if not, you must turn the child. Some
have succeeded in carrying up the cord upon their hand, and hanging
it upon some part of the child, and then allowing the head to descend.

Where the cord is without pulsation and flaccid, there will be no
need of interfering. [New York Journ. of Med.

Treatment of Cholera by Calomel. By Dr. Ayre, of Hull, Eng-
land. Calomel, therefore, in the minute dose of one or two grains,
with a drop or two of laudanum to assist the stomach to retain it, and
given every five or ten minutes, was my sole remedy in the stage of
collapse, and in the cases which I now subjoin, will be found the
proofs of its efficacy.

In the hospital there was one of my patients, to whom it was found,
from a very exact account that was kept, that no less than 580 grains
were given ; and one of my correspondents informed me that he had
exhibited to one of his patients a larger quantity than this by 2*20
grains, and in both with the happy result of restoring early to health,
and without the least appearance of ptyalism. But though neither
ptyalism nor any other inconvenience is produced by calomel, whea
exhibited in the stage of collapse, yet if continued after this stage is
wholly removed, its action on the system will be the same as it is in

440 Monthly Periscope. [July,

ctlior diseases, and two or three grains will do then what as many
hundreds could not do before. And in the cases presently to be given,
it will be seen, not only with what freedom I gave that medicine, but
also with what care 1 w^atched its exhibition, and attended to the
lessening or suspension of it, as the collapse progressively subsided.
By giving the remedy boldly, and yet cautiously, I was enable to sub-
due the collapse, and by subduing tlie collapse to prevent the
consecutive fever, and thus limit the duration of the disease to two or
three days. Ohio Medical and SurgicalJournal.

On Vinum Sem. Colchici Opiate in Gonorrhoea. By Dr.FROiNUS.

Dr. Eisenmann, in a communication to the ' Wochenschrift,' in 1847,
demonstrated the great utility of the Vin. sem. co/c/t. (V. s. c. Siij. ;
Tr. opii, 32), in doses of from 25 to 30 drops three or four times a day,
in the treatment of both male and female gonorrhoea. Without deny-
ing that it may be sometimes desirable to precede its use by purga-
lives or oleaginous fluids, he had himself found it applicable in all
stages of the disease, effecting a cure, upon an average, in about seven
days. In the present paper, 10 additional cases are related of its suc-
cessful employment in various stages of the affection ; apd reference
made to some 50 others, in which it proved as satisfactory in the re-
sults. It is not only useful in infectious gonorrhoea, but in discharges
from the mucus membranes from other causes. [iZ/ZtZ., from Casper's
Wochenschrift,

A Topical Application for Bruises. By M. De Monteze. Pow-
dered senna, powdered verbena, and powdered white pepper, mixed
in equal proportions with white of egg. The application of this mix-
ture has been found effectually to promote the absorption of blood
effused in bruises, and also to allay the attendant pain. [Western
Lancet, from Journ. de C hemic Medicale.

A Hindoo Remedy for Conjunctivitis. Take a flat, rusty piece of
iron, and a lump of alum about the size of a nutmeg. The alum is to
be melted on the iron over a lamp, then add the juice of half a small
Jemon, or a little juice, rub together and apply to the lids while warm,
morning and evening, for three or four days. This composition is ap-
parently the citrate of iron and alumina. [Boston M. ami S, Journ,

On the externa/ use of Iodine in Croup. Dr. VVillige speaks of hav-
ing had remarkable success in the treatment of urgent cases of croup
by the external application of Iodine to the larynx and trachea. He
recommends that tincture of iodine should be smeared with a feaiher
over the front part of the neck, corresponding to the larynx and trachea
and their immediate neighborhood ; and that this should be repeated
several times, with intervals of about four hours., until redness and
irritation of the skin is induced. In most cases this is followed by
subsidence of the distress of breathing, of the spasms of the glottis, and
of the other bad symptoms. He mentions the particulars of three

1849.] Monthly Periscope. . 441

cases in which, by this means, he succeeded in averting impending
death. [^London Medical Gazette.

Paronycliia. In the Bulletin d(^ I'Academie de Medicine de Belgi-
que, 1848, there is a suggestion of Dr. Henroz, concerning the means
of diminishing the distressing, throbbing pain of this affection. He
has succeeded, by trials upon himself, in annulling the pain of a whit-
low, by skilfully compressing the brachial artery between two little
splints. The author adds, that moderate pressure of the radial artery
near the wrist will suffice, when the inflammation has attacked either
the thumb, index or middle finger ; whilst compression of the ulnar
will allay the pain in the ring and little fingers. \^London Lancet.

To make a prompt Issue. Prof. Parker, of New York city, recom-
mends strong Nitric Acid, (the acid of the shops will not do,) dropped
on paper filling the hole made in adhesive plaster applied on the sur-
face to be cauterized. This acts in a few minutes, gives but little
pain, and a slough will be thrown off" an issue may then be kept up
with peas, or a ball of wax.

Prescription of Br. A. H. Buchanan, of Nashville, Tenn.,for Pre-
monitory Symptoms of Cholera.
ft. Alcohol, 1 pint.

Gum Camphor, ii, dissolve, and add
Laudanum, gii.

Comp. Spts. Lavender, gii. Dose, 30 to 60 drops', on a
lump of sugar, after each evacuation.

Prescription for Typhoid Fever.
R. Spts. Turpentine,

Balsam Copaiva, aa 3ii.
Solution Gum Arabic ii. M.
Dose, a tea-spoonful every 4 to 6 hours, for one, two or three daya, till
the secretions show a change.

Prescription for Cholera Infantum.
R. Rheubarb Root, (burnt).
Loaf Sugar, aa 3ii,

Water, vii. Boil and strain, and to each ounce add 5 grs. Bi-
carbonate of Soda. Dose, a tea-spoonful given three or four times daily.

To make Mercurial Ointment. Rub the mercury with spermacetti
(instead of lard) a few minutes, add a few drops of sweet oil, stir a
minute, and the work is done.

Camphor Mixture. Chloroform, 3i.

Camphor Solid, 3iii.
Yellow of Eggs and
Water beat up, iv. Mix.
Dose a tea-spoonful, equal to grs. 5.

44ii Medical Intelligence. U^^^Y*

MEDICAL INTELLIGENCE.

Notice of the Mineral Springs in ike State of Georgia. "We have had it in con-
templation to prepare some account of the Mineral Springs of this State. In
connection with the subject, we had proposed a visit to each one, and through
the kindness of the chief Engineer of the State Rail Road, we made with him
last fall an examination of Gordon's and Murray's Springs ; having previously
been at one or two others, and obtained the waters from most of them. Believ-
ing that some notice, however brief and imperlect, would do good at this period
of excitement regarding the public health, we submit the few facts in our pos-
session, with the regret that the information is not more minute and accu-
rate in reference to theanal5'sis of the mineral waters of Georgia.

Probably no State in the Union possesses greater mineral wealth than this.
Her resources in this respect, yet unexplored, and very superficially ex-
amined, prove them to be very various and apparently inexhaustible. In
Georgia are found gold, some of the precious stones, mines of coal, lime and
iron; also sulphur, marble, granite, &c., &c. As a consequence to this geolo-
gical formation, we have ferruginous, sulphureous, carbonic acid and saline
waters. Chalybeate and sulphur springs are not uncommon in different sections
of the State, and for years a few of them have become watering places, and
favourite summer retreats for a portion of our citizens.

Mineral waters are those which contain so much foreign matter as to render
them unfit for culinary purposes. For this reason many are used for their sup-
posed medicinal virtues. The properties of mineral \vaters have been classed into
four divisions viz., chalybeate.s, ferruginous or iron ; acidulous or acid waters;
sulphureous; and lastly, saline, or water holding in solution some of the vari-
ous salts. The same spring may contain more than one, or may even possess
all the.se foreign matters. According to this definition and classification, all the
known varieties of mineral waters are to be found in Georgia.

No analysis of the mineral springs of the State has ever been made; indeed,
this could only be accurately done at their source, for with whatever care the
water may be bottled, some of their gaseous contents will escape. All that is
now proposed, is simply an enumeration of those now known to exist, with an
approximative estimate of their qualitative and not their quantitative properties.

1. One of the oldest mineral springs of Georgia, is the il/ar//5fl'i, situated in
the county of the same name, being 24 miles from Athens, the seat of the Uni-
versity of Georgia. The water of this spring is Chalybeate, its temperature is
C2 ot Farenheit, its supply good ; the climate is delightful, the accommodations
are excellent, and the place accessible by Rail Road as far as Athens.

2. Near Gainesville, in Ilall Co., 30 miles from the Madi.son springs, is a
Sulphur spring, but of limited supply still nearer the town is a splendid
Limestone spring.

3. The Indian springs (Svlp?iur)nrc in middle Georgia, not far from Macon,
The supply of the water is here sufficient for drinking, but not for bathing pur-
poses. The accommodations are very good; the place can be reached within a
few miles by Rail Road. This has long been one of the most fashionable resorts
of our State.

4. At the Stone mountain in DeKalb Co., directly on the Georgia Rail Road,
is a C/^fl'/v*'''^'''' spring, as yet however attracting little notice; which indeed may
be aid of several other ferruginous springs in other parts of the Slate.

1849.] Medical Intelligence. 443

5. The Merri wether springs (Thermal) sure near the Pine mountain, in a
county bearing the same name, and are, we believe, the only natural warm
waters in Georgia; the temperature is about 90. The accommodations lor
bathing are good. There are several other springs along this range of moun-
tains, such as the Thunder spring in Upson Co., (so called Irom the copious dis-
charge of Carbonic acid gas,) Chalybeate, Sulphur, &c.

In North-western Georgia, known as the Cherokee country, a section whose
geological structure is exceedingly interesting, exists the greatest mineral pro-
ductions of the State. Here are the coalmines, lime kilns, marble quarries,
iron, sulphur ore, &c., &c.

6. The Powder springs, so named I'rom {he'w Sulphurettcd-hy^ro^eTx gas, are in
Cobb Co., not far from Marietta, through which pa.sses the State Rail Road*
They have yet attracted little notice.

7. Rowland springs are in Cass Co., 6 miles from the Rail Road, and was the
most popular resort the past summer. They are near the iron-ore most exten-
sively worked in the State. The water is Chalybeate, and the accommodations
equal to those of the Madison and Indian, their rivals.

8. The Cohutta springs are in Murray Co., high up in the mountains, near
the Tennessee line. These waters are strongly Chalybeate, are very cold, very
abundant, and are situated in a most deiighilul climate. It is a place formerly
frequented by the Indians in the summer. The contemplated Hiwassee or East
Tennessee and Georgia Rail Road will pass near the Cohutta springs, which,
with good accommodations and the natural advantages of the location, cannot
fail to make them a pleasant retreat.

9. Murray's springs are within a few miles of the Tunnel of the State Rail
Road, 12 miles fromDalton, and are like the Cohutta in the mountains. They
are very numerous; breakout in the bottom of a small stream; and contain
Lime, Sulphur, a.nd Iron. The temperature of these waters in the middle of the
day (clear) w is (i: ,

10. The Gordon's springs are also near the Tunnel andDalton. Prof. Means
says of these, "I have examined a good many of Ihe mineral .springs of Geor-
gia, and tested their waters, but have not seen any that 1 think furnishes as good
^variety of medicinal properties, within the same geographical limits. Several
^ne cok Q lalybeate springs of different degrees of strength, together with one
or two Saline springs, largely impregnated with Magnesia, combined with
Sulphuric and Carbonic acids, (Soda and Lime being also included,) are found
within the space oi forty yards; while at the distance of a half mile, a pleasant
cold spring, charged with Sulphuretted Hydrogen, breaks out within 30 feet of
another very cold and large ferruginous spring."

"We have thus. Acidulous, Chalybeate, Svlphureons, and Saline waters at this
one location. They are at the foot ol Taylor's ridge of mountain. All these
waters are very abundant ; their temperature 59. The accommodations are
rapidly improving, and under proper arrangement, this watering place is des-
tined to become one of the most fashionable in the South.

11. The last waters we notice are those on Lookout mountain, where at a
glance six States of the Union may be seen. This is the line of Georgia and
Tennessee, with Alabama hard by here is the terminusof one State Rail Road
and tl.e commencement of the other here is the Tennesse river navigable for
hundreds of miles, and here was Ross' landing, now known as the location of
^he flourishing town called Chattanooga.

444 Medical Intelligence. [July,

"NVc are indebted to our friend, Dr. Frazier, of llie town just mentioned, for the
following information respecting this interesting section of our country:

" The mountain ranges nearly North and South. It commences on the
south bank of the Tennessee river, about three or four miles from the State
line; rises abruptly from the bank of the river in the distance of a mile to
the height of 2000 J'eet. its greatest altitude, runs through the north-west corner
of Georgia and into Alabama, where it breaks off into irregular spurs and
ridges. The unbroken and highest part is in Tennessee and Georgia, and is
some 40 or 50 miles long. The northern point is the highest part ot the moun-
tain, an*d is narrowed on top to a few hundred yards, which is nearly level and
quite productive. There are several farms now opening about this plain. On
this part of the mountain are the springs, from which the waters were taken
that you have analyzed. The soil is sandy, and the rocks are entirely mountain
sand stone. The spring No. 3 is in Georgia, and breaks out within about 100
feet of the highest point ; Tt is a bold and constant stream. No. 2 is in Tennes-
see, just on this side of the line; is also a good stream. Temperature 58. No. >
(the pure water) is on the side of the mountain, runs out of a perpendicular
bluff'some 250 or 300 feet high; its temperature is 5G. * * There
is perhaps not to be found in the world a more romantic spot than the point of
Lookout mountain. You can stand upon this broad flat rock, 2000 feet above
the surrounding country, and survey at a glance, six States of the Union
Kentuck}^, Virginia, North-Carolina, Georgia, Alabama and Tennessee. You
look down upon mountains and liills, green forests and cultivated fields, flour-
ishing villages and towns. The Tennesse river is seen too in all its beauty and
grandeur, for miles and miles in the dim distance. You see it as it rolls just
below you; then as it dashes onwards to the North, making almost a com-
plete circuit to enter the clifi's in the Cumberland mountain, called the Suck."

The Doctor also states in this letter the fact that from a register kept in 1842
or '43, it was ascertained that the difference in the mean temperature between
the valley of the river and the summit of the mountain was 6h lower on Look-
out than in Chattanooga. The vvaters sent us were Sulphureous &nd Chalybeate,
the strongest we have ever tested.

The common temperature of the water (pump and spring) in and about Au-
gusta is G5. At the U. S. Arsenal, on our Sand-hills, 200 or more feet above
us, is a well IGO feet deep its water isGG. There are two pumps in Augusta
of G3, and a spring lately opened in one of our Factories is even a fraction
below this; the water is pure mountain probably derived from the canal.
The temperature of our up-country water is G2, while in the mountains it is as
low as 58 and 5G. The common temperature of the Saratoga mineral v/aters
is 50, one of the springs is as low as 48.

We commend our various mineral springs to the notice of our profession ; it
maybe, like our indigenous botany, they are undeservedly too much neglected,
only visited as fashionable resorts, and not for medicinal purposes. An accurate
analysis of them, or well observed cases treated at their sources, would no doubt
enhance very greatly their value. We cannot close, however, without directing
the attention of the proprietors of these various 'medicinal waters, as we conceive
them to be, to the importance of connecting extensive Zia^An?.,^ establishments with
them. At Saratoga nearly every spring has its bath-house. Ifgood internally,
lliese waters must prove .so when externally applied.

Proposed amendments of the Constitution of the National Medical Association.
In view of the fact that under the existing .state of things the Reports of tha
Standing Committees must necessarily, in several instances, be in a great de-

1849.] Medical Intelligence. 445

gree repetitions of each other, and that their great length precludes the possibili-
ty of hearing them read in extenso, Dr. Dugas laid upon the table, for action at
the next meeting of the Association, a proposition so to amend the Constitution
as to assign to each Standing Committee a separate and distinct department of
Medical knowledge. The number of the Committees will, it is true, be much
increased, but the Reports will be correspondingly shortened and to the point,
so that each may be heard without the risk of wearying the Convention. The
vote to refer to the Commtttee on Publication several of the Reports presented to
the last meeting of the Association, without having them read, cannot be viewed
as otherwise than discourteous, and would indicate the necessity of a change.
The Standing Committees proposed by Dr. Dugas's amendment are as follows :
One on Anatomy, human, comparative and Microscopic.

" " Physiology, human and comparative.

" " Materia Medica et Alimentaria.

" " Chemistry, Medical and Organic.

" " Pathological Anatomy.

" " Principles and Practice of Medicine.

' '* do, do. " Surgery.

" " do. do. " Obstetrics.

< Hygiene and Sanitory regulations.

" " Forensic Medicine.

" " Medical Education,

" ' American Medical Biography.

" " Medical and Vital Statistics.

" ** Publication.

" " Arrangements.

To the Editor of the Southern Med. and Surg. Journal :

Dear Sir You will oblige me by publishing the following facts, which con-
firm certain positions assumed in my Lecture on Syphilis, contained in your
last number. Yours truly,

L. A. DUGAS.

On the Absorption of Virus. By M. Renault. M. Renault has recently com-
municated to the Academy of Sciences the results of certain experiments made
at the Veterinary School at Alfort, the object of which was the determination of
the period at which the action of Virus ceases to be local, and becomes general.

This was endeavored to be determined by ascertaining how soon a parcel of
Virus placed under the epidermis becomes absorbed; or, in other words, how
long is the peiiod after inoculation vvithin which we may destroy or remove the
portion of skin under which such deposition has been made, without modifying'
the absorptionof the virus, so as to prevent or sensibly modify the general effects.
In thirteen experiments, the animals were inoculated with the matter of acute
Glanders, and the actual cautery applied, after previous excision of the congest-
ed parts, at periods after the inoculation varying in the different animals from
96 hours to I hour. In all the animals became diseased. In another series of
experiments in which the virus of the rot of sheep was employed, it resulted that
the virus was absorbed in five minutes. [Gazette Medicate, 1848, No. 51. Brit-
ish and Foreign Medico- Chirurgical Review, April 1S49. P. 531.

Proposed specific for Cholera Sulphur. Under the impression that Epidemic
Cholera depends upon ozone, (a change in the atmosphere produced by electri-
city acting upon its watery vapour,) Dr. Bird, of Chicago, has recently proposed

L

446 Medical Intelligence. [July,

Sulphir in 4 ro 5 grs. doses with a little charcoal, as a specific. The suggestion
is announced to the public under the auspices of an editor of the North Western
Journal of Medicine, and some of the Professors of the Rush Medical College at
Chicago,

There is no specific for any disease; and, moreover, no disease is cured ex-
cept by nature. All that medicine can do is lo prevent or modify impressions
upon the system the cure, we repeat, is after all the work of nature. That
Cholera does not prevail at Sulphur Springs, or among those who handle sul-
phur, is no more true of it than of other epidemics. We sincerely hope Dr.
Bird and his friends may be right, but we confess that we would prefer to use
the preparations spoken of in larger doses, as well as to have other agents hard
by when attacked with Cholera.

Dr. Bird deserves the thanks of his profession and of his country, lor the noble
manner in which he has made his proposition known to the world. It was
not only spread on the wings of the wind, but went by telegraph to New York
and New Orleans from which places favorable reports (of course limited)
were received in reference to its use. Should his suggestion prove to be true,
viz., that Sulphur will prevent Cholera, his name will be associated with that of
Prof. Simpson of Edinburgh, and the immortal Jenner.

Professional Changes in the Medical Colleges of the United States. We notice
in the Journals several changes in our Medical Institutions some caused by
death, others by resignations. Dr. Thomas Hunt fills the chair vacated by the
death of Dr. Harrison, in the University of Louisiana; and Dr. Nott, brother to
Josiah C, of Mobile, has been elected to the professorship of Dr. Carpenter, in
the same College. Dr. Mitchell has resigned his chair in the Transylvania
University to accept one in the Philadelphia College of Medicine his late place
is filled by Dr. Bullett, of Louisville. Drs. Donne and Miller have resigned in
ihe Memphis Medical College. Dr. Drake has left the Louisville Medical
School and gone toCincinnalli, destined perhaps to be the next President of the
National Medical Association. The venerable Dr. Caldwell has also resigned
liis professorship in Louisville-^Prof. Yandell succeeds him, and Prof. Benj.
Silliman, Jun., is the successor to the chair of Chemistry. Dr. Fitch has re-
signed the post of Theory and Practice in the Rush Medical College, Chicago.
Prof. Bartlett has resigned his chair in the Transylvania University and accept-
ed one in the Louisville University. Prof. Hayward has resigned the chair of
Surgery in the Massachusetts Medical College, and his place is filled by the
election of Dr. H.J Bigelow.

MEDICAL MISCELLANY.

IVie origin of Moks ( Gnmen Falsoin). Dr. Thomas Lipscomb, of ShelbyVille,
Tenn., advocates the opinion, in the Western Journal ol Medicine and Surgery,
iha.t prolonged lactationis the most frequent source of false conception.

To ascertain if a child is born dead or not. Dr. Van Hengel, ot Holland, has
addressed a note to the Academy of Medicine of Paris, relative to the discovery
of a certain sign by which it can be ascertained if infants are born dead or not.
The means consist in injecting into the rectum a mixture of brandy and cold
water.

1849.] Medical Intelligence. 447

Sir Bevjamin Brodieh Liniment fcr Knee. Sulphuric Acid and Olive Oil, in
the proporiion ot one to three.

New Ohsktrical Forceps. Prof. White, in the Buffalo Medical College, has
invented a new Forceps* which is pronounced bv competent judges to be superi-
or to any other in use. The Tiemans of New York have them for sale.

McMiain's Elixir of Opivm its covipcsitinn. A Dr. Ritchie, of Chicago, in a
letter to the editors of the Western Lancet, believes that this preparation is com-
posed of Laudanum with elaterium. He judges from its effects upon himself.

Emigration and Sickness. Of 3079 sick emigrants, chiefly Irish, thrown upon
the city of New York in one month 1002 died.

Quarantine and Cholera. An Aberdeen paper says, that while the prayer book
and clbthes of a diseased cholera patient were most carefully burnt, six l notes
found in his pockets, were religiously preserved they of course not being coiita-
gious. Alas, poor human nature ! to what inconsistencies art thou driven.

Coating for Pills. Collodion is now used with much advantage in coaling
bitter or disagreeable pills. Stuck on a needle, two coats will be sufficient for
each pill.

Diseased Eyes from Decayed Teelh. Dr. Isaac Hays, than whom no one is
belter authority for diseases of the eyes, reports several cases in the Transac-
tions of the College of Physicians of Philadelphia, wherein photophobia was
extreme, relieved by extraction of decayed teeth irritation of the dental branch
of the fifth pair of nerves, being the source, and abscesses at the root of the teeth
verifying the diagnosis.

To expel Foreign Bodies from the Larynx. Dr. Hansford, of Illinois, says he
has expelled water melon seeds, a grain of corn, a glass bead, and a pin from
the larynx, by directing the patient to lie upon a bench, face downwards with
head projecting over the ed^e, and to take a deep inspiration. He then, while
the lungs are filled with air, gives a smart blow between the shoulders with a
pillow made hard by compression.

Depopulation of parts of Europe. In the kingdom of Netherlands the popula-
tion of 1848 was 3,050,840 souls. In 1847, there were 91,G70 births deaths
during the same period 99,457 decrease for one year 7,787.

Tinxtxire of Belladonna in Cholera. Dr. Debrevne proposes in the Journal des
Connaissances Medico-Chirurg. the Tinct. of Belladonna with Laudanum in
the treatment of Cholera. He says Belladonna has been with me, for many
years, the anti-convulsive and anti-tetanic par excellence.

Nev) Suture for the Trachea. Dr. Sylva, in the same Journal (above), applied
two silver needles paralleled to the wounded trachea, and then secured by a
thread their extremities.

Qidck Lime to produce heat in Cholera patients. Dr. Poiseuille, of France, has
suggested that quick lime enveloped in a wetted linen, then in another cloth,
placed near the patient in bed, will rapidly develope heat in the algide stage of
cholera.

Chloroform in Midwifery. Prof. Simpson has used chloroform in 150 women
in child-birth. Nothing unpleasant has occurred in them, either primary or
secondary, and but two children of those delivered have died one was putrifi-
ed, the other asphyxied.

Night Visits wlienare they made? By a decision recently had before a tribu-
nal at Hall, all visits made between 9 in the evening and 6 in the morning, are
considered as made at night.

A neio mode of Tampon in the Nose. A soft wire doubled upon itself passed
through the nostril, the nose is then filled with cotton or charpie, as it project*
alongside of the uvela, the wire is drawn tight and the two ends at the anterior
naris secures a second pleget.

448

Obituary Notices. Meteorology.

OBITUARY NOTICES.
The celebrated surgeon, Samuel Cooper, author of the Surgical Dictionarj",
First Lines of Surgery, &c., died last December, in London, England, in the
68th year of his age.

M. Serres, Professor of Surgical Clinic in the Montpellier School of Medi-
cine, France, died suddenly at the age of 48, the 21st of March.

Prof. BLANDiisr, in the School of Medicine in Paris, has just died from Cholera,
aged 50,

Dr. TowNSEND, translator of Velpeau's Surgery, died in New York, March,
1849, aged 53 years.

Dr. Prichard, the celebrated author on Insanit}"-, &c., died in London.

Dr. TowNES. Professor of Chemistry in University College, London, died
January 31st, 1849.

Dr. WuRDEMAN, of Charleston, a most excellent physician and of amiable
character, formerly Demonstrator of Anatomy in the school of his native city,
&c., died of consumption, on a vessel near Savannah, while returning home
from Florida to his friends.

METEOROLOGICAL OBSERVATIONS, for May, J 849, at Augusta,
Ga. Latitude3327'north Longitude 4 32' west Wash. Altitude above
tide, 152 feet.

<

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

1()

17

18

19

20

21

22

23

24

25

2(1

27

Sun
Ther

Gl
64
66
63

66
70
68
66
70

56
50
58
62
63
68
68
56
50
53
58
63
71

6(;

65

-. (^^>
28 65

59
58
63

Rise.
Bar.

29 90-100
" 94-lOOJ

30 6-100
30 7-100
30 I
29 72-100

" 8O-IOO:
" 64-iOO
" 62-100
" 57-100
" 44-100
" 74-100
" 75-100;
" 65-100
" 60-100
" 54-100
" 57-100
" 58-100
" 78-100
" 92-100
" 91-101)
" 88-100
" 75-100
" 61-100
" 62-100
" 61-100
" 66-100
" 72-100

" 79-100:

" 85-100^
" 85-100

2,

TlIER.

P.M.
Bar.

90
86
78
87
87
85
74
89
87
71
64
75
82
85
90
76
70
57
75
78
81
81
89
82
88
87
72
81
82
81
88

29 89-100
" 92-100

30 9-100
30 3-100!
29 94-100

86-100
70-100
57-100,
60-100
45-100
59-1001
75-100
66-IOO1
59-100:
.50-100;
53-100
52-100
67-100
85-100!
92-100'
90-UK);
85-100
71-100!
62-100,
60-100
65-100
73-100
71-100
85-100
86-100
82-100

Wind.

s. w.
w.

N. E.
S.

s.
s, w.

s.
s. w.
s, w.
s. w.

N. W.
E.
W.

s. w.

N. E.

N.
N. E.
N. E.

S.
S. E.

s. w,
s. w.
s. w.

S. AV.
S. E.

W.

W.

W.

W.

Remarks.

5 Fair days, duantity of Rain 6 inches and 45-100.
S. 7 days. West of do. do. 17 days.

Pair morning storm at 7i, P.M.

Flying cl'ds sprink. last night.

Cloudy sprinkle yesterday.

Fair some clouds.

Fair some clouds.

Showery afternoon, rain 45-100.

Rain.

Fair morning.

Cloudy rain afternoon 55-100.

Rain, 1 inch and 80-100.

Cloudy blow.

Fair.

Fair breeze some clouds.

Fair breeze. [Ide at 8, p m.

Fair some cl'ds-blow, & sprin-

Showery.

Cloudy blow rain, 40-100.

Cloudy blow rain, 95-100.

Pair blow.

Fair.

Cloudy.

Cloudy.

Pair.

Cloudy rain, 30-100,

Pair morn 'g rain night 10-100-

Pairmorn'g-rain night 35-100.

Cloudy rain storm at 8, p.m., I

(Cloudy morning, [in. & 55-100.

Pair afternoon.

Some clouds.

Some clouds sprinkle.

Wind East of N. ami

SOUTHERN

MEDICAL AND SURGICAL

J 0 UH N A L .

Vol. .] NEW SERIES. AUGUST, 1819. [No. 8.

PART FIRST,
rtgitial (Eommunicattona.

ARTICLE XXHl.

Observations on Malarious Influences. By W. L. Jones, M. D.,

of Athens, Georgia.

The deteiimination of the conditions of existence* of the
human race, is the great, ultimate problem presented to the
medical Philosopher. The legitimate object of all his investi-
gations, the point to which they all converge, is the knowledge,
of that combination of external influences which is most favor-
able to the perfect development of man, and of the natures and
habitudes of those which are unfavorable to his existence.
That peculiar and definite relations do exist, between man and
the world external to him, is proved not only from the fact that
this is a fundamental idea in our conception of a living being,
but also by analogy and the observation of various modifica-
tions in the races inhabiting different parts of the world. The
labours of Geologists have w^ell established the fact, that organ-
ized nature has undergone various and striking changes in
correspondence with the mutations of the Earth ; so distinctly
marked are these, that they naturally divide the geological
epoch into four ages the primary characterized by the pre-
dominance of Fishes ; the secondary, of Reptiles ; the tertiary,
of Mammals, and the modern, of Man. (Vide. Principles of

* This expression is employed to convey a somewhat different and more com-
prehensive idea than that intended by Cuvier.- (See his An, King., vol. 1st,
p. 3d. New York. 1831.)

N. s. VOL. V. jvo. vin. 29

450 Jones, on Malarious Influences. [August,

Zoology, by Agassiz and Gould, p. 190. Bost. 1848.) The
geographical distribution of existing Plants and Animals, also
confirms the idea of definite relations ; thus, there are Faunas
and Floras peculiar to the Arctic, the Temperate and the Tro-
pical regions, besides an almost innumerable number of those
which are less distinctly marked and more local in their nature:
of the latter, the Galapagos Islands present a most interesting
and remarkable instance. But one indigenous Mammal has
been discovered there, and it is peculiar; 25 of 26 land Birds,
3 of 11 water Birds, G of 7 Reptiles, all the Sea Fish (15 spe-
cies), 15 of 16 land Shells, 47 of CO Sea Shells, 22 of 25 Coleop-
terous Insects, and more thanhalf of their flowering Plants are
found in no other part of the world. New Holland also is
scarcely less distinguished for the individuality oi'iis Fauna,
than for the peculiar types of its animals. In oceans and seas,
where the variations of external circumstances are not as great
as upon land, Animals are not so restricted in their habitations ;
but even here the laws of limitation are still observed. Most
of the aquatic tribes live near shores, and are therefore affected
more or less by the same influences as the occupants of the
land hence we observe that they are governed to some ex-
tent by the same laws. A remarkable confirmation of this
truth is found in the fact recently discovered, that the change
of a few feet in the depth of water, changes completely the kind
of animals inhabiting the bottom of the ocean. In truth we
can find no exception to the law, that all animals, from the
highest to the lowest, and all forms of vegetable life are gov-
erned to a greater or less extent by external circumstances^ in
their geographical distribution.

Now is it reasonable to suppose that Man, who w^as fashion-
ed according to the same type as the vertebrated animals and
who is connected with all organized beings by so many thou-
sand links should not be subject to the same modifying influ-
ences? Assuredly not and facts coincide with reason to
prove, that his existence is modified by external agents. Al-
though a cosmopolite in one sense, a comparison of races in
different parts of the globe, plainly indicates that all situations
are not equally favorable to his development. As an example,
the Patagonians with their long arms and slender legs, approxi-

1849. J Jones, on Malarious Influences. 451

mate the Quadramana very considerably, differing widely from
the Mexicans and Peruvians both physically and mentally, and
yet recent investigations shew that they belong to the same
family. "I can aver," says Dr. Morton, " that sixteen years of
almost daily comparisons have only confirmed me in the con-
clusions announced in my Crania Americana, that all the
American nations, excepting the Esquimaux, are of one race, and
that this race is peculiar and distinct from all others." (Silli-
man's Journ., 2d series, vol. 2d, p. 7th.) Many instances of a
similar nature might be ad iuced, but it is unnecessary perhaps,
as every one has remarked the difference in the physical ap-
pearance of the inhabitants of various portions of our country,
and even of our own State. But the influence of external
agents is still more strikingly displayed, in the variety of dis-
eases which prevail indifferent regions. It is well known that
the prevailing forms of disease in tropical countries, are affec-
tions of the alimentary canal and idiopathic fevers whilst
pulmonary affections and those of an inflammatory nature
supplant them in colder regions ; but careful observations have
shewn that even in temperate climates, the relative abund-
ance of different diseases in different localities is very much
modified by local influences. This is beautifully exhibited by
the researches of the late Samuel Forry, M. D., in his work on
the "Climate of the United States."* Speaking of Catarrhal
diseases, he observes, "on the New England coast, as the
ocean modifies the atmospheric temperature, the annual ratio
treated per 1000 of mein strength, is as low as 233 ; on the
great lakes, where a similar modifying influence is in operation,

* Having at his command quarterly reports of all cases of sickness and of the
number of deaths in a mean strength of 40,000 men, stationed in various parts
of the land, during twenty years; and collating and comparing these with the
calm and rigid scrutiny of a truly inductive philosopher, he was enabled to
establish some of the most splendid generalizations that have ever graced the
annals of medicine. He appreciated fully the well established truth that in a
science of observation, like medicine, conclusions founded on numbers, can
alone be relied on ; hence the laws he deduced are established not upon vague
and indefinite ideas that certain diseases prevailed in certain localities, but upon
an actual comparison of all the cases which had happened among a certain
number of men during a certain period of time; and this is an example which
medical men must follow if they indulge the hope of raising medicine to the
standard of an exact science.

45'J Jones, on Malarious Injluf/ncrsi. [Augusts

it is 300 ; whilst the third class, (posts remote from the ocean
and inland seas), characterized by the extreme range of the
thermometer, has a ratio as high as 552. But let us follow
more narrowly the isotheral and isocheimal lines (representing
the mean temperature of summer and winter) which describe
four curves within the same space, presenting alternately a
mild and an excessive climate. As these lines, on the coast of
the Atlantic, present comparatively little deviation from the
terrestrial parallel, the ratio of catarrhal diseases is low ; ad-
vancing into the interior, the line of equal summer rises and
that of winter sinks, and the ratio increases proportionally;
proceeding into the region of the lakes, the lines again converge
beneath the controlling power of the waters, and the ratio of
Catarrh and Influenza is modified accordingly ; again advanc-
ing into the interior beyond these ocean-lakes, the average
rises in proportion as the isotheral and isocheimal curves tend
to opposite directions." (p. 231.) In regard to Pleuritis and
Pneumonia, he establishes the fact that the average number of
cases " is much lowxr in the cold and variable climate of our
northern and eastern States, than in the middle and south-
western regions of the United States. At the south-western
posts the annual ratio is 92, whilst on the coast of New England
it is only 41." (p. 239.) Speaking of the variety of Intermit-
tent fever on the New England coast compared with interior
regions on the same parallels, he observes, "The same contrast
as regards the prevalence of Intermittent fever, is shown, in
the statistics of the British army, to exist between Canada, on
the one hand, and Nova-Scotia and New-Brunswick, on the
other. Whilst several thousand cases are annually reported in
the former command, the disease is so rare in the latter that
scarcely one indigenous case has been known to occur."
(p. 278.) Numerous instances of a similar nature might be
adduced, but who, after a due consideration of these alone, can
doubt that there are definite relations between the human sys-
tem and the world external to it ? or who that appreciates the
magic power of the "inductive philosophy" in revealing truth,
when applied to a sufficiently extensive collection of carefully
observed facts, can hesitate for a moment to believe, that all the
lav:s of these relations may be fully and accurately established.

1849.] Jones, on Malarious Influences. 463

This problem requires for its solution a perfect knowledge of
the human system and of all external agencies, whether organic
or inorganic, together with all the modifications which can be
observed to result from their action ; and to attain to this it is
only necessary that medical men should imitate the example of
the cultivators of the physical sciences, many of which, though
dating their origin at a later period than Medicine, have yet far
outstripped her in the race towards perfection.

Let us now apply these general considerations to the subject
of malarious influences, which have been universally attributed
to external agencies, and the diseases which they produce be-
ing therefore the result of some peculiar I'elation which the
human system sustains to one or more of these agents. We
have seen that those great and primary physical agents which
are ordinarily embraced under the term " climatic influences/'
are capable of modifying the development and of determining
the nature and prevalence of the diseases of the human system ;
now are they sufficient to account for the existence of malarious
diseases? It is not uncommon to find in medical works, the
assertion that they are not because, it is said. Intermittent
fevers prevail in a very great variety of climates. This may
be true, as far as vague and general impressions concerning
climates can determine the question ; but is it philosophical to
trust these, or even accurate meteorological records, if they be
incomplete ? Nowj until within a few years past, there were
no records of atmospheric Electricity ;* and is it reasonable to
reject entirely this powerful agent from the list of climatic influ-
ences and assume the unqualified position above-mentioned ?
May there not be in the midst of very great apparent varia-
tions, some invariable relations or conditions of the primary
agents heat, light, moisture and electricity, which might pro-
duce these diseases? This can only be determined by very
extensive observations and records of meteorological phenome-
na and the diseases which prevailed cotemporaneously both in
miasmatic districts and those which are perfectly healthy, during

No one can doubt the existence of changes in the electrical equilibrium of
the atmosphere, after reading the observations of Crosse (Noad's Lectures on
Electricity) or the influence of this agent in organic processes, after reading
the researches of Matteuci and Ducros.

454 Jones, on Malarious Injluences. [August,

periods of considerable duration. It is by the collation and
comparison of such records only, that the laws of the relations
between climates and diseases can be discovered. And this is
a point of the first importance in Medical Science, since with-
out this knowledge, we are constantly liable, in the explanation
of pathological phenomena, to the error of introducing causes
which are entirely superfluous, or of attributing too much or
too little efficacy to those which really exist. Even in the pre-
sent imperfect state of knowledge, however, concerning mete-
orological influences, there are some considerations founded
both on reason and observation, which would lead us to believe,
that climate either produced or co-operated largely in the pro-
duction of malarious diseases. Upon this supposition, their
characteristic j9eno<i/cz7y might be readily anticipated; since
climatic influences are themselves periodical, it would naturally
be expected, therefore, that their effects would appear at inter-
vals. As every one knows, there is a maximum and a mini-
mum of Light and Heat each day those of the former varying
at times, the minimum of heat being about sun-rise and
the maximum between 2 and 3 o'clock, P. M. By daily
observations for more than ten years at Halle, M. Kaemtz
found that the humidity of the atmosphere attained its maxi-
mum just before sun-rise and reached its minimum about 3
o'clock, P. M. The universality of this law is confirmed by
the observations of Neuber at Apenrade, "of Kopfer at Peters-
burg, i.nd by his own observations at the Sea and on the Alps.
(Vide. Kaemtz's Met. by Walker, p. 82. Lond. 1845.) "It
has been ascertained by the observations of De Saussure,
Schubler, Arago and others, that the positive electricity of the
atmosphere is subject to diurnal variations of intensity, there
being two maxima and two minima during the 24 hours. The
first minimum takes place a little before the rising of the sun ; as it
rises, the intensity, at first gradually and then rapidly, increases,
and arrives at its first maximum a few hours after. This
excess diminishes at first rapidly and allterwards slowly, and
arrives at its minimum some hours before sun-set ; it re-ascends
when the sun ayproaches the horizon, and attains its second
ma>imum a few hours after; then diminishes till sun-rise, and
pre ceeis in (hs order already indicated." (Phil. Mag., vol

1S49.] Jones, on Malarious Injluences, 455

15th, p. 219. 1839.) It will thus be seen that the maxima and
minima of these forces coincide in point of time, and their
effects ought therefore to be in like manner periodical and ob-
serve daily intervals. And it is a curious coincidence, to say
the least of it, that the intervals of periodic fevers are either a
day or a multiple of a day. Why the interval is sometimes the
multiple of a day and not always a day, may be explained on
this hypothesis by the interference of disturbing forces; which
would increase the length of the interval in direct proportion
to their number and power, as is the case in all purely physi-
cal phenomena. And here again the analogy is striking, for
antiperiodics when insufficient to stop an ague, are often ob-
served to prolong its intervals.

Another consideration which should direct our attention to
climatic influences, is, that during autumn, when these diseases
abound most, the combined influence of light, heat, moisture
and electricity, reaches its greatest intensity, for although the
heat and light has then decreased slightly, yet the humidity
and free electricity of the atmosphere has increased. " The
quantity of vapour attains its maximum in July, the month in
which the air is driest. At the approach of winter, when the
heat diminishes, tbe quantity of water precipitated in the form
of rain, dew and hoar-frost, greatly exceeds that which passes
into the state of vapour. Its quantity, therefore, goes on dimin-
ishing, although the humiditij is continually increasing^
(Kaemtz's Met., p. 92.) ' The intensity of the free electricity
of the atmosphere has also been found to undergo annual
changes, increasing from the month of July to the month of
November inclusive, so that the greatest intensity occurs in
winter, and the least in summer." (Phil. Mag., vol. 15th,
p. 220. 1839.) So that although heat and light attain their
maxima in summer, and the humidity and electricity of the
atmosphere attain their maxima in winter; still during the
intermediate periods, of autumn and spring, they will all co-
operate to the greatest extent ; and these are the seasons in
which malarious diseases prevail most. Our knowledge of
Meteorology being so limited, as to enable us to trace out
these general laws only, the attempt to explain any local phe-
nomena, by this hypothesis, would be premature. It could

456 Jones, on Malarious Influences. [August,

only be done with any rational hope of discovering truth, when
extensive records of local climates shall have been kept, and
this is a point to which the attention of medical men should be
especially directed. We should be induced to follow this course
of investigation, not only from apriori considerations and from
the striking coincidences above-mentioned, but from the unsat-
isfactory nature of all the theories concerning malaria, which
have been proposed. That which refers it to a deleterious gas
or gases, has been the most generally received ; but independ-
ently of the fact that these gases are merely hypothetical ex-
istences never having been discovered, there are some consid-
erations which render this theory very improbable. It is
opposed, in the first place, to well established laws of gaseous
action, that they should be confined to any localities. It has
been shewn by the researches of Graham and Dalton, that the
spaces occupied by different gases, are as vacua to each other,
and that they tend to diffuse mutually through each other with
velocities, which vary inversely as the square roots of their
densities. So powerful is this tendency, that if equal quantities
of Carbonic Acid and Hydrogen are put in a closed vessel,
although carbonic acid is more than twenty times heavier than
hydrogen, yet in a short time they will be uniformly diffused
throughout, so that as much of either gas will be found at the
top as the bottom of the vessel. It is on account of this difTu-
sive property in gases, that the proportion of Oxygen and
Nitrogen is so uniform ; for did gravitation alone operate, the
oxygen would sink to the surface of the earth and the nitrogen
would rise to the upper regions, their specific gravities being in
the ratio of 1.1111 to 0.97. " The importance of this mechan-
ism by which gases rapidly permeate each other's texture and
become equally diflused, it is scarcely possible adequately to
appreciate. The welfare of the whole organic creation de-
pends upon the due maintainance of the proportions of the
several aeriform fluids of which the atmosphere consists. The
processes of Respiration and Combustion are perpetually tend-
ing to destroy the nicely adjusted proportions, by the abstrac-
tion of the vital air and the substitution of the carbonic acid,
which is a deadly poison to animal life, and yet by the simple
means which we are considering, the poi-sonous air is not'al-

1849.] Jones, on Malarious Injluences. 457

lowed to accumulate, but diffuses itself rapidly through space,
while the vital gas rushes by a counter-tendency to supply the
deficiency which the local consumption has created. Hence
the invariable uniformity of this mixture, which is such, that the
most accurate analysis of the most eminent chemists, have
failed to detect any material difference in the proportion
of oxygen in air taken from localities the most opposite to each
other, in all the circumstances which might be supposed to
affect its purity." (Daniell's Meteorology, 3d ed., vol. 1st, pp.
25 and 26. Lond. 1845.) The Coal consumed in the metropo-
lis, London, during the year 1839, was, according to Brande's
Diet., 2,638,256 tons, and according to McCullock's Gaz., the
amount consumed in 1849, was 2,566,809 tons ; taking 2,500,000
tons as the average amount consumed per year, the quantity
burnt per day would be 6,849 tons, and per hour 258 tons, equal
to 638,400 pounds. Now estimating 70 per cent, of this coal to
be pure carbon, it follows that 446,880 pounds of carbon are
burnt every hour, and this will generate 1,638,560 pounds of car-
bonic acid every hour, and 27,809 pounds per minute or 233,981
cubic feet of carbonic acid each minute. The population of the
metropolis in 1841, according to McCullock, was 2,560,281.
According to Liebig, an adult in moderate exercise consumes
daily 13.9 ounces of carbon, and taking 5 ounces as the average
for persons of all ages, ttie population of London will burn up
800,000 pounds of carbon each day, and 555 pounds each min-
ute, and this will generate 2,035 pounds or 17,435 cubic feet
of carbonic acid every minute. So that from the combustion
of fuel and food, the amount of carbonic acid generated each
minute in London, is 29,344 pounds or 251,416 (in round num-
bers 250,000) cubic feet, and 1,760,640 pounds or 15,000,000
cubic feet each hour, and 42,255,360 pounds or 360,000,000
cubic feet each day. Moreover, for every equivalent of carbon
thus consumed, there are two equivalents of oxygen abstracted
from the atmosphere, and yet the analysis of the most accurate
chemists have detected scarcely any appreciable difference in
any of the constituents of the air, whether taken from the
densest cities, as London and Paris, or from the summits of
lofty mountains. The law of diffusion which thus acts so uni-
versally and so powerfully in preventing the unequal distribu-

468 Jones, on Mularioiis Infiiiencea. [August,

tion of gaseous bodies is assisted also in this important work
by currents of air in the form of winds, and at night by the
displacement of air in valleys by the descent of cold air from
the sides of hills and mountains. Under the combined influen-
ces of these powerful agencies, is it probable that any gas could
so accumulate as to afl^ect the occupants of the lower story of a
house and not those of the upper, or the inhabitants on one side
of a road or wall, and not those on the other ? (Vide. Quart.
Journ., vol. 24th, p. 51. 1827; and Ency. Metrop., vol. 5th,
pp. 797-8. Lond. 1844.) In the second place, it is not true
that malarious influences exist only in places favorable to the
decomposition of organic substances. Several instances of their
existence in barren, sandy regions are recorded by Dr. Fergu-
son and others. (See Philad. Journ. of the Med. and Phys.
Sciences, No. 13. 1828.) Speaking of Ague, Darwin says,
" This disease is common on the whole coast of Peru, but is
unknown in the interior. The attacks of illness which arise
from miasma never fail to appear most mysterious. So diffi-
cult is it to judge from the aspect of a country, whether or not
it is healthy, that if a person had been told to choose within the
tropics a situation appearing favorable to health, very probably
he would have named this coast. Miasma is not always pro-
duced by a luxuriant vegetation with an ardent climate ; for
many parts of Brazil, even where th'ere are marshes and rank
vegetation, are much more healthy than this sterile coast of
Peru." (Voy. of a Nat., vol. 2d, pp. 128 and 130. New York.
1846.) That agues should be produced by sulphuretted hydro-
gen, as Daniell supposed, appears very improbable, when we
reflect that chemists often remain for hours in a room through
which this gas is diff'used, and yet have no chills or fevers, and
that the vicinity of Sulphur Springs, where large quantities of
this gas is extricated, is often entirely exempt from these dis-
eases.

The theory that these diseases are produced by animalcula
and by fungi has been promulgated at various times, and Prof.
Mitchell, of Philadelphia, has recently published a very elabor.
ate monograph on the "Cryptogamous Origin of Malarious and
Epidemic Fevers." It is not convenient at this time to review
this little volume in full, but I propose to make some general

1849.] Jones, on Malarious Injiuencts. 459

observations upon the ground on which his theory is based. It
is universally admitted that the growth and qualities of fungi
are greatly modified by light, heat, moisture, &;c., and that it
ve(\\x\res peculiar combinations of these for the rapid develope-
ment of the Cryptogamia. Now why may not these peculiar
combinations of physical agencies produce these diseases in-
stead of the fungi? Why should we not go back at once to
those great primary agents, which we know to affect both
vegetable and animal life, and regard both the development of
fungi and of agues as concomitant results merely, of their ac-
tion? We know that physical agents do afiect the human
system, and that they exist in their greatest intensity during the
autumnal months ; we only know on the other hand, that fungi
abound at the same time, but have no direct evidence that they
do afiect the system. The fact mentioned by various writers,
that fungi are more abundant than usual during periods of gen-
eral epidemics and sickly seasons in tropical countries, and that
during these same seasons there is a greater tendency to de-
composition of all kinds, shows that there are peculiar meteoro-
logical influences present, and why should the human system
be proof against these? Moreover, the fact that some fungi
are poisonous when eaten, is not a confirmation of this theory,
as the diseases thus produced do not exhibit any striking analo-
gies wqth malarious affections, and in some respects are widely
difTerent from them, according to Dr. Mitchell's own state-
ments. Even in those instances where they exhibit a tendency
to assume the characteristic periodicity of the latter, it maybe
due to malarious influence, as w^e know that various diseases
assume this peculiarity in miasmatic districts. Again, if the
minute species act by being inhaled, they ought to exert their
greatest influence during the day, for although produced in
greatest abundance during the night, the forces which diffuse
them through the atmosphere are most active during the day.
That their poisonous qualities are lost during the day, is rather
improbable, when those which are poisonous, remain so after
being cooked. Moreover, if they are so readily diffused through
the air, why should their effects be so markly circumscribed?
This objection does not apply to the action of physical agents,
as their limitation can often be detected by such imperfect testi

460 Jones, on Malarious Infiuences. [August,

as our feelings. It was beautifully shewn by the effects of the
destructive frosts which occurred from the 16th to the 22d of
April of the present year. Vegetation was so much more in-
jured in the neighborhood of streams, that from some elevated
station, it was easy to mark out their courses by the appearance
of the forests. Another interesting phenomenon then exhibited,
was the destruction of the lower leaves of the trees whilst the
upper remained untouched. Dr. Mitchell advances the idea,
moreover, with considerable confidence, that some diseases
both of plants and animals are produced by fungi becoming
true parasites upon them. But is it not absolutely impossible
to determine whether the fungi are the causes of the diseases,
or whether the latter give rise to the development of the fungi
by furnishing the conditions favorable to their existence. Does
not analogy incline rather to the latter side ; are not fungoid
plants generally observed to flourish upon dead or dying organ-
ism ? They do not attack fresh meat or vegetables, and yet if
these furnished the requisite conditions for their existence, with
their rapid powers of development, they ought often to appear
upon them, for after decomposition has commenced a single
night is often sufficient to produce a most luxuriant growth. Is
it not most reasonable, then, to suppose that they are the accom-
paniments and not the causes of these diseases, for our limited
powers of observation will not warrant us in asserting that no
diseased processes pre-existed, even in those ambiguous cases
where no unnatural changes had been detected previous to their
appedrance? Our knowledge in reference to specific poisons
is so indefinite and uncertain, that any argument founded upon
it, must be alike uncertain and unsatisfactory. We are entirely
ignorant of the conditions requisite for the generation of a spe-
cific poison.

These are some of the objections to this theory which have
arisen in my mind. It is somewhat to be feared that its at-
tractiveness may create so much enthusiasm in its advocates,
as to make them lose sight of the legitimate object of all enquiry,
which is the discovery of truth. It cannot be denied that the
gaseous theory has retarded the progress of knowledge by ren-
dering men exclusive both in observation and thought ; and so
must every hypothesis which cannot be tested directly by ab-

1849.] Vend\eion, on Diseases of Hancock County. 461

stract reasoning, experiment or observation. The true philoso-
pher takes a position elevated above all prepossessions where
light may beam upon him from all directions and in its greatest
intensity ; he examines with care and rigid scrutiny the phe-
nomena presented to him, and seeks for their origin by tracing
the operation of causes which experience has shewn to exist.
Their influence he determines accurately, and if they be insuffi-
cient to explain the phenomena, he subducts their effects, and
proceeds with greater ease and certainty in the investigation
of the now simplified "residual phenomena." This mode of
procedure has effected the solution of very many difficult pro-
blems in Physics, and it is that which is best calculated to
unravel the mysteries of life.

ARTICLE XXIV.

Statistics of Diseases of Hancock County. By E. M. Pendle-
ton, M. D., of Sparta, Georgia. (Continued.)

The next table which I present shows the relative proportion
between the several classes of disease in the different seasons of
the year. Also, the contrast between the six warm months
(beginning with April) and the six cold months (beginning with
October), thus:

TABLE 2.

Classes of Disease.

Digestive, ....
Respiratory, . . .

Osseous,

Brain and Nerves,

Urinary,

Peculiar to women.

Visual,

Skin,

Periodic fevers, . .
Continued fevers, .

Articular,

Abscess,

Injuries,

All others, ....

m
110

S

m
127

c
S

138

o

i

^ c

c

02

G
O

o

2 cr:

o -c

50

283

17.5

142

53

39

64

70

92

5.7

132

25

37

24

20

65

4.0

40

2.3

26

18

22

46

2.8

43

14

11

8

4

24

1.5

13

51

77

46

40

117

7.2

87

7

3

3

8

9

0.5

12

22

12

19

17

34

2.1

36

12

56

107

13

117

7.2

71

9

6

10

12

14

0.8

23

11

11

6

10

20

1.2

18

5

19

8

9

26

1.6

15

20

20

18

24

38

2.3

44

14

13

13

13

27
912

1.7

56.0

26
702

376

447

482

312

8.8
8.2
2.5
2.7
0.8
5.4
0.7
2.3
4.4
1.4
1.1
0.9
2.7
1.6
44.0

468 Tend\eioi\ on Diseases of Hancock Coitnty. [August,

From the above table it will be perceived that Autumn is the
sickliest season, Summer the next, Spring next, and Winter the
healthiest. There is not, however, that marked difference be-
tween the seasons in this county that many parts of our State
would show, owing to its comparative freedom from malarious
fevers. This tendency is getting more manifest every year,
and I doubt not the time will come in this old county, under
the improved system of drainage and agriculture, and the de-
crease of vegetable putrefaction, that our spring diseases will
cope with the autumnal. All new countries (at least it has so
proved in the South), are more subject to autumnal fevers than
old ones, and it is doubtless owing in part to the immense decay
of vegetable matter, presented to the sun in the rotten trees,
roots and stumps of the late flourishing forests. This cause
being removed in this county, together with the drainage of
stagnant and pent-up creeks and rivulets, have completely
changed the aspect of our diseases. There are now only one
or two marked localities of periodic fevers in this county, and
they are evidently becoming weaker in their influence.

The six warm months predominate over the cold as 56.0 to
44.0 in the aggregate. The different classes of disease are re-
presented about as follows: Of the digestive system, there are
two to one in the warm against the cold months ; of the urin-
ary, about the same, owing no doubt to the increased tendency
of these organs to take on inflammation in the warm seasons.
Belonging to this class, also, though in a decreased ratio, are
diseases of the teeth, those peculiar to women, abscess and
periodic fevers. It is a little singular that tooth-ache prevails
more in summer than winter, yet it is true, as the table shows,
65 for the warm against 40 for the cold months. I am sure
this is against the commonly received opinion which classes it
with those diseases originating in cold and sudden alternations
of temperature, wfiich, if it were true, would certainly throw
its prevalence in the winter months.

It would seem that all diseases which are inflammatory in
their character prevail more in the summer than winter, except
those affecting the respiratory organs, which are as 8.2 against
6.7, unless we class continued fevers in this category, which we
presume depends upon atmospheric causes. These have 23 for

1849. J Ftind\iilon,cfi Diseases of Hancock County. 463

the cold against 14 for the warm months. And here I would
remark that there seems to be an antagonism between periodic
and continued fevers as to the time and perhaps causes of their
production. In the winter and spring months proper, there
were 25 cases of periodic fever, while in the summer and fall
there were 163. On the other hand, the continued fevers
stands as 21 to 16. This, though taken from a small table, might
throw some light upon the future investigation of the etiology
of the different classes of fevers. The eruptive fevers prevail
mostly in spring and autumn. In the above table all cutaneous
affections are put down in one class, but they mainly belong to
the exanthemata. Thus, for spring and autumn we have 41
against 29 for summer and winter. The pure exanthemata
would make the contrast still more striking. Why is it that
these variable seasons of the year are better calculated to su-
perinduce eruptive diseases than the more equable extremes of
winter and summer? It would be an interesting question for
the curious etiologist.

The remaining classes of disease seem to be but little affect-
ed by changes of temperature. Those affecting the brain,
nervous and articular systems, prevailing a little more in the
warm months, while diseases of the eye have a greater affinity
for the cold months. This latter, I doubt not, is owing to the
fact that the bleak winds of winter and spring are very apt to
produce ophthalmia among those who are exposed to them.
Thus we have in the above seasons 15 against 6 for the sum-
mer and autumn.

It would further seem that women are more subject to dis-
eases peculiar to them in the warm months, as 7.2 per cent,
against 5.4. This I suppose is to be accounted for in some
diseases, because of the relaxing tendency of the season, and in
others on account of the inflammatory tendency. Another re-
markable feature connected with this table, is the fact that
rheumatism prevails more in the warm than in the cold months.
This I am sure is contrary to the generally received opinion,
as rheumatics are supposed to be affected by cold, damp wea-
ther, more than any other kind. But the table indicates but
little difference as to season, and that difference in favor of the
warm months. Is it not true that articular rheumatism de-

464 Robert, o)i Schirro-Cancer. [August,

pends more upon the state of the primce vicn and constitution
generally than physicians are apt to imagine ? The worst case
I have ever known was brought on in the hot month of August.
One thing is very clear, that there is yet much to be learned
about the different phases as well as etiology of this and other
diseases, and we hope these statistical tables will help to induce
other and abler hands to set about the work of eliciting facts
from the great laboratory of nature, which will tend to place
our profession more nearly in conjunction with fixed sciences
than it may at present claim to be.

ARTICLE XXV.

A Cane of Schirro-Cancer of the Vagina and Uterus. Re-
ported by W. H. Robert, M. D., of Russell Co., Alabama.

That Schirro-Cancer of the Vagina and Uterus is a very
rare disease, in our country, may be inferred from the fact that,
the extensive practice of Dr. Dewees had furnished him so few
cases of it that he was compelled to borrow from Mr. Clark
the description of it contained in his work on the Diseases of
Females. I am, therefore, induced to lay the following case
before the profession.

I was called, on the 11th April, 1847, to see Fanny, a negro
woman about 35 years of age, and pregnant with her eighth
child. She quickened, according to her report, sometime in
February, and since that time had frequent discharges of blood
from the vagina, but not to such an extent as to cause alarm
until the day I was called. I found that she had had pretty free
hemorrhage; pulse not much affected ; complained of pain in
back and loins. On examination by touch, I found the whole
of the anterior lip of the os tincac in a state of ulceration, pre-
senting a very uneven and knotty feel, and which bled when
touched. There was a free and constant muco-purulent dis-
charge. I prescribed pills of opium and sub-acet. plimbi, to be
taken until the hemorrhage ceased, and resumed upon its re-
currence.

I stated the nature of her case to her master, and advised a
regular course of treatment, which, however, was not attended

1849.] Hubert, on Schirru- Cancer. 465

to. I saw nothing more of the case until the 10th of May,
when I was again called in great haste to see Fanny. For sev-
eral days she had suffered general uneasiness of the uterus,
which now amounted to positive labour pains, frequent, though
not strong. Upon examination, I found the os uteri soft, flaccid
and not dilated ; the ulcer had increased so as to compass nearly
the whole of the ostincse. Venesection and anodynes were
administered without controlling the contractions, which con-
tinued until delivery. The child died two days after birth, and
I was now requested to treat the mother's case.

The treatment was commenced by an application of the acid
nitrate of mercury to the ulcer on the 17th May, and the fol-
lowing lotion directed to be thrown up the vagina four or five
times a day: sulph. zinc, 3j. ; tinct. iodine, 3ij. ; water, 2 Ife.
Mix. I continued this plan for months, occasionally with ap-
parent benefit. During the same time I used preparations of
arsenic or iron internally, and cauterized the uterus every two
weeks with either the acid nitrate of mercury or the nitrate of
silver.

In October following, Fanny was placed in charge of two
other physicians, who made an attempt to perform an operation
on her, probably amputation of the os tincae. I did not again
prescribe for her, but frequently saw her and perceived that
she was fast wearing away. She suffered constant and great
pain in the right iliac region, for which she took large doses of
laudanum. For two months prior to her death the cancerous
fetor existed.

On 15th October, 1848, I was requested to make a post-
mortem examination of Fanny. The body was very much
emaciated, and was less ofl^ensive to the smell than when alive.
The bladder was found very full of urine, and on the left side
of it, without the peritoneum, between the vagina, rectum and
bladder, there existed a collection of about a pint of slightly
bloody fluid. On the right side, and in firm connection with
the superior portion of the vagina as well as with the brim of
the pelvis, there was a schirrous tumour about the size of a
walnut, which grated under the knife, and in the centre of which
was a small ulceration. The tumour, uterus, vagina and blad-
der were now removed. The vagina was very much thicken-

N, a. VOL. v. NO. VIII. 30

466 Eve, on Polypus of Nose. [August,

ed, and studded with ulcers in every part, except a surface about
the size of a dime, just behind the urethra. Indeed the vagina
appeared to be rather covered by one extensive ulcer than by a
number of small ones, the ulcerated surface extending up to the
uterus. Tiiere was no vestige of the ostincae, and the lowest
point of the uterus was ulcerated. The texture of the uterus
was not very firm, as the tenaculum frequently tore out. On
cutting through the uterus, I found its substance very pale and
studded with tubercles, some of which were in a state of ulcer-
ation. The mucous membrane was slightly injected, the walls
of the uterus were about an inch thick, and the cavity of this
organ resembled more a fissure than the normal uterine cavity.
That portion of the vagina which corresponded to the schirrous
was very thick, and in fact the tumour appeared to be a portion
of the vagina itself.

The bladder was about a third of an inch thick throughout its
whole extent. Its posterior part was intimately connected with
the anterior portion of the vagina and was affected with a simi-
lar disease, but not yet in a state of ulceration. An aperture
existed in the posterior portion of the bladder; internally, this
was about three quarters of an inch long, and externally about
the size of a crow quill. This may account for the collection of
fluid found in the pelvis, as above stated.

ARTICLE XXVI.

Removal of a large Polypus from the Nose Jhrough the Pharynx.
By Paul F. Eve, M. D., Professor of Surgery in the Medical
College of Georgia.

While on a recent professional visit to Newnan, Ga., I was
requested by my friend, Dr. C, to see a negjro woman,
a red about 40, who had been for some time laboring under
Polypus of the nose. A tumor could be seen projecting be-
liind the uvula in the ))harynx, and the finger could trace it still
further by pushing up the soft palate. Havitig heard, while a
student in Philadelphia, that Dr. Physick had once removed a
polypus, under similar circumstances, by a tape secured to it
through the i>hMrynx, by a littlo fTinnipulation, ;v noose was

1849.] Bibliographical. Ui'

thrown around this one, then wra ^ping the ends of the hgature
around the fore-fingers, by a su Iden and forcible thrust down
the pharynx, the foreign body was easily extracted indeed
so readily, that I know not whether the patient or surgeon was
most surprised and gratified. There was but slight hemor-
rhage, and the woman had a good recovery.

The polypus had but two slender attachments, hke cords, ex-
tending up each nostril ; and it weighed about one ounce. It
makes quite a respectable showing in a common quinine
bottle.

PART II.
tlEDitt)0 anir ^-et facts.

BIBLIOGRAPHICAL NOTICES.

1. Lectures on the Theory and Practice of Physic. By John Bell,
M. D., &c., &;c., &c., and by Wm. Stokes, M. D., &c., &c.,&c.

Fourth edition, revised and enlarged. In two vols., pp. 784 and 976.
Philadelphia : Edward Barrington and Geo. D. Haswell. 1848.

We give the title to a work well and favorably known throughout
our wide extended country ; the character, worth, and usefulness of
which are now fully appreciated by every student of medicine. It
ceitainly needs no commendation of ours. We are indebted to the
publishers for these two elegantly bound volumes.

2. A System of Clinical Medicine. By Robert Ja5ies Graves,
M. D., M. R. I. A., &c., &;c., <fcc. With Notes and a series of Lec-
tures, by W. H. Gerhard, M. D., &c. Third American edition.
Vol. 1, pp. 751. Philadelphia: Edward Barringtoni^nd Geo. D.
Haswell. 1848.

This is another capital work on the Practice of Medicine, and issu-
ed, as may be remarked, by the same publishers, whose liberality we
again acknowledge for a copy. This too is a new edition of an excel-
lent European book, long and well received by the American medical
reader.

3. Parturition and the Principles and Practice of Obstetrics. By W.
Tyler Smith, M. D., London. Duodecimo pp. 395. Philada.:
Lea & Blanchard. 1849.

T'iiat the nnthor may oppress his ohj^ct in publishing this work, we

468 Cane of Hydrophobia. [August,

present the reader with the preface ; simply observing, that he seems
to have executed his task in a satisfactory manner, and the publishers
have done well in placing it before our professional brethren.

** Preface. I began to study Reflex Obstetrics in 1842, and the
present work is the result of seven years' close and earnest attention
to the subject. I may say truly, that during this time, though much
occupied by other matters, it has scarcely ever been absent from my
waking thoughts.

" I have no wish to deprecate criticism, but I trust I shall not be con-
sidered merely in the light of one who applies facts and principles
already known to his'own department of practice. I believe every
candid person conversant with the current knowledge of the Reflex
Function, and of Obstetrics, when I began to write, must admit that I
have both added to reflex physiology, and made extensive applications
in practice, which had eluded previous observers. Indeed, reflex ob-
stetrics is a new department of the reflex function and its aj)plications.
Taking the whole range of reflex physiology, the Cause of Labour is
only second in importance to the Cause of Respiration, and no one
had perceived that the relation of the ovarian nerves to parturition is
the same as the relation of the pneumogastric nerves to respiration;
while, in the investigation of the causes of the Genesial Cycles, in the
Twelfth Lecture, I have entered upon a new field, altogether distinct
from the reflex motor function.

"When I published my first * Observations,' reflex physiology had
not found even a verbal home in any work on obstetrics, but 1 do not
think it will be possible to say the same of future works in this depart-
ment of medicine."

Case of Hydrophobia Cure. (Ohio Med. and Sur. Journal.)

The following is the detailed account of the case of Mrs.
Burrows, of Camden, N. J., by Prof. Jackson, of Phila., a short
account of which, we published in our Jan. No. We extract
it from tha^last No. of the Transactions of the College ol Phy-
sicians of Philadelphia.

The third case is that of Mrs. Burrows, which ha? excited
some curiosity and interest from the recovery of the patient.
This very uncommon result is well calculated to cast a doubt
on the true nature of the disease, and suggest suspicions whether
it was a true case of rabies canina. On this account, 1 shall
lay before the College a somewhat minute and detailed state-
ment of all the circumstances of the case, and leave it with
them to decide the question.

Mrs. Burrows is about 30 years of age, rather of full em-
bonpoint, a brunette, with black hair and dark eyes. She has
R phy!5i<"allv nervous temperament, but possess*s a determined

1849.] Case of Hydrophobia. 460

character, great resolution, and a flow of spirits ihat rarely
fails. When a girl she was subject to nervous aitJicks and
spasnns. The last severe one, her fathej and herself infornned
me, occurred ten years since. She has been married seven
years, and has had four children; one she lost last sumnner;
the youngest was nine weeks old at the peiiod of her attack.

Since her marriage she has had but one nervous spasm,
which took place four years sine . It was brought on by the
painfal attempts to remove a pin she had accidentally swal-
lowed, and which was slicking in the fauces near the top of
the larnyx. This was the last nervous spasm she had suffered
prior to the invasion of the disease. Doctor Horner saw her
at the time, with her brother, Doctor Cooper, at present a sur-
geon in the U. S. Army.

In the month of July last, then residing in Cooper Street,
Camden, she was at the gate door with her child, a little girl
aged years. She saw two dogs running up the street ; she
stepped into the yard alongside the house, leavinor the child at
the door. She soon after was alarmed by the cries of the child,
and the noise of a dog, and runninji to the door, found one of
the dogs had attacked her child. She flew to its rescue, and
in saving it received a bite on the inside of the wrist of the
right hand. Two punctured wounds were made by the fangs
oi the dog, about an inch apart. They were slight, and she
did not mention the circumstance to her husband, or pay any
attention to them ; tliey healed in a day or two. The dog dis-
appeared, and nothing more has been heard of him.

No inconvenience was experienced from the bites until the
commencement of October, when the slight cicatrices made
became red, slightly tumefied, and painful. In some days af-
ter, one festered, which she opened ; it discharged a few drops
of greenish matiei-, he;ded, and gave no further trouble. The
other remained hard and painful, and pains extended from it
up the arm, to the shoulder. In a few days the whole arm be-
came painful and swollen, a small tumor formed on the inner
side of the arm about two inches below the axilla. It did not
gather.

During this period, as she occasionally complained of her
arm, her friends would inquire of her what ailed it ; to which
she frequently replied jokingly, that she had heard of a milk-
leg, and she supposed her's must be a milk-arm. This is men-
tioned to show that her mind was not occupied with the idea
of the bites.

On Friday, 27th October, Mrs. Burrows, after coming down
stairs in the morning, drank a class of cold water, as is her
custom. She was suprised by a sudden shuddering sensation,

470 Case of Hydrophobia. [August,

but as it passed off, she thought no more of it. In tiie course
of the day she crossed over to the city to visit her parents.
When on the river, particularly on her return, siie felt a sin-
gular dread and uneasiness at the sight of the water she could
not u derstnnd. It left her wfien she landed. In the evening,
feeling unwell, she resolved to bathe her feet before going to
bed. When the water was brought, she attempted to try with
her hand its temperature. She was instantly seized with a
violent shuddering, and sense of dread. Her husband, who
w; s prtsent, laughed at her, and asked whether she had not
bten bitten by a mad dog. She was fearful of giving him un-
easiness, and did not mention the bite she had received in
July. Soon after, in atteujpting to take a drink of water, she
was seized with violent spasms of the throat, and a sense of
suffocation, to an alarming degree. Dr. Fisler, of Camden,
who was her physician, was sent for, and remained with her
the greater part of the night, as the spasms continued to recur
at intervals. She w-as treated with acetat. morph. gr. \, every
two hours. Dr. Cooper, of Camden, also saw her. I received
a messase requesting my attendance, and visited her at 2 P.
M. While in the parlor down stairs, I heard a peculiar sound
that bore some resemblance to a dog's bark. It was remark-
ed that the patient was then in a spasm, as in them she made
that noise. When I reached the chamber, the spasm had ceas-
ed. Mrs. B. was in bed, in full possession of her senses,
conversed with me, without hesitation or difficulty, in a
pleasant manner. She had no fever; pulse G8 to 70; skin
cool ; she complained of fullness of the head, wiiich she attri-
buted to the pills of acetat. morph. The adnata were slightly
injected ; she complained of pain in the neck, and in the throat;
fauces appeared dry, and voice hoarse. Right arm swollen,
and exceedingly sensitive; epigastrium sensitive to pressure,
but it did not cause spasms, or disturb her breathing. Fan-
ning, or waving the hand did not produce spasms, or un-
pleasant effects. Water poured from a vessel, though unseen,
and no previous intimation given of the intention, Dr. l^sler
informed me, had caused paroxysms in the course of the morn-
ing. I requested her to drink some water, with which she
complied immediately. She took a mouthful, but in trying to
swaiiuw, a liightiul spasm was induced, limited, as it ajipeared
to rne, to the larynx and fauces ; she appeared suffocating.
The d-aphragm and abdominal muscles did not participate m
it, as I kept my hand on the r;bdomen to ascertain the fact. She
appeared to me for a short time to be unconscious, the eyes roll-
ed upwards, but she declared she retiined her senses perfectly.
It was a violent struggle for breath, but not general convulsion

1849.] Case of Hydrophobia, 4T1

or spasms. There was no salivation of mucus collected in the
mouth.

At this visit I expressed to my colleagues, Drs. Fisler and
Cooper, that although the symptoms were somewhat suspicious,
yet, taking everything into consideration, I was disposed to
look on the affection as a simple nervous one, and probably
hysterical.

The following course was aorreed on. Sinapisms to the
epigastrium ; cups on backofnsck ; sinapisms down the spine ;
enemata of assafoetida, 3iij suspended in water, and chloro-
form, 3J5S in an emulsion, every hour if required.

Sunday Morning, October 29th. Patient apparently better,
very cheerful, calm, collected in manner, and gay in conversa-
tion. Spasms had continued yesterday until evening, when
they had ceased, and had not again returned ; passed a quiet
night, but did not sleep sound. She had drank water freely
several times. Some difficulty had been experienced in swal-
lowing it, but no spasms were excited. Head more comforta-
ble since the pills were omitted. Throat feels sore, but less
painful than yesterday. Skin, pulse, and tongue natural.
Sensibility entirely lost in the skin of the right arm, below the
deltoid muscle ; does not feel pinching, or touching. She asked
me to stick it with my knife, to ascertain whether she could
feel that. There is notwithstanding, deep-seated pain in the
course of the nerves. There are also slight spasmodic twitch-
ings of the muscles of the arm. The whole abdomen feels
sore and uncomfortable ; pressing the epigastrium gave most
uncomfortable sensations, and disturbed the respiration, ren-
dering it irregular, but did not cause spasms. In the night
ejected some blood by vomiting, which did not coagulatj.
Bowels have not been opened.

At this visit my first impressions were rather confirmed
than weakened. I was determined to continue the same plan
of treatment, and to add the following, with a view of acting
on the bowels: Mass. hydrarg.. By, syr. rhei, 5j. A teas-
poonful every hour. Enema of emulsion of assafoetida, if
spnsms continue.

The first dose was given at 12 M. The attempt to swallow
it brought on violent spasms of larynx and chest, threatening
suffocation.

From this time, the spasms occurred, with short intermia*
sions, spontaneously, notwithstanding the assafoetida injectir)ns,
the sinapisms to abdomen, and other means resorted to by Drs.
Fisler and Cooper.

I saw her at 5 P. M. There was an intermission when I
entered the room. She expressed herself as suffering great

472 Case of Hydropkohia. [August,

bodily distress. The right arm was in constant agitation from
slight spasms; the rigiit shoulder painful ; no sensibility in the
foiearm. The cicatrix was tumid, red, and sensitive to pres-
suie, though the hand and arm were insensible. She com-
plained of acute pain in both hams. Pressing on the groins,
on the calves of the legs, in the armpits, as well as under the
knees, excited acute pain. Has sense of distress in throat,
chest, heart and abdomen. Notwithstanding this state of suf-
fering, talks cheerfully, even answered in the same spirit to
some jocose observations, and expiessed her full confidence in
her attendant's skill. Without her observing it, I placed my
hand near the back of the head, some inches from it, and
gently waved it. She was on the instant seized with shudder-
ing, followed by strangling spasms of the larynx, fauces, and
of the chest, arresting respiration, followed immediately by
spasms of the trunk, in which she was tossed about the bed,
gnashing her teeth, and plunging her head into the pillows, and
bed clothes, biting and tearing them.

Chloroform was sent for. It was obtained from an apoth-
ecary in the neighborhood. When procured, as no sponge
was at hand, I soaked a rag with it, and seizing her by the
back of the neck, attempted to hold it near her mouth. The
inhalation was imperfect, as the spasms kept the patient in con-
stant motion, and as she was making plunging efforts to seize
the rag with her teeth, some caution was required to avoid
being bitten.

A sponge was then procured, and the inhalation was more
effectually performed ; as the effect took place, and the spasms
were mitigated, the patient assisted herself to hold the sponge
to her mouth. In a few minutes the full efiect was ]iroduced,
and she fell perfectly insensible, every muscle in perfect re-
laxation, and the respiration easy and natural. An enema
was now adtninistered, consisting of Pulv. ipecac, composit.
9ij ; chloroform 3ij, in starch water.

The medical attendants retired to another room, where the
excision of the cicatrix was talked over and determined on.

After returning to the room, while sitting by the bed-side,
she suddenly addressed me, saying, "Dr. Jackson, what is my
disease ?"' " Nervous spasms,' I answered " I know that, but
what causes these spasms?"' "Many causes of various na-
tures may give rise to them." "That is true, but is not that
the cause," putting her left forefinger on the cicatrix on the
right wrist. "Is it not that ?" " Most probably it is." " Why
not, then, cut it out? why not, if necessary, take ofT my arm 1
I can bear it, I have nerve for anything."' '' Cutting it out is
precisely what wo have concluded, just now, to do, but it so

1849.] Case cf Hydrophobia. 473

happens, we have no instrument with us." " Well, take your
pei. knife, I won't flinch." Dr. ('ooper, who had stepped out
returned with a venerable scalpel that had evidently not been
in service for a long time, and a tenaculum. I hooked up the
Cicatrix, and with some efl^ort succeeded in excising the skin
surrounding the cicatrix. This rude surgery was borne well.
She then said, '' Do you not think it wou'd be better to apply
causae to the cut ?" " A good suggestion," I replied, and im-
mediately applied caustic liberally over the whole surface. A
poultice of pulv. ulm. rubr. was directed to be applied.

The excision of the cicatrix was hardly completed, when a
spasm came on. The chloroform was immediately adminis-
tered w.th the sponge, its full effects were induced, and she
agiin became insensible. She was sometime in this state; as
she was recoverng from it ; she raised herself slowly on her
knees, and with her eyes intently g.'izng, and her arms stretch-
ed upwards, she addiessed the vision of her lately lost child.
When she had entirely recovered, she related the vision she
had s(^en.

It was agreed that the chloroform should be given as soon
as a paroxysm was observed coming on, that in the course of
the n ght another enema similar to the last should be adminis-
tered, if the spasms continued to recur, and calomel, gr. xx
shou'd be given, to relieve the bowels.

Monday, October SOt/t. At my visit this morn-'ng found her
better, calm, and cheertui ; pulse 90 ; temperature of skin natu-
ral. Tongue moist, slightly coated. 1 was informed that
spasms had continued to recur from the time I left her until
midnight. Many were exceedingly violent. The chloroform
had been timidly administered. As the spasms appeared to
yield, the chloroform was withdrawn, from an apprehension
of some ill consequences from usng it so constantly. The pa-
tient, as soon as the spasms would permit her to articulate,
wou'd call for more and urge its use. After 12 o clock, the
spasms were subdued so much, that instead of being instanta-
neous, she had a warning of their approach, when a few inha-
lations arrested their further develo[)ment.

Was sick in the night, and vomited more blood, which re-
mained li(iuid.

Throat feels sore, voice is hoarse ; abdomen uncomfortable,
and slight pressure distressing; cannot bear the weight of the
bed-clothes on it. Pressure on the calves, under the knees,
groins, and arms, very painful. Bowels have not been moved.
In the fconfusion from the conflict with the spasms, the calomel
directed had not been given. No feeling in the right arm. It
is paralyzed, but is often affected with tremulous spasms.

474 Case of Hydrophobia. [August..

Mrs. B is naturally nearsicrhted. Her father assured

me she had been so from early youth. She was unable to dis-
tinguish the features of a person standinprat the foot of the bed.
Her sight is now quite acute. The shutters are bowed, and
the curtains drawn, as the light is offensive, yet she sees a pin
sticking in the paper on the opposite wall of the chamber, dis-
tant at least twelve feet.

The hearing is' equally acute, though her hearing is rather
dull in health. Yesterday, when the medical attendnnts were
in the parlor beneath the chamber, the stairway opening into
a small entry communicating with the bed-room she henrd the
conversation below, and repeated parts of it to those with her
at the time.

She remarked to me that her throat felt so uncomfortable
and dry, tfiat she wished it could be greased inside with a
feather. I sugfrested to her to take some oil of butter, to which
she assented. It was prepared and brought to her in a silver
spoon ; but as soon as the glitter of the metal caught her eye,
she was taken with a strong shuddering, and spasmodic ac-
tion of the throat and face. The oil was then placed in a
small toy-cup; she received it in the mouth without difficulty,
but in attempting to swallow if, a spasm came on. 1 called to
her to spit it out ; but she made another effort, when most
of it was expelled, and a strong spasm was induced. The
chloroform on a sponge was brought under her mouth, a few
inhalations produced pirtial insensibility and relaxation, and
the paroxysm ceased. Calomel (gr. xvi.) was given. Pills are
swallowed without difficulty, crackers can be chewed and
swallowed.

6. P M. No complete paroxvsm since morning:; several
times spasms were threatened, but arrested immediately by
chloroform inhaled. This al'ternoon, her father seeinj^ a fly
about to light on her face, waved his hand to drive it away.
This excited a spasm, checked, however, by chloroform. The
looking-glass, and other shinning objects in the room, were
covered over. The glitter distressed her. The windows were
also kept down ; she could not bear the air to blow upon her

I inquired of her what had been and were, her feelings; she
said ii was difficult to describe them, but they were more like
a dread of someth'ng, she knew not what, than any other feel-
ing. Her mind is tranquil ; she converses cheerfully; being a
Catholic, she has observed tho religious obligations of her faith,
and is fuliy prepared for any event.

The wound is discharging freely a thin serous fluid. The
arm feels, she says, as though sensation was returning in it.

Bowels have not been open, or urine passed. Directed a

1 84 9. ] Case of Hydrophobia . 47.

purgative enema, and after evacuations, pulv. ipecac, comp.
5ss. in injection. Chlorolorm pro re nata.

Tuesday SUY. Had pa?std a coml'ortable night; bowels
and bladder had both been relieved last evening, and again
this morning; hnd taken the Dover's powder injection.
Twee spasms had been excited in the evening; once by a
young girl coming into the room, and approaching the bed with
a g!ass of water in her hand ; the other, by an attendant, with-
out thinking of it, bringing a basin of water into the room ;
each time chloi-oform arrested the spasms.

The wound discharges freely ; suppuration has commenced;
sensibility has returned to the arm ; pressure on the calves,
beneath the knees, in the groins, and armpits, much less
painful.

She took last evening, some ice-cream, and repeated it this
miOruing ; she has taken also, some milk this morning. The
untas ness of the tlu'oat greatly abated; epigastrium less sen-
sitive, bears pressure without the same distress. She inform-
ed me this morning, that during the violence of the attacks, a
feci ng appeared to start from the cicatrix, ascend the arm,
pass down the chest, and strike into the stomach ; but that now
the feelii.g appeal s reversed, and seems to pass from the stomach
into tlie arm, and descends into the wound.

The chloroform is used whenever there are threats of spasms
from uneasy sensations. Repeat the enema of Dover's powder.

I inquiied of her whether there was any difference between
the attacks she had suffered during the last few days, and
those I had understood she was fornierly subject to. She said
there was ; they were wholly dissimilar. I asked in what res-
pect. There is this difference, she remarked : in the former at-
tacks I uas generally uncouscious ; I knew no one about me,
what was said, or what was dong. When I came to myself,
I did not know that anything had happened to me. In these
last, 1 had my consciousness entire. I knew every one, heard
Till that was said, and I knew all that was doing. There is
also this difference. In my old attacks, bandages w^ere tied
tight around my stomach, and pressure made, which always
gave me relief in the milder attacks ; in those I have lately ex-
perienced, I could not bear the slightest presure on the stomach;
the bed-clothes oppressed me.

Nov. 1st. Was restless in the night. The hand, wound
and arm more painful; the edges of the wound pale and un-
healthy ; discharge thin and sanious. Directed it to be dressed
with ^mgt. resinae flav. Abdomen and epigastrium are no longer
sensitive, or the seat of uncomfortable sensations ; bowels re-
lieved. This mornincT has taken ice-cream and milk. She

470 Case of Hydrophobia. [August,

has swallowed three or four raw ovsters ; complains of thirst,
and wishes to make a trial of drinking water. Some was
brought to her, and she took a large draught. A slight tremor
only was produced, followed by a sense of glow, and suffusion
of the face; continue milk, ice-cream, and raw oysters. At
night the usual enema of Dover's Powder. Chloroform has
been discontinued.

4:th. Has continued free from spasms; arm been painful.
To-day was brought in a carriage from Camden, to her fath-
er's residence in Market Street above Ninth. Saw her after
her arrival. She was in the sitting room down stairs resting
herself At 9 P. M., I was sent for to see her. In carrying
her up stairs to her chamber she had fainted. She continued
from fi teen to twenty minutes in that state. She revived soon
after I entered the room, when, as usual, she commenced with
me a cheerful conversation.

She informed me that she had lost her milk during her ill-
ness, and will be compelled to get a nurse.

5M. Had rested well; feels better though feeble; arm less
painful.

23rr/. Have not seen Mrs. Burrows until this evening, at
10 P. M., when her brother, Doctor Cooper, of the U. S. Army,
urged me to visit her immediately.

Since last report her general health has been good. The arm
has remained piini^ul ; the pain appears to be confined to the
ulnar nerve in the forearm, but the whole shoulder is painful.
On the 17th, Doctor Fisler saw her, and as she was that day
feeling very uncomfortable, with increased pain of the arm,
and the wound was nearly healed, he again applied caustic
potash. The slough was thrown off to-day. The pam of the
arm had been increasing for the last two days, and finally, this
evening, strong spasms of the arm came on, recurring, in par-
oxysms, every ten or twelve minutes accompanied with sense
of numbness. Severe pain existed also in the nape of the
neck, extending down the back to the last dorsal vertebra.

I directed a w^arm poultice with ten grains of powdered opi-
um, to be applied to the wound. A pill containing sulph.
morph. gr. |, was ordered to be given every two hours, and a
dozen dry cups to be applied along the spine on the neck and
back. One spot opposite the third dorsal vertebra, was ex-
ceedingly sensitive ; when a cup was applied to it the right
arm was thrown into violent spasms, the forearm was rigidly
flexed, and the hand clenched. It continued in this state un-
til the cup was removed.

24^/i. The pain and spasms of the arm continued nearly
all night. Towards morning became less, and the patient got
some sleep.

1849.] On Rachitis. 477

No spasms of the arm to-day; the course of the nerve is yet
tender; a little below the axilla is very sensitive; wound dis-
charging freely; a liniment of extr. of stramonium, aconite,
opium, with cerate oil, was directed to be rubbed on the arm,
and the pill to be continued, at intervals of from four to six
hours.

2oth, Rested well last night ; arm less sensitive ; wound
looks healthy ; omit the pills; continue the liniment.

From this period Mrs. Burrows continued to improve in
health. Her milk returned. The wound cicatrized in the
second week of December, the pain ceased in the forearm, but
the shoulder and axilla continued sensitive, and occasionally
painful, until the commencement of January. To the present
time (Feb. 6,) she continues to enjoy the most perfect health.

On Rachitis. BJr M. Trousse.\u. (British and Foreign Med.
Chirurg. Rev., from Gaz. des Hop.) ,

It is a remarkable circumstance that rachitis seems to be a
comparatively modern affection, it having first appeared in
England during: the 17th century. So complete is the practi-
cal portion of Glisson's work on this disease, that M. Trousseau,
after bestowing great pains in accumulating and arranging
facts respecting it, was surprised at finding nearly every im-
portant point anticipated. The affection is never congenital;
and although some commencement of the deformity may occur
as early as the 3d or 4th month, it does not usually show itself
until the 10th or 12th. augmenting most during the second year.
It is rare indeed for the disease to commence after the 2d or 3d,
and especially the 4th year. Parents seldom perceive the
symptoms until they have considerably advanced. The child
is then dull and heavy, breathes with difficulty, and suffers pain
when taken up; and on examinincr the chest, the flattening of
its sides and the projection of the stern utn are obvious. A
remarkable excavation exists opposite the 5th. 6th, and 7th ribs.
The articulations of the ribs with the projecting sternum give
rise to so many projecting points, and the same may be seen
at the dorsal articulation. The clavicle is carried strongly
forwards, projecting where it joins the sternum. The spine
becomes bent upon itself as in old age, but not distorted
laterally, and the vertebrae are enlarged as if they had been sub-
mitted to compression when soft. The anterior fontanelle
remains open for two, three, or four years, though it should be
closed by the 14th or 20th month ; its texture remaining cartila-
ginous as late as six years, whereas, at latest, it should be bony by

478 On Rachitlii. [August,

the second year. In like manner, the sutures continue un-united
for a period far too loni^. The head enlarges in all directions; the
forehead resembles that of the hydrocephalic head ; the chin is
short, and the jaws, especially the lower, are swollen. Almost
invariably the teeth are very backward, or if present, they are
ill formed, carious, and brittle. In respect to the pelvis, the
iliac portion widens out, while the ischiatic narrows, contract-
ing tfie cavity. The humerus and femur are especially short-
ened, and this occurs to some extent in all the otlier bones, the
longest ones generally shortening most. The bones of the fore-
arm are curved with the concavity towards the palmar aspect.
The humerus is curved inwards, and the bones oithe lower ex-
tremities forwards and inwards. The heads of the bones are
enlarged, and their ligaments relaxed, allowing movements of
the hands and feet without the intervention of the forearm or
leg.

The first stage of the pathological change is termed by
Guerin ramollissemcnt the whole texture of the bone becom-
ing softened, and the intervals of its lamellce bein^r filled with a
substance of the consistence of current jelly, which also fills
the medullary canals of the expanded bone. The periosteum
swells and becomes incrusted with osseous matter as after a
fracture. If these processes go on, an amorphous osseous mat-
ter becomes deposited, which gives to the bone a remarkable
softness, so as to render it capable of receiving an impression
as in oedema, or of being bent by the hands. However, the
osseous matter becomes more and more deposited, and after a
while hardens the bone and acts curatively. In from four to
six years this hardening becomes so great (hat the term
ehurnation may be then correctly applied, although used by
Guerin at an earlier period. Very slight force, however,
suffices to fracture such a bone.

Children labouring under rickets suffer much pain, and w\\q\\
the disease is advanced, great a^^ony, on the least movement.
The first symptom that strikes the mother is the great debility
of the child, perhaps heretofore apparently strong. It sutlers
much when attemptin^c to stand alone, and bends forward like
an old man. If we find a child so suffering, and that it has a
large head, fever, and sweats which persist for weeks or
months, the disease will surely prove to he rickets. Too often
both the mother and physician are induced by the cough and
dyspnoea, which in so deformed a chest are present, to mistake
the disease for a catarrhal aflection. So, too, the large belly
produced by the thrusting down of the enlarged liver by the
contents of the thorax, leads to the supposition of mesenteric
disease. Rickets seem quite incompatible with tnherch, as the

1849. J Diseaties of Mucous Membrane in Artisans 170

two diseases are never found associated, and the same remark
applies to scrofula. Almost all the children who die from
rickets do so on account of the development of acute or chronic
pneumonia. In other cases diarrhoea takes them off; but they
never die from affection of the head.

One is struck by the fact that most cases of rickets occur
between the 10th and 15th months, which is just the period of
dentition; but the supposition that it arises from the fel)rile
action dependent on that process will not bear examination.
These children generally have not yet ^ot any teeth. This is
also the usual period of weaning^ and rickets is of very common
occurrence in children who have been prematurely weaned ;
and M. Guerin's experiments show the great influence exerted
by improper diet in its production. In those whose diet is toc^
animalized, it is developed sometimes with wonderful rapidity;
and we have to insist on prolonged suckling or the use of milk,
whereas practitioners too often order broths, meat &c., on
account of the weakness of the child ; in all such children, milk
is the proper diet for the first three years, the good diet, tonics,
&c., given advantasreously in scrofula being quite unadapted
to this affection. Yet cod-liver oil, so useful in scrofula and
numerous chronic diseases of debility, is of marvellous efficacy
here ; the common shoemaker's oil being, however just as
useful as the more expensive preparations. It first produces
a cessation of pain, and, if continued, a cure rapidly follows.

Diseased Condition of the Tracheo-hronchial Mucous Mem-
brane of the Artisans of Sheffield^ and the Statistics of
Mortality among them. (Amer. Journ. of Med. Sciences.)

Dr. Craigie, in the late edition of his elements of *' General
and Pathological Anatomy/' states : In the tow'n and vicinity
of Sheffield, two sorts of grinding of edged tools are practised;
one, dry grinding on a dry stone, the other, w^et grinding on a
stone moistened with water. Many articles, as scissors, razors,
and penknives, are ground partly on dry stone and partly on
the wet stone. Others, as forks and needles, are ground mostly
on a dry stone. Table knives are ground principally on a wet
stone. Saws, files, and scythes, are ground entirely on a wet
stone. Dry grinding is most injurious, and tends most direct-
ly and effectually to induce bronchial and pulmonary disease,
and thereby to abridge the duration of life amongst the grind-
ers. The dry griiKlers, therefore, are most speedily destroyed.
The life of the wet grinder is often prolonged to a considera-
ble age.

180 Disease of Mucous Membrane in Artisans. [August,

Of 1,000 scissors-grinders above 20 years of age, only 20
attain the age of between 50 and 55 years ; only 10 the age of
between 51 and 65; and none live beyond the latter age ; while
of the inhabitants of Sheffield generally, 224 in 1,000 are fonnd
living at 65 and above, and in the midland counties 413 in
1,000. Of artisans in this branch 843 in 1,000 die under 45
years of a^e.

With the fork-grinders it is worse. Among 1,000 fork-
grinders, ag^ed above 20 years, not 1 attains the age of 59;
while in Sheffield, among 1,000 persons, 155 are living at 59.
Of these 1,000 person*, 472 die between 20 and 29 years, 410
between 30 and 39 ; and the residual 115 are all gone before
the age of 50.

Among 1,000 razor-grinders above 20 years of age, 749 die
under 41 years o^ age, the rest mostly between 41 and 60;
between 61 and 65, only 5 are living ; and after 65 all are gone.

Of the penknife-grinders, not 1 in 1,000 arrives at the age of
60 ; 731 die before the 40th year ; and the rest are all destroy-
ed before the 60th year.

Saw-grinders, file-grinders, and scythe-grinders, who work
on the wet stone, are less liable to bronchial disease, and are
longer lived. The numbers pursuing saw-grind ng are not
great. Yet among 78 persons engaged in it in 1843, 9 were
between 60 and 65, and 1 died between 66 and 70, and 1 at 79.

The number of scythe-grinders is also not great. In 1843,
there were 30; of these, 8 were between 41 and 60 years of
age. Both the saw-grinders and the scythe-grinders are ex-
posed to accidents, sometimes fatal, from the breaking of the
stone.

The lesions which produce thisgrea/ mortality are of a com-
plicated character. The most common lesions are chronic
inflammation, with thickening of the bronchial membrane, en-
largement or dilation of the bronchial tubes, emphysema, and
exp-msion of the pulmonary tissue.

The bronchial glands are enlarged, or converted into a black,
hard, gritty substance, varying in size from half a marble to a
large hazelnut. In dividing these glands, the sound emitted is
the same as if the scalpel were dividing a soft stone, and the
section is black and polished, and grates over the edge of the
knife. Such masses aie commonly detected in grinders who
have belonged to the most destructive brandies. Similar soft,
sectile, gritty, or stony matter is found in almost every part of
the lungs, in portions varying from the size of a currant to that
of a bean; adhesions between the pulmonai^y and costal pleura
are also frequent. In some instances the lungs present an ap-
pearance as if black currants had been distributed through their

1849.1 Nux Vomica in Epidemic Dysentery. 481

whole substance, and accompanied with similar bodies, larger
in size, but hard and gritty like them. These currant-like
bodies are also observed on the surface of the lungs. They
are supposed to consist of the dilated extremities of veins con-
taining some of the solid constituents of the blood.

Tubercles are also occasionally found, vi^ith their consequen-
ces, vomicae.

Another state, frequently observed, is engorgement or infil-
tration of the lungs with a dark colored fluid, which is ascribed
to the inhalation of the fine black dust floating in the atmos-
phere during the operation of glazing.

On the mode of production of these lesions, or the order of
their succession, observers are not agreed.

Nux Vomica in Ejndemic Dysentery. By W. M. Cornell,
M. D., of Boston, Mass. (Charleston Medical Journal and
Review.)

After the failure of most of the usual remedies of the materia
medica, in this epidemic, I was led to look around for some
other medicine, and in turning over the volumes of my library,
I hit upon the following passage in the first volume of Dr.
John Armstrong's Works, of London, page 419 : " A friend of
mine, Mr. George Vaux, of Ipswich, has tried a remedy for
sixteen years, in about two hundred cases ; and the result has
been so successful, and so remarkably uniform, that I feel it my
duty to mention the treatment here. This gentleman gives in
dysentery, or inflammation of the mucous membrane about the
colon, seven grains of nux vomica thrice, daily. It neither
purges nor constipates, but removes the inflammation, and
healthy evacuations follow. Mr. Vaux, who resides in London,
bears similar testimony to the value of this remedy, and I
strongly recommend it to your notice. I shall certainly try it
in the next case I meet with. It seems to operate as a sort of
specific. It was first mentioned by Hagstrem, and has been
very much neglected since his day."

Upon reading the above, I immediately determined, under
the circumstances above stated, to make trial of the nux. I
did so. I gave it in the full dose of seven grains, thrice a day,
to adults, and from one to three or four grains to children, in
proportion to the age. The result was most happy. Not a
patient who was treated with this medicine died. It was pre-
scribed in ten cases, within three or four weeks, and all recov-
ered. No cathartic medicine was given, except ,teaspoonful
doses of the hitarirate of potassa in a few cases.

It would be presumption to say that this medicine is a per-

N. rf. VOL. V. NO. VIII. 31

482 Imagination of Mothers over Infants, [August,

feet specific for dysentery in all cases. Indeed, I am far from
having much confidence in specifics generally ; but I feel con^
strained to say, that th-e above named medicine altogether ex-
ceeded my expectations, and I earnestly recommend a trial of
it in dysentery.

I tried the strychnine ; but on the whole, much preferred the
powdered nux to that.

During the prevalence of the epidemic, I, myself, had an at-
tack of the complaint. It was not very severe. I took the
same medicine that I prescribed for my patients.

I had one case which was very severe and where I almost
despaired of recovery, yet the patient did recover under the use
of the nux vomica, and is now in excellent health. The nux
was usually continued till it produced its characteristic symp-
toms, and at this period, and often before, it checked the dis-
ease.

If other physicians shall have the same success that I have
had with this medicine, it will be more decided proof of its
efficacy, and, I hope this communication may not prove entire-
ly useless to the profession.

Influence of the Mother'^s Imagination upon the Production of
Monstrous Children. By Dr. Burdon. (Month. Retrospect,
from Dublin Med. Press.)

It is a fact, that the workings of a strongly excited mind
may produce very great changes in the body, either immediate
or remote ; but it may at the same time be observed, that this
power of the mind is circumscribed within a limited circle,
even within its own body. It may be felt in the several tissfies,
glands, and viscera ; it may produce sympathetic irritations and
nervous movements ; but it has no constructive or creative
power. Who, by an effort of his mind, could place another
hair on his head, or add a cubit to his stature ?

In forgctfulness of this and common sense, and only noticing
the fact, that the mind of one individual cannot alter the body
of another, it is asserted, that the little being within the womb
cannot be considered as a foreign body with respect to the
mother, but rather (in consideration of its connections) as a
part of herself

Dr. William Hunter examined very patiently the influence
of the mother's imagination upon her still unborn child, and
proceeded upon the right plan of investigation. In 2000 cases
of labour, immediately on delivery, and before examining the
child, he inquired of the woman whether, during her pregnancy,
she had a longing for, or had been frightened by, or her thoughts

1 8 19. ] Imaginaticn of Mothers over Infants. 483

had dwelt on, anything particular for any length of time ? He
questioned her also as to her own ideas on the subject, as to
whether she expected to find a mark on the child; if so, what
kind, and why ? All her answers were taken down in writing ;
and then he examined the child. He declares that though he
found many children marked, yet in not one single instance of
these two thousand did the answers or expectations of the
woman agree with the result. Many expected a mark where
there was none ; and others had not thought of the subject, and
had got through there term unnoted by any incidence when
there was. Both the St. Hilaires, father and son, have been
very assiduous in collecting the particulars of every recorded
abnormal birth ; and the latter asserts, as I have mentioned fur-
ther back, tha.t Dr. Martin's case is the only authentic one in
which the woman said before her confinement that her child
should be born marked, and her feelings proved to be correct.
Thus it is clear how the numbers of instances have been col-
lected to form such a large mass of evidence as proof of the
truth of our subject. But when closely examined, the magni-
tude of this mass fades in4;o insignificance. Remove the ample
folds of its gossip draper}?-, and the giant becomes a dwarf. As
I have myself mentioned a number of cases of monstrosities, in
which the impression was made on the mind of the mother
prior to the birth of the child, do I mean to deny the existence
of cause and effect ? Certainly not. Let us examine Avhat
constitutes the logical term, cause and effect. It is this: A
certain act being alwaySj or nearly so, followed by the same
consequences. If occasionally the primary being present, the
succeeding phenomenon does not appear, we readily admit
that in such instances the usual cause is overpowered by some
other cause. But be it remembered, that the exceptions must
be few in comparison with the rule. Is such the case with
the subject before us? No such thing. Every woman, I
repeat, during her gestation of nine months, must have had her
attention arrested by some object, or must have been struck
by some one idea more forcibly or more frequently than by
others, and yet, comparatively speaking, there are but very
few children born with a blemish. How, then, are these facts
to be explained which have occurred ? I answer, the agree-
ment between them is merely accidental, and cannot be looked
upon as cause and effect. Every person has been struck by
meeting with a number of remarkable fortuitous coincidences.
If these were collected and set in a note-book, they should far
out-number those which take place between mother and child.

484 The Epidemic Cholera, [August,

The Epidemic Cholera.

The reader will reasonably expect a considerable portion of
this No. of the Journal occupied with the all-engrossing subject
of the epidemic, now committing its ravages over a wide extent
of our goodly land. We at present occupy a position, having
Richmond, Va. on the north-east, and Nashville, Tenn. on the
north-west, within which points w^e have no cholera. Augusta
still preserves its usual health, though at times there is consid-
erable diarrhoea ; a remark, we learn, alike applicable to every
place and location from our sea-board to the mountains. In
the selections on the subject, the editor has rather had to en-
counter les emharras des riches (a circumstance unusual in
Southern literature) rather than to enter upon researches. He
hopes the extracts may be profitable to the reader. [Edt.

Remarks on Epidemic Cholera. By Fred. B, Page, M. D.,
of Louisiana. (Communicated for the Boston Medical and
Surgical Journal.)

After all that has been said and written upon Asiatic Chole-
ra, I am persuaded its whole character and management may
be comprised within the compass of a nutshell ; and I shall now
proceed to narrate, as briefly as possible, the whole sum and
substance of what may be necessary to the full comprehension
of its treatment, confidently assuring the reader, from ample
experience, and a close familiarity with the epidemics of 1832-3,
and 1849, when my whole time and attention were devoted to
it, that this formidable malady loses much of its terror when
divested of its empiricism, and is subjected to the test of a sim-
ple and rational mode of cure. " Taken in time, it is the most
curable of all dangerous diseases. If suffered to run into the
stage of collapse, it is the most fatal."

Cholera, when fully formed, either from the duration of the
disease, or the force of the symptoms which characterize it, has
been well and simply divided into four stages or periods. Dr.
Formcnto, of New Orleans, enumerates the following train of
symptoms, as characterizing the several sta2;es, which I trans-
cribe for their simplicity and accuracy, giving, at the same
time, under each head respectively, my own mode of treat-
ment, which has proved generally successful, I may say in a
multitude of cases, especially the past season, and all that could
be expected even under the circumstances, if not all that could
be desired.

1st. The period of incubation or excitement. Symptoms

1849.] The Epidemic Cholera. 485

lassitude ; anorexia ; nausea ; oppression or \vei,!]:ht at the pit
of the stomach ; flatulency ; abdominal pains, or tormina, es-
pecially at night ; restlessness ; thirst ; white tongue ; bitter
taste in the mouth ; colics ; burning sensation in the stomach ;
pyrosis ; vomiting ; diarrhoea, without tenesmus ; headache ;
vertigo ; muscular weakness ; twitchings ; cramps, and ordi-
narily a slow pulse. This state may be prolonged from one to
two weeks. It requires prompt attention. Taken in time, it
furnishes the physician an opportunity of preventing the de-
velopment of the disease, since nine-tenths of the cholera cases
are preceded by some of the above sensations.

" The earliest manifestations of cholera, however, especially
on its first invasion, are generally confined to irritation of the
stomach and bowels, and in this state it is unquestionable that
the mere exhibition of an anodyne, a cordial, or an antispas-
modic medicine, is sufficient, in numberless instances, to stop
the progress of the disease and effect a cure.*' Abstinence
from solid food, confinement to the house or bed, with a warm
alkaline foot-bath, and warm aromatic, opiated, or camphorated
drinks, &c., will usually ward off an attack, and restore the
patient to health.

The symptoms of the disease often vary, notwithstanding,
with the locality of a place, and the medical attendant will often
find himself compelled, in the same place, and with the same
patient, to adopt an opposite mode of treatment, and be aston-
ished to find recoveries under these apparent contradictions.
This is common with most epidemics, as is known to every prac-
titioner. They rarely return under exactly the same form, nor
yield to exactly the same remedies, in two successive seasons.
" How erroneous, therefore," says Rush, in one of his notes to
Sydenham, " must that practice be, which is influenced by the
name of the disease. Bleeding, purging, vomiting, ai\d sweat-
ing medicines and opiates, all do good or harm, according as
they are regulated or not, by its existing character. This
should be studied anew by the physician every season."

Epidemic cholera varied its character most strikingly in its
former visitations to our cities In 1832, nearly every patient
that was bled was lost. This was the case in the epidemic
spotted fever of former seasons. Bleeding in Asiatic cholera
had been declared the very sheet anchor of the faculty in some
European cities and was relied on greatly in the practice of
several physicians upon this Continent, but death was the con-
sequence. Upon the return of the disease in 1833, the lancet
was resorted to, under added recommendations from the South-
west, and with signal success. Bleeding is now generally
avoided, and with happier results, under a better acquaintance
with the disease.

48G Tlie Epidemic Cholera. [August,

The present epidemic has changed its form frequently, ac-
cording to locaUty and other circumstances, and often differs
materially from the epidemics of 1832-3, in several important
particulars. Generally speaking, it is of a milder type the
discharges are not so copious or profuse the spasms are less
severe and constant, while it has been observed that a much
smaller number are restored after entering the stage of col-
lapse, than at the former period.*

*' Cholerine, which is the simplest form of the disease, and
which appears particularly at the commencement of the epi-
demics, or in mdividuals placed under the most favorable cir-
cumstances to become affected with it, is characterized by
general indisposition, an unusual depression of the moral and
physical powers, insomnia, epigastric uneasiness, a sensation of
weight, and sometimes of heat at the stomach, feebleness of the
pulse, which is small, soft, and more or less slow ; nausea,
borborygmi, a clammy dryness of the mouth ; thickened,
scanty, and high-colored urine, and alvine evacuations, often
analogous in their nature and frequency to those of cholera,
sometimes yellowish or colored with blood, but almost always
mixed with white mucosities, accompanied in some cases by
vomiting. Though cramps are sometimes observed, they are
more frequently w^anting, and the livid discoloration of the skin,
with the phenomena of asphyxia, are never present."

Cholera sicca has been among the common forms of the
present epidemic in some localities, and has been very fatal.
It is unaccompanied by evacuations, and on several plantations,
in the South, has struck down the most healthy and vigorous ;
the more aged, and children, probably from less exposure to
the cholera influence, having entirely escaped. This form of
cholera is generally, though not necessarily, fatal.

Cholara spasmodica, or foudroyant, has also appeared on
many ])lantations, and in several localities in the South-west.
Individuals are suddenly attacked, with or without the precur-
sory phenomena, with vomiting, diarrhoea, cramps and coldness,
and die in one or two hours, even before the appearance of cyano-
sis. Sometimes death occurs without the evacuations having
taken place, solely from the violence of the epigastric distress
and cramps. Soldiers, when in full march, are attacked with
vertigo and violent cramps, quit the ranks, lay down their arms,
and die in two hours. f In 1832, between 90 and 100 negroes
fell prostrate by this form of the disease on one plantation in
Louisiana, in a single night, and died before morning. " The
past season several estates lost from 20 to 50 in a few days.
Many were afllicted with violent spasins of the stomach and bow-

New Orleans Medical Journal- t Tardicu's Lectures.

1849.] The Epidemic Cholera. 487

els, and abdominal muscles, without discharges, similar to what
is commonly called cramp colic. In some cases all the voluntary-
muscles are violently cramped ; the spasms recurred at inter-
vals of a few minutes, not unlike tetanus."*

M. Rayer has described, under the term *^ etat cerebral cho-
Urique^"* a group of peculiar phenomena, very distinct from
those of inflammation of the meninges and brain, which super-
vene upon the cold period. This is a sort of prolongation of
that period, with a diminution or cessation of the vomiting,
alvine evacuations and cramps, and the development of cerebral
symptoms ; the skin continues cold or cool, the nose is cold, the
tongue is yellowish, and sometimes cold ; if there be injection
of the eyes, it is only upon their inferior parts ; the pulse is
feeble, the head heavy, the countenance stupid, and in some
cases the tint peculiar to cholera remains. f

In the /?ra/7/^ic form, described by Magendieand others, the
chances of recovery are but little greater than in ihefoudroy-
ant cholera.

In young children the disease often proves fatal under the
characteristic symptoms of hydrocephalus, and is usually at-
tended by worms in the first passages.

Let the physician, then, discard the name of cholera in his
treatment of the disease, and when called to the bed-side of the
patient come untrammelled by any specious reasoning. Let
him investigate, as far as may be, the history of his case, and
endeavor to detect the cause, and the attendant chxumstances
of its appearance. Let him be guided by sound common sense,
a rare but inestimable quality in the practice of medicine,
and use his medical knowledge, and apply the resources at
his command, according to the existing necessity, and he
may triumph where many fail, and only fail where none may
triumph.}.

Asiatic cholera, says an astute observer, is a subtle poison
invading the organic life, and destroying it, so that decomposition
often seems to begin before animal and intellectual life leaves
the body. It is shocking to see those, in whom all that consti-
tutes organic life has ceased except breathing, go on conversing
in the full possession of their senses.

It depends on the poisonous nature of cholera tliat treat-
ment is of so little avail. The writer has seen the emesis and
catharsis cease, and that, too, where neither had been violent,
for full twelve hours before death, and this without great pros-
tration at first, yet the patient would steadily sink until death,
without the disease for a moment appearing to be arrested by
any of the appliances which could be used, whether external or

Buchanan . t Tardiou . t Brigham on Cholera.

488 The Epidemic Cholera. [August,

internal, any more than the hke symptoms can be arrested in a
case of full poisoning by arsenic*

2d. Forming period, or period of invasion. A distressing
sensation at the pit of the stomach suddenly ensues in the night
or towards morning. All the symptoms previously enumera-
ted acquire an extraordinary intensity; there is nausea, and
vomiting of rice-watery fluid of a peculiar odor, somewhat re-
sembling the vapor of iodine, in the first place serous or slightly
bilious, afterwards of a matter termed choleric by Tardieu,
which is liquid, whitish, grumous, or very uniformly troubled,
sometimes resembling unclarificd whey, sometimes a decoction
of rice or oatmeal, sometimes thickened milk nearly clear, emit-
ting an insipid spermatic odor, and sometimes presenting traces
of blood or bile, and even worms.

The secretions, especially the urine, are suspended. The
body and limbs are cold first beginning at the nose, feet and
hands, and gradually invading the trunk ; the features are
changed, and soon assume the cholera countenance ; pulse ra-
pid, from 120 to 130 in a minute; dyspnoea; great thirst, with
a desire for cold drinks. This period may last some hours, or
even a whole day.

Treatment. Confine the patient to bed, order a hot alkaline
or mustard foot-bath, and give a tea-spoonful of the following
anodyne mixture, in hot camomile or ginger tea, every hour or
half hour, till warmth and tranquility are restored. %. Comp.
spts. lavend., spts. camphor, aa ss. ; Hoffman's anodyne liq.,
acet. tr. opii, aa 3ij. M. The above remedy of Dr. Jackson,
of Philadelphia, was first suggested to me by his former pupil,
my friend Dr. Edward Dufiel, Jr., whose name recalls to mind
his probity and candor, and his indefatigable zeal to investigate
andcure diseases, and his warm personal friendship. We used
it constantly in our practice, and with the greatest satisfaction
and success. It found its way afterwards into the hands of
apothecaries, overseers and others on the plantations, and was
among the most })opular and useful remedies of the day. Its
success in the earlier stages of the disease was quite prompt
and gratifying. Dr. Buchanan, of Nashville, Tenn., speaks of
the same, or a similar remedy, which he used almost exclusive^
ly in the premonitory symptoms, attended by pain and fulness
of the stomach and diai'rhoca, &c.

If the diarrhoea be urgent, give one of the Persian pills, com-
posed of a grain each of o})ium, assafoctida and black pepper,
and repeat every two or three hours or oftener if recjuired. It
seldom fails to arrest the disease. Apply a mustard plaster to
the pit of the stomach, and use friction of ammoniatcd liniment

Sec this Journal lur January, 1819.

1849.] The Epidemic Cholera. 489

and camphor, or cayenne pepper, absolute diet, and rice water,
toast water, &c., for drink.

Opium in some form or other, according to the uniform expe-
rience of the profession, combined either with camplior or
acetate of lead, or small dos<es of calomel, is the sheet anchor in
this stage of the disease^ to be followed by a little Champaign
brandy and water, the latter to be used only on the attack and
not freely as a preventive.

The following remedy of Dr. Teilman was used with good
success in Russia, and more recently by myself and others,
during the present epidemic in Louisiana, and the South-west.
I received it from my intelligent and zealous young friend, Dr.
A. Sigur, Jr., of Iberville, and have found it in practice very
agreeable and very useful : Take of wine of ipecac, and strong
essence of peppermint, each two fluid drachms ; Sydenham's
laudanum, one fluid drachm ; and ethereal tincture of valerian,
half an ounce. Mix, and give as follows. From thirty to sixty
drops, or a full tea-spoonful, every hour or half hour, in a little
brandy and water, according to the age and condition of the
patient, or the violence of the disease.

Or, take of pulverized gum guaiacum, cloves and cinnamon,
each two drachms ; laudanum, two drachms. Infuse in a pint
of brandy, and give from one tea to one table spoonful every
hour, or half hour even, till the disease is arrested.

Or ^. Spts. camph., comp. tr. valerian, aa j. ; laudanum,
essence peppermint, aa 1 ss. M. Dose, thirty to sixty drops
every hour or half hour.

Or ^. Camphor mixture, essence peppermint, aa iiv. ;
tr. opii, tr. cinnamon, aa 3j. ; syr. ginger, ss. M. A table-
spoonful at short intervals, according to the urgency of the
symptoms.

Or Take of tr. rhubarb, laudanum, spts. camphor, essence
peppermint, equal parts. Mix. Dose for an adult, twenty to
sixty drops, repeated every hour or two till the disease is check-
ed. In some cases of diarrhoea, the dose may be gradually
increased, and repeated until the desired effect is produced.

A few drops of spirits of hartshorn in cold w^ater, repeated
and followed by spirits of camphor every few minutes, has been
found quite useful in controlling the forming stage of the disease.

The following pills, first used by Dr. Holyoke in some forms
of diarrhoBa and dysentery, some seventy years since, and more
recently in cholerine by Dr. Graves, of Dublin, are quite eftect-
ual in almost all cases, if administered early. I^. Plumb, acet.,
9j. ; opii, gr. ij. ; pulv. glycyrrhiz., gr. vj. ; muc. acacia, q. s. M.
Fiat pil. 12. Give one every half hour till the rice- watery diar-
rhoea begins to diminish, when the intervals between each pill
may be gradually prolonged.

490 The Epidemic Cholera. [August,

Or l^. Hydrarg. cum. cretn, assafoetida, oa grs. xv^ ; cam-
phor, grs. xij. ; opii, grs. vj. ; oil black pepper, gtt. vj. M. Fiat
pil. 12. Give one ev^ery two or three hours.

i^. Blue mass, pulv. kino, aa grs. ij. ; camphor, opii, aa gr. ss.
M. Incorporate the opium, kino and camphor, and then add
the blue mass with treacle to form a pill. Give one every half
hour or hour, till the diarrhoea and cramps cease.

A few hours after the vomiting and purging have ceased, and
the warmth of the body is restored, a pill oftw^o or three grains
each of calomel, or blue mass, Dover's powder and quinine, may
be given and repeated every three hours, till recovery takes
place. Should the above remedies not be sufficient to control
the disease, which in a large proportion of cases they wmII,
bleeding in the feet, with calomel, opium and ginger, followed
by calcined magnesia, &c., should be resorted to, with the addi-
tion of scarifying cups, sinapisms, &c., over the epigastrium,
frictions, 6z:c., and iced water given ad libitum to the patient.
Iced water allays thirst, nausea and vomiting, and is most grate-
ful to the patient. Warm, dry frictions are also useful, and the
steam of alcoholic liquors may be applied to the patient's body
and limbs, beneath the bed-clothes, by means of a tin tube at-
tached to a spirit lamp.

The following cheap and simple substance for a vapor hath^
will induce immediate and abundant perspiration. Take a
piece of quick lime, about the size of an egg, and wrap round it
a wet cloth, sufficiently wrung to prevent water running from
it. A dry cloth is to be several times wrapped round this.
Place one of these packets on each side of the patient when in
bed. An abundant humid heat is soon developed by the com-
bination of the lime w'ith the water, which quickly induces copi-
ous transpiration ; the effect lasting for two hours, at least.
When sweating is fully established, we may withdraw the lime,
which is now reduced to a powder, and is easily removed. In
this way neither copious drinks, nor loading the bed with cov-
ering, is required.

The discharges from the bowels may often be arrested by
giving, in connection with the astringent pills, injections of
starch water and laudanum, or the compound sulphate injection
of sulph. copper, sulph. zinc and alum, twenty grains of each,
in four ounces of cold water, as recommended by Dr. Patterson,
of Dublin. This may be followed, either in convalescence or in
the sinking stage, by tepid enema of high seasoned becf-toa, to
which flour, wine and laudanum have been added. Rapid re-
covery has often followed the above simple means.

If the disease commences like common bilious cholera, give
acetate of lead and opium, or chalk mixture, wilh opium and

1849.] The Epidemic Cholera. 491

aromatic confection ; give effervescing draughts with camphor,
or calcined magnesia and paregoric, or tar water, to allay vom-
iting, and keep the patient warm in bed, and the next day give
a large emollient injection. But if the more severe and char-
acteristic symptoms come on, or if there is great debility from
the first, and cramps and coldness of the skin are observed,
bleed largely if the pulse will allow, and give calomel, opium
and quinine, as above recommended, in large and oft-repeated
doses, till the secretions are changed and re-action has taken
place. If there be great prostration and frequent spasms, with
oppressed breathing, give a few minims of chloroform on a
sponge or handkerchief, and repeat immediately, if necessary,
increasing the dose according to circumstances. Give inter-
nally, also, six drops of cliloroform, with about fo/'^y of oil of
turpentine in brandy and vvater. Bleed gently if re-action, after
the use of chloroform, is excessive.

Petroleum, it is said, may be advantageously given in this
stage of the disease. Petroleum Barbadense or Texas petro-
leum for it is found equally abundant and pure in one of the
counties of Eastern Texas and I have often picked it up in
large indurated parcels on the beach near Galveston. This is
the chief ingredient in the elixir Woreneje, employed so gen-
erally and successfully by the Russian physicians and many
surgeons in the East. It is given in diarrhcea cholerica, in the
dose of from five to ten drops, in a little brandy, white wine or
mint tea, taken cold. A single dose usually suffices to arrest
the complaint. The diet should not be too strictly, but care-
fully, regulated. In completely developed cholera of a deadly
nature the cures are not so constant, and from fifteen to twenty
drops of the napththa or petroleum are to be given at a dose.
If vomited up, the dose should be repeated. A second is rarely
required, if the first is retained. It acts speedily on the skin
and kidneys, and removes the cramps. It is a pure hydro-
carbon, and a mild though effective stimulant, antispasmodic
and antiseptic, supplying the system with its due proportion of
carbon for excretion, and preserving the frame from the rapid-
ly fatal effects of this horrible disease, by evolving carbonic
acid from the lungs.

If the diarrhoea be accompanied by pain in thebow^els, opium
should be conjoined with it. In' the cold, blue stage, accompa-
nied by cramps, &c., it has even proved successful while it
relieves almost instantly the tympanic condition of the bowels,
so often present in the disease.

The ciystalline substance named naphthaline, which is the
purest hydro-carbon, may be given in the form of pills, in one
or two grain doses, with opium, aromatic confection, &c. The

492 The Epidemic Cholera. [August,

petroleum may be given in the following form, .as recommended
and used by Dr. Tunstall, of Bath, England. Take the yolk of
one egg, and amalgamate with it a tea-spoonful of the petro-
leum, and to it add forty drops of the aromatic spirits of ammo-
nia, filling a wine-glass with equal quantities of brandy and
water ; and this dose may be repeated according to the emer-
gency of the case. It is quite probable if the physicians of
La Baca and San Antonio, in Texas, had been familiar with
this remedy, so near at hand, the disease which raged there
with such frightful and deadly severity, would have been more
within their control, and many valuable lives might have been
saved.

I notice this remedy especially here, as it becomes every
physician and army surgeon to be familiar with all known and
available remedies, and have them at hand, at a moment's call,
wheresoever his services may be demanded, either on the
march or in the camp; and especially in the far- west, where
the scourge is now sweeping multitudes away with the *' besom
of destruction."

3d. Cold stage, or period of collapse. The algide, or cold
stage, rapidly progresses into the cyanose or blue stage, or con-
firmed collapse. The aspect of the countenance is completely
changed ; the complexion is of a violet or indigo blue color, the

extremities and sometimes the w^hole bodv assumiuG^ the same

*
appearance. The nails become livid and almost black, the

fingers wi'inkled, and the genital organs retracted. There is
extreme prostration; the pulse is imperceptible, and the motions
of the heart abnormal, or have nearly ceased. Respiration is
oppressed ; voice husky and low the sepulchral of Broussais,
and choleriqiie of Russia, &c.; the breath cold; tongue blanch-
ed, or co^o?l7^e^^>6^, and icy; feeble cramps, and cold, clammy
sweat ; eyes half closed and sunk in their orbits ; pupils dilated;
limbs stiflened. The patient, in one word, according to the ex-
pression of Magendie, cadaveinzed, smd manifesting only slight
respiration, with a few suppressed groans and the intellectual
faculties entire. The disease soon becomes aggravated, and
death ensues, often without convulsions, and almost unper-
ceived.

In the most deadly form of cholera, says Dr. White, there is
a tone of voice, or wail, which, once heard, can never be mista-
ken : by him upon whose ear it has fallen in the accents of
anguish, it can never bo ibrgotten. I have always found it the
certain prognostic of death. This period is the most fatal. In
this stage of the disease, little ellectual can be done but to leave
the case to nature. Whatever treatment may be adopted, will
avail but little. The patient is already doomed. Life is ex-

1849.] The Epidemic Cholera. 493

hausted, and art is powerless. Nature, assisted by art, howe-
ver, has sometimes triumphed. Some cases have recovered
from the use of ice internally, or ice or cold water simply,
externally applied ; wiiile others have recovered from the ap-
plication of the wet blanket wrung out of hot water, and baths
of hot pepper and water, &c., after all other means have failed.
There is, therefore, hope till the last, and these means may be
adopted as a dernier resort.

In order to rouse the patient from this sinking, cold stage of
cholera, and produce re-action, great confidence has been
placed in the salt emetic, two table-spoonsful dissolved in half
a pint of water. It may be rendered more certain and stimu-
lating by the addition of a tea-spoonful of the flour of mustard.
This generally produces speedy and forcible vomiting, followed
by more or less re-action. A large injection of hot salt water
is highly praised by many. Ice and iced water may be allowed
the patient ad libitum, in this stage of the disease, while great
benefit is often found by rubbing it on the surface.

Whenever we fail in checking the disease at first, we have
no resource but to treat urgent symptoms, and they must al-
ways be met with decision as they occur. The patient ought
never to be left a moment without an attendant who is capable
of acting according to circumstances, and who may take advan-
tage of any and every change. The most decidedly favorable
symptom in this stage of cholera, is a full and easy secretion of
healthy urine. On this symptom we may rely with safety,
and without it we can never with confidence offer a favorable
prognosis.

4th. Period of re-action, or crisis. The pulse returns to the
extremities the motions of the heart are renewed, and heat
returns. The blue, turquoise color disappears from the limbs
the face and eyes are re-animated the breath is warmed, the
respiration becomes regular, and the voice regains its natural
tone. The cramps disappear altogether, or occasional twitches
only occur. The vomiting ceases, the evacuations become
bilious, warm perspiration ensues, and the urine becomes free
and is increased. Should the above condition not ensue on con-
valescence, unfavorable congestions of the stomach and bow'els,
of the chest and heart, &c., follow, and the disorder then takes
on the form of adynamic or typhoid fever. " The treatment in
the stage of re-action, or in the true cholera fever, will be regu-
lated by the evidence of inflammation and congestion in the
important organs, such as the brain, lungs, liver, and gastro-
intestinal surface," &c.

We may remark, in conclusion, that cholera unaccompanied
by evacuations cholera sicca is almost always fatal. Here

494 The Epidemic Cholera. [August,

c\\\oYo{oxxn, ox verij hot water ^ internally and externally, maybe
used. Professor Jackson, of Philadelphia, tells me that he
saved two cases of this kind in the former epidemic, by the use
of hot water, in large and repeated draughts and fomentations,
as suggested to him by previous successful practice in gout of
the- stomach. The strongest testimony in favor of warm water,
perhaps, is that given by Dr. Sturm, a surgeon in the Polish
army. It consists in nothing else than giving to the patient as
much vv^arm, nearly hot, water as he is able to drink, in the
quantity of a glass full every fifteen or thirty minutes. By the
time he has taken fourteen glasses, the cure is complete, with
the exception of a slight diarrhoea, which it is not proper sud-
denly to suspend. The eflects of this plan of treatment are so
quick and effectual, that in two hours, and often sooner, the
patient is well, particularly when it is commenced with suffi-
ciently early.

During the epidemic influence, all persons who are exposed,
should be particularly on their guard. Avoid unwholesome
food, and all excess either in eating or drinking. Avoid all
undue excitement, both of mind and body, and exposure to
damp or night air. Atmospheric changes especially control
the disease ; therefore full and free ventilation is important.
The use of cooling purgatives, such as Epsom and Glauber's
salts, and Seidlitz powders, should be guarded against ; they
become dangerous at this time, in whatever quantity they are
taken. Drastic purgatives, of all sorts, such as senna, colocynth
and aloes, ought not to be employed, except by special order of
the physician. No harsh medicines will do in cholera ; all
must be of the mildest description and, above all, they must
be such as will be relished and desired by the sick, and such as
can be constantly taken for the relief of the urgent, destroying
thirst constantly present from the commencement of the disease.
The wishes of the patient, moreover, should be strictly attended
to. Nature is the best physician. If he wishes for cool air, or
cold water, he must have it ; if he wishes to be covered up, he
must be so. Many perish from being too much covered up at
first, when the fresh air would revive them.

A flannel bandage, impregnated with camphor spirits, and
worn round the body, as recommended by my father in the
treatment of epidemic spotted fever, is of great use. It gives
support to the bowels, and patients often find from it the great-
est relief.

Throughout the whole period of the disease, and during con-
valescence, the mildest and most nourishing food only should be
allowed as arrow-root, barley-water, rice-gruel, black tea,
toast-water, chicken-water, &c., with cordial drink, brandy and
water, port wine negus, wine whey, ^c.

1841).] The Epidemic Cholera. 495

Relapses are to be especially guarded against, as they are
generally fatal.

Epidemic cholera, in all its forms, runs its course with great
rapidity; and if it be considered that almost everywhere more
than one half the patients have died, it will be at once evident
how few are the chances of recovery from this terrible disease ;
it is precisely these chances which it remains for us to appre-
ciate.*

There are two points in regard to epidemic cholera, still sub
judice, which are quite important and interesting the former
to New England, especially, and the latter to the whole com-
munity. I mean its extent or locality, and its nature. It is
contended, and with some plausibility of truth, that cholera does
not extend into the districts of primary formations, or the gran-
ite regions. But in answer to this, several of the French
savans, and among others Tardieu, have come to the conclusion
that " all that has been written to prove that cholera is more
prone to attack those soils which are identical in geological
constitution, is in manifest opposition to numerous contradictory
facts." Again, it is said that ozone, a peculiar modification of
oxygen gas, is the sole cause of cholera, and that sulphur is the
antidote. Ozone, to which Dr. Bird ascribes the cholera, was
discovered by Professor Schonbein, the inventor of gun-cotton.
It is generated by the passage of electricity through air, and is
the cause of the peculiar odor perceived during the working of
an electric machine, or after a flash of lightning. The question
has been often asked, what is ozone ? We answer, in the
words of Berzelius, '* We have thus arrived at the highly im-
portant result that ozone is no pecuhar element, nor any com-
bination of known elements, but is oxygen gas peculiarly modi-
fied."

But cholera is independent of all atmospheric changes ; and
meteorological conditions and vicissitudes seem to have but
slight influence on the disease. At St. Petersburgh, the cholera
seems to have showed itself comparatively independent of
temperature, barometrical changes, and electrical vicissitudes.
Re-agents did not in the least indicate the presence of ozone in
the atmosphere.]

Now, what, we may ask, becomes of the new theory, and
how, in this case, is sulphur to operate in curing cholera ? Will
it not follow its predecessors, and speedily descend to the
" tomb of all the capulets ?"'

I have little faith in any of the thousand and one popular and
specific medicines now in use for cholera, and I believe many
have fallen victims to their abuse, who would otherwise have

Tardieu. t Medico-Chirurgical Review, Jan. 1811).

496 The Epidemic Cholera. [August,

recovered under proper professional treatment, adapted to the
peculiar symptoms of the several forms and stages of the dis-
ease. It would be absolute madness, indeed, to trust a confirm-
ed cholera patient to a ^qw drops of camphor spirits, or three
grains oi sulphur and charcoal.

He who. depends

Upon such favors, swims with fins of lead,

And hews down oaks with rushes.

Larger doses of these medicines might be all very well in sim-
ple cases, if many of the most simple did not, in fact, turn out to
be the most suddenly fatal. Such cholera as we are most
familiar with in the South and West is not to be trifled with,
nor to be arrested and cured by specific treatment. Camphor,
chloroform, naphtha, guano, Worenege, sulphur, and other
boasted specifics, display but their pigmy strength when grap-
pling with this fell destroyer. A remedy for malignant cholera
is yet to be discovered.

The above general observations on epidemic cholera, by no
means wholly original, or novel to the profession, are hastily
thrown together, in advance of a more comprehensive treatise
upon the subject, for the benefit of the community, again suflfer-
ing under this wide spread and terrific scourge with the con-
fident hope that they may be available for much good, and save
a multitude of lives. My familiarity with the disease has been
long and painful, through three several epidemics, and though
my success has been as flattering, perhaps, as most of my com-
peers, none of us, I apprehend, can boast much above that
which is written.

Report on Cholera, made by a committee appointed by the Medi^
cal Society of Charleston, So. Ca.

Means of preventing or mitigating the epidemic. All
suggestions relating to this head, must be deduced from a con-
sideration of the causes of the disease. Of the nature of these
causes, it has been affirmed above that we know nothing. But
there are numerous collateral influences which exercise a pow-
erful agency in giving efficiency to them, and which, being
known, and many of them within our reach, demands of us a
careful consideration. They all pertain to the heads of the
public or private Hygiene, or general and special health police,
and may be conveniently considered under the following
divisions: 1. Accidental vitiations of the Atmosphere. 2.
Food and drinks. 3. Clothinfr. 4. Exercise and bodily oc-
cupations and pursuits. 5. The intellectual operations and the
passions of the minds. G. Residence.

a. The sources of Atmosi)heric vitiation are so numerous,

1849.] The Asiatic Cholera. 497

and at the same time so obvious, that they claim a prominent
share of our attention. The streets, lanes and alleys of the
city, the docks and wharves, the markets, stores and places of
business, the drains and common sewers, uninhabited and low
lots, sinks, and pools of stagnant water, private residences,
kitchens, the apartments of servants, stables, yards, privies,
pump drains, &c., all present so many points for the accumula-
tion of filth, and the consequent generations, under a neglect
of cleanliness, of deliterious Atmospheric vitiations, that they
should claim the serious attention of both the health police and
of every private individual. No means of purification, disin-
fection, and general melioration should be neglected, and in this
important work, designed to secure the general safety, all
should co-operate with zeal and assiduity. The efforts of the
public authorities must, from the nature of circumstances, be
confined chiefly to the outside arrangements, and however im-
portant they may be, they will avail but little unless seconded
by a concurrent attention on the part of the citizens generally
to the state of their premises.

The streets, market places, drains, and places of business,
where filth is liable to accumulate, should be kept thoroughly
clean ; low lots, and other places, should be filled up ; stagnant
water should be drained off; and no putrid vegetable or ani-
mal matter, decayed fruit, or filth of any kind, should be al-
lowed to accumulate in the streets or elsewhere. Disinfec-
tants, as quick lime, chloride of lime, chloride of soda, &c.,
should be liberally applied in the drains, and all other situations
where their employment can prove serviceable ; and while
these points are duly attended to out of doors, a rigid and
thorough process of purification and disinfection should be car-
ried out on our premises. Dwellings, kitchens, servants apart-
ments, outbuildings generally, cellars, fences. &c., should claim
special attention in the way of scouring, white washing, and
thorough ventilation. Proprietors and heads of families can-
not be too scrupulous in giving their personal attention to these
points, especially so far as servant's apartment's are concerned.
The habits of many of our domestics are so lamentably de-
ficient in the principles of cleanliness, that nothing short of a
rigid and unremitting surveillance over them can prevent
an accumulation of filth about their apartments, both noisome
and dangerous to health. A liberal supply of quick lime should
be thrown into all sinks, privies and drains, and strewed about
the premises generally. Rooms should be sprinkled, from time
to time, with chloride of lime or chloride of soda, or fumigated,
by pouring occasionally' a small quantity of oil of vitrol upon
common salt, distributed in plates about the apartments.

N. 3. VOL. V. NO. VIII. 32

408 The Epidemic Cholera, [August,

Chloride of lime, chloride of soda, or sulphate of iron in solu-
tion, should be thrown, with a liberal hand, into privies, sinks
and private drains, so as to thoraughly disinfect their noisome
exhalations. ***********
h. There is, perhaps, no epidemic, during the prevalence of
which, a due attention to diet, and habits of living, is more im-
portant to be observed, than in cholera. At such times, the
entire population seems to be more or less predisposed to the
disease, and the slightest imprudence in diet, either as regards
quantity or quality, is often sufficient to bring on a fatal attack.
Temperance, sobriety, and regularity in all things, may, therefore,
be justly regarded as the most effectual means of prevention.
While persons who are, at all times, temperate in eating
and drinking, should be careful to make no important change
in their mode of living, especially in the wa}- of reduction,
they, as well as others, should avoid certain articles of food,
and other disturbing causes. The prohibition should extend to
all fruits and vegetables to pork, fish, crabs, shrimps, lobsters,
and oysters, and as far as drinks are concerned, to avoid acid
and acescent beverages, as beer, cider, lemonade, &c. The
diet should consist mainly of animal food, such as beef, mutton,
poultry and game, with rice, or sound, wholesome, well beaked
bread. Highly seasoned dishes of every kind should be care-
fully avoided, and the viands to be consumed, should be plain-
ly cooked, in general either roasted, broiled, or boiled. Pure
water is of course the most wholesome of all drinks, but those
who have been in the habit of taking wine, or spirits, temper-
ately, with their meals, should make no change in this respect.
The same remark will apply to tea and coflee ; but habits of
temperance, irregularities, and excesses of every kind, should
be carefully shunned. They derange the healthful functions
of the body, enfeeble the vital powers, and by impairing their
ability to resist the influence of disturbing causes, become a
fruitful source of disease.

c. The subject of clothing does not demand any extended
remarks. It should be carefully adapted to the varying con-
ditions of the atmosphere, in point of temperature, moisture,
&c., so as to effectually guard against any sudden disturbance
of the healthful action of the skin, which always exercises great
influence in developing disease. In this view^ it might be well,
especially for those of delicate frame, to wear flannel next the
skin. Too much caution cannot be observed in avoiding wet
clothes and damp feet.

d. In the regulation of exercise, and the bodily occupations
generally, fatigue and exhaustion should be carefully avoided.
Unnecessary exposure to the hot sun, to wet and damp

1819.] The Epidemic Cholera. 4U9

weather, and the night air, should he sedulously guarded
against, as should also long walks, fatigueing excursions, and
crowded assemblies. But as moderate exercises, rational
amusements, and a due amount of sleep, cheer the mind and
invigorate the body, individuals should avail themselves of
these salutary influences.

e. No truth is better established, than the influence of the
depressing passions in the development and extension of
epidemic diseases, and no duty can be more important, on the
occasion of such calamitous visitations, than the cultivation
of a perfect security of mind, and an abiding confidence in
the wisdom and benificence of an overruling Providence,
which cherishes while it chastises, which presides over, and
protects, and ordains all things for the best. It has been truly
remarked, that panic destroys more victims than cholera, and
the result of general experience is, that while calmness and
tranquility of mind contribute greatly to avert the ravages of
pestilence, the depressing passions fear, grief, anxiety, &c.,
promote its extension. Another dangerous error is, an over-
weening confidence in the efficacy of the numerous nostrums,
puffed and lauded by quacks and unprincipled persons, as
preventives of Cholera. Such individuals, in thus pandering
to human credulity, minister to their own base cupidity.

It should ever be borne in mind, that the most certain means
of prevention are, a strict observance of the precepts of
Hygiene, and a careful avoidance of the excitant causes of the
disease.

/. Residence, considered in relation to cholera, is a subject
of great importance. It has been observed already, that the
disease seldom prevails in a sparse or isolated population.
This fact suggests an important precept in regard to the
negro population on our rice and cotton plantations. As soon
as the disease appears in such a situation, isolation should be
immediately resorted to, and while every attention is devoted
to comfort, cleanliness, diet, &c., if no better arrangement can
be made, the people should be at once encamped upon some
high, healthy, and dry pine land situation. This procedure
cannot be too strongly recommended. Within the knowledge
of the writer of this report, it has been tried on previous occa-
sions, and found eminently successful.

4. General directions for the treatment op cholera.
While it would be absurd to attempt to prescribe any special
rules for the treatment of cholera, and dangerous for the com-
munity to rely implicity, upon any such directions, in the man-
agement of a disease of such fatal tendency, it is nevertheless
important, when the loss of even a short space of time may

500 , The Epidemic Cholera. [August,

be followed by such serious consequences, to suggest some
general rules, which may be advantageously acted upon, in
case of a sudden attack, until medical aid can be obtained. In
every case, however, a Physician should be immediately sent
for, on the first intimation of the invasion of the disease.

a. Treatment of Cholerine. Previous experience has
fully shewn, that during the prevalence of a cholera epidemic,
a large proportion of the population is affected with more or
less derangement of the digestive organs usually in form of
oppression, or sickness at the stomach, deranged appetite,
diarrhoea, with griping pains, and general abdominal uneasiness.
To this assemblage of symptoms, the term cholerine has been
applied a condition which should never be neglected, as when
it once takes place, it is liable at any moment, to be converted
into an open attack of cholera, with all its direful consequences.
In all such cases, the diarrhoea should be arrested as soon as
possible. To effect this end, the invidual may take at once,
fifteen or twenty drops of Laudanum, combined with some
stimulating aromatic tincture as for example, a teaspoonful
of camphorated spirits, the same quantity of tincture of ginger
or cayenne pepper, comp. spirits of lavendar, comp. tincture of
cardamon, or a weak infusion of cayenne pepper to be re-
peated, if necessary, in half an hour, or 'an hour, and continued
until relief is obtained. The following pills have been much
used under the same circumstances, and it is affirmed with
great benefit : take of sugar of lead twenty grains, opium two
grains, mix and divide into twelve pills one of these may be
given, at first, every half hour then at longer intervals, until
the dian'hoea is checked. But w^hile these means will general-
ly relieve the immediate difficulty, there will be a constant
tendency to recurrence, unless measures be resorted to, to re-
store the suspended secretions of the liver. With this view, a
pill composed of three grains of blue mass, half a grain of
opium, and half a grain of camphor, may be advantageously
administered every tv^o or three hours.

The patient should remain at home, in a state of repose ;
apply mustard or pepper plasters to the abdomen, and confine
himself to a diet of aiTow root, sago, or tapioca carefully
avoiding all solid and indigestible food.

During the prevalence of cholera, the ordinary purgative
medicines should be scrupulously avoided, except under the di-
rection of a physician ; and this should be especially the
case with the neutral salts, magnesia, castor oil, and the
more drastic articles generally. It has often happened, that
the operation of even a mild purgative, has excited an attack of
cholera in an individual, who had previously manifested no
synjptom of the disease.

1849.] The Epidemic Cholera. 501

h. The treatment of Cholera proper. The invasion of
cholera is exceedingly variable in different cases. Most fre-
quently preceded by diarrhoea for several hours sometimes
for several days ; it nevertheless occasionally invades at once,
without any previous warning, with all its characteristic symp-
toms. These are, usually, violent vomiting and purging the
fluid ejected resembling water in which rice has been boiled,
and contains numerous small white flakes, or particles ; twisting
and griping pains of the abdomen ; cramps of the stomach ;
spasms and cramps of the muscles of the abdomen and limbs;
a general coldness of the whole surface of the body, especially
of the extremities; intense thirst-; shrivelling of the skin,
which is covered with cold, clammy sweats; sinking of the eyes
and cheeks, which become hollow and ghastly ; and a feeble,
fluttering pulse. As the stage of collapse approaches, an icy,
coldness diffuses itself over the surface ; the tongue and breath
become cool ; the skin assumes a lurid, livid aspect, and the in-
dividual falls rapidly into a profound state of listlessness and in-
difference, his frame being, from time to time, agitated by
frightful spasms and contortions. To prevent and control this
direful train of consequences, the following rules should be ob-
served :

1. To arrest the discharges as promptly as possible.
This may be accomplished by various means, and the safety of
the patient depends upon its being done early. When the at-
tack takes place upon a full stomach, and spontaneous vomiting
does not ensue, it will be advisable to evacuate the organ at
once, by means of a salt and mustard emetic. A tablespoonful
of common salt and teaspoonful of mustard, dissolved in a half
pint of warm water and swallowed at once, will usually pro-
duce the desired eflfect, without prostrating the patient.

Various means may be employed to arrest the discharges.
Those recommended above for the treatment of cholerine, re-
peated every half hour, as long as necessary, will very gener-
ally succeed. But it has been found better, in most cases, after
administering one or two doses of laudanum, with the additions
advised above, to resort at once to the use of the following pills,
or something equivalent. Take forty grains of calomel, twenty
of cayenne pepper, twenty of comphor, and two grains of
opium, and after duly mixing them, divide the whole into
twenty-four pills. One of these may be given at first every
half hour then every hour or every two hours, until the
vomiting and purging are arrested. This combination not
only tends to suspend the discharges, but also to allay the pains
and spasms, overcome conjestion, and restore the secretions of
the liver.

502 The Epidemic Cholera. [August,

When the discharges by the bowels are profuse and repeated
in quick succession, a strong astringent injection should be im-
mediately resorted to. An ounce of oak galls, or the same
quantity of oak bark, should be boiled in a pint of water, and a
gill of this, with thirty drops of laudanum, should be immediate-
ly thrown into the rectum, and there retained, when the
instrument is withdrawn, by means of a compress held firmly
against the part, for ten or fifteen minutes. This may be re-
peated, if necessary. While these means are being resorted
to, the patient should be confined to bed. Large mustard, or
pepper plasters should be applied to the abdomen and extremi-
ties, while stimulating frictions are made to the whole surface
of the body.

2. To OVERCOME Congestion and promote reaction. Cho-
lera is always associated with congestion of the internal organs,
which, if not speedily removed, will keep up the discharges,
and hurry the patient into a state of collapse. The pills recom-
mended above, will contribute materially to overcome this con-
gestion. They should, therefore, be continued, even after the
vomiting and purging have ceased, but need not be repeated
oftener than once an hour, or once in two hours. At this junc-
ture, it may be useful, in some cases, to increase the calomel in
each dose, to five grains, the other ingredients remaining the
same. The eflfects of the opium, however, should be carefully
watched, and as soon as any evidence of its stupifying influence
is perceived, it should be immediately withdrawn. Collapse is
often brought on by over doses of anodynes, and persons should
be cautious not to use opium, in any of its forms, to such an
extent as to incur this risk.

The next most important means of fulfilling this indication
is, external stimulation. This can be most effectually secured
by mustard and pepper plasters, already referred to ; stimula-
ting frictions ; and the application of dry heat. Spirits of tur-
pentine, tincture of cayenne pepper, powdered cayenne pepper,
incorporated with mercurial ointment, will be very useful for
this purpose. The writer of the Report can confidently recom-
mend the following liniment, as a very useful means of external
stimulation. Take of strong cayenne pepper, three ounces;
strong powdered mustard, one ounce and a half; gum camphor,
half an ounce; powdered cantharides, three drachms; and
alcohol, a pint. Digest for several days then strain, and add
of spirits of turpentine, six ounces. This may be rubbed over
the whole surface of the body and limbs, and the frictions should
be frequently repeated, as long as the skin remains cold.

Dry heat may be conveniently applied about the patient, by
jneans of bags filled wifcli heated salt, sand, or corn flour, but far

1849,] The Epidemic Cholera. 503

more efficiently, by tin vessels filled with hot water, so fashion-
ed as to fit accurately the surface of the body and limbs. Three
of these will be useful, viz: a broad one for the abdomen, and
two long ones one for each of the lower limbs. They should
be convex on one side, and concave on the other, as to fit accu-
rately to the part.

When, notwithstanding these means, collapse, or sinking,
takes place, or wiiere the disease seizes, from the first, with such
violence, as to run rapidly into this condition, the state of the
patient is deplorable, yet not hopeless. He should-not be aban-
doned, even under these unfavorable circumstances, but all
proper means for his restoration should be continued persever-
ingly, and unremittingly. The body being now cold, the wrist
pulseless, the skin blue and shrivelled, the tongue and breath
cold, the intellect hstless and indifferent to all surrounding ob-
jects, and the whole frame agitated with frightful cramps and
spasms every thing seems to indicate that life has reached its
lowest ebb, and that active stimulation alone can maintain its
existence. In regard to the propriety of internal stimulation
under such circumstances, there is a difference of opinion
amongst the profession. The writer of this Report has gener-
ally found it either useless or injurious. He has seen more
cases of collapse recover under the use of external stimulants,
quietude, and ice frictions over the whole surface, than under
any other treatment. No one but a Physician, however, can be
competent to act in such a case, and every thing must be left to
his judgment and discrimination.

3. To RESTORE SECRETION AND REMOVE THE EFFECTS OF DIS-
EASE. But little need be said under this head. It will always
be found, that even after the disease has been arrested, the secre-
tions of the liver, and of the digestive organs generally, will
remain more or less suspended or perverted, until these de-
rangements are corrected. The patient will not convalesce
readily. Indeed, it will frequently happen, after reaction has
taken place, that fever of several days continuance will super-
vene, presenting all the characters of common Typhoid fever,
and requiring the same treatment.

To restore healthy secretion, it will be necessary to adminis-
ter, three or four times a day, five grains of blue pill, or two or
three grains of calomel, either alone, or combined with the same
quantity of rhubarb, aloes, or compound extract of colocynth,
until the operations assume a bilious character.

During the early stages of the disease, nothing in the way of
drinks or nourishment, should be taken into the stomach ; but
to allay the raging thirst, small pieces of ice should be held in

504 The Ejnde?tiic Cholera. [August,

the mouth. As soon as the first stage has passed, the discharges
having been arrested, and the stomach rendered retentive, the
patient may be allowed arrow root, tapioca,- sago, &c., in small
quantities.

In closing this Report, it is felt to be a subject of crrateful feli-
citation, that, however, while many sections of the Union, under
the afllictive dispensations of Providence, are suffering all the
calamities of a fatal epidemic, our own State and city have thus
far been spared ; and while we sympathise with our afflicted
fellow-men elsewhere, we should devoutly pray Almighty God,
in His mercv, to continue to us the hic^h decree of health which
we at present enjoy, and avert the pestilence from our shores ;
but, if in His infinite wisdom, it should be deemed fit that we
should participate in the ills which have already sown sorrow
and desolation amongst our neighbors then let us be prepared
to meet the emergency with calmness and resignation putting
our trust in the Supreme Ruler of the universe, and using, with
becoming diligence, all the means He has given us of cheering,
aiding, and comforting each other under our afflictions.

E. Geddings, M. D.

Thos. Y. Simons, M. D.

Elias Horlbeck, M. D. )>Committee.

John Bellinger, M. D.

P. C. Gaillard, M. D.

Letter from the distinguished Dr. Cartwrigiit, formerly of
Natchez, now of New Orleans, detailing his theory and treat-
ment of Cholera his recent experience in New Orleans the
results of Post-mortem Examinations, etc.

Natchez, May 28, 1849.

* Dr. Johnson Dear Sir: On a flying visit from New Orleans
to this place, your favor of the 21st directed to me here, reach-
ed me, and I hasten to send an answer, as I return to New
Orleans to-day. I have removed to that city I went there
soon after the cholera made its appearance. I served an ap-
prenticeship in the Hospital before I commenced, and attended
numerous post-mortem examinations of those who had died of
cholera. The gall bladder was invariably distended with black
bile, the liver congested, and the great veins leading to it. The
pulmonary arteries were very much distended with a black
thickblood, and the right side of the heart and vena cava as full
as they possibly could hold with the same black, thick fluid.
The puhnonary veins had no florid blood in them. The heart
contained oyster-looking substances showing that the blood had
undergone a chemical decomposition. The thoracic duct was

1849.] The Epidemic Cholera. 505

empty, and every cavity contained a rice-water looking fluid.
The contents of the alimentary canal miglit well he denomina-
ted white blood, as they pgree with blood in all their chemical
properties. This was owing to their being composed in a great
manner of the contents of the thoracic duct. The urinary blad-
der, the uterus, and even the fallopian tubes, contained rice-
water, owing, no doubt to the watery portions of the arterial
blood having percolated from the exhalent capillary arteries
instead of going into the veins. I then commenced practice.
I have been practising medicine in New Orleans upwards of
seven months. I have had cholera cases every day, and some
days a good many cases. I have only lost four cases in all,
none of whom had any pulse when I first saw them. I have
cured every one to whom I have been called before the pulse
failed. I now proceed to answer the question you put to me :
" What is the best prescription or course of practice in a case
of cholera?" Give the patient instantly 20 grs. Hydrargum
cum creta, 20 grs. best cayenne pepper,. 10 grs. gum camphor,
15 grs. calcined charcoal, 15 grs. gum Arabic, mixed together
in two table-spoonsfuls of cold water, and cram a wet towel in
the mouth to take away the burning taste and prevent vomit-
ing. The patient should swallow the above dose quickly, and
the whole of it without stopping to taste it. He should lie down
and cover up and keep down. The doors and windows should
be opened to give fresh air to fan and feed the combustion in
the lungs which burns slowly in cholera, i. e. : the change from
black to red blood does not go on as in health, and the tempera-
ture falls. A jacket or a flannel shirt wrung out of scalding
water and rolled into a ball as large as a child's head until it
will not drip should be wrapped in a dry cloth and applied over
the stomach and bowels, as hot as it can be borne. Bottles
filled with hot water should be applied to the extremities. Five
minutes having elapsed from the taking of the powder, a spoon-
ful of hot sage, balm, mint or chamomile tea, to be given to the
patient from time to time, with a table-spoonful of cold water
or a tea-spoonful of pounded ice alternated with the hot tea.
Now look out for perspiration. From 10 to 15 minutes after
the powder is taken perspiration is generally established. If in
10 the patient is safe. Nothing more is needed but to give warm
teas, or any warm fluid the patient likes best, in suflicient quan-
tities to allay the thirst, and support the sweat. The sweat
should be kept up six or eight hours then gruel to assist the
Hydrargum cum creta to empty the gall bladder. Then the
circulation will go on through the liver. The vena potarum
will be released from its plethora, and the serous part of the
arterial blood will no longer be poured from the exhalent arte-

500 The Epidemic Cholera. [August,

ries, but find its way into the portal veins. The revulsion to the
surface will cause the absorbents to suck up the fluids taken
into the stomach, and the pouring back action will be arrested.
This sucking up action caused by the sweat will restore the
natural fluidity of the blood. When the sweat is established
stimulants are unnecessary, or hurtful, as- they may stop it. To
put back the lost water in the blood is the best mode of stimu-
lating. I have thus described a case cured by one dose of medi-
cine a part of that dose might have been sufficient, you may
suppose. A small dose might have fallen in with the disease
and operated on the bowels. A large dose is a non-purgative
because it is sudorific, revulses to the surface, starts a centrifu-
gal action of the fluids and averts the centripetal action of the
disease. But if one dose does not sweat, give another, or half a
dose ; if that does not do, bleed from the arm or cup freely over
the epigastrium, and give warm stimulating drinks to force a
sweat, and apply hot applications externally. Suppose the skin
gets too hot under this high stimulation outside and inside, wash
the patient all over with cold water to bring the system down
to the sweating point if the pulse will not bear bleeding. Sup-
pose the extremities are too cold to be compatible with healthy
perspiration, warm them by hot applications and friction. Sup-
pose the patient vomits the medicine, give a cup of chamomile
tea, let him vomit that, and then repeat the medicine. Suppose
he still vomits, then give one grain sulphate of morphine in a
desert spoonful of camphor water, or half a grain if the cure is
not urgent, and repeat after each stool or vomiting spell. As
soon as the stomach is settled throw in 20 grains Hydrarg. cum
creta, or 20 calomel. Give coflfee if the morphine be used.
You may think the dose large, but if opiates be used at all in
cholera the doses should be four fold. Small doses do more
harm than good. I give nothing to work the medicine off' be-
fore the next day or the day after. A purgative before the
aqueous parts of blood are restored is a dangerous thing. The
medicine generally works itself off*. Under this plan no second-
ary fever follows. But if stimulants be used after the patient
begins to sweat, secondary pain is sure to occur. Stimulants
until the sweat begins are all important none are too strong.
Fire itself is scarcely too strong. But when a sweat is estab-
lished, all stimulants internally and externally should be sus-
pended. Then diluent drinks to thin the blood are the best of
stimulants. I often give mineral water, soda water, and even
lemonade, for that purpose any diluent or watery fluid that
agrees best with the stomach. The patient cannot purge and
sweat at the same time. The rice water in the bowels may
run out after the perspiration is established, but more cannot

1849.] Monthly Periscope. 507

be poured into the bowels while the perspiration goes on, in-
deed the perspiration generally causes the rice water in the
bowels to be absorbed. Very respectfully, yours, &c.

Sam'l a. Cartwright.

PART III.

Sickness in Baltimore Aims-House. June 16, 1849. (To the Edi-
tors of the Baltimore Patriot.) Various and contradictory statements
having been made through the daily press of our city, relating to a
fever which has lately been introduced into the medical wards at the
Baltimore Aims-House, we deem it our duty to say, that this fever is a
highly malignant typhus, modified by climate, infectious in its charac-
ter, but accompanied, in a large majority of cases, by intense jaun-
dice, in this respect resembling typhus icterodes of systematic writers.

It has come to us only in the past three weeks, during which time
forty-six cases have been admitted, and of these the very large pro-
portion of twenty have proved fatal. The remainder are still under
treatment.

It has been brought alike from every section of the city, and as yet
has only occurred among the free blacks.

Thus far it has been much more grave among males than females,
owing probably to differences of habits and occupation.

A large majority of cases have been fatal between the third and
seventh day, and in some instances they have died a few minutes after
admission, and three days from the date of seizure.

This disease is by no means confined to the worthless and abandon-
ed, but has, on the contrary, frequently happened in individuals of
temperate and industrious habits, whose means were adequate to pro-
vide them with wholesome food and sufficient clothing.

The point of importance, at present, is its infectious character.
Two strong and healthy women, residents of the house, and employed
as nurses, have taken the disease and died.

Thos. H. Buckler, M. D.
H. Willis Baxley, M. D.

New metliod of reducing Dislocations at the Elbow backward. M.
Maisonneuve, of Paris, placed the extending band directly upon the
projecting elecranon of the ulna, then crossed it upon the anterior sur-
face of the fore-arm, and again upon its posterior surface, to the end of
which the force of extension was now applied. The reduction was
readily afTected.

Treatment of Cholera by Ipecacuanha and Calomel. (Gazette A^edi -
cale de Paris.) Prof. Spring, of the University of Liege, Belgium,

508 Monthly Periscope. [August,

insists upon the use of Ipecac, in powder, 15 to 20 grs. doses every
quarter of an hour until bile is vomited. If this is provoked (the vom-
iting of bile) 4 out of every 5 patients will be saved. Should cerebral
congestion be produced by the vomitings, he bleeds cautiously. He
next gives calomel in large doses, about 40 to 70 grs. every half hour,
until green stools are obtained. Should the spasms be considerable,
he combines camphor with the calomel in the proportion of 1 gr. cam-
phor to 3 or 5 of calomel. During this internal administration of
agents, the usual means of producing reaction on the surface must not
be neglected.

Anti' choleric mixture of Stragonof. We find the following com-
bination in the June No. of the Journ. des Connaissances Medico-Chir.
It is said to have been used at the St. Louis Hospital of Paris, with
some success. It is employed in the last stage of cholera, when even
the pulse is extinct. The dose is 15 to 40 drops in a wine-glass of
some generous wine, and may be repeated two or three times, half an
hour apart. Take, Etherial Tincture of Valerian, 4 3.

Tincture of Nux Vomica, - 2 3.

Hoffman's Liquor, - - - 4 3.

Tincture of Arneca, - - - 2 3.

Essence of Mint, - - - - 15.

Tincture of Opium, - - - 3 3. Mix.

Injection of Water into the Bladder in Cholera. (Gazette Medicale
de Paris.) Prof. Piorry (4th June) mentioned to the Academy of Sci-
ences, that a student had injected two pints of water into the bladder
of a patient laboring under cholera. He says the effects were that the
veins became full, the pulse was developed, the heart and liver were
augmented in volume, and the condition of the patient was infinitely
better.

Valerianate of Zinc in Chorea. About the middle of April I was

called to see Anne P , nine years old, a delicate child, afllicted

most dreadfully with chorea; she could not talk, walk, nor even
stand alone. I gave her a smart purgative, and after the bowels had
been well cleared, ordered her a grain of valerianate of zinc three
times a day ; this was continued for a fortnight, when the dose was
increased to a grain and a half. In a few days the remedy produced
nausea, and it was reduced to the original dose ; this was steadily con-
tinued until the middle of June, when it was given twice a day for a
short time, and then discontinued. The child is now quite well.

[London Lancet.

Quackery in Medicine. Dr. Bell's notice of Cholera in Louis-
ville, Kentucky.

Whenever a terrific and sweeping pestilence commences its rava-
ges, it is surprising to see what Hocks of cormorants wing their way
to the scene of devastation, to prey upon the credulity, the fears, and

1849.] Monthly Periscope. 509

the follies of the public. With the most imperturbable mendacity, the
coolest impudence imaginable, and the most utter indifFerence to all
consequences, they announce that they have an unfailing remedy for
the disease ; that it is suitable for every age, condition and sex, and
for any stage of the distemper, and that its miraculous powers have
been hidden from all the human race, but the particular individual
who manufactures it. They announce that it succeeds where physi-
cians fail, and that nothing but the purest philanthrophy induces them
to keep it secret, and to offer it for sale to a suffering world. These
things are an utter abomination, and demand the interposition of law,
not to protect medical men, but the public, from these designing sharp-
ers. They do infinite harm, and can do no kind of good.

In the midst of a great conflagration, or near the scene of a wreck,
we see philanthropists of the same stripe we have described as hover-
ing over the ravages of a destroying pestilence. These characters are
busily engafjed in saving all they can lay hold of from the devouring
elements, and are filled with an amazing love for the human race,

whose entire boundaries are contained in self. [ Western Journ,

of Med. and Surgery,

Gahanism in Paralysis of the Bladder. The manner of applying
this remedy, adopted by M. Michon, of La Pitie Hospital, is very simple,
and is as follows : Two silver catheters or sounds are introduced, the
one into the bladder, the other (the female) into the rectum, and being
connected with the two poles of a simple electro-magnetic machine, Ae
current is established and continued for a few minutes, when the sounds
are withdrawn. M. Mihon, in two cases which he lately treated
with success, used the remedy but once in the twenty-four hours.

[Ih., fi'om Gaz. des Hop.

Aphtha. By J. Yale Ware, Mass. The following simple pre-
scription has proved a specific in my hands in many hundred cases of
aphtha. I learnt it of Dr. Eli Ives, New Haven. R. Ipecac, gr. vi. ;
tinct. opii; ess. pep., aa git. iv. ; boiling water, xxiv. tea -spoonsful.
Sweeten with loaf sugar. Dose, a tea-spoonful every two hours. At
the same time apply to the tongue equal parts of a powder of borax
and loaf sugar, which the child will carry over the mouth. I have
never known the above to fail in any case of infants' sore mouth. It
generally cures in two days. Occasionally, in delicate subjects, the
disease returns again, when the remedy needs repeating. [American
Journal of Med. Sciences.

Prolapsus Ani and Hemorrhoids. Dr. J. Batchelder, an aged and
eminent physician of this city, informs us that during the last fifteen
or twenty years, he has completely cured or greatly relieved a very
large number of cases of prolapsus ani and hemorrhoids, by simply
causing the patient to evacuate the bowels habitually in the standing
posture or as nearly so as possible. In this position the sphincter is
so far aided by the surrounding muscles as to retain the relaxed mu-

510 Monthly Periscope. [August,

cous membrane or the hemorrhoidal tumours above it, while the usual
squatting position directly favors their protrusion. This is an import-
ant suggestion, and the practice recommended is certainly well worth
trying. \^Annalist.

Salt, a prophylactic to Worms. It is said that persons who take
little or no salt with their food are very subject to intestinal worms.
Lord Somerville, in his address to the Board of Agriculture, states that
the ancient laws of Holland " ordained men to be kept on bread alone
unmixed with salt, as the severest punishment that could be inflicted
upon them in their moist climate ; the effect was horrible : these
wretched criminals are said to have been devoured by worms engend-
ered in their own stomachs." Mr. Marshall tells us of a lady who
had a natural aversion to salt : she was most dreadfully affected with
worms during the whole of her life. [Pereira, vol. 1, p. 463.

Quack Bills. One City coming to its senses.. We find in the New
Orleans Med. and Surg. Journal, the following resolutions, passed by
the city authorities. They deserve much credit for even doing their
duty in these degenerate days. [Ohio Med. and Surg. Journ.
Council Municipality, No. One.
Extract of the Sitting of Monday, 24th June, 1846.

Be it further Resolved, That the fact of announcing publicly, by
posting hand-bills in public places, the sale of medicines for the cure
of diseases, shall constitute a police misdemeanor.

Be it further Resoloed, That a fine of twenty-five dollars shall be
imposed on every bill-sticker convicted of ffaving posted up in one or
several places, one or several hand-bills, offering for sale medicines
for the cure of diseases.

[Signed.] PAUL BURTUS, President.

A true copy : A. D. GROSSMAN, Mayor.

Cholera in New Orleans. We are compelled to refer again, under
this head, to the progress of cholera in our city. Since the middle of
December last, it has dwelt among, and dealt unkindly with us.
Neither the course nor force of the M'inds, the rise and fall of the
thermometer, and barometer nor deluging rains or cloudless skies
nor any or all the vicissitudes for which bur climate is remarkable,
have had much ellbct in modifying either tlie symptoms, or checking
the progress of the direful scourge. In 1832, the cholera, after raging
in this place for five or six weeks, disappeared in 24 hours, after a
heavy gale from the north. Not so, however, in 1848-9. For nearly
seven months, it has been carrying on the work of death, and during
all this period, about one half of the deaths which have taken place
in this city, from actual disease, have been produced by this epidemic.
This fact is at once startling, and well calculated to lead Us to inves-
tigate the cause of its protracted stay in our city. Is it about to take
up its permanent abode among us, and become a co-worker of death
with yellow fever ? Heaven forbid ! Time, however, will decide this

1849.] Monthly Periscope. 'Medical Miscellany. 511

question ; at present we have neither the wish nor ability to engage in
the investigation of a subject fraught with such melancholy reflec-
tions. [iV. O. Med. Jour,

Cosmetics. A solution of Bichloride of Mercury in Bitter Almond
Emulsion (about gr. j. ad fj.) has long been a favorite face wash:
it constitutes Gowland's lotion. Bichloride of Mercury, it is well
known, unites with albumen, and hardens animal tissues. Bitter Al-
monds are mentioned by Celsus, as remedies for ephelides (freckles).
Withering recommends, as one of the safest and best cosmetics, an
infusion of Horse-radish in cold milk. [Pereira, vol. 1, p. 218.

An officer of the U.S. A., Gen. T., recommends the following,
which will also dye the hair, as well as relieve furfuraceous eruptions
of the skin: R. Milk of sulphur, 5ii. ; Sugar of Lead, 5i. ; Rose
Water, ^viii. Mix. It relieves dandruff.

To produce Artificial Cold. R. Hydrochlorate of Ammonia and
Nitrate of Potash, each 5, to a pint of water.

MEDICAL MISCELLANY.

Modification of DessaiiU's long Splint. Dr. A. Hays, in the Medical Examiner
of July, says, that in 1812, when employed as Hospital Surgeon on the Northern
frontier, he cut out a portion of Dr. Physick's improved splint (Dessault) so as
to have free access to the wound in cases of compound Fractures the two pie-
ces^f the splint being firmly secured or re-united by a curved strip of iron so
as still to maintain extension and counter-extension.

Professor of Theory and Practice in the School at Richmond, Virginia. ^Dr. Da-
vid H. Tucker, of Philadelphia, one of the Editors of the Medical Examiner,
has received this appointment.

Destruction of the Press of the St. Louis Medical and Surgical Journal by the great
fire in that city. One of the Editors of this Journal, Dr. McPheeters,' requests
the above fact to be made known to the subscribers of that Medical Periodical.

Death of an Editor and Professor at St. Louis. We have just seen announced
the death of Dr. Barbour, of St. Louis, of Cholera.

Sub-nitrate of Bismuth in large doses for Chokri^ie. M. Monneret, of the Hos-
pital of Bon-Secours, recommends this preparation in large doses for the relief
of cholerine and thus the prevention of cholera. In 91 cases, two only had cho-
lera. He gives the sub-nitrate in 10 to 40 grammes (3ii. to ^iss., immense doses,)
per diem.

Death of Dr. Bougery, of Paris. The Medical Gazette of Paris, of June 16,
announces the death of M. Bougery, author of the great work on the Anatomy
of Man. He died of Cholera .

Munificent gift to the poor of Paris. Baron Rothschild has putat the disposition
of the Prefect of the Seine 10,000 francs, for the relief of families sufiering from
cholera in the city of Paris.

Extent of the Clwlcra in France. Up to 9th June, the cholera prevails or has
prevailed in 33 departments and 360 communes of France . There had occurred
about 22,000 cases, and 14,000 deaths.

One grain Doses of Calomel in Cholera. Dr. Ayre, of Hull, England, contends
in the Lancet that 1 grain doses of calomel with Idrop of laudanum, every five
or ten minutes, according to the intensity of the collapse, is capable of restoring
the patient to health without the aid of any auxiliary means.

512

Medical Miscellany . Meleorologij,

Anii-licvwrrJuigic property of Matico. An ounce of the leaves of matico to a
pint of boiling water Dose, a wine-glass full every quarter of an hour with 25
drops of turpentine for first hour, then the same dose every two hours, omitting
the turpentine occasionally, however. The hemorrhage from the lungs was
arrested in IG hours.

Sterilily in Londofi. Dr. Webster stated before the Westminster Medical So-
ciety, that he knew among his friends 140 couples who had no children,

Ckart)is af^ainst Cliolcra. In a shop in the Rue Vivienne, Paris, are sold little
copper medals, fastened to a silk ribbon, and said to be endowed with the power
of preserving the wearer from cholera. This istJie lOlh century of the Christian
era. Where are the galvanic rings 1

Early Menstruation and Pregnancy. Dr. J, Smith reports, in the London
Medical Gazette, the case of a girl who menstruated at 10^ years old, conceived
at 11 years and 10 months, and gave birth nine months thereafter, to a living
healthy child.

METEOROLOGICAL OBSERVATIONS, for June, 1849, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet.

Sur
Ther.

I Rise.
Bar.

2,
Ther.

P.M.
Bar.

29 79-100

Wind.

Remarks.

1

70

29 82-100

79

S. E.

Cloudy thunder.

2

G8

" 76-100

83

" 75-100

S. E.

iCloudy.

3

68

" 75-100

86

" 76-100

S. E.

'Cloudy morning breeze.

4

70

'' 75-100

93

" 69-100

S. W.

Fair. [1 in. 75-100.

5

75

" 73-100

92

" 68-100

S. E.

Fair morning rain at 4, p. m.,

6

73

" 75-100

83

" 70-100

s.

Rain, 35-100.

/

73

" 70-100

87

" 67-100

S. W.

Flying cl'ds sprinkle storm.

8

70

" 68-100

84

' 65-100

w.

Rain storm at7j,p.M,, 20-100.

9

70

" 62-100

89

" 58-100,

w.

Rain-storms, 70-100.

10

72

" 60-100

91

" 66-100

N. W.

Fair breeze storm at 7, r.M.

11

70

" 70-100

83

" 86-100,

E.

Cloudy blow.

12

69

" 92-100

82

*' 90-100

E.

iCloudy rain, 35-100.

13

68

" 92-100

85

" 94-100

S. E.

Cloudy slight rain.

14

70

" 97-100

84

30

S. E.

Cloudy till 2, p.m. breeze:

15

6G

" 96-100

84

29 90-100

E.

Fair afternoon breeze.

16

6G

" 87-100

84

" 86-1001

E.

Cloudy sprinkle. [10-100.

17

70

" 89-100

87

" 92-100|

N. E.

(Moudy storm at3, p.m., 1 inch

18

70

" 97-100

85

30 1

N. E.

Cloudy storm at 6, p. m.

19

69

30

84

29 98-100

E.

Cloudy heavy blow.

20

71

29 92-100

74

" 97-100

E.

Rainy day storms still, 35-100.

21

66

" 98-100

86

" 98-100;

S. E.

Fair cloudy afternoon.

22

70

' 98-100

89

" 92-100;

S. E.

Fair morning.

23

72

" 90-100

91

" 80-100,

S. E.

Fair morning.

2^1

72

" 79-100

91

" 74-100!

S. E.

Fair sprinkle in afternoon.

25

74

" 73-100

88

" 68-100,

S.

Fair sprinkle in alternoon.

2G

73

" 67-100

94

" 66-100

s. w.

Cloudy breeze.

27

74

" 72-100

92

" 73-1001

s. w.

Cloudy breeze.

28

73

" 75-100

90

" 76-100,

s. w.

Cloudy breeze.

29

73

" 76-100

92

" 75-1 OOj

s. w.

Cloudy breeze.

30

75

" 77-lOOi

95

" 75-100'

s. w.

Cloudy breeze.

1 Fair day. auantity of Rain 4 inches and 80-100. Wind East of N. and
S. 18 days. West of do. do. 10 days.

ERRATA In the May No. of the Journal, the following errors escaped our notice,

in the Article of Professor Le Conte, on " The Philosophy of Medicine."

On page '259, 13th line from the top, read arrangement for "derangement"
" " 265, l:Uh " " the bottom, read bearing for "learning"
" " a67, 4th " " the top, road astronomy for "anatomy"
" " 267, 18th " " the top, read impotent for "important"
" " 268, 7th " " the bottom, read judicious for "injudicious".

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. .] NEW SERIES.-SEPTE3IBER, 1849. [No. 9.

PART FIRST.
rtgtnal (Hommttnicattons.

ARTICLE XXVII.

A Report on the Medical Topography, Meteorology, and pre-
vailing Diseases of Wetumpka, and its vicinity, for the year
1848 Read before the Alabama State Medical Association,
on the 8th March, 1849, by James C. Harris, M. D. (Pub-
lished by order of the Association.)

Mr. President, and Fellows of the Med. Asssociation :

In appearing before you to-day, as reporter, on the prevailing
diseases of this looality for the past year, we feel a peculiar
sadness ; for, in casting our eyes over this assembly, we cannot
but be forcibly impressed with the visible flight of time. Fifteen
years ago we walked these streets an inexperienced medical
practitioner, buoyant with hope and high aspirations, that
future has now, with its joys, its sorrows and its disappoint-
ments, become the past. With thoughts like these welling up
from the ocean of our memory, we are insensibly and irresisti-
bly led to inquire, where are those with whom we first met in
consultation? Need we say they are gone: the places that
knew them then, know them now no more forever. Whilst all
of them, we trust, are gone to join their friends in the general
association of Heaven, we, the spared monument of God's
goodness, are here alone to bear them record. But though
their places have been by an inscrutible and all-wise Providence
rendered vacant, and death and the grave has closed over and
separated us from them, together with many more of the com-

N. 9. VOL. V. NO. XIV. .33

514 Harris, on the Diseases of Wetumpka. [September,

panions of our boyhood, still we should not mourn as those that
have no hope, or be unmindful that each one of us has our ap-
pointed niche to fill in the temple of time, and task on earth to
perform, and that we must work while it is called to-day, for
death and the grave will come, in which we can do no work.
Then, Mr. President, with these melancholy, though to some
extent pleasing recollections for it is pleasant to know and
feel that even in the spirit land we shall be again united to those
we have known on earth the best, and loved th^ most we
proceed with the consideration of our subject, by first giving a
brief account 'of the Medical Topography of our locality ; 2dly,.
the Meteorology for the year, and 3dly, and lastly, some ac-
count of prevailing Diseases, &c. ; and in so doing, shall endea-
vor to be as little fatigueing as the nature of our undertaking
will allow.

1st. Medical Topograph]/. The towns of East and West
Wetumpka, connected by a fine and apparently durable bridge',
are situated on both sides of the Coosa river, at the foot of the
falls of the same name, and head of steam-boat navigation, in
latitude 32 30', and longitude w^est from Washington 10 15\
These have been by legislative enactment erected into and
constitute one city, containing upwards of eighteen hundred
inhabitants, several schools, four churches, and the State prison,
together with immense water facilities for the propulsion of all
kinds of machinery.

Thus situated, with many internal evidences of her own
greatness, in the untiring zeal and enterprize of her citizens,
surrounded upon all sides by an intelligent, and upon the west and
south a dense and wealthy population, she holds out to the
merchant, the artizan, and capitalist, for a permanent location
in their different avocations, a fair prospect of pecuniary re-
ward.

The site of the western town is a level sandy plain, cut and
interspersed with an occasional ravine and lagoon, terminating
rather abruptly at the river bank in a high bluff. Not so, how-
ever, with the eastern. Here a greater portion of the town is
so completely hemmed in with a range of high hills extending
its whole length, and rising several hundred feet above the level

1849.] Harris, oji the Diseases of Wetumpka. 515

of the river, that at many points there is scarcely space enough
between their base and the waters edge, for the erection of the
necessary business buildings. These hills, sloping back with
gentle acclivities and terminating in level tops, afford most de-
sirable sites for the erection of private residences, and from one
of which, to the admirer of the works of nature, the prospect is
most enchanting. To the south and south-west, as far as the
eye can reach, nothing is to be seen but one extended landscape,
interspersed with forest, fields, and farm-houses whilst at your
feet, sweeping in silent and unbroken majesty, roll the gushing
waters of the Coosa. The agitation of these waters in their
passage over the falls, causes the evolution of a large amount
of vapour, which descending at nightfall in copious showers of
dew, gives to the air of the vicinity an unusual and at times un-
healthy degree of dampness.

The river, after entering the limits of the tow^n, runs for the
first h^lf mile in a south-westerly direction, when it passes under
the bridge, and then shifts its course more to the south-east,
pursuing this direction for about a mile more it then turns
west and runs in a devious line until its junction with the Tal-
lapoosa. ^

In the original plan of the city, the streets were laid out north
and south, east and west, crossing each other at right angles ;
but owing to the peculiar structure of the surface of the earth
upon the eastern side, this arrangement has been lost : here
Main-street runs south from the end of the bridge, and Bridge-
street east two hundred yards to the market-house, forming an
angle here upon its outer section with Gay-street then runs
north-east and parallel with the river to the north-eastern ex-
tremity of the corporation.

Atlow^ stages of the water the current of the river above the
bridge is thrown almost entirely against the western bank,
leaving exposed to the action of the sun a large portion of de-
caying vegetable matter. There are also at low stages of
water, among the rocks and shoals, many pools of stagnant
water, in which a mass of organic matter is continually under-
going decomposition one in particular, commencing not far
above the bridge, and extending some hundred yards up the
river, is a fruitful source of exhalation : a large ravine also

516 Harris, on the Diseases of Wetumpha, [September,

extends from the waters edge in the rear of the buildings on
Bridge-street nearly up to the market-house, and receives the
filth from the greater portion of this part of the city. There
are also other sources of disease of a local character within the
corporation on both sides of the river, and also within the
immediate vicinity, but as they are similar to those already
described, and common to many other southern towns and
neighborhoods, we will pass them by without any further no-
tice, referring the Association for a fuller account to two arti-
cles published by the writer in Sept. No. 1845, and June No,
1846, of the Western Journal of Medicine and Surgery, pages
191-2 and 490-91.

After the foregoing account of our locality, it would be al-
most needless for us to remark, that if the wind in a dry spell,
during the months of August and September, should set in and
continue to blow regularly from the north, north-west, or south,
or from almost any other direction between these points, for
three or four days in succession, over these prolific sources of
malaria, nothing else could be expected but that all the inhabit-
ants residing on Bridge, Main, Gay, and Company streets, and
the sides and tops of the adjacent hills, would become liable in
a peculiar manner to fevers ; and in the assertion that they
always do suffer to a greater or less extent, we are borne out
by the observation of all those who have paid any attention to
the matter,

2dly. State of the Weather. Januar}^ February and March^
were remarkably clear and warm. The mean temperature for
January being 54 44', February 57 51', and March 62 33'.
There were during this period sixty-three (63) clear days,
eleven (11) cloudy, and seventeen (17) that it rained. On the
7th of March occurred the greatest daily range of the thermom-
eter for the year, and on the night of the 2d a hail-storm, ac-
companied with thunder and lightning.

April, May and June. April was an exceedingly pleasant
month, with a warm thermometrical temperature of 66.50, and
a maximum of 73.10, presenting little else than a continued
succession of sun-shine and shower. On the evening of the
29th we were visited with a heavy hail-storm some of the

1849.] Harris, on the Diseases of Wetumpka. 517

hail-stones observed by us were as large as a pigeon's egg.
May, although noticed in our table with 24 clear days, was,
notwithstanding, very wet, heavy rains falling throughout the
night, and of which no account was kept. The mean daily
temperature for the month was 75.44, and the range 11.40,
attended generally throughout the day with a damp, oppressive
atmosphere. June was also exceedingly wet, the rains howe-
ver falling mostly throughout the day, the mean temperature
being 78.44, and the range IP 40'.

July, August, and September. Throughout July the rains
still continued to fall, but as in May, mostly during the night,
the mean temperature for the month being 80.54, antl the mean
range 11.02. The warmest day was the 27th, and the coldest
the 21st, the former being 83. 10, and the latter 76.20. In Au-
gust there fell a great deal of rain up to the 18th, at which time
it suddenly turned dry, and remained so until the 26th, when
it commenced raining again, and continued to do so for several
days in succession, after which it turned off clear, and continu-
ed so for the balance of the month, the mean heat being 79.45,
and the range 11.54. The warmest day was the 29th, and the
coldest the 1st. The mean temperature of the former being
83.10, and that of the latter 75 50'. September was exceed-
ingly dry and dusty throughout, presenting a mean temperature
of 75.24, with a range of 12.34. The mean maximum of the
thermometer on the 4lh was 84.40, and the minimum on the
22d 65.20.

October, November and December. The dryness and heat
continued uninterruptedly up to the 9th of October, when a
few light showers coming on reduced the temperature consid-
erably. The remainder of the month, with the exception of a
few days, was pleasant and dry, presenting a mean of 66.22,
with a range of 13.40. The greatest mean daily heat being on
the 6th, 76.20, and the lowest on the 22d, 48.40. November
was not remarkable for anything more than its low tempera-
ture and high range, chilling winds and frosty mornings. The
mean temperature for the month being 53.14, with a range of
15.08. Not so, however, with December, which proved to be
almost the reverse of November, as regards temperature and
^nge, the thermometrical mean being 66.37, and the range

518

Harris, on the Diseases of Wetiwipha. [September,

9.21. For the purpose of making ourselves more clearly un-
derstood on this part of the subject, we herewith submit the

following :

Abstract of a Meteorological Register kept at Wetumpka, for
the year 1848.

THERMOMETER.

WEATHER.;

u^

.

.

Greatest

Months.

Mean.

Max.

Min.

Range.

a

o

24

O
5

2

5

daily
Range.

Date.

24lh

Prevailing.

Jan....

54.44

60.25

46.30

14

28

Clear.

Feb ... .

57.51

62.43

51.10

12

16

3

10

7

2

25

10th

Clear.

March .

G2.33

68.33

53.38

15.30

23

3

5

8

29

7th

Clear.

April . .

66.50

73.10

59.24

13.48

22

3

5

1

26

2nd

Clear.

May.. . .

75.44

81.50

69.17

11.40

24

1

6

23

13th

Clear.

June. ..

78.44

85.04

73.28

11.40

14

16

18

7th

Rain cl'dv.

July...

80.54

86.04

75.02

11.02

19

2

10

18

11th

Clear.

August,

79.45

87.15

74.13

11.54

20

1

10

18

29th

Clear.

Sept. ..

75.24

79.10

65.48

12.34

27

2

1

22

19th

Clear.

October.

66.22

73.17

59.36

13.40

22

4

5

2

22

27ih

Clear.

Nov....

53.14

59.34

44.46

15.08

19

4

7

14

7

26

30th

Clear.

Dec. ..

66.37

64.48

55.27

9.21

15

3

13

4

23

3rd

Rain.

68.14

245

31

90

41

11

On comparing the foregoing table with one kept in the same
locality for the preceding year, (see Western Journ. Med. and
Surg., July No., 1848, p. 28,) we learn, that although the mean
annual temperature was nearly the same, there was considera-
ble variation as regards its monthl}^ distribution, November,
1847, being 9 warmer than the same month in 1848, and De-
cember, 1847, 16 colder than December, 1848. The prevail-
ing winds in the fall season at this point are generally from the
south and south-west. Navigation remained good for small
steam-boats, with the exception of a few wrecks, throughout the
entire fall.

3rd. Diseases, <^c. The weather throughout the month of
.January being pleasant, there was but little sickness, with the ex-
ception of an occasional case of Jaundice, sporadic cases of
which continued to occur up to about the 20th of June. At
this time it became epidemic, and after remaining so for several
weeks gradually commenced declining, and by the last of Sep-
tember had done so, so completely, that not a vestige of its
former existence, in the type of the then prevailing diseases
could be traced. During the months of February, March*
April and Mav, a few cases of Measles and Inflammatory fevers

1849.] Harris, on the Diseases of Wetumpka. 519

made their appearance. The few cases of measles seen and
treated by us, wore rather an aggravated character, requiring
for their successful management the -most active depletion,
the lancet having to be used freely to subdue the pneumonic
pain and attendant excitement ; after w^hich anodynes, warm
teas and demulcent drinks, constituted the remainder of the
treatment. The cases of inflammatory fever that fell under
our notice (observation), came on as a general rule with more or
less chilliness ; with but little disturbance of the bowels, attend-
ed with a quick, tense pulse ; violent pain in the head, confined
more particularly to the frontal and occipital regions, and
extending down the spine to about midway between the should-
ers ; aching in the joints and loins, with hot, dry skin, and
restlessness. Nausea was most commonly present, and the
tongue in every instance was covered with a thin, white fur.
In one case there was considerable contraction of the pupils,
dimness of vision and delirium. This case recovered. The
exposed portions of both races, were equally liable.

The treatment adopted and pursued by your reporter, con-
sisted of pretty free bleedings, mercurial cathartics, blisters
extending from the nape of the neck eight or ten inches down
the spine, and affusions of cold water on the head. Although
there was considerable anxiety manifested on the part of the
community in relation to the type of this particular fever, we
did not discover that it differed in any material point from the
ordinary spring fevers of this locality, in any other respect, than
perhaps a greater sanguineous determination to the encephalon,
and was as a general rule, with proper care, equally as easily
managed.*

From the 10th up to the 26th of June, Jaundice, as has been
before remarked, prevailed epidemically. During this period,
the atmosphere was close and oppressive the average daily
thermometer high, and the range low. The cases, though,
were generally of so mild a character as scarcely to require
any thing more than a dose or two of calomel or blue mass,
with low diet, and for a few days quietude within doors. After

* At this time, an epidemic cerebro-spinal meninofiiis was prevailing in the
city of Montgomery an interesting account of which, by Dr. Silas Ames, may
be found and consulted in the New Orleans Medical and Surgical Journal, fof
November, 1848, p. 295.

520

Harris, on the Diseases of Weiumpka. [September,

the liver commenced pouring out bile, under the influence of
either of the above remedies, a very common domestic medi-
cine, and one that v^-as frequently used, and seemed to aid con-
valescence materially, was a wine-glassful three times a day of
the watery infusion of the bark of the wild cherry-tree, or
smaller doses of the same, in spirituous tincture. This remedy
appeared to act very effectually, but rather insensibly on the
skin and kidneys. There were also, during the latter part of
this month, some Diarrhoea, and Intermittent fever. The latter
gradually continued to increase up to the 18th of August, when
the weather suddenly turni'ig dry and warm, the whole county
Was completely laid under the dominion and influence of mala-
ria periodical fevers prevailing now, and continuing to do so,
to a considerable extent, up to near the middle of November,
at which time, from the coming on of cooler weather, they
commenced declining, and finally disappeared under those
influences known to be unfavorable to their generation. Re-
lapses, however, were more frequent, and cases continued to
occur later in the season than usual. For the purpose of show-
ing to some extent, the variety and number of prevailing dis-
eases, we herewith submit the following table of cases, treated
by Dr. Thomas W. Mason, and in so doing. have to regret the
suspension, from indisposition, of his labors after the 11th Sep-
tember.

Consolidated Table of Cases treated fi^om the 1st of March to
the I Ith September, 1848, inclusive.

FEVERS.

OTHER DISEASES. |

Months.

o

TO

s

a
a

c

OJ

1

c

5

5

8

.8

9

45

c

1

1

7
5

14
7

40

6

'7.

c
0

4
~4

5

"E-
H'

1
1

"3

c

t

c

'c
0

2
"2

(Li

'/;

Cw

2
5

7

G

2

1

1

2

1
7

C

>

Q

4

1

1
2

1

"9

i

-a
c
s

1
2

"4

c
c

4
3

~7

a!

1
T

1

s

03

C

3
"3

c

3

OJ

c

QJ
0

X

0

1
T

0
H
-a
a
2
0

March . .
April. . .
May. . . .
June.. ..
July....
August..
Sept

Total...

4
1

139

1849.] Harris, on the Diseases of Wetumpka,

521

It may not be amiss here to remark, that the report from
which the foregoing table has been condensed, shows the whole
number of cases tieated by the Dr. within the period specified,
to have been two hundred and twelve (212) ; but as many of
them were'such as occur in all latitudes and at ail seasons, and
were not epidemic in this locality within the past year, they
have therefore been excluded.

On a careful examination of the following table of cases
compiled from ihe register of your reporter, showing the rela-
tive liability of the sexes of the black and white races, of the
different periods of life, &c., to the several forms of periodical
fever, as they prevailed in this locality during the past summer
and fall, and which is herewith submitted.

Consolidated Report of Cases treated during the year.

FEVERS. 1

AGE. 1

SEX

5
o

83

39

122

Q

2
1

3

OTHKR

D

ISEASES. 1

2
to
E

E
a

1

c
S

17
10

27

tc

c
o

;j

5
1

6

3

3
C

O

6
2

8

o

14

1

!15

o
o

o

i

15
13

28

5

_o

c

CO

11

8
19

o

o

7
4

'1

1

2
7

\

69

13
E

33
20

53

2
4

6

1

CD

5

5
2

7

3
3

1

i

c

2

2

4

2

1

3

>->

1
1

o
2

z
5

4
4

c

c
ce
_^

2

a;

1
2

3

S9

2
2

Whites,
Blacks,

4 51
I 26

19 12
10 1

2
O

Total.

5

77

29

13

160

It will also be discovered that the number of cases of Inter-
mittent fever is greater than the sum of all the other varieties
put together a rather unusual circumstance with us according
to our experience. In fact the type of all the varieties of peri-
odical fever, throughout the fall, were decidedly intermittent,
and much more easily managed than they have heretofore been
in seasons of epidemic visitation, but few deaths having occur-
red, and these for the most part as the result of sheer neglect
on the part of those afflicted, their friends, or attendants.

The symptoms characterizing the different varieties of fever
as seen by us, differed in no essential particular from those laid
down by the various writers w'ho have described them, with
the exception of a decidedly greater determination of blood to
the brain than usual, running in children, sometimes into coma,
or convulsions, but most frequently the latter. We will, there-

522 Harris, on the Diseases of Wetumpka. [September,

fore, on the present occasion, not weary your patience with a
detail of them.

The first clearly marked case of malignant intermittent or
congestive fever that fell under our observation, occurred in the
person of a lady, a resident of this city, on the 23d of June, and
terminated in the course of seventy-two hours in coma and
death. She had been subject to occasional attacks of simple
intermittent for some time previous. And the last case on the
1st of October, in the person of a negro woman, the property
of Mr. P., of West Wetumpka. This case also terminated in
death; and being of the comatose variety is herewith detailed,
and is as follows :

Case. Caroline, aged 18 years, attacked on the evening of
the 1st of October, about 7 o'clock, with a chill, succeeded in
the usual length of time with febrile reaction. During the fore-
part of the chill, she sang, whistled and made strange noises,
becoming, however, towards its conclusion, rather comatose.
The next morning she was up, but seemed rather dull; her
tongue coated down the centre with a dark brown fur, bowels
costive ; in other respects apparently but little the matter. On
the morning of the 1st (we afterwards ascertained) she ate a
large quantity of wild whortle-berries, and some raw chestnuts.

On the morning of the 2nd, Mr. P. gave her a dose of Cooke's
pills. About 10 o'clock this day she threw up, by vomiting, a
large quantity of ropy grass-green bile, and complained of vio-
lent pain in the head and breast ; skin rather cool ; pulse feeble.
Mrs. P. applied a mustard plaster to epigastrium, after which
she ceased to vomit, and fell asleep. In this condition she re*
mained until near sun-down, when her master attempting to
arouse her for the purpose of giving her a dose of calomel,
found to his astonishment that he could not do so. Dr. B. being
on a visit at Mr. P.'s, was invited to prescribe, and finding her
slightly convulsed, with a quick corded pulse, bled her xxiv 5.,
and attempted the administration of the calomel ; in the latter
he however failed. After the expiration of several hours, Mr.
P., observing no perceptible improvement, had me sent for.
On arriving, we found her lying upon her back, breathing easy,
22 respirations to the minute; pulse small and frequent; skin

1.841).] Harris, oji the Diseases of Wetumpka. 523

of the extremities cool, with rather warm perspiration about
tfie face, neck and breast ; coma complete and profound ; bow-
els not moved by the pills ; swallows with great difficulty and
with danger of strangulation ; eye-lids half closed ; pupils con-
tracted ; eyes not fixed, glassy, or suffused, but slightly yellow ;
with violent pulsations in the arteries of the neck and temples ;
head moderately cool. Ordered, dry heat to the extremities,
and 4 grs. of quinine every three hours until morning ; 20 grs.
of calomel to betaken, if she ever gets into a condition so that
she can swallow.

October 3d. Swallowed with great difficulty, through the
night, three portions of the quinine, and at sun-rise about half
of the calomeL No action as yet from the bowels ; pulse full
and frequent ; skin warm ; in other respects the same. At-
tempted the administration of the calomel, but failed. 10
o'clock, A. M. Extremities growing cold, and breathing becom-
ing rather laborious ; pulse small and quick ; tossing about of
the arms ; grinding of the teeth, and frothing at the mouth.
Gave 40 gutta of laudanum, and applied large mustard plas-
ters over epigastrium and abdomen ; sinapisms to the extremi-
ties, and cold applications to the head. Afternoon. No im-
provement. Gave, with great difficulty, two capsules of castor
oil, and directed cold applications to the head to be continued.
8 o'clock, P. M. No alterations in symptoms ; no action from
the oil capsules ; abdomen tumid and tense. Clysters to be
given until bowels are moved.

4th Morsiing. Clysters returned with a small admixture of
bile, and a large quantity of partially digested berries ; one or
two alvine evacuations afterwards of the same character ; stu-
por equally as great when spoken to very loudly seems to
recognize the sound by turning the eyes in the direction of the
speaker. Applied blisters to the ankles and down the spine
the one down the spine two inches wide and ten inches long.
At my noon, evening, and night visits, could perceive no mate-
rial alteration. Blisters drew well.

5th Morning 8 o'clock. No perceptible improvement since
last night. Gave pill of calomel 10 grs. Noon. No alteration.
Repeated pill of calomel. 8 o'clock, R M. No action as yet on
the bowels patient growing rapidly worse, unable to swallow

i24 Hariis, on the Diseases of Wetumpka. [September,

any thing; still warm; head cool; pulse thread-hke and very
rapid ; breathing laborious and intermitting. Applied large
blister to epigastrium, and failed in an attempt to give 30 drops
of laudanum. From this time she continued to grow gradually
worse, until near day-light, when she calmly expired.

In this case, hopeless from the comm nceiuent, we cannot but
be forcibly struck with the great tenacity of life, under such
nnahgnant symptoms.

As regards the further management of the other varieties of
congestive fever, we would say that, when called during the
chill, our first effort was always to get the patient out of this
stage as soon as possible ; and for this purpose we resorted to
the external application of dry heat, frictions to the extremities
and over the surface, and sinapisms and blisters to the epigas-
trium, extremities and spine, aided by the internal administration
of the most powerful stimulants. This desirable end accom-
plished, the prevention then of the recurrence of the chill, was
essayed by the liberal internal administration of quinine.

In the treatment of the other varieties, our prescriptions were
always made, and remedies given, for the purpose of relieving
urgent symptoms, and warding offthose in perspective. In the
continued and remittent types, in the plethoric and where there
was much local pain, the lancet, at the commencement of the
attack, was sometimes employed, and, under such circum-
stances, frequently with advantage. Where there was much
hepatic devsingement, calomel was given for the purpose of dis-
gorging the liver, and removing locaJ congestions; and for these
purposes it stands, as it must continue to do, unrivalled. This
remedy, according to the urgency of the symptoms, was re-
peated daily, or every other day, for several times in succession,
or until the reasons for its further administration ceased to exist.
In the latter variety, as soon as a very clear remission took
place, the administration of quinine in 4 or 6 grains doses, at
intervals of two or three hours, was commenced, and continued
for several times in succession, under the hope that a solution
of the febrile symptoms might take place; and we are gratified
that we have it in our power to state ^//^^^//z^T/rffr, the practice
in our hands was attended with much better success than it has
ever heretofore been.

1849.] Harris, on the Diseases of Wetumpka. 525

There sometimes appears in ihis locality a form of intermit-
tent fever, denoniinated suh-intermit ; ami in which there is an
entire absence of the sweating stage the patient going directly
out of the cold stage into the iQ'vev, and out of this again into
the chill. In this variety, a few doses of quinine of the ordina-
ry size, and admin'stered in the usual way, before the expected
cold stage, breaks up the paroxysms with as much certainty,
and as completely as in any other variety.

The month of December will be long remembered by the citi-
zens of this city and its vicinity, for its high temperature and low
range: there not being, from the 4th to the 28th, scarcely two
days in succession cold enough to justify the killing of hogs.
This warm, moist state of the atmosphere, exerted also a most
unfavoiable influence upon the health of our citizens ; bowel af-
ections and gastric irritation being unusually prevalent. On the
26th of the month, there being several cases of cAo/er^ reported
on board the steamer Montgomery, then discharging freight at
our wharf, and direct from the port of Mobile, where the dis-
ease was said to be epidemic, caused our city authorities to
appoint a board of health. On the 27th, said board made the
following communication :

"In view of the actual existence of epidemic Cholera on our
borders, and in obedience to a resolution of your body asking
information on this subject, beg leave to report That they be-
lieve the disease to depend, to a considerable extent, upon at-
mospheric alterations of the locality where it prevails, and
therefore, not contagious ; and for the purpose of preventing a
visitation, or in that event, should we be so unfortunate, mitiga-
ting to as great an extent as possible its violence ; recommend
the adoption of every means that are in the least calculated to
purify the air, such as the immediate and thorough cleansing
of the entire city, by the removal and, wherever practicable,
total destruction, by burning or otherwise, of all decaying ani-
mal and vegetable matters that all ravines, ditches and cellars,
be thoroughly drained and dried, and that the doors and win-
dows of all unoccupied buildings be thrown open for the purpose
of ventilation ; and that fires be built at least once a day in all
rooms that have fire-places. That the citizens generally be
requested to use lime freely about their premises, and co-operate

526 Pendleton, on Diseases of Hancock Co. [September,

with the city authorities in carrying out the Hygienic recom-
mendations of the board of health.

" They would also recommend that our citizens be admonish-
ed from going, through idle curiosity, on board of steam-boats
that may land at our wharves from known infected regions ;
and that the crews of said vessels be forbidden from leaving
said wharves, or mixing promiscuously with our citizens."

Fortunately, a few days after this report was made a change
took place in the weather, and with this change fled the terror
of our citizens from an immediate visitation from this oriental
scourge.

Having now, Mr. President, finished our report, in which
we have endeavored to present more an outline of the treat-
ment and phases of disease in general, than a critical account
of any one in particular; and in submitting it (sensible, as we
are, of its many defects) to the consideration of the association,
permit us to say, that we feel at least a consciousness of having
discharged our task, to the best of our ability, and an assurance
that our labors will receive at their hands, that reward to which
they are entitled.

ARTICLE XXVIII.

Statistics of Diseases of Hancock County. By E. M. Pendle-
ton, M. D., of Sparta, Georgia.

In this number I propose to give a table of specific diseases,
which I hope may not prove wholly uninteresting to your read-
ers. Although the numbers of each are small, it will serve to
give some idea of the general prevalence of specific disease in
the middle region- of Georgia.

1st. Those

of the

Digestive System.

Diarrhcea, - -

- 55

Cholera Morbus,

16

Gastric fever, -

- 55

Hepatitis, . . - -

13

Colic, - . . .

- 39

Irritable Stomach, -

9

Worm fever, - -

- 37

Constipation, - - -

5

Dyspepsia, - -

- 35

Hematamesis, -

4

Gastritis, - - -

- 30

Cardialgia, - - -

4

Dentition, - -

. 26

Hemorrhoids, - -

o

Dysentery, - -

- 25

Prolapsus Ani, - -

2

Gastro-cntcritis, .

. 19

1849.] Pendleton, on Diseases of Hancock Co.

527

Some of these, it may be observed, are more symptoms than
diseases ; but where there seems to be a difficulty of defining
the exact disease, I have put down the leading symptoms as
Irritable Stomach.

Gastric fever, which numbers so high, embraces a class of
disease recurring mostly in children, attended with high fever,
generally remittent, without inflammation, and evidently de-
pending upon noxious substances introduced upon the .delicate
gastro-intestinal mucous membrane such as, fruits, chestnuts,
chinquepins, &:c. For a better name, I class it under this gen-
eral term.

Catarrhal fever,
Influenza,

Pneumonia, -

Catarrh, - -

Bronchitis, .

Pleurisy, - -

Asthma, - -

2nd. Respiratory.

54
37
26
24

18
9
8

Hooping Cough, -
Haemoptysis, - -
Croup, - - - -
Hydrothorax, - -
Phthisis PulmonaHs,
Laryngeal Consumption,
Catarrhal Consumption,

3rd. Diseases Peculiar to Women.

Parturition, ... - 55
Plethora during gestation, 26

Threatened Abortion, - 19

Dysmenorrhoea, - - 13

Abortion, - . . . H

Uterine Hemorrhage, - 10

Prolapsus Uteri, - - 10

Amenorrhcea, - - - 9

Menorrhagia, ... 9

4th. Brain
Convulsions, - -
Epilepsy, - - -
Nervous Head-ache,
Spinal Irritation, -
Neuralgia, - - -
Lumbago, - - -
Apoplexy, - - -
Delirium Tremens,
Catalepsy, - - -

and
13
7
11
6
5
4
2
2
2

5th. Exenthemata,
Urticaria, .... 16

Herpes, 10

Erysipelas, .... 8
Eruptive Reumatic fever, 6

Hysteritis, - - -

Peritonitis, - - -

Leucorrhoea, - - -
Puerperal Convulsions,

Attached Placenta, -

Excessive Lochia, -

Irritable Uterus, - -
Prurigo Pudendi,

Nervous System.
Hemaplegia, -
Tic Dolereux,
Insanity, - -
Tetanus, - -
Hydrocephalus,
Arachnitis.
Hysteria, - -
Partial Paralysis,

and Skin Diseases.
Scabies, . . - .
Varicella, - - -
Tenia Capitis, - -
Roseola, . . . .

588

Pendleton, on Diseases of Hancock Co, [September,

Scarlatina,
Red Gum,

Measles, -

Eczema, - -

Herpes Zoster,

Strangury,

Gonorrhoea, - - - . 5

Syphilis, 4

Nephritis, 4

Cystitis, - - - . . 4

Retention of Urine, - - 3

6th. Urinary Organs.

8 i Incontinence of Urine, - 3
Calculus, ----- 3

Paraphymosis,
Irritable Bladder,
Varicocele, - -
Impotence,

7th. Visual Organs.
Opthalmia, .... 18 Amaurosis, - - - -
Ectropium, ... - 1 Inflammation of Eyelids,

8th. Heart.
Hypertrophy, - - - - 1 | Palpitation (functional),

9th. Surgical Cases.

Contused Wounds,
Abscess, - -
Ophthalmia, -
Incised Wounds,
Furunculus, -
Burns, - - -
Whitlow, - -
Tongue-tie,
Distorted Spine,
Fracture of lower Jaw,
Dislocation of lower Jaw,

10th.
Intermittent fever, - -
Bilious Remittent, - -
Congestive fever, - - -

Periodic fevers, - - .

29
24

18
14
8
5
3
3
2
1
2

Fracture osFemoris, - -

Necrosis, -

Gun-shot Wound, ....
Dislocation metatarsal bone of

thumb,

Rupture of ligaments of 3d and

4th cervical vertebrae, - -
Dislocation Shoulder-joint, -
Fracture of OS Humerus, - -
Fracture of Clavicle - - -

Idiopathic Fever

128

52

9

181

Common continued,

. 18

Inflammatory, 18

Continued fevers, - - - 36

The physician who has attempted to classify all the cases
that present themselves to him, will readily overlook any seem-
ing failures in the above table. There are many cases present-
ing such a complication and diversity of character, that we
either have to take their most prominent symptoms, or leave
them out altogether. We have generally pursued the latter
plan. There are others, where an individual is subject to re-
peated attacks of the same disease, and to put down every case
would run up the number to a high point, as in Epilepsy and
Rheumatism, Diarrhoea, &c. We have generally in such in-
stances marked them down as only one case.

1849.] Pendleton, on Diseases of Hancock Co.

529

We propose now to give a table of the fatality of the above
cases, with some other facts connected with it :

1st. Respiratory System.

Tubercular Consumption,
Acute Bronchitis, - -
Catarrhal Consumption,
Hooping Cough, - - -

2d.
Diarrhoea from teething,
Hematemesis, - - -
Gastro-enterite, - - >
all from ardent spirits. \

Pneumonia, -
Catarrhal Fever,
Hydiothorax,
Croup, - -

5

Digestion,

Hepatitis, -
Worm fever,

4

1
1
1

712

2
1

311

3d. Diseases peculiar to Women,

Puerpural Convulsions, 3
Uterine Hemorrhage, 2

Acute Hysteritis,

4. Brain and Nervous System.

Convulsions from Teething,

Rachitis,

Scarlatina,

Cancer of Breast, . . - -
Fracture of Vertebrae, - -
Hypertrophy, . . . . -
Dry mortification of foot, subse-
quent to amputation of toe.

Arachnitis, - -
Delirium Tremens,

Continued fever, - - .
Eruptive Reumatic fever,
Acute Cystitis, . . - -
Fungus Hsematoides, - -
Old Age, - - . - .
Unknown, . - - - .

Of these deaths, 18 occurred in the winter months, 9 in the
spring, 6 in the summer, and 11 in the autumn, showing a great-
er tendency to mortality in the cold than in the warm month.
There were 20 males to 26 females, and 26 whites to 20 blacks,
and 33 adults to 13 children. Of the 5 deaths from brain and ner-
vous system, 4 were children; of the 11 digestive organs, 5
were children ; respiratory 3, and exanthemata, 1 showing a
large per cent, of the nervous and digestive system over every
other in the mortality of children.

The ratio of the mortality of the different classes of diseases,
stands about as follows : Of the digestive system, 2.58 per cent.

N. S. VOL. V. NO. IX. 34

680 Pendleton, on Diseases of Hancock Co. [September,

die ; of the respiratory, 4.93 per cent. ; of diseases of women,
3.43; of the brain and nervous, 5.16; exanthemata, 2.85;
idiopathic fevers, 0.44 per cent, or 1 out of 225; urinary, 2.70,
&c., &:c. showing diseases of the brain and nervous system to
be more fatal than any other ; respiratory next ; diseases of
Avomen next then the exanthemata, urinary, digestive, and
idiopathic fevers, in regular succession. Other classes of dis-
ease, as articular, visual, osseous, and abscesses, are rarely, if
ever, fatal ; while others are almost universally so, as organic
diseases of the heart, cancers, &c.

How can we account for there being more disease in the
warm than cold months, while the mortality is decidedly worse
in the latter. Thus, in the winter months, out of 312 cases,
there are 18 deaths, or 5.77 per cent. ; the spring, out of 376,
there are 9 deaths, or 2.37 per cent.; summer, out of 447
cases, there are but 6 deaths, or 1.32 per cent. ; and in au-
tumn, out of 482, we have 11 deaths, or 2.49 per cent. show-
ing the mortality of disease in winter, over summer, as more
than four to one, according to the number of cases. This is a
curious fact, and deserves further investigation. If stiil sus-
tained by a greater mass of cases, it may throw some light upon
the comparative capability of a warm and cold atmosphere to
sustain human life. It seems to carry out the truth of the adage,
that " old people always die in the winter," as well as the sta-
tistics of this country, which teaches that we have more cen-
tenarians in the Southern than in the Northern States.

We will note the ratio of mortality of a few leading specific
diseases, and close this number. Thus, diarrhoea is 7.27 per
cent. : this includes all the cases of the fatal summer complaint
of children. Inflammation of stomach and bowels 6.12 per
cent. It is a singular fact, that every fatal case of this class
was superinduced by ardent spirits. Such constitutions suc-
cumb much easier to disease than others, and show a greater
resistance to the curative powers of agents. In hepatitis, the
deaths are 15.38 per cent., being a very fatal form of disease;
and what is singular, pneumonia presents exactly the same
ratio. Bronchitis, 5.55 per cent., whooping cough, 16.66, and
croup, 25 per cent. ; but in these two last instances there is no
lest as to the mortality, as but few now employ physicians in

1849.] Pendleton, on the Diseases of Hancock Co 531

these diseases, unless in very bad cases, having learned to treat
them themselves. In uterine hemorrhage, the fatality has been
20 per cent. Every case of puerperal convulsions died, being
only three ; but this is a mere coincidence, as I have had the'
same number the present year, and but one has died. I have
always found it, however, one of the most fatal forms of disease,
with a mortality of some 50 per cent. Out of 36 cases of con-
tinued fever, embracing typhoid, common continued and in-
flammatory, but one died, being 2.77 per cent. ; this I conceive
to be much below the average of this malignant type of fever.
Out of 189 cases of periodic fevers, there is not a single death,
being 52 of bilious, 9 of congestive, and 128 of intermittent.
This is truly gratifying, when we take into the account the
dreadful mortality of these forms of fever some twenty or thirty
years ago, in this region of country. This is doubtless owing
to the decrease of morbid causes constituting a less malignant
disease, as well as, in a great measure, to the improved methods
of treatment. Formerly it was calomel and tart, emetic, in
heroic doses, with drastic purgatives, and no water to drink,
which, of itself, was enough to kill most of the patients, without
fever. Now, the gentle alterative and anti-periodic treatment,
with particular reference always to the protection of the deli-
cate mucous membrane of the alimentary canal from lesion,
will cure nearly every case through a series of years. To no one
so much as the immortal Broussais is modern medicine indebt-
ed for the rapid strides it has made in curing disease, and the
subduction of our tables of mortality. With reference to my
own tieatment of periodic fevers, I think it proper to state that
I am not a quinine practitioner, in the modern acceptation
of that term. 1 do not always give it in intermittent fevers,
rarely in bilious remittent, and never in continued fevers.
When I do give it, it is for its therapeutic agency in equalizing
the circulation as atonic stimulant, not for any supposed speci-
fic effect that it may have sedatively upon the nerves ; conse-
quently my doses are small, in comparison with the heroic
treatment of modern times, and I think my fever book will show
advantageously, in comparison with any who pursue a different
course.

The whole ratio of deaths being 46 out of 1614 cases, is 2.84

532 Word, on Mammary Abscess. [September,

per cent. And here it is proper to state, that every case I saw,
and some I prescribed for without seeing, is included. In sev-
eral instances the patient was moribund, and beyond all hope.
The only case of continued fever that died, I was called in
consultation, but my prescription (a venesection) was refused
by the patient. He died in two or three days after, without
submitting to my treatment, in any way ; but still, to carry out
a universal rule, I have assumed the responsibility in my tables
of statistics, and so of other cases.

ARTICLE XXIX.

Mammary Abscess treated by Hydriodate c/f Potash, By
Robert C. Word, M. D., of Cassville, Georgia.

Every experienced practitioner must have met with obstinate
cases oi mammary abscess cases which resist every method
of treatment, and which continued sometimes for months, at-
tended with gi'eat suffering and with serious impairment of the

general health. Such was the condition of Mrs. with her

first child. Evidences of abscess were apparent soon after the
usual period for the formation of milk, and despite every effort
suppuration came on about the 10th day. The bi'east was
punctured, and a larger quantity of pus flowed from the orifice.
This gave rehef for a few days, but it was not long until another
portion of the gland became indurated, and proceeded rapidly
to suppuration. Other portions of the gland also suppurated
and required lancing. The breasts were dra^m as often as
practicable. General and local antiphlogistic treatment and
all the usual remedies were resorted to, with only occasional
and partial relief. In one mamma there seemed to be small
sinuses opening in different directions, similar to a variety of
the disease described by Mr. Hey, and for which he recom-
mends deep incision. Both mammae finally became involved.
The treatment recommended by Hey, was not tried, being
deen>ed too severe ; and besides, the patient being exceedingly
nervous and timid, would not submit to it. The following
treatment was finally advised: 4 ^v^. iodide potassium, m solu-
tion, three times daily. To use, as a local application, the

1849.] Eve, on Amputation at Shoulder-joint. 533

ungt. iodini; the milk to be occasionally drawn with a glass,
and the diet to consist solely of bread and water. In two days
relief was apparent, and the patient proceeded rapidly to re-
cover, and in a few days was able to attend to her ordinary
avocations. The remedies were continued nearly three weeks,
when all signs of soreness having disappeared, and the abscesses
having healed, they were withheld. Three months have since
passed away, and the lady is now suckling her child with no
inconvenience.

The writer is not aware that this treatment has been used
before in mammary abscess, though it would seem very natural-
ly to suggest itself in the treatment of this, as in other, glandular
affections.

ARTICLE XXX.

Successful Amputation at the Shoulder-joint the joint anchy-
losed patient under chloroform. By Paul F. Eve, M. D.,
Prof, of Surgery in the Med. College of Georgia.

The last of June, a boy about eight years old, belonging to
Gen. Taylor of Early county, was sent to me by Dr. Reese of
Athens. Six months before, he had sustained from a fall, a
compound comminuted fracture of the right arm. There was
now existing an enlargement of the whole length of the hu-
merus ; a stiff shoulder-joint ; two fistulae, one about the inser-
tion of the deltoid muscle, and the other at the head of the bone ;
a probe would pass, as it were, through the shoulder-joint, and
in the direction of the bone, encountering rough or denuded
surfaces ; from both openings there was a pretty copious dis-
charge of ill-conditioned pus.

The propriety of an operation having been decided upon in
consultation, and the patient placed under chloroform, an incision
from the acromion process of the scapula was made through
the deltoid muscle down to the bone, laying open freely the
upper fistula. The humerus thus exposed was felt extensively
involved in the disease (necrosis,) and according to previous
counsel, amputation at the shoulder-joint was now attempted.
In performing this, an unexpected difBculty occurred this was

584 Expulsion of an Iron Fork per anum. [September,

encountering an intimate union of the head of the bone to the
glenoid cavity. In the effort to disarticulate at the joint, it was
found that the knife did not and could not be made to pass
around the upper extremity of the humerus the joint was then
attacked from the opposite side, but with no better success.
Having confidence in the knife (English), the original position
was resumed, and the head of the bone was cut through, leav-
ing the part above its anatomical neck in the glenoind cavity
of the scapula. This was now carefully dissected out by a
scalpel, the bond of union being intimate and complete through
the intervention of what was supposed to have been fibrin or
the plastic matter of the blood. The knife passed through what
originally was the epiphysis of the bone, and its edge was un-
injured.

The whole humerus was found necrosed, the old bone was
confined in an effort of nature to form a new one. The seques-
tra could only be removed by extensive incisions and forcible
eflTorts, and the bone presented throughout a worm-eaten aspect.
It was not a part, but the whole of the bone, which was diseased.

The boy had a good recovery, leaving for home in the cars
a week after the operation.

PART II.
Hct)ltus anb ^xixati^.

Expulsion of an iron Fork per anum, twenty months after
having been swallowed. By M. J. B. S. Chemin. (Trans-
lated by Henry Rossignol, M. D., of Augusta, Ga.)

On the 15th Mny, 1847, I was called to M. Houe, farmer,
aged 32 years. In endeavoring to extract a bone from the up-
per part of the oesophagus, he had swallowed an iron Fork
coated with tin. It was five inches in length and about one
in width.

The bone was. scarcely arrested, when deglutition became
very difficult ; there was immediately a sharp pain felt about the
middle of the sternum ; a sensation of sticking and extreme
uneasiness in this region ; and respiration was anxious. M.
Houe introduced a fork into the oesophagus, with the intention
of extracting or pushing down the foreign body. This at first

1849.] Expulsion of an It on Fork per anum. 535

caused nausea, then such violent efforts at vomiting, that, in his
sufferings he let the fork go, which, after a few attempts at
deglutition, dropped into the stomach.

Becoming very uneasy about his situation, he went to Paris,
hoping that the fork might be withdrawn from the stomach.
He consulted M. Yelpeau among others, who removed his fears,
by telling him that no bad effects would follow the accident,
and that it would be expelled, sooner or later, through the natu-
ral passages, without the necessity for an operation.

On his return home, he sent for me. I found him less uneasy
in mind ; but nevertheless he experienced great sufferings, par-
ticularly after eating or drinking. He is occasionally troubled
with nausea ; water rising frequently and abundantly to the
mouth. The fork is believed to be in the larger end of the
stomach, the teeth turned to the left side. It continued in this
position fifteen days, then passed towards the pylorus, w-here it
remained nearly four months. During this time, there was
vomiting of black matter several times during each day. The
mouth is continually filled with an aqueous fluid ; excessive and
incessant suffering ; epigastrium very tender ; pulse normal ;
tongue moist; no appetite; sensation of drawling about the
stomach ; impossibility of supporting the least food.

At length the fork passed the pylorus, and went through the
small intestines in six weeks, and stopped for thirteen months
at the ileo-coecal valve.

During the passage of the fork through the small intestines,
the pain was sharp and intermittent; impossibility of lying up-
on either side ; walking and the slightest movements occasioned
pain, and produced a sensation resembling pricking of needles.
In the morning, M. Houe can, by palpation, feel the fork dis-
tinctly with the hand ; he has great difficulty on going to stool.

After remaining five months in the right side, the fork began
to dissolve. At this time, M. Houe experienced severe colics
and passed matter of a black and brick-dust colour ; continual
constipation ; abdomen much distended and very sensible to
the touch ; acute pains in the hypochondriac regions : violent
colics; disgust; headache ; sleeplessness ; pulse natural ; emis-
sion of urine frequent and painful; right testicle swelled. For
the next eight months, constipation and diarrhoea alternately ;
colics less violent ; blackish, stercoracious matter ; abdomen
tender ; thirst great. (M. Houe consulting his taste only, drank
from five to six litres of wine daily, and at breakfast thirty
grammes of aniseed cordial to expel wnnd.) Appetite very
great ; an incessant desire of eating, (five to eight pounds
of food per day, without satisfying the appetite.)

The patient nevertheless resumed nearly all of his former

536 Injluence of Tea and Coffee upon Health, [September,

occupations, and recovered his strength. Towards the 10th of
December, 1848, Houe experienced such violent colics and
weakness, that he was near dying.

1 was again called. On my arrival, I found the abdomen
distended ; a dull and deep pain was felt in the right iliac fossa ;
obstinate constipation for some weeks past ; tongue moist ;
pulse natural. After taking 60 grammes of castor oil, which
caused a large evacuation, he was relieved. From this period
he has not suffered, believed himself rid of the fork and con-
tinued his ordinary occupations.

At length, on the 8th February, 1849, twenty months after
swallowing the fork, M. Houe suddenly experienced pains in the
lumbar region and a desire to go to stool. Stool copious, com-
posed of bloody fecal matter, in which M. Houe found a large
portion of the fork. It was the portion between the handle
and teeth.

He is now perfectly well, and experiences no inconvenience
whatever.

The treatment consisted of flax-seed tea, cataplasms, emollient
injections and laxatives, (castor oil.) Med. Gaz. of Paris.

On the Influence upon Health by the Introduction of Tea and
Coffee in large proportion into the Dietary of Children and
the Labouring Classes. By Samuel Jackson, M. D., Prof,
of the Institutes of Medicine in the University of Pennsylva-
nia. (American Journ. of Med. Sciences.)

Tea and Coffee enter more largely into the diet of the people
of this country than into that of any other. The ordinary
breakfast and supper of thousands of persons in every part of
the United States, are tea, cofiee, and bread ; while tea, bread,
and potatoes, with occasionally a modicum of meat, constitute
their dinner. Even children, as soon as they are able to sit at
meals, are habitually placed at the family table, and allowed to
partake of the same food as adults.

In the poorer classes, the evil of a common diet for all ages
cannot probably be avoided. It is one of the causes productive
of the greater mortality of the children of the poor. But this
injurious practice, which with the poor is to be regarded as an
inevitable misfortune, is followed by those who are placed in
circumstances above the necessity of it. In them it is most
condemnable, and can be excused only on the plea of ignorance.

The classes in which the kind of alimentation alluded to
prevails, are female teachers, seamstresses, factory women,
weavers, tradesmen, small retailers, clerks with families, and

1849.] Injluence of Tea aad Coffee upon Health. 537

others living on restricted means, and very generally farmers
in the country. [Not true of farmers at the South.] Edt.
M. and S. J.

The inducement for its adoption is its economy, as to money,
time, and fuel a meal of coffee, or tea and bread, or the addi-
tion of potatoes, for a small family, will not cost beyond a few
cents, while it requires but little fuel and a very short time for
its preparation. Tea and coffee are, besides, very palatable,
produce temporary exhilaration and force, and abate hunger.
Coffee, as will be shown, is not devoid of some nutritive pro-
perties. Ostensibly answering, in this manner, the purposes of
food, tea and coffee have, from the considerations of cheapness
and convenience, become the substitutes of more substantial
diet.

In this country and England, chiefly, tea and coffee are intro-
duced into the daily meals as aliment. In China, tea is used as
a refreshing and cordial beverage, presented to visitors, or
drunk between meals; in the East, coffee is regarded in the
same light, and employed in the same manner ; on the conti-
nent of Europe, coffee is extensively used, but more as a cordial
drink, or to flavour cream and milk, than as aliment.

In prosecuting this inquiry with a view to the effects on the
economy, of tea and coffee, some preliminary matters require
previous examination.

Every one know^s that food is indispensable to life. But what
is this connection between them ? How is it that food is an
indispensable condition of life? The solution of these questions
is necessary to the understanding of the nature and objects of
food, to determine the value of any alimentary articles, and to
settle the pretensions of any substance for a place in the cate-
gory of food.

Before examining the relation existing between food and life-
action, it is important to obtain an accurate idea of what is life,
or organic action. This term we limit to a single series or
class of phenomena. These phenomena are the evolution or
production of specific organizable matter, and definite organic
forms, from a primary formless organic substance. Albumen
is that substance in man and the higher animals. All other
phenomena are excluded. They are subordinate to, depend
on, but are indispensable to maintain life-action.

Organized tissues and organs worked out by life-action, are
the instruments of life. They differ widely from each other.
Each has its special office. The phenomena of each are
special in character and purposes. They are the same as
similiar phenomena in the exterior and inorganic world. They
can be properly understood and studied only in their connexion

538 Influence of Tea and Coffee upon Health. [September,

with those phenomena. Some are chemical, as the transforma-
tion of abdomen, the processes of digestion, secretion, and the
oxidation of carbon and hydrogen in the blood producing
animal heat. Others are physical, as the capillarity of tissues,
imbibition, endosmose, atmospheric pressure, and Graham's
law of the diffusion of gases, in respiration ; others are
dynamic, as the excitor, motor, and other forces of the nervous
system ; others, again, are purely mechanical, as the actions of
the muscular system.

Not one of those is properly an organic or life-phenomenon.
They are indispensable to maintain the condition of the exist-
ence of life, or organic action. They are chemical, physical,
dynamic, and mechanical actions, executed by organized and
living apparatus and instruments, for the objects of life.

The organizable matter and organic forms are the products,
and, consequently, the expression of existing forces or causes
of action. Forces, matter, and form, are indissolubly con-
nected with, and give rise to, phenomena or function ; and,
inversely, function and phenomena, are the correlatives of
force, matter, and form. Organized matter, from its nature,
cannot be persistent. Under normal states, force, matter,
form, and function or phenomena, are permanent; but the
structural material itself is not permanent it wastes, decays,
disintegrates, and is reproduced in every act of life. Life-
action is thus resolvable into two inseparable actions, or links
of one action, a birth and a death, the formation and destruc-
tion of the organic material of our structure.

The supply of the primary organic substance for this inces-
sant renewal and building up of the organized structure and
maintenance of organic forms, is derived from the blood.
This fluid, in its natural state, is a concentrated solution of all
the solids and products of the animal economy. The amount
of azoiized or albuminous compound matter destroyed in
twenty-four hours by life, or organic action, may be taken, on an
average, at two to three ounces.* The blood would rapidly
become impoverished and unfitted for life objects, unless its
losses of albumen and its organic derivatives were constantly
restored. The renewal of the organizable or plastic material
of the blood, and its maintenance in its normal composition, for
structural formation, is one of the offices of our food. Repeat-
ed analyses have demonstrated that, of the aliment that is
adapted to healthy nutrition, one-eighth part only consists of
albumen, or its protein compounds, or their derivative com-
pounds ; and whatever is devoid of those substances that is,
the chemical combination of carbon, hydrogen, nitrogen, and

* Dumas, Chiraie Physiologique el Medical, p. 463.

1849.] Influence of Tea and Coffee upon Health. 539

oxygen, in the proportion to constitute protein (C40H30N5
0,2*) or albuminous compounds cannot perform the office of
food, or be fitted for nutrition.

Another condition, not less indispensable to life-action, than
organizable or plastic matter in the blood, is a definite tempera-
ture. For man and the warm blooded animals, the heat
essential to healthy, vigorous life-action is 98 to 100 F. So
important is heat to life, that nature has made provision for its
constant disengagement in the economy. This is accomplish-
ed by the incessant oxidation of carbon and hydrogen in the
blood. The temperature of this fluid is thus kept at an
equable point in every part of the economy. Every organized
molecule requires, for the exciting and sustaining of its life-
action, the presence of plastic or organizable material, and a
definite temperature.

The blood furnishes both these indispensable conditions of
life-action to each living molecule.

The carbon and hydrogen oxidized in the blood, and in this
manner generating animal heat, are obtained from the food.
Nature has made most ample provision for the supplies of these
chemical elements, by constituting them a large portion of the
food of animals. Not less than from six-sevenths to seven-
eights of the alimentary substances of animals consist of
non-azotized bodies. Fatty, starchy, and saccharine matters,
are of this character ; they are not adapted to or intended for
nutrition, but solely for the purpose of calorification, by their
combustion or combination with oxygen introduced into the
blood by the processes of respiration. This proposition is
demonstrated in the composition of the alimentary portion of
milk. The casein or plastic matter- for nutrition, averages 13
per cent., the calorifacient, or the cream and sugar of milk, 87
per cent.

Temperature is required not only for life-action, but also for
the dynamic forces, and mechanic power and actions seated in
and performed by the muscular apparatus.

The identity of heat and mechanic force has been establish-
ed by M. Joule. t It is expressed in the following formula ; the
heat required to raise one gramme (15 grains) of water one
degree (cent.), is capable of raising 432 grammes (3700 grains)
one metre, or 3^ feet.

According to the estimate of Dumas, the quantity of carbon
consumed by a man in good health (valuing the hydrogen by
an equivalent proportion of carbon), averages from seventeen
to twenty-eight ounces per diem. The large amount of heat

Mulder. t Comptes Rendus, tome xxv., p. 209.

540 Influence of Tea and Coffee upon Health. [September,

thus disengaged, is the sum of the dynamic or excito-motor
force of the nervous system.

By the estabhshment of the above facts, we obtain precise
ideas of the nature of food, its objects in the economy, and the
modes of its operation. We are enabled to say with certainty
what substances are or are not food ; and to fix the relative
value of each article of diet.

From these investigations, it is ascertained that alimentary
substances form two distinct classes, differing from each other
by the most striking diversities of nature, composition, and
operation.

The first class are the protein or albuminous compounds.
They have nearly the same chemical composition as the tissues,
are isomeric with many of the immediate organizable materials
of animal structure, and are exclusively destined to nutrition
proper, or the reconstruction and repair of the solids.

No substance in which this especial chemical composition,
protein and its compounds do not exist, can belong to this class,
or can be employed in the economy for its nutrition. Some of
the most eminent oi'ganic chemists and physiologists appear to
suppose, that any organic nitrogenized body may answer for
nutrition. This is not so. Morphia, quinia, strychnia, urea,
taurine, as well as theine, and caffeine, are organic nitrogenized
bodies, yet cannot be ranked as food. It is the possession of
the specific combination of which protein is the base, that can
alone entitle any substance to rank in this class.

The second or calorifacient class of aliment, comprehends
those special chemical compounds, hydro-carbons mostly, that
are capable of prompt decomposition into carbon and hydrogen
in the blood. No other 'organic substances, though rich in
carbon and hydrogen, are capable of entering into this division
of aliments.

The normal substances of this kind are glucose and lactic
acid, into which saccharine and amylaceous substances are
converted by the process of salivary digestion ; and fatty mat-
ters, modified and reduced to the finest and minutest particles
possible, in the emulsion formed with them by the pancreatic
and biliary secretions.

This last class is the more immediately connected with the
maintenance of life. It is established by the experiment of
Chossat,* that death from starvation does not occur from inani-
tion, or the waste of the organs, but from the cooling of the
blood, from the absence of the carbon and hydrogen requisite
to carry on the process of combustion and the generation of
caloric.

* Recherches Experimentalcs sur I'lnaniiion, Paris, 1843.

1849.] Injluence of Tea and Coffee upon Health. 541

With the preceding facts ascertained, we can now proceed
to investigate the claims of tea and coffee, to be regarded as
properly belonging to either of the above classes of food.

Theine and caffeine, according to Liebig, are the essential
elenaents of tea and cofllee. The two are identical as to chemi-
cal equivalents. The formula for each is CgjHjjNajOg. M.
Payen, in a later and more elaborate examination, gives a some-
what diflJerent formula, but not such as to vary their properties to
any extent. Liebig considers them as closely approximating to
alloxan, C8,H4,N2,Oj, a principle obtained from urea, by the
action of concentrated nitric acid; and to taurine (C4,H8,
NOj J, a principle which may be obtained from ox bile, but
not from human bile.

In this view, tea and coflfee must be excluded wholly from the
classes of aliments, to which theine and caffeine can have no
pretensions.

But M. Payen, in 1846, in a communication to the Academic
des Sciences,* presented a highly laboured and accurate exam-
ination of the proximate constituents of coffee, which unques-
tionably brings it, at least, into the category of aliments, as it
contains the constituents of both classes.

The following is his analysis of coffee : f

Cellulose

Fat substances - . - -

Glucose, dextrine, and an indeterminate
vegetable acid . - - -

Legumin, casein (gluten)

Chloroginate of caffeine and potassa

Azotized organic matter

Free caffeine _ - _ -

Insoluble concrete vegetable oil

Fluid aromatic essence of sweet odour,

and a less soluble acrid aroma - 0.002

Mineral substances, potassa, lime, magne-
sia, phosphoric, sulphuric, silicic acids,
and a trace of chlorine - - 6.697

Water 12

34

10tol3

15.5
10

3.5 to 5
3

0.8
0.001

100

From this comparison of coffee, it is evident the grain is
endued with nutrient or plastic and calorifacient elements, and,
consequently, is an aliment ; yet the proportion of those ele-
ments is not sufficient to place it in a high rank in either class,

* Comptes Rendus, Tomes xxii., xxiii., 1816.
t Comptes Rendus, Tome xxiii . , 1'. 219.

542 Injluence of Tea and Coffee upon Health. [September,

or to justify the substitution of its infusion as a chief material of
food, by those who are engaged in active and laborious pur-
suits.

But when the quality of the weak infusion almost generally
used as food, and the consequent very small proportions of the
alimentary elements held in solution in it are taken into consid-
eration, the disparity between the waste of the blood and the
elements for its reparation contained in coffee, become striking-
ly displayed. The ordinary coffee of the laboring and indus-
trious classes, is little more than warm water colored and
aromatized by coffee. It contains but a very small portion, if
any, of the nutritive and calorifacient elements. It is impossi-
ble, with such diet, to maintain in the blood the two indispen-
sable conditions of life-action and nerve-force, organizable
material and heat.

Coffee, to be prepared as food, should be first but slightly
roasted, merely browned and rendered crisp, so as to be easily
reduced to a coarse powder. A concentrated infusion is then
to be made by the process of displacement. There should be
added to it an equal, or double its quantity of cream or good
milk, and be sweetened with sugar. An alimentary drink is
thus prepared, possessing all the requisites of good food, with
the addition of a specific excitant action on the nervous system
and brain, that entitles coffee to the appellation bestowed on it
by Rousseau, "boisson intellectuelle."

The ordinary miserable preparation of coffee so extensively
used as food, deficient in proper alimentary principles, by taking
away appetite, by distending the stomach with a warm liquid,
and thus impairing its digestive power, and by its agreeable
aroma corrupting the taste, rendering more nutritious food un-
palatable, tends to the ultimate impoverishment of the blood.
This fluid loses its proper character, that of a concentrated solu-
tion of all the organic elements and products of the economy.

As a consequence of this condition of the blood, the waste of
the tissues exceeds the repair, death-action is stronger than
birth-action; disintegration of structure predominates over its
reformation. In time this loss of balance tells : the organs are
degraded from their piimitive type ; their functions are impair-
ed, and the organism descends in the scale of development.
There is an approach to inferior organisms, and to cold blood-
ed animals ; or, rather, the system is kept permanently in what
constitutes the cold stage, or tendency to collapse in febrile
diseases.

In this state, individuals suffer from a variety of vague anom-
alous symptoms, characterizing no definite disease. They are
always ailing, complaining, suffering, but not absolutely sick.

1849.] Infiuence of Tea and Coffee upon Health. 543

They are miserable themselves, a plague to doctors, the prey
and victims of quacks.

In this condition of the economy, the temperature is low.
Dynamic force, which is identical with heat, is equally depress-
ed ; and, consequently, the mechanic or muscular power is at
zero, and the offices of the economy depending on it are im-
perfectly performed. The circulation is feeble, digestive move-
ments slow and defective ; languor and exhaustion prevail.
Exercise augments the evils by expending the forces more
rapidly than produced, and the nervous functions are in a state
of perturbation or depression. These disordered states are
the results of a slow inanition or starvation, not suspected, be-
cause food is taken to the full repletion of the stomach ; yet
still it is starvation, for the blood does not possess the elements
for heat and nutrition adequate to the full energy and the con-
sumption of life-action. These cases are not remediable by
medicine ; they can be relieved only by a restoration of the
digestive functions, and a return to a wholesome and appro-
priate diet.

Cases of this character have augmented in our towns and
cities, and it is believed in the country, particularly amongst
women, and in the industrious and laboring classes, in the last
ten or fifteen years most rapidly. The neuroses, as gastralgia,
different visceralgias, and other forms of neuralgia, are now
quite as common amongst those classes, if not more so, than
they were formerly amongst the luxurious and idle, to which
they were almost exclusively confined.

A suspicion has arisen that this circumstance is to be attribu-
ted to the perversion of the use, as food, of tea and cofl^ee, from
their proper employment as nervous excitants and cordials,
which are their appropriate properties. On inquiry it is almost
uniformly found, at least, in the observations of many medical
practitioners, that the greatest suflTerers from these disordered
states, are the inconsiderate consumers of tea and coffee, who
substitute them largely for food.

It would extend this inquiry too far to enforce the above
views by relations of specific cases. A large number could be
cited as strongly illustrating their correctness.

The practice of giving tea and coffee to children at their
meals cannot be too strongly reprehended and discountenanced.
In the first periods of life, the most nutritive food, rich in plas-
tic elements and capable of favoring the highest organization,
is that which is required for growth and development. In the
first fifteen years, nature is employed in constructing and per-
fecting the mechanism of life, fitting it for the conflicts, the
exertions, the labors it must encounter and undergo in the

644 Influence of Tea and Coffee upon Health. [September,

struggles and difficulties of the great arena of the world, as well
as with exterior malignant influences hostile to its existence, to
which it is incessantly exposed. Without good materials there
cannot be produced a good fabric.

Whatever tends to excite, to render irritable, or to develop
unduly the cerebral structure and functions in children, is of
necessity injurious. The bills of mortality show the fearful
ravages in the early years of life from cerebral disease ; and
the foundation of most of the neurotic diseases and of ill-health
in adult life, dates from the abortive efforts of nature to build
up substantial organs from the paucity and poverty of the build-
ing materials, or the abnormal direction imparted to nutritive
action, by over-excitement, in the commencement of develop-
ment.

Tea and coffee being cerebral excitants cannot act otherwise
than injuriously on children, in whom there exists no object for
such artificial stimulation. Indirectly, they are mischievous
by taking the place of food that contains all the elements and
constituents of the fluids and solids of the organs and their pro-
ducts. They should be abolished from the dietary of children
in all well-regulated families, and by parents careful of their
childrens' welfare.

The analysis of tea is not complete, like that of coffee, by M.
Payen. As far as known, it contains no alimentary elements,
and cannot be classed with food. It is a purely cerebral ex-
citant.

Though the grain of coffee has amongst its constituents
alimentary elements, yet in the common slovenly process of
torrefaction, the calorifacient principles are destroyed; and the
plastic are also more or less decomposed. But when more
carefully performed, and these principles are not materially in-
jured, still a small portion only can be dissolved in the infusion
or decoction made in the ordinary mode.

The infusions of tea and coffee cannot, therefore, be used as
food, and be made substitutes for nutritious aliment, without a
serious detriment to the economy. They are cordial bevera-
ges, and as such are grateful and useful, especially to those
engaged in mental pursuits, and who lead sedentary lives.
They must, at the same time, be combined with substantial
nutriment, or the blood becomes impoverished, and fails to con-
tain the materials for organic structure, evolution of nerve-
force.

In proportion to the degree of physical exertions, are the wear
and tear of the solids, and the expenditure of the forces. The
elements to maintain these in their normal conditions, must ex-
ist iu the blood, and the blood obtains them from the aliment in

1849.] Sectional Teachings of Medicine. 515

which they exist, through the digestive apparatus. Tea and
coflee largely drunk at their meals by those engaged in active
and laborious pursuits, by excluding a due quantity of substan-
tial food, rich in the plastic and force-producing elements, are
more injurious to these classes than to the sedentary.

The inevitable consequences of this practice must be to un-
dermine the constitution, to impair the health, to break down
the forces, to cause various nervous sufferings, and finally to
produce disability for labor.

The Sectional Teachings of Medicine. B}^ Damel Staiil,
M. D., of Quincy, 111. (N. Western Med. and S. Jour.)

Is " sectional teaching" of the practice of medicine useful or
necessary? or "to treat diseases understandingly, is it requi-
site for the student to be educated in the localities where they
prevail ?" These are questions which are now asked and dis-
cussed in the circles of Medical men, and in the medical papers
of the United States, and concerning which I think we ought
to come to some understanding. Having no connection, di-
rectly or indirectly, with any medical institution, and having no
private ends to accomplish which, in the remotest manner,
could possibly bias my judgment, I trust that you will consider
the opinions which I shall take the liberty to advance here, as
the expressions of an honest conviction a conviction which
has been forced upon me in the trying school of an experience
to which I look back with any other than pleasurable feelings.

The physical or material man is every where the same ; his
organization, with but very slight qualifications, is the same on
the sandy plains of Arabia, and on the summit of the Rocky
Mountains; on the banks of the Rhine and on those of the
Colorado ; every where man presents the same number of or-
gans in (mutatis mutandis) the same shape, and organic chem-
istry finds the same elements in their composition. The func-
tions of this complex organism are also every where the same
in the whole species of that wonderfully constructed animal
hovio. When, therefore, we wish to examine and to study the
construction, the composition, and the functions of this living
machine when we wish to study anthropology it matters
little where we are taught, if only taught welt whether at
Paris or Vienna, at Riga or Philadelphia. But it is quite differ-
ent with the study of pathology and therapeutics. Pathologi-
cal change and remedial agents difler, and must necessarily
differ, according to climate, and even, sometimes, according to
locality. Does it follow, as a matter of course, that, because

\. d. VOL. v. NO. IX. o5

546' Sectional Teachings of Medicine. [September,

man's physical organization is every where the same, he is,
therefore, subject to the same diseases, no matter whether he
inspires the mepbitic air of the jungles of Bengal, or the balmy
atmosphereof the valleys of the Rhine? By no means. The
experience of those physicians who have visited different cli-
mates will testify to the contrary ; works written by medical
men in different countries will testify to the contrary. Although
the principle of self-preservation is in man, and, consequently,
that of reaction against inimical influences, yet the constant
actions of these external impressions will and do produce an
effect either on the whole system or on single organs primarily,
and, by sympathy or otherwise, on the whole system. Thus
we find that the inhabitants of warm climates are more subject
to hepatic affections ; in some parts of the world there is goitre,
in another plica polonicaendemica; in some countries, we find
yellow fever and never see a case of the plague ; in others we
find the plague in its most horrible form and never have an op-
portunity of seeing yellow fever. Without extending these
illustrations any further, I think I have proved sufficiently that
our climate and even our locality can predispose to and produce
ills from which the inhabitants of another climate or locality
are perfectly exempt, and that hence '' sectional teaching," in
the liberal sense of the word, is indispensable, unless the practi-
tioner prefers the slow process of experimenting on his patients
till he has supplied the advantages of '' sectional teaching," by
his own observations at the bedside and at the dissecting table.
To render the illustration, or, if you will, the argument, still
more striking, let us suppose a young man of liberal education
and all the other qualifications necessary to make him a good
physician, from Mississippi or Louisiana, to have studied medi-
cine at Paris or Berlin, and i-eturning to his native state with the
most honorable credentials of his proficiency, learning, and skill
in his profession, think you that he will be able to treat yellow
fever, congestive fever, and all the sequalce of these endemic
fevers, with the same ready tact, skill, and familiarity as he who,
during his pupilage, watched at the bedside of patients with
such maladies, and who has been taught by men who have ob-
served and treated thousands of such cases? You certainly
cannot think so, because you must know that the former had
not only no opportunity to see such cases at Paris or Berlin,
but they were not even described to him by men who are sup-
posed to have seen them, but by those who have probably read
outlines of these pernicious fevers, and from these outlines
formed a picture of them in their minds in short this unfortu-
nate Mississippian or Louisianian with his great medical ac-
quirements cannot diagnosticate and treat these endemical

1849.] Sectional Teachings of Medicine. ol7

diseases ofhis native state with as much skill and efficiency as
he who availed himself of "sectional teaching," because he was
taught by men who cannot communicate practical instruction
either at the bedside or from actual knowledge. Book-learning
alone will not do either with the teacher or practitioner ; both
must have " seen and handled."

You perceive then, that although "all men are created equal,"
" sectional " influences produce " sectional " diseases, the nature,
course, and treatment of wdiich can, from the peculiarity of
these influences and their efl^ects on the organism, be taught
practically and to useful ends only by those who can speak
from experience. An ounce of experience, with a little learn-
ing, both of the teacher and pupil, is worth more to the patient
than never so many pounds of learning without experience.
Ask any one of the professors of the theory and practice of
medicine in the western medical colleges what, aside from his
general medical education, renders him competent to instruct
his pupils in the symptomatology, course and treatment of the
diseases peculiar to the western country as modified by the
influence of its climate, and if he does not answer, '"practical
knowledge," he is incompetent to the task he has assumed, and
he violates the trust reposed in him. The fact is, the teacher
must have the true picture of the disease he treats of vividly in
his mind, and so he must have the picture of all the phases this
disease may assume, and such a picture can be impressed on his
mind by observations, by the perception of his senses, and by
no other means; and all the sophistical talk about the general
principles of medicine, etc., etc., in order to get around the
necessity of this "sectional teaching," I consider as coming from
men who do not know better or who will not know better.
What renders the works of Eberle, Bell, and other American
authors, and the monographs (as far as the practical part is
concerned) of Dr. S. Cartwright so useful and valuable to us
but the truly practical instructions they contain concerning the
diseases of this country? and could these have written as they
have if they had not seen and treated these diseases? Certain-
ly not. Dr. Bell, in his " lectures," frequently appeals to his
experience in deciding points of controversy in relation to the
treatment of our diseases, and in the preface to his "Bell and
Stokes' Lectures," he says and this I cite as a potent argu-
ment for "sectional teaching," "and by steadily bearing in
mind the w^ants and expectations of the American practitioner
for information respecting the fevers of the United States and
analogous climates, rather than those of European hospitals,
camps, and jails, less disappointment, it is hoped, will be felt at
my abbreviations on this head, (the literature and history of

548 Sectional Teachings of Medicine. [September,

fevers). I have curtailed to some extent my former lectures
on congestive fever, but have still retained those distinctive
features which imparted to them that interest in the minds of
the physicians of the South and West, which I was sanguine
enough to anticipate when I first took up the subject,' etc., ''for
a complete elucidation of the nature and treatment of which
(Southern and Western fevers) they (the physicians of the South
and West,) must not look to the hospital statistics nor to the col-
legiate teachings of Europe,^'' etc. And in an article in the
October number, 1840, of "The Bulletin of Medical Science,"
(vol. iv., No. 10,) this same distinguished writer, (Dr. John Bell,)
says, pp. 344 and 345, in reply to Dr. Cartwright's remark,
that Dr. Bell has written about as well on congestive fever as
any other northern writer who has gone to the north of Europe,
where these types of fever never prevailed, to get information,
instead of coming South or turning to Hippocrates "It is not
easy to reply to an assertion which could not have been made
by any person in his right senses, who had ever read the lec-
tures on congestive fever. He would then have learned readily
enough that Dr. Bell did not go to the north of Europe to get
information on this subject, but that he did go to the South, not
only in the sense intended by Dr. Cartwright, viz., by consult-
ing those who had southern experience,, but, still more, that he
went, himself, South, and that by many degrees nearer the
equator than either Dr. Cartwright or any of his state rights
medicine party. Dr. Bell studied medicine and observed dis-
ease in Virginia," etc.

Many of the diseases of the Western States, particularly of
the valley of the Mississippi, require a different treatment from
similar diseases of Europe and even of the Atlantic States ;
others, again, v/e have here, which are absx)lutely unknown
either in Europe or in New England. If the doctrine of the
catholicity of medicine be correct it ought to be indifferent
whether a physician is educated at Berlin^ Parss, or Chicago,
provided he obtains good and sufficient instruction, and this
instruction received in any one of these places, ought, conse-
quently, to enable him to practice his profession any where on
the habitable globe. Btitis this attainable? I think not ; and
to prove this, let us suppose a physician fresh from the best
university and hospital of Europe to visit a patient laboring
lander that dreadful scourge of American infants, cholera infan-
tum, and what will be his dingnosis ? Anything but the real
disease. Or let him be called to a case of milk-sickness,
(N. B. Do our eastern brethren know any thing about this ?)
and is it at all probable that he can diagnosticate and treat the
case correctly ? It is almost impossible, because even syste-

1849.] Sectional Teachings of Medicine. 549

matic works on the theory and practice of medicine rarely
contain any notice of this disease a disease which the practi-
tioner in Kentucky, Indiana, and other western States has so
often to encounter. Admitting that these two complaints are
American and that the European cannot know tliem except by
reading, and we can therefore not pre-suppose him to possess
any knowledge of them, let us invite him to the bed-side of a
patient, who labours under a malady that is found both in Eu-
rope and America. I mean the disease which is here vulgarly
called winter fever. I doubt not but what our stranger will
properly diagnosticate the case ; but finding the patient the
resident of a log cabin standing upon the banks of one of our
w'estern rivers, (and there or in similar locations is where we
mostly find these cases of pneumonia notha,) does any western
physician suppose that he can treat it with safety? I, for my
part, doubt it ; at least I would not trust myself in his hands
until he had gained the knowledge of its course, etc., by expe-
rience.

I could extend these illustrations, but I trust that these few
will be sufficient to prove the necessity of acquiring a know-
ledge of those diseases, which it will be the future lot of the
practitioner to treat, not only from men who from experience
know them, but also from observation at the bed-side.

Let one of those who maintain that " the great principles of
pathology and therapeutics can never be sectional," (and this
position I will say, en passant, I don't altogether dispute, I only
dispute the "universal application" of subordinate principles:)
be taken sick of yellow or congestive fever, let him be sur-
rounded by Schoenbien, Louis, Williams, Mitchell and Cart-
wright, and let him choose one of these to attend him profess-
ionally. Is it likely that he would take the Berlin or Paris, or
even the Philadelphia professor, w^orld renow^ned as each of
them may be, when he has at his command the services of a
Cartwright, who has spent the best years of his life in observ-
ing, studying and treating these diseases ? I trow he would
trust to " sectional medicine," and sectional treatment too. Or
if this same man this opponent of *' sectional teaching"
wishes his son to study medicine wnth a view of locating at
Natchez, New Orleans, or St. Louis, or even atQuincy, would
he not advise him to obtain instruction in relation to the dis-
eases incident to these localities from physicians who know
them from experience, in preference to those who know them
but by reading, or judge of them by ''analogy." Most assur-
edly he would.

To avoid misunderstanding, I must beg you to consider my
advocacy of "sectional teaching" in that sense in which alone

Cholera. [September,

it can be reasonably defended, or is necessary or salutary. To
say that the European schools, or the schools on the other side
of the Alleghanies, cannot impart to our western physicians a
good general scientific and practical medical education would
be anabsurdhy ; but, notwithstanding this concession, I think I
have shown sufficiently in the preceding remarks that these
European and Eastern schools cannot teach their pupils the
s3^mptomatology, astiology, course and treatment of our western
diseases. As well of western physicians, western schools, and
western hospitals ; and I wish you to bear it in mind that to this
class of diseases (to treat which, by the by, is two-thirds of the
employment of a western physician) I confine my admcacy of
** sectional teaching- '^

Letter from Dr. Reese on the Cholera. (New York Com-
mercial Advertiser.)

Messrs Editors. The numerous inquiries addressed to me
from various and distant portions of the country, in relation to
the epidemic cholera still prevailing in our city, have induced
me to solicit the privilege, through your columns, of giving a
general answer, my public duties- forbidding an attempt at in-
dividual replies. My residence in a public hospital precludes
the imputation of mercenary motives in this communication,
and in the hope of being useful I am indiflferent to any other.

And first, to those with whom my professional opinion may
be of any worth, I wish to say that the present epidemic is
identical in all respects with that of 1832, in its nature, symp-
toms, malignity and fatality, nor has it differed in any impor-
tam particular in the pathological results revealed by dissec-
tion.

Of its origin and remote cause the profession are as profound-
ly ignorant as they are of the atmospheric poison upon which
intermittent, remittent, and yellow fevers depend, and not a
whit more so. For, after all the theories which have been
promulgated, we know absolutely nothing of the intrinsic
nature of any other morbid poison infecting the atmosphere.
Nor is it any reproach to the profession that such is the fact,
since from the impalpable and inappreciable character of the
subject, by any known tests or instruments, these morbid
poisons are inscrutable in the present state of human science.
This sober truth is felt everywhere, and honesty demands its
frank acknowledgement, if we would retain any share in the
public confidence.

The history of our present epidemic in New York is well

1849.] Cholera. 5r>l

known. The obvious indications of the presence of the cholera
atmosphere in our vicinity weie manifested last December,
when cases occurred at our quarantine, and a few sporadic
instances were observed in the city. There cannot be a
rational doubt that we should then have been visited with the
epidemic but for the cold weather of Winter, which, so far as
second causes we're concerned, suspended its influence. For
whatever may be said of Russia and other cold climates, all
history and all experience have established the fact that on
our Atlantic coast neither yellow fever nor cholera can prevail
extensively during the existence of frost, or with the mercury
below 32 degrees of Fahrenheit. The suspension of the
cholera until Spring, and the absence of all just ground for ap-
prehending an epidemic in the Winter, constituted the subject
of a letter from me, published at the time in the Commercial
Advertiser. And though my opinions were then uncourteous-
ly treated by certain editorial philippics, time has fulfilled to
the letter what I ventured then to predict from our knowledge
of the laws of the epidemic, derived from history and expe-
rience.

After the suspension of the epidemic until Spring, not until
the warm weather began to develope the exhalations from the
filthy localities of the city did cholera assume any thing like an
epidemic form. These exhalations constitute the pabulum
vitcB of cholera, and in these and no where else, so far as we
know, it "lives, moves and has its being/' Hence, first at the
" Five Points," and next in the other sections of the city, some-
times miles apart, where a similar dense and filthy population
are found, did the present epidemic commence its ravages.
Radiating from these points, as the impurities of the air ac-
cumulated and extended, has the disease spread it ravages, all
the while finding the majority of its victims in the crowded
apartments and ill ventillated abodes of squalid poverty, and
especially where intemperance and kindred vices abound.

Meanwhile that the cholera atmosphere is hovering over our
entire city is rendered certain by the universal predisposition,
of which most of our population have evidence, in the sensible
diminution of appetite and strength, imperfect digestion, dis-
turbed stomach, nervous rigors, nausea, and even diarrhoea,
vomiting and cramp.s, all of which are evidences of being aflJect-
ed by the morbid poison, and are premonitory of an attack,
either separately or together; if they be either neglected or
mistreated. They do not however constitute cholera, or even
*' the first stage of cholera," but are only proofs of existing pre-
disposition, and call for immediate attention and treatment, as
hereinafter advised. For want of this discrimination and be-

552 Cholera. [September,

cause of the contrary having been put forth on pseudo-medical
authority, the multiform varieties of quackery have vaunted a
host oi cures, when neither of their cases of so called cholera
was any thing else than premonition of the malady, their
means of prevention, whether right or wrong, having no cura-
tive tendency in cases of cholera, if fully developed by the
characteristic or pathognomonic signs.

But the evidence of this universal predisposition is still more
apparent in the certain attacks of many temperate and discreet
persons, even in the most healthy sections of the city, by reason
of some exciting cause, as by a casual excess, or imprudent indul-
gence in food or drink, by which the digestive functions are
disturbed. Not less obvious is the proof furnished in other
cases occasionally occurring, in which no indiscretion can be
traced, and which are yet sudden and fatal, with or without
the usual premonitions.

Still farther evidence of this hovering over our city of this
cholera atmosphere has been supplied by the simultaneous pre-
valence of the epidemic in Brooklyn and adjacent places, as
well as by its terrible ravages in the Penitentiary, Lunatic
Asylum and Alms House, all of which are on Blackwells'
Island, at least 4 miles in a direct line from the localities of
the city suffering at the time of its commencement there, with-
out any but scattered cases in the intermediate distance.

It is vain affectation, or worse, therefore, for any portion of
the press to conceal or mystify the fact that the pestilence is
doing its work, and that the air we breathe bears upon its
bosom the invisible, intangible and unknown poison upon
which cholera depends. We know it by its effects every
where apparent, and painfully so in the death of more than one
hundred per day of our population who have become its vic-
tims during the last week.

Nor are we authorized, by any occasional variation in the
number of cases in any day's reports, to presume on so slender
ground to promise ourselves an early subsidence of the de-
stroyer. Indeed without a remarkable interposition of Divine
Providence, such as this nation is called upon by its chief
magistrate to implore, there is no probable foundation for an-
ticipating the retirement of the disease, in its epidemic form,
until Winter shall approach and our city be again under the
domain of periodical frost. Then and not till then does the
history or known law of the epidemic justify a prediction that
there will be an end of the pestilence.

Still, however, there is no ground for panic, and still less
hope in fleeing from the destroyer, in view of the wide-spread
evidences of the cholera atmosphere all abroad in the land.

1849.] Cholera. 553

But especially have we reason for congratulation in tiie eviden-
ces which are at last constraining the overthrow of professional
prejudices, and overwhehnin^r even the ignorance and super-
sition of the popular mind with the proots that the cholera is
not contagious^ and that it never was and never will he con-
tagious. At every step of the march of the present epidemic,
new and demonstrable evidences have become apparent that
there is no danger in nursing the sick, and no pretext for the
cruel abandonment of the dead, to which the fable of contagion
has given rise. The common people have seen with their own
eyes that the cholera is '"'not catching,^'' and tiius being freed
from the bondage of contagion in this regard, half the terrors
of the pestilence are gone.

But I forbear to say more at present on the general subject,
and before offering my advice as to the prevention and treat-
ment, will briefly allude to what I concientiously regard as a
worse public calamity than cholera itself, because to this the
very worst results of the present epidemic are to be justly
ascribed. I mean the deplorable extent of popular delusion
by the devices, frauds and impostures of quackery, which
in some one of its Protean forms is daily and hourly promul-
gating offers of prevention and cure, too often endorsed by the
whole weight of the public press, and sanctioned by editorial
commendations, whereby its unutterable mischiefs to human
life are increased a thousand fold. I speak what I know, when
I affirm that in almost every case of fatal cholera which I have
seen or heard of in private practice in this city, the incurable
character of the disease was the direct result either of the loss
of time which was occasioned by the inert and useless treat-
ment of homoeopathy, or the equally fatal nostrums of the other
tribes of quackery.

In common with my professional brethren, I have visited in
consultation patients who had been drenched and dosed either
with cholera specifics, Brandreth pills, gallons of soda water,
sulphur, charcoal, capsicum, camphor, cuprum, veratrium, wet
sheets, sitz baths, brandy, opium, teas and ptisans of various
*' roots and yarbs," and subjected to several of these agencies
and varities of treatment, before any rational remedies had
been appealed to. Every one of these cases had passed into
incurable and hopeless collapse before I saw it and was utterly
beyond the reach of human art. That they might all have
been saved but for their resort to quackery it is not becoming
in me to say, but that most of them might have been rescued,
if under rational treatment, I have not a single doubt. I speak
as a witness, not as a controversialist, and express my honest
convictions.

ij\ Cholera. [September,

But another unhappy result of quackery, prolific of unmixed
evil, has been the wantonly false reports which their mercena-
ry craft has prompted, both of cases and cures, while the
deaths resulting among their victims have been cunningly
concealed by devices as wicked as they are deceitful. Every
person who bought a " cholera specific" from a mountebank,
whether he ever swallowed it or not, has been reported a case
and a cure ! All who have taken or promised to take a drop of
camphorated spirits, or any other homoeopathic preventive,
whether they ever had any symptoms of sickness except the
cholera phobia, have been reported as cases and ewes ! The
sanitary committees of the Board of Health have thoroughly
investigated scores of these cases, and have accumulated on their
files the documentary proofs of these frauds, all of which will
be forthcoming herealter ; too late however to prevent the
mischiefs of the present epidemic.

That more than four hundred deaths have been concealed
from the Board of Health and detected by the city inspector
during the last week, in collecting the interments, is a matter
of notoriety. But it is not generally known,- as it ought to be,
that this large disproportion is occasioned chiefly by the fail-
ure of the quacks to report their deaths, while those occurring
under the treatment of the regular practitioners are generally
reported from a sense of duty.

But a still farther explanation of the mysterious discrepancy
between the reports alluded to and the mortality by quackery
and cholera, is presented in the enormous number of fatal cases
ascribed to dysentery, diarrhoea, cholera morbus, cholera
infantum, inflammation of the bowels, &c., during the same
period. The whole tribes of quackery have claiined that all
or nearly all their cases of cholera are ciu^ed. Hence, when
their patients die, they deny that cholera is the disease, else
their specifics would have cured ; and they give certificates
that they only had dysentery, or diarrhoea, or some other
severe malady which they could not cure. None are called
cholera unless they recover, and all who die are recorded un-
der some other name. It is obvious how valuable to science
our statistics must be, the data of which thus abound with the
"false facts" of quackery !

In regard to the mortality attendant upon cholera, even un-
der any treatment which our most scientific and successful
practitioners have yet employed, candor and truth demand the
concession which the profession has every where made, that
after the collapse of cholera has been fully developed, recover-
ies are but rare, except in favorable circumstances of previous
constitution and habits. Hence the uniform and earnest re-

1649.] Cholera,

commendation of reputable physicians has every where been
repeated, that a resort to medical treatment should always be
had in the premonitory symptoms, or what has been recently
called for the first stage of cholera ; and for the express reason
that it is exceedingly hazardous to delay remedies beyond the
earliest periods of the malady.

It now only remains to describe the means of prevention
and cure, which, so far as my observation and experience in
1832, 34 and 49 enable me to judge, are best entitled to confi-
dence.

The presence of the epidemic in any neighborhood affords
prima facice ew\diQUc& that all persons inhaling the common
atmosphere are in a state of predisposition to the disease, by
reason of the morbid poison which constitutes the inscrutable
cause of cholera. They are all liable to it on any exciting
cause, sufficiently potent to develope it. The best means of
prevention under such circumstances are, a calm and quiet
state of both mind and body, the avoidance of all excitement
and excess of every kind, attention to the quantity and quali-
ty of food, rejecting every thing known to be indigestible, and
observing great moderation in food and drink, abstinence
from spirituous and fermented liquors, and above all taking no
physic.

On the earliest appearance of nausea, or diarrhoea, the pa-
tient should take the horizontal position in bed and secure abso-
lute rest for a few hours. If the diarrhoea continue, a tea-
spoonful of the following mixture may be taken in cold water,
and repeated after every evacuation from the bowels. The
same remedy and dose may be used if vomiting occurs, wnth
or without pain or cramp, and be repeated if necessary, swal-
lowing pieces of ice before and after, and drinking only ice
water.

I give the prescription, which, I may add, has been success-
fully used in this hospital, and is extensively employed else-
where by those who have seen its usefulness here.

Take of sulphuric ether, and compound spirits of lavendei*,
each 1 oz., wine of opium 2 drachms, oil of cloves 10 drops.
Mix. Dose, a tea-spoonful for an adult, and proportionally
less for a child, to be repeated as often as necessary.

My opportunities in this hospital for employing this compound
in the diarrhoea, vomiting and cramps w^hich have prevailed
here for months past to an unparalleled extent, have been am-
ple. And I ascribe our complete exemption from cholera here,
until very recently, and our comparative freedom from any
violent epidemic still, while all the neighboring institutions of
the city are suffering from it so fearfully, in part to the prompt

55G Cholera. [September,

resort to it in all cases of premonitory symptoms. No other
means has been necessary with us, and no case of cholera has
yet occurred among the hundreds who have been thus treated
here, or elsewhere, to my knowledge, yet they had most cer-
tainly what is erroneously called " the first stage," and many
of them with very great severity.

The only cases of cholera which have originated here thus
far, and they are few, have occurred without any first stage, or
premonition whatever, and most of them were rapidly fatal,
having occurred in bad subjects, previously prostrated by dis-
ease. In those who have recovered during the present epi-
demic here and elsewhere, under my observation, there has
been very great uniformity in the treatment and in its favorable
results ; the only difference being between those in the hospit-
als, and those in the private practice of my professional bretli-
ren. In the hospitals the patients, from previous sickness and
dissolute habits, have not admitted of bleeding in the incipient
collapse, nor has it been resorted to except in a few cases
which justified it. While in private practice the disease has
been obviously rendered manageable, and the consecutive fever
averted, by this practice. So also in the Penitentiary hospital,
where I learn bleeding has been eminently useful when resorted
to earl3^

But the chief reliance, after collapse has supervened, has
very properly been placed upon calomel, in doses of from 5 to
20 grains, according to circumstances, with or without opium,
capscium or camphor, as indicated in special cases. The dose
is repeated every hour or two, as the case requires, and the
patient is meanwhile encouraged to eat liberally of ice, which
allays thirst, prevents vomiting, and is alike grateful and re-
freshing.

The auxiliary remedies have been sinapisms to the legs,
arms and abdomen, with India rubber bags filled with hot
water surrounding the body, and frictions with cayenne pepper
and other stimulants, when the cramps required it. These
means with the employment of calomel as above noticed, have
repeatedly succeeded, under my observation, in restoring cases
after deep collapse ; and bile appearing in the dejections has
been the signal of speedy recovery.

I have thus hastily thrown together a summary of my views
on this important subject, as perspicuously as possible, and my
friends must excuse me from any other than this general reply
to their inquiries. At the close of the epidemic, I purpose
discussing the subject at length, through some of the medical
journals, if life and health permit. Respectfully,

D. MEREDITH REESE, M. D.

July 25th, 1849. Rcsidait Physician of Bcllevnc Ilm^pital.

1819.] Remedy for Cholera, S57

Remedy for Cholera. By L. Cox, M. D., of New York City.

The great point that he makes is, that what are called "the
premonitory symptoms" of the Cholera, are the Cholera itself
and must be attacked as such:

"Diarrhoea, therefore, is regarded as the grand and ruling feature
of the disease, and upon its proper treatment depend all the succeed-
ing symptoms as well as the final result. The common Cholera of
the country commences in the stomach, with pain and nausea, violent
vomiting and then copious discharges, first of the usual fa?cal matter,
and then of bile, with violent pain in the smaller intestines. In the Epi-
demic or Asiatic Cholera, on the contrary, neither nausea nor pain is
first manifest. The patient is first attacked with looseness, without
pain; then come thinner dejections, large fluid passages, and finally
pure fluid, of a marked character, in large quantities, with great vio-
lence, yet often without pain or nausea. There is, therefore, a clear
distinction between the two diseases."

The Doctor then proceeds to treat of the philosophy of the
disease, and the way to meet it. Cholera, the doctor regards,
as simply a sudden, violent discharge of the fluids of the blood.
And this theory explains every symptom of the disease. The
exhaustion which follows is precisely similar to that induced by
loss of blood, except the difference in the color of the skin :
and that is explained by the fact that the water of the blood,
instead of the red blood, is discharged. Nausea attends both
haemorrhages. Cramps always manifest themselves in case of
death from loss of blood. The sudden reduction of the bulk of
the body is ascribed to the same cause, the loss of its fluids.
The same thing accounts fully for the coldness of the surface,
as well as for the burning heat of which the patient complains.
The collapse of the whole body, the sinking of the eye, the
shrivelling of the fingers, and the pinched appearance of the
features, all bear testimony to the fact that the blood vessels
lose their fluid contents. So also of all the other symptoms.

He closes his treatise with the following directions for Treat-
ment, which we copy in full:

^^ Directions for treatment in the ahsence of a Physician. In order
to serve as some guide in the absence of a physician, it will be well to
recapitulate and to divide the disease into its several stages, briefly
stating the several treatments in each.

I. First we have what might be considered strictly the incipient
stage. This stage is often unnoticed, or perhaps does not always oc-
cur, but it most generally happens, and is characterized by loss of
appetite, nausea, slight disturbances in the bowels, feebleness of the
muscles, and languor. Here the remedy is.

1st. Rest in the horizontal position, if possible.

2d. The use of cordials, such as eight drops of spirits of camphor,

558 Preparations of Collodion. [September,

or a table spoonful of brandy with water as a medicine only, and not
to be retained afterwards as a diet drink, and great care to avoid all
improper articles of diet and exposure of the person to irregularities
of temperature.

II. Then the stage of diarrhoea comes on, without pain, and is
marked by its insidiousness only. The remedies are

1st. Rest on the back.

2d. The use of a suppository of opium, consisting of one grain,
which is calculated only for the beginning of the diarrhoea, and this is
often sufficient to arrest the disorder without further activity in the
treatment.

3d. In addition, the patient should use camphor or brandy as before
directed, either ammonia, or other cordials.

III. The next stage may be regarded as the advanced period of the
diarrhoea, when the faecal contents of the bowels having passed off,
there is simply the discharge of the rice-water. Fhis is the immediate
precursor of collapse. The remedy here must be more potent than
in the former cases.

1st. Rest in the horizontal posture.

2d. An injection of from two to four teaspoonfuls of laudanum, to
be instantly repeated if the first dose does not remain. This frequently
closes the bowels for a period of from three to five days. If at this
moment, before collapse takes place, you can succeed in arresting the
discharge from the bowels, the patient is safe. If not, he will assured-
ly die.

3d. The next object is to restore the fluid to the blood. If nausea
or vomiting prevail, the best remedy is ice or ice water. Chicken tea
and other drinks should be freely used.

4th. The cordials are then of importance. Brandy and camphor
are all important, but nothing without opium can be relied on.

IV. When collapse has taken place, the same indications of treat-
ment remain, but in a degree more urgent. The same treatment in
larger quantities must be used. They will be often successful, and
probably always, provided coagulation of blood has not taken place.
But in that case there is no possibility of recovery.

If the patient will implicitly obey these principal directions, there
is positively no need to fear the pestilence, otherwise so fatal. The
disease is diarrhoea, easily checked. Of this it is well to be afraid,
even when unattended with pain. In its tendency it is fatal; but it is,
perhaps, one of the easiest possible diseases to cure, if it be subjected
to proper and timely treatment.

Observations upon, and improvements in, the Preparations of
Collodion, By Charles S. Rand. (American Journal of
Pharmacy.)

All solutions of prepared cotton, now in use under the name
^^f collodion, are liable to objection, on account of the powerful

1849. J Preparations of Collodion. 559

contraction which takes place during the evaporation of the
ether, and formation of the pellicle. In certain cases this is its
most valuable property ; but where merely a protecting envel-
ope, or false skin is required and the surface to be covered is
large, this contractility is an objection which has in many cases
prevented its employment, and caused the substitution of pre-
parations, in other respects far inferior. In wounds of consid-
erable extent, such an action would evidently result in the-
formation of an irregular cicatrix, and even more serious re-
sults might follow, from the tension upon surrounding parts.

At the request of those who had experienced these difficul-
ties, I undertook a series of experiments with the view of
producing a collodion possessing all the adhesiveness and
transparency of the ordinary preparation, but deprived of the
contractility. I endeavored to combine with it a solution of
gutta-percha in chloroform ; but immediate precipitation was
the result. Where the latter was in excess, the ether united
with it, letting fall the gun-cotton : where collodion predomina-
ted, gutta-percha was precipitated.

It would be needless to mention in detail all the subsequent
experiments. The terebinthinates gave the most satisfactory
results. A few trials sufficed to show that but a small quantity
of resin ot turpentine, dissolved in recently prepared collodion,
would totally prevent contraction, and increase the adhesive-
ness of the preparation.

My recipe is as fo{}ows :

Take of Prepared Cotton, 3ij.

Venice Turpentine, 3ij.
Sulphuric Ether, i v.

Dissolve first the cotton in the ether, add the turpentine, and
by slight agitation complete the solution. I have preferred
Venice turpentine as the least frequently contaminated by
mechanical impurities.

The cotton used in these experiments was prepared accord-
ing to Mialhe's process, by dipping carded cotton into a
mixture of nitrate of potash and sulphuric acid: the ordinary
commercial varieties being in all cases used.

The above proportions should be carefully observed, as an
excess of turpentine will cause an opacity in the film, while too
small a quantity will not overcome the contractile tendency.
This opacity or, more correctly, opalescence is, however,
not permanent, generally disappearing in a few minutes.

When applied to the skin, this preparation forms a perfectly
smooth transparent pellicle, more difficult to remove than that
of ordinary collodion. Being more pliable, it yields to the mo-
tion of the skin and will not crack even after several days' ap-

560 Preparations of Collodion. [September,

plication. It might be supposed that the turpentine would
render it more irritating ; but this is not the case owing to the
absence of that mechanical stimulus, so powerfully displayed in
the former solutions.

The addition of two drachms of mastic to the above maybe
at limes advisable, if the pellicle be required of great toughness
and strength ; but it dries more slowly, and remains opalescent
longer than that containing Venice turpentine alone. This
preparation is much more suitable for the purpose of a varnish,
than as an application to the skin.

The label of a small vial was coated with it, and exposed
thirty-six hours to the action of cold water which was after-
wards raised to the boiling point without any effect, except a
temporary destruction of transparency. Cold and boiling alco-
hol were alike powerless.

Myrrh, balsam of tolu and gum benzoin were productive of
similar results. Solutions of these in collodion, spread upon
plates of glass, and permitted to dry spontaneously, or by very
gentle heat, form pellicles, easily detached while yet slightly
moist, and which when dry are very convenient for experi-
mental purposes. If a film of perfect transparency is desired,
certain precautions must be observed, or failure will result.
The solution, after being poured upon the glass, must De partial-
ly protected from the atmosphere by an inverted capsule or
similiar vessel ; a gentle heat applied beneath being advisable.

This mode of procedure has almost invariably resulted in
the formation of a perfectly transparent pellicle ; while por-
tions of the same liquid evaporated in the open air, became
cloudy, white, and sometimes perfectly opaque ; an eflect due
probably to the deposition of moisture from the atmosphere,
condensed by the cold surface from which evaporation was
taking place: the addition of even a minute quantity of water
to collodion, being well known to produce immediate precipi-
tation of a white insoluble substance.

Sheets of this material of any thickness may be prepared as
before mentioned, by drying the solution upon glass plates.
From a number of experiments upon this form of collodion, it
was found that a slight increase in the quantity of Venice tur-
pentine produced a more transparent and flexible film, resemb-
ling oiled silk closely in some of its properties ; for which, in
certain cases, it might advantageously be substituted. It is
inferior to the silk in strength, nor can it be sewed, as the
stitches give way immediately ; but it possesses a great superi-
ority in the absence of lead, which is largely present in the
former, and which blackens upon the discharge of pus or other
matters containing sulphur, from wounds, ulcers, &c. With

1849.] Bread for Diabetic raUenls. 50 1

this material no change is produced by any discharge, the
number of substances affecting its sensible properties being
very small.

If for a plate of glass be substituted a block of marble, the
pellicle will present a beautiful crystalline structure resembling
closely the film, which forms upon the surface of a saline liquid,
when crystallizing. A temporary substitute for ground glass
can thus be procured in a few moments.

The singular results afforded by every new experiment upon
this interesting and curious substance, induce a belief that other
characteristic properties will yet be discovered belonging to it,
rendering it of great value and importance to the arts.

Bread for Diabetic Patients. By Dr. Percy, F. 11. S.
(Ibid., from Chem. Gaz.)

It appears to be now^ generally admitted, that in the treat-
ment of Diabetes Mellitus, amylaceous matter should in a great
or less degree be excluded from the diet. But, as is well
known, under such restriction of food the diabetic patient soon
becomes weary of the ordinary kinds of azotized matter, as
beef, mutton, &c. Hence various substitutes for common
bread have been proposed. Some years ago my friend Mr.
Morson, of Southampton Rowe, London, prepared, at my re-
quest, specimens of bread containg gluten in various propor-
tions. However, the result was not satisfactory ;* it was only
relished by the patient when it contained a considerable quan-
tity of starch ; and when the proportion of gluten w^as increased
beyond a certain amount, it became so tough and tenacious as
to be very difficult of mastication. I have also made trial of
gluten bread, brought from Paris by Mr. Morson, but with no
better success. Recently Dr. Prout has published a receipt for
a kind of bread devised by his patient the late Rev. J. Rigg
{vide Stomach and Renal Diseases, 5th ed., p. 44) ; and this is
probably the best substitute for common bread which has hither-
to been proposed. Some time ago Mr. Charles F. Palmer, of
this town, prepared for me with great care, specimens of bread
from Dr. Prout's receipt ; but patients to whom it was given
complained of the difficulty in swallowing it, owing to the large
quantity of bran which it contained. Mr. Palmer then sug-
gested the matter of rasped potatoes, left after the complete
removal of the starch by w^ashing, to replace the bran. He
carried the suggestion into practice, and produced a kind of

I do not mean by this to assert, that bread deprived of a portion of its starch
is not preferable to common bread for diabetic patients.

i\. s. VOL. V. NO. IX. 30

562 Congressional Report on Patent Medicines. [September,

bread which I think well deserves the attention of the profess-
ion. It has been extensively employed in the General Hospital
of this town, especially by my friends Dr. James Johnstone and
Dr. Fletcher, and also by several private practitioners, with
decided advantage. In composition it may be considered as
Mr. Ring's bread, in which the bran has been replaced by the
residual matter of the potato above mentioned. And in the
fact of its being rendered light and porous by hydro-chloric
acid and carbonate of soda, precisely as m the preparation of
Dodson's unfermented bread, it is, as must be abvious, an ex-
j>ensive article ; but with many diabetic patients this will not
be an object of consideration. It is improved in taste by bein^
slightly toasted and eaten warm. I here subjoin Mr. Palmer's
receipt :

Take the ligneous matter of 16 lbs, of potatoes washed free
from starch, f af a pound of mutton suet^ \ a pound of fresh
butter, 12 eggs, \ an ounce of carbonate of soda, and 2 oz. of
dilute hydrochloric acid. This quantity to be divided into
eight cakes, and in a quick oven baked until nicely brawned.
At first gum-arabic in sensible quantities was aiso introduced
into this bread, on thegroiind of the assertion of Prof. Graham-r
that when that substance is taken by the diabetic patient, the
proportion of sugar evolved from his system is not thereby
increased, and that conseqently it might probably supply mat-
ter fo-r pulmonary oxidation. However, it w^as found that it
rendered the bread tenacious and disagreeable j sa that its use
was subsequently abandoned. I wish it to be understood that
whatever merit there may be in the productionof this bread, it
is entirely due to Mr. C. F, Palmer. My friend Dr. Evans
suggests, and I think with reason, that this bread would proba-
bly be improved by the addition of a certain proportion of bran..
Some gluten might also be added with advantage.

Congressional Report an Patented Medicines. (American
Journal of Pharmacy.)

It was our intention to have noticed the report of Dr. T. O,
Edwards upon Patent Medicines, in the last number, but as
circumstances placed it out of our power to do so, we now
refer to it as a document af too much interest and importance
to be allowed to slumber among the things that have been.
The Report was presented to Congress ooi the 6th of February,
1849, and originated in a resolution "ordering an inqudry into
the expediency of so amtending the patent laws as to prevent
ihe patenting of compound medicines." It commences with
ihc statement " that for many years a vast system of medical

184yi] Congressional Reporl on Patent Medicines. 563

impiricism, sustained by popular credulity and the sanction of
government, has prevailed in this country to the serious detri-
ment of the public health and morals ;" and it then goes on to
point out the iniquity which, with an implied sanction of law,
is perpetrated through this system. From the perusal of the
reports the conviction to every one of common sense must pro-
ceed that every species of quackery is an imposition upon the
public, but more especially that species which is sustained by
enactments, which through its means have been prostituted to
purposes never intended originally. The compounding of
drugs can not be regarded as an invention ; in accordance with
science it is done with advantage, but the principles upon which
such compounding rests are as well known and diffused as sci-
ence itself, and no exclusive right can be set up to some lucky
hit in combination, as usually stated in advertisements. It does,
in fact, appear as if the genius of ignorance presided over these
pretended revelations from the priests of Esculapius. Let us
present a few samples, selected for their brevity from among
the list of patents accompanying the report :

Anti-Bilious Pills. " The following are the ingredients
thereof, viz : Pulv. gum scammony, one hundred and forty-four
grains ; aloes^ one hundred and lorty-four grains ; rad. rhei.,
one hundred and forty-four grains ; sap. venet., twenty grains ;
carb. soda, twenty grains ; ol. caryophil. sixteen guttis ; tr
aloes, sufficient to form a mass, to be divided into one hundred
and forty-four pills."

Medicine for Cure of Flesh Wounds.-^" A vegetable ex*
tract, for speedily healing flesh wounds in the flesh of man of
animals ; also, scalds, burns, sore nipples, &c. The extract is
obtained by distilling the bark, twigs, leaves and berries of the
common witch hazel in the usual mode of distillation, and may
be preserved any length of time in well-corked bottles."

Anti-Fever Pills. " Prescription thereof, viz : Sulpb. qui-
nine, three ounces; rad. rhei. pulveris, three ounces ; piperinal
pural, one ounce ; acidum sulphuricum dilutum, (quantum sufii-
cit,) formam massam. Make the above recipe into pills of three
and a half grains each."

We have copied these beautiful excerpts literally ; they cef-
tainly constitute a genus in the family of prescriptions. Yet it
is to such productions of the human brain, that educated, scien-
tific, skilful and high-principled druggists and apothecaries are
lending themselves and assisting to reap a pecuniary profit.

While patentees are not afraid or too simple to conceal their
ignorance, more cunning nostrum mongers, in comparative
security from disclosure, continue their depredations on the
public, and with swelling names and lists of certificates pander

564 Slow Action of the Heart in Fever, [September,

to the credulity of the community. We know an instance
where a certificate, purporting to be written by a clergyman,
was fabricated in a dry goods store in this city by the young
gentlemen clerks as a literary relaxation.

At the present time, when the community are in a state of
nervous apprehension with regard to one of the most fatal
maladies known to mankind, we are sorry to see the avidity
with which the dose-swallowing propensity is taken advantage
of by some, from whose standing and tone in society we should
expect better things. To relieve symptoms of incipient dis-
ease is one thing, but to administer medicine to every one who
fancies himself sick is another, as wicked as it is pernicious.
We know of a case where a gentleman from the West has ab-
solutely injured his stomach by the quantity of anti-cholera
medicines taken. One remedy we have met with purports to
be the " Bombay Cholera Mixture," another, the " Western."
Surely extremes meet.

We have little hope that nostrum selling will be interrupted,
but the sanction of the government ought not to be given to
medicines as crude and incongruous as those which are
patented. We understand that Dr. Edwards has retired from
the scene of his labors, where he has done much for the good
of humanity in exposing abuses and staying imposition. May
another leader as zealous and talented, be found to succeed him.
Had he continued to hold his place in the national councils, he
would no doubt have been as successful in carrying the bill
for the suppression of Patent Medicines accompanying the re-
port, as he was in the case of the bill to prevent the introduc-
tion of Adulterated Drujis.

Case of slow Action of the Heart in Fever. By Charles Hal-
tin, M. D., Cavan. (Dublin Quart. Journal.)

In reply to the query in the Circular relative to Fever Report,
respecting the peculiar phenomena of the circulating system,
Dr. Mease and myself, in our joint report on the epidemic fever
of 1847, stated that we had met with " nine cases in which the
heart's action ranged between forty and fifty beats in the min-
ute, yet all those cases terminated favourably."'*'

Since that report was written, I had an opportunity of treat-
ing a similar case in the County Fever Hospital : a short history
of its course may not be uninteresting.

Ellen G , aged 18, was admitted to hospital 2d December,

1848. Pulse 96 ; skin hot; tongue dry, but clean, with con-

* Dublin Medical Journal, No. xiii., N. S., Feb. 1849, p. 110.

1849.] Tubercle and Scrofula. SGo

siderable thist ; no headache. The fever ran its course mildly,
and terminated, without appreciable crisis, on the 11th day.
On the 14th of December she relapsed; the skin became hot,
and the pulse rose to 84. On the 15th it fell to 70, and continu-
ed to decline gradually but steadily until the 18th, although
stimulants were given very freely. On the 18th the pulse
was 42; 19th, 45 ; 20th, 46. She took seven and a half ounces
of whiskey each twenty-four hours. 21st, felt better, but pulse
was 44 ; 22nd, 44 ; 23rd, 40. Ten ounces of spirits were again
taken.

Dec. 24th. Pulse 40. Took the same quantiry of stimuli ;
was up and dressed ; and, with the exception of this extremely
slow pulse, was apparently well.

Dec. 25th. Pulse 40. ' On this day she was ordered the
acetated tincture of iron, and small doses of tincture of Spanish
flies. Continued the spirits ; ten ounces daily.

Dec. 26th. Pulse 42 ; 27th, 52. Took six ounces spirits.
28th, 29th, and 30th, 80.

After this date all remedies were laid aside, and she was dis-
charged on the 6th January, the pulse being then 68.

On the Analogy and Differences between Tubercle and Scrofula.
By M. Legrand. (Revue Medicale. British and Foreign
Med. Chirurg. Rev.)

M. Legrand terminates an elaborate and valuable series of
papers, abounding in illustrative cases ; the fruit, he states, of
several years' research, with the following positions :

'*1. There undoubtedly exist analogies which we may call
symptomatic, between tubercle and scrofula that is to say,
one of these two morbid principles; the tubercular may exhibit
itself by symptoms w^hich appear to belong to the other. It is
not the case with regard to the latter. 2. Tubercle possesses,
so to speak, its morbid individuality, its molecular element the
tubercular globule which is often met with in the scrofulous
manifestations of tubercle. 3. Scrofula is always deficient in
the morbid molecular element, and its existence is only proved
by the constancy of the effects which are attributed to it.
4. The chief, or even the only seat of tubercle, is in the internal
organs, and the external manifestations of the morbid principle
irradiate from the centre to the circumference. 5. Scrofula
comports itself quite otherwise, and, manifesting itself on the
skin or periosteum, irradiates thence towards the internal or-
gans, which, however, it never disorganizes in the same manner
as tubercle. 6. Tubercle, in spite of the impoverishmu-nt of
the blood it alwaj^s induces, does not destroy, at least in the

566 Sanguineous Perspiration. [September,

early periods, the inflammatory element the fibrine which
well explains the occurrence of the phlegmasiae, which so often
complicate it, and which always hasten its disorganizing pro-
gress. 7, Scrofula likewise impoverishes the blood, but, at the
same time, it seems to annihilate the inflammatory element.
Thus inflammations rarely complicate it; and when such com-
plication does exist, it often favors the cure of the disease.
8. All the changes observed in the blood and urine of tubercu-
lous and scrofulous patients are evidently consecutive ; and
they cannot be considered as the cause of these two diseases,
whose principle is, nevertheless, very probably contained in
the blood. 9. Tubercle is never curable, or, at least, such cure
constitutes a rare exception, while scrofula is almost always
curabla,"

On Sanguineous Perspiration* By Dr. Schneider. (London
Med. Gaz., from Casper's Wochenschrift.)

It has often been a question whether, under any circumstan-
ces, blood is ever mixed with the fluid of perspiration in human
beings. Dr. Schneider remarks that he has several times ob-
served the phenomenon. He mentions having been once sum-
moned to a healthy man, 50 years of age, who, for a period of
twelve hours in succession, had travelled on foot: during the
journey he had perspired much in his feet ; and, on examining
them at the end of it, they were found covered as high as the
ankles with a sanguineous perspiration, which had also soaked
into and stained his stockings. In another case of a healthy
young man. Dr. S. mentions having noticed that, after violent
exercise, the perspiration beneath the arms was of a bright red
colour; and he quotes a similar case from HoflTmann.

In proof that the perspiration over the whole body may also
be of a sanguineous character, he mentions one case in which
it had been observed in a delicate man after copulation, and
then quotes the following still more remarkable case from
Paulini. While surgeon on board a vessel, a violent storm
arose, and threatened immediate destruction to all. One of the
sailors, a healthy Dane, 30 years of age, of fair complexion and
light hair, was so terrified that he fell speechless on the deck.
On going to him, Paulini observed large drops of perspiration
of a bright red colour on his face. At first he imagined the
bjood cam from the nose, or that the man had injured himself
by falling; but on wiping ofl'the red drops from the face, be
was astonished to see fresh ones start up in their place. This

'* And he sweat as it were great drops of blood." Bible.

1849.] Effects of Arsenic in Agriculture, 5G7

coloured perspiration oozed out from diflerent parts of the fore-
head, cheeks, and cliin; but it was not confined to these parts,
for, on opening his dress, he found it formed on the neck and
chest. On wiping and carefully examining the skin, he dis-
tinctly observed the red fluid exuding from the orifices of the
sudoriparous ducts. So deeply stained was the fluid, that on
taking hold of the handkerchief with which it was wipecfoff',
the fingers were made quite bloody. As the bloody perspira-
tion ceased, the man's speech returned ; and when the storm
had passed over he recovered, and remained quite well during
the rest of the voyage.

Effects of the Use of Arsenic in Agriculture. (American
Journal of Medical Sciences..)

Poisoned Game. Dr. Fuller, of St. George's Hospital, has
recently called attention to the probably injurious eflfects re-
sulting from the use of arsenic in steeping seed corn.

*'For some months past,'* says Dr. Fuller, "in certain parts
of Hampshire, partridges have been found dead in the fields,
presenting a very remarkable appearance. Instead of lying
prostrate on their side, as is usually the case with dead birds,
they have been found sitting with their heads erect and their
eyes open, presenting all the semblance of life. This peculiar-
ity, which for some time had attracted considerable attention
among sportsmen in the neighborhoed, led to no practical re-
suit until about ten days ago, when a covey of ten birds having
been found nestled together in this condition, two of the birds,
together with the seeds taken from the crops of the remaining
eight, were sent up to London for examination. I was request-
ed to undertake the investigation, and the result of my experi-
ments I will now briefly detail.

" I first examined the s6eds taken from the crops of the birds,
and detected, as I anticipated, a large quantity of arsenic. 1
then proceeded to ascertain whether the flesh of birds so poi-
soned might not itself prove poisonous when eaten, and with
this view I carefully cut the flesh oflfthe breast and legs of one
of the birds, and gave it, together with the liver, to a fine healthy
cat. She ate it with avidity, but in about half an hour she
began to vomit, and vomited almost incessantly for nearly
twelve hours, during the whole of which time she evidently
suflfered excessive pain. After this nothing would induce her
to eat any more partridge. I kept her without food for twenty-
four hours, but in vain ; she resolutely refused to touch an atom
more of the bird. This being the case, I gave her some beef

568 Effects of Arsenic in Agriculture. [September,

and some milk, which she eagerly swallowed proving, beyond
doubt, that her instinct, and not her want of appetite, induced
her to forego the dainty meal which had just been offered her.

" I cut the flesh off one side of the breast of the other part-
ridge, and, after about an hour's boiling, obtained, by Reinsch's
process, a thin incrustation of metallic arsenic thus demon-
strating, beyond question, what the previous experiments had
left little room for doubting.

" It is notorious that many of the dealers in game are supplied
through the agency of poachers and others, who have a direct
pecuniary interest in supplying them with the largest possible
number of birds. It is certain, moreover, that, if men of this
sort were to find a covey of partridges in a field, dead, but
fresh and in good condition, they would not hesitate to send
them with the remainder of their booty to the poulterer, who
would as certainly, without suspicion, sell them to his custom-
ers. And, after the experiments above detailed, there can be
no reasonable grounds for doubting that these birds, when eaten,
would produce disagreeable and injurious, not to say poisonous,
effects on those who partake of them. It is obvious, therefore,
that in all cases of supposed cholera, or of suspicious bellyache,
occurring at this season of the year, we shall do well to make
particular inquiry as to whether our patient has recently par-
taken of pheasants or partridges purchased at a poulterer's ;
and it is further manifest that, in all cases of poisoning, or sus-
pected poisoning by arsenic, the fact of the persons having lately
eaten of partridges and pheasants must form an important ele-
ment in the inquiry, and must tend to cast a suspicion on the
evidence adduced to prove a criminal intent in the administra-
tion of the poison. So that, in a medico-legal point of view,
the question is one of the gravest import." Lancet.

[The subject to which Dr. Fuller has very properly called
attention has been pretty fully discussed by Mr. Taylor, in his
recently published work on poisons. Mr. Taylor had found
arsenic in the flesh of game which had been poisoned by steeped
corn, and arrived at the same conclusions as Dr. Fuller. The
subject has also been investigated in France, where a commis-
sion was appointed by the Academy of Sciences to prosecute
an inquiry as to whether the flesh of sheep suffering from the
effects of arsenic was poisonous. It was ascertained that the
flesh of poisoned animals is noxious; but if they live sufficiently
long, the whole of the arsenic is voided in the urine and feces,
and the flesh may then be eaten with impunity.] Ph. Journ.

1819.] Monthly Periscope. 509

PART III.
illotitljla IPeriscopc

Origin of Sugar in the Animal Economy. The following conclu-
sions are copied from a memoir on the above subject, by Dr. C.
Bernard in the Archives Generales de Medecinc. ( Western Journal
Medicine and Surgery.)

1st. That in the physiological state there exists constantly and
normally diabetic sugar in the arterial blood, and in the liver of man
and animals.

2d. That this sugar is formed in the liver, and that it is indepen-
dent of a sugar or starch alimentation.

3d. That the formation of sugar in the liver begins before the ani-
mal is born.

4th. That it appears connected with the integrity of the pneumo-
gastric nerves. D. W. Y.

Fecundity. Fecundity is greater with some than with others.
Haller knew families who had sixteen, twenty, twenty-eight, and thirty
children. A friend of mine knew a lady of title, who is still a fine and
youthful-looking woman, who had twenty-seven children. A patient
of mine, at St. John's Hospital, said she had had thirty-two ; and a
woman, aged seventy, appeared at the Police-office, Bow Street, in
May, 1834, who stated that she was the mother of forty children, and
that her daughters had twins three or four times.

Sir George Tuthill is said to have stated, that an Asiatic Russian
had by his first wife sixty-nine infants at twenty seven births ! and,
by his second, eighteen at eight births ! ! eighty-seven children ! ! !
He was alive in 1782, and aged seventy-five years. Hanhemann,
the father of homoeopathy, near eighty, lately married a Parisian lady
aged thirty-six. [^Select Medical Library.

Influence of condition of the Brain on the child. A medical practi-
tioner of Douglas, in the Isle of Man, mentions the following case :
A man's first child was of sound mind ; afterwards he had a fall from
his horse, by which his head was much injured. His next two chil-
dren proved to be both idiots. After this he was trepanned, and had
other children, and they turned out to be of sound mind. [Ibid.

Non-contagiousness of Yellow Fever. By E. D. Fenner, M. D.,
of New Orleans. Be it remembered then, that ever since the city of
Vera Cruz fell into the hands of our victorious army, (March, 1847,)
the intercourse between that place and New Orleans has been unin-
terrupted and very great :

Be it remembered that yellow fever prevails in Vera Cruz all the
year round, if there be any unacclimated subjects present :

Be it remembered that between the first of May and August, 1848,
about 30,000 men, mostly unacclimated^ came from Vera Cruz to

570 Monthly Periscope. [September,

New Orleans ; that these men came on ships, and in bodies number-
ing from 150 to 450 ; that a few cases of yellow fever occurred on
board these ships, and at the hospitals and hotels in New Orleans,
without in a single msiance communicating the disease to those around
them. In this observation I have tlie concurrence of a/Z the army and
hospital surgeons, with whom I have conversed, as well as the
physicians of this city drnd our Board of Health. [New Orleans Med,
aiid Surg. JoumaL

An Anticoniagionist Fact. M. Stienard, of Valenciennes, men-
tions in a paper addressed to the Academy of Medicine, of Paris,
(May 1st), that a child violently attacked by cholera was kept warm
by its parents by being put into bed with them. By this means the
child resisted the algide period, eventually recovered, and the parents
never had a bad symptom. [Boston Med. and S. Jour,

Castor Oil and Spirits of Turpentine in Typhoid Fever. Dr. C. W.
Crozier, of Russellville, Ky., has communicated to us the particulars
of a case of typhoid fever in which, at an advanced period, castor oil
and spirits of turpentine were administered with success. The life
of the patient had been despaired of by her friends, and her recovery
Dr. C. attributes to the use of these remedies, in doses of a teaspoon-
ful each, repeated three times daily. While employing this mixture,
he had the patient bathed m tepid ley, the effect of which seemed to
be salutary. This practice in typhoid fever, attended with coma and
watery discharges from the bowels, was suggested to Dr. C. by Dr.
James H. Baker, of Knox county, Tenn., in whose hands Dr. C. says
it has bean found invaluable. [ Western Med. Jour.

Helonias Dioecia {Unicom Plant.) To the Editor of the Boston
Medical and Surgical Journal. Sir : Having for nine years past used
this article in certain forms of disease, as a remedial agent, and found
very beneficial results to accrue, I feel desirous of introducing it to the
profession.*

The affections for which it is peculiarly applicable, are such as have
their origin in atony of the generative organs of both sexes, hut par-
ticularly those of the female.

In leucorrhoea I consider it invaluable. This, as we are all well
aware, is a source of infinite annoyance to the patient. How often do
we hear complaints of " pains in the head, side, back and loins, loss
of strength, failure of appetite, chilliness, dejection of spirits, and oc-
casional difficult respiration, palpitation, fainting, swelling of the ex-
tremities," &c. &c. Our first impressions may be that we have a
formidable organic malady to contend with, but upon making further
investigation we find that the patient, for a longer or shorter time, has
had leucorrhoea, and perhaps at the catamenial period an undue flow of

* Unicorn is employed by the disciples of the botanical school, as a curative
agent. Vide Mattson,

1849.] Monthly Periscope. 571

that secretion. It is in such circumstances that the unicorn,
judiciously administered, has produced the most happy results. I
use it with a confidence I attach to no other medicine. Under its in-
fluence, the patient, whose life heretofore has been almost a burden,
soon revives. Her uncomfortable sensations vanish, and ultimately
an entire recovery of health and strength is established.

This article may be given in the form of powder, tincture, or syrup.
It can be found at Mr. Wm. Brown's, 481 Washington street, Boston.
The syrup is the most eligible, and Mr. Brown has prepared this in an
exceedingly compact and elegant manner. Dose of the powder,
3jss. ; of the tincture, f 3 j. ; of the syrup, f 3 iij. ; to be taken three
times a-day, half an hour before the ordinary meals. The quantity
may be increased if the patient bears it well, according to the
exigencies of the case but in irritable stomachs nausea, is sometimes
produced, when it will be necessary to diminish, rather than to
augment the dose. I. G. Braman.

Valerianate of Morphine. Dr. Wyman, of Cambridge, near the
University, has shown us a beautiful specimen of this elegant prepa-
ration, valerianic acid and morphine, manufactured in that city at the
Lawrence laboratory. It has been tried partially, and is believed to
combine the properties of the two articles. If Dr. Wyman would
favor the profession with his experience in the use of this new combina-
tion, he would confer a special favor. [^Boston M. and S. Journal.

Homoeopathy and the Cholera (Paris). Dr. Guillot, attached to
the Salpetriere, annoyed at the little success his treatment of cholera
was meeting with, and staggered by the high sounding promises of
the adherents of homoeopathy, lately gave one of the latter six beds in
the-above named establishment, the patients to be treated homoeo-
phatically. Hahnemann's follower immediately set to work, and be-
gan to exhibit, first globules of arsenic, then globules of bryony, and
lastly of charcoal. But alas for the poor patients ! out of seven thus
treated not one recovered ! Of course, the homoeopathic practitioner
was obliged to give up ; but he cheered himself with the belief that,
after running through the whole materia medica, the true treatment of
cholera must at last be found. Similar trials have been made at the
Hopital St. Louis with pretty nearly the same results. These facts
will be a warning to those who would be inclined to give faith to the
magnificent promises of homoeopath ists. [Lancet.

Annihilation of the smell of Musk by Ergot of Rye. Some years
ago, the emulsion of bitter almonds was found to possess the property
of annihilating the smell of musk, and most of the cyanic preparations
evinced the same power. According to M. Bertot, a pharmacien of
Bayeux, in Normandy, ergot of rye will produce the same effect.
"1 had, says he, "to prepare a certain number of pills, containing
both musk and ergot, hardly were the two substance mixed, than
the sttiell completely went off so much so, that the patient, who was not

572 Monthly Periscope. [September,

aware of the nature of the pills only noticed the musk by the effects of
flatulency. [Jour, de Chimie Med., and Boston M. and S. Journ.

Spina-Bifida cured hy Injections of Iodine. An Indiana Journal
reports a case of spina-bifida in a young lady, aged 13 years, cured
by Dr. Brainard by the use of two small iodine injections practiced at
an interval of twenty-five days from each other, and followed by com-
pression. The tumor was situated upon the sacrum, was nine inches
in circumference, and three inches in height, and accompanied by
paraplegia and recto- vesical incontinence. The injection, composed
of one grain of iodide of potassium, half a grain of iodine, and one
drachm of distilled water, was introduced by the subcutaneous method,
and allowed to remain in the tumor. The reaction was considerable
after the first injection, but quite moderate after the second. Com-
pression obliterated the sac. Radical cure in two months. Amelior-
ation of the paraplegia. In very young children and infants a solution
of half the strength of the above. [Annnalesde Tlierap. D. W. Y.,
and West. Journ. of Med. and Surg.

Re-union of an amputated portion. To the Editor Boston Med. &
Surg. Journ. Sir, The unexpected result of a small bit of surgery
makes it worth reporting. The end of a thumb, with a piece of the
nail, was cut clean off by a sharp knife. I secured the amputated
portion accurately in its place with adhesive straps. Perfect union
has taken place, so that the thumb is symmetrical, which could hard-
ly have been the case had the stump been dressed differently.

William Ingalls Jr. M. D.

Quack Medicines. We find in U Union Medicale, that at Aurillac,
in France, the Sisters of Charity sell more drugs to the public than
three apothecaries. They practise medicine without any conceal-
ment, and very often take upon themselves to criticise the physician's
prescriptions. They likewise sell a large amount of quack medicines,
which no regular pharmacien is allowed to keep, and they laugh at
the warnings of the medical jury, as they know themselves supported
by the local authorities. Thus are the most beneficial regulations
concerning the sale of quack medicines frustrated by persons who
ought to afford a better example. [London Lancet.

The Gratitude of Patients. The dowager Queen of Sardinia died a
short time ago. In her will she expressed the wish that the persons
belonging to her household should continue to receive their salary for
the rest of their lives. The executors have excepted one class of in-
dividuals from this favour, and these are no other than the physicians
and surgeons, who were in the queen's establishment. This is the
more to be deplored, as the medical men are the only members of the
household from which this boon was withheld. [Ibid.

Method of Soldering caM iron with wrought iron. The following

1849.] Medical Lite lligence. 573

process has been recommended for this purpose : First melt filings of
soft cast-iron with calcined borax in a crucible ; then pulverize the
black vitreous substance which is thereby produced, and sprinkle it
over the parts which are intended to be united ; after which, heat the
pieces of cast and wrought-iron and weld them together on an anvil,
using only gentle blows. This method is peculiarly applicable for
the manufacture of iron articles which are intended to be made red
hot, and are required to be impervious to fluids or liquids ; as such a
result cannot be obtained by simple fastening. [Ajner. Journ. of Sci-
ence and Arts.

Ink for Steel Pens, by M. Rtjnge. (Polyt. Jour, in Chem. Gaz.)
Ten parts of logwood are to be exhausted with eighty of boiling water.
To the solution one thousandth of its weight of yellow chromate of
potash is to be gradually added the liquid turns brown, and at last
blue black no gum is needed, and the ink is not removed by soaking
in water. G. C. S. [Am. Journ. of Sci. and Arts.

MEDICAL INTELLIGENCE.

The Cholera. It is with sincere pleasure that we announce to our readers the
gradual subsidence of this fearful epidemic throughout our country. Recent
intelligence from various and distant sections of the United States, leaves no
doubt of its regular decline, God grant its complete and speedy extinction.

Through the goodness of a kind Providence, we are able still to report a total
exemption from chokra in South Carolina and Georgia.

A Hen Nursing Kittens. Our friend and correspondent. Dr. Cluintard, for
merly of Macon, now of Marion, writes us, thai during a recent visit made to
Roswell, Cobb Co., he there witnessed a strange phenomenon a hen sitting on
four kittens. When their legitimate mother made her appearance, she was
attacked by the old hen, and failing to drive her off, she then quietly stretched
cut her wings and covered with them the cat and her young progeny.

Organization of a Medical Society in Twiggs County ^ Georgia.

Marion, Geo.
Doctor Eve Dear Sir : On Monday, the 6th Aug., the Physicians of Twiggs
county met in this place, and organized a Society, to be known as the " Twiggs
County Medical Society'^ and elected the following officers.
Dr. R. A. Nash, President.
Dr. Ira Dupree, Vice-President.
Dr. Taliaf. Jones, Secretary.
Dr. Thos. J, JoHNso>j, Treasurer.
The next meeting of the Society will be held in Jeffersonville, on the second
Tuesday in September next, at which time and place a public address will be
delivered by Dr. Charles T. CIuintard.

TALIAFERRO JONES, M. D., Sec. Twiggs Co. Med. So,

674 Medical Intelligence. [September,

National Convention for revising the Pluirmacopa^ia of the United St<ilcs. The
Convention for revisin"*^ the Pharmacoposia, which met in Washington in Janu.
ar)^ 18-40, adopted the ibllowing resolutions:

'*1. The President of this Convention shall, on the first day of May, 1849,
issue a notice requesting the incorporated State Medical Societies, the incorporated
Medical Colleges, the incorporated Colleges of Physicians and Surgeons, and the
hKorporated Colleges of Pharmacy, throughout the United States, to elect a num-
ber of delegates, not exceeding three, to attend a general Convention, to be held
at Washington, on the first Monday in May, 1850.

"2. The several incorporated bodies thus addressed, shall also be requested by
the President, to submit the PharmacopcEia to a careful revision, and to trans-
mit the result of their labors, through their delegates, or through any other
channel, to the next Convention.

" 3. The several Medical and Pharmaceutical bodies shall be further request-
ed to transmit to the President of the Convention, the names and residences of
their respective delegates, as soon as they shall have been appointed, a list of
^vhom shall be published, under his authority, for the information of the medical
public, in the newspapers and medical journals in the month of March, 1850.

"4. In the event of the death, resignation, or inability to act, of the President
of the Convention, these duties shall devolve on the Vice-President, and, should
the Vice-President also be prevented from serving, upon the Secretary or Assist-
ant Secretary, the latter acting in the event of the inability of the former."

In compliance with the foregoing resolutions, the undersigned, having been
informed by the President of the late Convention, Dr. Lewis Condect, that he
would be unable, from indisposition, to perform the duty assigned to him, gives
notice to the several medical and pharmaceutical bodies enumerated in the
first resolution, that a convention lor revising the national Pharmacopccia will
meet in the city of Washington, on the first Monday in May, 1850.

The undersigned also requests of the several bodies referred to, that they will
fulfil the wishes of the Convention, as set forth in the second resolution ; and,
further, that they will transmit to his address, on or before the first of March
next, the names and residences of the delegates whom they may appoint, in
order that a list of them may be published, as directed in the third resolution.

GEO. B. WOOD, M.D.,
Vice President of the Convention o/'l840.

Philadelphia, May 1st, 1849.

The Western Journal of Medicine and Surgery its honorable course. If there
is one thing more honorable, more deserving of imitation than another, in a
learned profession, it is a god-like generosity, a noble liberality towards a rival-
This we conceive to be the true spirit of Christianity the doing unto others as
we would they should do unto us. We are led to these reflections, by reading
in the late Nos. of the Western Journal of Medicine and Surgery, the follow-
ing notices of the rival schools to the University of Louisville, from which
institution this periodical is issued :

" Ohio Medical College. It was announced a short time since, that the chairs
in the Ohio Medical College had all been declared by the Board of Trustees
vacant, preparatory to a reorganization of the Faculty. We learn from the
public prints that the former professors have been restored, and that Dr. Drak
and Dr. George W. Bayless have been added to their number. Dr. Drake takes
the chair of Theory and Practice, and Dr. Bayless has been appointed to the
chair of Descriptive Anatomy. We conrrafnlate- the friends of the school on
the accession of so much talent to its able corps of teachers. Dr. Drake is
now entirely at home in the city and the chair of his choice, and in the school
which he founded. He has our fervent wishes for long life and unvarying
prosperity. Dr. Bayless is a practised and thorough anatomist, and a good lec-
turer, and with his industry and ambition to excel will not fail in the duties of
his chair. The Ohio Medical College, one of the oldest institutionsin the West,
ih 80 identified with our profession, that no one who takes an interest in the

1849.] Medical Intelligence. 575

latter can feel indifferent to the fame of the former. Every friend of true medi-
cal science must wish the college a speedy and complete triumph over those
malign influences which have hitherto hindered its progress."

" lyansijlrania University. Prof. Annan has been transferred to the chair of
Theory and Practice, lately vacated by Prof. Barilett, and Prof. William M.
Boling, late of the Memphis Medical College, has been elected to the chair ol" Ob-
.:tetrics and the diseases of Women and Children, in Transylvania University.
Prof B. is well known to the readers of American medical journals as the au-
thor of many able papers on a variety of subjects. He is a writer of unques-
tioned talents, industry and learning, and although not so well known as a
lecturer, the experience of one winter in Memphis authorizes the belief that he
will not be less successful in that line. His reputation in the South is high, and
his election will strengthen the school in that quarter. We tender to Prof Bo-
ling our cordial wishes for his success."

"Richmond Medical College. Dr. David Tucker, one of the Editors of the
Medical Examiner, has recently been appointed Professor of the Practice of
Medicine, in the above institution. Dr. Tucker is a gentleman of high profes-
sional worth and will doubtless fill the chair to which he has been called with
distinguished ability and success."

A long and prosperous career, honorable we know it ever will be, to Lunsford
P. Yandell, M. D., the author of the above quotations.

T%e New Orleans Medical and Surgical Journal l!\i\s very able periodical,
edited now solely by Dr. A. Hester, one of its original projectors, comes to us
in an entire new dress, in entering upon its sixth volume. It is published every
second month, and each number contains 144 closely printed pages. In despite
of yellow fever, cholera, &c., it has never failed to make its appearance, though
delayed once or twice-
Sustained, as this Journal has been, by such writers and medical philosophers,
as Dowler, Harrison, (yarpenter, Boling, Fenner, Ames, Hort, &c. &c., and
conducted by its talented editor, there is no medical publication having a higher
claim to the patronage of the South and West. In the brief space of five years,
it has done more to illustrate the yelloic fever, to say nothing of its other valuable
contributions to medical science, than all other laborers on the same subject put
together. If Southern and Western physicians desire to know more of the dis-
eases they are called upon to treat, we recommend them to read the New Or-
leans Medical and Surgical Journal.

MEDICAL MISCELLANY.

Death of Mr. Carmicfiael, the Dublin Surgeon. The celebrated Surgeon of
Dublin, Mr. R. Carmichael, was drowned while crossing a river (arm of the
sea) on horseback. By his will, he left considerable amounts of money to be-
nevolent professional objects.

Physicians volunteering to encounter Disease. The Prussian government late-
ly called for 26 physicians of Berlin to be sent to Silesia to aid their brethren
against a formidable epidemic typhus no less than 300 applied to be sent.

Deaths of Medical Students by Cholera. Two medical students have lately
died of cholera in Philadelphia; one, a Mr. White of Mississippi, had distin-
guished himself in the Mexican war.

Death of Mr. Clift, of the Hunterian Museum. Mr. Clift, known as the con-
servator of the Hunterian Museum of the College of Surgeons, London, is dead.

Cure of Polypus b]i Peach Leaves. Dr. Beck, of Delphi, Indiana, says, he
cured a case of nasal polypus of fourteen years standing, by the local applica-
tion of peach leaves bruised and stuffed up the nostrils.

576

Medical Intelligence. Meteorology,

Is the Clwlera contagious? This important question has just been subjected to
a singular experiment at St. Petersburg, by the order of the Czar. Four mur-
derers, condemned to death, were placed in beds in which cholera patients had
died, without being attacked by it. They were then told that now they would
be made to sleep in beds where patients had died of ihe epidemic, and that their
lives would be spared if they escaped. They were, however, placed in beds
never occupied by the choleric ; notwithstanding, the four died in less than three
days from the effects of the imagination. \^Gaz. Med. de Paris.

Rice, a diuretic, and not suitable for boroel complaints. Dr. Tracy, writing to
the Editor of the Boston Medical and Surgical Journal, says that rice without
condiments (red pepper,) proves powerfully diuretic, and is not proper food for
patients suffering from bowelcomplainls this he writes as regards the Siamese
and inhabitants of hot climates.

Death from Cho]erdi-pkobia of a Professor. We regret to announce, from
good authority, that a distinguished Professor in one of oar Northern Medical
Colleges has recently departed to parts unknown, declaring as he went, the
cholera is contagious, it is contagious!

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet.

for July, 1849, at Augusta,
32' west Wash. Altitude above

1
2
3
4

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28 1
29
30
31

Sun Rise.

Ther.

76
74
72
65
61
62
73
73
74
74
71
72
72
70
72
64
67
70
72
72
70
71
72
71
72
72
74
71
70
71
71

Bar.

29 70-100{
" 55-100
" 70-iOOi
" 85-1001
" 90-100
" 95-100
" 95-1001
94-100{
" 90-100
" 78-1001
" 83-lOOi
" 99-100!

30 4-100|
29 95-100!

83-l00!
92-100
84-100
82-100
87-100
89-100
7.5-100
69-100
78-100
85-100
87-100
90-100
93-100
85-100
84-100
90-100
87-100

2, P

Ther.

93~

85
81
89
83
89
88
88
72
81
86
89
92
87
68
78
83
80
77
73
85
86
85
88
88
88
88
84
80

M.
Bar.

29 60-100
" 57-100
' 80 100
" 87-100
" 90-lOOt
" 95-100
" 90-100
^' 90-100
" 85-100
" 78-100
" 88-100

30 I
30 4-100
29 87-lOOi

82-100
95-100
82-100
82-100
89-100
87-100
73-100
70-100
83-100
85-100
87-100
92-100
87-100
80-100
85-100
90-100
82.100

Wind.

w.

S. E.

E.

E.

W.
N. E.
N. E.
N. E.
S. E.
S. E.
S. W.

s. w.

s.

N, E.

S.

S.
S, W.
S. W.

s. w.

s. w.

s. w.

w.

Remarks.

jBreeze storm rain 2inche.'5.

Fair some clouds.

iFair blow cloudy afternoon.

Fair blow.

Fair.

Cloudy sprinkle.

Cloudy.

Showery, 20-100 of an inch.

Cloudy.

Rain, 1 inch and 25-100.

Rainy, 25-100.

Showery, 30-100.

Fair.

Fair some clouds.

Cl'dy stormatS p.m. ) 2 inches

Rain. 5 15-100.

Cloudy some rain.

Cloudy- rain, 10-100. [80-100.

Rain storm at 3i p. m., 1 inch

Rain all dav, 1 inch and 5-100.

Rain -breeze. 35-100.

Rainy morning. [5-100.

Sprinkle rain all night, 1 inch

Sprink. rain all night, 55-100.

Cloudy sprinkle. [25-100.

Cloudy showery day & night,

Cl'y .storm rain. Tin. 70-100.

Cloudy heavy thun.show'ry.

CI'dy rain at 1 & 6 p.m., 20-100.

Cl'dy r. storm at 12 M., 55-100.

B'air morning cloudy evening.

3 Fair days. Quantity of Rain 13 inches and 75-100.
S. 15 day.s. West of do. do. U days.

Wind East of N. and

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 5.] NEW SERIES. OCTOBER, 1849. [No. 10.

PART FIRST,
riginai ommnn\ cations.

ARTICLE XXXI.

A Clinical Lecture upon Colic, delivered at the Augusta HoS'
pital. By L. A. Dug as, M. D., Professor in the Medical

College of Georgia, and one of the attending Physicians to
said Hospital.*

There is perhaps no term so generally misapplied by the un-
professional as Colic, for while it is used to designate all painful
affections of the abdominal region, it is not unfrequently invoked
to qualify pain in almost every other part of the body. Every
practitioner in our country has occasionally heard of colic of
the face, tooth, eye, ear, hand, chest, &c. Indeed, I recently
attended a good matron, who stated that she had a colic in her
blood, which would frequently fly out at the surface and occa-
sion an eruption attended with intolerable itching. It is diffi-
cult to account for so great an extension of a word, which,
being derived from the Greek, KwXou, was evidently designed
originally to convey the idea of pain in this particular portion
of the large intestines. The word is now, however, generally
restricted by the profession to painful affections of the bowels,
attended with constipation more or less obstinate, sometimes
with vomiting, and existing without fever. Even in this re-
stricted sense, it is yet so ambiguous as to cover a variety of
affections essentially different in their nature, and which, there-
fore, require modes of treatment correspondinglj^ dissimilar.
On looking into the works upon the Practice of Medicine, the
Published by request. See this Journal for last June, note, p. 321.

N. S. VOL. V. NO. X. 37

578 Dugas, on Colic. [October,

Physician of experience cannot fail to be surprised at the very
unsatisfactory manner in which this important subject is treated.
Diagnosis is, for the most part, entirely neglected, and the vari-
ous remedial means are enumerated with a degree of confusion
amounting to complete empiricism. It is not strange, there-
fore, that junior members of the profession should generally
regard cases of colic as among the most difficult and trouble-
some they have to manage. Diseases are annoying to a phy-
sician in a direct ratio with the obscurity of their diagnosis :
this once clearly understood, a knowledge of general principles
makes the indication plain, and whether the case terminate fa-
vorably or otherwise, the greatest source of anxiety is removed.

Limiting, then, the application of the term colic to pain in the
abdomen, with more or less constipation, nausea and vomiting,
let us see what pathological conditions may occasion these
phenomena. They may probably be all comprehended under
three heads, viz: lesions of innervation, improper digestion,
and mechanical obstructions. The lesions of innervation in-
duce cramp colic, neuralgic, rheumatic and gouty colic, colica
pictonum, and colic from fa:cal accumulation. Improper di-
gestion occasions flatulent colic and is frequently the exciting
cause of the lesion of innervation, which produces cramp colic.
The mechanical obstructions may arise from intussusception,
from a knot in the intestines, from hernia, adhesions, stricture,
the pressure of a tumor, the accumulation of foreign bodies, as
worms, cherry stones, earthy concretions, biliary calculi, &c.

You perceive that colic is not a disease, but merely a symp-
tom, which may be induced by a considerable variety of cir-
cumstances that no given prescription, nor set of prescriptions,
can be applicable to all cases and that a correct diagnosis
must be of the utmost importance. To treat so extensive a
subject satisfactorily, would require much more time than we
can at present devote to it. I will, however, endeavor, as
summarily as possible, to call your attention to some of the
leading principles by which you should be governed in your
diagnosis and treatment, hoping that you will not rest here, but
extend your researches whenever opportunity presents itself

Lesions of Innervation. The most common form of colic
belonging to this class, is Cramp Colic. The patient is usually

1849.] Dugas, on Colic. 579

taken more or less suddenly, with violent pain in the abdomen,
attended with strong contractions of the muscles and flexion
of the trunk. He feels as if his abdomen were drawn in forci-
bly and that he cannot straighten himself These pains are not
continuous, but remit, to return in a few minutes with increased
violence. Respiration is short, the surface, especially the ex-
tremities, frequently cold, and the pulse in severe cases is very
much depressed from intensity of suffering, and, unless relief
be speedily obtained, the patient may die from the exhausting
influence of pain and impeded respiration. The cramps occur
sometimes after taking a large draught of iced or very cold
water, when the system is overheated ; sometimes, after the
ingestion of articles of difficult digestion ; often without any
appreciable cause.

Now, where is the seat of the spasm or cramp? What mus-
cles are afTected ? On placing the hand upon the abdomen,
you will find that it is hard, knotty, that the abdominal muscles
are evidently contracted with great force, and that their con-
tractions increase simultaneously with the recurrence of vio-
lent pain. These muscles scarcely move during the respira-
tory act. The diaphragm is also not un frequently implicated,
and when this is the case, respiration is still more impeded, and
nausea will probably exist. The patient will tell you, that the
whole of his abdominal contents " are drawn up into a knot, and
that he can scarcely get his breath." Thus far, the seat of spasm
is evident ; but may it not also exist in the muscles of the stomach
and intestines ? The question is not yet decided, although the
probability is in favor of the belief that the muscles of organic
life may and do suiTer spasmodic contractions.

The symptoms just enumerated are so striking, that diagnosis
can present no difficulty, except in very mild cases and even
in these very little. The treatment should, of course, be such
as will most readily overcome the cramp ; J-gr. sulph. morphine,
or 30 drops of laudanum with GO drops tincture of camphor, in
a little water or a tea-spoonful of a mixture of equal parts of
tr. opii, tr. camphor, and sulph. ether, by being repeated every
20 or 30 minutes, according to emergency, will usually be all-
sufficient. These internal* remedies will, however, be mate-
rially aided in their eflcct, by the application of a sinapism

580 Dugas, on Colic. [October,

along the dorsal vertebra?, the origin of the splanchnic nerves.
You should bear in mind, that the first indication is to relieve
the spasm, for it is this that occasions the pain. The remedies
just mentioned, must therefore be given freely, but judiciously.
I never bleed in such cases, nor do I administer any cathartic
until complete relief has been obtained after this, it is very
well to empty the bowels with oil, jalap and cream of tartar,
salts and senna, or any other prompt cathartic. The patient
feels better after it and is less liable to relapse. If there be any
reason to suspect the attack to be occasioned by improper in-
gesta, and vomiting has not already taken place spontaneously,
this should at once be provoked by a prompt emetic. A tea-
spoonful of table salt and one of pulverized mustard, in a cup
of warm water, may generally be easily procured, and answers
the purpose remarkably w^ell. The stomach being emptied,
the opiates, &c., should be immediately administered.

The Neuralgic, Rheumatic and Gouty pains of the bowels,
differ in many respects from Cramp Colic. Their invasion is
more gradual ; they are much more rare, less violent, attended
with neither nausea nor vomiting, more apt to return after
having been relieved by narcotics, and are not materially ben-
efitted by cathartics. Pressure upon the abdomen does not
increase the pain ; percussion does not reveal any undue degree
of flatulency ; the patient is not usually confined to his bed, but
goes about complaining every now and then of sharp pain,
which intermits to return again in a short time. The neuralgic
form not unfrequently assumes the quotidian type, returning
daily 'at the same hour.

In these forms of disease, pressure upon the spinal column
will very often reveal the existence of tenderness over some of
the dorsal vertebrae. The spine should therefore be cupped
freely and then blistered, at the same time that we administer
quinine in combination with morphine, in quantities sufficient
to give relief and lo prevent a recurrence of pain. The pre-
cipitated carbonate of iron may also be advantageously resorted
to, if the disease does not yield to these means.

You have seen that I class Cohca Pictonum with the lesions
of Innervation. I did so, many years ago, and published my
views upon the subject in the Southern Medical and Surgical

1849.] Dugas, on Colic. 581

Journal,* since when, every case I have seen has but confirmed
me in my position. This afiection is, as you know, confined to
those who work in lead mines, or who handle and breathe the
preparations of this metal, in painting, setting type, and other
arts. The pains usually commence gradually, and increase
until they become intense in the extreme. Indeed, I have seen
the patient thrown into violent convulsions, from their severity.
Pressure of the abdomen is rather agreeable than otherwise,
and percussion shows no accumulation of flatus ; yet constipa-
tion, owing to the torpor of the intestinal muscles, is obstinate.
The routine practice, almost universally recommended, consists
of a succession of the most drastic combination of cathartics.
This treatment is founded in the belief, that the lead produces
paralysis of a portion of the intestinal muscles, which allows
an accumulation of faeces and flatus, distending the canal inor-
dinately, and thus occasioning the pain. I think it an error to
attribute the pain to distention, instead of regarding it as en-
tirely nervous, for, although some relief (probably by revulsion)
is experienced during the operation of each dose, it ceases with
this, and it is only after daily purging for about a week, that
the disease finally yields, leaving the patient in a debilitated
state, from which he recovers but slowly. If you will, instead
of this, apply cups freely over the dorsal vertebrae and imme-
diately cover the same region with a blistering plaster, 3 by 12
inches, you will not only procure speedy relief, but also then be
able to empty the bowels with any mild cathartic. A full
opiate will usually complete the treatment. The success I
have obtained by this method of treatment is such that I now
generally expect to give complete relief in one, instead of
7 or 8 days, as required by the usual mode. It is recommend-
ed to use the diluted sulphuric acid, as a prophylactic, after the
attack. I have often prescribed it, but cannot say much in its
favor. The best preventive is a change of occupation, for
after having experienced one attack, the patient will be certain
to suffer again, if he continue to be exposed to the same cause.
There are cases of colic, occasioned by the mere accumula-
tion of intestinal matters. This state of things may result

See South. Med. and Surg. Journal, for December, 183G.

582 Dugas, on Colic. [October,

from deficient mucous secretion or torpor of tiie intestinal mus-
cles, and should then be referred to the lesions of innervation,
as any modification of secretion or of muscular action must
necessarily be the effect of a corresponding modification of the
nervous supply. In these cases, pain is manifested only after
constipation, more or less protracted, the abdomen is full, more
or less hard, sensitive to pressure, and percussion usually yields
a dull sound along the course of the colon, which is impacted,
although it may show the accumulation of flatus in the small
intestines. The pain is continuous, and the patient feels a strong
conviction that he would be relieved if he could only have a
good evacuation. An active cathartic, of salts and senna, or
of jalap and cream of tartar, will then be clearly indicated
and its effect will be made more certain and expeditious, by
applying a sinapism to the dorsal region of the spine. In our
remittent fevers, it was formerly customary to purge freely
and early after the attack, and yet the torpor of the intestines
was often so great as to render this very difficult. In such
cases, I resorted to a sinapism to the spine, and rarely had any
trouble in purging my patient after this.

We now come to the consideration of colics from improper
digestion, and the most common of these is flatulent colic. In
this, the pain increases gradually and is never so violent as in
cramp colic, nor does it occur in the paroxysmal form, although
it is more intense at some moments than at others. The seat
of pain sometimes changes as the flatus moves about ; the ab-
domen is sometimes tumid, though not necessarily so, for the
flatus is occasionally limited to a very small portion of the intes-
tines; pressure over the aflected region is painful, unless the
flatus be thereby dislodged; and percussion reveals the accumu-
lation of gas, by its clear or hollow sound. Eructation, or the
discharge of gas per rectum, is attended with relief, and the
consciousness of this, leads the patient to frequent efforts to
expel it. You perceive that, with these symptoms, the diagno-
sis cannot be difficult. The case cannot be confounded with
either of the forms of colic we have noticed. In the treatment,
we have 3 indications to fulfil :We must, if the pain be very
great, relieve this as soon as possible, at the same time that we
prevent any furtlun- formation of gas and cause the expulsion

1849.] Dugas, 071 Colic. 583

of that already formed These three ends may be accomplish-
ed, by the administration of a dose of castor oil with a tea-
spoonful of the tr. of camphor and 40 or 50 drops of laudanum.
The opiate obtunds sensibility, the camphor, by its aromatic
and antiseptic properties, prevents the formation of gas, and
the oil dislodges and carries down the alimentary and gaseous
contents of the intestines.

By the way, the well known efficacy of aromatics, in aiding
the expulsion of flatus from the stomach and bowels, as well as
in preventing its formation, has not, I believe, been satisfactori-
ly accounted for by writers on Materia Medica. A dose of
the essence of peppermint, or of any aromatic, will almost im-
mediately occasion eructation, if there be any gaseous accu-
mulation in the stomach, and it will prevent its reproduction.
I think that these effects result in the first place from the stim-
ulation of the muscular fibres of the stomach to contraction,
(through the nerves, of course,) and, in the second, from the
arrest of the process of fermentative decomposition, in conse-
quence of the antiseptic properties of the aromatics, brought into
admixture with the contents of the stomach. The same ex-
planation will apply to the effect upon the contents of the in-
testines. Aromatics are of very difficult digestion, and will
readily pass from the stomach into the intestines, without much
deterioration.

In the treatment of flatulent colic, we very frequently resort
alone to the tincture of camphor, for, unless the pain be very
great, it possesses narcotic properties enough, without the ad-
dition of opium, and does not so much impede the action of
the cathartic. It may be well to bear in mind, that the effect
of castor oil is less retarded by opiates than that of other ca-
thartics ; hence the preference usually given to it in such cases.

You will, not unfrequently, see cases in which the distress
is occasioned, not only by the flatus, but also by the excessive
ingestion of food, whether of an indigestible character or not.
In our cities, the practice of eating late suppers is a fruitful
source of colic and of cholera morbus. Men will, at a late
hour, resort to an oyster house and fill their stomach to excess,
with oysters, lobsters, shrimps, crackers, pickles, cheese, brandy,
&c., and immediately go to bed. They are fortunate when

584 Dugas, o7i Colic. [October,

they pass the night with only a Uttle interruption from night-
mare, and have a shght headache the next morning. Some-
times nature reheves itself, by copious vomiting and purging,
before morning, and the glutton charges his suffering to the
account of cholera morbus. Cases of colic resulting from such
imprudence, should be treated at once by an emetic, followed
by tr. camphor and lime water, in repeated doses, until relief
be complete.

Mechanical Obstructions. We have stated that colic may
be occasioned by mechanical obstructions. It is much easier
to determine the existence of such obstruction, than to distin-
guish its precise character. The symptoms, for example, of
intussusception, of an intestinal knot and of internal hernia, so
closely resemble each other, that it is impossible to diagnosti-
cate between them. The same may be said in relation to
the phenomena of stricture of the intestines, of pressure of
tumors upon them, and of adhesions of this canal to the sur-
rounding tissues by which its caliber is lessened or obliterated.
These two classes of obstructions, however, may be generally
distinguished from each other, without much difficulty. The
former present all the peculiarities of strangulated hernia. If
the hernia be external, it can be detected by the eye, and is
therefore not included in our enumeration of cases that may be
confounded. If it be internal, I repeat, it cannot be positively
distinguished from intussusception and an intestinal knot. The
attack in these three varieties of accidei^ is more or less sud-
den, the pain gradually increases in intensity, does not intermit,
and is fixed to a certain locality, from which, at first tender-
ness, and subsequently, great soreness radiates as from a centre
to the whole abdomen, as the peritoneal inflammation advances.
It is attended with nausea, vomiting, constipation, and a degree
of general prostration entirely disproportioned to the amount
of suflfering and duration of the disease in other forms of colic.
The pulse sinks rapidly, the surface becomes cold and clam-
my, the abdomen tympanitic, and the facia3s, assuming the
Hippocratic character, reveals but too surely the doonn of the
patient, who will sink, not unfrequently, in 48 hours from the
invasion of the disease. These attacks are not preceded by
any unusual constipation, nor attended with any great accumu-

1849.] Dugas, on Colic. .085

lation of faecal matter. The distress and danger are rather
the effects of peritoneal constriction and inflammation, than of
a mechanical obstruction to the passage of the intestinal con-
tents. Treatment, save the use of anodynes to relieve distress,
avails nothing. Cathartic medicines only add to the sufferings.

The symptoms and progress of the obstructions, by stricture,
tumors and adhesions, are very different. These causes in-
crease very gradually, and the patient finds that his bowels
are becoming more and more costive, more and more difficult
to move by cathartics. The obliteration of the intestine by
stricture, may be the work of years ; that by tumors, will vary
according to the nature of these ; and adhesions will proceed
more or less rapidly, according to their immediate cause.
When the crisis is reached, the pain is the immediate conse-
quence of the accumulation of foecal matters and flatus, and,
as the obstruction of the intestines has been gradually coming
on, the system does not sympathize with them so readily as in
sudden strangulation. The pain is one of distention ; the por-
tion of the canal below the obstruction may be emptied by
enemata, but no relief is afforded ; nausea and vomiting are
provoked by every mouthful of food or drink taken ; the matter
ejected from the stomach sometimes becomes stercoraceous ;
and the sufferer gradually sinks from inanition, after days or
weeks of anguish. I have before my mind just now, the case
of a female, who lived 20 days after the total obstruction of
the colon by a schirrous stricture, which had been progressing
about 10 years. I need scarcely say, that paliatives are the
only means left us under such trying circumstances. Quiet
your patient's suffering with opiates, and sustain him as long
as possible with nutritious broths, per rectum, after they cease
to be retained by the stomach.

We have been noticing the mpre formidable classes of me-
chanical obstruction. There are others which, although not
less painful, are yet more manageable. I allude to those result-
ing from the accumulation of foreign bodies in the intestines,
such as cherry stones, (some very remarkable cases of which
are upon record), earthy concretions, worms, &c. The symp-
toms here are those enumerated as belonging to faecal accumu-
lations ; and the treatment should be the same, with the addition

580 Dugas, on Colic. [October,

of anthelmintics, if worms are suspected. This suspicion
should be entertained in cases of children, and spigelia combi-
ned with senna, in the form of infusion, given freely every
hour until the bowels be thoroughly emptied. A combination
of wormseed oil (chenopodium anthelminticum), spts. of tur-
pentine, croton oil and syrup, in doses adapted to the age of the
child, is very efficacious in dislodging worms, but should be
discreetly used, lest it irritate the bowels too much. The spi-
gelia is a much safer remedy, and, when fresh, a more certain
one. Indeed, I regard good spigelia, as much a specific for
worms, as quinine is in intermittents.

You probably think that I am about to forget to mention a
form of colic, by no means uncommon in our climate, and
whose name is peculiarly fashionable, if I may use the expres-
sion, with those who regard bile as one of man's greatest ene-
mies. Bilious colic is about as significant a cognomen as bilious
fever ; it means any thing you wish : biliary derangement, ex-
cessive secretion, deficient secretion, vitiated secretion. As
no one should presume, however, to treat of fevers without
devoting a chapter to their bilious form, so no one should over-
look bilious colic, who does not wish to exclude one of the most
dreaded of these affections.

Well, what is Bilious Colic ? You will look in vain for a
description of it in some of the best English works on Practice
the Cyclopedia and the Library of Practical MedicinC; for
example. There is a detailed account of it, in Eberle's Prac-
tice, which, I well remember, when seeking information on the
pathology of this affection, did but add to the confusion I found
to prevail in relation to it. If all cases of colic in which the
patient vomits bile, or passes bile from the intestines, or becomes
jaundiced, are entitled to the distinctive appellation of bilious^
you will perceive, with but. a moment's reflection, that this
is not a special, but a protean form of colic, for a man may
vomit bile, when attacked with colic from flatulency, from
spasm, from obstruction, or indeed from any other cause, if the
case be attended with much nausea and emesis, and especially in
warm weather and in autumn, when tl>is secretion is generally
most abundant in our climate. We should then have bilious flatu-
lent colic, bilious cramp colic, bilious colic with obstruction, &c.,

1849.] Dugas, on Colic. 587

&c. I have long since come to the conclusion that, if the term
be retained at all, it should be so restricted as always to convey
the same and a definite idea. Let the terms we use be intelli-
gible, let them designate some fact or condition that may be
diagnosticated, and then they will cease to lead us astray in
our prescriptions. See the mischief done by calling our remit-
tent fevers bilious, when the presence of bile is but one symp-
tom of the disease. The whole world has waged war upon
bile for two thousand years, when, lo! it is now found that bile
is not the cause, but the effect of the fever, and that by arrest-
ing this, we effectually get rid of the nef^irious secretion ! So
long as you call colics '' bilious,'" you will direct all your ener-
gies against bile and neglect to treat the pain.

But there is a form of colic, in which a portion of the hepatic
system is really implicated very seriously, and which might
therefore, with a semblance of propriety, be called bilious. A
biliary calculus, in making its way down, may become lodged
in the hepatic, cystic or common duct, and give rise to some
of the most excrutiating pains than man can endure. The
attack is more or less sudden, comes on often without any pre-
monition, the pain is vaguely said by the patient to be in the
upper part of the abdomen ; but if you ask him to put his finger
upon it, he will apply it directly over the region of the gall
bladder and biliary ducts, that is to say, a little below and to
the right of the a|phoid cartilage or on the right portion of
the epigastric region. Before the attack has continued long,
he will tell you that he can cover the seat of the pain with a
dollar coin ; but if the obstruction continue, there will radiate
from that point a degree of soreness, which may increase in
intensity and finally 'invade the whole abdomen. This is occa-
sioned by the supervention and extension of peritonitis. If the
calculus be lodged in an hepatic duct, or in the cystic duct, bile
may continue to flow into the duodenum, and may therefore be
ejected from the stomach and intestines ; but if it obstruct the
common duct (the ductus communis choledochus), it must be
obvious, that no bile can pass into the duodenum, that none will
be ejected, and that jaundice will be produced. You have
now solved the whole mystery of the jargon and discrepancies
in relation to the so-called bilious colic. Lose sight of the

688 Dugas, on Colic. [October,

baneful effects of bile, look for the organic lesion, and all be-
comes plain and intelligible to the merest tyro. But let us re-
turn to the symptoms.

The patient suffers intensely, as already stated ; the pain is
persistent, though now and then much aggravated, especially
if the obstruction be in the common duct, and provokes violent
contractions of the cyst ; he rolls about the bed or upon the
floor, in agony ; great drops of perspiration trickle down his
face ; nausea and vomiting supervene upon the ingestion of
liquids to relieve thirst ; the pulse, at first slow and full, becomes
more frequent and thready ; and, unless relieved, he will suc-
cumb more or less rapidly, according to the secondary lesions
that may be induced. If the calculus occupy an hepatic duct,
and does not escape, it may occasion acute hepatitis, abscess of
the liver, and jaundice, which may gradually exhaust the pa-
tient. If it be situated in the cystic duct and remain there, it
may produce the same state of things, in addition to the in-
conveniences arising from a continuous flow of bile into the
duodenum, before it has gone into its legitimate receptacle.
Finally, if it close the common duct, the duodenum is entirely
deprived of bile ; chylification can no longer be properly effect-
ed ; the biliary vesicle becomes engorged and enormously dis-
tended, so as to form a tumor that may be seen and felt exter-
nally ; the liver itself is filled with its own secretion, which
passes into the general circulation with aUf. the symptoms of
deep jaundice ; and, if all this disturbance, added to intolera-
ble suffering, have not exhausted life, the gall bladder may be
ruptured, pour its contents directly into the peritoneal cavity,
and thus speedily close the scene. There are cases, however,
in which adhesions are formed between the biliary cyst and
the stomach or intestines, so that when the rupture takes place
the bile is thrown into the alimentary canal, and recovery may
be thus secured. Such cases are exceedingly rare.

In the treatment of these colics resulting from obstruction of
the biliary passages, the indications are to relieve the pain, to
prevent inflammation, and to facilitate or hasten the descent of
the calculus. The pain must be subdued by sulphate of morph-
ine, repeated as often as necessary. I usually give -} of a grain
every 20 or CO minutes, until the desired effect be secured, and

1849.] Dugas, on Colic. 589

then repeat it as the pain returns. If the sufferings were very
great, you should make the first dose larger, say \ gr. In giv-
ing morphine, I generally prefer a repetition of medium doses
to a very large one, for, as this salt is very soluble, it is imme-
diately imbibed and its full effect is brought to bear upon the
nervous system at once. With opium, the case is different ;
being gradually dissolved by the gastric juice, it is only gradu-
ally imbibed and also gradually carried to the nervous system.
A large dose of opium can, therefore, be administered with
much more impunity than one of morphine. I am induced to
make this digression, because I am well satisfied that I once
saw a case of colic terminate fatally, from an excessive dose of
the sulphate of morphine. Yet, in colics, morphine is prefer-
able to opium, because it is more prompt in its action, and may
be administered when the stomach is very irritable, by being
simply placed upon the tongue.

The violence of the pain having been subdued by the anodyne
it is proper to endeavor by castor oil, salts and senna, and en-
emata, to empty the bowels, not with the expectation of rehev-
ing the pain, but rather with the view of acting revulsively in
favor of the liver and peritoneum, which are threatened with
inflammation, if this have not already taken place. The too
common practice of administering calomel more or less freely
in this form of colic, has always seemed to me altogether ir-
rational. If it be desirable to purge promptly and freely, calo-
mel is assuredly one of the last cathartics we should think of,
for its operation is very slow and it rarely produces those co-
pious stools from which we expect the greatest revulsion. Again,
if it possess, as eminently as it is thought to do by many, the
property of increasing the secretion of the liver, it must aggra-
vate all the evils of an obstruction in the biliary passages. It
would be as unwise to administer calomel in such cases as it is
to give diuretics to one suffering from retention of urine. Ca-
thartics, especially if active, determine the circulation to the
intestines and abstract from the bloodvessels destined to the
liver, a portion of their contents, thus lessening the sum of the
portal circulation and consequently relieving the liver. There
can be no doubt, therefore, that purgation other than mercurial,
is one of the most efficient means by wiiich we may lessen the

90 Dugas, on Colic. [October,

tendancy to inflammation of the hepatic organ. We may add to
these a blister over the epigastrium, when the soreness begins
to extend. Venesection is frequently resorted to, both for the
purpose of producing relaxation and of obviating phlogosis. It
should be advised only in persons of plethoric habit, and, even
then cautiously. We cannot, at the onset of an attack, foresee
how long it may continue, and what a demand may be made
upon the patient for all his powers of endurance. The prudent
practitioner will therefore not too rashly impair energies that
may subsequently be needed to enable the patient to withstand
the prostrating effects of a protracted torture.

In order to hasten or to facilitate the descent of the calculus,
emetics have been recommended. They may be useful by in-
ducing relaxation ; but they are very distressing, and, if the
bihary cyst be much distended, might produce rupture instead
of forcing on the calculus lodged in its outlet. I have never
known them to give relief Tepid or even warm baths are gen-
erally very soothing, and the patient should be allowed to re-
main in them hours at a time, if he does not become faint. He
will often fall asleep in the bath if he be comfortably placed.
The bath gives relief, probably, by determining the circulation
to the surface, and it may facilitate the passage of the calculus
by the unequivocal relaxation it occasions in the whole system.
It should therefore never be omitted if possible, but repeated
as often as circumstances will permit.

There are other painful aflfections of the abdominal region
that may by the inexperienced, be mistaken for colic. Indeed,
I do not know why they might not be included under this gen-
eral name, as well as biliary obstructions, unless it be that they
do not necessarily implicate the alimentary canal. The pains
to which I allude are those occasioned by the obstruction of the
urinary passages by calculi, and those attending disorders of
menstruation.

The formation of calculi in the kidney, and their lodgement
in the ureters occasions pains very similar to those of biliary cal-
culi, exceedingly intense, but readily distinguished by their local-
ity. Anodynes and warm baths constitute the best treatment.
Dysmenorrhoeal pains are paroxysmal and seated in the uterus.
The palliative treatment here is the same, but the preventive
is more com})licated andcannot occupy us at present.

1849. J Campbell, on Infantile Convulsions. 591

I have now, as briefly as the nature of the subject would per-
mit, although not so fully as it deserves, passed in review the
principal forms of colic, and called your attention to the treat-
ment I most approve in each. If you have observed that in
some particulars my views do not accord with others for which
you may entertain respect, allow me at least to indulge the
hope that you will impartially reflect upon them, and apply to
them the surest test: that of bed-side observation.

^ ARTICLE XXXIf.

Infantile Paroxysmal Convulsions, and their Treatment with
Sulphate of Quinine, ivith Cases. By Henry F. Campbell,
M. D., Demonstrator of Anatomy in the Medical College of
Georgia.

"Therapeutics," it is remarked by the elegant and philosophic
Dr. Bartlett, ''rests wholly upon experience. It is absolutely
and exclusively an Empyric Art,"* and this apparently start-
ling assertion, we constantly find corroborated in the results of
our daily application of remedial agents. The theorist is com-
pelled to abandon his most ingenious hypothesis, although proved
by careful and logical ratiocination, to lay aside his favorite,
glowing assumption, and to admit the fallacy of all a priori
speculations, when scrutinized in the ordeal of experience, the
only criterion in medical science. Thus it is, that we receive
daily instruction and humiliation at the hand of nature, and are
made to feel, that it is" only in the humble position of the ob-
server of her phenomena, that we acquire any useful or abiding
indoctrination. But, to many, this rule for study is entirely
disregarded ; observed facts are discredited, unless they can be
distorted into the elucidation of their own theory, and establish-
ed truths are rejected as monstrous assumptions, if varying in
any degree, from the result anticipated by their rational hypo-
thesis.

There is, perhaps, no agent in the Materia Medica, the re-
medial power of which is so often invoked, and yet the thera-

* Med. Philos,, pp. 113-14.

592 Campbell, on Infantile Convulsions. [October,

peutic action so diversely interpreted, as Quinine ; to it, are
attributed the qualities of the stimulant, the sedative and the
narcotic; and while all acknowledge its value and avail them-
selves of its efficiency, as an anti-periodic, each persists in his
own explication of its results. On its introduction, it was pre-
scribed with extreme caution, being deemed applicable only in
intermittent fevers where the intermission was entire, a little
later, and the more marked remittents were treated with it, and
at present, its use has become so general that in nearly every
form of fever, even those of a continued character, its applica-
tion is thought worthy, at least, of consideration. We cannot
discuss the applicability of Quinine under any circumstances,
but we allude here to the relation in which it stands to the pro-
fession as a remedial agent, to show that our own empyrical
administration of it in the cases hereinafter reported, is not
so irrational as might at first sight appear.

From an attentive observation of many cases which our lo-
cality so abundantly affords, we are disposed to an opinion,
somewhat varying with that inculcated by most reports con-
cerning the ^ime of the occrrence of the infantile convulsions
of intermittent fever, viz : that they more frequently than other-
wise, if not invariably, occur at the beginning of the paroxysm,
or during the chill, and not at the acme of fever; and conse-
quently, they are not the result of a high degree of vascular ex-
citernentas has been, I believe, generally supposed. Now, it is
common to find them coming on at a time when there seems to
be least disturbance in the nervous or vascular system ; for in-
stance, a child will be playing or running about apparently
well, when suddenly it is attacked with a violent convulsion,*
often with others succeeding, and after their subsidence, the
case will be found to assume all the features of an ordinany inter-
mittent paroxysm, progessing regularly on to intermission, &c.
Indeed the convulsion seems to take the place of the cold stage
and is, so to speak, a chill very much exaggerated, that is the nor-
mal innervation which in a subject less favorable, would have

* Even while engaged in transcribing this sentence, I am called to the child
of a Professional friend, who has had a convulsion, taken while in excellent
spirits and playing about the room. This evening is the time of its expected
paroxysm, it having had one on yesterday afternoon.

1849.J CaiiJijbell, on Inj'anLile ConvuUloii^. 503

produced only a chill, here in the extremely mobile and impres-
sible nervous system of a child, gives rise to phenomena of graver
and more alarming character, and the paroxysm is ushered in
by a convulsion. We would here advert to an example which
may be considered a transition case between the chill and the
convulsion ; and develops, to a certain extent, our view regard-
ing the character of the convulsion, and the relation it bears to
the paroxysm. E. P., a young woman of nervous tempera-
ment and general bad health, aged about 22 years, on the ad-
vent of her second paroxysm, was affected with involuntary
contractions in the muscles of the arms and legs. I would not
be misapprehended, these were not the ordinary quaking and
subsultus of an ague, but of such a marked character as to as-
sume decidedly the form of a convulsion ; but not to the extent
however of the deprivation of consciousness. She was fully
aware when they were about to commence and would call to
her attendants for assistance in preventing their accession ; here
the ordinary ague-shaking was evidently exaggerated into a
true convulsion. On examination by pressure of the spine, we
found the dorsal and lumbar regions extremely sensible On
the removal of sinapisms from the legs (where they had been
very irrationally applied) to the spine, the convulsions were re-
lieved in a short time, and the administration of Quinine, during
the intermission, prevented the return of the paroxysm. As the
spinal irritation was of long standing, it was deemed expedient
in this case, to apply a blister, a more permanent revulsive.

Thus fully impressed with the analogy between the cold
stage and the convulsion, and having,. in a few instances, suc-
ceeded in arresting the progress of a paroxysm, by the admin-
istration of Quinine, even after the commencement of the chill,
and finding also, that evon when it did not entirely succeed in
arresting the paroxysm, it generally mitigated its violence, thus
disproving the gratuitous and pernicious dogma, that "where
Quinine does not cure, it makes worse," we have been in-
duced to use this remedy empyrically in severai obstinate cases
of infantile convulsions of this character. While we report
them, with some degree of confidence, as sup^gesiive cTpci^iments,
worthy, perhaps, of further investigation, yet we will not admit
for the practice, any thing like establislied merit, as tiic cases

N. ef. VUL. V. NO. X. ]H

594 Campbell, on Infantile Convulsions. [October,

are too few to deserve more than the credit perchance of ex-
citing enquiry into the value of the application.

In the relation of the followins; cases we have not deemed
it necessary to recount minutely the history of each, as they
are, in most respects, but ordinary cases of intermittent fever
and the history of one of them is but the prototype of the others.

Case 1. H. H., a boy, aged 2 years, had had a paroxysm of
intermittent fever, previously, while i)laying about on the floor,
was seized with a convulsion, which was quickly succeeded by
others, which resisting the ordinary means used for their relief,
we resorted to the administration of Quinine, grs. 2^ every hour
tillgrs. 7^ were taken. The convulsions subsided after the se-
cond dose. The calomel, previously given, acted upon the
bowels and the return of the paroxysm was prevented by Quin-
ine given in anticipation next day.

Case 2. Edward Bleese, aged about six years, had been the
subject of tertian intermittent fever for a week. We were
called to see him in a convulsion which came on at the begin-
ning of the paroxysm. When seen, he had had many convul-
sions. The bowels were emptied by oil and enemata mustard
plasters were applied to the spine, abdomen and extremities,
without exerting any controlling influence on the convul-
sions. The convulsive action was almost incessant. Ten
grains of Quinine were administered at a single dose ; in about
an hour after, the convul?ions became less frequent and finally
entirely subsided. The succeeding paroxysm was met with
Quinine, and the patient was afterwards treated for worms
with very abundant results.

Case 3. A. McGraef, a boy of very delicate and unhealty
appearance, aged about 12 years, was seized with a convulsion
on the accession of his third or fourth. paroxysm. He had had
no treatment previous to this call. Dr. J. L. Watkins, then
our pupil, attended the case, and having applied the usual routine
of remedies as sinapisms, enemata, pediluvia, &c.,the following
dose, was administered Quinine grs. 10, Calomel grs. 15.
The mustard plasters, pediluvia, &c. were continued with the
application of cold to the head, and 5 grains of Quinine were
given in an hour after the first dose. The convulsions ceased
inabuul half an hour after the administration of the medicine.

1849.] Caiii[)bcll, on Infantile Convulsions. 595

The sweating stage quickly succeeded, and on the next day, the
boy was apparently as well as ever. Of course more than the
ordinary caution was observed to prevent another paroxysm,
by Quinine the next day.

We also constantly remark, that these convulsions are found
to attend the hebdomadal relapses of the paroxysmal fever, upon
which they depend, as the following will show :

Case 4. S., a child, aged 2i years, of excellent general
health and ruddy appearance, was taken at the first paroxysm
with a convulsion, while apparently quite well. When we saw
this case, the convulsions had continued for more than an hour
with but short intermissions. After ascertaining that the child
had not lately taken any crude ingesta that required removal,
we administered of Hyd. Chlor. Mit. 6 grains, Quinine 8 grains,
in one powder. The convulsions ceased in about an hour after
this dose, and on the operation of the calomel, the fever subsided
and the case regularly proceeded through the phases of an or-
dinary infantile intermittent, and was subsequently treated ac-
cordingly. In about three weeks after, a relapse occurred at-
tended with .convulsions. The Quinine was given in a single
dose of 5 grains in combination with calomel. The douche to
the head and sinapisms to the spine were also applied. The
Quinine was here given earlier, and the case was of shorter du-
ration than before.

We could here advert to other cases, one occurring under the
observation of our friend Dr. L. D.Ford, of this city, wherein
the hebdomadal returns of the paroxysm is invariably attended
with a convulsion in its approach, and another similar one, in
our own practice, wherein the administration of minute doses
of Fowler's solution in the interval prevented the paroxysm and
the attending convulsion, but our limits will not admit of their
full report.

Above we have given a faithful, though not a minute recoun-
tal of four cases of convulsions, treated with the sulphate of
Quinine during the attack. We are free to admit, with due
candor, that they are far from conclusive ; their paucity, as well
as the mixed treatment to which such cases must necessarily
be subjected, detract much from their weight, and render us
cautious in our opinion of their results. Wo are aware that

596 Eve, on Lithotonnj. [October,

our opinion, the opinion of medical men generally, respecting
the effect of their remedies, is apt to be influenced by prejudice,
and determined by a j)riori conclusions, and should be treated
by the profession with some degree of distrust, but still, as we
have before remarked, we would fain attach some little impor-
tance to the results of our observations on this mode of practice,
and although we cannot recommend Quinine as an only reme-
dy, to be depended on in the treatment of this class of infantile
convulsions, we cherish the hope that this report, imperfect as it
is, may instigate further investigation on this subject, so impor-
tant to the profession and to the world.

^ ARTICLE XXXm.

Lithotomy in a hoy 10 years old calculus iDcighs 3xxv. and
measures in the circumferences 7f and 6 inches. By Paul
F. Eve, M. D., Professor of Surgery in the Medical College
of Georgia.

On the 23d of last May, I operated upon a case of stone in the
bladder, near Newnan, Coweta county, Georgia. _ The pattent
was a boy about ten years of age, who had suffered more or less
from infancy, symptoms of calculus. At certain periods he
had been greatly reduced by intense and prolonged irrita-
tion produced by the foreign body in the bladder. The stone
having been readily detected by his physicians, the parents
finally consented to an operation.

Through the kindness of my professional friends, and aided
by them, the usual bilateral operation was performed by me
with the double lithotome, while the patient w^as under the in-
fluence of chloroforn. The calculus was found to be very
large, the cutting instruments were used a second time, the in-
cisions made in the soft parts, were extended, and by continued
and careful traction it was extracted. The stone weighs about
twenty-five drachms or over three ounces. It measures in the
longest circumference seven and three-fourth inches by six in-
ches in the shortest. It is of an oval shape and })retty rough up-
on its surface. Its composition is uric acid.

The patient continued progressively to improve up to the
ninth day after the operation, when he was unfortunately at-

1849.] Eve, on LiikoLomy. 5117

tacked with dysentery, then becoming prevalent in his neigh-
borhood, and which carried him oU'in a few days. His attend-
ing physician wrote me that the wound had nearly healed, that
he had suffered nothing special in the region of the bladder,
and that his death was not attributed to the operation. No
doubt was entertained of his recovery until the invasion of the
bowel aflection.

The size of this urinary calculus compared with the age of
the patient is certainly worthy of note. It may prove to be as
large as any yet recorded. I believe, too, all who witnessed
the operation, were convinced that it would have been extreme-
ly hazardous, if not impossible to have removed it by the lateral
method of lithotomy.

Having had the misfortune to puncture the rectum, so that
gaseous and lluid contents escaped through the section made
in the perineum, while recently operating in another case of
stone, (though this patient was happily dismissed cured on the
eleventh day after the accitient,) I have been engaged in at-
tempting to simplify and perfect lithotomy. My reflections
have resulted in two propositions one, an addition to the staff
or sound, and the other to the double lithotome cachee of Du-
puytren.

When the groove staff is introduced into the bladder for the
performance of lithotomy, a section is next made in, the peri-
neum down upon it. The urethra, it is well known, is a closed
canal, and its mucous membrane is accurately applied upon
any instrument introduced into it. In opening it, then, in this
condition, more or less embarrassment and delay are encoun-
tered. It is precisely at this stage of the operation that the
rectum is usually implicated. To obviate this, w^e have a rude
instrument in our chirurgicuvi armamentum, and Prof. N. R.
Smith, of Baltimore, chairman of the committee of Surgery
for the past year, presented another one for this same purpose,
at the late meeting of the National Medical Association in Bos-
ton. My suggestion is to have the straigiit or upper portion
of the staff made hollow, through which canula a stilet is made
to distend the urelhera at the point to he opened in lithotomy.

My second proposition is to add the cutting edges of the hi-

598 Essay on Intestinal Auscultation. [October,

sector (Stevens's or Post's) to the double lithotome. Those
who have used the lithotome of Dupuytren know that to intro-
duce it into the bladder upon the grooved staff, some force is
required, especially when operating upon children, now consti-
tuting a majority of our cases. This is owing to the size
of the instrument, although the one I employ is made small.
The uretha, instead then of being neatly cut, is actually lacera-
ted by the blunt shoulders of this instrument. If force be used,
the recto-vesical septum may be injured, by its escape from the
groove of the staff. To prevent these accidents, it has occured
to me, that by giving a short cutting edge to the shoulders of
the double lithotome, and by a button added to the beak made
to fit and slide in the groove of the staff, the bilateral operation
of lithotomy would be simplified. A vent or "slit at the* inter-
nal extremity of the staff, would allow the lithotome to escape
from it, when this latter instrument has fairly entered the blad-
der. The cutting edges of the bisector should be made to project
by a spring at the handle of the lithotome this, in order to pro^
tect all other soft parts but the urethra, in manipulating with it.

These suggestions are now before Mr, Charriere, the celebra-
ted instrument maker in Paris, and are here presented for what
they are worth, (perhaps nothing,) to the profession, and with,
out setting up any claims to invention or originality.

PART II.
Het)icrD3 anir ( xtvatis.

An Essay on Intestinal Auscultation. By Charles Hooker,
M. D., Professor of Anatomy and Physiology in Yale
College. (Boston Med. and Surg Journal.)

The object of the following essay, is to draw attention to an
application of the art of auscultation hitherto neglected the aus-
cultation of the sounds produced in the intestinal canal. The
cavity of the stomach and intestines, both in health and disease,
contains, together with solid and liquid matters, a considerable
quantity of aeriform substances. This is shown by examina-
tion after death, when air is invariably found in the intestinal
canal, and may also be rendered evident, at any time during
life, by percussion. These aeriform substances consist of com

1849.] Essay on Inbistinal Auscuilation. 599

mon air, hydrogen and its different compounds, carbonic acid,
and various otlier gases, in variable quantities and proportions
in different subjects and in different conditions of the body.

The peristaltic action, which is constant in health and is
commonly continued in disease, necessarily produces motions
of the solid, liquid and gaseous contents of the intestines; and
from the known laws of acoustics it might be philosophically
inferred that these motions would be productive of sound.
These sounds are sometimes audible at a distance from the
body, and are noticed, under the term borborygmi, as a symp-
tom in various diseases. As the quantity and proportions of
the liquid and gaseous contents of the intestines are known to
vary, and the peristaltic action to be variously modified, by
the changes of disease, it might reasonably be presumed that
the sounds produced within the intestines would be subject to
corresponding variations ; and it is not unphilosophical to sup-
pose that these varieties of sound may afford valuable practical
indications.

It is remarkable that a celebrated English philosopher, who
was not a medical man, directed attention to this subject, many
years before the discovery of the art of auscultation by Laen-
nec. Hook, in his posthumous works, says, "There may be a
possibility of discovering the internal motions and actions of
bodies by the sound they make. Who knows but that, as in a
watch we may hear the beating of the balance and the running
of the wheels, and the striking of the hammers, and the grating
of the teeth, and multitudes of other noises ; who knows, I say,
but that it may be possible to discover the motions of internal
parts of bodies, whether animal, vegetable or mineral, by the
sound they make ; that one may discover the works performed
in the several offices and shops of a man's body, and thereby
discover what engine is out of order, what works are going on
at several times, and lie still at others, and the like ? " " I have
this encouragement" " from experience, that I have been able
to hear very plainly the beating of a man's heart ; and it is com-
mon to hear the motion of the wind to and fro in the guts and
other small vessels ; the stopping in the lungs is easily discovered
by the wheezing." The prediction of this philosopher, who, as
Dr. Elliotson observes, seems almost to have prophesied the
stethoscope, has been fully verified in reference to the thoracic
viscera and the gravid uterus; but to this time it has been
strangely neglected in the iivestigation of the condition and
action of the intestinal canal.

It is now more than twenty vears since I have habitually at-
tended to the sounds produced in the abdomen in various dis-
eases; and in the early stage of my investigations I indulged

600 Essay on Intestinal Auscultation. [October,

the hope, that in disorders of the intestinal canal auscultation
might gain nearly the same distinctness and precision, that it
had already acquired in relation to thoracic diseases. Though
I long ago relinquished this sanguine expectation, continued
observation has confirmed my opinion of the importance of the
subject, and has enabled me to discover practical indications,
which I regard as of great value.

When the ear is applied to the abdominal parietes of a
healthy subject, there is heard an almost constant succession of
sounds produced by the motion of tiie contents of the intestinal
canal. These sounds are varied by many causes, such as the
quickness, regularity, and other variations of the peristalic
action, the degree of fulness of the intestines, the proportions of
the gaseous and other contents, the fluidity of the liquid con-
tents, &c. The sounds, thus varying with the causes of their
production, afibrd indication of these several causes ; and they
thus become signs of actions and conditions of the intestines, a
knowledge of which is of the utmost importance in investigating
the diseases of these viscera. " In most diseases of the intestinal
canal the sounds do not afford definite diagnostic signs to char-
acterize the different diseases, like the diagnostic signs dis-
closed by auscultation in thoracic diseases. They are chiefly
signs of particular conditions or actions, which may occur in
various intestinal diseases, rather than diagnostic signs to distin-
guish different diseases. In some diseases, however, signs are
thus obtained, which perhaps may be considered as truly diag-
nostic of the diseases in which they occur.

In the Asiatic CJiolera, which prevailed in New Haven in
1832, this application of auscultation was attended with inter-
esting results, which were noticed in an account of .the cases
which came under my observation, published in the Boston
Medical and Surgical Journal for July, 1833. Writers gener-
ally noticed the loud borborygmi, audible at a distance from
the patient, which occurred in that disease ; and to the ear
applied over the abdomen the sounds were so peculiar at
least so difierent from what I have observed in other diseases
that they seemed distinctly characteristic of that disease.
These sounds manifested a rapid commotion of the whole in-
testinal canal, and might be compared to those produced by
shaking together several flasks of various sizes partly filled
with water. Frequently the sounds appeared to indicate that
the rapid peristaltic motions wete suddenly arrested and re-
versed by an anti-peristaltic action, which occurrence imme-
diately preceded a paroxysm of vomiting. The large quantity
of serum ediiscd into the intestines, causing an extreme fluidity
of their contents, with the rapid and irregular peristaltic and

1849.] Essay on Intestinal Auscultation. 001

anti-peristaltic motions, would sufficiently account for this un-
usual variety of sounds.*

The effects of various remedies upon the intestinal action, as
indicated by the sounds, were carefully observed. Practition-
ers were generally disappointed, in that disease, to find the fre-
quent vomiting and purging not checked by the administration
of stimulants and astringents; and the sounds manifestly in-
dicated that the common effect of these remedies was decidedly
to increase the intestinal commotion.* Such was the manifest
effect of opium, unless given in doses so large as to produce
alarming prostration. On the contrary, frequent small doses of
camphor, with a free administration of ice, appeared to have a
soothing operation in moderating the rapid and irregular in-
testinal action. The comparative effects of large and small
doses of calomel were strikingly interesting. Frequent small
doses did not seem to diminish, but at least temporarily to in-
crease, the disordered peristaltic and anti-peristaltic motions ;
while a single drachm dose almost invariably caused a total
suspension of thf se motions. Calomel, in very large doses, thus
seemed to be the appropriate remedy for the disease It ap-
peared to overpower the diseased intestinal action, arrested the
vomiting and purging, and caused a total suspension of all in-
testinal motion,, during which no sound was audible. An
interval of perfect intestinal silence and repose now continued,
ordinarily from eight to twelve hours, after which a natural
peristaltic murmur indicated a gradual return of healthy action,
which was in time succeeded by the grass-green evacuations,
commonly regarded as evidence of a fa\;orable crisis of the dis-
ease. Thus the large doses of calomel, instead of exhausting
the system by an excessive cathartic operation, actually ob-
viated exhaustion by arresting the profuse serous evacuations
attending the di.sease.

Ordinarily the danger was considered as overcome, when
the disordered intestinal action was suspended, and the stage of
repose produced ; and in this town few cases terminated fatal-
ly, when the practice was adopted of effecting this result by
the large doses of calomel, before the system had been ex-
tremely exhausted by evacuations. In one case, however,
that of a little girl, 10 years of age, who, without any premoni-
tory symptoms, was most violently attacked with vomiting,
purging and spasms, this treatment had the ordinary effect of
promptly arresting the intestinal motions ; but the system did

*It remains to be shown, whether these sounds are constant diagnostic signs
of tliis disease, or whether, as I have observed in dysentery and other diseases,
the varying epidemic type, in different seasons, will produce in cholera a
variation of morbid intestinal action, with a corresponding variety oi' sounds.

002 Essnij on Intestinal Auscidtation. [October,

not re-act, the pulse failed and became imperceptible within an
hour from the attack, the coldness and lividity of the surface
increased, and, without any return of peristaltic action, the
patient died five hours from the attack.

Cholera Morbus is usually attended with intestinal sounds,
which indicate a succession of quick and irregular peristahic
and anti-peristaltic motions. In some cases these motions
continue until the contractile power of the intestines seems
nearly exhaustecl, when a* feeble, but more regular, peristaltic
and anti-peristaltic motions. In some cases these motions con-
tinue until the contractile power of the intestines seems nearly
exhausted, when a feeble, but more regular, peristaltic murmur
indicates a gradual return of healthy action. The violent
symptoms are not succeeded, as in Asiatic cholera, by a long
interval of total inaction of the intestines ; and the sounds are
very different from those heard in that disease.

There is, however, a great diversity in cases commonly
termed cholera morbus. Some cases commence with a vio-
lent diarrhoea, on the cessation of which occurs an obstinate
vomiting, during which, as in colic, no intestinal sounds are
heard, except those produced by anti-peristaltic action. Other
cases commence with vomiting, without any downward' mo-
tions, until at length the action is reversed, and the disease
terminates with diarrhoea.

Colic is a disease which is variously divided by writers into
several species. One of these, termed C. rachialgia, C.
pictonum, &c., produced by the poison of lead, has character-
istics certainly sufficient to give it a specific distinction ; but
the other divisions, I think, have reference to various exciting
causes, or attendant circumstances, rather than to any proper
specific characters. In the various forms of this disease
auscultation affords results, which I regard as highly inter-
esting, and of much practical value, and which may throw
some light on the pathology of the disease.

Common Colic is characterized by "griping pain in the
bowels, chiefly about the navel, with vomiting and costiveness."
The exciting causes are various, as irritating indigested food,
biliary derangement, habitual costiveness, hardened faeces, flatus,
worms, exposure to cold, and what I consider as much the
most common cause rhucmatisni affecting the intestines.
With these various exciting causes, the general characters of
the disease are similiar ; the severe griping pain, obstinate
constipation and vomiting, constituting the prominent symp-
toms.

There is, however, an incipirnt, for/nin^, or latent stage,
wliich with strict observation I think mav always be noticed,

1849.] Essay on Inlestinal Auscultation. 003

preceding the pain and other violent symptoms. The symp-
toms of this stage somewhat resemble those which precede the
cold stage of intermittent fever. There is a general languor
and lassitude, often a degree of moroseness or peevishness, nnd
commonly a slight chilliness. The sensations in the abdomen
are variously described by patients, as a numb, dead, heavy, or
cold feeling. Many speak of a sensation, as of a cold weight,
felt mostly between the region of the stomach and umbilicus.
The physician is rarely consulted during this stage; and the
symptoms are so slight, that ordinarily they are not particular-
ly noticed by patients unaccustomed to attacks of the disease ;
while persons subject to frequent attacks learn to notice these
sensations, as the invariable precursors of the more violent
syjnptotris.

In this stage, which continues in different cases from half an
hour to several hours, auscultation discovers a perfect stillness
within the abdominal cavity. Sometimes there is an occasion-
al rumbling in the course of the large intestines; and, with a
desire to relieve the. unpleasant sensations, the patient, by a
voluntary straining effort, produces an evacuation of faeces
with a quantity of flatus. There is, however, no indication of
the slightest motion in the small intestines. This forming or
latent stage of colic, which is commonly overlooked both by
patients and physicians, is deserving of particular attention ;
because during this stage the peristaltic action is easily restored,
and the violent symptoms thus prevented. In many cases this
may be effected simply by the application of heat to the sur-
face, especially to the extremities. Friction to the abdomen,
with a sort of kneading process, contributes also to this effect.
Often a free draught of hot coffee, or of some aromatic infu-
sion, is sufficient; in other cases, a small dose of rhubarb, or
other mild cathartic, with some aromatic, is required. Com-
monly, a ^Qw drops of cajeput oil will promptly restore the
peristaltic action. My usual remedy for this purpose is cam-
phor, in frequent small doses ; and I have instructed many per-
sons to w^ard oft' habitual attacks of colic, by carrying con-
stantly in the pocket a small piece of camphor, to be gradually
dissolved in the mouth, and swallowed with the saliva, when-
ever these premonitory symptoms occur. This remedy is
often more effectual, in exciting peristaltic action in such
cases, than a brisk cathartic.

This forming stage, unless the peristaltic action is soon re-
stored, is succeeded by the violent symptoms of the disease.
With occasional short remissions, the pain become severe ; the
abdominal muscles are rigidly contracted, producing a knotted
appearance of the surface, and there is occasional nausea and

cot Essay on Intestinal Auscultation. [October,

vomiting. The patient groans, and throws himself into various
positions, with the vain hope of relieving his distress. In this,
as well as in the forming stage of colic, the ear applied to the
abdomen discovers no evidence of peristaltic action, but on the
contrary a perfect stillness within the abdominal cavity.

This cessation of peristaltic action, I may confidently assert,
is Si chief essential characte?^ of colic ; the motion being suspen-
ded before the occurrence of the violent symptoms, and not
recurring until the disease is about to yield. Sometimes
during the violent contortions of the body, a momentary sound
is heard, indicating a slight intestinal motion, which seems to be
produced by the mechanical pressure of the abdominal parietes,
rather than by a peristaltic action. Occasionally, too, there are
sounds produced by anti-peristaltic motions, which motions
either terminate at the stomach causing simple nausea, or ex-
tend into the stomach so as to excite vomiting. By these circum-
stances, and by the variety of sounds, anti-peristaltic motions
can commonly be distinguished from a regular peristaltic ac-
tion. This distinction is important, for as a cessation of
peristaltic action is a main essential character of colic, so a
return of this action indicates a favorable crisis of the disease.
The sounds produced by anti-peristaltic motions are only oc-
casional and transient, preceeding commonly from a limited
portion of the intestinal canal ; and they are usually succeeded,
as before stated, by nausea or vomiting. Those attending a
regular peristaltic action are produced throughout the whole
course of the intestines, constituting an almost incessant rum-
bling, heard distinctly at one moment directly under the ear,
then ffraduallv recedinc: until it seems like a distant echo, and
again returning in the course of the convolutions of the intes-
tines. There is thus a union of near and distant sounds, indica-
ting a general action throughout the intestinal can<il. When
this description of sounds is iieard in colic, the patient may be
considered as safe, even if the pain continues severe ; on the
contrary, a complete subsidence of the pain and other violent
symptoms, unless attended by a return of healthy peristaltic
murmur, ailbrds no favorable indication, in any stage of the dis-
ease, and in an advanced stage, when the strength is exhausted
by protracted suffering, it indicates extreme danger a loss of
the sensibility and excitability of the intestines, and a failing of
the powers of life.

Commonly, a return of peristaltic motion is followed, almost
immediately, with a relief of pain and other severe symptoms;
but in protracted cases, when the bowels have become inflamed,
and the soreness such that the h^ist external pressure cannot be
tolerated, this return of peristaltic motion causes a decided in-

1849.] Essay on hitcstinal AascuUation. 605

crease of pain. This circumstance is similiar to what is often
observed during the resolution of pneumonin, when a return of
respiration to a portion of inflamed lung, which has previously
been impermeable to air, produces the keenest pain. In such
cases auscultation informs us that all is well, when the sensa-
tions of the patient would indicate an aggravation of the disease.
The signs thus furnished, in colic and other diseases, will often
direct the witliholding of medication, when it is no longer re-
quired, and when its continuance might sometimes be injurious.
Frequently they have enabled me to assure patients that the
cause of difliculty was removed, and that my services were no
longer required, some hours before the general symptoms
showed signs of any mitigation.

Some eighteen years ago, I called one morning to see an
eminent medical friend, who had been subject to frequent at-
tacks of colic, and who was now thought to be dying, after a
night of extreme suffering with this disease. Applying my ear
to the abdomen, I immediately assured him that a regular
peristaltic action was restored, and that the danger was over.
He replied that he experienced no relief of symptoms, saw^ little
reason for encouragment, and felt as though he could survive
but a short time. The pain was now severe and increasing ;
and it was more than two hours from this time before the ap-
prehensions of the patient, and of his friends generally, were at
all relieved. In this case, as in many others that I have ob-
served, it was full three hours, after my confident assurance
that the disease had made a favorable crisis, before there was
any evacuation from the bowels.

In March, 1847, 1 was called at night to a man affected with
colic. After the usual precursory symptoms, he had now, for
about too hours, suffered severe pain, which had suddenly in-
creased within the last few minutes, so that he could hardly
be confined to the bed. The application of the ear discovered
a regular active peristaltic motion. I concluded that this was
a case, such as are sometimes observed, of a spontaneous re-
storation of peristaltic motion, and that this returning motion
had caused the present sudden increase of pain. As the pain
had not corrtinued long enough to induce any considerable
inflammation or soreness of the intestines, I did not hesitate to
assure him, that if he would keep warm in bed, the pain would
soon subside. I remained with him about thirty minutes, and
left him in a quiet sleep not taking to myself the credit of a
cure, as-I might have done, had not auscultation informed me
that a spontaneous natural action had rendered medication un-
necessary.

Pathologists entertain different opinions in reference to the

606 Essay on Intestinal Auscultation. [October,

immediate cause of colic. Some, with CuUen, consider the
symptoms as owing to a spasmodic constriction of the in-
testines; while Abercrombie and others attribute the inaction
of the intestines to torpor, or a loss of their muscular power.
1 am inclined to the latter opinion to attribute the inaction
of the intestines to a suspension of the motor nervous influence,
and the supervening pain to a morbid excitement of the sensi-
tive nerves. Such an association of paralysis of motion, with
morbid sensibility, is not uncommon in other parts of the body.
Paralysis of the limbs is often attended with paroxysms of
severe pain : and in a painful sciatica, and in neuralgia of va-
rious parts of the system, the motor nervous influence is usually
more or less dimished.

It is well known, however, that all the symptoms of colic are
produced by any obstruction which mechanically arrests the
motion through any portion of the intestines ; as in strangula-
ted hernia, involution of the intestines, and in cases of ob-
struction from impacted faeces, calculi, .or any solid sub-
stances in the intestinal canal. It is remarkable, moreover,
that the same results are caused by sympathy of the intestines
with obstruction in other parts ; as a foreign substance in the
cul-de-sac of the appendix vermiformis, calculi in the ureters,
gall-stones in the biliary ducts, and also in severe cases of
dysmenorrhcea.

In all these afiections, in some stages of the complaints at
least, there is the same total suspension of peristaltic motion,
which occurs in colic. When the mechanical obstruction is
obviated in these complaints, -as in the relief ot the strangula-
tion in hernia, it is commonly observed that the relief is im-
mediately succeeded by a rumbling sound in the intestines,
which is usually followed by alvine evacuations.

It may be difficult to explain how these various mechanical
obstructions should cause a suspension of the motor nervous in-
fluence in the intestines ; but from my observations I may as-
sert that there is commonly (I would not say invariably) the
same numb, heavy sensation, preceding the pain and other
violent symptoms, that I have described as constituting the
forming stage of colic. '

Colica Rachialgia {Tjcad Colic) may be considered as
specifically diflerent from common colic. Its cause, its symp-
toms, and its obstinate character, sufficiently distinguish it.
Auscultation, also, in the course of the disease, discovers signs,
which are distinctly characteristic. There is not, indeed, any
paiticular sign, which, like the crepitation characteristic of
pneumonia, the moment it is heard, decides the character of the
disease ; but the auscultator has to notice a succession of va-

1849. J Essay on Intestinal Auscultation. 607

rious signs, which are severally indefinite and insignificant,
from the assemblage of which he will form his diagnosis.

The peristaltic action is wholly or partially suspended for a
longer period, and is re-excited with more difiiculty, than in
common colic. Some cases I have closely w^atchecl, for two,
three and even six days, without observing the least sound of
peristaltic motion. More commonly, however, the stillness of
the intestinal canal is occasionally broken, for a few moments,
by a dull rumbling sound, indicating a slight and sluggish ac-
tion in a limited portion of intestine. Often there is a transient
blowing or-sub-whisthng sound, seemingly produced by wind
crowded through a contracted portion of intestine. JDuring
the whole disease, aU the intestinal motions appear weak, slow
and sluggish ; the sounds not having the suddenness and regu-
lar succession of healthy peristaltic action. Indeed, for weeks
or months after convalescence, ordinarily the sedative influence
of the lead appears to continue ; the sounds indicating, a torpid
intestinal action, and regular evacuations being procured with
difficulty.

This disease does not, like comon colic, form a crisis by a
sudden transition from total inaction to a general peristaltic
motion, which terminates the disease. But in lead colic,
sometimes for days before there is any decided improvement,
an occasional rumbling is heard, indicating a considerable in-
testinal action. Again perhaps within an hour, or on the
succeeding day w^e find all silent ; and for several successive
days, these intervals of inaction may alternate with efforts of
the intestines to re-establish peristaltic motion. From not be-
ing aware of this circumstance, in my early observations, I
sometimes concluded that a favorable crisis had occurred, long
before the disease was subdued.

In this disease, as in common colic, sounds frequently occur,
produced by anti-peristaltic motions, which the practitioner
should not mistake for regular peristaltic action.

In dysentery there are no characteristic sounds, attending
the disordered intestinal action, sufficient to distinguish it from
other diseases. The general character of this disease varies
much in different seasons : and in particular cases, there are
many variations of disordered action, in its different stages.
These variations, however, are productive of signs, which,
after a little observation of the epidemic tendencies, the
auscultator m.ay learn to improve, in watching the changes, of
symptoms, and in directing his treatment.

Though no constant rules can be given, for the sounds to be
expected in the course of this disease, it is useful to watch by
ausculation the changes which occur in different portions of

608 Essay on Intestinal Auscultation, [October,

the intestinal canal. Commonly, thoiifrh the disease is seated
chiefly in the large intestines, the small intestines are more or
less afTected, their peristaltic action being irregular sometimes
morbidly increased, bat more commonly diminished, and some-
times wholly suspended. Attention to the signs furnished by
auscultation will often enable a practitioner to avoid being taken
by surprise, by the changes which frequently occur in the
course of this disease.

The proper management of cat! tar tic 7?iedicines is one of the
most important, and often one of the most difficult, subjects in
medical practice. The indications and contra-indications, for
the use of this class of remedies, are often obscure ; and in the
course of almost every case of fever, and other dangerous dis-
ease, the practitioner will frequently on this subject find him-
self in doubt. It is obvious that a correct knowledge of the
condition and action of the intestinal canal must essentially aid
to render these indications plain. Hence every available means
of acquiring such knowledge is calculated to aid the practi-
tioner's decision in frequent cases of doubt and uncertainty.
It is in this point of view, perhaps, more than any other, that
the exploration of the intestines by auscultation must become a
valuable auxiliary to the healing art. Much information is
thus afforded, in regard to the action and the contents of the
intestines circumstances which are obviously important in
determining the indications for cathartics.

In many cases the practitioner is importuned by patients, or
their attendants, for the employment of cathartics, when the ap-.
plication of the ear would give assurance that spontaneous
evacuations will soon occur. So when cathartics have been
administered, we have a pretty sure criterion, in the signs fur-
nished by auscultation, of the operation which they are likely to
effect. The practitioner is thus guarded against over-dosing
with cathartics, and thereby causing exhausting evacuations,
which might be very injurious in a debilitated condition of the
system.

It would be superfluous to attempt a description of the sounds
which afford these indications, as a little observation renders
obvious the sounds caused by a rapid peristaltic action briskly
agitating the liquid contents of the intestines.

In cases oi diarrhoea this method of exploration is valuable
in forming an estimate of the severity and obstinacy of the
complaint. In many cases moreover, in the progress of fevers,
and otlier diseases, the intestinal sounds will give the practi-
tioner timely warning of the approach of this complaint, long
before the occurrence of any evjicuations; just as in pneumonia
tiie sign of cre])itation reveals the character of the disease,

1849. J Essay on Intestinal Auscultation. 609

sometimes long before the appearance of the characteristic
bloody sputa. The occurrence of a diarrhoea being thus anti-
cipated, it may often be prevented by timely medication.

In other cases when the occurrence of frequent copious eva-
cuations might othervv^ise cause serious apprehension, we can
by this means obtain immediate assurance that there is no
danger. A single case is subjoined, as an instance of the satis-
factory information frequently afforded me in such cases.

Some years since, I was called in haste, in the absence of the
attending physician, to visit an aged woman, who in the course
of a fever had been suddenly attacked with diarrhoea. The
evacuations had caused extreme exhaustion, with faintness ;
and the patient and her friends were much alarmed. Apply-
ing the ear over the abdomen, I decided unhesitatingly that the
diarrhoea would give no further trouble ; but in reply I was
told that for two hours the evacuations had been copious and
frequent, the last only a few minutes previous ; and it was
urged that immediate remedies must be applied for arresting
the complaint. I persisted in my decision, and did nothing ex-
cept to quiet the alarm with my assurances that the diarrhoea
was suspended. It was now early in the afternoon ; and I af-
terwards learned, from the attending physician, that there was
no subsequent evacuation until the next morning.

The method of exploration, recommended in this essay, may
be practiced, either by the direct application of the ear, or
through the medium of the stethoscope. The stethoscope is ad-
vantageously used, when it is desired to discover the sounds
originating in any definite region of the intestinal canal ; but for
most purposes the direct application of the ear is preferable.

It is an advantage of the latter method, that ordinarily, it does
not require the bed-clothing of the patient to be removed ; as
the sounds, which are the objects of investigation, may com-
monly be heard, with sufficient clearness, through several thick-
nesses of clothing theear being applied, with moderate pres-
sure, over the abdomen, while the patient is lying on the back.
In no case, whether the immediate or mediate method is adopt-
ed, is it required to entirely uncover the abdomen.

The immediate method has another advantage, that it not
only discovers the sounds originating directly under the ear,
but at the same time notices those produced in more distant
portions of the intestines. It thus takes a general observation
of the condition and action of the intestinal canal, more fully
than can be done with the stethoscope.

In conclusion, I would remark, that the purpose, of bringing
to the notice of the medical profession the subject of intestinal
auscultation, has been delayed for many years, with the hope

N. S. VOL. v. NO. X. 39

()10 Early Pregnancy, cj-r. [October,

of being able to give the subject a more satisfactory degree of
precision and system. The importance of the subject, it will
be understood, is claimed,, not so much from its affording signs
to characterize and distinguish different diseases, as lor its
giving indications of particular morbid conditions and actions
of the intestines, which may occur in diseases. The difficulty,
which has been my chief source of discouragement and delay,
lias been the impossiblity of giving a satisfactory description
of the sounds aObrding these indications. To describe sounds,
by language, is ordinarily a difficult matter. We recognize at
once the voices of familiar acquaintances; but we should fail
in any attempt to give a definite description of the sounds of
these various voices. So the auscultator may discover varia-
tions of sound, produced within the intestinal canal, which a
little observation will enable him to recognize, as signs affording
clear and valuable indications ; but these signs are to be leamed
by the practioner's own experience, rather than from any des-
cription which the experience of others can furnish.

Early Pregnancy : and Infantile Menstruation. (London
Journal of Medicine.)

In the London Medical Gazette, for 3d Nov. 1848, Mr. John
Smith publishes a recent case of Early Pregnancy. It is in-
teresting, not only from the extreme youth of the mother, but
from the fact of her having borne a living and tolerably healthy
infant. The following is Mr. Smith's narrative:

"At the Coventry Assizes, of August, 1848, Julia Amelia
Sprayson preferred a charge of rape against her uncle, James
Chatiaway,who was convicted of the assault, and sentenced to
two years' imprisonment and hard labor in the House of Correct
-ion. The girl was far advanced in a state of pregnancy, and as
it is of rare occurrence for conception to take place at so early an
age as heiwecn eleven and twelve years, many surmises were
expressed by the gossips as to what would be the probable issue.
She continued in good health up to the day of delivery, which
took place on the IGth September, 1848. In the early part of
the morning she became restless and uneasy ; and from the hour
of 11, A. M., slight pains occurred at irregular intervals, until
about 5, P. M., when it was evident that labor was rapidly ad-
vancing. On being sent for soon after, in consequence of the
absence from town of Dr. Dewes, who had been engaged to at-
tend her, I proceeded to make an examination, when I found
ifie pelvis of average dimensions, and the os uteri about the size

181D.] Early rrcgnancy, 6yc. (jll

of a shilling piece ; but as the parturient throes were active,
and returned every ciL:;ht or ten minutes, it appeared prudent to
remain until the case had terminated. Nothing remarkable su-
pervened during the progress of the labor, except that it wasof
unusually short duration. From first to last she was not more
than ten hours ailing, while the period of actual labor was not
extended beyond four hours, and this would have been further
shortened but for the smallness of the external outlet. The
subsequent symptoms were just as favorable as the labor had
been short. The lochia ceased after the lapse of a few days:
the mamma) became duly developed, and the secretion of milk
was so copious as presently to suggest to her mother the idea
of seeking for a situation as wet nurse. The infant at birth was
lonu, slender, and emaciated, but rather below the average size,
and in many respects may be said to have borne a striking re-
semblance to the offspring of mothers who had been imperfectly
nourished durins^ preg:nancv. It did not occur to me at the
time, either to place it in the scales, or to take its admeasure-
ment, but atthetime of writing this report (23d October, 1848,)
it is 81 pounds in weight. The present weight of the mother
is 1041 pounds. When she had so flir recovered as to take a
share in domestic avocations, it seemed adv-isable to pay her an
early visit, to elicit if possible, some farther information than
what had transpired in court, with a view of establishing; some
data as to the period ofuterogestation ; and although foiled and
disappointed with the result of this part of the investigation,
some particulars of interest were readily obtained. She was ra-
ther of prepossessing appearance, of fair complexion, with brown
hair and dark gray eyes ; more womanly by far than is usually
witnessed at her age, her figure being tolerably plump, well set
and proportioned, and her height being rather more than five
feet ; and notwithstanding her casually childish manner, there
was that forwardness of expression which betokened a more
than ordinary developement of character. On inquiry her
mother assured me that she began to menstruate when ten years
and six weeks o\(\ ; and it was distinctly ascertained that there
had been a regular return of the catamonial discharge, in some-
what profuse quantity, up to the period at which conception
took place. The girl had lost her father about two years ago,
and that she might not be a burden to her widowed mother,
iiad been in residence with her uncle, who was a weaver at
Folcshill. This unhappy man, who proved her seducer, was
aged forty-seven, living with his wife, to whom he had been
married twenty-five years, and by whom he had had a tamily
of two or three children. The niece was taught to weave at a
haiidlooin, which stood in the same apartment in which her

612 Early Pregnancy, ^-c. [October,

uncle pursued his daily employment ; and here it would seem
that familiarities arose which issued at length in criminal inter-
course. This latter took place for the first time about the mid-
dle of November, 1847, and was allowed to be repeated on four
occasions at weekly intervals ; but as the catamenia had ap-
peared during the last week of that month, and did not recur
in the Christmas week, she dated conception from the latter
period. No communication was made to her relations of what
had transpired until six months had elapsed, when her situation
became too prominent to elude further observation, and then it
was that arrangements were made for bringing her under the
maternal roof; and means were taken for dehvering her seducer
into the hands of justice. The most rigid inquiry failed in de-
ducing any farther particulars that could be at all relied on as

authentic information I have been at the pains of

consulting the registers both of her birth and baptism. The
former bears the date of February 13th, 1836, and the latter
March 7th, of the same year."

Early Pregnancy. In connexion with the above, the fol-
lowing notes of cases of early pregnancy may be interesting to
many ; the more especially at present, when we may expect ta
hear of similar, or more remarkable cases, occurring in those
continental cities which have lately been the scene of revolu-
tionary license. That the aptitude of the human female for con-
ception at a tender age is greater than is commonly imagined,
we may infer from the fact that during national convulsions (in
which the bonds of social order and decency have been broken,)
Vases of early pregnancy have been observed to be of more
frequent occurrence. During the revolution in France, at the
close of the last century, several instances occurred of females
of eleven, and even below that age, being received, in a preg-
nant state, into the Maternite at Paris.

1. Sir Everard Home says, "I have met with corpora lutea
in virgins at fourteen, and know of two instances of girls still
earlier, one at thirteen, the other at twelve.'"^ Phil Trans. 1819,
page 61.

2. Dr. W. F. Montgomery says, that "the earliest instance of
pregnancy known to him, was that of a young lady who brought
forth twins before she had completed her fifteenth year."
^igns and Symptoms of Pregnancy, p. 163.

3. Mr. Robertson, of Manchester, mentions a case which oc-
curred in the practice of Mr. R. Thorpe. It is thus quoted
from the Edinburgh Medical and Surgical Journal, vol. xxxviii,
]). 231, by Dr. Montgomery : "She had been employed in a
i:ott.(>ii factory, and was represented to have beconie pregnant

1849.] Early Pregnancy, <J-c\ (Jlo

in her eleventh year. Mr. Thorpe and the late Dr. Ilaniie
were at the trouble of examining the registers of her birth and
christening, and ftdly satisfied themselves that she had really
conceived during the eleventh year of her age, and that at the
time of her delivery she was only a few months advanced in
her twelfth year ; her figure was that of a well-grown young
woman, with fully developed mamma), and it was ascertained
that she had menstruated before she became pregnant." Op.
cit., p. 162.

4. Dr. Rowlett, of Waisborough, Kentucky, reports, in the
Transylvania Medical Journal, vol. vii., p.447, the case of Sally
Deweese, born 7th April, 1824, in the county of Butler, Ken-
tucky. "She began to menstruate at a year old, and the pel-
vis and breasts became developed in an extraordinary degree :
she continued to menstruate regularly up to 1833, when she
became pregnant, and on the 20th April, 1834, she was deliver-
ed of a female child, weighing seven pounds and three-quarters.
At the time of publishing the case the child weighed eight
pounds and three-quarters, and the mother 100 pounds, and
was four feet seven inches in height." (As quoted by Mont-
gomery, Op. cit., p. 102.)

5. La Motte delivered a girl who had not completed her
thirteenth year, and who had never menstruated. {Traite des
Accouchemens, Obs. xxiii., p. 52, as quoted by Montgomery,
Op.cit. p. 163.)

6. Dr. Michael Ryanknewof a female pregnant at 12| years
of age. Medical Jurisprudence, p, 242.

Infantile Menstruation. The following are a few curious
instances, some of which certainly may be considered as pu-
berty at an infantile age :

1. Mr. Embling, in the Lancet for January 29, 1848, gives
the following case : At the date when the account was pub-
lished, the child was three years old, and had during some pre-
ceding months menstruated regularly. The mamma) and nates
were as fully developed as in an adult of twenty; the labia,
etc. were like those of a mature young woman ; the hymen
was perfect ; the vagina anteriorly was of large size ; and on
the pubes there ^vas a slight growth of hair. The^ountenance,
appearance and gait were in miniature those of an old woman.
At her menstrual periods, she suflfered the uterine, lumbar, and
other pains common in women capable of uterogestation.

2. Dr. Dieffenbach, of Berlin, in Meckel's Archiv. ftir Anato-
mic, etc., 1827, p, 367, relates a case of early menstruation in
a child nineteen months old. It was at birth of the natural
size, but after the first month began to grow rapidly. In her

614 Early Pregnancy, ^-r. [October,

ninth month she was as large as a child a year and a half old;
and about this time a discharge of blood from the vasjina was
observed. At the end of two months a more copious discharge
took place, which was accompanied with an increase in the
size oi'the mamma?, and the appearance of hairs on the genitals.
The same phenomenon recurred at fourteen, and again at
eighteen months. At the time of the report the mammae were
large, and the genitals were largely developed and covered,
with hairs. Nothing was remarked in her mental disposition
ditlerent from other children of the same age, and there was no
indication of sexual desire.

3. Dr. Catals, of Adge, attended a little girl of six years old,
who was affected with a spasmodic cough, colic, headache, and
epistaxis, which recurred every month. With other remedies
which this condition indicated, he applied leeches to the calves
of the legs. A discharge of blood from the uterus supervened,
which was preceded by a febrile state. These phenomena, ac-
companied with some enlargement of the mammae, pain in the
lumbar region, an itching of thegenitals, returned regularly every
month, and lasted three days. Journal de Medecine et de Chi-
rurgie, par Covisart, Leroux, et Boyer, t. xi. p. 37, as quoted
by De Boismont, in his work, De la -Menstruation, p. 83:
Paris, 1842.)

4. M. A. Brierre De Boismont, op. cit. p. 35, relates, on the
authority of M. Le Beau, the case of Matilda H., w^ho was born
at New Orleans in 1827, with the breasts and genitals as per-
fectly developed as in a girl of 13 or 14 years. The menses
appeared regularly each month, from the age of three years.
They continued three days ; and were as copious as in a per-
fect woman. At the age of four years, when the report was
made, she v/as well-formed, and of handsome appearance; the
mamma) were of the size of a large orange ; and the pelvis
seemed as larjie as in a child of eight years. Her health was
excellent. (From Annal. d^Hygiene, t. x. p. 484.)

5. Dr. Carus, of Dresden, mentions the case of Christina
Theresa, born in themountainsof Saxony, of parents of a weak
constitution. She was scarcely a ycaroKl when she began to
grow rapidl}'. At the end of the second twelve-month the ca-
tamenia appeared; and continued to flow regularly once a
month. Tlie mamma? were firm, like those ora strong girl of
16; the body was stoutly made; and the genital oi-gans were
covei'C.d with dark brown hair. Her intellectual functions,
tone of voice, and physiognomy, were those of a child three
years old. (Al/gnncine Zcitinig jvr Chir^irgic, as quoted in
Kdinhirgh Monthhi Journal of Medical Science, p. 1050. 1842.)

0. Mr. W. II. Whit more, of Cheltenham, communicated to

lti4l).J Puinwuai ij l*hUusis. (>15

I

tJie Northern Journal of Medicine, lor July, 1815, an account
of the case of a child who menstruated regularly, at intervals of
three weeks and two or three days, from a few days after birth,
until the age of four years and some months, when she died.
The developement of the body e(iunlled that of a girl 10 or
11 years of age. The mammse were unusually large: the
mons v^eneris well covered with hair; the labia pudendi more
sparingly so. In the absence of her periodical ailments, she
would enter into the amusements of children of her own age ;
but when she was indisposed, she was exceedingly reserved,
and would withdraw from all her playful occupations.

7. Dr. Lenz, of Dantzig, relates a case in which menstruation
appeared at the eighteenth month, and continued up to the age
of two years, when the case was reported. The general health
was unaflected in the intervals, provided the discharge took
place at the regular periods. The breasts and genital organs
presented no remarkable appearance, but experienced an in-
crease in temperature and size at each menstruation. Casper's
Wochenschrift, Oct. 3, 1840.

8. M. Gruere, of Dijon, was acquainted with the case of a
child, aged three years, w^ho had menstruated regularly since
she was one year old. Her general health was good. There
were no premonitory symptoms, except a slight feeling of
tension in the hypogastric region. There were no external
signs of puberty. (Journal de Medecine et de Cliirurgie
Pratique. Mai, 1842. Paris.)

In addition to the above cases, others have been recorded, in
which a discharge of blood, often accompanied with some en-
largement of the breasts, took place from the genital organs soon
after birth. It seems probable, however, that the hemorrhage
might have arisen from other causes than the establishment of
menstruation ; and that the enlargement of the mamma) may
be due to the sympathy which exists between them and the
genital organs, independent of sexual aptitude. Of this kind
are, probably, among others, the cases recorded by M. Mallat
in the Gazette Medicale for 1832; and by Dr. Camerer in the
Medicinisches Correspondenz-Blatt, as quoted in Gazette
Medicale, p. 248, 1845.

Summary of Dr. Wahhe^s Report on Pulmonary Pht/iisis.
(British and Foreign Medico-Chirurg. Review.)

1. There apparently exists a greater proneness to early
marriage among phthisical, than non-phthisical persons ; this
greater proneness exists in both sexes, and, in the cases ana-
lysed, prevailed to the same amount in males and females.

616 Pulmonary Phthisis. [October,

2. Of a given mass of patients entering the hospital in all
stages of the disease, and in every variety of general condition
between the actually moribund state and that of but slight con-
stitutional suffering the number leaving it, on the one hand,
improved or unadvanced was more than double that, on the
other hand, leaving it in a worse state or dying within its walls
(the exact ratio is 6784 : 32-16). If the cases, in which death
was actually imminent at the period of admission, were ex-
cluded, the result would be very materially more favourable
than this.

3. In 4*26 per cent, of the cases complete restoration to
health, not only as regards apparent disturbance of the func-
tions generally, but as regards local evidence of active pulmo-
nary disease was effected.

4. Complete removal of symptoms was more frequently
effected in the male than in the female : but, on the other hand,
the results were, on the whole, slightly more favourable in the
latter than in the former sex.

5. All patients whose condition grew worse, while they
were in the hospital, had reached the stage of excavation on
admission ; and all patients, whose tubercules were yet unsoft-
ened on admission, left the hospital either improved, or having
had a statu quo condition kept up.

Improvement is more probable than the reverse, even where
excavation exists on admission.

6. In a given mass of cases, the chances of favourable in-
fluence from sojourn in the hospital wqll be greater, in a certain
(undetermined) ratio, as the duration of the disease previous to
the admission has been greater, in other terms, natural ten-
dency to a slow course is a more important element of success
in the treatment of the disease, then the fact of that treatment
having been undertaken at an early period. (Vide p. 229,
4, 1,2,3.)

7. The mean length of stay in the hospital in the most
favourable class of cases, nearly doubled that in the least fa-
vourable.

8. The chances of benefit are more in favour of those
whose trades are pursued out of doors (wholly or partially),
than of those who work altogether within doors.

9. The results did not ai)])ear to be influenced by the labo-
rious or non-laborious character of the trade individuals might
have pursued.

10. The age of the sufferers did not exercise any very
material influence on the character of the results.

11. Patients coming from the country have, on an average,
a slightly stronger chance of improvement, than the residents
of London and the suburbs.

1849.] Pulmonary Phthisis. G17

12. Patients admitted during the warmer half of the year,
benefit by a sojourn at BromjUon, to a shght extent, more than
those received during the six colder months.

13. From a comparative analysis of the family histories of
446 persons, 162 of them phthisical, 284 non-phthisical, the final
conclusion flows: that phthisis in the adult hospital-popula-
tion of this country is, to a slight amount only, a disease dernon-
strahly derived from parents. It is possible (nay, indeed,
probable, for, in adults having a parental taint, the outbreak of
the disease occurred a mean period of two years and nine
months earlier, than in those free from such taint, vid. p. 238,
Table,) that, were investigation extended to infancy, child-
hood, and youth, the ratio, of cases of parental taint among the
phthisical would be proportionally greater than it proves where
injury is limited to adults. But, on the other hand, there is no
single valid reason for supposing (prior to actual experience)
that the increase in that ratio would be of more than trifling
amount. Again, whether the law difl^ers in the adult portion of
middle and upper classes of society, fiom that holding in the
humbler classes, (those supplying hospitals,) can only be posi-
tively determined by an analysis of family histories collected
among the former classes ; meanwhile, it appears justifiable to
doubt the reality of any such diflerence.

14. If no distinction of sex be made, it appears that the
softening point is attained with no very unequal rapidity in the
right and the left lung; but such diflerence as exists signifies
that softening is, on an average, more quickly accomplished on
the left side than the right.

15. But the law seems very clearly to differ in the two
sexes in regard of this point : the disease is more rapidly evolv-
ed in the right lung of males, and in the left of females.

16. Age exercises some influence over the course of the
disease in the two lungs in the two sexes ; in males, the excess
of frequency with which the right lung had reached the second
and third stages was within 2 per 100, the same before and after
the age of 30 ; whereas in females the excess of frequency with
which the left lung was found in those stages was about 45 per
100 greater after, than before, that age.

17. Haemoptysis is a symptom of extreme frequency,
occurring in about 81 per 100 of the cases.

18. It was of very slightly (4 per 100) more frequent oc-
currence in males than females.

19. Haemoptysis to a medium amount is about four times
less common tlian to very slight or to profuse amounts (both
taken together). Very profuse hemorrhage from the lungs is
more common in males than females.

018 Pulmonanj Phthisis. [October,

20. Medium frequency of recun'ence of haemoptysis is ma-
terially less common (and this in both sexes) than a single, or
than repeated attacks. Further, repetition of hasmoptysis is
more common in males than in females.

21. It is materially more common for a first hemorrhage to
be more profuse than subsequent ones, then for subsequent ones
to be more profuse than the first.

22. Haemo|)tysis is more frequently met with (and (his
independently of any influence of duration of the disease) in
persons who have reached the second and third stages, than in
those whose lungs have not yet softened. This proposition is
more markedly true of males than of females.

23. There does not appear to be any notably greater ten-
dency to haemoptysis, where the right lung has reached a more
advanced stage than the left, nor vice versa, where the left has
taken the lead. It seems improbable that either lung is more
effective in causing ha3moptysis than itsl'ellow.

24. The frequency of haemoptysis increases with advancing
years in both sexes. The increase is more abrupt in females
than in males, and in the former appears connected with cata-
menial function.

25. This greater frequency of haemoptysis in persons of
more advanced years, does not depend altogether on greater
duration of the disease ; for those, who had had haemoptysis,
had been phthisical for only a mean period of eight months
longer than those who had not spit blood.

26. The most common periods for the occurrence of
liaemoptysis, were, at the very outset, or after the expiration of
the first month ; it is very rare for hemoptysis to occur within
the first month, unless it has actually appeared as the first, or
among the first symptoms. The phrase " first symptom" here,
is to be understood with the qualification already explained.

27. In upwards of half the cases of notable hemorrhage
(beyond 4 oz.) tliis occurs, or has occurred, as the "first symp-
tom," corroborating the inference as to the excess of amount
of first over subsequent hemorrhages.

28. Hemorrhage of this amount is rare as a coexistence
with other first synqitoms (in j\^ of these cases) a])preciable by
tfie patient.

29. Streaked or tinged sputa are, on the contrary, of very
common appearance amongst the earliest symptoms.

30. But streaked or tinged sputa are rarely (or never) the
"first symptom" singly and alone.

31. Season does not appear to exercise any marked influ-
ence on the occurrence of a first hemorrhagic attack.

3-i. Uajnioj.tysis never appeared as the bona fid:', first

1849.] Pulmonarij Phthisis. G19

symptom in these cases, the phrase being understood in its ab-
solute sense without qLinlificntion.

33. Pulmonary apoplexy is not the cause of phthisical
haemoptysis ; the coexistence of pulmonary apoplexy and
tubercles in a person who hns had haemoptysis, more or less
recently before death, is at the least very rare. The common
cause of haemoptysis in tuberculous persons, is intense con-
gestion ending in molecular ruptures.

34. Expectoration of blood in persons labouring under
chronic bronchitis, with or without emphysema, but without
notable disease of the heart, justifies in itself a suspicion of the
existence of latent tubercles.

35. A given mass of cases of cancer of the lung will be
attended nearly as often with hemoptysis of all amounts, and
greatly more often with haemoptysis above an ounce at a time,
than an equal mass of cases of phthisis. But cancerous dis-
ease of the lung is, comparatively speaking, so rare, that this
proposition does not materially affect the diagnostic value of
haemoptysis in phthsis. Besides, the distinction of the diseases
is, clinically, easy.

36. Not only does chronic empyema not give rise in
itself to haemoptysis, but empyema, established in a phthisical
person, appears to a certain extent prophylactic against the
haemoptysis which is almost an appanage of the latter disease.

37. I have never once seen cardiac disease, of such kind as
to, cause haemoptysis, coexistent with phthisis, using the term
in its practical sense ; but in a fair number of instances I have
seen advanced cardiac disease in persons whose lungs contain-
ed crude tuherdcs and gray granulations, which had been com-
pletely, or almost completely, latent.

38. Contrary to common belief, it may be affirmed, that
when \.\\e'nisus hceinorrhagicus in woman menstruating imper-
fectly, directs itself to the lung, and leads to the evacuation by
that organ of a quantity of blood, amounting to or exceeding
an ounce, there is motive for suspecting the existence of tu-
bercles.

39. All these propositions tend to exhibit in strong light the
diagnostic signification of haemoptysis quoad tubercle ; but it is
to be remembered that they will only hold completely true, if
applied to latent as well as obvious tuberculization.

40. The diagnostic importance of haemoptysis as a symp-
tom of tuberculization of the lungs is, indeed, extreme, even
sputa, simfily streaked or tinged with blood, are not without
their significance under certain circumstances.

41. Haemoptysis is rare "directly" fatal ; more frequently
so in males than in females.

020 On Coxalgia. [October,

42. Frequently-recurring haemoptysis does not reduce the
mean duration of life in any given mass of tuberculous cases.

43. Afirst haemoptysis having been severe, it is unlikely that
a subsequent one will kill "directly;" and a first hemorrhage
being moderate, subsequent ones are not likely to be severe.

44. The prognosis of haemoptysis is materially more unfa-
vourable in males than in females.

On Coxalgia. By M. Malgaigne. (Gaz. des. Hopitaux, and
Medico-Chirurg. Review.)

By this term M. Malgaigne designates what is usually named
hip-joint disease. He objects to some of the received doctrines
concerning it. Thus he denies that the disease is indicated at
all generally by pain in the knee, the hip-joint comporting itself
in this particular like other joints. Moreover, when such co-
incident pains do occur, he believes them to be very rarely of
a nervous or sympathetic character, the affection being usually
a polyarticular phlegmasia of a rheumatic character.

Then again, the idea that the limb lengthens at an early peri-
od of the disease, and afterwards shortens without dislocation
taking place, is quite an erroneous one. In the great majority
of cases, if the limb be left to itself, and no force applied, a
shortening appears to exist. But in these this appearance is
produced by the limb lying in a state of adduction, obliquely,
as respects the pelvis ; and if by chance the limb were observed
while in a state of abduction, an elongation would be thought
to be present. It is only by supposing these changes of position
to have been overlooked, that we can explain Boyer's strange
statement as to the change of length in the limb without
dislocation. During the last ten years, M. Malgaigne has
made diligent search among a vast number of these cases, but
has met with no such example. Larrey was accustomed to
say a limb was two inches too long, and ordering his fa-
vorite moxas, declared soon afterwards that the normal length
was restored ; but his eye alone saw the miracle I For the ex-
planation of the supposed change, theories have not been want-
ing. It has been said that a swollen state of the fatty mass in
the articulation, or an effusion into the joint, extends the limb,
forgetting that the effect of these must be to thrust the head of
the bone outwards, and produce shortening. When the syno-
vial fluid is much increased, the head may become quite dislo-
cated, and some shortening be produced, as it may also when
the solid parts of the joints are attacked, and the head of the
bone in part eroded. While surgeons have paid so much at-
tention to this imaginary elongation and shortening, they have

1849.] Treatment of I jupus. 021

I

paid no heed to the muscular contraction, which, by inducing
adduction, produces the apparent shortening.

[While appreciating M. Malgaigne's ingenious criticisms
upon so many of the received doctrines of surgery, which stood
in ample need of revision, we can hardly understand how one
so familiar with hospital practice can bring in doubt the actual
occurrence of sympathetic pain in the knee in hip-joint disease,
and this quite independently of any inflammatory condition,
rheumatic or otherwise. As to the difference of length observ-
ed in the limbs, independently of consecutive dislocation, he
has probably indicated the true cause of the deceptive appear-
ance; and he justly observes elsewhere, that even by measure-
ment, as after accident, slight differences of length in the femur
are frequently very difficult of verification.]

On the Treatment of Lupus. By MM. Devergie and^PETREauiN.
(Brit, and For. Medico-Chirurg. Review.)

M. Devergie states that M. Emery has somewhat over-esti-
mated the beneficial eflfects of cod-liver oil in lupus (p. 279) ;
and he considers it a great mistake to depend upon any one
remedy for the cure of diseases, especially of the skin, which
may be simple or complicated in their nature, though still bear-
ing the same name. With respect to lupus, there are two
genera, the tuberculous, which affects the deeper parts, and the
serpiginous or herpetic form, which aflTects the surface. If it
has gone on to ulceration it is termed exedens and vorax when
this proceeds rapidly. Of all these it is the serpiginous form,,
prior to ulceration, that best yields to cod-liver oil, to which
remedy lupus of the limbs and trunk is more amenable than is
that of the face. In a case under treatment, in which the dis-
ease existed both on the body and on the face, the latter alone
has not yielded. Many cases of limited tubercular lupus may
yield to measures which exert a general modificatory power
upon the constitution, and to the use of Canquoin^s caustic,
which M. Devergie much employs in these cases. Herpetiform
lupus that has ulcerated is very advantageously modified by
the application of juniper oil to its. edges. M. Devergie is far
from underrating the beneficial effects of the cod-liver oil, pre-
ferring it, indeed, to any other separate remedy. He does not,
however, approve of its exclusive use, believing a combination
of means, both external and internal, to be the most judicious
procedure. To this end he lays down the following as being
the principles of treatment which should guide us. I. To en-
deavor to establish the regularity of the menstrual functions by
mcLins of the svrui) of the iodide of iron. 2. To administer cod-

622 Prolapsus Uteri. [Octobar,

liver oil internally. 3. To employ sulphureous or iodine baths.
4. To touch the lupus frequently, as every third day, for exam-
ple, with the oil of juniper. 5. To apply Canquoin's caustic to
tubercles wliich, durino- the process of cure, become isolated,
but which still are dissipated with difliculty, and to ulcers which
will not cicatrize. 6. To apply in some cases a slightly re-
solvent ointment, or a rubefacient preparation of iodine, to pro-
duce a modification in the more obstinate portions of the dis-
ease. {Bulletin de Therapeutigue, torn, xxxv., p. 466.)

M. Chavannes, a pupil of M. Petrequin, of Lyons, furnishes a
statement of the great success that practitioner has met with in
treating the ulcerated form of lupus lupus exedeiis by means
of the cliloride of gold, which is also of great utility in other
forms of skin disease when they take on an ulcerated form, as
carcinoma of the face, eczema, tuberculous syphilide, &c. The
caustic is composed oi very pure laminated gold 1 part, hydro-
chloric acid 3 parts, nitric acid 1 part. It produces a tempo-
rarily sharp pain, and coagulation of the albuminous matters on
the surface of the ulcer, which changes in colour successively
from an orange yellow to a purple, violet, and black. A thick
crust is the ultimate result, which, however, is no eschar, for
there is no mortification, no loss of substance ; but on the con-
trary, a vigorous reproduction. If after a while the crust be
raised, we see under it a delicate, reddish, newly-formed skin,
which needs the strengthening attainable by another slight
cauterization. The healing takes place without cicatrix, unless
the tissues of the part have already been deeply destroyed ;
and even the cicatrices, produced by other caustics may in
some degree be arrested by the application of this one. Next
to this caustic the acid nitrate of mercury is perhaps the best ;
but if applied over too large a surface, it may give rise to poi-
sonous efl^ects, while it produces much more pain and a very
inferior degree of cicatrization. (Revue Medicale, 1848, tom
iii, pp. 45-70.)

Prolapsus Uteri. By Professor IIoiil. (From Ibid.

Professor Hold believes that some very erroneous notions
prevail as to the causes of this occurrence, and that some ligfit
may be thrown upon the subject by considering the changes of
position which the uterus normally undergoes at ditlerent peri-
ods of life. In the mature foetus the uterus projects considera-
bly beyond the pelvis; and it is only when it has acquired its
completed shape and size at puberty, that it is found entirely
within the cavity. At the commencement of the menstrual
cycle it retains its ])0.sition or even ri^^cs still higher in the pel-

1849.] rro/</j)sas Uleri. 020

vis, while at the termination of this it again sinks, with the loss
ofhlood, in stout young women. In women who seldom or ne-
ver bear cliildren it sinks still deeper, as it does, too, after the
menstrual functions have ceased. In pregnancy the orgur*
rises remarkably, and M. Ilohl denies the correctness of the
statement that it sinks lower in the pelvis after the second
month, the apparent sinking being due to the turgescenceofthe
organ, and especially of its cervix. After delivery the uterus
remains high up in the abdomen, and only gradually resumes
its ordinary position. In old women it is found deep in the
pelvis.

The production of prolapsus is not dependent upon the condi-
tion of the vagina, and the ligaments of the uterus. The vital
power of the organ may be said to maintain it in position.
When this is augmented the uterus is raised, while, when it is
diminished or lost, it descends. Other organs, and indeed the
whole body, in like manner exhibit strength and power propor-
tionate to their turgor viialis. The increase of the vital activi-
ty of the uterus during its development and growth; as also
during menstruation and in pregnancy, is attended wnth eleva-
tion of the organ, which sinks again when these conditions
prevail no longer. So far from allowing that the prolapse
results from defective supporting power of the vagina, we may
rather regard the uterus as supporting the vagina, and prolapsus
of the latter may occur without any prolapsus uteri.

Thus the author refers the production of prolapsus to a pre-
ceding or co-existing condition of health, giving rise to a dimin-
ished vitality. This explains why we so seldom meet with the
disease in young healthy women ; while we know that whatever
favors the relaxation of the genital system, and lowers the tone
of the fibre, acts predisposingly, the germ of the evil being
found in the puerperal condition, when the uterus, after having
been high up in the abdomen, sinks down into the lesser pelvis.

Although prolapsus may be secondarily produced by other
affections, as tumours of the belly, prolapsus vagince, cystocele,
&c., &c., yet fiir more frequently a change in the direction,
rather than in the position of the organ then takes place; and
even while the portion of the rectum in connexion with its pos-
terior wall may prolapse entirely, the uterus may retain its
normal position.

There may be a diseased condition of the economy in gener-
al, or of the uterus in particular, upon which depends the ex-
tinction or diminution of its vital power ; and accordingly as
this is or is not curable, will depend whether a cure of a prolap-
sus is apparent or real ; as mere i-eposition with mechanical
support is not a cure. In some diseases which are attended

624 Patent and Secret Medicines. [October,

with an increased activity of the uterus, there is a rising of the
organ in the pelvis, as puerperal fever, hydrometra, &c. Dis-
ease of the ovaries do not produce any sinking of the organ ; nor
do tumors or indurations of its substance as long as they are in
process of development, nor until they have interrupted its
functions, or weighed it dow^n by their great bulk. Polypi also
seldom gave rise to prolapsus.

Treatment. Common as is the disease, a radical cure is
seldom accomplished. The indications are to remedy the de-
fective or disordered condition of the general vital powers or
of those of the uterus in particular. The author especially
warns us against the continued use of injections, and the too
early employment of pessaries. When the vital power of the
sexual system or uterus is exhausted in consequence of age,
over-stimulus, or incurable disease, mere paliative treatment
should be employed. (Zeitschrift fiir Geburtskunde, Band
xxiv, pp. 321-340!)

Patent and Secret Medicines. By Prof. Butterfield (New
Orleans Medical and Surgical Journal.)

It is amusing as well as melancholy, to read in the public
newspapers, the advertisements of the unprincipled dealers in
secret medicines. Assurance, impudence and falsehood can
scarcely go further. One would suppose that the public, seeing
so many and such contradictory statements and promises, would
have at least as much sense as the negro, when told that Jonah
swalled the whale, that they would discredit them all ; but no,
the more falsehoods that can be crammed into a small space,
the more noisy and importunate the quack or the vender, the
more oily do their throats become, and, like Oliver, they are
constantly " asking for more."

Take up almost any newspaper, and observe how large a
portion of its colums is prostituted to the unholy purposes of
deception and humbug. Several lie before us. Let us examine
one or two. The first is a leading daily paper of considerable
circulation and influence. It contains in all twenty columns,
fifteen of which are devoted to advertisements of all descrip-
tions. Of these fifteen columns, about two and a half herald
the praises and sound the \irtues of quack medicines, and this is
rather less than the usual proportion. First, we have " Ten
reasons for using Dr. Bras-i^'s (a capital name,) sugar coated
})ills," then " A good medicine,"' next " Be wise in time, 'tis
folly to defer:" "Vegetable vs. Mineral," " Read, mark and
})artake," (especially the partake!) and so on.

1849.] Nitrate of Silver in White Swelling a. U25

The next pnper is a weekly from one of the principal cities
of Massnchusetts. Ahhough they hra^r enough tliere, in ail
conscience, we do not know that Doctor! (save the mark !)
Bra^f[ has extended his operation so far. Though the whole
world, the medical faculty included, are generally convinced of
the trnnscendently miraculous power of numerous nostrums, it
is only now and then that one pushes its way beyond a com-
parative limited circle. The paper referred to has twenty-
ei^ht columns, only nine of which contain advertisements, and
over four of these are paid for by nostrum mongers. There is
old Tovvnsend with his Sarsaparilla, belaboring young Town-
send and his Sarsaparilla. There is young Townsend's
" Reply to Tricks of Quacks." They each make the other a
precious villain, and we believe them both. Then there is
"Consumption cured" and " Fits ! fits !" in a black ground like
a coffin. Ten-thousand persons lave been cured by one
remedy, and ten-thousand more are icanted to be cured by all
the rest. So it goes a regular trade of humbug and cheatery
and otherwise respectable men are found in every communi-
ty, ready for money to lend themselves to the fraud.

There is one establishment in Columbus for the exclusive
sale of patent and family medicines. VVe like the plan.
Isolate the business Respectable druggists should have noth-
ins: to do with it. Let it be by itself, that the very multiplicity
of its cure-alls and flaminof hand-bills become suspicious, as well
as ridiculous. We suppose that some honost men engage,
thoughtlessly, in this highly dishonest and disreputable traffic;
we suppose that more don't think of or care for, consequences
if the money comes, but for ourselves, there is no honest cal-
ling, however humble or degraded, that would not be preferred.

We hope to see the time, and that shortly, when every drug-
gist who deals in secret nostums will be shunned by our pro-
fession, and left to depend upon the patronage he prefers.

Use of Nitrate of Silver for White Swellinfrs, Hydrarthrosis,
and Venereal Bubo. (Dublin Med. Press.)

M. Decaisne, military surgeon at Anvers, has published in
the Archives de Medecine Militaire, some observations on this
subject ; two remarkable cases are given. One of the patients
was a man of 27 years of age, and of a lymphatic temperament,
who, on the night of the 5th of February, 1847, felt a severe
pain in the right knee; swelling soon followed, and the patient
was unable to use the limb. Every means were had recourse
to for his relief antiphlogistics, baths, calomel and opium, blis-

N. ri. VOL. v. NO. X. 10

626 Nitrate of Silver in White Swellings. [October,

ters, iodine, mercurial ointment, compression and douches, with-
out any eflect in arresting its pro^^ress into regular white swell-
ing. In the month cf July, M. Decaisne began the use of an
ointment of nitrate of silver, when the knee was double its
natural size, was so tender that the patient dreaded its being
touched, all motion in the joint impossible, and with three fis-
tulous openings at the inner side of the joint; amputation ap-
peared inevitable ; and in this very unfavorable aspect of affairs
it was ordered to employ friction twice a day of an ointment
composed of one gros (59.1 grains) of the salt of silver to an
ounce of lard; about two gros of the ointment were used at
each application. Under this ti-eatment the pain sensibly
abated in a few days, the swelling gradually diminished,
and in about a month the improvement, in every respect,
was considerable. During^ the month of August, the propor-
tion of the nitrate of silver to the lard was increased to a
gros and a half or two ^?ros to the ounce of lard, and at length,
at the end of the month, the cure was complete, and the young
man only experienced a slight stiffness in bending the knee.
The second case was that of a young boy, attacked with a
a white-swelling of the radio-carpal articulation. Previously
to the employment of the ointment of the nitrate of silver in
this case, a number of more active remedies had been tried in
vain; the swelling was considerable, and it was necessary to
open a large abscess near the articulation. After using the
ointment of the nitrate of silver for two months the ameliora-
tion was considerable, or rather the cure was completed.

After giving the above eases, the Journal de Medecine adds
the following remarks: Other cases, where the salt of silver
in the lorm of ointment have been recently published in the
Archives de la Medecine Beige, by Professor Uytterhoeven ;
he used it in a great number of cases, but all those he details
were dropsy of joints, not white-swelling: the ointment of ni-
trate of silver possesses a resolutive action upon those serous
swellings of joints. Tfiis therapeutic agent should not be em-
}>loyed until the inflammatory stage has passed.

In making the ointment it is necessary to dissolve the nitrate
of silver in water before incorporating it with the lard, to pre-
vent the rubefacient or cauterizing effect of the metallic salt
on the skin, or the formation of vesicles, which without this
precaution would be inevitable. Generally smart pain, but
tiansient, is exjTerienced on the application of tliis remedy at
the place on which it is rubbed.

The power of this ointment to resolve venereal buboes has
Ijeen experienced in the practice of i\l. Lutens; he dissolved-a
(Irnclmi of the salt in a sufficient quan'.iiy of distilled water, and

1849.] Arterial Compression as an Antiphlogistic, 627

then mixed it with an ounce of lard. His nnode ofusin;? it is
this, about two drachms of ths ointment are used at each rub-
bing : after three or four day.-? th3 skin becomes black and shi-
ning; instead of suspending the treatment until the epidermis
desquemates fully, the scales are detached with the nail, or a
spatula, and the frictions immsdiately recommenced. These
frictions never occasion pain, bat sometimes a slight uneasiness.
M. Lutens uses this ointment also in glandular swellings of the
neck and groin, and in all stages of bubo.

Arterial Compression as an Antiphlogistic. (American Jour.
Med. Science.% from Jour- de Medecine.)

Dr. Henroz de Marche has published a work on the value of
compressing the brachial artery in cases of whitlow to check
the inflammatory process in the finger ; this seems but an ex-
aggeration of M. Gerdy's principle of keeping the limb elevated
so as to lessen the force of the arterial circulation in the inflamed
part. Dr. Henroz was one day in his garden pruning an
arbutus, and got a prick of a thorn in his le't ring-finger at the
inner side of the third phalanx; the thorn was extracted, and
for twenty-four hours he felt no uneasiness in the part ; the
finger at this time began to swell rapidly, and to grow red, and
the inflammation extended by degrees to the palm and back of
the hand. On the fourth day, the pain was pulsatile and
severe; he could not sleep; had great thirst; skin hot, and
pulse frequent ; the axillary glands were swollen but indolent.
Stuping, leeches, poultices, opiates, mercurial frictions, were
in their turn tried without advantage. It then occurred to M.
Henroz to try compression of the brachial artery, which he did
immediately with his thumb; instantly, the severe pain which
he had endured for five days ceased, as if by magic, and he was
able, without the slightest uneasiness, to put his hand into any
position he pleased, and even the redness disappeared com-
pletely. However, as it was impossible to maintain the pi-es-
sure in this manner for any length of time, he contrived an in-
strument for the purpose, so simple in its construction as per-
haps to make it a valuable aid in such cases in the country,
where more perfect ones could not be readilv had. It was ap-
plied on the brachial artei'y, and the same good eflfects imme-
diately followed as when compression was made with the
thumb ; it was left on for three hours, during which the pain
in the hand did not recur for an instant ; it was pale and cool,
and the swelling had diminished. Fearing that a longer in-
terruption to the circulation might produce ill consequences,
M.- Heiuoz sus}ended the compression for three-quarters of an

628 The Medical Properties of Sulphur. [October^

hour. The pain returned; pressure was again made, but this
time it was on the ulnar not the brachial artery, and the symp-
toms were as suddenly relieved as in the former case. Com-
pression on the artery was thus continued f'^om half-past
twelve at noon until five o'clock in the evening, as well as the
palm and dorsum of the hand with firm compresses of wadding,
at which time the tumefaction of the hand and finger was per-
manently reduced, as also the tenderness ; the symptoms of
reaction had ceased, and their were no longer pain or fever.
In the evening, pressure was again made and continued all
night ; the next day the cure was complete.

The same treatment was employed by M. Henroz with the
same result on a young girl who had a very severe whitlow ;
in this case, in which the affection was eight days progressing,
the pain left the part the instant the compression was applied,
and the cure was complete in thirty six hours.

The Medical Properties of Sulphur. By Fenner H. Peck^
HAM, M,D., of North KilHngly, Connecticut. (Boston Med,
and Surg. Journal.)

It is unnecessary to speak of the physical appearance of this
substance. So common is the article that it is known to almost
every one. It is simply with its medical properties we have to
deal. Sulphur has long been known as a medicine, and has a
place in our oldest Dispensatories. It can be made to unite
with many other substances, changing materially their medical
qualities and physical appearance. Pure sulphur possesses va-
rious medical qualities. It is a laxative, and has important
diaphoretic, diuretic and alterative properties. When given in
doses from a scruple to a drachm, it operates as a laxative.
Whether its laxative powers depend upon the mechanical effect
which it exerts upon the stomach and bowels, or upon its chem-
ical action, I am not to decide; but probably upon both. When
taken in the above mentioned doses, it moves the bowels gently
and efficiently, without griping. I have found its efficacy very
manifest in costive habits, arising from inaction of the bowels,
and especially if accompanied with hemorrhoidal difficulties.
In such cases, it quickens the intestinal circulation, gives mus-
cular tone to the bowels, and restores peristaltic action. Hence,
as a laxative it has no superior, and few equals, in my estima-
mation, in all cases ofthe above description. Sulphur is more
efficacious as a laxative, in some cases, when combined with
other medicines. I have found it much more so in rheumatisnn
when combined with gum guaiac. and colchicuni. In this

1849.] The Medical Properties of Sulphur. 629

combination not only are its laxative powers more manifest,
but its diaphoretic and diuretic qualities greatly increase, and
I know of no aperient that equals this combination, in the above
disease. I have frequently administered the following in rheu-
matism, with great success:

^, Sulphur, .... 3ij.
Pulv. G. Guaiac.

'' Radex Colchic, aa 9j.
Mix, and divide into eight equal parts; give one every four
hours until the bowels are thoroughly moved. After this, one
may be used nrght and morning, or as the case may require.
I have sometimes used the above combined in spirits, prefer-
ring gin, especially if there was a suppression of urine. When
used in the spirituous form, I usually add one ounce of serpen-
taria using the above quantity to a pint of spirits, and giving
it in doses of a table-spoonful three times a day.

I have not only found this useful in all arthritic complaints,
but also in neuralgia and some cutaneous diseases. It will an-
swer a better purpose in acute arthritis, if used in the form of
powder ; but in cachectic habits, and especially where there is
a depraved state of the functions of assimilation, as is indicated
by biles and other eruptions upon the surface, the alcoholic
preparation will succeed best. In all cutaneous aftections,
where the bowels are required to be kept gently open, sulphur
is a valuable medicine. In cutaneous affections where there is
want of urinary secretion, as there almost always is, it will be
found more efficacious, if combined with cream of tartar.

In dyspepsia, accompanied with a weak, relaxed state of the
stomach and intestines, sulphur, combined with small doses of
cayenne and ipecac, taken three times a day, before eating, will
prove almost a specific. Where there is an inactive state of
the liver, accompanied, as it generally is, by an indolent state
of the bowels, sulphur, with calc. magnesia and a decoction of
dandelion and wild cherry tree bark, will speedily remove the
disease. In all cases where the cutaneous function is disorder-
ed, sulphur is a valuable medicine for, in the quaint language
of an old author, "pure sulphur loosens the belly, and promotes
insensible perspiration." It passes through the whole habit,
and manifestly transpires through the pores of the skin, as ap-
pears from the sulphurous smell of persons having taken it, and
from silver being stained of a black color in their pockets,
which is the known effect of sulphur.

In all mucous membranal diseases, as well as cutaneous, sul-
phur is a valuable medicine. It is valuable in these cases from
the diaphoretic, diuretic and laxative qualities which it possess-
es. It may possess other qualities that render it useful in these

630 The Medical Properties of Sulphur. [October.

diseases. Its bereficial nfluence in these disorders, indicates
clearly the ana'ogous structure ih&t exists between the skin and
mucous membrane. In mucous membraiial disease of the lungs,
it will prove more efficacious il" combined with antimony, mer-
cury, and opium ; and it is singular how it changes and modifies
the operation of these medicines. This efTect is spciken of in the
Edinburgli Dispensatory, and is there altributed to its laxative
powei"s ; but I think it is fi-om the chemical chan<ie it induces.

In mucous membranal disease of the bowels, sulphur, com-
bined with cream of tartar and oiher refrigerant sahs, is very
useful. It seems to exert a wonderful influence over tiie func-
tions of assimi'ation, and It is in this way, I imagine, that it
proves so sei'viceable in all disorders of the cutaneous function,
when taken internally. It certainly possesses a wonderful in-
fluence over diseases of this function, whttl er they exist locally
or from a ccnsiitutional cause. I have often been surprised at
the benefi'cial influence, in salt rheum, of a combination of
fl. sulphur, tar, and mutton tallow, in the proportion of equal
parts, simmered together in the form of an ointment. After
having tried various local applications, and constitutional
agents, with no benefit whatever,! have srcceeded in efiecling
a perfect cure, in a few days, by the apjlicatirn oi'this oint-
ment, two or three times a day, and with a few doses of cieam
tartar and sulphur. And so with other itching and eruptive
diseases.

Sulphur was formerly used in coughs to a considerable ex-
tent, and with good efi(?ct ; but it has quite gone into disuse for
this purpose, except among flirriers, who use it in coughs of
horses and other animals, with good success. In the horse I
have used it with good success, combined with crude antimony,
in the proportion of |tfe of antimony to lib of sulphur mix,
and give a table-spconful of this mixture, in oats or meal, three
times a day.

I have used sulphur in hooping cough with good effect, in
combination with sanguinaria. I have Uwud it useful in catar-
rhal cougfis of winter, especially in such cliildren as are trou-
bled with worms,

I have used sulphur in chlorosis with decided advantage. I
attribute the beneficial influence which it exerts upon this dis-
ease, to the healthy action it establishes in the assimilative
functions.

Sulphur, cliarcoal, and cnlc. magnesia, equal parts, form a
valuable aperient, in this disease.

I have never used sulphur in the form of vapor-bath, to any
very great extent. I have no doubt, however, of its utility,
Irom what I have observed of its external operation, especially

1849.] Bibliographical. 631

in cutaneous afTections, rlieumatism, scrol'ula. and other kindred
di^^eases. I know a liifzhly intelligent lady w ho was afflicted
with scrofula, to a very great extent. She was subjected to a
thoiough course of mercury, together witli iodine and saHne
medicines, with no benefit whatever, but was finally fully re-
stored by the use of the above bath.

Sulf)hur has lately been proclaimed a specific for the cholera.
In reference to its powers as a preventive or curative medicine,
in this disease, I am unable to speak, never having used it in
cholera. I have no doubt that, taken in laxative doses, by
clearing the prima viae and exciting the glandular secretions,
thereby keeping the digestive organs in a healthy condition, rt
might prevent cholera ; but that, taken occasionally, it would
render the system insusceptible to a deleterious atmosphere, is
very doubtful.

Sulphur ointment was formerly much used in the treatment of
psora. It has l)een considered a specific in this disease. The
disagreeable odour of sulphur, and its former use in the itch,
have created a popular prejudice against it, as a medicine, and
this is one reason why it has fallen into such general disuse.

BIBLIOGRAPHICAL NOTICES.

1. Human Anatomy. By Jones Quain, M. D., Edited by Richard
QuAiN, F. R. S. and vV:i.SnARi'Ev, M. D., F. R. S., Professors of
Anatomy and Physiology in University College, London. First
American, from the fifth London edition. Edited by Joseph
Leidy, M D. In two volumes with over five hundred illustra-
tions. Pp. 638-639. Philadelphia: Lea & Blanchard. 1849.

We have often had occasion to express our great indebtedness to
Messrs. Lea and Blanchard, the most distinguished of American
Medical publishers, for the many valuable works which they have
so repeatedly and liberally supplied us. On no one occasion do we
feel more thankful to them than in receiving Sharpey and Quaiii's
Anatomy. We believe we express the opinion of all who have exam-
ined these volumes, that there is no work superior to them on the
subject which they so ably describe the minute structure of the
human body. With Morton's and this work, every student ought to
know Anatomy. We cannot commend it too highly to the patronage
of the profession.

2. Dr. Fenner's Southern Medical Reports.

The undersigned proposes to publish an Annual Volume, on the
Meteorology, Medical Topography, and Diseases of the Southern
States, to be entitled Southern Medical Reports.

032 Bibliographical [October,

The object of this work, is to collect and present, in a durable
form, the observations of Physicians residing in different parts of the
Southern States, with the view to the cultivation of Medical Science,
and the formation of the medical history of the times.

It will consist of General and Special Rfpouts: the first to con-
tain concise accounts of the Meteorology, Medical Topography and
preva? ling diseases, ihroughoui the year; the second will be devoted
to Extraordinary Cases, Surgical Operatio7\s, SfC.

These reports are all to be handed to the Editor, by the first day of
January, and will appear in a neatly hound volume, as soon thereafter
as the work can be done. Each volume will also contain a brief
retrospect of the latest discoveries and improvements contained in the
Medical Journals of the year.

The Editor wishes to be distinctly understood, that this work is not
designed to conflict with the Medical Journals of the South. On the
contrary, he hopes his collaborators will contribute all they can to their
encouragement and support. If the Editor can command the co-
operation of his professional brethren, each volume of this work will
contain Reports from prominent points in the following States viz:
North and South Carolina, Georgia, Florida, Louisiana, Texas, Ala-
bama, Mississippi, Arkansas, and Tennessee. Also from the Southern
stations of the U. S. Army and Navy. Special Reports of interesting
cases will be thankfully received fiom any part of the South. The
cost of this work will be in proportion to the extent of patronage. It
is contemplated that each volume will contain from^t'e to six hundred
pages, and will be furnished to subscribers at $3 50. One copy will
be sent gratuitously to all contributors, and three or more copies to
the authors of Annual Reports.

All Medical Societies, within the above limits, are respectfully in-
vited to send in condensed reports of their transactions during each
year.

Publishers are requested to forward copies of all new Medical
Books; in return for which, bibliographical notices will be given.

Medical Colleges, throughout the Union, are requested to forward
their annual circulars ; from which will be extracted statistics, to
show the progress of medical education. In short, the proposed work
is designed to make up the medical history of the time, and to promote
the cultivation of medical science in the Southern States. The Edi-
tor will do all in his power to render the work advantageous, as well
to the collaborators, as to the profession at large.

E. D. FENNER, M D.,
New-Orlea^-s, La., June 1st, 1849. No. 5, Carondalet-st.

0:^ Due notice will be given when the work is completed, and it will
be deposited at the principal commercial points in the Union.

1849.] MimMy Periscope. 633

PART III.
flTontljlg {Jeriscopc

Paronychia. In the Bulletin de 1' Academic de Medecine de Bel-
gique, 1848, there is a suggestion of Dr. ilenroz, concerning the
means of diminishing the distressing, throbbing pain of this afftclion.
He has succeeded, by trials upon himself, in annulling the pain of a
whitlow, by skilfully compressing the brachial artery between two
little splints. The author adds, that moderate pressure of the radial
artery near the wrist will suffice, when the inflammation has attacked
either the thumb, index, or middle linger; whilst compression of the
ulnar will allay tiie pain in the ring and little fingers. \^Lond. Lancet.

On the Absence of Vomiting in the Horse. By M, Flourens. Ev-
ery one knows that the horse cannot vomit : but as to tlie cause of this
peculiarity, there has been a diiference of opinion. From his exper-
iments and dissections, M. Flourens is led to the conclusion, that the
obstacle to the reflux of the contents of the stomach, which is such as
to prevent the exit of a single drop of fluid by the cardiac orifice, when
the stomach has been distended with water and subjected to violent
pressure, is to be found partly in the very oblique mode of entrance
of the oesophagus, and partly in the peculiar arrangement of the mus-
cular fibres. These are so disposed, that various bands, arising from
the coats of the stomach, pass round a portion of the tube, and then
return into the muscular wall of the vis^cus ; from which it results
that, the more the latter is distended, the greater will be the constric-
tion exercised around the cardiac orifice. [Armales des Sciences
Naturelles, and Medico-Chirurg. Review.

On Asthma occurring in a Child. By Dr. Tott. A child set. l-i-
years, had been seized daily, at mid-day, for three months, with astli-
matic paroxysms of difficuhy of breathing, terminating in cough with-
out expectoration. An intermittent fever prevailing in the vicinity,
the author supposed that the disease might partake of its nature, and
administered quinine with hyoscyamus, &c., as well as external de-
rivatives; but without any avail. The tinct. lohel. in.ji (15 drops
every three hours) was then given in weak tea, and by the third day
the paroxysms had become much diminished in intensity and duration,
and in fourteen days no traces of the aflbction remained, the child con-
tinuing quite well when seen a year and a half afterwards [^Neue
Zeitschriftfur Geburtskunde, Band, xxv, p. 197, and Ibid.

On the Employment of Iodide of Potassium in Saturnine and Mer-
curial Affections. MM. Guillot and Melsens have recently presented
a memoir to the Academic des Sciences, detailing an experimental
investigation they have undertaken, respecting the powers of iodine
in lead and mercurial saturation of the system. The object in view
is to render soluble the metallic compounds which have entered the

634 Monthly Periscope. [October,

economy, by associating them with a body of very easy elimination.
All the insoluble compounds formed by the salts of mercury with the
matters met with in the economy, are soluble in iodide of potassium,
which substance is easily and rapidly got rid of by the economy. By
analogy we may infer, that the compounds of lead retained in the
economy are also very probably dissolved and eliminated in the same
manner; and in the memoir, cases of saturnine affections so cured
are given. Sulphuric acid, or the sulphates, cannot be regarded as
curative agents in the chronic diseases due to the employment of lead,
seeing that sulphate" of lead is itself a poison, capable of killing ani-
mals in a few weeks. If, however, we give to the animal sulphate of
zinc and iodide of potassium simultaneously, no injurious effect resuhs.
If, nevertheless, we suddenly give a large dose of the iodide to a dog
already suffering from disease from lead poisoning, it is speedily kill-
ed ; while, if we give it in small and gradually increased doses, the
animal gets rapidly well. [Gazette Medicale, and Ibid.

Administration of Rhubarh. .VI. Martin-Solon prescribes rhubarb
according to an old mode of employing it, which consists in mastica-
ting small morsels for half an hour or more, swallowing first the sa-
liva, and then the chewed portion. In this way a small dose acts
efficiently in dyspepsia, hypochondriasm, or habitual constipation. It
can easily be understood, that a medicine, thus incorporated with and
dissolved in the saliva, preserves much more of its power than when
given as powder or infusion. Dr. Giacomini states that it is thus ad-
ministered in Italy with great advantage to delicate and nervous
women and to convalescents from fever. [Rev. Med.-Chir. and Ibid.

On Inunction loith Lard in Scarlatina. The following plan of
treatment in scarlatina is advised by Manthner, an undeniable author-
ity in diseases of children. He observes : "I owe to M.-Schneeman
an excellent method of treating scarlatina, and one from which I have
derived the best results ; this is, the inunction of the entire surface
with lard. These inunctions never do harm ; they are cheap, and
may be employed by all classes. I am confident that they cause des-
quemation to take place more readily, and that dropsical sequelae are
less likely to occur. Moreover, if used as a prophylactic, the disease
is less likely to spread in a family. I would, without hesitation, treat
my own children in this manner, were they attacked by a disease
which I so much dread, but I should fear to employ cold affusions."
[Rev. Med. Chir., and Brit. Am. Jour.

Treatment of Neuralgice according to their Seat. The author, M.
Sandras, passes successively in review neuralgia of the fifth pair, of
the cervical plexus, ilio-scrotal neuralgia, crural and sciatic neuralgia.
His treatment is exj)ressed in the following rc5?yme:

Neuralgia of the fifth pair yields more readily than any other to
the internal administration of belladonna. He has also derived ben-
efit from a plaster of the black cyanide of potassium. The pomade

1849.] Monthly Periscope. C35

of strychnine has only appeared useful when, after the attack has
subsided, the skin has retained an exaggerated sensibility.

In temporal neuralgia, with the employment of belladonna inter-
nally, he conjoins compression of the temporal artery.

In suborbitar neuralgia, the eiidermic use of morphine, and the
cyanide of potassium, succeed better than in temporal or cervical neu-
ralgia.

In submaxillary neuralgia, belladonna is the m.ost useful remedy;
compression of the carotid likewise affords relief.

The same treatment is beneficial in cervical and occipital neural-
gia, but in this form compression of the artery is of little or no use.

The ireatment is likewise the same in intercostal, crural, and sciatic
neuralgia, but the author observes that these forms are often accom-
panied or produced by neuritis, and that it is therefore advisable to
premise the treatment by topical abstraction of blocd. Gazette il/c-
dicale, and Ihid.

Morbid Growths and their Extirpation. Mr. Hunt, in the Provin-
cial Medical and Surgical Journal, May 2d, sums up an interesting
paper on this subject, with the following conclusion:

"The extirpation of morbid growths may be said to be indicated
(their position being convenient for oj)eration,) 1. Whenever the
disease is clearly the result of local or mechanieal irritation from
some external source. 2. Whenever the tumor is neither painful,
tender, nor progressive, the health being good. 3. Whenever it can
be fairly demonstrated that the pain or irritation of the tumor, being
the primary and sole cause of disturbed health, its removal will be the
least of two evils. 4. A tumor in the mamma, originally depending
on disordered health, may, after the health is restored, become painful
from the pressure of the dress, and thus the absoibtnt glands may be
excited and the uterine functions disturbed. Excision may be justi-
fiable in such a case ; but the proper time must be chosen, and
great attenti-on should be paid to the health subsequently.

" The extirpation of morbid growths may be said to be contra-indi-
cated, 1. When failing health precedes or accompanies the appear-
ance of local disease. 2. When the disease is advancing, the tumor
sensibly growing, no local or meci]anical cause of irritation being ap-
parent. In this case it is right to assume the existence of latent consti-
tutional disease, and to treat the case medically rather than surgically.
3. When there is a plurality of tumors. 4. When the disease re-
appears, whether soon or late after an operation for its removal."

On the HcBmostatic Properties of Cotton, by M. Bourdin. M.
Bourdin states that he has long availed himself of the hcemostatic pro-
perties of this substance, and relates some of the cases in which it
appears to have been very efficacious as epistaxis, hemorrhage from
varicose veins, opening the temporal artery by caustic, (kc. It is of
no avail in hemorrhage from arteries of large calibre. The wound
must be very carefully sponged, and the cotton exactly applied, by

J36 Monthly Periscope. [October,

successive fragments, and moderate pressure maintained over it for
several minutes. If the first attempts prove unsuccessful, the cotton
should be entirely removed, and a new piece applied. When suc-
cessful, it adheres to the part with great force, although sometimes a
sero-sanguinolent fluid still, for a while, oozes out, on account of
which the cotton need not be removed. The cotton becomes as hard,
and as difficult to cut, as thick pasteboard, resists the action of water,
and can only be removed at the expiiation of several days, when
loosened by suppuration. [Brit, and For. Med. Chir Rev., iiom Re-
view Medicale.

The advantages of Chloride of Gold as a Caustic. By M . Chavan-
NES. MM. Recamier and Legrand signalized the advantages of the
chloride of gold as a caustic many years ago and our author con-
firms their statements from observations made chiefly in the treatment
of lupus and syphilitic tubercles and ulcers. M. Chavannes main-
tains that the chloride of gold destroys less than the other caustics,
and, when the crust separates, cicatrization is found in a forward
state of advancement. The cicatrix, which remains after the use of
this chloride, is said to be less marked than when other caustics are
employed. It is prepared thus : gold leaf one part, hydrochloric acid
three parts, nitric acid one part. [Monthly Retrospect^ from Gazette
Med. de Paris.

M. FilhoVs Method of Testing Arsenical Deposits. M. Filhol has
communicated to the Journal de Chimie Medicale, the following sim-
ple mode oftransforming arsenical stain into arseniate of silver. He
takes a porcelain saucer on which arsenical stain has been received,
and inverts it over another porcelain saucer, in which is contained a
small quantity of hypochloride (chloride) of soda, mixed with about its
volume of sulphuric acid, diluted with thirty or forty times its weight
of water. In about one or two minutes, the arsenical deposit will
have disappeared ; then into the saucer which contained it a strong
solution of neutral nitrate of silver is to be poured : immediately a
brick-red discoloration is obtained. This is a test of extreme delicacy.
It is important to remove the upper saucer immediately on the disap-
pearance of the stain, otherwise the red color of the arseniate may be
concealed by the chloride of silver which is simultaneously formed.
Journal de Chimie Medicale.

If the arsenical deposit were received in a watch-glass, the time
at which the stain disappears would be imnjediately perceptible.
Lond. Med. Gaz.

On Aconite. By M. Teissier. M. Teissier has undertaken a
prolonged series of researches in order to establish, if possible, the
therapeutical value of this substance, and especially anodyne and its
antiphlogistic power. The existence of the former is incontestible,
but it differs from opium in giving relief, not as that does to all
descriptions of pain, but only to certain kinds of it. This specialty of

1849.] Monthly Periscope. 637

the action of aconite is one of its characteristics, its anodyne property
being only in fact a secondary one. Its principal, and in some
measure specific, action is exerted upon the skin^ eliminating through
its vessels injurious principles and restoring the natural functions
when these have been disturbed. Thus aconite is a very appropriate
remedy in diseases induced by chills, or when morbid principles are
detained in the cutaneous tissues, as in the exanthemata ; and M.
Teissier, has especially derived benefit from its aijodyne properties
in diseaseses of a rheumatic or catarrhal origin. The antiphlogistic
power of the substance is quite subordinated to the influence exerted
by it upon the skin, and is especially observed in individuals of a
nervous or lymphatic temperament, and those predisposed to rheumat-
ic and cutaneous aflections ; and in such it is beneficial in lumbago,
angina and bronchitis, influenza, rheumatism, especially when recent
and not very acute, &c. M. Teissier prefers the tincture^ to obtain
the anodyne effect of which he rapidly increases the dose from 10 or
20 drops to 1 or 2 drachms per diem. [Revue Medicale, and British
and For. Medico- Chirurg. Rev.

Proportion of Nutritive Materials in different articles of Food.
Of all the alimentary substances, bread is one of the most nourishing,
as it contains 80 per cent, of nutritive materials ; peas and beans,
however, contain from 92 to 93 per cent, of them. Butcher's meat
contains on an average 35 per cent.; potatoes, 25 per cent.; carrots,
14 per cent.; greens and turnips, 8. Thus a pound of good bread is
equal to 2| or 3 pounds of the best potatoes ; and 75 pounds of bread
with 30 pounds of meat, are equal to 300 pounds of potatoes. But a
fact worthy of notice is, that one potind of rice or beans is equal to
three pounds of potatoes. [London Lancet.

Calomel in Acute Articular Rheumatism. Dr. Leclercq has pub-
lished in L'Union Medicale, several cases of acute articular rheuma-
tism successfully treated by small doses of calomel. Dr. Law, of
Dublin, had, so early as 1838, pointed out the advantages of this
practice, as Dr. Trousseau, of Paris, has likewise done, in his book on
therapeutics ; but these physicians used to combine quinine with the
calomel, and Dr. Leclercq has obtained very good results by calomel
alone. These were the diflerent steps of the treatment: 1. Bleed-
ing, if the subject be plethoric. 2. Calomel in divided doses viz.,
one grain of calomel in about a drachm of white sujrar, to be divided
into twelve papers ; one to be taken every hour. 3. An opiate at
night. 4. Cooling drinks. 5. Poultices, sprinkled with laudanum,
on the painful joints. This method has been found to counteract as
well, if not better, cardiac complications. Lemon juice, on the other
hand, seems to be a greater favorite in this country, and has yielded
excellent results. [Ibid.

Quackery in the Nineteenth Century. (To the Editor of the Boston
Medical and SurgicalJournal) Dear Sir, I have lliought it might

638 Monthly Periscope. [October,

be at least amusing to your subscribers to read the following somewhat
curious document. It was given to me by a patient who had been for
several years atHictcd with epileptic fits, and who applied to a mes-
merizer or mcsmerizere^^, to asccjtain the precise cause of the trouble.
It is amusing to see in what curiosities our goodly city abounds, and
what wonderful talent exists in the assumed medical profession in these
days. Here is a class of empirics who profess to look right through
all the integumej^ts of the human body, and take a " bird's-eye view"
of the state of all the viscera and of every internal organ. They
are so "eagle-eyed" that the smallest lesion in the minutest particle
of the liuman organization canliot escape their search, and so patho-
logically correct is their diagnosis, and so thorough their knowledge
of the materia medica and skill in prescribing, that they can direct to
the ^^ very medicine which ivhich will prove an all powerful specific, in
every case.'' "O temporal O mores!''* What will come next?
Perhaps it may seem like taking too much notice of one of the silliest
humbugs that has flown around, and buzzed among us, in these times
oi' progress, and of the astounding credulity of the age in which we
live. But, such as it is, iMr. Editor, here you have the genuine " Ex-
amination and Prescription," verhatim etliteratum, with only this addi-
tional remark, which was affirmed by the patient, that the priestess,
while declaring tlie arcana fiom the oracle (more wise than that of
Delphos), fell into two genuine epileptic fits, for the purpose of showing
the patient how one appeared in such a state : that is^ was really thus
affected.

^^Examination. Scrofulous Humour in Blood.

Get a Bottil Babery Snuif take it constantly

Put a blister Across from Ear to Ear

3 mornings before putting on the blister Shower the head With
Cold Water

Nervous System has been Renshed By convulsivcs fits

Convulsion Come on between twelve &; one O. C.

Rubtlic Linbs With flannels vinegar & Water

Get a ounce of Ether own of Camiir ^ oz paragoric take it Clear as
soon as the Spasm com on

take I of Great Spoon ful before they come on

Rub the temples armes & Stomach With vinegar & Water

Spassms liroughton By Straining the nervs & cramping them

JNounce Cramp Convulson fity

Blood in a Cold State

Get an oz of Picrc put in a pint of New Rum take a ^ Glass Tues-
day and friday Morning for Six Weeks

the Blood Gets in Cold Stat( Strikes to the Stomach When She is a
Sleep stagnates (Sc Cuscs the Spasms

Be verrey cautious not to Goo to Sleep on your Back Lay on your
Side turn over often

take .} pint Blood from Right arm before you Rub, this Will help
the pain in the head

1849.] Medical Miscellany. 639

Soak the feet on thursda in Salt &; Water Rub the Limbes with llie
Same

take table Spoon full of Oil twice a Week Opposite the Picra."

One more item, and we have done with the astounding medical ad-
vancements of the present day in good old Massachusetts. It may
serve as a grand climacterical auxiliary to the preceding, or some
other equally nonsensical humbug that feeds the gullible appetite of
the present age on medical "matters. The prefatory remarks are
from the Bee of this city.

" The following directions for using a cure for the rheumatism were
handed by the doctor who prepares it, to a printer in this city for pub-
lication in a hand-bill. We assure our readers, that it is not at all
exaggerated ; it is set up from the original, verbatim.''

" A CURK FOR THE RHE0MATI5M.

"A celebrated medercine for this complaint thismedeVcine is Com-
posed of metrials of his one Collection of South Canton jnass.
N. B. Directions for using ; take won teaspunful in the Morning mix-
ed with a Little of molaces accept those that have a Strong Constiton
which Can bare a little more, take it for fore Days and you will find
your pains Removing and in the Corse often or twelve Days you may
think your self gitting Red of them. In case that the patient has
swelled Joints and Paine ful thare is an Erb that anght to be used at
the same time as a poltice, in order to releave the pane in the Corse
of one or two Nights, and take down the swelling in a short time. I
have other other medercine on hand for many other Complants Sutable
for famerlys use to keep on hand in Case of Suding attacks which we
are all liable to meat with and not to be without and keep for ears if
tacon of, a Child can use the same in moderate Doses there is not a
nother person knone in the States tliat can prepare these articles, which
can be had by some agents in many places or towns &c and may bhad

of Mr No street, Boston. Prepared and put up only by

Dr .

"All of you that have eused this medercine and sattisfide Plese to
in form your nabours and frinds whare it may be had."

We shall not expect to hear anything more about progress in medi-
cine, as the ac7ne has now been reached ; so we bid farewell to Hip-
pocrates and Galen, and all the moderns will go to mesmerism and
S. C. Yours, W. M. C.

Medical Miscellany. A lady died al Detroit, Michigan, August lOih, from
the effecls of irihabng etlj^r, administered by a physician for the purpose of ex-
tracting a tooth. A medical board of examiners, lor the appointment of Assist-
ani Surgeons of the U. S. Army, will convene at Philadelphia on the 15ih Oct.
Beriholdt, the geologist, educated under Bhimembach, died al Alsau, in
July, aged 87 years. Doctors' fees at the mines in Calitbrnia, are SlOO per
vish. A physician from Westchester, N. Y., has e.sial)lishcd himself on the
banks ot the Sacramento, in a log-cabin, one half of which he uses as a store
and the other as a hospital: and it is said thai he receives as much gold daity
as ihe average of Uventy miners. Cases of yellow fevei' have been recognized
Ihasearlv ir. ihr pa.=on. at Ncui* Orl-an.s. Dr. .Tohn C. Pease, of Hariford,

040

Obituary Notices, Meteorology.

Conn., has bnen appointed 6th Auditor of the Post Office Department, atWash-
ino:ton. Dr. Burroiio:hs, of Buffalo, while playing: at ten-pins, at Avon Springs,
broke his thigh. It was done by the muscular action of throwing the hall.
Lobelia inflata is still extensively employed by quacks, and from the injudicious
use of it, a person, who had placed himself under the hands of an herb doctor
in the North of England, has latelv lost his life. At the inquest, it was proved
by two medical witnesses that ihe deceased had died from the effects of tlic lo-
belia inflata, and a verdict of manslaughter was returned against the quack.
A mixture ot collodion with canlharides has been contrived as a substitute for
the ordinary blistering plaster. The cantharides are digested in the ether, and
the latter afterwards mixed with the gun-cotton. The part lo be blistered is
painted over with the collodion by a pencil The New York City Inspector's
report sh'ws ih?t during the past week there have been 643 deaths, including
164 by Cholera. [Boston Med. and Surg. Jourji., Sept. 5.

Obituary Notices. We announce with deep regret, the deaths by Cholera, of
Prof. John P. Harrison, of Cincinnati, and Dr. Amirah Brigham, of Utica,
New York, both Editors of Medical Journals.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet.

for August, 1849, at Augusta,
32' west Wash. Altitude above

<

Sur
Ther.

72
72

Rise.
Bar.

29 83-100
" 8.3-100

2, 1
Ther.

79

86

^M.
Bar.

Wind.

Remarks.

1

2

29 82-100

" 88-100

N. E.

N. E.

laJ^d-v-Rat. 1 '-'0-

3
4

73

72

" 89-100

" 87-100

86

78

" 88 100
" 80-100

N. E.

Cloudy-rain. |,_,

5

72

" 82-100

91

" 78-100

S.

.Cloudy some sun-shine.

6

74

" 76-100

90

" 78-100

N W.

Fair.

7

72

" 82-100

91

" 83-100

N.

iFair.

8

71

" 84-100

81

' 80-100

W.

jCloudy rain, 22^-100.

9

73

" 84-100

83

" 70-100

w.

Rain, '7^-100.

10

70

" 66-100

89

" 65-100

w.

Fair.

11

71

" 75-100

90

" 66-100

N. W.

iFair.

12

72

" 84-100

89

" 87-100

W.

Cloudy.

13

72

" 86-100

91

" 79-100

\V.

Cloudy rain.

14

73

" 71-100

90

" 65-100

s. w.

Cloudy.

15

73

" 6.5-100

87

" 65-100

N. E.

Cloudy.

16

70

" 73-100

90

" 76-100

S. E.

Pair.

17

74

" 82-100

92

" 82-100

S.

Somewhat cloudy.

18

72

" 81-100

96

" 74-100

s. w.

Pair breeze.

19

76

" 74-100

92

" 75-100

N. W.

Pair breeze.

20

70

" 79-100

90

" 81-100

E,

Pair.

21

71

" 86-100

90

" 88-100

E.

Pair.

22

73

" 90-100

92

" 90-100

S.

Pair.

23

74

" 87-100

91

" 76-100

S.

Cloudy. [90-100.

24

75

" 75-100

91

" 74-100

w.

Cloudy sprin. rain at 7, pm.,

25 72

" 69-100

88

" 80-100

E.

Pair breeze splendid day.

26 73

" 84-100

86

" 85-100

E.

Cloudy afternoon breeze.

27 72

" 8.5-100

89

" 84-100

E.

Somewhat cloudy.

28

72

" 86-100

90

" 80-101'

E.

Somewhat cloudy.

2f>

72

" 82-100

92

" 82-100

E.

ICIoudy afternoon.

30

74

" 82-100

92

" 82 100

W.

jCloudy. [75-100.

31

75

' 78-100

90

" 71-100

W.

'Somewhat cl'dy rain at 3, a.m.

1 1 Fair days. Quantity of Rain 2 inches and 15-100. Wind East of N. and
S. 12 days. West of do. do. 13 days.

Erratt.'M. Page 502, ono line from bottom, read ^normal for " normn!.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. .] NEW SERIES. NOVEMBER, 1849. [No. 11.

PART FIRST.

rxginal (lommirnicationH.

^ ARTICLE XXXIV.

Therapeutic Effects of Tobacco, applied externally, for the
Expulsion of Worms. By John D. Twiggs, M. D., of
Edgefield District, South Carolina.

Three series of experiments have been made, in order to test
the vermifuge properties of tobacco placed over the abdomen.
They have not proved so satisfactory as could have been de-
sired.

On perusing an Essay read before the Medical Society of
Augusta, in 1839, 1 find this conclusion, viz : There are no pa-
thognomonic signs that will determine the existence of worms
in the alimentary canal. If this be the case, as the frequent
administration of anthelmintics to children, where worms do
not exist, and even where they do their continued use, would
in all probability prove pernicious to the child: it would cer-
tainly be a great desideratum to practitioner and patient if some
substance could be applied externally which would effect the ex-
pulsion of these noxious parasites: both would be benefitted by
its use; for the first could avoid giving a medicine the ill effects
of which might make a lasting impression on the system of his
patient ; and the latter would escape sw^allowing oft-repeated
doses of most nauseating drugs. If the external application of
tobacco be a substitute, the effects being equal, the remedy
would at least be more agreeable.

I have made the following experiments :

N. S. VOL. V. NO. XI. 41

642 Twiggs, on Therapeutic Effects of Tobacco. [November,

FinsT Series. Five negj-o children, from 5 io 8 years old.

Case 1st. Strong pressed bar tobacco, steeped in water and
applied to the abdomen in the form of a poultice. General
health of the child good, pulse 80. Applied the tobacco at 9i
o'clock (by means of a cloth about 12 inches broad) over the
abdominal region : \0\ o'clock, the pulse is 100 ; the eyes are
a little watery: 11 o'clock, pulse 106: 12 o'clock, pulse 108;
eyes still suffused with tears. 1 o'clock, p. m., pulse has in-
creased to 112 beats: 2 o'clock, p. m., found patient asleep,
pulse still 112: 3 o'clock, pulse still the same: 4 o'clock, re-
moved the tobacco. It has been 6| hourssince.it was applied,
during which time I have noticed a sligiit change in the eyes
which became lachrymal. An inclination to sleep was observ-
ed and also a great acceleration in the pulse, which is now 116,
an increase of 2 beats within the last hour. At 8 o'clock, p. m.,
gave 5 grs. of calomel ; it operated and worms were expelled
dead at 9, a. m.

Case 2nd. Applied the tobacco at d\ o'clock ; pulse 85.
General health of this child good ; has passed worms recently,
after the administration of (vSimilax China) China root. At \
past 10 o'clock, a. m., pulse of child 88; says he feels well.
11 o'clock, pulse of patient has increased from 88 to 100; eyes
injected : 12 o'clock, pulse 100 ; patient seems very cheeiful.
At 1 o'clock, pulse is 104 beats, being an increase of 4 strokes
within the hour: 2 o'clock, p, m., patient asleep, pulse 108 beats :

3 o'clock, patient seems well; pulse still on the increase, 110:

4 o'clock, removed the tobacco ; patient's pulse 112: noticed
the same change as in the preceding case, viz., eyes watery, an
acceleration of the pulse and a disposition to sleep. At 8 o'clock,
p. m., gave patient 5 grs. of calomel. At 7, a. m., passed sever-
al worms dead.

Case 3rd. A child about 0 years old, whose health has been
usually good, and has passed worms within a few days. At \
past 9 o'clock, a. m., placed the tobacco thoroughly wetted over
the abdomen : pulse 85. At 10^ o'clock, patient's pulse 90;
says the bandage feels very comfortable : 11 o'clock, pulse 96,
an increase of 6 strokes within the hour: 12 o'clock, examin-
ed patient, found a decrease of 4 beats, pulse now only 92.
1 o'clock, p.m., pulse of child 100, again on the increase.

1849.] Twiggs, on Therapeutic Ejfects of Tobacco. G13

At 2 o'clock, I found my patient's pulse had increased 8 beats
during the last hour, being now 108, full and regular : 3 o'clock,
my patient just roused from sleep, pulse 108. At 4 o'clock, p.m.,
I took off the tobacco; patient says he is well. In this case I
have not observed that change in the eyes, as in the two pre-
ceeding cases, but there seems to be here also an inclination to
sleep. At 8 o'clock, p. m., gave a dose of castor oil to patient,
it operated well and 3 or 4 worms were evacuated dead.

Case 4th. A child about 7 years old, general health good,
has passed worms, but not recently. At 9^ o'clock, a. m., ap-
plied the tobacco, steeped in water, over the abdomen ; pulse of
patient 85. At ^ past 10 o'clock, the pulse is only 80, a decrease
of 5 strokes. At 1 1 o'clock, pulse of patient 94, and feeble.
At 12 o'clock, pulse 91, child seems well and cheerful : 1 o'clock,
p. m., patient's pulse 94, a gain of 3 beats. At 2 o'clock, p. m.,
examined patient, whose pulse remains the same, 94, full and
regular; inclines to sleep : 3 o'clock, pulse 98; patient's eyes ra-
ther injected. At 4 o'clock, p. m., I removed the tobacco ; pulse
numbers 106 strokes. There has not been that rapid increase
in the pulse of this child as was manifested in the others it has
been fluctuating throughout, sometimes rising, then again falling.
At 8 o'clock, p. m., administered a dose of castor oil to patient,
who passed several worms, some dead, others alive.

Case 5th. A child aged 8 years, who, when an infant, was
unhealthy, but appears well now% has passed worms, though not
recently. At ^ past 9 o'clock, a. m., placed the tobacco over
the abdomen; pulse 100. At i past 10 o'clock, pulse 112, eyes
watery, countenance dull, has little to say : 1 1 o'clock, patient's
pulse 120; appears dull, says he does not feel well ; eyes inject-
ed, pupils dilated: 12 o'clock, pulse 116, eyes much injected:
1 o'clock, pulse 118; seems very sleepy; has been out and had
a motion from the bowels passed no w^orms had the tobacco
remoistened : 2 o'clock, my patient has been asleep ; pulse 118,
feeble ; he complains of no uneasiness about the abdomen ; de-
sires to eat : 3 o'clock, p. m., pulse of patient has increased 10
beats within the last hour, it now numbers 128 strokes: 4
o'clock, p. m., removed the tobacco from child. I have re-
marked greater changes in this case than with any of the others
eyes very red and watery, skin hot and dry, a disposition to

644 T\V\ggs, on Therapeutic Effects of Tobacco. [November,

sleep, and a great increase of pulse, which has now 132 beats
to the minute. At 8 o'clock, p. m., gave patient a dose of castor
oil which operated freely ; several worms were passed, at first
dead, at the last operation they were alive.

The increase in the pulses of the 5 cases, from 9i o'clock,
a. m., to 4 o'clock, p. m., is as follows: At 9^ a. m., 85, 85, 90,
100, 100. At 4, p. m., 106, 108, 112, 116, 132.

Second Series.

Case 1st. Richard, a lively boy, of 5 years, never has been
sick in his life, parents both healthy; has passed no worms this
year, though he has taken China root frequently. At 9 o'clock,
a. m., applied the tobacco, steeped in warm water, over the ab-
domen; pulse 80 strokes per minute: 10 o'clock, a. m., saw
patient ; pulse 90, full and strong : 1 1 o'clock, pulse of child 98,
an increase of 8 beats: 12 o'clock, examined patient; pulse
110, skin warm and moist, eyes watery : 1 o'clock, p. m., pa-
tient's pulse 120, quick and feeble; skin warm and moist: 2
o'clock, p. m., visited patient ; pulse. 112, a decrease of 8 beats
within the hour ; skin very dry : At 3| o'clock, p. m., pulse of
patient 114; says he feels well; skin dry, eyes watery: 4^
o'clock, examined patient: pulse 116, a gain of 2 beats; skin
hot and dry, eyes much injected : 6, p. m., visited patient ;
pulse 130 ; removed the tobacco, which has been on 9 hours,
during which time he has not had an operation. On the follow-
ing day, at 9 o'clock, a. m., patient took a dose of castor oil,
passed no worms the tobacco has not had the desired effect.

Case 2nd. Isum, a boy aged 5 years, general health good,
has passed worms, though not recently. At 5 minutes after 9
o'clock, a. m., applied strong pressed bar tobacco over the abdo-
men ; pulse 80 : 10 o'clock, a. m., child's pulse 96 ; sitting be-
fore the fire, says he is well : 11 o'clock, saw my patient whose
pulse numbered 101, an acceleration of 5 strokes : 12 o'^clock,
found patient's pulse 104, a slight increase ; skin moist ; the to-
bacco again saturated : 1 o'clock, patient sitting very quiet ;
says he feels very well, but has a dull countenance, eyes watery,
pulse 106 : 2 o'clock, pulse of patient 114, an acceleration of 8
beats since last examined. At I past 3 o'clock, p.m., chfld's
pulse 120, a gain of 0 strokes in one hour and a half. At 4

1849.] Tvi\gg% on Therapeutic Effects of Tobacco. G45

and4|^ o'clock, found my patient's pulse 110, a decrease of 10
beats ; skin hot and dry, countenance dull : G o'clock, p. m.,
examined patient, whose pulse numbered 114 beats; skin hot
apd dry ; has had two operations, passed no worms ; removed
the tobacco. Between 9 and 10 o'clock, a. m., gave patient a
dose of oil ; he passed one worm.

Case 3rd. Mary Ann, a girl 6 years old, whose general
health has been good ; worms have been expelled, though not
lately. At 9 o'clock, a. m., placed the tobacco, well soaked
with water, over the abdomen ; pulse 85 ; child very much
frightened: 10 o'clock, a. m., visited patient; pulse 100, quite
an increase within the hour : 11 o'clock, patient's pulse 102,
on the increase : 12 o'clock, examined patient; pulse 102, skin
warm and moist ; saturated the tobacco again : i o'clock, p.m.,
pulse of patient 108, skin warm, perspires at times. At 2
o'clock, p. m., found patient's pulse 120, feeble and full at inter-
vals; skin moist. At | past 4 o'clock, examined girl; pulse
116, a decrease of 4 beats; skin now dry, e3^es red and inject-
ed: 6 o'clock, visited patient ; pulse 120; skin hot and dry;
eyes suffused with tears: removed the tobacco. At 9|^ o'clock,
a. m., administered a dose of oil to patient no worms were
expelled.

Case 4th. Robert, a mulatto, aged 2| years, general health
good, passed several worms a week or two since, having taken
pink-root. At 15 minutes after 9 o'clock, a. m., applied the
tobacco on patient, who was very much alarmed and struggled
violently I could not examine his pulse: 10 o'clock, a.m.,
saw my unruly patient, pulse 100, doing well. At 11 o'clock,
the pulse of this child (whom it is impossible to keep quiet) is
106 : 12 o'clock, patient's pulse 112, skin cool ; still very play-
ful ; moistened the tobacco the last hour : 1 o'clock, p. m., ex-
amined the patient; pulse 120, an increase of 8 beats since last
seen. At 2 o'clock, p. m., the pulse of patient the same as last
hour, 120. At i past 3 o'clock, I found an increase in the pulse
of this patient of 10 teats ; it now ranges to 130, skin hot and
moist. At 4 and \ past, again examined patient ; pulse 124,
there being a falling off by 6 strokes since last examined. At
6 o'clock, p. m., saw my patient and took off the tobacco, much
to his satisfaction; pulse 120, skin dry. Next day, at 9, a.m.,
patient took a dose of oil, operated, but passed no worms.

64G Twiggs, on Therapeutic Effects of Tchacco. [November,

THIRD SERIES.

Commenced this morning at 9^ o'clock, and applied the to-
bacco to seven children 2 boys and 5 girls nearly all young-
er than the five preceding cases. I keep them out of the sun,
in any position they desire : sitting they prefer, and I find
them generally in this position. At 10| o'clock, found an in-
crease in the pulses of some, as also a diminution in that of
others. At 1 1 o'clock, an increase in all, probably owing to
their just having taken food. At { to 12 o'clock, a. m., I found
my patients doing well a decided acceleration in the pulses
of all, which now range from 98 to 120 ; the eyes of two were
filled with tears: 12 o'clock and a I after, examined four of the
children: the pulses of three had a slight increase, those of the
others remained the same as half an hour previous. At 1
o'clock, saw^ three of my patients : a very slight increase of the
pulse of each since last examination, which was at I before 12:
2 o'clock, discovered two of the children asleep and the others
nearly so: there has been an increase and also a great decrease
in their pulses during the last hour, the range is from 110 to 130
strokes per minute. At i past 3 o'clock, examined the children
again, found an increase in their pulses, they range from 114
to 136 I left them taking then' dinners I should mention that
one had an evacuation since 2 o'clock, put passed no worms.
At I to 5, p. m., visited my patients ; I found them doing v/ell ;
four others had a passage since 3 o'clock, expelled no worms ;
some of their pulses have increased and others diminished since
the last examination, the lowest number of beats being 108, the
highest 132 : 20 minutes after 7 o'clock, removed the tobacco
from the children ; found several asleep, the pulses of all had
decreased, except two, one of which had a great increase this
one was asleep when I first saw her, and the increase of pulse
may be owing to her being wakened suddenly one of the pa-
tients, whilst the tobacco was being removed, had a sudden and
co[)ious evacuation and had passed a worm alive a few minutes
previous none in the last passage. All seemed well when I
left them. At half-past 6 o'clock, a. m., visited my patients,
and discovered that the tobacco had had a strong cathartic ef-
fect on all some going out as often as two or three times it
still continued this morning when I saw them : it seems that the

1849.] Pendle'.on, on Diseases of Hancnch Coitnty. 047

desire to defecate came upon them so quickly, they relieved
themselves on the bed or floor, some getting as far as the steps
there were nine in .-ill, on whom the tobacco was applied
two I did not note down, but I find this morning that upon
them the effect is the same. At quarter-past 10, a. m., admin-
istered a dose of oil to each of my. patients. At 1 o'clock, p.m.,
medicine had operated on all no more worms. At 7 o'clock,
p. m., visited the children ; found that one had passed some
time before a large number of lumbricoides.

Minute records were kept of each individual case, but as
they are very similar to each other and to those already detail-
ed, they are omitted, as a narration of them might prove more
tiresome than interesting.

I have thus applied the tobacco in 16 cases; from 7 of these
worms were expelled, and none from 9. When we reflect up-
on the uncertainty of the presence of worms in any case, there
being no reliable symptom, and the uncertain eflTects of all ver-
mifuges, and the fact that in these experiments the children
were generally in jjood health, evincing no sign of worms, the
results are as satisfactory as could have been expected, espe-
cially as the worms were in most instances expelled dead. It
is not likely that if the same children, under the same circum-
stances, had been subjected to the internal administration of
the most powerful vermifuge, that the expulsion of more worms
would have been caused.

As tobacco, when thus employed, affects very decidedly the
circulatory and nervous systems, its effects should be carefully
observed during its application, that it may be removed in time
to prevent these efl^ects beino; carried too far.

We would not claim for these experiments that they are suf-
ficient to establish the character of tobacco thus used, as an
efficient vermifuge ; but if they only serve to excite others to
make more numerous and varied experiments, we will be satis-
fied with the belief that our task will not have been in vain.

/^ ARTICLE XXXV.

Statistics of Diseases of Hancock County. By E. M. Pendle-
Tox, M. D., of Sparta, Georgia. (Continued.)

With regard to the susceptibility of the Caucasian and Afri-
can races to the different classes of disease, it is difficult to form

648 Pendleton, on Diseases of Hancock County, [November,

a just ratio, owing to the fact that the services of physicians are
required oftener for the former than the latter. On large plan-
tations masters and overseers become, from necessity, pretty
good routinists in mild cases of fevers ; and it is only in bad
cases that physicians are called in. The consequence is, in a
population where the blacks largely predominate, (6.407 to 3,642
in the county,) we have but 564 cases of blacks to 1061 of
whites. We believe, however, that there are more cases
and a greater diversity of disease among the whites than the
blacks.

The ratio of deaths, according to the number of cases for
each class, is 2.57 for the whites against 3.54 for the blacks.
I think some allowance must be made from the fact, that cases
among blacks are more frequently delayed until it is too late to
effect much: but, at the same time, most medical men of close
observation will admit, that the Caucasian seems to yield more
readily to remedies (ceterus paribus) than the African. It is
much more difficult to form a just diagnosis or prognosis with
the latter than the former, consequently the treatment is often
more dubious. While then, as our tables indicate, there is less
actual disease among blacks than whites, it is of a more unman-
ageable character and the mortality is greater.

The following table will indicate the susceptibility of the
different races, ages and sexes, to different forms of disease :

Table

5.

o

c

a

xn

.

.

c

c

G

<u

c

c

S

c

w

a

d)

0)

o-

0)

fc.

ol

o

o

0)

o

y

<D

o

^

o

t-t

o

-G

id

T3

K

^

W

0)

P-.

s

^

^

Ph

105

55.9

PQ
90

31.8

O
120

^

Digestive,

303

28.7

120

21.2

158

25.2

219

23.7

19.2

Respiratory,

15G

13.8

1G3

28.0

80

13.7

125

12.4

42

22.3

43

15.2

130

20.8

Brain & Nerv.,

57

5.4

25

4.4

40

6.4

38

4.1

13

7.4

5

1 .7

04

9.7

Rheumatism,

21

2.0

17

3.0

11

1.9

20

2.8

0

.0

8

2.8

30

4.6

Idiopathic lev.

ir)3

14.5

G9

10.4

J 21)

20.0

89

9.G

8

4.2

75

20.0

144

22.0

Urinary,

21

2.0

20

3.5

21

3.3

19

2.0

4

2.1

3

1.0

34

5.2

Vi.su al,

11

1.0

5

0.8

13

2.0

7

0.7

2

i.O

5

1.7

14

2.1

Teeth,

62

5.0

40

8.1

37

5.9

07

7.2

0

.0

34

12.0

71

10.8

Exanthemata,

40

4.3

2(k

3 5

24

3.8

37

4.0

14

7.4

19

6.7

35

5.3

Pec. to women,

111

10.5

87

15.2

941

572

519

027

188

282

054

1849.] Pendleton, on Diseases of Hancock County, 649

It will be perceived from this table that the whites are more
subject to diseases of the prirncB vie than the blacks : a fact
easily accounted for from their diflerent modes of living, both
as to exercise and diet. But upon what etiological principles
are the latter race so much more subjected to pulmonary af-
fections ? Will their greater exposure, winter and summer,
account for so great a disparity, or is there .not with them so
great an affinity for the torrid zone, that their constitutions are
not fitted for the cold even of our temperate climate? As to
diseases of the brain and nervous system, we can more readily
account for the greater susceptibility of our race, in the fact
that they are brought into much greater activity from intel-
lectual pursuits, and have doubtless, by nature, a more delicate
nervous fibre.

But here another interesting question rises in reference to the
disparity between the two races in diseases pecuhar to women.
Reasoning a priori, one would have supposed that the delicate
white female would have had a much oftener demand for the
physician than the coarse muscular negress. But such is not
the fact. The table stands 15.2 per cent, for blacks, to 10.5
for whites. This disparity will be made much more manifest
if we abstract the cases of parturition, which is nothing but
fair, as physicians are seldom called to attend slaves except in
preternatural labor. Thus, out of 56 cases, we have 38 whites
to 18 blacks, reducing the per cent, to 6.9 and 12.4.

In philosophising upon this immense difference, we are led
to the conclusion, from facts within our knowledge, that it
originates in an unnatural tendency in the African female to
destroy her offspring. All country practitioners are aware of
the frequent complaints of planters upon this subject. Whole
families of women fail to have any children, and in many in-
stances these barren females become subject to chronic uterine
affections. Out of 31 cases of abortion and miscarriage, in our
table, we have only 9 for 1051 whites, and 22 for 554 blacks,
being 0.8 for whites, and 3.9 for blacks more than four to one.
This table either teaches that slave labor is inimical to the pro-
creation of the species from exposure, violent exercise, &c., or,
as the planters believe, the blacks are possessed of a secret by
which they destroy the foetus at an early stage of gestation.

650 VendletOY), on Diseases of Hancock County. [November,

That there are several domestic remedies calculated to produce
this effect is evident, but whether they are acquainted with
them is a question, and whether the natural instinct of the mo-
ther to love and protect her offspring should be overruled so
frequently by the moral obtundity of this class of people, is
another question for the philosopher and the philanthropist.
Certain it is, that the statistics of this country show a marked
increase of the white over the black, (about as 25 to 20 per ct.,)
which has been heretofore accounted for mainly from the influx
of foreigners; but our table indicates a cause worth investi-
gating further, involving, as it does at once, the interests of the
planter and the well-being of the African race.

We further find, from the above table, that the blacks are
more subject to rheumatism, urinary affections, and diseases of
the teeth. I suppose that their greater exposure, both in their
daily avocations and their dwellings, may account for their
over tendency to rheumatism. While the very causes which
have been supposed to produce among them a greater amount
of diseases of the genital functions, would sympathetically act
upon the urinary organs and produce more diseases of this
class. But how may we account for their being more subject
to diseases of the teeth. I have always believed this to be the
fact, for you will find but few negroes who are not subject to
tooth-ache. I suppose it must be owing to their sharing with
the whites in some of the evils of civilization, such as hot bread,
acids, medicines, &c., without ^possessing equal advantages
with the latter in the benefits which dental surgery now offers
in the cure and prevention of diseased teeth.

But here Vv'e have an interesting class, viz., idiopathic fevers,
in which the whites largely predominate, as 14.5 to 10.4. That
the African is less susceptible to malarious influences than the
white I have believed from general observation heretofore.
Although more exposed to the cold dews and hot sun of autumn,
as well as having more filth about their habitations, they seem
to be less liable to periodic fevers, and more readily recover
than the white. Is this not owing to the fact, that as heat is
an acknowledged principle in the formation of marsh miasm,
(or that hypothetical agency, whatever it is, that induces au-
tunmal fevers,) the anglo-saxon race inhabiting this country,

1849.] VendleionyOnDiseasesof Hancock County. G51

being from a colder region, is less able to stand diseases from
a southern clime than Africans fiom the torrid zone? We
know, as in Charleston and New Orleans, natives are exempt
from endemics, where one night's sleep of a stranger will often
superinduce a fatal form of fever. This I have frequently ob-
served myself in the former city, while under the tutelage of
my esteemed and honored preceptor. Professor Dickson. Are
not the constitutional tendencies and susceptibilities of a race,
which are impressed upon them by climate, so permanently
fixed as to remain for centuries after the influences of another
climate have been brought to bear upon them ? This is a fact,
I think, clearly established. Hence, the fresh imported African
can sustain the deathly climate of our rice fields far better than
the white, and (but in a decreasing ratio) with less mortality
than the native negro from the up-country.

The whites are more subject to diseases of the eye and ex-
anthematous aflections, by a small per cent. The number of
cases being few, however, and the differences not well marked,
it will be necessary to make further investigations, before any
definite facts are reached.

^With regard to the sexes, we find that the males are more
subject to diseases of the digestive, respiratory, urinary and
visual organs, as also the brain and nervous system while
the female, apart from diseases peculiar to them, are more liable
to the exanthemata, rheumatism, and diseases of the teeth.
The females predominate over the male by a considerable per
cent, in the general liability to disease. Thus, out of 1549
cases, we have 924 females, against 625 males. Abstract from
these 204 for diseases peculiar to women, and they still have a
considerable ascendency. But the diseases of females are less
fatal in their character than those of males. Thus, out of the
924, we have 26 deaths, or 2.8 per cent, of females while out
of the 625, there are 20 deaths, or 3.2 per cent, of males. I
believe that registers of births show that there are more females
than males born into the world ; if so, their over mortality may
be accounted for on another principle than a greater longevity,
though I am somewhat inclined to think that females will not
average such length of life as males in this land of freedom and
peace. I should like further statistical information on this
subject. [Error. More males arc born.] Edt.

52 Vendleion, on Diseases of Hancock County. [November,

Perhaps the most remarkable fact connected with this table,
as relates to the sexes, is the great preponderance of the males
in idiopathic fevers. This being as 20.0 per cent, against 9.0;
more than two to one. Can it be that the out-door employment
of the male gives him a greater tendency to these affections
or is there something with which nature has provided woman,
to ward off the poison of certain diseases to compensate in part
for the deaths through which she has to pass in affections pe-
culiar to herself I have noticed that enciente women are
rarely subject to fevers of any kind. Perhaps the general
phlogistic state of the system, at such times, may protect them
from the inception of poison to a certain extent, and thus tend
to establish the fact contained in the table.

A few deductions in relation to the particular ages at which
certain diseases seem most prevalent, will close this number.
Out of 1079 cases classified, 188 were under 5 years of age;
282 between 5 and 20, and 654 over 20. I have taken the per
cent, of these cases according to the number of each class, which
shows that children under 5 years of age are more subject to
the diseases of the digestive organs, and that adults are less so
than those under 20, by a considerable per cent. I think then
it may be safely announced as a principle in medicine, that the
proneness to injuries of the digestive functions becomes weaker
and weaker as we advance in age. The respiratory functions
are most subject to disease under 5 years than over 20, and
lastly between 5 and 20. The very young are subject to
croup, hooping-cough, catarrhal fevers the old to pneumonia
and bronchitis; while the other class are comparatively ex-
empt from all these affections.

In diseases of the brain and nervous system, adults predomi-
nate, and next children under 5 years of age; but few between
5 and 20 ever suffer with these affections. The table further
indicates rheumatism to be a disease of mature years, as none
have it under 5, and more after 20 than previous to that time.
In idiopathic fevers youth seems to suffer most, next the adult, and
children under 5 are nearly exempt. This is doubtless owing to
the critical stage of teething through which they have to pass
which prevents them from being subject to malarious influences
to a considerable extent. But why the adult should be less liable

1849.] VendleiOTif on Diseases of Hancock County, 653

than young persons is not so easily determined, unless young
people in miasmatic districts have to undergo a kind of accli-
mation, as foreigners, and afterwards become less subject. I
have observed, that parents seldom have fever where they have
lived a long time in unhealthy sections, while their children are
frequently every one prostrated at once. Enquire of them^
however, and you will find in former years they were equally
as subject to it as their children seem to be in later days.

In urinary affections the old largely predominate, and next
the very young, while those between 5 and 20 are nearly ex-
empt. The visual organs seems to suffer more as we get older,
thus: under 5, 1.0 per cent.; between 5 and 20, 1.7; over 20,
2.1. This is in accordance with nature and philosophy. The
young, between 5 and 20, suffer most from the teeth. This is
hardly to have been expected, particularly as the surgeon is
rarely called to operate for the first set of teeth. I think one
reason for this is, that the rising generation have decidedly
more causes operating to injure their teeth than the one which
is now passing away. Lastly, in the exanthemata it seems the
older we grow the less subject we become to this class of dis-
eases : thus 4.7, 6.7, 8.3 per cent. This also accords with
nature and philosophy as scarlatina, rubeola and varicella,
are rarely taken but once, and in most instances under 5 or 20
years of age.

One remark, and I have done. No age in human life is ex-
empt from disease. While the very young are free from almost
every other class, the vital functions of respiration and digestion
suffer to such an extent as to produce more mortality than at
any other period of human existence. The youth in the grow-
ing stage of life seems to be subject to no special constitutional
tendency to any one form of disease, like the very young and
old ; his functions are all in active, vigorous play. But at this
very age the constitution is more liable to all those contagious
and infectious diseases which, in the beautiful language of
scripture, " walk in darkness and waste at noon-day." As we
grow older, many of the functions, as the digestive, become
stronger and stronger, and better able to resist disease ; but
then others are more vulnerable: the wasting consumption,
the deadly cancer, or the terrible cardiac asthma, steals upon
us, and we feel, in the language of the poet,

651 Shef^ey^ on Strangulated Intestine. [November,

" That our hearts,
Like muffled drums, are beating
Funeral marches to the grave."

The lesson it teaches us of our mortaHty, is too obvious for the
wise not to heed its healthful instructions and solemn warnings,
and the good physician should always carry about him a medi-
icine "to minister to the mind diseased." It is not found in our
apothecaries shops, nor is it indigenous to this clime, but still it
may be obtained " without money and without price." It is
the Elixir of Immortality.

ARTICLE XXXVI.

A Case of Strangulated Intestine from adhesion of the Appen-
dix Vermiformis to the peritoneal covering of the Fundus
Uteri, By L. B. Sheffey, M. D., of Huntsville, Ala.

This was a case of a negro woman of this place, to whom
Dr. Erskine and myself were called on the 3d of August. We
found her laboring under symptoms of colic, with which she
had been attacked the day previous ; we failed, by the use of
anodynes, the most active cathartics and stimulating injections,
in giving her any relief from pain, or in producing an action
upon her bowels. The pain was confined to the umbilical re-
gion. In the progress of the attack there was considerable
tympanitic distensions, inverted peristaltic action, stercoraceous
vomiting towards the termination. The persisting constipa-
tion, twisting pain in the abdomen, tympanitic swelling and
stercoraceous vomiting, caused us to pronounce it a case either
of intussusceptio, or twisting of the intestine. She died on the
evening of the 5th.

Upon opening the abdomen, we found that an adhesion had,
at ome time previous to the attack, been formed between the
floating extremity of the appendix vermiformis and the fundus
of the womb, thus making a loop, through which a portion, about
a yard in length, of the small intestine had found its way, and
become incarcerated. The presumption is, that this adhesion
was of considera*ble standing, as the womb was found much
thickened and of cartilaginous hardness, indicating chronic dis-

1849.] Parturition, <^c. 655

ease of some standing, though no period could be referred to by
her owners when she had had an attack sufficient to bring
about this state of thinsrs.

PART II.
Ilex)iett)0 anir Sittracts.

ARTICLE XXXVII.

Parturition, and the Principles and Practice of Obstetrics.
By W. Tyler Smith, London.

The repubhcation of this work by Messrs. Lea & Blanchard,
Philadelphia, was stated in a former number of this Journal,
but having given it a careful and attentive perusal since then,
we think its claims to merit, as well as its defects, demand a
more particular notice.

We are happy to find this is not another system of obstetrics,
but a philosophical and scientific treatise. The author has
labored most earnestly and arduously, to advance the science
of obstetrics and elevate this department of medicine. Had he
not succeeded, he would still have deserved well of the profes-
sion, for his indefatigable industry and well-directed efforts to
serve the cause of science and humanity. But his labor has
not been lost. By the application of Marshall Hall's grand
discoveries in the nervous system, especially his doctrine of the
reflex function of the nerves to the physiology of the uterus, he
has thrown much light, not only on the functions of this
important system of organs, but on their pathology and the
therapeutics of obstetric practice.

By applying the principle of reflex action, he has explained
and illustrated the processes of menstruation, conception, ges-
tation, and parturition, much more satisfactorily than any one
hitherto had done.

It is not our design to make a regular analysis of this work,
or a close examination of all the opinions and doctrines ad-
vanced or maintained by the learned author. The following
extracts will develop his leading views and afford a good idea
of the doctrines taught :

656 Parturition, <^c. [November,

*' Uterine motor action, and the action of the accessory mus-
cles concerned in parturition, with the knowledge of the nature
and laws of the forces upon which these actions depend, are the
Dynamics of parturition. The phenomena of labour, and the
great majority of the accidents and complications of childbirth
and the puerperal period, are essentially nervi-motor; hence a
definite knowledge of motor action in general, and particularly
of the uterus and its associated organs, are of the first import-
ance to the scientific accoucheur." (p. 46.)

" The forms of motor action which it will be necessary for us
to consider are the Voluntary, the Emotional, the Excito-motor
or Reflex, and lastly, the Peristaltic or Immediate." (p. 47.)

"The Reflex actions of the uterus are very numerous, and it
is upon these, and the numerous extra-uterine reflex actions
excited during the process, that the natural performance of
parturition essentially depends. Contraction of the uterus,
from irritation of the mammae, as in the act of suckling the
child ; contraction of this organ from the cold water douche,
applied to the vulva or the abdominal surface; contraction ex-
cited by irritating the rectum, as by stimulating enemata ; or of
the stomach, by drinking a gulp of cold water ; of the ovaria,
by the presence of the menstrual nisus; of the vagina, by
manual irritation, as in 'taking a pain;' of the os uteri by irri-
tation, as in the introduction of the hand into the uterus are
all to be considered as so many instances of reflex spinal action.
Thus, in parturition, the uterus may be excited, in a reflex form,
by irritation of the mammary incident excitor nerves ; the
pubic and abdominal branches of the intercostals ; the rectal ;
the gastric division of the pneumogastric ; the ovarian nerves;
and also by the nerves of the vagina, and the os and cervix
uteri.

"Many of the difl^erent forms of abortion particularly when
the causes are extra-uterine strikingly illustrate the reflex
action of the uterus. A series of cases of abortion would be
one of the best expositions of reflex uterine action. Abortion
may be caused by irritation of the mammae, from .the sucking
of an infant, after milk has ceased to be secreted, as in cases in
which the mother becomes pregnant during lactation ; abortion
may be excited, as a morbid reflex act, from irritation of the
bladder, by a calculus ; by irritation of the trifacial nerve, as in
cutting the dens sapientia); by the mechanical irritation of
coitus; by plugging the vagina ; by disease of the os and cervix
uteri malignant or simple induration, inflammation and ulcera-
tion ; by the irritation of the placenta attached within the
uterine mouth; by ovarian irritation in ovarian disease; by
irritation of the rectum, as from ascarides, and the use of irri-

1849.] Parturition, <^c. ' 057

tating purgatives or enemata; by puncturing the membranes,
and evacuating the Hquor amnii, so as to bring the head of the
foetus to act as an excitant to the os uteri ; by irritation of the
inner surface of the uterus itself, in cases of bhghted foetus,
where the ovum acts as a foreign body ; bv riding on horse-
back, or any other violent exercise calculated, by succussion,
to bring the head of the foetus into violent contact with the os
uteri ; and by other sources of irritation to incident spinal
nerves which might be enumerated. All these are so many
instances of uterine reflex action, the distant parts of the econ-
omy being brought into connection with the uterus through the
medium of the spinal marrow, and its special incident excitor
and reflex motor nerves. These facts are of most extensive
practical application in devising means for the prevention of
abortion.

''' In cases of abortion in which the irritation is applied to the
OS or cervix uteri, or the internal surface of the organ, the im-
mediate action depending on the irritability of the uterus itself
is called forth, in connection with true reflex action ; but in the
instances in which a distal organ is irritated, there can be no
doubt whatever of the purely reflex nature of the uterine action
which ensues." (pp. 49, 50.)

"In natural labour, after the process has fairly commenced,
it is the ovum which furnishes the chief stimulus to the incident
excitor nerves, in its transit through the different portions of
the parturient canal. Besides the mere enumeration of the
various spinal excitors, by the irritation of which the uterus
may be affected physiologically or pathologically, we shall have
to study the order and succession of the normal reflex actions,
uterine and extra-uterine, occurring in labour. Parturition is
not one reflex act, but a function, the combined result of many
such actions, aided by other powers; and we must study the
preliminary phenomena, the different stages of the process,
and the final accomplishment of the function ; when we shall
find that Nature has at her disposal a wonderful succession of
stimulus and action, exactly adapted to the dilatation of the os
uteri and the vagina ; the propulsion and expulsion of the foetus;
and providing, also, for the safe contraction of the uterus, and
its return to the unimpregnated state.

" The uterus, as a motor organ, stands alone in many respects,
unlike the rectum and bladder, it is not directly influenced by
volition; and unlike the heart, it is extremely prone to reflex
action ; it more nearly resembles the oesophagus, which is un-
influenced by the will, but is endowed with reflex motor and
peristaltic action. It, however, difliers from the oesophagus in
the great number of excitor surfaces with which the spinal

N. 8. VOL. V. XO. XT. 42

658 < Parturition^ ^c, [November,

system places it in relation ; neither is there any other organ
not even the stomach which acts as a spinal excitor to so
great a number of organs as the uterus and its excitor nerves,
whether we consider it in the impregnated or the unimpregna-
ted states. Hence the physiological necessity for the abund-
ance of nerves recently discovered.

"Besides the reflex action of the spinal marrow and its system
of excitor and motor nerves, there is the Direct action of the
spinal marrow, though this does not play the important part
assigned to it by M. Serres, Brachat, and Segalas, in which
the central organ and its motor nerves, to the exclusion of the
excitors, are involved. The state of the circulation affects all
the motor organs under the control of the spinal marrow; and
they act with increased energy when the circulation is either
plethoric or anaemic, though in the latter, exhaustion of the
nervous energy quickly ensues. Thus, there is one puerperal
convulsion of hemorrhage, when the heart and blood-vessels
have been drained of blood, and another, of fullness of the circu-
lation. Want and excess of blood, or materies morbi in the
circulation, act as direct stimuli to the spinal centre, and thus
the state of the circulation materially affects the uterus during
labour. There are also certain agents of the materia medica,
which, taken into the circulation, affect the spinal marrow.
Thus, the ergot of rye, passing into the blood, affects the uterus
by a direct spinal action; so does strychnia, so does the inhala-
tion of carbonic acid, and so, I believe, does ipecacuan the
influence of which in producing uterine contraction is very re-
markable. Savine, aloes, alcohol, and the biborate of soda,
may probably be added to the same list." (pp. 51, 52, 53.)

" I believe, further, that at the time of parturition in mamma-
lia, the uterus and the uterine nervous system are excited by
the ovaria; that it is ovarian excitement which induces both
the permanent contraction of the uterus immediately before the
coming on of labour, and the tendency to those reflex, emotion-
al, and peristaltic actions, by which parturition is completed.
In menstruation, a small synergic and reflex arc is described
between the ovaria and the Fallopian tubes; in parturition a
larger arc is in operation, extending from the ovaria to the
uterus. According to my researches, the excitability of the
uterine nervous system at parturition, upon the presence of
which the due performance of this function depends, is caused
by ovarian excitement. At the time of ordinary menstruation,
the ovarian irritation which excites the contraction aud rigidity
of the Fallopian tubes is manifest. Throughout utero-gestation
the ovarian excitement returns in a slight degree at each peri-
odic date; but at the eleventh period after conception (reckoa-

1849.] Parturition, 4^*c, G59

ing the last catamenial period inclusively), the ovarian excite-
ment returns in full force, and, as a consequence, the uterine
excitability, and the uterine actions of labour be;^in." (p. 122.)

" Some of the above facts are pathological, others are physi-
ological ; as single facts, they have, many of them, often been
considered, but they have never yet been put together by the
aid of a constructive idea. I think I shall be able to show you
most clearly, that the mere arrangement of them in their proper
order gives us at once a beautiful Theory of the Cause and
Circuit of the sexual Periodicities.

" The different*organs of the reproductive system affect each
other in a special and peculiar manner in the causation of their
periodic phenomena. The ovaria are the organs in which,
during the continuance of the catamenia, the periodicities are
most distinctly manifested, though these organs doubtless de-
rive their periodic energies through the medium of the nervous
system. We also know that the ovarian periodicity is special-
ly modified by the condition of the breasts and the uterus.
There is a remarkable synergic balance preserved between
the three great organs of the sexual system namely, the Uterus,
Mammae, and Ovaria. In the virgin state, the condition of the
ovaria at each ovarian periodic excitement excites the uterus
to secrete the catamenial flow. When impregnation has oc-
curred, the changes set up in the uterus during the development
of this organ and its contents, re-act on the ovaria, and inter-
fere with the ovarian periodicities, so that they become masked
during the whole term of pregnancy. At the time of parturi-
tion, the ovaria and uterus are the seat of a special excitement,
and it is this excitement of the uterus and ovaria which excites
the mammae to the secretion of milk for the supply of the new-
born infant. After delivery, the uterus soon returns to a state
of comparative repose, but during lactation, the actions going
on in the mamma3, like those of the pregnant uterus in ordinary
cases, prevent the full development of the ovarian periods. As
soon, however, as lactation and the mammary development
have ceased, the uterus, breasts, and ovaria, all resume their
ordinary periodicity, and ovulation and the catamenial flow
proceed regularly until a fresh impregnation occurs. Thus the
catamenial cycle of twenty-eight days is departed from at con-
ception for another cycle namely, that of gestation, which
consists of 280 days, or ten lesser cycles After the comple-
tion of gestation, a new cycle is commenced that of lactation
upon the completion of which the system returns to the sim-
ple catamenial cycle. These cyclical and epicyclical periods
are themselves all included in another great period of develop-
ment, extending from pubertvto the decline of the catamenia."
(pp. 187, 188.)^'

660 Parturition, ^c. [November,

It must be admitted, that there is a good deal of speculation
in the opinions expressed in the foregoing extracts, and that all
the conclusions arrived at are not the results of rigid induction.
But even if mere theories, tfiey are nevertheless ingenious and
plausible and to a considerable extent founded in nature and
truth. The author evinces great powers of observation and
superior talent for bringing together and combining isolated
facts, so as to construct rational and consistent theories. If
not an originator, he is entitled to rank among the improvers
of science.

But whilst we can not commend too highly some parts of
Dr. Smith's work, other portions can not be too severely cen-
sured. It is truly astonishing that the same individual can at
one time write with the finest sense and strongest judgment and
soon after give vent to absurd and ridiculous nonsense. It is
passing strange that critics, so capable of discerning good from
evil in composition, and separating the chaif from the wheat,
should have so kindly passed over some portions of this work.
It certainly must require the thickest veil charity can weave to
hide such faults, or the largest amount of good nature to over-
look them.

We would deal fairly with the author and the reader ; there-
fore, as we made him speak for himself when we wished to shew
how well he could write, now when it becomes our painful duty
to expose his defects, we will adopt the same course. If the
reader can agree with Dr. Smith in the opinions expressed in
the following extract, we must acknowledge his observations,
experience, opinions and ratiocinations, must be entirely differ-
ent from our own.

"I have insisted, in a former lecture, that there is an actual
increase of the sexual emotion during, or immedietely after the
catamenial periods. There are also distinct traces of sexual
excitement in some cases of parturition. That they are not
always present does not tell against my argument, because the
reasons why they are not so present are, as we shall presently
see, very evident. My own observation convinces me of the
truth of the position, and I have obtained from some of the most
distinguished obstetricians of the present day the admission,
^ that sexual excitement is sometimes apparent during or after
labour in a very high degree ; indeed, cases of this kind may

1840.] Parturition, ^-c. r>6l

pass into erotomania after parturition ; and cases of puerperal
mania sometimes present this form of excitement as the most
remarkable concomitant of the disease. We should be bound
to speak the truth in any case; but it would be most offensive
to all the best feelings of our nature to suppose sexual excite-
ment present during ordinary cases of labour, and it would
certainly interfere very much with the' confidence now placed
in the obstetric practitioner. But no such suspicion need be
entertained. Happily, human emotions are very much under
moral control, and in women, almost universally, the utmost
retiredness is preserved in everything which relates to child-
bearing and the puerperal state. Provident Nature has, more-
over, specially exempted women from the dominion of all
passions save that of maternity at the time of childbirth. I
believe this exemption and moral superiority, arises, in a very
great degree, from the physical suffering of parturition. The
natural throes deliver woman-kind from those emotions natural
to the inferior animals. Here it is that we see more clearly
than under any other circumstances, the morality of pain, and
I cannot but consider women would dearly purchase relief
from the bitter pangs of travail at the expense of descending to
the condition of the brutes of the field. The pains of natural
labour are hard to bear, though of late they have been most
cruelly exaggerated by interested parties, but they ennoble the
sufferer morally, and after the trial has passed, there comes the
cry of her infant as the happy crown to the maternal martyr-
dom. I believe it to be right, and conducive to the safety both
of the mother and her child, that women should, with all the
alleviations we can offer, short of interfering with a physio-
logical process and dethroning reason, endure the sorrow
and the joy of travail. With our present knowledge, they
can, as I sincerely believe, only escape the suffering at the
risk of greater evils. On a former occasion I pointed out, that
in women to whom ether-vapour had been administered during
parturition, the sexual orgasm had been substituted for their
natural pains an exchange which women of modesty would
far more shrink from, than the liveliest agony. Under chloro-
form, too, I have been informed of instances in which the lying-
in room has been defiled by the most painful and obscene
conversation. There appears, therefore, apart from considera-
tions of safety, to be a moral objection to the use of anaesthetic
agents in natural labour an objection which should unite
against them all men who desire to uphold the respectability of
the obstetric department; for, most assuredly, the present kind
of attendance could not continue if the facts were understood
by parents and husbands, or by women themselves. The meta-

G62 Parturition, cj-c. [November,

morphosis of the rites of Lucina into the orgies of Venus would
be no real boon to woman, and it would probably degrade ob-
stetricity into mere midwife practice." (pp. 128, 129.)

We cannot believe, with the author, that there is an increase
of sexual emotion during or immediately after the catamenial
periods; we will not, however, controvert this position we
know this opinion is held by some ; but never before did we
hear, read, or dream of sexual excitement during parturition.
This is certainly an original idea, and if, in no other particular,
the author can claim originality, in this he has the most unques-
tionable title to it. Our own observation, and that of all w^ith
whom we have ever conversed on the subject, is directly the
reverse of Dr. Smith's. We have never observed such excite-
ment even in cases of puerperal mania; but ff present then, it
v/ould be a pathological development, a morbid phenomenon,
having no bearing on normal parturition. He admits that it is
not present in ordinary cases of labour, and that it v/ould be
offensive to the best feelings of our nature to suppose it ; and
we would add, repugnant to nature and revolting to common
sense. Such cases must be extraordinary indeed, inasmuch as
in more than twenty years' practice and reading not one has
ever been seen or heard of.

It appears to us the most preposterous and absurd notion the
mind of man ever conceived. The parturient female is not sus-
ceptible of, nor capable of exciting, any such emotion. Dr.
Smith himself admits that " Provident Nature has, moreover,
specially exempted women from the dominion of all passion,
save that of maternity, at the time of childbirth ;" but he thinks
'her moral superiority depends, in a very great degree, on
physical suiTering." He contends for "the morality of pain."
This is indisputably an original thought, but a most humiliating
and degrading idea of woman. We have ever been wont to
regard her moral superiority as resting on a higher and nobler
basis. According to Dr. Smith "it is pain that prevents woman
from descending to the condition of the brutes of the field."
Has Dr. Smith never seen cases of painless labour, independ-
ent of anaesthetic agents cases in which the patients have
suffered much less than generally when chloroform is employ-
ed ? Has he not attended some ladies who are almost entirely

1'849.] Parturition, ^-c. 0(13

:empted from pain during parturition? Has he found such

lies inferior in morality or reduced to "the condition of the

[rutes of the field ?' If so, his observation does not correspond

''ith our own. Does Dr. S. believe the Egyptian women were

iperior in morality to the Hebrew women who had such easy

id rapid births, that the midvvives would not reach them be-
[re they were delivered ?

We are surprised in such a work to find such a violent tirade

gainst chloroform, a phillipic *'full of sound and fury signifying
'nothing."

Like all others who oppose the use of chloroform in obstetric
practice, Dr. S. condemns it without a trial. It has been often
remarked, and with truth, that the advocates are those who
have and the opponents those who have never employed it.
Dr. S. does not mention having ever tried it, which is very
evident from the total ignorance he manifests with respect to its
effects. What can be more unscientific, unphilosophical, and
unfair, than thus to condemn an article which he has not sub-
jected to the test of the most careful and patient experiment.

Had he employed chloroform himself, he would never have
spoken of "sexual orgasm being substituted for natural pains,"
or have made the truly ridiculous remarks that follow that ex-
pression.

We are in the habit of employing chloroform frequently in
obstetric practice, but have never observed the slightest indica-
tion of any thing like sexual excitement, nor have we ever
heard an immodest or indelicate word uttered by a patient un-
der its influence, although they have often been rendered very
loquacious ; it is surprising that Dr. S. should have credited,
much less repeated, such disgusting and improbable stories.

We cannot account for Dr. S.'s opposition to chloroform,
upon any other principle than the well-known aversion elderly
gentlemen have to admit the value of any new discovery that
has not originated with themselves, however ambitious they
may be of the fame of invention.

Very few, if any, obstetricians contemplate the entire aboli-
tion of pain by anaesthetic agents. It is by very few, if any,
proposed to employ them in all cases : many are so compara-
tively easy, and of such short duration, that to say the least

664 Parturition, <^c. [November,

their employment is unnecessary and not desired by the patieiil
It is only in the more violent cases, in those in which pain
excessive and transcends what might be styled the physiolog]
cal point, in which there is a decided departure from eutocij
or in which some assistance, manual or instrumental, may
required ; in all such their utility is indescribably great thej
discovery to be considered one of the greatest blessings ev<
conferred on the human family, and should cause every humai
and feeling heart to expand with gratitude to Him from who!
cometh every good and perfect gift.

Although Dr. S. has such an admiration of pain, and regards
it so essential to the morality and elevation of the sex, he might,
by the cautious and limited use of chloroform, spare his patients
avast amount of suffering and, still, allow them to endure pain
enough for all imaginable purposes, moral or physical.

The utility, safety and propriety of employing chloroform in
obstetric practice, are so well established and so generally ad-
mitted by the profession, that we are surprised to find such
furious opposition to it from Dr. Smith, and not less astonished
that reviewers, should pass it without rebuke.

When we contemplate the extensive applicability of chloro-
form in bstetric practice, and the great amount of good to be
accomplished by it, we cannot regard its proscription by any
work on the subject, otherwise than as a cardinal and radical
defect.

Our limits will only allow reference to a few more of Dr.
Smith's opinions, to which we cannot assent. The following
extracts will shew the views he entertains with respect to the
modes generally adopted for supporting the perineum during
parturition.

"Now I confess I do not know a more absurd situation than
that of an accoucheur, doomed to squeeze the sphincter ani for
hours together. Not that I would for one moment ridicule
any practice which could be useful, for utility is before and
above all in the practice of our art; but I believe this plan to
be well nigh as useless as it is absurd in fact, it seems a true
reliquum of the midwife, and it would be no small boon to
obstetrics to relieve it from such barbarism altogether.

Even if there w^ere no such principle as reflex motor action,
and no danger whatever of exciting inflammation, it mav be

1819.] Parturition, tj-c. C05

fairly questioned whether the long-continued pressure of tlie
hand acting in a merely mechanical manner, is so adccjuate
to support the ]jerina3um as is generally supf)()spd. Piessiu-e
on the mouth of a distensible tube throuf^h which a large
solid body is passing, can have little elfect in preventing
la^ceration, unless it does this by preventing the advance of
the distending body. It is not a little singular, that pressure
exerted on the os uteri by the head of the child within, and the
rim ot" the pelvis without, should be considered a common
cause of rupture of the uterus, while the pressure of the
perina3um between the hand of the attendant and the head of
the child, should be deemed a means of preserving this part
from laceration ! There is no such great difference between
the structure of the two parts, and the circumstances in which
they are placed, as to warrant the opposite conclusions so gen-
erally arrived at." (pp. 245, 246.)

" Still there is one way in which I believe the support of
the perinaeum by the hand may be of service, and which
indicates distinctly the proper mode of managing cases in
which the danger of laceration exists. This is by mechanical-
ly retarding the advance oi the head. If by exerting pressure
we excite uterine action, and at the same time prevent its
effects by retarding the head, we do wrong and right at the
same time, and the right may moi-e than counterbalance the
wrong ; but if we practise the right alone, the gain will be far
greater. This we may do simply by moderate pressure on
the head of the child. I apply this pressure by the tips of the
fingers and the thumb of the right hand, arranged so as to
press in an annular form upon the presenting part. By acting
thus we do no injury to the child ; we retard the advance, but
we excite no unnecessary and unnatural motor action. The only
circumstances in which 1 would recommend perinssal pressure
are in those cases in which the perinoeum is largely developed in
its posterior portion, and where the head of the child, instead of
advancing under the pubic arch, is urged very forcibly against the
posterior portion ofthe perina.'um, the anterior being little dilated.
In some cases of tliis kind, support is advisable, the motor action
excited being of less consequence than the retardation of the
head, which is advancing in an improper direction." (p. 246.)

Burlesque is no argument, and it is often much more easy to
ridicule than to confute to criticise than to improve modes of
practice. Such attempts at wit, to say the least, are incom-
patible with the dignity of science.

There is no doubt but that many authors attach an undue
importance to supporting the perineum, in ordinary cases of

606 Parluritiun, <^c. [November,

labour ; and it is, fartlier, equnlly probable that wrongly di-
rected endeavors to prevent, have sometimes caused, lacerations
of that part. We have been long surprised at the following
expression of the late Prof Hamilton: "In this part of the
kingdom, the perineum requires to be supported in such cases,
(prifniparce.) from two to five hours and upwards." He says,
farther, " that he has often had to make counter-pressure on the
perineum for from five to nine hours.'' We are compelled to be-
lieve either that parturition must be attended with much greater
facility in our country, or that Prof H. was accustomed to sup-
port the perineum, long before there was any necessity for it.

In a large majority of cases, it is probable no laceration
would occur, if no support were aflforded ; but in some it is cer-
tainly indispensable to safety, and it is proper that due caution
should be observed in all, although in general the application of
the hand is not necessary until the perineum is considerably dis-
tended, frequently only during the last one or two pains.

Dr. S. compares the support given to the perineum to " pres-
sure on the mouth of a distensible tube while a hard body is
passing." This certainly is not stating the case fairly ; there is
no analogy the pressure is not made on the mouth of the tube,
but while the hard body is bearing hard on one side of the
tube and threatening to force its way through it, that side is
supported and the body pressed in the direction of the moulh
which is left free for its exit.

Dr. S. attempts another comparison v/hich is as inapplicable
as the former, the pressure of the os uteri between the head
and the brim of the pelvis, and the pressure of the perineum
between the head of the child and the hand of the accoucheur
the brim is a hard and sharp edge, the hand is broad and soft ;
the pressure in the former case is often constant, whereas the
other is alw^ays intermittent: besides. Dr. S. elsewhere con-
tends that when the mouth is separated from the body it is
torn oflTby the violent contractions of the uterus and hot cut
oflTby the pelvic brim.

Dr. S. advises, when the head is advancing too rapidly, so as
to endanger the perineum, to] retard its progress by pressing
against the head with the thumb and fingers, leaving the perine-
um untouched : this plan is not original with Dr. S., it was

1841).] Partuvition, (Jr. (K>7

recommended long ago by Dr. David D. Davis, in his mas.^y
woik entitled, "Obstetric Medicine," and we have known it
practised with the, result of a considerable laceration. It
may be necessary sometimes to resist the too rapid advance
of the head ; but it is far better to endeavor to diminish
the resistance of the perineum, by placing the patient in the
most favorable position, her thighs gently flexed on the pelvis
and moderately separated, by bloodletting, tartar emetic and
opium, and warm fomentations to the part, by directing the
patient to cry out during the pains, and to refrain as much as
possible from bearing down: the danger of laceration, when
imminently threatened, may perhaps be most effectually pre-
vented by putting the patient decidedly under the influence of
chloroform. In our attempts to support the perineum, our ob-
ject is not to make direct pressure against it, but to press it
slightly forward, lengthening out by the hand the curve of the
sacrum and coccyx, causing the head to turn from the axis of
the brim into that of the outlet, promoting thereby that period
in the mechanism of labour termed extension.

We would not deny altogether the reflex motor-action of the
uterus, excited by pressure on the perineum, but we believe it
is very much exaggerated by Dr. Smith : this, however, may be
regarded a venial fault, it is so common for those who have
favorite hobbies to ride them too hard.

Dr. Smith admits there are cases in which perineal pressure
is necessary, "in which the perineum is largely developed in
its posterior portion, and Vvhere the head of the child, instead of
advancing under the pubic arch, is urged very forcibly against
the posterior portion of the perineum, the anterior being little
dilated." This condition will be found very frequently to ob-
tain, especially in all cases in which the occiput presents poste-
riorly at the supei'ior strait, which are far more numerous than
generally supposed, because in these cases the occiput, after
greatly distending the perineum, almost invariably rotates for-
ward and emerges under the pubic arch, an occipito-posterior
being thus converted into an occipito-anterior position. It
must be in these cases that the child's head is sometimes driven
through the middle of the perineum, leaving the anterior and
posterior margins unirjuved.

(308 Parturition, <^'C. [November,

Dr. S. attempts to deduce an argument against the necessity
for supporting the perineum, from the fact that rupture does
not generally occur, when patients are delivered alone ; that it
does not happen oftener is rendily accounted for, when we re-
flect that in those cases which are so rapid that assistance can-
not be obtained in time, there is such perfect relaxation and
preparation of all the soft structures involved in parturition,
that little or no resistance is aiibrded; they almost appear, as
he seems to suppose, to dilate of their own accord and allow
the little stranger a free and unrestrained escape from prison.
The rapidity of the delivery is, perhaps, in every such case,
owing more to the want of resistance than to greater violence
of the expulsive powers.

Dr. S.'s arguments would not be likely to weigh much with
accoucheurs who are fortified by experience, but they are cal-
culated to mislead those who have no experimental knowledge:
at least we have had such abundant reason to be satisfied with
the method we have practiced for more than twenty years that
we could not be easily induced to change it, such an accident
never having occurred but once, and this was very slight, and
promptly and perfectly recovered from, having been caused by
the patient moving suddenly and violently during an instru-
mental delivery.

Dr. Smith contends that opium, instead of diminishing in-
creases uterine action.

"I believe opium generally, by its purely physical and
direct eflfects, increases rather than diminishes uterine action,
and that this is the secret of its utility in uterine hemorrhage.
Looking to its physical action alone, it is absurd that we
should give opium before turning, to allay uterine contraction
(a constant practice), and that it should also be given in
hemorrhage to produce contraction (a practice upon which
many obstetricians rely). Some explanation was necessary
to reconcile these apparent contradictions in obstetric thera-
peutics." (p. 233.)

We are aware that Dr. S. has some authority in support of this
opinion, and we are ready to admit that sometimes when admin-
istered during labour, it appears in moderate doses to exercise
little if any influence, at others it seems to lessen the perception
of pain, while the uterine contractions continue as strong and

1849.] Parturition, ^c. C69

efficient as before, even more so in some instances from the
patients' becoming more quiet, and refraining from unnecessary-
exertions and exclamations. But how often in obstetric prac-
tice, do we observe the most decided and happy effects of opium
in subduing uterine action ? In tedious labours, where patients'
strength and spirits are exhausted by ineffectual pains, how
often do we observe them entirely suspended, and sleep induced,
by a large dose of opium, to their great relief and subsequent
benefit ? We will say nothing of false pains, as their seat is
doubtless often not in the uterus. Is it not strange that ac-
coucheurs, from time immemorial, with very few exceptions,
have been accustomed to give large doses of opium to quiet
uterine action, before proceeding to turn or perform any other
important operation, without discovering that it produced the
very opposite effect? We verily believe, had Dr. Smith exhibi-
ted opium in sufficiently large doses, he could not have failed
to observe a temporary suspension or abatement of uterine ac-
tion. In the treatment of after-pains the most prompt and
decided relief is obtained by opium administered by the mouth,
or in the form of enema.

But it is in the prophylaxis and prevention of abortion that
opium is most frequently and beneficially employed we be-
lieve it is generally regarded by the profession as indispensable,
there being no substitute for it. If there be any certainty in
medicine, if we have positive knowledge of the effect of any
article of the materia medica, it is the power of opium in quiet-
ing uterine action, when prematurely excited. How often do
we witness the most signal benefit, the happiest results, from
large doses of opium in arresting abortion, when most immi-
nently threatened? How often do we observe strong uterine
contractions attended with violent pains promptly stopped, by
a full dose of opium or morphine ? What physician could be
induced to dispense with opium in such cases ? How often do
we see ladies, who were subject to habitual abortions, conduct-
ed safely through gestation by the long continued and frequent-
ly repeated administration of opium ? We could detail case
after case in point ; but we will only refer the reader to one,
related by Dr. Levert, of Mobile, in the first volume of the
second series of this Journal, in which his patient took nine

670 Parturition, ^-c. [November,

grains of morphine two or three times daily for some months,
and by this course gave birth to a healthy child at full term,
although she had always previously miscarried. The same
treatment was adopted in a subsequent pregnancy with the
same happy effect. We have never employed it to the same
extent, but we liave given two or three grains daily with the
most satisfactory results. The only employment Dr. S. re-
commends of this medicine is an opium and belladonna plaster
to the back.

Dr. S. says nothing of sinapisms or blisters to the sacrum in
the prevention of abortion, which we consider a very important
omission, as we have been wont to regard the former especially
as very valuable means; still, notwithstanding the exclusion
of opium and revellents from the treatment of abortion, which
we cannot but consider a great defect, his remarks are in gen-
eral excellent.

Dr. Smith's lectures on puerperal convulsions constitute one
of the best treatises we have ever seen on the subject, yet we
think he might to advantage have said more about the means
of prevention, when premonitory symptoms are present^ which
is in the highest degree important, as they can be so much more
easily and certainly prevented than cured ; but perhaps he
could not, compatibly with the opinions of the effects of opium
and chloroform, which, next to bloodletting, are certainly the
most powerful means we possess to allay turbulent excitement
during parturition, tranquilize the nervous system, and prevent
convulsions.

In commenting on a case, Dr. S. condemns the application
of a blister to the spine, on the principle that stimulating the
surface over the spine excites reflex motor action; we agree
with him decidedly that in that instance, the opiate enema ar-
rested the convulsions, before the blister had time to act ; but
we are compelled, from our experience, to regard revellents
over the spine, especially sinapisms, most valuable resources,
in arresting both puerperal and infantile convulsions; but ap-
plied to the extremities as well as the spine, they are still more
efficient in removing the coma that frequently results.

Discussion on theoretical subjects has been purposely avoid-
ed, and we only proposed to consider a few points in practice in

1849.] Actions of Medicines, ^c. 671

which we cannot agree with the author ; there are still some
others, but our limits will not allow us to proceed farther. We
are not fond of fault-finding, nor will we say

" Beauties and faults so thick lie scaiter'il here,
These I could read, if those were not so near."

We thankfully receive this work as a valuable contribution
to our science; and although we do not think it altogether a
suitable book to place in the hands of inexperienced pupils, we
heartily recommend it to practitioners, trusting they will derive
as much pleasure, if not profit, as we have, from its perusal.

J. A. E.

On the actions of Medicines on the Secreting and Excreting
Organs. By Dr. A. B. Garrod. (London Lancet.)

The function of the excreting organs is to remove from the
system matters produced during the metamorphoses of the
tissues and food, and which are no longer of arty service in the
animal economy. Now we know that during life changes of
an oxidizing character are constantly taking place, the ultimate
eflfects of which are much the same as if the tissues had under-
gone ordinary combustion, which, however, is not of a perfect
character', for the carbon and hydrogen are not entirely con-
verted into carbonic acid and w^ater ; these elements part-
ly assuming the form of less oxidized compounds; and again,
the nitrogen, although it is mostly thrown out as urea
(hydrated carbonate of ammonia), yet it is also eliminated as
uric and hippuric acids, kreatine and kreatinine, &c. These
various products of decomposition are removed from the sys-
tem by different channels, some of the excreting organs separa-
ting chiefly the nitrogen ized, others the carbonaceous com-
pounds, &c. In health there are removed,

Ti ,, , ( Carbonic acid.

By the lungs. | ^^^^^,^

( Water.
By the skin. < Carbonic acid (a little).

(' Nitrogenized matters containing urea.
rWater.

Urea.

Uric acid.

Hippuric acid.

Kreatine and Kreatanine.

Colouring matters, &c.
^^Fixed salts.

By the kidneys. <

672 Actions of Medicines^ ^'C. [November,

f Real bile afterward (reabsorbed).

By the liver and j ^I'^f"^"'-, 1

intestines. ^ Cliolestenne, &c ^p^ ^^

Indigestible matters ; peculiar se- [
^ cretion, from intestinal canal, &c. J

We have already seen that the perfect performance of the
functions of these various excreting organs is of the greatest
importance, and that many diseased states of the system may
arise from their defective action ; thus, if the kidneys become
injured, and urea, &c., accumulate in the blood, then dropsical
eliusions, affection of the brain, &c., may arise.

Again, if the action of the liver is stopped, the bile pigment
not being thrown out accumulates, and seeks other means for
its discharge, giving rise to the yellow skin, dark-coloured
urine, &c., symptoms known by the term jaundice. If the
lungs are unable, from any cause, to perform their function,
apnoea takes place, from the inability to obtain oxygen, but
partly, also, from the retention of carbonic acid in the blood,
and so on with the other excretions. Many remedies which
we are in the habit of administering are found in these various
excretions, having first been absorbed from the stomach into
the blood ; in some instances, these agents pass out in the state
they were administered ; in other cases, they become altered
by the action of the blood, and are eliminated in a modified
form. Many of the substances which have been found in the
urine, &c., have escaped detection in thd blood ; no doubt this
has arisen partly on account of the difficulty in detecting sub-
stances in this fluid, and partly, also, from the extreme facility
with which they are removed by the excreting organs. Cer-
tain bodies, however, have been discovered in this fluid,
amongst which I may mention, iodine, mercury, baryta,
cyanide and sulphocyanide of potassium, hydrochlorates of
ammonia, indigo, rhubarb, musk, camphor, &c. ; several sub-
stances have also been found deposited in the solids as mercury
and madder in the bones, silver in the skin, copper in the liver,
lead in the brain, spinal cord, and muscles. The kidneys ap-
pear very active in removing from the blood matters which
are abnormal to its constitution, and the substances which,
alter their adminstration, have been detected in the urine, are
very numerous, as they have been more sought for in this fluid
than in any other excretion.

Some substances are found in the urine in an altered state,
and the nature of the changes which they undergo is exceed-
ingly interesting. For example the salts of the vegetable
acids, as the alkaline tartrates, lactates, acetates, malates, &c.,
are decomposed in the system, and eliminated as carbonates of

1849. J Actions cf Medicines, ^. 673

the bases; this change is effected by the oxidizing action of the
system, and durinf]^ their metamorphoses they probably produce
some change in the respiratory process ; hence, also, the in-
fluence which even acid fruits, as oranges, lemons, &c., pos-
sess in causing an alkaline condition of the urine, the acids be-
ing decomposed into carbonic acid and water, and the
carbonates only escaping through the kidneys. Certain other
acids Undergo a different kind of metamorphoses for example,
benzoic and cinnamic acids ; these are not broken up into
carbonic acid and water, but, by uniting with other matters
found in the blood, are capable of forming an acid which is a
normal constituent of the urinary excretion. When benzoic
acid is taken into the stomch, and the urine passed during the
next five or six hours collected, it is found to contain, not
benzoic acid, but in its place hippuric acid. The amount of
hippuric acid exceeds that of the benzoic acid administered.
Mr. Ure, who first observed this change in the human subject,
thought that the benzoic acid in its passage destroyed the
uric acid, and by assuming its elements, became converted into
hippuric acid; but when repeating the experiment, found this
to be an error, for the amount of the uric acid in the urine re-
mained the same before and after its administration.

By the use of these bodies as remedies we produce a very
acid condition of urine, enabling this fluid to hold in solution a
large amount of phosphatic salts ; and hence, in some cases
where these are deposited, it proves a useful therapeutic agent.
A case illustrating this occurred recently under my care in
University College Hospital. A woman suffering from slight
paraplegia w^as voiding urine, alkaline in reaction, and which
deposited so large an amount of phosphates, as frequently to
occupy half the height of the fluid in the glass. The adminis-
tration of the usual remedies, as nitric acid, Pareira brava, &c.,
did not produce any effect on this condition of the urine; but
when benzoic acid was given in large doses, (two scruples
four times a day,) the phosphatic deposits soon became lessened,
and in a few days entirely ceased ; the urine also at the same
time became acid when voided, and did not very readily under-
go decomposition. When the remedy was discontinued the
abnormal condition of the urine did not return. In such cases
it is probable that the benzoic acid not only in)parts to the
urine the power of holding the phosphates in solution, but acts
also by stimulating the mucous membrane of the urinary pas-
sages, and correcting the secretion of an abnormal mucus,
which often serves as a ferment, and causes the decomposition
of the urea into carbonate of ammonia.

N. S. VOL. v. NO. XI. 43

674 Novel Effects of Potassium. [November,

Novel Effects of Potassium Foreign Bodies in the Urethra
Catalepsy. By A. B. Shipman, of Syracuse, N. Y. (Boston
Medical and Surgical Journal.)

A few months ago I was called in great haste to a young
gentleman who was in a most ludicrous yet painful condition.
I found, on examination, a bottle, holding about a pint, with a
short neck and small mouth, Hrmly attached to his body by
the penis, which was drawn through the neck and projected
into the bottle, being swollen and purple. The bottle, which
was a white one, with a ground-glass stopper and perfectly
transparent, had an opening of three fourths of an inch in
diameter only ; and the penis being much swollen rendered its
extraction utterly impossible. The patient was greatly fright-
ened, and so urgent for its removal that he would give me no
account of its getting into its present novel situation, but im-
plored me to liberate it instantly, as the pain was intense and
the mental anguish and fright intolerable. Seeing no hopes of
getting an explanation in his present predicament, and after
endeavoring to pull the penis out with my fingers, without
success, I seized a large knife lying on the table, and with the
back of it 1 struck a blow on the neck of the bottle, shivering
it to atoms and liberating the penis in an instant, much to the
delight of the terrified youth. The glans penis was enormous-
ly swollen and black, as was the prepuce; both were vesicated,
as though scalding water or fire had been applied to them.
He complained of smarting and pain in the penis, after the
bottle was removed ; and inflammation, swelling and dis-
coloration continued for a number of days, but by scarification
and cold applications, subsided ; yet not without great appre-
hensions on the part of the patient, and a good degree of real
pain in the penis.

The reader is probably anxious to know, by this time, how a
penis, belonging to a live man, found its way into so unusual a
place as the mouth of a bottle. I was extremely curious
myself; but the fright and perturbation of the patient's mind,
and his apprehensions of losing his penis entirely, either by the
burn, swelling, inflammation, or by my cutting it ofTto get it out
of the bottle, all came upon him at once, and overwhelmed him
with fear. Now for the explanation. A bottle in which some
potassium had been kept in na))htha, and which had been used
up in experiments, was standing in his room ; and wishing to
urinate without leaving his room, he pulled out the glass stop-
per and applied his penis to its mouth. The first jet of urine
was followed by an explosive sound and flash of fire, and quick
ar, thought the penis was drawn into the bottle with a force and

I

1849.] Foreign Body in the Bladder. 675

tenacity which held it as firmly as if in a vice. The burning
of the potassium created a vacuum instantaneously, and the
soft yielding tissue of the penis effectually excluding the air,
the bottle acted like a huge cupping glass to this novel portion
of the system. The small size of the mouth of the bottle com-
pressed the veins, while the arteries continued to pour their
blood into the glans, prepuce, &c. From this cause, and the
rarefied air in the bottle, the parts swelled and puffed up to an
emormous size.

How much potassium was in the bottle at the time is not
known, but it is probable that but a few grains were left, and
those broken off from some of the larger globules, and so small
as to have escaped the man's observation. I was anxious to
test the matter (though not with the same instruments which
the patient had done), and for that purpose took a few small
particles of potassium, mixed with about a tea-spoonful of
naphtha, and placed them in a pint bottle. Then I introduced
some urine with a dash, while the end of one of my fingers was
inserted into the mouth of the bottle, but not so tightly as to
completely close it, and the result was a loud explosion like a
percussion cap, and the finger was drawn forcibly into the
bottle and held their strongly thus verifying, in some degree,
this highly interesting philosophical experiment which so
frightened my friend and patient.

The novelty of this accident is my apology for spending so
many words in reporting it, while its ludicrous character wull,
perhaps, excite a smile ; but it was anything but a joke at the
time to the poor sufferer, who imagined in his fright that if his
penis was not already ruined, breaking the bottle to liberate it
would endanger its integrity by the broken spiculae cutting or
lacerating the parts.

Accidents frequently occur to young men, who, to gratifv a
morbid propensity, introduce substances into the urethra,
which sometimes slip beyond their reach, find their way into
the bladder, and prove fatal.

The following incident is somewhat interesting, as it illus-
trates one of these cases. On dissecting a subject a few years
ago, in the Indiana Medical College, a calculus was found, one
and a fourth inch in length and three fourths of an inch in
diameter rough on its outside, but in shape resembling an
egg. No satisfactory history of his case was obtained at the
time. In performing the operation of lithotomy before the
class, on the dead subject, this calculus was employed In one
instance, on removing it with the forceps, I accidentally
crushed it, and found the end of a lead pencil sticking out at
one extremity. It was a little, over an inch in length, and made

676 Foreign Body in the Urethra. [November,

of red cedar, ^vhich on cutting still exhaled the peculiar odor of
that wood. A small lead was in the centre, and one end of
the wood was sharpened, the other cut off square. A few days
after this, a young medical student brought me the annexed
history. Three years and six months previous to the death of
a young man, 20 years of age, he being in company with a lad
of his own age in the woods, introduced this pencil point first
into the orifice of the urethra, to gratify a morbid appetite,
and it slipped away from his fingers beyond his reach. Being
much terrified, he kept working at it, but the outward end
being squarely cut off, would not come out, but worked back-
wards into the bladder, when it ceased to trouble him.
Twelve months afterwards he began to experience difficulty
in urinaing; but called on no physician until the lapse of
eight months. This physician discovered stone in the bladder,
and advised him to have lithotomy performed. But about this
time a Uroscopian was consulted, who, after wisely peeping-
into a vial of his urine, made the discovery of simple liver dis-
eases, and under his treatment he died it being from three to
three and a half years from the introduction of the pencil. He
never from first to last, disclosed the accident to his physicians;
but the young man who was with him at the time of the oc-
currence gave the history, as he was a confidant of the patient.
Foreign bodies will sometimes get into the urethra and
bladder in a strange and unaccountable manner, especially in-
to the female urethra. A student of medicine, or rather a man
who had practised medicine in the West a number of years,
brought me a stone the size and shape of a pigeon's e,gg,
which he declared he had extracted from the urelha of a
female. It had lodged in the urethra an inch from the external
orifice, obstructing the urine and causing great distress. He
had not the least doubt of its being a calculus, formed in the
bladder originally. As soon as I saw it I was convinced that
it was formed in some lime-stone quarry originally, and found
its way into the uretha from without the why and the when
best known to the patient. On expressing my opinion to the
owner of the pebble, he was disposed to be crabbed, and was
for a hot dispute ; when, to convince him, I had him view the
stone through a micrascope, and lo ! it was plainly seen to be
composed of minute fossil shells evidence conclusive that it
was never formed in the bladder. On a more minute and
particular examination, the fact was elicited that the female
alluded to was one of those strange, hysterical beings, whose
minds are of a perverted cast, and who are always having
anomalous and out-of-the-way disorders.

An illustration of the value of the microscope as a diagnostic

1849.] Foreign bodies in the Bladder. 677

means, was had in the case of a female who was subject to
catalepsy, somnambulism, hysteria, mesmerism, and a long
catalogue of strange and anomalous aifections. One of the
most tangible of her intangible difficulties was the passage of
large quantities of gravel, sand and pebbles from the urethra.
It was said that quarts of these had passsed her from time to
time; and that no mistake in this matter might arise, the
catheter would detect them while in the urethra and bladder.
I procured half a gill of these gravel stones, and their physical
qualities were precisely like clean water- worn stones, selected
from a gravel bank or the brook. Examination of them
chemically, showed them to consist of heterogeneous substances
lime, silicious, and fossiliferous kiiids. And the microscope
plainly exhibited some of them to contain minute shells and
coralline formations. After this, the intelligent reader may
guess, at least, how the substances got into the bladder. Her
physician, who is a gentleman of skill and intelligence, believed
them to have been formed in the bladder or kidneys. They
were at times detected in her stools ; but as she strained much,
and sat over a vessel, her attendants were not certain but
these came also from the urethra. The history of this female
would furnish a tissue of as strange and extraordinary circum-
stances as that of Jane Rider, Rachel Baker, or any other of
the like stamp, which are on record ; and as 1 have copious
notes, I may some day furnish them entire for publication.
These cases are better understood at this day than formerly;
yet there are instances where these persons not only deceive
others but themselves likewise a species of moral insanity,
which prompts them to do things totally inconsistent with
reason and their own principles. If this female introduces
these foreign bodies into her urethra, and at times swallows
some of them, it is done in a paroxysm of intellectual or moral
perversion, unknown to her in her more lucid intervals.

A few years ago it was my fortune, or rather misfortune, to
have under my care a female patient who labored under this
perversion of mind, and she had the most strange and contra-
dictory kind of diseases, mostly alfecting the genito-urinary
organs. One day it would be an inability of retaining her urine ;
the next, perhaps, retention, requiring the catheter. One month,
menorrhagia ; the next, passing over the time, or scanty in
quantity. There would be weeks that nothing would pass the
bowels, the most drastic purgatives proving harmless, and ap-
parently digesting like the blandest aliment, when a dose of
opium would act promptly as a purgative. Then a diarrhoea
for days together, that opium and its preparations would in-
crease, but a dose of castor oil would put a stop to at once. She

678 Foreign Bodies in the Urethra. [November,

would vomit for hours, and the blandest food would be reject-
ed; but perhaps cold raw cabbage and vinegar, or pickled
beets, would be retained, and digest most perfectly. But she
was always showing me some curious substance which came
from the bowels, or bladder, or vagina, and quite a pretty col-
lection of unique curiosities might have been gathered from
her, had some one, who had a taste for such matters, taken
pains to preserve them. A ball of hair was voided from the
bowels ; also a substance like amber, some curious seeds which
no one could name, pieces of flesh, a tube like the intestine, a
liquid possessing the sensible quaHties of mine, milk, blood,
inky liquids, globules of quicksilver, sand, pieces of brick, &c.
All these substances were at some period of her case voided
per anum. A catalocjue not less numerous or dissimiliar came
from the bladder. From the skin there came shining scales,
which looked to me like bits of mica, and which she saved and
exhibited as some unknown metal that she professed to believe
had been given her years ago. I had never seen a case like
this before and as she was a very pious, exemplary girl, I took
it for granted that she told me the truth.

Along with the other marvels of her case, black urine was
often shown me, and she would go more than a week at a time
without once voiding a drop, or there being an}' secreted. This
staggered my belief, I must confess, a good deal ; but as I knew
of no motive for deceiving me, I rehictantly believed it. The
skin would exhibit curiously-colored spots occasional^, some-
times colored off very fancifully. Then a blister, as if a hot
substance had been applied, or a strong corrossive material.
At length the climax oi" the case arrived. I was called in great
haste to see her, and found the urethra obstructed with a hard
substance, which sounded, when the cathetar was applied to
it, like a calculus. She stated that it had been in the bladder
a long time, she w^as confident. But as it happened, I had
been obliged to use the cathether, from time to time, previous-
ly, and had even used a male silver instrument for the purpose
of exploring the bladder but a short time before, and no stone
could be detected. Besides this, the stone was a large rough
one, and appeared as if it had entered the urethra from its
external orifice, instead of from the bladder. As it was only
about thi-ee fourths of an inch from the meatus, it was readily
extracted with a pair of common forceps, when its true nature
was perfectly apparent. It was a piece of common slate
stone, and its kindred fellow \\'as the hearth stone of her own
room ! Light broke on me at once. I taxed her with imposing
upon me, and her only reply was a violent fit of hysteric grief
and anger. It is unnecessary, I })resume, to inform the reader

1849.] Catalepsy, (J79

that most of her strange and unaccountable symptoms vanished
from this time, her health improved, and whatever diseases
came upon her after this, were such as could be classified.

Lhave no doubt that most of the extraordinary phenomena
in this case had their solution in some of the ordinary laws
of nature. Black urine could easily be shown, as well as
bloody. Milk, or ink, or blood, could be mixed with it, and the
absence of the urine could be readily feigned. Seeds of plants,
also pieces of flesh, gravel, sand and brick-dust, with coal,
plaster, (kc, could be readily put into the urine and faeces.
Quicksilver or its amalgams might have composed the scales
of mica, 6>lq,., which were found on the skin ; and hot water,
hot irons and other burning substances, might have been used
in effecting the appearances of the skin. The object of all this
deception was probably to excite pity and compassion, or per-
haps to become an object of wonder and notority. A morbid
pruriency may have also entered into some of her calculations,
as manipulations about the genito-urinary apparatus seemed to
be specially her object.

It is this class of patients that are so susceptible to the influ-
ence of animal magnetism. In truth, I believe mesmerism is
only one phase of the comy)laint, and can be artificially induced
in these subjects very easily. I presume catalepsy is another
form of it, occurring naturally, for I have known a person who
was subject to fits of catalepsy, that could only be roused at
pleasure by mesmeric passes, and could be also thrown artifi-
cially into the cataleptic state, by mesmeric manipulations,
precisely like the natural fit of that disease. A case happened
a few years ago that was of this character.

A colored girl, about 20 years of age, fell into a cataleptic
state, which greatly alarmed the family in which she lived.
She appeared stiff, rigid, and insensible as a piece of statuary.
A young gentleman, who was sitting up in the room with her
during the night, commenced making frictions on the legs and
arms, and wiiile rubbing the arms, from below upwards, he
observed that they gradually relaxed, as did the legs also,
when she immediately arose, yet with her eyes perfectly closed.
In the greatest consternation he left the room, and rushed
down stairs, followed by this ebony Venus, who pursued him
through doors and passages, with eyes still closed, avoiding all
intervening obstacles, as though she saw them perfectly, and it
was with the greatest difficulty she could be got back into her
room, and not until the young man himself returned, when she
followed him readily. She continued to tall into the cataleptic
state spontaneously, on mv mesmeric passes, and was brought
out by reverse passes, until the case began to excite too much

080 Convulsions in Children. [November,

notoriety for the comfort and convenience of the family, who
had her carried home, and the subsequent history I never
knew.

Hysteria, catalepsy, mesmerism, somnambulism, and a num-
ber of the hysterical aflections, are so nearly allied to each
other, that they most probably have something of a kindred
origin. The disposition which such persons manifest to de-
ceive themselves and others, is a striking trait in their charac-
ter. While we should be constantly on our guard against
imposition, we should, notwithstanding, treat them kindly, and
look on them in the light of diseased beings, physically and
morally.

On the Pathology of Convulsions in Children. (British and
Foreign Medico-Chn*urgical Review.)

[A writer in the British and Foreign Medico-Chirurgical
Review, lays down the following proposition respecting the
convulsions of children. He says:]

1. The first proposition we may lay down is that of
Flourens, Magendie, and Hall, that no disease of the mere
cerebrum, or disorder limited in its eflects to thut organ, or to
the purely cerebral nerves, can induce convulsion ; for no
irritation confined to these parts can bring about muscular
contraction. If disease or disorder, or so called irritation,
commence in these parts, it must afterwards be propagated to,
or its results there must affect the membranes, or the incident
or motor nerves, or the medulla oblongata, before convulsions
can arise.

2. Convulsions, either partial or general, may occur, and
during the fit the child may die ; yet after death no visible
alterations, or organic lesions, or anatomical changes, can be
discovered in the nervous centres, with wdiich such convul-
sions can be rightly and satisfactorily associated as an eflect ;
nor has the child been known to have labored under any affec-
tion of other systems or organs, by which the centres may
have been more immediately on secondarily aflected, or witn
which they may have sympathised ; nor have the incident or
excitor nerves been known to have been exposed to such irri-
tation, as might have produced the convulsions in the way of

^fiplex actions. It is here then supposed that certain alterations,
of a dynamic character, in the nervous matters of the centres,
primarily arising there, are the cause of such convulsions, which
are therefore o{ centric origin, a cause which is certainly not
anatomicallv definable, but only assumable in its existence.

1849.] Convuhlons in Children. 081

3. Conuvlsions, either general or partial, may occur, and the
child may die in the fit ; but after death, no morbid lesional
changes are found to exist in the nervous centres, to which we
can ascribe the disorder as an eilect. We refuse to acknowledge
that the cause o^ the convulsions had its origin in the nervous
matter of the centres, or primatively affected it, because we
know the child to have been exposed to irritants of the incident
or excitor nerves; and we believe that these convulsions were
caused by reflex spinal actions, and that the latter were the
result of the irritation so produced. We believe, moreover,
that the child laboured under no affection of any organ which
could alter the proper relations of the vascular system of the
brain with the nervous matter, or at least produce such an
alteration which proves itself by an abiding and evident change
to be witnessed after death. These convulsions are o'i excen-
trie origin; and the only cause of them, down to which we can
generalize, is the peculiar irritation to which we believe
certain incident or excitor nerves have been subjected.

4. A child dies after having been convulsed. After death,
more or less evident and important lesional changes and
anatomical alterations are found in or about the nervous
centres. These we believe sufficient to account for such
convulsions, and we trace them to such morbid changes, &c.,
as their effect. We also affirm them to be caused by disease
of the centres, because before their appearance their existed a
greater or less amount of so-called "cerebral symptoms." We
believe these cerebral symptoms, and consequently the disease
of the centres, to have been o^ ?i primary character, that is to
say, to have had their commencement either in the nervous or
vascular apparatus contained in the cranium or spinal canal,
and not to have followed as a secondary disorder upon a more
or less acute affection of any other or more distant organ.
These convulsions are o^ centric origin.

5. A child dies in convulsions. After death we may, or we
may not, perceive such material changes in the centres as we
may affirm to have been their immediate cause. If they exist,
so far it is satisfactory ; if not, we yet believe that temporary
alterations were produced, either in the relations of the
vascular system of the brain, &c., to its nervous matter, or else
in the sympathetic relationships between the centres and other
symptoms, organs, or structures of the body, by the previous
existence of important disease in organs, &c., other than these
centres. This we believe, because we know the child to have
exhibited, for a greater or shorter space of time, other than
"cerebral symptoms," to have distinctly betrayed the existence
of more or less acute disorder of distant parts. We therefore

C82 Convulsions in Children. [November,

believe that such convulsions, or the disorder in the centres
were not o( pjnmari/ character, not the result of disease having
its primal origin in the centres themselves ; but that they were
oi secondary character, a well marked and evident disorder of
a distant part having at length drawn the brain not at first
disposed in itself to enter into the general whirlpool of mis-
chief. Such convulsions are yet o^ centric origin.

We believe that the above arrangement can be made to in-
clude all forms of convulsions spoken of by writers as occur-
ring in children. But we must admit that it is very doubtful
how far we may be permitted, as knowledge advances, to pre-
serve all its various divisions. For example, it may be asked
if we are 7zoi<; justified in making such a class of convulsive
actions as we should include in the characters of proposition
2, a class having only assumable endowments. Are we war-
ranted in believing that, in infants and young children, such
purely and essentially neurose disorder can arise, or that the
nervous matter of the centres can assume in itself any such
diseased condition ? a condition independent of alteration or
changes in its vascular system. It has been affirmed by some
later continental writers that before the period of the first
denition, essential convulsions, such primitive neurose disorder
as we have admitted, are things next to an impossibility; and
Mauthner asserts that, even later in life it forms the exception
to a great rule, when we are called upon to believe in their ex-
istence. According to Version, "before an organ or system
causes of disease being present can exhibit the development
of a pure and special form of malady, proper to and proceed-
ing from itself, it must be endowed with all those qualities
which make it capable of the conflict ; it must possess a com-
pletely developed organization, and through the latter be in a
condition to react against those influences which are affecting
it ; do we find this to be the case with the sensitive sphere of life
in the infant ? By no means. In it predominates the vegeta-
tive, and that portion of the nervous system alone which is ne-
cessary for the carrying on of its functions. The ganglionic
system is, therefore, developed relatively to such necessities.

The comparatively more perfect development of the spinal
cord in children, with which the ganglionic system is in such
intimate connexion, in relation to that of the biain, is one of the
main reasons advanced by some later writers to account partly
at least for the very great frequency of convulsion during in-
fantile life. Dr. West remarks:

" The grand I'eason for their frequency is no doubt to be
foun<l in thepredominancr of the spinal over the cerebral system
in early lifr. In the adult, the controlling power of the brain

1849.] Action of Medicines on the Nervous Si/stem. 683

checks the display of those reflex movements, which become
at once evident ii" disease heighten the excitabihty of the spinal
cord or cut off the influence of the brain from the paralysed
limb, or if even sleep suspend that influence for a season."

On the Action of Medicines which Influence the Nervous Sys-
tem. By Dr. A. B. Garrou. (London Lancet.)

We have seen that the composition of the nervous tissues
diflers remarkably from that of other textures, in containing a
large amount of phosphorized fatty matters, which have been
named cerebrin phosphorized oil ; that is, fats having phospho-
rous, in an unoxidized condition, entering into their constitu-
tion, in the same manner that iron forms an essential element
of ha^matosine, or the blood pigment. We have found also, that,
according to Dr. Bence Jones, the elimination of the phosphates
is increased in acute inflammation of the brain, the excess in these
cases doubtless arising from the increased vv^aste of the phosphor-
rized fats; and the conversion of the phosphorous into phosphor-
ic acid. These facts certainly indicate that phosphorous forms
an important element of the nervous system. On reviewing
the remedies which appears to have a direct influence on dif-
ferent portions of the nervous centres, we find that the most
prominent among them are certain principles derived from the
vegetable kingdom viz., the vegetable alkaloids bodies, all
of which contain nitrogen in their composition, with the ex-
ception, perhaps, of picrotoxia; but even this requires con-
firmation. The parts of the nervous system upon which the
action of these principles is directed difl^er considerably some,
as morphia, and codeia, acting on the brain ; others, as
strychnia, brucia, &c., on the spinal cord ; others, again, as
digitalia, nicotina, on the heart, through their influence proba-
bly on the ganglionic nerves. It was formerly supposed that
the essential oil of bitter almonds was poisonous, from its influ-
ence on the nerves ; if such were the fact^ it would prove a very
striking exception to the rule which we have found to hold
good in so many cases ; Wohler and Frerichs, have shown,
that when entirely freed from prussic acid its eflects are per-
fectly harmless.

We also find that there are bodies in the mineral kingdom
which produce similiar effects, among which the most striking
examples are seen in the metals arsenic and antimony ; and in
others, in a more or less degree. The same also may be said
of phosphorus itself, when given in an unoxidized form ; and
perhaps, also, of ammonia.

684 Foreign Bodies in the Mucous Canals. [November,

When considering the nature of the elementary substances in
our introductory lectures, you will remember that we arranged
them in certain groups, and stated, at the time that the ele-
ments in each group, however unlike in physical conditions,
yet possessed properties which, in a chemical point of view,
brought them in very close relation to each other. One of
these classes consisted of arsenic, antimony, phosphorus, and
nitrogen elements very nearly allied to, and frequently hav-
ing the power of replacing, one another in compounds. Hence,
then, we find that the substances which have the power of
acting most powerfully on the nervous system are those which
contain in their composition arsenic, antimony, nitrogen, and
also phosphorus. The first two eliments appear to operate,
when administered in any state of combination, provided they
are absorbed into the blood ; the two latter require to be in
certain peculiar states, as they are themselves normal constitu-
ents of the animal body; and with regard to nitrogen, different
amounts of this element and the different states in which it ex-
ists, appear to endow it with different properties. That differ-
ent methods of combination of the elements influence greatly
the effects of a substance on the economy is beautifully
exemplified in the action of the different cyanides ; ferrocyanide
of potassium (the common prussiate) being harmless, whereas
when heated to redness in a closed vessel, it is converted into
a most deadly poison, from the change of the ferrocyanide into
the simple cyanide of potassium. Again, we can trace still
further analogies between these differerent cerebro-spinants ;
thus, quinia, containing nitrogen, has its properties nearly ap-
proached by arsenic ; and antimony, in its power of subduing
vascular action, appears not very unlike the active principle of
digitalis. Of couise we only wish these remarks to be con-
sidered as purely hypothetical ; but still it is interesting to no-
tice any circumstances which seem to throw the shghtest
glimpse of light on the action of any therapeutic agents.

On Foreign Bodies in the Mucous Canals. By J. F. Vincent,
Esq. (Edinburg Medical and Surgical .fournal.)

A portion of an ear of barley slips into the nostrils, with the
stalk end foremost. The least touch of a body so formed, in
such a situation, thrusts it further inward. For one or two
days it produces considerable irritation, which, however, at
length subsides; and -the foreign body, coated with thick
mucus, is ejected without effort. A small piece of leaf of a
vegetable gets into the ventricle of the glottis; and causes

1849.] Foreign Bodies in the Mucous Canals. G8i

great irritation and coughing for some hours. It is soon en-
veloped in mucus, and comes quietly away next day.

These facts show what the surgeon should do under similar .
circumstances. He should not with his forceps irritate still
more parts already too much irritated. He is not to allow even
any etibrt of sneezing, in the one case, or unnecessary hawking
in the other. He is to require the ])atient to be kept quiet, that
the body may continue in one situation, so as to acquire as soon
as possible the coating which facilitates its ejection.

It has ne\ er happened to Mr. Vincent to have a case of foreign
body in the trachea. But should such a case come under his
management, he states that he should not think of making an
opening into the trachea, providing the body moved freely up
and down within the tube. He would even reverse the pres-
ent practice both in this and similiar cases. He would keep
the patient as quiet as possible in bed or on a sofa ; advising
him to avoid all eObrt to expectorate; and he doubts not that
very soon the foreign body would be ejected.

The rule seems to be on the whole not liable to objection, if
the condition specified the mobility of the body within the
trachea be kept in mind. When the body is fixed or detain-
ed in any way, it causes inflammation and ulceration of the air
tubes ; and sometimes the results are fatal. Yet, even when it
has caused ulceration for some time, it has happened that such
a body has been at length ejected, sometimes with recovery of
the patient, sometimes causing death from the injury done to
the bronchi and lungs.

The practice of surgery presents to us the resources of nature
of ridding parts of the presence of extraneous bodies by the
means of the stimulus of relief In cases of hemorrhage the
surgeon plugs the nostrils. The efficacy of the operation de-
pends upon the lint he uses being tightly pressed into the
posterior nostrils. So it remains for a few days, and then if
the surgeon withdraws it, he finds it free from all stricture;
indeed, so loose, that it will perhaps discharge itself into the
pharynx. The bulk of the wadding is the same as when tight-
ly introduced ; and so far from having lost any of its parts, it
has acquired an addition in the thick mucus with which it it
saturated. The fact is, that under the influence of the stimulus
of relief, the internal nares have been quietly enlarged. A
child was brought to St. Bartholomew's Hospital with a pebble
in the meatus of the ear. I found it of an oblong form, and
firmly wedged in. I could get the blades of a small pair of
forceps to grasp it when passed over the short diameter, but I
could not make it stir. Having the fear before me of doing
mischief by using force, I directed the mother to bring the

686 Ai'senic in Cutaneous Affections. [November,

child in a fortnight. She did so, and I found the pebble quite
loose, so that it might be removed by only a shake of the head.
The body was coated with cerumen, and of course insterstitial
absorption had been going on under the influence of the power
of relief setting it free.

Cases further illustrating the Power of Arsenic over Obstinate
Cutaneous Affections. By William I. Cox, Esq., L. S. A.
Kennington. (London Lancet.)

I forward to the Lancet subjoined reports of a few cases I
have selected, strongly illustrative of the great efficacy of
arsenic in inveterate skin diseases ; I hope they may interest
some of your numerous readers ; and I would earnestly re-
commend to such as may be attracted by the great importance
of the subject, but have not yet had opportunity of testing, by
personal experience, in their own practice, the value of the
remedy, the perusal of Mr, Hunt's excellent work. The num-
ber of suflTerers in society from these loathsome, intractable,
and often torturing complaints, is far greater than might at a
cursory view be imagined. Much unhappiness has its source
in such a cause ; and I conceive it to be the duty of any prac-
titioner who has been so fortunate as to rescue one victim,
whose case it was deemed hopeless, to bring such case in some
way before the notice of his professional brethren.

PRURIGO.

Case 5. Mr. C , aged forty-six, of a highly nervous and

irritable temperament, consulted me for a most distressing
pruritus around the verge of the anus, extending also along
the perina3um to the base of the scrotum, but chiefly aflfecting
the former locality. Had tried many remedies in vain, and
was now quite desponding, and worn out by the unceasing
irritation. The only application from which he had ever
derived the least benefit (and that but temporary) was a lotion
of hydrocyanic acid. Had been latterly obliged to take opiates
at night, the torment being much aggravated in the noctural
season. The integument of the affected part was inflamed,
tender, and covered with minute pa})uli3e. There was also
considerable excoriation, from manual interference, resorted to
in the vain hope of allaying the insupportable irritation. There
was no disorder connected with the alimentary canal. He
was treated with the arsenic, in the usual dose, which proved
rapidly eflicacious; and in seven weeks was entirely rid of his
j)laguc.

This case is strongly demonstrative of the power of arsenic

1849.] Arsenic in Cutaneous Affections. G87

over this horrid form of papular eruption, which often proves
intractable by any other known remedy. Although, perhaps,
the most interesting, this is by no means the only case of a
parallel nature and intensity I have satisfactorily treated with
arsenic. '

SYCOSIS.

Case 6. G. W. , a gentleman, thirty-four years of age,

consulted me some months since, having suffered severely
from this distressing complaint for a period of five years. Had
tried an immense number of ointments and soaps without
permanent benefit. Thought he derived temporary advantage
from the application of a leech under the chin occasionally.
He presented a most disgreeable, not to say disgusting ap-
pearance: the chin being scabbed over. Finding his general
health excellent, I prescribed him the solution of arsenite of
potass, four minims to be taken in porter three times a day.
One month sufficed for his cure, since which there has been no
re-appearance of the pustules.

The eyes were but very slightly affected.

ACNE ROSACEA.

Case 7. Emma B , aged twenty, waitress, came to me

presenting a well-marked case of the above disease, from which
she had suffered for two years and a half The pustules were
small, so as almost to induce a suspicion of a syphilitic origin,
clustered, very accuminated, and having a rosy inflamed base,
occupying the apex of the nose, together with the whole of the
left ala, and a greater part of the right. There was also a
large patch on the left cheek, but none in any other situation,
She said they had been at first very irritating, but latterly had
ceased to cause much annoyance. She was, however, ex-
tremely anxious to get rid of such a disfiguring *' humour," as
she termed it. I found, on inquiry, that she had not menstrua-
ted regularly for some years, the catamenia being sometimes
excessive and attended with dysmenorrho^a, but generally
scanty, and with slight fluor albus. The system at large, how-
ever, did not appear to be deranged thereby, and the natural
functions were well performed. But conceiving that the local
inflammatory action might depend upon the uterine or ovarian
derangement, I endeavored to restore the suspended function,
and in course of time succeeded so far. She now menstruated
regularly and normally. Still the acne was as bad as ever.
I now gave her the arsenical solution in full doses, but was
quickly obliged to reduce the quantity, her system proving un-
usually susceptible to the influence of the drug. She persisted
in its use about nine weeks, and was perfectly cured.

I have transcribed the above case, chiefly from its being cor-

688 Extraordinary Madness. [November,

roborative of Mr. Hunt's opinion, (expressed in his work,) that
the supposition that acne of this kind, in young females, is com-
monly dependent on disordered menstruation, is erroneous.
That the abnormal condition of the periodic function had no
influence over the cutaneous disease, in this instance, at all
events, may, I think, safely be inferred, from the fact of the
persistence of the latter, when the former had been restored to
a healthy state.

RUI'IA.

Case 8. Emma B , aged 1 1 years, was brought to me

with well-marked rupia, covering both legs, the anterior aspect
of both thighs, fore-arms, and wrists. The trunk was free.
This poor child had suffered from the disease ever since she
was two years old, (supervening on scarlatina,) and it had prov-
ed intractable in the hands of numerous surgeons. The irrita-
tion about the tubercles, which were very large in their earlier
stage, was great, and as often as the scabs disappeared they
were constantly succeeded by fresh eruptions. She had a uni-
versally faded, unhealthy look, and cachectic appearance, and I
had strong suspicions of syphilitic taint being the foundation of
her malady. I gathered, however, from her parents' account,
that mercurial alteratives had been tried, again and again, to no
purpose. I gave her at first, iodine with sarsaparilla, and af-
terwards sesqui-oxyde of iron, and the mineral acids. Finding,
after several months' trial, that I could not, by the aid of these
tonics, make any impression on the complaint, or cause any
apparent change in the local diseased action, I exhibited the
solution of the arsenite of potass, which began to show its effect
in three or four weeks. Continuing its use for five months,
with the occasional use of a mild aperient, the case resulted in
a complete cure. When I saw her last, there was only a slight
redness over the thighs and legs.

The conjunctivae were early and somewhat severely affected.

I deem the above case one of the most satisfactory and inter-
esting I have as yet met with.

Extraordinary Madness. (Ibid.)

Physiological pathologists have of late been as much on the
alert, in France, concerning the case of a sergeant of the line,
as they have been, in this country, concerning Miss Nottidge.
The two cases bear, however, no analogy to each other. Re-
ligious monomania is not rare; but the derangement of mind,
leading to the frightful and disgusting acts of Sergeant Ber-
trand, is, as far as we can remember, perfectly unique in the
annals of mental alienation. His mania consisted in exhuming

1849.] Extraordinary Madness. 689

the dead, and taking pleasure in mutilating the corpses ; but,
shocking to relate, there was an erotic tendency mixed up with
these horrible deeds, and he took especial delight in raising the
corpses of females, and satisfying his unnatural appetites upon
their putrefying remains.

From the trial which lately took place in Paris, before a court
martial, and from the confession written by himself, we learn
that this unfortunate individual is twenty-five years of age. He
first studied for the church, but suddenly enlisted, and, by his
good conduct, obtained the rank of sergeant. When young, he
was rather of a sullen and melancholy disposition, but nothing
positively pointing to derangement was then observed. His
hideous propensities appeared only in February, 1847, when
they were excited by the sight of a grave left unfilled after in-
terment, the diggers having been compelled to desist by a
heavy shower of rain. He then struck the corpse, which he
had exhumed with the tools left by the grave, w^ith the utmost
fury; and being interrupted, fled to a neighboring wood, where,
according to him, he remained for three hours in a state of per-
fect insensibility, after having been most violently excited.

From this time to the 15th of March, 1849, this wretched
man desecrated burying-places eight or ten times, both by day
and night, regardless of the severity of the weather, the dan-
gers he was encountering on the part of the keepers, and the
difficulties he had to surmount. By the aid of his small sword,
he used to raise eight or ten corpses in a single night; and he
adds that he opened many graves, and refilled them again, with
no assistance but his hands. He had not the courage of telling
the whole truth in his written declaration; but he confessed to
his medical attendant, M. Marchal, (de Calvi,) the most repul-
sive part of this awful tale viz., his preference for the remains
of females, and his hideous propensity of satisf\'ing sexual desires
upon them. He was wounded when getting over the wall of the
cemetery of Monte Parnasse, in Paris, brought to the hospital,
and thus was unveiled this unheard-of train of disgusting acts.

The court-martial have not taken that view of the case which
at first sight would have looked the most rational ; and waiving
altogether the possibility of monomania having impelled the
man to these hideous deeds, they looked upon the offence as a
misdemeanor, and condemned him to one year's imprisonment.

Different opinions have been given in the medical journals as
to which of the two kinds of mania exhibited was the first in
existence viz., the destructive, or the erotic. M. Marchal, the
sergeant's medical attendant, thinks the destructive prevailed :
but M. Michea, a well-known mental pathologist, maintains
that the second was, on the contrary, the strongest and only

N. 3. VOL. V. \0, XI. 44

690 Treatment of Eczema. [November,

mania. The various circumstances mentioned by each of these
gentlemen, to strengthen their respective positions, merely
rest on the prisoner's own declaration ; so that it would appear
that no very strong case can be made on either side. Indeed,
the whole series of these shocking occurrences might w^ell be
called in question, as it seems that no direct and conclusive
evidence has been brought forward besides the man's own ac-
count. But assuming the latter as true, the existence of mono-
mania can hardly be doubted, when we consider that a natural
instinct was entirely set aside, that there was not the slight-
est prospect of gain, that the wish of visiting churchyards
returned almost periodically, that the dangers incurred were
entirely disregarded, that none of the vices which generally
accompany ^depravity were present, &c. There was, besides,
a melancholy disposition, a total insensibility to the agency of
physical agents, (such as cold, rain, &c.,) during the paroxysm,
and an extraordinary amount of muscular and nervous energy
in the accomplishment of the acts, &c. All these considera-
tions would tend to prove that this man was irresistibly
impelled to such unheard-of abominations.

This disgusting case recalls at once that form of mental
aberration w^hich reigned so extensively, about a century and a
half ago, in the north of Europe, and known under the name of
vampirism. It will be recollected that vampires were suffering
under a sort of nocturnal delirium, which was often extended to
the waking hours, during which they believed that certain dead
persons were rising from their graves to come and draw their
blood; hence arose a desire for revenge, and burial-places were
disgracefully desecrated. Bertrand's case seems the very
reverse of this ; for we here see, not the dead rising to torment
the living, but a man disturbing the peace of cemeteries in the
most horrible manner imaginable.

On the Treatment of Eczema of the Scalp of Ch Udren, and of
the Legs of adults. By T. H. Burgess^, M. D. (London
Medical CJazette.)

As eczema is a constitutional and a local affection, it is ob-
vious that the treatment should be principally directed through
the system generally to the sent of the disease. In the chronic
form of the eruption this is especially the case ; and here the
first indication, after the usual measures of cleanliness have
been adopted, is to restore the tone of the system by means of
a course of mild tonics and alteratives. When circumstances
are favorable, and the proper time arrives for arresting the
discharge, it should be effected in as gentle a manner as posssi-

1849.] Trealinent of Ecztnia. G91

ble, so as not to derange tl)e internal ornrnns; and for this pur-
pose I prefer niild alkaline lotions oi' the carbonate or bicarbo-
nate of potass, and the frequent use of the simple or emolient
bath, in which the patient, unless very feeble, should remain at
least one hour ; the usual method of keeping the patient in
twenty minutes or half an hour, being useless.

If there is abundant serous exudation, and much smarting
in the parts, half a drachm of sulphuric acid in a pint of barley-
waterwill be found very useful. The patient should commence
with small doses, and take a little cold water after each dose,
until the stomach becomes accustomed to the acidulated drink.
If the discharge continues undiminished, and the eruption does
not appear to be affected by those remedies, we must have re-
course to alteratives, as sarsaparilla and hydriodate of potash,
to active purgatives, if the patient is strong, added to lotions of
the nitrate of silver, or of the bichloride of mercury. If there
is any inflammatory tendency in the parts, the application of a
few leeches behind the ears will be necessary.

Chronic eczema of the legs, in adults and especially when
the patients are of a debilitated or broken down constitution,
are generally very difficult and unsatisfactory cases to deal
with. The practitioner seldom sees the case until the disease
is so fully established, and, as it w^ere, engrafted on the limb,
that the habitual condition of the parts seems to be that of
subacute erysipelas, with puffiness of the ankles, and a swollen
if not varicose state of the veins; all denoting a sluggish or
impeded circulation in the extremity. This state of things not
infrequently terminates in that form of indolent ulcer of the legs
so familiar to practitioners, and so difficult of cure.

For cases of this description I have found the application of
the vapors of sulphur and iodine, in combination, the most cer-
tain and effectual remedy, when assisted, during the interim of
the applications, by bandaging the limb from the foot upwards.

My attention was directed several years ago, by Mr. Alfred
Walker, to a preparation of sulphur and iodine, the vapor of
which is an admirable local application in several cutaneous
diseases. At that period I witnessed its marked benefit in
many cases of chronic ulcer, under Mr. Walker's care. These
remedies combined seem to possess healing properties winch
are not manifested when they are used separately. When
employed judiciously, and in appropriate cases, they appear to
alter the vitality of the morbid parts, and to induce a state of
healthier action. If the eruption is indolent they gently stimulate
the diseased surface into greater activity ; and by regulating the
strength of the remedy, according to the nature of tlie case, and
the object in view, the most salutary effects may often be de-

692 Needle found in the Heart aftei' Death. [November,

rived from its use. I have seen cases of lepra of several years'
standing, which had resisted every other treatment, cured in a
very few months by the application of the vapor of sulphur and
iodine. It is particularly applicable to squamous and tubercular
diseases of the extremity, to chronic eczema, and ill-conditioned
ulcers of long standing. It may be administered in this form
^. Sulphuris, 3iij. ; hyd. sulph. rubri. 9ij. ; iodinii, gr. x. M.
fiat pulv. sex.

One of the powders to be used in the following manner three
times a day. If the disease be seated on the limbs, a tin case
or even a common jar, which will answer as well, provided it
be large enough to hold the limb, should be procured ; a heated
iron is to be placed at the bottom of the apparatus, \vith a
grating above it to protect the foot or hand. One of the pow-
ders being placed on this heated iron, the limb is to be instant-
ly put into the bath, the mouth of which should be covered
over to prevent the vapor from escaping. The limb may be
continued in the bath for from fifteen to twenty minutes, ac-
cording to cirumstances. In the course of a day or two the
proportion of iodine may be increased ; for example, thirty
grains of iodine, and at a later period double the quantity, may
be incorporated with an ounce and a half of the flowers of
sulphur, to be divided into twelve powders, and used in the
same manner as the former. I do not mean to extol this agent
as a specific for the cutaneous eruptions indicated above ;
nevertheless, from what I observed both in Mr. Walker's prac-
tice, with reference to ulcers, and in my own with regard to skin
diseases, I think it is worthy the attention of practioners, and
that it will be found a very efficacious remedy.

Needle found in the Heart after Death. Reported by John
Neill, M. D., Demonstrator of Anatomy, in the University
of Pennsylvania. (Medical Examiner.)

Upon the dissection of a black male subject, brought into the
anatomical room about the middle of December, my attention
was directed by a student to a foreign body in the heart. At
first, I supposed that it might have been introduced after death,
accidentally dropping into the cavity of the pericardium, dur-
ing the process of stitching after injection; but upon more
careful examination of the surface of the heart, no orifice was
detected by which it could have entered. I removed the heart
and placed it in alcohol, in order to examine it with care.

The pathological condition of the contiguous viscera could
not be made out very satisfactorily, on account of the length of
the period which had elapsed since death, and from the fact,

1849.] Needle found in the Heart after Death. 093

that an antiseptic injection (chlor. of zinc) had been userl, which
destroys colour, and coagulates albumen : there were, howe-
ver, marks of chronic disease evident, in adhesions of the pleura
and serous pericardium; there was also evidence of peritoneal
inflammation.

After the heart had been hardened in alcohol, and cleanly-
washed of clots, I found imbedded in the external wall of the
left ventricle, a broken needle, with its point directed forwards
towards the apex of the heart ; it was much oxidized, and could
not be moved trom its position, until tiie cyst containing it was
split up. The broken end encroached upon the cavity of the
ventricle, being actually contained in one of the columnse car-
neae : the needle was two inches in length, and a line in thick-
ness, belonging to a variety called worsted needles.

In the Medical Examiner for May, 1843, Dr. Leaming reports
the case of a seamstress, who had accidentally driven a needle,
which was sticking in her dress, forcibly into her breast, by
striking a table. In a month she had pleurisy, and subsequently
pericarditis and pneumonia, and at the end of nine months she
died. The post-mortem examination revealed lesions, corres-
ponding with the symptoms ; the body oftlie needle was found
imbedded partly in the wall of the riglit ventricle, and partly in
the ventricular septum, whilst the point projected for a quarter
of an inch into the cavity of the left ventricle.

In the summary of the American Medical .Journal, a case is
copied from the Archives Generales, 1842, in which a soldier
introduced two needles into his heart, and was brought scream-
ing into the hospital at St. Petersburg: he had a hard, quick
pulse; anxious countenance ; copious perspiration ; distressing
cough, and tumultuous action of the heart ; in nineteen days he
died ; and upon examination after death, it w^as discovered that
the needles had passed through the heart, and lodged in the lower
part of the left lung, where they were found in an abscess. The
whole track was easily recognized by the marks of inflammation.

In the Annalist for November, 1847, Dr. Graves records a
case of attempted suicide. A man pushed a needle into his
heart, expecting instant death, as in the instance of Admiral
Villeneuve, after the battle of Trafalgar ; but being disappoint-
ed in the immediate eftect, he undertook to cut his throat, which
also failed; the vessels having been secured, and the wound
dressed by his medical attendant: After reaction had taken
place, he had great sufl^ering, every breath being attended with
a scream ; the physician discovered the puncture made in the
skin by the needle, and dissected through the intervening
structures, until he " could distinctly see the heart pulsating
with the needle in it." ''With the aid of a pair of forceps, I

694 Monthly Periscope. [November,

extracted the needle, nnd it was followed with a forcible stream
of blood." "He continued to improve up to the sixth day,
when he was attacked with pleuritic pains, and inabilitv to
swallow : nnd died on the eighth day after the needle was ta-
ken from the heart. Post-mortem. "On opening into the left
ventricle, where the needle entered the cavity, there was a
small membranous sac, about the size of a pea, formed in the
left ventricle, which contained pus.'"

Note. I learn, through the politeness of Dr. Klapp, physi-
cian to the Moyamensing prison, that this man was admitted
May lllh, 1847, in rather feeble health ; but continued to work
for more than a year before complainincr of any inconvenience
about his chest. When removed to the infirmary, he had se-
vere cough, with some slight constriction in breathing, and
occasional palpitation. These symptoms, though never very
urgent, continued until his death. Though never delirious, and
able to answer questions to the last, he never spoke of having
received any injury of the kind, and had never manifested any
suicidal tendency.

PART III.
JHontljlg p^riarope.

On the Operation of Phymosis. By W. Colles, Esq., Surgeon to
Stevens' Hospital, Dublin, &c. [After alluding to the various opera-
tions for phymosis, all of which are in his opinion more or less objec-
tionable, Mr. Colles says :]

I have been in the habit, for some time, of removing the deformity
by a simple and very effectual operation. I seize the edge of the pre-
puce, at its fold forming the narrow band, in the left hand, and holding
the scalpel in the right, and at right angles with the penis, I remove a
circular portion of skin, about a quarter of an inch wide. The outer
fold of skin, being loose, is then drawn back on the penis, leaving the
glans covered by the inner and tighter fold. I then divide this layer
about halfway back, more or less, slitting it up exactly in the centre,
by passing a sharp-pointed bistoury under it. We have now the outer
fold of skin loose, with a large circular orifice; the inner, or more
contracted portion, prcscnting^also an orifice, but larger by double the
perpendicular incision, which forms two angular flaps. 1 then turn
these flaps outwards, and by a suture attach each angle to the edge of
the external !?kin, at about a quarter of its circumference from the
fiX'niim ; a slight suture at the fra^num completes the operation. I
then draw all forward so as to cover the glans. In two or three days
1 remove the sutures, and generally find the wound healed, leaving a

1849.] Monthly Periscope, 095

covering for the glans, differing in no respect fronn t!ie natural and per-
fect prepuce ; and in some cases it nould be difficult to know that any
operation had been performed, or that any had been required, on this
])art. [Duilin Quarterly Journal.

Use of Chloroform in Tooth-ache Mr. Tomes, in his Lectures on
Dental Physiology and Surgery, recommends chloroform to be applied
on a a little cotton wool to the tooth in order to remove the pain.
The best fonri for application is made by dissolvmg a little gum mas-
tic in the chloroform, whereby the fluid is thickened ; and, when put
into the tooth with cotton wool, will remain there a long time, and
keep up its sedative influence: whereas, if the chloroform be used
alone, it will be soon washed away by the saliva, and its effect lost.

[Medical Times.

Use of Chloroform in Hiccup. In the case of a gentleman, forty-six
years of age, of weak constitution, and highly nervous temperament,
M. Latour employed chloroform during a very severe attack, which
had lasted three hours, the convulsions of the diaphragm occurring at
intervals of six or eight seconds. A bottle containing chloroform was
applied to the nostrils, and removed after a few inspirations. At the
first removal, a temporary cessation was produced, and three applica-
tions of the chloroform bottle entirely put a stop to the paroxysm.

[L' Union Medicale. London Journ. of Med.

Hint on Sounding. By Samuel Solly, Esq., F. R. S., &c. When
you sound tor stone, use rather a short and straight instrument at first.
Introduce it very slowly and cautiously, so that the point of the
instrument sinks into the post-prostatic fossa, in which the stone is
generally situated. If you do so, you will generally strike the stono
at once; but if you sweep a sound, with a good full curve, into the
bladder rapidly, you carry your instrument over the stone, and you
may turn the point of it all round the bladder in vain. [3Ied. Gazette.

Hint on the Diet after Lithotomy. By Bransby Cooper, Esq.,
F. R. S., dec. Patients should not be kept on spare diet after the
operation of lithotomy, nor, indeed, after any severe ordeal of the kind.
It should always be remembered that you cannot diminish constitu-
tional power without increasing irritability ; and that, consequently,
support is generally requisite, and should be early prescribed.

I am sure that one of the greatest modern improvements in the
treatment of patients who have undergone surgical operations is with
respect to the better diet that is early advised : and hence, I believe,
arises the greater comparative success of operations in this than in any
other country. [Ihid.

Jnconiinenae of Urine after Lithotomy. By Samuel Solly, Esq.,
F. R. S., Sec. [In a clinical lecture upon urinary diseases, Mr. Solly,
speaking of incontinence of urine after lithotomy, observed :]

C96 Monthly Periscope. [November,

For this symptom which is not a common consequence of lithotomy
in the male, I have prescribed the extractwm nucis vomicae, having
found it very useful in cases of incontinence from other causes. Many
of you will, I think, remember a case that I had in Lazarus Ward,
about six months ago, where the patient, about twenty years of age,
wetted his bed every night. This man got perfectly well und.n- this
medicine. I had a similar case in private practice just about the
same time equally successful. I give very small doses at first, gradu-
ally increasing them. Kain took the 8th of a grain three times a day ;
he is now taking a grain, and he is improving, though slowly. He
can retain his water much better than he could a week ago. [Ibid.

Chloroform in Operations. The use of chloroform in operations is
not contra-indicated by any state of the patient as to age or constitu-
tion, nor by any disease which does not itself forbid the operation.
In administering chloroform, always use an inhaler, and watch care-
fully tlie effects produced : and do not seek to produce insensibility in
less time than two or three minutes. When the margin of the eyelid
can be touched without causing contraction of the orbicularis muscle,
or even when it causes but slight contraction, any operation can be
performed without pain. At this time, as the effects of chloroform
continue to increase for a few seconds after the inhalation is discon-
tinued, it is advisable to intermit the vapour for a few inspirations, or
to dilute it with more air, so as not to carry the insensibility too far.
When the operation is over, do not disturb the patient prematurely, but
await the complete return of consciousness. (Dr. J. Snow, p. 338.)

[Braithwaile^s Retrosjject.

[We object to all inhalers in using chloroform. Mr. Snow, how-
ever, employs an immense balloon containing a measured quantity of
the article largely diluted with atmospheric air.] Edt.

Prevention of Coniogion. To preserve the hands or any part of
them from the contact of contagious matter in dissection, post-mortem
examinations, or midwifery practice, apply collodion. (Mr. E. Wil-
son, p. 318, Mr. J. Startin, p. 320.)

A better application than collodion is, the compound solution of
caoutchouc and gutta percha ; made by adding a drachm of gutta per-
cha to an ounce of benzole, and also ten grains of India-rubber to an
ounce of the same fluid, dissolving })y a gentle heat, and then mixing
the solutions. (Mr. W. Action, p. 203.) [Ibid.

Orchitis, acute. Use active antiphlogistic treatment. Thus, in
persons of plethoric habit, bleed from the arm ; in others, in addition to
the application of leeches to the afiected organs, cup from the loins to
about eight ounces. Give also a pill containing a grain and a half of
calomel, one-third of a grain of tartarized antimony, and half a grain
of opium; and tiie following mixture: IjL. Magn. sulph. giij.; liq.
ammon. acet. 5i. ; liq. antim. tart, siss.; tinct. hyoscy. 5iss. ; aq.
menth. ^vij. M. Capt. gi. 3tis horis donee alvus bene responderit.

1849.] Monthly Periscope. (;97

Keep the patient on low diet, and in the rcciinibont jjosition. And as
a local application use a lotion containinr a drachm and a half of mu-
riate of ammonia, two ounces each of rectified spirit and licj. amnion,
acet., and tour ounces of water. If the intlammation does not abate,
open the congested vessels of the scrotum, and piomote bleeding from
them by warm fomentations. If enlargement and harshness of the
testicle remain after the subsidence of the inflammatory symptoms,
apply strips of lint spread with the following ointment: R. Ung.
hydrarg. ; cerat. saponis, aa. ij. ; campJiora?, gr. v. M.; and over
this, apply adhesive plaster, so as to make considerable pressure. Do
not, however, use pressure in the early and acute stage. \^lhid.

Leeching in Dysmenorrhcca. Prof. Annan concludes a very sensi-
ble article on Dysmenorrhcca, with the tbllowing reflections :

" Leeching of the os and cervix uteri then, i regard as the sine qua
non, the indispensable remedy, in all inveterate cases of dysmenor-
rhcea. I believe it is required in the delicate, feeble, and nervous,
along with the tonic plan of general treatment, quite as much as in
those of the opposite state of the system Indeed without local deple-
tion from the affected organ, I do not think the worst cases admit of
cure. Scarification has been substituted where leeches cannot be
procured. Seven or eight superficial, crucial incisions, may be made
with a thumb lancet fastened to a slender stick, around the os uteri.
It is a poor substitute.

^' Total abstinence from sexual intercourse, amongst the married,
is absolutely necessary in the worst varieties of this disease. Modera-
tion should be enjoined in all cases. I have known it follow marriage,
and resist all treatment (leeching was not tried) until the death of the
husband, when the lady was immediate'ly restored to health without
treatment" [Transylvania Med. Jour., from Western Lancet.

Fraisewonhy among Physicians. Intelligence having been receiv-
ed that cholera was raging with frightful mortality in Sandusky city,
and that the inhabitants Were without medical aid, the resident physi-
cians having fled in terror, Drs. Strader, Foote, Stevens, Banks, John-
son, Caroland, and Hughes, Quinn and Cheltree physicians' students
of this city, immediately repaired to that place for the purpose of
rendering all the assistance in their power. Such disinterested be-
nevolence deserves the highest commendation ; and we are proud of
a profession that will thus risk health and life in the discharge of a
vicarious duty, prompted by the cries of a strange community for
medical aid.

We trust it may prove untrue that the resident physicians fled ; but
if true, a just condemnation awaits them. [Western Lancet.

Effects of Quinine. By E. D. Fenner, M. D., of New Orleans.
This interesting case is worthy of special attention. It displays in a
striking manner the wonderful powers of quinine ; but candor compels
me to say, it shows also that I did not avail myself and my patient of

C98 Monthly Periscope. [November,

the full extent of these powers. One dose of 30 grains, given on the
first day, almost extinguished the fever. Very probably another such
a dose on the following morning would have done the work complete-
ly ; but, as the most of inexperienced persons would have supposed,
from the appearance of the patient, I thought it could be dispensed
with. The consequence was, that the fever was gradually rekindled,
and on the Gt.h day had become so high, that I had to resort to another
bold dose, combined with opium, to arrest it. This did master it, but
left the patient in a singuUr nervous condition. As strange as it
may appear to those who never witnessed it, I am convinced that 30
grs. of the sulph. quinine, with 30 drops tr. opii., or twogrs. of opium,
given during the exacerbaiioji, will, in perhaps nine cases of ten, put
down a fever like pouring water upon fire. But this is not always all
that is to be done. A good dose of calomel (15 to 20 grs.), may now
be required to emulge the liver freely, and to act upon the other se-
creting organs ; and then one or two liberal doses more of quinine, to
prevent the recurrence of fever. [Neiv Orleans Med. and Surg. Jour.

A Case of Hydrocephalus, icith Hypertrophy of the walls of the Cra-
nium. By T. VV. Masox, M.D., of Wetumpka, Ala. Black Male,
set. 12 years; Autopsy ten hours after death. The following table
shows the thickness of the bones that were divided in the examination:
Frontal, ... 1| inches.
Occipital, . . If "
Parietal, ... 1 "
Temporal, i "

The cellular structure forming the middle table of the cranial wall
seemed to be filled with coagulated blood ; the internal table was en-
tirely destroyed in some places ; the impressions made by the blood-
vessels were much larger than usual.

Meninges of the brain were so closely adhered, that they could not
be separated. Cerebrum of natural consistence, preternalwrally white ;
indeed, it was entirely cxsanguineous. The amount of effused seruni
was not as great as we expected to find, although it was considerable.
The ventricles were much enlarged by the cfTiision. Cerebellum was
found preternaturally soft, and also of a much lighter color than usual.

Remarks. We have been unable to obtain any thing like a satis-
factory history of the case ; we can therefore only furnish the following
imperfect items : The boy's head commenced enlarging, when he
was four years old ; he then was attacked with, what his mother
termed, *' fainty fits," and his mind was seriously affected. He, how-
ever, gradually recovered his lost faculties, and retained them till his
death.

When we saw the case, which was a few weeks before death, it
presented the following symptoms: eyes much projected and pupils
dilated; diarrhoea and occasional vomiting; he complained almost
constantly of a dull aching about the head, but no acute pain ; face,
hands, and foot would frequently swell toward evening and go down
by morning ; pulse usually about 120, weak and wiry ; skin warm

1849.] Monthly Periscope. 699

and dry ; the "faintyfits" continued to increase, in frequency and
severity, as the fatal issue approached. [Ibid.

Treatment of Gout and Rheumatism by Anodynes. To the Editor
of the London Lancet : Sir, For sonic years past I have conceived
both gout and rheuniatism to be altogotlier neuralgic attections ; and
under this impression 1 have for a considerable lime treat* d all cases
of this kind that have come under my care chiefly by anodynes, topi-
cally applied ; and the results of this practice have in no degree dis-
appointed my expectations.

In rheumatic fever which, I think, may be fairly considered as sym-
pathetic of many co-existing local irritations I content myself and
generally my patients too uith clearing out the imma facicp,, and ap-
plying lint, dipped in strong solution of opium, or of belladonna to the
seats of pain, covering the wetted lint with oiled silk, that the soothing
effects of warmth and moisture may at the same time be attained.
And I have tbund the febrile state, the local irritations being subdued,
easily controlled by the acetate liquor of ammonia, combined with
tincture of hyoscyamus and nitrate of potash.

In gout, unquestionably, the constitutional state must be more par-
ticularly attended to especially as far as regards the prophylaxis ; and
in young and robust people, where rhuematism occasionally attacks
the heart, I yet think it sometimes necessary to bleed from the arm.
That, however, in these cases, we might not often, if not always,
trust to narcotics, I am by no means well assured.
I am, sir, vours respectfully,

JOHN COOPER, F. R. C. S. E., &c.

On the employment of Collodoin in Ophthalmic Affections. By M.
Hairion. To be enabled to protect the inflamed cornea from the con-
tact with the air, prevent the movement of the eyelids over its surface,
and retain topical applications long in contact with it, are objects which,
if realized, would much diminish the severity of keratitis and con-
junctivitis Attempts at accomplishing these ends by the use of court
plaster and the like had failed in the author's hands, when collodion
oflTered itself to his notice. He usually applies it to the eyelids of one
eye, and afterwards, if both eyes are diseased, to the other; but
circumstances may render its simultaneous use necessary. The ad-
hesion never lasts longer than forty-eight hours ; frequently not so
long, and has to be reaccomplished. The discharges tVom the eye
usually work out a small passaije, or a little space may be left at the
angle of the eye, without interfering with immoveability. 'I'his often
forms an admirable means either of securing rest and darkness for the
inflamed conjunctiva or cornea, or of enabling us to make effectual
application of various ointments to the ocular surface. Then again,
in the various perverted conditions of the eyelids, as in trichiasis, dis-
tichiasis, entropion, ectropion, &c., the case with which, by collodion,
the desired rectitication can be secured, renders it a most valuable
palliative and even curative agent. [L' Union Medicale, from British
and Foreign Mcdico-Chirurtr. Rev.

'00 Montlily Periscope. [November,

The Mechanical Leech of MM. Alexander & Co., of Paris.
This apparatus consists essentially of two parts an instrument for
puncturing the skin, and another for promoting the flow of blood by
removing atmospheric pressure from the punctured part. The punc-
ture isetiected by a lancet, the bladeof which has the form of the cutting
apparatus of the leccH. This lancet is (ixed in the mouth of a tube,
and projects about the eighth of an inch beyond the edge of the tube,
in which position it is secured by a catch. Attached to the opposite
end of the tube, by a piece of vulcanized india-rubber, which acts as
a spring, is a piston, which is pressed down by a rod, and, on remov-
ing the pressure, is drawn back by the India-rubber spring. The
piston being pressed down, the open end of the tube in which the
lancet is fixed, is placed over the part to be punctured : the pressure
Is now removed when the piston is drawn back by the spring, and ex-
hausting the air within the tube, the skin is forced up into the mouth
of the tube. On loosening the lever, by which the lancet has been
elevated, the latter is drawn down by a spring, also of vulcanized
India-rubber, so as to effect the puncture. The cutting instrument is
now removed, and a glass tube with a piston, similiar to that already
described, is placed over the puncture, the air within being exhausted
so that the tube adheres to the part, and the blood flows freely into it.
Haifa dozen or a dozen tubes, each of which would draw as much
blood as a large leech, might be thus attached in two or three
minutes. The apparatus, consisting of a cutting instrument and six
or twelve suction tubes, together with sundry implements for cleaning
the lancet and tubes after use, are contained in a small case. It is
very neatly got up, and we understand from those who have used it,
is very efficient. The idea, however, is not new^ : so long ago as the
year 1813, the silver medal was awarded at the Society of Arts to
Mr. J. Whitford, of St. Bartholomew's Hospital, for the invention of a
somewhat similiar apparatus for the same purpose. In Mr.
Whitford's apparatus the exhaustion was effected by a syringe,
which was found to be inconvenient. The use of vulcanized India-
rubber springs, attached to the pistons, by which efficient suction
tubes are economically formed, is a great improvement in MM.
Alexander's appara.tus. [Lond. Med. Journal, from Pharni. Journal.

Cincinnati Homoeopath}/, vnder Allopathic Treatment. The follow-
ing candid and fearless expose of Homoeopathic knavery, as practised
by the apostles of that system in Cincinnati, is taken from the columns
of the " Methodist Expositor," of that city. It is from the pen of its
talented Editor, Dr. Latto, who has in this communication done
essential service to the cause of humanity, and for the bold stand he
has taken against that species of quackery, deserves the thanks of the
entire profession. It will be read with the deepest interest.

^^ Similia Similibus curantur :^' that which will produce the disease
will cure it, is the great fundamental principle upon which the system
is founded. Had they acted in harmony with this pretension, they
would have given to their cholera patients something which would

1849.] Monthly Periscope. 701

have produced purging and vomiting, such as ipicac, tartar emetic,
etc. But alas, instead of this we find them employing camphor, and
that too in larger doses than it is administered by most of their
allophatic neighbors. But who, we ask, ever heard that camphor was
emetic and cathartic.

The infmitessimal doses, as well as the fundamental principle, ac-
cording to the showing of Drs. Pulte and Ehrmann, iiave been aban-
doned, and yet they ascribe their cures to homoeopathy. We doubt
whether they will succeed in gulling the intelligent in the community
much longer by a system of quackery so palpably absurd so
grossly immoral. We have no doubt that camphor, administered in
ten or twenty grain doses, would secure a reasonable share of suc-
cess, whether employed by homoeophatic or allopathic practitioners.
It is known to the community, that regular physicians have always relied
upon the use of camphor in this disease to a great extent, in much
smaller doses than those prescribed by the Homoeopathists, and hence if
the latter have been successful, it is obviously, (if their own statements
can be relied upon) by the use of allopathic remedies, and not by
infinitessimal doses of medicines, as they would have it understood.
These gentlemen seem to have abandoned Hahnemann's theory,
" that the hair of the dog would cure the bite."

It is grossly immoral, -we think, to practice such a deception upon
the community. We have long believed that homoeopathic doctors
were practicing allopathy in disguise employing the " sampsons" of
the system, such as calomel, corrosive sublimate, arsenic, camphor,
belladona, pulsatilla, and many other powerful articles, in full doses
but now we have proof which sets the question forever at rest.

Sub-carbonate of Iron and Sulphur in Fever and Ague. By Major
R. Lachlan, of Montreal. Although not a professional man, I am
encouraged to crave a small space in the liberal columns of your
valuable journal, to put to the test the pretensions of a medicine,
stated to he an infallible cure for fever and ague, which has been in
my possession upwards of twelve years, but lias only lately been ana-
lyzed for me by our scientific friend, Mr. Hunt, chemist to the geolo-
gical survey.

To account for my having as yet been unable to vouch for the
effects of the medicine alluded to, I may observe that, having only
three doses or powders in my possession, and that number being
deemed necessary to produce a cure, I was unwilling to make use of
them before being analysed, and that in the mean time they had been
mislaid, until my arrival in Montreal.

It may dc proper to add that the powders were given to me by a
highly respectable and intelligent, as well as educated, friend in Dev-
onshire, (now no more,) accompanied by a memorandum of instruc-
tions, &c., of which the Ibllowing arc the j)articulars :

" One of the powders to be taken an hour before the ague fit comes
on, in a glass of mountain or other generous wlu'lc wine. If white
wine cannot be had, try sugar and water, but do not use red wine.

702 Monthly Periscope, [November,

Three powders are a certain cure ; and I understand it is also a pre-
ventive. Besides a lady and gentleman of my acquaintance who were
benefited by it, more than two hundred men were cured in the French
Prison, (at Dartmore,) one with four doses, who had had the ague four
years; and I myself cured a privattj soldier and an officer."

It is only necessary to add, that according to the memorandum of
the analysis of the powder furnished by iVIr. Hunt, "the fever and
ague medicine is an intimate mixture of sulphur and peroxide of iron,
(the carbonate of iron of the druggists,) and consists of nine parts of
the former and one of the latter;" and that Mr. H. inadvertently
omitted to ascertain the weight of the powder before analysis, but
judged it to be from half a scruple to forty grains, and that on my
weighing the only remaining powder in my possession I found it to
be between 44 and 45 grains.

How far this very simple compound possesses the powerful virtues
attributed to it, rests with the medical profession to decide, and more
particularly with those members who reside in parts of Upper Canada
where the distressing and debilitating disease in question is most pre-
valent, and where such a medicine would prove invaluable.

I might perhaps have been permitted to make this communication
over an anonymous signature, but I prefer attaching my real name to
it, as the best evidence of the credit I am disposed to attach to the
statements in favor of the power of the medicine. [British American
Journ. of Med. and Phys. Science.

Homoeopathic Victim. The Countess of Blessington, whose misfor-
tunes drove her from Great Britain, died very lately in Paris of apo-
plexy. The unfortunate lady was chiefly under the guidance of
the homoeopathic quacks, and Mr. Simon, a homoeopathic doctor, was
summoned to her assistance (?) in her fatal illness. The quack stood
by her bedside, and pronounced her disease to be apoplexy ! For this
malady, of course, homceopathy had no remedy, no treatment.

Such events bring this absurd form of quackery to the true and
severe test. All must see the perfect impotency of an infinitesimal
within the cerebrum ! What can a globule do with a clot of blood
among the fibres of the brain ? Occurrences of this kind ought to
prove a lesson and a warning to our nobility. Such cases as those
of Sir Francis I?urdctt ; Lady Denbigh, who died of uterine hemor-
rhage, homoeopathically ; and the present case of Lady Blessington,
speak louder against the fashionable quackeries than any homily of
orthodox medicine. [Lancet.

Iodine Inject ions for Fistula. M. Ameuille lately mentioned, at a
meeting of the Societe Medico-Pratique of Paris, that he had succeed-
ed in completely curing very refractory iistuhc of the groin and axilla,
by injecting into thorn, for a few days, a mixture of ten parts of tinc-
ture of iodine to fifty of distilled water. The mixture should neither
be decanted nor filtered, but well stirred before use. The pain re-
sulting from the injection may be mitigated by a poultice, and the

1849. J Monthly Periscope. Medical Intelligence. 703

patient be allowed to rest for a while. In some cases slight compres-
sion must be used besides the injection. [London Lancet.

Compression of the Carotids in Hemorrhage after Tonsillotomy. By
M. Gknsoul. In a case in which deatii was initninent, M. G. made
pressure on both carotids, and particularly on the side whence the
blood chiefly issued. The flow ceased. The compression being kept
up for half an hour, the bleeding did not recur. Since then, he has
always successfully adopted this plan, whenever the haemorrhage
seemed too free, after removing the tonsils. It is applicable to all
troublesome haemorrhages about the face and mouth, epistaxis, and
neuralgia of the face. [^Rev. Med. Chir.<, from Wood's Retrospect.

Remedy for Baldness. By Dr. Neligan. As a remedy for bald-
ness which follows herpes or pityriasis, Dr. Neligan recommends the
following pomade, from which he has found great benefit. Prepared
lard, two ounces ; white wax, two drachms ; melt together, remove
from the fire, and when the mixture is beginning to thicken, add, with
constant stirring, balsam oftolu, two fluid drachms, and oil of rosema-
ry, twenty minims. In very chronic cases, or where the baldness has
long existed, a drachm of tincture of cantharides may be added.

[Medical Gazette.

MEDICAL INTELLIGENCE.

The future Editor of the Southern Medical and Surgical Journal. We are
gratified to state that Dr. I. P. Garvin has consented to take charge of this
Journal after the present volume shall have been completed. One No, after
this one, and the new Editor will enter upon his duties. We congratulate our
readers in being able to secure so competent a gentleman to conduct the work.
It will be recollected that Dr. G. was associated as co-editor, a year or two ago ;
and the friends of southern medical literature will, we hope, take new courage
to sustain him in his labor for them.

The Health of our City Prospects of our College. We believe Augusta is the
only city in our country, where a Medical College exists, not visited by an
epidemic during the past six months.

The duties ol our Medical College will commence on Monday, the 5th of
November, at 12 M., by the delivery of a public Introductory, and the regular
exercises resumed the next morning at 9 A. M. The indications are favorable
for a good class the coming session.

The Committee on the Adulteration and Sophistication of Drugs, <^-c. The fol-
lowing letter was received in the early part of this month, (October,) and we
addressed Dr. Tufts, of Savannah, on the subject, but have received no reply
from him. We shall be greatly obliged for suggestions, fact.s, &c., from gen-
tlemen of the profession withig the State, bearing upon the subject of tliis
communication.

704

Medical Intelligence, Meteorology.

To Paul F. Eve, M. D.

Dear Sir, At the last annual meeting of the American Medical Associa-
tion, a resolution was adopted ordering that a Committee of two persons from
each State and Territory should be appointed, " ichose duly it shall be to note all
fa^ts that come to their knowledge, ivith regard to the Advllcralion and Sopkislication
of Drugs, Medicines, Chemicals, <^c., and to report them, throiLgh the Chairman at
the next Annual Meeting.'" In a communication which I have had the honor
to receive from the President of the Association, I am requested to inform you
and Dr. J. B. Tufts, of Savannah, that you have been appointed the delegates
irom the State of Georgia.

The subjects confided to the Committee, as I am informed by the President,
were deemed of great importance to the Association, and it was evidently the
wish of its members, that the most extensive inquiries should be made, in every
section of the country: I have to ask, therefore, on behalf of the Association,
that you will take an active part in these investigations, especially so far as
your State may be concerned, and that, at your earliest convenience, you will
be so good as to communicate to me, whatever facts you may possess, with
such suggestions as you may think proper to make.

I have the honor to be, &c.

R. M. HUSTON, Chairman.
Com. on Adulteration, &c. of Drugs, of the Am. Med. Association.

Philadelphia, Sept. 15th, 1649.

METEOROLOGICAL OBSERVATIONS, for September, 1849, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet.

Sun Rise.

2, ]

P.M.

Ther.

Bar.

Ther.

88

Bar.

75

29 66-100

29 62-100

69

" 80-100

79

" 83-100

69

" 80-100

80

" 86 10(.

72

" 86-100

79

" 86-100

68

" 86-100

84

" 84-100

65

" 81-100

89

" 70-100

68

" 67-100

92

" 72-100

m

" 90-100

84

' 94-100

64

30 4-100

84

30 5-lOO

62

30 6-100

82

30 4-lOOj

63

30 4-100

82

30 I

66

29 92-100

74

29 86-100

69

" 87-100

78

" 90-100

71

" 95-100

80

" 97-100

71

" 98-100

88

" 94-100

66

" 95-100

90

" 95-100

65

" 92-100

88

" 86-100

64

" 83-100

91

" 79-100'

73

" 73-100

85

" 68-100;

67

" 68-100

88

" 60-100

67

" 74-100

89

" 73-100!

70

" 73-100

84

" 60-100

69

" 63-100

87

" 58-100

58

" 75-100

80

" 76-100

51

" 7.5-100

82

" 75-100

56

" 70-100

85

" 69-100

59

" 74-100

85

" 79-100

60

" 93-100

89

" 94-100

67

" 94-100

86

" 81-100

70

" 67-100

78

" 50-100

Wind.

2

3

4

5

6

7

8

9

10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

18 Fair days. Quantity of Rain 35-100.
West of do. do. 9 days.

N.
W,

w.

N. E.

N. E.

N.

N.

N.

N.

N.

E.

E.

S.
N. E.

N.
N. W,

E.

W.
N. W,
N. W.
N. W.

W.
N. E.

K.

S,
S. W.

Remarks.

E. Cloudy blow all night.
E. jCloudy blow continues.
E. jcioady blows occasionally.
E. iCioudy blow continues.

Cloudy blow continues.

Fair.

Fair breeze.

Fair blow.

Fair breeze.

Fair blow.

Fair blow,

Cl'dy gale 14 hours-sprinkle.

Cloudy blow.

Cloudy blow.

Fair.

Fair.

Fair some clouds.

Fair breeze.

Somewhat cloudy dry gale.

Fair blow continues.

Fair some floating clouds.

Cloudy thunder breeze.

Fair breeze.

Fair splendid day,butdu.sty.

Fair splendid day, but dusty.

Fair breeze.

Fair breeze.

Fair.

Cloudy afternoon rain 25-100.

Showery 10-100^

Wind East of N. and S. 17 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. .] NEW SERIES DECEMBER, 1819. [No. 12.

PART FIRST.

riginal dommuntcattona.

'^ ARTICLE XXXVIII.

An account of the first use of Sulphuric Ether by Inhalation
as an Ancesthetic in Surgical Operations. By C. W.
Long, M. D., of Jefferson, Jackson Co., Georgia,

For nearly three years, the various medical journals have
contained numerous articles on the employment of Sulphuric
Ether hy Inhalation, for the purpose of rendering patients
insensible to pain during surgical operations.

The first notice I saw of the use of ether, or rather of Dr.
Morton's " Letheon," as an anaesthetic, was in the editorial of
the Medical Examiner for December, 1846, in which the editor
gives the following extract from a paper by Dr. H. J. Bigelow,
contained in the Boston Journal : "The preparation (letheon)
is inhaled from a small two-necked glass globe, and smells of
ether, and is, we have little doubt, an etherial solution of some
narcotic substance."

Having on several occasions used ether, since March, 1842,
to prevent pain in surgical operations, immediately after read-
ing this notice of "letheon," I commenced a communication to
the editor of the Medical Examiner, for publication ill that
Journal, to notify the medical profession that sulphuric ether,
when inhaled, would of itself render surgical operations pain-
less, and that it had then been used by me for that purpose for
more than four years. I was interrupted when I had written
but a few lines, and was prevented, by a very laborious country

N. 3, VOL. V. NO. XII. 45

706 Long, on Sulphuric Ether in Surgery. [December,

practice, from resuming my communication, until the Medical
Examiner for January, 1847, was received, which reached me
in a few days after reading the December number. It con-
tained several articles, giving accounts of different experiments
in etherization, in which surgical operations were performed
without pain. On reading these articles, I determined to wait
a few months, before publishing an account of my discovery,
and see whether any surgeon would present a claim to having
used ether by inhalation in surgical operations prior to the time
it was used by me.

A controversy soon ensued between Messrs. Jackson, Morton
and Wells, in regard to who was entitled to the honor of being
the discoverer of the anaesthetic powers of ether, and a consid-
erable time elapsed before I was able to ascertain the exact
period when their first operations were performed. Ascer-
taining this fact, through negligence I have now permitted a
much longer time to elapse than I designed, or than my pro-
fessional friends with whom I consulted advised ; but as no
account has been published, (so far as I have been able to
ascertain,) of the inhalation of ether being used to prevent pain
in surgical operations as early as March, 1842, my friends
think I would be doing myself injustice, not to notify my breth-
ren of the medical profession of my priority of the use of ether
by inhalation in surgical practice.

I know that my interests have suffered from not making an
earlier publication, and I would not be persuaded at this late
stage of the ether controversy to present my claim to being
the first to use ether as an anaesthetic in surgical operations, if
I were not fully satisfied of my ability to establish its justness.

In the month of December, 1841, or January, 1842, the sub-
ject of the inhalation of nitrous oxide gas was introduced in a
company of young men assembled at night in this village, (Jef-
ferson,) and several persons present desired me to prepare some
for their use. I informed them that I had no apparatus for
preparing or preserving the gas, but that I had a medicine
(sulphuric ether) which would produce equally exhilerating
effects ; that I had inhaled it myself, and considered it as safe
as the nitrous oxide gas. One of the company stated, that he
had inhaled ether while at school, and was then willing to inhale

1849.] Long, on Sulphuric Ether in Surgery. 707

it. The company were all anxious to witness its effects. The
ether was introduced: I gave it first to the gentleman who had
previously inhaled it, then inhaled it myself, and afterwards
gave it to all persons present. They were so much pleased
with the exhilerating effects of ether, that they afterwards in-
haled it frequently, and induced others to do so, and its inhala-
tion soon became quite fashionable in this county, and in fact
extended from this place through several counties in this part
of Georgia.

On numerous occasions I have inhaled ether for its exhilerating
properties, and would frequently, at some short time subsequent
to its inhalation, discover bruised or painful spots on my person,
which I had no recollection of causing, and which 1 felt satisfied
w^ere received while under the influence of ether. I noticed,
my friends, while etherized, received falls and blows, which I
believed were suflicient to produce pain on a person not in a
state of anaesthesia, and on questioning them, they uniformly
assured me that they did not feel the least pain from these
accidents. These facts are mentioned, that the reasons may
be apparent why I was induced to make an experiment in
etherization.

The first patient to whom I administered ether in a surgical
operation, was Mr. James M. Venable, who then resided within
two miles of Jefferson, and at present lives in Cobb county, Ga.
Mr. Venable consulted me on several occasions in regard to
the propriety of removing two small tumours situated on the
back part of his neck, but would postpone from time to time
having the operations performed, from dread of pain. At
length I mentioned to him the fact of my receiving bruises
while under the influence of the vapour of ether, without suffer-
ing, and as I knew him to be fond of, and accustomed to inhale
ether, I suggested to him the probability that the operations
might be performed without pain, and proposed operating on
him while under its influence. He consented to have one tu-
mour removed, and the operation was performed the same
evening. The ether w^as given to Mr. Venable on a towel ;
and when fully under its influence I extirpated the tumour. It
was encysted, and about half an inch in diameter. The patient
continued to inhale ether during the time of the operation ; and

708 Long, on Sulphuric Ether in Surgery. [December,

when informed it was over, seemed incredulous, until the tu-
mour was shown him. He gave no evidence of suffering
during the operation, and assured me, after it was over, that he
did not experience the slightest degree of pain from its perform-
ance. This operation was performed on the 20ih March, 1842.

The second operation I performed upon a patient etherized
was on the 6th June, 1842, and was on the same person, for
the removal of another small tumour. This operation required
more time than the first, from the cyst of the tumour having
formed adhesions to the surrounding parts. The patient was
insensible to pain during the operation, until the last attachment
of the cyst was separated, when hs exhibited signs of slight suf-
fering, but asserted, after the operation was over, that the
sensation of pain was so slight as scarcely to be perceived. In
this operation, the inhalation of ether ceased before the frst
incision w\ns made : since that time I have invariably desired
patients, when practicable, to continue its inhalation during the
time of the operation.

Having so long neglected presenting my claim to the discov-
ery of the anaesthetic powers of ether; for the purpose of
satisfying the minds of all, of its justness, I have procured, 1
conceive, a sufficient number of certificates to establish the
claim indisputably. I present, first, the certificate of James M.
Venable, the patient on whom the first experiments in etheri-
zation were made, and no comments on it, I conceive, are
necessary.

[Note. A few months ago. Dr. Long informed us of his early
attemptsat etherization, in Surgery. He was then informed that
any claim set up at this late day to priority of discovery, would
be severely criticised, if not violently resisted ; and that he had
best, therefore, do all he could to fortify his position. He has
accordingly sent us a number of certificates, properly attested;
but as it is unusual for medical journals to admit these, and as
besides, in our profession, the word of a gentlemen is sufficient
on all points of controversy, these are of course omitted here.
We state, however, they may be seen by any one curious in the
matter, and their character may be judged of by the two fol-
lowing, bearing most pointedly on the subject under discussion.

We have only to add, that the writer of this communication
is a highly worthy member of the medical profession, exceed-
ingly modest in his pretensions and entitled to full credit for all
he advances.] Edt.

1849.] Long, on Sulphuric Ether in Surgery. 709

(certificates.)

I, James M. Venable, of the county of Cobb, and State of
Georgia, on oath, depose and say, that in the year 1812, I re-
sided at my mother's, in Jackson county, about two miles from
the villafje of Jefierson, and attended the villaire academy that
year. In the early ])art of the year the vounijj men of Jcflerson,
and the country adjoining, were in 'die habit of inhaling ether,
for its exhileratin^r powers, and I inhaled it myself iVequently
for that purpose, and was very fond of its use.

While attending the academy, I was frequently in the office
ofDr.C. W.Long, and having two tumours on the side and rather
back of my neck, I several times spoke to him about the pro-
priety of cutting them out, but postponed the operation from
time to time. On one occasion, we had some conversation
about the probability that the tumours might be cut out while I
was under the influence of S. ether, without my experiencing
pain, and he proposed operating on me while under its influ-
ence. I agreed to have one tumoOr cut out, and had the oper-
ation performed that evening after school was dismissed. This
was in the early part of the spring of 1842.

I commenced inhaling the ether before the operation was
commenced, and continued it until the operation was over. I
did not feel the slightest pain from the operation, and could not
believe the tumour was removed until it was shown to me.

A month or two after this time. Dr. C. W. Long cut out the
other tumour, situated on the same side of my neck. In this
operation I did not feel the least pain until the last cut was
mad%, when I felt a little pain. In this operation, I stopped
inha-ling the ether before the operation was finished.

I inhaled the ether, in both cases, from a towel, which was
the common method of taking it.

James M. Venable.
GEORGIA, Cobb county, ? c. , . c

July 23d, 1849. 1 Sworn to before me.

Alfred Manes, J. P.

I certify that I was a pupil in the Academy in JeflJerson,
Jackson county, Ga., in the year 1842. Some time durini^ the
spring of that year I was present, and witnessed Dr. C. W.
Long cut out a small tumour from the neck of James M. Vena-
ble. I am well acquainted with the smell of sulphuric ether,
and know that Mr. Venable inhaled it, before and during the
time of the operation. He made no sign of sufl^ering pain
during the operation ; and after the tumour was cut out, he as-
serted that he did not feel any pain from the cutting out of the
tumour.

710 hong, on Sulphuric Ether in Surgejy. [December,

A few months after this operation, Mr. Venable informed me
that Dr. Long had cut out another tumour from his neck, while
he was under the effects of ether, and that he did not feel any
pain from the operatiop. Mr. Venable was a pupil in the
Academy during the year 1842, and I was intimate with and
heard him speak of the operations frequently, and he always
asserted they were performed without pain. I know the oper-
ations were performed in the year 1842 : my brother, Wm. H.
Thurmond, had charge of the academy that year, and it was
the only time I was a pupil in the academy.

August 21st, 1849. Andrew^ J. Thurmond.

In addition to Mr. Venable's, I present the certificates of
E. S.Rawls and Wm. H. Thurmond, who were present, and wit-
nessed one or both operations.

My third experiment in etherization was made on the 3rd
July, 1842, and was on a negro boy, the property of Mrs. S.
Hemphill, who resides nine miles from Jefferson. The boy
had a disease of a toe, which rendered its amputation necessa-
ry, and the operation was performed without the boy evincing
the least sign of pain.

I present Mrs. Hemphill's statement of the report the boy
gave her of the operation on his return home, which I conceive

is sufficient on this point.

# * # # * * # *

These were all the surgical operations performed by me
during the year 1842, upon patients etherized; no other case
occurring in which I believed the inhalation of ether applicable.
Since '42, I have performed one or more surgical operations
annually, on patients in a state of etherization.

The question will no doubt occur, why did I not publish the
results of my experiments in etherization soon after they were
made? I was anxious, before making my publication, to try
etherization in a sufficient number of cases to fully satisfy my
mind that ana3sthesia was produced by the ether, and was not
the .effect of the imagination, or owing to any peculiar insus-
ceptibility to pain in the persons experimented on.

At the time I was experimenting with ether, there were phy-
sicians "high in authority," and of justly distinguished charac-
ter, who were the advocates of mesmerism, and recommended

1849.] I jongf on Sulphuric Ether in Surgery. 711

the induction of the mesmeric state as adequate to prevent pain
in surgical operations. Notwithstanding thus sanctioned, I
was an unbeliever in the science, and of the opinion, tiiat if the
mesmeric state could be produced at all, it was only on " those
of strong imagination and weak minds," nr.d was to be ascribed
solely to the workings of the patient's imaginations. Enter-
taining this opinion, I was the more particular in my experi-
ments in etherization.

Surgical operations are not of frequent occurrence in a coun-
try practice, and especially in the practice of a young physician ;
yet I was fortunate enough to meet with two cases in w^hich I
could satisfactorily test the anaesthetic power of ether. From
one of these patients I removed three tumours the same day:
the inhalation of ether was used only in tlie second operation,
and was effectual in preventing pain, while the patient suffered
severely from the extirpation of the other tumours. In the
other case, I amputated two fingers of a negro boy: the boy
was etherized during one amputation, and not during the other ;
he suffered from one operation, and was insensible during the
other.

I have procured the certificates of the lady from whom the
tumours were removed and of her husband, who was present
and witnessed the operations; and also that of the owner of the
boy, establishing the fact of the insensibility of the patients to
pain during these operations. These certificates were procured
in preference to those establishing other operations, because
they not only show that the experiments were continued from
year to year, but also show that they were conducted so as to
test the power of etherization.

After fully satisfying myself of the power of ether to produce
anaesthesia, I was desirous of administering it in a severer sur-
gical operation than any I had performed. In my practice,
prior to the published account of the use of ethei as an anaes-
thetic, I had no opportunity of experimenting with it in a capital
operation, my cases being confined, with one exception, to the
extirpation of small tumours, and the amputation of fingers and
toes.

I have stated that ether was frequently inhaled in this and

712 Long, 071 Sulphuric Ether in Surgery. [December,

some of the adjoining counties, for its exhilarating effects; and
although I am conscious that I do not deserve any credit ior in-
troducing its use for that purpose, yet as others, through their
friends, have claimed to be the first to shew its safety, most of
the certificates I have obtained establish the fact of its frequent
inhalation for its exhilerating effects. I met with R. H. Good-
man, who was present the night ether was first inhaled in
Jefferson, and who removed to Athens, and introduced its
inhalation in that place, and present his certificate. All the
young gentlemen who were present the night I first adminis-
tered ether, with one exception, are living, and their certifi-
cates can be procured, if necessary.*

I have now, in a very concise manner, presented a "plain,
unvarnished" account of some of my experiments in etheriza-
tion, and have said nothing of the comparative merits of ether,
and the other anassthetics, because that was foreign to my pre-
sent subject. Had I been engaged in the practice of my pro-
fession in a city, where surgical operations are performed daily,
the discovery would, no doubt, have been confided to others,
who would have assisted in the experiments; but occupying a
different position, I acted differently, whether justifiable or not.
The result of my second experiment in etherization, was such
as led me to believe that the anaesthetic state was of such short
duration that ether would only be applicable in cases in which
its effects could be kept up, by constant inhalation, during the
time of the performance of the operations. Under this impres-
ion, up to January, 1847, I had not used ether, in but one case,
in extracting teeth, and thus deprived myself of experimenting
in the only class of cases which are of frequent occurrence in a
country practice.

While cautiously experimenting with ether, as cases occurred,
with the view of fully testing its ana?sthetic powers, and its ap-
plicability to severe, as well as minor, surgical operations,
others, more favorably situated, engaged in similar experiments;
and consequently the publication of etherization did not "bide
my time." This being the case, I leave it with an enlightened

* Oar friend, Dr. Long, can lay no claim to the introduction of sulphuric
ether as an exhijeraling agent when its vapour is inhaled. EIdt.

1849.] Erskine & Sheffey, on Chloroform. 713

medical profession, to say, wliether or not my claim to the
discovery of etherization is forfeited, by not being presented
earher, and with the decision which may be made, 1 shall be
content.

ARTICLE XXXIX.

Three Cases of the successful administration of Chloroform,
occurring in the practice of Drs. Erskine &l Sheffey, of
Huntsville, Alabama.

Case 1st. A little daughter of Mr. M , aged about 4

years, some months previous to the operation, had a needle
thrust into her breast, over the sternum, the point breaking off
in the bone. Caries ensued around the point of the needle, pro-
ducing a great deal of pain, and great suffering when touched.
Chloroform was administered; a crucial incision, two inches
long, was made through the centre of the inflamed point. No
sensibility was manifested during the dissection of the flaps, and
removal of the decayed bone. She was kept profoundly under
its influence from 30 to 40 minutes, no unpleasant symptoms
following.

This operation, without the anaesthetic agent, must have
proved excrutiatingly painful.

Case 2nd. A negro boy, belonging to Capt. M , aged

about 14 or 15, had his frontal bone fractured above the orbital
arch, a portion of bone driven into the brain through the dura
mater, &:c., and forcing out a portion of its substance. When
seen, he was sensible, and resisted all efforts to examine the
wound, to elevate or remove the bone. Chloroform was ad-
ministered ; profound sleep came on; the operation performed;
several spicule were removed; sutures applied to the flaps, and
the wound was dressed, while the boy remained peifectly quiet.
He was kept under the influence of chloroform nearly an hour:
no unfavorable symptoms supervened. The patient recovered
without an unpleasant occurrence.

Case 3rd. A negro girl, aged about 13 years, belonging to

Mr. R . She had extensive necrosis of the os femoris, and

was much emaciated from long sufiering. Chloroform was ad-

714 Mastin, on Rupture. [December.

ministered to her; an incision six inches in length made; a
corresponding length of the line trephined, and the dead portion
removed, &c. During the operation, she struggled several
times, though apparentlv profounrlly asleep. The cavity, after
removing the old bone, was enormous, sufficient to have held a
pint or more ; the bleeding from the internal surfaces was very
considerable. After the operation was completed, which oc-
cupied in the performance from three-quarters to an hour, and
before the dressing was applied, she was suffered to pass from
under the anaesthesia; shortly after she became sensible, she
gave indications of sinking, and soon was in an alarming state
of syncope. By the use of proper means, she gradually recov-
ered fromthis condition, which no doubt was the effect of loss
of blood, which was very great. The case progressed well,
and the cavity has almost entirely filled up. Without the an-
aesthetic agent she could not have survived the operation.

ARTICLE XL.

A Case of Rupture of the Quadriceps Femoris Muscle, which
came under the notice of C. H. Mastin, M. D., of Mobile.
Alabama.

In September, I was called to see an old man, aged 60 years,
who, in attempting to replace the bed of a wagon upon its
wheels, had his foot to slip, and his left leg, in a state of semi-
flexion, caught between the falling body and the ground. Upon
examination, I found the quadriceps femoris, about an inch and
three-quarters above the patella, ruptured; the patella driven
down, even out of its natural position, and its ligament "loosed'*
outward. Having satisfied myself of the correctness of my
diagnosis, the next question was, as to the mode of treatment ;
how the ruptured ends should be co-aptated and so retained.
I extended the leg upon the thigh, and flexed the thigh upon the
body ; a uniting compress was placed upon the thigh in the
direction of the fibres of the muscle, the patella restored to its
position, and a roller passed from the toes to the groin ; a splint
extending from the tuberosity of the ischium to the os calcis,
and the roller reversed and passed over the splint, down to the

1849.] Harper, on Obstetrical Cases. 715

foot. The leg was now placed upon a simple inclined plane,
which, by flexing the thigh u}ion the body, would keep the rup-
tured muscle in a relaxed condition, and thus more ellectually
approximate the ends. The patient was now left to rest. No
4)ad symptoms occurring, at the end of thirty days, the dress-
ings were removed, and the double inclined plane ofAmesbury
substituted, which, by gradual flexion and extension, anchylosis
was prevented, and in the time of forty-five days, from the ac-
cident, the patient w^as perfectly cured.

This proves to be an interesting case, from the advanced age
of the individual, from the fact, that the violence of the blow
sufficient to rupture so great a mass of muscle did not abrade
the skin, and the speedy recovery, even without a bad symptom.

That the accident cannot be regarded as trivial, we have but
to notice, that out of fourteen cases mentioned by Demarquay
as having occurred at the Hotel Dieu, only five may be consid-
ered as having had a favorable result. M. Velpeau mentions
two cases of rupture of the tendon of this muscle, which came
into LaCharite in 1838, and remarks, that although it was im-
possible to effect union by immediate contact, still the cure was
completed without the functions of the leg in either case being
perceptibly disturbed.

The fact of the new substance, which unites the two ends,
being ultimately transformed into a tissue resembling the ori-
ginal, may be the reason why, ruptures of the extensor tendons
and muscles, do not cause lameness more frequently ; the mus-
cle being only lengthened to a small extent, its retractions even-
tually overcome this elongation, and in a short time the move-
ments of the leg show but a slight derangement.

ARTICLE XLI.

Cases occurring in the Practice of P. W. Harper, M. D., of
the Shoals of Ogechee, Georgia.

Case 1. I was called to visit a healthy negro woman, be-
longing to Mrs. Y , 19 years old, who had borne a child at

full term, about eighteen months previously, without any diffi-
culty to herself or child: I found her, in the present instance,

710 Harper, on Obstetrical Cases. [December,

with preternatural presentation of the left hand and arm. From
the history of her case, I was ini'ormed she had ha:l, for many
hours, the most severe and bearing-down pains, although, at
the time I first saw her, she was hee from pain, but complained
of great prostration of strength, as was evident from her pulse^
In the usual way of proceeding, I found no difficulty at all in
returning the projecting arm and hand ; but, to my great sur-
prise and mortification, J was unable to ascertain the position
of the feet and legs: I could only insinuate my hand between
the dorsum of the child and the left lateral portion of the uterus,
to its fundus. The abdomen of the child was in such coaptation
with the right lateral port-ion of the uterus as to prevent all efforts
to make, in that direction, an examination. By giving an ano-
dyne, I had prepared her for this examination, and as I had
hoped, for a safe delivery. During the whole of the examina-
tion, she complained of no pain, only observing, at times, that
she was very weak and felt fainty. Failing in the first attempt
to get the feet, I desisted for a while, and then made the second
effort; but she sank and died under the operation, without a
sigh or a groan. By the kind permission of her mistress, I made
a post mortem examination. I found the right side of the uterus,
from near its fundus, extending longitudinally, lacerated about
six inches, and the feet and legs thrown out of the uterus into
the cavity of the abdomen of the mother, and contrary to ex-
pectation, but little hemorrhage supervened.

This case presents many features for consideration to the
speculative theorist. How was this fissure made, and that too,
so large as to admit the free passage of the child's feet and
legs? Why was there so little hemorrhage ? What caused
such great prostration of strength in such a young and healthy
constitution ? Why should the rupture of the uterus be longi-
tudinal instead of transversed ? The anatomical structure
would seem to favor the latter. With the ingenious theorist I
will leave the case.

Case 2. My friend. Dr. H. Allen, called me in consultation,

in 1835, to the lady of the Rev. R. B. F . about 36 years of

age, of good constitution, and mother of several healthy chil-
dren, her labours having been all fortunate. On my arrival, I
found the cass a footling presentation : all of the child was

1849.] Harper, on Obstetrical Cases, 717

delivered, with the exception of the head. Dr. Allen iiiff)rmed
me that the child had heen dend more than twelve hours '^"^1
that he had made several efforts to deliver her. After njakinjr
a thorough examination, I proceeded manually to operate, but
did not succeed in ef]ectinj4 delivery. We then concluded, that
the head was so impacted, that delivery could not be accom-
plished without the use of the perforator. After a short interval
of consultation, it was decided, thnt I should make another trial,
before resorting to instruments. I did so; and on the second
examination, I found the position of the head had been changed,
and that it had gradually descended into the superior aperture
of the pelvis. At this particular stage of the case, I could dis-
tinctly feel the mouth of the child, and with my right index
finger, 1 opened the mouth, and used that finger as a blunt hook
in the roof of the mouth, when I soon discovered the head de-
scending into the cavity of the pelvis: in a few moments the
lady was safely delivered.

The secret and difficulty of the case remain now to be men-
tioned. The head was hydrocephalus ; the sutures, bones, and
integuments, were so elastic as to admit of the necessary elonga-
tion of the head to pass through the diameter of the pelvis:
the return of the head to its diseased size was so great, imme-
diately on its expulsion, as to cause a gurgling noise quite
audible in the adjoining room. After the infant was shrouded,
the head measured thirteen inches from the chin to the vertex;
and eleven and a half inches in circumference. The whole
head assumed the appearance of a pulpy mass.

This lady never after was mother of another child, yet she
centinued to enjoy, generally, good health, and was alive when
I left Virginia, in January, 1847.

Here is another case Ibr speculative theory. With all of our
persuasion, Dr. Allen and myself could not prevail on the pa-
rents to grant us the permission to puncture the head, to ascer-
tain the quantity of water, and to make such other examinations
as might be necessary. We supposed there must have been
three pints of water, if no more. In every other particular,
the child was well formed, and of common size.

718 Eve, on Case of Ancesthesia. [December,

- ARTICLE XLII.

A Case of natural Ancesthesia. By Paul F. Eve, M. D., Pro-
fessor of Surgery in the Medical College of Georgia.

So universal has been the application of the Divine curse to
man, that, to suffer and to live are not only inseperable, but
may be considered as synonymous terms. In the observation
of more than twenty-three years, I have met with but a single
exception to this apparently absolute law of our existence. It
has occurred to me, that in these days of artificial anaesthesia, a
brief narration of this case might not be devoid of interest to the
profession; especially as this condition of the system was actu-
ally so complete and profound as to have cost the life of the
patient.

I had known Mr, A. for several years, and am the intimate
friend of his family physicians, the last of whom is one of my
earliest and most promising pupils From them I had occa-
sionally heard that this gentleman had a natural insensibility to
pain, previously to his becoming my patient. In 1845, I was
first consulted by Mr. A., in reference to the development of
cataracts in his eyes. In November, 1846, he had one eye
operated upon in a neighboring city, and for a time he could
see pretty well. The sight not proving, however, satisfactory,
the patient desired the cataract removed from the other eye;
and this was accordingly done by couching, on the 6th of
March, 1847. Believing there was a disposition in the case to
cerebral congestion, which might produce amaurosis, or even
apoplexy, the family physician was advised to keep up some
active derivation from the head.

After this second operation upon the eyes, the patient had a
rapid recovery, and was soon able to ride over his plantation
on horseback. In one of these excursions, he was unfortunately
exposed to a severe rain, and apprehending his eyes might
suffer, he ordered his servant to rub the nape of the neck with
tartar emetic ointment. Desiring this application to be re-
peated, he was told that the part was already inflamed, but, as
he says he did not feel it, and of course could not see the part
affected, his command was repeated and then obeyed. Ery-
sipelas now occurred, and I saw the patient on the 11th of

1849.] Eve, on Case of Anceslhesia. 719

April, being about a month after the last cataract was destroy-
ed. Free incisions were made through the skin ofthe inflamed
neck, and other local and constitutional means employed. The
disease, how^ever, continued to increase in spite of most active
treatment, coma supervened, .and he died during the night of
the 14th.

Mr. A. was about 56 years old at the time of his death. He
was of sanguino-leuco-phlegmatic temperament ; was a corpu-
lent man, weighing about 250 pounds, and had been a free liver.
He was a lawyer by profession, of good intellect, being a man
of strong mind and body, and had acquired considerable repu-
tation as an advocate and politician.

And now^ in relation to his possessing a natural state of anaes-
thesia, the following facts are submitted :

During a political campaign, not liking the appearance of a
finger injured in a rencounter, he bit it off himself and spate it
upon the ground.

He had at one time an ulcer on a toe, extending finally to the
foot, which resisted treatment for nearly three years. Mr. A.
told his physician at the time, and has since repeated the same
statement, that from first to last, it never gave him the slightest
pain.

An abscess also formed in his hand, involving in its progress
the whole fore-arm and arm, which became enormously swol-
len up to the body, and threatened his life. The lancet had
repeatedly and freely to be used, and was followed by a copious
discharge of pus for several weeks. During the whole treat-
ment, he says he experienced no pain.

He says he felt no pain when his eyes were operated upon for
cataract. Neither did either inflame. I can vouch for hrs
statue-Hke immovability during the second operation.

When his neck was pustulated by tartar emetic ointment, he
did not feel it, but ordered the application to be repeated.

I made three incisions with a bistoury in his neck to relieve
erysipelatous inflammation. He was so unconscious of the
operation, that after it was perfonned he asked me to doit, that
he might turn over on his back in the bed.

He told his attending physician that he never suflered pain
from any cause whatever, until his last illness. For two davs

720 Magendie and Bernard's Experiments. [December,

after its development he complained of the erysipelas, and then
passed into liis usual insensible condition, some lime before the
slate of coma supervened.

It is proper to say that Mr. A. was a man of great probity,
and never boasted of being insensible to pain.

The only cause suggested for this truly singular and peculiar
condition of the system of this patient, is the free use of alcoholic
potations to which he was at one time much addicted. But
others have drank more than ever he did, without producing the
same result. We think the case of sufficient interest to deserve
a passing notice.

PART II.
K^Dterus anir jttvact0.

A Detail of certain Experiments, performed hy Magendie and
Bernard in the College of Finance. By William II.
Anderson, M. D., of Mobile, Alabama. (Amer. Journal.)

In the winter of 1848, the writer of this article witnessed a
large number of experiments, vivisections, &c., made by
Magendie and Bernard, for the purpose of elucidating some of
the more mysterious functions of the digestive, nervous,
circulatory, and respiratory apparatus. Among others, a series
of experiments was instituted, to ascertain the action of various
poisons, the therapeutical effects of which have been sought
after of late years. We proceed to detail the facts relative to
several of these medicaments.

Strychnia. Of all the extracts, the alcoholic is undoubtedly
the best, but even this is uncertain, and should be administered
with caution. The great difficulty seems to be in arriving at a
proper strength ; for two preparations made precisely in the
same manner, are fi'equently found to possess different degrees
of activity. Trousseau was the first to remark this, in the case
of a patient under his care at hospital Neckar. To obviate
the difficulty, the alkaloid should always be given in substance,
and the same rule holds good with regard to all the powerful
alkaloids.

Strychnine is a very active substance, and when given in
poisonous doses, either to manor the lower animals, it produces
death by convulsions. Hence, it bears especially upon the
nervous system. It has no action on the brain, and produces

1849.] Magendie and Bernard's Experiments. 721

its efTects equally as Well when this orcan has been extirpated.
To prove this, Majzendie removed the brain of several animals,
and the administration of the poison was followed by the same
effects. A careful analysis of the experiments of Bernard and
Magendie leads to the belief that strychnine has a reflex ac-
tion ; that it acts on the periphery, not on the nervous centres.
An exaggeration of the reflex action, therefore, is its true
modus operandi. Its peculiar action seems to be on the nerves
of motion, yet to act on them requires the integrity of the pos-
terior roots. Bernard exposed the anterior roots of the nerves
goinir to a limb: he then cut the posterior roots, and applied
the alkaloid to the anterior ; no convulsion ensued; but by ap-
plying it to the posterior roots in a state of integrity, convul-
sions in the limb soon followed. The nerves of motion there-
fore became affected through the medium of the nerves of
sensation.

However applied, strychnine cannot act before absorption
takes place. When introduced into the veins, the effects are
immediately seen. When it was placed in the cellular tissue
of the foot, and the vessels between it and the heart tied, no
action ensued. Some of the German therapeutists thought
that when strychnine produced death, it did so by asphyxia, but
this theory is disproved by the fact, that it kills animals that
have no lungs. The true method of its action in poisonous
doses is an exhaustion {epuisement) of the nervous system.

Nicotine. The Virginia and the Cuba tobaccos are very
rich in this principle, though both are inferior to that which
grows in the south of France. There are various agents for
the extraction of nicotine from the nicotiana tabacum, but
ammonia is perhaps the best. When obtained in its pure state,
nicotine is a liquid, slightly yellowish, and without odour. The
w^orks on materia medica generally attribute to it the odour of
tobacco, but this is owing to a faulty manner of preparing it.
When entirely deprived of the potash, which is in intimate
association with it, it is quite free from odour ; but, on the ad-
dition of the smallest portion of potash, the pungent odour of
tobacco is immediately evolved. Nicotine is very volatile,
very easily absorbed, and exceedingly energetic in its effects on
the system. While its power bears principally upon the brain
and spinal cord, it is at the same time an active purgative and
diuretic. Almost all of the new comers in tobacco factories
are lightly purged for several days, and even children, nursed
by mothers who have lately become operatives, suffer from
diarrhcca.

One drop of pure nicotine, given to a medium-sized dog, is
followed by convulsions in all the limbs, the forelegs suffering

N. S. VOL. v. NO. XII. 40

722 Magendie and Bernard's Experiments, [December,

much more, however, than the hinder ones, the respiration is
very much quickened, and the heart's action accelerated. The
eyes sink, and the animal becomes temporarily blind, owing to
the third eyelid spreading itself over the eye. The blindness
is not owing to any lesion of the optic nerve, as has been sup^
posed. In addition to these effects, there are profuse saliva-
tion, an exaggerated secretion of urine, and active purging. In
the course of an hour the violence of the effects passes off, and
the animal calms the posterior linibs yield their convulsions
some time before the anterior. The next day, the dog entirely
recovers. The post-mortem examination of animals killed by
the introduction of nicotine into a wound, reveals nothing that
will account for the symptoms. Bernard cut the pneumo-
gastrics of a dog that had taken a poisonous dose, and the
usual phenomena produced by it on the lungs and heart did not
evince themselves. Death, however, occurred as quickly as if
the nerves had not been cut.

Prussic Acid. The action of this poison is rapid and ener-
getic, absorption taking place the instant that it is applied to a
proper surface. One drop of the anhydrous acid is sufficient
to kill a middle-sized dog. As soon as the poison is absorbed,
a slight tremulous motion takes place throughout the system ;
this soon increases to actual convulsion, which becomes more
and more intense, until death closes the scene. While Ber-
nard was preparing some of the anhydrous acid for experiment,
he inhaled some of the fumes, and was immediately rendered
senseless, with extreme difficulty of breathing. Several hours
elapsed before he entirely recovered. A series of experiments
was undertaken on a number of animals, in order to find out a
counterpoison for such a destructive agent, and they resulted
in the discovery that ether (sulphuric) was the best antidote,
if immediately inhaled. In the course of the experiments, it
was hoped that ether, largely taken, would prove to be an
effectual antidote to a very large quantity of the anhydrous
acid, for it was found that several animals revived, which had
been previously etherized, although several drops of the poison
had been administered. Subsequent experiments, however,
proved that the dose must be within certain limits.

Prussic acid acts on the system of sensibility as well as that
of movement, and its effects commencing in the cerebro-spinal
axis are diffused throughout the body by means of the nerves.
If the nerves going to a limb are cut, that member will not
evince the phenomena shown by the others, there will be no
tremor or convulsions in it.

In addition to its powerful effects on the nervous system,
Prussic acid has a peculiar action on the blood, so modifying

1 841).] [ Magendie and Bernard's Experiments.

that fluid as to render it incapable of oxidation. The bright
red colour of arterial blood is owing to the absorption of
oxygen. In man, this absorption takes place in the lungs, but
in some of the lower animals, it is performed by means of the
skin, and it may easily be seen going on, if the mesentery of a
cat or a rabbit be exposed. The iron of the globules is the
constituent that becomes oxidized, and Prussic acid has the
power of preventing it from apjiropriating oxygen. A very
feeble dose will, in a measure, put a stop to the process. This
phenomenon presents itself out of the body, in the same manner
that it does in the current of the circulation. Bernard took
two tubes, into each of which he put a quantity of blood.
Oxidation immediately commenced, but on the addition of a
few drops of Prussic acid into one of the tubes, the process of
oxidation was immediately arrested. What influence this pro-
perty has in producing death is a subject well worthy of con-
sideration. That the functional integrity of the cerebro-spinal
axis depends upon a proper supply of arterial blood, there is
no question. Either too much or too little oxygen in the blood
impairs the action of this system ; and it is the opinion of the
author, deduced from witnessing many experiments with
Prussic acid, that the beneficial eflTect of medicinal doses is
often owing to its property of checking undue oxidation of the
blood. In various diseases, accompanied with accelerated re-
spiration and exalted arterial action, there is reason for believing
that the blood is overloaded with oxygen ; and it is a fact
worthy of notice that, in these very diseases, medicinal doses
of Prussic acid exert a very salutary eflect. As it is intended,
however, merely to detail the experiments, and the well-ascer-
tained facts that flowed from them, we will not speculate farther
on this subject.

Among the preparations of cyanogen, the cyanuret, of
mercury is, perhaps, the most dangerous. If there be the
smallest quantity of gastric juice in the stomach, death imme-
diately ensues its administration. The gastric juice decomposes
the compound, and liberates the Prussic acid in its purest ibrm.
Bernard introduced into the stomach of a dog, during digestion,
a small portion of the cyanuret, and the animal died, in a few
minutes, with all the symptoms of death by a poisonous dose
of Prussic acid. On an immediate post-mortem examination,
both the stomach and the brain emitted the characteristic odour
of the acid.

If, from any cause, sulphuric ether cannot be obtained for
inhalation, when a person has been poisoned with Prussic acid,
the next best antidote is a solution of carbonate of potnsh,
followed by a solution of the sulphate of the i)rotoxide and the

724 Magendie and Berna2'd''s Experiments* [December,

peroxide of iron, The chemical interchange of elements is very
rapid, and results in the formation of the ferrocyanuret of iron.
Opium. The experiments performed by Magendie and Ber-
nard on opium, lead to the belief that it acts primitively on the
muscular system, and that its energy as a poison, in any given
case, depends on the degree of muscular paralysis it has pro-
duced. Its therapeutic effects, in small doses, are very variable,
and depend upon age, idiosyncrasy, habit, and particular con-
ditions of the body. Long-continued usage of the drug may so
inure the system to its influence, that very large doses may
be taken with impunity, so far as regards their immediate
effect. The poison, however, is slowly doing its mischief, and
sooner or later the tone of the muscular fibre becomes impaired,
and the heart, losing its wonted vigour, is unable to drive the
blood with sufficient force to reach the capillary tubes.
Hence, congestion of the brain and a general stasis of the
blood, are the constant effects of a poisonous dose of the
medicine. If the heart did not partake of the languor of the
muscular system, opium would perhaps not be so great a poison ;
but this organ, like the rest of the muscles, loses its contractili-
ty, and labours in vain to perform its functions.

Opium is one of those substances that act through the
vascular system. It may be applied in a very concentrated
form to a wound in a limb, and yet, if the vascular communica-
tion between the liuib and trunk be cut off, no effect is pro-
duced. This has been proved by repeated experiment.

Want of vigour in the action of the heart, being the great
danger in poisoning by opium, it would be natural to suppose
that any substance having powder to restore that vigoui-,
would be a good antidote to a poisonous dose. And this is
precisely what turns out to be the case with regard to coffee.
Of all known substances, coffee has the most influence in giving
power to the heart's action; and it is in this way, establishing,
as it were, the impeded circulation, that coffee is the best and
most certain antidote to opium.

Digitalis. There are several medicines which seem to have
double action on the system, that is, which have two distinct
and separate actions, the one not being the consequ(?nce of the
other, although it may follow it. Digitalis belongs to this class,
since it contains two distinct principle a sedative, and a
diuretic. Its diuretic property is independent of the heart's
action, for it may be combined with medicines w4iich annul its
sedative effects, and still the kidneys will mnnifestly be under
its influence. Chemistry has not as yet succeeded in isolating
these principles from each other.

Digitalis is a sedative, because it weakens the muscular

1849-] Magendie and Bernard's Ej-pcrimrnts. 7'2>

system of organic life. If tlio abdominal cavity of an animal
be opened, and the intestines exposed, aiter a sullicient (piantity
of digitalis has been administered, the heart's action will grow
weaker and weaker, and the intestinal motion will gradually
lessen until both will cease. This arrest of intestinal motion is
not owing to debilitated circulation, because, while under the
depressing influence of the digitalis, the heart's action may be
easily strengthened by the administration of coffee, but the
muscular coat of the intestines will remain unafTected, and
continue to become enfeebled till it stops altogether. An
experiment, verifying the above, may be easily performed on a
dog of medium size, by dissolving in the serum of the blood one
grain of digitalin, and injecting it into a vein. Digitalis
acts through the vascular system, not the nervous. Bernard
cut the pneumogastrics of a dog, and still it had its usual
effects on the heart. The narcotic action of the drug, and the
coma and convulsions tiiat precede death, when it has accumu-
lated in the system, are owing to deranged circulation in the
brain.

Quinine. The administration of this substance, in very
large doses, is followed by coma, convulsions, dilatation of the
pupil, and other symptoms denoting derangement of the brain.
When death is produced, the autopsy reveals a good deal of
irritation of the mucus membrane of the stomach. The
blood is black, and not coagulable ; extravasation is found in
various parts of the body ; the brain is invariably congested,
and the lungs much carnified.

Forty grains, given to a large dog, produce very serious
effects, but do not in general kill the animal. At the end of
two or three days, during which period he suffers much with
coma, tremors, and convulsions, he recovers, but almost always
there is paralysis in some part of the body, either in the hind-
foot, the foreleg, or some part of the flxce.

In medicinal doses, quinine has a decided action on the heart ;
that is, if the subject be in a state of health. Ten grains,
dissolved in acidulated water, and injected into the crural vein
of a dog, produced an increase of the heart's action, both in
force and frequency, and was followed by intense fever for
several houi's. The spleen being exposed to view, was closely
observed, but there was no reduction in its size. In this par-
ticular, quinine differs from strychnine, the latter producing a
marked decrease in the size of the spleen. An enlarged and
unhealthy spleen, however, seems readily to come under the
inffuence of proper doses of quinine. This is proved by ex-
periments on the lower animals, as well as by those performed on
man. The surgeons of the French army in Africa report that,

726 Magendie and Bernard's Experiments, [December,

in the malarious districts of that country, it is by no means
uncommon for dogs to have their spleens much enlarged, and
that they are easily reduced by the administration of medicinal
doses of quinine.

Quinine is administered by the stomach, by enema, by the
endermic method (either on a denuded surface, or by the gen-
eral bath,) and b}^ injection into a vein. Of these various
modes, that by injection into a vein is the most efficacious.
Ten grains, put into a vein, will have the effect of a much
larger dose put into the stomach. When given by the stomach,
it should always be administered in the state of fasting, the
state of digestion ffreat^v lesseninj^ its enerc^y. It has been
mentioned tliat quinine, in small doses, has a decided action on
the heart, increasing its force and frequency and producing
general fever. This is the case when it is administered in a
state of health, and when so taken, the fever lasts as long as
the medicine is in the current of the circulation. This is
from three to five hours, at the end of which period it is
eliminated by the urine, and the fever subsides. That depres-
sion of the vital power which immediately precedes and
accompanies ague, will rarely take place, when there is a
sufficient quantity of quinine in the current of the circulation
at the moment of its invasion ; and it is for this reason that the
remedy, when administered as an antiperiodic, is much more
efficacious, and much more certain in its effect, if the quantity
be taken three or four hours before the expected chill, than if
the same quantity be taken in smaller doses during a period of
eight or nine hours before, because, if there is any secretion of
urine going on, a large portion will in this latter case have
been eliminated from the system.

[A knowledge of the above fact, will have some practical
bearing on the diseases of southern latitudes, since it happens
that the important eflects of quinine (at times t^Va//// important)
are lost to the patient because the medicine is not in his system
at the proper moment. We take advantage of this opppor-
tunity to make a few remarks with regard to the injection
of quinine into the veins. We have frequently seen cases of
congestive and bilious remittent fever, where we had every
reason to believe that quinine was strongly indicated ; but
where, for substantial reasons, it could either be not given at
all, or, if given, would have been devoid of effect. Among
such cases are those where the medicine is ejected, in conse-
quence of an irritable stomach, and also those where the pa-
tient apparently, thou<>h not really moribund, can no longer
swallow. In thcs^e cases, it is usual to administer the medicine

1849.] Magendie and Bernard's Experiments. 727

cither by the rectum or by the endennic method; but when
the depression of the system is very great, and the vital action
ahnost extinct, the absorbent power is in a great measure lost,
and the good eflects of the remedy are not experienced, be-
cause it lies like an inert mass in the system. At this period,
the circulation of the blood still goes on, and, though partaking
of the general impairment of the system, it is feeble and
languid ; yet still it reaches the nervous centres, and can con-
vey to them materials capable of restoring and renewing their
vigour. How often does it happen that, in the low stage we
have described, the return of a slight chill will cause a con-
gestion of the brain and lungs, and.inevitably carry the patient
to his grave; and with what anxiety do we look forward to
the period of this return, hoping that it may be escaped or
kept off by the intervention of art. If quinine, therefore, be an
efficacious remedy; if it have the power of bracing up the ner-
vous system, and preventing another agitation, and the fatal
stasis consequent upon it, it is all important that it should, at
such times, be put in the current of the circulation. In this
country, the administration of quinine by transfusion has been
little, if at all, used ; but in Belgium and Holland, we have
known it employed with the happiest effect ; and since the
process is easily and perfectly innocuous, we think it well
worthy an extended trial. There are liquids which cannot
with safety be injected into the veins, because the globules of
such liquids are too large to pass the minute capillaries of the
lungs. The due oxygenation of the blood is thus interfered
with, and death is the consequence. But water does not belong
to this class. At the temperature of the blood, it passes freely
from the arterial to the venous capillaries, and is perfectly safe as
the vehicle of medicines which are to be used by transfusion.

The injection of certain medicines into the veins was used
in England and Germany some years ago ; but it fell into dis-
use, because a German physiologist of distinction, making use
o^ oil as the solvent of some remedy he wished to employ, in-
variably caused the death of his patient. The experiment
(using oil as the solvent) was extensively tried on animals, and
always with the same consequences. The true cause of death
was sought for in vain, and it was reserved for the untiring
industry of Magendie to discover it. The experiment that
ascertained and proved this, was repeated in the presence of
the writer, and it was found that the cause of death was a
mechanical obstruction of the capillaries of the lungs. The
globules of the oil being too large to pass, completely plugged
lip the finer tubes, and prevented the access of air to the blood.
This fact being known, the method by transfusion will doubt-
less be again brought into use.]

728 Magendie and Bernard^ s Experiments. [December,

Note. During our absence from the United States, an inter-
esting paper on the efiects of quinine, in poisonous doses, was
published in the American Journal of the Medical Sciences,
April, 1847, by Dr. Baldwin, of Montgomery, Alabama. We
have received this article, and from our experience relative to
the various susceptibility of different individuals to quinine
(both of the human species, and the lower animals), we must
refer to it. We are pleased to say that the experiments of the
French physiologists generally confirm those of Dr. Baldwin,
at least so far as the symptoms and lesions are concerned which
poisonous doses produce on dogs. These various effects hav-
ing been given to the profession, in the paper of Dr. B., it is
unnecessary for us to repeat them in this article. With
regard to the relative susceptibility of the system to the influ-
ence of quinine when injected into a vein, and when given by
the stomach, the French authorities differ from Dr. Baldwin ;
but it is highly probable that the latter did not perform a very
large number of experiments to ascertain this fact particularly.
In connection with the paper of Dr. Baldwin, we would state
that the best antidote to the state o{ qui?iinis7n, is an active and
efficient diuretic. Under the action of the acetate of potash,
combined with a very small portion of Prussic acid, we have
seen patients rapidly recover from the poisonous etiects of
quinine.

Arsenic. With regard to this substance, we have very lit-
tle to say. Experiment proves that, however introduced into
the system, whether by the stomach, through a wound, by
inhalation, or in a state of gas, it always causes inflammation
of the stom.ach, accompanied by some nervous and cerebral
agitation. There are two peculiarities about arsenic, worthy
of notice. The first is, the extreme slowness and great diffi-
culty with which it is eliminated from the system. It rests
along time in the economy, and may occasionally be found in
the blood after all symptoms of poisoning are gone. Its action
on the blood is to render it black, to diminish its plasticity, and
to make it very fluid. The consequence of all this is an in-
filtration of the tissues, and slight effusions of blood, particu-
larly in the lungs; the latter are always found when animals
have been poisoned by arsenic. Another striking peculiarity
of arsenic is, its manifest affinity for the tissue of the liver. No
matter how introduced, or how feeble the dose, if death ensues,
arsenic may always be found in the liver. Even when time,
or the intervention of art, has caused it to be eliminated from
all other parts of the system, the liver v/ill still be found to con-
tain a sufficient quantity for the appropriate test to act upon.

1849.] Magendie and Bernard* s Experiments, 729

So true is this, that when a person is j)r)isone(l, in tlie provinces
of France, they send only the hver to Paris lor examination.

When arsenic is eHininated from the system, it goes oil" by
the urine; and the iodide of potash is, perhaps the best sub-
stance to expel it throush that channel.

Ether. The wonderful effects of etiier upon the human
economy, and the new era wdiich its introduction caused in oper-
ative surgery, were sufficient inducements to submit it to the
test of very varied, and often repeated experiments. Not only
did Magendie and Bernard undertake a rigid analysis of its
effects on animal life, but Flourens, Longet, Beau, and a host
of other distinguished physiologists, turned their attention to
the subject, and illustiated, as far as possible, its mysterious
agency in the production of anaesthesia. While these celebra-
ted experimenters, were observing the effects of ether on the
lower animals, an equal number of the most enlightened practi-
cal surgeons were closely watching its action on the human
system, and so fashionable had its employment at one time be-
come in France, that even an abscess was scarcely ever
opened by surgical intervention, unless the sensation of the
patient had previously been lulled by the inhalation of the
ana3sthetic agent.

For the production of anaesthesia, the chlorohydric and acetic
ethers are equally as efficacious as the sulphuric ; but the latter,
being in more general use, was chosen as the most proper
variety for experiment. Sulphuric ether, applied locally, acts
as an irritant and refrigerant, and to some of the animal
tissues it acts as a solvent. When applied to the trunk of a
nerve, it destroys the sensibility of that nerve. This it does
by its refrigerant effect, ice possessing the property of doing
the same thing; but ether goes further than ice ; it dissolves
the fatty matter of that part of the nerve, and paralysis follows
as a consequence. When ether is applied to a muscle, it pro-
duces a kind of spasmodic separation (ecartement) of its fibres,
which is, perhaps, owing to its refrigerant effect on the ner-
vous fibrils supj^lying the muscles.

When inhaled, ether is absorbed by the blood with astonish-
ing rapidity, and when absorbed in sufficient quantity, pro-
duces a loss of sensibility, both general and special, a temporary
change in the blood, and a general lelaxation of the muscles of
animal life. There are several degrees of etherization. In
the first, the periphery alone of the nervous system loses its
sensation; in the second, the nervous centres are taken ; in the
third, death is produced. The loss of sensation always retires
from the periphery to the centre. Bernard exposed a part of
the spinal column of an animal, so that he could freely get ac-

730 Magendie and Bernard's Experiments. [December,

cess to the anterior and the posterior roots of the nerves.
Ether was then administered, and when the peripher\' was
completely devoid of sensation, both the anterior and the posteri-
or roots were still quite sensible ; by continuing the administra-
tion of the ether, however, the roots lost their sensation,, and
the brain and spine came under its influence. The anterior
roots first became insensible, thus beautifully corroborating the
doctrine of recurrent sensibility. Beau performed the same"
experiments, and was induced to believe that there was in
the skin a sensation of to2ich, and another of pain. This
doctrine, too, seems to gain plausibility from a fact which we
have often witnessed, viz., that a patient may be undergoing
an amputation, and may feel distinctly that something is being
done to the member, and yet not suffer the slightest pain from
the strokes of the knife. His intellect, in the mean time, though
somewhat clouded, retains integrity enough to recolleet and
appreciate remarks made by the su'-geon and the bystanders.

Ether to a certain extent, changes the colour of the blood.
At first, little or no difference in colour is perceived ; but by
degrees, when the excitation goes off, the patient becomes
pale, and the blood assumes a dark-reddish hue ; both veins and
arteries contain blood of the same colour. When etherization
is pushed to extreme, blood passes freely into the chyliferous
ducts, and the lymph and chyle are found to be of the same
colour as the blood. At this period the lungs become con-
gested, and death soon supervenes. It is an error here to say,
that the patient dies by asphyxia, because the blood does not
become black, nor does it lose its property of coagulation;
indeed, after death by etherization, the blood coagulates very
rapidly.

The anaesthetic agents, may be used with impunity, to
mitigate the pains of childbirth ; and, if employed with judg-
ment, no ill effects need be apprehended for either mother or
child. We have often seen women in labour submitted to
their influence, and while they produced annihilation of the
sensation of pain, and sometimes occasioned profound sleep,
the muscles of the interior retained their accustomed energy,
and both heart and uterus contracted well. It will be seen
that the effects of ether, in these instances, are just the reverse
of those of digitalis.

In closing this article upon ether (and most of the arguments
will apply equally well to chloroform), we mav take occasion to
state, that we have seen it often administered to the lower
animals, and to the human subject certainly not less than
several thousand times. We have seen every age, sex, and
condition under its influence from the octogenarian, at the

1849.] Therapeutic Action of Aconihim Napellus. 731

Salpetriere, to the inHint suckling nt the foundling hospital.
During the late revolutions in France and Germany, we saw it
used on the wounded, under every variety of temperament and
constitution the athletic grenadier, in the full glow of health,
subjected to its influence for the mere extraction of a splinter,
and the hroken-down pauper suhmittted to its agency, when
life was almost extinct from the prostrating shock of a severe
gunshot wound. With such experience, we can truly say that
the cases in which it did harm, were too few to be taken into
serious consideration. That death, in one or two instances,
did follow, we cannot deny ; but certain it is, we have never
seen death occasioned by ether or chloroform, when they were
administered with a due proportion of atmospheric air. It is not
to be wondered at, that a patient should occasionally succumb
to their influence, when they are suddenly thrown into the lungs,
without any admixture of atmospheric air; but such fatal cases
are no more argument against their employment, than are those
rare cases against ablution, in which the patient, suddenly
plunged into a very cold bath, never recovered from the shock.

Theaapeutic Action of Aconitiim NapcUua. (London Journal
of Medicine.)

The following is an abridgment of papers, by M. Tessier, on
this subject, in the Gazette Medicale do Lyon, for 15th and
31st January, 1849:

Aconite has three modes of action, viz. : a narcotic, an
antiphlogistic, and a special action on the skin.

I. Narcotic Action. Some deny that aconite acts in this
way ; but, nevertheless, ^he fact is incontestable. It is suffi-
cient to place some drops of the tincture on the tongue, to be
satisfied of the narcotic action on the nervous system ; for it
excites a very decided feeling of numbness in that organ.
Besides, when a full dose is administered, it is no uncommon
thing to observe delusions, vertigo, collapse, and delirium
in fact, such efiects are known to follow opium and poisons from
the family solaneoe. In painful diseases, too, it often gives a won-
derful immmunity from pain. I have administered Aconite in a
great number of painful diseases in dull ]>ains in the bones, in
facial neuralgia, in toothache, sciatica, cancer, <S;:c. ; and have
observed effects which, from their diversity, well merit atten-
tion. While morphia, with a few very rare exceptions, calms
every species of pain, aconite only relieves a certain special
class. Thus I have never been able, by means of it, to assuage
the pain of exostosis, cancer, myelitis, nephritis, gastralgia, or

73*2 Therapeutic Action of Arconiium Napellus, [December,

whitlow; but, on the other hand I have obtained the best
resuhs from its use in such painful afiections as have acatarriial
or rheuniatismal cause, along with disordered function of the
skin, such as rlieuinatism, angina, toothach, 6z:c. Aconite is,
then, in a certain class of cases, a narcotic agent {agent
siupcfiant), but this action is subordinate to another, after-
wards to be spoken ot^.

Antiphlogistic Action. The reality of this mode of opera-
tion is believed in by Dr. Fleming; by Dr Giacomini, who
places aconite among the hyposthenic arterial remedies; and
by the homoeopaths, who affirm that this medicine may be
used as a substitute for bleeding in the most urgent cases.
To solve the question, as to the existence of antiphlogistic
propeities, it will not do (like Dr. Fleming), to choose cases
of rheumatism, bronchitis, pneumonia. erysip(?las, or neuralgia,
all of which can usually be cured without the abstraction of
blood : but we must take diseases in which bleedings are re-
garded as indispensable, as inflammation of the brain, apoplexy,
peiitoniiis, hypertrophy of the heart, inflammatory fever, and
ophthalmia from the introduction of a foreign body into the
eye. In my experiments with aconite on the latter class of
cases, I have not met with a single instance in which the
aconite could usefully be preferred to bleeding. I have also
given it in active hemorrhages, in haemoptysis, and in
menorrhagia and without any advantage. From my ob-
s'ervations, aconite does not appear to be more suitable to the
plethoric: and upon the whole, I am inclined to think that it
answers best with persons of a nervous or lymphatic tempera-
ment, and especially with those predisposed to rheumatismal
and catarrhal aflections. I do not, however, maintain that
aconite nei^er acts as an antiphlogistic: for by and by I am
going to mention cases in which it has sensibly reduced the
pulse ; but then I will show, at the same time, that the action
oA tlie circulation was indirect, and that it is by regulating
another function that aconite diminishes fever.

3. Action on the Skin. If the principal therapeutic action
of aconite be neither narcotic and calmative, nor anti[>hlogistic,
what is it? My reply is, that the special action of aconite is
on the shin. It possesses the property of eliminating from the
vessels of the skin the hurtful matter, and of re-establishing the
cutaneous functions when deranged by checked transpiration,
or by some virus I think that it has the special power of con-
trolling diseases arising from cold, and others in which a
morbid pi'inciple is retained in the cutaneous tissues, as occurs
in the exanthematous fevers. It is a suitable medicine in all
those diseases in wdiich the function of the skin is disordered,

1849.] Therapeutic Action of ArconitumNapellus. 733

as in articular and muscular rheumatism, as well ns in rheuma-
tism of the nerves, including sciatica and odontalgia ; also in
affections of the mucus membranes, such as bronchitis, etc ;
likewise in the exanthemata.

Diseases iji which Aconite is used. Cuurhature. A bruised
feeling in the limbs, creeping sensations on the surface, las-
situe, headache, and general discomfort, constitute the group of
symptoms cnlled by this name; and thev are also svmptoms
which specially indicate the use of aconite. The desired relief
will generally follow, by taking daily from five to ten drops of
alcoholic tincture, in a little water, or bland vegetal)le infusion.

Catarrhal Fever, as Hufeland showed, is caused by the sus-
pension of the active functions of the skin. Its physical
characters are: alterations of heat and cold, dragging pains in
the limbs, increased frequency in the desire to make water, a
tendency to sweat, general fever complicated with a local affec-
tion, which is generally coryza, angina, or bronchitis. The
therapeutic indications are: 1st, To re-establish the functions
of the skin: 2d, To subdue the irritation of the nose, throat,
and bronchial tubes. Aconite fulfils all these intensions. In
catarrhal fever, as in courhature, it causes the pain in the
limbs, the shiverings. and the heats to subside, and, at the same
time, greatly simplifies the progress of the affection of the
mucous membrane. But aconite does not, unaided, fulfil the
second intention, which requires the assistance of opiates,
blisters, or such other means as may be suitable.

Angina and Acute Bronchitis. Like MM. Tessier, of
Paris, and Gabalda, the author has seen aconite of much
service in these affections, by diminishing in the former, the
pains of deglutition, and in the latter, rendering the fits of
coughing much less distressing.

Rheumatism. To have a correct appreciation of the action
of aconite in rheumatism, it is necessary to discriminate be-
tween the diflferent tbrms of rheumatism, for it is very far from
possessing the same influence over all of them. The cases in
which it succeeds best are recent rheumatic pains, unaccom-
panied by swelling and fever, or in which these symptoms are
slight. In them, it possesses very rri'eat efficacy, and is pre-
ferable to bleeding; also to inoculation with morphia, or the
use of belladonna which drugs are mere palliatives of pain.
In acute articular rheumatism, accompanied by decided swel-
ling of the joints and ardent fever, aconite is of less value. At
the onset, however, of such attacks, it may be administered
with advantage, for the purpose of diminishing the alllux of
blood [la fluxion'] to the joints ; but when the synovial
membrane and the fibrous and ligamentous structures of the

734 Therapeutic Action ofAconitum Napellus. [December,

joints become inflamed, aconite is useless, and, in my opinion,
the best treatment is b\- large doses of nitrate of potash. In
chronic apyrexial rheumatism, the results are good, though not
so striking as in recent attacks. By preserving in the use of
aconite for six weeks or two months, obstinate rheumatic
pains, which have existed for years, may be subdued. Aconite,
besides being remedial, possesses preventive properties, by its
decided influence over the rheumatic diathesis. When given
with this view, it must be continued for months. In all rheu-
matic affections, but especially those which are chronic, the
doses must be much larger than those which are suitable in the
diseases formerly spoken of. It is necessary to begin with ten
or twenty drops of the alcoholic tincture, and to increase the
quantity up to four, six, or eight grammes.*

Eruptive Fevers. In these afTections, as in catarrhal fever,
the pulse is brought down ; the eruption is also made to come
out better. The beneficial influence of aconite on the progress
of the exanthemata has already been mentioned, in a work pub-
lished at Lyons La Pharmacopee de Vitet. It does not ap-
pear whether the discovery of this property of the medicine
belongs to Vitet, or whether it was stated by him at second
hand.

Erysipelas. M. Teissier agrees with Drs. Fleming and
Gabalda in believing that aconite diminishes the duration and
the danger of this disease. I would wish to call the attention
of surgeons to its value in erysipelas attacking wounds ; so
that my observations may be verified. I have several times
seen a prompt and remarkable amendment follow the daily use
of from ten to twenty drops of the tincture, in cases of erysipelas
spreading around wounds and ulcers, and accompanied by
severe constitutional symptoms.

Pneumonia. M. Teissier agrees with Dr. Fleming that the
aconite, when administered at the commencement, tends to
restore the suppressed transpiration from the skin, and may
thus give a milder character to the disease: but if inflammation
have actively set in if auscultation reveal engorgement and
condensation we must not anticipate resolution from the ex-
hibition of aconite.

* Let us caution our readers not to use the tinctures in common use in this
country in such doses. No physician ought to prescribe aconite, without
minutely specifying the preparation lie intends to be used. That which we
prefer is Dr. Fleming's Tincture of the root, which is transparent, in colour like
sherry wine, and of a slightly bitter taste. The following is the formula:
" Take of root of A. Napellus, carefully dried and finely powdered, sixteen
ounces troy; rectified spirit, sixteen fluid ounces; macerate for four days; then
pack into a percolator; add rectified spirit until twenty ounces of tincture are
obtained." Dose, from three to five minims in repeated doses.

1819.] Toothache. 735

Mode of Administration. I am truly astonished at Dr.
Fleming recommending the largest doses to be used when an
antiphlogistic, rather than an anodyne or narcotic, effect is de-
sired. However much I respect so distinguished an authority,
I must state that my |)ractice is entirely different. In a case
of rheumatism, neural<zia, or any other affection in which I wish
the calmative properties of the medicine. I give from ten to
twenty drops of the tincture, and gradually augment the dose
to three, four, five, or even to eight grammes in the day; but,
on the contrary, when I give it in the courhature or catarrhal
fever, I order only from five to ten drops in the twenty-four
hours, and by such doses I bring down the pulse, and din)inish
all the other febrile symptoms, without inducing any symptoms
of poisoning. I prefer the tincture, as more certain than the
extract. Tlie tincture, diluted with one or two parts of water,
may be applied topically in neuralgia; but used in this way,
aconite is an uncertain remedv.

Toothache, By Dr. J. D. White, Dentist. (Dental News

Letter.)

Toothache may be divided into, and treated under three
heads, viz: True, False, and Si/mpathetic, hut may also be con-
sidered as only different stages of the same disease; because it
is evident, that however remote or obscure the pain and patho-
logical change may be, if excited by a tooth, it is none the less
toothache in some of its forms or stages.

1st. T?'ue Toothache is acute inflammation of the dental
pulp or nerve of the tooth only, and subject to the same changes
as any other vascular tissue of the body, wdiile running through
the diflerent stages of inflammatory action, and the intensity
and character of the pain depending somewhat upon, and mark-
ing the different pathological changes the pulp is undergoing at
the time. ^ Its causes, may be constitutional, remote, approxi-
mate or local. Constitutional, such as high sensibility and irri-
tability of the nervous and vascular system. Remote, when
other diseases are operating upon the system ; such as tubercu-
losus diseases of the nervous system, genital organs, attacks of
cold, &c. ; in short, any disease which operates to promote
irritability and a morbid condition of the system, will lavor an
attack of toothache of any kind. Approximate and local : such
as one diseased tooth operating upon another, by ifie/astasis,
sympathy or close proximity ; decay of the dentine sufliciently
to expose the pulp to air, and the irritating acids of the mouth,
sudden and extreme changesof temperature, erosion, &c ; dead

'36 Toothache, [December,

dentine, without much softening, actinrj as a foreign substance,
as in cases of blackness of tlie tooth, substance commonly called
black decay; on the contact of any foreign substance or plug-
ging mateiial, while inti'oducingaplug ; accumulation of serum,
blood or pus, beneath a metallic plug, or the decay of the tooth
itself; when inflammation attacks the pulp before the decay is
removed sufficiently to allow of the escape of the accumulating
fluids.

2nd. False Toothache is an inflammation of the alveolar
dental membrane and gums, and is commonly communicated
from within the tooth to without, by continued inflammation and
ulceration of the pulp through the foramen, at the end of the
root ; hence it almost invariably commences at the apex of the
fang. This membrane never continues acutely inflamed for any
length of time, without destroying the vitality of the pulp, be-
cause the swelling of the coats of the blood vessels around the
foramen, at the end of the root, cuts off' a supply of blood to it,
and the high grade of inflammation which exists in the pulp be-
fore it extends to any height externally, will cause it to slough.
This is the point at which true alveolar abscess commences,
and is never established without a loss of the dental pulp. It
causes salivary calculi, (but, as observed above, generally dis-
ease of the pulp,) which will often excite extensive inflammation
of the gum and periostieal membranes, aud sometimes to such
an extent as to even inflame the pulp and cause it to slough ; a
blow with any hard substance will often produce the same
effect. Calomel i-s also a common cause of periostieal inflam-
mation, especially when pushed to ptyalism, and acids of vari-
ous kinds, administered during illness, and the mouth not washed
carefully. But the most marked cases of the kind, and the most
painful, but without the extreme spongyness which exists in
severe ptyalism, that we have ever seen, has been during the
development and eruption of the wisdom teeth, in patients of
extreme irritability of the nervous and vascular system. And
what is most curious, however large, and however sensitive the
teeth may become in ptyalism or teething, as soon as the irrita-
ting cause is removed the teeth return again to their natural
and healthy condition, as a general rule, without a loss of the
l)ulp.

3rd. Sympathetic Toothache. This character of toothache
may be regarded as only existing in sound teeth, or in teeth in
which pain is experienced, but are not themselves the exciting
cause oi'the pain, but excited by some irritating cause along the
course of the nerves of the same side of the face; not, as is
supposed by some, caused by a diseased tooth of the same class
on the opposite side. Opposite jaws may be painful from the

1849.] Toothache. I'M

same cause, but not opposite sides of the face, except it be from
disease of the roots, or both of the nerves of the fifth pair such
as in rheumatism or irritabihty of the nerves of the head and
face generally.

Its causes. Diseased neighboring teeth; diseases of any
character involving the fifth pair of nerves; general irritation
of the gums from salivary calculi ; partially necrosed roots :
uterine pregnancy; development and eruption of the teeth;
exostosis of the roots and alveolar processes ; ossification of
pulp, &c., &c.

Diafrnosis of the true toothache. Actual contact with your
instrument, after removing the decay of the tooth, and ocular
demonstration, is almost the only positive signs of toothache;
still the following symptoms may sometimes lead to correct
conclusions, viz; pain upon taking substances into the mouth
above or below the common temperature of the blood. Yet
high sensibility of the tooth, when only slightly decayed, or
where they are wholly sound, may give rise to great pain upon
taking cold or sweet substances into the mouth, and sometimes
cold is the only temporary remedy for inflamed pulp; there-
fore, a toothache which is relieved by cold water, may be relied
upon as arising from inflammation of an exposed pulp; on the
contrary, warm, when it produces any impression at all, it is to
increase the pain, and that is frequently the first sign we have
oj'the inflamed pulp, after a tooth has been plugged with slight
exposure of the nerve. Tenderness to the tooth inside of the
cavity of decay, and more or less prolonged pain after the in-
strument is removed ; while pain excited by sensibility of the
bone, only lasts while the instrument is in actual contact with
it. Again, a little experience will render the operator capable
of judging whether the pain, excited by the contact of his
instrument, is really from an exposed pulp or sensitive bone, by
the peculiar thrill which it gives the patient.

These symptoms all become much exalted when acute in-
flammation attacks the pulp, together with intense pain accom-
panying. Intermitting pain is also a marked sign of true
toothache, especially in the after part of the day, and forepart
of the night, the febrile exacerbation the determination of
blood to the head and face, which gives the flushed cheek more
or less to all in the evening, accounts for more pain being ex-
perienced at this time than any other in the twenty-four hours.
Few have toothache in the morning: hence, the promises which
are made in the night, that the tooth shall be extracted in the
morning, are, on accout of the absence of pain at that time, so
frequently broken by the suflerer. When these symptoms are
present, and there is no seeming elongation of the tooth from

N. S. VOL. V. NO. XII. 47

738 Treatment of Nasal Catarrh. [December,

the socket, and no undue sensation by sharply strikinir against
the cutting edge or grinding surface of the tooth, with a hard
instrument, it may be generally relied on as diagnostic of true
toothache.

A few Remarks on the Treatment of Nasal Catarrh. By
John R. Pretty, M.R.C.S.E., L.S.A. (London Medical
Gazette.)

The fluid and dry diet has each its advocates for the cure of
coryza. The advantages of warm drinks and good nursing,
are the restoration of checked perspiration the removal of
the intropulsive effects of cold the diminution of fever, of the
acrimony of the discharge, and of the tendency the inflamma-
tion exhibits to descend to the trachea, bronchi, &c.

The disadvantages are the confinement required, and the
debility and relaxation produced, rendering the patient, who
was previously in a probably enervated state, still more so,
and when cured is in a condition most favorable for a return o-f
the disease.

The dry diet imposing almost " total abstinence from liquids,"
as recommended by Dr. C. J. B. Williams, has the advantages
of curing the patient within "48 hours ;" requires little or no
alteration in the kind of food taken scarcely any nursing
cannot relax the patient or leave him more liable to a return of
the complaint.

The disadvantages are the self-denial required ; the un-
diminished (I think increased) acrimony of the discharge, ac-
companied, according to my little experience, with a greater
tendency for the inflammation to descend to the chest.

A third plan of treatment has been advocated in the Medical
Gazette, June 1st, by Dr. Lockw^ood, U. S. the painting with
a camel-hair pencil the Schneiderian membrane with a solution
of nitrate of silver, Dr. L. states, that he has adopted this
practice for nearly a year with immediate success when applied
at the commencement of the attack.

I have for a period of two years adopted a plan of treatment
more easy, and with much success, and which I imagine
would be less objected to by patients, viz., the injecting the
nostrils with a solution of sulphate of zinc (about gr. iij. to I i.
of water). I order the patient to fill a 1 oz. ])ewter syringe,
and inject each nostril once or twice, and whilst doing so to
stoop over a basin. When the injection has been used at the
commencement of titillation in the nostrils, I have found it cut
short the attack. If the complaint have proceeded farther, I
have found it better to wait for the vessel's commencing dis-

1849.] Treatment of Nasal Catarrh, 739

gorgement by the discharge, for if not, the injection causes for
a few seconds aching about the frontal sinuses, and does not
prevent the discliarge occurring. Usually injecting the nos-
trils once is sufficient ; the discliarge may, however, return,
when the injection will be again required. Sometimes the
nostrils in severe cases have to be injected three or four times.

When a patient complains of coryza, and is unable to get
rid of it, I have found the injection stop a discharge, which has
existed for several days, in ten minutes. In such cases, with a
relaxed state of the Schneiderian membrane, the utility of the
injection will be most marked : and it is exactly in these cases
that the fluid plan of treatment will be found injurious.

Great susceptibility to coryza may arise from an atonic state
of the vessels of the pituitary membrane, besides a relaxed
state of system and increased perspiration. If under these cir-
cumstances the injection be used, this liability to nasal catarrh
will be greatly removed.

The usual prophylactic treatment can at the same time be
most advantageously employed, viz., curtailing the amount of
fluid, not allowing any to be drunk hot ; using the flesh-brush
and tepid or cold bathing where admissible.

When a tendency to phthisis exists, it is most important to
guard against cold, for with coryza the lungs may sufl^er from
inflammation descending from the Schneiderian membrane, or
from respiration being confined to the mouth.

The nose is nature's "respirator," and when its lining
membrane is too swollen to allow of breathing through it,
the air passing unwarmed to the larynx, proves an additional
excitant to disease. Frequently persons with severe coryza,
after having been confined to a warm room during the day,
retire to a cold bed-room for the night ; they cannot as usual
breath through their nostrils, and if something be not kept
over the mouth, they often awake with a sore throat and cough.
At such a time, a respirator worn at night is most useful in pre-
venting these.

When an instrument of this kind is required, I would recom-
mend to the notice of the profession, Mr. Roost's Inspirator, for
the easy respiration it permits, producing a w\arm, moist at-
mosphere, without becoming clogged by moisture. Another
advantage in its construction, is the use of very fine tubes in-
stead of wire gauze, and a valve for preventing the expired and
inspired air commingling ; and thus a supply of pure air is in-
sured.

I am surprised that coryza* has not been usually treated
locally as well as generally. However, as sulphate of zinc and
nitrate of silver are found useful in inflamed conjunctiva:, this

740 Corns, Bunions, and Curved Nails. [December,

may be an inducement to try them when the Schneiderian
piembrane is similarly attacked.

Corns, Bunions, and Curved Nails. By Chas. Merrifeld.
(Boston Medical and Surgical Journal.)

First, Their Cause. The shoe manufacturer is not alto-
gether to blame for these complaints, as sometimes the stocking
produces them, and retains them upon the feet for years after.
Boots or shoes are generally the primary cause, and India-
ruhher over shoes more than all others. They heat the feet
more. The direct cause is heat and friction, combined with
gentle pressure, which we always experience with a new, or
misfitting boot or shoe. Stockings which have large seams in
them, which press or imbed themselves into the large joints of
the foot, are a fruitful source of corns, bunions, and enlarged
joints. The lining of the boot is so situated as sometimes to
raise a crop the first day it is worn. It may therefore be con-
cluded that a proper shape, and a nice fit, are necessary to re-
move the cause, and to insure a permanent relief. A very
tight, good fitting shoe or boot, will prove less productive of
evil than a large misfitting one. In a word, one can wear a
boot or shoe, as tight as they can a glove on the hand, or as
the skin is on the foot, if they can find one to fit as well.

The rubber shoe I have attacked, and therefore it is but fair
that I give some reasons for so doing. Frst, to suit the eye it
must set close to the boot or shoe, over which it is worn, and it
is put on warm, or when flexible ; but when it becomes cold, is
smaller than it was before, and consequently the foot is brought
into a smaller compass, the shoe compressed, which before was
comparatively easy, so that uneasiness and actual pain ensue.
Every point on the foot suffers and especially those having
corns or callosities. These imbed themselves still deeper into
the flesh, till the agony is sometimes almost beyond endurance.
This is experienced when riding, walking, sitting in church, or
by the fire-side. Relief only comes when the rubber is taken
off. Next, an unhealthy condition of the feet follows. Who
would have their extiemities covered with cataplasms from
morning till late in the evening? No well person would con-
sent to it; yet rubbers are worse, for they retain the heat and
exhalations, and create vesicles or blisters, without exerting
any healthful influence. Suflerings thus produced ultimately
impair the general health. -Upon some they excite the
perspiration to such a degree, that the feet are constantly wet ;
more so certainly than they would be under ordinary circum-

1849.] Corns, Bunions, and Curved Nails. 741

stances, even were they not protected at all against external
dampness. Now who will say that this continual drain upon
the system williiot affect the health, producinfr, as it naturnlly
must, (in passing through the sudden changes of heat and cold
connected with every-day life), colds, coughs and consumption.

The same causes that ii-ritate old corns, will produce new
ones; and if continued, increase the magnitude of the old ones
by forming sacs at the bottom, which are often found, when
corns are extracted, resembling the pulpy nerve of a diseased
tooth a sac filled with fluid. Boots or shoes too short, too
narrow or two thin through the toes, will produce all the
trouble that is discoverable with nails that grow into the flesh,
become clubbed, thick or bloodshot. Yet these sometimes
come by accident.

With respect, however, to rubber shoes, it is not their use,
but their abuse which should be discountenanced. They are '
useful when put on cold, and worn in the wet and cold ; but
should not be kept on while sitting in a warm apartment.
Some persons wear them in warm shops to work in, because
they are soft and easy to the feet ; but such people ascertain,
sooner or later, that their feet are tender, sore and painful ;
and they are more susceptible to colds.

I may differ from some of the profession in my definition of
corns ; but what I pretend to know about them, did not come
from books, but from actual experience, from handling and
dissecting them every day for years. The public has been
misled by London Jews and German quacks, and many other
itinerant pretenders, who have visited our more populous
towns, being well supplied with points of bristles, and the like,
which they have shown, and pretended to take from the foot,
rendering their operation more satisfactory at the time, and
causing the patient to part with his money more readily. So
far as my observation extends, there is not one corn in one
hundred that will compare with their showing. Corns vary in
their shape and size, as much as the pebbles upon the sea-shore;
neither are they composed of the same material in all cases.
First we find one composed of serum, next pure blood, then
matter coagulated, and lastly lymph. All corns are enclosed
in a sac, or bag, which proves them to have been, at some pe-
riod, blisters just under the cuticle, filled with serum ; or perhaps
they were blood-blisters made in the skin, or they commenced
as deep ulcers. The matter, not discharged in the latter case
in healing, becomes coagulated by the heat of the foot. Most
of these kinds of accumulations become a very hard substance,
and usually take a conical form. 'J'his depends much, however,
on surrounding circumstances, and the degree of pressure.

742 Cholera its Course and Ravages. [December,

"svhich combine to irritate and inflame the part. A small sac at
the bottom of the old corn, which, in its turn, coagulates, and
adds to the former difficulty, constitutes a striking variety.
Common callosities, existing, as they are sometimes permitted
to, on the joint, are very liable to cause all the evils before men-
tioned, and in addition, the large joints, and instep to inflame,
and displace the small bones. Some corns are so sharp-pointed,
that from constant pressure they are driven deeply into the cap
of the joints, and the writer often finds those that have com-
pletely severed some of the minor blood-vessels. In either of
the three last locations, they prove sorry accompaniments.
They are more difficult to operate upon, and need a longer
course of treatment, but may be cured without pain or the ap-
pearance of blood.

Bunions are a multiplied and complicated mass of the same
materials, often embracing all the varieties in a single lump ;
they may be removed by the same treatment resorted to in the
others, and now familiarly known, as the operation has become
a distinct branch of business in the hands of chiropodists.

The old and vulgar idea that corns grow from the bone, to
the surface, still has its advocates. As they grow from the
surface into the foot, I find no difficulty in removing them en-
tirely from their irritating position.

Now if there are any unbelievers among physicians, in re-
spect to the modern improved method of extracting corns, I
respectfully invite them to witness my process. It is useless to
attempt a description of the operation, as it must be seen to be
understood.

154 Washington-st., Boston, Oct. 10, 1849.

. Cholera its Course and Ravages, (Cincinnati Gazette.)

The cholera has now swept over the entire extent of the
Mississippi Valley, as an epidemic, and spent its force at nearly
all importans points. Its deadliest ravages have been at New
Orleans, St. Louis, Quincy, Nashville, Lexington, Cincinnati,
Sandusky city, Lafayette and Buffalo. Of towns and cities of
considerable size that have been visited by it, it has fallen most
lightly on Mobile, Natchez, Vicksburg, Louisville, Wheeling,
Detroit, Cleveland, Columbus, and Pittsburgh. The small
towns in which it has raged worst, are Bellville in Illinois,
Lebanon in Tennessee, Paris and Richmond in Kentucky,
Aurora, Boston and Napoleon in Indiana, and Eatonton, Yan-
dalia and Minster in Ohio. Places that have suflered a good
deal, and yet cannot be classed among the worst, are Chicago,

1849.] Cholera its Course and Rata a^es. Ti^

Alton and Peoria in Illinois, ^Memphis and Clarksville in Ten-
nessee, Maysville in Kentucky, Richmond in Indiana, Xenia,
Dayton, Springfield and Batavia in Ohio. " Tlie Coast'* at
Louisiana has also sutiered a great deal iVom first to last, 10 to
25 per cent, of the slaves being carried off by the disease on the
principal plantations. Places of considera!)le size which have
either nearly or altogether escaped the visitation of the pesti-
lence, are Jackson in Mississippi, Little llock in Arkansas,
HuntsviHe, Tuscaloosa and Florence in Alabama, Knoxville in
Tennessee, Glasgow, Shelbyville, Frankfort and Georgetown
in Kentucky, Cairo and Springfield in Illinois, jVew Albanv,
Madison and Indianapolis in Indiana, and Zanesville, Steuben-
ville, Marietta, Chillicothe, Hamilton and Rossville in Ohio.

Here, now% are singular facts, plainly showing the mysterious
and capricious character of this dreadful disease. It appears
here, ihere, elsewhere, suddenly, and often giving no warning,
without reference to lines of travel, regardless of natural water
courses, wholly independent of the direction of prevailing
winds, and uncontrolled by the topographical character or geo-
logical formation of the district within its general course.
Spending itself where it lights first, either gently or ferociously,
it disappears, and while neighboring points are standing in awe
oi its proximity, and daily expecting its desolating presence, it
suddenly appears in altogether another region, a hundred or
two miles away. And again, two or three weeks, or two or three
months afterwards, while those who seemed to have escaped
are still warm in the congratulations of each other, and are
beginning to talk and write about the superior healthfulness of
their towns, the destroyer retraces its steps, strikes at their
best and their worst, their strong and their feeble, alike, and
carries mourning to every household.

This is the manner in which the cholera has appeared and
disappeared in the course of its march over the Mississippi
Vallev. For wrecks it is at New Orleans, and does not ap-
pear at Natchez, or Vicksburg, or Memphis, although the
intercommunication is incessant ; for even months it is in that
city, and does not appear in Mobile at all, except in the in-
stances of three or four persons who came home with the
disease developing in their systems, and die of it. It appears
at St. Louis, and scourges that city as no other American city
has been scourged ; and yet for the space of five months the
city of Alton, a few hours' travel above, on the same river, and
in dailv, we may say, hourly communication, does not feel its
presence in a single case.

Then Alton is stricken, and in a fortnight many of her best
citizens are borne to the grave, while the vile look on and

744 Stricture of the (Esophagus. [December,

escape. It leaps to Cincinnati, moving over hundreds of miles
of populated countiy in a direct line, and passing b\^ many
towns and cities on the water line of travel, and for two months
subjects us to its terrible ravages, carrying off thousands of our
people. Yet while this is going on, a populous city but little
more than a hundred miles from us, nearly altogether escapes
its presence, and many smaller towns, at half that distance, re-
main wholly exempt from its visitation. Then it leaps sixty
miles north to Dayton, a city of 12,000 to 14,000 inhabitants,
and eighty miles south to Lexington, a city of 7000 to 8000, and
fills their cemeteries with new-made graves, while the inter-
mediate towns, with their populations of 1000 to 5000 each,
experience entire immunity. In the rural districts, too, the
same capriciousness is shown. In some counties almost every
towm of from 100 to 300 inhabitants has witnessed the presence
and the ravages of the disease, while in adjoining counties even
its breath has not been felt.

And now, having moved thus capriciously from one extreme
to the other of this great valley, it threatens to return upon its
track, and wrap in darkness and desolation the places that till
now it has spared. This, indeed, is what it has already to
some extent done, in so recently striking Lebanon in Tennes-
see, and Harrodsburg I'n Kentucky, and Springfield in Ohio,
and Birmingham near Pittsburg, and seme other places near
which it showed itself a month or two ago, and from whose
vicinity it had almost entirely disappeared for weeks.

Stricture of the (Esophagus. (Boston Med. and Sur. Journal.)

One of the most extraordinary cases of stricture of the
oesophagus, known to us, now exists in a shoe-maker, of Boston,
who actually, keeps himself alive by the habitual practice of an
operation that no surgeon in New England would dare perform
in the rough manner pursued by this unfortunate sufferer. He
is a small man, rising of 70 years of age. For man}^ years he
had extreme difficulty in swallowing food. Deglutition finally
became so painful, that he took advice at the Mass. Gen.
Hospital, and, according to his own representation, an instru-
ment was introduced down his throat. The relief was not
entirely satisfactory: but discovering that the principle was
right, since there was evidently a narrowing in the canal, the
idea was conceived of practising upon himself. At the ex-
tremity of a rattan, perhaps a yard in length, and a quarter of
an inch in diameter, he wound on a mass of hemp, which was
confnied by twine. A rough mass, six inches long on the

1849.] Chorea. 715

stick, and an inch thick at the lower extremity, was thus made.
Having oiled it, the old man fearlessly forces it down through
the (Esophagus, fairly into the stomach. This he is obliged to
do frequently, otherwise the strictures for there are two, one
just at the top of the sternum, and the other a little above the
cardiac orifice become so closed, that fluids cannot pass at
all. Sometimes, after swallowing a draught of water, it is
stopped at the lower constriction. To ix'lieve himself, under
such a dilemma, he thrusts down a long feather, which produces
nausea, and by the sympathy of the gastric apparatus vomition
is induced, and the confined fluid, according to his account,
forced back. Sometimes food is checked in its descent, at the
same point, and ejected by mechanical assistance.

On Tuesday, of last week, al^ter giving us a minute history of
his condition, the narrator oiled the monstrous probang, forced
it down into the stomach, and brought it back dripping with
gastric juice. Not long since, the lower stricture utterly re-
fused to allow the great swab to pass. Recollecting that
tobacco was a relaxer, while the rattan was protruding above
his teeth he calmly lighted a pipe, and by taking only a few
whiffs had the satisfaction of relaxing the muscular grip, and
down the mass went, passinii the rebellious point into the great
membraneous receptacle below. On one occasion, the pro-
bang was coated over with ground mustard, and thrust through
the strictures, on the supposition that they required stimulating!

A more singular case, one more truly formidable in charac-
ter, and managed in the rude, fearless manner here described,
cannot be found, it is believed, in the annals of surgery. Under
any plan of treatment but his own, this man of ten millions
would have been dead, years ago, a victim to an incurable
malady. With the course he is habitually pursuing, life may
be protracted till he is unable to repeat the operation, and then
he may die of starvation.

Chorea^ with suppression of the Menses, treated successfiilli/ by
Ainmoniated Copper and Extract Belladonna. By Thomas
E. EvAxs, M. D., of Decatur, Newton Co., Alabama. (New
Orleans Med. and Surg. Journ.)

Miss J., setat. 18, had for eighteen months previous to date,
(June 29th, 1846,) slight symptoms of chorea, which gradually
increased until March, 1846: she was then placed under the
professional care of Dr. J. W. of this place. Treatment.
Bleeding, blisters to spine, mercurial course, A:c.. steadily per-
severed in, until the above date, June 29th, at which time the

746 Chorea. [December,

case was abandoned by the above gentleman as hopeless, and
her death declared certain.

June 29th. Visited Miss J. for the first time. Symptoms.
Countenance pale, anxious, sunken ; breathing with considera-
ble difficulty ; spasms violent and constant, extending over the
whole body, so that two persons had to be constantly employed
to keep her on the bed ; muscles of throat and tongue rigid, so
much so, that speech and deglutition were both in a great meas-
ure suspended ; bowels irregular; tongue slightly furred ; pulse
small and irregular, varying from 130 to 150 ; has not menstru-
ated for twelve months; spinal column slightly tender and a
little curved, probably by the constant spasms ; usual period of
catamenia 8th to 12th of the month.
^. Ammon. cupri, gr. ss.

Ex. Gentian, grs. iij. M. f> . \)\\. ter die sumenda.

Applicetur. Emplast. hydrarg. ant tart, ad spina. ^. Aloes;
sapo Castil. aa. M. f>. divid. in pil. grs. iv. singul. quatuor pro
re nata, nocte sumenda.

June 30th. Less rigidity in the muscles of throat and tongue ;
has swallowed with more facility; can articulate indistinctly ;
bowels acted twice ; skin moist. Slept some last night ; spasms
still continuous, but is more cheerful: prescription continued.

July 4th. Improving steadily ; can swallow, and speak more
plainly; complains of emplast. ^. Ammon. cupri, gr. f ; ex.
gent. grs. 5 ; ter die.

July 8th. Better. Omit capri sulph. ^. Ext. belladonna,
grs. iij. ter die. Warm mustard pediluvium at night.

July 9th. As yesterday.

July 10th. Slight menstrual discharge and very offensive ;
has produced a good effect on the mind. Rep. ext. belladonna,
ut here.

July 11th. Improving rapidly; the spasms, which have been
constantly becomino; milder, are now scarcely perceptible; can
walk with a steady gait and has tried to knit. Catamenia pre-
sent.

1). Ammon. cupri, gr. i.

Ex. Gcntianae, grs. iij. ; ter die.

July 12th to 15th. Catamenia still flows moderately and has
assumed a healthy character.

July 20th. Attendance discontinued ; the pills of ammon.
cupri to be continued for three wrecks more, and the belladonna
taken on the 8th, 9th and 10th of next month.

At the time of penning this paper. Miss J. yet unmarried, is
and has been ever since July 20th and 24th, in fine health.

I have allowed this length of time to elapse, nearly three
years, in order to be fully assured that the cure was complete;

1849.] Case of Fracture, relieved by Cups. 7 17

this is the third case I have treated successfully with cupri
ammon. and belladonna, after all other modes had failed. One
at Southampton in England, in 1832 ; when under the instruc-
tion of W. S. Oak, M. D., of the Royal College of Physicians ;
one in Tuscaloosa, Ala., and the one sent you. I make no com-
ments.

My rule for the seventeen years of my professional life, has
been to follow that course which experience teaches nie is most
successful. I have frequently given belladonna in suppressed
catamenia after other remedies had proved abortive, and with
pleasing success.

Case of Fracture and Depression of a large portion of the
Parietal Bone of a Child, relieved by the use of Cups. By
W. L. MouLTRiE, M. D., of St. John's, Berkley, S. C
(Charleston Medical Journal and Review.)

Messrs. Editors: The following case having been related
to an esteemed medical friend, it was deemed of sufficient in-
terest to be worthy of a place in your Journal, and I have
accordingly prepared the following brief monograph of it, which
is herewith transmitted to you, to be disposed of in any way
that your own views of the matter may suggest.

A negro child, 5 months old, the property of the Hon. T.
Bennett, of Mepshew plantation, was brought into my office on
the morning of the 2d of May, 1849, having incurred a fracture
and indentation of a large portion ol the right parietal bone, the
depression being sufficient to contain with ease the bowl of a
large table-spoon. The great disfiguration of the natural
spherical shape of the head caused by the injury, unaccompa-
nied as it was, when I saw it, by any manifest disturbance of
the functions of the brain, presented altogether an unusually
disproportionate relation between the extent of injury and the
usual accompanying morbid signs in such cases. The child
had, however, as represented, by both mother and nurse, who
brought him to me, been in a state of insensibility from the
time they first discovered the accident, (the time and manner of
the occurrence of which they could give no information,) until
he arrived at my office a peried of time, judging from the
distance travelled, on foot, and the time otherwise occupied in
receiving instructions relative to it from tlie owner, must have
taken up at least half an hour. By this tirjie, however, the
brain had recovered its functions, and the only and in)meiliate
object remaining for my attention and duty was to relieve the
depressed condition of the bone. And here will be found the

748 Spheroidal State of Bodies, [December,

chief interest which has induced me to invite your attention to
the case.

The application of the cupping instruments two or three
times, until they could be brought to work effectively, together
with the addition of traction upon the cup when it had taken
firm hold, completely and easily effected entire restitution of
the bone to its natural position. It is now^ upwards of two
months since the accident, and the child is without the occur-
rence of any evil result from the injury., Simple as this case
is, it is not without its teaching. The ease with which, in this
instance, the object was attained affords abundant reason to
believe that in similar cases of older subjects, where the bones
of the head have attained even greater development and firm-
ness, the cups would yet be adequate to accomplish the eleva-
tion of bone fractured and depressed by violence, and in this
way probably supersede for the time the necessity of operating
by incisions and the use of the trephine and elevator, at all
times requiring great surgical skill and mechanical dexterity.
The time that would be occupied in making trial of the cups
as a preliminary measure, particularly upon the craniums of
young subjects, could scarcely add any thing to the danger of
their condition, and if found adequate to accomplish all that is
desired, short of the last resort to the more complicated and
graver mode of surgery, as did occur in the above case, would
be so much saved to the perils of the subject, as well as so much
spared to the feelings of the surgeon himself, who, however con-
fident in knowledge and skillful in practice, must entertain an
abiding anxiety and doubt as to the result of his operation until
time shall have revealed to him its success.

Some facts relative to the Spheroidal state of Bodies Trial by
Fire Man Incombustible. By P. N. Boutigny. Reported
to Academic de Sciences. (Southern Literary Messenger.)

" Upon my return home," says M. Boutigny, " I did not Aiil
to inquire of the workmen what would happen if the finger
were immersed in the incandesent mass of melted iron ? Most
of them laughed in my face. But that did not discourage
me. After a while, being at the forge of Magny, near Lure, I
repeated my question to a workman, who replied that " nothing
was more simple ;" and to prove it, he instantly passed his
fingers into the incandescent column of ore which was just
then issuing from a Wilkinson. Another workman, who stood
])y, performed the same experiment with equal impunity.
Emboldened by what I saw, I did the same."

The fact in question was no longer doubtful, but M. Boutigny

1849.] Spheroidal State of Bodies. 719

hesitated to communicate it to the Academy until he should he
prepared to supj)ort it by the adduction ot" various other experi-
ments. These experiments he thus describes: "I cut or
divided with one hand a spout of melted ore five or six
c'enti metres (about 2 inches) in diameter, as it issued from the
furnace ; and plunged the other into a vessel filled with the
incandescent licpiid, which it was really frightful to behold. I
shuddered involuntarily. But both hands it^sued victorious
from the trial ; and now, if anylhirg apj)ears surprising to me,
it is that simi'iar experiments are not of every day occurrence.
Certainly it will be asked what precaution should be taken to
guaranty the hand from the action of the burning fiuid ? I
answer none! Fear not. Perform the experiment with con-
fidence. Pass the hand rapidly, yet not too rapidly, into the
molten mass. If the experiment is made timidly and with too
great rapidity, you may overcome the repulsive force which
exists in incandescent bodies, and thus establish contact with
the skin. In that case the skin would indubitably remain there
and in a condition not difficult to conceive. The experiment
succeeds particularly well when the skin is moist. The invol-
untary terror which one experiences in presence of these
masses of fire almost always puts the whole body in that
condition of moisture essential to success. The following I
have found to be the best preparation for the experiment. I
rub my hands with soap, so as to give them a polished surface.
Then at the moment of making the experiment I plunge the
hand into a cold solution of sal ammoniac saturated with
sulphurous acid, or simply into water containing sal ammoniac,
or if you have not the latter substance convenient dip the hand
merely in cold water."

M. Boutigny then gives the following philosophic explana-
tion of this phenomenon :

" It is to my mind a positively established fact that the hand
and metal do not come in contact with each other. If there be
no contact, heating can only take ])lace by means of radiation.
This is enormous it must be admitted; but in our experiment
no account need be taken of radiation, for in fact it is nullified
by reflection. I think that I have long since proved that water
in the spheroidal state possesses the remarkable property of
reflecting the calorific rays, and that its temperature never
reaches that of its boiling point: whence it follows that the
finger or the hand, being moist, cannot attain the temperature
of 100, the expcM'iment not being of sufficiently long duration
to permit the complete evaporation of its moisture to be elfect-
ed. Persons familiar with the experiment of immersing in
w-ater a body of incandescent silver or platina, will readily un-

750 Treatment of Hooping- Cough. [December,

derstand the mechanism of this. In the first case it is the water
retiring from the metal which then seems to be enclosed within
a crystal envelope ; in the second case it is the liquid metal
which retires from the moist hand. In the first place the metal
is active and the water passive; in the second, the moistened
hand is active and the fused metal is passive. It is the same ex-
periment reversed ; and the two form but one. In one word, the
hand, inserted in metal in a state of fusion, isolates itself. The
humidity which covers it passing to the spheroidal state, reflects
the radiant caloric and is not heated sufliciently to boil. It is
true, therefore, as I said in the beginning, that this experiment,
apparently so dangerous, is in fact almost absolutely without
danger. I have often repeated it with lead, bronze, &c., and
invariably with the same success. Thus in the course of ten
years I have made ice in a furnace heated to whiteness, and
have bathed with impunity in a mass of incandescent metal ;
and that by virtue of the laws which govern matter in the
spheroidal state. It results also from these notes that a consid-
erable number of facts reported in history and generally deemed
fabulous, may well be true. Ancient philosophers probably
knew much that we are now ignorant of. A little more re-
spect for them and a little less admiration for ourselves would
do us no harm."

The pretended miracle by which one of the Eastern Magi,
disciples of Zoroaster, is narrated to have gained thousands of
converts, is now of easy solution. He proposed that twenty
pounds of molten brass should be poured hot from the furnace
upon his naked body, upon condition that if he underwent the
trial uninjured, unbelievers, constrained by the prodigy, would
profess conversion to the faith. It was done, and the scientific
impostor witnessed the rapid acceptance of his creed.

[We shall be satisfied to leave these experiments to
others.] Edt.

On the Pathological Treatment of Hooping- Cough, By J,
PiDDucK, M. D. (Lancet.)

Pathological anatomy has supplied the principle which leads
to a rational practice in this disease. It has demonstrated the
existence of a congested state of the vessels at the origin of the
pneumogastric and other respiratory nerves, and a more
copious efliusion of serum around the medulla oblongata than in
death from other causes, except those involving diseases of the
lungs and heart.

It was the discovery of this state of the vessels at the origin

1849.] Opium in Continued Fever. 751

of these nerves, by the late Dr. Sanders, of Edinburgh, which
led him to a rational and successful practice in hoopin,r;-cou,i,'h.
It consists in applyini^ leeches directly over the junction of the
occiput and the atlas vertebra, for the purpose of relievini? the
congested state of those vessels, followed by a blister between
the shoulders, to promote their contraction. The rubefacient
eilect of the blister is sufficient to answer this indication, and
therefore, in delicate children, the mustard-poultice is prefera-
ble to a blister. The rule to be observed is, to apply one leech
for each year of the child's age, from one to six; and im-
mediately after the leeches, the small blister or sinapism; and
to repeat the leeches and rubefacient on the third or fourth
day, if necessary.

The first application usually succeeds in arresting the violent
paroxysms of the cough ; sometimes a second, but very rarely
a third application is required to put an end to the paroxysms.

During the period of nearly thirty years that I have pursued
this rational practice, I cannot recollect a single instance of
failure in uncomplicated cases of hooping-cough.

This mode of treatment applies strictly to the uncomplicated
cases of hooping-cough. The several complications require
their separate and appropriate modes of treatment. Leeching
the upper part of the spine, and blistering between the
shoulders, by arresting the violence of the cough, speedily re-
move the congested and inflammatory states of brain which the
hooping cough frequently occasions. The catarrhal complica-
tion requires the exhibition of the wine of colchicum, combined
with an alkali, after clearing the alimentary canal. The bron-
chitic and pneumonic complications require the administration
of the potassio-tartrate of antimony with nitrate of potass ; and
the biliary complication of mercury and rhubarb, with saline
aperients.

On the Use of Opium in Continued Fevers. 13y A. G. Henry,
M. D. (Boston Med. and Surg. Journal.)

For the last twelve years, opium, m four and five grain doses,
has been my main remedy, in all forms of typhoid fever. In
fact, when I use it at all in fever, it is in iour or five grain
(loses. I claim to have demonstrated, beyond all reasonable
doubt, by a long and careful observation and experince, that
while the maximum doses of the schools are of doubtful utility,
and often prove injurious in fever, by increasing the dryness of
skin, aggravating the pain in the head, &c. a five (rrain dose
will, nineteen times in twenty, produce free perspiration, and

752 Treatment of Orchitis. [December,

relieve every unpleasant symptom. Tlie notion that so gen-
erally prevails among the profession, that opium cannot be used
to advantage in fever while there is determination to the brain,
is certainly erroneous, if it is given in the doses which I recom-
mend, unless there is actual inflammation of the membranes
and cases of this kind are extremely rare, in my opinion, Dr.
Clutterbuck to the contrary notwithstanding.

There is, I believe, a high degree of irritation in the brain,
in our billious remittents, as a very general thing; and this
irritation may ultimatel}^ terminate in actual lesion ; but until
this takes place, opium, in sedative doses, is, in my opinion, the
appropriate remedy. I would not, however, theorize upon the
subject. The practice which I advocate has been based upon
facts, and I leave it to abler heads than mine to frame a
philosophical theory to suit them. All I ask of my medical
brethren is, to so far lay aside their preconceived opinions as to
give the dose which I recommend a fair trial, when they resort
to opium in fever as a remedy ; and, my word for it, they will
find the remedy, in four grains, not only safe, but far more bene-
ficial than when given in one or two grain doses, at one or two
hours intervals.

For example I am called to a case of remittent fever in the
morning. I find my patient with hot, dry skin, violent pain in
the head and back, &c. If of a full plethoric habit, I would
bleed, (but I very rarely.resort to the lancet latterly) ; evacuate
the stomach atid bowels freely ; and at bed-time, I would give
him five grains of opium, with ten or twelve of calomel and
direct him to drink fwt tea for an hour or two. I should visit
him in the morning with the confident expectation of hearing
that he had rested well during the night, perspiring freely, and
the pain in the head and back entirely relieved, I would then
direct a purgative of salts and senna, or salts and cream of
tartar, to be taken during the day. At night, I would give the
calomel and opium again, and in the morning I should expect
to find symptoms of slight ptyalism, with a full intermission,
when three five-grain doses of quinine, with laxatives, would
end the treatment. * # # # *

The great power of opium as a remedial agent, when given
in full sedative doses, is most striking and mixmiQ^im dysenteric
fever, which so often prevails epidemically in your section of
the Union. Nine times in ten, a single five-grain dose, com-
bined with ten or fifteen of calomel, after blood-letting, will
cure the disease, if resorted to within twenty-four or thirty-six
hours of the attack.

1849.] Treatment of Orchitis. 753

Treatment of Orchitis. By Bransby Cooper, Esq., F.R.S., &c.
(Medical Gazette, from Braithwaile's Retrospect.)

[After stating that in persons of a full plethoric habit, blood
should be taken from the arm, and that in other cases leeching
should be employed, Mr. Cooper says :]

In my own practice I always recommend cupping on the
loins in addition to the leeches, taking I viij, of blood ; and I
have found, by experience, that the pain is relieved with much
more certainty by this plan than when leeches alone are em-
ployed ; I also generally employ the following as internal
remedies.

I^. Hydrarg. chloridi, gr. iss. ; pulv. antim. potassio-tartratis,
gr. I ; pulv. opii. gr. \. M. Ft. pilul. statim sumenda.

^. Magnes. sulph. 3iij. ; liq. ammon. acet. 5j. ; liq. antim.
potassio-tartrat. 3iss. ; traj. hyoscy. 3iss. ; aq. menth. virid.
ivij. M. capt. cochl. larga. ij. quaque tertia hora donee
alvus bene responderit.

As a local application, I have also found the following lotion
beneficial :

l^. Ammon. hydrochlor. 3iss. ; sp. vini. rect., liq. amm. acet.
aa. 5ij; aquae destil. 5iv. M. Ft. lotio saepe applicand.

If the inflammation be not subdued by these means, and the
vessels of the scrotum appear to be congested, they must be
opened with a lancet, and copious. bleeding promoted by warm
fomentations; the patient should be kept in a recumbent posi-
tion, and made to abstain entirely from animal food.

[If the affection of the testis arises from metastasis from the
urethra in gonorrheal inflammation, we must apply warm
fomentations to the scrotum, perineum, and penis, in order to
re-establish the discharge, and when this is done, calomel and
opium given every night is stated by Mr. Cooper to be the best
means of preventing a return of the disease. As to rheumatic
orchitis, Mr. Cooper observes:]

Persons who are subject to rheumatism appear to be especial-
ly predisposed to a peculiar description of orchitis which seems
to attack the tunica albuginea : this form of the disease may be
diagnosed, by its commencing without any apparent exciting
cause, if we except the rheumatic tendency of the patient ; the
disease generally yields without difliculty to the administra-
tions of alkalies and a small dose of colchicum at bed time.
Individuals of gouty diathesis are also liable to a somewhat
similiar afl!ection. I had a gentlemen, a martyr to gout, for
many years under my care, in whose case the attacks were
frequently preceded by discharge from the urethra and swell-
ing of the testicle, without his having subjected himself to the
possibility of venereal infection.

N. S. VOL. v. NO. XII. 48

754 Senile Enlargement of the Prostate. [December,

_It^ sometimes happens that after acute orchitis (whatever its
origin may be) has been subdued, enlargement and hardening
of the testicle still remains, unattended, however, by pain or
uneasiness : the swelling is best reduced by the application of
the following ointment :

^. Ung hydrarg. ; cerat. saponis,aa. 3ij. ; camphorae, gr. v.
M. ft. unguentum.

The ointment should be spread upon lint, strips of which
should be laid smoothly over the swelling, and these confined
by adhesive plaster applied so as to maintain considerable pres-
sure upon the parts. Some practitioners have recommended
pressure as the most effectual means of subduing the swelling
from acute inflammation in its early stages, but I do not much
advocate such practice, excepting as a secondary mode of treat-
ment.

On Senile Enlargement of the Prostate. (Medical Gazette.)

The enlargement seems to be true hypertrophy, as it is rare-
ly attended by any alteration of texture, although I have in
some few cases found the gland softer, and in others harder, than
natural. The symptoms in enlargement of the prostate gland
depend with respect to their urgency upon the size it has ac-
quired; they are, sense of weight in the perineum, intolerance
of pressure from the hardness of a seat ; difficulty in passing
the urine, and also in voiding the faeces which will be found
flattened by the encroachment of the hypertrophied gland on
the rectum.

At this stage of the complaint, the retention of urine oc-
casionally supervenes, rendering the introduction of a catheter
necessary. This operation should be performed with the ut-
most gentleness, as the slightest flow of blood would cause de-
composition of the urine, and consequent the aggravation of all
the symptoms. An elastic gum catheter should always be
used for drawing off the water, and, if possible, it should be in-
troduced without a stilette ; leeches should be applied to the
perineum ; the rectum emptied by means of enemata ; and
suppositories, recumbent position, and soothing remedies em-
ployed. I have also found colchicum of great use in such
cases, and I believe that its beneficial influence arises from the
circumstance that this disease frequently attacks subjects of a
gouty diathesis. I usually prescribe the colchicum in the fol-
lowing form.

^- Ext. colchici acet. gr. j ; pil. hydrarg. gr. j. ; pulv.
Doveri gr. v. ; ext. colocynth. co. gr. iij. M. ft. pil. bis quotidie
sumenda.

1849.] Senile Enlargement of the Prostate. 755

As the complaint takes its origin from a particular epoch of
Hfe, nothing more tlian relief of the symptoms can be expected ;
but nevertheless, by a judicious system of diet, by keeping the
patient from excess of bodily exertion, and from vicissitudes of
temperature, his life, which was scarcely supportable under the
violent symptoms of the disease, is rendered comparatively free
from pain and inconvenience.

It does not always happen that the whole of the prostate
gland becomes hypertroj^hied in old age ; but very freciuently
the third lobe only is affected, or perhaps it may more proper-
ly be said that a new development arises ; for in a state of
health, at the adult period, the third lobe is scarcely perceptible.
When this third lobe enlarges, it presses the inferior region of
the bladder or "trigone" upwards above the commencement
of the urethra in the bladder, preventing the evacuation of
the urine, and consequently producing retention. Nor is this
the only inconvenience ; for by the raising of the bladder im-
mediately behind the prostate, a kind of reservoir is established
below the entrance to the urethra ; and, in the effort to empty
the bladder, a portion of its contents is always left; this be-
comes specifically heavier than the newly secreted urine, which
does not intermix with it : and, alter a time, the retained urine
undergoes decomposition, which gives rise to very urgent
symptoms such as frequent desire to make water, tenesmus,
deep-seated pain in the perineum, and liability to positive re-
tention. It is qute clear that these symptoms cannot be re-
moved while the exciting cause remains ; the lostid urine must
therefore be immediately drawn off by means of the catheter.
In such cases there is, however, a difficulty in passing the in-
strument, as the enlarged lobe offers some degree of obstruc-
tion to its passage, ana this is only to be overcome by employ-
ing a longer and larger catheter than that usually made use of;
this instrument is generally termed the prostatic catheter. The
mode of introducing the catheter in such cases is similiar to that
in ordinary practice, until it arrives at the point of obstruction,
when the penis and instrument are both to be drawn forwards
for the purpose of straightening the urethra; the handle of the
catheter is then to be considerably depressed, so as to tilt up the
point, and it is then pressed onwards into the bladder. But,
having efl^ected this, the urine would only be drawn off' to the
level of the urethra, and the heavier fluid would still remain,
unless further means were employed for its removal. The
cleansing of tlie bladder may be effected by injecting it with
tepid water by means of a syringe; and an improved instru-
ment has been invented for this purpose, by which a continuous
current is kept, the same stroke of the piston removing one ({uan-

756 Treatment of Stricture. [December,

tity, and supplying a fresh one. Constitutibnal remedies must
not be neglected ; and when an alkaline state of the urine exists,
medicines of an acid character are generally indicated. Among
the most efficacious of these will be found the following :

^. Nitro-hydrochlor. acid, gtt. iij. ; syr. papav. 3iij. ; inf.
colomb. I iss. M. Ft. haustus ter quotidie sumendus.

In addition to this an opiate suppository at bed-time will of-
ten be found of great advantage ; but if an acid condition of the
urine be not thus restored, liq. potassse will frequently be found
capable of re-establishing the normal acid state : this anomaly
has been accounted for by Dr. G. 0. Rees, on the supposition
that the alkali renders the secreted urine less irritating to the
mucous membrane of the bladder, and preventing the secretion
of alkaline mucus, for which the urine had acquired its abund-
ant preponderance of alkali.

I must again direct your attention to the propriety of em-
ploying the prostatic catheter in cases of enlarged prostate; for
I have frequently known great mischief arise from a persever-
ance in the attempt to relieve a patient by the ordinary instru-
ment.

On the Treatment of Stricture, By Samuel Solly Esq. F.R,
S., Senior Assistant-Surgeon at St. Thomas's Hospital, &c.
(Ibid.)

[Relating a case as an illustration of the mode of treatment,
Mr. Solly says ;]

I t#ok a moderate-sized sound, and passing it gently down
the urethra, found that there was some spasm, but not a great
deal. Waiting a little, I moved it onward again, till I found it
absolutely stopped. After removing it, I took a small catgut
bougie, and, passing, it gently down, soon found it quitting the
natural channel and entering a false passage. Having now
ascertained the direction in which this passage ran, I then
withdrew the bougie, gave the point a slight bend, and passing
it in again, feeling round the urethra for the pervious spot, but
avoiding the false passage, I managed to hit it off; so that the
instrument slipped into the bladder without using the least
pressure of force.

This is the great secret in the use of the thread-sized catgut
bougie : it must be handled most delicately, turned in the ure-
thra, something like a cork, screw, till the hole through which
the urine escapes from the bladder is pitched upon, and this is
immediately felt by the instrument passing forwards without
any sensation of obstruction. The catgut bougie must never be

1849.] Gun Cotton in Erectile Tumors. 757

used with the idea of breaking down a stricuture or pushing
through it, but, if I may so express it, coaxing it into the blad-
der. Whenever you find the bougie spring back, you must
stop and give it a Uttle twirl between your fore finger and
thumb ; you may often have to work for half an hour or more
in this way, without being able to hit off the opening; but pa-
tience and delicate handling will do a great deal. I assure you
it is worth taking some trouble to relieve a fellow-creature
efectually of such a serous malady without the use of the
knife. Having passed the stricture, and entered the bladder, I
desired that the bougie should be retained there for an hour.
I attached great importance to the retention of the bougie ;
and with the catgut bougie there is this additional advantage,
that the bougie swells to twice its original size.

On the use of Etherial Solution of Gun Gotten in the cure of
Erectile Tumors without Operation. By Daniel Brainard,
M. D., Professor of Surgery in Rush Medical College,
Chicago. (Ohio Med. and Surgical Journal.)

This adhesive liquid which was ushered into the profession
with great recommendations as a substitute for needles in
cases of hare lip, and for adhesive plaster in wounds, seems
to have failed in fulfilling the expectations which were excited
of its usefulness, and to have become rather an article of the
toilette, and a substitute for court plaster, than a useful addition
to our surgical armory. Struck, however, in the experiments
with it, with the contractile power it possesses, I determined to
test its application to the surface of any erectile tumor which
might present itself for treatment.

During the last winter a case of naevus of the size of a very
large strawberry, situated on the anterior fontanelle of a young
infant, was presented for operation. I immediately covered it
with a solution of gun cotton, and although it was much eleva-
ted above the surface, had the satisfaction of seeing it brought
by the contractile power of the liquid in drying to a level with
the sound skin. It was allowed to remain for several weeks,
and then a fresh application made ; and at the present time
scarcely any trace of the naevus remains, although but two ap-
plications have been made.

The next case was that of a young child, with a naevus J of
an inch in length, and \ an inch in breadth, situated beneath the
right eye. This at birth was scarcely perceptible ; but in six
months had acquired the size mentioned, and was rapidly in-
creasing. In order to avoid the irritation resulting from its
proximity to the eye, the application was made during the sleep

758 Treatment of Asphyxia Neonatorium. [December,

of the infant, and was required to be renewed twice a week,
on account of its becoming loosened. After two months use,
the naevus is scarcely perceptible, and the use of the solution
has been for sometime discontinued.

It is not improbable, that by preventing the necessity of re-
sorting to operations in such cases, this liquid may find a use
more important than any to which it has before been applied.

On the Treatment of Asphyxia Neonatorum. By J, O.
Fletcher, Esq., Manchester. (Medical Times.)

[Referrring to the plan of treating still-born children by the
use of warm and cold water alternately, Mr. Fletcher, says:]

I have been in the habit for some years of treating all such
cases in a very similiar way, and with great success. I first
immerse the child in warm water, and, upon withdrawing it,
cover the chest with a cloth or sponge well soaked with cold
water (the colder the better :) again immerse it in warm
water, and again apply the cold water, so on alternately using
the hot and cold water, until there is evidence of respiratory
movements. The first application of cold will generally pro-
duce a slight sob, and repeated applications will establish res-
piration. J conceive the good arises from the sudden impression
caused by the cold on the cutaneous nerves, (which are the
principal) " excitor nerves'' in the reflex action of respiration.
This is followed by response along the " motor nerves^^ of this
function as the phrenic, intercostal, &c. ; hence the sob on the
first application, and the establishing of respiration by being re-
peated. I have for an equally long period, been in the habit of
ligating the cord before the complete birth of the child, in breech
and feet presentations, sometimes even before the pulsations
were obliterated, believing as 1 do, that the child in these cases
dies from hemorrhage into the placenta, arising from the um-
bilical vein being much exposed to pressure, by virtue of its
superficial and unprotected position in the cord, which, toge-
ther with the tenuity of its tunics render it very liable to have its
current obliterated, whereas the tunics of the umbilical arteries
are firmer, and they themselves not much exposed ; thus they are
in a measure protected from the consequences of slight pres-
sure. Therefore, the flow of arterial blood through the vein
may become obliterated, whilst the venous blood continues to
How along the arteries, from the child into the placenta, with-
out there being any counterbalancing stream ; hence the great
mortality in these cases by the usual treatment, and hence the
utility of ligating the cord early, thereby removing one fatal
consequence; and, as it is well known that a child can breathe

1S49.] Honor to whom Honor is Due. 759

in the vagina, its chances of life are not to say the least
diminished, but, I think, much increased ; for out of thirty-
seven cases that I have treated in this way, two children only
have died, which is saying very much more than I can say for
the usual treatment. In this class of cases especially, I think the
good effects of alternate application of cold and warm water
will be seen, if tried.

Honor to whom Honor is Due. (Ohio Med. and Surg. Journal.)

An account of a case of tracheotomy performed by M. Ricord .
at the Hopital du Midi, where the operator finding that the
machinery of life had ceased to act during the operation, ap-
plied his mouth to the aperture in the patient's throat, rendered
very repulsive by the recent application of a blister, sucked out
the pus and blood which were obstructing the trachea, and by
artificial respiration restored the man to life, and finally to
health, has been transferred from the columns of Medical Jour-
nals to those of the public papers, accompanied by sundry well
earned compliments to the truly distinguished and philanthropic
Surgeon, who, laboring under choleric symptoms at the time,
allowed no thought of self to interfere with the performance of
his duties to humanity.

The action of Ricord was a noble one ; worthy of himself,
his fame, his character and his calling ; and we are well pleased
that a corner of the curtain which hides us from the public
gaze, should now and then be lifted up to let the world see what
manner of men we " Old Hunkers" are. For what does the
world hear of the host of as good men and true as Ricord, who
toil on through a painful life of self-sacrifice at the shrine of
humanity, until they sink into the quiet grave, not '' unwept,"
albeit *' unhonored and unsung." The noble act of Ricord is
rivalled nay, outdone every day of the week, by th(jusands
upon thousands of "country practitioners," in this great West,
to whom such doings are habitual, but who would blush to see
them in print. Who among them but rises promptly from
their warm beds, at the summons of the sick, to ride perchance
ten miles in the dead of the night dark and stormy limbs
benumbed teeth chattering to the log hut whore some poor
woman travaileth in the pangs and perils of child-birth, there to
pass hour after hour at the bedside of the sufferer, in that cheer-
less, miserable cabin, and then their duties performed, return
home to seek rest, warmth and food, and find it? no, to start
off to some other sufferer, again to buffet the driving sleet, to
ford the swollen creek, or cross the dangerous swamp, and fur
what reward? Well! they get well paid for their trouble,

760 Monthly Periscope. [December,

sneeringly says the worldly wise and worldly minded man.
What do you call well paid, good sir ? For what sum would
you consent to be called up unexpectedly now and then, often
just as you have closed your eyes in sleep, after a hard day's
work ? Would you think five dollars a rich reward ? Of a
surety, highly as you value the glittering ore, nothing like this
would you look upon as *' ample remuneration." Why the
average pay which a country physician receives, taking one
night case with another, would in any other trade or profession
be thought ridiculously disproportioned to the mere work and
labor done and performed ; and yet how frequently does he
receive nothing and less than nothing not even thanks ^but
in return for all his most successful and unselfish exertions, is
repaid with the grossest ingratitude. He does not complain of
this, he does not court the martyr's crown, he abhors cant, and
could never condescend to ask for sympathy and commisera-
tion; he has the approval of his conscience, and hopes for the
approval of his Maker, has enjoyed the pleasure of doing good,
and has the proud satisfaction of feeling that he has been useful
in his generation, and is content to plod on, loved and looked
up to by those capable of appreciating the good sense that
dwells in his head, or the kind feelings that warm his heart.
Such are "country practitioners;" be their motto "excelsior.'*

PART III.
iEtlontl)lB Jp^riBCop^.

Experimental Physiology intelligence without the Brain. By B.
DowLER, M. D., of New Orleans. The phrenologist, as well as the
biologist, pursues this route, namely, comparative anatomy, throughout
the entire realm of the animal kingdom, from the lowest type to the
highest, in order to prove that the brain is the exclusive organ of
the mind a theory, which some of the following experiments op-
pose ; for the headless trunk of an alligator, deprived of the supposed
organ of combativeness, displays a good will to fight, using both its
limbs, directing all its available means intelligentially, and, upon
finding, after a fair trial, that these fail, it retreats laterally, by rolling
over from its enemy, never towards him, as if guided by sight all of
which the sequel will prove. [New Orleans Med. and Sur. Journal.

Carbonate of Soda an antidote to Cholera. (Medical Examiner.)
Hydra-bad, Deckan, August 25th, 1849.
Sir, I do myself the honor to communicate to you for the infor-
mation of the President of the United States, and the benefit of the
people, the important fact which I have just ascertained in the treat-
ment of cholera, viz: that the carbonate of soda is a speedy and
eflcctual antidote to the poison of that disease.

1849.] Monthly Periscope. 7G1

I give it immediately a case of cholera is brousrht, in doses of a tea-
spoonful dissolved in gruel or water, and drank us iiot as the patient
can drink it.

It allays the pain and burning of stomach, produces sleep, and re-
stores the heat of skin and pulse in a very short time.

If it should be vomited, 1 immediately repeat it with a little luuda-
dum, and a full dose of oil, so as to cause the antidote to pass down as
speedily as possible to the poison in the small intestines.

When any portion of the oil and antidote is passed in the evacua-
tions, convalescence will he found to have already commenced, the
patient will presently pass urine, and then be out of all ddJiger.

I continue the antidote morning and evening, (if necessary,) and
reducing the dose.

I will not trouble you with details, which will appear hereafter.

By thus addressing the head of such an extensive empire, I make
sure that the knowledge of this antidote will be speedily transported
through its vast extent, instead of being left to chance to work its way
up against the stream.

Besides I am only performing what I consider a duty, at a time
when the epidemic appears to be on the increase.

And, with the greatest respect, I remain your most obedient and
obliged servant, N. E. Maxwell, M. D.

Surgeon, 3d Light Cavalry.
To the Secretary of State, United States, America.

Intermittent Fever. By Dr. N. Ward, Burlington, Vermont.
While in Ceylon, I treated many cases of fever and ague most satis-
factorily, with a mixture of oil of turpentine and castor oil, in the pro-
portion of one to two drachms of the former to one ounce of the latter,
and administered in a mildly cathartic dose at the beginning of every
cold stage. Where relief was not promptly obtained, there were gen-
erally present signs of biliary derangement, indicating the moderate
use of calomel or calomel and ipecac, after which a dose or two of the
mixture usually completed the cure. This was used in cases of long
standing, as well as in recent ones ; and in one case of enlarged^
spleen with good effect. [American Journal.

Nitrate of Silver in Jaundice and Chronic Gastritis. Dr. Peebles,
of Petersburg, Va., recommends in cases of Jaundice the internal
use of nitrate of silver, in doses of ^ of a grain twice a day, on an
empty stomach. Improvement is often observed on the second day,
and ten days is the longest time required to remove the disease.
The modus operandi is probably by correcting a state of irritation of
the duodenum, on which the disease often depends.

In the same Journal, Dr. Hartshorn reports cases of positive ad-
vantage being derived in patients affected with indigestion, accompa-
nied by epigastric tenderness, from the use of nit. argent, in doses
of \ increased to ^ a grain, twice a day, with half tlie (juantity of
opium. [Amer. Jour, of Med. Sciences, from Char. Med. Jour, and
Review.

762 Monthly Periscope, [December,

Dry Cupjring in Hiccup. Mr. Hunter states that he has found this
lately a successful means of cliecking hiccup. A soldier was attacked
with vomiting and purging. After the symptoms had subsided, he
was teased with the most distressing hiccup, which he said kept him
awake half the previous night. There was slight epigastric uneasi-
nes on pressure. Dry cupping over the region of the epigastrium,
leaving the glass on half an hour, stopped it almost instantly. It re-
curred again after taking some beef-tea, but was readily checked by
a re-applications of the glass. It also relieved the epigastric uneasi-
ness. [Prov. Med. and Sur. Journal.

Creosote in the Treatment of Diarrliaia. Dr. Spinks gives, in the
London Medical Gazette, the following statements respecting his use
of creosote in diarrhoea and cholera:

" From the 1st of July to the 1st of August, I have had 224 cases
of simple diarrhoea, 12 cases of rice water purging, and 18 cases of
cholera. The first 93 cases of diarrhoea were treated with the usual
chalk mixture and opium, the remainder with creosote ; in those treated
with the former the diarrhoea continued for some days, and, when
checked, was invariably followed by a disagreeable rumbling and
flatus in the bowels. In the 131 cases treated with creosote, the
diarrhoea immediately ceased, and was followed by none of the above
symptoms. In the 12 cases of rice-water purging, the effect was
instantaneous, the first dose generally putting a stop to the discharge.
In the 18 cases of cholera, all of whom had vomiting, rice-water
purging, cramps and blue skin, cresote had the same decided effect,
at once checking the purging and vomiting, the cramps very soon
afterwards subsiding, the pulse becoming full and soft, a free perspira-
tion breaking out over the body and extremities.

Of the 18 cases of cholera treated with creosote, I have only lost
two, these being far gone in collapse when I was called to them.
The formula in which I use the creosote, is R. Creosote, m.xxiv. ;
mist. acacioB, ^ss. ; sp. ammon., c. camphora, aa 3ij.; ether,
chlorici, 3iij. ; aqua?, gviss, M. Ft. misturae. Capiat, cochl. ij.
mag. omni hor^.

In simple diarrhoea I only give two drops every two hours, with the
above stimulants, and no astringent whatever. [^Boston Medical and
Surgical Journal.

Nasal Hemorrhage. By Samuel R. Smith, of 'j'ompkinsville,
Staten Island, N. \. There are few physicians who have not occa-
sionally been annoyed by the difriculty with which nasal hemorrhage
is arrested. An old shipmaster communicated to mo a method,
which shows that the artery furnisliing the supply of blood can be
perfectly compressed at the root of the upper incisor teeth. His pro-
cess was to roll up a piece of paper and place it under the upper lip.
The first opportunity I had of trying it, was a case of profuse hemor-
rhage fiom a fall, which had persisted four days, notwithstanding
repeated plugging of the nostrils, and the patient had become almost

1849.] Monthly Periscope. 7G3

exsanguine. In this case the front teeth of the patient were wanting,
and I applied the pressure by tying a knot in a bandage, which I
placed 071 the upper lip so as to make pressure immediately at the root
of the septum narium, and lied the bandage around the iicad above
the ears. The hemonliage was inmiediate and permanently ar-
rested. On mentioning the subject to scvoral of my medical friends,
I found the practice was new to them all, and I tlierefore communi-
cate it for the benefit of the profession. [Boston Medical and Surgical
Journal.

Detection of Chloroform in the Blood. This is effected by the con-
version of chloroform, at a red heat, into chlorini^ and hydrochloric
acid. Place the blood in a sandbath, pass the resulting vapor through
a tube heated in the centre to a red heat, and lined at its extremity
with a paste of iodide of potassium and starch, its open end also being
covered with paper moistened with the same mixture. If chloroform
be present the paper will be tinged blue. By this means one part in
ten thousand may be detected. [//. de C/iimie Medicale, from Ibid.

Sulphate ofPhyllerine. M. Jachelli, of Fcrrara, has lately added
this alkaloid to the list of febrifuges ; it is obtained from the well
known evergreen shrub, Phyllerea Latifolia. It was known before
the researches of Dr. Jachelli, as a cooling astringent, but it is now
found to possess the same active anti-periodic properties as others of
its class, the ash, the olive, etc.

An extensive series of experiments have been made since the year
1825, on the action of this alkaloid in agues, by Dr. Jachelli. He
has compared its operation with that of 1st, a powder of the young
leaves and twiggs, in doses of thirty grains during the intermission ;
2d, a simple decoction of the plant to 60 of water, down to one-third,
and given in large doses also during the intervals ; 3d, with a com-
pound decoction formed by adding 30 minims of dilute sulphuric acid
to the preceding. The sulphate, in doses of from 12 to 15 grains
during the apyrexia, has evinced its superior activity over other pre-
parations of the phyllerea; thus of 20 patients treat( d with the sulphate,
20 were cured ; of 13 to whom the powder was administered, 11 were
cured ; of 18 to whom the compound decoction was given, 14 were
cured ; of 16 who took the simple decoction, 7 were cured. [Bulletin
General de Therapeutic, from Western Journ. Med. and Surg.

Prolonged Inanition. Dr. Samuel LI. London, of West Point,
Tennesse, communicates to us the following case of j)rolonged inani-
tion, in a hog, which, although not quite so remarkable as the instance
oflen quoted of the pig buried under the chalk cliff in England, is
extraordinary enough to entitle it to a place among the rare cases in
physiology. Dr. L. says :

"A hog weighing about 190 pounds, the property of Mr. James
Kelly of this neighborhood, by accident got weclged in between two
logs, and in that situation remained confuied, without food or drink,

764 Monthly Periscope, [December,

for ninety-six days. When released, the weight of the animal was
reduced to thirty pounds, or more than five sixths. The accident oc-
curred during the past winter. At this time (June 10th) the hog is
alive and as thrifty as any on the farm." [Western Journal of Medi-
cine and Surgery.

Chloroform externally applied. The following examples of the
successful application of chloroform over the seat of pain, which have
lately come under our observation, appear to us worthy of record.

Mrs. , a respectable lady, had contracted lues from her child,

to whom the disease had been communicated by a black nurse. Her
physician for a long time mistook the character of the complaint both
in her child and herself; but when its true nature was revealed he
soon succeded in curing the latter, as well as the nurse. We saw
the lady a year after she had been under medical treatment, and at
that time she had ulcers on the scalp, and was suffering from most
acute neuralgic pain of the side of her head, which grew worse as
the day decHned and rendered her nights sleepless and wretched.
We advised the local application of chloroform. Thirty drops were
placed on a cloth which was kept in close contact with the head, and
this was renewed from time to time until anaBSthesia was induced.
The effect was prompt and most satisfactory. The night following
the first application of the remedy was one of comfort, and the ap-
pearance of^the patient, next morning, proved that she had enjoyed
refreshing sleep. The use of the remedy was continued for a few
nights ; but before an ounce of chloroform had been consumed she
was free from the pain, which, in three months, has not returned.

The character of the next case was entirely different, though the
result w^as quite as satisfactory. A colored woman had a tooth ex-
tracted in September. The operation was followed b}^ inflammation
of the lower jaw, which extended to the tonsils, and made deglutition
impracticable. She was bled, and afterwards a pourltice, on which
half a drachm of chloroform had been dropped, was applied to her
throat. In half an hour, after the removal once or twice of the anaes-
thetic, she became easy, fell asleep, and when she awoke, a few hours
afterwards, found that she could swallow. Remedies were then admin-
istered, and the patient has recovered. No doubt the bleeding contri-
buted to the removal of the cause which obstructed deglutition ; but
we have as little doubt that chloroform also had a large share in the
result. [Ihid.

Fracture of Neck of Femur and Autopsy. Reported to Dr. Ham-
ilton, by Darwin Colvin, M. D. T. B. S., aged 38 years, of
intemperate habits, much emaciated, and having for the last year or
two suffered from hepatic disturbance to such a degree as that his
skin has been constantly of a deep yellow color, received an injury,
Aug. 21, 1849, while in a state of intoxication. No one was present
at the time of the accident, and it is not ascertained how it occurred.
I saw him several hours afterwards. The toes were turned out, and

I

1849.] Monthly Periscope. 765

the leg shortened one inch and a half. The thigh was enormously
swollen, and tlie whole pelvic region ecchymosed, with evidences of
contusion, especially over the great trocliunler. The trochanter could
not be felt. Having made extension and rotation, with the assistance
of my father, and crepitus being manifest, we determined that it was
a fracture of the neck of the femur.

The limb was placed in a comfortable situation, with a view to the
reduction of the inflammation.

On the 23d delirium tremens supervened, and on the 2d inst. he
died, twelve days after the occurrence of the fracture.

Autopsy, eight hours after death :

The neck of the femur was broken half an inch from the root of the
trochanter major: the upper end of the lower fragment was comminuted,
and the trochanter itself was completely separated and drawn up under
the gluteus maximus. The head of the femur was j)artially removed
from the acetabulum. The spongy structure of the bones was yellow,
and nearly of the same color as the skin. [^Buffalo Medical Journal,

Dislocation of the Humerus, with Fracture. Mr. Syme has lately
met with a case of dislocation of the head of the humerus into the
axilla, complicated with fracture about the middle of the humerus.
This double accident is exceedingly rare. The patient had fallen
through a trap door into a cellar, and his arm had become entangled
among the spokes of a ladder during the fall. It was determined that
the dislocation should be reduced, before an attempt was made to set
the fractured bones. For this purpose, the forearm was bent upon
the humerus, and a bandage was then rolled round the whole arm as
high as the shoulder. Over this, a couple of Gooch's splints were
placed ; the lac was then attached above the seat of fracture, and
secured by another bandage. Extension was made in the direction
of the long axis of the trunk, a large pad being first stutled into the
axilla. Reduction was readily effected, and the subsequent progress
of the case had been satisfactory. [Proceedings of Edinburgh Med,
Chirurg. Society, in Monthly Journal.

On Sulphuric Ether, in a Hygienic and Therapeutic point of view.
M. Baudelocque addressed a note to the Academy of Sciences, May
21st, in which he says that sulphuric ether has the property of instantly
destroying sulphuretted hydrogen. If a few drops of the ether are
poured, beforehand, into the chamber vessel, the odor of the tecal mat-
ters will be destroyed. If a chamber has been infected with any such
odor, a few drops of the ether sprinkled about the room instantly
destroys it.

In medicine, sulphuric ether has been proposed in different diseases ;
among others, to strangulated hernia, applied locally to the tumor, to
produce rapid refrigeration. Would it not be better, asks iMr. B., to
give a dose of ether by the mouth, and in injection, to destroy the
sulphuretted hydrogen, which distends the hernial tumor; the reduc-
tion may thus be instantly effected. [Cumplcs Rcndus, from Cfuirlcs-
ton Med. Journ. and Review.

766 Monthly Periscope. [December,

Removal of Stains of Nitrate Silver. Accident first led M. Marti-
nenq to the observation, which he has since repeatedly confirmed,
that the stains produced by nitrate of silver on linen, &c., may be
readily removed by wetting the linen in a solution of bichloride of mer-
cury, (1 part to 31), rubbing it well, and then washing it in cold
water. [L' Union Medicate, from Buffalo Medical Journal.

Bacon a Quack. Ancient method of maintaining Health. That
very learned and universally celebrated philosopher, Lord Bacon,
" had extraordinary notions respecting the virtue of nitre, and conceiv-
ed it to be of inestimable value in the preservation of health. So
great was his faith, that he swallowed three grains of that drug, either
alone or with saffron, in warm broth, every morning for thirty years !
He seems to have been fond of quacking himself; once a week he
took a dose of the ' water of Mithridate,' diluted with strawberry wa-
ter. Once a month, at least, he made a point of swallowing a grain
and a half of 'castor' in his broth at breakfast for two successive
days. And every sixth or seventh day he drank an infusion of rhubarb
in white wine and beer immediately before dinner. He made it a
point to take air in some high and open place every morning, the
third hour after sunrise ; and, if possible, he selected a spot where he
could enjoy the perfume of musk, roses and sweet violets. Besides
thus breathing the pure air of nature, he was fumigated with the
smoke of lign-aloes, wath dried bays and rosemary, adding once a week
a little tobacco. On leaving his bed he was anointed all over with
the oil of almonds, mingled with salt and saffron, and this was followed
by gentle friction. He was rather a hearty feeder, and when young,
preferred game and poultry, but in after life gave the choice to butch-
er's meat, which had been w^ell beaten before roasted. At every
meal his table was strewed with flowers and sweet herbs. Half an
hour before supper he took a cup of wine or ale, hot and spiced, and
once during supper wine in which gold had been quenched. The
first draught which he drank at dinner or supper was always hot, and
on retiring to bed he ate a bit of bread steeped in a mixture of wine,
syrup of roses and amber, and washed it down with a cup of ale to
compose his spirits and send him to sleep." [i?05/07i M. and S. Jour,

Transactions of the American Medical Association. The second
volume of the Transactions was put to press immediately after the
adjournment of the Association, and every effort has been made by the
committee of publication for its early appearance. The default of
authors, however, in not furnishing their reports, and the delay caused
by the transmission of proofs to a distance, have baffled all the efforts
of the committee. The reports have at last all been received, and the
printing will be proceeded with as rapidly as possible. It is believed
that the volume will exceed eight hundred pages, of which about five
hundred and fifty have been printed. [Philadelphia Med. News.

1849.] Medical Intelligence. Miscellany. 767

MEDICAL INTELLIGENCE.

FAREWELL OF THE PRESENT EDITOR.
The fifth volume of the Southern Medical and Surgical Journal is completed
with this number; as has been determined upon, the present editor retires, and
another one assumes the management of conducting this periodical. To this
conclusion we have been forced by severe domestic affliction, which has now
continued unabated for nearly four years. Within this period, besides the ter-
rible disease alluded to in former numbers of the Journal, and for the relief cjf
which, advice has been sought for still in vain, both in this country and Europe,
the grave has been opened no less than three times to receive " flesh of our flesh
and bone of our bone."

" They, they alone whose hearts like mine have bled,
Know how the living sorrow for the dead."'

We improve this opportunity to solicit indulgence for the many imperfections
of our work. We have endeavored, under trials known to but few, to discharge
our whole duty faithfully to the patrons of the Journal. In the failure, we still
have the consciousness of having tried to act honestly to all. To those whom
we may have at any time and in any manner offended, we humbly ask their
forgiveness. AVe believe we love the brotherhood, and entertain no unpleasant
feeling to a single member of the profession. There is not one connected with
it whose prosperity we do not heartily desire.

We take leave, with regret, of our editorial brethren ; our thanks arc due
them for their valuable exchanges, and their generous notices of our feeble
labors ; our best wishes attend them in their arduous duties. With the kindliest
feelings to all who have aided us during the past five years, and with the sin-
cere hope of a brighter career, greater success and usefulness to the SuxUhern
Medical and SvrgicalJournal, now that it passes into better hands, we take our
leave of it and its patrons.

We are specially grateful to our Printer; for through his industry and punc-
tuality every number of the Journal (amounting now to sixty) has been issued
in time.

f^ We make known to our friends, the determination to confine our profes-
sional duties to Surgery.

MEDICAL MISCELLANY.

CoUodimi to prevent Pilting in Small-pox. Mr. Rankin makes this suggestion
of Collodion to the face to prevent the pitting in this loathsome afTection a
good idea.

Gargles. Sir James Murray says, the best way to use gargles is to draw them
through one or both nostrils. This must be very unpleasant.

Colica Piftonum. In chronic cases give Iodide of Potassium.

Dropsy. Give the fresh juice of the root of common Elder, as a drastic pur-
gative.

Sciatica. Try an eschar made on outer part of dorsum of foot by red-hot
iron, patient being under chloroform.

Pyrosis. A new salt of Bisulphate of Iron and Alumina in 5 to 10 grs. doses,
dissolved in any aromatic water.

Collodion Is now applied to Acne, Burns, Bed-sores, Chilblains, Chapped
Nipples.

Professors WiUiains and Wahhc of Ixtndan.F roL Williams, C. J. B., well
known by his works on Medicine, Has resigned the chair of the Principles and

768

Miscellany. Meteorology. [December,

Practice of Medicine in the London University, and Dr. Walshehas succeeded
him a good appointment, to our own personal knowledge.

Doctors. The number in New York, good, bad, and indifferent, is 641. In
Cincinnati 179.

A 71CIV mode of composing Children. Dr. Castle, dentist, of New York, says,
the Irish nurses are in the habit of swinging infants, head downwards, by the
feet, to put them to slape.

An aged Nurse. The Boston Medical and Surgical Journal states that a
grandmother, 61 years of age, at Indianapolis, nursed her grand-child and raised
it; the mother having died when it was four months old.

A Medical Professor elected to Congress. Dr. Fitch, late Professor in Rush
Medical College, has been elected to Congress from Indiana.

Acetate of Lead in pounler for granular Ophthalmia. Dr. Cunin, of Belgium,
has used this preparation reduced to a fine powder, and applied to the palbebral
conjunctiva.

Obituary. Professor John Butterfield, editor of the Ohio Medical and Sur-
gical Journal, at Columbus, making the death of no less than four editors of
medical journals in the United States within three months. Dr. B. was a man
of most decided talent, and well qualified for an editor.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet.

for October, 1849, at Augusta,
32' west Wash. Altitude above

o

Sun
Ther.

Rise.
Bar.

2, ]
Ther.

P.M.
Bar.

29 43-100

Wind.

Remarks.

1

72

29 45-100

88

s. w.

Cloudy.

2

75

" 48-100

73

" 57-100

s. w.

Rain 85-100.

3

71

" 65-100

76

" 72.100

w.

Rain 35-200 at 3 a.m., cloudy.

4

68

" 75-100

87

" 72-100

N. W.

Fair foggy morning.

5

63

" 74-100

83

" 72-100

s.

Fair morning. [ clear.

6

70

" 55-100

80

" 45-100

s. w.

Rain 5-100 blow in afternoon

50

" 60-100

65

" 62-100

N. W.

Fair blow.

8

45

" 78-100

70

' 81-100

N. W.

Fair.

9

48

" 86-100

72

" 84-100

S,

Fair.

10

50

" 76-100

73

" 68-100

N. W.

Fair breeze.

11

45

" 74-100

68

" 70-100

s. w.

Fair.

12

46

" 55-100

63

" 48-100

s. w.

Rainy breeze.

13

47

" 78-100

68

" 82-100

N.

Fair.

14

43

" 94-100

70

" 96-100

E.

Fair.

15

49

" 95-100

75

" 90-100

S. E.

Fair.

16

62

" 88-100

80

" 81-100

S. E.

Cloudy afternoon blow.

17

68

" 81-100

72

" 80-100

S. E.

Cloudy drizzle.

18

63

" 80-100

04

" 85-100

s. w.

Rain one day and two nights,

19

59

" 90-100

63

" 9-2-100

N. E.

Cloudy. [2 inches 75-100.

20

58

" 95-100

59

" 94-100

N.

^:i;;;l 2 inches.

21

64

" 51-100

79

" 47-100

S.

22

56

" 61-100

69

" 69-100

W.

Fair.

23

49

" 78-100

77

" 77-100

N.W.

Fair breeze.

24

55

" 88-100

71

" 97-100

N.

Fair.

25

49

30 12-100

67

30 16-100

N. E.

Fair.

26

47

30 12-100

68

30 10-100

N. E.

Cloudy.

27

55

30 8-100

70

30 5-100

N. E.

Cloudy.

28

59

30

74

29 89-100

S. E.

Cloudy sprinkle. [85-100.

29

68

29 63-100

70

" 63-100

W.

Fair blow rain last night,

30

44

" 88-100

68

" 90-100

W.

Fair breeze.

31

40

" 92-100

88

" 95-100

N.W.

Fair.

16 Fair days, auantity of Rain 6 inches 85-100.
9 days. West of do. do. 16 days.

Wind East of N. and S.

\39<^

INDEX TO VOL. V.

OF CONTRIIJLTORrf.

PAGK.

Blackburn, J. C. C, M.D. Case of
Uupiure Uterus 72

Campbell, H.F., M.D. Infantile Par-
oxysmal Convulsions 591

Campbell, H. F., M.D. Scirrhous
Degeneration of the Pancreas 336

Cooper, George F., M.D. Case of
extensive Gun-shot wound recov-
ery 390

Cullender, George D., M.D Singu-
lar case of Hysteria 400

Dugas, L. A., M.D. Clinical Lec-
ture on Colic , 577

Dugas, L. A., M.D. Clinical Lee- i
ture upon Syphilis 321

Dugas, L. A.,' M.D. Malformation j
of the Genito-Urinary Apparatus.. 193

Erskine & SheflTey, M.D'.s. Cases i
operated on under Chloroform .... 713

Eve, Joseph A., M.D, Review of
Meigs' Obstetrics 286

Eve, Joseph A., M.D. Review of
Smith's work on Parturition, &c. . 655

Eve, Paul F., M.D. Amputation at
Shoulder-joint 533

Eve, PaulF., M.D. Caseof Natural
Anaesthesia 718

Eve, Paul F., M.D. Deaths from
Sulphuric Ether 342

Eve, Paul F., M.D. Case of death
from foreign body in pharynx and
laryn.x 73

Eve, Paul F.. M.D. Report of Surgi-
cal Clinic in Medical College of
Georgia 29

Eve, PaulF., M.D. Lithotomy 117
Calculi 146

Eve, Paul F., M.D. Stale Medical
Convention 188

Eve, Paul F., M.D. Report of opera-
tions under Anaesthetic agents 278

Eve, Paul F., M.D. Notice of the
Mineral S})rinj;s of Georgia 442

Eve. Paul F., M.D. Removal of large
Polypus from ihe No.^e 466

Eve, Paul F., M.D. Lithotomy, case
of large calculus '. 59G

Eve, Paul F., M.D. Meteorology at
end of each No

Gordon, James M., M.D. Letter on
conlinuatK.e of this Journal 120

PAnn.

Gordon, James M., M.D. OnRanula 63

Harper, P. \V , M.U. Ca.scs in Ub-
steiricy 715

Harriss, Juriah, .M.D. Cholera in
the Hospitals ol Paris 388

Harriss, Juriah, M,D. Properties of
the Saliva, &c 202

Harris, James C, M.D. Topogra-
phy, Meteorology and Disea.ses of
Wetumpka, Ala 513

Jones, W. L , M.D. Observalionson
Malarious influences 449

Le Conte, John, M.D. The Philoso-
phy ot .Medic-ine 257

Long, C. W., M.D. First use of Sul-
phuric Ether by Inhalation 705

Mastin, C. H, M D. Rupture of
Cluadriceps Femoris Muscle 714

Mayes, J. A., M.D. On an Indigen-
ous, DeuLsiri.eni and Aheraiive
Compound 370

Mayes, J. A., M.D. Treatment of
Malarial Fevers 140

Means, Akwander, M.D. History of
Chemistry 128

Oakman, Erwin H., M.D. Thera-
peutic action of GLuinine 207

O'Keetie, D. C, M.D. Researches in
Cornine, or Dogwood Bark 1

Pendleton, E. M., M.D. Statistics of
Diseases, &c 461

P.ndleton, E. M., M.D. Statistics of
Diseases of Hancock Co 520

Pendleton, E. M., M.D. Statisiicsof
Diseases ot Hancock Co 047

Roberts, W. H., M.D, SchirrcvCan-
cer of Vagina and Uterus 404

Rossignol, Henry, M.D. Transla-
tion from French, of a case of Ex-
pulsion of iron Fork per anum 534

Shefiey.L. B., M.D. A caseof Stran-
gulation of Inte.'^tine 654

Twiggs, J. D., M.D. Therapeu-
tic Effects of Tobacco against
Worms 041

Westmoreland, J. G., M.D. On Fe-
ver 09

Wooten, H. V., M.D. Death from a
drop of Laudanum 398

Word. R. C, M.D. Mammary Ab-
sct-s treated hv Flvd. Pot 53-2

IV

INDEX.

INDEX OF ARTICLES.

Abscess, mainniary 5li'2

Aeon iie G3()

Aconite, its Tliorai)eijtic aclioii 741

Adlicv-iive, new mixture 247

Adulierated drugs 85

Adultcrulion of dru^js

Advanced liJe, diseases of 28G

Alcohol, lest for water in it 212

Amputation at hij) joint 117

Amputation, portion reunited 572

Amputation at shoulder-joint 533

Anaphrodisiac proj)ertiesoflupulin.. 3u5

Anapla.^ty for vesico-vaginal 403

Anatomy, human, of Gluain &Shar-

pey 031

Anatomy, Harrison's 225

Anatomy, Morton's 22G

Anaesthesia, case of natural 718

Anaesthesia in Surgery 401

Anaesthesia, from local application

of chloroform 3I3

Ana:;stliesia, predicted 55

Anaesthesia, local 187

Anaesthetic agents in Midwifery 78

Aneurism, compression in 7t)

Ani, prolapsus 509

Anthrax, treated by Vienna paste. 247
Anus, Fissures, subcutaneous tenoto-
my 217

Anus, fissures 372

Aphtha 372

Aphtha 509

Aisenic in agriculture 567

A) sen ic, Filhol's method 63G

Artery, ultimate eli'ecls of ligature to

carotid 77

Artery, rupture of femoral 315

Asphyxia neonatorum 758

Association, American Medical, its

transactions 32

Association, American Medical, how

obtained 63

Association, State medical 188

Association, State medical, its pro-
ceedings 250

Association, State medical, proceed-
ings again 317

Association, American medical, 1849 380
Association, American Medical,

amendments 444

Association, Med. in Twiggs co 573

Association, American Medical 766

Asthma, quinine in 107

Asthma in a child 633

Auscultation, intestinal 598

Auscultation and Percussion, Earth's 402

Bladder, foreign body in 675

Bladder, removal of picceof pipe from 436

Bladder, galvanism in Paralysis 509

Blood, su^rar in 213

PAGE.

Bones, difference in syphilitic and

scrofulous affections of 312

Brain, induence of, in the child 569

Bran, nutritive properties in 3ll

Bruises, application to 440

Burns, lotion for 247

Burns, collodion in 312

Calomel, does it expel bile 1 235

Cancer of tlie Breast 215

Cancer of the Lip, operation 366

Catarrh, nasal 738

Catarrh, new treatment 181

Catalepsy 679

Caustic, "chloride of gold 636

Caustic, chloride of gold as a 314

Cauterization, value in surgical op-
erations 352

Chancre, calotnel to 185

Chancre, proto-sulph of iron in 248

Chemistry, its history 129

Chemistry, Bowman's 402

Chest transfixed by a scythe-blade . . 314

Chilblains, collodion in 437

Children still-born, management of. 93

Children, fat 373

Children, management of. Bull's 402.

Chlorolbrm , another death from 375"

Chloroform, test for 375

Chlorolbrm in tooth-ache 695

Chiorol'orm in hiccups 695

Chloroform in operations 696

Chloroform, operations under 7l3

Chloroform externally applied 764

Chloroform in the blood 763

Cholera in England 56

Cholera, Asiatic, report from N.York

quarantine 121

Cholera board of health of IN. York. . 126

Cholera, iron as a prophylactic 119

Cholera, Asiatic at New Orleans 150

Cholera, means of warming patients 183
Cholera, treatment at St. Thomas'

Hospital 184

Cholera, prophylactic indications in 229

Cholera cured by chloroform 239

Cholera, is it contagions'? 240

Cholera in Nashville, Tenn 241

Cholera, quinine in 310

Cholera, treatment various 356

Cholera, as observed in Hospital of

Paris 385

Cholera, remedies for 419

Cholera, prevention 424

Cholera treated by calomel 439

Cholera prescription 441

Cholera infantum prescription 441

Cholera specific 445

Cholera, epidemic 484

Cholera, Report of committee in
Charleston 496

ixnnx.

Cliolcra, Dr. Carlwright 501

Cholera, by ipecac and calomel.... 507

Cholera, SSiragoiiol's mixture 508

Cholera, injection ot water into the

bladder 503

Cholera in New Orleans 510

Cholera, Dr. Reese's letter 550

Cholera, Dr. Cox's Remedy 557

Cholera, anti-contagious lact 570

Cholera and 1 Jomoiopalhy 571

Cholera .subsiding 573

(/holera, clinical lecture 17G

Cholera antidote 7tiO

Cholera, its sources and ravages 742

Chorea, &c 745

Chorea, valerianate of zinc in 508

Circulation, its sound 238

Club-loot, gutta-percha as splint .... 55

Cod-Liver Oil, test for 37G

Cort'ee in infantile cholera 435

Colic, clinical lecture 577

Collodion in ophthalmic affections.. 699

Collodion in erectile tumors 757

Collodion, improvement in prepartion 558

Collodion, preparation of 112

Compound, new one, indigenous... 37C
Compression, arterial as antiphlo-
gistic 627

Conjunctivitis 440

Consumption cured by Digitalis.... 245

Contagion, prevention of 690

Convulsions, inlantile treatment with i

quinine 591

Convulsions in children 680

Corn ine, or Dogwood bark, research- i

es in 1

Corns, Bunions, &c 740 |

Cosmetics , 510

Cotton, hajmostatic properties 635

Coxalgia 620

Croup, external u.se of iodine in 3 14

Croup, iodine externally 440

Cutaneous diseases, tar in 110

Cutaneous affections, arsenic in ... . 686

Diabetic patients, bread for 561

Diarrhoea, creosote in 762

Diarrhoja 371

DiarrhoBa in infancy 358

Diarrhica, nux vomica in 310

Disease of mucous membrane in arti-

zans 479

Diseases, &c. of Wetumpka, Ala. . . 513

Diseases of Mexicans 86

Dislocation of elbow backwards.... 507

Dislocation o( the pelvis 240

Drunkards, reclaiming 108

Dysentery, comparative efficacy of

medicine in 227

Dysentery, nux vomica in 481

Dysentery 372

Dysmcnorrhoca, leeching in 697

PAGK.

Dyspepsia, stomachics in 186

Dyspepsia, a remedy for 185

Elczema ot Scalp and Legs 690

Epidemic, contagious, infectious and

raeteoracious 35

Ergot of rye in dilated pupil 182

Ether, sulphuric, deaths trom 342

Ether, first use by inhalation 705

Ether, sulphuric, disinfecting powers, 765
Experiments of Magendie, &.c,, on

therapeutic agents 720

Expulsion ol Fork per anum 534

Extirpation of morbid growths 635

Fasting for 43 days and 5 hours 52

Fecundity 569

Femur, fracture neck of 764

Fever, intermittent 761

Fever, typhus or typhoid 36

Fever 69

Fever, quinine in West India 97

Fever, puerperal, quinine a prophy-
lactic 179

Fever, tartar emetic and opium in., 245

Fever, typhoid, prescription 441

Fever, yellow, non-contagious 569

Fever, typhoid, castor oil and spirits

turpentine 570

Fever and ague, iron and sulphur in.. 701

Fever, malarial, treatment of 140

Fever, cryptogaiuous origin 282

Fevers, continued, opium in 751

Fistula, iodine injections 702

Food, proportion of nutritive matter

in articles of 637

Foreign bodies in the mucous canals, 684
Foreign body in pharynx and larynx, 73
Fracture and depression of cranium, 747

Ga.strodynia 371

Gastrotomy in obstructed oesophagus, 360
Gastritis, chronic, nitrate of silver.. 761
Geniio-Urinary Apparatus, malform-
ation of 193

Gland, enlarged in axilla, operation.. 29

Gla.ss, writing upon 373

Gonorrhoea 440

Gout und Rheumatism, anodynes. , . 699
Graduates, Med. College Ga., 1849. . 250

Hare-Hp, operation for 116

Hare-lip, ofK-ration 429

Headache, from inf. of frontal sinuses, 61

Heart-clot 2S9

Heart, slow action in fever 5(V1

Heart, needle found in 692

Health, inlluence by tea and coffee.. 536

Hemorrhage, na.sal 762

Hemorrhage from tonsillotomy 247

Hemorrhage, turpentine in 106

Hen nursing kittens 573

VI

I\DKX.

PAGE. I

Hernia, reduction of 185

Hiccup, cure lor 119

Hiccup, intention of 374

Hiccup, dry cupping in 762

Homoeopathy, wonderful effects of. . , bl ]
Homoeopathy, under allopathic treat- I

ment '. 700

Homoeopathic victim 702 j

Honor to whom honor is due 759

Hooping-cough its pathology 750

Humerus, dislocation and fracture.. 765
Hydrocephalus with hypeitrophy of j

cranium 698

Hydropathy and its evils 302 ;

Hydrophobia, cure of case 468

Hydroma, subcutaneous puncture... 247
Hydropathy, Hood's illustration of.. 120
Hysteria, case of 400

Inanition, prolonged 763

Inflammations, mucous membrane. . 303

Injections, minute 187

Ink, for steel pens 573

Intelligence without brain 760

Iron, cast and wrought, how to solder, 572
Iodide Potassium in saturnine and

mercurial affections 633

Issue, to make prompt 441

Jaundice, nitrate of silver in 761

Journal, New Orleans Med. and Surg. 574
Journal, Southern Med. and Surg.,

shall it be continued 1 62

Journal, continuance of this 120

Journal, opinions of the Med. Press

on its discontinuance 318

Journal, Southern Med. and Surgical,

future Editor 703

Journal, Southern Med. and Surgical,

farewell ot Editor 767

Journal, Western of Med. and Surg. 574

Laryngitis, anlematous 37

Laudanum, death from one drop 398

Lecture, introductory by Dr. J. A. Eve 189

Leeches 116

Leech, mechanical 700

Lightning, death of child in uicro by 62
Liniment, chloroform, camphorated.. 369
Lipoma, subcutaneous section for . . . 185

I iihotomy 117 calculi 146

Lithotomy . . . 75

Liiiiotomy, large calculus 596

Lithotomy, diet after 695

Lithotomy, incontinence of urine af-
ter....'. 695

Lithotomy and Lithotrify compared. . 370

Liver, sugar in 243

Lumbago, local application of chlo-
roform 2^18

Lupus, treatment of 24(i

Lupu?, treatment of 621

PACK,

Madness:, extraordinary 688

Mal-practice, suit for 251

Man incombustible 743

Medical Literature, report by Dr.

Holmes 80

Medical Students in London 211

Medical Students, comparison of Lon-
don and Paris for 219

Medical Sciences, half-yearly, by

Ranking 226

Medical Miscellany .. .319, 446, 511, 575
639, 767.

Medical men, remuneration of 375

Medicine, Philosophy of 257

Medicine, Practice of Dr. Fort 3l7

Medicine, clinical of Graves 467

Medicine, sectional teachings 545

Medicine, aciions, on the secreting

and excreting organs 671

Medicines, action, on the nervous

system 683

Medicines, domestic 407

Medicines patented, congressional re-
port 562

Medicines patented 624

Mercurial ointment, to make 444

Midwifery, Lee's 226

Midwifery, Gooch's 401

Mineral Springs of Georgia 442

Mixture, camphor 441

Morphine, valerianate 571

Mother's imagination in production

of monstrous children 482

Mouth, how to keep clean 372

Muscle, rupture of quadriceps 714

Museum, Hunterian 212

Musk, its smell destroyed by ergot of
rye 571

Nffivi, new mode of removing 313

Naphtha 245

Neuralgia, local anaesthesia 2^15

Neuralgia, creosote a remedy for.. . 371

Neuralgia, treaimentof 634

Nijiples, fissures 439

Nitrate of Silver in white swelling,

&c. &c

f)2(:

Nitre, sweet spts., preservation of. . . 373

Obituary Notices

Paul F.Eve, jun 64

Mr. James Antony Student of

Medicine 127

Mr. D. W. .Tacobs, Student of

Medicine 2.56

Samuel Cooper 448

Prof. Serres 448

Prof. Blandin 448

Dr.Townsend 448

Dr. Pritchard 448

Dr. Wurdenian 448

Prof Harrison G40

IM>KX

Dr.righam

Prof. John Butierrield

Obstetric air-iraclor

Obstelrics, cases in

Obstetrics, by Smith ,

" ' " Review ol". .

Obstetrics, Meigs's

Esophagus, stricture

Onychia, treatment of

Operations under annesihesia .

Ophthalmia, chloroform in

Opium, tolerance of

Orchitis, landanum to

Orchitis, acute

Orchitis, treatment of

Pancreas, .schirrhous degeneration..

Paronychia

Paronychia

Patients, gratitude of

Penis, fracture of

Perspiration, sanguineous

Pessary, glass broken in vagina

Pharmacopoeia of U. States, revising.

Pharmacy, Mohr's

Phlebotomy in ancient times

Photuria or luminous urine

Phthisis, pulmonary, W. Walshe's
summary

Phthisis cured

Pbyllerine, sulphate

Phymosis, operation for

Phymosis, operation improved... .

Phvsic, theory and practice, by Bell
& Stokes

Physicians, praiseworthy

Physicians of Georgia, notice to

Physicians, right to charge as wit-
nesses

Physiology, manual of

Physiological fact, new

Pneumonia typhoides

Poisoning with powdered glass

Poisoning by poison oak

Polydipsia, camphor in

Potassium, novel effects

Practitioners, eclectic

Pregnancy, early and infantile men-
struation

Professional changes in medical col-
leges

Prostate gland enlarged

Prolapsus Uteri

Prolapsus of umbilical cord

Prostate senile enlargement

Prussic acid and opium, symptoms
produced by

Psoriasis, treatment of

Ptyalism, nitrate silver in

duackery, influence on health, mor-
als, &<:

540

168
431
715
4GT
055
286

ra

55

278
187
374
186
696
753

336
441
633
572
315
566
376
574
401

438;

186 1

615

4381

7631

694!

3671

407!
697 i
120

3791

2881

436 ;

441

53 i

ll6i

244;

674 i

60|

610 I
I
446
51
622
439
751

103

' TAnr..

duackery exposrd 118

duackery in medicine 5(*8

duack bill, prohibited 510

duackery in I9th century 037

duack. Bacon was one 700

duack medicines 572

duicksilver in ileus 03

duinine, etl'ects of 697

duinine, its therapeutic action 207

duinine to render it tasteless 181

llanula 65

Rectum, glass goblet in 309

Remedies, vegetable 374

Reports, southern medical 631

Rheumatism, nitrate of potash in . . . 102
Rheumatism, treatment by alkalies.. 180
Rheumatism, nitrate of potash in.. . 24-1

Rheumatism, calomel in 637

Rheumatic gout, lemon juice in 311

Rhubarb, administration 634

Saliva, its use in digestion 202

Saliva, creosote in 21.'^

Scabbies, treatment of 210

Scarlatina, inunction with lard in... 63^1
Scrofula and Tubercle, analogy and

difference 568

Scrofula, its causes 47

Scurvy, its causes and treatment 32

Sickness in Baltimore alms-house.. 507

Silver, nitrate, removal of stains ICtG

Skin, function of 1 It

Skin, preparation of 117

Skull, perforated 55

Sounding, hint on 005

Spina-bifida, treated by iodine 572

Spermatorrhoea 117

Springs of South Carolina 1 IH

Stammering, cure for in

Statistics of diseases 617

Statistics of diseases 393

Statistics of diseases 520

Statisiics, vital 373

Sterility, remediable by mechanical

treatment 343

Stomach, reptile in 115

Stomach, larvae of tlies ejected from.. 56

Strangulated intestine 654

Stranguary, liquor potassje in 249

Stricture, treatment of 750

Strychnine, its action on the bladder.. 212

Strychnine, antidote to 183

Sugar, origin in the animal economy, 5<9

Sulphur, its medical properties 628

Surgical Clinic of Medical College

of Georgia 29

Teeth, neumlpia of 115

Teeth, collodion for rnriouB 949

Tetanus . nit',

Vlll

INDEX.

PAGE.

Tonsillotomy, compression of carotids

in hemorrhage 703

Toothache, collodion and asbestos 816

Toothache 735

Tracheotomy, instrument for 105

Tumor, abdominal, enormous 55

Tumor, congenital, of the hand 30

Ulcer, callous 30

Unicorn plant 579

Urachus, persistence of. 119

Urethra, stricture, dilating 184

Urethra, strictures 211

Urethra, stricture 437

Urethra, stricture 31

Urethra, foreign body in 676

Urethral pains, treatment 438

Urine, ergot in retention 249

Uterine contractions, promoted by ice . . 79

Variocele, new operation for 42

PAGE.

Venereal, Ricord .' 402

Virus, absorption 445

Vomiting, blister to thigh in 116

Vomiting, nausea in yellow fever, pre-
scription for 62

Vomiting, acetate of lead in 181

Vomiting, absence in the horse 533

Whooping-cough, prescription 245

Whooping-cough, prescription for 61

Winds on the human constitution 299

Wood, Professor, compliment 249

Worms, in children 305

Worms, salt a prophylactic 510

Worms, therapeutic effects of tobacco, 641

Wound, gun-shot in hip 307

Wound, gun-shot 396

Wound, gun-shot 413

Wound, gun-shot 416

Wound, gun-shot 418

Wounds, gun-shot. 219